diff --git "a/english/train.jsonl" "b/english/train.jsonl"
--- "a/english/train.jsonl"
+++ "b/english/train.jsonl"
@@ -1,4967 +1,4967 @@
-{"_id":"annales-2018-dp-1-qi-1","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What are the elements (present or to be sought at the interrogation and clinical examination) that can evoke a malignant tumor of the kidney? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Smoking","justification":"Tobacco is indeed a risk factor for kidney (as well as bladder) cancer."},{"idx":1,"correct":true,"proposition":"Chronic high blood pressure","justification":""},{"idx":2,"correct":false,"proposition":"Long-term calcium channel blocker treatment","justification":""},{"idx":3,"correct":false,"proposition":"A family history of multiple endocrine neoplasia","justification":""},{"idx":4,"correct":true,"proposition":"Low back pain","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-1-qi-2","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"Which exam(s) are you asking for as a first line? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Urinary cytology with pathological examination","justification":"It is indeed a first-line examination"},{"idx":1,"correct":true,"proposition":"Cytobacteriological examination of urine","justification":""},{"idx":2,"correct":false,"proposition":"Serum erythropoietin assay","justification":""},{"idx":3,"correct":true,"proposition":"Abdominopelvic CT scan with and without contrast injection","justification":""},{"idx":4,"correct":false,"proposition":"Ultrasound-guided puncture of the mass","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-1-qi-3","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"On the cut shown below, what are the true propositions?  (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"This is an abdominal CT scan with injection","justification":""},{"idx":1,"correct":false,"proposition":"This is a coronal cup","justification":"Axial cut"},{"idx":2,"correct":false,"proposition":"Structure number 1 is the inferior vena cava","justification":"Aorta"},{"idx":3,"correct":true,"proposition":"The cut passes through the third duodenum","justification":""},{"idx":3,"correct":false,"proposition":"The number 2 corresponds to the inferior mesenteric artery","justification":"superior"}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-1-qi-4","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What are the real propositions? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The patient must receive red blood cells","justification":""},{"idx":1,"correct":false,"proposition":"The patient must receive platelet pellets","justification":""},{"idx":2,"correct":false,"proposition":"In case of transfusion of red blood cells, you would prescribe O-negative pellets","justification":""},{"idx":3,"correct":false,"proposition":"A search result for irregular agglutinins less than 48 h old must be available","justification":""},{"idx":4,"correct":false,"proposition":"Since 2003, there has been no risk of transmission of infectious pathogens through red blood cell transfusion","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-1-qi-5","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What is the real proposal(s)? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"This is acute renal failure","justification":""},{"idx":1,"correct":false,"proposition":"The glomerular filtration rate must be recalculated","justification":""},{"idx":2,"correct":false,"proposition":"An obstacle on the contralateral kidney is likely","justification":""},{"idx":3,"correct":true,"proposition":"It may be functional renal failure","justification":""},{"idx":4,"correct":true,"proposition":"An ionogram should be prescribed on a urine sample","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-1-qi-6","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What are the exact proposals? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"He has moderate chronic renal failure","justification":""},{"idx":1,"correct":true,"proposition":"His antihypertensive treatment must include an inhibitor of the renin-angiotensin system","justification":""},{"idx":2,"correct":false,"proposition":"The LDL cholesterol target to be achieved is 1.3 g\/L","justification":""},{"idx":3,"correct":false,"proposition":"He must follow a diet containing no more than 1.5 g\/kg of protein weight","justification":""},{"idx":4,"correct":false,"proposition":"It is necessary to advocate a diet low in fast sugars","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-1-qi-7","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What risk(s) does he run? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Gradual decrease in diuresis","justification":""},{"idx":1,"correct":true,"proposition":"Increased cardiovascular risk","justification":""},{"idx":2,"correct":true,"proposition":"Hyperphosphoremia","justification":""},{"idx":3,"correct":true,"proposition":"Erectile dysfunction","justification":""},{"idx":4,"correct":true,"proposition":"Contralateral kidney cancer","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-1-qi-8","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What is the true answer(s)? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The ALD file is completed by the patient and validated by the medical specialist","justification":""},{"idx":1,"correct":true,"proposition":"The attending physician must specify in the request the protocol of care envisaged including treatments, examinations and consultations","justification":""},{"idx":2,"correct":true,"proposition":"The care protocol must be validated by the medical officer of the Health Insurance","justification":""},{"idx":3,"correct":false,"proposition":"In case of coverage in ALD, remains the responsibility of the patient only the co-payment","justification":""},{"idx":4,"correct":false,"proposition":"The third-party payer is the part of the care paid by the insured whether or not he is registered in ALD","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-1-qi-9","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What is your interpretation of the electrocardiogram below? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Sinus rhythm","justification":""},{"idx":1,"correct":false,"proposition":"Sino-auricular block","justification":""},{"idx":2,"correct":false,"proposition":"T-waves suggestive of hyperkalemia","justification":""},{"idx":3,"correct":false,"proposition":"Expanded QRS Complexes","justification":""},{"idx":4,"correct":true,"proposition":"Left ventricular hypertrophy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-1-qi-10","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"To reduce edematous syndrome, what do you recommend at this stage? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A low-salt diet (less than 6 g\/d)","justification":""},{"idx":1,"correct":false,"proposition":"Water restriction","justification":""},{"idx":2,"correct":true,"proposition":"A loop diuretic (furosemide)","justification":""},{"idx":3,"correct":false,"proposition":"A thiazide diuretic (hydrochlorothiazide)","justification":""},{"idx":4,"correct":false,"proposition":"Blood ultrafiltration (start of hemodialysis)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-1-qi-11","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What are the possible cause(s) in the context of the new biological abnormality observed? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Excessive calcium intake","justification":""},{"idx":1,"correct":false,"proposition":"Taking furosemide","justification":""},{"idx":2,"correct":true,"proposition":"Chronic renal failure","justification":"This is a POSSIBLE (but rare) cause of hypercalcemia by tertiary hyperparathyroidism, one really needs to read the statements carefully and take them to the first degree. It should be remembered, however, that chronic renal failure is mainly a source of hypocalcaemia."},{"idx":3,"correct":false,"proposition":"Secondary hyperparathyroidism","justification":"Normal serum calcium"},{"idx":4,"correct":true,"proposition":"Bone metastases from kidney cancer","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-1-qi-12","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What additional examination(s) do you recommend to explore this biological anomaly? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Ionized serum calcium","justification":""},{"idx":1,"correct":false,"proposition":"Test de PAK","justification":""},{"idx":2,"correct":true,"proposition":"PTH assay","justification":""},{"idx":3,"correct":false,"proposition":"PTHrp assay","justification":""},{"idx":4,"correct":true,"proposition":"Bone scintigraphy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-1-qi-13","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"Which proposals are correct? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Metastatic cancer is a contraindication to dialysis","justification":""},{"idx":1,"correct":false,"proposition":"Haemodialysis confers survival advantage over peritoneal dialysis","justification":""},{"idx":2,"correct":false,"proposition":"The preparation of an arteriovenous fistula (AVF) is contraindicated given the prognosis","justification":""},{"idx":3,"correct":true,"proposition":"A tunneled central venous catheter may be placed to initiate hemodialysis","justification":""},{"idx":4,"correct":false,"proposition":"A transplant from a cadaveric donor must be discussed","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-1-qi-14","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"In general, regarding living donors, what are the real proposals? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Only people with a genetic link to the recipient can be donors","justification":""},{"idx":1,"correct":true,"proposition":"Transplantation can be done in incompatible ABO condition","justification":""},{"idx":2,"correct":false,"proposition":"Rhesus compatibility must be respected","justification":""},{"idx":3,"correct":false,"proposition":"HLA incompatibility between donor and recipient is a formal contraindication","justification":""},{"idx":4,"correct":false,"proposition":"The donor is remunerated on a basis proportional to the recipient's waiting time","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-2-qi-1","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"What additional examination(s) do you prescribe in early pregnancy? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Cervico-uterine smear","justification":""},{"idx":1,"correct":true,"proposition":"Hbs antigen","justification":""},{"idx":2,"correct":true,"proposition":"Fasting blood glucose","justification":""},{"idx":3,"correct":false,"proposition":"Pulmonary function tests","justification":""},{"idx":4,"correct":true,"proposition":"Cytobacteriological examination of urine","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-2-qi-2","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"Regarding trisomy 21 screening in this case, what is (are) the exact proposal(s)? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Nuchal translucency measurement is performed on an axial section of the fetus","justification":""},{"idx":1,"correct":true,"proposition":"Combined first trimester screening takes into account gestational age","justification":""},{"idx":2,"correct":false,"proposition":"Integrated sequential screening of the second trimester is not possible due to Turner syndrome","justification":""},{"idx":3,"correct":false,"proposition":"The patient's age is taken into account for the calculation of the combined risk of the first trimester","justification":""},{"idx":4,"correct":false,"proposition":"Total hCG is considered for combined first trimester screening","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-2-qi-3","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"What is the exact proposal(s)? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"This is a toxoplasma seroconversion","justification":""},{"idx":1,"correct":true,"proposition":"The initiation of treatment with spiramycin is lawful","justification":""},{"idx":2,"correct":true,"proposition":"Amniocentesis should be offered at least 4 weeks after the expected date of seroconversion","justification":""},{"idx":3,"correct":false,"proposition":"IgG avidity test is indicated","justification":""},{"idx":4,"correct":false,"proposition":"Cross-reaction with other infectious agents may explain this serological result","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-2-qi-4","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"You start treatment with spiramycin. Regarding this molecule and the pharmacological class to which it belongs, which is (are) the exact proposal(s)?  What is the exact proposal(s)? B. The genome of ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Spiramycin has a parasiticidal action on Toxoplasma gondii","justification":"Macrolides are parasitostatic"},{"idx":1,"correct":true,"proposition":"Spiramycin acts by inhibition of bacterial proteins by binding to a ribosomal subunit"},{"idx":2,"correct":true,"proposition":"Spiramycin is active on Mycoplasma hominis"},{"idx":3,"correct":true,"proposition":"P. aeruginosa is naturally resistant"},{"idx":4,"correct":true,"proposition":"The therapeutic class is used in the treatment of pertussis"}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-2-qi-5","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"You decide to look for mother-to-fetal transmission of T. gondii. What are the exact proposal(s)?","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"You perform a choriocentesis","justification":""},{"idx":1,"correct":true,"proposition":"The genome is sought in amniotic fluid","justification":"By amniocentesis"},{"idx":2,"correct":false,"proposition":"A search for specific IgG is performed on fetal blood","justification":""},{"idx":3,"correct":false,"proposition":"Chorioretinitis should be tested by fetal ultrasound","justification":""},{"idx":4,"correct":false,"proposition":"Anemia should be sought by measuring brain velocities in Doppler","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-2-qi-6","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"You perform an amniocentesis. The same evening, the patient comes to see you for abdominal pain that has lasted for several hours. There is no vaginal discharge and no bleeding. The patient is apyretic and normotensive. The cervix is shortened to the vaginal touch and measures 18mm. What treatment(s) do you introduce? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Betamethasone","justification":""},{"idx":1,"correct":true,"proposition":"Continuation of spiramycin treatment","justification":""},{"idx":2,"correct":false,"proposition":"Indomethacin","justification":""},{"idx":3,"correct":true,"proposition":"Atosiban","justification":""},{"idx":4,"correct":true,"proposition":"Magnesium sulphate","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-2-qi-7","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"After 24 hours of hospitalization, the patient notices losses of smelly fluid through the vagina. Uterine contractions have resumed and are painful. The temperature is 39.3°C.  She gets chills. Cardiotocographic recording shows fetal tachycardia and 5 uterine contractions every 10 minutes. What is the most likely diagnosis?","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Acute appendicitis","justification":""},{"idx":1,"correct":false,"proposition":"Acute pyelonephritis","justification":""},{"idx":2,"correct":false,"proposition":"Listeriosis","justification":""},{"idx":3,"correct":false,"proposition":"Toxoplasma sepsis","justification":""},{"idx":4,"correct":true,"proposition":"Chorioamnionitis","justification":"Most likely given the context (amniocentesis, fever)."}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-2-qi-8","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"In front of this chorioamnionitis and the presence of fetal heart rhythm abnormalities, you perform an emergency caesarean section under general anesthesia. As soon as the child is extracted, heavy bleeding of endouterine origin is observed. Manual delivery of the placenta is performed and the hysterotomy is sutured. The uterus remains soft and significant bleeding persists externalized vaginally despite the infusion of oxytocics. The patient is hemodynamically stable. What therapeutic option(s) can be used in this situation? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Mifepristone infusion","justification":""},{"idx":1,"correct":true,"proposition":"Ligation of uterine arteries","justification":""},{"idx":2,"correct":false,"proposition":"Methotrexate infusion","justification":""},{"idx":3,"correct":true,"proposition":"Sulprostone infusion","justification":""},{"idx":4,"correct":false,"proposition":"Ligation of the external iliac arteries","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-2-qi-9","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"An infusion of sulprostone is initiated. One Hemocue reveals a hemoglobin level of 6 g\/dL. Blood loss is estimated at 1500 ml. Blood pressure is 100\/60 and heart rate is 130 beats per minute (bpm). A biological assessment is carried out. The anesthesiologist orders labile blood products in a life-threatening emergency. After 30 minutes, the bleeding seems to dry up and the results of the laboratory workup are available: Leukocytes 15.2 G\/L. Platelets 70 G\/L. Haemoglobin 5.7 g\/dL. Prothrombin level 60%. Activated cephalin time 32\/30. Fibrinogenemia 0.5 g\/L. D-Dimers elevated. Which of the elements of this assessment is included in the definition of biological disseminated intravascular coagulation (DIC)? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Platelets","justification":""},{"idx":1,"correct":false,"proposition":"Leukocytes","justification":""},{"idx":2,"correct":true,"proposition":"Fibrinogen","justification":""},{"idx":3,"correct":true,"proposition":"D-dimer","justification":""},{"idx":4,"correct":false,"proposition":"Haemoglobin","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-2-qi-10","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"Taking into account the biological assessment, a transfusion of a platelet concentrate and 4 red blood cells is performed as well as an injection of 1.5 g of fibrinogen. One hour after birth, the bleeding has now dried up. The patient is monitored for 3 hours in the recovery room before being transferred to intensive care. The caesarean section allowed the birth of a girl weighing 790 grams who was immediately supported by the neonatal team. The clinical examination at 5 minutes of life is as follows: respiratory rate 70 \/ minute, intercostal and suprasternal pull, intense xyphoidian funnel, moderate fluttering of the wings of the nose, expiratory whining with the stethoscope, paradoxical respiration, generalized cyanosis, hypotonia, oxygen requirements (02) at 50% to maintain a 90% saturometry. About the neonatal clinical condition, which is the exact proposal(s)?","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This is transient respiratory distress","justification":""},{"idx":1,"correct":false,"proposition":"The Apgar score is not interpretable in case of prematurity","justification":""},{"idx":2,"correct":true,"proposition":"This child's oxygen needs are a sign of severity","justification":""},{"idx":3,"correct":true,"proposition":"Silverman's score is 8","justification":""},{"idx":4,"correct":false,"proposition":"Generalized cyanosis is in favor of anemia of the newborn","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-2-qi-11","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"The child's respiratory condition improves but after 36 hours in neonatology, his condition deteriorates sharply. A chest X-ray is performed. What diagnosis(s) can you retain from the interpretation of this shot?","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left fluid pleural effusion","justification":""},{"idx":1,"correct":false,"proposition":"Left retrocardiac atelectasis","justification":""},{"idx":2,"correct":true,"proposition":"Right pneumothorax","justification":""},{"idx":3,"correct":false,"proposition":"Left diaphragmatic hernia","justification":""},{"idx":4,"correct":false,"proposition":"Right pneumoperitoneum","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-2-qi-12","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"You diagnose a right pneumothorax. After exsufflation of the latter, the respiratory condition of the child improves markedly. In addition, at 48 hours of the caesarean section, the mother complains of chest pain. In this patient, which pathology(s) should you eliminate first? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Acute cardiogenic edema","justification":""},{"idx":1,"correct":true,"proposition":"Aortic dissection","justification":""},{"idx":2,"correct":false,"proposition":"Bacterial pneumonitis","justification":""},{"idx":3,"correct":false,"proposition":"Pericarditis","justification":""},{"idx":4,"correct":true,"proposition":"Pulmonary embolism","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-2-qi-13","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"In addition to the chest doubt, the patient complains of dyspnea. Blood pressure is at 130\/70 mmHg. The pulses are symmetrical. The temperature is 37.5 ° C.  You decide to immediately perform an emergency pulmonary angiography. What anomaly(s) do you identify on these 3 shots? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Dilation of the left ventricle","justification":""},{"idx":1,"correct":false,"proposition":"Ascending aorta dissection","justification":""},{"idx":2,"correct":true,"proposition":"Acute pulmonary heart","justification":""},{"idx":3,"correct":true,"proposition":"Bilateral pulmonary embolism","justification":""},{"idx":4,"correct":false,"proposition":"Pneumomediastinum","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-2-qi-14","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"A pulmonary embolism is diagnosed. Heparin therapy at curative dose is introduced. The patient is transferred back to the maternity ward after 48 hours. She wants to breastfeed but worries because she has cold sores. What do you say about breastfeeding? (one or more correct answers) ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Breastfeeding is possible despite heparin treatment","justification":""},{"idx":1,"correct":false,"proposition":"Breastfeeding is not possible, as the child is premature","justification":""},{"idx":2,"correct":false,"proposition":"Herpes labialis contraindicates breastfeeding","justification":""},{"idx":3,"correct":false,"proposition":"She won't have a milk rush due to Turner syndrome","justification":""},{"idx":4,"correct":false,"proposition":"Breastfeeding is not recommended in this patient due to complications of childbirth","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-3-qi-1","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"For the evaluation of dependence, which of the following proposals, which corresponds to an instrumental function? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Wash","justification":""},{"idx":1,"correct":true,"proposition":"Shopping","justification":""},{"idx":2,"correct":true,"proposition":"Prepare a meal","justification":""},{"idx":3,"correct":false,"proposition":"Dress","justification":""},{"idx":4,"correct":true,"proposition":"Manage your medications","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-3-qi-2","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"A dependent patient can benefit from the personalized autonomy allowance.  Select the right proposal(s) from the following: ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It concerns patients over 60 years of age","justification":""},{"idx":1,"correct":false,"proposition":"It is assigned to GIR 5 and 6 according to the AGGIR grid","justification":""},{"idx":2,"correct":true,"proposition":"Its amount depends on the level of dependency","justification":""},{"idx":3,"correct":true,"proposition":"Its amount depends on individual income","justification":""},{"idx":4,"correct":true,"proposition":"It also concerns patients in nursing homes","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-3-qi-3","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The IADL (Instrumental activities of daily living) scale is 6\/8. The patient is not very informative, but she says she is tired as soon as she tries to make an effort. She comes accompanied by her daughter who finds her mother sad, and who mentions the progressive appearance of anterograde memory disorders, forcing her to note the information. She has trouble finding certain objects, or the names of her children that she sometimes confords, which saddens her. A month ago, she got lost in a neighborhood she knew well before, which worried her daughter and justified the consultation. The neurological examination is normal, without pyramidal syndrome or parkinsonism. The MMS is at 23\/30, with a reminder of the 3 words at 2\/3. Regarding the evaluation of recent memory in the neuropsychological assessment, the encoding is normal but the patient has a deficit of free recall well corrected by the indication (reactivity 87.5%). The Front Efficiency Fast Battery (BREF) is 15\/18. You mention a major neurocognitive disorder according to DSM 5. Which of the following criterion(s) are actually part of it? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Slow progressive evolution","justification":""},{"idx":1,"correct":true,"proposition":"Decline in at least one cognitive domain","justification":""},{"idx":2,"correct":true,"proposition":"Memory impairment","justification":""},{"idx":3,"correct":true,"proposition":"Interference of cognitive impairment with autonomy","justification":""},{"idx":4,"correct":false,"proposition":"Worsening of disorders during confusional episodes","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-3-qi-4","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"Brain MRI shows Fazekas stage III vascular leukopathy, with two lacunar ischemic vascular sequelae, as well as Scheltens stage I hippocampal atrophy. The neuropsychological assessment shows a visuo-verbal impairment of subcortical profile, and a dyseexecutive syndrome. Which of the following diagnose(s) do you mention? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Alzheimer's disease","justification":""},{"idx":1,"correct":true,"proposition":"Cerebrovascular disease","justification":""},{"idx":2,"correct":false,"proposition":"Chronic hydrocephalus","justification":""},{"idx":3,"correct":true,"proposition":"Depression","justification":""},{"idx":4,"correct":false,"proposition":"Frontotemporal lobar degeneration","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-3-qi-5","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"You are diagnosed with major neurocognitive disorder of cerebrovascular origin and depressive syndrome. Which of the following elements of processing are you starting at this stage?","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Balance of cardiovascular risk factors","justification":""},{"idx":1,"correct":false,"proposition":"Acetylcholine esterase inhibitor","justification":""},{"idx":2,"correct":true,"proposition":"Psychological follow-up","justification":""},{"idx":3,"correct":false,"proposition":"Legal protection","justification":"The patient remains autonomous with an MMS score that does not seem to put her at risk."},{"idx":4,"correct":true,"proposition":"Personalized autonomy allowance","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-3-qi-6","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The patient is sedentary, weighs 70 kgs for 1.52 m or a body mass index of 30 kg \/ m2. Blood pressure is 133\/65 mmHg, heart rate is 45\/min. Her daughter tells you that the patient always has a slow pulse when she takes her constants at home, between 40 and 50\/min. The systolic pressure index is 1.2. HbA1C 7.9%, albumin 31 g\/l, CRP 2 mg\/L (normal 5), hemoglobin 12 g\/dL. Regarding the cardiovascular risk factors of this patient, what measure(s) are you taking? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Low-calorie diet","justification":""},{"idx":1,"correct":false,"proposition":"Low carbohydrate diet","justification":""},{"idx":2,"correct":true,"proposition":"High protein diet","justification":""},{"idx":3,"correct":false,"proposition":"Sodium diet","justification":""},{"idx":4,"correct":true,"proposition":"Adapted physical activity","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-3-qi-7","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"Regarding the systolic pressure index (SPI), which proposal(s) is(are) right? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It allows the screening of arterial disease obliterans of the lower limbs","justification":""},{"idx":1,"correct":false,"proposition":"Its measurement is contraindicated in case of critical ischemia","justification":""},{"idx":2,"correct":true,"proposition":"It is calculated as the ratio of ankle blood pressure to humeral blood pressure.","justification":""},{"idx":3,"correct":true,"proposition":"An SPI greater than 1.30 reflects incompressible, rigid and calcified arteries","justification":""},{"idx":4,"correct":true,"proposition":"It makes it possible to follow the evolution of arterial disease obliterating the lower limbs","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-3-qi-8","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The patient also reports three recent falls, while her daughter specifies that she did not fall before. The patient mentions a dizzying sensation during the first fall, fleeting, but evokes above all a clumsiness each time, as when she stumbled into the edge of a sidewalk. ENT explorations carried out in the city are normal. You perform a search for orthostatic hypotension. Choose the right proposal(s) from the following:","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Negative research eliminates orthostatic hypotension","justification":""},{"idx":1,"correct":false,"proposition":"An acceleration of the heart rate > 100\/min evokes dysautonomia","justification":""},{"idx":2,"correct":true,"proposition":"A decrease in systolic blood pressure 20 mmHg at orthostatism confirms the diagnosis","justification":""},{"idx":3,"correct":false,"proposition":"The absence of symptoms at orthostatism rules out the diagnosis","justification":""},{"idx":4,"correct":true,"proposition":"An isolated decrease in diastolic blood pressure of > 1O mmHg at orthostatism confirms the diagnosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-3-qi-9","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"You confirm orthostatic hypotension in this patient. Which of the following factors, in the case of this patient, may have contributed to this? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Non-insulin-dependent diabetes","justification":""},{"idx":1,"correct":false,"proposition":"High blood pressure","justification":""},{"idx":2,"correct":true,"proposition":"Calcium channel blocker","justification":""},{"idx":3,"correct":false,"proposition":"Sedentary lifestyle","justification":""},{"idx":4,"correct":false,"proposition":"Hemoglobin level","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-3-qi-10","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The systolic pressure index is 1.2.What therapeutic measure(s) in first line do you take regarding this orthostatic hypotension? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Class 2 venous compression","justification":""},{"idx":1,"correct":false,"proposition":"Addition of midodrine","justification":""},{"idx":2,"correct":false,"proposition":"Addition of fludrocortisone","justification":""},{"idx":3,"correct":false,"proposition":"Discontinuation of antihypertensive therapy","justification":""},{"idx":4,"correct":true,"proposition":"Regular physical activity","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-3-qi-11","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"What abnormality(s) do you notice on this ECG? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Sinus rhythm","justification":""},{"idx":1,"correct":true,"proposition":"Second degree atrioventricular block","justification":""},{"idx":2,"correct":false,"proposition":"Paroxysmal sinoatrial block","justification":""},{"idx":3,"correct":true,"proposition":"Left axis of QRS","justification":""},{"idx":4,"correct":true,"proposition":"Right branch block","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-3-qi-12","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"In view of the entire file, what anomaly(s) are you looking for on the holter requested by the attending physician? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Sinus dysfunction","justification":""},{"idx":1,"correct":true,"proposition":"Paroxysmal atrial fibrillation","justification":""},{"idx":2,"correct":false,"proposition":"Paroxysmal ventricular tachycardia","justification":""},{"idx":3,"correct":false,"proposition":"Ischemic heart disease","justification":""},{"idx":4,"correct":true,"proposition":"High-grade atrioventricular block","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-3-qi-13","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The holter shows sinus dysfunction (high-degree sinoatrial block) and nodal dysfunction (BAV2 Mobitz 2) with long periods of bradycardia between 35 and 40 per minute, without AF. Which treatment(s) do you decide? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Double chamber pacemaker installation","justification":""},{"idx":1,"correct":false,"proposition":"Discontinuation of calcium channel blocker","justification":"-dipine is not bradycardial (non-cardio-selective)."},{"idx":2,"correct":false,"proposition":"Curative anticoagulant treatment","justification":""},{"idx":3,"correct":false,"proposition":"Amiodarone","justification":""},{"idx":4,"correct":false,"proposition":"Therapeutic abstention and monitoring","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-3-qi-14","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"Finally, tests show a creatinine clearance of 27 mL\/min. You recover a value a year ago at 29 mL \/ min whose vascular and diabetic origin had been retained. What impact does this information have on your current or future treatment? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Contraindication to angiotensin-converting enzyme inhibitor therapy","justification":""},{"idx":1,"correct":true,"proposition":"Contraindication to bisphosphonate therapy if indicated","justification":"Car DFG30."},{"idx":2,"correct":false,"proposition":"Contraindication to a high protein diet","justification":""},{"idx":3,"correct":false,"proposition":"Contraindication to treatment with denosumab if indicated","justification":""},{"idx":4,"correct":false,"proposition":"Contraindication to pravastatin","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-4-qi-1","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"This patient consumed 1 glass of whisky per day and 75 cl of wine per day. He has been weaned for 3 months following the discovery of cirrhosis. About cirrhosis, what is the exact proposal(s)?","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Has a histological definition","justification":""},{"idx":1,"correct":true,"proposition":"Is a fibrous scar of the hepatic parenchyma","justification":""},{"idx":2,"correct":false,"proposition":"Is an irreversible disease","justification":""},{"idx":3,"correct":true,"proposition":"May be asymptomatic","justification":""},{"idx":4,"correct":true,"proposition":"Can be diagnosed without liver biopsy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-4-qi-2","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The clinical examination is unremarkable. He has no sign of portal hypertension, no sign of severe sepsis. The biological balance shows: Na at 135mmol \/ L, K at 3.7mmol \/ L, CRP at 15mg \/ L, creatinine at 80 μmol \/ L, urea at 6.1 mmol \/ L, Hb at 137g \/ L, platelets at 120G \/ L, PNN at 7.45G \/ L, TP at 43%, TCA at 35\/28, AST at 69Ul \/ L, ALT at 33IU \/ L, Alkaline phosphatase at 146U \/ L,  gammaGT at 236 IU\/L. The patient has abundant daily sputum. In front of dyspnea, you realize the arterial blood gases in ambient air: pH at 7.49, PCO2 at 29mmHg, P02 at 75mmHg, HCO3- at 22mmol. What is your interpretation (only one answer)? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Compensated metabolic alkalosis","justification":""},{"idx":1,"correct":false,"proposition":"Decompensated metabolic alkalosis","justification":""},{"idx":2,"correct":false,"proposition":"Decompensated mixed alkalosis","justification":""},{"idx":3,"correct":false,"proposition":"Compensated respiratory alkalosis","justification":""},{"idx":4,"correct":true,"proposition":"Decompensated respiratory alkalosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-4-qi-3","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"Chest X-ray shows a left basal opacity. You complete by performing a chest scan. What is the real proposal(s)?","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The mark A corresponds to the arch of the aorta","justification":""},{"idx":1,"correct":false,"proposition":"Benchmark B corresponds to the trunk of the pulmonary artery","justification":""},{"idx":2,"correct":false,"proposition":"The C mark corresponds to the left stem bronchus","justification":""},{"idx":3,"correct":false,"proposition":"Coordinate system D corresponds to the esophagus","justification":""},{"idx":4,"correct":false,"proposition":"The mark E corresponds to the inferior vena cava","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-4-qi-4","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The mediastinal window shows lymphadenopathy. Here is a chest window computed tomography section. What do you observe? (one or more correct answers) ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Micronodules","justification":""},{"idx":1,"correct":false,"proposition":"Intralobular cross-linking","justification":""},{"idx":2,"correct":false,"proposition":"From the honeycomb","justification":""},{"idx":3,"correct":false,"proposition":"An aspect in << release of balloons>>","justification":""},{"idx":4,"correct":true,"proposition":"A nodule of about 3 cm","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-4-qi-5","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"What diagnostic hypothesis(s) can explain the entire thoracic clinico-radiological picture? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Diffuse bronchiolitis","justification":""},{"idx":1,"correct":false,"proposition":"Stage I pulmonary carcinoma","justification":""},{"idx":2,"correct":false,"proposition":"Carcinomatous lymphangitis","justification":""},{"idx":3,"correct":false,"proposition":"Hypersensitivity pneumonitis","justification":""},{"idx":4,"correct":true,"proposition":"Pulmonary tuberculosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-4-qi-6","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"You suspect a tuberculosis miliary. How do you make the first-line diagnosis (one or more correct answers)? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Examination of sputum addressed in mycobacteriology for acid-alcohol-resistant bacilli (BAAR)","justification":""},{"idx":1,"correct":true,"proposition":"Cytobacteriological examination of urine addressed in mycobacteriology for acid-alcohol-resistant bacilli (RBBA)","justification":""},{"idx":2,"correct":false,"proposition":"Bronchoalveolar lavage addressed in mycobacteriology in search of acid-alcohol-resistant bacilli (BAAR)","justification":"Not in the first intention. It is done if the patient does not spit, the gastric tubing is negative, and the supiscion is diagnosis is strong."},{"idx":3,"correct":false,"proposition":"Lymph node puncture by bronchial endoscopic ultrasound addressed in mycobacteriology in search of acid-alcohol-resistant bacilli (BAAR)","justification":""},{"idx":4,"correct":false,"proposition":"Transthoracic puncture guided by CT scan of the mass addressed in mycobacteriology in search of acid-alcohol-resistant bacilli (BAAR)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-4-qi-7","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"Sputum analysis shows 10 to 100 BAAR\/field live. You retain the diagnosis of miliary tuberculosis to M. tuberculosis. Which examination(s) should be taken into consideration in your pre-therapeutic assessment? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hepatic test","justification":""},{"idx":1,"correct":true,"proposition":"Creatinine","justification":""},{"idx":2,"correct":true,"proposition":"Ophthalmological examination","justification":""},{"idx":3,"correct":false,"proposition":"Pulmonary function testing","justification":""},{"idx":4,"correct":true,"proposition":"HIV serology","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-4-qi-8","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"What anti-TB treatment(s) will you offer this patient as a first-line treatment? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Isoniazid (INH)","justification":""},{"idx":1,"correct":false,"proposition":"Streptomycin","justification":""},{"idx":2,"correct":true,"proposition":"Ethambutol (EMB)","justification":""},{"idx":3,"correct":true,"proposition":"Rifampicin (RMP)","justification":""},{"idx":4,"correct":false,"proposition":"Pyrazinamide (PZA)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-4-qi-9","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"What is (are) the other measure(s) to put in place in this patient? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Inhaled corticosteroid therapy","justification":""},{"idx":1,"correct":true,"proposition":"Request 100% coverage for long-term illness","justification":""},{"idx":2,"correct":true,"proposition":"Respiratory isolation","justification":""},{"idx":3,"correct":true,"proposition":"Anonymous notification to the Regional Health Agency (ARS)","justification":""},{"idx":4,"correct":false,"proposition":"Anonymous notification to the Tuberculosis Centre (CLAT) of the department of the case of domicile","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-4-qi-10","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"You start a combination of isoniazid, rifampicin and ethambutol. After 2 weeks, the patient leaves the hospital. You follow him every month in consultation, but you have doubts about the patient's compliance with the treatment. How do you monitor its observance? (one or more correct answers) ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Staining of teeth","justification":""},{"idx":1,"correct":true,"proposition":"Urine staining","justification":""},{"idx":2,"correct":false,"proposition":"Determination of uricemia","justification":"The patient is not taking pyrazinamide."},{"idx":3,"correct":false,"proposition":"Determination of transaminases","justification":""},{"idx":4,"correct":false,"proposition":"Color vision","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-4-qi-11","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The patient wonders about the role of his profession in the occurrence of tuberculosis. You consult the table of occupational diseases 40b of the general scheme. This table indicates that (one or more correct answers):","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Your patient's condition is in the list of conditions that can be recognized as an occupational disease","justification":""},{"idx":1,"correct":false,"proposition":"The period of care indicates that the patient must have been exposed for more than 6 months to be recognized as an occupational disease","justification":""},{"idx":2,"correct":true,"proposition":"Your patient's profession is in the exhaustive list of works","justification":""},{"idx":3,"correct":false,"proposition":"The patient can be directly recognized as an occupational disease","justification":""},{"idx":4,"correct":true,"proposition":"The application for recognition as an occupational disease must go before the regional committee for the recognition of occupational diseases","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-4-qi-12","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The patient asks you what advantage he can benefit from in case of a possible recognition as an occupational disease? (one or more correct answers) ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An impossibility of dismissal","justification":""},{"idx":1,"correct":false,"proposition":"Compensation for damage to possible secondary family cases","justification":""},{"idx":2,"correct":false,"proposition":"Better compensation for sick leave","justification":""},{"idx":3,"correct":true,"proposition":"100% coverage of treatments","justification":""},{"idx":4,"correct":true,"proposition":"A pension based on last salary and disability rate","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-4-qi-13","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"What is your interpretation of these pulmonary function tests (one or more correct answers)? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Obstructive ventilatory syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Restrictive ventilatory syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Chest distension"},{"idx":3,"correct":true,"proposition":"Carbon monoxide diffusion disorder","justification":""},{"idx":4,"correct":false,"proposition":"Normal functional explorations","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-4-qi-14","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The chest computed tomography no longer finds the abnormalities previously described and the pulmonary parenchyma appears normal. On the other hand, there is abnormal dilation of the pulmonary arteries. You suspect pulmonary hypertension associated with portal hypertension. In which group of the International Clinical Classification of Pulmonary Hypertension will you classify this patient? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Group 1","justification":""},{"idx":1,"correct":false,"proposition":"Group 2","justification":""},{"idx":2,"correct":false,"proposition":"Group 3","justification":""},{"idx":3,"correct":false,"proposition":"Group 4","justification":""},{"idx":4,"correct":false,"proposition":"Group 5","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-5-qi-1","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"On the wrist x-rays performed in the emergency room, what is(are) the exact proposal(s)?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The radial glenoid is anteverted","justification":""},{"idx":1,"correct":true,"proposition":"The radius fracture is extra-articular","justification":""},{"idx":2,"correct":false,"proposition":"The bistyloid line is verticalized","justification":""},{"idx":3,"correct":false,"proposition":"There is an excess length of the radius compared to the ulna","justification":""},{"idx":4,"correct":true,"proposition":"The fracture of the radius has a metaphyseal site","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-5-qi-2","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"On clinical examination, what element(s) do you find if the radius fracture is uncomplicated?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A medial bayonet face deformation","justification":""},{"idx":1,"correct":true,"proposition":"A deformation on the back of a fork","justification":""},{"idx":2,"correct":false,"proposition":"A hypoesthesia of the pulp of the first 3 fingers","justification":""},{"idx":3,"correct":false,"proposition":"An elective pain of the anatomical snuffbox","justification":""},{"idx":4,"correct":true,"proposition":"A protrusion of the styloid of the ulna","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-5-qi-3","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"During the initial clinical examination, the patient fails to perform active flexion of the interphalangienoe joint of the thumb. What is the exact proposal(s)?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This may be due to compression of the median nerve in the wrist.","justification":""},{"idx":1,"correct":true,"proposition":"This must evoke a cause other than the fracture itself.","justification":""},{"idx":2,"correct":false,"proposition":"This may be due to paralysis of the long abductor of the thumb.","justification":""},{"idx":3,"correct":false,"proposition":"This may be due to paralysis of the opponent of the thumb","justification":""},{"idx":4,"correct":true,"proposition":"This may be due to damage to the tendon of the long flexor of the thumb.","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-5-qi-4","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Which imaging examination(s) prescribed in first line seem to you relevant for his functional impotence of the lower right limb?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Computed tomography of the pelvis and right hip","justification":""},{"idx":1,"correct":true,"proposition":"X-ray of the front pelvis","justification":""},{"idx":2,"correct":true,"proposition":"X-ray of the right hip in profile","justification":""},{"idx":3,"correct":false,"proposition":"Bone scintigraphy","justification":""},{"idx":4,"correct":false,"proposition":"Angiocomputed tomography of the pelvis and right lower limb","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-5-qi-5","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"In view of the X-ray of the pelvis attached, what is the exact proposal?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This is a type 1 fracture according to Garden's classification","justification":""},{"idx":1,"correct":false,"proposition":"This is a type 2 fracture according to Garden's classification","justification":""},{"idx":2,"correct":false,"proposition":"This is a type 3 fracture according to Garden's classification","justification":""},{"idx":3,"correct":false,"proposition":"This is a type 4 fracture according to Garden's classification","justification":""},{"idx":4,"correct":true,"proposition":"Garden's classification does not apply for this type of fracture","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-5-qi-6","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"In view of the attached radiography of the pelvis, what is (are) the exact proposal(s)?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"There is a deformation in coxa vara","justification":"The angle between the head and the diaphysis is well reduced."},{"idx":1,"correct":false,"proposition":"There are gaps in << the >> punch of the left iliac wing","justification":""},{"idx":2,"correct":false,"proposition":"This is a sub-capital divide","justification":""},{"idx":3,"correct":true,"proposition":"It is a fracture of the trochanterian massif","justification":""},{"idx":4,"correct":false,"proposition":"There is a loss of congruence of the right coxofemoral joint","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-5-qi-7","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"You explain to the patient that she has a fracture of the proximal femur that requires surgery. The patient is reluctant to have an intervention for fear of possible complications. Which proposal(s) is (are) accurate?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"In the absence of intervention, fracture consolidation is possible","justification":""},{"idx":1,"correct":true,"proposition":"In the absence of intervention, there is a major risk of death related to complications of decubitus","justification":""},{"idx":2,"correct":true,"proposition":"The intervention is necessary to allow a rapid verticalization of the patient","justification":""},{"idx":3,"correct":true,"proposition":"The increase in the time before the intervention modifies the morbidity and mortality in the aftermath of the intervention","justification":""},{"idx":4,"correct":true,"proposition":"Stabilization surgery can effectively fight pain","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-5-qi-8","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Regarding anesthesia, what can you say to this patient? (one or more correct answers)","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The choice between general or locoregional anaesthesia has no real influence on postoperative morbidity and mortality","justification":""},{"idx":1,"correct":true,"proposition":"It will be mandatory to place a venous catheter and that the patient remains fasting whether it is a general or locoregional anesthesia","justification":""},{"idx":2,"correct":false,"proposition":"There is no cardiac risk under regional anaesthesia","justification":""},{"idx":3,"correct":false,"proposition":"If the anaesthetist opts for regional anesthesia, the patient is not required to stay in the recovery room","justification":""},{"idx":4,"correct":true,"proposition":"Several analgesics are usually used multimodally to reduce morphine consumption postoperatively.","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-5-qi-9","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Prior to her fall, the patient was travelling to the home without technical assistance. For the past few months, she had been using a cane for walks and when she went shopping, she used a rollator. What is the exact proposal(s)? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Parker's mobility score takes into account walking outside the home","justification":""},{"idx":1,"correct":false,"proposition":"Parker's mobility score is a quality of life score","justification":""},{"idx":2,"correct":true,"proposition":"Parker's mobility score ranges from O to 9","justification":""},{"idx":3,"correct":false,"proposition":"Parker mobility score takes into account the location of the fracture line","justification":""},{"idx":4,"correct":false,"proposition":"After a fracture of the upper extremity of the femur, recovery of the anterior Parker mobility score is the rule","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-5-qi-10","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Which of the following leads to delay the surgical management of the patient? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The patient's refusal to be operated on","justification":""},{"idx":1,"correct":false,"proposition":"Antiplatelet therapy","justification":""},{"idx":2,"correct":false,"proposition":"A cutaneous opening next to the ulnar styloid","justification":""},{"idx":3,"correct":true,"proposition":"Hyperkalemia with ECG changes","justification":""},{"idx":4,"correct":false,"proposition":"A venous ulcer of the right leg","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-5-qi-11","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"In this patient, you opted for proximal femur osteosynthesis using intramedullary material. Following such an intervention, what is (are) the exact proposal(s)? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"There is a significant risk of dislocation","justification":""},{"idx":1,"correct":true,"proposition":"The risk of infection at the surgical site is low","justification":""},{"idx":2,"correct":true,"proposition":"The primary complication is the vicious callus.","justification":""},{"idx":3,"correct":false,"proposition":"If after one month, the fracture is not consolidated, it is a delay in consolidation","justification":""},{"idx":4,"correct":true,"proposition":"If after 8 months the fracture is not consolidated, it is pseudarthrosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-5-qi-12","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Days after osteosynthesis, the patient slips on the wet floor on her way to the toilet and falls again. The patient complains of increased pain in the right hip. You take x-rays of the pelvis and right hip. What is the exact proposal(s)? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"There is a secondary displacement compared to intraoperative reduction plates","justification":""},{"idx":1,"correct":false,"proposition":"There is a dislocation of the right hip","justification":""},{"idx":2,"correct":false,"proposition":"There is a break in the hardware","justification":""},{"idx":3,"correct":false,"proposition":"There is a high risk of osteonecrosis of the femoral head","justification":""},{"idx":4,"correct":true,"proposition":"There is a decrease in the effectiveness of action of ilio-psoas","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-5-qi-13","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"During her fall, the patient also complains of spinal pain that you locate mainly at the thoracolumbar junction and which is accompanied by more diffuse pain. An MRI is performed. There is no transitional anomaly. In view of this review, what is the exact proposal(s)? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"There is a deformation of the vertebral body of T12","justification":""},{"idx":1,"correct":false,"proposition":"This is a sequence in T1","justification":""},{"idx":2,"correct":false,"proposition":"There is an antelisthesis of L4 on L5","justification":""},{"idx":3,"correct":true,"proposition":"The T12 fracture is recent","justification":""},{"idx":4,"correct":true,"proposition":"There are signs of disc degeneration between L 1 and L2","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-5-qi-14","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"The patient is reoperated on the right hip. In the aftermath of the intervention, she presents a state of agitation. Which element(s) of the clinical examination do you think is important in the etiological search for this state of agitation? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Performing a digital rectal exam","justification":""},{"idx":1,"correct":true,"proposition":"Abdominal palpation","justification":""},{"idx":2,"correct":true,"proposition":"Examination of cranial pairs","justification":""},{"idx":3,"correct":true,"proposition":"A measurement of capillary blood glucose","justification":""},{"idx":4,"correct":false,"proposition":"Performing the clock test","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-6-qi-1","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Which of the following is(are) one or more criteria for severity of acute bronchiolitis in this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"His premature birth","justification":""},{"idx":1,"correct":false,"proposition":"Intercostal draw","justification":""},{"idx":2,"correct":true,"proposition":"Respiratory rate","justification":""},{"idx":3,"correct":false,"proposition":"High temperature","justification":"The criteria are very specific. Temperature is not one of them."},{"idx":4,"correct":true,"proposition":"His eating difficulties","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-6-qi-2","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"In this child, which is (are) the essential examination(s) ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Multiplex PCR for respiratory viruses","justification":""},{"idx":1,"correct":false,"proposition":"A rapid flu test","justification":""},{"idx":2,"correct":true,"proposition":"A chest X-ray","justification":""},{"idx":3,"correct":false,"proposition":"An arterial blood gas","justification":""},{"idx":4,"correct":false,"proposition":"A cardiac ultrasound","justification":"Careful! The new HAS 2019 recommendation taken up in the R2C colleges of pediatrics make this proposal obsolete."}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-6-qi-3","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"In front of this chest X-ray, what is(are) the exact answer(s)? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Presence of chest distension","justification":""},{"idx":1,"correct":false,"proposition":"Presence of pleural effusion","justification":""},{"idx":2,"correct":true,"proposition":"Presence of pneumomediastinum","justification":""},{"idx":3,"correct":true,"proposition":"Presence of mean lobar alveolar condensation","justification":"Medium lobe because erases the edges of the heart"},{"idx":4,"correct":false,"proposition":"The upper left arc is not visible","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-6-qi-4","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"The child is hospitalized for 4 rounds for the treatment of bronchiolitis complicated by pneumornediastin. It was fed the first two days by nasogastric tube. Infusion was not necessary. His respiratory signs are improving. While he was out, he presents vomiting followed twelve hours later by profuse diarrhea with a temperature of 37.3 ° C.  What is the possible cause(s) of this acute diarrhoea? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Adenovirus infection","justification":""},{"idx":1,"correct":true,"proposition":"Norovirus infection","justification":""},{"idx":2,"correct":true,"proposition":"C.","justification":""},{"idx":3,"correct":false,"proposition":"Enterovirus infection","justification":"He didn't get antibiotics. He is not feverish."},{"idx":3,"correct":false,"proposition":"RSV infection","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-6-qi-5","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Regarding the episode of acute gastroenteritis of viral origin, which is(are) the exact statement(s)? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is an infection preventable by droplet precautions << >>","justification":""},{"idx":1,"correct":true,"proposition":"It is a certain nosocomial infection","justification":""},{"idx":2,"correct":false,"proposition":"The germ responsible for diarrhea is resistant to hydroalcoholic fluids (SHA)","justification":""},{"idx":3,"correct":false,"proposition":"It is necessary to make a declaration to the ARS (Regional Health Agency) of this infection","justification":""},{"idx":4,"correct":true,"proposition":"It is a manu-supported infection","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-6-qi-6","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Given the severity of the picture, intravenous rehydration is decided. A blood sample is taken at the time of the infusion. The results of this assessment are as follows: natremia 125 mmol \/ L, serum potassium 3.7 mmol \/ l, blood glucose 7.4 mmol \/ L. What is (are) the possible diagnosis(s) in this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cystic fibrosis","justification":""},{"idx":1,"correct":true,"proposition":"Oral rehydration with pure water given by parents","justification":""},{"idx":2,"correct":false,"proposition":"Intravenous rehydration with a solution not rich enough in sodium","justification":""},{"idx":3,"correct":false,"proposition":"Ulcerative-necrotizing enterocolitis","justification":""},{"idx":4,"correct":false,"proposition":"Hemolytic uremic syndrome (HUS)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-6-qi-7","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"At the end of the infusion, the child makes clonic movements of the 4 limbs for 1 minute. It has no post-critical deficit. Which of the following diagnoses can be considered in this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A complex febrile convulsion","justification":""},{"idx":1,"correct":true,"proposition":"An occasional seizure related to hyponatremia","justification":""},{"idx":2,"correct":false,"proposition":"West syndrome-type epilepsy","justification":""},{"idx":3,"correct":true,"proposition":"Cerebral venous thrombosis","justification":""},{"idx":4,"correct":false,"proposition":"Streptococcal B meningitis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-6-qi-8","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"After a few days, his clinical condition has improved and you prepare the discharge, he weighs 6000g and by taking the health record you find that he has not been followed since his arrival in France and that no vaccination has been carried out. You worry about his psychomotor development. What are the expected acquisitions for his age? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Stacks two cubes","justification":"1 year"},{"idx":1,"correct":false,"proposition":"Repeats one syllable","justification":"6 months"},{"idx":2,"correct":false,"proposition":"Picks up objects with thumb-index clip","justification":"9 months"},{"idx":3,"correct":true,"proposition":"Play with his hands L","justification":""},{"idx":4,"correct":true,"proposition":"Laughs out loud","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-6-qi-9","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Given the vaccine delay and its age, which of the following vaccines, is the one to be prioritized? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Influenza","justification":""},{"idx":1,"correct":true,"proposition":"Pneumococcus","justification":""},{"idx":2,"correct":true,"proposition":"Haemophilius","justification":""},{"idx":3,"correct":true,"proposition":"Meningococcal B","justification":""},{"idx":4,"correct":true,"proposition":"Measles","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-6-qi-10","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Before the outing, which of the following dietary tips do you give to parents? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Use sterilized baby bottles","justification":""},{"idx":1,"correct":true,"proposition":"Bottles can be prepared with tap water","justification":""},{"idx":2,"correct":false,"proposition":"In case of family history of allergy, the introduction of peanut should be postponed","justification":""},{"idx":3,"correct":false,"proposition":"Cow's milk can replace infant milk from the age of 1 year","justification":""},{"idx":4,"correct":false,"proposition":"It will be necessary to give 5 fruits and vegetables per day 1 month after the beginning of diversification","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-6-qi-11","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"You see him again 2 months later for a new episode of respiratory discomfort. Parents tell you he's been cluttered and coughing since his last episode. Its weight is 6,100 g. What is (are) the possible diagnosis(s) given the history of this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Infant asthma","justification":""},{"idx":1,"correct":true,"proposition":"Cystic fibrosis","justification":""},{"idx":2,"correct":false,"proposition":"Coarctation of the aorta","justification":""},{"idx":3,"correct":true,"proposition":"Immunodeficiency","justification":""},{"idx":4,"correct":false,"proposition":"Eosinophilic esophagitis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-6-qi-12","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"You suspect an immune deficiency. If confirmed, what vaccine(s) would be contraindicated in this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Injectable flu","justification":""},{"idx":1,"correct":true,"proposition":"Chickenpox","justification":""},{"idx":2,"correct":false,"proposition":"Pneumococcus","justification":""},{"idx":3,"correct":false,"proposition":"Meningococcal C","justification":""},{"idx":4,"correct":false,"proposition":"Hepatitis B","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-6-qi-13","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"No newborn screening was offered to this child. For children born in French maternity wards, newborn screening for cystic fibrosis: ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Requires signed parental consent for potential genetic research","justification":""},{"idx":1,"correct":false,"proposition":"Is proposed on the first day of life in case of delay in the emission of meconium","justification":""},{"idx":2,"correct":true,"proposition":"Is proposed on the third day of life","justification":""},{"idx":3,"correct":false,"proposition":"Consists of the analysis of the CFTR gene when the immunoreactive trypsin assay is below the threshold of positivity","justification":""},{"idx":4,"correct":true,"proposition":"Is sensitive but not very specific","justification":"There are many false positives but few false negatives: this is what we expect from a screening test (we do not want to miss a disease)."}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-6-qi-14","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"This child has a homozygous delta-F508 mutation. What support do you implement? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Daily chest physiotherapy sessions","justification":""},{"idx":1,"correct":false,"proposition":"Normal power supply","justification":""},{"idx":2,"correct":false,"proposition":"Interruption of breastfeeding","justification":""},{"idx":3,"correct":true,"proposition":"Oral supplementation of fat-soluble vitamins","justification":""},{"idx":4,"correct":true,"proposition":"Standard vaccination schedule","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-8-qi-1","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"The examination of the perianal region finds the following externalization at the pushing efforts.  Which of the following is correct? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The radial appearance of the folds is in favor of hemorrhoidal prolapse","justification":""},{"idx":1,"correct":false,"proposition":"The appearance of the lesion is in favor of cancer","justification":""},{"idx":2,"correct":false,"proposition":"The existence of haemorrhages on contact with or at the time of exemptions is in favour of cancerous degeneration.","justification":""},{"idx":3,"correct":true,"proposition":"The painless nature of the swelling is not in favor of hemorrhoidal thrombosis","justification":""},{"idx":4,"correct":false,"proposition":"This is a total externalized prolapse of the rectum","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-8-qi-2","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"You mention hemorrhoidal prolapse. Regarding your therapeutic care, what is (are) the exact proposal(s)?","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Regularization of transit is necessary to limit hemorrhoidal manifestations","justification":""},{"idx":1,"correct":false,"proposition":"This patient must be operated urgently, he risks thrombosis quickly","justification":""},{"idx":2,"correct":true,"proposition":"The regularization of transit and hygiene-dietary rules may be sufficient to relieve the patient","justification":""},{"idx":3,"correct":true,"proposition":"If he remains embarrassed after medical care, surgery may be considered","justification":""},{"idx":4,"correct":false,"proposition":"Hemorrhoids are a risk factor for cancer","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-8-qi-3","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"Regarding the care and follow-up of the patient, what is (are) the exact proposal(s)? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Once the hygiene-dietary rules are established, if the patient is relieved, there are no other examinations to perform","justification":""},{"idx":1,"correct":false,"proposition":"Surgery should be planned as soon as possible, there is no need to continue pre-operative explorations","justification":""},{"idx":2,"correct":true,"proposition":"The presence of rectal bleeding requires a colonoscopy","justification":""},{"idx":3,"correct":false,"proposition":"To authenticate bleeding, the patient may be offered a stool blood test.","justification":""},{"idx":4,"correct":false,"proposition":"In this context of symptomatic hemorrhoidal disease, colonoscopy can only be considered once the hemorrhoidal problem has been resolved.","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-8-qi-4","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"A colonoscopy under general anesthesia is performed. It highlights at the level of the sigmoid colon the following image that is not passable. Which of the following proposals concerning iconography is (are) accurate? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is an irregular and ulcerated lesion suggestive of a malignant tumor","justification":""},{"idx":1,"correct":false,"proposition":"It is an inflammatory colonic diverticulum","justification":""},{"idx":2,"correct":false,"proposition":"The mucosa around the lesion is inflammatory and suggestive of chronic inflammatory bowel disease","justification":""},{"idx":3,"correct":true,"proposition":"This lesion may explain the patient's increased constipation in recent months.","justification":""},{"idx":4,"correct":false,"proposition":"Endoscopic removal of the lesion is necessary to perform a total colonoscopy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-8-qi-5","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"The biopsy confirms that it is a well-differentiated lieberkhunian adenocarcinoma. Which of the following proposals concerning the extension and pre-therapeutic assessment is (are) accurate? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The thoraco-abdomino-pelvic CT scan is the reference examination for the extension assessment of this colon cancer","justification":""},{"idx":1,"correct":false,"proposition":"The PET scan must be performed to detect locations not seen on the scanner","justification":""},{"idx":2,"correct":false,"proposition":"The patient cannot be operated on if the colonoscopy is not complete","justification":""},{"idx":3,"correct":false,"proposition":"The determination of CA 125 and CA 19.9 markers is indicated","justification":""},{"idx":4,"correct":true,"proposition":"It is necessary to schedule a new pre-operative anesthesia consultation","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-8-qi-6","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"There are no metastases. Which of the following proposals for patient care is correct? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The patient's file must imperatively be presented in a multidisciplinary consultation meeting (RCP) before any treatment","justification":""},{"idx":1,"correct":true,"proposition":"Surgery is the gold standard treatment for non-metastatic colon cancer and the only curative option","justification":""},{"idx":2,"correct":false,"proposition":"Preoperative radiotherapy may be offered to improve the chances of local control of this advanced cancer","justification":""},{"idx":3,"correct":true,"proposition":"Chemotherapy may be indicated post-operative depending on the results of the histopathological examination of the operating room","justification":""},{"idx":4,"correct":false,"proposition":"Intraperitoneal intraperitoneal chemohyperthermia can be performed to prevent loco-regional recurrence","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-8-qi-7","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"You are planning a colectomy. Which of the proposals for the rules of cancer surgery is correct? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A colectomy with tumour safety margins of at least 5 cm is required","justification":""},{"idx":1,"correct":true,"proposition":"A lymph node dissection requires at least 12 lymph nodes for proper assessment of lymph node status","justification":""},{"idx":2,"correct":true,"proposition":"A colectomy with restoration of digestive continuity and without stoma is the rule in this situation apart from the emergency or an intraoperative abnormality","justification":""},{"idx":3,"correct":false,"proposition":"A stoma must be performed because the tumor has evolved and chemotherapy must be started quickly","justification":""},{"idx":4,"correct":true,"proposition":"In case of discovery of peritoneal carcinomatosis during the intervention, it is allowed to postpone the colectomy and to discuss the patient's file again in multidisciplinary consultation meeting","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-8-qi-8","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"The patient is operated in good conditions, with a restoration of continuity at the same time operative. The report of the histopathological examination concludes that circumlateral adenocarcinoma invades the sub-serosa. There is an invaded lymph node out of the 13 examined. There are vascular embols and perinervous sheaths. There is instability of micro-satellites. Which of the proposals concerning the stage of the disease and its prognosis is (are) accurate? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is a pT3N1 tumour","justification":""},{"idx":1,"correct":true,"proposition":"It is stage III colon cancer","justification":""},{"idx":2,"correct":false,"proposition":"The prognosis for overall survival at 5 years is 95%","justification":""},{"idx":3,"correct":true,"proposition":"The presence of vascular emboli is a factor of poor prognosis","justification":""},{"idx":4,"correct":false,"proposition":"Peri-nervous sheathing has no impact on prognosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-8-qi-9","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"The postoperative period is marked by the appearance of a fever at 38.5 ° C on the 5th day.   Which of the following is correct?","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is necessary to evoke a complication type of anastomotic fistula","justification":""},{"idx":1,"correct":true,"proposition":"A complete blood count is indicated","justification":""},{"idx":2,"correct":true,"proposition":"A cytobacteriological examination of urine is indicated in this patient who has undergone urinary catheterization for his procedure","justification":""},{"idx":3,"correct":false,"proposition":"A determination of D-dimer must be carried out","justification":""},{"idx":4,"correct":true,"proposition":"Palpation of the abdominal scar is essential","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-8-qi-10","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"A wall abscess was removed. The sequels are ultimately simple. The patient leaves the ward on Day 7. Regarding the continuation of the care during the first year, which proposal(s) is(are) accurate? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A colonoscopy should be performed within 6 months as the initial examination was not complete","justification":""},{"idx":1,"correct":true,"proposition":"Given lymph node invasion, adjuvant chemotherapy is indicated","justification":""},{"idx":2,"correct":false,"proposition":"Given the importance of parietal (subserosa) involvement, postoperative radiotherapy should be offered","justification":""},{"idx":3,"correct":true,"proposition":"As part of the patient's management, his colon cancer enters the list of conditions eligible for 100% coverage","justification":""},{"idx":4,"correct":false,"proposition":"Clinical and ultrasound monitoring should be semi-annually","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-8-qi-11","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"What is the element of anamnesis that makes you propose to the patient an onco-genetic consultation? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Age","justification":""},{"idx":1,"correct":false,"proposition":"The stenosing character of the tumor","justification":""},{"idx":2,"correct":false,"proposition":"Localization in the sigmoid colon","justification":""},{"idx":3,"correct":false,"proposition":"The presence of vascular emboli on histological examination","justification":""},{"idx":4,"correct":true,"proposition":"The instability of micro-satellites","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-8-qi-12","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"Which of the following cancers is (are) on the narrow spectrum of Lynch syndrome? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cancer of the urinary excretory tract","justification":"Two mnemonics: GOBES and VICE (see the mnemo means tab)"},{"idx":1,"correct":false,"proposition":"Breast cancer","justification":""},{"idx":2,"correct":true,"proposition":"Endometrial cancer","justification":""},{"idx":3,"correct":false,"proposition":"Thyroid cancer","justification":""},{"idx":4,"correct":true,"proposition":"Small intestine cancer","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-8-qi-13","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"Finally the patient receives adjuvant chemotherapy that he tolerates well. He wishes to resume his professional activity within a month of the end of his chemotherapy. What can you offer him as a doctor? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Encourage them to file an application for recognition as a disabled worker (RQTH)","justification":""},{"idx":1,"correct":false,"proposition":"Write him a certificate of aptitude for the resumption of his professional activity","justification":""},{"idx":2,"correct":true,"proposition":"Send it now to the occupational physician of his company for a pre-resumption visit","justification":""},{"idx":3,"correct":true,"proposition":"Prescribe part-time for therapeutic reasons","justification":""},{"idx":4,"correct":false,"proposition":"Submit an application for an adult disabled allowance (AAH)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-8-qi-14","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"A year later, the surveillance scanner shows the following image. Regarding this iconography, which is (are) the exact proposal(s)? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is a CT scan injected at arterial time","justification":""},{"idx":1,"correct":true,"proposition":"We individualize on this picture the spleen","justification":""},{"idx":2,"correct":true,"proposition":"A hypodense image compatible with liver metastasis is found","justification":""},{"idx":3,"correct":true,"proposition":"This lesion is located in the left liver","justification":""},{"idx":4,"correct":true,"proposition":"The stomach is visible in this picture","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-8-qi-15","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"This is actually a single liver metastasis of his colorectal cancer. Which of the following proposals for the management of this patient is correct? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"His file must be represented in a multidisciplinary consultation meeting (RCP)","justification":""},{"idx":1,"correct":true,"proposition":"Excision surgery can treat this patient curatively","justification":""},{"idx":2,"correct":true,"proposition":"A preoperative PET scan may be indicated to ensure the absence of further distant metastases","justification":""},{"idx":3,"correct":true,"proposition":" Chemotherapy may be offered to assess the tumor's response to treatment","justification":""},{"idx":4,"correct":false,"proposition":"In this patient already operated on the colon, an intervention on the liver is no longer possible","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-9-qi-1","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"Regarding the facial nerve, which proposals are accurate? (one or more possible answers) ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" It has a vegetative action","justification":""},{"idx":1,"correct":false,"proposition":"Its sensory ganglion is the trigeminal ganglion","justification":""},{"idx":1,"correct":false,"proposition":"His elbow separates his first portion from his second","justification":"It separates the second portion from the third"},{"idx":1,"correct":true,"proposition":"It innervates the stirrup muscle","justification":""},{"idx":1,"correct":true,"proposition":"It includes an intrapetrous position","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-9-qi-2","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"During peripheral facial paralysis: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The motor deficit is homogeneous affecting both the upper and lower territory","justification":""},{"idx":1,"correct":false,"proposition":"There is an automatic-voluntary dissociation","justification":""},{"idx":2,"correct":true,"proposition":"We can observe a sign of Charles-Bell","justification":""},{"idx":3,"correct":true,"proposition":"We can observe a sign of the eyelashes of Souques","justification":""},{"idx":4,"correct":false,"proposition":"Facial features are deflected to the paralyzed side","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-9-qi-3","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"What are the additional examinations that you will carry out initially? ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Bilateral otoscopy","justification":""},{"idx":1,"correct":true,"proposition":"Examination of other cranial pairs","justification":""},{"idx":2,"correct":true,"proposition":"Tonal audiometry","justification":""},{"idx":3,"correct":true,"proposition":"Search for stapedial reflexes","justification":""},{"idx":4,"correct":true,"proposition":"Speech audiometry","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-9-qi-4","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"What diagnosis do you evoke in front of this aspect? ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Seromucosal otitis","justification":""},{"idx":1,"correct":false,"proposition":"Fibroadhesive otitis","justification":""},{"idx":2,"correct":false,"proposition":"Earwax cap","justification":""},{"idx":3,"correct":true,"proposition":"Cholesteatoma","justification":""},{"idx":4,"correct":false,"proposition":"Retraction bag","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-9-qi-5","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You diagnose a cholesteatoma. You perform a tonal audiometry of which here is the result. These curves are characteristic of: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Right-hand transmission hearing loss","justification":""},{"idx":1,"correct":false,"proposition":"Left sensorineural hearing loss","justification":""},{"idx":2,"correct":false,"proposition":"Left mixed deafness","justification":""},{"idx":3,"correct":true,"proposition":"Left transmission hearing loss","justification":""},{"idx":4,"correct":false,"proposition":"Righteous sensorineural hearing loss","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-9-qi-6","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You diagnose left-handed conductive hearing loss. You perform an acoumetry. What is the exact proposal(s): ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"In the Weber test, the sound is lateralized on the left side.","justification":""},{"idx":1,"correct":false,"proposition":"Weber's test will be said to be positive","justification":"Weber is neither positive nor negative: he is either lateralized or non-lateralized."},{"idx":2,"correct":true,"proposition":"Rinne's test will be said to be negative","justification":""},{"idx":3,"correct":true,"proposition":"In the Rinne test, bone conduction will be better than air conduction","justification":""},{"idx":4,"correct":false,"proposition":"Stageian reflexes will be present","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-9-qi-7","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"Regarding the innervation of the face and neck:","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A section of the right hypoglossal nerve will cause during protraction a deviation of the tongue to the left","justification":""},{"idx":1,"correct":false,"proposition":"The levator muscle of the upper eyelid is innervated by the trochlear nerve","justification":""},{"idx":2,"correct":false,"proposition":"A section of the right vagus nerve at the mediastinal level will lead to paralysis of the right hemilarynx","justification":""},{"idx":3,"correct":true,"proposition":"A section of the left cervical sympathetic trunk will lead to Claude Bernard-Homer syndrome","justification":""},{"idx":4,"correct":true,"proposition":"The lateral rectus muscle is innervated by the abducens nerve","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-9-qi-8","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"The clinical examination of this patient shows that when the eyes are closed, his left eye does not close completely and that the deviation of the mouth is well obfecled at rest. You propose as early management:","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Facial electrotherapy","justification":""},{"idx":1,"correct":false,"proposition":"Oral amoxicillin","justification":""},{"idx":2,"correct":true,"proposition":"Eye care","justification":""},{"idx":3,"correct":false,"proposition":"Antiviral treatment with valaciclovir","justification":""},{"idx":4,"correct":true,"proposition":"Facial physiotherapy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-9-qi-9","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You carry out as an additional examination (an expected answer): ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Schüller incidence radiography","justification":""},{"idx":1,"correct":true,"proposition":"Scanning of the two rocks without injection of contrast medium","justification":""},{"idx":2,"correct":false,"proposition":"Bone scintigraphy","justification":""},{"idx":3,"correct":false,"proposition":"Early auditory evoked potentials","justification":""},{"idx":4,"correct":false,"proposition":"Microbiological","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-9-qi-10","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You perform a scan of both rocks without injection. On this scanner section of the left rock: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Arrow 1 designates the vestibule","justification":""},{"idx":1,"correct":true,"proposition":"Arrow 1 points to the cochlea","justification":""},{"idx":2,"correct":true,"proposition":"2 refers to the internal auditory canal","justification":""},{"idx":3,"correct":false,"proposition":"2 refers to the eardrum box","justification":""},{"idx":4,"correct":false,"proposition":"3 refers to the internal carotid artery","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-9-qi-11","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You propose as support for this chollessteatoma (an expected response): ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Treatment with amoxicillin-clavulanic acid for fifteen days","justification":""},{"idx":1,"correct":false,"proposition":"An instillation of ofloxacin in ear drops, one dose twice daily for one month","justification":""},{"idx":2,"correct":false,"proposition":"A 6-month consultation for a new otoscopy","justification":""},{"idx":3,"correct":true,"proposition":"Surgical treatment","justification":""},{"idx":4,"correct":false,"proposition":"Iterative aspirations under a microscope","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-9-qi-12","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You operated on this patient by performing a first time of tympanoplasty. You then discuss with him the continuation of his care: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The patient is at risk of residual cholesteatoma","justification":""},{"idx":1,"correct":true,"proposition":"Monitoring will include regular audiogram","justification":""},{"idx":2,"correct":true,"proposition":"The patient is at risk of recurrent cholesteatoma","justification":""},{"idx":3,"correct":true,"proposition":"Monitoring will include regular imaging","justification":""},{"idx":4,"correct":true,"proposition":"Monitoring will include regular otoscopy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-9-qi-13","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"The patient does not return to the various follow-up consultations you have scheduled. Three years after the surgery, he consults you again urgently for a large vertigo of sudden beginning, appeared since the day before, accompanied by nausea and vomiting. You are diagnosed with left harmonious vestibular syndrome. You will find at the clinical examination: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A right horizontal-rotational nystagmus","justification":""},{"idx":1,"correct":true,"proposition":"During nystagmus, a slow deviation of the eyes to the left","justification":""},{"idx":2,"correct":false,"proposition":"A blind walk deviated to the right","justification":""},{"idx":3,"correct":true,"proposition":"At the maneuver of the outstretched arms, a deviation of the index fingers to the left","justification":""},{"idx":4,"correct":false,"proposition":"Nystagmus persists with eye fixation","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-9-qi-14","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"On otoscopy, you visualize a recurrence of cholesteatoma. Clinical examination shows no involvement of the other cranial pairs. The audiogram shows bone conduction similar to that existing post-operatively. The most likely diagnosis is ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left vestibular neuritis","justification":""},{"idx":1,"correct":false,"proposition":"Right Wallenberg syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Thrombosis of the left internal auditory artery","justification":""},{"idx":3,"correct":true,"proposition":"Lysis of the left lateral semicircular canal","justification":""},{"idx":4,"correct":false,"proposition":"Spontaneous fracture of the left rock","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-9-qi-15","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You suspect lysis of the left lateral semicircular canal. You prescribe as additional examinations ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Standard X-ray incidence << rock in orbit >>","justification":""},{"idx":1,"correct":true,"proposition":"Videonystagmography","justification":""},{"idx":2,"correct":true,"proposition":"Left rock scanner without injection","justification":""},{"idx":3,"correct":false,"proposition":"Microbiological","justification":""},{"idx":4,"correct":false,"proposition":"Electromyogram of the face","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-10-qi-1","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"You want to specify the abnormalities found on the blood count. What additional examinations are you requesting? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Determination of vitamin B9","justification":"Anemia is not microcytic"},{"idx":1,"correct":false,"proposition":"TSH test","justification":"Anemia is not normocytic"},{"idx":2,"correct":false,"proposition":"Determination of vitamin B12","justification":"Anemia is not microcytic"},{"idx":3,"correct":true,"proposition":"Determination of ferritinemia","justification":""},{"idx":4,"correct":true,"proposition":"CRP testing","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-10-qi-2","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"What can be the reasons for the hyperplatektosis? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Vitamin deficiency","justification":""},{"idx":1,"correct":true,"proposition":"Iron deficiency","justification":""},{"idx":2,"correct":true,"proposition":"Inflammatory syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Beginning myeloproliferative syndrome","justification":""},{"idx":4,"correct":false,"proposition":"Hemolysis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-10-qi-3","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"You examine the patient. He has left axillary lymphadenopathy. It has no hepatosplenomêgalie. Blood pressure is at 130\/70. The temperature is 37.1°C at the time of the examination. It has very pale skin and you notice a slight thoracic collateral circulalion. You suspect superior cava syndrome. What signs will you look for in favor of this diagnosis? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Shortness of breath when lying down","justification":""},{"idx":1,"correct":false,"proposition":"Stellar angiomas","justification":"This is a sign of hepatocellular insufficiency."},{"idx":2,"correct":true,"proposition":"Jugular turgor","justification":""},{"idx":3,"correct":true,"proposition":"An edema filling the supraclavicular hollows","justification":""},{"idx":4,"correct":false,"proposition":"Edema of the lower limbs","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-10-qi-4","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"He actually does not tolerate the lying position well and sleeps with 2 pillows. Suspecting lymphoma pathology, you refer the patient for hospitalization in hematology. A PET scan is performed quickly. About this review, which propositions are true? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The marker used is iron-based","justification":"It is glucose-based"},{"idx":1,"correct":true,"proposition":"This is an examination indicated in the initial assessment of aggressive lymphomas","justification":""},{"idx":2,"correct":true,"proposition":"Tumor metabolism is evaluated by the SUV (Standard Uptake Value)","justification":""},{"idx":3,"correct":true,"proposition":"The patient must be fasting","justification":""},{"idx":4,"correct":false,"proposition":"The patient should be infused with glucose serum","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-10-qi-5","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"What is your interpretation? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"There is supra- and subdiaphragmatic lymph node involvement","justification":""},{"idx":1,"correct":false,"proposition":"There is myocardial involvement","justification":""},{"idx":2,"correct":true,"proposition":"It is compatible with an Ann Arbor Stage II","justification":""},{"idx":3,"correct":false,"proposition":"There are many artifacts that hinder interpretation","justification":""},{"idx":4,"correct":false,"proposition":"There is probable damage to the urinary tract","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-10-qi-6","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"The PET scan shows hypermetabolic axillary and mediastinal lymphadenopathy (SUV> 10). What exploration modalities do you choose in this context? (one or more possible answers)","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" Biopsy of axillary lymphadenopathy","justification":""},{"idx":1,"correct":false,"proposition":"Cytopuncture of axillary lymphadenopathy","justification":""},{"idx":2,"correct":false,"proposition":"Axillary dissection with extemporaneous examination","justification":""},{"idx":3,"correct":false,"proposition":"Immediate fixing of the levy","justification":""},{"idx":4,"correct":false,"proposition":"Mediastinoscopy and mediastinal mass sampling","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-10-qi-7","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"You perform a biopsy of an axillary lymph node. The histological report comes back to you: large cells with destroyed architecture, tumor cells expressing CD20. What is the most likely histological diagnosis? (only one answer expected) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Hodgkin's disease","justification":""},{"idx":1,"correct":true,"proposition":"Diffuse large cell non-Hodgkin B-cell lymphoma","justification":""},{"idx":2,"correct":false,"proposition":"T-cell lymphoma","justification":""},{"idx":3,"correct":false,"proposition":"Follicular lymphoma","justification":""},{"idx":4,"correct":false,"proposition":"Sarcoidosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-10-qi-8","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"The diagnosis of diffuse large cell B-cell lymphoma is retained. You perform an osteomedullary biopsy and lumbar puncture which are normal. You want to calculate the usual prognostic score (IPI for international prognostic index) in this patient. What do you need? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Sex","justification":""},{"idx":1,"correct":true,"proposition":"Age","justification":""},{"idx":2,"correct":true,"proposition":"Ann Arbor Clinical Stage","justification":""},{"idx":3,"correct":false,"proposition":"Beta2 microglobulin","justification":""},{"idx":4,"correct":true,"proposition":"LDH","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-10-qi-9","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"What do you offer the patient before starting treatment? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hepatitis B and C serologies","justification":""},{"idx":1,"correct":false,"proposition":"Brain MRI","justification":""},{"idx":2,"correct":true,"proposition":"Cardiac ultrasound with ejection fraction measurement","justification":""},{"idx":3,"correct":false,"proposition":"HLA typing","justification":""},{"idx":4,"correct":true,"proposition":"Sperm cryopreservation at CECOS","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-10-qi-10","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"You are starting immunochemotherapy such as rituximab, doxorubicin, vindesine, cyclophosphamide, bleomycin and prednisone. What are the classic side effects of doxorubicin (anthracycline): (one or more possible responses)","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cardiomyopathy","justification":""},{"idx":1,"correct":true,"proposition":"Extensive skin necrosis in case of extravasation","justification":""},{"idx":2,"correct":false,"proposition":"Pulmonary fibrosis","justification":""},{"idx":3,"correct":false,"proposition":"Dysthyroidism","justification":""},{"idx":4,"correct":true,"proposition":"Alopecia","justification":"Non-alopecic chemotherapies to know for NEC are platinum salts, 5-FU and methotrexate."}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-10-qi-11","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"Rituximab: (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Is a mouse monoclonal antibody","justification":"xi = chimerical"},{"idx":1,"correct":false,"proposition":"Is an antibody recognizing CD34 surface antigen","justification":""},{"idx":2,"correct":true,"proposition":"May cause viral hepatitis reactivations","justification":""},{"idx":3,"correct":true,"proposition":"May cause cytokine release syndrome on first infusion","justification":""},{"idx":4,"correct":true,"proposition":"Causes B-cell","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-10-qi-12","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"At 10 days of chemotherapy, the patient who is at home, calls you because he is feverish with several temperature peaks at 39 ° C and chills. The blood count carried out the day before shows Hemoglobin 91 g \/ dL, Leukocytes 1.8 G \/ L, neutrophils 0.4 G \/ L, Lymphocytes 1.2 GIL, Monocytes 0.2 G \/ L, Platelets 50 G \/ L. What are the proposals that apply to the blood count? (one or more correct answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Pancytopenia","justification":""},{"idx":1,"correct":true,"proposition":"Neutropenia","justification":""},{"idx":2,"correct":true,"proposition":"Lymphopenia","justification":""},{"idx":3,"correct":false,"proposition":"Monocytosis","justification":""},{"idx":4,"correct":true,"proposition":"Thrombocytopenia","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-10-qi-13","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"What attitude do you adopt? ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"You prescribe antibiotic therapy with amoxicillin","justification":""},{"idx":1,"correct":false,"proposition":"You resume corticosteroid therapy","justification":""},{"idx":2,"correct":false,"proposition":"You make him do a chest x-ray in town in emergency","justification":""},{"idx":3,"correct":true,"proposition":"You hospitalize him urgently","justification":""},{"idx":4,"correct":false,"proposition":"You ask him to contact you again after 12 hours of antibiotic treatment","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-10-qi-14","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"When he arrives in the hematology department, what examinations must be carried out urgently? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Blood","justification":""},{"idx":0,"correct":true,"proposition":"ECBU","justification":""},{"idx":0,"correct":false,"proposition":"Myelogram","justification":""},{"idx":0,"correct":false,"proposition":"Microbiological","justification":""},{"idx":0,"correct":false,"proposition":"LDH","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-10-qi-15","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"After taking blood cultures and an ECBU, what therapeutic attitude do you adopt? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Protective Custody","justification":""},{"idx":1,"correct":false,"proposition":"Antibiotic therapy started after blood culture results","justification":""},{"idx":2,"correct":false,"proposition":"Intravenous antifungal","justification":""},{"idx":3,"correct":false,"proposition":"Corticosteroid therapy","justification":""},{"idx":4,"correct":false,"proposition":"Transfusion of red blood cells","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-11-qi-1","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"What late complication(s) may result from contusive eye trauma? Decreased mydriasis of the photomotor reflex","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Retinal detachment","justification":""},{"idx":1,"correct":false,"proposition":"Retinal edema","justification":""},{"idx":2,"correct":true,"proposition":"Ocular hypertonia","justification":""},{"idx":3,"correct":true,"proposition":"A cataract","justification":""},{"idx":4,"correct":true,"proposition":"Mydriasis with decreased photomotor reflex","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-11-qi-2","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"Which symptom(s) would be suggestive of a cataract?","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Photophobia","justification":""},{"idx":1,"correct":true,"proposition":"A monocular diplopia","justification":""},{"idx":2,"correct":false,"proposition":"Metamorphopsies","justification":""},{"idx":3,"correct":false,"proposition":"Phosphenes","justification":""},{"idx":4,"correct":false,"proposition":"Visual field amputation","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-11-qi-3","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"Which symptom(s) would be suggestive of retinal detachment? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Photophobia","justification":""},{"idx":1,"correct":false,"proposition":"A monocular diplopia","justification":""},{"idx":2,"correct":false,"proposition":"Lagophthalmos","justification":""},{"idx":3,"correct":true,"proposition":"Phosphenes","justification":""},{"idx":4,"correct":true,"proposition":"Visual field amputation","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-11-qi-4","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"Your clinical examination regains a visual acuity measured at 10\/10 P2 with a correction in glasses of -1 (-0.50 to 85 °) in the right eye, and << see the hand move >> with -3 (-0.75 to 75 °) on the left eye. What refractive disorder(s) is present in this patient ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Low myopia"},{"idx":1,"correct":false,"proposition":"Strong myopia"},{"idx":2,"correct":false,"proposition":"Hyperopia"},{"idx":3,"correct":false,"proposition":"Unepresbyopia"},{"idx":4,"correct":true,"proposition":"Astigmatism"}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-11-qi-5","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"Intraocular pressure is measured at 18 mm Hg in the right eye and 20 mm Hg in the left eye. The examination of the anterior segment of the right eye is without departure. Examination of the anterior segment of the left eye finds a deep anterior chamber and a total white cataract. The examination of the eye food is unremarkable on the right side and not visible on the left side. What other abnormality(s) of traumatic origin could you find in the anterior segment of the left eye? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A miosis","justification":""},{"idx":1,"correct":true,"proposition":"Subluxation of the lens","justification":""},{"idx":2,"correct":true,"proposition":"Iridodialysis","justification":""},{"idx":3,"correct":true,"proposition":"A rupture of the iris sphincter","justification":""},{"idx":4,"correct":false,"proposition":"Central corneal opacification","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-11-qi-6","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"What additional examination(s) are you requesting to clarify the condition of the eye structures of the left eye? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An examination of the visual field","justification":""},{"idx":1,"correct":false,"proposition":"Optical coherence tomography (macular OCT).","justification":""},{"idx":2,"correct":true,"proposition":"An ocular ultrasound in mode B","justification":""},{"idx":3,"correct":false,"proposition":"Keratometry","justification":""},{"idx":4,"correct":false,"proposition":"An orbital scanner","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-11-qi-7","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"What examination(s) are needed before cataract surgery? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Pachymetry","justification":""},{"idx":1,"correct":true,"proposition":"Keratometry","justification":""},{"idx":2,"correct":false,"proposition":"A corneal topography","justification":""},{"idx":3,"correct":true,"proposition":"A measurement of the axial length of the eye","justification":""},{"idx":4,"correct":false,"proposition":"A kinetic Goldmann visual field","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-11-qi-8","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The ultrasound is without particularity to the left eye. You offer the patient cataract surgery on his left eye. What explanation(s) do you give to the patient? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Surgery is performed during a traditional 2-day hospitalization","justification":"Outpatient, without hospitalization"},{"idx":1,"correct":true,"proposition":"Anesthesia is most often local or locoregional","justification":""},{"idx":2,"correct":true,"proposition":"Visual recovery cannot be estimated because the fundus is not visible","justification":"It is necessary to see the state of the retina (which echo B does not allow) to have a prognosis of visual recovery."},{"idx":3,"correct":true,"proposition":"Complications are rare but can lead to loss of function of the eye","justification":""},{"idx":4,"correct":false,"proposition":"The absence of lens will be corrected by a corrective lens","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-11-qi-9","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The cataract operation does not go as planned. At the time of phacoemulsification, there is a large posterior capsular rupture.  What is (are) the possibility(s) of correction of aphakia in this case?","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Placement of a multifocal implant in the capsular bag","justification":""},{"idx":1,"correct":true,"proposition":"Placement of an anterior chamber implant ","justification":""},{"idx":2,"correct":false,"proposition":"Placement of a monofocal implant in the capsular bag","justification":""},{"idx":3,"correct":true,"proposition":"A correction by a contact lens","justification":""},{"idx":4,"correct":true,"proposition":"A correction by glasses","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-11-qi-10","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The operation finally tennine well and an anterior chamber implant is placed. Three weeks after the operation the patient consults urgently for a decrease in visual acuity of the left eye associated with a white and painless eye with a calm anterior segment. What diagnosis(s) do you mention?","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Retinal detachment"},{"idx":1,"correct":false,"proposition":"Acute anterior uveitis","justification":""},{"idx":2,"correct":false,"proposition":"Acute post-operative endophthalmitis","justification":""},{"idx":3,"correct":true,"proposition":"Macular edema"},{"idx":4,"correct":false,"proposition":"A clouding of the posterior capsule","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-11-qi-11","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The visual acuity of the left eye is measured at 5\/10 Parinaud 5 with a correction. Intraocular pressure is measured at 20 mm Hg and examination of the anterior segment is unremarkable. Examination of the fundus finds a loss of foveolar reflection. Which additional exam(s) are you requesting:","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An examination of the visual field","justification":""},{"idx":1,"correct":false,"proposition":"An ultrasound in mode B","justification":""},{"idx":2,"correct":true,"proposition":"Macular optical coherence tomography (OCT)","justification":"We want to see the macula to objectify an edema of Irvin Gass."},{"idx":3,"correct":false,"proposition":"Visual evoked potentials","justification":""},{"idx":4,"correct":false,"proposition":"An electroretinogram","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-11-qi-12","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"A macular optical coherence tomography (OCT) scan is performed. There is a post-operative macular edema of cataract surgery, which is (are) the exact proposal(s)? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is of infectious origin","justification":""},{"idx":1,"correct":false,"proposition":"It is accompanied by hemorrhages and cottony nodules","justification":""},{"idx":2,"correct":true,"proposition":"It is of inflammatory origin","justification":""},{"idx":3,"correct":true,"proposition":"It occurs in post-operative weeks or months","justification":""},{"idx":4,"correct":true,"proposition":"Local or loco-regional anti-inflammatory treatment is often effective","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-11-qi-13","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The patient consults again 3 years later because his visual acuity has deteriorated. It is quantifiable with the left eye at 1\/1O Parinaud 5 with the best optical correction. In this context of post-traumatic cataract and anterior chamber implant, what diagnosis(s) can (s) be evoked to explain this decrease in visual acuity? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Posterior vitreous detachment","justification":""},{"idx":1,"correct":true,"proposition":"Corneal edema","justification":""},{"idx":2,"correct":false,"proposition":"Peritasicular drusens","justification":""},{"idx":3,"correct":true,"proposition":"Retinal detachment","justification":""},{"idx":4,"correct":false,"proposition":"Bacterial endophthalmitis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-12-qi-1","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"After listening to the patient, you seek clarification of certain symptoms.  It seems important to you to look for the presence (or absence) of: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Epistaxis","justification":""},{"idx":1,"correct":true,"proposition":"Arthralgia","justification":""},{"idx":2,"correct":true,"proposition":"Red eye","justification":""},{"idx":3,"correct":true,"proposition":"Hemoptysis","justification":""},{"idx":4,"correct":true,"proposition":"Dyspnoea","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-12-qi-2","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"The patient confirms the presence of arthralgia. He had no epistaxis or red eye episodes. On the other hand, it is dyspneic and the Sp02 taken during the consultation is 94% in ambient air. Blood pressure is measured at 110\/65 mmHg. The pulse is at 85\/minute. You propose to the patient to carry out biological analyzes. You ask the nurse to sample: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A C-reactive protein assay","justification":""},{"idx":1,"correct":true,"proposition":"Blood cultures","justification":""},{"idx":2,"correct":true,"proposition":"A search for antinuclear antibodies","justification":""},{"idx":3,"correct":false,"proposition":"An anticardiolipin antibody assay","justification":""},{"idx":4,"correct":true,"proposition":"A plasma creatinine assay","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-12-qi-3","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"With the clinical context, these results point you towards ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Sjögren's syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Systemic lupus","justification":""},{"idx":2,"correct":false,"proposition":"An antiphospholipid antibody syndrome","justification":""},{"idx":3,"correct":true,"proposition":"Vasculitis","justification":""},{"idx":4,"correct":false,"proposition":"Sarcoidosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-12-qi-4","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You turn to vasculitis and decide to hospitalize the patient in the internal medicine department. The rest of the results arrive quickly especially the C-reactive protein which is at 451 mg \/ L. The available results are shown here. Chronic inflammation alone allows you to explain: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Microcytosis","justification":""},{"idx":1,"correct":true,"proposition":"Thrombocytosis","justification":""},{"idx":2,"correct":false,"proposition":"Eosinophilia","justification":""},{"idx":3,"correct":true,"proposition":"The increase in alpha-2 globulins","justification":""},{"idx":4,"correct":false,"proposition":"Lymphopenia","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-12-qi-5","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"With regard to ANCAs, it is true that: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"They are looking for each other in direct immunofluorescence","justification":"Indirect (direct FI refers to solid biopsies)."},{"idx":1,"correct":true,"proposition":"They are mainly directed against myeloperoxidase or proteinase 3","justification":""},{"idx":2,"correct":false,"proposition":"They are directed against the cytoplasm of eosinophilic polynuclear","justification":"PNN"},{"idx":3,"correct":false,"proposition":"They are directed against the cytoplasm of Hep-2 cells","justification":""},{"idx":4,"correct":false,"proposition":"Their positivity in this patient would direct you to vasculitis with deposits of immune complexes","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-12-qi-6","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"The ANCA result and urine strip are shown below. You think you need to:","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Perform an emergency kidney biopsy","justification":""},{"idx":1,"correct":false,"proposition":"Perform an arteriogram before renal biopsy","justification":""},{"idx":2,"correct":false,"proposition":"Contraindicate renal biopsy since ANCA are positive","justification":""},{"idx":3,"correct":true,"proposition":"Perform a kidney ultrasound before biopsy","justification":""},{"idx":4,"correct":false,"proposition":"Perform a uroscan before the biopsy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-12-qi-7","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You propose an emergency renal biopsy puncture. This will be carried out: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Under general anesthesia","justification":"local"},{"idx":1,"correct":true,"proposition":"After obtaining the patient's blood type","justification":"It will be necessary to think about also ticking the RAI if they are proposed"},{"idx":2,"correct":true,"proposition":"With a non-fixed sample for immunofluorescence","justification":""},{"idx":3,"correct":false,"proposition":"Preferably scan-guided","justification":""},{"idx":4,"correct":false,"proposition":"With a sample for electron microscopy (EM)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-12-qi-8","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You receive the report of the ACB: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"This is a histology compatible with pauci-immune vasculitis","justification":""},{"idx":1,"correct":false,"proposition":"The medullary part of the sample allowed the analysis of the glomeruli","justification":"This is the cortical part"},{"idx":2,"correct":false,"proposition":"There is mesangial proliferation","justification":"mesangium is fine"},{"idx":3,"correct":false,"proposition":"There are endomembranous deposits of imrrunoglobulins","justification":"All antibodies are negative"},{"idx":4,"correct":false,"proposition":"There are signs of vascular nephropathy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-12-qi-9","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"This renal histology is consistent with pauciimmune vasculitis. You propose to treat the patient with: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Venous corticosteroids","justification":""},{"idx":1,"correct":true,"proposition":"Plasmapheresis (plasma exchange)","justification":""},{"idx":2,"correct":true,"proposition":"Ivermectin","justification":""},{"idx":3,"correct":true,"proposition":"Cyclophosphamide","justification":""},{"idx":4,"correct":false,"proposition":"Aspirin anti-aggregating dose (AAP)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-12-qi-10","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"In this context, you choose a therapeutic protocol combining cyclophosphamide, corticosteroid therapy and plasmapheresis. You want to inform the patient about the potential toxicities of cyciophosphamide. You explain the risk(s) of:","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Increased renal impairment","justification":""},{"idx":1,"correct":true,"proposition":"Hemorrhagic cystitis"},{"idx":2,"correct":true,"proposition":"Infection"},{"idx":3,"correct":true,"proposition":"Infertility"},{"idx":4,"correct":true,"proposition":"Myelodysplasia"}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-12-qi-11","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You ask for a chest scan. In these images, you can distinguish: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Cross-linking","justification":""},{"idx":1,"correct":true,"proposition":"Frosted glass","justification":""},{"idx":2,"correct":false,"proposition":"Excavated nodules","justification":""},{"idx":3,"correct":true,"proposition":"Condensations","justification":""},{"idx":4,"correct":false,"proposition":"From the honeycomb","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-12-qi-12","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"The patient's situation improves after 6 plasma exchanges, corticosteroid therapy (performed by infusion and then relayed at 1 mg \/ kg \/ day orally) and cyclophosphamide. You added cotrimoxazole (trimethoprim-sulfamethoxazole) at a dose appropriate to renal function on day one and the patient received ivennecline at an appropriate dose. It is apyretic, dyspnea has disappeared as well as ENT symptoms. Plasma creatinine stabilizes at 140 μmol\/L. CRP is less than 5 mg\/L. The patient's blood count, 2 weeks before the start of treatment, finds: PNN at 15.87 G \/ L, PNE at 0 G \/ L, PNB at 0 G \/ L, Lymphocytes at 0.84 G \/ L and Monocytes at 0.84 G \/ L. You think the results are related to: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"a martial deficiency","justification":""},{"idx":1,"correct":true,"proposition":"cyclophosphamide","justification":""},{"idx":2,"correct":true,"proposition":"corticosteroid therapy","justification":""},{"idx":3,"correct":false,"proposition":"an infection","justification":""},{"idx":4,"correct":false,"proposition":"cotrimoxazole","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-12-qi-13","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"Twenty-eight days after the start of treatment, the patient presents with a rash of sudden onset whose photographs are shown to you. C-reactive protein, which was less than 5 mg\/L 72 hours previously, is at 115 mg\/L. Hemoglobin is at 13.5 g \/ dL, platelets at 480 G \/ L, leukocytes at 14 G \/ L (including 10 G \/ L neutrophils, 2 G \/ L eosinophils and 0.9 G \/ L lymphocytes), creatinine is stable at 140 μmol \/ L, AST are at 350 Ul \/ l, ALT at 390 IU \/ L,  gammaglutamyltransferases (GGT) at 390 IU\/L and alkaline phosphatases at 140 IU\/L. Emergency liver ultrasound is normal. You mention ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A relapse of vasculitis","justification":""},{"idx":1,"correct":false,"proposition":"Generalized acute exanthematous pustulosis","justification":""},{"idx":1,"correct":true,"proposition":"A DRESS Syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Angiocholitis","justification":""},{"idx":1,"correct":false,"proposition":"A parasitic infection on corticosteroids","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-12-qi-14","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You mention a synctome of hypersensitivity to cotrimoxazole that you stop immediately. The patient's vaccination record tells you that he received a BCG vaccination at 1 month of age (the subsequent tuberculin tests were all negative), a measles-mumps-rubella vaccination (2 injections), and a diphtheria-tetanus-pertussis-poliomyelitis vaccination whose last booster was made when the patient was 25 years old. He tells you that he has never had chickenpox. For prophylactic purposes, you advise vaccinating the patient with ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"An influenza vaccination around October","justification":""},{"idx":1,"correct":true,"proposition":"An anti-pneumococcal vaccination with 2 injections","justification":""},{"idx":2,"correct":false,"proposition":"Vaccination against chickenpox","justification":""},{"idx":3,"correct":true,"proposition":"A DTP booster in the context of immunosuppression","justification":""},{"idx":4,"correct":false,"proposition":"A reminder from BCG","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-13-qi-1","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"Regarding legislation on sexual violence, what is the exact proposal(s)? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Rape is sexual assault","justification":""},{"idx":1,"correct":true,"proposition":"Forced fellatio can be considered rape","justification":""},{"idx":2,"correct":false,"proposition":"Rape does not exist between spouses","justification":""},{"idx":3,"correct":true,"proposition":"Rape is any act of sexual penetration carried out under threat, coercion or surprise","justification":"This is the definition in the Penal Code."},{"idx":4,"correct":false,"proposition":"A vulvar caress can be considered rape","justification":"No penetration = not rape."}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-13-qi-2","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"This girl is alone, tells you she is ashamed, and wishes that neither her parents nor anyone around her knew what happened. What is the course of action? (only one exact answer) ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"You don't look at her until she files a complaint","justification":""},{"idx":1,"correct":true,"proposition":"You ask him to bring an adult of his choice to participate in his care","justification":""},{"idx":2,"correct":false,"proposition":"You tell his parents","justification":""},{"idx":3,"correct":false,"proposition":"You only do the integumentary examination but not the gynecological examination","justification":""},{"idx":4,"correct":false,"proposition":"You immediately notify the police","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-13-qi-3","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"The victim was joined by the 40-year-old mother of a friend. The victim asks you for a medical certificate. What is the exact proposal(s)? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This document is essential if she wishes to file a complaint","justification":""},{"idx":1,"correct":true,"proposition":"You give him the medical certificate, in the presence of the adult of his choice","justification":""},{"idx":2,"correct":false,"proposition":"You give the medical certificate to the judicial police officer on duty at the police station","justification":""},{"idx":3,"correct":false,"proposition":"In case of judicial requisition, you give this certificate to the judicial police officer only if the young woman agrees","justification":""},{"idx":4,"correct":false,"proposition":"If the filing of a complaint is uncertain, the issuance of a medical certificate is not possible","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-13-qi-4","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"What is (are) the method(s) of drafting the medical certificate? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The medical editor mentions his identity","justification":""},{"idx":1,"correct":false,"proposition":"The victim must prove his identity to the doctor by giving him an identity document","justification":""},{"idx":2,"correct":false,"proposition":"The doctor certifies that the facts reported are credible","justification":""},{"idx":3,"correct":true,"proposition":"The absence of gynaecological traumatic injury must be mentioned in the certificate","justification":""},{"idx":4,"correct":false,"proposition":"Sexual violence results in total incapacity for work of more than eight days","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-13-qi-5","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"At the end of the clinical examination, which additional examination(s) do you request?","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Determination of b-HCG","justification":""},{"idx":1,"correct":true,"proposition":"HIV serology 1 and 2","justification":""},{"idx":2,"correct":true,"proposition":"HBV serology","justification":""},{"idx":3,"correct":true,"proposition":"HCV serology","justification":""},{"idx":4,"correct":true,"proposition":"Syphilis serology","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-13-qi-7","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"The information you give her persuades the girl to file a complaint to complete your judicial report. You contact the Police. The judicial police officer (OPJ) explains that a police team will come to bring you a document and wait at the hospital for the end of your examination. What is this document? (only one exact answer) ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An interim care order","justification":""},{"idx":1,"correct":false,"proposition":"A letter rogatory","justification":""},{"idx":2,"correct":false,"proposition":"A report of filing a complaint","justification":""},{"idx":3,"correct":true,"proposition":"A judicial requisition","justification":""},{"idx":4,"correct":false,"proposition":"An extract from the criminal record","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-13-qi-8","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"You are requisitioned by the judicial police officer to carry out the examination of the victim and any useful samples. In this context, what sample(s) can you carry out? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Bite swabs","justification":""},{"idx":1,"correct":true,"proposition":"Swabs at the vaginal level","justification":""},{"idx":2,"correct":true,"proposition":"Anal swabs","justification":""},{"idx":3,"correct":true,"proposition":"Swabs at the mouth level","justification":""},{"idx":4,"correct":false,"proposition":"Swabs from the nasal cavities","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-13-qi-9","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"At the end of your examination, the judicial police officer wants to know the number of days of total incapacity for work. Regarding total incapacity for work in the criminal sense for this patient, what is (are) the exact proposal(s)? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Total incapacity for work must be mentioned on the medical certificate","justification":""},{"idx":1,"correct":true,"proposition":"Total incapacity for work in the criminal sense corresponds to functional discomfort in carrying out the gestures of daily life","justification":""},{"idx":2,"correct":false,"proposition":"Total incapacity for work in the criminal sense corresponds to the number of days of absence from work","justification":""},{"idx":3,"correct":false,"proposition":"Total incapacity for work does not apply to minors","justification":""},{"idx":4,"correct":false,"proposition":"Total incapacity for work only makes sense if it is strictly greater than 8 days","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-13-qi-10","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"What treatment(s) can you urgently prescribe to this girl, with her agreement and that of the adult accompanying her? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"HPV vaccination","justification":""},{"idx":1,"correct":true,"proposition":"Triple anti-retroviral therapy","justification":""},{"idx":2,"correct":true,"proposition":"Emergency contraception","justification":""},{"idx":3,"correct":false,"proposition":"Antidepressant treatment that inhibits serotonin reuptake","justification":""},{"idx":4,"correct":true,"proposition":"Azithromycin antibiotic prophylaxis","justification":"In prevention of infection with Chlamydia trachomatis (in 2022, treatment is based on Doxycicline 8 days)."}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-13-qi-11","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"What element(s) should be included in the information to be provided to the victim? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Known side effects of treatments","justification":""},{"idx":1,"correct":true,"proposition":"Methods of monitoring processing","justification":""},{"idx":2,"correct":true,"proposition":"Risks in case of refusal of treatment","justification":""},{"idx":3,"correct":true,"proposition":"Contact details of a victim support association","justification":""},{"idx":4,"correct":true,"proposition":"The need for safe sex during HAART","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-13-qi-12","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"Four days later, the victim has side effects following taking triple antiretroviral therapy. She is furious because she says she was not informed of these effects. Regarding medical information, what is the exact proposal(s)? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The burden of proof of information lies with the patient initiating a procedure","justification":""},{"idx":1,"correct":true,"proposition":"The information must be delivered orally","justification":""},{"idx":2,"correct":false,"proposition":"The information must be provided in writing","justification":"It is possible but not necessary."},{"idx":3,"correct":true,"proposition":"Information must be fair, clear and appropriate","justification":""},{"idx":4,"correct":false,"proposition":"A confirmation of the delivery of the information must be signed by the patient","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-13-qi-13","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"The girl comes back to see you, pregnant with 9 weeks of amenorrhea, as a result of sexual violence, she tells you. What is the exact proposal(s) ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Parental consent is required to carry out a voluntary termination of pregnancy","justification":""},{"idx":1,"correct":false,"proposition":"The girl may be accompanied by an adult of her choice for the different stages of the voluntary termination of pregnancy","justification":""},{"idx":2,"correct":false,"proposition":"The girl can benefit from a voluntary termination of pregnancy by medical means","justification":"The limit is 7 SA for the drug route. This duration may change in the coming months\/years, remember to check the latest recommendations of the HAS (and do not hesitate to let us know this proposal if it becomes true)."},{"idx":3,"correct":false,"proposition":"The girl can wait up to a term of 16 weeks of amenorrhea to request a voluntary termination of pregnancy","justification":""},{"idx":4,"correct":false,"proposition":"Due to the context, the cooling-off period is cancelled","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-14-qi-1","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"In the table of this patient, which of the following parameter(s) is (are) suggestive of sepsis with poor prognosis? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Temperature","justification":""},{"idx":1,"correct":true,"proposition":"Respiratory rate","justification":""},{"idx":2,"correct":false,"proposition":"Heart rate","justification":""},{"idx":3,"correct":false,"proposition":"Blood pressure","justification":""},{"idx":4,"correct":true,"proposition":"Score de Glasgow","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-14-qi-2","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"What is your immediate attitude? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"High concentration mask oxygen therapy","justification":""},{"idx":1,"correct":false,"proposition":"Establishment of a central venous first route","justification":""},{"idx":2,"correct":false,"proposition":"Filling with synthetic macromolecules (1L on the first hour)","justification":"Colloids are no longer used to fill patients (very limited indications in intensive care, this is not to be known for NEC)."},{"idx":3,"correct":false,"proposition":"Administration of vasopressive amines","justification":""},{"idx":4,"correct":false,"proposition":"Antibiotic therapy with ceftriaxone","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-14-qi-3","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"Which of the following exam(s) is part of your first-line assessment? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Chest X-ray","justification":""},{"idx":1,"correct":false,"proposition":"Bronchoalveolar lavage","justification":""},{"idx":2,"correct":false,"proposition":"Coproculture","justification":""},{"idx":3,"correct":true,"proposition":"Blood","justification":""},{"idx":4,"correct":true,"proposition":"Legionella antigenacuria","justification":"As well as pneumococcus"}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-14-qi-4","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The CBC targets anemia at 121 g\/L, leukocytosis at 4600 G\/L (including 3800 PNN), CRP at 254 mg\/L and PCT at 3.5 μg\/L. The ionogram is normal, kidney function is normal. Arterial blood gases under nasal oxygen 6L\/min are: pH 7.45 - pC02 30 mmHg - p02 65 mmHg - HC03- 25 mmol \/ L. A chest CT scan is performed immediately. What is your interpretation of this scanner? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Interstitial syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Pleural effusion","justification":""},{"idx":2,"correct":true,"proposition":"Alveolar condensation","justification":""},{"idx":3,"correct":false,"proposition":"Pericardial effusion","justification":""},{"idx":4,"correct":false,"proposition":"Caves","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-14-qi-5","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"Blood cultures are ongoing and legionella antigenuria is negative. Which of the following infectious agents may be responsible for this picture at this stage of your investigations?","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Streptococcus pneumoniae","justification":""},{"idx":1,"correct":true,"proposition":"Legionnella pneumophila","justification":"Which would be serotype 2 here (not detected by antigenuria, which can also be falsely negative)."},{"idx":2,"correct":false,"proposition":"Clostridium dificult","justification":""},{"idx":3,"correct":true,"proposition":"Pneumocystis jirovecii","justification":""},{"idx":4,"correct":true,"proposition":"Myxovirus influenzae","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-14-qi-6","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The patient is immediately transferred to intensive care where he is immediately intubated in the face of respiratory exhaustion. Do you prescribe anti-infective treatment(s) at this stage?","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cefotaxime","justification":""},{"idx":1,"correct":false,"proposition":"Amoxicillin","justification":""},{"idx":2,"correct":true,"proposition":"Spiramycin","justification":""},{"idx":3,"correct":true,"proposition":"Oseltamivir","justification":""},{"idx":4,"correct":false,"proposition":"Pristinamycin","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-14-qi-7","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The probabilistic anti-infective treatment implemented combines cefotaxime, spiramycin and oseltamivir. A bronchoalveolar lavage is quickly performed. It highlights many cysts of Pneumocystis jirovecii. How do you adjust your treatment knowing that you are diagnosed with pneumocystosis? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Intravenous fluconazole","justification":""},{"idx":1,"correct":true,"proposition":"High-dose intravenous cotrimoxazole","justification":""},{"idx":2,"correct":false,"proposition":"Fidaxomicin aerosol","justification":""},{"idx":3,"correct":true,"proposition":"Corticosteroid therapy","justification":"PAO2 is less than 70 mmHg. Corticosteroid therapy will reduce fibrosis due to inflammatory overstimulation."},{"idx":4,"correct":false,"proposition":"Intravenous ketoprofen","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-14-qi-8","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"In view of this diagnosis, an HIV serology has been performed and is positive. What additional exam(s) do you perform?","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"CD4\/CD8 lymphocyte subpopulations","justification":""},{"idx":1,"correct":true,"proposition":"HIV viral load","justification":""},{"idx":2,"correct":false,"proposition":"Hepatitis E virus (HEV) serology","justification":""},{"idx":3,"correct":true,"proposition":"Toxoplasmosis serology","justification":""},{"idx":4,"correct":false,"proposition":"Syphilis serology","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-14-qi-9","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"With cotrimoxazole and corticosteroids, the patient's condition improves rapidly and he is extubated after 48 hours. He began to refeed orally. No other infectious agents were identified in all the samples taken. CD4 count is 19\/mm3 (4.8%) and viral load is 159,000 copies\/ml. On Day 4 of the management, concerning antiretroviral treatment, which of the following proposals is accurate? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Introduction of dual therapy with protease inhibitor and entry inhibitor","justification":""},{"idx":1,"correct":false,"proposition":"Introduction of triple therapy with protease inhibitors and two non-nucleoside reverse transcriptase inhibitors","justification":""},{"idx":2,"correct":false,"proposition":"Introduction of triple therapy with protease inhibitor and two nucleoside reverse transcriptase inhibitors","justification":""},{"idx":3,"correct":false,"proposition":"Introduction of triple therapy with integrase inhibitor and two nucleoside reverse transcriptase inhibitors","justification":""},{"idx":4,"correct":true,"proposition":"No antiretroviral therapy at this stage","justification":"We'll let him recover from his lung infection first ☺️"}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-14-qi-10","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The trend continues to be favourable with cotrimoxazole. Corticosteroids were discontinued on Day 6 and antiretroviral therapy was not initiated. On Day 10 of the treatment, the fever reappears with a scarlatiniform rash of the trunk and face. What is (are) your hypothesis(s)? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Pneumocystis resistance to cotrimoxazole","justification":""},{"idx":1,"correct":true,"proposition":"Allergy to cortimoxazole","justification":""},{"idx":2,"correct":false,"proposition":"Rebound of pneumocystosis following discontinuation of corticosteroids","justification":""},{"idx":3,"correct":false,"proposition":"Immune restoration syndrome","justification":"Antiretrovirals have not yet been started."},{"idx":4,"correct":false,"proposition":"Staphylococcal toxic shock syndrome","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-14-qi-11","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The hypothesis of an allergy to cotrimoxazole is retained. What sign(s) of gravity are you looking for? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Positive Nikolsky sign","justification":""},{"idx":1,"correct":false,"proposition":"Maculopapular rash","justification":"This is not especially a sign of gravity"},{"idx":2,"correct":true,"proposition":"Edema of the face","justification":""},{"idx":3,"correct":true,"proposition":"Associated mucosal erosions","justification":""},{"idx":4,"correct":false,"proposition":"Hearing loss","justification":"No report"}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-14-qi-12","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"There is no sign of severity and the rash regresses within a few days following the reduction of cotrimoxazole doses. You decide on Day 15 to introduce antiretroviral treatment. Which of the following will be useful for the choice of initial antiretroviral therapy? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Search for the HLA B57*01 allele","justification":""},{"idx":1,"correct":true,"proposition":"Genotypic HIV resistance test","justification":""},{"idx":2,"correct":true,"proposition":"Hepatitis B serology","justification":""},{"idx":3,"correct":false,"proposition":"Syphilis serology","justification":""},{"idx":4,"correct":false,"proposition":"Plasma testing of antiretrovirals","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-14-qi-13","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The result of HBV serology is as follows: HBsAg positive, HBeAg positive, anti-HBc IgM negative, anti-HBc IgG positive, anti-HBe antibodies and HBs negative. HBV DNA PCR is high (10 million Ul\/ml) and transaminases are 2.5 times the norm. Which of the following is correct?","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is probably acute hepatitis B","justification":""},{"idx":1,"correct":true,"proposition":"It is a hepatitis B virus without pre-core mutation","justification":"The HBe antigen is positive so it is not mutated"},{"idx":2,"correct":true,"proposition":"Antiretroviral therapy should ideally include tenofovir","justification":""},{"idx":3,"correct":false,"proposition":"Ribavirin should be added to antiretroviral therapy","justification":"ribavirin is active against HCV"},{"idx":4,"correct":false,"proposition":"HBV serovaccination should also be given to the patient","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-14-qi-14","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"Triple antiretroviral therapy is initiated on Day 15. Which of the following proposals for support after D15 is correct? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Continuation of cotrimoxazole treatment at current doses for another week","justification":""},{"idx":1,"correct":true,"proposition":"Secondary prophylaxis (after the end of attack therapy) low-dose anti-pneumocystosis ar cotrimoxazole","justification":""},{"idx":2,"correct":false,"proposition":"Initiation of primary prophylaxis of esophageal candidiasis with fluconazole","justification":""},{"idx":3,"correct":false,"proposition":"Initiation of primary anti-toxoplasmosis prophylaxis with low-dose pyrimethamine","justification":""},{"idx":4,"correct":false,"proposition":"Maintenance of primary toxoplasmosis and secondary pneumocystosis prophylaxis for 2 years","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-14-qi-15","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"What other measure(s) can you personally take? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Information for sexual partners","justification":""},{"idx":1,"correct":false,"proposition":"Nominative declaration to the ARS","justification":"anonymous"},{"idx":2,"correct":true,"proposition":"Declaration of long-term illness (100%)","justification":"ALD 7"},{"idx":3,"correct":false,"proposition":"Declaration to occupational medicine","justification":""},{"idx":4,"correct":true,"proposition":"Proposal for psychological follow-up","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-15-qi-1","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Which lesional location(s) do you think are likely? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left Thalamic","justification":""},{"idx":1,"correct":true,"proposition":"Left frontal","justification":""},{"idx":2,"correct":false,"proposition":"Right midbrain","justification":""},{"idx":3,"correct":false,"proposition":"Left Capsular","justification":""},{"idx":4,"correct":true,"proposition":"Left parietal","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-15-qi-2","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What is your immediate care ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Realization of a Doppler ultrasound of the supra-aortic trunks","justification":""},{"idx":1,"correct":true,"proposition":"Support by the neurovascular sector","justification":""},{"idx":2,"correct":true,"proposition":"Performing a brain MRI","justification":""},{"idx":3,"correct":false,"proposition":"Initiation of antihypertensive therapy","justification":"High blood pressure figures are tolerated in ischemic stroke."},{"idx":4,"correct":false,"proposition":"Initiation of antiplatelet therapy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-15-qi-3","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What sequence(s) should the MRI include? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"T1 with gadolinium injection","justification":""},{"idx":0,"correct":false,"proposition":"T2","justification":""},{"idx":0,"correct":true,"proposition":"T2 FLAIR","justification":""},{"idx":0,"correct":true,"proposition":"Broadcast sequence (DWI)","justification":""},{"idx":0,"correct":true,"proposition":"3D TOF (angio-MRI, Time Of Flight)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-15-qi-4","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Here are two images of the MRI performed: ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left sylvian hypersignal in FLAIR sequence","justification":""},{"idx":1,"correct":true,"proposition":"Right occipital hypersignal in FLAIR sequence","justification":""},{"idx":2,"correct":true,"proposition":"Left sylvian hypersignal in diffusion sequence","justification":""},{"idx":3,"correct":false,"proposition":"Right silvian hypersignal in diffusion sequence","justification":""},{"idx":4,"correct":false,"proposition":"Left sylvian hyposignal in scattering sequence","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-15-qi-5","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Brain MRI reveals a recent lesion visible in diffusion sequence in the superficial left sylvian territory. It also finds a hypersignal in FLAIR sequence in the right, ancient occipital territory. There is no bleeding lesion or obstruction of the proximal large vessels. In view of these MRI results and the clinical context, which pathophysiological hypothesis do you think is most likely? (only one answer expected) ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left carotid dissection","justification":""},{"idx":1,"correct":false,"proposition":"Microangiopathy","justification":""},{"idx":2,"correct":false,"proposition":"Cerebral arteritis","justification":""},{"idx":3,"correct":true,"proposition":"Embologenic heart disease","justification":""},{"idx":4,"correct":false,"proposition":"Atheroma","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-15-qi-6","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What is your immediate therapeutic proposal? (only one answer expected) ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Parenteral antiplatelet agents","justification":""},{"idx":1,"correct":false,"proposition":"Unfractionated parenteral hypocoagulant heparin","justification":""},{"idx":2,"correct":false,"proposition":"New oral anticoagulants","justification":""},{"idx":3,"correct":true,"proposition":"Intravenous thrombolysis by rt PA","justification":""},{"idx":4,"correct":false,"proposition":"Thrombectomy","justification":"We are not in a case of late time. In addition, the clot is not proximal, which would make thrombectomy complicated."}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-15-qi-7","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Following the MRI, the patient was admitted to the neurovascular unit (UNV) and underwent intravenous thrombotyposis. The motor deficit has partially recovered, phasic disorders persist. What is(are) the element(s) of your prescription during the first 24 hours? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Antihypertensive treatment","justification":""},{"idx":1,"correct":false,"proposition":"Lift allowed","justification":""},{"idx":2,"correct":true,"proposition":"Subcutaneous insulin therapy if blood glucose above 1.8 g\/L","justification":""},{"idx":3,"correct":false,"proposition":"Transcranial Doppler","justification":""},{"idx":4,"correct":true,"proposition":"Multiple daily clinical monitoring by NIHSS score","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-15-qi-8","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"At 48 hours of evolution, the patient remains aphasiac. There persists a predominant distal right brachial motor deficit and oral feeding is resumed without discomfort. He did not present any complications. What is (are) the objective(s) of physiotherapy management at this stage? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Analytical reinforcement of motor skills","justification":""},{"idx":1,"correct":false,"proposition":"Breathing decluttering exercises","justification":""},{"idx":2,"correct":false,"proposition":"Sensory awakening work","justification":""},{"idx":3,"correct":false,"proposition":"Deep transverse massages","justification":""},{"idx":4,"correct":false,"proposition":"Passive mobilizations of the lower right limb","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-15-qi-9","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"To confirm your main etiological hypothesis, you prescribe ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A Doppler ultrasound of the supra-aortic trunks","justification":""},{"idx":1,"correct":true,"proposition":"A trans-thoracic cardiac ultrasound","justification":""},{"idx":2,"correct":true,"proposition":"Transesophageal cardiac ultrasound","justification":""},{"idx":3,"correct":true,"proposition":"An ECG holter","justification":""},{"idx":4,"correct":false,"proposition":"A tensional holter","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-15-qi-10","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"This patient has Broca's aphasia. Which characteristic(s) are compatible with this diagnosis?","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Presence of paraphasies"},{"idx":1,"correct":true,"proposition":"Impaired fluence"},{"idx":2,"correct":true,"proposition":"Normal comprehension"},{"idx":3,"correct":false,"proposition":"Normal written expression"},{"idx":4,"correct":false,"proposition":"Agnosia"}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-15-qi-11","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"The holter ECG shows paroxysmal atrial fibrillation. Cardiac ultrasound (transthoracic and transesophageal) and Doppler ultrasound of the supraaortic trunks are normal. The lipid and glycemic balance is normal. Blood pressure normalized. What is (are) the element(s) of your exit prescription? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"ACE inhibitor","justification":""},{"idx":1,"correct":false,"proposition":"Statine","justification":""},{"idx":2,"correct":true,"proposition":"Oral anticoagulant","justification":""},{"idx":3,"correct":false,"proposition":"Antiplatelet agent","justification":""},{"idx":4,"correct":false,"proposition":"Loop diuretic","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-15-qi-12","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What is(are) your non-drug prescription (s)? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Speech therapy","justification":""},{"idx":1,"correct":true,"proposition":"Work stoppage","justification":""},{"idx":1,"correct":false,"proposition":"First category invaladity","justification":"Not acute because the patient can continue to recover"},{"idx":1,"correct":false,"proposition":"Safeguarding justice","justification":""},{"idx":1,"correct":true,"proposition":"Physiotherapy assessment","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-15-qi-13","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"You see the patient again in follow-up consultation at 3 months. There is still clumsiness in the right hand and a reduction in fluency, as well as fatigability. He is autonomous for most activities of daily living but has not been able to resume his professional activity. He also complains of attention and sleep disorders, his weight is 65 kg. He continues his anticoagulantoral treatment with anti-vitamin K. What is your diagnostic orientation in the face of this clinical evolution (only one expected response) ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Recurrent ischemic stroke","justification":""},{"idx":1,"correct":false,"proposition":"Side effects of drug treatment","justification":""},{"idx":2,"correct":false,"proposition":"Vascular epilepsy","justification":""},{"idx":3,"correct":true,"proposition":"Depressive syndrome","justification":""},{"idx":4,"correct":false,"proposition":"Deficiency","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-15-qi-14","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What medico-social measure(s) can you propose? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Constitution of a file with the Departmental House of Disabled Persons for allocation of the Disabled Adult Allowance (AAH)","justification":""},{"idx":1,"correct":true,"proposition":"Preparation of a file with the Departmental House of Persons with Disabilities for recognition of quality disabled worker","justification":""},{"idx":2,"correct":false,"proposition":"First category invaladity","justification":""},{"idx":2,"correct":true,"proposition":"Renewal of the stoppage of work","justification":""},{"idx":2,"correct":false,"proposition":"Declaration of occupational disease","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-15-qi-15","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Regarding his long-term oral anticoagulant treatment, which is(are) the exact proposal(s)? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The target INR is between 2.5 and 3.5","justification":""},{"idx":1,"correct":true,"proposition":"The INR control must be at least monthly","justification":""},{"idx":2,"correct":true,"proposition":"An INR around 2 allows dental care","justification":""},{"idx":3,"correct":true,"proposition":"In case of hemorrhage, PPSB acts faster than vitamin K","justification":""},{"idx":4,"correct":false,"proposition":"In case of INR at 5, vitamin K intake is recommended","justification":"If he is asymptomatic, he simply has to skip a catch."}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-16-qi-1","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"What diagnosis(s) do you suspect? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Guttate psoriasis","justification":""},{"idx":1,"correct":false,"proposition":"Erythema multiforme","justification":""},{"idx":2,"correct":false,"proposition":"Primary HIV infection","justification":""},{"idx":3,"correct":true,"proposition":"Secondary syphilis","justification":""},{"idx":4,"correct":false,"proposition":"Dermatophytia","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-16-qi-2","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"You suspect secondary syphilis. Which symptom(s) or examination sign(s) presented by the patient is (are) suggestive with this diagnosis? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The localization on the trunk of the eruption","justification":""},{"idx":1,"correct":true,"proposition":"Asthenia","justification":""},{"idx":2,"correct":true,"proposition":"Polyadenopathy","justification":""},{"idx":3,"correct":true,"proposition":"Transient nature of trunk rash","justification":""},{"idx":4,"correct":false,"proposition":"Apyrexia","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-16-qi-3","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"Which of the following symptoms can also be highlighted in secondary syphilis? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Polyarthralgia","justification":""},{"idx":1,"correct":true,"proposition":"Facial paralysis","justification":""},{"idx":2,"correct":true,"proposition":"Hearing loss","justification":""},{"idx":3,"correct":true,"proposition":"Uveitis","justification":"This is the famous 'big simulator'"},{"idx":4,"correct":false,"proposition":"Recurrent cystitis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-16-qi-4","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"To reinforce your diagnosis, you look for the existence of symptomatic primary syphilis that preceded the current rash. Which of the following proposals for syphilitic chancro is (are) accurate? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is painful","justification":""},{"idx":1,"correct":true,"proposition":"It is most often unique","justification":""},{"idx":2,"correct":true,"proposition":"It is accompanied by lymphadenopathy","justification":""},{"idx":3,"correct":false,"proposition":"It is soft in consistency","justification":"It is endured"},{"idx":4,"correct":true,"proposition":"It can be of pharyngeal localization","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-16-qi-5","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"You do not find at the interrogation any element in favor of a syphilitic chancre. The patient informs you, however, that he was diagnosed with syphilis 10 years ago and that he received treatment. Which of the following tests do you request to confirm the diagnosis of secondary syphilis?","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"TPHA","justification":""},{"idx":1,"correct":false,"proposition":"Blood count","justification":""},{"idx":2,"correct":false,"proposition":"Skin biopsy","justification":""},{"idx":3,"correct":true,"proposition":"VDRL","justification":""},{"idx":4,"correct":false,"proposition":"Cultivation of a swab made on the palm","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-16-qi-6","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"The TPHA is positive (+++) and the VDRL is 1\/64. In context, what interpretation(s) do you make of it? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Previously treated syphilis serological scar","justification":""},{"idx":1,"correct":false,"proposition":"Very early syphilis","justification":""},{"idx":2,"correct":false,"proposition":"False positive","justification":""},{"idx":3,"correct":true,"proposition":"Untreated secondary syphilis","justification":""},{"idx":4,"correct":false,"proposition":"Non-venereal treponematosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-16-qi-7","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"Apart from syphilis, what is the situation(s) where a VDRL can be positive?","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Lupus","justification":""},{"idx":1,"correct":true,"proposition":"Anti-phospholipid antibody syndrome","justification":""},{"idx":2,"correct":true,"proposition":"Non-venereal treponematosis","justification":""},{"idx":3,"correct":true,"proposition":"Leprosy","justification":""},{"idx":4,"correct":true,"proposition":"Borreliosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-16-qi-8","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"Apart from syphilis, what is the situation(s) where APHD can be positive? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Lupus","justification":""},{"idx":1,"correct":false,"proposition":"Anti-phospholipid antibody syndrome","justification":""},{"idx":2,"correct":true,"proposition":"Non-venereal treponematosis","justification":""},{"idx":3,"correct":false,"proposition":"Leprosy","justification":""},{"idx":4,"correct":false,"proposition":"Borreliosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-16-qi-9","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"You are looking for another sexually transmitted disease(s) in this patient. Which exam(s) are you requesting? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hepatitis B serology","justification":""},{"idx":1,"correct":false,"proposition":"Serology Mycoplasma hominis","justification":"We don't track that"},{"idx":2,"correct":false,"proposition":"Serology Chlamydia trachomatis","justification":"Is done by PCR"},{"idx":3,"correct":false,"proposition":"Serology Neisseria gonorrhoae","justification":"Is done by PCR"},{"idx":4,"correct":true,"proposition":"HIV serology","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-16-qi-10","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"Because the patient is HIV-negative, what treatment(s) do you put in place, in the absence of drug allergy, to treat secondary syphilis?","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Ceftriaxone 500 mg, single intramuscular administration","justification":"Treatment of gonococci"},{"idx":1,"correct":false,"proposition":"Azithromycin 1 g, single oral administration","justification":"Treatment of Chlamydia trachomatis (today it is Doxycicline 8 days in first line)"},{"idx":2,"correct":true,"proposition":"Benzathine benzylpenicillin G 2.4 MUI, single intramuscular administration","justification":""},{"idx":3,"correct":false,"proposition":"Penicillin G 20 MUI, intravenous administration for 15 days","justification":"Neurosyphilis"},{"idx":4,"correct":false,"proposition":"Doxycycline 200 mg, single oral administration","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-16-qi-11","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"The patient received a single injection of benzathine benzylpeflicillin G 2.4 MUI. A few hours later, he complained of headaches and myalgia. The temperature is 38°C and lesions on the palms and plants appear more numerous and larger. What diagnosis(s) do you mention? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Drug urticaria","justification":""},{"idx":1,"correct":false,"proposition":"Fixed pigmented erythema","justification":""},{"idx":2,"correct":false,"proposition":"Taxidermy with macula-papular exanthema type","justification":""},{"idx":3,"correct":true,"proposition":"Reaction to treponeme lysis","justification":""},{"idx":4,"correct":false,"proposition":"Drug-induced hypersensitivity syndrome (DRESS)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-16-qi-12","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"In order to ensure the effectiveness of benzathine benzylpenicillin G 2,4 MIU treatment, when should you recheck TPHA and VDRL in this patient? (one or more correct answers) ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"15 days","justification":""},{"idx":1,"correct":false,"proposition":"1 month","justification":""},{"idx":2,"correct":false,"proposition":"Serological monitoring is not necessary","justification":""},{"idx":3,"correct":true,"proposition":"6 months","justification":""},{"idx":4,"correct":true,"proposition":"1 year","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-16-qi-13","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"The questioning of the patient taught you about the existence of several partners in the previous months, without protection from sexual intercourse. Only his most recent partner was able to be contacted by the patient and present for consultation. The last unprotected sex between them was 3 weeks ago. TPHA and VDRL are negative. What is the possible interpretation(s) of the partner's serology? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" Absence of syphilis","justification":""},{"idx":1,"correct":true,"proposition":"Very recent syphilis","justification":""},{"idx":2,"correct":false,"proposition":"Secondary syphilis","justification":""},{"idx":3,"correct":false,"proposition":"Tertiary syphilis","justification":""},{"idx":4,"correct":false,"proposition":"Non-venereal treponematosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-16-qi-14","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"What can you offer this partner? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A serological check 3 months later","justification":""},{"idx":1,"correct":true,"proposition":"An injection of benzathine benzylpenicillin G, after checking for allergy","justification":""},{"idx":2,"correct":false,"proposition":"Serological control is not necessary","justification":""},{"idx":3,"correct":true,"proposition":"Protected sex","justification":""},{"idx":4,"correct":false,"proposition":"Sexual abstinence","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-16-qi-15","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"You see the patient again 6 months after treatment of secondary syphilis with benzathine benzylpenicillin G 2.4 M. It is asymptomatic and the rash is gone. The VDRL is 1\/16, the TPHA is positive (+). As a reminder, in pre-therapeutics, the TPHA was positive (+++) and the VDRL was 1\/64. What interpretation(s) do you make? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Recontamination","justification":""},{"idx":1,"correct":false,"proposition":"Treatment resistance","justification":""},{"idx":2,"correct":true,"proposition":"Healing","justification":""},{"idx":3,"correct":false,"proposition":"Non-venereal treponematosis","justification":""},{"idx":4,"correct":false,"proposition":"Need for a new injection of benzathine benzylpenicillin G 2,4 MIU","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-17-qi-1","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"Which additional exam(s) are you considering? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Serum vitamin B12 assay","justification":""},{"idx":1,"correct":true,"proposition":"Reticulocyte count","justification":""},{"idx":2,"correct":true,"proposition":"Myelogram","justification":"The statement does not speak of first intention, so it is true since the myelogram is well envisaged in the prse in charge of a potentially central anemia."},{"idx":3,"correct":false,"proposition":"Tongue biopsy","justification":""},{"idx":4,"correct":true,"proposition":"Serum vitamin 89","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-17-qi-2","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The reticulocyte count is 70 OOO\/mm3. A myelogram is performed. The examination finds the presence of a rich marrow, with erythroblasts of large size, an asynchrony of nucleocytoplasmic maturation, the presence of giant metamyelocytes and hypersegmented polynuclear cells. There is no excess of blasts. What is your diagnosis? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Myelodysplastic syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Acute leukemia","justification":""},{"idx":2,"correct":false,"proposition":"Bone marrow suppression","justification":""},{"idx":3,"correct":true,"proposition":"Megaloblastic anemia","justification":""},{"idx":4,"correct":false,"proposition":"Anemia","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-17-qi-3","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The requested assessment finds a serum concentration of vitamin B12 at 75 ng \/ L (N>200). The dosage of vitamin B9 is normal. Which additional exam(s) do you prescribe to complete the assessment? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Determination of anti-transglutaminase antibodies","justification":""},{"idx":1,"correct":false,"proposition":"Determination of anti-nuclear antibodies","justification":""},{"idx":2,"correct":false,"proposition":"Enteroscanner with contrast injection","justification":""},{"idx":3,"correct":true,"proposition":"Determination of anti-intrinsic factor antibodies","justification":""},{"idx":4,"correct":true,"proposition":"Upper GI endoscopy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-17-qi-4","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"Anti-intrinsic factor antibodies are absent and upper gastrointestinal endoscopy finds pallor of the mucous membrane of the antrum and gastric body with excessive visibility of the small vessels. There is no esophagitis. Samples taken from the gastric body and the antrum reveal a rarefaction of the density of the glands with the presence of sectors of the epithelium consisting of intestinal type cells. Absence of visible pathogen. There is in the chorion a moderate lymphoplasmacytic infiltrate without neutrophil polynuclear. What is the real proposal(s)? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Pangastric glandular atrophy","justification":""},{"idx":1,"correct":true,"proposition":"Biermer's disease","justification":""},{"idx":2,"correct":false,"proposition":"Lymphocytic gastritis","justification":""},{"idx":3,"correct":false,"proposition":"Active inflammatory gastritis","justification":""},{"idx":4,"correct":true,"proposition":"Chronic gastritis with intestinal metaplasia","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-17-qi-5","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"What is (are) in this patient the predisposing factor(s) to this atrophic pangastritis with intestinal metaplasia? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An autoimmune pathology","justification":""},{"idx":0,"correct":true,"proposition":"the sequelae of a Helicobacter pylori infection","justification":""},{"idx":0,"correct":true,"proposition":"Tobacco","justification":""},{"idx":0,"correct":false,"proposition":"An autoimmune pathology","justification":""},{"idx":0,"correct":false,"proposition":"Taking proton pump inhibitors","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-17-qi-6","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"What consequence(s) does this atrophic gastritis with intestinal metaplasia expose? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Risk of gastric adenocarcinoma","justification":""},{"idx":1,"correct":true,"proposition":"Iron deficiency","justification":""},{"idx":2,"correct":false,"proposition":"Gastric lymphoma","justification":""},{"idx":3,"correct":false,"proposition":"Duodenal ulcer","justification":""},{"idx":4,"correct":true,"proposition":"Gastric ulcer","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-17-qi-7","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"Seven years later, the then 58-year-old patient consulted the Emergency Department for ascites of progressive onset within 15 days. It has appeared for 3 years a non-insulin-requiring diabetes treated with metformin. He drinks about 2 bottles of wine a day. The patient always takes esomeprazole 40 mg daily and an IM injection of vitamin 812 every month. No control endoscopy was performed. The biological assessment shows: Leukocyles at 7700\/mm3, neutrophils at 3200\/mm3, polynuclear eosinophils at 200\/mm3, lymphocytes at 3500\/mm3, hemoglobin at 9.3 g\/dL, MCV at 82 μ3 platelets at 110 0OO\/mm3, AST at 56 IU (N<40), ALT at 43 IU (N<40), TP at 54%, Total bilirubinemia at 87 μmol\/l. You perform an ascites puncture of which here are the results: proteins at 15g \/ L and elements: 500 \/ mm3 including 70% neutrophils, 20% lymphocytes, 10% monocytes. What diagnosis do you make?","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Peritoneal carcinomatosis"},{"idx":1,"correct":true,"proposition":"Ascites fluid infection on cirrhosis","justification":"Because PNN > 250\/mm3"},{"idx":2,"correct":false,"proposition":"Peritoneal tuberculosis"},{"idx":3,"correct":false,"proposition":"Rupture of a pancreatic pseudocyst","justification":""},{"idx":4,"correct":false,"proposition":"Rupture of hepatocellular carcinoma in the peritoneum","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-17-qi-8","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"You are diagnosed with ascites fluid infection. Which probabilistic antibiotic therapy(s) is\/are recommended as a first-line treatment? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Amoxicillin-clavulanic acid","justification":"Possible oral alternative"},{"idx":1,"correct":false,"proposition":"Vancomycin","justification":""},{"idx":2,"correct":false,"proposition":"Amikacin","justification":""},{"idx":3,"correct":false,"proposition":"Erythromycin","justification":""},{"idx":3,"correct":true,"proposition":"Cefotaxime","justification":"In the first intention"}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-17-qi-9","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"How will you confirm the diagnosis of cirrhosis with certainty in this patient? (one or more correct answers) ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Non-invasive fibrosis test","justification":""},{"idx":1,"correct":true,"proposition":"Hepatic ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Liver biopsy under ultrasound control","justification":"Contraindicated by ascites"},{"idx":3,"correct":true,"proposition":"Transjugular liver biopsy","justification":"Confirmatory diagnosis of cirrhosis is histological"},{"idx":4,"correct":false,"proposition":"Liver CT scan","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-17-qi-10","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"As part of the screening for viral hepatitis, what test(s) do you perform on this patient?","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Serology of viral hepatitis A","justification":""},{"idx":1,"correct":true,"proposition":"HBs antigen"},{"idx":2,"correct":true,"proposition":"Serology of viral hepatitis C (HCV)","justification":""},{"idx":3,"correct":false,"proposition":"Hepatitis B virus viral load","justification":""},{"idx":4,"correct":true,"proposition":"Hepatitis C virus viral load","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-17-qi-11","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The evolution of the episode is favorable under antibiotics. The patient no longer has ascites. You set up a long-term follow-up. What measure(s) do you propose? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Screening for hepatocellular carcinoma","justification":""},{"idx":1,"correct":true,"proposition":"Screening for portal hypertension","justification":""},{"idx":2,"correct":true,"proposition":"Secondary prevention of ascites fluid infection","justification":""},{"idx":3,"correct":true,"proposition":"Screening for ENT cancers","justification":""},{"idx":4,"correct":true,"proposition":"Gastric cancer screening","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-17-qi-12","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"How do you screen for hepatocellular carcinoma (single response)? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Liver ultrasound every 6 months","justification":""},{"idx":1,"correct":false,"proposition":"Liver ultrasound every year","justification":""},{"idx":2,"correct":false,"proposition":"Liver CT scan every 6 months","justification":""},{"idx":3,"correct":false,"proposition":"Liver scan every year","justification":""},{"idx":4,"correct":false,"proposition":"Serum alpha-fetoprotein assay annually","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-17-qi-13","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"During follow-up, a 2 cm segment IV hepatic nodule is highlighted. You perform a CT scan to characterize it. What CT characteristic(s) are you looking for in favor of hepatocellular carcinoma? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Spontaneously hyperdense","justification":""},{"idx":1,"correct":true,"proposition":"Spontaneously hypodense","justification":""},{"idx":2,"correct":true,"proposition":"Contrast taking at arterial time","justification":""},{"idx":3,"correct":false,"proposition":"Hyperdensity at portal time","justification":"Hypodensity (washing, wash-out)"},{"idx":4,"correct":true,"proposition":"Hypodensity at portal time","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-17-qi-14","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The CT scan reveals a spontaneously hypodense tumor, taking the contrast at arterial time and washing at portal time. The diagnosis of hepatocellular carcinoma is made. Which first-line treatment(s) will be discussed? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hepatic resection","justification":""},{"idx":1,"correct":false,"proposition":"Intravenous chemotherapy","justification":""},{"idx":2,"correct":false,"proposition":"Intra-arterial chemotherapy","justification":""},{"idx":3,"correct":true,"proposition":"Percutaneous ablation","justification":"By radio frequency"},{"idx":4,"correct":false,"proposition":"External beam radiation therapy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-17-qi-15","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The patient is treated with radiofrequency. Two years later, his liver function deteriorated with the onset of refractory ascites. He also has a recurrence of his hepatocellular carcinoma as a new 3 cm nodule. He is 62 years old and you mention the possibility of a liver transplant. What are the prerequisites? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Effective alcohol withdrawal","justification":""},{"idx":1,"correct":false,"proposition":"Effective smoking cessation","justification":""},{"idx":2,"correct":true,"proposition":"Absence of extrahepatic cancer","justification":""},{"idx":3,"correct":true,"proposition":"Absence of extrahepatic metastasis of hepatocellular carcinoma","justification":""},{"idx":4,"correct":false,"proposition":"Absence of endoscopic portal hypertension","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-18-qi-1","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Which of the following diagnoses can explain this picture? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Attention deficit disorder with or without hyperactivity","justification":""},{"idx":1,"correct":true,"proposition":"Characterized depressive episode","justification":""},{"idx":2,"correct":true,"proposition":"Hypochondria","justification":""},{"idx":3,"correct":false,"proposition":"Conversion hysteria","justification":""},{"idx":4,"correct":true,"proposition":"Persistent delusional disorder of somatic type","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-18-qi-2","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"At Mrs. B's insistence, the general practitioner finally agreed to prescribe a brain scan without injection. In the event of hypochondria (or excessive fear of having a disease), indicate the exact proposal(s). ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The prescription of this examination may maintain the disorder","justification":""},{"idx":1,"correct":false,"proposition":"The normality of this examination will provide lasting reassurance to the patient.","justification":""},{"idx":2,"correct":false,"proposition":"The normality of this examination is necessary to confirm the diagnosis","justification":""},{"idx":3,"correct":false,"proposition":"An abnormality on this examination would rule out the diagnosis of hypochondria","justification":""},{"idx":4,"correct":true,"proposition":"The doctor-patient relationship may have influenced this prescribing decision","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-18-qi-3","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The brain scan without injection performed during the week shows no abnormalities. Mrs. B consults the same doctor again and asks him to prescribe this examination again. She considers it to be << false results >> and explains that they want to make <<her look crazy but that they have not closed everything >>. Mrs. B states that she has a metal object in her brain following surgery. This object is not mentioned in the report of the scanner, so it would be according to her images of someone else. She wants to perform a new scanner in another radiology practice. We note in the words of Mrs. B.: ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A tendency to mythomania","justification":"The patient does not seem to be hiding the truth: she really believes what she says."},{"idx":1,"correct":true,"proposition":"Impaired judgment","justification":""},{"idx":2,"correct":false,"proposition":"Cenesthetic hallucinations","justification":""},{"idx":3,"correct":true,"proposition":"Delusions of persecution","justification":""},{"idx":4,"correct":false,"proposition":"Borderline personality traits","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-18-qi-4","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The general practitioner having refused to prescribe a new scanner, Mrs. B decides to consult the same day at the emergency reception service (SAU) closest to her home. She refuses the nurse to take vital constants and threatens to commit suicide << like my father >> she says, if she is not examined by a neurosurgeon. When she is told that there is no neurosurgeon in the facility, Mrs. B gets up and walks to the exit without a word. Which of the following indicates a high suicidal risk in Mrs. B.?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The presence of suicidal threats","justification":""},{"idx":1,"correct":true,"proposition":"The absence of relatives at his side","justification":""},{"idx":2,"correct":true,"proposition":"The presence of delusions","justification":""},{"idx":3,"correct":false,"proposition":"Taking estrogen-progestogens","justification":""},{"idx":4,"correct":true,"proposition":"His father's suicide","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-18-qi-5","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The reception and orientation nurse tries to restrain Mrs. B but she threatens her with a pair of scissors that she has taken out of her bag. Which of the following is correct about physical restraint? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is justified by the immediate self-aggressive risk","justification":""},{"idx":1,"correct":true,"proposition":"It is justified by the immediate hetero-aggressive risk","justification":""},{"idx":2,"correct":false,"proposition":"It must be prescribed by a psychiatrist","justification":""},{"idx":3,"correct":false,"proposition":"She requires an admission measure in psychiatric care under duress","justification":""},{"idx":4,"correct":false,"proposition":"It must be declared secondarily to the liberty and detention judge","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-18-qi-6","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Faced with self-threatening and hetero-aggressive threats, it is decided to resort to physical restraint. As the patient refuses any oral sedative treatment, an intramuscular injection of a sedative antipsychotic is prescribed. Which of the following considerations led to a preference for the class of antipsychotics over that of benzodiazepines in this case?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Electrocardiogram not performed","justification":""},{"idx":1,"correct":true,"proposition":"Better intramuscular absorption","justification":""},{"idx":2,"correct":false,"proposition":"Better respiratory tolerance","justification":"It is true that they do not have respiratory adverse effects but this is not at all a consideration to take into account since the patient has no respiratory history."},{"idx":3,"correct":false,"proposition":"Young age","justification":""},{"idx":4,"correct":false,"proposition":"Lower risk of dependence","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-18-qi-7","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Once Mrs. B is sedated, the physical restraint is lifted. The inventory of his belongings does not show any other dangerous object and makes it possible to find the report of the scanner. Upon awakening, psychiatric advice is sought. Mrs. B again exposes her conviction of having been deceived by the radiology office in front of the absence of metallic foreign body. She explains that << they are in cahoots with the intermeditators who point my thoughts... but I'm not going to obey them even if they mess me up... I'm not going to kill my mother... unless she's in them...I mean my mother is me actually... >>. We note in the words of Mrs. B.:","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hermetic speech","justification":"Incomprehensible and several degrees above"},{"idx":1,"correct":true,"proposition":"Neologism","justification":"Intermediator"},{"idx":2,"correct":true,"proposition":"Paralogism","justification":""},{"idx":3,"correct":false,"proposition":"Dreamlike","justification":""},{"idx":4,"correct":true,"proposition":"Hallucinations","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-18-qi-8","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Which of the following mental disorders could explain the entire clinical picture?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Depressive episode with psychotic features","justification":"No symptoms of depression"},{"idx":1,"correct":true,"proposition":"Schizophrenia","justification":""},{"idx":2,"correct":false,"proposition":"Persistent delusional disorder","justification":""},{"idx":3,"correct":true,"proposition":"Encephalitis","justification":""},{"idx":4,"correct":false,"proposition":"Dissociative disorders","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-18-qi-9","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The patient agrees to provide contact information for her mother who goes to the emergency room. She is received alone and then with her daughter who is told of the need for psychiatric hospitalization in another institution. The patient is reluctant to hospitalize in psychiatry but would accept to be hospitalized for << extraction of intermeditation electrodes >>. What orientation(s) do you recommend?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Admission to voluntary psychiatric care","justification":""},{"idx":1,"correct":true,"proposition":"Admission to Conventional Third Party Psychiatric Care (PTDC)","justification":""},{"idx":2,"correct":false,"proposition":"Admission to Psychiatric Care at the Request of a Third Party in Emergency (UTDPS)","justification":""},{"idx":3,"correct":false,"proposition":"Admission to psychiatric care for imminent peril (SPPI)","justification":""},{"idx":4,"correct":false,"proposition":"Admission to psychiatric care by decision of the representative of the state (SPDRE)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-18-qi-10","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The anamnesis is completed in the psychiatric ward where Mrs. B was hospitalized at the request of a third party. Mrs. B, who lives with her mother, has been complaining of trouble concentrating and paying attention for more than a year and has sometimes been soliloquizing for at least six months. She no longer goes out and has gradually abandoned her usual activities, especially social ones. Unemployed after the non-renewal of a COD, she has not taken any steps to find work. The diagnosis of schizophrenia is made and pharmacological treatment is indicated. Which of the following should be part of the pre-therapeutic assessment:","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Blood pressure measurement","justification":""},{"idx":1,"correct":true,"proposition":"Blood glucose measurement","justification":""},{"idx":2,"correct":true,"proposition":"Lipid profile","justification":""},{"idx":3,"correct":false,"proposition":"Proteinuria","justification":""},{"idx":4,"correct":false,"proposition":"Electroencephalogram","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-18-qi-11","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The pre-therapeutic assessment performed shows no abnormality and Mrs. B is not pregnant. Treatment with oral risperidone is started. After 4 weeks of treatment, neurological examination now shows a marked tremor of the extremities and a bilateral and symmetrical cogwheel. Mrs. B is less vehement but remains determined to obtain the surgical extraction of the device that she believes would have been implanted to manipulate it. Which of the following hypotheses could explain the persistence of positive symptoms? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Absence of associated psychotherapy","justification":"This cannot be a cause of persistence of hallucinations."},{"idx":1,"correct":false,"proposition":"Lack of actual treatment","justification":"The patient is hospitalized and the actual intake of treatments is monitored."},{"idx":2,"correct":true,"proposition":"Hidden cannabis intake","justification":""},{"idx":3,"correct":true,"proposition":"Comorbid neurological disorder","justification":""},{"idx":4,"correct":false,"proposition":"Partial dopaminergic agonist properties of the molecule","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-18-qi-12","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The same treatment is continued for 4 more weeks. Mrs. B continues to report a manipulation of her thoughts but no longer plans to resort to surgery and recognizes that the treatment does her good. The discourse and thought remain disorganized but the first home leaves went well and a release is envisaged. Faced with the persistence of cognitive complaints about attention and concentration, a neuropsychological assessment is carried out which shows a marked alteration of executive functions. To what can you attribute this objective alteration? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Schizophrenic disorder","justification":""},{"idx":1,"correct":true,"proposition":"To an unknown addictive comorbidity","justification":""},{"idx":2,"correct":false,"proposition":"Iatrogenic hyperprolactinemia","justification":""},{"idx":3,"correct":false,"proposition":"The stress of hospitalization","justification":""},{"idx":4,"correct":false,"proposition":"Extrapyramidal syndrome","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-18-qi-13","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Given the persistence of hallucina1ions and disorganization after several months of treatment, it was decided to replace risperidone with another atypical antipsychotic. After 3 months of treatment with olazanpine at optimal dosage, Mrs. B's disorders remain very disabling. You decide to change the antipsychotic treatment again. Which of the following options should be considered first? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Replacement with aripiprazole","justification":""},{"idx":1,"correct":true,"proposition":"Replacement with clozapine","justification":""},{"idx":2,"correct":false,"proposition":"Replacement with a typical antipsychotic","justification":""},{"idx":3,"correct":false,"proposition":"Potentiation by the addition of a typical antipsychotic","justification":""},{"idx":4,"correct":false,"proposition":"Potentiation by the addition of a thymoregulator","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-18-qi-14","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Which of the following is an advantage(s) of clozapine therapy in this patient ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Superior efficacy to other antipsychotics in treatment resistance","justification":""},{"idx":1,"correct":false,"proposition":"Lower risk of inducing metabolic syndrome","justification":"The risk is increased"},{"idx":2,"correct":true,"proposition":"Lower risk of extrapyramidal side effects","justification":""},{"idx":3,"correct":true,"proposition":"Reducing the risk of suicide","justification":""},{"idx":4,"correct":false,"proposition":"Possibility of resorting to a delayed form in case of poor compliance","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2018-dp-18-qi-15","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The symptomatology improves markedly with clozapine until Mrs. B considers working again. Which of the following measures can (which) specifically promote this project?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cognitive remediation","justification":""},{"idx":1,"correct":true,"proposition":"Application for recognition of the status of disabled worker","justification":""},{"idx":2,"correct":false,"proposition":"Application for guardianship","justification":""},{"idx":3,"correct":true,"proposition":"Use of an Establishment and Work Assistance Service","justification":""},{"idx":4,"correct":false,"proposition":"Search for a home of life","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-1-qi-1","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Among the risks associated with this trip, what are the 2 potentially most serious? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Turista (traveller's diarrhea)","justification":""},{"idx":1,"correct":true,"proposition":"Traffic accidents","justification":"Accidents in the broad sense are the leading cause of death when travelling abroad"},{"idx":2,"correct":false,"proposition":"Dengue fever","justification":""},{"idx":3,"correct":false,"proposition":"Rickettsiosis","justification":""},{"idx":4,"correct":true,"proposition":"Malaria","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-1-qi-2","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"What is (are) the possible preventive attitude(s) for this stay vis-à-vis the malaria risk? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"No chemoprophylaxis","justification":""},{"idx":1,"correct":true,"proposition":"Atovaquone-proguanil chemoprophylaxis","justification":"Daily intake from the first day + one week after return"},{"idx":2,"correct":false,"proposition":"Mefloquine chemoprophylaxis","justification":"She has a psychiatric history, which contraindicates mefloquine"},{"idx":3,"correct":true,"proposition":"Doxycycline chemoprophylaxis","justification":""},{"idx":4,"correct":false,"proposition":"Chloroquine-proguanil chemoprophylaxis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-1-qi-3","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"What information(s) do you give him about the yellow fever vaccine?","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Vaccine done in an approved center","justification":""},{"idx":1,"correct":true,"proposition":"Vaccine to be recorded on a WHO-approved international immunization record","justification":""},{"idx":2,"correct":false,"proposition":"Vaccine valid for 10 years","justification":""},{"idx":3,"correct":true,"proposition":"Live attenuated virus vaccine","justification":""},{"idx":4,"correct":false,"proposition":"Vaccine that should not be given on the same day as typhoid vaccine","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-1-qi-4","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"The patient travels to Côte d'Ivoire 🇨🇮 with antimalarial chemoprophylaxis with doxycycline. What should she remember as information about taking this medicine? (one or more answers are true) ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Daily intake","justification":""},{"idx":1,"correct":false,"proposition":"To start 1 month before departure","justification":"From the first day of departure"},{"idx":2,"correct":false,"proposition":"To be stopped on the day of return to France","justification":""},{"idx":3,"correct":true,"proposition":"To be stopped if pregnancy occurs","justification":""},{"idx":4,"correct":false,"proposition":"Must be combined with mefloquine due to prolonged stay","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-1-qi-5","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Three months later, on the day of her return to France, the patient comes to your office because, for 2 days, she has not felt well and has pollakiuria with urination burns. During your discussion, she tells you that she had abdominal pain and diarrhea for a few days a little more than a month before her return that led her to stop doxycycline, thinking that this drug was the cause. Which of the following clinical signs is the most important to collect when deciding what to do? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Number of urination per day","justification":""},{"idx":1,"correct":false,"proposition":"Blood in urine","justification":""},{"idx":2,"correct":false,"proposition":"Existence of urgency","justification":""},{"idx":3,"correct":false,"proposition":"Date of last urinary tract infection","justification":""},{"idx":4,"correct":true,"proposition":"Presence of fever","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-1-qi-6","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"The patient is not febrile and you are moving towards simple cystitis. The urine strip is positive. At this stage, what is the most relevant complementary examination? B. Search for ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"CRP","justification":""},{"idx":1,"correct":false,"proposition":"Chlamydia search","justification":""},{"idx":2,"correct":false,"proposition":"ECBU","justification":"Simple cystitis does not require ECBU (unlike cystitis at risk of complications)"},{"idx":3,"correct":true,"proposition":"No exam","justification":""},{"idx":4,"correct":false,"proposition":"NFS","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-1-qi-7","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"You do not carry out any additional examination. Which of the following treatment options will you choose as a first-line treatment for this patient? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Fosfomycin-trometamol single dose","justification":""},{"idx":1,"correct":false,"proposition":"Ofloxacin single dose","justification":""},{"idx":2,"correct":false,"proposition":"Ciprofloxacin 5 days","justification":""},{"idx":3,"correct":false,"proposition":"Pivmecillinam 5 days","justification":""},{"idx":4,"correct":false,"proposition":"Nitrofurantoin 5 days","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-1-qi-8","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"What other recommendation(s) do you make? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Do a follow-up ECBU in 72 hours (3 days)","justification":""},{"idx":1,"correct":true,"proposition":"Drink and urinate regularly","justification":""},{"idx":2,"correct":false,"proposition":"Take cranberry juice daily","justification":"This advice is relevant in case of recurrent cystitis (we are in the case of simple cystitis)"},{"idx":3,"correct":false,"proposition":"Do a vesicorenal ultrasound at a distance from the current episode","justification":""},{"idx":4,"correct":false,"proposition":"Abstaining from sex for 10 days","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-1-qi-9","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Ten days later, the patient returns to your office with her partner. She tells you that the urinary signs disappeared 2 days after the treatment but that, for 4 days, she had several outbreaks of high fever with chills and sweats. She complains of stubborn headaches, nausea and abdominal pain with loose stools. The patient is apyretic, her clinical examination is normal, there is in particular no meningeal syndrome. Which of the following diagnoses should you mention first in this patient? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Malaria","justification":""},{"idx":1,"correct":false,"proposition":"Acute pyelonephritis","justification":""},{"idx":2,"correct":false,"proposition":"Dengue fever","justification":""},{"idx":3,"correct":false,"proposition":"Typhoid fever","justification":""},{"idx":4,"correct":false,"proposition":"Chikungunya","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-1-qi-10","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Which of the following clinical elements supports the diagnosis of malaria in this patient? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"3 months stay in Ivory Coast","justification":""},{"idx":1,"correct":true,"proposition":"Digestive disorders","justification":""},{"idx":2,"correct":false,"proposition":"Cystitis preceding this febrile episode","justification":"There is no link between cystitis and malaria"},{"idx":3,"correct":true,"proposition":"Discontinuation of doxycycline 1 month before returning to France","justification":""},{"idx":4,"correct":true,"proposition":"Fever progressing in peaks","justification":"Periodic\/intermittent fever is common in malaria."}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-1-qi-11","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"You urgently carry out a check-up on this patient, the results of which are as follows. Which one(s) is the most suggestive of malaria diagnosis? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Hemoglobin: 10.8 g\/dL","justification":""},{"idx":1,"correct":true,"proposition":"Blisters: 45 g\/L","justification":""},{"idx":2,"correct":false,"proposition":"CRP to 95","justification":""},{"idx":3,"correct":false,"proposition":"ALAT to 1.2","justification":""},{"idx":4,"correct":false,"proposition":"Kalemia at 3.3 mmol\/L","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-1-qi-12","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Which exam(s) will allow you to make the diagnosis of malaria now? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Blood","justification":""},{"idx":1,"correct":false,"proposition":"Malaria blood serology","justification":""},{"idx":2,"correct":true,"proposition":"Rapid test for HRP2 antigen","justification":""},{"idx":3,"correct":true,"proposition":"Blood smear","justification":""},{"idx":4,"correct":false,"proposition":"Procalcitonin","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-1-qi-13","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"The blood smear is 0.5% positive for Plasmodium falciparum. The patient does not vomit and wishes to go home. What first-line care do you offer her knowing that she is not pregnant? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Quinine","justification":""},{"idx":1,"correct":false,"proposition":"Atovaquone + proguanil","justification":""},{"idx":2,"correct":true,"proposition":"Artenimol-piperaquine","justification":""},{"idx":3,"correct":true,"proposition":"Artemether-lumefantrine","justification":""},{"idx":4,"correct":false,"proposition":"Outpatient treatment","justification":"Her platelets are less than 50 G \/ L (question 11) so she has a hospitalization criterion. The statement is misleading because the patient's wish is always important and it is he who has the last word (we can not force this patient to be hospitalized), but the question is specifically about \"what we offer her\": we offer her hospitalization."}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-1-qi-14","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"You cannot treat this patient on an outpatient basis. Why (one or more possible answers)? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"CRP 95 mg\/L","justification":""},{"idx":1,"correct":false,"proposition":"0.5% parasitemia","justification":""},{"idx":2,"correct":true,"proposition":"45 G\/L blisters","justification":""},{"idx":3,"correct":false,"proposition":"Haemoglobin at 10.8 g\/dL","justification":""},{"idx":4,"correct":false,"proposition":"Treatment with artenimol-piperaquine","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-1-qi-15","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"After 3 days of hospitalization, the patient is apyretic with a negative thick drip smear and can be discharged. At what time(s) do you organise biological controls?","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"On the 5th day of the start of treatment"},{"idx":1,"correct":true,"proposition":"On the 7th day of the start of treatment","justification":"J3, J7, J28 😊 . It fell twice, so that's to know."},{"idx":2,"correct":false,"proposition":"On day 14 of the start of treatment"},{"idx":3,"correct":false,"proposition":"On the 21st day of the start of treatment"},{"idx":4,"correct":true,"proposition":"On the 28th day of the start of treatment"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-3-qi-1","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Which clinical sign(s) would direct you to Pancoast-Tobias syndrome? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"An alteration of the general condition","justification":""},{"idx":1,"correct":true,"proposition":"A deficit of the interosseous muscles of the hand","justification":"There are 4 palmar interosseous and 4 dorsal interosseous. They are innervated by the C8 Th1 ulnar nerve, which is affected in Pancoast-Tobias syndrome."},{"idx":2,"correct":false,"proposition":"Diplopia","justification":"It is a symptom found in alternating syndromes for example"},{"idx":3,"correct":false,"proposition":"Irradiation of pain in the thumb","justification":"The ulnar nerve innervates the fifth finger and medial half of the fourth."},{"idx":4,"correct":true,"proposition":"The association a ptosis","justification":"Ptosis - Myosis - Enophtalmos is part of another syndrome 😉"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-3-qi-2","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The patient does not have an impairment in the general condition. Which of the following signs is the one that points to a joint cause of pain? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Limiting passive lateral rotation","justification":""},{"idx":1,"correct":false,"proposition":"Localization of pain on the anterior side of the shoulder","justification":""},{"idx":2,"correct":false,"proposition":"Worsening pain in abduction","justification":""},{"idx":3,"correct":true,"proposition":"Presence of joint effusion","justification":"Joint effusion is often a sign of a local inflammatory cause"},{"idx":4,"correct":false,"proposition":"Pain on palpation of the delto-pectoral sulcus","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-3-qi-3","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Which of these muscles is (are) part of the rotator cuff? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The supraspinatus tendon","justification":""},{"idx":1,"correct":false,"proposition":"The large round tendon","justification":"The little circle is one of them. Unfortunately, you have to learn these muscles - this question often falls, whether in IQ or PD."},{"idx":2,"correct":false,"proposition":"The tendon of the deltoid","justification":""},{"idx":3,"correct":true,"proposition":"Subscapularis tendon","justification":""},{"idx":4,"correct":true,"proposition":"The infraspinatus tendon ","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-3-qi-4","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The clinical examination reveals an active abduction of normal but painful amplitude of the shoulder. There is a painful arc with active abduction pain between 60 ° and 120 °. The lateral rotation is of normal and symmetrical amplitude. The passive elevation of the upper limb in internal rotation and antepulsion is painful. The following clinical maneuver is painful while other cuff muscle tensioning maneuvers are painless. Which tendon is responsible?","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The supraspinatus tendon","justification":"This is Jobe's maneuver"},{"idx":1,"correct":false,"proposition":"The large round tendon","justification":""},{"idx":2,"correct":false,"proposition":"The tendon of the deltoid","justification":""},{"idx":3,"correct":false,"proposition":"Subscapularis tendon","justification":""},{"idx":4,"correct":false,"proposition":"The infraspinatus tendon ","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-3-qi-5","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"You do a standard X-ray to the patient (below). Which of these proposals is the exact answer(s)? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"There is a decrease in the height of the space under acromial","justification":""},{"idx":1,"correct":false,"proposition":"There is osteoarthritis","justification":""},{"idx":2,"correct":false,"proposition":"There is calcification of the rotator cuff tendons","justification":""},{"idx":3,"correct":true,"proposition":"X-ray is normal","justification":""},{"idx":4,"correct":false,"proposition":"There is osteolysis of the major tubercle","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-3-qi-6","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"At this stage of management, which additional imaging test(s) of the right shoulder can you request? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Scanner","justification":""},{"idx":1,"correct":true,"proposition":"MRI","justification":"MRI and ultrasound are the two tests that directly visualize the tendons."},{"idx":2,"correct":false,"proposition":"Arthro-MRI","justification":""},{"idx":3,"correct":false,"proposition":"Arthroscanner","justification":""},{"idx":4,"correct":true,"proposition":"Echography","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-3-qi-7","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The sonographer answers that it is an unruptured tendinopathy of the supraspinatus. You prescribe shoulder rehabilitation. In this patient, what is(are) the objective(s) of physiotherapy? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Strengthen the deltoid","justification":""},{"idx":1,"correct":true,"proposition":"Strengthen the latissimus dorsi","justification":""},{"idx":2,"correct":false,"proposition":"Increase passive range of motion","justification":"The question insists on 'this patient' who does not have passive range of motion."},{"idx":3,"correct":true,"proposition":"Reduce pain","justification":""},{"idx":4,"correct":true,"proposition":"Provide educational advice","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-3-qi-8","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"After a month and 15 sessions of physiotherapy, the patient is still as painful when raising the shoulder. Which strategy(s) is relevant? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"You check if the patient is observant","justification":""},{"idx":1,"correct":true,"proposition":"You check the tolerance of the sessions","justification":""},{"idx":2,"correct":true,"proposition":"You strengthen analgesic care","justification":""},{"idx":3,"correct":false,"proposition":"You request a shoulder scan","justification":"The CT scan is not very useful for the study of tendons, MRI is preferred."},{"idx":4,"correct":true,"proposition":"You check your differential diagnoses","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-3-qi-9","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The patient was able to return to work. Trying to catch up with a slide on a scaffolding, he has complete functional impotence of the right upper limb. Here is the front X-ray of the right shoulder. What element(s) does it bring you? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"There is a fracture of the surgical cervix of the humerus","justification":""},{"idx":1,"correct":true,"proposition":"There is an anteroinferior glenohumeral dislocation","justification":""},{"idx":2,"correct":false,"proposition":"There is an acromioclavicular disjunction","justification":""},{"idx":3,"correct":false,"proposition":"There is a fracture of a displaced rib","justification":""},{"idx":4,"correct":false,"proposition":"There is a notch of Malgaigne","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-3-qi-10","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Before proceeding to reduce this dislocation, you examine the sensitivity of the stump of the shoulder. An isolated abnormality at this level is in favor of nerve damage: ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"axillary","justification":""},{"idx":1,"correct":false,"proposition":"supraspinatus","justification":""},{"idx":2,"correct":false,"proposition":"long thoracic","justification":""},{"idx":3,"correct":false,"proposition":"radial","justification":""},{"idx":4,"correct":false,"proposition":"musculocutaneous","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-3-qi-11","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The patient did not have associated nerve damage prior to external manoeuvring reduction of the glenohumeral joint. The review of awareness after reduction is not changed. You set up an immobiliatlon by an elbow brace to the body. You see the patient again a month later. On clinical examination, you notice the following: passive mobility is not diminished, the right arm in anterior elevation and internal rotation, the patient can not resist the force of abbaissement that you exert, when he wants to bring his hand to the mouth, you observe that the patient is forced to raise his elbow laterally above the level of his hand. In addition, the arm placed in external rotation elbows to the body, there is an automatic internal rotation. Passive external rotation is not increased. The patient retains the possibility of taking off the hand placed in the back at the lumbosacral junction. There is no abnormality during thwarted active flexion of the elbow when the palms are up. Given the data of the clinical examination, you mention the possibility of a rupture of one or more of the following elements: (one or more true propositions)","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Supraspinatus","justification":""},{"idx":1,"correct":false,"proposition":"Pectoralis Major","justification":""},{"idx":2,"correct":true,"proposition":"Infraspinatus","justification":""},{"idx":3,"correct":true,"proposition":"Teres minor (small round)","justification":""},{"idx":4,"correct":false,"proposition":"Subscapular","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-3-qi-12","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Given the functional discomfort, rotator cuff repair surgery is offered to the patient. While waiting for the consultation of the anaesthetist, the patient asks you a few questions. Which of the following answers you could give is correct? ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"For this scheduled procedure, the anesthesia consultation can take place until the day before the intervention","justification":""},{"idx":1,"correct":false,"proposition":"You will see either a doctor or a nurse anaesthetist for this consultation","justification":""},{"idx":2,"correct":true,"proposition":"You will not necessarily have to take a blood test before the procedure","justification":""},{"idx":3,"correct":true,"proposition":"If you do not wish to have locoregional anesthesia, you can refuse it","justification":"It is always the patient who decides!"},{"idx":4,"correct":false,"proposition":"As you are taking aspirin for the heart, it will in any case be necessary to stop it between 5 and 7 days before the procedure","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-3-qi-13","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The patient is now in the post-interventional monitoring room following his surgery, which took place without incident anesthetic and surgically. He expresses pain at 8 out of 10 on the numerical scale and asks to be relieved. Which multimodal analgesia(s) are indicated in this context, among the analgesia represented in the figure below? PCA: patient-controlled analgesia (or PDA) ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Has","justification":""},{"idx":1,"correct":false,"proposition":"B","justification":""},{"idx":0,"correct":false,"proposition":"C","justification":""},{"idx":1,"correct":false,"proposition":"D","justification":""},{"idx":0,"correct":true,"proposition":"E","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-3-qi-14","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Morphine titration was initiated because it was severe pain. It was relayed by patient-controlled analgesia (PCA) with paracetamol and nefopam as part of multimodal postoperative analgesia. It has been effective. The ACP was arrested on the second day. On the third day, the patient again complains of pain, the intensity of which is measured at 54 mm on a visual analogue scale, and he wishes to be relieved. His current analgesic treatment includes paracetamol and nefopam. Which treatment(s) is (are) indicated in the context of multimodal analgesia in this context? ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Tramadol","justification":""},{"idx":1,"correct":false,"proposition":"Ketoprofen (NSAIDs)","justification":""},{"idx":2,"correct":false,"proposition":"Oxycodone","justification":""},{"idx":3,"correct":false,"proposition":"Transcutaneous electrical nerve stimulation (TENS)","justification":""},{"idx":4,"correct":true,"proposition":"Application of refrigeration","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-3-qi-15","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"After 5 months of rehabilitation, the patient has regained satisfactory active and passive mobility and he hardly complains of pain. He questions you about the resumption of his work because he fears that he will not be able to continue his activity. In agreement with your patient, you wish to contact his occupational physician. Which element(s) is (are) relevant to transmit to the occupational physician? ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"None, so as not to break medical confidentiality","justification":""},{"idx":1,"correct":true,"proposition":"Functional sequelae on the shoulder","justification":""},{"idx":2,"correct":true,"proposition":"The initial lesion assessment","justification":""},{"idx":3,"correct":false,"proposition":"A certificate of aptitude for his position","justification":""},{"idx":4,"correct":true,"proposition":"Possible extra-occupational risk factors","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-5-qi-1","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Which of the following clinical elements is present in the observation?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Spatial disorientation","justification":"'She thinks she is at home'"},{"idx":1,"correct":true,"proposition":"Zoopsies","justification":"'Scaring away cockroaches' 🐾"},{"idx":2,"correct":true,"proposition":"Disturbance of attention","justification":"'You have to repeat it several times because it seems elsewhere'"},{"idx":3,"correct":false,"proposition":"Tachypsychia","justification":""},{"idx":4,"correct":false,"proposition":"Mental automatism","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-5-qi-2","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Faced with this state of agitation, which of the following elements present in the observation, which one (directs) towards a delirium rather than an acute psychotic state?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Spatial disorientation","justification":""},{"idx":1,"correct":false,"proposition":"Delusions of persecution","justification":"These are characteristic of the LFS"},{"idx":2,"correct":true,"proposition":"Abrupt onset in a post-operative context","justification":"The postoperative context points much more towards confusion (known link between confusion and surgery) than towards EPA (no known link between EPA and surgery)"},{"idx":3,"correct":false,"proposition":"Major anxiety","justification":"Anxiety is found in both etiologies. This is a characteristic of agitation."},{"idx":4,"correct":true,"proposition":"Fluctuation of symptoms","justification":"The EPA does not fluctuate, or does not fluctuate, or little"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-5-qi-3","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Which of the following clinical elements would be in favor of delirium syndrome?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Time disorientation","justification":"This is characteristic"},{"idx":1,"correct":true,"proposition":"Hyperthermia","justification":"This can be a confusing trigger"},{"idx":2,"correct":true,"proposition":"Predominance of visual hallucinations","justification":"Visual (rather than auditory) hallucinations are often found in confusion."},{"idx":3,"correct":false,"proposition":"Psychiatric history","justification":""},{"idx":4,"correct":true,"proposition":"Reversal of the nycthemeral rhythm","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-5-qi-4","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The agitation is fluctuating but she does not repeat her hetero-aggressive threats and agrees to be escorted back to her room. She remains disoriented in space and time. At this stage, which of the following additional examinations is essential to carry out immediately? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Alcohol","justification":""},{"idx":1,"correct":false,"proposition":"Search for urinary toxicants","justification":""},{"idx":2,"correct":true,"proposition":"Capillary blood glucose","justification":"Any acute and non-systematized neurological signs should be investigated for hypoglycemia as a first-line treatment."},{"idx":3,"correct":false,"proposition":"Injected brain scan","justification":""},{"idx":4,"correct":false,"proposition":"Blood ionogram","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-5-qi-5","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Capillary blood glucose is 3.8 mmol\/L. Which of the following causes should be mentioned in front of the clinical picture presented by the patient? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Alcohol withdrawal","justification":""},{"idx":1,"correct":true,"proposition":"Adverse effects of opioid analgesics","justification":""},{"idx":2,"correct":false,"proposition":"Hypoglycaemia","justification":"Blood sugar is normal"},{"idx":3,"correct":true,"proposition":"Subacute subdural hematoma","justification":""},{"idx":4,"correct":true,"proposition":"Hyponatremia","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-5-qi-6","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Physical examination shows sweating, tachycardia and tremor of extremities. The neurological examination cannot be continued due to increased agitation. The patient nevertheless accepts oral treatment. What do you recommend? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Benzodiazepine therapy","justification":"We start on an alcoholic withdrawal in view of the clinical description and the context of the patient."},{"idx":1,"correct":false,"proposition":"Treatment with sedative neuroleptic","justification":""},{"idx":2,"correct":true,"proposition":"Brain scan without injection as soon as possible","justification":""},{"idx":3,"correct":true,"proposition":"Constant behavioural monitoring","justification":""},{"idx":4,"correct":false,"proposition":"Request for psychiatric opinion","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-5-qi-7","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Given the delirium syndrome and the context of fall with scalp wound, a brain scan is prescribed urgently after benzodiazepine sedation. The brain scan is normal but biology shows a moderate elevation of gamma-glutamyl-transpeptidase (GGT) and transaminases (predominant on AST) contrasting with a normal level of alkaline phosphatase, as well as an elevation of mean corpuscular volume. The blood ionogram and serum calcium are normal. CPKs are quietly increased. The temperature is 37.8 °C.  The patient is no longer agitated but still disoriented, anxious and continues to make delusional remarks. What do you recommend in the immediate future? (one or more responses) ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Thiamine","justification":""},{"idx":1,"correct":true,"proposition":"Hydration","justification":""},{"idx":2,"correct":false,"proposition":"Valproic acid","justification":""},{"idx":3,"correct":false,"proposition":"Physical restraint","justification":"The patient is no longer agitated"},{"idx":4,"correct":false,"proposition":"Antipsychotic","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-5-qi-8","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"You have set up intravenous hydration treatment and administration of vitamin B1 and Diazepam. Which of the following clinical and biological elements is part of the monitoring of delirium tremens?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Blood pressure"},{"idx":1,"correct":true,"proposition":"Heart rate"},{"idx":2,"correct":true,"proposition":"Temperature","justification":"The patient is subfebrile. The normalization of its temperature is monitored. This parameter is not part of the Cushman score (but it is still checked in the delirium tremens) 😉"},{"idx":3,"correct":false,"proposition":"Haemoglobin"},{"idx":4,"correct":false,"proposition":"Gamma-glutamyl-transpeptidase","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-5-qi-9","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The evolution of delirium is favorable in a few days and an addictological consultation is organized. The patient reports excessive daily alcohol consumption but says she has not lost control of her consumption and does not need addiction management. Which of the following attitudes you could adopt to promote patient adherence, which are specifically motivational interviewing techniques? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Explain the link between alcohol consumption and delirium tremens episode","justification":""},{"idx":1,"correct":false,"proposition":"Explain other risks associated with alcohol consumption","justification":""},{"idx":2,"correct":true,"proposition":"Ask the patient what her alcohol consumption brings","justification":""},{"idx":3,"correct":true,"proposition":"Talk about ambivalence to change as normal","justification":""},{"idx":4,"correct":false,"proposition":"Introduce drug treatments to help maintain abstinence","justification":"Motivational interviewing meets a very specific definition."}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-5-qi-10","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The patient is followed by her general practitioner with a goal of complete abstinence. However, she was unable to stop drinking for more than five days. Which of the following classes of drugs can be prescribed as an aid to maintain abstinence? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A selective serotonin reuptake inhibitor","justification":""},{"idx":1,"correct":false,"proposition":"A benzodiazepine","justification":""},{"idx":2,"correct":true,"proposition":"An opioid antagonist","justification":""},{"idx":3,"correct":false,"proposition":"A thymoregulator","justification":""},{"idx":4,"correct":false,"proposition":"An anticonvulsant","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-5-qi-11","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Management by the general practitioner continues, but without a significant reduction in alcohol consumption. She continues to drink one and a half bottles of wine a day. The patient often comes to the consultations having been drinking. She then cries a lot, says she is sad, lacking appetite and blaming herself. What therapeutic strategy(s) is (are) indicated for this patient? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Outpatient care in an addiction center","justification":""},{"idx":1,"correct":false,"proposition":"Emergency psychiatric hospitalization","justification":""},{"idx":2,"correct":false,"proposition":"Prescribing an antidepressant","justification":"The description does not meet the DSM-5 criteria for depression."},{"idx":3,"correct":true,"proposition":"Cognitive Behavioural Therapy","justification":""},{"idx":4,"correct":true,"proposition":"Scheduled hospitalization for alcohol withdrawal","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-5-qi-12","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The patient is cared for in a CSAPA (center for care, support and prevention in addiction) and a scheduled withdrawal has made it possible to obtain complete abstinence from alcohol for 3 months. Despite this, she continues to suffer from a deep malaise and tells her doctor that she can no longer bear to live alone, that she feels tired in the morning and needs several hours to prepare. It is very difficult to make decisions, she is incompetent in all areas and has a strong tendency to eat between meals to the point of having gained 5 kilos for 2 months. In addition, she worries almost all day and excessively for various reasons and takes more than an hour before falling asleep. She goes out little and sees very few people because she dreads all the encounters and is afraid of not being up to it. What diagnostic criterion(s) of severe depression do you identify among the symptoms presented by this patient:","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Self-depreciation","justification":"Minor criterion"},{"idx":1,"correct":false,"proposition":"Feeling lonely","justification":"Feeling lonely is not a DSM-5 criterion. Wicked trap 🙈"},{"idx":2,"correct":true,"proposition":"Cognitive impairment","justification":"Minor criterion"},{"idx":3,"correct":true,"proposition":"Overeating","justification":"Minor criterion"},{"idx":4,"correct":true,"proposition":"Slowdown","justification":"Minor criterion"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-5-qi-13","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"What other diagnosis(s) does the patient's clinical picture suggest? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Generalized anxiety disorder (GAD)","justification":""},{"idx":1,"correct":true,"proposition":"Social phobia","justification":""},{"idx":2,"correct":false,"proposition":"Agoraphobia","justification":""},{"idx":3,"correct":false,"proposition":"Syndrome de Korsakoff","justification":""},{"idx":4,"correct":false,"proposition":"Schizoid personality disorder","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-5-qi-14","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"A prescription of antidepressant monotherapy (escitalopram) was implemented 4 months ago and has achieved complete remission of the depressive episode for 3 months now. The patient remained abstinent in alcohol 🍷. However, she remains very anxious in many situations of everyday life. What therapeutic orientation(s) is (are) indicated at this stage?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Gradual discontinuation of escitalopram","justification":""},{"idx":1,"correct":true,"proposition":"Cognitive Behavioural Therapy","justification":""},{"idx":2,"correct":false,"proposition":"EMDR","justification":""},{"idx":3,"correct":false,"proposition":"Beta-blocker","justification":""},{"idx":4,"correct":false,"proposition":"Sedating neuroleptic","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-5-qi-15","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"After 12 months of treatment with escitalopram and maintenance of a complete and stable remission of the depressive episode, what argument(s) can justify the extension of this long-term treatment? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Identification of a history of depressive episodes","justification":""},{"idx":1,"correct":false,"proposition":"Identification of a history of manic episode","justification":""},{"idx":2,"correct":false,"proposition":"Signs of drug withdrawal occurring when you forget to take","justification":"There is no withdrawal syndrome"},{"idx":3,"correct":true,"proposition":"Severe generalized anxiety disorder","justification":""},{"idx":4,"correct":false,"proposition":"Avoidant personality disorder","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-5-qi-16","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The patient consults a year later. She has not taken an antidepressant for 6 months, but takes alprazolam in varying doses prescribed by another doctor every day. What therapeutic strategy(s) can be proposed to limit the risk of benzodiazepine dependence in this patient? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Information on the risks of chronic benzodiazepine use","justification":""},{"idx":1,"correct":true,"proposition":"Participation in a mutual aid group (GEM)","justification":"Doubt on this question: there is no mention of these GEM in the college 🤷 ♂️ But we decide to tick it just since it seems logical."},{"idx":2,"correct":false,"proposition":"Extension of the prescription of alprazolam at a stable dose to achieve complete remission","justification":""},{"idx":3,"correct":false,"proposition":"Replacement of alprazolam with a benzodiazepine with a shorter half-life","justification":"The shorter the half-life, the higher the risk."},{"idx":4,"correct":true,"proposition":"Information on non-drug therapeutic alternatives","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-6-qi-1","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Regarding the confusion in this situation, what is(are) the exact answer(s)? (one or more true propositions)","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"It can persist for several days","justification":"This is called post-critical confusion, which lasts a few minutes to a few hours."},{"idx":1,"correct":false,"proposition":"It may be followed by persistent cognitive impairment","justification":""},{"idx":2,"correct":true,"proposition":"It is manifested by a spontaneous language disorder","justification":""},{"idx":3,"correct":true,"proposition":"Its association with temporospatial disorientation is constant","justification":""},{"idx":4,"correct":true,"proposition":"It is manifested in particular by behavioral disorders","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-6-qi-2","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Regarding the mechanism of this loss of knowledge, what is (are) the right proposal(s)? (one or more true propositions)","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"You mention the diagnosis of tonic-clonic seizure because witnesses report convulsive movements"},{"idx":1,"correct":false,"proposition":"You retain the diagnosis of tonic-clonic seizure since the patient reported a loss of urine","justification":""},{"idx":2,"correct":false,"proposition":"The absence of tongue bite makes it possible to rule out the diagnosis of tonic-clonic seizure","justification":""},{"idx":3,"correct":false,"proposition":"The fact that the patient says she does not remember anything supports a psychogenic origin of the loss of consciousness","justification":""},{"idx":4,"correct":true,"proposition":"The existence of confusion during the management by the SAMU makes you evoke a tonic-clonic epileptic seizure","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-6-qi-3","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"What element(s) would be in favor of convulsive syncope? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Extreme pallor","justification":""},{"idx":1,"correct":true,"proposition":"Immediate resumption of normal consciousness","justification":""},{"idx":2,"correct":false,"proposition":"Duration of loss of consciousness of at least five minutes","justification":"Rather epilepsy"},{"idx":3,"correct":false,"proposition":"Clonic shaking of all four limbs","justification":"Not the four members 😉"},{"idx":4,"correct":false,"proposition":"Loss of urine","justification":"It is not discriminatory."}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-6-qi-4","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"During the interrogation, you learn that the patient is sometimes surprised in the morning by jolts of the upper limbs. She even suddenly dropped the cup of coffee she was holding as the movement was so abrupt. Regarding this symptom, you mention:  ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Tetany","justification":""},{"idx":1,"correct":false,"proposition":"Tics","justification":""},{"idx":2,"correct":false,"proposition":"Physiological myoclonus","justification":""},{"idx":3,"correct":true,"proposition":"Epileptic myoclonus","justification":""},{"idx":4,"correct":false,"proposition":"Psychogenic manifestations","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-6-qi-5","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"You integrate this symptom into your syndromic reasoning. What is the exact proposal(s):","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"This symptom calls into question the diagnosis of an epileptic mechanism concerning the episode of loss of consciousness","justification":""},{"idx":1,"correct":false,"proposition":"This symptom associated with the clinical suspicion of tonic-clonic seizure is in favor of secondarily generalized partial epilepsy","justification":""},{"idx":2,"correct":true,"proposition":"This symptom associated with clinical suspicion of tonic-clonic seizure is in favor of idiopathic generalized epilepsy","justification":""},{"idx":3,"correct":false,"proposition":"This symptom requires psychiatric advice","justification":""},{"idx":4,"correct":true,"proposition":"This symptom should cause the interrogation to look for photosensitivity","justification":"Triggering at light exposure."}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-6-qi-6","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"You remember the existence of epileptic myoclonus. Regarding epileptic myoclonus, which is (are) the exact proposal(s)? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"They can be observed during generalized epilepsy","justification":""},{"idx":1,"correct":true,"proposition":"They can be observed during partial epilepsies","justification":""},{"idx":2,"correct":true,"proposition":"They are favored by lack of sleep","justification":""},{"idx":3,"correct":true,"proposition":"They are favored by intermittent light stimulation","justification":""},{"idx":4,"correct":false,"proposition":"They can occur in the absence of concomitant epileptic discharge on the electroencephalogram","justification":"It would be bad luck anyway 🤔"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-6-qi-7","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"In the first hours of your care, which additional examination(s) for etiological purposes will you perform? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A brain MRI","justification":"Not in the first hours but it is systematic in a second time."},{"idx":1,"correct":false,"proposition":"A lumbar puncture","justification":"The repetition of symptoms is not in favor of an infectious origin."},{"idx":2,"correct":true,"proposition":"An electroeneghalogram","justification":"We will look for a background 😉 activity"},{"idx":3,"correct":false,"proposition":"A search for toxicants in urine","justification":"The repetition of symptoms is not in favor."},{"idx":4,"correct":false,"proposition":"A brain angiography","justification":"We can consider a CT scan, but not a CT angiography (we do not think of ischemia in front of this table)."}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-6-qi-8","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"You have to perform an electroencephalogram one hour after admission. What characteristic(s) do you remember at the seventh second of the recording? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Generalized epileptic discharge"},{"idx":1,"correct":false,"proposition":"A physiological trace (normal rhythm)"},{"idx":2,"correct":false,"proposition":"Discharge characteristic of an absence"},{"idx":3,"correct":true,"proposition":"One landfill recorded on all leads (lines)"},{"idx":4,"correct":false,"proposition":"A discharge characteristic of a partial crisis"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-6-qi-9","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"A brain MRI is performed remotely, what do you expect (indicate the exact proposal(s))? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"It will be normal in case of idiopathic generalized epilepsy","justification":""},{"idx":1,"correct":true,"proposition":"An MRI abnormality is not necessarily responsible for epilepsy","justification":""},{"idx":2,"correct":false,"proposition":"An MRI abnormality will prove that the patient's symptoms are epileptic","justification":""},{"idx":3,"correct":false,"proposition":"The absence of abnormalities on MRI will make it possible to reject the diagnosis of epilepsy in this patient","justification":""},{"idx":4,"correct":false,"proposition":"The presence of an abnormality on MRI will prove that epilepsy is of partial origin in this patient","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-6-qi-10","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Brain MRI is normal. What is the diagnosis? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":" Rolandic paroxysmic epilepsy ","justification":""},{"idx":1,"correct":true,"proposition":"Benign juvenile myoclonic epilepsy","justification":""},{"idx":2,"correct":false,"proposition":" Temporal partial epilepsy","justification":""},{"idx":3,"correct":false,"proposition":" Cryptogenic epilepsy","justification":""},{"idx":4,"correct":false,"proposition":"Convulsive syncope","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-6-qi-11","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"You have retained the diagnosis of benign juvenile myoclonic epilepsy. You discuss with the patient the initiation of background antiepileptic therapy. What is the exact proposal(s)? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"There is no indication for background anti-epileptic treatment as she had only one generalized seizure","justification":""},{"idx":1,"correct":false,"proposition":"The benign nature of epilepsia justifies therapeutic abstention","justification":""},{"idx":2,"correct":true,"proposition":"The prescription of background anti-epileptic treatment must be accompanied by therapeutic education","justification":""},{"idx":3,"correct":false,"proposition":"Prescription of background antiepileptic therapy contraindicates oral contraception","justification":""},{"idx":4,"correct":true,"proposition":"The prescription must be maintained over the long term to prevent the recurrence of its pathology","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-6-qi-12","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Treated for 18 months with lamotrigine, she has never reoffended. She wants to pass her driver's license. What is the exact answer(s) regarding driving? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Driving a public transit vehicle is definitely contraindicated","justification":""},{"idx":1,"correct":false,"proposition":"Driving a light vehicle is possible without restriction","justification":""},{"idx":2,"correct":true,"proposition":"The physician must inform the patient of the regulatory procedures","justification":""},{"idx":3,"correct":false,"proposition":"Driving will be possible with a certificate from the attending physician","justification":""},{"idx":4,"correct":false,"proposition":"Taking antiepileptic treatment prohibits driving","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-6-qi-13","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"She asks you about her contraception. What is the exact answer(s)? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Oral contraception is contraindicated","justification":""},{"idx":1,"correct":false,"proposition":"Lamotrigine is an enzyme inducer of estrogen-progestin contraceptives","justification":""},{"idx":2,"correct":false,"proposition":"You recommend stopping antiepileptic treatment","justification":""},{"idx":3,"correct":true,"proposition":"You authorize the contraception of his choice","justification":""},{"idx":4,"correct":false,"proposition":"You recommend a change in antiepileptic treatment","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-6-qi-14","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Five years later, the patient expresses a desire for pregnancy and wishes to have information. What is the exact answer(s)? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Genetic counseling should be offered","justification":""},{"idx":1,"correct":false,"proposition":"The context of pregnancy makes you offer dual therapy","justification":""},{"idx":2,"correct":true,"proposition":"You set up folic acid supplementation","justification":""},{"idx":3,"correct":false,"proposition":"Close ultrasound monitoring will be necessary during the last trimester of pregnancy","justification":""},{"idx":4,"correct":false,"proposition":"Under treatment the risk of malformation is higher than that of the general population","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-7-qi-1","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"In the emergency room, the patient is taken care of. The clinical examination, supplemented by imaging, confirms a closed fracture of the right wrist requiring surgery. The wounds of the upper limbs are to be sutured. The caregiver washes his hands according to the following steps. Which of the following suggestions for standard hygiene precautions for performing sutures in emergency rooms is correct?","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Wearing a surgical mask for the operator is recommended","justification":""},{"idx":1,"correct":false,"proposition":"The friction of the hands in 6 steps with a hydro-alcoholic solution, before the treatment, is in accordance with the recommendations","justification":""},{"idx":2,"correct":false,"proposition":"The duration of hand rubbing should last at least one minute","justification":"30 seconds ⌛ (painful trap)"},{"idx":3,"correct":true,"proposition":"Wearing a pair of goggles is recommended","justification":""},{"idx":4,"correct":true,"proposition":"Gloves are required","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-7-qi-2","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The wounds were sutured. You ask the patient about his vaccination status that he does not know. What modality(s) of prevention of the risk of infection do you implement?","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"You give him an injection of 250 IU of tetanus immunoglobulins in the emergency room","justification":""},{"idx":1,"correct":true,"proposition":"You give him an injection of a dose of vaccine containing tetanus valence in the emergency room","justification":""},{"idx":2,"correct":false,"proposition":"You start antibiotic therapy with amoxicillin and clavulanic acid for a period of 10 days","justification":""},{"idx":3,"correct":true,"proposition":"You are planning a tetanus vaccination booster for this patient","justification":""},{"idx":4,"correct":true,"proposition":"You are planning a new consultation for wound healing monitoring in a week 1 1","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-7-qi-3","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"You inform the patient of the need for surgery followed by hospitalization to treat their wrist fracture. The patient refuses surgery and hospitalization. Which of the following proposals regarding patient information and consent is accurate? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The patient's low level of understanding of the French language exempts the physician from obtaining the patient's consent","justification":""},{"idx":1,"correct":true,"proposition":"The doctor must inform this patient of the expected benefits and possible risks of the surgical procedure","justification":""},{"idx":2,"correct":false,"proposition":"The status of illegal alien exempts the doctor from obtaining the patient's consent","justification":""},{"idx":3,"correct":true,"proposition":"The physician must ensure the patient's understanding by asking him to say what he has understood","justification":""},{"idx":4,"correct":true,"proposition":"The presence of the interpreter is recommended during the interview with the patient","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-7-qi-4","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The exchange with the patient highlights that his refusal is mainly motivated by the cost of surgery and hospitalization. His hospitalization costs will be covered under which device?","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Universal Health Protection (PUMa)","justification":""},{"idx":1,"correct":false,"proposition":"Complementary Universal Health Coverage (CMUc)","justification":""},{"idx":2,"correct":false,"proposition":"Assistance to complementary health (ACS)","justification":""},{"idx":3,"correct":false,"proposition":"Active solidarity income (RSA)","justification":""},{"idx":3,"correct":true,"proposition":"State Medical Aid (AME)","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-7-qi-5","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"This patient meets the conditions to benefit from the State Medical Aid (AME) but he has not, to date, submitted an application. Which of the following proposals for AME is correct?","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The AME application must have been filed on the day of hospitalization","justification":""},{"idx":1,"correct":false,"proposition":"The hospital fee will remain the responsibility of the patient because he had not submitted an application for AME prior to his entry into the hospital","justification":""},{"idx":2,"correct":false,"proposition":"The AME will only allow him to access free emergency care","justification":""},{"idx":3,"correct":false,"proposition":"The AME will allow him to be reimbursed 100% of a medical consultation but he will have to advance the costs","justification":"No need to advance fees"},{"idx":4,"correct":true,"proposition":"The AME will allow him to be exempted from the medical deductible","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-7-qi-6","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"Following the information provided, the patient finally accepts the surgery and hospitalization. He was therefore taken to the operating room for an orthopedic procedure. Arriving at the operating room, the team uses the patient safety checklist << the operating room >> (2016 version) of the High Authority for Health (HAS). Which of the following proposals regarding the patient safety <<checklist in the >> operating room is which one is correct? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The checklist is a barrier to recovery according to Reason's model","justification":"This is the famous model in Gruyère 🧀"},{"idx":1,"correct":false,"proposition":"The checklist checks safety points of care at 4 key moments of surgery: before anesthetic induction, before, during and after surgery","justification":""},{"idx":2,"correct":true,"proposition":"The checklist promotes the sharing of information through cross-checking","justification":""},{"idx":3,"correct":true,"proposition":"The checklist significantly reduces postoperative morbidity and mortality","justification":""},{"idx":4,"correct":false,"proposition":"The checklist must be co-signed by the surgeon, anaesthetist and patient as soon as they wake up","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-7-qi-7","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The immediate aftermath of surgery is simple. The patient is now hospitalized. He is quickly seen by the mobile addiction team. The patient's clinical condition is stable and satisfactory. Postoperative pain is well controlled. There are no other notable clinical signs. Which of the following addiction consumption evaluation questionnaires is indicated in this patient? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The Fagerstrom test","justification":""},{"idx":1,"correct":false,"proposition":"Cushman's score","justification":""},{"idx":2,"correct":true,"proposition":"The CAST questionnaire","justification":""},{"idx":3,"correct":true,"proposition":"The AUDIT questionnaire","justification":""},{"idx":4,"correct":false,"proposition":"The SPICES score","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-7-qi-8","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"During the appointment with the addictologist, in the presence of the translator, the patient reports an alcohol consumption equivalent to 6 standard drinks every day. He feels the need to have a first drink in the morning and has already been injured in a context of alcoholization in the last 12 months. The addictologist uses the AUDIT test. These elements of consumption are in favor (one or more possible answers): ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Alcohol dependence ","justification":""},{"idx":1,"correct":false,"proposition":"The indication of a brief intervention only","justification":""},{"idx":2,"correct":true,"proposition":"Specialized addictological care","justification":""},{"idx":3,"correct":true,"proposition":"A risk of withdrawal syndrome","justification":""},{"idx":4,"correct":true,"proposition":"Misuse of alcohol","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-7-qi-9","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"As part of the prevention of alcohol withdrawal syndrome, the doctor of the department prescribes treatment with diazepam. The doctor on call is called during the following night because the patient has a state of convulsive status requiring a transfer to intensive care for 48 hours, lengthening the duration of hospitalization of this patient. Consultation of the patient's file during management by the doctor on duty shows that the patient has not received his diazepam treatment. You have no further information at this stage. How can we qualify this situation (one or more possible answers)? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A risky event","justification":""},{"idx":1,"correct":true,"proposition":"An adverse event associated with care","justification":""},{"idx":2,"correct":true,"proposition":"A serious adverse event","justification":""},{"idx":3,"correct":true,"proposition":"A preventable adverse event","justification":""},{"idx":4,"correct":false,"proposition":"An unexpected side effect","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-7-qi-10","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"As part of the quality approach within the department, it is decided to investigate the causes responsible for the occurrence of this adverse event. Which method(s) is (are) suitable? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A clinical audit","justification":""},{"idx":1,"correct":false,"proposition":"A clinical path","justification":""},{"idx":2,"correct":false,"proposition":"An analysis of failure modes, their effects and criticality","justification":""},{"idx":3,"correct":true,"proposition":"A mortality and morbidity review","justification":""},{"idx":4,"correct":false,"proposition":"A review of the relevance of care","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-7-qi-11","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The analysis of this event in mortality and morbidity review aims to (one or more possible responses):","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Setting a priori the optimal care pathway","justification":"The MMR (Mortality and Morbidity Review) is carried out a posteriori, that is to say after the event has taken place."},{"idx":1,"correct":true,"proposition":"Carry out a collective analysis integrating all the professionals concerned by the event","justification":""},{"idx":2,"correct":false,"proposition":"Identify the culprit(s) at the origin of the fault","justification":"This is absolutely not the objective of quality approaches."},{"idx":3,"correct":true,"proposition":"Implement prevention, recovery or mitigation actions ","justification":""},{"idx":4,"correct":true,"proposition":"Identify root causes","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-7-qi-12","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The ALARM method was used to identify the causes of this care-associated adverse event. The causes identified are as follows. First, a computer failure did not make it possible to carry out a computerized prescription. The prescription was made in a paper file that turned out to be that of a patient other than Mr. B. The prescription was made at the end of the morning nurses' shift. However, the computer failure was quickly resolved and the afternoon shift nurses were not informed of the computer failure. In the end, the computer failure concerned only Mr B.'s prescriptions. The prescriptions of the other patients of the department could be made on computer as is customary in this department. The patient did not speak French, and in the absence of an interpreter during hospitalization, there was a lack of communication. The nursing team was understaffed due to multiple work stoppages in the context of an influenza epidemic. The analysis of causes finds related factors (one or more possible answers):","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"To the work environment","justification":""},{"idx":1,"correct":true,"proposition":"To the organization of the service","justification":""},{"idx":2,"correct":true,"proposition":"How the team works","justification":""},{"idx":3,"correct":true,"proposition":"Patient characteristics","justification":""},{"idx":4,"correct":false,"proposition":"In the international context","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-7-qi-13","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"Following this adverse event associated with care, what should be done (one or more possible responses):","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Inform the patient that they have experienced an unwanted event","justification":""},{"idx":1,"correct":false,"proposition":"Explain to the patient that this event would not have occurred if they did not consume so much alcohol daily","justification":""},{"idx":2,"correct":true,"proposition":"Inform the patient that every effort has been made to understand the causes of this event and prevent it from happening again","justification":""},{"idx":3,"correct":false,"proposition":"Minimize the importance of this event as it has no sequelae","justification":""},{"idx":4,"correct":false,"proposition":"Offer, if necessary, spiritual support","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-8-qi-1","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"Which of the following clinical signs are the ones that immediately point to a surgical emergency:","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The sudden onset of pain","justification":"The criteria for a surgical emergency include: high and sudden abdominal pain, contracture (defense to a lesser extent), signs of hypovolemic shock (tachycardia, hypotension), signs of septic shock (fever), etc. "},{"idx":1,"correct":false,"proposition":"Lack of defense or contracture","justification":""},{"idx":2,"correct":false,"proposition":"The analgesic position in a gun dog","justification":"This points to acute pancreatitis"},{"idx":3,"correct":false,"proposition":"The 2 episodes of vomiting","justification":"Vomiting is not a surgical emergency"},{"idx":4,"correct":false,"proposition":"The onset of periumbilical pain","justification":"Periumbilical pain is not a worrying localization"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-8-qi-2","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"Which of the following diagnoses you think is most likely (an expected answer):","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Acute bowel obstruction","justification":""},{"idx":1,"correct":false,"proposition":"Sigmoid diverticulitis","justification":"The location of pain is not in favor (classically in left iliac fossa \/ left flank)"},{"idx":2,"correct":false,"proposition":"Infectious ileitis","justification":"Ileitis is much less likely than occlusion."},{"idx":3,"correct":false,"proposition":"Acute cholecystitis","justification":"The localization of the pain is not in favor (classically in right hypochondrium)"},{"idx":4,"correct":false,"proposition":"Acute salpingitis","justification":"We think rather of a digestive pathology here."}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-8-qi-3","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"The pulse is at 98 beats per minute, the BP at 110\/80 mmHg and the temperature at 37.8 °C.  Regarding emergency care, what is (are) the real proposal(s)? (one or more true answers)","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Nasogastric tube placement","justification":"Systematics in case of suspected occlusion"},{"idx":1,"correct":false,"proposition":"Placement of a urinary catheter","justification":""},{"idx":2,"correct":true,"proposition":"Placement of a peripheral venous line","justification":"Good caliber track"},{"idx":3,"correct":true,"proposition":"Level 3 analgesic treatment","justification":"In view of the EVA"},{"idx":4,"correct":true,"proposition":"Blood type and rhesus"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-8-qi-4","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"Which examination(s) do you think are useful for the management of this patient?","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Abdominal ultrasound","justification":""},{"idx":1,"correct":true,"proposition":"Abdominopelvic CT scan with contrast injection","justification":""},{"idx":2,"correct":false,"proposition":"Entero-MRI","justification":""},{"idx":3,"correct":false,"proposition":"X-ray of abdomen without face preparation","justification":"No longer 😊 done"},{"idx":4,"correct":false,"proposition":"Esogastric endoscopy","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-8-qi-5","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"An abdomino-pelvic CT scan is performed. Which of the following is correct?","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"It is an abdominal CT scan with injection, arterial time","justification":"The spleen is no longer tabby 👉 it is not arterial"},{"idx":1,"correct":false,"proposition":"This is an axial cut","justification":"Coronal Cup"},{"idx":2,"correct":false,"proposition":"The superior mesenteric artery is clouded and visible on this picture","justification":""},{"idx":3,"correct":true,"proposition":"A digestive loop is distended","justification":""},{"idx":4,"correct":true,"proposition":"There is a peritoneal effusion","justification":"Next to the liver"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-8-qi-6","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"The CT scan confirms the hypothesis of a small bowel occlusion on flange with suffering of a small loop and presence of a peritoneal effusion. What do you propose at this stage? ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Check the blood ionogram to adapt the ionic intake","justification":""},{"idx":1,"correct":false,"proposition":"Hospitalization, fasting, continuation of analgesic treatment and transit accelerators, clinical and biological reassessment at 24 h","justification":"Occlusion on flange + digestive suffering does not allow to wait"},{"idx":2,"correct":true,"proposition":"Contact the surgical and anesthetic team for emergency intervention","justification":""},{"idx":3,"correct":true,"proposition":"Starting intravenous probabilistic antibiotic therapy","justification":""},{"idx":4,"correct":false,"proposition":"Perform a rectosigmoidoscopy to lift the flange","justification":"Can be done in the volvulus of the sigmoid"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-8-qi-7","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"You decide to operate on the patient. A laparotomy is performed, you discover a flange responsible for strangulation of the ileum with ischemia of the small intestine for about 1 meter. Which of the following suggestions regarding your care is true? ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Section as quickly as possible of the flange responsible for strangulation","justification":""},{"idx":1,"correct":false,"proposition":"Rapid resection of the ischemic digestive segment to avoid bacterial translocation","justification":""},{"idx":2,"correct":true,"proposition":"Installation of moist and warm compresses in contact with the ischemic intestine and reassess its recoloration and vitality after a few minutes","justification":""},{"idx":3,"correct":true,"proposition":"The entire small intestine should be unwound to look for other flanges that may cause occlusions","justification":""},{"idx":4,"correct":true,"proposition":"You have informed the patient of the possibility of a stoma after the procedure","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-8-qi-8","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"You perform a resection-anastomosis of the hail. The patient is renourished on day 2. On the 5th day, she complains of diffuse abdominal pain, predominant at the periumbilical level. The temperature is 38.5 °C.  The examination finds a painful arch at the level of the operative scar. Which of the following diagnoses can you mention?","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"A wall abscess"},{"idx":1,"correct":true,"proposition":"An anastomotic fistula"},{"idx":2,"correct":false,"proposition":"Early recurrence of flange occlusion","justification":""},{"idx":3,"correct":true,"proposition":"A covered evisceration"},{"idx":4,"correct":false,"proposition":"A bladder globe "}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-8-qi-9","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"What test(s) do you request to support your diagnosis? (one or more responses)","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"No further examination","justification":""},{"idx":1,"correct":false,"proposition":"A suprapubic ultrasound","justification":""},{"idx":2,"correct":true,"proposition":"An abdominal CT scan with injection","justification":""},{"idx":3,"correct":false,"proposition":"An abdominal x-ray without preparation","justification":""},{"idx":4,"correct":false,"proposition":"A rectosigmoidoscopy to remove an anastomotic fistula","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-8-qi-10","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"The abdominal CT scan ordered urgently shows a wall abscess. The abscess is evacuated. The patient leaves the ward with local care at home with a 5-week absence from work. Why should she see the occupational physician again when resuming (one or more possible answers):","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Because the event occurred in the workplace","justification":""},{"idx":1,"correct":true,"proposition":"Because it's a stop of more than 30 days","justification":"The three situations that require a follow-up visit are: occupational disease, stoppage > 30J, maternity leave."},{"idx":2,"correct":true,"proposition":"To adapt the workstation if necessary","justification":""},{"idx":3,"correct":false,"proposition":"To approve!' Imputability of the accident at work","justification":""},{"idx":4,"correct":false,"proposition":"To determine the rate of disability related to the work-related accident","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-8-qi-11","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"She is seen again in consultation at his request 6 months later for the appearance of a << ball >> in front of his scar. On examination, there is an impulsive cough swelling, not painful. Which of the following diagnoses can be mentioned?","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A covered evisceration","justification":"The peritoneum does not 👉 hold evisceration. According to the College of Digestive Surgery: 'Early post-operative injury'"},{"idx":1,"correct":true,"proposition":"An uncomplicated eventration","justification":"The peritoneum holds 👉 ventration. According to the College of Digestive Surgery: 'Hernia through an opening secondary to a previous incision'"},{"idx":2,"correct":false,"proposition":"A recurrence of the wall abscess","justification":""},{"idx":3,"correct":false,"proposition":"A keloid scar","justification":""},{"idx":4,"correct":false,"proposition":"A parietal lipoma","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-8-qi-12","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"Given the impulsive nature of coughing and not painful, you evoke an uncomplicated eventration. Do you inform the patient that? ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Wearing a restraint belt for 6 months prevents their occurrence","justification":""},{"idx":1,"correct":true,"proposition":"An eventration always occurs on an acquired aponeurotic orifice","justification":"This is the definition 😊"},{"idx":2,"correct":true,"proposition":"Surgery is responsible for venting in the majority of cases","justification":"It is exceptionally post-traumatic."},{"idx":3,"correct":false,"proposition":"She should have had a work stoppage of at least 3 months to prevent the ventration","justification":""},{"idx":4,"correct":true,"proposition":"The occurrence of a parietal abscess is a risk factor for the occurrence of eventration","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-8-qi-13","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"You propose to the patient a surgical cure of the eventration. But she refuses this intervention. Three years later, she was admitted urgently for acute abdominal pain. Which of the following proposals will direct you towards the diagnosis of strangled ventration? ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Painful swelling","justification":""},{"idx":1,"correct":true,"proposition":"Irreducibility of eventration","justification":""},{"idx":2,"correct":true,"proposition":"Occurrence of iterative vomiting","justification":""},{"idx":3,"correct":false,"proposition":"Conjunctival jaundice","justification":""},{"idx":4,"correct":true,"proposition":"Loss of impulsivity at cough","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-8-qi-14","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"You make the diagnosis of strangulated ventration and the patient is operated urgently. There is no digestive suffering and the fascia is closed by a simple suture. The postoperative follow-up is simple and the patient leaves the service at 5 quality of general practitioner, you see the patient again 8 days later at home and you inform her ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"That, in its situation, the aponeurotic suture guarantees the absence of recurrence in 90% of cases","justification":""},{"idx":1,"correct":false,"proposition":"That the wearing of a restraint belt is recommended 24 hours a day","justification":""},{"idx":2,"correct":true,"proposition":"That it would be advisable to contact the occupational physician of his company","justification":""},{"idx":3,"correct":true,"proposition":"That in case of recurrence of its eventration, the installation of a parietal reinforcement prosthesis would be recommended","justification":""},{"idx":4,"correct":false,"proposition":"That you cannot ask his surgeon for his entire hospitalization file because of medical confidentiality","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-9-qi-1","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"Which of the following are the clinically severe symptoms(s) you are looking for in this child:  ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The child does not respond to the pain","justification":"In both children and adults, it is a sign of clinical seriousness"},{"idx":1,"correct":true,"proposition":"Heart rate is at 60 beats per minute","justification":"The threshold is 80 bpm"},{"idx":2,"correct":true,"proposition":"Breathing is irregular","justification":""},{"idx":3,"correct":true,"proposition":"She has fever and a rash that persists on vitropressure","justification":"The rash that persists with vitropressure is purpura, i.e. blood extravasation (blood coming out of the vessels). Any febrile purpura is a fulminans purpura until proven otherwise, and requires the introduction of antibiotic therapy as a matter of absolute urgency (even before bacteriological sampling if these delay management)."},{"idx":4,"correct":false,"proposition":"There is a notion of recent travel","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-9-qi-2","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"There is no rash or fever. In the absence of a verbal and motor response described by the mother as well as breathing that you hear as very slow and noisy, you send a team home. On the spot the doctor notes: a heart rate at 80 \/ min, a respiratory rate at 10 \/ min, a pink but sleepy child with a Glasgow score at 11, the temperature is at 36.2 ° C, skin recoloration is immediate and blood pressure is 102\/61 mmHg. The pupils are symmetrical and responsive, the nape is flexible. The mother does not report any unusual items in the previous days (no fever, no trauma). Which diagnosis(s) are compatible with this clinical picture? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Bacterial meningitis","justification":"The pupils are symmetrical and responsive, the nape is flexible."},{"idx":1,"correct":true,"proposition":"Trauma inflicted","justification":""},{"idx":2,"correct":true,"proposition":"Status epilepticus","justification":"a pink but sleepy child with a Glasgow score of 11"},{"idx":3,"correct":true,"proposition":"Exogenous poisoning","justification":""},{"idx":4,"correct":true,"proposition":"Hereditary abnormality of metabolism","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-9-qi-3","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"Regarding the hypothesis of a inflicted head trauma, what is (are) the exact proposal(s) in this pathology? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The age of the child is evocative","justification":""},{"idx":1,"correct":false,"proposition":"The absence of impact on the skull excludes this diagnosis","justification":""},{"idx":2,"correct":false,"proposition":"Disorders of consciousness are rare","justification":""},{"idx":3,"correct":true,"proposition":"The break of the cranial perimeter curve is suggestive","justification":""},{"idx":4,"correct":true,"proposition":"Look for a subdural hematoma","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-9-qi-4","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"As a general rule, under what circumstances can bradypnea be observed in children? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"In case of opiate poisoning","justification":""},{"idx":1,"correct":false,"proposition":"In case of metabolic acidosis","justification":"Polypnea"},{"idx":2,"correct":true,"proposition":"In case of hypoxia","justification":""},{"idx":3,"correct":false,"proposition":"In case of carbon monoxide poisoning","justification":"Neurological impairment"},{"idx":4,"correct":false,"proposition":"In case of paracetamol poisoning","justification":"Liver damage"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-9-qi-5","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The arterial gas balance made under oxygen is as follows: pH 7.26, PCO2 66 mmHg, Bicarbonates 24 mmol \/ L, HbCO 3%, PO2 90 mmHg. How do you interpret this balance sheet (only one answer)? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Compensated respiratory acidosis","justification":""},{"idx":1,"correct":true,"proposition":"Uncompensated respiratory acidosis","justification":"Acidosis because pH<7.35 (or 7.38 depending on the source). Respiratory because the drop in pH is caused by the increase in pCO2 (which is > 45). Not compensated because the pH is acidic."},{"idx":2,"correct":false,"proposition":"Compensated metabolic acidosis","justification":""},{"idx":3,"correct":false,"proposition":"Uncompensated metabolic acidosis","justification":""},{"idx":4,"correct":false,"proposition":"Mixed acidosis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-9-qi-6","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The child is admitted to the emergency room where you decide to perform a brain scan and prescribe a urine toxicity test. Which symptom(s) is compatible with drug poisoning? (one or more exact propositions)","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Urinary retention","justification":""},{"idx":1,"correct":true,"proposition":"Cyanosis","justification":""},{"idx":2,"correct":false,"proposition":"Hives","justification":""},{"idx":3,"correct":true,"proposition":"Nausea and vomiting","justification":""},{"idx":4,"correct":false,"proposition":"Pupillary asymmetry","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-9-qi-7","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"Here are the growth curves that you reconstitute in the health record. What diagnostic hypothesis(s) can (s) be evoked when reading these curves?","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Hydrocephalus"},{"idx":1,"correct":false,"proposition":"Craniopharyngioma"},{"idx":2,"correct":true,"proposition":"Congenital immunodeficiency","justification":""},{"idx":3,"correct":false,"proposition":"Syndrome de Turner"},{"idx":4,"correct":true,"proposition":"Psychosocial dwarfism"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-9-qi-8","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The search for toxic substances finds cannabis. The mother reports that her husband had friends the day before and that it is possible that they had left cannabis resin on the coffee table that the child would have ingested at the time. You also note on clinical examination gingival hypertrophy, cavities, pallor, some petechiae in the lower limbs. What first-line investigation(s) is (are) necessary in view of these growth charts and clinical signs?","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"A complete blood count","justification":"Because of petechiae and pallor"},{"idx":1,"correct":false,"proposition":"An X-ray of a skull","justification":""},{"idx":2,"correct":false,"proposition":"A weight assay of immunoglobulins","justification":""},{"idx":3,"correct":false,"proposition":"A FSH-LH assay","justification":""},{"idx":4,"correct":false,"proposition":"A CMV serology","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-9-qi-9","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The complete blood count shows a hemoglobin of 9.8 g\/dL, with a MCV of 68 fL, the platelet count of 525 G\/L. Which of the following do you think is the most likely diagnosis based on history, clinical signs and laboratory results? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Nutritional deficiency","justification":"Anemia is probably iron deficiency"},{"idx":1,"correct":false,"proposition":"Crohn's disease","justification":""},{"idx":2,"correct":false,"proposition":"Cystic fibrosis","justification":""},{"idx":3,"correct":false,"proposition":"Biermer's disease","justification":"Anemia would be rather macrocytic"},{"idx":4,"correct":false,"proposition":"Hepatocellular insufficiency","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-9-qi-10","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The dietary survey confirms your hypothesis of serious deficiency on an inadequate diet, since the child drinks only semi-skimmed cow's milk, sugary drinks and nibbles cakes. Regarding the recommended dietary and vitamin allowances at this age, which is (are) accurate? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Fluoride supplementation is recommended for all children from birth","justification":"You don't have teeth at birth 🦷😬"},{"idx":1,"correct":false,"proposition":"A vitamin C supplement is necessary in winter","justification":""},{"idx":2,"correct":false,"proposition":"Growing up milk can be replaced by cow's milk from 18 months","justification":""},{"idx":3,"correct":false,"proposition":"Breastfeeding provides adequate iron intake at this age","justification":""},{"idx":4,"correct":true,"proposition":"Infant formulas are fortified with vitamin D","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-9-qi-11","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"You consult his health record. At 2 months: hexavalent and pneumococcal conjugate vaccine with 13 valences. at 6 months: hexavalent and pneumococcal conjugate vaccine with 13 valences. At 7 months: meningococcal C. vaccination at 12 months: hexavalent and pneumococcal conjugate vaccine with 13 valences. There has been no medical examination since the age of 12 months. Regarding the vaccination recommendations in force for this 18-month-old infant, what is the exact proposal(s)? (one or more true propositions)","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Meningococcal C vaccine is missing","justification":"Two in total"},{"idx":1,"correct":true,"proposition":"One dose of hepatitis vaccine is missing","justification":"3 total"},{"idx":2,"correct":true,"proposition":"At least one dose of measles\/mumps\/rubella (MMR) vaccine is missing","justification":"2 in total, at 12 then 16-18 months"},{"idx":3,"correct":false,"proposition":"One dose of 23-valent pneumococcal polysaccharide vaccine is missing","justification":"13 valances"},{"idx":4,"correct":false,"proposition":"Missing dose of varicella vaccine","justification":"No mandatory varicella vaccine, nor recommended at this age (it is in adolescents and adults who were not infected in childhood)"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-9-qi-12","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"You are also worried about the psychomotor development of this 18-month-old child, who has very little stimulation from parents and spends her days in front of the television screen. Which of these propositions is (are) accurate?","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Walking must be acquired","justification":""},{"idx":1,"correct":true,"proposition":"The child knows how to drink alone","justification":""},{"idx":2,"correct":false,"proposition":"Their language must be at least 100 words long","justification":""},{"idx":3,"correct":true,"proposition":"It combines 2 to 3 words","justification":""},{"idx":4,"correct":true,"proposition":"The child can stack 2 cubes","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-9-qi-13","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"This child's language is dissyllabic, she does not associate two words and does not react to the call of her name. She stands alone and takes a few steps when invited but is spontaneously << very calm >>. Which of the following investigations should be carried out in the first line? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"An ENT consultation for audiometry","justification":"Deafness must be eliminated in front of this clinical description. It is a common cause of delayed psychomotor development."},{"idx":1,"correct":false,"proposition":"A CPK assay","justification":""},{"idx":2,"correct":false,"proposition":"Evoked potentials of the brainstem","justification":""},{"idx":3,"correct":false,"proposition":"An electromyogram","justification":""},{"idx":4,"correct":false,"proposition":"An ophthalmological examination","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-9-qi-14","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The ENT consultation finds normal hearing, you retain a deficiency origin to this psychomotor delay. Faced with this table of accidental poisoning and serious deficiency of food intake, irregular medical monitoring (with vaccination delay), what step(s) do you think is necessary? (one or more true propositions)","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A phone call from the gendarmerie","justification":"This is not the regulatory route"},{"idx":1,"correct":true,"proposition":"A report to the public prosecutor","justification":""},{"idx":2,"correct":false,"proposition":"A report to the Regional Health Agency","justification":"The ARS is not concerned"},{"idx":3,"correct":false,"proposition":"Worrying information at the High Authority of Health (HAS)","justification":"The HAS is not concerned"},{"idx":4,"correct":false,"proposition":"A phone call to the child's doctor and the Maternal Child Protection","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-9-qi-15","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"You write a judicial report. Which of the following is correct? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The name of the medical writer(s) must remain anonymous","justification":"It must be clearly identified"},{"idx":1,"correct":false,"proposition":"He must suggest the person responsible for the abuse","justification":"It must be objective and descriptive"},{"idx":2,"correct":false,"proposition":"It must be given to both parents","justification":"Parents may be informed, unless the child is in the best interests of the contrary"},{"idx":3,"correct":true,"proposition":"It must mention the identity of the persons holding parental authority","justification":""},{"idx":4,"correct":false,"proposition":"Parents must be informed of the report","justification":"Unless otherwise interested of the child"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-11-qi-1","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"What element(s) do you look for in the clinical examination of the patient who may participate in infertility? ","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Positive Prehn's sign","justification":"We do not think of acute orchitis in this context"},{"idx":1,"correct":true,"proposition":"Unilateral gynecomastia","justification":""},{"idx":2,"correct":true,"proposition":"Cryptorchidism","justification":""},{"idx":3,"correct":true,"proposition":"Hair abnormality","justification":""},{"idx":4,"correct":false,"proposition":"Ligament hyperlaxity","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-11-qi-2","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The patient has already made a spermogram after 4 days of abstinence of which he shows you the results: ejaculated volume at 5 ml, sperm concentration: 2 million \/ ml, total sperm motility: 10%, 75% spermatozoa, 1% normal forms. What are the exact proposal(s)?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"There is hypospermia","justification":"Threshold at 1.5 mL"},{"idx":1,"correct":true,"proposition":"There is oligospermia","justification":"Threshold at 15 million\/mL"},{"idx":2,"correct":true,"proposition":"There is teratospermia","justification":"1% is not much 😉"},{"idx":3,"correct":false,"proposition":"There is necrospermia","justification":"Well, we don't know what the 75% means (are these normal or dead spermatozoa?), so we don't tick"},{"idx":4,"correct":true,"proposition":"There is asthenospermia","justification":"10% mobility is not much at all 😅"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-11-qi-3","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"No etiology is found to these spermogram abnormalities explaining infertility and pregnancy is obtained by intracytoplasmic injection of spermatozoa. The 1 trimester of pregnancy passes without difficulty except for nausea and some bleeding of red blood. The patient consults at 27 SA because her last two urine strips showed the presence of leukocytes and nitrites. She has no fever, no urinary symptoms apart from slight cough leakage. She has had a recurrent cough since the beginning of winter. She therefore restricts herself from drinking to limit leakage. What is the most likely diagnosis? (only one answer expected)","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Urogenital tuberculosis","justification":""},{"idx":1,"correct":false,"proposition":"Cystitis","justification":""},{"idx":2,"correct":true,"proposition":"Urinary colonization","justification":""},{"idx":3,"correct":false,"proposition":"Molar pregnancy","justification":""},{"idx":4,"correct":false,"proposition":"Bladder lithiasis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-11-qi-4","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"You have a cytobacteriological examination of urine performed which shows: 42000 red blood cells \/ ml, 12000 leukocytes per mL, and 10 power 5 E. Coli \/ mL in culture. What do you do?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Amoxicillin treatment should be started as a first-line treatment","justification":""},{"idx":1,"correct":false,"proposition":"First-line fosfomycin-trometamol therapy should be started","justification":""},{"idx":2,"correct":true,"proposition":"It is necessary to wait for the results of the susceptibility test to treat","justification":""},{"idx":3,"correct":false,"proposition":"Intravenous dual antibiotic therapy is needed","justification":""},{"idx":4,"correct":true,"proposition":"There is a risk of acute pyelonephritis if left untreated","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-11-qi-5","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"Escherichia coli colonization recurs several times during pregnancy and required 4 lines of antibiotic treatment. The patient gives birth at 38 SA+ 4 J of a little girl of 4180 g vaginally without episiotomy. Three weeks later, she consults for an alteration of the general condition, a fever at 38.8 ° C, urinary functional signs such as pollakiuria and leakage with effort and pain that she has difficulty systematizing but predominant in the right hemiabdomen. Her daughter is formula-fed and is doing well. What diagnosis(s) are possible at this stage? ","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Cystitis","justification":""},{"idx":1,"correct":true,"proposition":"Endometritis","justification":""},{"idx":2,"correct":true,"proposition":"Pyelonephritis","justification":""},{"idx":3,"correct":false,"proposition":"Renal colic","justification":""},{"idx":4,"correct":true,"proposition":"Pelvic thrombophlebitis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-11-qi-6","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"On clinical examination the vaginal touch is painless, the breasts are flexible, there is pain at the shaking of the right lumbar fossa with a painful path radiating in addition pubic. Cardiopulmonary auscultation finds a decrease in vesicular murmur in the right base. The patient is febrile at 38.7°C, heart rate is 132\/min and blood pressure is 87\/53 mmHg. Which exam(s) are you asking for as a first line?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Doppler ultrasound of the lower limbs","justification":""},{"idx":1,"correct":true,"proposition":"Cytobacteriological examination of urine","justification":""},{"idx":2,"correct":true,"proposition":"Renal imaging"},{"idx":3,"correct":false,"proposition":"D-dimer"},{"idx":4,"correct":true,"proposition":"Blood"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-11-qi-7","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The imagery is as follows. Which proposal(s) is the exact proposal(s): (one or more expected proposals)","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"These are cuts of abdominal-pelvic CT scan after injection of contrast medium","justification":""},{"idx":1,"correct":true,"proposition":"There is dilation of the right pyelocalicial cavities","justification":""},{"idx":2,"correct":false,"proposition":"There is a right pyelic calculation","justification":""},{"idx":3,"correct":true,"proposition":"There is a right ureteral calculus","justification":""},{"idx":4,"correct":false,"proposition":"There is a syndrome of right kidney mass","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-11-qi-8","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The abdominopelvic CT scan therefore shows a dilation of the right pyelocalicial cavities upstream of a 7 mm ureteral stone. Direct examination of urine shows the presence of leukocytes, red blood cells and gram-negative bacilli. As she returned from the CT scan, the patient's blood pressure dropped to 65\/30 mmHg and the lumbar fossa pain intensified. Her state of consciousness is normal, she has some mottling on her knees. What therapeutic measure(s) is possible in the first line? ","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"No measures should delay surgical management","justification":""},{"idx":1,"correct":true,"proposition":"Crystalloid-like solute filling","justification":""},{"idx":2,"correct":false,"proposition":"Parenteral bi-antibiotic therapy with fluoroquinolone and aminoglycoside","justification":""},{"idx":3,"correct":true,"proposition":"Parenteral bi-antibiotic therapy with beta-lactam and aminoglycoside","justification":""},{"idx":4,"correct":true,"proposition":"Administration of vasopressive drug type noradrenaline","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-11-qi-9","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The patient responds well to crystalloid filling and her blood pressure is now stabilized at 100\/58 mmHg. What additional therapeutic measure do you propose in this context? (only one answer expected)","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Nonsteroidal anti-inflammatory drugs","justification":""},{"idx":1,"correct":true,"proposition":"Urine drainage by JJ or ureteral tube","justification":""},{"idx":2,"correct":false,"proposition":"Urine drainage by bladder tube alone","justification":""},{"idx":3,"correct":false,"proposition":"Ureteroscopy for stone extraction after 48 h of effective antibiotic therapy","justification":""},{"idx":4,"correct":false,"proposition":"Ureteral drainage by JJ tube after 48 h of effective antibiotic therapy","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-11-qi-10","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"After the placement of a JJ tube (non-purulent urine) and 72 hours of adapted antibiotic therapy, the patient's clinical condition improves and she can go home. You see it again in consultation 1 month later and the CT scan without injection shows that the stone has been pushed back into the upper calyx. It always measures 7 mm and its density is 1050 UH. The JJ tube is quite poorly tolerated with pollakiuria and almost permanent pain. What are the possible measures for the continuation of the care (one or more correct answers):","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"JJ probe removal and monitoring","justification":""},{"idx":1,"correct":true,"proposition":"Extracorporeal lithotripty","justification":""},{"idx":2,"correct":true,"proposition":"Ureteroscopy extraction","justification":""},{"idx":3,"correct":false,"proposition":"Percutaneous nephrolithotomy","justification":""},{"idx":4,"correct":false,"proposition":"Iterative changes to the JJ probe","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-11-qi-11","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"You finally decide to perform a flexible ureteroscopy with extraction of all the lithiasic fragments that are sent for analysis. Given the elements at your disposal, what is the most likely majority component of this calculation? ","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Calcium oxalate","justification":""},{"idx":1,"correct":false,"proposition":"Struvite","justification":""},{"idx":2,"correct":false,"proposition":"Medicated lithiasis","justification":""},{"idx":3,"correct":false,"proposition":"Cystine","justification":""},{"idx":4,"correct":false,"proposition":"Uric acid","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-11-qi-12","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"Infrared spectrophotometry concludes that it is a calculation composed of 75% whewellite (calcium oxalate monohydrate), 25% wedellite (calcium oxalate dihydrate). What can be the contributing factor(s) of such a calculation in this patient?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Primary hyperparathyroidism","justification":""},{"idx":1,"correct":false,"proposition":"Hypocalciuria"},{"idx":2,"correct":false,"proposition":"Recurrent urinary tract infections","justification":""},{"idx":3,"correct":true,"proposition":"Inadequate water intake","justification":""},{"idx":4,"correct":false,"proposition":"Protein intakes too low","justification":"Too important"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-11-qi-13","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The first-line etiological assessment you prescribed is normal. What recurrence prevention measure(s) are you putting in place?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Decreased calcium intake (< 400 mg\/d)","justification":"800-1000 mg\/day"},{"idx":1,"correct":true,"proposition":"Decrease in sodium intake (6 g\/d)","justification":""},{"idx":2,"correct":false,"proposition":"Hydration for a diuresis volume of about 1 L","justification":"2L"},{"idx":3,"correct":false,"proposition":"Alkalization of urine"},{"idx":4,"correct":false,"proposition":"Weekly antibiotic prophylaxis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-11-qi-14","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The patient comes back to see you 4 years later because she thinks her stones are recurring. However, she experienced a second pregnancy without lithiasis recurrence and gave birth without difficulty to a little boy weighing 3560 grams 18 months ago. For the past few weeks, she has felt embarrassed by a bladder stone that frequently makes her want to urinate day and night. She feels pelvic heaviness aggravated by prolonged standing. Her needs are so urgent that she can't always restrain herself. On the other hand, his cough leaks disappeared except possibly in the morning when he woke up. Sexual intercourse is unpleasant. What is the most likely diagnostic hypothesis?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Lithiasis enclosed in the urethra","justification":""},{"idx":1,"correct":false,"proposition":"Urinary tract infection","justification":""},{"idx":2,"correct":true,"proposition":"Genital prolapse","justification":""},{"idx":3,"correct":false,"proposition":"Carcinoma in situ","justification":""},{"idx":4,"correct":true,"proposition":"uterine fibroid","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-11-qi-15","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"Your clinical examination confirms the presence of a grade 3 anterior colpocele. What is the most plausible explanation for the disappearance of stress urinary incontinence: (one exact proposition)","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Lithiasis enclosed in the urethra","justification":""},{"idx":1,"correct":false,"proposition":"Childbirth-related synechia","justification":""},{"idx":2,"correct":true,"proposition":"Plication of the urethra by the colpocele","justification":""},{"idx":3,"correct":false,"proposition":"Sequelae of urinary tract infections","justification":""},{"idx":4,"correct":false,"proposition":"Urethral calcification by calcium oxalate","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-12-qi-1","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"What is the most relevant information to look for during the interview or clinical examination? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Abdominal pain","justification":"The main question is: is it a GEU? The absence of abdominal pain would then be very reassuring."},{"idx":1,"correct":false,"proposition":"An open neck","justification":""},{"idx":2,"correct":false,"proposition":"Abundant metrorrhagia","justification":""},{"idx":3,"correct":false,"proposition":"A uterus too large for the term","justification":""},{"idx":4,"correct":false,"proposition":"An exacerbation of sympathetic signs of pregnancy","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-12-qi-2","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"In this patient, physical examination reveals moderate pain caused in the defenseless right iliac fossa. Blood pressure is at 130\/70 mmHg. The heart rate is at 80 bpm. The uterus is impalpable due to the patient's overweight. On examination under speculum, moderate red bleeding comes from the endocervix. At vaginal touch, there is no mass, but palpation of the right cul-de-sac triggers moderate pain. Which diagnosis do you prefer at this stage of management? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Ectopic pregnancy","justification":"Priority is always given to the most serious and urgent 😉"},{"idx":1,"correct":false,"proposition":"Non-progressive intrauterine pregnancy","justification":""},{"idx":2,"correct":false,"proposition":"Molar pregnancy","justification":""},{"idx":3,"correct":false,"proposition":"Active intrauterine pregnancy","justification":""},{"idx":4,"correct":false,"proposition":"Spontaneous abortion in progress","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-12-qi-3","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Following your clinical examination, you decide to perform an endovaginal pelvic ultrasound. Which ultrasound sign(s) would be compatible with the diagnosis of ectopic pregnancy?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Thickening of the endometrium","justification":""},{"idx":1,"correct":true,"proposition":"Absence of effusion in the rectouterine cul-de-sac (Douglas)","justification":""},{"idx":2,"correct":true,"proposition":"Absence of visible right laterouterine mass","justification":""},{"idx":3,"correct":true,"proposition":"Corpus luteum on the right ovary","justification":""},{"idx":4,"correct":true,"proposition":"Hypoechoic intrauterine image without hyperechoic crown","justification":"Everything is 'compatible'"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-12-qi-4","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"The pelvic ultrasound you perform shows uterine emptiness, no intra-abdominal effusion and no visible adnexal mass. Plasma HCG is measured at 900 IU\/L. What therapeutic strategy do you adopt (only one expected response)?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Intramuscular injection of methotrexate on an outpatient basis","justification":""},{"idx":1,"correct":false,"proposition":"Laparoscopy explorer","justification":""},{"idx":2,"correct":false,"proposition":"Administration of oral misoprostol on an outpatient basis","justification":""},{"idx":3,"correct":true,"proposition":"Expectancy and reassessment within 48 h with new HCG assay and control ultrasound","justification":""},{"idx":4,"correct":false,"proposition":"Endorish aspiration with sending of samples in anatomical pathology for chorionic villus testing","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-12-qi-5","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"You see the patient again two days later. She still feels a slight pain in the right iliac fossa. Minimal metrorrhagia persist. The HCGs are at 1200 in the same laboratory. The control ultrasound reveals this time a hematosalpinx of 20mm on the right, without visible embryo and without abdominal effusion. Your increased suspicion of ectopic pregnancy therefore leads you to prescribe methotrexate. Which proposals are correct?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Folic acid should be systematically combined","justification":""},{"idx":1,"correct":true,"proposition":"A transient increase in HCG is usual","justification":""},{"idx":2,"correct":false,"proposition":"It may be accompanied by hand-foot syndrome","justification":""},{"idx":3,"correct":true,"proposition":"The success rate is correlated with the HCG rate","justification":""},{"idx":4,"correct":false,"proposition":"A tubal rupture can occur","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-12-qi-6","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"What advice(s) do you give to the patient? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Absolute contraindication to microprogestogens","justification":""},{"idx":1,"correct":false,"proposition":"Need for early pelvic ultrasound in case of new pregnancy","justification":"We have not found this notion even if it would seem logical 🤔 to us"},{"idx":2,"correct":false,"proposition":"Respect a minimum of 6 months after the injection of methotrexate to start a new pregnancy","justification":"The recommended period is 3 months"},{"idx":3,"correct":true,"proposition":"Smoking cessation","justification":"Always always"},{"idx":4,"correct":false,"proposition":"Perform a hysterosalpingography to assess tubal patency","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-12-qi-7","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Two years after the management of this ectopic pregnancy, the patient returns to consult as part of the follow-up of a new pregnancy. This pregnancy is desired. It is at 12 SA. She has no symptoms. It brings you the result of the early pregnancy assessment prescribed by its general practitioner: blood group O rhesus negative, negative search for irregular agglutinins, rubella serology IgG +, serology toxoplasmosis IgG + \/ lgM-, HBsAg-, TPHA-VDRL-, HIV serology- You take the opportunity to perform a urine strip, it reveals 2 blood crosses and 2 protein crosses, no leukocytes or nitrites. Blood pressure is measured at 130\/80 mmHg. What is (are) your prescription(s)? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Quantification of urinary red blood cells by ECBU","justification":"Positive BU -> ECBU of confirmation and precision"},{"idx":1,"correct":true,"proposition":"Renal ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Cystoscopy","justification":""},{"idx":3,"correct":true,"proposition":"Proteinuria\/creatinine ratio","justification":""},{"idx":4,"correct":false,"proposition":"Uroscanner","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-12-qi-8","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"The next day (12+1 SA), you receive the results of the prescribed examinations. The ECBU is sterile 3 but confirms a red blood cell rate of 10 red blood cells\/mm. The proteinuria\/creatinine ratio is 40 mg\/mmol. Ultrasound shows the absence of kidney malformation and normal-sized kidneys without macroscopic cysts as well as a bladder without abnormalities. The plasma creatinine assay is 50 micromoL\/L. What etiology(ies) is (are) compatible with the whole picture presented by this patient?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Pre-eclampsia"},{"idx":1,"correct":true,"proposition":"Alport syndrome"},{"idx":2,"correct":false,"proposition":"Stenosis of the renal arteries","justification":""},{"idx":3,"correct":true,"proposition":"lgA nephropathy"},{"idx":4,"correct":false,"proposition":"Autosomal dominant polycystic disease","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-12-qi-9","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Given the probable existence of nephropathy pre-existing to pregnancy, a consultation with a nephrologist is scheduled. In the absence of renal failure, the latter provides for a renal biopsy to be performed once the pregnancy is over. \nThe monitoring of pregnancy subsequently proves satisfactory, especially in terms of blood pressure. At 31 weeks, the patient consults for decreased fetal active movements. She is also asymptomatic. Its temperature is 37 °C.  His blood pressure is 140\/80 mmHg. The uterine height is measured at 26 cm. His osteotendinous reflexes are normal. Fetal cardio monitoring is normal. \nYou perform a fetal ultrasound. Fetal biometrics include: biparietal diameter at 258 percentile, cephalic perimeter at 308 percentile, abdominal perimeter at 58 percentile, femur length 48 percentile, fetal weight estimate at 38 percentile. The uterine Doppler has a decreased diastole on both sides, without notch. The umbilical Doppler has zero diastole. The cerebral Doppler has an increased diastole. There is no visible fetal malformation. The amount of amniotic fluid is decreased. \nWhat argument(s) support(s) the hypothesis of a vasculo-placental cause that can explain these biometrics?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Decreased diastole on uterine Doppler","justification":""},{"idx":1,"correct":true,"proposition":"Decreased amount of amniotic fluid","justification":""},{"idx":2,"correct":false,"proposition":"Absence of uterine Doppler \"notch\"","justification":"It is a present notch that directs us to a vascular cause"},{"idx":3,"correct":true,"proposition":"Preserved cephalic biometrics","justification":""},{"idx":4,"correct":true,"proposition":"Increased diastole on cerebral Doppler","justification":"This is a sign of brain adaption"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-12-qi-10","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Given this small fetus for gestational age, you decide to hospitalize the patient for fetal heart rate monitoring 3 times a day. What therapeutic measure(s) do you decide to implement? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Fetal lung maturation corticosteroid therapy","justification":"<34 Ltd"},{"idx":1,"correct":false,"proposition":"Tocolysis by atosiban","justification":""},{"idx":2,"correct":false,"proposition":"Magnesium sulphate","justification":"< 32 SA if imminent delivery for the baby potit or if neuros signs in front of pre-eclampsia for the mother potitis"},{"idx":3,"correct":false,"proposition":"Central antihypertensive","justification":""},{"idx":4,"correct":false,"proposition":"Low-dose aspirin","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-12-qi-11","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"After 24 hours of hospitalization, the patient's condition deteriorates. Blood pressure is now measured at 150\/100 mmHg. The patient complains of headache and epigastric pain. His diuresis is quantified at 200 ml since his hospitalization. The reflexes are sharp, diffused and polykinetic. Cardiofetal monitoring is not very oscillating with decelerations. You perform an emergency biological assessment, the results are as follows: platelets 60 G \/ L, hemoglobin 9 g \/ dL, schizocytes positive, haptoglobin 0.2 g \/ l, asat 230 IU \/ L, ALAT 340 IU \/ L. What are the priority therapeutic measures (one or more exact answers)? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Second injection of corticosteroids","justification":""},{"idx":1,"correct":true,"proposition":"Prevention of eclampsia by magnesium sulfate","justification":""},{"idx":2,"correct":true,"proposition":"Fetal extraction","justification":"This is an absolute emergency"},{"idx":3,"correct":false,"proposition":"Transfusion of red blood cells","justification":""},{"idx":4,"correct":false,"proposition":"Intravenous antihypertensive","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-12-qi-12","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"An emergency caesarean section is performed. The patient gives birth to a 1020 g girl cared for by the neonatal team. Breastfeeding is maternal. At 72 hours, maternal progress is satisfactory. High blood pressure has disappeared, as have headaches. Osteotendinous reflexes have normalized. Diuresis resumed normally. Maternal work-up also improved in the first 48 hours after delivery with the disappearance of HELLP syndrome. On day 4, the patient presents with fever at 38.5°C and significant hypogastric pelvic pain. His blood pressure is 130\/70 mmHg and his pulse is 90 bpm. Examination with the speculum reveals smelly lochia mixed with blood in small quantities. The caesarean section scar is clean. The breasts are tense, painful as a whole, without inflammatory cupboard or palpable mass. There is no axillary lymphadenopathy. The patient has not had a venous route or urinary catheter for 48 hours. No preventive anticoagulant therapy was initially initiated due to HELLP syndrome. What is the diagnosis you mention first? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Salpingitis","justification":""},{"idx":1,"correct":false,"proposition":"Pelvic abscess","justification":""},{"idx":2,"correct":true,"proposition":"Endometritis","justification":""},{"idx":3,"correct":false,"proposition":"Pelvic thrombophlebitis","justification":""},{"idx":4,"correct":false,"proposition":"Following an intraoperative perforation","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-12-qi-13","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"You perform a pelvic ultrasound in front of this suspicion of endometritis. A small placental retention measured 15 mm in sagittal section of the uterus is observed. What is (are) the element(s) of your therapeutic management? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Ceftriaxone and intravenous metronidazole","justification":"It's augmentin now (new reco 2021)"},{"idx":1,"correct":true,"proposition":"Endouterine aspiration in the operating room","justification":""},{"idx":2,"correct":false,"proposition":"Stopping breastfeeding","justification":""},{"idx":3,"correct":false,"proposition":"Methotrexate","justification":""},{"idx":4,"correct":true,"proposition":"Low molecular weight heparin at prophylactic dose","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-12-qi-14","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Three days after starting treatment with antibiotics and heparin therapy at a prophylactic dose, pelvic pain persists, as does fever. The patient is still bloated. You request a CT scan with contrast injection. What is the most likely diagnosis?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Textiloma"},{"idx":1,"correct":false,"proposition":"Urolithiasis enclosed in the lower right ureter","justification":""},{"idx":2,"correct":false,"proposition":"Acute appendicitis"},{"idx":3,"correct":true,"proposition":"Thrombosis of the right ovarian vein","justification":""},{"idx":4,"correct":false,"proposition":"Left pelvic abscess"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-12-qi-15","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"In addition to the patient's personal and family thrombotic history, what additional risk factor(s) do you identify in this context of right ovarian vein thrombosis?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Primiparity","justification":""},{"idx":1,"correct":false,"proposition":"The context of prematurity","justification":""},{"idx":2,"correct":true,"proposition":"The patient's body mass index","justification":""},{"idx":3,"correct":true,"proposition":"Caesarean section","justification":""},{"idx":4,"correct":true,"proposition":"Postpartum endometritis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-12-qi-16","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Knowing that serum creatinine is controlled at 70 micromol \/ L and that the patient wishes to continue breastfeeding, what is your anticoagulant prescription for this thrombophlebitis of the right ovarian vein ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Fluindione","justification":""},{"idx":1,"correct":false,"proposition":"Acenochocoumarol","justification":""},{"idx":2,"correct":false,"proposition":"Warfarin","justification":""},{"idx":3,"correct":true,"proposition":"Enoxaparin at a hypocoagulant dose","justification":"LMWH then AVK relay"},{"idx":4,"correct":false,"proposition":"Cellar filter","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-14-qi-1","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"In view of the context, which diagnosis is to be mentioned in the first intention? ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Bladder lithiasis","justification":""},{"idx":1,"correct":true,"proposition":"Cystitis","justification":""},{"idx":2,"correct":false,"proposition":"Pyelonephritis","justification":""},{"idx":3,"correct":false,"proposition":"Renal tumour","justification":""},{"idx":4,"correct":false,"proposition":"Urothelial tumour","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-14-qi-2","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What is (are) the element(s) to be collected during the interrogation in this context of discovery of hematuria? (one or more true propositions) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"History of gross hematuria","justification":""},{"idx":1,"correct":true,"proposition":"Presence of proteinuria on the strip","justification":""},{"idx":2,"correct":false,"proposition":"Exposure to lead","justification":"No report"},{"idx":3,"correct":true,"proposition":"Family history of hematuria","justification":""},{"idx":4,"correct":false,"proposition":"Family history of bladder cancer","justification":"We do not start at all on a bladder cancer, which is not a hereditary pathology"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-14-qi-3","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"The ECBU you prescribed to the patient currently finds: red blood cells 150,000\/ml; leukocytes< 1,000\/ml, sterile culture. There was a proteinuria with 2 crosses to the strip but the urine was concentrated. Her blood pressure is currently at 150\/90 mmHg in your consulting room. Her urinary beta-HCG is negative (the last menstrual period started 8 days ago). What biological examination(s) do you prescribe for this patient at this stage: (one or more expected proposals) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Serum creatinine with glomerular filtration rate calculation","justification":""},{"idx":1,"correct":true,"proposition":"Proteinuria and creatinineuria on urine specimen","justification":""},{"idx":2,"correct":false,"proposition":"Crystalluria","justification":""},{"idx":3,"correct":false,"proposition":"Urinary cytology","justification":""},{"idx":4,"correct":false,"proposition":"Urinary pH","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-14-qi-4","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What imaging test(s) do you prescribe for this patient at this stage? ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Uroscanner ","justification":""},{"idx":1,"correct":false,"proposition":"Endovaginal pelvic ultrasound","justification":""},{"idx":2,"correct":true,"proposition":"Renal and bladder ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"uro-MRI","justification":""},{"idx":2,"correct":false,"proposition":"Retrograde cystography and voiding","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-14-qi-5","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What is the action to take in the face of the discovery of this high blood pressure in this patient? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Prescription of amlodipine pending the results of biological tests","justification":""},{"idx":1,"correct":true,"proposition":"Request for outpatient self-measurement of blood pressure measurements","justification":""},{"idx":2,"correct":false,"proposition":"Prescription of an anxiolytic","justification":""},{"idx":3,"correct":false,"proposition":"Need to see the patient again within 48 hours for blood pressure control","justification":""},{"idx":4,"correct":true,"proposition":"Reassessment of blood pressure after discontinuation of ibuprofen","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-14-qi-6","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"The results of the prescribed examinations are as follows: Na 142 mmol\/L; K 4 mmol\/L, 2); proteinuria 2.5 g\/24 h, selective; serum creatinine 90 μmol\/L (DFG CKD-EPI at 71 mL\/min\/1.73 m^2 ECBU red blood cells 200,000\/mL, leukocytes< 1,000\/ml. Renal ultrasound finds kidneys of 118 mm and 122 mm respectively on the right and left with a cyst of the upper right pole of 1 cm. They are well differentiated, the cortical thickness is 22 mm, homogeneous. His ambulatory blood pressure is 150\/90 mmHg on average despite stopping ibuprofen. She describes asthenia and a recent loss of her hair that she links to strong tensions at work. You refer the patient to a nephrologist with other laboratory tests. Which examination(s) is the most relevant exam(s) given the context in this patient?","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"NFS, platelets","justification":""},{"idx":1,"correct":true,"proposition":"Plasma protein immunoelectrophoresis","justification":""},{"idx":2,"correct":false,"proposition":"Determination of parathyroid hormone and 250H vitamin D","justification":""},{"idx":3,"correct":true,"proposition":"Anti-nuclear factors, anti-DNA antibodies","justification":""},{"idx":4,"correct":true,"proposition":"Dosage C3, C4, CH50","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-14-qi-7","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"Your additional assessment is as follows: leukocytes 3.50 G \/ L, Hb 9 g \/ dL, VGM 92 fi; e platelets 200 G\/L, reticulocytes 250 G\/L, anti-nuclear factors positive at 1\/160 with native anti-DNA antibodies at 40 Ul\/ml, C3 0.5 g\/L (0.8-1.6); C4 0.08 g\/L (0.17-0.53), CH50 40 50 CRP 7 mg\/L; HCV and HIV negative serologies; HBV serology: anti-HBs 100 Ul\/ml antibodies, negative anti-HBc antibodies. What is (are) in favor of a diagnosis of systemic lupus? ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Leukopenia","justification":""},{"idx":1,"correct":true,"proposition":"Consumption of the supplement","justification":""},{"idx":2,"correct":true,"proposition":"Regenerative anemia","justification":""},{"idx":3,"correct":false,"proposition":"Inflammatory syndrome","justification":""},{"idx":4,"correct":true,"proposition":"Microscopic hematuria","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-14-qi-8","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What are the possible causes of this anemia in this context (one or more correct answers)? ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Chronic renal failure","justification":""},{"idx":1,"correct":false,"proposition":"Immunological thrombocytopenic purpura","justification":""},{"idx":2,"correct":true,"proposition":"Coombs-positive hemolytic anemia","justification":""},{"idx":3,"correct":false,"proposition":"Thrombotic microangiopathy","justification":""},{"idx":4,"correct":true,"proposition":"Acute gynecological bleeding","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-14-qi-9","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What extrarenal clinical signs will you look for in the context of this probable lupus flare-up? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Mouth ulcers","justification":""},{"idx":1,"correct":true,"proposition":"Erythema nodosum","justification":""},{"idx":2,"correct":true,"proposition":"Polyarthritis","justification":""},{"idx":3,"correct":false,"proposition":"Scleroditactyly","justification":""},{"idx":4,"correct":true,"proposition":"Vulvar ulcerations","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-14-qi-10","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"The patient has non-erosive mouth ulcers and arthritis of the hands and you are diagnosed with systemic lupus. What is the most appropriate course of action for this patient at this stage? (Only one response is expected.) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Biological monitoring as a first step","justification":""},{"idx":1,"correct":true,"proposition":"Performing a transparietal renal biopsy puncture","justification":""},{"idx":2,"correct":false,"proposition":"Realization of a uroscanner","justification":""},{"idx":3,"correct":false,"proposition":"Performing a renal angiography","justification":""},{"idx":4,"correct":false,"proposition":"No need for renal histological confirmation in this context of leupic nephropathy","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-14-qi-11","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"You decide to perform a kidney biopsy on this patient. She is hospitalized in nephrology. His clinical examination regained a blood pressure of 155\/90 mmHg. She is apyretic but has had voiding burns for 48 hours. Its biological balance finds: leukocytes 3.8 G \/ L, Hb 9.4 g \/ dL, VGM 88 fL, platelets 220 G \/ L, Na 142 mmol \/ L, K 3.7 mmol \/ L; 2 ); serum creatinine 99 μmol\/L (glomerular filtration rate CKD-EPI at 63 ml\/min\/1.73 m^2 proteinuria 2.2 g\/24 h, selective; ECBU red blood cells 300,000\/ml; leukocytes 20,000\/ml; many live Gram-negative bacilli. You decide to treat 48 hours this probable cystitis before performing the renal biopsy puncture and normalizing his blood pressure. What are the elements of your therapeutic care? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Treatment with metronidazole","justification":""},{"idx":1,"correct":false,"proposition":"Treatment with single-dose ofloxacin","justification":""},{"idx":2,"correct":false,"proposition":"Amoxicillin treatment","justification":""},{"idx":3,"correct":true,"proposition":"Treatment with fosfomycin-trometamol","justification":""},{"idx":4,"correct":false,"proposition":"Treatment with gentamicin","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-14-qi-12","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What are the possible basic histological elements in this patient given her clinicobiological presentation? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Dominant mesangial deposits of immunoglobulin A and complement","justification":""},{"idx":1,"correct":true,"proposition":"Extra-capillary proliferation","justification":""},{"idx":2,"correct":true,"proposition":"Endocapillary proliferation","justification":""},{"idx":3,"correct":true,"proposition":"Extramembranous immunoglobulin and complement deposits in immunofluorescence","justification":""},{"idx":4,"correct":false,"proposition":"Glomerular deposits of dominant C3","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-14-qi-13","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"Here is the report of your patient's renal biopsy: 8 mm renal cortical fragment containing 15 glomeruli including 1 sealing loaf; Optical microscopy: 10 glomeruli out of 15 are the site of endocapillary proliferation, presence of extra-capillary proliferations on 3 glomeruli, voluminous endomembranous deposits along the glomerular capillaries making << wireloops >>; - polymorphic interstitial infiltrate on about 30% of the cortical surface; - no vascular lesions or tubular lesions, presence of haematic cylinders in some tubular lumen; - immunofluorescence:  granular deposits of Ig G, lgM, C3 and C1q to 3+ mesangial and 2+ endomembranous on all glomeruli, no extramembranous deposits, fibrin deposits on 4 out of 18 glomeruli. What is your diagnosis?","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Extramembranous lupus glomerulonephritis","justification":""},{"idx":1,"correct":false,"proposition":"Pure mesangial lupus glomerulonephritis","justification":""},{"idx":2,"correct":true,"proposition":"Diffuse proliferative lupus glomerulonephritis","justification":""},{"idx":3,"correct":false,"proposition":"Tubulointerstitial lupus nephritis","justification":""},{"idx":4,"correct":false,"proposition":"Focal proliferative lupus glomerulonephritis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-14-qi-14","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"Your patient therefore has a systemic lupus flare-up with hemolytic anemia, polyarthritis, canker sores, alopecia and class IV lupus glomerulonephritis (diffuse proliferative). What are the treatment options for attack therapy in this patient? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A course of infliximab","justification":"It's an alpha anti-TNF, nothing to see"},{"idx":1,"correct":false,"proposition":"A course of rituximab","justification":"It's an anti-CD20, nothing to see"},{"idx":2,"correct":true,"proposition":"bolus of methylprednisolone then prednisone 1 mg\/kg","justification":""},{"idx":3,"correct":true,"proposition":"mycophenolate mofetil","justification":""},{"idx":4,"correct":true,"proposition":"cyclophosphamide","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-14-qi-15","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"You start the attack treatment which is well tolerated including corticosteroid therapy in high doses. His blood pressure is 145\/90 mmHg on ramipril that you started before the kidney biopsy. His renal assessment before discharge is as follows: serum creatinine 97 μmol \/ L (filtration rate 2 glomerular CKD-EPI at 65 ml \/ min \/ 1.73 m ^ 2 ), proteinuria 2.2 g \/ 24 h; ECBU red blood cells 350000\/ml. What are the different possible therapeutic measures before returning home? (one or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Amlodipine in combination with ramipril","justification":""},{"idx":1,"correct":true,"proposition":"Hydroxychloroquine","justification":""},{"idx":2,"correct":true,"proposition":"Cholecalciferol","justification":""},{"idx":3,"correct":true,"proposition":"Hydrochlorothiazide in combination with ramipril","justification":""},{"idx":4,"correct":false,"proposition":"Candesartan in combination with ramipril","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-15-qi-1","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"What are you looking for in interrogation to explore this anomaly? (One or more correct answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Recent extended stay at altitude","justification":""},{"idx":1,"correct":true,"proposition":"Tobacco use"},{"idx":2,"correct":true,"proposition":"Alcohol consumption"},{"idx":3,"correct":true,"proposition":"Recent fever"},{"idx":4,"correct":true,"proposition":"Recent weight gain"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-15-qi-2","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"On clinical examination, what signs would point you to primary polycythemia? (one or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Palar erythrosis","justification":""},{"idx":1,"correct":true,"proposition":"Aquagenic pruritus","justification":""},{"idx":2,"correct":false,"proposition":"Conjunctival hyperemia","justification":""},{"idx":3,"correct":false,"proposition":"Exertional dyspnea","justification":""},{"idx":4,"correct":false,"proposition":"Splenomegaly","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-15-qi-3","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"You make a blood count that shows: GR 6.9 T\/L; haemoglobin 18.7 g\/dL, haematocrit 57%; MCV 83 fL, MCHC 33 g\/dL, reticulocytes 80 G\/L, leukocytes 12.6 G\/L, neutrophils 10.4 G\/L, eosinophil polynuclear 0.3 G\/L, basophilic polynuclear 0.05 G\/L, lymphocytes 1.25 G\/L, monocytes 0.6 G\/L, platelets 534 G\/L. What does this blood count show? (one or more possible answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Polycythemia","justification":""},{"idx":1,"correct":false,"proposition":"Hyperreticulocytosis","justification":""},{"idx":2,"correct":false,"proposition":"Hyperchromia","justification":""},{"idx":3,"correct":false,"proposition":"Microcytosis","justification":""},{"idx":4,"correct":true,"proposition":"Thrombocytosis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-15-qi-4","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"You find on examination a splenomegaly with a costal overhang of 2 cm and the notion of aquagenic pruritus. Which of the following tests are useful in this patient to support the diagnosis of polycythemia vera (one or more answers are possible)?","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Erythropoietin Dosage","justification":""},{"idx":1,"correct":false,"proposition":"Myelogram","justification":""},{"idx":2,"correct":true,"proposition":"JAK2 mutation search","justification":""},{"idx":3,"correct":false,"proposition":"Culture of erythroid progenitors","justification":""},{"idx":4,"correct":false,"proposition":"Isotopic globular mass","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-15-qi-5","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"You see the patient again with the results of your tests. He has a JAK2 mutation and erythropoietin levels are plummeted. The patient, worried, asks you about complications that may occur. What do you say to him (One or more possible answers here)?","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Venous thrombosis","justification":""},{"idx":1,"correct":true,"proposition":"Arterial thrombosis","justification":""},{"idx":2,"correct":false,"proposition":"Lysis syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Disseminated intravascular coagulation","justification":""},{"idx":4,"correct":true,"proposition":"Gout attack","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-15-qi-6","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"About polycythemia vera, which propositions are true? (One or more possible answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"It is a clonal disease of mature hematopoietic cells","justification":""},{"idx":1,"correct":true,"proposition":"This is a myeloproliferative syndrome","justification":""},{"idx":2,"correct":false,"proposition":"There is an erythroblastic maturation blockade","justification":""},{"idx":3,"correct":false,"proposition":"Circulating erythroblasts are observed","justification":""},{"idx":4,"correct":true,"proposition":"There is spontaneous growth of erythroblastic progenitors in vitro","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-15-qi-7","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"The patient asks you about the principles of treatment. What kind of care do you discuss with him? (One or more correct answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Bleedings","justification":""},{"idx":1,"correct":true,"proposition":"Acetyl-salicylic acid","justification":""},{"idx":2,"correct":false,"proposition":"Anticoagulants","justification":""},{"idx":3,"correct":false,"proposition":"Mdt","justification":""},{"idx":4,"correct":false,"proposition":"Repeated blood donations at EFS","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-15-qi-8","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"The patient had initial bleeding and is currently on antiaggregants. Three months later, your patient comes to see you 48 hours after returning from vacation in the West Indies. He has a painful left calf that has been swollen for 24 hours. What clinical elements will support your suspicion of deep vein thrombosis (phlebitis)? (One or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Calf pressure pain","justification":""},{"idx":1,"correct":true,"proposition":"Increased calf circumference","justification":""},{"idx":2,"correct":false,"proposition":"Calf contracture","justification":""},{"idx":3,"correct":false,"proposition":"Decreased pediosus pulse","justification":""},{"idx":4,"correct":true,"proposition":"Dilation of superficial veins","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-15-qi-9","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"What are the risk factors for phlebitis in this patient? (One or more correct answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Obesity","justification":""},{"idx":1,"correct":false,"proposition":"Long-term antiplatelet agent","justification":""},{"idx":2,"correct":false,"proposition":"High blood pressure (hypertension)","justification":""},{"idx":3,"correct":false,"proposition":"Hypercholesterolemia","justification":""},{"idx":4,"correct":true,"proposition":"Air travel","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-15-qi-10","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"The clinical examination is not very specific. Which tests are useful for diagnosis? (One or more possible answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Pulmonary angiography","justification":""},{"idx":1,"correct":true,"proposition":"Doppler ultrasound of the lower limbs","justification":""},{"idx":2,"correct":false,"proposition":"Phlebography of the lower limbs","justification":""},{"idx":3,"correct":false,"proposition":"TP, TCA, fibrin","justification":""},{"idx":4,"correct":false,"proposition":"Search for protein C and S deficiency","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-15-qi-11","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"Doppler ultrasound confirmed the existence of sural phlebitis. What therapeutic attitudes are possible in this patient? (One or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Direct oral anticoagulants","justification":""},{"idx":1,"correct":false,"proposition":"Acetylsalicylic acid and clopidogrel","justification":""},{"idx":2,"correct":true,"proposition":"Low molecular weight heparin","justification":""},{"idx":3,"correct":false,"proposition":"Strict bed rest","justification":""},{"idx":4,"correct":true,"proposition":"Venous compression","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-15-qi-12","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"You have opted for LMWH treatment with early relay with vitamin K antagonist (warfarin). What recommendations do you give your patient in relation to this treatment? (one or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Wearing a card mentioning the treatment on oneself","justification":""},{"idx":1,"correct":true,"proposition":"Taking warfarin at a fixed time","justification":""},{"idx":2,"correct":false,"proposition":"Follow a strict diet","justification":"This is not a strict diet: just avoid a few foods that interfere with hepatic enzyme metabolism."},{"idx":3,"correct":false,"proposition":"Strict cessation of alcohol consumption","justification":""},{"idx":4,"correct":true,"proposition":"Prohibition of intramuscular injections","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-15-qi-13","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"During his follow-up, the patient calls you because his control INR is 5.5. He found no bleeding signs. What do you do? ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"You hospitalize him","justification":""},{"idx":1,"correct":true,"proposition":"You ask him to skip a catch","justification":""},{"idx":2,"correct":false,"proposition":"You prescribe vitamin K orally","justification":""},{"idx":3,"correct":false,"proposition":"You prescribe protamine sulfate","justification":""},{"idx":4,"correct":true,"proposition":"You recheck the INR the next day","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-15-qi-14","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"Your patient has been transferred to a city 500 km from your home. You have no news for several years. Then, a doctor who sees him for the first time calls you because the patient is referred to him for discomfort. The blood count shows: Hb 10 g\/dL, MCV 83 fL, leukocytes 3 G\/L, PNN 0.8 G\/L, lymphocytes 1 G\/L, monocytes 0.2 G\/L, blast cells 1 G\/L, platelets 86 G\/L. What abnormalities do you see on this blood count? (One or more correct answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Neutropenia","justification":""},{"idx":1,"correct":true,"proposition":"Thrombocytopenia","justification":""},{"idx":2,"correct":false,"proposition":"Balanced myelemia","justification":""},{"idx":3,"correct":true,"proposition":"Pancytopenia","justification":""},{"idx":4,"correct":false,"proposition":"Microcytic anemia","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-15-qi-15","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"What diagnoses do you mention in this context? (One or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Transformation into acute leukemia","justification":""},{"idx":1,"correct":false,"proposition":"Progression to myelofibrosis","justification":""},{"idx":2,"correct":false,"proposition":"Syndrome de Richter","justification":""},{"idx":3,"correct":false,"proposition":"Transformation into chronic myelogenous leukemia","justification":""},{"idx":4,"correct":false,"proposition":"Progression to myeloid splenomegaly","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-16-qi-1","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The nurse on the unit gives you the following information: blood pressure at 95\/55mmHg, temperature at 39°C and heart rate at 110\/min. Dyspnea is in the foreground. On pulmonary auscultation, you find a decrease in the vesicular murmur of the base of the left lung. Which of the following proposals is (are) the element(s) in favor of pleural effusion in this patient?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Noise added to left one-sided crackling type","justification":""},{"idx":1,"correct":true,"proposition":"Dull percussion at the left base","justification":""},{"idx":2,"correct":false,"proposition":"Increased vocal vibration","justification":""},{"idx":3,"correct":false,"proposition":"Noise added to expiratory sibilant type","justification":""},{"idx":4,"correct":false,"proposition":"Chest distension","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-16-qi-2","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"You get more information for this patient who lives alone at home independently. He has a history of NYHA stage III heart failure on ischemic and hypertensive heart disease. The nurse had her daughter on the phone telling her that her father has not been elected as usual for 48 hours, with incoherent words. \nAt careful pulmonary auscultation, you find noises added to type of unilateral crackles in the left base. Vocal vibrations are increased in the left base. He has no signs of right heart failure. \nWhich of the following is the most likely etiology(s) of the pulmonary picture? (one or more exact propositions)","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Acute pericarditis"},{"idx":1,"correct":false,"proposition":"Pulmonary embolism"},{"idx":2,"correct":true,"proposition":"Community-acquired bacterial pneumonia","justification":""},{"idx":3,"correct":false,"proposition":"Pneumothorax"},{"idx":4,"correct":true,"proposition":"Community-acquired viral pneumonia","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-16-qi-3","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"To assess the seriousness of this patient, which element seems most important?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Looking for a sign of neurological focus","justification":""},{"idx":1,"correct":false,"proposition":"Purpura search","justification":""},{"idx":2,"correct":true,"proposition":"Respiratory rate measurement","justification":""},{"idx":3,"correct":false,"proposition":"Diuresis measurement","justification":""},{"idx":4,"correct":false,"proposition":"Search for a paradoxical pulse","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-16-qi-4","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The patient has a respiratory rate of 35\/min and his saturation is measured at 94% in ambient air. You suspect acute lobar pneumonia. Which of the following additional examinations should be carried out immediately? (one or more exact propositions)","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Blood gas","justification":""},{"idx":1,"correct":true,"proposition":"ECG","justification":""},{"idx":2,"correct":false,"proposition":"D-Dimers","justification":""},{"idx":3,"correct":true,"proposition":"X-ray of the front chest","justification":""},{"idx":4,"correct":true,"proposition":"Blood","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-16-qi-5","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"Biological samples are in progress and chest X-ray shows alveolar opacity of the left base associated with low pleural effusion. Arterial blood gases show: PaO 62 mmHg; PaCO 28 mmHg; lactate 1.3 mmol\/L; pH 7.46. Which of the following propositions in this patient is(s) the correct statement(s)? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"You immediately think of a pulmonary embolism","justification":""},{"idx":1,"correct":false,"proposition":"You think it's consistent with the diagnosis of pneumonia","justification":""},{"idx":2,"correct":false,"proposition":"You think the value of lactate points to acute community-acquired pneumonia","justification":""},{"idx":3,"correct":false,"proposition":"You think pleural effusion may explain the gasometric shunt effect","justification":""},{"idx":4,"correct":false,"proposition":"You suspect a sampling error","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-16-qi-6","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"Given the context of falling, you examine the musculoskeletal system. Your exam finds pain in your right hip. You suspect a fracture of the right femoral neck because there are: (one or more possible answers) ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Functional impotence of the right lower limb","justification":""},{"idx":1,"correct":true,"proposition":"Pain on palpation of the right great trochanter","justification":""},{"idx":2,"correct":false,"proposition":"Internal rotation of the right hip","justification":""},{"idx":3,"correct":false,"proposition":"A psoitis on the right side","justification":""},{"idx":4,"correct":false,"proposition":"Shortening of the lower right limb","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-16-qi-7","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The hip X-ray does not show a fracture of the femoral neck. The blood count shows leukocytes at 15 G\/L, hemoglobin at 10 g\/dL and platelets at 349 G\/L. The serum creatinine is 75 micromol\/L. What care do you start with this patient? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Nasal oxygen","justification":""},{"idx":1,"correct":true,"proposition":"Peripheral venous route","justification":""},{"idx":2,"correct":false,"proposition":"Intravenous ciprofloxacin","justification":""},{"idx":3,"correct":true,"proposition":"Low molecular weight heparin at preventive dose","justification":""},{"idx":4,"correct":false,"proposition":"Isotonic saline in venous infusion 3 liters \/ day","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-16-qi-8","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"Which of the following other measures is the most important to put in place? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Prevention of swallowing disorders","justification":""},{"idx":1,"correct":false,"proposition":"Prevention of dehydration","justification":""},{"idx":2,"correct":true,"proposition":"Pressure ulcer prevention","justification":"It is an early complication and carries great morbidity"},{"idx":3,"correct":false,"proposition":"Urinary catheter placement","justification":""},{"idx":4,"correct":false,"proposition":"Oral care","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-16-qi-9","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"During the first 24 hours of hospitalization, the patient has incoherent words. He believes he is in 1939. At times, on the contrary, it seems well suited. It is most often drowsy. When you enter the room, he does not remember seeing you in the morning and does not know that he is hospitalized. You mention a delirium syndrome. Which semiological element(s) present in the observation is (are) in favor of this diagnostic hypothesis? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Attentional disorders","justification":""},{"idx":1,"correct":true,"proposition":"Fluctuations in unrest","justification":""},{"idx":2,"correct":false,"proposition":"Phasia disorders","justification":""},{"idx":3,"correct":false,"proposition":"Memory disorder","justification":""},{"idx":4,"correct":false,"proposition":"Apathy","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-16-qi-10","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The patient was put on oxygen and antibiotic therapy was started. The next morning the nurse finds that the patient is getting worse. What sign(s) would be in favor of hypercapnia? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The presence of low blood pressure","justification":""},{"idx":1,"correct":false,"proposition":"The presence of ample dyspnea","justification":""},{"idx":2,"correct":true,"proposition":"Deepening confusion","justification":""},{"idx":3,"correct":true,"proposition":"The presence of sweat","justification":""},{"idx":4,"correct":true,"proposition":"An asterixis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-16-qi-11","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"Finally, the patient evolves favorably on the respiratory plan in your 3 days with apyrexia and a reduction in respiratory rate. However, he has not eaten anything in the last 3 days and you fear the presence of protein-energy malnutrition (MPE). Which of the following proposals regarding its nutritional status is the right proposal(s)?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"His nutritional status may not have deteriorated sufficiently in 3 days","justification":""},{"idx":1,"correct":false,"proposition":"The determination of blood albumin is essential to determine the nutritional status","justification":""},{"idx":2,"correct":false,"proposition":"Lack of power over the last 3 days can define an MPE","justification":""},{"idx":3,"correct":false,"proposition":"MPE can be defined according to HAS by weight loss over the past year","justification":""},{"idx":4,"correct":true,"proposition":"A body mass index < 21 kg\/m^2 defines MPE","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-16-qi-12","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"On the 4th day, your patient can get up but the bipodal support is painful preventing walking and the unipodal support on the right is impossible. A second hip X-ray is re-read normally. \nWhich of the following proposals regarding his condition is(s) the correct statement(s) at this stage? (one or more exact propositions)","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"You prescribe a bone scan","justification":""},{"idx":1,"correct":false,"proposition":"You suspect a simple bruise","justification":""},{"idx":2,"correct":true,"proposition":"You are looking for an ilio- or ischiopubic branch fracture","justification":""},{"idx":3,"correct":true,"proposition":"You prescribe a scanograhie of the pelvis and hips","justification":""},{"idx":4,"correct":false,"proposition":"You prescribe an X-ray of the right knee","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-16-qi-13","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The CT scan revealed a fracture of the right iliopubic branch. The evolution is favorable under analgesic treatment and active early mobilization in one week. You plan to return home. What element(s) should be assessed before considering a return home?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"ADL","justification":""},{"idx":1,"correct":true,"proposition":"IADL","justification":""},{"idx":2,"correct":false,"proposition":"MNA","justification":""},{"idx":3,"correct":true,"proposition":"Fried's criteria","justification":""},{"idx":4,"correct":false,"proposition":"Geriatric depression scale","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-16-qi-14","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"You have assessed their basic activities of daily living (ADL score). What element(s) constitutes this score? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"His ability to shop without help","justification":""},{"idx":1,"correct":false,"proposition":"Its ability to answer the phone without aids","justification":""},{"idx":2,"correct":false,"proposition":"Its ability to use public transport without aids","justification":""},{"idx":3,"correct":true,"proposition":"Its ability to eat without aids","justification":""},{"idx":4,"correct":false,"proposition":"Their ability to manage medications without aids","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-16-qi-15","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"You measure their current ADL (Basic Activities of Daily Living) score at 4\/6, and their iso-resource group (GIR) at 4. What is the correct interpretation(s)?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The ADL score shows that there is an addiction for one's instrumental activities of daily living","justification":""},{"idx":1,"correct":false,"proposition":"The GIR is associated with the ADL level","justification":"At the AGGIR grid"},{"idx":2,"correct":true,"proposition":"The ADL score does not measure the presence of a cognitive disorder","justification":""},{"idx":3,"correct":true,"proposition":"Cognitive impairment is taken into account in the measurement of the GIR","justification":""},{"idx":4,"correct":true,"proposition":"It seems likely that he will obtain financial assistance for his home helpers","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-17-qi-1","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"What semeiological element(s) are you looking for in favor of a cardiac cause of dyspnea in this patient? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Morning cough and sputum","justification":""},{"idx":1,"correct":false,"proposition":"Digital Hippocratism","justification":""},{"idx":2,"correct":false,"proposition":"Cough during exertion and decubitus","justification":""},{"idx":3,"correct":false,"proposition":"Gravity of the hypochondrium right to effort","justification":""},{"idx":4,"correct":false,"proposition":"Palpitations at the effrt","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-17-qi-2","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The patient lives on the 38th floor with elevator. He does not present respiratory discomfort for everyday gestures. On the other hand, it signals dyspnea when walking uphill at normal speed (4 km \/ h). \nAt what stage of the NYHA does this description fit?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"I"},{"idx":1,"correct":true,"proposition":"II"},{"idx":2,"correct":false,"proposition":"III"},{"idx":3,"correct":false,"proposition":"IV"},{"idx":4,"correct":false,"proposition":"Unclassifiable with available data","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-17-qi-3","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The patient has NYHA stage II dyspnea. Cardiac auscultation reveals mitral insufficiency. On which auscultatory anomaly(ies) is this diagnosis based?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Protodiastolic murmur","justification":""},{"idx":1,"correct":false,"proposition":"Mesosystolic strengthening breath","justification":""},{"idx":2,"correct":true,"proposition":"Holosystolic murmur","justification":""},{"idx":3,"correct":false,"proposition":"Raspy tone","justification":""},{"idx":4,"correct":false,"proposition":"Abolition of B1","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-17-qi-4","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The general practitioner refers the patient to a cardiology consultation. While waiting for his appointment, the patient is admitted to the emergency room for acute dyspnea. The emergency physician evokes an acute edema of the lung (OAP) cardigenic. What is the main semeiological argument for this diagnosis?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"oxygen desaturation (SpO2)"},{"idx":1,"correct":false,"proposition":"focus of crackling rales"},{"idx":2,"correct":true,"proposition":"Complete intolerance to supine position"},{"idx":3,"correct":false,"proposition":"chest tightness"},{"idx":4,"correct":false,"proposition":"jugular turgor","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-17-qi-5","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The clinical examination finds bilateral crackling rales going back to mid-field. Routine laboratory tests (blood count, platelets, blood ionogram, urea and serum creatinine) have been taken and you are waiting for the results. What is (are) the additional examination(s) essential before starting treatment? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Electrocardiogram","justification":""},{"idx":1,"correct":false,"proposition":"Determination of BNP or NT-proBNP","justification":""},{"idx":2,"correct":false,"proposition":"Determination of D-dimer","justification":""},{"idx":3,"correct":false,"proposition":"Pulmonary angio-CT","justification":""},{"idx":4,"correct":false,"proposition":"Echocardiography","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-17-qi-6","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"A chest X-ray is performed. What abnormality(s) present on this picture is (are) in favor of the diagnosis of heart failure?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Cardiomegaly"},{"idx":1,"correct":true,"proposition":"Right pleural effusion"},{"idx":2,"correct":false,"proposition":"Vascular redistribution at the bases","justification":""},{"idx":3,"correct":true,"proposition":"Kerley Lines"},{"idx":4,"correct":false,"proposition":"Pericardial effusion"}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-17-qi-7","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The electrocardiogram does not show an argument in favor of an acute coronary syndrome. The presence of orthopnea, diffuse subcrackling rales halfway up the pulmonary fields with bilateral radiological alveolar syndrome was sufficient for the diagnosis of acute pulmonary edema. Blood pressure is at 140\/90 mmHg, heart rate is at 110 beats\/min, there is no mottling or cooling of the extremities. Treatment with furosemide and oxygen therapy are started. Which complementary treatment(s) should be prescribed urgently? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Nitrates by intravenous infusion with an electric syringe","justification":""},{"idx":1,"correct":false,"proposition":"Dobutamine intravenous infusion with an electric syringe","justification":""},{"idx":2,"correct":false,"proposition":"Bisoprolol orally in small doses","justification":""},{"idx":3,"correct":false,"proposition":"Unfractionated intravenous heparin for 2.5x control ACT","justification":""},{"idx":4,"correct":false,"proposition":"Isotonic salted serum infusion 1 Uj","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-17-qi-8","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The response to treatment is quickly favorable. An electrocardiogram is recorded again. What is the interpretation of this electrocardiogram?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Normal electrocardiogram"},{"idx":1,"correct":true,"proposition":"Sequelae of myocardial infarction","justification":""},{"idx":2,"correct":false,"proposition":"Full right branch block","justification":""},{"idx":3,"correct":true,"proposition":"Sinus rhythm"},{"idx":4,"correct":false,"proposition":"Left posterior hemibloc (fascicular block)","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-17-qi-9","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"An echocardiogram is performed with the following results: - dilation of the left ventricle with alteration of the ejection fraction to 30%; - Akinesia of the lower wall with hypokinesia of the lateral wall of the left ventricle; - dilation of the left atrium and right ventricle; - elevation of the filling pressures of the left ventricle; - moderate mitral leakage (grade II) of restrictive mechanism associated with dilation of the mitral ring. Systolic pulmonary arterial pressure is estimated to be elevated. What is (are) the contribution(s) of this echocardiography concerning the diagnosis?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Mitral insufficiency is ischemic","justification":""},{"idx":1,"correct":true,"proposition":"The patient presented with an unnoticed myocardial infarction","justification":""},{"idx":2,"correct":true,"proposition":"The current picture of heart failure is due to ischemic heart disease","justification":""},{"idx":3,"correct":false,"proposition":"The current picture of heart failure is valvular cause","justification":""},{"idx":4,"correct":false,"proposition":"The patient developed pulmonary embolism","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-17-qi-10","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"It is an ischemic heart disease with mitral leakage secondary to an unnoticed inferior myocardial infarction, complicated by heart failure with impaired ejection fraction. Which of the following decisions is, at this stage, the most important for this patient? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Confirmation of pulmonary hypertension by right catheterization","justification":""},{"idx":1,"correct":true,"proposition":"Search for viability and myocardial ischemia of the left ventricle","justification":""},{"idx":2,"correct":false,"proposition":"Analysis of the possibility of mitral plasty surgery","justification":""},{"idx":3,"correct":false,"proposition":"Pre-heart transplant assessment","justification":""},{"idx":4,"correct":false,"proposition":"Metabolic stress test (with gas analysis and V02 calculation)","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-17-qi-11","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The search for myocardial ischemia is positive in the anteroseptal territory and leads to the realization of a coronary angiography. This examination reveals critical stenosis of the anterior interventricular coronary artery that is treated by angioplasty (percutaneous coronary intervention) and placement of a stent (stent). \nWhat is (are) the therapeutic adaptation(s) to be made before returning home?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Introduce a bradycardial calcium channel blocker (diltiazem or verapamil)","justification":""},{"idx":1,"correct":false,"proposition":"Initiate triple antithrombotic therapy (e.g. aspirin+apixaban+clopidogrel)","justification":""},{"idx":2,"correct":false,"proposition":"Combine ezetimibe with rosuvastatin","justification":""},{"idx":3,"correct":true,"proposition":"Introduce a beta oral blocker in progressive doses","justification":""},{"idx":4,"correct":true,"proposition":"Prescribe cardiac rehabilitation","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-17-qi-12","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The patient discharges the hospital with carvedilol, enalapril, aspirin, prasugrel, rosuvastatin, furosemide, potassium salts and metformin. It is reviewed periodically to gradually increase the doses of carvedilol and enalapril to the target doses. Four months after revascularization, he is still dyspneic on exertion at NYHA stage II. He describes a first episode of brief loss of consciousness when climbing stairs, 30 minutes after taking his treatment. The search for orthostatic arterial hypotension is negative. The electrocardiogram is not changed. Echocardiography shows the persistence of systolic dysfunction with a stationary left ventricle ejection fraction at 30%, mitral leakage has not evolved and remains moderate (grade II). What is (are) the therapeutic adaptation(s) to be made to manage heart failure and its consequences? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Introduce a mineralocorticoid receptor antagonist","justification":""},{"idx":1,"correct":false,"proposition":"Implant a defibrillator","justification":""},{"idx":2,"correct":false,"proposition":"Reduce the dosages of enalapril and carvedilol","justification":""},{"idx":3,"correct":false,"proposition":"Implement ventricular resynchronization by biventricular stimulator","justification":""},{"idx":4,"correct":false,"proposition":"Prohibit excessive alcohol consumption","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-17-qi-13","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"A few months later the patient presents a brutal, intense pain in the lower right limb which wakes him up at 6 am. He consults you at noon. The pain is intolerable agitating the patient, the foot is livid and cold with functional impotence. You will only find the femoral pulse in the right lower limb. You observe a discrete bilateral perimalleolar edema, taking the bucket. Skin sensitivity is decreased on the right side of the knee to the foot. Palpation of the calf is painful. What is the diagnosis to evoke in this patient? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Gout attack","justification":""},{"idx":1,"correct":false,"proposition":"Deep vein thrombosis of the lower limb","justification":""},{"idx":2,"correct":false,"proposition":"Paralyzing sciatica","justification":""},{"idx":3,"correct":false,"proposition":"Cholesterol crystal embolism","justification":""},{"idx":4,"correct":true,"proposition":"Acute ischemia of the lower limb","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-17-qi-14","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"In front of this brutal clinical picture you retain the occurrence of acute limb ischemia. What is (are) the sign(s) of gravity?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The presence of edema"},{"idx":1,"correct":true,"proposition":"The presence of a sensory and motor deficit","justification":""},{"idx":2,"correct":true,"proposition":"Pain at the pressure of muscle masses","justification":""},{"idx":3,"correct":true,"proposition":"A long delay in handling","justification":""},{"idx":4,"correct":true,"proposition":"The level of arterial obstruction","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-17-qi-15","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"What additional diagnostic examination do you propose to this patient before entrusting him to the surgical team? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"No further examination","justification":""},{"idx":1,"correct":false,"proposition":"CT angiography (CT scan)","justification":""},{"idx":2,"correct":false,"proposition":"Arteriography","justification":""},{"idx":3,"correct":false,"proposition":"MRI angiography","justification":""},{"idx":4,"correct":false,"proposition":"Ultrasound-Doppler","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-17-qi-16","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The surgical team will immediately take care of the patient to perform emergency revascularization. What is (are) the modality(s) of care to be put in place immediately?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Lower limb elevation","justification":"This will further decrease the arterial influx. On the contrary, they must be put in the unslid position."},{"idx":1,"correct":true,"proposition":"Unfractionated heparin with an electric syringe after an intravenous bolus","justification":""},{"idx":2,"correct":true,"proposition":"Stage 3 analgesic","justification":""},{"idx":3,"correct":true,"proposition":"Protection of the limb by avoiding compression points","justification":""},{"idx":4,"correct":true,"proposition":"Intravenous arterial vasodilator therapy","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-17-qi-17","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"What risk(s) is (s) to which the patient is exposed due to the occurrence of this acute ischemia? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Hypokalemia","justification":""},{"idx":1,"correct":true,"proposition":"Metabolic acidosis","justification":""},{"idx":2,"correct":true,"proposition":"Acute renal failure","justification":""},{"idx":3,"correct":true,"proposition":"Heart rhythm disorders","justification":""},{"idx":4,"correct":false,"proposition":"Acute liver failure","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-18-qi-1","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"What are the diagnoses to evoke in front of dysphonia (one or more expected responses) in this patient? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Polyp of vocal folds (vocal cords)","justification":""},{"idx":1,"correct":false,"proposition":"Intracordal nodule","justification":""},{"idx":2,"correct":true,"proposition":"Cancer of the vocal folds (vocal cords)","justification":""},{"idx":3,"correct":true,"proposition":"Unilateral laryngeal immobility","justification":""},{"idx":4,"correct":false,"proposition":"Oropharyngeal cancer","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-18-qi-2","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"Which of the following risk factors promote the development of vocal fold cancer (one or more expected responses)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Isolated ethyl poisoning","justification":""},{"idx":1,"correct":true,"proposition":"Alcohol and tobacco poisoning","justification":""},{"idx":2,"correct":true,"proposition":"Isolated tobacco poisoning","justification":""},{"idx":3,"correct":false,"proposition":"Infection à Hu man Papilloma Virus","justification":""},{"idx":4,"correct":false,"proposition":"Infection à Epstein Barr Virus","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-18-qi-3","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"The patient is seen in consultation with 0RL. Among the following tests, which are those that make it possible to evoke the diagnosis of laryngeal cancer during a 0RL consultation (one or more expected answers):","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Acoustic voice analysis","justification":""},{"idx":1,"correct":true,"proposition":"Laryngeal fibroscopy","justification":""},{"idx":2,"correct":true,"proposition":"Indirect LaryngoscoP.ie","justification":""},{"idx":3,"correct":false,"proposition":"Laryngeal videostroboscopy","justification":""},{"idx":4,"correct":false,"proposition":"Panendoscopy of the upper aerodigestive tract","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-18-qi-4","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"You are moving towards the diagnosis of laryngeal cancer. Which of the following functional signs is related to a significant spread of cancer (one or more expected responses)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Otalgia right reflex","justification":""},{"idx":1,"correct":true,"proposition":"Dysphagia to solids","justification":""},{"idx":2,"correct":true,"proposition":"Laryngeal dyspnea","justification":""},{"idx":3,"correct":true,"proposition":"Bloody Spit","justification":""},{"idx":4,"correct":true,"proposition":"Swallowing disorders with false routes mainly when ingesting fluids","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-18-qi-5","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"During the clinical examination of the patient, what are the essential gestures to be performed (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Dental examination","justification":""},{"idx":1,"correct":true,"proposition":"Complete inspection of the oropharynx and oral cavity","justification":""},{"idx":2,"correct":true,"proposition":"Endooral palpation","justification":""},{"idx":3,"correct":false,"proposition":"Otoscopy","justification":""},{"idx":4,"correct":true,"proposition":"Precise examination of lymph node areas","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-18-qi-6","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"You highlight cervical lymphadenopathy. What are the elements to be specified during the clinical examination (one or more expected answers)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Seat"},{"idx":1,"correct":true,"proposition":"Waist"},{"idx":2,"correct":true,"proposition":"Deep infiltration"},{"idx":3,"correct":true,"proposition":"Skin condition in relation to"},{"idx":4,"correct":false,"proposition":"Compression of the internal jugular vein","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-18-qi-7","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"At the end of your clinical examination, you perform a pharyngolaryngeal nasofibroscopy. You highlight a tumor of the right hemilarynx with the presence of several right cervical lymphadenopathy. What are the important elements missing from the description of your clinical examination (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Tumour colour","justification":""},{"idx":1,"correct":true,"proposition":"Macroscopic appearance of the tumour","justification":""},{"idx":2,"correct":true,"proposition":"Mobility of the right arytenoid","justification":""},{"idx":3,"correct":true,"proposition":"Mobility of the right vocal fold","justification":""},{"idx":4,"correct":true,"proposition":"Tumour size","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-18-qi-8","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"For this patient, what are the examinations you request as part of the locoregional and general extension assessment (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"PET scanner","justification":""},{"idx":1,"correct":false,"proposition":"Ultrasound of the vessels of the neck","justification":""},{"idx":2,"correct":false,"proposition":"Cervical MRI","justification":""},{"idx":3,"correct":true,"proposition":"Cervico-thoracic CT with injection","justification":""},{"idx":4,"correct":true,"proposition":"Panendoscopy of the upper aerodigestive tract under general anesthesia","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-18-qi-9","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"You decide to perform a panendoscopy of the upper aerodigestive tract under general anesthesia. An anesthesia consultation is mandatory. What are the characteristics of this consultation (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"It is governed by a decree of the Public Health Code","justification":""},{"idx":1,"correct":false,"proposition":"It is performed by the anaesthetist who will practice anesthesia during surgery","justification":""},{"idx":2,"correct":true,"proposition":"Informing the patient about the anesthesia procedure is mandatory","justification":""},{"idx":3,"correct":false,"proposition":"It is performed by any doctor regardless of his specialty","justification":""},{"idx":4,"correct":true,"proposition":"It is performed at least 48 hours before panendoscopy","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-18-qi-10","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"Which of the following biological examinations is essential before performing panendoscopy? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Calcium phosphate balance","justification":""},{"idx":1,"correct":false,"proposition":"Carcinoembryonic antigen (CEA) test","justification":""},{"idx":2,"correct":false,"proposition":"Determination of transaminases","justification":""},{"idx":3,"correct":false,"proposition":"CRP testing","justification":""},{"idx":4,"correct":true,"proposition":"Haemostasis assessment including INR, TCA, p lacquettes","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-18-qi-11","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"The cervico-thoracic CT scan was performed. What are the exact proposals (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"1 refers to cricoid cartilage","justification":""},{"idx":1,"correct":true,"proposition":"1 refers to thyroid cartilage","justification":""},{"idx":2,"correct":false,"proposition":"2 refers to epiglottic cartilage","justification":""},{"idx":3,"correct":true,"proposition":"2 refers to the laryngeal tumour","justification":""},{"idx":4,"correct":true,"proposition":"3 refers to the sternocleidostoid muscle","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-18-qi-12","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"At the end of all the examinations performed, the final diagnosis is a moderately differentiated squamous cell carcinoma of the right hemianx classified T3N2bM0. What are the mandatory rules to respect for the management of a patient with carcinoma (one or more expected responses)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Decision on taking charge in a multidisciplinary consultation meeting (RCP)","justification":""},{"idx":1,"correct":true,"proposition":"Management defined in agreement with the patient","justification":""},{"idx":2,"correct":true,"proposition":"Care at an authorized facility","justification":""},{"idx":3,"correct":true,"proposition":"Mandatory notification consultation","justification":""},{"idx":4,"correct":true,"proposition":"Application for inclusion on the list of long-term conditions made by the attending physician","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-18-qi-13","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"During the multidisciplinary consultation meeting, it was decided to propose a laryngeal preservation strategy with two chemotherapy courses combining cisplatin, 5FU, Docetaxel. Which of the following complications could be related to cisplatin (one or more expected responses)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Renal failure","justification":""},{"idx":1,"correct":true,"proposition":"Hearing loss","justification":""},{"idx":2,"correct":false,"proposition":"Mucite","justification":"The college of oncology does not report it! We were as surprised as you probably are now 😖."},{"idx":3,"correct":true,"proposition":"Dysesthesia of the extremities","justification":""},{"idx":4,"correct":true,"proposition":"Nausea, vomiting","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-18-qi-14","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"Because of the 5FU treatment, what toxicity do you monitor first? (Only one answer expected)","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Neurological toxicity","justification":""},{"idx":1,"correct":false,"proposition":"Liver toxicity","justification":""},{"idx":2,"correct":true,"proposition":"Cardiac toxicity","justification":"Beware of coronary spasms"},{"idx":3,"correct":false,"proposition":"Digestive toxicity","justification":""},{"idx":4,"correct":false,"proposition":"Renal toxicity","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2019-dp-18-qi-15","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"After two courses of chemotherapy, a regression of tumor volume greater than 50% associated with remobilization of the right hemilarynx was highlighted. was decided to perform cetuximab-sensitized radiotherapy. What are the complications of radiotherapy that could be observed in the medium or long term (one or more expected responses)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Hyposialia","justification":""},{"idx":1,"correct":true,"proposition":"Hypothyroidism","justification":""},{"idx":2,"correct":true,"proposition":"Laryngeal edema","justification":""},{"idx":3,"correct":true,"proposition":"Laryngeal dyspnea","justification":""},{"idx":4,"correct":true,"proposition":"Cervical sclerosis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-1-qi-1","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"What is your main diagnostic hypothesis? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Obliterating arterial disease of the lower limbs","justification":"This is the typical presentation"},{"idx":1,"correct":false,"proposition":"Narrow lumbar canal","justification":""},{"idx":2,"correct":false,"proposition":"Lombosciatica","justification":""},{"idx":3,"correct":false,"proposition":"Hypokalemia","justification":""},{"idx":4,"correct":false,"proposition":"Deep vein thrombosis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-1-qi-2","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You suspect arterial disease obliterating the lower limbs. Which of the following semiological elements will guide the diagnosis towards this hypothesis? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Occurrence of pain when walking","justification":""},{"idx":1,"correct":true,"proposition":"Symptomatology type of calf cramp","justification":""},{"idx":2,"correct":false,"proposition":"Reduction of pain by leaning forward","justification":"This is the description of the famous shopping cart sign, found in the narrowed lumbar canal"},{"idx":3,"correct":false,"proposition":"Disappearance of pain gradually for several hours","justification":"Decrease in pain at cessation of exertion in PAD. It is the onset of pain that is progressive."},{"idx":4,"correct":true,"proposition":"Faster onset of symptoms when the patient climbs a slope","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-1-qi-3","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"The interrogation confirms the appearance of a pain when walking with a cramp type localized in the right calf. The pain manifests itself early when the patient climbs a slope, thus supporting your diagnostic hypothesis of arterial obliterating disease of the lower limbs. On clinical examination, the patient measures 1.77 m, weighs 70 kg and the blood pressure is 134\/68 mmHg in both arms. Abdominal palpation does not perceive pulsatile or expansive mass. At the level of the lower left limb all peripheral pulses are found, the popliteal pulse seems however too well perceived. At the level of the lower right limb, only the femoral pulse is found. At auscultation you will find only a right cervical murmur and a murmur in the upper 1\/3 of the left thigh. On the data of this clinical examination, which is(are) the arterial atheromatous lesion(s) that you should suspect?","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Stenosis of the right external iliac artery","justification":""},{"idx":1,"correct":true,"proposition":"Left common femoral artery stenosis","justification":"The perception of a murmur on auscultation points to stenosis of the artery. Not to be confused with an obliteration, which corresponds to a total stenosis, that is to say that the blood does not pass at all. At the auscultation of an obliteration, we do not find a breath. On palpation of an obliteration, no pulse is found."},{"idx":2,"correct":true,"proposition":"Right common femoral artery stenosis","justification":"No pulse = total stenosis."},{"idx":3,"correct":true,"proposition":"Left popliteal artery aneurysm","justification":"Pulse too well perceived = aneurysm"},{"idx":4,"correct":false,"proposition":"Left leg artery stenosis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-1-qi-4","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You mention the existence of a stenosis of the left femoral artery, a left popliteal aneurysm and a right femoral obliteration-reinjection. To confirm the diagnosis of obliterating arterial disease of the lower limbs you perform a measurement of the Systolic Pressure Index (SPI) in the ankle. The SPI is 0.67 at the lower right limb and 0.85 at the left lower limb. What are the semiological value and limitations of this parameter? (one or more correct answers). ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"When the SNI is less than 0.90, it confirms the diagnosis of peripheral arterial disease","justification":"The SPI standard is between 0.9 and 1.3 (1.4 is found as the higher standard in some sources). Below 0.9, he signs an AOMI. Above 1.3 (or 1.4), it signs arterial incompressibility (found in diabetic patients and chronic renal failure dialysis) due to mediacalcosis (calcification of the media, the intermediate tunica of the vessels, between the intima and the weed). An IPS below 0.7 indicates severe PAD."},{"idx":1,"correct":true,"proposition":"When the SNI is less than 0.90, it indicates an over-risk of cardiovascular morbidity and mortality","justification":""},{"idx":2,"correct":true,"proposition":"When the SPI is greater than 1.40, it indicates arterial stiffness associated with mediacalcosis","justification":""},{"idx":3,"correct":true,"proposition":"The presence of a mediacalcosis requires the use of toe pressure and not ankle pressure for the calculation of the IPS","justification":"This is the way we have found to counter the mediacalcolsis. The arteries of the toe are less prone to medicalcolsis. However, it should not be forgotten that it is physiological that the pressure of the toe is lower than the pressure of the ankle. The standard is therefore lower. Indeed, in case of taking the voltage of the ortel, the standard of the IPS is then 0.7"},{"idx":4,"correct":false,"proposition":"ABI should be measured in patients suspected of acute sensory-motor ischemia to confirm diagnosis","justification":"Acute limb ischemia is a medical-surgical, functional and even vital emergency. No examination should slow down management."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-1-qi-5","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"To specify the arterial lesion assessment, which is (are) the additional first-line examination(s) you are requesting? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"arteriography of the aorta and lower limbs","justification":""},{"idx":1,"correct":true,"proposition":"Doppler ultrasound of the abdominal aorta and arteries of the lower limbs","justification":"Makes it possible to precisely identify lesions, to evaluate the degree of stenosis and to objectify functional adaptation."},{"idx":2,"correct":true,"proposition":"a Doppler ultrasound of arterial axes for cervico-encephalic purposes","justification":"In the previous questions, the patient has a cervical murmur. It must therefore be explored."},{"idx":3,"correct":false,"proposition":"angio-MRI of the arterial axes for cervico-encephalic","justification":""},{"idx":4,"correct":false,"proposition":"CT angiography of the aorta and lower limbs","justification":"Is done pre-operatively of a revascularization"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-1-qi-6","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You asked in first intention the realization of a Doppler ultrasound of the axes for cervico-encephalic use, the aorta and the lower limbs to specify the arterial lesions. This objective examination an atheromatous overload at the level of the arterial axes of the supra-aortic trunks without significant stenosis. The abdominal aorta is regular and measures 28 mm in anteroposterior diameter. There is an obliteration of the right femoral artery with reinjection of the popliteal artery. There is also stenosis in the middle third of the left femoral artery. The left popliteal artery is regular and measures 13 mm in diameter in its widest dimension. Given the absence of a threatening lesion, you decide to treat this patient medically. What therapeutic measure(s) are you going to put in place? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Statine","justification":"Drug treatment of intermittent claudication is based on anti-platelet aggregation (by aspirin at anti-aggregating dose), an inhibitor of the converting enzyme (ACE inhibitor, the patient is already on perindopril for his hypertension, so we will keep it), and a statin (with an LDLc goal of less than 0.7 g \/ L because we are in secondary prevention,  the lesions are already there). It is associated with therapeutic education (sports activity, smoking cessation, Mediterranean diet, ...) and rehabilitation to progressive effort. Finally, we can discuss a gesture of revascularization."},{"idx":1,"correct":false,"proposition":"Beta-blocker to replace perindopril","justification":"ACE inhibitor is the treatment of choice in PAD"},{"idx":2,"correct":true,"proposition":"Antiplatelet agent","justification":"Treatment formally indicated from the stage of intermittent claudication. It is discussed in case of completely asymptomatic PAD (rare case)."},{"idx":3,"correct":false,"proposition":"Direct oral anticoagulant","justification":"We are not dealing with a coagulation problem. Neither AOD nor Heparin are therefore indicated. Indeed, in the arterial circuit, it is mainly a problem of primary hemostasis (platelet aggregation and formation of a thrombus) that may arise."},{"idx":4,"correct":false,"proposition":"Low molecular weight heparin","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-1-qi-7","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"In addition to drug treatment, what advice(s) will you give to your patient? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Smoking cessation","justification":"The patient still smokes"},{"idx":1,"correct":false,"proposition":"Low-calorie diet","justification":"He is not overweight"},{"idx":2,"correct":false,"proposition":"Strict salt-free diet","justification":"His high blood pressure seems to be under control. Even if this were not the case, we would potentially advise a low-sodium (<6g\/D) and unsodized (<4g\/D) diet. The latter, the soda diet, is reserved for cases of cirrhosis with refractory ascites for example."},{"idx":3,"correct":false,"proposition":"Hypoglycemic diet","justification":"He is not diabetic"},{"idx":4,"correct":true,"proposition":"30-minute walk a day 5 times a week","justification":"That's 150 minutes of physical activity per week"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-1-qi-8","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You see the patient again after 6 months of treatment and prescribe a treadmill walking test. Regarding this review, what is the exact proposal(s)? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"It makes it possible to assess the disability related to arterial disease obliterans of the lower limbs ","justification":"The shorter the patient can walk, the greater the disability."},{"idx":1,"correct":false,"proposition":"It makes it possible to measure in a standardized way the distance traveled in 6 minutes","justification":"This proposal refers to the 6-minute walking test (TM6), useful in pulmonology. It consists of measuring the distance that a patient can travel in 6 minutes. Here, the test of walking on a treadmill is something else entirely: the patient puts himself on a treadmill advancing at 3.2km\/h with a slope of 10%, and he walks as long as possible (no time limit)."},{"idx":2,"correct":true,"proposition":"It allows a reassessment of SNPs after walking","justification":"The SPI is evaluated after walking and compared to that at rest."},{"idx":3,"correct":false,"proposition":"It is only intended for patients with mediacalcosis","justification":"There is no real connection with medicalcosis 😅"},{"idx":4,"correct":true,"proposition":"It allows the evaluation of the functional value of collateral circulation","justification":"The longer the patient can walk, the more the collateral circulation ensures a satisfactory locum function."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-1-qi-9","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"The walking test shows only moderate functional disability, compatible with continued medical treatment. The cardiologist consulted beforehand performed a stress ultrasound on dobutamine which does not show signs of myocardial ischemia. Resting echocardiography is also normal, with the exception of the presence of dilatation of the left atrium. Smoking cessation is ongoing. The patient is treated with atorvastatin, aspirin and perindopril. A year later, he consulted the cardiologist for palpitations that had been evolving episodically for several weeks. What is the possible cause(s) of palpitations in this patient? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Atrial tachycardia","justification":"Atrial tachycardia can cause palpitations (this is what you can feel after a 100m sprint at the end of D4 🤭 #vecu)."},{"idx":1,"correct":true,"proposition":"Atrial extrasystoles","justification":"If there are many and as a result, it is possible to feel palpitations. This is also the case for ventricular extrasystoles."},{"idx":2,"correct":false,"proposition":"Paroxysmal atrioventricular block","justification":"We find rather a bradycardia. It is not a cause of palpitation."},{"idx":3,"correct":true,"proposition":"Atrial fibrillation","justification":"First etiology to look for in case of palpitations."},{"idx":4,"correct":false,"proposition":"Ventricular fibrillation","justification":"Ventricular fibrillation never returns to normal on its own, and leads to cardiorespiratory arrest quickly and death if left untreated. If the patient had had VF, we would know."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-1-qi-10","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"An electrocardiogram is performed, of which here is the trace.","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"junctional tachycardia"},{"idx":1,"correct":true,"proposition":"atrial fibrillation"},{"idx":2,"correct":false,"proposition":"Atrial Flutter"},{"idx":3,"correct":false,"proposition":"atrial extrasystoles"},{"idx":4,"correct":false,"proposition":"sinus tachycardia"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-1-qi-11","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"Which factor(s) were considered to assess the thromboembolic risk of atrial fibrillation in this patient? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Peripheral arterial disease (PAD)","justification":""},{"idx":1,"correct":false,"proposition":"Smoking","justification":""},{"idx":2,"correct":true,"proposition":"History of high blood pressure (hypertension)","justification":""},{"idx":3,"correct":true,"proposition":"Age","justification":""},{"idx":4,"correct":false,"proposition":"The recent nature of atrial fibrillation (AF)","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-1-qi-12","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"Renal function is normal and treatment with direct oral anticoagulant with apixaban is started due to age over 65 years, high blood pressure and peripheral arterial disease. The very reliable interrogation of the patient makes it possible to specify that palpitations occur in episodes whose duration varies between 6 and 72 hours. How to qualify this atrial fibrillation according to the data collected (only one answer)?","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Persistent","justification":""},{"idx":1,"correct":false,"proposition":"Perm","justification":""},{"idx":2,"correct":false,"proposition":"Isolated","justification":""},{"idx":3,"correct":true,"proposition":"Paroxysmal","justification":"Spontaneous reduction in less than 7 days (here 'between 6 and 72 hours' according to the statement)."},{"idx":4,"correct":false,"proposition":"Resistant","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-1-qi-13","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"This is paroxysmal atrial fibrillation. You decide to prescribe a beta-blocker to slow the frequency of atrial fibrillation. After 3 days of treatment, the patient presents to the emergency room for lipothymia and exertional dyspnea. The electrocardiogram shows only sinus bradycardia at 42 beats \/ minute. Blood pressure is normal, the patient is asymptomatic to decubitus, there is no sign of low flow, diuresis is preserved, pulmonary auscultation is normal. What is your care? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Modification of treatment and return home","justification":""},{"idx":1,"correct":true,"proposition":"Suspension of beta-blocker and resumed at reduced doses","justification":"It is probably the introduction of the beta-blocker that is at the origin of bradycardia, therefore of the patient's symptomatology. We therefore stop the offending drug, with a wash-out period, then resume in small doses when the patient stabilizes, finding a dose that optimizes the benefit\/risk balance."},{"idx":2,"correct":false,"proposition":"Placement of a percutaneous electrosystolic training probe","justification":""},{"idx":3,"correct":false,"proposition":"Isoprenaline infusion","justification":""},{"idx":4,"correct":false,"proposition":"Installation of a permanent pacemaker","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-1-qi-14","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"This is an adverse reaction of the beta-blocker whose dosage was not adequate. After dose reduction, the situation stabilizes favorably. Treatment with direct oral anticoagulant is continued. A few weeks later, the patient presents again for an attack of atrial fibrillation prolonged for more than 4 days but perfectly well tolerated under beta-blocker. You offer him an electrical cardioversion scheduled for the coming weeks. What will be the condition(s) for achieving this electrical cardioversion? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Previous transesophageal echocardiography","justification":"ETO is not useful if cardioversion is covered by 3 weeks of anticoagulation before."},{"idx":1,"correct":false,"proposition":"Relay of direct oral anticoagulant by low molecular weight heparin at curative dose","justification":"We are very happy with the AOD 😊. Furthermore, LMWHs do not have MA in atrial fibrillation. So, at the ECN, you should never tick them! The HnF will then be used."},{"idx":2,"correct":false,"proposition":"Realization at low energy under light sedation by midazolam","justification":"Must be done under general anesthesia (an external electric shock, it hurts a lot!). 😰"},{"idx":3,"correct":true,"proposition":"Anesthesia consultation","justification":"The medico-legal delay of an anesthesia consultation is at least 48 hours. The pre-anesthetic visit is carried out a few hours before."},{"idx":4,"correct":false,"proposition":"Weekly INR check for a target between 2 and 3","justification":"DOACs do not have biological monitoring parameters, which is sometimes problematic (when one needs to measure its effect exactly, for example when introducing a drug known for its enzymatic inducing effect)."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-1-qi-15","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"Electrical cardioversion is successfully performed two weeks later. Antiarrhythmic treatment is undertaken by flecainide which makes the symptoms disappear. The patient asks you about stopping direct oral anticoagulant therapy now that the atrial fibrillation has disappeared. What do you say to him (one correct answer)? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Discontinuation of direct oral anticoagulant therapy 4 weeks after cardioversion","justification":"This proposition would have been true if he had a CHADS-VASc at 0, or if he was under 65 and a purely isolated AF."},{"idx":1,"correct":false,"proposition":"Discontinuation of direct oral anticoagulant therapy if long-term Holter recording is normal","justification":""},{"idx":2,"correct":true,"proposition":"Indefinite maintenance of direct oral anticoagulant therapy","justification":"Its CHADS-VASc at 3 requires long-term anticoagulation."},{"idx":3,"correct":false,"proposition":"Discontinuation of direct oral anticoagulant therapy after 12 months without documented relapse of atrial fibrillation","justification":""},{"idx":4,"correct":false,"proposition":"Discontinuation of direct oral anticoagulant therapy if echocardiography shows haemodynamic efficacy of atrial systole","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-1-qi-16","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You continued the anticoagulant treatment. The patient asks you about the reasons for the occurrence of atrial fibrillation in his case. What do you say (one or more exact answers)? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is an arrhythmia frequently associated with arterial disease obliterans of the lower limbs","justification":"No report 😅🤭"},{"idx":1,"correct":false,"proposition":"It is a consequence of his smoking","justification":"Questionable proposal. Smoking is indeed a predisposing factor to heart disease, but establishing a direct link between FA tobacco 👉 seems too bold."},{"idx":2,"correct":true,"proposition":"It is a common arrhythmia in case of high blood pressure","justification":"High blood pressure is the leading cause of atrial fibrillation."},{"idx":3,"correct":false,"proposition":"It is an arrhythmia favored by its sedentary lifestyle","justification":"No report, especially in this patient who is neither diabetic nor overweight."},{"idx":4,"correct":true,"proposition":"It is an arrhythmia frequently associated with sleep apnea syndrome.","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-2-qi-1","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"What pathology(s) does the gynecological clinical examination (inspection, speculum examination and vaginal examination) allow you to eliminate with certainty? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"An endometrial polyp","justification":""},{"idx":1,"correct":false,"proposition":"A uterine fibroid","justification":""},{"idx":2,"correct":true,"proposition":"Vaginal cancer","justification":""},{"idx":3,"correct":false,"proposition":"Cervical dysplasia","justification":"The diagnosis of cervical dyaplsia is pathological pathology."},{"idx":4,"correct":false,"proposition":"Malignant tumor of the ovary","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-2-qi-2","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"On examination, the vaginal wall is unremarkable and the cervix is normal. Which additional exam(s) do you prescribe as a first-line treatment?","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"An x-ray of the abdomen without preparation","justification":"Hardly ticks anymore..."},{"idx":1,"correct":true,"proposition":"An abdominopelvic ultrasound","justification":"The king first-line examination in gynecology 👑"},{"idx":2,"correct":false,"proposition":"An abdomino-pelvic CT scan","justification":""},{"idx":3,"correct":false,"proposition":"Abdominopelvic magnetic resonance imaging","justification":""},{"idx":4,"correct":false,"proposition":"Hysterosalpingography","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-2-qi-3","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"A pelvic ultrasound is performed. It reveals a cystic right ovarian mass of about 6 cm with vascularized vegetation, a left hydrosalpinx and a left ovary carrying cystic formation with pure fluid content. The endometrial thickness is 18 mm with hypervascularization. There is also minimal peritoneal fluid effusion. What argument(s) is (or are) in favor of a malignant pathology? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Peritoneal effusion","justification":"It is minimal 👉 osef"},{"idx":1,"correct":false,"proposition":"The size of the right adnexal lesion","justification":"The size less than 7cm is a reassuring element."},{"idx":2,"correct":false,"proposition":"Left tubal lesion","justification":""},{"idx":3,"correct":false,"proposition":"Left ovarian lesion","justification":"Cystic nature is reassuring"},{"idx":4,"correct":true,"proposition":"The existence of vascularized vegetation on the right annex","justification":"The intense vascularization of a lesion is often in favor of malignancy (by secretion of VEGF from tumor cells)."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-2-qi-4","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"In this context, the right ovarian lesion as well as the endometrial thickness worry you. What other imaging exam(s) will you perform? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Abdominopelvic magnetic resonance imaging with Gadolinium injection","justification":""},{"idx":1,"correct":false,"proposition":"A brain scan","justification":""},{"idx":2,"correct":false,"proposition":"Fluoro-Deoxy-Glucose positron emission tomography","justification":""},{"idx":3,"correct":false,"proposition":"A bone scan","justification":""},{"idx":4,"correct":false,"proposition":"A liver ultrasound","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-2-qi-5","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Along with the MRI you request. What biological marker(s) will you dose for this patient? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Ca 125","justification":"Ovarian cancer marker"},{"idx":1,"correct":false,"proposition":"Alfa-fetoprotein","justification":""},{"idx":2,"correct":false,"proposition":"Beta-HCG","justification":"Look at the patient's 😉 age (and don't blame yourself for checking it, but make sure you NEVER get caught up in this trap 🤗)"},{"idx":3,"correct":false,"proposition":"Ca 19.9","justification":"Marker of ovarian cancer. ACE and HE4 would be added. Note that the use of these markers is discussed."},{"idx":4,"correct":false,"proposition":"SCC","justification":"Marker of squamous cell cancers"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-2-qi-6","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"The results of the markers: \n\nCA 15.3: 25U\/mL \n\nCA 125: 40 Ul\/ml. \n\nA pelvic MRI is performed. The radiologist confirms the strong suspicion of malignant lesion of the right ovary and endometrium, as well as the a priori benign nature of the lesions of the left appendix. What do you do to support the diagnosis? (one or more possible answer(s)) ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Puncture of the peritoneal effusion vaginally","justification":""},{"idx":1,"correct":false,"proposition":"Right ultrasound-guided ovarian biopsy vaginally","justification":""},{"idx":2,"correct":true,"proposition":"Diagnostic hysteroscopy","justification":"For the endometrium"},{"idx":3,"correct":true,"proposition":"Laparoscopy explorer","justification":"For the ovary"},{"idx":4,"correct":false,"proposition":"Right ovarian biopsy under CT scan","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-2-qi-7","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Laparoscopy is performed. What do you expect? (one or more possible answer(s)) ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Surgical removal of the right ovary","justification":""},{"idx":1,"correct":false,"proposition":"Staging swab","justification":""},{"idx":2,"correct":false,"proposition":"Surgical endometrial sampling","justification":"The endometrium is not removed directly."},{"idx":3,"correct":true,"proposition":"Assessment of the resectability of lesions","justification":""},{"idx":4,"correct":true,"proposition":"Assessment of peritoneal extension of the disease","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-2-qi-8","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Laparoscopy did not show peritoneal extension. The histological results of the endometrial sample are: grade II invasive endometrioid adenocarcinoma. The histological results of the right adnexal swab: an intraovarian endometrioid adenocarcinoma lesion without extension to the surface or tubal wall. What treatment should be performed? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A total hysterectomy with bilateral appendectomy","justification":""},{"idx":1,"correct":false,"proposition":"Expanded colpohysterectomy with bilateral appendectomy","justification":"The cervix is healthy. There is no indication to remove it."},{"idx":2,"correct":false,"proposition":"Abdominopelvic external beam radiation therapy combined with concomitant chemotherapy","justification":""},{"idx":3,"correct":false,"proposition":"Neoadjuvant chemotherapy","justification":""},{"idx":4,"correct":false,"proposition":"Tamoxifen-based hormone therapy","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-2-qi-9","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Regarding the epidemiological data of the type of endometrial cancer (endometrioid) of this patient, what is(are) the exact statement(s)?","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"It is the most common gynecological (pelvic) cancer","justification":""},{"idx":1,"correct":true,"proposition":"It is a cancer of epithelial origin","justification":""},{"idx":2,"correct":true,"proposition":"It is a hormone-dependent cancer","justification":""},{"idx":3,"correct":false,"proposition":"It is a cancer of poor prognosis","justification":""},{"idx":4,"correct":true,"proposition":"Tamoxifen is a risk factor","justification":"Because hormone-dependent cancer"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-2-qi-10","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"The patient's file is presented at a multidisciplinary consultation meeting (RCP). Regarding CPR, what is(es) the correct answer(s)? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is not mandatory pre-operative","justification":"Except in very special cases (emergency for example), CPR is mandatory"},{"idx":1,"correct":false,"proposition":"It is the referring surgeon who proposes a therapeutic strategy","justification":""},{"idx":2,"correct":true,"proposition":"Doctors from three different specialties must be present","justification":""},{"idx":3,"correct":false,"proposition":"The support person can attend CPR","justification":"It's a meeting between doctors"},{"idx":4,"correct":true,"proposition":"Decisions must be based on a repository","justification":"The decision is based on the objective data of science"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-2-qi-11","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"The patient's attending physician applies for admission to a long-term condition (ALDI. Which of the following is correct? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The care protocol must be drawn up by the attending physician, in consultation with the patient and the other corresponding physician(s) involved in the follow-up.","justification":""},{"idx":1,"correct":false,"proposition":"ALD recognition allows 100% coverage of all health costs","justification":""},{"idx":2,"correct":false,"proposition":"The patient will be able to enjoy the benefits of her ALD for life","justification":""},{"idx":3,"correct":true,"proposition":"ALD recognition commits the patient to respond to the controls carried out by her health insurance organization","justification":""},{"idx":4,"correct":false,"proposition":"Part of the fee overruns billed by health professionals may be covered by the ALD.","justification":"Fee overruns are not covered by ALD."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-2-qi-12","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Given the carcinological history of the patient and her family, what is (or are) the exact proposal(s)?","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A family predisposition is strongly suspected","justification":""},{"idx":1,"correct":false,"proposition":"A pelvic ultrasound is indicated in her daughter","justification":""},{"idx":2,"correct":false,"proposition":"A CA15.3 assay is indicated in his daughter","justification":""},{"idx":3,"correct":true,"proposition":"An onco-genetic consultation should be recommended","justification":""},{"idx":4,"correct":true,"proposition":"A search for microsatellite instability is done on operating room","justification":"Lynch syndrome is suspected. We therefore look for the corresponding mutations on the operating room."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-2-qi-13","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Which familial form do you suspect first?","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Un syndrome de Lynch"},{"idx":1,"correct":false,"proposition":"A BRCA1 mutation"},{"idx":2,"correct":false,"proposition":"A BRCA2 mutation"},{"idx":3,"correct":false,"proposition":"A mutation in the PTEN gene"},{"idx":4,"correct":false,"proposition":"Un syndrome de Li-Fraumeni"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-2-qi-14","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"At the end of her treatment, the patient is considered in complete remission. What monitoring do you put in place for the first two years? (one or more possible answers) ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A biannual clinical examination","justification":""},{"idx":1,"correct":false,"proposition":"A semi-annual assay of the serum marker CA 15.3","justification":"This is the CA 125 test for ovarian 🤭 cancer"},{"idx":2,"correct":false,"proposition":"An annual pelvic thoracoabdomino CT scan","justification":"No indication for systematic imaging"},{"idx":3,"correct":false,"proposition":"A biannual abdominal-pelvic ultrasound","justification":"No indication for systematic imaging"},{"idx":4,"correct":false,"proposition":"An annual mammogram","justification":"She had breast cancer 👉 Annual mammogram for life."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-3-qi-1","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"In front of this sleep disorder, you must look for Theo:","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"An adjustment disorder","justification":"It cannot be eliminated in the face of compatible symptoms and lack of information on the duration of the disorders. There are many possible triggering factors (domestic violence, moving, entry into a small section)."},{"idx":1,"correct":false,"proposition":"Early schizophrenia","justification":""},{"idx":2,"correct":true,"proposition":"Obstructive sleep apnea syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Oppositional disorder with provocation","justification":"Sleep disorders are against this diagnosis. Irritability and anger do not seem to be taken to extremes and can be explained by lack of sleep."},{"idx":4,"correct":true,"proposition":"Reactive attachment disorder","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-3-qi-2","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Among the symptoms presented by Theo, which is an obstructive sleep apnea syndrome? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Irritability","justification":""},{"idx":1,"correct":true,"proposition":"Snoring","justification":""},{"idx":2,"correct":true,"proposition":"Daytime sleepiness","justification":""},{"idx":3,"correct":false,"proposition":"Difficulty falling asleep","justification":""},{"idx":4,"correct":false,"proposition":"Refusal to sleep alone","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-3-qi-3","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"In the context of this sleep disorder, what do you recommend at first?","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Sleep hygiene tips","justification":""},{"idx":1,"correct":true,"proposition":"Behavioural measures","justification":""},{"idx":2,"correct":false,"proposition":"A prescription for melatonin","justification":""},{"idx":3,"correct":false,"proposition":"A prescription of anti-histamine for hypnotic purposes","justification":""},{"idx":4,"correct":false,"proposition":"A sleep cure","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-3-qi-4","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"You gave Theo's mother advice about sleep hygiene and how to behave with him. Six months later, you see the child again in consultation because the drowsiness is more and more marked. His school entry went well but, at times, he falls asleep in class. These phases are interspersed with phases of significant irritability associated with relational difficulties with other students. This boy is now 3 years and 6 months old, 1 meter tall and weighs 22 kilograms. The rest of the somatic clinical examination is normal. Faced with this drowsiness, among the following proposals, which is the most relevant in the first line? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A psychological assessment","justification":""},{"idx":1,"correct":false,"proposition":"Ventilatory polygraphy","justification":""},{"idx":2,"correct":false,"proposition":"A brain MRI","justification":""},{"idx":3,"correct":true,"proposition":"An ENT consultation","justification":""},{"idx":4,"correct":false,"proposition":"An electrocardiogram","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-3-qi-5","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"The ENT consultation diagnoses obstructive sleep apnea syndrome and finds tonsillar hypertrophy and vegetations. Theo is operated on and the drowsiness disappears. Two years later, you see Theo again in consultation at the request of the teacher who describes a very difficult behavior: he never sits, does not wait his turn in class activities, does not respect the instructions and is very slow in his school work. The mother reports that he very often loses his belongings. Theo now sleeps in his own bed but demands a night light. Besides, he wets the bed. During your consultation, he does not hold in place and cuts you off. You suspect attention deficit hyperactivity disorder (ADHD). Your diagnostic hypothesis for ADHD is based on:","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Impulsivity"},{"idx":1,"correct":true,"proposition":"Motor instability"},{"idx":2,"correct":true,"proposition":"Nocturnal enuresis","justification":"About 10% of children with isolated primary nocturnal enuresis have attention deficit hyperactivity disorder (ADHD)."},{"idx":3,"correct":true,"proposition":"Slow execution","justification":"Inattention syndrome"},{"idx":4,"correct":false,"proposition":"Fear of the dark"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-3-qi-6","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Apart from being overweight, the rest of your physical exam is normal. To support your diagnosis of ADHD, you propose: ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"An ophthalmological consultation","justification":""},{"idx":1,"correct":true,"proposition":"A questionnaire to be completed by the mother","justification":""},{"idx":2,"correct":true,"proposition":"A questionnaire to be completed by the teacher","justification":""},{"idx":3,"correct":false,"proposition":"A genetic assessment","justification":""},{"idx":4,"correct":false,"proposition":"A brain MRI","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-3-qi-7","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"The diagnosis of ADHD is confirmed. There is no associated learning disability. At this stage, you recommend: ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" Psychotherapy","justification":""},{"idx":1,"correct":false,"proposition":"Treatment with methylphenidate","justification":"This treatment is only possible from the age of 6. Theo is only 5 years old at this question. In addition, it is proposed as a second intention."},{"idx":2,"correct":true,"proposition":"Cognitive remediation","justification":""},{"idx":3,"correct":false,"proposition":"Speech therapy","justification":""},{"idx":4,"correct":false,"proposition":"Open educational assistance (AEMO)","justification":"AEMO is decided by a juvenile judge in special cases such as abuse."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-3-qi-8","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Six months later, Theo is 6 years old and faced with the little evolution of his disorders, you decide to prescribe methylphenidate. This molecule: ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Is a derivative of amphetamines","justification":""},{"idx":1,"correct":true,"proposition":"Is contraindicated before 6 years","justification":""},{"idx":2,"correct":false,"proposition":"Can be prescribed for up to 3 months","justification":"28 days, no limit on the total duration of treatment."},{"idx":3,"correct":true,"proposition":"Can be renewed by the general practitioner","justification":"Today, this proposition is true. Since 2021, the prescription and renewal of methylphenidate can be initiated by any neurologist, psychiatry or pediatrician and renewed by any doctor."},{"idx":4,"correct":false,"proposition":"Is prescribed without taking into account school holidays","justification":"We reduce during school holidays"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-3-qi-9","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"A few weeks after the introduction of the treatment, you see Theo and his mother again in consultation. Which of the following symptoms reported by his mother can methylphenidate be attributed to? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Increased appetite","justification":"Rather anorexia at lunch"},{"idx":1,"correct":true,"proposition":"Abdominal pain","justification":""},{"idx":2,"correct":true,"proposition":"Headaches","justification":""},{"idx":3,"correct":false,"proposition":"A sad mood","justification":""},{"idx":4,"correct":true,"proposition":"Difficulty falling asleep","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-3-qi-10","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Three years later, Theo is admitted to the pediatric emergency room for a major attack of agitation at home. In a fit of anger, he broke his tablet and threatened to jump out of the window. He has just learned from his mother that his father, whom he did not know, committed suicide. You learn on this occasion that his mother lives with a new spouse and that intra-family relations are very tense, especially between Theo and his stepfather. Theo is now 9 years old and is enrolled in CE2. When you meet him, alone, he is calm and tells you about his discomfort. Overweight is manifest and badly experienced. Between sobs, he says: <<I'm tired of it, it's been going on too long. I can't take it anymore. >> In pediatric emergencies, management includes: ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A prescription of an anti-histamine for anxiolytic purposes","justification":"It is described as calm at present."},{"idx":1,"correct":false,"proposition":"A prescription of a benzodiazepine for anxiolytic purposes","justification":""},{"idx":2,"correct":true,"proposition":"A referral to hospitalization","justification":""},{"idx":3,"correct":false,"proposition":"A report","justification":""},{"idx":4,"correct":false,"proposition":"A summons from the father-in-law","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-3-qi-11","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Which of the following proposals is one or more of Theo's emergency hospitalization objectives? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Prevention of suicidal risk","justification":""},{"idx":1,"correct":true,"proposition":"Prolonged clinical observation","justification":""},{"idx":2,"correct":false,"proposition":"Reassessment of ADHD treatment","justification":"This is not an indication for emergency hospitalization"},{"idx":3,"correct":true,"proposition":"Distancing intra-family tensions","justification":""},{"idx":4,"correct":false,"proposition":"Multidisciplinary assessment","justification":"This is not an indication for emergency hospitalization"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-3-qi-12","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Theo is hospitalized in pediatrics. During an interview, he described sexual touching by his stepfather but refused to be told about it to his mother. Faced with this situation ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"You avoid informing the mother","justification":""},{"idx":1,"correct":true,"proposition":"You make a report even if the mother objects","justification":""},{"idx":2,"correct":true,"proposition":"You make a report even without Theo's agreement","justification":""},{"idx":3,"correct":false,"proposition":"You identify the father-in-law on your certificate as responsible for the facts","justification":""},{"idx":4,"correct":false,"proposition":"You avoid transcribing Theo's words word for word","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-3-qi-13","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"To whom do you address your report?","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"To the Child Social Assistance (ASE)","justification":""},{"idx":1,"correct":false,"proposition":"To the social worker of the paediatric department","justification":""},{"idx":2,"correct":false,"proposition":"To the regional health agency (ARS)","justification":""},{"idx":3,"correct":true,"proposition":"To the public prosecutor","justification":""},{"idx":4,"correct":false,"proposition":"Maternal and Child Protection (PMI)","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-3-qi-14","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"The mother's spouse admits the facts and is incarcerated. A few weeks after his release from the hospital, Theo says he is reassured but remains sad and worried about his future. He is still treated with methylphenidate, which allows him to be calmer, but still has great academic difficulties. He has few classmates and often misses school due to somatic complaints. In view of this clinical picture, which diagnosis(s) should be mentioned?","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Depression","justification":""},{"idx":1,"correct":true,"proposition":"School phobia","justification":""},{"idx":2,"correct":false,"proposition":"Schizotypal personality disorder","justification":"A minor patient is not diagnosed with a personality disorder."},{"idx":3,"correct":false,"proposition":"Autism spectrum disorder","justification":""},{"idx":4,"correct":false,"proposition":"Conduct disorder","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-3-qi-15","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Which of the following measures, due to his situation and his difficulties at school, which can be put in place for Theo? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"An individualized reception project (PAI)","justification":"The PAI makes it possible to arrange Theo's reception by informing his pedagogical managers of his pathology."},{"idx":1,"correct":true,"proposition":"Open educational assistance (AEMO)","justification":"Theo has been put in danger and his current social context is difficult. Mentioning an AEMO will allow the juvenile judge to assess the need for support for Theo."},{"idx":2,"correct":true,"proposition":"An allowance for the education of disabled children (AEEH)","justification":"The request is made to the MDPH."},{"idx":3,"correct":true,"proposition":"A personalized support project (PAP)","justification":"The PAP concerns learning disabilities, from which Theo seems to suffer."},{"idx":4,"correct":true,"proposition":"A school life assistant (AVS)","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-4-qi-1","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What is the BMI (body mass index) in rounded value of this patient? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"25","justification":""},{"idx":1,"correct":true,"proposition":"30","justification":""},{"idx":2,"correct":false,"proposition":"35","justification":""},{"idx":3,"correct":false,"proposition":"40","justification":""},{"idx":4,"correct":false,"proposition":"45","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-4-qi-2","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Which is (are) the most likely diagnostic hypothesis(s) in front of this clinical picture?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Stasis dermohypodermatitis","justification":""},{"idx":1,"correct":true,"proposition":"Bacterial dermohypodermatitis","justification":""},{"idx":2,"correct":false,"proposition":"Necrotizing fasciitis","justification":""},{"idx":3,"correct":false,"proposition":"Lymphangitis","justification":""},{"idx":4,"correct":false,"proposition":"Erythema nodosum","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-4-qi-3","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What clinical characteristic(s) is (are) in favor of non-necrotizing bacterial dermohypodermatitis? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Brutal start","justification":""},{"idx":1,"correct":false,"proposition":"Slow expansion","justification":"Expansion is fast"},{"idx":2,"correct":false,"proposition":"Centripetal evolution of skin lesions","justification":"Centrifugal evolution"},{"idx":3,"correct":false,"proposition":"Severe spontaneous pain","justification":"Palpation pain"},{"idx":4,"correct":true,"proposition":"Demonstration of intertoe intertrigo","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-4-qi-4","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What comorbidity(ies) present in this patient is(are) a risk factor(s) for the occurrence of bacterial dermohypoderma? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Obesity","justification":""},{"idx":1,"correct":false,"proposition":"Diabetes","justification":"Risk factor for necrotizing dermohypodermitis."},{"idx":2,"correct":true,"proposition":"Venous insufficiency","justification":""},{"idx":3,"correct":false,"proposition":"History of phlebitis","justification":""},{"idx":4,"correct":false,"proposition":"High blood pressure","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-4-qi-5","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"You have several elements to orient you towards bacterial dermohypodermatitis especially as you find an intertrigo of the 2 feet. What gesture(s) do you perform in front of this lesion?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Search for an increase in local skin temperature","justification":""},{"idx":1,"correct":true,"proposition":"Stripping of a small bullous detachment within the erythematous zone","justification":""},{"idx":2,"correct":false,"proposition":"Bacteriological swab of the most inflammatory area of erythema","justification":""},{"idx":3,"correct":true,"proposition":"Marking erythema contours with felt","justification":""},{"idx":4,"correct":true,"proposition":"Investigation of lymphadenopathy","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-4-qi-6","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Palpation of the inguinal folds objective left inguinal lymphadenopathy. What is (are) the most likely cause(s) of this left inguinal lymphadenopathy?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Concomitant inflammatory pathology of the small pelvis","justification":""},{"idx":1,"correct":false,"proposition":"Concomitant inflammatory pathology of the perineal region","justification":""},{"idx":2,"correct":false,"proposition":"Concomitant or perianal lesion","justification":""},{"idx":3,"correct":true,"proposition":"Satellite lymphadenopathy of dermohypodermatitis","justification":""},{"idx":4,"correct":false,"proposition":"Sentinel lymphadenopathy of lymphoma","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-4-qi-7","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What is essential to achieve before starting the therapeutic management of this dermohypodermitis? (only one answer expected)","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Blood","justification":"Namely: blood cultures are positive in less than 5% of cases and are only to be performed in a particular context (bite, travel, occurring in an aquatic environment, post-traumatic, immunosuppression, nosocomial context, signs of clinical or biological seriousness)."},{"idx":1,"correct":false,"proposition":"Skin biopsy with culture","justification":""},{"idx":2,"correct":false,"proposition":"Doppler ultrasound of the leg","justification":""},{"idx":3,"correct":false,"proposition":"Left leg scanner"},{"idx":4,"correct":true,"proposition":"No additional assessment is essential","justification":"The form is typical and uncomplicated 👉 no additional examination. The diagnosis is clinical."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-4-qi-8","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Which infectious agent(s) is (are) most likely to be involved? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Streptococcus pyogenes","justification":""},{"idx":0,"correct":false,"proposition":"coagulase-negative staphylococcus","justification":"These are low-virulent staphylococci that are present on the skin commensally. These are often contaminants (S. Epidermidis ++)."},{"idx":0,"correct":false,"proposition":"Candida albicans","justification":""},{"idx":0,"correct":false,"proposition":"Pseudomonas ","justification":""},{"idx":0,"correct":false,"proposition":"Escherichia coli","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-4-qi-9","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What is your first-line anti-infectious therapeutic option(s) (knowing that you decide to treat her at home because of the lack of signs of severity and that she has no known allergy)?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Oral amoxicillin","justification":""},{"idx":0,"correct":false,"proposition":"Amoxicillin - Clavulanic Acid Orally"},{"idx":0,"correct":false,"proposition":"Pristinamycin orally (PO)","justification":"It is a treatment to be used in case of allergy to amoxicillin."},{"idx":0,"correct":false,"proposition":"Oral clindamycin","justification":"It is a treatment to be used in case of allergy to amoxicillin."},{"idx":0,"correct":false,"proposition":"3rd generation cephalosporin as intramuscular injection","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-4-qi-10","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What associated treatment do you prescribe?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Paracetamol","justification":""},{"idx":1,"correct":false,"proposition":"Nonsteroidal anti-inflammatory drugs","justification":""},{"idx":2,"correct":false,"proposition":"Calciparin curative dose","justification":""},{"idx":3,"correct":true,"proposition":"Rest with elevation of the left leg","justification":"This helps to evacuate the edema that accompanies the inflammatory phenomenon."},{"idx":4,"correct":true,"proposition":"Treatment of intertrigo","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-4-qi-11","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"You treat it with amoxicillin and paracetamol and plan to see it again 2 days later. Indeed, this patient is exposed to the risk of evolution to a necrotizing form. What is (are) the risk factor(s) of such a development? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Obesity","justification":"According to HAS, the risk factors for progression to a necrotizing form are: diabetes, nonsteroidal anti-inflammatory drugs, immunosuppression (corticosteroids, chemotherapy, immunosuppressants, chronic renal failure, cirrhosis), malnutrition, age over 60 years, intravenous drug addiction, venous insufficiency, peripheral arterial disease (PAD) and obesity. In children, chickenpox is the main risk factor for DHBN. The recommendation is here: https:\/\/www.has-sante.fr\/upload\/docs\/application\/pdf\/2019-04\/prise_en_charge_des_infections_cutanees_bacteriennes_courantes_recommandations.pdf"},{"idx":1,"correct":true,"proposition":"Diabetes","justification":""},{"idx":2,"correct":false,"proposition":"Smoking","justification":""},{"idx":3,"correct":true,"proposition":"Arterial disease of the lower limbs","justification":""},{"idx":4,"correct":true,"proposition":"Taking nonsteroidal anti-inflammatory drugs","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-4-qi-12","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Under treatment, dermohypodermatitis disappears. You see the patient again 3 months later because her company sends her to do an accounting in Abidjan in Côte d'Ivoire for 3 weeks. She has never traveled to Africa. What vaccination(s) do you offer? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Update of its diphtheria-tetanus-polio vaccines","justification":""},{"idx":1,"correct":true,"proposition":"Hepatitis A vaccine","justification":""},{"idx":2,"correct":true,"proposition":"Meningitis vaccine ACYW135","justification":"This proposal is contentious. This vaccine is indicated in case of close and prolonged contact with the local population in an epidemic\/endemic area. Is this the case in the case of public accounting? It's hard to know 🤷 ♂️."},{"idx":3,"correct":true,"proposition":"Yellow fever vaccine","justification":""},{"idx":4,"correct":false,"proposition":"Cholera vaccine","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-4-qi-13","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"You decide to prescribe atovaquone-proguanil for malaria chemoprophylaxis for this 3-week trip. How long do you write on the prescription? (only one answer expected) ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"3 weeks","justification":""},{"idx":1,"correct":true,"proposition":"4 weeks","justification":"Atovaquone-Proguanil: Length of stay + 1 week (daily dose)"},{"idx":2,"correct":false,"proposition":"5 weeks","justification":""},{"idx":3,"correct":false,"proposition":"6 weeks","justification":""},{"idx":4,"correct":false,"proposition":"7 weeks","justification":"Mefloquine: 1 week before + Length of stay + 3 weeks (weekly intake). \n\nDoxycycline: Length of stay + 4 weeks\/1 month (daily intake)"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-4-qi-14","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Upon her return from Côte d'Ivoire, the patient consults you again. She is doing well and the stay went well. She was even able to spend the last weekend in a bush camp. She describes rudimentary facilities with poor hygiene conditions, especially on bedding. Since her return, she has slept poorly due to pruritus of her forearms, wrists and fingers. One of her colleagues with whom she shared the same room has the same symptoms. On examination you see especially scratching lesions especially in interdigital spaces. She did not change personal care products. Which pathology do you think is most likely in this context? (only one answer expected)","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Atopic dermatitis","justification":""},{"idx":1,"correct":false,"proposition":"Pediculosis","justification":""},{"idx":2,"correct":true,"proposition":"Scabies","justification":""},{"idx":3,"correct":false,"proposition":"Larva Migrans","justification":""},{"idx":4,"correct":false,"proposition":"Contact dermatitis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-4-qi-15","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"You mention a scabies that is confirmed by the visualization of parasites with a dermoscope. What do you recommend? (one or more correct answers) ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Treatment with ivermectin","justification":""},{"idx":1,"correct":true,"proposition":"Treatment to be renewed at 7 days","justification":""},{"idx":2,"correct":true,"proposition":"Washing clothes at least 60 °C in a long cycle","justification":""},{"idx":3,"correct":true,"proposition":"Treatment at the same time of his colleague","justification":""},{"idx":4,"correct":false,"proposition":"2-week absence from work","justification":"Eviction from the community is up to 3 days after the start of treatment if common scabies (which seems to be the case here)."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-5-qi-1","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You notice the lesion opposite. You mention (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Squamous cell carcinoma","justification":"The lesion is regular. The patient is young. The area of attack is not classic."},{"idx":1,"correct":false,"proposition":"A canker sore","justification":""},{"idx":2,"correct":true,"proposition":"A hemorrhagic bubble","justification":""},{"idx":3,"correct":false,"proposition":"A bite","justification":""},{"idx":4,"correct":false,"proposition":"An angioma","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-5-qi-2","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"This is an oral hemorrhagic bubble. Given this lesion, which etiology is most likely? ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Severe thrombocytopenia","justification":""},{"idx":1,"correct":false,"proposition":"Willebrand disease","justification":"Willebrand disease is a pathology of primary hemostasis that is accompanied by a normal platelet count. This is a possible etiology but unlikely given the age of the patient."},{"idx":2,"correct":false,"proposition":"Hemophilia","justification":""},{"idx":3,"correct":false,"proposition":"Vitamin K deficiency","justification":""},{"idx":4,"correct":false,"proposition":"Protein C deficiency","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-5-qi-3","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You mention severe thrombocytopenia. What other bleeding signs are you looking for? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A purpura","justification":"Purpura will then be thrombocytopenic: petechial, mucocutaneous, non-infiltrated, on the trunk and upper limbs as well as on the lower limbs."},{"idx":1,"correct":true,"proposition":"Gingivorragies","justification":""},{"idx":2,"correct":false,"proposition":"Hemarthrosis","justification":"Hemarthrosis is deep bleeding. It therefore evokes a pathology of coagulation."},{"idx":3,"correct":true,"proposition":"An epistaxis","justification":""},{"idx":4,"correct":true,"proposition":"A melena","justification":"Melena testifies to mucosal involvement, which is readily found in thrombocytopenia."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-5-qi-4","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"On examination, you actually find purpura. What are the expected characteristics of purpura in this context? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Painful","justification":""},{"idx":1,"correct":false,"proposition":"Necrotic","justification":""},{"idx":2,"correct":true,"proposition":"Petechial","justification":""},{"idx":3,"correct":false,"proposition":"Infiltrated","justification":""},{"idx":4,"correct":true,"proposition":"Associated with bruising","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-5-qi-5","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"What first-line exams will you request? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Complete blood count","justification":"We want to know hemoglobin. Be careful, the NFS does not provide information on the platelets (it is the NFS-P that counts the platelets!)."},{"idx":1,"correct":false,"proposition":"INR","justification":"Bleeding disorders are not suspected."},{"idx":2,"correct":false,"proposition":"TP, TCA, fibrinogen","justification":"Bleeding disorders are not suspected."},{"idx":3,"correct":false,"proposition":"D-dimer","justification":"We have no arguments for a potential DICV here."},{"idx":4,"correct":false,"proposition":"Reticulocytes","justification":"It will be asked if there is anemia."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-5-qi-6","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"The CBC shows: red blood cells 2.24 T\/L, hemoglobin 76 g\/L, hematocrit 22.1%, MCV 98.7 fL, MCDC 34.4 g\/dL, leukocytes 1.3 G\/L, neutrophils 0.4 G\/L, lymphocytes 0.5 G\/L, monocytes 0.05 G\/L, blasts 0.35 G\/L, platelets 9 G\/L, reticulocytes 45 T\/L. Describe this NFS: ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Neutropenia","justification":"neutrophils 0.4 G\/L when normal is > 1.5 G\/L"},{"idx":1,"correct":false,"proposition":"Hyperlymphocytosis","justification":"lymphocytes 0.5 G\/L when normal is > 1.5 G\/L"},{"idx":2,"correct":true,"proposition":"Thrombocytopenia","justification":"9 G\/L blisters with a normal > 150 G\/L"},{"idx":3,"correct":true,"proposition":"Normochrome anemia","justification":"Normochrome because CCMH between 32 and 36"},{"idx":4,"correct":false,"proposition":"Regenerative anemia","justification":"reticulocytes 45 T\/L while we speak of regenerative above 120-150."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-5-qi-7","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"What diagnoses do you mention? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Idiopathic bone marrow suppression","justification":""},{"idx":1,"correct":false,"proposition":"Aggressive lymphoma","justification":""},{"idx":2,"correct":false,"proposition":"Immunological thrombocytopenic purpura","justification":""},{"idx":3,"correct":true,"proposition":"Acute leukemia","justification":"The circulating blasts direct us directly to leukemia."},{"idx":4,"correct":false,"proposition":"Chronic myeloid leukemia","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-5-qi-8","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You receive the hemostasis assessment. It shows: TP at 50%, TCA ratio 1.1, fibrinogen 0.88 g \/ l. How do you complete the hemostasis assessment? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The determination of D-dimer","justification":"The TP is decreased, the TCA begins to increase, the fibrinogen is low 👉 red alert CIVD! The dosage of D-Dimer will allow us to base the diagnosis."},{"idx":1,"correct":false,"proposition":"The search for circulating anticoagulant","justification":""},{"idx":2,"correct":true,"proposition":"Determination of factor V","justification":"The TP is low, so factor VII is decreased. The determination of factor V will allow us to know if the decrease in factor VII comes from the liver (hepatocellular insufficiency) or from the synthesis of vitamin-dependent factors (X, IX, VII, II)."},{"idx":3,"correct":false,"proposition":"Anti-Xa activity","justification":""},{"idx":4,"correct":false,"proposition":"Determination of factor VIII","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-5-qi-9","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You suspect acute myelogenous leukemia. You perform a myelogram. What are you waiting for? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Poor marrow","justification":""},{"idx":1,"correct":true,"proposition":"The presence of more than 20% of myeloblasts","justification":""},{"idx":2,"correct":false,"proposition":"An increase in the number of myelocytes and metamyelocytes","justification":"Myelocytes and metamyelocytes are greatly reduced"},{"idx":3,"correct":true,"proposition":"Decreased or absent megakaryocytes","justification":""},{"idx":4,"correct":true,"proposition":"The presence of blasts with Auer bodies","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-5-qi-10","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"Mr. R. does have acute myelogenous leukemia. What should you do? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Emergency hospitalization","justification":""},{"idx":1,"correct":true,"proposition":"Protective Custody","justification":""},{"idx":2,"correct":true,"proposition":"A multidisciplinary consultation meeting to decide on therapeutic conduct","justification":""},{"idx":3,"correct":true,"proposition":"Perform an ad consultation","justification":""},{"idx":4,"correct":true,"proposition":"Apply for ALD","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-5-qi-11","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"Mr. R.'s file was presented in PCR, which offers him to participate in a randomized phase therapeutic protocol. He is given information with a consent form. Who should sign it? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The patient","justification":""},{"idx":1,"correct":true,"proposition":"The local investigating physician","justification":"There are two signatures: that of the patient and that of his investigator."},{"idx":2,"correct":false,"proposition":"The intern in charge of the patient","justification":""},{"idx":3,"correct":false,"proposition":"The support person","justification":""},{"idx":4,"correct":false,"proposition":"The pharmacist who dispenses the study products","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-5-qi-12","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"Treatment is started and he needs a red blood cell transfusion. What biological tests should be performed before transfusion? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"ABO Rhesus Group","justification":""},{"idx":1,"correct":true,"proposition":"Rhesus-KEL phenotyping","justification":""},{"idx":2,"correct":true,"proposition":"Irregular agglutinin (RAI) testing","justification":""},{"idx":3,"correct":false,"proposition":"EBV Serology","justification":""},{"idx":4,"correct":false,"proposition":"CMV Serology","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-5-qi-13","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"Mr. R.'s uncle was infected during a transfusion in 1984. Mr. R. therefore wished to know what checks had been carried out on the red blood cells. Which of the following are true? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The products are all leukocyte-free","justification":""},{"idx":1,"correct":false,"proposition":"The products are all irradiated","justification":"For the premature, for the patient in SCID (and not DICV), ..."},{"idx":2,"correct":true,"proposition":"Products are tested for HIV","justification":"HIV1 and 2"},{"idx":3,"correct":true,"proposition":"Products are tested for hepatitis B and C","justification":""},{"idx":4,"correct":false,"proposition":"Products are tested for CMV","justification":"The products are tested for HIV, HTLV, HCV, HBV, and syphilis."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-5-qi-14","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"What are the legal provisions for transfusion? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The nurse must verify the conformity of the product received","justification":""},{"idx":1,"correct":true,"proposition":"A doctor must be available quickly","justification":""},{"idx":2,"correct":false,"proposition":"Pellets must be transfused within one hour of arrival in the department","justification":"Within 6 hours"},{"idx":3,"correct":true,"proposition":"The nurse checks the identity match between the patient and the group card","justification":""},{"idx":4,"correct":true,"proposition":"The nurse checks the match between the group card and the cap pocket","justification":"The famous ultimate bedside test."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-5-qi-15","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You prescribe the transfusion of 2 phenotyped red blood cells. The nurse performs the test on a test cardboard before the transfusion. The result is: {pos = presence of agglutinates, neg = absence of agglutinates}. Which propositions are true? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The patient is group A","justification":"The card contains anti-A antibodies. They react with the patient's 👉 blood it is group 🅰 ."},{"idx":1,"correct":false,"proposition":"The patient is Rhesus positive","justification":""},{"idx":2,"correct":false,"proposition":"The red blood cell group is identical to that of the patient","justification":""},{"idx":3,"correct":true,"proposition":"The red blood cell is compatible with the patient","justification":""},{"idx":4,"correct":true,"proposition":"The patient can be transfused without further prior examination","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-6-qi-1","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"In view of this clinical picture, which is (are) the diagnostic hypothesis(s) to evoke? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Fracture of the upper end of the femur","justification":"It would then be Garden 2."},{"idx":1,"correct":true,"proposition":"Fracture of the sacrum","justification":"The patient's symptoms are: foot levator\/lowering deficit, electrical pain + paresthesia of the right lower limb. These symptoms can be part of the nosological framework of damage to the L5-S1 roots, following a fracture of the sacrum or femur."},{"idx":2,"correct":false,"proposition":"Coxofemoral dislocation","justification":"Statement: 'The inspection does not find a vicious attitude of the lower limb.'"},{"idx":3,"correct":true,"proposition":"Adductor rupture","justification":"Trauma in abduction 👉 possible tearing of the adductors."},{"idx":4,"correct":false,"proposition":"Removal of the distal insertion of the iliopsoas","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-6-qi-2","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Which exam(s) should I request in the first line?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"X-ray of the front pelvis","justification":""},{"idx":1,"correct":true,"proposition":"X-ray of the thoracolumbar spine","justification":"She probably fell on her back and she has a pain in the lower 👉 limb lower lumbar vertebral fracture?"},{"idx":2,"correct":false,"proposition":"Thoraco-abdomino-pelvic CT scan","justification":""},{"idx":3,"correct":false,"proposition":"MRI of the pelvis","justification":""},{"idx":4,"correct":false,"proposition":"Ultrasound of the coxofemoral joint","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-6-qi-3","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"After a 2-hour decubitus rest in the emergency room, the patient wants to get back on her feet. She says she finds her right leg and foot still numb. She still can't lift or extend her foot. X-rays of the pelvis and thoracolumbar spine are performed. Given the clinical and radiological evidence available for this patient, what is the most likely diagnostic hypothesis? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A fracture of the spine","justification":"No fractures are visualized"},{"idx":1,"correct":false,"proposition":"A fracture of an ischiopubic branch","justification":"No fractures are visualized"},{"idx":2,"correct":false,"proposition":"A fracture of the upper end of the femur","justification":"No fractures are visualized"},{"idx":3,"correct":false,"proposition":"Damage to the obturator nerve","justification":"This nerve arises from the L2, L3 and L4 roots of the lumbar plexus. His sensory-motor innervation stops at the knee."},{"idx":4,"correct":true,"proposition":"Damage to the sciatic nerve","justification":"This corresponds to the symptomatology."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-6-qi-4","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"On X-rays, no fractures were observed. Nerve damage has been suggested. The patient was discharged from the emergency room the same day and you will see her at home 3 days after her fall. On inspection, you notice visible skin signs in the following photo. On clinical examination, the patient complains of having a cotton leg and right foot and localized pain in the sole of the right foot. The right patellar reflex is present, the right Achilles absent while it is present on the left. In distality, there is difficulty raising and lowering the tip of the right foot. Motor testing during knee extension, abduction and right hip extension are possible against resistance and are normal. You notice weakness in the flexion of the leg on the right thigh. She has hypoaesthesia of her right leg. There is no vesico-sphincter disorder. Given the clinical evidence you have, what type(s) of neurological impairment(s) can you discuss? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Monoradiculopathy","justification":"The involvement of a single root (L5 or S1) does not explain all the symptomatology. The infringement is therefore more distorted."},{"idx":1,"correct":false,"proposition":"Polyradiculopathy","justification":"The involvement of several roots would give a more proximal symptomatology."},{"idx":2,"correct":true,"proposition":"Monotroncular involvement","justification":"Absent right Achilles reflex (carried by the root S1) + difficulty raising and lowering the tip of the foot (involvement of the fibular nerve, branch of the sciatic nerve, which comes from the root L5) = involvement of the sciatic nerve = monotroncular involvement."},{"idx":3,"correct":false,"proposition":"Incomplete paraparesis","justification":"Paraparesis is bilateral. However, the symptoms here are one-sided."},{"idx":4,"correct":false,"proposition":"Cauda equina syndrome","justification":"No sphincter bladder disorders, no proximal involvement, no arguments 😅."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-6-qi-5","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Three days after the trauma, in the context of sciatic monotroncular involvement, which examination would be most likely to change the management of this patient? (only one answer expected) ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A lumbar spinal CT scan","justification":""},{"idx":1,"correct":false,"proposition":"Sacco-radiculography","justification":""},{"idx":2,"correct":false,"proposition":"A perineal electromyogram","justification":""},{"idx":3,"correct":false,"proposition":"An electromyogram of the lower limbs","justification":""},{"idx":4,"correct":true,"proposition":"An ultrasound of the right buttock and right thigh","justification":"The patient has a hematoma of the thigh, probably compressible 👉 we will try to see if this is really the case 😉"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-6-qi-6","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Ultrasound of the right buttock showed a hematoma that was evacuated because it compressed the sciatic nerve. You want to prescribe a right foot lifter-type technical aid. Which of the following regulatory elements for non-molded orthotics is(are) accurate:","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"They require a request for prior agreement","justification":""},{"idx":1,"correct":true,"proposition":"They are available from pharmacists","justification":""},{"idx":2,"correct":false,"proposition":"They are prescribed on a major appliance form.","justification":""},{"idx":3,"correct":true,"proposition":"They are prescribed on a simple prescription","justification":""},{"idx":4,"correct":false,"proposition":"They are fully reimbursed by the health insurance fund","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-6-qi-7","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"You decide to prescribe rehabilitation sessions on an outpatient basis at home. Among these elements, which is (are) mandatory on the prescription for the physiotherapist:","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Total number of sessions","justification":""},{"idx":1,"correct":true,"proposition":"The mention << at home>>","justification":""},{"idx":2,"correct":true,"proposition":"The region and\/or pathology to be treated","justification":""},{"idx":3,"correct":true,"proposition":"The mention << Masso-kinesitherapy>>","justification":""},{"idx":4,"correct":false,"proposition":"The physiotherapy technique used","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-6-qi-8","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"You follow your patient in regular consultation every month. Which of the following clinical or paraclinical elements is useful for monitoring recovery from this traumatic truncal nerve injury?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Electromyogram","justification":"As for most peripheral nerve damage, the EMG will make it possible to follow the (potention of) evolution with the monitoring of the speeds \/ amplitudes of the impulse."},{"idx":1,"correct":true,"proposition":"Motor clinical testing","justification":""},{"idx":2,"correct":true,"proposition":"Sensory clinical testing","justification":""},{"idx":3,"correct":false,"proposition":"Ultrasound","justification":""},{"idx":4,"correct":false,"proposition":"Muscle electrostimulation","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-6-qi-9","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"You see the patient again in consultation 3 months after the initial trauma. She always has an abnormal gait. In the oscillating phase of walking on flat ground, the tip of the right foot is constantly lowered, it raises the knee higher than it does at the same phase on the left side. Which of these statements is (are) accurate?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"This is a waddling approach","justification":""},{"idx":1,"correct":true,"proposition":"This is a steppage approach","justification":""},{"idx":2,"correct":false,"proposition":"This is a hot step","justification":""},{"idx":3,"correct":false,"proposition":"This is an earlier greeting","justification":""},{"idx":4,"correct":false,"proposition":"This is a mowing process","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-6-qi-10","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"The patient is increasingly anxious about walking due to her right sciatica neurological injury. She clings the tip of her right foot into a loose carpet at home, as she walked through a dark hallway. She stumbles and falls again. She can no longer support the right side because of pain. Here is the x-ray of the pelvis taken in the emergency room. What can you say from the X-ray? (one or more correct answers) ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Right sacrarian-iliac disjunction","justification":""},{"idx":1,"correct":false,"proposition":"Garden 3 fracture of the right femoral neck","justification":""},{"idx":2,"correct":true,"proposition":"Right ischiopubic branch fracture","justification":""},{"idx":3,"correct":false,"proposition":"Right pertrochanteric fracture","justification":""},{"idx":4,"correct":false,"proposition":"Fracture of the right little trochanter","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-6-qi-11","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Which of the various factors that may have contributed to this patient's fall, which do you consider to be an intrinsic factor(s) of falling? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Faulty lighting","justification":"Environmental factor"},{"idx":1,"correct":true,"proposition":"Damage to the sciatic nerve","justification":""},{"idx":2,"correct":false,"proposition":"The poorly fixed carpet","justification":"Environmental factor"},{"idx":3,"correct":true,"proposition":"Age-related macular degeneration","justification":""},{"idx":4,"correct":false,"proposition":"The orthosis (calf-plant lifter) ineffective","justification":"Walking disorder = predisposing factor"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-6-qi-12","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Which of the following is considered an activity limitation in this patient? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A decrease in the range of motion of the right hip","justification":"Impairment"},{"idx":1,"correct":false,"proposition":"Pain when walking","justification":"Impairment"},{"idx":2,"correct":true,"proposition":"Difficulty climbing stairs","justification":""},{"idx":3,"correct":false,"proposition":"A sensory disorder of the sole of the right foot","justification":"Impairment"},{"idx":4,"correct":true,"proposition":"Reduced walking performance","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-6-qi-13","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"You want to improve the patient's balance and walking disorders. Which of the following health professionals will contribute to the improvement of these symptoms?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Orthoptist"},{"idx":1,"correct":false,"proposition":"Speech therapist"},{"idx":2,"correct":true,"proposition":"Podo-orthotist"},{"idx":3,"correct":true,"proposition":"Physiotherapist"},{"idx":4,"correct":true,"proposition":"Psychomotor therapist"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-6-qi-14","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Given the patient's age, which insurance organization(s) will contribute to the patient's care?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Supplementary health fund","justification":""},{"idx":1,"correct":true,"proposition":"Caisse primaire d'assurance maladie","justification":""},{"idx":2,"correct":false,"proposition":"Communal social action services","justification":""},{"idx":3,"correct":false,"proposition":"Aid for the autonomy of the departmental council","justification":"APA is not insurance 😉"},{"idx":4,"correct":false,"proposition":"National Fund for Solidarity and Autonomy"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-7-qi-1","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"Among the following acrosyndromes, and at this stage of the semiological description, which one (or which) is (are) compatible with the clinical picture reported by Mrs. X.? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Acrocyanosis","justification":""},{"idx":1,"correct":true,"proposition":"Raynaud's phenomenon","justification":""},{"idx":2,"correct":true,"proposition":"Erythermalgia","justification":""},{"idx":3,"correct":false,"proposition":"Chilblains","justification":""},{"idx":4,"correct":false,"proposition":"Digital necrosis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-7-qi-2","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"She tells you that these episodes are clearly triggered by the cold, and presents you at the consultation a photograph taken during one of these episodes. With this new information, the possible diagnosis(s) is: ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Secondary Raynaud's phenomenon","justification":""},{"idx":1,"correct":true,"proposition":"Raynaud's disease","justification":""},{"idx":2,"correct":false,"proposition":"Erythermalgia","justification":""},{"idx":3,"correct":false,"proposition":"Fine fibre neuropathy","justification":""},{"idx":4,"correct":false,"proposition":"Acrocyanosis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-7-qi-3","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"You are diagnosed with Raynaud's phenomenon. What elements are to be looked for during the interrogation? (one or more expected answers) ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A cyanic phase","justification":""},{"idx":1,"correct":true,"proposition":"Damage to the toes","justification":""},{"idx":2,"correct":true,"proposition":"Thumb damage","justification":""},{"idx":3,"correct":true,"proposition":"A painful erythematous phase","justification":""},{"idx":4,"correct":false,"proposition":"Worsening when taking paracetamol","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-7-qi-4","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"On physical examination of the patient, you note: \n\n- whitening of the hand after compression of the ulnar and radial arteries and << pumping maneuvers >>, then obtaining a recoloration of the hand in 3 seconds following the relaxation of the ulnar artery; and in 4 seconds after the relaxation of the radial artery; \n\n- the absence of paresthesias of the fingers at the percussion of the anterior surface of the wrist or during the forced flexion of the wrist. \n\nThe patient's physical examination favours (one or more correct answers)","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"From a normal Allen maneuver","justification":"The cut-off is 7-10 seconds."},{"idx":1,"correct":false,"proposition":"Thrombosis of the radial artery","justification":""},{"idx":2,"correct":false,"proposition":"A positive Tinel sign","justification":""},{"idx":3,"correct":false,"proposition":"From compression of the median nerve to carpal tunnel","justification":""},{"idx":4,"correct":false,"proposition":"A positive Phalen sign","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-7-qi-5","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"What semiological element(s) are you looking for in favor of a secondary Raynaud's phenomenon? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Dry oral or ocular syndrome","justification":""},{"idx":1,"correct":true,"proposition":"Photosensitivity","justification":""},{"idx":2,"correct":true,"proposition":"Muscle pain","justification":""},{"idx":3,"correct":true,"proposition":"Scleroditactyly","justification":""},{"idx":4,"correct":true,"proposition":"Telangiectasias","justification":"Telangiectasias would be part of cutaneous scleroderma (CREST syndrome)."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-7-qi-6","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"When questioned by Mrs. X., she explains that these symptoms began around the age of 30, and occur every winter. She has no notable personal history, but her sister and mother have the same type of clinical manifestations. Thumbs are spared. It does not describe any other symptoms. On physical examination, you do not find trophic disorder, sclerodactyly or telangiectasia, peripheral pulses are perceived in all 4 limbs, and you do not notice audible murmur on auscultation of arterial pathways. Which clinical element(s) is compatible with Raynaud's disease (essential Raynaud's phenomenon)? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The age of onset of symptoms","justification":"We start to ask ourselves questions after 35 years."},{"idx":1,"correct":true,"proposition":"Family history","justification":""},{"idx":2,"correct":true,"proposition":"Winter upsurge","justification":""},{"idx":3,"correct":true,"proposition":"Lack of thumb involvement","justification":""},{"idx":3,"correct":true,"proposition":"Bilateral Achievement","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-7-qi-7","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"In the clinical situation of Mrs. X., which additional examination(s) do you prescribe? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"X-ray of the spine from the front centered on C7","justification":""},{"idx":1,"correct":false,"proposition":"Chest x-ray from the front","justification":""},{"idx":2,"correct":false,"proposition":"Ultrasound-Doppler of the arteries of the upper limbs","justification":""},{"idx":3,"correct":false,"proposition":"Cryoglobulinemia detection","justification":""},{"idx":4,"correct":true,"proposition":"Antinuclear antibody testing","justification":"As well as a capillaroscopy."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-7-qi-8","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"Antinuclear antibodies are 1\/80. You retain the diagnosis of essential Raynaud's phenomenon (Raynaud's disease) and propose symptomatic management. Five years later, Mrs. X. is referred to you by her doctor for a fever that has been evolving for 4 weeks. This fever is irregular, oscillating with a temperature of 37.9 ° C in the morning but higher in the evening, can rise up to 39 ° C and associated with sweating. Mrs. X. is tired, she has lost 2 kg since the beginning of this fever. She has no other symptoms. She lives in an urban setting, has never travelled abroad, and does not take any treatment. The clinical picture currently presented by the patient is compatible with: (one or more exact answers) ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A solid cancer","justification":""},{"idx":1,"correct":false,"proposition":"A familial Mediterranean fever","justification":"The picture does not stick: it is rather that of a teenager."},{"idx":2,"correct":true,"proposition":"An infectious disease","justification":""},{"idx":3,"correct":true,"proposition":"Lymphoma","justification":""},{"idx":4,"correct":true,"proposition":"Takayasu's disease","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-7-qi-9","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"In the clinical situation of the patient, what biological abnormality(s) would be suggestive of an inflammatory syndrome? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Increased albumin","justification":"Increase in all proteins except transport proteins: albumin, transferrin and transtyretrin."},{"idx":1,"correct":false,"proposition":"Decreased haptoglobin","justification":""},{"idx":2,"correct":true,"proposition":"Increased fibrinogen","justification":""},{"idx":3,"correct":true,"proposition":"Decreased transferrin","justification":""},{"idx":4,"correct":true,"proposition":"Increase in alpha2-globulins","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-7-qi-10","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"On physical examination of the patient in the supine position, you perceive a mass of the left hypochondrium lowering on deep inhalation. Which of the following proposals do you think is accurate given this new clinical element?","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"This clinical finding is common in a young, thin patient","justification":""},{"idx":1,"correct":false,"proposition":"This clinical finding makes an infectious cause less likely","justification":"Many infections can be accompanied by splenomegaly: mononucleosis syndrome (HIV, CMV, toxoplasmosis, ...), endocarditis, hepatitis, malaria, ..."},{"idx":2,"correct":false,"proposition":"This clinical finding makes an autoimmune cause less likely ","justification":"Lupus, sarcoidosis and rheumatoid arthritis (to name only the less rare) are often accompanied by splenomegaly."},{"idx":3,"correct":true,"proposition":"This clinical finding can be observed in cases of liver disease","justification":"👉 This is a sign of portal hypertension."},{"idx":4,"correct":true,"proposition":"This clinical finding should suggest a haemological pathy","justification":"Including lymphomas."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-7-qi-11","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"On cardiac auscultation of Mrs. X., you perceive a systolic murmur at 2\/6. This heart murmur was not known until now. There is no associated diastolic murmur, heart sounds are regular, there are no signs of associated heart failure. You suspect infective endocarditis. What element(s) are you looking for to support your suspected diagnosis?","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Purpura of the lower limbs","justification":"Vascular pupura is an immunological manifestation"},{"idx":1,"correct":true,"proposition":"Purplish nodules of the pulp of the fingers ","justification":"This is called Osler's False Panaris (pathognomonic sign of infective endocarditis)."},{"idx":2,"correct":true,"proposition":"Proteinuria the urine strip","justification":""},{"idx":3,"correct":false,"proposition":"Distal paresthesias of the lower limbs","justification":""},{"idx":4,"correct":false,"proposition":"Red and painful eye","justification":"Roth's nodules can be observed at the back of the eye, but without affecting the anterior chamber."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-7-qi-12","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"At this stage of the treatment, which examination(s) do you think are justified?","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Angiotensin-converting enzyme assay","justification":""},{"idx":1,"correct":false,"proposition":"PET-scanner"},{"idx":2,"correct":true,"proposition":"Blood"},{"idx":3,"correct":false,"proposition":"Antibodiesanti-pegtidescitrullinated (anti-CCP)","justification":""},{"idx":4,"correct":true,"proposition":"Transthoracic cardiac ultrasound","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-7-qi-13","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"Three blood cultures with aero-anaerobic cultures remain sterile, the good quality transthoracic cardiac ultrasound is normal, showing no vegetation image or significant valve abnormality. Which of the following proposals do you think is correct? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The realization of a trans-esophageal cardiac ultrasound is justified","justification":"The description of ETT is very reassuring. Blood cultures are negative. It is lawful to stop there."},{"idx":1,"correct":true,"proposition":"The realization of a thoraco-abdomino-pelvic CT scan is justified","justification":""},{"idx":2,"correct":true,"proposition":"The realization of viral serologies (HIV and EBV) is justified","justification":""},{"idx":3,"correct":false,"proposition":"A therapeutic test with corticosteroids is justified","justification":""},{"idx":4,"correct":false,"proposition":"A therapeutic test with antibiotics is justified","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-7-qi-14","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"HIV serology is negative, and EBV serology supports ancient immunity. A thoraco-abdomino-pelvic CT scan shows supracentimetric mediastinal lymphadenopathy and splenomegaly. Which of the following tests do you think is the most relevant way to advance in the diagnostic investigation of the patient? (only one answer expected) ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Search for anti-neutrophil cytoplasmic antibodies (ANCA)","justification":""},{"idx":1,"correct":false,"proposition":"lmmunophenotyping lymphocyte","justification":""},{"idx":2,"correct":false,"proposition":"Plasma LDH determination","justification":""},{"idx":3,"correct":false,"proposition":"Splenic biopsy","justification":"A spleen is not biopsied because there is too great a risk of bleeding."},{"idx":4,"correct":true,"proposition":"Mediastinal lymph node biopsy","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-7-qi-15","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"A diagnosis of diffuse large cell B-cell lymphoma is made by a lymph node biopsy performed by mediastinoscopy. An implantable chamber is placed and immunochemotherapy treatment with R-CHOP (rituximab - cyclophosphamide, hydroxydoxorubicin, vincristine and prednisone) is started. \n\nWhile the first 2 treatment cycles were uncomplicated, the patient ° presents on Day 10 of the 3rd treatment cycle a fever at 39 ° C with chills. You see her in an emergency consultation. Blood pressure is 130\/70 mmHg, heart rate is 95\/minute. The patient does not have a neurological disorder, the skin examination, especially with regard to the implantable chamber is normal, there is no obvious functional or physical respiratory, digestive or urinary sign. Your physical exam is normal. A blood count taken in town the same morning shows the following results: white blood cells 1.8 G\/L, hemoglobin 104 g\/L, mean corpuscular volume 85 fL, platelets 97 G\/L, leukocyte formula: neutrophils 0.4 G\/L eosinophilic polynuclear 0.1 G\/L, basophilic polynuclear 0.9 G\/L, lymphocytes 0.9 G\/L, monocytes 0.3 G\/L. What examination(s) do you perform before starting antibiotic therapy in your patient? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Aspergillary antigenemia","justification":""},{"idx":1,"correct":false,"proposition":"Blood smear looking for Jolly's bodies","justification":""},{"idx":2,"correct":true,"proposition":"Blood cultures on the periphery and on the central venous catheter","justification":""},{"idx":3,"correct":false,"proposition":"Chest X-ray","justification":""},{"idx":4,"correct":false,"proposition":"Thoraco-abdominal CT scan","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-7-qi-16","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"Outpatient care is offered. Treatment with amoxicillin\/clavulanic acid + ciprofloxacin is started urgently. The fever disappears within 24 hours. Samples taken before the start of treatment remain sterile, and treatment is continued for 7 days. \n\nThree weeks later, the patient sees you again because of the onset of a fever at 39.5°C associated with the next rash. Which of the following may be present in your patient in case of drug reaction syndrome with eosinophilia and systemic signs (DRESS)? (one or more expected answers)","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Extensive skin detachment","justification":""},{"idx":1,"correct":true,"proposition":"eosinophilia> 1500\/mm3","justification":""},{"idx":2,"correct":true,"proposition":"elevation of transaminases with decrease of TP","justification":""},{"idx":3,"correct":true,"proposition":"acute renal failure","justification":""},{"idx":4,"correct":true,"proposition":"diffuse lymphadenopathy","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-8-qi-1","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"Which additional examination should be carried out first at this stage?","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Chest x-ray from the front","justification":""},{"idx":1,"correct":false,"proposition":"Echocardiography","justification":""},{"idx":2,"correct":false,"proposition":"Chest CT scan","justification":""},{"idx":3,"correct":true,"proposition":"Electrocardiogram","justification":""},{"idx":4,"correct":false,"proposition":"Arterial blood gas","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-8-qi-2","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"In the event of a myocardial infarction, which early life-threatening complication should you keep in mind as a priority during your initial management? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Cardiogenic shock","justification":"It is less early, less serious, and less common than ventricular fibrillation."},{"idx":1,"correct":false,"proposition":"Septal rupture","justification":""},{"idx":2,"correct":false,"proposition":"Pericarditis","justification":""},{"idx":3,"correct":true,"proposition":"Ventricular fibrillation","justification":""},{"idx":4,"correct":false,"proposition":"Intraventricular thrombosis ","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-8-qi-3","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"The interrogation reveals that the pain is chronic, evolving crescendo for 3 months. The electrocardiogram performed immediately does not show an argument in favor of acute coronary syndrome. On physical examination, you find dyspnea at the slightest effort with appearance of edema of the bilateral lower limbs, a gain of 6 kg in 10 days as well as jugular turgor with hepatojugular reflux. The life constants are: BP 95\/65 mmHg, heart rate 112 beats\/min, OPS 98% ambient air, temperature 36.6 °C.  What are the two most likely diagnoses compatible with this clinical picture? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Acute edema of the lung","justification":"There would be no signs of right heart failure (OMI, TJ, RHJ)."},{"idx":1,"correct":true,"proposition":"Pericardial tamponade","justification":""},{"idx":2,"correct":false,"proposition":"Myocardial infarction","justification":""},{"idx":3,"correct":true,"proposition":"Recurrent pulmonary embolisms","justification":""},{"idx":4,"correct":false,"proposition":"Aortic dissection","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-8-qi-4","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"By resuming your physical examination, the intern reports observing a paradoxical pulse. Which of the following proposals corresponds to the description of a paradoxical pulse? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Pulse attenuated one out of two heartbeats","justification":""},{"idx":1,"correct":false,"proposition":"Expiratory pulse depression","justification":""},{"idx":2,"correct":true,"proposition":"Inspiratory pulse depression","justification":"Sign of tamponade."},{"idx":3,"correct":false,"proposition":"Pulse perception after the second heart sound","justification":""},{"idx":4,"correct":false,"proposition":"Increased pulse sitting leaning forward","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-8-qi-5","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"Inspiratory pulse depression confirms the paradoxical pulse. In this context, you ask for a front chest X-ray and echocardiography. What anomaly(s) do you identify on this shot taken in bed ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Right pleural effusion","justification":"We distinguish the pleural cul de sac."},{"idx":1,"correct":true,"proposition":"Cardiomegaly","justification":""},{"idx":2,"correct":false,"proposition":"Aspect of double aortic contour","justification":""},{"idx":3,"correct":false,"proposition":"Protrusion of the lower left arch of the cardiac silhouette","justification":"We asked a radiology PU-PH for his opinion on these two proposals. His answer: the protrusions of the heart arches correspond to cardiomegaly, but only when it is the heart that exceeds its usual size. We can not speak strictly of protrusion here, since the paradoxical pulse directs you to a pericardial effusion. "},{"idx":4,"correct":false,"proposition":"Protrusion of the lower right arch of the cardiac silhouette","justification":"We asked a radiology PU-PH for his opinion on these two proposals. His answer: the protrusions of the heart arches correspond to cardiomegaly, but only when it is the heart that exceeds its usual size. We can not speak strictly of protrusion here, since the paradoxical pulse directs you to a pericardial effusion. "}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-8-qi-6","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"On echocardiography, there is a circumferential pericardial effusion of great abundance with hemodynamic impact and a scalloped appearance of the serosa. You retain the diagnosis of pericardial tamponade. What element(s) is (are) involved in the pathophysiology of tamponade? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Decreased systolic ejection volume of the left ventricle","justification":""},{"idx":1,"correct":true,"proposition":"Compression of the right ventricle","justification":""},{"idx":2,"correct":false,"proposition":"Compensatory bradycardia","justification":""},{"idx":3,"correct":true,"proposition":"Increased intrapericardial pressures","justification":""},{"idx":4,"correct":false,"proposition":"Shunt effect","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-8-qi-7","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"What is (are) the therapeutic measure(s) to be applied urgently in front of this tamponade? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Pericardial drainage","justification":""},{"idx":1,"correct":false,"proposition":"Intravenous infusion of nitrates","justification":"It's not an OAP"},{"idx":2,"correct":false,"proposition":"Infusion of catecholamines (dobutamine or noradrenaline)","justification":""},{"idx":3,"correct":false,"proposition":"Volume depletion","justification":"It's not an OAP"},{"idx":4,"correct":false,"proposition":"Parenteral anticoagulation","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-8-qi-8","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"You transfer the patient for emergency drainage to the cardiac surgery block. 1,000 mL of bloody fluid was punctured. The pathologist identifies the presence of tumor cells of adenocarcinomatous nature. She was then admitted to intensive care. Which underlying primary tumor can you end up with a significant probability? (one or more correct answer(s)) ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Breast cancer","justification":""},{"idx":1,"correct":false,"proposition":"Melanoma","justification":"It is not adenocarcinoma"},{"idx":2,"correct":true,"proposition":"Lung cancer","justification":""},{"idx":3,"correct":false,"proposition":"Cavum cancer","justification":"It is not adenocarcinoma"},{"idx":4,"correct":false,"proposition":"Cervical cancer","justification":"It is not adenocarcinoma"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-8-qi-9","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"A chest CT scan identifies in addition to neoplastic pericarditis in particular: a left hilar tumor mass extending to the apico-dorsal segment of the culmen associated with homolateral mediastinal adenomegaly, bilateral pleural effusion. What is the stage of the disease?","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"1","justification":""},{"idx":0,"correct":false,"proposition":"2","justification":""},{"idx":0,"correct":false,"proposition":"3a","justification":""},{"idx":0,"correct":false,"proposition":"3b","justification":""},{"idx":0,"correct":true,"proposition":"4","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-8-qi-10","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"In the case of primary stage IV bronchial adenocarcinoma, what extension assessment do you request in the absence of a new symptom (one or more correct response(s))?","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Brain CT scan","justification":""},{"idx":1,"correct":false,"proposition":"Abdominopelvic CT scan","justification":""},{"idx":2,"correct":false,"proposition":"Bone scintigraphy","justification":""},{"idx":3,"correct":false,"proposition":"Panendoscopy","justification":""},{"idx":4,"correct":true,"proposition":"None","justification":"The tumour is stage IV (disseminated). The extension assessment has no therapeutic impact."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-8-qi-11","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"What is the reference oncological treatment for this stage IV bronchial cancer (one or more possible response(s))? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Pneumo-pleuro-pericardectomy","justification":""},{"idx":1,"correct":false,"proposition":"Mediastinal radiation therapy","justification":""},{"idx":2,"correct":true,"proposition":"Systemic chemotherapy","justification":""},{"idx":3,"correct":false,"proposition":"Intrapericardial chemotherapy","justification":""},{"idx":4,"correct":true,"proposition":"Supportive care","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-8-qi-12","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"The general condition being preserved, you retain an indication of systemic treatment of metastatic first-line associated with palliative care. What will you look for on the pathological report of pericardial drainage fluid to guide the choice of systemic treatment (one or more possible answers)? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"EGFR activating mutation","justification":""},{"idx":1,"correct":true,"proposition":"Expression de PDL1","justification":""},{"idx":2,"correct":true,"proposition":"Mutation de BRAF","justification":""},{"idx":3,"correct":true,"proposition":"Translocation of ALK","justification":""},{"idx":4,"correct":false,"proposition":"Nothing in particular, chemotherapy being based on a doublet of conventional drugs","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-8-qi-13","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"In the absence of targetable molecular alteration and expression of PDL1, you retain the indication of chemotherapy with carboplatin \/ paclitaxel. What is(s) the main expected side effect(s) of carboplatin of which you inform the patient? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Asthenia","justification":"the 2"},{"idx":1,"correct":true,"proposition":"Stomatitis","justification":"the 2"},{"idx":2,"correct":true,"proposition":"Cytopenia","justification":"the 2"},{"idx":3,"correct":true,"proposition":"Peripheral neuropathy","justification":"paclitaxel"},{"idx":4,"correct":false,"proposition":"Hearing loss","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-8-qi-14","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"Finally the situation is complicated with a DICD not allowing to start chemotherapy. You move towards exclusive palliative care and decide to hospitalize the patient in a palliative care unit. Regarding palliative care units (PHUs), what is(are) the exact statement(s)? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Their mission is to admit patients in end-of-life situations and who present a complex situation of care","justification":""},{"idx":1,"correct":false,"proposition":"The essential criterion for a patient to be admitted to USP is that his survival is estimated at less than three months","justification":""},{"idx":2,"correct":true,"proposition":"The main objective of a USP treatment is to improve the patient's quality of life","justification":""},{"idx":3,"correct":true,"proposition":"Chemotherapy treatments can be continued even while the patient is hospitalized in USP","justification":""},{"idx":4,"correct":false,"proposition":"The visit of children under 10 years old is not allowed in USP","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-8-qi-15","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"After a few days of hospitalization in the palliative care unit, the situation, although precarious, stabilized and the patient expressed the wish to return home. What element(s) could jeopardize the organization of this return home? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Physical or moral exhaustion of loved ones","justification":""},{"idx":1,"correct":false,"proposition":"The need for 3 electric syringes","justification":""},{"idx":2,"correct":true,"proposition":"A refusal of the family to consider death at home","justification":""},{"idx":3,"correct":false,"proposition":"The need for morphine treatment at a high dosage","justification":""},{"idx":4,"correct":true,"proposition":"A lack of mobilization of the attending physician","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-9-qi-1","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What therapeutic care do you offer for this diabetes? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"800 kcal\/d and low-carbohydrate diet","justification":""},{"idx":1,"correct":true,"proposition":"Low-calorie diet (30% reduction in current intake) and low in fast sugars","justification":""},{"idx":2,"correct":false,"proposition":"Metformin therapy","justification":"We always start with hygiene measures in type 2 diabetes."},{"idx":3,"correct":false,"proposition":"Treatment with slow insulin and basal bolus","justification":""},{"idx":4,"correct":true,"proposition":"Physical activity","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-9-qi-2","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"You recover the following balance: creatinine at 130 μmol \/ L or a glomerular filtration rate CKD-PPE estimated at 52 ml \/ min \/ 1.73 m ^2 \nUrine strip: protein three cross, red blood cells three cross, leukocytes negative, nitrites negative, ketone bodies negative. What biological tests are needed at this stage? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Renin aldosterone dosage","justification":""},{"idx":1,"correct":true,"proposition":"Cytobacteriological examination of urine","justification":""},{"idx":2,"correct":true,"proposition":"24-hour proteinuria","justification":""},{"idx":3,"correct":false,"proposition":"Anti-neutrophil cytoplasmic antibodies (ANCA)","justification":""},{"idx":4,"correct":false,"proposition":"Anti-PLA2R antibodies","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-9-qi-3","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"The results are as follows: \nECBU: red blood cells at 80,000\/ml, leukocytes< 1000\/ml, negative culture over 24 h. \n24-hour proteinuria: 2.5 g\/d composed of 70% albumin. \nWhat are the additional examinations to be carried out in the face of these anomalies? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" Fundus","justification":""},{"idx":1,"correct":true,"proposition":"Vesicorenal ultrasound with arterial Doppler","justification":""},{"idx":2,"correct":false,"proposition":"Accessory salivary gland biopsy","justification":""},{"idx":3,"correct":false,"proposition":"Renal MRI angiography","justification":""},{"idx":4,"correct":false,"proposition":"Uroscanner","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-9-qi-4","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"The fundus finds arterial stiffness with sign of crossing without further lesion. Renal Doppler ultrasound finds normal-sized kidneys without dilation of the pyelocalicial cavities. There is a simple kidney cyst of 1 cm on the right and one of 4 mm on the left. The Doppler analysis is not very contributory given the morphotype of the patient but the radiologist indicates that he does not find an indirect sign for significant renal arterial stenosis. \nThere is a 12 mm tissue-like image at the lower bladder bottom. In addition, despite the appropriate hygiene measures, diabetes control is unsatisfactory and you start treatment with metformin at a dose of 500 mg at a frequency of 3 times \/ day. Given these results, what can be the causes of this hematuria (one or more correct answers)?","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Polycystic kidney disease","justification":""},{"idx":1,"correct":false,"proposition":"Diabetic glomerular nephropathy","justification":"Hematuria is not found in diabetic glomerular nephropathy"},{"idx":2,"correct":true,"proposition":"lgA nephropathy","justification":""},{"idx":3,"correct":true,"proposition":"Urothelial tumour","justification":"The ultrasound imagining orients us somewhat."},{"idx":4,"correct":true,"proposition":"Extramembranous glomerulonephritis","justification":"GEM can be accompanied by hematuria"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-9-qi-5","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What tests are needed to explore this hematuria at this stage? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Puncture kidney biopsy","justification":""},{"idx":1,"correct":true,"proposition":"Bladder fibroscopy","justification":""},{"idx":2,"correct":true,"proposition":"Urinary cytology on fresh urine with histopathological examination","justification":""},{"idx":3,"correct":true,"proposition":"Uroscanner","justification":""},{"idx":4,"correct":false,"proposition":"Ascending urethrocystography and voiding","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-9-qi-6","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"You decide to do urinary cytology and bladder fibroscopy. \nRegarding the possible realization of the uroscanner in your patient, which proposals are accurate (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"This examination is contraindicated in this patient","justification":""},{"idx":1,"correct":true,"proposition":"Metformin should be stopped on the day of the exam","justification":"It will be reintroduced on Day 2."},{"idx":2,"correct":false,"proposition":"Hydration by glucose solute is to be expected before the examination","justification":""},{"idx":3,"correct":true,"proposition":"Oral hydration is to be expected before the examination","justification":""},{"idx":4,"correct":false,"proposition":"There is a risk of acute interstitial nephritis","justification":"There is a risk of acute tubular necrosis."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-9-qi-7","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"The uroscanner did not find any other urothelial lesions. Cystoscopy confirmed the existence of the polyp and a transurethral resection of the bladder polyp was performed. Anatomical pathology has shown that it is a low-grade urothelial carcinoma pTa. What is the exact proposal regarding his tumor? (an expected response) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is an invasive tumor infiltrating the muscle","justification":"From T2"},{"idx":1,"correct":false,"proposition":"This is carcinoma in situ","justification":"Tis"},{"idx":2,"correct":false,"proposition":"It is a tumor infiltrating the chorion","justification":"T1"},{"idx":3,"correct":true,"proposition":"It is a non-invasive papillary tumour","justification":""},{"idx":4,"correct":false,"proposition":"It is an epidermoid tumor","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-9-qi-8","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"In the absence of diabetic retinopathy, you decide to perform a kidney biopsy. The pathology report is as follows: \n8 mm renal cortical fragment containing 12 glomeruli including 2 sclerotic glomeruli. \nThe remaining 10 glomeruli exhibit nodular mesangial expansion with thickening of the basement membranes. \nThere is moderate arteriolar hyalinosis and interstitial fibrosis affecting 20% of the parenchyma of the biopsy. \nThe coloration by Congo red is negative. \nThe immunofluorescence study does not find significant deposits in the glomeruli. \nWhat is the most likely diagnosis (only one response expected) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Pauciimmune glomerulonephritis","justification":""},{"idx":1,"correct":false,"proposition":"Nephroangiosclerosis","justification":""},{"idx":2,"correct":false,"proposition":"Renal amyloidosis","justification":""},{"idx":3,"correct":true,"proposition":"Diabetic glomerulosclerosis","justification":""},{"idx":4,"correct":false,"proposition":"Membranoproliferative glomerulonephritis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-9-qi-9","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"Your patient therefore has diabetic glomerulosclerosis. Its renal function stabilizes at 135 μmol\/I (DFG CKD EPI = 50 ml\/min\/1.73 m^22). What is the stage of his chronic kidney disease? (an expected response) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Stage 2","justification":""},{"idx":1,"correct":true,"proposition":"Stage 3A","justification":""},{"idx":2,"correct":false,"proposition":"Stage 1","justification":""},{"idx":3,"correct":false,"proposition":"Stage 3B","justification":""},{"idx":4,"correct":false,"proposition":"Stage 4","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-9-qi-10","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What are the treatment targets in this patient at this stage? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Proteinuria < 0.5 g\/24 hours","justification":""},{"idx":1,"correct":false,"proposition":"Negativation of hematuria","justification":"Hematuria is not a nephrological cause. It comes from his tumor."},{"idx":2,"correct":false,"proposition":"Blood pressure less than or equal to 120\/70 mmHg","justification":""},{"idx":3,"correct":false,"proposition":"Protein intake less than 0.6 g\/kg\/day","justification":""},{"idx":4,"correct":true,"proposition":"Salt intake close to 6 g\/24 hours","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-9-qi-11","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"Which of the following molecules can be prescribed as a first-line treatment for this patient for high blood pressure? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"ACE inhibitor (ACE inhibitor)","justification":""},{"idx":1,"correct":true,"proposition":"Angiotensin II receptor antagonist (ARA2)","justification":""},{"idx":2,"correct":true,"proposition":"Angiotensin-thiazide receptor antagonist association","justification":"As a second line (amlodipine does not seem to be sufficient here)."},{"idx":3,"correct":true,"proposition":"Thiazide","justification":""},{"idx":4,"correct":false,"proposition":"Beta-blocker","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-9-qi-12","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What therapies are possible in this patient to reduce cardiovascular risk? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Clopidogrel","justification":""},{"idx":1,"correct":false,"proposition":"Effective anticoagulation","justification":""},{"idx":2,"correct":true,"proposition":"Statine","justification":""},{"idx":3,"correct":false,"proposition":"Allopurinol","justification":""},{"idx":4,"correct":false,"proposition":"Fibrate","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-9-qi-13","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"You have prescribed an angiotensin 2-thiazide receptor antagonist combination. You see him again in nephrology consultation two months later with a control biological assessment. He tells you that he was bedridden for a few days due to sciatica and that he took ibuprofen in self-medication. His blood pressure is 122\/73 mmHg, his heart rate is 82\/min. The electrocardiogram is normal. The blood test is as follows: Na 140 mmol\/L, K 5.5 mmol\/L, HCO3 21 mmol\/L, urea 18 mmol\/L, creatinine 212 μmol\/L. What are the factors that may have favored this acute renal failure (one or more exact responses) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Taking nonsteroidal anti-inflammatory drugs","justification":""},{"idx":1,"correct":false,"proposition":"Intracellular dehydration","justification":""},{"idx":2,"correct":true,"proposition":"Stenosis of the renal arteries","justification":""},{"idx":3,"correct":true,"proposition":"Treatment with angiotensin 2 and thiazide receptor antagonist","justification":""},{"idx":4,"correct":false,"proposition":"Metformin therapy","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-9-qi-14","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What is your therapeutic attitude? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Stop ibuprofen","justification":""},{"idx":1,"correct":true,"proposition":"Suspend angiotensin receptor antagonist 2","justification":""},{"idx":2,"correct":true,"proposition":"Suspend thiazide","justification":""},{"idx":3,"correct":false,"proposition":"Infusion of calcium gluconate ampoule IVD","justification":""},{"idx":4,"correct":false,"proposition":"Replace metformin with a sulphonylurea","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-9-qi-15","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"Her kidney function has improved thanks to your treatment and her serum creatinine has stabilized at 140 μmol\/L. You want to formally rule out stenosis of the renal arteries. What imaging tests are appropriate for this patient at this stage? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Renal Doppler ultrasound","justification":"Been there, done that 🤷 ♂️"},{"idx":1,"correct":true,"proposition":"Renal angiography","justification":""},{"idx":2,"correct":false,"proposition":"Kidney scan with captopril test","justification":""},{"idx":3,"correct":true,"proposition":"Renal MRI angiography","justification":""},{"idx":4,"correct":false,"proposition":"Renal arteriography","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-9-qi-16","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"You have performed the following radiological examination. What are the exact proposals? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Arrow 1 corresponds to the small intestine","justification":"It is rather the colon (the colonist is the most peripheral, if there is nothing on the right 👉 it is the colon 💩!)."},{"idx":1,"correct":true,"proposition":"Arrow 2 corresponds to the superior mesenteric vein","justification":""},{"idx":2,"correct":false,"proposition":"Arrow 3 corresponds to the pylorus","justification":"This is the pancreas. We are too low for the stomach."},{"idx":3,"correct":true,"proposition":"Arrow 4 corresponds to the right renal artery","justification":""},{"idx":4,"correct":true,"proposition":"The examination is done at an arterial phase","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-9-qi-17","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"The examination performed does not find significant stenosis. What advice do you give to your patient following this episode? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Hydration by Vichy water 2 liters \/ day","justification":""},{"idx":1,"correct":true,"proposition":"Drinks of at least 1 liter\/day and suitable for 24-hour diuresis","justification":""},{"idx":2,"correct":true,"proposition":"Suspend angiotensin II receptor antagonist and thiazide in dehydration","justification":""},{"idx":3,"correct":false,"proposition":"Hydration by low mineralized water 2 liters \/ day","justification":""},{"idx":4,"correct":true,"proposition":"Formal contraindication to nonsteroidal anti-inflammatory drugs","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-10-qi-1","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"During your first consultation, what element(s) could guide you towards secondary obesity? ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"His waistline","justification":""},{"idx":1,"correct":false,"proposition":"An acanthosis nigricans","justification":"Acanthosis nigricans is an aspecific sign of insulin resistance."},{"idx":2,"correct":true,"proposition":"Colored stretch marks from the root of the limbs","justification":"The famous 'purple stretch marks'."},{"idx":3,"correct":true,"proposition":"Edema of the lower limbs","justification":"Extracellular hyperhydration is not classic."},{"idx":4,"correct":true,"proposition":"Bruising of the forearms","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-10-qi-2","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"Waist circumference is measured at 102 cm and hip circumference at 128 cm. There is no acanthosis nigricans. You notice some stretch marks that the patient reports as related to her weight changes. His blood pressure is measured at 140\/84 mmHg. You prescribe an initial biological assessment. What will it include in the first intention? (one or more correct answers) ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Free thyroxine","justification":""},{"idx":1,"correct":true,"proposition":"Fasting blood glucose","justification":""},{"idx":2,"correct":true,"proposition":"Lipid profile","justification":""},{"idx":3,"correct":true,"proposition":"Uricemia","justification":"Uricemia is part of the list of the systematic bio assessment in front of adult obesity in the college 🤷 ♂️ (page 357 of the 2021 edition)."},{"idx":4,"correct":false,"proposition":"24-hour urinary free cortisol","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-10-qi-3","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"You see her again a month later, the weight is the same and the patient explains that she is very interested in bariatric surgery and wants more information. Which proposal(s) is (are) accurate?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"he sleep apnea syndrome is a contraindication to performing bariatric surgery","justification":""},{"idx":1,"correct":true,"proposition":"bariatric surgery has no indication when the BMI is less than 35 kg\/m2","justification":""},{"idx":2,"correct":false,"proposition":"Gastric banding is the technique that has shown the most effective","justification":""},{"idx":3,"correct":true,"proposition":"bariatric surgery cannot be performed until summer","justification":""},{"idx":4,"correct":true,"proposition":"Gastric bypass is responsible for weight loss through both restriction and malabsorption"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-10-qi-5","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"It presents the results of the prescribed biological assessment: \n\nnatremia 138 mmol\/L; \n\nserum potassium level 3.2 mmol\/L; \n\nfasting blood glucose 1.16 g\/L (6.38 mmol\/L); \n\ntotal cholesterol 1.83 g\/L (N: 1.8-2.4); \n\ntriglycerides 2.58 g\/L (N: 0.7-1.5); \n\nHDL-cholesterol 0.40 g\/L (N: 0.45-0.90); \n\nLDL-cholesterol 0.91 g\/L (N: 0.6-1.6); \n\nAST 38 IU\/L (N < 20); ALT 65 IU\/L (N< 40). \n\nYou suspect Cushing's syndrome. What arguments point to this hypothesis? (one or more correct answers) ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Blood sugar","justification":"Hyperglycemia can quite fit into the nosological framework of a common obesity and does not particularly point to a Cushing's syndrome."},{"idx":1,"correct":true,"proposition":"Potassium levels","justification":""},{"idx":2,"correct":false,"proposition":"Blood triglyceride levels","justification":"Hypertriglyceridemia can quite fit into the nosological framework of a common obesity and does not particularly point to a Cushing's syndrome."},{"idx":3,"correct":false,"proposition":"LDL-cholesterol levels","justification":"LDL-cholesterol levels are normal here."},{"idx":4,"correct":false,"proposition":"The level of transaminases","justification":"Cytolysis can quite fit into the nosological framework of a common obesity and does not particularly point to a Cushing's syndrome."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-10-qi-6","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"What biological tests can you order to support your diagnostic hypothesis? (one or more correct answers) ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Plasma cortisol at 8 o'clock","justification":""},{"idx":1,"correct":false,"proposition":"Plasma ACTH at 8 o'clock","justification":""},{"idx":2,"correct":false,"proposition":"Dosage of ACTH at midnight","justification":""},{"idx":3,"correct":true,"proposition":"Salivary cortisol at midnight","justification":""},{"idx":4,"correct":true,"proposition":"Dexamethasone minute brake test","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-10-qi-7","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"She tells you that she had an abdominal CT scan a few weeks ago because of abdominal pain. Two sections are reproduced below. Arrows with numbers represent anatomical structures. What is the exact answer(s)? ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"1 represents the right adrenal","justification":""},{"idx":1,"correct":false,"proposition":"2 represents the transverse colon","justification":"Stomach (we are too high to see the transverse colon, we do not see small intestine or right\/left colon)."},{"idx":2,"correct":true,"proposition":"3 represents the spleen","justification":""},{"idx":3,"correct":false,"proposition":"4 represents the inferior vena cava","justification":"This is the aorta. The VCI is very prominent."},{"idx":4,"correct":true,"proposition":"5 represents the body of the pancreas","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-10-qi-8","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The abdominal CT scan she performed was normal. The report you gave him gives the following results: salivary cortisol at midnight at 4 times normal. You have confirmed hypercortisolism by a 24-hour urine free cortisol assay with a result of 245 μg\/24 hours (N < 60). ACTH was dosed at 85 pg\/mL (N: 10-50). Which exam(s) can you now prescribe? ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A metopirone test","justification":""},{"idx":1,"correct":true,"proposition":"A test at the CRH","justification":"The increase in cortisol after a CRH injection may confirm the pituitary origin of the hypersecretion (versus a paraneoplastic origin)."},{"idx":2,"correct":false,"proposition":"A dosage of delta 4 androstenedione","justification":""},{"idx":3,"correct":true,"proposition":"Pituitary MRI","justification":""},{"idx":4,"correct":false,"proposition":"Insulin hypoglycemia","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-10-qi-9","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The CRH test shows a marked elevation of ACTH and cortisol. A section of the pituitary MRI you prescribed is reproduced below. Arrows with letters represent anatomical structures. Which structure(s) is correctly identified?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A represents the third ventricle","justification":""},{"idx":1,"correct":true,"proposition":"B represents the optical chiasm","justification":""},{"idx":2,"correct":true,"proposition":"C represents pituitary adenoma","justification":""},{"idx":3,"correct":false,"proposition":"D represents the cavernous sinus","justification":""},{"idx":4,"correct":true,"proposition":"E represents the left internal carotid artery","justification":"She makes a little bow of families (that's why we see her twice 🥐)"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-10-qi-10","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"In front of this pituitary macroadenoma, you want to complete your biological assessment. Which of the following proposals do you think is relevant to prescribe in this context? ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"T4 assay","justification":"TSH + T4 assay"},{"idx":1,"correct":false,"proposition":"DHA Testing","justification":"DHA is secreted by the post-pituitary gland."},{"idx":2,"correct":false,"proposition":"GnRH testing","justification":""},{"idx":3,"correct":false,"proposition":"Dosage de la POMC","justification":"Almost never doses."},{"idx":4,"correct":true,"proposition":"Prolactin Determination","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-10-qi-11","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The complementary balance shows: TSH 1.1 mIU\/L (N: 0.4-4); T4 14.8 pmol\/L (N: 8-20); estradiol 10 pg\/ml (N: 40-150); FSH 0, 1 IU\/L (N: 2-6); LH 0.5 IU\/L (N: 2-8); prolactin 30 μg\/L (N 25). What elements do you mention about this assessment? (one or more correct answers)","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Central hypothyroidism","justification":""},{"idx":1,"correct":true,"proposition":"Disconnection hyperprolactinemia","justification":"We speak of disconnection because < 100 μg\/L. Beyond that, we can talk about a prolactinoma."},{"idx":2,"correct":true,"proposition":"Hypogonadotropic hypogonadism","justification":""},{"idx":3,"correct":true,"proposition":"Pituitary anterior insufficiency","justification":"To check each time you have a deficiency of a lineage, it is an anterior pituitary insufficiency. Not to be confused with panhypopituitarism."},{"idx":4,"correct":false,"proposition":"Somatotropic deficiency","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-10-qi-12","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"To assess the impact of this Cushing's syndrome, you prescribe a bone densitometry, the results of which are reproduced below.\nWhich of the following is correct?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"There is trabecular osteoporosis","justification":""},{"idx":1,"correct":true,"proposition":"The risk of spinal fracture (RA) is 73%","justification":""},{"idx":2,"correct":true,"proposition":"The disorders observed may be increased by estrogenic deficiency","justification":""},{"idx":3,"correct":true,"proposition":"The observed disorders may be increased by hyperprolactinemia","justification":""},{"idx":4,"correct":false,"proposition":"The observed disorders may be increased by obesity","justification":"Obesity does not lead to osteoporosis. It is even sometimes considered a protective factor: more fatty 👉 tissue more protection of the bone in case of trauma."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-10-qi-13","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"You retain the diagnosis of corticotropic macro-adenoma and entrust the patient to your neurosurgeon colleague who practices his public activity at the CHU. He performed a rhinoseptal resection of this adenoma a few days later. There is no intraoperative incident and the neurosurgeon considers its excision satisfactory. In the recovery room, the patient quickly desaturates and presents a state of shock. Resuscitation measures are started immediately. However, the patient died a few minutes later. In this context, the neurosurgeon would like to perform a scientific autopsy to know the exact causes of death. What is (are) the procedure(s) to be carried out before this autopsy can be carried out ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Querying the automated national register of refusals","justification":""},{"idx":1,"correct":false,"proposition":"Judicial report to the public prosecutor","justification":""},{"idx":2,"correct":true,"proposition":"Obtaining the approval of a pathologist to perform the autopsy","justification":""},{"idx":3,"correct":false,"proposition":"Search for an organ donor card in the patient","justification":""},{"idx":4,"correct":true,"proposition":"Interview with the family to seek the non-opposition of the patient during her lifetime","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-10-qi-14","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The patient's family wishes to obtain a medical certificate. For what reason(s) can the doctor write it?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"To find out the cause of death","justification":""},{"idx":1,"correct":true,"proposition":"To defend the memory of the deceased","justification":""},{"idx":2,"correct":false,"proposition":"To provide a comprehensive list of the patient's history","justification":""},{"idx":3,"correct":false,"proposition":"To rule out a suicide"},{"idx":4,"correct":true,"proposition":"To assert the rights of the family","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-10-qi-15","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The scientific autopsy performed reveals a massive proximal pulmonary embolism of both branches of the pulmonary artery. The family decides to initiate proceedings. What type(s) of responsibility can be engaged then?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Criminal liability of the physician","justification":""},{"idx":1,"correct":false,"proposition":"No-fault liability of the physician","justification":"The patient died."},{"idx":2,"correct":true,"proposition":"Physician's civil liability","justification":"It will be engaged in case of detachable fault of the establishment."},{"idx":3,"correct":true,"proposition":"Administrative responsibility of the institution","justification":""},{"idx":4,"correct":true,"proposition":"Disciplinary responsibility of the physician","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-11-qi-1","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Which diagnosis do you mention as a priority?","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Infantile hemangioma"},{"idx":1,"correct":false,"proposition":"Planar angioma"},{"idx":2,"correct":false,"proposition":"Syndrome de Kasabach-Merritt","justification":""},{"idx":3,"correct":false,"proposition":"Venous angioma"},{"idx":4,"correct":false,"proposition":"Lymphangioma"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-11-qi-2","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"You suspect an infantile hemangioma. What is (are) the semiological element(s) that you will find at Romain's clinical examination? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A blowing character to auscultation","justification":""},{"idx":1,"correct":false,"proposition":"A shudder on palpation","justification":""},{"idx":2,"correct":true,"proposition":"An elastic consistency on palpation","justification":""},{"idx":3,"correct":false,"proposition":"A flat character on palpation","justification":""},{"idx":4,"correct":false,"proposition":"Hypertrophy of the hemiface on inspection","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-11-qi-3","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Romain's parents ask you about the evolution and possible complications to expect from this infantile hemangioma. What do you say to them? (one or more correct answers) ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A histological examination of the lesion makes it possible to better specify the chances of spontaneous involution","justification":""},{"idx":1,"correct":true,"proposition":"A growth phase may occur during the next few months","justification":""},{"idx":2,"correct":true,"proposition":"There is a risk of amblyopia","justification":"Given the location of this hemangioma, there is a risk that it covers the eye of little Theo and that this leads to functional 😥 amblyopia."},{"idx":3,"correct":true,"proposition":"The lesion may ulcerate","justification":""},{"idx":4,"correct":true,"proposition":"Complete disappearance without sequelae occurs in 50% of cases","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-11-qi-4","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Parents are concerned about the risk of growth of the lesion and the risk of functional amblyopia by occlusion of the cleft palpebral, and ask if treatment will then be offered for Romain. What do you say to them? (one or more correct answers) ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Treatment with propranolol will be offered","justification":""},{"idx":1,"correct":false,"proposition":"Pulsed dye laser treatment will be offered","justification":""},{"idx":2,"correct":false,"proposition":"Embolization treatment in interventional radiology will be proposed","justification":""},{"idx":3,"correct":false,"proposition":"Surgical treatment will be offered","justification":""},{"idx":4,"correct":false,"proposition":"Low molecular weight heparin therapy will be proposed","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-11-qi-5","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Following a phase of growth of the lesion and the risk of impact on the palpebral opening, treatment with propranolol was put in place, allowing the complete disappearance of the lesion, without sequelae. You see Romain again in consultation at the age of 18 months because he has for several weeks an itchy skin involvement predominant on the face, and his sleep is disturbed. It is apyretic with conservation of the general condition. What semiological element(s) do you identify on this image?","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Xerosis","justification":"Hard to see in this photo."},{"idx":1,"correct":true,"proposition":"Erythema","justification":""},{"idx":2,"correct":false,"proposition":"Excoriations","justification":"Hard to see in this photo."},{"idx":3,"correct":false,"proposition":"Exanthema","justification":""},{"idx":4,"correct":false,"proposition":"Enanthemum","justification":"No mucous membrane is seen."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-11-qi-6","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Which of the following interrogation elements is relevant, if present, to support the diagnosis you suspect in Romain? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"History of asthma in Romain's father","justification":""},{"idx":1,"correct":false,"proposition":"History of psoriasis in Romain's mother","justification":"Psoriasis is not affected by atopic risk."},{"idx":2,"correct":true,"proposition":"Cow's milk protein allergy in Romain's brother","justification":""},{"idx":3,"correct":false,"proposition":"Recent pruritus in several family members","justification":"We are not looking for scabies but rather eczema (= atopic dermatitis) 😅"},{"idx":4,"correct":false,"proposition":"Frequent herpetic recurrences in Romain's mother","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-11-qi-7","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"You are diagnosed with atopic dermatitis motivating local corticosteroid therapy. What attitude(s) of prevention and prophylaxis do you put in place? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Adapt the vaccination schedule according to the evolution of the pathology","justification":""},{"idx":1,"correct":false,"proposition":"Prophylaxis of herpes superinfections with aciclovir","justification":""},{"idx":2,"correct":false,"proposition":"Prevention of superinfection by regular use of antiseptics","justification":""},{"idx":3,"correct":true,"proposition":"Daily use of fragrance-free emollients on body and face","justification":""},{"idx":4,"correct":true,"proposition":"Maintain a cool temperature in the room","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-11-qi-8","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"You see again urgently Romain 1 month later for a predominant rash on the trunk, appeared the night before, in a context of fever up to 39 ° C for 2 days, without alteration of the general condition. The temperature measured in the office is 37.2 ° C (last taken of paracetamol 24 hours ago). The clinical examination, apart from the skin examination, is unremarkable. What diagnosis(s) do you mention?","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Food allergies"},{"idx":1,"correct":false,"proposition":"Syndrome de Kaposi-Juliusberg","justification":""},{"idx":2,"correct":false,"proposition":"Measles"},{"idx":3,"correct":true,"proposition":"Infantile roseola"},{"idx":4,"correct":false,"proposition":"Epidemic megalerythema"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-11-qi-9","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"You mention an infantile roseola (or sudden exanthema of the infant). What is the causative infectious agent? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Epstein-Barr virus"},{"idx":1,"correct":false,"proposition":"HSV-1 (herpes simplex virus)","justification":""},{"idx":2,"correct":false,"proposition":"Group A streptococcus"},{"idx":3,"correct":true,"proposition":"HHV-6 (herpes virus type 6)"},{"idx":4,"correct":false,"proposition":"Parvovirus B19"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-11-qi-10","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"What recommendation(s) and\/or prescription(s) do you make to parents regarding the management of Romain roseola? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Eviction from the nursery for 10 days","justification":""},{"idx":1,"correct":false,"proposition":"Realization of a urine strip for proteinuria in 3 weeks","justification":""},{"idx":2,"correct":false,"proposition":"Prescription of ibuprofen","justification":""},{"idx":3,"correct":true,"proposition":"Prescription of paracetamol 15 mg\/kg every 4 to 6 hours, if fever rises","justification":""},{"idx":4,"correct":false,"proposition":"Prescription of a 17-butyrate hydrocortisone cream with 1 application per day on the body for 5 days","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-11-qi-11","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"After this intercurrent infectious episode, atopic dermatitis experienced a spontaneously favorable evolution. Now 5 years old and enrolled in kindergarten, he is brought to you by his parents for skin and hair lesions evolving for a few weeks. What diagnosis(s) do you evoke in front of these facial and scalp lesions? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Psoriasis"},{"idx":1,"correct":false,"proposition":"Seborrheic dermatitis"},{"idx":2,"correct":true,"proposition":"Dermatophyte infection"},{"idx":3,"correct":false,"proposition":"Trichotillomania"},{"idx":4,"correct":false,"proposition":"Plate pelade"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-11-qi-12","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Examination with Wood's lamp shows yellow-green fluorescence of the hairs in favor of microsporic ringworm. What do you do while waiting for the result of cultivation? (only one answer expected) ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Therapeutic abstention","justification":""},{"idx":1,"correct":true,"proposition":"Prescription of local antifungals only","justification":"To be introduced after sampling to maximize their profitability."},{"idx":2,"correct":false,"proposition":"Prescription of systemic antifungals only","justification":""},{"idx":3,"correct":false,"proposition":"Prescription of local and systemic antifungals","justification":""},{"idx":4,"correct":false,"proposition":"Prescription of an antiseptic only","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-11-qi-13","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"In front of this microsporic ringworm with a very extensive alopecic plaque associated with several lesions of dermatophytosis of the hairless skin, you begin, without waiting for the results of the culture, a treatment combining local and systemic antifungals. Which systemic antifungal will you prescribe, as a first intention, to Romain? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Ketoconazole","justification":""},{"idx":1,"correct":false,"proposition":"ltraconazole","justification":""},{"idx":2,"correct":true,"proposition":"Griseofulvin","justification":"Treatment of moths of choice in children."},{"idx":3,"correct":false,"proposition":"Amphotericin B","justification":""},{"idx":4,"correct":false,"proposition":"Caspofungin","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-11-qi-14","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"The result of the culture comes back positive 3 weeks later to Microsporum canis. How could Romain be contaminated? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"By a dog","justification":""},{"idx":1,"correct":true,"proposition":"By a cat","justification":""},{"idx":2,"correct":false,"proposition":"By a land turtle","justification":""},{"idx":3,"correct":false,"proposition":"By a classmate","justification":""},{"idx":4,"correct":false,"proposition":"By the ground","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-12-qi-1","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"The doctor evokes the hypothesis of domestic violence. Which element(s) of the statement is (are) in favor of this hypothesis? ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The presence of bruises of different ages","justification":""},{"idx":1,"correct":true,"proposition":"An incompatibility between a fall from stairs and the lesions observed","justification":""},{"idx":2,"correct":true,"proposition":"Emergency room admission time","justification":""},{"idx":3,"correct":false,"proposition":"The age of the patient","justification":""},{"idx":4,"correct":true,"proposition":"Sleep disorders","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-12-qi-2","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"Ms. X confirms that she was physically abused by her spouse the day before. She states that he took her by the neck, that she tried to protect herself by putting his hand in front of her face, but took several punches to the left hemiface. During this episode there was forced sex. Mrs. X came tonight because she was home alone, but does not plan to file a complaint because she does not want marital separation. The doctor considers whether to notify the public prosecutor. What criteria in the statement support compliance with the patient's choice not to file a complaint? (one or more correct answers) ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The age of the patient","justification":""},{"idx":1,"correct":true,"proposition":"The absence of cognitive impairment","justification":""},{"idx":2,"correct":false,"proposition":"The presence of bruises of different ages","justification":""},{"idx":3,"correct":true,"proposition":"The absence of imminent danger at home","justification":""},{"idx":4,"correct":false,"proposition":"The occurrence of sexual violence associated with physical violence","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-12-qi-3","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"As Mrs. X is of age, without physical or psychological vulnerability, and not wishing to file a complaint, the doctor decided to respect her request and not to make a judicial report. What paraclinical element(s) can (s) be part of the management of this patient in the emergency room?","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Taking photographic photographs to document traumatic bodily injuries","justification":""},{"idx":1,"correct":false,"proposition":"Whole-body X-rays looking for fractures of different ages","justification":""},{"idx":2,"correct":false,"proposition":"A brain scan","justification":"Traumatic brain injury without loss of consciousness, without headache, without Master > 1 criteria."},{"idx":3,"correct":false,"proposition":"A fundus","justification":""},{"idx":4,"correct":false,"proposition":"A CPK blood test for muscle bruises","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-12-qi-4","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"Here is the picture of the arm of the outer face of the left arm. Which proposal(s) is true?","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"This lesion may correspond to the imprint of the pulp of a finger on the arm.","justification":""},{"idx":1,"correct":false,"proposition":"This lesion is recent in appearance","justification":""},{"idx":2,"correct":true,"proposition":"This lesion is older than those found in the left hemiface"},{"idx":3,"correct":false,"proposition":"This lesion may correspond to friction of the arm against a hard plane","justification":""},{"idx":4,"correct":true,"proposition":"This injury may correspond to a direct blow with an object on the arm.","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-12-qi-5","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"The doctor proposes to make a descriptive medical certificate. What should be mentioned? (one or more correct answers)","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The alleged date of the last episode of violence suffered by Ms X","justification":"In quotation marks"},{"idx":1,"correct":true,"proposition":"The objective account of the violence suffered by Mrs. X","justification":"In quotation marks"},{"idx":2,"correct":true,"proposition":"Description of all visible traumatic injuries","justification":""},{"idx":3,"correct":false,"proposition":"Ms. X's gynaecological history","justification":"This is irrelevant."},{"idx":4,"correct":true,"proposition":"The psychological symptoms resulting from the violence suffered by Ms X","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-12-qi-6","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"The psychological repercussions resulting from the violence must be investigated and mentioned on the descriptive medical certificate. What symptoms should the doctor look for when questioning Mrs. X to assess these repercussions and manage them? (one or more correct answers)","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Generalized anxiety"},{"idx":1,"correct":true,"proposition":"Nightmares"},{"idx":2,"correct":false,"proposition":"A quirk of contact"},{"idx":3,"correct":false,"proposition":"Auditory hallucinations","justification":""},{"idx":4,"correct":true,"proposition":"Avoidance pipes"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-12-qi-7","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"During the interrogation, Mrs. X explains that she has been disturbed for several months in a disturbed sleep, with bad dreams where she sees herself pursued by a threatening shadow. She wakes up early, little rested, but cannot sleep during the day, always awake, jumping at the slightest noise. She gets angry more easily with her children. During the day, when she goes shopping, she makes detours to avoid passing in front of her husband's work and gym, to be sure not to cross him. Eventually, she ends up falling asleep, exhausted, in front of the television at night.\nMrs. X puts all this down to tensions in her work, and a recent family bereavement.\nShe explains that apart from a few episodes of slapping and forced sex, she has never been a victim of violence by her husband. When she hears about domestic violence, she doesn't feel concerned.\nAmong the elements of the interrogation, what symptoms are suggestive of post-traumatic stress disorder? (one or more correct answers)","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Sleep disorders"},{"idx":1,"correct":true,"proposition":"Avoidance lines"},{"idx":2,"correct":true,"proposition":"Denial of violence"},{"idx":3,"correct":true,"proposition":"Irritability"},{"idx":4,"correct":true,"proposition":"Hypervigilance"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-12-qi-8","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"After a full information provided by the doctor, Mrs. X agrees to file a complaint. The doctor calls the judicial police officer on duty at the police station, who goes to the hospital to receive Ms. X's complaint. A gynaecological examination as well as medico-legal samples are requested on judicial requisition. These samples: ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Are analyzed urgently at the hospital laboratory at the request of the medical examiner","justification":""},{"idx":1,"correct":true,"proposition":"Aim to highlight the DNA of the perpetrator","justification":""},{"idx":2,"correct":true,"proposition":"Must be duplicated","justification":""},{"idx":3,"correct":true,"proposition":"Are placed under seal by the judicial police officer","justification":""},{"idx":4,"correct":true,"proposition":"Are elements of the judicial procedure","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-12-qi-9","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"In the requisition, the judicial police officer asks you to set the ITT resulting from the violence. What does this acronym mean? ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Total temporary incapacity","justification":"To avoid melting, we now speak of Total Functional Deficit (FTD)."},{"idx":1,"correct":true,"proposition":"Total incapacity for work","justification":""},{"idx":2,"correct":false,"proposition":"Temporary impossibility of work","justification":""},{"idx":3,"correct":false,"proposition":"Inability to work fully","justification":""},{"idx":4,"correct":false,"proposition":"Total impossibility of work","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-12-qi-10","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"What will be the purpose of the ITT (total incapacity for work) assessment for a victim of violence? (one or more correct answers) ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"To classify the criminal offence of which she was a victim","justification":""},{"idx":1,"correct":false,"proposition":"Obtain emergency social housing more quickly if they leave home","justification":""},{"idx":2,"correct":false,"proposition":"To determine the duration of the prescribed absence from work following his injuries","justification":""},{"idx":3,"correct":true,"proposition":"To enable the magistrate to know the repercussions of the violence suffered on the state of health","justification":""},{"idx":4,"correct":true,"proposition":"To determine the competent court to try the perpetrator of the violence","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-12-qi-11","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"In the case of Ms. X, solicitor-client privilege: (one or more correct answers) ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Is, unless otherwise specified, an obligation of the health professional","justification":""},{"idx":1,"correct":false,"proposition":"Allows the transmission of medical information about her to a police officer by telephone","justification":""},{"idx":2,"correct":false,"proposition":"Allows the transmission of medical information concerning her to her spouse","justification":""},{"idx":3,"correct":true,"proposition":"Persists in case of judicial requisition for all medical information that does not concern the questions of requisition","justification":""},{"idx":4,"correct":true,"proposition":"Allows the patient to be personally transmitted of the descriptive medical certificate upon discharge from the hospital if she does not wish to file a complaint","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-12-qi-12","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"Three weeks after Ms. X went to the emergency room, her husband, from whom she had separated, sent a letter to the hospital to complain about the medical certificate drawn up on requisition, which had been sent to her by her lawyer. He explains that the doctor did not put the story of the violence in the conditional and that he considers himself wrongly accused. In this context, what medical liability(s) can (s) be engaged? ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Disciplinary responsibility","justification":""},{"idx":1,"correct":true,"proposition":"Civil liability","justification":"If the fault is detachable from the service."},{"idx":2,"correct":true,"proposition":"Criminal liability","justification":""},{"idx":3,"correct":true,"proposition":"Administrative responsibility","justification":""},{"idx":4,"correct":false,"proposition":"No-fault liability","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-12-qi-13","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"Eleven weeks later, Ms. X returned to the hospital because she knew she was pregnant as a result of the sexual violence she had reported during admission. She wishes to benefit from a voluntary termination of pregnancy. What is the real proposal(s)? ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The doctor is obliged to inform the police of this pregnancy","justification":""},{"idx":1,"correct":false,"proposition":"A voluntary medical termination of pregnancy may be proposed to Mrs. X","justification":""},{"idx":2,"correct":true,"proposition":"Two consultations are offered before the voluntary termination of pregnancy","justification":""},{"idx":3,"correct":false,"proposition":"The consent of Mrs X's spouse is required for the initiation of the procedure","justification":""},{"idx":4,"correct":false,"proposition":"The agreement of the public prosecutor is necessary for the initiation of the procedure","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-14-qi-1","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"What is (are) the criterion(s) of severity in this febrile child? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"His plainty cry","justification":""},{"idx":1,"correct":false,"proposition":"Age","justification":"The severity criteria for acute bronchiolitis in infants are: FR > 60\/min, HR > 180\/min, pauses in breathing, signs of struggle, SpO2 < 92%, anorexia."},{"idx":2,"correct":true,"proposition":"His heart rate","justification":""},{"idx":3,"correct":true,"proposition":"His breathing rate","justification":""},{"idx":4,"correct":false,"proposition":"Its skin recoloration time","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-14-qi-2","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"Given this clinical picture, what action do you take immediately? (only one answer expected)","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"NaCl bolus 0.9% 20 mL\/kg","justification":""},{"idx":1,"correct":false,"proposition":"Microbiological","justification":""},{"idx":2,"correct":false,"proposition":"Capillary blood glucose","justification":""},{"idx":3,"correct":false,"proposition":"Blood lonogram","justification":""},{"idx":4,"correct":false,"proposition":"Paracetamol 15 mg\/kg","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-14-qi-3","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You have done vascular filling with 0.9% NaCl. Fifteen minutes later, his constants are as follows: heart rate 150 beats per minute, respiratory rate 70 per minute, temperature 39.1 ° C, skin recoloration time at 1 second. Chest auscultation regains a symmetrical vesicular murmur and a systolic murmur at 2\/6. Abdominal palpation is normal and otoscopy shows a hypervascularized right eardrum. The child is reactive, without hypotonia. \nWhat is the most likely diagnosis? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Purulent acute otitis media","justification":""},{"idx":1,"correct":false,"proposition":"Acute bronchiolitis","justification":""},{"idx":2,"correct":true,"proposition":"Acute pneumonia","justification":"High fever and lack of sibilants point more towards pneumonia."},{"idx":3,"correct":false,"proposition":"Infective endocarditis","justification":""},{"idx":4,"correct":false,"proposition":"Purulent meningitis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-14-qi-4","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You mention pneumococcal pneumonia. Which of the following is(s) in favor of this diagnosis?","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The presence of nasopharyngitis","justification":""},{"idx":1,"correct":false,"proposition":"Age","justification":""},{"idx":2,"correct":true,"proposition":"The brutal beginning","justification":""},{"idx":3,"correct":false,"proposition":"A family storytelling","justification":""},{"idx":4,"correct":true,"proposition":"Poor food intake","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-14-qi-5","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"Chest X-ray shows systematized opacity of the right upper lobe with an aerial bronchogram. What is your assessment? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Blood ionogram","justification":""},{"idx":1,"correct":false,"proposition":"Legionella antigen in urine","justification":""},{"idx":2,"correct":true,"proposition":"Blood","justification":""},{"idx":3,"correct":false,"proposition":"Pneumococcal PCR on nasopharyngeal secretions","justification":""},{"idx":4,"correct":false,"proposition":"Hepatic test","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-14-qi-6","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"The blood test shows the following results: \n\nhemoglobin 115 g\/L, \n\nleukocytes 20 G\/L with 75% neutrophils, \n\nplatelets 400 G\/L, \n\nCRP 250 mg\/l, \n\nnatremia 129 mmol\/l, potassium 3.7 mmol\/l, \n\nurea 1.5 mmol\/l, creatinine 30 micromoles\/l. \n\nWhat pathophysiological elements are likely involved in this hyponatremia? (one or more correct answers)","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A secretion of antidiuretic hormone","justification":""},{"idx":1,"correct":false,"proposition":"Adrenal insufficiency","justification":""},{"idx":2,"correct":true,"proposition":"Extracellular dehydration","justification":""},{"idx":3,"correct":false,"proposition":"An unsuitable infusion","justification":""},{"idx":4,"correct":false,"proposition":"Postpneumoccoccal glomerulonephritis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-14-qi-7","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You mention acute hyponatremia in a context of possible extracellular dehydration and DHA secretion complicating acute pneumonia. You set up an infusion adapted to ionic disorders. Which of the following offers do you offer antibiotic therapy?","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Intravenous amoxicillin","justification":""},{"idx":1,"correct":false,"proposition":"Dual therapy amoxicillin and macrolide","justification":""},{"idx":2,"correct":false,"proposition":"Oral amoxicillin","justification":""},{"idx":3,"correct":false,"proposition":"Intravenous cefotaxima","justification":""},{"idx":4,"correct":false,"proposition":"Macrolide per os","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-14-qi-8","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You have started treatment with amoxicillin 90 mg\/kg\/day intravenously. 72 hours later, the infant remains feverish at 39.5°C.  You make an X-ray of the chest, interpret the images you see. ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Shot made in the supine position","justification":""},{"idx":1,"correct":false,"proposition":"Strictly frontal impact","justification":""},{"idx":2,"correct":true,"proposition":"Presence of right fluid pleural effusion","justification":"We do not see a Damoiseau line because the child is lying, so the fluid is behind the pulmonary parenchyma and corresponds to the opacity of the lung."},{"idx":3,"correct":true,"proposition":"Presence of a right perihilar opacity","justification":""},{"idx":4,"correct":false,"proposition":"Abnormal enlargement of the upper mediastinum","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-14-qi-9","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You carry the diagnosis of purulent pleurisy and adapt your antibiotic therapy. Which germ(s) should or should be covered by this antibiotic therapy?  ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Staphylococcus aureus","justification":"Staphylococcus aureus infection is a common cause of purulent pleurisy."},{"idx":1,"correct":true,"proposition":"Streptococcus pneumoniae","justification":""},{"idx":2,"correct":true,"proposition":"Streptococcus pyogenes","justification":""},{"idx":3,"correct":false,"proposition":"Mycoplasma pneumoniae","justification":""},{"idx":4,"correct":false,"proposition":"Non-typeable Haemophilus","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-14-qi-10","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"The evolution is favorable under antibiotic therapy and the child is released from hospitalization 7 days later. He returned to the emergency room at 9 months of age for cough with fever at 38.2°C and difficulty breathing. The parents report that he presented with a febrile cough at the age of 7 months treated with oral antibiotic therapy. Weight gain between 6 and 9 months was 750 g. \n\nAt auscultation, you hear bilateral sibillants. You perform a chest X-ray that shows a systematized focus of the lower left lobe with aerial bronchogram. Faced with this recurrence, what is (are) the cause(s) to evoke? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Infant asthma","justification":"Infant asthma has a new definition: three episodes of wheezing dyspnea before 12 months, or two episodes + atopy (personal or family) before 12 months."},{"idx":1,"correct":true,"proposition":"Immunodeficiency","justification":""},{"idx":2,"correct":false,"proposition":"Intrabronchial foreign body","justification":""},{"idx":3,"correct":false,"proposition":"Congenital lung malformation","justification":""},{"idx":4,"correct":true,"proposition":"Cystic fibrosis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-14-qi-11","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"What additional examination(s) do you do on this child? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Pulmonary function tests","justification":"He is a little young to blow into a tube 😇. EFRs, in fact, are not feasible for 3 to 6 years."},{"idx":1,"correct":true,"proposition":"Chest CT scan","justification":""},{"idx":2,"correct":false,"proposition":"Bronchial endoscopy","justification":""},{"idx":3,"correct":true,"proposition":"Immune investigation","justification":""},{"idx":4,"correct":false,"proposition":"PH-metry","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-14-qi-12","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"For the exploration of an immune deficiency, what is your first-line assessment?","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Weight determination of immunoglobulins","justification":""},{"idx":1,"correct":false,"proposition":"Lymphocyte phenotyping","justification":"Lymphocyte phenotyping detects membrane antigens (CD4, CD8, CD19, CD20, etc.) of lymphocytes to know if they are B, T, NK lymphocytes or other. It is, in this situation, a second-line examination."},{"idx":2,"correct":true,"proposition":"Post-vaccination serology"},{"idx":3,"correct":false,"proposition":"Exploring complement pathways","justification":""},{"idx":4,"correct":false,"proposition":"Determination of lgE"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-14-qi-13","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"To explore the possibility of immune deficiency, the assessment includes a weight assay of immunoglobulins and post-vaccination serologies. The complete blood count was normal. Here are the results available at this stage: IgG 1 g\/L (N 3.3-6.2), lgA 0.2 g\/L (N 0.2-0.8), lgM 0.7 g\/L (0.5-1.3). Post-vaccination serologies reveal a defect in the production of specific antibodies. Which diagnosis do you think is most likely? (only one answer expected) ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Common variable immunodeficiency","justification":""},{"idx":1,"correct":false,"proposition":"Combined immunodeficiency","justification":""},{"idx":2,"correct":false,"proposition":"Severe combined immunodeficiency","justification":""},{"idx":3,"correct":false,"proposition":"CD40 ligand deficiency","justification":""},{"idx":4,"correct":false,"proposition":"Absence of immune deficiency","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-14-qi-14","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You confirm the diagnosis of variable common immunodeficiency. As the vaccination schedule was respected until the age of 9 months, which vaccine(s) are indicated for this child for the next 6 months? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Measles-mumps-rubella","justification":"This vaccine is a live attenuated vaccine. It is contraindicated in case of immunosuppression."},{"idx":1,"correct":true,"proposition":"Polysaccharide pneumococcal","justification":""},{"idx":2,"correct":true,"proposition":"Meningococcal C","justification":""},{"idx":3,"correct":false,"proposition":"Chickenpox","justification":""},{"idx":4,"correct":true,"proposition":"Hepatitis B","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-15-qi-1","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"Which of the following proposals concerning the etiology of malaise would you provide discriminating information?","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The slow return to consciousness","justification":""},{"idx":1,"correct":false,"proposition":"Urine loss","justification":"Urine loss is not to be considered as a distinguishing element between the cardiac or epileptic origin of the malaise."},{"idx":2,"correct":false,"proposition":"Abdominal pain","justification":""},{"idx":3,"correct":false,"proposition":"The localization of hematomas of the limbs","justification":""},{"idx":3,"correct":true,"proposition":"The bite of the lateral edge of the tongue","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-15-qi-2","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The dislocation is managed orthopedically. You hospitalize him for monitoring and assessment of the malaise. \n\nThe first night of hospitalization is difficult with constant wandering. The next morning, the staff noticed agitation and she tore off her drip. She does not see the point and wants to leave the institution. You notice a tremor of the upper limbs when maintaining the attitude. Objective examination (difficult given the patient's weak cooperation) seems normal except for an abolition of Achilles reflexes. The interrogation is difficult. Spontaneously, his speech is disjointed and incoherent. Which of the following suggestions regarding your diagnostic orientation on its current condition is compatible with this table?","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Pre delirium tremens","justification":""},{"idx":1,"correct":false,"proposition":"Status epilepticus","justification":""},{"idx":2,"correct":false,"proposition":"Parkinson's syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Amnesic ictus","justification":""},{"idx":3,"correct":true,"proposition":"Mental confusion","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-15-qi-3","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"What additional biological examination(s) are you performing at this stage to advance on the etiological context of this patient? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Complete blood count","justification":""},{"idx":1,"correct":true,"proposition":"Transaminases","justification":"An increase in OGT\/AST greater than that of TGP\/ALT may indicate chronic alcohol poisoning."},{"idx":2,"correct":true,"proposition":"Glycemia","justification":""},{"idx":3,"correct":true,"proposition":"Natremiah","justification":""},{"idx":4,"correct":false,"proposition":"Sedimentation rate","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-15-qi-4","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The patient remains agitated and not very compliant. At this stage, biological results show MCV at 114μm (N < 100), TGO (aspartame aminotransferase) at 155 (N < 40), TGP (alanine aminotransferase) at 63 (N < 40), zero ethylemia and natremia at 134 mmol \/ L. What non-biological examination should be performed at this stage and during the day (only one response expected):","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Brain scan","justification":""},{"idx":1,"correct":false,"proposition":"Doppler echo of supra-aortic trunks","justification":""},{"idx":2,"correct":false,"proposition":"Electroencephalogram","justification":""},{"idx":3,"correct":false,"proposition":"Electroneuromyogram","justification":""},{"idx":4,"correct":false,"proposition":"Abdominal ultrasound","justification":"Abdominal ultrasound could give arguments for cirrhosis (bumpy liver, increased hepatic arrow, hyperechogenicity of the parenchyma, signs of portal hypertension) but, in front of the neurological signs and the context of fall (and potential head trauma), brain scan is more priority."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-15-qi-5","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The brain scan reveals diffuse and age-significant atrophy. An electroencephalogram is performed but is artefacted by the patient's movements and does not allow reliable interpretation. Which of the following therapeutic proposals are you putting in place at this stage? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Hydration based on glucose serum","justification":"Glucose increases the use of vitamin B1 and therefore the risk of Gayet-Wernicke encephalopathy. The patient must be hydrated with 0.9% NaCl."},{"idx":1,"correct":false,"proposition":"Anti-staphylococcal antibiotic therapy","justification":""},{"idx":2,"correct":false,"proposition":"Parenteral neuroleptic","justification":""},{"idx":3,"correct":true,"proposition":"Vitamin supplementation","justification":""},{"idx":4,"correct":true,"proposition":"Parenteral benzodiazepine","justification":"The patient appears to have symptoms of alcohol withdrawal, which therefore requires an emergency pharmacological prerisk. The patient's lack of compliance and the need for rehydration (so the patient will have a venous line in all cases) directs us towards a parenteral route."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-15-qi-6","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"Concomitantly with the placement of the venous line, she presents a loss of consciousness with a period of generalized hypertonia and movements of the 4 limbs. She is receiving an intravenous benzodiazepine. The awakening is gradual. \n\nIn the hours that followed, confusion and agitation increased; The patient is covered in sweat, she makes incoherent remarks. Blood pressure is at 180\/110 mmHg. The heart rate is at 110\/min. The temperature is 38.5 °C.  The clinical examination is difficult but finds no obvious signs of neurological focus. \n\nWhich of the following diagnostic proposals is (are) accurate? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Acute delirious puff","justification":""},{"idx":1,"correct":false,"proposition":"Idiopathic generalized epilepsy","justification":""},{"idx":2,"correct":false,"proposition":"Toxic encephalopathy","justification":""},{"idx":3,"correct":true,"proposition":"Symptomatic seizure","justification":"The first part of the statement refers to an epileptic seizure secondary to alcohol withdrawal."},{"idx":4,"correct":true,"proposition":"Delirium tremens","justification":"Confusion, agitation, sweating, and incoherent remarks point to a delirium tremens."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-15-qi-7","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The clinical course under treatment is partially favorable. The patient is less agitated but confusion persists. You have contacted his doctor who confirms a significant and daily alcohol consumption, active smoking and social precariousness. By putting the patient in orthostatism, standing appears very unstable and walking is impossible without the help of a third party. During the examination, you notice multidirectional nystagmus and bilateral limitation of eye abduction. \n\nWhich of the following diagnostic hypotheses is compatible with the clinical picture? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Combined sclerosis of the spinal cord","justification":""},{"idx":1,"correct":false,"proposition":"Herpetic encephalitis","justification":""},{"idx":2,"correct":false,"proposition":"Paraneoplastic encephalitis","justification":""},{"idx":3,"correct":true,"proposition":"Gayet-Wernicke encephalopathy","justification":""},{"idx":4,"correct":false,"proposition":"Status epilepticus with confusional expression","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-15-qi-8","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"You mention the diagnosis of Gayet-Wernicke encephalopathy. In general, concerning the pathophysiological mechanism(s) that could explain or increase the symptoms of this pathology, which proposal(s) is(are) accurate? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Recent intake of isolated glucose serum","justification":""},{"idx":1,"correct":false,"proposition":"Presence of specific antibodies","justification":""},{"idx":2,"correct":true,"proposition":"Thiamine (vitamin B1) deficiency","justification":""},{"idx":3,"correct":false,"proposition":"Cobalamin (vitamin B12) deficiency","justification":""},{"idx":4,"correct":true,"proposition":"Inadequate dietary intake","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-15-qi-9","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"A brain MRI is performed. What is the sequence shown below? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Diffusion","justification":""},{"idx":1,"correct":false,"proposition":"T2 FLAIR","justification":"The gray matter (in the periphery) is white, the white matter (in medial) is gray 👉 It is a T2. The liquids are black 👉 It is a T2 FLAIR."},{"idx":2,"correct":false,"proposition":"T2","justification":"The median hypersignal that we see is not CSF, it is a hypersignal of the mammillary bodies that is readily found in deficiency encephalopathies."},{"idx":3,"correct":false,"proposition":"T1 with gadolinium injection","justification":""},{"idx":4,"correct":false,"proposition":"TOF (Time Of Flight) (Angio-MRI)","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-15-qi-10","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"Which of the following proposals for these MRIs is the visible anomaly? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Involvement of medial thalami","justification":"The thalami (plural of thalamus) are just opposite the lateral ventricles and the third ventricle. We can see in the first axial section that they are in hypersignal."},{"idx":1,"correct":true,"proposition":"Hypersignal in the periphery of the third ventricle","justification":"This hypersignal indicates an attack of the thalami."},{"idx":2,"correct":true,"proposition":"Periaqueductal hypersignal","justification":"The Sylvius aqueduct (synonymous with the midbrain aqueduct) is the small pipe that allows CSF communication between the third ventricle (located in the brain) and the fourth ventricle (located between the cerebellum and the brainstem). It is observed on the second axial section: it is in hypersignal (= we have a problem 😥)."},{"idx":3,"correct":false,"proposition":"Protuberantial lesion","justification":"The protuberance is synonymous with the bridge, which is the intermediate structure of the brainstem, making the link between the medulla elongata (synonym of myelencephalon) and the midbrain. We see it in the coronal cup: no hyper\/hypo-signal, everything is fine 👌"},{"idx":4,"correct":false,"proposition":"Damage to white matter","justification":"The white substance is gray on all cuts: there is no hypersignal, everything is fine 👌"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-15-qi-11","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"You have been diagnosed with Gayet-Wernicke encephalopathy. Which of the following processing proposals are you putting in place now? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Hypertonic solution infusion","justification":""},{"idx":1,"correct":false,"proposition":"Intravenous antiepileptic drugs","justification":""},{"idx":2,"correct":false,"proposition":"Antiplatelet agent","justification":""},{"idx":3,"correct":true,"proposition":"Intravenous vitamin B1 supplementation","justification":"⚠ Single-answer question."},{"idx":4,"correct":false,"proposition":"Parenteral benzodiazepine","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-15-qi-12","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The clinical course is favorable after three weeks of hospitalization. She therefore presented neurological complications of chronic alcoholism. Biological parameters are standardized except for MCV at 104 μm3. She seems to you to have understood the need for a definitive and total weaning. She keeps an abnormal neuropsychological assessment for her age with some visuospatial disorders, judgment and working memory. Walking is limited in terms of perimeter, cautious with widening of the lifting polygon, and tendency to hang the forefoot. \n\nWhat is (are) your hypothesis(s) to explain the gait disorders presented by this patient? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Apraxia when walking","justification":""},{"idx":1,"correct":true,"proposition":"Static cerebellar syndrome","justification":"Argued by the enlargement of the lift polygon"},{"idx":2,"correct":false,"proposition":"Lacunar syndrome","justification":""},{"idx":3,"correct":true,"proposition":"Polyneuropathy","justification":"Eroded by the deficit of foot lifters"},{"idx":4,"correct":false,"proposition":"Alcoholic myopathy","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-15-qi-13","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"You have been able to gather some social information: the patient lives alone, has no close relative, has been unemployed for 9 months. Regarding medico-social care, what approach(s) will you take? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Application for a disabled adult allowance","justification":"The AAH concerns people who have never worked, with a very high rate of disability. That is not the case here."},{"idx":1,"correct":true,"proposition":"Follow-up by the sector social worker","justification":""},{"idx":2,"correct":true,"proposition":"Proposal for a legal protection measure","justification":""},{"idx":3,"correct":false,"proposition":"Application for long-term illness with Social Security","justification":""},{"idx":4,"correct":false,"proposition":"Temporary suspension of driver's licence","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-15-qi-14","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"You have not heard from this patient again. Six months later, your psychiatrist colleague calls you about him. She is treated in psychiatric emergency for << delirium >>. You go to see it and see a seemingly normal reasoning but you are amazed by its familiarity. It presents significant memory disorders predominant on recent facts but also on older facts. The patient repeatedly asks you about her immediate future when you have already answered the same question several times. \n\nWhich of the following diagnostic proposals is accurate? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Acute drunkenness","justification":""},{"idx":1,"correct":true,"proposition":"Syndrome de Korsakoff","justification":""},{"idx":2,"correct":false,"proposition":"Paraneoplastic encephalitis","justification":""},{"idx":3,"correct":false,"proposition":"Vascular dementia","justification":""},{"idx":4,"correct":false,"proposition":"Status epilepticus with confusional expression","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-15-qi-15","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"Which of the following propositions, are the semiological argument(s) that characterize Korsakoff syndrome? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Oculomotor disorders","justification":"Gayet-Wernicke encephalopathy"},{"idx":1,"correct":false,"proposition":"Spasmodic laughter and crying","justification":"Lacunar syndrome"},{"idx":2,"correct":true,"proposition":"Anterograde amnesia","justification":""},{"idx":3,"correct":true,"proposition":"Fabulations","justification":""},{"idx":4,"correct":true,"proposition":"False acknowledgements","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-16-qi-1","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"After quickly collecting the history and circumstances of occurrence of epistaxis, what is (are) the gesture (s) that you practice quickly? ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Removal of clots by blowing their nose","justification":""},{"idx":1,"correct":true,"proposition":"Digital nasal compression for ten minutes","justification":""},{"idx":2,"correct":true,"proposition":"Establishment of a venous line","justification":""},{"idx":3,"correct":true,"proposition":"Blood group samples","justification":""},{"idx":4,"correct":true,"proposition":"Assessment of the presence of posterior hemorrhage by pharyngeal examination","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-16-qi-2","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Regarding the vascularization of the nasal cavities, what is(are) the exact answer(s)?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Branches of the internal carotid artery vascularize the lower turbinate","justification":""},{"idx":1,"correct":true,"proposition":"Vascularization comes mainly from the branches of the external carotid artery","justification":""},{"idx":2,"correct":true,"proposition":"The main artery is the sphenopalatine artery","justification":""},{"idx":3,"correct":false,"proposition":"The anterior ethmoidal artery is the terminal branch of the external carotid artery","justification":""},{"idx":4,"correct":true,"proposition":"The facial artery participates in the vascularization of the nasal cavities","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-16-qi-3","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Which element(s) are you looking for during the interrogation?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The unilateral or bilateral nature of the bleeding","justification":""},{"idx":1,"correct":true,"proposition":"A history of perforation of the nasal septum","justification":""},{"idx":2,"correct":true,"proposition":"The date and value of the last INR","justification":""},{"idx":3,"correct":true,"proposition":"The side with which epistaxis began","justification":""},{"idx":4,"correct":true,"proposition":"The abundance of epistaxis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-16-qi-4","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"On clinical examination, the patient is pale and sweaty. The epistaxis is both anterior and posterior. Blood pressure is at 150\/95 mmHg with a regular heart rate at 124\/min. The temperature is 37.5 °C and oxygen saturation is 98%. \n\nWhat is (are) the element(s) in favor of severe epistaxis in this patient?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Pallor","justification":""},{"idx":1,"correct":true,"proposition":"Sweats","justification":""},{"idx":2,"correct":true,"proposition":"Heart rate","justification":""},{"idx":3,"correct":false,"proposition":"Blood pressure","justification":""},{"idx":4,"correct":false,"proposition":"Previous bleeding","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-16-qi-5","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"You take a biological sample. Which biological parameter(s) are you asking for at this stage?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Ferritin","justification":""},{"idx":1,"correct":true,"proposition":"Coagulation assessment including TP, INR, TCA","justification":""},{"idx":2,"correct":true,"proposition":"HR Group, RAI","justification":""},{"idx":3,"correct":true,"proposition":"Creatinine emia","justification":""},{"idx":4,"correct":true,"proposition":"Blood count","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-16-qi-6","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"A few minutes later, blood pressure is 85\/55 mmHg and heart rate is 130\/min. The patient has some mottling at the knees. What measure(s) do you propose at this stage? (one or more correct answers) ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Find the cause of epistaxis","justification":"That is not the urgency here. The patient who appears to be in hemorrhagic shock must first be stabilized."},{"idx":1,"correct":true,"proposition":"Vascular filling by isotonic saline","justification":""},{"idx":2,"correct":true,"proposition":"Dry up the bleeding","justification":""},{"idx":3,"correct":false,"proposition":"Introducing intravenous noradrenaline as a continuous infusion","justification":""},{"idx":4,"correct":false,"proposition":"Perform an arteriogram","justification":"It is (almost) never possible to perform interventional radiology on an unstable patient."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-16-qi-7","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Vascular filling stabilized hemodynamics. The mottling has disappeared. You want to locate the origin of epistaxis at the level of the nasal cavities. \n\nWhat step(s) is necessary to localize the bleeding? (one or more correct answers) ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"You blow the patient's nose to evacuate the clots","justification":"Step 1"},{"idx":1,"correct":true,"proposition":"You introduce a wick impregnated with local vasoconstrictor into the hemorrhagic nasal cavity","justification":"Step 2"},{"idx":2,"correct":true,"proposition":"You explore the nasal cavity as a whole","justification":"Step 3"},{"idx":3,"correct":false,"proposition":"You perform an arteriogram","justification":""},{"idx":4,"correct":false,"proposition":"You request a non-injected CT scan of the facial mass","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-16-qi-8","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"The patient is calm and after your endonasal examination you observe unilateral bleeding from the vascular spot. The INR is at 2.5. The rest of the balance sheet is pending. What is (are) the possible option(s) to stop the bleeding? ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Installation of a double-balloon probe","justification":""},{"idx":1,"correct":true,"proposition":"Primary electrical cauterization of hemorrhagic vessels","justification":"This is a bleeding of the vascular 👉 task cauterization is to be done in first intention."},{"idx":2,"correct":true,"proposition":"Intravenous vitamin K prescription","justification":"The IV route is used here because it is a serious hemorrhage. The patient is not asymptomatic."},{"idx":3,"correct":false,"proposition":"The return home will be authorized in the absence of recurrence of the epistaxis after a surveillance of a few hours","justification":""},{"idx":4,"correct":false,"proposition":"Posterior dabbing with a greasy strand","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-16-qi-9","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"You performed cauterization of the vascular spot. Despite this, epistaxis persisted. You observe significant bleeding without being able to locate the exact origin. What is your immediate attitude? (only one exact answer) ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Previous tamponade with a greasy strand or hemostatic swab","justification":""},{"idx":1,"correct":false,"proposition":"Anteroposterior buffering by double balloon probe","justification":"As a second intention."},{"idx":2,"correct":false,"proposition":"Discontinuation of vitamin K antagonists","justification":"It's been a long time since we stopped them (and even poured them out)."},{"idx":3,"correct":false,"proposition":"Ligation of ethmoidal arteries","justification":"As a last resort."},{"idx":4,"correct":false,"proposition":"Arteriography with selective embolization","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-16-qi-10","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Despite a well-performed previous tamponade, you observe an early recurrence of epistaxis. What is your attitude? (only one exact answer) ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Arteriography with selective embolization","justification":""},{"idx":1,"correct":false,"proposition":"Endonasal ligation of the sphenopalatine artery","justification":"Third intention"},{"idx":2,"correct":false,"proposition":"Anterior ethmoidal artery ligation","justification":"Last intention"},{"idx":3,"correct":false,"proposition":"Posterior ethmoidal artery ligation","justification":""},{"idx":4,"correct":true,"proposition":"Anteroposterior buffering by double balloon probe","justification":"This is the second step"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-16-qi-11","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"You have managed to dry up epistaxis, and you decide to look for the etiology. Regarding epistaxis << >> symptom, which is (are) the diagnosis(s) that you can evoke? ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Septal perforation","justification":""},{"idx":1,"correct":true,"proposition":"Complication of endonasal surgery","justification":""},{"idx":2,"correct":true,"proposition":"Tumor cause","justification":""},{"idx":3,"correct":false,"proposition":"Willebrand disease","justification":"It is necessary to differentiate epistaxis << symptom >> (local cause) from epistaxis << epiphenomenon >> (general cause) of which Willebrand and Rendu-Osler disease are part."},{"idx":4,"correct":false,"proposition":"Rendu-Osier disease","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-16-qi-12","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Regarding epistaxis of general origin (<< epistaxis epiphenomenon >>), what is (are) the diagnosis (s) that you can evoke?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Thrombopathy","justification":""},{"idx":1,"correct":false,"proposition":"Hemophilia","justification":"Bleeding disorders are expressed more by deep bleeding. In addition, the advanced age and the fact that it is a woman lead us to count this false proposition."},{"idx":2,"correct":true,"proposition":"Granulomatosis with polyangiitis","justification":""},{"idx":3,"correct":false,"proposition":"A rheumatoid purpura","justification":"She's a bit old 🤭"},{"idx":4,"correct":true,"proposition":"HTA at 250\/120 mmHg","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-16-qi-13","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"During the etiological assessment, you ask for a scan of the sinuses. On this coronal CT scan of the sinuses, which is (are) the exact proposal(s):","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"1 represents the right maxillary sinus","justification":""},{"idx":1,"correct":true,"proposition":"2 represents the lower right horn","justification":""},{"idx":2,"correct":true,"proposition":"3 represents the middle left horn","justification":""},{"idx":3,"correct":false,"proposition":"4 represents a tumor mass","justification":""},{"idx":4,"correct":false,"proposition":"4 represents the left posterior turbeach","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-17-qi-1","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"She consults for a rather dry cough evolving for 3 months. This cough has become very disabling and wakes her up at night. You mention the possibility of a cough with ACE inhibitors. Which of the following answers is correct about IEC cough?","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It contraindicates angiotensin inhibitors II","justification":""},{"idx":1,"correct":false,"proposition":"It is dependent on the dose used","justification":""},{"idx":2,"correct":true,"proposition":"It can affect 5% or more of patients treated with ACE inhibitors","justification":""},{"idx":3,"correct":true,"proposition":"It is linked to a class effect","justification":""},{"idx":4,"correct":false,"proposition":"It usually occurs after an infectious episode","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-17-qi-2","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You stop its ACE inhibitor and replace it with an angiotensin II inhibitor. The cough decreases in a few days and will disappear in less than 15 days. She has no sputum. The patient nevertheless complains of discomfort during exercise with a feeling of shortness of breath when walking flat quickly and when she climbs a slight slope, which she has noticed for several months when she returns home. You rate his dyspnea in his medical record by the chronic dyspnea scale of modified MRC (modified scale of Medical Research Counci\/). This scale assesses the impact of physical activity on dyspnea. What is the mMRC stage of this patient? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Stage 0","justification":"everything is fine we are oklm (important effort like everyone else, even Benzema)"},{"idx":1,"correct":true,"proposition":"Stage 1","justification":"a feeling of shortness of breath when walking flat fast and when climbing a slight slope = mMRC 1"},{"idx":2,"correct":false,"proposition":"Stage 2","justification":"a feeling of shortness of breath when walking with people of his age"},{"idx":3,"correct":false,"proposition":"Stage 3","justification":"a feeling of shortness of breath when walking after a few minutes flat"},{"idx":4,"correct":false,"proposition":"Stage 4","justification":"a feeling of shortness of breath preventing him from going out"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-17-qi-3","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You examine the patient. Cardiac auscultation is normal. Pulmonary auscultation finds a diffuse decrease in vesicular murmur without sibilant or crackling. Vocal vibrations are transmitted. The percussion of the thorax is generally tympanic. There is no sign of heart failure either right or left. She weighs 44 kg and is 1.55 m tall. Which clinical sign(s) testify to chest distention? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Hoover's sign","justification":"When the patient inhales, the transverse diameter (from right to left) of the chest decreases, whereas normally it should increase."},{"idx":1,"correct":false,"proposition":"Pilgrim edema","justification":""},{"idx":2,"correct":false,"proposition":"Cyanotic lips","justification":""},{"idx":3,"correct":true,"proposition":"Barrel thorax","justification":""},{"idx":4,"correct":false,"proposition":"Digital Hippocratism","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-17-qi-4","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You carry out a spirometry of which here is the report. Which of the following proposal(s) is correct:","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"You can affirm the existence of an obstructive syndrome","justification":""},{"idx":1,"correct":true,"proposition":"CVL is higher than FVC","justification":""},{"idx":2,"correct":true,"proposition":"There is a significant lack of reversibility","justification":""},{"idx":3,"correct":false,"proposition":"You can claim chronic respiratory failure","justification":""},{"idx":4,"correct":false,"proposition":"You can affirm chest distension","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-17-qi-5","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You complete the examinations with a front chest x-ray and more complete pulmonary function tests (RFS). Taking into account clinical history, clinical examination, imaging and EFRs, it is true that: ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"You can claim chronic respiratory failure","justification":""},{"idx":1,"correct":true,"proposition":"You can affirm chest distension","justification":""},{"idx":2,"correct":true,"proposition":"You mention COPD"},{"idx":3,"correct":true,"proposition":"You suspect emphysema"},{"idx":4,"correct":false,"proposition":"You prescribe long-term oxygen therapy","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-17-qi-6","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"Given the clinical chest distension, chest distension on the lung X-ray with flattening of the diaphragmatic cupolas and EFRs you retain the diagnosis of COPD, probably in connection with emphysema, especially since there is an impairment of the diffusion. You explain to the patient that this disease is directly related to smoking and that quitting smoking will be essential. You assess his pharmacological\/nicotine dependence via the Fagerström test. \n\nWhich element(s) is (are) in favor of a strong pharmacological dependence? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Inhale smoke completely","justification":""},{"idx":1,"correct":false,"proposition":"Smoking brown tobacco","justification":""},{"idx":2,"correct":true,"proposition":"Smoking more than 30 cigarettes a day","justification":""},{"idx":3,"correct":true,"proposition":"Smoking a cigarette as soon as you wake up","justification":""},{"idx":4,"correct":false,"proposition":"Roll your own cigarettes","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-17-qi-7","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"After assessing her tobacco use and conducting a motivational interview, you find that the patient is motivated to quit smoking completely. She has a significant pharmacological dependence on nicotine with the first cigarette smoked within 5 minutes after waking up and again between 21 and 30 cigarettes a day. She does not consume other psychoactive products. You first prescribe nicotine substitutes in oral form. \n\nWhat is the exact proposal(s)? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"He will have to be prescribed a dose of 10 mg per day of nicotine","justification":""},{"idx":1,"correct":false,"proposition":"There is no support or refund","justification":""},{"idx":2,"correct":true,"proposition":"Nicotine substitutes have few side effects","justification":""},{"idx":3,"correct":true,"proposition":"Nicotine replacement therapy is more effective than placebo in cases of physical dependence","justification":""},{"idx":4,"correct":false,"proposition":"Nicotine substitutes are prescribed in his off-label case because of the cardiovascular history","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-17-qi-8","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"The patient will be able to quit smoking overnight, thanks in part to nicotine substitutes that you will be able to stop very gradually. She has never had an acute episode of worsening respiratory disease to date. As part of the treatment of his GCP0, what measure(s) to accompany the pharmacological management will you put in place? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Work stoppage","justification":""},{"idx":1,"correct":true,"proposition":"Physical Activity Tips","justification":""},{"idx":2,"correct":false,"proposition":"Low salt diet","justification":""},{"idx":3,"correct":false,"proposition":"Eviction of latex","justification":""},{"idx":4,"correct":true,"proposition":"Annual influenza and pneumococcal vaccinations","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-17-qi-9","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You carry out the necessary vaccinations. Regarding his drug treatments, what is (are) the exact proposal(s)? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"You contraindicate its beta-blocker treatment","justification":"The patient does not have asthma."},{"idx":1,"correct":true,"proposition":"You prescribe a short-acting bronchodilator on demand","justification":"Every COPD patient should carry their BDCA."},{"idx":2,"correct":true,"proposition":"You prescribe a long-acting bronchodilator once or twice a day","justification":""},{"idx":3,"correct":false,"proposition":"You prescribe an inhaled corticosteroid as part of a fixed combination","justification":""},{"idx":4,"correct":false,"proposition":"You prescribe loop diuretics in moderate doses","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-17-qi-10","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"Despite the treatments put in place, the patient still has dyspnea of the mMRC stage. You are considering pulmonary rehabilitation. Regarding the latter, its effectiveness has been demonstrated on:","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Exercise capacity","justification":""},{"idx":1,"correct":true,"proposition":"Consumption of care","justification":""},{"idx":2,"correct":true,"proposition":"Dyspnea","justification":""},{"idx":3,"correct":true,"proposition":"Quality of life","justification":""},{"idx":4,"correct":false,"proposition":"FEV1","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-17-qi-11","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"The patient benefited greatly from pulmonary rehabilitation. Two years later, she is retired and comes to see you again in consultation because she feels much more breathless for a few days while her condition was quite stable until then. This increase in dyspnea is associated with the reappearance of a cough and purulent sputum. You suspect an exacerbation of COPD. What is the exact proposal(s)?","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The majority of COPD exacerbations are infectious (viral, bacterial, or mixed)","justification":""},{"idx":1,"correct":false,"proposition":"The first exacerbation is usually not serious","justification":""},{"idx":2,"correct":true,"proposition":"The diagnosis of exacerbation is based on increased dyspnea, cough and\/or sputum","justification":""},{"idx":3,"correct":true,"proposition":"The main argument in favor of a bacterial infection is sputum purulence","justification":""},{"idx":4,"correct":false,"proposition":"The bacteria most often involved are Haemophilus influenzae, Pseudomonas aeruginosa and Moraxella catarrhalis","justification":"The 3 bacteria to know are: Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. Pseudomonas aeruginosa is rarer, but more serious."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-17-qi-12","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"She was admitted to the emergency room of the hospital. The nurse who takes care of her calls you because she is worried. You will find paradoxical abdominal breathing on clinical examination. Regarding paradoxical abdominal breathing, what is (are) the true proposition(s)? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"It is defined as the receding of the anterior wall of the abdomen during inspiration instead of the expected abdominal expansion","justification":""},{"idx":1,"correct":false,"proposition":"This is an active abdominal exhalation","justification":""},{"idx":2,"correct":true,"proposition":"Its presence indicates the absence of participation of the diaphragm in the ventilation which is then taken care of by the extra-diaphragmatic inspiratory muscles","justification":"That's what makes it serious."},{"idx":3,"correct":true,"proposition":"Its finding requires the admission of the patient to a structure where ventilatory assistance can be set up without delay.","justification":""},{"idx":4,"correct":true,"proposition":"Its presence raises fears of short-term failure","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-17-qi-13","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You will immediately transfer the patient to respiratory intensive care. Chest X-ray does not find an infectious focus or pneumothorax. Analysis of blood gases in ambient air shows a pH of 7.35, a PaO at 50 mmHg and a PaCO2 at 48 mmHg, HCO3- at 26 mmol \/ L.  What treatment(s) will you put in place? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Nebulizing bronchodilators","justification":""},{"idx":1,"correct":true,"proposition":"Systematic antibiotic therapy","justification":"The patient shows signs of severity. This is an indication for antibiotic therapy."},{"idx":2,"correct":true,"proposition":"Chest physiotherapy","justification":"Chest physiotherapy is offered acutely in case of significant bronchial secretions."},{"idx":3,"correct":true,"proposition":"Oxygen therapy with a titrated oxygen flow rate to obtain a pulsed oxygen saturation (Sp02) between 88% and 92%","justification":""},{"idx":3,"correct":false,"proposition":"3-week systemic corticosteroid therapy","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-17-qi-14","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"The evolution is favorable with the treatment implemented without the need for mechanical ventilation. She can be discharged from hospital 8 days later. She gradually returns to her usual state. You see her again 6 months later because she has just presented some sputum of pure blood during a coughing effort. She has no other symptoms elsewhere. His dyspnea is not increased. What is the exact proposal(s)? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"In the context of this patient, bronchial cancer must be ruled out until proven otherwise.","justification":""},{"idx":1,"correct":false,"proposition":"The administration of vitamin K should be carried out as a matter of urgency as a matter of principle","justification":""},{"idx":2,"correct":false,"proposition":"Taking the antiaggregant may be the cause of hemoptysis in this context of COPD","justification":"⚠ Recurrent pitfall: COPD is not a cause of hemoptysis."},{"idx":3,"correct":true,"proposition":"Chest computed tomography injected with arterial time is the key examination and will be performed if possible even before a bronchial endoscopy.","justification":""},{"idx":4,"correct":true,"proposition":"Despite good tolerance, management should be considered an emergency","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-18-qi-1","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"What element(s) are you looking for questioning about these pains to advance in your diagnostic hypotheses? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Belt irradiation","justification":""},{"idx":1,"correct":false,"proposition":"Association with headache","justification":"He's a little too young for a Horton 😅"},{"idx":2,"correct":true,"proposition":"Decrease during meals","justification":""},{"idx":3,"correct":true,"proposition":"Acute or progressive affixing mode","justification":""},{"idx":4,"correct":false,"proposition":"Improvement through arm elevation","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-18-qi-2","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"In this patient, what etiology(s) should you mention? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Bronchial cancer","justification":""},{"idx":1,"correct":true,"proposition":"Spondyloarthritis","justification":""},{"idx":2,"correct":false,"proposition":"Thoracic aorta dissection","justification":""},{"idx":3,"correct":false,"proposition":"Sequelae of vertebral growth epiphysitis","justification":""},{"idx":4,"correct":true,"proposition":"Duodenal ulcer","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-18-qi-3","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"The pain settled gradually over two months. Which element(s) point to the inflammatory nature of the pain in this patient? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Persistence despite rest","justification":""},{"idx":1,"correct":true,"proposition":"Awakening at night","justification":""},{"idx":2,"correct":false,"proposition":"Difficulty falling asleep","justification":""},{"idx":3,"correct":false,"proposition":"Progressive worsening of pain","justification":""},{"idx":4,"correct":true,"proposition":"Improvement after one hour of activity in the morning","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-18-qi-4","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"On clinical examination, the pain is maximum on palpation of the spinous located opposite the two points of scapula. At what spinal level does this localization correspond? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"1st thoracic vertebra","justification":""},{"idx":1,"correct":false,"proposition":"2nd thoracic vertebra"},{"idx":2,"correct":false,"proposition":"4th thoracic vertebra"},{"idx":3,"correct":true,"proposition":"7th thoracic vertebra","justification":"🤷‍♂️"},{"idx":4,"correct":false,"proposition":"11th thoracic vertebra","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-18-qi-5","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"In front of this inflammatory back pain located at the level of the 7th thoracic vertebra, what are you looking for in priority at the clinical examination? (one or more correct answers)","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Sign of Lasègue","justification":""},{"idx":1,"correct":true,"proposition":"Hypoaesthesia band"},{"idx":2,"correct":true,"proposition":"Abnormality of spine statics"},{"idx":3,"correct":true,"proposition":"Hyperthermia","justification":""},{"idx":4,"correct":false,"proposition":"Sign of Hoffman","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-18-qi-6","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"What exam(s) do you prescribe in the first line for this patient? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"D-dimer","justification":""},{"idx":0,"correct":true,"proposition":"CRP","justification":""},{"idx":0,"correct":true,"proposition":"Complete blood count","justification":""},{"idx":0,"correct":false,"proposition":"TSH","justification":""},{"idx":0,"correct":false,"proposition":"PSA","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-18-qi-7","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"There is no inflammatory syndrome and the CBC is without abnormalities. A systematic ECG is normal. Why do you decide to do imaging tests? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The duration of symptom evolution","justification":"< 3 months"},{"idx":1,"correct":false,"proposition":"The age of the patient","justification":""},{"idx":2,"correct":true,"proposition":"The localization of pain","justification":""},{"idx":3,"correct":true,"proposition":"The schedule of pain","justification":""},{"idx":4,"correct":false,"proposition":"History of ulcer","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-18-qi-8","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"In this patient with inflammatory back pain with a normal biological assessment, which imaging examination seems most relevant to you at this stage? (only one answer expected) ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Chest X-ray","justification":""},{"idx":1,"correct":false,"proposition":"Cardiac ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Thoraco-abdomino-pelvic CT scan","justification":""},{"idx":3,"correct":true,"proposition":"Spinal MRI","justification":""},{"idx":4,"correct":false,"proposition":"Bone scintigraphy","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-18-qi-9","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"MRI of the entire spine performed quickly is normal. At the follow-up consultation one month later, the back pain gradually and spontaneously improved within a month. The patient makes an appointment with you three months later because he has had pain in his right knee for 2 days. What are you looking for on the physical exam? (one or more correct answers) ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Clinostatism","justification":""},{"idx":1,"correct":true,"proposition":"A knee injury","justification":""},{"idx":2,"correct":true,"proposition":"A patellar shock","justification":""},{"idx":3,"correct":false,"proposition":"A plantar skin reflex","justification":""},{"idx":4,"correct":true,"proposition":"Pain of the lateral edge of the knee during its extension (sign of the windshield wiper)","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-18-qi-10","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"There is patellar shock of the right knee. The patient has a temperature of 37.3 °C. You are wondering about performing a knee puncture. What is the true statement? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is necessary to puncture the knee because there is an effusion","justification":""},{"idx":1,"correct":false,"proposition":"Do not puncture the knee because the pain has been evolving for less than 7 days","justification":""},{"idx":2,"correct":false,"proposition":"Do not puncture the knee because the temperature is normal","justification":""},{"idx":3,"correct":false,"proposition":"Do not puncture the knee because the patient is young","justification":""},{"idx":4,"correct":false,"proposition":"Do not puncture the knee because there is a risk of infecting the knee","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-18-qi-11","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"You decide to perform a joint puncture of the right knee. Which statement(s) is the correct statement(s)?","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The patient must be seated","justification":""},{"idx":1,"correct":true,"proposition":"The procedure requires an antiseptic skin preparation","justification":""},{"idx":2,"correct":false,"proposition":"Prophylactic antibiotic therapy is needed","justification":""},{"idx":3,"correct":true,"proposition":"Cytological examination of the fluid is essential","justification":""},{"idx":4,"correct":false,"proposition":"Written consent from the patient must be obtained prior to the procedure","justification":"There are very few actions that require written consent. Punctures are not part of it (except genetic test)."}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-18-qi-12","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"The joint puncture fluid has 5500\/mm3 leukocytes. Germs are not found on direct examination or after cultivation. There are no microcrystals.\nWhich etiology(ies) is(are) the most likely?","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A flare-up of osteoarthritis"},{"idx":1,"correct":false,"proposition":"One drop"},{"idx":2,"correct":true,"proposition":"Spondyloarthritis"},{"idx":3,"correct":false,"proposition":"Lupus"},{"idx":4,"correct":false,"proposition":"Osteonecrosis"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-18-qi-13","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"You suspect spondyloarthritis. What are you doing to support this diagnosis? (one or more correct answers) ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Search for a rocking fessalgia","justification":""},{"idx":1,"correct":true,"proposition":"Search for heel pain","justification":""},{"idx":2,"correct":true,"proposition":"Search for familial psoriasis","justification":""},{"idx":3,"correct":true,"proposition":"Looking for a history of finger in << sausage>>","justification":""},{"idx":4,"correct":false,"proposition":"Conducting an NSAID test","justification":"Ulcer history makes prescribing NSAIDs somewhat annoying 🤭"}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-18-qi-14","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"The search for the HLA B27 gene is positive. The patient is worried and asks you questions. What do you say to him? (one or more correct answers) ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The presence of HLA B27 in the blood is variable over the course of life","justification":"Either the protein is there or it is not."},{"idx":1,"correct":false,"proposition":"The presence of HLA B27 requires the protection of your partner during sexual intercourse","justification":""},{"idx":2,"correct":false,"proposition":"You have to do the research in your children","justification":""},{"idx":3,"correct":true,"proposition":"HLA B27 is present in more than 90% of patients with ankylosing spondylitis","justification":""},{"idx":4,"correct":true,"proposition":"The vast majority of HLA B27+ subjects will never have spondyloarthritis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2020-dp-18-qi-15","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"The patient asks you for advice regarding his long-term management. What measure(s) do you recommend? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Gluten-free diet","justification":""},{"idx":1,"correct":true,"proposition":"Regular physical activity","justification":""},{"idx":2,"correct":true,"proposition":"Smoking cessation","justification":""},{"idx":3,"correct":false,"proposition":"Nonsteroidal anti-inflammatory drugs for flare-ups","justification":"He cannot be recommended NSAIDs per se because of his history of ulcer."},{"idx":4,"correct":false,"proposition":"Eviction of cow's milk","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-1-qi-1","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":"What elements of the interrogation are you looking for to support this diagnosis? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":" Spasmodic abdominal pain","justification":""},{"idx":1,"correct":true,"proposition":"Glairo-bloody emissions","justification":""},{"idx":2,"correct":false,"proposition":"Presence of watery stools","justification":""},{"idx":3,"correct":true,"proposition":"oozing","justification":""},{"idx":4,"correct":true,"proposition":"Description of spurs","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-1-qi-2","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" The patient reports spurs relieved by glairo-bloody emissions, which reinforces your hypothesis of proctitis. You learn that the patient has unprotected sex with episodic male partners. What arguments are you looking for in favor of an infectious etiology? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Polyarthralgia","justification":""},{"idx":1,"correct":false,"proposition":"Mouth ulcers","justification":""},{"idx":2,"correct":true,"proposition":"Mucopurulent anal discharge","justification":""},{"idx":3,"correct":true,"proposition":"Inguinal lymphadenopathy","justification":""},{"idx":4,"correct":true,"proposition":"Fever","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-1-qi-3","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" The patient describes tenesmus but no muco-purulent discharge. There is no fever or deterioration in the general condition. The weight is 65 kg for a height of 1m70. The clinical examination does not find inguinal lymphadenopathy. The abdominal wall is not sensitive. What, at this stage, are the etiological hypotheses concerning this suspicion of proctitis? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Salmonella infection","justification":""},{"idx":1,"correct":false,"proposition":"Shigella infection","justification":""},{"idx":2,"correct":true,"proposition":"Ulcerative colitis","justification":""},{"idx":3,"correct":true,"proposition":"Sexually transmitted infection","justification":""},{"idx":4,"correct":true,"proposition":"Amoebiasis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-1-qi-4","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" What are the additional first-line examinations to be performed? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Coproculture","justification":""},{"idx":1,"correct":true,"proposition":"Microbiological collection by rectal swab","justification":""},{"idx":2,"correct":true,"proposition":"Recto-sigmoidoscopy with biopsy for histopathological examination","justification":""},{"idx":3,"correct":true,"proposition":"Stool parasitology","justification":""},{"idx":4,"correct":true,"proposition":"HIV serology","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-1-qi-5","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" Rectal swab with PCR examination does not find Chlamydia trachomatis or Neisseria gonorrhoeae. HIV serology is negative. Parasitological examination of stool is negative. Endoscopic examination shows a rectal mucosa of granite appearance with erosions that bleed on contact with the endoscope. The lesions do not extend beyond the rectosigmoid hinge and the sigmoid mucosa is normal. Histological examination shows glandular distortions, cryptic abscesses and an inflammatory infiltrate of the chorion, consisting of lymphoplasmocytes and polynuclear cells. The diagnosis of ulcerative colitis is retained. You propose treatment with 5-amino-salicylates rectally. What information do you give the patient about their illness? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Treatment can cure the disease permanently","justification":""},{"idx":1,"correct":true,"proposition":"A severe pancolic flare-up is possible","justification":""},{"idx":2,"correct":true,"proposition":"The risk of colorectal cancer is increased compared to the general population","justification":""},{"idx":3,"correct":false,"proposition":"The risk of primary biliary cirrhosis is increased compared to the general population","justification":""},{"idx":4,"correct":false,"proposition":"The risk of diverticular disease is increased compared to the general population","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-1-qi-6","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" The patient received maintenance therapy with 5 amino-salicylate suppository for 18 months. A few months later, after a period during which he was asymptomatic without treatment, he reported the presence of blood accompanying the stool for 15 days, without abdominal pain. What data do you seek, during the interrogation, in favor of a hemorrhoidal pathology at the origin of bleeding? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Bleeding after defecation","justification":""},{"idx":1,"correct":true,"proposition":"Presence of pain per and post defecatory","justification":""},{"idx":2,"correct":false,"proposition":"Presence of mucus in the stool","justification":""},{"idx":3,"correct":true,"proposition":"Exemption from hard stools","justification":""},{"idx":4,"correct":false,"proposition":"Presence of spontaneous anal discharge containing traces of blood","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-1-qi-7","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" A colonoscopy is therefore performed and shows cicatricial proctitis and congestive hemorrhoids without procidence in the lumen of the anal canal. What support do you envisage? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Rectal derivatives 5 amino-salicylates","justification":""},{"idx":1,"correct":true,"proposition":"Laxatives based on mucilages","justification":""},{"idx":2,"correct":true,"proposition":"Lubricating suppositories","justification":""},{"idx":3,"correct":false,"proposition":"Short course of nonsteroidal anti-inflammatory drugs","justification":""},{"idx":4,"correct":false,"proposition":"Surgical consultation to consider hemorrhoidectomy","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-1-qi-8","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" The symptomatology improved after a few days of treatment with lubricating suppositories and mucilage-based laxatives. During the follow-up, you carry out an assessment that objective: Hemoglobin: 14 g \/ dL \/ VGM: 85 fL \/ Leukocytes: 8.5 G \/ L \/ Polynuclear neutrophils: 5.3 G \/ L \/ Lymphocytes: 2.8 g \/ L \/ CRP: 6 mg \/ L \/ Ferritinemia: 80 μg \/ L (N: 50 -200 μg \/ L) \/ AST: 52 IU (N<35). What do you suspect?","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Hepatic colic","justification":""},{"idx":1,"correct":false,"proposition":"Cholangitis","justification":""},{"idx":2,"correct":false,"proposition":"Primary biliary cholangitis","justification":""},{"idx":3,"correct":false,"proposition":"Autoimmune hepatitis","justification":""},{"idx":4,"correct":true,"proposition":"Primary sclerosing cholangitis","justification":"This question was a hidden QRU"}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-1-qi-9","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" You suspect primary sclerosing cholangitis. What diagnostic tests do you perform as a first-line treatment? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Hepatobiliary ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"Biliary scintigraphy","justification":""},{"idx":2,"correct":true,"proposition":"Bili-MRI","justification":""},{"idx":3,"correct":false,"proposition":"High endoscopic echo","justification":""},{"idx":4,"correct":false,"proposition":"Endoscopic retrograde cholangiopancreatography","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-1-qi-10","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" Bili-MRI and ultrasound show a succession of dilatations and strictures of the bile duct, which suggests primitive sclerosing cholangitis. The patient is lost to follow-up and consults the emergency room 5 years later for jaundice associated with chills. Its vital parameters are: PA 130\/80 mmHg, FC92\/min, temperature 38.7°C.  There is no marbling. The biological assessment shows:Leukocytes 14 G\/LPolynuclear neutrophils 11.3 G\/LLymphocytes 2.6 G\/LCRP: 98 mg\/LASAT: 356 IU (N<35)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Bili-MRI","justification":""},{"idx":1,"correct":false,"proposition":"Upper endoscopic echoendoscopy","justification":""},{"idx":2,"correct":true,"proposition":"Hepatobiliary ultrasound","justification":""},{"idx":3,"correct":false,"proposition":"Liver CT scan","justification":""},{"idx":4,"correct":false,"proposition":"Endoscopic retrograde cholangiography","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-1-qi-11","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" Hepatobiliary ultrasound shows dilation of the intra- and extra-hepatic bile ducts upstream of stenosis of the main bile duct. What support do you offer? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Corticosteroid therapy","justification":""},{"idx":1,"correct":true,"proposition":"Antibiotic therapy","justification":"This proposal was essential"},{"idx":2,"correct":false,"proposition":"Cholecystectomy","justification":""},{"idx":3,"correct":false,"proposition":"Ursodeoxycolic acid","justification":""},{"idx":4,"correct":true,"proposition":"Endoscopic retrograde cholangiography","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-1-qi-12","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" In this patient, which antibiotics are essential in the first line? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Clindamycin","justification":""},{"idx":1,"correct":true,"proposition":"Cefotaxime","justification":""},{"idx":2,"correct":false,"proposition":"Amoxicillin","justification":""},{"idx":3,"correct":false,"proposition":"Vancomycin","justification":""},{"idx":4,"correct":false,"proposition":"Gentamicin","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-1-qi-13","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" You choose antibiotic therapy with cefotaxime and intravenous metronidazole. Which of the bacteria potentially involved in this infection is naturally resistant to the selected antibiotic therapy? (only one answer expected)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Enterococcus faecalis","justification":"This question was a QRU"},{"idx":1,"correct":false,"proposition":"Escherichia coli","justification":""},{"idx":2,"correct":false,"proposition":"Klebsiella pneumoniae","justification":""},{"idx":3,"correct":false,"proposition":"Streptococcus mitis","justification":""},{"idx":4,"correct":false,"proposition":"Bacteroides fragilis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-1-qi-14","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" In addition to antibiotic therapy, with a view to stenting, the patient benefits from endoscopic retrograde cholangiopancreatography. The latter shows biliary stenosis with dilation of the bile ducts upstream. What are the following structures? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"1 is the gallbladder","justification":""},{"idx":1,"correct":false,"proposition":"2 is the common hepatic duct","justification":""},{"idx":2,"correct":false,"proposition":"3 is the fourth portion of the duodenum","justification":""},{"idx":3,"correct":true,"proposition":"4 corresponds to an intrahepatic bile duct","justification":""},{"idx":4,"correct":false,"proposition":"5 is the main pancreatic duct","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-2-qi-1","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" As part of its follow-up, you request a blood count that shows: red blood cells 3.1 T\/L, hemoglobin 105 g\/L, MCV 105 fl, MCHC 32 g\/dl, leukocytes 4.8 G\/L, neutrophils 2.8 G\/L, eosinophilic polynuclear 0.2 G\/L, lymphocytes 1.4 G\/L, monocytes 0.4 G\/L, platelets 152 G\/L.","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Reticulocytes","justification":""},{"idx":1,"correct":false,"proposition":"Creatinine emia","justification":""},{"idx":2,"correct":false,"proposition":"GammaGT","justification":""},{"idx":3,"correct":false,"proposition":"Dosage vitamins B9 and B12","justification":""},{"idx":4,"correct":false,"proposition":"Ferritinemia","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-2-qi-2","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The assessment you had done shows reticulocytes at 2.5%. Which exams do you think are relevant? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"TSH","justification":""},{"idx":1,"correct":true,"proposition":"Creatinine clearance","justification":""},{"idx":2,"correct":false,"proposition":"Direct Coombs test","justification":""},{"idx":3,"correct":true,"proposition":"Dosage vitamins B9 and B12","justification":""},{"idx":4,"correct":false,"proposition":"Ferritinemia","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-2-qi-3","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The assessment carried out shows a normal TSH, the creatinine clearance evaluated on serum creatinine is normal and dosages of vitamins B9 and B12 within normal limits. You write her a letter for a hematologist, whom she does not decide to consult until 6 months later. The NFS made on the day of the consultation shows: red blood cells 2.1 T\/L, hemoglobin 79 g\/L, MCV 110 fl, MCDC 34.3 g\/dl, reticulocytes 33 G\/L, leukocytes 3.9 G\/L, neutrophils 1.7 G\/L, eosinophils 0.2 G\/L, lymphocytes 1.4 G\/L, monocytes 0.6 G\/L, platelets 112 G\/L. On reading the blood smear, lecytologist notes signs of dysgranulopoiesis but no blast. What are the reasons for diagnosing myelodysplasia? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"history of chemotherapy","justification":""},{"idx":1,"correct":false,"proposition":"dyslipidemia treated with simvastatin","justification":""},{"idx":2,"correct":false,"proposition":"chronic alcoholism","justification":""},{"idx":3,"correct":true,"proposition":"dysgranulopoiesis on the blood smear","justification":""},{"idx":4,"correct":true,"proposition":"progressive worsening of cytopenias","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-2-qi-4","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" Which exams do you think are indicated at this stage? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Osteomedullary biopsy","justification":""},{"idx":1,"correct":true,"proposition":"Myelogram","justification":""},{"idx":2,"correct":true,"proposition":"Medullary karyotype","justification":""},{"idx":3,"correct":false,"proposition":"Hemoglobin electrophoresis","justification":""},{"idx":4,"correct":false,"proposition":"Search for the BCR-ABL1 transcript","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-2-qi-5","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The myelogram shows a rich marrow with granular line 40%, of which 8% blasts, erythroblastic line 45%, lymphocytes 10%, monocytes 5%. Megakaryocytes are numerous. There are signs of dyserythropoiesis, dysgranulopoiesis, and dysmegakaryopoiesis. What diagnoses do you mention? (one or more correct answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"acute myelogenous leukemia","justification":""},{"idx":1,"correct":false,"proposition":"chronic myelogenous leukemia","justification":""},{"idx":2,"correct":true,"proposition":"refractory anemia with excess blasts","justification":""},{"idx":3,"correct":false,"proposition":"megakaryoblastic leukemia","justification":""},{"idx":4,"correct":false,"proposition":"myeloma","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-2-qi-6","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" It is therefore a refractory anemia with excess blasts type 1.At first, you decide to transfuse the patient. She was never transfused and did not become pregnant. What needs to be done? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the determination of the ABO Rhesus group must be carried out on two different samples","justification":""},{"idx":1,"correct":false,"proposition":"compatibility must be determined twice on the same sample","justification":""},{"idx":2,"correct":true,"proposition":"a search for irregular agglutinins is justified","justification":""},{"idx":3,"correct":false,"proposition":"the determination of the ABO group is sufficient for globular concentrates","justification":""},{"idx":4,"correct":false,"proposition":"the patient must receive irradiated red blood cells","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-2-qi-7","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" You propose to your patient to participate in a clinical trial testing a hypomethylating agent, an investigational drug that does not have the MA. About the patient's consent, what propositions are true? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"consent to participate in the trial may be given orally","justification":""},{"idx":1,"correct":true,"proposition":"consent must be signed by the patient and physician","justification":""},{"idx":2,"correct":true,"proposition":"consent must be signed without constraint and preceded by informed information","justification":""},{"idx":3,"correct":true,"proposition":"the information given to the patient before the possible signing of the consent can be given to him without the presence of a third party","justification":""},{"idx":4,"correct":false,"proposition":"Free and informed consent commits the patient to participate in the trial until its completion","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-2-qi-8","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The hypomethylating investigational medicinal product has already been tested in phase I and its dose and pharmacokinetics have been determined. The trial you are proposing to your patient is a phase II trial. Which propositions are true? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"a phase II trial may include randomization","justification":""},{"idx":1,"correct":true,"proposition":"a phase II trial evaluates the effectiveness of a drug","justification":""},{"idx":2,"correct":true,"proposition":"a phase II trial must conventionally, if successful, be followed by a phase III trial to obtain a marketing authorization","justification":""},{"idx":3,"correct":true,"proposition":"phase II trials can test drug combinations","justification":""},{"idx":4,"correct":false,"proposition":"patients in phase II trials are generally advanced\/refractory","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-2-qi-9","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The patient agrees to the clinical trial. It is warned of the risk of worsening cytopenias induced by the proposed treatment. What types of infections does severe neutropenia expose the patient to? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Bacterial pneumonia","justification":""},{"idx":1,"correct":false,"proposition":"Influenza","justification":""},{"idx":2,"correct":true,"proposition":"Gingivostomatitis","justification":""},{"idx":3,"correct":false,"proposition":"Pneumocystis jirovecii infection","justification":""},{"idx":4,"correct":true,"proposition":"Cellulitis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-2-qi-10","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" During this treatment exposing to a risk of thrombocytopenia, what semiological elements would suggest a risk of serious bleeding? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Purpura of the lower limbs","justification":""},{"idx":1,"correct":true,"proposition":"Intraoral hemorrhagic bubbles","justification":""},{"idx":2,"correct":false,"proposition":"Gingivoragies brushing teeth","justification":""},{"idx":3,"correct":false,"proposition":"Conjunctival hemorrhage","justification":""},{"idx":4,"correct":true,"proposition":"Bleeding at the back of the eye","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-2-qi-11","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" She receives 6 monthly cures quite well tolerated but she remains cytopenic. She is rehospitalized one week before her 7th cure for alteration of the general condition with dyspnea of recent installation. The CBC shows hemoglobin at 65 g\/L, leukocytes at 98 G\/L with 80% myeloid blasts and platelets at 15 G\/L. The patient was admitted to the emergency department and transfused overnight. The next morning, she is very dyspneic. What are the two most likely diagnostic hypotheses to explain this dyspnea?","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"alveolar proteinosis","justification":""},{"idx":1,"correct":true,"proposition":"pulmonary edema of overload","justification":""},{"idx":2,"correct":false,"proposition":"pulmonary edema post-transfusion lesional","justification":""},{"idx":3,"correct":true,"proposition":"pulmonary leukostasis","justification":""},{"idx":4,"correct":false,"proposition":"plasma hyperviscosity","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-2-qi-12","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The diagnosis finally retained is that of pulmonary edema of overload and dyspnea regresses rapidly under diuretic treatment. The patient is transferred to haematology for the management of her transformation into acute leukaemia. A hemostasis assessment shows: TP 30%, TCA patient\/control ratio 1.8, fibrinogen 0.7 g \/ l. D-dimer is at 9000 ng\/ml.How do you interpret this hemostasis assessment in this context? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Hepatocellular insufficiency","justification":""},{"idx":1,"correct":false,"proposition":"Acquired Willebrand disease","justification":""},{"idx":2,"correct":false,"proposition":"Antiphospholipid syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Disseminated intravascular coagulation","justification":""},{"idx":4,"correct":false,"proposition":"Cold agglutinin disease","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-2-qi-13","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The diagnosis of DICD is mentioned, so the patient leaves the clinical trial. A cytoreductive treatment is started to try to reduce blast proliferation. The patient becomes oliguric and serum creatinine doubles in 24 hours. Which diagnosis do you think is most likely?","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Rapidly progressive glomerulonephritis","justification":""},{"idx":1,"correct":false,"proposition":"Thrombotic microangiopathy","justification":""},{"idx":2,"correct":true,"proposition":"Tumor lysis syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Rhabdomyolysis","justification":""},{"idx":4,"correct":false,"proposition":"Thrombosis of a renal artery","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-2-qi-14","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" A tumor lysis syndrome is evoked, what biological argument(s) would be in favor of this diagnosis? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Hypokalemia","justification":""},{"idx":1,"correct":true,"proposition":"Hypocalcemia","justification":""},{"idx":2,"correct":true,"proposition":"Hyperuricemia","justification":""},{"idx":3,"correct":false,"proposition":"Hypophosphoremia","justification":""},{"idx":4,"correct":false,"proposition":"Hyperbilirubinemia","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-3-qi-1","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" Express in pack-years the smoking consumption of this man (only one answer expected)","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"54","justification":""},{"idx":1,"correct":false,"proposition":"44","justification":""},{"idx":2,"correct":false,"proposition":"27","justification":""},{"idx":3,"correct":false,"proposition":"22","justification":""},{"idx":4,"correct":false,"proposition":"14","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-3-qi-2","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" With the elements you have, what hypothesis(s) diagnosis (s) do you retain?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Upper airway infection","justification":""},{"idx":1,"correct":false,"proposition":"Acute respiratory failure","justification":""},{"idx":2,"correct":true,"proposition":"Exacerbation of chronic bronchitis","justification":""},{"idx":3,"correct":false,"proposition":"Alveolar pneumonia","justification":""},{"idx":4,"correct":false,"proposition":"Influenza","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-3-qi-3","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" What element(s) would be important to define the antibiotic therapeutic strategy?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Exact volume of sputum","justification":""},{"idx":1,"correct":true,"proposition":"Presence of exertional dyspnea","justification":""},{"idx":2,"correct":true,"proposition":"Presence of resting dyspnea","justification":""},{"idx":3,"correct":false,"proposition":"Excessive alcohol consumption","justification":""},{"idx":4,"correct":false,"proposition":"Winter context","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-3-qi-4","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" During a new interrogation, the patient reports dyspnea of effort for a few months. Which of the following antibiotics are indicated at this stage?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Levofloxacin","justification":""},{"idx":1,"correct":false,"proposition":"Amoxicillin","justification":""},{"idx":2,"correct":false,"proposition":"Metronidazole","justification":""},{"idx":3,"correct":false,"proposition":"Cefotaxime","justification":""},{"idx":4,"correct":false,"proposition":"Cotrimoxazole","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-3-qi-5","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" His condition improved after 7 days of amoxicillin. What do you foresee in the course of this episode?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Respiratory function tests","justification":""},{"idx":1,"correct":false,"proposition":"Allergological assessment","justification":""},{"idx":2,"correct":false,"proposition":"Lung scintigraphy","justification":""},{"idx":3,"correct":true,"proposition":"Pneumococcal vaccination","justification":""},{"idx":4,"correct":true,"proposition":"Annual influenza vaccination","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-3-qi-6","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" The patient is not seen again at the end of the episode. Six months after this first visit, he became unwell at home and was referred by his entourage to the emergency department. On clinical examination, the pulse is at 110 bpm, the temperature at 38.5 ° C, the blood pressure at 120\/70mmHg, the respiratory rate at 32 cycles \/ min with a saturation in ambient air of 91% initially. You mention pneumonia. Which clinical sign(s) would be in favor of this hypothesis?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"A hotbed of crackling","justification":""},{"idx":1,"correct":false,"proposition":"the presence of sibilants","justification":""},{"idx":2,"correct":false,"proposition":"decreased vocal vibration","justification":""},{"idx":3,"correct":false,"proposition":"A percussion tympanism","justification":""},{"idx":4,"correct":true,"proposition":"tubal murmur","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-3-qi-7","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" You have heard a focus of apical crackling upright. What is your assessment? (one or more correct answers)","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"venous Doppler of the lower limbs","justification":""},{"idx":1,"correct":false,"proposition":"a lung scan","justification":""},{"idx":2,"correct":true,"proposition":"chest x-ray","justification":""},{"idx":3,"correct":false,"proposition":"bronchial fibroscopy","justification":""},{"idx":4,"correct":false,"proposition":"bronchoalveolar lavage","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-3-qi-8","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" The chest X-ray is as follows: What is your interpretation?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Systematized impairment","justification":""},{"idx":1,"correct":false,"proposition":"Left upper lobar involvement","justification":""},{"idx":2,"correct":true,"proposition":"Alveolar syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Miliaria","justification":""},{"idx":4,"correct":false,"proposition":"Pneumothorax","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-3-qi-9","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" What biological assessment do you prescribe?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Blood platelet count","justification":""},{"idx":1,"correct":true,"proposition":"Blood ionogram - serum creatinine","justification":""},{"idx":2,"correct":true,"proposition":"Blood","justification":""},{"idx":3,"correct":false,"proposition":"Pneumococcal antigenemia","justification":""},{"idx":4,"correct":true,"proposition":"Cytobacteriological examination of sputum","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-3-qi-10","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" The laboratory assessment shows a biological inflammatory syndrome (CRP at 275 mg \/ L) with hyperleukocytosis. Biological kidney function is normal. Arterial lagazometrics is as follows: pH 7.48, PaO2 66 mmHg, PaCO 2 34 mmHg, HCO 3- 27 mmol \/ L.Regarding the cytobacteriological examination of sputum, which parameter(s) will encourage you to consider this examination as quality and reliable?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Monomicrobial character","justification":""},{"idx":1,"correct":false,"proposition":"Number of polynuclear units less than 25 per field","justification":""},{"idx":2,"correct":false,"proposition":"Number of bacterial colonies at 10 3 per m L","justification":""},{"idx":3,"correct":true,"proposition":"Number of epithelial cells less than 10 per field","justification":""},{"idx":4,"correct":false,"proposition":"Sampling in sputum medium","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-3-qi-11","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" Under 1 L\/min of nasal oxygen, saturation rises to 94% and respiratory rate drops to 22\/min. What is your attitude towards this patient? (one or more correct answers)","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Hospitalization in the medical department","justification":""},{"idx":1,"correct":false,"proposition":"Isolation \"air\"","justification":""},{"idx":2,"correct":false,"proposition":"Vancomycin treatment","justification":""},{"idx":3,"correct":false,"proposition":"Treatment with oseltamivir","justification":""},{"idx":4,"correct":false,"proposition":"Intravenous corticosteroid therapy","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-3-qi-12","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" A chest CT scan has been requested by your colleague on duty who also introduces treatment with amoxicillin-clavulanic acid. What is your interpretation of the image?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Alveolar condensation","justification":""},{"idx":1,"correct":false,"proposition":"Caves","justification":""},{"idx":2,"correct":false,"proposition":"Scissurite","justification":""},{"idx":3,"correct":false,"proposition":"Miliaria","justification":""},{"idx":4,"correct":true,"proposition":"Emphysema","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-3-qi-13","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" Two blood cultures are gram-positive diplococcus. Which antibiotic therapy(s) do you think are the most suitable at present?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Levofloxacin","justification":""},{"idx":1,"correct":false,"proposition":"Cefotaxime + spiramycin","justification":""},{"idx":2,"correct":false,"proposition":"Azithromycin","justification":""},{"idx":3,"correct":true,"proposition":"Amoxicillin","justification":""},{"idx":4,"correct":false,"proposition":"Amoxicillin + clavulanic acid","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-3-qi-14","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" Your patient's condition improves after 7 days of amoxicillin. As he goes home, he tells you that he worked for 30 years in insulation until his retirement, and handled a lot of asbestos. What pathology(s) can be related to this exposure to asbestos?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Pleural mesothelioma","justification":""},{"idx":1,"correct":false,"proposition":"Melanoma","justification":""},{"idx":2,"correct":true,"proposition":"Lung cancer","justification":""},{"idx":3,"correct":false,"proposition":"Ethmoid cancer","justification":""},{"idx":4,"correct":true,"proposition":"Asbestosis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-3-qi-15","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" An objective control CT scan of bilateral non-calcified pleural plaques that had not been seen on the previous CT scan. Pleural plaques in a context of exposure to asbestos are the subject of an occupational disease table with a treatment period of 40 years. Can the patient claim recognition as an occupational disease?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"No, because he is retired","justification":""},{"idx":1,"correct":false,"proposition":"No because he smoked","justification":""},{"idx":2,"correct":false,"proposition":"No because it is ethyl","justification":""},{"idx":3,"correct":true,"proposition":"Yes because of the principle of presumption of origin","justification":""},{"idx":4,"correct":true,"proposition":"Yes because it does not exceed the support time","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-4-qi-1","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" What is (are) the semeiological data(s) to be specified at the interrogation that would direct you towards the diagnosis of arteriopathy obliterans of the lower limbs?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the occurrence of this pain when walking","justification":"This proposal was essential"},{"idx":1,"correct":false,"proposition":"The characteristics of this pain type of electric shocks s","justification":""},{"idx":2,"correct":false,"proposition":"the disappearance of pain at elevation of the lower limbs","justification":""},{"idx":3,"correct":false,"proposition":"the later onset of pain when walking on hills than when walking on flat ground","justification":""},{"idx":4,"correct":true,"proposition":"the onset of pain for a constant walking distance on flat ground","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-4-qi-2","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" In this patient, the pain occurs when walking, only in the lower right limb, for a fixed distance on flat ground that he estimates at 350 meters with a cramp type sitting at the calf. You notice the presence of a right iliac murmur and a murmur in the lower 1\/3 of the left thigh. Femoral pulses are perceived on both the right and the left. The left popliteal pulse is very easily found it appears ample, the right popliteal pulse is not perceived. In distality you perceive only the left posterior tibial pulse and the left pedinous pulse. On these data you evoke the presence of an obliterating arterial disease of the lower limbs. Which arterial lesion(s) do you suspect based on these clinical data?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Right iliac stenosis","justification":""},{"idx":1,"correct":true,"proposition":"right femoral obliteration","justification":""},{"idx":2,"correct":false,"proposition":"obliteration of right leg arteries","justification":""},{"idx":3,"correct":true,"proposition":"Left femoral stenosis","justification":""},{"idx":4,"correct":true,"proposition":"Left popliteal aneurysm","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-4-qi-3","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" The clinical examination data led you to suspect the existence of right iliac stenosis, right femoral obliteration, left femoral stenosis and left popliteal aneurysm. What are the first two tests you need to order to confirm your diagnosis of peripheral arterial disease and to locate the arterial lesions you suspected?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"arteriogram of the lower limbs","justification":""},{"idx":1,"correct":true,"proposition":"a measurement of ankle systolic pressure indexes","justification":""},{"idx":2,"correct":true,"proposition":"arterial Doppler ultrasound of the lower limbs","justification":""},{"idx":3,"correct":false,"proposition":"angiography of the lower limbs","justification":""},{"idx":4,"correct":false,"proposition":"MRI of the lower limbs","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-4-qi-4","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" The measurement of ankle pressure indexes confirmed the diagnosis of peripheral arterial disease obliterating the lower limbs (humeral systolic pressure at 166mmHg in the right arm and 162 mmHg in the left arm with systolic pressure in the right ankle at 114 mmHg: IPS at 0.69 on the right and systolic pressure in the left ankle at 132 mmHg:  IPS at 0.80 on the left). The Doppler ultrasound of the aorta and lower limbs shows: a normal aorta (antero-posterior diameter at 22 mm), a stenosis at 50% of the right external iliac artery, an obliteration of the right femoral artery with reinjection of the popliteal artery. The left femoral artery has a non-significant stenosis and the other arterial axes on the left are the site of diffuse atheromatous overload but without significant obstructive lesion. The left popliteal artery is not aneurysmal. The examination does not retain significant lesion of the leg arteries on the right or left. There is obliterating arterial disease of the lower extremities. What is the element that allows you to say that it is at the stage of exercise ischemia?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"the value of the patient's estimated walking distance below the threshold of 500 meters","justification":""},{"idx":1,"correct":true,"proposition":"symptomatic character to intermittent claudication type","justification":""},{"idx":2,"correct":false,"proposition":"ankle systolic pressure greater than 50 mmHg","justification":""},{"idx":3,"correct":false,"proposition":"the value of the ankle pressure indexes less than 0.90","justification":""},{"idx":4,"correct":false,"proposition":"the existence of humeral anisotension","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-4-qi-5","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" In this symptomatic patient at the claudication stage, additional examinations objectified ankle systolic pressures greater than 50 mmHg and SNPIs <0.90 confirming the diagnosis of peripheral arterial disease of the lower limbs at the stage of exercise ischemia. There is no aneurysmal lesion, there is 50% right iliac stenosis and right femoral obliteration. The assessment of vascular risk factors in this former smoker did not find diabetes. What therapeutic strategies are possible at this stage? (one or more expected answers)","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"gait rehabilitation","justification":""},{"idx":1,"correct":false,"proposition":"Revascularization","justification":""},{"idx":2,"correct":true,"proposition":"Anti-aggregant treatment with aspirin","justification":""},{"idx":3,"correct":true,"proposition":"statin therapy","justification":""},{"idx":4,"correct":false,"proposition":"anticoagulant therapy","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-4-qi-6","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" The patient begins gait rehabilitation. He now receives atorvastatin, acetyl-salicylic acid, indapamide, fluoxetine and lercanidipine. He returned for consultation 3 months later. He performed a self-measurement cycle, the averaged values are 139\/64 mmHgThe blood pressure is measured at 160\/80 mmHg at the beginning of the consultation and then at 146\/60 mmHg symmetrically 15 minutes later. At this stage, what type(s) of high blood pressure can be suspected in this patient?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Systolic hypertension","justification":""},{"idx":1,"correct":false,"proposition":"Resistant HTA","justification":""},{"idx":2,"correct":false,"proposition":"Masked HTA","justification":""},{"idx":3,"correct":false,"proposition":"Systolo-diastolic hypertension","justification":""},{"idx":4,"correct":false,"proposition":"HTA << white coat>>","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-4-qi-7","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" A biological assessment carried out before this visit shows: Na 130 mmol \/ L, K 3.4 mmol \/ L, serum creatinine 75 μmol \/ L. LDL cholesterol is 0.90 g \/ L.Among the treatments taken by the patient, which drug (s) can (can) explain the abnormalities of the ionogram?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"indapamide","justification":""},{"idx":1,"correct":false,"proposition":"atorvastatin","justification":""},{"idx":2,"correct":true,"proposition":"fluoxetine","justification":""},{"idx":3,"correct":false,"proposition":"acetyl salicylic acid","justification":""},{"idx":4,"correct":false,"proposition":"lercanidipine","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-4-qi-8","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" Regarding the management of high blood pressure, what change(s) do you make to this patient's prescription?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Indapamide judgment","justification":""},{"idx":1,"correct":false,"proposition":"Lercanidipine stop","justification":""},{"idx":2,"correct":false,"proposition":"Prescription of furosemide","justification":""},{"idx":3,"correct":true,"proposition":"prescription of an ACE inhibitor","justification":""},{"idx":4,"correct":false,"proposition":"Prescription of a beta-blocker","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-4-qi-9","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" You replace indapamide with an ACE inhibitor. In addition, what other measure(s) do you propose to this patient?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"the prescription of potassium supplementation","justification":""},{"idx":1,"correct":false,"proposition":"the decrease in beverages to 0.75 liters per day","justification":""},{"idx":2,"correct":false,"proposition":"increased sodium intake","justification":""},{"idx":3,"correct":true,"proposition":"Annual flu vaccination","justification":""},{"idx":4,"correct":true,"proposition":"decreased alcohol consumption","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-4-qi-10","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" What is the most suitable test to evaluate the effectiveness of antihypertensive treatment in this patient? (only one exact answer)","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"resting electrocardiogram","justification":""},{"idx":1,"correct":true,"proposition":"Voltage self-measurement","justification":""},{"idx":2,"correct":false,"proposition":"echocardiography","justification":""},{"idx":3,"correct":false,"proposition":"24-hour voltage recording (MAPA)","justification":""},{"idx":4,"correct":false,"proposition":"24-hour electrocardiographic recording (Holter)","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-4-qi-11","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" What is (are) the expected benefit(s) of your care?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"decreased risk of stroke","justification":""},{"idx":1,"correct":true,"proposition":"decreased risk of heart failure","justification":""},{"idx":2,"correct":false,"proposition":"decreased risk of aortic valve disease","justification":""},{"idx":3,"correct":true,"proposition":"decrease in cardiovascular mortality","justification":""},{"idx":4,"correct":false,"proposition":"Decreased thromboembolic venous risk","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-4-qi-12","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" The patient is currently being treated with ACE inhibitor and calcium channel blocker for antihypertensive purposes. Self-measurement shows an average blood pressure of 158\/72 mmHg.What are you looking for at the origin of this therapeutic ineffectiveness in this patient? (one or more correct answers)","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"fibromuscular dysplasia of the renal arteries","justification":""},{"idx":1,"correct":true,"proposition":"alcohol abuse","justification":""},{"idx":2,"correct":true,"proposition":"non-adherence","justification":""},{"idx":3,"correct":true,"proposition":"sleep apnea syndrome","justification":""},{"idx":4,"correct":true,"proposition":"improper use of the blood pressure self-measuring device","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-4-qi-13","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" Poor blood pressure control was linked to medication non-adherence. The patient received therapeutic education. During the first check-up visit to his general practitioner, the blood pressure self-measurement values are in the objectives. Biological abnormalities are normalized. You renew his treatment. What follow-up do you propose to this patient? (one or more correct answers)","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"annual echocardiography","justification":""},{"idx":1,"correct":false,"proposition":"a stress test every two years","justification":""},{"idx":2,"correct":false,"proposition":"a monthly consultation with the general practitioner","justification":""},{"idx":3,"correct":true,"proposition":"an annual blood ionogram","justification":""},{"idx":4,"correct":true,"proposition":"Blood pressure monitoring by self-measurement","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-5-qi-1","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" Here is the dermatological aspect of the patient. What semiological characteristics do you find on the 2 photos? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"èrythema","justification":""},{"idx":1,"correct":true,"proposition":"Papules","justification":""},{"idx":2,"correct":true,"proposition":"Dander","justification":""},{"idx":3,"correct":false,"proposition":"annular lesions","justification":""},{"idx":4,"correct":false,"proposition":"Vesicles","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-5-qi-2","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" From your semiological analysis and the history of this patient, which dermatological diagnosis seems to you to be the most likely? (only one response expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Atopic dermatitis","justification":""},{"idx":1,"correct":false,"proposition":"maculopapular exanthema with bisoprolol","justification":""},{"idx":2,"correct":false,"proposition":"pityriasis rosé of Gibert","justification":""},{"idx":3,"correct":true,"proposition":"psoriasis","justification":""},{"idx":4,"correct":false,"proposition":"Mycosis fungoides","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-5-qi-3","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You remember the diagnosis of psoriasis. How do you assess the intensity, severity and impact of it? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"PASI score","justification":""},{"idx":1,"correct":false,"proposition":"Genetic analysis for determination of susceptibility genes","justification":""},{"idx":2,"correct":true,"proposition":"dermatology life quality index (DLQI) score","justification":""},{"idx":3,"correct":false,"proposition":"rheumatoid factor test","justification":""},{"idx":4,"correct":true,"proposition":"radiography of the pelvis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-5-qi-4","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You suspect the association with psoriatic arthritis. What semiological and anamnestic elements would be in favor of this association? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the existence of heel pain","justification":""},{"idx":1,"correct":true,"proposition":"nail damage","justification":""},{"idx":2,"correct":true,"proposition":"scalp involvement","justification":""},{"idx":3,"correct":false,"proposition":"high PASI score","justification":""},{"idx":4,"correct":false,"proposition":"Late onset in adulthood","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-5-qi-5","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" The PASI score is 22 (severe form) and the DLQI shows a profound alteration in the quality of life of this patient. At this stage, psoriatic arthritis is not confirmed. Blood ionogram, kidney function and liver function are normal. What are the treatment options available as a first-line treatment? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Local treatment with betamethasone and calcipotriol","justification":""},{"idx":1,"correct":true,"proposition":"UVB phototherapy","justification":""},{"idx":2,"correct":false,"proposition":"local treatment with vitamin D analogue","justification":""},{"idx":3,"correct":true,"proposition":"methotrexate","justification":""},{"idx":4,"correct":false,"proposition":"biotherapy","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-5-qi-6","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" The patient living in a rural area far from a phototherapy center, he asks you for an effective treatment because he is very affected by the extension of his dermatosis which confines him to his home. Which treatment do you prefer for this patient? (only one answer expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Spa","justification":""},{"idx":1,"correct":false,"proposition":"hydroxychloroquine","justification":""},{"idx":2,"correct":true,"proposition":"methotrexate","justification":""},{"idx":3,"correct":false,"proposition":"cyclosporine","justification":""},{"idx":4,"correct":false,"proposition":"salazopyrin","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-5-qi-7","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" The patient's hypertension makes you prefer methotrexate to ciclosporin. You start treatment with 17.5 mg methotrexate weekly. You see the patient again after 3 months, the PASI score (Psoriasis Area and Severity Index) is 15, the heel pain is less intense but the patient still has hip pain for which he regularly takes NSAIDs. You are considering the use of biotherapy. What elements are part of your pre-therapeutic assessment? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"IGRA (quantiferon®) test","justification":""},{"idx":1,"correct":true,"proposition":"HIV testing serology","justification":""},{"idx":2,"correct":true,"proposition":"hepatitis B and C screening serologies","justification":""},{"idx":3,"correct":true,"proposition":"Verification of vaccinations","justification":""},{"idx":4,"correct":false,"proposition":"Thoraco-abdomino-pelvic CT scan","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-5-qi-8","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" What three biotherapies are you considering for this patient?","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Anti-CD20","justification":""},{"idx":1,"correct":true,"proposition":"Anti-IL-12\/IL-23","justification":""},{"idx":2,"correct":true,"proposition":"Anti-IL-17","justification":""},{"idx":3,"correct":true,"proposition":"Anti-TNFalpha","justification":""},{"idx":4,"correct":false,"proposition":"Anti-PD-1","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-5-qi-9","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You have chosen to introduce an anti-IL17 biotherapy.What other elements should be considered in the management of psoriasis? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Dieting","justification":""},{"idx":1,"correct":true,"proposition":"Limiting alcohol intake","justification":""},{"idx":2,"correct":false,"proposition":"Valsartan stop","justification":""},{"idx":3,"correct":true,"proposition":"Bisoprolol replacement","justification":""},{"idx":4,"correct":true,"proposition":"seasonal influenza vaccination","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-5-qi-10","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You see the patient again 1 year later, he followed your advice, lost 5 kgs. Psoriasis was greatly improved by an anti IL-17. As the prescription has not been renewed, the patient has not received any treatment for 4 months. He complains of persistent pain in his right foot (see photo). What diagnosis do you envisage for the involvement of the right big toe? (only one answer expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"whitlow","justification":""},{"idx":1,"correct":false,"proposition":"Primary herpes infection","justification":""},{"idx":2,"correct":false,"proposition":"chronic candidosis dactylitis","justification":""},{"idx":3,"correct":true,"proposition":"onycho-pachydermo-periostitis","justification":""},{"idx":4,"correct":false,"proposition":"drop","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-5-qi-11","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" What test do you request in first line to confirm the diagnosis of onycho-pachydermo-periostitis? (only one answer expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"X-ray of the feet","justification":""},{"idx":1,"correct":false,"proposition":"MRI right big toe","justification":""},{"idx":2,"correct":false,"proposition":"ultrasound of soft parts","justification":""},{"idx":3,"correct":false,"proposition":"rheumatoid factor test","justification":""},{"idx":4,"correct":false,"proposition":"CRP test","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-5-qi-12","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" The X-ray of the feet confirms your hypothesis. In association with the resumption of anti-IL-17, you have infiltrated cortisonic derivatives and prescribed non-steroidal anti-inflammatory drugs on demand. During a biological assessment to monitor the treatment, you find a high ferritinemia greater than 600 ng\/ml (N: 30-300). What is the most likely cause? (only one answer expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Hereditary hemochromatosis","justification":""},{"idx":1,"correct":false,"proposition":"Psoriasis","justification":""},{"idx":2,"correct":true,"proposition":"Metabolic syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Beginning hepatic cirrhosis","justification":""},{"idx":4,"correct":false,"proposition":"Excessive meat consumption","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-5-qi-13","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You consider that the metabolic syndrome that this patient presents is the most likely cause of this hyperferritinemia. What therapeutic measure(s) do you propose in the context of this patient?","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"low-calorie diet","justification":""},{"idx":1,"correct":true,"proposition":"Replacement of glibenclamide with metformin","justification":""},{"idx":2,"correct":false,"proposition":"Limiting daily dietary intake of iron to less than 5 mg\/d","justification":""},{"idx":3,"correct":false,"proposition":"bloodletting","justification":""},{"idx":4,"correct":false,"proposition":"treatment with deferoxamine","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-6-qi-1","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" For this patient, what information available makes you suspect sleep apnea syndrome? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Daytime sweating","justification":""},{"idx":1,"correct":true,"proposition":"Systemic arterial hypertension","justification":""},{"idx":2,"correct":true,"proposition":"Obesity","justification":""},{"idx":3,"correct":true,"proposition":"Nocturnal snoring","justification":""},{"idx":4,"correct":true,"proposition":"Decreased libido","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-6-qi-2","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You perform a nocturnal polygraph that targets a hypopnea apnea index of 55\/h and confirms severe obstructive sleep apnea syndrome. What treatments do you offer as a first-line treatment? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Bariatric surgery","justification":""},{"idx":1,"correct":false,"proposition":"Inhaled bronchodilators","justification":""},{"idx":2,"correct":true,"proposition":"Continuous positive airway pressure","justification":""},{"idx":3,"correct":true,"proposition":"Hygiene-dietary rules","justification":""},{"idx":4,"correct":false,"proposition":"Pulmonary rehabilitation","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-6-qi-3","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" As part of his profession as a bus driver, what measures do you recommend? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"A work stoppage at the beginning of the care","justification":""},{"idx":1,"correct":false,"proposition":"Outplacement","justification":""},{"idx":2,"correct":true,"proposition":"A wakefulness maintenance test after 1 month of well-conducted treatment","justification":""},{"idx":3,"correct":false,"proposition":"Information about his sleep apnea from his employer","justification":""},{"idx":4,"correct":false,"proposition":"Stopping amlodipine","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-6-qi-4","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Despite the appropriate and effective management of sleep apnea syndrome for several months, your patient's wife sees no improvement in their sex life. What clinical elements would point to the existence of hypogonadism in this patient? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Baldness","justification":""},{"idx":1,"correct":true,"proposition":"Gynecomastia","justification":""},{"idx":2,"correct":false,"proposition":"An enlarged prostate","justification":""},{"idx":3,"correct":true,"proposition":"The absence of morning erection","justification":""},{"idx":4,"correct":false,"proposition":"Night cramps","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-6-qi-5","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Testicular palpation reveals small testicles, he has gynecomastia and states that he does not have a morning erection. You strongly suspect acquired male hypogonadism. Which biological examination, for diagnostic purposes, is the most relevant at this stage? (only one answer expected)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Total testosteronemia","justification":""},{"idx":1,"correct":false,"proposition":"PSA assay","justification":""},{"idx":2,"correct":false,"proposition":"Prolactin dosage","justification":""},{"idx":3,"correct":false,"proposition":"cortisol at 8am","justification":""},{"idx":4,"correct":false,"proposition":"spermogram and spermocytogram","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-6-qi-6","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You prescribe a total testosterone assay performed one morning on an empty stomach whose result is: 1.2 ng \/ mL (N: 4-10). What are the two tests that you must imperatively prescribe to advance in your diagnostic process?","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"LH","justification":""},{"idx":1,"correct":false,"proposition":"Free testosterone","justification":""},{"idx":2,"correct":true,"proposition":"Prolactin","justification":""},{"idx":3,"correct":false,"proposition":"Sulfate de DHEA","justification":""},{"idx":4,"correct":false,"proposition":"hCG","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-6-qi-7","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Here are the results of this assessment: LH 3.3 IU\/L ( N: 2.1 - 6.3); prolactin 54 μg\/L (N < 20). At this stage, what is the most relevant imaging test? (only one answer expected)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"MRI of the hypothalamic-pituitary region","justification":""},{"idx":1,"correct":false,"proposition":"Testicular ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Prostatic ultrasound","justification":""},{"idx":3,"correct":false,"proposition":"Abdominopelvic CT scan","justification":""},{"idx":4,"correct":false,"proposition":"Thyroid ultrasound","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-6-qi-8","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You request an MRI of the hypothalamic-pituitary region, a section of which is shown below. Which of the following are true? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"This is a coronal cup","justification":""},{"idx":1,"correct":false,"proposition":"This is a sequence in T2","justification":""},{"idx":2,"correct":true,"proposition":"There is pituitary adenoma","justification":""},{"idx":3,"correct":false,"proposition":"The arrow indicates the hypothalamus","justification":""},{"idx":4,"correct":false,"proposition":"There is an attack of the optic chiasma","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-6-qi-9","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Among the elements at your disposal, which can guide you towards the diagnosis of acromegaly in this patient? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"High blood pressure","justification":""},{"idx":1,"correct":true,"proposition":"Sleep apnea syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Obesity","justification":""},{"idx":3,"correct":false,"proposition":"Low libido","justification":""},{"idx":4,"correct":true,"proposition":"Excessive sweating","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-6-qi-10","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You recover the IGF1 test that you requested as part of the pituitary assessment. It returns moderately increased for the age of the patient. In order to establish your diagnosis of acromegaly, you perform oral induced hyperglycemia (OPGH) with 75 grams of glucose whose results are as follows:","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Changes in GH testing during OPGH are sufficient to confirm the diagnosis of acromegaly","justification":""},{"idx":1,"correct":false,"proposition":"Concomitant testing of IGF1 and GH is necessary to diagnose acromegaly","justification":""},{"idx":2,"correct":false,"proposition":"Diagnosis of acromegaly is based on concomitant blood glucose and GH testing during OPGH","justification":""},{"idx":3,"correct":false,"proposition":"Concomitant insulin and GH testing is necessary to diagnose acromegaly","justification":""},{"idx":4,"correct":false,"proposition":"The concomitant discovery of diabetes mellitus prevents the interpretation of the GH assay","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-6-qi-11","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You have been diagnosed with acromegaly and diabetes mellitus. He was cared for and considered cured of his acromegaly. His diabetes persists. Among the following biological results, what would be the two elements expected in the context of type 2 diabetes of recent discovery?","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Triglycerides at 2.40 g\/L (N: 0.6 - 1.6)","justification":""},{"idx":1,"correct":false,"proposition":"HDL-C at 0.68 g\/L (N > 0.35)","justification":""},{"idx":2,"correct":false,"proposition":"LDL-C at 1.85 g\/L (N: 0.6 - 1.6)","justification":""},{"idx":3,"correct":false,"proposition":"AST at 85 IU\/L (N < 35) and ALT at 35 IU\/L (N < 40)","justification":""},{"idx":4,"correct":true,"proposition":"HbA1c at 8.5% (N < 7%)","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-6-qi-12","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Metformin was introduced about one year after diagnosis. HbA1c is now at 7.3%, with late morning blood glucose levels at 2.30 g\/L. His current BMI is 28.5 kg\/m 2.Which of the following treatment options do you think is the most relevant?","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Adding a rapid-acting insulin injection before breakfast","justification":""},{"idx":1,"correct":true,"proposition":"Addition of sitagliptin","justification":"This question was a single answer, as indicated in the statement"},{"idx":2,"correct":false,"proposition":"Addition of acarbose","justification":""},{"idx":3,"correct":false,"proposition":"Addition of an analogue of GLP1","justification":""},{"idx":4,"correct":false,"proposition":"Adding a slow insulin injection at bedtime","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-6-qi-13","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" His treatment was intensified by the addition of sitagliptin. Which of the following elements from his medical history constitute an issue in order to validate or not his fitness to drive buses?","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Metformin treatment","justification":""},{"idx":1,"correct":false,"proposition":"treatment of high blood pressure","justification":""},{"idx":2,"correct":false,"proposition":"History of acromegaly","justification":""},{"idx":3,"correct":false,"proposition":"Treatment with sitagliptin","justification":""},{"idx":4,"correct":true,"proposition":"sleep apnea syndrome","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-6-qi-14","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" He complains of edema of the lower limbs which he attributes to amlodipine. He wants to stop this treatment. What therapeutic classes can be indicated for him in first line? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"central antihypertensive drug","justification":""},{"idx":1,"correct":true,"proposition":"ACE inhibitor","justification":""},{"idx":2,"correct":true,"proposition":"Sartan","justification":""},{"idx":3,"correct":false,"proposition":"beta-blocker","justification":""},{"idx":4,"correct":false,"proposition":"thiazide diuretic","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-7-qi-1","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" What measures do you take in the emergency room, when the patient is admitted? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"intravenous analgesic","justification":""},{"idx":1,"correct":false,"proposition":"Treatment with vasopressive amines","justification":""},{"idx":2,"correct":false,"proposition":"placement of a urinary catheter","justification":""},{"idx":3,"correct":true,"proposition":"nasogastric tube placement","justification":""},{"idx":4,"correct":true,"proposition":"vascular filling","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-7-qi-2","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" Regarding the abdominal contracture of this patient, what are the exact proposals? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"there is peritoneal irritation","justification":""},{"idx":1,"correct":true,"proposition":"It's a surgical emergency","justification":""},{"idx":2,"correct":false,"proposition":"  It may be related to significant desydratation","justification":""},{"idx":3,"correct":true,"proposition":"it is invincible on palpation","justification":""},{"idx":4,"correct":false,"proposition":"it is voluntary, in reaction to abdominal palpation","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-7-qi-3","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" What diagnoses do you mention at this stage? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"a perforated ulcer","justification":""},{"idx":1,"correct":true,"proposition":"diverticular perforated peritonitis","justification":""},{"idx":2,"correct":false,"proposition":"hepatic colic","justification":""},{"idx":3,"correct":false,"proposition":"acute pyelonephritis","justification":""},{"idx":4,"correct":true,"proposition":"appendicular peritonitis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-7-qi-4","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" What biological tests do you prescribe urgently? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"blood type and search for irregular agglutinins","justification":""},{"idx":1,"correct":false,"proposition":"serology Helicobacter pylori","justification":""},{"idx":2,"correct":true,"proposition":"Blood","justification":""},{"idx":3,"correct":true,"proposition":"serum creatinine","justification":""},{"idx":4,"correct":true,"proposition":"TP and TCA","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-7-qi-5","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" What additional examination do you request to establish your etiological diagnosis? (only one answer expected)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Abdominopelvic ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"X-ray of the abdomen without preparation","justification":""},{"idx":2,"correct":true,"proposition":"Abdomino-pelvic CT scan","justification":""},{"idx":3,"correct":false,"proposition":"Gastro-duodenal fibroscopy","justification":""},{"idx":4,"correct":false,"proposition":"chest X-ray","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-7-qi-6","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" Here are some scannographic sections:What are the exact proposals? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"it is an abdominopelvic scan in axial section (transverse)","justification":""},{"idx":1,"correct":false,"proposition":"the number 1 corresponds to the uterus","justification":""},{"idx":2,"correct":true,"proposition":"the number 2 corresponds to an effusion in Douglas' cul de sac","justification":""},{"idx":3,"correct":true,"proposition":"The number 3 corresponds to an appendicular stercolith","justification":""},{"idx":4,"correct":false,"proposition":"The right kidney is visible in one of these pictures","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-7-qi-7","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" About this scannographic section:What are the exact proposals? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the aorta is visible","justification":""},{"idx":1,"correct":false,"proposition":"there is a pneumoperitoneum","justification":""},{"idx":2,"correct":false,"proposition":"the number 4 corresponds to the left kidney","justification":""},{"idx":3,"correct":true,"proposition":"  The number 5 corresponds to a fluid effusion","justification":""},{"idx":4,"correct":false,"proposition":"There is a cluster of slender loops","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-7-qi-8","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" About digestive vascular anatomy, what are the exact answers? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the celiac trunk gives rise to the left gastric artery, the common hepatic artery and the splenic artery","justification":""},{"idx":1,"correct":true,"proposition":"the Riolan arch is an anastomosis between the upper and lower mesenteric territory","justification":""},{"idx":2,"correct":true,"proposition":"The appendix is vascularized by an arterial branch from the superior mesenteric artery","justification":""},{"idx":3,"correct":false,"proposition":"the right colon is vascularized by the inferior mesenteric artery","justification":""},{"idx":4,"correct":false,"proposition":"The inferior mesenteric vein drains into the inferior vena cava","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-7-qi-9","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" You are diagnosed with acute generalized peritonitis of appendicular origin. What are the main principles of management of this pathology? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The surgery may be postponed for a few hours under the guise of antibiotic therapy","justification":""},{"idx":1,"correct":true,"proposition":"At this stage, intravenous broad-spectrum antibiotic therapy should be prescribed.","justification":""},{"idx":2,"correct":true,"proposition":"A peritoneal toilet with saline will be systematically performed","justification":""},{"idx":3,"correct":false,"proposition":"An appendectomy and resection of the cecum more or less extensive to the ascending colon must be performed","justification":""},{"idx":4,"correct":true,"proposition":"The appendix is systematically sent to the Anatomical Pathology Laboratory","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-7-qi-10","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient receives an emergency appendectomy with peritoneal toilet. She has a postoperative antibiotic therapy for 5 days paramoxicillin-clavulanic acid, adapted to the identification of a multisensitive Escherichia coli isolated in samples taken intraoperatively. The postoperative follow-up is simple. Discharge is allowed on the 6th postoperative day. The patient is urgently readmitted 48 hours later for hyperthermia at 38.5 ° C associated with abdominal pain. The digital rectal examination objective a painful pelvic mass. What is the most likely diagnosis? (only one answer expected)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"pyelonephritis","justification":""},{"idx":1,"correct":true,"proposition":"a Douglassian abscess","justification":""},{"idx":2,"correct":false,"proposition":"phlebitis of the ovarian vein","justification":""},{"idx":3,"correct":false,"proposition":"a wall abscess","justification":""},{"idx":4,"correct":false,"proposition":"ulcer perforation","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-7-qi-11","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient quickly benefits from an abdominopelvic CT scan confirming the diagnosis of abscesses at the pelvic level, measured at 6 cm. (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"  there is no need to hospitalize the patient","justification":""},{"idx":1,"correct":true,"proposition":"drainage is required to drain the abscess","justification":""},{"idx":2,"correct":true,"proposition":"a bacteriological sample of the contents of the abscess must be taken","justification":""},{"idx":3,"correct":true,"proposition":"  Percutaneous radio-guided drainage is possible","justification":""},{"idx":4,"correct":false,"proposition":"Antibiotic therapy with amoxicillin-clavulanic acid should be resumed","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-7-qi-12","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient is hospitalized. The abscess is drained under CT control. Antibiotic therapy is adapted to bacteriological samples taken during drainage. There is no need to reoperate the patient. Six months later, she consults for the appearance of an umbilical swelling, appeared at the level of an incision scar. What signs point to uncomplicated eventration? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"swelling is expandable to cough","justification":""},{"idx":1,"correct":false,"proposition":"swelling is inflammatory","justification":""},{"idx":2,"correct":false,"proposition":"swelling is irregular","justification":""},{"idx":3,"correct":true,"proposition":"swelling is reducible","justification":""},{"idx":4,"correct":false,"proposition":"swelling is painful","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-7-qi-13","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient asks you about this eventration, what can you tell her? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The risk of strangulation increases with the size of the collar","justification":""},{"idx":1,"correct":true,"proposition":"An intervention can be scheduled to close the parietal defect","justification":""},{"idx":2,"correct":false,"proposition":"spontaneous closure is still possible","justification":""},{"idx":3,"correct":true,"proposition":"ventration may increase in size over time","justification":""},{"idx":4,"correct":true,"proposition":"  An intervention prevents the risk of strangulation","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-7-qi-14","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient prefers not to consider intervention. Five years later, she was referred to the emergency room for a sudden abdominal pain syndrome, associated with vomiting and stopping gas. On clinical examination, the abdomen is weathered, sensitive as a whole. The umbilical ventration has increased in volume, it is reducible. What is the most likely diagnosis? (only one answer expected)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Flanged occlusion","justification":""},{"idx":1,"correct":false,"proposition":"Recurrent appendicitis on stump","justification":""},{"idx":2,"correct":false,"proposition":"Recurrent peritonitis on appendicular stump release","justification":""},{"idx":3,"correct":false,"proposition":"Strangulation on ventration","justification":""},{"idx":4,"correct":false,"proposition":"hepatic colic","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-7-qi-15","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient is operated urgently for a flange occlusion. It is not necessary to do digestive resection and the postoperative follow-up is simple. What information can you give to the patient post-operatively? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"A new occlusion is no longer to be feared because the flange has been severed","justification":""},{"idx":1,"correct":true,"proposition":"Eventration can still occur on the scars of this procedure","justification":""},{"idx":2,"correct":true,"proposition":"Low molecular weight heparin at a prophylactic dose is indicated postoperatively","justification":""},{"idx":3,"correct":false,"proposition":"Rapid resumption of oral feeding is possible with a residue-free diet during the 20 post-operative days","justification":""},{"idx":4,"correct":true,"proposition":" The resumption of transit is favored by the rapid resumption of physical activity","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-8-qi-1","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" With the elements of pulmonary auscultation that you have, what are the two most likely diagnostic hypotheses?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"neuromuscular diseases","justification":""},{"idx":1,"correct":true,"proposition":"left heart failure","justification":""},{"idx":2,"correct":false,"proposition":"diffuse interstitial lung disease","justification":""},{"idx":3,"correct":false,"proposition":"asthma","justification":""},{"idx":4,"correct":true,"proposition":"chronic obstructive pulmonary disease (COPD)","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-8-qi-2","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" In the context of this chronic dyspnea, which additional examination(s) do you request in first line?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"X-ray of standing chest","justification":""},{"idx":1,"correct":false,"proposition":"Chest CT angiography with pulmonary arterial time","justification":""},{"idx":2,"correct":false,"proposition":"D-Dimers","justification":""},{"idx":3,"correct":false,"proposition":"PET scanner","justification":""},{"idx":4,"correct":false,"proposition":"CRP","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-8-qi-3","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":"    CBC is normal. The chest x-ray requested is below.   As part of the assessment of this chronic dyspnea, you perform the following examination:","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"There is a disorder in the diffusion of carbon monoxide","justification":""},{"idx":1,"correct":false,"proposition":"there is reversibility of FEV1 after taking beta2 mimetics","justification":""},{"idx":2,"correct":false,"proposition":"The exam, to be interpretable, requires smoking cessation for at least two days.","justification":""},{"idx":3,"correct":false,"proposition":"the FEV1\/FVC ratio is not interpretable","justification":""},{"idx":4,"correct":true,"proposition":"there is chest distension","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-8-qi-4","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" You associate, in a second step, a plethysmography to the volume flow loop previously realized. What is (are) the additional information(s) provided by this review?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"There is a disorder in the diffusion of carbon monoxide","justification":""},{"idx":1,"correct":true,"proposition":"It makes it possible to measure non-mobilizable lung volumes","justification":""},{"idx":2,"correct":true,"proposition":"total lung capacity is significantly increased","justification":""},{"idx":3,"correct":true,"proposition":"the residual volume is significantly increased","justification":""},{"idx":4,"correct":true,"proposition":"You can say that there is no restrictive syndrome","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-8-qi-5","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" In addition, to complete the EFRs, a carbon monoxide diffusion test (DLCO) was performed. It is 55% theoretical. Based on all the elements you now have available, what diagnosis(s) do you remember?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"asthma","justification":""},{"idx":1,"correct":false,"proposition":"chronic bronchitis","justification":""},{"idx":2,"correct":true,"proposition":"chronic obstructive pulmonary disease (COPD)","justification":""},{"idx":3,"correct":false,"proposition":"amyotrophic lateral sclerosis","justification":""},{"idx":4,"correct":false,"proposition":"Hyperventilation syndrome","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-8-qi-6","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" This patient therefore suffers from COPD. What therapeutic strategy(s) can you implement at this stage as background treatment?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"home nebulizations of short-acting beta2 mimetics","justification":"This proposal is unacceptable"},{"idx":1,"correct":true,"proposition":"inhaled treatment with a long-acting bronchodilator","justification":""},{"idx":2,"correct":false,"proposition":"inhaled therapy with a combination of two inhaled long-acting bronchodilators","justification":""},{"idx":3,"correct":false,"proposition":"inhaled therapy with a fixed combination of inhaled corticosteroid and long-acting beta2 mimetic","justification":"This proposal is also unacceptable."},{"idx":4,"correct":false,"proposition":"oral corticosteroids of 1 mg\/kg for 15 days before new EFRs","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-8-qi-7","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" Another essential step in its management is to consider quitting smoking as soon as possible. The patient seems motivated and asks you about nicotine substitutes. Regarding these nicotine substitutes, which is (are) the right answer(s)?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"None of these nicotine substitutes are covered by health insurance","justification":""},{"idx":1,"correct":false,"proposition":"A cardiological assessment must be carried out prior to prescription","justification":""},{"idx":2,"correct":true,"proposition":"they have few side effects at recommended doses","justification":""},{"idx":3,"correct":true,"proposition":"their dosage must be adapted to the consumption of cigarettes","justification":""},{"idx":4,"correct":false,"proposition":"Only the cutaneous form by patch is effective","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-8-qi-8","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" The patient also described during questioning daytime asthenia responsible for a lack of enthusiasm and drowsiness that she considered normal. You mention the possibility of sleep apnea syndrome. The patient does not know if she is snoring. What signs do you look for besides daytime sleepiness to get arguments in favor of diagnosing sleep apnea syndrome? Give the answer(s) right.","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Uncontrollable cravings during the day","justification":""},{"idx":1,"correct":true,"proposition":"morning headaches","justification":""},{"idx":2,"correct":true,"proposition":"feelings of suffocation during sleep","justification":""},{"idx":3,"correct":true,"proposition":"difficulty concentrating","justification":""},{"idx":4,"correct":true,"proposition":"nocturnal polyuria","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-8-qi-9","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" You decide to make a ventilatory polygraph recording of which you have attached an extract of its nocturnal trace. What is (are) the exact answer(s)?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"  This trace shows obstructive sleep apnea","justification":""},{"idx":1,"correct":false,"proposition":"This examination also includes an electroencephalogram","justification":""},{"idx":2,"correct":true,"proposition":"Oxygen saturation varies during this recording","justification":""},{"idx":3,"correct":false,"proposition":"This trace shows central sleep apnea","justification":""},{"idx":4,"correct":true,"proposition":"This plot shows that the thoraco-abdominal movements are in phase opposition during the phases of cessation of nasal flow","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-8-qi-10","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" After complete analysis of this recording, you were able to calculate a hypopnea apnea index greater than 60\/h. Give the right answer.","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"the patient is not obese, so you do not remember the diagnosis of obstructive sleep apnea syndrome","justification":""},{"idx":1,"correct":true,"proposition":"you are considering the installation of a continuous positive airway pressure device","justification":""},{"idx":2,"correct":false,"proposition":"you are considering hygiene measures alone for three months before a new inspection","justification":""},{"idx":3,"correct":false,"proposition":"you are considering a diuretic test before a new control at one month","justification":""},{"idx":4,"correct":false,"proposition":"you prescribe low doses of benzodiazepines","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-8-qi-11","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" She had recently benefited from a chest CT scan that she shows you. This confirms the predominant emphysema lesions at the top. This scanner also makes it possible to discover a nodule measured at 6 mm in its largest axis at the level of the lower left lobe (arrow). What are the criteria in favor of the benign nature of this nodule? Give the right answer(s)","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"its size","justification":""},{"idx":1,"correct":true,"proposition":"its regular contour","justification":""},{"idx":2,"correct":false,"proposition":"the patient's smoking","justification":""},{"idx":3,"correct":false,"proposition":"the diagnosis of COPD in this patient","justification":""},{"idx":4,"correct":false,"proposition":"the absence of calcification in its center","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-8-qi-12","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" Regarding the management of this nodule, what will you propose? (one or more correct answers)","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"positron emission tomography","justification":""},{"idx":1,"correct":false,"proposition":"a biopsy under CT scan","justification":""},{"idx":2,"correct":true,"proposition":"A scanner check in several months","justification":""},{"idx":3,"correct":false,"proposition":"an interferon release test even in the absence of tuberculosis contagion","justification":""},{"idx":4,"correct":false,"proposition":"Excision surgery from the outset","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-8-qi-13","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" A follow-up by control scanner was carried out. This monitoring is reassuring without any evolution of the nodule. Two years after initial management, the patient uses her continuous positive airway pressure (CPAP) machine very regularly and has benefited greatly symptomatically. His dyspnea is improved by taking a long-acting beta2-mimetic. She still pursues a smoking of the order of 5 cigarettes \/ day. She has no other comorbidities and is not taking any other treatment. Its EFRs are stable. You lose sight of it. She comes back to see you in consultation four years later because for about 3 days she has a worsening of her respiratory symptoms with an increase in dyspnea and the appearance of dirty sputum while she had no sputum before. Pulmonary auscultation findbilateral ronchi. The respiratory rate is 12\/min at rest. Air saturation is 96% at rest, there are no signs of respiratory distress. You prescribe appropriate antibiotic therapy. What other treatment(s) is (are) justified in the management of this COPD exacerbation? ","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"short-acting beta2 agonists","justification":"This proposal is essential"},{"idx":1,"correct":false,"proposition":"inhaled corticosteroids","justification":""},{"idx":2,"correct":false,"proposition":"home oxygen therapy to be re-evaluated in one month","justification":""},{"idx":3,"correct":false,"proposition":"oral corticosteroid therapy of 1 mg\/kg per day for 15 days","justification":"This proposal is unacceptable"},{"idx":4,"correct":false,"proposition":"non-invasive ventilation (NIV)","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-8-qi-14","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" It improves and returns to its basic state thanks to your treatment. In the following year she experienced at least two more similar episodes of COPD exacerbation. Her dyspnea is stage I of MRCD. To adapt his background treatment, what do you prescribe? Give the right answer(s)","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"inhaled therapy with a combination of two inhaled long-acting bronchodilators","justification":""},{"idx":1,"correct":true,"proposition":"inhaled therapy with a fixed combination of an inhaled corticosteroid and a long-acting beta2","justification":""},{"idx":2,"correct":false,"proposition":"inhaled therapy with a combination of two long-acting bronchodilators and an inhaled corticosteroid","justification":""},{"idx":3,"correct":false,"proposition":"oral corticosteroid therapy of 0.5 mg\/kg for one month before new EFRs","justification":""},{"idx":4,"correct":true,"proposition":"pulmonary rehabilitation","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-8-qi-15","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" You want the patient to undertake pulmonary rehabilitation. You have also prescribed inhaled treatment with a combination of an inhaled corticosteroid and a long-acting beta2-mimetic. What side effects are common with this type of inhaled treatment? Give the right answer(s)","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"dysphonia","justification":""},{"idx":1,"correct":true,"proposition":"Oral mycosis","justification":""},{"idx":2,"correct":false,"proposition":"peptic ulcer","justification":""},{"idx":3,"correct":true,"proposition":"tremors","justification":""},{"idx":4,"correct":false,"proposition":"systemic hypertension","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-8-qi-16","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" The patient continued to smoke for another two years and eventually stopped. She is 75 years old. Unfortunately very gradually his respiratory condition worsened and dyspnea only progressed. She is now dyspneic for moderate efforts of daily life. She had not wanted to do pulmonary rehabilitation. She has not had a new exacerbation for at least a year. You produce arterial blood gases at rest: pH 7.40; PaO 2 54 mmHg; PaCO2 42 mmHg; bicarbonates 26 mmol \/ l.Blood gases made three weeks apart under the same conditions are identical. She always puts on her CPAP well. You have achieved a nocturnal saturation that shows a regular pattern but a low saturation of the order of 89% all night. What can you conclude from the data you have available? Give the correct answer(s).","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It's too late to consider pulmonary rehabilitation","justification":""},{"idx":1,"correct":false,"proposition":"It will be necessary to make a blood gas while she sleeps","justification":""},{"idx":2,"correct":false,"proposition":"It will be necessary to replace CPAP with nocturnal oxygen therapy","justification":""},{"idx":3,"correct":false,"proposition":"The patient is on an indication for ambulation oxygen therapy only","justification":""},{"idx":4,"correct":true,"proposition":"The patient is undergoing long-term oxygen therapy","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-8-qi-17","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" The patient is undergoing long-term oxygen therapy. This will be implemented alone during the day and associated with CPAP at night. Give the correct answer(s) regarding long-term oxygen therapy.","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Its main purpose is to avoid the occurrence of right heart failure","justification":""},{"idx":1,"correct":true,"proposition":"It must be at least 15 hours out of 24","justification":""},{"idx":2,"correct":false,"proposition":"it will impose the institutionalization of the patient given her age","justification":""},{"idx":3,"correct":true,"proposition":"it will be necessary to ensure, during its implementation, that PaCO 2 remains stable","justification":""},{"idx":4,"correct":false,"proposition":"It is not covered by health insurance","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-9-qi-1","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" What can you conclude from these clinical elements? (one or more possible answers)","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The clinical picture suggests polyarthritis","justification":""},{"idx":1,"correct":true,"proposition":"He has asthenia","justification":""},{"idx":2,"correct":true,"proposition":"The interrogation of his wife can provide elements of etiological orientation","justification":""},{"idx":3,"correct":true,"proposition":"the clinical picture is compatible with a depressive syndrome","justification":""},{"idx":4,"correct":true,"proposition":"An associated weight loss should be sought","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-9-qi-2","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" The weight in consultation is 68 kg. He announces a usual weight of 70 kg, relatively stable in recent years, and he has not recently changed his eating habits. It is 1.75 m tall. The body mass index (BMI) is 22.2 kg\/m2. Which proposal(s) is (are) the exact proposal(s)?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"his weight loss corresponds to the definition of voluntary weight loss","justification":""},{"idx":1,"correct":false,"proposition":"his BMI corresponds to a phenotypic criterion of undernutrition","justification":""},{"idx":2,"correct":true,"proposition":"the presence of tachycardia would constitute an element of orientation","justification":""},{"idx":3,"correct":true,"proposition":"A sadness of mood must be sought","justification":""},{"idx":4,"correct":true,"proposition":"the existence of associated diarrhoea is a discriminating element of interrogation","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-9-qi-3","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" There is no mood sadness, or anything else in favor of a depressive syndrome. However, there has been a decrease in libido for several months. What question(s) should you ask to look for hypogonadism?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"depilation","justification":""},{"idx":1,"correct":false,"proposition":"dysuria","justification":""},{"idx":2,"correct":true,"proposition":"erectile dysfunction","justification":""},{"idx":3,"correct":true,"proposition":"gynecomastia","justification":""},{"idx":4,"correct":false,"proposition":"increased muscle mass","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-9-qi-4","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" Mr. R. has erectile dysfunction, depilation, predominant in the lower limbs, as well as a diffuse brown coloration, especially of the face, neck, back of the hands, forearms, and oral mucosa. What biological abnormality(s) can be associated with the abnormal skin coloration observed in this patient?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"low 8-hour cortisol level with high 8-hour plasma ACTH assay","justification":""},{"idx":1,"correct":false,"proposition":"increased 24-hour cortisoluria with low plasma ACTH assay","justification":""},{"idx":2,"correct":false,"proposition":"hypercalcemia with increased PTH","justification":""},{"idx":3,"correct":true,"proposition":"elevated transferrin saturation coefficient (TSC) with increased ferritin","justification":""},{"idx":4,"correct":false,"proposition":"Tricytopenia with increased erythropoietin","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-9-qi-5","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" The examination reveals a firm hepatomegaly at 2 finger crossings. The spleen is not palpable. You do not notice jaundice or stellar angioma. There is no abdominal collateral venous circulation. Abdominal percussion does not show dullness declivated. There is no palpable lymphadenopathy. Mr. R. consumes 3 glasses of red wine at the evening meal. What interpretation(s) can you make of this clinical picture? (one or more possible answers)","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"absence of signs of portal hypertension excludes hepatic cirrhosis","justification":""},{"idx":1,"correct":false,"proposition":"absence of signs of hepatocellular insufficiency excludes hepatic cirrhosis","justification":""},{"idx":2,"correct":true,"proposition":"It is necessary to look for hepatojugular reflux","justification":""},{"idx":3,"correct":false,"proposition":"the patient's BMI points to metabolic syndrome","justification":""},{"idx":4,"correct":false,"proposition":"The patient's daily consumption of pure alcohol is 15 grams per day","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-9-qi-6","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" The analyses show: ALT 105 IU\/L (normal: 8-35), AST 55 IU\/L (normal: 6-25), gamma-glutamyl-transpeptidase 60 IU\/L (normal < 40), alkaline phosphatase 173 IU\/L (normal: 35-105), TP 65%. The blood count is normal. A liver ultrasound shows hepatomegaly with hypertrophy of the left lobe and hepatic dysmorphism with heterogeneous parenchyma and irregularity of the hepatic contours (bumpy appearance). Absence of portal flow reversal or splenomegaly. Which exam(s) are you requesting?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"hepatitis B serology","justification":""},{"idx":1,"correct":true,"proposition":"transferrin saturation coefficient","justification":""},{"idx":2,"correct":false,"proposition":"Anti-cytoplasmic antibodies of neutrophils","justification":""},{"idx":3,"correct":true,"proposition":"hepatitis C serology","justification":""},{"idx":4,"correct":true,"proposition":"anti-smooth muscle antibodies (anti-LKM1)","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-9-qi-7","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" In this patient, who most likely has cirrhosis, the biological assessment reveals: transferrin saturation coefficient 80%, ferritin 2450 μg \/ L, search for anti-HCV antibodies negative, HBs antigen: negative, anti-HBs antibodies: positive with rate at 100 IU \/ L, anti-HBc antibody: negative. Against this background, you also prescribe serum protein electrophoresis. What is your interpretation of this electrophoresis? (one or more correct answers) ","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"polyclonal hypergammaglobulinemia","justification":""},{"idx":1,"correct":false,"proposition":"monoclonal gammopathy","justification":""},{"idx":2,"correct":false,"proposition":"hyper-alpha2-globulinemia","justification":""},{"idx":3,"correct":true,"proposition":"beta-gamma block","justification":""},{"idx":4,"correct":true,"proposition":"hypoalbuminemia","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-9-qi-8","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" Which condition(s) or situation(s) could be responsible for the results of the martial assessment observed in this patient?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"inflammatory syndrome","justification":""},{"idx":1,"correct":false,"proposition":"non-alcoholic steatohepatitis","justification":""},{"idx":2,"correct":false,"proposition":"rhabdomyolysis","justification":""},{"idx":3,"correct":true,"proposition":"Genetic hemochromatosis","justification":""},{"idx":4,"correct":false,"proposition":"hyperthyroidism","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-9-qi-9","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" You mention genetic hemochromatosis. Genetic analysis reveals a homozygous C282Y mutation in the HFE gene. Regarding the joint pain of which he complains, what elements would lead to an osteo-articular attack of his hemochromatosis? (one or more possible answers)","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Metacarpophalangeal involvement","justification":""},{"idx":1,"correct":true,"proposition":"Pseudo-gout attacks","justification":""},{"idx":2,"correct":false,"proposition":"erosion of distal interphalangeal","justification":""},{"idx":3,"correct":true,"proposition":"Radiological calcium border","justification":""},{"idx":4,"correct":true,"proposition":"  osteophytosis in hook of the heads of the metacarpals","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-9-qi-10","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" What examination(s) do you ask Mr. R to assess the possible impact of his hemochromatosis?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"trans-thoracic cardiac ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"coronary angiography","justification":""},{"idx":2,"correct":false,"proposition":"Whole body bone scintigraphy","justification":""},{"idx":3,"correct":true,"proposition":"testosteronemia","justification":""},{"idx":4,"correct":true,"proposition":"bone densitometry","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-9-qi-11","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" The results of the examinations are as follows:- trans-thoracic cardiac ultrasound: left ventricular ejection fraction 65%, normal filling pressures, undilated heart chambers, absence of valvular heart disease;- testosteronemia (total): 0.5 ng \/ mL (normal: 2.5 - 10); - vitamin D 10 ng \/ mL, serum calcium 2.2 mmol \/ L, phosphoremia 1.1 mmol \/ L;- bone densitometry: T-score at -2 at the lumbar spine, T-score at -1.8 at the femoral neck.- as a reminder,  the biological assessment has previously highlighted: transferrin saturation coefficient 80%, ferritin 2450 μg\/L, negative anti-HCV antibody test, HBs antigen: negative, anti-HBs antibodies: positive with 100 IU\/L level, anti-HBc antibodies: negative. What measure(s) should be put in place? ","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"vaccination against hepatitis B","justification":""},{"idx":1,"correct":false,"proposition":"vitamin C supplementation","justification":""},{"idx":2,"correct":true,"proposition":"vitamin D supplementation","justification":""},{"idx":3,"correct":true,"proposition":"Avoidance of alcohol","justification":""},{"idx":4,"correct":false,"proposition":"oral iron chelator","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-9-qi-12","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" Vitamin D supplementation is implemented, and you inform Mr. R of the importance of stopping alcohol consumption during pathology. You also start a depletive treatment with bloodletting. Regarding the methods, objectives and elements of bloodletting monitoring that you are going to set up at Mr. R, which is (are) accurate?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Initially monthly rhythm in the attack phase","justification":""},{"idx":1,"correct":true,"proposition":"regular monitoring of ferritinemia","justification":""},{"idx":2,"correct":false,"proposition":"annual liver biopsy","justification":""},{"idx":3,"correct":true,"proposition":"suspension of bleeding if the blood haemoglobin test falls below 11 g\/dL","justification":""},{"idx":4,"correct":true,"proposition":"Initiation of bloodletting in a hospital setting","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-9-qi-13","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" Mr. R. asks you about the mechanisms behind his disease and iron metabolism. Which proposal(s) is(are) accurate?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Iron absorption occurs mainly in the ileum","justification":""},{"idx":1,"correct":false,"proposition":"Hepcidin is increased during genetic hemochromatosis","justification":""},{"idx":2,"correct":true,"proposition":"Hepcidin inhibits the absorption of iron by the enterocyte","justification":""},{"idx":3,"correct":true,"proposition":"Hepcidin inhibits the release of iron by macrophages","justification":""},{"idx":4,"correct":false,"proposition":"Hepcidin is made by the kidney","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-9-qi-14","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" What genetic counseling will you offer Mr. R about his relatives? (one or more possible answers)","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"his 3 children must have a search for HFE mutation within the year","justification":""},{"idx":1,"correct":false,"proposition":"C282Y heterozygosity is associated with a minor form with moderate iron overload","justification":""},{"idx":2,"correct":true,"proposition":"his children have a one in 2 risk of being homozygous if his wife is heterozygous","justification":""},{"idx":3,"correct":true,"proposition":"Genetic testing in relatives is covered by health insurance","justification":""},{"idx":4,"correct":false,"proposition":"the attending physician should contact the patient's siblings for CST, ferritin and HFE genetic testing","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-9-qi-15","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" What follow-up exam(s) do you propose to Mr. R?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"liver ultrasound every 6 months","justification":"This question has been rescinded"},{"idx":1,"correct":false,"proposition":"beta-2 microglobulin every 6 months","justification":"This question has been rescinded"},{"idx":2,"correct":true,"proposition":"blood count before bleeding","justification":"This question has been rescinded"},{"idx":3,"correct":false,"proposition":"Cardiac MRI with annual iron overload measurement","justification":"This question has been rescinded"},{"idx":4,"correct":true,"proposition":"regular gastro-duodenal endoscopy","justification":"This question has been rescinded"}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-10-qi-1","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" What is most suggestive of the central origin of facial paralysis?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Asymmetry of the mouth with sagging of the labial commissure","justification":""},{"idx":1,"correct":true,"proposition":"Facial asymmetry more marked during voluntary movements than during automatic movements","justification":""},{"idx":2,"correct":false,"proposition":"Deviation of the tongue to the left during protraction","justification":""},{"idx":3,"correct":false,"proposition":"Sign of Souque's eyelashes during forced occlusion of the eyes","justification":""},{"idx":4,"correct":false,"proposition":"Left hearing loss","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-10-qi-2","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" What element(s) of favorable prognosis do you retain in this patient?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Age","justification":""},{"idx":1,"correct":true,"proposition":"Incomplete upper limb deficit","justification":""},{"idx":2,"correct":false,"proposition":"The moderate nature of proprioceptive sensory disorders","justification":""},{"idx":3,"correct":true,"proposition":"The ability to sit still","justification":""},{"idx":4,"correct":false,"proposition":"The presence of swallowing disorders","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-10-qi-3","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" Given the clinical elements, which of the professionals mentioned below will you solicit?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Physiotherapist","justification":""},{"idx":1,"correct":true,"proposition":"Occupational therapist","justification":""},{"idx":2,"correct":true,"proposition":"Speech therapist","justification":""},{"idx":3,"correct":false,"proposition":"Prosthetist","justification":""},{"idx":4,"correct":false,"proposition":"Podo-orthotist","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-10-qi-4","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" You have asked a physiotherapist, an occupational therapist and a speech therapist for the patient's rehabilitation program. After the speech-language pathologist has carried out an initial assessment, what elements will he have to work on to improve the patient's health? (one or more correct answers)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"On the motor skills of the face","justification":""},{"idx":1,"correct":true,"proposition":"On the phases of swallowing","justification":""},{"idx":2,"correct":true,"proposition":"On the adaptation of meal textures","justification":""},{"idx":3,"correct":false,"proposition":"On the improvement of language disorders","justification":""},{"idx":4,"correct":true,"proposition":"On improving articulation","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-10-qi-5","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" His rehabilitation is going normally and you are planning a therapeutic weekend. Given the age and fragility of the patient, you are considering a nursing visit morning and evening. His wife asks you about the necessary elements for this therapeutic outing. She is also worried because the arrangements for her Sunday are not made. What information can you provide? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Nursing care is covered by the health insurance fund","justification":""},{"idx":1,"correct":false,"proposition":"It will have to send the medical transport vouchers issued for the weekend to the departmental home for disabled people","justification":""},{"idx":2,"correct":true,"proposition":"If necessary, she can call her doctor or an emergency department during the weekend.","justification":""},{"idx":3,"correct":true,"proposition":"An occupational therapist will be able to best define with her the arrangements of her home","justification":""},{"idx":4,"correct":false,"proposition":"To make adjustments to her home, she will have to call on the departmental home for people with disabilities.","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-10-qi-6","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" Seven weeks after admission, the patient falls. He has left hip pain. The hospital student reports the data of his clinical examination to you. What proposals are compatible with a fracture of the upper end of the left femur? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Absence of deformation","justification":""},{"idx":1,"correct":false,"proposition":"A vicious attitude in irreducible internal rotation","justification":""},{"idx":2,"correct":true,"proposition":"An externally rotating left lower limb","justification":""},{"idx":3,"correct":true,"proposition":"Shortening of the lower left limb","justification":""},{"idx":4,"correct":true,"proposition":"A left lower limb in adduction","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-10-qi-7","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" You ask for X-rays as follows:What is your diagnosis?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"normal x-rays","justification":""},{"idx":1,"correct":true,"proposition":"basicervical fracture","justification":""},{"idx":2,"correct":false,"proposition":"Iliopubic branch fracture","justification":""},{"idx":3,"correct":false,"proposition":"Subtrochanteric fracture","justification":""},{"idx":4,"correct":false,"proposition":"Garden 1 cervical fracture","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-10-qi-8","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" The radiologist sends you his report with a diagnosis of coxarthrosis associated with a basicervical fracture. What proposals can treat both fracture and coxarthrosis? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Head of spinal cord nailing","justification":""},{"idx":1,"correct":false,"proposition":"Osteosynthesis by dynamic plate screw","justification":""},{"idx":2,"correct":false,"proposition":"Intermediate hip replacement","justification":""},{"idx":3,"correct":true,"proposition":"Total hip replacement","justification":""},{"idx":4,"correct":false,"proposition":"Trans-skeletal traction","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-10-qi-9","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" The patient received a total left hip replacement. Postoperatively, he presented with a hematoma of the thigh that required the cessation of anticoagulation and the transfusion of 2 red blood cells. He is transferred to the neurological follow-up care unit with his blood type card. On arrival a biological assessment shows: albumin 35 g \/ L (34-50); Calcium 1.90 mmol\/L (2.08-2.65); serum folate 7.9 nmol\/L (normal if greater than 12); vitamin B12 371 pmol\/L (156-672); Ultrasensitive TSH 0.460 mIU\/L (0.400-4.00). In view of these elements and for the purpose of prevention, which of the following treatments are you prescribing immediately?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Calcium","justification":""},{"idx":1,"correct":false,"proposition":"Alendronate","justification":""},{"idx":2,"correct":true,"proposition":"Vitamin d","justification":""},{"idx":3,"correct":false,"proposition":"Denosumab","justification":""},{"idx":4,"correct":false,"proposition":"Hormone therapy","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-10-qi-10","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" The patient is treated with calcium 1 g per day and vitamin D3 100,000 IU every 15 days for 3 months. Ten days after surgery a parapixaban treatment is resumed. Five days later, he has a very marked increase in the hematoma of the left thigh associated with a feeling of fatigue and a great mucocutaneous pallor. His blood pressure is at 100\/50mmHg his heart rate at 74 beats per minute. Its temperature is 37.2°C.What additional examinations do you prescribe urgently? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Complete blood count","justification":""},{"idx":1,"correct":false,"proposition":"Pelvic X-ray","justification":""},{"idx":2,"correct":true,"proposition":"Thigh scanner","justification":""},{"idx":3,"correct":true,"proposition":"Search for irregular agglutinins","justification":""},{"idx":4,"correct":false,"proposition":"INR","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-10-qi-11","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" Faced with the situation you evoke acute bleeding and ask the nurse to urgently order 3 red blood cells. The search for irregular agglutinins is negative. Which proposal(s) apply to your patient?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"you ask the patient for permission to consider a transfusion","justification":""},{"idx":1,"correct":false,"proposition":"you write a prescription for long-term illness (ALD) for 3 red blood cells","justification":""},{"idx":2,"correct":false,"proposition":"In this context of multiple transfusion you ask for compatible pellets","justification":""},{"idx":3,"correct":false,"proposition":"you check the patient's bedside Rhesus D compatibility with the Beth-Vincent test","justification":""},{"idx":4,"correct":false,"proposition":"You ask for irradiated red blood cells in front of this context of fragility","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-10-qi-12","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" When administering the third red blood cell, the nurse calls you because the patient shivers, and his temperature is at 39.2°C.What proposals apply to your patient? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"You stop the transfusion without delay","justification":""},{"idx":1,"correct":true,"proposition":"You will need to make a haemovigilance declaration","justification":""},{"idx":2,"correct":true,"proposition":"You call the blood transfusion centre","justification":""},{"idx":3,"correct":true,"proposition":"You address the blood bag that passed at the time of the febrile episode to the laboratory according to the local procedure","justification":""},{"idx":4,"correct":true,"proposition":"You have blood cultures taken","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-10-qi-13","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" The bleeding episode is controlled and there were no other post-transfusion complications. The patient can resume walking after 3 weeks and is considering returning home. Which of the following suggestions concerning the information you should include on the physiotherapy prescription apply to your patient? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"If the prescription is at home it must include the number of sessions","justification":""},{"idx":1,"correct":true,"proposition":"If the prescription is in the physiotherapist's office, it must include the mention \"physiotherapy treatments (or sessions)\"","justification":""},{"idx":2,"correct":false,"proposition":"If you want to insist on the recovery of hip joint amplitudes, you must precisely define on the prescription the number of sessions spent on this goal","justification":""},{"idx":3,"correct":true,"proposition":"If you want physiotherapy at home you must explicitly stipulate this on the prescription","justification":""},{"idx":4,"correct":true,"proposition":"If you want rehabilitation of the lower right limb and left hemiplegia you can register it on the same prescription","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-10-qi-14","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" You are considering home help. Which of the following proposals do you consider for your patient? (one or more exact proposals)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Applying for a disabled adult allowance","justification":""},{"idx":1,"correct":true,"proposition":"Application for a personalized autonomy allowance","justification":""},{"idx":2,"correct":false,"proposition":"Applying for a special education allowance","justification":""},{"idx":3,"correct":false,"proposition":"Application for compensation benefit","justification":""},{"idx":4,"correct":true,"proposition":"Applying for a home help","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-12-qi-1","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" Controls report an initial loss of consciousness estimated at 2 minutes. The patient has a motor response adapted to simple commands, opens his eyes to demand, reveals his identity and is correctly located in time and space. The case is a 38-year-old man with no known medical history. How much do you estimate his score in Glasgow? (only one answer expected)","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"14","justification":""},{"idx":1,"correct":false,"proposition":"12","justification":""},{"idx":2,"correct":false,"proposition":"10","justification":""},{"idx":3,"correct":false,"proposition":"8","justification":""},{"idx":4,"correct":false,"proposition":"6","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-12-qi-2","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" You estimate the Glasgow score at 14.Which of the following proposition(s) is true for this patient?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"There is an indication of cranioencephalic CT","justification":""},{"idx":1,"correct":false,"proposition":"The score is modified by the existence of an initial loss of consciousness","justification":""},{"idx":2,"correct":true,"proposition":"The score must be reassessed upon arrival at the hospital","justification":""},{"idx":3,"correct":false,"proposition":"There is an indication for airway protection by intubation","justification":""},{"idx":4,"correct":true,"proposition":"The score could be altered by taking psychotropic drugs","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-12-qi-3","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The patient mainly complains of pain in the right lower limb and right upper limb. In the right upper limb there is a deformity of the arm. The patient has functional impotence. You suspect a fracture of the humerus and seek to rule out paralysis of the radial nerve. To do this, what do you test specifically? (one or more correct answers)","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Altered sensitivity of the medial edge of the hand","justification":""},{"idx":1,"correct":false,"proposition":"Altered sensitivity of the thumb pulp","justification":""},{"idx":2,"correct":true,"proposition":"A deficit of active extension of the thumb","justification":""},{"idx":3,"correct":true,"proposition":"A deficit of active wrist extension","justification":""},{"idx":4,"correct":false,"proposition":"A deficit of active abduction\/adduction of long fingers","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-12-qi-4","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" At the level of the right knee, there is a large anterior wound, and a free bone fragment of the femoral condyle is externalized. Distal pulses are well perceived. Which of the following actions do you think is appropriate and to be implemented on the spot as a first intention?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Wound cleansing with an alcoholic antiseptic solution","justification":""},{"idx":1,"correct":true,"proposition":"Rinsing the wound with saline","justification":""},{"idx":2,"correct":false,"proposition":"Placing and tightening a tourniquet at the root of the thigh","justification":""},{"idx":3,"correct":true,"proposition":"Alignment of the lower limb in a splint","justification":""},{"idx":4,"correct":true,"proposition":"Moderately compressive sterile dressing","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-12-qi-5","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The patient is unable to lift his leg by holding the knee in extension. A photograph of the wound is shown below. Which of the following applies?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"This is a joint wound","justification":""},{"idx":1,"correct":false,"proposition":"This is a punctiform wound","justification":""},{"idx":2,"correct":true,"proposition":"A rupture of the extender apparatus is suspected","justification":""},{"idx":3,"correct":true,"proposition":"The mobilization of the knee in flexion puts tension on the skin banks","justification":""},{"idx":4,"correct":true,"proposition":"Management of this wound requires extensive surgical debridement","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-12-qi-6","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" Haemodynamic stability of the patient was achieved with the infusion of 750 ml of crystalloid during transport. Which of the following anamnestic and clinical elements is (are) in favor of performing a whole body scan?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"The estimated speed at the time of the accident was 75 km\/h","justification":""},{"idx":1,"correct":false,"proposition":"The patient has a Glasgow score calculated at 14","justification":""},{"idx":2,"correct":false,"proposition":"There is a joint wound of the right knee","justification":""},{"idx":3,"correct":true,"proposition":"An evolution requiring the introduction of vasopressive amines","justification":""},{"idx":4,"correct":false,"proposition":"Seat belt use","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-12-qi-7","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" X-rays of the right knee front and profile as well as frontal reconstructions of the CT scan are attached. Which of the following is (are) correct?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"There is a fracture involving the tip of the patella","justification":""},{"idx":1,"correct":false,"proposition":"There is a supracondylar fracture of the distal femur","justification":""},{"idx":2,"correct":true,"proposition":"There is a fracture of the lateral femoral condyle","justification":""},{"idx":3,"correct":false,"proposition":"There is a fracture of the proximal metaphysis of the tibia","justification":""},{"idx":4,"correct":true,"proposition":" There is an ascent of the patella","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-12-qi-8","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The whole body scanner finds no lesions other than those of the limbs. Injuries to the right knee and arm were managed in the operating room. At the knee, it was indeed a fracture of the lateral condyle, which was reinserted and osteosynthesized, and a fracture of the tip of the patella which was equivalent to an avulsion of the patellar ligament at the tip of the patella. Due to the articular nature of the lateral ducondyle fracture, you postpone the resumption of support during the 3rd postoperative month. To promote skin healing, you limit flexion to 90° during the first month after surgery. Post-operatively, you inform the patient of the progressive risks. What are the exact proposition(s) regarding the risk of postoperative stiffness?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"The limitation of the prescribed flexion is intended to promote the healing of the intra- and extra-articular elements","justification":""},{"idx":1,"correct":true,"proposition":"The intra-articular nature of the lesion increases the risk of stiffness","justification":""},{"idx":2,"correct":false,"proposition":"In the absence of complex regional pain syndrome type 1, there should be no loss of long-term mobility","justification":""},{"idx":3,"correct":true,"proposition":"The existence of a significant limitation of the flexion amplitude to 6 weeks after surgery may lead to discussion of mobilization under anesthesia","justification":""},{"idx":4,"correct":true,"proposition":"The persistence of stiffness beyond 3 months can be recovered by surgery","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-12-qi-9","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" For his rehabilitation, he is cared for in a follow-up care and rehabilitation department in a day hospital and wonders about the long-term goals of this treatment. Which of the following information(s) is (are) accurate and that you can give him?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"The knee will have to bend at least 110° for it to descend the stairs normally","justification":""},{"idx":1,"correct":true,"proposition":"A strengthening of the thigh muscles is necessary to ensure good stability in the phase of support to walking","justification":""},{"idx":2,"correct":true,"proposition":"The work of endurance to the effort will facilitate its resumption of activity","justification":""},{"idx":3,"correct":false,"proposition":"An evaluation of his workstation by the departmental home for disabled people will have to be organized","justification":""},{"idx":4,"correct":true,"proposition":"A regular assessment of participation restrictions will be made by a physical medicine and rehabilitation doctor throughout his recovery.","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-12-qi-10","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" Which of the following proposals is (are) the professional(s) who you think should be solicited for the rehabilitation of this patient?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"physiotherapist","justification":""},{"idx":1,"correct":true,"proposition":"occupational therapist","justification":""},{"idx":2,"correct":false,"proposition":"psychomotor therapist","justification":""},{"idx":3,"correct":false,"proposition":"Pedo-orthotist","justification":""},{"idx":4,"correct":true,"proposition":"Adapted physical activity teacher","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-12-qi-11","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" During the consultation he asks you about his professional future because he is worried. His accident is an accident at work (commuting accident). He has still not received daily allowance. Which of the following is (are) the exact answer(s)?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Knee pain may persist despite good consolidation","justification":""},{"idx":1,"correct":false,"proposition":"You confirm that his daily allowances will not be paid until he is released from hospital.","justification":""},{"idx":2,"correct":true,"proposition":"If he retains sequelae, he may request an evaluation which may give rise to compensation by the health insurance fund.","justification":""},{"idx":3,"correct":false,"proposition":"The adaptation of one's workstation may be carried out by the health insurance fund.","justification":""},{"idx":4,"correct":true,"proposition":"If necessary, the departmental home for disabled people may award him a certificate of disabled worker status.","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-12-qi-12","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" After two months, he was allowed to gradually resume support on the lower right limb. During follow-up, the patient complains of the gradual appearance of pain in the upper left limb, with an impression of numbness of the fingers. The phenomena are increased at the end of the day when he leans on his English cane. Which of the following elements of the clinical examination is (are) in favor of carpal tunnel syndrome?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Percussion next to the flexion fold of the wrist triggers pain","justification":""},{"idx":1,"correct":false,"proposition":"Painful phenomena increase when bending the elbow","justification":""},{"idx":2,"correct":false,"proposition":"Pain predominates in the last two fingers","justification":""},{"idx":3,"correct":true,"proposition":"Prolonged wrist flexion increases pain","justification":""},{"idx":4,"correct":false,"proposition":"  There is amyotrophy of the hypothenar eminence","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-12-qi-13","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The situation does not improve despite the gradual abandonment of the English cane on the left with persistent pain and paresthesias in the left hand. You suspect a comprehension of the ulnar nerve. What test do you prescribe to determine its location and impact? (only one answer expected)","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Ultrasound of the wrist","justification":""},{"idx":1,"correct":false,"proposition":"X-rays of the elbow and wrist","justification":""},{"idx":2,"correct":true,"proposition":"Comparative electroneuromyogram of the two upper limbs","justification":""},{"idx":3,"correct":false,"proposition":"Dynamic X-rays of the cervical spine","justification":""},{"idx":4,"correct":false,"proposition":"Cervical MRI","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-12-qi-14","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The electromyogram confirmed compression of the ulnar nerve but the symptoms gradually improved with the disappearance of paresthesia. The evolution of pain and strength was favorable to the lower right limb after 4 months of rehabilitation but he remains embarrassed for the descent of the stairs because the flexion of the knee reaches only 100 °. However, you are concerned because it retains pain in the upper right limb. Yet you notice a very good evolution both in the strength and amplitudes of the shoulder and elbow which have returned to normal. You gave him a prescription for physiotherapy sessions without specifying the number. Among the following proposals, which is (are) the one (s) you can make for his outpatient follow-up?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Physiotherapy may also be accompanied by balneotherapy despite the absence of specific mention on the prescription","justification":""},{"idx":1,"correct":false,"proposition":"The conditions of management of occupational therapy are no different from physiotherapy-balneotherapy","justification":""},{"idx":2,"correct":true,"proposition":"The physiotherapist will be able to adapt the number of sessions by himself without this posing any problem of coverage by the social security","justification":""},{"idx":3,"correct":false,"proposition":"It is not necessary to see the surgeon again before 18 months given the severity of the fractures","justification":""},{"idx":4,"correct":false,"proposition":"Physiotherapy can be performed at home despite the absence of specific mention on the prescription","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-12-qi-15","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" Since the patient fails to carry a load on the right side at 6 months postoperatively, you decided to refer him back to the surgeon. Here is the radiographic aspect on front and profile images. Which proposal(s) is (are) true?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"This is hypertrophic pseudarthrosis","justification":""},{"idx":1,"correct":true,"proposition":"The chances of spontaneous consolidation at this stage are minimal in the absence of intervention","justification":""},{"idx":2,"correct":false,"proposition":"This is the normal course of a fracture after osteosynthesis.","justification":""},{"idx":3,"correct":false,"proposition":"This is a vicious aspect of callus","justification":""},{"idx":4,"correct":true,"proposition":"The osteosynthesis material in place is a centromedullary nail","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-13-qi-1","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" What do you think is the most important thing to collect during questioning? (only one answer expected)","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"a family history of systemic inflammatory disease","justification":""},{"idx":1,"correct":false,"proposition":"A triggering factor","justification":""},{"idx":2,"correct":false,"proposition":"a cardiovascular history","justification":""},{"idx":3,"correct":false,"proposition":"A recent trip","justification":""},{"idx":4,"correct":true,"proposition":"the pain schedule","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-13-qi-2","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" What is (are) the element(s) that orient you towards an inflammatory nature of pain?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Awakenings at the end of the night","justification":""},{"idx":1,"correct":false,"proposition":"difficulty falling asleep","justification":""},{"idx":2,"correct":false,"proposition":"10-minute morning stiffness","justification":""},{"idx":3,"correct":true,"proposition":"persistence of pain at rest","justification":""},{"idx":4,"correct":false,"proposition":"progressive worsening of pain during the day","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-13-qi-3","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Joint pain is inflammatory. What are the three most likely diagnoses in this patient to explain all the symptoms?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"rheumatoid arthritis","justification":""},{"idx":1,"correct":true,"proposition":"scleroderma","justification":""},{"idx":2,"correct":false,"proposition":"a drop","justification":""},{"idx":3,"correct":true,"proposition":"lung cancer","justification":""},{"idx":4,"correct":false,"proposition":"myeloma","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-13-qi-4","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Your clinical examination objective the abnormalities visualized in the following photograph. What do you suspect (one or more possible answers)?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Tophus","justification":""},{"idx":1,"correct":true,"proposition":"rheumatoid nodules","justification":""},{"idx":2,"correct":false,"proposition":"erythema nodosum","justification":""},{"idx":3,"correct":false,"proposition":"Heberden's nodules","justification":""},{"idx":4,"correct":false,"proposition":"multiple abscesses","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-13-qi-5","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You prescribe a biological assessment. Which of the following proposals do you think is relevant at this stage?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"HLA typing","justification":""},{"idx":1,"correct":true,"proposition":"CRP","justification":""},{"idx":2,"correct":false,"proposition":"Antiphospholipid antibodies","justification":""},{"idx":3,"correct":true,"proposition":"anti-citrullinated peptide (ACPA) antibodies","justification":""},{"idx":4,"correct":true,"proposition":"anti-nuclear antibodies","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-13-qi-6","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" The immunological assessment shows: negative anti-citrullinated peptide antibodies (ACPA), anti-nuclear antibodies positive at 1\/80 without specificity, a rheumatoid factor positive. CRP is 60 mg\/L.Given all the clinical and paraclinical information available at this stage, what is the most likely diagnosis?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"a drop","justification":""},{"idx":1,"correct":true,"proposition":"rheumatoid arthritis","justification":""},{"idx":2,"correct":false,"proposition":"psoriatic arthritis","justification":""},{"idx":3,"correct":false,"proposition":"lupus","justification":""},{"idx":4,"correct":false,"proposition":"scleroderma","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-13-qi-7","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Faced with this distal, bilateral and symmetrical polyarthritis, the presence of rheumatoid nodules and the positivity of rheumatoid factor, you have made the diagnosis of rheumatoid arthritis and started a background treatment with methotrexate. The patient has progressive dyspnea stage 2 on the modified Medical Research Council (mMRC) scale that has been on for six months now. The objective auscultation of the dry crackling of the two bases. The rest of the chest examination is normal. The heart rate is regular without any particular breath. What do you suspect first (only one answer expected)?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"chronic bronchitis","justification":""},{"idx":1,"correct":false,"proposition":"pleural effusion","justification":""},{"idx":2,"correct":false,"proposition":"infectious pneumonia","justification":""},{"idx":3,"correct":true,"proposition":"diffuse interstitial lung disease","justification":""},{"idx":4,"correct":false,"proposition":"diaphragmatic paralysis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-13-qi-8","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Faced with this suspicion of diffuse interstitial lung disease, what are the two most relevant complementary examinations?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"bronchial fibroscopy with LBA","justification":""},{"idx":1,"correct":true,"proposition":"EFRs with DLCO measurement","justification":""},{"idx":2,"correct":true,"proposition":"a chest CT scan","justification":""},{"idx":3,"correct":false,"proposition":"echocardiography","justification":""},{"idx":4,"correct":false,"proposition":"a pulmonary ventilation\/perfusion scan","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-13-qi-9","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You complete your approach by performing a chest CT scan, a section of which is attached. What basic lesion(s) do you observe on this scanner?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"pleural effusion","justification":""},{"idx":1,"correct":false,"proposition":"condensation erasing vascular structures","justification":""},{"idx":2,"correct":false,"proposition":"micronodules","justification":""},{"idx":3,"correct":true,"proposition":"intralobular cross-linking","justification":""},{"idx":4,"correct":true,"proposition":"traction bronchiectasis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-13-qi-10","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You perform pulmonary function tests:What is (are) the exact answer(s)?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Diffusion disorder","justification":""},{"idx":1,"correct":false,"proposition":"obstructive syndrome","justification":""},{"idx":2,"correct":true,"proposition":"restrictive syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Significant reversibility","justification":""},{"idx":4,"correct":false,"proposition":"shunt","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-13-qi-11","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You are diagnosed with diffuse interstitial lung disease related to rheumatoid arthritis. Two years later, on the blood test, isolated neutropenia was found at 789\/mm3. The patient is asthenic. He has no fever. On examination, you find splenomegaly. Which diagnosis do you think is most likely?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"rheumatoid vasculitis","justification":""},{"idx":1,"correct":false,"proposition":"schistosomiasis","justification":""},{"idx":2,"correct":false,"proposition":"Gaucher disease","justification":""},{"idx":3,"correct":false,"proposition":"hairy cell leukemia","justification":""},{"idx":4,"correct":true,"proposition":"Felty's syndrome","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-13-qi-12","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You are diagnosed with Felty's syndrome. The patient is now being treated with immunosuppressants. He contacts you again after 3 months of treatment due to a worsening of dyspnea for two days with dyspnea at the slightest effort. The respiratory rate is 35 cycles per minute, hemodynamics are stable. Saturation is 95% under 6 liters of oxygen per minute. Pulmonary auscultation finds bilateral crackling at the bases. Vocal vibrations are unchanged and chest percussion is normal. What are the three diagnoses that you first mention in the face of this brutal decompensation?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"pulmonary embolism","justification":""},{"idx":1,"correct":false,"proposition":"lung cancer","justification":""},{"idx":2,"correct":false,"proposition":"pneumothorax","justification":""},{"idx":3,"correct":true,"proposition":"pneumocystosis","justification":""},{"idx":4,"correct":true,"proposition":"community-acquired acute pneumonia","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-13-qi-13","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Given the severity of the patient, you hospitalize him. The temperature is 38.6°C.  An X-ray of the chest in bed is performed while sitting. What do you see? (one or more correct answers)","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"right pleural effusion","justification":""},{"idx":1,"correct":false,"proposition":"left apical pneumothorax","justification":""},{"idx":2,"correct":false,"proposition":"cardiomegaly","justification":""},{"idx":3,"correct":true,"proposition":"Alveolar opacities on the left","justification":""},{"idx":4,"correct":true,"proposition":"Bilateral interstitial opacities","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-13-qi-14","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Severity criteria dictate that you transfer your patient to critical care. What sample(s) do you take to make the microbiological diagnosis of this infectious pneumonitis?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Legionella antigenuria","justification":""},{"idx":1,"correct":true,"proposition":"Blood","justification":""},{"idx":2,"correct":true,"proposition":"Multiplex PCR on nasopharyngeal swab","justification":""},{"idx":3,"correct":true,"proposition":"cytobacteriological examination of sputum","justification":""},{"idx":4,"correct":true,"proposition":"pneumococcal antigenuria","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-13-qi-15","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" While waiting for microbiological results, which probabilistic antibiotic therapy do you prescribe? (one or more correct answers)","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Spiramycin intravenously","justification":""},{"idx":1,"correct":false,"proposition":"intravenous amoxicillin","justification":""},{"idx":2,"correct":true,"proposition":"intravenous cefotaxime","justification":""},{"idx":3,"correct":false,"proposition":"Intravenous ciprofloxacin","justification":""},{"idx":4,"correct":false,"proposition":"intravenous metronidazole","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-13-qi-16","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" The microbiological balance is negative. Nevertheless, the patient's course is favorable after 7 days of treatment with cefotaxime and spiramycin. The patient returns home but is unable to leave easily due to fatigue. It retains bronchial congestion. You decide to continue chest physiotherapy. What elements must be included on the prescription? (one or more correct answers)","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the mention << home physiotherapy>>","justification":""},{"idx":1,"correct":false,"proposition":"the number of sessions you plan","justification":""},{"idx":2,"correct":false,"proposition":"diagnosis and type of pneumonia","justification":""},{"idx":3,"correct":false,"proposition":"the frequency of sessions per week","justification":""},{"idx":4,"correct":true,"proposition":"the mention << seven days a week>> if you consider weekend care necessary","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-14-qi-1","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Faced with this complicated fall from a head trauma, what elements justify the realization of an emergency brain scan? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Age","justification":""},{"idx":1,"correct":false,"proposition":"Suspected syncope","justification":""},{"idx":2,"correct":true,"proposition":"Taking anticoagulant","justification":""},{"idx":3,"correct":true,"proposition":"Confusion","justification":""},{"idx":4,"correct":false,"proposition":"Polypathology","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-14-qi-2","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Which proposals are correct regarding the brain scan? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Old bifrontal subdural collection","justification":""},{"idx":1,"correct":true,"proposition":"Subcortical atrophy","justification":""},{"idx":2,"correct":false,"proposition":"Signs of intracranial hypertension","justification":""},{"idx":3,"correct":true,"proposition":"Recent subdural hemorrhage","justification":""},{"idx":4,"correct":false,"proposition":"Right occipital old ischemic sequelae","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-14-qi-3","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Among the tests requested, the INR is 2.1. What therapeutic measures are you putting in place regarding anticoagulant treatment? (one or more possible answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"  Intravenous vitamin K prescription","justification":""},{"idx":1,"correct":true,"proposition":"Prescription of concentrate of prothrombin complexes","justification":""},{"idx":2,"correct":true,"proposition":"Discontinuation of coumadin treatment","justification":""},{"idx":3,"correct":false,"proposition":"Prescription of an antiplatelet agent","justification":""},{"idx":4,"correct":false,"proposition":"Prescription of a low molecular weight heparin at a prophylactic dose","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-14-qi-4","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" You stop coumadin, inject vitamin K and concentrate of prothrombin complexes intravenously. What monitoring measures do you put in place? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Platelet count at 30 minutes","justification":""},{"idx":1,"correct":true,"proposition":"INR check at 30 minutes","justification":""},{"idx":2,"correct":false,"proposition":"Anti-Xa activity","justification":""},{"idx":3,"correct":true,"proposition":"INR control at 6 a.m.","justification":""},{"idx":4,"correct":false,"proposition":"Factor V assay at 6 o'clock","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-14-qi-5","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" The controlled INR at 30 minutes is 1.1. As part of the exploration of the patient's chest pain, you perform an ECG and chest X-ray. What etiological diagnosis do you retain for this chest pain? (only one exact answer)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Pulmonary embolism","justification":""},{"idx":1,"correct":false,"proposition":"Pneumonia of the right base","justification":""},{"idx":2,"correct":true,"proposition":"Rib fracture","justification":""},{"idx":3,"correct":false,"proposition":"Pneumothorax","justification":""},{"idx":4,"correct":false,"proposition":"Acute coronary syndrome","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-14-qi-6","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Biologically, you note a natremia at 128 mmol \/ L. What additional elements can be used to explore this result? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Urinary ionogram","justification":""},{"idx":1,"correct":true,"proposition":"Protidemia","justification":""},{"idx":2,"correct":false,"proposition":"Serum anti-diuretic hormone assay","justification":""},{"idx":3,"correct":false,"proposition":"Total cholesterolemia","justification":""},{"idx":4,"correct":false,"proposition":"Proteinuria","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-14-qi-7","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Protein and blood sugar are normal. The appearance of the serum is normal. You conclude hypoosmotic hyponatremia.   Kidney function is normal. The urinary ionogram reveals: natriuresis 60 mmol \/ L; kaliuresis 30 mmol\/L; urinary urea 250 mmol\/L.What are the two etiologies you mention at this stage?","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Syndrome of inappropriate DHA secretion related to serotonin reuptake inhibitor therapy","justification":""},{"idx":1,"correct":true,"proposition":"Syndrome of inappropriate DHA secretion related to chronic subdural hematoma","justification":""},{"idx":2,"correct":false,"proposition":"Potomania","justification":""},{"idx":3,"correct":false,"proposition":"Water retention related to calcium channel blocker treatment","justification":""},{"idx":4,"correct":false,"proposition":"Syndrome of inappropriate DHA secretion related to pleural effusion","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-14-qi-8","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" What therapeutic measures do you take with regard to this hyponatremia? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Water restriction","justification":""},{"idx":1,"correct":false,"proposition":"NaCl infusion 9‰ 1000 ml\/24h","justification":""},{"idx":2,"correct":false,"proposition":"Treatment with loop diuretic","justification":""},{"idx":3,"correct":false,"proposition":"Sodium intake per os at 12 g \/ 24 hours","justification":""},{"idx":4,"correct":true,"proposition":"Discontinuation of serotonin reuptake inhibitor therapy","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-14-qi-9","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" You suspect syncope. Returning to the interrogation, the patient's daughter tells you that this is the second episode of sudden discomfort in a month, but her mother was not injured last time. What abnormalities do you notice on the ECG (same trace as question 5)? (one or more possible answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Full left branch block","justification":""},{"idx":1,"correct":true,"proposition":"Full right branch block","justification":""},{"idx":2,"correct":true,"proposition":"Left anterior hemiblock","justification":""},{"idx":3,"correct":false,"proposition":"Left posterior hemiblock","justification":""},{"idx":4,"correct":false,"proposition":"Atrial fibrillation","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-14-qi-10","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" What diagnosis do you mention in priority in this patient regarding the etiology of her syncopes?","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Tight aortic stricture","justification":""},{"idx":1,"correct":false,"proposition":"Severe pulmonary embolism","justification":""},{"idx":2,"correct":true,"proposition":"Atrioventricular block of the paroxysmal 3rd degree","justification":""},{"idx":3,"correct":false,"proposition":"Paroxysmal ventricular tachycardia","justification":""},{"idx":4,"correct":false,"proposition":"Orthostatic hypotension","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-14-qi-11","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Since her admission, the patient has spoken incoherently. The neurological condition is different from the usual state according to her daughter. What elements will you look for in favor of a delirium syndrome? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Fluctuations in unrest","justification":""},{"idx":1,"correct":false,"proposition":"Absences","justification":""},{"idx":2,"correct":true,"proposition":"Language disorders","justification":""},{"idx":3,"correct":true,"proposition":"Amnesia","justification":""},{"idx":4,"correct":true,"proposition":"Visual hallucinations","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-14-qi-12","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" You are diagnosing confusion. What factors do you mention to explain the appearance of delirium syndrome? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Subdural hematoma","justification":""},{"idx":1,"correct":true,"proposition":"Head trauma","justification":""},{"idx":2,"correct":false,"proposition":"Depressive syndrome","justification":""},{"idx":3,"correct":true,"proposition":"Chest pain","justification":""},{"idx":4,"correct":false,"proposition":"Sleep disorders","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-14-qi-13","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" What therapeutic measure(s) are you putting in place regarding this delirium syndrome?","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Continued treatment with benzodiazepine at the same dosage","justification":""},{"idx":1,"correct":false,"proposition":"Melatonin addition","justification":""},{"idx":2,"correct":false,"proposition":"Increased benzodiazepine treatment to cover nycthémère","justification":""},{"idx":3,"correct":true,"proposition":"Daily reminders on temporo-spatial orientation","justification":""},{"idx":4,"correct":true,"proposition":"Analgesic treatment with paracetamol","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-14-qi-14","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" The patient presents with significant false routes to saliva and during the water test. His daughter tells you that her mother had no difficulty swallowing her meals before this fall. What complications can occur because of these swallowing disorders? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Undernutrition","justification":""},{"idx":1,"correct":true,"proposition":"Death","justification":""},{"idx":2,"correct":false,"proposition":"Dysarthria","justification":""},{"idx":3,"correct":true,"proposition":"Pneumonia","justification":""},{"idx":4,"correct":false,"proposition":"Aphasia","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-14-qi-15","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" What measures do you put in place to avoid complications related to swallowing disorders? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Meals in the supine position at 45 °","justification":""},{"idx":1,"correct":true,"proposition":"Meal with head tilted forward","justification":""},{"idx":2,"correct":true,"proposition":"Cold drinks","justification":""},{"idx":3,"correct":true,"proposition":"Drinks","justification":""},{"idx":4,"correct":false,"proposition":"Food with small pieces","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-15-qi-1","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" What semiological elements are present in this patient? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"A fatigability suggestive of diabetic neuropathy","justification":""},{"idx":1,"correct":true,"proposition":"pyramidal syndrome","justification":""},{"idx":2,"correct":false,"proposition":"mowing","justification":""},{"idx":3,"correct":true,"proposition":"peripheral neurological clinical syndrome","justification":""},{"idx":4,"correct":false,"proposition":"myasthenic syndrome","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-15-qi-2","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" This patient has signs and symptoms consistent with diabetic neuropathy. Which ones are compatible with this diagnosis? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"  Very lively and diffused patellar tendon reflexes","justification":""},{"idx":1,"correct":true,"proposition":"Normal tendon reflexes in the upper limbs","justification":""},{"idx":2,"correct":true,"proposition":"Abolished Achileo tendon reflexes","justification":""},{"idx":3,"correct":true,"proposition":"Hypoaesthesia of both feet","justification":""},{"idx":4,"correct":false,"proposition":"Unilateral sensory deficit up to the umbilicus","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-15-qi-3","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" To confirm the lesional location that best explains the clinical picture, which additional examination is most relevant? (only one answer expected)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Bone marrow MRI","justification":""},{"idx":1,"correct":false,"proposition":"Electroneuromyogram","justification":""},{"idx":2,"correct":false,"proposition":"Brain MRI","justification":""},{"idx":3,"correct":false,"proposition":"Driving evoked potentials","justification":""},{"idx":4,"correct":false,"proposition":"Spinal scanner","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-15-qi-4","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" You have requested a spinal cord MRI :P the following proposals, which ones are correct? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"This is a coronal cup","justification":""},{"idx":1,"correct":true,"proposition":"An intramedullary hypersignal is observed next to thoracic vertebrae","justification":""},{"idx":2,"correct":true,"proposition":"The intramedullary signal suggests an inflammatory lesion","justification":""},{"idx":3,"correct":true,"proposition":"This is a T2-weighted cut","justification":""},{"idx":4,"correct":false,"proposition":"  There is a mass effect on the spinal cord","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-15-qi-5","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" In the light of the inflammatory involvement of the dorsal marrow in relation to the 5th thoracic vertebra, what additional examinations could confirm the etiology of this central neurological disease? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Brain MRI","justification":""},{"idx":1,"correct":false,"proposition":"Electroneuromyogram","justification":""},{"idx":2,"correct":false,"proposition":"Somesthetic evoked potentials","justification":""},{"idx":3,"correct":true,"proposition":"Microbiological","justification":""},{"idx":4,"correct":false,"proposition":"Serum CRP assay","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-15-qi-6","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" A brain MRI is performed. It is an MRI in axial section weighted in T2 at the subtentorial level and axial FLAIR at the supratentorial level. Which of the following are true? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Abnormal images are visualized in hyposignal","justification":""},{"idx":1,"correct":false,"proposition":"Hypersignals suggest multiple metastatic lesions","justification":""},{"idx":2,"correct":true,"proposition":"At least one subcortical lesion is visualized","justification":""},{"idx":3,"correct":true,"proposition":" At least one periventricular lesion is visualized","justification":""},{"idx":4,"correct":true,"proposition":" The largest lesion, in subtentorial, affects a cerebellar peduncle","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-15-qi-7","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" A study of cerebrospinal fluid was performed. The main results are as follows:P roteinorachia: 0.68 g \/ LCellules: 0 red blood cells; 6 mononuclear cellsGlycorachia: 0.90 g \/ LIndex IgG: 0.92Oligoclonal appearance with at least 9 supernumerary bands of IgG.Regarding this analysis of cerebrospinal fluid, what are the exact answers? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Proteinrachia is normal","justification":""},{"idx":1,"correct":true,"proposition":"There is an intrathecal synthesis of IgG","justification":""},{"idx":2,"correct":false,"proposition":"There are arguments in favor of bacterial meningitis","justification":""},{"idx":3,"correct":true,"proposition":"Elevated glycorachia is compatible with the context of diabetes","justification":""},{"idx":4,"correct":true,"proposition":"Cellularity is compatible with a diagnosis of multiple sclerosis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-15-qi-8","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" What diagnoses do you retain to explain all the clinical, radiological and biological data in this file? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Intramedullary tumour","justification":""},{"idx":1,"correct":true,"proposition":"Polyneuropathy","justification":""},{"idx":2,"correct":false,"proposition":"Biermer's disease","justification":""},{"idx":3,"correct":true,"proposition":"Multiple sclerosis","justification":""},{"idx":4,"correct":false,"proposition":"Acute polyradiculoneuritis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-15-qi-9","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" In addition to a picture of polyneuropathy, this patient has multiple sclerosis (MS). You tell him this diagnosis. He asks you questions about MS. Which of the following are true? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The primary progressive form is more common in the beginning of the disease","justification":""},{"idx":1,"correct":true,"proposition":"MS is more common in Caucasian women","justification":""},{"idx":2,"correct":true,"proposition":"The presence of cognitive disorders, during illness, is common","justification":""},{"idx":3,"correct":false,"proposition":"The association of MS and type I diabetes is linked to chance","justification":""},{"idx":4,"correct":true,"proposition":"The risk of MS in siblings is increased compared to the general population","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-15-qi-10","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" During his medical follow-up, the patient reports a few months later to be constipated. He sometimes needs to empty his bladder in two or three steps. His libido is diminished. Which of the following are true? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The patient has symptoms of overactive bladder","justification":""},{"idx":1,"correct":true,"proposition":"The post-voiding residue must be measured","justification":""},{"idx":2,"correct":false,"proposition":"You first mention prostatic hypertrophy","justification":""},{"idx":3,"correct":false,"proposition":"The decrease in libido is directly related to his spinal cord damage","justification":""},{"idx":4,"correct":true,"proposition":"Constipation may be related to MS","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-15-qi-11","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" In general, regarding neuroperineal disorders, which proposals are accurate? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Overactive bladder is mainly manifested by voiding emergencies","justification":""},{"idx":1,"correct":false,"proposition":"First-line drug therapy for overactive bladder relies on alpha-blockers","justification":""},{"idx":2,"correct":true,"proposition":"  Dysuria can be confirmed by flowmetry","justification":""},{"idx":3,"correct":true,"proposition":"In case of post-voiding residues, intermittent self-sounding should be preferred.","justification":""},{"idx":4,"correct":true,"proposition":"Both multiple sclerosis and diabetes can impair erectile abilities","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-15-qi-12","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" This patient has primary progressive MS. It has no background treatment. You see him again six months later. He tells you that he has been feeling particularly tired for a few months and that he is << stiff >>. You observe spasticity of the posterior laloge of the right leg. What support do you offer? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"You are initiating corticosteroid therapy with prednisolone","justification":""},{"idx":1,"correct":false,"proposition":"You contraindicate the resumption of physical activity","justification":""},{"idx":2,"correct":true,"proposition":"You are discussing an antispastic treatment (baclofene)","justification":""},{"idx":3,"correct":false,"proposition":"You gradually introduce pregabalin therapy","justification":""},{"idx":4,"correct":true,"proposition":"You prescribe physiotherapy","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-15-qi-13","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" An electroneuromyogram is performed in this patient given the context of diabetes. The results are as follows: normal sensory and motor conduction velocities to all four limbs. The amplitude of the motor and sensory potentials is halved. The tracings in detection are in favor of neurogenic involvement. What syndromic diagnosis do you remember? (only one answer expected)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Axonal involvement","justification":""},{"idx":1,"correct":false,"proposition":"Demyelinating involvement","justification":""},{"idx":2,"correct":false,"proposition":"Myogenic involvement","justification":""},{"idx":3,"correct":false,"proposition":"Motor plate involvement","justification":""},{"idx":4,"correct":false,"proposition":"Anterior horn involvement","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-15-qi-14","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" What medico-social measures should be put in place for this patient? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"MDPH file for applying for a mobility inclusion card","justification":""},{"idx":1,"correct":false,"proposition":"Invalidity second category","justification":""},{"idx":2,"correct":true,"proposition":"Application for ALD for MS","justification":""},{"idx":3,"correct":false,"proposition":"MDPH file for allocation of human aids","justification":""},{"idx":4,"correct":false,"proposition":"Outplacement","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-16-qi-1","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" The NFS finds: hemoglobin 10.5 g\/dL, MCV 70 fL, reticulocytes 10 G\/L. What is the most likely diagnosis?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"non-regenerative microcytic anemia","justification":""},{"idx":1,"correct":false,"proposition":"regenerative microcytic anemia","justification":""},{"idx":2,"correct":false,"proposition":"regenerative macrocytic anemia","justification":""},{"idx":3,"correct":false,"proposition":"non-regenerative macrocytic anemia","justification":""},{"idx":4,"correct":false,"proposition":"normocytic regenerative anemia","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-16-qi-2","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" What proposals can explain this non-regenerative microcytic anemia? (one or more correct answers)","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"chronic hemolysis","justification":""},{"idx":1,"correct":false,"proposition":"Folate deficiency","justification":""},{"idx":2,"correct":true,"proposition":"Iron deficiency","justification":""},{"idx":3,"correct":true,"proposition":"celiac disease","justification":""},{"idx":4,"correct":true,"proposition":"Helicobacter pylori infection","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-16-qi-3","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" By plotting the staturo-weight curve, you notice an absence of weight gain for 3 months, without stature break in this young girl previously having a growth curve on the median in weight and height. What are the plausible diagnostic hypotheses? (one or more correct answers)","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"simple pubertal delay","justification":""},{"idx":1,"correct":false,"proposition":"growth hormone deficiency","justification":""},{"idx":2,"correct":true,"proposition":"celiac disease","justification":""},{"idx":3,"correct":true,"proposition":"Crohn's disease","justification":""},{"idx":4,"correct":false,"proposition":"hypothyroidism","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-16-qi-4","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" During interrogation, the mother finds that her daughter eats little at home and sorts her food. What element(s) is (are) in favor of a restrictive eating disorder?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"relational impoverishment","justification":""},{"idx":1,"correct":true,"proposition":"physical hyperactivity","justification":""},{"idx":2,"correct":true,"proposition":"Concerns about his weight","justification":""},{"idx":3,"correct":false,"proposition":"Disinterest in schooling","justification":""},{"idx":4,"correct":true,"proposition":"wish to eat << healthy>>","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-16-qi-5","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" School absenteeism is important. The girl says that in addition to fatigue, she often has headaches. What element(s) are you looking for in the interrogation that will make you mention secondary headaches?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"occurrence with cough","justification":""},{"idx":1,"correct":false,"proposition":"occurred mainly on weekends","justification":""},{"idx":2,"correct":true,"proposition":"always occurred on the same side","justification":""},{"idx":3,"correct":true,"proposition":"morning vomiting","justification":""},{"idx":4,"correct":false,"proposition":"associated abdominal pain","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-16-qi-6","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" The headaches are bifrontal, lasting between 10 minutes and 2 hours, relieved with paracetamol that she has been taking about 2 times a month for more than a year. She is not bothered by noise or light. What can it be? One or more exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"typical migraine without aura","justification":""},{"idx":1,"correct":false,"proposition":"Analgesic abuse","justification":""},{"idx":2,"correct":true,"proposition":"tension headaches","justification":""},{"idx":3,"correct":false,"proposition":"chronic migraine","justification":""},{"idx":4,"correct":false,"proposition":"bilateral frontal sinusitis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-16-qi-7","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" On clinical examination, you notice a small breast bud with enlargement of the areola, the absence of pubic hair, it is not settled. Regarding pubertal development in this patient, which is the exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Tanner Stadium is S2P0","justification":""},{"idx":1,"correct":false,"proposition":"Tanner stadium is S1P0","justification":""},{"idx":2,"correct":true,"proposition":"Tanner Stadium is S2P1","justification":""},{"idx":3,"correct":false,"proposition":"she has a delayed puberty","justification":""},{"idx":4,"correct":false,"proposition":"She has a thelarche premature","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-16-qi-8","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" In front of these persistent headaches, you have a brain MRI performed, the image of which is here. Which proposal(s) is the exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"legend 1 corresponds to the stem of the pituitary gland","justification":""},{"idx":1,"correct":false,"proposition":"Legend 2 corresponds to the third ventricle","justification":""},{"idx":2,"correct":true,"proposition":"legend 3 corresponds to the corpus callosum","justification":""},{"idx":3,"correct":false,"proposition":"Legend 4 corresponds to the cerebellar vermis","justification":""},{"idx":4,"correct":true,"proposition":"Legend 5 corresponds to the sphenoid sinus","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-16-qi-9","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" Brain MRI is normal. The ingesta evaluated by the dietician are lower than the average energy requirement. What is the average energy requirement of a 12-year-old girl? (only one answer expected)","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"1200 kcal\/d","justification":""},{"idx":1,"correct":false,"proposition":"1700 kcal\/d","justification":""},{"idx":2,"correct":true,"proposition":"2200 kcal\/d","justification":""},{"idx":3,"correct":false,"proposition":"2700 kcal\/d","justification":""},{"idx":4,"correct":false,"proposition":"3200 kcal\/d","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-16-qi-10","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" In front of microcytic anemia and the absence of weight gain, you evoke celiac disease. Which proposal(s) is the exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"you find the child too old to discuss this diagnosis","justification":""},{"idx":1,"correct":true,"proposition":"you prescribe an anti-transglutaminase IgA assay","justification":""},{"idx":2,"correct":false,"proposition":"you prescribe an anti-endomysium IgG test","justification":""},{"idx":3,"correct":false,"proposition":"you prescribe the anti-gliadin IgA test","justification":""},{"idx":4,"correct":false,"proposition":"you are doing a proof treatment excluding gluten","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-16-qi-11","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" The dosage of anti-transglutaminase IgA is not in favor of the diagnosis of celiac disease, you now evoke Crohn's disease.Which element(s) would be the element(s) to look for in favor of this diagnostic hypothesis?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Arthralgia","justification":""},{"idx":1,"correct":true,"proposition":"oral aphthosis","justification":""},{"idx":2,"correct":false,"proposition":"alopecia","justification":""},{"idx":3,"correct":false,"proposition":"episodes of hematemesis","justification":""},{"idx":4,"correct":true,"proposition":"erythema nodosum","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-16-qi-12","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" What would be the biological element(s) in favor of the diagnosis of Crohn's disease?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Augmented CRP","justification":""},{"idx":1,"correct":true,"proposition":"hypoalbuminemia","justification":""},{"idx":2,"correct":false,"proposition":"increased fecal elastase","justification":""},{"idx":3,"correct":true,"proposition":"increased fecal calprotectin","justification":""},{"idx":4,"correct":false,"proposition":"positive anti-nuclear factors","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-16-qi-13","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" The diagnosis of Crohn's disease was ruled out in the absence of normal inflammatory syndrome, faecal calprotectin and albuminemia. You finally retain the diagnosis of isolated iron deficiency in front of a ferritinemia at 3 ng \/ mL.What element (s) do you seek at the interrogation to explain this disorder in this patient?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"presence of menorrhagia","justification":""},{"idx":1,"correct":true,"proposition":"Replacement of meat products with pulses","justification":""},{"idx":2,"correct":false,"proposition":"insufficient consumption of oranges","justification":""},{"idx":3,"correct":false,"proposition":"intensive sports practice","justification":""},{"idx":4,"correct":false,"proposition":"excessive consumption of milk products","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-16-qi-14","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" She reports not consuming any meat products. Regarding martial supplementation, what is (are) the exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The initial prescription is preferably in injectable form","justification":""},{"idx":1,"correct":true,"proposition":"Treatment may result in black stool staining","justification":""},{"idx":2,"correct":true,"proposition":"It is best to divide the daily dose into 3 doses","justification":""},{"idx":3,"correct":true,"proposition":"A reticulocyte seizure usually occurs around day 10 of treatment","justification":""},{"idx":4,"correct":true,"proposition":"The duration of supplementation will be at least 3 months","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-18-qi-1","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" Which diagnosis is most likely? (only one answer expected)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Acute benzodiazepine poisoning","justification":""},{"idx":1,"correct":false,"proposition":"Acute amphetamine poisoning","justification":""},{"idx":2,"correct":true,"proposition":"Acute opioid poisoning","justification":""},{"idx":3,"correct":false,"proposition":"acute intoxication with antidepressants","justification":""},{"idx":4,"correct":false,"proposition":"acute lithium poisoning","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-18-qi-2","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" Which of the following is more suggestive of opioid poisoning?","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"pupillary examination","justification":""},{"idx":1,"correct":false,"proposition":"the depth of coma","justification":""},{"idx":2,"correct":false,"proposition":"Discovery on public roads","justification":""},{"idx":3,"correct":true,"proposition":"respiratory rate","justification":""},{"idx":4,"correct":false,"proposition":"temperature","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-18-qi-3","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" A coma by opioid overdose is diagnosed. What elements are part of the immediate drug treatment? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Naloxone","justification":""},{"idx":1,"correct":false,"proposition":"Flumazenil","justification":""},{"idx":2,"correct":false,"proposition":"N-acetyl-cysteine","justification":""},{"idx":3,"correct":false,"proposition":"Atropine","justification":""},{"idx":4,"correct":false,"proposition":"Buprenorphine","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-18-qi-4","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" After a bolus of naloxone the patient wakes up, naloxone is kept in continuous infusion for a few hours. He reveals that he had bought 50 mg of methadone hydrochloride on the street where he has been living for 3 days, following his release from prison. He was incarcerated for a robbery. He doesn't understand what happened to him because, before entering prison two years ago, he had been taking 80 mg of methadone a day for several months. He was able to stop this treatment in prison, he says proudly: \"It was not easy, especially with the pain.\" But he admits to having \"plunged\" as soon as he left not having been able to control his desire for products. The health care team finds it a little odd. Which of the following elements of the observation are diagnostic criteria for opioid dependence? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Robberies to obtain the product","justification":""},{"idx":1,"correct":true,"proposition":"Abdominal pain between doses","justification":""},{"idx":2,"correct":false,"proposition":"The episode of overdose","justification":""},{"idx":3,"correct":true,"proposition":"Consumption continues despite negative consequences","justification":""},{"idx":4,"correct":true,"proposition":"Craving","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-18-qi-5","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" To take stock of the social situation of this patient, what needs to be specified? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"nationality","justification":""},{"idx":1,"correct":true,"proposition":"housing conditions","justification":""},{"idx":2,"correct":true,"proposition":"Health coverage","justification":""},{"idx":3,"correct":true,"proposition":"its resources and assistance","justification":""},{"idx":4,"correct":false,"proposition":"criminal record","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-18-qi-6","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient is homeless. What options can be considered to relocate him? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Hospitalization in psychiatry","justification":""},{"idx":1,"correct":false,"proposition":"Hospitalization in addictological follow-up care","justification":""},{"idx":2,"correct":true,"proposition":"Solicitation of a bed halte health care","justification":""},{"idx":3,"correct":false,"proposition":"Solicitation of a nursing home","justification":""},{"idx":4,"correct":true,"proposition":"Solicitation of associative hosting","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-18-qi-7","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" A few weeks later, the patient is housed in a Residential and Social Reintegration Centre (CHRS). He consults in addictology because \"decidedly, with heroin, it does not go anymore! \". He consumes 2 to 3 grams per day in sniffing or more rarely in injection. He went to see a doctor in town who advised him to withdraw or substitute treatment. Suspicious, he wants a second opinion on the resumption of methadone hydrochloride. Which of the following statements are true? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It is too risky given the history of overdose","justification":""},{"idx":1,"correct":false,"proposition":"It should be avoided in favor of clonidine withdrawal","justification":""},{"idx":2,"correct":true,"proposition":"It is possible with psychosocial support","justification":""},{"idx":3,"correct":false,"proposition":"It can be initiated by the town doctor","justification":""},{"idx":4,"correct":true,"proposition":"It is part of an overall risk reduction strategy","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-18-qi-8","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient now lives with a 23-year-old woman, with whom he has been shopping for three months. She occasionally uses heroin sniffing and does not think she needs treatment. She regularly visits a centre where she is given information on the risk of overdose. Which of the following are appropriate risk and harm reduction strategies in this context? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Condom distribution","justification":""},{"idx":1,"correct":true,"proposition":"The realization of serologies HIV, HVB, HVC","justification":""},{"idx":2,"correct":true,"proposition":"Recovery of used consumer equipment","justification":""},{"idx":3,"correct":true,"proposition":"Distribution of sterile syringes","justification":""},{"idx":4,"correct":false,"proposition":"Testing of products consumed","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-18-qi-9","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient has been stabilized for 2 years by treatment with 80 mg of methadone hydrochloride per day. It is his attending physician who reproduces. Last week, he was on vacation and the patient had to deal with a replacement. He was questioned about his drinking, particularly alcohol and tobacco. The patient admitted to regularly drinking two to three beers every night. In order to reduce his cravings for alcohol, the patient asks if he could benefit from treatment like one of his friends who has managed to be weaned. What are the two molecules that could have been prescribed to his friend to help him reduce alcohol consumption?","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Nalmefene","justification":""},{"idx":1,"correct":false,"proposition":"Acamprosate","justification":""},{"idx":2,"correct":true,"proposition":"Baclofen","justification":""},{"idx":3,"correct":false,"proposition":"Naltrexone","justification":""},{"idx":4,"correct":false,"proposition":"Disulfiram","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-18-qi-10","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient recalls that his friend received nalmefene treatment; He therefore wishes to obtain some. The patient's general practitioner's substitute explains the incompatibility of nalmefene with methadone, and offers acamprosate treatment after weaning. At the next consultation, the patient explains to his doctor that he thinks the replacement \"is in cahoots with the pharmaceutical industry\". He noted certain clues that support his idea. \"He would have done better to help me quit smoking,\" he told his doctor. He says he has smoked two packs a day for 10 years. He only supports cigarettes that he makes himself – \"It's safer,\" he says – and also the electronic cigarette. Which of the following signs of tobacco addiction is most severe? (only one answer expected)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The need to smoke several times a day","justification":""},{"idx":1,"correct":false,"proposition":"Continued consumption despite negative consequences","justification":""},{"idx":2,"correct":true,"proposition":"Smoking your first cigarette when you wake up","justification":""},{"idx":3,"correct":false,"proposition":"Smoking rolled cigarettes","justification":""},{"idx":4,"correct":false,"proposition":"Denial of his smoking problem","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-18-qi-11","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient is severely addicted to tobacco. He agrees to a treatment. Which treatments have a marketing authorization in this indication? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Nicotine replacement by patch","justification":""},{"idx":1,"correct":true,"proposition":"nicotine replacement by gum","justification":""},{"idx":2,"correct":true,"proposition":"varenicline","justification":""},{"idx":3,"correct":false,"proposition":"Baclofen","justification":""},{"idx":4,"correct":false,"proposition":"e-cigarettes","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-18-qi-12","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" Two years later, the patient presented to the emergency room of the hospital because he was not feeling well. He has now been living alone for several months. He has not resumed heroin and is still taking methadone hydrochloride treatment. His partner left him because she could no longer stand his << laziness >> and his lack of motivation to do the markets. She also blamed him for his lack of emotions. He is not well, according to him, since a doctor finally acceded to his request for nalmefene, which he did not support. He often repeats \"evil is not fun\" with a knowing tune and sometimes fabricates new words. He doesn't see anyone anymore. He has trouble washing. Which psychiatric syndrome dominates this clinical picture? (only one answer expected)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"A depressive syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Korsakoff's syndrome","justification":""},{"idx":2,"correct":true,"proposition":"A negative syndrome in schizophrenia","justification":""},{"idx":3,"correct":false,"proposition":"A positive syndrome in schizophrenia","justification":""},{"idx":4,"correct":false,"proposition":"A syndrome of disorganization in the context of schizophrenia","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-18-qi-13","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The picture is mainly dominated by a negative syndrome suggestive of a schizophrenic disorder. What semiological elements are in favor of this syndrome? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Sadness","justification":""},{"idx":1,"correct":true,"proposition":"Emotional blunting","justification":""},{"idx":2,"correct":true,"proposition":"Aboulia","justification":""},{"idx":3,"correct":true,"proposition":"Social withdrawal","justification":""},{"idx":4,"correct":false,"proposition":"Neologism","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-18-qi-14","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient claims that \"he was very harmed.\" He doesn't know who but he has researched the internet and knows \"now what really happened, and everything is connected\". He pauses in his speech and does not finish his sentences, but does not wish to say more because one could hear him and take it at him. In front of this clinical picture evolving for more than 6 months and the entire history of the patient we can conclude to a diagnosis of schizophrenia. What elements in favor of this diagnosis are in the observation? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Dams","justification":""},{"idx":1,"correct":true,"proposition":"Delusions","justification":""},{"idx":2,"correct":false,"proposition":"Acoustico-verbal hallucinations","justification":""},{"idx":3,"correct":false,"proposition":"Ideo-affective discordance","justification":""},{"idx":4,"correct":false,"proposition":"Catatonic syndrome","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2022-dp-18-qi-15","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient agrees to take treatment. Which of the following proposals apply to the antipsychotic treatment you are going to offer this patient? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"it must be based on a second-generation antipsychotic","justification":""},{"idx":1,"correct":false,"proposition":"It must be combined with an anticholinergic corrector","justification":""},{"idx":2,"correct":false,"proposition":"  It must be prescribed in delayed injectable form","justification":""},{"idx":3,"correct":false,"proposition":"it must have a sedative component","justification":""},{"idx":4,"correct":true,"proposition":"It must be prescribed after analysis of an electrocardiogram","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp","difficulte":null}
-{"_id":"annales-2016-qi-1","context":null,"enonce":"A study was carried out by drawing lots from the electoral lists 5,000 subjects aged 40 to 60.  Whether or not these subjects had diabetes was investigated by taking their medical history, treatments taken and measuring their fasting blood glucose. Which of the following is correct about this study?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"This is a cross-sectional study"},{"idx":1,"correct":false,"proposition":"This is a randomized study"},{"idx":2,"correct":true,"proposition":"This is an observational study"},{"idx":3,"correct":true,"proposition":"This study will estimate the prevalence of diabetes in this population"},{"idx":4,"correct":false,"proposition":"This study will estimate the case fatality associated with diabetes in this population"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-3","context":null,"enonce":"Primary enuresis is when:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"The child is over 5 years old"},{"idx":1,"correct":false,"proposition":"This enuresis has no identified cause"},{"idx":2,"correct":true,"proposition":"The child was never clean at night"},{"idx":3,"correct":false,"proposition":"The child sleeps too much"},{"idx":4,"correct":false,"proposition":"The child gets up at night to drink"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-4","context":null,"enonce":"A 3-year-old child is brought to the emergency room by his parents for diarrhea for 2 days associated with a fever at 40 ° C.  You learn that he returned from Senegal 3 days before. Which additional examination(s) do you think are etiologically justified in view of the whole clinical picture?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"A blood culture"},{"idx":1,"correct":false,"proposition":"Malaria serology"},{"idx":2,"correct":true,"proposition":"A rapid diagnostic test for malaria"},{"idx":3,"correct":true,"proposition":"A search for parasites in the stool"},{"idx":4,"correct":true,"proposition":"A stool culture"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-5","context":null,"enonce":"As part of the procedure before the Conciliation and Compensation Commission (CCI), following a medical accident, compensation from the National Office for Medical Accident Compensation (ONIAM) can be obtained if one or more conditions are met.  Which one(which)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Prior application of the administrative responsibility of the hospital"},{"idx":1,"correct":true,"proposition":"Harm directly related to medical care"},{"idx":2,"correct":true,"proposition":"The absence of culpable liability"},{"idx":3,"correct":true,"proposition":"Damage with a Violation of Physical or Mental Integrity (AIPP) greater than or equal to 25%"},{"idx":4,"correct":true,"proposition":"A cessation of professional activities greater than or equal to 6 months over a period of 12 months"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-6","context":null,"enonce":"A 3-year-old child with normal psychomotor development is usually able to:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Reproduce a round"},{"idx":1,"correct":true,"proposition":"Reproduce a stroke"},{"idx":2,"correct":false,"proposition":"Reproduce a diamond"},{"idx":3,"correct":false,"proposition":"Reproduce a square"},{"idx":4,"correct":false,"proposition":"Reproduce a cross"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-7","context":null,"enonce":"When a mother has gestational diabetes, there is an increased risk of:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Post-term delivery"},{"idx":1,"correct":false,"proposition":"That the newborn is hypotrophic (small for gestational age)"},{"idx":2,"correct":true,"proposition":"Dystocia"},{"idx":3,"correct":true,"proposition":"Free bilirubin jaundice in newborns"},{"idx":4,"correct":false,"proposition":"Neonatal hyperglycemia"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-8","context":null,"enonce":"A 10-month-old infant with normal psychomotor development should:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Standing with support"},{"idx":1,"correct":true,"proposition":"Repeat a syllable"},{"idx":2,"correct":true,"proposition":"Seated by yourself"},{"idx":3,"correct":true,"proposition":"Moving on the ground"},{"idx":4,"correct":true,"proposition":"Worrying at the sight of an unfamiliar face"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-9","context":null,"enonce":"What is (are) the complication(s) associated with prematurity?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Ulcerative-necrotizing enterocolitis"},{"idx":1,"correct":true,"proposition":"Retinopathy"},{"idx":2,"correct":true,"proposition":"Periventricular leukomalacia"},{"idx":3,"correct":false,"proposition":"Dilation of the bronchi"},{"idx":4,"correct":false,"proposition":"The atrioventricular canal"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-10","context":null,"enonce":"You are seeing a 12-year-old obese teenager. The body mass index curve shows a rebound in adiposity at age 3. There is an acceleration of the stature growth curve. On examination, you will see purple stretch marks on the flanks and thickened, rough skin on the neck. His parents report that he is constipated. Which additional exam(s) do you prescribe?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"TSH, T4"},{"idx":1,"correct":false,"proposition":"Urinary free cortisol"},{"idx":2,"correct":false,"proposition":"Plasma IGF 1"},{"idx":3,"correct":false,"proposition":"Testosteronemia"},{"idx":4,"correct":true,"proposition":"None of the previous exams"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-11","context":null,"enonce":"A child who has just been born is said:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Premature if born at a gestational age less than 37 weeks of amenorrhea"},{"idx":1,"correct":true,"proposition":"Hypotrophic if its measurements are strictly less than at least two standard deviations from the reference curves"},{"idx":2,"correct":true,"proposition":"Post-mature if born at a gestational age greater than or equal to 42 weeks of amenorrhea"},{"idx":3,"correct":false,"proposition":"Newborn in the first three months of life"},{"idx":4,"correct":true,"proposition":"Very premature if born at a gestational age of less than 32 weeks of amenorrhea"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-12","context":null,"enonce":"All newborns should be routinely screened for:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Cystic fibrosis"},{"idx":1,"correct":false,"proposition":"Congenital diabetes"},{"idx":2,"correct":true,"proposition":"Congenital hypothyroidism"},{"idx":3,"correct":true,"proposition":"Congenital adrenal hyperplasia"},{"idx":4,"correct":false,"proposition":"Thalassemia"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-13","context":null,"enonce":"At the maternity discharge examination, a healthy full-term child must have:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"A closed posterior fontanel"},{"idx":1,"correct":true,"proposition":"A popliteal angle less than or equal to 90°"},{"idx":2,"correct":false,"proposition":"A disappearance of automatic walking"},{"idx":3,"correct":true,"proposition":"An eye chase"},{"idx":4,"correct":false,"proposition":"A smile-response"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-14","context":null,"enonce":"A 55-year-old patient with breast cancer with bone metastases under pamidronate treatment consults you. She has had endooral bone exposure for several weeks, following the avulsion of a mobile tooth. She has no other medical history. You mention the diagnosis(s) of:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Osteoradionecrosis"},{"idx":1,"correct":true,"proposition":"Bone metastasis"},{"idx":2,"correct":false,"proposition":"Osteoma"},{"idx":3,"correct":true,"proposition":"Osteochimionecosis"},{"idx":4,"correct":false,"proposition":"Ameloblastoma"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-15","context":null,"enonce":"A 56-year-old patient, a tobacco user since the age of 16, consults you because of the appearance for 1 month and a half of lingual ulceration. The elements that guide you towards the diagnosis of squamous cell carcinoma are:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Peripheral halo erythematosus"},{"idx":1,"correct":true,"proposition":"Lesional induration"},{"idx":2,"correct":true,"proposition":"Contact bleeding"},{"idx":3,"correct":false,"proposition":"Feverish"},{"idx":4,"correct":true,"proposition":"Indurated homolateral group II cervical lymphadenopathy"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-16","context":null,"enonce":"In a displaced right zygomatomaxillary fracture, you are looking for hypoesthesia in the following territory(s):","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Upper right eyelid"},{"idx":1,"correct":false,"proposition":"Tip of the nose"},{"idx":2,"correct":true,"proposition":"Teeth number 11, 12 and 13"},{"idx":3,"correct":true,"proposition":"Right half of the upper lip"},{"idx":4,"correct":false,"proposition":"Cornea of the right eye"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-17","context":null,"enonce":"The walls of the orbit consist of:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Sphenoid bone"},{"idx":1,"correct":true,"proposition":"The ethmoid bone"},{"idx":2,"correct":true,"proposition":"Zygomatic bone"},{"idx":3,"correct":true,"proposition":"The maxillary bone"},{"idx":4,"correct":true,"proposition":"Frontal bone"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-18","context":null,"enonce":"The uvule:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Helps to delimit the isthmus of the throat"},{"idx":1,"correct":true,"proposition":"May be hypertrophic and responsible for snoring"},{"idx":2,"correct":true,"proposition":"May be bifid in a submucosal slit"},{"idx":3,"correct":true,"proposition":"Is essential in the mechanisms of swallowing"},{"idx":4,"correct":false,"proposition":"Is devoid of any muscle structure"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-19","context":null,"enonce":"Ameloblastoma:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Is an odontogenic tumor"},{"idx":1,"correct":false,"proposition":"Is a non-epithelial tumor"},{"idx":2,"correct":true,"proposition":"Is characterized by local aggressiveness"},{"idx":3,"correct":true,"proposition":"Is prone to recurrence"},{"idx":4,"correct":true,"proposition":"Gives a multilocular lytic radiological image"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-20","context":null,"enonce":"With which diagnosis(s) is compatible the following assessment: serum calcium 2.80 mmol \/ L; phosphoremia 0.6 mmol\/L (normal values 0.80 to 1.45); PTH 3 pmol\/L (normal values 1.2 to 5.8)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Primary hyperparathyroidism"},{"idx":1,"correct":false,"proposition":"Secondary hyperparathyroidism"},{"idx":2,"correct":false,"proposition":"Vitamin D poisoning"},{"idx":3,"correct":false,"proposition":"Paraneoplastic hyperparathyroidism"},{"idx":4,"correct":false,"proposition":"Myeloma"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-21","context":null,"enonce":"What examination(s) can you request for the diagnosis of corticotropic deficiency in a patient who has had corticosteroid therapy at a dose of 1 mg\/kg\/day of prednisone for 4 months?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"ACTH dosage only"},{"idx":1,"correct":true,"proposition":"ACTH and cortisol assay at 8 h"},{"idx":2,"correct":false,"proposition":"Renin dosage"},{"idx":3,"correct":true,"proposition":"Ordinary synacthene test"},{"idx":4,"correct":false,"proposition":"24-hour urinary free cortisol"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-23","context":null,"enonce":"Among the following proposals, which non-pharmacological therapeutic (s) can (s) be prescribed in the chronic phase of osteoarthritis (at a distance from a flare-up)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Landfill"},{"idx":1,"correct":true,"proposition":"Adapted physical activity"},{"idx":2,"correct":true,"proposition":"Crenotherapy"},{"idx":3,"correct":true,"proposition":"Muscle building"},{"idx":4,"correct":false,"proposition":"Immobilization"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-24","context":null,"enonce":"A 76-year-old patient, living alone in a single-storey house, had surgery for a total hip replacement on the right. She has lost weight by 1 kg since the procedure. However, she keeps a good appetite, is not afraid of falling and walks with a cane on the left. She plans to have cataract surgery. She consults 3 months after the intervention for pain in the right hip. What is (are) the sign(s) you are looking for in favor of a prosthesis infection visible on a prosthetic hip X-ray?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"A peri-prosthetic border"},{"idx":1,"correct":false,"proposition":"Parrot beaks"},{"idx":2,"correct":true,"proposition":"Osteolysis"},{"idx":3,"correct":true,"proposition":"Endorsed geodes"},{"idx":4,"correct":true,"proposition":"Periosteal appositions"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-25","context":null,"enonce":"Diabetic retinopathy, at the stage of \"rare micro-aneurysms\":","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Is associated with macular edema"},{"idx":1,"correct":false,"proposition":"Contraindicates the rapid achievement of strict normoglycemia"},{"idx":2,"correct":false,"proposition":"Indicates laser photocoagulation in preparation for pregnancy"},{"idx":3,"correct":false,"proposition":"Must be checked at three months"},{"idx":4,"correct":true,"proposition":"May be observed as soon as diabetes is diagnosed"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-26","context":null,"enonce":"Orthostatic proteinuria:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Disappears after 2 hours of clinostatism"},{"idx":1,"correct":true,"proposition":"Observed during puberty"},{"idx":2,"correct":false,"proposition":"Persists after age 25"},{"idx":3,"correct":false,"proposition":"Is associated with high cardiovascular risk"},{"idx":4,"correct":true,"proposition":"Is not pathological"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-28","context":null,"enonce":"Hypoglycemia in type 2 diabetes:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Are a potential side effect of all anti-diabetics"},{"idx":1,"correct":true,"proposition":"On sulfonamide, are more common in cases of renal failure"},{"idx":2,"correct":false,"proposition":"On metformin, are more common in heart failure"},{"idx":3,"correct":true,"proposition":"Are facilitated by taking alcohol"},{"idx":4,"correct":false,"proposition":"Are responsible for the majority of cardiovascular events in diabetics"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-29","context":null,"enonce":"Obesity:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Concerns 15% of the adult French population"},{"idx":1,"correct":true,"proposition":"Is considered a low-grade inflammatory disease"},{"idx":2,"correct":true,"proposition":"Is accompanied by an increase in lean body mass"},{"idx":3,"correct":false,"proposition":"Is associated with decreased resting metabolism"},{"idx":4,"correct":true,"proposition":"With a well-followed diet, the expected weight loss is of the order of 15% at 2 years"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-30","context":null,"enonce":"What is (are) the pathology(s) associated with a \"white\" scintigraphy in the presence of an increased free T4?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"De Quervain's thyroiditis"},{"idx":1,"correct":true,"proposition":"Iodine overload"},{"idx":2,"correct":false,"proposition":"Graves' disease"},{"idx":3,"correct":false,"proposition":"Multinodular goiter"},{"idx":4,"correct":true,"proposition":"Factitious thyrotoxicosis"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-31","context":null,"enonce":"On a systematic count carried out in a 63-year-old patient, you find: leukocytes 7.2 G \/ L; neutrophils 47%; lymphocytes 45%; monocytes 8%;  haemoglobin 14.4 g\/dL; VGM 89 fL; CCMH 33 g\/100 mL; platelets 755 G\/L. You mention:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Iron deficiency"},{"idx":1,"correct":false,"proposition":"Taking corticosteroids"},{"idx":2,"correct":true,"proposition":"An asplenism"},{"idx":3,"correct":true,"proposition":"An essential thrombocythemia"},{"idx":4,"correct":false,"proposition":"Active smoking"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-32","context":null,"enonce":"A 74-year-old woman has the following blood count: leukocytes 2.1 G\/L; neutrophils 0.7 G\/L; lymphocytes 1.4 G\/L; hemoglobin 8.5 g\/dLv VGM 104 fL; blisters 567 G\/L. The myelogram returns to a marrow of normal richness with 3% blasts and signs of dysmegakaryopoiesis. Which diagnosis(s) evokes this table?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Acute myelogenous leukemia"},{"idx":1,"correct":true,"proposition":"A 5q- syndrome"},{"idx":2,"correct":false,"proposition":"Refractory anemia with excess blasts"},{"idx":3,"correct":false,"proposition":"A myeloproliferative syndrome"},{"idx":4,"correct":true,"proposition":"Myelodysplastic syndrome"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-33","context":null,"enonce":"Metabolic adaptations observed during a hunger strike include:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Stimulation of gluconeogenesis"},{"idx":1,"correct":false,"proposition":"A brake of adipocyte lipolysis"},{"idx":2,"correct":true,"proposition":"A decrease in resting energy metabolism"},{"idx":3,"correct":true,"proposition":"Nitrogen savings"},{"idx":4,"correct":true,"proposition":"Increased ketogenesis"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-34","context":null,"enonce":"A 28-year-old patient comes to your consultation for a gradual installation fatigue over several weeks. She is out of breath at the effort and is very embarrassed in her activity as a cleaning lady. The clinical examination finds only a mucocutaneous pallor. A first assessment finds: leukocytes 7.6 G \/ L, neutrophils 62%, eosinophilic polynuclear 2%;  lymphocytes 33%; monocytes 3%; haemoglobin 9.7 g\/dL; VGM 76 fL; CCMH 31.2 g\/dL;  platelets 633 G\/L; reticulocytes 67 G\/L. Which of the following results explains the abnormalities of the blood count?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Ferritinemia increased"},{"idx":1,"correct":true,"proposition":"Lowered ferritinemia"},{"idx":2,"correct":false,"proposition":"Increased serum iron and normal transferrin"},{"idx":3,"correct":false,"proposition":"Collapsed vitamin B12"},{"idx":4,"correct":false,"proposition":"Hb A2 at 10.2% on hemoglobin electrophoresis"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-35","context":null,"enonce":"As part of the monitoring of synthetic antithyroid therapy, it is interesting to measure:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Creatinine"},{"idx":1,"correct":false,"proposition":"CPK"},{"idx":2,"correct":true,"proposition":"Blood count"},{"idx":3,"correct":false,"proposition":"CRP"},{"idx":4,"correct":true,"proposition":"Transaminases"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-36","context":null,"enonce":"Excess glucocorticoids cause:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Hyperglycaemia"},{"idx":1,"correct":false,"proposition":"Hypercalcemia"},{"idx":2,"correct":false,"proposition":"Hyperprotidemia"},{"idx":3,"correct":true,"proposition":"Hypokalemia"},{"idx":4,"correct":false,"proposition":"Hypernatremia"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-37","context":null,"enonce":"Polyclonal gammopathy:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Is common during lupus"},{"idx":1,"correct":true,"proposition":"Is common during sarcoidosis"},{"idx":2,"correct":false,"proposition":"Is usually seen during type 2 diabetes"},{"idx":3,"correct":false,"proposition":"May occur during AL amyloidosis"},{"idx":4,"correct":true,"proposition":"May occur during chronic liver disease"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-39","context":null,"enonce":"When monitoring differentiated papillary thyroid cancer with lymph node invasion, it is customary to use the following monitoring parameters:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Abdominal ultrasound"},{"idx":1,"correct":true,"proposition":"Cervical ultrasound"},{"idx":2,"correct":true,"proposition":"Iodine whole body scintigraphy"},{"idx":3,"correct":false,"proposition":"Bone scintigraphy"},{"idx":4,"correct":false,"proposition":"Thoraco-abdominopelvic CT"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-40","context":null,"enonce":"The clinical symptomatology of Willebrand disease is dominated by:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"A petechial purpura"},{"idx":1,"correct":true,"proposition":"Epistaxis"},{"idx":2,"correct":true,"proposition":"Meno-metrorrhagia"},{"idx":3,"correct":false,"proposition":"Hemathosis"},{"idx":4,"correct":false,"proposition":"Muscle hematomas"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-43","context":null,"enonce":"Malignant humoral hypercalcemia: B. Is due to hypersecretion of ","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Is one of the causes of hypercalcemia of myeloma"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-44","context":null,"enonce":"Regarding primary amenorrhea, which is (are) the exact proposal(s)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"It is characterized by the absence of secondary sexual characteristics after 16 years in young girls"},{"idx":1,"correct":false,"proposition":"It is more common than secondary amenorrhea"},{"idx":2,"correct":true,"proposition":"It can be linked to a central cause"},{"idx":3,"correct":true,"proposition":"It requires in its etiological assessment a dosage of gonadotropins"},{"idx":4,"correct":true,"proposition":"Associated with an absence of secondary sexual characteristics, it may be due to a syndrome"},{"idx":5,"correct":true,"proposition":"de Turner"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-45","context":null,"enonce":"What is (are) the exact proposal(s) regarding menopause?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"It is characterized by a stop of the rules"},{"idx":1,"correct":true,"proposition":"She is suspected in front of climacteric signs"},{"idx":2,"correct":false,"proposition":"His progestogen treatment will reinstate withdrawal hemorrhages"},{"idx":3,"correct":false,"proposition":"It must lead to the prescription of a bone densitometry"},{"idx":4,"correct":true,"proposition":"Its risks are mainly osteoporosis"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-46","context":null,"enonce":"Regarding the semiology of sensitivity, what following statement(s) is (are) true?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Sensory extinction is seen in parietal lobe involvement (parietal syndrome)"},{"idx":1,"correct":false,"proposition":"Romberg's sign testifies to the involvement of small amylin nerve fibers"},{"idx":2,"correct":false,"proposition":"Involvement of the left ulnar nerve can cause hypoaesthesia of the first 3 fingers of the left hand"},{"idx":3,"correct":true,"proposition":"Involvement of a thalamus causes contralateral hypoaesthesia in all modes (thalamic syndrome)"},{"idx":4,"correct":true,"proposition":"Alternate sensory syndrome is a sign of brainstem involvement"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-47","context":null,"enonce":"What following statement(s) is (are) true regarding the semiology of the cerebellum?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"The Stewart-Holmes maneuver highlights a delay in contraction of agonist muscles"},{"idx":1,"correct":false,"proposition":"Static cerebellar syndrome is linked to damage to the cerebellar hemispheres"},{"idx":2,"correct":true,"proposition":"Hypermetry of the right upper limb may be due to damage to the right cerebellar hemisphere"},{"idx":3,"correct":true,"proposition":"There is hypotonia in cerebellar syndrome"},{"idx":4,"correct":false,"proposition":"The voice may be paretic in case of cerebellar damage"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-48","context":null,"enonce":"A 55-year-old patient comes to consultation for vision disorders, he has had two traffic accidents because he did not see the priorities on the right. You will focus your clinical examination on the exploration of the visual field. Regarding this patient, what is (are) the exact proposal(s)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"He may have a right homonymous lateral hemianopsia"},{"idx":1,"correct":true,"proposition":"He may have bitemporal hemianopsia"},{"idx":2,"correct":true,"proposition":"If his lesion is intracranial, it may be in left retrochiasmatic"},{"idx":3,"correct":true,"proposition":"If his lesion is intracranial, it may be at the level of the chiasma"},{"idx":4,"correct":false,"proposition":"If his lesion is intracranial, it may be at the right occipital level"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-49","context":null,"enonce":"An alternate syndrome:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Refers to hemispheric brain damage"},{"idx":1,"correct":false,"proposition":"Corresponds to involvement of a long pathway homolateral to the lesion and a contralateral cranial nerve"},{"idx":2,"correct":true,"proposition":"There is an alternate sensory syndrome in Wallenberg syndrome"},{"idx":3,"correct":true,"proposition":"May be caused by a brainstem infarction"},{"idx":4,"correct":true,"proposition":"May include diplopia"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-50","context":null,"enonce":"The peripheral nerve(s) most often compressed in case of prolonged immobilization is (are):","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"The median nerve at the carpal tunnel"},{"idx":1,"correct":true,"proposition":"The ulnar nerve at the elbow"},{"idx":2,"correct":false,"proposition":"The fibular nerve in the popliteal fossa"},{"idx":3,"correct":true,"proposition":"The radial nerve in the humeral gutter"},{"idx":4,"correct":false,"proposition":"The sciatic nerve in the lower third of the thigh"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-51","context":null,"enonce":"False food routes can be prevented by:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"The taking of meals by the patient himself"},{"idx":1,"correct":false,"proposition":"The use of liquid food"},{"idx":2,"correct":false,"proposition":"The lying position, on the right side during meals"},{"idx":3,"correct":true,"proposition":"The use of a notched glass"},{"idx":4,"correct":true,"proposition":"Anteflexion of the head when swallowing"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-52","context":null,"enonce":"Regarding Parsonage-Turner syndrome, quote the exact proposal(s):","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Initial pains are centered on the shoulder"},{"idx":1,"correct":false,"proposition":"The motor deficit is present from the beginning"},{"idx":2,"correct":false,"proposition":"The motor deficit concerns the C8-T1 roots"},{"idx":3,"correct":false,"proposition":"Sensory disorders are important"},{"idx":4,"correct":true,"proposition":"Amyotrophy is classic in the evolution"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-53","context":null,"enonce":"What is (are) the typical clinical sign(s) to consider treatment without additional examination in case of vulvovaginal mycosis?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Vulvovaginal pruritus"},{"idx":1,"correct":true,"proposition":"Erythema vulvaris"},{"idx":2,"correct":false,"proposition":"Speculum examination: lilac collar"},{"idx":3,"correct":false,"proposition":"Greyish leucorrhoea"},{"idx":4,"correct":false,"proposition":"Inguinal lymphadenopathy"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-54","context":null,"enonce":"Regarding typical absence epilepsy, what is (are) the exact answer(s)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"The definition is clinical and electroencephalographic"},{"idx":1,"correct":false,"proposition":"Is characterized by generalized peak wave discharges at 6 Hz"},{"idx":2,"correct":false,"proposition":"Often has atonic seizures"},{"idx":3,"correct":true,"proposition":"EEG discharges are synchronous and symmetrical"},{"idx":4,"correct":true,"proposition":"May be associated with generalized tonic-clonic seizures"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-55","context":null,"enonce":"Which of the following proposals can (which) correspond to dysautonomic impairment?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Fragile and brittle appendages"},{"idx":1,"correct":true,"proposition":"Orthostatic hypotension"},{"idx":2,"correct":false,"proposition":"Headaches"},{"idx":3,"correct":true,"proposition":"Constipation"},{"idx":4,"correct":false,"proposition":"Anorexia"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-56","context":null,"enonce":"Zollinger-Ellison syndrome is related to hypergastrinemia secondary to gastrinoma.  In which condition(s) should this diagnosis be evoked? nor ","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"In case of multiple duodenal ulcers"},{"idx":1,"correct":true,"proposition":"In case of recurrent duodenal ulcer or resistant to medical treatment"},{"idx":2,"correct":true,"proposition":"In case of duodenal ulcer associated with gastric or jejunal ulcers"},{"idx":3,"correct":true,"proposition":"In case of duodenal ulcer associated with diarrhea"},{"idx":4,"correct":true,"proposition":"In case of duodenal ulcer occurring without taking aspirin, nonsteroidal anti-inflammatory drug,"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-57","context":null,"enonce":"What is (are) the exact answer(s) regarding the practical modalities of performing the immunological test for occult bleeding in the stool?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"It is necessary to follow a diet excluding foods rich in tryptophan three days before"},{"idx":1,"correct":true,"proposition":"It is the attending physician who gives the test to the patient"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-58","context":null,"enonce":"What is (are) the condition(s) for performing a colonoscopy under general anesthesia?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Colonoscopy can be done in outpatient care"},{"idx":1,"correct":false,"proposition":"All antiplatelet therapy must be stopped before the examination"},{"idx":2,"correct":false,"proposition":"Anesthesia can be performed by the gastroenterologist"},{"idx":3,"correct":false,"proposition":"Colic preparation requires a purge over three days"},{"idx":4,"correct":true,"proposition":"A residue-free diet is prescribed for a few days before the exam"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-59","context":null,"enonce":"Which of the following treatments has (have) a Marketing Authorization (MA) to help maintain abstinence?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Tiapride"},{"idx":1,"correct":true,"proposition":"Acamprosate"},{"idx":2,"correct":true,"proposition":"Naltrexone"},{"idx":3,"correct":false,"proposition":"Clonidine"},{"idx":4,"correct":true,"proposition":"Disulfiram"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-60","context":null,"enonce":"What characteristic(s) is suggestive of cirrhotic ascites?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Ascites of citrin appearance"},{"idx":1,"correct":false,"proposition":"Hemorrhagic ascites"},{"idx":2,"correct":true,"proposition":"Protein-poor ascites"},{"idx":3,"correct":false,"proposition":"Ascites of chylous appearance"},{"idx":4,"correct":false,"proposition":"Ascites rich in amylase"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-61","context":null,"enonce":"Regarding the serum total PSA (Prostate Specific Antigen):","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Its increase involves performing endorectal prostate ultrasound as a diagnosis"},{"idx":1,"correct":true,"proposition":"Its dosage is not of interest for subjects whose life expectancy is less than 10 years"},{"idx":2,"correct":false,"proposition":"Its dosage must be carried out annually from the age of 50 as part of a mass screening"},{"idx":3,"correct":false,"proposition":"Its increase implies the systematic realization of the determination of its free fraction"},{"idx":4,"correct":true,"proposition":"Its increase should lead to discuss the realization of prostate biopsies"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-63","context":null,"enonce":"The initial assessment of urinary incontinence systematically includes:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"An ECBU"},{"idx":1,"correct":false,"proposition":"A Pad-Test"},{"idx":2,"correct":false,"proposition":"A urodynamic balance sheet"},{"idx":3,"correct":false,"proposition":"Static and dynamic pelvic MRI"},{"idx":4,"correct":true,"proposition":"A measurement of the post-void residue by ultrasound"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-64","context":null,"enonce":"Irritative clinical signs of benign prostatic hyperplasia include:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"A delay in starting urination"},{"idx":1,"correct":true,"proposition":"A pollakiuria"},{"idx":2,"correct":false,"proposition":"A weak urinary stream"},{"idx":3,"correct":false,"proposition":"The presence of lagging drops"},{"idx":4,"correct":true,"proposition":"An emergency room"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-65","context":null,"enonce":"About the pathophysiology of renal colic, what are the true propositions?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"The pain is induced by irritation of the superior ureteral nerve"},{"idx":1,"correct":true,"proposition":"Intracavitary hyperpressure stimulates intrarenal synthesis of prostaglandin E2"},{"idx":2,"correct":true,"proposition":"Nausea and vomiting trigger the secretion of anti-diuretic hormone (ADH)"},{"idx":3,"correct":false,"proposition":"The dilation underlying the obstacle is related to the relaxation of ureteral smooth muscle fibers"},{"idx":4,"correct":false,"proposition":"The tensioning of the pyel-calycal cavities is responsible for a rapid decrease"},{"idx":5,"correct":false,"proposition":"glomerular filtration rate"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-66","context":null,"enonce":"Regarding this X-ray section:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"This is an abdominal CT scan injected into coronal sections"},{"idx":1,"correct":true,"proposition":"This is an injected abdominal CT scan, at a late time"},{"idx":2,"correct":false,"proposition":"The left adrenal gland is visible"},{"idx":3,"correct":true,"proposition":"There is a left kidney tumor"},{"idx":4,"correct":true,"proposition":"The left renal vein is visible"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-67","context":null,"enonce":"Normal sexuality includes the following phases:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"The excitement phase"},{"idx":1,"correct":true,"proposition":"The phase of desire"},{"idx":2,"correct":true,"proposition":"The orgasm phase"},{"idx":3,"correct":true,"proposition":"The plateau phase"},{"idx":4,"correct":true,"proposition":"The resolution phase"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-68","context":null,"enonce":"In acute urethritis in men, clinical examination includes:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Research to interrogation of a contaminating report"},{"idx":1,"correct":true,"proposition":"A digital rectal exam"},{"idx":2,"correct":false,"proposition":"Scrotal transillumination"},{"idx":3,"correct":true,"proposition":"The search for urethral discharge"},{"idx":4,"correct":true,"proposition":"The search for rectal inflammation"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-69","context":null,"enonce":"The presence of isolated leukocyturia without germs should suggest:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Urogenital tuberculosis"},{"idx":1,"correct":false,"proposition":"Urolithiasis"},{"idx":2,"correct":true,"proposition":"Interstitial cystitis"},{"idx":3,"correct":false,"proposition":"Diabetes mellitus"},{"idx":4,"correct":true,"proposition":"A bladder tumour"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-70","context":null,"enonce":"The electrocardiographic signs of hyperkalemia are:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Sharp T-waves"},{"idx":1,"correct":true,"proposition":"Atrioventricular block"},{"idx":2,"correct":true,"proposition":"Shortening QT space"},{"idx":3,"correct":true,"proposition":"QRS lengthening"},{"idx":4,"correct":false,"proposition":"Increase in U-wave"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-71","context":null,"enonce":"Which of these terms designates the suspension of all motor and language activity that can be observed following psychological shock?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Stupor"},{"idx":1,"correct":false,"proposition":"Dumbness"},{"idx":2,"correct":false,"proposition":"Amiemia"},{"idx":3,"correct":false,"proposition":"Negativism"},{"idx":4,"correct":false,"proposition":"Bradypsychia"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-72","context":null,"enonce":"What is (are) the positive symptom(s) of schizophrenia?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"The delirium of persecution"},{"idx":1,"correct":false,"proposition":"The alogy"},{"idx":2,"correct":true,"proposition":"Hallucinations"},{"idx":3,"correct":false,"proposition":"Emotional blunting"},{"idx":4,"correct":false,"proposition":"Dams"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-73","context":null,"enonce":"In generalized anxiety disorder, anxiety is associated with:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Muscle tension"},{"idx":1,"correct":true,"proposition":"Psychasthenia"},{"idx":2,"correct":false,"proposition":"Pessimism"},{"idx":3,"correct":true,"proposition":"The hustle and bustle"},{"idx":4,"correct":true,"proposition":"Sleep disorders"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-74","context":null,"enonce":"Social phobia includes:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Fear of being alone"},{"idx":1,"correct":true,"proposition":"Avoidance of feared situations"},{"idx":2,"correct":false,"proposition":"Lack of awareness of the morbid nature of the disorders"},{"idx":3,"correct":true,"proposition":"A fear of being observed by others"},{"idx":4,"correct":false,"proposition":"A feeling of inferiority"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-75","context":null,"enonce":"Lithium is:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Used in the form of salts"},{"idx":1,"correct":false,"proposition":"An antiepileptic drug"},{"idx":2,"correct":true,"proposition":"A thymoregulator"},{"idx":3,"correct":false,"proposition":"An antidepressant"},{"idx":4,"correct":true,"proposition":"A metal"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-76","context":null,"enonce":"School phobia in children and adolescents:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Concerns 3 to 5% of 12 to 19 year olds"},{"idx":1,"correct":false,"proposition":"Most often involves erythrophobia"},{"idx":2,"correct":true,"proposition":"Is associated with poor academic performance"},{"idx":3,"correct":true,"proposition":"Leads to a major risk of dropping out of school"},{"idx":4,"correct":false,"proposition":"Evolves into a social phobia in 65% of cases"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-77","context":null,"enonce":"What therapeutic strategy(s) to recommend as a first line in the face of post-traumatic stress disorder in adults?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Debriefing"},{"idx":1,"correct":true,"proposition":"Psychotherapy"},{"idx":2,"correct":false,"proposition":"Benzodiazepine"},{"idx":3,"correct":false,"proposition":"Serotonin reuptake inhibitor"},{"idx":4,"correct":false,"proposition":"Hydroxyzine"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-78","context":null,"enonce":"Among the possible proposals, which is (are) the possible cause(s) of pulmonary arterial hypertension?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Left heart failure"},{"idx":1,"correct":true,"proposition":"Taking benfluorex"},{"idx":2,"correct":true,"proposition":"Systemic scleroderma"},{"idx":3,"correct":true,"proposition":"Genetic origin"},{"idx":4,"correct":true,"proposition":"HIV infection"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-79","context":null,"enonce":"A 72-year-old patient is hospitalized for the first acute pulmonary edema. Which of the following tests is (are) the one that may be useful to clarify the etiology of his left heart failure?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Determination of BNP"},{"idx":1,"correct":false,"proposition":"Stress test with oxygen consumption measurement"},{"idx":2,"correct":true,"proposition":"Echocardiography"},{"idx":3,"correct":true,"proposition":"Coronary angiography"},{"idx":4,"correct":false,"proposition":"Right catheterization"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-80","context":null,"enonce":"Regarding heart failure, which is (are) the exact proposal(s)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Prevalence of heart failure increases with age"},{"idx":1,"correct":false,"proposition":"Heart failure with preserved ejection fraction is more common in young subjects"},{"idx":2,"correct":false,"proposition":"About one in 5 patients die 5 years after diagnosis"},{"idx":3,"correct":true,"proposition":"Sudden death is a common mode of death"},{"idx":4,"correct":true,"proposition":"Hospitalization for acute heart failure is a factor of severity"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-81","context":null,"enonce":"A 65-year-old patient consults her doctor because she is increasingly short of breath during exercise. Which examination(s) can be requested as a first-line test for the diagnosis of heart failure?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"A BNP assay"},{"idx":1,"correct":false,"proposition":"A stress test"},{"idx":2,"correct":true,"proposition":"Transthoracic echocardiography"},{"idx":3,"correct":false,"proposition":"A cardiac MRI"},{"idx":4,"correct":false,"proposition":"Straight catheterization"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-82","context":null,"enonce":"Which of the following proposals is (are) characteristic of the venous origin of a leg ulcer?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Location at the forefoot"},{"idx":1,"correct":true,"proposition":"Malleolar location"},{"idx":2,"correct":true,"proposition":"Presence of a phlebecatic crown of the plantar arch"},{"idx":3,"correct":false,"proposition":"Necrotic character"},{"idx":4,"correct":false,"proposition":"Tendon exposure"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-84","context":null,"enonce":"What therapeutic is (are) indicated for chronic venous insufficiency at the malleolar ulcer stage and secondary to varicose disease?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Anticoagulant"},{"idx":1,"correct":false,"proposition":"Vasodilator"},{"idx":2,"correct":true,"proposition":"Class III elastic compression"},{"idx":3,"correct":true,"proposition":"Varicose vein surgery (stripping +\/- crossectomy)"},{"idx":4,"correct":true,"proposition":"Local care"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-85","context":null,"enonce":"Regarding the interpretation of this electrocardiogram and among the following propositions, which one (are) accurate?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Sinus dysfunction"},{"idx":1,"correct":false,"proposition":"Second degree atrioventricular block"},{"idx":2,"correct":true,"proposition":"Atrioventricular dissociation"},{"idx":3,"correct":false,"proposition":"2:1 conductive atrial flutter to the ventricles"},{"idx":4,"correct":true,"proposition":"Third-degree atrioventricular block"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-86","context":null,"enonce":"A 70-year-old patient presents to the emergency room for palpitations that have been progressing for a week. He is dyspneic when climbing a floor. The electrocardiogram shows fine QRS atrial fibrillation with a ventricular cadence of 130 per minute. Blood pressure is at 140\/90 mmHg, saturation (SpO) is at 92%. The rest of the clinical examination is normal. Chest X-ray is normal. Blood ionogram, urea and serum creatinine are normal. Which of the following immediate therapeutic proposals is (are) accurate?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Amiodarone venous"},{"idx":1,"correct":false,"proposition":"Same-day electrical cardioversion"},{"idx":2,"correct":true,"proposition":"Unfractionated heparin via venous route"},{"idx":3,"correct":true,"proposition":"Digitoxin via venous route"},{"idx":4,"correct":false,"proposition":"Venous furosemide"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-87","context":null,"enonce":"A 66-year-old patient presents for consultation because her mother had age-related macular degeneration. She wishes to know which symptom(s) suggestive of this disease should lead her to consult urgently. What can you say to him?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Myodesopsias"},{"idx":1,"correct":true,"proposition":"Central scotomome"},{"idx":2,"correct":true,"proposition":"Metamorphopsies"},{"idx":3,"correct":false,"proposition":"Phosphenes"},{"idx":4,"correct":false,"proposition":"Bitemporal hemianopsia"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-88","context":null,"enonce":"Which of the following ametropia can (may) lead to monocular diplopia?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Myopia"},{"idx":1,"correct":true,"proposition":"Reverse astigmatism"},{"idx":2,"correct":false,"proposition":"Presbyopia"},{"idx":3,"correct":false,"proposition":"Farsightedness"},{"idx":4,"correct":true,"proposition":"Irregular astigmatism"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-89","context":null,"enonce":"A 74-year-old patient is referred to you for possible cataract surgery. What can be the functional sign(s) related to the development of a cataract?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Central scotomome"},{"idx":1,"correct":true,"proposition":"Decrease in visual acuity predominant by far"},{"idx":2,"correct":false,"proposition":"Myodesopsias"},{"idx":3,"correct":true,"proposition":"Photophobia"},{"idx":4,"correct":false,"proposition":"Phosphenes"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-90","context":null,"enonce":"In front of an eye redness occurring in a few days, in the absence of eye trauma, what are the elements that could point to acute anterior uveitis in a 30-year-old patient?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Identical, limiting ocular history under local corticosteroid treatment"},{"idx":1,"correct":true,"proposition":"History of low back pain"},{"idx":2,"correct":true,"proposition":"History of parotitis"},{"idx":3,"correct":true,"proposition":"History of bipolar aphthosis"},{"idx":4,"correct":false,"proposition":"History of diabetes in the family"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-92","context":null,"enonce":"A patient presents to the emergency room following a brawl two hours ago. He complains of pain in his right eye, and describes a decrease in visual acuity. What would be the eye lesions to be feared in this context?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Corneal wound"},{"idx":1,"correct":true,"proposition":"Subluxation or dislocation of the lens"},{"idx":2,"correct":true,"proposition":"Ocular hypertonia by recoil of the iridocorneal angle"},{"idx":3,"correct":true,"proposition":"Dehiscence or detachment of the retina"},{"idx":4,"correct":false,"proposition":"Internuclear ophthalmoplegia"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-93","context":null,"enonce":"Polyclonal hypergammaglobulinemia is (one or more exact answers):","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"A marker of inflammatory syndrome"},{"idx":1,"correct":true,"proposition":"Common during systemic lupus erythematosus"},{"idx":2,"correct":false,"proposition":"Common in multiple myeloma"},{"idx":3,"correct":true,"proposition":"Common during Sjögren's syndrome"},{"idx":4,"correct":true,"proposition":"Common during sarcoidosis"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-95","context":null,"enonce":"The biological marker(s) observed during macrophage activation syndrome is:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Thrombocytopenia"},{"idx":1,"correct":true,"proposition":"Hypofibrinogenemia"},{"idx":2,"correct":true,"proposition":"Hypertryglyceridemia"},{"idx":3,"correct":true,"proposition":"Hyperferritinemia"},{"idx":4,"correct":false,"proposition":"Hyperleukocytosis"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-96","context":null,"enonce":"An increase in the blood level of eosinophils may be observed in the following situation(s):","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Hodgkin's disease"},{"idx":1,"correct":false,"proposition":"Malaria"},{"idx":2,"correct":true,"proposition":"Systemic vasculitis"},{"idx":3,"correct":true,"proposition":"Ascariasis"},{"idx":4,"correct":true,"proposition":"Adrenal insufficiency"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-97","context":null,"enonce":"Of the following infections, indicate the one (s) due to Staphylococcus aureus.","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Toxic shock"},{"idx":1,"correct":true,"proposition":"Catheter infection"},{"idx":2,"correct":true,"proposition":"Pneumonia"},{"idx":3,"correct":true,"proposition":"Spondylodiscite"},{"idx":4,"correct":false,"proposition":"Erysipelas"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-98","context":null,"enonce":"What is (are) the symptom(s) encountered during pertussis?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Fever"},{"idx":1,"correct":true,"proposition":"Cough for several weeks"},{"idx":2,"correct":true,"proposition":"Emetogenic coughing fits"},{"idx":3,"correct":true,"proposition":"Syncopal cough"},{"idx":4,"correct":false,"proposition":"Hemoptysis"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-99","context":null,"enonce":"Which of the following viruses can induce congenital viral infections? D.","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Rubella virus"},{"idx":1,"correct":true,"proposition":"Cytomegalovirus (CMV)"},{"idx":2,"correct":true,"proposition":"Varicella zoster virus (VZV)"},{"idx":3,"correct":true,"proposition":"Herpes simplex virus (HSV)"},{"idx":4,"correct":false,"proposition":"Papillomavirus"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-100","context":null,"enonce":"A pregnant woman (11 weeks of amenorrhea), recently immigrated, was for several hours in contact with a little boy who developed the next day a febrile rash suggestive of rubella. This woman immediately consults her doctor. It has no notion of a previous vaccination. The rubella serology performed the same day is positive (presence of IgG) according to the validated standards of the laboratory. What can be concluded about the risk of congenital rubella related to the described exposure (indicate the correct answer(s))?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"A rubella IgM assay on the same serum of the patient is necessary before any interpretation"},{"idx":1,"correct":false,"proposition":"Rubella serology on a second serum of the patient is necessary before any interpretation"},{"idx":2,"correct":true,"proposition":"The patient is protected against rubella infection"},{"idx":3,"correct":false,"proposition":"The patient has biological signs of primary rubella infection"},{"idx":4,"correct":false,"proposition":"Further testing is useful following current exposure"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-101","context":null,"enonce":"Which proposal(s) is (are) the right proposal(s) concerning the action to be taken in the event of an accident involving exposure to blood by needlesticks?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Making the wound bleed"},{"idx":1,"correct":true,"proposition":"Clean the wound with running water"},{"idx":2,"correct":false,"proposition":"Use of hydroalcoholic solution"},{"idx":3,"correct":false,"proposition":"Dakin disinfection"},{"idx":4,"correct":false,"proposition":"Consultation with a referring physician to discuss the implementation of treatment"},{"idx":5,"correct":false,"proposition":"antiretroviral within one month"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-102","context":null,"enonce":"In front of axillary lymphadenopathy, unilateral, fistulized, evolving for three weeks in a 55-year-old woman, which cause(s) among the following seems to you (seem) compatible with this diagnosis? C. Primary infection with ","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Syphilis"},{"idx":1,"correct":false,"proposition":"Breast cancer"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-103","context":null,"enonce":"What is (are) the mechanism(s) involved in mononucleosis syndrome?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Proliferation of neutrophils"},{"idx":1,"correct":true,"proposition":"Activation of the lymphocyte immune response in response to an infectious agent in general viral"},{"idx":2,"correct":false,"proposition":"Monoclonal proliferation of a lymphocyte line"},{"idx":3,"correct":false,"proposition":"Proliferation of macrophage antigen-presenting cells"},{"idx":4,"correct":true,"proposition":"Activation of T cells"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-104","context":null,"enonce":"Which of the following proposal(s) on smoking is (are) erroneous?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"The minimum board has 5 questions"},{"idx":1,"correct":false,"proposition":"Fagerström's test evaluates pharmacological dependence on nicotine"},{"idx":2,"correct":false,"proposition":"Tobacco is estimated to kill 70,000 to 80,000 people a year in France"},{"idx":3,"correct":false,"proposition":"Second-hand smoke is a causal factor in sudden infant death syndrome"},{"idx":4,"correct":false,"proposition":"Smoking during pregnancy increases the risk of low birth weight"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-105","context":null,"enonce":"A 28-year-old woman, a non-smoker, underwent a chest x-ray as part of the assessment of a deterioration in the general condition associated with dyspnea and dysphonia. Which of the following proposals(s) is the right proposal(s)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Left inferior lobar atelectasis"},{"idx":1,"correct":true,"proposition":"Aortopulmonary window filling"},{"idx":2,"correct":true,"proposition":"Anterior mediastinal mass"},{"idx":3,"correct":true,"proposition":"Probable phrenic paralysis"},{"idx":4,"correct":true,"proposition":"Probable recurrent paralysis"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-106","context":null,"enonce":"What are the right answers regarding this pulmonary function test?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"VEMS\/FVC post-bronchodilation ratio of 63"},{"idx":1,"correct":false,"proposition":"FEV1\/FVC ratio pre-bronchodilation at 73"},{"idx":2,"correct":false,"proposition":"Restrictive ventilatory disorder"},{"idx":3,"correct":false,"proposition":"Completely reversible obstructive ventilatory disorder"},{"idx":4,"correct":true,"proposition":"Significantly reversible obstructive ventilatory disorder"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-107","context":null,"enonce":"During sarcoidosis, histological analysis of hilar lymphadenopathy conventionally shows epithelioid and gigantocellular granulomas. Which of the following conditions can (may) show a similar appearance?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Asthma"},{"idx":1,"correct":true,"proposition":"Common variable immunodeficiency"},{"idx":2,"correct":true,"proposition":"Lymphoma"},{"idx":3,"correct":false,"proposition":"Scleroderma"},{"idx":4,"correct":true,"proposition":"Silicosis"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-109","context":null,"enonce":"Regarding the scanner cut below, what is (are) the exact statement(s)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"There is a subcarenary mass"},{"idx":1,"correct":true,"proposition":"There is a mass in the mediastinum"},{"idx":2,"correct":false,"proposition":"You first request a transparietal needle puncture to obtain a diagnosis of certainty"},{"idx":3,"correct":false,"proposition":"You mention the diagnosis of germ cell tumour"},{"idx":4,"correct":false,"proposition":"You mention the diagnosis of neurogenic tumor"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-110","context":null,"enonce":"Which of the following can be a direct addressee(s) of a patient's cause of death?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"His beneficiaries, unless refused by the patient before his death"},{"idx":1,"correct":false,"proposition":"The patient's notary"},{"idx":2,"correct":false,"proposition":"The lawyer appointed by the patient's beneficiaries"},{"idx":3,"correct":false,"proposition":"The patient's attending physician"},{"idx":4,"correct":false,"proposition":"The doctor mandated by the death insurance company"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-111","context":null,"enonce":"What is (are) the circumstance(s) that should lead the physician to check the medical-legal obstacle box on a death certificate:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Sudden death in young adults"},{"idx":1,"correct":true,"proposition":"Suicide by hanging"},{"idx":2,"correct":true,"proposition":"Highway accident"},{"idx":3,"correct":false,"proposition":"Natural death expected in hospital"},{"idx":4,"correct":true,"proposition":"Sudden death syndrome of the child"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-112","context":null,"enonce":"Regarding the exchange of medical information, what is (are) the exact answer(s)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Physicians must ensure that professional secrecy is respected by their non-physician collaborators: secretaries and nurses"},{"idx":1,"correct":false,"proposition":"The sharing of medical information between healthcare professionals is limited to diagnostic information"},{"idx":2,"correct":true,"proposition":"Treating physicians may exchange information concerning a patient whom they treat together unless the latter objects to it."},{"idx":3,"correct":true,"proposition":"The transmission of medical information between doctors can lead to prosecution for non-compliance with medical confidentiality"},{"idx":4,"correct":false,"proposition":"A doctor can only provide medical information about a patient to another healthcare professional"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-113","context":null,"enonce":"Which of the following proposals falls within the remit of the High Authority for Health (HAS)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Certification of health facilities"},{"idx":1,"correct":true,"proposition":"Development of clinical practice guidelines"},{"idx":2,"correct":false,"proposition":"Collect and track adverse drug and health product events"},{"idx":3,"correct":false,"proposition":"Give authorization for the establishment of a phase III randomized therapeutic trial"},{"idx":4,"correct":true,"proposition":"Management of indicators for the improvement of the quality and safety of care (IPAQSS)"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-114","context":null,"enonce":"Which of the following people can be an investigator in a clinical research study?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"A general practitioner"},{"idx":1,"correct":false,"proposition":"A medical intern as part of his thesis"},{"idx":2,"correct":true,"proposition":"A public health physician"},{"idx":3,"correct":false,"proposition":"A midwife as part of her final thesis"},{"idx":4,"correct":true,"proposition":"A pharmacist"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-115","context":null,"enonce":"About the national program of indicators for the improvement of the quality and safety of care (IPAQSS), which of the following proposals, which is (are) accurate?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"It is managed by the High Authority of Health (HAS)"},{"idx":1,"correct":true,"proposition":"It is based on indicators that are reported by the institutions"},{"idx":2,"correct":true,"proposition":"One of the indicators collected relates to the maintenance of the patient's record"},{"idx":3,"correct":true,"proposition":"It includes the nosocomial infections dashboard"},{"idx":4,"correct":false,"proposition":"Indicators collected by institutions under this program are confidential"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-116","context":null,"enonce":"Which of the following measures constitutes a secondary prevention measure in oncology?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Offer hepatitis B vaccination to all children"},{"idx":1,"correct":true,"proposition":"Offer a blood test in the stool regularly, from the age of 50"},{"idx":2,"correct":true,"proposition":"Have a mammogram regularly, from the age of 50"},{"idx":3,"correct":true,"proposition":"Regularly perform a cervico-vaginal smear"},{"idx":4,"correct":false,"proposition":"Promoting smoking cessation"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-117","context":null,"enonce":"Which of the following areas of responsibility is covered by the Regional Health Agencies (RHAs)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Regional health security"},{"idx":1,"correct":false,"proposition":"Authorization to practice for liberal practitioners"},{"idx":2,"correct":true,"proposition":"The organization of the provision of care according to the needs of the population"},{"idx":3,"correct":true,"proposition":"Prevention actions in the region"},{"idx":4,"correct":false,"proposition":"Maternal and child protection"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-118","context":null,"enonce":"Verapamil (Isoptine®) and diltiazem (Bitildiem®):","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Are brakers at the atrioventricular node"},{"idx":1,"correct":true,"proposition":"Are brakers of the atrial knot"},{"idx":2,"correct":false,"proposition":"The usual digestive effect is diarrhea"},{"idx":3,"correct":true,"proposition":"May cause edema of the lower limbs"},{"idx":4,"correct":false,"proposition":"Are inotropic indifferent"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2016-qi-120","context":null,"enonce":"Thiazide diuretics:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Can be used in heart failure"},{"idx":1,"correct":true,"proposition":"May increase uricemia"},{"idx":2,"correct":false,"proposition":"May decrease serum calcium"},{"idx":3,"correct":false,"proposition":"May cause gynecomastia"},{"idx":4,"correct":false,"proposition":"Have a brutal and rapid effect on diuresis"}],"ts":{"$numberLong":"1647170687166"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-III","context":null,"enonce":"The Mini Nutritionna\/Assessment (or MNA) nutritional test:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Is a test with a total score out of 30 points","justification":""},{"idx":1,"correct":true,"proposition":"Is a test that defines malnutrition if the score is less than 23 5 points","justification":""},{"idx":2,"correct":true,"proposition":"Is a test that defines malnutrition if the score is less than 17 points","justification":""},{"idx":3,"correct":false,"proposition":"Is a test that requires the calculation of body mass index","justification":""},{"idx":4,"correct":true,"proposition":"Is a test that takes into account the presence of neuropsychological problems","justification":""}],"ts":{"$numberLong":"1665138642163"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-III","context":null,"enonce":"A woman of Martinican origin has just given birth. The child's father is also of Martinican origin. The child has a cleft lip and palate. With regard to regulatory newborn screening of this child, what is the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Phenylketonuria is the only disease of amino acid and organic acid metabolism currently being screened for newborn in France","justification":"Now there is the MCAD deficiency"},{"idx":1,"correct":false,"proposition":"General screening test can detect hypothyroidism of pituitary origin","justification":""},{"idx":2,"correct":true,"proposition":"This couple can refuse the screening after information","justification":""},{"idx":3,"correct":true,"proposition":"Completion before 48 h of life decreases the sensitivity and\/or specificity of the screening test","justification":""},{"idx":4,"correct":false,"proposition":"Targeted screening for sickle cell disease is not indicated in this child","justification":""}],"ts":{"$numberLong":"1665138862799"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-1","context":null,"enonce":"A 14-month-old infant comes to see for repeated cold episodes. The nose runs, then he coughs day and night, wakes up several times at night and is sometimes very short of breath. These episodes have been monthly since the age of 6 months, when he had bronchiolitis that was easy to treat. It has good growth in staturo-weight and << everything is going well >> between episodes. On this day, you see only clear rhinitis. The rest of the exam is normal. What do you offer?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Continue nose washes","justification":""},{"idx":1,"correct":false,"proposition":"Do chest physiotherapy sessions","justification":""},{"idx":2,"correct":true,"proposition":"Prescribe a frontal chest x-ray","justification":""},{"idx":3,"correct":false,"proposition":"Starting a long-acting bronchodilator","justification":""},{"idx":4,"correct":true,"proposition":"Start inhaled corticosteroid therapy","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-2","context":null,"enonce":"A 5-year-old boy, feverish at 38 ° C comes for respiratory discomfort with his chest X-ray requested by his doctor. He has had a cold for 3 days. In this context, which diagnosis(s) should be mentioned?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Left pleurisy","justification":""},{"idx":1,"correct":false,"proposition":"Interstitial lung disease","justification":""},{"idx":2,"correct":true,"proposition":"Myocarditis","justification":""},{"idx":3,"correct":true,"proposition":"Pericarditis","justification":""},{"idx":4,"correct":false,"proposition":"Lymphoma","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-3","context":null,"enonce":"A 2-month-old girl comes for consultation in December for respiratory discomfort. You refer him to pediatric emergencies. What element(s) of your review led you to this decision?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"A heart rate of 120\/min","justification":""},{"idx":1,"correct":true,"proposition":"A catch of 2 feedings in the last 24 hours","justification":""},{"idx":2,"correct":false,"proposition":"Audible hissing sounds outside of auscultation","justification":""},{"idx":3,"correct":false,"proposition":"A flapping of the wings of the nose","justification":""},{"idx":4,"correct":true,"proposition":"A respiratory rate of 65\/min","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-4","context":null,"enonce":"In a pregnant woman who had severe pre-eclampsia at 30 weeks of amenorrhea, which of the following is (are) correct about the use of low-dose aspirin?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"This treatment prevents any recurrence of pre-eclampsia","justification":""},{"idx":1,"correct":true,"proposition":"This treatment should be started preferentially before 15 weeks of amenorrhea","justification":""},{"idx":2,"correct":false,"proposition":"This treatment is administered according to the Doppler of the uterine arteries","justification":""},{"idx":3,"correct":false,"proposition":"This treatment includes 500 mg of aspirin","justification":""},{"idx":4,"correct":false,"proposition":"This treatment must be maintained until the end","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-5","context":null,"enonce":"What are (are) the possible antihypertensive treatment(s) during pregnancy?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Calcium channel blockers","justification":""},{"idx":1,"correct":false,"proposition":"Diuretics","justification":""},{"idx":2,"correct":true,"proposition":"Central antihypertensives","justification":""},{"idx":3,"correct":true,"proposition":"Blockers","justification":""},{"idx":4,"correct":false,"proposition":"IEC","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-7","context":null,"enonce":"What is (are) the factor(s) of poor prognosis of breast cancer?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"The inflammatory character","justification":""},{"idx":1,"correct":true,"proposition":"The absence of estrogen hormone receptors","justification":""},{"idx":2,"correct":true,"proposition":"Vascular emboluses","justification":""},{"idx":3,"correct":false,"proposition":"The association of an important intraductal component with the infiltrating component","justification":""},{"idx":4,"correct":true,"proposition":"High histological grade","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-8","context":null,"enonce":"In the most common form of trisomy 21 in the fetus, which is (are) the exact proposition(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"The measurement of nuchal translucency is usually increased","justification":""},{"idx":1,"correct":true,"proposition":"The free fraction of beta HCG is conventionally increased in the 1st trimester","justification":""},{"idx":2,"correct":false,"proposition":"PAPP-A (pregnancy associated placenta protein A) is classically decreased in the 2nd trimester","justification":""},{"idx":3,"correct":false,"proposition":"Alphafetoprotein in the 1st trimester is increased","justification":""},{"idx":4,"correct":true,"proposition":"All fetal cells are affected","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-9","context":null,"enonce":"In newborns the risk of nuclear jaundice:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Is absent in full-term infants","justification":""},{"idx":1,"correct":true,"proposition":"Increases if jaundice begins before the 24th hour of life","justification":""},{"idx":2,"correct":false,"proposition":"Is less important in premature infants","justification":""},{"idx":3,"correct":false,"proposition":"Is linked to the neurotoxicity of conjugated bilirubin","justification":""},{"idx":4,"correct":false,"proposition":"Rarely engages long-term neurological prognosis","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-10","context":null,"enonce":"A 53-year-old patient consults you for abnormalities of the blood count which shows: leukocytes 18.4 G \/ L; neutrophils 5.4 G\/L; eosinophilic polynuclear 0.2 G\/L; lymphocytes 12.3 G\/L; monocytes 0.5 G\/L; haemoglobin 13.5 g\/dL; VGM 84 fL; blisters 256 G\/L. Clinical examination found isolated centimetric cervical lymphadenopathy. Matutes' score is 5\/5. How do you complete your balance sheet?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Thoraco-abdominopelvic CT scan with iodinated contrast medium injection","justification":""},{"idx":1,"correct":false,"proposition":"PET-scanner","justification":""},{"idx":2,"correct":true,"proposition":"Serum protein electrophoresis","justification":""},{"idx":3,"correct":true,"proposition":"Direct Coombs test","justification":""},{"idx":4,"correct":false,"proposition":"Lymph node biopsy with histological examination","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-11","context":null,"enonce":"A 63-year-old patient consults you for intense asthenia. She has a mucocutaneous pallor. The clinical examination does not find hepatosplenomegaly. A first biological assessment shows: leukocytes 2.5 G \/ L; PNN 1.2 G\/L; lymphocytes 1.1 G\/L; monocytes 0.2 G\/L; Hb 8.3 g\/dL; VGM 109 fL; reticulocytes 22 G\/L; blisters 90 G\/L. Blood biochemistry finds: AST 23 IU\/L; ALT 27 IU\/L; total bilirubin 45 μmol\/L; free bilirubin 42 μmol \/ L; LDH 820 IU\/L; haptoglobin 0.1 g\/L. You mention:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Evans syndrome","justification":""},{"idx":1,"correct":true,"proposition":"Myelodysplastic syndrome","justification":""},{"idx":2,"correct":true,"proposition":"Biermer's disease","justification":""},{"idx":3,"correct":false,"proposition":"A MAT","justification":""},{"idx":4,"correct":false,"proposition":"Multiple myeloma","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-12","context":null,"enonce":"ACE inhibitors can cause: ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Functional acute renal failure (AIRD)","justification":""},{"idx":1,"correct":false,"proposition":"Hypokalemia","justification":""},{"idx":2,"correct":true,"proposition":"Bradykinin angioedema","justification":""},{"idx":3,"correct":false,"proposition":"Increased resistance of the glomerular efferent arteriole","justification":""},{"idx":4,"correct":true,"proposition":"A decrease in glomerular filtration pressure","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-13","context":null,"enonce":"What lesion(s) can be observed on the renal biopsy during rapidly progressive glomerulonephritis?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Linear deposition of IgG in immunofluorescence","justification":""},{"idx":1,"correct":true,"proposition":"Granular deposits of IgG in immunofluorescence","justification":""},{"idx":2,"correct":false,"proposition":"Congo red birefringent fibrillar deposits","justification":""},{"idx":3,"correct":true,"proposition":"Extracapillary croissants","justification":""},{"idx":4,"correct":true,"proposition":"Microvascular lesions with fibrinoid necrosis","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-14","context":null,"enonce":"In the context of the constitution of an expert group before the marketing of a new molecule, in which of the following situations can an expert doctor have a link of interest?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"If he worked for 30 years in the industry developing the molecule until he retired 2 years ago","justification":""},{"idx":1,"correct":true,"proposition":"If he has been paid by the pharmaceutical industry to teach general practitioners","justification":""},{"idx":2,"correct":false,"proposition":"If it has already published results questioning the interest of this new molecule, as part of a research program funded by public funds","justification":""},{"idx":3,"correct":true,"proposition":"If he has been paid by the manufacturer to include patients in phase III trials that evaluated this new molecule","justification":""},{"idx":4,"correct":true,"proposition":"If the son of this doctor is a medical delegate for the industry marketing the molecule","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-15","context":null,"enonce":"Areas of interest to indicators for improving the quality and safety of care (IPAQSS) include:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"The rate of methicillin-resistant staphylococci","justification":""},{"idx":1,"correct":true,"proposition":"Keeping the patient record","justification":""},{"idx":2,"correct":true,"proposition":"Operating compliance of PCRs in oncology","justification":""},{"idx":3,"correct":false,"proposition":"Screening for nutritional disorders","justification":""},{"idx":4,"correct":false,"proposition":"Surgical site infections","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-16","context":null,"enonce":"Which of the following proposals on the roles played by Regional Health Agencies (RHAs) at the regional level is correct?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"They are responsible for health monitoring and security at the regional level","justification":""},{"idx":1,"correct":true,"proposition":"They are responsible for prevention and health promotion","justification":""},{"idx":2,"correct":false,"proposition":"They are responsible for university preventive medicine","justification":""},{"idx":3,"correct":true,"proposition":"They are responsible for providing care in each health territory of the region.","justification":""},{"idx":4,"correct":true,"proposition":"They are responsible for the accreditation of medical internship sites in the region.","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-17","context":null,"enonce":"Which of the following study designs would allow us to study the relationship between coffee consumption and the risk of developing Alzheimer's disease?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"The follow-up of a cohort of several thousand patients with Alzheimer's disease","justification":""},{"idx":1,"correct":true,"proposition":"A study in which subjects with Alzheimer's disease and an equivalent number of subjects without dementia would be included","justification":""},{"idx":2,"correct":true,"proposition":"A study conducted on a population of subjects over 60 years of age free of dementia at baseline and followed for 10 years or more","justification":""},{"idx":3,"correct":false,"proposition":"A comprehensive study based on data on notifiable diseases","justification":""},{"idx":4,"correct":false,"proposition":"A study of the prevalence of coffee consumption in a representative sample of the general population","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-18","context":null,"enonce":"Infantile hemangiomas:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Appear in the perinatal period","justification":""},{"idx":1,"correct":true,"proposition":"May have skin, subcutaneous or combination (cutaneous and subcutaneous) development","justification":""},{"idx":2,"correct":true,"proposition":"At risk of ulceration and superficial necrosis","justification":""},{"idx":3,"correct":false,"proposition":"Affect boys more frequently","justification":""},{"idx":4,"correct":false,"proposition":"Are rarer than vascular malformations","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-19","context":null,"enonce":"Among the following examinations, which is the most efficient for the analysis of the morphology of a tooth root?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Orthopantomogram (dental panoramic)","justification":""},{"idx":1,"correct":false,"proposition":"Occlusal bitten cliché","justification":""},{"idx":2,"correct":false,"proposition":"Blondeau incidence (nose-chin-plate incidence)","justification":""},{"idx":3,"correct":true,"proposition":"Retro-alveolar image","justification":""},{"idx":4,"correct":false,"proposition":"Low-facing incidence","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-20","context":null,"enonce":"Which of the following imaging tests shows the temporomandibular joints?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Dental panoramic picture (orthopantomogram)","justification":""},{"idx":1,"correct":true,"proposition":"Low-side incidence","justification":""},{"idx":2,"correct":true,"proposition":"Teleradiography of the skull in profile","justification":""},{"idx":3,"correct":true,"proposition":"Computed tomography of the face (CT)","justification":""},{"idx":4,"correct":true,"proposition":"Nuclear magnetic resonance imaging (MRI)","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-21","context":null,"enonce":"For skin tumours of the face, please indicate the exact proposal(s):","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Tobacco is the main risk factor for developing basal cell carcinoma","justification":""},{"idx":1,"correct":true,"proposition":"Squamous cell carcinomas are more lymphophilic than basal cell carcinomas","justification":""},{"idx":2,"correct":false,"proposition":"Melanoma is a tumor exclusively with a cutaneous starting point","justification":""},{"idx":3,"correct":false,"proposition":"Melanomas are more common than basal cell carcinomas","justification":""},{"idx":4,"correct":true,"proposition":"The treatment of skin cancers is mainly based on surgery","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-22","context":null,"enonce":"A professional hockey player fell on the ice with a mandibular impact. The orthopantomogram performed is as follows: ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"There is a bifocal fracture of the mandible","justification":""},{"idx":1,"correct":false,"proposition":"One of the fracture features passes through the left mandibular neck","justification":""},{"idx":2,"correct":false,"proposition":"A fracture line passes through tooth No. 37","justification":""},{"idx":3,"correct":true,"proposition":"A fracture line passes behind tooth No. 33","justification":""},{"idx":4,"correct":true,"proposition":"Tooth No. 38 is missing","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-23","context":null,"enonce":"Regarding the anatomy of the eyelids:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Lacrimal punctums are lateral","justification":""},{"idx":1,"correct":true,"proposition":"The elevator muscle of the upper eyelid is inserted on the tarsus","justification":""},{"idx":2,"correct":true,"proposition":"Both eyelids delimit the palpebral cleft","justification":""},{"idx":3,"correct":true,"proposition":"The orbicular muscle of the eye is innervated by the facial nerve","justification":""},{"idx":4,"correct":false,"proposition":"The upper eyelid lift muscle is innervated by the facial nerve","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-24","context":null,"enonce":"You see a 6-month-old infant with no history before a one-month trip to Côte d'Ivoire (group 3 countries). What malaria prevention measure(s) are you prescribing for this infant?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"The use of an insecticide-treated net","justification":""},{"idx":1,"correct":true,"proposition":"The use of skin repellents","justification":""},{"idx":2,"correct":false,"proposition":"Chemoprophylaxis with chloroquine and proguanil","justification":""},{"idx":3,"correct":false,"proposition":"Chemoprophylaxis with atovaquone-proguanil","justification":""},{"idx":4,"correct":false,"proposition":"Chemoprophylaxis with artemeter-lumefantrine","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-25","context":null,"enonce":"Which of the following occupations is associated with an increased risk of bladder cancer?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Plasterer","justification":""},{"idx":1,"correct":true,"proposition":"Dye industry worker","justification":""},{"idx":2,"correct":true,"proposition":"Foundry worker","justification":""},{"idx":3,"correct":false,"proposition":"Baker","justification":""},{"idx":4,"correct":false,"proposition":"Nurse","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-26","context":null,"enonce":"In the context of a work stoppage relating to an occupational disease, indicate the exact proposal(s):","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"The occupational physician receives the obligatory employee during his return to work during his return to work.","justification":""},{"idx":1,"correct":false,"proposition":"The pre-recovery visit makes it possible to determine the date of consolidation of the disease","justification":""},{"idx":2,"correct":true,"proposition":"The pre-resumption visit makes it possible to plan a possible shift adjustment when work resumes","justification":""},{"idx":3,"correct":false,"proposition":"A systematic visit at the initiative of the occupational physician is planned one month after the resumption","justification":""},{"idx":4,"correct":false,"proposition":"The follow-up visit may be carried out by the attending physician at the request of the employer in the absence of the occupational physician.","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-27","context":null,"enonce":"Which of the following can be seen in a woman with polycystic ovary syndrome? Indicate the correct answer(s):","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Hirsutism","justification":""},{"idx":1,"correct":true,"proposition":"Normal estradiol","justification":""},{"idx":2,"correct":true,"proposition":"Increased testosterone","justification":""},{"idx":3,"correct":true,"proposition":"Normal FSH","justification":""},{"idx":4,"correct":true,"proposition":"Increased prolactin","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-28","context":null,"enonce":"In diabetic retinopathy:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Decreased visual acuity is early by macular edema","justification":""},{"idx":1,"correct":false,"proposition":"Retinal microaneurysms are mostly peripheral","justification":""},{"idx":2,"correct":true,"proposition":"In the absence of diabetic retinopathy, ophthalmological monitoring should be annual","justification":""},{"idx":3,"correct":true,"proposition":"The management of a diabetic involves glycemic and arterial blood pressure control","justification":""},{"idx":4,"correct":false,"proposition":"Laser photocoagulation treatment is indicated only for complicated stages of retinal detachment","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-29","context":null,"enonce":"A patient is treated by his ophthalmologist for primary open-angle glaucoma. You are his general practitioner, he asks you for information about his disease. What is (are) the element(s) you can give it?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Central visual acuity is affected only late.","justification":""},{"idx":1,"correct":true,"proposition":"The main element of follow-up is the examination of the visual field.","justification":""},{"idx":2,"correct":false,"proposition":"Monitoring of the retinal periphery is a major component of monitoring.","justification":""},{"idx":3,"correct":true,"proposition":"The patient should warn any new doctor of his glaucoma because some local treatments have systemic effects.","justification":""},{"idx":4,"correct":true,"proposition":"Monitoring of intraocular pressure is useful but not sufficient to judge the effectiveness of treatment.","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-30","context":null,"enonce":"In front of a non-traumatic acute neck pain in a 30-year-old woman, you can immediately realize in first intention?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"A prescription of NSAIDs","justification":""},{"idx":1,"correct":false,"proposition":"A physiotherapy prescription","justification":""},{"idx":2,"correct":false,"proposition":"Corticosteroid infiltration","justification":""},{"idx":3,"correct":false,"proposition":"Spinal manipulation","justification":""},{"idx":4,"correct":false,"proposition":"A flexible neck brace prescription","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-31","context":null,"enonce":"A 30-year-old patient, of normal build and with normal physical activity and diet, has type 1 diabetes that has been evolving for 5 years. Indicate the exact proposal(s):","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"The daily dose of insulin is usually 0.5 to 0.7 units\/kg weight\/day","justification":""},{"idx":1,"correct":true,"proposition":"Insulin glargine is given once a day","justification":""},{"idx":2,"correct":false,"proposition":"Basal insulin should be discontinued in case of fasting examination","justification":""},{"idx":3,"correct":true,"proposition":"Rapid insulin can be used occasionally to correct hyperglycemia","justification":""},{"idx":4,"correct":true,"proposition":"The dosage of prandial insulin depends on the amount of carbohydrates ingested during the meal","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-32","context":null,"enonce":"What is the correct answer(s) regarding the pathophysiology of asthma?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Activation of nerve fibers responsible for bronchodilation","justification":""},{"idx":1,"correct":false,"proposition":"Overexpression of interleukin 10 (IL-10) and TNFa","justification":""},{"idx":2,"correct":true,"proposition":"Inflammation TH2","justification":""},{"idx":3,"correct":true,"proposition":"Bronchial remodeling","justification":""},{"idx":4,"correct":false,"proposition":"Vascular remodeling","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-33","context":null,"enonce":"A 15-year-old girl consults for coughing and wheezing. You learn from the interrogation that these symptoms are intermittent and occur preferentially at the end of the night and in the morning. Which exam(s) do you perform as a first-line test?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"ECG","justification":""},{"idx":1,"correct":false,"proposition":"Total IgE","justification":""},{"idx":2,"correct":false,"proposition":"D-dimer","justification":""},{"idx":3,"correct":false,"proposition":"Pertussis serology","justification":""},{"idx":4,"correct":true,"proposition":"Spirometry","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-34","context":null,"enonce":"What is the exact proposal(s) regarding thyroid physiology?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"TSH stimulates thyroocyte proliferation","justification":""},{"idx":1,"correct":true,"proposition":"Triiodothyronine is the active hormone","justification":""},{"idx":2,"correct":true,"proposition":"Thyroid hormones increase bone turnover","justification":""},{"idx":3,"correct":false,"proposition":"Thyroid hormones are vasoconstrictors","justification":""},{"idx":4,"correct":true,"proposition":"Thyroid hormones increase gluconeogenesis","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-35","context":null,"enonce":"You asked for a TSH test in a 34-year-old woman, in front of weight loss. TSH is indosable. What additional examination(s) would you like before treatment?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Free T4 assay","justification":""},{"idx":1,"correct":false,"proposition":"Thyroglobulin testing","justification":""},{"idx":2,"correct":false,"proposition":"Determination of anti-thyroperoxidase antibodies","justification":""},{"idx":3,"correct":true,"proposition":"Determination of anti-TSH receptor antibodies","justification":""},{"idx":4,"correct":false,"proposition":"Thyrocalcitonin dosage","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-36","context":null,"enonce":"Damage to the right trigeminal nerve can manifest as: ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"An abolition of the right corneal reflex","justification":""},{"idx":1,"correct":false,"proposition":"Right facial paralysis","justification":""},{"idx":2,"correct":true,"proposition":"Amyotrophy of the right masseter muscle","justification":""},{"idx":3,"correct":false,"proposition":"A hypoaesthesia of the right masseterine notch","justification":""},{"idx":4,"correct":false,"proposition":"An agueusia of the anterior 2\/3 of the right hemi-tongue","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-37","context":null,"enonce":"A 30-year-old motorcyclist patient is hospitalized following a road accident. Which immediate sign(s) is compatible with complete spinal cord syndrome level T10?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Motor deficit of the four members","justification":""},{"idx":1,"correct":false,"proposition":"Suspended motor deficit of the upper limbs","justification":""},{"idx":2,"correct":false,"proposition":"Normal sensitivity above the umbilicus","justification":""},{"idx":3,"correct":true,"proposition":"Acute urine retention","justification":""},{"idx":4,"correct":true,"proposition":"Abolition of tendon reflexes in the lower limbs","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-38","context":null,"enonce":"A cerebral infarction in the territory of the left middle cerebral artery in a right-handed person may be responsible for the following sign(s). ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Aphasia","justification":""},{"idx":1,"correct":false,"proposition":"Horizontal diplopia","justification":""},{"idx":2,"correct":false,"proposition":"Left hemineglect","justification":""},{"idx":3,"correct":false,"proposition":"Left homonymous lateral hemianopsia","justification":""},{"idx":4,"correct":false,"proposition":"Right central facial paralysis","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-39","context":null,"enonce":"Regarding narcolepsy, what statement(s) is(are) accurate? ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Defined by a sudden loss of tone","justification":""},{"idx":1,"correct":false,"proposition":"Is characterized by excess irrepressible daytime sleepiness","justification":""},{"idx":2,"correct":true,"proposition":"May be associated with cataplexy","justification":""},{"idx":3,"correct":false,"proposition":"Temporal signal abnormalities are frequently found on MRI","justification":""},{"idx":4,"correct":false,"proposition":"There may be sleep paralysis","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-40","context":null,"enonce":"A 37-year-old man has been presenting urgently for a red and painful right eye for 24 hours. With correction, you measure a visual acuity of 12\/10 from afar and Parinaud 2 up close to both eyes. What are the possible etiologies of the symptoms described by this patient?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Allergic conjunctivitis","justification":""},{"idx":1,"correct":true,"proposition":"Scleritis","justification":""},{"idx":2,"correct":true,"proposition":"Foreign body in the conjunctival cul-de-sac","justification":""},{"idx":3,"correct":false,"proposition":"Intravitreal hemorrhage","justification":""},{"idx":4,"correct":false,"proposition":"Retinal vasculitis","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-41","context":null,"enonce":"A 62-year-old patient, hyperopic and of Asian origin, has a narrow iridocorneal angle. She has not yet received a preventive laser iridotomy. What factor(s) could (could) promote the occurrence of an acute hypertonia attack by closing the angle?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Taking morphine","justification":""},{"idx":1,"correct":false,"proposition":"Taking p aracetamol","justification":""},{"idx":2,"correct":true,"proposition":"Taking atropine","justification":""},{"idx":3,"correct":true,"proposition":"Instillation in the eyes of tropicamide","justification":""},{"idx":4,"correct":false,"proposition":"Instillation in the eyes of pilocarpine","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-42","context":null,"enonce":"A 90-year-old man with chronic renal failure has a 60 mm major axis erythematous cupboard in the mid-thoracic region. The lesion is asymptomatic and has been evolving for 30 years. What diagnosis do you remember?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Bowen's disease","justification":""},{"idx":1,"correct":false,"proposition":"Plaque psoriasis","justification":""},{"idx":2,"correct":false,"proposition":"Superficial extension melanoma","justification":""},{"idx":3,"correct":true,"proposition":"Superficial basal cell carcinoma","justification":""},{"idx":4,"correct":false,"proposition":"Chronic lichenified eczema","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-44","context":null,"enonce":"A 45-year-old man consults in front of the appearance of erythematous lesions infiltrated of the right cheek appeared for a few weeks. The general condition is preserved. What diagnoses can you evoke in front of this table? Cutaneous sarcoidosis Among these proposals concerning the bacterial species Escherichia coli, which is (are) accurate?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"This bacterial species is part of the family of enterobacteriaceae","justification":""},{"idx":1,"correct":true,"proposition":"It can be responsible for hemolytic uremic syndrome -","justification":""},{"idx":2,"correct":false,"proposition":"C.","justification":""},{"idx":3,"correct":false,"proposition":"It is sensitive to amoxicillin in less than 10% of cases","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-45","context":null,"enonce":"Which of the following proposals on mother-to-child transmission of HIV is the right one: ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"The risk of transmission is greater in the first trimester of pregnancy","justification":""},{"idx":1,"correct":true,"proposition":"Risk is related to maternal plasma HIV load during childbirth","justification":""},{"idx":2,"correct":true,"proposition":"Antiretroviral therapy should be started in the mother as soon as HIV infection is diagnosed","justification":""},{"idx":3,"correct":false,"proposition":"A caesarean section must be performed there to prevent transmission.","justification":""},{"idx":4,"correct":true,"proposition":"Antiretroviral therapy should be started at birth in the child to prevent transmission","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-46","context":null,"enonce":"In the context of community-acquired acute pneumonia, what is the true proposition(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Hyponatremia is specific to legionellosis","justification":""},{"idx":1,"correct":false,"proposition":"B.","justification":""},{"idx":2,"correct":false,"proposition":"Pneumococcal pneumonia and legionellosis are notifiable diseases","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-47","context":null,"enonce":"A 42-year-old woman with Hodgkin's disease started pneumocystosis prophylaxis with ® trimethoprim sulfamethoxazole (Bactrim) for 10 days. She presents to the emergency room with a picture of painful acute febrile exanthema accompanied by pharyngitis and burning eyes. The examination shows the following lesions. What diagnosis do you mention?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Syndrome de Stevens Johnson","justification":""},{"idx":1,"correct":true,"proposition":"Toxic epidermal necrolysis (Lyell's syndrome)","justification":""},{"idx":2,"correct":false,"proposition":"Pemphigus induced","justification":""},{"idx":3,"correct":false,"proposition":"Staphylococcal epidermolysis","justification":""},{"idx":4,"correct":false,"proposition":"Erythema multiforme","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-49","context":null,"enonce":"In the face of a hemorrhagic syndrome, which is (are) the element(s) that point to an abnormality of primary hemostasis ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Mucocutaneous hemorrhages","justification":""},{"idx":1,"correct":true,"proposition":"Delayed bleeding","justification":""},{"idx":2,"correct":true,"proposition":"Petechial purpura","justification":""},{"idx":3,"correct":false,"proposition":"Hemarthrosis","justification":""},{"idx":4,"correct":false,"proposition":"Hematoma of the psoas","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-50","context":null,"enonce":"A 23-year-old patient is hospitalized against a background of pancytopenia. You mention the diagnosis of acute pro-myelocytic leukemia in front of the presence of numerous bruises. Which abnormality(s) of hemostasis is (are) compatible with this diagnosis?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"A hypofibrinogenem","justification":""},{"idx":1,"correct":false,"proposition":"An increase in antithrombin levels","justification":""},{"idx":2,"correct":true,"proposition":"A decrease in factor V levels","justification":""},{"idx":3,"correct":true,"proposition":"An extension of the Cephalin Time + activateun","justification":""},{"idx":4,"correct":true,"proposition":"An increase in D-Dimer","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-51","context":null,"enonce":"A 58-year-old patient, a 35-PA smoker, consults for progressive onset dyspnea during the last semester. This dyspnea is accompanied by a dry cough. Pulmonary and cardiac auscultation is unremarkable. Here are his EFRs. What is your conclusion(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Obstructive ventilatory disorder","justification":""},{"idx":1,"correct":false,"proposition":"FEV1\/FVC ratio pre-bronchodilation to III","justification":""},{"idx":2,"correct":false,"proposition":"Partially reversible restrictive ventilatory disorder","justification":""},{"idx":3,"correct":true,"proposition":"Restrictive ventilatory disorder","justification":""},{"idx":4,"correct":false,"proposition":"These EFRs are compatible with a GOLD II stage COPD","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-52","context":null,"enonce":"Which of the following proposals regarding risk factors for lung cancer is the right one?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Exposure to asbestos is considered a risk factor","justification":""},{"idx":1,"correct":false,"proposition":"It is the primary current, which is the main carcinogenic risk factor related to passive smoking","justification":""},{"idx":2,"correct":true,"proposition":"The spouse (non-smoker) of a smoker has a 20-30% increased risk of lung cancer","justification":""},{"idx":3,"correct":false,"proposition":"Carbon monoxide (CO), resulting from incomplete carbon combustion, is considered a risk factor","justification":""},{"idx":4,"correct":false,"proposition":"Alkaline persulfates used by hairdressers are considered a risk factor","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-53","context":null,"enonce":"Which of the following proposals regarding transudative pleural effusions is(are) accurate?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"They can be consecutive to bacterial pneumonia","justification":""},{"idx":1,"correct":true,"proposition":"They can be consecutive to a pulmonary embolism","justification":""},{"idx":2,"correct":false,"proposition":"They can be consecutive to viral pneumonia","justification":""},{"idx":3,"correct":false,"proposition":"They may be consecutive to metastatic effusion","justification":""},{"idx":4,"correct":true,"proposition":"They may be consecutive to pulmonary atelectasis","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-54","context":null,"enonce":"About cholitis, what is the exact proposal(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"It results in the successive appearance of three signs: pain, pruritus, jaundice","justification":""},{"idx":1,"correct":true,"proposition":"There is most often an increase in predominantly conjugated bilirubinemia","justification":""},{"idx":2,"correct":true,"proposition":"At first, there may be cytolysis greater than 5 times the upper limit of normal","justification":""},{"idx":3,"correct":true,"proposition":"It may reveal a pancreatic tumour","justification":""},{"idx":4,"correct":true,"proposition":"Endoscopic retrograde biliary disobstruction with sphincterotomy should be discussed urgently","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-55","context":null,"enonce":"Secondary hypertension with low renin, hypokalaemia and kaliuresis > 20 mmol\/L may be linked to 11 ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Renal artery stenosis","justification":""},{"idx":1,"correct":true,"proposition":"Excessive consumption of licorice A deficiency of b-hydroxy-dehydrogenase","justification":""},{"idx":2,"correct":true,"proposition":"C.","justification":""},{"idx":3,"correct":true,"proposition":"Liddle's syndrome","justification":""},{"idx":4,"correct":false,"proposition":"21-hydroxylase deficiency","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-56","context":null,"enonce":"In front of renal colic, what are the factors of gravity requiring a urological opinion (one or more possible correct answers)? Rossess, ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Single kidney","justification":""},{"idx":1,"correct":true,"proposition":"Pregnancy","justification":""},{"idx":2,"correct":true,"proposition":"Anuria","justification":""},{"idx":3,"correct":true,"proposition":"Fever","justification":""},{"idx":4,"correct":false,"proposition":"Haematuria","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-57","context":null,"enonce":" What biological abnormality(ies) is present in systemic lupus erythematosus?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Presence of circulating immune complexes","justification":""},{"idx":1,"correct":false,"proposition":"Thrombocytosis","justification":""},{"idx":2,"correct":true,"proposition":"Coombs test positive","justification":""},{"idx":3,"correct":true,"proposition":"Spontaneous prolongation of the TCA","justification":""},{"idx":4,"correct":true,"proposition":"Polyclonal increase in gamma globulins","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-59","context":null,"enonce":"About gastrointestinal stromal tumours (GIST), which is (are) the exact proposal(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"They most often develop in the muscular layer","justification":""},{"idx":1,"correct":true,"proposition":"The stomach is the most common primitive location of GIST","justification":""},{"idx":2,"correct":true,"proposition":"GISTs are frequently diagnosed incidentally during a digestive endoscopy","justification":""},{"idx":3,"correct":false,"proposition":"They do not metastasize","justification":""},{"idx":4,"correct":false,"proposition":"They are characterized in immunohistochemistry by the expression of c-kit (CD117)","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-60","context":null,"enonce":"Which vessel(s) are directly related to the pancreas?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"The portal vein","justification":""},{"idx":1,"correct":true,"proposition":"The superior mesenteric vein","justification":""},{"idx":2,"correct":false,"proposition":"The inferior mesenteric artery","justification":""},{"idx":3,"correct":false,"proposition":"Gastroduodenal artery","justification":""},{"idx":4,"correct":true,"proposition":"Splenic vein","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-61","context":null,"enonce":"About acromegaly: ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"The absence of a decrease in GH during OGGH is characteristic","justification":""},{"idx":1,"correct":true,"proposition":"It is a cause of diabetes","justification":""},{"idx":2,"correct":true,"proposition":"It is a cause of heart failure","justification":""},{"idx":3,"correct":true,"proposition":"It is a cause of carpal tunnel syndrome","justification":""},{"idx":4,"correct":true,"proposition":"GIgAntism testifies to an onset of the disease before puberty","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-62","context":null,"enonce":"Which of the following pathologies is (are) the cause(s) of high blood pressure? Indicate the correct answer(s): ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Pheochromocytoma","justification":""},{"idx":1,"correct":true,"proposition":"Primary hyperaldosteronism","justification":""},{"idx":2,"correct":true,"proposition":"Cushing's syndrome","justification":""},{"idx":3,"correct":true,"proposition":"Hypothyroidism","justification":""},{"idx":4,"correct":true,"proposition":"Primary hyperparathyroidism","justification":""}],"ts":{"$numberLong":"1665228421293"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-63","context":null,"enonce":"Which of the following factors is(are) a scannographic criterion(s) for severity of acute pancreatitis?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Dilation of the main pancreatic duct","justification":""},{"idx":1,"correct":false,"proposition":"A functional ileus","justification":""},{"idx":2,"correct":true,"proposition":"The presence of intrapancreatic necrosis","justification":""},{"idx":3,"correct":true,"proposition":"The presence of extrapancreatic necrosis","justification":""},{"idx":4,"correct":false,"proposition":"Cholelithiasis","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-65","context":null,"enonce":"Ms. X., aged 39, a right hemiplegic and aphasiac, was incenced for incapacity (impossibility of professional redeployment in the bank where she worked). For what objective(s) can it solicit the Departmental House of People with Disabilities?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Obtain a PCH (Disability Compensation Benefit)","justification":""},{"idx":1,"correct":true,"proposition":"Obtaining recognition as a disabled worker (ROTH)","justification":""},{"idx":2,"correct":false,"proposition":"Obtaining a disability pension (Pl)","justification":""},{"idx":3,"correct":true,"proposition":"Getting a disability card","justification":""},{"idx":4,"correct":true,"proposition":"Get a parking card","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-66","context":null,"enonce":"A 70-year-old woman has been complaining of pruritus for 6 months and has had a generalized itchy rash for 15 days. The blood count finds a count of eosinophilic polynuclear 3. A skin biopsy is performed in the peribullous zone at 1,000\/mm (photo below). What will direct cutaneous immunofluorescence show?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Granular deposits of lgG and C3 at the dermal-epidermal junction","justification":""},{"idx":1,"correct":false,"proposition":"Linear IgA deposits along the dermo-e p idermal junction","justification":""},{"idx":2,"correct":true,"proposition":"Linear deposits of lgG and C3 along the dermal-epidermal junction","justification":""},{"idx":3,"correct":false,"proposition":"Intraepidermal deposits of lgG and C3 mesh","justification":""},{"idx":4,"correct":false,"proposition":"LgG deposits around vessels","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-67","context":null,"enonce":"A 26-year-old patient has just returned from a 3-week stay in Indonesia where he tells you that he walked barefoot on the beaches a lot. He has the lesion below which is very itchy to the point of preventing him from sleeping. Which pathology is most likely? (only one exact answer) ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Cutaneous leishmaniasis","justification":""},{"idx":1,"correct":false,"proposition":"Erysipelas","justification":""},{"idx":2,"correct":true,"proposition":"Larva migrans cutaneous","justification":""},{"idx":3,"correct":false,"proposition":"Pyoderma","justification":""},{"idx":4,"correct":false,"proposition":"Cutaneous mycosis","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-68","context":null,"enonce":"A 42-year-old woman with no medical history comes to see you for a picture of nasopharyngitis with a fever above 38.5 ° C evolving for six days despite symptomatic treatment. There is a predominant bilateral purulent rhinorrhea on the right associated with pharyngitis. She complains of a unilateral headache located on the face, just above the right eye, which interferes with sleep. Orbital and periorbital examination is normal. What care seems acceptable to you in the first line? (one or more correct answers) ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Carrying out a microbiological sample","justification":""},{"idx":1,"correct":false,"proposition":"Amoxicillin treatment","justification":""},{"idx":2,"correct":false,"proposition":"Treatment with amoxicillin-clavulanic acid","justification":""},{"idx":3,"correct":false,"proposition":"Treatment with levofloxacin","justification":""},{"idx":4,"correct":false,"proposition":"Non-steroidal anti-inflammatory","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-69","context":null,"enonce":"A 63-year-old patient is referred to you in a context of asthenia. She has already seen a doctor who prescribed serum protein 1 electrophoresis, the result of which is as follows. What diagnosis(s) do you evoke in front of these elements?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Giant cell arteritis (Horton's disease)","justification":""},{"idx":1,"correct":true,"proposition":"Chronic liver disease","justification":""},{"idx":2,"correct":true,"proposition":"Sjogren's syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Myeloma at lgG","justification":""},{"idx":4,"correct":false,"proposition":"Light chain myeloma","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-70","context":null,"enonce":"A 32-year-old patient consults for a cough. His chest x-ray is as follows. What abnormality(s) do you notice on the chest X-ray?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Hilar lymphadenopathy","justification":""},{"idx":1,"correct":true,"proposition":"Signs of pulmonary arterial hypertension","justification":""},{"idx":2,"correct":true,"proposition":"An interstitial syndrome","justification":""},{"idx":3,"correct":false,"proposition":"A pneumothorax","justification":""},{"idx":4,"correct":false,"proposition":"An airy bronchogramma","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-71","context":null,"enonce":"A patient comes to the emergency room because he is worried about the appearance of these tongue lesions that he has noted for 48 hours. He has no history, does not complain about anything else. He is apyretic, his blood pressure is 120\/70 mmHg. Which exam(s)? Ask yourself ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Blood","justification":""},{"idx":1,"correct":false,"proposition":"Determination of vitamin B12 (cobalamin)","justification":""},{"idx":2,"correct":false,"proposition":"Microbiological","justification":""},{"idx":3,"correct":true,"proposition":"Blood count","justification":""},{"idx":4,"correct":false,"proposition":"Lingual swab for herpes virus","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-72","context":null,"enonce":"Hypersexuality is frequently observed during certain disorders. Which one(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Manic syndrome","justification":""},{"idx":1,"correct":true,"proposition":"Frontal syndrome","justification":""},{"idx":2,"correct":true,"proposition":"Syndrome de Klein-Levin","justification":""},{"idx":3,"correct":false,"proposition":"Schizophrenic syndrome","justification":""},{"idx":4,"correct":false,"proposition":"Parkinson's disease treated with dopamine agonists","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-73","context":null,"enonce":"Regarding denial of pregnancy, what is (are) the exact proposal(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"It is defined by the lack of awareness of pregnancy beyond 22 weeks of amenorrhea","justification":""},{"idx":1,"correct":false,"proposition":"It most often appears in women with a history of psychiatric disorders","justification":""},{"idx":2,"correct":false,"proposition":"Clinically, the usually observable manifestations of pregnancy are not apparent or absent","justification":""},{"idx":3,"correct":true,"proposition":"A differential diagnosis is pregnancy deliberately concealed from the entourage","justification":""},{"idx":4,"correct":false,"proposition":"Progression to puerperal psychosis is common","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-74","context":null,"enonce":"What is(are) the typical characteristic(s) of hepatocellular carcinoma in sectional imaging?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Contrast taking at arterial time","justification":""},{"idx":1,"correct":true,"proposition":"Washing at portal time","justification":""},{"idx":2,"correct":false,"proposition":"Centripetal filling","justification":""},{"idx":3,"correct":false,"proposition":"Spontaneously hyperdense appearance on computed tomography","justification":""},{"idx":4,"correct":false,"proposition":"Lump contrast capture","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-75","context":null,"enonce":"A 45-year-old man arrives at the emergency room with severe lower back pain. He is very stiff and has a fever. Which imaging test(s) do you think are useful to support your suspected diagnosis?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"An X-ray of the lumbar spine from the front and profile","justification":""},{"idx":1,"correct":false,"proposition":"X-rays of 3\/4 of the lumbar spine","justification":""},{"idx":2,"correct":false,"proposition":"A CT scan","justification":""},{"idx":3,"correct":true,"proposition":"An MRI","justification":""},{"idx":4,"correct":false,"proposition":"A PET scanner","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-76","context":null,"enonce":"Which of the following proposals for fluorescein eye drops is accurate? Fluorescein is a fluorescent eye drop, which essentially allows us to explore the","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Can be used to check the integrity of the corneal endothelium","justification":""},{"idx":1,"correct":true,"proposition":"Can be used to highlight a transfixing corneal wound","justification":""},{"idx":2,"correct":false,"proposition":"Can be used to highlight herpetic keratitis","justification":""},{"idx":3,"correct":false,"proposition":"Can be used as an anesthetic before removal of a corneal foreign body","justification":""},{"idx":4,"correct":false,"proposition":"Can be used to highlight dry eye","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-77","context":null,"enonce":"Regarding the following iconography, which is (are) the exact proposal(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":" Arrow 1 denotes the ascending horacic aorta e","justification":""},{"idx":1,"correct":true,"proposition":"Arrow 2 designates the superior vena cava","justification":""},{"idx":2,"correct":false,"proposition":"Arrow 3 designates the left inferior pulmonary vein","justification":""},{"idx":3,"correct":false,"proposition":"There is a dissection of the ascending thoracic aorta","justification":""},{"idx":4,"correct":true,"proposition":"There is a proximal pulmonary embolism","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-78","context":null,"enonce":"Regarding the use of adrenaline during cardiac arrest, which is the exact proposal(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"In case of asystole, the first dose is 1 mg intravenously","justification":""},{"idx":1,"correct":false,"proposition":"If no venous line is available, injection through the intubation tube is possible","justification":""},{"idx":2,"correct":false,"proposition":"Control of heart rate effectiveness 5 min after first injection","justification":""},{"idx":3,"correct":true,"proposition":"In case of asystole, the injection of adrenaline most often leads to ventricular fibrillation","justification":""},{"idx":4,"correct":false,"proposition":"In case of ventricular fibrillation, adrenaline administration should be started after the fifth external electric shock","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-79","context":null,"enonce":"A patient benefits from aortic valve replacement with a new generation double-finned mechanical prosthesis. Its rhythm is sinus. Which of the following is (are) accurate in this patient?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"It must be treated with vitamin K antagonist for life","justification":""},{"idx":1,"correct":true,"proposition":"The effective target INR of vitamin K therapy is between 2 and 3","justification":""},{"idx":2,"correct":false,"proposition":"In case of labile INRs, it is possible to replace the antivitamin K with a direct oral anticoagulant","justification":""},{"idx":3,"correct":true,"proposition":"Antibiotic prophylaxis is essential before a dental avulsion","justification":""},{"idx":4,"correct":false,"proposition":"Vitamin K treatment should be suspended before dental scaling","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-80","context":null,"enonce":"A patient consults you for a recent dyspnea of exertion. You find a heart murmur. What is (are) the argument(s) in favor of mitral insufficiency?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":" The tone of the breath is often in steam jet","justification":""},{"idx":1,"correct":false,"proposition":" The breath is diastolic","justification":""},{"idx":2,"correct":true,"proposition":"The irradiation of the breath is done towards the armpit","justification":""},{"idx":3,"correct":false,"proposition":"The breath is accompanied by the abolition of the 82","justification":""},{"idx":4,"correct":false,"proposition":"The breath is accompanied by a fixed doubling of the 82 in children","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-81","context":null,"enonce":"Which of the following proposals concerning pharmacovigilance is true?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"It is based on spontaneous patient notification","justification":""},{"idx":1,"correct":true,"proposition":"It is based on spontaneous notification from health professionals","justification":""},{"idx":2,"correct":false,"proposition":"Spontaneous notifications cannot lead to the withdrawal of a medicinal product from the market","justification":""},{"idx":3,"correct":true,"proposition":"Accountability uses chronological and semiological criteria","justification":""},{"idx":4,"correct":true,"proposition":"Accountability estimates the causal link between a drug and an adverse reaction","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-82","context":null,"enonce":"Indicate the true answer(s) regarding temporary use authorizations for a medicinal product ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Can be nominative or cohort","justification":""},{"idx":1,"correct":true,"proposition":"Are given for serious situations","justification":""},{"idx":2,"correct":false,"proposition":"Do not require clinical studies","justification":""},{"idx":3,"correct":false,"proposition":"Allow for early availability after marketing authorisation","justification":""},{"idx":4,"correct":false,"proposition":"Avoid the application for marketing authorisation","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-83","context":null,"enonce":"Indicate the true answer(s) for pharmacological therapeutic monitoring based on pharmacokinetic parameters. Pharmacological therapeutic monitoring can be useful:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"To prevent auditory toxicity of aminoglycosides ","justification":""},{"idx":1,"correct":false,"proposition":"In order to prevent ineffectiveness of Tramadol","justification":""},{"idx":2,"correct":false,"proposition":"In order to understand the therapeutic success of morphine [>","justification":""},{"idx":3,"correct":true,"proposition":"To verify lithium adherence","justification":""},{"idx":4,"correct":true,"proposition":"To prevent ineffectiveness of tacrolimus","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-84","context":null,"enonce":"Which of the following drug classes is(s) nephrotoxic at usual doses ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":" Aminoglycosides","justification":""},{"idx":1,"correct":false,"proposition":"Statins","justification":""},{"idx":2,"correct":false,"proposition":"Nonsteroidal anti-inflammatory drugs","justification":""},{"idx":3,"correct":false,"proposition":"Corticosteroids","justification":""},{"idx":4,"correct":false,"proposition":"Antiparkinsonians","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-85","context":null,"enonce":"• Direct tubular toxicity.","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Synovitis"},{"idx":1,"correct":true,"proposition":"Erosions"},{"idx":2,"correct":true,"proposition":"Joint effusion"},{"idx":3,"correct":true,"proposition":"A pinching of the joint spacers","justification":""},{"idx":4,"correct":false,"proposition":"Inflammation of the epiphyses","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-86","context":null,"enonce":"You receive in consultation a 28-year-old patient who performed a CT scan of the junction a posteriori thoraco-lumbar (between TS and L2) 2 months ago. She discovered that she was pregnant at the time of the scan. She asks for your opinion on the rest of her pregnancy ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"You reassure her, the FCETUS running little risk since outside the irradiation field","justification":""},{"idx":1,"correct":false,"proposition":"You reassure her because in view of the type of examination carried out, the dose received by the fetus is necessarily less than 10 mGy, threshold of appearance of radiation-induced risks in the unborn child","justification":""},{"idx":2,"correct":true,"proposition":"You reassure her because in view of the type of examination carried out, the dose received by the fetus is necessarily less than 100 mGy, threshold of appearance of radiation-induced risks in the unborn child","justification":""},{"idx":3,"correct":false,"proposition":"You request a dosimetric expertise and wait for the result before pronouncing an opinion","justification":""},{"idx":4,"correct":false,"proposition":"You explain the risks associated with the examination and discuss with her a possible medical termination of pregnancy","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-87","context":null,"enonce":"The maximum passive joint amplitudes of this patient's right knee are represented by the photos below. Which of the following is (are) accurate? ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"The patient has an extension of 30°","justification":""},{"idx":1,"correct":false,"proposition":"The patient has a recurvatum of 30 degrees","justification":""},{"idx":2,"correct":true,"proposition":"The patient has a 30° injury","justification":""},{"idx":3,"correct":true,"proposition":"The patient has a joint stroke of 70 degrees","justification":""},{"idx":4,"correct":false,"proposition":"The patient has a flexion of 100°","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-88","context":null,"enonce":"The maximum passive joint amplitudes of this patient's right knee are represented by the photos below. Which of the following is correct? Maximum flexion Maximum extension ° Indicate true response(s) regarding adverse effects of opioid analgesics: ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Visual disturbances","justification":""},{"idx":1,"correct":true,"proposition":"Nausea","justification":""},{"idx":2,"correct":false,"proposition":"Diarrhoea","justification":""},{"idx":3,"correct":true,"proposition":"Itch","justification":""},{"idx":4,"correct":true,"proposition":"Acute urine retention","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-89","context":null,"enonce":"In front of a clinical picture of agitation, which is (are} the exact proposal(s) on the use of antipsychotics for sedative purposes?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Are useful for all degrees of stirring severity","justification":""},{"idx":1,"correct":false,"proposition":"Decrease alertness","justification":""},{"idx":2,"correct":false,"proposition":"Are to be associated with benzodiazepines","justification":""},{"idx":3,"correct":true,"proposition":"Should not be prescribed for angle-closure glaucoma","justification":""},{"idx":4,"correct":true,"proposition":"Cannot be used in case of long QT","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-90","context":null,"enonce":"What medication(s) can cause agitation in the elderly?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Corticosteroids","justification":""},{"idx":1,"correct":true,"proposition":"Antidepressants","justification":""},{"idx":2,"correct":false,"proposition":"Vitamin D","justification":""},{"idx":3,"correct":true,"proposition":"Benzodiazepines","justification":""},{"idx":4,"correct":true,"proposition":"Anticholinergics","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-91","context":null,"enonce":"A 66-year-old man, with no particular history, is hospitalized after suddenly presenting a transient loss of vision in the right eye, spontaneously regressive after 3 minutes. The interrogation finds asthenia and temporal headaches for 3 weeks. Your clinical examination is normal. A biological assessment was performed: blood ionogram, blood glucose, renal function, normal blood count, CRP 67mg\/L. What do you urgently ask for before instituting a specific treatment?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Brain scan","justification":""},{"idx":1,"correct":false,"proposition":"Fluorescein retinal angiography","justification":""},{"idx":2,"correct":false,"proposition":"Microbiological","justification":""},{"idx":3,"correct":false,"proposition":"Determination of anti-cytoplasmic antibodies of neutrophils (ANCA)","justification":""},{"idx":4,"correct":true,"proposition":"None of these exams","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-92","context":null,"enonce":"Which element(s) should evoke the secondary character of a bilateral Raynaud's phenomenon ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Occurring after 40 years"},{"idx":1,"correct":false,"proposition":"Revelation by an attack of the indexes and majors","justification":""},{"idx":2,"correct":true,"proposition":"Presence of telangiectasias"},{"idx":3,"correct":true,"proposition":"Thumb damage"},{"idx":4,"correct":true,"proposition":"Presence of retractile scars on the pulp of the index fingers","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-93","context":null,"enonce":"You present the daughter of a palliative care patient at an advanced stage with family solidarity leave. Which statement(s) is the correct statement(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Is for a duration of 6 months","justification":""},{"idx":1,"correct":false,"proposition":"Is intended for any employee close to the patient","justification":""},{"idx":2,"correct":true,"proposition":"Is unpaid","justification":""},{"idx":3,"correct":true,"proposition":"Guarantees to return to work under the same conditions","justification":""},{"idx":4,"correct":true,"proposition":"Allows the daughter of the p atiente to say p dare to p lus of tem p s with her mother","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-94","context":null,"enonce":"According to the law concerning the person of trust, which is (are) the correct statement(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"It has decision-making power","justification":""},{"idx":1,"correct":true,"proposition":"It must be obligatorily designated in writing","justification":""},{"idx":2,"correct":true,"proposition":"It is consulted when the patient is no longer able to express his will","justification":""},{"idx":3,"correct":false,"proposition":"Its designation is obligatory","justification":""},{"idx":4,"correct":false,"proposition":"It can be the private nurse or the patient's attending physician","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-95","context":null,"enonce":"Concerning the characteristic(s) of breakthrough pain: ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"They are characterized by quick installation","justification":""},{"idx":1,"correct":true,"proposition":"They are characterized by a short duration","justification":""},{"idx":2,"correct":true,"proposition":"They have variable intensity","justification":""},{"idx":3,"correct":true,"proposition":"They may have a neuropathic origin","justification":""},{"idx":4,"correct":false,"proposition":"They impose an increase in the background treatment of pain","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-96","context":null,"enonce":"Which of the following proposals is(s) the risk factor(s) of complicated bereavement?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"A recent bereavement","justification":""},{"idx":1,"correct":true,"proposition":"Early loss of a first-degree relative","justification":""},{"idx":2,"correct":false,"proposition":"The advanced age of the bereaved","justification":""},{"idx":3,"correct":false,"proposition":"Social precariousness","justification":""},{"idx":4,"correct":true,"proposition":"The suddenness of death","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-97","context":null,"enonce":"During the assessment of the extension of clinically localized cancers of the larynx and hypopharynx, which is (are) the recommended examination(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Esophageal endoscopy","justification":""},{"idx":1,"correct":true,"proposition":"Head and neck CT","justification":""},{"idx":2,"correct":false,"proposition":"Head and neck MRI","justification":""},{"idx":3,"correct":false,"proposition":"FDG PET","justification":""},{"idx":4,"correct":false,"proposition":"Bone scintigraphy","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-98","context":null,"enonce":"In front of this table of palmar keratoderma evolving for 3 months, what diagnosis (s) is (are) to consider?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Hyperkeratotic scabies","justification":""},{"idx":1,"correct":false,"proposition":"Primary syphilis","justification":""},{"idx":2,"correct":true,"proposition":"Contact eczema","justification":""},{"idx":3,"correct":true,"proposition":"Syndrome de Sézary","justification":""},{"idx":4,"correct":true,"proposition":"Psoriasis","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-99","context":null,"enonce":"Which of the following dual antihypertensive therapies is (are) most often discouraged?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Hydrochlorothiazide and furosemide","justification":""},{"idx":1,"correct":true,"proposition":"Acebutolol and verapamil","justification":""},{"idx":2,"correct":true,"proposition":"Amlodipine and diltiazem","justification":""},{"idx":3,"correct":true,"proposition":"Candesartan and spironolactone","justification":""},{"idx":4,"correct":true,"proposition":"Perindopril and valsartan","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-100","context":null,"enonce":"Which diagnosis(s) is (are) classified as somatoform disorders?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Somatization","justification":""},{"idx":1,"correct":false,"proposition":"Post-traumatic stress disorder","justification":""},{"idx":2,"correct":false,"proposition":"Histerionic personality","justification":""},{"idx":3,"correct":true,"proposition":"Conversion disorder","justification":""},{"idx":4,"correct":true,"proposition":"Pain disorder No real difficulty here, we find the complete list of somatoform disorders in the College of Psychiatry Symptoms affecting several bodily domains before the age of 30 Neurological symptoms Pain without organic substrate maintained by stress Mistaken belief of having a non-psychiatric illness","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-101","context":null,"enonce":"For polycystic ovary syndrome, indicate the correct answer(s) ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"This is the most common cause of dysovulation","justification":""},{"idx":1,"correct":true,"proposition":"It is often associated with resistance to the action of insulin","justification":""},{"idx":2,"correct":true,"proposition":"Acne is common","justification":""},{"idx":3,"correct":true,"proposition":"The presence of more than 12 follicles is a diagnostic criterion","justification":""},{"idx":4,"correct":false,"proposition":"It is associated with thyroid cysts","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-102","context":null,"enonce":"A 3-month-old infant is brought by his parents to the pediatric emergency room for laryngeal dyspnea that has gradually worsened since the age of one month. Since delivery, the infant has not had a break in the staturo-weight curve, it is apyretic admission. In front of this laryngeal dyspnea, what etiology do you mention in the first place?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Laryngomalacia","justification":""},{"idx":1,"correct":false,"proposition":"A laryngeal diastema","justification":""},{"idx":2,"correct":false,"proposition":"Laryngitis","justification":""},{"idx":3,"correct":true,"proposition":"Subglottic angioma","justification":""},{"idx":4,"correct":false,"proposition":"A laryngeal foreign body","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-103","context":null,"enonce":"One patient, aged 45, has chronic cholesteatomatous otitis. He asks you what risk(s) is (are) leaving this lesion in place? You answer that this exposes him to a risk of: ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Peripheral facial paralysis","justification":""},{"idx":1,"correct":true,"proposition":"Conductive hearing loss"},{"idx":2,"correct":true,"proposition":"Perilymphatic fistula"},{"idx":3,"correct":true,"proposition":"Labyrinthitis"},{"idx":4,"correct":true,"proposition":"Meningitis"}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-104","context":null,"enonce":"Concerning the rapid diagnostic test (RDT) for screening in the context of angina. What is the real proposal(s)? D. Its positivity is in group A hemolytic bihemolytic streptococcus","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"It is made at any age","justification":""},{"idx":1,"correct":false,"proposition":"It has a specificity of 70%","justification":""},{"idx":2,"correct":true,"proposition":"The result is obtained after a duration of about 5 min","justification":""},{"idx":3,"correct":true,"proposition":"Its positivity is in favor of group A hemolytic B streptococcus","justification":""},{"idx":4,"correct":false,"proposition":"A shipment to the bacteriology laboratory is necessary to have the result","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-105","context":null,"enonce":"About risk factors for ENT cancer ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"EBV is a risk factor for cavum cancer","justification":""},{"idx":1,"correct":true,"proposition":"HPV is a risk factor for tonsillar cancer","justification":""},{"idx":2,"correct":false,"proposition":"Tobacco is a risk factor for ethmoid sinus cancer","justification":""},{"idx":3,"correct":false,"proposition":"Wood dust is a risk factor for maxillary sinus cancer","justification":""},{"idx":4,"correct":true,"proposition":"Alcohol and tobacco are risk factors for tonsillar cancer It is a multiple choice to which the table is reapplied<< Four complications of chronic otitis to control>> seen page 119 .","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-106","context":null,"enonce":"A patient consults for left sublobular induration. His GP ordered a head and neck MRI. He comes back to you with the MRI data. What can you tell him about the imagery below?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"It is a T1 sequence without gadolinium injection","justification":""},{"idx":1,"correct":false,"proposition":"The 1 corresponds to the right sphenoidal sinus","justification":""},{"idx":2,"correct":true,"proposition":"The 2 corresponds to the right parotid gland","justification":""},{"idx":3,"correct":true,"proposition":"There is a left parotid tumor","justification":""},{"idx":4,"correct":false,"proposition":"There is a tumor of the left submandibular gland","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-107","context":null,"enonce":"Regarding the 1+2+3 Bouchon rule in the elderly:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"It is not usable in very old individuals (> 90 years)","justification":""},{"idx":1,"correct":false,"proposition":"It allows the calculation of comorbidities","justification":""},{"idx":2,"correct":true,"proposition":"The<< 3 >> corresponds to an acute pathogen","justification":""},{"idx":3,"correct":false,"proposition":"It helps explain atypical clinical presentations in the elderly","justification":""},{"idx":4,"correct":true,"proposition":"It helps explain the accumulation of diseases during aging","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-108","context":null,"enonce":"Immobilization syndrome is a common complication in subjects over 75 years of age. Which of the following is true?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Associated with a risk of excess mortality","justification":""},{"idx":1,"correct":true,"proposition":"Increases the risk of dehydration","justification":""},{"idx":2,"correct":true,"proposition":"Occurs from the first hour of immobilization","justification":""},{"idx":3,"correct":false,"proposition":"Is explained by musculoskeletal aging","justification":""},{"idx":4,"correct":true,"proposition":"Increases the risk of venous insufficiency","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-109","context":null,"enonce":"You see an 85-year-old patient in the emergency room for a fall from her height with a head trauma while she usually takes anticoagulant treatment with vitamin K antagonist. The clinical examination is normal and the INR is 6.2. Which of the following proposals do you think corresponds to his management in the emergency room before any examination?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"No indication for a brain CT scan","justification":""},{"idx":1,"correct":true,"proposition":"Immediate brain computed tomography","justification":""},{"idx":2,"correct":false,"proposition":"Brain computed tomography scheduled within 48 hours","justification":""},{"idx":3,"correct":false,"proposition":"Administration of vitamin K and concentrates of prothrombin complexes","justification":""},{"idx":4,"correct":true,"proposition":"Administration of vitamin K alone","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-110","context":null,"enonce":"Age-related macular degeneration: ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Causes decreased peripheral vision","justification":""},{"idx":1,"correct":false,"proposition":"Is linked to abnormalities of the retinal pigment epithelium","justification":""},{"idx":2,"correct":true,"proposition":"May result in distorted images","justification":""},{"idx":3,"correct":true,"proposition":"Is confirmed at the fundus","justification":""},{"idx":4,"correct":false,"proposition":"Is favored by chronic alcoholism","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-111","context":null,"enonce":"The Mini Nutritionna\/Assessment (or MNA) nutritional test:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Is a test with a total score out of 30 points","justification":""},{"idx":1,"correct":true,"proposition":"Is a test that defines malnutrition if the score is less than 23 5 points","justification":""},{"idx":2,"correct":true,"proposition":"Is a test that defines malnutrition if the score is less than 17 points","justification":""},{"idx":3,"correct":false,"proposition":"Is a test that requires the calculation of body mass index","justification":""},{"idx":4,"correct":true,"proposition":"Is a test that takes into account the presence of neuropsychological problems","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-112","context":null,"enonce":"About cervical swelling, what is (are) the exact item(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"A cyst of the thyroglossal tract is mobile to swallowing","justification":""},{"idx":1,"correct":false,"proposition":"Right supraclavicular lymphadenopathy may be indicative of kidney cancer","justification":""},{"idx":2,"correct":true,"proposition":"Superficial renitent swelling localized to the anterior edge of the sternocleidomastoid muscle is suggestive of an amygdaloid cyst","justification":""},{"idx":3,"correct":false,"proposition":"Brachial plexus schwannoma is a differential diagnosis of submandibular lymphadenopathy","justification":""},{"idx":4,"correct":true,"proposition":"Accessory nerve schwannoma is a differential diagnosis of spinal lymphadenopathy","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-114","context":null,"enonce":"You had seen Mrs. V., 22 years old, for iron deficiency anaemia in connection with heavy periods. She was put on estrogen-progestin by her gynecologist and you prescribed martial replacement therapy. After 4 months of treatment you see it again with the following assessment: red blood cells %; 5.57 T\/L; hemoglobin 125 g\/L - hematocrit 39 VGM 70 fL; HCMC 32 g\/dL; leukocytes 5 g\/L - platelets 270 G\/L. Ferritin is at 40 ng\/mL (normal > 30). The CRP is 3 mg\/L. What is(are) your hypothesis(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Mrs. V. did not take her martial treatment","justification":""},{"idx":1,"correct":false,"proposition":"Mrs. V. has probable sickle cell disease","justification":""},{"idx":2,"correct":true,"proposition":"Mrs. V. has probable heterozygous thalassemia","justification":""},{"idx":3,"correct":false,"proposition":"Mrs. V. has not yet replenished her iron reserves","justification":""},{"idx":4,"correct":false,"proposition":"Mrs. V. has an added inflammatory pathology","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-115","context":null,"enonce":"High-grade glioblastoma is discovered in an 80-year-old person, otherwise free of pathology and whose general condition is good. It is an incurable cancer disease, with a median survival of about 15 months, with a combination of high-dose corticosteroid therapy for antiedematous, radiotherapy and anti-angiogenic chemotherapy. The aim of treatments is to slow down the tumor evolution. ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"This is an acute care approach, delaying entry into palliative care","justification":""},{"idx":1,"correct":false,"proposition":"This is an unreasonable obstinacy, given the incurability of the disease and the poor prognosis.","justification":""},{"idx":2,"correct":true,"proposition":"This is an acute care approach, to be conducted within a palliative care approach","justification":""},{"idx":3,"correct":true,"proposition":"This is an acute care approach, the objectives of which must be discussed and validated with the patient.","justification":""},{"idx":4,"correct":false,"proposition":"This is comfort care, the objective of which is to avoid unnecessary suffering","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-116","context":null,"enonce":"A 50-year-old patient consults you for a certificate of non-contraindication the practice of sport. You hear a diastolic heart murmur, maximal at the third left intercostal space, best perceived in the forward leaning position. What is(are) the possible cause(s) of this breath ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Aortic bicuspid"},{"idx":1,"correct":false,"proposition":"Mitral valve dystrophy","justification":""},{"idx":2,"correct":true,"proposition":"Ankylosing spondylitis"},{"idx":3,"correct":false,"proposition":"Rope break"},{"idx":4,"correct":true,"proposition":"Aortic annuloectasian disease","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-117","context":null,"enonce":"Regarding imaging of pancreatic tumors, what is(are) the exact answer(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"In front of jaundice, the first intention examination is the MRI to visualize the bile ducts","justification":""},{"idx":1,"correct":true,"proposition":"In case of suspicion of pancreatic cancer, it is the CT scan with injection of contrast medium that is the first-line examination","justification":""},{"idx":2,"correct":true,"proposition":"If pancreatic cancer is suspected, the CT scan should look for direct (tumor) and indirect (dilation of the bile ducts and\/or Wirsung's duct) signs.","justification":""},{"idx":3,"correct":false,"proposition":"The tumor of the pancreas is sometimes difficult to highlight in CT and it will then be necessary to complete with a retrograde cholangiopancreatography endoscopic (ERCP)","justification":""},{"idx":4,"correct":false,"proposition":"Most pancreatic cancers are diagnosed incidentally on imaging","justification":""},{"idx":5,"correct":false,"proposition":"abdominal performed for another indication","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-118","context":null,"enonce":"A 6-month-old child has a break in the curve of his head circumference with a macrocrania. You ask him for a transfontanelar ultrasound. Which item(s) is the correct item(s)? Has.","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"This examination makes it possible to analyze the infratentorial compartment better than the supratentorial compartment","justification":""},{"idx":1,"correct":false,"proposition":"This examination is impossible, the fontanelles are closed at his age","justification":""},{"idx":2,"correct":true,"proposition":"This test can detect hydrocephalus","justification":""},{"idx":3,"correct":true,"proposition":"This test can detect an intracranial tumor","justification":""},{"idx":4,"correct":true,"proposition":"This examination has operator-dependent sensitivity and specificity","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-119","context":null,"enonce":"What is the diagnostic criterion(s) to make the diagnosis of celiac disease without performing an intestinal biopsy? ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Anti-transglutaminase IgA greater than 10 times normal","justification":""},{"idx":1,"correct":false,"proposition":"anti-transglutaminase lgG greater than 10 times normal","justification":""},{"idx":2,"correct":false,"proposition":"Presence of anti-endom IgA at a significant level","justification":""},{"idx":3,"correct":false,"proposition":"Presence of anti-gliadin IgA at a significant level","justification":""},{"idx":4,"correct":false,"proposition":"Presence of a HLA DO2 or DO8 group This is an interesting MCQ, the appropriate answer is to be found in pediatrics. We distinguish","justification":""},{"idx":5,"correct":false,"proposition":"2 steps to the diagnosis of celiac disease","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2017-qi-120","context":null,"enonce":"What symptoms make you suspect rhegmatogenous retinal detachment?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Phosphenes","justification":""},{"idx":1,"correct":false,"proposition":"Photophobia","justification":""},{"idx":2,"correct":true,"proposition":"Amputation of the visual field in the sector","justification":""},{"idx":3,"correct":true,"proposition":"Myodesopsias","justification":""},{"idx":4,"correct":false,"proposition":"Isolated central scotomome","justification":""}],"ts":{"$numberLong":"1665228421294"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-1","context":null,"enonce":"In front of a febrile roseoliform exanthema of the child, the main etiologies are (one or more exact answers):","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A sudden exanthema","justification":""},{"idx":1,"correct":false,"proposition":"An epidemic megalerythema","justification":"Morbiliform"},{"idx":2,"correct":true,"proposition":"Rubella","justification":""},{"idx":3,"correct":false,"proposition":"Infectious mononucleosis","justification":"Morbiliform or scarlatiniform"},{"idx":4,"correct":false,"proposition":"Un syndrome de Kawasaki","justification":"Morbiliform or scarlatiniform"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-2","context":null,"enonce":"About heart failure, which proposal(s) is true?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Cardiac auscultation may show a burst of B2 at the aortic focus in pulmonary arterial hypertension","justification":"At the pulmonary focus"},{"idx":1,"correct":true,"proposition":"Cardiac auscultation may reveal a murmur of mitral insufficiency related to the dilation of the mitral ring","justification":""},{"idx":2,"correct":false,"proposition":"Jugular turgor is a peripheral sign of left heart failure","justification":"right"},{"idx":3,"correct":false,"proposition":"Peripheral edema is soft, blue and painful","justification":"soft, white, painless, declivated (so to look for in the lower back in a lying patient) and taking the bucket (unlike inflammatory edema, for example during bacterial dermohypoderma)"},{"idx":4,"correct":true,"proposition":"Crackling or subcrackling rails are often bilateral","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-3","context":null,"enonce":"A 70-year-old patient presents to the emergency room for chest pain and dyspnea. Give the exact proposal(s): ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"1 corresponds to the ascending aorta","justification":"Superior vena cava"},{"idx":1,"correct":true,"proposition":"2 corresponds to the esophagus","justification":""},{"idx":2,"correct":true,"proposition":"3 corresponds to the descending aorta","justification":""},{"idx":3,"correct":false,"proposition":"4 corresponds to a pulmonary embolism in the left pulmonary artery","justification":"right"},{"idx":4,"correct":false,"proposition":"4 corresponds to a dissection of the pulmonary artery","justification":"This is the thrombus"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-4","context":null,"enonce":"What is the true answer(s) regarding the management of diffuse bronchiectasis in adults (outside the context of cystic fibrosis) responsible for repeated infectious episodes:","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Daily bronchial drainage"},{"idx":1,"correct":false,"proposition":"Systemic corticosteroid therapy"},{"idx":2,"correct":false,"proposition":"Pulmonary lobectomy","justification":"The breach is diffuse"},{"idx":3,"correct":false,"proposition":"Systematic quarterly antibiotic therapy","justification":""},{"idx":4,"correct":false,"proposition":"Anti-inflammatory treatment with fluoroquinolone","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-5","context":null,"enonce":"You see a 70-year-old man in the winter. He has stage 1 dyspnea of mMRC associated with chronic cough without sputum. It presents a smoking of the order of 25 pack-years still pursued. He tells the notion of asthma in early childhood and has long suffered from seasonal grass pollen rhinitis. He has no other background. His pulmonary auscultation, the day you see him, is normal. It performs pulmonary function tests (EFR). Give the correct answer(s):","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Given these RFEs, the patient must be hospitalized","justification":""},{"idx":1,"correct":false,"proposition":"A methacholine bronchial hyperreactivity test should be performed","justification":"This is done when the suspiscion of asthma is very high despite a significantly non-reversible TVO."},{"idx":2,"correct":true,"proposition":"Clinical history and EFRs are consistent with asthma","justification":"Significant but not complete reversible TVO"},{"idx":3,"correct":true,"proposition":"Clinical history and EFRs are consistent with COPD","justification":"Significant but not complete reversible TVO"},{"idx":4,"correct":false,"proposition":"A treatment can only be put in place once smoking has been definitively stopped","justification":"We must indeed stop smoking but we start treating as soon as possible"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-6","context":null,"enonce":"A 58-year-old patient comes to your hospital's emergency room for expectoration of two glasses of red blood during a coughing effort. She had never coughed up blood. She is on aspirin aimed at anti-aggregating for coronary artery disease. His clinical examination is normal, his blood pressure is 132\/79 mmHg, the heart rate is 80\/min. Chest X-ray does not show any abnormalities. Give the correct answer(s): ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"You hospitalize the patient","justification":""},{"idx":1,"correct":false,"proposition":"You set up a vascular filling","justification":"It is neither tachycardium nor hypotensive. So no filling at this stage."},{"idx":2,"correct":false,"proposition":"You prescribe an intravenous vasoconstrictor agent such as telipressin","justification":"His coronary artery disease contraindicates this treatment"},{"idx":3,"correct":true,"proposition":"You prescribe an injected chest CT scan with arterial time acquisition after checking for contraindications","justification":"The master examination in case of hemoptysis"},{"idx":4,"correct":false,"proposition":"You reassure the patient and explain that it is normal to bleed on antiaggregants","justification":"Not at all normal"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-7","context":null,"enonce":"A 70-year-old woman consults for non-pruritic skin lesions that appeared several days ago, localized on the upper back (photo 1), in the scalp and in the axillary folds. She has been complaining for several months of painful oral lesions that interfere with feeding (photo 2). Nikolsky's sign is positive. His history includes high blood pressure treated with lercanidipine for 2 years and a drop treated with allopurinol for 1 year. What diagnosis do you mention? ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Pemphigus vulgaris","justification":"The picture is typical. It is a differential diagnosis of autoimmune bullous dermatoses."},{"idx":1,"correct":false,"proposition":"Bullous pemphigoid","justification":""},{"idx":2,"correct":false,"proposition":"Syndrome de Stevens-Johnson","justification":""},{"idx":3,"correct":false,"proposition":"Erythema multiforme","justification":""},{"idx":4,"correct":false,"proposition":"Fixed pigmented erythema","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-8","context":null,"enonce":"You see a 65-year-old man in consultation with isolated dyspnea of stage II of the mMRC classification. He is diabetic treated with metformin. He is also treated for hypertension with an angiotensin II antagonist. He has a smoking evaluated at 20 packs-year stopped 10 years ago. No other environmental and occupational exposures are known. The clinical examination finds crackling at both bases on auscultation. The rest of the exam is normal. The blood ionogram is normal. Complete blood counts are normal. The autoimmune balance is normal. You have a chest CT scan and pulmonary function tests (joints). Among the following proposals, which diagnosis do you think is the most likely?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Emphysema"},{"idx":1,"correct":true,"proposition":"Idiopathic pulmonary fibrosis","justification":"Cross-linking at the bases is very suggestive of this diagnosis."},{"idx":2,"correct":false,"proposition":"Heart failure"},{"idx":3,"correct":false,"proposition":"Cystic fibrosis"},{"idx":4,"correct":false,"proposition":"Drug pneumonitis"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-9","context":null,"enonce":"A 35-year-old woman has been presenting for a week with fever at 38.5 ° C, arthralgia of the knees and ankles and a rash on the legs (photo). Which of the following proposals, which diagnosis(s) do you retain?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Erythema multiforme","justification":""},{"idx":1,"correct":false,"proposition":"Ersipelas","justification":""},{"idx":2,"correct":true,"proposition":"Erythema nodosum","justification":"This is the typical photo of erythema nodosum"},{"idx":3,"correct":false,"proposition":"Fixed pigmented erythema","justification":""},{"idx":4,"correct":false,"proposition":"Rheumatoid purpura","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-10","context":null,"enonce":"A 17-year-old girl consults for painful lesions of the labial commissures appeared 2 weeks before, which do not heal under topical corticosteroids. The rest of the exam is normal. Which of the following is the most likely diagnosis?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Candidiasis","justification":""},{"idx":1,"correct":false,"proposition":"Herpes","justification":""},{"idx":2,"correct":false,"proposition":"Syphilis","justification":""},{"idx":3,"correct":false,"proposition":"Dermatophytia","justification":""},{"idx":4,"correct":true,"proposition":"Impetigo","justification":"Lesions of crustose, meliceric and perioral appearance (or sitting on the face)."}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-11","context":null,"enonce":"A 55-year-old patient with hyperlymphocytosis at 25 G \/ L without cytopenia is referred to you with a diagnosis of chronic lymphocytic leukemia on lymphocyte immunophenotyping. On clinical examination, the patient is in excellent general condition and there is polyadenopathy 1.5-2 cm in diameter in all lymph node areas. What review is needed at this stage? (only one answer)","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"None","justification":"The diagnosis is made."},{"idx":1,"correct":false,"proposition":"A PET scanner","justification":""},{"idx":2,"correct":false,"proposition":"Echocardiography","justification":""},{"idx":3,"correct":false,"proposition":"A myelogram","justification":""},{"idx":4,"correct":false,"proposition":"A bone scan","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-12","context":null,"enonce":"A 25-year-old man consults you because of abdominal pain. The examination is normal apart from a palpable spleen at the end of inspiration. The blood count shows: leukocytes 14 G\/L, PNN 8 G\/L, myelocytes 1 G\/L, metamyelocytes 1 G\/L, monocytes 1 G\/L, lymphocytes 3 G\/L and platelets 510 G\/L. You suspect chronic myeloid leukemia. What biological tests do you prescribe to confirm your diagnostic hypothesis? (one or more possible answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Leukocyte immunophenotyping on blood","justification":""},{"idx":1,"correct":false,"proposition":"Search for Jolly's body with a smear","justification":""},{"idx":2,"correct":true,"proposition":"Search for the BCR-ABL transcript","justification":"We think of an CML"},{"idx":3,"correct":false,"proposition":"Gumprecht's search for shadows","justification":""},{"idx":4,"correct":false,"proposition":"Search for a JAK2 mutation","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-13","context":null,"enonce":"Which of the following statements about weakening osteopathy is?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Primary hyperparathyroidism preferentially affects the cortical bone","justification":""},{"idx":1,"correct":false,"proposition":"Treatment of hypothyroidism increases the risk of osteoporotic fracture","justification":""},{"idx":2,"correct":false,"proposition":"Cortisonic osteoporosis mainly affects the cortical bone","justification":"Trabecular bone"},{"idx":3,"correct":true,"proposition":"Estrogen deficiency is responsible for osteoclastic hyperactivity","justification":""},{"idx":4,"correct":false,"proposition":"Treatment with bisphosphonate increases osteoblast activity","justification":"Only teriparatide (FORSTEO) has this effect. It is indicated in case of two vertebral fractures."}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-14","context":null,"enonce":"A 50-year-old woman arrives at the emergency room for discomfort. She has no particular history but describes fatigue that quickly appeared. The clinical examination is normal apart from a conjunctival subictera. The blood count shows hemoglobin 90 g\/L, red blood cells 2.7 T\/L, hematocrit 27%, MCV 102 fL, MCHC 33 g\/dL, leukocytes 8 G\/L, neutrophils 5 G\/L, lymphocytes 2.3 G\/L, monocytes 0.7 G\/L. Which biological tests do you think are relevant to prescribe as a first-line treatment? (one or more possible answers)","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"C-reactive protein (CRP)"},{"idx":1,"correct":false,"proposition":"Serum iron"},{"idx":2,"correct":false,"proposition":"Serum protein electrophoresis","justification":""},{"idx":3,"correct":true,"proposition":"Reticulocytes","justification":"Hemolytic anemia is being tested."},{"idx":4,"correct":true,"proposition":"LDH"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-16","context":null,"enonce":"Which of the following infectious diseases is(are) reportable in France?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Rubella"},{"idx":1,"correct":true,"proposition":"Plague"},{"idx":2,"correct":true,"proposition":"Tuberculosis"},{"idx":3,"correct":true,"proposition":"Legionellosis"},{"idx":4,"correct":false,"proposition":"Invasive pneumococcal disease"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-18","context":null,"enonce":"A 62-year-old man with no medical history has a spontaneous deep hematoma of the psoas muscle. The CBC shows hemoglobin at 90 g\/L and platelets at 170 G\/L. Its hemostasis assessment is as follows: TCA ratio at 2, 1, TP at 78% and fibrinogen at 3.1g \/ L. Mixing the patient's plasma with normal plasma does not correct the TCA (Rosner index of 28 for a normal < 15). The determination of endogenous pathway factors reveals a factor VIII at 4%. What hypothesis(s) do you retain? (one or more possible answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The presence of a lupus-type anticoagulant","justification":"Factor VIII is decreased"},{"idx":1,"correct":false,"proposition":"Constitutional hemophilia A","justification":"The addition of plasma did not correct it"},{"idx":2,"correct":true,"proposition":"The presence of an anti-factor VIII antibody","justification":""},{"idx":3,"correct":false,"proposition":"Willebrand disease type 1","justification":"The rate <10% is too low for a type 1"},{"idx":4,"correct":false,"proposition":"Acquired hemophilia B","justification":"Refers to factor IX and not factor VIII"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-19","context":null,"enonce":"A patient is brought unconscious by firefighters to the emergency room following a road accident. She has a polytrauma for which a brain and thoraco-abdomino-pelvic CT scan are urgently performed. She has a fractured spleen that requires surgery. When she arrives, her husband tells you that she is about 8 weeks pregnant with amenorrhea. The radiation dose received is 10 mGy. What risk(s) is (are) related to the accident and the care?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Developmental delay","justification":""},{"idx":1,"correct":false,"proposition":"Brain malformation","justification":""},{"idx":2,"correct":true,"proposition":"Abortion","justification":"Law of all or laughs)"},{"idx":3,"correct":false,"proposition":"Stunting","justification":""},{"idx":4,"correct":false,"proposition":"Retroplacental hematoma","justification":"In the third quarter"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-20","context":null,"enonce":"A patient comes to your office for a preconception consultation. She is 32 years old, nulligeste. She has been followed for a year for well-balanced high blood pressure on perindopril, one tablet a day. She has estrogen-progestin contraception, which she plans to stop at the end of her platelet. She weighs 81 kg for a height of 1 m 68. She consumes 5 cigarettes a day but would like to quit. What do you foresee at the end of the consultation? (One or more correct answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Rubella serology","justification":""},{"idx":1,"correct":true,"proposition":"Smoking cessation aid by nicotine replacement therapy","justification":""},{"idx":2,"correct":false,"proposition":"Cervico-uterine smear if it is more than one year old","justification":"3 years (5 years for HPV test)"},{"idx":3,"correct":true,"proposition":"Prescription of folate at a dose of 5 mg\/day","justification":"Obesity makes us tick this dosage"},{"idx":4,"correct":true,"proposition":"Discontinuation of perindopril treatment and switching to another antihypertensive drug","justification":"ACE\/ARA2\/Diuretics are contraindicated"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-21","context":null,"enonce":"A 28-year-old woman consults for palpation of swelling in the upper outer quadrant of the right breast. She is worried because her mother and maternal aunt had breast cancer at 55 and 60 respectively. On clinical examination, you palpate a round and regular swelling of 15 mm, not adherent to the deep and superficial planes. There is no inflammation or skin retraction in the regard. No suspicious lymphadenopathy is palpated in the axillary and supraclavicular lymph node areas. Which exam(s) should be requested as a first intention?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A breast ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"A chest x-ray","justification":""},{"idx":2,"correct":false,"proposition":"A dosage of CA 15-3","justification":""},{"idx":3,"correct":false,"proposition":"A breast MRI","justification":""},{"idx":4,"correct":false,"proposition":"A mammogram","justification":"The breasts are too dense before the age of 30, so an ultrasound is done."}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-22","context":null,"enonce":"A 38-year-old woman consults 3 months after her third delivery for a contraceptive request. She had a caesarean section after her first two deliveries were vaginal. She has just stopped breastfeeding her child because she has to resume her professional activity. In her history, she reports uterine perforation during the insertion of an intrauterine device 7 years ago, phlebitis under plaster 10 years ago and cervical laser treatment 4 years ago for cervical dysplasia related to human papillomavirus infection. She does not smoke but << vape >> from time to time. The last cervical smear, performed in early pregnancy, was normal. What contraceptive method(s) is (are) conceivable for this woman?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Levonorgestrel intrauterine device","justification":""},{"idx":1,"correct":true,"proposition":"Copper intrauterine device","justification":""},{"idx":2,"correct":false,"proposition":"Transdermal patch releasing norelgestromin and ethinyl estradiol","justification":"She has a history of DVT"},{"idx":3,"correct":true,"proposition":"Tubal sterilization by laparoscopy","justification":""},{"idx":4,"correct":true,"proposition":"Subcutaneous device releasing etonogestrel","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-23","context":null,"enonce":"Faced with a suspicion of metallic intraocular foreign body, which examination(s) do you propose urgently?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"An orbital scanner","justification":"The reference exam."},{"idx":1,"correct":false,"proposition":"An MRI","justification":""},{"idx":2,"correct":false,"proposition":"An X-ray of the orbit","justification":"We can't really see anything 🤷 ♂️"},{"idx":3,"correct":false,"proposition":"Fluorescein angiography","justification":""},{"idx":4,"correct":false,"proposition":"A measurement of intraocular pressure","justification":"This is contraindicated: by pressing, we increase the IOP, which is dangerous."}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-24","context":null,"enonce":"What is the exact proposal(s) concerning voluntary termination of pregnancy (IVG) in France?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A woman under guardianship can request an abortion","justification":""},{"idx":1,"correct":true,"proposition":"A woman can request complete anonymity for the performance of an abortion","justification":""},{"idx":2,"correct":false,"proposition":"IUD placement is contraindicated in the immediate aftermath of a surgical abortion","justification":""},{"idx":3,"correct":false,"proposition":"Prostaglandins cannot be used in cases of hereditary porphyria","justification":"Is it for anti-progesterone:)"},{"idx":4,"correct":false,"proposition":"A psychosocial interview must be systematically carried out before the abortion is carried out","justification":"Only in minors. It is always proposed"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-25","context":null,"enonce":"A chalazion :","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Is an infection of a pilosebaceous follicle of the eyelids","justification":"Inflammation"},{"idx":1,"correct":true,"proposition":"Is a resorption granuloma of a meibomian gland of the eyelids","justification":""},{"idx":2,"correct":true,"proposition":"Treated with corticosteroid ointment","justification":""},{"idx":3,"correct":false,"proposition":"Treated with systemic antibiotics","justification":"Stye (local route)"},{"idx":4,"correct":true,"proposition":"May require a surgical incision","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-26","context":null,"enonce":"What are the possible etiologies of decreased visual acuity associated with eye redness (several exact responses)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Acute glaucoma crisis due to angle closure","justification":""},{"idx":1,"correct":true,"proposition":"Anterior uveitis","justification":""},{"idx":2,"correct":false,"proposition":"Central retinal artery occlusion","justification":""},{"idx":3,"correct":true,"proposition":"Neovascular glaucoma","justification":""},{"idx":4,"correct":false,"proposition":"Retinal vasculitis","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-27","context":null,"enonce":"In case of myopia (one or more exact answers):","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" The optical system formed by the eye is too convergent","justification":""},{"idx":1,"correct":false,"proposition":"Distance vision is better than near vision without correction","justification":"The opposite:)"},{"idx":2,"correct":true,"proposition":"Light rays focus in front of the retina","justification":""},{"idx":3,"correct":true,"proposition":"A divergent lens can be used for correction","justification":"Lowers the refractive power that is too strong in myopia (and glass convergent for hyperopia)"},{"idx":4,"correct":true,"proposition":"The risk of retinal detachment may be increased","justification":"As well as chronic glaucoma"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-28","context":null,"enonce":"A 75-year-old patient has had left knee pain for several months. During interrogation, these pains are also present at night. The patient gets up 3 times a night to urinate. On clinical examination, the knee appears enlarged in volume compared to the opposite side. There is amyotrophy of the left thigh. Simple X-rays were performed regaining an osteolytic appearance. The patient brings you a TOM and an MRI of the left knee. What is the real proposal(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A secondary localization of prostate origin typically has an osteolytic appearance on the X-ray and CT scan.","justification":"Osteocondensant in three out of four cases."},{"idx":1,"correct":true,"proposition":"The appearance of the cortical is suggestive of a malignant lesion","justification":""},{"idx":2,"correct":true,"proposition":"There are periosteal appositions","justification":"They are observed on the first scanner, infero-lateral:)"},{"idx":3,"correct":true,"proposition":"There is an invasion of soft parts","justification":""},{"idx":4,"correct":false,"proposition":"On the bone level, this lesion remains confined to the metaphysis","justification":"It extends everywhere"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-29","context":null,"enonce":"You take care of an 83-year-old patient, well surrounded, on Day 2 of a knee replacement. The Redon drains were removed without problems. She has a knee increased in volume, very edematous and inflammatory. The scar is beautiful, non-inflammatory. What is the exact proposal(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Outpatient care is possible","justification":""},{"idx":1,"correct":true,"proposition":"The electrotherapy techniques practiced by the physiotherapist will aim to reduce edema","justification":"We are sceptical about this proposal. There is nothing on the new colleges, so we can forget 🙃 about it"},{"idx":2,"correct":true,"proposition":"The prescription of English cane could be made by the liberal physiotherapist after discharge from the hospital","justification":""},{"idx":3,"correct":false,"proposition":"Your physiotherapy prescription must mention the physiotherapy techniques to be used.","justification":""},{"idx":4,"correct":false,"proposition":"The adaptation of the home must be done after writing a file with the MDPH","justification":"The application will have to be made to the General Council to obtain an APA"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-30","context":null,"enonce":"You are taking care of a 32-year-old patient, computer scientist, whose smoking is estimated at 15 packs \/ year, without medical or surgical history, victim of a road accident responsible for a severe spinal cord injury by cervical fracture C5 osteosynthesizer anterior on April 30, 2018. As weaning from mechanical ventilation was difficult, he was tracheostomized on May 21, 2018 after orotracheal intubation. Weaning was then carried out on May 29. When he arrived, he was eupneic. He has a right trochanter eschar, stage 4 with a loss of substance to the bone. The background of the eschar is fibrinous, and purulent secretions are very abundant without inflammatory skin signs. What is the exact proposal(s):","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Tracheal stenosis is a complication of prolonged orotracheal intubation","justification":""},{"idx":1,"correct":false,"proposition":"You prefer for the treatment of this pressure ulcer a combination of local antiseptics and dry dressings.","justification":"No antiseptic"},{"idx":2,"correct":false,"proposition":"The presence of this pressure ulcer contraindicates wheelchair placement","justification":"Not at all, it is necessary to mobilize the patient to avoid the development of a new pressure ulcer."},{"idx":3,"correct":false,"proposition":"The lesion being of spinal cord level C6 you expect anesthesia from the lateral edge of the forearm in anatomical position","justification":"C6 is healthy:)"},{"idx":4,"correct":true,"proposition":"The request for long-term illness can be made by the attending physician","justification":"It is even he who does it most of the time"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-31","context":null,"enonce":"A 70-year-old patient falls down the stairs. He has trauma to his right ankle. In view of the following X-rays, which are the true proposition(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The lateral collateral ligament is probably ruptured","justification":"The mechanism is in eversion so it is the medial that breaks"},{"idx":1,"correct":true,"proposition":"Tibio-tal ratios are normal","justification":""},{"idx":2,"correct":false,"proposition":"The distal tibio-fibular ligament is probably intact","justification":""},{"idx":3,"correct":true,"proposition":"There is a suprasyndesmotic fracture of the malleola. Side","justification":""},{"idx":4,"correct":true,"proposition":"There is a risk of major skin pain on the medial side of the ankle","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-32","context":null,"enonce":"You prescribe a series knee articulated orthosis to one of your patients with a knee sprain. Check the correct prescription principle(s) for this type of medical device. ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is prescribed on a simple prescription","justification":""},{"idx":1,"correct":false,"proposition":"It is prescribed on a large apparatus form","justification":"It's a small ;)"},{"idx":2,"correct":false,"proposition":"It is refunded at 100% of its purchase price","justification":"65%"},{"idx":2,"correct":true,"proposition":"All specialists can prescribe it","justification":""},{"idx":2,"correct":false,"proposition":"Physiotherapists can prescribe it","justification":"It is articulated so no"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-33","context":null,"enonce":"Regarding carpal tunnel syndrome, which is (are) the true proposition(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is most often idiopathic","justification":""},{"idx":1,"correct":true,"proposition":"It is more common during pregnancy","justification":""},{"idx":2,"correct":false,"proposition":"The electromyogram is essential for diagnosis","justification":""},{"idx":3,"correct":false,"proposition":"It can cause a deficit of the long flexor of the thumb","justification":"This is the short flexor"},{"idx":4,"correct":false,"proposition":"It may lead to an abolition of the pen-radial reflex","justification":"Radial pen = C6 = radial nerve"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-35","context":null,"enonce":"You examine an ankle. Which characteristic(s) related to the anatomical structure pointed out is (are) correct?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This is the tendon of the extensor muscle of the toes","justification":""},{"idx":1,"correct":false,"proposition":"This is the tendon of the fibular muscle","justification":""},{"idx":2,"correct":true,"proposition":"This is the tendon of the anterior tibial muscle","justification":""},{"idx":3,"correct":true,"proposition":"The corresponding muscle is innervated by the deep fibular nerve","justification":"Like all muscles of the anterior compartment of the leg"},{"idx":4,"correct":true,"proposition":"The corresponding muscle is innervated by the roots L4 and L5","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-36","context":null,"enonce":"A young patient of 34 years comes to consult you for inflammatory low back pain that has appeared for 6 months. You suspect spondyloarthritis and have prescribed an MRI of the sacroiliac joints. What is (are) the exact proposal(s) regarding the MRI it brings you?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This is a T1-weighted sequence","justification":""},{"idx":1,"correct":true,"proposition":"There is a saturation of the fat signal","justification":"T2 FAT-SAT"},{"idx":2,"correct":true,"proposition":"There is bilateral sacroiliitis","justification":""},{"idx":3,"correct":false,"proposition":"There is MODIC1 type L5-S1 disc disease","justification":"This classification is for disk degeneration"},{"idx":4,"correct":true,"proposition":"This is a coronal plan","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-38","context":null,"enonce":"A 30-year-old patient arrives at the emergency room because he has just hurt his finger very much by grabbing the jersey of another player during a rugby 🏉 match. What is (are) the exact proposal(s) concerning the radiography of the hand that you have performed?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"We visualize a fracture of the base of the thumb","justification":""},{"idx":1,"correct":false,"proposition":"We visualize a fracture of a metacarpal","justification":""},{"idx":2,"correct":true,"proposition":"We visualize a phalanx fracture","justification":""},{"idx":3,"correct":true,"proposition":"Traumatic injury is the tearing of a long flexor tendon","justification":""},{"idx":4,"correct":false,"proposition":"Interphalangeal dislocation is seen","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-39","context":null,"enonce":"In case of paralysis of the oculomotor nerve (III), you may encounter on examination: ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A defect in elevation of the eye","justification":""},{"idx":1,"correct":false,"proposition":"A miosis","justification":"Mydriasis"},{"idx":2,"correct":true,"proposition":"A defect of adduction of the eye","justification":"Internal rectus muscle is innervated by the III"},{"idx":3,"correct":false,"proposition":"Exophthalmos","justification":"The ptosis will give a false enophtalmos rather"},{"idx":4,"correct":true,"proposition":"A ptosis","justification":"The eyelid levator"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-40","context":null,"enonce":"A 62-year-old patient has a history of essential hypertension treated as monotherapy for 2 years and active smoking (45 packs-year). For about two weeks, he has been complaining of daily headaches that settle willingly in the second part of the night. At first, they gradually faded during the morning. For about 3 days, they have been constant. These headaches are described as diffuse in helmets, fluctuate in intensity, are accentuated by physical activity. He also complains of inappetence and nausea that are also gradually evolving. The patient is apyretic. What syndrome do you evoke in front of this painting?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Migraine sickness","justification":""},{"idx":1,"correct":false,"proposition":"Daily chronic headaches","justification":""},{"idx":2,"correct":false,"proposition":"Meningeal syndrome of infectious origin","justification":""},{"idx":3,"correct":true,"proposition":"Intracranial hypertension","justification":"This is the typical picture"},{"idx":4,"correct":false,"proposition":"Meningeal syndrome related to subarachnoid hemorrhage (SAH)","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-41","context":null,"enonce":"A 59-year-old patient saw a tremor in the last three fingers of his right hand that his entourage also noticed when walking. It swings the upper right limb less to walking. On examination, you notice that the tremor disappears with outstretched arms. You perceive that passive mobilization of the right elbow is more difficult and mobilization of the right shoulder is painful. Osteotendinous reflexes are normal. This type of tremor is probably aggravated by what? ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Emotion","justification":"Stress increases it"},{"idx":1,"correct":true,"proposition":"Mental arithmetic","justification":""},{"idx":2,"correct":false,"proposition":"Writing","justification":""},{"idx":3,"correct":false,"proposition":"The movement","justification":""},{"idx":4,"correct":false,"proposition":"Sleep","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-42","context":null,"enonce":"Which of the following applies(s) to a central neurological bladder?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Spinal cord injury above the sacral centers","justification":""},{"idx":1,"correct":false,"proposition":"Detrusor hypoactivity","justification":"Acute urine retention is observed in peripheral disorders"},{"idx":2,"correct":true,"proposition":"Incontinence","justification":"No vesicosphincter dyssinergeria"},{"idx":3,"correct":true,"proposition":"Risk of ureterobesical reflux","justification":""},{"idx":4,"correct":false,"proposition":"Low intravesical pressures","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-44","context":null,"enonce":"Which of the following biological signs points you to iatrogenic adrenal insufficiency in a 38-year-old patient with a history of Crohn's disease treated for 5 years with 10 mg\/Day prednisone?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Natrimia at 128 mmol\/L","justification":""},{"idx":1,"correct":false,"proposition":"Kaliemia at 5.8 mmol\/L","justification":""},{"idx":2,"correct":true,"proposition":"Fasting blood glucose at 3 mmol\/L","justification":""},{"idx":3,"correct":false,"proposition":"Plasma ACTH at 8 hours at 585 pg\/ml (N: 10 - 20)","justification":""},{"idx":4,"correct":false,"proposition":"Urinary free cortisol at 25 μg\/24 hours (N: < 90)","justification":"It is used for hypercortiscime, and not for hypo (because there is no lower threshold) ☺️"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-45","context":null,"enonce":"You see a 15-day-old newborn who has an isolated fever at 38.2 ° C and a general condition preserved: ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"You reassure parents about the benign nature of this fever during viral epidemics","justification":"Its age makes it possible to consider the hypothesis of a late bacterial neonatal infection."},{"idx":1,"correct":false,"proposition":"The flu test is not informative at this age","justification":"It is quite informative"},{"idx":2,"correct":true,"proposition":"The urine strip is not informative at this age","justification":""},{"idx":3,"correct":true,"proposition":"Cytobacteriological examination of urine is systematic","justification":""},{"idx":4,"correct":true,"proposition":"The realization of a lumbar puncture is systematic","justification":"He has 15 days he 👉 has the right to a complete check-up and hospital supervision"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-46","context":null,"enonce":"The lesions in the photo below should evoke (only one expected response) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Polygenic hypercholesterolemia","justification":""},{"idx":1,"correct":false,"proposition":"Familial combined hyperlipidemia","justification":""},{"idx":2,"correct":true,"proposition":"Homozygous familial hypercholesterolemia","justification":"Tendon xanthomas -> problem of significant LDL -> homozygous familial hypercholesterolemia"},{"idx":3,"correct":false,"proposition":"Dysbetalipoproteinemia","justification":""},{"idx":4,"correct":false,"proposition":"A syndrome of familial hyperchylomicronemia","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-47","context":null,"enonce":"A 4-year-old efant presents to the emergency room for painful lameness without fever. What is the exact proposal(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Presence of a lump of butter fracture","justification":""},{"idx":1,"correct":false,"proposition":"Presence of a green wood fracture","justification":"No break in continuity"},{"idx":2,"correct":false,"proposition":"Presence of a hair fracture","justification":""},{"idx":3,"correct":true,"proposition":"Presence of traumatic curve","justification":"Fibula"},{"idx":4,"correct":false,"proposition":"Presence of a Salter II","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-48","context":null,"enonce":"In front of a lesion of the tongue, which is (are) the clinical sign(s) that will orient (steer) towards a malignant origin?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Indurated injury","justification":""},{"idx":1,"correct":false,"proposition":"Painful lesion","justification":"Pain does not point to one cause over another"},{"idx":2,"correct":true,"proposition":"Bleeding on contact when palpating the lesion","justification":""},{"idx":3,"correct":true,"proposition":"Submucosal induration","justification":""},{"idx":4,"correct":true,"proposition":"Presence of associated leukoplakia","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-49","context":null,"enonce":"You intervene at the home of an infant found dead by his parents a few minutes ago: ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"You ask to be accompanied by the police","justification":""},{"idx":1,"correct":false,"proposition":"You do not have to sign the death certificate before admission to the hospital","justification":""},{"idx":2,"correct":false,"proposition":"You write a report to the Public Prosecutor","justification":""},{"idx":3,"correct":true,"proposition":"You propose to the parents to perform an autopsy in search of the causes of death","justification":""},{"idx":4,"correct":false,"proposition":"The transfer of the body must be done to a forensic institute","justification":"Emergency College: 'It is recommended that the medical first responders or the regulation of Centre 15 contact an MIN reference centre as soon as possible in order to organise the immediate transfer of the child to this structure' (and not a forensic institute)"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-50","context":null,"enonce":"You explain to young parents whose child has a first febrile episode the measure(s) to take during this episode: ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Drug treatment is required for temperatures above 39°C","justification":"No drug is introduced on a temperature value"},{"idx":1,"correct":false,"proposition":"Drinking is necessary every hour as long as the fever persists","justification":"It is necessary for the goodwill of the child"},{"idx":2,"correct":false,"proposition":"Cool wraps should be used if the child is uncomfortable","justification":""},{"idx":3,"correct":true,"proposition":"The use of ibuprofen is possible only after 3 months","justification":""},{"idx":4,"correct":false,"proposition":"Keep the child out of the community for the duration of the fever","justification":"There is no such recommendation"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-51","context":null,"enonce":"Regarding cervical swelling, which proposal(s) is (are)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A cyst of the thyroglossal tract is mobile to swallowing","justification":""},{"idx":1,"correct":false,"proposition":"Right supraclavicular lymphadenopathy may be indicative of genitourinary cancer","justification":"Left (third ganglion)"},{"idx":2,"correct":true,"proposition":"Superficial renitent swelling localized to the anterior edge of the sternocleidomastoid muscle is suggestive of an amygdaloid cyst","justification":""},{"idx":3,"correct":false,"proposition":"Brachial plexus schwannoma is a differential diagnosis of submandibular lymphadenopathy","justification":"The mandible and arm are relatively far from each other ☺️"},{"idx":4,"correct":true,"proposition":"Accessory nerve schwannoma is a differential diagnosis of spinal lymphadenopathy","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-52","context":null,"enonce":"Regarding the peritonsillar phlegmon, which is (are) the exact item(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The abscess is localized at the level of the lateropharyngeal space","justification":""},{"idx":1,"correct":true,"proposition":"There may exist trismus","justification":"The retrostylian gives a torticollis:)"},{"idx":2,"correct":true,"proposition":"The anterior pillar of the palace veil is enlarged","justification":""},{"idx":3,"correct":false,"proposition":"In adults, hospitalization is systematic","justification":""},{"idx":4,"correct":false,"proposition":"The drainage of the abscess is done either by puncture or by no incision under general anesthesia","justification":"Not under GA;) It is done in two seconds in the emergency room, under AL"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-53","context":null,"enonce":"Regarding benign paroxysmal positional vertigo, what is(are) the exact item(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" It lasts less than one minute","justification":""},{"idx":1,"correct":false,"proposition":"It follows vestibular ischemia","justification":"lithiasis of one of the ciruclair ducts"},{"idx":2,"correct":true,"proposition":"It is treated with vestibular physiotherapy","justification":""},{"idx":3,"correct":false,"proposition":"It is associated with tinnitus","justification":"no appendix signs (no hearing loss, no nausea, ...)"},{"idx":4,"correct":true,"proposition":"There is a triggering positional factor","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-55","context":null,"enonce":"A 62-year-old patient has hyponatremia of progressive onset. It appears clinically euvolemic. His blood test is as follows: Na 125 mmol\/L - K 4 mmol\/L - chlorine 110 mmol\/L - HCO3- 25 mmol\/L - blood glucose 5 mmol\/L - protein 67 g\/L - urea 4 mmol\/L and serum creatinine 78 μmol\/L. Urine balance: Na 100 mmol\/L - K 25 mmol\/L - urea 350 mmol\/L and creatinine 8 mmol\/L. What is(are) the possible cause(s) of this biological table? (one or more correct answers)","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"SIADH","justification":"Plasma hyposmolarity, euvolemic patient and urinary hyperosmolarity make the diagnosis"},{"idx":1,"correct":false,"proposition":"Tea and toast syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Furosemide","justification":""},{"idx":3,"correct":false,"proposition":"Amlodipine","justification":""},{"idx":4,"correct":false,"proposition":"Lithium","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-56","context":null,"enonce":"An 86-year-old patient is hospitalized for hematemesis. It is known to have viral hepatitis B, not followed. His family describes a bloody vomiting equivalent in volume to that of a basin. On examination, he presents ascites and asterixis. Systolic blood pressure is 55 mmHg. Which of the following is associated with a poor prognosis? ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Age","justification":""},{"idx":1,"correct":false,"proposition":"Hematemesis volume","justification":"This is not a factor of poor prognosis because the estimate is not reliable"},{"idx":2,"correct":true,"proposition":"Blood pressure","justification":""},{"idx":3,"correct":true,"proposition":"Hepatic encephalopathy","justification":""},{"idx":4,"correct":true,"proposition":"Ascites","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-57","context":null,"enonce":"A 62-year-old patient has the following laboratory work: Na 142 mmol\/L - K 5.7 mmol\/L - chlorine 110 mmol\/L - HCO3- 18 mmol\/L - protein 88 g\/L - urea 20 mmol\/L - serum creatinine 170 μmol\/L. Which drug(s) can (can) give this biological table? (one or more correct answers)","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Ibuprofen ","justification":""},{"idx":1,"correct":true,"proposition":"Candesartan","justification":""},{"idx":2,"correct":true,"proposition":"Amiloride","justification":""},{"idx":3,"correct":false,"proposition":"Amlodipine","justification":"It does not act on the kidney"},{"idx":4,"correct":false,"proposition":"Prednisone","justification":"We would then find hypokalemia (by aldosterone-like effect on mineralocorticoid receptors)."}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-58","context":null,"enonce":"You take care of a 67-year-old patient in the emergency room whose reason for entry is right calf pain. The interrogation and clinical examination find a progressive cancer during treatment and a localized tenderness along the right deep venous network. The rest of the exam is unremarkable. You use a simplified clinical prediction model of deep vein thrombosis (DVT) that indicates a DVT probability of 17%. You ask for a venous Doppler ultrasound of the lower limbs to confirm this suspicion of DVT. Which of the following is correct:","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Post-test likelihood of DVT depends on the sensitivity of venous Doppler ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"The pre-test probability of DVT depends on the specificity of venous Doppler ultrasound","justification":""},{"idx":2,"correct":true,"proposition":"Post-DVT probability depends on venous Doppler ultrasound likelihood ratio","justification":""},{"idx":3,"correct":true,"proposition":"Post-test probability of DVT depends on the intrinsic performance of venous Doppler ultrasound","justification":""},{"idx":4,"correct":true,"proposition":"The post-test probability of DVT can be determined graphically using the Fagan nomogram","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-59","context":null,"enonce":"A 43-year-old patient consults for moderate hyperferritinemia at 2 times the normal discovered on a systematic assessment carried out by occupational medicine. It is asymptomatic. Which element(s) will orient towards metabolic hepatosiderosis?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"High transferrin saturation coefficient","justification":"would lead to hemoichromatosis"},{"idx":1,"correct":true,"proposition":"Overweight","justification":""},{"idx":2,"correct":true,"proposition":"Hypertriglyceridemia","justification":""},{"idx":3,"correct":false,"proposition":"Graves' disease","justification":""},{"idx":4,"correct":false,"proposition":"History of colon cancer","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-60","context":null,"enonce":"In front of sigmoid diverticulitis, an injected abdominal tomography CT scan is performed. Can it show (one or more exact answers)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Addition images containing air at the anti-mesenteric edge of the colon","justification":""},{"idx":1,"correct":false,"proposition":"Thinning of the colonic wall","justification":""},{"idx":2,"correct":true,"proposition":"An infiltration of fat around a diverticulum","justification":""},{"idx":3,"correct":true,"proposition":"A thickening of the colonic wall","justification":""},{"idx":4,"correct":true,"proposition":"Pylephlebitis","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-61","context":null,"enonce":"In which situation(s) does a patient benefit from an exemption from co-payment (based on Social Security tariffs)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Care of any minor children","justification":""},{"idx":1,"correct":true,"proposition":"Care, whatever it may be, to subjects benefiting from State Medical Aid (AME)","justification":""},{"idx":2,"correct":false,"proposition":"Care, whatever it is, for pregnant women from the 4th month of pregnancy","justification":"From the sixth month for pregnancy care"},{"idx":3,"correct":true,"proposition":"Performing a mammogram as part of the national screening program","justification":""},{"idx":4,"correct":false,"proposition":"Additional tests performed as part of participation in a clinical trial","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-62","context":null,"enonce":"A 48-year-old patient has been presenting for a few weeks headaches that lead to the diagnosis of high blood pressure. The average outpatient blood pressure is 177\/92 mmHg. Its biological balance is as follows: Na 142 mmol \/ L, K 3.4 mmol \/ L, Creatinine 70 μmol \/ I, Calcemia 2.5 mmol \/ L. Diuresis of 24 h: 1 400 ml. urinary lonogram: Na 180 mmol\/L, K 50 mmol\/L, proteinuria< 0.01 g\/1. In view of this assessment, what is (are) the cause (s) that you must mention for this high blood pressure?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Renal arterial stenosis","justification":""},{"idx":1,"correct":false,"proposition":"Syndrome de Gitelman","justification":""},{"idx":2,"correct":true,"proposition":"Primary hyperaldosteronism","justification":""},{"idx":3,"correct":true,"proposition":"Chronic licorice consumption","justification":""},{"idx":4,"correct":false,"proposition":"Pheochromocytoma","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-63","context":null,"enonce":"Which tumor marker is of interest in screening, diagnosis, prognosis and monitoring of the cancer of which it is specific? (1 response expected)","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"ACE","justification":""},{"idx":1,"correct":false,"proposition":"Alpha FP","justification":""},{"idx":2,"correct":false,"proposition":"hCG","justification":""},{"idx":3,"correct":false,"proposition":"CA125","justification":""},{"idx":4,"correct":true,"proposition":"PSA","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-64","context":null,"enonce":"Under the law of 2 February 2022 known as the Claeys-Leonetti << law>> when a patient can no longer express himself, a treatment that appears useless, disproportionate or when it has no other effect than the sole artificial maintenance of life, may be suspended at the end of a collegial procedure defined by regulation. Which element(s) are (s) provided for in this procedure?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Consultation of advance directives if they exist","justification":""},{"idx":1,"correct":true,"proposition":"The opinion of at least one consultant","justification":""},{"idx":2,"correct":true,"proposition":"A discussion with the healthcare team present","justification":""},{"idx":3,"correct":false,"proposition":"Information from the on-call director if this procedure takes place on weekends","justification":"He is not part of the medical team"},{"idx":4,"correct":true,"proposition":"The decision must be recorded in the medical record","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-65","context":null,"enonce":"On what means(s) is the assessment of the qualitative dimension of pain based?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Questionnaire DN4","justification":"Only qualitative questionnaire in the list of proposals"},{"idx":1,"correct":false,"proposition":"doloplus questionnaire","justification":""},{"idx":2,"correct":false,"proposition":"Algoplus scale","justification":""},{"idx":3,"correct":false,"proposition":"Analogue visual scale","justification":""},{"idx":4,"correct":false,"proposition":"Digital scale","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-66","context":null,"enonce":"By what therapeutic means(s) can neuropathic pain be managed as a first line?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A tricyclic antidepressant"},{"idx":1,"correct":true,"proposition":"An antiepileptic drug of the class Gabapentinoids","justification":""},{"idx":2,"correct":false,"proposition":"Morphine"},{"idx":3,"correct":true,"proposition":"Transcutaneous electrical stimulation","justification":""},{"idx":4,"correct":false,"proposition":"Spinal cord stimulation"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-67","context":null,"enonce":"A 55-year-old patient is being treated in a palliative care unit for a terminal course of respiratory failure complicating major emphysema. Her main complaint is an increase in her dyspnea. How to manage this dyspnea? (one or more correct answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Assessment of the symptom by a visual analogue scale","justification":""},{"idx":1,"correct":false,"proposition":"Adaptation of oxygen therapy flow rate so that arterial oxygen saturation is greater than 95%","justification":""},{"idx":2,"correct":true,"proposition":"Introduction or increase of opioid therapy","justification":"It is a treatment for dyspnea in palliative care"},{"idx":3,"correct":true,"proposition":"Comfortable patient installation","justification":""},{"idx":4,"correct":false,"proposition":"Deep and continuous sedation from the outset until death","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-68","context":null,"enonce":"Can obesity surgery such as a longitudinal gastrectomy be proposed (one or more exact answers)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"In adolescents from 15 years of age if their BMI is greater than 40","justification":""},{"idx":1,"correct":true,"proposition":"In a 55-year-old adult, OSA device, with a BMI > 35","justification":""},{"idx":2,"correct":false,"proposition":"in case of severe eating disorder","justification":"This is a contraindication"},{"idx":3,"correct":true,"proposition":"If the subject has understood and accepts post-operative medical and surgical follow-up for life","justification":""},{"idx":4,"correct":true,"proposition":"If the patient has received clear and complete information about the operative risks","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-69","context":null,"enonce":"A 52-year-old patient with no particular history has high blood pressure, proteinuria of 2g \/ 24 h, hematuria at 105 red blood cells \/ ml with serum creatinine at 130 μmol \/ L. His vesicorenal ultrasound is normal. Here is the report of his renal biopsy: cortical fragment comprising 15 glomeruli including 4 sclerotic glomeruli. The permeable glomeruli exhibit mesangial and endocapillary proliferation. Moderate arteriolosclerosis lesions. Lesions of tubular atrophy and interstitial fibrosis on approximately 20% of the parenchyma. Immunofluorescence finds deposits of IgA to +++ in the mesangium and C3 to 1+ in the vessels and glomeruli. What is (are) the possible diagnosis(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Tubulointerstitial nephropathy","justification":"No leukocyturia, proteinuria > 1g\/24h"},{"idx":1,"correct":false,"proposition":"Lupus nephropathy class IV","justification":""},{"idx":2,"correct":false,"proposition":"Pauciimmune glomerulonephritis","justification":""},{"idx":3,"correct":true,"proposition":"IgA nephropathy","justification":"This is the typical picture"},{"idx":4,"correct":false,"proposition":"Nephroangiosclerosis","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-71","context":null,"enonce":"As a young general practitioner, you are seeing for the first time a 52-year-old patient who complains of insomnia, anxious ruminations, loss of vital momentum and family and professional disinvestment. He indicates that his symptoms appeared 6 months ago, following the arrival of a new team leader who constantly remarks, about his slow work and lack of intellectual abilities. He even reports insults hurled at him several times, when he was alone with his boss. This patient has no notable medical history, apart from depression reactive to a divorce, 10 years ago. The patient asks you to make a declaration of occupational disease. What do you need to indicate on the initial medical certificate?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The existence of a depressive syndrome","justification":"'Insomnia, anxious ruminations, loss of vital momentum and family and professional disinvestment'"},{"idx":1,"correct":true,"proposition":"The date you first noticed the pathology","justification":""},{"idx":2,"correct":false,"proposition":"History of depressive syndrome","justification":"Only the medical information that is needed is shared"},{"idx":3,"correct":false,"proposition":"The existence of harassment by a colleague","justification":""},{"idx":4,"correct":false,"proposition":"The name of the head of department","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-72","context":null,"enonce":"A 12-year-old patient is admitted to the pediatric emergency department with meningeal syndrome. He is installed in an examination room by a nursing assistant and the nurse comes to take his temperature and blood pressure. The intern then comes to examine the child and suspects an invasive meningococcal infection, which will be confirmed by CSF (meningococcal C) analysis. The nurse, aged 30, comes to see the intern saying she is worried because she is pregnant and she wonders what she should do because she took care of the child without a mask and is not vaccinated against meningococcus. What measure(s) should be proposed to it","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Vaccination with meningococcal C conjugate vaccine","justification":""},{"idx":1,"correct":false,"proposition":"Prophylaxis with oral rifampicin for 5 days","justification":""},{"idx":2,"correct":false,"proposition":"Rifampicin prophylaxis per for 2 days","justification":""},{"idx":3,"correct":true,"proposition":"Reassure them that there is no risk of contamination","justification":"It is not contact case because the contact with the child lasted only a few minutes (less than 30-60 minutes)"},{"idx":4,"correct":false,"proposition":"Prophylaxis with ceftriaxone injection","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-74","context":null,"enonce":"What vaccinations are mandatory for a nurse working in a hospital in a care unit (one or more possible answers)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Pneumococcal vaccination","justification":""},{"idx":1,"correct":true,"proposition":"Vaccination against diphtheria, tetanus and poliomyelitis","justification":""},{"idx":2,"correct":false,"proposition":"Vaccination against hepatitis A","justification":""},{"idx":3,"correct":false,"proposition":"Pertussis vaccination","justification":""},{"idx":4,"correct":true,"proposition":"Vaccination against hepatitis B","justification":"These are the only two mandatory vaccines for caregivers"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-75","context":null,"enonce":"Regarding acute peritonitis, which proposal(s) do you retain?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The abdominal CT scan is the reference morphological examination for diagnosis","justification":""},{"idx":1,"correct":true,"proposition":"Surgical treatment should include washing of the peritoneal cavity","justification":""},{"idx":2,"correct":true,"proposition":"The 3 most common causes are appendicitis, peptic ulcer, diverticulum colic","justification":""},{"idx":3,"correct":true,"proposition":"The evolving risk of peritonitis is septic shock","justification":""},{"idx":4,"correct":false,"proposition":"Peritonitis is always linked to digestive perforation","justification":"Not primary peritonitis"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-76","context":null,"enonce":"Regarding acute bowel obstruction, what is the exact information(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A functional occlusion may be caused by a hydroelectrolyte disorder","justification":""},{"idx":1,"correct":true,"proposition":"A peritoneal flange can lead to occlusion by strangulation","justification":""},{"idx":2,"correct":true,"proposition":"Strangulation occlusion threatens gut vitality within hours","justification":""},{"idx":3,"correct":true,"proposition":"The abdominal CT scan with contrast injection is the reference exam","justification":""},{"idx":4,"correct":true,"proposition":"Colon cancer is the leading cause of obstruction colonic occlusion","justification":"Fecal impaction is the leading cause of rectal 💩 obstruction"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-77","context":null,"enonce":"Regarding occlusive syndrome: (one or more exact answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Stopping materials is a physical sign absent in 30% of cases","justification":""},{"idx":1,"correct":false,"proposition":"Abdominal pain is still the initial symptom","justification":""},{"idx":2,"correct":false,"proposition":"The seat of abdominal pain signs the seat of the obstacle","justification":""},{"idx":3,"correct":true,"proposition":"Repeated and frequent vomiting temporarily relieves abdominal pain in small intestine occlusions","justification":""},{"idx":4,"correct":true,"proposition":"The shutdown of the gas is the essential functional sign for diagnosis","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-78","context":null,"enonce":"Mr. M., 58 years old, is referred to you for anomalies in the martial record. In his history, there is only diabetes diagnosed 3 months ago. On clinical examination, the temperature is 37.3 °C.  You notice hepatomegaly evaluated at 5 cm under the right costal awning. His martial assessment is presented below: Transferrin saturation coefficient (TSC) at 62%, ferritin at 1,200 ng\/ml (normal 30 to 300 mg\/ml). Which of the following proposals could explain the abnormalities of the martial assessment presented in this clinical context?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Inflammatory syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Dysmetabolic hepatosiderosis","justification":""},{"idx":2,"correct":true,"proposition":"Genetic hemochromatosis","justification":"High CSE makes the diagnosis."},{"idx":3,"correct":false,"proposition":"Myelodysplasia","justification":""},{"idx":4,"correct":false,"proposition":"Macrophage activation syndrome","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-79","context":null,"enonce":"When admitting a polytrauma patient in severe hemorrhagic shock (one or more exact answers):","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A bodyscan is essential and must be carried out urgently","justification":""},{"idx":1,"correct":true,"proposition":"A fast-echo performed at the patient's bed is enough to affirm hemoperitoneum","justification":""},{"idx":2,"correct":false,"proposition":"An emergency laparotomy is indicated to affirm the abdominal origin of hemorrhagic shock","justification":""},{"idx":3,"correct":true,"proposition":"In case of massive hemoperitoneum, the << damage control technique >> is the reference technique","justification":""},{"idx":4,"correct":false,"proposition":"The <<damage control>> technique aims to control bleeding and at the same time treat digestive lesions","justification":"Only control bleeding to save the patient's life. We will take care of the rest in a second time."}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-80","context":null,"enonce":"Mr. M., 22 years old, consults urgently because of asthenia associated with a fever at 39 ° C evolving for 72 hours. He complains of odynophagia and diffuse myalgia. On clinical examination, you find cervical lymphadenopathy and splenomegaly through the finger. A blood test was performed in the city and shows the following results: Haemoglobin 13.2 g\/dl, MCV 89 fl, platelets 120 G\/L, leukocytes 10.6 G\/L, neutrophils 1.6 G\/L, basophils 0, 1 G\/L, eosinophils 0.4 G\/L, lymphocytes 8 G\/L, monocytes 0.5 G\/L. Blood smear: presence of many large lymphocytes with hyperbasophilic cytoplasm. Which of the following complementary examinations do you think should be carried out as a first-line treatment in this clinical context?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Myelogram"},{"idx":1,"correct":false,"proposition":"Lymphocyte immunophenotyping","justification":""},{"idx":2,"correct":true,"proposition":"Antigenemia p24"},{"idx":3,"correct":true,"proposition":"MNI test"},{"idx":4,"correct":false,"proposition":"Cytomegalovirus (CMV) serology","justification":"Does not give lymphadenopathy or angina (p. 178 of the R2C College of Hematology)"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-82","context":null,"enonce":"Ms. M., aged 58, is referred to internal medicine for a fever at 38.5 ° C associated with the following rash, present for 3 weeks. She also has paresthesias of the 2 feet. You mention: (one or more exact answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cryoglobulinemic vasculitis","justification":""},{"idx":1,"correct":false,"proposition":"Immunological thrombocytopenic purpura (ITP)","justification":"Purpura is rather vascular here"},{"idx":2,"correct":true,"proposition":"Microscopic polyangiitis","justification":""},{"idx":3,"correct":false,"proposition":"Giant cell arteritis","justification":"Vasculitis of the large vessels do not give purpura"},{"idx":4,"correct":false,"proposition":"Behçet's disease","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-83","context":null,"enonce":"About breath in mitral insufficiency, which is (are) the exact proposition(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is ejective mesosystolic","justification":""},{"idx":1,"correct":true,"proposition":"It is most often in steam jet","justification":""},{"idx":2,"correct":true,"proposition":"It may be associated with mesodiastolic rolling","justification":""},{"idx":3,"correct":true,"proposition":"It is most often of apexoaxillary site","justification":""},{"idx":4,"correct":false,"proposition":"It radiates to the carotids","justification":"This is the case of the RA"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-84","context":null,"enonce":"A 42-year-old patient is admitted for chest pain. After interpreting this electrocardiogram, indicate the exact proposal(s): ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This is acute pericarditis","justification":""},{"idx":1,"correct":true,"proposition":"This is an acute coronary syndrome","justification":""},{"idx":2,"correct":true,"proposition":"There are mirror images","justification":""},{"idx":3,"correct":false,"proposition":"There is a complete left branch block","justification":""},{"idx":4,"correct":false,"proposition":"This is a Wolff-Parkinson-White syndrome","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-85","context":null,"enonce":"A 62-year-old patient is admitted for lipothymia. After interpreting this electrocardiogram, indicate the exact proposal(s). ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"There is sinus dysfunction","justification":""},{"idx":1,"correct":false,"proposition":"There is an atrioventricular block of the first degree","justification":""},{"idx":2,"correct":true,"proposition":"There is a right branch block","justification":""},{"idx":3,"correct":true,"proposition":"There is a BAV 2 for 1","justification":""},{"idx":4,"correct":false,"proposition":"There is a complete atrioventricular block","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-86","context":null,"enonce":"In a clinical trial, randomization of the evaluated treatment is intended to be first and foremost:","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Establish comparable groups based on potential confounders","justification":""},{"idx":1,"correct":false,"proposition":"Conclude a difference with a statistical significance level of 5%","justification":""},{"idx":2,"correct":false,"proposition":"Mitigate sampling fluctuations","justification":"Fluctuations are mitigated by increasing the sample size (to approximate the size of the source population)"},{"idx":3,"correct":false,"proposition":"Keep subjects in ignorance of the treatment allocated for the duration of the study","justification":"This is the role of the blind"},{"idx":4,"correct":false,"proposition":"Reduce the number of subjects needed","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-88","context":null,"enonce":"In the following list of bacterial infections, which bacterial infection(s) is (are) not usually associated with hyperleukocytosis?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Gram-negative liver abscess","justification":""},{"idx":1,"correct":false,"proposition":"Acute pyelonephritis","justification":""},{"idx":2,"correct":true,"proposition":"Typhoid fever","justification":"The third to know is brucellosis 🦠"},{"idx":3,"correct":false,"proposition":"Pneumococcal lung infection","justification":""},{"idx":4,"correct":true,"proposition":"Tuberculosis","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-91","context":null,"enonce":"In the absence of a statistically significant difference in the primary outcome between the two groups of a prospective randomised placebo-controlled trial, mention should be made of: ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The risk of statistical error of the second kind (beta)","justification":""},{"idx":1,"correct":true,"proposition":"The lack of effect of the treatment","justification":"Oupsi doupsi"},{"idx":2,"correct":true,"proposition":"A lack of statistical power","justification":"Due to lack of subjects in the study"},{"idx":3,"correct":false,"proposition":"Non-inferiority of the treatment assessed","justification":""},{"idx":4,"correct":false,"proposition":"The risk of statistical error of the first kind (alpha)","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-92","context":null,"enonce":"The association, at autopsy, of a recent, bilateral and multi-focal subdurai hematoma and bilateral retinal hemorrhages in a 6-month-old baby with no particular history suggests the diagnosis of: (one or more exact answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Sudden infant death syndrome","justification":""},{"idx":1,"correct":true,"proposition":"Shaken baby syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Syndrome de Silverman","justification":""},{"idx":3,"correct":false,"proposition":"Rupture of cerebral arteriovenous malformation","justification":""},{"idx":4,"correct":false,"proposition":"Accidental head injury","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-93","context":null,"enonce":"The administrative part of the death certificate, electronically or on paper, is transmitted: (one or more correct answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"At the town hall of the place of death","justification":"who issues the burial permit"},{"idx":1,"correct":false,"proposition":"At the National Institute of Health and Medical Research (INSERM)","justification":""},{"idx":2,"correct":true,"proposition":"To the funeral home manager mandated by the family","justification":"to proceed with burial"},{"idx":3,"correct":false,"proposition":"To the public prosecutor","justification":""},{"idx":4,"correct":false,"proposition":"To the family of the deceased","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-94","context":null,"enonce":"Congenital long QT syndrome is an inherited rhythm disorder of autosomal dominant inheritance that predisposes to sudden death in childhood and can be managed preventively. This pathology is very heterogeneous at the genetic level. What is the exact proposal(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The genes involved code for ion channels","justification":""},{"idx":1,"correct":false,"proposition":"Long QT syndrome is most often associated with a congenital heart defect","justification":""},{"idx":2,"correct":false,"proposition":"The genetic evaluation of this pathology is done by the study of the karyotype","justification":""},{"idx":3,"correct":true,"proposition":"The diagnosis in an index case must lead to information to the relatives","justification":"through the patient (the doctor cannot contact the relatives himself because of medical confidentiality)"},{"idx":4,"correct":false,"proposition":"Molecular predictive diagnosis is not allowed in minor children in this situation","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-95","context":null,"enonce":"The drafting of a descriptive medical certificate requires the evaluation of the ITT in the criminal sense of the term. What is the meaning of this acronym?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Total incapacity for work","justification":""},{"idx":1,"correct":false,"proposition":"Temporary total incapacity","justification":""},{"idx":2,"correct":false,"proposition":"Total temporary incapacity","justification":""},{"idx":3,"correct":false,"proposition":"Inability to work fully","justification":""},{"idx":4,"correct":false,"proposition":"Total temporary incapacity","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-97","context":null,"enonce":"In this family with no particular history, 3 boys were diagnosed with fragile X syndrome (III-3, III-7 and III-11). What is the exact proposal(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Boys III-3, III-7 and III-11 carry a complete mutation in the FMR1 gene","justification":""},{"idx":1,"correct":false,"proposition":"Girl III-2 with mild intellectual disability is likely a heterozygous carrier of a premutation","justification":""},{"idx":2,"correct":true,"proposition":"The III-6 girl has a one in 2 risk of being a heterozygous carrier of a premutation or a complete mutation","justification":""},{"idx":3,"correct":true,"proposition":"Women II-1, II-4, and II-7 have an increased risk of premature ovarian failure","justification":""},{"idx":4,"correct":true,"proposition":"Subject I-2 is a hemizygous carrier of a premutation","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-98","context":null,"enonce":"The objectives of the forensic care of a victim of sexual violence are: (one or more exact answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Describe traumatic bodily injury","justification":""},{"idx":1,"correct":false,"proposition":"Determine if the person consented at the time of the facts","justification":"😨😨"},{"idx":2,"correct":false,"proposition":"Determine if victim impact statements are credible","justification":""},{"idx":3,"correct":true,"proposition":"Set up multidisciplinary care","justification":""},{"idx":4,"correct":true,"proposition":"Take DNA samples","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-99","context":null,"enonce":"What are the possible therapeutic strategies for asthma and chronic obstructive pulmonary disease (COPD)? (one or more correct answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Long-term inhaled corticosteroid therapy monotherapy in COPD","justification":""},{"idx":1,"correct":true,"proposition":"Continuous inhaled corticosteroid monotherapy for asthma","justification":""},{"idx":2,"correct":false,"proposition":"Long-acting long-acting beta-2 agonist as monotherapy for asthma","justification":"Every asthmatic should have his inhaled corticosteroid close to him."},{"idx":3,"correct":true,"proposition":"Combination of inhaled corticosteroid and long-acting beta-2 agonist inhaled as background therapy for asthma","justification":""},{"idx":4,"correct":true,"proposition":"Long-acting beta-2 agonist monotherapy in COPD","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-101","context":null,"enonce":"You receive the result of a blood ionogram showing a serum potassium level of 6 mmol \/ L. What iatrogenic cause(s) can you mention?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Long-term oral corticosteroid therapy","justification":""},{"idx":1,"correct":true,"proposition":"Angiotensin II antagonist","justification":""},{"idx":2,"correct":true,"proposition":"Mineralocorticoid receptor blocker","justification":""},{"idx":3,"correct":true,"proposition":"ACE inhibitor","justification":""},{"idx":4,"correct":false,"proposition":"Loop diuretic","justification":"Hypokalaemic agents"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-102","context":null,"enonce":"About drug antidotes:","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Protamine sulfate neutralizes the anticoagulant activity of heparin","justification":""},{"idx":1,"correct":true,"proposition":"Naloxone is a specific antagonist of morphinomimetics","justification":""},{"idx":2,"correct":false,"proposition":"Prothrombin factors are the antidote for clopidogrel","justification":"For anticoagulants"},{"idx":3,"correct":false,"proposition":"N-acetyl-cysteine is the antidote to acetylsalicylic acid","justification":"Paracetamol"},{"idx":4,"correct":true,"proposition":"Flumazenil is an antagonist of benzodiazepines and related molecules","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-103","context":null,"enonce":"A 23-year-old woman is hospitalized in psychiatry for a state of psychomotor arousal evolving for a week, with disinhibition having led to reckless spending and risky sexual behavior. She has not slept for 72 hours but shows no fatigue and undertakes to present herself to each of the patients of the department. If you were to opt for monotherapy, which of these options would seem appropriate to you?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Lithium"},{"idx":1,"correct":false,"proposition":"Valproic acid","justification":"She is a woman of childbearing age"},{"idx":2,"correct":true,"proposition":"Risperidone"},{"idx":3,"correct":false,"proposition":"Carbamazepine"},{"idx":4,"correct":true,"proposition":"Quetiapine"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-104","context":null,"enonce":"About the decision on medical termination of pregnancy (IMG) (one or more exact answers): ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Any request for IMG must be the subject of an opinion from the Multidisciplinary Center for Prenatal Diagnosis (CPDPN)","justification":""},{"idx":1,"correct":false,"proposition":"There is a list of pathologies for which there is a medical indication for IMG","justification":"No clear list"},{"idx":2,"correct":true,"proposition":"The admissibility of the claim is based on the demonstration of a << high probability of a particularly serious and incurable condition at the time of diagnosis>>","justification":""},{"idx":3,"correct":true,"proposition":"A reflection period should be offered to the pregnant woman between the diagnosis of the condition and the possible realization of the IMG","justification":""},{"idx":4,"correct":true,"proposition":"An IMG can be carried out after consultation with the FNDCP until the end","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-105","context":null,"enonce":"A 31-year-old woman describes the sudden onset of intense fatigue a month ago accompanied by deep sadness. She addresses a lot of blame, especially not being able to take care of her 2-month-old daughter, is very slow down and often wakes up in the middle of the night. Li then sometimes has suicidal thoughts. Which of the following characteristics can (can) be indicative of bipolar mood disorder?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Female sex","justification":""},{"idx":1,"correct":true,"proposition":"Postpartum context","justification":""},{"idx":2,"correct":true,"proposition":"Melancholic features","justification":""},{"idx":3,"correct":true,"proposition":"Brutal start","justification":""},{"idx":4,"correct":false,"proposition":"Suicidal ideation","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-106","context":null,"enonce":"Which of the following signs and symptoms is more common in the elderly compared to young adults?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" Somatic complaints","justification":""},{"idx":1,"correct":false,"proposition":"Feelings of guilt","justification":""},{"idx":2,"correct":false,"proposition":"Self-depreciation","justification":""},{"idx":3,"correct":false,"proposition":"Suicidal ideation","justification":""},{"idx":4,"correct":false,"proposition":"Sexual disorders","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-107","context":null,"enonce":"Which of the following signs can be a symptom(s) due to withdrawal from an opiate substance?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Constipation","justification":"Opiates make constipation"},{"idx":1,"correct":true,"proposition":"Bilateral mydriasis","justification":""},{"idx":2,"correct":false,"proposition":"Hallucinations","justification":""},{"idx":3,"correct":true,"proposition":"Vomiting","justification":""},{"idx":4,"correct":true,"proposition":"High blood pressure","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-108","context":null,"enonce":"In front of a patient with a disorder related to alcohol use and opposed to the idea of addictological care, what attitude(s) characterize motivational interviewing?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":" Giving the patient a case for change","justification":""},{"idx":1,"correct":true,"proposition":"Let the patient explain what alcohol brings","justification":""},{"idx":2,"correct":false,"proposition":"Exposing the patient to situations at risk of excessive consumption","justification":""},{"idx":3,"correct":true,"proposition":"Identify the patient's personal reasons for change","justification":""},{"idx":4,"correct":false,"proposition":"Emphasize to the patient the risks associated with alcohol consumption","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-109","context":null,"enonce":"A 69-year-old patient comes in for an annual visit to his new GP. Clinical examination reveals a pulse rate of 45 beats per minute. Name the drug(s) likely to be involved in this context: ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Selective beta-blocker","justification":""},{"idx":1,"correct":true,"proposition":"Class III antiarrhythmic","justification":""},{"idx":2,"correct":false,"proposition":"Dihydropyridine group calcium channel blocker","justification":"They are not bradycardic, to the contaire of verapamil\/diltiazem"},{"idx":3,"correct":true,"proposition":"Anticholinesterase","justification":""},{"idx":4,"correct":false,"proposition":"Inhaled rapid-acting, short-acting beta-2 mimetic bronchodilator","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-110","context":null,"enonce":"About trisomy 21 syndrome (one or more exact answers): ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It most often results from a maternal meiotic accident","justification":""},{"idx":1,"correct":false,"proposition":"When combined with a chromosomal formula 46,XX,der(14,21),+21, it does not require a family survey","justification":""},{"idx":2,"correct":false,"proposition":"Its post-natal diagnosis can be confirmed rapidly by molecular biology","justification":""},{"idx":3,"correct":true,"proposition":"Its risk of recurrence is close to 1\/100 to 1\/200 for a couple who had a first child affected","justification":""},{"idx":4,"correct":false,"proposition":"Its risk is decreased by advanced maternal age at the time of conception","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-111","context":null,"enonce":"About histological lesions of glomerulopathies (one or more exact answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Diagnosis of minimal glomerular lesions requires electron microscopy examination","justification":"There is no need to go all the way to the MO. We can be satisfied with the normality of the PBR in MO and MF and the clinical context."},{"idx":1,"correct":true,"proposition":"Segmental and focal hyalinosis may be primary in adults","justification":""},{"idx":2,"correct":true,"proposition":"Membranoproliferative glomerulopathy is characterized by double contours of the glomerular basement membrane","justification":""},{"idx":3,"correct":true,"proposition":"Deposits << humps >> are present in acute post-infectious glomerulonephritis","justification":""},{"idx":4,"correct":true,"proposition":"Diabetes can lead to glomerulopathy","justification":"Proteinuria without hematuria with fundus involvement"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-112","context":null,"enonce":"Histological diagnosis of prostate adenocarcinoma on biopsy mapping (one or more exact responses): ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Typically requires six biopsy samples","justification":"12"},{"idx":1,"correct":true,"proposition":"May affirm extra-prostatic involvement","justification":""},{"idx":2,"correct":false,"proposition":"Requires biopsy of seminal vesicles","justification":""},{"idx":3,"correct":true,"proposition":"Is specified in his prognosis by Gleason's architectural score","justification":"It's ISUP now:)"},{"idx":4,"correct":false,"proposition":"Is specified in its prognosis by the proliferation index","justification":"Prognosis = ISPU"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-113","context":null,"enonce":"During surgery, an extemporaneous examination on a tissue sample is requested. The sample must be sent to the pathology laboratory (one or more exact answers)","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"at +4°C","justification":"at room temperature"},{"idx":1,"correct":false,"proposition":"At -20°C"},{"idx":2,"correct":false,"proposition":"Immersed in formalin"},{"idx":3,"correct":true,"proposition":"Without fixing liquid"},{"idx":4,"correct":false,"proposition":"Accompanied by a consent sheet"}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-114","context":null,"enonce":"On a liver biopsy puncture, the diagnosis of acute alcoholic hepatitis (one or more exact answers) is retained ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Neutrophil inflammation","justification":""},{"idx":1,"correct":true,"proposition":"Bloated hepatocytes","justification":""},{"idx":2,"correct":false,"proposition":"Councilman bodies","justification":"Mallory's bodies"},{"idx":3,"correct":false,"proposition":"Cirrhosis","justification":"We are in Acute"},{"idx":4,"correct":false,"proposition":"Cholestasis","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-116","context":null,"enonce":"Regarding Alzheimer's disease, what statement(s) is(are) correct?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Diagnosis is often late","justification":""},{"idx":1,"correct":false,"proposition":"This is a secondary dementia","justification":""},{"idx":2,"correct":false,"proposition":"Behavioural disorders often occur early in the illness","justification":""},{"idx":3,"correct":false,"proposition":"Dubois' 5-word test makes it possible to make the diagnosis","justification":""},{"idx":4,"correct":false,"proposition":"It evolves by flare-up leading to iterative hospitalizations","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-117","context":null,"enonce":"Regarding organ ageing, which is the right proposal(s)? ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is marked by a decrease in maximum capacities","justification":""},{"idx":1,"correct":false,"proposition":"It is mainly due to oxidative stress","justification":"telomere shortening"},{"idx":2,"correct":false,"proposition":"This is a concept without scientific evidence","justification":""},{"idx":3,"correct":true,"proposition":"It is characterized by a reduction in functional reserve capacities","justification":""},{"idx":4,"correct":false,"proposition":"It makes it possible to judge the autonomy of the individual","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-118","context":null,"enonce":"Regarding fragility syndrome, which proposal(s) is(are) right?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is a concept without a precise definition","justification":"Criteria of Fried coughed cough"},{"idx":1,"correct":false,"proposition":"It makes it possible to evaluate the functional reserves of the organs","justification":""},{"idx":2,"correct":true,"proposition":"It is associated with a risk of addiction","justification":""},{"idx":3,"correct":false,"proposition":"It is associated with the risk of pressure ulcers during hospitalization","justification":"There is no definite association in the college between these two elements."},{"idx":4,"correct":false,"proposition":"It is associated with an increased risk of myocardial infarction","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-119","context":null,"enonce":"You take care of an 85-year-old patient for head trauma on vitamin K antagonization (VKA) prescribed for atrial fibrillation. The INR is at 2.9. There is petechia on the brain scan. Which of the following proposals do you retain for your therapeutic care?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" Immediate administration of prothrombin complex concentrate","justification":""},{"idx":1,"correct":false,"proposition":"Administration of vitamin K in 4 hours","justification":""},{"idx":2,"correct":false,"proposition":"Systematic control brain scan in 6 hours","justification":"Only if clinical worsening."},{"idx":3,"correct":false,"proposition":"Discontinuation of vitamin K antagonist with heparin relay at curative dose","justification":""},{"idx":4,"correct":true,"proposition":"Discontinuation of vitamin K antagonist","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2018-qi-120","context":null,"enonce":"Which of the following criteria(s) testify to severe malnutrition in the elderly?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"10% weight loss in 1 month","justification":""},{"idx":1,"correct":false,"proposition":"vitamin K administration in 4 hours","justification":""},{"idx":2,"correct":false,"proposition":"Scamer < systematic control in 6 hours","justification":""},{"idx":3,"correct":false,"proposition":"discontinuation of vitamin K antagonist with heparin relay at an effective dose","justification":""},{"idx":4,"correct":true,"proposition":"discontinuation of vitamin K antagonist","justification":""}],"ts":{"$numberLong":"1665228484038"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-1","context":null,"enonce":"Regarding cadaveric lividities, what is (are) the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"They correspond to a blow to the corpse","justification":""},{"idx":1,"correct":true,"proposition":"They correspond to a blood sweat through the vessels after death","justification":""},{"idx":2,"correct":true,"proposition":"They are one of the indicators of the movement of the body after death","justification":"They do not correspond to the parts that are detached in the new position of the body."},{"idx":3,"correct":false,"proposition":"They allow an accurate estimation of the post-mortem time","justification":"The estimate is not very precise (several hours of differential)."},{"idx":4,"correct":false,"proposition":"They are greenish in colour in case of fatal carbon monoxide poisoning","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-2","context":null,"enonce":"Regarding functional dependence in the elderly, which proposal(s) is(are) right?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is measured by the AGGIR grid in clinical practice","justification":""},{"idx":1,"correct":true,"proposition":"It is present if an individual can no longer take public transport","justification":""},{"idx":2,"correct":true,"proposition":"It is present in case of urinary incontinence","justification":""},{"idx":3,"correct":false,"proposition":"It is present in case of decrease in walking speed","justification":"It is a criterion of fragility"},{"idx":4,"correct":true,"proposition":"It can get worse suddenly","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-3","context":null,"enonce":"Acquired epithelial dysplasia is (one or more exact answers):","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A particular form of hyperplasia","justification":""},{"idx":1,"correct":false,"proposition":"A particular form of metaplasia","justification":""},{"idx":2,"correct":true,"proposition":"Synonym of intraepithelial neoplasia","justification":"According to Anapath's college: \"dysplasia (acquired epithelial): morphological alterations testifying to the existence of a neoplastic process at an early, non-invasive stage.\" No crossing of the basement membrane."},{"idx":3,"correct":true,"proposition":"A pre-cancerous lesion","justification":"Anapath College: \"Acquired dysplasia results from genetic abnormalities that alter proliferation control and cell maturation.\" "},{"idx":4,"correct":true,"proposition":"A potentially reversible lesion","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-4","context":null,"enonce":"About antenatal screening for trisomy 21 syndrome, which proposal(s) is (are) accurate?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Amniocentesis for fetal karyotyping is recommended for any pregnant woman over 38 years of age","justification":""},{"idx":1,"correct":true,"proposition":"Combined first trimester screening includes nuchal translucency measurement around 12 weeks of amenorrhea"},{"idx":2,"correct":true,"proposition":"Screening should be offered to all pregnant women","justification":"But it is not obligatory"},{"idx":3,"correct":false,"proposition":"Non-invasive prenatal screening (NIPT) is recommended for ultrasound diagnosis at 24 weeks of pregnancy of an atrioventricular canal","justification":""},{"idx":4,"correct":true,"proposition":"Medical termination of pregnancy for trisomy 21 syndrome is authorized in France until term","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-5","context":null,"enonce":"About Fragile X Syndrome: (one or more correct answers)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" There is never a father-son transmission","justification":""},{"idx":1,"correct":true,"proposition":"There is a correlation between the size of maternal premutation and the risk of having a child with fragile X syndrome","justification":""},{"idx":2,"correct":true,"proposition":"A father carrying the premutation oblIgAtoire transmits his premutation to all his daughters","justification":""},{"idx":3,"correct":true,"proposition":"A woman carrying the premutation in the heterozygous state can develop FXTAS (Fragile X Tremor Ataxia Syndrome) in adulthood.","justification":""},{"idx":4,"correct":true,"proposition":"A man carrying the premutation can develop FXTAS (Fragile X Tremor Ataxia Syndrome) in adulthood.","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-6","context":null,"enonce":"Cat scratch disease: (one or more exact answers)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"can be confirmed by serology","justification":""},{"idx":1,"correct":true,"proposition":"can be confirmed by PCR on lymph node biopsy product","justification":""},{"idx":2,"correct":false,"proposition":"is usually secondary to a cat flea bite","justification":""},{"idx":3,"correct":true,"proposition":"is usually characterized by large lymphadenopathy with a tendency to fistulization","justification":""},{"idx":4,"correct":false,"proposition":"is due to Bartonella bacilliformis","justification":"Bartonella henselae is a Gram-negative bacillus (BGN)."}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-7","context":null,"enonce":"Regarding pelvic endometriosis, what is the exact answer(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is an autosomal recessive disease","justification":"The relative risk for family history is 5. However, it is not a monogenic disease."},{"idx":1,"correct":true,"proposition":"Normal pelvic ultrasound does not eliminate the diagnosis","justification":""},{"idx":2,"correct":true,"proposition":"It can lead to tubal infertility","justification":""},{"idx":3,"correct":true,"proposition":"It leads to early menopause","justification":"The college (2021 version) does not report early menopause in the chapter on endometriosis."},{"idx":4,"correct":true,"proposition":"It can lead to deep dyspareunia","justification":"And no intromission dyspaneuria."}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-8","context":null,"enonce":"A 65-year-old patient is monitored annually for bicuspid aortic insufficiency. He recently developed exertional dyspnea in stage II of the NYHA (New York Heart Association) classification. An echocardiogram is performed, what is (are) the exact proposal(s) concerning this examination in this indication?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Echocardiography helps quantify the extent of leakage","justification":""},{"idx":1,"correct":true,"proposition":"Echocardiography may show dilation of the left ventricle","justification":""},{"idx":2,"correct":true,"proposition":"Echocardiography should look for dilation of the ascending aorta","justification":""},{"idx":3,"correct":false,"proposition":"Echocardiography should evaluate aortic valve cord injuries","justification":"The aortic valve has no cords (mitral and tricuspid valve contreatment)."},{"idx":4,"correct":true,"proposition":"Echocardiography is an essential element to pose the surgical indication","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-9","context":null,"enonce":"A 69-year-old patient underwent surgery for an aortic bicuspid with valve leakage. A bioprosthesis has been placed. Regarding bioprosthetic valves, which is (are) the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Bioprostheses are most often made of titanium or carbon","justification":""},{"idx":1,"correct":false,"proposition":"Bioprostheses require definitive anticoagulant treatment","justification":""},{"idx":2,"correct":true,"proposition":"The durability of bioprostheses is limited","justification":""},{"idx":3,"correct":false,"proposition":"Wearing a bioprosthetic valve prevents the occurrence of endocarditis","justification":""},{"idx":4,"correct":true,"proposition":"Bioprostheses are most often mounted on a metal frame","justification":"This allows the surgeon to make sutures easier."}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-10","context":null,"enonce":"Regarding focal nodular hyperplasia of the liver, which is (are) the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is a tumor with malignant potential requiring a curative resection","justification":""},{"idx":1,"correct":true,"proposition":"Three to five minutes after the CT scan of contrast medium, the lesion loses its enhancement","justification":"UFH receives only arterial blood (and nothing from the portal vein), so there is an early arterial enhancement and then a very progressive peripheral lavage that then leaves a central scar appearance."},{"idx":2,"correct":false,"proposition":"In a woman, it contraindicates any estrogen-progestin treatment","justification":"This proposition would be true if it concerned hepatic adenoma."},{"idx":3,"correct":true,"proposition":"From a histological point of view, it corresponds to a nodular reorganization of an area of hepatic parenchyma","justification":""},{"idx":4,"correct":false,"proposition":"In case of diagnostic certainty, it requires annual monitoring by liver MRI","justification":"No monitoring required."}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-12","context":null,"enonce":"A 45-year-old man consults for an uncomplicated right inguinal hernia. Generated by the regular externalization of this hernia, he wishes to have surgery. You are his general practitioner, you inform him that: (one or more exact answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Surgical treatment is indicated only if the volume of the hernia no longer allows its reintegration","justification":""},{"idx":1,"correct":true,"proposition":"The presence of pain signs symptomatic hernia and indicates surgical treatment","justification":""},{"idx":2,"correct":true,"proposition":"In case of surgery by first inguinal route, the intervention can be performed under local anesthesia","justification":""},{"idx":3,"correct":true,"proposition":"In case of laparoscopic first, the repair is done with a prosthesis","justification":""},{"idx":4,"correct":false,"proposition":"The interposition of a non-absorbable material eliminates the risk of recurrence","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-13","context":null,"enonce":"In lupus nephropathies: (one or more exact answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Mesangial deposits of C1q can be found","justification":""},{"idx":1,"correct":false,"proposition":"Extracapillary proliferation can be seen in class II","justification":"Class II = deposition + mesangial blooms."},{"idx":2,"correct":false,"proposition":"Mesangial hypercellularity in more than half of the glomeruli corresponds to a class IV","justification":"Endocapillary\/extracapillary proliferation."},{"idx":3,"correct":true,"proposition":"Immunoglobulin deposits can be mesangial or extramembranous","justification":"extramembranous = class V"},{"idx":4,"correct":true,"proposition":"Onset before age 15 is a criterion for poor renal prognosis","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-14","context":null,"enonce":"You receive in the emergency room of your hospital a 32-year-old woman who has just attempted suicide by ingesting liquid Destop (soda pipe unblocker). She is conscious. You must: (one or more correct answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Place the patient in a supine position to facilitate intubation if necessary","justification":""},{"idx":1,"correct":false,"proposition":"Place a gastric tube to evacuate caustic fluid","justification":"Especially not because there is a risk of digestive perforation."},{"idx":2,"correct":true,"proposition":"Do an examination of the oral cavity and the ENT sphere","justification":""},{"idx":3,"correct":false,"proposition":"Schedule upper endoscopy within 3 hours of patient admission","justification":"CT injected at H+3 and H+6 from ingestion (not management)"},{"idx":4,"correct":false,"proposition":"Administering activated charcoal","justification":"No antidote"}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-15","context":null,"enonce":"A first-semester intern takes up his duties in a new CHU. He is seen in consultation by the occupational physician. What is (are) the objective(s) of this consultation?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" Trace the previous occupational exposures of this intern","justification":""},{"idx":1,"correct":true,"proposition":"Find out if the intern is not suffering from a dangerous condition for his professional entourage","justification":""},{"idx":2,"correct":true,"proposition":"Check the status of the intern vis-à-vis mandatory vaccinations and recommended for caregivers","justification":""},{"idx":3,"correct":false,"proposition":"Check if the intern has sufficient knowledge to ensure its service","justification":""},{"idx":4,"correct":false,"proposition":"Inform the intern's manager of his\/her medical history","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-16","context":null,"enonce":"A patient, aged 56, has been off work for 6 months after the discovery of non-insulin-dependent diabetes complicated by arterial disease of the lower limbs. This patient is a mason in the building. What are the measures that could help him stay in employment? (one or more possible answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A therapeutic part-time resumption","justification":""},{"idx":1,"correct":false,"proposition":"A third-class disability application","justification":""},{"idx":2,"correct":true,"proposition":"An application for recognition as a disabled worker","justification":""},{"idx":3,"correct":true,"proposition":"A pre-resumption visit to the occupational physician","justification":""},{"idx":4,"correct":false,"proposition":"An extension of sick leave until retirement age","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-17","context":null,"enonce":"Which cancer(s) is (are) staged by the FIGO classification?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Endometrium"},{"idx":1,"correct":false,"proposition":"Multiple myeloma"},{"idx":2,"correct":true,"proposition":"Cervix"},{"idx":3,"correct":true,"proposition":"Ovary"},{"idx":4,"correct":false,"proposition":"Breast"}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-18","context":null,"enonce":"A 32-year-old patient has had renal colic for 3 years. He weighs 75 kg and his blood pressure is 121\/76 mmHg. It presents bilateral calculations of 3 to 8 mm visible to the scanner, density 1000 UH. \n\nIts biological balance shows: Na 142 mmol \/ L, K 4 mmol \/ L, protein 67 g \/ L, serum creatinine 70 μmol \/ L, serum calcium 2.5 mmol \/ L. Diuresis of 24 hours: 1000 mL. \n\n24-hour urinary lonogram shows natriuresis at 200 mmol\/L, kaliuresis at 35 mmol\/L and hypercalciuria. \n\nWhat is (are) the risk factor(s) for lithiasis in this patient?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"High kaluuresis ","justification":""},{"idx":1,"correct":true,"proposition":"Insufficient diuresis","justification":"At least 2 liters per day is recommended."},{"idx":2,"correct":false,"proposition":"Hypercalcemia","justification":""},{"idx":4,"correct":true,"proposition":"Hypercalciuria","justification":""},{"idx":5,"correct":true,"proposition":"Excessive salt intake","justification":"17 mmol NaCl = 1 g NaCl ingested. 200\/17 gives about 200\/20 = 10 g of NaCl per day. This is much more than the 6g \/ D indicated in a patient for secondary prevention of lithiasis."}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-19","context":null,"enonce":"An 88-year-old patient is referred to the emergency room for confusion during a heat wave. He lives in a nursing home. Its usual treatment is amlodipine, metformin, candesartan, furosemide. Its constants are: blood pressure 100\/70 mmHg, heart rate 92\/min, temperature 37.2 °C.  Its biological balance shows: Na 152 mmol\/L, K 5.7 mmol\/L, Chlorine 95 mmol\/L, HCO3- 14 mmol\/L, protein 88 g\/L, urea 20 mmol\/L, serum creatinine 170 μmol\/L. What is the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" The plasma anion hole is 43 mmol\/L (potassium not taken into account)","justification":""},{"idx":1,"correct":false,"proposition":"There is pure intracellular dehydration","justification":""},{"idx":2,"correct":true,"proposition":"Lactic acidosis should be sought","justification":""},{"idx":3,"correct":true,"proposition":"Renal failure explains the decrease in bicarbonates","justification":"Renal failure leads to decreased clearance of potassium and protons. The latter are buffered into the plasma by the bicarbonates, whose concentration then decreases."},{"idx":4,"correct":true,"proposition":"Candesartan promoted hyperkalaemia and acute renal failure","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-20","context":null,"enonce":"A 68-year-old patient is referred to the emergency room for acute kidney failure by his general practitioner. He is hypertensive and diabetic. He has asthenia and diffuse myalgia.\n\nIts constants are: blood pressure 150\/85 mmHg, heart rate 70\/min, temperature 37.7 °C.\n\nRenal ultrasound is normal.\n\nIts biological balance finds:\n• haemoglobin 10.5 g\/dL\n• leukocytes 8 G\/L\n• Na 141 mmol\/L, K 4.2 mmol\/L, Cl 100 mmol\/L, HCO3- 22 mmol\/L, protein 68 g\/L\n• urea 23 mmol \/ L, serum creatinine 350 μmol \/ L\n• urine strip: 2+ proteins, 3+ red blood cells, negative leukocytes, negative nitrites;\n• urine test: Na 100 mmol\/L, K 34 mmol\/L, urea 150 mmol\/L, creatinine 4 mmol\/L, proteinuria 1.5 g\/1.\nWhich proposal(s) is the exact proposal(s) at this stage?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"There is a functional part to his acute renal failure","justification":""},{"idx":1,"correct":false,"proposition":"It may be acute tubular necrosis","justification":"Acute tubular necrosis does not normally regain hematuria or proteinuria."},{"idx":2,"correct":true,"proposition":"It may be rapidly progressive glomerulonephritis","justification":""},{"idx":3,"correct":false,"proposition":"It is necessary to evoke a diabetic nephropathy","justification":""},{"idx":4,"correct":false,"proposition":"It is necessary to evoke a myeloma tubulopathy","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-21","context":null,"enonce":" Which proposal(s) regarding classification bias in analytical (or etiological) epidemiological studies is\/are correct?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Ranking biases may be differential between cases and controls","justification":"That is, the bias is not as strong between cases and controls. That is a possible situation."},{"idx":1,"correct":false,"proposition":"Ranking bias can be controlled for by multivariate analysis","justification":""},{"idx":2,"correct":false,"proposition":"The random selection of controls within a general population avoids ranking bias","justification":""},{"idx":3,"correct":true,"proposition":"Memory bias is a special case of ranking bias","justification":""},{"idx":4,"correct":true,"proposition":"The use of standardized and validated questionnaires makes it possible to limit the risk of ranking bias","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-22","context":null,"enonce":"A 62-year-old man is seeing positive hepatitis C (HCV) serology. Transaminases are raised to twice normal. Which exam(s) are you asking for as a first line?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Liver biopsy","justification":""},{"idx":1,"correct":true,"proposition":"Non-invasive liver fibrosis tests","justification":""},{"idx":2,"correct":true,"proposition":"Hepatic ultrasound","justification":""},{"idx":3,"correct":false,"proposition":"Upper GI endoscopy","justification":""},{"idx":4,"correct":true,"proposition":"HCV viral load","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-23","context":null,"enonce":"Which proposal(s) regarding the informational performance of a test is(are) accurate?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The sensitivity of a test is the conditional probability that the test will be positive if the subject is free of the disease","justification":"Se = T+ \/ M+"},{"idx":1,"correct":true,"proposition":"The specificity of a test is estimated by the proportion of true negatives among subjects free of the disease","justification":"Spe = T- \/ M-"},{"idx":2,"correct":true,"proposition":"The likelihood ratio of a positive test is equal to the ratio of the probability that the test will be positive in a sick subject to the probability that the test will be positive in a subject free of the disease under study","justification":"RV+ = Se \/ (1-Spe). Now, 1-Spe = 1- (T-\/M-). i.e. 1-Spe = T+\/M-. So RV+ = (T+\/M+) \/ (T+\/M-)"},{"idx":3,"correct":false,"proposition":"The likelihood ratio of a negative test is equal to the ratio of sensitivity to specificity","justification":"RV- = (1-Se)\/Spe"},{"idx":4,"correct":true,"proposition":"Negative predictive value is the conditional probability of being free of the disease if the test is negative","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-24","context":null,"enonce":"A 62-year-old patient consults you for pain that has been evolving for 5 days. This pain is permanent, intense and upsets the sitting position. On clinical examination, you perceive a left perianal inflammatory swelling. Inspection of the margin shows nothing in particular. Digital rectal examination is impossible because of pain. What etiology(s) do you mention?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"An fissure","justification":""},{"idx":1,"correct":false,"proposition":"Hemorrhoid thrombosis","justification":"The margin is described as normal. The pain has been permanent for five days (it is gradually decreasing in hemorrhoidal thrombosis)."},{"idx":2,"correct":false,"proposition":"Herpes","justification":""},{"idx":3,"correct":true,"proposition":"A perianal abscess","justification":""},{"idx":4,"correct":false,"proposition":"Chlamydia","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-25","context":null,"enonce":"An X-ray of the entire spine is requested as part of an abnormality of spinal statics. What is (are) the exact proposal(s) concerning this spinal deformity?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"She is left thoracic","justification":""},{"idx":1,"correct":true,"proposition":"There is a rotation of the vertebral bodies","justification":""},{"idx":2,"correct":false,"proposition":"It is, until proven otherwise, idiopathic scoliosis","justification":""},{"idx":3,"correct":false,"proposition":"It is associated with a rocker of the pelvis","justification":""},{"idx":4,"correct":true,"proposition":"Expert advice is needed","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-26","context":null,"enonce":"You are following a 22-year-old patient with a complete block of 21-hydroxylase, with a severe mutation on both alleles. She asks you about the risk of having a child with the same condition with her partner who has no particular history. Knowing that the frequency of heterozygosity in the general population is 1 in 50, what is the exact proposition?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"1 of 2","justification":""},{"idx":1,"correct":false,"proposition":"1 of 4","justification":""},{"idx":2,"correct":false,"proposition":"1 of 25","justification":""},{"idx":3,"correct":false,"proposition":"1 in 50","justification":""},{"idx":4,"correct":true,"proposition":"1 in 100","justification":"The mother will necessarily transmit her relief. So everything depends on the probability of the father to transmit his. The risk of it being heterozygous is 1 in 50. The risk that it will transmit its allele, if it is heterozygous, is 1\/2. 1\/50 * 1\/2 = 1\/100."}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-27","context":null,"enonce":"In a 68-year-old patient, with which etiology(ies) can this skin lesion be associated?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Polygenic hypercholesterolemia","justification":""},{"idx":1,"correct":true,"proposition":"Familial combined hyperlipidemia","justification":""},{"idx":2,"correct":true,"proposition":"Heterozygous familial hypercholesterolemia","justification":""},{"idx":3,"correct":false,"proposition":"A syndrome of familial hyperchylomicronemia","justification":"Clinical signs of hypertrygliceridemia: eruptive xanthomatosis, hepatosplenomegaly, acute pancreatitis (if > 10g\/L), retinal lipemia, abdominal pain."},{"idx":4,"correct":true,"proposition":"An etiology unrelated to dyslipidemia","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-28","context":null,"enonce":"A 6-year-old boy consults for the sudden appearance of diffuse edema within 10 days of a viral episode. His blood pressure is 100\/60 mmHg. The urine strip finds a three-choice proteinuria (+++) without hematuria. Blood urea and creatinine are normal. What is the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Diagnosis of pure nephrotic syndrome is most likely","justification":""},{"idx":1,"correct":false,"proposition":"You have to look for schizocytes","justification":""},{"idx":2,"correct":true,"proposition":"An albuminemia assay is essential","justification":""},{"idx":3,"correct":false,"proposition":"A renal biopsy is indicated before treatment","justification":""},{"idx":4,"correct":false,"proposition":"A hemostasis assessment must be done","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-29","context":null,"enonce":"In a patient with recent parkinsonism syndrome, what element(s) will make you remember a diagnosis other than Parkinson's disease?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A good response to dopatherapy","justification":""},{"idx":1,"correct":true,"proposition":"Falls","justification":""},{"idx":2,"correct":true,"proposition":"Dysautonomia","justification":""},{"idx":3,"correct":true,"proposition":"Cognitive impairment","justification":""},{"idx":4,"correct":false,"proposition":"A slow tremor of 4 - 6 Hz","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-30","context":null,"enonce":"A 25-year-old patient arrives at the emergency room because he has just violently twisted his ankle during a basketball game. His ankle is edematous. What is the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The presence of a sub-lateral malleolar bruise makes the radiographic assessment essential","justification":"It is not the bruise but the pain that falls within Ottawa's criteria"},{"idx":1,"correct":true,"proposition":"The impossibility of taking three steps makes the radiographic assessment essential","justification":""},{"idx":2,"correct":true,"proposition":"Pain of the base of the 5th metatarsal should suggest a tearing of the insertion of the short fibular tendon","justification":""},{"idx":3,"correct":true,"proposition":"An x-ray of the ankle showing a medial malleolar fracture without fracture of the lateral malleolus should be supplemented by an x-ray of the entire leg","justification":"The famous Maisonneuve 😋 fractures"},{"idx":4,"correct":true,"proposition":"A talo-crural effusion is at best visible on the front X-ray","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-31","context":null,"enonce":"On this X-ray of the pelvis from the front, to which anatomical structures do the numbers correspond? (one or more correct answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The number 1 corresponds to the acetabulum","justification":""},{"idx":1,"correct":false,"proposition":"The number 2 corresponds to the major tubercle","justification":"Grand trochanter"},{"idx":2,"correct":false,"proposition":"The number 3 corresponds to the third left obturator foramen","justification":"It's the second (or the first, it depends how you count) 😬"},{"idx":3,"correct":true,"proposition":"The number 4 corresponds to the first left sacred fora men","justification":""},{"idx":4,"correct":true,"proposition":"The number 5 corresponds to the right iliopubic branch","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-32","context":null,"enonce":"A quadriplegic patient complains of feeling the two angles of his jaw differently. Do you consider that it is an attack of the following neurological structure(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Facial nerve","justification":""},{"idx":1,"correct":true,"proposition":"C3 metamer","justification":""},{"idx":2,"correct":false,"proposition":"From the maxillary nerve","justification":""},{"idx":3,"correct":true,"proposition":"C2 metamer","justification":""},{"idx":4,"correct":false,"proposition":"Hypoglossal nerve","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-33","context":null,"enonce":"A patient has ankle pain with swelling following a mild sprain that occurred 3 weeks ago and for which she had not consulted. You suspect complex regional pain syndrome (CRPS) type 1. Which of these proposals concerning the CRPS is the true proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The edema of the SDRC does not take the bucket","justification":""},{"idx":1,"correct":true,"proposition":"CRPS is associated with joint effusion","justification":""},{"idx":2,"correct":false,"proposition":"CRPS is associated with biological inflammatory syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Scintigraphy is essential for diagnosis","justification":""},{"idx":4,"correct":true,"proposition":"X-ray may be normal","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-34","context":null,"enonce":"What are the possible etiologies of eye redness (one or more exact answers)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Acute glaucoma crisis due to angle closure","justification":""},{"idx":1,"correct":false,"proposition":"Obliteration of the central artery of the retina","justification":""},{"idx":2,"correct":true,"proposition":"Infectious keratitis","justification":""},{"idx":3,"correct":false,"proposition":"Posterior uveitis","justification":""},{"idx":4,"correct":true,"proposition":"Corneal ulcer","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-35","context":null,"enonce":"Which of the following are suggestive of an allergic etiology in conjunctivitis? (one or more correct answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Ocular pruritus","justification":"Pruritus strongly evokes an allergy. Pollen-allergic externals (like me) have a distinct advantage here 😅."},{"idx":1,"correct":false,"proposition":"Unilateral infringement","justification":""},{"idx":2,"correct":false,"proposition":"Abundant eye secretions","justification":"Secretions are often abundant in conjunctivitis, whatever their origins."},{"idx":3,"correct":true,"proposition":"Seasonal recurrence","justification":""},{"idx":4,"correct":true,"proposition":"Atopic terrain","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-36","context":null,"enonce":"In case of myopia: (one or more exact answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The optical system formed by the eye is too convergent","justification":""},{"idx":1,"correct":false,"proposition":"Distance vision is better than near vision without correction","justification":""},{"idx":2,"correct":true,"proposition":"Light rays focus in front of the retina","justification":""},{"idx":3,"correct":true,"proposition":"A divergent lens can be used for correction","justification":""},{"idx":4,"correct":true,"proposition":"The risk of retinal detachment may be increased","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-37","context":null,"enonce":"What is the exact proposal(s) regarding vaginal infection with Trichomonas vaginalis?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Upper genital infection is frequently associated","justification":""},{"idx":1,"correct":true,"proposition":"Leucorrhoea has a foul smell","justification":""},{"idx":2,"correct":true,"proposition":"Leucorrhoea are greenish in color","justification":""},{"idx":3,"correct":false,"proposition":"\"Clue-cells\" are visible under a microscope","justification":"This is true with Gardenerella vaginalis infections"},{"idx":4,"correct":false,"proposition":"Treatment includes fluconazole","justification":"👉 Metronidazole "}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-38","context":null,"enonce":"Which of the following infections is (are) the one that can (can) classically be associated with eosinophilia?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Loase","justification":""},{"idx":1,"correct":true,"proposition":"Strongyloidiasis","justification":""},{"idx":2,"correct":false,"proposition":"Pneumocystosis","justification":""},{"idx":3,"correct":false,"proposition":"Malaria","justification":""},{"idx":4,"correct":true,"proposition":"Schistosomosis","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-39","context":null,"enonce":"Which of the following proposals on antibiotic treatment for strep throat is, which is (are) accurate: ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The main goal of treatment is to reduce the risk of post-strep throat glomerulonephritis","justification":"The risk of glomerulonephritis is not diminished by drug treatment (but other complications, such as rheumatic fever, are)."},{"idx":1,"correct":false,"proposition":"One of the goals is to reduce the duration of symptoms by 3 to 4 days","justification":"The duration of symptoms is reduced by a maximum of 48 hours according to studies."},{"idx":2,"correct":true,"proposition":"The first-line treatment is amoxicillin","justification":""},{"idx":3,"correct":false,"proposition":"In case of allergy to first-line treatment, one possibility is levofloxacin","justification":""},{"idx":4,"correct":false,"proposition":"It is necessary to detect the contamination of the close entourage by a Rapid Diagnostic Test (RDT)","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-40","context":null,"enonce":"A young West Indian woman is referred to you by occupational medicine for abnormalities of the blood count. The CBC shows: red blood cells 5.17 T\/L, hematocrit 38.9%, Hb 124 g\/L, MCV 75 fL, MCDC 32 g\/dL, leukocytes 4.0 G\/L, platelets 232 G\/L. What do you do? (only one answer expected)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Determination of ferritinemia","justification":""},{"idx":1,"correct":false,"proposition":"Hemoglobin electrophoresis","justification":"Main lure here 👉 but it is first necessary to dose the ferritinemia before thinking of thalassemia 🤭."},{"idx":2,"correct":false,"proposition":"Determination of reticulocytes","justification":""},{"idx":3,"correct":false,"proposition":"No balance sheet","justification":""},{"idx":4,"correct":false,"proposition":"Oral iron prescription","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-41","context":null,"enonce":"A 70-year-old man consults for a diffuse itchy rash that appeared 48 hours ago, initially on the trunk. He has been widowed for 2 years and has an estimated active smoking of 45 packs years. His history includes plaque psoriasis since the age of 40 localized to the elbows, treated with topical corticosteroids and chronic obstructive pulmonary disease since the age of 55. He has been receiving amoxicillin-clavulanic acid treatment for bronchial superinfection for 10 days. The temperature is at 37.8 degrees Celsius, without alteration of the general condition. Examination of the mucous membranes is normal. There is no sign of Nikolsky. There is no peripheral lymphadenopathy or hepatosplenomegaly. The blood count, liver test and renal function are unremarkable. What diagnosis do you mention? (one or more correct answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Maculopapular exanthema of drug origin","justification":""},{"idx":1,"correct":false,"proposition":"Secondary syphilis","justification":""},{"idx":2,"correct":false,"proposition":"Measles","justification":""},{"idx":3,"correct":false,"proposition":"Acute generalized exanthematous pustulosis","justification":""},{"idx":4,"correct":false,"proposition":"Erythrodermic psoriasis","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-42","context":null,"enonce":"A 35-year-old man, with no particular history, has been complaining for 3 months of redness, heat and intense pain such as burns of both feet. Symptoms appear abruptly, often after exposure to heat, and usually disappear about 1 hour later. What diagnosis do you mention?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Raynaud's syndrome","justification":""},{"idx":1,"correct":true,"proposition":"Erythermalgia","justification":""},{"idx":2,"correct":false,"proposition":"Acrocyanosis","justification":""},{"idx":3,"correct":false,"proposition":"Acrocholosis","justification":"Acrocholosis is mainly observed during certain neurological pathologies such as peripheral neuropathies. Heat sensitization is observed, without any dermatological expression."},{"idx":4,"correct":false,"proposition":"Chilblains","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-43","context":null,"enonce":"Which pleural effusion(s) should be punctured urgently?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Fluid pleural effusion in a context of suspected pulmonary embolism","justification":""},{"idx":1,"correct":false,"proposition":"Fluid pleural effusion in acute heart failure","justification":""},{"idx":2,"correct":true,"proposition":"Fluid pleural effusion in an infectious context","justification":""},{"idx":3,"correct":true,"proposition":"Fluid pleural effusion suspected of hemothorax","justification":""},{"idx":4,"correct":false,"proposition":"Fluid pleural effusion suspected of neoplasia","justification":"This is not an emergency."}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-44","context":null,"enonce":"What main etiology(ies) may be responsible for chronic cough?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Active smoking","justification":""},{"idx":1,"correct":false,"proposition":"Treatment with calcium channel blocker","justification":"By IEC\/ARA2."},{"idx":2,"correct":true,"proposition":"Uncontrolled gastroesophageal reflux disease asthma","justification":""},{"idx":3,"correct":true,"proposition":"GERD","justification":""},{"idx":4,"correct":true,"proposition":"Chronic sinusitis","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-45","context":null,"enonce":"About heart failure, what is the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Its prevalence increases with the age of the population","justification":""},{"idx":1,"correct":true,"proposition":"Ejection fraction is the parameter used to characterize the systolic function of heart failure","justification":""},{"idx":2,"correct":true,"proposition":"Heart failure with preserved systolic function is mainly linked to left ventricular filling disorder","justification":""},{"idx":3,"correct":true,"proposition":"Heart failure with preserved systolic function is very often associated with hypertension","justification":"HTA 👉 Hypertrophic cardiomyopathy 👉 Heart failure with LVEF preserved."},{"idx":4,"correct":false,"proposition":"Heart failure with preserved systolic function is usually associated with","justification":""},{"idx":5,"correct":false,"proposition":"dilation of the left ventricle","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-46","context":null,"enonce":" What are the functional or clinical sign(s) of faecal incontinence?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Liquid oozing","justification":"Fecal incontinence = loss of uncontrolled stool."},{"idx":1,"correct":false,"proposition":"The impossibility of distinguishing the passage of gases and stool","justification":"Not related to faecal incontinence (which is the loss of uncontrolled stool). This proposal refers instead to incontinence, which corresponds to a completely different semiological framework."},{"idx":2,"correct":false,"proposition":"The emission of more than three bowel movements per day","justification":"This corresponds to the definition of diarrhea, of which fecal incontinence is a differential diagnosis to be aware of."},{"idx":3,"correct":true,"proposition":"Loss of the sensation of exonerating need","justification":""},{"idx":4,"correct":false,"proposition":"Urge to defecate","justification":"Tenesmus \/ Epreinte 👉 they are part of the rectal 💩 syndrome"}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-47","context":null,"enonce":"Regarding protein-energy malnutrition, which proposal(s) is(are) accurate?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"It reduces the speed of healing of chronic wounds","justification":""},{"idx":1,"correct":true,"proposition":"It is measured by the evolution of the weight over the last 6 months","justification":""},{"idx":2,"correct":false,"proposition":"It is diagnosed by a MNA score less than 21\/30","justification":""},{"idx":3,"correct":true,"proposition":"It reduces the speed of healing of chronic wounds","justification":""},{"idx":4,"correct":false,"proposition":"It is a consequence of physiological aging","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-48","context":null,"enonce":"Regarding successful ageing, which proposal(s) is\/are right ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Psychosocial determinants are major factors","justification":""},{"idx":1,"correct":false,"proposition":"It occurs only in individuals with a long life expectancy","justification":""},{"idx":2,"correct":false,"proposition":"It cannot exist in individuals with addiction","justification":""},{"idx":3,"correct":true,"proposition":"It partly has a genetic basis","justification":""},{"idx":4,"correct":false,"proposition":"It is superimposed on healthy aging","justification":"It's not just health in life 😉"}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-49","context":null,"enonce":"A bronchioloalveolar lavage with hyperlymphocytosis is seen when: (one or more responses) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Langheransian histiocytosis","justification":"Increase in NNCs"},{"idx":1,"correct":false,"proposition":"Active smoking","justification":"Increase in NNCs"},{"idx":2,"correct":true,"proposition":"Sarcoidosis","justification":"Increase in CD4+"},{"idx":3,"correct":true,"proposition":"Tuberculosis","justification":"Presence of lymphocytes"},{"idx":4,"correct":false,"proposition":"Alveolar hemorrhage","justification":"Presence of sideraphagous"}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-51","context":null,"enonce":"Investors want to estimate the prevalence of diabetes in a French city among subjects aged 18 or older. They draw lots from a representative sample of the subjects registered on the electoral list of that city. Random participants are invited to participate in this study. Which proposal(s) is (are) accurate?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"This is a descriptive epidemiology study","justification":""},{"idx":1,"correct":false,"proposition":"The subjects on the voters list of this city constitute the target population","justification":"Target population = subjects aged 18 or over living in the French city in question"},{"idx":2,"correct":false,"proposition":"Subjects refusing to participate may cause ranking bias","justification":""},{"idx":3,"correct":false,"proposition":"This is a randomized study","justification":""},{"idx":4,"correct":true,"proposition":"This is a cross-sectional study","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-54","context":null,"enonce":"Regarding the medical information transmitted to the patient, which is (are) the right proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The transmission of medical information must be mentioned in the medical record","justification":""},{"idx":1,"correct":true,"proposition":"Information must be clear, fair and appropriate","justification":""},{"idx":2,"correct":false,"proposition":"Proof that the medical information has been issued must be provided by the patient","justification":""},{"idx":3,"correct":true,"proposition":"The patient has the right to refuse to be informed","justification":""},{"idx":4,"correct":false,"proposition":"The physician has the right to refuse to inform a patient","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-55","context":null,"enonce":"A 33-year-old man, driving school instructor, consults for low back pain that has appeared for four months and wakes him up in the morning. You want to eliminate spondyloarthritis. What visible sign(s) on the standard lumbar spine X-ray might be in favor of this diagnosis?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Erosions of the vertebral plateaus","justification":""},{"idx":1,"correct":true,"proposition":"Thin, vertical bone bridges at the periphery of intervertebral discs","justification":""},{"idx":2,"correct":false,"proposition":"Disc pinches","justification":"Sign of osteoarthritis"},{"idx":3,"correct":true,"proposition":"Fusions of zygapophyseal line spacing","justification":""},{"idx":4,"correct":true,"proposition":"A square appearance of the vertebral bodies on profile X-rays","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-56","context":null,"enonce":"A 55-year-old patient comes to consult for pain of the anterior surface of the right thigh radiating to the knee appeared for 5 months. Its body mass index is measured at 32 kg\/m^2. An X-ray of the front pelvis is performed. What diagnosis do you mention on imaging? (only one answer expected)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Coxarthrosis","justification":""},{"idx":1,"correct":false,"proposition":"Fracture due to bone failure","justification":""},{"idx":2,"correct":false,"proposition":"Rheumatoid Coxite","justification":""},{"idx":3,"correct":false,"proposition":"Lysis of the acetabulum","justification":""},{"idx":4,"correct":false,"proposition":"The x-ray is normal, so you evoke cruralgia","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-57","context":null,"enonce":"A 57-year-old patient suffered trauma to her right ankle following a fall. She was unable to regain support on her lower limb when she stood up. She complains of elective pain in the posterior part of the fibula. You have had x-rays of your right ankle. What is the real proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"There is a trans-syndesmotic fibular fracture line","justification":""},{"idx":1,"correct":false,"proposition":"There is a fracture of the distal 1\/3 of the tibial diaphysis","justification":""},{"idx":2,"correct":false,"proposition":"There is a fracture of the neck of the talus","justification":""},{"idx":3,"correct":true,"proposition":"There is a tibio-fibular diastasis","justification":""},{"idx":4,"correct":false,"proposition":"There is a tibiotalar dislocation","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-59","context":null,"enonce":"A 45-year-old woman consults you following a skiing accident 3 days after the trauma. She complains of pain in the inner side of the left knee during flexion\/extension. You do not find patellar shock. You cause this pain on palpation visualized in this photo, as well as in valgus. There is no previous laxity. What is your diagnosis(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A complex regional pain syndrome","justification":""},{"idx":1,"correct":false,"proposition":"A fracture of the medial tibial plateau","justification":""},{"idx":2,"correct":false,"proposition":"A sprain of the anteroexternal cruciate ligament","justification":""},{"idx":3,"correct":true,"proposition":"A sprained medial collateral ligament","justification":"This is the right place and this is the right clinic 😉 Elective pain on flexion\/extension eliminates the fracture. The lack of laxity makes a sprain of the cruciate ligaments unlikely. As for CRPS, we are only 3 days away from trauma and there are no clinical arguments in favor."},{"idx":4,"correct":false,"proposition":"A fracture of the medial edge of the patella","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-60","context":null,"enonce":"A 35-year-old man consults you for a foot falling to the right. He explains that he was crouched for a long time for work. Achilles and quadricipital reflexes are preserved. The manual test finds a right hip abduction at 5\/5, a right leg extension at 5\/5, right foot lifters at 3\/5. The sensitivity of the back of the foot is impaired, while the cutaneous areas of the sole of the foot are respected. The lumbosacral and right hip mobilities are free. What is your most likely diagnosis?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A tendon rupture of a levator muscle in the right foot","justification":"This would not explain the sensory impairment."},{"idx":1,"correct":true,"proposition":"Damage to the right fibular nerve","justification":"This is the right territory 😉: affecting the lifters of the foot (at the motor level) and the back of the foot (at the sensory level)."},{"idx":2,"correct":false,"proposition":"Damage to the right tibial nerve","justification":"The numerous branches of the tibial nerve mainly innervate the muscles and skin of the calf (thus the posterior part of the leg), as well as the sole of the foot. This is not the right semiology!"},{"idx":3,"correct":false,"proposition":"Damage to the right obturator nerve","justification":"The right obturator nerve essentially innervates the thigh, at the motor and sensory level."},{"idx":4,"correct":false,"proposition":"An attack of the right L5 root","justification":"Root involvement is made very unlikely by the highly targeted involvement of a single nervous territory (that of the right fibular)."}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-62","context":null,"enonce":"You see a 63-year-old patient in consultation. A former English teacher, he is being treated for hypertension by an ACE inhibitor. He complains of stage 1 dyspnea of MRD. It has no other functional signs. He weighs 82 kg and is 171 cm tall. In terms of chest examination, palpation and percussion are normal. Auscultation finds bilateral but predominant crackles in the right base. The clinical examination is also strictly normal. He benefited from EFR. You do not yet have imaging tests that will of course be important. \nIn the light of these initial results, which diagnosis do you think is most likely? (only one answer expected)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Heart failure","justification":"This is the main distractor here, but is made less likely by the absence of signs of right heart failure, the lack of correlation between stage 1 dyspnea and the presence of crackling at rest (i.e. crackling is therefore not related to OAP, since the patient is dyspneic only with sustained effort),  the absence of a clear etiology to heart failure (no ACS, no alcohol consumption, etc.). All these arguments make REIT more likely."},{"idx":1,"correct":true,"proposition":"Idiopathic pulmonary fibrosis","justification":""},{"idx":2,"correct":false,"proposition":"Chronic obstructive pulmonary disease","justification":""},{"idx":3,"correct":false,"proposition":"Pleural effusion"},{"idx":4,"correct":false,"proposition":"Asthma"}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-64","context":null,"enonce":"What are the indications for the implementation of oral corticosteroid therapy when a diagnosis of sarcoidosis is highlighted? (one or more correct answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The presence of erythema nodosum","justification":""},{"idx":1,"correct":false,"proposition":"The presence of mediastinal lymphadenopathy exceeding 2 cm in diameter","justification":"The lymphadenopathy of sarcoidosis is not compressive. So OSEF frankly 😂."},{"idx":2,"correct":false,"proposition":"The presence of non-disabling arthralgia","justification":""},{"idx":3,"correct":true,"proposition":"The occurrence of central facial paralysis","justification":""},{"idx":4,"correct":true,"proposition":"The occurrence of hepatic cholestasis with gammaGT and alkaline phosphatases > 2N","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-65","context":null,"enonce":"AL amyloidosis can be revealed as: (one or more possible responses)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Spontaneous hematomas of the eyelids","justification":""},{"idx":1,"correct":true,"proposition":"From macroglossia"},{"idx":2,"correct":true,"proposition":"Polyadenopathy"},{"idx":3,"correct":true,"proposition":"Heart failure"},{"idx":4,"correct":true,"proposition":"Edema of the lower limbs","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-66","context":null,"enonce":"In a 40-year-old patient who has had deep vein thrombosis, what risk factors for venous thrombosis are you looking for? (one or more possible answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Smoking","justification":"It is a risk factor for arterial damage (venous thrombosis is an attack of the veins)."},{"idx":1,"correct":false,"proposition":"High blood pressure","justification":"It is a risk factor for arterial damage (venous thrombosis is an attack of the veins)."},{"idx":2,"correct":true,"proposition":"Air travel of more than 6 hours","justification":""},{"idx":3,"correct":false,"proposition":"Dyslipidemia","justification":"It is a risk factor for arterial damage (venous thrombosis is an attack of the veins)."},{"idx":4,"correct":true,"proposition":"Estrogen-progestin therapy","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-67","context":null,"enonce":"You see in consultation a patient of 34 years, without particular history for the discovery of a splenomegaly exceeding the costal rim of 3 cm. What abnormalities of the blood count could point you to a particular etiology? (one or more possible answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A haemoglobin of 11.5 g\/dl","justification":"Splenic sequestration of red blood cells and platelets is a consequence of splenomegaly (i.e. any splenomegaly, whatever its cause, is accompanied by anemia and thrombocytopenia distribution) and does not point us towards etiology."},{"idx":1,"correct":true,"proposition":"Reticulocytes at 200 G\/L","justification":""},{"idx":2,"correct":false,"proposition":"130 G\/L blisters","justification":""},{"idx":3,"correct":true,"proposition":"Lymphocytes at 13 G\/L","justification":""},{"idx":4,"correct":true,"proposition":"The presence of 2% myelocytes and 3% metamyelocytes","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-68","context":null,"enonce":"In case of exophthalmos, what are the clinical elements that would direct you to a Basedowian origin? (one or more correct answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Retraction of the upper eyelid","justification":""},{"idx":1,"correct":true,"proposition":"Diplopia by involvement of the inferior rectus muscle","justification":""},{"idx":2,"correct":false,"proposition":"Male","justification":""},{"idx":3,"correct":false,"proposition":"Unilateral infringement","justification":""},{"idx":4,"correct":true,"proposition":"Painless nature of exophthalmos","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-69","context":null,"enonce":"What pathology can result in myodesopsia? (only one exact answer) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Macular edema","justification":"Macular edema can give metamorphopsis (for example, in diabetic retinopathy or in AMD) but not myodesopsia."},{"idx":0,"correct":false,"proposition":"Anterior uveitis","justification":""},{"idx":0,"correct":false,"proposition":"Dry syndrome","justification":""},{"idx":0,"correct":false,"proposition":"Nuclear cataract","justification":""},{"idx":0,"correct":true,"proposition":"Retinal detachment","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-70","context":null,"enonce":"Your 66-year-old patient recently received BCG therapy and surgery for a vegetative tumour of the bladder underground, whose histology had concluded that there was high-grade urothelial carcinoma that deeply infiltrated the chorion (T1bG3). You have not yet applied to the health insurance fund for a long-term illness. He was a worker in a dye factory his entire career, until his retirement at age 60. Several of his former colleagues have been recognized as having an occupational disease for the same pathology. He wondered what recognition as an occupational disease would currently bring him, to know whether it was worthwhile to apply for it. What do you say to him? (one or more possible answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Increased daily allowances","justification":"A priori, he is not on sick leave 🤷 ♂️ If he were in AT, he would have an increase in daily allowances."},{"idx":1,"correct":true,"proposition":"A pension, depending on the degree of disability","justification":""},{"idx":2,"correct":false,"proposition":"A conviction of the employer for inexcusable fault","justification":""},{"idx":3,"correct":false,"proposition":"Compensation from the Asbestos Victims Compensation Fund (FIVA)","justification":""},{"idx":4,"correct":true,"proposition":"An exemption from user fees","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-71","context":null,"enonce":"Mrs. D., aged 27, gave birth vaginally 6 weeks ago to a girl weighing 3120 g who is doing well. She describes difficulties in caring for her child. Which of the following symptoms suggest postpartum depression?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Irritability","justification":""},{"idx":1,"correct":false,"proposition":"Temporo-spatial disorientation","justification":""},{"idx":2,"correct":true,"proposition":"Anxiety","justification":""},{"idx":3,"correct":true,"proposition":"Feeling of incapacity","justification":""},{"idx":4,"correct":false,"proposition":"Delirium of negation of the child","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-72","context":null,"enonce":"A 67-year-old woman with autosomal dominant polycystic kidney disease has reached the stage of end-stage renal disease and wants to be transplanted from a cadaveric donor. What is the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"She is past the age limit for kidney transplantation","justification":""},{"idx":1,"correct":false,"proposition":"There is a low risk of recurrence of polycystic disease on the transplant","justification":""},{"idx":2,"correct":false,"proposition":"The donor will necessarily be of the same sex","justification":""},{"idx":3,"correct":true,"proposition":"His risk of cancer will increase after transplantation","justification":""},{"idx":4,"correct":false,"proposition":"Its cardiovascular risk will decrease after transplantation","justification":"The cardiovascular risk is increased after transplantation, especially because of immunosuppressants. It is one of the leading causes of mortality in chronic transplant patients."}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-73","context":null,"enonce":"As part of the law of 2 February 2022 known as the Leonetti-Claeys law<<>>, the legislator has given the right to a patient with a serious and incurable condition to benefit from deep and continuous sedation until death if he decides to stop treatment with the consequence of a short-term commitment of his vital prognosis and unbearable suffering. What deadline has been adopted by the High Authority for Health to define this << short term >>?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Less than 48 hours","justification":""},{"idx":1,"correct":false,"proposition":"Less than 7 days","justification":""},{"idx":2,"correct":true,"proposition":"A few hours to a few days","justification":""},{"idx":3,"correct":false,"proposition":"A few days to a few weeks","justification":""},{"idx":4,"correct":false,"proposition":"1 to 6 months","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-74","context":null,"enonce":"Regarding the physiology of the larynx, what are the exact proposals? (one or more expected answers)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The vibration of the vocal folds is carried out thanks to the pressure under glottigue","justification":""},{"idx":1,"correct":true,"proposition":"The intrinsic muscles are innervated by the inferior laryngeal nerve","justification":""},{"idx":2,"correct":false,"proposition":"Laryngeal dystonia is a common cause of unilateral laryngeal immobility","justification":""},{"idx":3,"correct":true,"proposition":"Unilateral laryngeal immobility may be related to cricoarytenoid dislocation","justification":""},{"idx":4,"correct":true,"proposition":"Multiple sclerosis can lead to unilateral laryngeal immobility","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-75","context":null,"enonce":"Regarding the functional assessment of hearing, what are the exact proposals? (one or more correct answers)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"In the presence of sensorineural hearing loss, the Weber is lateralized on the deaf side","justification":""},{"idx":1,"correct":true,"proposition":"The Rinne test compares the transmission of sounds in air and bone conduction","justification":""},{"idx":2,"correct":false,"proposition":"Tonal audiometry is sufficient to analyze hearing acuity","justification":""},{"idx":3,"correct":true,"proposition":"In the presence of sensorineural hearing loss, the air and bone curves are superimposed","justification":""},{"idx":4,"correct":true,"proposition":"Impedancemetry is used to analyze the function of the tympano-ossicular system","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-76","context":null,"enonce":"A 59-year-old man has dysuria with an indurated nodule, painless occupying less than half of the right prostate lobe on digital rectal examination. The PSA value is 7 ng\/ml What is the evolutionary risk of this disease entity according to the D'Amico classification? (only one answer expected) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Low-risk prostate cancer","justification":""},{"idx":1,"correct":false,"proposition":"Intermediate-risk prostate cancer","justification":""},{"idx":2,"correct":false,"proposition":"High-risk prostate cancer","justification":""},{"idx":3,"correct":false,"proposition":"It is probably not a cancer and the d'Amico classification does not apply","justification":""},{"idx":4,"correct":true,"proposition":"This question cannot be answered with the elements of the statement alone.","justification":"We are missing the Gleason. If it is 3+3 👉 the risk is low. Note that the Gleason has recently been replaced by the ISUP score. This IQ therefore loses some of its interest 😬."}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-77","context":null,"enonce":"A young woman aged 35, practicing the profession of hairdresser consults you for increased lower limb pain at the end of the day and in the pre-menstrual period. These pains are type of heaviness of both legs. On clinical examination, there are no varicose veins but simple telangectasias and vesper edema. You remember the diagnosis of functional venous insufficiency.\n\nWhat measure(s) do you propose for this patient?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Wearing elastic compression","justification":""},{"idx":1,"correct":false,"proposition":"Stripping by bilateral stripping","justification":""},{"idx":2,"correct":false,"proposition":"Echosclerorosis of the great saphenous veins","justification":""},{"idx":3,"correct":true,"proposition":"Regular walking","justification":""},{"idx":4,"correct":true,"proposition":"Elevation of the legs of the bed","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-78","context":null,"enonce":"A 56-year-old patient consults with the results of an abdominopelvic CT scan with injection performed to explore left abdominal pain. The CT scan finds a left renal cyst of 2.9 cm, hyperdense not raising after injection of contrast medium, with thin partitions and fine parietal calcifications. What is your treatment option?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Renal lumpectomy","justification":""},{"idx":1,"correct":true,"proposition":"No treatment or monitoring","justification":"It is an incidentaloma that requires no treatment or supervision."},{"idx":2,"correct":false,"proposition":"Simple left nephrectomy","justification":""},{"idx":3,"correct":false,"proposition":"Left enlarged nephrectomy","justification":""},{"idx":4,"correct":false,"proposition":"Scannographic monitoring every year","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-79","context":null,"enonce":"What is(are) the correct statement(s) regarding permanent tubal sterilization?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"It can be performed in a single woman","justification":""},{"idx":1,"correct":false,"proposition":"It can be performed on a minor woman if both parents (or legal guardians) sign the authorization to operate","justification":""},{"idx":2,"correct":true,"proposition":"It can be performed in a woman who has never had an intrauterine device","justification":""},{"idx":3,"correct":false,"proposition":"It must be carried out after a reflection period of 3 months","justification":"The cooling-off period is... 🌟 4 months ⭐ (do not rage, life is too short)."},{"idx":4,"correct":true,"proposition":"It can be performed in a woman who has never had a child","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-80","context":null,"enonce":"A 65-year-old man consults you for a congenital thoracic nevus that has recently changed, with the appearance of pigment strengthening on two distinct areas. This hyperpigmentation would have started 2 years ago on the lateral edge and, since this summer, the patient has noticed the appearance of a central strengthening of the pigmentation that has become nodular. You suspect a degeneration of this pigment lesion which measures 4 x 3 cm. What is your attitude in the first intention towards this lesion? (only one answer expected) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Prescribing a PET scan","justification":""},{"idx":1,"correct":false,"proposition":"Prescription of a right axillary ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Pigmented nodule biopsy","justification":"This attitude is possible in the face 😊."},{"idx":3,"correct":true,"proposition":"Excision of the entire lesion with a margin of 1 cm","justification":"Suspicion of melanoma 👉 excision then histopathological study. The narrowest margins are chosen. A rework may be carried out depending on the histopathological 🔬 study."},{"idx":4,"correct":false,"proposition":"Excision of the entire lesion with a margin of 2 cm","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-81","context":null,"enonce":"You see in consultation M. P., 35 years old, 3 months from a head trauma. He was hit on a bicycle by a car. He suffered a brief loss of consciousness. The brain CT imaging assessment was without abnormalities. Since then, he complains of concentration difficulties that hinder him in his daily professional life, in particular, and his wife evokes a very marked irritability. What is the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"These symptoms correspond to a subjective syndrome of head trauma","justification":""},{"idx":1,"correct":true,"proposition":"Irritability can be part of dysexecutive semiology","justification":""},{"idx":2,"correct":false,"proposition":"These symptoms require a brain MRI","justification":"No brain MRI in the absence of clinical signs of calling."},{"idx":3,"correct":false,"proposition":"Professional prosecution is compromised","justification":"This proposition is too definitive to be true."},{"idx":4,"correct":true,"proposition":"A thorough neuropsychological evaluation is recommended","justification":"This assessment will be able to objectify the disorders as well as quantify them. It will make it possible to offer appropriate care."}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-83","context":null,"enonce":"A patient describes very severe pain in the right hemiface accompanied by rubefaction of the face and tearing. You mention cluster headache. Which proposal(s) concerning this diagnosis is (are) accurate?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It mainly affects women","justification":""},{"idx":1,"correct":false,"proposition":"It is treated with carbamazepine","justification":"A mnemonic means: \"AVF is rare, you will not see a thousand (verapamil).\" 😍"},{"idx":2,"correct":false,"proposition":"It affects alternately the right and left hemiface","justification":""},{"idx":3,"correct":true,"proposition":"It is treated by inhalation of oxygen","justification":""},{"idx":4,"correct":false,"proposition":"It is treated by thermocoagulation of the Gasser lymph node","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-84","context":null,"enonce":"Which of the following parasitosis is transmitted through skin contact (walking barefoot, swimming)? ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Ascariasis","justification":""},{"idx":1,"correct":true,"proposition":"Strongyloidiasis (anguillulosis)","justification":"barefoot walking"},{"idx":2,"correct":true,"proposition":"Schistosomosis (schistosomiasis)","justification":"bathing"},{"idx":3,"correct":false,"proposition":"Hydatidosis (echinococcosis)","justification":""},{"idx":4,"correct":false,"proposition":"Teniosis","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-85","context":null,"enonce":"In the following list of bacterial infections, which one or are the ones that do not usually cause hyperleucytosis?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Typhoid fever","justification":""},{"idx":1,"correct":false,"proposition":"Necrotizing dermohypodermatitis","justification":""},{"idx":2,"correct":false,"proposition":"Gram-negative liver abscess","justification":""},{"idx":3,"correct":false,"proposition":"Acute pyelonephritis","justification":""},{"idx":4,"correct":true,"proposition":"Pulmonary tuberculosis","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-87","context":null,"enonce":"What element(s) is (are) part of the diagnosis of conversion disorder?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Neurological symptoms","justification":""},{"idx":1,"correct":true,"proposition":"Psychological factor found","justification":""},{"idx":2,"correct":false,"proposition":"Histerionic personality","justification":""},{"idx":3,"correct":false,"proposition":"Simulation","justification":"Patients do not simulate. Their symptoms are sincere."},{"idx":4,"correct":false,"proposition":"Erotomania","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-90","context":null,"enonce":"You receive in the emergency room a 22-year-old patient brought by paramedics, who intervened at home at 9:30 p.m. on a call from her boyfriend. He found his girlfriend in a stuporous and confused state, two hours after an argument that took him out of the house. He doesn't know what happened during those two hours. You find a patient agitated. She aggressively answers your questions and yells that she wants to leave the hospital, struggling violently. You objectify reactive intermediate pupils and phlebotomies on both anterior surfaces of the wrists, the depth of which you cannot determine because of agitation. Which of the following proposals for the management of this patient is: ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The clinical picture makes you reject the hypothesis of benzodiazepine poisoning","justification":"This hypothesis cannot be eliminated."},{"idx":1,"correct":false,"proposition":"You must respect the patient's wishes and let her out","justification":""},{"idx":2,"correct":false,"proposition":"You must physically restrain the patient without chemical restraint","justification":""},{"idx":3,"correct":true,"proposition":"You mention possible alcohol consumption","justification":""},{"idx":4,"correct":false,"proposition":"The patient must be seen immediately by psychiatrists","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-91","context":null,"enonce":"A 25-year-old patient is hospitalized in hematology in the context of induction chemotherapy for acute lymphoblastic leukemia. On call, you are called at 8 p.m. because she \"does not breathe well\". You find a patient lying in bed, restless, polypneic with a supraclavicular pull and a thoraco-abdominal, cyanotic and marbled swing. Vital parameters are: heart rate at 125\/min, blood pressure at 95\/60 mmHg, respiratory rate at 38\/min, SpO2 at 87% under 2 L\/min of oxygen to the nasal glasses. What are you doing while waiting for the mobile resuscitation team? (one or more correct answers)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"You increase the O2 to 5 L\/min with glasses","justification":""},{"idx":1,"correct":false,"proposition":"You increase the O2 to 10 L\/min with glasses","justification":""},{"idx":2,"correct":true,"proposition":"You change the nasal glasses for a high-concentration face mask","justification":""},{"idx":3,"correct":false,"proposition":"You place the patient in the Trendelenburg position","justification":""},{"idx":4,"correct":true,"proposition":"You place the patient in a semi-seated position","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-93","context":null,"enonce":"Regarding immunohistochemistry during an histopathological examination, it is true that: (one or more exact answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It can be done extemporaneously","justification":""},{"idx":1,"correct":true,"proposition":"It is most often done on frozen samples","justification":""},{"idx":2,"correct":true,"proposition":"It highlights proteins","justification":""},{"idx":3,"correct":true,"proposition":"It can be quantitative","justification":"Either directly under the microscope (manual counting) or via flow cytometry techniques."},{"idx":4,"correct":true,"proposition":"It may be for prognostic purposes","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-94","context":null,"enonce":"A 22-year-old patient is referred for consultation by her general practitioner because of an abnormal blood count, which is presented to you below. The patient is asymptomatic, has no fever or other symptoms suggestive of an infectious episode, significant cutaneous or joint signs. The physical examination is normal, and finds no palpable lymphadenopathy or organomegaly.\nWhich of the following explorations do you carry out in 1st intention in this patient?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Hemostasis assessment"},{"idx":1,"correct":true,"proposition":"Hepatic test"},{"idx":2,"correct":false,"proposition":"Myelogram"},{"idx":3,"correct":false,"proposition":"Anti-native DNA antibodies"},{"idx":4,"correct":false,"proposition":"Thoraco-abdomino-pelvic CT scan","justification":"The systematic first-line assessment in front of isolated thrombocytopenia reminiscent of ITP is: CBC on citrated tube (if suspected of false thrombocytopenia with EDTA), a blood smear, a PPE, HIV HBV HCV serologies, a liver test, NAAs, a renal assessment (creatinine, hematuria), a hemostasis assessment (TP, TCA, fibrinogen), grouping and RAI (in severe forms). According to the PNDS of the HAS: https:\/\/www.has-sante.fr\/upload\/docs\/application\/pdf\/2017-06\/dir36\/pnds-_purpura_thrombopenique_immunologique.pdf"}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-95","context":null,"enonce":"Which of the following proposals can (may) constitute a criminal offence that can be charged against a doctor?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Writing a false certificate","justification":""},{"idx":1,"correct":false,"proposition":"Lack of information provided to the patient","justification":"Ordinal and civil offense, but not criminal."},{"idx":2,"correct":true,"proposition":"Non-assistance to a person in danger","justification":""},{"idx":3,"correct":true,"proposition":"The technical fault","justification":""},{"idx":4,"correct":true,"proposition":"Intentional homicide","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-96","context":null,"enonce":"A 15-year-old woman consults for heavy menstruation for 10 to 15 days a month since menarche. Which additional exam(s) do you prescribe as a first-line treatment?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Bleeding time","justification":"Really no longer done at the ECN (especially in the first line) 😅"},{"idx":1,"correct":false,"proposition":"Antithrombin III assay","justification":""},{"idx":2,"correct":false,"proposition":"Plasma Factor V assay","justification":""},{"idx":3,"correct":true,"proposition":"Complete blood and platelet count","justification":""},{"idx":4,"correct":true,"proposition":"Plasma determination of Willebrand factor ","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-97","context":null,"enonce":"You welcome to the emergency room Mrs. X. aged 75, referred by her doctor because of a picture of acute anuric renal failure in a context of diarrhea. Blood sugar levels measured in the city 3 hours earlier were 6.9 mmol\/L. At the time of the transfer to her bed in a cubicle, she suddenly loses consciousness. His pulse is no longer perceived. The scope is not yet plugged in. Which of the following proposals regarding its management is (are) accurate?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"You start by ventilating it with a balloon","justification":""},{"idx":1,"correct":true,"proposition":"You massage it right away","justification":""},{"idx":2,"correct":false,"proposition":"You immediately inject 1 mg of adrenaline","justification":""},{"idx":3,"correct":true,"proposition":"You have the external defibrillator brought in immediately","justification":""},{"idx":4,"correct":true,"proposition":"You prescribe intravenous calcium","justification":"Calcium gluconate has a cardioprotective function in hyperkalemia. In case of taking digitalis, magnesium chloride should rather be prescribed."}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-98","context":null,"enonce":"A 73-year-old man presents for dermatology for itchy skin lesions evolving for 2 years having started in the groin and pubis, with recent extension to the upper limbs, face and neck, despite treatment with antihistamines and very strong local dermocorticosteroids (clobetasol). The history includes untreated hypertension, prostatectomy for adenoma he was 3 years old and left total nephrectomy for kidney cancer he was 5 years old. Which test will be most cost-effective to confirm the diagnosis you suspect?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Cutaneous histology","justification":"Bullous dermatosis is not suspected in front of this table."},{"idx":1,"correct":false,"proposition":"Direct cutaneous immunofluorescence","justification":"Bullous dermatosis is not suspected in front of this table."},{"idx":2,"correct":false,"proposition":"Complete blood count","justification":""},{"idx":3,"correct":false,"proposition":"Search for clonality in the skin by PCR","justification":""},{"idx":4,"correct":true,"proposition":"Mycological skin sampling","justification":"Dermatophytosis is suspected here. The most cost-effective examination is therefore a mycological sample to find out what we are ⚔ fighting against."}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-99","context":null,"enonce":"A 45-year-old man consults you for dyspnea of effort. On cardiac auscultation, you find a proto-meso-diastolic murmur better perceived when sitting. Blood pressure is 120\/40 mmHg in both arms. Neck inspection finds synchronous pulse beats. What is your diagnosis?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Benign acute pericarditis","justification":""},{"idx":1,"correct":true,"proposition":"Aortic insufficiency","justification":""},{"idx":2,"correct":false,"proposition":"Mitral prolapse or Barlow's disease","justification":""},{"idx":3,"correct":false,"proposition":"!right heart failure","justification":""},{"idx":4,"correct":false,"proposition":"Aortic coarctation","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-100","context":null,"enonce":"As a general practitioner, you detect an HIV infection in a 27-year-old butcher. Several butchers work in his butcher shop and they share knives. Which prevention measure should you propose first (only one expected response)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Prescription of sick leave until an undetectable viral load is obtained","justification":""},{"idx":1,"correct":false,"proposition":"Tell the patient to inform other butchers of their HIV status","justification":""},{"idx":2,"correct":true,"proposition":"Recommend the use of strictly personal knives","justification":"Primary prevention measures are more urgent to put in place than secondary prevention measures (telling colleagues that they should be tested)."},{"idx":3,"correct":false,"proposition":"Inform other butchers yourself of this HIV status","justification":""},{"idx":4,"correct":false,"proposition":"Request the patient's invalidity from the medical officer","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-101","context":null,"enonce":"A 4-year-old boy is brought to the emergency room for a hematemesis that occurred in a context of rheumatoid purpura started 3 days earlier. Upon diagnosis, he complained of abdominal pain that was treated symptomatically. His heart rate is 120 beats per minute, his systolic blood pressure is 110 mmHg, his temperature is 37.1°C.  Abdominal palpation is painful, defenseless. What is the most likely diagnosis?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Acute intussusception","justification":"No hematemesis in IIA."},{"idx":1,"correct":false,"proposition":"Duodenal ulcer","justification":"This potit patient has no reason to have a duodenal 🤷 ♂️ ulcer"},{"idx":2,"correct":false,"proposition":"Swallowed epistaxis","justification":"The college reminds us several times: a swallowed epistaxis is not a cause of hematemesis but a differential diagnosis!"},{"idx":3,"correct":false,"proposition":"Esophagitis","justification":"This potit patient has no reason to have esophagitis 🤷 ♂️"},{"idx":4,"correct":true,"proposition":"Hematoma of the gastric wall","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-102","context":null,"enonce":"A 68-year-old man consults his GP for a recent onset resting tremor. The clinical examination shows a slowdown at the initiation of movements and a phenomenon of << cogwheel >> at the wrists. What medication(s) should you look for before making a definitive diagnosis?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Selective 5-hydroxytryptamine-1D receptor agonists (triptans)","justification":"Triptans are not a classic cause of iatrogenic parkinsonism syndrome."},{"idx":1,"correct":true,"proposition":"Certain intestinal motor stimulants, such as metoclopramide","justification":""},{"idx":2,"correct":true,"proposition":"Neuroleptics of the phenothiazine class","justification":""},{"idx":3,"correct":true,"proposition":"Some antihistamines for systemic use, such as alimemazine","justification":""},{"idx":4,"correct":true,"proposition":"Neuroleptics of the butyrophenone class","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-103","context":null,"enonce":"A young man consults the emergency room following an assault. His attacker stabbed him in the face. It has a transfixing jugal wound of 5 cm, above the lateral canthus (see diagram). What anatomical elements can be damaged by this wound? (one or more expected answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The frontal branch of the facial nerve","justification":""},{"idx":1,"correct":true,"proposition":"The parotid salivary duct","justification":""},{"idx":2,"correct":true,"proposition":"The oral branch of the facial nerve","justification":""},{"idx":3,"correct":true,"proposition":"The facial artery"},{"idx":4,"correct":false,"proposition":"The infraorbital nerve"}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-104","context":null,"enonce":"A 79-year-old man with Parkinson's disease has intense and continuous suprapubic pain. He has not been able to urinate for several hours. Palpation shows a rounded suprapubic mass, matte to percussion. It is treated with dopaminergics (levodopa-benserazide), sympathomimetic (midodrine) for orthostatic hypotension and alpha-blocker (tamsulosin). After bladder probing, what modification(s) of the drug treatment do you propose?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Decrease in the dosage of levodopa-benserazide","justification":""},{"idx":1,"correct":false,"proposition":"Discontinuation of tamsulosin"},{"idx":2,"correct":true,"proposition":"Discontinuation of midodrine"},{"idx":3,"correct":false,"proposition":"Introduction of furosemide"},{"idx":4,"correct":false,"proposition":"Introduction of a beta-blocker","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-106","context":null,"enonce":"A 34-year-old woman was diagnosed with pulmonary tuberculosis. A triple antibiotic therapy (rifampicin, isoniazid, pyrazinamide) is implemented. Its only usual treatment is oral contraception (levonorgestrel, ethinyl estradiol). What advice(s) do you have?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Use a mechanical contraceptive method for the duration of rifampicin treatment","justification":""},{"idx":1,"correct":false,"proposition":"Replace current contraception with a progestin","justification":"Rifampicin is an enzyme inducer that reduces the effectiveness of oral contraception."},{"idx":2,"correct":true,"proposition":"Inform about the risk of reducing the contraceptive effectiveness of an estrogen-progestin","justification":""},{"idx":3,"correct":false,"proposition":"Increase the dose of ethinyl estradiol","justification":""},{"idx":4,"correct":false,"proposition":"Regularly dose plasma rifampicin","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-107","context":null,"enonce":"A vestibular schwannoma can be diagnosed before: (one or more expected responses) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" Sudden deafness","justification":""},{"idx":1,"correct":false,"proposition":"Unilateral conductive hearing loss of slowly progressive evolution","justification":"Deafness is conductive."},{"idx":2,"correct":true,"proposition":"Facial paralysis","justification":""},{"idx":3,"correct":true,"proposition":"Ataxia with frustrated walking","justification":"Vestibular 👉 involvement Ataxia with light walking (= frustrated)."},{"idx":4,"correct":false,"proposition":"Minimal otolicorrhea","justification":"It's a bit far from the external 😉 ear canal"}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-108","context":null,"enonce":"A 75-year-old patient complains of a cough, with colored sputum, in a context of fever evolving for 72 hours. Her doctor did not notice any signs of seriousness and prescribed probabilistic clarithromycin antibiotics. Its usual treatment is limited to ezetimibe-simvastatin and low-dose acetylsalicylic acid. What advice(s) could you make?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"No therapeutic modification","justification":""},{"idx":1,"correct":true,"proposition":"Discontinuation of simvastatin for the duration of clarithromycin treatment","justification":"Macrolides are enzyme inhibitors. There is no risk in stopping statins for a few days."},{"idx":2,"correct":false,"proposition":"Discontinuation of acetylsalicylic acid for the duration of treatment with clarithromycin","justification":""},{"idx":3,"correct":false,"proposition":"Decrease in ezetimibe dosage during treatment with clarithromycin","justification":""},{"idx":4,"correct":false,"proposition":"Replacement of clarithromycin with erythromycin","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-109","context":null,"enonce":"Speech therapy sessions may be prescribed in case of: (one or more expected responses) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Severe bilateral deafness of the child","justification":""},{"idx":1,"correct":true,"proposition":"Stuttering in an adult","justification":""},{"idx":2,"correct":true,"proposition":"Decreased post-traumatic oral opening","justification":""},{"idx":3,"correct":true,"proposition":"Meniere's disease after an acute phase","justification":""},{"idx":3,"correct":true,"proposition":"acquisition of an esophageal voice","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-11","context":null,"enonce":"Jules, 7, is scheduled to have surgery for phimosis. The preoperative hemostasis assessment shows: Quick time (TQ) = 12.5 s; control= 11.5 s; ratio: 1.08; cephalin time with activator (TCA) = 59 s; control= 32 s; ratio: 1.84; fibrinogen 2.8 g\/L (standards: 2-4 g\/L); blisters 290 G\/L. \n\nWhat are the diagnostic hypotheses to be formulated in Jules in front of this hemostasis assessment? (one or more correct answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Willebrand disease","justification":""},{"idx":1,"correct":true,"proposition":"Factor XI deficiency","justification":"TCA: factor VIII (hemophilia A, Willebrand disease because this factor is protected by Willebrand factor), factor IX (hemophilia B), factor XI and factor XII."},{"idx":2,"correct":false,"proposition":"Protein C deficiency","justification":""},{"idx":3,"correct":true,"proposition":"Hemophilia A","justification":""},{"idx":4,"correct":true,"proposition":"Hemophilia B","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-111","context":null,"enonce":"A woman of Martinican origin has just given birth. The child's father is also of Martinican origin. The child has a cleft lip and palate. With regard to regulatory newborn screening of this child, what is the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Phenylketonuria is the only disease of amino acid and organic acid metabolism currently being screened for newborn in France","justification":"Now there is the MCAD deficiency"},{"idx":1,"correct":false,"proposition":"General screening test can detect hypothyroidism of pituitary origin","justification":""},{"idx":2,"correct":true,"proposition":"This couple can refuse the screening after information","justification":""},{"idx":3,"correct":true,"proposition":"Completion before 48 h of life decreases the sensitivity and\/or specificity of the screening test","justification":""},{"idx":4,"correct":false,"proposition":"Targeted screening for sickle cell disease is not indicated in this child","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-112","context":null,"enonce":"You receive a 3-month-old infant for a systematic visit. He was born at term after a normal pregnancy. You saw him at the age of 2 months for his vaccinations, his examination was normal. He is very awake but moves spontaneously very little. What proposal(s) is (are) in favor of peripheral neurological involvement?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Essentially axial hypotonia","justification":""},{"idx":1,"correct":true,"proposition":"Normal head circumference","justification":""},{"idx":2,"correct":false,"proposition":"Presence of oculomotor disorders","justification":""},{"idx":3,"correct":true,"proposition":"Presence of smile response","justification":""},{"idx":4,"correct":false,"proposition":"Presence of dysmorphic signs","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-114","context":null,"enonce":"You organize the care pathway of a 90-year-old patient, previously autonomous and living at home, admitted following a fracture of the upper end of the femur operated the day before with the placement of an intermediate prosthesis without surgical complications. Which proposal(s) are (are) part of your care?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Immediate resumption of walking","justification":""},{"idx":1,"correct":true,"proposition":"Preventive anticoagulation for a period of 45 days","justification":""},{"idx":2,"correct":false,"proposition":"Routine prescription of oral nutritional supplements","justification":""},{"idx":3,"correct":false,"proposition":"Prescribing benzodiazepines to ensure restful sleep","justification":""},{"idx":4,"correct":true,"proposition":"Prescription of bisphosphonates in case of femoral T-score ≤ -1","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-115","context":null,"enonce":" Which symptom(s) is part of the clinical picture of a hypomanic episode?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Disorganization of thought","justification":"Disorganization of thought is classically not found in bipolarity (rather a symptom of schizophrenia)."},{"idx":1,"correct":true,"proposition":"Distractibility","justification":""},{"idx":2,"correct":false,"proposition":"Suicidal ideation","justification":"The presence of suicidal ideation classifies the clinical picture in the manic phase."},{"idx":3,"correct":true,"proposition":"Megalomaniac ideas","justification":""},{"idx":4,"correct":true,"proposition":"Irritability","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-116","context":null,"enonce":"In front of a twelve-month-old child, what proposal(s) do you remember as a warning sign of a neurodevelopmental disorder?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" A lack of joint attention","justification":""},{"idx":1,"correct":false,"proposition":"Separation anxiety","justification":"This is quite normal at this age."},{"idx":2,"correct":false,"proposition":"A lack of daytime cleanliness","justification":""},{"idx":3,"correct":true,"proposition":"A lack of smile-response","justification":""},{"idx":4,"correct":true,"proposition":"An absence of nycthemeral periodicity of sleep","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-117","context":null,"enonce":"A 34-year-old patient complains of excessive anxiety. Which of the following symptoms specifically points to a diagnosis of generalized anxiety disorder?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" Irritability","justification":""},{"idx":1,"correct":true,"proposition":"A delay in falling asleep of more than 1 hour"},{"idx":2,"correct":false,"proposition":"Significant anxiety when speaking in public","justification":"This proposal refers to social phobia."},{"idx":3,"correct":true,"proposition":"A fatIgAbility","justification":""},{"idx":4,"correct":false,"proposition":"A sad mood for two weeks following an emotional breakdown","justification":"This proposal refers to the characterized depressive episode."}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-118","context":null,"enonce":"The mother of a 17-year-old patient smoking cannabis asks you about the risks associated with this use, acute or chronic. What information(s) is(are) accurate about this?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Possible occurrence of delirium","justification":""},{"idx":1,"correct":true,"proposition":"Possible occurrence of a withdrawal syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Increased risk of status seizure","justification":""},{"idx":3,"correct":true,"proposition":"Increased risk of bronchopulmonary disease","justification":""},{"idx":4,"correct":true,"proposition":"Risk of precipitating entry into schizo p hrenia in vulnerable individuals","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2020-qi-120","context":null,"enonce":"You are the general practitioner of Mr. M., 75 years old, who has been suffering for 3 years from small cell lung cancer. He is also followed by a mobile palliative care team for the management of very disabling pain related to bone metastases. The patient lives at home with his wife. With your agreement, the mobile team doctor came to see the patient at home because of an increase in the pain picture. He decided to modify the analgesic treatment by introducing corticosteroids and increasing the opioid treatment. 48 hours later, during her visit to her home, the liberal nurse calls you because she suspects an overdose with opioids. What is the most important question to ask?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Does the patient have a miosis?","justification":""},{"idx":1,"correct":false,"proposition":"Did the patient vomit that night?","justification":""},{"idx":2,"correct":true,"proposition":"What is the patient's respiratory rate?","justification":""},{"idx":3,"correct":false,"proposition":"Is the patient drowsy?","justification":""},{"idx":4,"correct":false,"proposition":"Is the patient painful?","justification":""}],"ts":{"$numberLong":"1665228895440"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-2","context":null,"enonce":" In consultation with his parents, you will see a 16-year-old teenager who has been suffering from generalized tonic-clonic seizures since the age of 12. Her epilepsy is poorly balanced by treatment (valproate). They ask you about his academic orientation, because he must choose a professionalizing path. They considered several possibilities. Among those they mention to you, which one (which) do you advise against (one or more expected proposals)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"tiler","justification":""},{"idx":1,"correct":false,"proposition":"Delivery driver","justification":""},{"idx":2,"correct":false,"proposition":"carpenter","justification":""},{"idx":3,"correct":false,"proposition":"car mechanic","justification":""},{"idx":4,"correct":false,"proposition":"roofer","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-3","context":null,"enonce":" Regarding AA amyloidosis, what is (are) the exact proposal(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"the kidney is frequently affected","justification":""},{"idx":1,"correct":false,"proposition":"the heart is frequently affected","justification":""},{"idx":2,"correct":false,"proposition":"the peripheral nerve is frequently affected","justification":""},{"idx":3,"correct":false,"proposition":"it is linked to an accumulation of IgA","justification":""},{"idx":4,"correct":false,"proposition":"Diagnosis can be made on a salivary gland biopsy","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-4","context":null,"enonce":" Regarding mutations in the APC gene in familial adenomatous polyposis syndrome, which proposals are correct? (one or more proposals expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Pathogenic mutations in this gene are expressed in the heterozygous state","justification":""},{"idx":1,"correct":false,"proposition":"A colonoscopy may be offered to minors","justification":""},{"idx":2,"correct":false,"proposition":"Genetic exploration must be offered to relatives","justification":""},{"idx":3,"correct":false,"proposition":"Upper gastrointestinal involvement is possible and warrants gastroscopy","justification":""},{"idx":4,"correct":false,"proposition":"Mutations in this gene predispose to breast cancer","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-5","context":null,"enonce":" Regarding cadaveric lividities, which is (are) the exact proposal(s):","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"They are dependent on the type of insects present on the corpse","justification":""},{"idx":1,"correct":false,"proposition":"They are less marked in case of internal bleeding at the time of death","justification":""},{"idx":2,"correct":false,"proposition":"They are non-existent in melanoderma individuals","justification":""},{"idx":3,"correct":false,"proposition":"They are one of the indicators of the post-mortem time","justification":""},{"idx":4,"correct":false,"proposition":"They are due to a passive phenomenon of blood sweating after death","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-6","context":null,"enonce":" A 42-year-old patient has cervical angioedema. The blood laboratory test shows a deficiency of C1 esterase inhibitor. Which drug(s) is (are) likely to be involved?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"proton pump inhibitors","justification":""},{"idx":1,"correct":false,"proposition":"calcium channel blockers","justification":""},{"idx":2,"correct":false,"proposition":"Selective competitive bradykinin receptor antagonist type 2","justification":""},{"idx":3,"correct":false,"proposition":"sartans","justification":""},{"idx":4,"correct":false,"proposition":"ACE inhibitors","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-7","context":null,"enonce":" Mr. C., 60 years old, is followed by his general practitioner whom he declared as a general practitioner. The latter has just diagnosed him with chronic obstructive pulmonary disease. The patient presents an active smoking quantified at 45 pack-years. He has just been admitted to long-term illness. He has no other pathology and is totally autonomous. Which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It is exempt from the flat-rate contribution of € 1 per consultation","justification":""},{"idx":1,"correct":false,"proposition":"He is exempt from the co-payment for all medical examinations that he will have to carry out","justification":""},{"idx":2,"correct":false,"proposition":"It benefits from a management of nicotine substitutes","justification":""},{"idx":3,"correct":false,"proposition":"He benefits from 100% coverage of his ambulance transport for all his consultations","justification":""},{"idx":4,"correct":false,"proposition":"In case of hospitalization, the hospital package may be reimbursed, in part or in full, by its complementary health","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-8","context":null,"enonce":" You receive a 70-year-old patient with a history of myocardial infarction, who has uncontrolled epistaxis. What will be the elements of your care? (one or more expected answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"you ask him not to blow his nose","justification":""},{"idx":1,"correct":false,"proposition":"you set up a venous line","justification":""},{"idx":2,"correct":false,"proposition":"you perform an ECG","justification":""},{"idx":3,"correct":false,"proposition":"You request a CT scan of the facial mass","justification":""},{"idx":4,"correct":false,"proposition":"embolization will be the first-line treatment","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-9","context":null,"enonce":" Here is an X-ray of the elbow in profile made in the context of a trauma. What is (are) the exact element(s) of radioanatomy?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"1 corresponds to the radius neck","justification":""},{"idx":1,"correct":false,"proposition":"2 corresponds to the olecranium","justification":""},{"idx":2,"correct":false,"proposition":"3 corresponds to the capitulum","justification":""},{"idx":3,"correct":false,"proposition":"4 corresponds to the ulna","justification":""},{"idx":4,"correct":false,"proposition":"5 corresponds to the coracoid process","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-10","context":null,"enonce":" A 45-year-old patient has weakness of the left hemibody predominant in the arm. His entourage tells you that he hit his left side several times when crossing the doors of his home. The bilateral and simultaneous tactile stimulation of the 2 upper limbs is not perceived on the left while the right and left stimulations are perfectly identified when the stimulation is done only on one side. By asking the patient to stare at your nose and alternately mobilizing your hands, he cannot discern the movements of your right hand while your left hand is perfectly perceived. The osteotendinous reflexes are more vivid on the left than on the right. The plantar skin reflex is extended to the left. Which clinical sign(s) should be mentioned?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"left hemicorporeal hypoaesthesia","justification":""},{"idx":1,"correct":false,"proposition":"Left sensory extinction","justification":""},{"idx":2,"correct":false,"proposition":"Left homonymous lateral hemianopsia","justification":""},{"idx":3,"correct":false,"proposition":"left pyramidal syndrome","justification":""},{"idx":4,"correct":false,"proposition":"extrapyramidal syndrome","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-11","context":null,"enonce":" One patient is being followed for minimal corticosteroid-dependent glomerular lesions syndrome. He suddenly relapses to the decline of corticosteroids. He gained 10 kg in 1 week. Its biology is as follows: albuminemia 12g \/ l, urea 25 mmol \/ l, serum creatinine 160 micromol \/ l, natriuresis 12 mmol \/ l, kaliuresis 35 mmol \/ l. ECBU: red blood cells <1000 \/ ml, leukocytes <1000 \/ ml, sterile in 24h. What is the most likely cause of acute renal failure in this patient?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"functional renal impairment by relative (or effective) hypovolemia","justification":""},{"idx":1,"correct":false,"proposition":"Functional renal impairment by true hypovolemia","justification":""},{"idx":2,"correct":false,"proposition":"thrombosis of renal veins","justification":""},{"idx":3,"correct":false,"proposition":"glomerular extracapillary proliferation","justification":""},{"idx":4,"correct":false,"proposition":"Extramembranous deposits","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-12","context":null,"enonce":" Which of the following symptoms is (are) part of the diagnosis of obsessive-compulsive disorder?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Ideative obsessions","justification":""},{"idx":1,"correct":false,"proposition":"fear of committing a reprehensible act in spite of oneself","justification":""},{"idx":2,"correct":false,"proposition":"Reference ideas","justification":""},{"idx":3,"correct":false,"proposition":"suicidal ruminations","justification":""},{"idx":4,"correct":false,"proposition":"verification rituals","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-13","context":null,"enonce":" You suspect multiple myeloma in a 58-year-old patient who comes to see you for impaired general condition and bone pain. It has a peak of monoclonal appearance at electrophoresis. Which exams do you think are relevant to perform? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Bone densitometry","justification":""},{"idx":1,"correct":false,"proposition":"A myelogram","justification":""},{"idx":2,"correct":false,"proposition":"Determination of serum calcium","justification":""},{"idx":3,"correct":false,"proposition":"Serum albumin determination","justification":""},{"idx":4,"correct":false,"proposition":"Determination of beta2 microglobulinemia","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-14","context":null,"enonce":" Regarding small cell lung cancers, what is (are) the exact answer(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"They represent 35% of all bronchial cancers","justification":""},{"idx":1,"correct":false,"proposition":"These are willingly cancers with proximal localization on the airways","justification":""},{"idx":2,"correct":false,"proposition":"They are readily accompanied by superior cava syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Paraneoplastic syndromes are exceptional in this histological form","justification":""},{"idx":4,"correct":false,"proposition":"Treatment is more often surgical in locally advanced forms","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-15","context":null,"enonce":" Mrs. F, 22, has a microcytic iron deficiency anemia of gynecological origin. You prescribe a martial treatment per os. What do you say to him? (one or more possible answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"An oral treatment of 1 month is usually sufficient to correct the iron deficiency","justification":""},{"idx":1,"correct":false,"proposition":"Martial supplementation will be continued until serum iron normalizes","justification":""},{"idx":2,"correct":false,"proposition":"Treatment can lead to digestive disorders","justification":""},{"idx":3,"correct":false,"proposition":"vitamin C increases oral iron absorption","justification":""},{"idx":4,"correct":false,"proposition":"oral iron causes stool discoloration","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-16","context":null,"enonce":" With regard to thyroid goiters, which proposition(s) is(are) true?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Iodine deficiency is a risk factor for simple goiter","justification":""},{"idx":1,"correct":false,"proposition":"Tobacco promotes the occurrence of goiters","justification":""},{"idx":2,"correct":false,"proposition":"A scintigraphy is the first-line examination in front of a goiter","justification":""},{"idx":3,"correct":false,"proposition":"The cervico-thoracic CT scan is used to diagnose plunging goiters","justification":""},{"idx":4,"correct":false,"proposition":"the blood test of TSH is essential in the goiter assessment","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-17","context":null,"enonce":" Which of the following proposals regarding indications for bariatric surgery is (are) true?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"BMI should be greater than 40 kg\/m2 or 35 kg\/m2 if there is associated co-morbidity","justification":""},{"idx":1,"correct":false,"proposition":"The indication for bariatric surgery should be taken in a multidisciplinary consultation meeting for all patients","justification":""},{"idx":2,"correct":false,"proposition":"Surgery can only be offered after failure of well-conducted medical care for at least 6 months","justification":""},{"idx":3,"correct":false,"proposition":"the patient must be over 21 years of age","justification":""},{"idx":4,"correct":false,"proposition":"the patient must agree to be followed for life","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-18","context":null,"enonce":" With regard to liver tumours, which is (are) the true proposition(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Hepatic adenoma has a hypodense, heterogeneous appearance with fleeting arterial enhancement on injected CT","justification":""},{"idx":1,"correct":false,"proposition":"focal nodular hyperplasia is characterized by the presence of a hypo-intense central scar on T1 MRI","justification":""},{"idx":2,"correct":false,"proposition":"On CT scan, the hemangioma is characterized by a << >> clod enhancement after injection of contrast medium","justification":""},{"idx":3,"correct":false,"proposition":"In the context of chronic liver disease, the first diagnosis to evoke in front of an isolated nodule on CT scan is hepatocellular carcinoma","justification":""},{"idx":4,"correct":false,"proposition":"MRI is used to characterize liver tumours","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-19","context":null,"enonce":" A patient, whom you have been following for a long time for her active non-progressive multiple sclerosis (MS) and who does not tolerate her treatment, consults you with a scientific article talking about a new treatment that has just been put on the market and that allows good control of flare-ups. She would like to hear from you. You see that this is a non-inferiority trial conducted in patients with non-progressive active MS compared to a reference treatment currently available to this patient. The authors of the study considered that a 10% increase in relapses compared to the standard of care was acceptable as long as there was also a decrease in adverse events. This is a sufficiently powered test with no obvious bias. The relative risk (RR) of relapse is 1.03 (95% confidence interval [1.01-1.06]), and the RR of adverse event is 0.95 (95% confidence interval [0.87-1.02]). The authors conclude that their treatment is interesting because it is non-inferior and without over-risk of adverse events. What can you tell your patient based on these results? (one or more proposals expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"New treatment controls flare-ups in an acceptable way","justification":""},{"idx":1,"correct":false,"proposition":"New treatment puts less risk of adverse events","justification":""},{"idx":2,"correct":false,"proposition":"The new treatment may be interesting for your patient","justification":""},{"idx":3,"correct":false,"proposition":"Only a superiority trial would make it possible to evaluate the interest of this new treatment","justification":""},{"idx":4,"correct":false,"proposition":"A statistical test of non-inferiority is missing to conclude that the treatment is worthwhile","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-20","context":null,"enonce":" A colleague wants to set up a study on a new preventive treatment for flare-ups in Crohn's disease. It is a known molecule, already used in other inflammatory diseases and without known serious adverse effects. The study sponsor has sent them documents to fill out and your colleague is asking for your opinion on the regulatory procedures. What do you say to this colleague? (one or more proposals expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"This is a minimal-risk interventional study","justification":""},{"idx":1,"correct":false,"proposition":"The favourable opinion of a Committee for the Protection of Persons (CPP) is necessary","justification":""},{"idx":2,"correct":false,"proposition":"The authorization of the National Agency for the Safety of Medicines and Health Products (ANSM) is necessary","justification":""},{"idx":3,"correct":false,"proposition":"An information sheet for the patient on the risks involved is necessary","justification":""},{"idx":4,"correct":false,"proposition":"A phase 1 study is required beforehand","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-21","context":null,"enonce":" A patient consults for the renewal of his glasses. Your clinical examination reveals acuity at 10\/10 th Parinaud 2 in both eyes with the following correction: - 8 (-1 to 150 °) in the right eye and -9 (-1.25 to 135 °) in the left eye. What are the risks associated with its ametropia? (one or more expected answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"chronic angle-closure glaucoma","justification":""},{"idx":1,"correct":false,"proposition":"retinal detachment","justification":""},{"idx":2,"correct":false,"proposition":"cataract","justification":""},{"idx":3,"correct":false,"proposition":"macular atrophy","justification":""},{"idx":4,"correct":false,"proposition":"accommodative strabismus","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-22","context":null,"enonce":" You are called to the home of a 10-year-old child who has acute hives 4 days after a booster vaccine. The lesions are diffuse in the chest and limbs, and rapidly migratory, which impresses the mother of the child. Pulmonary auscultation is free. Blood pressure is at 105\/70 mm Hg. What do you offer? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Oral corticosteroid therapy oral solution","justification":""},{"idx":1,"correct":false,"proposition":"H1 antihistamine oral solution once daily","justification":""},{"idx":2,"correct":false,"proposition":"Transfer to emergency department for a few hours of monitoring","justification":""},{"idx":3,"correct":false,"proposition":"Dermocorticoid class 2 for the duration of symptoms","justification":""},{"idx":4,"correct":false,"proposition":"Remote allergological investigation of the current acute episode","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-24","context":null,"enonce":" You take care of a patient in intensive care. He is married and has 3 children, one of whom is a minor. He designated his only brother as a trusted person. He did not write advance directives. Unfortunately, its clinical situation becomes extremely pejorative with an almost non-existent recovery capacity. You decide to initiate a reflection on a possibility of limitation of processing, in order to avoid unreasonable obstinacy. As part of this reflection, you initiate a collegial procedure as provided for by law. Which person should be consulted in the context of this collegial procedure to seek the wishes expressed by the patient?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"His only brother","justification":""},{"idx":1,"correct":false,"proposition":"The 2 adult children","justification":""},{"idx":2,"correct":false,"proposition":"His wife","justification":""},{"idx":3,"correct":false,"proposition":"His notary","justification":""},{"idx":4,"correct":false,"proposition":"The minor child","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-26","context":null,"enonce":" A 25-year-old woman, hairdresser, has erythematous and pruritic dermatitis of the hands, located in particular between the fingers, reminiscent of allergic contact dermatitis. What element(s) reinforces the hypothesis of work-related allergic contact dermatitis?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"regular use of products containing allergens in the workplace","justification":""},{"idx":1,"correct":false,"proposition":"similar injuries in co-workers","justification":""},{"idx":2,"correct":false,"proposition":"the presence of positive skin prick tests","justification":""},{"idx":3,"correct":false,"proposition":"regression of injuries during leave","justification":""},{"idx":4,"correct":false,"proposition":"the appearance of lesions from the first days of her apprenticeship as a hairdresser","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-28","context":null,"enonce":" In the context of palliative care, the High Authority for Health defines a concept of vital prognosis << in the short term >>. Which of the following best fits this definition?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"from seconds to minutes","justification":""},{"idx":1,"correct":false,"proposition":"from a few minutes to a few hours","justification":""},{"idx":2,"correct":false,"proposition":"from a few hours to a few days","justification":""},{"idx":3,"correct":false,"proposition":"from a few days to a few weeks","justification":""},{"idx":4,"correct":false,"proposition":"from a few weeks to a few months","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-29","context":null,"enonce":" A young man of 23 years comes to your office in a painting of asthenia and myalgia; it has no history. On examination, you notice erythematous angina, cervical and axillary lymphadenopathy of one or two centimeters, soft, mobile and painless. What are the biological arguments in favor of infectious mononucleosis? (one or more possible answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":">10% hyperbasophilic polymorphic lymphocyte cells","justification":""},{"idx":1,"correct":false,"proposition":"> 50% lymphocytes in the leukocyte formula","justification":""},{"idx":2,"correct":false,"proposition":"Hepatic cytolysis","justification":""},{"idx":3,"correct":false,"proposition":"Hepatic cholestasis","justification":""},{"idx":4,"correct":false,"proposition":"Thrombocytosis","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-30","context":null,"enonce":" During the clinical examination of a 62-year-old patient treated for high blood pressure and who consults you for the occurrence of pain in the lower right limb when walking, you have measured humeral pressure in both arms as well as distal pressures and established the value of systolic ankle pressure indexes:  humeral pressures at 162\/72 mmHg on the right and 158\/70 mmHg on the left arm; left ankle pressure at 148 mmHg (systolic left ankle pressure index at 0.93); right ankle pressures at 120 mmHg (systolic left ankle pressure index at 0.75). What can you say from these results? (one or more expected answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"the treatment of hypertension is not suitable","justification":""},{"idx":1,"correct":false,"proposition":"This patient is a carrier of arterial disease of the lower limbs","justification":""},{"idx":2,"correct":false,"proposition":"This limping patient is in the stage of exercise ischemia","justification":""},{"idx":3,"correct":false,"proposition":"This patient has significant anisotension","justification":""},{"idx":4,"correct":false,"proposition":"This patient is suspected of aortic dissection","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-31","context":null,"enonce":" You have been following Mr. X in consultation for 2 years. This 62-year-old patient has a subrenal abdominal aortic aneurysm. The last ultrasound assessment carried out 6 months ago did not show any evolution of the aneurysm which had been measured at 41 mm anteroposterior diameter. He presents today in emergency for the occurrence for more than an hour of a dull and continuous abdomino-lumbar pain. Gentle abdominal palpation is difficult. You find all the peripheral pulses. Blood pressure is measured at 140\/70 mmHg in both arms and heart rate is steady at 76 beats per minute. What management strategy do you propose to this patient? (only one answer expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Emergency exploratory laparotomy","justification":""},{"idx":1,"correct":false,"proposition":"Emergency Aortic Doppler Ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"emergency arteriogram of the aorta","justification":""},{"idx":3,"correct":false,"proposition":"emergency aortic angiography","justification":""},{"idx":4,"correct":false,"proposition":"Intensive Care Monitoring","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-33","context":null,"enonce":" You see in the early afternoon at your office a young man of 17 years who has a fever at 39 ° C since this morning. He is brought by his mother who prefers to come to your house because she lives next door, while the hospital is 1 kilometer away. He tells you that he has had a headache for several hours despite taking paracetamol. He vomited recently when he didn't eat anything at noon. The temperature is 39.2°C.  He has trouble bringing his chin back to the sternum, can't help but bend his lower limbs and says he is bothered by street noise. There are no skin abnormalities. What do you do very quickly? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Blood culture collection","justification":""},{"idx":1,"correct":false,"proposition":"Performing a lumbar puncture","justification":""},{"idx":2,"correct":false,"proposition":"Administration of one gram of ceftriaxone intramuscularly","justification":""},{"idx":3,"correct":false,"proposition":"Administration of oral or intravenous dexamethasone","justification":""},{"idx":4,"correct":false,"proposition":"Call to Centre 15 (UAS)","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-34","context":null,"enonce":" A 25-year-old woman consults with her 27-year-old husband for a desire for pregnancy. It reports regular cycles of 28 days and periods lasting 4 days. They have been in a relationship for five years and have been trying unsuccessfully to get pregnant for two years (stopping the pill and regular sex). This man has no history and he does not smoke. This woman has never smoked and was operated on for appendicular peritonitis at the age of 16, by laparoscopy. The clinical examination of this man shows normal hair and genitals (testicles and penis) of normal appearance and volume. He is 1m80 tall and weighs 74 kg. The clinical examination of this woman objectifies the scars of laparoscopy, normal breasts and normal external genitalia; She is 1m67 tall and weighs 59 kg. The examination of the cervix under speculum is normal, as is the vaginal examination which does not objectify any abnormality. Among all the examinations that you could prescribe for this interfility assessment, and taking into account your observation (interrogation and clinical examination of this couple), what are the two most important examinations to prescribe to determine the continuation of the care?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Antral follicle count by pelvic ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"Spermogram and spermocytogram","justification":""},{"idx":2,"correct":false,"proposition":"Hormonal plasma assays of the woman (FSH, LH, E2, AMH) on the third day of the cycle","justification":""},{"idx":3,"correct":false,"proposition":"Hysterosalpingography","justification":""},{"idx":4,"correct":false,"proposition":"Bacteriological, mycological and parasitological vaginal samples","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-35","context":null,"enonce":" A 40-year-old patient presents to the emergency room. He is known to be diabetic but adherence to treatment is poor. His left foot is deformed. The patient does not complain of pain. At the opening of the dressing, there is purulent discharge and a foul odor. On inspection, the patient is marbled. Blood pressure is at 80\/40mmHg. On palpation of the leg, you find a crackling and the local aspect is as follows. Which of the following proposals do you think is appropriate to the situation?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The absence of pain is an element of good prognosis","justification":""},{"idx":1,"correct":false,"proposition":"Mottling and general signs indicate a therapeutic emergency","justification":""},{"idx":2,"correct":false,"proposition":"The functional prognosis of the leg is exceeded","justification":""},{"idx":3,"correct":false,"proposition":"The introduction of antibiotic therapy will be done after deep samples are taken in the operating room","justification":""},{"idx":4,"correct":false,"proposition":"The prognosis is life-threatening","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-36","context":null,"enonce":" A 42-year-old woman consults for difficulty falling asleep that has lasted for years. She feels very tense and constantly worries \"about everything and nothing,\" she says. This makes her irritable and tiresome. What is the most likely diagnosis?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Depressive episode characterized with anxious characteristics","justification":""},{"idx":1,"correct":false,"proposition":"Adjustment insomnia","justification":""},{"idx":2,"correct":false,"proposition":"Generalized anxiety disorder","justification":""},{"idx":3,"correct":false,"proposition":"Panic disorder","justification":""},{"idx":4,"correct":false,"proposition":"Avoidant personality disorder","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-37","context":null,"enonce":" You see a 25-year-old patient in the emergency room who has a traumatic wound on the lateral side of the knee. A photograph of the lesion is attached. On clinical examination, the patient has a motor deficit of dorsal flexion of the ankle and foot. There is also hypoaesthesia of the back of the foot. Given the location of the wound, which lesion do you suspect in the first place?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Trunk of the sciatic nerve","justification":""},{"idx":1,"correct":false,"proposition":"Common fibular nerve","justification":""},{"idx":2,"correct":false,"proposition":"Anterior tibial tendon","justification":""},{"idx":3,"correct":false,"proposition":"Proximal insertion of the long fibular muscle","justification":""},{"idx":4,"correct":false,"proposition":"Clean extensor muscle of hallux","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-38","context":null,"enonce":" A 45-year-old woman consults for pelvic heaviness associated with moderate and intermittent left lower back pain. In her history, you note two vaginal deliveries, a cholecystectomy and a pollen allergy without associated asthma. His last cervical smear was two years ago and he was normal. She has contraception by copper intrauterine device. Clinical examination by abdominal palpation and objective vaginal examination a mobile pelvic mass of 10 cm, without ascites clinically identifiable with abdominal palpation. Vaginal secretions are normal in appearance. She weighs 62 kg for 1m59. The urine strip does not objectify leukocytes, red blood cells or nitrites and the search for beta-hCG is negative. What are the two most likely diagnoses?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Polymyomatous uterus","justification":""},{"idx":1,"correct":false,"proposition":"Endometrial adenocarcinoma","justification":""},{"idx":2,"correct":false,"proposition":"Pyosalpinx","justification":""},{"idx":3,"correct":false,"proposition":"Ovarian tumour","justification":""},{"idx":4,"correct":false,"proposition":"Uterine adenomyosis","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-39","context":null,"enonce":" An 85-year-old woman with a history of breast neoplasia consults for right thigh pain. These pains are permanent. X-rays of the right femur were performed. Which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"There is weakening of the right proximal femur","justification":""},{"idx":1,"correct":false,"proposition":"There are osteocondensing ranges","justification":""},{"idx":2,"correct":false,"proposition":"There are osteolytic beaches","justification":""},{"idx":3,"correct":false,"proposition":"There are periosteal appositions","justification":""},{"idx":4,"correct":false,"proposition":"There are multiple areas of disappearance of cortical","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-40","context":null,"enonce":" Regarding the osteology of the facial massif: (one or more expected answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"1 refers to the temporal bone","justification":""},{"idx":1,"correct":false,"proposition":"2 refers to the frontal bone","justification":""},{"idx":2,"correct":false,"proposition":"3 refers to the infraorbital foramen","justification":""},{"idx":3,"correct":false,"proposition":"4 refers to zygomatic bone","justification":""},{"idx":4,"correct":false,"proposition":"5 refers to the mandibular condyle","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-41","context":null,"enonce":" You receive a young woman victim of a sports accident, she has a periorbital hematoma. What clinical elements point you to a fracture of the floor of the orbit? (one or more expected answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"inferior palpebral emphysema","justification":""},{"idx":1,"correct":false,"proposition":"conjunctival hemorrhage","justification":""},{"idx":2,"correct":false,"proposition":"diplopia","justification":""},{"idx":3,"correct":false,"proposition":"hypoaesthesia of the wing of the nose","justification":""},{"idx":4,"correct":false,"proposition":"epistaxis","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-42","context":null,"enonce":" A 5-year-old child fell on his chin, he has a 1 cm wound, you want to eliminate a fracture of the mandibular condyle. What are you looking for at the clinical examination? (one or more expected answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"hypoaesthesia of the lower lip","justification":""},{"idx":1,"correct":false,"proposition":"an otorragia","justification":""},{"idx":2,"correct":false,"proposition":"stomatorragia","justification":""},{"idx":3,"correct":false,"proposition":"a limitation of the mouth opening","justification":""},{"idx":4,"correct":false,"proposition":"laterodeviation in the mouth opening","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-43","context":null,"enonce":" An 18-year-old patient is transferred from orthopaedic surgery to follow-up care and orthopaedic rehabilitation. He was operated on 5 days before a major exostosis of the tibiotal joint as part of Bessel Hagen disease (multiple exostosis disease). He wears a resin immobilization for 6 weeks. The pain is localized throughout the leg but predominates at the ankle. The rating on the numerical scale is 6\/10. The pain is not relieved by level 1 analgesics at an effective dose. Which of the following proposals should you mention?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Compression under resin","justification":""},{"idx":1,"correct":false,"proposition":"Hey intra-articular morrhage","justification":""},{"idx":2,"correct":false,"proposition":"Complex regional pain syndrome type 1","justification":""},{"idx":3,"correct":false,"proposition":"Surgical site infection","justification":""},{"idx":4,"correct":false,"proposition":"Venous thrombosis of the leg","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-44","context":null,"enonce":" A chronic low back pain patient enters a physical medicine and rehabilitation department for a multi-professional rehabilitation programme. He has been suffering from low back pain for 5 years. These continued after acute low back pain at his workplace. Which of the following applies(s) to the management of this patient?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The physiotherapist can work on isometric strengthening of the abdominal strap muscles","justification":""},{"idx":1,"correct":false,"proposition":"Ergotherapy has a role in the management of","justification":""},{"idx":2,"correct":false,"proposition":"The realization of plantar orthotics by an orthopaedic technician is indicated","justification":""},{"idx":3,"correct":false,"proposition":"CBT (cognitive behavioural therapies) can be used to better manage pain","justification":""},{"idx":4,"correct":false,"proposition":"You can apply to the social security fund to apply for recognition of disabled workers.","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-45","context":null,"enonce":" A 25-year-old patient presents for consultation for inflammatory arthralgia evolving for 6 months. She has Hashimoto's thyroiditis currently substituted with levothyroxine. She has no other symptoms to report and the clinical examination is poor, showing no synovitis. An immunological assessment was performed: - negative anti-CCP antibodies - rheumatoid factor positive >3N - anti-positive anti-nuclear antibodies - anti-SSA and anti-SSB positive >3N - negative native anti-DNA The search for antiphospholipids is positive anti-cardiolipin type (IgG and IgM positive >3N) without anti-b2GPI or circulating anticoagulant. The diagnosis of rheumatoid arthritis can be made","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"None of the propositions are true","justification":""},{"idx":1,"correct":false,"proposition":"The diagnosis of Sjögren's syndrome can be affirmed","justification":""},{"idx":2,"correct":false,"proposition":"Antiaggregant therapy should be introduced","justification":""},{"idx":3,"correct":false,"proposition":"It will be necessary to recontrol the anti-phospholipids at 3 months","justification":""},{"idx":4,"correct":false,"proposition":"The diagnosis of lupus may be suspected","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-47","context":null,"enonce":" Which of the following proposals characterizes COPD?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The constant association with chronic bronchitis","justification":""},{"idx":1,"correct":false,"proposition":"An incompletely reversible obstructive syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Often accelerated decline in respiratory function","justification":""},{"idx":3,"correct":false,"proposition":"Smoking cessation cure","justification":""},{"idx":4,"correct":false,"proposition":"A beneficial effect of mumomotor drugs","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-48","context":null,"enonce":" In a 40-year-old man complaining of a tendency to doze off during the day, what symptom(s) correspond to the diagnosis of narcolepsy?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"continuous and increasing sleepiness during the day","justification":""},{"idx":1,"correct":false,"proposition":"hypnopompic hallucinations","justification":""},{"idx":2,"correct":false,"proposition":"repeated bouts of abrupt abolition of muscle tone without altered consciousness","justification":""},{"idx":3,"correct":false,"proposition":"Hypnagogic hallucinations","justification":""},{"idx":4,"correct":false,"proposition":"transient complete paralysis occurring at the beginning of the night","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-49","context":null,"enonce":" A ten-year-old has been repeating regularly for more than two years that he has << stomach ache >>. These abdominal complaints, without identified triggering factor, have been the subject of numerous assessments that have shown no cause of injury. Which of the following diagnostic proposals is the most likely?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"excessive fear of having a disease (hypochondria)","justification":""},{"idx":1,"correct":false,"proposition":"disorder with functional neurological symptomatology (conversion disorder)","justification":""},{"idx":2,"correct":false,"proposition":"somatic symptomatological disorder (somatoform pain disorder)","justification":""},{"idx":3,"correct":false,"proposition":"simulation","justification":""},{"idx":4,"correct":false,"proposition":"factitious disorder","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-50","context":null,"enonce":" What type(s) of event(s) experienced can (can) lead to the development of post-traumatic stress disorder?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Receiving a letter of dismissal without having been prepared","justification":""},{"idx":1,"correct":false,"proposition":"verbal abuse and insults on the phone by an unhappy customer","justification":""},{"idx":2,"correct":false,"proposition":"Serious car accident without physical injury","justification":""},{"idx":3,"correct":false,"proposition":"Direct witness to the sudden death of a loved one by heart attack","justification":""},{"idx":4,"correct":false,"proposition":"Assault by a dog with severe bites","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-52","context":null,"enonce":" You see a 23-year-old patient who complains of nocturnal dyspnea episodes 2 to 3 times a week. These episodes almost always occur around 5 a.m. She sometimes uses a salbutamol spray, which relieves her within minutes. She lives in a seemingly healthy apartment and has no pets at home. It is also sometimes hampered by a shortness of breath in its activities. She does not complain of any other symptoms. She has no other history and does not smoke. When you see her in consultation, her auscultation is normal. Which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"A nocturnal ventilatory polygraph recording should be performed","justification":""},{"idx":1,"correct":false,"proposition":"An allergy assessment including prick-tests to the main pneumallergens is necessary","justification":""},{"idx":2,"correct":false,"proposition":"A diagnosis of asthma seems likely","justification":""},{"idx":3,"correct":false,"proposition":"an oral corticosteroid test should be undertaken","justification":""},{"idx":4,"correct":false,"proposition":"Pulmonary function testing is indicated","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-53","context":null,"enonce":" Regarding confusion in subjects over 75 years of age, which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It can be seen in case of meningoencephalitis","justification":""},{"idx":1,"correct":false,"proposition":"An organic etiology is rarely objectified","justification":""},{"idx":2,"correct":false,"proposition":"It is indicative of a decrease in cognitive reserves","justification":""},{"idx":3,"correct":false,"proposition":"It can be complicated by transient urinary incontinence","justification":""},{"idx":4,"correct":false,"proposition":"It can be complicated by bedsores","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-54","context":null,"enonce":" You see a 9-month-old infant due to contact with his uncle who was hospitalized 15 days ago for tuberculosis with a cave. Her uncle spent 8 days at the child's home 2 months ago. The child was vaccinated with BCG at one month of age. The child's chest x-ray is normal. Regarding the care of the child, which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"performing a tuberculin RDI","justification":""},{"idx":1,"correct":false,"proposition":"Performing an in vitro interferon gamma release test","justification":""},{"idx":2,"correct":false,"proposition":"realization of gastric tubing in search of BAAR","justification":""},{"idx":3,"correct":false,"proposition":"Prescription for prophylactic treatment with isoniazid and rifampicin","justification":""},{"idx":4,"correct":false,"proposition":"performing a chest CT scan","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-55","context":null,"enonce":" In anticipation of a caesarean section, a hemostasis assessment reveals a PT at 110%, a TCA ratio of 1.4 (42 seconds for a control at 30 seconds) and a fibrinogen at 3.5 g \/ l. Counts and platelets are normal. The patient has no history or clinical signs. What analysis would you ask for in the first line? (only one answer expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Determination of factor II","justification":""},{"idx":1,"correct":false,"proposition":"Determination of factor XIII","justification":""},{"idx":2,"correct":false,"proposition":"TCA correction test (sick TCA + control)","justification":""},{"idx":3,"correct":false,"proposition":"Platelet aggregation test","justification":""},{"idx":4,"correct":false,"proposition":"Determination of endogenous pathway factors","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-56","context":null,"enonce":" A 5-year-old child has febrile exanthema and vomiting. There are large, uniform bright red congestive tablecloths with no healthy skin gaps that predominate at the bending folds. Examination of the mouth and throat shows a partially depapillated saburral tongue and swollen and inflammatory tonsils. The temperature is 39.5°C.  The rapid diagnostic test for streptococcus A is positive. Which proposal(s) is (are) accurate regarding care?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"amoxicillin antibiotic therapy for 6 days","justification":""},{"idx":1,"correct":false,"proposition":"School eviction for 6 days","justification":""},{"idx":2,"correct":false,"proposition":"search for group A streptococcus in the patient's siblings","justification":""},{"idx":3,"correct":false,"proposition":"search for proteinuria at a distance from infection","justification":""},{"idx":4,"correct":false,"proposition":"Oral antibiotic prophylaxis in the 80-year-old grandmother","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-57","context":null,"enonce":" When monitoring a patient's pregnancy, intestinal hyperechogenicity was detected on the second morphological ultrasound of the fetus. The assessment of suspicion of cystic fibrosis led to demonstrate in the fetus the presence in the homozygous state of the p.Phe508del mutation at the CFTR locus. Which proposal(s) is (are) the exact proposal(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Full information about cystic fibrosis should be offered to this woman","justification":""},{"idx":1,"correct":false,"proposition":"Cystic fibrosis is a reportable disease","justification":""},{"idx":2,"correct":false,"proposition":"Recourse to medical termination of pregnancy is possible","justification":""},{"idx":3,"correct":false,"proposition":"A possible negative opinion of a CPDPN (Multidisciplinary Center for Prenatal Diagnosis) cannot be appealed","justification":""},{"idx":4,"correct":false,"proposition":"The patient can apply to the CPDPN (Multidisciplinary Center for Prenatal Diagnosis) through her gynecologist","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-58","context":null,"enonce":" A 15-day-old newborn is brought in for discomfort. On examination, there is mucocutaneous jaundice and the stool has been discolored for several days according to the parents. He has not regained his birth weight and has difficulty sucking. His capillary blood glucose is 0.3 g \/ L. What is (are) the possible diagnosis (s) in front of this whole table?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"viral hepatitis B","justification":""},{"idx":1,"correct":false,"proposition":"Neonatal diabetes","justification":""},{"idx":2,"correct":false,"proposition":"hypothyroidism","justification":""},{"idx":3,"correct":false,"proposition":"congenital adrenal hyperplasia","justification":""},{"idx":4,"correct":false,"proposition":"Insufficient energy intake","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-59","context":null,"enonce":" An 11-month-old infant is brought to the emergency room for functional impotence of the right lower limb without any notion of trauma. On examination the mobilization of the right lower limb is very painful and the joint amplitudes impossible to evaluate, there is a bruise on the right cheek The X-ray shows a fracture of the right femur. You suspect abuse. The child is kept at home by his paternal grandmother. What do you do? (one or more exact propositions)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Reporting to the public prosecutor","justification":""},{"idx":1,"correct":false,"proposition":"Taking pictures of the bruise","justification":""},{"idx":2,"correct":false,"proposition":"referral to the Brigade for the Protection of Minors","justification":""},{"idx":3,"correct":false,"proposition":"drafting an interim care order","justification":""},{"idx":4,"correct":false,"proposition":"Medical interrogation of grandmother","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-60","context":null,"enonce":" An infant born prematurely at 36 SA is brought to the emergency room at 4 months of age for bronchiolitis. His respiratory rate is 55 per minute, his heart rate is 140 beats per minute, his temperature is 38.2°C.  On clinical examination, there is intercostal pulling, cyanosis and intense cough. Parents report that he drinks about 120 mL of milk out of the 180 mL he used to drink. What is the main criterion of severity in this child? (only one answer expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"prematurity","justification":""},{"idx":1,"correct":false,"proposition":"intense cough","justification":""},{"idx":2,"correct":false,"proposition":"Intercostal draw","justification":""},{"idx":3,"correct":false,"proposition":"cyanosis","justification":""},{"idx":4,"correct":false,"proposition":"reduced food intake","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-61","context":null,"enonce":" Mrs. T. 57 years old, diabetic, consults you for her annual ophthalmological check-up. The diagnosis of diabetic retinopathy is based on the examination of the fundus, we can find: (one or more exact proposals)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Cottony nodules","justification":""},{"idx":1,"correct":false,"proposition":"Microaneurysms","justification":""},{"idx":2,"correct":false,"proposition":"Choroidal neovascularization","justification":""},{"idx":3,"correct":false,"proposition":"Intraretinal hemorrhages","justification":""},{"idx":4,"correct":false,"proposition":"Pre-retinal hemorrhages","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-62","context":null,"enonce":" In ophthalmology, about macular edema: (one or more exact answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"There is an increase in macular thickness in optical coherence tomography","justification":""},{"idx":1,"correct":false,"proposition":"The decrease in visual acuity is usually brutal","justification":""},{"idx":2,"correct":false,"proposition":"It can occur during diabetic retinopathy","justification":""},{"idx":3,"correct":false,"proposition":"It is visible after occlusion of the central artery of the retina","justification":""},{"idx":4,"correct":false,"proposition":"It can occur after cataract surgery","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-63","context":null,"enonce":" Ms. R., 42, is being treated for multiple sclerosis. It is sent to the ophthalmologist for assessment. Multiple sclerosis can cause: (one or more exact propositions)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Internuclear ophthalmoplegia","justification":""},{"idx":1,"correct":false,"proposition":"Nystagmus","justification":""},{"idx":2,"correct":false,"proposition":"An occlusion of the central artery of the retina","justification":""},{"idx":3,"correct":false,"proposition":"Retinal detachment","justification":""},{"idx":4,"correct":false,"proposition":"Increased retro-ocular pain during eye movements","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-64","context":null,"enonce":" A 70-year-old woman presents to the emergency room for a rash (see photograph) that appeared a week ago. She has been complaining of pruritus for 3 months. She is a widow, mother of 5 children and lives alone at home. She has no medical follow-up or background treatment. Which of the following tests will be most useful in confirming the diagnosis you suspect?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":" Direct immunofluorescence on skin biopsy","justification":""},{"idx":1,"correct":false,"proposition":"Indirect immunofluorescence on blood sample","justification":""},{"idx":2,"correct":false,"proposition":"Parasitological skin sampling for sarcoptes","justification":""},{"idx":3,"correct":false,"proposition":"Ferritinemia","justification":""},{"idx":4,"correct":false,"proposition":"Complete blood count","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-65","context":null,"enonce":" A patient is accompanied by her roommate to the emergency room at 2:00 a.m. Clinical examination suggests meningitis. The results of the lumbar puncture are: leukocytes 10,000 \/ ml; proteinorachy 2.8 g \/ l; glycorachia 0.8 mmol \/ l (blood glucose at 6 mmol \/ l); Gram-negative cocci in diplococci on direct examination. Which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"You will report this case as soon as confirmed by the microbiological culture","justification":""},{"idx":1,"correct":false,"proposition":"One of the objectives of mandatory disease reporting is epidemiological surveillance","justification":""},{"idx":2,"correct":false,"proposition":"One of the objectives of reporting is to initiate preventive measures","justification":""},{"idx":3,"correct":false,"proposition":"you prescribe precautions such as << Air>>","justification":""},{"idx":4,"correct":false,"proposition":"you initiate antibiotic prophylaxis for the patient's roommate","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-66","context":null,"enonce":" A 28-year-old patient comes to the emergency room with a very painful erection that has been going on for 9 hours now. What are the main possible causes of such a state? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Sickle-cell anemia","justification":""},{"idx":1,"correct":false,"proposition":"Trauma on flaccid penis","justification":""},{"idx":2,"correct":false,"proposition":"Testicular cancer","justification":""},{"idx":3,"correct":false,"proposition":"Intracavernous injection of prostaglandins","justification":""},{"idx":4,"correct":false,"proposition":"Multiple myeloma","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-67","context":null,"enonce":" What is (are) the true proposal(s) concerning the urodynamic balance?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It includes flowmetry","justification":""},{"idx":1,"correct":false,"proposition":"It gives information about bladder sensitivity","justification":""},{"idx":2,"correct":false,"proposition":"It includes a measurement of the post-voiding residue","justification":""},{"idx":3,"correct":false,"proposition":"It gives information on bladder compliance","justification":""},{"idx":4,"correct":false,"proposition":"It is performed under anesthesia","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-68","context":null,"enonce":" An 80-year-old patient is admitted for a hip fracture. He is being treated for ischemic heart disease with aspirin (75 mg\/day) combined with beta-blocker therapy. He has no other antecedent. His consciousness is normal and he is not confused. Its vital parameters are normal. Regarding the intensity of his pain, what is or are the scale(s) usable in this clinical context?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"DN4 scale","justification":""},{"idx":1,"correct":false,"proposition":"The analogue visual scale","justification":""},{"idx":2,"correct":false,"proposition":"the numerical scale of 0-10","justification":""},{"idx":3,"correct":false,"proposition":"The simple verbal scale","justification":""},{"idx":4,"correct":false,"proposition":"Behavioral Pain Scale (BPS)","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-69","context":null,"enonce":" You receive Mrs. V., 67 years old, for a table of alteration of the general condition associated with the following rash, which has been evolving for 4 weeks: Which of the following diagnoses seems compatible with the above clinical presentation?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"immunological thrombocytopenic purpura","justification":""},{"idx":1,"correct":false,"proposition":"IgA vasculitis","justification":""},{"idx":2,"correct":false,"proposition":"Purpura fulminans","justification":""},{"idx":3,"correct":false,"proposition":"Microscopic polyangiitis","justification":""},{"idx":4,"correct":false,"proposition":"vasculitis with anti-glomerular basement membrane antibodies","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-70","context":null,"enonce":" On an anatomo-pathological account of bronchoalveolar lavage, it is specified that the Golde score is equal to 5. Regarding Golde's score, check the exact proposal(s):","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"This is a histoprognostic score","justification":""},{"idx":1,"correct":false,"proposition":"It evaluates the amount of lymphocytes","justification":""},{"idx":2,"correct":false,"proposition":"It evaluates hemosiderin overload","justification":""},{"idx":3,"correct":false,"proposition":"It is based on a count of red blood cells","justification":""},{"idx":4,"correct":false,"proposition":"The result indicates intraalveolar hemorrhage in this patient","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-71","context":null,"enonce":" What is (are) the true proposal(s) concerning spinal anesthesia?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"This is perimedullary anesthesia","justification":""},{"idx":1,"correct":false,"proposition":"It is a loco-regional anesthesia","justification":""},{"idx":2,"correct":false,"proposition":"the anesthetic is given directly into the cerebrospinal fluid","justification":""},{"idx":3,"correct":false,"proposition":"It can be performed at the thoracic level","justification":""},{"idx":4,"correct":false,"proposition":"Respiratory complications are among the risks associated with this technique","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-73","context":null,"enonce":" A 30-year-old patient underwent a scheduled cholecystectomy surgery. He goes to the emergency room 72 hours after the procedure because he is not feeling well. The HR is at 115\/min, the BP is at 85\/35 mmHg, the FR is at 30\/min, the SpO2 is at 94% in ambient air. The patient is stuporous and the diuresis of the last hours is zero. What type of shock seems most likely to you? (only one answer expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"it is probably hypovolemic shock","justification":""},{"idx":1,"correct":false,"proposition":"it is probably cardiogenic shock","justification":""},{"idx":2,"correct":false,"proposition":"it is probably hemorrhagic shock","justification":""},{"idx":3,"correct":false,"proposition":"it is probably septic shock","justification":""},{"idx":4,"correct":false,"proposition":"it is probably an obstructive shock","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-74","context":null,"enonce":" What biological abnormality(s) usually accompanies moderate vitamin D deficiency in adults?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"hypocalcemia","justification":""},{"idx":1,"correct":false,"proposition":"hypercalciuria","justification":""},{"idx":2,"correct":false,"proposition":"hypercortisolemia","justification":""},{"idx":3,"correct":false,"proposition":"elevation of parathyroid hormone","justification":""},{"idx":4,"correct":false,"proposition":"hypomagnesemia","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-76","context":null,"enonce":" What clinical element(s) does (make) refute the diagnosis of Parkinson's disease at the beginning of the disease?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"swallowing problems","justification":""},{"idx":1,"correct":false,"proposition":"cognitive impairment","justification":""},{"idx":2,"correct":false,"proposition":"Falls","justification":""},{"idx":3,"correct":false,"proposition":"Impaired sense of smell","justification":""},{"idx":4,"correct":false,"proposition":"bradykinesia","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-77","context":null,"enonce":" Regarding meningiomas, what is (are) the exact answer(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"they develop from astrocytes","justification":""},{"idx":1,"correct":false,"proposition":"There is a female predominance","justification":""},{"idx":2,"correct":false,"proposition":"Their discovery is often fortuitous","justification":""},{"idx":3,"correct":false,"proposition":"they can develop as part of neurofibromatosis type 1","justification":""},{"idx":4,"correct":false,"proposition":"The peak incidence is around 40 years","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-78","context":null,"enonce":" Which proposal(s) for cotrimoxazole is (are) correct?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Cotrimoxazole is a combination of 2 anti-infective agents","justification":""},{"idx":1,"correct":false,"proposition":"Its bioavailability is excellent","justification":""},{"idx":2,"correct":false,"proposition":"It is eliminated through urine","justification":""},{"idx":3,"correct":false,"proposition":"It is naturally active on staphylococci and Escherichia coli","justification":""},{"idx":4,"correct":false,"proposition":"Cotrimoxazole may have an anti-parasitic action","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-79","context":null,"enonce":" An 85-year-old diabetic, hypertensive patient is hospitalized in front of the sudden appearance of a predominant rash with large folds of flexion and which gradually generalizes. The patient is dehydrated, her temperature is 38.5 ° C.  She has neutrophil hyperleukocytosis (8500\/mm3). The biological balance is also normal. The entourage tells you that she presented a picture of acute bronchitis 3 weeks ago. In the face of a persistent cough, treatment with amoxicillin combined with codeine and prednisolone was introduced 48 hours ago. His son tells you that his mother has already had many allergic reactions to antibiotics.","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"A maculopapular exanthema","justification":""},{"idx":1,"correct":false,"proposition":"acute generalized exanthematous pustulosis","justification":""},{"idx":2,"correct":false,"proposition":"drug hypersensitivity syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Stevens Johnson syndrome","justification":""},{"idx":4,"correct":false,"proposition":"a flare-up of pustular psoriasis","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-80","context":null,"enonce":" A 38-year-old patient underwent surgery for a non-functional pituitary macroadenoma, expressing beta-LH to immunohistochemistry, without markers of tumor aggressiveness. The postoperative period was marked by the occurrence of corticotropic insufficiency. Which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"treatment should include fludrocortisone","justification":""},{"idx":1,"correct":false,"proposition":"treatment should include hydrocortisone","justification":""},{"idx":2,"correct":false,"proposition":"The dosage of the treatment is adjusted according to the results of the cortisolemia at 8h","justification":""},{"idx":3,"correct":false,"proposition":"The return to normal of corticotropic function should be controlled by the 24-hour cortisolurie assay","justification":""},{"idx":4,"correct":false,"proposition":"Substitution of this deficiency renders annual influenza vaccination ineffective","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-81","context":null,"enonce":" Regarding the characteristics of carcinoma in situ, which is (are) the exact proposition(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It can interest the entire height of the epithelium","justification":""},{"idx":1,"correct":false,"proposition":"It carries a risk of metastases","justification":""},{"idx":2,"correct":false,"proposition":"It crosses the basement membrane","justification":""},{"idx":3,"correct":false,"proposition":"It is destined to remain non-invasive","justification":""},{"idx":4,"correct":false,"proposition":"He has an excellent prognosis after treatment","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-82","context":null,"enonce":" Regarding the prefixes\/suffixes used in TNM classifications, which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"c gives stage to clinical examination","justification":""},{"idx":1,"correct":false,"proposition":"p gives the postoperative stage","justification":""},{"idx":2,"correct":false,"proposition":"x means unrated or unknown","justification":""},{"idx":3,"correct":false,"proposition":"R gives stage after radiation therapy","justification":""},{"idx":4,"correct":false,"proposition":"gives it stage after neoadjuvant treatment","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-84","context":null,"enonce":" Which of the following recommended treatment options for impaired ejection fraction heart failure, in addition to certain beta-blockers, has (have) demonstrated a decrease in mortality?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Henlé's loop diuretics","justification":""},{"idx":1,"correct":false,"proposition":"mineralocorticoid receptor antagonists","justification":""},{"idx":2,"correct":false,"proposition":"angiotensin-converting enzyme II inhibitors","justification":""},{"idx":3,"correct":false,"proposition":"digitalis","justification":""},{"idx":4,"correct":false,"proposition":"implantable defibrillators","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-85","context":null,"enonce":" A 58-year-old patient, a former carpenter, is referred for unilateral nasal obstruction and you mention the diagnosis of adenocarcinoma of the ethmoid. Which proposals are correct? (one or more expected answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"there may be repeated epistaxis homolateral to obstruction","justification":""},{"idx":1,"correct":false,"proposition":"It is a disease entered in the schedule of occupational diseases","justification":""},{"idx":2,"correct":false,"proposition":"Cervical lymphadenopathy is common at the time of diagnosis","justification":""},{"idx":3,"correct":false,"proposition":"the tumour may be masked by a reactive polyp","justification":""},{"idx":4,"correct":false,"proposition":"the presence of exophthalmos would be a sign of an advanced tumor","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-86","context":null,"enonce":" One patient had a brief loss of consciousness. You question him and the witnesses. What are the arguments in favor of syncope? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Brief, low-amplitude muscle twitching of the shoulders 20 seconds after loss of consciousness","justification":""},{"idx":1,"correct":false,"proposition":"inability to get up on one's own after returning to consciousness","justification":""},{"idx":2,"correct":false,"proposition":"prolonged drowsiness after return to consciousness","justification":""},{"idx":3,"correct":false,"proposition":"feeling strange before loss of consciousness","justification":""},{"idx":4,"correct":false,"proposition":"palpitations before loss of consciousness","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-87","context":null,"enonce":" A couple consults you because of a pregnancy project. The woman is 32 years old and the man is on chronic hemodialysis due to X-linked Alport syndrome. What are the exact proposals? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Man cannot transmit the disease if they have a son","justification":""},{"idx":1,"correct":false,"proposition":"the child will necessarily carry a trait of the disease","justification":""},{"idx":2,"correct":false,"proposition":"It is better to resort to postnatal diagnosis if it is a son","justification":""},{"idx":3,"correct":false,"proposition":"It is better to resort to prenatal diagnosis if it is a girl","justification":""},{"idx":4,"correct":false,"proposition":"Hemodialysis of the husband contraindicates the plan of pregnancy","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-88","context":null,"enonce":" What is the main reason for chronic kidney disease to shorten life expectancy? (only one answer expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Increased vascular risk","justification":""},{"idx":1,"correct":false,"proposition":"increased risk of cardiac conduction disorder","justification":""},{"idx":2,"correct":false,"proposition":"increased risk of heart rhythm disorder","justification":""},{"idx":3,"correct":false,"proposition":"Increased risk of cancer","justification":""},{"idx":4,"correct":false,"proposition":"Increased risk of infection","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-89","context":null,"enonce":" A 42-year-old man was admitted to intensive care 48 hours ago for shock complicating acute pneumococcal pneumonia. Despite the correction of hemodynamic failure, it remains oliguric, and serum creatinine has increased from 78 μmol\/L at intake to 134 μmol\/L. What is (are) the exact proposal(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"there is acute renal failure","justification":""},{"idx":1,"correct":false,"proposition":"Acute tubular necrosis should be mentioned","justification":""},{"idx":2,"correct":false,"proposition":"It is necessary to evoke a cortical necrosis","justification":""},{"idx":3,"correct":false,"proposition":"It is necessary to evoke a secondary renal localization of the infection","justification":""},{"idx":4,"correct":false,"proposition":"a renal ultrasound should be performed","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-90","context":null,"enonce":" In what situations is anemia of central origin? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Vitamin B12 deficiency","justification":""},{"idx":1,"correct":false,"proposition":"Iron deficiency","justification":""},{"idx":2,"correct":false,"proposition":"Autoimmune hemolytic anemia","justification":""},{"idx":3,"correct":false,"proposition":"Myelodysplastic syndrome","justification":""},{"idx":4,"correct":false,"proposition":"Multiple myeloma","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-91","context":null,"enonce":" Your 55-year-old patient has been a cashier in a supermarket chain for 30 years. He has incomplete paraplegia following a road accident that occurred during his vacation 8 months ago. He is currently still on sick leave. What accompanying measures do you recommend? (one or more proposals expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Request an appointment at Pôle emploi","justification":""},{"idx":1,"correct":false,"proposition":"apply for recognition of the status of disabled worker","justification":""},{"idx":2,"correct":false,"proposition":"apply for disability","justification":""},{"idx":3,"correct":false,"proposition":"request a pre-resumption visit with your occupational physician","justification":""},{"idx":4,"correct":false,"proposition":"Request recognition in a commuting accident","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-92","context":null,"enonce":" A 25-year-old patient, smoker (10 cigarettes a day since the age of 15), is referred for consultation for symmetrical polyarthritis affecting the wrists, proximal interphalangeal, and metacarpophalangeal, present for 2 months. She has a history of pericarditis 6 months before your consultation, which has improved on nonsteroidal anti-inflammatory drugs. However, she retains a persistent deep inspiration discomfort. She tells you that she has been sensitive to cold since the age of 15 (with fingers that turn white), and also sensitivity to the sun since she took the last summer of significant \"sunburn\" on the face and décolleté, while she had little exposure. She does not have a feeling of dry eye or dry mouth. The biological analyses are as follows:","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The whole is in favor of inflammatory myopathy","justification":""},{"idx":1,"correct":false,"proposition":"the diagnosis of lupus can be affirmed even in the absence of native anti-DNA antibodies","justification":""},{"idx":2,"correct":false,"proposition":"The whole is in favor of rheumatoid arthritis","justification":""},{"idx":3,"correct":false,"proposition":"there is probably a secondary Sjögren's syndrome","justification":""},{"idx":4,"correct":false,"proposition":"there may be a congenital C4 deficiency","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-93","context":null,"enonce":" What biological abnormality(s) may be related to an inflammatory syndrome?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Thrombocytopenia","justification":""},{"idx":1,"correct":false,"proposition":"increase in alpha-2 globulins","justification":""},{"idx":2,"correct":false,"proposition":"hypoalbuminemia","justification":""},{"idx":3,"correct":false,"proposition":"hyperferritinemia","justification":""},{"idx":4,"correct":false,"proposition":"decrease in transferrin","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-94","context":null,"enonce":" A 48-year-old woman consults for paresthesias of the anterior surface of the thigh. You suspect cruralgia. What is (are) the true statement(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It can be caused by a foraminal disc herniation L5-S1","justification":""},{"idx":1,"correct":false,"proposition":"It can be caused by a paramedian disc herniation L4-L5","justification":""},{"idx":2,"correct":false,"proposition":"A motor deficit of the quadriceps can be observed","justification":""},{"idx":3,"correct":false,"proposition":"The pain may radiate to the anterior surface of the tibia","justification":""},{"idx":4,"correct":false,"proposition":"It can be caused by reducing the size of an osteoarthritic conjugation foramen","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-95","context":null,"enonce":" Regarding the judicial report, which is (are) the exact proposal(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It can only be performed by a health professional","justification":""},{"idx":1,"correct":false,"proposition":"It is one of the authorized derogations from professional secrecy","justification":""},{"idx":2,"correct":false,"proposition":"It is done orally during a telephone communication to the public prosecutor","justification":""},{"idx":3,"correct":false,"proposition":"If written by a doctor, it increases the punishment of the perpetrator","justification":""},{"idx":4,"correct":false,"proposition":"It makes it possible to warn the judicial authorities of suspected violence in a minor","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-96","context":null,"enonce":" Regarding the autopsy, which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"A medical autopsy may be requested by the doctor in order to investigate the causes of death","justification":""},{"idx":1,"correct":false,"proposition":"The family of the deceased may refuse to have a forensic autopsy of the body performed","justification":""},{"idx":2,"correct":false,"proposition":"The family of the deceased is the recipient of the conclusions of a medico-legal autopsy","justification":""},{"idx":3,"correct":false,"proposition":"Medical autopsy is governed by the same laws as organ harvesting","justification":""},{"idx":4,"correct":false,"proposition":"Family cannot see body before medical autopsy","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-97","context":null,"enonce":" In case of metastatic pulmonary adenocarcinoma, the search for therapeutic molecular targets: (one or more exact answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"is systematic","justification":""},{"idx":1,"correct":false,"proposition":"can be made from formalin-fixed biopsy material and included in paraffin","justification":""},{"idx":2,"correct":false,"proposition":"can be done from frozen biopsy material","justification":""},{"idx":3,"correct":false,"proposition":"determines the therapeutic choice of first-line treatment","justification":""},{"idx":4,"correct":false,"proposition":"requires prior morphological pathological examination","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-98","context":null,"enonce":" For osteosarcoma of the lower end of the femur, check the exact proposal(s):","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It consists of a proliferation of osteoblasts","justification":""},{"idx":1,"correct":false,"proposition":"The most frequent metastases are pulmonary","justification":""},{"idx":2,"correct":false,"proposition":"Its diagnosis requires a histo-radiological confrontation","justification":""},{"idx":3,"correct":false,"proposition":"Its diagnosis requires molecular confirmation","justification":""},{"idx":4,"correct":false,"proposition":"Surgical treatment from the outset is recommended","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-99","context":null,"enonce":" An 89-year-old patient comes to consultation for a fall. He has had three falls in the past year. What factor(s) will you look for at the interrogation and clinical examination as a risk factor for osteoporosis in the elderly?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Obesity (body mass index > 30)","justification":""},{"idx":1,"correct":false,"proposition":"Smoking","justification":""},{"idx":2,"correct":false,"proposition":"Vitamin D deficiency","justification":""},{"idx":3,"correct":false,"proposition":"Chronic alcoholism","justification":""},{"idx":4,"correct":false,"proposition":"Sedentary lifestyle","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-100","context":null,"enonce":" A patient has a fracture of the third thoracic vertebra and a fracture of the first lumbar vertebra. What are the elements in favor of vertebral fractures due to bone failure? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Disappearance of a thorny","justification":""},{"idx":1,"correct":false,"proposition":"Fracture of the third thoracic vertebra","justification":""},{"idx":2,"correct":false,"proposition":"Fracture of the first lumbar vertebra","justification":""},{"idx":3,"correct":false,"proposition":"Disappearance of the anterior cortical of the vertebral body","justification":""},{"idx":4,"correct":false,"proposition":"Respect for the pedicles of the fractured vertebra","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-101","context":null,"enonce":" Which first-line examination(s) for etiological purposes should be requested in the face of hyperferritinemia? (one or more expected answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Transferrin saturation coefficient","justification":""},{"idx":1,"correct":false,"proposition":"Fasting blood glucose","justification":""},{"idx":2,"correct":false,"proposition":"Abdominal CT scan","justification":""},{"idx":3,"correct":false,"proposition":"Liver biopsy","justification":""},{"idx":4,"correct":false,"proposition":"Triglyceride levels","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-103","context":null,"enonce":" Which semiological element(s) of imagery enter into the definition of a fluid pleural effusion?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"In radiography, it is a declivated opacity, basi-thoracic if the patient is standing","justification":""},{"idx":1,"correct":false,"proposition":"In radiography, in case of partitioned effusion, the internal limit of opacity can become convex","justification":""},{"idx":2,"correct":false,"proposition":"In radiography, there is an airy bronchogram within the abnormal opacity","justification":""},{"idx":3,"correct":false,"proposition":"There is an erasure of the diaphragm in radiography","justification":""},{"idx":4,"correct":false,"proposition":"Pleural ultrasound is the technique of choice for the diagnosis of fluid effusion in a lying patient","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-104","context":null,"enonce":" Among the following proposals, what is the main clinical manifestation of an infection of the gastric mucosa by Helicobacter pylori? (only one answer expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"motor diarrhea","justification":""},{"idx":1,"correct":false,"proposition":"fever","justification":""},{"idx":2,"correct":false,"proposition":"dyspeptic syndrome","justification":""},{"idx":3,"correct":false,"proposition":"vomiting","justification":""},{"idx":4,"correct":false,"proposition":"pyrosis","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-105","context":null,"enonce":" A 48-year-old non-diabetic patient experienced multiple episodes of hypoglycemia. What proposals are in favour of hypoglycaemia by hidden injections of rapid insulin? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"C-peptide increased during hypoglycemia","justification":""},{"idx":1,"correct":false,"proposition":"Weight gain","justification":""},{"idx":2,"correct":false,"proposition":"Pro-insulin increased during hypoglycemia","justification":""},{"idx":3,"correct":false,"proposition":"No sign of neuroglucopenia during episodes","justification":""},{"idx":4,"correct":false,"proposition":"Low cortisol during hypoglycemia","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-106","context":null,"enonce":" A 6-year-old boy is brought to a dermatology consultation by his mother. He lives in rural areas and attends school. He has been presenting for 1 month alopecic plaques that continue to spread despite the prescription of topical corticosteroids. What diagnosis(s) do you mention?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Kerion","justification":""},{"idx":1,"correct":false,"proposition":"Scalp psoriasis","justification":""},{"idx":2,"correct":false,"proposition":"Alopecia","justification":""},{"idx":3,"correct":false,"proposition":"Seborrheic dermatitis","justification":""},{"idx":4,"correct":false,"proposition":"False asbestos moth","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-107","context":null,"enonce":" Which bacterium(s) are the main responsible bacteria(s) for acute purulent otitis media?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Streptococcus pneumoniae","justification":""},{"idx":1,"correct":false,"proposition":"Haemophilus influenzae","justification":""},{"idx":2,"correct":false,"proposition":"Pseudomonas aeruginosa","justification":""},{"idx":3,"correct":false,"proposition":"Bordetella pertussis","justification":""},{"idx":4,"correct":false,"proposition":"Coxiella burnetii","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-108","context":null,"enonce":" Which of the following infectious agents is usually associated with a biological mononucleosis syndrome?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"HIV","justification":""},{"idx":1,"correct":false,"proposition":"Toxoplasma gondii","justification":""},{"idx":2,"correct":false,"proposition":"Pneumocystis jirovecii","justification":""},{"idx":3,"correct":false,"proposition":"Gardnerella vaginalis","justification":""},{"idx":4,"correct":false,"proposition":"CMV","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-111","context":null,"enonce":" You receive the result of the first toxoplasmosis screening serology of a patient who is 12 weeks pregnant with amenorrhea (AS). This is positive with the presence of IgM and IgG. Which proposals are correct? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"an IgG avidity test should be prescribed","justification":""},{"idx":1,"correct":false,"proposition":"It may be a primary infection in early pregnancy","justification":""},{"idx":2,"correct":false,"proposition":"it may be an old infection prior to the period of conception","justification":""},{"idx":3,"correct":false,"proposition":"amniocentesis with toxoplasma testing should be performed","justification":""},{"idx":4,"correct":false,"proposition":"the risk of mother-to-child transmission is high","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-112","context":null,"enonce":" You are caring for a patient who opens their eyes to verbal stimulation, has an appropriate motor response to a painful stimulus, and responds confusedly. Regarding its Glasgow score, which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It takes into account brainstem reflexes","justification":""},{"idx":1,"correct":false,"proposition":"This is a comatose patient","justification":""},{"idx":2,"correct":false,"proposition":"the opening of the eyes is rated 3","justification":""},{"idx":3,"correct":false,"proposition":"motor skills are rated 4","justification":""},{"idx":4,"correct":false,"proposition":"The total score is 11","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-113","context":null,"enonce":" When faced with this type of lesion in a child, what is the main diagnostic hyothesis? (only one exact answer)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"polygenic hypercholesterolemia","justification":""},{"idx":1,"correct":false,"proposition":"heterozygous familial hypercholesterolemia","justification":""},{"idx":2,"correct":false,"proposition":"homozygous familial hypercholesterolemia","justification":""},{"idx":3,"correct":false,"proposition":"dysbetaliboproteinemia","justification":""},{"idx":4,"correct":false,"proposition":"familial hyperchylomicronemia syndrome","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-114","context":null,"enonce":" What are the possible side effects of strong opioids? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Constipation","justification":""},{"idx":1,"correct":false,"proposition":"Nausea","justification":""},{"idx":2,"correct":false,"proposition":"Drowsiness","justification":""},{"idx":3,"correct":false,"proposition":"Organic renal failure","justification":""},{"idx":4,"correct":false,"proposition":"Heart failure","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-115","context":null,"enonce":" Regarding Takayasu's disease, what are the exact proposals? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It can be revealed by high blood pressure","justification":""},{"idx":1,"correct":false,"proposition":"it can give carotidodynias","justification":""},{"idx":2,"correct":false,"proposition":"It affects 9 women for 1 man","justification":""},{"idx":3,"correct":false,"proposition":"It can affect adults of any age","justification":""},{"idx":4,"correct":false,"proposition":"It belongs to the group of vasculitis of medium-sized vessels","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-116","context":null,"enonce":" About bacterial endocarditis, which is (are) the exact proposal(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":" It occurs more frequently on an injured valve than on a healthy valve","justification":""},{"idx":1,"correct":false,"proposition":"It occurs more frequently in valvular heart disease of the right heart than of the left heart","justification":""},{"idx":2,"correct":false,"proposition":"The elemental lesion is composed of fibrinoplatelet debris","justification":""},{"idx":3,"correct":false,"proposition":"It occurs preferentially on an atrial septal defect","justification":""},{"idx":4,"correct":false,"proposition":"Patients with prosthetic valves are at higher risk of endocarditis","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-117","context":null,"enonce":" The diagnosis of brain death requires: (one or more exact answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Check the absence of spontaneous breathing by extubating the patient","justification":""},{"idx":1,"correct":false,"proposition":"Check for the absence of brain activity by a brain MRI with injection","justification":""},{"idx":2,"correct":false,"proposition":"Eliminate hypothermia","justification":""},{"idx":3,"correct":false,"proposition":"To be ascertained by a doctor practicing outside the establishment where the patient is hospitalized","justification":""},{"idx":4,"correct":false,"proposition":"To verify clinical or paraclinical criteria established by decree","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-118","context":null,"enonce":" About sickle cell disease, which is (are) the exact proposal(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It is a disease of membrane origin of the red blood cell","justification":""},{"idx":1,"correct":false,"proposition":"It is the most common genetic pathology of red blood cells in the world","justification":""},{"idx":2,"correct":false,"proposition":"Sick subjects are heterozygous for the causal mutation","justification":""},{"idx":3,"correct":false,"proposition":"Sickle cell screening is offered to all children born in France","justification":""},{"idx":4,"correct":false,"proposition":"A sick person who unites with a spouse from northern Europe has a high risk of having a sick child","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2022-qi-120","context":null,"enonce":" In case of sarcoidosis, what are the exact answers regarding the granuloma? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"it contains T cells","justification":""},{"idx":1,"correct":false,"proposition":"it contains epithelial cells","justification":""},{"idx":2,"correct":false,"proposition":"It is a tuberculoid granuloma","justification":""},{"idx":3,"correct":false,"proposition":"It can be seen on skin samples of erythema nodosum","justification":""},{"idx":4,"correct":false,"proposition":"It can be seen on accessory salivary gland samples","justification":""}],"ts":{"$numberLong":"1665243632006"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-2","context":null,"enonce":"A 30-year-old woman consults following an episode of spontaneous deep vein thrombosis. At the interrogation, you find a history of pulmonary embolism at age 50 in the mother. You suspect constitutional thrombophilia. Which analysis(s) do you think are relevant?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The determination of protein Ce of protein S","justification":""},{"idx":1,"correct":false,"proposition":"Determination of factor V","justification":""},{"idx":2,"correct":true,"proposition":"The search for a mutation of the II factor","justification":""},{"idx":3,"correct":true,"proposition":"The dosage of antithrombin","justification":""},{"idx":4,"correct":false,"proposition":"The determination of D-dimer","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-3","context":null,"enonce":"Mr. R., 54 years old, comes to consult for the discovery of a lump in the groin. On examination, you palpate a left inguinal lymphadenopathy 2.5 cm in diameter. What should your clinical examination include? (one or more possible answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Inspection of the skin of the entire left lower limb","justification":""},{"idx":1,"correct":true,"proposition":"An anal examination","justification":""},{"idx":2,"correct":true,"proposition":"Palpation of all lymph node areas","justification":""},{"idx":3,"correct":true,"proposition":"Inspection and palpation of the external genitalia","justification":""},{"idx":4,"correct":true,"proposition":"The search for splenomegaly","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-4","context":null,"enonce":"A 45-year-old man consults the emergency room for severe pain in his right wrist that woke him up this morning. You find hyperthermia at 38.5 ° C.  The wrist is red, warm and very swollen. You suspect septic arthritis. Which of the following proposition(s) is (are) correct?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Standard radiography should be performed","justification":""},{"idx":1,"correct":true,"proposition":"Joint puncture is useful and easy to perform in emergency","justification":""},{"idx":2,"correct":false,"proposition":"Ultrasound is specific to the diagnosis","justification":""},{"idx":3,"correct":false,"proposition":"MRI is part of the systematic assessment","justification":""},{"idx":4,"correct":true,"proposition":"The scintigraphy may be indicated in a second step to look for osteitis","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-5","context":null,"enonce":"A young student wakes up the day after a party with toxic abuse and notices a deficit in her right arm. You mention paralysis of the right radial nerve by compression at the tricipital gutter. Which of the following proposals corresponds to this diagnosis?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Gooseneck deficiency","justification":""},{"idx":1,"correct":false,"proposition":"Triceps brachial muscle deficiency","justification":""},{"idx":2,"correct":false,"proposition":"A sensory deficit of the entire posterior surface of the forearm","justification":""},{"idx":3,"correct":true,"proposition":"Brachioradial muscle deficiency","justification":""},{"idx":4,"correct":false,"proposition":"An abolition of the cubito-pronator reflex","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-6","context":null,"enonce":"The diagnosis of childhood autism spectrum disorder is based on:","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A normal intellectual level","justification":""},{"idx":1,"correct":true,"proposition":"Fears unusual for age","justification":""},{"idx":2,"correct":false,"proposition":"A sadness of mood","justification":""},{"idx":3,"correct":true,"proposition":"Circumscribed and persevering interests","justification":""},{"idx":4,"correct":true,"proposition":"A deficit of social reciprocity","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-7","context":null,"enonce":"An 8-year-old child comes to your consultation for swallowing pain, earache and fever. Examination of the objective throat of inflammatory tonsils. What is your attitude?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"You have a sample for streptococcus and rhinovirus PCR taken at the laboratory","justification":""},{"idx":1,"correct":false,"proposition":"You perform a strep rapid diagnostic test in the office","justification":""},{"idx":2,"correct":false,"proposition":"You prescribe symptomatic treatment with Ketoprofen","justification":""},{"idx":3,"correct":false,"proposition":"You prescribe amoxicillin + clavulanic acid as a first line","justification":""},{"idx":4,"correct":false,"proposition":"You prescribe in-the-ear antibiotic therapy","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-8","context":null,"enonce":"Among the following proposals concerning the entourage of a patient with meningococcal meningitis, indicate which one(s) is\/are right.","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Ciprofloxacin is a second-line antibiotic prophylaxis","justification":""},{"idx":1,"correct":true,"proposition":"Antibiotic prophylaxis aims to eradicate pharyngeal carriage in contact subjects","justification":""},{"idx":2,"correct":false,"proposition":"Antibiotic prophylaxis is offered up to 1 month after last contact with the index case","justification":""},{"idx":3,"correct":true,"proposition":"Antibiotic prophylaxis is based primarily on rifampicin","justification":""},{"idx":4,"correct":true,"proposition":"Vaccination may be offered in combination with antibiotic prophylaxis","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-10","context":null,"enonce":"A 92-year-old patient has seen this tumor develop on the left nasal wing for a few months. The tumor is nodular, with bleeding ulceration on the surface. The patient is in good general condition, with no notable history. She worked as a farmer for 50 years. What is your diagnosis?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":" Nodular basal cell carcinoma","justification":""},{"idx":1,"correct":false,"proposition":"Merkel's carcinoma","justification":""},{"idx":2,"correct":false,"proposition":"Achromic nodular melanoma","justification":""},{"idx":3,"correct":false,"proposition":"Squamous cell carcinoma","justification":""},{"idx":4,"correct":false,"proposition":"Dubreuilh's melanoma","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-11","context":null,"enonce":"A 64-year-old man has this chronic rash reaching 45% of the body surface area, evolving for about ten years. He has a history of hypertension treated with losartan, hydrochlorothiazide and atenolol, and smoking valued at 25 pack-years, as well as daily alcohol consumption. Which of the following measures do you think is appropriate for the management of this patient?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Smoking cessation","justification":"There are relatively few situations where this proposal is not checked off at EDN"},{"idx":1,"correct":true,"proposition":"Discontinuation of atenolol","justification":""},{"idx":2,"correct":false,"proposition":"Replacement of sartan with a calcium channel blocker","justification":""},{"idx":3,"correct":false,"proposition":"Very strong local dermocorticotherapy with clobetasol 30 grams per day","justification":""},{"idx":4,"correct":false,"proposition":"TL01 UVB Phototherapy (narrow spectrum)","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-13","context":null,"enonce":"You receive a feverish 16-month-old infant in the emergency room, whose mother is worried because she finds him tired. Which of the following is(are) in favor of a serious infection?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Fever above 39.5°C","justification":""},{"idx":1,"correct":false,"proposition":"Lack of response to paracetamol","justification":""},{"idx":2,"correct":true,"proposition":"Anorexia","justification":""},{"idx":3,"correct":true,"proposition":"Hypotonia","justification":""},{"idx":4,"correct":false,"proposition":"Enanthemum","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-14","context":null,"enonce":"An 80-year-old patient consults his general practitioner at the request of his wife for an annual check-up. What symptom(s) could you link to age-related androgen deficiency?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Sadness of mood","justification":""},{"idx":1,"correct":false,"proposition":"Haematuria","justification":""},{"idx":2,"correct":true,"proposition":"Gynecomastia","justification":""},{"idx":3,"correct":true,"proposition":"Abdominal obesity","justification":""},{"idx":4,"correct":false,"proposition":"Dysuria","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-15","context":null,"enonce":"A 67-year-old patient consults a urologist because his father and brother have prostate cancer. What symptom(s) would be in favor of prostate cancer?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Erectile dysfunction","justification":""},{"idx":1,"correct":false,"proposition":"Stress urinary incontinence","justification":""},{"idx":2,"correct":false,"proposition":"Terminal hematuria","justification":""},{"idx":3,"correct":true,"proposition":"Dysuria","justification":""},{"idx":4,"correct":true,"proposition":"Initial hematuria","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-16","context":null,"enonce":"What advantage(s) does permanent implant brachytherapy offer in prostate cancer compared to conventional irradiation?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Non-invasive treatment","justification":""},{"idx":1,"correct":false,"proposition":"Outpatient treatment","justification":""},{"idx":2,"correct":true,"proposition":"Higher dose delivered to the tumour","justification":""},{"idx":3,"correct":true,"proposition":"Better protection of healthy tissue","justification":""},{"idx":4,"correct":true,"proposition":"Lower risk of sequelae erectile dysfunction","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-17","context":null,"enonce":"Ms. M., 35 years old, presents for a dull pain in her right calf that has existed since the previous evening. During the interrogation, you find the existence of arterial disease of the lower limbs in the father of this patient, which led to a leg amputation at the age of 78. Despite this hereditary history, Ms. M. reports smoking quantified at half a pack of cigarettes a day since the age of 18. You also find Raynaud's syndrome in the patient's mother. Ms. M. has no treatment and has just presented a spontaneous miscarriage for which she remained hospitalized 24 hours. Clinical examination reveals an increase in the circumference of the edema of the right calf by 1 cm compared to the contralateral calf. There is also an increase in skin heat in the right lower limb as well as an increase in the visibility of the superficial veins and pain on deep palpation of the calf. In this patient, what element(s) should be taken into account to establish the clinical probability score?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Family history of vascular pathology","justification":""},{"idx":1,"correct":false,"proposition":"Increased right calf circumference by 1 cm","justification":""},{"idx":2,"correct":true,"proposition":"Pain on deep palpation","justification":""},{"idx":3,"correct":true,"proposition":"Increased visibility of superficial veins","justification":""},{"idx":4,"correct":true,"proposition":"Recent hospitalization of 24 hours","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-19","context":null,"enonce":"A 45-year-old woman consults for a right parotid mass. Which of the following criteria is (are) that directs you towards the diagnosis of pleomorphic adenoma?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Epidemiological criterion","justification":""},{"idx":1,"correct":true,"proposition":"Indurated lesion sometimes bumpy","justification":""},{"idx":2,"correct":true,"proposition":"Absence of facial paralysis","justification":""},{"idx":3,"correct":false,"proposition":"Algic character","justification":""},{"idx":4,"correct":true,"proposition":"Spontaneous hyper signal in T2 sequence on MRI","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-20","context":null,"enonce":" What element(s) contraindicate(s) the organization of palliative care care at home?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The fact that the patient is a child","justification":""},{"idx":1,"correct":true,"proposition":"Lack of consent and consent of the patient","justification":""},{"idx":2,"correct":false,"proposition":"The fact that the patient lives in a building without an elevator","justification":""},{"idx":3,"correct":false,"proposition":"The fact that the patient has more than 2 electric syringes","justification":""},{"idx":4,"correct":false,"proposition":"The fact that the patient lives alone at home","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-21","context":null,"enonce":"On what argument(s) do you assess the seriousness of an epistaxis?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Abundance","justification":""},{"idx":1,"correct":true,"proposition":"Associated comorbidities","justification":""},{"idx":2,"correct":true,"proposition":"Tachycardia","justification":""},{"idx":3,"correct":true,"proposition":"Presence of sweat","justification":""},{"idx":4,"correct":true,"proposition":"Recurrent bleeding","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-22","context":null,"enonce":"In order to avoid any << unreasonable obstinacy>> and in accordance with the terms of the law of 2 February 2022 known as the Leonetti-Claeys <<>> law, a treatment may be suspended or not undertaken, in accordance with the patient's will if the following condition(s) is (are) respected.","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"It is useless","justification":""},{"idx":1,"correct":true,"proposition":"It is disproportionate","justification":""},{"idx":2,"correct":true,"proposition":"It has no other effect than the only artificial maintenance of life","justification":""},{"idx":3,"correct":false,"proposition":"It can lead to a double effect","justification":""},{"idx":4,"correct":false,"proposition":"It is not scientifically proven","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-23","context":null,"enonce":"A 44-year-old man's bank check revealed hypokalemia at 3.2 mmol \/ L. What is the exact proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The patient must be hospitalized in an emergency","justification":""},{"idx":1,"correct":false,"proposition":"A urine ionogram on a sample should be requested","justification":""},{"idx":2,"correct":true,"proposition":"Hypokalaemia poses a risk of complete arrhythmia by atrial fibrillation","justification":""},{"idx":3,"correct":true,"proposition":"In case of associated high blood pressure, it is necessary to look for a chronic intake of licorice","justification":""},{"idx":4,"correct":true,"proposition":"In case of associated high blood pressure, it is necessary to seek a cocaine intake","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-24","context":null,"enonce":" What advice(s) can you give to a 78-year-old man with hypertension effectively treated with a low-salt diet and ACE inhibitor, and who is worried about the announcement in the media of an impending heat wave?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Drink enough","justification":""},{"idx":0,"correct":true,"proposition":"To suspend your salt-free diet during the heat wave","justification":""},{"idx":0,"correct":true,"proposition":"Watch your weight during the heat wave","justification":""},{"idx":0,"correct":true,"proposition":"Quantify your diuresis during the heat wave","justification":""},{"idx":0,"correct":false,"proposition":"Bring urine strips to measure daily urine density","justification":"Let's not go that far anyway 😂"}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-25","context":null,"enonce":" What is(are) the characteristic(s) of therapeutic part-time?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"It can be prescribed by the general practitioner","justification":""},{"idx":1,"correct":false,"proposition":"It may be prescribed by the occupational physician","justification":""},{"idx":2,"correct":true,"proposition":"It may be refused by the employer","justification":""},{"idx":3,"correct":false,"proposition":"It can last a maximum of 3 years","justification":""},{"idx":4,"correct":true,"proposition":"It can correspond to a recovery of 80 percent of a full-time equivalent.","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-26","context":null,"enonce":"A 38-year-old woman is hospitalized after an emergency caesarean section at 36 weeks of amenorrhea for severe pre-eclampsia with HELLP syndrome. She is anuric upon admission. Which additional examination is a priority?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Abdominopelvic CT angiography","justification":""},{"idx":1,"correct":false,"proposition":"Angio-lRM of the renal arteries","justification":""},{"idx":2,"correct":true,"proposition":"Renal and urinary tract ultrasound","justification":""},{"idx":3,"correct":false,"proposition":"Pelvic ultrasound","justification":""},{"idx":4,"correct":false,"proposition":"Renal perfusion scintigraphy","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-27","context":null,"enonce":"A 45-year-old woman has been consulting for persistent pelvic pain for a few weeks. She tells you that her last period was 3 weeks ago and she reports a few episodes of bleeding between periods, but very few. An endovaginal pelvic ultrasound was performed. This objective a moderate fluid effusion in the Douglas cul-de-sac and a heterogeneous right adnexal swelling measuring 3 cm of major axis, painful at the passage of the ultrasound probe. The objective clinical examination a flexible, slightly sensitive abdomen in the iliac fossa, defenseless. Blood pressure is 120\/60 mmHg. The temperature is 37.3°C.  The heart rate is 65 bpm. What plasma dosage(s) do you prescribe as a first-line treatment?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"CA 125","justification":""},{"idx":1,"correct":true,"proposition":"B-HCG","justification":"Any woman of childbearing age ..."},{"idx":2,"correct":false,"proposition":"HE4","justification":""},{"idx":3,"correct":false,"proposition":"Ca 19-9","justification":""},{"idx":4,"correct":false,"proposition":"CRP","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-28","context":null,"enonce":"You receive a patient suffering for 2 weeks from a depressive syndrome. He tells you that he has been working more than 50 hours a week for months, regularly bringing home work and feeling << drained >>. In addition, he tells you that his executive reproaches him daily and unjustified since he refused his advances. He wishes to apply for recognition as an occupational disease. Which element(s) do you indicate on the initial medical certificate?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Burnout in a context of work overload","justification":"Burnout is not, today, a recognized pathology"},{"idx":1,"correct":false,"proposition":"Sexual and psychological harassment"},{"idx":2,"correct":true,"proposition":"Depressive syndrome"},{"idx":3,"correct":false,"proposition":"Reactive anxio-depressive syndrome following sexual insistence","justification":""},{"idx":4,"correct":false,"proposition":"The precise date of the advances of its executive","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-29","context":null,"enonce":"At 25 years old, you have just passed your passage in the 38th cycle and you arrive in a new city as a first-semester intern, in the adult emergency room of the CHU. You had never been seen in school medicine or occupational medicine before, and you lost your health record a long time ago. You have no notable history, other than atopy in childhood, and two unreported blood-exposure accidents during your surgical rotations. You are summoned for an occupational medicine consultation. What should the occupational physician do (one or more exact proposals)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Look for latex irritation dermatitis due to a history of atopy","justification":""},{"idx":1,"correct":true,"proposition":"Performs an anti-Hbs antibody test to check for immunization against hepatitis B virus","justification":""},{"idx":2,"correct":true,"proposition":"Require you to be vaccinated with the dTP vaccine","justification":""},{"idx":3,"correct":false,"proposition":"Require you to get a flu shot","justification":"Flu vaccine is highly recommended but not mandatory"},{"idx":4,"correct":true,"proposition":"Perform an HIV serology"}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-30","context":null,"enonce":"You are seeing a 40-year-old patient with non-calcifying rotator cuff tendinopathy in the right shoulder. She is right-handed and works as an oyster worker. She explains that she has to handle bags of oysters weighing 20 kg to unload the barge, which leads her to have to abduct her shoulders. In her history, she is followed for well-balanced insulin-dependent diabetes. She quit smoking 3 months ago and started learning tennis. Which element(s) is (are) in favor of a potential occupational origin of his pathology?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Pathology is lateralized on the dominant limb","justification":""},{"idx":1,"correct":false,"proposition":"Diabetes is well balanced","justification":""},{"idx":2,"correct":false,"proposition":"You noticed the pathology while it was active","justification":""},{"idx":3,"correct":true,"proposition":"The patient is under 50 years of age","justification":""},{"idx":4,"correct":true,"proposition":"The gestures performed are at risk for the rotator cuff","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-31","context":null,"enonce":"A 75-year-old woman has been consulting for bleeding externalized through the vagina for two months. She weighs 89 kg for 1 m 50. In her history, there are two vaginal deliveries and high blood pressure. She does not smoke and has no allergy. What is the most likely diagnosis?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Malignant tumor of the ovary","justification":""},{"idx":1,"correct":false,"proposition":"Malignant tumor of the cervix","justification":""},{"idx":2,"correct":false,"proposition":"Malignant tumor of the fallopian tube","justification":""},{"idx":3,"correct":false,"proposition":"Malignant tumor of the vagina","justification":""},{"idx":4,"correct":true,"proposition":"Malignant endometrial tumour","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-32","context":null,"enonce":"A 27-year-old pregnant woman is seeking urination burns that have been ongoing for 24 hours. She is at 23 weeks of amenorrhea. This is her first pregnancy. She has no allergies and no history. The objective clinical examination a pain at the shaking of the right lumbar fossa. On vaginal touch, the cervix is long, posterior and closed. Blood pressure is 125\/65 mmHg. His heart rate is 78 bpm. Its temperature is 38.1 °C.  The urine strip objectifies the presence of proteins, leukocytes, blood and nitrites. A cytobacteriological examination of urine was prescribed. Direct examination shows 10,000\/mL leukocytes and gram-negative bacilli. Which antibiotic treatment is most relevant at this stage?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Ofloxacin","justification":""},{"idx":1,"correct":false,"proposition":"Amoxicillin-clavulanic acid","justification":""},{"idx":2,"correct":false,"proposition":"Fosfomycin","justification":""},{"idx":3,"correct":false,"proposition":"Amikacin","justification":""},{"idx":4,"correct":true,"proposition":"Cefotaxime","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-33","context":null,"enonce":"Which of the following pathologies can (may) promote the appearance of cataracts?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Hyperthyroidism","justification":""},{"idx":1,"correct":true,"proposition":"Diabetes","justification":""},{"idx":2,"correct":true,"proposition":"Down syndrome","justification":""},{"idx":3,"correct":true,"proposition":"Horton's disease","justification":""},{"idx":4,"correct":false,"proposition":"Steinert's myopathy","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-34","context":null,"enonce":"A 72-year-old patient has bilateral primary open-angle glaucoma treated with eye drops based on prostaglandin analogues and beta-blockers (fixed combination). Which of the following tests may have been used for the diagnosis of his glaucoma (one or more exact proposals)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Tonometry","justification":""},{"idx":1,"correct":true,"proposition":"Gonioscopy","justification":""},{"idx":2,"correct":false,"proposition":"Keratometry","justification":""},{"idx":3,"correct":true,"proposition":"Automated perimetry","justification":""},{"idx":4,"correct":true,"proposition":"Optical coherence tomography","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-35","context":null,"enonce":"You are following Mrs. F., aged 32, for chronic thrombocytopenic purpura progressing by flare-ups. Her platelet count remains around 20 G\/L. What advice(s) do you give to this patient?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Do not take acetylsalicylic acid","justification":""},{"idx":1,"correct":false,"proposition":"Do not take paracetamol","justification":""},{"idx":2,"correct":false,"proposition":"Do not take antibiotics","justification":""},{"idx":3,"correct":true,"proposition":"Avoid intramuscular injections","justification":""},{"idx":4,"correct":false,"proposition":"Prohibit subcutaneous injections","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-36","context":null,"enonce":"A 67-year-old patient arrives at the emergency department with fever at 39°C with chills of sudden onset. He is very asthenic. His wife who accompanied him found him pale and tired for several days. The first results on the hospital server show hemoglobin: 8.2 g \/ dL, leukocytes 2.8 G \/ L, polynuclear 0.41 G \/ L, platelets 36 G \/ L, reticulocytes 20 G \/ L. The automaton has not returned a formula and the smear has not yet been read. Which diagnosis(s) is compatible? (one or more exact propositions)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Bone marrow suppression","justification":""},{"idx":1,"correct":true,"proposition":"Acute leukemia","justification":""},{"idx":2,"correct":true,"proposition":"Myelodysplastic syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Chronic lymphocytic leukemia","justification":""},{"idx":4,"correct":true,"proposition":"Hodgkin's disease","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-37","context":null,"enonce":"A 19-year-old patient is referred to you for consultation because of repeated episodes of upper airway infection (ear infections, sinusitis) and bronchitis, with multiple antibiotic therapies (5 to 10 per year) in the last five years. A serum protein electrophoresis performed in the city shows the following results albumin 44 g \/ L - alpha1-globulins 2.61 g \/ L - alpha2-globulins 4.7 g \/ L - beta1-globulins 3.8 g \/ L - gamma globulins 3 g \/ L. blood lymphocyte immunophenotyping finds a decrease in switched memory B lymphocytes, without associated T-cell deficiency. To which of the following microorganism(s) does your patient have an increased susceptibility?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Streptococcus pneumoniae"},{"idx":1,"correct":false,"proposition":"Candida albicans","justification":""},{"idx":2,"correct":false,"proposition":"Mycobacterium tuberculosis"},{"idx":3,"correct":false,"proposition":"Pneumocystis jirovecii"},{"idx":4,"correct":false,"proposition":"Giardia lamblia"}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-38","context":null,"enonce":"A 62-year-old patient is referred by her general practitioner to the emergency department for pallor. The blood count is below. \n Reticulocytes are at 40 G\/L. You mention: (one or more expected answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Iron deficiency"},{"idx":1,"correct":false,"proposition":"Thrombotic microangiopathy","justification":""},{"idx":2,"correct":false,"proposition":"G6PD deficiency"},{"idx":3,"correct":false,"proposition":"Evans syndrome"},{"idx":4,"correct":true,"proposition":"Myelodysplasia"}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-39","context":null,"enonce":"A 37-year-old patient suffered a sprained right ankle 4 months ago. She complains of pain in the lower right limb when walking with allodynia of the upper surface of the right foot, equine varus of the right foot when walking, and edema of the foot. You mention a complex regional pain syndrome. What technique(s) can (s) be used by the physiotherapist?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Gain in range of motion","justification":""},{"idx":1,"correct":false,"proposition":"Work in charge","justification":""},{"idx":2,"correct":true,"proposition":"Skin desensitization","justification":""},{"idx":3,"correct":true,"proposition":"Triceps stretching","justification":""},{"idx":4,"correct":true,"proposition":"Balneotherapy","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-40","context":null,"enonce":"About the decision on medical termination of pregnancy (IMG), which is (are) the exact proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The couple can make the IMG decision on their own if the disease is particularly severe","justification":""},{"idx":1,"correct":false,"proposition":"Serious and incurable diseases are listed in a list giving entitlement to an IMG","justification":""},{"idx":2,"correct":false,"proposition":"IMG is only allowed if it is certain that the unborn child has the disease","justification":""},{"idx":3,"correct":true,"proposition":"The IMG is authorized by law with no term limit","justification":""},{"idx":4,"correct":true,"proposition":"The particular severity of a disease meets certain objective criteria such as the risk of premature death or cognitive impairment.","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-41","context":null,"enonce":"A young man of 25 years old consults you for acute low back pain occurred when getting up from his bed, radiating above 2 knees. He is addicted to the hard drugs he injects. All mobility of the spine is limited, pain in standing position is evaluated with an EN (numerical scale) of 7\/10. You find on the general examination a systolic heart murmur. He tells you that he has been coughing for several days. What do you suspect in this patient? (one or more possible answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Lumbago","justification":""},{"idx":1,"correct":true,"proposition":"Endocarditis","justification":""},{"idx":2,"correct":true,"proposition":"Cauda equina syndrome","justification":""},{"idx":3,"correct":true,"proposition":"Spondylodiscite","justification":""},{"idx":4,"correct":false,"proposition":"Ankylosing spondylitis","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-42","context":null,"enonce":"An 84-year-old man is referred to you after falling from bed. You have an x-ray of the pelvis. What is the real proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"There is a fracture of the right femoral neck","justification":""},{"idx":1,"correct":false,"proposition":"There is a fracture of the left trochanterian massif","justification":""},{"idx":2,"correct":false,"proposition":"There is a dislocation of the left coxofemoral joint","justification":""},{"idx":3,"correct":false,"proposition":"There is a fracture of the pubic symphysis","justification":""},{"idx":4,"correct":false,"proposition":"There is a fracture of the right shutter frame","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-43","context":null,"enonce":"The assessment of a bilateral form of breast cancer in a 42-year-old woman revealed a pathogenic BRCA1 mutation. What is the exact proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"High risk of ovarian cancer may warrant oophorectomy","justification":""},{"idx":1,"correct":false,"proposition":"Breast monitoring relies on simple breast ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"The risk of early breast cancer justifies genetic analysis in her underage daughters","justification":""},{"idx":3,"correct":true,"proposition":"The breast risk of recurrence may justify mastectomy","justification":""},{"idx":4,"correct":false,"proposition":"She is at high risk for colon cancer","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-44","context":null,"enonce":"It is necessary to offer an oncogenetic consultation in the following situation(s):","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"In a patient with a breast tumor at age 35","justification":""},{"idx":1,"correct":true,"proposition":"Faced with the existence of a bilateral breast tumor","justification":""},{"idx":2,"correct":true,"proposition":"In front of the existence of polyfocal colonic malignancies","justification":""},{"idx":3,"correct":false,"proposition":"Faced with the existence of an ovarian tumor in a 74-year-old woman","justification":""},{"idx":4,"correct":true,"proposition":"In a subject with a hundred polyps on the entire colonic frame","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-45","context":null,"enonce":"A general practitioner is required by a gendarme, a judicial police officer, to note the death of a 62-year-old man, who was not his patient, discovered in the barn of his house, with a ballistic trauma of the cephalic end, with an entrance hole visibly under the chin. A firearm is located along the body. The gendarme found a suicidal writing in the house. The constable informs the doctor that there will be no investigation. Which proposal(s) is the right proposal?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"In the absence of an investigation announced by the gendarme, the doctor does not have to check << medical-legal obstacle >> on the death certificate","justification":"Checking this box is a medical decision based on medical arguments"},{"idx":1,"correct":true,"proposition":"The doctor must examine the body for an exit hole for the projectile","justification":""},{"idx":2,"correct":true,"proposition":"The appearance of cadaveric lividities on the body will allow the doctor to support the hypothesis of a suicide","justification":"Cadaveric lividities not corresponding to pressure points may indicate secondary displacement of the body"},{"idx":3,"correct":true,"proposition":"The presence of recent bruises on the wrists and forearms goes against the hypothesis of suicide","justification":"We can think that these are traces of fights"},{"idx":4,"correct":false,"proposition":"An immediate putting in beer in a simple coffin must be requested in this context","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-46","context":null,"enonce":"The genital lesion that typically occurs at the time of a girl's first sexual intercourse is (only one response):","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A contuse laceration of the osterious fork","justification":""},{"idx":1,"correct":true,"proposition":"A complete tear of the posterior part of the hymen","justification":""},{"idx":2,"correct":false,"proposition":"A superficial cut from the vestibule","justification":""},{"idx":3,"correct":false,"proposition":"Diffuse erythema of the labia minora","justification":""},{"idx":4,"correct":false,"proposition":"A bilateral contagious wound of the vaginal walls behind the hymen","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-47","context":null,"enonce":"A judicial police officer takes a victim to a general medical office for the doctor to examine upon request. She says she has been subjected to domestic violence. Which proposal(s) is the right proposal?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The physician may refuse to respond to the requisition if he has no training in forensic medicine","justification":""},{"idx":1,"correct":false,"proposition":"Only a judicial police officer may request a doctor to examine a victim","justification":""},{"idx":2,"correct":false,"proposition":"The refusal to respond to the requisition is likely to engage the administrative liability of the doctor","justification":""},{"idx":3,"correct":true,"proposition":"The requested physician is released from the obligation of professional secrecy in the specific context of the mission entrusted to him","justification":""},{"idx":4,"correct":false,"proposition":"A copy of the report issued is given to the victim in person to assert what is right.","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-48","context":null,"enonce":"A patient with advanced left gonarthrosis for which a surgical indication has been decided in a CHU, understands upon waking that the knee prosthesis was placed by mistake on the right side. What are the right proposals? (One or more correct answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Side error is medical malpractice","justification":""},{"idx":1,"correct":true,"proposition":"The criminal liability of the surgeon may be engaged","justification":""},{"idx":2,"correct":false,"proposition":"It is not a medical fault because the prosthesis has been positioned according to the rules of the art","justification":""},{"idx":3,"correct":true,"proposition":"This situation may lead to an amicable settlement","justification":""},{"idx":4,"correct":false,"proposition":"The administrative responsibility of the establishment may be engaged for failure to organize the service","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-49","context":null,"enonce":"The shared medical record can be created by: (one or more exact answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The patient","justification":""},{"idx":1,"correct":false,"proposition":"The patient's designated support person","justification":""},{"idx":2,"correct":true,"proposition":"The holder of parental authority for a minor patient","justification":""},{"idx":3,"correct":true,"proposition":"The patient's attending physician","justification":""},{"idx":4,"correct":true,"proposition":"Social assistance for the patient","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-51","context":null,"enonce":"A 52-year-old patient is being treated with inhaled corticosteroids (fluticasone) for asthma. Her doctor prescribes antimycotic treatment (itraconazole) and a short course of oral corticosteroids for an asthma exacerbation triggered by an infection. What is(are) the iatrogenic risk(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Increased plasma concentrations of inhaled corticosteroid","justification":""},{"idx":1,"correct":false,"proposition":"Risk of developing a cushingoid syndrome","justification":""},{"idx":2,"correct":true,"proposition":"Increased plasma concentrations of oral corticosteroid","justification":""},{"idx":3,"correct":false,"proposition":"Risk of developing adrenal insufficiency","justification":""},{"idx":4,"correct":false,"proposition":"Low risk of drug interaction with itraconazole","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-52","context":null,"enonce":"A 75-year-old patient is treated with cholesterol-lowering (simvastatin) and vitamin K antagonist (warfarin). Her doctor prescribed macrolide antibiotics (clarithromycin) for acute bronchitis. What risk(s) can (s) be increased by a drug interaction?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Risk of tendinopathy","justification":""},{"idx":1,"correct":true,"proposition":"Risk of rhabdomyolysis","justification":""},{"idx":2,"correct":true,"proposition":"Increased risk of bleeding","justification":""},{"idx":3,"correct":true,"proposition":"Risk of potentially fatal arrhythmia","justification":""},{"idx":4,"correct":false,"proposition":"Decrease in lipid-lowering effect","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-53","context":null,"enonce":"About substances used for doping purposes in sport:","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Early baldness may be a sign of chronic anabolic androgenic steroid administration","justification":""},{"idx":1,"correct":true,"proposition":"Beta-2 agonists exert an anabolic effect in high doses resulting in an increase in muscle mass","justification":""},{"idx":2,"correct":true,"proposition":"Beta-blockers are prohibited in competition in some sports","justification":""},{"idx":3,"correct":true,"proposition":"The occurrence of a pulmonary embolism in a professional cyclist should be investigated for taking erythropoietin receptor agonist","justification":""},{"idx":4,"correct":false,"proposition":"Caffeine is prohibited","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-54","context":null,"enonce":"About the mechanisms of action of antibiotics:","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Penicillin inhibits penicillin-binding proteins (PLPs), enzymes of the peptidoglycan biosynthesis pathway","justification":""},{"idx":1,"correct":true,"proposition":"Macrolides inhibit bacterial protein synthesis by binding to the ribosome","justification":""},{"idx":2,"correct":true,"proposition":"Fluoroquinolones inhibit the replication, transcription, repair and recombination of bacterial DNA","justification":""},{"idx":3,"correct":true,"proposition":"Glycopeptides inhibit cell wall synthesis of bacteria","justification":""},{"idx":4,"correct":true,"proposition":"Trimetroprim-sulfamethoxazole is a folic acid inhibitor","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-55","context":null,"enonce":"An 80-year-old patient is brought by his daughter for consultation for signs of nocturnal agitation attributed to repeated nightmares. He had been treated with bromazepam for several years but he reports that he stopped this medicine two weeks ago. What clinical sign(s) associated with a withdrawal syndrome are you looking for?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Headache","justification":""},{"idx":1,"correct":true,"proposition":"Motor incoordination","justification":""},{"idx":2,"correct":false,"proposition":"Hypothermia","justification":""},{"idx":3,"correct":false,"proposition":"Bradycardia","justification":""},{"idx":4,"correct":false,"proposition":"Tremors","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-56","context":null,"enonce":"Regarding testicular germ cell tumors, it is true that: (one or more answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"They represent the first solid cancer in 20-year-old men","justification":""},{"idx":1,"correct":true,"proposition":"They may be associated with a serum increase in total HCG.","justification":""},{"idx":2,"correct":false,"proposition":"Biopsy is needed before orchiectomy","justification":""},{"idx":3,"correct":false,"proposition":"They are often associated with inguinal lymphadenopathy","justification":""},{"idx":4,"correct":true,"proposition":"They are often associated with lumbo-aortic lymphadenopathy.","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-57","context":null,"enonce":"You receive a 25-year-old woman for the implementation of estrogen-progestin contraception combining ethinyl estradiol and levonorgestrel. What contraindication(s) are you looking for in questioning and clinical examination?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Family history of deep vein thrombosis","justification":""},{"idx":1,"correct":true,"proposition":"Severe high blood pressure","justification":""},{"idx":2,"correct":false,"proposition":"History of ectopic pregnancy","justification":""},{"idx":3,"correct":true,"proposition":"Migraine with focal neurological signs","justification":""},{"idx":4,"correct":true,"proposition":"Familial hypercholesterolemia","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-58","context":null,"enonce":"Regarding the diagnosis of lymph node Hodgkin lymphoma, it is true that (one or more answers):","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" It usually requires a biopsy removed from a lymph node","justification":""},{"idx":1,"correct":false,"proposition":"The levy must be fixed in full immediately","justification":""},{"idx":2,"correct":true,"proposition":"It is based on the identification of Reed-Sternberg cells","justification":""},{"idx":3,"correct":true,"proposition":"A national pathological network for proofreading has been set up by INCa","justification":""},{"idx":4,"correct":true,"proposition":"it requires immunohistochemical labeling","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-59","context":null,"enonce":"Among the bone tumors for which a biopsy is necessary for diagnosis there are (one or more responses):","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Chondrosarcoma","justification":""},{"idx":1,"correct":false,"proposition":"Non-ossifying fibroid","justification":""},{"idx":2,"correct":false,"proposition":"Osteoid osteoma","justification":""},{"idx":3,"correct":true,"proposition":"Osteosarcoma","justification":""},{"idx":4,"correct":true,"proposition":"Giant bone cell tumour","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-60","context":null,"enonce":"Among the following, which criterion(s) is (are) part of the criteria of fragility of the elderly subject according to Fried?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Unintentional weight gain","justification":"Unintentional weight loss"},{"idx":1,"correct":true,"proposition":"Feeling tired","justification":""},{"idx":2,"correct":true,"proposition":"Decreased walking speed","justification":""},{"idx":3,"correct":false,"proposition":"Attentional disorders","justification":"The other 2 are: decreased muscle strength and decreased physical activity"},{"idx":4,"correct":false,"proposition":"Vesico-sphincter disorders","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-61","context":null,"enonce":"Regarding the first-line management of urinary incontinence in the elderly, which of the following proposal(s) is (are) correct?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Wearing protective gear","justification":""},{"idx":1,"correct":true,"proposition":"Implementation of scheduled urination","justification":""},{"idx":2,"correct":true,"proposition":"Bladder anticholinergics for emergency","justification":""},{"idx":3,"correct":false,"proposition":"Placement of an indwelling urinary catheter","justification":""},{"idx":4,"correct":false,"proposition":"Transcutaneous electrical stimulation of the pudendal nerve","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-62","context":null,"enonce":"Ms B., 57, is employed by a taps-making company. She has subscribed to a mutual health insurance. She lives in a rural area in metropolitan France, without the possibility of personal transport. As a general practitioner, you had already referred her to a cardiology consultation in the past. You now consider that a new cardiology consultation is necessary and you refer it to the cardiologist who follows Mrs. B. As the cardiologist's office is located 50 km from the patient's home, the cardiologist offers a teleconsultation. Ms. B. is not recognized as having a long-term illness. This cardiologist is conventionné, sector 1. Which of the following proposition(s) is the exact proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Ms. B. will receive an Internet link inviting her to connect at the scheduled time of the appointment to a secure site or application","justification":""},{"idx":1,"correct":true,"proposition":"The cardiologist must request and obtain Ms. B.'s consent before conducting the teleconsultation","justification":""},{"idx":2,"correct":false,"proposition":"As part of this teleconsultation, the cardiologist will not be able to write a prescription for treatment or additional examination","justification":""},{"idx":3,"correct":true,"proposition":"Mrs. B. will be reimbursed by the Health Insurance","justification":""},{"idx":4,"correct":false,"proposition":"The price of the teleconsultation is freely set by this cardiologist","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-63","context":null,"enonce":"You take care of a 52-year-old patient in the emergency room of the hospital for right calf pain. Your elements of interrogation and clinical examination lead you to hypothesize a deep vein thrombosis (DVT). As part of your diagnostic approach, you use a simplified clinical prediction model of DVT. The probability of DVT predicted by the model is high at 53 You decide to order an additional imaging test to confirm or refute your diagnostic hypothesis of DVT. Which of the following statements(are) the exact proposition(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The pre-test probability of DVT is implicitly estimated from your subjective impression.","justification":""},{"idx":1,"correct":true,"proposition":"The post-test probability of DVT depends on the pre-test probability and the informational characteristics intrinsic to the prescribed imaging test.","justification":""},{"idx":2,"correct":false,"proposition":"The pre-test probability of DVT is estimated from the positive and negative predictive values of the prescribed imaging examination.","justification":""},{"idx":3,"correct":true,"proposition":"The post-test probability of DVT depends on the likelihood ratios of the imaging test.","justification":""},{"idx":4,"correct":true,"proposition":"The more the plausibility ratio of the exam tends towards O, the more the post-test probability of DVT will tend towards 0","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-64","context":null,"enonce":"A 65-year-old man has nodular basal cell carcinoma (BCC) of the forehead 1 cm in diameter. What is the exact proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"CBC develops on pre-existing actinic keratosis","justification":""},{"idx":1,"correct":true,"proposition":"CBC occurs in photo-exposed areas","justification":""},{"idx":2,"correct":true,"proposition":"Surgery is the first-line treatment","justification":""},{"idx":3,"correct":false,"proposition":"The evolutionary risk is the appearance of visceral metastases","justification":""},{"idx":4,"correct":false,"proposition":"Debulking chemotherapy may be offered","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-65","context":null,"enonce":"What is your interpretation of this electrocardiogram recorded in a 50-year-old type II diabetic patient admitted to the emergency room for a sudden onset respiratory gene? (only one answer)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"CBC develops on pre-existing actinic keratosis","justification":""},{"idx":1,"correct":true,"proposition":"CBC occurs in photo-exposed areas","justification":""},{"idx":2,"correct":true,"proposition":"Surgery is the first-line treatment","justification":""},{"idx":3,"correct":false,"proposition":"The evolutionary risk is the appearance of visceral metastases","justification":""},{"idx":4,"correct":false,"proposition":"Debulking chemotherapy may be offered","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-66","context":null,"enonce":"A 75-year-old patient presents to the emergency room for difficulty breathing. Here is his chest x-ray from the front standing. What element(s) are you visualizing?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Cardiomegaly","justification":""},{"idx":1,"correct":true,"proposition":"A fracture of the left collarbone","justification":""},{"idx":2,"correct":false,"proposition":"Left pleural effusion","justification":""},{"idx":3,"correct":true,"proposition":"Perihilar alveolar opacities","justification":""},{"idx":4,"correct":false,"proposition":"A pneumothorax","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-68","context":null,"enonce":"A depressive episode characterized postpartum:","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Occurs mainly between 3 and 6 weeks after delivery","justification":""},{"idx":1,"correct":true,"proposition":"Affects nearly 25% of women who have given birth","justification":""},{"idx":2,"correct":true,"proposition":"Is unknown in 50% of cases"},{"idx":3,"correct":false,"proposition":"Is most often associated with psychotic features","justification":""},{"idx":4,"correct":true,"proposition":"Is at high risk of progression to bipolar disorder","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-69","context":null,"enonce":"Dyspnea with prolonged expiratory time can evoke","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Acute edema of the lung","justification":""},{"idx":1,"correct":false,"proposition":"A pneumothorax","justification":""},{"idx":2,"correct":true,"proposition":"An asthma exacerbation","justification":""},{"idx":3,"correct":true,"proposition":"An exacerbation of chronic obstructive pulmonary disease","justification":""},{"idx":4,"correct":false,"proposition":"Laryngeal tumour","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-70","context":null,"enonce":"Which clinical and paraclinical sign(s) suggestive of severity in a patient with pneumothorax?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Cyanosis","justification":""},{"idx":1,"correct":true,"proposition":"Polypnea > 30\/min","justification":""},{"idx":2,"correct":false,"proposition":"Reduction or abolition of vesicular murmur","justification":""},{"idx":3,"correct":false,"proposition":"Hypotension with systolic blood pressure less than or equal to 90 mmHg","justification":""},{"idx":4,"correct":false,"proposition":"Percussion tympanism","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-71","context":null,"enonce":"A 65-year-old woman consults for a dry cough evolving for 2 months; This cough wakes her up at night. She has been being treated for high blood pressure for a few months. She never smoked. She has no other history. To specifically explore this cough, which propositions are accurate (one or more exact answers)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Uncontrolled high blood pressure is a common cause of chronic cough","justification":""},{"idx":1,"correct":true,"proposition":"Looking for the prescription of an ACE inhibitor on its prescription","justification":""},{"idx":2,"correct":true,"proposition":"Looking for gastroesophageal reflux symptoms","justification":""},{"idx":3,"correct":true,"proposition":"Looking for sibilants pulmonary auscultation","justification":""},{"idx":4,"correct":false,"proposition":"Looking for a calcium channel blocker prescription on your prescription","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-72","context":null,"enonce":"A 16-year-old girl has these facial lesions that have been evolving for a few months (photo). Which of the following proposals, which diagnosis(s) do you retain?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Sarcoidosis","justification":""},{"idx":1,"correct":false,"proposition":"Papulopustular Rosacea","justification":""},{"idx":2,"correct":true,"proposition":"Polymorphic juvenile acne","justification":""},{"idx":3,"correct":false,"proposition":"Discoid lupus","justification":""},{"idx":4,"correct":false,"proposition":"Seborrheic dermatitis","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-73","context":null,"enonce":"Which of the following proposals regarding the complications of prolonged use of estrogen-progestin contraception is (are) accurate?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Subsequent decrease in fertility","justification":""},{"idx":1,"correct":false,"proposition":"Increased triglycerides","justification":""},{"idx":2,"correct":false,"proposition":"Increased risk of ovarian cancer","justification":""},{"idx":3,"correct":false,"proposition":"Increased risk of endometrial cancer","justification":""},{"idx":4,"correct":false,"proposition":"Increased risk of ectopic pregnancy","justification":""},{"idx":5,"correct":false,"proposition":"-miscarriage","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-74","context":null,"enonce":"Which of the following viruses is sexually transmittable?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Adenovirus","justification":""},{"idx":1,"correct":false,"proposition":"Influenza virus","justification":""},{"idx":2,"correct":true,"proposition":"Hepatitis A virus","justification":""},{"idx":3,"correct":true,"proposition":"Hepatitis B virus","justification":""},{"idx":4,"correct":true,"proposition":"Hepatitis C virus","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-75","context":null,"enonce":"A 26-year-old patient presents to the emergency department at 28 weeks of amenorrhea for headache and edema of the lower limbs. His blood pressure checked three times at rest is 160\/110 mmHg. You prescribe antihypertensive treatment. Which of the following medicinal products is authorised during pregnancy?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Urapidil","justification":""},{"idx":1,"correct":false,"proposition":"Enalapril","justification":""},{"idx":2,"correct":false,"proposition":"lndapamide","justification":""},{"idx":3,"correct":true,"proposition":"Nicardipine","justification":""},{"idx":4,"correct":true,"proposition":"Methyldopa","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-76","context":null,"enonce":"A 75-year-old patient has right papillary edema with a significant decrease in visual acuity. He complains of fatigue and weight loss for 3 months and headaches. Which of the following tests allows you to confirm your main diagnostic hypothesis?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Optical coherence tomography","justification":""},{"idx":1,"correct":false,"proposition":"Sedimentation rate","justification":""},{"idx":2,"correct":false,"proposition":"CRP","justification":""},{"idx":3,"correct":true,"proposition":"Temporal artery biopsy","justification":"This is the only test that can CONFIRM Horton's hypothesis"},{"idx":4,"correct":false,"proposition":"Retinal angiography","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-77","context":null,"enonce":"Three months after cataract surgery, a 72-year-old patient complains of myodesopsia. Which of the following signs could lead to fear of retinal detachment? (one or more answers are correct)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Dyschromatopsia","justification":""},{"idx":1,"correct":false,"proposition":"Phosphenes","justification":""},{"idx":2,"correct":false,"proposition":"Lagophthalmos","justification":""},{"idx":3,"correct":false,"proposition":"Visual field amputation","justification":""},{"idx":4,"correct":false,"proposition":"Ptosis","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-78","context":null,"enonce":"A young woman has reducible bilateral exophthalmos. In the following list, which examination(s) are necessary for the diagnosis of Graves' disease?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Thyroid scintigraphy","justification":""},{"idx":1,"correct":false,"proposition":"Kinetic perimetry","justification":""},{"idx":2,"correct":false,"proposition":"Orbital CT scan without injection of iodinated contrast medium","justification":""},{"idx":3,"correct":true,"proposition":"Anti-TSH receptor antibodies (TRAK)","justification":"Graves' disease = Hyperthyroidism by activation of TRAK receptors"},{"idx":4,"correct":false,"proposition":"Anti-thyroglobulin (TG) antibodies","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-79","context":null,"enonce":"What are the possible etiologies of decreased visual acuity associated with eye redness? (one or more correct answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Acute glaucoma crisis due to angle closure","justification":""},{"idx":1,"correct":true,"proposition":"Anterior uveitis","justification":""},{"idx":2,"correct":false,"proposition":"Central retinal artery occlusion (OACR)","justification":""},{"idx":3,"correct":false,"proposition":"Neovascular glaucoma","justification":""},{"idx":4,"correct":false,"proposition":"Retinal vasculitis","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-80","context":null,"enonce":"Which of the following clinical elements points to adhesive capsulitis of the shoulder?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"A lateral rotation at 0°","justification":""},{"idx":1,"correct":true,"proposition":"A traumatic trigger","justification":""},{"idx":2,"correct":false,"proposition":"Shoulder swelling","justification":""},{"idx":3,"correct":false,"proposition":"Redness of the shoulder","justification":""},{"idx":4,"correct":false,"proposition":"History of diabetes","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-81","context":null,"enonce":"You examine a 40-year-old patient after the harvest. He complains of a muscle control disorder to raise his right foot to walking. He has a sensory disorder of the first dorsal interosseous space. There is a step to walking, the Trendelenburg test is without abnormality, the fibular muscles are rated at 5\/5 in the motor test. What is your diagnosis(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Damage to the tibial nerve in the leg","justification":""},{"idx":1,"correct":false,"proposition":"Damage to the superficial fibular nerve","justification":""},{"idx":2,"correct":true,"proposition":"Deep fibular nerve damage","justification":""},{"idx":3,"correct":false,"proposition":"An attack of the root L4"},{"idx":4,"correct":false,"proposition":"Damage to the S1 root"}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-82","context":null,"enonce":"An 80-year-old patient comes to consult because she has left wrist pain for several years but is now very disabling. What is (are) the exact proposal(s) concerning the wrist X-ray that it brings you?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"There is rhizarthrosis","justification":""},{"idx":1,"correct":true,"proposition":"There is scaphotrapezian osteoarthritis","justification":""},{"idx":2,"correct":false,"proposition":"There is chondrocalcinosis","justification":""},{"idx":3,"correct":false,"proposition":"There is necrosis of lunatum","justification":""},{"idx":4,"correct":false,"proposition":"There is an old fracture of the scaphoid","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-83","context":null,"enonce":"A 20-year-old patient arrives at the emergency room because she had a ski fall the previous weekend and has persistent severe knee pain that prevents support. What is the exact proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"A knee effusion on a profile X-ray may suggest an acute rupture of the anterior cruciate ligament","justification":""},{"idx":1,"correct":true,"proposition":"X-rays of a spontaneously reduced patellofemoral dislocation may be normal","justification":""},{"idx":2,"correct":false,"proposition":"A fracture of the tibial plateau visible on the X-ray requires further exploration by an MRI","justification":""},{"idx":3,"correct":false,"proposition":"Arthroscan exploration of a chondral knee injury requires the injection of intra-articular gadolinium salt","justification":""},{"idx":4,"correct":false,"proposition":"Ultrasound is a good examination to study the knee extensor apparatus","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-85","context":null,"enonce":"During amyotrophic lateral sclerosis, you may observe the following clinical sign(s)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Hypoaesthesia of the lower limbs","justification":""},{"idx":1,"correct":true,"proposition":"Cognitive impairment","justification":""},{"idx":2,"correct":true,"proposition":"Slurred speech","justification":""},{"idx":3,"correct":false,"proposition":"Vesico-sphincter disorders","justification":""},{"idx":4,"correct":true,"proposition":"Scattered fasciculations","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-86","context":null,"enonce":"A 3-week-old newborn is brought by his parents to his pediatrician because his stool is discolored. The clinical examination finds jaundice. What is the exact proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"This clinical situation is an emergency","justification":""},{"idx":1,"correct":false,"proposition":"There is a risk of neurological complication by nuclear jaundice","justification":""},{"idx":2,"correct":false,"proposition":"Phototherapy should be done as soon as possible","justification":""},{"idx":3,"correct":false,"proposition":"Breastfeeding should be interrupted so as not to aggravate jaundice","justification":""},{"idx":4,"correct":false,"proposition":"Mother-child ABO compatibility must be checked","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-87","context":null,"enonce":"Which of the following applies(s) to NPH insulin?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Its duration of action is about 12 hours","justification":""},{"idx":1,"correct":true,"proposition":"It is an insulin suspension","justification":""},{"idx":2,"correct":false,"proposition":"It should not be injected into a venous","justification":""},{"idx":3,"correct":false,"proposition":"It should not be combined with rapid insulin","justification":""},{"idx":4,"correct":false,"proposition":"It should not be prescribed to pregnant women","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-89","context":null,"enonce":"You refer a 47-year-old patient to the surgeon because of an isolated thyroid nodule, without satellite lymphadenopathy, which measures 38 x 25 x 23 mm in diameter. It is rated TIRADS 3 on ultrasound but interferes with swallowing. A surgical indication is made (right thyroid lobo-isthmectomy). What is (are) the possible event(s) in the postoperative period?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Hypoparathyroidism","justification":""},{"idx":1,"correct":false,"proposition":"Hypothyroidism","justification":""},{"idx":2,"correct":false,"proposition":"Left recurrent paralysis","justification":""},{"idx":3,"correct":true,"proposition":"Dysphonia","justification":""},{"idx":4,"correct":true,"proposition":"Tabulation of thyroidectomy if the nodule is papillary cancer","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-91","context":null,"enonce":"A 42-year-old patient consults you for retrosternal chest pain and nocturnal regurgitation. The cardiovascular balance is negative. What is (are) the argument(s) in favor of a primitive achalasia?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Upper gastrointestinal endoscopy revealing stenosis of the lower esophagus","justification":""},{"idx":1,"correct":false,"proposition":"Presence of dysphagia only for solids","justification":""},{"idx":2,"correct":true,"proposition":"Regurgitation of food residues","justification":""},{"idx":3,"correct":false,"proposition":"Presence of iron deficiency anemia","justification":""},{"idx":4,"correct":false,"proposition":"Presence of propagated peristaltic waves with significant hyperpressure of the sphincter on an esophageal manometry","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-92","context":null,"enonce":"What diagnosis(s) is (are) to evoke in a 2-year-old child who has functional impotence of the lower limb of sudden onset without notion of trauma in a non-febrile context?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"A fracture on tumor","justification":""},{"idx":1,"correct":false,"proposition":"Juvenile osteoarthritis","justification":""},{"idx":2,"correct":false,"proposition":"Epiphysiolysis of the femoral head","justification":""},{"idx":3,"correct":true,"proposition":"A fracture by trauma inflicted","justification":""},{"idx":4,"correct":false,"proposition":"Higher femoral osteonecrosis","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-93","context":null,"enonce":"In front of a table of acute maxillary sinusitis, which is (are) the element (s) that orient (s) towards a bacterial origin?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Increased infraorbital sinus pain despite symptomatic treatment prescribed for at least 48 hours","justification":""},{"idx":1,"correct":true,"proposition":"One-sided and throbbing pain","justification":""},{"idx":2,"correct":true,"proposition":"Increased pain during trunk anteflexion","justification":""},{"idx":3,"correct":false,"proposition":"Pain increasing during the morning","justification":""},{"idx":4,"correct":false,"proposition":"Increase in rhinorrhea over time","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-94","context":null,"enonce":"A 76-year-old patient is referred for dysphagia. Which element(s) would orient (s) towards the diagnosis of Zenker's diverticulum?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Presence of regurgitation of undigested food","justification":""},{"idx":1,"correct":true,"proposition":"Fluctuating dysphagia","justification":""},{"idx":2,"correct":true,"proposition":"Sign of the << tide >> to nasofibroscopy","justification":""},{"idx":3,"correct":true,"proposition":"Presence of a nocturnal cough","justification":""},{"idx":4,"correct":false,"proposition":"Presence of dysphonia","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-96","context":null,"enonce":"A 45-year-old patient consults for persistent low back pain for 3 months with macroscopic hematuria. The following imaging is performed. What is the exact proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"This is an abdominal MRI","justification":""},{"idx":1,"correct":true,"proposition":"This is a coronal cup","justification":""},{"idx":2,"correct":true,"proposition":"This is imaging with contrast injection","justification":""},{"idx":3,"correct":true,"proposition":"There is a tumor of the right kidney","justification":""},{"idx":4,"correct":false,"proposition":"There is a left pyelocalicial dilation","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-97","context":null,"enonce":"On this CT scan of the abdomen: (one or more exact answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The structure designated by the number 1 is a hepatic vein","justification":""},{"idx":1,"correct":false,"proposition":"The structure designated by the number 2 is the portal vein","justification":""},{"idx":2,"correct":true,"proposition":"The structure designated by the number 3 is the aorta","justification":""},{"idx":3,"correct":true,"proposition":"The structure designated by the number 4 is the spleen","justification":""},{"idx":4,"correct":false,"proposition":"The structure designated by the number 5 is the stomach","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-98","context":null,"enonce":"In hepatic computed tomography, in typical forms, after intravenous injection of iodinated contrast medium, which proposal(s) is(are) exact?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"A hemangioma becomes opaque through the periphery","justification":""},{"idx":1,"correct":true,"proposition":"Hepatocellular carcinoma increases with arterial time","justification":""},{"idx":2,"correct":true,"proposition":"Hepatocellular carcinoma is the site of late-time wash-out","justification":""},{"idx":3,"correct":false,"proposition":"A biliary cyst rises at portal time","justification":""},{"idx":4,"correct":false,"proposition":"A metastasis rises intensely at the portal time","justification":"hypodense all the time"}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-99","context":null,"enonce":"Ms. C., with no particular background, is a senior executive, an employee in a company and benefits from a mutual insurance company. Mrs. C. made an appointment directly with a cardiologist in sector 1, outside the framework of the coordinated care pathway. Which of the following is correct?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The Health Insurance will only reimburse 30% of the basic fee of the consultation","justification":""},{"idx":1,"correct":true,"proposition":"Ms C. will have a flat-rate contribution of one euro for this consultation","justification":""},{"idx":2,"correct":false,"proposition":"The Health Insurance will refuse to reimburse the drugs prescribed by this cardiologist","justification":""},{"idx":3,"correct":true,"proposition":"The cardiologist is authorized to practice an excess fee of up to 60 euros","justification":""},{"idx":4,"correct":false,"proposition":"The amount reimbursed by Social Security will be 11.51 euros","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-100","context":null,"enonce":"What adjuvant therapeutic management(s) will you offer to a 53-year-old patient with invasive adenocarcinoma of non-specific type of right breast, triple negative, pT2N+MO after conservative surgery and right axillary dissection?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Radiotherapy"},{"idx":1,"correct":true,"proposition":"Chemotherapy"},{"idx":2,"correct":false,"proposition":"Hormone therapy"},{"idx":3,"correct":false,"proposition":"Trastuzumab"},{"idx":4,"correct":false,"proposition":"Complementary clavicular dissection","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-101","context":null,"enonce":"A patient is admitted to an identified palliative care bed for the management of amyotrophic lateral sclerosis. The patient is at a terminal stage of his disease. It benefits from nutrition, hydration by a gastrostomy device and non-invasive ventilation. After meeting the patient, the family asks to see you to discuss the principle of deep and continuous sedation until death as described in the law of February 2, 2022. What is the exact information(s) you can give the family about this sedation?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"It may accelerate the occurrence of death"},{"idx":1,"correct":false,"proposition":"Its objective is to accelerate the occurrence of death"},{"idx":2,"correct":false,"proposition":"It can be implemented at the request of the family under certain conditions"},{"idx":3,"correct":false,"proposition":"When a patient suffering from a serious and incurable condition decides to stop treatment and this cessation is life-threatening in the short term and is likely to cause unbearable suffering, he may request it."},{"idx":4,"correct":false,"proposition":"It is systematic as soon as a patient enters the agonic phase","justification":"Not at all systematic. It is the result of a multidisciplinary exchange between caregivers"}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-102","context":null,"enonce":" i You are caring for a 71-year-old patient in good general condition for Gleason 7 (3+4) prostate adenocarcinoma, initial PSA at 8 ng\/ml, clinical stage T2NOMO, recently discovered. Which therapeutic option(s) do you choose?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Cryotherapy","justification":""},{"idx":1,"correct":true,"proposition":"Radical prostatectomy","justification":""},{"idx":2,"correct":true,"proposition":"Long exclusive hormone therapy","justification":""},{"idx":3,"correct":true,"proposition":"Exclusive external beam radiation therapy","justification":""},{"idx":4,"correct":false,"proposition":"Transurethral prostate resection","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-103","context":null,"enonce":"A 60-year-old type 2 diabetic patient has mixed dyslipidemia. Its balance is as follows: LDL cholesterol 2.9 g\/L (7.54 mmol\/L); HDL cholesterol 0.32 g\/L (0.78 mmol\/L); apo B 1.8 g\/L (normal< 1.2 g\/L); triglycerides 2.5 g\/L (2.75 mmol\/L). This lesion located on the major must evoke: (one or more exact answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Combined hyperlipidemia entangled with type 2 diabetes","justification":""},{"idx":1,"correct":false,"proposition":"Dysbetalipoproteinemia entangled with type 2 diabetes","justification":""},{"idx":2,"correct":true,"proposition":"Nephrotic syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Lipoid necrobiosis","justification":""},{"idx":4,"correct":true,"proposition":"Heterozygous familial hypercholesterolemia + type 2 diabetes","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-104","context":null,"enonce":"A 27-year-old woman is hospitalized urgently for pain in the right flank and nausea progressing for 24 hours. She is at 25 weeks of amenorrhea (AS). When it arrives, you notice a temperature of 38.5 ° C.  The pain radiates into the right lumbar fossa. You must (one or more correct answers):","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Make a urine strip to look for an infection","justification":""},{"idx":1,"correct":true,"proposition":"evoke appendicitis because in the 2nd trimester of pregnancy the coecal bottom is repressed in the right flank","justification":""},{"idx":2,"correct":false,"proposition":"initiate non-steroidal anti-inflammatory therapy in principle","justification":""},{"idx":3,"correct":true,"proposition":"request an abdominal ultrasound","justification":""},{"idx":4,"correct":false,"proposition":"Start antibiotic therapy in emergency","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-106","context":null,"enonce":"Which of the following occupational exposures result in a proven excess risk of lung cancer (one or more possible responses)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Silica","justification":""},{"idx":1,"correct":true,"proposition":"Asbestos fibres","justification":""},{"idx":2,"correct":true,"proposition":"Polycyclic aromatic hydrocarbons","justification":""},{"idx":3,"correct":false,"proposition":"Aromatic amines","justification":""},{"idx":4,"correct":false,"proposition":"Formalin","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-107","context":null,"enonce":"A 41-year-old patient, with no medical or surgical history, has epigastralgia and must undergo a digestive endoscopy. The anaesthetist ordered a blood count and hemostasis tests. Haemoglobin is 12.1 g\/dL, platelets 151 G\/L. Leukocytes are at 7.5 G\/L. The TCA is 1.7 times the control, the TP is 97%. She never had a bleeding episode. These results are consistent with:","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Vitamin K deficiency","justification":""},{"idx":1,"correct":false,"proposition":"A circulating anticoagulant of the lip type","justification":""},{"idx":2,"correct":true,"proposition":"Hereditary factor XII deficiency","justification":""},{"idx":3,"correct":true,"proposition":"Hereditary factor XI deficiency","justification":""},{"idx":4,"correct":false,"proposition":"An anti-factor VII antibody","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-108","context":null,"enonce":"You are called to the neurovascular intensive care unit for a 37-year-old patient who has had a transient ischemic attack. By examining it, you notice lesions on the thighs. These are: (one exact answer)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Purpura","justification":""},{"idx":1,"correct":false,"proposition":"Confluent telangiectasias","justification":""},{"idx":2,"correct":false,"proposition":"Stretch marks","justification":""},{"idx":3,"correct":true,"proposition":"A livedo","justification":""},{"idx":4,"correct":false,"proposition":"Bruising","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-109","context":null,"enonce":"A 57-year-old man is hospitalized urgently for left iliac fossa pain and hyperthermia. You see it in the emergency room and suspect acute diverticulitis of the sigmoid. You ask: (one or more correct answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A picture of the abdomen without preparation standing from the front to visualize the colonic frame and possible liquid levels","justification":""},{"idx":1,"correct":false,"proposition":"An abdominal CT scan without injection because sepsis increases the risk of kidney failure","justification":""},{"idx":2,"correct":false,"proposition":"A water-soluble enema, to eliminate another pathology with similar symptomatology, and avoid a barium in case of diverticular perforation","justification":""},{"idx":3,"correct":true,"proposition":"An abdominal CT scan with contrast medium injection, after checking for severe renal impairment or a history of severe allergy to contrast medium","justification":""},{"idx":4,"correct":false,"proposition":"A rectosigmoidoscopy because the risk of perforation is less than with a long colonoscopy, and this examination makes it possible to formally eliminate the presence of colon cancer","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-110","context":null,"enonce":"Which of the following antimalarials for prophylaxis should only be continued one week after returning from an area at risk of malaria infection?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Chloroquine","justification":""},{"idx":1,"correct":false,"proposition":"Chloroquine-proguanil","justification":""},{"idx":2,"correct":true,"proposition":"Atovaquone-proguanil","justification":""},{"idx":3,"correct":false,"proposition":"Cyclines","justification":""},{"idx":4,"correct":false,"proposition":"Mefloquine","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-111","context":null,"enonce":"Which of the following bacteria has natural resistance to third-generation cephalosporins?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Golden staph","justification":""},{"idx":1,"correct":false,"proposition":"Klebsiella pneumoniae","justification":""},{"idx":2,"correct":false,"proposition":"Escerichia coli","justification":""},{"idx":3,"correct":false,"proposition":"Pneumococcus","justification":""},{"idx":4,"correct":true,"proposition":"Listeria monocytogenes","justification":"Mnemo: Princess LLEIA (Listeria, Legionella, Enterococcus, Intracellular, Anaerobic)"}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-112","context":null,"enonce":"You are reading an article reporting the results of a randomized, double-blind clinical trial, comparing two groups of patients, treated with either a new or a reference drug","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Beyond statistical significance, it is essential to assess the clinical relevance of the observed difference in effect","justification":""},{"idx":1,"correct":false,"proposition":"Randomization increases risk of bias when interpreting results","justification":""},{"idx":2,"correct":false,"proposition":"The double-blind technique is a method that aims to reduce bias in the realization and interpretation of the results of a clinical trial","justification":""},{"idx":3,"correct":false,"proposition":"The Transparency Commission of the HAS (Haute Autorité de Santé) can participate in the statistical analysis of this clinical trial on French territory","justification":""},{"idx":4,"correct":true,"proposition":"The statistical significance of the difference in effect of the two drugs is necessary to establish the superiority of therapeutic efficacy of the new drug","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-113","context":null,"enonce":"In this family, the diagnosis of cystic fibrosis (frequency 1\/3000 in the population) was confirmed and 2 composite heterozygous mutations in the CFTR gene were identified in the young woman 11-2. What is the exact proposal(s)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The risk of cystic fibrosis transmission for couples 11-1 and 11-2 is about 1\/60","justification":""},{"idx":1,"correct":true,"proposition":"The future risk for the II-3 free sister of having an affected child is about 1\/120","justification":""},{"idx":2,"correct":false,"proposition":"I-4's spouse is pregnant. The a priori risk that the unborn child is affected is about 1\/240","justification":""},{"idx":3,"correct":false,"proposition":"The woman II-3 can directly exercise a right of access to the medical file of her sister II-2","justification":""},{"idx":4,"correct":false,"proposition":"The I-1 woman refused the genetic test for heterozygosity for herself. The I-2 subject can directly transmit his own results to the children of I-1","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-114","context":null,"enonce":"Social phobias:","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Are specific forms of phobias","justification":""},{"idx":1,"correct":false,"proposition":"Mostly start from the age of 20","justification":""},{"idx":2,"correct":false,"proposition":"May manifest as delusions of persecution","justification":""},{"idx":3,"correct":true,"proposition":"Can manifest as fear of eating in public","justification":""},{"idx":4,"correct":true,"proposition":"Warrant treatment with antidepressants in severe forms","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-116","context":null,"enonce":"Regarding urothelial histological bladder carcinomas, which proposal(s) is(are) accurate?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"They are detected with good sensitivity by urinary cytology","justification":""},{"idx":1,"correct":false,"proposition":"They are low-grade when they are carcinomas in situ","justification":""},{"idx":2,"correct":false,"proposition":"They are associated with bladder schistosomiasis in Africa","justification":""},{"idx":3,"correct":true,"proposition":"Grade has little interest for tumors infiltrating the muscular.","justification":""},{"idx":4,"correct":false,"proposition":"They can be classified T2 on endoscopic resection chips","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-117","context":null,"enonce":"Regarding the diagnosis of cirrhosis on a liver biopsy: (one or more exact answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"This is a stage 4 of the METAVIR classification","justification":""},{"idx":1,"correct":true,"proposition":"There are almost no false positives","justification":""},{"idx":2,"correct":false,"proposition":"There are almost no false negatives","justification":"Yes, we can tap next to it"},{"idx":3,"correct":true,"proposition":"Diagnostic performance depends on the size of the sample","justification":""},{"idx":4,"correct":false,"proposition":"Diagnostic performance is better in micronodular cirrhosis","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-118","context":null,"enonce":"Which of the following treatments may be responsible for delirium by its anticholinergic property?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Antiparkinsonian tropatepine","justification":""},{"idx":1,"correct":true,"proposition":"Antiemetic metoclopramide","justification":""},{"idx":2,"correct":true,"proposition":"Antihistamine H1 hydroxyzine","justification":""},{"idx":3,"correct":false,"proposition":"Acetylcholine esterase inhibitor donepezil","justification":""},{"idx":4,"correct":true,"proposition":"Antispasmodic oxybutynin","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-119","context":null,"enonce":"For vesicular or follicular thyroid carcinomas: (one or more exact answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"They account for less than 5% of thyroid cancers","justification":""},{"idx":1,"correct":false,"proposition":"They are frequently associated with multiple endocrine neoplasia type 2 (MEN-2)","justification":""},{"idx":2,"correct":true,"proposition":"They usually diffuse through the blood","justification":""},{"idx":3,"correct":true,"proposition":"The sensitivity of the diagnosis of malignancy by cyto-puncture is good","justification":""},{"idx":4,"correct":true,"proposition":"It is more common in men over 70","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"annales-2019-qi-120","context":null,"enonce":"Regarding confusion, which proposal(s) is(are) right?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"It is a rapidly evolving dementia","justification":""},{"idx":1,"correct":true,"proposition":"It is most often linked to an organic cause","justification":""},{"idx":2,"correct":false,"proposition":"It can manifest itself only in the form of drowsiness","justification":""},{"idx":3,"correct":true,"proposition":"It corresponds to the acute decompensation of brain function","justification":""},{"idx":4,"correct":true,"proposition":"It is more common in the elderly","justification":""}],"ts":{"$numberLong":"1665246517956"},"type":"qi","difficulte":null}
-{"_id":"psygrossesse-psy-0","context":null,"enonce":"General:","item":"psygrossesse","matiere":"psy","propositions":[{"idx":0,"proposition":"Perinatal psychiatric disorders are mainly characterized depressive episodes","correct":true},{"idx":1,"proposition":"Seeking and preventing a risk of suicide and\/or infanticide is an imperative","correct":true},{"idx":2,"proposition":"In cases of severe postpartum depressive episode, the use of a joint mother-child hospitalization unit is currently recommended.","correct":true},{"idx":3,"proposition":"* In cases of depressive episodes with psychotic symptoms, management may be close outpatient","correct":false},{"idx":4,"proposition":"* In case of serious maternal failure or in case of immediate danger to the baby (risk of infanticide), hospitalization of both must be carried out urgently","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"psygrossesse-psy-1","context":null,"enonce":"Regarding mental disorders of pregnancy and postpartum:","item":"psygrossesse","matiere":"psy","propositions":[{"idx":0,"proposition":"Postpartum blues is a condition that we do not know how to treat at present","correct":false},{"idx":1,"proposition":"Psychotropic treatments should be prescribed with caution","correct":true},{"idx":2,"proposition":"Pregnancy and the arrival of a child are essential stages in a woman's life and involve profound physiological and psycho-social changes, which are to be considered as major stressors.","correct":true},{"idx":3,"proposition":"The perinatal period is a period of particular vulnerability for psychiatric disorders","correct":true},{"idx":4,"proposition":"There are no known risk factors","correct":false,"justification":"They exist and must be evaluated and detected as early as possible by the various partners in care in the perinatal period (attending physician, gynaecologist-obstetrician, midwife, maternal and child protection services, psychiatrist)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"psygrossesse-psy-2","context":null,"enonce":"Regarding the management of per-pregnancy disorders:","item":"psygrossesse","matiere":"psy","propositions":[{"idx":0,"proposition":"An \"early prenatal interview\" is systematically offered in the 4th month of pregnancy","correct":true},{"idx":1,"proposition":"Every pregnant woman should be informed about the risks of taking addictive substances during pregnancy","correct":true},{"idx":2,"proposition":"Blame for risky behaviour allows for more effective cessation and should be preferred in emergency cases such as pregnancy.","correct":false,"justification":"We must avoid any guilt and stigmatization that only have opposite effects to those sought"},{"idx":3,"proposition":"Treatment of a maternal addictive disorder involves evaluating the benefits of withdrawal versus psychotropic treatment","correct":true},{"idx":4,"proposition":"The evaluation of associated psychiatric comorbidities must lead to a proposal for specialized follow-up","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"psygrossesse-psy-3","context":null,"enonce":"Regarding the management of anxious trooubles:","item":"psygrossesse","matiere":"psy","propositions":[{"idx":0,"proposition":"Pregnancy anxiety disorders are often the expression of pre-existing anxiety disorders","correct":true},{"idx":1,"proposition":"The postpartum period is a period conducive to the physiological compensation of anxiety disorders thanks to the major release of endorphins","correct":false,"justification":"The postpartum period is a period conducive to their aggravation, especially regarding obsessive-compulsive disorder (OCD)"},{"idx":2,"proposition":"Consultation with the Reference Centre for Teratogens will allow a safer prescription in case of need for psychotropic treatment","correct":true},{"idx":3,"proposition":"Abrupt cessation of treatment upon discovery of pregnancy is not recommended","correct":true},{"idx":4,"proposition":"The possible occurrence of transient neonatal disorders will be systematically taken into account when examining the newborn of each patient who has received psychotropic treatment during pregnancy.","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"psygrossesse-psy-4","context":null,"enonce":"Regarding the treatment of psychiatric disorders in pregnant women:","item":"psygrossesse","matiere":"psy","propositions":[{"idx":0,"proposition":"The prescription of benzodiazepines is totally contraindicated in pregnant women","correct":false,"justification":"Anxiolytics The prescription of benzodiazepines is to be avoided if possible, but if the clinical situation requires it then benzodiazepines with short half-life are to be preferred in particular Oxazepam (Seresta®)"},{"idx":1,"proposition":"Benzodiazepines also contraindicate breastfeeding","correct":false,"justification":"Breastfeeding is possible with these molecules prescribed in low doses"},{"idx":2,"proposition":"Serotonin reuptake inhibitors (SRIs) in pregnant women should be preferred over other anti-depressants","correct":true},{"idx":3,"proposition":"Both first and second generation antipsychotics can be used","correct":true},{"idx":4,"proposition":"No thymoregulators can be prescribed in pregnant women","correct":false,"justification":"The most documented thymoregulators, recommended and can be prescribed in pregnant women are: olanzapine (Zyprexa®) and lamotrigine (Lamictal®)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"comportementadd-psy-0","context":null,"enonce":"Which of these proposals are behavioral addictions?","item":"comportementadd","matiere":"psy","propositions":[{"idx":0,"proposition":"Compulsive shopping","correct":true},{"idx":1,"proposition":"Sports addiction","correct":true},{"idx":2,"proposition":"Aversion to TV series","correct":false,"justification":"Behavioral addiction is not defined by a lack of behavior"},{"idx":3,"proposition":"Gambling while travelling","correct":false,"justification":"Simple gambling is not an addiction. It is the repetition of behavior despite negative consequences and the inability to control it that make it an addiction."},{"idx":4,"proposition":"Uncontrolled and negative sexual activities","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"comportementadd-psy-2","context":null,"enonce":"General information on behavioral addictions:","item":"comportementadd","matiere":"psy","propositions":[{"idx":0,"proposition":"The only behavioral addiction found in the DSM-5 is sex addiction.","correct":false,"justification":"Only one is officially defined in international classifications: gambling disorder also called \"pathological gambling\" (ICD-10, DSM-IV) or \"pathological gambling\" (DSM-5)"},{"idx":1,"proposition":"The mechanisms of behavioural addiction share the pathophysiological basis described in illicit substance use disorders","correct":true},{"idx":2,"proposition":"One of the main systems involved in these disorders is the serotonin reward system.","correct":false,"justification":"The dopaminergic reward system"},{"idx":3,"proposition":"In addictive disorders, the homeostasis of neurotransmission networks is disrupted","correct":true},{"idx":4,"proposition":"Behavioral addictions are of multifactorial origin","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"comportementadd-psy-3","context":null,"enonce":"Regarding risk factors and the impact of behavioral addictions:","item":"comportementadd","matiere":"psy","propositions":[{"idx":0,"proposition":"Behavioral addictions have a zero genetic component in view of the almost total impact of the environment","correct":false,"justification":"There are genetic predisposing factors (estimated heritability of 40-60% for addictive disorders), but also other individual risk factors (gender, age, sensation-seeking personality traits or impulsivity)"},{"idx":1,"proposition":"Psychiatric comorbidities are an important risk factor","correct":true},{"idx":2,"proposition":"Anxiety disorders are a risk factor for behavioral addictions","correct":true},{"idx":3,"proposition":"Attention deficit disorder predisposes to behavioral addictions only when there is hyperactivity","correct":false,"justification":"Even without hyperactivity"},{"idx":4,"proposition":"Definition Games of chance and gambling are games for which the subject irreversibly bets a good based on chance","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"comportementadd-psy-4","context":null,"enonce":"Regarding JHA:","item":"comportementadd","matiere":"psy","propositions":[{"idx":0,"proposition":"By definition, it is impossible to predict or control the outcome of a JHA.","correct":true},{"idx":1,"proposition":"There are phenomenological similarities, neurocognitive, neurobiological and therapeutic similarities between pathological gambling and other addictive behaviors","correct":true},{"idx":2,"proposition":"Gambling behavior is motivated solely by the hope of making money","correct":false,"justification":"Gambling behavior is motivated by different reasons: hope to earn money, search for thrills (especially feeling the \"thrill\", or thrill), desire to relieve negative emotions, search for social connections"},{"idx":3,"proposition":"A pathological gambler is invaded by urge to play, called \"craving\"","correct":true},{"idx":4,"proposition":"JHA is very unpopular and not very present in France because it is associated with alcoholism","correct":false,"justification":"In France, in 2014, three-quarters of French people between the ages of 15 and 75 said they had already played a JHA in their life, with just over half saying they had played it in the year."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"comportementadd-psy-5","context":null,"enonce":"Regarding JHA:","item":"comportementadd","matiere":"psy","propositions":[{"idx":0,"proposition":"Expenditures related to the practice of JHA represented 0.8% of annual household expenditures in 2012, in France","correct":true},{"idx":1,"proposition":"More than half of players spend less than 100 euros per year","correct":true},{"idx":2,"proposition":"The most represented games are blackjack and poker","correct":false,"justification":"Lottery games, \"hard\" (bars-tobacco)"},{"idx":3,"proposition":"Online games are mainly about horse betting","correct":false,"justification":"Online games (7.3% of players, a third of whom are mobile) are more concerned with poker and sports betting."},{"idx":4,"proposition":"The prevalence of pathological gambling in France is estimated to be 0.5% in the general population","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"anesth-anesth-0","context":null,"enonce":"Regarding generalities:","item":"anesth","matiere":"anesth","propositions":[{"idx":0,"proposition":"The practice of anesthesia is governed by the decree of 5 December 1335","correct":false,"justification":"December 5, 1994: it is a relatively recent specialty"},{"idx":1,"proposition":"Anesthesia consultation, pre-anesthetic visit and immediate post-operative monitoring are mandatory","correct":true},{"idx":2,"proposition":"General anesthesia is defined by irreversible loss of consciousness","correct":false,"justification":"The loss is reversible, otherwise it would be problematic x)"},{"idx":3,"proposition":"GA is broken down into 4 phases: falling asleep, unconscious, waking up, opening the eyes","correct":false,"justification":"3 phases: induction, maintenance and awakening"},{"idx":4,"proposition":"The purpose of locoregional anesthesia (ALR) is to transiently interrupt the transmission of nerve conduction while preserving the state of consciousness.","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"anesth-anesth-1","context":null,"enonce":"Which propositions are true?","item":"anesth","matiere":"anesth","propositions":[{"idx":0,"proposition":"ALRs are less regulated than MAs","correct":false,"justification":"They are subject to the same regulatory obligations"},{"idx":1,"proposition":"A distinction is made between perimedullary ALR (around the peripheral nerve) or peripheral ALR (around the spinal cord)","correct":false},{"idx":2,"proposition":"IN ALR, the local anesthetic is injected by MI, SC or IV","correct":false,"justification":"Local anesthesia is defined as the administration of a local anesthetic by infiltration or topically (by contact) in relation to the area to be operated or analgesive. IV injection is at risk of cardiology or neurological disorders."},{"idx":3,"proposition":"Transdural analgesia is the gold standard technique for ensuring quality analgesia during obstetric labour","correct":false,"justification":"Epidural analgesia"},{"idx":4,"proposition":"In 2010, more than 11 million procedures of anaesthesia were recorded in France","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"anesth-anesth-2","context":null,"enonce":"Regarding the consutlation:","item":"anesth","matiere":"anesth","propositions":[{"idx":0,"proposition":"About 2% of anhestesic procedures are treated on an outpatient basis","correct":false,"justification":"43%, almost half"},{"idx":1,"proposition":"In case of unscheduled intervention (emergency), the pre-anesthetic visit replaces the consultation","correct":true},{"idx":2,"proposition":"The purpose of the consultation is to carry out a medical evaluation of the patient","correct":true},{"idx":3,"proposition":"Anaesthetic risk is assessed according to the ASA (American Society of Anesthesiologists) classification","correct":true},{"idx":4,"proposition":"Patient information is an issue in consultation so that the patient can formulate informed consent","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"anesth-anesth-3","context":null,"enonce":"Regarding the GA and the ALR:","item":"anesth","matiere":"anesth","propositions":[{"idx":0,"proposition":"The pre-anesthetic visit takes place a few days (maximum 7) before the scheduled procedure under anesthesia","correct":false,"justification":"A few hours before. The objective is to confirm the information"},{"idx":1,"proposition":"General anesthesia (GA) is defined as a reversible loss of consciousness induced by the administration of a hypnotic often combined with an analgesic agent","correct":true},{"idx":2,"proposition":"A benzodiazepine is frequently used to cause muscle paralysis facilitating tracheal intubation and surgery.","correct":false,"justification":"This is the role of curare most often"},{"idx":3,"proposition":"ALR techniques are indicated in the surgical setting only","correct":false,"justification":"ALR techniques are indicated in the anesthetic context (allowing surgical intervention) but also for analgesic purposes (intraoperative, post-operative, obstetrical, etc.)"},{"idx":4,"proposition":"Local anesthesia is defined by the administration of a local anesthetic either by infiltration (intradermal, subcutaneous or diusion plane) or topically (by contact) in relation to the area to be operated or analgesia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"anesth-anesth-4","context":null,"enonce":"Regarding general anesthesia: ","item":"anesth","matiere":"anesth","propositions":[{"idx":0,"proposition":"A delay of a few hours is recommended between the anesthesia consultation and scheduled surgery","correct":false,"justification":"A few days before (< 48h if possible)"},{"idx":1,"proposition":"There are 3 phases in general anesthesia: Maintenance -> Induction -> Awakening","correct":false,"justification":"Well 3 phases, but the order is: Induction -> Maintenance -> Awakening"},{"idx":2,"proposition":"Curare allows relaxation of all the muscles of the human body.","correct":false,"justification":"Trap;) not of the heart (which is a skeletal muscle but not governed by the motor plate)"},{"idx":3,"proposition":"A passage to the SSPI is mandatory for any general anesthesia or regional loco, even if the patient was conscious","correct":true,"justification":"According to decree, any surgical procedure with the use of an anesthetic product requires postoperative monitoring (AG and ALR included)"},{"idx":4,"proposition":"In general, morphine is THE drug used to put the patient to sleep during general anesthesia.","correct":false,"justification":"It is the hypnotic that puts the patient to sleep in general (propofol IV \/ inhaled halogenated ...)"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"anesth-anesth-5","context":null,"enonce":"A patient must undergo a scheduled endoscopy in 48 hours, but he goes on a trip in 24 hours, what are the true answers.","item":"anesth","matiere":"anesth","propositions":[{"idx":0,"proposition":"It is necessary to postpone endoscopy.","correct":true,"justification":"Not within the deadline for the anesth consultation, postponement of the mandatory endoscopy"},{"idx":1,"proposition":"He can have his pre-anesthetic consultation now and have the endoscopy right after.","correct":false,"justification":"Scheduled surgery. It would have been true in a hurry."},{"idx":2,"proposition":"He may have a pre-anesthetic visit before having his endoscopy right after","correct":false},{"idx":3,"proposition":"If he had had his anesthesia consultation 24 hours ago, he can do the endoscopy in 24 hours (48 hours after consultation) and directly jump on his plane just after the endoscopy","correct":false,"justification":"Use of anesthetic products, so mandatory passage to SSPI"},{"idx":4,"proposition":"If he had been able to have his endoscopy, the patient would have had a pre-anesthetic visit a few hours before the endoscopy.","correct":true,"justification":"Visit pre anesth qq hours before the act, to check that there have been no new events."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"anesth-anesth-6","context":null,"enonce":"What is the minimum conditioning in a patient who will undergo general anesthesia?","item":"anesth","matiere":"anesth","propositions":[{"idx":0,"proposition":"A peripheral venous route","correct":true},{"idx":1,"proposition":"Venous saturation with O2","correct":false,"justification":"False. It is a pulsed oxygen saturation (SpO2)"},{"idx":2,"proposition":"A measurement of the concentration of O2, CO2, NO and anesthetic gas of the inhaled and exhaled gases","correct":false,"justification":"False. The fraction in NO is not measured"},{"idx":3,"proposition":"Scope","correct":true},{"idx":4,"proposition":"Conditioning in anesthesia is called multiparametric monitoring","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"voyagetrop-infectio-0","context":null,"enonce":"Which of these trips are considered to be very risky?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"proposition":"Young adults on an unorganized trip to India for 4 weeks","correct":true},{"idx":1,"proposition":"Hitchhiking travellers in Eastern Europe","correct":false,"justification":"3 types of travellers most at risk: young adults travelling unorganized to India or Sub-Saharan Africa for a stay of several weeks, immunocompromised people and people who have emigrated to France and stayed in their country of origin when it is a source of endemic"},{"idx":2,"proposition":"Patients with diabetes","correct":false},{"idx":3,"proposition":"People over 75 years of age","correct":false},{"idx":4,"proposition":"People infected with hepatitis B","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"voyagetrop-infectio-1","context":null,"enonce":"Among these proposals, which are the first and second causes of medical repatriation or death during a stay in a tropical zone?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"proposition":"HIV infection","correct":false},{"idx":1,"proposition":"Tuberculosis","correct":false},{"idx":2,"proposition":"Cardiovascular events","correct":true},{"idx":3,"proposition":"Traumatic events","correct":true},{"idx":4,"proposition":"Terrorist attacks","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"voyagetrop-infectio-2","context":null,"enonce":"What are the main preventive measures?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"proposition":"Updating the vaccination schedule","correct":true},{"idx":1,"proposition":"Travel to Australia requires yellow fever vaccine","correct":false,"justification":"The endemic areas of yellow fever are intertropical Africa, South America and the Amazon region. In this case, the vaccine is recommended"},{"idx":2,"proposition":"Vector protection measures are advised in malaria prevention","correct":true},{"idx":3,"proposition":"Food hygiene helps limit the risk of turista and faecal diseases","correct":true},{"idx":4,"proposition":"Traveller education during consultation is essential","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"HBP-uro-1","context":null,"enonce":"Abstention\/monitoring is indicated in case of:","item":"HBP","matiere":"uro","propositions":[{"idx":0,"proposition":"Uncomplicated BPH","correct":true},{"idx":1,"proposition":"Moderate SBAU with return on quality of life","correct":false,"justification":"Medical or surgical treatment"},{"idx":2,"proposition":"SBAU severe","correct":false,"justification":"Surgical treatment"},{"idx":3,"proposition":"Moderate SBAUs with no clear impact on quality of life","correct":true,"justification":"And patient preference"},{"idx":4,"proposition":"Minimal SBAUs without impaired quality of life","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"HBP-uro-2","context":null,"enonce":"Regarding BPH management:","item":"HBP","matiere":"uro","propositions":[{"idx":0,"proposition":"α-blockers are effective after 6 months of treatment","correct":false,"justification":"This is the case for 5-alpha reductase inhibitors. A-blockers are effective in 48 hours"},{"idx":1,"proposition":"After TURP or AVH, the prostate adenoma should be sent to anatomical pathology in search of prostate cancer","correct":true},{"idx":2,"proposition":"The main side effect of surgical management is the spread of cancer","correct":false,"justification":"The main side effect is retrograde ejaculation"},{"idx":3,"proposition":"Prostate cancer screening by TR and annual PSA is recommended in patients aged 30 to 50 years in the general population","correct":false,"justification":"Screening for prostate cancer by TR and an annual PSA is recommended in patients aged 50 to 75 years or from 45 years in case of risk factors (Afro-Caribbean origin, family history)"},{"idx":4,"proposition":"Benign prostatic hyperplasia (BPH) is a subvesical obstacle to urine flow","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"HBP-uro-3","context":null,"enonce":"Regarding BPH:","item":"HBP","matiere":"uro","propositions":[{"idx":0,"proposition":"BPH is a common benign condition","correct":true},{"idx":1,"proposition":"BPH is hyperplasia of the glands in the marginal zone of the prostate","correct":false,"justification":"It corresponds to hyperplasia of the glands of the periurethral prostate (transition zone of the prostate)"},{"idx":2,"proposition":"The symptomatology may be stable or worsen more or less rapidly","correct":true},{"idx":3,"proposition":"There is a clear parallelism between the volume of BPH and the severity of SBAUs","correct":false,"justification":"There is no parallelism between the volume of BPH and the severity of SBAUs"},{"idx":4,"proposition":"BPH is hyperplasia of the transition zone of the prostate surrounding the subbladder urethra","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"HBP-uro-4","context":null,"enonce":"Regarding BPH:","item":"HBP","matiere":"uro","propositions":[{"idx":0,"proposition":"The evolution of a prostate adenoma does not systematically lead to the appearance of complications","correct":true},{"idx":1,"proposition":"BPH cannot be latent, it is always symptomatic, especially from the age of 70","correct":false,"justification":"BPH may be latent and responsible only for functional discomfort"},{"idx":2,"proposition":"BPH never escalates into prostate cancer","correct":true},{"idx":3,"proposition":"Prostate cancer is developed from the transition zone of the prostate","correct":false,"justification":"Prostate cancer, developed from the peripheral area of the prostate, is therefore often sought when diagnosed with BPH."},{"idx":4,"proposition":"BPH is multifactorial","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"autonomiegeria-mpr-0","context":null,"enonce":"For the following definitions, check the correct answer(s):","item":"autonomiegeria","matiere":"mpr","propositions":[{"idx":0,"proposition":"Autonomy and dependence are two opposite terms","correct":false},{"idx":1,"proposition":"Autonomy is the person's ability to move","correct":false,"justification":"Autonomy refers to the person's ability to make a free choice."},{"idx":2,"proposition":"Addiction is defined by the need for human help","correct":true},{"idx":3,"proposition":"The assessment of dependence in the elderly must be systematic during its management","correct":true},{"idx":4,"proposition":"The assessment of dependence in the elderly is part of the personalized health project","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbnutrigeria-nutri-0","context":null,"enonce":"Which propositions are true?","item":"tbnutrigeria","matiere":"nutri","propositions":[{"idx":0,"proposition":"A person is said to be \"old\" after the age of 50 or 55","correct":false,"justification":"A person is said to be \"old\" after the age of 70 or 75"},{"idx":1,"proposition":"Sarcopenic obesity is defined by BMI ≥ 30 and sarcopenia\n","correct":true},{"idx":2,"proposition":"An undernourished obese is defined by a BMI ≥ 30 and a criterion of undernutrition","correct":false,"justification":"Obese undernourished BMI ≥ 30 and a criterion of undernutrition"},{"idx":3,"proposition":"Decreased muscle performance signs probable sarcopenia","correct":false,"justification":"Severe sarcopenia (see Table 11.1, page 155, College of Nutrition, 3rd edition)"},{"idx":4,"proposition":"Entry into an institution is one of the criteria of fragility","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbnutrigeria-nutri-1","context":null,"enonce":"Which of these proposals make it possible to define undernutrition?","item":"tbnutrigeria","matiere":"nutri","propositions":[{"idx":0,"proposition":"Weight loss greater than or equal to 15% in 3 months","correct":false,"justification":"Weight loss greater than or equal to 5% in 1 month or 10% in 6 months"},{"idx":1,"proposition":"Weight loss greater than or equal to 15% in 6 months","correct":false},{"idx":2,"proposition":"Weight loss greater than or equal to 5% in 1 month","correct":true},{"idx":3,"proposition":"A BMI < 21 kg\/m2","correct":true},{"idx":4,"proposition":"An albuminemia < 35 g\/L","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbnutrigeria-nutri-2","context":null,"enonce":"Which of these proposals make it possible to define severe undernutrition?","item":"tbnutrigeria","matiere":"nutri","propositions":[{"idx":0,"proposition":"Weight loss greater than or equal to 15% in 3 months","correct":false,"justification":"Weight loss greater than or equal to 10% in 1 month or 15% in 6 months"},{"idx":1,"proposition":"A BMI < 19 kg\/m2","correct":false,"justification":"BMI< 17kg\/m2"},{"idx":2,"proposition":"A global NAM < 17","correct":false,"justification":"Undernutrition criterion"},{"idx":3,"proposition":"Weight loss greater than or equal to 15% in 6 months","correct":true},{"idx":4,"proposition":"Weight loss greater than or equal to 5% in 1 month","correct":false,"justification":"Undernutrition criterion"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbnutrigeria-nutri-3","context":null,"enonce":"Which propositions are true?","item":"tbnutrigeria","matiere":"nutri","propositions":[{"idx":0,"proposition":"BMI increases with age, reaching about 26–27 on average between the ages of 70 and 80","correct":true},{"idx":1,"proposition":"There are changes in body composition during aging: fat mass increases, muscle mass decreases.","correct":true},{"idx":2,"proposition":"Muscle mass decreases by about 40% between the ages of 20 and 80","correct":true},{"idx":3,"proposition":"Energy consumption increases as we age","correct":false,"justification":"It decreases"},{"idx":4,"proposition":"The prevalence of obesity increases with age with a peak of 20–23% at age 55–65 years, then gradually decreases.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbnutrigeria-nutri-4","context":null,"enonce":"Among these proposals, which are pathologies of which obesity could be a protective factor?","item":"tbnutrigeria","matiere":"nutri","propositions":[{"idx":0,"proposition":"Osteroporosis","correct":true,"justification":"Decreased risk of fracture (mechanical protective role of adipose tissue in case of trauma, stimulating pressure of weight on bone structure and hormonal effect related to the transformation of adrenal androgens into estrogens by adipose tissue)"},{"idx":1,"proposition":"Adrenal insufficiency","correct":false},{"idx":2,"proposition":"Type 2 diabetes","correct":false,"justification":"Risk factor"},{"idx":3,"proposition":"Respiratory failure","correct":false,"justification":"Risk factor"},{"idx":4,"proposition":"Arthrosis","correct":false,"justification":"Risk factor"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemangiome-dermato-0","context":null,"enonce":"Regarding angiomas:","item":"hemangiome","matiere":"dermato","propositions":[{"idx":0,"proposition":"vascular tumors are most often capillary","correct":true},{"idx":1,"proposition":"The term 'angioma' is a generic term for vascular tumours such as hemangiomas and vascular malformations such as CAVs.","correct":true},{"idx":2,"proposition":"The main vascular tumor is angiocarcinoma of the elderly","correct":false,"justification":"Hemangiomas in infants"},{"idx":3,"proposition":"The prevalence of infant hemangiomas is 0.01%","correct":false,"justification":"Most common childhood tumours, with a prevalence of 10%"},{"idx":4,"proposition":"Hemangioma is a malignant tumor and a diagnostic emergency","correct":false,"justification":"Benign skin proliferations of vascular endothelial cells, non-congenital, more common in girls, premature infants and low birth weight infants"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"hemangiome-dermato-1","context":null,"enonce":"Which propositions are true?","item":"hemangiome","matiere":"dermato","propositions":[{"idx":0,"proposition":"The origin of infant hemangiomas is unknown","correct":true},{"idx":1,"proposition":"The endothelium is proliferating in malformations","correct":false,"justification":"Quiescant"},{"idx":2,"proposition":"Biopsy is usually unnecessary in typical uncomplicated hemangioma","correct":true},{"idx":3,"proposition":"Hemangioma is often present at birth","correct":false,"justification":"Often absent"},{"idx":4,"proposition":"The hemangioma is non-blowing on auscultation","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemangiome-dermato-2","context":null,"enonce":"Regarding hemangiomas:","item":"hemangiome","matiere":"dermato","propositions":[{"idx":0,"proposition":"Hemangiomas are the most common tumours in children, with a prevalence of 10%","correct":true},{"idx":1,"proposition":"Deep hemangiomas are arterial and present with bright red swelling","correct":false,"justification":"bluish swelling or normal skin colour"},{"idx":2,"proposition":"Deep hemangiomas are more elastic in consistency than superficial forms","correct":true},{"idx":3,"proposition":"Subcutaneous hemangiomas are always clinically diagnosed only","correct":false,"justification":"The clinic is sometimes non-specific: imaging may be necessary"},{"idx":4,"proposition":"Doppler ultrasound shows a richly vascularized tumor","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemangiome-dermato-3","context":null,"enonce":"Regarding the evolution of hemangiomas:","item":"hemangiome","matiere":"dermato","propositions":[{"idx":0,"proposition":"Management of hemangiomas is surgical","correct":false,"justification":"Hemangiomas regress completely and the majority require no treatment"},{"idx":1,"proposition":"The variation in the evolution of hemangiomas is important depending on the individual","correct":false,"justification":"Their natural history is stereotyped and is an important part of the diagnosis"},{"idx":2,"proposition":"Hemangiomas are absent at birth","correct":true},{"idx":3,"proposition":"The growth phase begins between the 3rd and 6th month of life","correct":false,"justification":"A beginning in the first days\/weeks of life"},{"idx":4,"proposition":"The increase in size is quite rapid during the first 5 to 6 months","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"polytrauma-urg-0","context":null,"enonce":"Regarding the key points:","item":"polytrauma","matiere":"urg","propositions":[{"idx":0,"proposition":"The life-threatening prognosis of severe trauma is still at stake","correct":true,"justification":"By definition, a severely traumatized person is a trauma patient whose violence or mechanism of trauma may result in life-threatening injuries."},{"idx":1,"proposition":"The first 15 minutes in the hospital are spent performing standard X-rays and a biological work-up","correct":false,"justification":"The first fifteen minutes of hospital care are devoted to clinical assessment and conditioning"},{"idx":2,"proposition":"The first 30 minutes in the hospital are devoted to the radiographic assessment including the CT scan","correct":false,"justification":"TDM does not enter the process of the first 30 minutes"},{"idx":3,"proposition":"Whole body computed tomography with contrast injection should be performed in all severe trauma patients whose haemodynamic status has been stabilized","correct":true},{"idx":4,"proposition":"Pre-hospital management includes an assessment of the haemodynamic, infectious, urinary and orthopaedic impact of lesions","correct":false,"justification":"What interests us urgently is the hemodynamic, ventilatory and neurological repercussions"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"polytrauma-urg-1","context":null,"enonce":"Regarding the management of polytrauma patients:","item":"polytrauma","matiere":"urg","propositions":[{"idx":0,"proposition":"Coagulopathy must be managed early","correct":true},{"idx":1,"proposition":"Hemodynamic failure is managed by the treatment of hemorrhagic shock","correct":true,"justification":"Mostly"},{"idx":2,"proposition":"Surgical management prioritizes bleeding lesions","correct":true},{"idx":3,"proposition":"Treatment of ventilatory failure involves orotracheal intubation","correct":true},{"idx":4,"proposition":"Treatment of neurological failure involves orotracheal intubation","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"polytrauma-urg-2","context":null,"enonce":"What are the roles of the witness of an accident?","item":"polytrauma","matiere":"urg","propositions":[{"idx":0,"proposition":"Protect","correct":true,"justification":"avoid the \"super-accident\", protect yourself, remove the injured person(s) from the traumatic agent"},{"idx":1,"proposition":"Treat","correct":false},{"idx":2,"proposition":"Alert","correct":true,"justification":"call 15 (Samu-SMUR), 18 (Firefighters), look for help around you."},{"idx":3,"proposition":"Rescue","correct":true,"justification":"compression of active bleeding, lateral safety position (PLS), basic cardiopulmonary resuscitation (CPR)"},{"idx":4,"proposition":"Accompany","correct":false,"justification":"The 3 essential roles of the first link in the chain of survival are: Protect, Alert, Rescue"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"PECKc-urg-0","context":null,"enonce":"Which of the following propositions concerning pre-eclampsia are true?","item":"PECKc","matiere":"urg","propositions":[{"idx":0,"proposition":"Pre-eclampsia is defined by the combination of blood pressure ≥140\/90 mmHg and proteinuria ≥ 300 mg\/24h occurring at any time during pregnancy","correct":false,"justification":"False, occurring from 20SA"},{"idx":1,"proposition":"Pre-eclampsia is said to be early when it occurs before 34 SA","correct":true},{"idx":2,"proposition":"In the majority of cases, pre-eclampsia disappears before the end of the 6th postpartum week","correct":true},{"idx":3,"proposition":"Pre-eclampsia affects less than 1% of pregnancies","correct":false,"justification":"False, 3 to 10% of pregnancies"},{"idx":4,"proposition":"A woman who has already had pre-eclampsia will have a decreased risk of pre-eclampsia for a later pregnancy.","correct":false,"justification":"False, increased risk"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"PECKc-urg-1","context":null,"enonce":"Which of the following proposals for the treatment of pre-eclampsia are true?","item":"PECKc","matiere":"urg","propositions":[{"idx":0,"proposition":"The only effective treatment is delivery of the placenta.","correct":true},{"idx":1,"proposition":"It is recommended to use calcium sulfate during the appearance of severe neurosensory signs and during eclampsia.","correct":false,"justification":"False, magnesium sulfate"},{"idx":2,"proposition":"IV nicardipine is the attack treatment for pre-eclampsia with a SBP of 190 mmHg.","correct":true,"justification":"True, for a SBP > 180 mmHg or a > 140mmHg MPA, the attack treatment is Nicardipine IV bolus of 0.5 to 1 mg, then infusion of 4-7 mg over 30 min. Evaluation of the efficacy and safety of the treatment after 30 min."},{"idx":3,"proposition":"Blood pressure objectives are a PAD between 80 and 105 mmHg.","correct":true},{"idx":4,"proposition":"Perindopril is part of the antihypertensive therapeutic arsenal in pre-eclampsia","correct":false,"justification":"False. All ACE inhibitors and angiotensin II receptor antagonists (sartans or ARA II) are contraindicated in the 2nd and 3rd trimesters of pregnancy!! Perindopril is an ACE inhibitor, and therefore contraindicated! They are contraindicated because they can induce acute renal failure in the fetus, resulting in oligo-amnios."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"APMP-mdt-0","context":null,"enonce":"Concerning accidents at work:","item":"APMP","matiere":"mdt","propositions":[{"idx":0,"proposition":"It is an accident caused by work","correct":true,"justification":"Any accident at the workplace is considered a TA, it also concerns the home-to-work journey or accidents in common areas (toilets, cafeteria)"},{"idx":1,"proposition":"The TA only concerns the company's employees","correct":false,"justification":"It also concerns stagaire pupils, people under contract, temporary workers, etc."},{"idx":2,"proposition":"TA is defined by its suddenness","correct":true,"justification":"This is particularly relevant for differentiation with PD"},{"idx":3,"proposition":"The maternality of the accidental event refers to the material that caused the accident","correct":false,"justification":"These are the precise conditions, localizable in time and space, in which TA occurs."},{"idx":4,"proposition":"Accidents occurring during strikes are TAs","correct":false,"justification":"There is suspension of the employment contract, so it is not a TA"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"APMP-mdt-1","context":null,"enonce":"Regarding accountability:","item":"APMP","matiere":"mdt","propositions":[{"idx":0,"proposition":"The insured must provide proof of this in the TAs","correct":false,"justification":"There is a presumption of accountability"},{"idx":1,"proposition":"The insured must provide proof in the PM","correct":true,"justification":"Via the classification tables for example which will determine the minimum exposure times"},{"idx":2,"proposition":"In the TA, imputability is established by the occupational physician","correct":false,"justification":"The CPAM medical officer is responsible for determining accountability"},{"idx":3,"proposition":"Relapses and late complications of TAs are covered by the presumption of initial imputability","correct":false,"justification":"The presumption of imputability applies only to initial injuries and direct complications"},{"idx":4,"proposition":"No one can dispute a TA and its accountability","correct":false,"justification":"Within the time limits, the employer and the CPAM may contest the imputability of a TA"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"APMP-mdt-2","context":null,"enonce":"Concerning occupational diseases: ","item":"APMP","matiere":"mdt","propositions":[{"idx":0,"proposition":"The installation of PM is often brutal","correct":false,"justification":"Progressive and insidious unlike TAs which are sudden"},{"idx":1,"proposition":"The only way to recognize PM is the array system","correct":false,"justification":"There is an ancillary system with the Regional Committee for the Recognition of Occupational Diseases which will in particular recognize as PM pathologies in workers who do not meet the criteria set out in the tables"},{"idx":2,"proposition":"There are 362 PM tables","correct":false,"justification":"114"},{"idx":3,"proposition":"The CMI has 5 components","correct":false,"justification":"3 components"},{"idx":4,"proposition":"It is the victim who must notify the employer","correct":true,"justification":"Unlike the AT, it is not the employer but the employee who must send the declaration of PM to the CPAM within 15 days of the finding of the disease."}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Kcoeso-onco-0","context":null,"enonce":"Which of the following are true?","item":"Kcoeso","matiere":"onco","propositions":[{"idx":0,"proposition":"Esophageal cancers are the most common digestive cancers","correct":false,"justification":"This is the 4th digestive cancer after colorectal, pancreatic and stomach cancer"},{"idx":1,"proposition":"Esophageal cancers are most often excellent prognosis","correct":false,"justification":"The prognosis is often poor"},{"idx":2,"proposition":"Esophageal cancers affect 75% of men","correct":true},{"idx":3,"proposition":"Esophageal cancers more common in the northwest","correct":true},{"idx":4,"proposition":"None of the propositions are true","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcoeso-onco-1","context":null,"enonce":"What is the risk of malignant transformation of an endobrachyoesophagus (EBO) during life?","item":"Kcoeso","matiere":"onco","propositions":[{"idx":0,"proposition":"0%","correct":false,"justification":"False"},{"idx":1,"proposition":"10%","correct":true,"justification":"True. College of HGE (4th edition)"},{"idx":2,"proposition":"50%","correct":false,"justification":"False"},{"idx":3,"proposition":"80%","correct":false,"justification":"False"},{"idx":4,"proposition":"100%","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcoeso-onco-2","context":null,"enonce":"Which of the following are true about Plummer-Vinson syndrome?","item":"Kcoeso","matiere":"onco","propositions":[{"idx":0,"proposition":"It has hypochromic microcytic anemia","correct":true,"justification":"True, ferriprive"},{"idx":1,"proposition":"It has koilonychia","correct":true},{"idx":2,"proposition":"It affects humans 🕺 more often","correct":false,"justification":"It affects women 💃 more often"},{"idx":3,"proposition":"It has glossitis","correct":true},{"idx":4,"proposition":"It is also called \"Kelly-Paterson syndrome\"","correct":true,"justification":"True. It is a risk factor for squamous cell cancer of the esophagus"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"Kcoeso-onco-3","context":null,"enonce":"Which of the following are true about endobrachyoesophagus?","item":"Kcoeso","matiere":"onco","propositions":[{"idx":0,"proposition":"Its other name is Barrett's esophagus","correct":true},{"idx":1,"proposition":"Monitoring is done, in the absence of dysplasia, every year","correct":false,"justification":"Every 2, 3 or 5 years depending on the length of metaplasia"},{"idx":2,"proposition":"Monitoring involves only a clinical examination","correct":false,"justification":"Fibroscopy with biopsies"},{"idx":3,"proposition":"Suspected low-grade dysplasia involves fibroscopic control after 6 months of PPI","correct":false,"justification":"Low-grade dysplasia involves fibroscopic control after 2-3 months of double-dose PPI"},{"idx":4,"proposition":"It is an important risk factor for adenocarcinoma of the esophagus","correct":true,"justification":"True. And no squamous cell carcinoma"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"Kcoeso-onco-4","context":null,"enonce":"Which of the following are risk factors for squamous cell cancer of the esophagus?","item":"Kcoeso","matiere":"onco","propositions":[{"idx":0,"proposition":"Tobacco 🚬","correct":true},{"idx":1,"proposition":"Alcohol 🥃","correct":true},{"idx":2,"proposition":"Cold 🧊 drinks ","correct":false,"justification":"Hot 🥵 drinks"},{"idx":3,"proposition":"Infection par HPV","correct":true},{"idx":4,"proposition":"Caustic esophagitis after several decades of evolution","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcoeso-onco-5","context":null,"enonce":"What is the 5-year survival of esophageal tumors?","item":"Kcoeso","matiere":"onco","propositions":[{"idx":0,"proposition":"15%","correct":true,"justification":"True, it is a tumor of poor prognosis 😕"},{"idx":1,"proposition":"50%","correct":false,"justification":"False"},{"idx":2,"proposition":"80%","correct":false,"justification":"False"},{"idx":3,"proposition":"90%","correct":false,"justification":"False"},{"idx":4,"proposition":"95%","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcovaire-onco-0","context":null,"enonce":"Which of the following are true?","item":"Kcovaire","matiere":"onco","propositions":[{"idx":0,"proposition":"About 10% of ovarian cancers occur in a context of genetic predisposition","correct":true},{"idx":1,"proposition":"It ranks 5th in cancer deaths in women","correct":true},{"idx":2,"proposition":" About 5-10% of women will have an ovarian tumor in their lifetime, and it is most often a benign ovarian cyst.","correct":true},{"idx":3,"proposition":"The ovary is a complex organ that is home to many different cell types ","correct":true},{"idx":4,"proposition":"Mature dermoid cysts or teratomas derive from a highly differentiated cell","correct":false,"justification":"Mature dermoid or teratoma cysts derive from a multipotent cell that can be the source of different tissues present within the cyst"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Kcovaire-onco-1","context":null,"enonce":"Which of the following are formal contraindications in case of suspicion of ovarian cancer?","item":"Kcovaire","matiere":"onco","propositions":[{"idx":0,"proposition":"Transparietal biopsy of the ovary","correct":true,"justification":"True, Risk of Dissemination"},{"idx":1,"proposition":"Transvaginal ovarian biopsy","correct":true,"justification":"True, Risk of Dissemination"},{"idx":2,"proposition":"Transureteral biopsy of the ovary","correct":true,"justification":"True, impossible to do"},{"idx":3,"proposition":"Exploratory coeolioscopy","correct":false,"justification":"This is what is done in the first line"},{"idx":4,"proposition":"Diagnostic and therapeutic abstention","correct":true,"justification":"True, except in very special cases (end of life), it is necessary to explore urgently because the prognosis is very poor"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"CCR-onco-0","context":null,"enonce":"Which of the following proposals fall within the scope of Lynch syndrome?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"proposition":"Liver","correct":false,"justification":"No but possible for the bile ducts"},{"idx":1,"proposition":"Colon","correct":true},{"idx":2,"proposition":"Lung","correct":false,"justification":"False"},{"idx":3,"proposition":"ENT","correct":false,"justification":"Lynch syndrome: mainly colon, endometrium, small intestine and excretory urinary tract"},{"idx":4,"proposition":"Excretory urinary tract","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"CCR-onco-1","context":null,"enonce":"Which of the following proposals are part of the assessment of the extension of adenocarcinoma of the cecum?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"proposition":"Colonic endoscopic ultrasound","correct":false,"justification":"Not in the extension balance sheet"},{"idx":1,"proposition":"Thoracoab-abdominopelvic CT angiography","correct":true},{"idx":2,"proposition":"Positron emission tomography","correct":false,"justification":"Not in the first intention. Can be done in case of an increase in CEB"},{"idx":3,"proposition":"Dosage of CEA","correct":true,"justification":"True. An elevation of the CEA suggests a metastasis that will be sought by PET-CT"},{"idx":4,"proposition":"Cerebral magnetic resonance imaging","correct":false,"justification":"However, a liver MRI injected with gadolinium can be performed with a chest CT scan without injection, if an injected TDP-TAP is contraindicated (renal failure for example)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"CCR-onco-2","context":null,"enonce":"Which of the following are true for preoperative measures in a patient with adenocarcinoma of the cecum?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"proposition":"Information with informed consent","correct":true,"justification":"True, as always"},{"idx":1,"proposition":"Preoperative immunonutrition","correct":true,"justification":"True because all surgical procedures are at risk of malnutrition. In case of oncological digestive surgery, a supply of micronutrients to begin 7 days before the intervention, is recommended to limit infectious complications and postoperative mortality."},{"idx":2,"proposition":"Colic preparation","correct":false,"justification":"Unnecessary in the case of laparotomy or laparoscopy."},{"idx":3,"proposition":"Ad consultation","correct":true},{"idx":4,"proposition":"ALD Application","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"CCR-onco-3","context":null,"enonce":"Which of the following propositions are true regarding the monitoring of Lynch syndrome-prone patients who have previously had resected colonic adenocarcinoma?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"proposition":"A gynecological examination","correct":true,"justification":"True, for Lynch syndrome (endometrial cancer)"},{"idx":1,"proposition":"A carcinoembryonic antigen assay","correct":true},{"idx":2,"proposition":"A colonoscopy with chromoendoscopy","correct":true,"justification":"True, for Lynch syndrome"},{"idx":3,"proposition":"A thoraco-abdomino-pelvic CT scan","correct":true},{"idx":4,"proposition":"A urine strip","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"CCR-onco-4","context":null,"enonce":"Which of the following are true about Lynch syndrome?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"proposition":"There are more polyps in the lining of the colon than in Familial Adenomatous Polyposis (FAP)","correct":false,"justification":"No, there are fewer"},{"idx":1,"proposition":"The risk of developing CRC during life is about 70% in humans","correct":true},{"idx":2,"proposition":"The risk of developing CRC during life is about 70% in women","correct":false,"justification":"About 50%"},{"idx":3,"proposition":"In the majority of cases, cancer develops in the sigmoid","correct":false,"justification":"At the level of the right colon"},{"idx":4,"proposition":"The positive relative risk is only for colon tumours","correct":false,"justification":"Also cancer of the urinary tract, small intestine, endometrium. Also from the ovary, stomach, bile ducts, pancreas and brain"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"CCR-onco-5","context":null,"enonce":"In case of stage T3 N+ stage T3 N+ lieberkühnian adenocarcinoma surgically resected, what postoperative treatment(s) do you prescribe?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"proposition":"External beam radiation therapy","correct":false,"justification":"False"},{"idx":1,"proposition":"Radiochemotherapy","correct":false,"justification":"False"},{"idx":2,"proposition":"Chemotherapy","correct":true,"justification":"True, this is the only adjuvant therapy in stage 3 colonic adenocarcinoma (i.e., which are N+). 5-FU and oxaliplatin are preferred"},{"idx":3,"proposition":"None of the answers are accurate","correct":false,"justification":"False"},{"idx":4,"proposition":"No adjuvant therapy","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"CCR-onco-6","context":null,"enonce":"Which of the following are true in cases of adenocarcinoma of the cecum with negative extension assessment?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"proposition":"Surgical removal of colonic tumor","correct":true},{"idx":1,"proposition":"None of these proposals","correct":false,"justification":"False"},{"idx":2,"proposition":"Radiochemotherapy alone","correct":false,"justification":"False"},{"idx":3,"proposition":"Endoscopic resection","correct":false,"justification":"The cecum is far too far."},{"idx":4,"proposition":"Radio frequency","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"CCR-onco-7","context":null,"enonce":"Which of the following are true about Lynch syndrome?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"proposition":"There are more polyps in the lining of the colon than in Familial Adenomatous Polyposis (FAP)","correct":false,"justification":"No, there are fewer"},{"idx":1,"proposition":"The risk of developing CRC during life is about 70% in humans","correct":true},{"idx":2,"proposition":"The risk of developing CRC during life is about 70% in women","correct":false,"justification":"About 50%"},{"idx":3,"proposition":"In the majority of cases, cancer develops in the sigmoid","correct":false,"justification":"At the level of the right colon"},{"idx":4,"proposition":"The positive relative risk is only for colon tumours","correct":false,"justification":"Also cancer of the urinary tract, small intestine, endometrium. Also from the ovary, stomach, bile ducts, pancreas and brain"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"CCR-onco-8","context":null,"enonce":"Which of the following are true about Lynch syndrome?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"proposition":"It is also called HNPCC Syndrome","correct":true,"justification":"True, for Hereditary Non Polyposis Colorectal Cancer"},{"idx":1,"proposition":"It is responsible for 25% of colorectal cancers","correct":false,"justification":"4% of CRC, it is the most common form of hereditary cancers"},{"idx":2,"proposition":"The abnormality is expressed on the genes of the mismatch repair proteins","correct":true,"justification":"True, MMR (MisMatch Repair) genes. Mainly MLH1 and MSH2"},{"idx":3,"proposition":"Its transmission is autosomal dominant","correct":true},{"idx":4,"proposition":"Replication errors are mostly found on chromosome 6 and 18","correct":false,"justification":"They are found at the level of micro-satellite sequences (DNA sequences formed by a repetition of patterns), which themselves are found in all chromosomes"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"lithiaseU-nephro-0","context":null,"enonce":"Among these proposals, which favor the occurrence of renal colic?","item":"lithiaseU","matiere":"nephro","propositions":[{"idx":0,"proposition":"Long-term travel","correct":true},{"idx":1,"proposition":"Immobilization","correct":true},{"idx":2,"proposition":"The cold","correct":false,"justification":"Heat, on the other hand, is a contributing factor"},{"idx":3,"proposition":"Renal failure","correct":false,"justification":"It can, however, cause kidney failure, in very rare cases"},{"idx":4,"proposition":"Dehydration","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"lithiaseU-nephro-1","context":null,"enonce":"Regarding epidemiology:","item":"lithiaseU","matiere":"nephro","propositions":[{"idx":0,"proposition":"Urolithiasis affects 50% of the population in France","correct":false,"justification":"Between 5 and 10%. It is a common disease"},{"idx":1,"proposition":"She never reoffends","correct":false,"justification":"It recurs in 50% of cases if preventive treatment is not put in place"},{"idx":2,"proposition":"Uric acid calculus is the most common","correct":false,"justification":"Calcium lithiasis is the most common. It represents 80% of urolithiasis"},{"idx":3,"proposition":"Infectious stones account for 5% of urolithiasis","correct":true},{"idx":4,"proposition":"Calcium lithiasis is usually idiopathic","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"lithiaseU-nephro-2","context":null,"enonce":"What are the elements of gravity to look for?","item":"lithiaseU","matiere":"nephro","propositions":[{"idx":0,"proposition":"Anuria","correct":true,"justification":"It is then a question of acute obstructive renal failure"},{"idx":1,"proposition":"Pregnancy","correct":true,"justification":"It is one of the three risk areas: pregnancy, kidney transplantation and kidney failure."},{"idx":2,"proposition":"The epileptic field","correct":false,"justification":"Is not a particular terrain"},{"idx":3,"proposition":"Fever","correct":true,"justification":"Sign obstructive pyelonephritis"},{"idx":4,"proposition":"Pollakiuria","correct":false,"justification":"Doesn't matter. It is a normal sign associated with"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"Kcdermato-onco-0","context":null,"enonce":"Which of the following are true about melanoma?","item":"Kcdermato","matiere":"onco","propositions":[{"idx":0,"proposition":"The incidence is increasing","correct":true,"justification":"True, the incidence of melanoma doubles almost every 10 years 😱"},{"idx":1,"proposition":"Mortality is on the rise","correct":true,"justification":"True, mortality increases less than incidence, which can be attributed to earlier 😊 diagnosis."},{"idx":2,"proposition":"The clear phenotype ⚪ is not a risk factor","correct":false,"justification":"False, it is indeed a risk factor"},{"idx":3,"proposition":"The main prognostic index is the Breslow index","correct":true},{"idx":4,"proposition":"The main prognostic index is the Clark index","correct":false,"justification":"This is the Breslow index"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcdermato-onco-1","context":null,"enonce":"Which of the following propositions are true about the halo nevus?","item":"Kcdermato","matiere":"onco","propositions":[{"idx":0,"proposition":"Its other name is the nevus of Ota","correct":false,"justification":"The Ota nevus is a birth nevus 👼 with a distribution in unilateral rule, superimposed on the territories of the two upper branches of the trigeminal. The other name for the halo nevus is the Sutton nevus"},{"idx":1,"proposition":"There is a development of an achromic halo (white)","correct":true},{"idx":2,"proposition":"The halo observed is due to cytotoxic inflammatory infiltrate","correct":true},{"idx":3,"proposition":"This nevus remains for life","correct":false,"justification":"It disappears completely"},{"idx":4,"proposition":"It occurs at birth","correct":false,"justification":"It occurs mostly around the second decade and on the trunk. A later onset or irregular appearance of the halo should lead to fear of melanoma. (cf College of Dermatology, 7th edition, page 305). It is the Ota nevus or Mongolian blue spot that occurs from birth 👼"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"Kcdermato-onco-4","context":null,"enonce":"Which skin carcinoma should suggest a budding, ulcerated and crusty lesion in an elderly person who has worked outdoors all his life?","item":"Kcdermato","matiere":"onco","propositions":[{"idx":0,"proposition":"Squamous cell carcinoma","correct":true,"justification":"True. These are the 3 characteristics that make you think of a squamous cell tumor"},{"idx":1,"proposition":"Basal cell carcinoma","correct":false,"justification":"Raised skin nodule. We think about it especially in front of a short and intense sun ☀ exposure"},{"idx":2,"proposition":"Melanoma","correct":false,"justification":"It is not cutaneous carcinoma. Melanoma is developed from melanocytes"},{"idx":3,"proposition":"Wart","correct":false,"justification":"False, it is not a carcinoma"},{"idx":4,"proposition":"Nevus","correct":false,"justification":"False, it is not a carcinoma"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Kcdermato-onco-5","context":null,"enonce":"Which of the following are true?","item":"Kcdermato","matiere":"onco","propositions":[{"idx":0,"proposition":"Bowen's disease is invasive squamous cell carcinoma","correct":false,"justification":"It is a squamous cell carcinoma in situ"},{"idx":1,"proposition":"Squamous cell carcinoma is squamous cell carcinoma in situ","correct":false,"justification":"Epidermoid and squamous cell are synonymous 😊"},{"idx":2,"proposition":"Basal cell carcinoma does not have a precancerous lesion","correct":true,"justification":"True, unlike squamous cell carcinoma"},{"idx":3,"proposition":"The evolution of invasive squamous cell carcinoma is first done in the lymph nodes","correct":true,"justification":"True. Stereotyped evolution: lung blood ➡ ➡ nodes ➡ then other organs"},{"idx":4,"proposition":"Hematogenous metastatic course is more common for cutaneous squamous cell carcinomas than for mucosal squamous cell carcinomas","correct":false,"justification":"It is more common for mucosal squamous cell carcinomas"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"souffleped-cardio-0","context":null,"enonce":"Regarding heart murmurs in children","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"The discovery of a heart murmur is a very common possibility in children","correct":true},{"idx":1,"proposition":"A third noise or B3 is common at the apex in children (50% of cases), it is physiological","correct":true},{"idx":2,"proposition":"There is a correlation between the intensity of a breath and the severity of the underlying disease","correct":false,"justification":"It should be noted that there is often no correlation between the intensity of a breath and the severity of the underlying disease."},{"idx":3,"proposition":"Often there is no functional sign","correct":true},{"idx":4,"proposition":"Exertional dyspnea is the most common symptom","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"souffleped-cardio-1","context":null,"enonce":"Regarding heart murmurs in children","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"Chest pain is exceptionally of cardiac origin in children, unlike in adults","correct":true},{"idx":1,"proposition":"Abnormalities of physical examination, such as hypertension and absence of femoral pulse, immediately point to aortic coarctation","correct":true},{"idx":2,"proposition":"The heart rate is all the faster the older the child is","correct":false,"justification":"The heart rate is all the faster the younger the child is"},{"idx":3,"proposition":"The QRS axis is straighter than in adults, the PR delay is shorter","correct":true},{"idx":4,"proposition":"The echocardiogram-Doppler is the key diagnostic test","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"souffleped-cardio-2","context":null,"enonce":"Regarding heart murmurs in children","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"In newborns (from birth to the end of the 2nd month), a very early breath is less pathological than when it is heard after a few days","correct":false,"justification":"In newborns (from birth to the end of the 2nd month) 1 Isolated breath in a newborn A very early murmur is more pathological than when it is heard after a few days"},{"idx":1,"proposition":"It is necessary to perform a cardiac ultrasound before leaving the maternity in case of breath heard on Day 1 or Day 2","correct":true},{"idx":2,"proposition":"Transposition of the great vessels is the most common cause of neonatal cyanosis","correct":true},{"idx":3,"proposition":"Transposition of the large vessels represents the very type of neonatal cardiology emergency","correct":true},{"idx":4,"proposition":"Regarding the transposition of the large vessels, anatomical correction surgery must be performed in the first 15 days of life","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"souffleped-cardio-3","context":null,"enonce":"Regarding heart murmurs in children","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"Early surgery is imperative for infants with large shunts, especially IVC","correct":true},{"idx":1,"proposition":"Anorganic or innocent breaths are very common in children","correct":true},{"idx":2,"proposition":"In case of innocent breathing, no therapy, or supervision, or restriction of activity, is justified, and these children can lead a strictly normal life.","correct":true},{"idx":3,"proposition":"In case of innocent breath it is useful to see the child periodically in consultation","correct":false,"justification":"It is useless and even harmful to see the child periodically in consultation"},{"idx":4,"proposition":"Asymptomatic systolic murmurs discovered in infancy most often correspond to anorganic murmurs, or \"innocent\" or \"functional\" murmurs.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"souffleped-cardio-5","context":null,"enonce":"What are the two physiological shunts in the fetal circulation?","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"Foramen oval","correct":true},{"idx":1,"proposition":"Round Foramen","correct":false,"justification":"False. The round foramen is a round foramen is a foramen of the middle stage of the base of the skull."},{"idx":2,"proposition":"Ventricular septal defect","correct":false,"justification":"False. It is pathological"},{"idx":3,"proposition":"Pulmonary canal","correct":false,"justification":"False"},{"idx":4,"proposition":"Ductus arteriosus","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"souffleped-cardio-6","context":null,"enonce":"Which of the following are cyanogenic heart diseases?","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"Transposition of the large vessels","correct":true},{"idx":1,"proposition":"Tetralogy of Fallot","correct":true,"justification":"True, the leading cause of cyanogenic heart disease in children according to the College of Pediatrics"},{"idx":2,"proposition":"Pulmonary stenosis","correct":false,"justification":"Non-cyanogen"},{"idx":3,"proposition":"Persistent ductus arteriosus","correct":false,"justification":"Non-cyanogen"},{"idx":4,"proposition":"Coarctation of the aorta","correct":false,"justification":"Non-cyanogen"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"souffleped-cardio-8","context":null,"enonce":"What heart defects form a left-right shunt?","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"Ventricular septal defect","correct":true},{"idx":1,"proposition":"Tetralogy of Fallot","correct":false,"justification":"False. It causes an obstacle of the right heart."},{"idx":2,"proposition":"Transposition of the large vessels","correct":false,"justification":"False. It causes poor connections in the heart."},{"idx":3,"proposition":"Patent ductus arteriosus","correct":true},{"idx":4,"proposition":"Pulmonary valve stenosis","correct":false,"justification":"False. It causes an obstacle of the right heart."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"souffleped-cardio-9","context":null,"enonce":"Which of the following are non-cyanogenic heart diseases?","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"Tetralogy of Fallot","correct":false,"justification":"Cyanogen"},{"idx":1,"proposition":"Transposition of the large vessels","correct":false,"justification":"Cyanogen"},{"idx":2,"proposition":"Persistent ductus arteriosus","correct":true},{"idx":3,"proposition":"Ventricular septal defect","correct":true},{"idx":4,"proposition":"Inter-atrial communication","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"souffleped-cardio-10","context":null,"enonce":"What is the prevalence of congenital heart disease in live births?","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"0,08%","correct":false,"justification":"None"},{"idx":1,"proposition":"0,8%","correct":true},{"idx":2,"proposition":"2%","correct":false,"justification":"None"},{"idx":3,"proposition":"4%","correct":false,"justification":"None"},{"idx":4,"proposition":"6%","correct":false,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"contraception-gyn-0","context":null,"enonce":"Which of the following are true?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"The Pearl Index (PI) is the number of pregnancies that occurred in 100 women exposed to the method studied for 1 year","correct":true},{"idx":1,"proposition":"The higher the Pearl Index (PI), the more effective the contraceptive method concerned","correct":false,"justification":"It's the other way around. The lower it is, the more effective the contraceptive method."},{"idx":2,"proposition":"The patch is a progestin-only contraception","correct":false,"justification":"Oestro-progestin"},{"idx":3,"proposition":"The ring is an estrogen-progestin contraception","correct":true},{"idx":4,"proposition":"Macro-progestogens have no MA for contraception","correct":true,"justification":"Their prescription is off-label. No study has calculated a Pearl index."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"contraception-gyn-1","context":null,"enonce":"Which of the following proposals are part of the follow-up assessment in a woman on an estrogen-progestogen contraceptive?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"Fasting blood glucose","correct":true},{"idx":1,"proposition":"Total cholesterol","correct":true},{"idx":2,"proposition":"HDL cholesterol","correct":true},{"idx":3,"proposition":"Creatinine","correct":false,"justification":"No impact on kidney function"},{"idx":4,"proposition":"Triglycerides","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"contraception-gyn-3","context":null,"enonce":"After unprotected sex, how soon should levonorgestrel be taken?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"Within 24 hours","correct":false,"justification":"Within 72 hours"},{"idx":1,"proposition":"Within 48 hours","correct":false,"justification":"Within 72 hours"},{"idx":2,"proposition":"Within 72 hours","correct":true},{"idx":3,"proposition":"Within 5 days","correct":false,"justification":"This is true for EllaOne®, Ulipristal Acetate"},{"idx":4,"proposition":"It is not emergency contraception","correct":false,"justification":"Norlevo® is an emergency contraception consisting of a 2nd generation progestin (levonorgestrel 1.5 mg)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"contraception-gyn-4","context":null,"enonce":"What is the concentration of ethinyl estradiol (EE) of a so-called \"normodosed\" contraception (in micrograms)?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"10","correct":false,"justification":"False"},{"idx":1,"proposition":"20","correct":false,"justification":"False"},{"idx":2,"proposition":"30","correct":false,"justification":"False"},{"idx":3,"proposition":"40","correct":false,"justification":"False"},{"idx":4,"proposition":"50","correct":true,"justification":"True: the pill is called \"normo-dosed\" if it contains 50 μg of EE"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"contraception-gyn-5","context":null,"enonce":"What emergency contraception is administered 4 days after sexual intercourse?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"EllaOne®","correct":true},{"idx":1,"proposition":"Norlevo®","correct":false},{"idx":2,"proposition":"Levonorgestrel ","correct":false,"justification":"max within 72h"},{"idx":3,"proposition":"Ulipristal Acetate","correct":true},{"idx":4,"proposition":"Copper IUDs","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"contraception-gyn-6","context":null,"enonce":"Which of the following are absolute contraindications (ICs) of estrogen-progestogen contraceptives (OCCs)?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"Severe unbalanced hypertension","correct":true},{"idx":1,"proposition":"Family history of VTE","correct":false,"justification":"Not an absolute CI if it is family, personal only. Family = relative (we will not CI a COP to a patient because her older sister had phlebitis at 65 years after 8 hours of plane returning from Reunion ^^)"},{"idx":2,"proposition":"Obesity","correct":false,"justification":"It is a relative IC"},{"idx":3,"proposition":"Migraine with aura","correct":true},{"idx":4,"proposition":"All propositions are true","correct":false,"justification":"The absolute ICs of COP are: ischemic heart disease, complicated valvular heart disease, ischemic stroke ATCD, migraine with aura, porphyrias \/ connective tissue (lupus are hormone-dependent),\r\nPersonal ATCD or venous (DVT or PE) or arterial TED accident\r\nmajor surgery with prolonged immobilization, hereditary or acquired predisposition to thrombosis (AV), tobacco > 15 cigarettes \/ day if > 35 years, severe unbalanced hypertension or FdR CV, confirmed or suspected pregnancy, breastfeeding < 6S postpartum, severe dyslipidemia, active viral hepatitis, severe or recent liver disease (including cirrhosis), benign hepatic tumor, malignant or suspected breast tumor, uterus, meningioma, pituitary tumor (on a case-by-case basis) and non-genital hemorrhages Diagnosed."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"contraception-gyn-7","context":null,"enonce":"Which of the following have a Pearl Index (PI) of less than 1?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"Condom","correct":false,"justification":"IP to 2"},{"idx":1,"proposition":"Progestin-only subcutaneous implant","correct":true,"justification":"True, one of the contraceptives with the lowest Pearl index"},{"idx":2,"proposition":"Progrestin only","correct":true},{"idx":3,"proposition":"\"Withdraw\"","correct":false,"justification":"Does not work\/little. Not recommended"},{"idx":4,"proposition":"Intrauterine device (IUD)","correct":true,"justification":"True. IP = 0.6 for classics. IP = 0.2 for impregnated IUDs"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"contraception-gyn-8","context":null,"enonce":"How soon should ulipristal be taken after unprotected sex?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"24h","correct":false,"justification":"5 days"},{"idx":1,"proposition":"48h","correct":false,"justification":"5 days"},{"idx":2,"proposition":"5 days","correct":true},{"idx":3,"proposition":"10 days","correct":false,"justification":"5 days"},{"idx":4,"proposition":"It is a progesterone receptor antagonist","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"contraception-gyn-9","context":null,"enonce":"Among the following proposals, which are part of the biological assessment to be prescribed essential before starting estrogen-progestin contraception in a woman without personal or family history of metabolic or thromboembolic disease, who does not smoke and whose clinical examination is normal?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"No assessment is essential","correct":true,"justification":"True. In a person with no personal or family history of metabolic or thromboembolic disease, who does not smoke and whose clinical examination is normal, the laboratory assessment can be performed 3 to 6 months after prescription."},{"idx":1,"proposition":"NFS-P","correct":false,"justification":"False"},{"idx":2,"proposition":"Assessment of renal function","correct":false,"justification":"False"},{"idx":3,"proposition":"Cholesterol","correct":false,"justification":"False"},{"idx":4,"proposition":"Fasting blood glucose","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"contraception-gyn-10","context":null,"enonce":"Which of the following are true about emergency contraception? (one or more exact propositions)","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"It is free","correct":false,"justification":"Free only for minors. Reimbursed at 65% for adults, if medical prescription."},{"idx":1,"proposition":"It can be issued to minors free of charge, anonymously and without a doctor's prescription, regardless of the medication used.","justfication":"Contrairement à ce que l'on peut trouver dans certaines sources, l'ulipristal est bien disponible sans ordonnance d'après cette fiche de la HAS (mise à jour en 2019) : https:\/\/webzine.has-sante.fr\/upload\/docs\/application\/pdf\/2015-07\/contraception_urgence_officine_maj_juillet2015.pdf Si elle n'est plus valide, n'hésitez pas à nous prévenir en signalant la QI :)","correct":true},{"idx":2,"proposition":"They are only dispensed in pharmacies","correct":false,"justification":"Or in a CeGIDD, in a family planning or education center, with the school nurse or academic medicine"},{"idx":3,"proposition":"Ulipristal has no contraindication (CI)","correct":false,"justification":"Two ICs: Allergy to one of the components and pregnancy. In addition, it is not recommended in cases of severe hepatic impairment and severe asthma insufficiently controlled by oral glucocorticoid. After taking UPA, breastfeeding not recommended for one week (during this period, express and discard breast milk in order to maintain lactation stimulation). (according to HAS)"},{"idx":4,"proposition":"None of the propositions are true","correct":false,"justification":"Almost none 😜"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"contraception-gyn-11","context":null,"enonce":"Which of the following are true for intrauterine devices (IUDs)?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"It is a long-acting contraception","correct":true,"justification":"True, about 5 years"},{"idx":1,"proposition":"It can be placed by a midwife","correct":true,"justification":"True, L-5134 of the CSP: \"The insertion of intrauterine contraceptives can only be performed by a doctor or midwife.\""},{"idx":2,"proposition":"Wilson's disease is a contraindication to the copper IUD","correct":true},{"idx":3,"proposition":"Monitoring is every six months","correct":false,"justification":"Annual monitoring"},{"idx":4,"proposition":"It is not refunded","correct":false,"justification":"It is refunded. It is proposed as a first-line treatment for multiparous women with stable sex lives"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"contraception-gyn-12","context":null,"enonce":"Which of the following are true for intrauterine devices (IUDs)?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"The Pearl Index of the progesterone IUD is less than 0.5","correct":true},{"idx":1,"proposition":"The Pearl number of the copper IUD is less than 0.5","correct":false,"justification":"IP = 0.6"},{"idx":2,"proposition":"It is a mechanical contraception","correct":true},{"idx":3,"proposition":"A history of ectopic pregnancy is a contraindication (CI)","correct":true},{"idx":4,"proposition":"Taking chronic NSAIDs is a contraindication (CI)","correct":false,"justification":"Not an IC"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"contraception-gyn-13","context":null,"enonce":"Which of the following are true about progestin-only contraception?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"They have the same contraindications (CI) as estrogen-progestogens","correct":false,"justification":"No metabolic or cardiovascular IC"},{"idx":1,"proposition":"The cycle disorders they can cause are sometimes poorly tolerated","correct":true},{"idx":2,"proposition":"Their tolerance to forgetfulness is 12 hours","correct":false,"justification":"3 hours for progestin-based contraceptives"},{"idx":3,"proposition":"The micropill should be taken every day","correct":true,"justification":"True, even during menstruation"},{"idx":4,"proposition":"Personal history of ectopic pregnancy (GEU) is part of the contraindications (CI)","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"contraception-endoc-0","context":null,"enonce":"Which of the following proposals concerning estrogen-progestogen is (are) correct?","item":"contraception","matiere":"endoc","propositions":[{"idx":0,"proposition":"They are also called combined oral contraceptives or combination pills and are composed of a synthetic or natural estrogen and a progestin","correct":true},{"idx":1,"proposition":"Ethinyl-estradiol is a synthetic estrogen","correct":true,"justification":"It can be replaced by 17β-estradiol"},{"idx":2,"proposition":"The dosage of synthetic estrogen ranges from 15 to 50 μg","correct":true},{"idx":3,"proposition":"Estrogens and progestins may contain a natural estrogen, estradiol","correct":true},{"idx":4,"proposition":"The dose of estradiol in estrogen-progestogens is conventionally 1.5 mg","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"contraception-endoc-1","context":null,"enonce":"Which of the following is (are) correct?","item":"contraception","matiere":"endoc","propositions":[{"idx":0,"proposition":"The first generation progestinfs are levonorgestrel and norgstrel","correct":false,"justification":"1st generation = norethisterone and lynestrenol"},{"idx":1,"proposition":"The third generation progestogens are gestodene and norgestimate","correct":true},{"idx":2,"proposition":"Chlormadinone acetate is a toxic element contraindicated in humans","correct":false,"justification":"Chlormadinone acetate is not toxic at all and is used in combination pills"},{"idx":3,"proposition":"Nomegestrol acetate is in combination with levonorgestrel most often","correct":false,"justification":"It is a progestin in combination with estradiol most often in estrogen-progestin pills"},{"idx":4,"proposition":"Cyproterone acetate is a progestin used in combination pills","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"contraception-endoc-2","context":null,"enonce":"Which of the following proposals regarding progestogens is (are) accurate?","item":"contraception","matiere":"endoc","propositions":[{"idx":0,"proposition":"The first generation progestins were obtained from the testosterone molecule","correct":true},{"idx":1,"proposition":"Second-generation progestogens are gonans","correct":true},{"idx":2,"proposition":"Third-generation progestogens have a very high affinity for the progesterone receptor and a lower affinity for the androgen receptor","correct":true},{"idx":3,"proposition":"3rd generation progestogens have very minor antigonadotropic activity","correct":false,"justification":"Their antigonadotropic activity is very high and has reduced the dose of ethinylloestradiol used"},{"idx":4,"proposition":"The androgenic effect of 3rd generation progestins is major","correct":false,"justification":"They have a lesser androgenic effect, on the contrary"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrabdogrossesse-gyn-0","context":null,"enonce":"Among these proposals, which fall into the triad of symptoms of retroplacental hematoma:","item":"dlrabdogrossesse","matiere":"gyn","propositions":[{"idx":0,"proposition":"Vomiting","correct":false,"justification":"Abdominal pain in stabbing, uterine contracture, metrorrhagia"},{"idx":1,"proposition":"Abdominal defense","correct":false},{"idx":2,"proposition":"Metrorrhagia","correct":true},{"idx":3,"proposition":"Palpitations","correct":false},{"idx":4,"proposition":"Balance disorders","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dlrabdogrossesse-gyn-1","context":null,"enonce":"Regarding acute abdominal pain in pregnant women:","item":"dlrabdogrossesse","matiere":"gyn","propositions":[{"idx":0,"proposition":"Abdominopelvic pain without metrorrhagia in the 1st trimester may be a telltale sign of an ectopic pregnancy","correct":true},{"idx":1,"proposition":"The severity argument suggests a retroplacental hematoma in the 2nd and 3rd trimesters","correct":true},{"idx":2,"proposition":"Retroplacental hematoma is to be evoked systematically in the 2nd half of pregnancy","correct":true},{"idx":3,"proposition":"Retroplacental hematoma is life-threatening for the fetus","correct":true},{"idx":4,"proposition":"The HELLP Syndrome is to be evoked in case of epigatric pain or right hypochondrium","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrabdogrossesse-gyn-2","context":null,"enonce":"Which propositions are true?","item":"dlrabdogrossesse","matiere":"gyn","propositions":[{"idx":0,"proposition":"HELLP syndrome is life-threatening for mother and fetus","correct":true},{"idx":1,"proposition":"Pregnancy can mask an abdominal defense","correct":true},{"idx":2,"proposition":"Salpingitis is a common and relatively benign algic etiology in pregnant women","correct":false,"justification":"Salpingitis and endometritis DO NOT exist in pregnant women!"},{"idx":3,"proposition":"Diagnostic criteria for UTI are extremely different in pregnant women compared to non-pregnant women","correct":false,"justification":"The diagnostic criteria are identical"},{"idx":4,"proposition":"Urinary pathologies have no impact on pregnancy","correct":false,"justification":"Careful! Urinary pathologies can trigger a threat of premature delivery"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dlrabdogrossesse-gyn-3","context":null,"enonce":"Which of these propositions are true?","item":"dlrabdogrossesse","matiere":"gyn","propositions":[{"idx":0,"proposition":"Pregnancy drastically reduces the frequency of urinary tract infections","correct":false,"justification":"Caution: Pregnancy increases the frequency of urinary tract infections"},{"idx":1,"proposition":"PAD and UTI is a common association","correct":true},{"idx":2,"proposition":"Uro-scanner is contraindicated in pregnant women","correct":false,"justification":"Renal colic: The uro-scanner is possible if the ultrasound is not contributory"},{"idx":3,"proposition":"A pyelocalicial dilation of 100 mm is physiological and frequent in pregnant women, especially on the left","correct":false,"justification":"Be careful, a physiological moderate pyelocalicial dilation (< 20 mm) is common in pregnant women, especially on the right because of the physiological dextrorotation of the uterus"},{"idx":4,"proposition":"Injected abdominal CT scan is strictly contraindicated during pregnancy","correct":false,"justification":"Ultrasound is not always very effective because of pregnancy and injected abdominal CT is possible at any age of pregnancy (benefit\/risk ratio)\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"dlrabdogrossesse-gyn-4","context":null,"enonce":"Which statements are true?","item":"dlrabdogrossesse","matiere":"gyn","propositions":[{"idx":0,"proposition":"Digestive pathologies can trigger a threat of premature delivery","correct":true},{"idx":1,"proposition":"Uterine palpation is looking for uterine contracture or deformity of the uterus","correct":true},{"idx":2,"proposition":"Cardiotocographic recording is done from 25 SA","correct":true},{"idx":3,"proposition":"Retroplacental hematoma is ultrasound diagnosis","correct":false,"justification":"Retroplacental hematoma is exceptionally seen in ultrasound, the diagnosis is clinical"},{"idx":4,"proposition":"The BU always shows the presence of blood in case of metrorrhagia","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrabdogrossesse-gyn-5","context":null,"enonce":"Regarding acute abdominopelvic pain in pregnant women:","item":"dlrabdogrossesse","matiere":"gyn","propositions":[{"idx":0,"proposition":"Ultrasound of the cervix is indicated only in case of imminent threat of delivery","correct":false},{"idx":1,"proposition":"Renal and abdominal ultrasounds are made difficult by pregnancy","correct":true},{"idx":2,"proposition":"In the absence of an identified etiology, the patient is redirected to her general practitioner with a close consultation.","correct":false},{"idx":3,"proposition":"The 4 major etiological families are obstetrical, urinary, gynecological and digestive","correct":true},{"idx":4,"proposition":"Urinary causes are only very rarely due to pain of this type","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dlrabdogrossesse-gyn-6","context":null,"enonce":"Which of the following are signs or symptoms of uterine rupture?","item":"dlrabdogrossesse","matiere":"gyn","propositions":[{"idx":0,"proposition":"It is especially to be evoked in a nulliparous woman","correct":false,"justification":"Especially in case of uterine scars (history of caesarean section in particular)"},{"idx":1,"proposition":"Red-blooded metrorrhagia","correct":true},{"idx":2,"proposition":"Pain outside of work","correct":false,"justification":"Exceptional outside of work, it is especially during work that we evoke a uterine rupture"},{"idx":3,"proposition":"Brutal pain","correct":true,"justification":"True ++"},{"idx":4,"proposition":"Uterine deformity","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrabdogrossesse-gyn-7","context":null,"enonce":"Which of the following proposals is(are) possible cause(s) of acute abdominal pain in pregnant women?","item":"dlrabdogrossesse","matiere":"gyn","propositions":[{"idx":0,"proposition":"Endometritis ","correct":false,"justification":"rather in the postpartum period"},{"idx":1,"proposition":"Salpingitis","correct":false,"justification":"not found in pregnant women"},{"idx":2,"proposition":"Ectopic pregnancy ","correct":true,"justification":"True, especially in the first trimester, to evoke systematically"},{"idx":3,"proposition":"HELPP Syndrome","correct":true,"justification":"True especially in the context of hypertension or preeclampsia"},{"idx":4,"proposition":"Uterine rupture ","correct":true,"justification":"True, especially in cases of sudden pain, red blood metrorrhagia and uterine deformity"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrbuccale-neuro-0","context":null,"enonce":"Regarding primary headaches:","item":"dlrbuccale","matiere":"neuro","propositions":[{"idx":0,"proposition":"Primary headaches are far more common than secondary headaches","correct":true},{"idx":1,"proposition":"They often evolve by paroxysmal crises and less often in a continuous and daily mode","correct":true},{"idx":2,"proposition":"The diagnosis of a primary headache is clinical, based on questioning in particular","correct":true},{"idx":3,"proposition":"Additional examinations show an inflammatory syndrome in 60% of cases","correct":false,"justification":"Complementary examinations are by definition normal"},{"idx":4,"proposition":"Primary headaches are mild and do not require management","correct":false,"justification":"Although benign, primary headaches and essential facial neuralgia have a significant impact on quality of life"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dlrbuccale-neuro-1","context":null,"enonce":"Regarding headaches:","item":"dlrbuccale","matiere":"neuro","propositions":[{"idx":0,"proposition":"There is no specific treatment for migraine","correct":false,"justification":"The management of migraine is based on non-specific treatments (paracetamol, aspirin, nonsteroidal anti-inflammatory drugs [NSAIDs]) and specific treatments (triptans)"},{"idx":1,"proposition":"Subarachnoid hemorrhage is a secondary headache etiology","correct":true},{"idx":2,"proposition":"Facial and cranial neuralgia are responsible for electrical discharges in the territory of a sensory nerve","correct":true},{"idx":3,"proposition":"The main causes of headaches occurring less than 15 days a month are intracranial hypertension and meningitis","correct":false,"justification":"Headaches < 15 days a month: the main causes are migraine and episodic tension headache"},{"idx":4,"proposition":"Chronic daily headache (CCQ) is the leading cause of headache occurring more than 15 days per month for at least 3 months","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrbuccale-neuro-2","context":null,"enonce":"Regarding migraines:","item":"dlrbuccale","matiere":"neuro","propositions":[{"idx":0,"proposition":"\"Short-term\" chronic daily headaches (QCDs) are seizures lasting less than 30 minutes a day","correct":false,"justification":"\"Short-term\" CCQ: seizures lasting less than 4 hours a day"},{"idx":1,"proposition":"The main causes of QCC are cluster headache and trigeminal neuralgia","correct":false,"justification":"Chronic migraine or, more rarely, chronic tension headache, both with or without medication abuse"},{"idx":2,"proposition":"With a prevalence of 75%, migraine is one of the most common neurological conditions","correct":false,"justification":"With a prevalence of 15%, migraine is one of the most common neurological conditions"},{"idx":3,"proposition":"Migraine without aura is a more common cause of CCQ than migraine with aura","correct":true},{"idx":4,"proposition":"Some patients have only one variety of migraine attacks and others have both (with and without aura)","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dlrbuccale-neuro-4","context":null,"enonce":"Which of the following propositions are true about reversible cerebral vasoconstriction syndrome?","item":"dlrbuccale","matiere":"neuro","propositions":[{"idx":0,"proposition":"It can be promoted by SSRIs","correct":true},{"idx":1,"proposition":"It can be triggered by the Valsalva maneuver","correct":true},{"idx":2,"proposition":"It can be triggered by coitus","correct":true},{"idx":3,"proposition":"It can be complicated by cerebral ischemia","correct":true},{"idx":4,"proposition":"It can be complicated by cerebral hemorrhage","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrbuccale-neuro-5","context":null,"enonce":"Which of the following propositions are true about reversible cerebral vasoconstriction syndrome?","item":"dlrbuccale","matiere":"neuro","propositions":[{"idx":0,"proposition":"It can be promoted by SSRIs","correct":true},{"idx":1,"proposition":"It can be triggered by the Valsalva maneuver","correct":true},{"idx":2,"proposition":"It can be triggered by coitus","correct":true},{"idx":3,"proposition":"It can be complicated by cerebral ischemia","correct":true},{"idx":4,"proposition":"It can be complicated by cerebral hemorrhage","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"violence-sp-0","context":null,"enonce":"Which of the following are true?","item":"violence","matiere":"sp","propositions":[{"idx":0,"proposition":"Sexual violence is any sexual assault committed with violence, coercion, threat or surprise","correct":true},{"idx":1,"proposition":"Rape is any act of sexual penetration of any kind, committed by violence, coercion, threat or surprise.","correct":true},{"idx":2,"proposition":"The competent court to try marital rape is the administrative court","correct":false,"justification":"Penalty: jurisdiction: crime: Assize Court 15 years imprisonment 20 years if aggravating circumstances (rape by spouse or common-law partner ...)"},{"idx":3,"proposition":"The limitation period is 5 years","correct":false,"justification":"Limitation period: 10 years if adult victim 20 years if rape committed when the victim was a minor In France:"},{"idx":4,"proposition":"In France, there were 980 rapes in 2014 (about 3 per day)","correct":false,"justification":"12,700 rapes\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"violence-sp-1","context":null,"enonce":"Which of the following are true?","item":"violence","matiere":"sp","propositions":[{"idx":0,"proposition":"16% of women and 5% of men report having been raped or attempted rape in their lifetime","correct":true},{"idx":1,"proposition":"Sexual assault is a non-penetrative act committed by violence, coercion, threat or susception.","correct":true},{"idx":2,"proposition":"Sexual assault is a crime","correct":true},{"idx":3,"proposition":"The jurisdiction that judges sexual assaults is the criminal court","correct":true},{"idx":4,"proposition":"The penalty for sexual assault is a fine of up to 100,000 euros (but no prison sentence)","correct":false,"justification":"Penalty: offenses: (minimum) 5 years in prison € 75,000 fine these penalties vary the prison sentence depending on 7 to 1 0 years, and the fine to € 100,000 of \"aggravating situations\": increase of possible\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"violence-sp-2","context":null,"enonce":"Concerning sexual violence and harassment","item":"violence","matiere":"sp","propositions":[{"idx":0,"proposition":"There were 26,700 sexual assaults in 2014","correct":true},{"idx":1,"proposition":"Sexual harassment is the infliction of non-consensual touching (without penetration) of a person.","correct":false,"justification":"Definition: Imposing connotations or intimidating on a person who repeatedly engage in sexual comments or behaviours that violate their dignity or create a hostile situation"},{"idx":2,"proposition":"Sexual harassment is a crime punishable by law","correct":false,"justification":"Qualification: misdemeanour"},{"idx":3,"proposition":"The competent court to deal with sexual harassment cases is the Assize Court only","correct":false,"justification":"Jurisdiction: Jurisdiction of High Court If sexual harassment at work: (private sector) Administrative Court (public sector)"},{"idx":4,"proposition":"Penalties can be up to 2 years in prison and a fine of €30,000 (without aggravating circumstances)","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"violence-sp-4","context":null,"enonce":"During the somatic examination of a rape victim, we look for:","item":"violence","matiere":"sp","propositions":[{"idx":0,"proposition":"Virology status","correct":true,"justification":"VIh and Hepatitis B in particular"},{"idx":1,"proposition":"Traumatic injuries","correct":true},{"idx":2,"proposition":"An inspection of the hymen","correct":true,"justification":"It will have to be carefully described in the medical record"},{"idx":3,"proposition":"Hemmoragy mucous membranes","correct":true},{"idx":4,"proposition":"A breast nodule on palpation","correct":false,"justification":"Never breast palpation spontaneously, unless clearly urgent and informed agreement of the patient\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"violence-sp-5","context":null,"enonce":"Which of the following are true?","item":"violence","matiere":"sp","propositions":[{"idx":0,"proposition":"Dealing with sexual assault\/rape is an emergency","correct":true},{"idx":1,"proposition":"If the rape victim is a minor, contact the legal guardians and the public prosecutor.","correct":true},{"idx":2,"proposition":"If the person is of age, the information of the Public Prosecutor is done only with the agreement of the patient","correct":true},{"idx":3,"proposition":"Psychological examination of rape victim looks for suicidal risk and acute stress","correct":true},{"idx":4,"proposition":"Samples are taken with sterile gloves in duplicate for DNA (spermatozoa)","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"violence-sp-6","context":null,"enonce":"What are the biological elements to be systematically sought, within a reasonable time, in the event of rape?","item":"violence","matiere":"sp","propositions":[{"idx":0,"proposition":"HIV, HAV, HBV, HCV, TPHA-VDRL serology","correct":false,"justification":"By VHA"},{"idx":1,"proposition":"Beta-HCG","correct":true,"justification":"Qualitative at first, most often"},{"idx":2,"proposition":"Troponin US","correct":false,"justification":"No use except clinical orientation"},{"idx":3,"proposition":"GFR calculation","correct":false,"justification":"No interest except clinic orientation"},{"idx":4,"proposition":"Serology Chlamydia","correct":false,"justification":"Local sampling for chlamydia and gonococci but never blood serology\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"violence-gyn-0","context":null,"enonce":"Concerning sexual violence","item":"violence","matiere":"gyn","propositions":[{"idx":0,"proposition":"Rape is defined as any act of sexual penetration carried out against the will of the person by surprise, threat, violence or coercion.","correct":true},{"idx":1,"proposition":"Lack of consent results exclusively from physical violence","correct":false,"justification":"Lack of consent may result from physical or moral violence"},{"idx":2,"proposition":"Victims of sexual abuse have experienced criminal violence that must be handled in the most professional manner","correct":true},{"idx":3,"proposition":"6% of women report having experienced forced or attempted forced sex in their lifetime","correct":false,"justification":"Epidemiology: 16% of women report having experienced forced or attempted forced sex in their lifetime"},{"idx":4,"proposition":"Oral penetration is sexual violence but not rape","correct":false,"justification":"Oral penetration is called rape because it involves a sexual organ and an orifice."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"violence-gyn-1","context":null,"enonce":"Concerning the care of victims of sexual violence","item":"violence","matiere":"gyn","propositions":[{"idx":0,"proposition":"Taking samples to identify the perpetrator is crucial","correct":true},{"idx":1,"proposition":"The doctor must write an initial medical certificate","correct":true},{"idx":2,"proposition":"Rapes dating back more than 5 days require emergency care with samples and declaration to the prosecutor","correct":false,"justification":"It is the recent aggression of less than 72 hours that requires urgent care, in particular because it allows samples to be taken."},{"idx":3,"proposition":"Medical consultation with genito-anal examination should be carried out with maximum competence","correct":true},{"idx":4,"proposition":"After explaining the objectives of the medical examination, it must be carried out in a welcoming, well-lit room","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"violence-gyn-2","context":null,"enonce":"The interrogation of rape victims makes it possible to specify:","item":"violence","matiere":"gyn","propositions":[{"idx":0,"proposition":"Number of abusers","correct":true,"justification":"Difficult question to ask, like many others, but necessary"},{"idx":1,"proposition":"The relationship is a question that does not arise","correct":false,"justification":"Absolutely not!"},{"idx":2,"proposition":"The victim's behaviour after the assault is unnecessary","correct":false,"justification":"If she has lost consciousness, changed her clothes or made a toilet, the medical management changes"},{"idx":3,"proposition":"The date and time of the assault","correct":true},{"idx":4,"proposition":"The victim's medical-surgical history","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"VH-infectio-0","context":null,"enonce":"Which propositions are true?","item":"VH","matiere":"infectio","propositions":[{"idx":0,"proposition":"The Maddreay score calculates the probability of contracting viral hepatitis","correct":false,"justification":"Maddrey's score defines the severity of alcoholic hepatitis"},{"idx":1,"proposition":"There is never a severe form of HEV infection","correct":false,"justification":"Fulminant hepatitis in pregnant women"},{"idx":2,"proposition":"The hepatitis B virus has a diameter of 2 microns","correct":false,"justification":"Viruses are smaller than cells (so about ten ometers). HBV is 47 ometers in diameter"},{"idx":3,"proposition":"Mutated pre-C HCV viruses cause more severe chronic hepatitis than non-mutated viruses","correct":true},{"idx":4,"proposition":"Hepatitis is said to be chronic when it lasts more than 3 months","correct":false,"justification":"Acute < 6 months. Chronic> 6 months."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"VH-infectio-1","context":null,"enonce":"Regarding HAV:","item":"VH","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is a DNA virus","correct":false,"justification":"HAV is an RNA virus"},{"idx":1,"proposition":"It is a reportable disease","correct":true},{"idx":2,"proposition":"There is never chronic hepatitis","correct":true},{"idx":3,"proposition":"There is never a severe form","correct":false,"justification":"There may be, but very rarely, fulminant hepatitis"},{"idx":4,"proposition":"Incubation is 48 hours","correct":false,"justification":"Incubation is between 10 and 45 days"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"VH-infectio-2","context":null,"enonce":"A positive HBs antigen can be found in case of:","item":"VH","matiere":"infectio","propositions":[{"idx":0,"proposition":"Acute and active hepatitis B","correct":true},{"idx":1,"proposition":"Immunoprotective vaccination against HEV","correct":false,"justification":"HBs antigen signs the presence of HBV"},{"idx":2,"proposition":"HBV vaccination","correct":false,"justification":"HBs antigen signs the presence of HBV"},{"idx":3,"proposition":"Active chronic hepatitis B","correct":true},{"idx":4,"proposition":"Hepatitis B cured","correct":false,"justification":"HBs antigen signs the presence of HBV"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"VH-infectio-3","context":null,"enonce":"Regarding the transmission of hepatitis viruses:","item":"VH","matiere":"infectio","propositions":[{"idx":0,"proposition":"HAV is not transmitted from mother to child during pregnancy","correct":true,"justification":"No mother-to-child transmission"},{"idx":1,"proposition":"HBV can be transmitted during sex","correct":true,"justification":"This is the case for all viruses are HEV"},{"idx":2,"proposition":"HCV is not affected by fecal-oral transmission","correct":true},{"idx":3,"proposition":"Blood transmission is possible for all hepatitis viruses","correct":true},{"idx":4,"proposition":"HEV cannot be transmitted during sexual intercourse","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"VH-infectio-4","context":null,"enonce":"Which of the following designates active hepatitis B?","item":"VH","matiere":"infectio","propositions":[{"idx":0,"proposition":"HBsAg negative \/ Anti-HBs Ac negative \/ HBeAg negative \/ Anti-HBc Ac negative","correct":false,"justification":"HBsAg negative so no virus"},{"idx":1,"proposition":"HBsAg negative \/ Ac anti-HBs positive \/ HBeAg negative \/ Ac anti-HBc negative","correct":false,"justification":"HBsAg negative so no virus"},{"idx":2,"proposition":"HBsAg negative \/ Ac anti-HBs positive \/ HBeAg negative \/ Ac anti-HBc cloudy","correct":false,"justification":"HBsAg negative so no virus"},{"idx":3,"proposition":"HBsAg positive \/ Anti-HBs ac negative \/ HBeAg negative \/ Positive anti-HBc Ac","correct":true},{"idx":4,"proposition":"HBsag positive \/ anti-HBs ac negative \/ HBeAg positive \/ positive anti-HBc ac","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"gynecomastie-endoc-0","context":null,"enonce":"Which propositions are true?","item":"gynecomastie","matiere":"endoc","propositions":[{"idx":0,"proposition":"It signs an androgen\/estrogen imbalance","correct":true},{"idx":1,"proposition":"It signs an increase in androgen or a decrease in estrogen","correct":false,"justification":"The opposite: an increase in estrogen and\/or a decrease in androgens"},{"idx":2,"proposition":"Parapubertal gynecomastia must evoke a gonadotropic tumor","correct":false,"justification":"It is physiological and regresses spontaneously"},{"idx":3,"proposition":"The different etiologies are all endogenous","correct":false,"justification":"There are also many exogenous etiologies: alcohol, drug addiction, iatrogeny, etc."},{"idx":4,"proposition":"An increase in hCG should be investigated for testicular choriocarcinoma","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"gynecomastie-endoc-1","context":null,"enonce":"Which of these proposals can cause gynecomastia?","item":"gynecomastie","matiere":"endoc","propositions":[{"idx":0,"proposition":"Decreased testosterone production","correct":true},{"idx":1,"proposition":"Inhibition of aromatization of androgens into estrogens","correct":false,"justification":"Decreased estrogen"},{"idx":2,"proposition":"Ectopic increase in estrogen production","correct":true},{"idx":3,"proposition":"The genetic absence or decrease of estrogen receptors","correct":false,"justification":"No effect"},{"idx":4,"proposition":"Iatrogenic decrease in androgen receptor availability","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"gynecomastie-endoc-2","context":null,"enonce":"Which of these proposals can cause gynecomastia?","item":"gynecomastie","matiere":"endoc","propositions":[{"idx":0,"proposition":"Hypogonadism","correct":true},{"idx":1,"proposition":"Hyperthyroidism","correct":true},{"idx":2,"proposition":"Syndrome de Klinefelter","correct":true},{"idx":3,"proposition":"Syndrome de Turner","correct":false,"justification":"Patients are women"},{"idx":4,"proposition":"Hyperprolactinemia","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"gynecomastie-endoc-3","context":null,"enonce":"What element(s) are included in the biological assessment of gynecomastia:","item":"gynecomastie","matiere":"endoc","propositions":[{"idx":0,"proposition":"hCG","correct":true},{"idx":1,"proposition":"NFS-P","correct":false,"justification":"The assessment contains (according to the College of Endocrinology): hCG, estradiol, testoserone, LH, FSH, Prolactin, TSH, Liver enzyme, Ionogram and Creatitine"},{"idx":2,"proposition":"Ferritin","correct":false},{"idx":3,"proposition":"DHEA","correct":false},{"idx":4,"proposition":"Lipase","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"gynecomastie-endoc-4","context":null,"enonce":"Which propositions are true?","item":"gynecomastie","matiere":"endoc","propositions":[{"idx":0,"proposition":"Adipomastia is a subcutaneous fat deposit next to the nipple","correct":true},{"idx":1,"proposition":"An increase in estrogen is a sign of Leydig cell tumor","correct":true},{"idx":2,"proposition":"An increase in estrogen may be a sign of a malignant adrenocortical carcinoma","correct":true},{"idx":3,"proposition":"Spironolactone can cause gynecomastia","correct":true},{"idx":4,"proposition":"A karyotype 47,XXY signs Klinefelter syndrome","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Sdmononuc-hemato-0","context":null,"enonce":"Regarding mononucleosis syndrome:","item":"Sdmononuc","matiere":"hemato","propositions":[{"idx":0,"proposition":"The diagnosis of mononucleosis syndrome is clinical","correct":false,"justification":"The diagnosis of mononucleosis syndrome is made on the leukocyte formula of the blood count"},{"idx":1,"proposition":"The diagnosis is made on a blood count showing a proportion > 5% of mononuclear cells in the leukocyte population","correct":false,"justification":"Diagnosis is made on the blood count and the leukocyte formula: proportion > 50% of mononuclear cells in the leukocyte population; and proportion > 10% of activated lymphocytes (increased size, polymorphs, basophilic staining)."},{"idx":2,"proposition":"Mononucleosis syndrome shows intense activation of cellular immunity","correct":true,"justification":"T cells are activated by a virus, most often"},{"idx":3,"proposition":"The presence on physical examination of lymphadenopathy and\/or angina should be sought on clinical examination.","correct":true,"justification":"TRUE. In EBV infection, fever and influenza-like syndrome are found with, on clinical examination, erythematous, erythematopultaceous or pseudomembranous angina, lymphadenopathy predominant in the cervical and posterior, splenomegaly and \/ or hepatomegaly (more rarely)"},{"idx":4,"proposition":"Other biological abnormalities can lead to a misdiagnosis of mononucleosis syndrome by the laboratory, especially in acute leukemia.","correct":true,"justification":"TRUE. Confusion between circulating blasts and activated T cells. In acute lymphoblastic leukemia, lymphocytes are immature and monomorphic."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Sdmononuc-hemato-1","context":null,"enonce":"Regarding mononucleosis syndrome:","item":"Sdmononuc","matiere":"hemato","propositions":[{"idx":0,"proposition":"An HIV infection is to be evoked systematically","correct":true,"justification":"TRUE. It's rarer than toxoplasmosis, CMV or EBV, but it's also much more serious."},{"idx":1,"proposition":"Some drug hypersensitivity reactions (to sulfonamides, ß-lactams, certain anticonvulsants...) can result in a mononucleosis syndrome","correct":true,"justification":"TRUE. This is the DRESS syndrome"},{"idx":2,"proposition":"A mononucleosis syndrome may accompany a DRESS syndrome (Drug Rash with hyperEosinophilia and Systemic Symptoms)","correct":true,"justification":"TRUE. Some drugs induce a viral reaction against certain viruses (present but asymptomatic), including EBV and CMV, causing severe toxiderma and containing a mononucleosic syndrome: this is the DRESS syndrome"},{"idx":3,"proposition":"The most common cause is primary infection with Epstein Barr virus.","correct":true,"justification":"TRUE. The Epstein Barr Virus (EBV) is the cause of infectious mononucleosis, or MNI. It is a DNA virus. The other two main causes are CMV infection (DNA virus too) and toxoplasmosis (intracellular parasitic zoonosis)"},{"idx":4,"proposition":"In the face of a mononucleosic syndrome, to look for primary EBV infection, a first-line serological search is carried out","correct":false,"justification":"First, a MNI-test is performed. This agglutination test is fast for diagnostic orientation, but not very sensitive."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Sdmononuc-hemato-2","context":null,"enonce":"About CMV: ","item":"Sdmononuc","matiere":"hemato","propositions":[{"idx":0,"proposition":"Transmission occurs through contact with infected shedding","correct":true},{"idx":1,"proposition":"It is the leading cause of mononucleosis syndrome","correct":false,"justification":"This is the second cause. The first cause is NIM (infectious mononucleosis), caused by the EBV virus."},{"idx":2,"proposition":"It is an RNA virus","correct":false,"justification":"DNA viruses"},{"idx":3,"proposition":"There is systematic screening for pregnancy","correct":false,"justification":"No systematic organized screening"},{"idx":4,"proposition":"In pregnancy, seroconversion can be serious\/fatal to the fetus","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Sdmononuc-hemato-3","context":null,"enonce":"About EBV:","item":"Sdmononuc","matiere":"hemato","propositions":[{"idx":0,"proposition":"It is the leading cause of mononucleosis syndrome","correct":true},{"idx":1,"proposition":"The virus has a tropism for B lymphocytes causing lymph node hyperplasia","correct":true},{"idx":2,"proposition":"It is a DNA virus","correct":true},{"idx":3,"proposition":"Transmission is sexual most of the time","correct":false,"justification":"Mostly salivary transmission"},{"idx":4,"proposition":"The MNI-test has low specificity and high sensitivity","correct":false,"justification":"Low sensitivity. The College of Hematology does not mention its specificity"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Sdmononuc-hemato-4","context":null,"enonce":"Regarding the ancillary causes of mononucleosis syndrome:","item":"Sdmononuc","matiere":"hemato","propositions":[{"idx":0,"proposition":"It can reveal HIV infection","correct":true},{"idx":1,"proposition":"Rickettsiosis are parasites that can cause this syndrome","correct":false,"justification":"These are bacteria"},{"idx":2,"proposition":"Hepatitis B and C viruses can cause this syndrome","correct":true},{"idx":3,"proposition":"Malaria is a possible cause","correct":true},{"idx":4,"proposition":"SCA ST+ can be accompanied by this syndrome because of muscle soreness","correct":false,"justification":"Nothing to see"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"herpes-infectio-0","context":null,"enonce":"Which of these virus proposals are not herpes viruses?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"HIV","correct":true},{"idx":1,"proposition":"VZV","correct":false},{"idx":2,"proposition":"EBV","correct":false},{"idx":3,"proposition":"Covid-19","correct":true},{"idx":4,"proposition":"CMV","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"herpes-infectio-1","context":null,"enonce":"Which of these virus proposals are not herpes viruses?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"HPV","correct":true},{"idx":1,"proposition":"CMV","correct":false},{"idx":2,"proposition":"HSV1","correct":false},{"idx":3,"proposition":"HSV2","correct":false},{"idx":4,"proposition":"HBV","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"herpes-infectio-2","context":null,"enonce":"Regarding herpes viruses:","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"These viruses are DNA","correct":true},{"idx":1,"proposition":"These viruses are double-stranded RNA","correct":false},{"idx":2,"proposition":"These viruses are single-stranded RNA","correct":false},{"idx":3,"proposition":"These viruses are enveloped","correct":true},{"idx":4,"proposition":"These viruses are naked","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"herpes-infectio-3","context":null,"enonce":"Which of these proposals are factors promoting primary post-infection reactivation?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"Stress","correct":true},{"idx":1,"proposition":"Prolonged exposure to the sun","correct":true,"justification":"For cutaneous tropism viruses such as HSV and VZV"},{"idx":2,"proposition":"Significant asthenia","correct":true},{"idx":3,"proposition":"The rules","correct":true},{"idx":4,"proposition":"Weekly sport","correct":false,"justification":"Unless it is a factor of major stress"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"herpes-infectio-4","context":null,"enonce":"Regarding the VZV:","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"It's the shingles virus only","correct":false,"justification":"Chickenpox too"},{"idx":1,"proposition":"Incubation of chickenpox is about 21 days","correct":false,"justification":"14 days after the Pilly 2020"},{"idx":2,"proposition":"Chickenpox is accompanied by a fever","correct":false,"justification":"True fever at 38°C-39°C"},{"idx":3,"proposition":"Rashes may be maculopapular at first","correct":true,"justification":"Scattered vesicles and pruritus with possible scratching lesions are then observed."},{"idx":4,"proposition":"Healing takes about 10 days","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"herpes-infectio-5","context":null,"enonce":"Which of these propositions is true?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"Herpes viruses are the second most common entity in infectious encephalitis","correct":false,"justification":"Herpes virus = first cause of infectious encephalitis"},{"idx":1,"proposition":"EBV is the most common cause of viral encephalitis.","correct":false,"justification":"HSV"},{"idx":2,"proposition":"HSV is responsible for about 33% of viral encephalitis","correct":true},{"idx":3,"proposition":"Primary HSV-1 infection is preferentially sexual","correct":false,"justification":"HSV-1 = oropharyngeal. HSV-2 = sexual."},{"idx":4,"proposition":"HSV-2 is more frequently responsible for encephality than HSV-1","correct":false,"justification":"HSV1 = 95% of HSV encephalitis"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"herpes-infectio-6","context":null,"enonce":"Which area(s) is\/are respected by chickenpox?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"The face","correct":false,"justification":"Only the extremities of the limbs are respected by chickenpox"},{"idx":1,"proposition":"Back","correct":false},{"idx":2,"proposition":"Hands","correct":true},{"idx":3,"proposition":"The belly","correct":false},{"idx":4,"proposition":"Buttocks","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"herpes-infectio-7","context":null,"enonce":"Which propositions are true?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"In case of genital lesions due to HSV-2 concomitant with late pregnancy, caesarean section is recommended","correct":true},{"idx":1,"proposition":"Aciclovir is an inhibitor of HSV DNA polymerase","correct":true},{"idx":2,"proposition":"Aciclovir will be phosphated 3 times before use","correct":true,"justification":"The active metabolite is therefore aciclovir-triphosphate"},{"idx":3,"proposition":"Valaciclovir is a predrug","correct":true,"justification":"It is better absorbed"},{"idx":4,"proposition":"All propositions are true","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"herpes-infectio-8","context":null,"enonce":"Which pathology(s) is\/are favored by HHV8?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"Ewing's sarcoma","correct":false,"justification":"Kaposi's sarcoma"},{"idx":1,"proposition":"HIV co-infection","correct":false,"justification":"The repository does not mention it in any case"},{"idx":2,"proposition":"Castleman's disease","correct":true},{"idx":3,"proposition":"Purulent meningitis","correct":false,"justification":"Viral meningitis is clear fluid most often"},{"idx":4,"proposition":"Acute anterior uveitis","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"herpes-infectio-9","context":null,"enonce":"Which elements of the blood count are greatly increased in case of infectious mononucleosis (EBV)?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"Monocytes","correct":false},{"idx":1,"proposition":"Lymphocytes","correct":true,"justification":"These are the hyperbasophilic lymphocytes"},{"idx":2,"proposition":"Neutrophils","correct":false},{"idx":3,"proposition":"Polynuclear eosinophils.","correct":false},{"idx":4,"proposition":"Leukocytes","correct":true,"justification":"And more specifically, lymphocytes"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"herpes-infectio-10","context":null,"enonce":"How many viruses are there belonging to the group of Herpes Viruses?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"5","correct":false},{"idx":1,"proposition":"6","correct":false},{"idx":2,"proposition":"7","correct":false},{"idx":3,"proposition":"8","correct":true,"justification":"VZV (varicella-zoster), CMV, EBV (mononucleosis), HSV1, HSV2, HHV6 (Castleman and Kaposi), HHV7, HHV8"},{"idx":4,"proposition":"9","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"herpes-infectio-11","context":null,"enonce":"Which of the following propositions about chickenpox are true?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"The elementary lesion is a vesicle","correct":true},{"idx":1,"proposition":"There are different age elements","correct":true},{"idx":2,"proposition":"Mucosa involvement may be found","correct":true},{"idx":3,"proposition":"Pruritus is absent","correct":false,"justification":"Pruritus is very present"},{"idx":4,"proposition":"Fever is absent","correct":false,"justification":"It can be very important"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"herpes-infectio-12","context":null,"enonce":"Which of the following propositions about chickenpox are true?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"The causative agent is HSV2","correct":false,"justification":"The causative agent is herpes virus type 3 or VZV (Shingles and Chickenpox virus)"},{"idx":1,"proposition":"It is contagious until D + 2 of the beginning of the eruption","correct":false,"justification":"Until the appearance of crusts in practice"},{"idx":2,"proposition":"Transmission is possible by droplets","correct":true},{"idx":3,"proposition":"Transmission is possible through direct contact","correct":true,"justification":"True, with mucocutaneous lesions"},{"idx":4,"proposition":"Incubation is about 4 weeks","correct":false,"justification":"About 2 weeks of incubation"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"preventionpsy-psy-0","context":null,"enonce":"General:","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"There are several types of risk factors: * social, * psychological, * biological","correct":true},{"idx":1,"proposition":"The age of the individual has little impact on his or her likelihood of developing a psychiatric disorder","correct":false,"justification":"Some risk factors are more specifically related to the age of the individual"},{"idx":2,"proposition":"Any situation of social and family isolation is a risk factor for psychiatric disorder","correct":true},{"idx":3,"proposition":"Any stressful social environment is a risk factor for psychiatric disorder","correct":true},{"idx":4,"proposition":"Primary prevention does not exist in psychiatry","correct":false,"justification":"There are three types of prevention: * primary prevention is the set of acts aimed at reducing the risk of new cases appearing (incidence)"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"preventionpsy-psy-1","context":null,"enonce":"General:","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Mental health is an integral part of health","correct":true},{"idx":1,"proposition":"Mental health is defined by the College of Physicians as \"a state of well-being in which a person can achieve self-fulfillment, overcome the normal stresses of life, perform productive work and contribute to the life of his community\"","correct":false,"justification":"The MDG does not make a definition. The latter comes from the WHO and is accurate"},{"idx":2,"proposition":"Psychiatric disorders are most often genetic in origin","correct":false,"justification":"Multifactorial and non-unique origin"},{"idx":3,"proposition":"Analytical epidemiology assesses the frequency and impact of psychiatric disorders","correct":false,"justification":"This is the role of descriptive epidemiology, while analytical epidemiology is concerned with the correlation and causal relationships between several variables (e.g. alcohol consumption and incidence of schizophrenia)."},{"idx":4,"proposition":"In France, about 3 million people suffer from a psychiatric disorder","correct":false,"justification":"In France, almost one in five people suffer from at least one psychiatric disorder, or 12 million people"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"preventionpsy-psy-2","context":null,"enonce":"On the impact of psychiatric pathologies:","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"The prevalence of psychiatric disorders in general practice is about 25%","correct":true},{"idx":1,"proposition":"Psychiatry pathologies are the 3rd most common disease, after cancer and cardiovascular diseases","correct":true},{"idx":2,"proposition":"Psychiatric disorders are a major cause of disability","correct":true},{"idx":3,"proposition":"Psychiatric disorders have no impact on mortality","correct":false,"justification":"They are associated with high mortality"},{"idx":4,"proposition":"The resulting socio-economic repercussions make it a major public health issue","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"preventionpsy-psy-3","context":null,"enonce":"Regarding analytical epidemiology:","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Analytical epidemiology identifies vulnerability, risk and prevention factors","correct":true},{"idx":1,"proposition":"A genetic factor is defined as a characteristic regarding DNA material and may be heritable","correct":true},{"idx":2,"proposition":"Genetic and environmental factors are distinct and mutually exclusive","correct":false,"justification":"Genetic and environmental factors can interact"},{"idx":3,"proposition":"A risk factor (genetic and\/or environmental) increases the likelihood of developing a disease","correct":true},{"idx":4,"proposition":"There are also genetic and\/or environmental protective factors that decrease the likelihood of disease occurring.","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"preventionpsy-psy-5","context":null,"enonce":"Regarding prevention:","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"According to the WHO: \"Prevention is the set of measures aimed at avoiding or reducing the number and severity of diseases, accidents and disabilities\"","correct":true},{"idx":1,"proposition":"Primary prevention is directly aimed at reducing prevalence","correct":false,"justification":"Primary prevention is the set of acts aimed at reducing the risk of new cases (= incidence and not prevalence, which can only be reduced by cure or time)"},{"idx":2,"proposition":"Primary prevention aims globally to improve the quality of life and living conditions of individuals","correct":true},{"idx":3,"proposition":"Primary prevention of psychiatric disorders, says WHO, should also aim to strengthen social integration","correct":true},{"idx":4,"proposition":"The objective of secondary prevention is to reduce the prevalence of a disease in a population","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"preventionpsy-psy-7","context":null,"enonce":"Regarding adolescence:","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"This is a critical period for psychic development","correct":true},{"idx":1,"proposition":"Harassment at work explains almost all possible psychiatric pathologies of adolescents","correct":false,"justification":"False for two reasons: we talk about school bullying at this age (except in special cases), and bullying is not the main risk factor for neurodevelopmental disorders (even if it is a very strong risk factor)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"preventionpsy-psy-8","context":null,"enonce":"Which pathologies are more common in women?","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"CAW","correct":true},{"idx":1,"proposition":"Chronic hallucinatory psychosis","correct":true},{"idx":2,"proposition":"Conduct disorder","correct":true},{"idx":3,"proposition":"Schyzophrenia","correct":false,"justification":"Sex ratio almost to 1"},{"idx":4,"proposition":"Depression","correct":true,"justification":"Sex ratio at 1.7 F\/H"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"preventionpsy-psy-9","context":null,"enonce":"Which pathologies are more common in men?","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"CAW","correct":false,"justification":"Plûtot in girls"},{"idx":1,"proposition":"Erotomanic delirium","correct":false,"justification":"Rather in the female sex"},{"idx":2,"proposition":"Social phobia","correct":false,"justification":"Rather in the female sex"},{"idx":3,"proposition":"Conduct disorder","correct":true},{"idx":4,"proposition":"Delirium of claim","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"preventionpsy-psy-11","context":null,"enonce":"What are the real proposals regarding primary prevention?","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"It decreases morbidity and mortality directly","correct":false,"justification":"It aims to reduce the incidence of"},{"idx":1,"proposition":"It increases the general quality of life of individuals","correct":true},{"idx":2,"proposition":"It directly decreases the prevalence","correct":false,"justification":"It is secondary prevention that aims to reduce the prevalence"},{"idx":3,"proposition":"It directly reduces disability","correct":false,"justification":"This is the case of tertiary prevention"},{"idx":4,"proposition":"It is part of general public health actions","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"preventionpsy-psy-12","context":null,"enonce":"Which propositions are true?","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Mental health is the absence of mental disorders","correct":false,"justification":"A much more complex definition given by the WHO and which boils down to the sufficient degree of adaptation to the social group"},{"idx":1,"proposition":"Mental health is \"a state of well-being in which a person can achieve self-fulfillment, overcome the normal stresses of life, perform productive work and contribute to the life of his or her community.\"","correct":true},{"idx":2,"proposition":"Only biological and social factors impact mental health ","correct":false,"justification":"3 factors: biological, psychological and social"},{"idx":3,"proposition":"Psychiatric disorders affect 1 in 2 French people","correct":false,"justification":"12% of the population. 25% of consultations in general practice"},{"idx":4,"proposition":"Psychiatric disorders are the 8th type of disease in terms of prevalence","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"valeurspro-sp-0","context":null,"enonce":"Regarding the code of medical ethics:","item":"valeurspro","matiere":"sp","propositions":[{"idx":0,"proposition":"The committee for the protection of persons makes it possible to involve citizens in ethical reflection.","correct":false,"justification":"It is the National Consultative Ethics Committee (CCNE) whose one of its objectives is to involve citizens in ethical reflection."},{"idx":1,"proposition":"Medical ethics is the \"set of rules and duties that govern medical practice and individual relationships vis-à-vis the practice concerning their patients and colleagues\"","correct":true},{"idx":2,"proposition":"The ethical principles in the medical field are: Primum non nocere, beneficence, patient autonomy and justice\/equity.","correct":true},{"idx":3,"proposition":"It serves as a reference for criminal courts","correct":false,"justification":"It serves as a reference for the judicial bodies of doctors, the Order but first and foremost as a guide to doctors in their daily practice, at the service of patients. 23 iKB PUBLIC HEALTH 2.CODE OF MEDICAL ETHICS 2.1. HISTORY The Hippocratic Oath: from the Code of Ethics"},{"idx":4,"proposition":"The Hippocratic Oath has nothing to do with the Code of Ethics","correct":false,"justification":"Always used to take an oath of the Code of Ethics: 1st version"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"valeurspro-sp-1","context":null,"enonce":"Regarding the patient's freedoms:","item":"valeurspro","matiere":"sp","propositions":[{"idx":0,"proposition":"He is free to choose his doctor","correct":true},{"idx":1,"proposition":"He is free to refuse care","correct":true},{"idx":2,"proposition":"He is free to choose his medication","correct":false,"justification":"He is completely free to refuse to take medication if he does not want to. He cannot, however, oblige a doctor to prescribe a specific medicinal product."},{"idx":3,"proposition":"It is free to require the prescription of originators instead of generics","correct":false,"justification":"He can ask. The doctor can accept if necessary. But he is in no way entitled to oblige the doctor"},{"idx":4,"proposition":"His freedom is reinforced by the doctor's duty to inform","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"valeurspro-sp-2","context":null,"enonce":"Which of the following are true?","item":"valeurspro","matiere":"sp","propositions":[{"idx":0,"proposition":"Medical ethics is the \"set of duties imposed on professionals in the exercise of their profession\" ","correct":true},{"idx":1,"proposition":"Deontology brings together the elements of a discourse on duties","correct":true},{"idx":2,"proposition":"Medical ethics concerns the doctor who exercises a profession in the strict sense of the term, to which French laws have given for nearly two centuries a monopoly in the field of health","correct":true},{"idx":3,"proposition":"The patient has the fundamental freedom to choose his or her physician and to accept or refuse care ","correct":true},{"idx":4,"proposition":"Medical acts cannot be tried by a court because it does not have the jurisdiction to do so. ","correct":false,"justification":"May be tried at the criminal, civil, administrative or disciplinary level"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"antalgie-therapeutique-0","context":null,"enonce":"Regarding the basics:","item":"antalgie","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Drugs used to treat nociceptive pain are classified into three tiers by WHO","correct":true},{"idx":1,"proposition":"Co-analgesic drugs are contraindicated when administering true analgesic","correct":false,"justification":"Specific drugs for neuropathic pain as well as so-called \"coanalgesic\" drugs can be combined with analgesics at WHO levels"},{"idx":2,"proposition":"Non-drug therapies are useless in times of crisis and should be reserved for cold periods","correct":false,"justification":"Non-drug therapies, alone or as part of multimodal analgesia in combination with drug therapies, can reduce the intensity of acute or chronic pain"},{"idx":3,"proposition":"The benefit\/risk balance should be evaluated before the administration of analgesic therapies, except in case of 10\/10 pain.","correct":false,"justification":"It should be systematically evaluated"},{"idx":4,"proposition":"Pain relief is a fundamental right of every person","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"antalgie-therapeutique-1","context":null,"enonce":"Major bases:","item":"antalgie","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"The source of the pain will need to be treated before the pain itself is treated","correct":true},{"idx":1,"proposition":"Placebos have no effect on acute pain","correct":false,"justification":"There is no ethical or scientific rationale for using placebos, even though 30-70% of patients seem sensitive to them to varying degrees."},{"idx":2,"proposition":"Optimal treatment results from a proprietary medication approach that relieves pain","correct":false,"justification":"Optimal treatment results from the combination of several approaches, both drug and non-drug, ideally coordinated by a multidisciplinary team"},{"idx":3,"proposition":"Non-therapeutic approaches have several interests, so that of limiting iatrogeny","correct":true,"justification":"It would allow an improvement in analgesia as well as a reduction in side effects via a decrease in the doses of each drug"},{"idx":4,"proposition":"The source of the pain will need to be treated concomitantly with the pain itself","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"antalgie-therapeutique-3","context":null,"enonce":"Which propositions are true?","item":"antalgie","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"The WHO established a 3-tiered conceptual model in 1986 to guide pain management.","correct":true},{"idx":1,"proposition":"Therapeutic pain management always begins at level 1 and then increases in step until it reaches the desired effectiveness","correct":false,"justification":"Not at all. We go directly to the most suitable level"},{"idx":2,"proposition":"NSAIDs are contraindicated postoperatively if clearance < 50 ml\/min","correct":true},{"idx":3,"proposition":"The choice of level is based on the assessment of the intensity of the pain","correct":true},{"idx":4,"proposition":"Moderate pain assessed between 3 and 7 requires a level 3 analgesic","correct":false,"justification":"Moderate pain is 4 to 6\/10 and requires a level 2"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"puberte-gyn-0","context":null,"enonce":"General:","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"Puberty in girls begins with the appearance of the breast bud","correct":true},{"idx":1,"proposition":"The absence of breast development at the age of 13 makes it possible to define a pubertal delay","correct":true},{"idx":2,"proposition":"Primary amenorrhea at the age of 15 can define delayed puberty","correct":true},{"idx":3,"proposition":"Puberty lasts an average of 2 years","correct":false,"justification":"On average 4 years"},{"idx":4,"proposition":"Puberty includes accelerated growth rate","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"puberte-gyn-1","context":null,"enonce":"Regarding the gonadotropic axis:","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"The gonadotropic axis is functional for the first time during puberty","correct":false,"justification":"This gonadotropic axis is functional during intrauterine life and for a few weeks after birth"},{"idx":1,"proposition":"\"Mini puberty\" is seen during the few weeks postpartum in infants","correct":true},{"idx":2,"proposition":"During childhood, the gonadotropic axis is inhibited","correct":true},{"idx":3,"proposition":"Puberty is the consequence of the pulsatile secretion of GnRH by pituitary neurons","correct":false,"justification":"GnRH is secreted by hypothalamic neurons"},{"idx":4,"proposition":"The gonadal steroid is estradiol in girls","correct":true,"justification":"And testosterone in the boy"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"puberte-gyn-2","context":null,"enonce":"Regarding the onset of puberty","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"The age of onset of puberty depends on genetic factors only","correct":false,"justification":"Also environmental factors, especially nutrition and energy expenditure"},{"idx":1,"proposition":"Obese children have puberty later than children in the general population","correct":false,"justification":"Earlier"},{"idx":2,"proposition":"Excessive physical exertion or lack of sleep induces delayed puberty","correct":true},{"idx":3,"proposition":"In girls, the first sign of puberty is enlarged breasts","correct":true},{"idx":4,"proposition":"In boys, the first sign of puberty is increased muscle volume","correct":false,"justification":"Increased testicular volume"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"puberte-gyn-3","context":null,"enonce":"Regarding the clinical signs of puberty:","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"Pubarche is the appearance of pubic hair","correct":true,"justification":"And it's not a sign of puberty"},{"idx":1,"proposition":"Llyel stages follow breast development","correct":false,"justification":"Tanner Stadium (not Turner, mind you)"},{"idx":2,"proposition":"The stage S2 or appearance of the breast bud corresponds to the telarche","correct":true},{"idx":3,"proposition":"Stage S2 occurs on average at the age of 16","correct":false,"justification":"Rather 10– or 11 years"},{"idx":4,"proposition":"The vulva changes from the horizontal to the vertical position","correct":false,"justification":"It changes from the vertical position to the horizontal position, the labia minora develop, the clitoral volume increases"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"puberte-gyn-4","context":null,"enonce":"Clinical signs of puberty:","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"The onset of menstruation is the first stage of puberty","correct":false,"justification":"First breast development and then changes in the vulva"},{"idx":1,"proposition":"In France, the average age of menarche is 16.9 years","correct":false,"justification":"12.5 years on average"},{"idx":2,"proposition":"An irregularity of the cycles during the first 2 years after menarche should lead to explore the pathology","correct":false,"justification":"It's physiological"},{"idx":3,"proposition":"In boys, Tanner's stadiums range from G1 to G3","correct":false,"justification":"From G1 (G for Gonad) to G5"},{"idx":4,"proposition":"The development of testicular size begins on average around the age of 11.5 years","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"puberte-gyn-5","context":null,"enonce":"General:","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"Testicular volume greater than 4 mL or height greater than 2.5 cm is in favour of early puberty","correct":true},{"idx":1,"proposition":"Normal adult testicular volume is greater than 35 mL","correct":false,"justification":"Greater than 16 mL"},{"idx":2,"proposition":"The onset of puberty coincides with the appearance of capitatum","correct":false,"justification":"The onset of puberty coincides with the appearance of the sesamoid of the thumb, on the bone age X-ray performed on the left wrist in right-handed people and vice versa."},{"idx":3,"proposition":"At puberty, there is an acceleration of the growth rate from 5 mm\/year to 9 mm\/year","correct":false,"justification":"From 5 or 6 cm\/year to 7 to 9 cm\/year"},{"idx":4,"proposition":"The peak of growth occurs in the girl around the age of 12","correct":true,"justification":"And 14 years for the boy"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"puberte-gyn-6","context":null,"enonce":"Regarding pubertal growth and precocious puberty:","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"Total pubertal growth averages 25 cm in boys","correct":true,"justification":"And 20cm in girls"},{"idx":1,"proposition":"Final height is reached on average at 21 years in boys","correct":false,"justification":"At 16 for girls and 18 for boys"},{"idx":2,"proposition":"There is during puberty a major increase in lean mass compared to fat mass, in girls","correct":false,"justification":"Especially fat mass in girls"},{"idx":3,"proposition":"When breast development occurs before the age of 8 in girls, it is called precocious puberty","correct":true,"justification":"And it's 9 years in the boy"},{"idx":4,"proposition":"Precocious puberty affects 15% of boys today","correct":false,"justification":"It is rather rare: 0.2% of girls and 0.05% of boys"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"puberte-gyn-7","context":null,"enonce":"Regarding precocious puberty and advanced puberty:","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"Precocious puberty is 10 times more common in boys than in girls","correct":false,"justification":"Converse: it is 10 times more common in girls than in boys"},{"idx":1,"proposition":"Puberty is said to be advanced when it occurs between 8 and 10 years of age in girls","correct":true,"justification":"And between 9 and 11 years old in boys"},{"idx":2,"proposition":"Advanced puberty is as pathological as precocious puberty","correct":false,"justification":"It is not pathological at all"},{"idx":3,"proposition":"Precocious puberty is of central or hypothalamic-pituitary origin","correct":false,"justification":"Precocious puberty can be a \"true\" puberty of central or hypothalamic-pituitary origin or a \"pseudo puberty\" of peripheral origin, either of gonadal or adrenal origin"},{"idx":4,"proposition":"Precocious puberty is not pathological","correct":false,"justification":"Precocious puberty is idiopathic in 90% of cases in girls, it is pathological in 66% of cases in boys"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"puberte-gyn-9","context":null,"enonce":"Which of these proposals are possible etiologies of precocious puberty?","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"Optic chiasma glioma","correct":true,"justification":"Which impacts the pituitary gland"},{"idx":1,"proposition":"History of brain radiation therapy","correct":true},{"idx":2,"proposition":"Type 2 diabetes","correct":false},{"idx":3,"proposition":"Syndrome de Turner","correct":false,"justification":"No puberty"},{"idx":4,"proposition":"Syndrome de McCune-Albright","correct":true,"justification":"Associated with café au lait spots and fibrous bone dysplasia. Resulting from a mutation in the GNAS gene\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"puberte-gyn-10","context":null,"enonce":"Regarding puberty:","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"The main impact of precocious puberty in the long term is the permanent small size","correct":true},{"idx":1,"proposition":"Pubertal delay should be evoked in boys in the absence of an increase in testicular volume at the age of 14 years","correct":true},{"idx":2,"proposition":"Pubertal delay is always acquired","correct":false,"justification":"Pubertal delay can be congenital or acquired"},{"idx":3,"proposition":"A family investigation is necessary in case of pubertal delay","correct":true,"justification":"At the interrogation ++"},{"idx":4,"proposition":"Pubertal delay is always of central origin","correct":false,"justification":"Pubertal delay can be of central or peripheral origin"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PeCKc-onco-0","context":null,"enonce":"Among these proposals, which are times of the announcement device?","item":"PeCKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Caregiver accompaniment time","correct":true},{"idx":1,"proposition":"Medical time","correct":true},{"idx":2,"proposition":"The patient's time","correct":false},{"idx":3,"proposition":"Time for questions","correct":false},{"idx":4,"proposition":"Shock time","correct":false,"justification":"The 4 times of an announcement consultation are, in order: the medical time, the time of caregiver accompaniment, the time of support care and the time of articulation with the city medicine"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PeCKc-onco-1","context":null,"enonce":"Which of these proposals belongs to level 3 analgesics?","item":"PeCKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Paracetamol","correct":false,"justification":"Level 1"},{"idx":1,"proposition":"NSAIDs","correct":false,"justification":"Level 2"},{"idx":2,"proposition":"Tramadol","correct":false,"justification":"Level 2"},{"idx":3,"proposition":"Oxycodone","correct":true},{"idx":4,"proposition":"Fentanyl","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PeCKc-onco-2","context":null,"enonce":"Which of these proposals is(are) supportive care?","item":"PeCKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Social monitoring","correct":true},{"idx":1,"proposition":"Psychological support","correct":true},{"idx":2,"proposition":"Anti-emetic treatment of chemotherapy","correct":true},{"idx":3,"proposition":"Hormone therapy for breast cancer","correct":false,"justification":"It is a basic disease treatment"},{"idx":4,"proposition":"Pain management","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PeCKc-onco-3","context":null,"enonce":"Which of these proposals concerning medical information are true?","item":"PeCKc","matiere":"onco","propositions":[{"idx":0,"proposition":"It must be appropriate","correct":true},{"idx":1,"proposition":"It must go into scientific details","correct":false,"justification":"It must be fair but understandable"},{"idx":2,"proposition":"It must be loyal","correct":true},{"idx":3,"proposition":"Information must be repeated","correct":true,"justification":"And we must ensure that the patient has understood and integrated it by asking him to reformulate"},{"idx":4,"proposition":"The information must be verified with relatives before being delivered to the patient","correct":false,"justification":"Medical confidentiality contravenes this proposal"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PeCKc-onco-4","context":null,"enonce":"Regarding taking oral morphine:","item":"PeCKc","matiere":"onco","propositions":[{"idx":0,"proposition":"It is contraindicated except in end-of-life care","correct":false,"justification":"It is an essential treatment for pain"},{"idx":1,"proposition":"It is usually established at a dose of 10 mg \/ day","correct":false,"justification":"Instead, it is introduced at 60 mg\/D."},{"idx":2,"proposition":"There is no maximum dose common to all patients","correct":true,"justification":"The dose-efficacy-tolerability relationship varies greatly from one patient to another. It is therefore important to frequently evaluate efficacy and tolerability, and to adapt the dosage gradually according to the patient's needs. There is no maximum dose, as long as adverse effects can be controlled."},{"idx":3,"proposition":"The only effect of morphine is analgesic","correct":false},{"idx":4,"proposition":"The main side effect is digestive","correct":true,"justification":"Morphine is constipative"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PeCKc-onco-5","context":null,"enonce":"Regarding Supportive Oncology Care:","item":"PeCKc","matiere":"onco","propositions":[{"idx":0,"proposition":"It facilitates the use of active euthanasia","correct":false,"justification":"Absolutely not. Active euthanasia is illegal in France"},{"idx":1,"proposition":"It makes it possible to stop all treatments","correct":false,"justification":"We do not stop medications that have a positive effect on patient comfort"},{"idx":2,"proposition":"They are set up exclusively at the patient's home","correct":false,"justification":"Possible also in the hospital, or with relatives for example"},{"idx":3,"proposition":"They call for more pain management","correct":false,"justification":"No more \"than elsewhere\", pain management is still essential"},{"idx":4,"proposition":"All proposals are wrong","correct":true,"justification":"The main goal is to improve the patient's comfort of life through better control of symptoms."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"traumacrane-urg-0","context":null,"enonce":"Which of the following propositions are true about Lefort's classification?","item":"traumacrane","matiere":"urg","propositions":[{"idx":0,"proposition":"Lefort III corresponds to an abnormal mobility of the upper dental arch compared to the base of the skull","correct":true},{"idx":1,"proposition":"Lefort III corresponds to an abnormal mobility of the dental arch superior compared to the eyebrow arch","correct":false,"justification":"Relative to the base of the skull"},{"idx":2,"proposition":"Lefort II corresponds to an abnormal mobility of the upper dental arch compared to the cheekbones","correct":true},{"idx":3,"proposition":"The most common fracture is the Lefort I","correct":false,"justification":"This is the Lefort II"},{"idx":4,"proposition":"The most serious fracture is the Lefort II","correct":false,"justification":"This is the Lefort III"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"traumacrane-urg-1","context":null,"enonce":"Which of the following are innervated by the mandibular V3 portion of the trigeminal nerve?","item":"traumacrane","matiere":"urg","propositions":[{"idx":0,"proposition":"Chin","correct":true},{"idx":1,"proposition":"Upper lip","correct":false,"justification":"Infraorbital nerve V2"},{"idx":2,"proposition":"Temporal muscle","correct":true},{"idx":3,"proposition":"Masseter muscle","correct":true},{"idx":4,"proposition":"Medial cheek","correct":false,"justification":"Lateral cheek (zygomatic process)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infdermato-infectio-0","context":null,"enonce":"Regarding mucocutaneous infections","item":"infdermato","matiere":"infectio","propositions":[{"idx":0,"proposition":"Pyogen skin infections are mainly due to Staphylococcus aureus and Streptococcus pyogenes (also called ß-hemolytic group C streptococcus)","correct":false,"justification":"From Group A"},{"idx":1,"proposition":" Impetigo is a contagious infection of the epidermis due to S.aures or S. pyogènes","correct":true},{"idx":2,"proposition":"Local treatment is most often sufficient in impetigo","correct":true},{"idx":3,"proposition":"Folliculitis and boils are infections of the pilosebaceous follicle","correct":true},{"idx":4,"proposition":"General antibiotic therapy is indicated in boils of the face because of the risk of malignant staphylococcal disease","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"infdermato-infectio-1","context":null,"enonce":"Regarding mucocutaneous infections","item":"infdermato","matiere":"infectio","propositions":[{"idx":0,"proposition":"The skin abscess is most often linked to S. pyogènes","correct":false,"justification":"The skin abscess is most often linked to S. aureus"},{"idx":1,"proposition":"The treatment of abscesses is essentially based on antibiotic therapy","correct":false,"justification":"Treatment is essentially surgical"},{"idx":2,"proposition":"Erysipelas is a necrotizing dermohypodermatitis mainly due to S. Aureus","correct":false,"justification":"Erysipelas is a non-necrotizing dermo-hypodermatitis mainly due to Streptococcus pyogenes"},{"idx":3,"proposition":"Diagnosis is clinical for erysipelas","correct":true},{"idx":4,"proposition":"Treatment of erysipelas is surgical","correct":false,"justification":"It is based on antibiotic therapy"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infdermato-infectio-2","context":null,"enonce":"Regarding mucocutaneous infections","item":"infdermato","matiere":"infectio","propositions":[{"idx":0,"proposition":"Superficial mycoses are frequent and benign infections of the epidermis and appendages due to fungi","correct":true},{"idx":1,"proposition":"The diagnosis of mycoses is essentially microbiological","correct":false},{"idx":2,"proposition":"In France, community Staphylococcus aureus are sensitive to methicillin in > 95% of cases and the reference antibiotic is penicillin M (cloxacillin)","correct":true,"justification":"TRUE (or Oxacillin)"},{"idx":3,"proposition":"Streptococcus pyogenes is 100% sensitive to penicillin and the reference antibiotic is amoxicillin","correct":true},{"idx":4,"proposition":"In case of allergy to ß-lactam in staphylococcal or streptococcal infections, pristinamycin or clindamycin is used.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infdermato-infectio-3","context":null,"enonce":"Which of the following propositions are true for osteitis of the foot in diabetic patients?","item":"infdermato","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is common in diabetes","correct":true},{"idx":1,"proposition":"It predominates at the heel","correct":false,"justification":"From the forefoot"},{"idx":2,"proposition":"It is due to vascular involvement only","correct":false,"justification":"Not only: neuropathic impairment too"},{"idx":3,"proposition":"It exposes to a risk of amputation","correct":true},{"idx":4,"proposition":"None of the propositions are true","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infdermato-infectio-4","context":null,"enonce":"Which of the following propositions are true about impetigo?","item":"infdermato","matiere":"infectio","propositions":[{"idx":0,"proposition":"S. aureus and S. pyogenes are the two most common germs found in impetigos","correct":true},{"idx":1,"proposition":"Diagnosis requires bacteriological sampling before starting antibiotic therapy","correct":false,"justification":"The diagnosis of impetigo is clinical"},{"idx":2,"proposition":"Impetigo is not contagious","correct":false,"justification":"Impetigo is contagious"},{"idx":3,"proposition":"Treatment of simple impetigo is based on doxycycline","correct":false,"justification":"Fusidic acid in topical application"},{"idx":4,"proposition":"Soap helps loosen bacteria","correct":true,"justification":"True, and water rinse them. Daily washing with soap and water of the lesions is a measure to advise in all cases"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infdermato-dermato-1","context":null,"enonce":"Regarding mucocutaneous infections","item":"infdermato","matiere":"dermato","propositions":[{"idx":0,"proposition":"There is no fever in impetigos","correct":true},{"idx":1,"proposition":"Ecthyma is a common pathology of precariousness","correct":true},{"idx":2,"proposition":"Complications of ecthyma include post-strep throat and rheumatic fever","correct":true},{"idx":3,"proposition":"Control of proteinuria 3 weeks after the infectious episode is necessary","correct":true},{"idx":4,"proposition":"Folliculitis is inflammatory papulopustulous in nature","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infdermato-dermato-2","context":null,"enonce":"Regarding mucocutaneous infections","item":"infdermato","matiere":"dermato","propositions":[{"idx":0,"proposition":"The boil is a deep but non-necrotizing infection of the pilosebaceous follicle","correct":false,"justification":"It is necrotizing"},{"idx":1,"proposition":"Handling of boils by the patient should be avoided","correct":true},{"idx":2,"proposition":"For boils, oral systemic antibiotic therapy if necessary should be active on S. Aureus","correct":true},{"idx":3,"proposition":"Panari is an elementary lesion of the erythematous, edematous and painful nail fold","correct":true},{"idx":4,"proposition":"Incision and drainage in case of purulent collection of a panari are necessary","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"agranulocytose-onco-0","context":null,"enonce":"Which of these propositions are true?","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"Agranulocytosis can be toxic or infectious","correct":false,"justification":"There are two possible causes of agranulocytosis: either it is immunoallergic or it is toxic. Infections do not cause agranulocytosis, on the contrary, there is an increase in PNN as part of the immune response"},{"idx":1,"proposition":"True agranulocytosis is defined by a PNN threshold of less than 1 G\/L","correct":false,"justification":"The threshold for true agranulocytosis is set at 0.2G\/L. Deep neutropenia is defined at 0.5G\/L"},{"idx":2,"proposition":"Neutropenia corresponds to ANCs less than 1 G\/L","correct":false,"justification":"The threshold for neutropenia is set at 1.5 G\/L"},{"idx":3,"proposition":"Agranulocytosis corresponds to a sharp and dangerous drop in the number of monocytes in the blood","correct":false,"justification":"Monocytosis (i.e. dendritic cells and macrophages) do not fit into the definitional framework of agranulocytosis. Agranulocytosis is defined by the fall of neutrophils (PNNs) in the blood"},{"idx":4,"proposition":"Agranulocytosis accounts for less than 3% of iatrogenic accidents","correct":true,"justification":"The college reports 2.4%"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"agranulocytose-onco-1","context":null,"enonce":"Which of these propositions are true?","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"Agranulocytosis is objectivable by a hemogram","correct":true,"justification":"True agranulocytosis is observed when the PNN is less than 0.2 G\/L. However, we can speak of agranulocytosis in case of PNN less than 0.5 G \/ L (which is the threshold for severe neutropenia, grade IV);  The risk of infection is then very important."},{"idx":1,"proposition":"5% of deaths are observed even with optimal care","correct":true},{"idx":2,"proposition":"The main complication is hemostatic","correct":false,"justification":"It is infectious"},{"idx":3,"proposition":"Toxic agranulocytosis most often affects a single cell line","correct":false,"justification":"This is the case of immunoallergic (iatrogenic) agranulocytosis. Toxic agranulocytosis often leads to pancytopenia"},{"idx":4,"proposition":"Toxic agranulocytosis is now less common than drug-induced agranulocytosis","correct":false,"justification":"Drug agranulocytosis is acute, brutal and has given the phenomenon its formidable reputation; But it has actually become a minority today, since the eviction of pyramidon and phenylbutazone derivatives."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"agranulocytose-onco-2","context":null,"enonce":"Which of these proposals are causes of agranulocytosis?","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"Bone marrow suppression","correct":true},{"idx":1,"proposition":"Acute leukemia","correct":true},{"idx":2,"proposition":"Bone metastasis","correct":false,"justification":"Bone metastases that do not affect flat bones (sternum, hip bones and vertebrae) cannot have any impact on the bone marrow since there are no more in these bones. Vertebral metastases very rarely have spinal cord invasion."},{"idx":3,"proposition":"Drug iatrogenesis","correct":true},{"idx":4,"proposition":"Myelodysplastic syndromes","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"agranulocytose-onco-3","context":null,"enonce":"At what threshold, in G\/L, can we speak of severe neutropenia (i.e. agranulocytosis)?","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"1.5","correct":false,"justification":"Threshold for neutropenia"},{"idx":1,"proposition":"1","correct":false},{"idx":2,"proposition":"0.5","correct":true,"justification":"It is from here that the risk of infection becomes extremely high."},{"idx":3,"proposition":"0.2","correct":false,"justification":"This is the threshold of \"true agranulocytosis\""},{"idx":4,"proposition":"0.1","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"agranulocytose-onco-4","context":null,"enonce":"From what threshold, in G \/ L, can we speak of true agranulocytosis?","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"1.5","correct":false,"justification":"Alone for neutropenia"},{"idx":1,"proposition":"1","correct":false},{"idx":2,"proposition":"0.5","correct":false,"justification":"Threshold for severe neutropenia (stage IV)"},{"idx":3,"proposition":"0.2","correct":true,"justification":"This is the threshold of \"true agranulocytosis\""},{"idx":4,"proposition":"0.1","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"agranulocytose-onco-5","context":null,"enonce":"Which of these molecules are most likely to cause drug agranulocytosis?","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"Amoxicillin","correct":false},{"idx":1,"proposition":"Tamoxifen","correct":false},{"idx":2,"proposition":"Synthetic anti-thyroid drugs","correct":true,"justification":"The drugs most prone to drug agranulocytosis are: antipsychotics (especially clozapine), synthetic antithyroid drugs, allopurinol and colchicine, sulfonamide antibiotics (e.g. cotrimoxazole, aka bactrim) and anti-epileptic drugs."},{"idx":3,"proposition":"NSAIDs","correct":false},{"idx":4,"proposition":"None of these proposals","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"agranulocytose-onco-6","context":null,"enonce":"Which of these molecules are most likely to cause drug agranulocytosis?","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"PPIs","correct":false},{"idx":1,"proposition":"Methotrexate","correct":false},{"idx":2,"proposition":"La L-Tyroxine","correct":false},{"idx":3,"proposition":"Clozapine","correct":true,"justification":"The drugs most prone to drug agranulocytosis are: antipsychotics (especially clozapine), synthetic antithyroid drugs, allopurinol and colchicine, sulfonamide antibiotics (e.g. cotrimoxazole, aka bactrim) and anti-epileptic drugs."},{"idx":4,"proposition":"None of these proposals","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"agranulocytose-onco-7","context":null,"enonce":"Which of these propositions are true?","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"Neutropenia is rare in collagenosis","correct":false,"justification":"Collagenosis = connective tissue. It is very common. It is one of the classic biological signs in lupus"},{"idx":1,"proposition":"Most often, agranulocytosis is accompanied by a fall in other blood lines","correct":true,"justification":"Indeed, agranulocytosis is most often toxic (vs immunoallergic) and is accompanied by thrombocytopenia and anemia."},{"idx":2,"proposition":"In toxic agranulocytosis, the megakaryocytic lineage is respected","correct":false,"justification":"This type of agranulocytosis results in pancytopenia if left untreated. Initially, it is often accompanied by anemia and thrombocytopenia."},{"idx":3,"proposition":"Drug agranulocytosis is peripheral agranulocytosis","correct":true},{"idx":4,"proposition":"Toxic agranulocytosis is central agranulocytosis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"agranulocytose-onco-8","context":null,"enonce":"Regarding toxic agranulocytosis:","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"It is often due to radiation therapy","correct":false,"justification":"It is often chemotherapy that is involved. Indeed, these molecules inhibit cell division and therefore have an impact on all cell types that divide a lot. The bone marrow, which produces several billion red blood cells, platelets and immune cells every day, is therefore a target (often collateral and non-voluntary from a therapeutic point of view) of chemotherapy."},{"idx":1,"proposition":"It is unpredictable","correct":false,"justification":"It is predictable: we know the impact that molecules will have before administering them."},{"idx":2,"proposition":"It is time-dependent exclusively","correct":false,"justification":"It is mostly dose-dependent"},{"idx":3,"proposition":"It can lead to pancytopenia","correct":true},{"idx":4,"proposition":"Its mechanism is peripheral","correct":false,"justification":"Central mechanism by direct toxicity"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"agranulocytose-onco-9","context":null,"enonce":"Regarding immunoallergic agranulocytosis:","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"It concerns classical drug agranulocytosis","correct":true},{"idx":1,"proposition":"Its beginning is often brutal","correct":true},{"idx":2,"proposition":"The mechanism is peripheral","correct":true},{"idx":3,"proposition":"It is dose-dependent","correct":false,"justification":"No, it is independent of dose."},{"idx":4,"proposition":"It can take place when a drug is first introduced","correct":false,"justification":"An external gave us this sentence in the college: College of Hematology (2020 edition; page 122): \"toxicity may be due to treatment over a period of several days (even if first introduction of the drug)\". Warning: this sentence means that toxicity occurs after the first intake (because the cells must be sensitized a first time) but can occur during the first PERIOD of introduction (for example after ten days of treatment with amoxicillin) :) Good luck!!"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"agranulocytose-onco-10","context":null,"enonce":"Regarding myelogram and osteomedullary biopsy:","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"It is necessary for the diagnosis of toxic agranulocytosis","correct":false,"justification":"The blood count, knowledge of the drug and temporality are enough most of the time"},{"idx":1,"proposition":"It shows, in both types of agranulocytosis, a decrease in the richness of the marrow","correct":true},{"idx":2,"proposition":"BOM is done on long bones","correct":false,"justification":"Flat bones, often the sternum"},{"idx":3,"proposition":"It requires general anhesesia","correct":false,"justification":"It is not so painful but it causes a very unpleasant feeling of \"aspiration\""},{"idx":4,"proposition":"All proposals are wrong","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"diarrheechr-HGE-0","context":null,"enonce":"About chronic diarrhea","item":"diarrheechr","matiere":"HGE","propositions":[{"idx":0,"proposition":"In clinical practice, diarrhea, according to the WHO, is when there are at least 3 very soft to watery stools per day.","correct":true},{"idx":1,"proposition":"Chronic acute diarrhea is said to occur for more than a month","correct":false,"justification":"Diarrhea is said to be acute when it evolves for less than 2 weeks, prolonged when it evolves for 2 to 4 weeks, chronic when it evolves for more than a month"},{"idx":2,"proposition":"A polyexemption related to a dyschesic syndrome and \/ or a pelvic static disorder: • fecal incontinence; • False diarrhea of constipated are the three differential diagnoses to rule out","correct":true},{"idx":3,"proposition":"Nocturnal stools reflect the organic nature of diarrhea","correct":true},{"idx":4,"proposition":"It is important to look at weight, height, body mass index and weight loss kinetics when weight loss is lost","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"diarrheechr-HGE-1","context":null,"enonce":"About chronic diarrhea","item":"diarrheechr","matiere":"HGE","propositions":[{"idx":0,"proposition":"In front of any motor diarrhea it will be necessary to look for hyperthyroidism","correct":true},{"idx":1,"proposition":"Celiac disease is one of the most common causes of chronic diarrhea","correct":true},{"idx":2,"proposition":"Celiac disease is diagnosed in particular thanks to anticorsantigliadin and anti-endomysium","correct":false,"justification":"An antitransglutaminase and anti-endomysium"},{"idx":3,"proposition":"Functional chronic motor diarrhea is generally easily improved by slowing down transit","correct":true},{"idx":4,"proposition":"The appearance of moderate diarrhea without significant biological abnormality in an adult with no personal history of functional intestinal disorders should suggest, among other hypotheses, pancreatic cancer and\/or carcinomosis.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diarrheechr-HGE-2","context":null,"enonce":"About chronic diarrhea","item":"diarrheechr","matiere":"HGE","propositions":[{"idx":0,"proposition":"In case of diarrhea on return from travel it is necessary to look for chronic parasitosis","correct":true},{"idx":1,"proposition":"During motor diarrhea, watery stools typically occur upon waking and post-prandial","correct":true},{"idx":2,"proposition":"The transit time of carmine red is accelerated during motor diarrhea","correct":true},{"idx":3,"proposition":"Malabsorption diarrhea can be responsible for deficiencies and weight loss despite preserved food intakes","correct":true},{"idx":4,"proposition":"The stools are distributed over the day, voluminous, sometimes visibly greasy in osmotic diarrhea","correct":false,"justification":"This is the case for diarrhoea due to malabsorption"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diarrheechr-HGE-3","context":null,"enonce":"Which of the following proposals should be avoided in the case of a gluten-free diet?","item":"diarrheechr","matiere":"HGE","propositions":[{"idx":0,"proposition":"Wheat","correct":true},{"idx":1,"proposition":"Rice","correct":false},{"idx":2,"proposition":"Maize","correct":false},{"idx":3,"proposition":"Rye","correct":true},{"idx":4,"proposition":"Barley","correct":true,"justification":"Wheat, rye, barley and oats"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcrein-onco-2","context":null,"enonce":"Among these organs, which are preferentially the site of metastases of kidney cancers?","item":"Kcrein","matiere":"onco","propositions":[{"idx":0,"proposition":"Bone","correct":true},{"idx":1,"proposition":"Bladder","correct":false},{"idx":2,"proposition":"Liver","correct":true},{"idx":3,"proposition":"Lungs","correct":true,"justification":"The 5 locations to remember are: CNS, Liver, Lungs, Bones, Lymph nodes. The most affected lymph nodes are those of the renal hilum and those of the retroperitoneum. Also to remember: kidney tumors have an accentuated tropism for the two glands that are the adrenal glands and the prostate."},{"idx":4,"proposition":"EMB","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"hemoptysie-pneumo-0","context":null,"enonce":"Which of these proposals designates a criterion of severity of hemoptysis?","item":"hemoptysie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Less than 9 g\/dL hemoglobin","correct":false},{"idx":1,"proposition":"A hemoglobin less than 11 g\/dL in a woman who had a real period 1 week ago","correct":false,"justification":"The severity of hemoptysis is not at all in the loss of hemoglobin. It is very rare, impossible way for hemoptysis to cause hemodynamic instability of any kind. The main severity is asphyxiation."},{"idx":2,"proposition":"Bulky bleeding","correct":true,"justification":"It is often said that it is important at more than 250 mL"},{"idx":3,"proposition":"Orthostatic hypotension","correct":false},{"idx":4,"proposition":"All propositions are true","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemoptysie-pneumo-1","context":null,"enonce":"Which of the following are true?","item":"hemoptysie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"A hemoptysis is a nosebleed","correct":false,"justification":"This is epistaxis"},{"idx":1,"proposition":"An epistaxis is digestive bleeding","correct":false,"justification":"This is the hematemesis"},{"idx":2,"proposition":"A rectal bleeding is bleeding from the rectum","correct":true,"justification":"True, sorry for the ease but we had to find a fifth proposal 😅"},{"idx":3,"proposition":"A hematemesis is digestive bleeding ","correct":true},{"idx":4,"proposition":"A hemoptysis is bleeding from the respiratory mucous membranes","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemoptysie-pneumo-3","context":null,"enonce":"Which of the following is the possible cause of death for haemoptysis?","item":"hemoptysie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Hemorrhagic 🩸 shock","correct":false,"justification":"Too little blood lost"},{"idx":1,"proposition":"Cardiogenic 💘 shock","correct":false,"justification":"No cardiac impact"},{"idx":2,"proposition":"Asphyxia 🌬","correct":true},{"idx":3,"proposition":"Digestive obstruction by posterior passage of blood","correct":false,"justification":"Blood is expectorated during reflex coughing efforts most often"},{"idx":4,"proposition":"There are no deaths due to hemoptysis","correct":false,"justification":"It's rare but possible"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemoptysie-pneumo-4","context":null,"enonce":"Regarding hemoptysis:","item":"hemoptysie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The main causes of hemoptysis are COPD and right heart failure","correct":false,"justification":"Bronchiectasis, bronchopulmonary cancers, tuberculosis, aspergillomas are the main causes of hemoptysis"},{"idx":1,"proposition":"The management of severe hemoptysis is multidisciplinary involving pulmonologists, resuscitators, radiologists but never thoracic surgeons","correct":false,"justification":"Sometimes, when the EAB does not work, surgical management is required"},{"idx":2,"proposition":"Bronchial artery embolization is central to the management of severe hemoptysis","correct":true},{"idx":3,"proposition":"Hemoptysis corresponds to bleeding, externalized or not, of the nasal mucosa","correct":false,"justification":"Hemoptysis corresponds to bleeding, externalized or not, from the subglottic airways"},{"idx":4,"proposition":"Hemoptysis reflects the existence of an abnormality in the bronchi","correct":false,"justification":"Hemoptysis indicates the existence of an abnormality that can sit on all floors of the respiratory system"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemoptysie-pneumo-5","context":null,"enonce":"Which of the following are the severity elements of hemoptysis?","item":"hemoptysie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Hypotension","correct":false,"justification":"Severity is judged on asphyxiation and not hemodynamic involvement (there is classically none. When there is, it is caused by asphyxiation)"},{"idx":1,"proposition":"Tachycardia","correct":false,"justification":"Severity is judged on asphyxiation and not hemodynamic involvement (there is classically none. When there is, it is caused by asphyxiation)"},{"idx":2,"proposition":"Bleeding > 200 mL","correct":true},{"idx":3,"proposition":"Uncontrollable desaturation","correct":true},{"idx":4,"proposition":"Hemoptysis is never serious","correct":false,"justification":"It can go as far as death by asphyxiation"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemoptysie-pneumo-6","context":null,"enonce":"Which of the following are common causes of hemoptysis?","item":"hemoptysie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Bronchopulmonary cancer","correct":true},{"idx":1,"proposition":"chronic obstructive pulmonary disease","correct":false,"justification":"No hemoptysis"},{"idx":2,"proposition":"Sarcoidosis","correct":false,"justification":"Not described in colleges"},{"idx":3,"proposition":"Aspergillosis","correct":true},{"idx":4,"proposition":"Pulomaire embolism","correct":true,"justification":"True, this is one of the criteria of the Geneva Score"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemoptysie-pneumo-7","context":null,"enonce":"Which of the following are true?","item":"hemoptysie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Haemoptysis is to be distinguished from haematemesis and epistaxis, based on the clinic","correct":true,"justification":"False"},{"idx":1,"proposition":"A hemoptysis < 20mL is benign","correct":false,"justification":"A hemoptysis should always be considered an emergency"},{"idx":2,"proposition":"The management of severe hemoptysis is multidisciplinary involving pulmonologists, resuscitators, radiologists and sometimes thoracic surgeons","correct":true,"justification":"False"},{"idx":3,"proposition":"Bronchial artery embolization is central to the management of severe hemoptysis","correct":true,"justification":"False"},{"idx":4,"proposition":"It reflects the existence of an abnormality that can sit on all floors of the respiratory system","correct":true,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcsein-onco-0","context":null,"enonce":"Which of the following immunotherapies is conditioned by HER2 overexpression?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Cetuximab","correct":false,"justification":"EGF-R inhibitor (especially colorectal cancer or lung tumours)"},{"idx":1,"proposition":"Bevacizumab","correct":false,"justification":"Direct anti-EGF. Used, according to Wikipedia, in colorectal cancer, lung, breast, kidney and ovarian cancers, and glioblastoma"},{"idx":2,"proposition":"Trastuzumab","correct":true,"justification":"True, it's the anti-HER2 antibody"},{"idx":3,"proposition":"Pembrolizumab","correct":false,"justification":"Anti-PDL1 (melanoma, Hodgkin's disease and non–small cell lung tumours)"},{"idx":4,"proposition":"Ipilimumab","correct":false,"justification":"Anti-CTLA4 (melanoma and high-grade kidney tumour)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcsein-onco-1","context":null,"enonce":"Which of the following are true?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Breast cancer is the most common cancer in women","correct":true},{"idx":1,"proposition":"Breast cancer is part of mass screening","correct":true},{"idx":2,"proposition":"Breast cancer does not affect men","correct":false,"justification":"It is much rarer than in women but there are"},{"idx":3,"proposition":"Breast cancer is the second leading cause of cancer death in women","correct":false,"justification":"It is the leading cause of cancer death in women"},{"idx":4,"proposition":"Breast cancer can affect women at any age","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcsein-onco-2","context":null,"enonce":"What is the TNM stage of a 3-centimetre invasive ductal carcinoma with mobile axillary lymphadenopathy without metastatic extension?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"T2N1M0","correct":true,"justification":"True. Tumor > 2 and ≤ 5cm. Mobile homolateral axillary lymphadenopathy. No distant metastasis."},{"idx":1,"proposition":"T3N2M0","correct":false,"justification":"False"},{"idx":2,"proposition":"T2N2M0","correct":false,"justification":"False"},{"idx":3,"proposition":"T3N2M0","correct":false,"justification":"False"},{"idx":4,"proposition":"T1N2M0","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcsein-onco-3","context":null,"enonce":"Which of the following are possible options for breast cancer extension assessment?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Chest X-ray + abdominal ultrasound + bone scintigraphy","correct":true},{"idx":1,"proposition":"Chest X-ray + bone scintigraphy","correct":false,"justification":"You have to see the belly:)"},{"idx":2,"proposition":"TED-CT","correct":true},{"idx":3,"proposition":"Brain MRI","correct":false,"justification":"Only on point of call"},{"idx":4,"proposition":"CT-TAP and bone scintigraphy","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcsein-onco-4","context":null,"enonce":"Which of the following are true about the BRCA1 mutation?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Inheritance is autosomal dominant","correct":true},{"idx":1,"proposition":"Inheritance is autosomal recessive","correct":false,"justification":"False"},{"idx":2,"proposition":"The risk of transmission to offspring is about 25%","correct":false,"justification":"False"},{"idx":3,"proposition":"The risk of transmission to offspring is about 50%","correct":true},{"idx":4,"proposition":"None of the propositions are true","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcsein-onco-5","context":null,"enonce":"Inflammatory carcinoma directly classifies the tumour into:","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"T4a","correct":false,"justification":"Wall infiltration alone"},{"idx":1,"proposition":"T4b","correct":false,"justification":"Skin infiltration alone"},{"idx":2,"proposition":"T4c","correct":false,"justification":"Infiltration of the wall and skin"},{"idx":3,"proposition":"T4d","correct":true,"justification":"True, inflammatory carcinoma"},{"idx":4,"proposition":"T5","correct":false,"justification":"The T5 does not exist. It is T4d which is the maximum"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcsein-onco-7","context":null,"enonce":"Which of the following are expected toxicities during anthracycline treatment?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Bladder toxicity","correct":false,"justification":"False"},{"idx":1,"proposition":"Heart failure","correct":true,"justification":"True, by dilated cardiomyopathy"},{"idx":2,"proposition":"Coronary vasospasm","correct":false,"justification":"False"},{"idx":3,"proposition":"Encephalopathy","correct":false,"justification":"False"},{"idx":4,"proposition":"Hand-foot syndrome","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcsein-onco-8","context":null,"enonce":"Which of the following are poor prognosis criteria?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Hormone receptor positive","correct":false,"justification":"It is a criterion of good prognosis because accessible to hormonal treatment"},{"idx":1,"proposition":"SBR III","correct":true,"justification":"True, also called Elston and Ellis. Grade III is the maximum grade"},{"idx":2,"proposition":"HER2 overexpressed","correct":true},{"idx":3,"proposition":"Lymph node invasion","correct":true},{"idx":4,"proposition":"Ki67% = 70%","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcsein-onco-10","context":null,"enonce":"You biopsy a macroscopic lesion of the right breast. Which of the following propositions should appear in the histopathological report?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"The expression of PD-L1","correct":false,"justification":"Useless in breast cancer"},{"idx":1,"proposition":"SAR status","correct":false,"justification":"Not wanted for breast cancer (but lung or colorectal tumours)"},{"idx":2,"proposition":"HER2 status","correct":true,"justification":"True, as well as the Ki67 proliferation index"},{"idx":3,"proposition":"The SBR grade","correct":true,"justification":"True, also called Elston Ellis grade"},{"idx":4,"proposition":"The degree of expression of hormone receptors","correct":true,"justification":"True, prognostic and therapeutic goal (if positive, adjuvant hormone therapy will be prescribed)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcsein-onco-11","context":null,"enonce":"Which of the following are histological and immunohistochemical criteria useful for better characterizing the tumor?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Overexpression of HER-2","correct":true},{"idx":1,"proposition":"Proliferation index (percentage of cells expressing Ki67)","correct":true},{"idx":2,"proposition":"Expression of estrogen receptors","correct":true},{"idx":3,"proposition":"Expression of progresterone receptors","correct":true},{"idx":4,"proposition":"Classification BI-RADS","correct":false,"justification":"Radiological classification"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcsein-onco-12","context":null,"enonce":"Among the following proposals, what are the essential steps before therapeutic management?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Discussion in Multidisciplinary Consultation Meeting","correct":true},{"idx":1,"proposition":"Ad consultation in the rules of the art","correct":true},{"idx":2,"proposition":"Request for ALD by a specialist","correct":false,"justification":"False. A request must be made for ALD, but it is the attending physician who makes the request"},{"idx":3,"proposition":"Work stoppage","correct":false,"justification":"False. Discuss with patient. It is not essential."},{"idx":4,"proposition":"Genetic testing for BRCA1\/2 mutations","correct":false,"justification":"False. Not at all systematic."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcsein-onco-13","context":null,"enonce":"Which of the following proposals are included in conventional adjuvant chemotherapy for breast cancer?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Anthracycline","correct":true},{"idx":1,"proposition":"Taxane","correct":true},{"idx":2,"proposition":"Topoisomerase II inhibitors","correct":true,"justification":"True, these are anthracyclines"},{"idx":3,"proposition":"Polymerase inhibitors ","correct":false,"justification":"False. Taxanes are inhibitors of depolymerization"},{"idx":4,"proposition":"Antifolic","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diplopie-ophtalmo-0","context":null,"enonce":"Which of the following are diagnoses to evoke in front of a non-painful binocular diplopia?","item":"diplopie","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Head trauma ","correct":true,"justification":"True, with isolated involvement of the abducens nerve (which innervates the lateral right)."},{"idx":1,"proposition":"Diabetes","correct":true,"justification":"True, with common oculomotor nerve involvement. Pain is very inconsistent in diabetics"},{"idx":2,"proposition":"Occipital cerebral hemorrhage","correct":false,"justification":"No diplopia in this territory"},{"idx":3,"proposition":"Myasthenia","correct":true,"justification":"True, with the features of myasthenia gravis (ptosis, increased at the end of the day, etc.)"},{"idx":4,"proposition":"Ischemic stroke of the brainstem","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diplopie-ophtalmo-1","context":null,"enonce":"Which of the following are causes of painful diplopia?","item":"diplopie","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Myasthenia","correct":false,"justification":"No pain"},{"idx":1,"proposition":"Graves' disease","correct":false,"justification":"Classically non-painful exophthalmos"},{"idx":2,"proposition":"Giant cell arteritis","correct":true,"justification":"True, or Horton's disease"},{"idx":3,"proposition":"Type 2 diabetes","correct":true},{"idx":4,"proposition":"Cataract","correct":false,"justification":"No pain"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diplopie-ophtalmo-2","context":null,"enonce":"Which of the following are true?","item":"diplopie","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The common oculomotor nerve innervates the superior rectus muscle","correct":true,"justification":"True, it also innervates the inferior rectus muscle, the inferior oblique muscle, and the medial rectus muscle. It is the nerve that innervates the most muscle of oculomotricity. It also innervates the eyelid levator and ensures the parasympathetic innervation of the pupil"},{"idx":1,"proposition":"The abducens nerve innervates the medial rectus muscle","correct":false,"justification":"As its name suggests, it deals with the abduction of the eye. It therefore innervates the lateral right"},{"idx":2,"proposition":"The trochlear nerve innervates the superior oblique muscle","correct":true,"justification":"True. This is the only muscle it innervates"},{"idx":3,"proposition":"The common ocular motor nerve ensures parasympathetic innervation of the pupil","correct":true},{"idx":4,"proposition":"The trochlear nerve innervates the levator muscle of the eyelid","correct":false,"justification":"It is the oculomotor nerve that innervates the levator muscle of the eyelid"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diplopie-ophtalmo-3","context":null,"enonce":"Which of the following are diagnoses to evoke in front of painful binocular diplopia?","item":"diplopie","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"An aneurysm of the carotid end","correct":true,"justification":"True, the aneurysm can reach the common oculomotor nerve. The latter ensuring the parasympathetic innervation of the pupil, its involvement can cause mydriasis (intrinsic involvement)"},{"idx":1,"proposition":"Diabetes","correct":true,"justification":"True, it is the most common even if the pain is inconstant, as always in diabetics"},{"idx":2,"proposition":"Claude-Bernard-Horner syndrome (CBH)","correct":false,"justification":"There is no diplopia in CBH. There is ptosis, myosis, and enophthalmos. Normally, there is no pain either (unless combined with carotid dissection)"},{"idx":3,"proposition":"A stroke","correct":true,"justification":"True, any focal neurological deficit must evoke a stroke"},{"idx":4,"proposition":"All these propositions are accurate","correct":false,"justification":"Not the HBC"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"diplopie-ophtalmo-4","context":null,"enonce":"Which of the following are true?","item":"diplopie","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The medial rectus muscle is innervated by the third pair of cranial nerves","correct":true},{"idx":1,"proposition":"The lateral rectus muscle is innervated by the third pair of cranial nerves","correct":false,"justification":"The lateral right is the only oculomotor muscle to be innervated by the VI pair (abducens nerve)"},{"idx":2,"proposition":"The inferior oblique muscle is innervated by the third pair of cranial nerves","correct":true},{"idx":3,"proposition":"The superior oblique muscle is innervated by the fourth pair of cranial nerves","correct":true,"justification":"True, the trochlear nerve"},{"idx":4,"proposition":"The superior rectus muscle is innervated by the fourth pair of cranial nerves","correct":false,"justification":"It is innervated by the common oculomotor nerve (third pair of cranial nerves)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diplopie-ophtalmo-5","context":null,"enonce":"Which of the following are causes of binocular diplopies?","item":"diplopie","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Ophthalmic nerve II paralysis","correct":false,"justification":"Paralysis of III, IV or VI"},{"idx":1,"proposition":"Paralysis of the VI abducens nerve","correct":true},{"idx":2,"proposition":"Myasthenia","correct":true},{"idx":3,"proposition":"Corneal pillowcase","correct":false,"justification":"Monocular diplopia"},{"idx":4,"proposition":"Nuclear cataract","correct":false,"justification":"Monocular diplopia"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diplopie-ophtalmo-6","context":null,"enonce":"Which of the following are causes of monocular diplopies?","item":"diplopie","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Significant astigmatism","correct":true},{"idx":1,"proposition":"Keratoconus","correct":true},{"idx":2,"proposition":"Cortical cataract","correct":false,"justification":"Nuclear cataract"},{"idx":3,"proposition":"Traumatic iridodialysis","correct":true},{"idx":4,"proposition":"Intracranial hypertension ","correct":false,"justification":"Binocular diplopia"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"glomeruloP-nephro-0","context":null,"enonce":"Regarding the basics:","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"Glomerular nephropathies are chronic diseases","correct":false,"justification":"There are acute and chronic glomerular nephropathies"},{"idx":1,"proposition":"Glomerular nephropathy is always the consequence of genetic diseases","correct":false,"justification":"Not always. They can be related to a metabolic, autoimmune, infectious disease, etc."},{"idx":2,"proposition":"Kidney damage may or may not be isolated","correct":true},{"idx":3,"proposition":"Diagnosis of glomerular nephropathies is based on Magnetic Resonance Imaging","correct":false,"justification":"Diagnosis is based on histology\/anapath"},{"idx":4,"proposition":"Diagnosis of glomerular nephropathy is based on identification of glomerular syndrome","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"glomeruloP-nephro-1","context":null,"enonce":"Regarding the diagnosis:","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"A glomerular pathology is evoked in front of proteinuria and \/ or hematuria","correct":true},{"idx":1,"proposition":"The presence of hypertension or edema eliminates the diagnosis of glomerular syndrome","correct":false,"justification":"Three signs may be associated with hematuria and\/or proteinuria: hypertension; Edema; renal impairment"},{"idx":2,"proposition":"In IgA nephropathy, there is no hematuria","correct":false,"justification":"The main symptom is recurrent macroscopic hematuria to which may be added microscopic hematuria"},{"idx":3,"proposition":"Nephrotic syndrome combines proteinuria greater than 3g per 24h and albuminemia less than 30 g \/ L","correct":true},{"idx":4,"proposition":"HIVAN is a nephropathy associated with the HIV virus","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"glomeruloP-nephro-2","context":null,"enonce":"Among these proposals, which correspond to a glomerular syndrome:","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"Recurrent macroscopic hematuria syndrome","correct":true},{"idx":1,"proposition":"Acute nephritic syndrome","correct":true},{"idx":2,"proposition":"Proximal tubular syndrome","correct":false,"justification":"It does not exist"},{"idx":3,"proposition":"Le syndrome de Fanconi","correct":false,"justification":"It is an abnormality of proximal renal tubular reabsorption"},{"idx":4,"proposition":"The nephrotic syndrone","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"glomeruloP-nephro-3","context":null,"enonce":"Regarding the diagnosis:","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"Measuring ANCA tests the diagnostic hypothesis of lupus","correct":false,"justification":"For lupus, anti-nuclear antibodies and native anti-DNA are measured"},{"idx":1,"proposition":"Antiplatelet agents should be discontinued in case of renal biopsy","correct":true,"justification":"Stop several days before the gesture: 5 days for aspirin and 10 days for clopidogrel"},{"idx":2,"proposition":"In case of hemostasis disorder, it is possible to perform a transjugular PBR","correct":true},{"idx":3,"proposition":"Anti-glomerular basement membrane antibodies (MBG) test the diagnostic hypothesis of Alport syndrome","correct":false,"justification":"These antibodies are an argument for Goodpasture's disease"},{"idx":4,"proposition":"PBR is indicated in most glomerular nephropathy syndromes","correct":true,"justification":"Except for children between 1 and 10 years with pure nephrotic syndrome, hereditary glomerulopathies already documented, etc. (cf item 258, 8th edition of the college p. 151)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"glomeruloP-nephro-4","context":null,"enonce":"Secondary causes of GEM are:","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"Solid cancers","correct":true},{"idx":1,"proposition":"Lupus","correct":true},{"idx":2,"proposition":"NSAIDs ","correct":true},{"idx":3,"proposition":"Infectious causes such as HBV, HCV, syphilis, leprosy, filariasis ","correct":true},{"idx":4,"proposition":"We then find antibodies against PLA2-R. ","correct":false,"justification":"Primitive Qd"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"glomeruloP-nephro-5","context":null,"enonce":"Regarding the histology of glomerular syndromes:","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"Deposits are found in glomerulonephritis of ANCA vasculitis ","correct":false,"justification":"Hence < pauci > imminune"},{"idx":1,"proposition":"Sirius red colorartion allows you to see amyloid deposits ","correct":false,"justification":"Red Congo, Sirius for hepatic regeneration nodules"},{"idx":2,"proposition":"There is cell proliferation and deposits in the LGM","correct":false},{"idx":3,"proposition":"Linear IgA deposits along MBG are found in Goodpasture disease ","correct":false,"justification":"IgG"},{"idx":4,"proposition":"Accumulation of glycosylated extracellular matrix is found in diabetic nephropathy ","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"glomeruloP-nephro-6","context":null,"enonce":"Regarding IgA nephropathies: ","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"The primary form is called Berger's disease, it is the most common glomerulonephritis in the world","correct":true},{"idx":1,"proposition":"It mainly affects older women","correct":false,"justification":"Young men"},{"idx":2,"proposition":"IgA deposits can be secondary to diseases such as cirrhosis, IBD, spondyloartritis or bullous dermatosis","correct":true},{"idx":3,"proposition":"After liver transplantation, there is recurrence on the graft, without loss of the latter ","correct":true},{"idx":4,"proposition":"High blood pressure is a factor in poor prognosis","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"glomeruloP-nephro-7","context":null,"enonce":"Which of the following are prognostic factors for mesangial IgA glomerulonephritis?","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"The stage of renal failure at diagnosis","correct":true},{"idx":1,"proposition":"The severity of hypertension","correct":true,"justification":"True, a progression factor"},{"idx":2,"proposition":"The importance of proteinuria","correct":true,"justification":"True, a progression factor"},{"idx":3,"proposition":"Female sex","correct":false,"justification":"Male sex"},{"idx":4,"proposition":"The importance of glomerular sclerosis and interstitial fibrosis","correct":true,"justification":"True, at PBR"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"glomeruloP-nephro-9","context":null,"enonce":"Which of the following propositions regarding rapidly progressive glomerulonephritis (GNRP) are true?","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"They are usually characterized by severe endocapillary lesions","correct":false,"justification":"Extracapillary blooms"},{"idx":1,"proposition":"Immunofluorescence makes it possible to differentiate the 3 types of GNRP","correct":true,"justification":"True. Type 1: Goodpasture syndrome (IgG on MBG with linear deposition). Type 2: associated with deposits of IgG immunoglobulin complexes (rheumatoid purpura, LES, mixed cryoglobulinemia). Type 3: associated with vasculitis (Wegener and Polyangiitis) where ANCA is found"},{"idx":2,"proposition":"Goodpasture disease is linked to anti-PLA2R antibodies","correct":false,"justification":"This is the case of primary extramembranous glomerulonephritis (GEM)"},{"idx":3,"proposition":"Rheumatoid purpura is a cause of GNRP","correct":true,"justification":"True, IgA nephropathy"},{"idx":4,"proposition":"Depositions are linear in immunofluorescence in GEM","correct":false,"justification":"This is the case in Goodpasture syndrome"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"glomeruloP-nephro-10","context":null,"enonce":"Which of the following propositions about Goodpasture's syndrome are true?","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"It is a cause of pneumorenal syndrome","correct":true},{"idx":1,"proposition":"The antibody is directed against the alpha 3 chain of collagen IV","correct":true},{"idx":2,"proposition":"Treatment is based on corticosteroids, plasma exchange and cyclophosphamide","correct":true},{"idx":3,"proposition":"Renal prognosis is generally good","correct":false,"justification":"Unfortunately, renal replacement often happens quickly"},{"idx":4,"proposition":"There is frequently a biological inflammatory syndrome","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"glomeruloP-nephro-11","context":null,"enonce":"Which of the following proposals should be sought in the face of suspected glomerulonephritis?","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"Hearing loss","correct":true,"justification":"True, Alport syndrome"},{"idx":1,"proposition":"Macroscopic hematuria","correct":true,"justification":"True, glomerulonephritis with mesangial deposits of IgA"},{"idx":2,"proposition":"Lithium treatment","correct":false,"justification":"Responsible for tubulointerstitial nephritis, but not glomerular syndrome"},{"idx":3,"proposition":"Chronic hepatitis C","correct":true,"justification":"True, cryoglobulinemia (GNRP type 2) may be complicated."},{"idx":4,"proposition":"Periarteritis nodosa","correct":false,"justification":"No glomerular involvement, rather vascular nephropathy, unlike ANCA vasculitis (Wegener and Polyangiitis) which can make GNRP type 3"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"BK-infectio-1","context":null,"enonce":"About tuberculosis","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"Diagnosis of latent TB infection is based on the tuberculin RDI or interferon gamma test","correct":true},{"idx":1,"proposition":"Primary tuberculosis infection most often asymptomatic","correct":true},{"idx":2,"proposition":"Tuberculosis disease represents the clinical expression of infection, pulmonary or extrapulmonary","correct":true},{"idx":3,"proposition":"Pulmonary tuberculosis is the most common form","correct":true},{"idx":4,"proposition":"Extrapulmonary tuberculosis is highly contagious","correct":false,"justification":"Extrapulmonary tuberculosis is non-contagious"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"BK-infectio-2","context":null,"enonce":"About tuberculosis","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"The dissemination of a tuberculosis miliary is by lymphoid route","correct":false,"justification":"Miliarius tuberculosis = blood-borne dissemination"},{"idx":1,"proposition":"The declaration is mandatory to the ARS","correct":true},{"idx":2,"proposition":"Tuberculosis is a long-term condition","correct":true},{"idx":3,"proposition":"2nd line anti-tuberculosis drugs: are to be reserved for multidrug-resistant tuberculosis","correct":true},{"idx":4,"proposition":"Multidrug-resistant forms are those resistant to isoniazid and spiramycin.","correct":false,"justification":"Multi-resistance = isoniazid resistance +"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"BK-infectio-3","context":null,"enonce":"About tuberculosis","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is the 3rd leading cause of death from infectious disease in the world","correct":true},{"idx":1,"proposition":"ƒƒ in active tuberculosis, BK will have 3 phenotypes in 3 compartments: intracellular in macrophages, extracellular within the caseum, extracellular in caves","correct":true},{"idx":2,"proposition":"ƒƒ The cave is the main support for human-to-human transmission of BK through the air","correct":true},{"idx":3,"proposition":"Only 10% of individuals exposed to BK inoculum develop primary TB infection","correct":false,"justification":"Only 1\/3 of individuals exposed to BK inoculum develop primary TB infection"},{"idx":4,"proposition":"HAART makes it possible to detect the emrgence of naturally resistant mutants crossed","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"BK-infectio-4","context":null,"enonce":"Which of the following proposals are part of the tuberculosis complex?","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":" Mycobacterium tuberculosis","correct":true},{"idx":1,"proposition":"M. avium","correct":false,"justification":"M. tuberculosis, M. bovis, M. africanum"},{"idx":2,"proposition":"Mr. Bovis","correct":true},{"idx":3,"proposition":"Mr. africanum","correct":true},{"idx":4,"proposition":"M. pneumoniae","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"BK-infectio-5","context":null,"enonce":"To which organism(s) should TB infection be reported?","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"Tuberculosis Control Centre (CLAT)","correct":true,"justification":"True, urgently, nominative declaration that will investigate the case and the entourage"},{"idx":1,"proposition":"Directorate-General for Health","correct":false,"justification":"False"},{"idx":2,"proposition":"Regional Pharmacovigilance Centre (CRPV)","correct":false,"justification":"False"},{"idx":3,"proposition":"Regional Health Agency (ARS)","correct":true,"justification":"True, anonymous statement"},{"idx":4,"proposition":"Hospital management","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"BK-infectio-6","context":null,"enonce":"Which of the following propositions are true about quantiferon?","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"Its other name is IDR","correct":false,"justification":"The RDI is another immunological test. The other name for Quantiferon is the interferon gamma release test."},{"idx":1,"proposition":"It is very specific to infection with the tuberclosis complex","correct":true,"justification":"True. 98% specificity for tuberculosis complex bacteria: M. tuberculosis, M. bovis and M. africanum"},{"idx":2,"proposition":"He signs a tuberculosis disease","correct":false,"justification":"It signs a tuberculosis infection (including latent infection)."},{"idx":3,"proposition":"Positivity to this test does not give an indication of the recent or old nature of the infection","correct":true},{"idx":4,"proposition":"Positivity to this test is not influenced by BCG vaccination","correct":true,"justification":"True, unlike the IDR"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"BK-infectio-7","context":null,"enonce":"Which of the following propositions are true about tuberculosis?","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"Tuberculosis is the third leading cause of death from infectious disease worldwide","correct":true},{"idx":1,"proposition":"The annual incidence in children under 15 years of age in France is about 250","correct":true},{"idx":2,"proposition":"The proportion of direct tests positive is identical in children and adults","correct":false,"justification":"Much rarer to find BAAR in sputum in children, microscopic examination is positive in less than 20% of children with tuberculosis-disease. The culture is positive in less than 50% of cases.\r\nDespite this low profitability, microbiological research is systematic in the face of any suspicion of tuberculosis-disease. Their positivity will require screening around the child."},{"idx":3,"proposition":"In case of infection, the child under 2 years of age is more at risk of progressing immediately to tuberculosis-disease","correct":true},{"idx":4,"proposition":"The risk of transmission is zero if the patient has pulmonary tuberculosis with negative direct examination","correct":false,"justification":"Pulmonary tuberculosis = air isolation"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"BK-infectio-8","context":null,"enonce":"Which of the following propositions are true about tuberculosis?","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"Tuberculosis is the third leading cause of death from infectious disease worldwide","correct":true},{"idx":1,"proposition":"The annual incidence in children under 15 years of age in France is about 250","correct":true},{"idx":2,"proposition":"The proportion of direct tests positive is identical in children and adults","correct":false,"justification":"Much rarer to find BAAR in sputum in children, microscopic examination is positive in less than 20% of children with tuberculosis-disease. The culture is positive in less than 50% of cases.\r\nDespite this low profitability, microbiological research is systematic in the face of any suspicion of tuberculosis-disease."},{"idx":3,"proposition":"In case of infection, the child under 2 years of age is more at risk of progressing immediately to tuberculosis-disease","correct":true},{"idx":4,"proposition":"The risk of transmission is zero if the patient has pulmonary tuberculosis with negative direct examination","correct":false,"justification":"Pulmonary tuberculosis = air isolation"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"BK-infectio-9","context":null,"enonce":"Which of the following propositions are true about tuberculosis?","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"Tuberculosis is the third leading cause of death from infectious disease worldwide","correct":true},{"idx":1,"proposition":"The annual incidence in children under 15 years of age in France is about 250","correct":true},{"idx":2,"proposition":"The proportion of direct tests positive is identical in children and adults","correct":false,"justification":"Much rarer to find BAAR in sputum in children, microscopic examination is positive in less than 20% of children with tuberculosis-disease. The culture is positive in less than 50% of cases.\r\nDespite this low profitability, microbiological research is systematic in the face of any suspicion of tuberculosis-disease."},{"idx":3,"proposition":"In case of infection, the child under 2 years of age is more at risk of progressing immediately to tuberculosis-disease","correct":true},{"idx":4,"proposition":"The risk of transmission is zero if the patient has pulmonary tuberculosis with negative direct examination","correct":false,"justification":"Pulmonary tuberculosis = air isolation"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"BK-infectio-10","context":null,"enonce":"Which of the following propositions are true about tuberculosis?","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"Tuberculosis is the third leading cause of death from infectious disease worldwide","correct":true},{"idx":1,"proposition":"The annual incidence in children under 15 years of age in France is about 250","correct":true},{"idx":2,"proposition":"The proportion of direct tests positive is identical in children and adults","correct":false,"justification":"Much rarer to find BAAR in sputum in children, microscopic examination is positive in less than 20% of children with tuberculosis-disease. The culture is positive in less than 50% of cases.\r\nDespite this low profitability, microbiological research is systematic in the face of any suspicion of tuberculosis-disease."},{"idx":3,"proposition":"In case of infection, the child under 2 years of age is more at risk of progressing immediately to tuberculosis-disease","correct":true},{"idx":4,"proposition":"The risk of transmission is zero if the patient has pulmonary tuberculosis with negative direct examination","correct":false,"justification":"Pulmonary tuberculosis = air isolation"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"BK-infectio-11","context":null,"enonce":"Which of the following propositions are true about tuberculosis?","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"Tuberculosis is the third leading cause of death from infectious disease worldwide","correct":true},{"idx":1,"proposition":"The annual incidence in children under 15 years of age in France is about 250","correct":true},{"idx":2,"proposition":"The proportion of direct tests positive is identical in children and adults","correct":false,"justification":"Much rarer to find BAAR in sputum in children, microscopic examination is positive in less than 20% of children with tuberculosis-disease. The culture is positive in less than 50% of cases.\r\nDespite this low profitability, microbiological research is systematic in the face of any suspicion of tuberculosis-disease."},{"idx":3,"proposition":"In case of infection, the child under 2 years of age is more at risk of progressing immediately to tuberculosis-disease","correct":true},{"idx":4,"proposition":"The risk of transmission is zero if the patient has pulmonary tuberculosis with negative direct examination","correct":false,"justification":"Pulmonary tuberculosis = air isolation"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"BK-infectio-13","context":null,"enonce":"Which of the following are true for preventing transmission of TB during hospitalization?","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"Permanent wearing of a surgical mask by the patient in his room","correct":false,"justification":"Not so alone"},{"idx":1,"proposition":"Wearing an FFP2 mask by anyone entering the patient's room","correct":true},{"idx":2,"proposition":"In case of leaving the room, wearing a surgical mask by the patient","correct":true},{"idx":3,"proposition":"Removal of mask worn by staff before leaving the patient's room","correct":false,"justification":"Right at the exit"},{"idx":4,"proposition":"Single room with negative pressure for the patient","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"soinspal3-soinspal-0","context":null,"enonce":"Which of the following proposals designate countries that allow euthanasia?","item":"soinspal3","matiere":"soinspal","propositions":[{"idx":0,"proposition":"No country","correct":false,"justification":"Euthanasia is authorized in Switzerland, Holland, Belgium, Luxembourg and 3 American states"},{"idx":1,"proposition":"Sweden","correct":false,"justification":"False"},{"idx":2,"proposition":"Brazil","correct":false,"justification":"None"},{"idx":3,"proposition":"Belgium","correct":true,"justification":"None"},{"idx":4,"proposition":"Switzerland","correct":true,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"soinspal3-soinspal-1","context":null,"enonce":"Which of the following corresponds to a Rudkin score of 4?","item":"soinspal3","matiere":"soinspal","propositions":[{"idx":0,"proposition":"The patient is drowsy","correct":false,"justification":"Rudkin 2"},{"idx":1,"proposition":"The patient is awake","correct":false,"justification":"Rudkin 1"},{"idx":2,"proposition":"The patient does not respond to mild tactile stimulation and has his eyes closed","correct":false,"justification":"Rudkin 5"},{"idx":3,"proposition":"The patient responds to mild tactile stimulation and has his eyes closed","correct":true,"justification":"Rudkin 4"},{"idx":4,"proposition":"The patient has his eyes closed but answers the call","correct":false,"justification":"Rudkin 3"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"soinspal3-soinspal-2","context":null,"enonce":"Which of the following are true?","item":"soinspal3","matiere":"soinspal","propositions":[{"idx":0,"proposition":"An experience described as unbearable does not justify sedation in itself","correct":true},{"idx":1,"proposition":"Induction of sedation in adults is medically indicated only","correct":true},{"idx":2,"proposition":"The procedure for making a decision on sedation is the sole responsibility of the attending physician","correct":false,"justification":"The sedation decision-making procedure is collegial"},{"idx":3,"proposition":"The method of sedation is based on ketamine","correct":false,"justification":"The method of sedation is based on midazolam IV 1mg"},{"idx":4,"proposition":"Sedation decreases alertness and can lead to loss of consciousness","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"soinspal3-soinspal-3","context":null,"enonce":"Which of the following proposals designate countries that allow physician-assisted suicide?","item":"soinspal3","matiere":"soinspal","propositions":[{"idx":0,"proposition":"Switzerland","correct":true},{"idx":1,"proposition":"England","correct":false,"justification":"False"},{"idx":2,"proposition":"The France","correct":false,"justification":"False"},{"idx":3,"proposition":"Spain","correct":false,"justification":"False"},{"idx":4,"proposition":"The Netherlands","correct":true,"justification":"Countries that allow euthanasia are also those that allow physician-assisted suicide: Switzerland, Luxembourg, Belgium, Holland and 3 American states"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pancreatiteaigue-HGE-0","context":null,"enonce":"Regarding acute pancreatitis","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"idx":0,"proposition":"There are 2 forms: acute benign pancreatitis, called edematous, and acute necrotizing pancreatitis, potentially serious","correct":true},{"idx":1,"proposition":"The migration of a gallstone into the common bile duct or chronic and prolonged alcohol consumption, account for 80% of the causes","correct":true},{"idx":2,"proposition":"The clinical examination also looks for signs of severity, including visceral failure: polypnea, sign of extracellular dehydration, blood pressure instability and tachycardia, disorientation","correct":true},{"idx":3,"proposition":"Determination of pancreatic enzymes in the blood The determination of amylase should be preferred","correct":false,"justification":"Determination of pancreatic enzymes in the blood The determination of lipase should be preferred (better sensitivity and specificity), with a threshold of 3 N; that of amylasemia must be abandoned"},{"idx":4,"proposition":"The elevation of lipasemia is early, sometimes fleeting, reaching a maximum in 4 to 8 hours","correct":false,"justification":"The elevation of lipasemia is early, sometimes fleeting, reaching a maximum in 24 to 48 hours"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pancreatiteaigue-HGE-3","context":null,"enonce":"Which of the following are true?","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"idx":0,"proposition":"The incidence of acute pancreatitis is higher in men than in women","correct":true,"justification":"True, 30 per 100,000 in men vs. 20 per 100,000 in women"},{"idx":1,"proposition":"There are two forms to distinguish in acute pancreatitis (AP): edematous and necrotizing","correct":true},{"idx":2,"proposition":"The analgesic position is in gun dog ","correct":true},{"idx":3,"proposition":"To establish with certainty the diagnosis of acute pancreatitis, imaging is necessary","correct":false,"justification":"False, the diagnosis of certainty is made by the combination of typical abdominal pain and lipasemia > 3N"},{"idx":4,"proposition":"The Balthazar score is predictive of mortality and is based on a CT scan comprising a sequence with contrast injection","correct":true,"justification":"True, the CT scan is performed at best 48 to 72 hours after the onset of symptoms. Contrast medium injection assesses pancreatic necrosis"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pancreatiteaigue-urg-1","context":null,"enonce":"Regarding acute pancreatitis","item":"pancreatiteaigue","matiere":"urg","propositions":[{"idx":0,"proposition":"Organ failure is defined as cardiovascular shock, renal failure, Glasgow score < 13, thrombocytopenia < 80,000\/mm3 or gastrointestinal bleeding","correct":true},{"idx":1,"proposition":"Necrosis is defined by the presence of gangrenous pancreatic tissue","correct":false,"justification":"Necrosis is defined by the presence of invasive pancreatic tissue"},{"idx":2,"proposition":"The diagnosis of necrosis is established by the presence of focal or diffuse areas that do not take the contrast at the arterial time of a CT scan with injection of contrast medium","correct":true},{"idx":3,"proposition":"Hemorrhagic lesions in the pancreas or surrounding tissues are possible","correct":true},{"idx":4,"proposition":"Pseudocysts • A pseudocyst is a collection of pancreatic fluid, circumscribed by a wall, without epithelium","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"pancreatiteaigue-urg-2","context":null,"enonce":"Regarding acute pancreatitis","item":"pancreatiteaigue","matiere":"urg","propositions":[{"idx":0,"proposition":"The fluid of pseudocysts is most often inflammatory in nature rich in pancreatic enzymes and tissue and necrotic debris can superinfect","correct":true},{"idx":1,"proposition":"The formation of pseudocysts requires several hours","correct":false,"justification":"The formation of pseudocysts requires several weeks"},{"idx":2,"proposition":"Severe acute forms of pancreatitis represent, depending on the series, 10 to 30% of pancreatitis","correct":true},{"idx":3,"proposition":"• Cholelithiasis and alcohol poisoning are the most common causes of pancreatitis, observed in 35-45% of cases for each of them","correct":true},{"idx":4,"proposition":"• Drug and toxic etiologies are rare","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pancreatiteaigue-urg-3","context":null,"enonce":"Regarding chronic pancreatitis","item":"pancreatiteaigue","matiere":"urg","propositions":[{"idx":0,"proposition":"The reason for APs in the emergency department is most often acute abdominal pain syndrome","correct":true},{"idx":1,"proposition":"Diagnosis in the emergency department is based on a combination of intense epigastric abdominal pain with posterior irradiation and elevated amylasemia (> 3N)","correct":false,"justification":"Diagnosis in the emergency department is based on a combination of intense epigastric abdominal pain with posterior irradiation and elevated lipasemia (> 3N)"},{"idx":2,"proposition":"• Normal amylasemia does not exclude diagnosis","correct":true},{"idx":3,"proposition":"Chest X-ray is systematic at admission and looks for pleural effusions","correct":true},{"idx":4,"proposition":"• Pancreatic imaging is requested urgently systematically","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"amaigrissemt-nutri-0","context":null,"enonce":"Which propositions are true?","item":"amaigrissemt","matiere":"nutri","propositions":[{"idx":0,"proposition":"Weighing should be a systematic part of any clinical examination","correct":true},{"idx":1,"proposition":"Changing clothing sizes, belt circumference and previous photographs can help the practitioner in the absence of prior weight available.","correct":true},{"idx":2,"proposition":"The SEFI score is used to assess food intake","correct":true},{"idx":3,"proposition":"A SEFI < 9 defines undernutrition","correct":false,"justification":"A SEFI < 7 signs a risk of undernutrition"},{"idx":4,"proposition":"Skin examination makes it possible to objectify possible melanoderma","correct":true,"justification":"Or on the contrary a depigmentation, a conjunctival jaundice, a pallor"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"amaigrissemt-nutri-1","context":null,"enonce":"What is the correct BMI formula?","item":"amaigrissemt","matiere":"nutri","propositions":[{"idx":0,"proposition":"Weight in kg \/ height in m","correct":false},{"idx":1,"proposition":"Weight in kg \/ height in cm squared","correct":false},{"idx":2,"proposition":"Weight in kg \/ height in m squared","correct":true},{"idx":3,"proposition":"Weight in g \/ height in m squared","correct":false},{"idx":4,"proposition":"Weight in kg \/ the square of the height in meters","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"amaigrissemt-nutri-2","context":null,"enonce":"What are the possible etiologies of weight loss with involuntary food restriction?","item":"amaigrissemt","matiere":"nutri","propositions":[{"idx":0,"proposition":"A gastric bypass","correct":false,"justification":"No dietary restrictions in general"},{"idx":1,"proposition":"An ENT pathology","correct":false,"justification":"Rather a voluntary dietary restriction"},{"idx":2,"proposition":"An infectious pathology","correct":true},{"idx":3,"proposition":"Cancer","correct":true},{"idx":4,"proposition":"Hyperthyroidism","correct":false,"justification":"Weight loss without dietary restriction"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"amaigrissemt-nutri-3","context":null,"enonce":"What are the possible etiologies of weight loss without dietary restriction?","item":"amaigrissemt","matiere":"nutri","propositions":[{"idx":0,"proposition":"Decompensated diabetes","correct":true},{"idx":1,"proposition":"Hyperthyroidism","correct":true},{"idx":2,"proposition":"Anorexia nervosa","correct":false,"justification":"There is voluntary dietary restriction"},{"idx":3,"proposition":"Septic arthritis","correct":false,"justification":"Some inflammatory pathologies induce weight loss with involuntary food restriction"},{"idx":4,"proposition":"ENT Pathology","correct":false,"justification":"Weight loss with voluntary dietary restriction"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbmictionped-ped-0","context":null,"enonce":"General:","item":"tbmictionped","matiere":"ped","propositions":[{"idx":0,"proposition":"This is a very rare reason for consultation.","correct":false,"justification":"It is very common"},{"idx":1,"proposition":"The consultation is always conducted by a uro-pediatrician","correct":false,"justification":"Often the general practitioner in first consultation"},{"idx":2,"proposition":"About 12% of children aged 6 to 8 have urinary leakage","correct":true},{"idx":3,"proposition":"Urinary leakage is exclusively nocturnal from 6 years old","correct":false,"justification":"Daytime or nocturnal"},{"idx":4,"proposition":"The cause is most often organic","correct":false,"justification":"Functional"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbmictionped-ped-1","context":null,"enonce":"Regarding urination:","item":"tbmictionped","matiere":"ped","propositions":[{"idx":0,"proposition":"Physiological urination should result in complete emptying of the bladder","correct":true},{"idx":1,"proposition":"During urination, destrusor contracts","correct":true},{"idx":2,"proposition":"During urination, bladder sphictera contract","correct":false,"justification":"They relax in harmony with the contraction of the detrusor"},{"idx":3,"proposition":"The acquisition of voiding control is contemporary with birth","correct":false,"justification":"Usually between 18 months and 3 years"},{"idx":4,"proposition":"The diagnosis of a voiding disorder is clinical","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbmictionped-ped-2","context":null,"enonce":"Regarding the voiding catalogue:","item":"tbmictionped","matiere":"ped","propositions":[{"idx":0,"proposition":"It makes it possible to objectify certain urinary disorders","correct":true},{"idx":1,"proposition":"It quantifies the severity of the emergency","correct":true},{"idx":2,"proposition":"It takes place over 5 days","correct":false,"justification":"48 hours"},{"idx":3,"proposition":"It differentiates between the organic or functional nature of leaks","correct":false,"justification":"Above all, it allows to objectify the urinary disorder and to quantify the urgency"},{"idx":4,"proposition":"It requires increased patient compliance","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbmictionped-ped-3","context":null,"enonce":"Which of these proposals is\/are malformative uropathy(s)?","item":"tbmictionped","matiere":"ped","propositions":[{"idx":0,"proposition":"Lupus nephropathy","correct":false,"justification":"Not uropathy and not malformative"},{"idx":1,"proposition":"Epispadias","correct":true,"justification":"It occurs as a result of a defective migration of the primordial genital tubercles to the cloacal membrane, and therefore a malformation of the genital tubercle, around the 5th week of gestation."},{"idx":2,"proposition":"Micropenis","correct":false,"justification":"Not a uropathic malformation"},{"idx":3,"proposition":"Renal failure","correct":false,"justification":"Perhaps a consequence"},{"idx":4,"proposition":"Bladder tumour","correct":false,"justification":"Not a malformation"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbmictionped-ped-4","context":null,"enonce":"Regarding the clinical examination:","item":"tbmictionped","matiere":"ped","propositions":[{"idx":0,"proposition":"A urine strip is performed to rule out diabetes","correct":false,"justification":"To eliminate an infection"},{"idx":1,"proposition":"The search for a bladder globe is systematic","correct":true},{"idx":2,"proposition":"The appearance of the urinary stream is important to assess","correct":true},{"idx":3,"proposition":"The search for a fecal impaction is done at the digital rectal exam","correct":false,"justification":"The search for stercoral congestion is done on abdominal palpation"},{"idx":4,"proposition":"None of the propositions are true","correct":false,"justification":"FALSE"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbmictionped-ped-5","context":null,"enonce":"Regarding acute urine retention in children:","item":"tbmictionped","matiere":"ped","propositions":[{"idx":0,"proposition":"It is a therapeutic emergency ","correct":true},{"idx":1,"proposition":"It is defined by a complete and painful inability to urinate for more than 6 hours","correct":false,"justification":"For more than 12 hours"},{"idx":2,"proposition":"First-line treatment is ureteral catheterization","correct":false,"justification":"These are the measures to stimulate urination"},{"idx":3,"proposition":"Second-line treatment is suprapubic catheterization ","correct":false,"justification":"This is the simple ureteral probing"},{"idx":4,"proposition":"One of the possible etiologies is the adverse drug effect","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbmictionped-ped-6","context":null,"enonce":"Regarding the diagnosis:","item":"tbmictionped","matiere":"ped","propositions":[{"idx":0,"proposition":"Permanent leaks with preserved urination point to ureteral ectopic abouchement","correct":true},{"idx":1,"proposition":"Dysuria may point to a urinary disorder of the lower apparatus","correct":true,"justification":"No vesicosphincter dyssynergy"},{"idx":2,"proposition":"Isolated nocture enuresis is often of very little concern","correct":true},{"idx":3,"proposition":"Oxyurosis is an infectious cause of voiding disorders","correct":true},{"idx":4,"proposition":"Detrusorian hyperactivity causes pollakiuria","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbmictionped-ped-7","context":null,"enonce":"Regarding the diagnosis:","item":"tbmictionped","matiere":"ped","propositions":[{"idx":0,"proposition":"Pathology of the valves of the posterior urethra causes permanent leakage","correct":false,"justification":"Cause of dysuria"},{"idx":1,"proposition":"Functional detrusor hyperactivity causes emergency","correct":true},{"idx":2,"proposition":"Pollakiurias are often accompanied by urgency","correct":true},{"idx":3,"proposition":"A neuro-orthopedic disorder can cause emergency","correct":true},{"idx":4,"proposition":"Dysuria may be due to hyperactivity of the functional detrusor","correct":false,"justification":"Rather vesicosphincter dyssynergy"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbmictionped-ped-8","context":null,"enonce":"Regarding enuresis: ","item":"tbmictionped","matiere":"ped","propositions":[{"idx":0,"proposition":"It is associated with ADHD in 45% of cases","correct":false,"justification":"10% of cases"},{"idx":1,"proposition":"The positive diagnosis is made by flow-volume curve","correct":false,"justification":"Clinical diagnosis"},{"idx":2,"proposition":"It is said to be isolated when there are no daytime symptoms","correct":true},{"idx":3,"proposition":"It mainly concerns children under 5 years of age","correct":false,"justification":"More than 5 years"},{"idx":4,"proposition":"The leak is unintentional","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"peritonite-urg-0","context":null,"enonce":"Regarding acute peritonitis","item":"peritonite","matiere":"urg","propositions":[{"idx":0,"proposition":"The natural course of peritonitis is marked by a septic state that can be accompanied by septic shock that is often fatal.","correct":true},{"idx":1,"proposition":"In patients with underlying diseases, the occurrence of peritonitis often results in abrupt decompensation of the picture with an inaugural state of shock or multiple organ failure.","correct":true},{"idx":2,"proposition":"The maximum frequency of postoperative peritonitis occurs between 5 and 7 days after the procedure","correct":true},{"idx":3,"proposition":"Biological examinations are mainly used to assess the impact of the infection and to make a pre-operative assessment","correct":true},{"idx":4,"proposition":"In case of suspicion of peritonitis, as in the face of any suspicion of sepsis, blood cultures should be taken","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"peritonite-urg-1","context":null,"enonce":"Regarding acute peritonitis","item":"peritonite","matiere":"urg","propositions":[{"idx":0,"proposition":"The terrain plays an essential prognostic role: age, comorbidity, immunosuppression, undernutrition, obesity","correct":true},{"idx":1,"proposition":"The more proximal a perforation, the higher the septic risk","correct":false,"justification":"The more distal a perforation, the higher the septic risk (colonic stercoral peritonitis)"},{"idx":2,"proposition":"Postoperative peritonitis is a good prognosis","correct":false,"justification":"Postoperative peritonitis has a poor prognosis and the time to reintervention plays a major role"},{"idx":3,"proposition":"Regardless of the origin of peritonitis, the main prognostic factor is the precocity of surgical treatment","correct":true},{"idx":4,"proposition":"Other main diagnoses are mesenteric ischemia, chronic pancreatic (check for amylasemia), occlusions","correct":false,"justification":"Other main diagnoses are mesenteric ischemia, acute pancreatitis (lipasemia), occlusions"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"peritonite-urg-2","context":null,"enonce":"Regarding acute peritonitis","item":"peritonite","matiere":"urg","propositions":[{"idx":0,"proposition":"In case of spontaneous infection of ascites fluid, it is recommended to use macrolides combined with vascular albumin filling","correct":false,"justification":"In case of spontaneous infection of ascites fluid, it is recommended to use a 3rd generation cephalosporin, combined with vascular albumin filling"},{"idx":1,"proposition":"In case of infection on peritoneal dialysis, intraperitoneal antibiotic therapy is oriented on staphylococci, gram-negative and Candida (Vancomycin + aminoglycosides)","correct":true},{"idx":2,"proposition":"Removal of the dialysis catheter should be discussed according to the course","correct":true},{"idx":3,"proposition":"Treatment of secondary and tertiary peritonitis combines resuscitation and emergency surgical treatment","correct":true},{"idx":4,"proposition":"For localized forms with abscess formation, radiological or surgical drainage is useful and should be associated with the control of the causal focus by antibiotic therapy","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"peritonite-HGE-0","context":null,"enonce":"Regarding acute peritonitis","item":"peritonite","matiere":"HGE","propositions":[{"idx":0,"proposition":"Peritonitis is an acute inflammation of the peritoneum, localized or generalized, the cause of which is most often infectious","correct":true},{"idx":1,"proposition":"The diagnosis must therefore be rapid and treatment is an emergency in the vast majority of surgical cases","correct":true},{"idx":2,"proposition":"The Hamburg classification separates peritonitis into 5 classes according to the origin of the infection","correct":false,"justification":"The Hamburg classification separates peritonitis into 3 classes according to the origin of the infection"},{"idx":3,"proposition":"Secondary peritonitis accounts for 5% of acute peritonitis","correct":false,"justification":"Secondary peritonitis accounts for 90% of acute peritonitis"},{"idx":4,"proposition":"Primary peritonitis is due to a monobacterial spontaneous infection of the peritoneum of hematogenous origin or by translocation","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"peritonite-HGE-1","context":null,"enonce":"Regarding acute peritonitis","item":"peritonite","matiere":"HGE","propositions":[{"idx":0,"proposition":"Treatment of primary peritonitis is surgical","correct":false,"justification":"It is primarily medical, based on antibiotic therapy"},{"idx":1,"proposition":"The most common causes of primary peritonitis are ascites infection in cirrhosis; staphylococcus infection via the peritoneal catheter in patients with peritoneal dialysis; pneumococcal spontaneous peritonitis","correct":true},{"idx":2,"proposition":"Secondary peritonitis is related to the spread of a localized abdominal infection or perforation of a digestive viscera","correct":true},{"idx":3,"proposition":"Tertiary peritonitis corresponds to persistent abdominal infections despite treatment (adapted antibiotic therapy and eradication of the primary abdominal focus by one or more interventions)","correct":true},{"idx":4,"proposition":"The diagnosis of peritonitis is radiological","correct":false,"justification":"BDiagnostic positive The diagnosis of peritonitis is clinical and usually easy"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"peritonite-HGE-2","context":null,"enonce":"Regarding acute peritonitis","item":"peritonite","matiere":"HGE","propositions":[{"idx":0,"proposition":"Paraclinical examinations are useful to clarify the origin of peritonitis and \/ or plan management; under no circumstances should they delay treatment","correct":true},{"idx":1,"proposition":"The diagnosis of peritonitis is quickly made on physical examination in front of the presence of peritoneal signs","correct":true},{"idx":2,"proposition":"Contracture is the essential sign of acute peritonitis","correct":true},{"idx":3,"proposition":"Peritoneal signs may be moderate or absent, especially in the elderly, or malnourished","correct":true},{"idx":4,"proposition":"All peritonitis is accompanied by pneumoperitoneum","correct":false,"justification":"Be careful, not all peritonitis is accompanied by a pneumoperitoneum"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"peritonite-HGE-3","context":null,"enonce":"Regarding acute peritonitis","item":"peritonite","matiere":"HGE","propositions":[{"idx":0,"proposition":"The abdominal CT scan is the best examination when the clinical examination is doubtful (immunocompromised, asthenic peritonitis of the old man, obesity, post-operative peritonitis, traumatized abdomen)","correct":true},{"idx":1,"proposition":"The interrogation looks for a history of ulcer, recent use of gastrotoxic drugs","correct":true},{"idx":2,"proposition":"In an ulcer perforation generalized or localized contracture to the hypogastric region with defense in the rest of the abdomen","correct":false},{"idx":3,"proposition":"Upper GI endoscopy is formally contraindicated in peritonitis caused by ulcer perforation","correct":true},{"idx":4,"proposition":"There is no pneumoperitoneum in appendicular peritonitis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"RAU-urg-0","context":null,"enonce":"Which of the following are acute urine retention etiologies?","item":"RAU","matiere":"urg","propositions":[{"idx":0,"proposition":"Prostatitis","correct":true},{"idx":1,"proposition":"Enlarged prostate","correct":true},{"idx":2,"proposition":"Ureteral stenosis","correct":false,"justification":"Urethral stenosis, classic !!"},{"idx":3,"proposition":"Cholinergic drugs","correct":false,"justification":"Anticholinergic"},{"idx":4,"proposition":"Morphine","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"RAU-urg-1","context":null,"enonce":"Which of the following are contraindications to suprapubic catheterization?","item":"RAU","matiere":"urg","propositions":[{"idx":0,"proposition":"VKAs","correct":false},{"idx":1,"proposition":"Presence of laparotomy scars","correct":false,"justification":"True\r\nOn \r\nThe elimination of the presence of an intestinal loop by ultrasound is necessary beforehand"},{"idx":2,"proposition":"Hemostasis disorders","correct":false},{"idx":3,"proposition":"History of bladder tumours","correct":false},{"idx":4,"proposition":"All propositions are true","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"RAU-urg-2","context":null,"enonce":"Which of the following proposals designates a contraindication(s) to bladder probing?","item":"RAU","matiere":"urg","propositions":[{"idx":0,"proposition":"Urinary tract infection","correct":true,"justification":"True, this is the only relative IC"},{"idx":1,"proposition":"Absence of globe","correct":false,"justification":"CI of suprapubic catheterization"},{"idx":2,"proposition":"Hemostasis disorders","correct":false,"justification":"CI of suprapubic catheterization"},{"idx":3,"proposition":"Amyotrophic lateral sclerosis","correct":false,"justification":"False"},{"idx":4,"proposition":"Anticholinergic therapy","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"RAU-urg-3","context":null,"enonce":"Which of the following are absolute contraindications to bladder probing?","item":"RAU","matiere":"urg","propositions":[{"idx":0,"proposition":"Urethral stenosis","correct":true},{"idx":1,"proposition":"Trauma to the urethra","correct":true},{"idx":2,"proposition":"Fracture of the pelvis","correct":true,"justification":"True, these are the three absolute contraindications to bladder probing"},{"idx":3,"proposition":"Urinary tract infection","correct":false,"justification":"Relative CI"},{"idx":4,"proposition":"All propositions are true","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"RAU-urg-4","context":null,"enonce":"Which of the following are true?","item":"RAU","matiere":"urg","propositions":[{"idx":0,"proposition":"A full bladder differentiates acute urine retention from anuria ","correct":false,"justification":"Anuria (= no urine secreted by the kidney) is a differential diagnosis and something else"},{"idx":1,"proposition":"Anuria is painful","correct":false,"justification":"False"},{"idx":2,"proposition":"Anuria is urination <200 ml\/24","correct":true},{"idx":3,"proposition":"Anuria is not accompanied by bladder globe","correct":true},{"idx":4,"proposition":"Ultrasound makes the difference between anuria and RAU","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"RAU-urg-5","context":null,"enonce":"Which of the following are absolute contraindications to suprapubic catheterization?","item":"RAU","matiere":"urg","propositions":[{"idx":0,"proposition":"Absence of globe","correct":true},{"idx":1,"proposition":"Vascular bypass surgery in the suprapubic region","correct":true,"justification":"True, these are the two absolute ICs of suprapubic catheterization."},{"idx":2,"proposition":"Hemostasis disorder","correct":false,"justification":"Relative CI"},{"idx":3,"proposition":"History of bladder tumours","correct":false,"justification":"Relative CI"},{"idx":4,"proposition":"All propositions are true","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"voiesIV-cardio-0","context":null,"enonce":"Concerning venous surroundings","item":"voiesIV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Peripheral venous tracts are used to infuse drugs with low venotoxicity","correct":true},{"idx":1,"proposition":"The most common immediate complication is puncture failure","correct":true},{"idx":2,"proposition":"The complications of these venous approaches although relatively rare constitute because of the number of catheters used a frequent problem","correct":true},{"idx":3,"proposition":"The monitoring of these venous surroundings in search of complications is therefore the domain of the doctor's daily life.","correct":true},{"idx":4,"proposition":"In addition, in order to limit this iatrogenic risk as much as possible, the first peripheral installation must be systematic","correct":false,"justification":"In addition, in order to limit this iatrogenic risk as much as possible, the doctor must constantly ask himself the question of the indication to maintain these venous approaches in place."}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"voiesIV-cardio-1","context":null,"enonce":"Concerning the venous surroundings","item":"voiesIV","matiere":"cardio","propositions":[{"idx":0,"proposition":"The term peripheral venous catheter is used when the end is placed in the superior or inferior vena cava","correct":false,"justification":"The term central venous catheter is used when the tip is placed in a \"central\" vein, i.e. the superior or inferior vena cava."},{"idx":1,"proposition":"The central venous tracts are reserved for toxic products for the veins (chemotherapy, some antibiotics) only","correct":false,"justification":"Central venous lines are reserved for vein toxicants but can also be used for long-term infusions or in patients with \"poor\" peripheral venous capital."},{"idx":2,"proposition":"in the first superficial ways The most common complication is the wound of the vein that will cause a hematoma","correct":true},{"idx":3,"proposition":"If this wound is not diagnosed promptly, an extravenous infusion may occur","correct":true},{"idx":4,"proposition":"The most common complication is puncture failure","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"voiesIV-cardio-2","context":null,"enonce":"Concerning venous surroundings","item":"voiesIV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Learned societies recommend the use of ultrasound and the performance of ultrasound-guided puncture for the approach of the internal jugular vein","correct":true},{"idx":1,"proposition":"The catheter (and\/or the guide used for its placement) can perforate the vein and have an aberrant path in the soft parts","correct":true},{"idx":2,"proposition":"A Pneumothorax may result from puncture of the pleural dome during an attempt to puncture the subclavian vein","correct":true},{"idx":3,"proposition":"Air embolism can occur during catheter placement when the lumen of the vein is in communication with atmospheric air","correct":true},{"idx":4,"proposition":"This risk is all the more important as the mediastinal pressure is lower than atmospheric pressure","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"voiesIV-cardio-3","context":null,"enonce":"Concerning the complications of venous surroundings","item":"voiesIV","matiere":"cardio","propositions":[{"idx":0,"proposition":"The contributing factors of an infection include the duration of maintenance of the venous line, manipulations, loss of tightness of the occlusive dressing","correct":true},{"idx":1,"proposition":"Monitoring and complications of venous approaches ²²Ä Deep catheters: infection starting with a central venous line is rare","correct":false,"justification":"Surveillance and complications of venous approaches ²²Ä Deep catheters: infection starting with a central venous line is relatively common since the coordination center for the control of nosocomial infections estimates that the prevalence is of the order of 2% of carriers of a central venous line"},{"idx":2,"proposition":"In addition to the general factors favoring infection, the occurrence of this complication directly depends on the duration of use of the catheter and","correct":true},{"idx":3,"proposition":"The catheter can be colonized by skin germs during placement or subsequent manipulations: this is contamination by the extraluminal route","correct":true},{"idx":4,"proposition":"The endoluminal pathway will be likely to be colonized during microbial contamination from taps and tubing that will be connected to the catheter.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"otite-infectio-0","context":null,"enonce":"About acute otitis media","item":"otite","matiere":"infectio","propositions":[{"idx":0,"proposition":"Acute otitis media is a very common infection","correct":true},{"idx":1,"proposition":"Streptococcus pneumoniae and Staphyloccocus Aureus represent the two main bacterial etiologies","correct":false,"justification":"Haemophilius influenzae and Streptococcus pneumoniae"},{"idx":2,"proposition":"The diagnosis of purulent AOM should be evoked in front of fever and earache","correct":true},{"idx":3,"proposition":"The diagnosis is confirmed by performing an otoscopy showing inflammatory signs of the eardrum","correct":true},{"idx":4,"proposition":"After the age of 2, the majority of purulent AOMs heal spontaneously","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"otite-infectio-2","context":null,"enonce":"Concerning infectious otitis","item":"otite","matiere":"infectio","propositions":[{"idx":0,"proposition":"Otitis externa is an inflammation of the skin of the external auditory canal","correct":true},{"idx":1,"proposition":" Seromucosal otitis corresponds to chronic retrotympanic effusion","correct":true},{"idx":2,"proposition":" In nasopharyngitis, the viral infection also affects the lining of the inner, middle and outer ear.","correct":false,"justification":"Viral infection also affects the lining of the middle ear"},{"idx":3,"proposition":"It is much less common after the age of 6","correct":true},{"idx":4,"proposition":" Externalized mastoiditis with purulent retro-auricular collection is exceptional","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"otite-infectio-3","context":null,"enonce":"Concerning infectious otitis","item":"otite","matiere":"infectio","propositions":[{"idx":0,"proposition":"In case of purulent AOM in a child > 2 years, antibiotic therapy is recommended from the outset","correct":false},{"idx":1,"proposition":"If the evolution is favorable, systematic control of eardrums at the end of treatment is not necessary","correct":true},{"idx":2,"proposition":"In case of otitis externa, the fever is usually very high","correct":false,"justification":"No fever in otitis externa"},{"idx":3,"proposition":"Seromucosal otitis (OSM) is defined by the existence of chronic inflammation, evolving for more than 3 months, of the middle ear with closed eardrum","correct":true},{"idx":4,"proposition":"Seromucosal otitis is unlateral in the vast majority of cases","correct":false,"justification":"It is bilateral in the vast majority of cases"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"otite-infectio-4","context":null,"enonce":"Which of the following are indications for antibiotic therapy for acute otitis media?","item":"otite","matiere":"infectio","propositions":[{"idx":0,"proposition":"Children under two years of age, systematically","correct":true,"justification":"True, systematic in children under two years of age"},{"idx":1,"proposition":"Children under two years of age, with mild symptoms","correct":true,"justification":"True, regardless of the severity of symptoms for children < 2 years (in 1st line Amoxicillin PO 2-3 taken \/ D, 80 to 90 mg \/ kg \/ Day)"},{"idx":2,"proposition":"Child over two years of age, in case of severe symptoms","correct":true},{"idx":3,"proposition":"Children over two years of age, with mild symptoms","correct":false,"justification":"False, if noisy symptoms"},{"idx":4,"proposition":"Systematics whatever the age","correct":false,"justification":"In children > 2 years of age, antibiotic therapy is introduced if AOM is poorly tolerated or in case of treatment failure or complication"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"otite-infectio-5","context":null,"enonce":"What antibiotic therapy should be prescribed for otitis-conjunctivitis syndrome in a patient with no particular allergy?","item":"otite","matiere":"infectio","propositions":[{"idx":0,"proposition":"C3G","correct":false},{"idx":1,"proposition":"Fluoroquinolones ","correct":false},{"idx":2,"proposition":"Aminoglycosides","correct":false},{"idx":3,"proposition":"Pristinamycin ","correct":false},{"idx":4,"proposition":"Amoxicillin-clavulanic acid ","correct":true,"justification":"The SOC strongly suggests Hameophilus influenzae infection"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"otite-infectio-6","context":null,"enonce":"Which of the following is the recommended duration of antibiotic therapy for acute otitis media in children under two years of age?","item":"otite","matiere":"infectio","propositions":[{"idx":0,"proposition":"8-10 D","correct":true},{"idx":1,"proposition":"2- 3 D","correct":false,"justification":"False"},{"idx":2,"proposition":"5 D ","correct":false,"justification":"In children over two years of age"},{"idx":3,"proposition":"15-17 D","correct":false,"justification":"False"},{"idx":4,"proposition":"21-23 J","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"otite-infectio-7","context":null,"enonce":"Which germ is most often incriminated in front of otitis-conjunctivitis syndrome?","item":"otite","matiere":"infectio","propositions":[{"idx":0,"proposition":"Streptococcus pneumoniae","correct":false,"justification":"False"},{"idx":1,"proposition":"Haemophilus influenzae","correct":true},{"idx":2,"proposition":"Branhamella catarrhalis","correct":false,"justification":"False"},{"idx":3,"proposition":"Staphylococcus aureus ","correct":false,"justification":"False"},{"idx":4,"proposition":"Neisseria meningitidis","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"otite-infectio-8","context":null,"enonce":"Which of the following proposals lead to serous otitis?","item":"otite","matiere":"infectio","propositions":[{"idx":0,"proposition":"Episodes of vertigo","correct":false,"justification":"Refer to a Menieree"},{"idx":1,"proposition":"Nasopharyngeal obstruction","correct":true,"justification":"True, chronic"},{"idx":2,"proposition":"Family history of deafness","correct":false,"justification":"Genetic cause"},{"idx":3,"proposition":"Otorrhea","correct":false,"justification":"Otitis externa, tympanic perforation or cholesteatoma"},{"idx":4,"proposition":"Disappearance of the luminous 🔅 triangle","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbmarche-ortho-0","context":null,"enonce":"The range of motion required for walking is as follows:","item":"tbmarche","matiere":"ortho","propositions":[{"idx":0,"proposition":"Hip: 100 degrees flexion and 30 degrees extension","correct":false,"justification":"It's the opposite: 30° bending and 100° extension"},{"idx":1,"proposition":"The knee: 0° extension and 70° flexion","correct":true},{"idx":2,"proposition":"Dorsal ankle flexion: 1°","correct":false,"justification":"10°"},{"idx":3,"proposition":"plantar flexion of the ankle: 15°","correct":true},{"idx":4,"proposition":"Toe extension: 100 degrees","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"tbmarche-ortho-1","context":null,"enonce":"Regarding walking and balance disorders","item":"tbmarche","matiere":"ortho","propositions":[{"idx":0,"proposition":"Joint movements necessary to go up and down the stairs by chaining the stairs: hip flexion 110 ° and extension 10 °","correct":true},{"idx":1,"proposition":"Joint debate required to sit: 90° for hip and knee flexion","correct":true},{"idx":2,"proposition":"The quadricpes is a braking muscle when taking support in the support phase","correct":true},{"idx":3,"proposition":"The anterior tibial is a propellant muscle at the beginning of the support phase and a muscle","correct":false,"justification":"He is a brakeman"},{"idx":4,"proposition":"The gluteus medius and the tensor of the facia lata are lateral stabilizing muscles of the flexed knee","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbmarche-ortho-2","context":null,"enonce":"Regarding walking and balancing disorders:","item":"tbmarche","matiere":"ortho","propositions":[{"idx":0,"proposition":"The essential muscles of standing are the antigravity muscles, namely the extensors of the lower limb and the paravertebrals.","correct":true},{"idx":1,"proposition":"During a dodge lameness, there is a decrease in the time of monopdal support and the downforce on the side of pain","correct":true},{"idx":2,"proposition":"Steppage is related to a deficit of the muscles of the posterior compartment of the leg","correct":false},{"idx":3,"proposition":"A loss of quadriceps strength is at the origin of a lameness with greeting","correct":true},{"idx":4,"proposition":"Damage to the posterior tibial nerve causes stepping","correct":false,"justification":"common or superficial fibular nerve"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbmarche-neuro-0","context":null,"enonce":"Regarding walking and balance disorders:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"Walking, a highly automated motor production, largely escapes conscious control","correct":true},{"idx":1,"proposition":"Romberg's sign is the aggravation of instability at the closing of the eyes and signs the sensory origin of ataxia","correct":true,"justification":"It can be vestibular or proprioceptive ataxia"},{"idx":2,"proposition":"Postural reflexes are impaired in case of damage to the basal ganglia or frontal regions","correct":true},{"idx":3,"proposition":"Almost all drugs prescribed in the field of neuropsychiatry can induce low blood pressure and attentional disorders that can increase the risk of falls.","correct":true},{"idx":4,"proposition":"The walk is classically drunk, the lifting polygon is widened, the tightrope walk is altered early during proprioceptive impairment","correct":false,"justification":"This is the cerebellous syndrome"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbmarche-neuro-1","context":null,"enonce":"Regarding walking and balance disorders:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"Peripheral vestibular syndrome is noisy, manifested as rotational vertigo accompanied by vomiting and vegetative signs","correct":true},{"idx":1,"proposition":"In vestibular syndrome the abnormalities of walking and balance are lateralized from the side of the slow saccade of nystagmus, to the healthy side","correct":false,"justification":"Abnormalities in walking and balance are well lateralized on the side of the slow saccade of nystagmus, but this is the diseased side"},{"idx":2,"proposition":"Romberg's test is very disturbed, aggravated markedly when the eyes close during proprioceptive ataxia","correct":true},{"idx":3,"proposition":"During proprioceptive ataxia, posture reflexes are disturbed, the polygon is enlarged.","correct":false,"justification":"The polygon is well enlarged but posture reflexes are normal."},{"idx":4,"proposition":"During proprioceptive impairment, walking is heelating, ground support is poorly controlled and contact is sometimes violent.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbmarche-neuro-2","context":null,"enonce":"Regarding walking and balance disorders:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"The sequelae of stroke are essentially in the form of hemiparesis or hemiplegia causing mowing, the homolateral upper limb being fixed in abduction.","correct":false,"justification":"In the sequelae of stroke, the homolateral upper limb is fixed in adduction"},{"idx":1,"proposition":"Paraparesis with spasticity is secondary to spinal cord disorders: multiple sclerosis, myelitis, tumor or mechanical compression, and hereditary spastic paraparesis.","correct":true},{"idx":2,"proposition":"Lower limb dystonias are always bilateral","correct":false,"justification":"They can be unilateral or bilateral"},{"idx":3,"proposition":"A dopa-sensitivity test should be performed in front of dystonia, most often","correct":true},{"idx":4,"proposition":"In Huntington's chorea, gait and balance disorders are complex: severe impairment of the postural reflexes, akinetic syndrome, axial and limb choreodystonic movement","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbmarche-neuro-3","context":null,"enonce":"Regarding hypokinetic motor disorders:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"In Parkinson's disease, levodopa-induced dyskinesias induce imbalances when walking","correct":true},{"idx":1,"proposition":"Chronic hydrocephalus in adults is clinically characterized by the Hakim and Adams triad: walking and balance disorders, sphincter disorders and dementia.","correct":true},{"idx":2,"proposition":"In chronic hydrocephalus of adults, there is an enlargement of the lifting polygon and freezing in 2-3% of cases","correct":false,"justification":"There is an enlargement of the lift polygon and freezing in 20 to 30% of cases"},{"idx":3,"proposition":"The diagnosis of chronic hydrocephalus in adults is based on brain MRI which shows tetraventricular dilation with little cortical atrophy and T2 hyposignal ranges around the ventricles","correct":true},{"idx":4,"proposition":"Treatment of chronic adult hydrocephalus consists of a ventriculoperitoneal bypass that results in inconsistent improvement in motor and cognitive disorders","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"tbmarche-neuro-4","context":null,"enonce":"Regarding normal walking:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"The oscillating phase concerns 60% of the running time","correct":false,"justification":"Oscillating phase = 40%; Support phase = 60%"},{"idx":1,"proposition":"The beginning of the walking cycle begins with an attack through the heel","correct":true},{"idx":2,"proposition":"For normal walking, you need a hip extension at 10° and a hip flexion at 30°","correct":true},{"idx":3,"proposition":"For normal walking, you need a knee flexion at 70° and a knee extension at 10°","correct":false,"justification":"A knee extension of 0° is required. Beyond this angle, we speak of recurvatum of the knee which is abnormal when walking."},{"idx":4,"proposition":"For normal walking, you need a plantar ankle flexion of 15° and a dorsal flexion of 10°","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbmarche-neuro-7","context":null,"enonce":"Postural reflexes are modified by lesions in which part(s) of the brain?","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"Lesions of the basal ganglia","correct":true},{"idx":1,"proposition":"Deep left parietal","correct":false},{"idx":2,"proposition":"Frontal regions","correct":true},{"idx":3,"proposition":"Brain stem","correct":false},{"idx":4,"proposition":"Occipital cortex","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbmarche-neuro-8","context":null,"enonce":"Regarding ataxias:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"Ataxia can be of vestibular, proprioceptive or cerebellar origin","correct":true},{"idx":1,"proposition":"A worsening of balance disorders when closing the eyes (Romberg's sign) is a sign of cerebellar syndrome","correct":false,"justification":"Closing the eyes eliminates sensory afferents from the eyes that help keep balance. There will be a worsening of balance if there is a vestibular syndrome or proprioception disorder."},{"idx":2,"proposition":"Kinetic cerebellar ataxia is secondary to vermis injury","correct":false,"justification":"Cerebellar hemispheres. Vermis = static"},{"idx":3,"proposition":"Cerebellar ataxia is multidirectional in the Romberg test","correct":true},{"idx":4,"proposition":"The walk is classically drunk, the lifting polygon is widened, the tightrope walk is altered early during cerebellar syndrome","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbmarche-neuro-9","context":null,"enonce":"Are causes of cerebellar ataxia:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"Multiple sclerosis","correct":true},{"idx":1,"proposition":"Vertebrobasilar territory stroke with AIPD","correct":true},{"idx":2,"proposition":"Alcohol","correct":true,"justification":"Think of your friends in the evening;)"},{"idx":3,"proposition":"Creutzfeldt-Jakob disease","correct":true},{"idx":4,"proposition":"Paraneoplastic syndrome","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbmarche-neuro-10","context":null,"enonce":"Regarding ataxias:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"Biermer's disease can cause proprioceptive ataxia","correct":true,"justification":"Biermer's disease is an autoimmune disease with antibodies to intrinsic factor, which inhibits the absorption of vitamin B12. This vitamin B12 deficiency induces combined sclerosis of the spinal cord: posterior cordonal syndrome (proprioceptive ataxia, Romberg's sign, deep sensitivity disorders) and pyramidal syndrome by lateral cord damage (bilateral Babinski's sign, exaggerated ROT)."},{"idx":1,"proposition":"During vestibular ataxia, walking is in a star pattern ","correct":true},{"idx":2,"proposition":"During proprioceptive ataxia, walking is tillering, ground support is poorly controlled, ground contact is sometimes violent and the lift polygon is increased","correct":true},{"idx":3,"proposition":"MS can cause cerebellar ataxia and proprioceptive ataxia","correct":true,"justification":"Cerebellar ataxia by cerebellum damage and proprioceptive ataxia by posterior cord involvement of the spinal cord"},{"idx":4,"proposition":"Damage to the cerebellum worm can cause static cerebellar ataxia","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"tbmarche-neuro-11","context":null,"enonce":"Regarding dystonias","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"It is a hyperkinetic motor disorder","correct":true},{"idx":1,"proposition":"Dystonias are only caused by prolonged use of L-Dopa in Parkinson's disease","correct":false,"justification":"They can be caused by inherited generalized dystonias and neonatal anoxia"},{"idx":2,"proposition":"A painful equine varus foot is dystonia","correct":true},{"idx":3,"proposition":"A \"heron\" walk is dystonia","correct":true},{"idx":4,"proposition":"If there is the presence of dystonia, a dopa-sensitivity test should be done","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"tbmarche-neuro-12","context":null,"enonce":"Regarding the Hakim and Adams triad in chronic hydrocephalus in adults:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"There are sphincter disorders","correct":true},{"idx":1,"proposition":"There is a dementia syndrome of the subcorticofrontal type","correct":true},{"idx":2,"proposition":"There is a loss of arm swing when walking","correct":false,"justification":"The arm swing is preserved"},{"idx":3,"proposition":"There is an enlargement of the lift polygon when walking","correct":true},{"idx":4,"proposition":"There may be freezing when walking","correct":true,"justification":"Just like late-onset Parkinson's disease"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbmarche-neuro-13","context":null,"enonce":"Regarding the physiology of walking:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"The quadriceps is a braking muscle during the support phase","correct":true},{"idx":1,"proposition":"The anterior tibial muscle shortens the limb during the oscillating phase","correct":true},{"idx":2,"proposition":"A dorsal flexion of 10° is necessary for normal walking","correct":true},{"idx":3,"proposition":"The triceps sural allows a propulsion of the limb at the end of the support phase","correct":true},{"idx":4,"proposition":"A toe extension is not necessary for normal walking","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbmarche-neuro-14","context":null,"enonce":"Which anomaly(s) is\/are likely to cause a start of walking by an attack by the tip of the foot?","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"Equine fixed from the ankle","correct":true,"justification":"This is the main etiology"},{"idx":1,"proposition":"A Tredelenburg lameness","correct":false},{"idx":2,"proposition":"A steppage","correct":true,"justification":"By foot lifters' deficit"},{"idx":3,"proposition":"Spasticity of the triceps sural ","correct":true,"justification":"May also cause knee recurvatum"},{"idx":4,"proposition":"Spasticity of the quadriceps","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbmarche-neuro-16","context":null,"enonce":"Regarding the physiology of walking:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"Walking is controlled by subcortical circuits, including basal ganglia, brainstem and spinal cord regions.","correct":true},{"idx":1,"proposition":"The stride is defined as a succession of 2 steps","correct":true,"justification":"2 steps = 1 walking cycle; about 1.4m"},{"idx":2,"proposition":"The gluteal medius muscle is a stabilizer of the hip","correct":true,"justification":"Just like the tensor of the fascia lata"},{"idx":3,"proposition":"The walking speed is 2 m\/s","correct":false,"justification":"1 m\/s"},{"idx":4,"proposition":"There is always at least 1 ground support when walking","correct":true,"justification":"Unlike the race"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"soinspalrea-anesth-1","context":null,"enonce":"Which propositions are true? (one or more correct answers)","item":"soinspalrea","matiere":"anesth","propositions":[{"idx":0,"proposition":"Management in intensive care involves continuous monitoring of vital functions and, where appropriate, the use of methods of replacement of failing organs","correct":true},{"idx":1,"proposition":"Resuscitation is based on active therapies only","correct":false,"justification":"Supportive care should always be continued"},{"idx":2,"proposition":"Unreasonable obstinacy is defined by the initiation or continuation of a curative therapy not desired by the family.","correct":false,"justification":"Unreasonable obstinacy is defined as the initiation or continuation of a curative therapy or diagnostic strategy (and this is why unreasonable obstinacy is more inclusive than therapeutic relentlessness) that is unnecessary and unjustified in terms of prognosis in terms of survival or quality of life."},{"idx":3,"proposition":"Palliative care is acute care delivered in a comprehensive approach to the person with a terminal illness","correct":false,"justification":"It must concern all chronically ill patients (especially cancers, whatever their phase of the disease)"},{"idx":4,"proposition":"An LATA involves the cessation of all care and replacement of organs, regardless of the LATA made.","correct":false,"justification":"A LATA defines ethically authorized care (light monitoring at least, replacement of organs if decided)"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"vertige-neuro-0","context":null,"enonce":"Regarding physiological reminders:","item":"vertige","matiere":"neuro","propositions":[{"idx":0,"proposition":"Vertigo is an illusion of movement of the environment exclusively, without subjective movement","correct":false,"justification":"Vertigo is an illusion of movement, either of the patient or of the environment, which most often results in an impression of rotation or sometimes linear displacement"},{"idx":1,"proposition":"The impression of displacement is always rotating","correct":false,"justification":"Rotatory or linear"},{"idx":2,"proposition":"The peripheral vestibular system consists of the semicircular canals, utricle and saccule","correct":true},{"idx":3,"proposition":"The ampullary ridges of the semicircular canals detect the rotational movements of the head","correct":true},{"idx":4,"proposition":"The otolithic macules of the utricle and saccule detect linear head movements and gravity direction","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vertige-neuro-1","context":null,"enonce":"Regarding vertigo:","item":"vertige","matiere":"neuro","propositions":[{"idx":0,"proposition":"Information from the posterior labyrinth is conveyed in the twelfth cranial nerve","correct":false,"justification":"Cochleovestibular nerve = VIIIth cranial nerve"},{"idx":1,"proposition":"The vestibular nuclei are closely connected with the vestibular cerebellum","correct":true},{"idx":2,"proposition":"An acute or subacute lesional process of one of the vestibular structures leads to asymmetric functioning, resulting in the appearance of acute vestibular syndrome","correct":true},{"idx":3,"proposition":"Chronic involvement of vestibular structures is mainly manifested by nystagmus","correct":false,"justification":"Essentially by vestibular ataxia"},{"idx":4,"proposition":"The duration and frequency of seizures make it possible to classify dizziness into four categories useful for diagnosis.","correct":true,"justification":"This is the determining element of the interrogation that makes it possible to classify vertigo into four categories very useful in terms of etiological diagnosis."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vertige-neuro-3","context":null,"enonce":"Regarding posture disorders in the context of peripheral vestibular syndrome:","item":"vertige","matiere":"neuro","propositions":[{"idx":0,"proposition":"A vestibular syndrome usually gives postural disorders aggravated by closing the eyes","correct":true},{"idx":1,"proposition":"A normal subject holds more than 6 seconds with his eyes closed standing in static without moving his feet","correct":true},{"idx":2,"proposition":"In case of proprioceptive disorders, the oscillations of the body are in all directions","correct":true},{"idx":3,"proposition":"In case of vestibular involvement, there is a slow deviation of the axis of the body towards the back","correct":false,"justification":"In case of vestibular involvement, there is a slow deviation of the axis of the body always on the same side (lateral)"},{"idx":4,"proposition":"In case of vestibular involvement, the lateral deviation of the axis of the body contributes to the fact that the subject does not remain on the same line but moves in a star","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vertige-neuro-4","context":null,"enonce":"Which of these structures make up the vestibular system?","item":"vertige","matiere":"neuro","propositions":[{"idx":0,"proposition":"The saccule","correct":true},{"idx":1,"proposition":"The right ventricle","correct":false},{"idx":2,"proposition":"The stirrup","correct":false,"justification":"Inner ear"},{"idx":3,"proposition":"The rock","correct":false},{"idx":4,"proposition":"Semicircular canals","correct":true,"justification":"The peripheral vestibular system consists of the semicircular canals, utricle and saccule"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"tbdecubitus-mpr-0","context":null,"enonce":"Regarding generalities:","item":"tbdecubitus","matiere":"mpr","propositions":[{"idx":0,"proposition":"The decubitus is without consequences during a night's sleep in the healthy subject","correct":true},{"idx":1,"proposition":"Decubitus and hypomobility are the cause of complications in bedridden patients","correct":true},{"idx":2,"proposition":"Decubitus has no impact on sensory functions","correct":false,"justification":"We have an impoverishment of sensory afferents"},{"idx":3,"proposition":"Reduced effort induces cardiorespiratory maladaptation","correct":true},{"idx":4,"proposition":"Prolonged decubitus causes amyotrophy","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbdecubitus-mpr-1","context":null,"enonce":"Regarding general complications:","item":"tbdecubitus","matiere":"mpr","propositions":[{"idx":0,"proposition":"Bone resorption leads to hypercalciuria","correct":true},{"idx":1,"proposition":"There is a neuropsychological impact that is sometimes significant","correct":true},{"idx":2,"proposition":"The complications of hypomobility and decubitus can be distinguished according to their precocity and their local, regional or general character.","correct":true},{"idx":3,"proposition":"Muscle retractions are early complications","correct":false,"justification":"Late"},{"idx":4,"proposition":"Constipation is an early complication of decubitus","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"tbdecubitus-mpr-2","context":null,"enonce":"Among these proposals, which are early complications:","item":"tbdecubitus","matiere":"mpr","propositions":[{"idx":0,"proposition":"Thromboembolic","correct":true},{"idx":1,"proposition":"Cardiac maladaptation","correct":true},{"idx":2,"proposition":"Osteoporosis","correct":false,"justification":"Late"},{"idx":3,"proposition":"Mental","correct":false,"justification":"Late"},{"idx":4,"proposition":"False roads","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbdecubitus-mpr-3","context":null,"enonce":"Which of these proposals are late complications of decubitus?","item":"tbdecubitus","matiere":"mpr","propositions":[{"idx":0,"proposition":"Muscle retractions","correct":true},{"idx":1,"proposition":"Gastric reflux","correct":false,"justification":"Precocious, but present all the time"},{"idx":2,"proposition":"Nerve compressions","correct":false,"justification":"Precocious, but present all the time"},{"idx":3,"proposition":"Dysuria","correct":false,"justification":"Precocious, but present all the time"},{"idx":4,"proposition":"Mental","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbdecubitus-mpr-4","context":null,"enonce":"What medical circumstances really require bed rest?","item":"tbdecubitus","matiere":"mpr","propositions":[{"idx":0,"proposition":"Coma","correct":true},{"idx":1,"proposition":"The consequences of certain surgeries","correct":true},{"idx":2,"proposition":"Bi-maleolar fracture","correct":false,"justification":"No prolonged decubitus"},{"idx":3,"proposition":"Paraplegia","correct":false,"justification":"Must move via adapted means"},{"idx":4,"proposition":"Shock","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbdecubitus-mpr-5","context":null,"enonce":"Regarding complications of bed rest:","item":"tbdecubitus","matiere":"mpr","propositions":[{"idx":0,"proposition":"Complications are predictable and often prevented by appropriate therapeutic care, undertaken from the beginning of the decubitus position","correct":true},{"idx":1,"proposition":"Neurological deficit with disorders of trunk tone is a pathology inducing a decubitus for life","correct":false,"justification":"Only at the initial stage. It must then be put an end to it by appropriate means"},{"idx":2,"proposition":"Immobility promotes venous stasis and the occurrence of thromboembolic disease with a risk of pulmonary embolism","correct":true},{"idx":3,"proposition":"Dehydration promotes VTE","correct":true},{"idx":4,"proposition":"Preventive treatment of VTE relies on low molecular weight heparins (LMWH)","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"cirrhose-HGE-0","context":null,"enonce":"Which of the following are true?","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"proposition":"The definition of cirrhosis is clinical","correct":false,"justification":"It is histological"},{"idx":1,"proposition":"The definition of cirrhosis is biological","correct":false,"justification":"It is histological"},{"idx":2,"proposition":"The definition of cirrhosis is pathological","correct":true,"justification":"True, it's the same"},{"idx":3,"proposition":"The definition of cirrhosis is histological 🔬","correct":true},{"idx":4,"proposition":"The definition of cirrhosis is radiographic","correct":false,"justification":"It is histological"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"cirrhose-HGE-1","context":null,"enonce":"Which of the following are included in the calculation of Maddrey's score?","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"proposition":"Prothrombin levels","correct":true,"justification":"True, unless it is < 30% (because the score is then always greater than 32)"},{"idx":1,"proposition":"Total bilirubin","correct":true},{"idx":2,"proposition":"Albumin","correct":false,"justification":"The Maddrey score is a prognostic score assessing the severity of alcoholic hepatitis. Score = TP * 4.6 + (Total bilirubin \/ 17)"},{"idx":3,"proposition":"Factor V","correct":false,"justification":"TP * 4.6+ (Total Bilirubin \/ 17)"},{"idx":4,"proposition":"LDL cholesterol","correct":false,"justification":"TP * 4.6+ (Total Bilirubin \/ 17)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"cirrhose-HGE-2","context":null,"enonce":"Which of the following are ultrasound (or Doppler echo) signs of cirrhosis?","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"proposition":"Dilation of the umbilical vein","correct":true,"justification":"True. More specifically, a repermeabilization of this vein (collateral circulation set up because circulation within the liver is too difficult)"},{"idx":1,"proposition":"Bumpy liver contours","correct":true},{"idx":2,"proposition":"Presence of peritoneal effusion (ascites)","correct":true},{"idx":3,"proposition":"Portal hypertension","correct":true},{"idx":4,"proposition":"Hepatic impairment","correct":false,"justification":"It is a biological 🩸 sign"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"cirrhose-HGE-3","context":null,"enonce":"Which of the following are biological signs of cirrhosis? 💉","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"proposition":"Low prothrombin (PT) levels","correct":true},{"idx":1,"proposition":"Increase in Leiden factor V","correct":false,"justification":"Decrease"},{"idx":2,"proposition":"Decrease in INR","correct":false,"justification":"Increase"},{"idx":3,"proposition":"Decreased albumin","correct":true},{"idx":4,"proposition":"Increase in billirubine","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"cirrhose-HGE-4","context":null,"enonce":"Which of the following are included in the Child Pugh calculation?","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"proposition":"Prothrombin levels","correct":true,"justification":"True. TP > 50%: 1 point. TP 40-50%: 2 points. TP <40%: 3 points"},{"idx":1,"proposition":"Presence of meningitis","correct":false,"justification":"Encephalopathy. Absence: 1 point. Mild to moderate: 2 points. Severe: 3 points."},{"idx":2,"proposition":"Leiden factor V","correct":false,"justification":"Does not fit into the calculation. The 5 things to consider are: ascites, bilirubin, encephalopathy, prothrombin and albumin levels."},{"idx":3,"proposition":"Albumin","correct":true,"justification":"True. In g\/L. Albumin> 35 : 1 point. Albumin 28-35: 2 points. Albumin< 28: 3 points."},{"idx":4,"proposition":"Free bilirubin","correct":false,"justification":"It is the total bilirubin that is taken into account. < 35: 1 point. 35-50: 2 points. >50: 3 points."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"cirrhose-HGE-5","context":null,"enonce":"Which of the following are signs of portal hypertension?","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"proposition":"Stellar angioma","correct":false,"justification":"Sign of hepatocellular insufficiency"},{"idx":1,"proposition":"Jaundice","correct":false,"justification":"Sign of hepatocellular insufficiency (increased bilirubin)"},{"idx":2,"proposition":"Hypogonadism","correct":false,"justification":"Sign of hepatocellular insufficiency"},{"idx":3,"proposition":"Ascites","correct":true,"justification":"True, by increasing hydrostatic pressure (increased resistance of hepatic capillaries)"},{"idx":4,"proposition":"Splenomegaly","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LLC-onco-0","context":null,"enonce":"Which of the following are true for chronic lymphocytic leukemia?","item":"LLC","matiere":"onco","propositions":[{"idx":0,"proposition":"Most often it is a hematological disease of the child","correct":false,"justification":"Haemopathy in the elderly"},{"idx":1,"proposition":"The diagnosis can be made incidentally on the blood count","correct":true},{"idx":2,"proposition":"Complications include autoimmune","correct":true},{"idx":3,"proposition":"Prague is feared to be transformed","correct":false,"justification":"Richter transformation (5-10% of CLL results in aggressive Non-Hodgkin lymphoma)"},{"idx":4,"proposition":"Binet's classification has 5 possibilities, from A to E","correct":false,"justification":"3: Binet A, Binet B and Binet C (most pejorative)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LLC-onco-1","context":null,"enonce":"What is the Binet stage of a patient in whom there are only 2 axillary lymphadenopathies without hepatomegaly or splenomegaly, without biological abnormalities (except hyperlymphocytosis)?","item":"LLC","matiere":"onco","propositions":[{"idx":0,"proposition":"Binet A","correct":true,"justification":"True. <3 lymph node areas affected, no anemia, no thrombocytopenia."},{"idx":1,"proposition":"Binet B","correct":false,"justification":"False"},{"idx":2,"proposition":"Binet C","correct":false,"justification":"False"},{"idx":3,"proposition":"Not enough evidence to conclude","correct":false,"justification":"False"},{"idx":4,"proposition":"The elements are discordant","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LLC-onco-2","context":null,"enonce":"What is the Binet stage of a patient with 2 left axillary lymphadenopathy, 2 left inguinal lymphadenopathy, 4 right cervical lymphadenopathy, hepatomegaly and splenomegaly, without biological abnormalities (except hyperlymphocytosis)?","item":"LLC","matiere":"onco","propositions":[{"idx":0,"proposition":"Binet A","correct":false,"justification":"False"},{"idx":1,"proposition":"Binet B","correct":true,"justification":"True. >= 3 lymph node areas affected, without anemia or thrombocytopenia"},{"idx":2,"proposition":"Binet C","correct":false,"justification":"False"},{"idx":3,"proposition":"Not enough evidence to conclude","correct":false,"justification":"False"},{"idx":4,"proposition":"The elements are discordant","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LLC-onco-3","context":null,"enonce":"Which of the following are true?","item":"LLC","matiere":"onco","propositions":[{"idx":0,"proposition":"At the time of diagnosis, 1\/3 of patients are BINET A ","correct":false,"justification":"70 to 80% of patients are in Binet A at the time of diagnosis"},{"idx":1,"proposition":"Binet's classification is exclusively clinical","correct":false,"justification":"Clinico-biological (anemia or Binet C thrombocytopenia ➡)"},{"idx":2,"proposition":"Binet A stage does not require treatment most often","correct":true,"justification":"True. Clinicobiological surveillance every 6 months"},{"idx":3,"proposition":"CLL is the most common childhood leukemia","correct":false,"justification":"It is not found in children. The median age at diagnosis is 72 years."},{"idx":4,"proposition":"The discovery of CLL is most often fortuitous","correct":true,"justification":"True. During a blood test"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LLC-onco-5","context":null,"enonce":"Which of the following proposals are poor prognosis?","item":"LLC","matiere":"onco","propositions":[{"idx":0,"proposition":"Binet A","correct":false,"justification":"Good prognosis"},{"idx":1,"proposition":"CD38 expression on CLL cells","correct":true},{"idx":2,"proposition":"Doubling time of blood lymphocytosis less than 36 months","correct":false,"justification":"Less than 12 months"},{"idx":3,"proposition":"Somatic mutation of the immunoglobulin heavy chain gene (LHIVG)","correct":false,"justification":"Good prognosis criterion"},{"idx":4,"proposition":"del11q","correct":true,"justification":"True, more exactly dell(11q22.3)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LLC-onco-6","context":null,"enonce":"What is the Binet stage of a patient in whom there is no axillary lymphadenopathy but hepatomegaly and splenomegaly, and anemia <10g\/dL?","item":"LLC","matiere":"onco","propositions":[{"idx":0,"proposition":"Binet A","correct":false,"justification":"False"},{"idx":1,"proposition":"Binet B","correct":false,"justification":"False"},{"idx":2,"proposition":"Binet C","correct":true,"justification":"True. Anemia directly classifies CLL as stage C"},{"idx":3,"proposition":"Not enough evidence to conclude","correct":false,"justification":"False"},{"idx":4,"proposition":"The elements are discordant","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LLC-onco-7","context":null,"enonce":"What is the Binet stage of a patient in whom there is no axillary lymphadenopathy but hepatomegaly and splenomegaly, without biological abnormalities (except hyperlymphocytosis)?","item":"LLC","matiere":"onco","propositions":[{"idx":0,"proposition":"Binet A","correct":true,"justification":"True. <3 lymph node areas affected, no anemia, no thrombocytopenia."},{"idx":1,"proposition":"Binet B","correct":false,"justification":"False"},{"idx":2,"proposition":"Binet C","correct":false,"justification":"False"},{"idx":3,"proposition":"Not enough evidence to conclude","correct":false,"justification":"False"},{"idx":4,"proposition":"The elements are discordant","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SMP-onco-0","context":null,"enonce":"Which of the following is one or more visible complications in polycythemia vera?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"Acute lymphoblastic leukemia","correct":false,"justification":"Acute myelogenous leukemia"},{"idx":1,"proposition":"Secondary myelofibrosis","correct":true},{"idx":2,"proposition":"Lymphoma","correct":false,"justification":"No transformation into lymphoma"},{"idx":3,"proposition":"Secondary hemochromatosis","correct":false,"justification":"Rather, there is a martial deficiency due to bloodletting"},{"idx":4,"proposition":"Leg ulcers under Phosphorus 32","correct":false,"justification":"Phosphorus-32 is no longer used in France because of its highly leukeogenic potential. It is hydroxycarbamide (prescribed in +60 years or in case of history of thrombosis) that has skin side effects"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SMP-onco-1","context":null,"enonce":"Which of the following is the minor criterion for polycythemia vera according to WHO (2016)?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"Palpable splenomegaly","correct":false,"justification":"False"},{"idx":1,"proposition":"Myelogram disorders","correct":false,"justification":"False. Major criterion (rich myelogram)"},{"idx":2,"proposition":"Spontaneous growth of medullary erythroblastic progenitors","correct":false,"justification":"False"},{"idx":3,"proposition":"Myelemia","correct":false,"justification":"False"},{"idx":4,"proposition":"Low serum erythropoietin (EPO) dosage","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SMP-onco-3","context":null,"enonce":"Which of the following proposals makes it possible to define a polycythemia with certainty?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"Mean corpuscular volume (MCV)","correct":false,"justification":"None"},{"idx":1,"proposition":"Total corpuscular volume (VGT)","correct":true,"justification":"True, this is the reference examination (isotopic measurement). By definition, the measurement of blood mass is increased: we speak of true polycythemia when the total corpuscular volume is 25% higher than the normal value."},{"idx":2,"proposition":"Hematocrit","correct":false,"justification":"None"},{"idx":3,"proposition":"Hemoglobin level","correct":false,"justification":"None"},{"idx":4,"proposition":"Chromia","correct":false,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SMP-onco-4","context":null,"enonce":"Which of the following are clinical signs in favor of polycythemia vera?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"Splenomegaly","correct":true,"justification":"True, related to myeloproliferative syndrome (just like water pruritus)"},{"idx":1,"proposition":"Venous or arterial thrombosis","correct":true,"justification":"True, related to blood hyperviscosity"},{"idx":2,"proposition":"Adenomegaly","correct":false,"justification":"False"},{"idx":3,"proposition":"Erythrosis of the face","correct":true,"justification":"True, appeared gradually"},{"idx":4,"proposition":"Concomitant amyloidosis","correct":false,"justification":"No relationship described between these two pathologies in the college"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SMP-onco-5","context":null,"enonce":"Which of the following are true for the V617F mutation in JAK2?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"This is a constitutional genetic anomaly","correct":false,"justification":"No, it's an acquired mutation"},{"idx":1,"proposition":"It may be present in circulating polynuclear drugs","correct":true},{"idx":2,"proposition":"It is mandatory at the diagnosis of polycythemia vera","correct":false,"justification":"There are other mutations that can induce a primitive polycythemia (mutation of exon 12 of JAK2, mutation of CARL, mutation of MPL ...). They are much rarer"},{"idx":3,"proposition":"It is present in about half of cases of essential thrombocythemia","correct":true},{"idx":4,"proposition":"It is not found in chronic myelogenous leukemia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SMP-onco-6","context":null,"enonce":"Which of the following are the causes of false polycythemia?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"Hemoconcentration","correct":true},{"idx":1,"proposition":"Splenomegaly","correct":false,"justification":"There is red blood cell sequestration and hemodilution, so rather anemia (often moderate with a small hemolytic component of stasis). For information, a voluminous splenomegaly can sequester up to 25% of the total blood mass."},{"idx":2,"proposition":"Thalassemia minor","correct":true,"justification":"True, it is often microcytic"},{"idx":3,"proposition":"Thrombotic Microangiopathy","correct":false,"justification":"None"},{"idx":4,"proposition":"Acute bleeding","correct":false,"justification":"In acute cases, there is no impact on the CBC (equivalent loss of red blood cells and plasma). Prolonged, we find anemia"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SMP-onco-7","context":null,"enonce":"Which of the following are the major criteria for polycythemia vera according to WHO (2016)?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"Palpable splenomegaly","correct":false,"justification":"Does not fall within the scope of the WHO 2016 criteria because it is not very specific"},{"idx":1,"proposition":"Thrombocytosis","correct":false,"justification":"Does not fall within the scope of the WHO 2016 criteria because it is not very sensitive (only 2\/3 of patients) and not very specific (many differential diagnoses)"},{"idx":2,"proposition":"Desaturation","correct":false,"justification":"There is no hypoxia"},{"idx":3,"proposition":"Mutation de JAK2","correct":true,"justification":"True, mutation V617F for example"},{"idx":4,"proposition":"Myeloid hypertrophy on bone marrow biopsy","correct":true,"justification":"True, we find panmyelosis"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SMP-onco-8","context":null,"enonce":"Which of the following are causes of moderate polynucleosis?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"Pregnancy","correct":true},{"idx":1,"proposition":"Corticosteroid treatment","correct":true},{"idx":2,"proposition":"Hemolysis regeneration","correct":true},{"idx":3,"proposition":"Viral infection","correct":false,"justification":"In this case, it is mostly lymphocytosis. Polynucleosis is found in bacterial infections."},{"idx":4,"proposition":"Taking acetylsalicylic acid ","correct":false,"justification":"NSAIDs do not cause polynucleosis, on the contrary"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SMP-onco-10","context":null,"enonce":"Which of the following propositions are true regarding the etiology of CML?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"None of these propositions are true","correct":false,"justification":"False"},{"idx":1,"proposition":"It may be secondary to exposure to ionizing radiation","correct":true},{"idx":2,"proposition":"It may be secondary to exposure to benzene","correct":true,"justification":"True, these are the only two occupational diseases in the PM tables."},{"idx":3,"proposition":"It may be secondary to exposure to statins","correct":false,"justification":"False"},{"idx":4,"proposition":"It may be secondary to exposure to cocaine","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SMP-onco-11","context":null,"enonce":"Which of the following are true about myelofibrosis?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"Secondary myelofibrosis can complicate all myeloproliferative neoplasias","correct":true},{"idx":1,"proposition":"In polycythemia vera, this course is more common in case of bloodletting treatment","correct":true},{"idx":2,"proposition":"The diagnosis is made on the appearance of poor marrow to the myelogram","correct":false,"justification":"We do not see the appearance of the bone marrow on the myelogram but on the osteospinal cord biopsy. Abnormalities of the medullary structure are observed.  Myelofibrosis is an abnormality highlighted by specific stains, which can evolve in several stages (reticulin stained by silver derivatives, collagen visible with trichrome, or sclerosing and then willingly mutilating) and often prevents aspiration of bone marrow juice."},{"idx":3,"proposition":"In primary myelofibrosis, the JAK2 mutation is found in about 50% of cases","correct":true},{"idx":4,"proposition":"There is targeted therapy with JAK2 inhibitor","correct":true,"justification":"True, ruxolitinib"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hypoGly-endoc-0","context":null,"enonce":"What is the most common cause of tumor hypoglycemia in adults?","item":"hypoGly","matiere":"endoc","propositions":[{"idx":0,"proposition":"Insulinoma","correct":true,"justification":"Insulinoma is a benign tumor"},{"idx":1,"proposition":"Adrenaloma","correct":false},{"idx":2,"proposition":"Hepatocellular carcinoma","correct":false},{"idx":3,"proposition":"Pituitary glioma","correct":false},{"idx":4,"proposition":"Stomach tumours","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hypoGly-endoc-1","context":null,"enonce":"Regarding the diagnosis of hypoglycemia:","item":"hypoGly","matiere":"endoc","propositions":[{"idx":0,"proposition":"It is based on Whipple's triad","correct":true,"justification":"Whipple's Triad: Sign of neuroglucopenia + Low venous blood glucose < 0.50 g\/L (2.75mmol\/L) + Symptoms disappear during re-sugaringnot to be confused with Whipple's disease, infection caused by the intracellular bacterium Tropheryma whipplei"},{"idx":1,"proposition":"Normalization of blood glucose should lead to correction of symptoms","correct":true,"justification":"Indeed, as indicated in the reference system, the diagnosis of hypoglycemia is based on Whipple's triad which involves a correction of symptoms after normalization of blood glucose"},{"idx":2,"proposition":"Signs of insulinopenia are in the foreground","correct":false,"justification":"Signs of neuroglucopenia (i.e. NS dysfunction) are in the foreground"},{"idx":3,"proposition":"Low capillary glucose measurement is the basis of diagnosis","correct":false,"justification":"It is the measurement of venous blood glucose that must be performed in order to be able to make a diagnosis of hypoglycemia"},{"idx":4,"proposition":"A blood glucose level of 0.4 g\/L is used to diagnose hypoglycemia","correct":false,"justification":"An isolated low blood sugar is not enough to carry the diagnosis, it is necessary to find the elements of the triad of Whipple"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"hypoGly-endoc-3","context":null,"enonce":"Which of these proposals are signs of adrenergic reaction to hypoglycemia?","item":"hypoGly","matiere":"endoc","propositions":[{"idx":0,"proposition":"Anxiety","correct":true},{"idx":1,"proposition":"Slurred speech","correct":false,"justification":"This is a sign of neuroglucopenia"},{"idx":2,"proposition":"The paleur","correct":true},{"idx":3,"proposition":"Tachycardia","correct":true},{"idx":4,"proposition":"Visual disturbances","correct":false,"justification":"These are signs of neuroglucopenia"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hypoGly-endoc-4","context":null,"enonce":"Which of these proposals are signs of neuroglucopenia?","item":"hypoGly","matiere":"endoc","propositions":[{"idx":0,"proposition":"Anxiety","correct":false,"justification":"It's an adrenergic sign"},{"idx":1,"proposition":"Diplopia","correct":true},{"idx":2,"proposition":"Limb paresthesias","correct":true},{"idx":3,"proposition":"Bradycardia","correct":false,"justification":"This is a sign of the adrenergic reaction"},{"idx":4,"proposition":"Delirium","correct":true,"justification":"Possible coma"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hypoGly-endoc-5","context":null,"enonce":"Regarding hypoglycemia, which of the following propositions are true?","item":"hypoGly","matiere":"endoc","propositions":[{"idx":0,"proposition":"Whipple's triad, essential to the DG, includes: neurovegetative syndrome, blood glucose < 0.5 g \/ L and correction of symptoms after normalization of blood glucose.","correct":false,"justification":"Whipple's triad, essential for the DG, includes: NEUROGLUCOPENIC syndrome*, a blood glucose < 0.5 g \/ L and a correction of symptoms after normalization of blood glucose."},{"idx":1,"proposition":"Functional hypoglycemia, synonymous with idiopathic hyperketotic hypoglycemia, is characterized in particular by its appearance during a short fast.","correct":false},{"idx":2,"proposition":"Hypoglycemia in a child with soft and bulky hepatomegaly suggests glycogen storage disease.","correct":true,"justification":"None"},{"idx":3,"proposition":"Hypoglycemia associated with multiple organ failure suggests a deficit in the β oxidation of fatty acids. ","correct":true,"justification":"None"},{"idx":4,"proposition":"Hypoglycemia associated with multiple organ failure suggests primary adrenal insufficiency.","correct":true,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"VIH-infectio-0","context":null,"enonce":"Which of the following are true for progressive multifocal leukoencephalopathy (PML)?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is common between 200 and 400 circulating CD4 lynphocytes","correct":false,"justification":"From <100"},{"idx":1,"proposition":"It is a demyelinating condition ","correct":true},{"idx":2,"proposition":"There is a deficit that is only sensory","correct":false,"justification":"It can be sensitive and\/or motor, depending on the fibers that are demyelinated"},{"idx":3,"proposition":"We can find a cerebellar syndrome","correct":true},{"idx":4,"proposition":"It is classically fever-free","correct":true,"justification":"True, no fever, headache, or intracranial hypertension"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"VIH-infectio-1","context":null,"enonce":"What is the prevalence of HIV in France?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"20 000","correct":false,"justification":"False"},{"idx":1,"proposition":"150 000","correct":true,"justification":"True and an incidence of about 6400 cases per year"},{"idx":2,"proposition":"500 000","correct":false,"justification":"False"},{"idx":3,"proposition":"1 500 000","correct":false,"justification":"False"},{"idx":4,"proposition":"5 000 000","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"VIH-infectio-2","context":null,"enonce":"Which of the following are true?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"Triple therapy is to be continued for about 15 years","correct":false,"justification":"It is to be continued for life"},{"idx":1,"proposition":"PML is most often accompanied by fever","correct":false,"justification":"Classically no fever, no HTIC, no headache"},{"idx":2,"proposition":"We can find a mononucleosis syndrome","correct":true,"justification":"True, just as in EBV, CMV, toxoplasmosis and DRESS syndrome"},{"idx":3,"proposition":"The risk of mother-to-child transmission is almost zero when management is adapted","correct":true,"justification":"True, it is 0.3%"},{"idx":4,"proposition":"All live attenuated vaccines are contraindicated in HIV patients","correct":false,"justification":"Not if CD4 LTs are greater than 200, except for BCG (always contraindicated in HIV patients)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"VIH-infectio-3","context":null,"enonce":"Which of the following are true about HIV?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"HIV-2 is more common than HIV-1","correct":false,"justification":"It's the other way around"},{"idx":1,"proposition":"Tenofovir is a reverse transcriptase inhibitor","correct":true},{"idx":2,"proposition":"Kaposi's disease requires the patient to offer an HIV diagnostic test","correct":true},{"idx":3,"proposition":"HIV, untreated, induces a significant decrease in LT CD8 helpers, up to the AIDS stage","correct":false,"justification":"These are the LT CD4 (helpers). CD8 LTs are cytotoxic lymphocytes"},{"idx":4,"proposition":"Primary infection is most often accompanied by thrombocytosis","correct":false,"justification":"Rather, cytopenia is observed: thrombocytopenia and leukopenia predominant on lymphocytes"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"VIH-infectio-4","context":null,"enonce":"What is the incubation period for HIV?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"Between 2 and 3 days","correct":false,"justification":"This is the case of scarlet fever"},{"idx":1,"proposition":"Between 5 and 6 days","correct":false,"justification":"This is the case of whooping cough"},{"idx":2,"proposition":"Between 10 and 14 days","correct":true},{"idx":3,"proposition":"Between 18 and 20 days ","correct":false,"justification":"This is the case of rubella"},{"idx":4,"proposition":"Between 22 and 23 days","correct":false,"justification":"This is the case with mumps"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"VIH-infectio-5","context":null,"enonce":"Which of the following are verified types of HIV transmission?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"Sanguine","correct":true},{"idx":1,"proposition":"Sexual","correct":true},{"idx":2,"proposition":"Salivary","correct":false,"justification":"False"},{"idx":3,"proposition":"Materno-fetal","correct":true},{"idx":4,"proposition":"Contact","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"VIH-infectio-6","context":null,"enonce":"What is the CD4 LT threshold below which the AIDS stage is defined?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"100","correct":false,"justification":"False"},{"idx":1,"proposition":"200","correct":true,"justification":"True, it is from this threshold that most opportunistic infections can occur."},{"idx":2,"proposition":"50","correct":false,"justification":"False"},{"idx":3,"proposition":"400","correct":false,"justification":"False"},{"idx":4,"proposition":"600","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"VIH-infectio-7","context":null,"enonce":"What is the annual incidence of HIV in France?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"1 000","correct":false,"justification":"6400"},{"idx":1,"proposition":"6 400","correct":true},{"idx":2,"proposition":"10 000","correct":false,"justification":"6400"},{"idx":3,"proposition":"64 000","correct":false,"justification":"6400"},{"idx":4,"proposition":"100 000","correct":false,"justification":"6400"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"VIH-infectio-8","context":null,"enonce":"Which of the following proposals are NRTIs (Nucleoside Reverse Transcriptase Inhibitors)?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"Ritonavir","correct":false,"justification":"Protease inhibitor"},{"idx":1,"proposition":"Tenofovir","correct":true},{"idx":2,"proposition":"Emtricitabine","correct":true},{"idx":3,"proposition":"Atazanavir","correct":false,"justification":"Protease inhibitor"},{"idx":4,"proposition":"Efavirenz","correct":false,"justification":"NNRTI (Non-Nucleoside Reverse Transcriptase Inhibitor). IC during pregnancy 🤰"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"VIH-infectio-9","context":null,"enonce":"Which of the following proposals are NNRTIs (Non-Nucleoside Reverse Transcriptase Inhibitors)?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"Ritonavir","correct":false,"justification":"Protease inhibitor"},{"idx":1,"proposition":"Emtricitabine","correct":false,"justification":"Nucleoside reverse transcriptase inhibitor (NRTI)"},{"idx":2,"proposition":"Tenofovir","correct":false,"justification":"Nucleoside reverse transcriptase inhibitor"},{"idx":3,"proposition":"Efavirenz","correct":true},{"idx":4,"proposition":"Nevirapine","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"VIH-infectio-10","context":null,"enonce":"Which of the following are protease inhibitors?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"Tenofovir","correct":false,"justification":"NRTI (Nucleoside Reverse Transcriptase Inhibitor)"},{"idx":1,"proposition":"Ritonavir","correct":true},{"idx":2,"proposition":"Atazanovir","correct":true},{"idx":3,"proposition":"Efavirenz","correct":false,"justification":"NNRTI (Non-Nucleoside Reverse Transcriptase Inhibitor)"},{"idx":4,"proposition":"Rilpivirine","correct":false,"justification":"NNRTI (Non-Nucleoside Reverse Transcriptase Inhibitor)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"VIH-infectio-11","context":null,"enonce":"Which of the following are true about HIV and TB?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"HIV-TB co-infection is common","correct":true},{"idx":1,"proposition":"Mother-to-child transmission of the virus is impossible","correct":false,"justification":"Very low risk (0.3%) if properly managed, but not impossible"},{"idx":2,"proposition":"Announcing the diagnosis to a teenager is useless as long as he is a minor","correct":false,"justification":"Diagnosis, treatment and prevention of essential complications at any age"},{"idx":3,"proposition":"Curative treatment for tuberculosis does not differ in HIV+ subjects from that recommended in non-HIV patients","correct":true},{"idx":4,"proposition":"Rifampicin interacts with many protease inhibitors","correct":true,"justification":"True. Pilly 2020: \"Drug interactions between antiretrovirals and rifampicin\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"compressionmed-neuro-0","context":null,"enonce":"Which propositions are true?","item":"compressionmed","matiere":"neuro","propositions":[{"idx":0,"proposition":"Non-traumatic spinal cord compressions are extremely rare","correct":false,"justification":"Non-traumatic compressions of the spinal cord and cauda equina represent a frequent clinical situation whose diagnosis must be made very early at the onset of signs in order to limit the pathophysiological and functional consequences"},{"idx":1,"proposition":"Extradural compressions are the most common, with in particular vertebral metastases","correct":true},{"idx":2,"proposition":"Intramedullary compressions are the most common","correct":false,"justification":"Intramedullary: rarer (example: ependymoma)"},{"idx":3,"proposition":"The only reference test is the non-injected CT scan","correct":false,"justification":"The analysis of the level of the lesion is decisive to guide the level explored by the only reference examination that is magnetic resonance imaging (MRI)"},{"idx":4,"proposition":"The spinal cord extends in adults from the foramen magnum to the intervertebral disc L4","correct":false,"justification":"The medulla arises from the emergence of C1 and ends at the level of the intervertebral discs L1-L2"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"compressionmed-neuro-1","context":null,"enonce":"Regarding some definitions:","item":"compressionmed","matiere":"neuro","propositions":[{"idx":0,"proposition":"Below the T12 vertebra, there can be no spinal cord compression","correct":false,"justification":"Below the L2 vertebra, there can therefore be no spinal cord compression, it is a cauda equina syndrome"},{"idx":1,"proposition":"The lesional syndrome corresponds to the involvement at the site of the compression and the extent in height of the involvement of the gray matter and or several contiguous roots","correct":true},{"idx":2,"proposition":"The sublesional syndrome corresponds to the expression of the involvement of the long descending and ascending pathways at the level of the lesion","correct":true},{"idx":3,"proposition":"Tetraplegia is a deficit or loss of motor and sensory functions in the lumbar segments of the spinal cord","correct":false,"justification":"Tetraplegia (preferred term to quadriplegia): this term corresponds to a deficit or loss of motor and sensory functions in the cervical segments of the spinal cord due to damage to the neurax inside the spinal canal"},{"idx":4,"proposition":"Paraplegia is a deficit or loss of motor and\/or sensory functions in the thoracic, lumbar and sacral segments of the ME","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"compressionmed-neuro-3","context":null,"enonce":"Regarding the initial management of patients:","item":"compressionmed","matiere":"neuro","propositions":[{"idx":0,"proposition":"ASIA Grade E corresponds to normal sensory and motor functions","correct":true},{"idx":1,"proposition":"The systematization of the examination of the spinal cord injury, including the examination of the sacral sphere, makes it possible to identify initial prognostic factors for recovery","correct":true},{"idx":2,"proposition":"Additional motor testing of non-key muscles is optional","correct":false,"justification":"Must complete the minimum standard exam"},{"idx":3,"proposition":"A proprioception assessment should be performed","correct":true},{"idx":4,"proposition":"The assessment of spasticity is made by the modified Allen scale","correct":false,"justification":"an assessment of spasticity (modified Ashworth scale, Penn spasm scale) and its impact on motor control and functionality"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"compressionmed-neuro-4","context":null,"enonce":"What are their proposals?","item":"compressionmed","matiere":"neuro","propositions":[{"idx":0,"proposition":"Spinal cord compressions most often produce incomplete pictures when the diagnosis is not too late","correct":true},{"idx":1,"proposition":"Cauda equina syndrome should be suspected and investigated during any sciatica","correct":true},{"idx":2,"proposition":"Cauda equina syndrome is never lateralized","correct":false,"justification":"Cauda equina syndrome may be lateralized and incomplete"},{"idx":3,"proposition":"The great specificity of spinal cord injuries is to be at the origin of a table of multi-organ and multi-system deficiencies","correct":true},{"idx":4,"proposition":"Management of spinal cord injuries is the responsibility of physical medicine and rehabilitation services","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"compressionmed-neuro-5","context":null,"enonce":"Regarding patient care:","item":"compressionmed","matiere":"neuro","propositions":[{"idx":0,"proposition":"The rehabilitation scheme for non-traumatic spinal cord injuries follows the same principles as that for traumatic injuries","correct":true},{"idx":1,"proposition":"The spinal cord injury is a major risk of esores from 3 months post-accident","correct":false,"justification":"From the initial phase and throughout the patient's life"},{"idx":2,"proposition":"The pathophysiology of pressure ulcers in the medulla injured is related to sensory disorders alone","correct":false,"justification":"The pathophysiology of pressure ulcers in the medulla-injured is related to the sensory and motor disorders induced by the spinal injury but also to the associated vegetative paralysis (lack of microcirculatory adaptation to pressure)"},{"idx":3,"proposition":"The incidence and prevalence of pressure ulcers is in the order of 0.3%","correct":false,"justification":"The incidence and prevalence of pressure ulcers, whether acute or chronic, are in the order of 30%, and pressure ulcers are one of the leading causes of re-hospitalization in spinal cord injuries."},{"idx":4,"proposition":"Chest involvement (Th6 and above) is characterized by sympathetic and parasympathetic involvement","correct":false,"justification":"Sympathetic impairment and parasympathetic preservation"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"compressionmed-neuro-6","context":null,"enonce":"Regarding support:","item":"compressionmed","matiere":"neuro","propositions":[{"idx":0,"proposition":"The interruption of the efferent pathways of the baro-reflex is the cause of major orthostatic hypotension when the attack is above T6","correct":true},{"idx":1,"proposition":"Prevention of OH requires progressive verticalization on inclined plane","correct":true},{"idx":2,"proposition":"Thromboembolic risk requires prevention by LMWH for at least 8 weeks post-accident","correct":true},{"idx":3,"proposition":"Vesicosphincter disorders are rare in this type of lesion","correct":false,"justification":"These disorders are still today one of the leading causes of morbidity and rehospitalizations justifying specialized care and long-term follow-up."},{"idx":4,"proposition":"In the initial phase, especially during the subacute installation of a spinal cord injury or cauda equina, bladder symptoms are non-existent","correct":false,"justification":"In the initial phase, especially during the subacute installation of a spinal cord injury or cauda equina, acute retention is the rule"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"compressionmed-neuro-7","context":null,"enonce":"Which of the following proposals are in favor of spinal cord compression?","item":"compressionmed","matiere":"neuro","propositions":[{"idx":0,"proposition":"Spastic paraparesis","correct":true},{"idx":1,"proposition":"Babinski's sign","correct":true},{"idx":2,"proposition":"Sensory level","correct":true},{"idx":3,"proposition":"Inexhaustible epileptoid trepidation","correct":true},{"idx":4,"proposition":"Bilateral cogwheel","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"compressionmed-neuro-8","context":null,"enonce":"Which of the following proposals can lead to a disco-radicular conflict in case of lumbo-cruralgia L4?","item":"compressionmed","matiere":"neuro","propositions":[{"idx":0,"proposition":"Foraminal hernia L4-L5 ","correct":true},{"idx":1,"proposition":"Foraminal hernia L3-L4","correct":false,"justification":"Foraminal or extraforaminal hernia X-Y = > X key"},{"idx":2,"proposition":"A median or paramedian hernia L3-L4","correct":true},{"idx":3,"proposition":"A median or paramedian hernia L4-L5","correct":false,"justification":"Median or paramedian hernia X-Y = > touch Y"},{"idx":4,"proposition":"An extraforaminal hernia L4-L5","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diarrheeaigue-HGE-0","context":null,"enonce":"Regarding acute diarrhoea","item":"diarrheeaigue","matiere":"HGE","propositions":[{"idx":0,"proposition":"Diarrhea is defined in adults by the emission of too frequent, too abundant stools, of abnormal consistency (liquid or very soft), and weight greater than 30 g \/ d","correct":false,"justification":"Definitions Diarrhoea is defined in adults by the emission of stools that are too frequent, too abundant, of abnormal consistency (liquid or very soft), and of weight greater than 300 g \/ day"},{"idx":1,"proposition":"Diarrhea is said to be acute when it has progressed for less than 2 weeks","correct":true},{"idx":2,"proposition":"In the majority of cases, acute diarrhea is sudden onset","correct":true},{"idx":3,"proposition":"It is then most often due to an infection, usually lasts less than a week and recurrences in the short term","correct":false,"justification":"It is then most often due to an infection, usually lasts less than a week and does not recur in the short term."},{"idx":4,"proposition":"A dysenteric syndrome is defined by bloody and glairous evacuations that can be dissociated from the materials","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"diarrheeaigue-HGE-1","context":null,"enonce":"Regarding acute diarrhoea","item":"diarrheeaigue","matiere":"HGE","propositions":[{"idx":0,"proposition":"When it involves afecal evacuations, dysenteric syndrome indicates a distal colonic organic lesion","correct":true},{"idx":1,"proposition":"Acute diarrhea most often regresses spontaneously or under symptomatic treatment within 3 days","correct":true},{"idx":2,"proposition":"Digestive losses due to diarrhea include water, sodium (about 50 mmol\/L), potassium and bicarbonates","correct":true},{"idx":3,"proposition":"Physical examination of the abdomen is most often normal or shows only diffuse tenderness on abdominal palpation","correct":true},{"idx":4,"proposition":"In infants, dehydration can cause: apathy, difficulty waking up with moans, unusual behavior and bradypnea","correct":false,"justification":"When it involves afecal evacuations, dysenteric syndrome indicates a distal colonic organic lesion"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"rachialgie-rhumato-0","context":null,"enonce":"Regarding generalities about rachialgia:","item":"rachialgie","matiere":"rhumato","propositions":[{"idx":0,"proposition":"The infectious origin of spinal pain is the most common","correct":false,"justification":"Rachialgia, whether cervical, thoracic or lumbar, is a symptom whose etiology can be extremely varied, even if the degenerative origin (often called \"common\" vertebral pathology) is, by far, the most frequent"},{"idx":1,"proposition":"Neck pain is extremely common pain of the cervical spine","correct":true},{"idx":2,"proposition":"Torticollis is an acute cervical pain syndrome with associated muscle contracture","correct":true,"justification":"A distinction is made between torticollis, which is an acute cervical pain syndrome with associated muscle contracture, and subacute or chronic neck pain, most often of degenerative origin."},{"idx":3,"proposition":"The so-called \"common\" neck pain is related to osteoarthritis or disc disease lesions","correct":true},{"idx":4,"proposition":"Discopathic lesions are always symptomatic","correct":false,"justification":"In the majority of cases, it is asymptomatic, and this notion must be present in mind so as not to attribute the symptomatology too easily to radiographic abnormalities."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"rachialgie-rhumato-1","context":null,"enonce":"Concerning common neck pain:","item":"rachialgie","matiere":"rhumato","propositions":[{"idx":0,"proposition":"\"Common\" neck pain is cervical pain related to degenerative discovertebral mechanical lesions","correct":true},{"idx":1,"proposition":"Common circles check for the absence of general signs or a particular general context","correct":true},{"idx":2,"proposition":"Common low back pain is an inflammatory lesion","correct":false,"justification":"Mechanical injuries"},{"idx":3,"proposition":"Spinal muscles can be painful on palpation","correct":true},{"idx":4,"proposition":"A median and impulsive low back pain in a person between 20 and 60 years of age points to an inflammatory origin","correct":false,"justification":"Rather of mechanical origin"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"rachialgie-rhumato-2","context":null,"enonce":"Regarding common neck pain:","item":"rachialgie","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Standard X-ray In front of a common neck pain is necessary to eliminate any inflammatory, infectious or neoplastic process","correct":false,"justification":"In front of a simple torticollis, acute neck pain, or a recurrence of chronic neck pain known and already explored, without any red flag, there is no need to perform imaging"},{"idx":1,"proposition":"Dynamic images (in flexion and profile extension) are useful if there is a traumatic history when X-rays are indicated","correct":true},{"idx":2,"proposition":"MRI is contraindicated in front of neck pain because useless","correct":false,"justification":"It is only useful in front of red flags,"},{"idx":3,"proposition":"In the disc origin, pain is little present, if at all","correct":false,"justification":"The picture is often very algic, with cervical stiffness and contracture, analgesic attitude, impulsivity"},{"idx":4,"proposition":"Degenerative\/osteoarthritis origin is the most common","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"rachialgie-rhumato-3","context":null,"enonce":"Which propositions are true?","item":"rachialgie","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Senile kyphosis known as \"Schmorl\" is linked to Scheuermann's disease","correct":true},{"idx":1,"proposition":"Senile kyphosis is still symptomatic","correct":false,"justification":"It is rarely symptomatic"},{"idx":2,"proposition":"Herniated discs may be asymptomatic","correct":true,"justification":"They are in the majority of cases"},{"idx":3,"proposition":"Scoliosis promotes costovertebral osteoarthritis","correct":true,"justification":"Just as hip dysplasia promotes coxarthrosis; and varus\/valgus gonarthrosis"},{"idx":4,"proposition":"\"Common\" low back pain is lumbar spine pain related to degenerative discovertebral mechanical injuries","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"rachialgie-rhumato-4","context":null,"enonce":"Which of the following proposals are in favour of common low back pain?","item":"rachialgie","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Long-term corticosteroid use","correct":false,"justification":"False"},{"idx":1,"proposition":"Freedom from HIV infection","correct":true},{"idx":2,"proposition":"Immunosuppression","correct":false,"justification":"False"},{"idx":3,"proposition":"Lack of weight loss","correct":true},{"idx":4,"proposition":"Cauda equina syndrome","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"rachialgie-rhumato-6","context":null,"enonce":"Which of the following proposals are in favour of common low back pain?","item":"rachialgie","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Chest pain","correct":false,"justification":"False"},{"idx":1,"proposition":"The mechanical schedule of pain","correct":true},{"idx":2,"proposition":"Structural deformation","correct":false,"justification":"False"},{"idx":3,"proposition":"35 years","correct":true},{"idx":4,"proposition":"The absence of fever","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"coma-urg-0","context":null,"enonce":"Which of the following are mixed nerves?","item":"coma","matiere":"urg","propositions":[{"idx":0,"proposition":"Olfactory nerve I","correct":false,"justification":"Sensory nerve"},{"idx":1,"proposition":"Optic nerve II","correct":false,"justification":"Sensory nerve"},{"idx":2,"proposition":"Trigeminal V nerve","correct":true},{"idx":3,"proposition":"Nerve VI abducens","correct":false,"justification":"Motor nerve (lateral straight, abduction of the eye)"},{"idx":4,"proposition":"Facial nerve VII ","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"coma-urg-3","context":null,"enonce":"Which of the following propositions are true regarding decebration?","item":"coma","matiere":"urg","propositions":[{"idx":0,"proposition":"The upper limbs are in flexion","correct":false,"justification":"Extension"},{"idx":1,"proposition":"The upper limbs are in extension","correct":true},{"idx":2,"proposition":"The lower limbs are in flexion","correct":false,"justification":"Extension"},{"idx":3,"proposition":"The lower limbs are in extension","correct":true},{"idx":4,"proposition":"The head is flexed","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"coma-urg-4","context":null,"enonce":"Which of the following proposals are involved in the reflex of the veil of the palate 👄?","item":"coma","matiere":"urg","propositions":[{"idx":0,"proposition":"Glossopharyngeal nerve IX","correct":true,"justification":"True. Mixed nerve involved in the afferent pathway of this reflex"},{"idx":1,"proposition":"Vagus X nerve","correct":true,"justification":"True. Mixed nerve involved in the efferent pathway of this reflex"},{"idx":2,"proposition":"Spinal nerve XI","correct":false,"justification":"Mixed nerve"},{"idx":3,"proposition":"Nerve XII hypoglossus","correct":false,"justification":"False"},{"idx":4,"proposition":"Craniooccipital nerve XIII","correct":false,"justification":"This nerve does not exist, it is invented 🧙 ♂️"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"coma-urg-5","context":null,"enonce":"Which of the following are attenuated forms of coma? (Emergency MedLine)","item":"coma","matiere":"urg","propositions":[{"idx":0,"proposition":"Obnubilation","correct":true},{"idx":1,"proposition":"Confusion","correct":true},{"idx":2,"proposition":"Anxiety","correct":false,"justification":"False"},{"idx":3,"proposition":"Profuf asthenia","correct":false,"justification":"False"},{"idx":4,"proposition":"Stupor","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grippe-infectio-0","context":null,"enonce":"Regarding influenza virus infection","item":"grippe","matiere":"infectio","propositions":[{"idx":0,"proposition":"It presents an epidemic with a seasonal rhythm autumn-winter","correct":true},{"idx":1,"proposition":"It has a strict human-to-human transmission","correct":true},{"idx":2,"proposition":"The high attack rate in case of close and repeated contact","correct":true,"justification":"In epidemiology, the attack rate (ATR) is an indicator used to characterize the morbidity of an epidemic. It most often corresponds to a cummule incidence rate"},{"idx":3,"proposition":"Transmission mainly within the family and in communities","correct":true},{"idx":4,"proposition":"Influenza is a disease circulating in 2 modes: seasonal and pandemic","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"grippe-infectio-1","context":null,"enonce":"Regarding influenza infection","item":"grippe","matiere":"infectio","propositions":[{"idx":0,"proposition":"During an epidemic season, about 10% of the world's population is infected","correct":true},{"idx":1,"proposition":"Children play a major role in the spread of an epidemic","correct":true,"justification":"Being often asymptomptopopatic, they play the role of healthy carriers"},{"idx":2,"proposition":"Influenza easily decompensates an underlying medical condition","correct":true,"justification":"This is why people at risk (elderly or immunocompromised) should be monitored."},{"idx":3,"proposition":"Secondary bacterial pneumonia (post influenza) is found particularly in the elderly","correct":true},{"idx":4,"proposition":"Chest X-ray will be systematically useful","correct":false,"justification":"Chest X-ray will be useful in for differential diagnosis or in case of complications"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grippe-infectio-2","context":null,"enonce":"About the flu virus","item":"grippe","matiere":"infectio","propositions":[{"idx":0,"proposition":"Staphylococcus aureus, Haemophilus influenzae and pneumococcus are the main bacteria implicated in bacterial superinfection","correct":true},{"idx":1,"proposition":"Microbiological tests have no indication for uncomplicated seasonal influenza","correct":true},{"idx":2,"proposition":"The reference method of virus detection is antigen detection by ELISA","correct":false,"justification":"The reference method is PCR"},{"idx":3,"proposition":"Serology has no interest","correct":true},{"idx":4,"proposition":"An inflammatory syndrome (high CRP) can appear in case of bacterial superinfection and is very specific","correct":false,"justification":"An inflammatory syndrome (elevated CRP) may occur in case of bacterial superinfection. But beware, this is not at all a specific sign"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grippe-infectio-3","context":null,"enonce":"Regarding influenza virus infection","item":"grippe","matiere":"infectio","propositions":[{"idx":0,"proposition":"Rest at home and, where appropriate, a work stoppage are to be prescribed","correct":true},{"idx":1,"proposition":"Analgesics and antipyretics are prescribed if poorly tolerated fever","correct":true,"justification":"Paracetamol is the molecule of choice"},{"idx":2,"proposition":"NSAIDs and corticosteroids should be avoided","correct":true},{"idx":3,"proposition":"Cough suppressants and bronchial thinners are ineffective in treating influenza","correct":true},{"idx":4,"proposition":"If bacterial pulmonary superinfection characterized, antibiotic therapy targeting Haemophilius Influenzae should be prescribed","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grippe-infectio-4","context":null,"enonce":"Which of the following statements about influenza are true?","item":"grippe","matiere":"infectio","propositions":[{"idx":0,"proposition":"Transmission is strictly human-to-human ","correct":true},{"idx":1,"proposition":"Direct transmission by air is via aerosols ","correct":false,"justification":"False.\r\nVia droplets."},{"idx":2,"proposition":"Contagiousness of the subject is defined as 1 day before the onset of symptoms to 6 days after. ","correct":true},{"idx":3,"proposition":"The incubation period is 1-3 days.","correct":true},{"idx":4,"proposition":"Bacterial superinfection usually occurs between the 5th and 7th day after the onset of symptoms.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"adenomehypoP-endoc-0","context":null,"enonce":"Regarding the compression of the optical chiasm:","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"proposition":"Pituitary tumor syndrome can compress the optic pathways","correct":true},{"idx":1,"proposition":"Visual acuity is most often lowered","correct":false,"justification":"Visual acuity is most often normal due to the absence of involvement of the central visual field; sometimes it is reduced in case of very large and long neglected lesions"},{"idx":2,"proposition":"Fundus examination is normal most often","correct":true},{"idx":3,"proposition":"The study of the visual field with the Goldman apparatus finds a superior temporal quadranopsia","correct":true},{"idx":4,"proposition":"Emergency imaging allows diagnosis by showing an adenoma in the process of necrosis or hemorrhage","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"adenomehypoP-endoc-1","context":null,"enonce":"Regarding the diagnosis of pituitary adenomas:","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"proposition":"The indication of CT scan of the pituitary region is currently limited to bone impact analysis of macroadenomas","correct":true},{"idx":1,"proposition":"Magnetic resonance imaging (MRI) is the gold standard test for exploring the hypothalamic-pituitary region","correct":true},{"idx":2,"proposition":"In T2 weighting, adenomas can be hypo, iso or more often hyperintense","correct":true},{"idx":3,"proposition":"After injection, the microadenoma appears hypointense to the rest of the pituitary gland which takes the contrast homogeneously in T1","correct":true},{"idx":4,"proposition":"Dynamic shots are used to analyze differences in contrast taking","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"adenomehypoP-endoc-2","context":null,"enonce":"Which of the following are dosages to look for corticotropic insufficiency after pituitary surgery for cortisolic adenoma?","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"proposition":"Urinary free cortisol for 24h","correct":false,"justification":"Used for hypercorticism"},{"idx":1,"proposition":"Cortisolemia at 8 a.m.","correct":true,"justification":"True, there is a physiological peak, which disappears in case of corticotropic insufficiency"},{"idx":2,"proposition":"Cortisolemia at any time","correct":false,"justification":"False, difficult to interpret"},{"idx":3,"proposition":"Braking test","correct":false,"justification":"False, hypercorticism screening test"},{"idx":4,"proposition":"None of the propositions are true","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"adenomehypoP-endoc-3","context":null,"enonce":"Which of the following are pathologies that fall within the scope of an NMS 1?","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"proposition":"Macroprolactinoma","correct":true,"justification":"Pituitary adenomas are part of the MEN1 spectrum"},{"idx":1,"proposition":"Parathyroid adenoma","correct":true},{"idx":2,"proposition":"Hyperthyroidism","correct":false,"justification":"False"},{"idx":3,"proposition":"Wilson's disease","correct":false,"justification":"False"},{"idx":4,"proposition":"Adisson's disease","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"adenomehypoP-endoc-4","context":null,"enonce":"Which of the following are signs or symptoms of Cushing's syndrome?","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"proposition":"Android obesity","correct":true},{"idx":1,"proposition":"Muscle hypertrophy","correct":false,"justification":"Muscular"},{"idx":2,"proposition":"Bison hump","correct":true},{"idx":3,"proposition":"Acanthosis nigricans","correct":true},{"idx":4,"proposition":"Hyperkeratosis","correct":false,"justification":"Capillary fragility"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"adenomehypoP-endoc-5","context":null,"enonce":"Which of the following are signs or symptoms of Cushing's syndrome?","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"proposition":"Gynoid obesity","correct":false,"justification":"Android obesity"},{"idx":1,"proposition":"Muscular","correct":true,"justification":"True, sign of the stool"},{"idx":2,"proposition":"Facial erythrosis","correct":true},{"idx":3,"proposition":"White vertegures","correct":false,"justification":"Purple stretch marks"},{"idx":4,"proposition":"Psychic hyperactivity","correct":false,"justification":"False, rather a depressive tendency"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"adenomehypoP-endoc-6","context":null,"enonce":"Which of the following are plasma assays that can confirm Cushing's syndrome?","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"proposition":"Dexamethasone Brake Test","correct":true},{"idx":1,"proposition":"24-hour cortisol assay","correct":true},{"idx":2,"proposition":"Urinary free cortisol","correct":false,"justification":"Screening test"},{"idx":3,"proposition":"Determination of ACTH","correct":false,"justification":"Test that determines the etiology of Cushing"},{"idx":4,"proposition":"Cortisol assay at 8 a.m.","correct":false,"justification":"Not very informative because physiological peak at 8 am"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRespiC-pneumo-0","context":null,"enonce":"Regarding chronic respiratory failure or CKD","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Chronic respiratory failure (CKD) is defined by the inability of the respiratory system to provide haematosis","correct":true},{"idx":1,"proposition":"The main clinical sign of chronic respiratory failure is dyspnea","correct":true},{"idx":2,"proposition":"Chronic respiratory failure is the common evolutionary term for many respiratory diseases","correct":true},{"idx":3,"proposition":"His prognosis is benign","correct":false,"justification":"His prognosis is severe"},{"idx":4,"proposition":"Comorbidities, depending on the etiology of CKD, are common and should be systematically sought","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"IRespiC-pneumo-1","context":null,"enonce":"Regarding chronic respiratory failure or CKD","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The withdrawal of a possible tobacco intoxication is secondary because the attack is already at an advanced stage","correct":false,"justification":"Quitting from possible tobacco intoxication is essential"},{"idx":1,"proposition":"Patients with chronic respiratory failure are at risk of decompensation (acute respiratory failure), which has significant morbidity and mortality","correct":true},{"idx":2,"proposition":"Assessment of pulmonary arterial pressure should be sought during follow-up","correct":true},{"idx":3,"proposition":"The existence of a decrease in the partial pressure of oxygen (PaO2) in the arterial blood (hypoxemia) is necessary to speak of chronic respiratory failure","correct":true},{"idx":4,"proposition":" The realization of blood gas is therefore essential to make the diagnosis of chronic respiratory failure (CKD)","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"IRespiC-pneumo-2","context":null,"enonce":"Regarding chronic respiratory failure or CKD","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The most common cause of CKD (75% of cases) is COPD","correct":true},{"idx":1,"proposition":"Hypoxia is a decrease in the distribution of oxygen to tissues","correct":true},{"idx":2,"proposition":"We speak of shunt effect when certain lung units are ventilated normally but poorly infused","correct":true,"justification":"Or when some lung units are infused normally but poorly ventilated"},{"idx":3,"proposition":"The passage of gases (O2 and CO2) through the alveolo-capillary membrane depends on the thickness of the membrane and its surface but also on the integrity of the pulmonary vascular bed","correct":true},{"idx":4,"proposition":"Polycythemia is an adaptive, inconstant phenomenon that aims to compensate for the decrease in oxygen saturation to maintain arterial content of O2 (CaO2), due to the production by the liver of erythropoietin (EPO),","correct":false,"justification":"Polycythemia It aims to maintain normal arterial oxygen transport  adaptive, inconsistent phenomenon  aims to compensate for the decrease in oxygen saturation to maintain arterial O2 (CaO2) content  due to the kidney's production of erythropoietin (EPO), in response to chronic hypoxemia  leads to blood hyperviscosity and an increased risk of arterial or venous thrombosis"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRespiC-pneumo-3","context":null,"enonce":"Regarding chronic respiratory failure or CKD","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Only the presence of chronic hypoxemia is necessary for the diagnosis of CKD but most CKD is complicated in the long term by alveolar hypoventilation and therefore hypercapnia","correct":true},{"idx":1,"proposition":"The capnia of some patients can thus be established, chronically, at high levels (> 60 mmHg)","correct":true},{"idx":2,"proposition":"Hypercapnia is extremely harmful even with normal pH","correct":false,"justification":"Hypercapnia is not or only slightly harmful as long as the pH remains normal"},{"idx":3,"proposition":"CKD is the common evolutionary term for many respiratory diseases","correct":true},{"idx":4,"proposition":"Lung exchanger involvement is by far the leading cause of CKD","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"IRespiC-pneumo-4","context":null,"enonce":"Regarding chronic respiratory failure or CKD","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Depending on the etiologies, EFRs show obstructive ventilatory disorder (OVD) defined by a FEV1\/FVC ratio < 70%, a restrictive ventilatory disorder (RVC) defined by a CPT < 80%) or a mixed ventilatory disorder","correct":true},{"idx":1,"proposition":"The most effective way to correct hypoxemia related to lung exchanger involvement is long-term oxygen therapy (OLD).","correct":true},{"idx":2,"proposition":"Ventilatory pump refers to the different structures surrounding the lung exchanger and involved in chest amplification and therefore lung ventilation.","correct":true},{"idx":3,"proposition":"The operation of the ventilatory pump can be altered by different mechanisms sometimes associated:  decrease in ventilatory control (stroke)  neuromuscular pathologies: spinal lesions, myopathies, amyotrophic lateral sclerosis  increase in the load imposed by the chest wall   chest deformity morbid obesity and obesity\/hypoventilation syndrome (increasingly common cause of CKD by damage to the ventilatory pump)An accident cerebral vascular can lead to alteration of the ventilatory pump","correct":true},{"idx":4,"proposition":"The main mechanism responsible for hypoxemia is the reduction of alveolar ventilation (alveolar hypoventilation)","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRespiC-pneumo-5","context":null,"enonce":"Regarding chronic respiratory failure or CKD","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Only the presence of chronic hypoxemia is necessary for the diagnosis of CKD","correct":true},{"idx":1,"proposition":"Lung exchanger involvement is by far the leading cause of CKD","correct":true},{"idx":2,"proposition":"The operation of the ventilatory pump can be altered by different mechanisms sometimes associated such as the decrease in ventilatory control related to a stroke","correct":true},{"idx":3,"proposition":"In CKD related to ventilatory pump involvement, PaCO2 is increased very early in the course of the disease","correct":true},{"idx":4,"proposition":"The most effective way to correct hypercapnia (and hypoxemia) is oxygen therapy but non-invasive ventilation.","correct":false,"justification":"The most effective way to correct hypercapnia (and hypoxemia) is not oxygen therapy but mechanical ventilation that replaces the \"pump function\" that is defective."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRespiC-pneumo-6","context":null,"enonce":"Regarding chronic respiratory failure or CKD","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Cyanosis reflects the existence in the integuments of a high amount of hemoglobin desaturated with oxygen","correct":true},{"idx":1,"proposition":"The diagnosis of CKD is confirmed by the measurement of arterial blood gases showing PaO2 < 70 mmHg twice (steady state)","correct":true},{"idx":2,"proposition":"Pulmonary function tests play a pivotal role in the etiological orientation of a patient with CKD","correct":true},{"idx":3,"proposition":"Obstructive ventilatory disorder (OSVD) is characterized by a FEV1\/FVC ratio <40%","correct":false,"justification":"obstructive ventilatory disorder (OPT) are characterized by a FEV1\/FVC ratio <70%"},{"idx":4,"proposition":"it is by definition obstructive CKD","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRespiC-pneumo-7","context":null,"enonce":"Regarding chronic respiratory failure or CKD","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"proposition":"BCPO is the leading cause of restrctive CKD","correct":false,"justification":"Obstructive"},{"idx":1,"proposition":"The NFS will look for anemia during CKD","correct":false,"justification":"NFS will look for polycythemia"},{"idx":2,"proposition":"A normal ECG does not rule out proven right ventricular failure","correct":true},{"idx":3,"proposition":"The 6-minute walking test and the cardiorespiratory stress test in particular allow a prognostic evaluation of patients with chronic respiratory failure","correct":true},{"idx":4,"proposition":"Right cardiac catheterization confirms PH and the exact level of right pressures","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRenA-urg-0","context":null,"enonce":"Which propositions are true?","item":"IRenA","matiere":"urg","propositions":[{"idx":0,"proposition":"An AKI can complicate underlying chronic kidney disease, for example after injection of iodinated contrast media or taking nonsteroidal anti-inflammatory drugs","correct":true},{"idx":1,"proposition":"Acute renal failure is never accompanied by anemia","correct":false,"justification":"AKI may be associated with anemia, in cases of acute hemolysis or hemorrhagic shock themselves causing AKI"},{"idx":2,"proposition":"Early and sometimes profound hypocalcemia may be present during ARI","correct":true,"justification":"Especially in case of rhabdomyolysis"},{"idx":3,"proposition":"In obstructive ARIs, the patient is always anuric","correct":false,"justification":"The obstacle may not be complete"},{"idx":4,"proposition":"In practice in front of any ARI, imaging of the urinary tract is essential to visualize the pyel-calicial cavities and in case of dilation, look for an obstacle","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRenA-urg-1","context":null,"enonce":"Which of these pathologies can cause chronic kidney failure without kidneys of reduced size?","item":"IRenA","matiere":"urg","propositions":[{"idx":0,"proposition":"Myeloma","correct":true,"justification":"The 4 pathologies are: diabetes, amyloidosis, myeloma and autosomal dominant polycystic kidney disease (PKAD)"},{"idx":1,"proposition":"High blood pressure","correct":false},{"idx":2,"proposition":"A kidney tumour","correct":false,"justification":"Be careful, the question is in the plural. A kidney tumor usually involves only one kidney"},{"idx":3,"proposition":"Amyloidosis","correct":true},{"idx":4,"proposition":"Extracellular hyperhydration","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRenA-urg-2","context":null,"enonce":"Which of these pathologies can cause obstructive kidney failure?","item":"IRenA","matiere":"urg","propositions":[{"idx":0,"proposition":"One-sided calculation on a single functional kidney ","correct":true},{"idx":1,"proposition":"Prostate cancer","correct":true},{"idx":2,"proposition":"Retroperitoneal liposclerosis","correct":true,"justification":"Be careful, in this case, dilation may be lacking because the urinary tract is enclosed in fibrosis"},{"idx":3,"proposition":"Thoracic aortic aneurysm","correct":false,"justification":"It's upstream"},{"idx":4,"proposition":"Bladder tumour","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRenA-urg-3","context":null,"enonce":"Let PUF be the glomerular transcapillary pressure gradient, and K the filtration coefficient, how is the GFR calculated?","item":"IRenA","matiere":"urg","propositions":[{"idx":0,"proposition":"GFR = UFP + K","correct":false,"justification":"GFR = UFP x K"},{"idx":1,"proposition":"GFR = UFP x K","correct":true},{"idx":2,"proposition":"GFR = PUF\/K","correct":false},{"idx":3,"proposition":"GFR = PUF - K","correct":false},{"idx":4,"proposition":"GFR = PUF x 10 + K","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"IRenA-urg-4","context":null,"enonce":"Which of these proposals can cause extracellular dehydration that can induce functional renal failure?","item":"IRenA","matiere":"urg","propositions":[{"idx":0,"proposition":"Extensive skin burns","correct":true},{"idx":1,"proposition":"Severe nephrotic syndrome","correct":false,"justification":"It is a cause of true or effective hypovolemia, but not of extracellular dehydration (the latter are due to losses). See page 221 of the CUEN"},{"idx":2,"proposition":"Taking NSAIDs","correct":false},{"idx":3,"proposition":"Adrenal insufficiency","correct":true,"justification":"Induces kidney loss"},{"idx":4,"proposition":"Profuse diarrhea","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"IRenA-urg-5","context":null,"enonce":"Among these proposals, which can cause hypovolemia (real or effective) that can induce functional renal failure?","item":"IRenA","matiere":"urg","propositions":[{"idx":0,"proposition":"Decompensated hepatic cirrhosis","correct":true},{"idx":1,"proposition":"Lithium","correct":false},{"idx":2,"proposition":"Congestive heart failure","correct":true,"justification":"This is cardio-renal syndrome"},{"idx":3,"proposition":"Cardiogenic shock","correct":true},{"idx":4,"proposition":"Internal gastrointestinal bleeding","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbneuroSegeria-geria-1","context":null,"enonce":"Regarding epidemiology:","item":"tbneuroSegeria","matiere":"geria","propositions":[{"idx":0,"proposition":"20% of people over 85 years of age are affected by presbycusis","correct":false,"justification":"About 60% of people over 85"},{"idx":1,"proposition":"There are approximately 120,000 hearing-impaired people in France","correct":false,"justification":"Between 4 and 6 million"},{"idx":2,"proposition":"85% of people over 60 have visual impairments","correct":false,"justification":"60% of over 60s"},{"idx":3,"proposition":"There are 207,000 blind (or deeply visually impaired) people in France","correct":true},{"idx":4,"proposition":"Total anosmia affects 10 to 15% of people over 80 years of age","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbneuroSegeria-geria-2","context":null,"enonce":"Regarding the management of disorders:","item":"tbneuroSegeria","matiere":"geria","propositions":[{"idx":0,"proposition":"There is no drug treatment for taste disorders","correct":true},{"idx":1,"proposition":"There is no drug treatment for smell disorders","correct":true},{"idx":2,"proposition":"The treatment of glaucoma involves the normalization of intraocular pressure by adrenergic agonists for example","correct":true},{"idx":3,"proposition":"The hearing aid is indicated as soon as the loss exceeds 5 dB between 1000 and 2000 Hz","correct":false,"justification":"Exceeds 30 dB"},{"idx":4,"proposition":"Prevention of diabetic retinopathy requires monitoring of glyccated hemoglobin every 3 months","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"infmigrant-infectio-0","context":null,"enonce":"Regarding the basics:","item":"infmigrant","matiere":"infectio","propositions":[{"idx":0,"proposition":"Infectious pathologies of migrants are all imported pathologies","correct":false,"justification":"No. It can also be pathologies acquired on French territory"},{"idx":1,"proposition":"Prevalences of HPV infection, EBV and hepatitis C are higher in migrant populations than in the general population","correct":false,"justification":"No, but this is the case for HIV infection, tuberculosis and hepatitis B."},{"idx":2,"proposition":"The metropolitan France has 11.2 million migrants mainly from sub-Saharan Africa","correct":false,"justification":"5.3 million migrants mainly from Africa and Europe"},{"idx":3,"proposition":"Infectious diseases acquired in metropolitan France are linked to changes in environment and unfavourable socio-economic conditions","correct":true},{"idx":4,"proposition":"Infectious diseases acquired in metropolitan France mainly concern political refugees","correct":false,"justification":"Infectious import pathologies concern: migrant workers and their families who have just arrived in France, political refugees, illegal immigrants, migrants returning regularly to their country of origin"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infmigrant-infectio-1","context":null,"enonce":"Which propositions are true?","item":"infmigrant","matiere":"infectio","propositions":[{"idx":0,"proposition":"Pneumococcal infection is particularly serious in sickle cell patients","correct":true},{"idx":1,"proposition":"HIV infection and tuberculosis are often acquired in France","correct":true},{"idx":2,"proposition":"HIV, HBV, HCV serology and the interferon gamma test are to be performed as a first-line","correct":true},{"idx":3,"proposition":"The hemogram looking for eosinophilia is performed in first line","correct":false,"justification":"No. It depends on the context"},{"idx":4,"proposition":"Fasting blood glucose is performed when diabetes risk factors are present","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infmigrant-infectio-2","context":null,"enonce":"Regarding support:","item":"infmigrant","matiere":"infectio","propositions":[{"idx":0,"proposition":"Social Security Health Examination Centers also offer a free health check-up","correct":true},{"idx":1,"proposition":"CeGIDD, CLAT and PASS carry out a large part of the health check-ups in migrants","correct":true},{"idx":2,"proposition":"Hepatitis should be systematically evoked in front of any fever with a history of a stay in an endemic area","correct":false,"justification":"Tuberculosis must be eliminated"},{"idx":3,"proposition":"Amoebosis can be hepatic (non-febrile diarrhea) or colic (painful and febrile hepatomegaly)","correct":false,"justification":"Colic form = non-febrile diarrhea. Hepatic form = painful and febrile hepatomegaly"},{"idx":4,"proposition":"The colonic form of aemobosis involves PNN hyperleukocytosis","correct":false,"justification":"This is the hepatic form"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pathofer-HGE-0","context":null,"enonce":"Regarding iron metabolism in the body","item":"pathofer","matiere":"HGE","propositions":[{"idx":0,"proposition":"The body contains 3 to 4 g of iron","correct":true},{"idx":1,"proposition":"The majority of functional iron is in heme form in hemoglobin (2.5 g)","correct":true},{"idx":2,"proposition":"In the physiological state, the body does not absorb iron","correct":false,"justification":"About 10% of dietary iron is absorbed (± 1 mg\/d), which compensates for natural losses"},{"idx":3,"proposition":"Absorption is carried out by the enterocytes of the ileum","correct":false,"justification":"Absorption is carried out by the enterocytes of the duodenum and the proximal part of the jejunum"},{"idx":4,"proposition":"Another route of entry of iron into plasma is the recycling of erythrocytes by macrophages","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"pathofer-HGE-1","context":null,"enonce":"Concerning iron metabolism","item":"pathofer","matiere":"HGE","propositions":[{"idx":0,"proposition":"In the plasma sector, iron is supported by ferritin","correct":false,"justification":"In the plasma sector, iron is supported by transferrin"},{"idx":1,"proposition":"The regulation of iron metabolism is done at the level of absorption","correct":true},{"idx":2,"proposition":"Hepcidin, synthesized by the liver, will inhibit ferroportin inhibiting the export of iron to plasma by enterocytes and macrophages","correct":true},{"idx":3,"proposition":"Iron blocked in intestinal cells blocked by hepcidin will be eliminated by desquamation of enterocytes","correct":true},{"idx":4,"proposition":"The iron reserve in the body is between 0 and 1 g of iron, stored as transferrin","correct":false,"justification":"The iron reserve in the body is between 0 and 1 g of iron, stored in the form of ferritin, mainly in the liver, bone marrow and spleen"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pathofer-HGE-2","context":null,"enonce":"Concerning iron pathologies","item":"pathofer","matiere":"HGE","propositions":[{"idx":0,"proposition":"Transferrin testing is the first-line test for assessing iron stock","correct":false,"justification":"It is the determination of ferritin that is the first-line examination to evaluate the iron stock"},{"idx":1,"proposition":"Ferritin is the storage protein of iron","correct":true},{"idx":2,"proposition":"The transferrin saturation coefficient is calculated from serum iron and transferrin","correct":true},{"idx":3,"proposition":"Under normal conditions, more than 80% of transferrin binding sites are occupied by iron","correct":false,"justification":"Under normal conditions, 20-45% of transferrin binding sites are occupied by iron"},{"idx":4,"proposition":"The transferrin saturation coefficient increases earlier than ferritin in hemochromatosis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pathofer-HGE-3","context":null,"enonce":"Concerning iron pathologies","item":"pathofer","matiere":"HGE","propositions":[{"idx":0,"proposition":"Iron deficiency affects nearly 10% of people in industrialized countries","correct":true},{"idx":1,"proposition":"Iron deficiency is marked by several successive stages: depletion of the iron stock, alteration of erythropoiesis resulting in microcytosis without anemia, then hypochromic and microcytic sideropene anemia ","correct":true,"justification":"Microcytic = > mean corpuscular volume [MCV] < 80 μ3\/fl"},{"idx":2,"proposition":"Iron deficiency can result from 3 mechanisms, which can be associated: malabsorption, lack of intake, excessive losses","correct":true},{"idx":3,"proposition":"In menopausal men and women, the origin of bleeding explaining iron deficiency is essentially digestive","correct":true},{"idx":4,"proposition":"In premenopausal women, the origin of the bleeding explaining the iron deficiency is primarily gynecological","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pathofer-HGE-4","context":null,"enonce":"Regarding digestive explorations as part of the assessment of iron deficiency anemia:","item":"pathofer","matiere":"HGE","propositions":[{"idx":0,"proposition":"In the absence of signs of orientation, it should include upper endoscopy at any age and systematic colonoscopy after 50 years.","correct":true},{"idx":1,"proposition":"Duodenal biopsies should be routinely performed if gastroduodenal endoscopy is unremarkable.","correct":true},{"idx":2,"proposition":"Exploration of the small intestine by enteroscopy is systematic in case of colonoscopy without particularity","correct":false,"justification":"As a first line, the hail will be explored by videosendoscopic capsule."},{"idx":3,"proposition":"The endoscopic capsule is considered only after performing one or two upper endoscopies and a total colonoscopy","correct":true},{"idx":4,"proposition":"Total colonoscopy is contraindicated in subjects under 50 years of age","correct":false,"justification":"No contraindication of age"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"pathofer-HGE-5","context":null,"enonce":"Concerning the absoption of iron","item":"pathofer","matiere":"HGE","propositions":[{"idx":0,"proposition":"In the physiological state, the body absorbs 3-4 grams of iron every day","correct":false,"justification":"The body absorbs almost no iron (1mg). It is the iron stock that is 3-4 grams."},{"idx":1,"proposition":"Hepcidin inhibits ferroportin","correct":true},{"idx":2,"proposition":"Hepcidin is produced by the kidney","correct":false,"justification":"Produced by the liver and allows the homeostasis of iron metabolism by inhibiting the absorption of iron in the body. It blocks ferroportin, which normally allows iron to pass from the intracellular space of the enterocyte to the plasma sector."},{"idx":3,"proposition":"Transferrin is the storage form of iron ","correct":false,"justification":"This is ferritin. Transferrin transports iron in the plasma sector"},{"idx":4,"proposition":"Iron absorption occurs in the duodenum and proximal jejunum","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pathofer-HGE-6","context":null,"enonce":"At what stage is hemocromatosis treated?","item":"pathofer","matiere":"HGE","propositions":[{"idx":0,"proposition":"Stage 0","correct":false,"justification":"Hemocromatosis is started at stage 2. The treatment is done by blood subtraction with an induction phase (frequency up to 1x \/ week) then a maintenance phase (every 1, 2, 3 ... month)"},{"idx":1,"proposition":"Stage 1","correct":false},{"idx":2,"proposition":"Stage 2","correct":true},{"idx":3,"proposition":"Stage 3","correct":false},{"idx":4,"proposition":"Stage 4","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pathofer-HGE-7","context":null,"enonce":"What are the non-sideric causes of hyperferritininemia?","item":"pathofer","matiere":"HGE","propositions":[{"idx":0,"proposition":"Renal failure","correct":false,"justification":"Not related to ferritin metabolism"},{"idx":1,"proposition":"Hepatic cytolysis","correct":true},{"idx":2,"proposition":"An inflammatory syndrome","correct":true},{"idx":3,"proposition":"Misuse of alcohol","correct":true},{"idx":4,"proposition":"Colon cancer","correct":false,"justification":"Not related to ferritin metabolism"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"pathofer-HGE-8","context":null,"enonce":"Which of the following foods provides the most iron in the same amount ingested?","item":"pathofer","matiere":"HGE","propositions":[{"idx":0,"proposition":"Beef","correct":true,"justification":"It contains heme iron"},{"idx":1,"proposition":"Spinach","correct":false,"justification":"Contains a lot of iron but very little is absorbed"},{"idx":2,"proposition":"Lenses","correct":false,"justification":"Contains a lot of iron but very little is absorbed"},{"idx":3,"proposition":"Egg","correct":false},{"idx":4,"proposition":"Milk","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"HTA-cardio-0","context":null,"enonce":"Concerning hypertension","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"High blood pressure is the leading cause of death worldwide","correct":true},{"idx":1,"proposition":"Only 50% of hypertensive patients have their hypertension controlled under treatment","correct":false,"justification":"Much less: 50% of hypertensive patients know this, of which 80% are treated, and among treated patients, only 50% achieve their goals"},{"idx":2,"proposition":"Repeated stress promotes hypertension","correct":true},{"idx":3,"proposition":"A blood pressure of 166\/94 corresponds to moderate high blood pressure","correct":true,"justification":"Either a grade 2: PAS 160-179 or PAD 100-109 (between PAS and PAD, the highest grade is retained)"},{"idx":4,"proposition":"A blood pressure of 135\/83 is considered optimal","correct":false,"justification":"A voltage is optimal below 120\/80, the proposed voltage is considered \"normal high\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"HTA-cardio-1","context":null,"enonce":"Concerning hypertension","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"A blood pressure at 181\/99 should be confirmed by ambulatory self-measurement before a consultation at 1 month, in order to confirm the diagnosis before initiating treatment","correct":false,"justification":"In case of grade 3 hypertension (>180\/110), treatment should be initiated promptly"},{"idx":1,"proposition":"Blood pressure norms measured in MAPA at night are <130\/80","correct":false},{"idx":2,"proposition":"A measurement by MAPA is systematically indicated to confirm hypertension","correct":false,"justification":"Only in cases of BP variability, inconsistencies between clinical involvement and measurements, resistant hypertension, suspected sleep apnea syndrome, pregnant woman or suspected episodes of orthostatic hypotension"},{"idx":3,"proposition":"The systematic secondary HTA research assessment includes a 12-lead ECG","correct":false,"justification":"The ECG is performed as part of the impact assessment of hypertension: search for left ventricular hypertrophy"},{"idx":4,"proposition":"In patients over 65 years of age, hypertension is more common in women","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"HTA-cardio-2","context":null,"enonce":"Concerning hypertension","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"The assessment carried out systematically upon discovery of hypertension includes a fundus","correct":false,"justification":"This is only performed in case of hypertensive emergency, grade 3 hypertension or diabetes"},{"idx":1,"proposition":"High blood pressure is the leading cause of AF","correct":true,"justification":"It also increases the thromboembolic risk associated with AF"},{"idx":2,"proposition":"A Sokolow index > 45 mm on the ECG indicates left ventricular hypertrophy","correct":false},{"idx":3,"proposition":"High blood pressure can lead to chronic kidney failure, which itself aggravates hypertension","correct":true},{"idx":4,"proposition":"In the assessment of arterial hypertension, the measurement of albuminuria should only be performed in non-proteinuric diabetics","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"HTA-cardio-3","context":null,"enonce":"Concerning hypertension","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"In case of NOIA (anterior ischemic optic neuropathy) due to arteriosclerosis (hypertension among others), fluorescein angiography shows associated choroidal ischemia","correct":false,"justification":"This sign is in favor of an arteritic cause: gigantocellular arteritis (Horton's disease, to be evoked absolutely in case of NOIA)"},{"idx":1,"proposition":"Hypertensive retinopathy is minimally symptomatic, except in cases of severe or prolonged hypertension","correct":true,"justification":"Late visual acuity decrease\/ only if hypertensive flare-up"},{"idx":2,"proposition":"Hypertensive choroidal disease is detected in particular by the presence of a sign of crossing at the fundus","correct":false,"justification":"This sign concerns arteriosclerosis. Hypertensive choroidopathy is characterized in particular by Elschnig's spots (small deep pigmented spots)"},{"idx":3,"proposition":"In ocular involvement of arterial hypertension, retinal hemorrhages correspond to grade II of arterial disease","correct":false,"justification":"Grade 2 hypertensive retinopathy"},{"idx":4,"proposition":"In case of hypertension, aspirin is recommended for primary prevention for all patients","correct":false,"justification":"Recommended only for primary prevention or diabetes, not recommended for severe uncontrolled hypertension (risk of cerebral hemorrhage)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"HTA-cardio-4","context":null,"enonce":"Concerning hypertension","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Regarding the treatment of hypertension, verapamil bisoprolol is a possible dual therapy","correct":false,"justification":"Verapamil is a bradycardial calcium channel blocker: it is contraindicated in combination with beta-blockers. Only the combination between dihydropyridine calcium channel blockers and beta-blockers is possible"},{"idx":1,"proposition":"During the first 6 months of hypertension management, until the blood pressure goal is reached, a monthly consultation is recommended","correct":true},{"idx":2,"proposition":"An early sign of renal involvement secondary to hypertension is the appearance of microalbuminuria (> 300 mg\/24 h)","correct":false},{"idx":3,"proposition":"High blood pressure can lead indirectly to renal failure via atheromatous stenosis of the renal artery or cholesterol embolisms","correct":true},{"idx":4,"proposition":"In a patient over 80 years of age, the recommended blood pressure goal is a PAS < 150, or <145 in blood pressure self-measurement","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"HTA-cardio-5","context":null,"enonce":"Concerning hypertension ","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Dual antihypertensive therapy is possible from the outset in case of grade 2\/3 blood pressure","correct":true,"justification":"TA >160\/100"},{"idx":1,"proposition":"In case of blood pressure objectives reached, follow-up consultations are recommended every year","correct":false,"justification":"Every 3 to 6 months"},{"idx":2,"proposition":"Resistant hypertension should be verified by ambulatory blood pressure self-measurement or ABMD","correct":true},{"idx":3,"proposition":"A resistant hypertension can be explained by a poor measurement, for example a cuff too small on a large arm","correct":true},{"idx":4,"proposition":"Renal Doppler ultrasound is part of the systematic review of secondary hypertension","correct":false,"justification":"It is made in case of suspicion of secondary hypertension only (resistant hypertension for example)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"HTA-cardio-6","context":null,"enonce":"Concerning hypertension","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Black patients are more sensitive to beta-blockers","correct":false,"justification":"More sensitive to thiazides or calcium channel blockers, less sensitive to beta-blockers"},{"idx":1,"proposition":"In case of albuminuria, the blood pressure objective to be achieved is <130\/80","correct":true,"justification":"And an RAS blocker is routinely recommended"},{"idx":2,"proposition":"Secondary hypertension concerns 5-20% of hypertension, and the majority are curable","correct":false,"justification":"Less than half of the causes are curable"},{"idx":3,"proposition":"A resistant hypertension must be suspected in case of severe hypertension from the outset, hyperkalemia, clinical sign (para-umbilical murmur for example)","correct":false,"justification":"Hypokalemia!"},{"idx":4,"proposition":"Dysthyroidism is a rare cause of secondary hypertension","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"HTA-cardio-7","context":null,"enonce":"Concerning secondary hypertension","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Renal parenchymal causes constitute the 1st cause of secondary hypertension","correct":true},{"idx":1,"proposition":"A renovascular hypertension should be evoked especially in case of unexplained flash OAP","correct":true,"justification":"Flash OAP = abrupt, rapidly evolving, with preserved systolic function and little impaired heart on post-crisis cardiac ultrasound"},{"idx":2,"proposition":"In case of secondary renovascular hypertension, revascularization is systematically indicated","correct":false,"justification":"Only if fibrodysplastic origin, non-systematic if atheromatous origin !!"},{"idx":3,"proposition":"Hypokalemia is constant in primary hyperaldosteronism","correct":false,"justification":"50% of cases: normokalemia!"},{"idx":4,"proposition":"The combined dosage of aldosterone-renin should be done in situation of normovolemia, normokalemia, fasting, at 8-10am (among others)","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"HTA-cardio-8","context":null,"enonce":"Concerning secondary hypertension","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"In case of bilateral adrenal hyperplasia, treatment includes high-dose spironolactone","correct":true,"justification":"Surgery is not recommended in this case"},{"idx":1,"proposition":"Renin tumors give a picture of secondary hyperaldosteronism","correct":true,"justification":"That is to say with a high renin (primary = low renin while high aldosterone)"},{"idx":2,"proposition":"Cushing's disease may be secondary to a secreting adrenal tumor","correct":false,"justification":"Cushing's syndrome (hypercorticism) may be due to an adrenal tumor, but Cushing's disease characterizes a corticotropic pituitary adenoma!"},{"idx":3,"proposition":"A pheochromocytoma can be integrated into a genetic syndrome, including neurofibromatosis type 1","correct":true,"justification":"Recklingshausen neurofibromatosis"},{"idx":4,"proposition":"A hypertension with a continuous left mesodiatostolic parasternal murmur should suggest an aortic coarctation","correct":false,"justification":"Continuous mesosystolic murmur"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"HTA-cardio-9","context":null,"enonce":"Regarding malignant hypertension and acute hypertensive crisis","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"A hypertensive crisis is defined as a > 180 SBP or > 120 PAD with life-threatening organ involvement","correct":false,"justification":"The item concerns hypertensive urgency. A hypertensive crisis is a BP >180\/110 in a normothendu subject, without visceral impact: it is not an emergency"},{"idx":1,"proposition":"Malignant hypertension with stage 3 or 4 hypertensive retinopathy is a hypertensive emergency","correct":true,"justification":"So with hemorrhages, exudates, or papillary edema at the back of the eye"},{"idx":2,"proposition":"Malignant hypertension can be complicated by CRVO (central retinal vein occlusion) or acute renal failure, among others.","correct":true},{"idx":3,"proposition":"Malignant hypertension can be caused by a bladder globe","correct":true},{"idx":4,"proposition":"In the treatment of hypertensive emergency without OAP, filling is indicated in combination with antihypertensive therapy","correct":true,"justification":"There is extracellular dehydration with hyperaldosteronism secondary to hypokalaemia: filling (cautious: 500-1500cc of ISS) breaks the vicious circle"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrabdo-HGE-0","context":null,"enonce":"Regarding acute abdominal and lumbar pain","item":"dlrabdo","matiere":"HGE","propositions":[{"idx":0,"proposition":"• Abdominal pain is said to be acute if it elapses less than 24 hours between the onset of symptoms and the first consultation","correct":false},{"idx":1,"proposition":"Any acute abdominal pain can be a symptom of a life-threatening surgical emergency.","correct":true},{"idx":2,"proposition":"Transfixing epigastric pain suggests hepato-biliary origin","correct":false,"justification":"rather pancreatic"},{"idx":3,"proposition":"Pain relief through diet evokes an ulcerative origin","correct":true},{"idx":4,"proposition":"Pain relief by vomiting suggests a pacreatic origin","correct":false,"justification":"of occlusvial origin"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrabdo-HGE-1","context":null,"enonce":"Regarding acute abdominal and lumbar pain","item":"dlrabdo","matiere":"HGE","propositions":[{"idx":0,"proposition":"In women, it is always necessary to think about an ectopic pregnancy (and, more generally, gynecological conditions)","correct":true},{"idx":1,"proposition":"The diagnosis of acute pancreatitis is made in front of amylasemia greater than three times normal","correct":false,"justification":"Lipasemia > 3 times normal"},{"idx":2,"proposition":"The clinical examination should look for an interventional scar, defense or contracture","correct":true},{"idx":3,"proposition":"Pelvic touching should be systematic","correct":true},{"idx":4,"proposition":"Abdominal CT scan should be preferred to any other radiological investigation in case of unexplained acute abdominal pain","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrabdo-HGE-2","context":null,"enonce":"Regarding acute abdominal and lumbar pain, which propositions are true?","item":"dlrabdo","matiere":"HGE","propositions":[{"idx":0,"proposition":"Blood cultures should be performed in case of fever with chills or greater than 39 ° C","correct":true},{"idx":1,"proposition":"Urine strips (± ECBU) are used to rule out a urinary cause","correct":true},{"idx":2,"proposition":"In front of any acute epigastric abdominal pain, an ECG should be performed","correct":true},{"idx":3,"proposition":"Ultrasound is useful in case of suspected biliopancreatic, gynecological or urinary cause","correct":true},{"idx":4,"proposition":"The site of hepatobiliary pain is hypogastric or hypochondrical right","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ascite-HGE-0","context":null,"enonce":"Regarding ascites:","item":"ascite","matiere":"HGE","propositions":[{"idx":0,"proposition":"Ascites is defined as peritoneal fluid effusion","correct":true},{"idx":1,"proposition":"The formal argument of the positive diagnosis is the demonstration of fluid by the puncture of the abdominal cavity","correct":true},{"idx":2,"proposition":"An increase in volume of the abdomen with a declivable abdominal dullness, mobilizable, drawing a concave curve at the top on the subject in supine position strongly evokes ascites","correct":true},{"idx":3,"proposition":"The puncture of ascites fluid should be done at a point at the junction of the outer third and the middle third of the line joining the left anterosuperior iliac spine and the umbilicus, and in full dullness","correct":true},{"idx":4,"proposition":"Puncture fluid can be made bloody by accidentally passing through a blood vessel from the wall","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ascite-HGE-1","context":null,"enonce":"Regarding ascites:","item":"ascite","matiere":"HGE","propositions":[{"idx":0,"proposition":"Ascites fluid from a breach of the hepatic lymphatic ducts is low in protein and chylomicrons","correct":false,"justification":"Ascites fluid from a breach of the hepatic lymphatic ducts is rich in protein (> 30 g\/L) but not in chylomicrons"},{"idx":1,"proposition":"Cancers of the digestive system (with the exception of hepatocellular carcinoma) and ovarian cancer are common causes of peritoneal carcinomatosis","correct":true},{"idx":2,"proposition":"Ascites fluid contains only cells, in case of peritoneal carcinomatosis","correct":false,"justification":"Ascites fluid is often rich in protein (> 25 g\/L) and cells"},{"idx":3,"proposition":"Peritoneal mesothelioma is a very rare cause of ascites","correct":true},{"idx":4,"proposition":"The main factor promoting peritoneal mesothelioma is exposure to asbestos fibers","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ascite-HGE-2","context":null,"enonce":"Regarding ascites in tuberculosis:","item":"ascite","matiere":"HGE","propositions":[{"idx":0,"proposition":"Ascites is a cardinal manifestation of peritoneal tuberculosis that may be associated with digestive or other organ tuberculosis.","correct":true},{"idx":1,"proposition":"The fluid is frequently rich in protein (> 25 g\/L) but low in leukocytes (< 100\/mm3) in peritoneal tuberculosis","correct":false,"justification":"The fluid is frequently rich in protein (> 25 g\/L) and leukocytes (> 1,000\/mm3)"},{"idx":2,"proposition":"The search for BK by direct examination is usually negative","correct":true},{"idx":3,"proposition":"Determination of the enzyme adenosine deaminase in ascites may be useful","correct":true},{"idx":4,"proposition":"The diagnosis is made by biopsy of the peritoneum under laparoscopy on possible peritoneal granulations with evidence of tuberculous granulomas and culture revealing BK","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"ascite-HGE-3","context":null,"enonce":"Regarding ascites:","item":"ascite","matiere":"HGE","propositions":[{"idx":0,"proposition":"In case of infected ascites, antibiotic therapy with quinololes or beta-lactam should be urgently started","correct":true},{"idx":1,"proposition":"Isolated left heart failure, peritoneal carcinomatosis and cirrohsis are the 3 main causes of ascites","correct":false,"justification":"Right heart failure or global heart failure"},{"idx":2,"proposition":"Effective treatment of ascites fluid infection should decrease the level of PNN by at least 25% in the ascites fluid","correct":false,"justification":"At least 50%"},{"idx":3,"proposition":"Ascites complicating heart failure is rich in protein > 25 g \/ L and low in leukocytes","correct":true},{"idx":4,"proposition":"Ascites may cause parietal hernia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"HTAP-cardio-0","context":null,"enonce":"Regarding pulmonary arterial hypertension (PH)","item":"HTAP","matiere":"cardio","propositions":[{"idx":0,"proposition":"PH is defined by a mean mPAP pulmonary arterial pressure of 15mmHg or higher","correct":false,"justification":"25mmHg or more"},{"idx":1,"proposition":"PAH corresponds to group 2 PH in the WHO classification","correct":false,"justification":"PAH corresponds to group 1 of this classification"},{"idx":2,"proposition":"Pulmonary PH is PH with an OPAP (pulmonary arterial pressure occlude) of 25mmHg or less","correct":false,"justification":"15mmHg or less"},{"idx":3,"proposition":"Group 5 of the WHO classification corresponds to a precapillary PH","correct":true,"justification":"All PH is precapillary except group 2 (left heart disease)"},{"idx":4,"proposition":"PAH (group 1 PH) mainly affects women","correct":true,"justification":"2 times more women affected than men"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"HTAP-cardio-1","context":null,"enonce":"About PH","item":"HTAP","matiere":"cardio","propositions":[{"idx":0,"proposition":"PAH (PH group 1) may be associated with connective tissue disease, e.g. Eisenmenger syndrome","correct":false,"justification":"Eisenmenger syndrome is not connective tissue disease, it is severe cyanogenic heart disease (which may also be associated with PAH)"},{"idx":1,"proposition":"The spontaneous course of PAH, if left untreated, is fatal in 60% of cases","correct":false,"justification":"100% of cases"},{"idx":2,"proposition":"Tricuspid valvular heart disease can be complicated by group 2 PAH","correct":false,"justification":"Aortic or mitral valve disease, but not tricuspid"},{"idx":3,"proposition":"Group 2 of PH is the 1st cause of PH","correct":true,"justification":"These are left heart disease"},{"idx":4,"proposition":"Group 3 consists of chronic post-embolic PH","correct":false,"justification":"By respiratory diseases"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"HTAP-cardio-2","context":null,"enonce":"About PH","item":"HTAP","matiere":"cardio","propositions":[{"idx":0,"proposition":"HIV-associated PH is group 5 PH","correct":false,"justification":"Group 1"},{"idx":1,"proposition":"Pulmonary artery arteritis gives group 4 PH","correct":true,"justification":"Pulmonary arterial endovascular obstacle"},{"idx":2,"proposition":"Dialysis CKD can give group 5 PH","correct":true},{"idx":3,"proposition":"The most common call sign of PH is cough","correct":false,"justification":"Dyspnea (exertion and rest)"},{"idx":4,"proposition":"Auscultation is normal for a long time in PH","correct":true,"justification":"Analogy with pulmonary embolism: dyspnea with normal auscultation"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"HTAP-cardio-3","context":null,"enonce":"About PH","item":"HTAP","matiere":"cardio","propositions":[{"idx":0,"proposition":"The breath associated with PH is a protosystolic murmur","correct":false,"justification":"Has a holosystolic murmur (tricuspid insufficiency) increased on deep inspiration = sign of Carvalho"},{"idx":1,"proposition":"If PH is suspected, B4 noise on auscultation should be sought for a differential diagnosis","correct":false,"justification":"A B4 (straight gallop) suggests right heart failure that may be due to PH"},{"idx":2,"proposition":"HTP is particularly associated with negative T waves in V1-V2","correct":true},{"idx":3,"proposition":"Routine screening for PH in patients with diffuse lupus erythematosus is recommended","correct":false,"justification":"In scleroderma patients"},{"idx":4,"proposition":"Maximum tricuspid regurgitation rate > 3.4m\/s on cardiac ultrasound supports PH","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"HTAP-cardio-4","context":null,"enonce":"About PH","item":"HTAP","matiere":"cardio","propositions":[{"idx":0,"proposition":"Postitive NO vasomotricity test is an indication for oral calcium channel blockers","correct":true,"justification":"It predicts a favorable therapeutic response to these"},{"idx":1,"proposition":"For PH, transthoracic cardiac ultrasound is indicated only if left cardiopathic etiology is suspected.","correct":false,"justification":"Baseline non-invasive examination, systematic if PH is suspected"},{"idx":2,"proposition":"In the diagnostic approach of PH, etiological groups 2 and 3 should be sought as a priority.","correct":true,"justification":"These are the most frequent: we then look for group 4, then finally 5\/1 (elimination diagnostics)"},{"idx":3,"proposition":"Isolated OSA may explain PH","correct":false},{"idx":4,"proposition":"In case of PAH, at EFR, flow rates and volumes are normal but the DLCO is lowered","correct":true,"justification":"3 causes of lowering DLCO: emphysema, PAH and thromboembolic pulmonary vascular involvement"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"HTAP-cardio-5","context":null,"enonce":"About PH","item":"HTAP","matiere":"cardio","propositions":[{"idx":0,"proposition":"The PAH assessment includes HBV\/HCV\/HIV serology and an autoimmune assessment ","correct":true},{"idx":1,"proposition":"Arterial gas is always impaired in HTP","correct":false,"justification":"Arterial gas is often normal or with very moderate hypoxemia; Hypocapnia is quite common due to alveolar hyperventilation; Deep hypoxemia is possible in severe or complicated forms (e.g. reopening of the foramen ovale with right-left shunt or interatrial septal defect)"},{"idx":2,"proposition":"PAH is possible in children","correct":true,"justification":"Congenital heart disease"},{"idx":3,"proposition":"A typical sign of PH in an 8-year-old child is oxygen-refractory cyanosis","correct":false,"justification":"This is typical in newborns: in children, the signs are syncope, dyspnea, behavioral disorders or malaise"},{"idx":4,"proposition":"PH with dyspnea that slightly limits usual physical activities but does not persist at rest corresponds to NYHA grade 1","correct":false,"justification":"NYHA 2"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"angine-infectio-0","context":null,"enonce":"Concerning angina","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"ƒAngina is a benign pathology of spontaneously favorable evolution in the vast majority of cases","correct":true},{"idx":1,"proposition":"ƒƒAntibiotic therapy is indicated in group A streptococcal tonsillitis","correct":true},{"idx":2,"proposition":"ƒIn practice, group A streptococcus should be tested for when the MacIsaac clinical score is ≥ 4 in adults","correct":false},{"idx":3,"proposition":"ƒƒ Antibiotic therapy is indicated in case of streptococcal infection detected in RDT: augmentin in 1st line","correct":false},{"idx":4,"proposition":"It is an inflammation of infectious origin of the tonsils (tonsillitis) and \/ or the entire oropharynx (pharyngitis)","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"angine-infectio-1","context":null,"enonce":"Concerning angina","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"Group B ß-hemolytic streptococcus is the first bacterial agent responsible for angina","correct":false,"justification":"This is Pyogenic Streptococcus (group A)"},{"idx":1,"proposition":"ƒThe diagnosis of diphtheria requires mandatory reporting to the ARS, additional droplet-type precautions and eviction from the community","correct":true},{"idx":2,"proposition":"No clinical sign is strictly discriminating between viral or bacterial etiology","correct":true},{"idx":3,"proposition":"Only SBHA angina is common, other bacterial causes are exceptional","correct":true},{"idx":4,"proposition":"Symptomatic treatment with analgesic and antipyretic is to be considered in all cases ","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"angine-infectio-2","context":null,"enonce":"Concerning angina","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"In adults, the MacIsaac score has a good positive predictive value","correct":false,"justification":"In adults, the MacIsaac score has a good negative predictive value"},{"idx":1,"proposition":"In adults, a clinical score of Mac Isaac < 2 has a negative predictive value > 95% to eliminate the streptococcal origin of angina","correct":true},{"idx":2,"proposition":"All strains of SBHA have rheumatogenic or nephritogenic potential","correct":false,"justification":"Only certain strains of SBHA have rheumatogenic or nephritogenic potential"},{"idx":3,"proposition":"Scarlet fever is one of the toxic complications","correct":true},{"idx":4,"proposition":"There is no indication for antibiotic therapy for acute tonsillitis in children under 3 years of age","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"angine-infectio-3","context":null,"enonce":"Concerning tonsillitis","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"Antibiotic therapy is only of interest in SBHA angina","correct":true,"justification":"The goal is essentially to prevent complications"},{"idx":1,"proposition":"ƒƒ The strains of SBHA responsible for RAA are very rare in metropolitan France, but more frequent in the DOM-TOM","correct":true},{"idx":2,"proposition":"Antibiotic treatment involves individual and collective risks: adverse effects and bacterial resistance in particular","correct":true},{"idx":3,"proposition":"The risk of AAF is prevented even in case of late antibiotic therapy (up to Day 9 after the onset of symptoms)","correct":true},{"idx":4,"proposition":"Only documented SBHA tonsillitis should be treated with antibiotic therapy","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"angine-infectio-4","context":null,"enonce":"Regarding angina in children, which is the exact proposal(s)?","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"In front of angina, it is necessary to perform an RDT because no clinical sign allows to move towards a bacterial or viral etiology","correct":false,"justification":"False, clinically bacterial angina is more brutal, painful, gives a higher fever and more extra ENT sign than viral angina. But only a microbiological examination can conclude."},{"idx":1,"proposition":"RDT should always be performed in children","correct":false,"justification":"False, <3 years the etiology is mainly viral. The RDT is only performed above 3 years"},{"idx":2,"proposition":"Extra-ENT symptoms of group A streptococcus infection include: abdominal pain, vomiting, non-painful ADP","correct":false,"justification":"False, infectious lymphadenopathy is painful"},{"idx":3,"proposition":"Faced with a suspicion of angina, look for signs of locoregional complications such as torticollis.","correct":true,"justification":"True, torticollis would sign a retropharyngeal abscess. It is also necessary to look for a trismus that signs an amygdala phlegmon."},{"idx":4,"proposition":"None of the propositions are true","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"angine-infectio-5","context":null,"enonce":"Which of the following are the objectives of antibiotic treatment for strep throat?","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"Reduction of cough duration","correct":true},{"idx":1,"proposition":"Reduction of complications","correct":true,"justification":"This is the main objective"},{"idx":2,"proposition":"Reduce viral carriage","correct":false,"justification":"Bacterial carriage"},{"idx":3,"proposition":"No antibiotic therapy is indicated in this case","correct":false,"justification":"Amoxicillin streptococcus ➡"},{"idx":4,"proposition":"Achieving the patient's request","correct":false,"justification":"We do not prescribe antibiotics because the patient asks us to, but because it is justified:)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"angine-infectio-7","context":null,"enonce":"What is the antibiotic therapy to be implemented in case of erythematopultaceous angina with positive RDT, in first line?","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"Amoxicillin","correct":true},{"idx":1,"proposition":"Amoxicillin-clavulanic acid","correct":false,"justification":"No indication"},{"idx":2,"proposition":"C2G","correct":false,"justification":"2nd intention, if allergy to amoxicillin (risk cross-allergy <5%)"},{"idx":3,"proposition":"Macrolides","correct":false,"justification":"3rd intention, if allergy to beta-lactam (<10% resistance)"},{"idx":4,"proposition":"Glycopeptides","correct":false,"justification":"No indication"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"angine-infectio-8","context":null,"enonce":"What is the recommended average duration of eviction from the community in case of angina?","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"6 hours","correct":false,"justification":"False"},{"idx":1,"proposition":"48 hours","correct":true},{"idx":2,"proposition":"1 week","correct":false,"justification":"False"},{"idx":3,"proposition":"3 weeks","correct":false,"justification":"False"},{"idx":4,"proposition":"No eviction","correct":false,"justification":"Contagiousness by coughing"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"angine-infectio-9","context":null,"enonce":"Which of the following is a reportable cause of pseudomembranous angina?","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"Diphtheria","correct":true},{"idx":1,"proposition":"Group A beta-hemolytic streptococcus","correct":false,"justification":"False"},{"idx":2,"proposition":"Staphylococcus aureus","correct":false,"justification":"False"},{"idx":3,"proposition":"Adenovirus","correct":false,"justification":"False"},{"idx":4,"proposition":"EBV","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"angine-infectio-10","context":null,"enonce":"Which of the following proposals are indications for making a TDR?","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"Mac Isaac score = 4 in adults","correct":true},{"idx":1,"proposition":"Mac Isaac score = 2 in adults","correct":true},{"idx":2,"proposition":"Mac Isaac score = 1 in adults","correct":false,"justification":"TDR if MacIsaac at least equal to 2"},{"idx":3,"proposition":"6 years old","correct":true},{"idx":4,"proposition":"6-month-old baby","correct":false,"justification":"RDT if child > 3 years old"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"angine-infectio-11","context":null,"enonce":"What is the antibiotic therapy to be implemented in case of erythematopultaceous angina with positive RDT, in case of true allergy to amoxicillin?","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"Amoxicillin","correct":false,"justification":"Allergy"},{"idx":1,"proposition":"Amoxicillin-clavulanic acid","correct":false,"justification":"Allergy to amoxicillin. No indication of this association in tonsillitis (SBHA sensitive to amoxicillin alone)"},{"idx":2,"proposition":"C2G","correct":true},{"idx":3,"proposition":"Macrolides","correct":false,"justification":"3rd intention, if allergy to beta-lactam (<10% resistance)"},{"idx":4,"proposition":"Glycopeptides","correct":false,"justification":"No indication"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"angine-infectio-12","context":null,"enonce":"Which of the following are viral causes of angina?","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"Streptococcus","correct":false,"justification":"Strepto is a bacterium"},{"idx":1,"proposition":"Bartonella henselae\r\n","correct":false,"justification":"It is a gram-negative bacillus"},{"idx":2,"proposition":"EBV","correct":true},{"idx":3,"proposition":"HSV","correct":true},{"idx":4,"proposition":"Echovirus","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"OH-gastro-0","context":null,"enonce":"Concerning simple use:","item":"OH","matiere":"HGE","propositions":[{"idx":0,"proposition":"The term 'use' corresponds to abstinence","correct":false,"justification":"Abstinence is non-use"},{"idx":1,"proposition":"It is recommended to consume no more than 21 drinks on average per week for men","correct":false},{"idx":2,"proposition":"It is recommended to consume no more than 5 drinks on average per week for women","correct":false,"justification":"ATTENTION: new recommendation in 2019 -> single use = no more than 10 drinks per week for everyone (woman and man)"},{"idx":3,"proposition":"Simple use: one alcohol-free day per week","correct":true,"justification":"Be careful though, if the patient drinks a bottle of wine a day except Wednesday (a day without alcohol) it is not simple use"},{"idx":4,"proposition":"A standard glass of France corresponds to bar doses and contains 10 grams of pure alcohol","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"OH-gastro-1","context":null,"enonce":"Regarding the terms used:","item":"OH","matiere":"HGE","propositions":[{"idx":0,"proposition":"Risky use (risky consumption) corresponds to consumption above the recommended thresholds, likely to cause physical, psychological or social damage","correct":true},{"idx":1,"proposition":"Harmful or harmful use refers to consumption that has adverse consequences for health, physical or mental, but in the absence of criteria of dependence.","correct":true},{"idx":2,"proposition":"Addiction defines a type of relationship marked by an inability to reduce consumption and a behavioral obligation","correct":true},{"idx":3,"proposition":"Signs of withdrawal are mostly psychological","correct":false,"justification":"The signs are psychological and physical"},{"idx":4,"proposition":"Harmful health consequences sign alcohol dependence","correct":false,"justification":"Addiction can lead to®negative (harmful) consequences, but not necessarily, especially at the beginning \/ I formulated it backwards"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"OH-gastro-2","context":null,"enonce":"Regarding alcohol:","item":"OH","matiere":"HGE","propositions":[{"idx":0,"proposition":"Excessive consumption covers all misuse","correct":true},{"idx":1,"proposition":"Alcoholism is an outdated term that often corresponds to severe addictions","correct":true},{"idx":2,"proposition":"We talk about alcoholism when we exceed 3 drinks a day","correct":false,"justification":"We no longer talk about alcoholism"},{"idx":3,"proposition":"It is estimated that in France 6 million people consume alcohol daily.","correct":true},{"idx":4,"proposition":"Regular alcohol consumption decreases in France but occasional alcoholization increases","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"OH-gastro-3","context":null,"enonce":"What test(s) are used to screen for alcohol addiction?","item":"OH","matiere":"HGE","propositions":[{"idx":0,"proposition":"FACE","correct":true},{"idx":1,"proposition":"Framingham","correct":false,"justification":"Framingham is an overall coronary risk score"},{"idx":2,"proposition":"Fägerstrom","correct":false,"justification":"Fagerström's test can detect tobacco addiction"},{"idx":3,"proposition":"AUDIT-C","correct":true},{"idx":4,"proposition":"Horn","correct":false,"justification":"Tobacco"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"OH-gastro-5","context":null,"enonce":"What signs accompany a delirium tremens?","item":"OH","matiere":"HGE","propositions":[{"idx":0,"proposition":"A commotion","correct":true},{"idx":1,"proposition":"Catatonia","correct":false,"justification":"Rather a agitation with incoherent remarks"},{"idx":2,"proposition":"Delusions","correct":true},{"idx":3,"proposition":"Reversal of the nycthemeral rhythm","correct":true},{"idx":4,"proposition":"Fever","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"OH-gastro-6","context":null,"enonce":"What signs or symptoms are consistent with Korsakoff's Syndrome?","item":"OH","matiere":"HGE","propositions":[{"idx":0,"proposition":"Vitamin B1 deficiency","correct":true},{"idx":1,"proposition":"Fabulations","correct":true},{"idx":2,"proposition":"Retrograde memory loss","correct":false,"justification":"Anterograde memory loss (almost) exclusively"},{"idx":3,"proposition":"Brainstem damage classically","correct":false,"justification":"Not classically: damage to the mammillary bodies (structures that are part of the hypothalamus and involved in memory, especially in the Papez circuit)"},{"idx":4,"proposition":"A very advanced age","correct":false,"justification":"Often in the \"young\" subject (can start in the forties)"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"OH-gastro-7","context":null,"enonce":"Regarding Gayet-Wernicke encephalopathy:","item":"OH","matiere":"HGE","propositions":[{"idx":0,"proposition":"It cannot give Korsakoff syndrome","correct":false,"justification":"Most Korsakoff syndromes are due to untreated (or poorly) Gayet Wernicke's encephalopathy"},{"idx":1,"proposition":"There is a cerebellar syndrome explaining frequent nystagmus","correct":false,"justification":"Cerebellous syndrome (which is static) explains the problems with walking and coordination. Nystagmus, like oculomotor palsy or diplopia, are separate signs found in Gayet-Wernicke encephalopathy."},{"idx":2,"proposition":"It is due to vitamin B6 deficiency","correct":false,"justification":"Vitamin B1 deficiency"},{"idx":3,"proposition":"Carbohydrate recharge must be done urgently ","correct":false,"justification":"Glucose promotes B1 deficiency (alcohol is sweet)"},{"idx":4,"proposition":"It is a therapeutic emergency","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"OH-gastro-8","context":null,"enonce":"Regarding alcohol withdrawal syndrome:","item":"OH","matiere":"HGE","propositions":[{"idx":0,"proposition":"It is constant","correct":false,"justification":"A significant proportion of patients do not experience withdrawal syndrome"},{"idx":1,"proposition":"Hypersomnia is observed","correct":false,"justification":"Rather insomnia"},{"idx":2,"proposition":"We find a HTA","correct":true},{"idx":3,"proposition":"We can objectify tachycardia","correct":true},{"idx":4,"proposition":"Depression is common","correct":false,"justification":"Not depression but anxiety, frustration, etc."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"OH-gastro-9","context":null,"enonce":"Which of the following are included in healthy alcohol consumption? 🍷","item":"OH","matiere":"HGE","propositions":[{"idx":0,"proposition":"2 drinks per day maximum 🥃🥃","correct":true,"justification":"True. Attention ⚠, new recs in 2019: more distinction man 👨 woman 👩, 2 drinks max per occasion of drinking, no alcohol every day, and no more than 10 🔟 drinks per week."},{"idx":1,"proposition":"No more than 6 glasses per drinking occasion ","correct":false,"justification":"No more than two"},{"idx":2,"proposition":"At least one alcohol-free day per week","correct":true},{"idx":3,"proposition":"No more than 26 drinks on average per week for men ","correct":false,"justification":"The new recs do not make a distinction M\/F. No more than 10 drinks per week"},{"idx":4,"proposition":"No more than 10 standard drinks per week","correct":true,"justification":"The links of the new reco: https:\/\/www.drogues.gouv.fr\/actualites\/sante-publique-france-presente-nouvelles-recommandations-lalimentation-y-compris-lalcool"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"drogues-psy-0","context":null,"enonce":"Regarding cannabis and cocaine:","item":"drogues","matiere":"psy","propositions":[{"idx":0,"proposition":"The active substance in cocaine is tetra-hydrocannabinol (THC)","correct":false,"justification":"It is the active ingredient of Cannabis"},{"idx":1,"proposition":"Withdrawal syndrome is a disorder related to the use of an addictive substance","correct":true,"justification":""},{"idx":2,"proposition":"Cannabis can induce a psychotic disorder, an anxiety disorder, and even a delirium","correct":true},{"idx":3,"proposition":"For cannabis, treatment of intoxication and withdrawal are symptomatic","correct":true},{"idx":4,"proposition":"Cocaine is a drug while cannabis is not","correct":false,"justification":"Both are uh yes it's not very discriminating"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"drogues-psy-1","context":null,"enonce":"Regarding cannabis:","item":"drogues","matiere":"psy","propositions":[{"idx":0,"proposition":"The action of cannabis is mainly the rapid and fleeting over-release of serotonin","correct":false,"justification":"It acts on the cannabinoid receptors CB1 and CB2 that regulate glutamatergic and GABA neurotransmission and also potentiates dopamine release"},{"idx":1,"proposition":"Marijuana is the most THC-laden presentation","correct":false,"justification":"In order of increasing concentration of Delta9-THC: * herb (marijuana), resin (hashish), * * oil, rarer"},{"idx":2,"proposition":"Cannabis is mostly smoked in the form of cigarettes mixed with tobacco","correct":true,"justification":"This is the famous joints"},{"idx":3,"proposition":"Cannabis is the most commonly used illicit substance in France","correct":true},{"idx":4,"proposition":"Regular consumption is mostly female, regardless of age group","correct":false,"justification":"Regular consumption is mostly male"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"drogues-psy-2","context":null,"enonce":"Regarding cannabis:","item":"drogues","matiere":"psy","propositions":[{"idx":0,"proposition":"The effects of cannabis appear about 15 to 20 minutes after consumption if smoked","correct":true},{"idx":1,"proposition":"The effects fade in about 10 minutes","correct":false,"justification":"The effects fade in several hours: about 4 hours for the consumption of a conventional dose"},{"idx":2,"proposition":"The extent of cannabis' effects depends on tolerance, age, sex and individual genetic susceptibilities","correct":false,"justification":"The extent of the effects of cannabis depends on the dose used, the mode of consumption and individual factors such as the rate of absorption, tolerance"},{"idx":3,"proposition":"Acute cannabis intoxication can lead to conjunctival hyperemia","correct":true},{"idx":4,"proposition":"Regular use of cannabis leads to a tolerance phenomenon that decreases the feeling of well-being and forces to increase doses","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"drogues-psy-3","context":null,"enonce":"Which of these proposals are symptoms of cannabis withdrawal syndrome?","item":"drogues","matiere":"psy","propositions":[{"idx":0,"proposition":"Irritability","correct":true},{"idx":1,"proposition":"Insomnia","correct":true},{"idx":2,"proposition":"Polyphagia","correct":false,"justification":"Rather anorexia and weight loss"},{"idx":3,"proposition":"Excessive sweating","correct":true},{"idx":4,"proposition":"Fever","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"drogues-psy-4","context":null,"enonce":"Regarding withdrawal syndrome and the consequences of cannabis:","item":"drogues","matiere":"psy","propositions":[{"idx":0,"proposition":"Complications related to cannabis use cannot occur with the first dose","correct":false,"justification":"They can occur from the first intake"},{"idx":1,"proposition":"The dose threshold defining risky consumption is more than 3 joints per week (two days apart on average)","correct":false,"justification":"No known threshold"},{"idx":2,"proposition":"90% of cannabis users report cannabis withdrawal symptoms","correct":false,"justification":"10 to 40%"},{"idx":3,"proposition":"The withdrawal syndrome more often concerns heavy and regular consumption","correct":true},{"idx":4,"proposition":"Most symptoms appear within 24 to 72 hours after stopping consumption","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"drogues-psy-5","context":null,"enonce":"Regarding the consequences of cannabis:","item":"drogues","matiere":"psy","propositions":[{"idx":0,"proposition":"Sleep disorders related to withdrawal syndrome can last a month","correct":true},{"idx":1,"proposition":"Cannabis poisoning delirium sets in just at the end of the withdrawal syndrome","correct":false,"justification":"It settles in a few hours or days and tends to have a fluctuating evolution throughout the day."},{"idx":2,"proposition":"A psychotic disorder may develop during or shortly after acute intoxication","correct":true},{"idx":3,"proposition":"The clinical symptomatology of cannabis-induced psychotic disorder is similar to that of psychotic disorder","correct":true},{"idx":4,"proposition":"Treatment of induced psychotic disorder involves stopping intoxication only (antipsychotics are contraindicated)","correct":false,"justification":"Treatment involves stopping intoxication and possibly treatment with antipsychotics"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"drogues-psy-6","context":null,"enonce":"General information about cannabis:","item":"drogues","matiere":"psy","propositions":[{"idx":0,"proposition":"Chronic intoxication can lead to impaired cognitive performance, social disinterest, decreased performance at work or school.","correct":true},{"idx":1,"proposition":"A cannabis-induced psychotic disorder may develop during or shortly after acute intoxication (and up to a month after)","correct":true},{"idx":2,"proposition":"The management of dependency is comprehensive: psychiatric, general medical, school and social","correct":true},{"idx":3,"proposition":"Cognitive-behavioral and family psychotherapies have shown their effectiveness","correct":true},{"idx":4,"proposition":"Fewer than one million people are regular cannabis users in France","correct":false,"justification":"More than one million people"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"drogues-psy-8","context":null,"enonce":"Regarding cocaine:","item":"drogues","matiere":"psy","propositions":[{"idx":0,"proposition":"There are 400,000 people affected by a cocaine use problem in France","correct":true},{"idx":1,"proposition":"The onset of effects and felt effects is 2 to 4 hours in all cases","correct":false,"justification":"The onset of effects and the effects experienced depend on the route of administration, the individuals and the dose consumed"},{"idx":2,"proposition":"Complications related to cocaine use can occur from the first dose","correct":true},{"idx":3,"proposition":"There is no known dose threshold below which there is little or no risk","correct":true},{"idx":4,"proposition":"The dose threshold below which there is no risk is one intake per year, which is very difficult to respect given the addictive potential of cocaine.","correct":false,"justification":"There is no known dose threshold below which there is little or no risk"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"pericardite-cardio-0","context":null,"enonce":"About pericarditis","item":"pericardite","matiere":"cardio","propositions":[{"idx":0,"proposition":"The performance of an ECG and echocardiography is systematic in the face of suspicion of pericarditis","correct":true},{"idx":1,"proposition":"The key symptom is prolonged chest pain, resistant to trinitrine, increased in decubitus, deep inhalation and coughing, calmed by sitting forward (anteflexion)","correct":true},{"idx":2,"proposition":"The absence of pericardial friction eliminates the diagnosis of pericarditis","correct":false,"justification":"Its absence does not eliminate the diagnosis. In practice, it is actually very rare to hear it."},{"idx":3,"proposition":"Pleural effusion eliminates diagnosis","correct":false,"justification":"An associated pleural effusion may be found."},{"idx":4,"proposition":"Holzman's stage II corresponds to negative T-waves ","correct":false,"justification":"Stage I: concave ST elevation upwards, positive T waves on the first day. Stage II: flat T-waves between the 24th and 48th hours. Stage III: negative T-waves in the first week. Stage IV: normalization in the first month"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"pericardite-cardio-1","context":null,"enonce":"About pericarditis","item":"pericardite","matiere":"cardio","propositions":[{"idx":0,"proposition":"Chest X-ray is normal most often","correct":true},{"idx":1,"proposition":"Echocardiography assesses the abundance, topography and hemodynamic tolerance of pericardial effusion and confirms the diagnosis of possible tamponade","correct":true},{"idx":2,"proposition":"Echocardiography makes it possible to visualize, if necessary, a possible mass localized in the pericardial cavity","correct":true,"justification":"For example, metastasis or clot"},{"idx":3,"proposition":"MRI has the advantage of visualizing the pericardial cavity without injection of contrast medium or irradiation","correct":true},{"idx":4,"proposition":"Pericardial puncture is to be considered in the presence of abundant pericardial effusion, symptomatic, despite a well-conducted medical treatment for a month","correct":false,"justification":"For a week. One month is far too long"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pericardite-cardio-2","context":null,"enonce":"About pericarditis","item":"pericardite","matiere":"cardio","propositions":[{"idx":0,"proposition":"Surgical pericardial drainage is preferred in case of suspicion of acute purulent pericarditis","correct":true},{"idx":1,"proposition":"Pericardial fluid is collected for cytological and microbiological analysis","correct":true},{"idx":2,"proposition":"Once the diagnosis is established, hospitalization is systematic","correct":false,"justification":"Once the diagnosis is made, hospitalization should not be systematic and depends on the case"},{"idx":3,"proposition":"Hospitalization is done in case of predictive factors of a non-idiopathic origin or risk of complications","correct":true},{"idx":4,"proposition":"In nine out of ten cases, the cause is viral or unknown (acute idiopathic pericarditis)","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pericardite-cardio-4","context":null,"enonce":"Regarding acute pericarditis","item":"pericardite","matiere":"cardio","propositions":[{"idx":0,"proposition":"During HIV infection, the occurrence of pericarditis with pericardial effusion is common","correct":true},{"idx":1,"proposition":"The progression is common to tamponade, recurrence or pericardial constriction in case of tuberculous pericarditis","correct":true},{"idx":2,"proposition":"In case of tuberculous pericarditis, treatment is symptomatic","correct":false,"justification":"Treatment is etiologic (anti-tuberculosis)"},{"idx":3,"proposition":"Primary pericardial tumours (primary pericardial mesothelioma) are 4 times more common than metastases","correct":false,"justification":"Primary pericardial tumours (primary pericardial mesothelioma) are rare, 40 times less common than metastases"},{"idx":4,"proposition":"The most common secondary tumours are bronchial cancers, breast cancers, melanomas and leukemias.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pericardite-cardio-5","context":null,"enonce":"About pericarditis","item":"pericardite","matiere":"cardio","propositions":[{"idx":0,"proposition":"Hemorrhagic pericardial effusion is extremely rare","correct":false,"justification":"Hemorrhagic pericardial effusion is common, as is tamponade in neoplastic pericarditis"},{"idx":1,"proposition":"The diagnosis of neoplastic pericarditis is confirmed by imaging","correct":false,"justification":"Ultrasound, CT and\/or MRI = evoke the diagnosis. Confirmation is pathomopathological\/biological"},{"idx":2,"proposition":"Analysis of pericardial puncture fluid or pericardial biopsy are essential for diagnosing malignancy","correct":true},{"idx":3,"proposition":"In case of tamponade, emergency pericardial puncture is necessary","correct":true},{"idx":4,"proposition":"Recurrence of pericardial effusion is frequent and requires clinical and echocardiographic follow-up","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pericardite-cardio-6","context":null,"enonce":"Regarding the treatment of acute pericarditis","item":"pericardite","matiere":"cardio","propositions":[{"idx":0,"proposition":"Nonsteroidal anti-inflammatory drugs are prescribed in benign acute pericarditis","correct":true,"justification":"Ibuprofen and Aspirin"},{"idx":1,"proposition":"Colchicine alone or in combination with ibuprofen, calms pain and reduces recurrence","correct":true},{"idx":2,"proposition":"Colchicine is contraindicated in severe renal impairment","correct":true},{"idx":3,"proposition":"NSAID\/Aspirin treatment is stopped after 14 days if there are no complications","correct":false,"justification":"The cessation of NSAID or aspirin treatment is done gradually after one month, preferably after performing an echocardiogram that ensures the absence of pericardial effusion"},{"idx":4,"proposition":"Corticosteroids are not indicated in acute benign pericarditis due to the risk of viral replication","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"psyado-psy-0","context":null,"enonce":"Concerning the main generalities:","item":"psyado","matiere":"psy","propositions":[{"idx":0,"proposition":"The prevalence of ADHD in the general population is 5%","correct":false,"justification":"These disorders have a high prevalence in the pediatric (and not general) population: 5% for ADHD, 3% for TOD and 1.5% for TBI."},{"idx":1,"proposition":"Normal adolescence is defined primarily by endocrine criteria (puberty)","correct":true},{"idx":2,"proposition":"Puberty is earlier in boys than in girls","correct":false,"justification":"As a reminder: at 10-11 years for girls, and at 12-13 years for boys"},{"idx":3,"proposition":"The integration of body changes due to puberty is not always obvious","correct":true},{"idx":4,"proposition":"Sexual urges appear at puberty","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"psyado-psy-1","context":null,"enonce":"Regarding ADHD and TOP:","item":"psyado","matiere":"psy","propositions":[{"idx":0,"proposition":"ADHD (Attention Deficit Hyperactivity Disorder) is considered a neurodevelopmental disorder","correct":true},{"idx":1,"proposition":"The TOP is the Opposition Disorder with Provocation","correct":true},{"idx":2,"proposition":"\"Adolescent Behavioral Disorders\" begin around puberty","correct":false,"justification":"Although the title of the item is \"Adolescent behavioural disorders\", these behavioural disorders usually begin in childhood"},{"idx":3,"proposition":"ADHD affects 5% of children and adolescents","correct":true},{"idx":4,"proposition":"Inattention syndrome is only visible in a school setting","correct":false,"justification":"It is visible from the age of walking and in private life situations. But it is true that the syndrome of inattention becomes more visible in elementary school, when the child is confronted with situations requiring an effort of concentration."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"psyado-psy-2","context":null,"enonce":"Regarding ADHD:","item":"psyado","matiere":"psy","propositions":[{"idx":0,"proposition":"When inattention syndrome is predominant, diagnosis is often late","correct":true},{"idx":1,"proposition":"The disorder usually begins in childhood","correct":true},{"idx":2,"proposition":"The sex ratio of ADHD is about the same as that of conduct disorders.","correct":true},{"idx":3,"proposition":"The etiology is multifactorial","correct":true},{"idx":4,"proposition":"There is a genetic risk factor","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"psyado-psy-3","context":null,"enonce":"Regarding risk factors and protective factors:","item":"psyado","matiere":"psy","propositions":[{"idx":0,"proposition":"Smoking during pregnancy is a risk factor for behavioural disorders","correct":true},{"idx":1,"proposition":"Alcohol use during pregnancy is not a recognized risk factor","correct":false,"justification":"Alcohol consumption during pregnancy is totally a risk factor"},{"idx":2,"proposition":"Home placement or educational neglect are protective factors","correct":false,"justification":"Negative life events during early childhood: sexual abuse, educational and emotional neglect, physical and\/or psychological maltreatment, foster care, etc. are all risk factors for the development of TBI"},{"idx":3,"proposition":"Overly rigorous and rigid educational rules are mainly associated with TOPs and TCs.","correct":true},{"idx":4,"proposition":"Dating other adolescent offenders is a risk factor for TC","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"psyado-psy-5","context":null,"enonce":"Which of these proposals fall within the framework of a hyperactivity syndrome?","item":"psyado","matiere":"psy","propositions":[{"idx":0,"proposition":"Urgency","correct":false,"justification":"Falls within the framework of an impulsivity syndrome"},{"idx":1,"proposition":"Hostility","correct":false,"justification":"Falls within the framework of the opposition-provocation syndrone"},{"idx":2,"proposition":"Motor instability","correct":true},{"idx":3,"proposition":"Procrastination","correct":true},{"idx":4,"proposition":"Lack of productivity","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"psyado-psy-6","context":null,"enonce":"Which of these proposals fall within the framework of an inattention syndrome?","item":"psyado","matiere":"psy","propositions":[{"idx":0,"proposition":"The rapid drop in concentration","correct":true},{"idx":1,"proposition":"Disorganization","correct":false},{"idx":2,"proposition":"Distractibility","correct":true},{"idx":3,"proposition":"Disability","correct":false,"justification":"Falls within the framework of an opposition-provocation syndicate"},{"idx":4,"proposition":"Non-compliance with standards","correct":false,"justification":"Falls within the framework of an antisocial behaviour syndrome"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"psyado-psy-7","context":null,"enonce":"Regarding pharmacological treatment:","item":"psyado","matiere":"psy","propositions":[{"idx":0,"proposition":"It is set up in first intention most often","correct":false,"justification":"As a second line, except in cases of emergency"},{"idx":1,"proposition":"Risperidone can be given from 1 year","correct":false,"justification":"MA risperidone = from 5 years. AMM Cyamémazine = from 3 years."},{"idx":2,"proposition":"Risperidone is a background treatment","correct":false,"justification":"Short treatment for persistent aggressiveness in a patient with 'below-average intellectual functioning'"},{"idx":3,"proposition":"Methylphenidate is a treatment for TODs","correct":false,"justification":"ADHD"},{"idx":4,"proposition":"Cyamémazine is contraindicated in children (before puberty)","correct":false,"justification":"MA from 3 years old"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"retardSP-ped-0","context":null,"enonce":"Which of these proposals correspond to normal parameters?","item":"retardSP","matiere":"ped","propositions":[{"idx":0,"proposition":"Height at birth: 50 cm","correct":true},{"idx":1,"proposition":"Cranial circumference at birth: 35 cm","correct":true},{"idx":2,"proposition":"Weight at 9 months: 4 kg","correct":false,"justification":"9 kg"},{"idx":3,"proposition":"Height at 2 years is double height at birth","correct":false,"justification":"This is the case of the size at 4 years"},{"idx":4,"proposition":"Weight at 9 months: 9 kg","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"retardSP-ped-1","context":null,"enonce":"Which of these proposals correspond to normal parameters?","item":"retardSP","matiere":"ped","propositions":[{"idx":0,"proposition":"Size at 4 months: 60 cm","correct":true},{"idx":1,"proposition":"Cranial circumference at birth: 75 cm","correct":false,"justification":"Around 35 cm"},{"idx":2,"proposition":"Weight at 4 years: 21 kg","correct":false,"justification":"16 kg"},{"idx":3,"proposition":"The head circumvention at 4 years is around 50 cm","correct":true},{"idx":4,"proposition":"Weight at 1 year is triple the weight at 4 months","correct":false,"justification":"Triple the birth weight"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"retardSP-ped-2","context":null,"enonce":"Which of these proposals correspond to normal parameters?","item":"retardSP","matiere":"ped","propositions":[{"idx":0,"proposition":"Birth weight: 3.5 kg","correct":true},{"idx":1,"proposition":"Weight at 4 years: 16 kg","correct":true},{"idx":2,"proposition":"Head circumference at 9 months: 45 cm","correct":true},{"idx":3,"proposition":"Size at 4 months: 60 cm","correct":true},{"idx":4,"proposition":"Weight at 4 months: double the birth weight","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"retardSP-ped-3","context":null,"enonce":"Regarding the growth of the child:","item":"retardSP","matiere":"ped","propositions":[{"idx":0,"proposition":"Infants should take 25 g per day","correct":true},{"idx":1,"proposition":"Infants gain about 25 cm in the first year","correct":true},{"idx":2,"proposition":"Height, weight and PC parameters should be measured at each consultation","correct":true},{"idx":3,"proposition":"Growth at -1.5 SD is normal","correct":true},{"idx":4,"proposition":"Growth at 3 DS is normal","correct":false,"justification":"Between -2 and 2 DS"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"retardSP-ped-4","context":null,"enonce":"What proposals fall within the definition of stunting in stature?","item":"retardSP","matiere":"ped","propositions":[{"idx":0,"proposition":"A size less than -1DS","correct":false},{"idx":1,"proposition":"BMI below the 10th percentile","correct":false,"justification":"Below 3rd percentile"},{"idx":2,"proposition":"Increased growth speed","correct":false,"justification":"Slow growth rate"},{"idx":3,"proposition":"Statural growth less than or equal to -1.5 SD (relative to genetic target size)","correct":true},{"idx":4,"proposition":"A size less than -3 DS","correct":true,"justification":"It must be at least less than -2 DS"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"retardSP-ped-5","context":null,"enonce":"Regarding the etiologies of failure to thrive:","item":"retardSP","matiere":"ped","propositions":[{"idx":0,"proposition":"Congenital hypothyroidism is routinely screened at 3 days of life","correct":true},{"idx":1,"proposition":"The screening test for congenital hypothyroidism is the Tanner test","correct":false,"justification":"Test de Guthrie"},{"idx":2,"proposition":"Congenital GH deficiency is not symptomatic at birth","correct":true},{"idx":3,"proposition":"Simple delay in puberty is the most common cause of statural delay in adolescence","correct":true,"justification":"Common in boys, but rare in girls"},{"idx":4,"proposition":"Pituitary imaging makes it possible to confirm the diagnosis of craniopharyngioma","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"retardSP-ped-7","context":null,"enonce":"Which of these proposals can cause statural stunting?","item":"retardSP","matiere":"ped","propositions":[{"idx":0,"proposition":"Hypothyroidism","correct":true},{"idx":1,"proposition":"Hypercorticism","correct":true},{"idx":2,"proposition":"Brain tumour","correct":true},{"idx":3,"proposition":"Growth hormone resistance","correct":true},{"idx":4,"proposition":"Delayed puberty","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"retardSP-ped-8","context":null,"enonce":"In Turner syndrome:","item":"retardSP","matiere":"ped","propositions":[{"idx":0,"proposition":"Support is 75%","correct":false,"justification":"100 %. It's an off-list ALD"},{"idx":1,"proposition":"Growth hormone is started in childhood","correct":true},{"idx":2,"proposition":"Growth hormone is started at puberty","correct":false,"justification":"It is the estrogen replacement that is prescribed around the normal age of puberty"},{"idx":3,"proposition":"Diagnostic confirmation is done by karyotype","correct":true},{"idx":4,"proposition":"Diagnostic certainty is done on X-chromosome sequencing","correct":false,"justification":"No sequencing. Turner syndrome is the absence of the X chromosome"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"retardSP-ped-9","context":null,"enonce":"At 1 year, the birth weight is:","item":"retardSP","matiere":"ped","propositions":[{"idx":0,"proposition":"Unchanged","correct":false,"justification":"False"},{"idx":1,"proposition":"Double","correct":false,"justification":"at 4 months"},{"idx":2,"proposition":"Triplet","correct":true,"justification":"True, about 10kg"},{"idx":3,"proposition":"Quadruplet","correct":false,"justification":"False"},{"idx":4,"proposition":"Quintuplet","correct":false,"justification":"Around 4 years: about 16 kg for a child with a birth weight of 3.5 kg"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrphysiopath-mpr-0","context":null,"enonce":"Regarding acute and chronic pain:","item":"dlrphysiopath","matiere":"mpr","propositions":[{"idx":0,"proposition":"The best assessment of pain remains the patient's self-assessment","correct":true},{"idx":1,"proposition":"Self-assessment or hetero-evaluation requires the rigorous use of validated scales","correct":true},{"idx":2,"proposition":"Hetero-assessment is used routinely in all patients","correct":false,"justification":"Hetero-assessment is only used if the patient cannot communicate"},{"idx":3,"proposition":"Pain is an important clinical sign and should never be masked by the use of analgesics","correct":false,"justification":"Pain must be treated effectively as soon as possible"},{"idx":4,"proposition":"Chronic pain is a real disease with considerable health and economic repercussions","correct":true,"justification":"Cf College of MPR"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dlrphysiopath-mpr-1","context":null,"enonce":"Regarding acute and chronic pain:","item":"dlrphysiopath","matiere":"mpr","propositions":[{"idx":0,"proposition":"Chronic pain is defined as a course greater than 1 month","correct":false,"justification":"We talk about chronic pain, when it has been evolving for more than 3 months"},{"idx":1,"proposition":"Neuropathic pain is secondary to nerve damage and is often chronic","correct":true},{"idx":2,"proposition":"Mixed pain accounts for 25% of chronic pain","correct":true},{"idx":3,"proposition":"Pain is a dynamic phenomenon that evolves over time","correct":true},{"idx":4,"proposition":"In communicating adults, acute pain is assessed using quantitative self-report scales","correct":true,"justification":"Cf College of MPR"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrphysiopath-mpr-2","context":null,"enonce":"Regarding pain rating scales:","item":"dlrphysiopath","matiere":"mpr","propositions":[{"idx":0,"proposition":"The most used are the visual analogue scale (EVA), the digital scale (EN) and the simple verbal scale (EVS)","correct":true,"justification":"Cf College of MPR"},{"idx":1,"proposition":"EVA uses a graduation from 0 (no pain) to 10 (maximum bearable pain)","correct":false,"justification":"EVA uses a graduation from 0 (no pain) to 100 (maximum sustainable pain)"},{"idx":2,"proposition":"The EN rates pain from 0 (no pain) to 100 (maximum conceivable pain)","correct":false,"justification":"The EN scores pain from 0 (no pain) to 10 (maximum conceivable pain) and the EVS scores pain in 5 categories: 0 (no pain), 1 (low), 2 (moderate), 3 (intense), 4 (very intense), VAS rates pain from 0 to 100"},{"idx":3,"proposition":"Rating scales are not sufficient to assess chronic pain","correct":true,"justification":"These scales are insufficient for the assessment of chronic pain, which must take into account not only the intensity of the pain but all the dimensions of pain and its impact on quality of life."},{"idx":4,"proposition":"The search for a neuropathic component to pain is essential","correct":true,"justification":"Neuropathic pain is to be sought, it testifies to the lesion of the somatosensory system and responds to a specific treatment involving in particular antidepressants and antiepileptics"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrphysiopath-mpr-3","context":null,"enonce":"Regarding acute and chronic pain:","item":"dlrphysiopath","matiere":"mpr","propositions":[{"idx":0,"proposition":"The diagnosis of neuropathic pain is based on the use of specific scales (DN4, S-LANSS, NPQ), the most widely used in France is the DN4 questionnaire.","correct":true,"justification":"Cf College of MPR"},{"idx":1,"proposition":"The DN4 questionnaire has 100 items to check","correct":false,"justification":"The DN4 questionnaire has 10 items to check"},{"idx":2,"proposition":"The DN4 questionnaire is completed by the patient","correct":false,"justification":"The practitioner questions the patient himself and completes the questionnaire"},{"idx":3,"proposition":"If the patient's DN4 score is greater than or equal to 4, the test is positive with significant sensitivity and specificity","correct":true},{"idx":4,"proposition":"The most frequent etiologies of neuropathic pain are radiculalgia (sciatica, cervicobrachial neuralgia), shingles or diabetes.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrphysiopath-rhumato-0","context":null,"enonce":"Regarding acute and chronic pain","item":"dlrphysiopath","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Chronic pain triggers a diagnostic approach that will clarify the presence of an underlying lesion","correct":false,"justification":"Acute pain triggers a diagnostic approach that will clarify the presence of an underlying lesion"},{"idx":1,"proposition":"Chronic pain corresponds to disease pain, i.e. a complex, biopsychosocial pathology","correct":true},{"idx":2,"proposition":"Inflammatory pain is often daytime pain","correct":false,"justification":"Inflammatory pain is often nocturnal pain (but nocturnal pain can also be of mechanical origin, for example in low back pain)"},{"idx":3,"proposition":"An inflammatory schedule pain is a pain that sets in in the second part of the night","correct":true},{"idx":4,"proposition":"The fibers that transmit the nociceptive message are fibers A and C","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrphysiopath-rhumato-1","context":null,"enonce":"Regarding acute pain","item":"dlrphysiopath","matiere":"rhumato","propositions":[{"idx":0,"proposition":"The modulation of nociceptive messages is subject to control systems of segmental and supraspinal origin","correct":true},{"idx":1,"proposition":"To assess pain, the diagnostic approach is based on the definition of the type of pain, knowledge of the mechanisms generating the pain and the intensity of the pain.","correct":true},{"idx":2,"proposition":"To determine the intensity of pain, multidimensional scales are used to estimate pain in a global way","correct":false,"justification":"To determine pain intensity, one-dimensional pain scales are used to estimate pain holistically."},{"idx":3,"proposition":"the preferred scale is the numerical scale EN","correct":true},{"idx":4,"proposition":"The simple visual scale consists of 4 items, rated: 1: Low; 2: Moderate; 3: Intense; 4: Extremely intense","correct":false,"justification":"The simple visual scale consists of five items, rated: 0: Absent; 1: Low; 2: Moderate; 3: Intense; 4: Extremely intense"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrphysiopath-neuro-0","context":null,"enonce":"Regarding acute and chronic pain","item":"dlrphysiopath","matiere":"neuro","propositions":[{"idx":0,"proposition":"Pain is an unpleasant sensory and emotional experience, associated with, or described in terms of, present or potential tissue damage.","correct":true},{"idx":1,"proposition":"Pain is sometimes objectivable","correct":false,"justification":"Pain is always subjective"},{"idx":2,"proposition":"There are two main routes of transmission of somesthetic information: the lateral lemniscal system and the medial lemniscal system","correct":false,"justification":"There are two main routes of transmission of somesthetic information: the lemniscal system and the extralemniscal system"},{"idx":3,"proposition":"The lemniscal system corresponds to epicritical and proprioceptive sensitivities","correct":true},{"idx":4,"proposition":"The extralemniscal system corresponds to protopathic, nociceptive and thermal sensitivities","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"dlrphysiopath-neuro-1","context":null,"enonce":"Regarding acute and chronic pain","item":"dlrphysiopath","matiere":"neuro","propositions":[{"idx":0,"proposition":"The neospinothalamic bundle rather connected to the Aδ fibers joins the ventro-postero-lateral nucleus of the thalamus before reaching the somatosensory cortex","correct":true},{"idx":1,"proposition":"The paleospinothalamic bundle rather connected to the C fibers joins the medial thalamus with a relay to the limbic structures and the frontal cortex","correct":true},{"idx":2,"proposition":"Diffuse inhibitory control of nociception-induced pain allows attention to be focused on the new painful area","correct":true},{"idx":3,"proposition":"Nociceptors can release neurotransmitters as well as substance P which has a vasodilating action and promotes the secretion of histamine, serotonin sensitizing neighboring nociceptors","correct":true},{"idx":4,"proposition":"It is neurogenic inflammation that causes primary hyperalgesia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrphysiopath-neuro-2","context":null,"enonce":"Regarding acute and chronic pain","item":"dlrphysiopath","matiere":"neuro","propositions":[{"idx":0,"proposition":"NSAIDs act on the synthesis of prostaglandins by inhibiting the action of cyclooxygenase (COX)","correct":true},{"idx":1,"proposition":"GABA has an algesic action","correct":false,"justification":"Analgesic function"},{"idx":2,"proposition":"Tissue damage leads to the secretion of analgesic substances such as opioid peptides","correct":true},{"idx":3,"proposition":"Serotonin (5-HT), dopamine and norepinephrine are largely involved in pain regulation by activating ascending neurons","correct":false,"justification":"Serotonin (5-HT), dopamine and norepinephrine are largely involved in pain regulation via descending inhibitory controls. This is the << gate control >>: they activate the A-alpha fibers which, in turn, inhibit the A-dela and C fibers (carriers of nociception) in the spinal cord."},{"idx":4,"proposition":"The routes of transmission of the nociceptive message are lemniscal","correct":false,"justification":"What to remember The routes of transmission of the nociceptive message are extralemniscal"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrphysiopath-neuro-3","context":null,"enonce":"Regarding acute and chronic pain","item":"dlrphysiopath","matiere":"neuro","propositions":[{"idx":0,"proposition":"The main excitatory neurotransmitters of pain are adrenaline and corticosteroids glutamate, aspartate and substance P","correct":false,"justification":"These are glutamate, aspartate and substance P"},{"idx":1,"proposition":"Acute pain is an often helpful symptom","correct":true,"justification":"It will be necessary to quickly determine the origin and nature in order to implement the appropriate treatment to remove the cause (if possible) and the complete disappearance of the pain."},{"idx":2,"proposition":"In case of severe pain, a strong analgesic treatment, including strong opioid, is often useful","correct":true},{"idx":3,"proposition":"The pain is chronic if its duration is longer than 8 weeks","correct":false,"justification":"The pain is chronic if its duration is longer than 3 or 6 months"},{"idx":4,"proposition":"Chronic pain is a syndrome, multifactorial and complex, associating physical but also psychic, behavioral and social manifestations","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrphysiopath-neuro-4","context":null,"enonce":"Among these structures, at what level do the fibers of the lemniscale pathway decuss?","item":"dlrphysiopath","matiere":"neuro","propositions":[{"idx":0,"proposition":"The bulb","correct":true},{"idx":1,"proposition":"The brain stem","correct":true,"justification":"The fibers of the lemniscale pathway decuss at the buble, which is the lower part of the brainstem"},{"idx":2,"proposition":"The thalamus","correct":false},{"idx":3,"proposition":"Cervical cord","correct":false},{"idx":4,"proposition":"Hypothalamus","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"dlrphysiopath-neuro-5","context":null,"enonce":"Through which structures do the fibers of the lemniscale pathway pass?","item":"dlrphysiopath","matiere":"neuro","propositions":[{"idx":0,"proposition":"The anterior horn of the spinal cord","correct":false,"justification":"These are sensory fibers (mainly Abeta) so they pass not the posterior horn of the spinal cord"},{"idx":1,"proposition":"Hypothalamus","correct":false,"justification":"They pass through the Ventro-Postero-Lateral nucleus of the thalamus"},{"idx":2,"proposition":"The gracile nucleus","correct":true},{"idx":3,"proposition":"The cuneiform nucleus","correct":true},{"idx":4,"proposition":"The pre-central gyrus","correct":false,"justification":"It is the post-central gyrus that is sensitive. The pre-central gyrus is motor"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"dlrphysiopath-neuro-6","context":null,"enonce":"Which of these sensitivities are conveyed by extra-lemniscal routes?","item":"dlrphysiopath","matiere":"neuro","propositions":[{"idx":0,"proposition":"Nociception","correct":true,"justification":"There are three according to the College of Neurology: protopathic, nociception, thermal"},{"idx":1,"proposition":"Epicritics","correct":false,"justification":"A-beta fibres: leminscale route"},{"idx":2,"proposition":"Proprioception","correct":false,"justification":"A-beta fibres: lemniscale route"},{"idx":3,"proposition":"Protophatic","correct":true},{"idx":4,"proposition":"Thermoalgic","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"DE-uro-0","context":null,"enonce":"Regarding the anatomy of the penis:","item":"DE","matiere":"uro","propositions":[{"idx":0,"proposition":"The corpora cavernosa is an active vascular sponge consisting of smooth muscle cells surrounded by connective and elastic supporting tissue","correct":true},{"idx":1,"proposition":"Around the corpora cavernosa, the albuginea is a poorly stretched and resistant membrane","correct":true},{"idx":2,"proposition":"The albuginary muscle contracts rhythmically allowing the expulsion of semen during ejaculation","correct":false,"justification":"The bulbo-spongy muscle, which surrounds the initial part of the albuginea (= the bulb)"},{"idx":3,"proposition":"The glans is the terminal part of the corpus spongiosum that caps the distal end of the corpora cavernosa","correct":true},{"idx":4,"proposition":"The vascularization of the penis is largely anastomosed between the network of spongy arteries and dorsal arteries of the penis","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"DE-uro-1","context":null,"enonce":"Regarding erection:","item":"DE","matiere":"uro","propositions":[{"idx":0,"proposition":"Venous drainage is provided by a deep network","correct":true},{"idx":1,"proposition":"Pudendal veins flow into the external iliac veins","correct":false,"justification":"EMB drainage is through the internal iliac veins"},{"idx":2,"proposition":"Pro-erectile innervation comes from the orthosympatic system","correct":false,"justification":"Pro-erectile innervation comes from the parasympathetic system and NANC (non-adrenergic and non-cholinergic: essentially nitrergic [NO])"},{"idx":3,"proposition":"Pro-erectile innervation is of sacral origin S2-S4","correct":true},{"idx":4,"proposition":"In the flaccid state, adrenergic sympathetic innervation keeps the smooth muscle contracted limiting the opening of the sinusoid spaces","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"DE-uro-3","context":null,"enonce":"Regarding patient care:","item":"DE","matiere":"uro","propositions":[{"idx":0,"proposition":"Age is an independent risk factor for erectile dysfunction","correct":true},{"idx":1,"proposition":"It is estimated that about 10% of couples have active sexuality by age 70.","correct":false,"justification":"70% of couples"},{"idx":2,"proposition":"ED is a sentinel symptom of cardiovascular disease and especially coronary artery disease","correct":true},{"idx":3,"proposition":"The prevalence of ED increases in comorbidities such as hypertension, diabetes, dyslipidemia and obesity","correct":true},{"idx":4,"proposition":"ED is an isolated sexual disorder, barring chance","correct":false,"justification":"There is a common association between ED and other sexual disorders"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"progrossesse-sp-0","context":null,"enonce":"Which of these proposals are CMR substances (carcinogenic, mutagenic, reprotoxic)?","item":"progrossesse","matiere":"sp","propositions":[{"idx":0,"proposition":"Alcohol","correct":false},{"idx":1,"proposition":"Fulfuryl alcohol","correct":true},{"idx":2,"proposition":"Arsenic","correct":true},{"idx":3,"proposition":"Tobacco","correct":false,"justification":"Not in the CMR list"},{"idx":4,"proposition":"Nickel","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"progrossesse-sp-1","context":null,"enonce":"Which of these proposals are physical risks for pregnant women?","item":"progrossesse","matiere":"sp","propositions":[{"idx":0,"proposition":"Hyberbaria","correct":true},{"idx":1,"proposition":"Cosmic radiation","correct":true,"justification":"Work in aircraft in flight for example"},{"idx":2,"proposition":"Heavy load port","correct":false,"justification":"Not a physical risk"},{"idx":3,"proposition":"Pesticide exposure","correct":false,"justification":"Chemical risk"},{"idx":4,"proposition":"Exposure to rubella","correct":false,"justification":"Biological risk\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"progrossesse-sp-2","context":null,"enonce":"Which statements are true?","item":"progrossesse","matiere":"sp","propositions":[{"idx":0,"proposition":"It is strictly forbidden to expose an unprotected pregnant woman to rubella","correct":true},{"idx":1,"proposition":"It is strictly forbidden to expose an unprotected pregnant woman to toxoplasmosis","correct":true},{"idx":2,"proposition":"Jackhammer work is not contraindicated in women before the 10th SA","correct":false,"justification":"Jackhammer work: generally forbidden to women, especially if they are pregnant."},{"idx":3,"proposition":"Care shall be taken to ensure that exposure does not exceed 1 mSv if it is necessary for use","correct":true},{"idx":4,"proposition":"If she so requests, the pregnant woman or a woman who has given birth may request to move to a temporary day shift.","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"progrossesse-sp-3","context":null,"enonce":"What are the real propositions?","item":"progrossesse","matiere":"sp","propositions":[{"idx":0,"proposition":"There is no legal obligation to declare the pregnancy to the employer","correct":true},{"idx":1,"proposition":"Declaring the pregnancy to the employer can lead to the implementation of optimized working conditions","correct":true},{"idx":2,"proposition":"A pregnant woman is not allowed to work for more than 5 consecutive days","correct":true},{"idx":3,"proposition":"The maximum working time is 40 hours\/week at the beginning of pregnancy","correct":true},{"idx":4,"proposition":"From 6 months, the maximum weekly working time is 35 hours","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"progrossesse-sp-4","context":null,"enonce":"Regarding pregnancy and labour:","item":"progrossesse","matiere":"sp","propositions":[{"idx":0,"proposition":"If pregnancy leads to maladjustment to the position, dismissal is possible","correct":false,"justification":"No dismissal during pregnancy and maternity leave"},{"idx":1,"proposition":"Breastfeeding in the labour establishment is not possible","correct":false,"justification":"Possible"},{"idx":2,"proposition":"Maternity leave in its classic form is 24 weeks in total","correct":false,"justification":"The duration of maternity leave is: 6 weeks before the expected date of delivery and 10 weeks after"},{"idx":3,"proposition":"Prenatal leave is typically 6 weeks","correct":true},{"idx":4,"proposition":"Maternity leave is extended in the event of multiple births","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pso-dermato-0","context":null,"enonce":"Regarding the basics of psoriaris:","item":"pso","matiere":"dermato","propositions":[{"idx":0,"proposition":"Psoriasis is an erythematosquamous dermatosis","correct":true},{"idx":1,"proposition":"Psoriasis is characterized by decelerated epidermal renewal and therefore hypoproliferation","correct":false,"justification":"Accelerated epidermal renewal with hyperproliferation and keratinocyte differentiation disorders"},{"idx":2,"proposition":"There is no genetic component that has been found until today","correct":false,"justification":"It involves, on a particular genetic terrain, complex interactions between the immune system, epidermal cells (keratinocytes) and vessels"},{"idx":3,"proposition":"The histopathological examination is mandatory to consider the diagnosis","correct":false,"justification":"Histopathological examination of a psoriatic lesion skin biopsy may be useful but is usually not necessary"},{"idx":4,"proposition":"The prevalence of psoriasis in the general population is about 2%","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"pso-dermato-1","context":null,"enonce":"What is found during the histopathological examination?","item":"pso","matiere":"dermato","propositions":[{"idx":0,"proposition":"An acanthosis is the thickening of the epidermis","correct":true},{"idx":1,"proposition":"T-cell micro-abscesses","correct":false,"justification":"neutrophil microabscesses"},{"idx":2,"proposition":"Bacterial inflammatory infiltrates (often Staphylococcus aureus)","correct":false,"justification":"inflammatory lymphocyte infiltrate"},{"idx":3,"proposition":"Dilated neoformed vessels","correct":true},{"idx":4,"proposition":"Hypokeratosis with parakeratosis","correct":false,"justification":"Hyperkeratosis and parakeratosis"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pso-dermato-2","context":null,"enonce":"Regarding psoriasis:","item":"pso","matiere":"dermato","propositions":[{"idx":0,"proposition":"Many susceptibility genes have been identified","correct":true},{"idx":1,"proposition":"Some psoriasis in children begins as a result of nasopharyngeal infectious episodes","correct":true},{"idx":2,"proposition":"Infectious episodes have no impact on already established psoriasis","correct":false,"justification":"They can aggravate already known psoriasis"},{"idx":3,"proposition":"The occurrence or worsening of psoriasis during HIV infection is possible","correct":true},{"idx":4,"proposition":"Beta-blockers are an inducing or aggravating factor in psoriasis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pso-dermato-3","context":null,"enonce":"Regarding psoriasis risk factors:","item":"pso","matiere":"dermato","propositions":[{"idx":0,"proposition":"Stopping systemic corticosteroids often stops psoriasis","correct":false,"justification":"Significant rebound possible or even development of severe forms (erythrodermic psoriasis, generalized pustular psoriasis) when stopping general corticosteroid therapy"},{"idx":1,"proposition":"Emotional shock has no impact on psoriasis","correct":false,"justification":"Possible role of emotional shock and trauma in triggering illness or flare-ups"},{"idx":2,"proposition":"Psychological stress could induce increased secretion of neurotransmitters with pro-inflammatory activity","correct":true},{"idx":3,"proposition":"Alcohol and tobacco are recognized factors of severity and therapeutic resistance","correct":true},{"idx":4,"proposition":"Overweight is a protective factor","correct":false,"justification":"Overweight is a factor of resistance to treatment"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"pso-dermato-4","context":null,"enonce":"Regarding the diagnosis:","item":"pso","matiere":"dermato","propositions":[{"idx":0,"proposition":"The diagnosis of psoriasis is a pathological diagnosis","correct":false,"justification":"Clinical diagnosis"},{"idx":1,"proposition":"Skin biopsy is indicated only in case of diagnostic doubt in front of atypical lesions","correct":true},{"idx":2,"proposition":"The elementary lesion is a poorly limited tense bubble","correct":false,"justification":"Well-limited erythematosqal papule"},{"idx":3,"proposition":"The size of the lesions is always less than 5 mm","correct":false,"justification":"The size of the lesions is variable"},{"idx":4,"proposition":"An AEG associated with elementary lesions strongly points to psoriasis","correct":false,"justification":"In the usual psoriasis, the general condition is not impaired"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"matraitanceped-sp-0","context":null,"enonce":"Child abuse is:","item":"matraitanceped","matiere":"sp","propositions":[{"idx":0,"proposition":"Failure to respect the rights and basic needs of the child","correct":true},{"idx":1,"proposition":"Parental neglect","correct":false,"justification":"Do not confuse abuse with neglect"},{"idx":2,"proposition":"Refusal on the part of schooling in a classical school","correct":false,"justification":"Homeschooling is possible, legal and must be a respected choice"},{"idx":3,"proposition":"Non-respect for the child's desires","correct":false,"justification":"Their basic needs and rights"},{"idx":4,"proposition":"More common in cases of prematurity or disability","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"matraitanceped-sp-1","context":null,"enonce":"What are the risk factors for child maltreatment?","item":"matraitanceped","matiere":"sp","propositions":[{"idx":0,"proposition":"Prematurity","correct":true},{"idx":1,"proposition":"Disability","correct":true},{"idx":2,"proposition":"Obesity","correct":false,"justification":"Not recognized"},{"idx":3,"proposition":"Female sex","correct":false,"justification":"Not in the repository"},{"idx":4,"proposition":"Behavioural disorders","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"matraitanceped-sp-2","context":null,"enonce":"What are the risk factors for parental abuse?","item":"matraitanceped","matiere":"sp","propositions":[{"idx":0,"proposition":"Their young age","correct":true},{"idx":1,"proposition":"Unemployment","correct":true},{"idx":2,"proposition":"Addictions","correct":true},{"idx":3,"proposition":"History of childhood abuse","correct":true},{"idx":4,"proposition":"Fatigue","correct":false,"justification":"Not a risk factor every parent is tired"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"matraitanceped-sp-3","context":null,"enonce":"What examinations are to be carried out in case of suspicion of abuse?","item":"matraitanceped","matiere":"sp","propositions":[{"idx":0,"proposition":"A hemostasis assessment is useless and only delays the real management","correct":false,"justification":"Eliminates a hemostasis disorder that can explain the lesions"},{"idx":1,"proposition":"NFS and CRP\/VS","correct":false,"justification":"Useless in this case"},{"idx":2,"proposition":"Calcium phosphate balance","correct":true,"justification":"Eliminates rickets"},{"idx":3,"proposition":"X-rays of the skeleton","correct":true,"justification":"Looking for silverman's syndrome"},{"idx":4,"proposition":"A thyroid test","correct":false,"justification":"Useless because would not explain common signs of abuse"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"matraitanceped-sp-4","context":null,"enonce":"Which propositions are true?","item":"matraitanceped","matiere":"sp","propositions":[{"idx":0,"proposition":"Abuse is a life-threatening emergency","correct":false,"justification":"With some exceptions, it is mainly a medico-legal emergency (see KB page 271)"},{"idx":1,"proposition":"The MIC is descriptive and photographs of the lesions must be attached","correct":true},{"idx":2,"proposition":"Administrative reporting is reserved for serious cases","correct":false,"justification":"Systematics if situations of concern"},{"idx":3,"proposition":"Judicial reporting is reserved for serious cases","correct":true},{"idx":4,"proposition":"Shaken baby syndrome affects children under 1 year of age","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"matraitanceped-sp-5","context":null,"enonce":"Which propositions are true?","item":"matraitanceped","matiere":"sp","propositions":[{"idx":0,"proposition":"The PMI service is under the Ministry of Social Welfare","correct":false,"justification":"Departmental service (this ministry does not exist)"},{"idx":1,"proposition":"The PMI is responsible for ensuring the health protection of mothers and children","correct":true},{"idx":2,"proposition":"The accompaniment is psychological and social","correct":false,"justification":"Medical and pedagogical too"},{"idx":3,"proposition":"PMI manages administrative reports","correct":true},{"idx":4,"proposition":"PMI trains psychologists","correct":false,"justification":"No, but childminders yes"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbconscience-urg-0","context":null,"enonce":"Which of the following are true for Gayet-Wernicke encephalopathy?","item":"tbconscience","matiere":"urg","propositions":[{"idx":0,"proposition":"It is due to vitamin B1 deficiency","correct":true},{"idx":1,"proposition":"It is due to vitamin B3 deficiency","correct":false,"justification":"False"},{"idx":2,"proposition":"It is due to vitamin B9 deficiency","correct":false,"justification":"False"},{"idx":3,"proposition":"It is due to vitamin B6 deficiency","correct":false,"justification":"False"},{"idx":4,"proposition":"It is due to vitamin B12 deficiency","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"choc-urg-0","context":null,"enonce":"Regarding the basics of shock:","item":"choc","matiere":"urg","propositions":[{"idx":0,"proposition":"Shock is responsible for tissue hypoxia","correct":true},{"idx":1,"proposition":"Lactatemia has no relation to the severity of organ failure","correct":false,"justification":"Shock is responsible for organ failure(s) and elevated lactatemia (> 2 mmol\/L) whose magnitude is proportional to the severity"},{"idx":2,"proposition":"The diagnosis of shock is biological","correct":false,"justification":"Diagnosis is essentially clinical"},{"idx":3,"proposition":"Shock is defined by the combination of hypotension AND at least 1 organ failure","correct":true},{"idx":4,"proposition":"There are two types of shocks: hypovolemic and distributive","correct":false,"justification":"4 types of shock: hypovolemic, cardigenic, septic, anaphylactic"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"choc-urg-2","context":null,"enonce":"What is the dosage of volume expansion to prescribe in a child in hypovolemic shock?","item":"choc","matiere":"urg","propositions":[{"idx":0,"proposition":"NaCl 0,9 % 20 ml\/kg","correct":true,"justification":"True, not exceeding 500 ml per filling"},{"idx":1,"proposition":"NaCl 0.9% 120 ml\/kg","correct":false,"justification":"False"},{"idx":2,"proposition":"NaCl 0.9% 200 ml\/kg","correct":false,"justification":"False"},{"idx":3,"proposition":"NaCl 0,9 % 2000 ml\/kg","correct":false,"justification":"False"},{"idx":4,"proposition":"NaCl 0.9% 2 ml\/kg","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"soinspalped-soinspal-0","context":null,"enonce":"Which of the following are possible indications for the implementation of palliative care in paediatrics?","item":"soinspalped","matiere":"soinspal","propositions":[{"idx":0,"proposition":"Cancer in remission","correct":false,"justification":"This is not an indication according to the college"},{"idx":1,"proposition":"The entourage of a child who died suddenly and unexpectedly","correct":true,"justification":"True, like road accidents or stillbirths"},{"idx":2,"proposition":"Disabling mitochondrial metabolic diseases","correct":true},{"idx":3,"proposition":"Acute infectious meningitis","correct":false,"justification":"A cure exists"},{"idx":4,"proposition":"Cystic fibrosis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"bacteriemie-infectio-0","context":null,"enonce":"Regarding bacteremia and fungemia","item":"bacteriemie","matiere":"infectio","propositions":[{"idx":0,"proposition":"Diagnosis is based on 2 to 3 pairs of well-filled blood cultures (10 mL), which must be performed before any antibiotic therapy","correct":true},{"idx":1,"proposition":"ƒƒ The term \"sepsis\" is no longer used","correct":true},{"idx":2,"proposition":"The incidence of bacteremia\/fungal among hospitalized patients is 1%","correct":true},{"idx":3,"proposition":"A quarter of bacteremia\/fungal infections are associated with signs of hemodynamic distress (sepsis, septic shock)","correct":true},{"idx":4,"proposition":"Blood cultures do not need to be particularly performed at peak fever, hypothermia and\/or chills","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"bacteriemie-infectio-1","context":null,"enonce":"Regarding bacteremia, sepsis and fungalemia","item":"bacteriemie","matiere":"infectio","propositions":[{"idx":0,"proposition":"The bacteriology laboratory must be informed of the clinical context, and of the possible search for particular infectious agents in case of emocultures.","correct":true},{"idx":1,"proposition":"In endocarditis, blood cultures are incubated for 10 days (slow-growing microbe), hence the importance of notifying the laboratory of the search for endocarditis","correct":true},{"idx":2,"proposition":"Any foreign material must be suspected in the absence of any other obvious cause","correct":true},{"idx":3,"proposition":"Any bacteremia with sepsis is a therapeutic emergency","correct":true},{"idx":4,"proposition":"ƒƒ If a foreign material is at the origin of bacteremia, its removal is most often necessary sometimes urgently, to hope to obtain a cure","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"bacteriemie-infectio-2","context":null,"enonce":"Regarding infections by S.aureurs","item":"bacteriemie","matiere":"infectio","propositions":[{"idx":0,"proposition":"aureus are serious infections, by: ƒƒ high frequencyInfetions by s; AUREUS ARE serious infections due to the frequency of spetic metastasis","correct":true},{"idx":1,"proposition":"Any infection with S. aureus must therefore perform a complete clinical examination in search of secondary septic locations (heart, bone, ...) and must systematically perform an echocardiogram in search of endocarditis","correct":true},{"idx":2,"proposition":"Antibiotic therapy is usually IV monotherapy with penicillin M or cefazolin (SASM) or vancomycin or daptomycin (MRSA)","correct":true},{"idx":3,"proposition":"Initial dual therapy is often required in these infections","correct":false,"justification":"Initial dual therapy is only necessary in case of signs of severity (association with gentamicin) or suspicion of endocarditis on prosthetic valve (combination with gentamicin then rifampicin)"},{"idx":4,"proposition":"The persistence of positivity is blood cultures is in favor of the existence of secondary septic localizations or endovascular infection,","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"classifpsy-psy-0","context":null,"enonce":"DSM and CIM:","item":"classifpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Diseases are organized by the International Classification of Diseases, currently in its version 5 (ICD 5)","correct":false,"justification":"The current version is 10 (ICD 10)"},{"idx":1,"proposition":"A specific classification system for mental disorders has been defined by the American Psychiatric Association","correct":true},{"idx":2,"proposition":"The current DSM is DSM-4.5","correct":false,"justification":"Currently in its version 5, translated into French (DSM-5)"},{"idx":3,"proposition":"DSM-5 is more widely used than ICD-10 for clinical research in psychiatry","correct":true},{"idx":4,"proposition":"The DSM-5 allows the scoring of medical acts in psychiatry","correct":false,"justification":"The DSM-5 also refers to routine clinical practice, while ICD-10 remains the France reference for the rating of acts in hospitals."}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"classifpsy-psy-1","context":null,"enonce":"Regarding the psychiatric clinic:","item":"classifpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"A sign is an \"objective\" clinical observation","correct":true},{"idx":1,"proposition":"A symptom is a \"subjective\" experience described by the patient","correct":true},{"idx":2,"proposition":"A syndrome is a set of symptoms","correct":false,"justification":"A syndrome is a set of signs and symptoms forming a recognizable set"},{"idx":3,"proposition":"The psychiatric examination is essentially clinical","correct":true},{"idx":4,"proposition":"Semeiological analysis in psychiatry consists of exploring eight domains of the patient's lived experience and behaviour.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"classifpsy-psy-2","context":null,"enonce":"Semiological data in psychiatry:","item":"classifpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"The evolution of the symptomatology over time unfortunately does not bring additional elements to the clinical reflection","correct":false,"justification":"It is also important to explore."},{"idx":1,"proposition":"Personal hygiene can be indicative of carelessness (with indifference and lack of care)","correct":true},{"idx":2,"proposition":"An amimic expression signs the disappearance of all mimicry","correct":true},{"idx":3,"proposition":"Discourse is the quality of language (lexical field, vocabulary, etc.)","correct":false,"justification":"Discourse is the association of language and thought"},{"idx":4,"proposition":"The neologism is the invention of words","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"classifpsy-psy-3","context":null,"enonce":"Semiology in psychiatry:","item":"classifpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"The form of speech can be altered in its continuity with inconsistencies","correct":true},{"idx":1,"proposition":"Fading is the gradual cessation of the patient's speech","correct":true},{"idx":2,"proposition":"Fading can go as far as a dam","correct":true},{"idx":3,"proposition":"The content of the speech is most often uninteresting","correct":false,"justification":"The content of the speech can find: delusions, worries and worries, obsessions, revivals and flashbacks, phobic ideas, ideas related to anticipatory anxiety, ideas related to mood (negative, devaluation, incurability etc.), ..."},{"idx":4,"proposition":"Illusions are distorted perceptions","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"classifpsy-psy-5","context":null,"enonce":"Psychiatric semiology:","item":"classifpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Anhedonia refers more specifically to the loss of the ability to experience pleasure","correct":true},{"idx":1,"proposition":"Hyperthymia is a form of hypersexuality","correct":false,"justification":"Hyperthymia is a euphoric mood"},{"idx":2,"proposition":"Increased mood is very rarely associated with hypertune","correct":false,"justification":"This is a common association"},{"idx":3,"proposition":"Hypertune is a hypersensitivity to context and atmosphere","correct":true},{"idx":4,"proposition":"Aboulie and apragmatism are synonymous","correct":false,"justification":"Aboulie is to be distinguished from apragmatism (difficulty in initiating an action due to lack of planning)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"GEU-gyn-0","context":null,"enonce":"Regarding the generalities of UEGs:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"The most common presentation of GEU is implantation on the ovary","correct":false,"justification":"The most frequent presentation is tubal pregnancy with implantation that begins in the tube: in its ampullary part in 75% of cases, isthmian in 20% of cases, or even pavilion for 3% of GEU"},{"idx":1,"proposition":"The rarest presentation of GEU is pavilion nesting","correct":false,"justification":"More rarely, implantation can occur in the interstitial part of the uterus, on the ovary or in the abdomen and exceptionally in the cervix (cervical pregnancy) or in a rudimentary uterine horn in case of malformed uterus"},{"idx":2,"proposition":"Heterotopic pregnancy is the coexistence of two simultaneous pregnancies: an intrauterine pregnancy and a GEU","correct":true},{"idx":3,"proposition":"The main risk factor for heterotopic pregnancy is advanced age","correct":false,"justification":"The main risk factor for the latter is medically assisted procreation"},{"idx":4,"proposition":"EMG is a relative non-life-threatening emergency most often","correct":false,"justification":"The GEU, when it is evolved, is therefore the very example of the vital emergency and remains a major cause of maternal mortality in the world.\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"GEU-gyn-1","context":null,"enonce":"Regarding the evolution and FDR of EMGs:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"The incidence of EMGs has declined significantly in developed countries","correct":false,"justification":"The incidence of ectopic pregnancies has increased in developed countries, accounting for 2% of pregnancies in France"},{"idx":1,"proposition":"Morbidity and mortality has increased significantly in recent years","correct":false,"justification":"Morbidity and mortality has been significantly reduced thanks to the possibilities of early diagnosis and effective and less invasive treatments such as drug treatment or laparoscopy."},{"idx":2,"proposition":"There are no demonstrated risk factors for GEU","correct":false,"justification":"The risk factors for GEU are therefore all factors altering tubal motility: • upper genital infections (IGH), endometriosis, tubal or abdominal surgery atcd, etc."},{"idx":3,"proposition":"Tuberculosis may be a cause of damage to the tubal wall","correct":true},{"idx":4,"proposition":"Schistosomiasis may be a cause of tubal wall ateration","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"GEU-gyn-2","context":null,"enonce":"Regarding EMGs:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"High maternal age is a risk factor for GEU","correct":true},{"idx":1,"proposition":"The intrauterine device leads to a relative risk of GEU of 0.3 and therefore makes it a protective factor","correct":false,"justification":"intrauterine device (risk relative to 3)"},{"idx":2,"proposition":"IVF patients cannot have a GEU because the injection is uterine","correct":false,"justification":"For these patients, we must think about heterotopic pregnancies"},{"idx":3,"proposition":"The diagnosis of GEU should be discussed in any woman of childbearing potential presenting to the emergency room for pelvic pain and\/or metrorrhagia","correct":true},{"idx":4,"proposition":"In a woman of childbearing age who has pelvic pain, we can do without a clinical examination and do a pelvic ultrasound directly.","correct":false,"justification":"Clinical examination, pelvic ultrasound and plasma βHCG assay (not set = 0) should be performed\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"GEU-gyn-4","context":null,"enonce":"Concerning the diagnosis of GEU","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Vaginal touch is always normal at Douglas' cul-de-sac","correct":false,"justification":"At the posterior vaginal cul-de-sac (Douglas), touch can cause sharp tenderness indicating peritoneal irritation related to hemoperitoneum"},{"idx":1,"proposition":"Uterine emptiness with normal βHCG is the main indirect sign of GEU","correct":false,"justification":"Uterine emptiness with βHCG greater than 1,500 IU\/L is the main (indirect) sign of GEU"},{"idx":2,"proposition":"GEU is never visible on endovaginal ultrasound","correct":false,"justification":"The GEU may be visible on endovaginal ultrasound as a \"laterouterine mass\" (Figure 2"},{"idx":3,"proposition":"The laterouterine mass is exceptionally located on the side of the corpus luteum","correct":false,"justification":"In 90% of cases, the laterouterine mass is located on the side of the corpus luteum"},{"idx":4,"proposition":"The presence of blood in Morrison's space is a sign of a large hemoperitoneum","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"GEU-gyn-5","context":null,"enonce":"Regarding BHCG and GEU:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"The BHCG test is urgently requested in any patient of childbearing age who presents pelvic signs","correct":true},{"idx":1,"proposition":"If βHCG is above 1,500 IU\/L with uterine acuity on ultrasound, the diagnosis of GEU is very likely","correct":true},{"idx":2,"proposition":"βHCG less than 1,500 IU\/L eliminates the diagnosis of GEU","correct":false},{"idx":3,"proposition":"In intrauterine pregnancy, BHCG levels remain stable from the first days of pregnancy","correct":false,"justification":"Indeed, in intrauterine pregnancy βHCG levels double in this time interval"},{"idx":4,"proposition":"In case of spontaneous miscarriage, BHCG remains stable for several weeks","correct":false,"justification":"In case of spontaneous miscarriage, they decrease\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"GEU-gyn-6","context":null,"enonce":"What does the preoperative assessment of a patient suspected of GEU contain:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"NFS","correct":true,"justification":"Standard balance sheet"},{"idx":1,"proposition":"TP\/TCA","correct":true},{"idx":2,"proposition":"Rhesus RAI Group","correct":true},{"idx":3,"proposition":"Hepatic test","correct":false,"justification":"With some exceptions"},{"idx":4,"proposition":"Anesthetic consultation","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"GEU-gyn-7","context":null,"enonce":"Which of these proposals are differential diagnoses of GEU in beta-HCG negative?","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Cervical tumour","correct":true},{"idx":1,"proposition":"Spontaneous miscarriage","correct":false,"justification":"b-HCG is positive"},{"idx":2,"proposition":"Hydatidiform mole","correct":false,"justification":"b-HCG is positive"},{"idx":3,"proposition":"Intrauterine pregnancy","correct":false,"justification":"b-HCG is positive"},{"idx":4,"proposition":"Hemorrhagic cyst of the corpus luteum","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"GEU-gyn-8","context":null,"enonce":"Regarding EMM:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"In GEU, βHCG levels show insufficient ascent or stagnate","correct":true},{"idx":1,"proposition":"In case of suspicion of GEU, the BHCG assay is to be completed by a preoperative assessment","correct":true},{"idx":2,"proposition":"A hemoCue® is to be performed if the patient has clinical or ultrasound signs of severity","correct":true},{"idx":3,"proposition":"If the mother's Rhesus is negative, the spouse's blood type should be requested for the prevention of alloimmunization (anti-D Ig)","correct":true},{"idx":4,"proposition":"The affirmation of the diagnosis of GEU goes through BHCG","correct":false,"justification":"If the patient presents clinical signs of severity and in case of diagnostic doubt, it is the emergency laparoscopy that will affirm the diagnosis\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"GEU-gyn-9","context":null,"enonce":"Which of these criteria fall within the definition of surgical emergency in case of GEU?","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Anuria","correct":false,"justification":"3 criteria: hemodynamic instability, abdominal defense and hemoperitoneum on echo"},{"idx":1,"proposition":"Abdominal defense","correct":true},{"idx":2,"proposition":"Iliac fossa pain greater than 7\/10","correct":false},{"idx":3,"proposition":"From blood in Morrison's space to ultrasound","correct":true,"justification":"Sign a hemoperitoneum"},{"idx":4,"proposition":"Hemodynamic instability","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"GEU-gyn-10","context":null,"enonce":"Regarding GEU support:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"The presence of unsafe pain makes the diagnosis of surgical emergency","correct":false,"justification":"The presence of only one of these severity criteria defines surgical urgency: • hemodynamic instability, • hemoperitoneum on ultrasound and • abdominal defense"},{"idx":1,"proposition":"Surgical treatment is performed urgently after conditioning the patient with 2VPP and an infusion of macromolecules","correct":true},{"idx":2,"proposition":"Surgery is always the treatment for GEUs, even asymptomatic","correct":false,"justification":"If the patient is pauci or asymptomatic, surgery remains indicated if she refuses or if she has a contraindication to methotrexate treatment or if outpatient follow-up is difficult"},{"idx":3,"proposition":"Laparoscopy confirms the diagnosis and specifies the location of the pregnancy","correct":true},{"idx":4,"proposition":"Salpingectomy treatment is the gold standard in young patients","correct":false,"justification":"Conservative treatment or salpingotomy should always be preferred if it extracts the pregnancy and stops bleeding.\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"GEU-gyn-11","context":null,"enonce":"Regarding the treatment of GEUs:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"A postoperative βHCG assay is performed until negativation","correct":true},{"idx":1,"proposition":"If bleeding is too great, radical treatment (salpingectomy) is performed.","correct":true},{"idx":2,"proposition":"If the couple wishes to become pregnant, salpingectomy should be preferred so as not to alter fertility.","correct":false,"justification":"If the couple wishes a pregnancy, it is necessary to favor conservative treatment so as not to alter fertility"},{"idx":3,"proposition":"The risk of treatment failure with salpingotomy is about 65%","correct":false,"justification":"The risk of treatment failure with salpingotomy is about 6-15%"},{"idx":4,"proposition":"In case of asymptomatic GEU, drug therapy with methotrexate 1mg\/kg may be considered","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"GEU-gyn-13","context":null,"enonce":"Regarding the non-surgical management of GEUs:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"If the first injection fails, we go directly to surgical treatment","correct":false,"justification":"If this fails, a second injection of methotrexate or laparoscopy may be performed."},{"idx":1,"proposition":"After an injection of methotrexate, it is normal to have abdominal pain, which should not lead to worry or to consult again","correct":false,"justification":"Finally, the patient must consult urgently in case of significant abdominal pain or discomfort because it occurs in rare cases a tubal rupture after injection of methotrexate with indication of emergency surgery"},{"idx":2,"proposition":"Given the seriousness of EOGs, therapeutic abstention is never a good solution","correct":false,"justification":"In some exceptional cases, if the patient is asymptomatic, the initial βHCG level is less than 1,000 IU \/ L and the kinetics of βHCG shows a progressive and constant decrease, therapeutic abstention can be discussed subject to good compliance of the patient (βHCG assay every 48 hours and clinical and ultrasound controls once a week)"},{"idx":3,"proposition":"The patient should be informed of the risk of failure of medical and surgical treatments","correct":true},{"idx":4,"proposition":"The patient's blood type is of no interest if the management is not surgical","correct":false,"justification":"It is necessary to remember to check the blood group of the patient in order to prevent if necessary the anti-D alloimmunization (not put = zero)\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"GEU-gyn-14","context":null,"enonce":"Regarding the ectopic pregnancy clinic:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Delayed periods","correct":true,"justification":"Clinical triad of GEU: 1. Delayed menstruation (witness to pregnancy), 2. Metrorrhagia (witness of haematosalpinx secondary to erosion of tubal vessels), 3. Lateralized pelvic pain (but not necessarily on the GEU side)"},{"idx":1,"proposition":"Metrorrhagia","correct":true,"justification":"None"},{"idx":2,"proposition":"Lateralized pelvic pain","correct":true,"justification":"None"},{"idx":3,"proposition":"Sometimes there may be the presence of a tusk that testifies to a hemoperitoneum","correct":true,"justification":"None"},{"idx":4,"proposition":"A lateoterine TR mass painful in 50% of cases.","correct":false,"justification":"On TV, not on TR"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"GEU-gyn-16","context":null,"enonce":"Which of the following proposals are part of the pre-therapeutic assessment of methotrexate?","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"NFS","correct":true,"justification":"True, thrombocytopenia and leukopenia possible under methotrexate"},{"idx":1,"proposition":"TP, TCA, Groupage, RAI","correct":false,"justification":"Not for the assessment of methotrexate treatment, but it should be done for the assessment of the impact of the GEU in case of bleeding"},{"idx":2,"proposition":"Hepatic test","correct":true,"justification":"True. Hepatic failure is a contraindication"},{"idx":3,"proposition":"Creatinemia, urea","correct":true,"justification":"True. Renal failure is a contraindication"},{"idx":4,"proposition":"Blood ionogram","correct":true,"justification":"True, frequent vomiting or diarrhea in methotrexate treatment"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"GEU-gyn-19","context":null,"enonce":"Regarding medical treatment with methotrexate for GEU. Which of the following are true?","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"It is an antimetabolite treatment of nucleic acids","correct":true,"justification":"True. Specifically, it is a folic acid antagonist that inhibits folic acid reduction and tissue cell proliferation."},{"idx":1,"proposition":"Methotrexate is most often injected into the GEU, directly into the tube, under ultrasound or laparoscopic control.","correct":false,"justification":"The injection is mainly done in one dose intramuscularly. This technique is rarely used for methotrexate"},{"idx":2,"proposition":"It is recommended if the β-HCG level is > 5000 IU\/L","correct":false},{"idx":3,"proposition":"It is recommended if the hematosalpinx is < 4 cm","correct":true},{"idx":4,"proposition":"It is possible as a first-line treatment in an obese grade 2 woman with a haematosalpinx > 4 cm","correct":false,"justification":"Grade 3 (morbid obesity)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"GEU-gyn-20","context":null,"enonce":"Regarding complementary examinations in the GEU, which proposal(s) are true?","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"β-HCG double every 48 hours in a GEU","correct":false,"justification":"The β-HCG doubles every 48 hours in a normal pregnancy. In GEU, the kinetics of β-HCG stagnate, have insufficient elevation or fall."},{"idx":1,"proposition":"If the β-HCG is negative, the diagnosis of GEU can be ruled out with certainty.","correct":true,"justification":"No b-HCG = No GEU. As for the 🍫"},{"idx":2,"proposition":"In front of any abdominal pain in women of childbearing age, it is necessary to dose the β-HCG to eliminate a GEU. ","correct":true,"justification":"Subcortical reflex. Just like malaria and fever after a blah blah..."},{"idx":3,"proposition":"Pelvic ultrasound is not systematic in the diagnosis of GEU. ","correct":false,"justification":"Pelvic ultrasound is systematic in the diagnosis of GEU. She looks for direct and indirect signs of GEU."},{"idx":4,"proposition":"Diagnostic laparoscopy is sometimes indicated in case of doubtful diagnosis in a symptomatic patient.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"GEU-gyn-21","context":null,"enonce":"Regarding implantation:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"It takes place only in the uterine cavity.","correct":false,"justification":"It can take place anywhere: in the fallopian tube, in the uterine cavity, and even in the ovary (very rare)."},{"idx":1,"proposition":"It takes place at 1 SA. ","correct":false,"justification":"No, it takes place 7 days after fertilization. Fertilization occurs at 2 SA, so implantation occurs at 3 SA."},{"idx":2,"proposition":"Implantation is the fact that the embryo implants in the uterine cavity.","correct":true},{"idx":3,"proposition":"It takes place 7 days after fertilization.","correct":true},{"idx":4,"proposition":"More rarely, implantation may occur in the interstitial part of the uterus, on the ovary or in the abdomen and exceptionally in the cervix. ","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"GEU-gyn-22","context":null,"enonce":"Which of the following are true?","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Heterotopic pregnancy is the coexistence of two simultaneous pregnancies ","correct":true,"justification":"Specifically, it is having a GEU and an intrauterine pregnancy at the same time."},{"idx":1,"proposition":"Ectopic pregnancy is the implantation of the egg outside the uterus","correct":true},{"idx":2,"proposition":"During a GEU, the most frequent location of implantation is at the isthmian level.","correct":false,"justification":"At the ampullary level: 70% (the most frequent). At the isthmian level: 20%."},{"idx":3,"proposition":"The main risk factor for heterotypic pregnancy is medically assisted reproduction.","correct":true},{"idx":4,"proposition":"The incidence of ectopic pregnancies has increased in developed countries, accounting for 15% of pregnancies in France","correct":false,"justification":"2% of pregnancies in France"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"aNcycle-gyn-0","context":null,"enonce":"Regarding premenstrual syndrome (PMS):","item":"aNcycle","matiere":"gyn","propositions":[{"idx":0,"proposition":"Premenstrual syndrome (PMS) is an extremely rare functional discomfort","correct":false,"justification":"It is the most frequently reported functional impairment by women (30-40%)"},{"idx":1,"proposition":"PMS is a set of clinical signs of interest to the genital tract, appearing in the days before menstruation to disappear at the beginning or during menstruation","correct":false,"justification":"It is a set of benign manifestations that can interest all devices, and whose only common point is their cyclical nature, appearing in the days before menstruation to disappear at the beginning or during menstruation"},{"idx":2,"proposition":"The evolution of PMS is punctuated by the events of psycho-affective life and episodes of genital life","correct":true},{"idx":3,"proposition":"Premenstrual syndrome is intractable","correct":false,"justification":"Several treatments exist, more or less effective"},{"idx":4,"proposition":"The pathophysiology is poorly known but interstitial tissue edema seems to play a role","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"aNcycle-gyn-1","context":null,"enonce":"Regarding the management of premenstrual syndrome (PMS)","item":"aNcycle","matiere":"gyn","propositions":[{"idx":0,"proposition":"There are three main signs: breast, abdomino-pelvic and psychic","correct":true},{"idx":1,"proposition":"The elimination of psychoactive substances such as coffee are part of the treatment","correct":true},{"idx":2,"proposition":"Diuretics have no place in therapeutic management","correct":false,"justification":"They are useful in case of predominant edema"},{"idx":3,"proposition":"Synthetic progestogens are useful in the management of","correct":true},{"idx":4,"proposition":"In case of isolated mastodynia, local progesterone preparations can be used","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"aNcycle-gyn-2","context":null,"enonce":"Regarding premenstrual syndrome (PMS):","item":"aNcycle","matiere":"gyn","propositions":[{"idx":0,"proposition":"Selective serotonin reuptake inhibitors (SSRIs) are effective on premenstrual, physical and emotional symptoms","correct":true},{"idx":1,"proposition":"Anxiolytics are not recommended systematically, especially because of the risk of tolerance and dependence","correct":true},{"idx":2,"proposition":"PMS is common and affects 30-40% of women","correct":true},{"idx":3,"proposition":"The three main clinical components are: headache, fatigue and somnolence","justification":"Premenstrual syndrome is common (30–40%). The three main clinical components are: mastodynia, abdominal bloating and mood disorders. The diagnosis is clinical: appearance of symptoms in the premenstrual period.","correct":false},{"idx":4,"proposition":"The diagnosis is affirmed by biology","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"IOA-infectio-0","context":null,"enonce":"Which of the following proposals designate antibiotics with good diffusion in the bone?","item":"IOA","matiere":"infectio","propositions":[{"idx":0,"proposition":"Amoxicillin","correct":false,"justification":"None"},{"idx":1,"proposition":"Amoxicillin-clavulanic acid","correct":false,"justification":"None"},{"idx":2,"proposition":"Aminoglycosides","correct":false,"justification":"None"},{"idx":3,"proposition":"2nd generation cephalosporin","correct":false,"justification":"None"},{"idx":4,"proposition":"None of these proposals","correct":true,"justification":"True. Antibiotics with good bone diffusion = fluoroquinolone, rifampicin, fusidic acid, clindamycin, cyclins"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IOA-infectio-1","context":null,"enonce":"Which of the following are antibiotics with good diffusion in the bone?","item":"IOA","matiere":"infectio","propositions":[{"idx":0,"proposition":"Rifampicin","correct":true},{"idx":1,"proposition":"fluoroquinolone","correct":true},{"idx":2,"proposition":"fusidic acid","correct":true},{"idx":3,"proposition":"Cyclins","correct":true},{"idx":4,"proposition":"clindamycin ","correct":true,"justification":"True, FRACC (because they shatter bone): Fluoroquinolones, Rifampicin, Fusidic acid, Cyclines, Clindamycin"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IOA-infectio-2","context":null,"enonce":"Which of the following propositions are true about spondylodiscitis?","item":"IOA","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is the most common osteoarticular infection (IOA)","correct":false,"justification":"It is a very rare IOA"},{"idx":1,"proposition":"The attack is most often cervical","correct":false,"justification":"The most common involvement is lumbar"},{"idx":2,"proposition":"The lymphatic pathway is most often involved","correct":false,"justification":"It is the blood-borne route that is the most common"},{"idx":3,"proposition":"Surgical management is contraindicated","correct":false,"justification":"False"},{"idx":4,"proposition":"None of these propositions are true","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"atherome-cardio-0","context":null,"enonce":"Concerning cardiovascular diseases","item":"atherome","matiere":"cardio","propositions":[{"idx":0,"proposition":"Cardiovascular diseases are the leading cause of death worldwide","correct":true,"justification":"According to the 2017 WHO report"},{"idx":1,"proposition":"Cardiovascular mortality is steadily increasing in France.","correct":false,"justification":"Plateau phase \/ slight decrease (progress in management and prevention)"},{"idx":2,"proposition":"There is an ongoing epidemiological transition in developing countries, with an increase in the prevalence and incidence of atheromatous diseases","correct":true,"justification":"In particular because of the lack of prevention and management of risk factors"},{"idx":3,"proposition":"Variations in CV disease prevalence are less related to environmental and lifestyle factors than to genetic differences","correct":false,"justification":"These variations are more related to environmental factors and lifestyle."},{"idx":4,"proposition":"In France, CV diseases cause one in three deaths","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"atherome-cardio-1","context":null,"enonce":"Concerning cardiovascular diseases","item":"atherome","matiere":"cardio","propositions":[{"idx":0,"proposition":"There is a difference in incidence between the sexes, which decreases with age","correct":true},{"idx":1,"proposition":"The prevalence of cardiovascular disease increases with the age of the population","correct":true,"justification":"Significant risk from age 50 in men\/age 60 in women"},{"idx":2,"proposition":"CV mortality is higher in Southern Europe than in Northern Europe","correct":false,"justification":"Higher mortality in North\/Western Europe (non-Mediterranean diet)"},{"idx":3,"proposition":"Atherogenesis begins in childhood","correct":true},{"idx":4,"proposition":"The increase in the thickness of the wall by increasing the volume of the plates is associated with an increase in the diameter of the vessel","correct":true,"justification":"In order to compensate (initially) for the reduction in light gauge"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"atherome-cardio-3","context":null,"enonce":"About atherosclerosis","item":"atherome","matiere":"cardio","propositions":[{"idx":0,"proposition":"Atheroma can also alter the parietal structure of the vessel and destroy the extracellular matrix, which can promote the formation of an aneurysm","correct":true,"justification":"Among others at the level of the abdominal aorta"},{"idx":1,"proposition":"Treatment of high blood pressure helps prevent the development of atheroma","correct":true,"justification":"By reducing the mechanical stresses applied to enfothelium"},{"idx":2,"proposition":"Atheroma develops mainly near turbulent arterial flows: ostium, bifurcation, mechanical stress zone","correct":true},{"idx":3,"proposition":"Atheroma reaches small arteries","correct":false,"justification":"Atheroma affects large and medium arteries : mainly the aorta and its branches"},{"idx":4,"proposition":"Atheromatous plaques lead to a tendency to vasoconstriction and vascular spasm","correct":true,"justification":"Remodeling prevents the passage and action of NO"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"atherome-cardio-4","context":null,"enonce":"About atherosclerosis","item":"atherome","matiere":"cardio","propositions":[{"idx":0,"proposition":"Predisposing factors for atherosclerosis include obesity, physical inactivity, stress and psychosocial conditions.","correct":true},{"idx":1,"proposition":"Polyatheromatous disease is an atheromatous involvement of at least two different arterial territories","correct":true,"justification":"Symptomatic or not"},{"idx":2,"proposition":"Atheromatous involvement may or may not be symptomatic","correct":true},{"idx":3,"proposition":"Frequent associations require screening for lesions of other arterial territories, whenever an atheromatous lesion is discovered","correct":true,"justification":"Minimum work-up: clinical (including BP), ECG, IPS measurement, EAL, fasting blood glucose"},{"idx":4,"proposition":"The atheromatous localization most frequently associated with coronary involvement are the arteries of the lower limbs (PAD)","correct":true,"justification":"Strong association with coronary artery disease PAD"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SDRC-rhumato-0","context":null,"enonce":"Regarding the basics of CRPS type 1:","item":"SDRC","matiere":"rhumato","propositions":[{"idx":0,"proposition":"It was called causalgia","correct":false,"justification":"Its former name was algodystrophy."},{"idx":1,"proposition":"Hand-shoulder syndrome is typical after stroke","correct":true,"justification":"Hemiplegic stroke"},{"idx":2,"proposition":"The definition of CRPS is radiological","correct":false,"justification":"It is purely clinical"},{"idx":3,"proposition":"There are 4 types of CRPS","correct":false,"justification":"2 types. Type 2 is associated with nerve damage, unlike type 1"},{"idx":4,"proposition":"The evolution of type 1 CRPS is spontaneously favorable in 10% of cases","correct":false,"justification":"In 90% of cases, but the evolution lasts several months"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"SDRC-rhumato-1","context":null,"enonce":"Regarding CRPS:","item":"SDRC","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Trophic disorders and aponeurotic retractions may be observed in CRPS type 1","correct":true,"justification":"This happens in about 10% of cases"},{"idx":1,"proposition":"The pain is constant in CRPS: it is intermittent with inflammatory rhythm","correct":false,"justification":"The pain is continuous, disproportionate to the triggering event"},{"idx":2,"proposition":"CRPS is never seen in young people under the age of 20","correct":false,"justification":"CRPS is possible at any age, but remains exceptional in adolescents and children"},{"idx":3,"proposition":"The pathophysiology of CRPS includes neurological dysfunction of the peripheral, medullary and cerebral nervous systems","correct":true},{"idx":4,"proposition":"The most common triggers of CRPS1 are central neurological disorders","correct":false,"justification":"Traumatic triggers are predominant"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"SDRC-rhumato-2","context":null,"enonce":"Regarding triggers and the CRPS clinic:","item":"SDRC","matiere":"rhumato","propositions":[{"idx":0,"proposition":"CRPS associated with pregnancy mainly affects the shoulder","correct":false,"justification":"The hip"},{"idx":1,"proposition":"The severity of CRPS 1 is proportional to the severity of the triggering factor","correct":false,"justification":"No correlation found"},{"idx":2,"proposition":"Stroke or MS can cause CRPS","correct":true,"justification":"Type 1 most often"},{"idx":3,"proposition":"The diagnosis is made according to the Budapest criteria","correct":true,"justification":"Criteria of pain, various sensory symptoms, vasomotors, sudomotor players, trophic (...) and exclusion of differential diagnoses"},{"idx":4,"proposition":"Typically, in post-traumatic, CRPS is composed of two phases","correct":false,"justification":"3 phases: inflammatory hot phase, pure dystrophic cold phase and atrophic phase (in practice, these three phases are rarely found)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SDRC-rhumato-3","context":null,"enonce":"Regarding the diagnosis of CRPS type 1:","item":"SDRC","matiere":"rhumato","propositions":[{"idx":0,"proposition":"The joint space is the site of erosions in advanced forms","correct":false,"justification":"Line spacing is always respected"},{"idx":1,"proposition":"MRI confirms diagnosis of CRPS 1","correct":false,"justification":"Clinical diagnosis, and low specificity of MRI (17% according to the college of MPR)"},{"idx":2,"proposition":"CRPS type 1 leads to an increase in CRP","correct":false,"justification":"No biological abnormalities, except due to the trigger. In any case, a biological inflammatory syndrome must seek a differential diagnosis."},{"idx":3,"proposition":"Normal MRI rules out diagnosis of CRPS","correct":false,"justification":"MRI can be normal, without questioning the diagnosis"},{"idx":4,"proposition":"MRI is the gold standard exam but it is not systematic","correct":true,"justification":"This is indeed the reference examination, and no imaging is systematic: the diagnosis is clinical, the complementary examinations aim to exclude differential diagnoses and are guided by the clinic"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SDRC-rhumato-4","context":null,"enonce":"Regarding the management of CRPS type 1:","item":"SDRC","matiere":"rhumato","propositions":[{"idx":0,"proposition":"The only curative treatment that has been shown to be effective in CRPS1 is vitamin C","correct":false,"justification":"It is the only preventive treatment that has been shown to be effective."},{"idx":1,"proposition":"Analgesics are an effective curative treatment","correct":false,"justification":"It is symptomatic treatment, not curative. In addition, drug treatments are not very effective in CRPS, although they are necessary."},{"idx":2,"proposition":"Occupational therapy is indicated as a first-line treatment in case of upper limb involvement","correct":true,"justification":"Cf the college of MPR"},{"idx":3,"proposition":"Total rest is indicated during the hot phase","correct":false,"justification":"Rest must be kept to a minimum: rehabilitation is started as early as possible"},{"idx":4,"proposition":"Bisphosphonates have an early indication in severe forms or to treat signs of neurogenic inflammation","correct":true,"justification":"In IV\/PO. Neurogenic signs of inflammation include pain and neuropathic sensory signs."}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"meningite-neuro-0","context":null,"enonce":"Regarding meningeal syndrome:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"The majority of acute meningitis and meningoencephalitis are infectious by contamination of the CSF with an infectious agent","correct":true},{"idx":1,"proposition":"Meningeal syndrome is characterized by the inconsistent association of the triad of headache, vomiting and meningeal stiffness","correct":true},{"idx":2,"proposition":"A meningeal syndrome should be evoked in front of a whiny child, presenting cries on mobilization (skin hyperesthesia), behavioral changes, unusual drowsiness interspersed with periods of agitation","correct":true},{"idx":3,"proposition":"Abnormal tension of the fontanel can be found in case of meningeal syndrome of the infant ","correct":true},{"idx":4,"proposition":"In children, clinical signs may be more crude with an infectious syndrome often in the background","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"meningite-neuro-1","context":null,"enonce":"Regarding meningitis and meningoencephalitis:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"In adult bacterial meningitis, 95% of patients have at least two of the following signs: headache, fever, stiff neck, impaired alertness","correct":true,"justification":"However, diagnosis is more difficult at extreme ages."},{"idx":1,"proposition":"Bone marrow aspiration is the key test to confirm the diagnosis of meningitis","correct":false,"justification":"Lumbar puncture (LP) is the key test to confirm the diagnosis of meningitis"},{"idx":2,"proposition":"An EEG showing a slow trace with diffuse periodic slow waves is in favor of encephalitis ","correct":true},{"idx":3,"proposition":"Herpetic meningoencephalitis is a diagnostic and therapeutic emergency because there is a risk of serious sequelae","correct":true},{"idx":4,"proposition":"Normal CSF, including HSV PCR examination, early in the disease does not exclude the diagnosis of herpetic meningoencephalitis.","correct":true,"justification":"HSV PCR in CSF can be negative for up to 4 days and should be repeated if clinically suspected."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"meningite-neuro-2","context":null,"enonce":"Regarding meningitis and meningoencephalitis:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"Cerebrospinal fluid (CSF) analysis can tell the difference between meningitis and meningoencephalitis","correct":false,"justification":"This difference is clinical"},{"idx":1,"proposition":"Droplet precautions should be instituted until meningococcal meningitis has been ruled out and\/or during the first 24 hours of antibiotic therapy.","correct":true},{"idx":2,"proposition":"Faced with clinical suspicion, lumbar puncture (LP) is the key examination, to be performed urgently","correct":true},{"idx":3,"proposition":"Taking antiplatelet agents does not contraindicate PL","correct":true,"justification":"On the other hand, taking anticoagulants is a contraindication."},{"idx":4,"proposition":"Venous glucose is performed concomitantly with the PL for a correct interpretation of glycorachia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"meningite-neuro-3","context":null,"enonce":"Regarding meningitis and meningoencephalitis:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"The macroscopic aspect of the CSF provides a 1st etiological information: if it is cloudy on the different tubes, it evokes elevated leukocytorachia and therefore purulent meningitis","correct":true},{"idx":1,"proposition":"Antibiotic therapy should be initiated prior to PL if purpura fulminans is suspected","correct":true},{"idx":2,"proposition":"Probabilistic treatment of a bacterial meningitis chart is dominated by IV C3G and that of an encephalitis chart by amoxicillin-aciclovir","correct":true},{"idx":3,"proposition":"In case of purpura fulminans, it is essential to make an IV or IM injection of ceftriaxone pre-hospital","correct":true},{"idx":4,"proposition":"In case of meningococcal meningitis, antibiotic prophylaxis of contact subjects (± vaccination) and case reporting are essential.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"meningite-neuro-4","context":null,"enonce":"Regarding the meninges:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"The pia mater is directly attached to the bone","correct":false,"justification":"It is the most in-depth layer, directly covering the central nervous system."},{"idx":1,"proposition":"The arachnoid is the outermost layer","correct":false,"justification":"The arachnoid is the middle layer, between the dura mater (attached to the bone) and the pia mater (acolated to the CNS)."},{"idx":2,"proposition":"The dura mater directly covers the brain and spinal cord","correct":false,"justification":"This is the case of the pia mater."},{"idx":3,"proposition":"The dura mater is pachymeninge","correct":true},{"idx":4,"proposition":"The arachnoid and pia mater form leptomeninge","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"meningite-neuro-5","context":null,"enonce":"Regarding the LCS:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"It is contained in the subdural space","correct":false,"justification":"It is contained in the subarachnoid space (between the arachnoid and the pia mater, that is, between the two leptomeninges)."},{"idx":1,"proposition":"The study of the contents of the CSF by lumbar puncture, together with clinical examination, allows the diagnosis of meningitis","correct":true},{"idx":2,"proposition":"The study of the contents of CSF by lumbar puncture, together with clinical examination, allows the diagnosis of meningoencephalitis","correct":true},{"idx":3,"proposition":"The majority of acute meningitis and meningoencephalitis are infectious by contamination of the CSF with an infectious agent","correct":true},{"idx":4,"proposition":"An increase in lactates is suggestive of a bacterial infection","correct":true,"justification":"Suggestive of bacteria: hyperproteinrachia, hypoglycorachia (relative to blood glucose), hyperlactatemia, nuclei elements > 1000 (with PNN) and cloudy CSF."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"meningite-neuro-6","context":null,"enonce":"Regarding the clinical examination:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"Brudzinski's sign corresponds to an involuntary flexion of the lower limbs following the anterior forced flexion of the neck","correct":true,"justification":"This is a sign that can accompany meningeal syndrome"},{"idx":1,"proposition":"Kernig's sign is an inability to sit without bending the knees and painful resistance to full extension of the lower limb when the thigh is flexed.","correct":true,"justification":"This is a sign that can accompany meningeal syndrome"},{"idx":2,"proposition":"In a patient with meningeal syndrome, live ROT may be found","correct":true},{"idx":3,"proposition":"In a patient with meningeal syndrome, hypoaesthesia of the lower limbs may be found","correct":false,"justification":"Rather, diffuse cutaneous hyperesthesia is found."},{"idx":4,"proposition":"The meningitic line of Trousseau corresponds to the fact that the drawing of a line on the skin with a foam tip reveals a line first white, which then reddens and disappears late","correct":true,"justification":"This is a sign that can accompany meningeal syndrome"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"meningite-neuro-7","context":null,"enonce":"These signs and symptoms, which are part of encephalitic syndrome, include:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"Disorders of consciousness","correct":true,"justification":"To varying degrees, from simple drowsiness to deep coma"},{"idx":1,"proposition":"Photo-phonophobia","correct":false,"justification":"Part of meningeal syndrome (inflammation of the meninges) and not encephalitic syndrome (inflammation of the brain)"},{"idx":2,"proposition":"Signs of focus","correct":true,"justification":"For example, motor deficit, cranial pair paralysis, aphasia, abnormal movements"},{"idx":3,"proposition":"Nausea and vomiting","correct":false,"justification":"Meningeal syndrome (inflammation of the meninges) and not encephalitic syndrome (inflammation of the brain) are part of."},{"idx":4,"proposition":"Status epilepticus","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"meningite-neuro-8","context":null,"enonce":"Regarding purpura fulminans:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"Purpura fulminans is defined by the presence of at least 1 necrotic or ecchymotic element greater than 3mm","correct":true},{"idx":1,"proposition":"The 2 germs most often involved in purpura fulminans are meningococcal and pneumococcus.","correct":true,"justification":"But more often meningococcal"},{"idx":2,"proposition":"CSF should always be collected before antibiotics are introduced in front of purpura fulminans","correct":false,"justification":"When managing purpura fulminans pre-hospital, antibiotics should be given before CSF is collected."},{"idx":3,"proposition":"It is necessary to administer 1g of C3G IV or IM","correct":false,"justification":"2g (doses are to be known for iNECs)"},{"idx":4,"proposition":"Meningococcal is a gram-positive diplococcus","correct":false,"justification":"Gram-negative diplococcus. The gram-positive diploma is a pneumococcus."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"meningite-neuro-9","context":null,"enonce":"Regarding meningeal syndrome:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"The 2 diagnoses to evoke are infectious meningitis and subarachnoid hemorrhage","correct":true},{"idx":1,"proposition":"This is the triad of meningeal stiffness + headache (with photophonophobia) + jet vomiting","correct":true},{"idx":2,"proposition":"Kernig's sign corresponds to an involuntary flexion of the hip and knee in response to a forced flexion of the neck","correct":false,"justification":"This is Brudzinski's sign"},{"idx":3,"proposition":"Brudzinski's sign corresponds to painful resistance to full knee extension when the hip is flexed","correct":false,"justification":"This is the Kerning sign"},{"idx":4,"proposition":"Meningeal stiffness is a contracture of the paravertebral muscles in response to pain","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"meningite-neuro-11","context":null,"enonce":"Are signs of severity during meningitis \/ meningoencephalitis:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"Glaswgow ≤ 13","correct":false},{"idx":1,"proposition":"Signs of focus","correct":true},{"idx":2,"proposition":"Hemodynamic instability","correct":true,"justification":"Evoking septic shock"},{"idx":3,"proposition":"Signs of brainstem suffering","correct":true},{"idx":4,"proposition":"Extensive purpura","correct":true,"justification":"Evoking purpura fulminans"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"meningite-neuro-12","context":null,"enonce":"Are the antibiotic (s) authorized before a purpura fulminans","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"Ceftriaxone","correct":true,"justification":"MI or IV"},{"idx":1,"proposition":"Amoxicillin","correct":true,"justification":"As a last resort"},{"idx":2,"proposition":"Fluoroquinolone","correct":false,"justification":"There are only 3 antibiotics allowed: ceftriaxone, cefotaxime and amoxicillin"},{"idx":3,"proposition":"Amoxicillin-clavulanic acid (Augmentin)","correct":false,"justification":"Amoxicillin"},{"idx":4,"proposition":"Cefotaxime","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"meningite-neuro-13","context":null,"enonce":"What are the situations where a lumbar puncture is not done before starting the treatment of meningitis?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"Purpura fulminans","correct":true,"justification":"On the other hand, in hospital it is necessary to do blood cultures before antibiotic treatment. In out-of-hospital blood cultures, blood cultures are not done."},{"idx":1,"proposition":"Signs of cerebral engagement","correct":true},{"idx":2,"proposition":"If the transfer to the hospital is less than 120 minutes","correct":false,"justification":"More than 90 minutes (120 minutes is for SCA ST+)"},{"idx":3,"proposition":"Taking antiplatelet agent","correct":false,"justification":"Anticoagulant only"},{"idx":4,"proposition":"Glasgow score ≤ 11","correct":false,"justification":"No longer a contraindication if isolated"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"meningite-neuro-14","context":null,"enonce":"Regarding the CSF of purulent meningitis","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"CRL is predominantly PNN","correct":true,"justification":"NN> 50% = purulent meningitis; lymphocytes > 50% = clear fluid meningitis"},{"idx":1,"proposition":"Glycorachia is > 2\/3 x blood glucose","correct":false,"justification":"This is glycorachia in normal CSF. In purulent meningitis, glycorachia is < 0.4 x blood glucose (very specific for a bacterial cause)"},{"idx":2,"proposition":"Proteinorachy is < 1 g \/ L","correct":false},{"idx":3,"proposition":"On direct examination, we will always find gram-positive cocci","correct":false,"justification":"There are two bacteria that are most often involved: meningococcal (gram-negative diplococcus) and pneumococcus (gram-positive diplococcus). These are encapsulated bacteria."},{"idx":4,"proposition":"Lactatopachia is > 3.2 mmol\/L","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"meningite-neuro-15","context":null,"enonce":"Etiologies causing glycorachia < 0.4 x blood glucose with clear fluid meningitis:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"Listeria","correct":true,"justification":"Gram-positive bacillus"},{"idx":1,"proposition":"Tuberculosis","correct":true},{"idx":2,"proposition":"Syphilis","correct":false,"justification":"Glycorachia > 2\/3 x blood glucose"},{"idx":3,"proposition":"Leptospirosis","correct":false,"justification":"Glycorachia > 2\/3 x blood glucose"},{"idx":4,"proposition":"Cryptocoque","correct":true,"justification":"The causes of glycorachia < 0.4 x blood glucose with clear fluid CSF are: listeria, tuberculosis, cryptococcus and carcinomatous meningitis"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"meningite-neuro-17","context":null,"enonce":"What germs give normoglycorachic lymphocytic meningitis?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"Listeria","correct":false,"justification":"Hypoglycorachic lymphocytic meningitis, hypoglycorachic purulent meningitis, or hypoglycorachic variegated meningitis"},{"idx":1,"proposition":"Tuberculosis","correct":false,"justification":"Hypoglycorachic lymphocytic meningitis"},{"idx":2,"proposition":"Spirochetes (lyme, syphilis and leptospirosis)","correct":true},{"idx":3,"proposition":"HPV","correct":true},{"idx":4,"proposition":"Malaria","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"meningite-neuro-18","context":null,"enonce":"Regarding pneumococcal mennigitis:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"It is the leading cause of purulent meningitis in all age groups.","correct":false,"justification":"Meningococcal disease is most often involved in 15- to 24-year-olds. Pneumococcus is most often involved in other age groups. Meningococcal is transferred by close relation and by saliva, I let you use your imagination;)"},{"idx":1,"proposition":"20% of pneumococci have a change in PLP target","correct":true,"justification":"They are therefore resistant to penicillins (amoxicillin). We therefore use C3G as a first line because we want to cover resistant germs in the face of a potentially very serious infection."},{"idx":2,"proposition":"Pneumococcal infection is promoted by a meningeal breach","correct":true,"justification":"Always look for a notion of head trauma during interrogation."},{"idx":3,"proposition":"Complement protein deficiency promotes pneumococcal purulent meningitis","correct":true,"justification":"In a subject with pneumococcal meningitis or sepsis, it is necessary to look for a complement protein deficiency"},{"idx":4,"proposition":"There is often a carriage of pneumococcus at the ENT level","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"meningite-neuro-19","context":null,"enonce":"Regarding the latency time of a meningococcal infection:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"7 days","correct":false},{"idx":1,"proposition":"14 days","correct":false},{"idx":2,"proposition":"28 days","correct":false},{"idx":3,"proposition":"10 days","correct":true,"justification":"It is for this reason that the definition of the contact case is anyone who has had a contact of < 1m for > 1h for the last 10 days. These contact cases should be treated with antibiotic prophylaxis and vaccination to eradicate meningococcal carriage."},{"idx":4,"proposition":"48h","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"meningite-infectio-0","context":null,"enonce":"Which of the following are situations where a brain scan must be performed before the lumbar puncture?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"proposition":"Hemiplegia","correct":true,"justification":"True, sign of localization"},{"idx":1,"proposition":"Glasgow = 12","correct":false,"justification":"Glasgow less than 12 (from Glasgow = 11)"},{"idx":2,"proposition":"Convulsive seizures (after 5 years)","correct":true},{"idx":3,"proposition":"Effective anticoagulation","correct":true},{"idx":4,"proposition":"Taking antiplatelet agents","correct":false,"justification":"Not a PL IC, and no need to scan"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"meningite-infectio-1","context":null,"enonce":"What is the main pathogen responsible for primary purulent meningitis in young immunocompetent adults?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"proposition":"Pneumococcus","correct":false,"justification":"None"},{"idx":1,"proposition":"Listeria monocytogenes","correct":false,"justification":"None"},{"idx":2,"proposition":"Herpes simplex virus 1","correct":false,"justification":"None"},{"idx":3,"proposition":"Herpes simplex virus 2","correct":false,"justification":"None"},{"idx":4,"proposition":" Meningococcus","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"meningite-infectio-2","context":null,"enonce":"Which of the following proposals are found in a normal CSL?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"proposition":"< 5 elements \/ mm3","correct":true},{"idx":1,"proposition":"Glycorachia < 2\/3 of venous blood glucose ","correct":false,"justification":"Glycorachia >2\/3 of venous blood glucose"},{"idx":2,"proposition":"Proteinorachy < 0.4 g\/L ","correct":true},{"idx":3,"proposition":"Lactatopachia < 3.2 mmol\/l ","correct":true},{"idx":4,"proposition":"A direct gram-negative staining examination","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"responsabilite-sp-2","context":null,"enonce":"Which of these responsibilities lead to a sanction of the doctor?","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"Criminal liability","correct":true,"justification":"3 types of responsibilities can lead to a sanction of the doctor: criminal, ordinal and disciplinary"},{"idx":1,"proposition":"Ordinal responsibility","correct":true},{"idx":2,"proposition":"Disciplinary responsibility","correct":true},{"idx":3,"proposition":"Civil liability","correct":false,"justification":"Leads to compensation to the patient but not to a sanction to the physician"},{"idx":4,"proposition":"Administrative responsibility","correct":false,"justification":"Leads to compensation for the patient but not to a sanction for the doctor.\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"responsabilite-sp-3","context":null,"enonce":"Which of these proposals are reprehensible from a criminal point of view?","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"Fake certificates","correct":true},{"idx":1,"proposition":"Euthanasia","correct":true},{"idx":2,"proposition":"Refusal to perform an abortion","correct":false,"justification":"The conscience clause makes it possible not to perform an abortion but obliges the practitioner to re-direct the patient to a colleague who will receive her within a reasonable time."},{"idx":3,"proposition":"Non-assistance to a person in danger","correct":true},{"idx":4,"proposition":"Breach of solicitor-client privilege","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"responsabilite-sp-4","context":null,"enonce":"Which of these proposals refer to an exemption from medical liability?","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"Paid leave","correct":false,"justification":"Whether the doctor is in clinical practice or not does not exempt medical liability in all cases (non-assistance to a person in danger for example)"},{"idx":1,"proposition":"Leave without pay","correct":false},{"idx":2,"proposition":"Cases of force majeure","correct":true,"justification":"See KB Public Health (page 144)"},{"idx":3,"proposition":"Alteration of the doctor's consciousness","correct":true},{"idx":4,"proposition":"Fatigue","correct":false,"justification":"Does not allow an exemption from medical liability\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"responsabilite-sp-5","context":null,"enonce":"Before which court is a contravention judged?","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"The Police Court","correct":true},{"idx":1,"proposition":"The Court of Justice","correct":false},{"idx":2,"proposition":"The Assize Court","correct":false,"justification":"Place where crimes are tried"},{"idx":3,"proposition":"The Criminal Court","correct":false,"justification":"Place where crimes are tried"},{"idx":4,"proposition":"The Administrative Tribunal","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"responsabilite-sp-6","context":null,"enonce":"In the event of a complaint, the Public Prosecutor's Office must prove:","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"The doctor's fault","correct":true},{"idx":1,"proposition":"Harm to the patient","correct":true},{"idx":2,"proposition":"The correlation between physician's fault and patient harm","correct":false,"justification":"It must be causality"},{"idx":3,"proposition":"The solvency of the doctor or hospital","correct":false,"justification":"Not the fact of the public prosecutor"},{"idx":4,"proposition":"The Public Prosecutor's Office is represented by the Public Prosecutor","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"responsabilite-sp-7","context":null,"enonce":"Regarding medical liability","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"Criminal law is the application of the rules contained in the Penal Code","correct":true,"justification":"1"},{"idx":1,"proposition":"Criminal liability is based on fault (not error)","correct":true,"justification":"1"},{"idx":2,"proposition":"The Penal Code defines 2 types of offences: misdemeanours and crimes","correct":false,"justification":"The Penal Code defines 3 types of offenses: Contraventions (rare in the medical field), Misdemeanors and Crimes"},{"idx":3,"proposition":"The dismissal is decided by the gendarme receiving the complaint","correct":false,"justification":"The Prosecutor decides on the Republic: If it is necessary to continue (If the case of investigations, request expert opinions ...) the prosecution, or if there is no need is not in a state to be judged, the investigating judge intervenes to expedite"},{"idx":4,"proposition":"If one of the 2 parties is not satisfied with the judgment, he can appeal the decision","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"responsabilite-sp-8","context":null,"enonce":"The limitation period for contraventions is:","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"1 year","correct":true,"justification":"Be careful, there has been a reform of the limitation periods. It is now: 1 year for misdemeanors, 6 years for misdemeanors, and 20 years for general crimes."},{"idx":1,"proposition":"3 years","correct":false,"justification":"for offences"},{"idx":2,"proposition":"5 years","correct":false},{"idx":3,"proposition":"10 years","correct":false},{"idx":4,"proposition":"20 years","correct":false,"justification":"For general crimes (30 years for serious crimes such as terrorism)"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"responsabilite-sp-9","context":null,"enonce":"The statute of limitations for misdemeanours is:","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"1 year","correct":false,"justification":"For contraventions"},{"idx":1,"proposition":"6 years","correct":true,"justification":"Be careful, there has been a reform of the limitation periods. It is now: 1 year for misdemeanors, 6 years for misdemeanors, and 20 years for general crimes."},{"idx":2,"proposition":"5 years","correct":false},{"idx":3,"proposition":"10 years","correct":false},{"idx":4,"proposition":"15 years","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"responsabilite-sp-10","context":null,"enonce":"The statute of limitations for general crimes is:","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"1 year","correct":false,"justification":"For contraventions"},{"idx":1,"proposition":"5 years","correct":false},{"idx":2,"proposition":"6 years","correct":false,"justification":"for offences"},{"idx":3,"proposition":"10 years","correct":false},{"idx":4,"proposition":"20 years","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"responsabilite-sp-11","context":null,"enonce":"Regarding medical liability","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"The Code of Medical Ethics provides for the rights and duties of physicians towards their patients but also towards their colleagues.","correct":true,"justification":"1"},{"idx":1,"proposition":"The Code of Ethics has no legal value","correct":false,"justification":"This code is itself inserted into the Public Health Code (Articles R. 4127-1 to R. 4127112)"},{"idx":2,"proposition":"Disciplinary misconduct occurs when the physician's conduct undermines the interests governing the profession","correct":true,"justification":"1"},{"idx":3,"proposition":"There is a list of sets of possible disciplinary offences","correct":false,"justification":"No list (as in the Penal Code) can therefore cover all disciplinary offences."},{"idx":4,"proposition":"Medical malpractice may be subject to both the ordinal jurisdiction and the ordinary courts","correct":true,"justification":"1"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"responsabilite-sp-12","context":null,"enonce":"Among these proposals, what are the penalties incurred during a disciplinary sanction decided by the Order of Physicians","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"Warning","correct":true},{"idx":1,"proposition":"Blame","correct":true},{"idx":2,"proposition":"Temporary disqualification","correct":true},{"idx":3,"proposition":"Permanent prohibition to practise in a given region","correct":false,"justification":"No sanction limited to one region"},{"idx":4,"proposition":"Public apology","correct":false,"justification":"This is not a possible sanction.\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"responsabilite-sp-13","context":null,"enonce":"Regarding the fundamentals of medical liability","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"The Civil Code governs the liability of doctors practising in private practice","correct":true,"justification":"1"},{"idx":1,"proposition":"Civil liability is demonstrated by the existence of a fault of the doctor and a prejudice for the patient","correct":false,"justification":"Civil liability is based on the existence of a fault of a damage of a causal link (or damage) between the 2, link that will have to be proven by the victim A distinction is made between:"},{"idx":2,"proposition":"Patient dissatisfaction often stems from a lack of communication with the doctor","correct":true,"justification":"1"},{"idx":3,"proposition":"The physician is no longer the one who makes decisions alone that he imposes on the patient","correct":true,"justification":"1"},{"idx":4,"proposition":"The distinction between major tort and contractual nature is important","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"ADP-hemato-0","context":null,"enonce":"Regarding superficial lymphadenopathy:","item":"ADP","matiere":"hemato","propositions":[{"idx":0,"proposition":"Lymphadenopathy is an enlargement of more than 1 cm of a lymph node (or node)","correct":true},{"idx":1,"proposition":"Infectious etiologies are the most common, followed by cancers and lymphomas","correct":true},{"idx":2,"proposition":"All lymph node areas should be examined to determine whether it is localized lymphadenopathy or polyadenopathy, as the diagnostic approach is different","correct":true,"justification":"TRUE. In the case of polyadenopathy, a blood count should be performed to look for acute leukemia, CLL or mononucleosis syndrome"},{"idx":3,"proposition":"Any lymphadenopathy whose diagnosis is not quickly specified justifies a cytopuncture, or even a biopsy or surgical excision for analysis","correct":true,"justification":"TRUE. Cytopuncture is the examination of choice in single lymphadenopathy. For poly-adenopathy, if the blood count is not sufficient, lymph node biopsy is preferred"},{"idx":4,"proposition":"Non-infectious lymphadenopathy is mainly represented by hematological malignancies (lymphomas, leukemias) and cancer metastases.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ADP-hemato-2","context":null,"enonce":"Additional examinations are indicated in case of:","item":"ADP","matiere":"hemato","propositions":[{"idx":0,"proposition":"Bulky lymphadenopathy > 1.5 cm","correct":false,"justification":"Lymphadenopathy is said to be voluminous if > 2 cm. Conf College of Infectiology"},{"idx":1,"proposition":"Lack of etiology at the end of the clinical examination","correct":true},{"idx":2,"proposition":"An alteration of the general condition","correct":true,"justification":"Refers to neoplasia"},{"idx":3,"proposition":"Very red lymphadenopathy","correct":false,"justification":"Inflammatory etiology ++"},{"idx":4,"proposition":"Soft lymphadenopathy","correct":false,"justification":"TRUE. It is a hard lymphadenopathy that will rather direct to cancer"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ADP-hemato-3","context":null,"enonce":"Which of the following proposals point to cancerous lymphadenopathy?","item":"ADP","matiere":"hemato","propositions":[{"idx":0,"proposition":"Size greater than 2cm in inguinal region ","correct":true,"justification":"True, but it doesn't have to be"},{"idx":1,"proposition":"Fixed","correct":true},{"idx":2,"proposition":"Flexible","correct":false,"justification":"Motionless"},{"idx":3,"proposition":"Fluctuating","correct":false,"justification":"Always present, and growing"},{"idx":4,"proposition":"Painless","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ADP-hemato-4","context":null,"enonce":"Which of the following are possible causes of inflammatory lymphadenopathy?","item":"ADP","matiere":"hemato","propositions":[{"idx":0,"proposition":"Cat scratch disease","correct":true},{"idx":1,"proposition":"Brucellosis","correct":true},{"idx":2,"proposition":"Rubella","correct":true},{"idx":3,"proposition":"Parvovirus B19","correct":true},{"idx":4,"proposition":"EBV","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbrefraction-ophtalmo-0","context":null,"enonce":"General:","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Light propagates in a straight line in space, but when it encounters a surface separating two transparent media of different index, its direction changes: this phenomenon of deflection is called refraction","correct":true},{"idx":1,"proposition":"Light rays pass through refractive surfaces and refractive media, the whole of which constitutes the dioptric apparatus of the eye.","correct":true},{"idx":2,"proposition":"The two most important refractive elements of the eye are the cornea (on average 42 diopters) and the lens (about 20 diopters)","correct":true},{"idx":3,"proposition":"The total convergence power of the eye is about 12 diopters","correct":false,"justification":"The eye is therefore a complex optical system composed of several diopters, whose total convergence power is about 60 diopters."},{"idx":4,"proposition":"In the optically normal or emmetropic eye, parallel rays focus on the retina, spontaneously giving a clear image.","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbrefraction-ophtalmo-1","context":null,"enonce":"General:","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"In hyperopia, the image of an object located at infinity is not formed on the retina and it is therefore seen blurred","correct":false,"justification":"Myopia"},{"idx":1,"proposition":"Myopia and hyperopia are so-called punctiform ametropia","correct":false,"justification":"Myopia and hyperopia are so-called spherical ametropia, the optical anomaly being the same regardless of the plane in which the light ray is located"},{"idx":2,"proposition":"The punctum remotum is defined by the closest point that the eye can see clearly without accommodating","correct":false,"justification":"The punctum remotum is defined by the farthest point that the eye can see clearly without accommodating (to infinity for the emmetropic eye)"},{"idx":3,"proposition":"The main ametropias are glaucoma and AMD","correct":false,"justification":"The main ametropias are myopia, hyperopia and astigmatism"},{"idx":4,"proposition":"In hyperopia, the image is formed virtually behind the retina","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbrefraction-ophtalmo-2","context":null,"enonce":"Regarding ametropia and visual acuity:","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Astigmatism is a disease of the elderly","correct":false,"justification":"Appears at the same time as other ametropia"},{"idx":1,"proposition":"In myopia, the refraction of the eye is not the same depending on the plane in which the incident rays are located.","correct":false,"justification":"Astigmatism"},{"idx":2,"proposition":"Visual acuity (VA) is the discriminating power of the eye","correct":true},{"idx":3,"proposition":"VA is one of the functional parameters (along with color vision and contrast vision) specific to the macula.","correct":true},{"idx":4,"proposition":"Distance VA is measured with the Menetrier scale","correct":false,"justification":"The VA from afar is measured with scales, the most used in France is that of Monoyer (1875), graduated in tenths"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbrefraction-ophtalmo-3","context":null,"enonce":"Regarding ametropia and presbyopia:","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The lens is suspended inside the globe by a set of fibers constituting an elastic ligament, the zonule.","correct":true},{"idx":1,"proposition":"When the zonule contracts, it increases the convergence power of the lens","correct":false,"justification":"When she relaxes"},{"idx":2,"proposition":"The amplitude of accommodation is defined by the difference in the dioptric power of the eye in distance and near vision","correct":true},{"idx":3,"proposition":"Symptoms of presbyopia usually begin to appear in patients after the age of 80","correct":false,"justification":"After the age of 40"},{"idx":4,"proposition":"Presbyopia is responsible for a decrease in visual acuity in distance vision such as hyperopia","correct":false,"justification":"Presbyopia is responsible for decreased visual acuity in near vision"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbrefraction-ophtalmo-4","context":null,"enonce":"Regarding refractive abnormalities:","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Presbyopia must be compensated by the addition of a correction consisting of convex spherical glasses","correct":true},{"idx":1,"proposition":"at age 60: frequent addition of 3 diopters","correct":true},{"idx":2,"proposition":"In a healthy and emmetropic subject, VA is spontaneously satisfactory","correct":true},{"idx":3,"proposition":"In a refractive anomaly, the VA can be improved by wearing an optical correction","correct":true},{"idx":4,"proposition":"The myopic eye is an eye too convergent","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"appendicite-urg-0","context":null,"enonce":"Regarding acute appendicitis","item":"appendicite","matiere":"urg","propositions":[{"idx":0,"proposition":"It is an inflammation of the ileocecal appendix of unpredictable course (inflammation, abscess, perforation)","correct":true},{"idx":1,"proposition":"There is no anatomo-clinical parallelism","correct":true},{"idx":2,"proposition":"In the face of abdominal pain, no clinical signs or symptoms (including fever or apyrexia) have sufficient individual diagnostic value to confirm or exclude a diagnosis of appendicitis (HAS, strong agreement)","correct":true},{"idx":3,"proposition":"Ultrasound is the preferred examination in children, young subjects, women of childbearing age","correct":true},{"idx":4,"proposition":"The non-visualization of the appendix on ultrasound does not exclude appendicitis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"appendicite-urg-1","context":null,"enonce":"Regarding acute appendicitis","item":"appendicite","matiere":"urg","propositions":[{"idx":0,"proposition":"As soon as complicated appendicitis is suspected, the CT scan then becomes the first-line examination.","correct":true},{"idx":1,"proposition":"The CT scan must be performed within 24 hours with clinical signs of severity or occurring on fragile ground","correct":false,"justification":"The examination must be carried out within 4 hours with clinical signs of severity or occurring on fragile ground, and within 24 hours for suspicions of uncomplicated appendicitis"},{"idx":2,"proposition":"The appendicular abscess is suspected before: a tusk that may extend to the right flank and hypogestrium, general signs marked with a fever above 38.5 ° C, and transit disorders suggestive of occlusion","correct":true},{"idx":3,"proposition":"The appendicular plastron is marked by persistent pain, fever and biological inflammatory syndrome.","correct":true},{"idx":4,"proposition":"Appendicitis can be immediately revealed in the form of peritonitis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"appendicite-urg-2","context":null,"enonce":"Regarding acute appendicitis","item":"appendicite","matiere":"urg","propositions":[{"idx":0,"proposition":"Intussusception of the infant should be discussed in case of abdominal pain with vomiting","correct":true},{"idx":1,"proposition":"In children, right base pneumonitis is a differential diagnosis that can be expressed by abdominal pain in a febrile context","correct":true},{"idx":2,"proposition":"In adults celiac disease should be evoked on recurrent abdominal pain, diarrhea and scannographic data","correct":false,"justification":"Crohn's disease should be discussed on recurrent abdominal pain, diarrhea and scannographic data"},{"idx":3,"proposition":"A right colonic tumor and other causes of febrile occlusion should be evoked in the elderly","correct":true},{"idx":4,"proposition":"Treatment of acute appendicitis is surgical","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"appendicite-urg-3","context":null,"enonce":"Regarding acute appendicitis","item":"appendicite","matiere":"urg","propositions":[{"idx":0,"proposition":"Treatment is based on appendectomy within 2 hours in case of uncomplicated acute appendicitis","correct":true},{"idx":1,"proposition":"The operating time includes an exploration of the peritoneal cavity and the realization of bacteriological samples","correct":true},{"idx":2,"proposition":"The surgical piece must be sent to pathology","correct":true},{"idx":3,"proposition":"In case of peritonitis or suspicion of gangrenous appendicitis, surgery is indicated urgently, combined with antibiotic therapy","correct":true},{"idx":4,"proposition":"Water-electrolyte rehydration in case of complication is necessary","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"appendicite-HGE-0","context":null,"enonce":"Regarding appendicitis:","item":"appendicite","matiere":"HGE","propositions":[{"idx":0,"proposition":"Its risk is the progression to perforation and peritonitis which is life-threatening.","correct":true},{"idx":1,"proposition":"Acute appendicitis is the most common surgical emergency in France","correct":true},{"idx":2,"proposition":"The majority of cases of acute appendicitis occur in women over 40 years of age","correct":false,"justification":"The majority of cases occur in adolescents and young adults between the 2nd and 3rd decade with a male predominance"},{"idx":3,"proposition":"The incidence of perforation is 70 to 80% in children and 30% in the elderly","correct":true},{"idx":4,"proposition":"The typical pain of appendicitis begins in the left iliac fossa","correct":false,"justification":"Starts right in the right iliac fossa (FID) and gradually increases in intensity over the first 24 hours"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"appendicite-HGE-1","context":null,"enonce":"Regarding acute appendicitis:","item":"appendicite","matiere":"HGE","propositions":[{"idx":0,"proposition":"Palpation regains pain caused or maximum IDF defense at the rovsing point","correct":false,"justification":"Maximum at Macburney point"},{"idx":1,"proposition":"The NFS shows polynuclear hyperleukocytosis (> 10,000\/mm3) (80% of cases)","correct":true},{"idx":2,"proposition":"A negative urine strip eliminates a urinary tract infection","correct":true},{"idx":3,"proposition":"β-HCG are dosed in women of childbearing potential to rule out the possibility of an ectopic pregnancy","correct":true},{"idx":4,"proposition":"Ultrasound is preferred as a first-line approach in women","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"appendicite-HGE-2","context":null,"enonce":"Regarding acute appendicitis:","item":"appendicite","matiere":"HGE","propositions":[{"idx":0,"proposition":"The abdominal CT scan has become the reference complementary examination for any abdominal emergency in case of diagnostic doubt, due to a positive predictive value close to 100%","correct":false,"justification":"The abdominal CT scan has become the reference complementary examination for any abdominal emergency in case of diagnostic doubt, due to a negative predictive value close to 100% – that is, the visualization of a normal appendix on the CT scan eliminates the diagnosis of appendicitis"},{"idx":1,"proposition":"CT scan is indicated as a first-line test in the elderly","correct":true},{"idx":2,"proposition":"On imaging, the diagnosis is based on an increase in size of the appendix and its wall, an infiltration of the fat of the mesoappendage and the possible presence of stercolith","correct":true},{"idx":3,"proposition":"In front of abdominal pain suggestive of appendicitis, the concomitant absence of a defense in the right iliac fossa, a leukocytosis greater than 10 × 10^9 cells \/ L and a CRP greater than 8 mg \/ L makes the diagnosis of acute appendicitis unlikely","correct":true},{"idx":4,"proposition":"In the face of abdominal pain suggestive of appendicitis, the combination of a defense in the right iliac fossa, leukocytosis greater than 10 × 109 cells \/ L and a CRP greater than 8 mg \/ L in young men makes the diagnosis of acute appendicitis very likely","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"appendicite-HGE-3","context":null,"enonce":"Regarding acute appendicitis: ","item":"appendicite","matiere":"HGE","propositions":[{"idx":0,"proposition":"In the face of abdominal pain, no biological parameter (leukocytes, PNN, CRP) has an individual diagnostic value high enough to confirm or exclude a diagnosis of appendicitis","correct":true},{"idx":1,"proposition":"In case of pelvic appendicitis the pains are localized to the left hypogastric region ","correct":false,"justification":"The pains, localized to the right hypogastric region, are in the foreground, most often associated with a febricle"},{"idx":2,"proposition":"In case of subhepatic appendicitis the symptoms are those of acute cholecystitis: pain of the right hypochondrium, fever and defense","correct":true},{"idx":3,"proposition":"The patient sometimes has an analgesic position in psoitis in case of subhepatic appendicitis","correct":true},{"idx":4,"proposition":"In case of meso celiac appendicitis the appendix is located in the middle of a digestive loop and its inflammation is at the origin of a more or less important reflex ileus in a febrile context","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"coqueluche-infectio-0","context":null,"enonce":"About whooping cough","item":"coqueluche","matiere":"infectio","propositions":[{"idx":0,"proposition":"Disease caused by Bordetella pertussis","correct":true},{"idx":1,"proposition":"In France, the reservoir of the disease is in adults and the elderly ","correct":true},{"idx":2,"proposition":"The reference identification technique is immunostaining","correct":false,"justification":"Reference identification technique: PCR"},{"idx":3,"proposition":"Fluoroquinolones are the basis of curative antibiotic therapy and antibiotic prophylaxis","correct":false,"justification":"Macrolides are the basis of curative antibiotic therapy and antibiotic prophylaxis"},{"idx":4,"proposition":"Bordetella pertussisest is a gram postive cocci","correct":false,"justification":"Bordetella pertussis = pertussis agent, gram-negative bacillus"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"coqueluche-infectio-1","context":null,"enonce":"About whooping cough","item":"coqueluche","matiere":"infectio","propositions":[{"idx":0,"proposition":"Transmission is strictly human-to-human, airborne.","correct":true},{"idx":1,"proposition":"The attack rate is high (75%) in case of close and repeated contact","correct":true},{"idx":2,"proposition":"Transmission is mainly intra-family and intra-community","correct":true},{"idx":3,"proposition":"Children are the reservoir of contamination in the world","correct":true},{"idx":4,"proposition":"Infant mortality remains low","correct":false,"justification":"Infant mortality is high (malnutrition, respiratory complications)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"coqueluche-infectio-2","context":null,"enonce":"About whooping cough","item":"coqueluche","matiere":"infectio","propositions":[{"idx":0,"proposition":"Maternal antibodies do not protect the infant from disease (apart from vaccination during pregnancy, not recommended in France)","correct":true},{"idx":1,"proposition":"Fever is relatively high","correct":false,"justification":"Fever is ABSENT"},{"idx":2,"proposition":"the adult form is atypical, readily attenuated by residual immunity","correct":true},{"idx":3,"proposition":"Main symptom is cough organized in paroxysmal fits with difficulty of inspiratory recovery or chronic spasmodic cough","correct":true},{"idx":4,"proposition":"There is hyperlymphocytosis at the NFS often > 10 G \/ L, suggestive, but inconstant","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"coqueluche-infectio-3","context":null,"enonce":"About whooping cough","item":"coqueluche","matiere":"infectio","propositions":[{"idx":0,"proposition":"There is no inflammatory syndrome","correct":true},{"idx":1,"proposition":"ƒƒ ACE inhibitors can cause prolonged coughing","correct":true},{"idx":2,"proposition":"While stereotyped 3-phase evolution is common in unvaccinated infants, it is not always identifiable in adults.","correct":true},{"idx":3,"proposition":"There is an Ineffectiveness of treatment on symptoms when prescribed in the fifths phase","correct":true},{"idx":4,"proposition":"The alternative if contraindication macrolides is cotrimoxazole for 14 days","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"arthrite-rhumato-0","context":null,"enonce":"Regarding effusions:","item":"arthrite","matiere":"rhumato","propositions":[{"idx":0,"proposition":"A joint effusion can be physiological","correct":false,"justification":"It is always the expression of intra-articular suffering"},{"idx":1,"proposition":"Physiological joint fluid has a nutritious function for cartilage","correct":true},{"idx":2,"proposition":"The diagnosis of joint effusion is always clinical","correct":false,"justification":"For the shoulder and hip, the diagnosis is mainly ultrasound or radiological"},{"idx":3,"proposition":"A patellar shock at the knee signs an effusion","correct":true},{"idx":4,"proposition":"MRI is the exam of choice to objectify an effusion in the deep joints","correct":false,"justification":"Rather ultrasound in this case of use. MRI does not provide additional information (except in the case of hemarthrosis)."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"arthrite-rhumato-1","context":null,"enonce":"Regarding the diagnosis of joint effusion","item":"arthrite","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Involvement of the proximal and distal interphalangeal joints and respect for metacarpophalangeal refers to rheumatoid arthritis","correct":false,"justification":"Towards digital osteoarthritis. There is respect for distal interphalangeal in rheumatoid arthritis"},{"idx":1,"proposition":"MRI can identify the etiology of effusion in most cases","correct":false,"justification":"No. Only if hemarthrosis"},{"idx":2,"proposition":"Arthritis with a digestive infection 2 weeks ago suggests septic arthritis","correct":false,"justification":"Reactive arthritis (absence of germs in the joint)"},{"idx":3,"proposition":"A hygroma is a special type of effusion","correct":false,"justification":"Hygroma = Bursitis. This is an attack of the periarticular structures"},{"idx":4,"proposition":"Viral arthritis is typically polyarticular","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"arthrite-rhumato-2","context":null,"enonce":"Which propositions are true?","item":"arthrite","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Bursitis may be punctured","correct":true,"justification":"However, a joint puncture is contraindicated in this case to avoid joint contamination."},{"idx":1,"proposition":"Hip pain should evoke a knee injury, by projection of pain. ","correct":false,"justification":"It's the opposite: a hip injury can be depressed by gonalgia"},{"idx":2,"proposition":"The diagnosis of rheumatoid arthritis can only be made after 6 weeks of evolution","correct":true},{"idx":3,"proposition":"During a joint puncture, biochemical analysis is systematic","correct":false,"justification":"Non-systematic"},{"idx":4,"proposition":"In fibromyalgia, the pain is brutal","correct":false,"justification":"Most often, they arrive gradually"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"convulsionsped-urg-0","context":null,"enonce":"Which of the following are true?","item":"convulsionsped","matiere":"urg","propositions":[{"idx":0,"proposition":"Non-febrile seizures require EEG 🧠 exploration within a week","correct":true},{"idx":1,"proposition":"Febrile seizures require a lumbar puncture if the age is less than 9 months 👶","correct":true},{"idx":2,"proposition":"The most common cause is epilepsy-absence","correct":false,"justification":"The most common cause is hyperthermic seizure"},{"idx":3,"proposition":"Simple seizures never recur","correct":false,"justification":"Simple seizures recur in 20 to 30% of cases"},{"idx":4,"proposition":"Cerebral thrombophlebitis are rare causes of seizures 🤕","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LA-onco-0","context":null,"enonce":"What is the annual incidence per 100,000 inhabitants of acute leukaemia?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"1","correct":false},{"idx":1,"proposition":"5","correct":true},{"idx":2,"proposition":"100","correct":false},{"idx":3,"proposition":"1 000","correct":false},{"idx":4,"proposition":"10 000","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"LA-onco-1","context":null,"enonce":"Which propositions are true? ","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"AML mainly affects children","correct":false,"justification":"Especially the elderly"},{"idx":1,"proposition":"ALL mainly affects the elderly","correct":false,"justification":"ALL mainly affects children"},{"idx":2,"proposition":"Leukemias are the most common cancers in children","correct":true,"justification":"With intracranial tumors"},{"idx":3,"proposition":"AMLs concern blasts (CS-M)","correct":true},{"idx":4,"proposition":"ALL involves lymphoid precursors (L-CS)","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LA-onco-2","context":null,"enonce":"Which of these proposals are etiological factors for leukemia?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"HTLV1","correct":true},{"idx":1,"proposition":"EBV","correct":true,"justification":"Especially in case of immunosuppression (in transplant recipients for example)"},{"idx":2,"proposition":"Down syndrome","correct":true},{"idx":3,"proposition":"Syndrome de Klinefelter","correct":false},{"idx":4,"proposition":"Syndrome de Li-Fraumeni","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LA-onco-4","context":null,"enonce":"Regarding the different forms of leukemia:","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Monoblastic AML is accompanied by frank hyperleukocytosis","correct":true},{"idx":1,"proposition":"Post-chemotherapy AML does not typically find karyotype abnormalities","correct":false,"justification":"We often find a complex karyotype"},{"idx":2,"proposition":"ALL with Philadelphia chromosome finds a translocation 11;14","correct":false,"justification":"There is a translocation 9;22 (BCR ABL). Translocation 11;14 is a factor in good prognosis for multiple myeloma"},{"idx":3,"proposition":"Burkitt's ALL may be accompanied by tumor lysis syndrome","correct":true},{"idx":4,"proposition":"Most acute leukemias are rapidly fatal without treatment","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LA-onco-5","context":null,"enonce":"Which of the following are causes of thrombocytosis?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Myeloproliferative syndrome","correct":true},{"idx":1,"proposition":"Cancers","correct":true},{"idx":2,"proposition":"Iron deficiency","correct":true},{"idx":3,"proposition":"Vitamin B12 overdose","correct":false,"justification":"Does not have this effect, it is not integrated by the marrow"},{"idx":4,"proposition":"Chronic alcoholism","correct":false,"justification":"Thrombocytopenia of central origin"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LA-onco-6","context":null,"enonce":"Which of the following are classic ways of revealing acute leukemia?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Spinal cord compression","correct":true},{"idx":1,"proposition":"Bone marrow failure","correct":true},{"idx":2,"proposition":"Mediastinal syndrome","correct":true},{"idx":3,"proposition":"Splenomegaly","correct":true},{"idx":4,"proposition":"Hepatomegaly","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LA-onco-7","context":null,"enonce":"Which of the following are factors in poor prognosis for AML?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Complex karyotype","correct":true},{"idx":1,"proposition":"Relapse","correct":true},{"idx":2,"proposition":"Pulmonary invasive aspergillosis","correct":true},{"idx":3,"proposition":"No compatible donor","correct":true},{"idx":4,"proposition":"Severe undernutrition","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LA-onco-8","context":null,"enonce":"Which of the following are causes of pancytopenia?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"B9 deficiency","correct":true},{"idx":1,"proposition":"B12 deficiency","correct":true},{"idx":2,"proposition":"Medullary invasion of clonal proliferation","correct":true},{"idx":3,"proposition":"Iron deficiency","correct":false,"justification":"False"},{"idx":4,"proposition":"Post-chemotherapy aplasia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LA-onco-9","context":null,"enonce":"Regarding promyelocytic myeloid leukemia (AML 3), which propositions are true?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Is often associated with DICD","correct":true},{"idx":1,"proposition":"A t(9;22) translocation is often found at the karyotype","correct":false,"justification":"t(15;17)\r\nThe translocation t(9;22) corresponds to the Philadelphia chromosome found in 2 pathologies: ALL with Philadelphia chromosome and CML with Philadelphia chromosome"},{"idx":2,"proposition":"Its treatment is based on ATRA (all-trans retinoid acid)","correct":true,"justification":"True, 5-year relapse-free survival of 80%"},{"idx":3,"proposition":"Gingival hypertrophy is often found","correct":false,"justification":"False. It is in monoblastic myeloid leukemia (AML5)"},{"idx":4,"proposition":"Pancytopenia is often found on a blood count","correct":true,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LA-onco-11","context":null,"enonce":"Regarding monoblastic leukemia (AML5). Which of the following are true?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Is often associated with DICD","correct":false,"justification":"False. DICD is often associated with promyelocyte leukemia (AML3)"},{"idx":1,"proposition":"Leukemides can be found","correct":true,"justification":"True. Leukemides are a cutaneous localization of blasts."},{"idx":2,"proposition":"There is often a meningeal involvement which justifies prophylaxis. ","correct":true},{"idx":3,"proposition":"It often includes leukostasis syndrome, which can cause acute respiratory distress, impaired consciousness and epilepsy through damage to the pulmonary and cerebral capillaries.","correct":true,"justification":"Leukostasis syndrome is common in monoblastic leukemia. It appears when there is hyperleucytosis > 100 G \/ L"},{"idx":4,"proposition":"There can be gingival hypertrophy","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LA-onco-12","context":null,"enonce":"Which of the following are tests to clarify the diagnosis of acute leukemia?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Immunophenotyping of blasts","correct":true,"justification":"True, performed on spinal cord puncture but can also be performed on circulating blasts"},{"idx":1,"proposition":"Myelogram","correct":true,"justification":"True, indispensable: allows to affirm leukemia and to type it"},{"idx":2,"proposition":"Molecular biology analysis of bone marrow cells","correct":true},{"idx":3,"proposition":"Cytogenetics","correct":true},{"idx":4,"proposition":"Measurement of Ki67 cellular activity","correct":false,"justification":"Not for leukemias"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LA-onco-13","context":null,"enonce":"Which additional examination(s) are systematically part of the assessment of complications of acute leukaemia?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Systematic lumbar puncture","correct":false,"justification":"False. PL is systematic even in the absence of signs of call of meningeal invasion only in case of ALL, monoblastic LA and hyperleukocyte LA (hematic college 3rd edition)"},{"idx":1,"proposition":"Fibrinogen","correct":true,"justification":"True. Necessary for the review of the DIC."},{"idx":2,"proposition":"LDH determination","correct":true,"justification":"True. To look for tumor lysis syndrome. The amount of LDH is proportional to lysis syndrome."},{"idx":3,"proposition":"Complete liver test","correct":true,"justification":"True. It is necessary to look for a secondary localization of blasts."},{"idx":4,"proposition":"Bone marrow biopsy","correct":false,"justification":"False. It is useless unless spinal aspiration is impossible or unless there is a suspicion of associated myelofibrosis."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LA-onco-14","context":null,"enonce":"A myelogram would show what abnormalities in acute myeloid leukemia?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Auer's bodies","correct":true,"justification":"True. These are small red sticks that are specific to AML"},{"idx":1,"proposition":"Presence of 15% blasts","correct":false,"justification":"False. By definition, acute leukemia present ≥ 20% of bone marrow blasts"},{"idx":2,"proposition":"Positive myeloperoxidase enzyme activity","correct":true},{"idx":3,"proposition":"Small and medium-sized blasts","correct":false,"justification":"Small and medium-sized blasts are suggestive of ALL"},{"idx":4,"proposition":"Granulations","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LA-onco-16","context":null,"enonce":"Which of the following proposals, which, independently of others, can the diagnosis of acute leukaemia be affirmed?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Immunophenotyping of circulating lymphocytes","correct":false,"justification":"Evocative but not affirmative"},{"idx":1,"proposition":"Myelogram with cytological examination","correct":true,"justification":"True, it is the only examination that can confirm the diagnosis"},{"idx":2,"proposition":"Complete blood count","correct":false,"justification":"May be sufficient in CLL"},{"idx":3,"proposition":"Karyotype on blood","correct":false,"justification":"False"},{"idx":4,"proposition":"Puncture of lymphadenopathy","correct":false,"justification":"May help in lymphoma"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbpaupieres-ophtalmo-0","context":null,"enonce":"Regarding the basics of anatomy:","item":"tbpaupieres","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The eyelids, upper and lower, have the essential role of protecting the eyeball","correct":true},{"idx":1,"proposition":"They are composed of an anterior plane and a posterior plane","correct":true},{"idx":2,"proposition":"The anterior plane is purely cutaneous","correct":false,"justification":"anterior cutaneous plane"},{"idx":3,"proposition":"The posterior plane is tarsoconjunctival","correct":true},{"idx":4,"proposition":"The conjunctiva is reflected at the conjunctival cul-de-sac and then lines the eyeball (bulbar conjunctiva)","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbpaupieres-ophtalmo-1","context":null,"enonce":"Regarding anatomy and physiology:","item":"tbpaupieres","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The eyelids contain Durkeim's glands that secrete lipids used in tears.","correct":false,"justification":"Meibomian glands"},{"idx":1,"proposition":"Tears are eliminated either by evaporation or by drainage to the nose through the excretory tear ducts.","correct":true},{"idx":2,"proposition":"The two tear points, lower and upper, are visible on the free edges in the vicinity of the inner canthus","correct":true},{"idx":3,"proposition":"Insufficient secretion does not lead to any particular symptom","correct":false,"justification":"Insufficient secretion can lead to dry ocular syndrome"},{"idx":4,"proposition":"The palpebral closure is provided by the orbicular muscle of the eyelids innervated by the trigeminal","correct":false,"justification":"The palpebral closure is provided by the orbicular muscle of the eyelids innervated by the VII (facial nerve)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbpaupieres-ophtalmo-2","context":null,"enonce":"Regarding anatomy and stye:","item":"tbpaupieres","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The opening of the eyelids is related to the levator muscle of the upper eyelid, innervated by the III (common ocular motor)","correct":true},{"idx":1,"proposition":"The stye is a boil of the free edge of the eyelid centered on a pilosebaceous follicle of the eyelash","correct":true},{"idx":2,"proposition":"The stye corresponds to a parasitic infection","correct":false,"justification":"It corresponds to a bacterial infection, most often Staphylococcus aureus, of the pilosebaceous follicle"},{"idx":3,"proposition":"The stye is painless almost systematically","correct":false,"justification":"It develops within a few days and can lead to sharp pain."},{"idx":4,"proposition":"Treatment of stye is purely symptomatic pending spontaneous healing","correct":false,"justification":"Treatment consists of eye drops or antibiotic ointment for 8 days"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbpaupieres-ophtalmo-3","context":null,"enonce":"About Chalazion","item":"tbpaupieres","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Chalazion is an inflammatory granuloma developed on a meibomian gland","correct":true},{"idx":1,"proposition":"Chalazon is a bacterial infection, most commonly due to Staphylococcus aureus","correct":false,"justification":"Most of the time, there is no infection and the secretions contained in the chalazion are purely sebaceous"},{"idx":2,"proposition":"Chalazon presents clinically as a painful swelling of the eyelid most often","correct":true},{"idx":3,"proposition":"Chalazon heals in 3 to 5 days of antibiotic therapy","correct":false,"justification":"It can evolve over a longer period than stye, up to several weeks"},{"idx":4,"proposition":"First-line treatment is the application of local corticosteroid ointment combined with eyelid care","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbpaupieres-ophtalmo-4","context":null,"enonce":"Concerning entropion and chalazion:","item":"tbpaupieres","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"In Chalazion, if corticosteroids are not effective, antibiotics are prescribed","correct":false,"justification":"If this treatment is not effective and if the chalazion progresses to the encystement, it is sometimes necessary to make an incision of the meibomian gland under local anesthesia."},{"idx":1,"proposition":"Incising the Meibomian gland then allows, with a scalpel, to incise the chalazion to express the sebum","correct":true},{"idx":2,"proposition":"In case of surgery, the gland is left without suture and antiseptic eye drops are prescribed for 8 days","correct":true},{"idx":3,"proposition":"Surgery is contraindicated in case of anti-thrombotic treatment","correct":false,"justification":"No big ships at all. The most common complication is low bleeding that usually breaks away within minutes by simple compression."},{"idx":4,"proposition":"Entropion is the tilting of the eyelid towards the conjunctiva","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbpaupieres-ophtalmo-5","context":null,"enonce":"Regarding entropion and ptosis:","item":"tbpaupieres","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Entropion can lead to a chronic red and painful eye","correct":true},{"idx":1,"proposition":"Senile entropion is the tilting from the lower eyelid to the eyeball, resulting in friction of the eyelashes on the conjunctiva and cornea.","correct":true},{"idx":2,"proposition":"Senile ectropion is linked to sagging skin tissue","correct":true},{"idx":3,"proposition":"Watery eyes eliminate diagnosis of ectropion","correct":false,"justification":"It can lead to corneal exposure and tearing by rocking of the lower tear point which then no longer collects tears, and consequently a red and chronic painful eye"},{"idx":4,"proposition":"Ptosis is an involuntary, unexplained and permanent miosis","correct":false,"justification":"The ptosis is defined by a too low position of the free edge of the upper eyelid, the ptosis can be:"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"purpura-hemato-0","context":null,"enonce":"Regarding child and adult purpura","item":"purpura","matiere":"hemato","propositions":[{"idx":0,"proposition":"Purpura is an elementary lesion of the skin or mucous membrane by extravasation of blood into the dermis or chorion.","correct":true},{"idx":1,"proposition":"Purpura is a flat or infiltrated lesion that does not fade with vitropression","correct":true},{"idx":2,"proposition":"The three semiological forms of a purpura: petechiae, ecchymosis, vibicies","correct":true},{"idx":3,"proposition":"Purpura disappears spontaneously without sequelae","correct":true},{"idx":4,"proposition":"It is difficult to distinguish it from telangectasias not both fading to vitropression","correct":false,"justification":"with possible • Elementary lesions possibly associated • Macules, papules, more rarely nodules"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"purpura-hemato-1","context":null,"enonce":"About purpura fulminans","item":"purpura","matiere":"hemato","propositions":[{"idx":0,"proposition":"Purpura should always suggest invasive meningococcal infection","correct":true},{"idx":1,"proposition":"Hospitalization is urgently provided if extensive and\/or necrotic purpura","correct":true},{"idx":2,"proposition":"Meningococcal is the most frequently involved germ","correct":true},{"idx":3,"proposition":"There is a systemic picture in the foreground with sepsis severe beremic ± septic shock ± disorders of consciousness","correct":true},{"idx":4,"proposition":"In children the picture is crude, petechiae of rapid onset, deceptive infectious syndrome with little fever, sometimes drome hypothermia)","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"purpura-hemato-2","context":null,"enonce":"About purpura","item":"purpura","matiere":"hemato","propositions":[{"idx":0,"proposition":"In case of a platelet count > 100,000\/mm3 thrombocytopenia is not attributable in purpura, it is necessary to look for another cause (thrombosis, vasculitis)","correct":true},{"idx":1,"proposition":"Purpura fulminans requires immediate antiobiotic treatment and urgent management in an intensive care unit","correct":true},{"idx":2,"proposition":"A platelet count must be done in front of all purpura to rule out thrombotic origin","correct":true},{"idx":3,"proposition":"A platelet count below 40000\/mm3 indicates the imputability of thrombocytopenia in purpura","correct":false,"justification":"30000\/mm3"},{"idx":4,"proposition":"In case of major thrombocytopenia or DIC, the prognosis is determined by the risk of visceral haemorrhage, especially meningeal hemorrhage","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"purpura-infectio-0","context":null,"enonce":"About purpura","item":"purpura","matiere":"infectio","propositions":[{"idx":0,"proposition":"There are two main types of purpura: thrombocytopenic purpura and vascular purpura","correct":true},{"idx":1,"proposition":"Thrombocytopenic purpura is petechial (lesions < 3 mm) and\/or ecchymotic, not infiltrated","correct":true},{"idx":2,"proposition":"Vascular purpura is petechial, infiltrated, sometimes necrotic or ecchymotic","correct":true},{"idx":3,"proposition":"Any febrile purpura justifies emergency hospitalization and the implementation of additional precautions Droplets until the elimination of a (meningococcus)","correct":true},{"idx":4,"proposition":"The presence of at least one ecchymotic element ≥ 3 cm and \/ or necrotic evokes purpura fulminans and justifies the pre-hospital administration in extreme urgency of a first injection of injectable 3rd generation cephalosporin","correct":false,"justification":"The presence of contagiousness minus an ecchymotic element ≥ 3 mm"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"purpura-infectio-1","context":null,"enonce":"About purpura","item":"purpura","matiere":"infectio","propositions":[{"idx":0,"proposition":"Any purpura associated with fever requires hospitalization","correct":true},{"idx":1,"proposition":"Purpura fulminans requires pre-hospital therapeutic management (antibiotic therapy) in extreme urgency","correct":true},{"idx":2,"proposition":"Any extensive thrombocytopenic purpura indicates a bleeding risk","correct":true},{"idx":3,"proposition":"Purpura is an extravasation of red blood cells in the superficial dermis entering tahes that do not fade with vitropression.","correct":true},{"idx":4,"proposition":"The presence of at least one ecchymotic element ≥ 3 mm and\/or necrotic is a sign of severity","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"purpura-infectio-2","context":null,"enonce":"About purpura","item":"purpura","matiere":"infectio","propositions":[{"idx":0,"proposition":"Purpura in adults and children is of central origin rarely, or of peripheral origin most often","correct":true},{"idx":1,"proposition":"There are 3 mechanisms of peripheral thrombocytopenia on a pathophysiological level: destruction (most frequent), consumption (DIC), sequestration (hypersplenism)","correct":true},{"idx":2,"proposition":"Hepatitis B and C cause vascular purpura","correct":true},{"idx":3,"proposition":"EBV, CMV viruses cause thrombocytopenic purpura","correct":false},{"idx":4,"proposition":"Hematopoietic tuberculosis causes thrombocytopenic cental purpura","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SMD-onco-0","context":null,"enonce":"Regarding myelodysplastic syndrome, which propositions are true?","item":"SMD","matiere":"onco","propositions":[{"idx":0,"proposition":"This is a clonal hematological disease","correct":true},{"idx":1,"proposition":"It becomes common after age 60","correct":true},{"idx":2,"proposition":"It is idiopathic in about 5% of cases","correct":false,"justification":"It is most often idiopathic, in about 85% of cases"},{"idx":3,"proposition":"Clonal involvement involves peripheral hematopoietic stem cells","correct":false,"justification":"Hematopoietic stem cells are medullary"},{"idx":4,"proposition":"We talk about spinal cord abortion","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"SMD-onco-1","context":null,"enonce":"Which of these proposals are possible causes of myelodysplastic syndrome?","item":"SMD","matiere":"onco","propositions":[{"idx":0,"proposition":"Fanconi anemia","correct":true},{"idx":1,"proposition":"Hypothyroidism","correct":false,"justification":"Not on the college list"},{"idx":2,"proposition":"Chemotherapy","correct":true},{"idx":3,"proposition":"Benzene poisoning","correct":true},{"idx":4,"proposition":"There are no genetic causes","correct":false,"justification":"There are many genetic causes: trisomy 21, Fanconi anemia, Kostmann's neutropenia, neurofibromatosis."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SMD-onco-2","context":null,"enonce":"Which of these genetic diseases can cause myelodysplastic syndrome?","item":"SMD","matiere":"onco","propositions":[{"idx":0,"proposition":"Fragile X syndrome","correct":false},{"idx":1,"proposition":"Le syndrome de Lyell","correct":false,"justification":"Is not a genetic disease and does not cause myelodysplastic syndrome. It is a bullous dermatosis of drug etiology, characterized by acute necrosis of the epidermis over the entire height of the mucous body."},{"idx":2,"proposition":"Neurofibromatosis","correct":true},{"idx":3,"proposition":"Trisomy 18","correct":false},{"idx":4,"proposition":"Kostmann's neutropenia","correct":true,"justification":"The genetic causes listed in the college are: trisomy 21, Fanconi anemia, Kostmann's neutropenia, neurofibromatosis."}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"SMD-onco-3","context":null,"enonce":"Regarding additional examinations in the context of myelodysplastic syndrome, which proposals are true?","item":"SMD","matiere":"onco","propositions":[{"idx":0,"proposition":"The blood count shows anemia in most cases","correct":true,"justification":"The blood count may also show thrombocytopenia and leukopenia predominant on the PNN"},{"idx":1,"proposition":"In case of monocytosis > 0.5g \/ L, we speak of CMML (Chronic Myelomonocytic Leukemia)","correct":false,"justification":"We talk about CMML during monocytosis > 1g \/ L"},{"idx":2,"proposition":"Myelogram shows poor marrow in 90% of cases","correct":false,"justification":"In about 80% of cases, the marrow is rich or normal, which raises suspicions of spinal cord abortion."},{"idx":3,"proposition":"Anemia is aregenerative","correct":true},{"idx":4,"proposition":"Anemia is microcytic","correct":false,"justification":"Anemia is macrocytic most often. It can be normocytic."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SMD-onco-4","context":null,"enonce":"Which of these proposals are recognized treatments in case of low risk?","item":"SMD","matiere":"onco","propositions":[{"idx":0,"proposition":"Hypomethylating agents","correct":false,"justification":"It is the first-line treatment in case of high risk"},{"idx":1,"proposition":"Chemotherapy","correct":false,"justification":"Chemotherapy concerns high risks"},{"idx":2,"proposition":"Therapeutic abstention","correct":false,"justification":"The risk of transition to acute myeloid leukemia is 30% and the impact of anemia can be significant."},{"idx":3,"proposition":"EPO","correct":true},{"idx":4,"proposition":"Lenalidomide","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"SMD-onco-5","context":null,"enonce":"Which of the following are true for secondary acute leukemias?","item":"SMD","matiere":"onco","propositions":[{"idx":0,"proposition":"Prognosis is favourable","correct":false,"justification":"Unfavourable"},{"idx":1,"proposition":"The prognosis is unfavourable","correct":true},{"idx":2,"proposition":"The prognosis is unchanged from that of the myelodysplasia that precedes it","correct":false,"justification":"More unfavorable"},{"idx":3,"proposition":"Allogeneic hematopoietic stem cell transplantation is a curative treatment","correct":true},{"idx":4,"proposition":"Lack of remission after induction is a poor prognosis criterion","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SMD-onco-6","context":null,"enonce":"Which of the following proposals promote the onset of myelodysplastic syndrome?","item":"SMD","matiere":"onco","propositions":[{"idx":0,"proposition":"Type 2 diabetes","correct":false,"justification":"The FDRs are: previous chemotherapy, previous radiotherapy, toxic intake, acquired hematopathy, genetic causes (trisomy 21 or Fanconi anemia for example)"},{"idx":1,"proposition":"Thiazide diuretics","correct":false,"justification":"False"},{"idx":2,"proposition":"Solid cancer (untreated)","correct":false,"justification":"False"},{"idx":3,"proposition":"Chemotherapy","correct":true},{"idx":4,"proposition":"Radiotherapy","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcphysiopath-onco-0","context":null,"enonce":"Which of these proposals are part of the three stages of carcinogenesis?","item":"Kcphysiopath","matiere":"onco","propositions":[{"idx":0,"proposition":"Promotion","correct":true,"justification":"Step 2"},{"idx":1,"proposition":"Initiation","correct":true,"justification":"Step 1"},{"idx":2,"proposition":"Development","correct":false,"justification":"Step 3 is progression"},{"idx":3,"proposition":"Progression","correct":true,"justification":"Step 3"},{"idx":4,"proposition":"The beginning","correct":false,"justification":"Step 1 is initiation"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Kcphysiopath-onco-2","context":null,"enonce":"Which cancers predispose to BRCA1 or BRCA2 mutations?","item":"Kcphysiopath","matiere":"onco","propositions":[{"idx":0,"proposition":"Prostate cancer","correct":true,"justification":"For BRCA2"},{"idx":1,"proposition":"Breast cancer","correct":true,"justification":"For BRCA1\/2"},{"idx":2,"proposition":"Endometrial cancer","correct":false},{"idx":3,"proposition":"Ovarian cancer ","correct":true,"justification":"For BRCA1\/2"},{"idx":4,"proposition":"Colon cancer","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"Kcphysiopath-onco-3","context":null,"enonce":"Concerning occupational cancers:","item":"Kcphysiopath","matiere":"onco","propositions":[{"idx":0,"proposition":"Their number is overestimated","correct":false,"justification":"It is assumed to be vastly underestimated"},{"idx":1,"proposition":"4 to 8.5% of cancers are of occupational origin","correct":true},{"idx":2,"proposition":"Women are more affected than men","correct":false,"justification":"Men are more affected than women"},{"idx":3,"proposition":"The majority of occupational cancers compensated in France are linked to previous exposure to asbestos","correct":true},{"idx":4,"proposition":"Secondary prevention is to be prioritized","correct":false,"justification":"Primary prevention"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcphysiopath-onco-4","context":null,"enonce":"Concerning occupational cancers:","item":"Kcphysiopath","matiere":"onco","propositions":[{"idx":0,"proposition":"Mesothelioma is the most represented cancer","correct":true},{"idx":1,"proposition":"Occupational exposures to carcinogens are more common in women","correct":false,"justification":"More common in men"},{"idx":2,"proposition":"All occupational cancers are recognized as such","correct":false,"justification":"They are vastly underestimated"},{"idx":3,"proposition":"Exposure to wood dust should be accompanied by an ENT examination and naso-fibroscopy regularly","correct":true},{"idx":4,"proposition":"Prevention and follow-up stops at retirement","correct":false,"justification":"Post-occupational supervision must be provided by the doctor chosen by the insured person"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Kcphysiopath-onco-5","context":null,"enonce":"Which of these proposals are proto-oncogenes?","item":"Kcphysiopath","matiere":"onco","propositions":[{"idx":0,"proposition":"RAS","correct":true},{"idx":1,"proposition":"BRCA1","correct":false,"justification":"It is an anti-oncogene"},{"idx":2,"proposition":"p53","correct":false,"justification":"It is an anti-oncogene"},{"idx":3,"proposition":"BRAF","correct":true},{"idx":4,"proposition":"TGF-alpha","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"Kcphysiopath-onco-6","context":null,"enonce":"Which of these proposals are anti-oncogenes?","item":"Kcphysiopath","matiere":"onco","propositions":[{"idx":0,"proposition":"ERB","correct":false,"justification":"It is a proto-oncogene"},{"idx":1,"proposition":"HER2","correct":false,"justification":"It is a proto-oncogene"},{"idx":2,"proposition":"p21","correct":true},{"idx":3,"proposition":"BRCA2","correct":true},{"idx":4,"proposition":"NF1","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"DgKc-onco-1","context":null,"enonce":"Regarding excision surgery:","item":"DgKc","matiere":"onco","propositions":[{"idx":0,"proposition":"R0 means that the quality of resection is not determined ","correct":false,"justification":"R0 status refers to a resection with healthy margins"},{"idx":1,"proposition":"Surgery is a marginal therapy compared to chemotherapy","correct":false,"justification":"Surgery is still the first-line management in most non-metastatic cancers (breast, lung, liver, colon, skin, etc.)"},{"idx":2,"proposition":"Surgery is done by the oncologist","correct":false,"justification":"Oncology is a medical specialty. The surgery is done by the surgeon of the organ concerned"},{"idx":3,"proposition":"There are 3 R statuses: R1, R2 and R3","correct":false,"justification":"R0, R1 and R2"},{"idx":4,"proposition":"R2 status refers to resections in which margins are macroscopically invaded. ","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"DgKc-onco-2","context":null,"enonce":"Regarding TNMs:","item":"DgKc","matiere":"onco","propositions":[{"idx":0,"proposition":"pTNM is measured post-chemotherapy ","correct":false,"justification":"p means that it is an anatomopathological observation"},{"idx":1,"proposition":"The usTNM is measured with MRI ","correct":false,"justification":"Thanks to ultrasound, as the name suggests."},{"idx":2,"proposition":"TNM is a prognostic grade","correct":true},{"idx":3,"proposition":"Almost all types of cancer have a TNM grade","correct":true},{"idx":4,"proposition":"TNM cannot, without definition, be measured after neoadjuvant chemotherapy ","correct":false,"justification":"Yes, it's the yTNM"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"DgKc-onco-3","context":null,"enonce":"Regarding TNM:","item":"DgKc","matiere":"onco","propositions":[{"idx":0,"proposition":"The cTNM classification is clinical or radiological","correct":true},{"idx":1,"proposition":"The pTNM classification is anatomo-pathological.","correct":true},{"idx":2,"proposition":"The most reliable classification is the usTNM","correct":false,"justification":"This is pTNM. Histological evidence is often the most accurate"},{"idx":3,"proposition":"The N goes from N0 to N4 inclusive","correct":false,"justification":"4 possibility: N0, N1, N2 or N3"},{"idx":4,"proposition":"The M is binary: M0 or M1","correct":true,"justification":"M0: no distant metastasis. M1: distant metastasis(s)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"DgKc-onco-4","context":null,"enonce":"Which of these proposals corresponds to a WHO 2 stage?","item":"DgKc","matiere":"onco","propositions":[{"idx":0,"proposition":"A person bedridden less than half of his time","correct":true},{"idx":1,"proposition":"A person who is autonomous but cannot work","correct":true},{"idx":2,"proposition":"A person who is permanently bedridden or in a chair","correct":false,"justification":"This is stage 4. It is then totally dependent"},{"idx":3,"proposition":"It is capable of activity comparable to that before the disease","correct":false,"justification":"This is the stadium at"},{"idx":4,"proposition":"She is able to carry out a job","correct":false,"justification":"This is stage 1"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemorragiedig-HGE-0","context":null,"enonce":"Regarding digestive bleeding:","item":"hemorragiedig","matiere":"HGE","propositions":[{"idx":0,"proposition":"Before age 80, upper gastrointestinal bleeding is more common in men","correct":true},{"idx":1,"proposition":"Lower bleeding accounts for 40% of gastrointestinal bleeding","correct":false,"justification":"Lower bleeding accounts for 20% of gastrointestinal bleeding"},{"idx":2,"proposition":"Lower gastrointestinal bleeding is more common in women","correct":false,"justification":"They are more common in men"},{"idx":3,"proposition":"The most common cause of upper gastrointestinal bleeding is peptic ulcer disease.","correct":true},{"idx":4,"proposition":"Lower gastrointestinal bleeding is of hail origin in more than 80% of cases ","correct":false,"justification":"Lower gastrointestinal hemorrhages are most often of colo-rectal or origin"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"hemorragiedig-HGE-1","context":null,"enonce":"Regarding digestive bleeding: ","item":"hemorragiedig","matiere":"HGE","propositions":[{"idx":0,"proposition":"The risk of ulcerative complications is multiplied by 3 to 4 in patients on NSAIDs and that of fatal ulcer complications by a factor of 7 to 8","correct":true},{"idx":1,"proposition":"Gastrointestinal bleeding-related deaths increase in patients treated with NSAIDs","correct":true},{"idx":2,"proposition":"Some risk factors further increase the risk of bleeding complications with NSAIDs such as age > to 65 years, excessive alcohol consumption","correct":true},{"idx":3,"proposition":"Compared to non-selective NSAIDs, anti-COX-2 drugs reduce the risk of serious gastrointestinal events (bleeding, perforations, strictures) by 50%.","correct":true},{"idx":4,"proposition":"The risk of digestive toxicity of aspirin is dose-independent","correct":false,"justification":"The risk of digestive toxicity of aspirin increases with dose"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemorragiedig-HGE-2","context":null,"enonce":"Regarding digestive bleeding:","item":"hemorragiedig","matiere":"HGE","propositions":[{"idx":0,"proposition":"Aspirin has high-dose antiplatelet effects","correct":false,"justification":"Aspirin has low-dose antiplatelet effects"},{"idx":1,"proposition":"There would be in patients treated with serotonergics a blockade of the reuptake of serotonin by platelets inducing a disorder of primary hemostasis","correct":true},{"idx":2,"proposition":"Helicobacter pylori infection is an independent risk factor for ulcerative upper gastrointestinal bleeding","correct":true},{"idx":3,"proposition":"Mortality from upper gastrointestinal bleeding is 1-3%","correct":false,"justification":"Mortality from upper gastrointestinal bleeding is 3-10%"},{"idx":4,"proposition":"Haemorrhage-related mortality is constantly increasing","correct":false,"justification":"It goes down"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemorragiedig-HGE-3","context":null,"enonce":"Regarding digestive bleeding:","item":"hemorragiedig","matiere":"HGE","propositions":[{"idx":0,"proposition":"In front of a hematemesis and a melena the origin of the bleeding is usually upstream of the right colonic angle","correct":true},{"idx":1,"proposition":"Rectorrhage is usually a sign of lower gastrointestinal bleeding","correct":true},{"idx":2,"proposition":"In front of a hemorrhagic shock without externalization of blood it is necessary to evoke in principle a digestive hemorrhage, especially of the upper digestive tract","correct":true},{"idx":3,"proposition":"The amount of externalized bloody fluid is a reliable outcome","correct":false,"justification":"To assess the immediate severity of bleeding, the amount of externalised bloody fluid is a poor outcome. Pay attention to signs of shock."},{"idx":4,"proposition":"Hemodynamic impact assessment is the best way to assess the immediate severity of bleeding","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemorragiedig-urg-0","context":null,"enonce":"Regarding digestive bleeding","item":"hemorragiedig","matiere":"urg","propositions":[{"idx":0,"proposition":"They are considered by definition high when the lesion is located upstream of the Treitz angle (duodenum-jejunum junction), and low downstream of this zone.","correct":true},{"idx":1,"proposition":"The incidence of high HD is estimated at 100 to 150\/100,000 per year","correct":true},{"idx":2,"proposition":"The incidence remains high despite therapeutic progress on HD-generating pathologies, due to the aging of the population and the greater use of NSAIDs & anti-thrombotics","correct":true},{"idx":3,"proposition":"Mallory-Weiss syndrome is a tear of the mucosa in the cardia following iterative vomiting","correct":true},{"idx":4,"proposition":"Acute hemorrhagic gastritis and duodenitis correspond to multiple ulcerations and are favored by taking NSAIDs or tobacco.","correct":false,"justification":"Acute hemorrhagic gastritis and duodenitis correspond to multiple ulcerations and are favored by taking NSAIDs or alcohol"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemorragiedig-urg-1","context":null,"enonce":"Regarding digestive bleeding","item":"hemorragiedig","matiere":"urg","propositions":[{"idx":0,"proposition":"Hemobilia is a common cause associating high HD, biliary pain and jaundice","correct":false,"justification":"Hemophilia is a rare cause combining high HD, biliary pain and jaundice"},{"idx":1,"proposition":"The risk of HD occurring in patients with cirrhosis is the same regardless of the severity of the cirrhosis","correct":false,"justification":"The risk of HD in patients with cirrhosis increases with severity of cirrhosis"},{"idx":2,"proposition":"The intensity of clinical signs depends on how quickly the bleeding builds","correct":true},{"idx":3,"proposition":"In subjects with cirrhosis, the pulse should be interpreted according to the intake of beta-blockers, the presence of a withdrawal syndrome in case of alcoholism, and the existence of a possible associated infection","correct":true},{"idx":4,"proposition":"The active nature of the hemorrhage is assessed by the evolution of hemodynamic parameters under filling, and possibly by repeated gastric lavages.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemorragiedig-urg-2","context":null,"enonce":"Regarding digestive bleeding","item":"hemorragiedig","matiere":"urg","propositions":[{"idx":0,"proposition":"Initial hematocrit is an excellent reflection of blood loss","correct":false,"justification":"Initial hematocrit is not a good reflection of blood loss, until physiological hemodilution or vascular filling has occurred."},{"idx":1,"proposition":"Upper GI endoscopy is the key examination","correct":true},{"idx":2,"proposition":"Endoscopy should be performed best in the first 24 hours after the onset of bleeding because the early examination improves diagnostic performance","correct":true},{"idx":3,"proposition":"The time to perform a gastro-duodenal endoscopy is 6 hours in case of associated cirrhosis","correct":false,"justification":"This period is 12 hours in case of associated cirrhosis"},{"idx":4,"proposition":"The endoscopy procedure is possibly preceded by an injection of gentamycin 250 mg IV route in the 30 minutes preceding the examination.","correct":false,"justification":"Possibly preceded by an injection of erythromycin 250 mg IV route (unless contraindicated, QT prolongation on ECG) within 30 minutes prior to examination"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemorragiedig-urg-3","context":null,"enonce":"Regarding digestive bleeding","item":"hemorragiedig","matiere":"urg","propositions":[{"idx":0,"proposition":"Endoscopy is performed as soon as possible when high active HD is suspected","correct":true},{"idx":1,"proposition":"It affirms the cause of bleeding in 90% of cases, assesses the risk of bleeding recurrence, and allows possible hemostatic treatment","correct":true},{"idx":2,"proposition":"Sometimes the CT scan is indicated in case of severe HD (abundant externalization and hemodynamic impact) and: – high HD presumption but FOGD not available immediately, – or suspicion of aorto-duodenal fistula","correct":true},{"idx":3,"proposition":"Mortality from PH-related hemorrhages is about 20%, while mortality from ulcerative bleeding is about 5%.","correct":true},{"idx":4,"proposition":"Hemorrhagic recurrence is an independent severity factor","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"hemorragiedig-urg-4","context":null,"enonce":"Regarding digestive bleeding","item":"hemorragiedig","matiere":"urg","propositions":[{"idx":0,"proposition":"Prognostic factors for high HD in general are related to the abundance of bleeding, its active nature and the terrain","correct":true},{"idx":1,"proposition":"For ulcerative hemorrhages, the endoscopic appearance of the ulcer is assessed by Forrest's classification","correct":true},{"idx":2,"proposition":"Adherent clots (IIb) are at intermediate risk of recurrence","correct":true},{"idx":3,"proposition":"Ulcers with pigmented spots (Ic) or clean bottom (III) are at low risk of bleeding","correct":false,"justification":"Ulcers with pigmented spots (IIc) or clean bottom (III) are at low risk of bleeding"},{"idx":4,"proposition":"Three quarters of HDs stop spontaneously","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"DT-cardio-0","context":null,"enonce":"Regarding chest pain","item":"DT","matiere":"cardio","propositions":[{"idx":0,"proposition":"Early postprandial chest pain points to gastroesophageal reflux disease or peptic ulcer disease","correct":false,"justification":"Gastroesophageal reflux disease or angina. A peptic ulcer is rather associated with a late postprandial doulor"},{"idx":1,"proposition":"Chest pain yielding to trinitrine in less than 3 minutes may suggest pericarditis","correct":true,"justification":"By lowering the parietal tension and friction"},{"idx":2,"proposition":"In the case of pericarditis, pain is triggered by anteflexion","correct":false,"justification":"Relieved by anteflexion"},{"idx":3,"proposition":"A normal intercritical ECG eliminates the diagnosis of acute coronary syndrome","correct":false,"justification":"Caution: a normal intercritical ECG does not eliminate the diagnosis, and a left branch block should be considered as an equivalent of SCA with ST segment elevation. Ischemia in the territory of the circumflex artery can be electrically mute!"},{"idx":4,"proposition":"A paradoxical pulse, i.e. decreased on inspiration, is a sign of hemodynamic gravity","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"DT-cardio-1","context":null,"enonce":"Regarding chest pain","item":"DT","matiere":"cardio","propositions":[{"idx":0,"proposition":"Hyperkalemia is a cause of ST elevation","correct":true},{"idx":1,"proposition":"ST elevation associated with PQ undershift suggests left ventricle aneurysm","correct":false,"justification":"Pericarditis"},{"idx":2,"proposition":"In pulmonary pain associated with dyspnea, an elevation of a pulmonary cupola on chest X-ray suggests a pulmonary embolism","correct":true},{"idx":3,"proposition":"Cardiomegaly symmetrical on chest X-ray suggests left heart failure","correct":false,"justification":"A pericardial effusion. Cardiomegaly of left heart failure is asymmetric"},{"idx":4,"proposition":"A negative troponin assay should be systematically repeated","correct":false,"justification":"Only in case of chest pain that started less than 6 hours ago"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"DT-cardio-2","context":null,"enonce":"Regarding chest pain","item":"DT","matiere":"cardio","propositions":[{"idx":0,"proposition":"Chest pain with dyspnea and normal chest x-ray must necessarily evoke the diagnosis of aortic dissection","correct":false,"justification":"Pulmonary embolism"},{"idx":1,"proposition":"On blood gas, a hypoxemia hypocapnia combination characterizes a shunt effect","correct":true,"justification":"Pulmonary embolism must then be systematically evoked"},{"idx":2,"proposition":"Arterial gas is systematically indicated in front of chest pain","correct":false,"justification":"Only in case of arterial oxygen saturation <95%, brady^nea or tachypnea"},{"idx":3,"proposition":"A T1 T4 negative T wave on ECG characterizes ischemia of the right ventricle","correct":true,"justification":"Sign seen among others in the massive EP, reflecting a suffering of the right heart"},{"idx":4,"proposition":"Distal pulmonary embolisms are painful","correct":true,"justification":"Because of the pulmonary infarction they cause. Proximal PE is rather associated with inaugural shock"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"DT-cardio-3","context":null,"enonce":"Regarding chest pain","item":"DT","matiere":"cardio","propositions":[{"idx":0,"proposition":"Dissection of the descending aorta is associated with a risk of tamponade and shock","correct":false,"justification":"This concerns the dissection of the ascending aorta"},{"idx":1,"proposition":"The first risk factor for aortic dissection is high blood pressure","correct":true,"justification":"It is present in more than 80% of cases"},{"idx":2,"proposition":"Faced with a suspicion of acute pericarditis, echocardiography and troponin testing should be performed","correct":true},{"idx":3,"proposition":"In case of chest pain, pericarditis is a diagnosis of elimination","correct":true,"justification":"Benign cause: serious causes must first be eliminated"},{"idx":4,"proposition":"Cardiomegaly with a \"carafe\" appearance on X-ray raises fears of aortic dissection","correct":false,"justification":"A tamponade"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"DT-cardio-4","context":null,"enonce":"Regarding chest pain","item":"DT","matiere":"cardio","propositions":[{"idx":0,"proposition":"The DAILY\/STANFORD classification is the reference classification for aortic dissection","correct":true},{"idx":1,"proposition":"Infectious pneumonia is constantly accompanied by chest pain","correct":false,"justification":"Only in case of parietal contact (the pleura is innervated, but not the pulmonary parenchyma)"},{"idx":2,"proposition":"Some severe pulmonary arterial hypertension gives anginal pain ","correct":true,"justification":"By ischemic suffering of the right ventricle"},{"idx":3,"proposition":"Chest pain may be due to vesicular lithiasis","correct":true,"justification":"Projection of abdominal pain"},{"idx":4,"proposition":"Tietze syndrome is a form of tracheobronchitis associated with chest pain","correct":false,"justification":"Parietal pain of the chondrocostal or sternoclavicular joint"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"DT-cardio-5","context":null,"enonce":"Regarding chest pain","item":"DT","matiere":"cardio","propositions":[{"idx":0,"proposition":"Chest pain caused by pericarditis is not influenced by breathing","correct":false},{"idx":1,"proposition":"Psychogenic pain is rare","correct":false,"justification":"Extremely common (1\/4 of chest pain in the emergency room), they remain however a diagnosis of elimination"},{"idx":2,"proposition":"Absence of effusion on transthoracic echocardiography excludes diagnosis of pericarditis","correct":false,"justification":"Possible dry pericarditis"},{"idx":3,"proposition":"Esophageal spasm may be associated with anginal pain yielding to nitrates","correct":true},{"idx":4,"proposition":"A pneumothorax is to be evoked in case of chest pain with signs of severity","correct":true,"justification":"Pneumothorax suffocating. Other etiologies to be mentioned in priority in case of signs of severity: ACS, massive PE, tamponade, aortic dissection"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"anaphylaxie-urg-0","context":null,"enonce":"Which of the following are blood tests to be performed urgently (after drug management)? (one or more expected answers)","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"proposition":"Tryptase","correct":true},{"idx":1,"proposition":"Hepatic test","correct":false,"justification":"Urgently unnecessary"},{"idx":2,"proposition":"Total IgE","correct":false,"justification":"Urgently unnecessary"},{"idx":3,"proposition":"Ionogram","correct":false,"justification":"Urgently unnecessary"},{"idx":4,"proposition":"Renal assessment","correct":false,"justification":"Urgently unnecessary"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"anaphylaxie-urg-2","context":null,"enonce":"After an injection of IM adrenaline, symptoms persist. How often should the adrenaline injection be repeated?","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"proposition":"After 30 seconds","correct":false,"justification":"False"},{"idx":1,"proposition":"After 1 minute","correct":false,"justification":"False"},{"idx":2,"proposition":"After 5 minutes","correct":true},{"idx":3,"proposition":"After 10 minutes","correct":false,"justification":"False"},{"idx":4,"proposition":"After 15 minutes","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"anaphylaxie-urg-3","context":null,"enonce":"What is the preferred route to introduce adrenaline?","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"proposition":"Per Os","correct":false,"justification":"False"},{"idx":1,"proposition":"Intramuscular","correct":true},{"idx":2,"proposition":"None of these proposals","correct":false,"justification":"False"},{"idx":3,"proposition":"Subcutaneous","correct":false,"justification":"False"},{"idx":4,"proposition":"Nebulization","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"anaphylaxie-urg-4","context":null,"enonce":"What type of reaction causes anaphylaxis, according to the classification of Gell and Coombs?","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"proposition":"Type I","correct":true},{"idx":1,"proposition":"Type III","correct":false,"justification":"False"},{"idx":2,"proposition":"Type II","correct":false,"justification":"False"},{"idx":3,"proposition":"Type IV","correct":false,"justification":"False"},{"idx":4,"proposition":"Type V","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"anaphylaxie-urg-6","context":null,"enonce":"What is a grade II severity according to the Ring and Messmer classification?","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"proposition":"Generalized mucocutaneous signs","correct":false,"justification":"Grade I"},{"idx":1,"proposition":"Moderate multi-organ involvement","correct":true,"justification":"True, with mucocutaneous signs, arterial hypotension and unusual tachycardia, bronchial hyperresponsiveness (cough, ventilatory difficulty)"},{"idx":2,"proposition":"Severe life-threatening multi-organ disease","correct":false,"justification":"Grade III"},{"idx":3,"proposition":"Cardiocirculatory inefficiency and respiratory arrest","correct":false,"justification":"Grade IV"},{"idx":4,"proposition":"None of the proposals","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"anaphylaxie-urg-7","context":null,"enonce":"What is a grade IV severity according to the Ring and Messmer classification?","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"proposition":"Generalized mucocutaneous signs","correct":false,"justification":"Grade I"},{"idx":1,"proposition":"Moderate multi-organ involvement","correct":false,"justification":"Grade II"},{"idx":2,"proposition":"Severe life-threatening multi-organ disease","correct":false,"justification":"Grade III"},{"idx":3,"proposition":"Cardiocirculatory inefficiency and respiratory arrest","correct":true,"justification":"True, requiring cardiopulmonary resuscitation maneuvers"},{"idx":4,"proposition":"None of the proposals","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"anaphylaxie-urg-8","context":null,"enonce":"Which cells degranulate massively during anaphylaxis?","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"proposition":"Lymphocytes B","correct":false,"justification":"False, anaphylaxis is a reaction of innate immunity"},{"idx":1,"proposition":"T cells","correct":false,"justification":"False, anaphylaxis is a reaction of innate immunity"},{"idx":2,"proposition":"All these cells at the same time","correct":false,"justification":"False"},{"idx":3,"proposition":"Basophilic polynuclear","correct":true},{"idx":4,"proposition":"Mast cells","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"anaphylaxie-urg-9","context":null,"enonce":"What is a grade I severity according to the Ring and Messmer classification?","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"proposition":"Generalized mucocutaneous signs","correct":true,"justification":"True, erythema, urticaria, with or without angioneurotic edema"},{"idx":1,"proposition":"Moderate multi-organ involvement","correct":false,"justification":"Grade II"},{"idx":2,"proposition":"Severe life-threatening multi-organ disease","correct":false,"justification":"Grade III"},{"idx":3,"proposition":"Cardiocirculatory inefficiency and respiratory arrest","correct":false,"justification":"Grade IV"},{"idx":4,"proposition":"None of the proposals","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SII-HGE-0","context":null,"enonce":"About functional colopathy","item":"SII","matiere":"HGE","propositions":[{"idx":0,"proposition":"Irritable bowel syndrome (IBS), a preferable designation to functional colopathy, is one of the first reasons for consultation in gastroenterology","correct":true},{"idx":1,"proposition":"IBS is defined by the coexistence of chronic abdominal pain and fluctuating transit disorders (constipation, diarrhea, alternation of both).","correct":true},{"idx":2,"proposition":"This condition does not engage the prognosis but considerably alters the quality of life of patients and has a strong medico-economic impact","correct":true},{"idx":3,"proposition":"The prevalence of IBS in the general population ranges from 40 to 50% in all countries of the world","correct":false,"justification":"The prevalence of IBS in the general population ranges from 10 to 15% in all countries of the world"},{"idx":4,"proposition":"There is a female predominance, 70% of consultants are women","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"SII-HGE-1","context":null,"enonce":"About functional colopathy","item":"SII","matiere":"HGE","propositions":[{"idx":0,"proposition":"There is visceral hypersensitivity in at least 60% of patients","correct":true,"justification":"2020-02-03 00:00:00"},{"idx":1,"proposition":"Regular exposure to stressful events are factors associated with greater severity of symptoms","correct":true},{"idx":2,"proposition":"Abdominal pain is the main symptom of IBS and the main reason for consultation","correct":true},{"idx":3,"proposition":"An colscopy should be performed in front of a family history of cancer or colorectal adenomas","correct":true},{"idx":4,"proposition":"An age > 40 years (in the absence of a complete colonoscopy since the onset of symptoms) is an indication for colonoscopy","correct":false,"justification":"Age > 50 years (in the absence of a complete colonoscopy since onset of symptoms)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SII-HGE-2","context":null,"enonce":"About functional colopathy","item":"SII","matiere":"HGE","propositions":[{"idx":0,"proposition":"Resistance to symptomatic treatment or recent change in symptoms are incdications for colonoscopy","correct":true},{"idx":1,"proposition":"The presence of warning signs such as overt digestive bleeding or weight loss are indications for colonoscopy","correct":true},{"idx":2,"proposition":"Abdominal bloating is the second main reason for consultation","correct":true},{"idx":3,"proposition":"Bloating may be aggravated transiently by the emission of gas and\/or stool","correct":false,"justification":"It can be improved transiently by the emission of gases and\/or stool"},{"idx":4,"proposition":"Transit disorders are constant","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ictere-HGE-0","context":null,"enonce":"Concerning jaundice","item":"ictere","matiere":"HGE","propositions":[{"idx":0,"proposition":"Normal bilirubinemia is less than 20 μmol\/L","correct":true},{"idx":1,"proposition":"Jaundice occurs when bilirubinemia exceeds 60 μmol\/L","correct":false,"justification":"Jaundice occurs when bilirubinemia exceeds 40 μmol\/L"},{"idx":2,"proposition":"A light jaundice, or beginner, is visible next to the ocular sclera, the lightest place of the integuments","correct":true},{"idx":3,"proposition":"In healthy subjects, bilirubin circulates in plasma in 2 forms","correct":true,"justification":"Non-conjugated and conjugated"},{"idx":4,"proposition":"In healthy subjects, plasma total bilirubin is almost exclusively represented by unconjugated bilirubin","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ictere-HGE-1","context":null,"enonce":"Concerning jaundice","item":"ictere","matiere":"HGE","propositions":[{"idx":0,"proposition":"The main causes of conjugated bilirubin jaundice are hyperhemolysis and dyserythropoiesis","correct":false,"justification":"These are causes of unconjugated bilirubin jaundice (also the case of decreased activity of bilirubin glucuronide transferase)"},{"idx":1,"proposition":"Urine is normal in colour in case of unconjugated bilirubin jaundice (free)","correct":true},{"idx":2,"proposition":"Gilbert's syndrome is a totally benign and very common condition linked to partial glycuronyl transferase deficiency.","correct":true},{"idx":3,"proposition":"Crigler-Najjar syndrome is an exceptional, often very serious condition due to an absence or collapse of glucuronyl transferase activity.","correct":true},{"idx":4,"proposition":"Crigler-Najjar syndrome is inherited genetically in an autosomal dominant manner","correct":false,"justification":"It is transmitted genetically in an autosomal recessive manner"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ictere-HGE-2","context":null,"enonce":"Concerning jaundice","item":"ictere","matiere":"HGE","propositions":[{"idx":0,"proposition":"Cholestasis is the most common mechanism of conjugated bilirubin jaundice","correct":true},{"idx":1,"proposition":"Cholestasis is defined by decreased bile secretion","correct":true},{"idx":2,"proposition":"Cholestasis is mainly manifested by a concomitant increase in serum alkaline phosphatase and γ-GT","correct":true},{"idx":3,"proposition":"Isolated elevation of γ-GT or alkaline phosphatases does not indicate cholestasis","correct":true},{"idx":4,"proposition":"Small bile duct involvement must be diffuse to result in jaundice","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"handicap-mpr-0","context":null,"enonce":"Concerning the ICF:","item":"handicap","matiere":"mpr","propositions":[{"idx":0,"proposition":"The ICF was adopted by WHO in 2001","correct":true},{"idx":1,"proposition":"The CIF was adopted by the European Union in 2002 and enshrined in French law.","correct":true},{"idx":2,"proposition":"ICF allows for a holistic approach to all aspects of a disease","correct":true},{"idx":3,"proposition":"The ICF applies only to children and the elderly","correct":false,"justification":"to all"},{"idx":4,"proposition":"The ICF is a participatory model","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"handicap-mpr-1","context":null,"enonce":"Regarding the PCH and the ICF:","item":"handicap","matiere":"mpr","propositions":[{"idx":0,"proposition":"Depending on the person's life project, a compensation plan is developed that translates into a disability compensation benefit (PCH)","correct":true},{"idx":1,"proposition":"The CNSA acts at the national level","correct":true},{"idx":2,"proposition":"The MDPH acts at the national level","correct":false,"justification":"At the local level"},{"idx":3,"proposition":"The ICF model distinguishes between two levels of disease expression: functional and social.","correct":false,"justification":"4 levels: lesional, clinical, functional and social"},{"idx":4,"proposition":"Impairment refers to alterations in an anatomical function or structure, such as a significant deviation or loss","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"handicap-mpr-2","context":null,"enonce":"General generalities:","item":"handicap","matiere":"mpr","propositions":[{"idx":0,"proposition":"Activity refers to the execution of a task in everyday life","correct":true},{"idx":1,"proposition":"Personal factors include age, gender and physical condition","correct":true},{"idx":2,"proposition":"Impairment refers to the inability to perform an action","correct":false,"justification":"Impairment refers to alterations in an anatomical function or structure, such as a significant deviation or loss"},{"idx":3,"proposition":"In practice, the most common impairments that cause functional limitations are neurological and musculoskeletal impairments.","correct":true},{"idx":4,"proposition":"A limitation of joint amplitudes can be quantified in degrees using a goniometer","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"obesite-endoc-0","context":null,"enonce":"What is the prevalence of overweight in France?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"proposition":"0.15","correct":false,"justification":"The prevalence of overweight (BMI between 25 and 30) is about 35% in France"},{"idx":1,"proposition":"0.2","correct":false},{"idx":2,"proposition":"0.25","correct":false},{"idx":3,"proposition":"0.3","correct":false},{"idx":4,"proposition":"0.35","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"obesite-endoc-2","context":null,"enonce":"Which of these proposals are complications of adult obesity?","item":"obesite","matiere":"endoc","propositions":[{"idx":1,"proposition":"OSA","correct":true,"justification":"With hypopnea index greater than or equal to 5 (severe if greater than or equal to 30)"},{"idx":2,"proposition":"Hyperuricemia","correct":true,"justification":"With gout attack"},{"idx":3,"proposition":"Bipolar disorder","correct":false,"justification":"Not a known risk factor"},{"idx":4,"proposition":"Osteoporosis ","correct":false,"justification":"In this particular case, it is rather a protective factor."}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"obesite-endoc-3","context":null,"enonce":"Among these proposals, which indicate the carrying out of additional examinations in an overweight minor?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"proposition":"The presence of a family history of diabetes ","correct":true},{"idx":1,"proposition":"The presence of a family history of dyslipidemia ","correct":true},{"idx":2,"proposition":"Melanoma","correct":false},{"idx":3,"proposition":"Psychomotor retardation","correct":true},{"idx":4,"proposition":"Behavioural disorder with opposition","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"obesite-endoc-4","context":null,"enonce":"Which of these proposals are the causes of secondary obesity?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"proposition":"Hypothyroidism","correct":true},{"idx":1,"proposition":"Addison's disease","correct":false,"justification":"Primary adrenal insufficiency. It results in hypotension and hyperpigmentation and can be complicated by acute adrenal insufficiency with cardiovascular collapse."},{"idx":2,"proposition":"Syndrome de Kallman","correct":false,"justification":"A genetic disease of the development of the olfactory system characterized by the association of hypogonadotrophic hypogonadism due to gonadotropin-releasing hormone deficiency (GnRH) and anosmia or hyposmia."},{"idx":3,"proposition":"Taking neuroleptics","correct":true},{"idx":4,"proposition":"Taking sulfonamides","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"obesite-endoc-5","context":null,"enonce":"Which of the following are complications of obesity?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"proposition":"Type 2 diabetes","correct":true},{"idx":1,"proposition":"Gonarthrosis","correct":true},{"idx":2,"proposition":"Depressive syndrome","correct":true},{"idx":3,"proposition":"Obstructive ventilatory disorder","correct":false,"justification":"Restrictive ventilatory disorder rather!"},{"idx":4,"proposition":"High blood pressure","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"obesite-endoc-6","context":null,"enonce":"Which of the following are true?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"proposition":"Obesity is defined as a BMI > 25kg\/m squared","correct":false,"justification":"BMI > 25 -> Overweight\r\nBMI > 30 -> Obesity"},{"idx":1,"proposition":"First-line treatment is dominated by anorectic molecules","correct":false,"justification":"False, they are not indicated in the medical care (attention!). Lifestyle change and hygiene-dietary rules are the first-line measures."},{"idx":2,"proposition":"Treatment can be surgical in case of grade 3 obesity","correct":true,"justification":"True especially with a bypass or a sleeve-gastrectomy!"},{"idx":3,"proposition":"Treatment may be surgical in cases of grade 2 obesity under certain conditions","correct":true},{"idx":4,"proposition":"Android obesity is more at cardiovascular risk than gynoid obesity","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"myasthenie-neuro-0","context":null,"enonce":"Regarding the clinical diagnosis of myasthenia gravis:","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"The diagnosis of myasthenia gravis must be evoked in front of fluctuating sensory-motor signs from the age of 40","correct":false,"justification":"The diagnosis of myasthenia gravis should be evoked in front of exclusively muscular signs and symptoms"},{"idx":1,"proposition":"Muscle disorders are constant over time","correct":false,"justification":"Fluctuating = fatigability"},{"idx":2,"proposition":"Only the muscles directly put into action during the effort are at the origin of the symptoms","correct":false,"justification":"The symptoms may be related to muscles directly activated during the effort or to remote muscles not directly involved in the effort."},{"idx":3,"proposition":"The only symptom is muscle weakness of the limbs","correct":false,"justification":"Diagnosis can be made on ptosis"},{"idx":4,"proposition":"There may be swallowing problems","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"myasthenie-neuro-1","context":null,"enonce":"Regarding the positive diagnosis of myasthenia gravis:","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Unilateral ptosis should suspect myasthenia gravis of the eye and palpebral muscles","correct":true},{"idx":1,"proposition":"Damage to the eye muscles cannot result in diplopia","correct":false,"justification":"Diplopia possible, most often intermittent"},{"idx":2,"proposition":"Damage to the bulbar innervation muscles induces, among other things, swallowing, phonation and chewing disorders","correct":true},{"idx":3,"proposition":"Myasthenia gravis affects only the proximal muscles","correct":false,"justification":"The involvement predominates on the proximal muscles, but can more rarely affect the distal musculature also"},{"idx":4,"proposition":"The Barré event is normally held 2 min 30 ","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"myasthenie-neuro-3","context":null,"enonce":"Regarding pathologies associated with myasthenia gravis:","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"The diagnostic sensitivity of the ENMG is 98%","correct":false,"justification":"It does not exceed 75%"},{"idx":1,"proposition":"When myasthenia gravis is diagnosed, a CT scan or chest MRI should be prescribed to explore the thymic compartment for thymic hyperplasia or thymoma.","correct":true},{"idx":2,"proposition":"Thymic hyperplasia is found in 90% of myasthenia gravis cases","correct":false,"justification":"65% of cases"},{"idx":3,"proposition":"Thymomas can be mild or malignant and need to be operated on","correct":true},{"idx":4,"proposition":"Thymic hyperplasia corresponds to a macroscopically normal thymus but microscopically characterized by a proliferation of germinal follicles with a clear center","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"myasthenie-neuro-4","context":null,"enonce":"Which of the following are symptoms or signs of early generalized myasthenia gravis?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Paralysis of nerve XII (hypogloss)","correct":false,"justification":"Cranial nerves are respected in myasthenia gravis"},{"idx":1,"proposition":"Swallowing disorders","correct":true,"justification":"True, it is a sign of severity (like dyspnea and dysphonia)"},{"idx":2,"proposition":"Muscle fatigability of the upper limbs","correct":true},{"idx":3,"proposition":"Muscular atrophy of the limbs","correct":false,"justification":"No amyotrophy because it is a non-total damage to the neuromuscular junction. Amyotrophy is observed in motor deficits by damage to the second motor neuron. Be careful ⚠, in myasthenia gravis in the late stage, when they are severe and chronic, selective muscular atrophy can be seen."},{"idx":4,"proposition":"Falling head forward","correct":true,"justification":"True, this is the Dropped-Head Syndrome 😌. It is also seen in amyotrophic lateral sclerosis."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"myasthenie-neuro-5","context":null,"enonce":"Which of the following propositions are true for the first-line management of generalized myasthenia gravis?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Treatment with pyridostigmine-type anticholinesterase","correct":true},{"idx":1,"proposition":"A background treatment with corticosteroid therapy","correct":false,"justification":"Third line (after pyridostigmine and thymectomy)"},{"idx":2,"proposition":"A course of immunoglobulins IV","correct":false,"justification":"It is a treatment for myasthenic crisis"},{"idx":3,"proposition":"A remission of the list of contraindicated drugs","correct":true},{"idx":4,"proposition":"Treatment with benzodiazepine if needed","correct":false,"justification":"Benzodiazepine have a muscle relaxant effect that contraindicate them in myasthenia gravis"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"myasthenie-neuro-6","context":null,"enonce":"Which of the following proposals about electroneuromyogram (ENMG) are true?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"It may be normal","correct":true,"justification":"True. This is the case for all examinations whose sensitivity is less than 100%"},{"idx":1,"proposition":"It can objectify a decrement after repetitive stimulation at 3 Hz","correct":true},{"idx":2,"proposition":"Motor conduction velocities are normal","correct":true,"justification":"True, otherwise we come across a differential diagnosis (demyelinating pathology such as polyradiculoneuropathies)"},{"idx":3,"proposition":"It is most often associated with motor evoked potentials","correct":false,"justification":"Useless in diagnosis"},{"idx":4,"proposition":"Sensitivity increases in clinically healthy territories","correct":false,"justification":"It must be done on affected territories"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"myasthenie-neuro-7","context":null,"enonce":"Which of the following are true?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"It is an autoimmune pathology","correct":true},{"idx":1,"proposition":"It is a pathology that affects the neuromuscular junction","correct":true},{"idx":2,"proposition":"None of the proposals are accurate","correct":false,"justification":"None"},{"idx":3,"proposition":"It predominates in children","correct":false,"justification":"It mainly affects adults"},{"idx":4,"proposition":"There is a decrement in ENMG","correct":true,"justification":"True, at repetitive stimulation at 3 Hz"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"myasthenie-neuro-8","context":null,"enonce":"Which of the following are true?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Myasthenia gravis is linked to a pre-synaptic block of the neuromuscular junction","correct":false,"justification":"False"},{"idx":1,"proposition":"Myasthenia gravis is related to a postsynaptic block of the neuromuscular junction","correct":true,"justification":"True since this concerns acetylcholine receptors"},{"idx":2,"proposition":"Myasthenia gravis usually begins after an infection","correct":false,"justification":"This is the case of Guillain-Barré syndrome (acute inflammatory polyradiculoneuritis)"},{"idx":3,"proposition":"None of the propositions are true","correct":false,"justification":"False"},{"idx":4,"proposition":"Myasthenia gravis is an autoimmune disease","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"myasthenie-neuro-9","context":null,"enonce":"Which of the following are myasthenia gravis abnormalities that can be seen in a chest CT scan?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Interstitial pulmonary fibrosis","correct":false,"justification":"Not associated with myasthenia gravis"},{"idx":1,"proposition":"Tuberculous cavern","correct":false,"justification":"Not associated with myasthenia gravis"},{"idx":2,"proposition":"Thymoma","correct":true,"justification":"True, in 15% of myasthenia gravis"},{"idx":3,"proposition":"Thymic hyperplasia","correct":true,"justification":"True, in 65% of myasthenia gravis"},{"idx":4,"proposition":"Pulmonary hypertension","correct":false,"justification":"Not seen on chest CT scan + is not associated with myasthenia gravis"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"myasthenie-neuro-10","context":null,"enonce":"Which of the following are additional tests for myasthenia gravis?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Anti-actin antibodies","correct":false,"justification":"It is not dosed in this disease"},{"idx":1,"proposition":"Anti-RAC antibodies","correct":true,"justification":"True. They have a sensitivity of about 80%, and are very specific."},{"idx":2,"proposition":"ENMG","correct":true,"justification":"True, we are looking for a decrement to repetitive stimulation at 3 Hz"},{"idx":3,"proposition":"Muscle biopsy","correct":false,"justification":"Useless in this pathology"},{"idx":4,"proposition":"Thoracic CT","correct":true,"justification":"True, looking for thymoma or thymic hyperplasia"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"myasthenie-neuro-11","context":null,"enonce":"In what proportion of myasthenia gravis is associated thymic hyperplasia found?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"45%","correct":false,"justification":"False"},{"idx":1,"proposition":"55%","correct":false,"justification":"False"},{"idx":2,"proposition":"65%","correct":true},{"idx":3,"proposition":"75%","correct":false,"justification":"False"},{"idx":4,"proposition":"85%","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"myasthenie-neuro-12","context":null,"enonce":"Which of the following proposals are in favor of a cholinergic crisis?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Sweats","correct":true,"justification":"True, muscarinic sign"},{"idx":1,"proposition":"Diarrhoea","correct":true,"justification":"True, muscarinic sign"},{"idx":2,"proposition":"Mydriasis","correct":false,"justification":"Rather, a miosis is found in parasympathetic hyperactivation"},{"idx":3,"proposition":"Swallowing disorders","correct":false,"justification":"Rather, they are found in myasthenic seizures."},{"idx":4,"proposition":"Fasciculations","correct":true,"justification":"True, nicotinic sign"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"myasthenie-neuro-13","context":null,"enonce":"What is the minimum percentage decrease in the amplitude of the muscle evoked potential necessary to evoke a decrement at the ENMG?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"10 %","correct":true,"justification":"True. A decrement at the ENMG is significant if it is greater than or equal to 10%"},{"idx":1,"proposition":"20 %","correct":false,"justification":"False"},{"idx":2,"proposition":"30 %","correct":false,"justification":"False"},{"idx":3,"proposition":"40 %","correct":false,"justification":"False"},{"idx":4,"proposition":"50 %","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"myasthenie-neuro-14","context":null,"enonce":"Which of the following are signs or symptoms of myasthenia gravis?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Ptosis","correct":true},{"idx":1,"proposition":"Areflexia","correct":false,"justification":"No central reach"},{"idx":2,"proposition":"Dyspnoea","correct":true,"justification":"True, it's a sign of gravity"},{"idx":3,"proposition":"Nasoneous voice","correct":true},{"idx":4,"proposition":"Difficulty in swallowing","correct":true,"justification":"True, it's a sign of gravity"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"myasthenie-neuro-15","context":null,"enonce":"In what proportion of myasthenia gravis is an associated thymoma?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"10%","correct":false,"justification":"False"},{"idx":1,"proposition":"15%","correct":true},{"idx":2,"proposition":"20%","correct":false,"justification":"False"},{"idx":3,"proposition":"25%","correct":false,"justification":"False"},{"idx":4,"proposition":"30%","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diabete-endoc-0","context":null,"enonce":"Which of these patients have an HbA1c goal of 7% or less? ","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"Seniors whose life expectancy is considered satisfactory","correct":true},{"idx":1,"proposition":"Most patients with T2DM","correct":true},{"idx":2,"proposition":"Patients before considering pregnancy","correct":false,"justification":"Target <= 6.5%"},{"idx":3,"proposition":"Patients with moderate CKD","correct":true},{"idx":4,"proposition":"Newly diagnosed T2DM with life expectancy >15 years and no history","correct":false,"justification":"Target <= 6.5%"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diabete-endoc-1","context":null,"enonce":"Which of these patients have an HbA1c goal of 6.5% or less? ","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"Limited life expectancy (< 5 years)","correct":false,"justification":"Target <= 8%"},{"idx":1,"proposition":"Frail elderly","correct":false,"justification":"Target <= 8%"},{"idx":2,"proposition":"Patients before considering pregnancy","correct":true},{"idx":3,"proposition":"Patients during pregnancy","correct":true,"justification":"With fasting blood glucose levels< 0.95 g \/ L and 2h post prandial < 1.20 g \/ L"},{"idx":4,"proposition":"Recent stroke","correct":false,"justification":"Target <= 8% (patient categories with advanced cardiovascular complications)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diabete-endoc-2","context":null,"enonce":"Which of these patients have an HbA1c goal of 8% or less? ","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"Most patients with T2DM","correct":false,"justification":"Target <= 7%"},{"idx":1,"proposition":"Sick and dependent elderly people","correct":false,"justification":"Objective< 9% and\/or pre-prandial capillary blood glucose between 1 and 2 g\/L"},{"idx":2,"proposition":"Patients with microvascular complications","correct":false},{"idx":3,"proposition":"Myocardial infarction with heart failure","correct":true,"justification":"Group of patients with a history of advanced macrovascular complications"},{"idx":4,"proposition":"Moderate KDI","correct":false,"justification":"Moderate CKD: target <= 7%. Severe or terminal CKD: target <= 8%"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diabete-endoc-3","context":null,"enonce":"What are the goals of a type 2 diabetic patient during pregnancy?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"HbA1C< 7%","correct":false,"justification":"HbA1c < 6.5%"},{"idx":1,"proposition":"HbA1C < 8%","correct":false,"justification":"HbA1c < 6.5%"},{"idx":2,"proposition":"Fasting blood glucose levels< 0.95 g\/L","correct":true},{"idx":3,"proposition":"Postprandial blood glucose levels <= 1.25 g\/L","correct":false,"justification":"Postprandial blood glucose levels at two hours < 1.20 g\/L"},{"idx":4,"proposition":"Blood sugar > 0.4 g\/L","correct":false,"justification":"There is no goal or monitoring of nighttime blood glucose"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"diabete-endoc-4","context":null,"enonce":"Which propositions are true?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"NPH insulins are intermediate-acting insulins","correct":true,"justification":"Approximately 12 hours of action"},{"idx":1,"proposition":"Insulins are contraindicated during pregnancy","correct":false},{"idx":2,"proposition":"Metformin is the only antidiabetic drug to lose weight","correct":false,"justification":"These are GLP1 agonists"},{"idx":3,"proposition":"Insulin doses are less than 1 U\/kg most often ","correct":true},{"idx":4,"proposition":"Insulins are preferred to metformin in case of pregnancy or breastfeeding","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diabete-endoc-5","context":null,"enonce":"Which of the following are possible causes of polyuro-polydipsic syndrome?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"Diabetes","correct":true},{"idx":1,"proposition":"Malignant HTA","correct":true,"justification":"True, hyper-filtration due to high pressure"},{"idx":2,"proposition":"Inappropriate secretion of DHA","correct":false,"justification":"Pure water retention"},{"idx":3,"proposition":"Hypercalcemia","correct":true,"justification":"True, diabetes insipidus"},{"idx":4,"proposition":"Benign prostatic hyperplasia","correct":false,"justification":"No polydipsia"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diabete-endoc-8","context":null,"enonce":"Regarding the paediatric peculiarities of diabetes, which proposals are true?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"An acanthosis nigricans is a peculiarity of T1D","correct":false,"justification":"An acanthosis nigricans and a polycystic ovary syndrome should suspect insulin resistance and in particular T2DM (rare ++ in T1D)"},{"idx":1,"proposition":"Vaginal yeast infections should suggest T2DM","correct":true},{"idx":2,"proposition":"HbA1c ≥ 8.5% is a diagnostic criterion for T2DM","correct":false,"justification":"False, the diagnosis of T2DM is made on venous blood glucose"},{"idx":3,"proposition":"The presence of autoantibodies does not rule out the presence of T2DM","correct":false,"justification":"The presence of autoantibodies eliminates the presence of T2DM and points to T1D"},{"idx":4,"proposition":"Drug therapies that have marketing authorisation for T2DM in children are sulphonylureas and insulin.","correct":false,"justification":"Drug therapies that have MAiD in the treatment of T2DM in children are metformin and insulin"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diabete-endoc-9","context":null,"enonce":"Regarding the paediatric peculiarities of diabetes, which proposals are true?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"The finding of a blood glucose > 2.5 g \/ L must make a urine strip in search of ketone bodies.","correct":true,"justification":"None"},{"idx":1,"proposition":"Among the complications of ketoacidosis, cerebral edema has a mortality of 25%.","correct":true,"justification":"None"},{"idx":2,"proposition":"Regarding the management of cerebral edema complicating ketoacidosis, it is essential to confirm its presence by a brain scan before starting treatments.","correct":false,"justification":"If clinical suspicion:\r\n1. 30% decrease infusion rate\r\n2. Mannitol injection 20%\r\n3. Elevation of the patient's head\r\n4. Brain scan in a stable child on mannitol"},{"idx":3,"proposition":"Neuroglucopenic syndrome occurs quickly for blood glucose levels < 0.7 g \/ L in diabetics.","correct":false,"justification":"Blood glucose < 0.7 g\/L: Neurovegetative SD ++\r\n< 0.54 g\/L: Neuroglucopenic Sd ++"},{"idx":4,"proposition":"In a diabetic child who is unconscious during hypoglycemia, it is recommended as a first line to inject him with Glucagon.","correct":true,"justification":"Glucagon 0.5 mg if < 25Kg \/ 1 mg if > 25 Kg"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diabete-endoc-10","context":null,"enonce":"Which of the following proposals can be used to diagnose diabetes?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"2 fasting blood glucose levels > 1.26 g\/L","correct":true,"justification":"True it is the gold standard"},{"idx":1,"proposition":"Fasting blood glucose > 2 g\/L at any time of the day ","correct":false,"justification":"False, association with symptoms of hyperglycemia is necessary"},{"idx":2,"proposition":"Blood glucose > 2 g\/L at 2 hours from OGGH 75g","correct":true},{"idx":3,"proposition":"HbA1c > 7%","correct":false,"justification":"HbA1c is not used in France for the diagnosis of TD"},{"idx":4,"proposition":"Fasting blood glucose > 2 g\/L at any time of day associated with polyuria","correct":true,"justification":"True, associated with one or more symptoms of hyperglycemia (polyuria, polydipsia, polyphagia, ...)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diabete-endoc-14","context":null,"enonce":"Which of the following are true about type 1 diabetes?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"Alpha-pancreatic cells are destroyed by autoantibodies","correct":false,"justification":"These are the Beta-pancreatic cells that secrete insulin!"},{"idx":1,"proposition":"It is an autoimmune disease","correct":true},{"idx":2,"proposition":"It can occur at any age","correct":true,"justification":"True, although it is more common to diagnose it in young people"},{"idx":3,"proposition":"The HLA DR2 gene is a protective factor","correct":true},{"idx":4,"proposition":"The sex ratio is very close to 1","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diabete-endoc-15","context":null,"enonce":"Which of the following proposals designate drugs that can cause hypoglycemia?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"Metformin","correct":false,"justification":"No hypoglycaemia on metformin #safe"},{"idx":1,"proposition":"Sulfonamides","correct":true,"justification":"This is thanks to the discovery of a PU of Réa de Montpellier who realized that his patients had unexplained manifestations under Sulfonamides (then used as ATB).\r\nBy measuring their blood sugar he realized this unsuspected therapeutic action."},{"idx":2,"proposition":"DPP4 inhibitors","correct":false,"justification":"False"},{"idx":3,"proposition":"Somastatin","correct":false,"justification":"False, it is not an antidiabetic"},{"idx":4,"proposition":"Insulin","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Hu-nephro-0","context":null,"enonce":"Regarding the basics of nephrological (or renal) hematuria:","item":"Hu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Urological hematuria corresponds to an anatomical lesion","correct":true,"justification":"Communication of a urinary tract (between the calyx and the prostatic urethra) and one or more blood vessels"},{"idx":1,"proposition":"Nephrological hematuria is most often due to tubular disease","correct":false,"justification":"It is most often a disease of the glomerulus"},{"idx":2,"proposition":"Alport syndrome is a congenital anomaly in the composition of the basement membrane","correct":true},{"idx":3,"proposition":"Red blood cells have a diameter of 70 mm","correct":false,"justification":"We are several orders of magnitude lower; the diameter of red blood cells is 7 μM"},{"idx":4,"proposition":"Macroscopic hematuria of glomerular origin does not find clots or voiding burns","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Hu-nephro-1","context":null,"enonce":"Regarding generalities:","item":"Hu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Hematuria can be the consequence of a urological condition","correct":true},{"idx":1,"proposition":"The main etiology of urological hematuria is taking anticoagulant therapy","correct":false,"justification":"The main etiologies of these hematuria are urinary tract infections and neoplasias. We also find renal lithiasis."},{"idx":2,"proposition":"Nephrological hematuria is most often glomerular","correct":true},{"idx":3,"proposition":"Microscopic hematuries can be objectivized by confocal or two-photon microscope only","correct":false,"justification":"Not at all. We discover them on BU."},{"idx":4,"proposition":"Diagnosis of hematuria is based on quantitative cytological examination of urine","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Hu-nephro-2","context":null,"enonce":"Which propositions are true?","item":"Hu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Hematuria is defined as the presence of more than 50 red blood cells per mL","correct":false,"justification":"That's more than 10,000 red blood cells per mL. It is quite physiological to have some red blood cells that cross the barrier of the glomerulus."},{"idx":1,"proposition":"Quantitative cytological examination of urine eliminates false hematuria","correct":true,"justification":"See item in the last (8th) edition of the college p.111"},{"idx":2,"proposition":"A red coloration of urine is the pathognomonic sign of hematuria ","correct":false,"justification":"There are many other causes of red urine: hemoglobinuria, myoglobinuria, porphyria, metronidazole, rifampicin, beets, ..."},{"idx":3,"proposition":"Initial macroscopic hematuria is often cervico-prostatic","correct":true},{"idx":4,"proposition":"Nephrological hematuria finds associated lower back pain most often","correct":false,"justification":"No lower back pain, no clots, no fever, no burning urination"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Hu-nephro-3","context":null,"enonce":"Which propositions are true?","item":"Hu","matiere":"nephro","propositions":[{"idx":0,"proposition":"One of the main causes of mascroscopic hematuria of glomerular origin is IgA deposition nephropathy","correct":true},{"idx":1,"proposition":"Associated with significant alteration of GFR, glomerular mascrocopic hematuria indicates an imperative and urgent renal biopsy","correct":true,"justification":"And this because of the need to quickly treat the causes of extracapillary proliferative glomerulonephritis"},{"idx":2,"proposition":"The most common etiologies of microscopic hematuria due to glomerular nephropathics are trauma and cysts.","correct":false,"justification":"These are diseases of the basement membranes (Sd d'Alport for example) and Berger's disease"},{"idx":3,"proposition":"Renal ultrasound with bladder time is indicated in case of microscopic hematuria after 50 years","correct":true},{"idx":4,"proposition":"The presence of haematic cylinders and\/or deformed red blood cells points to a glomerular cause","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Hu-nephro-4","context":null,"enonce":"Which of the following propositions point to a nephrological origin of hematuria?","item":"Hu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Terminal location","correct":false,"justification":"Total"},{"idx":1,"proposition":"Presence of clots","correct":false,"justification":"No clots in nephrological hematuria"},{"idx":2,"proposition":"Presence of hematic cylinders","correct":true},{"idx":3,"proposition":"Proteinuria","correct":true},{"idx":4,"proposition":"None of these proposals","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TdC-cardio-0","context":null,"enonce":"Regarding conduction disorders","item":"TdC","matiere":"cardio","propositions":[{"idx":0,"proposition":"The nodal tissue that constitutes NS and NAV is contrasted with the \"Purkinje\" tissue that makes up the bundle of His, the branches and the Purkinje network.","correct":true},{"idx":1,"proposition":"Sinus dysfunction and BAV can be symptomatic unlike branch blocks which are never symptomatic if isolated","correct":true},{"idx":2,"proposition":"NS is under close dependence on the autonomic nervous system","correct":true},{"idx":3,"proposition":"NS is vascularized by a branch of the left coronary artery or circumflex artery","correct":false,"justification":"NS is vascularized by a branch of the right coronary artery or circumflex artery"},{"idx":4,"proposition":"Sinuslae dysfunction or DS may follow a bradycardial medication","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"TdC-cardio-1","context":null,"enonce":"Regarding conduction disorders","item":"TdC","matiere":"cardio","propositions":[{"idx":0,"proposition":"In case of DS, an escape rhythm may hatch in the atrium or NAV (emergency rhythm)","correct":true},{"idx":1,"proposition":"The bundle of His is the only communication between atrium and ventricles and travels through the membranous septum","correct":true},{"idx":2,"proposition":"BAV is common in the elderly","correct":true},{"idx":3,"proposition":"The AV Node is also under close dependence on the autonomic nervous system","correct":true},{"idx":4,"proposition":"NAV is most often vascularized by a branch of the left coronary artery that arises from the cross of the furrows (artery of the NAV)","correct":false,"justification":"NAV is most often vascularized by a branch of the right coronary artery that arises from the cross of the furrows (artery of the NAV)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TdC-cardio-2","context":null,"enonce":"Regarding cardiac conduction disorders","item":"TdC","matiere":"cardio","propositions":[{"idx":0,"proposition":"In the case of a full nodal BAV, an escape rhythm may hatch in the His beam at a frequency between 35 and 50 bpm","correct":true},{"idx":1,"proposition":"In case of BAV in the beam of His or infrahissian, the escape rate is unstable and slower (15 to 30 bpm), which makes the gravity of this localization","correct":true},{"idx":2,"proposition":" The bundle of His is divided into right and left branches which are subdivided into thin and thick anterior hemi-branches or hemi-branches.","correct":true},{"idx":3,"proposition":"The branches are very highly sensitive to the effects of the autonomic nervous system","correct":false,"justification":"The branches are not very sensitive to the effects of the autonomic nervous system"},{"idx":4,"proposition":"In the branch block, there is a slowdown or interruption of conduction in a branch","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TdC-cardio-3","context":null,"enonce":"About BAVs","item":"TdC","matiere":"cardio","propositions":[{"idx":0,"proposition":"A BAV can be totally asymptomatic, this is of course the case of the BAV of the first degree and most blocks of the second degree)","correct":true},{"idx":1,"proposition":"Nodal blocks are often responsible for first-degree BAVs or Möbitz I type second-degree BAVs","correct":true},{"idx":2,"proposition":"Blocks in the bundle of His or infra-hissians occur beforehand on branch blocks or BAVs of the second degree of type Möbitz I","correct":false,"justification":"Blocks in the His or infra-hissian bundle occur beforehand on branch blocks or second-degree BAVs of the Möbitz II type."},{"idx":3,"proposition":"At BAV III, the exhaust is wide (40%) or thin (60%)","correct":true},{"idx":4,"proposition":"Block is sometimes promoted by beta-blockers or reperfusion;  in the latter case, the BAV contraindicates beta-blockers","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"TdC-cardio-4","context":null,"enonce":"Regarding conduction disorders","item":"TdC","matiere":"cardio","propositions":[{"idx":0,"proposition":"In BAVs, the width of the QRS often gives the seat of the block","correct":true},{"idx":1,"proposition":"The 24-hour ECG (Holter) is very helpful and non-traumatic","correct":true},{"idx":2,"proposition":"A branch block is always asymptomatic if isolated","correct":true},{"idx":3,"proposition":"A branch block is often of fortuitous discovery","correct":true},{"idx":4,"proposition":"The isolated left branch block can be benign and considered a variant of normal, whether complete or incomplete.","correct":false,"justification":"The isolated right branch block can be benign and considered a variant of normal, whether complete or incomplete"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TdC-cardio-5","context":null,"enonce":"Regarding conduction disorders","item":"TdC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Right branch block is almost always seen in most congenital heart defects affecting the right ventricle","correct":true},{"idx":1,"proposition":"The left branch block is never considered benign.","correct":true},{"idx":2,"proposition":"A left branch block is observed in 10% of cases of anterior infacrtus, with uni-, biou trifascicular block type, either pre-existing or acquired during infarction","correct":true},{"idx":3,"proposition":"A prolonged sinus arrest or complete BSA are the cause of asystole or simple bradycardia thanks to an escape for example atrial","correct":true},{"idx":4,"proposition":"A progressive elongation of the PR until the observation of a single blocked P wave followed by a conducted P wave with a shorter PR interval signs a second degree BAV mobitz 2","correct":false,"justification":"BAV of the second degree type Möbitz I or Luciani-Wenckebach: – progressive prolongation of PR until the observation of a single blocked P wave followed by a conducted P wave with a shorter PR interval; – often associated with a 2:1 BAV; – as a rule, nodal seat and most often QRS duration < 120 ms (fine QRS)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nephroPvascu-nephro-0","context":null,"enonce":"Concerning the main generalities:","item":"nephroPvascu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Vascular nephropathies include heterogeneous diseases characterized by damage to the renal vessels.","correct":true},{"idx":1,"proposition":"Nephroangiosclerosis involves the small vessels of the kidney","correct":true},{"idx":2,"proposition":"High blood pressure is very rarely associated with these diseases","correct":false,"justification":"It is often very present. It can be either the cause or the consequence"},{"idx":3,"proposition":"Vascular nephropathies can be classified according to their rate of evolution","correct":true},{"idx":4,"proposition":"These diseases can be classified according to the arterial territory affected.","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"nephroPvascu-nephro-1","context":null,"enonce":"Which of these nephropathies are rapidly progressive or acute?","item":"nephroPvascu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Stenosis of the renal artery","correct":false,"justification":"Chronic course"},{"idx":1,"proposition":"Anti-phospholipid syndrome in all cases","correct":false,"justification":"Chronic course"},{"idx":2,"proposition":"Macroscopic periarteritis nodosa","correct":true,"justification":"Affects medium-grade arterioles"},{"idx":3,"proposition":"Cholesterol crystal emboli disease","correct":true,"justification":"Affects small intrarenal arterioles"},{"idx":4,"proposition":"Thrombotic microangiopathy syndrome","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nephroPvascu-nephro-2","context":null,"enonce":"Regarding etiologies:","item":"nephroPvascu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Thrombotic microangiopathy syndrome belongs to the group of chronic or slow-growing NVs","correct":false,"justification":"It belongs to the group of acute or rapidly progressive NV"},{"idx":1,"proposition":"Moschowitz syndrome preferentially affects children","correct":false,"justification":"Mostly affects adults. Cerebral damage is at the forefront."},{"idx":2,"proposition":"Hemolytic uremic syndrome preferentially affects children","correct":true,"justification":"Kidney damage is at the forefront"},{"idx":3,"proposition":"Hemolytic uremic syndrome is, most often, due to toxins produced by enterobacteriaceae that destroy the endothelium","correct":true},{"idx":4,"proposition":"HUS is the leading cause of acute renal failure in children aged 1 to 3 years","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nephroPvascu-nephro-3","context":null,"enonce":"Regarding hemolytic uremic syndrome (HUS) in children:","item":"nephroPvascu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Post-diarrheal HUS is a reportable disease in all cases","correct":false,"justification":"Only when the patient is under 15 years of age"},{"idx":1,"proposition":"The infectious agent most often involved is Shillega","correct":false,"justification":"This is Escherichia coli"},{"idx":2,"proposition":"HUS starts slowly and gradually with low back pain","correct":false,"justification":"The onset is brutal with diarrhea, fever, acute renal failure and anuria"},{"idx":3,"proposition":"Renal biopsy is indicated in emergency in front of a supiscion of HUS","correct":false,"justification":"It is most often useless in children"},{"idx":4,"proposition":"Treatment is purely symptomatic most often","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nephroPvascu-nephro-4","context":null,"enonce":"Regarding malignant nephroangiosclerosis","item":"nephroPvascu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Malignant nephroangiosclerosis is the renal consequence of malignant hypertension by ischemic lesions","correct":true},{"idx":1,"proposition":"HTA generates a significant natriuresis called \"pressure\"","correct":true},{"idx":2,"proposition":"Paradoxical hypovolemia puts the renin angiotensin (RAS) system to rest","correct":false,"justification":"On the contrary, it activates it"},{"idx":3,"proposition":"HTA and SRA maintain a vicious circle","correct":true},{"idx":4,"proposition":"Blood renin and asdosterone are very low","correct":false,"justification":"They are increased because of hypovolemia"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nephroPvascu-nephro-5","context":null,"enonce":"Regarding nephoangiosclerosis due to malignant hypertension:","item":"nephroPvascu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Malignant hypertension is clinically defined","correct":true},{"idx":1,"proposition":"Proteinuria and renal failure are observed","correct":true},{"idx":2,"proposition":"Secondary hyperaldosteronism causes hyperkalemia","correct":false,"justification":"Hypokalemia"},{"idx":3,"proposition":"PBR is indicated in diagnostic emergency","correct":false,"justification":"It is contraindicated as long as hypertension is not controlled"},{"idx":4,"proposition":"Treatment of malignant hypertension is a medical emergency","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Sdocclusif-HGE-0","context":null,"enonce":"The positive diagnosis of an occlusive syndrome is based on a combination of the following functional and clinical signs: ","item":"Sdocclusif","matiere":"HGE","propositions":[{"idx":0,"proposition":"Abdominal pain","correct":true},{"idx":1,"proposition":"Shutting down materials but not gases","correct":false,"justification":"Shutdown of substances and gases"},{"idx":2,"proposition":"Nausea or vomiting","correct":true},{"idx":3,"proposition":"Abdominal meteorism","correct":true},{"idx":4,"proposition":"Diarrhoea","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Sdocclusif-HGE-1","context":null,"enonce":"Regarding occlusive syndrome:","item":"Sdocclusif","matiere":"HGE","propositions":[{"idx":0,"proposition":"Bowel obstruction is one of the most common reasons for emergency hospitalization in surgical settings","correct":true},{"idx":1,"proposition":"The most specific sign is the cessation of transit and in particular gases","correct":true},{"idx":2,"proposition":"Stool transit can be temporarily preserved","correct":true},{"idx":3,"proposition":"Vomiting may be late in case of high and progressive obstacle","correct":false,"justification":"Vomiting may be late in case of low and progressive obstruction"},{"idx":4,"proposition":"Meteorism may be minimal in case of low occlusion","correct":false,"justification":"Meteorism may be minimal in case of high occlusion"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Sdocclusif-HGE-2","context":null,"enonce":"Regarding occlusive syndrome:","item":"Sdocclusif","matiere":"HGE","propositions":[{"idx":0,"proposition":"Flanged occlusion is the most common cause of colon occlusion","correct":false,"justification":"It is the most common cause of small bowel occlusion"},{"idx":1,"proposition":"Volvulus of the pelvic colon occurs most often in postpartum women","correct":false,"justification":"Volvulus of the sigmoid most often in the elderly ( > 70 years)"},{"idx":2,"proposition":"It is possible to perform a diagnostic endoscopy. ","correct":false,"justification":"Contraindicated: risk of perforation. Endoscopy only indicated for placement of colonic or duodenal prosthesis or treatment of a sigmoid volvulus."},{"idx":3,"proposition":"The CT scan is the reference morphological examination","correct":true},{"idx":4,"proposition":"In case of high occlusion the hydroaeric levels are multiple, central and wider than high","correct":true,"justification":"Signs present qd standing. Lying down: presence of conniving valves (spring aspects). Look for abdominal scars, palpate hernial orifices and perform a digital rectal examination."}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"Sdocclusif-urg-0","context":null,"enonce":"About occlusive syndrome","item":"Sdocclusif","matiere":"urg","propositions":[{"idx":0,"proposition":"The occlusive syndrome, defined by an interruption of normal intestinal transit with a cessation of materials and gases, is a diagnostic and therapeutic emergency","correct":true},{"idx":1,"proposition":"Small bowel occlusions are observed at any age, colonic occlusions are more frequent beyond 50 years","correct":true},{"idx":2,"proposition":"The volvulus corresponds to a twisting of a digestive loop on a vascular axis","correct":true},{"idx":3,"proposition":"Most often, the patient is seen in the emergency room for abdominal pain syndrome","correct":true},{"idx":4,"proposition":"Shutting down of materials and gases can be replaced by false diarrhea (downstream segment emptying)","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Sdocclusif-urg-1","context":null,"enonce":"About occlusive syndrome","item":"Sdocclusif","matiere":"urg","propositions":[{"idx":0,"proposition":"imaging is systematically indicated when occlusion is suspected","correct":true},{"idx":1,"proposition":"The abdominal CT scan is the reference exam","correct":true},{"idx":2,"proposition":"Moderate renal impairment secondary to dehydration is not a contraindication to injection","correct":true},{"idx":3,"proposition":"The sensitivity and specificity of the CT scan is greater than 95% to make a positive diagnosis of an occlusion","correct":true},{"idx":4,"proposition":"In case of occlusion of the small intestine, the CT scan shows a dilation of more than 5 cm of the small loop and more than 9 cm in case of colonic occlusion","correct":false,"justification":"In case of occlusion of the small intestine, the CT scan shows a dilation of more than 2.5 cm of the small loop and more than 6 cm in case of colonic occlusion"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Sdocclusif-urg-2","context":null,"enonce":"About occlusive syndrome","item":"Sdocclusif","matiere":"urg","propositions":[{"idx":0,"proposition":"A caecal distention of more than 9 cm should raise fears of a perforation","correct":true},{"idx":1,"proposition":"The place of ultrasound is very limited. In occlusive syndrome, it can nevertheless be useful in children (intussusception)","correct":true},{"idx":2,"proposition":"Absence of peristalsis and hypoechoic parietal thickening are signs of intestinal distress","correct":true},{"idx":3,"proposition":"In case of occlusion of the small intestine the clinical signs are in the foreground with: – a sharp pain of sudden onset, – abundant vomiting, – and a rapid alteration of the general condition","correct":true},{"idx":4,"proposition":"The shutdown of materials and gases is not very clear in case of hail obstruction","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Sdocclusif-urg-3","context":null,"enonce":"Which of the following is a first-line recommended examination(s) for the diagnosis of an occlusive syndrome?","item":"Sdocclusif","matiere":"urg","propositions":[{"idx":0,"proposition":"A snapshot of the abdomen without preparation of face and profile","correct":false,"justification":"False"},{"idx":1,"proposition":"An endoscopy","correct":false,"justification":"False"},{"idx":2,"proposition":"Enteroscopy","correct":false,"justification":"False"},{"idx":3,"proposition":"A colonoscopy","correct":false,"justification":"False"},{"idx":4,"proposition":"A CT-TAP","correct":true,"justification":"True, this is the only indicated examination recommended in first line"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IVeinC-cardio-0","context":null,"enonce":"Regarding the veins of the lower limbs and varicose veins","item":"IVeinC","matiere":"cardio","propositions":[{"idx":0,"proposition":"The veins of both superficial and deep networks of the lower limbs are provided with valves","correct":true},{"idx":1,"proposition":"The superficial femoral vein is a deep proximal vein ","correct":true},{"idx":2,"proposition":"The popliteal vein is a distal vein","correct":false,"justification":"Proximal vein"},{"idx":3,"proposition":"Venous insufficiency is defined by obstruction of the venous system, with or without valve dysfunction","correct":false,"justification":"It's the opposite: Valvular dysfunction, with or without obstruction of the venous system"},{"idx":4,"proposition":"A varicose vein is defined by a permanent venous dilation of more than 3mm in orthostatism","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"IVeinC-cardio-1","context":null,"enonce":"Regarding chronic venous insufficiency","item":"IVeinC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Varicose veins affect 30 to 60% of the population of industrialized countries","correct":true},{"idx":1,"proposition":"Chronic venous insufficiency affects both men and women","correct":false,"justification":"4 times more women than men"},{"idx":2,"proposition":"Primary venous insufficiency is promoted by post-thrombotic syndrome","correct":false,"justification":"By definition, post-thrombotic syndrome is the cause of secondary venous insufficiency"},{"idx":3,"proposition":"Cockett syndrome refers to the compression of the left common iliac vein by a pelvic tumor, which can result in iliofemoral thrombosis. ","correct":false,"justification":"Compression of the left common iliac vein by the right common iliac artery"},{"idx":4,"proposition":"Obesity and constipation promote chronic venous insufficiency","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"IVeinC-cardio-2","context":null,"enonce":"Regarding chronic venous insufficiency","item":"IVeinC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Telangiectasia is defined by a diameter <1 mm","correct":true,"justification":"And a reticular vein by a diameter between 1 and 3 mm"},{"idx":1,"proposition":"Symptoms are aggravated by contact with the cold, when walking, or when elevating the legs","correct":false,"justification":"These symptoms are calmed by contact with the cold, when walking, or when raising the legs."},{"idx":2,"proposition":"The clinical examination of varicose veins is performed in the supine position","correct":false,"justification":"The clinical examination of varicose veins is performed in a standing position, at best on a platform with altered unipodal support, in order to highlight ambulatory venous hyperpressure"},{"idx":3,"proposition":"Venous ulcer is the most common cause of leg ulcer","correct":true},{"idx":4,"proposition":"Typically, the venous ulcer is perimalleolar, round or oval in shape, little algic","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IVeinC-cardio-3","context":null,"enonce":"Regarding chronic venous insufficiency","item":"IVeinC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Corona phlebectatica is a therapeutic emergency","correct":false,"justification":"This is a very early cutaneous clinical sign of venous insufficiency. Not to be confused with phlegmatia cerulea (ischemic DVT, therapeutic emergency)"},{"idx":1,"proposition":"Hemorrhagic ruptures of varicose veins are common","correct":false,"justification":"Classics but rare"},{"idx":2,"proposition":"Stasis dermohypodermatitis has an initial course by inflammatory flare-ups","correct":true,"justification":"Then sequelar sclerosis"},{"idx":3,"proposition":"Eczema secondary to venous stasis predominates in the upper 1\/3 of the leg","correct":false,"justification":"1\/3 lower"},{"idx":4,"proposition":"Atrophic dermatitis concerns advanced old venous insufficiency, and fears the occurrence of a venous ulcer","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IVeinC-cardio-4","context":null,"enonce":"Regarding chronic venous insufficiency","item":"IVeinC","matiere":"cardio","propositions":[{"idx":0,"proposition":"In case of septic venous thrombosis, class 2 venous compression is indicated","correct":false,"justification":"In this case, venous compression is contraindicated"},{"idx":1,"proposition":"Compressive bands should be preferred in case of venous ulcer","correct":true},{"idx":2,"proposition":"Compression should be worn within two months of an episode of deep vein leg thrombosis","correct":false,"justification":"Compression must be worn within two years, usually by Class II compression socks"},{"idx":3,"proposition":"In case of chronic venous insufficiency, and especially in the ulcer stage, venous restraint must be worn daily and for life","correct":true},{"idx":4,"proposition":"In cases of peripheral arterial disease (PAD), compression is contraindicated if the systolic pressure index (SPI) is less than 0.09","correct":false,"justification":"Compression is contraindicated if the systolic pressure index (SPI) is less than 0.5. It should be reduced to a maximum of 30 mmHg for patients with an SNI between 0.5 and 0.9"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"denutrition-nutri-0","context":null,"enonce":"Among these proposals, which are situations of lack of inputs?","item":"denutrition","matiere":"nutri","propositions":[{"idx":0,"proposition":"The young","correct":true},{"idx":1,"proposition":"Celiac disease","correct":false,"justification":"This is an increase in losses by malabsorption, according to the College of Nutrition (2019 edition, page 134)"},{"idx":2,"proposition":"Diabetes","correct":false,"justification":"Increased losses via urine"},{"idx":3,"proposition":"Post-stroke sequella swallowing disorders","correct":true},{"idx":4,"proposition":"Extensive burns","correct":false,"justification":"Increased protein losses via skin tissue"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"denutrition-nutri-1","context":null,"enonce":"Which of these proposals are situations of increased losses?","item":"denutrition","matiere":"nutri","propositions":[{"idx":0,"proposition":"Bedsores","correct":true,"justification":"Protein loss via damaged skin coating"},{"idx":1,"proposition":"Vomiting","correct":true},{"idx":2,"proposition":"Zenker's diverticulum","correct":false,"justification":"May cause an obstacle of the upper digestive tract, and therefore a limitation of the intake"},{"idx":3,"proposition":"Taking neurolpetics","correct":false,"justification":"May have as an adverse effect anorexia and therefore a decrease in intake"},{"idx":4,"proposition":"Nephrotic syndrome","correct":true,"justification":"Protein loss"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"denutrition-nutri-2","context":null,"enonce":"Which propositions are true?","item":"denutrition","matiere":"nutri","propositions":[{"idx":0,"proposition":"Lean mass is mainly represented by skeletal muscle","correct":true},{"idx":1,"proposition":"Lean body mass is the body's main protein store","correct":true},{"idx":2,"proposition":"The lean butse is the compartment most affected by nutrition","correct":true},{"idx":3,"proposition":"Fat mass disappears in case of malnutrition","correct":false,"justification":"The metabolism is protein in case of prolonged youth"},{"idx":4,"proposition":"Undernutrition affects the elderly only","correct":false,"justification":"Higher prevalence at the extreme ages of life (infants and the elderly) but also exists between the two"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"denutrition-nutri-3","context":null,"enonce":"Which propositions are true?","item":"denutrition","matiere":"nutri","propositions":[{"idx":0,"proposition":"A BMI below 16 indicates undernutrition","correct":true},{"idx":1,"proposition":"A BMI below 18.5 indicates undernutrition","correct":false,"justification":"He makes her suspect only"},{"idx":2,"proposition":"Unintentional weight loss of more than 5% in 6 months is a sign of undernutrition","correct":false},{"idx":3,"proposition":"An involuntary weight loss greater than or equal to 15% in 6 months is a sign of severe undernutrition","correct":true},{"idx":4,"proposition":"Without inflammatory syndrome, a serum albumin less than 50 g \/ L suggests severe malnutrition","correct":false,"justification":"The thresholds are 30 g\/L for undernutrition and 20 g\/L for severe undernutrition"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"secu-sp-0","context":null,"enonce":"Which of these proposals are social risks?","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"Motherhood","correct":true,"justification":"Includes social and medical benefits related to maternity"},{"idx":1,"proposition":"Housing","correct":true,"justification":"Housing allowances"},{"idx":2,"proposition":"Addiction","correct":true,"justification":"Personalized autonomy allowance (APA)"},{"idx":3,"proposition":"Sexual harassment","correct":false,"justification":"It is a crime. It is its consequences on employment or health that are social risks."},{"idx":4,"proposition":"Poverty","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"secu-sp-1","context":null,"enonce":"Which of these propositions are true?","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"Social protection refers to all collective pension schemes that enable individuals or households to cope financially with the consequences of social risks.","correct":true},{"idx":1,"proposition":"Social risks are situations that can lead to a decrease in resources or an increase in expenses within a household","correct":true},{"idx":2,"proposition":"In France, there is only one social protection body (unlike Germany or the USA)","correct":false,"justification":"There is not just one social protection body but several: mutual societies, private insurance, social security, etc."},{"idx":3,"proposition":"Social Security was founded in 1981 on the occasion of the election of Francois Mitterand","correct":false,"justification":"On 4 and 19 October 1945, two ordinances instituted \"an organization of Social Security intended to guarantee workers and their families against risks of any kind likely to reduce or eliminate their earning capacity\"."},{"idx":4,"proposition":"Social security is the main source of social protection.","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"secu-sp-2","context":null,"enonce":"Which of these propositions are true?","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"Social security consists of two main schemes: general and SNCF.","correct":false,"justification":"It consists of four main schemes: the general scheme the agricultural scheme the social scheme the special schemes for self-employed persons and civil servants (non-agricultural self-employed persons) 2.2. HISTORY-MAIN REFORMS"},{"idx":1,"proposition":"Social security is created in 1954","correct":false,"justification":"Creation in 1945 (ordinances of 4 and 19 October) according to 3 principles: Equal access to care Quality of care Solidarity"},{"idx":2,"proposition":"The 1967 ordinance saw the creation of the 3 autonomous branches: sickness, old age, family","correct":true},{"idx":3,"proposition":"80% of French people are covered by the general scheme","correct":true},{"idx":4,"proposition":"The CNAMTS manages the risk of maternity only","correct":false,"justification":"Manages sickness, maternity, disability, death and, as part of a separate management, occupational accidents"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"secu-sp-3","context":null,"enonce":"Regarding the organization of social security:","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"The sickness branch is managed by the CNAMTS only","correct":false,"justification":"CNAMTS, CPAM and CGSS"},{"idx":1,"proposition":"There are 166 CRAMs (1 for about 2 departments)","correct":false,"justification":"16"},{"idx":2,"proposition":"The old-age branch is managed by the CNAV and CARSAT","correct":true},{"idx":3,"proposition":"The family branch is managed by CAF and CNAF","correct":true},{"idx":4,"proposition":"The recovery branch is managed by the URSSAF","correct":false,"justification":"The URSSAF is responsible for collecting contributions and social contributions but it is the ACOSS that manages and coordinates the URSSAF\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"secu-sp-4","context":null,"enonce":"Regarding other schemes:","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"The agricultural scheme is managed by the MSA","correct":true,"justification":"The Mutualité Sociale Agricole"},{"idx":1,"proposition":"The agricultural scheme is a special scheme","correct":false,"justification":"3 types of special regimes: the civil service, public establishments and enterprises and 'others'"},{"idx":2,"proposition":"The RSI is the regime of computer scientists","correct":false,"justification":"This is the regime for the self-employed"},{"idx":3,"proposition":"The current trend is towards an increase in special diets","correct":false,"justification":"Rather to their decrease\/disappearance"},{"idx":4,"proposition":"The public service plan is managed by the IHR","correct":false,"justification":"The RSI is the regime for the self-employed\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"secu-sp-5","context":null,"enonce":"Concerning the different social protection schemes","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"The agricultural scheme covers material risks linked to the weather","correct":false,"justification":"It covers farmers and agricultural employees"},{"idx":1,"proposition":"The agricultural scheme is administered by the Ministry of Agriculture","correct":false,"justification":"It is managed by the Mutualité Sociale Agricole (MSA)"},{"idx":2,"proposition":"The MSA collects the contributions itself","correct":true},{"idx":3,"proposition":"The MSA operates as a \"one-stop shop\": all benefits (sickness, family, old age) are covered by the MSA","correct":true},{"idx":4,"proposition":"The IHR covers graphic designers and computer scientists","correct":false,"justification":"It covers craftsmen, traders, industrialists and liberal professions\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"secu-sp-6","context":null,"enonce":"Regarding the sources of financing of the social security system:","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"There are 5 sources of funding","correct":false,"justification":"There are 3: social contributions, taxes and public contributions"},{"idx":1,"proposition":"VAT contributes directly to the financing of social security","correct":false,"justification":"The taxes and taxes allocated to the financing of social security are: compulsory levies, general taxes, the CSG, the CRDS and taxes on alcohol, tobacco and medicines."},{"idx":2,"proposition":"Social contributions are paid directly to the Ministry of Health","correct":false,"justification":"Social contributions (employer and employee) are paid to the URSSAF"},{"idx":3,"proposition":"The CRDS was created in 1996","correct":true,"justification":"Its scope of levies is wider than that of the CSG"},{"idx":4,"proposition":"The CSG only concerns employees on permanent contracts","correct":false,"justification":"It concerns all the incomes of people living in France (including pensioners for example)\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"secu-sp-7","context":null,"enonce":"Concerning the different schemes and the financing of social protection","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"The IHR operates as a one-stop shop for collecting contributions and paying benefits.","correct":true},{"idx":1,"proposition":"The Social Security Financing Act has been in place since 1945","correct":false,"justification":"Established in 1996"},{"idx":2,"proposition":"The LFSS aims to control social and health spending","correct":true},{"idx":3,"proposition":"The National Health Insurance Expenditure Target (ONDAM) is approved by Parliament each year","correct":true},{"idx":4,"proposition":"In 2015, the expenditure of the various basic social security schemes was more than €500 billion.","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"secu-sp-8","context":null,"enonce":"Which of these costs are covered by the sickness branch of social security?","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"Disability-related costs","correct":true},{"idx":1,"proposition":"Thermal cures","correct":true},{"idx":2,"proposition":"Hospitalization costs","correct":true},{"idx":3,"proposition":"Laboratory tests","correct":true},{"idx":4,"proposition":"Transportation costs","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"secu-sp-9","context":null,"enonce":"Concerning the reimbursement of social protection","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"The social security deficit is of the order of 10 million euros per year","correct":false,"justification":"The deficit of the general scheme, for all risks, was 6.8 billion euros in 2015: This is the famous \"hole\" of the social security"},{"idx":1,"proposition":"The amount of the reimbursement is made on the basis of conventional or regulatory tariffs","correct":true},{"idx":2,"proposition":"The assumption of certain expenses is subject to the agreement of the medical officer of the CPAM","correct":true},{"idx":3,"proposition":"The co-payment is the amount covered by the mutual insurance company","correct":false,"justification":"Rest at the expense of the insured after reimbursement by !' Health insurance on the \"compulsory\" part"},{"idx":4,"proposition":"Co-payment applies to all reimbursable medical expenses","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"allergie-infectio-0","context":null,"enonce":"Which of the following is a type 2 reaction (according to Gell and Coombs)?","item":"allergie","matiere":"infectio","propositions":[{"idx":0,"proposition":"Immediate IgE-mediated hypersensitivity","correct":false,"justification":"This is type 1"},{"idx":1,"proposition":"Hypersensitivity due to IgM and IgG mediated cytotoxicity","correct":true,"justification":"True. Type 2 (drug allergy)"},{"idx":2,"proposition":"Hypersensitivity mediated by immune complexes","correct":false,"justification":"Type 3 (pneumonia)"},{"idx":3,"proposition":"Depot, T-cell mediated hypersensitivity","correct":false,"justification":"Type 4 (eczema)"},{"idx":4,"proposition":"Immediate IgG-mediated hypersensitivity","correct":false,"justification":"Type 1. It is mediated by IgE"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"allergie-infectio-1","context":null,"enonce":"Which of the following is a type 3 reaction (according to Gell and Coombs)?","item":"allergie","matiere":"infectio","propositions":[{"idx":0,"proposition":"Immediate IgE-mediated hypersensitivity","correct":false,"justification":"This is type 1"},{"idx":1,"proposition":"Hypersensitivity due to IgM and IgG mediated cytotoxicity","correct":false,"justification":"Type 2 (drug allergy)"},{"idx":2,"proposition":"Hypersensitivity mediated by immune complexes","correct":true,"justification":"True. Type 3 (pneumonia)"},{"idx":3,"proposition":"Depot, T-cell mediated hypersensitivity","correct":false,"justification":"Type 4 (eczema)"},{"idx":4,"proposition":"B-cell mediated hypersensitivity","correct":false,"justification":"These lymphocytes do not mediate any hypersensitivity reaction"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"allergie-infectio-2","context":null,"enonce":"Which of the following is a type 4 reaction (according to Gell and Coombs)?","item":"allergie","matiere":"infectio","propositions":[{"idx":0,"proposition":"Immediate IgE-mediated hypersensitivity","correct":false,"justification":"Type 1"},{"idx":1,"proposition":"Hypersensitivity due to IgM and IgG mediated cytotoxicity","correct":false,"justification":"Type 2 (drug allergy)"},{"idx":2,"proposition":"Hypersensitivity mediated by immune complexes","correct":false,"justification":"Type 3 (pneumonia)"},{"idx":3,"proposition":"Depot, T-cell mediated hypersensitivity","correct":true,"justification":"True. Type 4 (eczema)"},{"idx":4,"proposition":"Depot, B-lymphocyte-mediated hypersensitivity","correct":false,"justification":"These lymphocytes do not mediate any hypersensitivity reaction"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"allergie-infectio-3","context":null,"enonce":"Which of the following are true?","item":"allergie","matiere":"infectio","propositions":[{"idx":0,"proposition":"Atopy is a genetically determined ability to produce IgE against certain allergens","correct":true},{"idx":1,"proposition":"Sensitization is a positive reaction to a known allergen","correct":true},{"idx":2,"proposition":"Allergy is biological in definition","correct":false,"justification":"The definition of allergy is clinical. This is a manifestation of exposure to a sensitized allergen"},{"idx":3,"proposition":"The preferred treatment is the eviction of the allergen","correct":true},{"idx":4,"proposition":"Binet's classification makes it possible to differentiate the different mechanisms of immunological hypersensitivity","correct":false,"justification":"This is the classification of Gell and Coombs. Binet's classification is a prognostic score for CLL (Chronic Lymphocytic Leukemia)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"allergie-infectio-4","context":null,"enonce":"Which of the following is a type 1 reaction (according to Gell and Coombs)?","item":"allergie","matiere":"infectio","propositions":[{"idx":0,"proposition":"Immediate IgE-mediated hypersensitivity","correct":true,"justification":"True. This is type 1"},{"idx":1,"proposition":"Hypersensitivity due to IgM and IgG mediated cytotoxicity","correct":false,"justification":"Type 2 (drug allergy)"},{"idx":2,"proposition":"Hypersensitivity by immune complexes","correct":false,"justification":"Type 3 (pneumonia)"},{"idx":3,"proposition":"Depot, T-cell mediated hypersensitivity","correct":false,"justification":"Type 4 (eczema)"},{"idx":4,"proposition":"Hypersensitivity due to IgE-mediated cytotoxicity","correct":false,"justification":"It is mediated by IgG and IgM"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TS-urg-0","context":null,"enonce":"Which of the following are true?","item":"TS","matiere":"urg","propositions":[{"idx":0,"proposition":" 10% of HCW patients commit suicide ","correct":true},{"idx":1,"proposition":"Like any crisis, the suicidal crisis reflects a moment of rupture in the balance of the subject with himself and with his environment.","correct":true},{"idx":2,"proposition":"Support and closeness to family, a loved one, a spouse and social relationships are risk factors","correct":false,"justification":"These are protective factors"},{"idx":3,"proposition":"Never ask a patient if they are having suicidal thoughts, as there is a risk of encouraging them to do so.","correct":false},{"idx":4,"proposition":"The search for protective factors allows the identification of members of the patient's entourage who can be caregivers","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"TS-urg-1","context":null,"enonce":"Which of the following are true?","item":"TS","matiere":"urg","propositions":[{"idx":0,"proposition":" The most common mode of suicide is hanging ","correct":true},{"idx":1,"proposition":" The incidence of suicide increases with age, and men over 85 are the most affected ","correct":true},{"idx":2,"proposition":" The France is one of the most affected European countries, with 16.2 suicides per 100,000 inhabitants ","correct":true},{"idx":3,"proposition":"Women most often resort to drug autointoxication","correct":true},{"idx":4,"proposition":" Suicide is the act of deliberately killing oneself ","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"TS-urg-2","context":null,"enonce":"Which of the following are true?","item":"TS","matiere":"urg","propositions":[{"idx":0,"proposition":" 10% of HCW patients commit suicide ","correct":true},{"idx":1,"proposition":"Like any crisis, the suicidal crisis reflects a moment of rupture in the balance of the subject with himself and with his environment.","correct":true},{"idx":2,"proposition":"Support and closeness to family, a loved one, a spouse and social relationships are risk factors","correct":false,"justification":"These are protective factors"},{"idx":3,"proposition":"Never ask a patient if they are having suicidal thoughts, as there is a risk of encouraging them to do so.","correct":false},{"idx":4,"proposition":"The search for protective factors allows the identification of members of the patient's entourage who can be caregivers","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"TS-urg-3","context":null,"enonce":"Which of the following are true?","item":"TS","matiere":"urg","propositions":[{"idx":0,"proposition":" The most common mode of suicide is hanging ","correct":true},{"idx":1,"proposition":" The incidence of suicide increases with age, and men over 85 are the most affected ","correct":true},{"idx":2,"proposition":" The France is one of the most affected European countries, with 16.2 suicides per 100,000 inhabitants ","correct":true},{"idx":3,"proposition":"Women most often resort to drug autointoxication","correct":true},{"idx":4,"proposition":" Suicide is the act of deliberately killing oneself ","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"TS-urg-4","context":null,"enonce":"Which of the following are true?","item":"TS","matiere":"urg","propositions":[{"idx":0,"proposition":" 10% of HCW patients commit suicide ","correct":true},{"idx":1,"proposition":"Like any crisis, the suicidal crisis reflects a moment of rupture in the balance of the subject with himself and with his environment.","correct":true},{"idx":2,"proposition":"Support and closeness of family, relative, spouse and social relationships are risk factors","correct":false,"justification":"These are protective factors"},{"idx":3,"proposition":"Never ask a patient if they are having suicidal thoughts, as there is a risk of encouraging them to do so.","correct":false,"justification":"Clinical experience shows that asking the question usually has the effect of relieving the suicidal person, by offering to talk openly about suicide and to clearly express his suicidal ideations."},{"idx":4,"proposition":"The search for protective factors allows the identification of members of the patient's entourage who can be caregivers","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"TS-urg-5","context":null,"enonce":"Which of the following are true?","item":"TS","matiere":"urg","propositions":[{"idx":0,"proposition":"The most common mode of suicide is hanging ","correct":true},{"idx":1,"proposition":"Incidence of suicide increases with age","correct":true},{"idx":2,"proposition":"The France is one of the most affected European countries, with 16.2 suicides per 100,000 inhabitants ","correct":true},{"idx":3,"proposition":"Women most often resort to drug autointoxication","correct":true},{"idx":4,"proposition":"Suicide is the act of deliberately killing oneself","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"TS-urg-6","context":null,"enonce":"Which of the following are true?","item":"TS","matiere":"urg","propositions":[{"idx":0,"proposition":"Suicide is the leading cause of death for young adults (25-35 years) ","correct":true},{"idx":1,"proposition":"Suicide is the leading cause of death among adolescents (15-24 years)","correct":false,"justification":"This is the second, after trauma"},{"idx":2,"proposition":"There are about 10,000 suicides a year in France","correct":true},{"idx":3,"proposition":"There is about 1 suicide every 4 minutes","correct":false,"justification":"1 suicide every 40 minutes, 1 TS every 4 minutes"},{"idx":4,"proposition":"There is about 1 suicide attempt every 4 minutes","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TS-urg-7","context":null,"enonce":"Regarding suicide attempts:","item":"TS","matiere":"urg","propositions":[{"idx":0,"proposition":"Hospitalization is systematic in case of suicidal ideation","correct":false,"justification":"Hospitalization 🏥 occurs when UDR is elevated, if TS is proven, or when there is no viable alternative."},{"idx":1,"proposition":"Suicide by firearm is non-existent 🔫","correct":false,"justification":"It happens and they mostly concern adult men"},{"idx":2,"proposition":"Symptomatic treatments (hypnotics, sedatives, anxiolytics) are contraindicated in adolescents","correct":false,"justification":"They are not systematic, but possible"},{"idx":3,"proposition":"HCW recidivism rate is zero","correct":false,"justification":"40% in the year"},{"idx":4,"proposition":"None of the propositions are true","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TS-urg-8","context":null,"enonce":"Which of the following are true?","item":"TS","matiere":"urg","propositions":[{"idx":0,"proposition":"3.9% of the population had suicidal ideation (SDI) in the year.","correct":true},{"idx":1,"proposition":"There are 10,000 suicide attempts (HCPs) per year in France","correct":false,"justification":"10,000 suicides per year in France, 100,000 TS"},{"idx":2,"proposition":"Rigel's pre-suicidal syndrome corresponds to a state of deep calm before suicide","correct":true},{"idx":3,"proposition":"Suicidal ideation is impossible before 10 years 👦","correct":false,"justification":"Quite infrequent, but can appear as early as 5 years. The preferred means are hanging or defenestration."},{"idx":4,"proposition":"In adolescents, there are mainly IMVs (80% of cases)","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AES-infectio-0","context":null,"enonce":"During an EAS:","item":"AES","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is an accident at work","correct":true,"justification":"It must be declared as such"},{"idx":1,"proposition":"The risk of hepatitis B transmission is zero with effective vaccination","correct":true,"justification":"It is considered null and void."},{"idx":2,"proposition":"The risk of HIV transmission is 10%","correct":false,"justification":"This risk is estimated at 0.3%"},{"idx":3,"proposition":"The declaration of accident at work must be made within 72 hours","correct":false,"justification":"Within 48 hours maximum by the victim"},{"idx":4,"proposition":"The risk of HCV transmission is 45%","correct":false,"justification":"The overall risk is estimated at 3%"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AES-infectio-1","context":null,"enonce":"What are the first steps to take in case of EAS? ","item":"AES","matiere":"infectio","propositions":[{"idx":0,"proposition":"Washing with hydro-alcoholic solution","correct":false,"justification":"Cleaning with soap and water"},{"idx":1,"proposition":"Report the occupational disease within 48 hours","correct":false,"justification":"An accident at work is declared"},{"idx":2,"proposition":"Antiseptic rinsing should last 30 seconds","correct":false,"justification":"First, clean with soap and water. Then rinse with an antiseptic for several minutes. It is important that all patient cells that can be removed are removed."},{"idx":3,"proposition":"We go to the occupational medicine that will take care of us","correct":false,"justification":"Occupational medicine has a preventive and not curative role"},{"idx":4,"proposition":"Washing should be done with water and mild soap","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"AES-infectio-2","context":null,"enonce":"The risk of an ESA is significant if:","item":"AES","matiere":"infectio","propositions":[{"idx":0,"proposition":"The sting is deep","correct":true,"justification":"None"},{"idx":1,"proposition":"The needle is hollow","correct":true,"justification":"There are only 3 important risks: the needle is deep, the needle is hollow, and the needle is intramuscular (arterial or venous)"},{"idx":2,"proposition":"The needle is intramuscular ","correct":false,"justification":"The needle is intravascular (arterial or venous)"},{"idx":3,"proposition":"The cut is done with a scalpel","correct":false,"justification":"This is an intermediate risk"},{"idx":4,"proposition":"Mucocutaneous exposure with a contact time > 15 minutes","correct":false,"justification":"This is an intermediate risk"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AES-infectio-3","context":null,"enonce":"Regarding the ESA. Which of the following are true?","item":"AES","matiere":"infectio","propositions":[{"idx":0,"proposition":"The declaration of accident at work is mandatory within 24 hours","correct":false,"justification":"The declaration of work accident is mandatory within 48 hours"},{"idx":1,"proposition":"An initial medical certificate describing the injury and expressly stating that it is an accident with risk of HIV seroconversion is mandatory","correct":true,"justification":"None"},{"idx":2,"proposition":"Post-exposure treatment is 28 days","correct":true,"justification":"None"},{"idx":3,"proposition":"HCV seroconversion rate is 3%","correct":true,"justification":"None"},{"idx":4,"proposition":"The HIV seroconversion rate is 3%","correct":false,"justification":"The HIV seroconversion rate is 0.3%"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AES-infectio-4","context":null,"enonce":"The declaration of a compulsory work accident must be made in:","item":"AES","matiere":"infectio","propositions":[{"idx":0,"proposition":"24h","correct":false,"justification":"None"},{"idx":1,"proposition":"48h","correct":true,"justification":"None"},{"idx":2,"proposition":"72h","correct":false,"justification":"None"},{"idx":3,"proposition":"12:00","correct":false,"justification":"None"},{"idx":4,"proposition":"60h","correct":false,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AES-infectio-6","context":null,"enonce":"Regarding the cleaning of the wound following an accident of exposure to blood, which proposal(s) are true?","item":"AES","matiere":"infectio","propositions":[{"idx":0,"proposition":"The wound must be made to bleed","correct":false,"justification":"Absolutely not! This can create a capillary breach and promote infection by passing into the systemic circulation."},{"idx":1,"proposition":"Cleaning with running water and soap","correct":true,"justification":"We are looking for an effect of cleansing and elimination of organic matter brought by the accident"},{"idx":2,"proposition":"Cleaning with hydro-alcoholic solution","correct":false,"justification":"Cleaning with dakin soap or other..."},{"idx":3,"proposition":"Rinsing","correct":true,"justification":"None"},{"idx":4,"proposition":"Antisepsis: Bleach with 2.5% active chlorine diluted 1\/5 or 1\/10, Dakin solution, or failing that alcohol at 70 ° or polyvidone iodine, with a maximum contact of 5 minutes","correct":false,"justification":"It takes a contac of more than 5 minutes! The rest of the statement is true."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AES-infectio-7","context":null,"enonce":"Regarding the cleaning of the wound following an accident of exposure to blood, which proposal(s) are true?","item":"AES","matiere":"infectio","propositions":[{"idx":0,"proposition":"The wound must be made to bleed","correct":false,"justification":"Absolutely not! This can create a capillary breach and promote infection by passing into the systemic circulation."},{"idx":1,"proposition":"Cleaning with running water and soap","correct":true,"justification":"We are looking for an effect of cleansing and elimination of organic matter brought by the accident"},{"idx":2,"proposition":"Cleaning with hydro-alcoholic solution","correct":false,"justification":"Cleaning with dakin soap or other..."},{"idx":3,"proposition":"Rinsing","correct":true,"justification":"None"},{"idx":4,"proposition":"Antisepsis: Bleach with 2.5% active chlorine diluted 1\/5 or 1\/10, Dakin solution, or failing that alcohol at 70 ° or polyvidone iodine, with a maximum contact of 5 minutes","correct":false,"justification":"It takes a contac of more than 5 minutes! The rest of the statement is true."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AES-infectio-8","context":null,"enonce":"After an accident of exposure to blood with a high risk of HIV infection, the duration of TPE is:","item":"AES","matiere":"infectio","propositions":[{"idx":0,"proposition":"60 days","correct":false,"justification":"60 days"},{"idx":1,"proposition":"35 days","correct":false,"justification":"35 days"},{"idx":2,"proposition":"28 days","correct":true,"justification":"None"},{"idx":3,"proposition":"15 days","correct":false,"justification":"None"},{"idx":4,"proposition":"7 days","correct":false,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AES-infectio-9","context":null,"enonce":"Regarding HIV seroconversion rate","item":"AES","matiere":"infectio","propositions":[{"idx":0,"proposition":"The seroconversion rate is estimated to be 1% after insertive anal intercourse","correct":false,"justification":"The seroconversion rate is estimated to be 1% after susceptible anal intercourse"},{"idx":1,"proposition":"The seroconversion rate is estimated to be 1% after insertive vaginal intercourse","correct":false,"justification":"The seroconversion rate is estimated to be 0.1% after insertive vaginal intercourse"},{"idx":2,"proposition":"The seroconversion rate is estimated at 0.3% after an AES","correct":true},{"idx":3,"proposition":"The risk of HIV transmission through non-traumatic vaginal sex is zero when the infected partner is on antiretroviral therapy, an HIV load that has not been detectable for more than 6 months","correct":true},{"idx":4,"proposition":"The seroconversion rate is estimated to be 1% after susceptible anal intercourse","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"menopause-uro-0","context":null,"enonce":"General generalities:","item":"menopause","matiere":"uro","propositions":[{"idx":0,"proposition":"LAD (age-related androgen deficiency) is an age-associated biochemical syndrome,","correct":true},{"idx":1,"proposition":"LAD is consistent in men over 70","correct":false,"justification":"LAD is inconsistent although it is common (10–20% of men after age 50, and up to 50% after age 70)"},{"idx":2,"proposition":"The depth of LAD varies from one subject to another, and its onset is very gradual.","correct":true},{"idx":3,"proposition":"Decreasing nocturnal or morning erections is an essential call sign","correct":true},{"idx":4,"proposition":"During LAD, erectile dysfunction is functional in origin","correct":false,"justification":"Organic origin"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"menopause-uro-1","context":null,"enonce":"Which proposition(s) is\/are true?","item":"menopause","matiere":"uro","propositions":[{"idx":0,"proposition":"The erection is generally longer to obtain despite ever greater stimuli","correct":true},{"idx":1,"proposition":"Detumescence is slower","correct":false,"justification":"Detumescence is faster and the refractory phase lengthens"},{"idx":2,"proposition":"Libido does not drop, but abilities do","correct":false,"justification":"A decrease in libido should be sought during questioning, as well as a reduction in the frequency of sexual intercourse"},{"idx":3,"proposition":"The quality of orgasm remains the same but its occurrence is slower","correct":false,"justification":"An alteration in the quality of orgasm is sometimes associated with these disorders"},{"idx":4,"proposition":"Semen volume is increased most of the time","correct":false,"justification":"Rather, there is a reduction in volume and low sperm expulsion"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"menopause-uro-2","context":null,"enonce":"Regarding explorations:","item":"menopause","matiere":"uro","propositions":[{"idx":0,"proposition":"Sarcopenia is rare and never severe","correct":false,"justification":"The decrease in muscle mass corresponds to sarcopenia and can be severe (up to 40%) accompanied by muscle weakness"},{"idx":1,"proposition":"Skin atrophy eliminates the diagnosis of LAD","correct":false,"justification":"Goes with hormonal drop"},{"idx":2,"proposition":"It is recommended to try to perform a bioavailable testosterone assay","correct":true,"justification":"TRUE: Sex Hormone Binding Globulin (SHBG) and albumin must also be measured with total testosteronemia to estimate the bioavailable concentration"},{"idx":3,"proposition":"Total testosterone dosage cannot be used as a rough value for bioavailable testosterone","correct":false,"justification":"When this assay is not possible, the determination of total testosterone should be used as an approximate value of bioavailable testosterone."},{"idx":4,"proposition":"Testosterone dosage should be carried out in the evening at midnight","correct":false,"justification":"The dosage should be carried out between 8 a.m. and 10 a.m."}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"menopause-uro-3","context":null,"enonce":"Regarding support:","item":"menopause","matiere":"uro","propositions":[{"idx":0,"proposition":"A new dosage of bioavailable testosterone 2 to 4 weeks after the first is recommended","correct":true},{"idx":1,"proposition":"Advanced age (over 75 years) contraindicates treatments for LAAD","correct":false,"justification":"The patient should be treated if there are one or more deficiencies in the androgen-dependent systems and a lower than normal testosterone level. Age is not a contraindication at all."},{"idx":2,"proposition":"There is no pre-therapeutic assessment specific to the treatment","correct":false,"justification":"If. It includes prostate evaluation (IPSS score, digital rectal examination and total PSA assay), endocrine laboratory work (hematocrit, lipid profile, liver test, blood glucose) and bone densitometry in case of deep LAD or clinical call points"},{"idx":3,"proposition":"Treatment is based on the administration of natural testosterone to the patient until a plasma concentration is obtained as close as possible to physiological secretion.","correct":true},{"idx":4,"proposition":"The only possible route of administration of testosterone is IM","correct":false,"justification":"Transdermal or intramuscular according to the College of Urology (5th edition, page 239)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"EDC-psy-0","context":null,"enonce":"General information on the characterized depressive episode:","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"Depressive disorder is associated with a major suicidal risk","correct":true},{"idx":1,"proposition":"A depressive episode characterized is defined in particular by a break with the previous state","correct":true},{"idx":2,"proposition":"Symptoms must be present every day for 6 consecutive days","correct":false,"justification":"present almost every day for at least 2 consecutive weeks"},{"idx":3,"proposition":"The significant increase or decrease in weight or appetite is a symptom of a characterized depressive episode","correct":true},{"idx":4,"proposition":"Psychomotor slowdown is always present","correct":false,"justification":"agitation or psychomotor slowdown"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"EDC-psy-1","context":null,"enonce":"What symptoms are associated with the rupture of the previous state to define the characterized depressive episode?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"feelings of worthlessness or guilt","correct":true},{"idx":1,"proposition":"impaired concentration or indecision","correct":true},{"idx":2,"proposition":"Thoughts of death or suicidal","correct":true},{"idx":3,"proposition":"Hyperconcentration","correct":false,"justification":"Indecision or alteration of concentration"},{"idx":4,"proposition":"Hypersomnia","correct":true,"justification":"or insomnia"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"EDC-psy-2","context":null,"enonce":"Regarding the management of the characterized depressive state:","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"The only complication is the risk of suicide","correct":false,"justification":"Complications are mainly represented by the risk of suicide, socio-professional disintegration, depressive recurrences and psychiatric and non-psychiatric comorbidities"},{"idx":1,"proposition":"Drug treatments have no place in the management","correct":false,"justification":"For moderate to severe forms, drug treatment is always necessary: antidepressant (1st line SSRI) for at least 6 months"},{"idx":2,"proposition":"ECT is indicated in the most severe forms of depressive episode","correct":true},{"idx":3,"proposition":"Management is often combined with supportive psychotherapy","correct":true},{"idx":4,"proposition":"Characterized depressive disorder is a common psychiatric disorder associated with a high risk of suicide","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"EDC-psy-3","context":null,"enonce":"Regarding the epidemiology of the characterized depressive episode:","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"The characterized depressive episode is an isolated psychiatric disorder most often","correct":false,"justification":"The characterized depressive episode fits into different nosographic entities (characterized depressive disorder, bipolar disorder) or can be comorbid of another psychiatric disorder (anxiety disorders, addictive disorders) or a non-psychiatric disorder"},{"idx":1,"proposition":"The term \"depression\" corresponds in the current DSM-5 classification to the characterized depressive episode (formerly \"major depressive episode\")","correct":true},{"idx":2,"proposition":"WHO records more than 100 million cases of characterized depressive episodes worldwide each year.","correct":true},{"idx":3,"proposition":"30-50% of suicide attempts in France are secondary to a characterized depressive episode","correct":true},{"idx":4,"proposition":"The first characterized depressive episode occurs in adolescence most often","correct":false,"justification":"The first characterized depressive episode can occur at any age"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"EDC-psy-4","context":null,"enonce":"Regarding the presentation of the characterized depressive episode:","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"The first EDC occurs more frequently in young adults","correct":true},{"idx":1,"proposition":"It is more common in men","correct":false,"justification":"It is more common in women from adolescence with a sex ratio of 1\/2 (1 man to 2 women)"},{"idx":2,"proposition":"A depressive syndrome can be evoked in case of pathological sadness of mood and a drop in energy","correct":true},{"idx":3,"proposition":"It is one of the rare psychiatric pathologies whose interindividual variability of symptoms is almost zero.","correct":false,"justification":"It is characterized by a constellation of symptoms and signs, which varies from one subject to another."},{"idx":4,"proposition":"Psychomotor slowdown or agitation may alternate or be associated","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"EDC-psy-5","context":null,"enonce":"What symptoms are not compatible with a first EDC?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"Tachycardia","correct":false,"justification":"Possible neuro-vegetative sign. Congruent of anxiety"},{"idx":1,"proposition":"An asymmetrical abolition of reflexes","correct":true,"justification":"Must evoke a neurological differential diagnosis"},{"idx":2,"proposition":"Enuresia","correct":false,"justification":"Possible"},{"idx":3,"proposition":"An extension of RCP","correct":true,"justification":"Must have a pyramidal syndrome sought"},{"idx":4,"proposition":"A cogwheel","correct":true,"justification":"Must have extrapyramidal syndrome sought"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"EDC-psy-6","context":null,"enonce":"Which of these propositions are true?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"Negativism translates into active resistance exclusively","correct":false,"justification":"Both passive and active resistance"},{"idx":1,"proposition":"Anhedonia is an intense feeling of sadness","correct":false,"justification":"Anhedonia is the inability to feel emotions"},{"idx":2,"proposition":"Bradypsychia is the inability to express one's thoughts with fluidity","correct":false,"justification":"Bradypsychia is the slowness of reflection"},{"idx":3,"proposition":"Amoemia is the absence of the usual facial expression","correct":true},{"idx":4,"proposition":"Mutism is the voluntary loss of language","correct":false,"justification":"The absence of language is involuntary"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"EDC-psy-7","context":null,"enonce":"Regarding OCD:","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"First-line management is by CBT","correct":true,"justification":"SSRIs are to be reserved for chronic, resistant and disabling forms."},{"idx":1,"proposition":"The 'obsessive' part corresponds to the act of avoidance","correct":false,"justification":"Obsessive = thought. Compulsive = act in reaction to thought."},{"idx":2,"proposition":"The most recurring themes are the 'washer', the 'magician' and the 'recuperator'","correct":false,"justification":"Washer \/ Checker \/ Conjurer"},{"idx":3,"proposition":"It is a rare disorder, found in 3% of adolescents","correct":false,"justification":"OCD is considered common and is found in both adolescents and adults."},{"idx":4,"proposition":"SSRIs should be prescribed at a minimum dose","correct":false,"justification":"Doses are high or maximum for at least 12 weeks, and up to 2 years"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"EDC-psy-8","context":null,"enonce":"Regarding depression:","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"Melancholy is an EDC due to alcohol","correct":false,"justification":"It is a possible characteristic of EDC (such as psychotic, mixed, anxious, catatonic, etc.) that defines a maximum EDC, with major suicidal risk, deep sadness, etc."},{"idx":1,"proposition":"Cotard's syndrome is a delusional syndrome during a melancholic EDC","correct":true},{"idx":2,"proposition":"A mixed EDC finds a manic association","correct":true},{"idx":3,"proposition":"A catatonic EDC may regain echolalia or echopraxia","correct":true},{"idx":4,"proposition":"An EDC may be associated with a schizophrenic disorder","correct":true,"justification":"Psychiatric comorbidity is not uncommon"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"EDC-psy-9","context":null,"enonce":"In which pathologies is CBT psychotherapy indicated?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"The characterized depressive episode","correct":false,"justification":"Treatment of EDC = SSRIs + Supportive Psychotherapy"},{"idx":1,"proposition":"Phobic disorder","correct":true},{"idx":2,"proposition":"Le PTSD","correct":true},{"idx":3,"proposition":"Generalized anxiety disorder","correct":true},{"idx":4,"proposition":"Adjustment disorder","correct":false,"justification":"Not in first line given the short duration"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"EDC-psy-10","context":null,"enonce":"Regarding treatments for anxiety, which proposals are true?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"Hypnotics are contraindicated in adolescents","correct":true},{"idx":1,"proposition":"Hypnotics are potentiators of GABA","correct":true},{"idx":2,"proposition":"Zolpidem is a benzodiazepine","correct":false,"justification":"Zolpidem = Hypnotic"},{"idx":3,"proposition":"Oxazepam is the shortest-lived benzodiazepine","correct":true},{"idx":4,"proposition":"OSA is a relative contraindication to benzodiazepine","correct":false,"justification":"Absolute contraindication: severe respiratory failure, OSA, myasthenia gravis, hepatic impairment"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"EDC-psy-11","context":null,"enonce":"What symptoms lead to post-traumatic stress disorder?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"Flashbacks","correct":true},{"idx":1,"proposition":"Anxious ruminations ","correct":false,"justification":"Rather to classify in the symptoms of anxiety. The 3 symptoms of repetition syndrome are flashbacks, revivals and nightmares."},{"idx":2,"proposition":"Hypervigilence","correct":true},{"idx":3,"proposition":"Hallucinations","correct":true},{"idx":4,"proposition":"Sleep disorders","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"EDC-psy-12","context":null,"enonce":"Which of these proposals are found in post-traumatic stress disorder?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"Avoidance syndrome","correct":true},{"idx":1,"proposition":"Depressive syndrome","correct":false,"justification":"Is apart"},{"idx":2,"proposition":"Neuro-cognitive hyperactivation syndrome","correct":false,"justification":"This is neuro-vegetative hyperactivation syndrome"},{"idx":3,"proposition":"Avoidance syndrome","correct":true},{"idx":4,"proposition":"Heteroaggressive syndrome","correct":false,"justification":"Heteroaggressiveness is a consequence of PTSD"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"EDC-psy-13","context":null,"enonce":"Which of these proposals are predictive factors for EDC's recurrence?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"Female sex","correct":true},{"idx":1,"proposition":"The Late Age of the First EDC","correct":false,"justification":"Rather early age"},{"idx":2,"proposition":"A very low intensity of the first episode","correct":false,"justification":"A very high intensity of the first episode increases the risk of relapse"},{"idx":3,"proposition":"Non-psychiatric comorbidity","correct":true,"justification":"The sicker you are, the more likely you are to redo an EDC"},{"idx":4,"proposition":"EDC's Family History","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"EDC-psy-14","context":null,"enonce":"Which of the following proposals fall within the scope of diagnosing the characterized depressive episode?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"The feeling of omnipotence","correct":false,"justification":"Feelings of worthlessness or guilt"},{"idx":1,"proposition":"Impaired concentration or indecision","correct":true,"justification":"None"},{"idx":2,"proposition":"Thoughts of death or suicidal ","correct":true,"justification":"None"},{"idx":3,"proposition":"Lack of functional impact","correct":false,"justification":"Clinically significant suffering or impaired functioning"},{"idx":4,"proposition":"The absence of non-psychiatric medical causes and the absence of toxic causes ","correct":true,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"parasitedig-infectio-0","context":null,"enonce":"Which of the following are true about amoebose?","item":"parasitedig","matiere":"infectio","propositions":[{"idx":0,"proposition":"Hypereosinophilia","correct":false,"justification":"Not in ameobosis"},{"idx":1,"proposition":"It is due to Entamoeba histolytica","correct":true},{"idx":2,"proposition":"The intestinal form is accompanied by fever","correct":false,"justification":"No, this is the case with the hepatic form"},{"idx":3,"proposition":"Treatment of the intestinal form is based on Metronidazole and Tiliquinol ","correct":true,"justification":"True. Tiliquinol is a contact antiamibian"},{"idx":4,"proposition":"Hepatic form induces hyperneutrophilia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"parasitedig-infectio-1","context":null,"enonce":"Which of the following are true about oxyurosis?","item":"parasitedig","matiere":"infectio","propositions":[{"idx":0,"proposition":"Brain damage can be found","correct":false,"justification":"False, unlike cysticercosis (by tapeworm)"},{"idx":1,"proposition":"The worm involved is a nematode","correct":true,"justification":"True, i.e. it is a roundworm"},{"idx":2,"proposition":"The interrogation mainly finds a pruritus of the back","correct":false,"justification":"Pruritus is mostly anal"},{"idx":3,"proposition":"Storytelling is important","correct":true,"justification":"True, especially in children"},{"idx":4,"proposition":"Treatment is based on Albendazole","correct":true,"justification":"True, as for ascariasis"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"parasitedig-infectio-3","context":null,"enonce":"Which of the following propositions are true concerning Giardiosis?","item":"parasitedig","matiere":"infectio","propositions":[{"idx":0,"proposition":"The protozoan involved is Giardia duodenalis","correct":true},{"idx":1,"proposition":"It is always symptomatic","correct":false,"justification":"Often asymptomatic"},{"idx":2,"proposition":"Diagnosis is based on serology","correct":false,"justification":"It is based on parasitological stool examination (PSE) and PCR"},{"idx":3,"proposition":"Treatment is based on Ivermectin","correct":false,"justification":"Metronidazole PO 5 days"},{"idx":4,"proposition":"The examination does not find fever","correct":true,"justification":"True. There are loose stools without fever"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"parasitedig-infectio-4","context":null,"enonce":"Which of the following propositions are true about ascariases?","item":"parasitedig","matiere":"infectio","propositions":[{"idx":0,"proposition":"The worms concerned are plathelmintes","correct":false,"justification":"They are nemathelmintes"},{"idx":1,"proposition":"Worms are visible only under a confocal 🔬 microscope","correct":false,"justification":"Visible to the naked eye"},{"idx":2,"proposition":"A bioclinical Löffler syndrome can be observed","correct":true,"justification":"True. Löffler syndrome or Loeffler syndrome, is characterized by the presence of parahilar or subclavicular pulmonary infiltrates, labile, most often related to mechanical and allergic phenomena secondary to the presence of parasite larvae in the pulmonary alveoli. These radiological images are associated with blood eosinophilia."},{"idx":3,"proposition":"Treatment is based on Metronidazole","correct":false,"justification":"Treatment is based on Albendazole PO (or Flubendazole PO)"},{"idx":4,"proposition":"Hypereosinophilia can be found","correct":true,"justification":"True, but it is rare"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"suivivalv-cardio-0","context":null,"enonce":"Concerning the monitoring of vascular prosthesis wearers","item":"suivivalv","matiere":"cardio","propositions":[{"idx":0,"proposition":"Mechanical heart valves require definitive anticoagulant treatment with vitamin K (risk of thrombosis of the prosthetic valve) and therefore expose to the risks of this treatment","correct":true},{"idx":1,"proposition":"Mechanical valves have excellent durability","correct":true},{"idx":2,"proposition":"Biological valves are most often animal valves (especially pigs)","correct":true},{"idx":3,"proposition":"The biological prosthesis does not require anticoagulants beyond the 3rd post-operative month","correct":true},{"idx":4,"proposition":"The durability of biological prostheses is poor","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"suivivalv-cardio-1","context":null,"enonce":"Concerning the monitoring of vascular prosthesis wearers","item":"suivivalv","matiere":"cardio","propositions":[{"idx":0,"proposition":"There is a major risk of infective endocarditis (IE) regardless of the type of prosthesis, mechanical or biological,","correct":true},{"idx":1,"proposition":"Thromboembolic complications are the most common complications of prosthetic valves","correct":true},{"idx":2,"proposition":"Thromeboembolic complications are more common in the first year after surgery, before endothelialization of the prosthesis, but the risk persists beyond","correct":true},{"idx":3,"proposition":"The risk is lower for mitral prostheses than for aortic prostheses","correct":false},{"idx":4,"proposition":"Embolisms are most often cerebral","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"suivivalv-cardio-2","context":null,"enonce":"Concerning the monitoring of vascular porthesis carrier","item":"suivivalv","matiere":"cardio","propositions":[{"idx":0,"proposition":"Hospitalization for emergency reoperation is required for valve change in case of acute denture thrombosis","correct":true},{"idx":1,"proposition":"In case of prosthesis dysfunction of lesser gravity, the patient will have to be reoperated in a deliasis of one month","correct":false,"justification":"In case of less serious prosthesis dysfunction, anticoagulant treatment should be rebalanced with transient transition to heparin if necessary"},{"idx":2,"proposition":"The differential diagnosis of prosthetic thrombosis with infective endocarditis is sometimes difficult, especially since a fever is possible in prosthesis thrombosis","correct":true},{"idx":3,"proposition":"The diagnosis of disinsertion of a porthesis is made by the ETT and especially by the ETO:","correct":true},{"idx":4,"proposition":"Postoperative mediastinitis is one of the leading causes of early mortality from valve surgery","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"suivivalv-infectio-0","context":null,"enonce":"Concerning the survival of vascular prosthesis wearers","item":"suivivalv","matiere":"infectio","propositions":[{"idx":0,"proposition":"Mechanical heart valves require definitive anticoagulant treatment, by vitamin K or LMWH and therefore exposing to the risks of this treatment","correct":false,"justification":"No MA for LMWH in this indication. However, they remain an \"acceptable alternative\" in practice."},{"idx":1,"proposition":"Mechanical valves have excellent durability and should, in principle, last the patient's entire life.","correct":true,"justification":"This is the principle of mechanical valves versus biological valves."},{"idx":2,"proposition":"Biological valves are, most often, animal valves (pigs in particular)","correct":true,"justification":"For biological valves, bovine pericardium or porcine aortic valve can also be used."},{"idx":3,"proposition":"The biological prosthesis does not require anticoagulants beyond the 3rd post-operative month.","correct":true},{"idx":4,"proposition":"The durability of biological prostheses of the order of 55 years","correct":false,"justification":"10-20 years of lifespan (varies according to sources)"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"suivivalv-infectio-1","context":null,"enonce":"Concerning the monitoring of vascular prosthesis wearers","item":"suivivalv","matiere":"infectio","propositions":[{"idx":0,"proposition":"There is a major risk of infective endocarditis (IE) regardless of the type of prosthesis, mechanical or biological,","correct":true},{"idx":1,"proposition":"Thromboembolic complications are among the most common complications of prosthetic valves","correct":true,"justification":"Especially the 1st post-operative year."},{"idx":2,"proposition":"Thromboembolic complications are more common in the first year after surgery, before endothelialization of the prosthesis, but the risk persists beyond","correct":true},{"idx":3,"proposition":"The risk is lower for mitral prostheses than for aortic prostheses","correct":false,"justification":"The risk is higher: for mitral prostheses (which operate at low pressures) than for aortic prostheses; for antique prostheses than for double-finned prostheses; in case of atrial fibrillation (AF), or left ventricular dysfunction"},{"idx":4,"proposition":"Embolisms are most often cerebral","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"suivivalv-infectio-2","context":null,"enonce":"Concerning the monitoring of vascular prosthesis wearers","item":"suivivalv","matiere":"infectio","propositions":[{"idx":0,"proposition":"Hospitalization for emergency reoperation is required for valve change in case of acute denture thrombosis","correct":true},{"idx":1,"proposition":"In case of less serious prosthesis dysfunction, the patient should be reoperated within one month","correct":false,"justification":"In case of less serious prosthesis dysfunction, anticoagulant treatment should be rebalanced with transient transition to heparin if necessary"},{"idx":2,"proposition":"The differential diagnosis of prosthesis thrombosis with infective endocarditis is sometimes difficult, especially since a fever is possible in prosthesis thrombosis","correct":true},{"idx":3,"proposition":"The diagnosis of disinsertion of a prosthesis is made by the ETT and especially by the ETO","correct":true},{"idx":4,"proposition":"Postoperative mediastinitis is one of the leading causes of early mortality from valve surgery","correct":true,"justification":"20% of deaths"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"suivivalv-infectio-3","context":null,"enonce":"Concerning the monitoring of vascular prosthesis wearers","item":"suivivalv","matiere":"infectio","propositions":[{"idx":0,"proposition":"All anticoagulants are authorized in bioprostheses from 3 months post-op as part of a non-valvular indication (e.g. AF)","correct":true,"justification":"Even AODs"},{"idx":1,"proposition":"For mechanical valves and bioprostheses, cardiac Doppler ultrasound monitoring is done every 1 to 2 years","correct":false,"justification":"For mechanical valves: every 1 to 2 years \/ For bioprostheses: at M3, 1 year, 5 years and then every year if there is no sign of degradation or infection."},{"idx":2,"proposition":"It is unnecessary to prescribe an antiplatelet agent in the case of a post-op thromboembolic complication under effective INR.","correct":false,"justification":"Antiplatelet indications: if TAVI (lifetime), if stent placement or thromboembolic complications under effective INR."},{"idx":3,"proposition":"There is no self-measurement of the INR to date.","correct":false,"justification":"CoaguCheck (same principle as the blood glucose monitoring device): 50% of patients use it"},{"idx":4,"proposition":"The fibrous Pannis is an atrial connective tissue covering the aortic prosthesis and performing extravalvular stenosis.","correct":false,"justification":"Atrial connective tissue if mitral valve, ventricular connective tissue if aortic valve."}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"ACG-immuno-0","context":null,"enonce":"Among these proposals, which are symptoms that can be found in case of Horton's disease?","item":"ACG","matiere":"immuno","propositions":[{"idx":0,"proposition":"Diplopia","correct":true},{"idx":1,"proposition":"Hyperesthesia of the scalp","correct":true},{"idx":2,"proposition":"A sign of the Shopping Cart","correct":false,"justification":"It can be found in osteoarthritis or shrinking lumbar canal syndrome"},{"idx":3,"proposition":"A sign from Claude Bernard Hoerner","correct":false,"justification":"CBH = ptosis, myosis, enophthalmos. It is found in case of involvement of the sympathetic pupillary territory homolateral to the symptoms and has nothing to do with GCAs."},{"idx":4,"proposition":"Temporal or occipital headaches","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"ACG-immuno-1","context":null,"enonce":"Among these proposals, which are symptoms that can be found in case of Horton's disease?","item":"ACG","matiere":"immuno","propositions":[{"idx":0,"proposition":"A NOIAA","correct":true,"justification":"Acute anterior ischemic optic neuropathy"},{"idx":1,"proposition":"A non-ischemic NORB","correct":false,"justification":"Non-ischemic NORB = nerve damage = sign of MS"},{"idx":2,"proposition":"Transient amaurosis","correct":true,"justification":"It is transient blindness. Patients describe a falling veil. It's painless"},{"idx":3,"proposition":"Occlusion of the branches of the retinal artery","correct":false,"justification":"Not branches, only central artery"},{"idx":4,"proposition":"An indomitable migraine","correct":false,"justification":"There are no migraines, but temporo-occipital headaches"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"ACG-immuno-2","context":null,"enonce":"What organs can be affected by Horton's disease when isolated?","item":"ACG","matiere":"immuno","propositions":[{"idx":0,"proposition":"Kidneys","correct":false,"justification":"No renal damage classically"},{"idx":1,"proposition":"The brain","correct":true,"justification":"Headache"},{"idx":2,"proposition":"The lymphatic network","correct":false,"justification":"This is not described in the College of Internal Medicine"},{"idx":3,"proposition":"EMBs","correct":false,"justification":"Not described"},{"idx":4,"proposition":"Lungs","correct":true,"justification":"Chronic cough"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"ACG-immuno-3","context":null,"enonce":"Regarding temporal artery biopsy:","item":"ACG","matiere":"immuno","propositions":[{"idx":0,"proposition":"It is carried out in strict condition of asepty in the operating room","correct":false,"justification":"Is done, conventionally, in the service (with satisfactory conditions of asepsis of course)"},{"idx":1,"proposition":"It is done under general anesthesia","correct":false,"justification":"A simple local anesthesia is sufficient, as during sutures in the emergency room."},{"idx":2,"proposition":"It is done before any corticosteroid therapy","correct":false,"justification":"Biopsy should not delay starting treatment, especially if eye signs occur"},{"idx":3,"proposition":"It must be long enough, more than 1 cm","correct":true},{"idx":4,"proposition":"In some cases, ultrasound may be preferred.","correct":true,"justification":"Ultrasound gives interesting results, but there is greater inter-operator variability"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"opacitetho-pneumo-0","context":null,"enonce":"Which of the following are true?","item":"opacitetho","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Peripheral lesions are generally not accessible in bronchial endoscopy","correct":true,"justification":"Bronchial endoscopy = paramedian lesions"},{"idx":1,"proposition":"Diagnosis of peripheral lesions is based on CT","correct":false,"justification":"Diagnosis of peripheral lesions is based on transparietal needle puncture"},{"idx":2,"proposition":"The diagnostic discussion is based on the location of the lesion in one of the 2 mediastinal compartments","correct":false,"justification":"There are 9 lodges in the mediastinum"},{"idx":3,"proposition":"CT scan is the key examination for anterior and middle mediastinum masses","correct":true},{"idx":4,"proposition":"Ultrasound is the reference examination for the diagnosis of masses of the posterior mediastinum","correct":false,"justification":"This is MRI for masses of the posterior mediastinum"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"opacitetho-pneumo-1","context":null,"enonce":"Which of the following proposals favor the benignity of a micronodule?","item":"opacitetho","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Only biology makes it possible to have a diagnosis of certainty.","correct":false,"justification":"Only pathology (histology) can"},{"idx":1,"proposition":"Weak PET fixation","correct":true},{"idx":2,"proposition":"The absence of evolution at 2 years","correct":true},{"idx":3,"proposition":"Irregular contours","correct":false,"justification":"Malignancy criteria: high size, irregular contours, spiculate, attractants"},{"idx":4,"proposition":"Localized in the upper lobes","correct":false,"justification":"Malignancy criterion"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"opacitetho-pneumo-2","context":null,"enonce":"Which of the following are true?","item":"opacitetho","matiere":"pneumo","propositions":[{"idx":0,"proposition":"A micronodule is less than 3 mm in size","correct":true},{"idx":1,"proposition":"A mass has a size greater than 3\r\ncm","correct":true},{"idx":2,"proposition":"A mass has a size greater than 30\r\ncm","correct":false,"justification":"3 cm"},{"idx":3,"proposition":"A nodule is between 30 mm and 3 cm","correct":false,"justification":"Between 3 mm and 3 cm"},{"idx":4,"proposition":"A nodule is between 3 mm and 13 cm","correct":false,"justification":"Between 3 mm and 3 cm"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbsommeil-pneumo-0","context":null,"enonce":"Regarding sleep apnea syndrome","item":"tbsommeil","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Sleep Apnea Syndrome (SAS) is a real public health problem","correct":true},{"idx":1,"proposition":"It is an underdiagnosed condition","correct":true},{"idx":2,"proposition":"OSA mainly results in the presence of nocturnal hypersomnia and nocturnal snoring in a patient who is frequently overweight but","correct":false,"justification":"OSA mainly results in the presence of daytime hypersomnia and nocturnal snoring in a patient who is frequently but not systematically overweight."},{"idx":3,"proposition":"The diagnosis of certainty is based on polygraphy during sleep","correct":true},{"idx":4,"proposition":"Continuous positive airway pressure (CPAP) treatment with the nasal mask is the most effective treatment for OSA","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbsommeil-pneumo-1","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The effectiveness of CPAP treatment is conditioned by initial therapeutic education as well as by the quality of its adherence and patient follow-up _ _","correct":true},{"idx":1,"proposition":"Central sleep apnea syndrome (SACS) and periodic ventilation which are due to instability of the ventilatory control during sleep and which is observed in particular in advanced respiratory insufficiency","correct":false,"justification":"Central sleep apnea syndrome (SACS) and periodic ventilation which are due to instability of ventilatory control during sleep and which is observed in particular in advanced heart failure"},{"idx":2,"proposition":"OSA and SACS have a very different nocturnal oximetry profile","correct":false,"justification":"OSA and SACS have a similar nocturnal oximetry profile"},{"idx":3,"proposition":"Pure alveolar hypoventilation manifests itself in oximetry by deep and sustained desaturations, most often contemporary with REM sleep periods","correct":true},{"idx":4,"proposition":"A central appnea is the cessation of the naso-oral airflow for at least 10 seconds with no ventilatory efforts during apnea","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbsommeil-pneumo-2","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Mixed apnea begins as a central apnea and ends with breathing efforts","correct":true},{"idx":1,"proposition":"The severity of OSA is based on AHI or apnnea index is hypopnea","correct":true},{"idx":2,"proposition":"We talk about severe OSA for an AHI ≥ 60","correct":false,"justification":"Severe OSA is called for AHI ≥ 30 The importance of daytime sleepiness should also be considered in assessing severity."},{"idx":3,"proposition":"Obesity, especially abdominal obesity, is a major risk factor for OSA","correct":true},{"idx":4,"proposition":"There is no parallelism between the prevalence of obsity and the severity of OSA","correct":false,"justification":"The prevalence of OSA increases with the severity of obesity (60-80% of morbidly obese patients have OSA)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbsommeil-psy-0","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"psy","propositions":[{"idx":0,"proposition":"The prescription of hypnotic is recommended as a first-line treatment in the treatment of chronic insomnia in adults","correct":false,"justification":"Hypnotic prescription is not recommended as a first-line treatment for chronic insomnia in adults"},{"idx":1,"proposition":"The prescription of hypnotic should only be done for a short time in the context of transient acute insomnia","correct":true},{"idx":2,"proposition":"The presence of restless legs syndrome should systematically be sought in front of a complaint of chronic insomnia with difficulty falling asleep in adults","correct":true},{"idx":3,"proposition":"Obstructive sleep apnea syndrome should always be evoked in the face of a complaint of excessive daytime sleepiness and snoring","correct":true},{"idx":4,"proposition":"Severe drowsiness in young subjects should suggest central hypersomnia","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbsommeil-psy-1","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"psy","propositions":[{"idx":0,"proposition":"Normal sleep occurs at night, it lasts on average 7 to 8 hours, with large interindividual variations","correct":true,"justification":"It is suspected that these inter-individual variations are largely genetic."},{"idx":1,"proposition":"The reference test for the study of sleep is the EEG during sleep","correct":false,"justification":"The reference examination for the study of sleep is polysomnography"},{"idx":2,"proposition":"The alternation of sleep cycles can be visualized by means of the hypnogram","correct":true},{"idx":3,"proposition":"The complaint of insomnia is extremely common in the general population: 30% of adults have experienced transient insomnia during their lifetime, and 10% chronic insomnia","correct":true},{"idx":4,"proposition":"Prevalence is higher in males and increases with age","correct":false,"justification":"Prevalence is higher in women and increases with age"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbsommeil-psy-2","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"psy","propositions":[{"idx":0,"proposition":"The diagnosis of insomnia is clinical","correct":true},{"idx":1,"proposition":"Insomnia is a subjective complaint that is not defined by the objective duration of sleep","correct":true},{"idx":2,"proposition":"Insomnia must be responsible for a negative daytime impact on the subject's activities","correct":true,"justification":"It is associated with functional symptoms"},{"idx":3,"proposition":"Actimetry is a tool that makes it possible to assess sleep-wake rhythms under standardized conditions","correct":false,"justification":"This tool makes it possible to appreciate sleep-wake rhythms in ecological conditions"},{"idx":4,"proposition":"The drug approach is the first-line treatment for chronic insomnia","correct":false,"justification":"The non-drug approach is the first-line treatment for chronic insomnia"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbsommeil-psy-3","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"psy","propositions":[{"idx":0,"proposition":"Insomnia disorder must be distinguished from the insomnia 'symptom', which is then one of the clinical manifestations of another etiology.","correct":true},{"idx":1,"proposition":"Symptoms such as dyspnea, pollakiuria, gastroesophageal reflux, or pain can cause sleep disorders","correct":true,"justification":"The sleep disorder is then secondary"},{"idx":2,"proposition":"Restless Legs Syndrome (RLS) is most often associated with a complaint of sudden awakenings in the early morning","correct":false,"justification":"Restless Legs Syndrome (RLS) is most often associated with a complaint of insomnia falling asleep and maintaining"},{"idx":3,"proposition":"The diagnosis of restless legs syndrome is clinical and defined by the presence of unpleasant sensations in the legs responsible for an irrepressible need to mobilize them.","correct":true},{"idx":4,"proposition":"Electromyogram of the lower limbs reveals numerous abnormalities in restless legs syndrome","correct":false,"justification":"An electromyogram of the lower limbs is not indicated to explore an RLS, if performed it reveals no abnormality"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbsommeil-psy-4","context":null,"enonce":"Which propositions are true?","item":"tbsommeil","matiere":"psy","propositions":[{"idx":0,"proposition":"Treatment of insomniac disorder relies on CBT","correct":true},{"idx":1,"proposition":"The prescription of hypnotic is not recommended as a first-line treatment in the treatment of chronic insomnia in adults.","correct":true},{"idx":2,"proposition":"The prescription of hypnotic is contraindicated in case of insomnia in adults","correct":false,"justification":"It should only be done for a short time in the context of transient acute insomnia."},{"idx":3,"proposition":"OSA only affects adolescents over the age of 16","correct":false,"justification":"They can also be found in children"},{"idx":4,"proposition":"Narcolepsy is central hypersomnia","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbsommeil-psy-5","context":null,"enonce":"Regarding sleep physiology: ","item":"tbsommeil","matiere":"psy","propositions":[{"idx":0,"proposition":"The homeostatic, accumulative process increases throughout wakefulness and decreases during sleep.","correct":true},{"idx":1,"proposition":"There are two processes: C and S","correct":true,"justification":"Circadian and HomeoStatic"},{"idx":2,"proposition":"The biological clock is located in the basal ganglia","correct":false,"justification":"It is located in the suprachiasmatic nuclei"},{"idx":3,"proposition":"The biological clock modulates states of alertness but also other parameters including hormonal secretions, internal temperature, cell division cycles and mood.","correct":true},{"idx":4,"proposition":"The ultradian rhythm of alertness is faster than the circadian rhythm","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"tbsommeil-psy-6","context":null,"enonce":"Which of these proposals are included in sleep polysomnography?","item":"tbsommeil","matiere":"psy","propositions":[{"idx":0,"proposition":"ECG","correct":false,"justification":"There is a monitor of cardiorespiratory parameters but not as advanced as an ECG"},{"idx":1,"proposition":"EMG","correct":true},{"idx":2,"proposition":"EOG","correct":true},{"idx":3,"proposition":"EEG","correct":true},{"idx":4,"proposition":"Video recording","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"tbsommeil-psy-7","context":null,"enonce":"Regarding the types of sleep:","item":"tbsommeil","matiere":"psy","propositions":[{"idx":0,"proposition":"There are two main types of sleep: slow wave sleep and deep sleep.","correct":true,"justification":"Slow wave sleep, on the other hand, ranges from light to deep."},{"idx":1,"proposition":"Slow wave sleep is characterized by increased EEG activity","correct":false,"justification":"On the contrary, in slow-wave sleep, EEG activity gradually decreases"},{"idx":2,"proposition":"REM sleep is characterized by an EEG state close to wakefulness","correct":true},{"idx":3,"proposition":"Slow-wave sleep accounts for more than 50% of total sleep","correct":true},{"idx":4,"proposition":"REM sleep is accompanied by rapid eye movements","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbsommeil-psy-8","context":null,"enonce":"Which propositions are true?","item":"tbsommeil","matiere":"psy","propositions":[{"idx":0,"proposition":"The alternation of sleep cycles can be visualized by means of the hypnogram.","correct":true},{"idx":1,"proposition":"There are 5 stages of slow-wave sleep","correct":false,"justification":"3 stages of slow wave sleep: light, moderate, deep."},{"idx":2,"proposition":"30% of the general population complains of chronic insomnia.","correct":false,"justification":"0.1"},{"idx":3,"proposition":"The sleep agenda is conventionally done over 3 nights","correct":false,"justification":"Several weeks"},{"idx":4,"proposition":"Polysomnography is not recommended when exploring primary insomnia.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbsommeil-neuro-0","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"neuro","propositions":[{"idx":0,"proposition":"Slow-wave sleep is subdivided into three stages, of increasing depth, defined on ECG criteria.","correct":false,"justification":"Slow wave sleep is subdivided into three stages, of increasing depth, defined on EEG criteria"},{"idx":1,"proposition":"The amount of slow delta waves during sleep reflects the depth of sleep and is regulated in a homeostatic way","correct":true},{"idx":2,"proposition":"Circadian sleep pressure is highest between 1 a.m. and 5 a.m.","correct":true},{"idx":3,"proposition":"Serotonin is the main hormone regulating chronobiological rhythms","correct":false,"justification":"Melatonin is the main hormone regulating chronobiological rhythms"},{"idx":4,"proposition":"Insomnia is dissatisfaction with the quantity or quality of sleep with daytime repercussions","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbsommeil-neuro-1","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"neuro","propositions":[{"idx":0,"proposition":"Insomnia can be secondary to a psychiatric pathology","correct":true},{"idx":1,"proposition":"Psychophysiological insomnia is the most common primary chronic insomnia","correct":true},{"idx":2,"proposition":"Treatment of insomnia in children and adolescents should be etiological","correct":true},{"idx":3,"proposition":"In children and infants, the therapeutic approach is often behavioral and educational in first line","correct":true},{"idx":4,"proposition":"Drug treatments are often overprescribed and should be avoided","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbsommeil-neuro-2","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"neuro","propositions":[{"idx":0,"proposition":"The main differential diagnosis is circadian rhythm phase delay which can be confused with insomnia of sleep initiation or falling asleep.","correct":true},{"idx":1,"proposition":"Regardless of the nosological framework used, the diagnosis and evaluation of insomnia is essentially based on the questioning of the patient","correct":true},{"idx":2,"proposition":"Sleep aggenda is an essential tool for the assessment of insomnia and its management","correct":true},{"idx":3,"proposition":"The sleep diary often highlights discrepancies between the patient's overall appreciation of his sleep disorders and their reality.","correct":true},{"idx":4,"proposition":"Actimetric recording makes it possible to establish the activity-rest rhythm over several weeks","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbsommeil-neuro-3","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"neuro","propositions":[{"idx":0,"proposition":"Polysomnography in the laboratory is still necessary for diagnosis","correct":false,"justification":"Laboratory polysomnography Not necessary for diagnosis but indicated punctually to eliminate a specific etiology including"},{"idx":1,"proposition":"Melatonin is a hypnotic substance","correct":false,"justification":"It also exerts a hypnogenic effect but should not be considered a hypnotic substance"},{"idx":2,"proposition":"Immediate-release melatonin can be used to improve sleep-onset insomnia at night","correct":true},{"idx":3,"proposition":"Extended-release melatonin (Circadin®) may be used to improve sleep-maintaining insomnia (intrasleep wakefulness)","correct":true},{"idx":4,"proposition":"Hypnotics are indicated in the treatment of transient or occasional insomnia for a limited time","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"deuil-psy-0","context":null,"enonce":"Regarding definitions:","item":"deuil","matiere":"psy","propositions":[{"idx":0,"proposition":"Grief is a physiological process","correct":true},{"idx":1,"proposition":"Persistent complex bereavement is the persistence, for more than 12 months (or 6 months for children), of severe and disabling psychiatric symptoms.","correct":true},{"idx":2,"proposition":"Psychiatric disorders occurring during bereavement have a specific management","correct":false,"justification":"When a psychiatric disorder is identified as a result of bereavement, in particular a characterized depressive episode, it should be managed in the same way as if it had occurred in another context."},{"idx":3,"proposition":"Grief corresponds to the reactions that the body develops as a result of the announcement of the death of a person we have already met","correct":false,"justification":"Definition Grief refers to the reactions: * emotional, * cognitive, * behavioral, * and sociocultural, to the loss by death of a loved one to whom one was significantly attached (such as a parent, a spouse, a friend)"},{"idx":4,"proposition":"It is classic to distinguish 3 phases in the grieving process","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"deuil-psy-1","context":null,"enonce":"Which propositions are true?","item":"deuil","matiere":"psy","propositions":[{"idx":0,"proposition":"Grief is a stressor that exposes to biological, psychological and social changes","correct":true},{"idx":1,"proposition":"Bereavement is a risk factor for the occurrence of decompensations of existing pathologies","correct":true},{"idx":2,"proposition":"Psychological reactions usually disappear within a few hours","correct":false},{"idx":3,"proposition":"Children don't feel grief","correct":false,"justification":"Grief in children and adolescents may manifest as a moderate initial reaction, and then they experience the full effects later"},{"idx":4,"proposition":"The impact of grief is purely psychiatric in children","correct":false,"justification":"The child may also manifest polymorphic symptoms of cognitive appearance (regression in acquisitions for example) or non-psychiatric (enuresis for example)"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"deuil-psy-2","context":null,"enonce":"Which proposals are correct?","item":"deuil","matiere":"psy","propositions":[{"idx":0,"proposition":"The elderly are no longer at risk of pathological bereavement from the age of 60","correct":false,"justification":"The elderly are particularly at risk of a marked depressive episode and the risk of suicide is all the higher as one ages, especially in men"},{"idx":1,"proposition":"Despite the pain of grief, most people adapt to the loss and cravings of the deceased and continue to live satisfactorily.","correct":true},{"idx":2,"proposition":"Normal grief lasts on average 1 to 2 week(s)","correct":false,"justification":"Normal grief lasts on average 2 to 3 months, but will depend on the bond of attachment that united the bereaved to the deceased, the age of the deceased, and the circumstances of the death"},{"idx":3,"proposition":"Persistent complex grief occurs when a subject has experienced the death of a loved one and has clinically significant symptoms after more than one year.","correct":true},{"idx":4,"proposition":"The characteristic symptoms of persistent complex grief are those of nostalgia related to the state of withdrawal of the deceased and invasive ruminations","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vaccin-sp-0","context":null,"enonce":"Concerning vaccination","item":"vaccin","matiere":"sp","propositions":[{"idx":0,"proposition":"Subcutaneous vaccination is done in the deltoid region","correct":true},{"idx":1,"proposition":"Flu vaccination can be done without a doctor's prescription","correct":true},{"idx":2,"proposition":"Attenuated vaccines are most often effective at a single dose, whereas inactivated vaccines must be administered multiple times.","correct":true},{"idx":3,"proposition":"Measles, mumps and rubella vaccine is an inactivated vaccine","correct":false,"justification":"These are attenuated live vaccines"},{"idx":4,"proposition":"Contraindications of vaccination should be systematically sought","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vaccin-sp-1","context":null,"enonce":"Concerning vaccination","item":"vaccin","matiere":"sp","propositions":[{"idx":0,"proposition":"Live vaccines are generally contraindicated in cases of congenital or acquired immunosuppression.","correct":true},{"idx":1,"proposition":"Serious complications of vaccination are exceptional","correct":true},{"idx":2,"proposition":"The hepatitis B vaccine is a mandatory vaccine","correct":true,"justification":"Mandatory since the law of 1 January 2018"},{"idx":3,"proposition":"The measles, mumps and rubella vaccine is a mandatory attenuated vaccine before 2 years of age","correct":true,"justification":"Since January 2018, vaccination against tuberculosis is mandatory and helps prevent severe forms of the disease"},{"idx":4,"proposition":"No proposition is true","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vaccin-sp-2","context":null,"enonce":"Concerning vaccination","item":"vaccin","matiere":"sp","propositions":[{"idx":0,"proposition":"Pneumocooccal vaccination is recommended for all children before 2 years of age","correct":true},{"idx":1,"proposition":"Flu vaccination is recommended from November to March (to be done as soon as possible)","correct":true},{"idx":2,"proposition":"Vacciantion against pneumococcus is strongly recommended in spelonectomized subjects","correct":true},{"idx":3,"proposition":"BCG is a live attenuated vaccine","correct":true},{"idx":4,"proposition":"The flu vaccine is an attenuated live vaccine","correct":false,"justification":"It is an inactivated vaccine"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vaccin-infectio-0","context":null,"enonce":"Concerning vaccination","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"proposition":"The vaccines provide protection against a large number of serious diseases for non-existent or benign side effects","correct":true},{"idx":1,"proposition":" Vaccination not only prevents the vaccinated person from the disease, but also prevents the circulation of the disease in the population, provided that vaccination coverage is sufficient.","correct":true},{"idx":2,"proposition":" Live vaccines usually do not need a booster; they are contraindicated in immunocompromised patients","correct":true},{"idx":3,"proposition":"Tenuated vaccines require several administrations close together during primary vaccination","correct":false},{"idx":4,"proposition":" Polysaccharide vaccines (pneumococcus, meningococcus, Haemophilus influenzae, Salmonella typhi) are more effective in their so-called \"conjugate\" form, which should be preferred","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vaccin-infectio-1","context":null,"enonce":"Concerning vaccination","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Vaccination is active immunoprophylaxis","correct":true},{"idx":1,"proposition":"Serotherapy is an active humoral immunoprophylaxis","correct":false,"justification":"Serotherapy is passive humoral immunoprophylaxis"},{"idx":2,"proposition":"Vaccine provides immediate but transient protection","correct":false},{"idx":3,"proposition":"Pneumococcal vaccines and most meningococcal vaccines have several antigenic valences of the pathogen, allowing vaccination against several serogroups","correct":true},{"idx":4,"proposition":"Attenuated vaccines produce rapid protection is durable","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vaccin-infectio-2","context":null,"enonce":"Concerning vaccination and catching up on vaccinations","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Only conjugate vaccines can eliminate carriage (pharyngeal for example for pneumococcus)","correct":true},{"idx":1,"proposition":"The subcutaneous route is generally more effective than the intramuscular route","correct":false,"justification":"The intramuscular route is generally more effective than the subcutaneous route"},{"idx":2,"proposition":"In an adult or child of unknown vaccination status, a complete age-sensitive regimen is delayed at the outset.","correct":true},{"idx":3,"proposition":"For diphtheria and tetanus, we can use the anti-tetanus antibody assay after a 1st injection: if the titer is high, the subject has already been vaccinated and we can schedule a booster at the ages provided for in the schedule","correct":true},{"idx":4,"proposition":"All vaccines are given SC or IM (in the deltoid), except BCG (intradermal)","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vaccin-infectio-3","context":null,"enonce":"Which of the following are recommended vaccines for splenectomized patients?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Pneumococcal vaccine","correct":true,"justification":"True, encapsulated germ"},{"idx":1,"proposition":"Seasonal influenza vaccine","correct":true,"justification":"True, patient at risk of severe form"},{"idx":2,"proposition":"Haemophilus vaccine","correct":true,"justification":"True, encapsulated germ"},{"idx":3,"proposition":"Meningococcal vaccine","correct":true,"justification":"True, encapsulated germ"},{"idx":4,"proposition":"Covid19 vaccine","correct":true,"justification":"True, patient at risk of severe form"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vaccin-infectio-4","context":null,"enonce":"At 3 months, which vaccines have been injected?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"proposition":"rubella","correct":false,"justification":"M12 and M16-18"},{"idx":1,"proposition":"mumps","correct":false,"justification":"M12 and M16-18"},{"idx":2,"proposition":"measles","correct":false,"justification":"M12 and M16-18"},{"idx":3,"proposition":"hepatitis B","correct":true},{"idx":4,"proposition":"Poliomyelitis ","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vaccin-infectio-5","context":null,"enonce":"Which of the following proposals are contraindicated in immunocompromised patients (CD4 < 200)?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"proposition":"MMR vaccine","correct":true,"justification":"True, live attenuated IC vaccine if CD4 < 200"},{"idx":1,"proposition":"Tuberculosis vaccine (BCG)","correct":true,"justification":"True, always CI in HIV patients with CD4 < 200"},{"idx":2,"proposition":"DTP vaccine","correct":false,"justification":"Inert vaccine"},{"idx":3,"proposition":"Leptospirosis vaccine","correct":false,"justification":"Inert vaccine"},{"idx":4,"proposition":"Pertussis vaccine","correct":false,"justification":"Internal vaccine"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vaccin-infectio-6","context":null,"enonce":"At what ages is it recommended to inject the pertussis vaccine?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"proposition":"2 months ","correct":true,"justification":"True, 1st dose"},{"idx":1,"proposition":"4 months","correct":true,"justification":"True, 2nd dose"},{"idx":2,"proposition":"11 months","correct":true,"justification":"True, reminder"},{"idx":3,"proposition":"16-18 months","correct":false,"justification":"16-18 months: MMR (2nd dose)"},{"idx":4,"proposition":"3 years","correct":false,"justification":"No vaccine at 3 years"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vaccin-infectio-7","context":null,"enonce":"Which of the following are mandatory vaccines in the second month of life?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"proposition":"DTPaP","correct":true,"justification":"True. 2 months, 4 months, 11 months (booster) and 6 years (booster)"},{"idx":1,"proposition":"Haemophilus inflenzae B","correct":true,"justification":"True. 2 months, 4 months, 11 months (booster)"},{"idx":2,"proposition":"MMR","correct":false,"justification":"To M12 and M16-18"},{"idx":3,"proposition":"Meningococcal C","correct":false,"justification":"To M5 and M12"},{"idx":4,"proposition":"Pneumococcus","correct":true,"justification":"True. M2, M4, M11 (reminder)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IVG-gyn-1","context":null,"enonce":"Regarding abortion and the morning-after pill:","item":"IVG","matiere":"gyn","propositions":[{"idx":0,"proposition":"The Veil law is definitively renewed from 1979","correct":true},{"idx":1,"proposition":"The doctor must obtain the authorization of one of the two parents which is mandatory","correct":false,"justification":"The doctor must endeavour to obtain the authorization of one of the parents or the legal representative, or verify that this has been done during the social consultation. But this authorization is not mandatory. However, the minor must be accompanied by an adult."},{"idx":2,"proposition":"In the absence of parental consent, an abortion may be performed solely by an adult accompanied by an adult.","correct":true},{"idx":3,"proposition":"If the person is a foreigner, the abortion can only be performed if he or she has been living in France for more than 3 months.","correct":false,"justification":"For foreign women: abortion is no longer subject to any condition of duration and regularity of stay in France"},{"idx":4,"proposition":"The law requires pharmacists to dispense the morning-after pill free of charge to minors","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IVG-gyn-2","context":null,"enonce":"Concerning reception facilities:","item":"IVG","matiere":"gyn","propositions":[{"idx":0,"proposition":"The reception centre must ensure a correct reception with respect for confidentiality","correct":true},{"idx":1,"proposition":"Abortion care facilities operate seasonally","correct":false,"justification":"Structures must ensure fast deadlines with weekly operation all year round"},{"idx":2,"proposition":"An abortion can only be performed in an establishment with a surgical technical platform","correct":false,"justification":"Up to 12 weeks, they can be carried out in a simple sound establishment with a gynecology-obstetrics department"},{"idx":3,"proposition":"Abortions must be taken care of in a structure with a surgical technical platform when they are between 12 and 14 SA","correct":true},{"idx":4,"proposition":"Reception centers are required, by the HAS, to have at least one ultrasound machine with a vaginal probe","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"IVG-gyn-3","context":null,"enonce":"Regarding abortion in practice:","item":"IVG","matiere":"gyn","propositions":[{"idx":0,"proposition":"Anyone requesting an abortion must get a consultation appointment within 30 days of their call","correct":false,"justification":"Within 5 days of his call"},{"idx":1,"proposition":"The earlier abortion occurs during pregnancy, the lower the risk of complications","correct":true},{"idx":2,"proposition":"Access to abortion must therefore be simple and fast in all circumstances","correct":true},{"idx":3,"proposition":"Abortions require 24-hour hospitalization for monitoring and psychological support","correct":false,"justification":"Except in exceptional cases, abortions must be performed on an outpatient basis or in a day hospital (stay of less than 12 hours). This in a concern for confidentiality in particular"},{"idx":4,"proposition":"A psychosocial interview is systematically offered for adults","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"IVG-gyn-4","context":null,"enonce":"Which propositions are true?","item":"IVG","matiere":"gyn","propositions":[{"idx":0,"proposition":"The psychosocial interview is mandatory for adults","correct":false,"justification":"It is not mandatory but it is proposed"},{"idx":1,"proposition":"Psychosocial retention is compulsory for minors","correct":true},{"idx":2,"proposition":"We must try to understand the reasons for the failure of current contraception or its absence","correct":true},{"idx":3,"proposition":"Gestational age is deduced from the interrogation or ultrasound","correct":true},{"idx":4,"proposition":"The subsequent contraceptive method must be prescribed from the visit preceding the abortion","correct":false,"justification":"It is discussed and discussed, but it is by no means mandatory (neither to prescribe it, nor that the patient accepts it)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IVG-gyn-5","context":null,"enonce":"Regarding the initial consultation:","item":"IVG","matiere":"gyn","propositions":[{"idx":0,"proposition":"The cooling-off period is 7 days and must be respected in all circumstances","correct":false,"justification":"There is no longer a mandatory reflection period of 7 days (or 48 hours) between the two consultations."},{"idx":1,"proposition":"All propositions are true","correct":false,"justification":""},{"idx":2,"proposition":"All patients should have Rhesus groupage and RAI","correct":true},{"idx":3,"proposition":"If Rhesus is positive, a prophylactive injection of anti-D gamma globulins should be performed","correct":false,"justification":"If the Rhesus is negative, a prevention of Rhesus immunization by an injection of gamma globulins anti-D, should be carried out at the time of the act"},{"idx":4,"proposition":"The initial certificate of request for abortion must be given to the patient if the doctor agrees to perform the abortion","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"IVG-gyn-6","context":null,"enonce":"Regarding the second abortion consultation:","item":"IVG","matiere":"gyn","propositions":[{"idx":0,"proposition":"The second consultation is carried out 21 days after the initial consultation","correct":false,"justification":"7 days after the initial consultation, which corresponds to the cooling-off period"},{"idx":1,"proposition":"The patient must confirm the abortion request in writing during the second consultation","correct":true},{"idx":2,"proposition":"If the patient is a minor, she must present the certificate of social maintenance","correct":true},{"idx":3,"proposition":"The second consultation is when the abortion is performed","correct":false,"justification":"This is a confirmatory consultation. Abortion is performed at the third consultation"},{"idx":4,"proposition":"A surgical abortion can do without a pre-anhesthesic consultation since anhesthesia is local","correct":false,"justification":"Pre-anesthetic consultation necessary in case of surgical abortion. They are also not reserved for general anesthesia."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IVG-gyn-8","context":null,"enonce":"Concerning abortion techniques","item":"IVG","matiere":"gyn","propositions":[{"idx":0,"proposition":"Post-abortion consultation is done between the 14th and 21st day after the act","correct":true},{"idx":1,"proposition":"It is impossible to perform an abortion under general anesthesia","correct":false,"justification":"In all cases where possible, women must be able to choose the technique, medical or surgical, as well as the mode of anesthesia, local or general."},{"idx":2,"proposition":"Surgery involves dilation of the cervix and evacuation of uterine contents by aspiration","correct":true},{"idx":3,"proposition":"A medicated cervical preparation can help with cervical dilation in surgical technique","correct":true},{"idx":4,"proposition":"The medical technique is based on the combination of antiprogesterone and prostaglandins","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"usagemedic-therapeutique-0","context":null,"enonce":"Which of the following are complications of low molecular weight heparins?","item":"usagemedic","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Thrombocytopenia","correct":true},{"idx":1,"proposition":"Decreased creatinine","correct":true},{"idx":2,"proposition":"Skin necrosis","correct":true,"justification":"True, at the injection site. Patients are therefore asked to vary the injection sites as much as possible."},{"idx":3,"proposition":"Hemolytic anemia","correct":false,"justification":"Not described"},{"idx":4,"proposition":"Neutrophilia","correct":false,"justification":"Not described"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"usagemedic-therapeutique-1","context":null,"enonce":"Which of the following are drug causes of MAT?","item":"usagemedic","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"NSAIDs","correct":false,"justification":"Functional IR, glomerular involvement and allergic nephritis"},{"idx":1,"proposition":"Interferon","correct":false,"justification":"Glomerular involvement"},{"idx":2,"proposition":"Clopidogrel","correct":true},{"idx":3,"proposition":"Ciclosporin","correct":true},{"idx":4,"proposition":"Mycophenolic acid","correct":false,"justification":"No kidney damage"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"usagemedic-therapeutique-2","context":null,"enonce":"Which of the following are drug causes of functional renal failure?","item":"usagemedic","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Paracetamol","correct":false,"justification":"Hepatic elimination"},{"idx":1,"proposition":"IEC","correct":true,"justification":"True, by inhibition of vasoconstriction of efferent arteriole"},{"idx":2,"proposition":"Cisplatin","correct":false,"justification":"Renal organ failure due to direct tubular toxicity"},{"idx":3,"proposition":"NSAIDs","correct":true},{"idx":4,"proposition":"Diuretics","correct":true,"justification":"True, not hypovolemia"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"epidemio-sp-0","context":null,"enonce":"Regarding general information on epidemiological investigations:","item":"epidemio","matiere":"sp","propositions":[{"idx":0,"proposition":"Epidemiology is a discipline that deals with health problems within a population","correct":true,"justification":"TRUE. This is the description given in the Public Health KB"},{"idx":1,"proposition":"An experiment is any investigation where the attribution of exposure is controlled by the proponent alone.","correct":false,"justification":"An experiment is any investigation where the attribution of exposure is controlled by the investigator."},{"idx":2,"proposition":"In epidemiology, studies are most often experimental","correct":false,"justification":"They are rare in epidemiology because the exposure of subjects to a particular factor often cannot be controlled."},{"idx":3,"proposition":"Experimental studies may or may not be randomized","correct":true},{"idx":4,"proposition":"Observational surveys are very rare in epidemiology","correct":false,"justification":"Observational surveys are often the only possible ones. Their interpretation is often more difficult, but they have the advantage of reflecting more faithfully the real situation of the subjects of a population.\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"epidemio-sp-1","context":null,"enonce":"Regarding observational epidemiology:","item":"epidemio","matiere":"sp","propositions":[{"idx":0,"proposition":"Prevalence is a parameter from analytical epidemiology","correct":false,"justification":"Descriptive epidemiology, incidence and evolution"},{"idx":1,"proposition":"Incidence is a parameter from evaluative epidemiology","correct":false,"justification":"Descriptive epidemiology, prevalence and evolution"},{"idx":2,"proposition":"The cohort study is part of analytical epidemiology","correct":true},{"idx":3,"proposition":"There are 2 types of observational epidemiology: descriptive and analytical","correct":false,"justification":"3: descriptive, analytical and evaluative"},{"idx":4,"proposition":"There are 3 types of analytical studies: cohorts, case-controls and cross-sectional studies","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"pathogeria-geria-1","context":null,"enonce":"Among these proposals, which ones designate markers of fragility of the elderly?","item":"pathogeria","matiere":"geria","propositions":[{"idx":0,"proposition":"Programmed weight loss","correct":false,"justification":"A marker of fragility only when it is involuntary"},{"idx":1,"proposition":"A muscle test < 3\/5","correct":false,"justification":"It's pathological when it's so pathological. But decreased grip strength (with normal testing) is a marker"},{"idx":2,"proposition":"Sedentary lifestyle","correct":true},{"idx":3,"proposition":"Poor endurance","correct":true},{"idx":4,"proposition":"Accelerated walking speed","correct":false,"justification":"It is slowed down"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"pathogeria-geria-2","context":null,"enonce":"Regarding the cork model:","item":"pathogeria","matiere":"geria","propositions":[{"idx":0,"proposition":"The 1 concerns the decompensating factor","correct":false,"justification":"Physiological aging"},{"idx":1,"proposition":"The 2 corresponds to the chronic disease","correct":true},{"idx":2,"proposition":"The 2 corresponds to acute stress","correct":false,"justification":"It's the 3"},{"idx":3,"proposition":"The 3 corresponds to physiological aging","correct":false,"justification":"Acute stress = Decompensating factor"},{"idx":4,"proposition":"The 2 corresponds to the decompensating factor","correct":false,"justification":"3"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"securisation-sp-1","context":null,"enonce":"Regarding the PACTE:","item":"securisation","matiere":"sp","propositions":[{"idx":0,"proposition":"It is the Certified Advancement Program in Technical and Experience","correct":false,"justification":"This is the Continuous Improvement Program of Teamwork"},{"idx":1,"proposition":"It is proposed by the Ministry of Health","correct":false,"justification":"By the HAS (sorry for the trap)"},{"idx":2,"proposition":"The primary issue is patient safety","correct":true},{"idx":3,"proposition":"The primary challenge is to reduce EIAS to an acceptable level.","correct":true,"justification":"i.e. to ensure patient safety"},{"idx":4,"proposition":"It was proposed in 1996","correct":false,"justification":"2015"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"securisation-sp-2","context":null,"enonce":"Regarding team accreditation","item":"securisation","matiere":"sp","propositions":[{"idx":0,"proposition":"Debriefing is the short sharing of information before team action","correct":false,"justification":"Debriefing: Short information sharing after the team action."},{"idx":1,"proposition":"Team accreditation has been launched by the ANSM","correct":false,"justification":"Launched by the HAS"},{"idx":2,"proposition":"Physician accreditation involves an evaluative component and a cognitive component","correct":true},{"idx":3,"proposition":"Team accreditation is complemented by a collective work dimension","correct":true},{"idx":4,"proposition":"Team accreditation has been launched by the HAS","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"recherche-sp-1","context":null,"enonce":"Regarding the formulation of the scientific question:","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"It must respect the PACOTI elements","correct":false,"justification":"This is PICOT, for P = study population, I = the type of intervention, C = the comparison group, O = outcome (= outcome) and T = type of study"},{"idx":1,"proposition":"There must be an element of comparison\/control","correct":true},{"idx":2,"proposition":"The outcome must be clear","correct":true},{"idx":3,"proposition":"The population studied may be vague (for example: seniors)","correct":false,"justification":"The type of population must be extremely well detailed."},{"idx":4,"proposition":"The design of the study is chosen according to the question","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"recherche-sp-2","context":null,"enonce":"Regarding literature search and Clinical Research Methodology hypotheses","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"HO: alternative hypothesis (which we wish to reject)","correct":false,"justification":"HO: null hypothesis"},{"idx":1,"proposition":"H1: alternative hypothesis that we wish to demonstrate","correct":true},{"idx":2,"proposition":"Documentary research is a process of identifying relevant information","correct":true},{"idx":3,"proposition":"Literature search should aim for completeness","correct":true},{"idx":4,"proposition":"The formulation of the research question is an essential step","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"recherche-sp-3","context":null,"enonce":"Which of these proposals are secondary sources of information?","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"Nature Medicine","correct":false,"justification":"Primary source"},{"idx":1,"proposition":"The HAS","correct":true,"justification":"Produces professional recommendations"},{"idx":2,"proposition":"The ANSM","correct":true,"justification":"Produces professional recommendations on the use of the drug"},{"idx":3,"proposition":"NICE in the United States","correct":false,"justification":"NICE is in England. It is indeed a secondary source (equivalent to HAS)"},{"idx":4,"proposition":"AHRQ in England","correct":false,"justification":"The AHRQ is in the USA. It is indeed a secondary source (equivalent to HAS)\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"recherche-sp-4","context":null,"enonce":"Which of these proposals are part of 'grey literature'?","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"The INSERM journal","correct":false,"justification":"It is a secondary source"},{"idx":1,"proposition":"Conference proceedings","correct":true},{"idx":2,"proposition":"BMJ Summaries","correct":false,"justification":"It is a primary source"},{"idx":3,"proposition":"Publications of learned societies","correct":false,"justification":"It is a secondary source"},{"idx":4,"proposition":"Government documents","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"recherche-sp-5","context":null,"enonce":"Concerning the bibliographic search of Methodology in clinical research","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"The primary sources are the recommendations of the HAS (in France)","correct":false,"justification":"Primary sources are accessible reports Either in the form of a summary in electronic banks: study, data Or in full by the search of the periodical (paid access most often)"},{"idx":1,"proposition":"Accessibility to primary sources is extremely simple (internet search)","correct":false,"justification":"Accessibility to primary sources is problematic: cost of subscriptions, time needed for research, need for training, etc. 2.3.2. Secondary sources"},{"idx":2,"proposition":"Secondary sources convey information directly from research laboratories","correct":false,"justification":"Secondary sources convey information previously digested by an intermediary Syntheses, literature reviews, meta-analyses, professional recommendations The intermediaries are mainly:"},{"idx":3,"proposition":"The journal Prescrire is independent of the pharmaceutical industry","correct":true},{"idx":4,"proposition":"\"Grey literature\" refers to publications funded by the pharmaceutical industry","correct":false,"justification":"The search for \"grey literature\": literature not indexed in conventional channels of information dissemination (congresses, government documents, unpublished studies, other unconventional documents)\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"recherche-sp-7","context":null,"enonce":"Which of these propositions are true?","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"OPHANET is a research server on diseases concerning orphans","correct":false,"justification":"Open access rare disease and orphan drug information server for professionals and the general public"},{"idx":1,"proposition":"ORPHANET is a non-scientifically validated portal set up by patients","correct":false,"justification":"Global Reference Portal on Rare Diseases"},{"idx":2,"proposition":"Comprehensive and effective keyword research is important to find relevant results","correct":true},{"idx":3,"proposition":"Reading the summaries of the publications allows you to make a first sort","correct":true},{"idx":4,"proposition":"The abundance of references requires a critical mind at all times","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"recherche-sp-9","context":null,"enonce":"Regarding the different types of research","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"Routine care research is a type of non-interventional research","correct":false,"justification":"Intervention research because there are specific monitoring modalities"},{"idx":1,"proposition":"Biomedical research is a type of intervention research","correct":true},{"idx":2,"proposition":"Biomedical research focuses on health products only","correct":false,"justification":"May also include things other than health products"},{"idx":3,"proposition":"Biomedical research involves action on the person","correct":true,"justification":"It is a type of intervention research"},{"idx":4,"proposition":"Randomized controlled tests (RCTs) are interventional","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"recherche-sp-10","context":null,"enonce":"Which of these propositions are true?","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"Sample research is generally non-interventional","correct":true},{"idx":1,"proposition":"Data research is generally non-interventional","correct":true},{"idx":2,"proposition":"Biomedical research is carried out on human beings with a view to developing biological or medical knowledge","correct":true},{"idx":3,"proposition":"Biomedical research involves sick people only","correct":false,"justification":"Involves an action on the person (healthy or sick) who habitually takes care of modifies the RESEARCH"},{"idx":4,"proposition":"Routine care research is an assessment of current medical practices","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"recherche-sp-12","context":null,"enonce":"Which of these propositions are true?","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"The preclinical phase takes place in vitro (cells or cell cultures) and\/or in vivo (animal)","correct":true},{"idx":1,"proposition":"Clinical trials are organized in 3 phases","correct":false,"justification":"Clinical trials are organized in 4 phases (see table) In total, 10 to 15 years are needed for the research and development of a new drug. PHASES OF THE CLINICAL TRIAL POPULATION OBJECTIVES l F#iB PHASE I PHASE IL Healthy volunteers ■ Safety (maximum tolerated dose) Small number in some (Patients ■ Toxicity cases, in ■ Pharmacokinetics oncology for example) Patients (effective dose) Small number ■ Pharmacodynamics ■ Efficacy PHASE Ill Patients Large comparative number ■ Efficacy ■ Toxicity Ratio ■ benefit\/risk PHASE IV General population ■ Pharmacovigilance of new ■ Research After MA indications = study of the fate of the drug in the body: absorption, metabolism, pharmacokinetics distribution and elimination Pharmacodynamics Toxicity MA = Authorization = side effects of Marketing = effect of the drug on the body 0 (.9 LJ. J a: (.9 LJ. J a: CO 0 z a: LJ. J > in z 0 fC = 0 LJ. J @ 228 ITEM 18 1 THE METHODOLOGY OF EXPERIMENTAL AND CLINICAL RESEARCH 4.2. REGULATORY FRAMEWORK FOR THERAPEUTIC TRIALS The founding texts 4.2.1. The founding texts:"},{"idx":2,"proposition":"In total, it takes between 10 and 15 years to develop a new drug","correct":true},{"idx":3,"proposition":"Phase 2 involving patients with small numbers of patients","correct":true},{"idx":4,"proposition":"The objective of Phase 3 is to assess the benefit\/risk balance","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Kcpancreas-onco-0","context":null,"enonce":"Which of the following are true?","item":"Kcpancreas","matiere":"onco","propositions":[{"idx":0,"proposition":"Cephalic duodenopancreatectomy (CPD) is the gold standard of care for tail pancreatic tumours","correct":false,"justification":"pancreatic head tumour = cephalic duodenopancreatectomy"},{"idx":1,"proposition":"Cephalic duodenopancreatectomy (CPD) is the standard of care for tumours of the body of the pancreas","correct":false,"justification":"pancreatic head tumour = cephalic duodenopancreatectomy"},{"idx":2,"proposition":"Cephalic duodenopancreatectomy (CPD) is the standard of care for pancreatic head tumours","correct":true},{"idx":3,"proposition":"Left splenopancreatectomy is the standard of care for left pancreatic tumours","correct":true},{"idx":4,"proposition":"Left splenopancreatectomy is the standard of care for pancreatic head tumours","correct":false,"justification":"left pancreatic tumour = left splenopancreatectomy"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcpancreas-onco-1","context":null,"enonce":"Which of the following are true?","item":"Kcpancreas","matiere":"onco","propositions":[{"idx":0,"proposition":"Serous cystadenoma degenerates only exceptionally","correct":true},{"idx":1,"proposition":"Mucinous cystadenoma never degenerates","correct":false,"justification":"It can degenerate"},{"idx":2,"proposition":"Cystic tumors of the pancreas are most often of incidental discovery","correct":true},{"idx":3,"proposition":"Ultrasound is the exam of choice to study cystic tumors of the pancreas","correct":false,"justification":"First-line examinations are CT and MRI"},{"idx":4,"proposition":"Mucosal cystadenoma does not communicate with the main pancreatic duct","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcpancreas-onco-2","context":null,"enonce":"Which of the following are useful markers for the diagnosis and\/or monitoring of neuroendocrine tumours?","item":"Kcpancreas","matiere":"onco","propositions":[{"idx":0,"proposition":"Ca 15-3","correct":false,"justification":"False"},{"idx":1,"proposition":"Amylasemia","correct":false,"justification":"This dosage should no longer be done (College of HGE, 4th edition)"},{"idx":2,"proposition":"Chromogranin A","correct":true,"justification":"True. It is a general marker of all neuroendocrine tumors. The college of HGE (4th edition) does not report other markers to be measured"},{"idx":3,"proposition":"Alpha feto protein ","correct":false,"justification":"False"},{"idx":4,"proposition":"TP53","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcpancreas-onco-3","context":null,"enonce":"Which of the following are true for endocrine pancreatic tumors?","item":"Kcpancreas","matiere":"onco","propositions":[{"idx":0,"proposition":"Pancreatic neuroendocrine tumors are malignant in more than 60% of cases","correct":true,"justification":"True (outside insulinoma)"},{"idx":1,"proposition":"Symptoms are related to hormonal secretion","correct":true},{"idx":2,"proposition":"Gastrinoma causes maladaptive organic hypoglycemia","correct":false,"justification":"This is the case with insulinoma. Gastrinoma causes recurrent OGD ulcers and diarrhea"},{"idx":3,"proposition":"Necrolytic erythema migrans may be a sign of glucagonoma","correct":true},{"idx":4,"proposition":"No additional imaging is required","correct":false,"justification":"Spiral TAP CT +\/- Abdo MRI (liver metastases) +\/- endoscopic ultrasound (if little or not visible)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcos-onco-0","context":null,"enonce":"Which of the following are tumors that preferentially metastasize to the bones?","item":"Kcos","matiere":"onco","propositions":[{"idx":0,"proposition":"Thyroid","correct":true},{"idx":1,"proposition":"Kidney","correct":true},{"idx":2,"proposition":"Lung","correct":true},{"idx":3,"proposition":"Breast","correct":true},{"idx":4,"proposition":"Brain","correct":false,"justification":"Brain tumors hardly metastasize"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"EI-cardio-0","context":null,"enonce":"About infective endocarditis","item":"EI","matiere":"cardio","propositions":[{"idx":0,"proposition":"The appearance or increase of a heart murmur in a febrile context is very suggestive of the diagnosis","correct":true},{"idx":1,"proposition":"The diagnosis should also be evoked in front of a stroke, purpura or febrile low back pain.","correct":true},{"idx":2,"proposition":"Fever is the most constant symptom","correct":true},{"idx":3,"proposition":"The absence of breath makes it possible to exclude the diagnosis","correct":false,"justification":"However, the absence of breath does not exclude the diagnosis"},{"idx":4,"proposition":"Any febrile heart failure should suggest the diagnosis of endocarditis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"EI-cardio-1","context":null,"enonce":"About infective endocarditis","item":"EI","matiere":"cardio","propositions":[{"idx":0,"proposition":"The two pillars of AE diagnosis are blood cultures and echocardiography","correct":true},{"idx":1,"proposition":"Blood cultures isolate the responsible microorganism in 100% of cases","correct":false,"justification":"They make it possible to isolate the responsible microorganism in 90% of cases"},{"idx":2,"proposition":"They should be repeated for 2 or 3 days if the initial blood cultures are negative, especially in subjects who have received antibiotics.","correct":true},{"idx":3,"proposition":"The suspicion of AE is to be reported to the microbiology laboratory, because it sometimes takes a long culture time for microorganisms with difficult growth (HACEK group, Brucella, deficient streptococci, yeasts)","correct":true},{"idx":4,"proposition":"Echocardiography affirms the diagnosis in front of one of the characteristic lesions: vegetation, abscess, valve perforation or disinsertion of prosthesis","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"EI-cardio-2","context":null,"enonce":"About infective endocarditis","item":"EI","matiere":"cardio","propositions":[{"idx":0,"proposition":"Vegetation is identified by transthoracic echocardiography (ETT) or transesophageal ultrasound (TEO) especially in case of valve prosthesis","correct":true},{"idx":1,"proposition":"The periannular abscess, on native valve or prosthesis, is present in 30% of cases, most often visible in ETT","correct":false,"justification":"The periannular abscess, on native valve or prosthesis, is present in 30% of cases, most often visible in ETO and on the aortic ring rather than mitral"},{"idx":2,"proposition":"Gastric fibroscopy or colonoscopy in case of germ of digestive origin are performed in search of the front door","correct":true},{"idx":3,"proposition":"The clinical manifestations of endocarditis are very varied, not very specific and can affect several organs","correct":true},{"idx":4,"proposition":"Diagnostic classification of infectious endocarditis based on Jones criteria","correct":false,"justification":"Classification de Duke"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"EI-infectio-0","context":null,"enonce":"About infective endocarditis","item":"EI","matiere":"infectio","propositions":[{"idx":0,"proposition":"Infective endocarditis (IE) is a rare but serious infection","correct":true},{"idx":1,"proposition":"Staphylococci (mainly Staphylococcus aureus) and streptococci are responsible for 50% of cases of infectious endocarditis","correct":false,"justification":"0.8"},{"idx":2,"proposition":"The rapid initiation of antibiotic therapy is crucial even before blood culture is performed","correct":false,"justification":"The identification of the causative infectious agent is crucial for diagnosis and treatment: 3 aero-anaerobic blood cultures should be collected before any antibiotic therapy in case of suspicion of AE"},{"idx":3,"proposition":"When AE is suspected, an echocardiogram should be performed as soon as possible and repeated if the first is negative.","correct":true},{"idx":4,"proposition":"Renal (glomerulonephritis) and digestive complications are the most frequent and serious complications","correct":false,"justification":"Cerabral and cardiac complications are the most frequent and serious complications"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"EI-infectio-1","context":null,"enonce":"About infective endocarditis","item":"EI","matiere":"infectio","propositions":[{"idx":0,"proposition":"Management of patients with AE without signs of severity can now be ambulatory","correct":false,"justification":"The management is hospitable and must involve an experienced multidisciplinary team"},{"idx":1,"proposition":"Indications for antibiotic prophylaxis of infective endocarditis are restricted to invasive dental procedures","correct":true},{"idx":2,"proposition":"Infective endocarditis (IE) is an infection of one or more heart valves, native or prosthetic, most often by bacteria, more rarely by a fungus","correct":true},{"idx":3,"proposition":"Right heart valves are affected more often (90% of cases) than left heart valves","correct":false,"justification":"The valves of the infectious left heart are more often affected (90% of cases) than the valves of the right heart (mainly tricuspid valve in case of drug addiction)"},{"idx":4,"proposition":"Bacterial grafting at the endocardium level results in the development of infectious lesions associating vegetations and progressive lesions consisting of fibrin clusters.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"EI-infectio-2","context":null,"enonce":"About infective endocarditis","item":"EI","matiere":"infectio","propositions":[{"idx":0,"proposition":"It affects men more than women and is more common before age 70.","correct":false,"justification":"After 70 years TRUE"},{"idx":1,"proposition":"Predisposing factors are intravenous drug addiction, prosthetic heart valves, degenerative valve sclerosis.","correct":true},{"idx":2,"proposition":"Oral streptococci have supplanted staphylococci and are in first place in the distribution of infectious agents responsible for AEs","correct":false,"justification":"Staphylococci occupy the 1st place"},{"idx":3,"proposition":"The most frequent streptococci are oral streptococci, of oral origin, and Streptococcus gallolyticus","correct":true},{"idx":4,"proposition":"In 40-50% of cases, blood cultures remain negative and the causative agent may not be identified","correct":false,"justification":"In only 5 to 10% of cases"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"tbmiction-uro-0","context":null,"enonce":"Regarding the basics of urinary incontinence:","item":"tbmiction","matiere":"uro","propositions":[{"idx":0,"proposition":"The diagnosis of urinary incontinence is clinical","correct":true},{"idx":1,"proposition":"Urinary incontinence is defined as a subjective feeling of urinary loss","correct":false,"justification":"Urinary incontinence is defined as an involuntary loss of urine, objectively demonstrable, constituting a social and\/or hygiene problem."},{"idx":2,"proposition":"It is first and foremost a deficiency","correct":true},{"idx":3,"proposition":"For women, it is a major public health problem","correct":true},{"idx":4,"proposition":"Urinary incontinence in men is due to prostate pathology in 95% of cases","correct":false,"justification":"Especially iatrogenic and prostate"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbmiction-uro-1","context":null,"enonce":"For UI and EUI (effort):","item":"tbmiction","matiere":"uro","propositions":[{"idx":0,"proposition":"It is defined as \"involuntary loss of urine through the urethra\"","correct":true},{"idx":1,"proposition":"Overactive bladder urinary incontinence is due to sphincter insufficiency","correct":false,"justification":"Sphincter insufficiency = UI of cerco-cystoptosis\/hypermobility origin. It is a type of UI in itself"},{"idx":2,"proposition":"Effort UI is human specific","correct":false,"justification":"It is more common in women, especially postmenopausal women, with a history of obstetric trauma"},{"idx":3,"proposition":"There are two types of mechanisms explaining SUI: cervicocystoptosis\/urethral hypermobility (HMU) and sphincter insufficiency (SI)","correct":true},{"idx":4,"proposition":"There is no etiology specific to the SUI","correct":false,"justification":"Many possible etiologies: trauma, trophic disorders, urological disorders, neurological disorders, etc."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbmiction-uro-2","context":null,"enonce":"Regarding the interrogation:","item":"tbmiction","matiere":"uro","propositions":[{"idx":0,"proposition":"SUI is an involuntary loss preceded by an urgent and uninhibited need from the outset","correct":false,"justification":"This is the case with overactive bladder UI"},{"idx":1,"proposition":"Bladder hyperactivity UI is an involuntary loss of urine without feeling of craving","correct":false,"justification":"There is the feeling of urge"},{"idx":2,"proposition":"Obesity promotes SUI","correct":true},{"idx":3,"proposition":"Intense sports activity protects against UI","correct":false,"justification":"RR is greater than 1"},{"idx":4,"proposition":"Drug treatments must be identified because some aggravate the voiding status and in particular anticholinergics and opioids (decrease in bladder contraction)","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"addpsychotropes-psy-0","context":null,"enonce":"General:","item":"addpsychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Addiction is often the result of inappropriate prescriptions","correct":true},{"idx":1,"proposition":"Among psychotropic drugs, benzodiazepines and related have a very marked addictive potential","correct":true},{"idx":2,"proposition":"About 2% of women in France have been prescribed benzodiazepines or related benzodiazepines","correct":false,"justification":"About 12%"},{"idx":3,"proposition":"Harmful use results in medical complications or prolonged social repercussions","correct":true},{"idx":4,"proposition":"Dependence is defined by an inability to stop use because the desire to stop is not present","correct":false,"justification":"Dependence is defined by an inability to stop benzodiazepine use, either because of signs of withdrawal or because of excessive cravings."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"addpsychotropes-psy-1","context":null,"enonce":"Regarding the effect of benzodiazepines:","item":"addpsychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"In case of dependence, there is a risk of withdrawal syndrome at the sudden cessation of consumption","correct":true},{"idx":1,"proposition":"Benzodiazepines are GABA-A agonists","correct":true},{"idx":2,"proposition":"In therapy, benzodiazepines are used exclusively for sedative purposes","correct":false,"justification":"In therapeutics, benzodiazepines are used for anxiolytic, sedative and hypnotic purposes, but also muscle relaxant and anticonvulsant"},{"idx":3,"proposition":"Benzodiazepines and related drugs are among the most prescribed psychotropic treatments in France and Europe","correct":true},{"idx":4,"proposition":"3 benzodiazepines or related benzodiazepines are currently marketed in France","correct":false,"justification":"There are 22"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"addpsychotropes-psy-2","context":null,"enonce":"Regarding the consequence of benzodiazepine addiction:","item":"addpsychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Benzodiazepines are anorectic","correct":false,"justification":"They are orogenic and require a check-up (EAL and blood glucose)"},{"idx":1,"proposition":"60% of benzodiazepine or related users are women","correct":true},{"idx":2,"proposition":"Prescriptions rarely exceed 2 months","correct":false,"justification":"Half of the subjects treated with this type of molecule are treated for a period of more than two years"},{"idx":3,"proposition":"In case of significant disturbances of alertness, benzodiazepine poisoning is a vital emergency","correct":true},{"idx":4,"proposition":"It is very clearly established an increase in the risk of dementia type Alzheimer's disease in case of prolonged use of benzodiazepines","correct":false,"justification":"French authors have recently found an increased risk of Alzheimer's dementia in case of prolonged use of benzodiazepines, but these results are still debated internationally."}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"autoformation-sp-0","context":null,"enonce":"Concerning continuing training","item":"autoformation","matiere":"sp","propositions":[{"idx":0,"proposition":"Article analysis is a standardised method of analysing a study in order to assess its quality and to be able to define the level of evidence.","correct":true},{"idx":1,"proposition":"Assessing the conflicts of interest of the CPP is done by the AGREE grid (second version)","correct":false,"justification":"Assessing quality"},{"idx":2,"proposition":"The AGREE grid is used to develop a method for creating CPRs","correct":true},{"idx":3,"proposition":"Advances in medical knowledge require an effort of synthesis","correct":true},{"idx":4,"proposition":"The only method to develop recommendations is the PRC","correct":false,"justification":"There are several methods, 2 will be presented: Consensus Conference (CC) Recommendations for Clinical Practice\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"autoformation-sp-1","context":null,"enonce":"Concerning consensus conferences","item":"autoformation","matiere":"sp","propositions":[{"idx":0,"proposition":"Consensus conference begins with the presentation of expert reports synthesizing knowledge at a public conference","correct":true},{"idx":1,"proposition":"The second step in a consensus conference is the drafting of recommendations by a multidisciplinary jury in a public manner.","correct":false,"justification":"Then the drafting of recommendations by a multidisciplinary jury behind closed doors 3.2.2. The 1. The promoter actors"},{"idx":2,"proposition":"The promoter of consensus conferences are either university hospitals or pharmaceutical companies","correct":false,"justification":"It is in practice either a scholar, an organization of health professionals, insurance organization of a health health organization, a public association, a patient society, an industrialist. .. Its role: the initiative"},{"idx":3,"proposition":"The promoter does not have the opportunity to choose the theme of the reflection","correct":false,"justification":"He chooses the theme and signals"},{"idx":4,"proposition":"The promoter provides the financial means","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"autoformation-sp-2","context":null,"enonce":"Concerning consensus conferences ","item":"autoformation","matiere":"sp","propositions":[{"idx":0,"proposition":"The organizing committee is composed of members from the promoter","correct":false,"justification":"Persons nominated by the sponsor (usually 5 to 10 members), but independent of the sponsor"},{"idx":1,"proposition":"A leader (the President of the organizing committee) is designated to organize and coordinate the meetings","correct":true},{"idx":2,"proposition":"The jury of a consensus conference is composed of 5 researchers and doctors","correct":false,"justification":"8 to 16 members, multiprofessional methodologists, researchers, other ethical, economic: physicians, and multidisciplinary representatives or legislative professionals, health, representatives of the general public"},{"idx":3,"proposition":"The jury is coordinated by a president, appointed by the organizing committee (sometimes in consultation with the promoter)","correct":true},{"idx":4,"proposition":"Jury members must have no financial or professional interest (no conflict of interest)","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"autoformation-sp-3","context":null,"enonce":"Concerning consensus conferences ","item":"autoformation","matiere":"sp","propositions":[{"idx":0,"proposition":"The bibliographic group provides an objective analysis of the literature, literature analysis without interpretation of the results","correct":true},{"idx":1,"proposition":"The experts are chosen by the organizing committee","correct":true},{"idx":2,"proposition":"Experts must have particular expertise on the theme of the conference (recent works and publications)","correct":true},{"idx":3,"proposition":"The composition of the expert panel must be representative of the diversity of opinions on the subject","correct":true},{"idx":4,"proposition":"The expert group must present its results orally to the jury","correct":false,"justification":"Provide a text gathering the information (from their experience and literature) to answer\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"autoformation-sp-4","context":null,"enonce":"Regarding recommendations for clinical practice ","item":"autoformation","matiere":"sp","propositions":[{"idx":0,"proposition":"The CPM is an analysis of the extensive literature by a working group that drafts the recommendations","correct":true},{"idx":1,"proposition":"The subject to be dealt with must be sufficiently broad","correct":true},{"idx":2,"proposition":"Literature data must be diverse and dispersed","correct":true},{"idx":3,"proposition":"We make a PRC when there is a lot of controversy on the subject","correct":false,"justification":"There is little controversy"},{"idx":4,"proposition":"Proponent takes the lead in developing recommendations","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"autoformation-sp-6","context":null,"enonce":"Concerning links and conflicts of interest","item":"autoformation","matiere":"sp","propositions":[{"idx":0,"proposition":"The concept of a link of interests covers the interests or activities, past or present, patrimonial, professional or family, of the expert in relation to the object of the expert opinion entrusted to him.","correct":true},{"idx":1,"proposition":"A conflict of interest arises from a situation in which the links of interest of an expert are by their nature or to call into question his impartiality or independence.","correct":true},{"idx":2,"proposition":"The declaration of links of interest is optional if one has nothing to reproach oneself with.","correct":false,"justification":"It is mandatory"},{"idx":3,"proposition":"The declaration of links of interests concerns direct and indirect links","correct":true},{"idx":4,"proposition":"The declaration of links of interest concerns only physicians","correct":false,"justification":"It must be carried out by any expert called upon to draw up expertise in the field of health and health safety\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"autoformation-sp-7","context":null,"enonce":"Concerning links of interest and their impacts","item":"autoformation","matiere":"sp","propositions":[{"idx":0,"proposition":"The declaration of links of interest engages the responsibility of the order of physicians which must ensure that it is updated","correct":false,"justification":"It engages the responsibility of the declarant, who must ensure that it is sincere, up-to-date (continuous updating) and exhaustive"},{"idx":1,"proposition":"The anteriority of the links to be declared is 15 years","correct":false,"justification":"The anteriority of the links to be declared is 5 years"},{"idx":2,"proposition":"The longer a collaboration lasts, the stronger the impact of the link of interest will be.","correct":true},{"idx":3,"proposition":"Too strong links of interest can lead to erroneous expert conclusions","correct":true},{"idx":4,"proposition":"The stronger a healthcare professional's interests, the more patients trust him\/her.","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dyslip-cardio-0","context":null,"enonce":"About Dyslipidemia","item":"dyslip","matiere":"cardio","propositions":[{"idx":0,"proposition":"LDL-cholesterol is the most powerful cardiovascular lipid risk factor","correct":true},{"idx":1,"proposition":"Pure hypercholesterolemia affects 10% of 35-64 year olds.","correct":false,"justification":"30% ! All dyslipidemias combined, 51% of this population is concerned"},{"idx":2,"proposition":"The LDLc level is calculated with the Friedewald formula only if the triglyceride level is greater than 4g\/L","correct":false,"justification":"Less than 4g\/L, or 4.6 mmol\/L"},{"idx":3,"proposition":"An EAL is routinely requested for an overweight individual (BMI >25)","correct":false,"justification":"Systematic in case of obesity (BMI >30)"},{"idx":4,"proposition":"If a screening EAL is abnormal, it should be repeated","correct":true,"justification":"It is then associated with a measurement of fasting blood glucose"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dyslip-cardio-1","context":null,"enonce":"About Dyslipidemia","item":"dyslip","matiere":"cardio","propositions":[{"idx":0,"proposition":"Tuberous xanthomas are a clinical sign of hypertriglyceridemia","correct":false,"justification":"Hypercholesterolemia"},{"idx":1,"proposition":"During an EAL, in the creaming test, a cloudy subnatant indicates an abnormality in the chylomicronemia level","correct":false,"justification":"An anomaly in the VLDL level. A creamy supernatant indicates an abnormality in the rate of chylomicronemia."},{"idx":2,"proposition":"In the Frederickson classification, dyslipidemia of phenotype IIA is pure hypercholesterolemia","correct":true,"justification":"High LDL, clear serum"},{"idx":3,"proposition":"<b>Chronic<\/b> renal failure is a cause of secondary hypercholesterolemia","correct":true},{"idx":4,"proposition":"Loop diuretics are an iatrogenic cause of mixed dyslipidemia","correct":false,"justification":"On the other hand, thiazides are"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dyslip-cardio-2","context":null,"enonce":"About Dyslipidemia","item":"dyslip","matiere":"cardio","propositions":[{"idx":0,"proposition":"Primary monogeneic hypercholesterolemia by mutation of the LDL-cholesterol receptor is inherited autosomal dominant","correct":true,"justification":"The involvement can be heterozygous (50% functional receptors) or homozygous (0% functional, severe++)"},{"idx":1,"proposition":"Familial combined hyperlipidemia affects 1 to 2% of the general population in France","correct":true,"justification":"And 10-11% of patients who had a myocardial infarction before 60 years"},{"idx":2,"proposition":"According to the HAS 2017, the LDL-cholesterol objective to be achieved in case of moderate cardiovascular risk is a level below 1.3","correct":true,"justification":"Attention, the thresholds recommended by the ESC are different"},{"idx":3,"proposition":"In a patient with a SCORE calculated at 7% who has not reached his LDL-cholesterol goal, lipid-lowering drug therapy is indicated from the outset","correct":true,"justification":"Here, the cardiovascular risk is high (5-10%): drug treatment from the outset"},{"idx":4,"proposition":"The combination statin + fibrate is recommended from the outset in case of mixed dyslipidemia","correct":false,"justification":"The combination statin + fibrate is classically at risk and strongly discouraged"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dyslip-cardio-3","context":null,"enonce":"About Dyslipidemia","item":"dyslip","matiere":"cardio","propositions":[{"idx":0,"proposition":"Initiation of lipid-lowering drug therapy is not recommended for primary prevention in patients over 80 years of age","correct":true},{"idx":1,"proposition":"Statins induce a decrease in triglyceride levels","correct":true,"justification":"Decrease of 10-15% on average"},{"idx":2,"proposition":"Statins are contraindicated in pregnancy","correct":true},{"idx":3,"proposition":"Cholestyramine induces myalgia ","correct":false,"justification":"This concerns statins, ezetimibe and fibrates. Cholestyramine induces digestive disorders."},{"idx":4,"proposition":"Treatment with fibrates is indicated in 1°intention in a patient with a triglyceride level of 3 g \/ L","correct":false,"justification":"Fibrates are indicated only after failure of hygienic measures, or in case of isolated severe hypertriglyceridemia"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dyslip-cardio-4","context":null,"enonce":"About Dyslipidemia","item":"dyslip","matiere":"cardio","propositions":[{"idx":0,"proposition":"Gemfibrozil + Simvastatin is not recommended","correct":false,"justification":"It is absolutely contraindicated!! And the combination of a statin with any other fibrate is not recommended"},{"idx":1,"proposition":"A monitoring EAL is indicated 4 weeks after initiation of lipid-lowering therapy to assess effects","correct":false,"justification":"12-24 weeks in case of low\/moderate cardiovascular risk, 8-12 weeks if high\/very high"},{"idx":2,"proposition":"When the LDL-c objective is reached, a control EAL is scheduled every 3 years (except comorbidities)","correct":false,"justification":"Every year"},{"idx":3,"proposition":"CPK testing is recommended before statin initiation, 8 weeks after any dose change, and then 1 time per year","correct":false,"justification":"This concerns the control of liver function. CPK testing is only recommended in case of muscle pain or risk factor for muscle damage"},{"idx":4,"proposition":"In case of increase in CPK < 5 times normal on statins with moderate myalgia, treatment can be continued","correct":true,"justification":"CPKs are rechecked at one week. In case of severe myalgia, statins are discontinued"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"MAI-immuno-0","context":null,"enonce":"About autoimmune diseases","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"Their prevalence varies greatly from one pathology to another, but taken together, they would affect about 1% of the population of industrialized countries. ","correct":false},{"idx":1,"proposition":"Given the extreme diversity of the repertoire of these antigen receptors, the appearance of lymphocytes recognizing antigens of the self is statistically inevitable.","correct":true},{"idx":2,"proposition":"Pathological autoimmunity is the result of a breakdown in immunological tolerance","correct":true},{"idx":3,"proposition":"The presence of isolated autoimmune biology (e.g. isolated positivity from anti-nuclear antibody testing) poses the inevitable diagnosis of autoimmune disease","correct":false,"justification":"The presence of isolated autoimmune biology (e.g. isolated positivity from an anti-nuclear antibody test) without clinical or other biological manifestations is not sufficient to define an autoimmune disease as such."},{"idx":4,"proposition":"The term \"overlap syndrome\" refers to patients who meet the criteria for classification of several autoimmune diseases at once.","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"MAI-immuno-1","context":null,"enonce":"Regarding autoimmune diseases:","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"Autoimmune dysthyroidism is very common in the general population, while primary ANCA vasculitis is very rare.","correct":true},{"idx":1,"proposition":"According to the European definition, a pathology is said to be \"rare\" when its prevalence is less than 50\/100,000 (i.e. affects less than 1 in 2,000 people)","correct":true},{"idx":2,"proposition":"Autoimmune diseases are multifactorial pathologies, which result from the complex interaction between a genetic terrain at risk and environmental factors favoring","correct":true},{"idx":3,"proposition":"The existence of a genetic predisposition to autoimmune diseases is attested ","correct":true},{"idx":4,"proposition":"In the majority of cases, autoimmune diseases are monogenic","correct":false,"justification":"In the majority of cases, autoimmune diseases are called \"polygenic\", because the genetic terrain favoring these diseases is determined by the polymorphisms of many genes each conferring only a low to moderate excess risk of developing the disease"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"MAI-immuno-3","context":null,"enonce":"Regarding autoimmune diseases:","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"Anti-nuclear antibodies are encountered in about 10% of healthy subjects","correct":true},{"idx":1,"proposition":"aPLs are common during systemic lupus (30-80%) but can be present in many connective tissue diseases such as RA and systemic scleroderma","correct":true},{"idx":2,"proposition":"The Rheumatoid Factor was classically sought after by Elisa","correct":false,"justification":"By the Waaler-Rose reaction and the latex test"},{"idx":3,"proposition":"Anti-CCP are positive in 30% of RA that are negative for RF","correct":true},{"idx":4,"proposition":"The joint positivity of RF and anti-CCP confers a very good positive predictive value for the diagnosis of RA, but with a sensitivity not exceeding 40-50%","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"MAI-immuno-4","context":null,"enonce":"Which of the following are possible complications of Sjögren's syndrome?","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"Sensory neuropathy","correct":true},{"idx":1,"proposition":"Pneumonia","correct":true,"justification":"True, by lymphocyte infiltrates"},{"idx":2,"proposition":"Glomerular syndrome","correct":false,"justification":"No, however, we can sometimes observe a tubulointerstitial syndrome by lymphocyte infiltration (significant diapedesis)"},{"idx":3,"proposition":"Parotitis","correct":false,"justification":"False"},{"idx":4,"proposition":"Valvular heart disease","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"MAI-immuno-5","context":null,"enonce":"Which of the following are causes of dry syndrome?","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"Prolonged fever","correct":false,"justification":"False"},{"idx":1,"proposition":"Head and neck radiation therapy","correct":true},{"idx":2,"proposition":"The characterized depressive episode","correct":false,"justification":"Not directly. But some psychotropic treatments can cause dry syndrome."},{"idx":3,"proposition":"Sarcoidosis","correct":true},{"idx":4,"proposition":"Benign prostatic hyperplasia","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"MAI-immuno-6","context":null,"enonce":"What types of ACAN are found in Sjögren's syndrome?","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"Native anti-DNA","correct":false,"justification":"Rather in the case of lupus (useful in follow-up)"},{"idx":1,"proposition":"Anti-centromeres","correct":false,"justification":"anti-SSA or anti-SSB"},{"idx":2,"proposition":"Soluble anti-nuclear","correct":true},{"idx":3,"proposition":"Fluorescence is speckled","correct":true},{"idx":4,"proposition":"Fluorescence is homogeneous","correct":false,"justification":"Rather in favor of native anti-DNA (lupus)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"MAI-immuno-7","context":null,"enonce":"Which of the following are additional tests useful in the diagnosis of Sjögren's syndrome?","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"Schirmer's test to objectify xerophthalmia","correct":true},{"idx":1,"proposition":"None of these proposals","correct":false,"justification":"False"},{"idx":2,"proposition":"Parotid biopsy","correct":false,"justification":"Accessory salivary glands are biopsy"},{"idx":3,"proposition":"The search for anti-CPP","correct":false,"justification":"Useless in this case (useful in rheumatoid arthritis)"},{"idx":4,"proposition":"ACAN's research","correct":true,"justification":"True, anti-SSA are quite sensitive"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"MAI-immuno-8","context":null,"enonce":"Which of the following proposals can cause polyclonal hypergammaglobulinemia greater than 20 G\/l?","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"sarcoidosis","correct":true},{"idx":1,"proposition":"leishmaniasis ","correct":true,"justification":"True, when visceral"},{"idx":2,"proposition":"hepatitis C","correct":false,"justification":"None"},{"idx":3,"proposition":"lupus","correct":false,"justification":"None"},{"idx":4,"proposition":"autoimmune hepatitis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"MAI-immuno-9","context":null,"enonce":"Which of the following proposals are possibly associated with Sjögren's syndrome?","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"Septic arthritis","correct":false,"justification":"False"},{"idx":1,"proposition":"Lupus","correct":true},{"idx":2,"proposition":"Autoimmune thyoiditis","correct":true},{"idx":3,"proposition":"Osteonecrosis of the femoral head","correct":false,"justification":"False"},{"idx":4,"proposition":"AL amyloidosis","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TED-psy-0","context":null,"enonce":"Regarding ASD:","item":"TED","matiere":"psy","propositions":[{"idx":0,"proposition":"Children with Autism Spectrum Disorder (ASD) have deficits in communication only","correct":false,"justification":"Children with Autism Spectrum Disorder (ASD) have deficits in 3 clinical domains: (1) Verbal and nonverbal communication abnormalities (2) abnormal reciprocal social interactions and (3) Restricted and repetitive behaviours, interests and activities"},{"idx":1,"proposition":"The prevalence of ASD is 0.01% in the general population","correct":false,"justification":"ASD prevalence is 1% and sex ratio is 4:1 in favour of boys"},{"idx":2,"proposition":"Diagnosis of ASD is done clinically in a single consultation","correct":false,"justification":"The diagnostic evaluation is based on the patient's current symptomatology as well as his developmental trajectory over time. It is a dynamic diagnosis"},{"idx":3,"proposition":"ASD has a multifactorial origin","correct":true},{"idx":4,"proposition":"Management of patients with ASD really begins at puberty","correct":false,"justification":"Management of patients with ASD should be early, intensive, multidisciplinary and adapted to the clinical profile of each child"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"TED-psy-1","context":null,"enonce":"Regarding ASD:","item":"TED","matiere":"psy","propositions":[{"idx":0,"proposition":"Autism is a neurodevelopmental disorder","correct":true},{"idx":1,"proposition":"ASD is the presence of persistent deficits in ideation and social behaviour","correct":false,"justification":"This syndrome corresponds to the presence of persistent deficits in 3 clinical domains: * abnormalities in verbal and non-verbal communication * abnormality of reciprocal social interactions * restricted and repetitive nature of behaviors, interests and activities"},{"idx":2,"proposition":"The prevalence of ASD in the general population is 1%","correct":true},{"idx":3,"proposition":"The sex ratio of ASD is 4 boys to one girl","correct":true},{"idx":4,"proposition":"Childhood affected by ASD seeks to attract the attention of others","correct":false,"justification":"It does not seek to draw the attention of others to an object or situation"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TED-psy-2","context":null,"enonce":"Regarding the signs of ASD:","item":"TED","matiere":"psy","propositions":[{"idx":0,"proposition":"One of the symptoms of the autistic child is that he does not respond when called even insistently.","correct":true},{"idx":1,"proposition":"The child only participates in games that do not require interaction with adults","correct":false,"justification":"No reciprocal social games, with adults or children"},{"idx":2,"proposition":"Relational isolation is often found","correct":true},{"idx":3,"proposition":"The child has an aversion to all objects and does not tolerate physical contact with them","correct":false,"justification":"Repetitive use of objects: the child tends to line up his toys or other objects, spin the wheel of a small car, etc."},{"idx":4,"proposition":"Verbal stereotypies are a sign that can point to autism","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TED-psy-3","context":null,"enonce":"Regarding ASD:","item":"TED","matiere":"psy","propositions":[{"idx":0,"proposition":"Autism severity levels are assessed based on impact on parents, social interactions, and school adjustment","correct":false,"justification":"These levels of severity are determined from the intensity of autistic symptoms and their functional impact."},{"idx":1,"proposition":"40% of patients with ASD have an intellectual disability","correct":true},{"idx":2,"proposition":"15% of children with ASD have attention deficit hyperactivity disorder (ADHD)","correct":false,"justification":"Double: 30%"},{"idx":3,"proposition":"20% of patients with ASD have impaired acquisition of motor coordination","correct":true},{"idx":4,"proposition":"The presence of genetic disease (such as Rett syndrome) eliminates the diagnosis of ASD","correct":false,"justification":"Many genetic (such as Rett syndrome or fragile X syndrome) and metabolic diseases are associated with ASD."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TED-psy-4","context":null,"enonce":"Which of the following proposals are structures dedicated to the management of ASD at home?","item":"TED","matiere":"psy","propositions":[{"idx":0,"proposition":"SESSAD","correct":true,"justification":"Education and home care services"},{"idx":1,"proposition":"CMP","correct":false,"justification":"Medical and psychological centres. It is not home care, but close to home."},{"idx":2,"proposition":"CMPP","correct":false,"justification":"Psycho-pedagogical medical centres. Not at home."},{"idx":3,"proposition":"CAMSP","correct":false,"justification":"Centre for Early Medico-Social Action. Not at home."},{"idx":4,"proposition":"IME","correct":false,"justification":"Medical-educational institutes. Not at home. These are structures whose mission is to take care of patients with intellectual disabilities, and whose missions are education, care, and general education."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"noduleTh-endoc-1","context":null,"enonce":"Regarding goiters:","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"The main goitrogenic factor is iodine deficiency","correct":true,"justification":"Even relative iodine deficiency is a risk factor"},{"idx":1,"proposition":"The recommended iodine intake in a pregnant woman is higher than in the general population","correct":true,"justification":"Normal population: 100-150μg in adults, In pregnant women: 200-250μg"},{"idx":2,"proposition":"The genetic factor is zero","correct":false,"justification":"A family predisposition is often found. Several susceptibility genes have been identified but it is a multigenic condition that does not warrant screening."},{"idx":3,"proposition":"The first-line bioassay is T4-L","correct":false,"justification":"This is the TSH test. If it is abnormal, free T4 is dosed to quantify the extent of hormonal dysfunction."},{"idx":4,"proposition":"A goiter and increased TSH makes suspect a disease of Graves.","correct":false,"justification":"TSH is lowered in Graves' disease. This biological context makes us suspect rather an autoimmune thyoiriditis of Hashimoto, which leads us to perform an assay of anti-thyroperoxidase antibodies (anti-TPO), then, in case of negativity, anti-thyroglobulin antibodies (anti-Tg)."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"noduleTh-endoc-2","context":null,"enonce":"Regarding thyroid nodules:","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"A thyroid nodule is a localized enlargement of the thyroid gland","correct":true},{"idx":1,"proposition":"The majority of nodules are malignant and require surgical management","correct":false,"justification":"95% of thyroid nodules are benign"},{"idx":2,"proposition":"About 10% of thyroid nodules are hyperfunctional","correct":true,"justification":"They are therefore at risk of hyperthyroidism"},{"idx":3,"proposition":"Transition to malignancy of a benign nodule is exceedingly rare","correct":true},{"idx":4,"proposition":"It is a male-dominated pathology","correct":false,"justification":"As for the goiter, the sex ratio is 3-4F\/1H"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"noduleTh-endoc-3","context":null,"enonce":"Regarding thyroid nodules:","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"It is not necessary to explore nodules less than 1 cm in diameter except in special circumstances.","correct":true},{"idx":1,"proposition":"The first-line biological assessment is the TSH assay","correct":true},{"idx":2,"proposition":"Ultrasound uses very low frequency probes","correct":false,"justification":"Low frequency probes allow deep penetration. The thyroid being superficial, very high frequency probes are used, which also have the advantage of making images of better definition."},{"idx":3,"proposition":"An isolated low TSH strongly points to a functional adenoma","correct":true},{"idx":4,"proposition":"Hyperfunctional nodules that cause hyperthyroidism are treated with surgery","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"noduleTh-endoc-4","context":null,"enonce":"Regarding thyroid cancers:","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"5-year survival is extremely low","correct":false,"justification":"The overall prognosis is good, with a 10-year survival greater than 90%"},{"idx":1,"proposition":"Differentiated papillary carcinomas are the most common vesicular carcinomas","correct":true,"justification":"In 85% of cases. Differentiated vesicular carcinomas constitute 5% of cases while the rest is represented by poorly differentiated and oncocytic carcinomas, and anaplastic carcinomas"},{"idx":2,"proposition":"Surgery is the first-line treatment for virtually all thyroid cancers.","correct":true},{"idx":3,"proposition":"Papillary or vesicular differentiated thyroid cancers never recur","correct":false,"justification":"Papillary or vesicular differentiated thyroid cancers can recur in the long term, requiring prolonged monitoring"},{"idx":4,"proposition":"Cervical recurrences are treated with hormone therapy","correct":false,"justification":"Surgery remains the best treatment for local recurrences, supplemented by radioactive iodine when these recurrences fix."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"noduleTh-endoc-5","context":null,"enonce":"Which propositions are true?","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Toxic adenoma causes hypothyroidism","correct":false,"justification":"Hyperthyroidism"},{"idx":1,"proposition":"Benign adenoma is accompanied by euthyroidism","correct":true},{"idx":2,"proposition":"Papillary carcinoma may be accompanied by euthyroidism","correct":true},{"idx":3,"proposition":"A benign goiter is accompanied by euthyroidism","correct":true},{"idx":4,"proposition":"An over-functional nodule is accompanied by hyperthyroidism","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"noduleTh-endoc-6","context":null,"enonce":"Regarding IRA-therapy:","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Pregnancy is contraindicated","correct":true},{"idx":1,"proposition":"Breastfeeding is allowed","correct":false,"justification":"Breastfeeding is contraindicated"},{"idx":2,"proposition":"Iodine-139 is used","correct":false,"justification":"Iodine-139 is a very rare isotope not used at all in medicine. Iodine-131 is used."},{"idx":3,"proposition":"The treatment is done over one week in day hospital (outpatient)","correct":false,"justification":"Hospitalization in radio-protected rooms"},{"idx":4,"proposition":"It is a complementary treatment to surgical management","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"noduleTh-endoc-7","context":null,"enonce":"Regarding malignant nodules and cancers:","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"A male sex directs to a malignant nodule","correct":true},{"idx":1,"proposition":"40% of nodules are malignant","correct":false,"justification":"95% of thyroid nodules are benign"},{"idx":2,"proposition":"Papillary cancers have a pretty good prognosis","correct":true,"justification":"Papillary carcinomas constitute 85% of differentiated carcinomas, they have an excellent prognosis (95% survival at 10 years), it is the only form observed in young people and follow-up is carried out using thyroglobulin"},{"idx":3,"proposition":"Vesicular carcinomas can be encapsulated or invasive","correct":true},{"idx":4,"proposition":"Ac Anti-TPO is dosed for follow-up","correct":false,"justification":"Anti-Tg for follow-up, anti-TPO are indicated in particular for the etiological assessment of hypothyroidism"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Fr-urg-0","context":null,"enonce":"Which of the following are true?","item":"Fr","matiere":"urg","propositions":[{"idx":0,"proposition":"Up to age 40, the annual incidence of distal radius fractures is higher in women","correct":false,"justification":"Up to age 40, the annual incidence of distal radius fractures is higher in men"},{"idx":1,"proposition":"There is no link between the quality of anatomical reduction and functional outcome","correct":false,"justification":"There is a parallelism between the quality of the anatomical reduction and the functional result"},{"idx":2,"proposition":"Fractures of the distal end of the radius are fractures mainly involving the proximal epiphysis","correct":false,"justification":"Fractures of the distal end of the radius are fractures mainly involving the metaphysis but can also concern the distal epiphysis"},{"idx":3,"proposition":"The distal epiphysis is articular with the head of the ulna and the first row of the carpus  ","correct":true},{"idx":4,"proposition":"It is necessary to oppose extra-articular fractures which are the prerogative of the elderly subject and which most often follow a low-energy trauma, complex joint fractures affecting more readily the young subject and resulting from a high-energy trauma","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"veilleSP-sp-0","context":null,"enonce":"Which propositions are true?","item":"veilleSP","matiere":"sp","propositions":[{"idx":0,"proposition":"Health safety is the protection of health against the risks induced by the metabolism of infectious agents","correct":false,"justification":"It is the protection against the risks induced by the functioning of the company"},{"idx":1,"proposition":"A health crisis is an unforeseen and complex situation","correct":true},{"idx":2,"proposition":"A health crisis is always of proven seriousness","correct":false,"justification":"Not always proven. It may only be potential"},{"idx":3,"proposition":"A health crisis requires immediate action","correct":true},{"idx":4,"proposition":"The means of managing health crises is exceptional","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"veilleSP-sp-2","context":null,"enonce":"Which propositions are true?","item":"veilleSP","matiere":"sp","propositions":[{"idx":0,"proposition":"Cosmetovigilance only concerns consmetic products sold in pharmacies","correct":false,"justification":"All cosmetic products are concerned"},{"idx":1,"proposition":"Manufacturers report any adverse reaction to the ANSM directly","correct":false,"justification":"To the DGCCRF first"},{"idx":2,"proposition":"The Biomedicine Agency is the authority that deals with biovigilance","correct":true},{"idx":3,"proposition":"Reactovigilance concerns radiation risks","correct":false,"justification":"In vitro diagnostic devices"},{"idx":4,"proposition":"Materiovigilance is organized around 4 levels of procedure","correct":true,"justification":"Minor, major, critical incidents and the overall assessment"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"deficitMoSembre-neuro-0","context":null,"enonce":"General:","item":"deficitMoSembre","matiere":"neuro","propositions":[{"idx":0,"proposition":"Disorders of motility or sensitivity of a limb are very rare","correct":false,"justification":"Limb motility or sensitivity disorders are common reasons for consultation, sometimes in emergency situations"},{"idx":1,"proposition":"This type of disorder must be referred directly to hospital neurologists in view of the potential seriousness","correct":false,"justification":"Every physician must know how to guide his diagnosis: by distinguishing between a deficit due to impairment of motor or sensitivity pathways and a disorder of non-neurological origin"},{"idx":2,"proposition":"There are four major neurological motor syndromes","correct":true},{"idx":3,"proposition":"Syndromic diagnosis makes it possible to establish the topographic diagnosis of the attack","correct":true},{"idx":4,"proposition":"Involvement of the first motor neuron is responsible for pyramidal syndrome","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"deficitMoSembre-neuro-1","context":null,"enonce":"Regarding the central and peripheral origins:","item":"deficitMoSembre","matiere":"neuro","propositions":[{"idx":0,"proposition":"In pyramidal syndrome, the lesion may be in the cerebral hemisphere, brain stem or spinal cord","correct":true},{"idx":1,"proposition":"Lumbar spinal cord involvement is peripheral involvement","correct":false,"justification":"Power plant"},{"idx":2,"proposition":"Central involvement is characterized by the presence of an extrapyramidal syndrome","correct":false,"justification":"The central involvement is characterized by the presence of a pyramidal syndrome: the motor deficit predominates on the extensor muscles of the upper limbs (radial, interosseous) and the shortening muscles of the lower limbs (psoas, anterior hamstring)"},{"idx":3,"proposition":"A spastic deficit is always of peripheral origin","correct":false,"justification":"Remember A spastic deficit is always of central origin"},{"idx":4,"proposition":"A flaccid deficit is always of peripheral origin","correct":false,"justification":"Most often but not always"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"deficitMoSembre-neuro-2","context":null,"enonce":"Regarding the neurological semiology of motor deficits:","item":"deficitMoSembre","matiere":"neuro","propositions":[{"idx":0,"proposition":"The RCP is in flexion in pyramidal syndrome","correct":false,"justification":"It is the only syndrome where it is in extension = Babinski's sign"},{"idx":1,"proposition":"Hemiplegia reflects damage to the central nervous system above the cervical cord (included)","correct":true},{"idx":2,"proposition":"Alternate motor syndrome is the combination of hemiparesis or hemiplegia and contralateral involvement of a motor cranial nerve (III, VII, XII)","correct":true},{"idx":3,"proposition":"Tetraplegia reflects damage to the thoracic or lumbar spinal cord","correct":false,"justification":"It reflects damage to the upper cervical spinal cord or brain stem"},{"idx":4,"proposition":"Paraplegia reflects damage to the motor cortex","correct":false,"justification":"It reflects low, thoracic or terminal cone cervical involvement, the spinal cord ending at the L1-L2 level"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"deficitMoSembre-neuro-3","context":null,"enonce":"Regarding motor impairments:","item":"deficitMoSembre","matiere":"neuro","propositions":[{"idx":0,"proposition":"When the lesion is small and\/or spares sensory structures, the motor deficit can be isolated","correct":true},{"idx":1,"proposition":"Peripheral neurogenic syndrome is characterized by impairment of voluntary and reflex motor skills","correct":true},{"idx":2,"proposition":"Spontaneous fasciculations may be observed upon inspection in peripheral neurogenic syndrome","correct":true},{"idx":3,"proposition":"There is no amyotrophy in perpipheric neurogenic syndrome","correct":false,"justification":"Abolition of osteotendinous reflexes and Amyotrophy of affected muscles when motor deficit is prolonged"},{"idx":4,"proposition":"There are three main types of diffuse neuropathies depending on the mode of installation","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"deficitMoSembre-neuro-4","context":null,"enonce":"Which propositions are true?","item":"deficitMoSembre","matiere":"neuro","propositions":[{"idx":0,"proposition":"Acute polyradiculoneuritis has unilateral involvement","correct":false,"justification":"Bilateral"},{"idx":1,"proposition":"Acute polyradiculoneuritis has symmetrical involvement","correct":true},{"idx":2,"proposition":"Acute polyradiculoneuritis is exclusively proximal","correct":false,"justification":"proximal and distal"},{"idx":3,"proposition":"Multiple mononeuropathies are multiple truncal disorders","correct":true},{"idx":4,"proposition":"Focal neuropathies are related to the involvement of a root, plexus or trunk responding to a precise systematization","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"deficitMoSembre-neuro-5","context":null,"enonce":"Concerning motor and sensory impairments:","item":"deficitMoSembre","matiere":"neuro","propositions":[{"idx":0,"proposition":"Myogenic syndrome is characterized by a motor deficit of varied topography","correct":true},{"idx":1,"proposition":"Myogenic syndrome affects the distal muscles","correct":false,"justification":"in principle rather proximal"},{"idx":2,"proposition":"In case of complete transverse involvement of the spinal cord, in addition to motor deficit (tetra or paraplegia), there is a sensory level with a lesional and sublesional syndrome","correct":true},{"idx":3,"proposition":"Hemi-marrow syndrome (Brown-Séquard syndrome) has a very high localizing value","correct":true},{"idx":4,"proposition":"Plexic involvement corresponds to the involvement of a single dermatome","correct":false,"justification":"The sensory territory corresponds to the involvement of several dermatomes"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pathosalivaire-ORL-0","context":null,"enonce":"General:","item":"pathosalivaire","matiere":"ORL","propositions":[{"idx":0,"proposition":"Sialitis is an inflammation of the salivary glands","correct":true},{"idx":1,"proposition":"Sialitis can have an infectious component","correct":true},{"idx":2,"proposition":"Sialoses are parasitic infections","correct":false,"justification":"Global hypertrohpia"},{"idx":3,"proposition":"Sialoses are global hypertrophies","correct":true},{"idx":4,"proposition":"Slave glands can be the site of tumors","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"pathosalivaire-ORL-1","context":null,"enonce":"Regarding tumors:","item":"pathosalivaire","matiere":"ORL","propositions":[{"idx":0,"proposition":"Tumors can be diagnosed by ultrasound","correct":false,"justification":"Difficult to formally diagnose a tumor, except by histological examination"},{"idx":1,"proposition":"An isolated non-inflammatory swelling evokes a tumor in first line","correct":true},{"idx":2,"proposition":"Tumours of the main salivary glands sometimes appear for several years","correct":true},{"idx":3,"proposition":"Differential diagnoses are numerous and must be eliminated","correct":false,"justification":"They are relatively rare (mastoiditis, transverse apopysis of the atlas, etc.)"},{"idx":4,"proposition":"The most common parotid tumors are pleomorphic adenomas","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"pathosalivaire-ORL-2","context":null,"enonce":"Regarding tumors:","item":"pathosalivaire","matiere":"ORL","propositions":[{"idx":0,"proposition":"Treatment of pleomorphic adenoma is surgical","correct":true},{"idx":1,"proposition":"Post-surgery monitoring of pleomorphic adenoma is unnecessary","correct":false,"justification":"Prolonged because it exsites a small risk of cancerization"},{"idx":2,"proposition":"Tubular adenoma is a malignant tumor","correct":false,"justification":"Benign"},{"idx":3,"proposition":"Malignant tumors account for 50% of tumors","correct":false,"justification":"8 to 18%"},{"idx":4,"proposition":"In children, almost 50% of parotid tumors are malignant","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ISurR-endoc-0","context":null,"enonce":"Regarding acute adrenal insufficiency:","item":"ISurR","matiere":"endoc","propositions":[{"idx":0,"proposition":"This is a vital emergency","correct":true},{"idx":1,"proposition":"Treatment is started as soon as the hromonal assays have validated the diagnosis.","correct":false,"justification":"Treatment is urgent even without diagnostic certainty. Hormonal assays can be carried out secondarily."},{"idx":2,"proposition":"Hemoconcentration is found in primary adrenal insufficiency","correct":true},{"idx":3,"proposition":"Hyponatremia is specific for primary adrenal insufficiency","correct":false,"justification":"No, but hyperkalemia yes, due to aldosterone deficiency"},{"idx":4,"proposition":"Biology regains metabolic alkalosis","correct":false,"justification":"Metabolic acidode is found in blood gases"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"ISurR-endoc-1","context":null,"enonce":"Regarding the symptoms of acute adrenal insufficiency:","item":"ISurR","matiere":"endoc","propositions":[{"idx":0,"proposition":"Extracellular dehydration is often marked","correct":true,"justification":"These include a skin fold and hypotension up to collapse"},{"idx":1,"proposition":"Hypernatremia can lead to confusion and seizures","correct":false,"justification":"It is hyponatremia and hypoglycemia that have these effects."},{"idx":2,"proposition":"The presence of fever eliminates the diagnosis of adrenal insufficiency","correct":false,"justification":"Fever may be present, it may be part of an infection that has precipitated decompensation"},{"idx":3,"proposition":"Associated urinary disorders confirm the picture","correct":false},{"idx":4,"proposition":"Myalgia may be part of the picture","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ISurR-endoc-2","context":null,"enonce":"Regarding the diagnosis of acute adrenal insufficiency:","item":"ISurR","matiere":"endoc","propositions":[{"idx":0,"proposition":"The positive diagnosis is pathological","correct":false,"justification":"It is biological (determination of cortisol and ATCH). In children, renin is additionally dosed."},{"idx":1,"proposition":"Known chronic adrenal insufficiency renders hormone testing unnecessary","correct":true,"justification":"Hormonal dosages are of no interest if adrenal insufficiency is known"},{"idx":2,"proposition":"Cortisolemia collapsed in acute adrenal insufficiency","correct":true},{"idx":3,"proposition":"ACTH collapsed in primary adrenal insufficiency","correct":false,"justification":"It is greatly increased in primary adrenal insufficiency"},{"idx":4,"proposition":"Complete adrenal enzyme block (21-hydroxylase) is an etiology of acute adrenal insufficiency","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"ISurR-endoc-3","context":null,"enonce":"Regarding the management of acute adrenal insufficiency:","item":"ISurR","matiere":"endoc","propositions":[{"idx":0,"proposition":"It is done in clinical medicine","correct":false,"justification":"The patient is transferred to emergency or intensive care"},{"idx":1,"proposition":"At the patient's home, 100mg of hydrocortisone is injected","correct":true,"justification":"In IV or IM. failing that, in SC. A patient with known adrenal insufficiency should have at least two packs of Hydrocortisone 100 mg with him and know how to make an SC injection of hydrocortisone in case of Emergency."},{"idx":2,"proposition":"In hospitals, dehydration is compensated by filling with 0.9% NaCl","correct":true},{"idx":3,"proposition":"Hydroelectrolyte disorders are compensated by the administration of potassium and bicarbonates","correct":false,"justification":"No potassium supplementation, because hyperkalemia (+++)"},{"idx":4,"proposition":"Maintenance therapy is 100 mg per 24 hours as an IV infusion","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ISurR-endoc-4","context":null,"enonce":"Regarding adrenal insufficiency, which propositions are true?","item":"ISurR","matiere":"endoc","propositions":[{"idx":0,"proposition":"Melanoderma is specific for secondary adrenal insufficiency.","correct":false,"justification":"Melanoderma (due to excess ACTH) is specific for primary adrenal insufficiency, it is a clinical element that can help guide the diagnosis"},{"idx":1,"proposition":"In children, the treatment of adrenal insufficiency can not correct the signs of hyperandrogenism in the long term, in case of deficiency of 21 hydroxylase","correct":false,"justification":"The absence of signs of long-term hyperandrogenism is one of the objectives of treatment in case of 21 hydroxylase deficiency"},{"idx":2,"proposition":"In the biological follow-up of the treatment of chronic adrenal insufficiency in children, it is recommended to measure cortisol and plasma ACTH","correct":false,"justification":"Clinical monitoring +++"},{"idx":3,"proposition":"In the case of acute adrenal insufficiency in a newborn or infant, persistent cholestatic jaundice may be found.","correct":true,"justification":"Hypoglycemia, hypotonia, convulsions, low blood pressure and persistent cholestatic jaundice"},{"idx":4,"proposition":"Acute adrenal insufficiency can be triggered in older children by abruptly discontinuation of long-term, high-dose inhaled corticosteroid therapy.","correct":true,"justification":"Abrupt cessation of corticosteroid treatment p.o., inhaled (high-dose and prolonged Fluticosone) or topically applied (large area)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IST-infectio-0","context":null,"enonce":"Which of the following are etiologies of false syphilitic serology?","item":"IST","matiere":"infectio","propositions":[{"idx":0,"proposition":"Leprosy","correct":true},{"idx":1,"proposition":"Lupus","correct":true},{"idx":2,"proposition":"HSV meningitis","correct":false,"justification":"No report"},{"idx":3,"proposition":"HHV-8","correct":false,"justification":"No report"},{"idx":4,"proposition":"Leptospirosis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IST-infectio-1","context":null,"enonce":"Which of the following are true about Chlamydia trachomatis?","item":"IST","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is the leading cause of bacterial STIs in Europe","correct":true},{"idx":1,"proposition":"The incidence is more common between 15 and 34 years of age in women","correct":true},{"idx":2,"proposition":"Peak incidence occurs later in humans","correct":true,"justification":"True, between 20 and 39 years old"},{"idx":3,"proposition":"It is a gram-positive bacillus","correct":false,"justification":"The gram is negative, like many bacillus (except Clostidioides, Listeria and Tropheryma)"},{"idx":4,"proposition":"Carriage is never asymptomatic in humans","correct":false,"justification":"In 10% of cases, it is"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IST-infectio-2","context":null,"enonce":"Which of the following is the first-line treatment for N. gonorrhoeae?","item":"IST","matiere":"infectio","propositions":[{"idx":0,"proposition":"None of the proposals","correct":true,"justification":"True, indeed, it is Ceftriaxone in IM monodose of 500 mg"},{"idx":1,"proposition":"Metronidazole","correct":false,"justification":"False"},{"idx":2,"proposition":"Imidazole","correct":false,"justification":"False"},{"idx":3,"proposition":"Doxycycline","correct":false,"justification":"False"},{"idx":4,"proposition":"C3G IV","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"glaucomechr-ophtalmo-0","context":null,"enonce":"General:","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"CAPG is defined as progressive optic neuropathy","correct":true},{"idx":1,"proposition":"It is the widely predominant clinical form of all glaucoma in Western countries.","correct":true},{"idx":2,"proposition":"CAPG mainly affects the population over 40 years of age","correct":true},{"idx":3,"proposition":"It is the second leading cause of blindness in Western countries (after AMD) and the leading cause of irreversible blindness worldwide.","correct":true},{"idx":4,"proposition":"CAPM has no known risk factor","correct":false,"justification":"CAPG has several risk factors such as age or ethnicity"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"glaucomechr-ophtalmo-1","context":null,"enonce":"Risk factors and epidemiology","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Prevalence is about 10% after age 85","correct":true},{"idx":1,"proposition":"Ocular hypertonia is not a known risk factor","correct":false,"justification":"ocular hypertonia: increased intraocular pressure (IOP) beyond two standard deviations is a risk factor"},{"idx":2,"proposition":"Ocular hypertonia is a known cause of CAPG","correct":false,"justification":"a risk factor but not the cause of CAPM"},{"idx":3,"proposition":"Direct family history confers a 3-fold higher risk of developing CAPM for offspring","correct":true},{"idx":4,"proposition":"No genes predisposing to CAPG were found","correct":false,"justification":"Genes have been identified but their research has no clinical application at the moment"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"glaucomechr-ophtalmo-2","context":null,"enonce":"General:","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Melanoderma patients have a 3-fold higher risk of developing CAPM","correct":true},{"idx":1,"proposition":"Myopia regardless of its intensity multiplies by three the risk of developing a CAPM","correct":true},{"idx":2,"proposition":"Cardiovascular and metabolic diseases are not proven risk factors","correct":false,"justification":"Other risk factors such as diabetes, cardiovascular diseases are described but much less well supported than those retained above"},{"idx":3,"proposition":"The pathophysiology of CAPM is part of neurodegenerative diseases","correct":true},{"idx":4,"proposition":"There are about 1 million ganglion cells in each eye","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"glaucomechr-ophtalmo-3","context":null,"enonce":"General and pathophysiology:","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"After 40 years, the simple fact of aging leads to the loss of about 8000 ganglion cells per year","correct":true},{"idx":1,"proposition":"CAPG is the sudden and fleeting loss of retinal cells whose impact is spread over time","correct":false,"justification":"CAPM is actually the accelerated loss of these optical fibers compared to age-related physiological loss."},{"idx":2,"proposition":"An open angle is observed in gonioscopy (visibility of the pigmented trabeculum of more than 180 °)","correct":true},{"idx":3,"proposition":"Visual acuity drops steadily and aggravates myopia already often present","correct":false,"justification":"Visual acuity is not affected, except in the late stages of the disease or in case of other associated eye pathology (cataract, age-related macular degeneration)"},{"idx":4,"proposition":"High-pressure CAPM is extremely rare","correct":false,"justification":"It accounts for about 70% of CAPM cases in Western populations."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"glaucomechr-ophtalmo-4","context":null,"enonce":"Regarding the diagnosis of CAPM:","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"It is characterized by progressive optic neuropathy with structural and\/or functional abnormalities","correct":true},{"idx":1,"proposition":"Increased papillary excavation accompanies loss of the neuroretinal ring","correct":true},{"idx":2,"proposition":"An asymmetry of this ratio greater than 0.2 between the two eyes is suspicious of glaucoma","correct":true},{"idx":3,"proposition":"OCT can calculate areas and volumes at a resolution of about 5 microns","correct":true},{"idx":4,"proposition":"OCT has no place in CAPG","correct":false,"justification":"It is useful for the positive diagnosis and differential diagnosis of CAPM as well as for the evaluation of the follow-up and effectiveness of the treatments put in place."}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"glaucomechr-ophtalmo-5","context":null,"enonce":"Regarding the CAPG:","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Central visual acuity is affected very late","correct":true},{"idx":1,"proposition":"The key examination is the visual field performed today with automated static perimetry (PSA)","correct":true},{"idx":2,"proposition":"The PSA takes about 30 minutes per eye and is performed by an orthoptist","correct":false,"justification":"This exam, which today takes about 5 minutes per eye, requires good cooperation and understanding of the test."},{"idx":3,"proposition":"The alteration of the visual field is mainly marked by the appearance of scotomas","correct":true},{"idx":4,"proposition":"The usual form of CAPM occurs untreated with IOP greater than 21 mmHg","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"glaucomechr-ophtalmo-6","context":null,"enonce":"The CAPG:","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Normal pressure CAPM accounts for approximately 70% of CAPM cases in Asian populations","correct":true},{"idx":1,"proposition":"Alterations in structure and function are substantially the same as high-pressure CAPM","correct":true},{"idx":2,"proposition":"Unlike the classic form of CAPG, normal IOP CAPM occurs untreated with IOP less than or equal to 21 mmHg","correct":true},{"idx":3,"proposition":"CAPG is a risk factor for retinal vein occlusions","correct":true},{"idx":4,"proposition":"Ocular hypertonia is defined as IOP greater than 15 mmHg","correct":false,"justification":"Ocular hypertonia It is defined as IOP greater than 21 mmHg, an open angle in gonioscopy and the absence of optic neuropathy"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PID-pneumo-0","context":null,"enonce":"About PIDs","item":"PID","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Diffuse interstitial lung disease (PID) brings together many entities whose common point is to give diffuse infiltrative opacities on the chest X-ray","correct":true},{"idx":1,"proposition":"Acute IRS is dominated by infectious and hemodynamic causes","correct":true},{"idx":2,"proposition":"Bronchoalveolar lavage is the key examination during acute febrile PID","correct":true},{"idx":3,"proposition":"Cardiology is essential during acute febrile IRS","correct":false,"justification":"Cardiology is essential during acute non-febrile IRS"},{"idx":4,"proposition":"Sub-acute or chronic PID are dominated by sarcoidosis, idiopathic pulmonary fibrosis and pulmonary fibrosis associated with connective tissue","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"PID-pneumo-1","context":null,"enonce":"About PIDs","item":"PID","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Clinical presentation and EFRs of IRS are indiscriminate","correct":true},{"idx":1,"proposition":"Chest CT is the cornerstone of the etiological orientation of sub-acute or chronic IRS","correct":true},{"idx":2,"proposition":"PIDs have in common to chest imaging DIFFUSE, non-systematized, bilateral and symmetrical parenchymal opacities","correct":true},{"idx":3,"proposition":"The diagnostic approach and management are fundamentally different, depending on whether you are dealing with acute PID or sub-acute or chronic PID (PID-SC)","correct":true},{"idx":4,"proposition":"The LBA is very effective for the diagnosis of infections and allows diagnostic guidance in other cases","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PID-pneumo-2","context":null,"enonce":"About PIDs","item":"PID","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The analysis of the predominant lesions, their topography and associated lesions makes it possible to define radiological profiles (patterns) which each have an etiological orientation value.","correct":true},{"idx":1,"proposition":"The diagnostic approach uses histology very frequently","correct":false,"justification":"Histology is used in less than 10% of IRS"},{"idx":2,"proposition":"The complexity of the reasoning in the face of IRS justifies that the vast majority of cases are the subject of a multidisciplinary discussion","correct":true},{"idx":3,"proposition":"1 Idiopathic pulmonary fibrosis (IPF) The most common IRS of unknown cause after sarcoidosis","correct":true},{"idx":4,"proposition":"Hypersensitivity pneumonitis rare in smokers","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"arthrose-rhumato-0","context":null,"enonce":"Regarding the main generalities on osteoarthritis:","item":"arthrose","matiere":"rhumato","propositions":[{"idx":0,"proposition":"It mainly affects the spine, knees, hips and hands","correct":true},{"idx":1,"proposition":"It affects articular cartilage only","correct":false,"justification":"It is a disease of all joint tissues affecting primarily articular cartilage, but also the synovial membrane and subchondral bone"},{"idx":2,"proposition":"It causes inflammatory pain","correct":false,"justification":"When it becomes symptomatic, it causes mechanical pain and functional disability"},{"idx":3,"proposition":"It affects about 1% of the French population","correct":false,"justification":"Prevalence of about 10%"},{"idx":4,"proposition":"Excess cardiovascular mortality is observed in gonarthrosic patients","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"arthrose-rhumato-1","context":null,"enonce":"Regarding histo-anatomy:","item":"arthrose","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Chondrocytes are in charge of the production and degradation of the extracellular matrix of cartilage","correct":true},{"idx":1,"proposition":"The extracellular matrix is composed of more than 10% water","correct":false,"justification":"This matrix is composed of more than 80% water and a network of collagen and proteoglycans, strongly hydrophilic"},{"idx":2,"proposition":"The interactions between bone and cartilage are very important and allow the passage of nutrients and different mediators","correct":true},{"idx":3,"proposition":"The inner surface of the joint capsule is lined with the synovial membrane responsible for the production of synovial fluid","correct":true},{"idx":4,"proposition":"Cancellous bone provides nutrients for articular cartilage","correct":false,"justification":"It is the synovial membrane that takes care of it"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"arthrose-rhumato-2","context":null,"enonce":"Regarding coxarthrosis:","item":"arthrose","matiere":"rhumato","propositions":[{"idx":0,"proposition":"The pain is due to inflammation of the cartilage","correct":false,"justification":"Pain is a poorly understood phenomenon in osteoarthritis and complex since cartilage is not innervated. It is rather a suffering of the subchondral bone that is responsible for the pain"},{"idx":1,"proposition":"Coxarthrosis refers to gonalgia due to osteoarthritis","correct":false,"justification":"Osteoarthritis of the coxofemoral joint"},{"idx":2,"proposition":"Functional limitation is the most common reason for consultation","correct":false,"justification":"It's the pain"},{"idx":3,"proposition":"The most specific localization of coxarthrosis pain is in the groin crease","correct":true},{"idx":4,"proposition":"Mechanical knee pain is very specific to gonarthrosis","correct":false,"justification":"Careful! The pain of coxarthrosis can be said to be \"projected\" in front of the knee, which can be misleading"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"arthrose-rhumato-3","context":null,"enonce":"Which of the following proposals could correspond to an installed coxarthrosis?","item":"arthrose","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Knee pain","correct":true},{"idx":1,"proposition":"Pain when mobilizing internally rotates","correct":true},{"idx":2,"proposition":"Mowing","correct":false,"justification":"Is rather seen in the after-effects of stroke (stiffness of the knee, hypertonia of the quadriceps \/ triceps sural which gives an attitude of the foot in varus)"},{"idx":3,"proposition":"Dodge limp","correct":true},{"idx":4,"proposition":"Steppage","correct":false,"justification":"Rather seen in Charcot-Marie-Tooth or in peripheral neurological disorders, where there is a defect in dorsiflexion of the foot"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"confusiongeria-neuro-0","context":null,"enonce":"Concerning cognitive disorders in the elderly","item":"confusiongeria","matiere":"neuro","propositions":[{"idx":0,"proposition":"The most common cause of dementia is Alzheimer's disease","correct":true},{"idx":1,"proposition":"Demeance includes deterioration in cognition","correct":true},{"idx":2,"proposition":"Dementia includes loss of independence","correct":true},{"idx":3,"proposition":"Demence includes sleep disorders","correct":false},{"idx":4,"proposition":"In the predemential phase of Alzheimer's disease the most common clinical sign is forgetfulness","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"confusiongeria-neuro-1","context":null,"enonce":"The histological stigmas of Alzheimer's disease are","item":"confusiongeria","matiere":"neuro","propositions":[{"idx":0,"proposition":"Amyloid plaques","correct":true},{"idx":1,"proposition":"fibrinoid necrosis","correct":false},{"idx":2,"proposition":"Cell loss","correct":true},{"idx":3,"proposition":"Neurofibillary degeneration","correct":true},{"idx":4,"proposition":"caseous necrosis","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"confusiongeria-neuro-2","context":null,"enonce":"The minimum balance sheet of a demence shall include","item":"confusiongeria","matiere":"neuro","propositions":[{"idx":0,"proposition":"A spinal cord MRI","correct":false},{"idx":1,"proposition":"A brain MRI","correct":true},{"idx":2,"proposition":"a biological assessment","correct":true},{"idx":3,"proposition":"a neuropsychological assessment","correct":true},{"idx":4,"proposition":"An occupational therapy consultation","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"confusiongeria-neuro-3","context":null,"enonce":"About Alzheimer's disease","item":"confusiongeria","matiere":"neuro","propositions":[{"idx":0,"proposition":"Carriage of homozygosity for apolipoprotein E ε4 allele is a risk factor for Alzheimer's disease","correct":true},{"idx":1,"proposition":"abnormal accumulation of β-amyloid proteins (Aβ-42) in extracellular clusters characterizes Alzheimer's disease","correct":true},{"idx":2,"proposition":"Low level of education protects against Alzheimer's disease","correct":false,"justification":"it is a risk factor"},{"idx":3,"proposition":"Analysis of cerebrospinal fluid found during Alzheimer's disease finds a massive decrease in AB42 and an increase in TAU-p","correct":true},{"idx":4,"proposition":"The diagnosis of certainty of Alzheimer's disease is based on neuropathology (post mortem)","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"confusiongeria-neuro-4","context":null,"enonce":"Which of the following proposals are mandatory and systematic in the first instance?","item":"confusiongeria","matiere":"neuro","propositions":[{"idx":0,"proposition":"Biology: NFS, CRP, TSH, ionogram, Blood glucose, Calcemia","correct":true},{"idx":1,"proposition":"HIV serology","correct":false,"justification":"Non-systematic"},{"idx":2,"proposition":"HBV, HCV and HEV serology","correct":false,"justification":"Not recommended. The recommended serologies according to the context are: HIV, Syphilis, B9 and B12"},{"idx":3,"proposition":"Brain MRI with sections passing through the axis of the hippocampuses","correct":true},{"idx":4,"proposition":"No additional examination is mandatory","correct":false,"justification":"False, on the other hand this is the case of typical Parkinson's disease"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"confusiongeria-neuro-5","context":null,"enonce":"Which of the following proposals can be found in Alzheimer's disease?","item":"confusiongeria","matiere":"neuro","propositions":[{"idx":0,"proposition":"Temporo-spatial disorientation","correct":true},{"idx":1,"proposition":"Visuopraxic disorder with errors when copying the MMSE figure","correct":true,"justification":"True, by parietal involvement"},{"idx":2,"proposition":"Delayed recall disruption during the 5-word test, normalized by indication","correct":false,"justification":"There is no problem of restitution or access to information in Alzheimer's disease"},{"idx":3,"proposition":"Delayed recall disruption during the 5-word test, little improved by cueing","correct":true,"justification":"True, related to an encoding problem"},{"idx":4,"proposition":"Difficulty with motor sequences during the BREF (Fast Battery of Frontal Efficiency)","correct":false,"justification":"As its name suggests, it would be found in frontal syndromes"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"deficitMo-neuro-0","context":null,"enonce":"General","item":"deficitMo","matiere":"neuro","propositions":[{"idx":0,"proposition":"A neurological deficit is the loss of function related to a temporary dysfunction (transient deficit) or lesional (permanent deficit) of a region of the nervous system","correct":true},{"idx":1,"proposition":"A recent neurological deficit (less than 1 month) is a common reason for emergency room and neurology visits","correct":true},{"idx":2,"proposition":"A recent neurological deficit most often indicates an attack of the central nervous system but can also be caused by an attack of the peripheral nervous system, the neuromuscular or muscular junction","correct":true},{"idx":3,"proposition":"A recent neurological deficit is a sign of entry into a chronic disease and is therefore never urgent.","correct":false,"justification":"A recent neurological deficit may be a sign of a serious neurological problem requiring specific and urgent treatment, but may also be a mode of entry into a chronic neurological disease."},{"idx":4,"proposition":"Any recent neurological deficit of sudden onset should lead to suspicion of a stroke","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"deficitMo-neuro-1","context":null,"enonce":"Concerning basic semiology:","item":"deficitMo","matiere":"neuro","propositions":[{"idx":0,"proposition":"In the case of central nervous system involvement, the lesion is located on the roots, plexuses, nerve trunks, neuromuscular junction or muscles","correct":false,"justification":"Peripheral nervous system"},{"idx":1,"proposition":"Damage to the peripheral nervous system is evoked in front of the involvement of a hemibody (motor or sensory)","correct":false,"justification":"Damage to the central nervous system is evoked in the face of such an attack"},{"idx":2,"proposition":"The homonymous lateral hemianopsia is a sign of involvement of the frontal cortex","correct":false,"justification":"Homonymous lateral hemianopsia is a sign of retrochiasmatic involvement"},{"idx":3,"proposition":"The sign of Babinski is an interesting sign the spinal cord","correct":false,"justification":"Babinski's sign = pyramid sign = central involvement"},{"idx":4,"proposition":"Damage to the peripheral nervous system is evoked in front of fasciculations","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"deficitMo-neuro-2","context":null,"enonce":"Concerning etiologies and differential diagnoses:","item":"deficitMo","matiere":"neuro","propositions":[{"idx":0,"proposition":"Involvement of the neuromuscular or muscular junction is evoked in front of pure motor impairment","correct":true},{"idx":1,"proposition":"The clinical analysis must make it possible to define the syndrome","correct":true},{"idx":2,"proposition":"There is no non-neurological differential diagnosis of recent neurological deficit","correct":false,"justification":"Metabolic, psychiatry, orthopedics, etc."},{"idx":3,"proposition":"A cuff rupture can mimic a recent neurological deficit","correct":true},{"idx":4,"proposition":"Speech disorders always have a neurological origin","correct":false,"justification":"For speech, balance and vision disorders, the cause may be non-neurological, of local origin: ENT"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"deficitMo-neuro-3","context":null,"enonce":"Concerning the main generalities:","item":"deficitMo","matiere":"neuro","propositions":[{"idx":0,"proposition":"A deficit can have a psychogenic origin, it is then a conversion disorder","correct":false,"justification":"It is then a somatomorphic disorder: motor or sensory territory a little \"aberrant\", non-anatomical, with discordance of the clinical examination, changing complaints, \"beautiful indifference\"... Somatoform disorders can be part of different contexts: hysterical (conversion), simulation, depressive syndrome..."},{"idx":1,"proposition":"The mode of installation of the deficit is a major element of diagnostic orientation","correct":true},{"idx":2,"proposition":"The study of the anamnesis must be particularly careful","correct":true},{"idx":3,"proposition":"Age The older the patient, the more frequent the vascular causes","correct":true},{"idx":4,"proposition":"Complementary neurological examinations are guided by topographic diagnosis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"MSN-urg-0","context":null,"enonce":"What is the corrected QT threshold to suspect long QT syndrome?","item":"MSN","matiere":"urg","propositions":[{"idx":0,"proposition":"400 ms","correct":false,"justification":"None"},{"idx":1,"proposition":"420 ms","correct":false,"justification":"None"},{"idx":2,"proposition":"430 ms","correct":false,"justification":"None"},{"idx":3,"proposition":"440 ms","correct":true,"justification":"None"},{"idx":4,"proposition":"460 ms","correct":false,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"KcVADS-onco-0","context":null,"enonce":"Which of these generalities are true?","item":"KcVADS","matiere":"onco","propositions":[{"idx":0,"proposition":"EBV is an important risk factor for cavum cancer","correct":true},{"idx":1,"proposition":"Unilateral earache can sometimes be the only symptom of VADS cancer","correct":true},{"idx":2,"proposition":"HPV is a very important risk factor for oropharyngeal tumors","correct":true},{"idx":3,"proposition":"HPV-induced oropharyngeal tumors are favored by sex","correct":false,"justification":"Favored by genito-oral relationships"},{"idx":4,"proposition":"The most common histological type of sinus tumours is undifferentiated carcinoma","correct":false,"justification":"This is the case of the cavum. For the nasal cavity and sinuses, we mainly find adenocarcinomas"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"KcVADS-onco-1","context":null,"enonce":"Which of these generalities are true?","item":"KcVADS","matiere":"onco","propositions":[{"idx":0,"proposition":"Cervical radiation therapy can induce hypothyroidism","correct":true},{"idx":1,"proposition":"MRI is mainly indicated in the assessment of extension of tumors under the hyoid bone ","correct":false,"justification":"Above the hyoid bone (oral cavity, cavum, sinuses, nasal cavity, oropharynx): MRI. Below: Scan"},{"idx":2,"proposition":"The CT scan is mainly indicated in the assessment of extension of tumors above the hyoid bone ","correct":false,"justification":"Above the hyoid bone: MRI. Below (larynx, hypopharynx): CT scan"},{"idx":3,"proposition":"The localization of VADS tumors is often bilateral","correct":false,"justification":"Often almost exclusively unilateral. The accompanying symptoms are therefore also unilateral."},{"idx":4,"proposition":"Upper endoscopy is systematic","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"KcVADS-onco-2","context":null,"enonce":"Which of these specialties are absolutely necessary for the holding of a CPR?","item":"KcVADS","matiere":"onco","propositions":[{"idx":0,"proposition":"The surgeon","correct":true},{"idx":1,"proposition":"The radiotherapist","correct":false,"justification":"Three specialties: surgery, oncology, and radiology"},{"idx":2,"proposition":"The radiologist","correct":true},{"idx":3,"proposition":"The medical oncologist","correct":true},{"idx":4,"proposition":"ENT","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"KcVADS-onco-3","context":null,"enonce":"Regarding the tumor of the cacum:","item":"KcVADS","matiere":"onco","propositions":[{"idx":0,"proposition":"The cavum is the new name for the oropharynx","correct":false,"justification":"The cavum is the new name for the nasopharynx (or nasopharynx)"},{"idx":1,"proposition":"It is specifically promoted by HPV infection","correct":false,"justification":"EBV"},{"idx":2,"proposition":"This is most often adenocarcinoma","correct":false,"justification":"Undifferentiated carcinoma"},{"idx":3,"proposition":"It represents 30 to 50% of VADS tumors","correct":false,"justification":"Less than 1%"},{"idx":4,"proposition":"Examination of the ear can find unilateral seromucosal otitis","correct":true,"justification":"Sometimes it's the only symptom"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"KcVADS-onco-4","context":null,"enonce":"Which of the following is the most common histological type of ethmoid tumor?","item":"KcVADS","matiere":"onco","propositions":[{"idx":0,"proposition":"Squamous cell carcinoma","correct":false,"justification":"Common in tumors of the oral cavity, oropharynx, larynx and hypopharynx"},{"idx":1,"proposition":"Adenocarcinoma","correct":true,"justification":"True, common in nasal cavity and sinus tumors"},{"idx":2,"proposition":"Undifferentiated carcinoma","correct":false,"justification":"Common in EBV-induced cavum tumors"},{"idx":3,"proposition":"Carcinoma in situ","correct":false,"justification":"It is not a histological type but a stage T"},{"idx":4,"proposition":"None of these propositions are accurate","correct":false,"justification":"Adenocarcinoma is the most common hystrophological type of ethmoid tumors."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"KcVADS-onco-5","context":null,"enonce":"Regarding the epidemiology of VADS tumors, which proposals are true?","item":"KcVADS","matiere":"onco","propositions":[{"idx":0,"proposition":"These tumours most often occur in women","correct":false,"justification":"False, in humans in 80% of cases."},{"idx":1,"proposition":"The peak frequency is between 60 and 70 years.","correct":true,"justification":"The peak frequency is between 60 and 70 years (except HPV-related oropharyngeal cancers)"},{"idx":2,"proposition":"They are often associated with a low socio-economic level.","correct":true,"justification":"They are often associated with a low socio-economic level."},{"idx":3,"proposition":"They are most often located at the level of the cavum.","correct":false,"justification":"False, cavum in < 1% of cases. Most often in the larynx (35%)."},{"idx":4,"proposition":"There is currently a decrease in the incidence of these tumours in humans.","correct":true,"justification":"There is currently a decrease in the incidence in humans of these tumors due to the decrease in alcohol and tobacco intoxication."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"KcVADS-onco-6","context":null,"enonce":"Regarding the cancer risk factors of VADS, which proposals are accurate? ","item":"KcVADS","matiere":"onco","propositions":[{"idx":0,"proposition":"Alcohol","correct":true,"justification":"Alcohol"},{"idx":1,"proposition":"Tobacco ","correct":true,"justification":"Tobacco"},{"idx":2,"proposition":"CMV infection ","correct":false,"justification":"Not CMV but EBV for cavum cancer and HPV for oropharynx."},{"idx":3,"proposition":"Poor oral hygiene","correct":true,"justification":"Poor oral hygiene"},{"idx":4,"proposition":"Exposure to wood dust","correct":true,"justification":"Exposure to wood dust (possible recognition as an occupational disease)"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"KcVADS-onco-7","context":null,"enonce":"Which of the following are true?","item":"KcVADS","matiere":"onco","propositions":[{"idx":0,"proposition":"Ethmoid cancers are frequently associated with EBV. ","correct":false,"justification":"False, these are nasopharyngeal cancers."},{"idx":1,"proposition":"Cavum cancers are usually squamous cell carcinoma. ","correct":false,"justification":"False, they are most often UCNT type (undifferenciated carcinoma of nasopharyngeal type)"},{"idx":2,"proposition":"Alcohol and tobacco are the most common risk factors for head and neck cancers.","correct":true,"justification":"Alcohol and tobacco are the most common risk factors for head and neck cancers."},{"idx":3,"proposition":"Adenocarcinoma of the ethmoid is considered an occupational disease.","correct":true,"justification":"Ethmoid adenocarcinoma is considered an occupational disease (occupational exposure to wood dust)"},{"idx":4,"proposition":"VADS cancers are the 5th most common cancer in France.","correct":true,"justification":"VADS cancers are the 5th most common cancer in France."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcped-onco-0","context":null,"enonce":"What is the annual incidence of childhood cancer in France?","item":"Kcped","matiere":"onco","propositions":[{"idx":0,"proposition":"1200","correct":false},{"idx":1,"proposition":"2400","correct":true},{"idx":2,"proposition":"4800","correct":false},{"idx":3,"proposition":"9600","correct":false},{"idx":4,"proposition":"19200","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Kcped-onco-1","context":null,"enonce":"What is the approximate cure rate for childhood and adolescent tumors?","item":"Kcped","matiere":"onco","propositions":[{"idx":0,"proposition":"0.2","correct":false},{"idx":1,"proposition":"0.4","correct":false},{"idx":2,"proposition":"0.6","correct":false},{"idx":3,"proposition":"0.8","correct":true},{"idx":4,"proposition":"1","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Kcped-onco-2","context":null,"enonce":"About childhood cancers:","item":"Kcped","matiere":"onco","propositions":[{"idx":0,"proposition":"Have very slow and pauci-symptomatic growth","correct":false,"justification":"They are indeed pauci-symptomatic, but their growth is very fast (in general, much more than adult tumors)"},{"idx":1,"proposition":"Are characterized by a profuse AEG","correct":false,"justification":"Except in some leukemias, there is a general condition fairly well preserved"},{"idx":2,"proposition":"Result in disparate and non-specific clinical signs","correct":false},{"idx":3,"proposition":"Are mostly glioblastomas","correct":false,"justification":"Hematological tumours in the foreground"},{"idx":4,"proposition":"Are relatively good prognosis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcped-onco-3","context":null,"enonce":"Which of the following are elements of Claude Bernard Horner syndrome?","item":"Kcped","matiere":"onco","propositions":[{"idx":0,"proposition":"Profuf asthenia","correct":false,"justification":"False, this does not fit into the definition of CBH"},{"idx":1,"proposition":"Congenital cataract","correct":false,"justification":"False, this does not fit into the definition of CBH"},{"idx":2,"proposition":"Unilateral mydriasis","correct":false,"justification":"It is a myosis of the affected eye that falls within the definition of CBH"},{"idx":3,"proposition":"Pseudo-enophtalmos","correct":true},{"idx":4,"proposition":"Sign of Charles-Bell","correct":false,"justification":"The CBH includes: ptosis, myosis and enophtalmos, all on the same side"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcped-onco-4","context":null,"enonce":"Which of the following are true about Lactate Dehydrogenase?","item":"Kcped","matiere":"onco","propositions":[{"idx":0,"proposition":"It is often used as a marker of tissue damage","correct":true},{"idx":1,"proposition":"It catalyzes the conversion of pyruvate to lactate","correct":true},{"idx":2,"proposition":"It is an extracellular protein","correct":false,"justification":"Intracellular enzyme"},{"idx":3,"proposition":"It is specific to the human being","correct":false,"justification":"LDH are enzymes found in a wide variety of organisms, both plant and animal."},{"idx":4,"proposition":"It is abundant in red blood cells and can therefore be used to guide hemolysis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"boiterieped-ortho-0","context":null,"enonce":"The basics:","item":"boiterieped","matiere":"ortho","propositions":[{"idx":0,"proposition":"Lameness corresponds to an asymmetrical approach","correct":true},{"idx":1,"proposition":"Additional examinations will be requested based on the data collected by the clinic","correct":true,"justification":"1"},{"idx":2,"proposition":"The age of the child is the determining factor that points towards one pathology rather than another.","correct":true},{"idx":3,"proposition":"In view of the emergency that is not vital, we start by questioning the patient","correct":true},{"idx":4,"proposition":"Episodes of fever strongly point to an infectious phenomenon","correct":true,"justification":"1"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"boiterieped-ortho-1","context":null,"enonce":"Regarding interrogation and clinical examination:","item":"boiterieped","matiere":"ortho","propositions":[{"idx":0,"proposition":"The precise origin of the lameness is difficult to trace in small children","correct":true},{"idx":1,"proposition":"The observation of lameness: in the shoulder lameness or equilibration that reflects a pathology of the hip, the child transfers his center of gravity to each support on the side of the physiological hip","correct":false,"justification":"The observation of lameness: in the shoulder lameness or equilibration that reflects a pathology of the hip, the child transfers his center of gravity to each support on the side of the pathological hip"},{"idx":2,"proposition":"Dodge lameness is analgesic","correct":true},{"idx":3,"proposition":"A skin lesion points to endocrine pathology","correct":false,"justification":"Infectious"},{"idx":4,"proposition":"The tibial diaphysis is palpated with particular attention to detect a possible fracture of the acetabulum","correct":false,"justification":"Possible subperiosteal fracture"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"boiterieped-ortho-2","context":null,"enonce":"Regarding pain in small children:","item":"boiterieped","matiere":"ortho","propositions":[{"idx":0,"proposition":"In hip diseases, adduction and external rotation are impossible","correct":false,"justification":"In hip disease, abduction and internal rotation are limited"},{"idx":1,"proposition":"The neurological examination looks for an equine walk, tests muscle tone, muscle strength, osteotendinous reflections","correct":true},{"idx":2,"proposition":"Refusal to sit is sometimes the only objective sign","correct":true,"justification":"1"},{"idx":3,"proposition":"The disease area is more easily identifiable in small children than in adolescents","correct":false,"justification":"Much simpler in adolescents"},{"idx":4,"proposition":"Hip pathologies are often responsible for projected heel pain","correct":false,"justification":"At the knee"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"boiterieped-ortho-3","context":null,"enonce":"Concerning paraclinical examinations:","item":"boiterieped","matiere":"ortho","propositions":[{"idx":0,"proposition":"Biological examination is systematic in search of an inflammatory syndrome","correct":true},{"idx":1,"proposition":"The best test to identify a joint effusion is the x-ray at the hip","correct":false,"justification":"It is the ultrasound that best visualizes a joint effusion at the hip or ankle"},{"idx":2,"proposition":"Ultrasound can objectify an effusion of soft parts","correct":true},{"idx":3,"proposition":"Comparative images are only justified in case of doubt about an image of osteolysis, or edema of the soft parts","correct":true,"justification":"1"},{"idx":4,"proposition":"MRI is indicated as a first-line test when the suspicion of ligament rupture is moderate to strong","correct":false,"justification":"First an ultrasound"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"boiterieped-ortho-4","context":null,"enonce":"Regarding osteoarticular infections:","item":"boiterieped","matiere":"ortho","propositions":[{"idx":0,"proposition":"CT scans and MRIs are not routine","correct":true},{"idx":1,"proposition":"An infectious assessment is essential in case of suspicion of osteoarticular infection","correct":true},{"idx":2,"proposition":"The puncture for bacteriological research is urgent in case of doubt about osteoarticular infection","correct":true},{"idx":3,"proposition":"Lameness in a febrile context is suspected of tendon rupture in the first place","correct":false,"justification":"Ë Lameness in a febrile context is due to an osteoarticular infection until proven otherwise"},{"idx":4,"proposition":"Bacteriological samples must be taken under general anesthesia, as a matter of urgency","correct":true,"justification":"1"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"boiterieped-ortho-5","context":null,"enonce":"Which propositions are true?","item":"boiterieped","matiere":"ortho","propositions":[{"idx":0,"proposition":"An osteochondritis of the hip is febrile and concerns the child between 8 and 10 years","correct":false,"justification":"Non-febrile and between 3 and 8 years old"},{"idx":1,"proposition":"Epiphysiolysis is rare before 10 years","correct":true},{"idx":2,"proposition":"Infantile cerebral hemiplegia can occur at any age in childhood","correct":true},{"idx":3,"proposition":"Congenital hip dislocation is very common before 3 years of age","correct":true},{"idx":4,"proposition":"Transient acute synovitis is very febrile at peak","correct":false,"justification":"No fever most often"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"boiterieped-ortho-6","context":null,"enonce":"Regarding the IOA:","item":"boiterieped","matiere":"ortho","propositions":[{"idx":0,"proposition":"CT scans and MRIs are not routine","correct":true},{"idx":1,"proposition":"An infectious assessment is essential in case of suspicion of osteoarticular infection","correct":true,"justification":"CRP in particular"},{"idx":2,"proposition":"The puncture for bacteriological research is urgent in case of doubt about osteoarticular infection","correct":true,"justification":"Can be done under GA"},{"idx":3,"proposition":"Lameness in a febrile context is suspected of tendon rupture in the first place","correct":false,"justification":"Lameness in a febrile context is due to an osteoarticular infection until proven otherwise"},{"idx":4,"proposition":"Initial antibiotic therapy is urgent, intravenous and adapted to the susceptibility test","correct":false,"justification":"It is initially probabilistic"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"zoonose-infectio-0","context":null,"enonce":"Concerning zoonoses","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Zoonoses are infectious diseases transmitted to humans, either directly by an animal or indirectly via vectors. ","correct":true},{"idx":1,"proposition":"In metropolitan France, the most frequent zoonoses are Lyme borreliosis, pasteurellosis, toxoplasmosis and cat's scratch disease.","correct":true},{"idx":2,"proposition":"Brucellosis has been controlled and is currently almost non-existent in France","correct":true,"justification":"See item in the latest edition of the college"},{"idx":3,"proposition":"Slow incubation is characteristic of pasteurellosis","correct":false,"justification":"It is the speed of incubation is characteristic of pasteurellosis"},{"idx":4,"proposition":"In 10% of cases of pasteurellosis, an ophthalmic form combining conjunctivitis and pretrageal lymphadenopathy is described, mainly in children","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"zoonose-infectio-1","context":null,"enonce":"Regarding cat scratch disease:","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"The cat flea is the vector of cat scratch disease","correct":true},{"idx":1,"proposition":"In humans, from the inoculation lesion, the bacterium will multiply in a relay ganglion","correct":true,"justification":"See item in the latest edition of the college"},{"idx":2,"proposition":"Lymphadenopathy is a sign of an inflammatory reaction with caseous granuloma","correct":false,"justification":"This lymphadenopathy is the site of an inflammatory reaction with epithelioid granuloma without caseous necrosis"},{"idx":3,"proposition":"This disease is more common in children and young adults, with an incubation of 2-3 days on average.","correct":false,"justification":"Incubation of 2-3 weeks on average"},{"idx":4,"proposition":"In half of the cases, there is a primary papular erythematous lesion located in the lymphatic drainage territory of the skin lesion","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"zoonose-infectio-2","context":null,"enonce":"Regarding Lyme borreliosis:","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Man is mainly stung during walks in fortê","correct":true},{"idx":1,"proposition":"From the inoculation point, the bacterium migrates and multiplies in the dermis (erythema migrans)","correct":true,"justification":"See item in the latest edition of the college"},{"idx":2,"proposition":"In a second step, it can spread through the blood and reach the central and peripheral nervous system, meninges and large joints.","correct":true,"justification":"See item in the latest edition of the college"},{"idx":3,"proposition":"A large proportion of infections are inapparent, leaving the only trace of their occurrence being the detection of specific antibodies","correct":true,"justification":"See item in the latest edition of the college"},{"idx":4,"proposition":"The vast majority of diagnoses are made in the tertiary phase of the disease","correct":false,"justification":"The vast majority of diagnoses are made in the primary phase of the disease"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"zoonose-infectio-3","context":null,"enonce":"Regarding the Q fever:","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Humans are contaminated either by the digestive tract (consumption of raw milk) or by inhalation (inhalation of aerosols from elements contaminated by the bacteria: straw, manure, etc.)","correct":true,"justification":"See item in the latest edition of the college"},{"idx":1,"proposition":"Ticks cannot transmit the bacteria","correct":false,"justification":"Ticks can eventually transmit the bacteria"},{"idx":2,"proposition":"It is an exclusive disease of the Mediterranean basin and the Caribbean, more common in rural areas","correct":false,"justification":"It is a cosmopolitan disease, more common in rural areas"},{"idx":3,"proposition":"About 95% of infections will remain asymptomatic","correct":false,"justification":"About 60% of infections will remain asymptomatic"},{"idx":4,"proposition":"It is the fever Q eagle that is by far the most common clinical form of the disease","correct":true,"justification":"See item in the latest edition of the college"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"zoonose-infectio-4","context":null,"enonce":"Which of the following are directly transmitted 🐩➡👩 pathologies?","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Toxoplasmosis","correct":true,"justification":"True, from the chat 🐱"},{"idx":1,"proposition":"Brucellosis","correct":true},{"idx":2,"proposition":"Pasteurellosis","correct":true},{"idx":3,"proposition":"Tularemia","correct":true},{"idx":4,"proposition":"All propositions are true","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"zoonose-infectio-6","context":null,"enonce":"Which of the following are directly transmitted 🐩➡👩 pathologies?","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Toxoplasmosis","correct":true,"justification":"True, from the chat 🐱"},{"idx":1,"proposition":"Brucellosis","correct":true},{"idx":2,"proposition":"Pasteurellosis","correct":true},{"idx":3,"proposition":"Tularemia","correct":true},{"idx":4,"proposition":"All propositions are true","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"zoonose-infectio-7","context":null,"enonce":"Which of the following are vector-borne pathologies?","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Q fever 🤒 ","correct":false,"justification":"Transmission is direct"},{"idx":1,"proposition":"Leishmaniasis","correct":true},{"idx":2,"proposition":"Lyme disease","correct":true,"justification":"True, via ticks 🦟"},{"idx":3,"proposition":"Tularemia","correct":false,"justification":"Transmission is direct"},{"idx":4,"proposition":"Brucellosis","correct":false,"justification":"Transmission is direct"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"zoonose-infectio-8","context":null,"enonce":"Which of the following are possible heart effects of Lyme disease?","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Myocarditis","correct":true,"justification":"True, it is rarer than the BAV"},{"idx":1,"proposition":"Atrioventricular block","correct":true},{"idx":2,"proposition":"Sino-atrial block","correct":false,"justification":"BAV"},{"idx":3,"proposition":"Syndrome de Brugada","correct":false,"justification":"It is a genetic disease"},{"idx":4,"proposition":"Coronary spasm","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"zoonose-infectio-9","context":null,"enonce":"Which of the following propositions are true regarding rabies 🐕 🦺?","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is due to Lyssavirus","correct":true,"justification":"True. Lyssaviruses are a genus of viruses in the family Rhabdoviridae, order Mononegavirales, which includes rabies virus and related viruses. In 2017, this genus has at least 14 members, the first known serotype of which is the rabies virus or RABV for RABies Virus, responsible for human rabies."},{"idx":1,"proposition":"Serotherapy is possible ","correct":true},{"idx":2,"proposition":"Incubation does not exceed 2 days","correct":false,"justification":"It can sometimes be long ⏳"},{"idx":3,"proposition":"Wound management involves washing with soap, antiseptic and trimming","correct":true},{"idx":4,"proposition":"Vaccination should be carried out urgently if the patient is no longer immunized 🚨 ","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"zoonose-infectio-10","context":null,"enonce":"Which of the following are signs or symptoms of congenital toxoplasmosis in a newborn?","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Birth weight> 3.5 kg","correct":false,"justification":"Rather prematurity so a low birth weight"},{"idx":1,"proposition":"Intrauterine growth restriction","correct":true},{"idx":2,"proposition":"Jaundice","correct":true},{"idx":3,"proposition":"Hepatosplenomegaly","correct":true},{"idx":4,"proposition":"Respiratory distress","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"zoonose-infectio-11","context":null,"enonce":"Which of the following are true about the Zika virus?","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is transmitted by an Aedes mosquito","correct":true,"justification":"True. Tiger mosquito = Aedes albopictus"},{"idx":1,"proposition":"It is teratogenic","correct":true},{"idx":2,"proposition":"Erythema migrans may be observed","correct":false,"justification":"NO, this is the case for Lyme disease"},{"idx":3,"proposition":"MS can be seen","correct":false,"justification":"A Guillain-Barré"},{"idx":4,"proposition":"It is a reportable disease","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"zoonose-infectio-12","context":null,"enonce":"Which of the following are true?","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"A zoonosis is a disease that can be transmitted from animals to humans","correct":true},{"idx":1,"proposition":"Brucellosis is transmitted by only one vector","correct":false,"justification":"Direct transmission"},{"idx":2,"proposition":"Erythema migrans is found in Lyme disease","correct":true},{"idx":3,"proposition":"Tularemia is classically apyretic","correct":false,"justification":"Fever is high"},{"idx":4,"proposition":"Q fever is caused by Coxiella Burnetii","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"immunoD-immuno-1","context":null,"enonce":"Which of the following are encapsulated bacteria?","item":"immunoD","matiere":"immuno","propositions":[{"idx":0,"proposition":"Neisseria gonorrhoeae","correct":true},{"idx":1,"proposition":"Neisseria meningitidis","correct":true},{"idx":2,"proposition":"Staphylococcus aureus","correct":false,"justification":"Staphylococci are not encapsulated"},{"idx":3,"proposition":"Haemophilus influenzae","correct":true},{"idx":4,"proposition":"Escherichia coli","correct":false,"justification":"The 3 to remember are: Haemophilus, Neisseria, Streptococcus"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"constipation-HGE-0","context":null,"enonce":"About constipation","item":"constipation","matiere":"HGE","propositions":[{"idx":0,"proposition":"Constipation is a symptom that corresponds to a dissatisfaction of the patient during defecation","correct":true},{"idx":1,"proposition":"The chronic nature of constipation is defined by a duration of symptom evolution greater than 6 weeks","correct":false,"justification":"According to international criteria (Rome criteria), the chronic nature of constipation is defined as a duration of symptom evolution greater than 6 months"},{"idx":2,"proposition":"There is a female predominance","correct":true},{"idx":3,"proposition":"In drug addicts and especially morphine addicts, constipation is almost constant","correct":true},{"idx":4,"proposition":"Hyperactivity corresponds to an increase in segmental contractions in the sigmoid region, which slow down the progression of materials","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"constipation-HGE-1","context":null,"enonce":"The elements that point to distal constipation are:","item":"constipation","matiere":"HGE","propositions":[{"idx":0,"proposition":"Pushing efforts","correct":true},{"idx":1,"proposition":"The absence of exonerating need","correct":true},{"idx":2,"proposition":"Shortened exemption time","correct":false,"justification":"It is extended"},{"idx":3,"proposition":"Less than 3 bowel movements per week","correct":false,"justification":"This is the case for transit constipation"},{"idx":4,"proposition":"Sensation of a gene at the passage of stool or incomplete evacuation","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"constipation-HGE-2","context":null,"enonce":"About constipation","item":"constipation","matiere":"HGE","propositions":[{"idx":0,"proposition":"Daily fibre intake should be greater than 5 g\/d","correct":false,"justification":"Must be greater than 15 g\/d"},{"idx":1,"proposition":"Recent constipation or worsening of chronic constipation should investigate an organic cause","correct":true},{"idx":2,"proposition":"Osmotic laxatives are the first-line treatment for any constipation","correct":true},{"idx":3,"proposition":"In case of transit conservation, rectal laxatives are often necessary","correct":false,"justification":"This is the case for distal constipation"},{"idx":4,"proposition":"Certain medications can cause constipation such as anti-depressants and opiates","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"intox-urg-0","context":null,"enonce":"What is the antidote to iron poisoning?","item":"intox","matiere":"urg","propositions":[{"idx":0,"proposition":"No known antidote","correct":false,"justification":"False, chelator of iron"},{"idx":1,"proposition":"Iron chelator","correct":true},{"idx":2,"proposition":"Alkaline diuresis","correct":false,"justification":"Salicylated poisoning"},{"idx":3,"proposition":"Hyperbaric chamber oxygen","correct":false,"justification":"CO poisoning"},{"idx":4,"proposition":"Hydroxocobalamin (vitamin B12)","correct":false,"justification":"Fire smoke poisoning (cyanide)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"intox-urg-1","context":null,"enonce":"What is the antidote to paracetamol poisoning?","item":"intox","matiere":"urg","propositions":[{"idx":0,"proposition":"None","correct":false,"justification":"False"},{"idx":1,"proposition":"N-acetylcysteine","correct":true},{"idx":2,"proposition":"Antidigoxin Fab","correct":false,"justification":"Digitalis poisoning"},{"idx":3,"proposition":"Repeated activated charcoal","correct":false,"justification":"Phenobarbital or theophylline poisoning"},{"idx":4,"proposition":"Hemodialysis","correct":false,"justification":"Lithium poisoning"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"intox-urg-2","context":null,"enonce":"What is the antidote to benzodiazepine poisoning?","item":"intox","matiere":"urg","propositions":[{"idx":0,"proposition":"Flumazenil","correct":true},{"idx":1,"proposition":"Naloxone","correct":false,"justification":"Opioid poisoning"},{"idx":2,"proposition":"Glucagon","correct":false,"justification":"Beta-blocker poisoning"},{"idx":3,"proposition":"Insulin","correct":false,"justification":"Calcium channel blocker poisoning"},{"idx":4,"proposition":"No known antidote","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"intox-urg-3","context":null,"enonce":"Which of the following are systematic additional examinations in case of suspicion of acute intoxication?","item":"intox","matiere":"urg","propositions":[{"idx":0,"proposition":"Electrocardiogram 💓","correct":true},{"idx":1,"proposition":"Capillary 🧁 blood glucose","correct":true},{"idx":2,"proposition":"Chest ☢ X-ray","correct":false,"justification":"On sign of respiratory complication"},{"idx":3,"proposition":"Brain 🧠 computed tomography","correct":false,"justification":"If alertness disorder"},{"idx":4,"proposition":"No review is systematic","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"intox-urg-4","context":null,"enonce":"Which of the following proposals are providers of serotonin syndrome?","item":"intox","matiere":"urg","propositions":[{"idx":0,"proposition":"LSD","correct":false,"justification":"Sympathomimetic syndrome"},{"idx":1,"proposition":"Anti-histamines","correct":false,"justification":"Anticholinergic syndrome"},{"idx":2,"proposition":"Antidepressants that inhibit serotonin reuptake","correct":true},{"idx":3,"proposition":"Specific serotonin reuptake agonist","correct":true},{"idx":4,"proposition":"Benzodiazepine","correct":false,"justification":"Opioid syndrome (narcotic)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"intox-urg-5","context":null,"enonce":"Which of the following proposals are providers of sympathomimetic syndrome?","item":"intox","matiere":"urg","propositions":[{"idx":0,"proposition":"Xantines","correct":true},{"idx":1,"proposition":"Cocaine","correct":true},{"idx":2,"proposition":"Amphetamines","correct":true},{"idx":3,"proposition":"LSD","correct":true},{"idx":4,"proposition":"Atropine","correct":false,"justification":"Anticholinergic syndrome"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"intox-urg-6","context":null,"enonce":"Which of the following are the providers of anticholinergic syndrome?","item":"intox","matiere":"urg","propositions":[{"idx":0,"proposition":"Atropine","correct":true},{"idx":1,"proposition":"Anti-histamines","correct":true},{"idx":2,"proposition":"Anti-parkinsonians","correct":true},{"idx":3,"proposition":"Tryciclic anti-depressants","correct":true},{"idx":4,"proposition":"Heroin","correct":false,"justification":"Opioid syndrome (narcotic)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"intox-urg-7","context":null,"enonce":"Which of the following are true?","item":"intox","matiere":"urg","propositions":[{"idx":0,"proposition":"Poisoning is the leading cause of hospital admission for adults under 30 years of age","correct":true,"justification":"True, this is exactly what is written in the college of anesthesia-resuscitation (2018 edition, page 365)"},{"idx":1,"proposition":"The ECG is done on the call point","correct":false,"justification":"It is systematic"},{"idx":2,"proposition":"CO2 poisoning accounts for 4,000 to 8,000 victims each year in France","correct":false,"justification":"False, it is at the CO (note that it is written 4000 in the college of resuscitation, and 8000 in the college of emergencies)"},{"idx":3,"proposition":"The incidence of poisoning is drastically decreasing","correct":false,"justification":"On the rise"},{"idx":4,"proposition":"The most frequent etiology is represented by voluntary intoxication with psychotropic drugs.","correct":true,"justification":"True, exactly the sentence of the Emergency Medline"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hyperEo-hemato-0","context":null,"enonce":"About eosinophils","item":"hyperEo","matiere":"hemato","propositions":[{"idx":0,"proposition":"Hypereosinophilia is defined as an absolute number of eosinophilic polynuclear > 5 G\/L, confirmed on a second sample","correct":false,"justification":"Hypereosinophilia is defined by an absolute number of eosinophilic polynuclear > 0.5 G \/ L, confirmed on a second sample"},{"idx":1,"proposition":"The main causes of eosinophilia are, in order of frequency: allergic, infectious (parasitic), more rarely neoplastic (hematological malignancy, cancer) or related to a systemic disease","correct":true},{"idx":2,"proposition":"Major eosinophilia, whatever the cause, can have harmful consequences on the functioning of different organs and in particular the heart","correct":true,"justification":"TRUE. Activated NEPs release mediators (ationic proteins, toxic oxygen metabolites), toxic to certain organs, including the heart"},{"idx":3,"proposition":"A careful interrogation must seek in particular the possibility of giardosis","correct":false,"justification":"In particular, a helmintis is sought"},{"idx":4,"proposition":"Among parasitosis, only helminthoses cause eosinophilia","correct":false,"justification":"It is most often a helminthosis, but other parasites may be involved"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hyperEo-hemato-1","context":null,"enonce":"About eosinophils","item":"hyperEo","matiere":"hemato","propositions":[{"idx":0,"proposition":"Hypereosinophil is found in some hemopathies","correct":true,"justification":"Mainly Hodgkin's disease, T-cell lymphomas, especially cutaneous, or myeloproliferative syndromes"},{"idx":1,"proposition":"The interrogation will have to look in particular for elements towards a parasitic attack such as the consumption of undercooked meat or a stay in a tropical zone","correct":true},{"idx":2,"proposition":"In case of eosinophilia with signs of severity, the patient must be put under emergency outpatient treatment","correct":false,"justification":"The patient must be hospitalized urgently with a specialized opinion"},{"idx":3,"proposition":"The introduction of new medicinal products and the taking of medicinal products must be sought at the interrogation","correct":true,"justification":"The imputability of a drug in the development of EO is difficult to prove, proof is sometimes provided only with the slow and gradual disappearance of HE after eviction of the drug"},{"idx":4,"proposition":"Hypereosinophilia> 1 G\/L for >3 months are signs of severity","correct":false,"justification":"Hypereosinophilia> 1.5 G\/L for >6 months"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hyperEo-hemato-2","context":null,"enonce":"The first-line assessment of an asymptomatic patient who has stayed in the tropics will be completed by","item":"hyperEo","matiere":"hemato","propositions":[{"idx":0,"proposition":"Total igE assays","correct":false,"justification":"The IgE assay is not in 1st intention but after the antiparasitic treatment of test of a chronic HE according to the college of hematology"},{"idx":1,"proposition":"Total IgA determination","correct":false},{"idx":2,"proposition":"Parasitological examination of stool to be repeated three times","correct":true},{"idx":3,"proposition":"Serology schistosomiasis, fillariosis, stronglyoidosis","correct":true},{"idx":4,"proposition":"A specialized opinion is mandatory","correct":false,"justification":"It is desirable but not mandatory"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SpA-rhumato-0","context":null,"enonce":"Regarding the basics of SpA:","item":"SpA","matiere":"rhumato","propositions":[{"idx":0,"proposition":"The 5 spondyloarthritis are: ankylosing spondylitis, psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory enterocolopathies and undifferentiated SpA","correct":true},{"idx":1,"proposition":"The overall prevalence of all spondyloarthritis is 0.35% in France","correct":true},{"idx":2,"proposition":"The majority of cases begin in young adults (before thirty-five or forty years of age)","correct":true},{"idx":3,"proposition":"The sex ration is 2 women for 1 man","correct":false,"justification":"Sex ratio of 1.5 men to 1 woman"},{"idx":4,"proposition":"Entheses are the bone insertions of organs on bones","correct":false,"justification":"Rather tendons, ligaments, capsules and fascia on the bones"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"SpA-rhumato-1","context":null,"enonce":"Regarding the sacro-illite:","item":"SpA","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Sacroiliitis is a pain of the buttock of mechanical schedule","correct":false,"justification":"Inflammatory"},{"idx":1,"proposition":"Fessalgia is always unilateral","correct":false,"justification":"Either unilateral, bilateral or rocking"},{"idx":2,"proposition":"Pyalgia never radiates","correct":false,"justification":"If. It can radiate below the gluteal fold and be confused with truncated sciatica"},{"idx":3,"proposition":"Neurological signs associated with this pyalgia can be found","correct":false,"justification":"No neurogenic or root character in pure sacroillitis"},{"idx":4,"proposition":"We manage to trigger these pains by shearing maneuvers of the sacroiliacs","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SpA-rhumato-2","context":null,"enonce":"Regarding clinical signs:","item":"SpA","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Psoriatic arthritis may be accompanied by arthritis of the distal interphalengals","correct":true,"justification":"Not seen in osteoarthritis or RA"},{"idx":1,"proposition":"The characteristic involvement of spondyloarthritis is the distal fracture of the femur","correct":false,"justification":"This is the enthesite"},{"idx":2,"proposition":"Only the entheses of the lower limbs and back are affected","correct":false,"justification":"All entheses can potentially be reached"},{"idx":3,"proposition":"The most frequent and characteristic condition is heel pain","correct":true},{"idx":4,"proposition":"Talalaga is unilateral most often","correct":false,"justification":"Bilateral and rocking"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"SpA-rhumato-3","context":null,"enonce":"Regarding the associated signs and symptoms:","item":"SpA","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Dactylitis is pathognomonic of spondyloarthritis","correct":false,"justification":"Can be seen in many other pathologies!"},{"idx":1,"proposition":"SpA has purely rheumatological manifestations","correct":false,"justification":"In psoriatic arthritis: dermal involvement. In SpA associated with enterocolopathy: digestive involvement. etc"},{"idx":2,"proposition":"Acute anterior uveitis is, most often, non-granulomatous","correct":true},{"idx":3,"proposition":"Acute anterior uveitis can be either unilateral or bilateral","correct":true},{"idx":4,"proposition":"Acute anterior uveitis is never inaugural","correct":false,"justification":"Its prevalence is 20% and it can quite be inaugural"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SpA-rhumato-4","context":null,"enonce":"Regarding ankylosing spondylitis:","item":"SpA","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Psoriasis precedes the onset of psoriatic arthritis by 10 years in most cases","correct":true},{"idx":1,"proposition":"Ankylosing spondylitis is the most typical and severe form of SpA","correct":true},{"idx":2,"proposition":"Peripheral syndrome is clinically predominant","correct":false,"justification":"Pelvirachidal involvement is at the forefront"},{"idx":3,"proposition":"The ossification of entheses is not always painful","correct":true,"justification":"It is most often said that said"},{"idx":4,"proposition":"The extrarheumatic sign in the foreground is acute anterior uveitis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SpA-rhumato-5","context":null,"enonce":"Which propositions are true?","item":"SpA","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Fiessinger-Leroy-Reiter syndrome is the most complete form of reactive arthritis and is defined by the urethritis-conjunctivitis-arthritis triad","correct":true},{"idx":1,"proposition":"10% of patients have an HLA-27 gene","correct":false,"justification":"50 to 95% of them"},{"idx":2,"proposition":"Undifferentiated SpA are SpA that meet the criteria of the ESSG for example","correct":true},{"idx":3,"proposition":"Peripheral enthesitis is the most common clinical sign","correct":true},{"idx":4,"proposition":"Undifferentiated SpA is most often benign","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbiono-nephro-0","context":null,"enonce":"At the clinical examination of a 75-year-old patient at the UAA you find a BP at 106\/67 mm Hg in the supine position and 85\/45 mm Hg in the standing position and a skin fold. NFS = Hb: 16 g\/dL, pq: 250 G\/L, leuko: 9.6 G\/L. Natraemia: 115 mmol\/L. Kaliemia: 3.5 mmol\/L. Protidemia 90 g\/L. What is the state of hydration? ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"No hydration disorder","correct":false},{"idx":1,"proposition":"Extracellular dehydration ","correct":true,"justification":"Skin fold, hypototension, hyperprotidemia"},{"idx":2,"proposition":"Extracellular hyperhydration ","correct":false},{"idx":3,"proposition":"Intracellular dehydration ","correct":false},{"idx":4,"proposition":"Intracellular hyperhydration ","correct":true,"justification":"Hyponatremia"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbiono-nephro-1","context":null,"enonce":"Formula for calculating plasma osmolarity: ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"Na + K + blood sugar","correct":false},{"idx":1,"proposition":"Na + K + blood sugar + urea","correct":false},{"idx":2,"proposition":"Na + Cl + blood sugar ","correct":false},{"idx":3,"proposition":"Na x 2 + blood sugar ","correct":true},{"idx":4,"proposition":"(Na + K) x 2 + blood glucose ","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbiono-nephro-2","context":null,"enonce":"Analyze this GDS: pH = 7.20 pCO2 = 45 mmHg pO2 = 75 mmHg HCO3 = 17 mmol\/L. ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"Ventilatory acidosis with metabolic compensation because bicarbonates are elevated","correct":false},{"idx":1,"proposition":"Metabolic acidosis with ventlatory compensation because capnia is elevated ","correct":false},{"idx":2,"proposition":"Mixed, ventilatory and metabolic acidosis ","correct":false},{"idx":3,"proposition":"We speak of acidosis when the pH is < 7.38 ","correct":false},{"idx":4,"proposition":"In case of simple metabolic acidosis, the expected PaO2 is = 1.5 x HCO3+ 8 ( +\/2 ) ","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbiono-nephro-3","context":null,"enonce":"Which of the following are etiologies of inappropriate hypothalamic secretion of DHA?","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"Haloperidol","correct":true},{"idx":1,"proposition":"Vincristine","correct":true},{"idx":2,"proposition":"Assisted ventilation with PEEP","correct":true},{"idx":3,"proposition":"Tuberculosis","correct":true},{"idx":4,"proposition":"Lymphoma","correct":false,"justification":"Cause of paraneoplastic syndrome (ectopic tumor secretion of ADH, or ADH-like substance)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbiono-nephro-4","context":null,"enonce":"Which of the following are true?","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"Water makes up 60% of body weight","correct":true},{"idx":1,"proposition":"Posm = [Na+ x 2] + Blood glucose (mmol\/L)","correct":true},{"idx":2,"proposition":"Posm = [Na+ x 2] + Blood glucose (mmol\/L) + Kaliemia","correct":false,"justification":"The two possible formulas for calculating plasma osmolarity are: P = 2Na + Glc or P = 2Na + Glc + Urea"},{"idx":3,"proposition":"Posm = [Na+ x 2] + Blood glucose (mmol\/L) + Chloremia","correct":false,"justification":"The two possible formulas for calculating plasma osmolarity are: P = 2Na + Glc or P = 2Na + Glc + Urea"},{"idx":4,"proposition":"Posm = [Na+ x 2] + Blood glucose (mmol\/L) + Uric acid","correct":false,"justification":"The two possible formulas for calculating plasma osmolarity are: P = 2Na + Glc or P = 2Na + Glc + Urea"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbiono-nephro-5","context":null,"enonce":"Which of the following are etiologies of inappropriate hypothalamic secretion of DHA?","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"Traumatic brain injury","correct":true},{"idx":1,"proposition":"Carbamazepine","correct":true},{"idx":2,"proposition":"Bronchial carcinomas","correct":false,"justification":"It is indeed a cause of DHA secretion, but the secretion is ectopic (paraneoplastic syndrome) and not pituitary"},{"idx":3,"proposition":"Theophylline","correct":false,"justification":"It potentiates the effect of DHA (such as chlorpropamide or clofibrate) but does not cause more secretion"},{"idx":4,"proposition":"Acute respiratory failure","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbiono-nephro-6","context":null,"enonce":"Which of the following are causes of isotonic hyponatremia?","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"Hyperglycaemia","correct":false,"justification":"Hypertonic hyponatremia"},{"idx":1,"proposition":"Severe hyperprotidemia","correct":true},{"idx":2,"proposition":"Hyperlipidemia","correct":true},{"idx":3,"proposition":"Hypocalcemia","correct":false,"justification":"No impact on osmolarity"},{"idx":4,"proposition":"Isotonic hyponatremia is not possible","correct":false,"justification":"Isotonic hyponatremia called \"pseudohyponatremia\", are those that are associated with severe hyperlipidemia or hyperprotidemia and do not darken with any intracellular hydration disorder."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbiono-nephro-8","context":null,"enonce":"Which of the following proposals can aggravate severe hypokalemia?","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"KCl IV in isotonic saline","correct":false,"justification":"This is the right care. It must not exceed 20 mmol \/ h and under rhythmic supervision"},{"idx":1,"proposition":"KCl IV in G5","correct":true},{"idx":2,"proposition":"IV insulin-glucose","correct":true},{"idx":3,"proposition":"Du Kayexalate de Calcium","correct":true},{"idx":4,"proposition":"Du DIFFU-K per os","correct":false,"justification":"Not recommended in case of severity, but does not aggravate it"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbiono-nephro-9","context":null,"enonce":"Which of the following are clinical signs of intracellular dehydration?","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"Dark circles","correct":false,"justification":"Extracellular dehydration"},{"idx":1,"proposition":"Dryness of mucous membranes","correct":true},{"idx":2,"proposition":"Anorexia","correct":false,"justification":"False"},{"idx":3,"proposition":"Disorders of consciousness","correct":true},{"idx":4,"proposition":"Skin fold","correct":false,"justification":"Extracellular dehydration"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbiono-nephro-10","context":null,"enonce":"Which of the following may be ECG abnormalities secondary to hypokalemia?","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"Subsidence of the T wave","correct":true},{"idx":1,"proposition":"J wave","correct":false,"justification":"False"},{"idx":2,"proposition":"QT at 340 ms","correct":false,"justification":"Normal"},{"idx":3,"proposition":"Left anterior hemiblock","correct":false,"justification":"False"},{"idx":4,"proposition":"Atrial fibrillation","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"valvuloP-cardio-0","context":null,"enonce":"Regarding aortic stricture","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"Bicuspidism is the most common etiology between 35 and 65 years of age","correct":true},{"idx":1,"proposition":"Bicuspidism is a \"progressive\" malformation that eventually leads to aortic narrowing in adulthood.","correct":true},{"idx":2,"proposition":"The bicuspid valve is often associated with an aneurysm of the ascending aorta","correct":true},{"idx":3,"proposition":"Post-rheumatic acquired aortic stricture is a very common etiology in France","correct":false,"justification":"Post-rheumatic RA has become rare in developed countries"},{"idx":4,"proposition":"The prevalence of degenerative aortic valve narrowing decreases with age","correct":false,"justification":"Prevalence increases with age and, in fact, is by far the most common cause of aortic valve narrowing"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"valvuloP-cardio-1","context":null,"enonce":"Regarding aortic stricture","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"The main etiology of RA is degenerative in the majority of cases after 65-70 years","correct":true},{"idx":1,"proposition":"In the presence of an obstacle to ventricular ejection, there is the appearance of left intraventricular hyperpressure with ventriculo-aortic systolic pressure gradient: PVG > PAorta","correct":true},{"idx":2,"proposition":"The pressure gradient VG-aorta is lower the tighter the aortic narrowing","correct":false,"justification":"The tighter the AR, the greater the pressure gradient"},{"idx":3,"proposition":"When the VG-aorta pressure gradient reaches 4 mmHg, the AR is considered tight","correct":false,"justification":"it is when the VG-aorta pressure gradient reaches 40 mmHg that the RA is considered tight"},{"idx":4,"proposition":"Patients with AR maintain normal systolic performance for a long time","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"valvuloP-cardio-2","context":null,"enonce":"Regarding aortic stricture","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"Initially, overall LV systolic performance is most often normal in a patient with AR.","correct":true},{"idx":1,"proposition":"Systolic performance of the ventricle can normalize as soon as the aortic obstacle is removed","correct":true,"justification":"By valve replacement"},{"idx":2,"proposition":"ARs are symptomatic from the outset","correct":false,"justification":"The onset of symptoms in the presence of tight AR is preceded by a long asymptomatic period that can last several years"},{"idx":3,"proposition":"Cough, anginal pain and edema are the three main symptoms of aortic narrowing","correct":false,"justification":"The three main symptoms are: stress angina, stress syncope and exertional dyspnea."},{"idx":4,"proposition":"When symptoms appear, the prognosis may be life-threatening","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"valvuloP-cardio-3","context":null,"enonce":"Regarding aortic stricture","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"We find at auscultation a mesosystolic murmur, intense, soft, grating, maximum in the 2nd left intercostal space, radiating into the left armpit","correct":false,"justification":"The murmur is mesosystolic, ejectional, intense, rough, raspy at the maximum at the right intercostal 2nd space, radiating into the vessels of the neck"},{"idx":1,"proposition":"In advanced cases, there is a widening of the peak shock that is deflected at the top and left","correct":false,"justification":"The deviation of the tip shock is at the bottom and left signifying the dilation of the left ventricle"},{"idx":2,"proposition":"There is potential atrial fibrillation, usually poorly tolerated","correct":true,"justification":"It can be inaugural and revealed the RA"},{"idx":3,"proposition":"Symptomatic tight AR is never complicated by sudden death","correct":false,"justification":"This is why the vital prognosis can be engaged according to hemodynamic tolerance"},{"idx":4,"proposition":"Chest X-ray may be strictly normal","correct":true,"justification":"Sometimes it shows cardiomegaly is pulmonary overload"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"valvuloP-cardio-5","context":null,"enonce":"Regarding aortic stricture","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"The size of the aorta is important to evaluate, especially in case of biscupidia in the preoperative assessment to know if an associated gesture on the aorta may be necessary","correct":true},{"idx":1,"proposition":"Catheterization is performed systematically","correct":false,"justification":"Catheterization is not usually performed"},{"idx":2,"proposition":"Angina can be seen in AR in the absence of any direct coronary involvement","correct":true,"justification":"Angina is functional"},{"idx":3,"proposition":"The place of the coroCT scan as a replacement for preoperative coronary angiography is established","correct":false,"justification":"Coronary angiography is still preferred"},{"idx":4,"proposition":"The scanner reliably assesses the size of the aorta","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"valvuloP-cardio-6","context":null,"enonce":"Regarding aortic stricture","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"Replacement with mechanical prosthesis requires lifelong anticoagulant treatment","correct":true},{"idx":1,"proposition":"A biological prosthesis, indicated in the patient is young, avoids anticoagulant treatment ","correct":false,"justification":"The biological prosthesis avoids anticoagulant treatment well but is indicated in patients over 65 years of age because there is a risk of degeneration within 10–15 years"},{"idx":2,"proposition":"The indication of percutaneous aortic valve cannot be carried without the approval of an experienced medical-surgical team and only after a multidisciplinary discussion in dedicated staff in trained teams","correct":true},{"idx":3,"proposition":"Any symptomatic tight aortic stricture should be operated on in view of the existing life-threatening risk and virtually without age limit, subject to a general condition preserved","correct":true},{"idx":4,"proposition":"In case of asymptomatic tight RA according to the interrogation, a surgical valve replacement is systematically proposed","correct":false,"justification":"In case of asymptomatic tight AR according to the interrogation, a stress test is proposed to check that the patient is really asymptomatic and thus detect false asymtomatics that are related to surgery: if blood pressure does not rise during the stress test or decreases with effort, the operative indication can be discussed"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"valvuloP-cardio-7","context":null,"enonce":"Regarding mitral insufficiency","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"Mitral insufficiency is a leak in the mitral valve resulting in blood backflow from the left ventricle to the left atrium during diastole","correct":false,"justification":"The backflow of blood from the left ventricle to the left atrium is during systole"},{"idx":1,"proposition":"In type III MI according to the Carpentier classification: at least one valve protrudes beyond the plane of the ring during ventricular systole","correct":false,"justification":"type II: at least one valve protrudes beyond the ring plane during ventricular systole"},{"idx":2,"proposition":"Rheumatic etiology has become rare in developed countries","correct":true},{"idx":3,"proposition":"The combination of stenosis and mitral insufficiency is referred to as mitral disease.","correct":true},{"idx":4,"proposition":"Dystrophic mitral insufficiency is a very common etiology","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"valvuloP-cardio-9","context":null,"enonce":"Regarding mitral insufficiency","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"Severe MI may be asymptomatic","correct":true},{"idx":1,"proposition":"The onset of dyspnea is often brutal","correct":false,"justification":"The onset of dyspnea is slow and progressive"},{"idx":2,"proposition":"On examination, there is a deflection and lowering of the peak shock if there is a dilation of the LV","correct":true,"justification":"Left deviation"},{"idx":3,"proposition":"Auscultation contains a systolic murmur of maximum regurgitation at the tip","correct":true,"justification":"Irradiating into the armpit"},{"idx":4,"proposition":"ECG remains normal for a long time in moderate MI","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"valvuloP-cardio-10","context":null,"enonce":"Regarding mitral insufficiency","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"On radiography, cardiomegaly by dilation of the VD is found even in moderate MI","correct":false,"justification":"RT is often normal in MIs. In severe and advanced MI, cardiomegaly may be observed by LV hypertrophy"},{"idx":1,"proposition":"ETT is the key test for positive diagnosis and etiological diagnosis","correct":true},{"idx":2,"proposition":"The mitral leakage is confirmed by a holosystolic Doppler signal behind the mitral floor recorded in pulsed, continuous and color Doppler","correct":true},{"idx":3,"proposition":"The mechanism must be specified by echocardiography (according to the Carpentier classification)","correct":true},{"idx":4,"proposition":"ETT is a fundamental examination for the diagnosis of MI on endocarditis, highlighting sometimes very fine vegetations","correct":false,"justification":"ETO is a fundamental examination for the diagnosis of MI on endocarditis, highlighting vegetations sometimes very fine and impossible to see in ETT"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"valvuloP-cardio-11","context":null,"enonce":"Regarding mitral insufficiency","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"Coronary angiography is systematic as part of the preoperative assessment when a surgical indication is retained in case of cardiovascular FDR","correct":true},{"idx":1,"proposition":"The gradation of MI is based on the calculation of the regurgitating fraction","correct":true},{"idx":2,"proposition":"Right catheterization allows the measurement of cardiac output by thermodilution and the measurement of straight pressures (capillary and pulmonary pressures)","correct":true},{"idx":3,"proposition":"The main interest of the test is to unmask symptoms and understand them in patients who say they are asymptomatic.","correct":true},{"idx":4,"proposition":"The stress test with VO2 measurement makes it possible to better assess the patient's exercise capacity","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"valvuloP-cardio-12","context":null,"enonce":"Regarding mitral insufficiency","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"A low maximum O2 consumption < 15 mL\/kg\/min indicates poor tolerance of MI","correct":true},{"idx":1,"proposition":"Stress echocardiography makes it possible to assess the leakage during exercise, its possible increase, its impact (increase in PAPs> 60 mmHg)","correct":true},{"idx":2,"proposition":"In general, gradually formed MIs are well tolerated for a long time, and signs of heart failure appear late.","correct":true},{"idx":3,"proposition":"On the contrary, MI of sudden onset (rupture of ropes, endocarditis, MI on infarction) are generally poorly tolerated and quickly evolve towards the appearance of a picture of edema of the lung","correct":true},{"idx":4,"proposition":"Complications of MI include infective endocarditis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"valvuloP-cardio-13","context":null,"enonce":"Regarding mitral insufficiency","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"The appearance of atrial fibrillation or atrial flutter can lead to cardiac decompensation","correct":true},{"idx":1,"proposition":"Heart failure is late onset in chronic MI but can occur rapidly in acute MI. It can be favored by a rhythm disorder","correct":true},{"idx":2,"proposition":"Always look for signs of other associated pathologies (e.g. stigmata of Marfan's disease)","correct":true},{"idx":3,"proposition":"If mitral leakage is significant and responsible for functional symptomatology, it is urgent to consider surgery","correct":true},{"idx":4,"proposition":"In case of acute MI, treatment for OAP or shock should be initiated, and emergency surgery should be discussed.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"valvuloP-cardio-14","context":null,"enonce":"Regarding Aortic Narrowing, which propositions are true?","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"Monckeberg's disease is synonymous with calcified aortic narrowing (CAR)","correct":true,"justification":"None"},{"idx":1,"proposition":"Aortic narrowing leads to an increase in afterload and thus induces a decrease in the ventriculo-aortic gradient.","correct":false,"justification":"Aortic narrowing leads to an increase in afterload and thus induces an increase* in the ventriculo-aortic gradient."},{"idx":2,"proposition":"Aortic narrowing is well tolerated for a long time, until an advanced stage with the appearance of stress symptoms such as exertional angina, exertional dyspnea and intermittent claudication of the lower limbs.","correct":false,"justification":"The clinical triad of tight aortic stricture is: stress angina, stress syncope, exertional dyspnoea"},{"idx":3,"proposition":"Criteria for tight aortic narrowing on cardiac Doppler ultrasound include: a mean gradient > 40 mmHg and an aortic surface area > 1 cm2 (0.6 cm2\/m2 body surface area)","correct":false,"justification":"Aortic surface <* 1 cm2 (0.6 cm2\/m2 body surface area)"},{"idx":4,"proposition":"It is possible to find on the ECG: left ventricular hypertrophy, left atrial hypertrophy, conduction disorder (BAV 1 and left branch block), as well as a rhythm disorder (atrial fibrillation).","correct":true,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"lithiaseB-HGE-0","context":null,"enonce":"About cholelithiasis and its complications","item":"lithiaseB","matiere":"HGE","propositions":[{"idx":0,"proposition":"The frequency of vesicular lithiasis in Western countries is about 20%","correct":true},{"idx":1,"proposition":"The frequency increases with age to reach 60% after 80 years","correct":true},{"idx":2,"proposition":"•Almost 90% of subjects with a gallbladder never have any symptoms","correct":false},{"idx":3,"proposition":"A gallstone complicates this in 20% of cases, this complication is the migration of the stone into the cystic duct or the main bile duct","correct":true},{"idx":4,"proposition":"• It can therefore be estimated that 2 to 4% of French people are likely to develop at least one complication requiring an exploration of the bile duct","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"lithiaseB-HGE-2","context":null,"enonce":"Concerning vesicular lithiasis and its complications","item":"lithiaseB","matiere":"HGE","propositions":[{"idx":0,"proposition":"Despite its frequency, screening for vesicular lithiasis is not indicated","correct":true},{"idx":1,"proposition":"The incidental discovery of an asymptomatic gallstone does not lead, in most cases, to any treatment","correct":true},{"idx":2,"proposition":"The most typical symptom is hepatic colic","correct":true},{"idx":3,"proposition":"Hepatic colic is due to the sudden tension of the bile ducts, by permanent blockage of a stone, either in the cystic duct or in the main bile duct","correct":false,"justification":"It is due to the sudden tension of the bile ducts, by transient blockage of a stone, either in the cystic duct or in the bile duct"},{"idx":4,"proposition":"Typically, hepatic colic is a sudden pain often intense, permanent, sitting in the epigastrium (2\/3 of cases) or the right hypochondrium","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"lithiaseB-HGE-3","context":null,"enonce":"About cholelithiasis and its complications","item":"lithiaseB","matiere":"HGE","propositions":[{"idx":0,"proposition":"Treatment of cholecystitis is cholecystectomy without delay","correct":true},{"idx":1,"proposition":"Clinical manifestations can be of varying severity, and are: colic, cholitis, cholecystitis","correct":true},{"idx":2,"proposition":"Cholangio-MRI and endoscopic ultrasound are the most sensitive tests to detect a stone of the main bile duct","correct":true},{"idx":3,"proposition":"Acute cholitis lithiasis results in the successive appearance of 3 signs","correct":true},{"idx":4,"proposition":"Cholitis is apyretic most often","correct":false,"justification":"Fever is one of the 3 signs"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dvlptpsychoMo-psy-0","context":null,"enonce":"General:","item":"dvlptpsychoMo","matiere":"psy","propositions":[{"idx":0,"proposition":"ASD is a neurodevelopmental disorder","correct":true},{"idx":1,"proposition":"ADHD is a neurodevelopmental disorder","correct":true},{"idx":2,"proposition":"Video game addiction is a neurodevelopmental disorder","correct":false,"justification":"Video game addiction does not fall within this framework"},{"idx":3,"proposition":"These disorders have a prevalence of about 10% in the general population in France","correct":true},{"idx":4,"proposition":"These disorders are more common in girls than boys","correct":false,"justification":"It's the opposite: they are more common in boys"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dvlptpsychoMo-psy-1","context":null,"enonce":"Regarding neurodevelopmental disorders:","item":"dvlptpsychoMo","matiere":"psy","propositions":[{"idx":0,"proposition":"The management of these patients is done by the psychiatrist only","correct":false,"justification":"Multidisciplinary care is very important"},{"idx":1,"proposition":"The origin of these disorders is essentially genetic","correct":false,"justification":"It is multifactorial and unknown. The genetic part is surely non-zero."},{"idx":2,"proposition":"Neurodevelopmental disorders are often associated with other psychiatric disorders","correct":true},{"idx":3,"proposition":"These disorders are common in the general population (~10%) and more common in boys than girls.","correct":true},{"idx":4,"proposition":"Neurodevelopmental disorders are defined in particular by their functional impact","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dvlptpsychoMo-psy-3","context":null,"enonce":"Regarding the impact of parents and child development:","item":"dvlptpsychoMo","matiere":"psy","propositions":[{"idx":0,"proposition":"There is very little inter-individual variability in child development","correct":false,"justification":"Inter-individual variability is important"},{"idx":1,"proposition":"Developmental age is measured directly by automatic standardized tools","correct":false,"justification":"Tests measure skills. Developmental age is based on statistics: 95% of children have acquired these skills at this age"},{"idx":2,"proposition":"Early parent-child interactions have little impact on child development, which is essentially controlled by genetics.","correct":false,"justification":"They have an important role in the development of the child"},{"idx":3,"proposition":"It is very pathological for a child aged 6 months to show anxious manifestations in moments of separation from his parents","correct":false,"justification":"Quite physiological in most cases. The College of Psychiatry indicates that it is physiological until the age of 1 year"},{"idx":4,"proposition":"Separation anxiety is an anxiety disorder that appears in situations of separation from parents at a young age","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dvlptpsychoMo-psy-4","context":null,"enonce":"Which propositions are true?","item":"dvlptpsychoMo","matiere":"psy","propositions":[{"idx":0,"proposition":"Psychologists have no role to play in these pathologies","correct":false,"justification":"Psychologists can intervene in the raliization of assessment, for psychotherapy and learning"},{"idx":1,"proposition":"The functional impact corresponds to the difficulties in carrying out actions in one or more given areas","correct":true},{"idx":2,"proposition":"A deficit in the development of a domain is said to be \"specific\" when it is not explained by another disorder","correct":true},{"idx":3,"proposition":"Children with hearing loss frequently have oral language delay","correct":true},{"idx":4,"proposition":"There are several levels of severity of intellectual disability","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"exantheme-dermato-0","context":null,"enonce":"Regarding scarlet fever:","item":"exantheme","matiere":"dermato","propositions":[{"idx":0,"proposition":"It is due to group A streptococcus","correct":true},{"idx":1,"proposition":"It affects the newborn and the infant","correct":false,"justification":"Child between 5 and 10 years"},{"idx":2,"proposition":"The incubation period is about one week","correct":false,"justification":"2 to 4 days"},{"idx":3,"proposition":"It is usually apyretic","correct":false,"justification":"High fever"},{"idx":4,"proposition":"Eruptions predominate at the limbs","correct":false,"justification":"With large folds"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"exantheme-dermato-1","context":null,"enonce":"Regarding Kawasaki Syndrome:","item":"exantheme","matiere":"dermato","propositions":[{"idx":0,"proposition":"This is acute systemic vasculitis","correct":true},{"idx":1,"proposition":"It affects the pre-pubert teenager","correct":false,"justification":"Children under 5 years of age"},{"idx":2,"proposition":"Fever is usually absent","correct":false,"justification":"AEG + Fever > 38.5 degrees celsius"},{"idx":3,"proposition":"Biology shows inflammatory syndrome","correct":true},{"idx":4,"proposition":"There is no enanthema","correct":false,"justification":"Cheílite and raspberry tongue"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"exantheme-dermato-2","context":null,"enonce":"Regarding staphylococcal epidermolysis:","item":"exantheme","matiere":"dermato","propositions":[{"idx":0,"proposition":"It is also called staphylococcal scarlet fever","correct":true},{"idx":1,"proposition":"The bacterium secretes mainly exotocins","correct":false,"justification":"This is the case of streptococci. Staphylococci secrete enterotoxins, also called TSST1"},{"idx":2,"proposition":"It only affects newborns","correct":false,"justification":"Also: infants, young children or immunocompromised adults"},{"idx":3,"proposition":"Exanthemas begin at the level of the large folds","correct":true},{"idx":4,"proposition":"Treatment is symptomatic","correct":false,"justification":"Antibiotic (oxacillin)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"exantheme-dermato-3","context":null,"enonce":"Regarding morbiliform exanthemas:","item":"exantheme","matiere":"dermato","propositions":[{"idx":0,"proposition":"Measles is caused by morbilivirus","correct":true},{"idx":1,"proposition":"Infectious mononucleosis is caused by HCV","correct":false,"justification":"Epstein Barr virus (EBV)"},{"idx":2,"proposition":"Epidemic megalerythema has a fracture-type rheumatological component ","correct":false,"justification":"Arthralgia"},{"idx":3,"proposition":"Kawasaki syndrome cannot give morbiliform exanthema","correct":false,"justification":"This is one of the causes (but rare)"},{"idx":4,"proposition":"The incubation of measles is about a month","correct":false,"justification":"Between 10 and 12 days"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"NFS-hemato-0","context":null,"enonce":"Concerning the blood count","item":"NFS","matiere":"hemato","propositions":[{"idx":0,"proposition":"Its indications are very numerous and go far beyond the framework of hematological pathologies","correct":true},{"idx":1,"proposition":"This is the most prescribed exam in France","correct":true},{"idx":2,"proposition":"It is made from a blood sample taken by venipuncture and collected in a tube containing a dry anticoagulant type EDTA","correct":true},{"idx":3,"proposition":"It aims to provide quantitative information on blood cells but also qualitative information","correct":true},{"idx":4,"proposition":"Accurate identification of cells and their possible abnormalities requires a good quality blood smear","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"NFS-hemato-1","context":null,"enonce":"About the blood count","item":"NFS","matiere":"hemato","propositions":[{"idx":0,"proposition":"Normal values vary by age, gender and ethnicity","correct":true},{"idx":1,"proposition":"Thrombocytopenia <200 G\/L should always be checked on the blood smear examination","correct":false,"justification":"We speak of thrombocytopenia if < 150 G \/ L (serious if <50 G \/ L)"},{"idx":2,"proposition":"The lower limit of hemoglobin (anemia) is as follows: Newborn: 14 g\/L ● Adult male: 13 g\/L ● Adult female: 12 g\/L","correct":false,"justification":"The limits are: Newborn: 140 g\/L Adult male: 130 g\/L Adult female: 120 g\/L Pregnant woman (from the second trimester of pregnancy): 105 g\/L"},{"idx":3,"proposition":"MCV can be calculated as the ratio of hematocrit to red blood cell count.","correct":true},{"idx":4,"proposition":"The normal value of MCV is 60 to 80 fl","correct":false,"justification":"The normal value is 80 to 100 fl in adults"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"NFS-hemato-2","context":null,"enonce":"Concerning the blood count","item":"NFS","matiere":"hemato","propositions":[{"idx":0,"proposition":"MCV < 80 fl signs microcytosis in adults","correct":true,"justification":"In children, the only one is at 70 fl"},{"idx":1,"proposition":"CCMH is the Average Corpuscular Hemoglobin Concentration","correct":true},{"idx":2,"proposition":"CCMH normal values range from 32 to 46 g\/dL","correct":false,"justification":"Normal values range from 32 to 36 g\/dL"},{"idx":3,"proposition":"The leukocyte formula, expressed in %, has no interest taken in isolation","correct":true},{"idx":4,"proposition":"Preference should be given to absolute values concerning the leukocyte formula","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"NFS-hemato-3","context":null,"enonce":"Concerning the blood count","item":"NFS","matiere":"hemato","propositions":[{"idx":0,"proposition":"Normal TGMH values are 27 to 32 pg per cell","correct":true},{"idx":1,"proposition":"Any thrombocytopenia without bleeding signs should be investigated for false thrombocytopenia with EDTA by platelet agglutination","correct":true},{"idx":2,"proposition":"A hemoglobin level < 60 g \/ L or poorly tolerated requires urgent management by a specialist","correct":true},{"idx":3,"proposition":"Anemia is defined as a decrease in CCMH concomitant with clinical signs","correct":false,"justification":"Anemia is defined as a decrease in hemoglobin at the hemogram, after eliminating false anemia by hemodilution"},{"idx":4,"proposition":"Microcytic anemias (MCV < 80 fl) reflect a disorder of hemoglobin synthesis","correct":true,"justification":"The most common cause is iron deficiency"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"NFS-hemato-4","context":null,"enonce":"Concerning the blood count","item":"NFS","matiere":"hemato","propositions":[{"idx":0,"proposition":"The most common microcytic anemias are hyposideremic anemias due to iron deficiency.","correct":true},{"idx":1,"proposition":"Macrocytic anemias (MCV > 100 fl) first evoke 3 major etiologies: Ethylism, vitamin B12 deficiency, myelodysplastic syndrome","correct":true},{"idx":2,"proposition":"Regenerative anemia with reticulocytes < 150 G\/L reflects periperic involvement","correct":false,"justification":"They reflect a central attack"},{"idx":3,"proposition":"Viral infections do not usually result in neutrophil polynucleosis apart from superinfection","correct":true},{"idx":4,"proposition":"Myelemia is the passage into the blood of immature forms of the granular line of the spinal cord","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"NFS-hemato-5","context":null,"enonce":"About hemogrammme","item":"NFS","matiere":"hemato","propositions":[{"idx":0,"proposition":"Significant myelemia is pathological","correct":true},{"idx":1,"proposition":"Blood erythroblastosis (erythroblastemia) corresponds to the passage into the blood of erythroblasts","correct":true},{"idx":2,"proposition":"Erythromyelemia is the combination of myelemia and blood erythroblastosis","correct":true},{"idx":3,"proposition":"The two main etiologies of eosinophilia are parasitic and allergic etiologies","correct":true},{"idx":4,"proposition":"True hyperlymphocytosis is defined as an increase in the absolute number of blood lymphocytes","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"NFS-hemato-7","context":null,"enonce":"Which of the following are causes of false anemia?","item":"NFS","matiere":"hemato","propositions":[{"idx":0,"proposition":"Hypothyroidism","correct":false,"justification":"True anemia"},{"idx":1,"proposition":"Heart failure 💓","correct":true},{"idx":2,"proposition":"Pregnancy 🤰 ","correct":true},{"idx":3,"proposition":"Stay at altitude ⛰","correct":false,"justification":"Rather a polycythemia"},{"idx":4,"proposition":"Monoclonal hypergammaglobulinemia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TTTperso-therapeutique-0","context":null,"enonce":"Which of the following are healthcare professionals?","item":"TTTperso","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Orthoptist","correct":true},{"idx":1,"proposition":"Occupational therapist","correct":true},{"idx":2,"proposition":" Prosthetist","correct":true},{"idx":3,"proposition":"Dietitian","correct":true},{"idx":4,"proposition":"Pharmacy preparer","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TTTperso-therapeutique-1","context":null,"enonce":"Which of the following are enzyme inhibitors?","item":"TTTperso","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Amiodarone","correct":true},{"idx":1,"proposition":"Carbamazepine","correct":false,"justification":"Inductor"},{"idx":2,"proposition":"Ciclosporin","correct":true},{"idx":3,"proposition":"Orange juice","correct":false,"justification":"No effect"},{"idx":4,"proposition":"Phenobarbital","correct":false,"justification":"Inductor"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TTTperso-therapeutique-2","context":null,"enonce":"Which of the following are enzyme inducers?","item":"TTTperso","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Phenobarbital","correct":true},{"idx":1,"proposition":"Tobacco","correct":true},{"idx":2,"proposition":"Grapefruit juice","correct":false,"justification":"Enzyme inhibitor"},{"idx":3,"proposition":"Fifampicin","correct":true},{"idx":4,"proposition":"St. John's wort","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"sterilite-endoc-0","context":null,"enonce":"How long does it take to affirm a couple's infertility?","item":"sterilite","matiere":"endoc","propositions":[{"idx":0,"proposition":"Three months","correct":false,"justification":"A couple is considered infertile in the absence of pregnancy after 1 year of unprotected sex"},{"idx":1,"proposition":"6 months","correct":false},{"idx":2,"proposition":"1 year","correct":true},{"idx":3,"proposition":"18 months","correct":false},{"idx":4,"proposition":"2 years","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"sterilite-endoc-1","context":null,"enonce":"How many couples in France consult for pregnancy?","item":"sterilite","matiere":"endoc","propositions":[{"idx":0,"proposition":"0.05","correct":false,"justification":"In France, one in seven couples (14%) consult for children"},{"idx":1,"proposition":"0.14","correct":true},{"idx":2,"proposition":"0.21","correct":false},{"idx":3,"proposition":"1 of 7","correct":true},{"idx":4,"proposition":"1 of 12","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"sterilite-endoc-2","context":null,"enonce":"Regarding certain definitions:","item":"sterilite","matiere":"endoc","propositions":[{"idx":0,"proposition":"The term sterility can only be used if the situation of infertility is definitive ","correct":true},{"idx":1,"proposition":"A bilaterally castrated person is sterile","correct":true},{"idx":2,"proposition":"A postmenopausal woman is said to be infertile","correct":false,"justification":"A postmenopausal woman is said to be sterile, the term infertility is reserved for couples"},{"idx":3,"proposition":"The fecundability of the woman per cycle is about 75% per exposure cycle.","correct":false,"justification":"At best, fecundability is 25% per cycle."},{"idx":4,"proposition":"Fertility is a term defined in the context of a couple.","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"sterilite-endoc-3","context":null,"enonce":"Regarding the epidemiology of the origin of infertility:","item":"sterilite","matiere":"endoc","propositions":[{"idx":0,"proposition":"She is feminine half the time","correct":false,"justification":"1\/3 female, 1\/3 male and 1\/3 of shared origin"},{"idx":1,"proposition":"It is only very rarely shared","correct":false,"justification":"Infertility is shared in 1\/3 of cases"},{"idx":2,"proposition":"It is of male origin in about 33% of cases","correct":true},{"idx":3,"proposition":"It is of shared origin in 80% of cases","correct":false,"justification":"In a third"},{"idx":4,"proposition":"She is rarely of female origin","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"sterilite-endoc-4","context":null,"enonce":"Regarding the interrogation:","item":"sterilite","matiere":"endoc","propositions":[{"idx":0,"proposition":"The frequency of reporting needs to be addressed","correct":true,"justification":"In particular, whether they are regular or episodic"},{"idx":1,"proposition":"Gynecological history will need to be clarified","correct":true},{"idx":2,"proposition":"Pelvic pain in women may suggest endometriosis","correct":true},{"idx":3,"proposition":"It is not important to look for a possible history of abortion, especially in the presence of the husband","correct":false,"justification":"This is not at all useless since there can be consequences. On the other hand, it will obviously be necessary to discuss it alone with the patient, at first."},{"idx":4,"proposition":"Libido disorders cannot impact fertility","correct":false,"justification":"Libido disorders can decrease the frequency of sexual intercourse"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"sterilite-endoc-5","context":null,"enonce":"Regarding first-line hormonal exploration in women:","item":"sterilite","matiere":"endoc","propositions":[{"idx":0,"proposition":"In case of irregularity of the cycle, the dose is mainly LH","correct":false,"justification":"The first attempt is to clarify the origin of the irregularity"},{"idx":1,"proposition":"In case of irregularity of the cycle, the FSG is mainly dosed","correct":false,"justification":"The first attempt is to clarify the origin of the irregularity"},{"idx":2,"proposition":"Estradiol (E4), LH, FSH and prolactin are dosed","correct":false,"justification":"Indeed we dose LH, FSH and Prolactin. It is not estradiol E4 but estradiol E2!"},{"idx":3,"proposition":"The objective in case of regular cycle and to determine their ovulatory character (or not)","correct":true,"justification":"If the cycles are regular, we try to clarify their character \novulatory by plasma progesterone assay, on Day 22-Day 23 of the cycle"},{"idx":4,"proposition":"A carbohydrate balance is systematic","correct":false,"justification":"Not systematic but depending on the clinic"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"sterilite-endoc-6","context":null,"enonce":"Regarding the spermogram:","item":"sterilite","matiere":"endoc","propositions":[{"idx":0,"proposition":"It is a very informative examination in humans","correct":true},{"idx":1,"proposition":"It should be done after 1 week of abstinence","correct":false,"justification":"3 days of abstinence is enough"},{"idx":2,"proposition":"A normal volume is between 1.5 and 6 mL","correct":true,"justification":"Below we talk about hypospermia and above we talk about hyperspermia"},{"idx":3,"proposition":"Mobility of less than 30% defines asthenospermia","correct":true,"justification":"Thinking about asthenia -> fatigue"},{"idx":4,"proposition":"Vitality below 80% defines necrospermia","correct":false,"justification":"Necrospermia is defined by a rate <58% of living forms"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"BPCO-pneumo-0","context":null,"enonce":"About COPD","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"proposition":"COPD is a common disease, causing morbidity, mortality and high health costs","correct":true},{"idx":1,"proposition":"COPD is defined by the presence of chronic respiratory symptoms and permanent bronchial restriction","correct":false,"justification":"It is defined as the presence of chronic respiratory symptoms (at least one among cough, sputum, exercise dyspnea, repeated or dragging lower respiratory infections) and permanent bronchial obstruction: there is an obstructive ventilatory disorder (defined by a FEV1\/FVC ratio<0.70) that persists after taking bronchodilators"},{"idx":2,"proposition":"The main risk factor is smoking","correct":true},{"idx":3,"proposition":"Occupational exposures may also be involved","correct":true},{"idx":4,"proposition":"The main symptom is early dyspnea","correct":false,"justification":"The main symptom is dyspnea but it is late often underestimated"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"BPCO-pneumo-1","context":null,"enonce":"About COPD","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The main differential diagnoses are asthma and bronchial dilatations","correct":true},{"idx":1,"proposition":"Spirometric assessment of bronchial obstruction severity is based on FEV1 measurement in the absence of any medication","correct":false,"justification":"Spirometric assessment of bronchial obstruction severity is based on FEV1 measurement after bronchodilator"},{"idx":2,"proposition":"pulmonary rehabilitation is an integral part of treatment","correct":true},{"idx":3,"proposition":"COPD is a chronic respiratory disease defined by the existence of chronic respiratory symptoms (at least one among cough, sputum, exercise dyspnea, repeated or dragging) and reversible obstruction","correct":false,"justification":"Frequent chronic respiratory disease, defined as the existence of chronic respiratory symptoms (at least one among cough, sputum, exercise dyspnoea, repeated or dragging) and permanent and progressive airway obstruction = obstructive ventilatory disorder (OVD) not completely reversible"},{"idx":4,"proposition":"Obstructive ventilatory disorder (OSVD) is defined as a FEV1\/FVC ratio < 0.7 (or < 70%)","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"BPCO-pneumo-2","context":null,"enonce":"About COPD","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Chronic bronchitis is a daily or near-daily productive cough lasting at least 3 months a year and for at least two consecutive years","correct":true},{"idx":1,"proposition":"Emphysema without TVO is not COPD","correct":true},{"idx":2,"proposition":"− Asthma should be evoked when there is a very significant reversibility of bronchial obstruction (increase in FEV1 of more than 400 ml),","correct":true},{"idx":3,"proposition":"− The \"frequent exacerbator\" phenotype is an element in assessing the severity of COPD","correct":true},{"idx":4,"proposition":"The severity of exacerbations: 1 exacerbation \/ year requiring hospitalization is an element of poor prognosis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"BPCO-pneumo-3","context":null,"enonce":"About COPD","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"proposition":"COPD is a major health problem affecting 5-10% of the population over 45 years old","correct":true},{"idx":1,"proposition":"Worldwide, COPD is on the rise and is expected to be the 3rd or 4th leading cause of death by 2030","correct":true},{"idx":2,"proposition":"Exposure to occupational air contaminants is implicated as a risk factor for COPD","correct":true},{"idx":3,"proposition":"At least 15% of COPD are occupational","correct":true},{"idx":4,"proposition":"Alpha-1 antitrypsin deficiency is the only identified genetic risk factor for COPD","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"BPCO-pneumo-4","context":null,"enonce":"About COPD","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The severity of TVO assessed by VEMS post BD makes this simple measure an important prognostic factor","correct":true},{"idx":1,"proposition":"Parameters such as dyspnoea intensity and undernutrition are also strongly predictive of COPD-related mortality.","correct":true},{"idx":2,"proposition":"Spirometry allows the diagnosis of certainty, helps in differential diagnosis with asthma, evaluates severity, participates in therapeutic choices","correct":true},{"idx":3,"proposition":"Obstructive TV rises after BD administration","correct":false,"justification":"This TVO persists after BD administration. He gets up in case of asthma:)"},{"idx":4,"proposition":"The severity of bronchial obstruction varies depending on the value of post-BD FEV1","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"BPCO-pneumo-5","context":null,"enonce":"About COPD","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"proposition":"reversibility is studied by performing a 1st spirometry before the administration of fast-acting BD and a 2nd spirometry 10 minutes after","correct":true},{"idx":1,"proposition":"The measurement of carbon monoxide transfer capacity (which reflects the available gas exchange surface) makes it possible to evaluate alveolar destruction","correct":true},{"idx":2,"proposition":"Any value of DLCO (or OBT) < 50% of the predicted value is considered pathological","correct":false,"justification":"Any value of DLCO (or OBT) < 70% of the predicted value is considered pathological"},{"idx":3,"proposition":"Chest X-ray has no interest in the positive diagnosis of COPD","correct":true},{"idx":4,"proposition":"Chest X-ray may suggest associated heart disease","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dermatosefaciale-dermato-0","context":null,"enonce":"Regarding the generalities of facial dermatoses:","item":"dermatosefaciale","matiere":"dermato","propositions":[{"idx":0,"proposition":"Acne is a chronic inflammatory dermatosis of the pilosebaceous follicle","correct":true},{"idx":1,"proposition":"Sebum secretion is triggered and maintained mainly by dihydrotestosterone","correct":true},{"idx":2,"proposition":"Circulating androgens are often increased in acne","correct":false,"justification":"Circulating androgens are present at normal levels and acne results only from a particular sensitivity of androgen receptors present on sebocytes and keratinocytes (peripheral hyperandrogenism)"},{"idx":3,"proposition":"The formation of comedo is due to hyperproliferation of keratinocytes of the pilosebaceous follicle","correct":true},{"idx":4,"proposition":"The anaerobic flora of the sebaceous follicles is dominated by a gram-positive bacterium Propionibacterium acnes","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dermatosefaciale-dermato-1","context":null,"enonce":"Which propositions are true?","item":"dermatosefaciale","matiere":"dermato","propositions":[{"idx":0,"proposition":"Acne is an infectious disease","correct":false,"justification":"Acne is not an infectious disease but an inflammatory disease of the pilosebaceous follicle"},{"idx":1,"proposition":"The diagnosis is clinical","correct":true},{"idx":2,"proposition":"Seborrhea is an abnormally thin aspect of the skin","correct":false,"justification":"Oily and shiny skin appearance"},{"idx":3,"proposition":"Acne mainly affects areas low in sebaceous glands such as the face and back","correct":false,"justification":"Affects areas rich in sebaceous glands: central part of the face (nose, forehead, chin, cheeks) and upper thoracic region (neck, back and anterior surface of the chest)"},{"idx":4,"proposition":"Ironed comedones are small papules of 2 to 3 mm of normal skin color","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dermatosefaciale-dermato-2","context":null,"enonce":"Regarding acne:","item":"dermatosefaciale","matiere":"dermato","propositions":[{"idx":0,"proposition":"Closed comedones correspond to \"blackheads\"","correct":false,"justification":"These are the open comedones"},{"idx":1,"proposition":"Open comedones correspond to the accumulation of oxidized keratinocytes within the dilated orifice of the infudibular duct","correct":true},{"idx":2,"proposition":"Open comedones are on the order of a centimeter","correct":false,"justification":"These are infracentimetric lesions, between 1 and 3 mm"},{"idx":3,"proposition":"The natural course of open comedones is inflammation in any case","correct":false,"justification":"can spontaneously expel or become inflamed"},{"idx":4,"proposition":"Inflammatory papules progress to resorption or pustule formation","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"dermatosefaciale-dermato-3","context":null,"enonce":"Regarding the basic lesions of acne:","item":"dermatosefaciale","matiere":"dermato","propositions":[{"idx":0,"proposition":"Pustules are usually derived from papules","correct":true},{"idx":1,"proposition":"The contents of pustules are inflammatory by accumulation of lymphocytes","correct":false,"justification":"Polynuclides"},{"idx":2,"proposition":"Deep inflammatory lesions give papules","correct":false,"justification":"Nodules larger than 10mm reaching the dermis"},{"idx":3,"proposition":"The nodules are of the order of a centimeter and reach the dermis","correct":true},{"idx":4,"proposition":"Papules give scars","correct":false,"justification":"These are the nodules"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"dermatosefaciale-dermato-4","context":null,"enonce":"Regarding the different clinical forms of acne:","item":"dermatosefaciale","matiere":"dermato","propositions":[{"idx":0,"proposition":"Juvenile combination acne is the most common form of acne","correct":true},{"idx":1,"proposition":"Juvenile mixed acne occurs in late adolescence","correct":false,"justification":"Occurs around the time of puberty"},{"idx":2,"proposition":"Exogenous acne has a predominance of open comedones","correct":true},{"idx":3,"proposition":"Acne in adult women appears after about 25 years","correct":true},{"idx":4,"proposition":"Adult female acne concerns women who did not have acne during adolescence only","correct":false,"justification":"Most of the time, juvenile acne extending into adulthood"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PRNA-neuro-0","context":null,"enonce":"Which of the following is true for acute inflammatory polyradiculoneuritis?","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"proposition":"This is Guillain-Barré syndrome","correct":true},{"idx":1,"proposition":"The incidence is 5 per 100","correct":false,"justification":"1 per 100,000"},{"idx":2,"proposition":"The lesions affect the motor neurons of the precentral cortex","correct":false,"justification":"Root of nerves and their nerve trunks downstream"},{"idx":3,"proposition":"The prognosis is poor","correct":true},{"idx":4,"proposition":"The prevalence is 2 million in France","correct":false,"justification":"No prevalence reported in college"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"PRNA-neuro-1","context":null,"enonce":"In Guillain-Barré:","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"proposition":"The incidence is about 1 in 100,000","correct":true},{"idx":1,"proposition":"Cytomegalovirus infection may precede Guillain-Barré syndrome","correct":true},{"idx":2,"proposition":"Epstein-Barr virus infection often causes an axonal form of GBS","correct":false,"justification":"Demyelinating form"},{"idx":3,"proposition":"Campylobacter jejuni often causes an AMAN-like demyelinating form of GBS","correct":false,"justification":"Amonal form of AMAN type"},{"idx":4,"proposition":"The lesions affect in particular the roots of the nerves","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PRNA-neuro-2","context":null,"enonce":"Regarding Guillain-Barré syndromes (GBS):","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"proposition":"They evolve in 8 phases more or less long (about 1 year in total)","correct":false,"justification":"3 phases: extension, plateau, recovery. The duration of each of these phases varies"},{"idx":1,"proposition":"The diagnosis is confirmed by MRI and biopsy","correct":false,"justification":"Clinic + ENMG"},{"idx":2,"proposition":"Acute axonal motor neuropathies are pure motor","correct":true},{"idx":3,"proposition":"Acute motor axonal neuropathies (AMAN) are at risk of intubation","correct":false,"justification":"Usually not"},{"idx":4,"proposition":"Sensory-motor GBS is demyelinating","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"PRNA-neuro-3","context":null,"enonce":"Regarding the extension phase of Guillain-Barré syndrome:","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"proposition":"It lasts less than 4 weeks","correct":true},{"idx":1,"proposition":"Its evolution is always ascending","correct":false,"justification":"True for the sensory form, but false for the motor form"},{"idx":2,"proposition":"The motor impairment is unilateral and not very severe most often","correct":false,"justification":"Relatively symmetrical, extensive and severe, it predominates proximal and then affects the extremities"},{"idx":3,"proposition":"Motor involvement begins in the extremities and then goes up","correct":false,"justification":"First proximal and then affects the extremities"},{"idx":4,"proposition":"1-5% of patients should be on assisted ventilation","correct":false,"justification":"15 to 30%"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"PRNA-neuro-4","context":null,"enonce":"Regarding the plateau phase of Guillain-Barré Syndrome:","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"proposition":"One-third of patients are bedridden","correct":true},{"idx":1,"proposition":"75% of patients can walk","correct":false,"justification":"One-third"},{"idx":2,"proposition":"One hundredth of patients require respiratory support","correct":false,"justification":"One-third"},{"idx":3,"proposition":"Tendon reflexia in deficit territories fades rapidly ","correct":false,"justification":"It persists throughout the plateau phase"},{"idx":4,"proposition":"It lasts from 5 to 25 days","correct":false,"justification":"It can last up to several months in some cases. It's very variable"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PRNA-neuro-5","context":null,"enonce":"Which of the following propositions about Miller-Fischer syndrome are true?","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"proposition":"Anti-Gq1b antibodies are found","correct":true},{"idx":1,"proposition":"There is a progressive fatigability throughout the day","correct":false,"justification":"Not classic in the Miller-Fischer"},{"idx":2,"proposition":"It is a dysimmune disease","correct":true},{"idx":3,"proposition":"We find ataxia","correct":true},{"idx":4,"proposition":"Facial paralysis is found","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vomisst-HGE-0","context":null,"enonce":"Regarding vomiting","item":"vomisst","matiere":"HGE","propositions":[{"idx":0,"proposition":"Vomiting can be provoked or spontaneous","correct":true},{"idx":1,"proposition":"Nausea is a painless disagrable subjective sensation originating from the upper digestive tract.","correct":true},{"idx":2,"proposition":"Differential BDiagnostics • Regurgitation: passive rise of gastric contents Regurgy","correct":true},{"idx":3,"proposition":"• Merycism or rumination: are involuntary rises in the mouth of recently ingested food that is then swallowed again after chewing","correct":false},{"idx":4,"proposition":"Upper GI endoscopy is necessary to confirm the diagnosis and, if necessary, to perform hemostasis; Rupture of the oesin case of Mallory-Weiss syndrome","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vomisst-HGE-1","context":null,"enonce":"Among the complications of vomiting","item":"vomisst","matiere":"HGE","propositions":[{"idx":0,"proposition":"Vinson Pulmmer Syndrome","correct":false},{"idx":1,"proposition":"Karatgener syndrome","correct":false},{"idx":2,"proposition":"Hydro-electric disorders","correct":true},{"idx":3,"proposition":"Mallory Weiss syndrome","correct":true},{"idx":4,"proposition":"Rupture of the esopaph","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vomisst-HGE-2","context":null,"enonce":"Regarding vomiting","item":"vomisst","matiere":"HGE","propositions":[{"idx":0,"proposition":"Chronic vomiting is vomiting that lasts more than 7 days","correct":true},{"idx":1,"proposition":"Drug use may be accompanied by vomiting (cannabis), as well as withdrawal syndrome (heroin)","correct":true},{"idx":2,"proposition":"The evaluation of the metabolic impact of vomiting is systematic","correct":true},{"idx":3,"proposition":"Vomiting should be sought for pregnancy, adrenal insufficiency and intracranial hypertension","correct":true},{"idx":4,"proposition":"Vomiting related to chemotherapy can be treated with antihistamines","correct":false,"justification":"Chemotherapy-related vomiting can be treated on a case-by-case basis by:"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vomisst-HGE-3","context":null,"enonce":"Which of the following proposals is expected in case of pyloric stenosis?","item":"vomisst","matiere":"HGE","propositions":[{"idx":0,"proposition":"Hypochloremic metabolic alkalosis","correct":true},{"idx":1,"proposition":"Hypochloraemic metabolic acidosis","correct":false},{"idx":2,"proposition":"Hypochloraemic respiratory alkalosis","correct":false},{"idx":3,"proposition":"Hyperchloremic respiratory alkalosis","correct":false},{"idx":4,"proposition":"Hyperchloremic metabolic alkalosis","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vomisst-HGE-4","context":null,"enonce":"Which of the following are ultrasound signs in favor of pyloric stenosis?","item":"vomisst","matiere":"HGE","propositions":[{"idx":0,"proposition":"Peritoneal effusion","correct":false},{"idx":1,"proposition":"Pyloric canal lengthening","correct":true},{"idx":2,"proposition":"Roundel appearance","correct":true,"justification":"True. The signs are: \"roundel\" appearance, thickening of the muscle ≥ 4 mm, lengthening of the pyloric canal and gastric stasis (College of Pediatrics, 2021)"},{"idx":3,"proposition":"Mesenteric lymph nodes","correct":false,"justification":"False"},{"idx":4,"proposition":"Hypertrophy of the pylorus","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vomisst-HGE-5","context":null,"enonce":"Which of the following are ultrasound signs in favor of pyloric stenosis?","item":"vomisst","matiere":"HGE","propositions":[{"idx":0,"proposition":"Peritoneal effusion","correct":false},{"idx":1,"proposition":"Pyloric canal lengthening","correct":true},{"idx":2,"proposition":"Roundel appearance","correct":true,"justification":"True. The signs are: \"roundel\" appearance, thickening of the muscle ≥ 4 mm, lengthening of the pyloric canal and gastric stasis (College of Pediatrics, 2021)"},{"idx":3,"proposition":"Mesenteric lymph nodes","correct":false},{"idx":4,"proposition":"Hypertrophy of the pylorus","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"sexualite-psy-0","context":null,"enonce":"General:","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"All sexual disorders are of the order of psychiatric pathology","correct":false,"justification":"They may be related to non-psychiatric pathologies or psychological disorders"},{"idx":1,"proposition":"Hypersexuality is considered addictive behavior","correct":true},{"idx":2,"proposition":"Hypersexuality can be iatrogenic","correct":true},{"idx":3,"proposition":"Sexual health is a state of physical, mental and social well-being in the field of sexuality","correct":true},{"idx":4,"proposition":"'Normal' sexuality requires a positive and respectful approach to sexuality and sexual relationships","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"sexualite-psy-1","context":null,"enonce":"Regarding 'normal' sexuality:","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"The excitation phase is characterized in men by the establishment of erection","correct":true},{"idx":1,"proposition":"The sexual relationship is preceded by a phase of sexual desire consisting of sexual and erotic thoughts or imaginative fantasies.","correct":true},{"idx":2,"proposition":"The orgasm phase consists of several successive phases in men","correct":false,"justification":"It is often unique in humans"},{"idx":3,"proposition":"In men, orgasm and ejaculation usually coincide","correct":true,"justification":"But this is not always the case"},{"idx":4,"proposition":"Vaginal or clitoral stimulation is the same","correct":false,"justification":"The vaginal or clitoral difference corresponds to different stimulation modalities, but is underpinned by the same anatomophysiological entity (glans or pillars of the clitoris)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"sexualite-psy-2","context":null,"enonce":"Regarding sexual disorders:","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"Notions of deviance, normality of sexual performance, and behavioral role identity can vary across cultures and times.","correct":true},{"idx":1,"proposition":"The interview is a fundamental moment in the assessment of a sexual complaint","correct":true},{"idx":2,"proposition":"The interview must look for all history of psychiatric disorders","correct":true},{"idx":3,"proposition":"Nocturnal penile plethysmography and cavernography (venous leakage, Peyronie) are almost no longer used in common practice.","correct":true},{"idx":4,"proposition":"Sexual conduct disorders are classically distinguished into six pathophysiological categories","correct":false,"justification":"3: sexual dysfunction, paraphilic disorders, and hypersexuality"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"sexualite-psy-3","context":null,"enonce":"Regarding sexual dysfunction","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"Sexual dysfunctions often correspond to one of the phases of sexual intercourse (desire, arousal, or orgasm)","correct":true},{"idx":1,"proposition":"Sexual pain is not a real sexual dysfunction","correct":false,"justification":"Sexual pain is part of sexual dysfunction"},{"idx":2,"proposition":"A fairly high proportion of men and women in the general population suffer from sexual dysfunction (5-35% depending on type and sex)","correct":true},{"idx":3,"proposition":"Comorbid psychiatric disorders have little impact on sexual dysfunction and should not be considered in etiological research","correct":false,"justification":"A comorbid psychiatric disorder is found in 30% of cases – depressive or anxiety disorder, addictive disorder, anorexia nervosa, etc."},{"idx":4,"proposition":"Non-psychiatric differential diagnoses are to be systematically sought by a systematic clinical examination","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"sexualite-psy-5","context":null,"enonce":"Which of these propositions are true?","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"Exhibitionism is the act of being excited to show one's body to one's partner(s)","correct":false,"justification":"It is sexual arousal caused by exposing one's body to strangers in public places."},{"idx":1,"proposition":"Exhibitionism is the act of being sexually aroused by objects","correct":false},{"idx":2,"proposition":"Exhibitionism is being sexually aroused by showing one's body to strangers in public places.","correct":true},{"idx":3,"proposition":"Fetishism is being sexually aroused by humiliating others","correct":false,"justification":"Fetishism is sexual arousal caused by visual and\/or physical contact with a specific object, body part or situation."},{"idx":4,"proposition":"Masochism is always pathological","correct":false,"justification":"Pathological if it meets the 4 criteria of the DSM"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"sexualite-psy-6","context":null,"enonce":"Which of these proposals can promote sexual conduct disorder?","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"An anxiety disorder","correct":true},{"idx":1,"proposition":"A characterized depressive episode","correct":true},{"idx":2,"proposition":"Anorexia","correct":true},{"idx":3,"proposition":"Bipolar disorder","correct":true},{"idx":4,"proposition":"Schizophrenic disorder","correct":true,"justification":"Any history of psychiatric disorder can promote sexual conduct disorder"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"sexualite-psy-7","context":null,"enonce":"Which of these proposals can promote sexual conduct disorder?","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"A HTA","correct":true},{"idx":1,"proposition":"OSA","correct":true},{"idx":2,"proposition":"Adrenal insufficiency","correct":true},{"idx":3,"proposition":"A twin pregnancy","correct":false,"justification":"In any case, it is not mentioned in the colleges"},{"idx":4,"proposition":"Hypoprolactinemia","correct":false,"justification":"Rather, it is hyperprolactinemia, which may be responsible for secondary amenorrhea or erectile dysfunction."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"sexualite-psy-8","context":null,"enonce":"What propositions are part of classic sexual behavior in both sexes?","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"The phase of desire","correct":true},{"idx":1,"proposition":"The regret phase","correct":false,"justification":"Desire -> Arousal -> Plateau -> Orgasm -> Resolution -> Refractory period (in men only)"},{"idx":2,"proposition":"The refractory period","correct":false,"justification":"In humans only"},{"idx":3,"proposition":"The orgasm phase, which always corresponds to ejaculation in men","correct":false,"justification":"Most often yes, but not always"},{"idx":4,"proposition":"The Resolving Phase","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"sexualite-psy-9","context":null,"enonce":"What is the neurotransmitter most involved in the refractory period?","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"Serotonin","correct":false,"justification":"These are endorphins. Researchers believe that serotonin curbs arousal and desire"},{"idx":1,"proposition":"Dopamine","correct":false,"justification":"Dopamine increases arousal and desire"},{"idx":2,"proposition":"Le GABA","correct":false,"justification":"College does not report GABA role in sexuality"},{"idx":3,"proposition":"Glutamate","correct":false},{"idx":4,"proposition":"Endorphins","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"sexualite-psy-10","context":null,"enonce":"What is the neurotransmitter that curbs arousal and desire?","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"Serotonin","correct":true,"justification":"Researchers believe that serotonin curbs arousal and desire"},{"idx":1,"proposition":"Dopamine","correct":false,"justification":"Dopamine increases arousal and desire"},{"idx":2,"proposition":"Le GABA","correct":false,"justification":"College does not report GABA role in sexuality"},{"idx":3,"proposition":"Glutamate","correct":false},{"idx":4,"proposition":"Endorphins","correct":false,"justification":"Endorphins are involved in the refractory phase mainly"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"sexualite-psy-12","context":null,"enonce":"Which of these proposals can cause hypersexuality?","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"Untreated Parkinson's disease","correct":false,"justification":"However, some dopamingergic agonists used in the treatment of Parkinson's disease can cause hypersexuality."},{"idx":1,"proposition":"A manic episode","correct":true},{"idx":2,"proposition":"A frontal syndrome","correct":true},{"idx":3,"proposition":"A temporal syndrome","correct":true},{"idx":4,"proposition":"An occipital syndrome","correct":false,"justification":"Frontal and temporal syndromes can cause hypersexuality. But not occipital syndrome."}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"radiculalgie-ortho-0","context":null,"enonce":"In symptomatic radiculalgia, the pain is:","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"Calmed by rest","correct":false,"justification":"Through activity"},{"idx":1,"proposition":"Awakening in the second part of the night","correct":true},{"idx":2,"proposition":"Maximum in the evening","correct":false,"justification":"Maximum in the morning or at night"},{"idx":3,"proposition":"Compounded by activity","correct":false,"justification":"Aggravated by rest"},{"idx":4,"proposition":"Morning rusting of more than 30 minutes","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"radiculalgie-ortho-1","context":null,"enonce":"Which of these proposals refer to mechanical pain?\r\n","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"Maximum at the end of the day","correct":true},{"idx":1,"proposition":"Relieved by rest","correct":true},{"idx":2,"proposition":"No nocturnal awakening","correct":true,"justification":"Or positional awakening in the first part of the night"},{"idx":3,"proposition":"Compounded by activity","correct":true},{"idx":4,"proposition":"Without morning rusting","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"radiculalgie-ortho-2","context":null,"enonce":"Which muscles are affected by a C5 deficiency?","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"Deltoide","correct":true},{"idx":1,"proposition":"Brachial biceps","correct":true,"justification":"The biceps is innervated by C5 and C6, like the deltoide"},{"idx":2,"proposition":"Brachial","correct":true,"justification":"innervated by C5 C6 as well."},{"idx":3,"proposition":"The triceps brachial","correct":false},{"idx":4,"proposition":"Quadriceps","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"radiculalgie-ortho-3","context":null,"enonce":"Regarding the brachial plexus:","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"The tricipital reflex is C8 dependent","correct":false,"justification":"C7"},{"idx":1,"proposition":"The anterior surface of the arm is innervated by C6\r\n","correct":true},{"idx":2,"proposition":"Outer side of the forearm is innervated by C7","correct":false,"justification":"By C6, which innervates the front of the arm, the outer surface of the forearm and the thumb"},{"idx":3,"proposition":"The brachial plexus is notably composed of C7 and C8","correct":true},{"idx":4,"proposition":"The roots of the brachial plexus are mostly sensitive","correct":false,"justification":"Sensory-motor"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"radiculalgie-ortho-4","context":null,"enonce":"Which fingers are innervated by C7:","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"The thumb","correct":false,"justification":"C6"},{"idx":1,"proposition":"The index","correct":true},{"idx":2,"proposition":"The middle finger","correct":true},{"idx":3,"proposition":"The ring finger","correct":true,"justification":"C7 = the 3 medial fingers, especially the middle finger"},{"idx":4,"proposition":"The little finger","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"radiculalgie-ortho-5","context":null,"enonce":"Regarding the upper limb:","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"The posterior side of the arm and forearm is innervated by C7","correct":true},{"idx":1,"proposition":"The three middle fingers (especially the middle finger) are innervated by C8","correct":false,"justification":"By C7, which also innervates the posterior surface of the arm and forearm (the root arrives from the back)"},{"idx":2,"proposition":"C8 innervates the lateral side of the arm and forearm","correct":false,"justification":"Medial side of the arm and forearm, as well as the 4th and 5th fingers"},{"idx":3,"proposition":"The Deltoid allows the abduction of the arm\r\n","correct":true},{"idx":4,"proposition":"The biceps brachial is innervated by C8","correct":false,"justification":"By C6"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"radiculalgie-ortho-6","context":null,"enonce":"Regarding the roots of the upper limb:","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"The Brachial allows the flexion of the elbow\r\n","correct":true},{"idx":1,"proposition":"The Triceps brachial allows the extension of the hand\r\n","correct":false,"justification":"Elbow extension since it is a muscle of the arm (and not the forearm)"},{"idx":2,"proposition":"Interosseous muscles are innervated by C8","correct":true},{"idx":3,"proposition":"The Bicipital reflex is dependent on C5","correct":true},{"idx":4,"proposition":"The Bicipital reflex is only dependent on C6","correct":false,"justification":"Bicipital = C5 and\/or C6"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"radiculalgie-ortho-7","context":null,"enonce":"Regarding sensory territories and reflexes:","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"The Stylo-radial reflex is C6 dependent","correct":true},{"idx":1,"proposition":"The Tricipital reflex is C7 dependent","correct":true},{"idx":2,"proposition":"The Cubito-pronator reflex is dependent on C7","correct":false,"justification":"C8"},{"idx":3,"proposition":"The front of the thigh is innervated by S1\r\n","correct":false,"justification":"Anterior surface of the thigh = L3. Posterior side of the thigh = S1"},{"idx":4,"proposition":"The medial side of the knee is innervated by L3","correct":true,"justification":"This is where C3 ends."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"radiculalgie-ortho-8","context":null,"enonce":"Regarding the sensory territories of the leg:","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"The outer thigh is innervated by L4","correct":true},{"idx":1,"proposition":"The anterior side of the knee is innervated by L4","correct":true},{"idx":2,"proposition":"The anteromedial side of the leg is innervated by L3","correct":false,"justification":"L3 stops at the medial surface of the knee after passing through the anterior surface of the thigh. It is L4 that innervates the anteromedial surface of the knee"},{"idx":3,"proposition":"The posterior side of the thigh is innervated by L2","correct":false,"justification":"Posterior thigh = L5 and S1"},{"idx":4,"proposition":"The lateral side of the leg is innervated by S1","correct":false,"justification":"It's L5. S1 innervates the posterior side of the leg"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"radiculalgie-ortho-9","context":null,"enonce":"Regarding the sensory territories of the leg and the patellar reflex:","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"The back of the foot and the big toe are innervated by L5","correct":true},{"idx":1,"proposition":"The posterior side of the thigh is innervated by L4","correct":false,"justification":"Posterior thigh = L5 and S1"},{"idx":2,"proposition":"The posterior side of the leg is innervated by S1","correct":true},{"idx":3,"proposition":"The sole of the foot and the 5th toe are innervated by L4","correct":false,"justification":"S1"},{"idx":4,"proposition":"The Patellar reflex is dependent on the root L3 ","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"risquesenvironnemt-HGE-0","context":null,"enonce":"Regarding the bases of risks related to the consumption of water or food:","item":"risquesenvironnemt","matiere":"HGE","propositions":[{"idx":0,"proposition":"Encapsulated commercial water bottles do not normally contain bacteria, viruses or parasites","correct":true},{"idx":1,"proposition":"Transmission of intestinal infections through food is impossible","correct":false,"justification":"by food: very common"},{"idx":2,"proposition":"Swimming is not a vector of transmission until you drink the water","correct":false,"justification":"During swimming (in swimming pools, fresh water or at sea), contact with dirty water is a vector of transmission"},{"idx":3,"proposition":"Human-to-human transmission can be reduced by simple hygiene measures","correct":true},{"idx":4,"proposition":"Food can be vectors of toxins responsible for digestive tables generally brief and benign","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"risquesenvironnemt-HGE-1","context":null,"enonce":"Which propositions are true?","item":"risquesenvironnemt","matiere":"HGE","propositions":[{"idx":0,"proposition":"Certain foods are responsible for poisoning","correct":true},{"idx":1,"proposition":"Any TIAC must be declared to the departmental health authority","correct":true},{"idx":2,"proposition":"Only the physician must make the mandatory declaration of TIAC","correct":false,"justification":"This declaration is also mandatory for the person in charge of the premises where the patients are located."},{"idx":3,"proposition":"Mandatory reporting is unnecessary from a health point of view, its only function being administrative","correct":false,"justification":"It is this that makes it possible to decide, if necessary, on an epidemiological inquiry"},{"idx":4,"proposition":"The main causes of TIAC reported in France are Escherichia Coli","correct":false,"justification":"These are, in order of frequency, salmonella (70% of TIAC), Clostridium perfringens and Staphylococcus aureus"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"rhumcrist-rhumato-0","context":null,"enonce":"Regarding the generalities of gout:","item":"rhumcrist","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Gout is intermittent inflammatory rheumatism, in countries with high GDP, the most prevalent","correct":true},{"idx":1,"proposition":"Chronic arthropathies are due to dysregulation of renal purification","correct":false,"justification":"This is due to intra-articular and bony tophus"},{"idx":2,"proposition":"The diagnosis of gout is made by the detection of strongly birefringent tapered microcrystals in the joint fluid","correct":true},{"idx":3,"proposition":"The genetic component of gout is zero","correct":false,"justification":"It is a polygenic disease with several predisposing genes"},{"idx":4,"proposition":"The usual terrain is the young vegan woman","correct":false,"justification":"The middle-aged man with too much calorie diet and too much animal protein"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"rhumcrist-rhumato-1","context":null,"enonce":"Regarding the diagnosis of gout:","item":"rhumcrist","matiere":"rhumato","propositions":[{"idx":0,"proposition":"The symptomatological peak is reached in about 31 days","correct":false,"justification":"Peak of symptoms in 24 hours"},{"idx":1,"proposition":"The skin coating is unchanged","correct":false,"justification":"There is swelling and local redness, a sign of inflammation"},{"idx":2,"proposition":"The most frequent localization is the first metatarsophalangeal","correct":true},{"idx":3,"proposition":"The resolution of the crisis necessarily requires drug treatment associated with good hydration","correct":false,"justification":"Resolution is spontaneous but can be shortened by NSAIDs"},{"idx":4,"proposition":"Any patient who has uricemia greater than 60 mg\/L is at risk of gout","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"rhumcrist-rhumato-2","context":null,"enonce":"Which propositions are true?","item":"rhumcrist","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Joint ultrasound is unnecessary in this context","correct":false,"justification":"This is very useful in the absence of specific radiographic signs. We can see a \"double contour\" aspect"},{"idx":1,"proposition":"The female predominance of chondrocalcinosis decreases with age","correct":true},{"idx":2,"proposition":"CCP rheumatism is never asymptomatic","correct":false,"justification":"It happens that it is"},{"idx":3,"proposition":"Diagnosis is based on cubic deposits in articular cartilage that are not refrigent","correct":true},{"idx":4,"proposition":"In apatitic rheumatism, the diagnosis can be made by anamnesis","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"nutriped-nutri-0","context":null,"enonce":"Regarding the diet of the infant:","item":"nutriped","matiere":"nutri","propositions":[{"idx":0,"proposition":"The only diet of the baby under 5 months is milk","correct":true,"justification":"Maternal or not"},{"idx":1,"proposition":"Breastfeeding is ideal and sufficient","correct":true},{"idx":2,"proposition":"Breastfeeding strengthens the mother-child bond","correct":true},{"idx":3,"proposition":"For 100 kcal, a 1st age milk contains about 3kg of cow's milk protein","correct":false,"justification":"Between 2 and 3 grams"},{"idx":4,"proposition":"Low sodium is less than 1 mg of salt per 100 kcal","correct":false,"justification":"Low sodium: < 39 mg\/100 kcal"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nutriped-nutri-1","context":null,"enonce":"General information about infant:","item":"nutriped","matiere":"nutri","propositions":[{"idx":0,"proposition":"Never force a healthy baby to finish rations if he seems full.","correct":true},{"idx":1,"proposition":"Growth charts for weight and height confirm the baby's good nutrition","correct":true},{"idx":2,"proposition":"During the first three years of life, the child multiplies his weight by 4","correct":true},{"idx":3,"proposition":"The brain grows 30 to 200 grams between 0 and 3 years","correct":false,"justification":"From 300 to 1000g"},{"idx":4,"proposition":"During the first three years of life, the child multiplies his height by four","correct":false,"justification":"Step 2"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"nutriped-nutri-2","context":null,"enonce":"Regarding the infant:","item":"nutriped","matiere":"nutri","propositions":[{"idx":0,"proposition":"Daily energy requirements vary little in the first 36 months","correct":true,"justification":"90 to 100 kcal\/kg"},{"idx":1,"proposition":"Diversification is a stage arriving at the third week of life","correct":false,"justification":"From the 6th or 7th month"},{"idx":2,"proposition":"There are three types of external breastfeeding: 1st age milk, 2nd age milk and growth formulas","correct":true,"justification":"Growth preparation = 3rd age"},{"idx":3,"proposition":"Nitrogen absorbed = nitrogen ingested urinary nitrogen","correct":false,"justification":"Nitrogen absorbed = nitrogen ingested faecal nitrogen"},{"idx":4,"proposition":"Nitrogen retained = nitrogen absorbed urinary nitrogen","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"nutriped-nutri-3","context":null,"enonce":"Regarding the infant:","item":"nutriped","matiere":"nutri","propositions":[{"idx":0,"proposition":"AaE can be provided by sources with complementary chemical indices","correct":true},{"idx":1,"proposition":"For premature or very low birth weight children, we have milks covering their specific needs such as milk with non-hydrolyzed proteins","correct":true},{"idx":2,"proposition":"Food diversification involves stages of gradual substitution","correct":true,"justification":"Like slow-digesting sugars, fiber, different proteins, etc."},{"idx":3,"proposition":"The second category of foods to introduce, after slow-digesting sugars, is those rich in fast sugars.","correct":false,"justification":"First the fibers. They also provide water, minerals and vitamins"},{"idx":4,"proposition":"Fibers are responsible for fermentation","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"nutriped-nutri-4","context":null,"enonce":"Regarding the infant and the baby:","item":"nutriped","matiere":"nutri","propositions":[{"idx":0,"proposition":"The interest of fiber is also to provide water, minerals, vitamins provided that we respect certain ways of cooking them","correct":true},{"idx":1,"proposition":"Fiber also has the interest of regulating the glycemic response, therefore hunger, and limiting the absorption of cholesterol","correct":true},{"idx":2,"proposition":"At 6 months a baby will be able to receive, instead of a bottle of milk at noon, a vegetable puree and dairy","correct":true},{"idx":3,"proposition":"Cooked cheeses can be introduced around 6 months of age","correct":false,"justification":"Around 9 months for cooked pasta, around 12 months for fermented pasta"},{"idx":4,"proposition":"There is no danger in leaving the bottle for several months or even years as breakfast","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"nutriped-nutri-5","context":null,"enonce":"Regarding the baby and child:","item":"nutriped","matiere":"nutri","propositions":[{"idx":0,"proposition":"With diversification, fat intake increases from 50% to 30-35% of the daily energy intake","correct":true},{"idx":1,"proposition":"Iron is provided by meat exclusively","correct":false,"justification":"Also by fortified cereals or so-called 3rd age or growth milks that are fortified with iron"},{"idx":2,"proposition":"Eggs are a source of protein but do not contain vitamins","correct":false,"justification":"Eggs provide a lot of vitamins, proteins and cholesterol"},{"idx":3,"proposition":"During diversification, you have to be very careful not to introduce too much protein","correct":false,"justification":"What you really need to pay attention to is sugar+sodium+calories"},{"idx":4,"proposition":"Carbohydrate food excesses have no impact in view of age","correct":false,"justification":"May cause early adiposity rebound"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"nutriped-nutri-6","context":null,"enonce":"Regarding the adolescent:","item":"nutriped","matiere":"nutri","propositions":[{"idx":0,"proposition":"Adolescence is a period of nutritional risk","correct":true},{"idx":1,"proposition":"Adolescent obesity all began at puberty","correct":false,"justification":"Too often obesity is discovered in adolescents that began long before"},{"idx":2,"proposition":"Obesity usually begins between 3 and 5 years of age when the child should start to be lean","correct":true,"justification":"While the child is normal\/coated, and this explains most of the obesity seen in adolescence"},{"idx":3,"proposition":"It is useful or even imperative to develop the habit of regular physical activity","correct":true},{"idx":4,"proposition":"One in two teenagers admits they don't like looking at themselves in a mirror or having their picture taken","correct":true,"justification":"and 63% of girls say they want to lose weight"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nutriped-nutri-7","context":null,"enonce":"Regarding the adolescent:","item":"nutriped","matiere":"nutri","propositions":[{"idx":0,"proposition":"It is recommended to administer vitamin D supplementation every 3 months during the peripubertal period","correct":false,"justification":"At least once a year"},{"idx":1,"proposition":"It is recommended to provide at least 100g of calcium per day","correct":false,"justification":"At least 1g or 1000mg"},{"idx":2,"proposition":"The recommended intake of iron is in the range of 15 to 22 mg\/day","correct":true,"justification":"Higher in girls than boys"},{"idx":3,"proposition":"It is recommended to take a dairy product at each meal including snack","correct":true},{"idx":4,"proposition":"Snacking is to be formally discouraged","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"nutrigrossesse-endoc-1","context":null,"enonce":"Which of the following are risk factors for gestational diabetes?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"idx":0,"proposition":"Maternal age over 35 years","correct":true},{"idx":1,"proposition":"A first-degree family history of type 2 diabetes","correct":true},{"idx":2,"proposition":"A diet rich in fat","correct":false},{"idx":3,"proposition":"Lupus in the mother","correct":false},{"idx":4,"proposition":"Diabetes in the grandfather","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"nutrigrossesse-endoc-4","context":null,"enonce":"Regarding gestational diabetes:","item":"nutrigrossesse","matiere":"endoc","propositions":[{"idx":0,"proposition":"Often, it is a diabetes present before but asymptomatic","correct":true},{"idx":1,"proposition":"It is conventionally revealed in the third trimester","correct":false,"justification":"It is conventionally revealed in the second trimester"},{"idx":2,"proposition":"Screening is systematic","correct":false,"justification":"It is now done on risk factor: age over 35, overweight or obesity, personal or family history of diabetes or macrosomia"},{"idx":3,"proposition":"It concerns 15% of pregnancies 🤰 ","correct":false,"justification":"3 to 6%"},{"idx":4,"proposition":"There is an increased risk of macrosomia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nutrigrossesse-endoc-7","context":null,"enonce":"At what time of pregnancy is OGGH for gestational diabetes indicated? ","item":"nutrigrossesse","matiere":"endoc","propositions":[{"idx":0,"proposition":"Between 24 and 28 SA","correct":true,"justification":"True, only indicated if fasting blood glucose < 0.92g\/L (threshold of gestational diabetes in the first trimester"},{"idx":1,"proposition":"Between 22 and 28 SA","correct":false,"justification":"False"},{"idx":2,"proposition":"Between 24 and 38 SA","correct":false,"justification":"False"},{"idx":3,"proposition":"Between 20 and 24 SA","correct":false,"justification":"False"},{"idx":4,"proposition":"None of the above answers are accurate","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"epidemioKc-onco-0","context":null,"enonce":"Concerning the epidemiology of cancers","item":"epidemioKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Breast cancer is the leading cause of cancer death in women","correct":true},{"idx":1,"proposition":"It is a major public health problem for all industrialized countries.","correct":true},{"idx":2,"proposition":"5-year survival rate (all cancers) = 73%","correct":false},{"idx":3,"proposition":"Cancer is the 1st leading cause of death in humans","correct":true},{"idx":4,"proposition":"Lung cancer is the 1st leading cause of cancer death in men","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"epidemioKc-onco-1","context":null,"enonce":"Concerning the epidemiology and prevention of cancer","item":"epidemioKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Prematured mortality from cancer is twice as high in men as in women","correct":true},{"idx":1,"proposition":"Between 1980 and 2015, the overall incidence of cancer has increased since 1980 (+109% in both men and women)","correct":true},{"idx":2,"proposition":"Tobacco is a factor on which we can act","correct":true},{"idx":3,"proposition":"Prevention must contribute to reducing inequalities in the face of cancer","correct":true},{"idx":4,"proposition":"At least 1\/3 of cancers are preventable, the main risk factor being alcohol","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"epidemioKc-onco-2","context":null,"enonce":"Concerning the epidemiology and prevention of cancer","item":"epidemioKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Alcohol is responsible for 15,000 cancer deaths","correct":true},{"idx":1,"proposition":"The consumption of fruits and vegetables is associated with a reduced risk of several cancers: oral cavity, pharynx, larynx, esophagus, stomach","correct":true},{"idx":2,"proposition":"Eating salt and salty foods increases the risk of stomach cancer","correct":true},{"idx":3,"proposition":"Eating red meat and deli meats is associated with an increased risk of colorectal cancer","correct":true},{"idx":4,"proposition":"Infectious agents are responsible for 76% of cancers worldwide","correct":false,"justification":"They are responsible for 16%"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"epidemioKc-onco-3","context":null,"enonce":"A 57-year-old patient comes to your office.\r\nWhich of the following are screenings that she could have benefited from?","item":"epidemioKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Mass breast cancer screening","correct":true},{"idx":1,"proposition":"Endometrial cancer screening","correct":false,"justification":"False"},{"idx":2,"proposition":"Individual cervical cancer screening","correct":true},{"idx":3,"proposition":"Mass screening for colon cancer","correct":true},{"idx":4,"proposition":"Mass screening for ovarian cancer","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TCA-psy-0","context":null,"enonce":"General generalities:","item":"TCA","matiere":"psy","propositions":[{"idx":0,"proposition":"There are two eating disorders: anorexia and bulimia","correct":false,"justification":"There are also binge eating, atypical disorders such as nocturnal eating syndrome and food intake disorders such as pica."},{"idx":1,"proposition":"It is important to eliminate non-psychiatric medical causes before any TCA","correct":true},{"idx":2,"proposition":"Psychiatric comorbidities are extremely rare and minor in intensity","correct":false},{"idx":3,"proposition":"Suicidal risk should be systematically assessed","correct":true,"justification":"TCA are among the psychiatric disorders with the highest mortality (about 10% of patients, half of whom by suicide)"},{"idx":4,"proposition":"It is never necessary to hospitalize these patients whose care is done on a long-term outpatient basis","correct":false,"justification":"Hospitalization criteria, especially for anorexia must be known"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"TCA-psy-1","context":null,"enonce":"Which propositions are true?","item":"TCA","matiere":"psy","propositions":[{"idx":0,"proposition":"Diet belongs to the instinctual functions of mammals","correct":true},{"idx":1,"proposition":"The etiopathogenesis of TCA is still poorly understood","correct":true},{"idx":2,"proposition":"The lifetime prevalence of anorexia nervosa is estimated to be more than 6% in Caucasian women","correct":false,"justification":"Its lifetime prevalence is estimated at 0.6% in the Caucasian adult population"},{"idx":3,"proposition":"The sex ratio of anorexia is 1 man to 8 women","correct":true},{"idx":4,"proposition":"Anorexia is not a fatal disease","correct":false,"justification":"Mortality is estimated at 1% per year"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AOMI-cardio-0","context":null,"enonce":"Concerning arteriopathy obliterans","item":"AOMI","matiere":"cardio","propositions":[{"idx":0,"proposition":"After coronary and cerebral involvement, PAD is by its frequency the third localization of atherosclerosis","correct":true},{"idx":1,"proposition":"It is, in its symptomatic form, 3 to 4 times more common in women than in men","correct":false,"justification":"3 to 4 times more common in men"},{"idx":2,"proposition":"The peak of presentation is between 60 and 75 years in humans","correct":true,"justification":"And 70 to 80 years in women"},{"idx":3,"proposition":"Diabetes is responsible for severe involvement from the outset, with more proximal involvement ","correct":false,"justification":"A more distal attack"},{"idx":4,"proposition":"Hypertension and diabetes are the two predominant cardiovascular risk factors in PAD","correct":false,"justification":"Diabetes and tobacco"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"AOMI-cardio-1","context":null,"enonce":"Concerning arteriopathy obliterans","item":"AOMI","matiere":"cardio","propositions":[{"idx":0,"proposition":"Symptomatic involvement affects 10 to 15% of people over 60 years of age","correct":false,"justification":"1-5% of people over 60. Asymptomatic forms affect 10-15% of this population"},{"idx":1,"proposition":"In the intermittent claudication stage, mortality at 5 years is 15%","correct":true},{"idx":2,"proposition":"It is estimated that for every symptomatic PAD case, there are two to four patients with a subclinical form of the disease.","correct":true},{"idx":3,"proposition":"The Leriche-Fontaine classification is the classification currently recommended to understand the severity of clinical involvement","correct":false,"justification":"It is supplanted today by the Rutherford classification."},{"idx":4,"proposition":"PAD should be tested for in any patient over 50 years of age with cardiovascular risk factors","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AOMI-cardio-2","context":null,"enonce":"Concerning arteriopathy obliterans","item":"AOMI","matiere":"cardio","propositions":[{"idx":0,"proposition":"The disease is rapidly symptomatic","correct":false,"justification":"Long asymptomatic, due to a moderate hemodynamic impact and the progressive and compensatory development of collateral arteries"},{"idx":1,"proposition":"During intermittent claudication, symptoms disappear spontaneously within 10 minutes","correct":false,"justification":"In less than 5 minutes"},{"idx":2,"proposition":"Claudication is said to be severe if the walking distance is less than 300 meters","correct":false,"justification":"100 meters"},{"idx":3,"proposition":"The walking distances of claudication can be variable from one day to another, in the same patient","correct":true,"justification":"However, this is an atypical form."},{"idx":4,"proposition":"Critical ischemia is a clinical diagnosis exclusively","correct":false,"justification":"Clinico-hemodynamics: infusion pressure <50mmHg at the ankle or 30mmHg at the level of the big toe"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"AOMI-cardio-3","context":null,"enonce":"Concerning arteriopathy obliterans","item":"AOMI","matiere":"cardio","propositions":[{"idx":0,"proposition":"Leriche syndrome indicates femoral involvement","correct":false,"justification":"Aortoiliac involvement. As a reminder, Leriche syndrome associates gluteal claudication or fatigability with walking + erectile dysfunction"},{"idx":1,"proposition":"Pain at the pressure of the calf muscle masses testifies to moderate ischemia","correct":false,"justification":"Pain at the pressure of the muscle masses of the calf testifies to severe ischemia"},{"idx":2,"proposition":"Normal recoloration time is <5 seconds","correct":false},{"idx":3,"proposition":"The ABI is calculated by the ratio of the highest systolic pressure of the two arms to the higher pressure of the two ankles.","correct":false,"justification":"It's the opposite (ankle pressure \/ arm pressure)"},{"idx":4,"proposition":"Ulcers are generally very algic, small and hollow, on the support areas of the foot","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AOMI-cardio-4","context":null,"enonce":"Concerning arteriopathy obliterans","item":"AOMI","matiere":"cardio","propositions":[{"idx":0,"proposition":"Two causes of medicalcosis arterial stiffness are diabetes and tobacco use.","correct":false,"justification":"Diabetes and the dialysis patient. This arterial stiffness results in an IPS >1,4"},{"idx":1,"proposition":"Trophic disorders are systematically sought especially in interdigital spaces","correct":true},{"idx":2,"proposition":"An abolished pedinous pulse testifies to obliterating arterial disease","correct":false,"justification":"Pediose pulse may not be present congenitally, in 5% of the population"},{"idx":3,"proposition":"SPI <0.9 characterizes critical ischemia","correct":false,"justification":"If the ankle infusion pressure is >50mmHg, no. An IPS <0.9 characterizes a PAD"},{"idx":4,"proposition":"In case of IPS >1.4, ankle infusion pressure should be used to make the diagnosis of PAD","correct":false,"justification":"In this case the ankle perfusion pressure is not interpretable: the perfusion pressure at the big toe is used."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AOMI-cardio-5","context":null,"enonce":"Concerning arteriopathy obliterans","item":"AOMI","matiere":"cardio","propositions":[{"idx":0,"proposition":"To diagnose PAD, injected CT angiography is frequently used","correct":false,"justification":"CT angiography is only used if there is an indication for revascularization"},{"idx":1,"proposition":"Critical ischemia pain is improved in the declivated position","correct":true,"justification":"It forces you to get up at night or keep your leg out of bed"},{"idx":2,"proposition":"In case of discovery of PAD, a resting ECG and ultrasound of the abdominal aorta are systematic","correct":true},{"idx":3,"proposition":"A patient with asymptomatic PAD should receive treatment with a statin and an ACE inhibitor","correct":true},{"idx":4,"proposition":"Revascularization may be offered in case of intermittent claudication","correct":true,"justification":"In case of threatening lesions or disabling symptomatology despite optimal treatment for 3 months"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"AOMI-cardio-6","context":null,"enonce":"Which of the following are true for popliteal artery aneurysms?","item":"AOMI","matiere":"cardio","propositions":[{"idx":0,"proposition":"They are frequently associated with abdominal aortic aneurysms","correct":true},{"idx":1,"proposition":"They are rarely bilateral","correct":false,"justification":"Bilateral in almost half of the cases"},{"idx":2,"proposition":"The operative indication arises when they are greater than 15 mm","correct":false,"justification":"20 mm"},{"idx":3,"proposition":"The most common complication is embolism","correct":true},{"idx":4,"proposition":"They can manifest as compression of adjacent tissues","correct":true,"justification":"True, nerves, compressed TV, etc."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AOMI-cardio-7","context":null,"enonce":"Among the following proposals, which are treatments to be implemented in case of stage I PAD according to the Leriche and Fontaine classification?","item":"AOMI","matiere":"cardio","propositions":[{"idx":0,"proposition":"Smoking cessation","correct":true,"justification":"True, avoid passive smoking too"},{"idx":1,"proposition":"Arterial revascularization","correct":false,"justification":"Not at stage 1"},{"idx":2,"proposition":"Walking rehabilitation","correct":false,"justification":"No problem walking in stage 1"},{"idx":3,"proposition":"Implementation of antiplatelet agents","correct":false,"justification":"Implementation of Statine, and IEC\/ARA2 if necessary"},{"idx":4,"proposition":"Balancing diabetes, if applicable","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"KcSNC-onco-0","context":null,"enonce":"Regarding the management of glioblastomas:","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"The median survival is about 1.5 years","correct":true,"justification":"18 months"},{"idx":1,"proposition":"Hormone therapy is applicable as a second line","correct":false,"justification":"Has no place in this care"},{"idx":2,"proposition":"Focal radiation therapy is often offered as a first-line treatment","correct":false,"justification":"In all intracerebral tumors, first-line excision is preferred, often supplemented by chemotherapy and\/or radiotherapy."},{"idx":3,"proposition":"Radiation therapy is often concomitant with chemotherapy","correct":true},{"idx":4,"proposition":"It is a deadly tumor in most cases","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"KcSNC-onco-1","context":null,"enonce":"What does a gliobastoma give on an MRI?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"A strong contrast gain in injected T1","correct":true},{"idx":1,"proposition":"Regular contours","correct":false,"justification":"Irregulars"},{"idx":2,"proposition":"Peripheral necrosis","correct":false,"justification":"Central necrosis"},{"idx":3,"proposition":"A hypoT1 image without injection of contrast medium","correct":true},{"idx":4,"proposition":"A hyperT2 image","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"KcSNC-onco-2","context":null,"enonce":"Among these tumor proposals, which are among the 4 cancers that metastasize the most intracranial?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Kidney","correct":true},{"idx":1,"proposition":"Lung","correct":true},{"idx":2,"proposition":"Breast","correct":true},{"idx":3,"proposition":"Melanoma","correct":true},{"idx":4,"proposition":"Prostate","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"KcSNC-onco-3","context":null,"enonce":"Which of these propositions are true?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"There are many more metastases than primary tumors, from an epidemiological point of view","correct":true},{"idx":1,"proposition":"85% of intracranial tumors are subtentorial","correct":false,"justification":"85% of them are sustenorial"},{"idx":2,"proposition":"There are more than 15 large entities of intrancranial tumors","correct":false,"justification":"There are 9"},{"idx":3,"proposition":"There are more than 240 subtypes of intrancranial tumors, almost all of which differ in their management.","correct":false,"justification":"There are about 80 subtypes of intracranial tumors. There is a lot of overlap between them."},{"idx":4,"proposition":"Type 3 glioma is called low-grade","correct":false,"justification":"Glioma types 1 and 2: low grade. Glioma types 3 and 4: high grade. Type 3 glioma is anaplastic. Type 4 glioma is a glioblastoma."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"KcSNC-onco-4","context":null,"enonce":"Regarding amydala engagement:","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"It concerns supratentorial tumors","correct":false,"justification":"Supratentorial tumors (85% of intracranial tumors) have a temporal commitment. It is the subtentorial tumors that cause tonsillar engagement"},{"idx":1,"proposition":"It results in hemiparesis, diplopia, ptosis and\/or unilateral areactive mydriasis","correct":false,"justification":"This is the case of temporal engagement"},{"idx":2,"proposition":"It concerns the middle pit","correct":false,"justification":"The posterior fossa"},{"idx":3,"proposition":"It can result in stiff neck and torticollis.","correct":true},{"idx":4,"proposition":"It is as serious and urgent as temporal engagement","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"KcSNC-onco-5","context":null,"enonce":"Which propositions are true?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Intratumoral hemorrhages are more common in primary tumors","correct":false,"justification":"They are more common in cases of metastases of kidney or skin tumors."},{"idx":1,"proposition":"Lumbar punctures are formally contraindicated in case of hydrocephalus","correct":false,"justification":"It depends on the type of hydrocephalus. If it is the tumor that prevents CSF from flowing, then PL is indeed contraindicated because it can cause, by << aspiration>>, occipital engagement. If, on the other hand, it is leptomeningeal proliferation that prevents the CSF from resorbing, then PL is possible."},{"idx":2,"proposition":"Choroidal plexus tumors can cause hypersecretion of CSF","correct":true},{"idx":3,"proposition":"Temporal engagement corresponds to the passage of the uncus and hippocampus in the Bichat cleft","correct":true,"justification":"Between the free edge of the cerebellum tent and the brainstem"},{"idx":4,"proposition":"Meningeal stiffness is rare in tumor meningitis","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"KcSNC-onco-6","context":null,"enonce":"Which of these tumor biomarkers have a good prognosis in diffuse gliomas in adults?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"The codeletion of chromosomes 1p and 19q","correct":true,"justification":"Result of an unbalanced chromosomal translocation"},{"idx":1,"proposition":"The mutation of the IDH gene","correct":true,"justification":"Encodes the enzyme isocitrate dehydrogenase involved in the energy metabolism of the cell"},{"idx":2,"proposition":"Acetylation of the MGMT gene","correct":false,"justification":"Methylation"},{"idx":3,"proposition":"The BRAF mutation","correct":false,"justification":"Melanoma"},{"idx":4,"proposition":"Amplification of NMYC","correct":false,"justification":"Prognostic marker for neuroblastomas"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"KcSNC-onco-8","context":null,"enonce":"Which of the following are signs of intracranial hypertension (ICPH)?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Areactive mydriasis","correct":true,"justification":"True, III (ptosis and mydriasis)"},{"idx":1,"proposition":"Ptosis","correct":true,"justification":"True, by reaching III"},{"idx":2,"proposition":"Paralysis of the abduction of the eye","correct":true,"justification":"True, achieved by VI"},{"idx":3,"proposition":"Impaired alertness","correct":true,"justification":"True, in case of severity"},{"idx":4,"proposition":"Hiccup","correct":true,"justification":"True, in severe ICTs"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"KcSNC-onco-9","context":null,"enonce":"Which of the following propositions concerning gliobastoma are true?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"High-grade brain tumour","correct":true,"justification":"True, it is a grade IV glial tumor"},{"idx":1,"proposition":"Prognosis is good","correct":false,"justification":"False"},{"idx":2,"proposition":"Prognosis is poor","correct":true},{"idx":3,"proposition":"Source cell line is neural","correct":false,"justification":"False"},{"idx":4,"proposition":"The source cell line is microglial","correct":false,"justification":"The cell line is astrocytic or oligodendrocytic, not microglial"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"KcSNC-onco-10","context":null,"enonce":"Which of the following are tumors metastasizing to the brain frequently?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Lung","correct":true},{"idx":1,"proposition":"Kidney","correct":true},{"idx":2,"proposition":"Breast","correct":true},{"idx":3,"proposition":"Pancreas","correct":false,"justification":"The 4 to know by heart are: lung, breast, kidney, melanoma."},{"idx":4,"proposition":"Bladder","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"KcSNC-onco-11","context":null,"enonce":"Which of the following proposals manifest itself in an image of a roundel on MRI?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Meningioma","correct":true,"justification":"Roundel = MAGIC. Meningioma, abscess, glioblastoma, infarction, contusion"},{"idx":1,"proposition":"Glioma","correct":false,"justification":"False"},{"idx":2,"proposition":"Glioblastoma","correct":true},{"idx":3,"proposition":"Meningitis","correct":false,"justification":"False"},{"idx":4,"proposition":"Abscess","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"KcSNC-onco-12","context":null,"enonce":"Which of the following are classic signs or symptoms of intracranial hypertension (ICPH)?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Abducens nerve damage","correct":true,"justification":"True, it is nerve VI, innervating the lateral right. Its involvement is responsible for horizontal binocular diplopia. It is the most 'fragile' cranial nerve"},{"idx":1,"proposition":"Paresthesia of the limbs","correct":false,"justification":"Not classic"},{"idx":2,"proposition":"Decubitus headaches","correct":true,"justification":"True, aggravated at the end of the night or in the morning"},{"idx":3,"proposition":"Jet vomiting","correct":true,"justification":"True, which relieve headaches"},{"idx":4,"proposition":"One-sided ptosis","correct":false,"justification":"Not a sign of HTIC"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"KcSNC-onco-13","context":null,"enonce":"Which of the following proposals manifest itself in an image of a roundel on MRI?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Alzheimer's disease","correct":false,"justification":"Roundel = MAGIC. Meningioma, abscess, glioblastoma, infarction, contusion"},{"idx":1,"proposition":"Meningioma","correct":true},{"idx":2,"proposition":"Extradural hematoma","correct":false,"justification":"Convex peripheral hematoma image"},{"idx":3,"proposition":"Bruise","correct":true},{"idx":4,"proposition":"Ischemic stroke","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"KcSNC-onco-14","context":null,"enonce":"Which of the following are tumors metastasizing to the brain frequently?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Kidney","correct":true},{"idx":1,"proposition":"Adrenal gland","correct":false,"justification":"False"},{"idx":2,"proposition":"Basal cell carcinoma","correct":false,"justification":"It does not give metastasis"},{"idx":3,"proposition":"Larynx","correct":false,"justification":"The 4 to know by heart are: lung, breast, kidney, melanoma"},{"idx":4,"proposition":"Melanoma","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"KcSNC-onco-15","context":null,"enonce":"Which of the following are true?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Primary cerebral lymphomas occur only in immunocompromised patients. ","correct":false,"justification":"False, the risk is increased in the immunocompromised patient (untreated HIV, organ transplant) but primary cerebral lymphomas exist in the immunocompetent."},{"idx":1,"proposition":"Meningiomas have estradiol receptors.","correct":true,"justification":"Meningiomas have estradiol receptors. Their discovery should stop all hormonal contraception, THM or cyproterone acetate treatment."},{"idx":2,"proposition":"Tobacco is a risk factor for primary brain tumours.","correct":false,"justification":"False: no absolute proof"},{"idx":3,"proposition":"In front of a glial tumor, it is necessary to look for certain molecular abnormalities for diagnostic and prognostic purposes.","correct":true,"justification":"True: \r\n-mutation IDH1 and IDH2 \r\n- codeletion 1P19Q\r\n-MGMT methylation (better prognosis and sensitivity to temozolomide)"},{"idx":4,"proposition":"In front of a medulloblastoma, we look for a SHH mutation","correct":true,"justification":"True: Prognostic and theranostic value (introduction of SHH inhibitors)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"KcSNC-onco-16","context":null,"enonce":"Which of the following are true?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"In adults, the most common primary brain tumors are gliomas.","correct":true,"justification":"True: gliomas in 42% of cases then meningiomas in 32%"},{"idx":1,"proposition":"Meningiomas are more common in women.","correct":true},{"idx":2,"proposition":"Primary CNS tumors account for 10% of cancers","correct":false,"justification":"False, 1%"},{"idx":3,"proposition":"In adults, the most common brain tumors are gliomas.","correct":false,"justification":"False, these are metastases."},{"idx":4,"proposition":"CNS metastases are thought to affect at least 20% of cancers.","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"KcSNC-onco-17","context":null,"enonce":"Regarding the treatment of brain tumors, which proposals are accurate? ","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"In medulloblastomas, prophylactic craniospinal irradiation is performed in addition to irradiation of the tumor area.","correct":true,"justification":"True: because frequent intra-neuraxic metastases."},{"idx":1,"proposition":"Stereotactic radiation therapy can be performed on brain metastases","correct":true,"justification":"True: if small lesions circumscribed < 3 cm"},{"idx":2,"proposition":"Treatment of glioblastomas relies on chemotherapy alone","correct":false,"justification":"False: Surgical resection followed by radiotherapy and chemotherapy with TEMOZOLOMIDE"},{"idx":3,"proposition":"Treatment of meningioma is based on radiotherapy and chemotherapy.","correct":false,"justification":"False: no chemotherapy in meningioma, it is a benign tumor. Treatment is based on surgical resection or radiotherapy if not operable."},{"idx":4,"proposition":"Radiation therapy of the brain in toto may be recommended in young patients with primary cerebral lymphoma.","correct":true,"justification":"True: primary cerebral lymphomas are chemo and radiosensitive > chemotherapy with methotrexate and consolidation by radiotherapy of the brain in toto or intensification of chemo with HSC transplantation."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"KcSNC-onco-19","context":null,"enonce":"Regarding intracranial hypertension syndrome, which proposals are true?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"ICH headaches occur at the end of the day.","correct":false,"justification":"False: morning headache or second part night"},{"idx":1,"proposition":"Vomiting usually relieves headaches. ","correct":true},{"idx":2,"proposition":"There is classically an attack of the IV which has no localizing value. ","correct":false,"justification":"False: Reaching VI"},{"idx":3,"proposition":"In front of any ICH linked to a CNS tumor, it is essential to introduce high-dose corticosteroids. ","correct":false,"justification":"False: corticosteroids are formally contraindicated in case of primary CNS lymphoma (risk of negativation of the histo diagnosis)"},{"idx":4,"proposition":"In front of an HTIC, it is necessary to perform a lumbar puncture in first line in order to search for the etiology.","correct":false,"justification":"False: Never in first intention! Always perform brain imaging before to rule out an expansive process or hydrocephalus (otherwise risk of commitment)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"KcSNC-onco-20","context":null,"enonce":"Regarding pilocytic astrocytoma, which proposals are accurate?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"It is a low-grade glioma ","correct":true,"justification":"It is a low-grade glioma (grade I astrocytoma)"},{"idx":1,"proposition":"This tumor usually occurs around 50-60 years of age. ","correct":false,"justification":"False: pilocytic astrocytoma occurs in young adults. These are grade III and IV gliomas that occur around 50-60 years of age."},{"idx":2,"proposition":"It can be associated with phacomatoses. ","correct":true,"justification":"True: associated with NF1 or Von Recklinghausen disease"},{"idx":3,"proposition":"These are well-circumscribed tumors, hypodense in CT, hyperintense in T2 MRI, taking the contrast and having a cystic component.","correct":true},{"idx":4,"proposition":"Treatment is mainly based on surgery.","correct":true,"justification":"True, if not operable and progressive, it is possible to offer radiotherapy or chemotherapy."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"KcSNC-onco-21","context":null,"enonce":"Regarding carcinomatous meningitis, what are the exact proposals? ","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"It results from the extension of a primary brain tumor to the subarachnoid spaces or the metastatic invasion of a systemic cancer","correct":true},{"idx":1,"proposition":"The diagnosis should be evoked in the face of any neurological symptoms in a patient with cancer","correct":true},{"idx":2,"proposition":"In imaging, there is abnormal meningeal or periventricular contrast taking","correct":true},{"idx":3,"proposition":"Meningeal stiffness is the main symptom","correct":false,"justification":"Meningeal stiffness is very rare in this type of meningitis."},{"idx":4,"proposition":"Lumbar puncture can be used to make the diagnosis ","correct":true,"justification":"True: the diagnosis can be made on imaging in case of typical image and\/or on PL if cancer cells"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRespA-urg-0","context":null,"enonce":"Regarding acute respiratory failure","item":"IRespA","matiere":"urg","propositions":[{"idx":0,"proposition":"Acute respiratory failure (AKI) is defined as the inability of a patient to maintain normal haematosis","correct":true},{"idx":1,"proposition":"• The haematosis disorder is accompanied by changes in blood gases with hypoxemia (defined as PaO2 < 90 mmHg), which may or may not be associated with hypercapnia (PaCO2 < 45 mmHg)","correct":false},{"idx":2,"proposition":"• Hypercapnia is not systematic, it may be absent or replaced by hypocapnia depending on the etiology of the AKI","correct":true},{"idx":3,"proposition":"• The appearance of signs of acute respiratory distress indicates the severity of a respiratory condition","correct":true},{"idx":4,"proposition":"An AKI is related to either the failure of the hematosis, or the failure of the acid-base balance function of the lung","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRespA-urg-1","context":null,"enonce":"Regarding acute respiratory insufficiency","item":"IRespA","matiere":"urg","propositions":[{"idx":0,"proposition":"Any situation causing fatigue of the respiratory muscles via an increase in ventilatory work can be a source of acute respiratory failure","correct":true},{"idx":1,"proposition":"Intrathoracic distension (\"trapping\" phenomenon in chronic respiratory failure) decreases the contraction of the diaphragm by flattening effect","correct":true},{"idx":2,"proposition":"Plasma pH varies between 7.36 and 7.42 at rest","correct":false,"justification":"Plasma pH varies between 7.38 and 7.42 at rest"},{"idx":3,"proposition":"Any pH value below 7.32 indicates the existence of associated metabolic acidosis","correct":false,"justification":"Any pH value below 7.30 indicates the existence of associated metabolic acidosis"},{"idx":4,"proposition":"Aggravaction of disorders of consciousness is an indcation to orotracheal intubation","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRespA-urg-2","context":null,"enonce":"Regarding acute respiratory insufficiency","item":"IRespA","matiere":"urg","propositions":[{"idx":0,"proposition":"Severe hypoxemia assessed by PaO2\/FiO2 ratio in mmHg","correct":true},{"idx":1,"proposition":"Minimal ARDS: PaO2\/FiO2 between 200 and 300 with PEEP or CPAP ≥ 5 cmH2O","correct":true},{"idx":2,"proposition":"An average ARDS PaO2\/FiO2 between 200 and 300 with PEEP or CPAP ≥ 5 cmH2O","correct":false},{"idx":3,"proposition":"3\/4SDRA severe: PaO2\/FiO2 ≤ 100 with PEEP ≥ 5 cmH2O","correct":true},{"idx":4,"proposition":"Average ARDS: PaO2\/FiO2 between 100 and 200 with PEEP ≥ 5 cmH2O","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"IRespA-urg-3","context":null,"enonce":"Which of the following proposals are additional examinations to be carried out urgently in the event of electrification?","item":"IRespA","matiere":"urg","propositions":[{"idx":0,"proposition":"ECG","correct":true},{"idx":1,"proposition":"Brain scan","correct":false,"justification":"False"},{"idx":2,"proposition":"Troponin","correct":true},{"idx":3,"proposition":"CPK","correct":true},{"idx":4,"proposition":"Urea","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRespA-urg-4","context":null,"enonce":"Which of the following are systematic reviews of paraclinical assessment in acute respiratory failure?","item":"IRespA","matiere":"urg","propositions":[{"idx":0,"proposition":"Chest X-ray","correct":true},{"idx":1,"proposition":"Blood gas","correct":true},{"idx":2,"proposition":"Cervical CT","correct":false,"justification":"False, only in case of obstruction of the VAS"},{"idx":3,"proposition":"Bronchial fibroscopy","correct":false,"justification":"False, not systematic"},{"idx":4,"proposition":"ECG","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRespA-urg-5","context":null,"enonce":"Which of the following are mechanisms involved in hypoxemia where the alveolo-arterial gradient for oxygen is normal?","item":"IRespA","matiere":"urg","propositions":[{"idx":0,"proposition":"Reduction of PiO2","correct":true},{"idx":1,"proposition":"True right-left shunt","correct":false,"justification":"False, increases the alveolo-arterial gradient for oxygen"},{"idx":2,"proposition":"Shunt effect","correct":false,"justification":"False, increases the alveolo-arterial gradient for oxygen"},{"idx":3,"proposition":"Diffusion disorder","correct":false,"justification":"False, increases the alveolo-arterial gradient for oxygen"},{"idx":4,"proposition":"Alveolar hypoventilation","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"jamberouge-urg-0","context":null,"enonce":"Which of these proposals is\/are erysipelas risk factors?","item":"jamberouge","matiere":"urg","propositions":[{"idx":0,"proposition":"A BMI below 21","correct":false,"justification":"Obesity is a risk factor"},{"idx":1,"proposition":"A BMI below 17","correct":false},{"idx":2,"proposition":"High blood pressure","correct":false},{"idx":3,"proposition":"An ulcer of the lower limbs","correct":true},{"idx":4,"proposition":"Kidney failure","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"jamberouge-urg-2","context":null,"enonce":"Regarding erisypela:","item":"jamberouge","matiere":"urg","propositions":[{"idx":0,"proposition":"First-line antibiotic therapy combines a penicilinase inhibitor","correct":false,"justification":"The erisypel is classically Streptococcus A. The first-line antibiotic is amoxicillin, without clavulanic acid"},{"idx":1,"proposition":"It is a dermo-hypodermatitis","correct":true},{"idx":2,"proposition":"It is caused by bacterial germs","correct":true},{"idx":3,"proposition":"She is usually non-febrile","correct":false,"justification":"She is feverish most often"},{"idx":4,"proposition":"It is necrotizing","correct":false,"justification":"It is non-necrotizing"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"jamberouge-urg-3","context":null,"enonce":"Regarding fasciitis:","item":"jamberouge","matiere":"urg","propositions":[{"idx":0,"proposition":"It is necrotizing","correct":true,"justification":"Indeed, its full name is \"necrotizing fasciitis\""},{"idx":1,"proposition":"There are no general signs","correct":false,"justification":"General signs are marked as well as infectious signs."},{"idx":2,"proposition":"The notion of animal bite must point towards a pasteurellosis of inoculation.","correct":true},{"idx":3,"proposition":"It is due to an allergy","correct":false,"justification":"It is an infectious pathology"},{"idx":4,"proposition":"It may be accompanied by a DIC.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"jamberouge-urg-4","context":null,"enonce":"Which of these propositions are true about eczema?","item":"jamberouge","matiere":"urg","propositions":[{"idx":0,"proposition":"Its treatment is based on mid-dose antibiotic therapy","correct":false,"justification":"It is based on the eviction of the supposed allergen"},{"idx":1,"proposition":"The use of local corticosteroids leads to rapid improvement.","correct":true},{"idx":2,"proposition":"It is an immuno-allergic dermatosis due to hypersensitivity to a contact allergen.","correct":true},{"idx":3,"proposition":"Pruritus points to another diagnosis","correct":false,"justification":"The picture is clinically characterized by pruritus, the presence of vesicles on an inflammatory basis and crumbled border. It is usually located in the region of contact with the allergen."},{"idx":4,"proposition":"It can be concomitant with a leg ulcer","correct":true,"justification":"The mechanism is then unknown"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"malaise-urg-0","context":null,"enonce":"Which of the following are characteristic of syncope?","item":"malaise","matiere":"urg","propositions":[{"idx":0,"proposition":"Bite of the tip of the tongue","correct":true},{"idx":1,"proposition":"Quick start","correct":true},{"idx":2,"proposition":"Long duration","correct":false,"justification":"Short duration"},{"idx":3,"proposition":"It is due to global and transient cerebral hypoperfusion","correct":true},{"idx":4,"proposition":"Spontaneously resolutive","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"malaise-urg-1","context":null,"enonce":"Which of the following are true?","item":"malaise","matiere":"urg","propositions":[{"idx":0,"proposition":"Discomfort is a subjective feeling of malaise","correct":true},{"idx":1,"proposition":"Syncope is a loss of consciousness","correct":true},{"idx":2,"proposition":"Lipothymia is a decrease in postural tone without loss of consciousness","correct":true},{"idx":3,"proposition":"Syncope is a subjective feeling of malaise","correct":false,"justification":"False"},{"idx":4,"proposition":"Lipothymia is a loss of consciousness","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbvisionbrutal-ophtalmo-0","context":null,"enonce":"Regarding interrogatory:","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Diagnosis of brutal BAV based on interrogation","correct":true},{"idx":1,"proposition":"The sensation of \"flying flies\" is myodesopsia","correct":true},{"idx":2,"proposition":"The speed of installation has little semiological value","correct":false,"justification":"Its speed of installation is fundamental in the diagnostic algorithm"},{"idx":3,"proposition":"Vision abnormalities never have associated pain","correct":false,"justification":"If. The interrogation specifies the presence or absence of associated pain and its type"},{"idx":4,"proposition":"Deep pain may radiate into the trigeminal territory","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbvisionbrutal-ophtalmo-1","context":null,"enonce":"Regarding interrogation and examination:","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Superficial pain suggests acute glaucoma","correct":false,"justification":"These are deep pains"},{"idx":1,"proposition":"'True' headaches suggest a neuro-ophthalmological cause","correct":true},{"idx":2,"proposition":"Ocular trauma can have an impact on eyesight but only if it is major","correct":false,"justification":"even minimal"},{"idx":3,"proposition":"Ophthalmological examination concerns only the pathological eye","correct":false,"justification":"It includes both eyes"},{"idx":4,"proposition":"Measurement of visual acuity from far and near is done without optical correction","correct":false,"justification":"With optical correction if necessary"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbvisionbrutal-ophtalmo-2","context":null,"enonce":"Regarding the ophthalmological examination:","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"pupillary reactivity is systematic","correct":true},{"idx":1,"proposition":"examination of the anterior segment includes vitreous and lens","correct":false,"justification":"examination of the anterior segment: cornea, anterior and crystalline chamber"},{"idx":2,"proposition":"Eye tone measurement is only done in rare cases","correct":false,"justification":"The measurement of eye tone is systematic"},{"idx":3,"proposition":"The examination of the fundus after pupillary dilation makes it possible to visualize the cornea","correct":false,"justification":"examination of the fundus after pupillary dilation: optic nerve, retinal vessels, retina"},{"idx":4,"proposition":"Complementary examinations such as OCT have become systematic","correct":false,"justification":"Additional examinations are not systematic and are guided by questioning and clinical examination:"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbvisionbrutal-ophtalmo-3","context":null,"enonce":"Regarding pathologies:","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"In acute keratitis, decreased visual acuity is accompanied by significant superficial pain","correct":true},{"idx":1,"proposition":"Fluids are clear and transparent in acute keratitis","correct":false,"justification":"There is a decrease in transparency of the cornea, a perikeratic circle and one or more corneal ulcerations"},{"idx":2,"proposition":"Acute angle-closure glaucoma is painless in most cases","correct":false,"justification":"Acute angle closure glaucoma: The pain is deep, intense, ocular and periocular radiating into the trigeminal territory"},{"idx":3,"proposition":"Often nausea or vomiting occurs in acute angle-closure glaucoma","correct":true},{"idx":4,"proposition":"The anterior chamber is narrow in acute keratitis","correct":false,"justification":"The anterior chamber is narrow in acute glaucoma by closure of the angle"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbvisionbrutal-ophtalmo-4","context":null,"enonce":"Regarding pathologies:","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"There is a major elevation of eye tone in acute glaucoma by angle closure","correct":true},{"idx":1,"proposition":"The decrease in visual acuity is most often minimal in acute glaucoma by closure of the angle","correct":false,"justification":"The decrease in visual acuity depends on corneal edema related to hypertonia and retinal perfusion, it is often significant"},{"idx":2,"proposition":"Acute anterior uveitis is iridocyclitis","correct":true},{"idx":3,"proposition":"Decreased visual acuity and pain is common in iridocyclitis","correct":true},{"idx":4,"proposition":"A perikeratic circle eliminates the diagnosis of acute anterior uveitis","correct":false,"justification":"A perikeratic circle may well appear"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbvisionbrutal-ophtalmo-5","context":null,"enonce":"Regarding uveitis:","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"A pupil in miosis by iridocrystalline synechiae is a sign of iridocyclitis","correct":true},{"idx":1,"proposition":"Tyndall's phenomenon is pathognomonic of posterior uveitis","correct":false,"justification":"It is in acute anterior uveitis that slit lamp examination reveals the presence of inflammatory cells in the anterior chamber (Tyndall's phenomenon), possibly with retrocorneal precipitates and iridocrystalline synechiae"},{"idx":2,"proposition":"The most common cause of choroiditis is ocular toxoplasmosis.","correct":true},{"idx":3,"proposition":"Posterior uveitis is responsible for recurrent retinochoroiditis","correct":true},{"idx":4,"proposition":"Retinitis is manifested by myodesopsias","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"tbvisionbrutal-ophtalmo-6","context":null,"enonce":"Concerning ocular pathologies:","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Treatment of ocular toxoplasmosis based on antibacterials","correct":false,"justification":"Treatment is based on the antiparasitic drugs – pyrimethamine (Malocide®) and sulfadiazine (Adiazine®) – prescribed if there is a threat to visual acuity"},{"idx":1,"proposition":"Neovascular glaucoma is seen in unbalanced diabetes","correct":true},{"idx":2,"proposition":"The postoperative context is suggestive of endophthalmitis","correct":true},{"idx":3,"proposition":"The hypopion has anterior chamber fibrin visible to the slit lamp","correct":true},{"idx":4,"proposition":"B-ultrasound may reveal a retinal tear","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbvisionbrutal-ophtalmo-7","context":null,"enonce":"Regarding intravitreal hemorrhages:","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Ultrasound B is contraindicated when the hemorrhage is massive because the retina is then not very visible","correct":false,"justification":"Ultrasound B is anyway always indicated when the retina is not visible to eliminate the presence of retinal detachment (+++)"},{"idx":1,"proposition":"Proliferative diabetic retinopathy is a cause of intravitreal hemorrhage","correct":true},{"idx":2,"proposition":"A retinal tear causes intravitreal hemorrhage only when there is retinal detachment","correct":false,"justification":"Hemorrhage in all cases"},{"idx":3,"proposition":"Terson syndrome is a genetic condition affecting chromosome 6 that increases the risk of intravitreous hemorrhage and subarachnoid hemorrhage.","correct":false,"justification":"Terson syndrome: unior bilateral intravitreal hemorrhage associated with subarachnoid hemorrhage due to intracranial aneurysm rupture (Terson syndrome may also be associated with traumatic subarachnoid hemorrhage)"},{"idx":4,"proposition":"Intermediate uveitis is a subgroup of uveitis where the vitreous is the main site of inflammation","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"tbvisionbrutal-ophtalmo-8","context":null,"enonce":"Which propositions are true?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Phosphenes are flashes of light","correct":true},{"idx":1,"proposition":"Metamorphopsies concern patients with color blindness ","correct":false,"justification":"Image distortion"},{"idx":2,"proposition":"Dyschromatopsias are a distortion of the image","correct":false,"justification":"Achievement of colour vision"},{"idx":3,"proposition":"Diploplolia has a purely central neurological origin","correct":false,"justification":"Can also be peripheral (oculomotor nerves)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbvisionbrutal-ophtalmo-9","context":null,"enonce":"Which of these pathologies can cause monocular involvement?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"A stroke","correct":false,"justification":"Rather binocular"},{"idx":1,"proposition":"A vertebrobasillary TIA","correct":false,"justification":"Rather binocular. On the other hand, TIAs by unilateral carotid stenosis can cause monocular involvement."},{"idx":2,"proposition":"CRAOs and CRVOs","correct":true},{"idx":3,"proposition":"The HTIC","correct":true},{"idx":4,"proposition":"Focal seizures","correct":false,"justification":"Rather binocular"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"preventionnutri-nutri-0","context":null,"enonce":"What are the recommendations in terms of daily calorie intake for adult men?","item":"preventionnutri","matiere":"nutri","propositions":[{"idx":0,"proposition":"1500-1800 calories \/ day","correct":false},{"idx":1,"proposition":"2400-2600 calories \/ day","correct":true},{"idx":2,"proposition":"2200-2400 calories \/ day","correct":false},{"idx":3,"proposition":"1800-2000 calories \/ day","correct":false},{"idx":4,"proposition":"2800-3000 calories \/ day","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"preventionnutri-nutri-1","context":null,"enonce":"What are the recommendations in terms of daily calorie intake for adult women?","item":"preventionnutri","matiere":"nutri","propositions":[{"idx":0,"proposition":"1800-2200 calories \/ day","correct":true},{"idx":1,"proposition":"2400-2600 calories \/ day","correct":true},{"idx":2,"proposition":"2200-2400 calories \/ day","correct":false},{"idx":3,"proposition":"1800-2000 calories \/ day","correct":false},{"idx":4,"proposition":"2800-3000 calories \/ day","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"preventionnutri-nutri-2","context":null,"enonce":"Which propositions are true?","item":"preventionnutri","matiere":"nutri","propositions":[{"idx":0,"proposition":"A diet that is too salty is a risk factor for high blood pressure","correct":true},{"idx":1,"proposition":"A diet that is too fat is a risk factor for type 2 diabetes","correct":false,"justification":"It is a risk factor for high cholesterol"},{"idx":2,"proposition":"A diet rich in protein promotes colon cancer","correct":true},{"idx":3,"proposition":"A diet that is too sweet is a risk factor for type 2 diabetes","correct":true},{"idx":4,"proposition":"An unbalanced diet is a risk factor for osteoporosis in the elderly","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"preventionnutri-nutri-3","context":null,"enonce":"What are the recommended proportions of nutrients in a meal?","item":"preventionnutri","matiere":"nutri","propositions":[{"idx":0,"proposition":"20% carbohydrates","correct":false,"justification":"50% carbohydrates, 30% fat and 20% protein"},{"idx":1,"proposition":"80% protein","correct":false},{"idx":2,"proposition":"30% fat","correct":true},{"idx":3,"proposition":"10% fat","correct":false},{"idx":4,"proposition":"20% protein","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ACR-urg-0","context":null,"enonce":"Concerning the major bases:","item":"ACR","matiere":"urg","propositions":[{"idx":0,"proposition":"Ischemic heart disease is the world's leading cause of death","correct":true},{"idx":1,"proposition":"In Europe, cardiovascular diseases are responsible for about 40% of deaths before the age of 75","correct":true},{"idx":2,"proposition":"Even imperfect CPR is always better than no CPR, even in children","correct":true,"justification":"See College Emergencies and Acute Failures, page 326"},{"idx":3,"proposition":"CPR should be initiated 30 seconds after loss of consciousness, in case the patient wakes up on his own","correct":false,"justification":"CPR should be initiated as early as possible and continued with the minimum of interruption by the first witness(ies) pending the arrival of specialized assistance"},{"idx":4,"proposition":"Any victim who is unconscious, not breathing or breathing abnormally, should be considered in CA","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"ACR-urg-1","context":null,"enonce":"Regarding cardiopulmonary resuscitation and circulatory arrest:","item":"ACR","matiere":"urg","propositions":[{"idx":0,"proposition":"The presence of agonic \"gasps\" at a frequency of 5-6\/min can be misinterpreted as ventilatory movements","correct":true},{"idx":1,"proposition":"Taking the pulse at the carotid level is the most reliable method to confirm the absence of circulation","correct":false,"justification":"Taking the pulse (at the carotid level or any other site) is an unreliable method to confirm the absence of circulation, even for healthcare professionals, and is therefore no longer recommended for diagnosing CA."},{"idx":2,"proposition":"There is no specific recommendation on the content or form of the alert to be given to the emergency services","correct":true},{"idx":3,"proposition":"In adults, the origin of CA is most often cardiac","correct":true},{"idx":4,"proposition":"The recommended optimal technique for chest compressions requires a frequency of at least 180\/min","correct":false,"justification":"The recommended optimal technique for chest compressions requires a frequency of at least 100\/min, with an amplitude of compressions of at least 5 cm in adults (not exceeding 6 cm), or at least one third of the anteroposterior diameter of the chest in infants and children"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ACR-urg-2","context":null,"enonce":"Which propositions are true?","item":"ACR","matiere":"urg","propositions":[{"idx":0,"proposition":"The number of chest compressions per minute during CPR is an important determinant of return to spontaneous circulatory activity (RACS) and survival without sequelae","correct":true},{"idx":1,"proposition":"Total chest relaxation after each compression must be ensured with an equal time between compression and relaxation","correct":true},{"idx":2,"proposition":"CPR plus mechanical ventilation is much more effective than CPR with chest compressions alone in the first 5 minutes","correct":false,"justification":"CPR by chest compressions alone is as eective as CPR plus artificial ventilation in the first minutes after the onset of non-traumatic and non-asphyxia CA in adults"},{"idx":3,"proposition":"Numerous and serious cases of transmission of viral diseases such as HIV have been reported during artificial ventilation, which requires the use of protective devices.","correct":false,"justification":"Very few cases have been reported. The use of simple protective devices can reduce the transmission of diseases, but in practice it is only recommended if the victim is known to be carrying a serious infection."},{"idx":4,"proposition":"VF is the most common etiology among non-traumatic CA etiologies","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ACR-urg-3","context":null,"enonce":"For CPR and specialized pulmonary CPR:","item":"ACR","matiere":"urg","propositions":[{"idx":0,"proposition":"CPR takes priority over defibrillation","correct":false,"justification":"Priority to defibrillation over CPR is confirmed"},{"idx":1,"proposition":"In hospitals, oxygen should be given as early as possible during CPR","correct":true},{"idx":2,"proposition":"Tracheal intubation is the gold standard technique for airway control","correct":true},{"idx":3,"proposition":"Pulmonary resuscitation is useless in hospital since a defibrillator is always present","correct":false,"justification":"You have to control the airway in less than 10 seconds"},{"idx":4,"proposition":"Once tracheal intubation is performed, chest compressions are continued continuously at a frequency of 100\/minute, regardless of insuations which are performed at a frequency of 10\/minute","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ACR-urg-4","context":null,"enonce":"Regarding specialized cardiovascular resuscitation:","item":"ACR","matiere":"urg","propositions":[{"idx":0,"proposition":"Sternal punching should no longer be used to treat out-of-hospital KT","correct":true},{"idx":1,"proposition":"Sternal punching may be considered in a patient with atrial CA fibrillation","correct":false,"justification":"It may be considered in a patient with unstable ventricular tachycardia (TV) (including pulseless TV), occurring under the supervision of a specialized first aider, only if a defibrillator cannot be used immediately"},{"idx":2,"proposition":"Standard CPR allows coronary and cerebral perfusion equal to 100% of its physiological value","correct":false,"justification":"At best, standard CPR allows coronary and cerebral perfusion equal to 30% of its physiological value"},{"idx":3,"proposition":"The small-axis parasternal window is the one recommended in ETT to identify a reversible cause of CA","correct":false,"justification":"However, the performance of an ETT should not result in a prolonged interruption of the CPR, and the subcostal window, which seems to best meet this requirement, is the one recommended."},{"idx":4,"proposition":"The recommended position for the electrodes is anterolateral, with a subclavicular electrode","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ACR-urg-5","context":null,"enonce":"Which of the following proposals are shockable rhythms?","item":"ACR","matiere":"urg","propositions":[{"idx":0,"proposition":"Asystole","correct":false,"justification":"False"},{"idx":1,"proposition":"Electromechanical dissociation","correct":false,"justification":"False"},{"idx":2,"proposition":"Ventricular fibrillation","correct":true},{"idx":3,"proposition":"Torsade de pointe","correct":true},{"idx":4,"proposition":"Ventricular tachycardia without pulse","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"ACR-urg-6","context":null,"enonce":"Which of the following proposals are shockable rhythms?","item":"ACR","matiere":"urg","propositions":[{"idx":0,"proposition":"Asystole","correct":false,"justification":"False"},{"idx":1,"proposition":"Electromechanical dissociation","correct":false,"justification":"False"},{"idx":2,"proposition":"Ventricular fibrillation","correct":true},{"idx":3,"proposition":"Torsade de pointe","correct":true},{"idx":4,"proposition":"Ventricular tachycardia without pulse","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"soinspal2-soinspal-0","context":null,"enonce":"Which of the following propositions are true about the person of trust?","item":"soinspal2","matiere":"soinspal","propositions":[{"idx":0,"proposition":"It is necessarily part of the family","correct":false,"justification":"Anyone around you can take on this role."},{"idx":1,"proposition":"It has veto power over medical decisions","correct":false,"justification":"His role is to be consulted by the medical team if the patient is no longer able to clearly express his will"},{"idx":2,"proposition":"Its designation is not mandatory","correct":true},{"idx":3,"proposition":"It is consulted when the patient is no longer able to clearly express his will","correct":true},{"idx":4,"proposition":"None of these propositions are true","correct":false,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"soinspal2-soinspal-1","context":null,"enonce":"Which of the following are true?","item":"soinspal2","matiere":"soinspal","propositions":[{"idx":0,"proposition":"Palliative care is multidisciplinary","correct":true},{"idx":1,"proposition":"Palliative care is only for the sick patient","correct":false,"justification":"To the patient and all loved ones who need it"},{"idx":2,"proposition":"Palliative care is mandatory for patients at the end of life","correct":false,"justification":"They are proposed according to the context"},{"idx":3,"proposition":"Palliative care is contraindicated in children","correct":false,"justification":"No age-related contraindications"},{"idx":4,"proposition":"Palliative care can only be introduced with the patient's consent when possible","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemorroides-HGE-1","context":null,"enonce":"Regarding hemorrhoidal disease","item":"hemorroides","matiere":"HGE","propositions":[{"idx":0,"proposition":"Thus, the presence of bleeding during defecation is an alarm sign requiring a colorectal screening exploration","correct":true},{"idx":1,"proposition":"The treatment of hemorrhoidial thrombosis is based on the simple incision or excision of the thrombosed area that immediately relieves the patient when the patient is seen in the rapid aftermath of the constitution of the thrombosis","correct":true},{"idx":2,"proposition":"Hemorrhoid hemorrhages result in the emission of gleaming red blood in the immediate course of a defecatory episode usually mixed with the materials","correct":false,"justification":"Hemorrhoid hemorrhages They result in the emission of gleaming red blood in the immediate course of a defecatory episode usually not mixed with the materials"},{"idx":3,"proposition":"The presence of a permanent perianal swelling may be sequelale (marisque) but must evoke a benign associated condition (fistula, abscess) cancer","correct":true},{"idx":4,"proposition":"A manually reducible externalized procidence represents grade 3 hemorrhoids","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemorroides-HGE-2","context":null,"enonce":"Regarding hemorrhoidal disease","item":"hemorroides","matiere":"HGE","propositions":[{"idx":0,"proposition":"The diagnosis of hemorrhoidal disease is based solely on the data of the interrogation and clinical examination","correct":true},{"idx":1,"proposition":"In case of isolated bleeding, the hemorrhoidal origin can be affirmed after ensuring that there is no other colo-rectal cause for the described bleeding (colonic endoscopy)","correct":true},{"idx":2,"proposition":"Drug treatment relies on antibiotics, transit retarders and local topicals","correct":false,"justification":"Drug treatment is based on hygiene-dietary rules, control of transit disorders and local topicals"},{"idx":3,"proposition":"Endoscopic techniques are reserved for patients suffering regularly from procidence or bleeding related to medium-sized hemorrhoids","correct":true},{"idx":4,"proposition":"The instrumental method that seems to offer the best benefit\/risk ratio today is the elastic ligation.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemorroides-HGE-3","context":null,"enonce":"Regarding hemorrhoidal disease","item":"hemorroides","matiere":"HGE","propositions":[{"idx":0,"proposition":"Traditional surgical treatment of hemorrhoidal disease is based on excision and\/or pedicle resection of vascular tissue and support of hemorrhoidal plexuses","correct":true},{"idx":1,"proposition":"Surgical treatment is usually offered after instrumental treatments have failed or because the anatomical disease is too severe.","correct":true},{"idx":2,"proposition":"Anoscopy should be done in all patients with hemorrhoidal symptomatology","correct":true},{"idx":3,"proposition":"The hemorrhoidal symptomatology remains very specific","correct":false},{"idx":4,"proposition":"The patient should be informed of the deleterious effects of long-term surgery as continence disorders.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemorroides-HGE-4","context":null,"enonce":"Which of the following are true about hemorrhoids?","item":"hemorroides","matiere":"HGE","propositions":[{"idx":0,"proposition":"Treatment concerns only symptomatic forms","correct":true,"justification":"Non-symptomatic hemorrhoids are not treated +++"},{"idx":1,"proposition":"Treatment is based on surgery","correct":false,"justification":"Hygyieno-dietary rules and endoscopic gestures (elastic ligation, photocoagulations, etc.). Surgery is really a last resort"},{"idx":2,"proposition":"An anoscopy should be done in any patient with hemorrhoidal symptomatology","correct":true,"justification":"And it's not very pleasant"},{"idx":3,"proposition":"The risk of recurrence after surgery is zero","correct":false},{"idx":4,"proposition":"Surgery can induce continence disorders","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"cephalee-neuro-1","context":null,"enonce":"Regarding headaches and neuralgia:","item":"cephalee","matiere":"neuro","propositions":[{"idx":0,"proposition":"Headaches perceived by the patient as recent and unusual (\"acute\") are by definition essential headaches","correct":false,"justification":"These are secondary headaches until proven otherwise and require emergency examinations"},{"idx":1,"proposition":"Headaches recognized by the patient as old and usual (\"chronic\") are usually primary headaches and are managed without urgency.","correct":true},{"idx":2,"proposition":"Headaches can never be permanent","correct":false,"justification":"They can be paroxysmal (seizures) or permanent"},{"idx":3,"proposition":"Any recent change in an old and usual headache leads to suspicion of a secondary headache","correct":true},{"idx":4,"proposition":"Meningeal syndrome and intracranial hypertension syndrome are life-threatening emergencies","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"cephalee-neuro-2","context":null,"enonce":"Concerning additional examinations of headaches and neuralgia:","item":"cephalee","matiere":"neuro","propositions":[{"idx":0,"proposition":"Any recent and unusual headache should be considered secondary until proven otherwise.","correct":true},{"idx":1,"proposition":"In front of a first episode, the key examinations are brain imaging (CT and\/or MRI), cerebral and\/or cervical angiography (CT angiography, MRI-angiography) and lumbar puncture","correct":true},{"idx":2,"proposition":"In front of a first episode, the brain scan without injection looks for spontaneous hyperdensity (presence of blood)","correct":true},{"idx":3,"proposition":"Sections on the sinuses look for ethmoiditis","correct":true,"justification":"Ethmoiditis is technically sinusitis (but not the most common)"},{"idx":4,"proposition":"A CT scan without normal injection eliminates a cause of injury","correct":false,"justification":"A CT scan without normal injection does not rule out a lesional cause: CT scan is normal in 7% of subarachnoid hemorrhages after 24 hours, 30% of cerebral venous thrombosis, in almost all cervical artery dissections at the stage of local signs and in almost all meningitis"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"cephalee-neuro-3","context":null,"enonce":"Concerning additional examinations of headaches and neuralgia:","item":"cephalee","matiere":"neuro","propositions":[{"idx":0,"proposition":"Brain MRI is more sensitive than CT scan for all parenchymal or pituitary lesions","correct":true},{"idx":1,"proposition":"T2 FLAIR coronal cervical MRI sections are needed to look for arterial dissection","correct":false,"justification":"Axial cervical MRI (T1 FAT-SAT) sections are needed to look for arterial dissection"},{"idx":2,"proposition":"MRI is the most common examination in emergencies","correct":false,"justification":"MRI often remains unavailable in emergency"},{"idx":3,"proposition":"The lumbar puncture does not highlight a hemorrhage","correct":false,"justification":"The lumbar puncture makes it possible to highlight a subarachnoid hemorrhage not visible in imaging (xantochromia) (but also meningitis and to measure the pressure of the cerebrospinal fluid (CSF) in search of intracranial hypertension)"},{"idx":4,"proposition":"PL is to be performed as a first-line treatment in case of suspected meningitis, after eliminating contraindications","correct":true,"justification":"Contraindications include suspicion of commitment or intracranial hypertension, too much blood fluidity"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"cephalee-neuro-4","context":null,"enonce":"Concerning additional examinations of headaches and neuralgia:","item":"cephalee","matiere":"neuro","propositions":[{"idx":0,"proposition":"There are no contraindications to PL in case of emergency","correct":false,"justification":"Contraindications include local infection at the puncture site, severe hemostasis disorder, signs of intracranial hypertension with threat of engagement pointing to a lesion with mass effect. Imaging is therefore necessary when the lumbar puncture is performed for isolated headaches"},{"idx":1,"proposition":"In case of PL, the use of an atraumatic needle of the smallest possible caliber (25 G) minimizes the risk of headache by dural breach","correct":true},{"idx":2,"proposition":"An inflammatory syndrome can evoke Horton's disease or an infectious syndrome","correct":true},{"idx":3,"proposition":"Ophthalmological examination looks for bilateral papillary edema that is indicative of type 2 diabetes","correct":false,"justification":"Bilateral papillary edema = intracranial hypertension"},{"idx":4,"proposition":"Any sudden headache must suspect a vascular cause and in the first place a serious epistaxis","correct":false,"justification":"Suspect subarachnoid hemorrhage in the first place"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"cephalee-neuro-5","context":null,"enonce":"Regarding chronic headaches:","item":"cephalee","matiere":"neuro","propositions":[{"idx":0,"proposition":"Tension headaches can last from 30 minutes to 7 days","correct":true},{"idx":1,"proposition":"Cluster headaches can last between 3 and 14 days","correct":false,"justification":"Duration of the order of the hour: between 15 and 180 minutes in general"},{"idx":2,"proposition":"A migraine usually lasts between 4 and 72 hours","correct":true},{"idx":3,"proposition":"Cluster headaches are very intense","correct":true,"justification":"They are also unilateral, periorbital, frontal or temporal."},{"idx":4,"proposition":"During a migraine, the headache is often accompanied by photo-phonophobia and nausea","correct":true,"justification":"Nausea can induce vomiting. In case of migraine with aura, we will also observe transient visual, sensory or language disorders, of progressive and successive installation, preceding or accompanying the headache"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"cephalee-neuro-6","context":null,"enonce":"Which of these proposals can result in a normal non-injected CT scan?","item":"cephalee","matiere":"neuro","propositions":[{"idx":0,"proposition":"A 6-hour cerebral infarction","correct":false,"justification":"Cerebral infarctions appear on CT scan after 3 hours"},{"idx":1,"proposition":"Pituitary necrosis","correct":true},{"idx":2,"proposition":"Temporal arteritis","correct":true},{"idx":3,"proposition":"Acute sphenoidal sinusitis","correct":false,"justification":"It is seen on a scanner without injection"},{"idx":4,"proposition":"Hypertensive encephalopathies","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"cephalee-neuro-7","context":null,"enonce":"Which of these proposals are visible on the non-injected scanner?","item":"cephalee","matiere":"neuro","propositions":[{"idx":0,"proposition":"Intracranial hemorrhage","correct":true,"justification":"Hyperdensity"},{"idx":1,"proposition":"An ischemic stroke dating back 2 hours","correct":false,"justification":"Brain infarctions give signs on CT scan after 3 hours"},{"idx":2,"proposition":"Cerebral venous thrombosis","correct":false},{"idx":3,"proposition":"Acute sinusitis","correct":true,"justification":"Especially sphenoidal sinusitis"},{"idx":4,"proposition":"Dissection of the cervical arteries","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"cephalee-neuro-8","context":null,"enonce":"Which propositions are true?","item":"cephalee","matiere":"neuro","propositions":[{"idx":0,"proposition":"Any \"explosive\" headache with normal brain imaging requires a lumbar puncture to look for xanthochromia","correct":true},{"idx":1,"proposition":"An aneurysm-free SAH may correspond to reversible cerebral vasoconstriction syndrome (SVCR)","correct":true},{"idx":2,"proposition":"SAH (or subarachnoid hemorrhage) accounts for 10 to 30% of sudden headaches","correct":true},{"idx":3,"proposition":"Reversible Cerebral Vasoconstriction Syndrome (SVCR) is over-diagnosed","correct":false,"justification":"Underdiagnosed because it is a syndrome of recent description (2007)"},{"idx":4,"proposition":"SVCR accounts for 10 to 45% of \"thunderclap\" headaches","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"handicappsy-neuro-0","context":null,"enonce":"Some definitions:","item":"handicappsy","matiere":"neuro","propositions":[{"idx":0,"proposition":"The restriction of participation expresses the impact in social life","correct":true},{"idx":1,"proposition":"The concept of incapacity has given way to the notion of restriction of participation","correct":false,"justification":"Now activity restriction"},{"idx":2,"proposition":"The inability to read is a restriction of participation","correct":false,"justification":"Activity restriction"},{"idx":3,"proposition":"Loss of employment status due to impairment is a restriction of participation","correct":true},{"idx":4,"proposition":"An evaluation that is too difficult that puts the patient in check is useful to show him his limits","correct":false,"justification":"Absolutely useless and counterproductive! Evaluation must be conducted with tact and, above all, must be adapted"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"handicappsy-neuro-1","context":null,"enonce":"Which of these proposals are restrictions on participation?","item":"handicappsy","matiere":"neuro","propositions":[{"idx":0,"proposition":"The impossibility of dressing","correct":false,"justification":"Activity"},{"idx":1,"proposition":"Dependence for driving","correct":true},{"idx":2,"proposition":"Inability to drive","correct":false,"justification":"It is an activity restriction"},{"idx":3,"proposition":"Changes in family relationships","correct":true},{"idx":4,"proposition":"Loss of professional status","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"handicappsy-neuro-3","context":null,"enonce":"Regarding memory:","item":"handicappsy","matiere":"neuro","propositions":[{"idx":0,"proposition":"Declarative memory engages explicit processes","correct":true},{"idx":1,"proposition":"Episodic memory refers to facts and knowledge","correct":false,"justification":"Episodic memory referring to experiences that fit into a spatial context"},{"idx":2,"proposition":"Episodic memory is that of 'where? when? how?'","correct":true},{"idx":3,"proposition":"The memory of a birthday meal that took place with such protagonists will bring procedural memory into play","correct":false,"justification":"Episodic memory"},{"idx":4,"proposition":"Semantic memory refers to facts and knowledge","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"handicappsy-neuro-4","context":null,"enonce":"Which of these proposals are causes of mental disability?","item":"handicappsy","matiere":"neuro","propositions":[{"idx":0,"proposition":"Fragile X syndrome","correct":true},{"idx":1,"proposition":"Alzheimer 's","correct":false,"justification":"Cognitive disability (cf. College of Psychiatry page 565: mental disabilities are from birth)"},{"idx":2,"proposition":"Autism Spectrum Disorder","correct":true},{"idx":3,"proposition":"Schyzophrenia","correct":false,"justification":"Mental disability: begins in adolescence or adulthood, progressive, possible or even essential drug treatments."},{"idx":4,"proposition":"Down syndrome","correct":true,"justification":"Mental disability: early onset from birth, stable, infrequent medical care"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"handicappsy-neuro-5","context":null,"enonce":"According to the WHO, an IQ of 58 corresponds to:","item":"handicappsy","matiere":"neuro","propositions":[{"idx":0,"proposition":"A normal IQ","correct":false},{"idx":1,"proposition":"Severe mental retardation","correct":false},{"idx":2,"proposition":"Mild mental retardation","correct":true,"justification":"Mild mental retardation: between 55 and 70 IQ points"},{"idx":3,"proposition":"Moderate mental retardation","correct":false},{"idx":4,"proposition":"Severe mental retardation","correct":false,"justification":"Severe mental retardation: between 20 and 34 IQ points"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"handicappsy-neuro-7","context":null,"enonce":"The GEVA is offered by:","item":"handicappsy","matiere":"neuro","propositions":[{"idx":0,"proposition":"The ARS","correct":false,"justification":"The MDPH"},{"idx":1,"proposition":"The MDPH","correct":true},{"idx":2,"proposition":"The CHU","correct":false},{"idx":3,"proposition":"CMPs","correct":false},{"idx":4,"proposition":"Les SMASAH","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"LM-onco-0","context":null,"enonce":"From which cell does Reed Stenberg's cell derive?","item":"LM","matiere":"onco","propositions":[{"idx":0,"proposition":"Lymphocyte B","correct":true},{"idx":1,"proposition":"T cell","correct":false},{"idx":2,"proposition":"Lymphocyte NK","correct":false},{"idx":3,"proposition":"Monocyte","correct":false},{"idx":4,"proposition":"Platelet","correct":false,"justification":"Let's remember that a platelet is not a cell. It is a fragment of the Megakaryocyte"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"LM-onco-1","context":null,"enonce":"A lymph node biopsy in a 26-year-old woman, with no history, who has supradiaphragmatic lymphadenopathy, shows a lymph node architecture modified by broad bands of fibrosis delimiting cell nodules. Binucleolate giant cells of CD20-, CD30+, CD15+ phenotype are identified. \r\n\r\nWhich of the following are true?","item":"LM","matiere":"onco","propositions":[{"idx":0,"proposition":"This description is in favor of the diagnosis of diffuse large cell malignant B-cell lymphoma","correct":false,"justification":"Hodgkin lymphoma (phenotype corresponds to Hodgkin cells and binucleolate giant cells correspond to Reed-Sternberg cells)"},{"idx":1,"proposition":"CD20- phenotype supports T-cell lymphoma ","correct":false,"justification":"CD20- = lymphocyte B"},{"idx":2,"proposition":"Binucleolate giant cells correspond to Sternberg cells","correct":true},{"idx":3,"proposition":"This description is typical of Hodgkin lymphoma of the \"mixed cellularity\" subtype.","correct":false,"justification":"Scleronodular (because clears the lymph node architecture and has wide bands of fibrosis)"},{"idx":4,"proposition":"EBV virus expression can be found in 20% of cases","correct":true,"justification":"True. Caused by EBV in 20% of cases"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LM-onco-2","context":null,"enonce":"A PET-CT scan regains intense hyperfixation of right jugulo-carotid lymphadenopathy and an anterior mediastinal mass, without other hypermetabolism.\r\n\r\nWhich of the following is Ann Arbor Stadium?","item":"LM","matiere":"onco","propositions":[{"idx":0,"proposition":"I","correct":false,"justification":"We have more than one area"},{"idx":1,"proposition":"II","correct":true,"justification":"True, 2 lymph node areas affected on the same side of the diaphragm"},{"idx":2,"proposition":"III","correct":false,"justification":"Only one side of the affected diaphragm"},{"idx":3,"proposition":"IV","correct":false,"justification":"Remote SAR"},{"idx":4,"proposition":"Impossible to conclude","correct":false,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LM-onco-4","context":null,"enonce":"Which of the following are characteristics of the Hodgkin cell?","item":"LM","matiere":"onco","propositions":[{"idx":0,"proposition":"CD20+","correct":false,"justification":"CD20-, these are not B lymphocytes"},{"idx":1,"proposition":"CD20-","correct":true},{"idx":2,"proposition":"CD30+","correct":true},{"idx":3,"proposition":"CD15-","correct":false,"justification":"CD15+"},{"idx":4,"proposition":"CD15+","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"MM-onco-0","context":null,"enonce":"Regarding renal damage:","item":"MM","matiere":"onco","propositions":[{"idx":0,"proposition":"Renal failure is found in about 50% of symptomatic cases","correct":true},{"idx":1,"proposition":"There is a decrease in endogenous EPO","correct":true},{"idx":2,"proposition":"Anemia is inflammatory","correct":false,"justification":"It is due to a decrease in EPO"},{"idx":3,"proposition":"Fanconi syndrome is a distal tubulopathy","correct":false,"justification":"Fanconi syndrome is proximal tubulopathy"},{"idx":4,"proposition":"NCM is the most common condition","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"amenorrhee-gyn-1","context":null,"enonce":"General and definitions:","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"proposition":"A woman may have ovulatory cycles without periods","correct":true,"justification":"For example in case of absence of uterus"},{"idx":1,"proposition":"The presence of menstruation affirms the presence of ovulatory cycles","correct":false,"justification":"It is possible to have anovulatory cycles with menstruation"},{"idx":2,"proposition":"The only physiological circumstance of amenorrhea is menopause","correct":false,"justification":"Also: pregnancy and lactation"},{"idx":3,"proposition":"Primary amenorrhea is defined as the absence of menarche at age 12","correct":false,"justification":"Defined at 16 years"},{"idx":4,"proposition":"Secondary amenorrhea is defined by stopping menstruation for more than 3 months without previous irregularities","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"amenorrhee-gyn-2","context":null,"enonce":"Among these proposals, which are signs of accompaniment of primary amenorrhea that must be specified during questioning?","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"proposition":"Irritability","correct":false,"justification":"Not a recognized sign"},{"idx":1,"proposition":"Anosmia","correct":true},{"idx":2,"proposition":"Headache","correct":true},{"idx":3,"proposition":"Fatigue","correct":false,"justification":"Not an interesting sign in this context, although it can orient in specific cases"},{"idx":4,"proposition":"Visual disturbances","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"amenorrhee-gyn-3","context":null,"enonce":"Regarding the interrogation in case of primary amenorrhea:","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"proposition":"Infectious pathologies such as meningitis are to be specified during questioning","correct":true,"justification":"Meningitis, tuberculosis, etc."},{"idx":1,"proposition":"A history of appendicitis is important to specify","correct":true,"justification":"Especially so complicated"},{"idx":2,"proposition":"Inguinal hernia cures are not relevant given their location in the iliac fossa","correct":false,"justification":"Very important because can affect the ovaries"},{"idx":3,"proposition":"Corticosteroid therapy can cause primary amenorrhea","correct":true,"justification":"As well as chemotherapy or radiotherapy"},{"idx":4,"proposition":"The interrogation must go back to the circumstances of pregnancy and childbirth","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"amenorrhee-gyn-4","context":null,"enonce":"Regarding the gynecological examination:","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"proposition":"Gynecological examination is performed with empty bladder","correct":true},{"idx":1,"proposition":"Inspection of the vulva makes it possible to specify the degree of hair","correct":true,"justification":"As well as the appearance of the labia, the size of the clitoris, etc."},{"idx":2,"proposition":"The appearance of the labia minora and labia majora does not matter","correct":false,"justification":"It is inspected and provides interesting information"},{"idx":3,"proposition":"The classification of pubertal stages is Turner's","correct":false,"justification":"Tanner Stadiums"},{"idx":4,"proposition":"Speculum examination can detect the presence of the uterine tubes","correct":false,"justification":"Vagina + Cervix"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"amenorrhee-gyn-5","context":null,"enonce":"Among these proposals, which are signs of hyperandrogenism?","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"proposition":"Clitoral hypertrophy","correct":true},{"idx":1,"proposition":"The absence of a vagina","correct":false,"justification":"No direct report"},{"idx":2,"proposition":"Cervical mucus very present","correct":false,"justification":"Sign of estrogenic impregnation"},{"idx":3,"proposition":"Losangic pubic hair","correct":true,"justification":"Especially if it goes down on the thighs"},{"idx":4,"proposition":"Hypertrophy of the vaginal mucosa","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"amenorrhee-gyn-7","context":null,"enonce":"Regarding supplementary examinations:","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"proposition":"The first test to order in case of secondary amenorrhea is the LH\/FSH to rule out pituitary adenoma","correct":false,"justification":"This is the plasma assay of βHCG in order to eliminate a pregnancy"},{"idx":1,"proposition":"The objective of the first examinations is to find the exact cause of amenorrhea","correct":false,"justification":"The first objective is to specify the level of amenorrhea, not its exact pathophysiology"},{"idx":2,"proposition":"Menothermic corube is required in all women","correct":false,"justification":"It is performed if secondary sexual characteristics are developed"},{"idx":3,"proposition":"The menothermic curve must be carried out over 1 month","correct":false,"justification":"2 months minimum"},{"idx":4,"proposition":"Ovulation occurs at the highest point of the temperature curve","correct":false,"justification":"Ovulation occurs at the lowest point of the menothermic curve before the temperature rises (thermal shift of about 0.5 °C)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"amenorrhee-gyn-8","context":null,"enonce":"Regarding hormonal dosages:","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"proposition":"Radiography of the hand helps define bone age","correct":true,"justification":"It is prescribed in case of impubertism + primary amenorrhea"},{"idx":1,"proposition":"Sesamoid of the thumb appears for a bone age of 16 years","correct":false,"justification":"For a bone age of 13 years"},{"idx":2,"proposition":"Central involvement in low FSH","correct":true},{"idx":3,"proposition":"The involvement is ovarian in case of low FSH and high LH","correct":false,"justification":"The involvement is ovarian in case of elevated FSH"},{"idx":4,"proposition":"After checking the integrity of the genitals, the progestin test is offered as a first-line","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"amenorrhee-gyn-9","context":null,"enonce":"Regarding amenorrhea:","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"proposition":"Secondary amenorrhea is much more common than primary amenorrhea","correct":true,"justification":"Especially because of pregnancy"},{"idx":1,"proposition":"The first cause of primary amenorrhea is the impermeable hymen","correct":false,"justification":"It's the simple delay of periods"},{"idx":2,"proposition":"In front of a primary amenorrhea, the first examinations are the assay of FSH and prolactin, in particular","correct":true,"justification":"As well as hand X-ray and pelvic ultrasound"},{"idx":3,"proposition":"In case of secondary amenorrhea, a progestogen test is performed as a first-line","correct":false,"justification":"ATTENTION, we first eliminate a pregnancy"},{"idx":4,"proposition":"Turner syndrome is an important etiology of primary amenorrhea without secondary sex characteristics","correct":true,"justification":"As well as simple pubertal delay"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SPSC-sp-0","context":null,"enonce":"Regarding psychiatric care without consent:","item":"SPSC","matiere":"sp","propositions":[{"idx":0,"proposition":"Free care must remain the rule","correct":true,"justification":"And care without consent, the exception"},{"idx":1,"proposition":"There are two distinct constraint procedures","correct":true,"justification":"By decision of the Prefect or at the request of a third party"},{"idx":2,"proposition":"They may be practised by decision of the Prefect.","correct":true},{"idx":3,"proposition":"They can be practiced at the request of a third party (=SDRE)","correct":false,"justification":"SDRE = decision of a state official"},{"idx":4,"proposition":"There are 5 conditions that can motivate them","correct":false,"justification":"2: mental disorders that make consent impossible and a condition requiring immediate care"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"SPSC-sp-1","context":null,"enonce":"Concerning the admission procedure under ordinary law:","item":"SPSC","matiere":"sp","propositions":[{"idx":0,"proposition":"It requires 2 documents","correct":false,"justification":"3 documents: 2 medical certificates and 1 application for admission from a third party"},{"idx":1,"proposition":"Medical certificates must be made by psychiatrists","correct":false,"justification":"Not necessarily"},{"idx":2,"proposition":"Verification of the patient's identity is carried out by the intake officer","correct":false,"justification":"By the director of the institution prior to any admission of the patient"},{"idx":3,"proposition":"Medical certificates must be less than 15 days old","correct":true},{"idx":4,"proposition":"The third party must be family","correct":false,"justification":"Or if it can justify the existence of relationships with the patient that make him act in his interest"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AM-gyn-0","context":null,"enonce":"Regarding the areola:","item":"AM","matiere":"gyn","propositions":[{"idx":0,"proposition":"The pigmented appearance of the areola is strengthened during pregnancy","correct":true},{"idx":1,"proposition":"During pregnancy, the areola loses its sensitivity to tactile stimulation","correct":false,"justification":"It is more sensitive to tactile stimulation"},{"idx":2,"proposition":"During pregnancy, the areola completely loses its thermal sensitivity","correct":false,"justification":"Davatange sensitive to thermal stimulation"},{"idx":3,"proposition":"Montgomery's glands participate in the secretion of an odorous liquid","correct":true},{"idx":4,"proposition":"The odorous liquid is a powerful olfactory landmark for the newborn","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"AM-gyn-1","context":null,"enonce":"Regarding the mammary gland:","item":"AM","matiere":"gyn","propositions":[{"idx":0,"proposition":"The areola is a cone in the center of the nipple","correct":false,"justification":"It is of course the opposite: the nipple is a small cone in the center of the areola that contains many smooth muscle fibers and at its top, many pores to release milk"},{"idx":1,"proposition":"The mammary gland is composed of two lobes on the left and three on the right","correct":false,"justification":"Let's not confuse with the lung: the mammary gland consists of about fifteen lobes on the right and left"},{"idx":2,"proposition":"Each lobe behaves like an independent gland with its own excretory duct","correct":true},{"idx":3,"proposition":"The milk ducts have a very sinuous path and open at the top of the nipple through the pores","correct":true},{"idx":4,"proposition":"More than half of the mammary gland is 3 cm from the base of the nipple","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AM-gyn-2","context":null,"enonce":"Which of these proposals are accurate?","item":"AM","matiere":"gyn","propositions":[{"idx":0,"proposition":"Prolactin has a negative lactogenic action","correct":false,"justification":"Prolactin has a positive lactogenic action!"},{"idx":1,"proposition":"Feeding causes elevated prolactin and oxytocin","correct":true},{"idx":2,"proposition":"Breast milk only has a nutritional function for the child","correct":false,"justification":"Breast milk has two main functions: nutritious and immunological"},{"idx":3,"proposition":"Its composition and quantity are constant over time but there is a small interindividual variation","correct":false,"justification":"Its composition and quantity are variable: water and trace elements, high lactose content, low casein but rich in soluble proteins (α-lactoglobulins), etc. Also, there is a modification of content from the 15th day to go towards a higher fat composition"},{"idx":4,"proposition":"The first breastfeedings are composed of 99% lactose","correct":false,"justification":"The first breastfeedings are composed of collostrum, a substance rich in IgA, glycoproteins, oligosaccharides, immune cells and low in fat"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"AM-gyn-3","context":null,"enonce":"Regarding some generalities:","item":"AM","matiere":"gyn","propositions":[{"idx":0,"proposition":"There is a change from the 15th day in transition milk increasingly rich in fat","correct":true},{"idx":1,"proposition":"Breastfeeding has little effect on immunity","correct":false,"justification":"It brings to the newborn passive immunity against certain infections"},{"idx":2,"proposition":"The composition of milk is common to all mammals and falls within the definition of these","correct":false,"justification":"Milk is a species-specific substance, each with milk of different content"},{"idx":3,"proposition":"Breast milk is translucent and relatively low in vitamin D","correct":true},{"idx":4,"proposition":"Infant formula is obtained by processing beef milk","correct":false,"justification":"Infant formula is obtained by processing cow's milk. The boeur being the male, it does not produce milk"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AM-gyn-4","context":null,"enonce":"Among these proposals, which are a contraindication to breastfeeding:","item":"AM","matiere":"gyn","propositions":[{"idx":0,"proposition":"HIV status","correct":true},{"idx":1,"proposition":"Synthetic antithyoids taken by the mother","correct":true},{"idx":2,"proposition":"Type 2 diabetes","correct":false,"justification":"Not a known contraindication"},{"idx":3,"proposition":"Active HBV infection","correct":false},{"idx":4,"proposition":"Latent tuberculosis","correct":false,"justification":"Scalable only\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AM-gyn-5","context":null,"enonce":"Regarding breastfeeding:","item":"AM","matiere":"gyn","propositions":[{"idx":0,"proposition":"Artificial breastfeeding is in every way equivalent to breastfeeding","correct":false,"justification":"Artificial breastfeeding does not have the immunoprotective function of breastfeeding because it is derived from cow's milk while the immunological elements are species-specific."},{"idx":1,"proposition":"Breastfeeding should not begin before 12 p.m. postpartum","correct":false,"justification":"It is advisable to breastfeed immediately, if possible in the labor room"},{"idx":2,"proposition":"It usually takes one feeding every 12 to 24 hours at the beginning","correct":false,"justification":"Far too long! Every 2 to 3 hours at the beginning"},{"idx":3,"proposition":"Prohibiting smoking during breastfeeding is necessary","correct":true},{"idx":4,"proposition":"The only complication of breastfeeding is engorgement","correct":false,"justification":"Congestion and congestion"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"AM-gyn-6","context":null,"enonce":"Which of the following proposals designate the advantages of growing up milk over cow's milk?","item":"AM","matiere":"gyn","propositions":[{"idx":0,"proposition":"More fatty acids","correct":true},{"idx":1,"proposition":"More vitamin D","correct":true},{"idx":2,"proposition":"More iron","correct":true},{"idx":3,"proposition":"More protein","correct":false,"justification":"Less protein"},{"idx":4,"proposition":"All propositions are true","correct":false,"justification":"Growing up milk has about half as much protein as cow's milk"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AM-gyn-7","context":null,"enonce":"Which of the following are the benefits of breastfeeding?","item":"AM","matiere":"gyn","propositions":[{"idx":0,"proposition":"decreases the risk of infection","correct":true},{"idx":1,"proposition":"decreases the risk of obesity","correct":true},{"idx":2,"proposition":"decreases the risk of atopic diseases","correct":true},{"idx":3,"proposition":"It is adapted to the nutritional needs of the newborn","correct":true,"justification":"True, up to the child's 6 months"},{"idx":4,"proposition":"It covers vitamin K needs","correct":false,"justification":"It is deficient in vitamin K. If it is exclusive, vitamin K 2mg PO should be supplemented at 1 month (after routine supplementation at birth)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossesseN-gyn-0","context":null,"enonce":"Regarding the generalities of pregnancy","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Most pregnancies are normal and can be managed by a doctor or midwife","correct":true},{"idx":1,"proposition":"For these pregnancies without a risk situation or a low level of risk (follow-up A of the HAS), the management is medical and psycho-social with a screening and prevention approach.","correct":true},{"idx":2,"proposition":"Pregnancy monitoring aims to assess the only fetal risk of developing diseases","correct":false,"justification":"Pregnancy monitoring aims throughout pregnancy to assess fetal and maternal risk in order to prevent, screen, diagnose and manage by specialized teams abnormal situations detected"},{"idx":3,"proposition":"Pregnancy monitoring is the responsibility of a medical gynecologist","correct":false,"justification":"Pregnancy monitoring is a team effort that combines: medical and psycho-social problems"},{"idx":4,"proposition":"Pregnancy monitoring requires the collaboration of all specialists involved","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"grossesseN-gyn-1","context":null,"enonce":"Regarding pregnancy monitoring and the choice of maternity:","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Pregnancy monitoring can call on the services of PMI (maternal and child protection), CAF, psychologists, dieticians, etc.","correct":true},{"idx":1,"proposition":"Pregnancy monitoring includes 9 consultations per pregnancy covered 100% by the Health Insurance","correct":false},{"idx":2,"proposition":"There are two consultations per month between the 5th and 7th month normally scheduled","correct":true},{"idx":3,"proposition":"From the 7th month, it is preferable that it is the team that will ensure the birth that does the surveillance","correct":true},{"idx":4,"proposition":"Expectant parents always turn to the maternity wards of their choice","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossesseN-gyn-2","context":null,"enonce":"Regarding maternity wards in France:","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Level I maternity wards account for 80% of maternity wards","correct":false,"justification":"The three types of maternity are: • Level I maternity wards (49% of maternity wards): − management of low-risk pregnancies"},{"idx":1,"proposition":"Level 1 maternity wards have neonatal units with fewer than 6 beds","correct":false},{"idx":2,"proposition":"Level II maternity wards are intended for high-risk deliveries","correct":true},{"idx":3,"proposition":"Level 2a maternity wards have a neonatal intensive care unit","correct":false,"justification":"these maternity wards have: − a neonatal unit (level II a) (23%)"},{"idx":4,"proposition":"49% of maternity hospitals in France have a neonatal intensive care unit","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossesseN-gyn-3","context":null,"enonce":"Which of these proposals refer to the objectives of the first pregnancy consultation?","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Making the diagnosis of pregnancy exclusively clinically","correct":false,"justification":"Clinically + Biologically"},{"idx":1,"proposition":"Determine clinical term via ultrasound only","correct":false,"justification":"Clinic + Ultrasound"},{"idx":2,"proposition":"Talking about screening for trismia risk 13","correct":false,"justification":"Down syndrome"},{"idx":3,"proposition":"Inform about early prenatal maintenance","correct":true},{"idx":4,"proposition":"Legally declaring pregnancy","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"grossesseN-gyn-5","context":null,"enonce":"Regarding the beginning of pregnancy:","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"23% of maternity hospitals in France are level 3","correct":false},{"idx":1,"proposition":"Level 3 maternity wards have a neonatal resuscitation unit within a CH with an adult resuscitation unit","correct":true},{"idx":2,"proposition":"The first consultation of the pregnancy follow-up must take place in the first month of pregnancy","correct":false,"justification":"The first consultation of the pregnancy follow-up takes place before 3 months of pregnancy (the HAS in its recommendations of 2007 proposes two consultations in the 1st trimester one to 10 SA and one before 15 SA), the Health Insurance reimburses one at 100%"},{"idx":3,"proposition":"The diagnosis of pregnancy is based on the clinic and complementary examinations most often","correct":true},{"idx":4,"proposition":"The vaginal touch shows the increase in volume of the uterus which thickens from front to back giving a spherical shape","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossesseN-gyn-6","context":null,"enonce":"Which of these additional tests can be used to diagnose pregnancy?","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"The urine pregnancy test","correct":true},{"idx":1,"proposition":"Ultrasound of the ovaries","correct":false,"justification":"Ultrasound of the uterus. Pregnancy is then visible only from 5 SA and cardiac activity from 5.5 SA on vaginal ultrasound"},{"idx":2,"proposition":"Qualitative bHCG determination","correct":true},{"idx":3,"proposition":"Determination of quantitative bHCG","correct":true},{"idx":4,"proposition":"Vaginal ultrasound","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossesseN-gyn-7","context":null,"enonce":"Regarding the duration of a normal pregnancy:","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Uterine 'softening' begins at week 24","correct":false,"justification":"Uterine softening begins at week 8"},{"idx":1,"proposition":"Fetal heart sounds can be heard by the fetal Doppler apparatus at the end of the 1st month","correct":false,"justification":"Fetal heart sounds (BDC) can be heard with the fetal Doppler machine at the end of the 3rd month (sound signal heard at the 10th SA, sometimes as early as the 9th)"},{"idx":2,"proposition":"The duration of pregnancy varies between 280 and 290 days","correct":true},{"idx":3,"proposition":"The duration of pregnancy varies between 40SA and 41.3SA","correct":true},{"idx":4,"proposition":"The average length of pregnancy is 284 days","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossesseN-gyn-8","context":null,"enonce":"Among these proposals, which designate a cranio-caudal length in the standards:","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"11 13.6 SA: between 45 and 84 mm","correct":true},{"idx":1,"proposition":"12 SA: 56 cm","correct":false,"justification":"56 mm"},{"idx":2,"proposition":"14 SA: 105 mm","correct":false,"justification":"85 mm"},{"idx":3,"proposition":"11 SA: 25 mm","correct":false,"justification":"45 mm"},{"idx":4,"proposition":"13 SA: 72 mm","correct":true,"justification":"11SA = 45 mm, 12SA: 56 mm, 13SA = 72 mm, 14SA = 85 mm\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"grossesseN-gyn-9","context":null,"enonce":"Among these proposals, which designate tests not recommended in patients during pregnancy?","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Determination of bHCG","correct":false,"justification":"Useful for determining pregnancy"},{"idx":1,"proposition":"Lipid profile","correct":true},{"idx":2,"proposition":"Measurement of SVR","correct":true},{"idx":3,"proposition":"Determination of IARs","correct":false,"justification":"Essential to do them"},{"idx":4,"proposition":"Determination of alkaline phosphatases","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"grossesseN-gyn-10","context":null,"enonce":"Concerning the course of a non-pathological pregnancy","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"For a woman who has a regular 28-day cycle and a last menstrual period on January 1, the beginning of pregnancy is January 14 and the expected term is August 14.","correct":false,"justification":"For a woman who has a regular 28-day cycle and a last period on January 1, the beginning of pregnancy is January 14 and the term is October 14."},{"idx":1,"proposition":"In case of IVF, the date of onset of pregnancy is defined by the date of puncture","correct":true},{"idx":2,"proposition":"In case of IVF, the date of pregnancy is the date on which the sounds of the heart are observed with Doppler, minus 3 months","correct":false,"justification":"In case of IVF, the date of onset of pregnancy is defined by the date of puncture (professional agreement)"},{"idx":3,"proposition":"Ultrasound dating is based on the antero-posterior length of the fetus","correct":false,"justification":"To reduce the risk of prolonged pregnancy, the CNGOF in its 2011 CPR recommends ultrasound dating of early pregnancy using ultrasound measurement of craniocaudal length, which ideally should be done between 11 and 13.6 SA (CCL between 45–84 mm): • CCL at 11 SA = 45 mm"},{"idx":4,"proposition":"Interrogation alone will define the mode of obstetric monitoring","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossesseN-gyn-12","context":null,"enonce":"Which of these proposals are oligatory biological examinations during normal pregnancy?","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"A double determination of blood group","correct":true},{"idx":1,"proposition":"A serology of rubella","correct":true},{"idx":2,"proposition":"A serology of systematic toxoplasmosis","correct":false,"justification":"Not if there are written results that allow immunity to be considered acquired"},{"idx":3,"proposition":"Albuminuria","correct":true},{"idx":4,"proposition":"Glycosuria","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"grossesseN-gyn-13","context":null,"enonce":"Regarding the follow-up of type B pregnancy","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Type B follow-up is the least at risk","correct":false},{"idx":1,"proposition":"In type B follow-up, regular follow-up can be done by an authorized midwife","correct":false,"justification":"Regular follow-up should be provided by an obstetrician gynecologist"},{"idx":2,"proposition":"If the patient does not have a complete blood group card, a double determination is mandatory","correct":true},{"idx":3,"proposition":"Screening for syphilis TPHA-VDRL is mandatory in all cases","correct":true},{"idx":4,"proposition":"Rubella serology is mandatory in all cases","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossesseN-gyn-14","context":null,"enonce":"Concerning the follow-up of non-pathological pregnancy","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Irregular antibody testing (IAR) is mandatory in all cases","correct":true},{"idx":1,"proposition":"The search for antibodies A and B is mandatory","correct":false,"justification":"excluding antibodies to A and B antigens"},{"idx":2,"proposition":"Toxoplasma serology is repeated every month from the 2nd prenatal examination in all cases","correct":false,"justification":"Toxoplasma serology is repeated monthly from the 2nd prenatal examination if immunity is not acquired"},{"idx":3,"proposition":"The search for albuminuria is to be done at the 3rd and 6th month only","correct":false,"justification":"The search for albuminuria is to be done every month during pregnancy"},{"idx":4,"proposition":"Obstetric ultrasound is a mandatory examination","correct":false,"justification":"Obstetrical ultrasound is not a mandatory examination but it is necessary for a good obstetrical follow-up"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"reeducation-mpr-0","context":null,"enonce":"From the following proposals, check the exact answer(s):","item":"reeducation","matiere":"mpr","propositions":[{"idx":0,"proposition":"The responsibility for whether or not to prescribe a rehabilitation program rests with the physician","correct":true},{"idx":1,"proposition":"The realization of rehabilitation is a prerequisite for the establishment of a","correct":true,"justification":"Cf College of MPR"},{"idx":2,"proposition":"The legislation distinguishes 84 rehabilitation professions","correct":false,"justification":"Seven: masseurskinesitherapists, occupational therapists, speech therapists, psychomotor therapists, orthoptists, pedicures-podiatrists and dieticians"},{"idx":3,"proposition":"There are 13 different rehabilitation programs that are chosen for each patient according to their situation","correct":false,"justification":"The rehabilitation program is adapted and personalized for each patient"},{"idx":4,"proposition":"A rehabilitation programme must be followed by the evaluation of results; involving the doctor and paramedics","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"reeducation-mpr-1","context":null,"enonce":"From the following proposals, check the exact answer(s):","item":"reeducation","matiere":"mpr","propositions":[{"idx":0,"proposition":"Simple rehabilitation programs involve the collaboration of the doctor regardless of his specialty and a medical assistant, physiotherapist or speech therapist mainly","correct":true,"justification":"Cf College of MPR"},{"idx":1,"proposition":"Complex rehabilitation programs require the collaboration of MPR and several rehabilitation auxiliaries","correct":true,"justification":"Cf College of MPR"},{"idx":2,"proposition":"Treatment of urinary incontinence in women requires complex rehabilitation","correct":false,"justification":"1st line treatment of UI in women: rehabilitation and treatment of contributing factors"},{"idx":3,"proposition":"Healing is the goal of rehabilitation","correct":false,"justification":"The overall goals of rehabilitation can be anatomical or functional recovery, maintenance or compensation for a disability."},{"idx":4,"proposition":"Edema and trophic disorders are indications for massage physiotherapy","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"hyperCa-nephro-0","context":null,"enonce":"Regarding hypercalcemia","item":"hyperCa","matiere":"nephro","propositions":[{"idx":0,"proposition":"It is necessary to distinguish true hypercalcemia, with elevation of ionized calcium from false hypercalcemia by increase in the protein-bound fraction","correct":true},{"idx":1,"proposition":"Hyperalbuminemia, by severe dehydration for example, leads to an increase in total calcium, but without an increase in ionized calcium","correct":true},{"idx":2,"proposition":"The assessment of hypercalcemia must therefore include an ionized calcium assay or an albuminemia assay","correct":true},{"idx":3,"proposition":"Severe or rapid onset hypercalcemia is accompanied by general signs, digestive disorders and often confusing neuropsychic manifestations","correct":true},{"idx":4,"proposition":"Signs of hypercalcemia are very specific ","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"hyperCa-nephro-1","context":null,"enonce":"Regarding hypercalcemia","item":"hyperCa","matiere":"nephro","propositions":[{"idx":0,"proposition":"Neuro-psychic signs are common (memory problems, depression or anxiety)","correct":true},{"idx":1,"proposition":"Digestive disorders (anorexia, nausea and vomiting) are common when serum calcium is > 2 mmol \/ L","correct":false,"justification":"Digestive disorders Anorexia, nausea and vomiting are common when serum calcium is > 3 mmol\/L"},{"idx":2,"proposition":"Hypercalcemia leads to a decrease in QT space and rhythm disorders","correct":true},{"idx":3,"proposition":"Chronic hypercalcemia can lead to renal lithiasis and chronic renal failure","correct":true},{"idx":4,"proposition":"Calcemia is regulated by two hormones: parathyroid hormone (PTH) and vitamin D, which control digestive calcium absorption, bone formation and renal excretion.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hyperCa-nephro-2","context":null,"enonce":"Regarding hypercalcemia","item":"hyperCa","matiere":"nephro","propositions":[{"idx":0,"proposition":"10 to 20% of cancer patients will have at least one episode of hypercalcemia during the course of their disease","correct":true},{"idx":1,"proposition":"Primary hyperparathyroidism results in 20% of cases a simple adenoma and in 15% of cases, hyperplasia of all four glands","correct":false,"justification":"Primary hyperparathyroidism results in 80% of cases a simple adenoma and in 15% of cases, hyperplasia of all four glands"},{"idx":2,"proposition":"Parathyroid carcinoma (malignant form of primary hyperparathyroidism) is exceptional (< 1%) and is accompanied by severe hypercalcemia (> 3.5 mmol \/ L) poorly tolerated","correct":true},{"idx":3,"proposition":"Parathyroid adenoma mainly affects women after 40 years","correct":true},{"idx":4,"proposition":"Primary hyperparathyroidism can be the consequence of chronic lithium intake","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hyperCa-nephro-3","context":null,"enonce":"Which of the following are ECG signs of hypercalcemia?","item":"hyperCa","matiere":"nephro","propositions":[{"idx":0,"proposition":"QT segment elongation","correct":false,"justification":"False"},{"idx":1,"proposition":"ST segment shortening","correct":true},{"idx":2,"proposition":"QT segment shortening","correct":true},{"idx":3,"proposition":"Ventricular tachycardia","correct":true},{"idx":4,"proposition":"Atrioventricular block","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hyperCa-nephro-4","context":null,"enonce":"Which of the following are signs related to hypercalcemia?","item":"hyperCa","matiere":"nephro","propositions":[{"idx":0,"proposition":"Nausea and vomiting","correct":true},{"idx":1,"proposition":"Abdominal pain","correct":true},{"idx":2,"proposition":"Mucocutaneous pallor","correct":false,"justification":"False"},{"idx":3,"proposition":"Sensory level","correct":false,"justification":"False"},{"idx":4,"proposition":"Skin fold","correct":true,"justification":"True, related to dehydration"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hyperCa-rhumato-0","context":null,"enonce":"Regarding calcium metabolism","item":"hyperCa","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Ionized serum calcium varies between 1.15 and 1.3 mmol\/L","correct":true},{"idx":1,"proposition":"The determination of ionized calcium can be disturbed by pH and phosphate ","correct":true},{"idx":2,"proposition":"Calcium homeostasis is essentially based on three key organs (intestine, kidney and bone) and two regulatory hormones.","correct":true},{"idx":3,"proposition":"Digestive inputs are regulated by active vitamin D, also known as calcidiol (25-[OH]-vitamin D2), which promotes calcium absorption","correct":false,"justification":"The active vitamin D is calcitriol (1,25-[OH]2-vitamin D3)"},{"idx":4,"proposition":"Urinary excretion is regulated by renal reabsorption in the distal tubule which is promoted by PTH","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"hyperCa-rhumato-1","context":null,"enonce":"Regarding hypercalcemia","item":"hyperCa","matiere":"rhumato","propositions":[{"idx":0,"proposition":"PTH is the key hormone that supports serum calcium","correct":true},{"idx":1,"proposition":"PTH then stimulates the distal renal tubular reabsorption of calcium, the conversion by 1α-hydroxylase, of 25-OH-vitamin D3 into active vitamin D","correct":true},{"idx":2,"proposition":"Hypercalcemia is defined as a total calcium level (corrected if necessary) greater than 6 mmol\/L or an ionized serum calcium greater than 1.5 mmol\/L","correct":false,"justification":"Hypercalcemia is defined as a total calcium level (corrected if necessary) greater than 2.6 mmol\/L or an ionized serum calcium greater than 1.35 mmol\/L"},{"idx":3,"proposition":"The discovery of hypercalcemia requires a second confirmatory test, without delaying treatment if there are threatening signs","correct":true},{"idx":4,"proposition":"It is estimated that 40% of hypercalcemias are asymptomatic and incidentally discovered.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hyperCa-rhumato-2","context":null,"enonce":"Regarding hypercalcemia","item":"hyperCa","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Chronic hypercalcemia is often complicated by phosphate lithiasis or calcium oxalate (renal colic, hematuria or urinary tract infection), nephrocalcinosis, obstructive renal failure","correct":true},{"idx":1,"proposition":"Acute hypercalcemia is a medical emergency with a risk of death from heart rhythm disorders","correct":true},{"idx":2,"proposition":"An emergency ECG should be performed to look for rhythm disorders (tachycardia, QT shortening, early onset T waves) because there is a risk of ventricular fibrillation and sudden death.","correct":true},{"idx":3,"proposition":"The discovery of malignant hypercalcemia requires hospitalization to carry out emergency treatment","correct":true},{"idx":4,"proposition":"Calcitonin should be given urgently in acute hypercalcaemia","correct":false,"justification":"It includes the following measures:Calcitonin no longer has a place in the treatment of hypercalcemia"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"IC-cardio-0","context":null,"enonce":"About heart failure","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Most heart conditions if not detected or treated in time can lead to heart failure","correct":true},{"idx":1,"proposition":"HF is a syndrome that can be defined as the combination of symptoms and signs associated with cardiac dysfunction","correct":true},{"idx":2,"proposition":"The diagnosis of HF is, in most cases, easy to make","correct":false,"justification":"Relatively difficult generally. In doubtful cases, the clinical response favorable to appropriate treatment (diuretic) may be an argument in favor of the diagnosis"},{"idx":3,"proposition":"It is estimated that the prevalence of heart failure in the general population is between 15 and 20% in France","correct":false,"justification":"That would be far too much. It is estimated that the prevalence of heart failure in the general population is between 1 and 2%"},{"idx":4,"proposition":"The average age of diagnosis in Europe is around 40 years","correct":false,"justification":"Around 75 years"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IC-cardio-1","context":null,"enonce":"About heart failure","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Population aging explains why the prevalence of HF tends to increase","correct":true},{"idx":1,"proposition":"Ejection fraction is the most widely used parameter to characterize diastolic function","correct":false,"justification":"Systolic function"},{"idx":2,"proposition":"In case of cardiac dysfunction, the body will react by bringing into play a number of compensatory mechanisms","correct":true},{"idx":3,"proposition":"Tachycardia under the dependence of the activation of the parasympathetic system helps to maintain cardiac output","correct":false,"justification":"Tachycardia is dependent on the activation of the (ortho)sympathetic system. It helps maintain cardiac output (DC = VES × HR)"},{"idx":4,"proposition":"Vasoconstriction in response to activation of the sympathetic system and renin angiotensin system helps maintain perfusion pressure","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"IC-cardio-2","context":null,"enonce":"About heart failure","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Exertional angina is often indicative of the disease","correct":false,"justification":"It is rather the dyspnea of effort that reveals the disease. There is rarely angina at the beginning of the disease"},{"idx":1,"proposition":"The degree of effort at which dyspnea appears makes it possible to quantify the functional tolerance of the disease","correct":true},{"idx":2,"proposition":"In severe or end-stage heart failure, respiratory disorders such as Cheynes-Stokes breathing sleep apnea syndrome may be observed.","correct":true},{"idx":3,"proposition":"Apart from an acute flare-up of the disease, the physical examination of the heart failure is often quite rich (dyspnea, pallor, edema, etc.)","correct":false,"justification":"Apart from an acute flare-up of the disease, the physical examination of heart failure is often quite poor, especially when HF is treated and controlled."},{"idx":4,"proposition":"At the cardiac level, palpation sometimes makes it possible to note a spike shock deviated at the top and right, related to left ventricular dilation","correct":false,"justification":"In case of dilation of the LV, the tip shock is deflected at the bottom and left, in the axis of the heart"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IC-cardio-3","context":null,"enonce":"About heart failure","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"At a very advanced stage, heart failure can be accompanied by an alternating pulse, oliguria, muscle wasting, sometimes achieving a real cachectic state.","correct":true},{"idx":1,"proposition":"Cheynes-Stokes dyspnea is sometimes noted in patients with heart failure during sleep","correct":true,"justification":"Especially in cases of severe or terminal HF"},{"idx":2,"proposition":"ECG is low contributory to the diagnosis of heart failure","correct":true},{"idx":3,"proposition":"The existence of a branch block in particular left (duration of the QRS > 120 ms), is an important element to take into account given the current therapeutic implications","correct":true},{"idx":4,"proposition":"Chest X-ray is unnecessary","correct":false,"justification":"It is essential to appreciate the pleuropulmonary impact"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IC-cardio-4","context":null,"enonce":"About heart failure","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"BNP or NT-proBNP can help in the diagnosis of heart failure, with good positive predictive value.","correct":false,"justification":"BNP or NT-proBNP can help in the diagnosis of heart failure, with a good negative predictive value; thus, normal values of BNP (< 100 pg\/mL) or NT-proBNP (< 125 pg\/mL) make the diagnosis of heart failure very unlikely in the presence of acute dyspnea with a good negative predictive value"},{"idx":1,"proposition":"There are values of BNP\/NT-proBNP for which the diagnosis is uncertain, the interpretation must imperatively take into account the clinical data","correct":true},{"idx":2,"proposition":"Transthoracic echocardiography (ETT) coupled with Doppler is the essential key test in case of suspected heart failure","correct":true},{"idx":3,"proposition":"Coronary angiography is a key test for suspected primary heart failure","correct":false,"justification":"Coronary angiography is usually offered in case of impaired systolic function (decreased ejection fraction [EF]) to rule out coronary artery disease."},{"idx":4,"proposition":"Ischemic heart disease is the leading cause of heart failure.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IC-cardio-5","context":null,"enonce":"About heart failure","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Pulmonary arterial hypertension is defined as a mean PAP greater than 25 mmHg","correct":true},{"idx":1,"proposition":"Normal cardiac output is 5 L\/min, cardiac index is 3 L\/min\/m2","correct":true},{"idx":2,"proposition":"All heart conditions can lead to heart failure","correct":true},{"idx":3,"proposition":"High blood pressure is also an important factor or cofactor in heart failure","correct":true},{"idx":4,"proposition":"Dilated cardiomyopathies (DCM) are defined by damage to the heart muscle that results in dilation and decreased LV ejection fraction.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IC-cardio-6","context":null,"enonce":"About heart failure","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"All left valvular heart disease can be complicated by heart failure (mitral or aortic insufficiency, mitral or aortic stricture)","correct":true},{"idx":1,"proposition":"Ventricular or supraventricular rhythm or conduction disorders can cause heart failure","correct":true},{"idx":2,"proposition":"Chronic anemia can cause heart failure","correct":true},{"idx":3,"proposition":"Pulmonary oedema in a young migrant, especially if it is associated with atrial fibrillation, should suggest the diagnosis of rheumatic valvular disease, especially mitral valve disease.","correct":true},{"idx":4,"proposition":"mortality remains high in heart failure, averaging 50% at five years but can reach up to 40-50% per year in severe heart failure (NYHA IV)","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"IC-cardio-7","context":null,"enonce":"About heart failure","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"HF is considered the leading cause of hospitalization after age 65","correct":true},{"idx":1,"proposition":"Hospitalization for cardiac decompensation is always a severity factor","correct":true},{"idx":2,"proposition":"Heart failure can be accompanied by anemia, iron deficiency, sleep apnea syndrome","correct":true},{"idx":3,"proposition":"Prevention of heart failure begins with management of cardiovascular risk factors","correct":true},{"idx":4,"proposition":"The success of treatment depends closely on the patient's education and understanding of the disease.","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"IC-cardio-8","context":null,"enonce":"Which of the following are true about the NT proBNP?","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Faced with acute dyspnea, he directs to a cardiac origin","correct":true},{"idx":1,"proposition":"It is a prognostic marker of heart failure","correct":true},{"idx":2,"proposition":"It is interpreted according to age","correct":true},{"idx":3,"proposition":"It is increased in case of heart failure","correct":true},{"idx":4,"proposition":"No proposition is true","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IC-cardio-9","context":null,"enonce":"Which of the following are early complications of triple-chamber defibrillator implantation?","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Probe displacements","correct":true},{"idx":1,"proposition":"Infective tube endocarditis","correct":false,"justification":"Not early"},{"idx":2,"proposition":"Pericardial effusion","correct":true},{"idx":3,"proposition":"Low blood pressure","correct":false,"justification":"False"},{"idx":4,"proposition":"Decompensation of heart failure","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"epilepsie-neuro-2","context":null,"enonce":"About epilepsy","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"proposition":"The incidence of epilepsy is higher in children and after 60 years","correct":true},{"idx":1,"proposition":"About 1% of epilepsies begin before the age of 5","correct":false,"justification":"About 50% of epilepsies begin before the age of 10"},{"idx":2,"proposition":"EEG during juvenile myoclonus is characterized by generalized, bilateral, symmetrical and synchronous polyspikes-waves","correct":true},{"idx":3,"proposition":"EEG during the typical absence is characterized by a generalized, bilateral, symmetrical and synchronous paroxysmal discharge of wave-peaks at 3 Hz, abruptly beginning and ending, of a few seconds, interrupting normal background activity","correct":true},{"idx":4,"proposition":"Disorders of consciousness during focal seizures do not have a precise localizing value","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"epilepsie-neuro-3","context":null,"enonce":"About epilepsy","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"proposition":"When faced with an epileptic seizure in a known epileptic, it is necessary to do a brain imaging in first line","correct":false,"justification":"No. Antiepileptic drugs must be dosed as a first-line measure."},{"idx":1,"proposition":"The most common cause of seizures in an epileptic is lack of sleep","correct":false,"justification":"It is the lack of adherence, hence the fact of dosing antiepileptics in the first-line assessment in the known epileptic"},{"idx":2,"proposition":"Prevalence is about 1% in the general population","correct":true},{"idx":3,"proposition":"In 50% of cases, no cause of the seizure is found","correct":false,"justification":"In 25% of cases"},{"idx":4,"proposition":"The tonic phase of a tonic-clonic seizure lasts 30 seconds","correct":false,"justification":"It lasts 10 to 20 seconds. The clonic phase lasts about 30 seconds."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"epilepsie-neuro-4","context":null,"enonce":"Signs of severity of a seizure include:","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Repetition of crises","correct":true},{"idx":1,"proposition":"Mental confusion persisting for more than 15 minutes","correct":false,"justification":"Only 30 minutes left"},{"idx":2,"proposition":"Alcohol withdrawal","correct":true},{"idx":3,"proposition":"Head trauma","correct":true},{"idx":4,"proposition":"Fever > 38°C","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"epilepsie-neuro-5","context":null,"enonce":"Which of these proposals are suggestive of an epileptic seizure?","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"proposition":"The bite of the tip of the tongue","correct":false,"justification":"Lateral bite of the tongue"},{"idx":1,"proposition":"Rapid recovery in post-crisis","correct":false,"justification":"Recovery is slow, often in transport to the hospital. Confusion can last a long time"},{"idx":2,"proposition":"Generalized hypotonia","correct":true},{"idx":3,"proposition":"Head trauma","correct":false,"justification":"Often due to the fall and does not portend the character of the crisis"},{"idx":4,"proposition":"A fever","correct":false,"justification":"Fever is a criterion of severity of the seizure, but is not in itself an element pointing to an epileptic seizure"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"epilepsie-neuro-6","context":null,"enonce":"Regarding West syndrome:","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Its other name is Lennox Syndrome","correct":false,"justification":"These are two different syndromes, although their clinical impact is close"},{"idx":1,"proposition":"It affects patients over the age of 65","correct":false,"justification":"It concerns infants of about 6 months"},{"idx":2,"proposition":"It is characterized by generalized EEG discharge","correct":true,"justification":"EEG hysprarhythmia"},{"idx":3,"proposition":"Wave peaks usually have a frequency of 3hz","correct":false,"justification":"Very slow and wide waves are observed"},{"idx":4,"proposition":"EEG signs are bilateral","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"epilepsie-neuro-7","context":null,"enonce":"Regarding treatments in a woman of childbearing potential:","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"proposition":"In patients of childbearing potential, enzyme inducer treatments are preferred to be avoided","correct":true,"justification":"They decrease the effectiveness of oral contraception"},{"idx":1,"proposition":"Levetiracetam does not present an over-risk of malformation compared to the general population","correct":true},{"idx":2,"proposition":"Valproic acid should not be prescribed to a woman of childbearing age","correct":true},{"idx":3,"proposition":"Oxcarbazepine is contraindicated in Wilson's disease","correct":false,"justification":"It is contraindicated in case of porphyria"},{"idx":4,"proposition":"Lamotrigine is an enzyme inhibitor","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"epilepsie-neuro-8","context":null,"enonce":"Among these anti-epileptic molecules, which are also indicated for bipolar disorders?","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Levetiracetam","correct":false,"justification":"Broad-spectrum molecule whose main EI is asthenia. The route of elimination is renal and has a half-life between 7 and 11 hours."},{"idx":1,"proposition":"Lamotrigine","correct":true,"justification":"Also indicated in bipolar disorder, lamotrigine is a broad-spectrum anti-epileptic whose main AE is to aggravate myoclonus, Lyell's syndrome, insomnia and headache. Its elimination pathway is hepatic (it is an enzyme inhibitor) and has a half-life of about 1 day (25 hours)"},{"idx":2,"proposition":"Oxcarbazepine ","correct":false,"justification":"Narrow-spectrum anti-epileptic drugs with hyponatremia, rash, dizziness, and diplopia as main ARs. Its elimination pathway is mixed (hepatic and renal). It is an enzyme inducer"},{"idx":3,"proposition":"Topiramate","correct":false,"justification":"Broad-spectrum anti-epileptic drugs with urolithiasis and weight loss as AEs. It is also used in migraines (not in bipolar disorder)"},{"idx":4,"proposition":"Sodium valproate","correct":true,"justification":"Absolutely contraindicated in women of childbearing age. This question is based on this table: https:\/\/www.cen-neurologie.fr\/sites\/www.cen-neurologie.fr\/files\/files\/capture_decran_2019-12-19_a_14.41.14.png"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"epilepsie-neuro-9","context":null,"enonce":"Which of the following proposals regarding electroencephalogram (EEG) are true?","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"proposition":"An epileptic seizure is a clinical manifestation of the hyperactivity of a group of cortical and\/or subcortical neurons","correct":true},{"idx":1,"proposition":"A normal EEG rules out an epileptic cause","correct":false,"justification":"None"},{"idx":2,"proposition":"During epileptic seizures, we can find at the EEG paroxysmal activities of the poly-peak wave (PPO) type.","correct":true},{"idx":3,"proposition":"EEG may reveal paroxysmal intercritical activities","correct":true},{"idx":4,"proposition":"EEG abnormalities can be activated by sleep deprivation","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"RGO-HGE-0","context":null,"enonce":"Regarding gastroesophageal reflux disease or GERD","item":"RGO","matiere":"HGE","propositions":[{"idx":0,"proposition":"Gastroesophageal reflux refers to the passage through the cardia of gastric contents into the esophagus","correct":true},{"idx":1,"proposition":"20-40% of adults suffer from pyrosis","correct":true},{"idx":2,"proposition":"The key element of the RGP is the failure of the anti-reflux barrier forged by the lower esophageal sphincter (SIO) and the diaphragm","correct":true},{"idx":3,"proposition":"The combination of pyrosis acid regurgitations are almost pathognomonic of GERD","correct":true},{"idx":4,"proposition":"GERD diagnsotic is clinical","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"RGO-HGE-2","context":null,"enonce":"Regarding epidemiology in the general population, which propositions are true?","item":"RGO","matiere":"HGE","propositions":[{"idx":0,"proposition":"10% of people describe a pyrosis at least weekly","correct":true},{"idx":1,"proposition":"60% of people are subject to monthly GERD","correct":false,"justification":"No data in the college on monthly frequency"},{"idx":2,"proposition":" 2 to 5% of people experience GERD a daily pyrosis","correct":true},{"idx":3,"proposition":"20-40% of adults suffer from pyrosis","correct":true},{"idx":4,"proposition":"About 70% of adults complain of GERD","correct":false,"justification":"20 to 40%"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"RGO-HGE-4","context":null,"enonce":"Which of the following refers to the main mechanism of GERD in very young infants?","item":"RGO","matiere":"HGE","propositions":[{"idx":0,"proposition":"Pyloric stenosis","correct":false},{"idx":1,"proposition":"Inappropriate and transient relaxations of ORS","correct":true,"justification":"True, with 5-second episodes of relaxation ≥ independent of swallowing"},{"idx":2,"proposition":"Umbilical hernia","correct":false},{"idx":3,"proposition":"Delayed gastric emptying","correct":false},{"idx":4,"proposition":"Atresia of the esophagus","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"RGO-HGE-5","context":null,"enonce":"Which of the following proposals are part of the management of simple gastroesophageal reflux disease in small children?","item":"RGO","matiere":"HGE","propositions":[{"idx":0,"proposition":"Reassure parents about the benignity of regurgitation","correct":true},{"idx":1,"proposition":"Putting the child to bed in the supine position","correct":false,"justification":"Never advise this is a high risk factor for sudden infant death syndrome.  \r\nAccording to the college, the inclination of the cradle (proclive) as well as the eviction of passive smoking have no proven effectiveness."},{"idx":2,"proposition":"Contraindicate breastfeeding ","correct":false,"justification":"This is not at all a contraindication to breastfeeding, which is on the contrary advisable. \r\nIf hygiene-dietary rules are not enough, it is possible to express milk and thicken it."},{"idx":3,"proposition":"Splitting bottles","correct":true},{"idx":4,"proposition":"Thickening of milk if applicable","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"RGO-HGE-6","context":null,"enonce":"Which of the following are possible treatments for simple gastroesophageal reflux disease in a bottle-fed infant?","item":"RGO","matiere":"HGE","propositions":[{"idx":0,"proposition":"Sodium alginate","correct":false,"justification":"Alginates and other esophageal dressings are a controversial adjuvant measure of efficacy, especially in infants"},{"idx":1,"proposition":"Sodium bicarbonate","correct":false,"justification":"Alginates and other esophageal dressings are a controversial adjuvant measure of efficacy, especially in infants"},{"idx":2,"proposition":"Omeprazole","correct":false,"justification":"They have an antisecretory action acids. They are therefore only effective in case of acid reflux only. They have no effectiveness on regurgitation and are not used in simple GERD."},{"idx":3,"proposition":"Metoclopramide","correct":false,"justification":"Contraindicated in children under 18 years of age because risk of extrapyramidal syndrome."},{"idx":4,"proposition":"None of these proposals","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"RGO-HGE-7","context":null,"enonce":"Which of the following are complications of GERD?","item":"RGO","matiere":"HGE","propositions":[{"idx":0,"proposition":"Endobrachyoesophagus (EBO)","correct":true},{"idx":1,"proposition":"Peptic stenosis","correct":true},{"idx":2,"proposition":"Barrett's ulcer","correct":true},{"idx":3,"proposition":"Digestive obstruction","correct":false},{"idx":4,"proposition":"Squamous cell carcinoma (on EBO)","correct":false,"justification":"Adenocarcinoma"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pancreatitechr-HGE-0","context":null,"enonce":"Regarding chronic pancretis:","item":"pancreatitechr","matiere":"HGE","propositions":[{"idx":0,"proposition":"It is a chronic inflammation of the pancreas resulting in progressive fibrosis of the pancreatic parenchyma","correct":true},{"idx":1,"proposition":"Chronic pancreatitis first affects exocrine tissue, then endocrine tissue","correct":true},{"idx":2,"proposition":"• At the initial stage, the disease is characterized by outbreaks of acute pancreatitis, and by chronic pain that represent the main clinical translation of the disease","correct":true},{"idx":3,"proposition":"• Prevalence of about 1\/1,000,000 inhabitants in Western countries","correct":false},{"idx":4,"proposition":"There is female predominance","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"pancreatitechr-HGE-1","context":null,"enonce":"Regarding chronic pancreatitis:","item":"pancreatitechr","matiere":"HGE","propositions":[{"idx":0,"proposition":"Excessive alcohol consumption is the cause of the majority of chronic pancreatitis (CP) in the West","correct":true},{"idx":1,"proposition":"Tobacco is a risk factor present in more than 80% of cases","correct":true},{"idx":2,"proposition":"Hypercalcemia is a rare cause of chronic pancreatitis","correct":true},{"idx":3,"proposition":"hereditary CP is an autosomal dominant disease characterized by an age of onset of less than 30 years","correct":false,"justification":"hereditary CP is an autosomal dominant disease characterized by an age of onset of less than 15 years"},{"idx":4,"proposition":"Transfixing epigastric pain relieved by alcohol intake is a main sign of chronic pancreatitis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pancreatitechr-HGE-2","context":null,"enonce":"Regarding pancreatitis:","item":"pancreatitechr","matiere":"HGE","propositions":[{"idx":0,"proposition":"A pseudocyst is a fluid collection containing either pure, clear pancreatic juice or liquefied pancreatic necrosis.","correct":true},{"idx":1,"proposition":"A pseudocyst complicates 2-4% of PCs","correct":false,"justification":"A pseudocyst: • complicates 20 to 40% of PCs; • can form as a result of an acute flare-up (necrosis) or by ductal retention (clear liquid); • may remain stable, regress or become complicated: compression of a neighborhood organ (bile duct, duodenum, splenoportal axis), (resulting in a pancreatic abscess), hemorrhage or rupture in a nearby hollow organ or in the peritoneal cavity or in a serous (pleura, peritoneum)"},{"idx":2,"proposition":"Stenosis of the main bile duct most often results in anicteric cholestasis","correct":true,"justification":"Rarely from jaundice"},{"idx":3,"proposition":"Digestive bleeding occurs in 10% of chronic pancreatitis","correct":true},{"idx":4,"proposition":"During CP, exocrine pancreatic insufficiency occurs almost inevitably after an average of ten years of evolution","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"pancreatitechr-HGE-3","context":null,"enonce":"Regarding chronic pancreatitis:","item":"pancreatitechr","matiere":"HGE","propositions":[{"idx":0,"proposition":"Chronic pancreatitis is a chronic inflammation of the pancreas that results in the death of the patient in the majority of cases","correct":false,"justification":"It is not a fatal pathology"},{"idx":1,"proposition":"Migration of a gallstone into the wirsung is the main cause of chronic pancreatitis","correct":false,"justification":"The main cause of CP is acute pancreatia"},{"idx":2,"proposition":"Stenosis of the main bile duct is a cause of CP","correct":true},{"idx":3,"proposition":"Diabetes mellitus is one of the complications of chronic pancreatitis","correct":true},{"idx":4,"proposition":"Pain management in a specialized unit is essential","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"raisonnement-sp-0","context":null,"enonce":"Concerning reasoning and decision in medicine","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"The medical decision precedes the decision","correct":false,"justification":"It is the medical reasoning that precedes the decision"},{"idx":1,"proposition":"The decision engages the responsibility of the doctor","correct":true},{"idx":2,"proposition":"The diagnostic approach corresponds to choosing the best therapy for the patient","correct":false,"justification":"This is the therapeutic approach"},{"idx":3,"proposition":"The therapeutic approach corresponds to the fastest and most effective way to arrive at the diagnosis","correct":false,"justification":"This is the diagnostic approach"},{"idx":4,"proposition":"The medical decision engages the responsibility of the hospital","correct":false,"justification":"The medical decision engages the responsibility of the one who makes it, therefore the doctor\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"raisonnement-sp-1","context":null,"enonce":"Which of the following are true?","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"From the clinical signs will be built the diagnostic approach","correct":true},{"idx":1,"proposition":"Following the clinical interrogation, the doctor develops hypotheses based on his physiopathological clinical knowledge, in particular","correct":true},{"idx":2,"proposition":"Diagnostic hypotheses should always be verified by examinations such as imaging or biology.","correct":false,"justification":"These hypotheses will have to be verified by a guided clinical examination and possibly additional examinations"},{"idx":3,"proposition":"The choice of a complementary diagnostic (or therapeutic) examination must always be justified","correct":true},{"idx":4,"proposition":"The doctor is the one who makes the diagnosis","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"raisonnement-sp-2","context":null,"enonce":"Concerning the diagnostic approach","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"If there is a diagnosis, the doctor must assess its seriousness","correct":true},{"idx":1,"proposition":"When the diagnosis is made, the doctor should always propose a curative treatment if it exists","correct":false,"justification":"Situations where the proposal of a curative treatment is not a solution"},{"idx":2,"proposition":"The doctor usually has to inform the patient about his illness","correct":true},{"idx":3,"proposition":"When the main symptom does not correspond to any disease, the doctor should dismiss his patient and not prescribe anything","correct":false,"justification":"The doctor must try to find the motivation of the request for consultation for two reasons: to avoid medical nomadism and the prescription of unnecessary check-ups"},{"idx":4,"proposition":"Incidentalomas are a type of medical error","correct":false,"justification":"This is the detection of abnormalities unrelated to the main symptomatology\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"raisonnement-sp-3","context":null,"enonce":"Concerning the therapeutic approach","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"Diagnosed pathologies should always be treated","correct":false,"justification":"Only when the benefit\/risk balance is in favor and the treatment is the patient's will"},{"idx":1,"proposition":"There are 5 possible reasonings that dictate the decision to treat","correct":false,"justification":"There are 3: analog reasoning, pharmacological reasoning, and evidence-based reasoning."},{"idx":2,"proposition":"Automatic reasoning is very common in internal medicine","correct":false,"justification":"It is common in medicines where the speed of action is important (eg emergency medicine, resuscitation, etc.)"},{"idx":3,"proposition":"Habit reasoning is an analogical type of reasoning","correct":true},{"idx":4,"proposition":"Reasoning by dictated behaviour is evidence-based","correct":false,"justification":"It is dictated by a line manager\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"raisonnement-sp-4","context":null,"enonce":"About EBM","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"Medical knowledge has slowed down in recent years (few major discoveries)","correct":false,"justification":"The number of publications reaches peaks year after year, with great discoveries such as artificial intelligence, hepatitis and HIV treatments, CRISPR-Cas9, etc."},{"idx":1,"proposition":"EBM is a conscientious use of the best current evidence from basic biological research","correct":false,"justification":"According to the Public Health KB, EBM is the use of clinical research data (not basic research)"},{"idx":2,"proposition":"An EBM approach contains 6 steps","correct":false,"justification":"4 steps: question formulation, literature review, outcome assessment and application to the patient"},{"idx":3,"proposition":"Literature review must follow PICO criteria","correct":false,"justification":"The PICO criteria concern the formulation of the question (Patient, Intervention, Comparator and Outcome)"},{"idx":4,"proposition":"Patient decision making (step 4) should be based on the patient's experience","correct":true,"justification":"As well as patient preferences and available resources\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"raisonnement-sp-5","context":null,"enonce":"Among these proposals, which are not components of the HBS:","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"The cost","correct":true,"justification":"The 3 components of HBS according to the KB of Public Health and the Cochrane French Centre: Clinical expertise, patient preferences and research data"},{"idx":1,"proposition":"Family preferences","correct":true,"justification":"Patient preferences"},{"idx":2,"proposition":"Hierarchical pressures","correct":true,"justification":"Of course not"},{"idx":3,"proposition":"Clinical expertise","correct":false},{"idx":4,"proposition":"Research data","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"raisonnement-sp-6","context":null,"enonce":"Regarding the levels of evidence of the HAS:","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"Grade A is the best level","correct":true,"justification":"Level 1 = Grade A = established scientific pereuve"},{"idx":1,"proposition":"Level 3 is the lowest","correct":false,"justification":"This is level 4"},{"idx":2,"proposition":"Grade C corresponds to level 4 only","correct":false,"justification":"Grade C corresponds to Level 3 and Level 4"},{"idx":3,"proposition":"Level 2 is that of scientific presumption","correct":true,"justification":"Level 2 = Grade B"},{"idx":4,"proposition":"Level 3 is a low level of scientific evidence","correct":true,"justification":"Level 3 = Grade C"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"raisonnement-sp-7","context":null,"enonce":"Regarding the levels and grades of proof of the HAS:","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"High-powered randomized controlled trials are grade C","correct":false,"justification":"Grade A = Level 1 = scientifically established evidence"},{"idx":1,"proposition":"Cohort studies are generally Grade C","correct":false,"justification":"Grade B = Level 2 = Scientific presumption"},{"idx":2,"proposition":"Low-powered randomized controlled trials are grade B","correct":true,"justification":"As well as cohort studies, and well-conducted non-randomized controlled studies"},{"idx":3,"proposition":"Case-control studies are grade C","correct":true,"justification":"And level 3"},{"idx":4,"proposition":"Retrospective studies are grade C and level 3","correct":false,"justification":"Only case-control studies are level 3. Retrospective studies are Grade C and Level 4"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"raisonnement-sp-9","context":null,"enonce":"The collegiate procedure may be requested by:","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"The patient's doctor","correct":true,"justification":"4 possibilities: the doctor, the family\/relatives, the person of trust and the patient himself by his advance directives"},{"idx":1,"proposition":"The support person","correct":true},{"idx":2,"proposition":"The patient's employer","correct":false,"justification":"Unless he is family or a relative"},{"idx":3,"proposition":"The patient","correct":true,"justification":"Through its advance directives"},{"idx":4,"proposition":"Parents","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"raisonnement-sp-10","context":null,"enonce":"Concerning the collegiate procedure","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"Most often, it is triggered by the person of trust","correct":false,"justification":"By the doctor most often (cf. KB Public Health, page 35)"},{"idx":1,"proposition":"Only the opinions of doctors are taken into account","correct":false,"justification":"The entire healthcare team, the support person, etc."},{"idx":2,"proposition":"The final opinion is taken by the family","correct":false,"justification":"By the physician only"},{"idx":3,"proposition":"The procedure is notified in the medical record","correct":true},{"idx":4,"proposition":"An external doctor is called in as a consultant","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"pathoOGE-endoc-0","context":null,"enonce":"Which of the following proposals regarding cryptorchidism is (are) accurate?","item":"pathoOGE","matiere":"endoc","propositions":[{"idx":0,"proposition":"Cryptorchidism describes an abnormal location of the testicle","correct":true},{"idx":1,"proposition":"Association with a hernia is possible","correct":true,"justification":"Hernia \/ cryptorchidism association is not uncommon"},{"idx":2,"proposition":"Cryptorchidism is bilateral in 75% of cases","correct":false,"justification":"In 20% of cases"},{"idx":3,"proposition":"The origin of cryptorchidism is genetic most often","correct":false,"justification":"It is most often unknown"},{"idx":4,"proposition":"The scrotal migration phase is testosterone-dependent","correct":true,"justification":"While the intra-abdominal migration phase would be dependent on the hormone INSL3"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pathoOGE-endoc-1","context":null,"enonce":"Regarding hormonal explorations:","item":"pathoOGE","matiere":"endoc","propositions":[{"idx":0,"proposition":"At full-term birth, a penis smaller than 4 cm is a micropenis","correct":false,"justification":"Micropenis (penis < 2 cm in a term newborn)"},{"idx":1,"proposition":"Hormonal exploration is considered if cryptochidism persists at the end of puberty","correct":false,"justification":"It must be taken care of well before, from birth to find the etiology and the impact"},{"idx":2,"proposition":"When cryptorchidism is bilateral, the urgency is to eliminate an abnormality of the enzyme block type 21-hydroxylase","correct":true},{"idx":3,"proposition":"The most common abnormality of normal karyotype sexual development is the 21-hydroxylase block. ","correct":true},{"idx":4,"proposition":"A 17-hydroxyprogesterone assay allows screening for congenital hyperplasia of the spleen","correct":false,"justification":"17-hydroxyprogesterone assay allows screening for congenital adrenal hyperplasia"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"pathoOGE-endoc-2","context":null,"enonce":"Regarding cryptorchidism and anorchidism:","item":"pathoOGE","matiere":"endoc","propositions":[{"idx":0,"proposition":"AMH testing can assess the existence of testicular functional tissue","correct":true},{"idx":1,"proposition":"Ultrasound can detect Müllerian derivatives if the cryptorchidism is bilateral","correct":true},{"idx":2,"proposition":"Anorchidism is rare and affects only one in 40 newborns","correct":false,"justification":"Anorchidism is much rarer and its pathophysiology is poorly understood"},{"idx":3,"proposition":"AMH is indosable in true anorchidism","correct":true},{"idx":4,"proposition":"Surgical exploration in case of anorchidism makes it possible to look for the testicles in the abdominal area","correct":false,"justification":"Surgical exploration is, most often, not useful"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pathoOGE-endoc-3","context":null,"enonce":"Regarding cryptorchidism:","item":"pathoOGE","matiere":"endoc","propositions":[{"idx":0,"proposition":"Cryptorchidism is a call sign of a hypogodatrophic pathology that is a diagnostic emergency in the newborn","correct":true,"justification":"Diagnostic and therapeutic emergency"},{"idx":1,"proposition":"Cryptorchidism is a developmental anomaly very often found in polymalformative syndromes","correct":true},{"idx":2,"proposition":"There is a risk of ischemic necrosis by traction of the vascular pedicle during surgical lowering of the gonad","correct":true},{"idx":3,"proposition":"Two-step surgical lowering reduces the risk of necrosis","correct":true},{"idx":4,"proposition":"Surgical management must wait until puberty","correct":false,"justification":"The first consultation with a pediatric surgeon should ideally take place within the first six months of life."}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"pathoOGE-endoc-4","context":null,"enonce":"Regarding cryptorchidism in adults:","item":"pathoOGE","matiere":"endoc","propositions":[{"idx":0,"proposition":"In front of cryptorchidism in adults, hormonal exploration looks for type 1 diabetes","correct":false,"justification":"We look for hypogonadism (FSH, LH, total testosterone assay)"},{"idx":1,"proposition":"The determination of hCG is indicated in front of a testicular mass","correct":true},{"idx":2,"proposition":"A spermogram is performed to look for azoospermia or oligospermia","correct":true},{"idx":3,"proposition":"Testicular microlithiasis is indicative of malignant pathology","correct":false,"justification":"Their number greater than five should encourage vigilance given their frequent association with malignant testicular lesions."},{"idx":4,"proposition":"Any cryptorchidism requires early endocrine exploration","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pathoOGE-endoc-5","context":null,"enonce":"Which of the following proposals regarding cryptorchidism is (are) accurate?","item":"pathoOGE","matiere":"endoc","propositions":[{"idx":0,"proposition":"Surgery is indicated before 12 months","correct":true,"justification":"According to a 2018 HAS care relevance report, it is preferable to perform this surgery between 6 and 12 months (spermatogenesis optimization). However, surgery should not be performed before the age of 6 months (apart from an inguinal hernia cure) because the testicle can descend spontaneously during the first months of life."},{"idx":1,"proposition":"Cryptorchidism surgery patients in childhood do not need special follow-up","correct":false,"justification":"They must be monitored and reviewed at puberty to assess the impact on gonadal functions"},{"idx":2,"proposition":"Cryptorchidism may be associated with infertility","correct":true,"justification":"The search for cryptorchid atcd is essential during infertility consultations. It can also be associated with hypogonadism."},{"idx":3,"proposition":"The relative risk of testicular cancer is zero with cryportchidism","correct":false,"justification":"Cryptorchidism increases RR of testicular cancer"},{"idx":4,"proposition":"Gynecomastia accompanying cryptorchidism points instead to hormonal dysregulation","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"amylose-hemato-0","context":null,"enonce":"About amyloidosis","item":"amylose","matiere":"hemato","propositions":[{"idx":0,"proposition":"Amyloidosis is a set of diseases characterized by extracellular tissue deposits of insoluble, fibrillar proteins, organized in folded, antiparallel beta sheets","correct":true},{"idx":1,"proposition":"The diagnosis of amyloidosis is histological","correct":true,"justification":"By biopsy of an affected organ, or, due to the dissemination of deposits, by biopsy of subcutaneous fat or accessory salivary glands"},{"idx":2,"proposition":"In amyloidosis, a normally insoluble protein will become soluble and form extracellular aggregates.","correct":false,"justification":"In amyloidosis, a normally soluble protein will become insoluble and form extracellular aggregates organized into folded, antiparallel beta sheets (amylose deposits or amyloid substance)"},{"idx":3,"proposition":"Amyloidosis is an inherited disease","correct":false,"justification":"Some amyloidosis are acquired diseases, others are hereditary (amyloidosis by mutated transthyretin ATTR deposits)"},{"idx":4,"proposition":"Amyloidosis deposits are composed of 95% fibrillar proteins, and 5% glycoproteins","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"amylose-hemato-1","context":null,"enonce":"Regarding amyloidosis","item":"amylose","matiere":"hemato","propositions":[{"idx":0,"proposition":"The biochemical nature of the amyloid fibrillar protein gives the name of the type of amyloidosis (example: amyloidosis type AL = immunoglobulin light chain)","correct":true,"justification":"Example: amyloidosis type AL = immunoglobulin light chain"},{"idx":1,"proposition":"Many proteins can cause amyloidosis deposits","correct":true,"justification":"Serum amyloid protein in AA amyloidosis, Ig light chains in AL amyloidosis, e.g."},{"idx":2,"proposition":"The histological aspect varies according to the type of amyloidosis","correct":false,"justification":"Regardless of the type of amyloidosis, the histological appearance is the same: fibrils in beta-pleated sheets. They are highlighted by the Congo Red, and are birefringents to polarized light"},{"idx":3,"proposition":"These extracellular deposits may affect only one organ (localized amyloidosis as a single mass) or several organs (generalized amyloidosis which can be life-threatening)","correct":true,"justification":"They can also affect several organs (generalized amyloidosis which can be life-threatening)"},{"idx":4,"proposition":"The organs preferentially affected depend on the type of amyloidosis","correct":true,"justification":"AL amyloidosis: renal (65%), cardiac (61%), and in about 20% of cases hepatic, neurological, soft tissue or digestive system involvement. AA amyloidosis: mainly renal and hepatic damage"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"amylose-hemato-2","context":null,"enonce":"Regarding amyloidosis","item":"amylose","matiere":"hemato","propositions":[{"idx":0,"proposition":"Kidney damage results in proteinuria, nephrotic syndrome, and renal failure","correct":true,"justification":"There is, classically, neither HTA nor hematuria"},{"idx":1,"proposition":"In case of suspicion of amyloidosis, a sample is sent to the laboratory, fixed in formalin for inclusion in paraffin for the detection of deposits, accompanied by a second sample sent fresh to be frozen for the typing of deposits","correct":true},{"idx":2,"proposition":"Deep rectal biopsies have a sensitivity of about 80%","correct":true,"justification":"They highlight gastrointestinal involvement of AL amyloidosis"},{"idx":3,"proposition":"Accessory salivary gland biopsies have a sensitivity of 80-85%","correct":true},{"idx":4,"proposition":"In case of amyloidosis, transparietal liver biopsy has a very high diagnostic interest","correct":false,"justification":"Frankly no interest. A blood enzyme assay is sufficient (greater increase in PAL than GGT). No cytolysis (normal TGO and TGP) and no jaundice (except in very rare cases, poor prognosis)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"amylose-hemato-3","context":null,"enonce":"Regarding the skin involvement of AL amyloidosis:","item":"amylose","matiere":"hemato","propositions":[{"idx":0,"proposition":"Purpura can be observed","correct":true},{"idx":1,"proposition":"Bruising may be observed","correct":true},{"idx":2,"proposition":"Necrotic lesions may be observed","correct":false,"justification":"It's not described in colleges"},{"idx":3,"proposition":"They sit preferentially at the level of the legs","correct":false,"justification":"The preferred seat is the trunk and face"},{"idx":4,"proposition":"They may be accompanied by the sign of the shoulder pads","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"amylose-hemato-4","context":null,"enonce":"Regarding renal involvement of AL amyloidosis:","item":"amylose","matiere":"hemato","propositions":[{"idx":0,"proposition":"Renal failure appears in about half of cases","correct":true},{"idx":1,"proposition":"The kidney is affected in 15% of cases","correct":false,"justification":"Kidney damage is very common: in more than 70% of cases (according to the College of Internal Medicine)"},{"idx":2,"proposition":"Proteinuria is mainly composed of light chains ","correct":false,"justification":"Proteinuria is part of a glomerular syndrome (in a third of cases). It is therefore mainly composed of albumin and relatively abundant."},{"idx":3,"proposition":"Hematuria is found in 20% of cases","correct":false,"justification":"There is never hematuria"},{"idx":4,"proposition":"The size of the kidneys is increased","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"amylose-hemato-5","context":null,"enonce":"Regarding cardiac involvement:","item":"amylose","matiere":"hemato","propositions":[{"idx":0,"proposition":"It is present in 10% of patients at diagnosis ","correct":false,"justification":"It is present in 60% of patients at diagnosis"},{"idx":1,"proposition":"Cardiac involvement is the major prognostic factor ","correct":true},{"idx":2,"proposition":"It is manifested by ischemic cardiomyopathy","correct":false,"justification":"It is a restrictive hypertrophic cardiomyopathy"},{"idx":3,"proposition":"It progresses to asystole","correct":false,"justification":"It evolves towards adiastolia: the heart can no longer relax"},{"idx":4,"proposition":"It progresses to restrictive heart failure","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"amylose-hemato-7","context":null,"enonce":"What is the organ with the most severe prognosis?","item":"amylose","matiere":"hemato","propositions":[{"idx":0,"proposition":"The heart","correct":true,"justification":"True, mortality from amyloidosis is largely linked to cardiac involvement (restrictive cardiomyopathy). The appearance is brilliant in ultrasound. There is a QS V1-V3 microvoltage on the ECG."},{"idx":1,"proposition":"Liver","correct":false,"justification":"False"},{"idx":2,"proposition":"Spleen","correct":false,"justification":"False"},{"idx":3,"proposition":"The brain","correct":false,"justification":"No central neuronal involvement"},{"idx":4,"proposition":"The eye","correct":false,"justification":"No vitreous body damage"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"soinspsy-psy-0","context":null,"enonce":"General generalities:","item":"soinspsy","matiere":"psy","propositions":[{"idx":0,"proposition":"The Medical Psychological Centre (CMP) is the pivotal structure of the sector","correct":true},{"idx":1,"proposition":"The Medical and Psychological Centres (CMP) offer outpatient care","correct":true},{"idx":2,"proposition":"Liberal psychiatrists are very much in touch with the actors of general medicine","correct":true},{"idx":3,"proposition":"Multidisciplinary health homes are time-full hospitalization structures","correct":false,"justification":"Ambulatory. We also talk about a multi-professional health home."},{"idx":4,"proposition":"The financing of the health care system is provided by health insurance","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"soinspsy-psy-1","context":null,"enonce":"General:","item":"soinspsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Health insurance is based on a logic of compensation for illness","correct":true},{"idx":1,"proposition":"In general, health insurance guarantees the reimbursement of care provided as part of the \"Coordinated Care Pathway\".","correct":true},{"idx":2,"proposition":"In case of consultation with a medical specialist, the maximum reimbursement rate is guaranteed to the insured if the pathology is serious","correct":false,"justification":"If he is referred by his \"attending physician\""},{"idx":3,"proposition":"A patient between 16 and 25 years of age can consult a psychiatry without losing the usual rate of reimbursement","correct":true},{"idx":4,"proposition":"The use of the psychiatric care system is declining sharply","correct":false,"justification":"Rising sharply"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"soinspsy-psy-2","context":null,"enonce":"Regarding the organization of psychiatric care in France:","item":"soinspsy","matiere":"psy","propositions":[{"idx":0,"proposition":"The prevalence of mental disorders in the general population in France is about 3%","correct":false,"justification":"About 20%"},{"idx":1,"proposition":"The fight against stigmatization of people with psychiatric disorders is still relevant","correct":true},{"idx":2,"proposition":"The HSPT law of 2009 provides for the creation of ARS responsible for defining new health territories relevant to fight against health inequalities.","correct":true},{"idx":3,"proposition":"Psychiatry is the only medical discipline that can provide care without the consent of the person","correct":true},{"idx":4,"proposition":"The different types of care without consent can only be provided by public structures","correct":false,"justification":"The different types of care without consent (full inpatient or outpatient) are most often provided by public psychiatric services, but some private institutions may also provide this type of care."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"soinspsy-psy-4","context":null,"enonce":"Care in psychiatry:","item":"soinspsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Sequential care occurs after the CMP for the follow-up of the compensated patient","correct":false,"justification":"They allow intensive outpatient care"},{"idx":1,"proposition":"Part-time therapeutic reception centres (CATTP) provide therapeutic and occupational activities","correct":true},{"idx":2,"proposition":"Full-time hospitalization corresponds to \"traditional\" hospitalization within the hospital (24 hours a day), during the acute phase of the disease","correct":true},{"idx":3,"proposition":"The after-care centers are very short-stay units to ensure the compensation of the disease in 48 hours","correct":false,"justification":"After-care centres are medium-stay units, transitional units between hospital and return home"},{"idx":4,"proposition":"Care aims to limit disability and support the return to independence","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"soinspsy-psy-5","context":null,"enonce":"Which propositions are true?","item":"soinspsy","matiere":"psy","propositions":[{"idx":0,"proposition":"CMPs are free","correct":true},{"idx":1,"proposition":"The most used care structure in child psychiatry is the HDJ","correct":false,"justification":"This is the CMP"},{"idx":2,"proposition":"CMP and CMPP are the same thing","correct":false,"justification":"The CMPP is out of sector"},{"idx":3,"proposition":"The most widely used care structure in child psychiatry is the CMP","correct":false,"justification":"This is the HDJ"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"soinspsy-psy-7","context":null,"enonce":"Regarding CMPs:","item":"soinspsy","matiere":"psy","propositions":[{"idx":0,"proposition":"These are liberal medical structures","correct":false,"justification":"Multidisciplinary structure (doctors, nurses, social workers, psychologists, ...) public."},{"idx":1,"proposition":"They allow hospital care of decompensated patients","correct":false,"justification":"Management is outpatient"},{"idx":2,"proposition":"The reimbursement of consultations is made within 72 hours","correct":false,"justification":"CMPs are free"},{"idx":3,"proposition":"They are open 24 hours a day","correct":false,"justification":"However, this is the case for PACs."},{"idx":4,"proposition":"They ensure a diversity of care offer","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"soinspsy-psy-8","context":null,"enonce":"Regarding the epidemiology of the impact of mental disorders:","item":"soinspsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Mental disorders account for 15% of disabilities","correct":true},{"idx":1,"proposition":"Mental disorders cause more disability than cardiovascular disease","correct":false,"justification":"As much as cardiovascular disease"},{"idx":2,"proposition":"Mental disorders cause more disability than cancers","correct":true},{"idx":3,"proposition":"About 2% of the French population suffers from mental disorders","correct":false,"justification":"More than 15%"},{"idx":4,"proposition":"Mental disorders account for 30% of life days lost through preventable mortality or disability","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"somatopsy-psy-0","context":null,"enonce":"Regarding somatoform disorders:","item":"somatopsy","matiere":"psy","propositions":[{"idx":0,"proposition":"There are three main somatoform disorders","correct":true},{"idx":1,"proposition":"The distinction between somatoform disorder and psychosomatic disorder is clearly identified and clinically important","correct":false,"justification":"The distinction between somatoform disorder and psychosomatic disorder is not always easy and repeated changes in nosographic classifications have contributed to the confusion."},{"idx":2,"proposition":"The prevalence of somatoform disorders is around 0.1% in adults in the general population","correct":false,"justification":"The prevalence of somatoform disorders is difficult to identify and depends on diagnostic tools and context: it is probably in the range of 5 to 10% for all somatoform disorders in the general adult population (and much more so in a population of medical consultants)"},{"idx":3,"proposition":"Somatization disorder typically begins in late adolescence or young adulthood, at any age for conversion disorder and pain disorder","correct":true},{"idx":4,"proposition":"The ratio by sex is 2:1, with a more frequent presence in women","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"somatopsy-psy-1","context":null,"enonce":"Regarding the disorders:","item":"somatopsy","matiere":"psy","propositions":[{"idx":0,"proposition":"The prevalence of suicide attempts is a function of the depressive psychiatric comorbidity to be systematically sought","correct":true},{"idx":1,"proposition":"The association of multiple polymorphic and long-lasting functional complaints has been called Lighter syndrome","correct":true},{"idx":2,"proposition":"Symptoms and signs do not respect the anatomical organization of the central or peripheral nervous system in conversion disorder","correct":true},{"idx":3,"proposition":"In the case of the painful symptom, it is pain whose intensity must be evaluated by a visual analogue scale","correct":true},{"idx":4,"proposition":"We speak of acute painful symptoms if the duration is less than 6 months","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"fievrechr-infectio-0","context":null,"enonce":"Regarding prolonged fever:","item":"fievrechr","matiere":"infectio","propositions":[{"idx":0,"proposition":"A prolonged fever is defined as a temperature above 38°C for more than 3 weeks.","correct":true},{"idx":1,"proposition":"10% of prolonged fevers remain without identified etiology, and then require patient monitoring","correct":true,"justification":""},{"idx":2,"proposition":"The temperature is taken, at best, just after the meal","correct":false,"justification":"The temperature is taken away from meals and after 20 minutes of rest"},{"idx":3,"proposition":"The axillary or oral routes are usually used and the measured temperature must be increased by 2°C to obtain the core temperature.","correct":false,"justification":"The axillary or oral tract is usually used: the measured temperature must be increased by 0.5°C to obtain the core temperature"},{"idx":4,"proposition":"The drugs mainly involved in prolonged fivres are antibiotics (ßlactams, rifampicin ...), antiepileptics and antiarrhythmics","correct":true,"justification":"Iatrogenic etiology is one of the elimination diagnoses"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"fievrechr-infectio-2","context":null,"enonce":"Concerant prolonged fevers:","item":"fievrechr","matiere":"infectio","propositions":[{"idx":0,"proposition":"It will be necessary to look for a dental or sinus focus ","correct":true},{"idx":1,"proposition":"Malignant diseases are responsible for 20 to 30% of prolonged fevers","correct":true},{"idx":2,"proposition":" \"HORTON's disease is the most common immunoinflammatory cause\"","correct":true},{"idx":3,"proposition":"In case of drug cause, fever usually occurs between 7 and 28 days after the introduction of a new treatment","correct":true},{"idx":4,"proposition":"Hypereosinophilia is present in only 20% of drug-induced fever cases","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"fievrechr-infectio-3","context":null,"enonce":"What is the threshold for defining the prolonged nature of a fever?","item":"fievrechr","matiere":"infectio","propositions":[{"idx":0,"proposition":"7 days","correct":false,"justification":"3 weeks"},{"idx":1,"proposition":"2 weeks","correct":false,"justification":"3 weeks"},{"idx":2,"proposition":"3 weeks","correct":true,"justification":"True. A prolonged fever is defined as a body temperature above 38.3 degrees Celsius for more than three weeks."},{"idx":3,"proposition":"1 month","correct":false,"justification":"3 weeks"},{"idx":4,"proposition":"Three months","correct":false,"justification":"3 weeks"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"reactioninfl-infectio-0","context":null,"enonce":"Regarding the inflammatory reaction in general:","item":"reactioninfl","matiere":"infectio","propositions":[{"idx":0,"proposition":"Inflammatory diseases are the leading cause of death","correct":false,"justification":"It is the third leading cause of global mortality, after cancer (1) and cardiovascular disease (2)"},{"idx":1,"proposition":"About 30% of hospitalized patients have a general inflammatory reaction","correct":true},{"idx":2,"proposition":"Inflammatory diseases are often accompanied by AEG","correct":true,"justification":"AEG = anorexia, weight loss, asthenia"},{"idx":3,"proposition":"The 4 clinical signs of inflammation are: redness, warmth, pain, effusion","correct":false,"justification":"The 4 cardinal signs are rougueur, pain, edema and heat"},{"idx":4,"proposition":"Hypotermia eliminates the possibility of an inflammatory reaction","correct":false,"justification":"Some inflammatory diseases are accompanied by a body temperature < 36 degrees Celsius"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"reactioninfl-infectio-1","context":null,"enonce":"Which molecules are classically increased during an inflammatory reaction?","item":"reactioninfl","matiere":"infectio","propositions":[{"idx":0,"proposition":"The CRP","correct":true,"justification":"Within 24 hours"},{"idx":1,"proposition":"The VS","correct":true},{"idx":2,"proposition":"Ferritin","correct":true},{"idx":3,"proposition":"Albumin","correct":false,"justification":"Albumin is decreased. This is clearly seen in protein electrophoresis"},{"idx":4,"proposition":"Transthyrein","correct":false,"justification":"It is one of the diminished proteins"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"reactioninfl-infectio-2","context":null,"enonce":"What can be the causes of a normal ESR inflammatory syndrome?","item":"reactioninfl","matiere":"infectio","propositions":[{"idx":0,"proposition":"Leukocytosis","correct":true},{"idx":1,"proposition":"Kidney failure","correct":false,"justification":"Renal failure increases ESR (even without inflammatory syndrome)"},{"idx":2,"proposition":"Polyclonal hypergammaglobulinemia","correct":false,"justification":"Polyclonal hypergammaglobulinemia increases ESR, even in the absence of an inflammatory syndrome"},{"idx":3,"proposition":"Associated sickle cell disease","correct":true},{"idx":4,"proposition":"Dysthyroidism","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"FdRCV-cardio-0","context":null,"enonce":"Which of these proposals concerning cardiovascular prevention are true?","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"proposition":"A risk factor is a clinical or biological element associated with an increased risk of developing a disease, with a causal relationship between the factor and the disease.","correct":true,"justification":"In the case of a statistical association without a causal relationship, we speak of a risk marker"},{"idx":1,"proposition":"Removal or reduction of a risk marker does not change the course of a disease","correct":true,"justification":"A risk marker is not causally linked to the disease"},{"idx":2,"proposition":"Framingham study estimates cardiovascular mortality at 10 years","correct":false,"justification":"Risk of cardiovascular events, not mortality"},{"idx":3,"proposition":"In individual prevention, the effect of a prevention program is all the greater the higher the risk of the disease","correct":true},{"idx":4,"proposition":"Aspirin is systematically indicated for secondary prevention of cardiovascular risk","correct":true,"justification":"After a vascular event, the risk is considered very high, aspirin has a benefit"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"FdRCV-cardio-1","context":null,"enonce":"Which of these proposals concerning cardiovascular prevention are true?","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"proposition":"An absolute risk makes it possible to estimate the risk of an event in an individual over time","correct":true,"justification":"While relative risk allows for comparison"},{"idx":1,"proposition":"Absolute cardiovascular deaths lower in women than in men","correct":false,"justification":"The absolute number of cardiovascular deaths is higher in women (54%), but before age 65 the cardiovascular mortality of men is 3 to 4 times higher than that of women"},{"idx":2,"proposition":"The SCORE depends among other things on the LDLc level","correct":false,"justification":"Total cholesterol or HDLc, but not LDLc"},{"idx":3,"proposition":"The SCORE is valid for any adult under 65 years of age","correct":false,"justification":"The SCORE is valid between 40 and 65 years only"},{"idx":4,"proposition":"Dairy products are associated with increased cardiovascular risk","correct":false,"justification":"On the other hand, red meat is."}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"FdRCV-cardio-2","context":null,"enonce":"Which of these proposals concerning cardiovascular prevention are true?","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Nicotine promotes coronary spasms","correct":true,"justification":"By sympathetic stimulation"},{"idx":1,"proposition":"Smoking lowers LDL-cholesterol levels and increases HDL-cholesterol levels","correct":false,"justification":"Lowering of HDL-cholesterol levels and increased oxidation of LDL-cholesterol, which participates in atherogenesis"},{"idx":2,"proposition":"SCORE tends to underestimate cardiovascular risk in desocialized patients","correct":true},{"idx":3,"proposition":"Sleep apnea syndrome increases cardiovascular risk by 70%","correct":true},{"idx":4,"proposition":"Erectile dysfunction is a cardiovascular risk factor","correct":false,"justification":"A risk marker"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"FdRCV-cardio-3","context":null,"enonce":"Which of these proposals concerning cardiovascular prevention are true?","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"proposition":"The share attributable to smoking in the occurrence of myocardial infarction is all the more important the younger the subjects","correct":true},{"idx":1,"proposition":"The risk of developing an abdominal aortic aneurysm is significantly increased in smokers","correct":true},{"idx":2,"proposition":"A high cardiovascular risk corresponds to a SCORE of 5-10%","correct":true},{"idx":3,"proposition":"Elevated fibrinogen is associated with coronary cardiovascular excess risk","correct":true},{"idx":4,"proposition":"High blood pressure exposes more to cerebrovascular risk than coronary risk","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"FdRCV-cardio-4","context":null,"enonce":"Which of these proposals concerning cardiovascular prevention are true?","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Dyslipidemia is a minor cardiovascular risk factor","correct":false,"justification":"They are a major risk factor"},{"idx":1,"proposition":"An EAL includes a determination of TG, LDLc and HDLc","correct":false,"justification":"LDLc is calculated, according to Friedewald's formula"},{"idx":2,"proposition":"Hypercholesterolemia is mainly due to too high intakes of unsaturated fatty acids","correct":false,"justification":"In saturated fatty acids"},{"idx":3,"proposition":"The diagnosis of hypertension is made on a single measurement when the blood pressure is greater than 180\/60 mmHg","correct":false,"justification":"The diagnosis of hypertension should not be made on a single measurement"},{"idx":4,"proposition":"A normal EAL should be rechecked at 5 years in the absence of an intercurrent event","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"FdRCV-cardio-5","context":null,"enonce":"Which of these proposals concerning cardiovascular prevention are true?","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"proposition":"The ambulatory measurement of blood pressure (MAPA) eliminates a \"white coat\" effect related to the presence of the doctor","correct":true},{"idx":1,"proposition":"A screening EAL is recommended for an 85-year-old smoker","correct":false,"justification":"No screening EAL indicated after age 80"},{"idx":2,"proposition":"A 45-year-old type 1 diabetic with no other cardiovascular risk factors or organ damage has a moderate cardiovascular risk","correct":false,"justification":"High cardiovascular risk"},{"idx":3,"proposition":"Abdominal obesity is an indispensable criterion in the diagnosis of metabolic syndrome","correct":false,"justification":"It is no longer an indispensable criterion"},{"idx":4,"proposition":"About 20 million French people are overweight, including 6 million obese","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"FdRCV-cardio-6","context":null,"enonce":"Which of the following are non-modifiable cardiovascular risk factors?","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Chronic renal failure","correct":false,"justification":"Modifiable because it can be taken care of and made sure that it is no longer a risk factor"},{"idx":1,"proposition":"Dyslipidemia","correct":false,"justification":"Non-pharmacological and pharmacological management"},{"idx":2,"proposition":"Age","correct":true},{"idx":3,"proposition":"Sex","correct":true},{"idx":4,"proposition":"Heredity","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"FdRCV-cardio-7","context":null,"enonce":"Which of the following designate situations in which the SCORE table is not usable?","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Diabetic patient","correct":true},{"idx":1,"proposition":"Smoking patient","correct":false,"justification":"Smoking taken into account"},{"idx":2,"proposition":"Elderly patient","correct":false,"justification":"Age"},{"idx":3,"proposition":"Chronic renal failure patient","correct":true},{"idx":4,"proposition":"Hypertensive patient","correct":false,"justification":"Systolic BP taken into account"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"FdRCV-cardio-9","context":null,"enonce":"Which of the following proposals fall within the scope of metabolic syndrome?","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Fasting blood glucose","correct":true},{"idx":1,"proposition":"Waist circumference","correct":true},{"idx":2,"proposition":"Blood pressure","correct":true},{"idx":3,"proposition":"LDL cholesterol","correct":false,"justification":"False"},{"idx":4,"proposition":"Triglyceridemia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TNC-neuro-0","context":null,"enonce":"Regarding delirium syndrome:","item":"TNC","matiere":"neuro","propositions":[{"idx":0,"proposition":"The diagnosis is biological","correct":false,"justification":"Purely clinical"},{"idx":1,"proposition":"A rise in cortisol levels can precipitate or maintain delirium","correct":true},{"idx":2,"proposition":"Oxidative brain metabolism is decreased","correct":true,"justification":"It is believed that the cholinergic system is largely involved"},{"idx":3,"proposition":"It corresponds to acute and severe brain dysfunction","correct":true},{"idx":4,"proposition":"It is responsible for an increase in morbidity and mortality in the following year.","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"TNC-neuro-1","context":null,"enonce":"Which of these proposals are part of the DSM-V diagnostic criteria?","item":"TNC","matiere":"neuro","propositions":[{"idx":0,"proposition":"Attention disturbance","correct":true,"justification":"It is the decrease in the ability to lead, focus, support and shift attention."},{"idx":1,"proposition":"Installation in a chronic mode","correct":false,"justification":"The installation is on a short time, from a few hours to a few days"},{"idx":2,"proposition":"It is necessary to highlight a break with the previous state","correct":true,"justification":"In particular through the interrogation of a relative"},{"idx":3,"proposition":"The increase in billirubine","correct":false,"justification":"No biological criteria. The diagnosis is purely clinical"},{"idx":4,"proposition":"There are 5 criteria in total","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TTTKc-onco-0","context":null,"enonce":"Regarding 5-FU, which propositions are true?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Its full name is: 5-Fermanto-Uracile","correct":false,"justification":"5-Fluorouracil"},{"idx":1,"proposition":"It is an analogue of guanine","correct":false,"justification":"It is an analogue of pyrmidines (bases C, T and U)"},{"idx":2,"proposition":"It is an inhibitor of topoisomerases type II","correct":false,"justification":"Toposiomerase type 2 inhibitors are etoposide and anthracycline"},{"idx":3,"proposition":"It has heart type side effects","correct":true},{"idx":4,"proposition":"It has respiratory type side effects","correct":false,"justification":"It is not described in the college"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TTTKc-onco-1","context":null,"enonce":"Which of these proposals is, or are, type 2 topoisomerase inhibitors?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Etoposide","correct":true},{"idx":1,"proposition":"Cyclophospamide","correct":false,"justification":"It is an alkylating agent"},{"idx":2,"proposition":"The 5-FU","correct":false,"justification":"It is an antimetabolic (analogue of pyramidin)"},{"idx":3,"proposition":"Anthracycline","correct":true},{"idx":4,"proposition":"Cisplatin","correct":false,"justification":"It is a platinum salt"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TTTKc-onco-2","context":null,"enonce":"Which of these propositions is, or is, or is, true with respect to platinum salts?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Cisplatin is one of them","correct":true},{"idx":1,"proposition":"Oxaliplatin is one of them","correct":true},{"idx":2,"proposition":"Carboplatin is one of them","correct":true,"justification":"The three platinum salts are: cisplatin, oxaliplatin and carboplatin"},{"idx":3,"proposition":"These compounds are DNA alkylating agents","correct":true},{"idx":4,"proposition":"Cisplatin has renal toxicity that may cause acute tubular necrosis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TTTKc-onco-3","context":null,"enonce":"Which of these proposals are, or are, expected adverse effects of hydroxyurea?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Disruption of the blood count","correct":true,"justification":"Hydroxyurea is a myelosupressor: penias can be observed (leukopenia, thrombocytopenia, or even macrocytic anemia)"},{"idx":1,"proposition":"Lung damage","correct":false},{"idx":2,"proposition":"Heart damage","correct":false},{"idx":3,"proposition":"Digestive disorders","correct":false},{"idx":4,"proposition":"Skin damage","correct":true,"justification":"Ulcers in particular"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TTTKc-onco-4","context":null,"enonce":"Which of these proposals are, or are, folic antimetabolics?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Mehotrexate","correct":true},{"idx":1,"proposition":"The 5-FU","correct":false,"justification":"It is a pyrimide antimetabolic, along with gemcitabine"},{"idx":2,"proposition":"Thiopurine","correct":false},{"idx":3,"proposition":"Cyclophosphamide","correct":false,"justification":"It is an alkylating agent"},{"idx":4,"proposition":"Pemetrexed","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TTTKc-onco-5","context":null,"enonce":"Which of these proposals are, or are, stabilizers of the spindle?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Docetaxel","correct":true},{"idx":1,"proposition":"Etoposide","correct":false,"justification":"It is a type 2 topoisomerase inhibitor"},{"idx":2,"proposition":"Anthracycline","correct":false,"justification":"It is a type 2 topoisomerase inhibitor"},{"idx":3,"proposition":"Paclitaxel","correct":true},{"idx":4,"proposition":"Taxanes","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TTTKc-onco-6","context":null,"enonce":"Which of the following are true about Denosumab?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"It is a bi-phosphonate","correct":false,"justification":"None"},{"idx":1,"proposition":"It is an anti-RANK-L antibody","correct":true},{"idx":2,"proposition":"It decreases bone resorption","correct":true},{"idx":3,"proposition":"There is a risk of hypocalcemia","correct":true},{"idx":4,"proposition":"It reduces bone pain","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TTTKc-onco-7","context":null,"enonce":"Which of the following is true?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Platinum salts block chromosome depolymerization","correct":false,"justification":"This is the case with depolymerase inhibitors (taxanes such as Paclitaxel)"},{"idx":1,"proposition":"Platinum salts cause adducts with DNA inhibiting its replication","correct":true,"justification":"True, these are alkylating agents"},{"idx":2,"proposition":"Platinum salts inhibit folate synthesis","correct":false,"justification":"This is the case of antimetabolics"},{"idx":3,"proposition":"Platinum salts inhibit the action of topoisomerase I","correct":false,"justification":"This is the case of Tecans (irinotecan and topotecan)"},{"idx":4,"proposition":"Platinum salts inhibit the action of topoisomerase II","correct":false,"justification":"This is the case for anthracyclines and etoposide"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TTTKc-onco-8","context":null,"enonce":"Which of the following are the toxicities of platinum salts?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Renal toxicity ","correct":true},{"idx":1,"proposition":"Cardiotoxicity","correct":false,"justification":"This is the case of 5-FU (coronary spasm) and anthracyclines (dilated cardiomyopathy)"},{"idx":2,"proposition":"Ototoxicity","correct":true},{"idx":3,"proposition":"Peripheral neuropathy","correct":true,"justification":"True, neuropathy in cold"},{"idx":4,"proposition":"Pulmonary fibrosis","correct":false,"justification":"This is the case of bleomycin"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TTTKc-onco-10","context":null,"enonce":"Which of the following are recommended before starting Denosumab therapy?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Oral check-up","correct":true},{"idx":1,"proposition":"ECG and ETT","correct":false,"justification":"No cardiac toxicity"},{"idx":2,"proposition":"Calciuria","correct":false,"justification":"Useless"},{"idx":3,"proposition":"X-rays of the skeleton","correct":false,"justification":"Useless"},{"idx":4,"proposition":"Calculation of corrected serum calcium","correct":true,"justification":"True, in front of the risk of hypercalcemia"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TTTKc-onco-11","context":null,"enonce":"Which of the following are complications of an autologous transplant?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Febrile aplasia","correct":true},{"idx":1,"proposition":"Need to transfuse","correct":true},{"idx":2,"proposition":"Graft vs host reaction (GvH)","correct":false,"justification":"The \"plugin\" comes from the host"},{"idx":3,"proposition":"Failure","correct":false,"justification":"The \"plugin\" comes from the host"},{"idx":4,"proposition":"Mucite","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"TTTKc-onco-12","context":null,"enonce":"Which of the following are true?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Anthracyclines have cumulative cardiac toxicity","correct":true},{"idx":1,"proposition":"Taxanes are spindle poisons","correct":true},{"idx":2,"proposition":"Cyclophosphamide is a platinum salt","correct":false,"justification":"It is an alkylating agent"},{"idx":3,"proposition":"Trastuzumab poses risk of myocardial toxicity","correct":true},{"idx":4,"proposition":"Anti-pyrimides are topoisomerase inhibitors","correct":false,"justification":"They are anti-metaboblic"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TTTKc-onco-13","context":null,"enonce":"Which of the following are true for bentuximab?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"It is an anti-CD30 monoclonal antibody","correct":true},{"idx":1,"proposition":"It is a tyrosine kinase inhibitor","correct":false,"justification":"False, this is the case of Jakavi for example"},{"idx":2,"proposition":"It is administered orally","correct":false,"justification":"It is administered intravenously"},{"idx":3,"proposition":"There is a risk of peripheral neuropathy","correct":true},{"idx":4,"proposition":"It is conjugated to a spindle poison","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"TTTKc-onco-14","context":null,"enonce":"Which of the following proposals regarding the adverse effects of brain radiotherapy are true?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Cerebral focal radionecrosis","correct":true,"justification":"True, remote"},{"idx":1,"proposition":"Cerebral edema","correct":true,"justification":"True, in acute"},{"idx":2,"proposition":"Radiation leukoencephalopathy","correct":true,"justification":"True, remote"},{"idx":3,"proposition":"Cognitive impairment","correct":true,"justification":"True, due to transient diffuse demyelination"},{"idx":4,"proposition":"Fever","correct":true,"justification":"True, acute, but it's rare"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"anapathKc-onco-0","context":null,"enonce":"Which of these proposals make it possible to study isolated cells?","item":"anapathKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Biopsy of a VADS tumor","correct":false,"justification":"Biopsies of solid tumours extract tissue, not isolated cells."},{"idx":1,"proposition":"Biopsy of a gastric tumor induced by H. Pylori","correct":false,"justification":"Biopsies of solid tumours extract tissue, not isolated cells."},{"idx":2,"proposition":"A blood test","correct":true},{"idx":3,"proposition":"A urine sample","correct":true},{"idx":4,"proposition":"A myelogram","correct":true,"justification":"While the BOM makes it possible to study the fabric"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"anapathKc-onco-2","context":null,"enonce":"Among these colorations, which one or which ones make it possible to highlight Iron?","item":"anapathKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Perls","correct":true,"justification":"It makes it possible to highlight the iron fixed in hemosiderin colored blue by Prussian blue; The nuclei are highlighted by nuclear red."},{"idx":1,"proposition":"Hemalun-Eosin","correct":false,"justification":"Classic fabrics"},{"idx":2,"proposition":"Polarized light","correct":false,"justification":"Be careful, it does not count as a coloring. This is a different microscopy technique"},{"idx":3,"proposition":"Red Congo","correct":false,"justification":"Amyloid deposits"},{"idx":4,"proposition":"Grocott","correct":false,"justification":"It is used in histology for the visualization of fungi, certain pathogens, basement membranes"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"anapathKc-onco-4","context":null,"enonce":"Which of these stains can highlight lipids?","item":"anapathKc","matiere":"onco","propositions":[{"idx":0,"proposition":"India ink","correct":false},{"idx":1,"proposition":"Perls","correct":false},{"idx":2,"proposition":"Black Sudan","correct":true,"justification":"Sudan dyes are synthetic dyes characterized by a nitrogen group. Their main property is to be soluble in hydrocarbons, oils, fats and waxes, which are then colored."},{"idx":3,"proposition":"Formalin","correct":false,"justification":"It is not a coloring but a fixing agent"},{"idx":4,"proposition":"Ziehl","correct":false,"justification":"It is the dye used to highlight Acid-Alcohol-Resistant Bacilli (tuberculosis bacilli)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemgenitale-gyn-0","context":null,"enonce":"General:","item":"hemgenitale","matiere":"gyn","propositions":[{"idx":0,"proposition":"Genital bleeding is a very rare reason for consultation in general practice","correct":false,"justification":"Frequent reason for consultation"},{"idx":1,"proposition":"The main etiology is urinary tract infection","correct":false,"justification":"2 main etiologies: hormonal dysfunctions + pregnancy"},{"idx":2,"proposition":"Pregnancy is a leading cause of genital bleeding","correct":true},{"idx":3,"proposition":"The essential complementary examination is the LH\/FSH assay","correct":false,"justification":"This is ultrasound"},{"idx":4,"proposition":"They are therefore not limited to uterine haemorrhages","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"hemgenitale-gyn-1","context":null,"enonce":"General:","item":"hemgenitale","matiere":"gyn","propositions":[{"idx":0,"proposition":"A distinction is made between vulvar hemorrhages, vaginal hemorrhages and cervical hemorrhages","correct":true,"justification":"These are the three subtypes of hemorrhages"},{"idx":1,"proposition":"In case of suspicion of adenomyosis, MRI is indicated","correct":true},{"idx":2,"proposition":"Postmenopausal endometrial cancer should be suspected","correct":true},{"idx":3,"proposition":"Upper genital hemorrhage originates from the cervix","correct":false,"justification":"This would be a lower genital hemorrhage. High = hutterine cavity externalized by the cervix"},{"idx":4,"proposition":"The duration of normal menstruation is between 3 and 6 days","correct":true,"justification":"Normal abundance is between 50 and 80 mL"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemgenitale-gyn-2","context":null,"enonce":"Regarding abnormal bleeding during menstruation:","item":"hemgenitale","matiere":"gyn","propositions":[{"idx":0,"proposition":"Conventionally the periods are more abundant the first 3 days and less abundant thereafter","correct":true},{"idx":1,"proposition":"Normal period blood is coagulable, like venous blood","correct":false,"justification":"Normal period blood is incoagulable"},{"idx":2,"proposition":"Menorrhagia.","correct":true},{"idx":3,"proposition":"Polymenorrhea are menorrhagia","correct":true,"justification":"Rules with anomalies of duration and abundance"},{"idx":4,"proposition":"The prevalence of menometrorrhagia is around 1% in the general population","correct":false,"justification":"Between 11 and 13%"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"hemgenitale-gyn-4","context":null,"enonce":"Regarding genital bleeding:","item":"hemgenitale","matiere":"gyn","propositions":[{"idx":0,"proposition":"Functional metrorrhagia are due to endometrial alteration","correct":true,"justification":"Often caused by an imbalance in the estrogen-progestin balance"},{"idx":1,"proposition":"Functional menorrhagia is non-existent","correct":false,"justification":"It can exist"},{"idx":2,"proposition":"Organic bleeding affects the cervix most often","correct":false,"justification":"Uterine, tubal or ovarian pathology. Bleeding from the cervix is part of lower genital bleeding"},{"idx":3,"proposition":"The causes of menoage and metrorrhagia are often intertwined","correct":true,"justification":"Especially non-menopausal"},{"idx":4,"proposition":"Genital bleeding is not limited to uterine hemorrhages","correct":true,"justification":"They are due to a permanent or temporary alteration of the endometrium caused by a hormonal imbalance of the estrogen-progestin balance"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"bioT-rhumato-0","context":null,"enonce":"Some general generalities:","item":"bioT","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Biotherapies have existed for a hundred years","correct":false,"justification":"Rather fifteen years"},{"idx":1,"proposition":"Biotherapies are molecules taken from the human body and injected in large quantities into sick people","correct":false,"justification":"They are substances produced and purified from the use of living organisms for the purpose of treating diseases"},{"idx":2,"proposition":"Background treatments are opposed to symptomatic treatments","correct":true},{"idx":3,"proposition":"DMARDs are Drug Modifing the Activity of the Rheumatic Disease","correct":true},{"idx":4,"proposition":"Synthetic and biological DMARDs are separated","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"bioT-rhumato-1","context":null,"enonce":"Regarding the nomenclature:","item":"bioT","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Methotrexate is a csDMARD","correct":true},{"idx":1,"proposition":"A distinction is made between original bDMARDs (boDMARDs) and biosimilar bDMARDs (bsDMARDs)","correct":true},{"idx":2,"proposition":"Biosimilars are copies of the original molecules but require the same technology to produce them.","correct":true},{"idx":3,"proposition":"The boDMARD are cheaper than the bsDMARDs","correct":false,"justification":"It's the other way around"},{"idx":4,"proposition":"-mumab are chimeric antibodies","correct":false,"justification":"They are completely humanized ACs"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"bioT-rhumato-2","context":null,"enonce":"Which propositions are true?","item":"bioT","matiere":"rhumato","propositions":[{"idx":0,"proposition":"The tsDMARDs are the targeted synthetic DMARDs","correct":true},{"idx":1,"proposition":"The bsDMARDs are the biological original DMARDs","correct":false,"justification":"These are the biosimilars"},{"idx":2,"proposition":"There are twelve biotherapies that have a MA in chronic inflammatory rheumatism and autoimmune diseases","correct":true},{"idx":3,"proposition":"The prescription of biomedicines is governed by an initial hospital prescription (PIH)","correct":true},{"idx":4,"proposition":"The first-line prescription in osteoarthritis is methotrexate","correct":false,"justification":"In RA"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"bioT-rhumato-3","context":null,"enonce":"Regarding the indications for targeted therapies:","item":"bioT","matiere":"rhumato","propositions":[{"idx":0,"proposition":"If contraindications to methotrexate in RA are prescribed.","correct":false,"justification":"Leflunomide if CI to methotrexate in RA"},{"idx":1,"proposition":"In RA, it is generally advisable to combine biotherapy with DMARD","correct":true},{"idx":2,"proposition":"Anti-TNF have indications in some SpA","correct":true},{"idx":3,"proposition":"Secukinumab has MA for ankylosing spondylitis","correct":true},{"idx":4,"proposition":"Secukinumab has MA only in ankylosing spondylitis","correct":false,"justification":"Also in psoriatic arthritis"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"transfusion-therapeutique-0","context":null,"enonce":"What are the indications for phenotyped red blood cells?","item":"transfusion","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Immunological thrombocytopenic purpura","correct":false,"justification":"No indication"},{"idx":1,"proposition":"Sickle-cell anemia","correct":true},{"idx":2,"proposition":"The woman in immediate post-menopause","correct":false,"justification":"The young woman, until menopause"},{"idx":3,"proposition":"IgG deficiency","correct":false,"justification":"Unless at risk of repetitive transfusions"},{"idx":4,"proposition":"Rhesus alloimmunization","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"acroSd-cardio-0","context":null,"enonce":"Which of these substances can cause secondary Raynaud's syndrome?","item":"acroSd","matiere":"cardio","propositions":[{"idx":0,"proposition":"Amiodarone","correct":false,"justification":"Class III antiarrhythmic according to the Vaughan-Williams classification. It delays the repolarization of the heart cell and extends the refractory period of the latter homogeneously. It has no significant effect on vasoconstriction of finger arteries."},{"idx":1,"proposition":"Beta-2 mimetics","correct":false,"justification":"It is the beta-blockers that cause peripheral vasoconstriction"},{"idx":2,"proposition":"Some chemotherapies","correct":true},{"idx":3,"proposition":"Les IEC","correct":false,"justification":"ACE inhibitors (which then reduce the production of angiotensin II) do not have significant effects on the arteries of the hands"},{"idx":4,"proposition":"Calcium channel blockers","correct":false,"justification":"calcium channel blockers, such as nifedipine or amlodipine, reduce the number of seizures and decrease their severity through their vasodilator effect"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"acroSd-cardio-1","context":null,"enonce":"Which of these proposals concerning Raynaud's syndrome is true?","item":"acroSd","matiere":"cardio","propositions":[{"idx":0,"proposition":"The syncopal phase is the final phase","correct":false,"justification":"This is the first phase"},{"idx":1,"proposition":"The syncopal phase begins the phenomenon","correct":true},{"idx":2,"proposition":"The syncopal phase is painful","correct":false,"justification":"It is painless"},{"idx":3,"proposition":"During the syncopal phase, the fingers are red","correct":false,"justification":"They are white and cold"},{"idx":4,"proposition":"The syncopal phase is accompanied by cutaneous hyperesthesia","correct":false,"justification":"Rather, there is cutaneous hypoaesthesia"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"acroSd-cardio-2","context":null,"enonce":"Which propositions are true?","item":"acroSd","matiere":"cardio","propositions":[{"idx":0,"proposition":"Raynaud's phenomenon is the most common acrosyndrome.","correct":true},{"idx":1,"proposition":"Acrosyndromes may be accompanied by trophic disorders","correct":true},{"idx":2,"proposition":"Scleroderma may accompany Raynaud's phenomenon","correct":true},{"idx":3,"proposition":"Raynaud's disease is the only etiology of Raynaud's phenomenon","correct":false,"justification":"Raynaud's phenomenon can have many etiologies: Rayaud's disease, scleroderma, Leo Burger, ..."},{"idx":4,"proposition":"Essential acrocyanosis finds hot and painful extremities","correct":false,"justification":"In essential acrocyanosis, the extremities are purple, cold, clammy and painless."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"acroSd-cardio-3","context":null,"enonce":"Which of these proposals are acrosyndromes?","item":"acroSd","matiere":"cardio","propositions":[{"idx":0,"proposition":"Rheumatoid purpura","correct":false},{"idx":1,"proposition":"Frostbite","correct":true,"justification":"Skin lesions after exposure to cold and\/or moisture"},{"idx":2,"proposition":"Livedo","correct":false},{"idx":3,"proposition":"PAD","correct":false},{"idx":4,"proposition":"Essential acrocyanosis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"acroSd-cardio-4","context":null,"enonce":"Regarding Leo Buerger's disease:","item":"acroSd","matiere":"cardio","propositions":[{"idx":0,"proposition":"It is also called Thromboangiitis Obliterans","correct":true},{"idx":1,"proposition":"It is characterized by segmental and inflammatory obliteration of medium and small vessels","correct":true},{"idx":2,"proposition":"Tobacco is a protective factor","correct":false,"justification":"The role of tobacco appears essential in the initiation and clinical aggravation of the disease."},{"idx":3,"proposition":"It is benign and does not require further examination","correct":false,"justification":"An underlying immunological cause or thrombophilia (inflammatory or immunological assessment for ANCA, antiphospholipid antibodies, or antinuclear antibodies) must be ruled out and imaging tests are often required"},{"idx":4,"proposition":"Calcium channel blockers are proposed as a first-line treatment","correct":false,"justification":"There is currently no specific treatment for Buerger's disease. Only smoking cessation has been shown to be effective"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"PKRAD-nephro-0","context":null,"enonce":"The basics of autosomal dominant polycystic kidney disease (ADPKD):","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"Autosomal dominant polycystic kidney disease has a prevalence of 1\/1,000 in the general population","correct":true},{"idx":1,"proposition":"It causes about 60-80% of end-stage renal failure","correct":false,"justification":"The leading cause of ESRD is hypertensive nephropathy. ADPKD is responsible for 8-10% of IRTs"},{"idx":2,"proposition":"Transmission of the disease occurs in an autosomal dominant manner","correct":true},{"idx":3,"proposition":"The gene concerned is located on the Y chromosome","correct":false,"justification":"It is either chromosome 16 (for PKD1) or chromosome 4 (for PKD2)"},{"idx":4,"proposition":"ADPKD is genetically heterogeneous","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"PKRAD-nephro-1","context":null,"enonce":"Which propositions are true?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"PKD2 is more common than PKD1","correct":false,"justification":"It's the opposite: the frequency of PKD1 is 85%"},{"idx":1,"proposition":"About 5% of patients have a de novo mutation","correct":true},{"idx":2,"proposition":"Abdominal ultrasound can evoke the diagnosis","correct":true},{"idx":3,"proposition":"The diagnosis is most often made from the age of 60, when renal failure becomes terminal","correct":false,"justification":"It is usually in young adults (hypertension, abdominal thinker, etc.)"},{"idx":4,"proposition":"After the age of 40, the presence of less than 2 cysts excludes the disease","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PKRAD-nephro-2","context":null,"enonce":"Which propositions are true?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"Ultrasound has a higher sensitivity than CT scan","correct":false,"justification":"The scanner is more sensitive to detect"},{"idx":1,"proposition":"Cysts are multiple and bilateral most often","correct":true},{"idx":2,"proposition":"Cysts are responsible for compression and progressive fibrosis of the non-cystic renal parenchyma","correct":true},{"idx":3,"proposition":"ADPKD is therefore glomerular nephropathy","correct":false,"justification":"Tubulointerstitial nephropathy"},{"idx":4,"proposition":"Cysts are fluid cavities","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PKRAD-nephro-3","context":null,"enonce":"Which propositions are true?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"The exact characterization of the mutation in question is essential","correct":false,"justification":"Being a polygenic disease, with relatively independent management of the type of mutation, accurate genetic analysis is both complex and unnecessary"},{"idx":1,"proposition":"The mode of transmission concerns gonosomes","correct":false,"justification":"Chromosome 4 (PKAD 2) and 16 (PKAD 1) mostly"},{"idx":2,"proposition":"It is the cause of about 10% of ESRD","correct":true},{"idx":3,"proposition":"It requires a family tree for the identification and monitoring of relatives","correct":true},{"idx":4,"proposition":"It is linked to de novo mutations in 90% of cases","correct":false,"justification":"5 %"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PKRAD-nephro-4","context":null,"enonce":"What are the symptoms possibly caused by autosomal dominant polycystic kidney disease?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"Macroscopic hematuria","correct":true},{"idx":1,"proposition":"High blood pressure","correct":true},{"idx":2,"proposition":"Testicular torsion","correct":false,"justification":"No link mentioned in the college"},{"idx":3,"proposition":"Major glomerulopathy","correct":false,"justification":"It is a tubulointerstitial disease"},{"idx":4,"proposition":"Vasculitis","correct":false,"justification":"No link mentioned in the college"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PKRAD-nephro-5","context":null,"enonce":"What are the symptoms possibly caused by autosomal dominant polycystic kidney disease?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"Chronic renal failure","correct":true},{"idx":1,"proposition":"A urinary tract infection","correct":true},{"idx":2,"proposition":"Severe acute pyelonephritis","correct":true},{"idx":3,"proposition":"A ruptured cerebral aneurysm","correct":true},{"idx":4,"proposition":"Severe hypertension","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"PKRAD-nephro-6","context":null,"enonce":"Regarding the conscriptive cerebrity aneurysms of PKAD:","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"They are linked to the PKD2 gene only","correct":false,"justification":"PKD1 and PKD2"},{"idx":1,"proposition":"The prevalence of cerebral aneurysms is 40% in case of confirmed PKAD","correct":false,"justification":"8%, or 16% in case of family history of aneurysm. In the general population, the prevalence is 1.5%"},{"idx":2,"proposition":"They sit preferentially within the Willis polygon","correct":true},{"idx":3,"proposition":"The average age of rupture is 81 years","correct":false,"justification":"Much younger: at 41"},{"idx":4,"proposition":"Screening angio-MRI should be offered before age 50 to first-degree relatives of PKRAD patients who have ruptured a cerebral aneurysm","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PKRAD-nephro-7","context":null,"enonce":"Which of the following are true?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"A brain aneurysm should be routinely tested for by MRI angiography in all patients with ADPKD","correct":false,"justification":"False. Only if a patient has a 1st degree family history of brain aneurysm, or if the patient is doing a risky job (e.g. airline pilot)"},{"idx":1,"proposition":"In a family with ADPKD, an unaffected person does not transmit the disease","correct":true},{"idx":2,"proposition":"About 5% of patients have a de novo mutation, i.e. one not transmitted by a parent","correct":true},{"idx":3,"proposition":"When faced with the diagnosis of ADPKD, it is not currently indicated to identify the genetic mutation in families, except in special cases ","correct":true},{"idx":4,"proposition":"If a mother with ADPKD wishes to have a child, she can have genetic counselling and pre-implantation diagnosis.","correct":false,"justification":"False. This is not provided for in the ADRP"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PKRAD-nephro-8","context":null,"enonce":"In what circumstances(ies) can the diagnosis of ADKDP be affirmed?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"6 cysts per kidney in a subject over 60 years of age","correct":true,"justification":"True. ≥ 5 cysts \/ kidney from 60 years"},{"idx":1,"proposition":"1 cyst on the right kidney and 2 cysts on the left kidney in a 45-year-old subject","correct":false,"justification":"False. It takes ≥ 2 cysts \/ kidney between 40 and 60 years to make the diagnosis."},{"idx":2,"proposition":"4 cysts per kidney in a 63-year-old subject","correct":false,"justification":"False. It is necessary ≥ 5 cysts \/ kidney from 60 years"},{"idx":3,"proposition":"1 cyst on the left kidney and 2 cysts on the right kidney in a 33-year-old subject","correct":true,"justification":"True. ≥ 3 uni- or bilateral cysts if the subject is under 40 years of age."},{"idx":4,"proposition":"5 cysts on the right kidney and 4 cysts on the left kidney in a 69-year-old subject","correct":false,"justification":"False. ≥ 5 cysts \/ kidney from 60 years"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PKRAD-nephro-9","context":null,"enonce":"Which of the following are true?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"A patient under 18 years of age with a parent with ADPKD should be screened by abdominal ultrasound","correct":false,"justification":"False. No screening of minors. Abdominal ultrasound will be done after 18 years"},{"idx":1,"proposition":"In a patient under 18 years of age with a parent with ADPKDP, paediatric follow-up with annual monitoring of hypertension is required.","correct":true},{"idx":2,"proposition":"Renal involvement is secondary to the progressive development of multiple cysts in both kidneys, responsible for compression and progressive fibrosis of the non-cystic renal parenchyma.","correct":true},{"idx":3,"proposition":"Cysts are developed only at the expense of the distal renal tubules ","correct":false,"justification":"False. Cysts are developed at the expense of any renal tubule"},{"idx":4,"proposition":"The growth of cysts results from a proliferation of the cells lining the cysts, and a secretion of fluid by these same cells","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PKRAD-nephro-10","context":null,"enonce":"In front of a patient affected by ADPKD and who has macroscopic hematuria without fever, it is necessary to evoke what diagnosis(s)?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"Intracystic hemorrhage","correct":true},{"idx":1,"proposition":"Urolithiasis","correct":true},{"idx":2,"proposition":"Acute pyelonephritis","correct":false,"justification":"False. There would be a fever."},{"idx":3,"proposition":"Intracystic infection","correct":false,"justification":"False"},{"idx":4,"proposition":"None of these answers","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PKRAD-nephro-11","context":null,"enonce":"Which of the following proposals may be present in a patient with ADPKD?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"Aortic insufficiency","correct":false,"justification":"False. Mitral insufficiency"},{"idx":1,"proposition":"Diverticular disease","correct":true},{"idx":2,"proposition":"Umbilical hernia","correct":false,"justification":"False. Inguinal hernia"},{"idx":3,"proposition":"Cerebral aneurysm","correct":true},{"idx":4,"proposition":"Pancreatic cysts","correct":false,"justification":"False. Hepatic cysts"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PKRAD-nephro-12","context":null,"enonce":"Regarding the management of intracystic infections. Which of the following are true?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"Urinary functional signs are uncommon","correct":true},{"idx":1,"proposition":"If ECBU does not show bacteria, the diagnosis of a kidney cyst infection may be rejected","correct":false,"justification":"False. ECBU is often sterile because the bacteria are in the cyst."},{"idx":2,"proposition":"Dual therapy with C3G + amikacin is recommended","correct":false,"justification":"False. Fluoroquinolone + Cotrimoxazole 3 to weeks"},{"idx":3,"proposition":"It is necessary to systematically puncture the cyst to evacuate its contents","correct":false,"justification":"False. A puncture of the cyst will be done when there is a persistence of fever > 7 days under dual antibiotic therapy"},{"idx":4,"proposition":"A PET scanner is systematically recommended","correct":false,"justification":"False. The PET scanner can be done in case of failure of antibiotic therapy"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"oedemes-nephro-0","context":null,"enonce":"Concerning generalized edema:","item":"oedemes","matiere":"nephro","propositions":[{"idx":0,"proposition":"Generalized oedema is the consequence of extracellular hyperhydration","correct":true},{"idx":1,"proposition":"An anasarca corresponds to edema of the lower limbs that do not disappear after 3 months","correct":false,"justification":"It is the association of generalized edema and effusions of serous"},{"idx":2,"proposition":"Generalized edema is not accompanied by ochre dermatitis","correct":true},{"idx":3,"proposition":"A venous obstacle can only involve generalized edema","correct":false,"justification":"Thrombophlebitis can result in IMO"},{"idx":4,"proposition":"The formation of edema requires increased purification of salt by the kidneys","correct":false,"justification":"On the contrary, sodium and water retention is observed by the kidneys"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"oedemes-nephro-1","context":null,"enonce":"What are the real propositions?","item":"oedemes","matiere":"nephro","propositions":[{"idx":0,"proposition":"The increase in capillary hydrostatic pressure corresponds to an increase in Starling force","correct":true},{"idx":1,"proposition":"Areas with minimal capillary hydrostatic pressure are deck zones.","correct":false,"justification":"The capillary hydrostatic pressure is, on the contrary, maximum in the detached zones. This is why edema is formed preferentially in these areas (lower limbs when the patient is in an upright position, lower back when he is in a horizontal position)"},{"idx":2,"proposition":"The amount of sodium contained in the human body determines the extracellular volume","correct":true},{"idx":3,"proposition":"The regulation of the body's sodium capital is carried out by the liver","correct":false,"justification":"Through the kidneys"},{"idx":4,"proposition":"True hypervolemia is sodium retention by the kidney","correct":true,"justification":"Seen during renal failure"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"oedemes-nephro-3","context":null,"enonce":"Regarding the etiologies of edema and their clinical signs:","item":"oedemes","matiere":"nephro","propositions":[{"idx":0,"proposition":"In heart failure, antinatriuretic systems are stimulated and reabsorb sodium and water","correct":true},{"idx":1,"proposition":"The increase in blood volume following the positive sodium and fluid balance increases filling pressures and improves cardiac function","correct":true},{"idx":2,"proposition":"True hypovolemia is observed in hepatic cirrhosis","correct":false,"justification":"It is an effective hypovolemia that is due to the sequestration of blood in the splanchnic territory"},{"idx":3,"proposition":"Clinical signs begin to be frank from 100 mL of edema","correct":false,"justification":"They are frank when they exceed 3% of body weight (2L at least)"},{"idx":4,"proposition":"Generalized edema is white, soft, painful and does not take the bucket","correct":false,"justification":"They are bilateral, symmetrical, declivated, white, soft, painless, taking the bucket"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"oedemes-nephro-4","context":null,"enonce":"Which propositions are true?","item":"oedemes","matiere":"nephro","propositions":[{"idx":0,"proposition":"Regular weighing of a patient is the best parameter to evaluate the effectiveness of the treatment put in place","correct":true},{"idx":1,"proposition":"Edema has no clear consequences on the biological balance","correct":false,"justification":"Hemodilution and decreased hematocrit and protein are observed"},{"idx":2,"proposition":"Natriueresis is preserved in the phase of constitution of edema","correct":false,"justification":"It is collapsed"},{"idx":3,"proposition":"Pleural effusions suggest anasarca","correct":true},{"idx":4,"proposition":"Chronic or acute viral hepatitis can cause edema","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"oedemes-nephro-5","context":null,"enonce":"Edema can be caused by: ","item":"oedemes","matiere":"nephro","propositions":[{"idx":0,"proposition":"An increase in systemic blood pressure ","correct":false},{"idx":1,"proposition":"An increase in capillary hydrostatic pressure ","correct":true},{"idx":2,"proposition":"An increase in plasma oncotic pressure ","correct":false},{"idx":3,"proposition":"An increase in plasma osmolality ","correct":false},{"idx":4,"proposition":"An increase in capillary permeability ","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"oedemes-nephro-6","context":null,"enonce":"A 50-year-old patient consults for edema of the lower limbs. The balance sheet finds a hypertension, an albuminemia at 20 g \/ L, a proteinemia at 50 g \/ L, a natremia at 120 mmol \/ L. BU: 3 cross of prot, a cross of red blood cells, no leukocyte. The patient presents: ","item":"oedemes","matiere":"nephro","propositions":[{"idx":0,"proposition":"Edema is explained by hyponatremia. ","correct":false,"justification":"Natremia reflection of the intraCR sector"},{"idx":1,"proposition":"Pure nephrotic syndrome ","correct":false},{"idx":2,"proposition":"Impure nephrotic syndrome ","correct":true,"justification":"Nephrotic SD: Proteinuria + Hypoabuminemia. Impure because hematuria and HTA."},{"idx":3,"proposition":"A nephretic syndrome ","correct":false},{"idx":4,"proposition":"A syndrome of redidivating hematuria ","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"pratiquespro-sp-0","context":null,"enonce":"Regarding the quality approach","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"The quality of care and the health system is a real public health issue","correct":true},{"idx":1,"proposition":"ANDEM was created in 1801 by Napoleon","correct":false,"justification":"Health system evaluation structures were created very late. The first (ANDEM) was created in 1989."},{"idx":2,"proposition":"The HAS (Haute Autorité de Santé) was created in 1946","correct":false,"justification":"2004. She is the descendant of ANAES (1996), herself who comes from ANDEM (1989)"},{"idx":3,"proposition":"The quality approach is inspired by the world of industry and services","correct":true},{"idx":4,"proposition":"The France is a pioneer in the field of","correct":false,"justification":"We started with a lot of delay.\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"pratiquespro-sp-1","context":null,"enonce":"Quality of care is an approach that must allow:","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"To guarantee the patient to heal","correct":false,"justification":"To guarantee him the best care (not necessarily cure)"},{"idx":1,"proposition":"Have a minimum cost for acceptable results","correct":false,"justification":"Have a minimum cost for the best result (concept of efficiency)"},{"idx":2,"proposition":"Limit iatrogenic risk","correct":true},{"idx":3,"proposition":"To bring the best satisfaction to the stakeholders (patients and caregivers)","correct":true},{"idx":4,"proposition":"It is a concept of the HAS","correct":false,"justification":"implementation and defined by WHO"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pratiquespro-sp-2","context":null,"enonce":"Concerning the generalities of the quality approach","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"The France was very early in the field of quality approach with many institutions created in the 19th century","correct":false,"justification":"The France has been slow to set up evaluation structures: ANDEM in 1989 (National Agency for the Development of Medical Evaluation), which became ANAES in 1996 (National Agency for Accreditation and Evaluation in Health), then HAS in 2004 (High Authority for Health)"},{"idx":1,"proposition":"The formalization of a \"quality approach\", inspired by the world of industry and services, gradually developed in France, after having imposed itself in Anglo-Saxon countries.","correct":true},{"idx":2,"proposition":"Quality is the set of properties of a product that make it last over time","correct":false,"justification":"Set of properties and characteristics of a product or product that give it service the ability to satisfy expressed or implicit needs (ISO 8402)"},{"idx":3,"proposition":"Quality assurance is the set of actions necessary to give the appropriate confidence that a product or service will meet the requirements","correct":true},{"idx":4,"proposition":"The quality approach is the set of actions to satisfy customers and users.","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"pratiquespro-sp-3","context":null,"enonce":"Which of these proposals are indicators of quality and safety of care?","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"Clinical relevance","correct":true},{"idx":1,"proposition":"Feasibility","correct":true},{"idx":2,"proposition":"Public satisfaction","correct":false,"justification":"It is an indicator. It does not validate one."},{"idx":3,"proposition":"Internal consistency","correct":true,"justification":"Part of the metrological qualities"},{"idx":4,"proposition":"Adjustment","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"pratiquespro-sp-4","context":null,"enonce":"Regarding quality and safety of care indicators:","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"They are divided into 5 types","correct":false,"justification":"3 types: structure indicator, process indicator, result indicator"},{"idx":1,"proposition":"There are 179 indicators in total","correct":false,"justification":"79"},{"idx":2,"proposition":"It is mandatory to collect them all","correct":false,"justification":"Some are mandatory, others are optional"},{"idx":3,"proposition":"They only concern public establishments","correct":false,"justification":"All health facilities are concerned"},{"idx":4,"proposition":"They are divided into two main themes","correct":true,"justification":"Cross-cutting themes and specialty themes\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"pratiquespro-sp-6","context":null,"enonce":"Regarding the quality approach","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"Each hospital has the obligation to have a quality department with a quality manager.","correct":true},{"idx":1,"proposition":"The continuous quality improvement approach is symbolized by the Demin wheel","correct":true},{"idx":2,"proposition":"A quality and safety of care indicator is a tool for tracking the costs of safety procedures","correct":false,"justification":"Tool for measuring a state of health, one or the practical occurrence of an event, which makes it possible to evaluate in a valid and reliable way the quality of care and its variations in time and space"},{"idx":3,"proposition":"The scope of application of quality indicators is limited to peripheral CHU and CHU with more than 200 employees","correct":false,"justification":"Public and private health institutions by the HAS: IPAQSS program (Indicators for the Improvement of Quality and Safety Management of Care)"},{"idx":4,"proposition":"The HAS regularly informs the ARS of the commitment and progress of the establishments in the certification procedure.","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pratiquespro-sp-7","context":null,"enonce":"Regarding the certification process for healthcare facilities","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"The interface document must be sent 3 weeks before sending the quality account","correct":false,"justification":"Sent by the establishment to the HAS in the 6 months preceding the sending of the Quality Account (i.e. 12 months before the visit)"},{"idx":1,"proposition":"The HAS chooses a visit date for certification and has the legal obligation to respect it","correct":false,"justification":"The HAS may postpone the certification visit if important points of patient safety management are not fulfilled by the institution, after analysis of the interface document"},{"idx":2,"proposition":"The method of analysis of the quality account is chosen and specific to each institution: it is not imposed by the HAS.","correct":true},{"idx":3,"proposition":"The HAS has the sole role of visiting the establishment and issuing (or not) the certification based on it only","correct":false,"justification":"It carries out a quality control of the Quality Account: it can request additional information"},{"idx":4,"proposition":"The visiting experts are appointed by the HAS","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pratiquespro-sp-8","context":null,"enonce":"Regarding the different levels of certification:","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"They are classified from 1 to 5","correct":false,"justification":"From A (best) to E (non-certification)"},{"idx":1,"proposition":"Certification with improvement recommendation is valid for 3 years","correct":false,"justification":"Valid for 4 years"},{"idx":2,"proposition":"The decision to suspend certification requires a follow-up visit within 6 months","correct":true,"justification":"A new decision will be rendered at the end of this follow-up visit"},{"idx":3,"proposition":"Simple certification is valid for 4 years","correct":false,"justification":"6 years for Level A certification"},{"idx":4,"proposition":"Certification with improvement obligations requires the sending of a quality account 12 months before the visit","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"pratiquespro-sp-9","context":null,"enonce":"Regarding the quality approach","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"The HAS makes the decision to certify or not an establishment after analyzing the recommendations of the CREDO","correct":true},{"idx":1,"proposition":"The certification report is confidential and the health institution is prohibited from disseminating it","correct":false,"justification":"The institution must: ensure the widest possible dissemination of the certification report (CME, CDU ...) make available to the public the results of the quality and safety of care indicators"},{"idx":2,"proposition":"The institution's welcome booklet for inpatients must include information on the results of the various procedures for assessing the quality of care.","correct":true},{"idx":3,"proposition":"The HAS website must not contain hospital certification reports","correct":false,"justification":"The HAS publishes the certifications and the various reports on its website"},{"idx":4,"proposition":"The accreditation of doctors is implemented by the HAS","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"pratiquespro-sp-10","context":null,"enonce":"Which of these specialties are subject to accreditation?","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"All surgeries","correct":true},{"idx":1,"proposition":"General medicine","correct":false,"justification":"Obstrical ultrasound, gynecology-obstetrics, surgeries, anesthesia-resuscitation, intensive care and interventional specialties"},{"idx":2,"proposition":"Anesthesia-resuscitation","correct":true},{"idx":3,"proposition":"Neurology","correct":false},{"idx":4,"proposition":"Vascular medicine","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"MICI-HGE-0","context":null,"enonce":"Regarding Crohn's disease:","item":"MICI","matiere":"HGE","propositions":[{"idx":0,"proposition":"Crohn's disease can affect all segments of the digestive tract, most commonly the terminal ileum, colon and anus.","correct":true},{"idx":1,"proposition":"Crohn's disease can start at any age but its peak frequency is between 20 and 30 years","correct":true},{"idx":2,"proposition":"To make the diagnosis, it is necessary to perform an eso-gastro-duodenal endoscopy and an ileocolonoscopy with biopsies of the injured areas but also macroscopically healthy areas","correct":true},{"idx":3,"proposition":"The endoscopic lesions of Crohn's disease are very specific","correct":false,"justification":"The endoscopic lesions of Crohn's disease are not specific"},{"idx":4,"proposition":"Lesions extend into the digestive tract without leaving gaps of healthy mucosa","correct":false,"justification":"Intervals of healthy mucosa are possible,"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"MICI-HGE-2","context":null,"enonce":"Among the characteristics of ulcerative colitis:","item":"MICI","matiere":"HGE","propositions":[{"idx":0,"proposition":"Rectal involvement is constant","correct":true},{"idx":1,"proposition":"the anoperineal lesion is constant","correct":false,"justification":"It is absent: there is no involvement of the anus in UC"},{"idx":2,"proposition":"There is no lesion of the ileum","correct":true},{"idx":3,"proposition":"The colonic extension can reach, at most, the cecum","correct":true},{"idx":4,"proposition":"There are healthy mucosa intervals between lesions","correct":false,"justification":"Lesions do not leave a healthy mucosa gap"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"AV--ophtalmo-1","context":null,"enonce":"Regarding the etiologies of progressive visual acuity decreases:","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Cataract is a clouding of the vitreous humor","correct":false,"justification":"Crystalline lens"},{"idx":1,"proposition":"The topography of cataract clouding is always peripheral","correct":false,"justification":"It can be nuclear (central), cortical (peripheral) or posterior"},{"idx":2,"proposition":"Chronic open-angle glaucoma is immediately symptomatic","correct":false,"justification":"Long asymptomatic, unlike angle-closure glaucoma"},{"idx":3,"proposition":"The most common hereditary maculopathy is Stargardt's disease","correct":true},{"idx":4,"proposition":"Retinopathy pigmentosa concerns batônnets in priority","correct":true,"justification":"Sometimes the damage can extend to the cones and lead to complete blindness."}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"AV--ophtalmo-3","context":null,"enonce":"Which of the following are part of the posterior segment?","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Iris","correct":false,"justification":"False"},{"idx":1,"proposition":"Cornea","correct":false,"justification":"False"},{"idx":2,"proposition":"Previous chamber","correct":false,"justification":"False"},{"idx":3,"proposition":"Sclera","correct":true,"justification":"It is on this fibrous support shell that the oculomotor muscles are inserted. It is also in its posterior part that the optic nerve is inserted."},{"idx":4,"proposition":"All proposals are wrong","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AV--ophtalmo-4","context":null,"enonce":"Which of the following proposals are transparent environments of the eye?","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Macula","correct":false,"justification":"3 transparent media: vitreous body, aqueous humor, crystalline"},{"idx":1,"proposition":"Aqueous humor","correct":true,"justification":"True, as the name suggests"},{"idx":2,"proposition":"Vitreous humour","correct":true},{"idx":3,"proposition":"Crystalline","correct":true,"justification":"True, its clouding causes cataracts"},{"idx":4,"proposition":"Choroid","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AV--ophtalmo-5","context":null,"enonce":"Where is the main lacrimal gland?","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Upper-outer part of the orbit","correct":true},{"idx":1,"proposition":"Infero-external part of the orbit","correct":false,"justification":"False"},{"idx":2,"proposition":"Upper inner part of the orbit","correct":false,"justification":"False"},{"idx":3,"proposition":"Infero-internal part of the orbit","correct":false,"justification":"False"},{"idx":4,"proposition":"Central part of the orbit","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AV--ophtalmo-6","context":null,"enonce":"Which of the following proposals are part of the previous segment?","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Cornea","correct":true},{"idx":1,"proposition":"Iris","correct":true},{"idx":2,"proposition":"Previous chamber","correct":true},{"idx":3,"proposition":"Iridorodicorneal angle","correct":true},{"idx":4,"proposition":"All propositions are true","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"UGD-HGE-0","context":null,"enonce":"Regarding peptic ulcer disease","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"proposition":"The ulcer is an attack of the submucosa","correct":false,"justification":"An ulcer is defined as a loss of substance from the gastric or duodenal wall deeply affecting the muscular."},{"idx":1,"proposition":"Gastric or duodenal ulcers (UGD) result from the imbalance between chlorhydropeptic aggression and defense mechanisms (mucosal barrier) at a specific point in the mucosa","correct":true},{"idx":2,"proposition":"H. pylori is a gram-positive cocci that resists gastric acidity thanks to its urease activity and colonizes the surface of the gastric mucosa","correct":false,"justification":"H. pylori is a gram-negative bacillus"},{"idx":3,"proposition":"H. pylori infection is most often acquired in childhood by the oral-oral or faecal-oral route","correct":true},{"idx":4,"proposition":"Most often, gastritis with HP does not get complicated","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"UGD-HGE-1","context":null,"enonce":"Regarding peptic ulcer disease","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"proposition":"Selective NSAIDs (coxibs) that inhibit COX-2 by preserving COX-1 activity reduce the risk of ulcerative complications","correct":true,"justification":"They do not eliminate this risk but reduce it, in fact"},{"idx":1,"proposition":"Zolliger ellison syndrome should be evoked in case of multiple or recurrent ulcers, which are often complicated","correct":true},{"idx":2,"proposition":"\"Stress\" or psychological factors have no demonstrated role in the pathophysiology of ulcer","correct":true},{"idx":3,"proposition":"The incidence of DMUs has increased in developed countries over the past 3 decades","correct":false,"justification":"The incidence of GDU has declined in developed countries over the past 3 decades in line with the decline in gastric H-infection."},{"idx":4,"proposition":"Duodenal ulcer is less common than gastric ulcer before age 55","correct":false,"justification":"It is more common"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"UGD-HGE-2","context":null,"enonce":"Regarding peptic ulcer disease","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"proposition":"The mortality rate for ulcerative complications is about 10%","correct":true},{"idx":1,"proposition":"The typical ulcer syndrome is an association of epigastric pain, without irradiation, punctuated by meals with a free interval of 1 to 3 hours, type of cramp or painful hunger, calmed by taking food or antacids.","correct":true,"justification":"This is the classic definition. Beware, however, of atypical syndromes"},{"idx":2,"proposition":"Physical examination is normal in the absence of complications","correct":true},{"idx":3,"proposition":"Upper GI endoscopy allows to visualize the upper digestive tract up to the second duodenum and to perform biopsies","correct":true},{"idx":4,"proposition":"Gastrodudenal endoscopy is the key diagnostic test","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"UGD-HGE-3","context":null,"enonce":"Regarding peptic ulcer disease","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"proposition":"Duodenal ulcer is always benign","correct":true},{"idx":1,"proposition":"Gastric ulcer is at risk of cancerization","correct":true},{"idx":2,"proposition":"NSAIDs are responsible for one-third of ulcer complications","correct":true},{"idx":3,"proposition":"Duodenal ulcer requires systematic healing control","correct":false,"justification":"This is the case for gastric ulcer"},{"idx":4,"proposition":"The eradication treatment of H. pylori is based on antibiotics only, for 10 to 14 days depending on the chosen protocol","correct":false,"justification":"Antibiotics + PPI +\/bismuth salts according to protocol"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"UGD-HGE-4","context":null,"enonce":"Which of the following are true for Helicobacter pylori?","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"proposition":"It is a risk factor for gastric ulcer","correct":true},{"idx":1,"proposition":"It is a risk factor for MALT lymphoma","correct":true},{"idx":2,"proposition":"It is a risk factor for gastric carcinoma (in case of gastric atrophy)","correct":true},{"idx":3,"proposition":"It is a risk factor for pancreatitis","correct":false},{"idx":4,"proposition":"It is a risk factor for Barrett's ulcer","correct":false,"justification":"Also called Endobrachyoesophagus\r\nRisk factors tend to be overweight or chronic GERD"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"UGD-HGE-5","context":null,"enonce":"Which of the following are true for Helicobacter pylori?","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"proposition":"It is a risk factor for the occurrence of duodenal ulcer","correct":true},{"idx":1,"proposition":"It is a parasite","correct":false,"justification":"Gram-negative bacillus"},{"idx":2,"proposition":"It is a gram-positive bacillus","correct":false,"justification":"Gram-negative bacillus"},{"idx":3,"proposition":"It is contracted most often in childhood","correct":true,"justification":"True, oral-oral or faecal-oral"},{"idx":4,"proposition":"100% of Helicobacter pyloria infections progress to gastritis","correct":true,"justification":"True, according to Figure 9.2 of the 4th edition of the HGE College"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossessepatho-gyn-0","context":null,"enonce":"Regarding genital bleeding in the 1st trimester:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"Genital bleeding complicates about 25% of pregnancies","correct":true},{"idx":1,"proposition":"A molar pregnancy is a very rare cause of 1st trimester hemorrhage","correct":true},{"idx":2,"proposition":"Cervical cancer is a very rare cause of 1st trimester hemorrhage","correct":true},{"idx":3,"proposition":"The vaginal examination makes it possible to check the permeability of the cervix and the possible presence of a laterouterine mass","correct":true,"justification":"The vaginal touch makes it possible to appreciate the condition of the cervix, the uterine volume, the appendages. TRUE"},{"idx":4,"proposition":"Genital bleeding of the first trimester is frequent, it does not require additional examination","correct":false,"justification":"Any genital bleeding in a pregnant woman should be explored. The main complementary examinations are: • plasma assay of 'hCG in case of doubt about the state of pregnancy, an endovaginal ultrasound and a urine strip. A blood test will be performed in case of significant hemorrhage with hemodynamic impact."}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"grossessepatho-gyn-1","context":null,"enonce":"Which of these signs is (are) in favor of spontaneous abortion?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"A disappearance of sympathetic signs of pregnancy","correct":true},{"idx":1,"proposition":"Dark blood hemorrhages without clots or debris","correct":false,"justification":"Light red blood, abundant, with clots and debris"},{"idx":2,"proposition":"A soft cervix permeable to the finger","correct":true},{"idx":3,"proposition":"A flattened ovular sac","correct":true},{"idx":4,"proposition":"An ovular sac with irregular contours","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossessepatho-gyn-3","context":null,"enonce":"Regarding signs in favor of an EMG:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"The presence of an intrauterine device is in favor of a GEU","correct":true,"justification":"If pregnant in a woman with an IUD, it is more likely to be a GEU. However, the IUD is not recognized as an ELT FDR. TRUE"},{"idx":1,"proposition":"A very large uterus is a clinical sign in favor of a GEU","correct":false,"justification":"In case of GEU, the uterus is smaller than the expected volume in case of intrauterine pregnancy."},{"idx":2,"proposition":"There is a loose and open collar in case of GEU","correct":false,"justification":"In case of GEU, the cervix will be rather toned and closed"},{"idx":3,"proposition":"The presence of a painless laterouterine mass is a clinical sign in favor of a GEU","correct":false,"justification":"The inconstant laterouterine mass (the GEU) will typically be painful, pain may be caused in the lateral or posterior cul-de-sac (signs of peritoneal irritation)"},{"idx":4,"proposition":"A well-centered intrauterine egg sac in the uterine cavity points to a normal pregnancy.","correct":false,"justification":"Be careful, the \"pseudo-bag\" is to be distinguished from the gestational sac. Unlike the gestational sac, the pseudo-sac is centered in the cavity and without trophoblastic crown (unlike the gestational sac which is lateralized and with a peripheral hypoechoic area): it is often a blood clot\nin the uterine cavity, in the process of expulsion, which can be found on ultrasound in case of GEU. Pseudo-sac is common and can lead to a misdiagnosis."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossessepatho-gyn-4","context":null,"enonce":"Regarding trophoblastic disease:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"It is a very common disease in France.","correct":false,"justification":"Trophoblastic disease or molar pregnancy is exceptional in the West, more common in Southeast Asia. It results from an abnormality of fertilization and is characterized by abnormal trophoblastic proliferation without possible normal embryonic development."},{"idx":1,"proposition":"A molar pregnancy results in a uterus that is smaller than gestational age would like.","correct":false,"justification":"On ultrasound: the uterus is larger than the management age would like. It is occupied by a heterogeneous, flaky mass, containing multiple small vesicles. The ovaries are large, polycystic"},{"idx":2,"proposition":"Ultrasound finds no ocular cavity or visible embryo in case of trophoblastic disease.","correct":true,"justification":"Indeed, there can be no embryonic development in case of trophoblastic disease. TRUE"},{"idx":3,"proposition":"The diagnosis of molar pregnancy is ultrasound","correct":false,"justification":"The diagnosis evoked on ultrasound requires aspiration under ultrasound control with systematic histopathological examination"},{"idx":4,"proposition":"The hCG level is abnormally low.","correct":false,"justification":"Molar pregnancy is accompanied by very intense sympathetic signs of pregnancy, as well as very high hCG levels. Treatment consists of aspiration of endouterine contents under GA, and monitoring of the correct decrease in hCG levels over time. In the absence of decay, invasive mole or cholangiocarcinoma (chemotherapy treatment) may be feared."}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"grossessepatho-gyn-5","context":null,"enonce":"Regarding spontaneous abortions in the first trimester:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"The main cause of spontaneous abortions in the first trimester is teratogenic self-medication","correct":false,"justification":"Banal for the doctor, miscarriage is often experienced by the woman as a guilt-inducing trauma, a source of concern for the future. \nIt is important to devote a few minutes to information: • the usual cause (60% of cases) of ASP is a chromosomal abnormality of the embryo, due to chance. Miscarriage is a commonplace phenomenon that affects 10 to 15% of pregnancies and has no consequences on the future obstetrics."},{"idx":1,"proposition":"Physical activity is a factor in miscarriages","correct":false,"justification":"Physical activity and the car have nothing to do with it."},{"idx":2,"proposition":"Miscarriage is a commonplace phenomenon that affects 10 to 15% of pregnancies and has no impact on the future of obstetrics.","correct":true},{"idx":3,"proposition":"The expulsion of the stopped pregnancy is imperatively done by surgery.","correct":false,"justification":"Two methods are available: • medical treatment with prostaglandins if the egg is small and bleeding is small, surgical treatment in other cases."},{"idx":4,"proposition":"Repeated spontaneous abortions occur when at least five consecutive spontaneous abortions occur before 14 weeks.","correct":false,"justification":"At least three consecutive spontaneous abortions before 14 SA"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossessepatho-gyn-6","context":null,"enonce":"Among these proposals, which is (are) a possible etiology(s) of repeated spontaneous early abortion:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"Lupus","correct":true},{"idx":1,"proposition":"Chronic endometritis","correct":true},{"idx":2,"proposition":"Anti-phospholipid syndrome","correct":true},{"idx":3,"proposition":"Uterine malformation","correct":true},{"idx":4,"proposition":"Balanced diabetes","correct":false,"justification":"Unbalanced diabetes (controversial). Otherwise: the possible causes of repeated ASP are:\na uterine malformation (rather responsible for late-term abortions); a hysterography must be done \nlupus, an antiphospholipid syndrome \ngenetic causes (karyotype) \nchronic endometritis (which may be caused by a chronic infection to look for)\nhormonal and metabolic causes (dysovulation, hyperandrogenism, hypothyroidism, diabetes) that are classic but very controversial \nimmunological causes (immunization against spousal antigens). \nThe etiological balance is often negative.\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"grossessepatho-gyn-7","context":null,"enonce":"Regarding repeated spontaneous abortions:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"An etiological investigation becomes legitimate in case of repeated spontaneous abortions","correct":true},{"idx":1,"proposition":"The etiological balance is often negative","correct":true},{"idx":2,"proposition":"Preventive treatment of recurrence with low-dose aspirin and low molecular weight heparin has been proposed","correct":true,"justification":"This treatment is effective in case of antiphospholipid syndrome (placental vascularization disorders). \nOtherwise, it has no interest. Some offer a low-dose preventive aspirin treatment based on the placebo effect. TRUE"},{"idx":3,"proposition":"Preventive treatment with aspirin and LMWH is effective in diabetes","correct":false,"justification":"This treatment is effective in case of antiphospholipid syndrome"},{"idx":4,"proposition":"Preventive treatment of recurrent ASP with misoprostol is proposed.","correct":false,"justification":"Misoprostol is a teratogenic PGE1 prostaglandin analogue used in medical terminations (GymsO, MisoOne)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossessepatho-gyn-9","context":null,"enonce":"Regarding third trimester hemorrhages:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"A third trimester genital hemorrhage is an obstetric emergency","correct":true,"justification":"The diagnostic approach is focused on the differential diagnosis between the two main causes of placenta previa (inserted in part or in whole on the lower segment) and retroplacental hematoma, 2 therapeutic emergencies."},{"idx":1,"proposition":"Vaginal examination is contraindicated until placenta previa has been ruled out","correct":true,"justification":"Risk of severe maternal hemorrhage, risk of extremely serious fetal hemorrhage in case of rupture of a praevia vessel."},{"idx":2,"proposition":"The clinical examination focuses on fetal impact only","correct":false,"justification":"The examination focuses on: • maternal impact: pulse"},{"idx":3,"proposition":"A vascular context is in favor of a retroplacental hematoma","correct":true},{"idx":4,"proposition":"A small hemorrhage eliminates a retroplacental hematoma","correct":false,"justification":"Typically, retroplacental hematoma presents with:\na sparse, blackish, incoagulable hemorrhage associated with sudden, permanent uterine pain, which dominates the picture;\na severe maternal impact unrelated to the abundance of hemorrhages: prostrate woman, state of shock, tachycardia but variable BP, sometimes high (gestational hypertension, proteinuria)\na permanent and painful uterine contracture (\"wooden belly\")\nunperceived fetal cardiac activity (dead fetus) in full forms."}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"grossessepatho-gyn-10","context":null,"enonce":"Regarding retroplacental hematoma:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"There is little maternal impact, due to the low abundance of hemorrhages.","correct":false,"justification":"The maternal impact can be severe, unrelated to the abundance of hemorrhage."},{"idx":1,"proposition":"A permanent and painful uterine contracture (\"wooden belly\") should evoke it.","correct":true},{"idx":2,"proposition":"A retroplacental hematoma without signs of severity can be managed on an outpatient basis","correct":false,"justification":"Treatment of an HRP is an emergency. The action to be taken involves hospitalization of the patient, urgent medical treatment (O2, filling, defibrination if necessary), the realization of a preoperative assessment and fetal extraction in emergency."},{"idx":3,"proposition":"Emergency obstetric ultrasound is required","correct":true},{"idx":4,"proposition":"Retroplacental hematoma is often visible on ultrasound","correct":false,"justification":"Rarely visible. A negative ultrasound does not eliminate the diagnosis"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossessepatho-gyn-11","context":null,"enonce":"Regarding the haemorrhage of delivery:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"Hemorrhage of delivery is an obstetric emergency","correct":true},{"idx":1,"proposition":"The hemorrhage of deliverance is life-threatening fetal but not maternal","correct":false,"justification":"In its severe or neglected forms, it is life-threatening to the maternal"},{"idx":2,"proposition":"It is currently the third leading cause of maternal mortality in France","correct":false,"justification":"It is currently the leading cause of maternal mortality in France"},{"idx":3,"proposition":"It occurs in about 0.7% of births","correct":false,"justification":"It occurs in about 7% of births"},{"idx":4,"proposition":"Its early diagnosis is based on rigorous monitoring of any woman who has given birth, especially during the 2 hours after delivery.","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossessepatho-gyn-12","context":null,"enonce":"Regarding the haemorrhage of delivery:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"Prevention is based on the injection of oxytocin at the time of placental expulsion.","correct":false,"justification":"The oxytocin injection is done at the time of release of the shoulder of the newborn (or in the seconds after birth), this is called directed delivery."},{"idx":1,"proposition":"The recognition of a hemorrhage of delivery requires a precise quantification of bleeding.","correct":true,"justification":"The hemorrhage of delivery is defined by bleeding > 500 ml. Management must be immediate."},{"idx":2,"proposition":"There are no risk factors found in more than 50% of cases of hemorrhage of delivery.","correct":true,"justification":"cf item"},{"idx":3,"proposition":"There are deliveries with a \"low risk\" of hemorrhage of delivery.","correct":false,"justification":"In more than half of the cases of hemorrhage of delivery, no risk factor is found: any woman who gives birth has a possible risk of hemorrhage of delivery. It is one of the\nReasons why we can never speak of \"low-risk\" birth."},{"idx":4,"proposition":"The presence of a scarred uterus is a protective factor against hemorrhage of delivery due to the slightest distension of the fibrotic uterus.","correct":false,"justification":"The risk factors are:\n• fibroids\n• Placenta previa\n• scar uterus\n• history of hemorrhage of delivery\n• the work triggered\n• very fast or prolonged work\n• hyperthermia\n• macrosomia, hydramnios, multiple pregnancy;\n• Greater multiparity\n• no uterotonic injection (oxytocin 5 to 10 IU IVD) in the seconds that\nfollow the birth of the child"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossessepatho-gyn-13","context":null,"enonce":"Regarding the management of a hemorrhage of delivery:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"The first step is to carry out an artificial delivery in emergency.","correct":true,"justification":"True, if the hemorrhage occurs before the placenta is expelled."},{"idx":1,"proposition":"Inspection of the genital tract under valve is systematic only in case of strong argument for a vaginal tear.","correct":false,"justification":"It is systematic in case of haemorrhage of delivery."},{"idx":2,"proposition":"The administration of uterotonics is done only in case of absence of previous injection of oxytocin.","correct":false,"justification":"The injection of oxytocin after artificial delivery should be systematic and is part of the treatment of hemorrhage of delivery, even if the injection has already been performed at birth."},{"idx":3,"proposition":"Antibiotic prophylaxis is imperative.","correct":true,"justification":"The management of the hemorrhage of delivery involves endouterine gestures (artificial delivery + uterine revision). Antibiotic prophylaxis should therefore be administered."},{"idx":4,"proposition":"In a second step, sulprostone can be injected.","correct":false,"justification":"In case of persistence of hemorrhage, the second usable uterotonic is suprostone (analogue of prostaglandin E2 with oxytocic activity). In the absence of improvement, interventional radiology (embolization of bleeding arteries) or surgery (ligation of uterine arteries, up to hysterectomy if necessary) will be used."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossessepatho-gyn-14","context":null,"enonce":"Regarding the management of a hemorrhage of delivery:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"Prostaglandin therapy should be administered within 30 minutes of the start of management if bleeding persists.","correct":true,"justification":"Administration of sulprostone should occur within 30 minutes of diagnosis of delivery haemorrhage. In case of oxytocin failure, this period may be shortened depending on the severity of the bleeding (reco CNGOF 2014)."},{"idx":1,"proposition":"The uterine revision is carried out immediately in front of any hemorrhage of delivery.","correct":false,"justification":"It is performed after artificial delivery if the expulsion of the placenta has not taken place, otherwise immediately after natural delivery."},{"idx":2,"proposition":"In some situations, it is possible to perform hemostasis by uterine tamponade with an intrauterine balloon.","correct":true,"justification":"If radiological and surgical techniques are not readily available, this may be a waiting solution until a possible transfer to a specialized unit."},{"idx":3,"proposition":"In case of unstable hemodynamics, the preferable management is surgical.","correct":true,"justification":"Management must be extremely rapid in case of unstable hemodynamics, which does not leave time to perform a transfer or radioembolization."},{"idx":4,"proposition":"Monitoring of the coagulation balance is not imperative.","correct":false,"justification":"The sometimes rapid evolution of coagulopathy during a hemorrhage of delivery justifies biological monitoring of coagulation (reco CNGOF 2014)"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"grossessepatho-gyn-15","context":null,"enonce":"Regarding normal pregnancy:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"There is a decrease in blood volume","correct":false,"justification":"Volume increases"},{"idx":1,"proposition":"GFR increases in the first quarter","correct":true},{"idx":2,"proposition":"Blood pressure remains unchanged","correct":false,"justification":"It decreases"},{"idx":3,"proposition":"Cardiac output decreases due to hypervolemia","correct":false,"justification":"It increases precisely to cope with vasodilation"},{"idx":4,"proposition":"Solidarity does not appear until the third trimester","correct":false,"justification":"It is precocious"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossessepatho-gyn-16","context":null,"enonce":"Regarding pre-eclampsia:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"It can only be diagnosed from 30 SA","correct":false,"justification":"From 20 SA"},{"idx":1,"proposition":"The PAd must be greater than 100 mmHg","correct":false,"justification":"One must objectify a HTA, ie a PAs greater than or equal to 140 mmHg and \/ or a PAd greater than or equal to 90 mmHg"},{"idx":2,"proposition":"Proteinuria is greater than 30 mg\/24h in pre-eclampsia","correct":false,"justification":"It is greater than 300mg\/24h"},{"idx":3,"proposition":"One of the consequences of pre-eclampsia can be intrauterine growth retardation","correct":true},{"idx":4,"proposition":"Pre-eclampsia can be complicated by OAP","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossessepatho-gyn-17","context":null,"enonce":"What are the blood pressure goals in a hypertensive pregnant woman?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"These are the same as in non-pregnant women","correct":false,"justification":"BP figures < 140\/90 mmHg are not targeted because this would result in fetal distress"},{"idx":1,"proposition":"PAs < 140 mmHg","correct":false},{"idx":2,"proposition":"PAd < 90 mmHg","correct":false},{"idx":3,"proposition":"PAs < 160 mmHg","correct":true,"justification":"The blood pressure objectives are a PAs < 160 mmHg and a PAd between 85-100 mmHg"},{"idx":4,"proposition":"PAd < 80 mmHg","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"grossessepatho-gyn-18","context":null,"enonce":"What are the reasons for a HELLP syndrome?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"Hemolysis","correct":true,"justification":"H = hemolysis. EL = Elevation of liver enzymes. LP = Low Platelets"},{"idx":1,"proposition":"An elevation of hemoglobin","correct":false,"justification":"A decrease"},{"idx":2,"proposition":"An increase in transaminases","correct":true},{"idx":3,"proposition":"A DICV","correct":false,"justification":"Not related to HELLP most often"},{"idx":4,"proposition":"Thrombocytopenia","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"grossessepatho-gyn-19","context":null,"enonce":"Which of the following are molecules that can be used for tocolysis?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"Beta-mimetics ","correct":false,"justification":"They can cause maternal undesirables sometimes serious. \r\nIt is recommended that they no longer be prescribed."},{"idx":1,"proposition":"Beta-blockers","correct":false,"justification":"They have no tocolytic effects"},{"idx":2,"proposition":"Calcium antagonists","correct":true,"justification":"True, Nifedipine for example"},{"idx":3,"proposition":"Atosiban","correct":true},{"idx":4,"proposition":"NSAIDs","correct":false,"justification":"It's not a tocolytic"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossessepatho-gyn-20","context":null,"enonce":"Which of the following are among the benefits of antenatal corticosteroid administration in case of threat of premature delivery?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"Reduced rate of jaundice in newborns","correct":false,"justification":"False"},{"idx":1,"proposition":"Reduction of neonatal death rate","correct":true},{"idx":2,"proposition":"Reduction in the rate of maternal-fetal infection","correct":false,"justification":"False"},{"idx":3,"proposition":"Reduction in the rate of hyaline membrane disease","correct":true},{"idx":4,"proposition":"Reduced rate of ulcerative-necrotizing enterocolitis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"grossessepatho-gyn-21","context":null,"enonce":"Which of the following should be made upon admission of a patient at risk of preterm birth?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"Collection of a biological assessment including among others an NFS and CRP","correct":true,"justification":"True, in search of a biological inflammatory syndrome, in favor of an intrauterine infection"},{"idx":1,"proposition":"Single BU","correct":false,"justification":"We do an ECBU"},{"idx":2,"proposition":"Fetal ultrasound","correct":true},{"idx":3,"proposition":"Digital rectal examination","correct":false,"justification":"False"},{"idx":4,"proposition":"External electrocardiotocography ","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pbsuitescouches-gyn-0","context":null,"enonce":"Regarding postpartum pathologies:","item":"pbsuitescouches","matiere":"gyn","propositions":[{"idx":0,"proposition":"The period of the postpartum period is between 2 hours postpartum and about 40 days","correct":true},{"idx":1,"proposition":"The most common cause of postpartum fever is milky rise and therefore does not require exploration","correct":false,"justification":"This is the milky rise, but it is a diagnosis of elimination so it is necessary to eliminate infectious etiologies, thromboembolics, etc."},{"idx":2,"proposition":"If breastfeeding is artificial, the main causes of postpartum fever are related to accumulated stress","correct":false,"justification":"No. In this case, the main causes of fever are endometritis, urinary tract infection and thromboembolic disease."},{"idx":3,"proposition":"Endometritis is a cause of postpartum fever","correct":true},{"idx":4,"proposition":"The diagnosis of endometritis is clinical","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"pbsuitescouches-gyn-1","context":null,"enonce":"Which of these proposals designate a factor promoting endometritis?","item":"pbsuitescouches","matiere":"gyn","propositions":[{"idx":0,"proposition":"Dystocic childbirth","correct":true},{"idx":1,"proposition":"Chorioamnionitis","correct":true},{"idx":2,"proposition":"Treatment with bisphosphonate","correct":false,"justification":"Has nothing to do with it"},{"idx":3,"proposition":"Psychosis","correct":false,"justification":"Not recognized"},{"idx":4,"proposition":"Placental retention","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"pbsuitescouches-gyn-2","context":null,"enonce":"About endometritis","item":"pbsuitescouches","matiere":"gyn","propositions":[{"idx":0,"proposition":"The onset of endometritis is often late, around 30 days postpartm","correct":false,"justification":"No, it is often early: 3 to 5 days after delivery"},{"idx":1,"proposition":"Stagnant uterine height and gaping cervix are signs of endometritis","correct":true},{"idx":2,"proposition":"Management of endometritis is most often ambulatory","correct":false},{"idx":3,"proposition":"In case of endometritis, antibiotic therapy is started when the susceptibility test is ready","correct":false,"justification":"It is started directly in IV and then adapted secondarily to the results of vaginal ECB"},{"idx":4,"proposition":"The optimal duration of antibiotic therapy is between 5 and 10 days","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pbsuitescouches-gyn-3","context":null,"enonce":"Regarding endometritis and NAPs:","item":"pbsuitescouches","matiere":"gyn","propositions":[{"idx":0,"proposition":"Endometritis is rapidly favorable under appropriate treatment","correct":true},{"idx":1,"proposition":"The clinical picture of a urinary tract infection has nothing to do with postpartum, compared to the clinical picture of a UTI outside a pregnancy context","correct":false,"justification":"The clinical picture and principles of treatment are identical"},{"idx":2,"proposition":"ECBU confirms diagnosis of urinary tract infection","correct":true},{"idx":3,"proposition":"Renal ultrasound is of no use in acute postpartum pyelonephritis","correct":false,"justification":"It removes an obstacle"},{"idx":4,"proposition":"Antibiotic treatment lasts 5-10 days","correct":false,"justification":"Antibiotic treatment should be compatible with possible breastfeeding (3rd generation cephalosporins ± aminoglycoside) and continued for a total of 21 days. 5-10 days is the duration of treatment for endometritis"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"soinspal-soinspal-0","context":null,"enonce":"Regarding palliative care:","item":"soinspal","matiere":"soinspal","propositions":[{"idx":0,"proposition":"Palliative care occurs only in the last stage of the disease","correct":false,"justification":"It is care that accompanies the patient throughout his care, intended to relieve annoying symptoms such as pain"},{"idx":1,"proposition":"Palliative care only concerns people over the age of 65","correct":false,"justification":"They concern all patients"},{"idx":2,"proposition":"Palliative care is incompatible with curative care","correct":false,"justification":"They are quite compatible with the goal of curing the disease"},{"idx":3,"proposition":"Palliative care is reserved for patients with a VAS of pain greater than 6\/10","correct":false,"justification":"They concern all patients"},{"idx":4,"proposition":"None of the propositions are true","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"soinspal-soinspal-1","context":null,"enonce":"Which of the following are some medications that can cause constipation?","item":"soinspal","matiere":"soinspal","propositions":[{"idx":0,"proposition":"Methotrexate","correct":false,"justification":"Diarrhoea and vomiting"},{"idx":1,"proposition":"Carbamazepine","correct":true},{"idx":2,"proposition":"The 5-FU","correct":false,"justification":"The main drugs responsible for constipation are: morphine, most psychotropic drugs, thiazide diuretics, GABA analogues, platinum salts and iron."},{"idx":3,"proposition":"Loperamide","correct":true},{"idx":4,"proposition":"Gabapentin","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"soinspal-soinspal-2","context":null,"enonce":"Which of the following are palliative care goals?","item":"soinspal","matiere":"soinspal","propositions":[{"idx":0,"proposition":"Accelerating death","correct":false,"justification":"Of course not. It is about relieving pain and supporting patients by improving their quality of life."},{"idx":1,"proposition":"Provide supportive psychotherapy","correct":false,"justification":"The palliative care approach may be similar to some psychological techniques, but the latter are much more comprehensive and complex to be palliative care goals."},{"idx":2,"proposition":"Relieve the patient of symptoms altering his quality of life","correct":true,"justification":"True, like pain, constipation, etc."},{"idx":3,"proposition":"Supporting caregivers","correct":true},{"idx":4,"proposition":"None of the propositions are true","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"soinspal-soinspal-3","context":null,"enonce":"Which of the following are some medications that can cause constipation?","item":"soinspal","matiere":"soinspal","propositions":[{"idx":0,"proposition":"Morphine","correct":true},{"idx":1,"proposition":"Iron","correct":true},{"idx":2,"proposition":"Hyperhydration","correct":false,"justification":"The main drugs responsible for constipation are: morphine, most psychotropic drugs, thiazide diuretics, GABA analogues, platinum salts and iron."},{"idx":3,"proposition":"Spironolactone","correct":false,"justification":"Thiazide diuretics"},{"idx":4,"proposition":"Calcium","correct":false,"justification":"Iron"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"soinspal-soinspal-4","context":null,"enonce":"Which of the following are some medications that can cause constipation?","item":"soinspal","matiere":"soinspal","propositions":[{"idx":0,"proposition":"Morphine","correct":true},{"idx":1,"proposition":"Antiparkinsonians","correct":true},{"idx":2,"proposition":"Tacrolimus","correct":false,"justification":"The main drugs responsible for constipation are: morphine, most psychotropic drugs, thiazide diuretics, GABA analogues, platinum salts and iron."},{"idx":3,"proposition":"Furosemide","correct":false,"justification":"Thiazide diuretics"},{"idx":4,"proposition":"Magnesium","correct":false,"justification":"Iron"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"oeilR-D-ophtalmo-0","context":null,"enonce":"General:","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The sensation of grains of sand in the eye evokes conjunctivitis","correct":true},{"idx":1,"proposition":"Blepharospasm suggests angle-closure glaucoma","correct":false,"justification":"Acute keratitis"},{"idx":2,"proposition":"The pains are devastating and very intense in episcleritis","correct":false,"justification":"Episcleritis is accompanied by moderate pain"},{"idx":3,"proposition":"Severe pain with irradiation in the territory of the trigeminal nerve evokes acute glaucoma","correct":true},{"idx":4,"proposition":"Conjunctivitis is not accompanied by a decrease in visual acuity","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"oeilR-D-ophtalmo-1","context":null,"enonce":"Regarding the clinical examination:","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"A red eye without visual field abnormalities may suggest subconjunctival hemorrhage or episcleritis","correct":true,"justification":"Subconjunctival hemorrhage is not painful. Episcleritis is moderately painful."},{"idx":1,"proposition":"The clinical examination is bilateral and comparative","correct":true},{"idx":2,"proposition":"Visual acuity is measured from far and near, with possible optical correction","correct":true},{"idx":3,"proposition":"A conjunctival wound should be systematically searched, even without apparent trauma","correct":true},{"idx":4,"proposition":"MRI is indicated in emergency in case of intraocular foreign body","correct":false,"justification":"Contraindicated because risk of projection of the foreign body. An orbital CT scan is done."}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"oeilR-D-ophtalmo-2","context":null,"enonce":"Concerning the clinical examination with the slit lamp and fluorescein:","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Eye redness is diffuse in case of conjunctivitis","correct":true},{"idx":1,"proposition":"Ocular redness is sectorized in case of episcleritis","correct":true},{"idx":2,"proposition":"Healthy corneal epithelium does not bind fluorescein","correct":true},{"idx":3,"proposition":"Localized ulceration with an adjacent white area suggests bacterial keratitis with a corneal abscess","correct":true,"justification":"Cf. Item in the latest edition of the College of Ophthalmology"},{"idx":4,"proposition":"A dendritic ulcer evokes posterior uveitis","correct":false,"justification":"A dendritic ulcer evokes herpetic keratitis"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"oeilR-D-ophtalmo-3","context":null,"enonce":"Regarding the iris, pupil and conjunctival cul-de-sac:","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Fluorescein is an orange dye","correct":true},{"idx":1,"proposition":"The presence of iridocrystalline synechiae is seen in anterior uveitis","correct":true},{"idx":2,"proposition":"Diabetes is a cause of iris atrophy.","correct":false,"justification":"Herpes most often"},{"idx":3,"proposition":"A miosis is found in acute keratitis or acute uveitis","correct":true},{"idx":4,"proposition":"Areflexive semimydriasis is found in neovascular glaucoma","correct":false,"justification":"In acute glaucoma"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"oeilR-D-ophtalmo-4","context":null,"enonce":"Regarding the clinical examination:","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"A narrow or flat anterior chamber suggests acute glaucoma or a puncture wound","correct":true},{"idx":1,"proposition":"The Tyndall effect is pathognomonic of retinitis","correct":false,"justification":"Retrocorneal precipitates found in anterior uveitis"},{"idx":2,"proposition":"The measurement of ocular tone is carried out with an air tonometer or flattening","correct":true},{"idx":3,"proposition":"Hypotonia is suggestive of a transfixing eye wound","correct":true,"justification":"Cf. Item in the latest edition of the College of Ophthalmology"},{"idx":4,"proposition":"Seidel's sign highlights an aqueous humor leak that washes the previously instilled fluorescein. ","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"oeilR-D-ophtalmo-5","context":null,"enonce":"Regarding eye pathologies:","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Viral conjunctivitis is accompanied by the presence of lymphoid follicles","correct":true},{"idx":1,"proposition":"Spontaneous subconjunctival hemorrhage is a major surgical emergency","correct":false,"justification":"Frequent, banal, painless, it regresses in a few weeks without treatment"},{"idx":2,"proposition":"Subconjunctival hemorrhage should be tested for high blood pressure (hypertension) and\/or a bleeding disorder","correct":true,"justification":"V"},{"idx":3,"proposition":"Conjunctivitis is manifested by a feeling of grains of sand in the eye","correct":true},{"idx":4,"proposition":"Conjunctivitis is very algic during the first 3 days","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"oeilR-D-ophtalmo-6","context":null,"enonce":"Regarding uveitis in sarcoidosis:","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Anterior uveitis is the most common ophthalmological presentation in sarcoidosis","correct":true,"justification":"Intermediate uveitis (= hyalitis) and posterior uveitis may also be present, but are rarer than anterior uveitis"},{"idx":1,"proposition":"The existence of thick retrocorneal precipts and nodules defines the granulomatous character of acute anterior uveitis in sarcoidosis","correct":true},{"idx":2,"proposition":"Chronic anterior uveitis (> 3 months) occurs preferentially in young subjects","correct":false,"justification":"In middle-aged women (50-60 years). In young subjects, acute uveitis is more common."},{"idx":3,"proposition":"Uveitis is typically acute and unilateral in sarcoidosis","correct":false,"justification":"It is most often chronic (> 3 months) and bilateral"},{"idx":4,"proposition":"Cysteoid macular edema is the main cause of decreased visual acuity in posterior uveitis","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"oeilR-D-ophtalmo-7","context":null,"enonce":"What are the 2 most common causes of intermediate uveitis (hyalitis)?","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Sarcoidosis","correct":true},{"idx":1,"proposition":"Behçet's disease","correct":false,"justification":"Especially seen in anterior uveitis"},{"idx":2,"proposition":"Ankylosing spondyloarthritis","correct":false},{"idx":3,"proposition":"Multiple sclerosis","correct":true,"justification":"Sarcoidosis and MS are the 2 main etiologies of hyalitis. But hyalite is mostly idiopathic. Cf. Sarcoidosis in the College of Internal Medicine."},{"idx":4,"proposition":"Systemic lupus erythematosus","correct":false,"justification":"Acute uveitis"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"oeilR-D-ophtalmo-8","context":null,"enonce":"Regarding the definition of uveitis","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Anterior uveitis is defined as iritis or iridocyclitis","correct":true,"justification":"Inflammation of the uvea of the anterior segment"},{"idx":1,"proposition":"Intermediate uveitis is pars planitis and\/or posterior cyclitis and\/or hyalitis","correct":true},{"idx":2,"proposition":"Posterior uveitis is focal or diffuse choroiditis or retinochoroiditis or retinitis","correct":true},{"idx":3,"proposition":"Panuveitis is an attack of the 3 segments of the eye","correct":true},{"idx":4,"proposition":"Posterior uveitis is a cause of red and painful eye","correct":false,"justification":"It is only the involvement of the anterior segment (anterior uveitis) that can cause a red and painful eye"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"allergiecut-immuno-0","context":null,"enonce":"About urticaria","item":"allergiecut","matiere":"immuno","propositions":[{"idx":0,"proposition":"Urticaria is a common inflammatory dermatosis due to mast cell activation","correct":true},{"idx":1,"proposition":"Diagnosis of urticaria is based on increased isolated IgE","correct":false,"justification":"The diagnosis is clinical"},{"idx":2,"proposition":"Urticaria corresponds to dermal edema with increased capillary permeability secondary to release by seortonin mast cells","correct":false,"justification":"Mast cells essentially release histamine. Hence the effectiveness of anti-histamines"},{"idx":3,"proposition":"Elementary lesions of superficial urticaria are edematous pustules","correct":false,"justification":"They are papules"},{"idx":4,"proposition":"Whatever the type of lesions, they are itchy, fleeting, and migratory.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"allergiecut-immuno-1","context":null,"enonce":"About urticaria","item":"allergiecut","matiere":"immuno","propositions":[{"idx":0,"proposition":"In deep urticaria, the edema is pinkish-white, firm and itchy in consistency","correct":false,"justification":"It is not itchy but gives a feeling of tension or pain"},{"idx":1,"proposition":"Superficial urticaria is isolated in half of cases, associated with angioedema in 40% of cases","correct":true},{"idx":2,"proposition":"In 70% of cases, there is only angioedema","correct":false,"justification":"There is only angioedema in 10% of cases, which require a different diagnostic and therapeutic approach"},{"idx":3,"proposition":"Insect bites and bullous dermatoses in the pre-bullous stage represent differential diagnoses of urticare","correct":true},{"idx":4,"proposition":"When urticaria is atypical, little or not pruritic, fixed, other diagnoses should be evoked such as urticarial vasculitis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"allergiecut-immuno-2","context":null,"enonce":"Regarding eczema and the different forms of urticaria:","item":"allergiecut","matiere":"immuno","propositions":[{"idx":0,"proposition":"Acute eczema of the face may be responsible for edema lesions are fixed, vesicular and oozing","correct":true},{"idx":1,"proposition":"The diagnosis of physical urticaria is made at the interrogation","correct":false,"justification":"Need for provocation tests"},{"idx":2,"proposition":"The diagnosis of cold urticaria is confirmed by the ice cube test","correct":true},{"idx":3,"proposition":"Confirmation of the diagnosis of solar urticaria is done by photo-test","correct":true},{"idx":4,"proposition":"The confirmation of urticarian dermographism is done by rubbing the skin with a foam tip","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"hyperTh-endoc-0","context":null,"enonce":"Which of the following is (are) correct?","item":"hyperTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"The thyroid is under the control of pituitary hormone TSH which stimulates all stages of thyroid hormone biosynthesis.","correct":true},{"idx":1,"proposition":"In children, it is usually a Graves' disease","correct":true},{"idx":2,"proposition":"In important forms, X-ray radiography of the Turkic saddle can measure the degree of protrusion","correct":false,"justification":"MRI is now used"},{"idx":3,"proposition":"Biosynthesis of thyroid hormones requires mercury","correct":false,"justification":"Iodine"},{"idx":4,"proposition":"Postpartum thyroiditis is autoimmune","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hyperTh-endoc-1","context":null,"enonce":"Which of the following is (are) correct?","item":"hyperTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Hyperthyroidism is the set of disorders related to the hyperfunctioning of the thyroid gland","correct":true},{"idx":1,"proposition":"Thyrotoxicosis syndrome corresponds to the consequences of excess thyroid hormones when it is due to primary hyperthyroidism","correct":false,"justification":"Whatever its cause (for example, an excess of exogenous thyroid hormones)"},{"idx":2,"proposition":"The prevalence of hyperthyroidism is about 10% in the general population","correct":false,"justification":"The prevalence of hyperthyroidism is high but varies between countries (0.2 to 1.9% for all causes)"},{"idx":3,"proposition":"The sex ratio is about 7 women to 1 man","correct":true},{"idx":4,"proposition":"Thyroperoxidase, or TPO, allows the organification of iodide among other things","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hyperTh-endoc-2","context":null,"enonce":"Regarding the causes and symptoms of hyperthyroidism:","item":"hyperTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Each of the TSHR, TPO, Tg proteins is likely to behave as an autoantigen","correct":true},{"idx":1,"proposition":"The thyroid mainly produces thyroxine (T4)","correct":true},{"idx":2,"proposition":"The half-life of T4 is approximately 5 days","correct":true},{"idx":3,"proposition":"Thyroid hormones have multiple effects by binding T3 to its membrane receptor","correct":false,"justification":"The T3 receptor, the active hormone, is nuclear. It enables rapid genomic response"},{"idx":4,"proposition":"The cardiovascular effects of hyperthyroidism are, in particular, regular tachycardia, sinus, exaggerated during efforts and emotions, persistent at rest","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hyperTh-endoc-3","context":null,"enonce":"Regarding the diagnosis of hyperthyroidism:","item":"hyperTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Hyperthyroidism may be accompanied by hypotonic delirium that may be similar to depression","correct":false,"justification":"Neuropsychic disorders These disorders are characterized by: excessive nervousness, psychomotor agitation and mood lability; a n and regular tremor of the extremities (manoeuvre \"of the oath\"); on the contrary, we witness"},{"idx":1,"proposition":"Thermophobia is accompanied by excessive sweating, with warm hands","correct":true},{"idx":2,"proposition":"Weight loss due to hyperthyroidism is very often followed by weight gain due to excessive polyphagia","correct":false,"justification":"It is rarely followed by paradoxical weight gain. This is indeed the case when polyphagia \"exceeds\" hypercatabolism"},{"idx":3,"proposition":"Constipation is a master symptom","correct":false,"justification":"Increased frequency of bowel movements: by accelerating transit; sometimes with real motor diarrhea"},{"idx":4,"proposition":"The first-line biological examination is the determination of free T4","correct":false,"justification":"This is TSH. TSH has collapsed, except in certain exceptional cases (examination to be requested in the first line according to HAS)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hyperTh-endoc-4","context":null,"enonce":"Regarding thyrotoxicosis and hyperthyroidism:","item":"hyperTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"The elevation of free T4 and\/or free T3 (there are hyperthyroidism with elevated T3 alone) makes it possible to assess the importance of thyrotoxicosis","correct":true},{"idx":1,"proposition":"The main heart rhythm disorder in thyrotoxicosis is supraventricular to atrial fibrillation type","correct":true},{"idx":2,"proposition":"Heart failure is classically predominantly left","correct":false,"justification":"Heart failure is: usually associated with AF; classically predominantly straight; with high or normal cardiac output"},{"idx":3,"proposition":"Osteoporosis is due to the osteoclastic action of thyroid hormones and predominates in the spine with a risk of vertebral settlement","correct":true,"justification":"This phenomenon is mainly observed in postmenopausal women"},{"idx":4,"proposition":"In Europe, the most frequent causes are, in addition to iatrogeny, in descending order: Graves' disease; toxic multinodular goiter; toxic adenoma","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"hemorragie-hemato-0","context":null,"enonce":"Regarding haemorrhages","item":"hemorragie","matiere":"hemato","propositions":[{"idx":0,"proposition":"An abnormality of hemostasis may be evoked in the course of an suggestive clinical event (unexplained hemorrhage, unusual thrombosis) or because of an abnormal laboratory test systematically prescribed","correct":true},{"idx":1,"proposition":"The interrogation must specify, in particular, the spontaneous or provoked nature of the","correct":true},{"idx":2,"proposition":"Questioning and clinical examination help to distinguish a pathology of primary hemostasis from a coagulation disease, and point to a constitutional or acquired etiology","correct":true},{"idx":3,"proposition":"Petechial and \/ or echymotic purpura, spontaneous bleeding and \/ or caused point to an attack of hemostasis","correct":true},{"idx":4,"proposition":"Reference values in adults are usually between 30 and 40 seconds for the TCA","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemorragie-hemato-1","context":null,"enonce":"Regarding bleeding disorders","item":"hemorragie","matiere":"hemato","propositions":[{"idx":0,"proposition":"A significant prolongation of the TCA is defined by a ratio of sick time \/ control time greater than 1.2","correct":true},{"idx":1,"proposition":"Elongated TCA can detect antihemophilic factor deficiency when isolated","correct":true,"justification":"FVIII (antihemophilic factor A), FIX (antihemophilic factor B)"},{"idx":2,"proposition":"The prolongation of an TCA may indicate an asymptomatic deficiency, not predisposing to bleeding","correct":true,"justification":"FXII deficiency for example"},{"idx":3,"proposition":"The quick time explores the direct (so-called \"extrinsic\") pathway of coagulation","correct":true},{"idx":4,"proposition":"Bleeding time explores primary hemostasis as a whole","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemorragie-hemato-2","context":null,"enonce":"Regarding bleeding disorders","item":"hemorragie","matiere":"hemato","propositions":[{"idx":0,"proposition":"The expression in INR of the quick time is to be reserved for monitoring AVK treatments","correct":true},{"idx":1,"proposition":"Bleeding time (TS) is operator-dependent, with poor reproducibility and sensitivity","correct":true},{"idx":2,"proposition":"The result of bleeding time is predictive of bleeding risk","correct":false,"justification":"the result obtained is not predictive of the risk of bleeding"},{"idx":3,"proposition":"Willebrand disease is the most common constitutional pathology of hemostasis","correct":true},{"idx":4,"proposition":"Thrombopathy is suggested in the event of unexplained mucocutaneous bleeding, associated with a normal platelet count, normal TCA and TQ","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemorragie-hemato-3","context":null,"enonce":"About Willebrand disease","item":"hemorragie","matiere":"hemato","propositions":[{"idx":0,"proposition":"Willebrand disease is caused by a quantitative or qualitative deficiency of Wilebrand factor","correct":true,"justification":"FVIII deficiency is often associated"},{"idx":1,"proposition":"Willebrand disease is transmitted in the majority of cases in an autosomal dominant manner","correct":true},{"idx":2,"proposition":"The plasma level of wWF is between 50 and 150% in normal subjects","correct":true},{"idx":3,"proposition":"The clinical expression of Willebrand disease is very heterogeneous","correct":true},{"idx":4,"proposition":"Intramuscular injections are contraindicated in patients with willebrand disease","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemorragie-hemato-4","context":null,"enonce":"About hemophilia","item":"hemorragie","matiere":"hemato","propositions":[{"idx":0,"proposition":"Congenital hemophilia is due to a deficiency of FVIII (hemophilia A) or FIX (hemophilia B, 5 times less common)","correct":true},{"idx":1,"proposition":"Hemophilia is inherited in an autosomal < recessive manner","correct":false,"justification":"Hemophilia is transmitted in a sex-linked recessive manner, with the FVIII and IX genes located on the X chromosome"},{"idx":2,"proposition":"Only boys are affected and women are drivers","correct":true},{"idx":3,"proposition":"The severity of hemorrhagic syndrome depends on the severity of the FVIII or FIX deficiency: the deficiency may be severe (< 10%)","correct":false,"justification":"The severity of hemorrhagic syndrome depends on the severity of the FVIII or FIX deficiency: the deficiency can be severe (rate < 1%), moderate (rate between 1 and 5%) or minor (rate between 5 and 30%)"},{"idx":4,"proposition":"Clinical manifestations are dominated by bleeding caused by sometimes minimal shock","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hemorragie-hemato-5","context":null,"enonce":"Which of the following are true?","item":"hemorragie","matiere":"hemato","propositions":[{"idx":0,"proposition":"Protein S is a coagulation inhibitor","correct":true},{"idx":1,"proposition":"Protein S is vitamin-K dependent","correct":true},{"idx":2,"proposition":"Protein S acts as a cofactor of activated protein C (PCa)","correct":true},{"idx":3,"proposition":"The determination of protein S is part of the thrombophilia balance sheet","correct":true},{"idx":4,"proposition":"All propositions are true","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"psychoT-psy-0","context":null,"enonce":"Regarding the generalities of psychotherapies:","item":"psychoT","matiere":"psy","propositions":[{"idx":0,"proposition":"It is 'Any method of treating psychic or bodily disorders using psychological means and, more precisely, the relationship between therapist and patient'","correct":true},{"idx":1,"proposition":"Simple verbal exchange is psychotherapy","correct":false,"justification":"Any verbal exchange\/conversation does not constitute psychotherapy although a simple verbal exchange can form a therapy provided it is structured around predefined criteria."},{"idx":2,"proposition":"Psychotherapy aims to cure illness when drug treatments are ineffective","correct":false,"justification":"Psychotherapy aims to improve the overall well-being of the patient. This sometimes allows healing but not only in desperation when drug treatment is ineffective."},{"idx":3,"proposition":"Psychotherapy is suitable for all patients because they can be almost totally passive","correct":false,"justification":"It implies on the part of the patient a request for care and change"},{"idx":4,"proposition":"All psychotherapy has a framework with its rules such as the number of sessions, their duration, etc.","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"psychoT-psy-1","context":null,"enonce":"Regarding the practice of psychotherapy:","item":"psychoT","matiere":"psy","propositions":[{"idx":0,"proposition":"A psychotherapist is an over-specialized psychologist","correct":false,"justification":"A psychotherapist can have different types of training: psychiatrist, psychologist, or specific training in psychotherapeutic technique without another degree."},{"idx":1,"proposition":"The title of psychologist is at bachelor's level","correct":false,"justification":"Master"},{"idx":2,"proposition":"The title of hypnotherapist escapes any regulation","correct":true},{"idx":3,"proposition":"The title of psychopractitioner requires a bac + 4 minimum","correct":false,"justification":"No regulation governs this title"},{"idx":4,"proposition":"Not all psychotherapy is applicable to every patient","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"psychoT-psy-2","context":null,"enonce":"Regarding psychotherapy:","item":"psychoT","matiere":"psy","propositions":[{"idx":0,"proposition":"A common point to all these psychotherapies is the establishment of a quality therapeutic relationship, based on empathy.","correct":true},{"idx":1,"proposition":"Psychotherapy is not just a conversation","correct":true},{"idx":2,"proposition":"It is generally easier to measure the effectiveness of therapies focused on a defined symptom (such as a phobia) than on a global syndrome.","correct":true},{"idx":3,"proposition":"Supportive psychotherapy is considered first-level psychotherapy","correct":true},{"idx":4,"proposition":"Supportive psychotherapy is the least used technique","correct":false,"justification":"It is the most used and least theorized psychotherapy but it responds to a precise framework and defined techniques"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SCZ-psy-0","context":null,"enonce":"On the main generalities:","item":"SCZ","matiere":"psy","propositions":[{"idx":0,"proposition":"The diagnosis of schizophrenia is biological","correct":false,"justification":"Early clinical diagnosis"},{"idx":1,"proposition":"Delusions are characterized by their intensity and impact on normal ideation","correct":false,"justification":"Delusions are characterized by their theme, mechanism, systematization, adherence, and emotional and behavioral impact."},{"idx":2,"proposition":"Schizophrenia is a chronic disease","correct":true},{"idx":3,"proposition":"The impact of schizophrenia on life expectancy has recently become zero thanks to new management methods","correct":false,"justification":"Life expectancy is decreased, mainly due to comorbidities (including cardiovascular disease) and suicides"},{"idx":4,"proposition":"Management is based on pharmacological treatment with benzodiazepines","correct":false,"justification":"Management is based on antipsychotic pharmacological treatment, treatment of comorbidities and psycho-social rehabilitation (psycho-education, cognitive-behavioral therapy, cognitive remediation and psychosocial rehabilitation)"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"SCZ-psy-1","context":null,"enonce":"Schizophrenia:","item":"SCZ","matiere":"psy","propositions":[{"idx":0,"proposition":"Schizophrenia was described in the early twentieth century as a common and severe disease","correct":true},{"idx":1,"proposition":"This disease is currently classified by the WHO among the ten diseases that cause the most disability, especially in young people.","correct":true},{"idx":2,"proposition":"It is characterized in the foreground by an alteration of language and memory","correct":false,"justification":"It is one of the chronic psychotic disorders that are characterized by an alteration of contact with reality"},{"idx":3,"proposition":"The etiology mainly found is iatrogenic (adverse effects of drugs, vaccines and GMOs)","correct":false,"justification":"The hypothesis of a neurodevelopmental disorder, which prevails today, postulates that schizophrenia is the delayed consequence of neurodevelopmental abnormalities beginning years before the onset of the disease."},{"idx":4,"proposition":"The prevalence of schizophrenia is about 10% in the general population","correct":false,"justification":"About 0.6-1%"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SCZ-psy-2","context":null,"enonce":"Prevalence and symptomatology:","item":"SCZ","matiere":"psy","propositions":[{"idx":0,"proposition":"The disease typically begins in late adolescence or in young adults between 15 and 25 years of age.","correct":true},{"idx":1,"proposition":"The age of onset is usually later in women compared to men by about 5 years","correct":true},{"idx":2,"proposition":"The emergence of schizophrenic symptoms is brutal and unexpected (thunderclap in a calm sky)","correct":false,"justification":"The emergence of schizophrenic symptoms is usually preceded by cognitive alterations and non-specific prodromal symptoms may be present 2 to 5 years before the emergence of the disorder"},{"idx":3,"proposition":"The sex ratio shows that women are more affected than men","correct":false,"justification":"The sex ratio is fairly balanced, although there is a slight predominance among men (x 1.4)"},{"idx":4,"proposition":"Delusions correspond to alterations in the content of thought resulting in an alteration of contact with reality","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"SCZ-psy-3","context":null,"enonce":"Regarding the symptomatology:","item":"SCZ","matiere":"psy","propositions":[{"idx":0,"proposition":"In schizophrenia, the prevalence of delusions is estimated at more than 90%","correct":true},{"idx":1,"proposition":"The theme of the delusional idea corresponds to the degree of reality of it","correct":false,"justification":"This is the main subject of this idea"},{"idx":2,"proposition":"The themes are often those of self-flagellation","correct":false,"justification":"The themes can vary infinitely, be unique or multiple, associate with each other in a more or less logical way"},{"idx":3,"proposition":"The mechanism of the delusional idea corresponds to the process by which the delusional idea is established and constructed.","correct":true},{"idx":4,"proposition":"There are 2 different types of mechanism at the origin of delusions: hallucination and imagination","correct":false,"justification":"There are 4 types of mechanism at the origin of delusions: interpretative, hallucinatory, intuitive and imaginative mechanisms"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SCZ-psy-4","context":null,"enonce":"Delusions in schizophrenia:","item":"SCZ","matiere":"psy","propositions":[{"idx":0,"proposition":"The delusional idea theme evaluates the organization and coherence of delusions.","correct":false,"justification":"It is the degree of systematization that evaluates this"},{"idx":1,"proposition":"A delusional idea is considered unsystematized when the organization is fuzzy, vague and incoherent.","correct":true},{"idx":2,"proposition":"In schizophrenia, delusions are often very precise and systematized.","correct":false,"justification":"In schizophrenia, we find in the majority of cases delusions that are not systematized, fuzzy, without logic, incoherent, unlike the persistent delusional disorder of persecution type during which delusions are generally systematized and where coherence gives a certain logic to delusional production"},{"idx":3,"proposition":"Adherence to delusions is the degree of conviction the patient feels about these ideas.","correct":true},{"idx":4,"proposition":"When the conviction is unshakeable, inaccessible to reasoning and criticism, adherence is said to be \"not reasonable\"","correct":false,"justification":"We speak of \"total\" membership"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"SCZ-psy-5","context":null,"enonce":"Concerning delusions","item":"SCZ","matiere":"psy","propositions":[{"idx":0,"proposition":"When adherence is partial, the patient is able to criticize their own delusions.","correct":true},{"idx":1,"proposition":"Delusions very rarely induce self-aggression","correct":false,"justification":"Dangerousness for oneself or for others can be the direct consequence of delusions (escaping the conspiracy, atone's faults, taking revenge on a persecutor)"},{"idx":2,"proposition":"Persecution is a type of delusional idea in which the central theme for the subject is to be attacked, harassed, etc.","correct":true},{"idx":3,"proposition":"A somatic delusional idea has as its central theme the functioning of the body","correct":true},{"idx":4,"proposition":"A patient who explains that: \"At 8pm, Laurent Delahousse spoke to me through television to tell me that I had to save the world\" may be an example of a crazy idea of reference","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SCZ-psy-6","context":null,"enonce":"Symptoms of schizophrenia:","item":"SCZ","matiere":"psy","propositions":[{"idx":0,"proposition":"Hallucination is defined as a perception without object","correct":true},{"idx":1,"proposition":"Schizophrenia is incompatible with real hallucinations","correct":false,"justification":"In schizophrenia, 75% of patients present with hallucinations, especially in the acute phase"},{"idx":2,"proposition":"Psychosensory hallucinations are sensory manifestations","correct":true},{"idx":3,"proposition":"In schizophrenia, all senses can be affected","correct":true},{"idx":4,"proposition":"Tactile hallucinations are extremely common and are found in more than half of patients with schizophrenia","correct":false,"justification":"Tactile hallucinations (superficial sense of touch) are present in about 5% of patients with schizophrenia"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"SCZ-psy-7","context":null,"enonce":"Semiology of schizophrenia:","item":"SCZ","matiere":"psy","propositions":[{"idx":0,"proposition":"Hallucinations affecting taste are very common in schizophrenia","correct":false,"justification":"Very rare"},{"idx":1,"proposition":"Olfactory hallucinations most often involve bad odors coming from the patient himself","correct":true},{"idx":2,"proposition":"Cenesthetic hallucinations concern internal sensitivity","correct":true},{"idx":3,"proposition":"Influence syndrome is characterized by the feeling of being directed and losing free will","correct":true},{"idx":4,"proposition":"Negative syndrome corresponds to depression associated with pre-existing schizophrenia","correct":false,"justification":"The negative syndrome includes clinical signs that reflect an impoverishment of psychic life"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SCZ-psy-8","context":null,"enonce":"Regarding clinical signs:","item":"SCZ","matiere":"psy","propositions":[{"idx":0,"proposition":"An anhedonia is the loss of ability to experience pleasure","correct":true},{"idx":1,"proposition":"Clinophilia can ultimately lead to negligence","correct":true},{"idx":2,"proposition":"The syndrome of disorganization corresponds to the loss of the psychic unity between ideas, affectivity and attitudes","correct":true},{"idx":3,"proposition":"In this disease, the ability to speak is preserved","correct":false,"justification":"Disorganization at the cognitive level is also manifested by a symptomatology affecting language"},{"idx":4,"proposition":"Catalepsy is a waxy flexibility of the limbs with maintenance of imposed attitudes","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"precarite-psy-0","context":null,"enonce":"General and definitions","item":"precarite","matiere":"psy","propositions":[{"idx":0,"proposition":"Precariousness is defined as a state of fragility and social instability","correct":true},{"idx":1,"proposition":"The 2 essential health security identified by the WHO is access to medicines and drinking water.","correct":false,"justification":"The essential health security identified by the WHO is much more numerous than this: * housing, * access to education and information, * adequate food in quantity and quality, * have a sufficient, certain and stable income, * benefit from a stable, protective ecosystem, * rely on a sustainable supply of resources, * have the right to social justice and fair treatment."},{"idx":2,"proposition":"Precariousness corresponds to the modest social classes","correct":false,"justification":"Precariousness does not characterize a particular social category but a set of situations of insecurity and economic, social and family fragility."},{"idx":3,"proposition":"Precariousness is a dynamic, reversible and multifactorial situation","correct":true},{"idx":4,"proposition":"A subject in a precarious situation does not have the means to support himself","correct":false,"justification":"Be careful, a subject in a precarious situation is not necessarily poor or excluded"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"precarite-psy-1","context":null,"enonce":"On poverty and exclusion:","item":"precarite","matiere":"psy","propositions":[{"idx":0,"proposition":"Poverty is a term that generally refers to the financial dimension","correct":true},{"idx":1,"proposition":"Around 10% of the population lives below the poverty line","correct":true},{"idx":2,"proposition":"Exclusion is a static state that is difficult to adjust","correct":false,"justification":"Exclusion 113 Exclusion is a dynamic reality characterised by the absence for an individual, for a more or less long period, of the possibility of enjoying the same social rights as another individual"},{"idx":3,"proposition":"Exclusion is most often experienced","correct":true},{"idx":4,"proposition":"Exclusion requires medical care most often","correct":false,"justification":"Exclusion is not a disease, but it reduces perceived social support and creates a sense of social worthlessness and self-worthlessness that causes intense psychological suffering and difficulty in integrating into a social fabric."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"precarite-psy-2","context":null,"enonce":"Regarding the impact of precariousness:","item":"precarite","matiere":"psy","propositions":[{"idx":0,"proposition":"Exclusion is the extreme form of precariousness","correct":true},{"idx":1,"proposition":"The phenomenon of precariousness, in the sense of the absence of one or more securities, affects about 5% of the population","correct":false,"justification":"Epidemiology: The phenomenon of precariousness, in the sense of the absence of one or more security measures, affects 12 to 15 million people in France, or 20 to 25% of the entire population."},{"idx":2,"proposition":"In France, the gap in life expectancy at age 35 between blue-collar workers and senior managers is very small because of the welfare state.","correct":false,"justification":"It is important, from 8 years to 35 years and from 4.5 years to 60 years"},{"idx":3,"proposition":"Medical morbidity and mortality is not impacted by precariousness because access to emergency care is free","correct":false,"justification":"Medical morbidity and mortality is increased among individuals in precarious situations"},{"idx":4,"proposition":"Precariousness is a positive risk factor for the occurrence of psychiatric disorders","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"dysphagie-HGE-0","context":null,"enonce":"About dysphagia","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"It must be differentiated from the odynophagia pain felt during the progression of food in the esophagus but without feeling of blockage of the diet","correct":true},{"idx":1,"proposition":"Dysphagia is a sensation of discomfort or obstacle to the progression of the bolus of food occurring during swallowing","correct":true},{"idx":2,"proposition":"Gastro-duodenal endoscopy is the key examination to do in the first place in front of any dysphagia","correct":true},{"idx":3,"proposition":"Even in the case of normal mucosa, mucosal biopsies should be routinely performed to look for eosinophilic esophagitis.","correct":true},{"idx":4,"proposition":"Endoscopic ultrasound is the most precise examination of the esophageal wall","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dysphagie-HGE-1","context":null,"enonce":"About dysphagia","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"If the gastro-duodenal endoscopy is normal, look for an esophageal motor disorder","correct":true},{"idx":1,"proposition":"Esophageal manometry: • is the key test for diagnosing motor disorders of the esophagus","correct":true},{"idx":2,"proposition":"Manotry may be useful to attach anginal-like chest pain to the esophagus","correct":true},{"idx":3,"proposition":"In case of lesional dysphagia, dysphagia in general predominates over fluids","correct":false,"justification":"dysphagia in general: • predominates over solids; • • and has an impact on the general condition"},{"idx":4,"proposition":"Eosinophilic esophagitis, which mainly affects humans, is associated in 50% of cases with atopic manifestations","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dysphagie-HGE-2","context":null,"enonce":"About dysphagia","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"In case of eosinophilic esophagitis the endoscopy may be normal, or visualize the following lesions: whitish granita, thickened mucosa with presence of vertical linear fissures, single or multiple strictures and appearance in \"pseudo-trachea\"","correct":true},{"idx":1,"proposition":"In Zenker's diverticulum dysphagia is high and associated with food regurgitation sometimes triggered by cervical pressure","correct":true},{"idx":2,"proposition":"Zenker's diverticulum diagnsotic occurs on gastro-duodenal endoscopy","correct":false,"justification":"Zenker's diverticulum is CONTRAINDICATED to EOGD because of the risk of perforation"},{"idx":3,"proposition":"Achalasia is a primary motor disorder of the esophagus of unknown cause, defined by the complete absence of peristalsis in the body of the esophagus.","correct":true},{"idx":4,"proposition":"The most common organic causes of dysphagia are tumors and esophagitis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dysphagie-HGE-3","context":null,"enonce":"About dysphagia","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"The diagnosis of achalasia is endoscopic","correct":false,"justification":"It is manometric"},{"idx":1,"proposition":"Esophagitis with esopniphilia can cause food impaction","correct":true},{"idx":2,"proposition":"Esophageal cancer causes progressive dysphagia that starts with fluids","correct":false,"justification":"It focuses first on solids"},{"idx":3,"proposition":"Oro-pharyngeal dysphagia is essentially ENT or neurological","correct":true},{"idx":4,"proposition":"Secondary motor disorders of the esophagus may be observed in scleroderma or diabetes","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dysphagie-HGE-4","context":null,"enonce":"Which of the following are true?","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"Gastro-duodenal endoscopy (EOGD) is the key test to do first in front of any dysphagia","correct":true,"justification":"Looking for organ lesions"},{"idx":1,"proposition":"CT is the most effective method for diagnosing esophageal and esophagitis tumours","correct":false,"justification":"EOGD is the most effective method for diagnosing esophageal and esophagitis tumors"},{"idx":2,"proposition":"EOGD allows both the precise study of the mucosa and the realization of biopsies","correct":true,"justification":"Great maneuverability and live << visualization>>"},{"idx":3,"proposition":"Even in case of normal mucosa, mucosal biopsies should be routinely performed to look for lymphocyte esophagitis","correct":false,"justification":"Eosinophilic esophagitis is sought, which is often associated with blood eosinophilia and atopic manifestations"},{"idx":4,"proposition":"The chest CT scan makes it possible to look for a mediastinal lesion and appreciates the parietal, mediastinal and lymph node extension of cancers","correct":true,"justification":"And even remotely for advanced forms"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dysphagie-HGE-5","context":null,"enonce":"What is the extent of Eckart's score?","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"2","correct":false,"justification":"3"},{"idx":1,"proposition":"3","correct":true,"justification":"Eckart's score ranges from 0 to 3 and is for dysphagia."},{"idx":2,"proposition":"4","correct":false,"justification":"3"},{"idx":3,"proposition":"5","correct":false,"justification":"3"},{"idx":4,"proposition":"6","correct":false,"justification":"3"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dysphagie-HGE-6","context":null,"enonce":"Which of the following are true?","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"Dysphagia is a feeling of discomfort or obstruction to the progression of the bolus of food occurring during swallowing","correct":true},{"idx":1,"proposition":"Odynophagia is pain felt during the progression of food in the esophagus but without a feeling of blockage of food","correct":true},{"idx":2,"proposition":"The \"globus hystericus\" is a sensation of cervical striction related to the endobrachy-esophagus","correct":false,"justification":"Globus hystericus is linked to anxiety"},{"idx":3,"proposition":"Odynophagia electively affects certain foods  ","correct":false,"justification":"No, but globus hystericus yes"},{"idx":4,"proposition":"Oropharyngeal dysphagia results in difficulty initiating swallowing and propelling the bolus into the esophagus.","correct":true,"justification":"True. The causes of oropharyngeal dysphagia are mostly ENT or neurological"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dysphagie-HGE-8","context":null,"enonce":"Which of the following proposals may be responsible for esophagitis?","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"Doxycycline","correct":true},{"idx":1,"proposition":"Potassium chloride tablets","correct":true},{"idx":2,"proposition":"NSAIDs","correct":true,"justification":"Aspirin++"},{"idx":3,"proposition":"Biphosphonates","correct":true},{"idx":4,"proposition":"Antiparkinsonians","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dysphagie-HGE-9","context":null,"enonce":"Which of the following are true for esophageal candidiasis?","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"The immunocompromised terrain is at risk","correct":true},{"idx":1,"proposition":"It may be responsible for dysphagia without stenosis","correct":true},{"idx":2,"proposition":"It may be responsible for regurgitation","correct":false},{"idx":3,"proposition":"It may be responsible for squamous cell carcinoma","correct":false},{"idx":4,"proposition":"False membrane deposits are found at FOGD","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dysphagie-HGE-10","context":null,"enonce":"Which of the following proposals are in favor of adenocarcinoma of the esophagus?","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"Alcohol","correct":false,"justification":"In favor of squamous cell carcinoma of the esophagus"},{"idx":1,"proposition":"Tobacco","correct":false,"justification":"In favor of squamous cell carcinoma of the esophagus"},{"idx":2,"proposition":"Rapid weight loss","correct":true},{"idx":3,"proposition":"History of gastroesophageal reflux disease","correct":true,"justification":"Chronic GERD and overweight are the 2 main risk factors for EDA of the esophagus"},{"idx":4,"proposition":"Progressive dysphagia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dysphagie-HGE-11","context":null,"enonce":"Which of the following are possible causes of dysphagia?","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"Amyotrophic lateral sclerosis","correct":true,"justification":"True, is accompanied by fasciculations of the language"},{"idx":1,"proposition":"Radiation esophagitis","correct":true,"justification":"True, delayed complication of radiation therapy"},{"idx":2,"proposition":"Closed Rhinolalia","correct":false,"justification":"False, no direct impact"},{"idx":3,"proposition":"Meckel's diverticulum","correct":false,"justification":"Zencker's diverticulum (Meckel = digestive)"},{"idx":4,"proposition":"Scleroderma","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dysphagie-HGE-12","context":null,"enonce":"Which of the following are possible causes of dysphagia?","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"All propositions are true","correct":true},{"idx":1,"proposition":"Squamous cell carcinomium of the pharynx","correct":true},{"idx":2,"proposition":"Adenocarcinoma of the esophagus","correct":true},{"idx":3,"proposition":"Esophageal candidiasis","correct":true},{"idx":4,"proposition":"Lupus","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dysphagie-HGE-13","context":null,"enonce":"Which of the following are true about eosinophilic esophagitis?","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"They affect more men than women","correct":true},{"idx":1,"proposition":"Asthma is a contributing factor","correct":true},{"idx":2,"proposition":"Treatment is based on the prescription of antihistamines","correct":false,"justification":"Corticosteroids"},{"idx":3,"proposition":"5-year survival is 15%","correct":false,"justification":"False, survival relatively little impacted"},{"idx":4,"proposition":"Biopsies show infiltration by PNE 35% per field","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"toux-pneumo-0","context":null,"enonce":"Concerning the main generalities:","item":"toux","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The etiologies of chronic cough are more or less the same as those of acute cough","correct":false,"justification":"The etiologies are very different"},{"idx":1,"proposition":"The majority of acute coughs are allergic","correct":false,"justification":"Especially post-infectious and they do not require investigation"},{"idx":2,"proposition":"Chronic cough is often a defensive phenomenon in response to aggression","correct":true},{"idx":3,"proposition":"Coughing involves a reflex neural arc whose conduction pathways are still unknown to this day.","correct":false,"justification":"They are known in a fairly precise way"},{"idx":4,"proposition":"Cough is a relatively rare symptom in liberal","correct":false,"justification":"This is extremely common"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"toux-pneumo-2","context":null,"enonce":"Which propositions are true:","item":"toux","matiere":"pneumo","propositions":[{"idx":0,"proposition":"We speak of chronic cough when the duration is greater than 3 weeks in French literature","correct":true},{"idx":1,"proposition":"Post-infectious coughs require a biological work-up","correct":false,"justification":"No investigation"},{"idx":2,"proposition":"A chronic cough can cause a rib fracture","correct":true},{"idx":3,"proposition":"Urine loss associated with chronic cough should suggest overactive bladder","correct":false,"justification":"Are often due to the cough itself"},{"idx":4,"proposition":"Capsaicin stimulates C-fiber receptors and causes coughing","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"toux-pneumo-3","context":null,"enonce":"Which of the following suggest causes of iatrogenic cough?","item":"toux","matiere":"pneumo","propositions":[{"idx":0,"proposition":"IEC","correct":true},{"idx":1,"proposition":"Beta-blockers","correct":true},{"idx":2,"proposition":"Amniodarone","correct":false},{"idx":3,"proposition":"Aspirin","correct":false},{"idx":4,"proposition":"Sartans","correct":true,"justification":"There are also vaporized or inhaled drugs"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"toux-pneumo-4","context":null,"enonce":"Which of the following suggest causes of organic cough?","item":"toux","matiere":"pneumo","propositions":[{"idx":0,"proposition":"IEC intake","correct":false,"justification":"It is an iatrogenic cause, not an organic one"},{"idx":1,"proposition":"Asthma","correct":true},{"idx":2,"proposition":"Pertussis","correct":true},{"idx":3,"proposition":"Malaria","correct":false,"justification":"No cough"},{"idx":4,"proposition":"Chronic meningitis","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nephroPinterst-nephro-0","context":null,"enonce":"Concerning the main generalities:","item":"nephroPinterst","matiere":"nephro","propositions":[{"idx":0,"proposition":"Chronic interstitial nephropathies include a wide variety of pathologies","correct":true},{"idx":1,"proposition":"Most often, the course is rapid and fatal without treatment","correct":false,"justification":"It is rather slow"},{"idx":2,"proposition":"Repeated history of UTIs supports a diagnosis of NIC","correct":true},{"idx":3,"proposition":"Sarcoidosis cannot cause NIC","correct":false,"justification":"This is one of the etiologies"},{"idx":4,"proposition":"Sjögren's syndrome is one of the etiologies of NIC","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"nephroPinterst-nephro-1","context":null,"enonce":"Which of these proposals are signs of NIC?","item":"nephroPinterst","matiere":"nephro","propositions":[{"idx":0,"proposition":"A very early and secondary hypertension","correct":false,"justification":"It is late in this type of nephropathy"},{"idx":1,"proposition":"Leukocyteturia","correct":true},{"idx":2,"proposition":"Polyuria","correct":true,"justification":"With nocturia"},{"idx":3,"proposition":"Type 2 diabetes","correct":false,"justification":"There is no indication of impact or link (in the repository in any case) between the T2D and the NICs"},{"idx":4,"proposition":"Acute renal failure","correct":false,"justification":"It is chronic and slow-growing. GFR drops by less than 5 ml\/min each year"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nephroPinterst-nephro-2","context":null,"enonce":"Regarding the diagnosis:","item":"nephroPinterst","matiere":"nephro","propositions":[{"idx":0,"proposition":"Ultrasound shows significant dilation of the kidneys and possible cysts","correct":false,"justification":"The kidneys are reduced in size"},{"idx":1,"proposition":"Kidney biopsy is urgent for diagnostic purposes","correct":false,"justification":"Most often, it is not performed, because of the small size of the kidneys and the often very suggestive clinical context"},{"idx":2,"proposition":"Histology is non-specific to the cause of NIC","correct":true,"justification":"See item in the last (8th) edition of the college p.394"},{"idx":3,"proposition":"Anatomical pathology consistently reveals interstitial infiltration by cancer cells","correct":false,"justification":"Infiltration is due to mononuclear cells. The presence of granulomas can sometimes be observed (in the case of a corresponding etiology, e.g. sarcoidosis)"},{"idx":4,"proposition":"Glomeruli and vessels are most often preserved in the initial stages","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nephroPinterst-nephro-3","context":null,"enonce":"Which of these proposals are urological causes of NIC?","item":"nephroPinterst","matiere":"nephro","propositions":[{"idx":0,"proposition":"Lead poisoning","correct":false,"justification":"Toxic cause"},{"idx":1,"proposition":"Sjögren's syndrome","correct":false,"justification":"Dysimmune cause"},{"idx":2,"proposition":"Hyperuricemia","correct":false,"justification":"Metabolic cause"},{"idx":3,"proposition":"Lithiases","correct":true},{"idx":4,"proposition":"Vesicoureteral reflux","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"nephroPinterst-nephro-4","context":null,"enonce":"Regarding NICs secondary to lithium intake:","item":"nephroPinterst","matiere":"nephro","propositions":[{"idx":0,"proposition":"30-45% of patients have functional renal abnormalities after 10-15 years of treatment ","correct":true},{"idx":1,"proposition":"There is a polyuropolidipsic syndrome ","correct":true},{"idx":2,"proposition":"There is central diabetes insipidus","correct":false,"justification":"Nephrogenic"},{"idx":3,"proposition":"There is proximal tubular acidosis","correct":false,"justification":"Distal"},{"idx":4,"proposition":"There are microcysts at biopsy ","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"nephroPinterst-nephro-5","context":null,"enonce":"The drugs responsible for NIC are:","item":"nephroPinterst","matiere":"nephro","propositions":[{"idx":0,"proposition":"Aminoglycosides","correct":false,"justification":"Direct NTA"},{"idx":1,"proposition":"Antineoplastics (e.g. cisplatin)","correct":true},{"idx":2,"proposition":"Anticalcineurins ( ciclosporin and tacrlimus ) ","correct":true},{"idx":3,"proposition":"Statins","correct":false,"justification":"Indirect NTA"},{"idx":4,"proposition":"Interferon","correct":false,"justification":"Immunological glomerular"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"nephroPinterst-nephro-6","context":null,"enonce":"NITU syndrome:","item":"nephroPinterst","matiere":"nephro","propositions":[{"idx":0,"proposition":"Means Interstitial and Tubular Nephropathy with Urethritis","correct":false,"justification":"Uveitis"},{"idx":1,"proposition":"It is a dysimmune pathology ","correct":true},{"idx":2,"proposition":"Is more common in adults than in children ","correct":false},{"idx":3,"proposition":"Is interstitial nephritis associated with uveitis ","correct":true},{"idx":4,"proposition":"Is treated with corticosteroids","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"fievreimmunoD-infectio-0","context":null,"enonce":"Regarding fever in immunocompromised patients","item":"fievreimmunoD","matiere":"infectio","propositions":[{"idx":0,"proposition":"Three therapeutic emergencies are identified: febrile neutropenia, asplenic fever, sepsis\/septic shock","correct":true},{"idx":1,"proposition":" The presence of immunosuppression requires taking into account the possibility of opportunistic infection","correct":true},{"idx":2,"proposition":"Any febrile neutropenia requires emergency antibiotic therapy","correct":true},{"idx":3,"proposition":"The symptomatology of febrile neutropenia is poor due to the absence of phagocytic effectors","correct":true},{"idx":4,"proposition":"Any fever in an asplenic should be treated with probabilistic antibiotic therapy amoxicillin + clavulanic acid ","correct":false,"justification":"Any fever in an asplenic should be treated with 3rd generation cephalosporin probabilistic antibiotic therapy (after blood cultures) because of the risk of fulminant pneumococcal infection"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"fievreimmunoD-infectio-1","context":null,"enonce":"Regarding fever in immunocompromised patients","item":"fievreimmunoD","matiere":"infectio","propositions":[{"idx":0,"proposition":"Immunosuppression has 3 consequences: the impossibility of setting up an adapted immune response vis-à-vis endogenous or exogenous infectious agents, reduced clinical signs making it difficult to assess the clinical severity that may be underestimated, the possibility of a more rapid multiplication of the infectious agent(s) involved","correct":true,"justification":"This is what makes diagnosis and management so difficult."},{"idx":1,"proposition":"Any acute fever in an immunocompromised patient is a diagnostic emergency","correct":true},{"idx":2,"proposition":"Any acute fever in an immunocompromised patient is infectious until proven otherwise.","correct":true},{"idx":3,"proposition":"Neutropenia is most often secondary to cancer chemotherapy with a delay of onset of 2 to 10 weeks","correct":false,"justification":"Time to onset of 2 to 10 days depending on chemotherapy"},{"idx":4,"proposition":"The term neutropenia applies below 1000\/mm3 neutrophils","correct":false,"justification":"The term neutropenia applies below 1500\/mm3 neutrophils (PNN)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"fievreimmunoD-infectio-2","context":null,"enonce":"Regarding fever in immunocompromised patients","item":"fievreimmunoD","matiere":"infectio","propositions":[{"idx":0,"proposition":"The infectious emergency is frank when PNN < 500\/mm3","correct":true},{"idx":1,"proposition":"Febrile neutropenia is defined by PNN < 500\/mm3 and fever","correct":true},{"idx":2,"proposition":"The most frequent bacterial translocations originate in the digestive tract","correct":true},{"idx":3,"proposition":"The 3 most common gateways are the digestive tract, skin and lungs","correct":true},{"idx":4,"proposition":"The clinical examination is often poor in a febrile neutropenic patient, because of the absence of inflammatory focus","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"fievreimmunoD-infectio-3","context":null,"enonce":"Regarding infections in immunocompromised people","item":"fievreimmunoD","matiere":"infectio","propositions":[{"idx":0,"proposition":"Fever is often the main, if not the only, manifestation of the infection","correct":true},{"idx":1,"proposition":"The presence of sepsis marks the absolute urgency and the need for prompt referral to a continuing care unit","correct":false,"justification":"Intensive Care Unit"},{"idx":2,"proposition":" Pleiocytosis is constant in CSF in meningitis","correct":false},{"idx":3,"proposition":"Leukocyteturia is often absent in urinary tract infections","correct":true},{"idx":4,"proposition":"The frequency and severity of infections are proportional to the depth of neutropenia","correct":true,"justification":"The risk of infection is significant if PNN < 500\/mm3 and it is major if PNN < 100\/mm3"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcfoie-onco-0","context":null,"enonce":"Regarding the biliary cyst:","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"This tumor affects 5% of the population","correct":true,"justification":"We speak of tumor (in the onco MedLine) and, indeed, it is quite common"},{"idx":1,"proposition":"The wall is unicellular","correct":true},{"idx":2,"proposition":"The contents are biliary","correct":false,"justification":"Independent clear fluid content (not communicating with the biliary tree)"},{"idx":3,"proposition":"They are often multiple","correct":true},{"idx":4,"proposition":"They are hyperintense in T1 sequence MRI","correct":false,"justification":"Hyperintense in T2"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Kcfoie-onco-1","context":null,"enonce":"Regarding hemangioma:","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"It is a malignant tumor","correct":false,"justification":"This is quite benign"},{"idx":1,"proposition":"It affects 0.1% of the general population","correct":false,"justification":"It is a fairly common tumor that affects about 3% to 5% of the population (3% in the MedLine of oncology, 5% in the college of hepato-gastroenterology)"},{"idx":2,"proposition":"It requires mild chemotherapy","correct":false,"justification":"It does not require any treatment"},{"idx":3,"proposition":"It is hypervascularized","correct":true},{"idx":4,"proposition":"On MRI, it is hyperintense in T2 with an increasingly intense peripheral lump filling towards the center","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcfoie-onco-3","context":null,"enonce":"Regarding hepatocellular adenoma: ","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"Diagnosis requires a biopsy most often","correct":true},{"idx":1,"proposition":"The lesion is hypoechoic","correct":true},{"idx":2,"proposition":"The lesion is hypodense","correct":true},{"idx":3,"proposition":"The lesion is hypointense in T1","correct":true},{"idx":4,"proposition":"The lesion is hyperintense in T2","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcfoie-onco-4","context":null,"enonce":"Regarding abscesses and cysts:","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"The pyogenic abscess is hyper-dense on CT scan with a central enhancement","correct":false,"justification":"The pyogenic abscess is hypoechogenic and hypodense on CT scan with peripheral enhancement"},{"idx":1,"proposition":"A serology of amoebiasis must be carried out at the slightest doubt","correct":true},{"idx":2,"proposition":"The amoebic abscess is often unique","correct":true},{"idx":3,"proposition":"Hydatid cyst is caused by echinococcus fermantosus","correct":false,"justification":"Echinococcus granulosus (fermantosus is invented, it does not exist)"},{"idx":4,"proposition":"Alveolar echinococcosis is caused by echnicoccus multilocularis","correct":true,"justification":"Imaging in favor of sometimes invasive nodules, which can mimic neoplasia."}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"Kcfoie-onco-5","context":null,"enonce":"Regarding metastatic lesions:","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"Metachrone metastases have a poorer prognosis than synchronous metastases","correct":false,"justification":"It's the other way around. Synchronous lesions can indeed sign a very weakened immune system"},{"idx":2,"proposition":"In general, metastases appear hypodense and do not rise to arterial time","correct":true},{"idx":3,"proposition":"If metastases appear within 8 years, in the context of a known primary tumor and imaging is considered compatible, the diagnosis is affirmed without recourse to biopsy","correct":false,"justification":"Within two years (according to the Oncology MedLine)"},{"idx":4,"proposition":"Biopsy is necessary if the patient has two primary cancers in their history","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcfoie-onco-6","context":null,"enonce":"Regarding Hepatocellular Carcinoma (HCC):","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"It is the most common hepatic malignancy","correct":false,"justification":"Only in primary malignant lesions. Otherwise, it is mainly benign lesions (the simple biliary cyst affects almost 5% of the population). Also, there are more metastases than primary liver tumors."},{"idx":1,"proposition":"HCC is more common in women","correct":false,"justification":"HCC is more common in humans. The sex ratio is 6"},{"idx":2,"proposition":"The leading cause of HCC is hepatitis C virus","correct":false,"justification":"It is especially ethyl cirrhosis"},{"idx":3,"proposition":"Atoxin gives hepatocellular carcinomas on healthy liver by causing p53 mutations","correct":true},{"idx":4,"proposition":"Any nodular image on cirrhosis is a CHC until proven otherwise.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcfoie-onco-7","context":null,"enonce":"Which of the following are benign tumors that do not require monitoring?","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"Focal nodular hyperplasia","correct":true},{"idx":1,"proposition":"Benign hemangioma","correct":true},{"idx":2,"proposition":"Hepatocellular adenoma","correct":false,"justification":"It has the potential for degeneration and can be complicated by bleeding, so it should be monitored."},{"idx":3,"proposition":"Cholangiocarcinoma","correct":false,"justification":"It is a malignant tumor"},{"idx":4,"proposition":"All must be monitored","correct":false,"justification":"False, not UFH or benign hemangioma"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcfoie-onco-8","context":null,"enonce":"Which of the following are risk factors for HCC?","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"Focal nodular hyperplasia","correct":false,"justification":"No risk of degeneration"},{"idx":1,"proposition":"A metabolic syndrome ","correct":true},{"idx":2,"proposition":"NASH","correct":true},{"idx":3,"proposition":"Cirrhosis","correct":true,"justification":"True, main risk factor"},{"idx":4,"proposition":"Alveolar echinococcosis","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcfoie-onco-10","context":null,"enonce":"What is the proportion of HCC occurring on cirrhosis?","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"5%","correct":false,"justification":"False"},{"idx":1,"proposition":"25%","correct":false,"justification":"False"},{"idx":2,"proposition":"50%","correct":false,"justification":"False"},{"idx":3,"proposition":"90%","correct":true},{"idx":4,"proposition":"100%","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcestomac-onco-0","context":null,"enonce":"Which of the following are true?","item":"Kcestomac","matiere":"onco","propositions":[{"idx":0,"proposition":"Malignant epithelial tumors are the most common ","correct":true},{"idx":1,"proposition":"Worldwide, stomach cancer is the fifth most common cancer ","correct":true},{"idx":2,"proposition":"The average age of onset is 70 years with a female predominance ","correct":false,"justification":"Male"},{"idx":3,"proposition":"The most used histological classification is Lauren's which distinguishes 2 types of adenocarcinoma ","correct":true},{"idx":4,"proposition":"The epidemiology of gastric cancer evolves differently depending on location and histological type ","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Kcestomac-onco-1","context":null,"enonce":"Which of the following are true?","item":"Kcestomac","matiere":"onco","propositions":[{"idx":0,"proposition":"    In France, stomach cancer is the second most common cancer ","correct":false,"justification":"Fifth"},{"idx":1,"proposition":"In recent years, there has been an increase in the incidence of cancers of the cardia and diffuse types ","correct":true},{"idx":2,"proposition":"There is a decrease in the incidence of distal forms and intestinal adenocarcinoma","correct":true},{"idx":3,"proposition":"Helicobacter pylori is a risk factor","correct":true},{"idx":4,"proposition":"H. pylori is a gram-negative bacillus transmitted mainly in childhood  ","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"DBAI-dermato-0","context":null,"enonce":"Regarding definitions:","item":"DBAI","matiere":"dermato","propositions":[{"idx":0,"proposition":"Autoimmune bullous dermatoses are very common diseases, especially in post-puberty women","correct":false,"justification":"Autoimmune bullous dermatoses (IBD) are a heterogeneous group of infrequent diseases with variable prognosis, often pejorative."},{"idx":1,"proposition":"The diagnosis of DBAI is clinical","correct":false,"justification":"The diagnosis of IBAD requires a combination of clinical, pathological and immunopathological examinations"},{"idx":2,"proposition":"Desmosomes allow interkeratinocyte adhesion","correct":true},{"idx":3,"proposition":"the dermal-epidermal junction (JDE) is a morphologically complex region","correct":true},{"idx":4,"proposition":"There are two main groups of DBAI: supraepidermal and subepidermal","correct":false,"justification":"Intra-epidermal and subepidermal (there is nothing above the epidermis)"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"DBAI-dermato-1","context":null,"enonce":"Regarding definitions:","item":"DBAI","matiere":"dermato","propositions":[{"idx":0,"proposition":"Intraepidermal DBAI are part of the pemphigus group","correct":true},{"idx":1,"proposition":"Intraepidermal IABDs are due to acantholysis","correct":true},{"idx":2,"proposition":"Desmosome alteration is caused by circulating PNNs","correct":false,"justification":"By autoantibodies \"anti-intercellular substance\""},{"idx":3,"proposition":"A bubble is a superficial elementary fluid lesion larger than 15 mm","correct":false,"justification":"Size greater than 5 mm"},{"idx":4,"proposition":"The bubbles sit exclusively on the skin coating","correct":false,"justification":"It can sit on the skin or mucous membranes"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"DBAI-dermato-2","context":null,"enonce":"Regarding the clinic and histopathology:","item":"DBAI","matiere":"dermato","propositions":[{"idx":0,"proposition":"Nikolsky's sign corresponds to skin detachment caused by friction on healthy skin","correct":true},{"idx":1,"proposition":"An acantholysis is an intraepidermal detachment","correct":true},{"idx":2,"proposition":"A subepidermal bubble by cleavage between the dermis and the epidermis is a tense bubble","correct":true},{"idx":3,"proposition":"The contents of a subepidermal bubble are clear or haematic","correct":true},{"idx":4,"proposition":"An intraepidermal bubble by detachment of keratinocytes from each other is a tense bubble","correct":false,"justification":"It is a flaccid and fragile bubble (because the roof of the bubble is very thin due to intraepidermal cleavage)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"DBAI-dermato-3","context":null,"enonce":"Regarding the diagnosis of DBAI:","item":"DBAI","matiere":"dermato","propositions":[{"idx":0,"proposition":"There is a list of known DBAI-inducing drugs","correct":true},{"idx":1,"proposition":"Bullous pemphigoid is an intraepidermal DBAI","correct":false,"justification":"Bullous pemphigoid (linear deposits of IgG and C3) is a subepidermal DBAI"},{"idx":2,"proposition":"ACE inhibitors are known inducers of pemphigus","correct":true},{"idx":3,"proposition":"Potassium-sparing diuretics are known inducers of bullous pemphigoid","correct":true},{"idx":4,"proposition":"The bubbles are stretched in the DBAI of the JDE","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"epistaxis-ORL-1","context":null,"enonce":"Concerning anatomo-histo-physiology:","item":"epistaxis","matiere":"ORL","propositions":[{"idx":0,"proposition":"Like all mucous membranes, that of the nasal cavity is composed of three layers","correct":true},{"idx":1,"proposition":"The epithelium is composed of a cell monolayer","correct":true},{"idx":2,"proposition":"The basement membrane is non-existent","correct":false,"justification":"a basement membrane is present"},{"idx":3,"proposition":"A chorion is composed of a single hypervascular layer","correct":false,"justification":"A chorion is composed of three layers"},{"idx":4,"proposition":"From the surface to the depth, there is the lymphoid layer, the glandular layer and the vascular layer","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"epistaxis-ORL-2","context":null,"enonce":"Regarding the vascularization of the nasal cavity:","item":"epistaxis","matiere":"ORL","propositions":[{"idx":0,"proposition":"Arterial vascularization of the nasal cavity is dependent on both carotid systems","correct":true},{"idx":1,"proposition":"These arterioles lack an internal elastic membrane","correct":true},{"idx":2,"proposition":"The artery of the subseptum vascularizes the anteroinferior part of the septum","correct":true},{"idx":3,"proposition":"The branches of the anterior ethmoidal remain independent from their birth to their passage through the microcirculation","correct":false,"justification":"The artery of the subseptum anastomoses with the artery of the septum and with the branches of the anterior ethmoidal"},{"idx":4,"proposition":"The vascular spot is an anastomosis area of three arterial systems","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"epistaxis-ORL-3","context":null,"enonce":"Regarding anatomy and diagnosis:","item":"epistaxis","matiere":"ORL","propositions":[{"idx":0,"proposition":"Kiesselbach's vascular spot is the main area of epistaxis","correct":true},{"idx":1,"proposition":"The venous system is distributed in three layers at the mucosal level","correct":true},{"idx":2,"proposition":"The veins of the nasal cavity have abundant anastomoses with the arterial system","correct":true},{"idx":3,"proposition":"Specifying the abundance and impact of epistaxis makes it possible to deduce the seriousness","correct":true},{"idx":4,"proposition":"Etiologies are never found","correct":false,"justification":"It happens that if: trauma, taking anticoagulant\/antithrombotic, etc."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"epistaxis-ORL-4","context":null,"enonce":"Regarding the diagnosis:","item":"epistaxis","matiere":"ORL","propositions":[{"idx":0,"proposition":"Ensuring hemostasis is the first therapeutic act to consider","correct":true},{"idx":1,"proposition":"In benign epistaxis, the flow is scarce, dripping through the nostril, at first almost always unilateral","correct":true},{"idx":2,"proposition":"The appreciation of the bleeding volume is essential to find and guides all the care","correct":false,"justification":"The appreciation of bleeding volume is always difficult to estimate, frequently overestimated by the patient or the entourage but sometimes misleading by default because swallowed. Rather, it is based on the objective hemodynamic impact"},{"idx":3,"proposition":"The presence of bleeding disorders makes bleeding control more difficult","correct":true},{"idx":4,"proposition":"Severe epistaxis is frequently unilateral","correct":false,"justification":"Examination of the nasal cavities is sometimes delicate due to the abundance of bleeding, frequently bilateral and anteroposterior"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"epistaxis-ORL-6","context":null,"enonce":"Regarding treatment:","item":"epistaxis","matiere":"ORL","propositions":[{"idx":0,"proposition":"An oral or injectable anxiolytic in an agitated and anxious patient may be proposed","correct":true},{"idx":1,"proposition":"The search for an etiology is urgent in the face of an epistaxis in progress","correct":false,"justification":"We first take care of the epistaxis"},{"idx":2,"proposition":"Drying up bleeding is the primary treatment","correct":true},{"idx":3,"proposition":"The examination of the nasal cavity will be performed using a rigid endoscope 0 or 30 degrees","correct":true},{"idx":4,"proposition":"Simple finger compression of the nose wing for 10 minutes can stop most epistaxis","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"epistaxis-ORL-7","context":null,"enonce":"Regarding epistaxis:","item":"epistaxis","matiere":"ORL","propositions":[{"idx":0,"proposition":"Compression by hemostatic buffer is possible in first line","correct":true},{"idx":1,"proposition":"cauterization of the vascular spot is done in the operating room","correct":false,"justification":"cauterization of the vascular spot is done at the patient's bed"},{"idx":2,"proposition":"In case of undetermined localization, endonasal coagulation of sphenopalatine arteries is the first-line treatment","correct":true},{"idx":3,"proposition":"It is common to transfusion patients who have been victims of severe epistaxis","correct":false,"justification":"Exceptional transfusion Apart from massive loss and deterioration of the general condition, it is preferable to replenish the martial reserves (oral iron or injectable) or to offer treatment with erythropoietin (EPO)"},{"idx":4,"proposition":"An essential epistaxis of the young is treated by anteroposterior tamponade most often","correct":false,"justification":"Simple compression for 10 minutes. See cauterization of vascular spot"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"epistaxis-ORL-8","context":null,"enonce":"Which of the following propositions concerning epistaxis are true?","item":"epistaxis","matiere":"ORL","propositions":[{"idx":0,"proposition":"First-line treatment is based on digital compression for previous bleeding","correct":true},{"idx":1,"proposition":"Ethmoidal artery embolization is the third-line treatment","correct":false,"justification":"Embolization of the ethmoid artery is contraindicated because it is a branch of the internal carotid artery (ICA). Its embolization therefore exposes to a risk of stroke or occlusion of the central artery of the retina (blindness). A ligature is therefore performed instead."},{"idx":2,"proposition":"Nasopharyngeal fibroid is a choanal vascularized tumor","correct":true,"justification":"True, it mainly affects boys at peripubertal age"},{"idx":3,"proposition":"Cauterization of the vascular spot is most often bilateral","correct":false,"justification":"Unilateral because risk of perforating the nasal septum if bilateral"},{"idx":4,"proposition":"The first measure to be carried out in case of severe epistaxis is the previous wicking","correct":false,"justification":"It is first necessary to perform a stripping because the clots, when they dissolve, cause even more bleeding"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infdentaire-urg-0","context":null,"enonce":"Which of these propositions are true?","item":"infdentaire","matiere":"urg","propositions":[{"idx":0,"proposition":"Parsnip is an infection of the soft parts of the hand or fingers","correct":true},{"idx":1,"proposition":"Phlegmon is an infection that develops in an anatomical space of the hand or fingers","correct":true},{"idx":2,"proposition":"Acute infections of the soft parts are monobacterial most often","correct":true},{"idx":3,"proposition":"The most frequently involved bacteria are oral streptococci","correct":false,"justification":"These are Staphylococcus aureus"},{"idx":4,"proposition":"Treatment of phlegmon is surgical","correct":true,"justification":"This is an excision"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infdentaire-urg-1","context":null,"enonce":"Which of these germs is, or is, responsible for impetigo?","item":"infdentaire","matiere":"urg","propositions":[{"idx":0,"proposition":"Staphylococcus Epidermidis","correct":false,"justification":"Cocci gram + occurring in clusters (like all staphylococcus). It is facultatively anaerobic and has no coagulase. In particular, it can be found in infectious endocarditis on equipment."},{"idx":1,"proposition":"Staphylococcus aureus","correct":true,"justification":"Cocci gram + occurring in clusters (like all Staphylococcus). The treatment of choice is amox-ac. clav or C3G IV. Other antibiotics may work depending on the indication: fluoroquinolones, cotrimoxazole, macrolides, or glycopeptides (non-exhaustive list). It can cause many infections such as sinusitis, panaris, abscesses, bursitis, etc."},{"idx":2,"proposition":"Streptococcus Gallolyticus","correct":false,"justification":"Cocci gram + presenting in diplococcus (like all streptococcus). It can be found in infectious endocarditis, rarely."},{"idx":3,"proposition":"Streptococcus Pyogenes","correct":true,"justification":"We see it, sometimes, in the impetigos. It is a gram + cocci presenting as a diplococcus (like all streptococci). It is also found in scarlet fever, tenosynovitis or panaris. It is a pyogenic germ, part of the Streptococci of Group A, which imposes additional contact precautions."},{"idx":4,"proposition":"Enterococcus Faecalis","correct":false,"justification":"It is a gram + cocci in chains (like all enterococcus)."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infdentaire-urg-2","context":null,"enonce":"Which of these germs is, or is, most frequently responsible for boils?","item":"infdentaire","matiere":"urg","propositions":[{"idx":0,"proposition":"Staphylococcus Epidermidis","correct":false,"justification":"Cocci gram + occurring in clusters (like all staphylococcus). It is facultatively anaerobic and has no coagulase. In particular, it can be found in infectious endocarditis on equipment."},{"idx":1,"proposition":"Staphylococcus aureus","correct":true,"justification":"Cocci gram + occurring in clusters (like all Staphylococcus). The treatment of thing is amox-ac. clav or C3G IV. Other antibiotics may work depending on the indication: fluoroquinolones, cotrimoxazole, macrolides, or glycopeptides (non-exhaustive list). It can cause many infections such as sinusitis, panaris, abscesses, bursitis, etc."},{"idx":2,"proposition":"Streptococcus Gallolyticus","correct":false,"justification":"Coccy gram + presenting in diplococcus (like all streptococcus). It can be found in infectious endocarditis, rarely."},{"idx":3,"proposition":"Streptococcus Pyogenes","correct":false,"justification":"We see it, sometimes, in the impetigos. It is a gram + cocci presenting as a diplococcus (like all streptococci). It is also found in scarlet fever, tenosynovitis or panaris. It is a pyogenic germ, part of the Streptococci of Group A, which imposes additional contact precautions."},{"idx":4,"proposition":"Enterococcus Faecalis","correct":false,"justification":"It is a gram + cocci in chains (like all enterococcus)."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infdentaire-urg-3","context":null,"enonce":"Which of these proposals about dacryocystitis are true?","item":"infdentaire","matiere":"urg","propositions":[{"idx":0,"proposition":"This is an infection of the eye","correct":false,"justification":"Dacryocystitis is an infection of the tear sac"},{"idx":1,"proposition":"Redness of the eye is observed","correct":false,"justification":"There is an unusual size of the inner corner of the eye"},{"idx":2,"proposition":"The edema caused can interfere with eyesight","correct":true,"justification":"The swelling can indeed generate the vision of the eye concern (internally)"},{"idx":3,"proposition":"Age is a risk factor","correct":true,"justification":"It is rare in children and more common in the elderly."},{"idx":4,"proposition":"It is often secondary to stenosis of the lacrimal glands","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infdentaire-urg-4","context":null,"enonce":"Which of these signs and symptoms can be found at the stage of collected parsnip?","item":"infdentaire","matiere":"urg","propositions":[{"idx":0,"proposition":"Pain","correct":true,"justification":"These are the 4 cardinal signs of inflammation: edema, redness, heat and pain"},{"idx":1,"proposition":"Redness","correct":true},{"idx":2,"proposition":"Oedema","correct":true},{"idx":3,"proposition":"Haemorrhage","correct":false},{"idx":4,"proposition":"Dystonia","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"infdentaire-urg-5","context":null,"enonce":"Which of these treatment proposals is, or is, recommended in the case of collected parsnip?","item":"infdentaire","matiere":"urg","propositions":[{"idx":0,"proposition":"NSAIDs","correct":false},{"idx":1,"proposition":"Surgical excision","correct":true,"justification":"At the phlegmasic stage, the treatment consists of antiseptic baths (+\/- combined with antibiotic therapy depending on the case). At the collected stage, it is surgical excision and antibiotic therapy directed against staphylococcus."},{"idx":2,"proposition":"Amoxicillin","correct":false},{"idx":3,"proposition":"Amoxicillin - Clavulanic acid","correct":true},{"idx":4,"proposition":"C3G IV","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"DRA-CE-urg-0","context":null,"enonce":"Regarding acute breathatory shrinkage","item":"DRA-CE","matiere":"urg","propositions":[{"idx":0,"proposition":"The clinical examination • In all cases, the clinical examination, is the first fundamental step for the estimation of the severity and etiological orientation of respiratory distress","correct":true},{"idx":1,"proposition":"Cyanosis is rather predominant in the mucous membranes in case of circulatory cyanosis and rather at the extremities in case of breathatory cyanosis","correct":false,"justification":"Classically it is rather predominant in the mucous membranes in case of respiratory cyanosis (and called \"hot\") and rather at the extremities in case of circulatory cyanosis (and called \"cold\")"},{"idx":2,"proposition":"Blood gases will be taken arterial in adults","correct":true},{"idx":3,"proposition":"Blood gases will be collected from veins or capillaries in children and young infants without underlying chronic cardiopulmonary disease","correct":true},{"idx":4,"proposition":"Hypoxemia can only be analyzed on an arterial blood gas","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"DRA-CE-urg-1","context":null,"enonce":"Regarding acute breathatory shrinkage","item":"DRA-CE","matiere":"urg","propositions":[{"idx":0,"proposition":"– Hypercapnia will be observed during central neurological causes acting on the cerebral respiratory centers or during damage to the respiratory muscles","correct":true},{"idx":1,"proposition":"Any state of shock or severe infectious state may be accompanied by hypoxemia and therefore respiratory distress without pure respiratory cause found.","correct":true},{"idx":2,"proposition":"Foreign body of the child • Inhalation of foreign body mainly concerns children from 6 months to 6 years","correct":false,"justification":"Foreign body of the child • Inhalation of foreign body mainly concerns children from 6 months to 3 years, although inhalation can occur later and including in adults, sometimes giving tables of hypoxic cardiac arrest"},{"idx":3,"proposition":"A recurrent infectious pathology in the same territory and resistant to well-conducted treatment must evoke a foreign body of the respiratory tract and must discuss bronchial fibroscopy","correct":true},{"idx":4,"proposition":"• In case of doubt, on the inhalation of a foreign body bronchial endoscopy is the rule","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"DRA-CE-urg-2","context":null,"enonce":"Regarding acute respiratory distress","item":"DRA-CE","matiere":"urg","propositions":[{"idx":0,"proposition":"Epiglottitis is an absoule life emergency and occurs after 6 months and can be seen until adulthood.","correct":true},{"idx":1,"proposition":"It has become extremely rare since vaccination against Haemophilus influenzae b (1st causative agent), to be sought at the interrogation of parents","correct":true},{"idx":2,"proposition":"Haemophilus microabscesses are responsible for inflammatory edema of the epiglottis","correct":true},{"idx":3,"proposition":"Typically, in case of epiglottitis the child refuses to lie down","correct":true},{"idx":4,"proposition":"• Antibiotic therapy with amoxicillin and clavulanic acid is urgent (50 mg\/kg then 150 mg\/kg\/day)","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"DRA-CE-urg-3","context":null,"enonce":"Regarding acute respiratory distress","item":"DRA-CE","matiere":"urg","propositions":[{"idx":0,"proposition":"Transport to hospital should be medicalized and tongue depressors should not be used in epiglottia","correct":true},{"idx":1,"proposition":"In case of intubation, she will have to be a child in a sitting position, more or less under fibroscopy, by a trained operator, with tracheostomy equipment available","correct":true},{"idx":2,"proposition":"Acute laryngitis is a common condition in the general population, giving a barking cough and a hoarse voice, linked to inflammation of the vocal cords","correct":true},{"idx":3,"proposition":"Acute laryngitis can cause expiratory dyspnoea in infants and young children","correct":false,"justification":"It can cause inspiratory dyspnea in infants and young children"},{"idx":4,"proposition":"It is exceptional before the age of 6 months, and must in these cases seek an underlying condition (laryngeal stenosis, subglottic hemangioma, other rarer conditions)","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dopage-psy-0","context":null,"enonce":"General information on doping:","item":"dopage","matiere":"psy","propositions":[{"idx":0,"proposition":"It is possible for some athletes to use certain treatments to manage an acute or chronic intercurrent health problem","correct":true},{"idx":1,"proposition":"The screening circumstances are set up by the HAS","correct":false,"justification":"Screening circumstances * set up by the AFLD, * carried out by a sworn person, * concerns all athletes participating in sports competitions or events, * collection of a urine sample, analyzed in an approved laboratory, * athlete's biological passport: hematological and endocrine module"},{"idx":2,"proposition":"AMPD provides anonymous consultations","correct":true},{"idx":3,"proposition":"One of the main objectives of doping is fatigue resistance","correct":true},{"idx":4,"proposition":"WADA will one day maintain the list of prohibited substances and methods","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dopage-psy-1","context":null,"enonce":"General generalities:","item":"dopage","matiere":"psy","propositions":[{"idx":0,"proposition":"The World Anti-Doping Agency (WADA) annually updates a list of prohibited substances and methods, available annually","correct":true},{"idx":1,"proposition":"The French Anti-Doping Agency (AFLD) offers a search engine to check if a drug is banned","correct":true},{"idx":2,"proposition":"In France, almost 4% of doping controls carried out in 2012 contained prohibited substances (before verification of a possible ATU)","correct":true},{"idx":3,"proposition":"The Therapeutic Use Exemption (TUE) procedure allows certain athletes to use certain treatments to manage an acute or chronic intercurrent health problem","correct":true},{"idx":4,"proposition":"For diuretics, there is a need to deliver a TUE for any substance in or out of competition, in addition to that obtained for the diuretic","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dopage-psy-2","context":null,"enonce":"Which propositions are true?","item":"dopage","matiere":"psy","propositions":[{"idx":0,"proposition":"There are urinary thresholds for the latter beyond which it is not an intentional therapeutic use","correct":true},{"idx":1,"proposition":"A controlled pharmacokinetic study in athletes can confirm therapeutic use","correct":true},{"idx":2,"proposition":"Taking EPO may be associated with handling blood for doping purposes","correct":true},{"idx":3,"proposition":"The violation threshold is equivalent to a blood alcohol concentration of 0.10 g\/L","correct":true},{"idx":4,"proposition":"Alcohol is never completely forbidden","correct":false,"justification":"For some sports if: aeronautics, automotive, karate, motorcycle, archery and powerboating"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"dopage-psy-3","context":null,"enonce":"Regarding screening circumstances:","item":"dopage","matiere":"psy","propositions":[{"idx":0,"proposition":"Gene doping is defined by WADA as \"transfer of nucleic acids or nucleic acid sequences\" and \"the use of normal or genetically modified cells\"","correct":true},{"idx":1,"proposition":"A direct screening measure is the verification of the drug-aided coat of arms","correct":false,"justification":"A direct measure: anti-doping controls. An untimely check of athletes' homes is of course illegal"},{"idx":2,"proposition":"Only professional athletes participating in a competition or event approved by a sports federation can be checked","correct":false,"justification":"Professional or amateur"},{"idx":3,"proposition":"Tests can take place during competitions but also during training for these competitions or events","correct":true},{"idx":4,"proposition":"They are set up by the AFLD","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ulcere-cardio-0","context":null,"enonce":"About leg ulcer","item":"ulcere","matiere":"cardio","propositions":[{"idx":0,"proposition":"This is a leg wound that has not healed for more than 3 months","correct":false,"justification":"More than a month"},{"idx":1,"proposition":"Arterial ulcer is the most common case","correct":false,"justification":"Venous ulcer accounts for 80% of ulcer cases"},{"idx":2,"proposition":"The leg ulcer affects women prelaterially","correct":true},{"idx":3,"proposition":"In the case of venous ulcer, the measurement of the IPS is systematic","correct":true,"justification":"To look for arterial participation (IPS 0.7-0.9), which would constitute a mixed ulcer"},{"idx":4,"proposition":"To attribute an ulcer to an arterial cause, the ankle infusion pressure must be less than 30mmHg","correct":false,"justification":"Less than 50 mmHg"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"ulcere-cardio-1","context":null,"enonce":"About leg ulcer","item":"ulcere","matiere":"cardio","propositions":[{"idx":0,"proposition":"The ulcer of necrotic angiodermatitis is very painful","correct":true,"justification":"Insomnia pain"},{"idx":1,"proposition":"In case of venous ulcer, venous and arterial Doppler ultrasound is systematic","correct":false,"justification":"Venous only. Arterial Doppler ultrasound is indicated in case of clinical suspicion of PAD (including abnormal IPS)"},{"idx":2,"proposition":"In the case of ABI between 0.7 and 0.9, the ulcer is mixed predominantly arterial","correct":false,"justification":"Mixed predominantly venous (PAD does not explain the ulcer)"},{"idx":3,"proposition":"Ecthyma is an infectious ulcer due to Staphylococcus aureus: it is small in size and occurs after a blackish crust","correct":false,"justification":"Streptococcus A infection"},{"idx":4,"proposition":"The ulcer is frequently complicated by atopic dermatitis","correct":false,"justification":"Contact dermatitis"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ulcere-cardio-2","context":null,"enonce":"About leg ulcer","item":"ulcere","matiere":"cardio","propositions":[{"idx":0,"proposition":"In case of ulcer, antibiotic prescription is systematic to avoid superinfection","correct":false,"justification":"No systematic antibiotic therapy: colonization is frequent and non-pathological"},{"idx":1,"proposition":"In the case of venous ulcer, cancerization is common and doubtless to be suspected in case of painful persistent ulcer","correct":false,"justification":"It is rare and late, but should still be mentioned, especially in case of pain or excessive budding on a chronic ulcer"},{"idx":2,"proposition":"Vasculitis ulcers are rare","correct":true},{"idx":3,"proposition":"Pellet transplantation is systematic in an arterial ulcer","correct":false,"justification":"Only in case of resistance to treatment for more than 6 months or larger than 10cm2"},{"idx":4,"proposition":"In case of ulcer infection, a silver dressing is indicated","correct":true,"justification":"For a maximum of 4 weeks"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"mvtsaN-neuro-0","context":null,"enonce":"Concerning the main generalities:","item":"mvtsaN","matiere":"neuro","propositions":[{"idx":0,"proposition":"Abnormal and\/or involuntary movements are most often caused by motor prefrontal gyrus disorder","correct":false,"justification":"Abnormal and\/or involuntary movements are most often caused by dysfunction, injury or degenerative pathology affecting the basal ganglia system (or basal ganglia) also called extrapyramidal system"},{"idx":1,"proposition":"The basal ganglia are responsible for programming and automatically executing learned motor sequences","correct":true},{"idx":2,"proposition":"Abnormal movements correspond to a disorder of programming and\/or execution of movement","correct":true},{"idx":3,"proposition":"Abnormal movements have two characteristics: they are little or not controlled by the will and occur in the absence of paralysis (except in cases of associated involvement of the pyramid system)","correct":true},{"idx":4,"proposition":"The positive diagnosis of these abnormal movements is biological","correct":false,"justification":"The positive diagnosis of these abnormal movements is clinical, but the etiological diagnosis sometimes requires additional biological (including genetic) or imaging examinations"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"mvtsaN-neuro-1","context":null,"enonce":"Regarding Parkinsonian tremors:","item":"mvtsaN","matiere":"neuro","propositions":[{"idx":0,"proposition":"They are present at rest and disappear during muscle contraction only","correct":false,"justification":"Also disappear during sleep"},{"idx":1,"proposition":"They concern the distorted limbs, the lips or chin, and the head","correct":false,"justification":"They affect the limbs in distal, lips or chin, but never the leader unlike essential tremors"},{"idx":2,"proposition":"They are unilateral or asymmetrical","correct":true},{"idx":3,"proposition":"They are aggravated by emotions and mental arithmetic.","correct":true},{"idx":4,"proposition":"They are examined in a resting position (hands resting on a plane or on the thighs, palms facing up in a relaxed patient)","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"mvtsaN-neuro-2","context":null,"enonce":"In case of Parkinsonian tremors:","item":"mvtsaN","matiere":"neuro","propositions":[{"idx":0,"proposition":"Wilson's disease can cause abnormal movement and parkinsonism","correct":true},{"idx":1,"proposition":"In case of parkinsonism related to an antipsychotic, it should be discontinued if possible and replaced if necessary by clozapine","correct":true},{"idx":2,"proposition":"A DaTSCAN® brain scan should only be performed if there is doubt between Parkinson's disease-related parkinsonian tremor and neuroleptic-related parkinsonian tremor","correct":true,"justification":"In practice, the DAT-scan can potentially be used for all problematic diagnostic orientations of parkinsonism syndrome."},{"idx":3,"proposition":"If the diagnosis of Parkinson's disease is strongly suspected and it is an individual over 40 years of age, no further examination is necessary.","correct":true},{"idx":4,"proposition":"In case of parkinsonian tremors before age 40, a brain MRI and cupric workup including cupremia, ceruleoplasminemia and cupruria for 24 hours are necessary to rule out Wilson's disease.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"mvtsaN-neuro-3","context":null,"enonce":"Regarding essential tremors:","item":"mvtsaN","matiere":"neuro","propositions":[{"idx":0,"proposition":"The most common cause of postural tremor is parkinsonism","correct":false,"justification":"These are the essential tremors"},{"idx":1,"proposition":"Its frequency is 4 to 6 Hz","correct":false,"justification":"This is the case of parkisonian tremor. Essential tremor has a frequency of 6 to 12 Hz"},{"idx":2,"proposition":"Essential tremor is usually unilateral and asymmetric","correct":false,"justification":"The essential tremor is usually bilateral and symmetrical, with a frequency of 6 to 12 Hz, affecting the upper limbs, the leader"},{"idx":3,"proposition":"Action tremors are all willingly improved by alcohol intake but aggravated by emotions and caffeine.","correct":false,"justification":"This is the case of essential tremor. Not all action tremors are."},{"idx":4,"proposition":"In case of doubt between a tremor related to Parkinson's disease and an essential tremor, a DaTSCAN® can be performed (it is normal in essential tremor), in order to help in the diagnosis and start a suitable treatment","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"mvtsaN-neuro-4","context":null,"enonce":"Regarding essential tremor and cerebellar tremor:","item":"mvtsaN","matiere":"neuro","propositions":[{"idx":0,"proposition":"Brain MRI is normal in essential tremor","correct":true,"justification":"Brain MRI is normal in essential tremor and should not be performed when the picture is typical"},{"idx":1,"proposition":"The most effective treatments for essential tremors are beta-blocker propranolol and barbiturate primidone","correct":true},{"idx":2,"proposition":"Cererebellar tremor is a tremor of action that appears or is maximum when arriving at the target","correct":true,"justification":"It is an intentional tremor"},{"idx":3,"proposition":"Cererebellar tremor is highlighted during action with intent","correct":true,"justification":"For example: the finger-nose test, drinking a glass of water, etc."},{"idx":4,"proposition":"A walk with an enlargement of the lifting polygon evokes a cerebelous origin","correct":true,"justification":"There is also incoordination of movements"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diverticulose-HGE-0","context":null,"enonce":"Concerning diverticular disease","item":"diverticulose","matiere":"HGE","propositions":[{"idx":0,"proposition":"A diverticulum colon is an acquired hernia of the mucosa and submucosa through an area of weakness in the muscular wall of the colon.","correct":true},{"idx":1,"proposition":"The predominant localization is in the sigmoid colon","correct":true},{"idx":2,"proposition":"• Sigmoid or sigmoid diverticulitis corresponds to inflammation occurring in the vicinity of one or more sigmoid diverticula","correct":true},{"idx":3,"proposition":"There is a predominance in developing countries","correct":false,"justification":"Predominance in countries with a Western-style lifestyle"},{"idx":4,"proposition":"Uncomplicated diverticular disease is by definition asymptomatic, most often discovered during a colonoscopy performed for other digestive symptoms.","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"diverticulose-HGE-1","context":null,"enonce":"Regarding diverticulosis and diverticulitis","item":"diverticulose","matiere":"HGE","propositions":[{"idx":0,"proposition":"No treatment is needed for divertiuclose colic","correct":true},{"idx":1,"proposition":"The 2 possible complications are: • diverticulitis and its complications (peritonitis, abscesses, fistulas, strictures) and diverticular hemorrhage","correct":true},{"idx":2,"proposition":"Dietary measures are to be implemented to prevent diverticulitis","correct":false},{"idx":3,"proposition":"Abdominopelvic computed tomography is the key emergency test for the diagnosis of diverticulitis","correct":true,"justification":"the diagnosis of diverticulitis which is based on 3 associated signs: thickening of colonic aroi to more than 4 mm, infiltration of pericolic fat, presence of diverticula"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diverticulose-HGE-2","context":null,"enonce":"Regarding diverticulosis and diverticulitis","item":"diverticulose","matiere":"HGE","propositions":[{"idx":0,"proposition":"Ultrasound, abdomen without preparation, MRI and opaque enema are not indicated","correct":true},{"idx":1,"proposition":"A residue-free diet is not warranted during the diverticulitis episode","correct":false},{"idx":2,"proposition":"One-third of sigmoid diverticulitis are complicated by abscesses","correct":true},{"idx":3,"proposition":"If the abscess is accessible and of sufficient size, its radiological drainage is indicated","correct":true},{"idx":4,"proposition":"In case of impossibility or failure of drainage, a resection-anastomosis, possibly protected by an upstream stoma, is indicated","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diverticulose-HGE-3","context":null,"enonce":"Regarding diverticulitis and diverticulosis","item":"diverticulose","matiere":"HGE","propositions":[{"idx":0,"proposition":"Diverticular hemorrhages are often brutal, by erosion of arterioles of the collar or the bottom of the diverticulum","correct":true},{"idx":1,"proposition":"Diverticular hemorrhages are the cause of 60% of lower gastrointestinal bleeding","correct":false,"justification":"The cause of one-third of sudden lower bleeding of red blood"},{"idx":2,"proposition":"The diagnosis of diverticulitis is generally suspected in the presence of pain in the left iliac fossa accompanied by transit disorders, fever, elevated serum C-reactive protein levels and hyperleukocytosis","correct":true},{"idx":3,"proposition":"Diverticulitis, in its usual form, is treated with antibiotics for 7 to 14 days","correct":false,"justification":"Diverticulitis, in its usual form, is treated with antibiotics for 7-10 days"},{"idx":4,"proposition":"• In case of diverticulitis complicated by abscess, peritonitis, or fistula, management is conditioned by the general condition of the patient and the severity of the peritoneal infection assessed according to the Hinchey classification","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"diverticulose-HGE-4","context":null,"enonce":"You suspect an attack of sigmoid diverticulitis. Which additional exam(s) do you prescribe urgently?","item":"diverticulose","matiere":"HGE","propositions":[{"idx":0,"proposition":"A total colonoscopy","correct":false,"justification":"Useless"},{"idx":1,"proposition":"A recto-sigmoidoscopy","correct":false,"justification":"Not in emergency"},{"idx":2,"proposition":"An unprepared abdomen","correct":false,"justification":"Useless"},{"idx":3,"proposition":"None of these proposals","correct":false,"justification":"The diagnosis must be confirmed by imaging"},{"idx":4,"proposition":"An abdominopelvic CT angiography","correct":true,"justification":"True. Allows diagnosis as well as to see complications (abscess for example)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"HSA-urg-0","context":null,"enonce":"Which of the following are true for headaches in SAH?","item":"HSA","matiere":"urg","propositions":[{"idx":0,"proposition":"SAH (or subarachnoid hemorrhage) accounts for 10 to 30% of sudden headaches.","correct":true},{"idx":1,"proposition":"The typical headache is explosive","correct":true},{"idx":2,"proposition":"Typical headache is associated with other signs of meningeal syndrome","correct":true},{"idx":3,"proposition":"Headache cannot be isolated","correct":false,"justification":"However, the headache can be isolated, more progressive, or disappear in a few hours, especially in case of HSA of low abundance (headache called \"sentinel\" of a ruptured aneurysm, preceding a massive SAH)"},{"idx":4,"proposition":"All propositions are true","correct":false,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"HSA-urg-1","context":null,"enonce":"Which of the following are the tests you request as a first-line treatment when you suspect a subarachnoid hemorrhage?","item":"HSA","matiere":"urg","propositions":[{"idx":0,"proposition":"Brain scan with injection right away","correct":false,"justification":"False"},{"idx":1,"proposition":"Cerebral arteriography","correct":false,"justification":"Invasive technique, not in first line"},{"idx":2,"proposition":"Brain scan without injection","correct":true,"justification":"True, this is the key diagnostic test. Its sensitivity is 95% on the first day"},{"idx":3,"proposition":"Lumbar puncture (LP)","correct":false,"justification":"Absolutely contraindicated in the first intention by the risk of commitment"},{"idx":4,"proposition":"Hemostasis assessment","correct":true,"justification":"True, especially for PL"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"HSA-urg-3","context":null,"enonce":"Which of the following are possible signs of subarachnoid hemorrhage?","item":"HSA","matiere":"urg","propositions":[{"idx":0,"proposition":"Initial loss of consciousness","correct":true},{"idx":1,"proposition":"Delirium","correct":true},{"idx":2,"proposition":"Phono-photophobia","correct":true},{"idx":3,"proposition":"Impaired alertness","correct":true},{"idx":4,"proposition":"Vomiting in jets","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"HSA-urg-4","context":null,"enonce":"Which of the following proposals regarding lumbar puncture in case of suspected subarachnoid hemorrhage are true?","item":"HSA","matiere":"urg","propositions":[{"idx":0,"proposition":"The recrudescence of headaches would contraindicate the realization of the lumbar puncture","correct":false,"justification":"Does not fall within the contraindications of PL, which are: local infections, severe hemostasis disorders and intracranial hypertension with threat of engagement"},{"idx":1,"proposition":"The absence of xanthochromia of the fluid after 12 hours helps to eliminate a subarachnoid hemorrhage","correct":true,"justification":"True, xanthochromia is present in all aneurysmal SAHS when CSF is collected between 12 hours and 14 days after the onset of symptoms and analyzed by spectrophotometry."},{"idx":2,"proposition":"The presence of a clear supernatant after centrifugation with the absence of blood pigment is in favor of a traumatic lumbar puncture","correct":true},{"idx":3,"proposition":"If imaging does not provide a diagnosis, a lumbar puncture should be done","correct":true,"justification":"True, even if the headache is gone"},{"idx":4,"proposition":"Headaches from subarachnoid hemorrhage may fluctuate","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"HSA-urg-5","context":null,"enonce":"Which of the following MRI propositions are true?","item":"HSA","matiere":"urg","propositions":[{"idx":0,"proposition":"MRI becomes more sensitive than CT beyond 24 hours","correct":true,"justification":"True, it is then the FLAIR and T2* sequences that can detect hemorrhages"},{"idx":1,"proposition":"MRI eliminates subarachnoid hemorrhage at all stages","correct":false,"justification":"After 24h. Before, it is the scanner that is more sensitive"},{"idx":2,"proposition":"MRI allows an exploration of the intracranial arteries without injection","correct":true},{"idx":3,"proposition":"MRI is a longer exam than CT","correct":true},{"idx":4,"proposition":"All these propositions are true","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vascularite-immuno-0","context":null,"enonce":"Which of the following are true?","item":"vascularite","matiere":"immuno","propositions":[{"idx":0,"proposition":"Vasculitis can cause aseptic 🤒 fever ","correct":true},{"idx":1,"proposition":"Vasculitis corresponds to an inflammatory involvement of the lymphatic vessels","correct":false,"justification":"Vasculitis typically only concerns blood vessels"},{"idx":2,"proposition":"There are no causes of secondary vasculitis","correct":false,"justification":"Bacterial, viral, iatrogenic, parasitic causes, etc. Note also the deleterious role of cocaine 💮"},{"idx":3,"proposition":"The Chapel Hill classification to differentiate between different vasculitis","correct":true},{"idx":4,"proposition":"c-ANCA correspond to proteinase 3","correct":true,"justification":"True. X-ANCA with cathepsin G (PR, lupus) or lactoferrin (UC, sclerosing cholangitis) and p-ANCA with myeloperoxidase (MPA, Churg-Strauss, ...)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Frped-urg-1","context":null,"enonce":"Which propositions are true?","item":"Frped","matiere":"urg","propositions":[{"idx":0,"proposition":"Green wood fractures concern the lower limb","correct":false,"justification":"The 2 bones of the forearm, radius\/ulna"},{"idx":1,"proposition":"The butter fracture affects the lower quarter of the radius","correct":true},{"idx":2,"proposition":"An unusual fracture can lead to a tumor","correct":true},{"idx":3,"proposition":"An unusual fracture may point to hyperthyroidism","correct":false,"justification":"Does not usually cause this type of fracture"},{"idx":4,"proposition":"An unusual fracture may point to osteogenic imperfecta","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Frped-urg-2","context":null,"enonce":"Which of these fractures are the most common in children?","item":"Frped","matiere":"urg","propositions":[{"idx":0,"proposition":"The motte de beure","correct":true,"justification":"The lower quarter of the radius"},{"idx":1,"proposition":"The bones of the skull","correct":false,"justification":"Happens only in case of head trauma normally"},{"idx":2,"proposition":"Joint fracture of the elbow","correct":true},{"idx":3,"proposition":"Carp","correct":true},{"idx":4,"proposition":"Odds","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"Frped-urg-3","context":null,"enonce":"Which of the following are true?","item":"Frped","matiere":"urg","propositions":[{"idx":0,"proposition":"Regional anaesthesia is contraindicated in children","correct":false,"justification":"It is to be dicutered (femoral block for example)"},{"idx":1,"proposition":"If fracture is suspected, the child should be left on an empty stomach","correct":true,"justification":"In anticipation of possible general anesthesia"},{"idx":2,"proposition":"The x-ray must allow to visualize the entire limb concerned","correct":false,"justification":"Not the whole limb, but systematically the over- and underlying joints"},{"idx":3,"proposition":"Radiography should include orthogonal incidences","correct":true,"justification":"Single incidence only in case of very painful obvious displaced fracture (single incidence, with subsequent additional incidences under anaesthesia)"},{"idx":4,"proposition":"Trauma to growth cartilage is radiotransparent","correct":true,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nvxne-gyn-0","context":null,"enonce":"Which propositions are true?","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"In the immediate postnatal period, most organs, except the heart and brain, are still in full development.","correct":false,"justification":"Especially the brain"},{"idx":1,"proposition":"The clinical examination of the newborn is legally mandatory before the 30th day of life","correct":false,"justification":"Day 8"},{"idx":2,"proposition":"The legal examination of the newborn ends with an interview with the parents","correct":true},{"idx":3,"proposition":"Anamnestic investigation is optional and reserved for complicated births","correct":false,"justification":"It is systematic"},{"idx":4,"proposition":"Maternal age below 18 years of age puts you at increased risk of prematurity","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"nvxne-gyn-1","context":null,"enonce":"Regarding the questioning of the family:","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"A maternal age > 35 years induces an increased risk of malformation and trisomy 21","correct":true},{"idx":1,"proposition":"Nephropathies and diabetes have no consequences on the fetus if they are balanced","correct":false,"justification":"If, in several ways: the drugs used, silent decompensations, the impacts of nephropathies that are difficult to balance, etc."},{"idx":2,"proposition":"Feto-pelvic disproportion is a common source of perinatal anoxia","correct":true},{"idx":3,"proposition":"The duration of pregnancy is determined from the onset of sympathetic signs (nausea, breast thickening, etc.)","correct":false,"justification":"The duration is arbitrarily determined in completed amenorrhea (AS) weeks"},{"idx":4,"proposition":"Any birth after 42SA is post-term","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nvxne-gyn-2","context":null,"enonce":"Regarding the postpartum interrogation of pregnant women:","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"Maternal infection in the 1st trimester puts at risk of malformative embryopathy","correct":true},{"idx":1,"proposition":"Oligohydramnios is a sign of pulmonary hypoplasia or osteoarticular deformity","correct":true},{"idx":2,"proposition":"Hydramnios may be explained by lack of control of gestational diabetes","correct":true},{"idx":3,"proposition":"An anamnios may be a consequence of esophageal atresia","correct":false,"justification":"Atresia of the esophagus results in hydramnios"},{"idx":4,"proposition":"Amniotic fluid is normally clear","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"nvxne-gyn-3","context":null,"enonce":"Regarding amniotic fluid and immediate care:","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"Amniotic fluid is physiologically tinted","correct":false,"justification":"It is tinted in case of infection"},{"idx":1,"proposition":"Greenish amniotic fluid may indicate meconium emissions in utero","correct":true},{"idx":2,"proposition":"Physiological amniotic fluid has no particular odor","correct":true},{"idx":3,"proposition":"A liquid with a fetid odor can point to a risk of maternal-fetal infection","correct":true},{"idx":4,"proposition":"From birth, it is necessary to assess the condition of the child to initiate adapted resuscitation gestures if necessary","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nvxne-gyn-4","context":null,"enonce":"What is the Agpar score of a newborn at 85 bpm, with normal breathing, pink skin color, hypotonic, who screams loudly?","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"6","correct":false,"justification":"It's 8 (85bpm = 1, breathing = 2, pink = 2, hypotonic = 1, cries = 2)"},{"idx":1,"proposition":"7","correct":false},{"idx":2,"proposition":"8","correct":true},{"idx":3,"proposition":"9","correct":false},{"idx":4,"proposition":"10","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"nvxne-gyn-5","context":null,"enonce":"Concerning the immediate postnatal","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"Morrison's score makes it possible to instantly judge the condition of the newborn","correct":false,"justification":"It is the Apgar score that makes it possible to judge instantly the condition of the newborn and guides the action to be taken"},{"idx":1,"proposition":"Agpar's score is assessed at 1 and 10 minutes postnatal","correct":false,"justification":"1 minute then 5 and 10 minutes"},{"idx":2,"proposition":"If the Apgar score is greater than 8 to 1 minute: the newborn is healthy","correct":true},{"idx":3,"proposition":"An agpar score of less than 3 to 1 minute implies emergency management","correct":true},{"idx":4,"proposition":"The assessment of the condition of the newborn and the practice of resuscitation gestures must be done with the child lying on a heated and illuminated table","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"nvxne-gyn-6","context":null,"enonce":"Concerning the immediate postnatal:","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"Checking the permeability of the choanas, esophagus and anus is to be carried out urgently postnatally","correct":false,"justification":"Checking the permeability of the choanas, esophagus and anus should be systematic before leaving the delivery room but not necessarily urgently from birth"},{"idx":1,"proposition":"The verification of the permeability of the orifices is done in particular by flexible probe","correct":true},{"idx":2,"proposition":"Administration of eye drops prevents Staphylococcus aureus conjunctivitis","correct":false,"justification":"Administration of eye drops prevents gonococcal conjunctivitis and vitamin K1 2 mg orally prevents hemorrhagic disease of the newborn"},{"idx":3,"proposition":"The initial examination must be done between the 3rd and 8th day of life","correct":false,"justification":"The initial examination must be done during the first hours of life, at best before leaving the delivery room"},{"idx":4,"proposition":"At birth the skin is covered with an adherent whitish coating called vernix caseosa","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nvxne-gyn-7","context":null,"enonce":"Regarding the initial clinical examination of the newborn:","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"It is mandatory","correct":true},{"idx":1,"proposition":"spots are physiological","correct":true},{"idx":2,"proposition":"Peeling of the skin during the first few days is a sign of a skin infection that must be treated urgently","correct":false,"justification":"During the first days a more or less extensive desquamation appears, its evolution is spontaneously favorable"},{"idx":3,"proposition":"Simple hydration may be necessary in case of crevices in the folds","correct":true},{"idx":4,"proposition":"A mild rash made of minimal vesicles of the \"toxic erythema of the newborn\" type may occur within the first 3 days, and disappears spontaneously","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"nvxne-gyn-8","context":null,"enonce":"What is the threshold for heartbeat APGAR from 1 to 2?","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"25","correct":false,"justification":"False"},{"idx":1,"proposition":"50","correct":false,"justification":"False"},{"idx":2,"proposition":"100","correct":true},{"idx":3,"proposition":"130","correct":false,"justification":"False"},{"idx":4,"proposition":"150","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nvxne-gyn-9","context":null,"enonce":"Which of the following are part of the Guthrie test?","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"PKU","correct":true},{"idx":1,"proposition":"Hepatitis C","correct":false,"justification":"Infections are not part of this test"},{"idx":2,"proposition":"Congenital adrenal hyperplasia","correct":true},{"idx":3,"proposition":"Adrenaloma","correct":false,"justification":"Tumors are not part of this test"},{"idx":4,"proposition":"Cystic fibrosis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nvxne-gyn-10","context":null,"enonce":"Which of the following are part of the APGAR score?","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"Heart rate","correct":true,"justification":"True, threshold at 100 (2 if beyond, 1 if below)"},{"idx":1,"proposition":"Coloring","correct":true,"justification":"True (Overall blue = 0 \/ blue ends = 1 \/ overall pink = 2)"},{"idx":2,"proposition":"Grasping","correct":false,"justification":"False. Does not fit into APGAR's score. It is one of the 6 archaic reflexes."},{"idx":3,"proposition":"Breathing","correct":true},{"idx":4,"proposition":"Muscle tone","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nvxne-gyn-11","context":null,"enonce":"Which of the following proposals designate the two germs most often involved in a maternal-fetal infection in a full-term newborn?","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"E. coli","correct":true},{"idx":1,"proposition":"K. pneumoniae","correct":false,"justification":"False. E. Coli and GBS"},{"idx":2,"proposition":"L. monocytogenes","correct":false,"justification":"False. E. Coli and GBS"},{"idx":3,"proposition":"Group A Streptococcus","correct":false,"justification":"False. E. Coli and GBS"},{"idx":4,"proposition":"Group B Streptococcus","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nvxne-gyn-12","context":null,"enonce":"Which of the following are risk factors for poor adaptation to ectopic life?","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"Severe gestational hypertension of the mother","correct":true},{"idx":1,"proposition":"Vaginal delivery","correct":false,"justification":"False"},{"idx":2,"proposition":"Mini-oscillated fetal heart rate","correct":true},{"idx":3,"proposition":"Diabetes","correct":true},{"idx":4,"proposition":"IUGR","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nvxne-gyn-13","context":null,"enonce":"What pathologies are detected at birth by the Guthrie test?","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"Congenital adrenal hypoplasia","correct":false,"justification":"Hyperplasia"},{"idx":1,"proposition":"Hyperthyroidism ","correct":false,"justification":"Hypothyroidism"},{"idx":2,"proposition":"Cystic fibrosis","correct":true},{"idx":3,"proposition":"Thalassemia","correct":false,"justification":"False"},{"idx":4,"proposition":"PKU","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"antithrombotiques-therapeutique-0","context":null,"enonce":"Regarding anti-thrombotics, which proposals are true?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Heparins are sulfated polysaccharides of varying size","correct":true},{"idx":1,"proposition":"Unfractionated heparins (UFH) are of porcine origin","correct":true},{"idx":2,"proposition":"UFH have an exclusive anti-Xa action","correct":false,"justification":"UFHs, like LMWHs, have anti-IIa and anti-Xa action. It is fondaparinux that has exclusive anti-Xa activity"},{"idx":3,"proposition":"Low molecular weight heparins (LMWHs) consist mainly of short chains","correct":true},{"idx":4,"proposition":"LMWH has predominant anti-IIa activity","correct":false,"justification":"LMWH has predominant anti-Xa activity"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"antithrombotiques-therapeutique-1","context":null,"enonce":"Regarding heparins, which propositions are true?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Treatment with curative doses of UFH should be monitored daily by measuring heparinemia","correct":true},{"idx":1,"proposition":"In case of curative dose UFH, the therapeutic target is 0.3 to 0.7 IU\/ml","correct":true},{"idx":2,"proposition":"For UFH monitoring in curative use, TCA is preferred over heparinemia","correct":false,"justification":"Heparinemia is preferred to TCA"},{"idx":3,"proposition":"A factor XII deficiency or the presence of a circulating anticoagulant such as antiprothrombinase makes monitoring by measuring heparinemia essential.","correct":true},{"idx":4,"proposition":"Heparinemia should be performed immediately after the first injection","correct":false,"justification":"Heparinaemia should be performed at least four hours after initiation of treatment or dose change and at any time with continuous IV infusion"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"antithrombotiques-therapeutique-3","context":null,"enonce":"When is LMWH treatment monitoring necessary?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"A BMI > 25","correct":false,"justification":"The College of Hematology indicates monitoring as necessary in obese patients, so BMI > 30 (BMI > 25 indicates overweight)"},{"idx":1,"proposition":"A weight < 50 kg","correct":true},{"idx":2,"proposition":"Cachexia","correct":true},{"idx":3,"proposition":"Renal failure, even mild","correct":true,"justification":"Creatinine clearance between 30 and 60 ml\/min indicates monitoring"},{"idx":4,"proposition":"Signs of drowsiness","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"antithrombotiques-therapeutique-4","context":null,"enonce":"Regarding heparins, which propositions are true?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"During UFH treatment, monitoring of platelet counts is essential","correct":true,"justification":"Indeed, and this is in order to detect heparin-induced thrombocytopenia. It is a rare complication (less than 1% of cases) but serious requiring immediate discontinuation of heparin or LMWH and switching to another fast-acting anticoagulant"},{"idx":1,"proposition":"UFH can be injected into IV","correct":true},{"idx":2,"proposition":"LMWH can be injected in IV","correct":false,"justification":"In the heparin family, only HnF can be injected into IV"},{"idx":3,"proposition":"LMWH can be injected into SC","correct":true},{"idx":4,"proposition":"Fondaparinux can be injected in IV","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"antithrombotiques-therapeutique-5","context":null,"enonce":"Which of these heparins has\/have 100% bioavailability after injection?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"The HnF","correct":false,"justification":"The bioavailability of HnF is highly variable from patient to patient. For this reason, surveillance of heparinemia, or failing that, ACT, is necessary."},{"idx":1,"proposition":"LMWH","correct":false,"justification":"Their bioavailability is high, but not 100%. The college of hematology indicates 90% (table 22.1 on page 264)"},{"idx":2,"proposition":"Fondaparinux","correct":true},{"idx":3,"proposition":"Les anti-GP IIb\/IIIa","correct":false,"justification":"Be careful, these are not heparins. They are anti-platelet agents."},{"idx":4,"proposition":"P2Y12 receptor inhibitors","correct":false,"justification":"Be careful, these are not heparins. They are anti-platelet agents."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"antithrombotiques-therapeutique-6","context":null,"enonce":"Which of the following are true about DRESS?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Poly-lymphadenopathy can be found","correct":true},{"idx":1,"proposition":"It is a toxiderma","correct":true,"justification":"True, severe toxiderma"},{"idx":2,"proposition":"Facial edema is an early sign","correct":true},{"idx":3,"proposition":"The onset time is a few hours","correct":false,"justification":"It is long, between 2 and 8 weeks"},{"idx":4,"proposition":"Regression is always rapid after early discontinuation of the drug","correct":false,"justification":"Rarely, slow regression can be observed."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Exprenuptial-gyn-0","context":null,"enonce":"Regarding the prenuptial examination:","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"It was initially provided for in a regulatory and mandatory framework 6 months before any marriage","correct":false,"justification":"Initially planned in a regulatory and mandatory framework 2 months before any marriage"},{"idx":1,"proposition":"It was to be officially handed over to the parents of the bride and groom.","correct":false,"justification":"to be handed over by each of the bride and groom to the civil registrar"},{"idx":2,"proposition":"Without this examination, historically, the civil registrar could not celebrate a marriage.","correct":true},{"idx":3,"proposition":"It was to allow the future spouses to take stock of their state of health.","correct":true},{"idx":4,"proposition":"It was an opportunity for information on lifestyle and family planning.","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Exprenuptial-gyn-1","context":null,"enonce":"Regarding the prenuptial examination:","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"It was suppressed at the liberation of 1945 due to the change of morals.","correct":false,"justification":"It was abolished by Law No. 2007-1787 of 20 December 2007 on the simplification of the law, partly because of the scarcity of married couples at the time of the first pregnancy, but also because of the cost"},{"idx":1,"proposition":"The interest of such a consultation is currently nil.","correct":false,"justification":"However, the interest of such a preconception approach as a mode of prevention for the health of young couples is highlighted in the information document for professionals entitled \"Pregnancy project: information, prevention messages, examinations to propose\" published in September 2009 by the High Authority of Health (HAS)"},{"idx":2,"proposition":"The consultation must be conducted by a doctor","correct":false,"justification":"The consultation can be conducted by a doctor (general practitioner, medical gynecologist, gynecologist-obstetrician), or a midwife, whether or not this professional follows the pregnancy afterwards."},{"idx":3,"proposition":"The future spouses are the main targets of this type of consultation, but not the only ones","correct":true},{"idx":4,"proposition":"Questioning relies almost exclusively on family history to screen for genetic diseases in the family.","correct":false,"justification":"This is the family and personal history, as well as the consultation of the health record\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"Exprenuptial-gyn-2","context":null,"enonce":"Regarding the conduct of the pre-conception examination:","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"Addressing individual cardiovascular risk factors is not of interest in this type of consultation.","correct":false},{"idx":1,"proposition":"In case of family history or person of genetic damage, genetic counseling should be considered.","correct":true},{"idx":2,"proposition":"A conization or myomectomy are examples of gynecological history to look for","correct":true},{"idx":3,"proposition":"The gynecological examination focuses on the reproductive system","correct":false},{"idx":4,"proposition":"In case of positive rhesus, it is proposed to inform the woman of the interest of determining the blood group of the future father","correct":false,"justification":"in case of negative Rhesus, it is proposed to inform the woman of the interest of determining the blood group of the future father\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Exprenuptial-gyn-3","context":null,"enonce":"Regarding the interrogation and clinical examination during the pre-nuptial consultation:","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"Rubella serology is prescribed if there is a notion of previous negative serology (even if two vaccinations have been performed)","correct":false},{"idx":1,"proposition":"HIV serology is always offered","correct":true},{"idx":2,"proposition":"The benefit\/risk balance of any drug prescription should be carefully evaluated in a woman who expresses a desire for pregnancy","correct":true},{"idx":3,"proposition":"Pregnancy should be anticipated as much as possible","correct":true},{"idx":4,"proposition":"If pregnancy is desired, folate should be prescribed up to the 24th week of amenorrhea at a dose of 5 micrograms per day.","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Exprenuptial-gyn-4","context":null,"enonce":"In case of planning pregnancy:","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"A catch-up\/booster of the DTP and pertussis vaccine should be offered in adults likely to become parents soon","correct":true},{"idx":1,"proposition":"Pertussis vaccination is crucial because of the vulnerability of children up to 1 1\/2 years","correct":false,"justification":"Pertussis vaccination is particularly important, given the vulnerability of newborns during their first two months"},{"idx":2,"proposition":"Varicella vaccination is possible if the pregnancy test is negative, and effective contraception for 3 weeks is recommended by the HAS","correct":false,"justification":"Vaccination is possible if the pregnancy test is negative, and according to MA (marketing authorization) data, effective contraception for 1 month is recommended after each dose of vaccine. According to this document from the transparency commission of the HAS (https:\/\/www.has-sante.fr\/upload\/docs\/evamed\/CT-17743_VARILRIX_PIS_RI_Avis2_CT17743.pdf), << Vaccination against chickenpox is contraindicated during pregnancy. Pregnancy should be avoided within one month of vaccination: women intending to start pregnancy should be advised to postpone their project.>>"},{"idx":3,"proposition":"Meat must be cooked to control the risk of toxoplasmosis","correct":true},{"idx":4,"proposition":"This consultation is an opportunity to highlight the risks of self-medication and remind that taking medication without a prescription is not recommended in case of pregnancy planning","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Exprenuptial-gyn-5","context":null,"enonce":"Regarding preconception questioning in women:","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"Alcohol withdrawal is unnecessary unless chronic alcoholism is well documented","correct":false},{"idx":1,"proposition":"If consumption is occasional, it is advisable to stop taking alcohol as soon as pregnancy is proven by an ultrasound","correct":false,"justification":"In case of occasional consumption, stop drinking alcohol early in pregnancy"},{"idx":2,"proposition":"The medicine can offer help with smoking cessation if necessary","correct":true},{"idx":3,"proposition":"Tobacco has a negative effect on fertility and child development during pregnancy","correct":true},{"idx":4,"proposition":"All elements that relate to the patient's work concern the occupational physician only","correct":false,"justification":"Determine possible exposure to teratogenic products by contacting the occupational health physician if necessary\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Exprenuptial-gyn-6","context":null,"enonce":"Regarding the generalities of the preconception examination:","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"A cervical screening smear is to be performed again if the last one is more than 2 to 3 years old.","correct":true},{"idx":1,"proposition":"Folic acid supplementation in women who want pregnancy is a prophylactic procedure","correct":true},{"idx":2,"proposition":"The health record must be up to date, otherwise, reminders or catch-ups must be carried out, with caution","correct":true},{"idx":3,"proposition":"This consultation is an opportunity to raise awareness of the effects of smoking (decreased fertility, delayed child development, ...)","correct":true},{"idx":4,"proposition":"The preconception examination concerns exclusively married couples with a plan to become pregnant","correct":false,"justification":"The \"preconception examination, formerly a premarital examination, must be conceived in the more general context of information among women or couples planning to become pregnant, given the number of couples who currently conceive outside marriage.\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Exprenuptial-gyn-7","context":null,"enonce":"Regarding folic acid supplementation. Which of the following are true?","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"Folic acid helps reduce the risk of neural tube closure abnormalities ","correct":true},{"idx":1,"proposition":"For primary prevention, the dose of folic acid is 0.4 mg\/d","correct":true},{"idx":2,"proposition":"For secondary prevention, the dose of folic acid is 5 mg\/d","correct":true},{"idx":3,"proposition":"Folic acid should be taken 2 months before and 3 months after conception","correct":true},{"idx":4,"proposition":"Folic acid should be stopped at 12 SA","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Exprenuptial-gyn-8","context":null,"enonce":"Which of the following are indications for prescribing 5 mg\/d of folic acid?","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"History of non-closure of the neural tube in a previous pregnancy","correct":true,"justification":"True. 5 mg\/d for secondary prevention."},{"idx":1,"proposition":"Epilepsy treated","correct":true,"justification":"True. Increased risk of neural tube closure abnormality due to anti-epileptic therapy"},{"idx":2,"proposition":"HTA in the mother","correct":false,"justification":"False. This is a dose of 0.4 mg\/d as it is not an indication for a dose of 5 mg\/d."},{"idx":3,"proposition":"Maternal diabetes","correct":false,"justification":"False"},{"idx":4,"proposition":"Maternal HIV","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Exprenuptial-gyn-12","context":null,"enonce":"Which of the following are true?","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"The prenuptial certificate is always mandatory","correct":false,"justification":"False. The requirement for a prenuptial certificate for civil marriage was abolished in 2007. 50% of children are born out of wedlock."},{"idx":1,"proposition":"Toxoplasmosis and rubella serologies are part of the pre-conception assessment","correct":true,"justification":"True. On the other hand, rubella serology is not routine in a woman who has received 2 doses of the vaccine and who has proof of this vaccination."},{"idx":2,"proposition":"CMV serology is systematically part of the pre-conception assessment ","correct":false,"justification":"False. It is indicated in women in contact with children under 3 years of age."},{"idx":3,"proposition":"For diabetes screening, the OPGH is done as a first-line","correct":false,"justification":"False. For diabetes screening, fasting blood glucose (normal threshold < 0.92 g\/L) should be done first in the first trimester, and if it is negative, test at the OPGH in the second half of the year."},{"idx":4,"proposition":"Vitamin folic acid supplementation is routine up to 12 SA to prevent the risk of neural tube defect closure","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Exprenuptial-gyn-13","context":null,"enonce":"Regarding vaccination in pregnant women. Which vaccine(s) are not recommended during pregnancy?","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"Whooping cough","correct":true,"justification":"True. It is not a live vaccine so it is not contraindicated during pregnancy, but it is not recommended to vaccinate pregnant women in France. On the other hand, it is desirable to vaccinate women before or after childbirth."},{"idx":1,"proposition":"Rubella","correct":true,"justification":"True. It is a live vaccine and therefore contraindicated in pregnant women. On the other hand, it is recommended to vaccinate all women with rubella-negative serology pre-conceptional. Women who have received 2 prior vaccinations should not be vaccinated, regardless of the result of serology if it is performed. Due to the teratogenic risk, it is necessary to ensure the absence of an early pregnancy and to avoid any pregnancy within one month of vaccination."},{"idx":2,"proposition":"Chickenpox","correct":true,"justification":"True. It is a live vaccine with a teratogenic risk. Women of childbearing age who have no history of chickenpox should be vaccinated. Vaccination is possible if the pregnancy test is negative. Effective contraception for 1 month is recommended after each dose of vaccine (2 doses in total)."},{"idx":3,"proposition":"Influenza","correct":false,"justification":"The flu vaccine is recommended for pregnant women because they are a population at risk of severe influenza (fetal death and maternal death, refractory hypoxemia, etc.)."},{"idx":4,"proposition":"Measles","correct":true,"justification":"True. It is a live vaccine, therefore teratogenic."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Mgenetiques-gyn-0","context":null,"enonce":"General:","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"Trisomy 21 is the leading cause of hereditary intellectual disability","correct":false,"justification":"T21 is the leading cause of intellectual disability (ID). Comes in 2nd the fragile X syndrome which is the 1st cause of hereditary ID"},{"idx":1,"proposition":"Prenatal diagnosis is proposed to couples at risk of transmitting a genetic disease to their offspring","correct":true,"justification":"Proposing is different from obliging, of course."},{"idx":2,"proposition":"Fragile X syndrome is an incomplete mutation of the TIRx2 gene","correct":false,"justification":"Complete mutation of FMR1 with expansion of CGG triplets more than 200 times. Premutation (\"incomplete\" mutation) does not give fragile X syndrome."},{"idx":3,"proposition":"Cystic fibrosis involves the CFTR gene","correct":true,"justification":"The CFTR gene, present on chromosome 7, has many known mutations including F508 del, the most commonly involved in cystic fibrosis. FYI CFTR is involved in the flow of Cl ions and the acronym \"cystic fibrosis transmembrane conductance regulator\" makes it easy to find the English (and Quebecois) name of the disease, cystic fibrosis."},{"idx":4,"proposition":"2\/100,000 births are affected by cystic fibrosis","correct":false,"justification":"1\/4500 births in France"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Mgenetiques-gyn-1","context":null,"enonce":"Regarding cystic fibrosis and trisomy 21:","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"Cystic fibrosis transmission is autosomal recessive","correct":true,"justification":"2 pathogenic variations in the CFTR gene are needed"},{"idx":1,"proposition":"The most common mutation in the CFTR gene that causes cystic fibrosis is C19947del","correct":false,"justification":"It is F508del whose exact nomenclature is c.1521_1523delCTT or p.Phe508del"},{"idx":2,"proposition":"The main risk factor for trisomy 21 is paternal age","correct":false,"justification":"Maternal age"},{"idx":3,"proposition":"The management of trisomy 21 also involves the psychological care of the family","correct":true,"justification":"and the subject reaches of course. This is the case for the majority of rare diseases."},{"idx":4,"proposition":"Trisomy 21 is an ALD","correct":true,"justification":"100% coverage with disability card"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Mgenetiques-gyn-2","context":null,"enonce":"General information on mucovisciod, fragile X and trisomy 21:","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"The karyotype is of no interest in fragile X syndrome","correct":false,"justification":"Helps identify an additional cause of intellectual disability"},{"idx":1,"proposition":"The diagnostic triad of fragile X (intellectual disability, macro-orchidism and craniofacial dysmorphism) is pathognomonic and very constant","correct":false,"justification":"Inconsistent triad"},{"idx":2,"proposition":"Trisomy 21 is a chromosomal disease linked to the presence of a single chromosome 21","correct":false,"justification":"Chromosome 21 supernumerary, three in total although it is not always \"isolated\" (free and homogeneous)"},{"idx":3,"proposition":"Antenatal screening occupies an important place in terms of diagnostic circumstances in trisomy 21","correct":true,"justification":"This does not prevent postnatal diagnoses whose management must be attentive"},{"idx":4,"proposition":"The realization of a karyotype with parental consent allows the confirmation of the diagnosis of cystic fibrosis","correct":false,"justification":"Useless because it is not visible by the karyotype (mutation in the CFTR gene). Except very rare case of break point in the CFTR gene which is not on the program of ECN"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Mgenetiques-gyn-4","context":null,"enonce":"Regarding trisomy 21:","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"The risk of giving birth to a child with T21 is 1\/700","correct":true},{"idx":1,"proposition":"The only known risk factor is tobacco","correct":false,"justification":"Maternal age and the existence of chromosomal variation involving chromosome 21 in one of the 2 parents"},{"idx":2,"proposition":"The risk of T21 is schematically 1\/50 when the mother is 42 years old","correct":true},{"idx":3,"proposition":"The clinical phenotype associates morphological abnormalities and intellectual disability","correct":true,"justification":"It is more or less severe"},{"idx":4,"proposition":"A disabled child requires careful medical follow-up and psychosocial measures","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Mgenetiques-gyn-6","context":null,"enonce":"Which of these proposals correspond to serum markers measured in the first trimester?","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"PAPP-1","correct":false,"justification":"This is the PAPP-A"},{"idx":1,"proposition":"The Alpha fraction of HCG","correct":false},{"idx":2,"proposition":"The HCG beta chain","correct":true},{"idx":3,"proposition":"Serum albumin","correct":false},{"idx":4,"proposition":"Fasting blood glucose","correct":false,"justification":"Nothing to do with maternal serum markers"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"Mgenetiques-gyn-7","context":null,"enonce":"Regarding the screening and diagnosis of trisomy 21:","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"The calculation of the combined risk is based on ultrasound measurement of neck clarity and determination of maternal serum markers of the 1st trimester","correct":true},{"idx":1,"proposition":"Neck clarity measurement should be performed between 11 SA + 0 days and 13 SA + 6 days","correct":true,"justification":"LCC between 45 and 84 mm"},{"idx":2,"proposition":"Maternal serum markers should be measured 14 days after ultrasound","correct":false,"justification":"Performed at the same term as neck clarity measurement"},{"idx":3,"proposition":"Prenatal screening is mandatory","correct":false,"justification":"This examination is not mandatory but the information must be given to all pregnant women, regardless of their age"},{"idx":4,"proposition":"There are 5% false negatives","correct":false,"justification":"About 30%"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"Mgenetiques-gyn-9","context":null,"enonce":"Regarding cystic fibrosis:","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"Cystic fibrosis is the most common serious autosomal recessive disease affecting the Caucasian population","correct":true,"justification":"Incidence in France = 1\/4500 births. It is not considered a rare disease!"},{"idx":1,"proposition":"Cystic fibrosis is linked to a mutation in the CFTR gene, the most common of which is G18463del","correct":false,"justification":"The most common is F508del"},{"idx":2,"proposition":"Newborn screening is performed with the so-called Guthrie test at 3 days of life","correct":true,"justification":"Generalized since 2002"},{"idx":3,"proposition":"Newborn screening has been widespread since 1975","correct":false,"justification":"Since 2002"},{"idx":4,"proposition":"The saliva test is the complementary reference test for diagnostic confirmation","correct":false,"justification":"This is the sweat test"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Mgenetiques-gyn-10","context":null,"enonce":"Regarding cystic fibrosis:","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"Management is multidisciplinary","correct":true},{"idx":1,"proposition":"Management is based in particular on daily chest physiotherapy","correct":true,"justification":"And the treatment of bronchopulmonary superinfections"},{"idx":2,"proposition":"Cystic fibrosis affects 1\/10000 births in France","correct":false,"justification":"1\/4,500 births in France"},{"idx":3,"proposition":"The frequency of heterozygous subjects is estimated at 1\/30","correct":true},{"idx":4,"proposition":"Cystic fibrosis is caused by mutations in the CFTR gene located on the long arm of the X chromosome","correct":false,"justification":"This condition is caused by mutations in the CFTR (Cystic Fibrosis Transmembrane Conductance Regulator) gene, located on the long arm of chromosome 7."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Mgenetiques-gyn-11","context":null,"enonce":"Regarding cystic fibrosis:","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"In France, in 70% of cases, the mutation is the deletion of the 508th amino acid (F = phenylalanine), called F508del","correct":true,"justification":"It is F508del whose exact nomenclature is c.1521_1523delCTT or p.Phe508del"},{"idx":1,"proposition":"It is a disease of the respiratory system only","correct":false,"justification":"The mucus clogs different sites of the body, including the respiratory system but not only: also the digestive tract and its appendages (pancreas, bile ducts and liver), sweat glands and genital tract"},{"idx":2,"proposition":"Cystic fibrosis is a disease that does not impact life expectancy","correct":false,"justification":"Cystic fibrosis is a chronic disease that remains particularly severe"},{"idx":3,"proposition":"Follow-up is carried out by the pulmonologist and the general practitioner only","correct":false,"justification":"Multidisciplinary follow-up in specialized centers called Cystic Fibrosis Resource and Skills Centers (CRCM) is the rule, in order to best care for these patients and improve their prognosis and quality of life."},{"idx":4,"proposition":"Antenatal screening for cystic fibrosis is offered to all pregnant women","correct":false,"justification":"\"Generalized\" antenatal screening is not recommended to date by the National Consultative Ethics Committee (CCNE)"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"exanthemeped-infectio-0","context":null,"enonce":"Which of the following are true about enterovirus infections?","item":"exanthemeped","matiere":"infectio","propositions":[{"idx":0,"proposition":"Exanthema is morbiliform","correct":true},{"idx":1,"proposition":"There are mainly digestive signs","correct":true},{"idx":2,"proposition":"They mainly concern the elderly","correct":false,"justification":"Especially children 🧒"},{"idx":3,"proposition":"They are found especially during the winter","correct":false,"justification":"Relatively more frequent during the summer"},{"idx":4,"proposition":"An enanthema is found in 90% of cases","correct":false,"justification":"It is quite rare"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"exanthemeped-infectio-1","context":null,"enonce":"Which of the following are true about measles?","item":"exanthemeped","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is a reportable disease","correct":true},{"idx":1,"proposition":"Serology is only salivary","correct":false,"justification":"Saliva and blood"},{"idx":2,"proposition":"PCR is only blood","correct":false,"justification":"It is not sanguine, it is saliva, nasal, and urinary"},{"idx":3,"proposition":"We can find a sign of Koplik","correct":true,"justification":"True, they are bluish-white \"grains of salt\" on a red background near the molars."},{"idx":4,"proposition":"The bacterium involved is Coxiella burnetii","correct":false,"justification":"Coxiella is the agent of Q fever. The virus involved in measles is Morbillivus"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"exanthemeped-infectio-2","context":null,"enonce":"Which of the following are possible complications of measles?","item":"exanthemeped","matiere":"infectio","propositions":[{"idx":0,"proposition":"Viral pneumonitis","correct":true},{"idx":1,"proposition":"Bacterial pneumonitis","correct":true},{"idx":2,"proposition":"Meningitis","correct":false,"justification":"Rather encephalitis. Neurological complications are rare"},{"idx":3,"proposition":"Arteriovenous malformation","correct":false,"justification":"Measles does not impact angiogenesis"},{"idx":4,"proposition":"Deep vein thrombosis","correct":false,"justification":"No vascular involvement"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"exanthemeped-infectio-4","context":null,"enonce":"With regard to eruptive diseases of childhood, what are the right proposals?","item":"exanthemeped","matiere":"infectio","propositions":[{"idx":0,"proposition":"Diagnosed with megalerythema, the child should avoid contact with pregnant women because the virus in question can give birth defects such as cataracts and glaucoma.","correct":false,"justification":"False, parvovirus B19 (agent of epidemic megalerythema) in pregnant women gives fetal anemia or fetoplacental anasarca. It is rubella that gives these birth defects."},{"idx":1,"proposition":"Chickenpox can be transmitted through the respiratory route","correct":true,"justification":"True, transmission is respiratory before the eruptive phase"},{"idx":2,"proposition":"Clinically, infectious mononucleosis gives high fever, erythematopultaceous angina often associated with splenomegaly and lymphadenopathy.","correct":true,"justification":"True, biologically there is also leukocytosis, and hepatic cytolysis is also possible"},{"idx":3,"proposition":"During the eruptive phase of measles, a Köplick sign can be found","correct":false,"justification":"Köplinick's sign (white-blue punctiform spots on an erythematous jugal mucosa) is found during the invasion phase (with fever and cattarhe)"},{"idx":4,"proposition":"Chickenpox is a reportable disease","correct":false,"justification":"This is the case for measles and rubella"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"neuroPperiph-neuro-0","context":null,"enonce":"Which of the following definitions is true?","item":"neuroPperiph","matiere":"neuro","propositions":[{"idx":0,"proposition":"Mononeuropathy is the involvement of a nerve trunk","correct":true},{"idx":1,"proposition":"Multiple mononeuropathy is multineuritis","correct":true},{"idx":2,"proposition":"Multiple mononeuropathy is the involvement of several nerve trunks","correct":true},{"idx":3,"proposition":"Polyradiculoneuropathy is damage to the cell body of sensory neurons","correct":false,"justification":"It is defined by the involvement of all the sensory and motor nerve roots and nerve trunks (example of Guillain-Barré syndrome)"},{"idx":4,"proposition":"Guillain-Barré syndrome is polyradiculoneuropathy","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"neuroPperiph-neuro-1","context":null,"enonce":"Which propositions are true?","item":"neuroPperiph","matiere":"neuro","propositions":[{"idx":0,"proposition":"Motor neuronopathies are often asymmetric","correct":true},{"idx":1,"proposition":"Length-dependent axonal polyneuropathies result from diffuse and symmetrical involvement ","correct":true},{"idx":2,"proposition":"Length-dependent axonal polyneuropathies begin in the hands","correct":false,"justification":"They start at the feet (longest nerve fibers)"},{"idx":3,"proposition":"In long-term-dependent axonal polyneuropathies, subjective disorders affecting the extremities of the lower limbs are permanent, diurnal and willingly nocturnal","correct":true},{"idx":4,"proposition":"In length-dependent axonal polyneuropathy, the onset of motor symptoms are brutal and consist of permanent paralysis within a few weeks.","correct":false,"justification":"At first, the patient reports difficulty walking, abnormal fatigability"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"neuroPperiph-neuro-2","context":null,"enonce":"Which of the following proposals for length-dependent axonal polyneuropathy is true?","item":"neuroPperiph","matiere":"neuro","propositions":[{"idx":0,"proposition":"There are no vegetative disorders in length-dependent axonal polyneuropathies","correct":false,"justification":"Yes, vegetative disorders are related to damage to amylin fibers: orthostatic arterial hypotension, vesico-sphincter disorders, sexual (impotence), digestive disorders (diarrhea, constipation)"},{"idx":1,"proposition":"Clinical examination does not find amyotrophy","correct":false,"justification":"He finds: abolition of calcaneal reflexes (Achilles), motor deficit affecting the lifters of the foot, amyotrophy, sensory deficit that can be discreet, vegetative involvement (skin and appendages, hypotension)"},{"idx":2,"proposition":"There is no known etiology to length-dependent axonal polyneuropathies","correct":false,"justification":"Many etiologies. In children: rare and hereditary. In adults: nearly two hundred causes"},{"idx":3,"proposition":"The geographical focus of familial amyloidosis is Portugal","correct":true},{"idx":4,"proposition":"Diabetes is one of the most common causes of peripheral neuropathy","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"neuroPperiph-neuro-3","context":null,"enonce":"Which of the following propositions are true in the context of a right Brown Sequard?","item":"neuroPperiph","matiere":"neuro","propositions":[{"idx":0,"proposition":"A right Babinski sign","correct":true},{"idx":1,"proposition":"Thermo-algic sensory disorders on the left","correct":true},{"idx":2,"proposition":"Thermo-algic sensory disorders on the right","correct":false,"justification":"False"},{"idx":3,"proposition":"A sign from Babinski on the left","correct":false,"justification":"False"},{"idx":4,"proposition":"None of the proposals","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"neuroPperiph-neuro-4","context":null,"enonce":"Which of the following propositions about Brown Sequard syndrome are true?","item":"neuroPperiph","matiere":"neuro","propositions":[{"idx":0,"proposition":"It is a syndrome of the hemi-marrow","correct":true},{"idx":1,"proposition":"Spinal cord involvement is transverse and total","correct":false,"justification":"Only half of the bone marrow is affected"},{"idx":2,"proposition":"There is an engine deficit in homolateral","correct":true},{"idx":3,"proposition":"There is a proprioceptive deficit in contralateral","correct":false,"justification":"The motor and proprioceptive deficit is homolateral. In contralateral, there is a thermoalgic hypoaesthesia"},{"idx":4,"proposition":"There is a homolateral thermoalgic hypoesthesia","correct":false,"justification":"Thermoalgic hypoaesthesia is contralateral. In homolateral, there is a motor and propriceptive deficit"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"prurit-dermato-0","context":null,"enonce":"Regarding definitions:","item":"prurit","matiere":"dermato","propositions":[{"idx":0,"proposition":"Pruritus is a functional sign that is defined as \"a sensation that causes the need to scratch\"","correct":true},{"idx":1,"proposition":"Pruritus is always localized because it concerns a particular nervous territory","correct":false,"justification":"It can be localized or generalized"},{"idx":2,"proposition":"It only concerns the skin","correct":false,"justification":"Skin + some mucous membranes or semi-mucous membranes"},{"idx":3,"proposition":"Pruritus is always pathological","correct":false,"justification":"There is a pruritus that can be described as physiological"},{"idx":4,"proposition":"Physiological pruritus is major at birth","correct":false,"justification":"Physiological pruritus is discrete"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"prurit-dermato-2","context":null,"enonce":"Regarding lesions:","item":"prurit","matiere":"dermato","propositions":[{"idx":0,"proposition":"Histamine is the key element in the pathophysiology of any pruritus","correct":false,"justification":"Histamine may be involved but not always"},{"idx":1,"proposition":"The origin of pruritus is nervous only","correct":false,"justification":"Pruritus can sometimes start higher in the transmission routes (central or peripheral nervous system) or its origin can be cutaneous"},{"idx":2,"proposition":"Diagnosis of pruritus requires ultrasound of areas rich in sebaceous glands","correct":false,"justification":"The diagnosis of pruritus is clinical and on the interrogation"},{"idx":3,"proposition":"Excoriations may be consecutive to scratching","correct":true},{"idx":4,"proposition":"Prurigo may be secondary to chronic pruritus","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"prurit-dermato-3","context":null,"enonce":"Regarding scratching lesions and etiologies of pruritus:","item":"prurit","matiere":"dermato","propositions":[{"idx":0,"proposition":"Chronic pruritus can lead to lichenification","correct":true},{"idx":1,"proposition":"Pruritus cannot cause superinfection","correct":false,"justification":"It can lead to impetigo and pyoderma type superinfection"},{"idx":2,"proposition":"Scabies is responsible for morning recrudescence pruritus sparing the back","correct":false,"justification":"Scabies: nocturnal pruritus sparing the face"},{"idx":3,"proposition":"Body pediculosis is the cause of diffuse pruritus, predominant on the trunk and root of the limbs","correct":true},{"idx":4,"proposition":"Psoriasis lesions are almost never the cause of pruritus","correct":false,"justification":"Contrary to a classic notion, psoriasis lesions are itchy in more than half of patients and reworked by scratching."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"prurit-dermato-4","context":null,"enonce":"Regarding the etiologies of pruritus:","item":"prurit","matiere":"dermato","propositions":[{"idx":0,"proposition":"Pruritus often telltale in primary biliary cirrhosis","correct":true},{"idx":1,"proposition":"Pruritus is very common in acute renal failure","correct":false,"justification":"Chronic renal failure where it is common in hemodialysis patients"},{"idx":2,"proposition":"Pruritus is very common in hemodialysis patients","correct":true},{"idx":3,"proposition":"Any naked and chronic pruritus in a young adult must suggest lymphoma","correct":true},{"idx":4,"proposition":"Polycythemia vera causes pruritus after contact with water","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ectoparasitose-infectio-0","context":null,"enonce":"Which of these proposals designates the main ectoparasite of scabies?","item":"ectoparasitose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Gallolipicus Siridens","correct":false},{"idx":1,"proposition":"Sarcoptes Scabei","correct":true,"justification":"The others are invented names"},{"idx":2,"proposition":"Severades Minota","correct":false},{"idx":3,"proposition":"Vivigallie Tarcoptei","correct":false},{"idx":4,"proposition":"Sarcota Aurea","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ectoparasitose-infectio-1","context":null,"enonce":"Which of these incubation periods are compatible with scabies?","item":"ectoparasitose","matiere":"infectio","propositions":[{"idx":0,"proposition":"24 hours","correct":false,"justification":"The incubation period is from 5 days to 1 month"},{"idx":1,"proposition":"3 days","correct":false},{"idx":2,"proposition":"7 days","correct":true},{"idx":3,"proposition":"15 days","correct":true},{"idx":4,"proposition":"25 days","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ectoparasitose-infectio-2","context":null,"enonce":"Which of these areas are spared from scabies?","item":"ectoparasitose","matiere":"infectio","propositions":[{"idx":0,"proposition":"The face","correct":true},{"idx":1,"proposition":"Back","correct":true},{"idx":2,"proposition":"Elbows","correct":false,"justification":"The only areas spared are the face and back"},{"idx":3,"proposition":"Feet","correct":false},{"idx":4,"proposition":"Hands","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ectoparasitose-infectio-3","context":null,"enonce":"Which of these signs are in favor of Sarcoptes Scabei Hominis infection?","item":"ectoparasitose","matiere":"infectio","propositions":[{"idx":0,"proposition":"The presence of pearl vesicles","correct":true},{"idx":1,"proposition":"A diurnal recrudescence pruritus","correct":false,"justification":"The resurgence of pruritus is nocturnal"},{"idx":2,"proposition":"The presence of epidermal folds","correct":true},{"idx":3,"proposition":"The presence of scabéeux nodules","correct":true},{"idx":4,"proposition":"Risky sexual behaviour","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ectoparasitose-infectio-4","context":null,"enonce":"Regarding pediculosis:","item":"ectoparasitose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Pediculosis is accompanied by alopecia","correct":false,"justification":"Lice do not cause hair loss"},{"idx":1,"proposition":"The main clinical sign is pruritus","correct":true},{"idx":2,"proposition":"Body pediculosis is accompanied by maculopapular rashes in the back and chest","correct":true},{"idx":3,"proposition":"Pediculesis is strictly human","correct":true},{"idx":4,"proposition":"Treatment of pediculosis of the scalp is a lotion of dimeticone","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ectoparasitose-infectio-5","context":null,"enonce":"Which of the following are signs and symptoms of scabies?","item":"ectoparasitose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Epidermal furrows","correct":true},{"idx":1,"proposition":"Pearly vesicles","correct":true},{"idx":2,"proposition":"Scabious nodules","correct":true,"justification":"True, evidenced by India ink"},{"idx":3,"proposition":"Enanthemas of the face","correct":false,"justification":"Not described in scabies"},{"idx":4,"proposition":"Maculopapular rashes in the back and chest","correct":false,"justification":"Not in scabies. This is a sign of body pediculosis"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ectoparasitose-infectio-6","context":null,"enonce":"Which of the following are true about scabies?","item":"ectoparasitose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Minimum incubation is 5 days","correct":true,"justification":"True, incubation can range from 5 days to 1 month (2-3 weeks on average)"},{"idx":1,"proposition":"Incubation can be up to 45 days","correct":false,"justification":"It can go up to 1 month maximum"},{"idx":2,"proposition":"Pruritus is on the morning upsurge","correct":false,"justification":"Pruritus is on the rise at nocturnal"},{"idx":3,"proposition":"The parasite cycle lasts 3 hours","correct":false,"justification":"It lasts about 3 weeks"},{"idx":4,"proposition":"Treatment is both individual and collective","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ectoparasitose-infectio-7","context":null,"enonce":"Which of the following propositions are true about pediculosis?","item":"ectoparasitose","matiere":"infectio","propositions":[{"idx":0,"proposition":"There are 3 types of pediculosis: neurological, hepatic and splenic","correct":false,"justification":"Pediculosis is not a visceral pathology. There are 3 types of pediculosis: body, scalp, and phtiriasis (morpion)"},{"idx":1,"proposition":"Phtiriasis is an STI","correct":true,"justification":"True, it is an ectoparasitosis caused by Phritirus inguinalise also called Morpion in everyday language"},{"idx":2,"proposition":"The parasites concerned are strictly human","correct":true},{"idx":3,"proposition":"Body pediculosis is caused by Pediculus humanus capitis","correct":false,"justification":"This is the case of pediculosis of the scalp"},{"idx":4,"proposition":"None of the propositions are true","correct":false,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ectoparasitose-infectio-8","context":null,"enonce":"What are the non-drug measures to put in place in case of non-profuse scabies?","item":"ectoparasitose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Decontamination of linen and bedding","correct":true,"justification":"60% wash recommended on Day 1 and Day 9"},{"idx":1,"proposition":"Declaration to the ARS","correct":false},{"idx":2,"proposition":"Routine treatment of persons who have had prolonged and\/or intimate contact with the patient","correct":true},{"idx":3,"proposition":"Environmental disinfection","correct":false,"justification":"Useless according to the College of Dermatology (page 184, 2017 edition) unless"},{"idx":4,"proposition":"Treatment of symptomatic contact cases","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"suiviMIT-sp-0","context":null,"enonce":"Regarding infectious disease surveillance:","item":"suiviMIT","matiere":"sp","propositions":[{"idx":0,"proposition":"In France, in 2021, there are 36 notifiable diseases","correct":true},{"idx":1,"proposition":"A pandemic is an unusual occurrence of a large number of cases in a limited time but in an unlimited geographical space","correct":true},{"idx":2,"proposition":"An epidemic is the existence of a large number of cases in a limited time and geographical space.","correct":false,"justification":"This is the definition of endemic"},{"idx":3,"proposition":"Horizontal transmission occurs from mother to child breastfeeding by hematogenous and\/or genital transplacental tract or","correct":false,"justification":"It is a vertical transmission"},{"idx":4,"proposition":"Prevalence is the proportion of people with a disease in a given population at a given point in time.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"suiviMIT-sp-1","context":null,"enonce":"Concerning the monitoring of infectious diseases","item":"suiviMIT","matiere":"sp","propositions":[{"idx":0,"proposition":"The incidence rate is the proportion of people in a given population during a given period of time newly reached.","correct":true},{"idx":1,"proposition":"Cumulative incidence is the ratio between the number of new cases that occurred during a given period and the average population to be at risk of illness during that period.","correct":true},{"idx":2,"proposition":"Sensitivity is probability of having a negative test knowing that one is not sick","correct":false,"justification":"Specificity • Probability of having a negative test knowing that one is not sick"},{"idx":3,"proposition":"The predictive value is the Positive probability (PPV) of being sick knowing that one has a positive test","correct":true},{"idx":4,"proposition":"The VPN negative predictive value is the probability of being free of the disease knowing that the test is negative","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"suiviMIT-sp-2","context":null,"enonce":"Concerning the monitoring of transmissible mishelp","item":"suiviMIT","matiere":"sp","propositions":[{"idx":0,"proposition":"Communicable disease control relies on a national and international surveillance system","correct":true},{"idx":1,"proposition":"• There is no single surveillance system but several systems, adapted to the nature of the problem, detection and its health, social or economic consequences","correct":true},{"idx":2,"proposition":"In France, Santé Publique France (ex-lnVS) is at the centre of the surveillance system","correct":true},{"idx":3,"proposition":"The Health Agencies (ARS) define the scoping policies of monitoring and regulation","correct":false,"justification":"This is the role of the Directorate-General for Health, the ARS implements the policies decided at central level"},{"idx":4,"proposition":"The High Council of Public Health is an expert agency to the Ministry of Health","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"suiviMIT-sp-3","context":null,"enonce":"Notifiable diseases include: ","item":"suiviMIT","matiere":"sp","propositions":[{"idx":0,"proposition":"Tuberculosis","correct":true},{"idx":1,"proposition":"Measles","correct":true},{"idx":2,"proposition":"Indigenous urogenital schistosomiasis","correct":true},{"idx":3,"proposition":"Hepatitis C","correct":false},{"idx":4,"proposition":"Smallpox","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"suiviMIT-infectio-0","context":null,"enonce":"Concerning the surveillance of transmissible infectious malaides","item":"suiviMIT","matiere":"infectio","propositions":[{"idx":0,"proposition":"Communicable infectious diseases presenting a high risk of spread and involving public health action around the case must be declared by name without delay to the ARS medical inspector.","correct":true},{"idx":1,"proposition":"These are mainly tuberculosis, invasive meningococcal disease, measles and collective food-borne illnesses.","correct":true},{"idx":2,"proposition":"dCommunicable infectious diseases are defined by: the fact that they are caused by an infectious agent: bacteria, virus, parasite and that they can be transmitted between humans","correct":true},{"idx":3,"proposition":"All infectious diseases are transmissible between humans","correct":false,"justification":"Not all of them are transmissible between humans (for example: tetanus, botulism, legionellosis...)"},{"idx":4,"proposition":"Most transmissible infections are called endogenous","correct":false,"justification":"Most transmissible infections are said to be exogenous, i.e. the reservoir of infectious agents is located outside the infected organism."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"suiviMIT-infectio-3","context":null,"enonce":"Which of the following propositions are true regarding droplet isolation?","item":"suiviMIT","matiere":"infectio","propositions":[{"idx":0,"proposition":"It concerns pathologies with indirect transmission","correct":false,"justification":"Direct transmission"},{"idx":1,"proposition":"It requires the wearing of an FFP2 mask by caregivers","correct":false,"justification":"Surgical mask for everyone!"},{"idx":2,"proposition":"It requires the patient to wear a surgical mask when alone in his room","correct":false,"justification":"Not if he's all alone 😅"},{"idx":3,"proposition":"It requires visitors to wear a surgical mask","correct":true},{"idx":4,"proposition":"It requires limiting the patient's movements outside his room","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"suiviMIT-infectio-5","context":null,"enonce":"Which of the following propositions are true about air-type insulation?","item":"suiviMIT","matiere":"infectio","propositions":[{"idx":0,"proposition":"It concerns pathologies with direct transmission","correct":true},{"idx":1,"proposition":"It requires a single room","correct":true},{"idx":2,"proposition":"It requires, for the patient, the wearing of an FFP2 mask when moving (outside his room)","correct":false,"justification":"Surgical mask"},{"idx":3,"proposition":"It requires, for the patient, to limit his movements in his room","correct":false,"justification":"Limit his movements outside his room (he is not in prison wesh)"},{"idx":4,"proposition":"All propositions are true","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"suiviMIT-infectio-7","context":null,"enonce":"Which of the following proposals require the implementation of \"contact\" isolation?","item":"suiviMIT","matiere":"infectio","propositions":[{"idx":0,"proposition":"Chickenpox","correct":true},{"idx":1,"proposition":"Malaria","correct":false},{"idx":2,"proposition":"Scabies","correct":true},{"idx":3,"proposition":"Clostridium dificile colitis","correct":true},{"idx":4,"proposition":"HCV infection","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"sarcoidose-pneumo-0","context":null,"enonce":"Concerning sarcoidosis","item":"sarcoidose","matiere":"pneumo","propositions":[{"idx":0,"proposition":"It is characterized by tuberculoid granulomas with caseous necrosis in the affected organs","correct":false,"justification":"It is characterized by tuberculoid granulomas without caseous necrosis in the affected organs"},{"idx":1,"proposition":"Mediastinopulmonary involvement is observed in more than 90% of patients and is very useful for diagnosis","correct":true},{"idx":2,"proposition":"Extrathoracic localizations are polymorphic","correct":true},{"idx":3,"proposition":"Lung, ocular, cutaneous, peripheral lymph node and hepatic disorders are very common","correct":true},{"idx":4,"proposition":"Löfgren's syndrome combines febrile erythema nodosum or arthritis of the ankles and bilateral mediastinal and hilar lymphadenopathy","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"sarcoidose-pneumo-2","context":null,"enonce":"Concerning sarcoidosis","item":"sarcoidose","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Of unknown cause Characterized by infiltration of organs affected by epithelioid and gigantocellular immune granulomas (also called tuberculoid granulomas) without caseous necrosis","correct":true},{"idx":1,"proposition":"Diagnosis requires having eliminated the known causes of granulomas","correct":true},{"idx":2,"proposition":"Mediastinopulmonary involvement is by far the most common","correct":true},{"idx":3,"proposition":"mediastinopulmonary involvement is isolated in half of the cases","correct":true},{"idx":4,"proposition":"Tobacco is a risk factor for the disease","correct":false,"justification":"Tobacco would protect against sarcoidosis"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"sarcoidose-pneumo-4","context":null,"enonce":"Concerning sarcoidosis","item":"sarcoidose","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Löfgren's syndrome is self-limiting in more than 90% of cases within 2 to 4 months","correct":false,"justification":"Löfgren's syndrome is self-limiting in more than 90% of cases within 12 to 24 months"},{"idx":1,"proposition":"Significant asthenia may be in the 1st plan including in limited forms of the disease","correct":true},{"idx":2,"proposition":"Fever is rare outside of Löfgren's syndrome, febrile uveoparotitis with or without facial paralysis, liver or kidney damage","correct":true},{"idx":3,"proposition":"Weight loss can be observed in Löfgren's syndrome, or in multi-organ forms","correct":true},{"idx":4,"proposition":"No biological examination is specific for sarcoidosis only histology will confirm granulomatosis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"sarcoidose-pneumo-5","context":null,"enonce":"Concerning sarcoidosis","item":"sarcoidose","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The diagnosis of sarcoidosis is based on 3 elements ine suggestive clinico-radiographic presentation with evidence of tuberculoid granulomatous lesions without caseous necrosis and elimination of other granulomatoses","correct":true},{"idx":1,"proposition":"Recent forms evolving for less than 2 years evolve favorably without treatment in less than 2 years most often","correct":true},{"idx":2,"proposition":"In chronic forms, evolving for more than 2 years, spontaneous regression is less likely","correct":true},{"idx":3,"proposition":"Chest X-ray is a key component of monitoring in combination with RFEs","correct":true},{"idx":4,"proposition":"Relapses occur most often within 2 to 6 months of treatment interruption and are exceptional after 3 years of setback without treatment.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"systemeconv-sp-0","context":null,"enonce":"Concerning the dates marking the evolution of the conventional system","item":"systemeconv","matiere":"sp","propositions":[{"idx":0,"proposition":"He was born in 1945.","correct":false,"justification":"1971 births"},{"idx":1,"proposition":"The 2 sectors were created in 1995 on the occasion of the election of Jacques Chirac","correct":false,"justification":"In 1980"},{"idx":2,"proposition":"The carte vitale was launched in 1998","correct":true,"justification":"At the same time as the CMU"},{"idx":3,"proposition":"The coordinated care pathway (with the DMP, the notion of attending physician, etc.) was born in 1975.","correct":false,"justification":"2005"},{"idx":4,"proposition":"2016 is the year of the revaloratization of physician remuneration","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"systemeconv-sp-2","context":null,"enonce":"What are the main types of consultations set up by the 2016 Convention?","item":"systemeconv","matiere":"sp","propositions":[{"idx":0,"proposition":"Reference consultation","correct":true,"justification":"Most common situations of the liberal practitioner"},{"idx":1,"proposition":"Remedial consultation","correct":false,"justification":"Does not exist"},{"idx":2,"proposition":"Coordinated consultation","correct":true,"justification":"As part of the care pathway"},{"idx":3,"proposition":"Really difficult consultation","correct":false,"justification":"Does not exist. However, there is the very complex consultation: clinical situations requiring very complex management"},{"idx":4,"proposition":"Complex consultation","correct":true,"justification":"Management of a complex, unstable pathology or one with a high public health stake\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"systemeconv-sp-3","context":null,"enonce":"Which of these specialties are concerned by remuneration based on public health objectives (ROSP)?","item":"systemeconv","matiere":"sp","propositions":[{"idx":0,"proposition":"Cardiologists","correct":true},{"idx":1,"proposition":"Vascular physicians","correct":true},{"idx":2,"proposition":"Neurologists","correct":false,"justification":"Are concerned: attending physicians, cardiologists, vascular physicians, gastroenterologists and hepatologists, and endocrinologists"},{"idx":3,"proposition":"Public Health Physicians","correct":false},{"idx":4,"proposition":"Urologists","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"systemeconv-sp-4","context":null,"enonce":"Concerning the Convention and PSRs","item":"systemeconv","matiere":"sp","propositions":[{"idx":0,"proposition":"The price of acts is fixed in the Convention","correct":true},{"idx":1,"proposition":"The lump sum payment is paid by the ANSM for care requiring drug prescriptions","correct":false,"justification":""},{"idx":2,"proposition":"There are several compensation packages","correct":true},{"idx":3,"proposition":"The ROSP was introduced in 2011","correct":true},{"idx":4,"proposition":"PSRO indicators are independent of each other","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"MTMV-nutri-0","context":null,"enonce":"What are the proven effects of physical activity?","item":"MTMV","matiere":"nutri","propositions":[{"idx":0,"proposition":"Reduction of premature mortality by 30%","correct":true},{"idx":1,"proposition":"Increased quality of life","correct":true},{"idx":2,"proposition":"Reduction of mortality","correct":false,"justification":"We cannot, a priori, reduce mortality. It is 100% in the long term"},{"idx":3,"proposition":"Maintenance of autonomy in the elderly","correct":true},{"idx":4,"proposition":"Reduction in the occurrence of colon cancer by 95%","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"MTMV-nutri-1","context":null,"enonce":"Regarding dietary prescription:","item":"MTMV","matiere":"nutri","propositions":[{"idx":0,"proposition":"The written medical prescription is mandatory in the hospitalized patient who requires a special diet","correct":true},{"idx":1,"proposition":"It is a medico-legal act engaging the responsibility of medicine","correct":true,"justification":"This is a medico-legal act engaging the responsibility of the doctor insofar as certain food textures may be at risk of \"wrong route\" in the presence of swallowing disorders and where certain diets are essential in the presence of certain pathologies (heart failure, renal, diabetes with risk of hypoglycemia, etc.)."},{"idx":2,"proposition":"The doctor must record the food texture","correct":true},{"idx":3,"proposition":"The doctor must record the number of snacks, if any,","correct":true},{"idx":4,"proposition":"Meal assistance (e.g. postural) is prescribed by the dietician","correct":false,"justification":"It is a medical prescription"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"MTMV-nutri-2","context":null,"enonce":"Which propositions are true?","item":"MTMV","matiere":"nutri","propositions":[{"idx":0,"proposition":"It is advisable to reduce the consumption of unsaturated fatty acids in case of hypercholestereolmia","correct":false,"justification":"It is the consumption of saturated fatty acids that must be reduced, especially palmitic acid"},{"idx":1,"proposition":"The use of margarine rich in phytosterols is advised in case of hypercholesterolemia","correct":true},{"idx":2,"proposition":"Hypertriglyceridemia should lead to a reduction in the consumption of monounsaturated fatty acids","correct":false,"justification":"Monounsaturated fatty acids, and especially omega 3, are recommended in this case"},{"idx":3,"proposition":"Rapeseed oil is rich in omega 7","correct":false,"justification":"In omega-3"},{"idx":4,"proposition":"Undernutrition worsens respiratory function in chronic respiratory failure","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbdelirantaigu-psy-0","context":null,"enonce":"Concerning the main generalities:","item":"tbdelirantaigu","matiere":"psy","propositions":[{"idx":0,"proposition":"Persistent delusional disorders begin around the age of 20-25 most often","correct":false,"justification":"Between 40 and 50 years"},{"idx":1,"proposition":"The different types are: erotomaniac, megalomaniac, jealousy, persecution, somatic type","correct":true},{"idx":2,"proposition":"Treatment includes antipsychotic treatment +\/antidepressant treatment","correct":true},{"idx":3,"proposition":"Most psychotic disorders were described in Europe in the early twentieth century","correct":true},{"idx":4,"proposition":"The lifetime prevalence of persistent delusional disorders is estimated at 8%","correct":false,"justification":"The lifetime prevalence of persistent delusional disorders is estimated to be 0.2% and the annual incidence is estimated to be between 1 and 3 per 100,000"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbdelirantaigu-psy-1","context":null,"enonce":"Concerning clinical semiology:","item":"tbdelirantaigu","matiere":"psy","propositions":[{"idx":0,"proposition":"Immigration is a risk factor","correct":true},{"idx":1,"proposition":"A delusional idea corresponds to an alteration of the content of thought, resulting in a loss of contact with reality.","correct":true},{"idx":2,"proposition":"A delusional idea is an \"internal evidence\" but one that does not seem plausible from the outside point of view.","correct":true,"justification":"This is an \"internal evidence\" that may seem plausible, but is generally not shared by the subject's socio-cultural group."},{"idx":3,"proposition":"The mechanisms encountered are mainly interpretative, intuitive, and imaginative","correct":true},{"idx":4,"proposition":"The hallucinatory mechanism is generally not predominant","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbdelirantaigu-psy-2","context":null,"enonce":"Regarding delusions and psychoses:","item":"tbdelirantaigu","matiere":"psy","propositions":[{"idx":0,"proposition":"Delusions are fuzzy just like in schizophrenia","correct":false,"justification":"Delusions are well systematized, that is, they take place in a logical and coherent way"},{"idx":1,"proposition":"They usually feature convoluted and multiple themes.","correct":false,"justification":"Usually a single theme"},{"idx":2,"proposition":"The subject totally adheres to his delusions","correct":true},{"idx":3,"proposition":"The emotional and behavioural impact should be assessed systematically, including the level of anxiety","correct":true},{"idx":4,"proposition":"We recognize 2 types of psychoses: paranoid psychoses (purely interpretative mechanism) and paraphrenia (hallucinatory mechanism)","correct":false,"justification":"History of psychiatry The French Psychiatric School recognizes three types of non-schizophrenic persistent delusional disorders differentiated according to their main mechanism: * paranoid psychoses (interpretative and intuitive mechanism), * chronic hallucinatory psychosis (hallucinatory mechanism), * paraphrenia (imaginative mechanism)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbdelirantaigu-psy-3","context":null,"enonce":"Regarding the symptomatology of delusional disorders:","item":"tbdelirantaigu","matiere":"psy","propositions":[{"idx":0,"proposition":"The diagnosis is made in front of the presence of delusions evolving for more than six days without interruption","correct":false,"justification":"Evolution for more than a month"},{"idx":1,"proposition":"Delusional disorder may contain disorganization syndrome in some cases","correct":false,"justification":"To make the diagnosis there must be no disorganization syndrome or negative syndrome"},{"idx":2,"proposition":"Hallucinations are often associated and disabling by their intensity","correct":false,"justification":"If hallucinations are present they are not in the foreground"},{"idx":3,"proposition":"The different clinical forms of persistent delusional disorders are defined according to the intensity of delusions.","correct":false,"justification":"Depending on the theme of delusions"},{"idx":4,"proposition":"The erotomanic type is characterized by the erroneous belief of being loved by an individual","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbdelirantaigu-psy-4","context":null,"enonce":"Regarding the different types of delusional disorders:","item":"tbdelirantaigu","matiere":"psy","propositions":[{"idx":0,"proposition":"The erotomanic type is more common in men","correct":false,"justification":"It stems from an intuitive mechanism at first, then interpretative and is more common in women"},{"idx":1,"proposition":"The megalomaniac type is characterized by the belief of being adored by all.","correct":false,"justification":"Persistent delusional disorder of the megalomaniac type is characterized by delusions centered on the belief of being gifted with an unknown talent or power, or having made an important discovery."},{"idx":2,"proposition":"There is a persistent delusional disorder of jealousy type","correct":true},{"idx":3,"proposition":"Persistent persecution-type delusional disorder is called 'paranoid delirium' in ICD-10","correct":true},{"idx":4,"proposition":"Persistent delusional somatic disorder is characterized by delusions centered on sensations or bodily functions","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tabac-psy-0","context":null,"enonce":"Regarding tobacco addiction and cessation:","item":"tabac","matiere":"psy","propositions":[{"idx":0,"proposition":"Smoking is often linked to behaviour acquired in adolescence","correct":true},{"idx":1,"proposition":"Smoking cessation must be organized without delay and regardless of the motivation of the smoker in case of scheduled surgery","correct":true},{"idx":2,"proposition":"Any medical consultation must be able to be the occasion of a stop advice","correct":true},{"idx":3,"proposition":"Nicotine-related physical dependence is assessed by the Fagerstrom test","correct":true},{"idx":4,"proposition":"Weaning is based on stimulating the patient's motivation through encouragement during consultations every two weeks","correct":false,"justification":"Withdrawal is based on a combination of cognitive-behavioural management (CBT), therapeutic education and nicotine replacement therapy."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tabac-psy-1","context":null,"enonce":"Regarding smoking:","item":"tabac","matiere":"psy","propositions":[{"idx":0,"proposition":"Tobacco use is the 1st cause of preventable premature death worldwide","correct":true},{"idx":1,"proposition":"The primary current is inhaled by the smoker when he pulls on the cigarette","correct":true},{"idx":2,"proposition":"The secondary current is the passage of smoke through the bronchioles","correct":false,"justification":"The secondary current escapes from the cigarette through the glowing end between 2 puffs"},{"idx":3,"proposition":"The secondary current is the one that causes passive smoking","correct":false,"justification":"The tertiary current is the current exhaled by the smoker (cause of passive smoking) \/ but the secondary current also participates"},{"idx":4,"proposition":"There are more than 4000 components identified in tobacco smoke","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tabac-psy-2","context":null,"enonce":"Regarding the composition of the cigarette:","item":"tabac","matiere":"psy","propositions":[{"idx":0,"proposition":"Nicotine is delivered to the brain in 30 minutes","correct":false,"justification":"It is sent to the brain by a quick shot (8 seconds) during each puff"},{"idx":1,"proposition":"Addiction to addictive substances includes the release of dopamine in the midbrain, activating the reward system in smokers","correct":true},{"idx":2,"proposition":"Tobacco smoke particles have an aerodynamic median diameter of 0.3 microns","correct":true},{"idx":3,"proposition":"Nitrosamines are carcinogens","correct":true},{"idx":4,"proposition":"Broadly similar components are found in cannabis smoke","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tabac-psy-3","context":null,"enonce":"Regarding the consequences of tobacco and its epidemiology:","item":"tabac","matiere":"psy","propositions":[{"idx":0,"proposition":"The France had nearly 16 million smokers in 2013","correct":true},{"idx":1,"proposition":"Among men, the prevalence of regular smoking has been stable (around 32%) since 1990","correct":false,"justification":"Smoking prevalence has increased since 2005"},{"idx":2,"proposition":"The proportion of ex-smokers is increasing among women","correct":true,"justification":""},{"idx":3,"proposition":"Cancer pathologies: Active smoking is responsible for about 50% of bronchopulmonary cancers","correct":false,"justification":"Cancer pathologies:  Active smoking responsible for 90% of bronchopulmonary cancers (nearly 40,000 new cases\/year, nearly 30,000 deaths\/year)"},{"idx":4,"proposition":"Passive smoking is responsible for 2% of bronchopulmonary cancers in nonsmokers","correct":false,"justification":"More around 20% (it's discussed)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tabac-psy-4","context":null,"enonce":"Regarding the consequences of tobacco and its management:","item":"tabac","matiere":"psy","propositions":[{"idx":0,"proposition":"20% of COPD patients are unaware of it","correct":false,"justification":"COPD: 3.5 million people are affected in France of which 2\/3 are unaware"},{"idx":1,"proposition":"COPD is responsible for 17,000 deaths each year","correct":true},{"idx":2,"proposition":"Tobacco is not a known cause of arteritis","correct":false,"justification":"If: ischemic heart disease, thrombosis, arteritis, etc."},{"idx":3,"proposition":"The tobacco-atheroma relationship is clearly demonstrative","correct":true},{"idx":4,"proposition":"The measurement of expired CO level is not systematic in a diagnostic context","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"medmalade-psy-0","context":null,"enonce":"Which of these proposals correspond to a type of doctor-patient relationship?","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"Actf\/liability relationship","correct":true,"justification":"The 4 types of relationships are: active\/passive, consensual, cooperative and participatory."},{"idx":1,"proposition":"Confrontational relationship","correct":false,"justification":"FALSE"},{"idx":2,"proposition":"Cooperative relationship","correct":true},{"idx":3,"proposition":"Participatory relationship","correct":true},{"idx":4,"proposition":"Consensual relationship","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"medmalade-psy-1","context":null,"enonce":"Which of the following are true?","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"Transaction processes are an individual's efforts to adjust to stressful situations.","correct":true},{"idx":1,"proposition":"Transaction processes determine the adjustment strategies that the patient can put in place to adapt to the disease","correct":true},{"idx":2,"proposition":"The doctor-patient relationship is a friendly relationship","correct":false,"justification":"The doctor-patient relationship is an interpersonal relationship, involving several people (doctors, caregivers, patients, families, caregivers), which passes through the disease, which is exercised in a socio-cultural, unequal framework, made of expectation and hope."},{"idx":3,"proposition":"The doctor-patient relationship is an equal relationship","correct":false,"justification":"It is an unequal relationship on the patient's side because his request makes him dependent on the doctor but also because of his suffering, his fear, his uncertainties that handicap him and make him vulnerable"},{"idx":4,"proposition":"The patient is often passive (especially during acute phases) and often tends to seek the \"protection\" of caregivers","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"medmalade-psy-2","context":null,"enonce":"Regarding the different types of relationships","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"It is an unbalanced relationship on the doctor's side, because of his supposed knowledge","correct":true},{"idx":1,"proposition":"The increase in the frequency of chronic diseases in the 20th century led to the consideration of new types of doctor-patient relationships","correct":true},{"idx":2,"proposition":"The type of relationship called \"active\/passive\" (or \"paternalistic\") sometimes adapted to acute serious illnesses, has evolved into a relationship called \"participatory\" more adapted to chronic diseases, through a \"consensual\" and \"cooperative\" relationship.","correct":true},{"idx":3,"proposition":"The active\/passive relationship involves the patient speaking and the doctor passively listening","correct":false,"justification":"The active\/passive relationship does not involve any activity of the patient, it is the doctor who does his therapeutic act"},{"idx":4,"proposition":"The consensual relationship implies acceptance of care and cooperation between the patient and","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"medmalade-psy-3","context":null,"enonce":"Regarding the different types of relationships","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"In consensual relationships, the patient is already convinced of the need for medical care","correct":true},{"idx":1,"proposition":"The cooperative relationship involves the patient's acceptance and cooperation in the medical gesture.","correct":true},{"idx":2,"proposition":"A gynecological examination is an example of a cooperative relationship","correct":true},{"idx":3,"proposition":"The participatory relationship positions the patient as a passive actor in his care","correct":false,"justification":"The participatory relationship positions the patient as the privileged actor of remission and \/ or recovery who must then change his lifestyle and habits."},{"idx":4,"proposition":"The \"participatory\" relationship requires specific knowledge and skill on the part of the patient","correct":false,"justification":"The \"participatory\" type of relationship requires specific knowledge and skill on the part of the doctor.\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"medmalade-psy-5","context":null,"enonce":"Concerning the medical interview","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"The \"learned theory\" corresponds to biomedical knowledge but is different from the own experience of the disease","correct":true},{"idx":1,"proposition":"The scholarly theory perfectly represents what patients experience, think and feel when they have a disease","correct":false,"justification":"It only incompletely represents what patients experience, think and feel when they have a disease."},{"idx":2,"proposition":"Medical knowledge confronts a secular theory of disease and health that influences patients' behavior, possible actions and relationships with physicians.","correct":true},{"idx":3,"proposition":"The doctor must therefore take into account scientific knowledge exclusively (= evidence-based medicine) in his doctor-patient relationship.","correct":false,"justification":"The doctor must therefore take into account both: his own representations concerning the disease (his scholarly theory), and the representations and values of the patient (his secular theory) during the interviews, but also those of the family environment (interview carried out with the patient in the presence of this entourage)"},{"idx":4,"proposition":"Patient consent or during an interview is essential to obtain","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"medmalade-psy-6","context":null,"enonce":"Regarding the process of empathy in the doctor-patient relationship","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"The patient's consent during an interview leads to a therapeutic alliance","correct":true},{"idx":1,"proposition":"Validating emotions and patient representation is crucial","correct":true},{"idx":2,"proposition":"Validating the emotions and representations of the patient essentially involves the gaze","correct":false,"justification":"In practice, validating the patient's emotions and representations involves reformulation (which mirrors the patient's own emotions and representations and tells him that he has been heard and that he is not alone)"},{"idx":3,"proposition":"Empathy is the ability to be friendly with others without being friendly deep down.","correct":false,"justification":"Empathy is the ability to understand others and make them understand that they have been understood."},{"idx":4,"proposition":"Empathy is different from sympathy which is the ability to feel the same as others.","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"medmalade-psy-7","context":null,"enonce":"Concerning resistance ","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"Most patients want caregivers to feel the same way they do.","correct":false,"justification":"Most patients don't want a caregiver to feel the same way they do, but to try to understand how they feel."},{"idx":1,"proposition":"An important element to which the doctor must remain attentive is the appearance of resistance that can arise","correct":true},{"idx":2,"proposition":"Resistance is a sign of ill will on the part of the patient","correct":false,"justification":"Resistance is not a sign of ill will on the part of the patient, but a natural reaction to a change in his or her life: the disorder or illness."},{"idx":3,"proposition":"A patient who resists change is a lost cause and no longer needs to be cared for","correct":false,"justification":"It needs to be handled differently"},{"idx":4,"proposition":"In the face of resistance, getting angry and scaring the patient is a technique that often works","correct":false,"justification":"A calm and serene emotional expression of the clinician in the face of resistance is essential\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"medmalade-psy-8","context":null,"enonce":"Concerning the interview in the doctor-patient relationship","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"The physician will have to convey to the patient the feeling that he will not be judged, and that no decision will be imposed on him without it making sense to him in his own system of representations.","correct":true},{"idx":1,"proposition":"An important element for each interlocutor is the feeling of freedom","correct":true},{"idx":2,"proposition":"The patient's freedom means that behaviour change cannot be initiated","correct":false,"justification":"Appealing to the patient's freedom should not be a way for the physician to abandon any possibility of change with the patient."},{"idx":3,"proposition":"Motivation for change is not an immutable \"patient trait\"","correct":true},{"idx":4,"proposition":"The first step in the empathy process is the patient's expression of a thought (representation) or emotion.","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"medmalade-psy-9","context":null,"enonce":"About motivational interviewing","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"It's a participatory interview","correct":true},{"idx":1,"proposition":"It is an active\/passive interview","correct":false,"justification":"This is a type of participatory interview"},{"idx":2,"proposition":"It helps to strengthen the patient's own motivation for change","correct":true},{"idx":3,"proposition":"It's about convincing the patient to change","correct":false,"justification":"The goal is to explore with the patient the advantages and disadvantages of the problematic behavior and the alternatives available to him."},{"idx":4,"proposition":"Exploration must be empathetic and non-judgmental","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"medmalade-psy-10","context":null,"enonce":"Regarding the process of empathy in the doctor-patient relationship","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"The physician's recognition of the patient's thought\/emotion is accompanied by an understanding of the patient's representations and worldview.","correct":true},{"idx":1,"proposition":"The third step in the empathy process is the physician's expression of recognition and understanding of the patient's thought or emotion.","correct":true},{"idx":2,"proposition":"The fourth step in the empathy process is the patient's acceptance of recognition and the doctor's understanding of the thought or emotion.","correct":true},{"idx":3,"proposition":"The phase of receiving recognition by the patient is independent of the patient's personality","correct":false,"justification":"This reception phase is influenced as the expression phase by the symptoms, clinical signs and the patient's situation."},{"idx":4,"proposition":"An effective empathic process allows the patient to express in more detail his experience","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"medmalade-psy-11","context":null,"enonce":"Concerning the patient in the doctor-patient relationship","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"From the patient's point of view, a disease is not simply \"an underlying organic pathology\"","correct":true},{"idx":1,"proposition":"According to the 1946 WHO definition, health is \"a complete state of physical, mental and social well-being and not merely the absence of disease or disability.\"","correct":true},{"idx":2,"proposition":"The disease is a disruption of balance in a biological, psychological and social whole","correct":true},{"idx":3,"proposition":"Transaction processes are the cognitive, emotional, and behavioral efforts made by an individual to adjust to stressful situations, such as illness.","correct":true},{"idx":4,"proposition":"Transaction processes in the doctor-patient relationship determine the outcome of the consultation","correct":false,"justification":"They determine the adjustment strategies that the patient can put in place to adapt to the disease, also known as patient coping skills.\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"medmalade-psy-12","context":null,"enonce":"Concerning the evaluation phase in the doctor-patient relationship","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"There are two phases of assessment: primary and secondary","correct":true},{"idx":1,"proposition":"Primary assessment is the \"perceived stress\" of the subject in the stressful situation","correct":true},{"idx":2,"proposition":"Perceived stress is more predictive of the patient's subsequent health than an objective measure of the stress situation","correct":true},{"idx":3,"proposition":"For the patient, the perceived control refers to social aid and protection","correct":false,"justification":"Perceived control corresponds to the inventory of his personal resources and his ability to control the situation and the perceived social support corresponds to the inventory of relational and social aids, protections and valorizations available to him."},{"idx":4,"proposition":"\"Perceived control\" and \"perceived social support\" are negative (inversely correlated) predictors of later health status","correct":false,"justification":"'Perceived control' and 'perceived social support' are positive predictors of later health by reducing the impact of stressful life events and facilitating the adoption of lifestyle changes needed in disease management.\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"medmalade-psy-13","context":null,"enonce":"Concerning the adjustment phase and the interview in the doctor-patient relationship","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"A sense of loss of control or lack of social support proves deleterious for most patients","correct":true},{"idx":1,"proposition":"The adjustment or coping phase is the set of transactional processes that an individual interposes between him and the stressful situation in order to reduce its impact","correct":true},{"idx":2,"proposition":"Whatever the situation, the information provided must be fair, clear, appropriate, appropriate to the situation and understood by the patient.","correct":true},{"idx":3,"proposition":"Patient-patient interviews are always carried out one-on-one to respect medical confidentiality.","correct":false,"justification":"The patient may wish his relatives to be present during the transmission of information and this must be accepted"},{"idx":4,"proposition":"Teenagers and children cannot be seen without their parents","correct":false,"justification":"For teenagers in particular, we must not forget to offer a moment of exchange alone without the parents\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"medmalade-psy-14","context":null,"enonce":"Concerning interviews in the doctor-patient relationship","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"It is necessary to choose a place of quiet information, known to the patient, where the doctor will take the time, as part of a personalized relationship","correct":true},{"idx":1,"proposition":"Information must be communicated to the patient and the entourage if the patient so wishes.","correct":true,"justification":"Information must be communicated to the patient and the entourage if the patient so wishes."},{"idx":2,"proposition":"The steps of the medical process can be used to explain to the patient the arguments on which the doctor's decisions were made.","correct":true},{"idx":3,"proposition":"It is essential to use medical terms so as not to make approximations","correct":false,"justification":"Giving alternative names that the patient can understand can be helpful"},{"idx":4,"proposition":"The management of a chronic disease involves a therapeutic patient education (TPE) strategy","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"medmalade-psy-15","context":null,"enonce":"Concerning FTE in the doctor-patient relationship","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"It is an ongoing process, integrated into care and focused on the patient rather than the disease.","correct":true},{"idx":1,"proposition":"It includes organized awareness-raising, information, learning and psycho-social support activities.","correct":true},{"idx":2,"proposition":"FTE is for the patient himself only","correct":false,"justification":"It aims to help the patient and their loved ones understand the disease and the treatment, cooperate with caregivers in a participatory relationship, live as healthily as possible while maintaining or improving quality of life."},{"idx":3,"proposition":"Therapeutic education must make the patient a scientific expert in his disease","correct":false,"justification":"Therapeutic education must enable the patient to acquire and maintain the strategies necessary to optimally manage his life with the disease, in the perspective of the WHO definition of health of 1984"},{"idx":4,"proposition":"In the context of an FTE, the physician must avoid any contra-attitude","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PR-rhumato-0","context":null,"enonce":"Regarding the basics:","item":"PR","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Osteoarthritis is the most common chronic inflammatory rheumatism","correct":false,"justification":"Osteoarthritis is not inflammatory but mechanical. It is RA that is the most common chronic rheumatism"},{"idx":1,"proposition":"RA always starts after age 40","correct":false,"justification":"Most often around fifty years, but it can occur at any age. There are juvenile forms before 16 years"},{"idx":2,"proposition":"RA is three times more common in women before the age of sixty","correct":true},{"idx":3,"proposition":"The prevalence of RA in the general population is around 8%","correct":false,"justification":"Its prevalence in the general population is of the order of 0.3 to 0.8% in adults"},{"idx":4,"proposition":"There are no genetic factors in RA","correct":false,"justification":"The prevalence among first-degree relatives is approximately 2-4%"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"PR-rhumato-1","context":null,"enonce":"Regarding pathophysiology and diagnosis:","item":"PR","matiere":"rhumato","propositions":[{"idx":0,"proposition":"The pathogen(s) causing RA are unknown to date","correct":true},{"idx":1,"proposition":"RA is characterized by an overflow of pro-inflammatory cytokine production","correct":true},{"idx":2,"proposition":"Osteoclasts are the effector cells of bone erosions seen in RA","correct":true},{"idx":3,"proposition":"Early RA diagnosis is clinic-based","correct":false,"justification":"As well as biological and radiographic examinations plus an ultrasound if doubt"},{"idx":4,"proposition":"Treatment of RA only begins when it becomes disabling, from the age of 65-70","correct":false,"justification":"Diagnosis of RA should be as early as possible in order to institute background treatment very early"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PR-rhumato-2","context":null,"enonce":"Regarding the diagnosis of RA:","item":"PR","matiere":"rhumato","propositions":[{"idx":0,"proposition":"RA only affects women","correct":false,"justification":"Sex ratio to the disadvantage of women but not exclusive"},{"idx":1,"proposition":"The picture of acromelic arthritis is extremely rare","correct":false,"justification":"This is the most common"},{"idx":2,"proposition":"RA is most often acute","correct":false,"justification":"evolving in a chronic mode (> 6 weeks) most often"},{"idx":3,"proposition":"The pain is mechanical","correct":false,"justification":"characterized by inflammatory joint pain (waking up at the end of the night and morning stiffness > 30 minutes)"},{"idx":4,"proposition":"The most frequent location is that of the wrists","correct":true,"justification":"most often located on the wrists:)"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"PR-rhumato-3","context":null,"enonce":"Regarding the diagnosis of RA:","item":"PR","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Metacarpophalangeal joints and proximal interphalangeal joints are frequent localizations","correct":true},{"idx":1,"proposition":"Spontaneously painful joints are most often painful under pressure","correct":true},{"idx":2,"proposition":"The skin coating is not usually affected","correct":true,"justification":"Unlike psoriatic arthritis, septic arthritis or microcrystalline arthritis"},{"idx":3,"proposition":"Distal interphalangeal joints are usually respected during RA","correct":true},{"idx":4,"proposition":"Tenosynovitis points to differential diagnosis and is incompatible with RA","correct":false,"justification":"Possible. Especially around the extensor tendons of the fingers or opposite the ulnar extensor of the carpus"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PR-rhumato-4","context":null,"enonce":"Which propositions are true?","item":"PR","matiere":"rhumato","propositions":[{"idx":0,"proposition":"There is an increase in sedimentation rate (ESR) and\/or CRP in the majority of patients","correct":true},{"idx":1,"proposition":"Rheumatoid Factor (RF) arrives late in the disease","correct":false,"justification":"It is most often present at the first clinical signs of the disease"},{"idx":2,"proposition":"The positivity of the RF may precede the appearance of clinical signs by several months to several years","correct":true},{"idx":3,"proposition":"FR positivity is specific to RA","correct":false,"justification":"It is very possible during Sjögren's disease, systemic lupus, or systemic scleroderma"},{"idx":4,"proposition":"A positive RF can be found in patients who are not sick","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"erreurs-sp-0","context":null,"enonce":"Concerning the analysis of SAEs of therapeutic hazard","item":"erreurs","matiere":"sp","propositions":[{"idx":0,"proposition":"The analysis of SAEs involves their detection and reporting to the institution's risk manager.","correct":true},{"idx":1,"proposition":"Safety culture is optional and not paramount in patient care","correct":false,"justification":"Need for a culture of safety and risk management: Culture of reporting and positive culture of error (any error, malfunction or failure is an opportunity for individual and collective progress)."},{"idx":2,"proposition":"For a positive culture of error, \"no punishment\" or \"incentive to report\" measures must be put in place.","correct":true},{"idx":3,"proposition":"Data anonymization is a necessity in the conduct of SAE analysis","correct":true},{"idx":4,"proposition":"Analysis of the consequences of the SAE makes it possible to prevent them in the future","correct":false,"justification":"Analysis of causes\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"erreurs-sp-1","context":null,"enonce":"Which of these proposals are factors for the success of risk management?","item":"erreurs","matiere":"sp","propositions":[{"idx":0,"proposition":"The commitment of the management of the establishment","correct":true},{"idx":1,"proposition":"Training and awareness","correct":true},{"idx":2,"proposition":"Punitive error management","correct":false,"justification":"It's useless. Non-punitive error management is needed"},{"idx":3,"proposition":"A non-punitive management of faults","correct":false,"justification":"Mistakes (not mistakes)"},{"idx":4,"proposition":"The understanding of the issues by all professionals","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"erreurs-sp-3","context":null,"enonce":"Concerning the prevention of damage to second victims","item":"erreurs","matiere":"sp","propositions":[{"idx":0,"proposition":"This term was introduced by Claude Bernard in 1849.","correct":false,"justification":"By Albert Wu in a 2000 BMJ editorial"},{"idx":1,"proposition":"The second victim is the person closest to the patient","correct":false,"justification":"This is the caregiver"},{"idx":2,"proposition":"The second victim is emotionally and professionally impacted","correct":true,"justification":"Emotionally: shame and guilt. Professionally: mistrust, damage to reputation, loss of trust, etc."},{"idx":3,"proposition":"One of the consequences may be burnout or suicide","correct":true},{"idx":4,"proposition":"The second victim, most often, files a complaint against the hospital for failure to assist a person in danger.","correct":false,"justification":"The second victim is the caregiver who made the mistake.\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"erreurs-sp-4","context":null,"enonce":"Which of the following are true?","item":"erreurs","matiere":"sp","propositions":[{"idx":0,"proposition":"To prevent damage to the second victim, it is necessary to move from the latter to the first actor","correct":true},{"idx":1,"proposition":"The prevention barrier makes it possible to limit the consequences of a mistake already made","correct":false,"justification":"They prevent the occurrence of the error and the accident (action on latent and patent errors) PREVENTION Ex: the surgical checklist, which avoids forgetting perioperative antibiotic prophylaxis"},{"idx":2,"proposition":"The recovery barrier prevents the occurrence of the error and the accident","correct":false,"justification":"The error is made but recovered before having consequences Ex: antibiotic prophylaxis is prescribed but the nurse becomes aware of a penicillin allergy in the patient's medical file and alerts the prescriber who changes his prescriotion"},{"idx":3,"proposition":"The attenuation barrier prevents the consequences of the mistake already made","correct":false,"justification":"The accident is proven but the consequences are limited ATTENUATION barrier Ex: a patient who has not benefited from antibiotic prophylaxis is in septic shock, but blood cultures were carried out very early, the germ was identified quickly, a bed in intensive care is immediately available, treatment is initiated quickly."},{"idx":4,"proposition":"The root cause is the one that is at the origin of all the effects it is the most undesirable, upstream of the problem.","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"erreurs-sp-5","context":null,"enonce":"Which of the following are true?","item":"erreurs","matiere":"sp","propositions":[{"idx":0,"proposition":"It corresponds to the first hole of the first plate (in Reason's model)","correct":true},{"idx":1,"proposition":"We also talk about root cause","correct":true},{"idx":2,"proposition":"It is wiser to treat the racid cause than the consequences of the latter","correct":true},{"idx":3,"proposition":"Root cause analysis (RCA) analyzes and treats the causes of a problem rather than treating its symptoms.","correct":true},{"idx":4,"proposition":"The root cause forest is one of the root cause analysis methods","correct":false,"justification":"Tree of causes"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"erreurs-sp-7","context":null,"enonce":"Which of these proposals are compensated under national solidarity?","item":"erreurs","matiere":"sp","propositions":[{"idx":0,"proposition":"Medical accidents","correct":true},{"idx":1,"proposition":"The victims of the Mediator","correct":true},{"idx":2,"proposition":"Transfusion damage","correct":true},{"idx":3,"proposition":"Nosocomial infections","correct":true},{"idx":4,"proposition":"Iatrogenic diseases","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"erreurs-sp-8","context":null,"enonce":"Which of the following are true?","item":"erreurs","matiere":"sp","propositions":[{"idx":0,"proposition":"It's an accident","correct":true},{"idx":1,"proposition":"The therapeutic hazard occurs when the patient suffers a sudden aggravation in connection with the medical act but without there being a medical fault","correct":true},{"idx":2,"proposition":"Therapeutic hazard does not give right to any compensation","correct":false,"justification":"As medical risk is no longer accepted by patients, important reforms on damage compensation have been established."},{"idx":3,"proposition":"There can be no financial payment for patients suffering from therapeutic hazards","correct":false,"justification":"Following the Act of 4 March 2002 on the rights of patients, victims of risk may be compensated under national solidarity. (i.e. the State) when the responsibility of health professionals or institutions is not engaged."},{"idx":4,"proposition":"To be compensable, the damages invoked must have three cumulative conditions","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"erreurs-sp-9","context":null,"enonce":"Which of the following are true?","item":"erreurs","matiere":"sp","propositions":[{"idx":0,"proposition":"Compensation is paid by ONIAM","correct":true},{"idx":1,"proposition":"Proof must be provided by the applicant","correct":true},{"idx":2,"proposition":"The limitation period is 5 years","correct":false,"justification":"The limitation period is 10 years"},{"idx":3,"proposition":"The compensation procedure is fast and free of charge","correct":true},{"idx":4,"proposition":"It is only valid for medical accidents occurring after 6 August 1997.","correct":false,"justification":"Valid for the victim: fast and free procedure only for medical accidents occurring after 4 September 2001."}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"diarrheeinf-infectio-0","context":null,"enonce":"Regarding the basics:","item":"diarrheeinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"Diarrhea is the elimination of at least 3 unmolded stools per day","correct":true},{"idx":1,"proposition":"Febrile diarrhea indicates enterocolic infection","correct":false,"justification":"Not necessarily: the acceleration of transit and the emission of liquid stools can be caused by many other infections (malaria, sepsis, etc.)"},{"idx":2,"proposition":"Acute diarrhea is less than 2 weeks","correct":true},{"idx":3,"proposition":"The majority of acute diarrhoea is of infectious origin","correct":true},{"idx":4,"proposition":"Diarrhoea often progresses to colonic performation and sepsis when left untreated","correct":false,"justification":"Spontaneously limiting most often"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diarrheeinf-infectio-1","context":null,"enonce":"What are the emergency situations to be identified?","item":"diarrheeinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"More than 10 trips to the toilet per day","correct":false,"justification":"The number of times you have a bowel movement is not a sign of severity"},{"idx":1,"proposition":"Acute dehydration","correct":true,"justification":"Especially in at-risk subjects"},{"idx":2,"proposition":"Occlusive syndrome","correct":true},{"idx":3,"proposition":"The return of a malaria-endemic country","correct":true,"justification":"Always think about asking about travel"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"diarrheeinf-infectio-2","context":null,"enonce":"Regarding loperamide:","item":"diarrheeinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is a transit retarder","correct":true},{"idx":1,"proposition":"It is indicated in febrile diarrhea","correct":false,"justification":"It is contraindicated!"},{"idx":2,"proposition":"It is indicated in bloody diarrhea","correct":false,"justification":"Formal contraindication"},{"idx":3,"proposition":"It is indicated in non-febrile diarrhea of the infant","correct":false,"justification":"Contraindicated before 30 months of age"},{"idx":4,"proposition":"It has many side effects including frequent headaches","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"diarrheeinf-infectio-3","context":null,"enonce":"What are the indications for a stool culture?","item":"diarrheeinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"Febrile diarrhea","correct":true},{"idx":1,"proposition":"HIV infection","correct":false,"justification":"Only if immunosuppression"},{"idx":2,"proposition":"Dehydration","correct":true,"justification":"In case of signs of severity"},{"idx":3,"proposition":"A return of the tropics","correct":true},{"idx":4,"proposition":"A notion of storytelling","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diarrheeinf-infectio-5","context":null,"enonce":"What situations require hospitalization during infectious diarrhea?","item":"diarrheeinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"Sepsis","correct":true,"justification":"Life-threatening emergency"},{"idx":1,"proposition":"Diarrhoea larger than 3 litres ","correct":false,"justification":"False"},{"idx":2,"proposition":"Pseudo-occlusive syndrome","correct":true},{"idx":3,"proposition":"Acute dehydration","correct":true,"justification":"Life-threatening emergency"},{"idx":4,"proposition":"Febrile diarrhoea returning from endemic country ","correct":true,"justification":"True, evoking a malarial attack"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diarrheeinf-infectio-6","context":null,"enonce":"From what time frame do we speak of prolonged diarrhea?","item":"diarrheeinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"1 week","correct":false},{"idx":1,"proposition":"2 weeks","correct":true},{"idx":2,"proposition":"3 weeks","correct":false},{"idx":3,"proposition":"4 weeks","correct":false,"justification":"From one month, we talk about chronic diarrhea"},{"idx":4,"proposition":"14 days","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diarrheeinf-infectio-7","context":null,"enonce":"From what time frame do we talk about chronic diarrhea?","item":"diarrheeinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"1 week","correct":false,"justification":"It is acute diarrhea"},{"idx":1,"proposition":"2 weeks","correct":false,"justification":"Acute diarrhea is called an episode < 2 weeks"},{"idx":2,"proposition":"3 weeks","correct":false},{"idx":3,"proposition":"4 weeks","correct":true},{"idx":4,"proposition":"6 weeks","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diarrheeinf-infectio-8","context":null,"enonce":"Among the following proposals, what is the main risk in acute diarrhoea in children?","item":"diarrheeinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"Hypokalemia","correct":false},{"idx":1,"proposition":"Hyperkalemia","correct":false},{"idx":2,"proposition":"Undernutrition","correct":false},{"idx":3,"proposition":"Dehydration","correct":true,"justification":"Major risk, to be assessed (CI and EC according to the criteria) upon admission"},{"idx":4,"proposition":"Sepsis","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"strabismeped-ophtalmo-0","context":null,"enonce":"General:","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Childhood strabismus is a symptom of an underlying pathology","correct":true},{"idx":1,"proposition":"There are two types of strabismus: paralytic or normal mobility","correct":true},{"idx":2,"proposition":"Treatment is surgical","correct":false,"justification":"It is only indicated in case of persistence of strabismus with the port of total optical correction"},{"idx":3,"proposition":"Surgical treatment is performed under general anhesis","correct":true},{"idx":4,"proposition":"Strabismus is a lack of parallelism of visual axes","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"strabismeped-ophtalmo-1","context":null,"enonce":"Regarding the definition of strabismus:","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Strabismus is indicative of sensorineural impairment","correct":true},{"idx":1,"proposition":"The motor component involves an abnormal position of the deviated eye relative to the dominant eye","correct":true},{"idx":2,"proposition":"The child's strabismus is essentially the consequence of a disturbance in the interpretation of color","correct":false,"justification":"The strabismus of the child is essentially the consequence of a disturbance of the fusion (cortical integration aimed at bringing together the images perceived by each eye in a single image)"},{"idx":3,"proposition":"The purpose of fusion is to allow a simple perception of any fixed object.","correct":true},{"idx":4,"proposition":"Fusion is a pure sensory response","correct":false,"justification":"It results as a motor response (contraction–relaxation of the oculomotor muscles of both eyes) to binocular stimulations (vision of one image per eye)"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"strabismeped-ophtalmo-2","context":null,"enonce":"Concerning strabismus and its consequences","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Fusion creates the conditions for simultaneous vision of both eyes","correct":true},{"idx":1,"proposition":"Fusion enables stereoscopy","correct":true,"justification":"This is vision in space"},{"idx":2,"proposition":"Acute strabismus resulting in two different images implies visual confusion","correct":false,"justification":"In case of acute strabismus, two images of the same object can be perceived, it is diplopia"},{"idx":3,"proposition":"Old strabismus without complaints can lead to normal vision by pausing the retina of one of the two eyes","correct":false,"justification":"In ancient strabismus or in children who do not express complaints, the doubled image can be suppressed by a cortical phenomenon, neutralization (the image of one of the two eyes is ignored)"},{"idx":4,"proposition":"Amblyopia is the decrease in visual function due to early impairment of visual experience.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"strabismeped-ophtalmo-3","context":null,"enonce":"Regarding strabismus:","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Some patients describe visual confusion","correct":true},{"idx":1,"proposition":"Visual confusion is related to the perception of two objects in the same place","correct":true},{"idx":2,"proposition":"All patients describe stereoscopic vision disturbance","correct":true},{"idx":3,"proposition":"Strabismus most often sets in in childhood","correct":true},{"idx":4,"proposition":"The prevalence of strabismus is estimated at 12% of the population","correct":false,"justification":"4% of the population"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"strabismeped-ophtalmo-4","context":null,"enonce":"Strabismus:","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Strabismus is never physiological","correct":true},{"idx":1,"proposition":"Strabismus screening should be performed in all children in late adolescence","correct":false,"justification":"Ideally for any child under 2 years old"},{"idx":2,"proposition":"The early appearance of strabismus determines its impact on binocular vision","correct":true},{"idx":3,"proposition":"The relative risk of strabismus in case of family history is not changed","correct":false,"justification":"It is increased"},{"idx":4,"proposition":"The prefix \"éso\" is used for convergent vertical strabisms","correct":false,"justification":"For convergent horizontal strabismus (esotropy and esophoria)"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"strabismeped-ophtalmo-5","context":null,"enonce":"Clinical examination:","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The differential diagnosis of convergent strabismus is epicanthus","correct":true},{"idx":1,"proposition":"The prefix \"exo\" is used for divergent strabismus (exotropy and exophoria)","correct":true},{"idx":2,"proposition":"A tropy is a permanent strabismus","correct":true},{"idx":3,"proposition":"A phoria is a permanent strabismus","correct":false,"justification":"A phoria is an intermittent strabismus (observed episodically on examination) and can be observed in convergence (esophoria) or divergence (exophoria)"},{"idx":4,"proposition":"In case of permanent strabismus, binocular vision is absent","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"strabismeped-ophtalmo-6","context":null,"enonce":"Ophthalmological examination in strabique children:","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Binocular vision is lost in intermittent strabismus","correct":false,"justification":"In intermittent strabismus, binocular vision is often retained when the eyes are aligned"},{"idx":1,"proposition":"The risk of amblyopia is major when the deviated eye is always the same","correct":true},{"idx":2,"proposition":"The risk of amblyopia is 99% in case of alternating fixation","correct":false,"justification":"The risk is moderate in this case"},{"idx":3,"proposition":"Concomitant strabismus does not find any systematized deficit of ocular motility","correct":true},{"idx":4,"proposition":"Concomitant strabismus is very rare in children","correct":false,"justification":"Concomitant strabismus account for the vast majority of childhood strabismus"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"strabismeped-ophtalmo-7","context":null,"enonce":"Concerning additional examinations in case of strabismus:","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The discovery of strabismus requires an urgent ophthalmological examination","correct":true},{"idx":1,"proposition":"Strabismus can reveal a retinal pathology such as retinoblastoma or macular scar","correct":true},{"idx":2,"proposition":"Nystagmus associated with strabismus requires the performance of an EEG","correct":false,"justification":"In case of associated nystagmus, an electroretinogram (ERG) will be performed to rule out retinal dystrophy and visual evoked potentials (EPI) and magnetic resonance imaging (MRI) of the optical pathways will be prescribed for the assessment of potential visual tract damage"},{"idx":3,"proposition":"Any strabic child should benefit from an objective refractive measurement under cycloplegic to determine whether it is an esotropy or an exotropy","correct":false,"justification":"Objective refractive measurement is the basic element of screening for ametropia and amblyopia in a child"},{"idx":4,"proposition":"The measurement of subcycloplegic refraction will look for ametropia","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"strabismeped-ophtalmo-8","context":null,"enonce":"Regarding associated pathologies:","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The presence of astygmatism is very common in case of strabismus","correct":false,"justification":"The presence of hyperopia is very frequently associated with strabismus"},{"idx":1,"proposition":"Any accommodation effort is associated with convergence","correct":true},{"idx":2,"proposition":"Objective refraction under cycloplegic makes it possible to measure the visual acuity with correction of a child","correct":true},{"idx":3,"proposition":"Any strabic child must wear total optical correction","correct":true},{"idx":4,"proposition":"The measurement of visual acuity makes it possible to objectify myopia which is frequently associated with strasbism","correct":false,"justification":"The measurement of visual acuity will highlight a possible amblyopia (difference in visual acuity between the two eyes of at least 2\/10th with correction)"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"strabismeped-ophtalmo-9","context":null,"enonce":"Principles of treatment","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The presence of binocular vision is a major prognosis of treatment","correct":true},{"idx":1,"proposition":"Any strabic patient must wear total optical correction","correct":true},{"idx":2,"proposition":"Treatment of possible amblyopia will be maintained until the age of 2 years","correct":false,"justification":"Treatment of possible amblyopia will be maintained until the age of 6 to 8 years, which corresponds to the end of the child's visual development"},{"idx":3,"proposition":"Indications for orthoptic rehabilitation are marginal in the management of strabismus","correct":true},{"idx":4,"proposition":"The role of the orthoptist is especially major in the measurement of strabic deviations and binocular vision, as well as for the follow-up of amblyopia in support of the ophthalmologist","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"certifsport-nutri-0","context":null,"enonce":"The main purpose of the medical examination is:","item":"certifsport","matiere":"nutri","propositions":[{"idx":0,"proposition":"Evaluate achievable sports performance","correct":false},{"idx":1,"proposition":"Detect cardiovascular pathologies responsible for sudden death","correct":true},{"idx":2,"proposition":"To encourage the practice of sport","correct":false},{"idx":3,"proposition":"Discourage the practice of dangerous sports such as climbing or judo","correct":false},{"idx":4,"proposition":"To recall the dangerousness of doping products","correct":false,"justification":"This is one of the objectives, but the really main objective is the detection of cardiovascular pathologies, such as BAV or long QT, which can be responsible for sudden death."}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"certifsport-nutri-1","context":null,"enonce":"Which propositions are true?","item":"certifsport","matiere":"nutri","propositions":[{"idx":0,"proposition":"The medical examination for fitness for sport is not reimbursed by health insurance","correct":true,"justification":"According to the College of Endocrinology"},{"idx":1,"proposition":"There are about 1 to 4 sudden deaths per 100,000 people over the age of 35.","correct":true},{"idx":2,"proposition":"If the sport is considered at risk, the consultation must be made by a sports doctor","correct":true},{"idx":3,"proposition":"ECG is mandatory","correct":false,"justification":"Update 2016 on HCSP recos, extract from the College of Pediatrics 2021: A complete clinical examination is usually sufficient. The HCSP recommends that the ECG should not be systematic but left to the judgment of the clinician (2016). Discomfort and\/or syncopes occurring during exercise should be considered as a warning sign of cardiac origin: a clinical cardiological assessment with at least one ECG, a stress test and echocardiography is then essential. The item is therefore false. (The item was previously corrected as true. Thanks to the external who reported the error)"},{"idx":4,"proposition":"Doping contraindicates the realization of a certificate of non-contraindication to the practice of sport","correct":true,"justification":"The patient must then be referred to see AMPD"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"certifsport-nutri-4","context":null,"enonce":"Under what conditions is a stress test indicated?","item":"certifsport","matiere":"nutri","propositions":[{"idx":0,"proposition":"An age greater than 20 years","correct":false,"justification":"Over 40 years"},{"idx":1,"proposition":"Male sex","correct":false},{"idx":2,"proposition":"Diabetes","correct":true,"justification":"To detect microangiopathic complications"},{"idx":3,"proposition":"The presence of 2 cardiovascular risk factors","correct":true},{"idx":4,"proposition":"Alcohol consumption","correct":false,"justification":"Alcohol is not a cardiovascular risk factor"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SEP-neuro-0","context":null,"enonce":"Regarding the main generalities about MS:","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"Multiple sclerosis usually occurs after age 40","correct":false,"justification":"Occurs in young adults"},{"idx":1,"proposition":"The diagnosis is based on the notions of spatial dissemination and temporal dissemination","correct":true},{"idx":2,"proposition":"The lumbar puncture makes it possible to affirm the inflammatory nature of the CNS involvement","correct":true},{"idx":3,"proposition":"The criterion of dissemination over time is mandatory to make the diagnosis of MS","correct":false,"justification":"CNS inflammation objectified to CSF analysis may replace the criterion of dissemination over time if it is absent."},{"idx":4,"proposition":"There is no known treatment","correct":false,"justification":"There are treatments that aim to speed up symptom recovery, limit the frequency of flare-ups and disease progression, and improve symptoms."}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"SEP-neuro-1","context":null,"enonce":"Regarding the epidemiology and risk factors of MS:","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"There is a male predominance","correct":false,"justification":"Female predominance (3 women to 1 man)"},{"idx":1,"proposition":"MS is more common when moving away from the equator","correct":true},{"idx":2,"proposition":"The prevalence is 5000 people per year in France","correct":false},{"idx":3,"proposition":"Less exposure to certain infections in childhood would increase the risk","correct":true},{"idx":4,"proposition":"Vitamin D deficiency is associated with an increased risk of disease","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SEP-neuro-3","context":null,"enonce":"Regarding the different clinical forms:","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"Progression is defined as the continuous worsening, over a period of at least six months, of neurological symptoms.","correct":true},{"idx":1,"proposition":"The relapsing-remitting form is progressive from the beginning, without flare-up, consistently","correct":false,"justification":"It is the primary progressive form, which affects 15% of patients. The relapsing-remitting form is composed exclusively of flare-ups, which can leave sequelae"},{"idx":2,"proposition":"The secondarily progressive form is the late classical course of the relapsing-remitting form","correct":true},{"idx":3,"proposition":"The primary progressive form begins on average a little later, around 40 years of age","correct":true},{"idx":4,"proposition":"Types of symptoms depend on the clinical phase","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"SEP-neuro-4","context":null,"enonce":"Regarding the diagnosis:","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"In the relapsing-remitting form, there is most often an inaugural flare-up of partial myelitis or NORB","correct":true,"justification":"NORB = Retrobulbar optic neuritis"},{"idx":1,"proposition":"\"Partial myelitis\" is an MRI term that means that demyelination does not extend to the entire cross-section of the spinal cord.","correct":true},{"idx":2,"proposition":"Partial myelitis is of medullary topography","correct":true},{"idx":3,"proposition":"Motor disorders are never found in partial myelitis","correct":false,"justification":"There are sometimes motor and\/or sphincter disorders."},{"idx":4,"proposition":"The sign of Rutteau is very evocative","correct":false,"justification":"The sign of Lhermitte is very evocative: it is an impression of very brief electric discharge along the spine, sometimes limbs, triggered electively at the bending of the head forward"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SEP-neuro-5","context":null,"enonce":"Regarding the analysis of cerebrospinal fluid in the MS:","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"The presence of oligoclonal bands replaces the criterion of temporal dissemination","correct":true,"justification":"According to McDonald's 2017 criteria"},{"idx":1,"proposition":"Lumbar puncture is mandatory for the diagnosis of MS","correct":false,"justification":"It is not mandatory"},{"idx":2,"proposition":"Oligoclonal bands are present in only 15% of MS","correct":false,"justification":"They are present in more than 90% of MS! An absence of oligoclonal bands should call into question the diagnosis of MS."},{"idx":3,"proposition":"A proteinorachy > 1 g\/L is suggestive of MS","correct":false,"justification":"No, it is suggestive of a differential diagnosis, such as bacterial meningitis, and must call into question the diagnosis of MS."},{"idx":4,"proposition":"Intrathecal IgG secretion > 0.7 g\/L suggestive of a diagnosis of MS","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SEP-neuro-6","context":null,"enonce":"Regarding NORB in MS:","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"The NORB is inaugural in 25% of cases","correct":true},{"idx":1,"proposition":"NORB is specific to MS","correct":false,"justification":"NORB is also present in neuromyelitis optica (Devic disease), in HIV, in Horton's disease, and also caused by drugs (ethambutol, isoniazid)"},{"idx":2,"proposition":"There is blue-yellow dyschromatopsia","correct":false,"justification":"It is red-green dyschromatopsia (optic neuropathy). Blue-yellow dyschromatopsia is present in some retinal conditions."},{"idx":3,"proposition":"Papillary edema may be observed at the back of the eye","correct":true,"justification":"It is an inflammatory attack of the optic nerve. Edema is present in 10% of NORBs."},{"idx":4,"proposition":"In the static visual field, there is a central scotoma or caeco-central","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SEP-neuro-7","context":null,"enonce":"What background MS treatment(s) is\/are likely to cause progressive multifocal leukoencephalopathy (PML)?","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"Natalizumab","correct":true},{"idx":1,"proposition":"Let's interfere betâ","correct":false,"justification":"Side effects: flu-like syndrome for ≈ 50% of patients after injection; Skin side effects"},{"idx":2,"proposition":"Glatiramer acetate","correct":false,"justification":"Immunomodulatory therapy that may cause skin side effects"},{"idx":3,"proposition":"Dimethyl fumarate","correct":true,"justification":"Immunomodulatory therapy that can cause flushing, digestive upset and prolonged lymphopenia (occurrence of opportunistic infections such as PML)"},{"idx":4,"proposition":"Mitoxantrone","correct":false,"justification":"Risk of acute myeloid leukemia"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"SEP-neuro-8","context":null,"enonce":"Good prognosis factors for MS include:","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"Young onset age","correct":true},{"idx":1,"proposition":"Male","correct":false,"justification":"It is the female sex"},{"idx":2,"proposition":"Initial sensory impairment","correct":true},{"idx":3,"proposition":"Remitting mode","correct":true,"justification":"The primary progressive form has a poor prognosis"},{"idx":4,"proposition":"Start with a NORB or motor signs","correct":false,"justification":"Initiation with NORB is a good prognosis factor, but onset with motor signs is a poor prognosis factor."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SEP-neuro-9","context":null,"enonce":"Which of the following proposals are frequently included in a first outbreak of multiple sclerosis?","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"Proportional brutal hemiplegia","correct":false,"justification":"Not brutal (more reminiscent of vascular involvement), no hemiplegia"},{"idx":1,"proposition":"Decreased visual acuity","correct":true,"justification":"True, symptom of NORB"},{"idx":2,"proposition":"Paresthesias of a hemibody or lower limbs","correct":true},{"idx":3,"proposition":"Peripheral facial paralysis (PFP)","correct":false,"justification":"Not in the first push"},{"idx":4,"proposition":"Delirium","correct":false,"justification":"No cognitive impairment"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SEP-neuro-10","context":null,"enonce":"Which of the following are additional tests that can lead to multiple sclerosis (MS)?","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"Brain MRI","correct":true},{"idx":1,"proposition":"Bone marrow MRI","correct":true},{"idx":2,"proposition":"Microbiological","correct":true},{"idx":3,"proposition":"ENMG","correct":false,"justification":"Totally unnecessary (central reach)"},{"idx":4,"proposition":"EEG","correct":false,"justification":"Totally useless"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SEP-neuro-11","context":null,"enonce":"Which of the following are common features of retrobulbar optic neuritis (NORB)?","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"Central scotomome","correct":true},{"idx":1,"proposition":"A fundus usually normal in the acute phase","correct":true},{"idx":2,"proposition":"Pain when mobilizing the eyeball","correct":true},{"idx":3,"proposition":"Unilateral decrease in visual acuity","correct":true},{"idx":4,"proposition":"All propositions are true","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"splenomeg-HGE-1","context":null,"enonce":"Regarding the causes and consequences of spleen pathologies:","item":"splenomeg","matiere":"HGE","propositions":[{"idx":0,"proposition":"Lupus can be the cause of a splenectomy","correct":true},{"idx":1,"proposition":"Hemorrhagic shock due to rupture of the spleen can result in asplenism","correct":true},{"idx":2,"proposition":"Pneumococcal sepsis may be caused by splenomegaly","correct":false,"justification":"Asplenism"},{"idx":3,"proposition":"Any palpable spleen is pathological except in children","correct":true,"justification":"Source: https:\/\/lyon-sud.univ-lyon1.fr\/servlet\/com.univ.collaboratif.utils.LectureFichiergw?ID_FICHIER=1320402929586"},{"idx":4,"proposition":"Splenomegaly can cause hemodilution anemia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"splenomeg-HGE-2","context":null,"enonce":"What can be the consequences of splenomegaly: ","item":"splenomeg","matiere":"HGE","propositions":[{"idx":0,"proposition":"Acute hepatitis","correct":false,"justification":"No, but may be the cause"},{"idx":1,"proposition":"Malabsorption","correct":false,"justification":"No, but celiac disease can cause splenopathy"},{"idx":2,"proposition":"Hemodilution","correct":true,"justification":"Inconstant although more or less proportional to the splenic volume, it depends on the etiology of splenomegaly"},{"idx":3,"proposition":"Leukocytosis","correct":false,"justification":"Rather leukopenia by sequestration. We readily find thrombocytopenia. In extreme forms, this can go as far as pancytopenia."},{"idx":4,"proposition":"Diarrhea","correct":false,"justification":"Not described in the college"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"splenomeg-HGE-3","context":null,"enonce":"In case of splenectomy:","item":"splenomeg","matiere":"HGE","propositions":[{"idx":0,"proposition":"Vaccinated against all encapsulated germs","correct":false,"justification":"Meningoto and pneumo vaccine only. There are many other encapsulated germs, including haemophilius influenzae."},{"idx":1,"proposition":"Vaccination against neisseria meningitidis","correct":true},{"idx":2,"proposition":"Streptoccocus pneumoniae is vaccinated","correct":true},{"idx":3,"proposition":"Listeria vaccinated","correct":false,"justification":"Not in the recommendations"},{"idx":4,"proposition":"Bouts of fever are immediately treated with fluoroquinolones","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"splenomeg-HGE-4","context":null,"enonce":"Which of the following are causes of splenomegaly?","item":"splenomeg","matiere":"HGE","propositions":[{"idx":0,"proposition":"High blood pressure","correct":false},{"idx":1,"proposition":"Gaucher disease","correct":true},{"idx":2,"proposition":"Cirrhosis","correct":true},{"idx":3,"proposition":"Hepatocellular carcinoma","correct":true},{"idx":4,"proposition":"Infective endocarditis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PF-neuro-0","context":null,"enonce":"Regarding central facial deficit:","item":"PF","matiere":"neuro","propositions":[{"idx":0,"proposition":"It predominates on the forehead","correct":false,"justification":"Lower part of the face. The two nuclei of the trunk of the facial nerves each receive afferences of 1st corticonuclear motor neurons of both hemispheres. However, the homolateral corticonuclear neuron innervates mainly the upper stage of the face. So in case of damage of the 1st neuron, central, the deficit will predominate on the lower floor."},{"idx":1,"proposition":"There is a deletion of the nasolabial fold","correct":true},{"idx":2,"proposition":"Fall of the labial commissure is rare","correct":false,"justification":"Frequent"},{"idx":3,"proposition":"It is associated with a motor deficit that is homolateral most often","correct":true},{"idx":4,"proposition":"It always includes automatic-voluntary dissociation","correct":false,"justification":"In general, not always. Sometimes dissociation is reversed"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"PF-neuro-1","context":null,"enonce":"Regarding peripheral facial paralysis","item":"PF","matiere":"neuro","propositions":[{"idx":0,"proposition":"The sign of Charles Bell shows a tilt of the eyeball upwards","correct":true,"justification":"This switch is physiological. The incomplete closure of the palpebral cleft makes it possible to observe it (by occlusion deficit of the eye) = Charles Bell's sign"},{"idx":1,"proposition":"There is an erasure of forehead wrinkles","correct":true},{"idx":2,"proposition":"There is an agueusia of the anterior 2\/3 of the tongue when the involvement is very proximal","correct":true,"justification":"It is a localizing sign of the lesion: upstream of the eardrum cord. So a FP related to a lesion downstream (eg compression by a parotid tumor) will not be associated with ageusia."},{"idx":3,"proposition":"Schumascher's test reveals drying up of tear secretions","correct":false,"justification":"Schirmer's test"},{"idx":4,"proposition":"The face is sluggish in case of facial diplegia","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"PF-neuro-2","context":null,"enonce":"Regarding idiopathic acute facial paralysis:","item":"PF","matiere":"neuro","propositions":[{"idx":0,"proposition":"It is called a frigore","correct":true},{"idx":1,"proposition":"It is a very rare cause of paralysis","correct":false,"justification":"By far the most common; \"very rare\" suggests the answer"},{"idx":2,"proposition":"It is, as a rule, isolated","correct":true},{"idx":3,"proposition":"Recovery is slow and sequelale in very few cases","correct":true,"justification":"About 10%"},{"idx":4,"proposition":"There is no specific treatment","correct":false,"justification":"Prescription of oral corticosteroid therapy (1 mg\/kg per day for 10 days). There are symptomatic treatments: eye protection, speech therapy,..."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcpulm-onco-0","context":null,"enonce":"Which of the following are true?","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"proposition":"Platinum salts are the basis of chemotherapy","correct":true,"justification":"None"},{"idx":1,"proposition":"Treatment decisions must be validated in a multidisciplinary consultation meeting with 2 doctors of different specialties","correct":false,"justification":"3 different specialties"},{"idx":2,"proposition":"Survival at all stages is < 20% at 5 years","correct":true,"justification":"None"},{"idx":3,"proposition":"Its main risk factor is air pollution","correct":false,"justification":"Its main risk factor, tobacco, is clearly identified and preventable"},{"idx":4,"proposition":"     There is no recommendation for screening for CP currently in France ","correct":true,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"orgamdt-mdt-0","context":null,"enonce":"Which of these principles apply to occupational medicine?","item":"orgamdt","matiere":"mdt","propositions":[{"idx":0,"proposition":"Universality: occupational medicine concerns all employees","correct":true},{"idx":1,"proposition":"It is curative and preventive","correct":false,"justification":"Exclusively preventive"},{"idx":2,"proposition":"It must be organized by the ANSM and the HAS","correct":false,"justification":"It must be organized by the employer"},{"idx":3,"proposition":"It is exercised within an SST","correct":true,"justification":"OHS = Occupational Health Service"},{"idx":4,"proposition":"It is independent of the State","correct":false,"justification":"The action of the MT is independent of the employer"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"orgamdt-mdt-1","context":null,"enonce":"Which of these proposals are actions potentially carried out by the occupational physician?","item":"orgamdt","matiere":"mdt","propositions":[{"idx":0,"proposition":"Workplace visits","correct":true},{"idx":1,"proposition":"Training for specific risks","correct":true},{"idx":2,"proposition":"The development and updating of the company file","correct":true},{"idx":3,"proposition":"Carrying out metrological measurements","correct":true},{"idx":4,"proposition":"Fracture management in the workplace","correct":false,"justification":"The role of TM is exclusively PREVENTIVE"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"orgamdt-mdt-2","context":null,"enonce":"Regarding the return to work visit:","item":"orgamdt","matiere":"mdt","propositions":[{"idx":0,"proposition":"It is always optional","correct":false,"justification":"It is mandatory in certain cases: after maternity leave, absence due to occupational disease, ..."},{"idx":1,"proposition":"It concerns in particular workers returning from maternity leave","correct":true},{"idx":2,"proposition":"It concerns in particular workers returning from paternity leave","correct":false},{"idx":3,"proposition":"It may conclude with a notice of incapacity","correct":true},{"idx":4,"proposition":"It can be replaced by the pre-return to work visit","correct":false,"justification":"The pre-resumption visit is different, it is organized during the work stoppage and has different objectives"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"osteoporose-rhumato-0","context":null,"enonce":"General generalities:","item":"osteoporose","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Osteoporosis is a generalized disease of the skeleton, characterized by decreased bone strength predisposing to a high risk of fracture","correct":true},{"idx":1,"proposition":"Bone strength is synonymous with bone density","correct":false,"justification":"Bone strength is the result of bone density and bone quality (alteration of bone microarchitecture in particular)\""},{"idx":2,"proposition":"Biomechanical studies show that bone mineral density (BMD) is the main determinant of bone fragility","correct":true},{"idx":3,"proposition":"The main complication of osteoporosis disease is malignant hypercalcemia","correct":false,"justification":"Fractures are \"the\" complication of osteoporotic disease and constitute the full severity of this disease"},{"idx":4,"proposition":"The scanner is the reference technique for measuring BMD","correct":false,"justification":"This is the DXA: Two-photon X-ray absorptiometry"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"osteoporose-rhumato-2","context":null,"enonce":"Regarding support:","item":"osteoporose","matiere":"rhumato","propositions":[{"idx":0,"proposition":"X-rays should be taken for vertebral fracture(s) in case of significant loss of size (≥ 4 cm)","correct":true},{"idx":1,"proposition":"The realization of a BMD is necessary in front of fractures of the ESF or vertebral only","correct":false,"justification":"When an osteoporotic-like fracture occurs (or is discovered on X-rays), or when one or more risk factors for osteoporosis are discovered by questioning, BMD must be performed"},{"idx":2,"proposition":"Vertebral fractures are osteroporotic only","correct":false,"justification":"In case of red flag (context or presentation or appearance rx), it is necessary to fear a secondary fracture (tumor, myeloma, spondylodiscite ..). In case of doubt, the realization of a CT scan and \/ or an MRI, will confirm the absence of signs suggestive of another origin, in particular tumor"},{"idx":3,"proposition":"In postmenopausal osteoporosis, serum calcium is increased","correct":false,"justification":"Calcium and phosphatemia are normal in postmenopausal osteoporosis. In case of primary hyperparathyroidism, however, there is hypercalcemia and hypophosphoremia"},{"idx":4,"proposition":"Vitamin D deficiency should be screened for osteoporosis","correct":true,"justification":"The dosage of 25 OH vitamin D is part of the assessment of weakening osteopathy to detect osteomalacia."}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"osteoporose-rhumato-3","context":null,"enonce":"Which of the following are radiographic criteria for benign vertebral fracture?","item":"osteoporose","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Multiple settlements","correct":true},{"idx":1,"proposition":"Conservation of the posterior wall","correct":true},{"idx":2,"proposition":"Absence of paravertebral spindle","correct":true},{"idx":3,"proposition":"Gas translucency within the fracture","correct":true},{"idx":4,"proposition":"Soft parts involvement","correct":false,"justification":"In favor of malignant infringement"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"osteoporose-rhumato-4","context":null,"enonce":"Which of the following are radiographic criteria for malignant vertebral fracture?","item":"osteoporose","matiere":"rhumato","propositions":[{"idx":0,"proposition":"A T2 level fracture","correct":true,"justification":"True, like all fractures higher than T5"},{"idx":1,"proposition":"A setback of the back wall","correct":true},{"idx":2,"proposition":"An invasion of the soft parts","correct":true},{"idx":3,"proposition":"Lysis of bony cortical cortical","correct":true},{"idx":4,"proposition":"Respect for the posterior arch","correct":false,"justification":"Rather, there is a recoil of the posterior arch"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"osteoporose-rhumato-5","context":null,"enonce":"Which of the following are radiographic criteria for benign vertebral fracture?","item":"osteoporose","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Multiple settlements","correct":true},{"idx":1,"proposition":"Conservation of the posterior wall","correct":true},{"idx":2,"proposition":"Absence of paravertebral spindle","correct":true},{"idx":3,"proposition":"Gas translucency within the fracture","correct":true},{"idx":4,"proposition":"Soft parts involvement","correct":false,"justification":"In favor of malignant infringement"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"asthme-immuno-0","context":null,"enonce":"Which of the following proposition(s) is true about asthma?","item":"asthme","matiere":"immuno","propositions":[{"idx":0,"proposition":"Pulmonary function tests (RFEs) find a reversible restrictive ventilatory disorder","correct":false,"justification":"EFRs regain reversible obstructive ventilatory disorder"},{"idx":1,"proposition":"Mortality is almost zero","correct":false,"justification":"It is about 1,000 per year"},{"idx":2,"proposition":"Asbestos causes asthma","correct":false,"justification":"No asthma caused by asbestos"},{"idx":3,"proposition":"The severity of asthma is defined by the number of annual exacerbations","correct":false,"justification":"It is defined by the necessary therapeutic level"},{"idx":4,"proposition":"Asthma contraindicates underwater scuba pongey","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"asthme-immuno-1","context":null,"enonce":"What is the prevalence of asthma in France? 🤔","item":"asthme","matiere":"immuno","propositions":[{"idx":0,"proposition":"0.1% 😯","correct":false,"justification":"False"},{"idx":1,"proposition":"1% 😩","correct":false,"justification":"False"},{"idx":2,"proposition":"6% 😨","correct":true},{"idx":3,"proposition":"10% 😰","correct":false,"justification":"False"},{"idx":4,"proposition":"16% 😱","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"asthme-immuno-2","context":null,"enonce":"Which of the following are signs of severity during an asthma exacerbation?","item":"asthme","matiere":"immuno","propositions":[{"idx":0,"proposition":"The presence of bilateral sibilants","correct":false,"justification":"This is normal even in classic asthma"},{"idx":1,"proposition":"Constipation","correct":false,"justification":"Not a sign of gravity"},{"idx":2,"proposition":"bradycardia","correct":true,"justification":"True, any hemodynamic instability is a sign of severity"},{"idx":3,"proposition":"Auscultatory silence","correct":true,"justification":"True, absence of vesicular murmur"},{"idx":4,"proposition":"Disorders of consciousness","correct":true,"justification":"True, like all acute neurological instabilities"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"asthme-immuno-3","context":null,"enonce":"What is the prevalence of rhinitis in France? 🤔","item":"asthme","matiere":"immuno","propositions":[{"idx":0,"proposition":"4% 🥴","correct":false,"justification":"False"},{"idx":1,"proposition":"14% 🤯","correct":false,"justification":"False"},{"idx":2,"proposition":"24% 😱","correct":true},{"idx":3,"proposition":"0.4 % 😬","correct":false,"justification":"False"},{"idx":4,"proposition":"34% 😵","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"fievreaigue-infectio-0","context":null,"enonce":"Regarding acute fever","item":"fievreaigue","matiere":"infectio","propositions":[{"idx":0,"proposition":"Any patient with acute fever is contagious until proven otherwise.","correct":true},{"idx":1,"proposition":"A diastolic BP < 100 mmHg is a sign of severity","correct":false,"justification":"Systolic, not diastolic,"},{"idx":2,"proposition":"Each degree above 37°C increases water loss by 400ml\/d","correct":true},{"idx":3,"proposition":"Fever and chills increase oxygen requirements","correct":true},{"idx":4,"proposition":"Social isolation is an indication for hospitalization for acute fever","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"fievreaigue-infectio-1","context":null,"enonce":"Regarding acute fever","item":"fievreaigue","matiere":"infectio","propositions":[{"idx":0,"proposition":"The core temperature considered normal is ≤ 37.5°C in the morning and ≤ 37.8°C in the evening.","correct":true},{"idx":1,"proposition":"Fever classically refers to a body temperature ≥ 38 ° C in the morning (38.3 ° C in the evening)","correct":true},{"idx":2,"proposition":"The term \"feverish\", imprecise, usually refers to a temperature > 37.5°C and < 36°C","correct":false,"justification":"The term \"feverish\", imprecise, usually refers to a temperature > 37.5°C and < 38°C"},{"idx":3,"proposition":"Rectal temperature measurement is the most used because it is extremely precise","correct":false,"justification":"Rectal intake is no longer used (risk of thermometric ulceration)"},{"idx":4,"proposition":"Fever is a symptom","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"fievreaigue-infectio-2","context":null,"enonce":"Regarding acute fever","item":"fievreaigue","matiere":"infectio","propositions":[{"idx":0,"proposition":"Etiologies are most often infectious","correct":true},{"idx":1,"proposition":"Acute fever especially if associated with dyspnea is a decantant factor of acute coronary syndrome","correct":true},{"idx":2,"proposition":"Pyelonephritis is systematically sought in women especially in the 3rd trimester","correct":true},{"idx":3,"proposition":"Lung, urinary and digestive infections dominate in the elderly","correct":true},{"idx":4,"proposition":"In valve prosthesis wearers, blood cultures are systematic before any antibiotic therapy to look for infectious endocarditis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"fievreaigue-infectio-4","context":null,"enonce":"Faced with a fever without a precise diagnosis, which of these situations are indications for probabilistic antibiotic therapy in emergency?","item":"fievreaigue","matiere":"infectio","propositions":[{"idx":0,"proposition":"Splenectomized patient","correct":true},{"idx":1,"proposition":"Neutropenia < 500\/mm","correct":true},{"idx":2,"proposition":"Purpura fulminans ","correct":true,"justification":"Absolute urgency"},{"idx":3,"proposition":"In the presence of signs of sepsis ","correct":true,"justification":"Absolute urgency"},{"idx":4,"proposition":"A qSOFA score >2","correct":false,"justification":"Indication faux pas"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AMP-gyn-0","context":null,"enonce":"Which of these proposals fall within the definition of an MPA technique?","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"IAC with spouse's sperm","correct":true,"justification":"IAC = artificial insemination"},{"idx":1,"proposition":"AI with donor sperm","correct":true,"justification":"This is the IAD: artificial insemination with donor sperm"},{"idx":2,"proposition":"IVF","correct":true,"justification":"ICSI or IMSI"},{"idx":3,"proposition":"Embryo transfer","correct":true},{"idx":4,"proposition":"Amniocentesis","correct":false,"justification":"Absolutely not\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AMP-gyn-1","context":null,"enonce":"Regarding general information on the GPA:","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"Assisted reproduction procedures allow in vitro conception in particular","correct":true,"justification":"Assisted reproduction (ART) procedures are \"all clinical and biological practices allowing in vitro conception, conservation of gametes, germinal tissues and embryos, embryo transfer and artificial insemination\" (Article 31 of the Bioethics Act of 07\/07\/2011)"},{"idx":1,"proposition":"These techniques have the sole purpose of fighting proven infertility","correct":false},{"idx":2,"proposition":"The pathological nature of infertility must be medically diagnosed before requiring ART","correct":true},{"idx":3,"proposition":"The indication for ART techniques has extended to the field of oncofertility during the decade 2010","correct":true},{"idx":4,"proposition":"The therapeutic management of couples most often begins with a simple induction of ovulation with scheduled sexual intercourse","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AMP-gyn-2","context":null,"enonce":"Among these proposals, which impede embryo insemination or transfer:","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"The death of one of the members of the couple","correct":true},{"idx":1,"proposition":"Too old or too young","correct":true},{"idx":2,"proposition":"Important joint problems","correct":true,"justification":"Especially if cessation of cohabitation, or petition for divorce"},{"idx":3,"proposition":"HIV positive serology","correct":false,"justification":"This is not an obstacle at all, but will require a verification of serology and multidisciplinary care in a specialized center."},{"idx":4,"proposition":"An oral revocation of consent","correct":false,"justification":"The revocation must be in writing\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"AMP-gyn-3","context":null,"enonce":"Regarding the GPA in general:","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"HIV 1 and 2, hepatitis B and C, syphilis should be checked","correct":true},{"idx":1,"proposition":"In case of STIs, MPA techniques are contraindicated","correct":false,"justification":"No, but the care is multidisciplinary and carried out in a specialized center"},{"idx":2,"proposition":"A consultation with a psychiatrist or psychologist must eliminate any contraindications of a psycho-social nature","correct":true},{"idx":3,"proposition":"ART is proposed as a first-line treatment in cases of confirmed infertility in all couples, in France","correct":false,"justification":"The AMP requires an investment of time, effort and emotions. If the couple does not seem to be able to assume this, the ART may not be proposed as a first line"},{"idx":4,"proposition":"Infertility is not managed (considered comfort care)","correct":false,"justification":"100% support. It is not at all a comfort, but a real pathology with psychosocial implications sometimes strong"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AMP-gyn-4","context":null,"enonce":"Regarding the GPA:","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"Intrauterine insemination gives good results only in combination with stimulation of the ovary","correct":true},{"idx":1,"proposition":"Ovulation stimulation is passive and requires no supervision","correct":false,"justification":"Yes, monitoring by hromonal assays + repeated ultrasounds"},{"idx":2,"proposition":"The timing of insemination is one of the essential success factors","correct":true},{"idx":3,"proposition":"Insemination is ideally performed 36 hours after the artificial onset of ovulation, or the day after a spontaneous LH spike","correct":true},{"idx":4,"proposition":"Artificial insemination is concocted whatever the cause of infertility","correct":false,"justification":"The tubes must be permeable and the sperm must be of good quality"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AMP-gyn-5","context":null,"enonce":"Regarding the indications of the IACs:","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"At least 1 million motile sperm must be deposited in insemination","correct":true},{"idx":1,"proposition":"Infertility of cervical origin is a great indication of artificial insemination","correct":true},{"idx":2,"proposition":"Infertility of cervical origin is mainly due to the HPV virus","correct":false,"justification":"Nothing to see: it is due to the asbence of mucus or mucus hostile to the passage or survival of spermatozoa"},{"idx":3,"proposition":"Ejaculatory mascular infertility is an indication for IAC","correct":true},{"idx":4,"proposition":"female permeable tube infertility is an indication for IAC","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"AMP-gyn-7","context":null,"enonce":"Regarding IAD:","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"The first indication of IAD is the sterility of the spouse","correct":true},{"idx":1,"proposition":"The donor may never have procreated","correct":true},{"idx":2,"proposition":"The average pregnancy rate is 17.3% with donor sperm","correct":true},{"idx":3,"proposition":"The result of the IAD depends on the rank of the attempt, including","correct":true,"justification":"That's right"},{"idx":4,"proposition":"Artificial insemination is always associated with ovulation stimulation","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AMP-gyn-8","context":null,"enonce":"Which of the following dosages can be used to assess the follicular ovarian reserve?","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"FSH","correct":true,"justification":"None"},{"idx":1,"proposition":"LH","correct":true,"justification":"None"},{"idx":2,"proposition":"Testosterone","correct":false,"justification":"None"},{"idx":3,"proposition":"WHA","correct":true,"justification":"None"},{"idx":4,"proposition":"DHA","correct":false,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AMP-gyn-9","context":null,"enonce":"What are the particularities of AMH dosing?","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"Not reimbursed","correct":true,"justification":"None"},{"idx":1,"proposition":"Achievable at any point in the cycle ","correct":true,"justification":"None"},{"idx":2,"proposition":"Achievable only in the first part of the cycle ","correct":false,"justification":"None"},{"idx":3,"proposition":"Very reliable ","correct":true,"justification":"None"},{"idx":4,"proposition":"Unreliable","correct":false,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AMP-gyn-10","context":null,"enonce":"What should the FSH assay be coupled with to interpret follicular ovarian reserve?","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"SDHEA assay ","correct":false,"justification":"None"},{"idx":1,"proposition":"AMH determination","correct":false,"justification":"None"},{"idx":2,"proposition":"Determination of estradiol","correct":true,"justification":"Estradiol provides feedback to FSH and may distort its dosage."},{"idx":3,"proposition":"Endovaginal ultrasound","correct":false,"justification":"None"},{"idx":4,"proposition":"Hysteroscopy","correct":false,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ethique-psy-0","context":null,"enonce":"Regarding consent:","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"It must be free","correct":true},{"idx":1,"proposition":"It must be illuminated","correct":true},{"idx":2,"proposition":"He must be re-examined with each new situation","correct":true,"justification":"1 consent = 1 action"},{"idx":3,"proposition":"It cannot be revoked for cost reasons","correct":false,"justification":"Consents are revocable at any time"},{"idx":4,"proposition":"It can be oral","correct":true,"justification":"It can be written as well. When it is oral, the discussion should be mentioned in the medical record. Some cases must be written: \"This written consent concerns acts related to fertility or pregnancy (for example, voluntary termination of pregnancy), acts of removal of tissues, cells and collection of products from the human body, clinical research, examination of genetic characteristics. The law does not require written consent for surgery, but the physician is advised to obtain such consent in writing whenever it is an important decision.\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"ethique-psy-1","context":null,"enonce":"Among these proposals, which are major principles of medical ethics:","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"Malfeasance","correct":false,"justification":"Non-maleficence"},{"idx":1,"proposition":"Non-charity","correct":false,"justification":"Charity"},{"idx":2,"proposition":"Proportionality","correct":true},{"idx":3,"proposition":"Heteronomy","correct":false,"justification":"Autonomy"},{"idx":4,"proposition":"Justice","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"ethique-psy-2","context":null,"enonce":"Among these proposals, which are criteria for brain death:","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"The absence of consciousness","correct":true},{"idx":1,"proposition":"The absence of brainstem reflexes","correct":true},{"idx":2,"proposition":"The absence of patellar reflex","correct":false,"justification":"Peripheral reflex"},{"idx":3,"proposition":"A single EEG showing an absence of brain activity","correct":false,"justification":"It takes two EEGs 4 hours apart to be able to conclude"},{"idx":4,"proposition":"An angiogram showing an absence of brain activity","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"ethique-psy-3","context":null,"enonce":"Concerning the generality of medical ethics","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"A pregnant woman can ask a doctor for an abortion at 24 weeks of amenorrhea","correct":false},{"idx":1,"proposition":"A medical termination of pregnancy after the 12th week requires the authorization of a multidisciplinary diagnostic center which has competence to decide which diseases justify it or not.","correct":true},{"idx":2,"proposition":"Prenatal diagnosis concerns only genetic analyses to verify chromosomal diseases","correct":false},{"idx":3,"proposition":"The absence of all brainstem reflexes is a criterion for brain death","correct":true},{"idx":4,"proposition":"Biomedical intervention research and research on healthy volunteers is governed by the Huriet-Sérusclat law","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"ethique-psy-4","context":null,"enonce":"Regarding the application(s) of medical ethics","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"The Huriet-Sérusclat law implies obtaining the agreement of the HAS","correct":false,"justification":"This law requires the sponsor to take out insurance, to obtain the favorable opinion of a committee for the protection of persons [CPP] and the authorization of the national agency for the safety of medicines and health products [ANSM]"},{"idx":1,"proposition":"No medical procedure may be performed without free and informed consent on the part of the patient, except in cases of emergency.","correct":true},{"idx":2,"proposition":"The physician must respect the wishes of the person who can refuse care","correct":true},{"idx":3,"proposition":"When the person is unable to express his will, no act can be carried out, even in an emergency.","correct":false,"justification":"When the person is unable to express his will, no act can be carried out, except in an emergency, without the person of trust, or the family, or failing that, one of his relatives maintaining close and stable links with the person having been consulted (law of 4 March 2002, known as the Kouchner law)"},{"idx":4,"proposition":"You can test a patient for a serious genetic disease without warning them to avoid scaring them","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ethique-psy-5","context":null,"enonce":"Concerning medical ethics","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"Consent must be free, informed, special and revocable at any time","correct":true},{"idx":1,"proposition":"Legal protection only applies to patients whose mental faculties are impaired","correct":false},{"idx":2,"proposition":"The conditions for deciding to limit active therapies are defined by the Geneva Convention","correct":false},{"idx":3,"proposition":"The Clayes-Leonetti law obliges the doctor to stop treatment if the chances of survival are deemed low by an independent medical committee","correct":false,"justification":"It gives the right to interrupt or not to undertake treatments deemed useless, disproportionate or having no other purpose than the artificial maintenance of life and the possibility of using treatments with the intention of relieving the lady, even if they risk shortening life (principle of double eect)"},{"idx":4,"proposition":"In the event of a decision to limit treatment, the patient or his representatives will be informed and the decisions will be clearly recorded in the medical record.","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ethique-psy-6","context":null,"enonce":"Which of the following are true?","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"The decision to limit treatment is made by the attending physician","correct":false,"justification":"The decision must be taken collectively"},{"idx":1,"proposition":"The word ethics comes etymologically from the Greek ETHOS which means way of being and behaving according to morals","correct":true},{"idx":2,"proposition":"Ethics can be thought of as the science of morality","correct":true},{"idx":3,"proposition":"We can envisage an \"applied ethics\" for each field of human activity, and therefore a \"medical ethics\"","correct":true},{"idx":4,"proposition":"Medical ethics is closely related to bioethics (biomedical ethics), but not identical to it.","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"ethique-psy-7","context":null,"enonce":"Which of the following are true?","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"The first principle of medicine is to do everything for the good of the patient without harming him.","correct":true},{"idx":1,"proposition":"Autonomy consists in saying that everything must be done so that the patient can move autonomously","correct":false,"justification":"Autonomy: The patient is the only one (provided he is in perfect lucidity) to be able to give his opinion and agreement to the treatments that are proposed and explained to him"},{"idx":2,"proposition":"The principle of justice requires us to refer to the court any criminal or penal information issued by the patient","correct":false,"justification":"Justice: all patients must be treated with the same care and respect"},{"idx":3,"proposition":"Voluntary termination of pregnancy (IVG) is an induced abortion, decided for non-medical reasons within the legal framework established by the Veil law of 1975","correct":true},{"idx":4,"proposition":"The law sets at 12 weeks of pregnancy (14 weeks of amenorrhea) the period during which a woman can request an abortion.","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"ethique-psy-8","context":null,"enonce":"Regarding abortion","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"Medical abortion (medical termination of pregnancy, IMG) is possible when the pregnancy endangers the woman's life","correct":true},{"idx":1,"proposition":"The IMG after 12 weeks of pregnancy requires the authorization of multidisciplinary diagnostic centers that have competence to decide which diseases justify it or not (notion of particular seriousness)","correct":true},{"idx":2,"proposition":"The costs of care and hospitalization related to a voluntary termination of pregnancy are covered by the patient or her family","correct":false,"justification":"Covered by social security Care and hospitalization costs related to a voluntary termination of pregnancy are 100% covered by health insurance (for all women since 2014)"},{"idx":3,"proposition":"The consent of the spouse is mandatory for an abortion to be done","correct":false,"justification":"The consent of the spouse must be as far as possible to the maximum sought, but is not mandatory"},{"idx":4,"proposition":"A minor woman may not have an abortion without the consent of her parents or legal guardian.","correct":false,"justification":"A minor woman may have an abortion without the consent of her parents or legal guardian, provided that she is accompanied by an adult.\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"ethique-psy-9","context":null,"enonce":"Concerning abortion, contraception and PND","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"A psycho-social interview, conducted by a marriage counsellor, is offered to any woman who is considering an abortion.","correct":true},{"idx":1,"proposition":"The interview with a marriage counsellor is optional for minors who wish to have an abortion","correct":false,"justification":"It is mandatory for minors"},{"idx":2,"proposition":"There is a conscience clause whereby a doctor can refuse to participate in an abortion.","correct":true},{"idx":3,"proposition":"Contraception is not 100% reimbursed","correct":true},{"idx":4,"proposition":"Ultrasound is not an examination that is part of the prenatal diagnostic process","correct":false,"justification":"This diagnosis can be made non-invasively (ultrasound, analysis of DNA fragments of the fetal placenta contained in small quantities in the maternal blood) or invasive (amniocentesis or choriocentesis with a risk of miscarriage of about 1%) for chromosomal or molecular biology study\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ethique-psy-10","context":null,"enonce":"About PGD and organ donation","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"The main indication for PGD is to prevent couples with or carriers of a rare and serious genetic disease from passing it on to their child.","correct":true},{"idx":1,"proposition":"Pre-implantation diagnosis only concerns couples where both parents are carriers of a genetic problem","correct":false,"justification":"It also applies when one of the partners of a couple is a carrier of a chromosomal abnormality"},{"idx":2,"proposition":"Pre-implantation diagnosis poses in itself a problem of eugenics","correct":true},{"idx":3,"proposition":"The attestation of the irreversible nature of the brain destruction is by a clinical examination only","correct":false,"justification":"Medical ethics ¡ The attestation of the irreversible nature of the brain destruction must be by a paraclinical examination: * either two electroencephalographic (EEG) tracings without activity (isoelectric maximum amplification) for 30 minutes at 4-hour intervals"},{"idx":4,"proposition":"The removal of organs from a person whose death has been duly certified may be carried out if the latter has not made known during his lifetime his refusal of such removal (presumed consent)","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ethique-psy-11","context":null,"enonce":"About organ donation","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"Such refusal may be expressed by any means by any person over 13 years of age, in particular by entry in an automated national register provided for that purpose.","correct":true},{"idx":1,"proposition":"Consent is irrevocable most often","correct":false,"justification":"It is revocable at any time"},{"idx":2,"proposition":"In the case of organ donation, the collection from relatives of the opposition expressed by the deceased during his lifetime must be systematic","correct":true},{"idx":3,"proposition":"The law on the modernization of the health system strengthened the principle of presumed consent as well as the role of the National Register of Refusals (main, but not exclusive, means of expressing refusal) of organ donation","correct":true},{"idx":4,"proposition":"Relatives must be informed of the purpose of the samples taken","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ethique-psy-12","context":null,"enonce":"Concerning living donor specimens","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"The removal of an organ for the purpose of donation to others exposes the donor to risks to his health, he must be clearly and fairly informed","correct":true},{"idx":1,"proposition":"The removal of an organ from a living person, who donates it, can only be carried out in the direct therapeutic interest of a recipient","correct":true},{"idx":2,"proposition":"No organ removal for donation may take place from a living minor or from a living adult subject to a legal protection measure.","correct":true},{"idx":3,"proposition":"No payment in any form may be made to a person who takes parts from his body.","correct":true},{"idx":4,"proposition":"The Agency for Biomedicine must be informed prior to its realization, of any removal of organs for therapeutic purposes from a living person","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"ethique-psy-13","context":null,"enonce":"Concerning biomedical research","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"The CPP gives its opinion orally to the investigator on the conditions of validity of the research","correct":false,"justification":"The committee gives its opinion in writing to the investigator on the conditions of validity of the research, in particular the protection of individuals (information given, methods of obtaining consent, respect for autonomy) more particularly if they are vulnerable and on the general relevance of the project (objectives, means, experimenters)"},{"idx":1,"proposition":"The safeguards imposed and the type of consent vary depending on the level of risk to the patient","correct":true},{"idx":2,"proposition":"The Data Protection Act applies to all research projects that collect patients' personal data.","correct":true},{"idx":3,"proposition":"In the case of collection of digital patient data, research can only start after agreement of the EMA","correct":false,"justification":"The research can only start after authorization from the National Commission for Informatics and Liberties (CNIL), according to variable modalities depending on the complexity of the project and the nature of the data collected"},{"idx":4,"proposition":"Research on human beings must have a general purpose which aims to improve scientific knowledge without the interests of science and society taking precedence over the interests of individuals.","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ethique-psy-14","context":null,"enonce":"Concerning biomedical research","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"Biomedical research is a necessity","correct":true},{"idx":1,"proposition":"The thirst for knowledge or to develop knowledge must not be exercised without limits or precautions.","correct":true},{"idx":2,"proposition":"The rules of scientific validation of an experiment can be exceeded in case of emergency (research on covid19 for example)","correct":false,"justification":"The rules of scientific validation of an experiment must be strictly respected as well as the independence and safety of patients included in the studies"},{"idx":3,"proposition":"No biomedical research may be carried out on human beings if the foreseeable risk to the persons taking part in the research is disproportionate to the expected benefit to those persons or the interest of such research.","correct":true},{"idx":4,"proposition":"Respect for human dignity and human autonomy are core values","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"anemie-hemato-0","context":null,"enonce":"Regarding anemias","item":"anemie","matiere":"hemato","propositions":[{"idx":0,"proposition":"Normal hemoglobin varies with sex (in adults) and age","correct":true},{"idx":1,"proposition":"Clinical anemic syndrome may be latent and only discovered on blood count","correct":true},{"idx":2,"proposition":"Anemia is not a diagnosis but a symptom requiring etiological research","correct":true},{"idx":3,"proposition":"Central anemias show too much elimination of red blood cells produced","correct":false,"justification":"Central anemias testify to an attack on production either by damage to the hematopoitic cell or by damage to its environment"},{"idx":4,"proposition":"All central anemias have one biological sign in common: a reticulocyte count greater than 150 G\/L","correct":false,"justification":"They are aregenerative"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"anemie-hemato-1","context":null,"enonce":"Regarding peripheral anemia, which proposals are true?","item":"anemie","matiere":"hemato","propositions":[{"idx":0,"proposition":"In cases of peripheral anemia, bone marrow production is normal or even increased","correct":true},{"idx":1,"proposition":"These peripheral anemias have in common a biological sign: the high number of reticulocytes, greater than 150 G \/ L","correct":true},{"idx":2,"proposition":"They are called regenerative","correct":true},{"idx":3,"proposition":"Hemolysis induces a decrease in free bilirubin","correct":false,"justification":"Hemolysis induces an increase in free bilirubin reflecting the catabolism of hemoglobin and a low or even collapsed haptoglobin"},{"idx":4,"proposition":"High LDH and serum iron are indirect signs of hemolysis","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"anemie-hemato-2","context":null,"enonce":"Regarding sickle cell disease and thalassemia syndromes:","item":"anemie","matiere":"hemato","propositions":[{"idx":0,"proposition":"Sickle cell disease mainly affects people from South America","correct":false,"justification":"Sickle cell disease mainly affects people from black Africa and is linked to mutation of the beta chain of globin"},{"idx":1,"proposition":"Only sickle cell homozygotes are symptomatic and present with hemolysis from childhood associated with thrombotic manifestations in the form of joint or abdominal pain","correct":true},{"idx":2,"proposition":"Thalassaemic syndromes are characterized by an increase in the production of normal alpha globin chains","correct":false,"justification":"A decrease in normal chains"},{"idx":3,"proposition":"thalassemia syndromes mainly affect subjects around the Mediterranean basin and South-East Asia","correct":true},{"idx":4,"proposition":"The diagnosis of thalassaemic syndrome is based on bone marrow aspiration","correct":false,"justification":"Diagnosis of thalassemia syndrome is based on hemoglobin electrophoresis"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"anemie-hemato-4","context":null,"enonce":"Regarding biermer's anemia","item":"anemie","matiere":"hemato","propositions":[{"idx":0,"proposition":"Biermer's anemia occurs in women most often, it is due to a lack of secretion of intrinsic factor","correct":true},{"idx":1,"proposition":"Biermer's anemia is a common cause of vitamin deficiency","correct":true},{"idx":2,"proposition":"Concurrent diabetes eliminates diagnosis of Biermer's anemia","correct":false,"justification":"It is frequently associated with diseases such as vitiligo, autoimmune thyroiditis, diabetes"},{"idx":3,"proposition":"The picture is very clinically polymorphic, but medullary megaloblastosis is constant","correct":true},{"idx":4,"proposition":"The prognosis is sap even under lifelong vitamin therapy","correct":false,"justification":"Prognosis is benign under lifelong vitamin therapy"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"anemie-hemato-5","context":null,"enonce":"Regarding biermer's anemia","item":"anemie","matiere":"hemato","propositions":[{"idx":0,"proposition":"Without proper treatment, neurological complications are irreversible","correct":true},{"idx":1,"proposition":"Biermer's anemia is accompanied by atrophic glossitis and sensory disturbances in the absorption of hot or spicy dishes","correct":true},{"idx":2,"proposition":"There are no mucosal or skin disorders","correct":false,"justification":"Skin disorders can be observed: dry, flaky skin, brittle nails, hair loss"},{"idx":3,"proposition":"In its advanced form, the neurological picture is that of combined sclerosis of the spinal cord with quadriparesis associated with incontinence","correct":true},{"idx":4,"proposition":"Anemia is microcytic","correct":false,"justification":"It is macrocytic with MCV, usually greater than 110 fl"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SCA-urg-0","context":null,"enonce":"Regarding myocardial markers:","item":"SCA","matiere":"urg","propositions":[{"idx":0,"proposition":"Troponin elevation is non-specific to heart tissue ","correct":false,"justification":"Troponin is a cardiac enzyme released in myocardial necrosis, it is specific to heart tissue and is therefore not elevated by other muscle damage."},{"idx":1,"proposition":"During a myocardial infarction, troponin rises about 3 hours after the onset of chest pain.","correct":true},{"idx":2,"proposition":"Myoglobin is a myocardial marker whose elevation persists up to 15 days","correct":false,"justification":"Myoglobin is an early marker that rises in about 2 hours, peaks between 8 and 12 hours and normalizes between 24 and 36 hours."},{"idx":3,"proposition":"LDL is one of the myocardial markers that rises during an ACS","correct":false,"justification":"It is the LDH (LDH1 +++) that will have an elevation (peak in 3-4 days) and normalization in 6 days"},{"idx":4,"proposition":"Myocardial markers are essential for the diagnosis of SCA ST+","correct":false,"justification":"The diagnosis is established by the clinic (prolonged chest pain > 30 minutes) coupled with the ECG"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SCA-urg-1","context":null,"enonce":"Regarding myocardial infarction:","item":"SCA","matiere":"urg","propositions":[{"idx":0,"proposition":"ST myocardial infarction is a reflection of transmural myocardial involvement","correct":false,"justification":"NSTEMI = subendocardial infarction"},{"idx":1,"proposition":"STEMI occurs during total occlusion of a coronary artery  ","correct":true,"justification":"STEMI = SCA ST+ = total occlusion by rupture of atheromatous plaque most often"},{"idx":2,"proposition":"On ECG, a Q wave of necrosis directs us to transmural myocardial involvement ","correct":true},{"idx":3,"proposition":"The critical oral ECG should be obtained less than 10 minutes after the first medical contact when the patient presents to an emergency department","correct":true},{"idx":4,"proposition":"The presence of a ST segment shift is pathognomonic of a STEMI","correct":false,"justification":"An ST segment elevation can be found in various pathologies: SCA ST +, pericarditis, Brugada syndrome, aortic dissection, Prinzmetal's angina, left ventricle aneurysm, early repolarization, BBG"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"hernie-HGE-0","context":null,"enonce":"Concerning parietal herenia","item":"hernie","matiere":"HGE","propositions":[{"idx":0,"proposition":"A parietal hernia occurs when a peritoneal sac crosses the transverse fascia.","correct":true},{"idx":1,"proposition":"Congenital hernias account for more than 55% of hernias in children","correct":false,"justification":"Congenital hernias account for more than 95% of hernias in children"},{"idx":2,"proposition":"There is a swelling of the inguinal region appearing at prolonged standing during an inguinal henrni","correct":true},{"idx":3,"proposition":"The examination should be carried out lying down, without then with pushing efforts, then standing","correct":true},{"idx":4,"proposition":"The review is unilateral","correct":false,"justification":"It must be bilateral"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"hernie-HGE-1","context":null,"enonce":"Concerning parietal herenia","item":"hernie","matiere":"HGE","propositions":[{"idx":0,"proposition":"The diagnosis of uncomplicated groin hernia is clinical by palpation of painless, impulsive and expansive cough swelling","correct":true},{"idx":1,"proposition":"Among the risk factors for hernia have found chronic obstructive pulmonary disease, chronic cough, constipation, dysuria","correct":true},{"idx":2,"proposition":"In case of direct hernia, the hernia is reduced by a direct antero-posterior path, and the beats of the epigastric vessels are perceived outside","correct":true},{"idx":3,"proposition":"Coral hernia accounts for 30% of groin hernias","correct":false,"justification":"Coral hernia • 10% of groin hernias"},{"idx":4,"proposition":"Coral herenia almost always occurs in humans","correct":false,"justification":"Almost always in women"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hernie-HGE-2","context":null,"enonce":"Regarding parietal hernia","item":"hernie","matiere":"HGE","propositions":[{"idx":0,"proposition":"Lipoma and inguinal lymphadenopathy are other causes of inguinal swelling but unlike unstrangulated hernias are irreducible","correct":true},{"idx":1,"proposition":"Eventration is a parietal complication following a wound, most often of surgical origin","correct":true},{"idx":2,"proposition":"Transillumination and non-reducible character allow differential diagnosis between hydrocele and internal oblique hernia","correct":false,"justification":"Transillumination and non-reducible character allow the differential diagnosis between hydrocele and external inguinal hernia"},{"idx":3,"proposition":"All hernias can be complicated by strangulation","correct":true},{"idx":4,"proposition":"Strangulation is more common in coral hernia than in inguinal hernia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hernie-HGE-3","context":null,"enonce":"Concerning parietal herenia","item":"hernie","matiere":"HGE","propositions":[{"idx":0,"proposition":"It is a common pathology with about 150,000 cases per year in France","correct":true},{"idx":1,"proposition":"The treatment of hernias is surgical and most often performed on an outpatient basis","correct":true},{"idx":2,"proposition":"Due to the risk of high strangulation, crural hernias must all be operated on.","correct":true},{"idx":3,"proposition":"Incinquinal herenia in a child less than 6 years younger is a formal indcation to surgery","correct":false,"justification":"e in a child over 6 months of age."},{"idx":4,"proposition":"In case of asymptomatic inguinal hernia the risk of strangulation is extremely low","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"hernie-HGE-4","context":null,"enonce":"Which of the following is needed to confirm the diagnosis of a hernia of the groin?","item":"hernie","matiere":"HGE","propositions":[{"idx":0,"proposition":"An abdominopelvic ultrasound","correct":false,"justification":"Clinical diagnosis"},{"idx":1,"proposition":"An abdominopelvic CT scan with injection of contrast medium (after checking for contraindications, including renal)","correct":false,"justification":"Clinical diagnosis"},{"idx":2,"proposition":"A pelvic MRI","correct":false,"justification":"Clinical diagnosis"},{"idx":3,"proposition":"An unprepared abdomen (ASP)","correct":false,"justification":"Clinical diagnosis"},{"idx":4,"proposition":"None of these proposals","correct":true,"justification":"True, the diagnosis is purely clinical"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hernie-HGE-5","context":null,"enonce":"Which of the following are true?","item":"hernie","matiere":"HGE","propositions":[{"idx":0,"proposition":"Irritation on the path of the spermatic cord is classic of an inguinal hernia","correct":true,"justification":"True. In addition, coral hernia is very rare (90% of hernias are inguinal) and affects 10 women for 1 man"},{"idx":1,"proposition":"Coral hernia is more common in men than in women","correct":false,"justification":"10 times more in women"},{"idx":2,"proposition":"It is an impulsive cough injury when not strangled.","correct":true},{"idx":3,"proposition":"A reducible lesion has no indication for surgery","correct":false,"justification":"Coral hernia = surgery in all cases. Painful inguinal hernia\/child over 6 months = surgery."},{"idx":4,"proposition":"Hernias are always congenital","correct":false,"justification":"They can be acquired (coral hernia in elderly women)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PNO-urg-0","context":null,"enonce":"Concerning pneumothorax or PNO","item":"PNO","matiere":"urg","propositions":[{"idx":0,"proposition":"Pneumothorax (PNO) is defined by the presence of air in the pleural space","correct":true},{"idx":1,"proposition":"• PNO can be spontaneous or traumatic","correct":true},{"idx":2,"proposition":"Spontaneous PNO in young people affects women more frequently than hommzq","correct":false},{"idx":3,"proposition":"Slender morphotype and smoking are risk factors for spontaneous PNO","correct":true},{"idx":4,"proposition":"The entry of air into the pleural space via the visceral pleura results either from the rupture of peripheral alveoli, blebs, or emphysema bubbles","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"PNO-urg-1","context":null,"enonce":"Which propositions are true","item":"PNO","matiere":"urg","propositions":[{"idx":0,"proposition":"Traumatic PNOs are iatrogenic or caused by penetrating or non-penetrating chest trauma","correct":true},{"idx":1,"proposition":"Chest pain: pleural type, constant, sometimes violent in \"stabbing\", to type of side stitch, inhibiting breathing, radiating to the shoulder, unilateral supsected a pneumothorax","correct":true},{"idx":2,"proposition":"Pain most often occurs at rest","correct":false,"justification":"It most often occurs at rest"},{"idx":3,"proposition":"– Dyspnea is often associated, of varying intensity depending on the terrainA dry cough of pleural origin is common","correct":true},{"idx":4,"proposition":"– On physical examination: tympanism, abolition of vocal vibrations, decrease or disappearance of vesicular murmur on the side of the PNO","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PNO-urg-2","context":null,"enonce":"About pneumothorax","item":"PNO","matiere":"urg","propositions":[{"idx":0,"proposition":"• X-ray Chest X-ray (RT) is the key examination","correct":true},{"idx":1,"proposition":"RT makes it possible to visualize a bordering line or pleural line delimiting the pulmonary parenchyma, sometimes reduced to a stump","correct":true},{"idx":2,"proposition":"• RT makes it possible to highlight signs of compression: contralateral displacement of the mediastinum","correct":true},{"idx":3,"proposition":"A complete detachment corresponds to the complete detachment corresponds to the detachment of the lung over its entire hatuer","correct":true},{"idx":4,"proposition":"• The RT in forced expiration (which aims to aggravate the PNO) is to be requested only in a second step, when the PNO is not visible on the radiograph in standard inspiration","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"PNO-urg-3","context":null,"enonce":"About pneumothorax","item":"PNO","matiere":"urg","propositions":[{"idx":0,"proposition":"Chest drainage is necessary in the first instance in case of underlying pulmonary pathology","correct":true},{"idx":1,"proposition":"The risk of homolateral recurrence is 15%","correct":false,"justification":"It is 30%"},{"idx":2,"proposition":"It is necessary to inform the patient about the need to consult urgently in case of a new painful episode","correct":true},{"idx":3,"proposition":"It is necessary to prevent the effors glottis closed","correct":true},{"idx":4,"proposition":"During a first episode of spontaneous PNO pleural symphysis is indicated if bubbling persists beyond 14 days","correct":false,"justification":"4 days"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"agitation-urg-0","context":null,"enonce":"Which of the following are possible etiologies of agitation or delirium?","item":"agitation","matiere":"urg","propositions":[{"idx":0,"proposition":"Hypoglycaemia","correct":true},{"idx":1,"proposition":"Hypoparathyroidism","correct":false,"justification":"Hyperparathyroidism can cause agitation. Hypothyroidism, on the contrary, can cause symptoms mimicking sadness."},{"idx":2,"proposition":"Subdural hematoma","correct":true,"justification":"True, as well as stroke or meningitis 🧠"},{"idx":3,"proposition":"Sepsis","correct":true},{"idx":4,"proposition":"Hypocorticism","correct":false,"justification":"Rather hypercorticism"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"agitation-urg-1","context":null,"enonce":"From what time frame is a delirium no longer considered acute?","item":"agitation","matiere":"urg","propositions":[{"idx":0,"proposition":"5 days","correct":false,"justification":"1 month"},{"idx":1,"proposition":"1 week","correct":false,"justification":"1 month"},{"idx":2,"proposition":"1 month","correct":true},{"idx":3,"proposition":"6 weeks","correct":false,"justification":"1 month"},{"idx":4,"proposition":"Three months","correct":false,"justification":"1 month"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"agitation-urg-2","context":null,"enonce":"Which of the following are true?","item":"agitation","matiere":"urg","propositions":[{"idx":0,"proposition":"Agitation accounts for 10-15% of emergency room visits","correct":true,"justification":"True. often via the entourage 👨 👩 👧 or the police. 🚔"},{"idx":1,"proposition":"Agitation is defined by excessive, often unproductive and stereotyped motor activity related to internal tension.","correct":true},{"idx":2,"proposition":"The biological 🩸 assessment is systematic","correct":true,"justification":"True. NFS-P, BES, Calcemia, Blood glucose, CRP."},{"idx":3,"proposition":"This is an emergency 🚨, which must be hospitalized 🏥 ","correct":true,"justification":"True, under duress if necessary"},{"idx":4,"proposition":"All propositions are true","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IBP-infectio-0","context":null,"enonce":"Regarding acute bronchitis","item":"IBP","matiere":"infectio","propositions":[{"idx":0,"proposition":"Acute bronchitis is the most common lower airway infection: several million\/year in France","correct":true},{"idx":1,"proposition":"It is a viral infection in almost all cases","correct":true},{"idx":2,"proposition":"An upper airway infection may precede the symptomatology (rhinitis, pharyngitis)","correct":true},{"idx":3,"proposition":"The secondarily purulent character of sputum is a sign of bacterial superinfection","correct":false},{"idx":4,"proposition":"The chest X-ray should be performed systematically","correct":false,"justification":"No additional examination is justified to make the positive or etiological diagnosis 4"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"IBP-infectio-1","context":null,"enonce":"Regarding respiratory infections","item":"IBP","matiere":"infectio","propositions":[{"idx":0,"proposition":"The course is favorable spontaneously and no antibiotic therapy is indicated in acute bronchitis","correct":true},{"idx":1,"proposition":"The lack of improvement should reconsider the diagnosis of simple acute bronchitis","correct":true},{"idx":2,"proposition":"Tobacco is the most common cause of COPD","correct":true},{"idx":3,"proposition":"The clinic and the parameters of pulmonary function tests allow to classify COPD into 6 stages","correct":false,"justification":"The clinic and the parameters of the pulmonary function tests allow to classify COPD into 4 stages (classification of the Global Initiative for Chronic Obstructive Lung Disease (GOLD)"},{"idx":4,"proposition":"The exacerbation of COPD corresponds to the increase in dyspnea, cough, sputum volume and \/ or purulence","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IBP-infectio-2","context":null,"enonce":"Regarding COPD exacerbation","item":"IBP","matiere":"infectio","propositions":[{"idx":0,"proposition":"Frankish greenish purulence of sputum is in favor of a bacterial origin","correct":true},{"idx":1,"proposition":"Exacerbations are infectious in 50% of cases","correct":true},{"idx":2,"proposition":"The risk of this exacerbation is severe acute respiratory failure","correct":true},{"idx":3,"proposition":"Cough suppressants moderate exacerbation of COPD","correct":false,"justification":"Contraindication of cough suppressants"},{"idx":4,"proposition":"Reassessment of antibiotic therapy if initiated is essential at 48-72 h","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IBP-infectio-3","context":null,"enonce":"Concerning community-acquired acute pneumonia (CAP)","item":"IBP","matiere":"infectio","propositions":[{"idx":0,"proposition":"Community = acquired in an out-of-hospital setting (\"city\") or occurring less than 48 hours after admission","correct":true},{"idx":1,"proposition":"Auscultation finds a condensation syndrome (crackling, tubal murmur)","correct":true},{"idx":2,"proposition":"Main risk factors: smoking, age > 65 years, comorbidities","correct":true},{"idx":3,"proposition":"The terrain is the essential element of the prognosis","correct":true},{"idx":4,"proposition":"Case fatality averages 15%","correct":false,"justification":"Lethality: average 5%"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IBP-pneumo-0","context":null,"enonce":"Regarding acute bronchitis","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Community-acquired lower respiratory infections (BRIs) in adults include three entities: acute bronchitis, acute exacerbation of chronic obstructive pulmonary disease (COPD), and acute community-acquired pneumonia (CABG).","correct":true},{"idx":1,"proposition":"Viral cause in 90% of cases","correct":true},{"idx":2,"proposition":"The diagnosis is clinical","correct":true},{"idx":3,"proposition":"No further examination is warranted","correct":true},{"idx":4,"proposition":"The absence of antibiotic therapy is the rule in healthy adults","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-1","context":null,"enonce":"Regarding respiratory infections","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The evolution is spontaneously favorable with disappearance of fever in 3 days and respiratory signs in about ten days in acute bronchitis","correct":true},{"idx":1,"proposition":"1 An infection is community-acquired if it is acquired outside a hospital facility or occurs within the first 48 hours of admission to hospital.","correct":true},{"idx":2,"proposition":"Chest ultrasound may help diagnose pleural effusion associated with acute community-acquired pneumonia","correct":true},{"idx":3,"proposition":"The search for soluble urinary antigens (legionella & pneumococcus) is not decapitated by prior antibiotic therapy","correct":true},{"idx":4,"proposition":"Microbiological investigations should not delay antibiotic therapy in cases of acute community-acquired pneumonia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IBP-pneumo-2","context":null,"enonce":"Concerning acute community-acquired pneumonia","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The CRB 60 score is a useful score for the diagnosis of acute community-acquired pneumonia","correct":false},{"idx":1,"proposition":"Streptococcus pneumoniae is the most frequently isolated pathogen in CABG patients","correct":true},{"idx":2,"proposition":"Streptococcus pneumoniae and Legionnella pneumoniae are the 2 agents most frequently responsible for serious PAC in intensive care","correct":true},{"idx":3,"proposition":"Legionella antigenuria is an examination of good sensitivity and specificity","correct":true},{"idx":4,"proposition":"These infections are sometimes complicated by a pleural effusion that will have to be punctured to specify whether it is an aseptic parapneumonic effusion (reactive) or purulent pleurisy","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbauditif-ORL-0","context":null,"enonce":"Which propositions are true?","item":"tbauditif","matiere":"ORL","propositions":[{"idx":0,"proposition":"Genetic causes are very common","correct":true},{"idx":1,"proposition":"The best way to limit the impact on the communication of deafness is to make early diagnosis","correct":true},{"idx":2,"proposition":"Deafness screening is done if there is a family history only","correct":false,"justification":"It is systematic"},{"idx":3,"proposition":"Infant hearing loss is diagnosed in a few minutes","correct":false,"justification":"Long process with objective tests (PEA)"},{"idx":4,"proposition":"Chronic ear infections can cause deafness in children or adolescents","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbauditif-ORL-1","context":null,"enonce":"Which propositions are true?","item":"tbauditif","matiere":"ORL","propositions":[{"idx":0,"proposition":"The outer ear consists of the pinna and the external auditory canal","correct":true},{"idx":1,"proposition":"In the absence of the tympanossicular system, about 5 decibels are lost.","correct":false,"justification":"50 to 55 dB loss"},{"idx":2,"proposition":"Pathology of the outer ear can give conductive hearing loss","correct":true},{"idx":3,"proposition":"A pathology of the middle ear will give conductive hearing loss","correct":true},{"idx":4,"proposition":"Hearing loss is mild or moderate hearing loss","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tbauditif-ORL-2","context":null,"enonce":"Which of the following are for mild hearing loss?","item":"tbauditif","matiere":"ORL","propositions":[{"idx":0,"proposition":"-15 dB","correct":false,"justification":"Between 0 and -20 dB: normal or subnormal hearing"},{"idx":1,"proposition":"-25 dB","correct":true},{"idx":2,"proposition":"-35 dB","correct":true,"justification":"True, between -20 and -40 dB: slight loss"},{"idx":3,"proposition":"-55 dB","correct":false,"justification":"Between -40 and -70 dB: average loss"},{"idx":4,"proposition":"-75 dB","correct":false,"justification":"Between -70 and -90 dB: severe loss"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbauditif-ORL-3","context":null,"enonce":"At what threshold of auditory stimulation can we speak of 'supraliminal stimulation'?","item":"tbauditif","matiere":"ORL","propositions":[{"idx":0,"proposition":"20 dB","correct":false,"justification":"False"},{"idx":1,"proposition":"40 dB","correct":false,"justification":"False"},{"idx":2,"proposition":"60 dB","correct":false,"justification":"False"},{"idx":3,"proposition":"80 dB","correct":true,"justification":"True. It makes it possible to collect the stapedial reflex"},{"idx":4,"proposition":"100 dB","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"tbauditif-ORL-4","context":null,"enonce":"Which of the following corresponds to average hearing loss?","item":"tbauditif","matiere":"ORL","propositions":[{"idx":0,"proposition":"-15 dB","correct":false,"justification":"Between 0 and -20 dB: normal or subnormal hearing"},{"idx":1,"proposition":"-25 dB","correct":false,"justification":"Between -20 and -40 dB: slight loss"},{"idx":2,"proposition":"-35 dB","correct":false,"justification":"Between -20 and -40 dB: slight loss"},{"idx":3,"proposition":"-55 dB","correct":true,"justification":"True. Between -40 and -70 dB: average loss"},{"idx":4,"proposition":"-75 dB","correct":false,"justification":"Between -70 and -90 dB: severe loss"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tbauditif-ORL-5","context":null,"enonce":"Which of the following is severe hearing loss?","item":"tbauditif","matiere":"ORL","propositions":[{"idx":0,"proposition":"-95 dB","correct":false,"justification":"If loss greater than 90 dB: deep loss"},{"idx":1,"proposition":"-25 dB","correct":false,"justification":"Between -20 and -40 dB: slight loss"},{"idx":2,"proposition":"-35 dB","correct":false,"justification":"Between -20 and -40 dB: slight loss"},{"idx":3,"proposition":"-55 dB","correct":false,"justification":"Between -40 and -70 dB: average loss"},{"idx":4,"proposition":"-75 dB","correct":true,"justification":"True. Between -70 and -90 dB: severe loss"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"risquesfoetaux-infectio-0","context":null,"enonce":"Regarding the epidemiology of MFIs:","item":"risquesfoetaux","matiere":"infectio","propositions":[{"idx":0,"proposition":"In France, the incidence of Streptococcus B infection is 0.23 per 1000 pregnancies","correct":true},{"idx":1,"proposition":"In France, the prevalence of toxoplasome, per 10000 birthsm, is 3","correct":true},{"idx":2,"proposition":"Less than 20% of CMV infections are symptomatic","correct":true},{"idx":3,"proposition":"Congenital toxoplasmosis is linked to primary infection during the first days of life","correct":false,"justification":"TOXOPLASMOSIS Congenital toxoplasmosis ƒƒ Linked to primary maternal infection during pregnancy"},{"idx":4,"proposition":"In France, the seroprevalence of toxoplasmosis in pregnant women is 1%","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"risquesfoetaux-infectio-1","context":null,"enonce":"Regarding toxoplasmosis:","item":"risquesfoetaux","matiere":"infectio","propositions":[{"idx":0,"proposition":"The risk of transmission increases with the term while the severity decreases with the term","correct":true},{"idx":1,"proposition":"The serology of toxoplasmosis is systematic in the 1st trimester","correct":true},{"idx":2,"proposition":"There is no hygiene rule, apart from the eviction of cats, which exists to prevent the risk of toxoplasmosis","correct":false},{"idx":3,"proposition":"In immune women, serology should be re-monitored in the third trimester","correct":false,"justification":"Immune woman: no supervision or precautions"},{"idx":4,"proposition":"In case of confirmed primary infection, treatment is done with metronidazole and follow-up by the general practitioner","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"risquesfoetaux-infectio-2","context":null,"enonce":"Regarding malaria in pregnancy:","item":"risquesfoetaux","matiere":"infectio","propositions":[{"idx":0,"proposition":"Malaria during pregnancy can lead to abortion","correct":true},{"idx":1,"proposition":"In pregnant women, uncomplicated P. Falciparum malaria indicates hospitalization","correct":true},{"idx":2,"proposition":"In the first trimester, uncomplicated access to P. Falciparum can be treated with quinine","correct":true},{"idx":3,"proposition":"From the second trimester, in case of uncomplicated malaria attacks of Falciparum, atovaquone-proguanil should be preferred","correct":false,"justification":"From the second trimester, artemether-lumefantrine should be preferred"},{"idx":4,"proposition":"Pregnant women should be advised to avoid travel to malaria-endemic areas","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"risquesfoetaux-infectio-3","context":null,"enonce":"Regarding rubella infection during pregnancy:","item":"risquesfoetaux","matiere":"infectio","propositions":[{"idx":0,"proposition":"Primary rubella infection in the first trimester is teratogenic","correct":true},{"idx":1,"proposition":"Vaccination is recommended for infants","correct":false,"justification":"General population: mandatory immunization for infants of both sexes (MMR)"},{"idx":2,"proposition":"If serology is negative, vaccination is indicated in newly pregnant women","correct":false},{"idx":3,"proposition":"Performing rubella serology is mandatory in the 1st trimester of pregnancy","correct":false},{"idx":4,"proposition":"In non-immune women, serological control at 20 SA is indicated","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"risquesfoetaux-infectio-4","context":null,"enonce":"Regarding maternal-fetal infections (MFIs):","item":"risquesfoetaux","matiere":"infectio","propositions":[{"idx":0,"proposition":"Some infections in pregnant women can be transmitted to the fetus and are called maternal-fetal infections.","correct":true},{"idx":1,"proposition":"Most of the time, it is impossible to prevent maternal-fetal infections","correct":false,"justification":"These infections and their impact on the fetus and newborn can be prevented through prevention, monitoring and treatment."},{"idx":2,"proposition":"Prevention involves routine screening of pregnant women for toxoplasmosis, rubella, syphilis and HIV","correct":true},{"idx":3,"proposition":"Prevention involves routine screening of pregnant women for toxoplasmosis, rubella, syphilis and HIV","correct":true},{"idx":4,"proposition":"Maternal-fetal infections (MFIs) result from vertical transmission from mother to fetus","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"risquesfoetaux-infectio-5","context":null,"enonce":"Regarding maternal-fetal infections (MFIs):","item":"risquesfoetaux","matiere":"infectio","propositions":[{"idx":0,"proposition":"The impact on the fetus depends only on the type of infection","correct":false,"justification":"These infections have a more or less important impact on the fetus or newborn depending on the gestational age at which the infection occurs."},{"idx":1,"proposition":"Infections that cause miscarriage attack embryonic tissue","correct":false,"justification":"In a non-specific way, any infection leading to fever may be responsible for a spontaneous miscarriage, especially in early pregnancy, even if it did not directly affect the embryonic tissue."},{"idx":2,"proposition":"MFIs are viral in nature only","correct":false,"justification":"MFIs are protozoan (toxoplasmosis, malaria), viral (rubella, cytomegalovirus (CMV), herpes simplex virus (HSV), chickenpox, HIV, HBV, parvovirus B19, Zika), or bacterial (listeriosis, streptococcus B, syphilis, Q fever)"},{"idx":3,"proposition":"MFIs contaminate offspring only by hematogenous route","correct":false,"justification":"The mechanism of contamination is then by ascending route (HSV, streptococcus B) or by hematogenous route (rubella, CMV, chickenpox, HIV, parvovirus B19, listeriosis, syphilis, Q fever, toxoplasmosis) before birth"},{"idx":4,"proposition":"Contamination during childbirth concerns in particular bacteria of the vaginal commensal flora","correct":true,"justification":"Keep in mind that contamination during childbirth also concerns hematogenous bacteria such as hepatitis B, HSV, streptococcus B, HIV"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"risquesfoetaux-infectio-6","context":null,"enonce":"Which of these proposals are possible consequences of MFIs?","item":"risquesfoetaux","matiere":"infectio","propositions":[{"idx":0,"proposition":"Spontaneous healing","correct":true},{"idx":1,"proposition":"The death of the fetus","correct":true},{"idx":2,"proposition":"Embryopathy","correct":true},{"idx":3,"proposition":"Neonatal death","correct":true},{"idx":4,"proposition":"Microcephaly","correct":true,"justification":"All these proposals are fair"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tetanos-infectio-0","context":null,"enonce":"About tetanus","item":"tetanos","matiere":"infectio","propositions":[{"idx":0,"proposition":"ƒƒ Severe toxi-infection with a lethality of 30%","correct":true},{"idx":1,"proposition":"ƒƒ Prevention is based on vaccination and administration of human-specific immunoglobulins","correct":true},{"idx":2,"proposition":"ƒƒ Indications for vaccine and immunoglobulins depend on tetanus vaccination status is routine","correct":false},{"idx":3,"proposition":"1 Basics to understand ƒƒ Tetanus is a serious acute toxi-infection due to CloThe tetanus germ is clostridium tetani, strict aerobic bacillus Gram positive, telluric","correct":true,"justification":"Strict anaerobic"},{"idx":4,"proposition":"ƒƒ The neurotoxin induces muscle spasms, predominant in the jaw initially (trismus not painful, without fever), then generalized","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tetanos-infectio-1","context":null,"enonce":"About tetanus","item":"tetanos","matiere":"infectio","propositions":[{"idx":0,"proposition":"The association of a non-febrile trismus after a soiled wound (rusty nail, etc ...) should make the disease considered and prescribe vaccination and serotherapy (immunoglobulins specific for tetanus toxin) immediately without waiting for biological confirmation","correct":true},{"idx":1,"proposition":"ƒƒ Non-immunizing disease (–> need to vaccinate patients at the end) and non-contagious disease (no additional precautions)","correct":true},{"idx":2,"proposition":"ƒƒ Contamination by tetanus spores following mucocutaneous intrusion in an unvaccinated or poorly vaccinated subject","correct":true},{"idx":3,"proposition":"Only generalized tetanus is reportable","correct":true},{"idx":4,"proposition":"Trismus corresponds to a generalized tetanus excluding a pure cephalic form on local wound (localized tetanus = single limb or pure cephalic tenanos)","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tetanos-infectio-2","context":null,"enonce":"About tetanus","item":"tetanos","matiere":"infectio","propositions":[{"idx":0,"proposition":"In a person up to date with his vaccinations with a wound of major gravity it is necessary to administer, in a low dose of vaccine and in the other arm immunoglobulin","correct":false,"justification":"It is the in the person not up to date in his vaccinations with a major wound"},{"idx":1,"proposition":"In a person who is not up to date with a minor wound a dose of vaccine should be administered immediately","correct":true},{"idx":2,"proposition":"Wound treatment consite in trimming, disinfection and dressing","correct":false,"justification":"Never sutuer or put a thought on the wound"},{"idx":3,"proposition":"Tetanos has become rare in Europe","correct":true},{"idx":4,"proposition":"Neonatal tetanus causes 150,000 deaths per year in non-developed countries","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"FA-cardio-0","context":null,"enonce":"Concerning the","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"AF is an irregular tachycardia of supraventricular origin, anarchic at the level of the atria with preservation of their hemodynamic efficiency","correct":false,"justification":"Atrial fibrillation (according to international nomenclature) or \"auricular\" or AF is an irregular tachycardia (arrhythmia), of supraventricular origin, due to rapid electrical activity (400–600\/min) anarchic of the atria with loss of their hemodynamic efficiency"},{"idx":1,"proposition":"In principle, AF is when the duration of the episode is greater than 30 seconds","correct":true},{"idx":2,"proposition":"It is the most common rhythm disorder ","correct":true},{"idx":3,"proposition":"AF is responsible for one-sixth of all strokes by cerebral embolism","correct":true},{"idx":4,"proposition":"AF may follow or be associated with typical or atypical atrial flutter.","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"FA-cardio-1","context":null,"enonce":"About AM","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Heart rate in AF depends on the effectiveness of filtering the beam of His","correct":false,"justification":"The bundle of His does not filter. It is the AV node that has this role"},{"idx":1,"proposition":"Cardioversion or AF reduction are the medical actions that restore sinus rhythm.","correct":true},{"idx":2,"proposition":"AF is said to be isolated when it is without underlying heart disease","correct":true},{"idx":3,"proposition":"AF is often revealed by a complication (stroke, heart failure flare-up)","correct":true},{"idx":4,"proposition":"It is often necessary to use ECG monitoring to make the diagnosis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"FA-cardio-2","context":null,"enonce":"About AM","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Cardiac auscultation regains regular heart sounds and a more or less rapid rhythm","correct":false,"justification":"Heart sounds are irregular"},{"idx":1,"proposition":"Initial management should assess AF tolerance","correct":true},{"idx":2,"proposition":"The diagnosis of AF can only be confirmed on an ECG trace documenting it (ECG, Holter or monitoring)","correct":true},{"idx":3,"proposition":"AF with slow and regular QRS is indicative of an associated second-degree Mobitz 2 atrioventricular block","correct":false,"justification":"AF with slow and regular QRS: in this case there is an association between AF and complete atrioventricular block"},{"idx":4,"proposition":"The etiological assessment should include an ECG and an ETT only","correct":false,"justification":"As well as a standard laboratory workup and chest X-ray"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"FA-cardio-3","context":null,"enonce":"About AM","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Objectifying paroxysmal AF may be impossible despite the use of Holter's method","correct":true},{"idx":1,"proposition":"Cardioversion is done by Flecaine as a first-line treatment in most cases","correct":true},{"idx":2,"proposition":"Cardioversion is done urgently and in first line in front of a paroxysmal AF","correct":false,"justification":"It must be ensured that there are no thrombus in the OG. Often, a period of anticoagulation is required"},{"idx":3,"proposition":"After reduction of persistent AF, maintenance of sinus rhythm is ensured by digoxin","correct":false,"justification":"Maintenance of sinus rhythm is provided by amiodarone"},{"idx":4,"proposition":"In case of retroversion failure, AF is adhered to with frequency control by calcium channel blockers","correct":false,"justification":"In case of failure, AF is respected with frequency control by beta-blockers"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"FA-cardio-4","context":null,"enonce":"About AM","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"The embolic risk is high, justifying long-term VKA in all cases in AF on valvular pathology","correct":true},{"idx":1,"proposition":"Cardioversion should be preceded by three weeks (usually four weeks) of effective anticoagulation documented by weekly INRs","correct":true,"justification":"It is followed by 4 weeks of effective anticoagulation most often"},{"idx":2,"proposition":"This rule can be circumvented in case of prior ETT or if the onset of FMD is perfectly datable and less than 24–48 hours","correct":false,"justification":"This rule can be circumvented in case of prior ETO or if the onset of FMD is perfectly datable and less than 24–48 hours (which is rarely possible)"},{"idx":3,"proposition":"The elements of CHADS2VASC are used to assess the need for anticoagulation of AF","correct":true},{"idx":4,"proposition":"The assessment of this risk determines the acute prescription of oral anticoagulants","correct":false,"justification":"The assessment of this risk determines the long-term prescription of anticoagulants: • • if low risk, no anticoagulant; if very high risk (AF valvular) or high CHADS2 score > 1, then indicated anticoagulants; • if intermediate risk (CHADS2 = 0 or 1), then discussion on a case-by-case basis by weighing the benefit\/risk ratio"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"FA-cardio-5","context":null,"enonce":"About AM","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Prevention of thromboembolic risk is mandatory in case of persistent AF","correct":true},{"idx":1,"proposition":"Cardioversion is immediate in case of persistent AF","correct":false,"justification":"Place of cardioversion: • it should be immediate by electric shock only in case of vital emergency (shock)"},{"idx":2,"proposition":"cardioversion is delayed after three weeks of effective oral anticoagulation","correct":true,"justification":"3 to 4 weeks before. 3 to 4 weeks later"},{"idx":3,"proposition":"It is performed by electric shock under general anesthesia or by antiarrhythmic drugs (amiodarone) or both actions combined.","correct":true},{"idx":4,"proposition":"If it is a first episode, no long-term chronic antiarrhythmic treatment once sinus rhythm is restored","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"FA-cardio-6","context":null,"enonce":"About AM","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"The effectiveness of VKAs is monitored by INR, their antidotes are vitamin K dependent factors (II, VII, IX and X) as well as vitamin K","correct":true},{"idx":1,"proposition":"The effectiveness of new oral anticoagulants is monitored by INR","correct":false,"justification":"Monitoring is clinical. There are no specific antidotes."},{"idx":2,"proposition":"The most recommended VKA for prescription is fluindione","correct":false,"justification":"Fluidione is no longer recommended as an initial prescription. Coumadin\/warfarin is the most recommended molecule."},{"idx":3,"proposition":"Dabigatran and rivaroxaban are AODs","correct":true},{"idx":4,"proposition":"In valvular AF, only VKAs are recommended with a target INR of 2.5 (between 2 and 3), unless mitral mechanical valve or disc valve (in this case target INR 3–4.5)","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"FA-cardio-7","context":null,"enonce":"Concerning the","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"In nonvalvular AF, VKAs or other oral anticoagulants are mandatory for preventive purposes.","correct":false,"justification":"The CHADS-VASc score is useless in case of mitral narrowing (AVK from the outset)"},{"idx":1,"proposition":"Oral aspirin dose ranging from 75 to 325 mg \/ day (most often 75 mg \/ d) is a questionable alternative in case of low risk","correct":true},{"idx":2,"proposition":"In coronary patients, only amiodarone and sotalol can be used","correct":true},{"idx":3,"proposition":"Similarly, newer oral anticoagulants should be used with caution and at reduced doses after age 80.","correct":true},{"idx":4,"proposition":"Precautions or contraindications are frequent for these new molecules in case of renal failure","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"FA-cardio-8","context":null,"enonce":"Which of the following proposals for atrial fibrillation (AF) is true?","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Cardiac auscultation finds irregular heart sounds and an ever more or less slow pace","correct":false,"justification":"AF is tachycardia, the heartbeat is fast. It should be noted that there are, however, \"slow AF\" (case of an AF with high-degree BAV for example) but do not constitute the classic framework of an AF."},{"idx":1,"proposition":"It is responsible for one-sixth of all strokes by cerebral embolism.","correct":true},{"idx":2,"proposition":"The diagnosis of AF is clinical and can only be confirmed by stethoscope auscultation.","correct":false,"justification":"The diagnosis of AF can only be confirmed on an ECG trace documenting it."},{"idx":3,"proposition":"The embolic risk is very low not justifying long-term anticoagulants","correct":false,"justification":"The embolic risk is estimated by the CHAD2S-VASc score. A score >1 requires the implementation of anticoagulation"},{"idx":4,"proposition":"Cardioversion or AF reduction are medical actions that restore sinus rhythm","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"FA-cardio-9","context":null,"enonce":"Which of the following are included in the management of rapid non-valvular AF in case of CHADS-VASc score greater than 1?","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Double anti-platelet aggregation","correct":false,"justification":"Need for anticoagulation"},{"idx":1,"proposition":"Direct oral anticoagulant (DOAC) anticoagulation","correct":true},{"idx":2,"proposition":"Anticoagulation by anti-vitamin K (VKA)","correct":false,"justification":"VKA in valvular AF (regardless of CHADS-VASc)"},{"idx":3,"proposition":"Emergency electrical cardioversion ","correct":false,"justification":"False"},{"idx":4,"proposition":"Beta-blocker retarder treatment","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"FA-cardio-10","context":null,"enonce":"Which of the following are included in the management of rapid non-valvular AF in case of CHADS-VASc score greater than 1?","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Double anti-platelet aggregation by clopidogrel and Aspirin","correct":false,"justification":"Need for anticoagulation"},{"idx":1,"proposition":"Direct oral anticoagulant (DOAC) anticoagulation","correct":true},{"idx":2,"proposition":"Anticoagulation with anti-vitamin K (VKA), fluindione (Previscan) as a first-line","correct":false},{"idx":3,"proposition":"Electrical cardioversion in first line","correct":false,"justification":"False"},{"idx":4,"proposition":"Antihypertensive treatment if hypertension duly diagnosed","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"FA-cardio-11","context":null,"enonce":"Which of the following are included in the calculation of the CHADS2-VASc score?","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Age","correct":true},{"idx":1,"proposition":"Diabetes","correct":true},{"idx":2,"proposition":"Tobacco","correct":false,"justification":"False"},{"idx":3,"proposition":"High blood pressure","correct":true},{"idx":4,"proposition":"Hypertiglyceridemia","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"FA-cardio-12","context":null,"enonce":"Which of the following are procedures to be performed before an external electric shock (ECC) before 3 weeks of effective anticoagulation?","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"ETT and ETO","correct":true,"justification":"True, check for clots"},{"idx":1,"proposition":"Pre-anesthesia consultation","correct":true},{"idx":2,"proposition":"Myocardial scintigraphy","correct":false,"justification":"False"},{"idx":3,"proposition":"Stress test","correct":false,"justification":"False"},{"idx":4,"proposition":"Classification SCORE","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"FA-cardio-13","context":null,"enonce":"Which of the following are possible complications of atrial fibrillation?","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Embolic stroke","correct":true},{"idx":1,"proposition":"Arterial embolisms","correct":true},{"idx":2,"proposition":"Heart failure","correct":true},{"idx":3,"proposition":"Deep vein thrombosis (DVT)","correct":false,"justification":"Arterial network"},{"idx":4,"proposition":"Acute limb ischemia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"FA-cardio-14","context":null,"enonce":"Which of the following are included in the calculation of the CHADS2-VASc score?","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"LVEF < 40%","correct":true},{"idx":1,"proposition":"History of stroke","correct":true},{"idx":2,"proposition":"Sex","correct":true},{"idx":3,"proposition":"Dyslipidemia","correct":false,"justification":"False"},{"idx":4,"proposition":"Tobacco","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diuretiques-nephro-1","context":null,"enonce":"Regarding the different diuretics:","item":"diuretiques","matiere":"nephro","propositions":[{"idx":0,"proposition":"Loop diuretics work by inhibiting sodium reabsorption in the ascending branch of the loop of Henle","correct":true},{"idx":1,"proposition":"Thiazide diuretics are sulfonamides","correct":true},{"idx":2,"proposition":"Hydroxychlorothiazide inhibits sodium excretion through the distal tube","correct":false,"justification":"It is a thiazide diuretic. It therefore inhibits sodium reabsorption on the proximal part of the distal tube"},{"idx":3,"proposition":"Cortical collecting tube diuretics oppose Na\/K exchange","correct":true},{"idx":4,"proposition":"All sodium-carrying cells have NaK-ATPase-dependent pumps on their basolateral membrane","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diuretiques-nephro-2","context":null,"enonce":"Which propositions are true?","item":"diuretiques","matiere":"nephro","propositions":[{"idx":0,"proposition":"Eplerone is a thiazide diuretic","correct":false,"justification":"It is a diuretic of the cortical collecting tube"},{"idx":1,"proposition":"Furosemide is a loop dietic","correct":true},{"idx":2,"proposition":"Chlortalidone is a proximal diuretic","correct":false,"justification":"Like hydrochlorothiazide and chlortalidone, it is a thiazide diuretic. Proximal diuretics are mannitol and acetazolamide"},{"idx":3,"proposition":"In the physiological state, most of the filtered Na is reabsorbed at the proximal bypassed tube and the loop of Henlé","correct":true},{"idx":4,"proposition":"Loop diuretics directly inhibit the reabsorption of Na, K, and Cl","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diuretiques-nephro-3","context":null,"enonce":"Which of the following are possible side effects of thiazide diuretics?","item":"diuretiques","matiere":"nephro","propositions":[{"idx":0,"proposition":"hyperkalemia","correct":false,"justification":"Like loop diuretics, they are hypokalaemic (but much less)"},{"idx":1,"proposition":"hyperuricemia","correct":true},{"idx":2,"proposition":"hypernatremia","correct":false,"justification":"False"},{"idx":3,"proposition":"metabolic alkalosis","correct":true},{"idx":4,"proposition":"Volume depletion","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"diuretiques-nephro-4","context":null,"enonce":"Which of the following propositions regarding thiazide diuretics are true?","item":"diuretiques","matiere":"nephro","propositions":[{"idx":0,"proposition":"They inhibit Na-K-2Cl cotransport","correct":false,"justification":"This is the target of loop diuretics."},{"idx":1,"proposition":"They oppose the action of aldosterone","correct":false,"justification":"This is the case of anti-aldosterone (aldactone, spironolactone)"},{"idx":2,"proposition":"They allow sodium excretion of 20 to 25% of the amount of filtered Na","correct":false,"justification":"About 5%"},{"idx":3,"proposition":"They decrease calciuria","correct":true},{"idx":4,"proposition":"They are contraindicated in severe renal impairment","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"santepop-mpr-0","context":null,"enonce":"Concerning general information about disability","item":"santepop","matiere":"mpr","propositions":[{"idx":0,"proposition":"Very few people will face disability in their lifetime (<10%)","correct":false,"justification":"Disability is part of the human condition – virtually everyone, at some point in life, will have a temporary or permanent impairment and those who reach old age will experience increasing functional difficulties"},{"idx":1,"proposition":"Disability is complex and interventions to overcome disadvantages are multiple and general, varying with the context","correct":true},{"idx":2,"proposition":"The International Classification of Functioning, Disability and Health (ICF) defines disability as an umbrella term for impairments, activity limitations and participation restrictions.","correct":true},{"idx":3,"proposition":"The ICF gives a definition of disability based on positive characteristics (which is)","correct":false,"justification":"it refers to the negative aspects of the interaction between an individual with a health problem and personal and environmental factors (such as negative attitudes, inaccessibility of transport and public buildings, and limited social supports)"},{"idx":4,"proposition":"Disability is multifactorial","correct":false,"justification":"Disability being multifactorial and dependent on the countries where the populations studied are located, this synthesis has two parts: the first is quite general and deals with disability in the world, the second is more precise and focuses on the French population (adults and children)\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"santepop-mpr-2","context":null,"enonce":"Regarding population health measurement tools:","item":"santepop","matiere":"mpr","propositions":[{"idx":0,"proposition":"In countries with life expectancy over 70 years, each individual will spend an average of 8 years or 11.5% of their life living with a disability.","correct":true},{"idx":1,"proposition":"YLDs are the average number of years lived with disability (disease-weighted) under current mortality and health conditions.","correct":true},{"idx":2,"proposition":"Disability-free life expectancy is defined as the average number of years lived without disability","correct":true},{"idx":3,"proposition":"Life expectancy depends very little on the region where one lives","correct":false,"justification":"These studies have also shown a wide variety of results between the Member States of the European Union."},{"idx":4,"proposition":"The DALY is a measure increasingly used in public health, particularly for the evaluation of health care systems","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"santepop-mpr-3","context":null,"enonce":"On general information on disability in France","item":"santepop","matiere":"mpr","propositions":[{"idx":0,"proposition":"The DALY is a measure that does not take into account the functional impact of diseases","correct":false,"justification":"This measure has the merit of taking into account mortality and the functional impact of diseases"},{"idx":1,"proposition":"The origin of the main pathologies causing disability depends on the environment and health policies of the countries","correct":true},{"idx":2,"proposition":"In developed countries, disability is most often born","correct":false,"justification":"In developed countries, it is pathologies due to aging, and in particular cardio-neuro-vascular pathologies that are most often at the origin of a situation of disability (Table 7"},{"idx":3,"proposition":"Disability is usually the direct consequence of illnesses","correct":false,"justification":"Finally, more than the diseases themselves, personal and environmental factors are often at the origin of disability situations."},{"idx":4,"proposition":"The HID survey estimates that around 3 million people are affected by disability in France","correct":false,"justification":"The HID survey estimates that around 23 million people are affected by disability in France\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"santepop-mpr-5","context":null,"enonce":"Regarding the epidemiology of disability in France:","item":"santepop","matiere":"mpr","propositions":[{"idx":0,"proposition":"The most common cause of impairment is old age","correct":false,"justification":"The most common causes of impairments are illness (about a quarter of the disabled population suffers from an impairment due to illness), socio-family problems (13%) and old age (11%)"},{"idx":1,"proposition":"Impairments due to disease increase steadily with age","correct":true},{"idx":2,"proposition":"The accidental origin of the disability of young people is the most frequent","correct":true},{"idx":3,"proposition":"In general, the impairments that most affect the population are motor and intellectual impairments.","correct":true},{"idx":4,"proposition":"Overall, women are less affected than men","correct":false,"justification":"Overall, women are more affected than men.\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"santepop-mpr-6","context":null,"enonce":"Regarding impairment and disability in France:","item":"santepop","matiere":"mpr","propositions":[{"idx":0,"proposition":"Motor impairments in children or adolescents are rare (1% and 3%, respectively)","correct":true},{"idx":1,"proposition":"In general, it can be seen that young people tend to suffer from multiple impairments, and older subjects from monodeficiency","correct":false,"justification":"It is young people who tend to suffer from monodeficiency, and older subjects from multiple disabilities"},{"idx":2,"proposition":"Impairments can lead to activity limitations","correct":true,"justification":"This is part of the definition of impairment"},{"idx":3,"proposition":"The inability to hear is the one most often reported among the French population","correct":false,"justification":"The inability to carry out activities related to effort (such as those related to distant travel) is the one most often reported among the French population"},{"idx":4,"proposition":"2.11% of the population has difficulty washing","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"santepop-mpr-8","context":null,"enonce":"Regarding the impact of disability on personal life, in France:","item":"santepop","matiere":"mpr","propositions":[{"idx":0,"proposition":"Difficulties in participating in social life have little impact on the quality of life of people with disabilities","correct":false,"justification":"This has a direct impact on the quality of life of people with disabilities."},{"idx":1,"proposition":"25% of people reporting at least one disability almost never or never go on vacation","correct":true},{"idx":2,"proposition":"Disability has no impact on professional integration","correct":false,"justification":"With regard to the professional integration of people under 60, here too, those who declare a disability have a significantly lower employment rate compared to the rest of the population."},{"idx":3,"proposition":"In 2009, there were 322,300 workers with disabilities working in the regular workplace.","correct":true},{"idx":4,"proposition":"Jobseekers with recognition as disabled workers represent 6% of all jobseekers","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"santepop-mpr-9","context":null,"enonce":"Regarding disability in France:","item":"santepop","matiere":"mpr","propositions":[{"idx":0,"proposition":"The unemployment rate for persons with administrative recognition of disability is 22%, more than double that for all persons aged 15 to 64.","correct":true},{"idx":1,"proposition":"Disability-related social protection benefits account for about 26.6% of all social benefits","correct":false,"justification":"F Medico-economic data Disability-related social protection benefits accounted for 6.6 per cent of total social benefits in 2007"},{"idx":2,"proposition":"Private insurance pays the majority of disability-related benefits","correct":false,"justification":"Social security schemes paid the majority of disability-related benefits (fig."},{"idx":3,"proposition":"In the general population, congenital malformations affect 12 to 13% of live births","correct":false,"justification":"In the general population, congenital malformations affect 2 to 3% of live births. a minority of these children (about 20%) will have severe impairment (less than 1% of all births)"},{"idx":4,"proposition":"The prevalence rate of severe disability in the eighth year of life is estimated to be between 6.2 and 6.6 per 1000 children","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"ECG-cardio-0","context":null,"enonce":"What are the real propositions?","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"proposition":"The ventricular T wave is a repolarization wave","correct":true},{"idx":1,"proposition":"A normal T-wave has the same polarity as the QRS","correct":true},{"idx":2,"proposition":"When a wave leaks the collecting electrode, it is positive","correct":false,"justification":"It is negative"},{"idx":3,"proposition":"D1, D2 and D3 are precordial leads","correct":false,"justification":"Front"},{"idx":4,"proposition":"Electrodes from V1 to V9 explore the transverse plane","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"ECG-cardio-1","context":null,"enonce":"What statements about the ECG are true?","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"proposition":"The QRS axis is measured using the Bailey double tri-axis","correct":true},{"idx":1,"proposition":"V4 is a lateral bypass","correct":false,"justification":"Apical"},{"idx":2,"proposition":"V1 explores the right atrium","correct":false,"justification":"The anterior wall of the left ventricle"},{"idx":3,"proposition":"V6, V7 and V8 are posterior leads","correct":false,"justification":"This is the case from V7 to V9. V6 is a low side bypass, just like V5"},{"idx":4,"proposition":"V3R and V4R explore the right ventricle","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"ECG-cardio-2","context":null,"enonce":"What value(s) is\/are normal in an ECG?","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"proposition":"A heart rate of 125 bpm","correct":false,"justification":"It is tachycardia"},{"idx":1,"proposition":"A P-wave that lasts 150 ms","correct":false,"justification":"It must be less than 120 ms"},{"idx":2,"proposition":"A PR distance of 45 ms","correct":false,"justification":"It would be reduced. A normal PR is between 120 and 200 ms"},{"idx":3,"proposition":"A QRS axis at 60 degrees","correct":true,"justification":"It is normally between -30 and +90 degrees"},{"idx":4,"proposition":"A Q wave of amplitude corresponding to half of the QRS","correct":false,"justification":"It would be a Q wave of necrosis. A normal Q wave lasts less than 40 ms and makes less than a third of the QRS"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ECG-cardio-3","context":null,"enonce":"Which propositions are true?","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"proposition":"An electric LVH can be found by the sign of Sokolov","correct":true},{"idx":1,"proposition":"Sokolov's sign is QVA + SV5","correct":false,"justification":"SV1 + RV5 must be less than 35 mm"},{"idx":2,"proposition":"A negative lateral T-wave may indicate severe LVH","correct":true},{"idx":3,"proposition":"Severe LVH induces total left axial deviation","correct":false,"justification":"Very modest"},{"idx":4,"proposition":"Right ventricular hypertrophy cannot be seen on ECG","correct":false,"justification":"Several signs, including axial deviation of QRS greater than 110 degrees"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ECG-cardio-5","context":null,"enonce":"Which of the following propositions are true about the ACFA?","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"proposition":"Regular tachycardia is often seen ","correct":false,"justification":"false, FMD is irregular"},{"idx":1,"proposition":"Often has bradycardia ","correct":false,"justification":"Tachycardia"},{"idx":2,"proposition":"QRS are expanded","correct":false,"justification":"Purposes"},{"idx":3,"proposition":"QRS are fine","correct":true},{"idx":4,"proposition":"There is a tremulation of the baseline with the presence of a P wave ","correct":false,"justification":"There must be an absence of P wave to make the diagnosis of AF"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ECG-cardio-6","context":null,"enonce":"Which of the following are left branch block signs?","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"proposition":"Wide QRS","correct":true,"justification":"True, sign the branch block"},{"idx":1,"proposition":"Negative QS aspect in V6","correct":false,"justification":"Negative QS aspect from V1 to V3"},{"idx":2,"proposition":"Negative QS aspect in V2","correct":true},{"idx":3,"proposition":"Negative QS aspect in V1","correct":true},{"idx":4,"proposition":"A pseudo sub-ST can be associated","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ECG-cardio-7","context":null,"enonce":"Which of the following are true about atrial flutter?","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"proposition":"This is supraventricular tachycardia","correct":true},{"idx":1,"proposition":"This is a junctional tachycardia","correct":false,"justification":"False"},{"idx":2,"proposition":"This is ventricular tachycardia","correct":false,"justification":"False"},{"idx":3,"proposition":"QRS are fine","correct":true},{"idx":4,"proposition":"The frequency is generally regular","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ECG-cardio-8","context":null,"enonce":"Which of the following are signs of atrial flutter?","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"proposition":"Isoelectric line tremulation","correct":false,"justification":"Atrial fibrillation"},{"idx":1,"proposition":"F-waves on factory roofs","correct":true},{"idx":2,"proposition":"Retrograde P-waves","correct":false,"justification":"Junctional tachycardia"},{"idx":3,"proposition":"Sinus rhythm","correct":false,"justification":"Non-sinus"},{"idx":4,"proposition":"No return to the iso-electric line","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ECG-cardio-9","context":null,"enonce":"Which of the following describe ventricular tachycardia?","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"proposition":"It is regular","correct":true},{"idx":1,"proposition":"QRS are wide","correct":true},{"idx":2,"proposition":"All propositions are true 🤡","correct":false},{"idx":3,"proposition":"It is irregular","correct":false,"justification":"Regular"},{"idx":4,"proposition":"It may precede ventricular fibrillation","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nvxrisques-infectio-0","context":null,"enonce":"Regarding the basics:","item":"nvxrisques","matiere":"infectio","propositions":[{"idx":0,"proposition":"National stockpiles of medicines and vaccines are built up to address key threats","correct":true},{"idx":1,"proposition":"An \"emerging risk\" is defined as any risk that is both new and exponentially decreasing.","correct":false,"justification":"Both new and growing"},{"idx":2,"proposition":"Cancers are the first type of emerging biological risk","correct":false,"justification":"Among biological risks, environmental risks and infectious diseases are at the forefront"},{"idx":3,"proposition":"The emergence of an infectious disease is a phenomenon that results from the interaction between three factors: the host, the biological agent and the environment.","correct":true},{"idx":4,"proposition":"Climate change has no scientifically recognized impact on the emergence of new epidemics","correct":false,"justification":"Environmental changes have a proven impact"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"nvxrisques-infectio-1","context":null,"enonce":"Which propositions are true?","item":"nvxrisques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Deforestation does not impact the emergence of diseases","correct":false,"justification":"If: Hendra virus example"},{"idx":1,"proposition":"The spread of Aedes albopictus was through the tyre trade","correct":true},{"idx":2,"proposition":"Emerging diseases cannot re-emerge by definition","correct":false,"justification":"The history of humanity has been punctuated by emerging infections (recent example of the HIV pandemic) or re-emerging infections (example of influenza pandemics or syphilis)"},{"idx":3,"proposition":"There will be no more emerging diseases by 2030 thanks to advances in medicine","correct":false,"justification":"Everything suggests that these emergence phenomena will continue, which justifies maintaining an effective health monitoring system."},{"idx":4,"proposition":"Bioterrorism is defined as the use (or threat of use) of biological agents as a weapon, with a view to inducing disease or death in humans, animals and\/or plants.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nvxrisques-infectio-2","context":null,"enonce":"Concerning epidemiological monitoring and EIF:","item":"nvxrisques","matiere":"infectio","propositions":[{"idx":0,"proposition":"A \"biological agent\" is naturally found in the environment","correct":false,"justification":"Under the term \"biological agent\", we include natural infectious agents (bacteria, viruses, parasites, fungi), the toxins they produce, but also genetically modified infectious agents"},{"idx":1,"proposition":"Health surveillance is carried out worldwide by WHO only","correct":false,"justification":"Health surveillance is carried out worldwide by the WHO, in Europe by the European Center for Diseases Prevention and Control (ECDC) and in France by the France Public Health Agency and its regional structures."},{"idx":2,"proposition":"Any emergence of a new infectious agent is analyzed as potentially dangerous","correct":true},{"idx":3,"proposition":"According to the International Health Regulations, the DGS is responsible for reporting to WHO all health emergencies of international concern","correct":true},{"idx":4,"proposition":"Nearly 5 infectious agents have emerged in the last 50 years","correct":false,"justification":"Nearly 180"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"nvxrisques-infectio-3","context":null,"enonce":"Which propositions are true?","item":"nvxrisques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Two-thirds of emerging diseases are zoonoses","correct":true},{"idx":1,"proposition":"Government plans have been developed and are regularly updated","correct":true},{"idx":2,"proposition":"Each health institution must develop, as part of the white plan, procedures allowing it to develop a dedicated circuit, premises and organization","correct":true},{"idx":3,"proposition":"The realization of full-scale exercises is forbidden in hospitals because the organization would be extremely complex","correct":false,"justification":"Carrying out full-scale exercises is useful"},{"idx":4,"proposition":"During national alerts, a definition of suspected cases developed and disseminated by the HAS","correct":false,"justification":"By the Directorate General of Health through the ARS"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"tbmarchegeria-neuro-1","context":null,"enonce":"Regarding walking and balance disorders","item":"tbmarchegeria","matiere":"neuro","propositions":[{"idx":0,"proposition":"During a labyrinthine attack, standing and walking are impossible during vertiginous accesses","correct":true},{"idx":1,"proposition":"At a distance from the latter, walking is cautious and unstable with a lateral deviation from the walking line","correct":true},{"idx":2,"proposition":"When reaching the cerebellum, the standing person stands with his legs apart to widen his support polygon, with the arms in abduction and walking he progresses zigzagging and staggering, realizing the drunk gait","correct":true},{"idx":3,"proposition":"The parkinsonian gait is characterized by a walk with the trunk inclined forward, the limbs in slight extension with swinging of the arm preserved","correct":false,"justification":"The parkinsonian gait is characterized by walking with the trunk inclined forward, the limbs in slight flexion with loss of arm swing."},{"idx":4,"proposition":"At a more advanced stage of Parkinson's disease, walking is done in small steps with foot rubbing and a decomposed U-turn.","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"algiespelviennes-gyn-0","context":null,"enonce":"What are the 4 etiologies to discuss first? ","item":"algiespelviennes","matiere":"gyn","propositions":[{"idx":0,"proposition":"Acute appendicitis ","correct":true},{"idx":1,"proposition":"Upper genital infection ","correct":true},{"idx":2,"proposition":"Cholangitis","correct":false,"justification":"Not the same location most often. Many other clinical signs, such as fever or ictere, point to cholitis."},{"idx":3,"proposition":"The GEU","correct":true,"justification":"Always think about it in a woman of childbearing age"},{"idx":4,"proposition":"Annex twisting ","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"algiespelviennes-gyn-1","context":null,"enonce":"Which of these proposals can often cause acute pelvic pain? ","item":"algiespelviennes","matiere":"gyn","propositions":[{"idx":0,"proposition":"Post-miscarriage retention","correct":true},{"idx":1,"proposition":"Renal artery aneurysm ","correct":false,"justification":"Is not painful"},{"idx":2,"proposition":"Ovarian cyst rupture","correct":true},{"idx":3,"proposition":"Osteonecrosis of the femoral head ","correct":false,"justification":"Possible pelvic irradiation even rare"},{"idx":4,"proposition":"Pyelonephritis ","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"algiespelviennes-gyn-3","context":null,"enonce":"Regarding CCAs:","item":"algiespelviennes","matiere":"gyn","propositions":[{"idx":0,"proposition":"The pain is usually very intense in case of torsion of appendix","correct":true},{"idx":1,"proposition":"A gradual onset points to IGH or acute appendicitis","correct":true},{"idx":2,"proposition":"Pain of brief evolution eliminates the possibility of a complication of an ovarian cyst","correct":false,"justification":"On the contrary, it points towards cystic origin"},{"idx":3,"proposition":"The time of onset of pain is of little importance in terms of diagnostic orientation","correct":true},{"idx":4,"proposition":"Pain topography can be relied upon to identify the organs involved","correct":false,"justification":"This is made very difficult\/impossible by the mode of innervation of the pelvic organs."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"algiespelviennes-gyn-4","context":null,"enonce":"Regarding CCAs:","item":"algiespelviennes","matiere":"gyn","propositions":[{"idx":0,"proposition":"The unilateral character is more in favor of an adnexal pathology","correct":true},{"idx":1,"proposition":"In case of upper genital infection, the pain is willingly diffused to the entire pelvis","correct":true},{"idx":2,"proposition":"Pain with lumbar irradiation should be sought as a priority for hepatic origin","correct":false,"justification":"Lumbar origin: renal colic for example"},{"idx":3,"proposition":"An appendage torsion never radiates to the lumbar because of the mode of innervation of the tubes","correct":false,"justification":"Hypogastric and aortic plexus, so possible irradiation"},{"idx":4,"proposition":"– scapulalgia should be sought for intraperitoneal effusion","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"algiespelviennes-gyn-5","context":null,"enonce":"What does localized pelvic pain in the flanks remind you of?","item":"algiespelviennes","matiere":"gyn","propositions":[{"idx":0,"proposition":"Renal colic","correct":true,"justification":"Renal colic and pyelonephritis are to be evoked in front of a pain of the flanks, assessment to be completed by a BU and an ultrasound of the urinary tract"},{"idx":1,"proposition":"Acute appendicitis ","correct":false,"justification":"None"},{"idx":2,"proposition":"Cyst rupture","correct":false,"justification":"None"},{"idx":3,"proposition":"Pyelonephritis","correct":true,"justification":"None"},{"idx":4,"proposition":"Annex twisting","correct":false,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"algiespelviennes-gyn-6","context":null,"enonce":"What are the etiologies of acute pelvic pain?","item":"algiespelviennes","matiere":"gyn","propositions":[{"idx":0,"proposition":"FCS","correct":true,"justification":"None"},{"idx":1,"proposition":"Renal colic","correct":true,"justification":"None"},{"idx":2,"proposition":"Annex twisting","correct":true,"justification":"None"},{"idx":3,"proposition":"Acute appendicitis ","correct":true,"justification":"None"},{"idx":4,"proposition":"Upper genital infection","correct":true,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"algiespelviennes-gyn-7","context":null,"enonce":"What does localized pelvic pain in the flanks remind you of?","item":"algiespelviennes","matiere":"gyn","propositions":[{"idx":0,"proposition":"Renal colic","correct":true,"justification":"Renal colic and pyelonephritis are to be evoked in front of a pain of the flanks, assessment to be completed by a BU and an ultrasound of the urinary tract"},{"idx":1,"proposition":"Acute appendicitis ","correct":false,"justification":"None"},{"idx":2,"proposition":"Cyst rupture","correct":false,"justification":"None"},{"idx":3,"proposition":"Pyelonephritis","correct":true,"justification":"None"},{"idx":4,"proposition":"Annex twisting","correct":false,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"algiespelviennes-gyn-8","context":null,"enonce":"What are the diagnoses to be discussed in priority in front of acute pelvic pain in women?","item":"algiespelviennes","matiere":"gyn","propositions":[{"idx":0,"proposition":"Pyelonephritis","correct":false,"justification":"Pyelonephritis"},{"idx":1,"proposition":"Normal pregnancy ","correct":false,"justification":"Think about the GEU"},{"idx":2,"proposition":"Upper genital infection","correct":true,"justification":"The term salpingite is dropped in the latest edition of the CNOG"},{"idx":3,"proposition":"Annex twisting","correct":true},{"idx":4,"proposition":"Cholecystitis","correct":false,"justification":"Evoke acute appendicitis instead"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"algiespelviennes-gyn-9","context":null,"enonce":"Which of the following are true?","item":"algiespelviennes","matiere":"gyn","propositions":[{"idx":0,"proposition":"There is a link between endometriosis and ovarian cancer","correct":false,"justification":"False. There is no link (HAS 2017 recommendations). Therefore, there is no need to screen patients with endometriosis for ovarian cancer."},{"idx":1,"proposition":"If there are no symptoms in a woman with endometriosis who is being treated, imaging should be done on an annual basis to monitor the progress of the lesions.","correct":false,"justification":"False. According to HAS, in the absence of symptoms, routine imaging monitoring of patients treated for endometriosis is not required."},{"idx":2,"proposition":"The definition of endometriosis is histological: presence of endometritis glands or stroma outside the uterus","correct":true},{"idx":3,"proposition":"There is no need to seek endometriosis in cases of isolated dysmenorrhea controlled by hormonal contraception, without other painful symptoms or immediate pregnancy wishes","correct":true,"justification":"True. See HAS 2017"},{"idx":4,"proposition":"The \"Endometriosis Health Profile-30\" questionnaire and its short version \"EHP-5\", or the SF-36 questionnaire, are questionnaires assessing the quality of life of women with endometriosis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"RCIU-gyn-0","context":null,"enonce":"Regarding the epidemiology of prematurity:","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Prematurity is defined as a birth occurring before 42 weeks of amenorrhea","correct":false,"justification":"Prematurity is defined as a birth occurring before 37 weeks of amenorrhea (AS) and from 22 SA of a child weighing at least 500 g"},{"idx":1,"proposition":"60% of neonatal mortality comes from children born before 30 weeks","correct":true},{"idx":2,"proposition":"The preterm birth rate is 0.7% for all births","correct":false,"justification":"The preterm birth rate is 7.4 per cent for all births and 6.6 per cent for live births due to a high proportion of preterm infants among stillbirths."},{"idx":3,"proposition":"Among live births, the preterm birth rate is 6.6 per cent","correct":true},{"idx":4,"proposition":"About 75% of preterm births occur before 28 SA","correct":false,"justification":"About 10% of preterm deliveries occur before 28 weeks (extreme prematurity), 10 per cent occur before 28 to 31 weeks (severe prematurity) and 80% occur before 32 to 36 weeks (moderate prematurity)\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"RCIU-gyn-1","context":null,"enonce":"What are the true statements?","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Extreme prematurity concerns births before 28 SA","correct":true,"justification":"Extreme prematurity < 28 SA. Severe prematurity < 32 SA. Moderate prematurity < 36 SA."},{"idx":1,"proposition":"Severe prematurity is between 28 and 42 SA","correct":false,"justification":"42 SA is a normal term"},{"idx":2,"proposition":"Moderate prematurity is in 32 and 38 SA","correct":false,"justification":"Between 32 and 36"},{"idx":3,"proposition":"A birth at 33 SA is moderate prematurity","correct":true},{"idx":4,"proposition":"A birth at 41 SA is normal","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"RCIU-gyn-2","context":null,"enonce":"Which of these proposals are possible causes of induced prematurity?","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Pre-eclampsia","correct":true},{"idx":1,"proposition":"GEU","correct":false,"justification":"First trimester pathology"},{"idx":2,"proposition":"Decompensated maternal heart disease","correct":true},{"idx":3,"proposition":"Retroplacental hematoma","correct":true},{"idx":4,"proposition":"Lupus","correct":false,"justification":"Not as such\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"RCIU-gyn-3","context":null,"enonce":"Which of these proposals are recognized risk factors for preterm birth?","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Celibacy","correct":true,"justification":"RR 1-2"},{"idx":1,"proposition":"Alcohol","correct":true,"justification":"RR 1-2"},{"idx":2,"proposition":"Tobacco","correct":true,"justification":"RR 1-2"},{"idx":3,"proposition":"The single pregnancy","correct":false,"justification":"Multiple pregnancy yes, with RR between 4 and 10"},{"idx":4,"proposition":"Urinary tract infection","correct":true,"justification":"RR 1-3\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"RCIU-gyn-4","context":null,"enonce":"Regarding preterm births:","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Spintaneous prematurity rarely occurs after spontaneous work with intact membranes","correct":false,"justification":"Spontaneous prematurity occurs after spontaneous labour with intact membranes (40–45%) or premature rupture of membranes (25–30%), while induced prematurity is most often induced for fetal or maternal pathology (30–35%)"},{"idx":1,"proposition":"Patients who have preterm rupture of membranes do not need induced delivery","correct":false,"justification":"Patients who have preterm rupture of membranes may also have an induced delivery if the condition of the newborn or mother requires induction of delivery or caesarean section."},{"idx":2,"proposition":"Distilbene has been shown not to promote preterm births","correct":false,"justification":"In addition, the risk of OA would be multiplied by a factor ranging from 2 to 5 in case of in utero exposure to Distilbene®."},{"idx":3,"proposition":"Cervico-isthmic gaping results in a late miscarriage at the end of the third trimester and with extremely algic and progressive uterine contractions","correct":false,"justification":"Clinically, it is accepted that it is in its typical form an event of sudden onset, unpredictable, little or no preceded by prior clinical cervical changes."},{"idx":4,"proposition":"A history of conization increases the risk of preterm birth","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"RCIU-gyn-5","context":null,"enonce":"Regarding risk factors for prematurity:","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"proposition":"In case of multiple pregnancy, the risk of prematurity is multiplied by 1.2","correct":false,"justification":"The rate of prematurity is 43%, a risk multiplied by 7 compared to single children"},{"idx":1,"proposition":"Twin pregnancies exclusively expose to the risk of moderate prematurity","correct":false,"justification":"Excess risk is observed for both moderate and severe prematurity"},{"idx":2,"proposition":"Hydramnios is always idiopathic","correct":false,"justification":"It may be the witness of an underlying fetal pathology (diabetes, fetal anemia by Rhesus alloimmunization or parvovirus B19 infection, fetal malformations or placental pathologies), idiopathic hydramnios remaining a diagnosis of elimination"},{"idx":3,"proposition":"Plana previa increases the risk of prematurity","correct":true,"justification":"It is associated with a 6 to 7 times increased risk of PA"},{"idx":4,"proposition":"Gestational vascular pathologies are mainly responsible for spontaneous prematurity","correct":false,"justification":"These pathologies are responsible for 25 to 30% of global prematurity and essentially induced prematurity\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"RCIU-gyn-6","context":null,"enonce":"Among these propsitions, which prevent prematurity:","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Limit orthostatic work","correct":true},{"idx":1,"proposition":"Limit day work","correct":false,"justification":"Limiting night work"},{"idx":2,"proposition":"Smoking cessation","correct":true},{"idx":3,"proposition":"Alcohol withdrawal","correct":true},{"idx":4,"proposition":"Optimizing the balance of chronic diseases","correct":true,"justification":"Like diabetes, hypertension, asthma, etc.\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"RCIU-gyn-7","context":null,"enonce":"Regarding intra-uterine growth retardation","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"proposition":"A newborn is said to be small for gestational age if its birth weight is below the 50th percentile","correct":false,"justification":"A newborn is said to be small for gestational age (PAG) if its birth weight is below the 10th percentile"},{"idx":1,"proposition":"PAG affects 10% of newborns","correct":true},{"idx":2,"proposition":"IUGR corresponds to a PAG and a break in the intrauterine growth curve","correct":true},{"idx":3,"proposition":"IUGR is said to be early if it appears before 35 SA","correct":false,"justification":"IUGR is said: • early if it appears in the 2nd trimester, versus late if it appears in the 3rd trimester"},{"idx":4,"proposition":"True IUGR is a purely intrauterine pathology that has no consequences after birth","correct":false,"justification":"Conversely, true IUGR is a pathology that exposes to complications: fetal death in utero, neonatal encephalopathy, abnormalities of psychomotor development\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"RCIU-gyn-8","context":null,"enonce":"Which of the following proposals are favored by prematurity?","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Ulcerative-necrotizing enterocolitis","correct":true,"justification":"True, prevented by antenatal corticosteroid therapy"},{"idx":1,"proposition":"Early closure of the ductus arteriosus","correct":false,"justification":"The opposite: the persistence of the ductus arteriosus. It can be a source of pulmonary hyper-output (by aortopulmonary shunt at high pressure) and pulmonary arterial hypertension"},{"idx":2,"proposition":"Intraventricular cerebral hemorrhage","correct":true,"justification":"True, prevented by antenatal corticosteroid therapy"},{"idx":3,"proposition":"Hyaline membrane disease ","correct":true,"justification":"True, prevented by antenatal corticosteroid therapy"},{"idx":4,"proposition":"Hypercalcemia","correct":false,"justification":"HYPOcalcemia, HYPOGLYCEMIA, HYPOthermia"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"antiinf-infectio-0","context":null,"enonce":"Regarding penicillins:","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"Penicillin V is administered in IV","correct":false,"justification":"Per Os"},{"idx":1,"proposition":"The depot form of penicillins G\/V is benzathine penicillin","correct":true},{"idx":2,"proposition":"Amoxicillin is penicillin A","correct":true},{"idx":3,"proposition":"The most common combination with amoxicillin is clavulanic acid","correct":true},{"idx":4,"proposition":"Penicillin G is administered Per Os","correct":false,"justification":"Track IV"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"antiinf-infectio-1","context":null,"enonce":"Regarding penicillins:","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"They are bactericidal","correct":true},{"idx":1,"proposition":"They are concentration-dependent","correct":false,"justification":"Time-dependent"},{"idx":2,"proposition":"Penicillins V and G have a short half-life","correct":true},{"idx":3,"proposition":"The elimination of amoxicillin is done by urine at more than 70%","correct":true},{"idx":4,"proposition":"The diffusion is very good in the prostate","correct":false,"justification":"Very bad"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"antiinf-infectio-2","context":null,"enonce":"On which bacteria are penicillins A useful?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"Streptococci","correct":true},{"idx":1,"proposition":"Staphylococci","correct":false,"justification":"Clavulanic acid must be added"},{"idx":2,"proposition":"Group 2 and 3 Enterobacteriaceae","correct":false,"justification":"Only group 1"},{"idx":3,"proposition":"Fusobacterium","correct":true},{"idx":4,"proposition":"SARMs","correct":false,"justification":"By definition, they are resistant"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"antiinf-infectio-4","context":null,"enonce":"Which of the following are true?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"Any antibiotic therapy should be reassessed early","correct":true,"justification":"At 48-72h, it will take into account the efficacy, tolerance and possible bacteriological documentation"},{"idx":1,"proposition":"It is customary to reduce spectrum as soon as possible","correct":true},{"idx":2,"proposition":"Except in special cases, antibiotic therapy of more than 3 days is not justified","correct":false,"justification":"Most often does not exceed more than 10 days"},{"idx":3,"proposition":"There are treatments for only a minority of viruses ","correct":true},{"idx":4,"proposition":"Antivirals eradicate the viral presence most often","correct":false,"justification":"Their purpose may be to control long-term viral replication."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"antiinf-infectio-5","context":null,"enonce":"Which of the following are true about vancomycin?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is an aminoglycoside","correct":false,"justification":"Glycopeptides"},{"idx":1,"proposition":"Its toxicity is pulmonary","correct":false,"justification":"Kidney"},{"idx":2,"proposition":"Its activity is concentration dependent","correct":false,"justification":"Time dependent"},{"idx":3,"proposition":"It has no activity on gram-negative bacilli","correct":true},{"idx":4,"proposition":"It has activity on staphylococci","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"thromboP-hemato-0","context":null,"enonce":"Regarding thrombocytopenia","item":"thromboP","matiere":"hemato","propositions":[{"idx":0,"proposition":"Thrombocytopenia is a platelet count of less than 100 g \/ l regardless of age","correct":false},{"idx":1,"proposition":"Platelet depletion can lead to thrombotic syndrome","correct":false,"justification":"Hemorrhagic syndrome"},{"idx":2,"proposition":"Severe thrombocytopenia causes infiltrated petechial purpura, sometimes associated with large hematomas","correct":false,"justification":"Purpura from thrombocytopenia is not infiltrated"},{"idx":3,"proposition":"The discovery of a purpura requires the prescription of a blood count","correct":true},{"idx":4,"proposition":"Look for signs of infection, anemia, liver disease, splenomegaly or lymphadenopathy","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"thromboP-hemato-1","context":null,"enonce":"About thrombocytopenia","item":"thromboP","matiere":"hemato","propositions":[{"idx":0,"proposition":"Signs of severity of hemorrhagic syndrome are those related to the existence of mucosal bleeding","correct":true,"justification":"These include: intraoral hemorrhagic bubbles, metrorrhagia, gingerage and epistaxis"},{"idx":1,"proposition":"Disseminated ecchymotic purpura, associated with significant mucosal hemorrhages, headache, neurological clinical signs, raises fears of the occurrence of a severe hemorrhagic syndrome","correct":true,"justification":"The three most feared locations are cerebral, mucosal and digestive"},{"idx":2,"proposition":"When severe bleeding is suspected, preventive treatment is essential, as bleeding is often spontaneous and unpredictable.","correct":true,"justification":"Indeed, bleeding is often spontaneous and unpredictable."},{"idx":3,"proposition":"The presence of abnormal cells on the smear will suggest potentially malignant myelopathy","correct":true},{"idx":4,"proposition":"Vitamin B12 deficiency causes peripheral thrombocytopenia","correct":false,"justification":"Default medullary production plant. This is also the case for folate"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"thromboP-hemato-2","context":null,"enonce":"Regarding thrombocytopenia","item":"thromboP","matiere":"hemato","propositions":[{"idx":0,"proposition":"When severe bleeding is suspected, preventive treatment is essential","correct":true,"justification":"Because the bleeding is then often spontaneous and unpredictable (especially cerebromeningeal hemorrhages)"},{"idx":1,"proposition":"Platelet concentrates have a very rapid efficacy in thrombocytopenia of central origin but more moderate and fleeting in thrombocytopenia of peripheral origin","correct":true},{"idx":2,"proposition":"Pseudothrombocytopenia may be related to EDTA","correct":true,"justification":"When there are no clinical signs, it is then necessary to repeat the sample on a dedicated tube"},{"idx":3,"proposition":"The risk of bleeding is major if the platelet count is less than 70 G \/ L","correct":false,"justification":"The risk of bleeding is major if the platelet count is less than 20 G \/ L"},{"idx":4,"proposition":"Osteomedullary biopsy is always prescribed when the myelogram is non-demonstrative","correct":false,"justification":"Most often, we don't even do a medullogram"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"masseabdo-HGE-0","context":null,"enonce":"About hepatomegaly","item":"masseabdo","matiere":"HGE","propositions":[{"idx":0,"proposition":"Hepatomegaly is defined as an increase in liver volume","correct":true},{"idx":1,"proposition":"Hepatomegaly can be considered homogeneous or heterogeneous depending on the macroscopic appearance (palpation, examination of the section, or imaging examinations)","correct":true},{"idx":2,"proposition":"The liver is considered enlarged when its projection on the medioclavicular line is greater than 22 cm","correct":false,"justification":"The liver is considered enlarged when its projection on the medioclavicular line is greater than 12 cm"},{"idx":3,"proposition":"A mass of the right hypochondrium or epigastrium may be attached to hepatomegaly when it is mobile with breathing","correct":true},{"idx":4,"proposition":"Abdominal ultrasound makes it possible to specify the diagnsotic of hepatomegaly showing that the distance between the top of the time is of its lower edge, and the mid-clavicular line is greater than 12 cm","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"masseabdo-HGE-1","context":null,"enonce":"About hepatomegaly","item":"masseabdo","matiere":"HGE","propositions":[{"idx":0,"proposition":"Most liver diseases can cause hepatomegaly","correct":true},{"idx":1,"proposition":"A cirrhotic liver is soft in consistency with a sharp lower edge","correct":false,"justification":"It is of hard consistency"},{"idx":2,"proposition":"The clinical examination should look for hepatojugular reflux and systolic expansion of the liver","correct":true},{"idx":3,"proposition":"The clinical examination tries to find out if the liver is painful","correct":true},{"idx":4,"proposition":"To clarify the cause of heterogeneous hepatomegaly, contrast ultrasound, CT scan or MRI are often useful.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"masseabdo-HGE-3","context":null,"enonce":"About hepatomegaly","item":"masseabdo","matiere":"HGE","propositions":[{"idx":0,"proposition":"Malignant or benign liver tumors are the most common cause of heterogeneous hepatomegaly","correct":true},{"idx":1,"proposition":"Steatosis is cirrhosis are the most frequent legoses of homogenic hepatomeaglia","correct":true},{"idx":2,"proposition":"Liver biopsy cannot be performed transparientally when haemostasis disorders are present","correct":true},{"idx":3,"proposition":"In front of an abdominal mass the clinical examination makes it possible to eliminate among other things a fecal impaction, a bladder globe, a herenia","correct":true},{"idx":4,"proposition":"Liver biospsia can be echoguided or scannoguided","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"securitepro-mdt-0","context":null,"enonce":"Which of the following is (are) correct?","item":"securitepro","matiere":"mdt","propositions":[{"idx":0,"proposition":"Every year there are about 10,000 accidents at work (AT) in France","correct":false,"justification":"More than 620,000 TAs were recorded in 2014"},{"idx":1,"proposition":"Each year, TAs are responsible for more than 500 deaths in France","correct":true,"justification":"More than 500 deaths by AT in France each year"},{"idx":2,"proposition":"Occupational diseases are constantly increasing","correct":true},{"idx":3,"proposition":"About 2% of the population is exposed to a carcinogen through work","correct":false,"justification":"More than 13% of the French population is exposed"},{"idx":4,"proposition":"Very few notices of incapacity lead to dismissal","correct":false,"justification":"Unfortunately, far too many opinions still lead to dismissal"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"securitepro-mdt-2","context":null,"enonce":"Which of the following is (are) correct?","item":"securitepro","matiere":"mdt","propositions":[{"idx":0,"proposition":"The state of health can never constitute a reason for dismissal","correct":false,"justification":"In case of incapacity and impossibility of redeployment, it may lead to dismissal"},{"idx":1,"proposition":"Medical incapacity is pronounced following a meeting between the patient, his manager at the workplace, and the doctor","correct":false,"justification":"Only the doctor can pronounce an incapacity, no consultation with a hierarchical superior is necessary"},{"idx":2,"proposition":"Unfitness for a job is always total","correct":false,"justification":"It can be total\/restricted, definitive\/temporary"},{"idx":3,"proposition":"There are 2 types of reclassification: upper and lower","correct":false,"justification":"There are 2 types of outplacements: internal or external"},{"idx":4,"proposition":"External redeployment calls on Pôle Emploi","correct":true,"justification":"This is the case with external redeployment"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"risques-infectio-0","context":null,"enonce":"Which propositions are true?","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Adverse events associated with care are rare conditions","correct":false,"justification":"Important points Adverse events associated with care are frequent, costly pathologies, responsible for significant morbidity and mortality Nosocomial infection: any infection – neither present nor incubating at management – occurring in a health facility, more than 48 hours after admission"},{"idx":1,"proposition":"The delay is extended to 15 days post-surgery","correct":false,"justification":"This period is extended to 30 days in case of surgery"},{"idx":2,"proposition":"Healthcare-associated infections include nosocomial infections and infections associated with out-of-hospital care","correct":true},{"idx":3,"proposition":"Prevention is essential and hand hygiene with hydroalcoholic solutions is the main measure","correct":true},{"idx":4,"proposition":"Nosocomial infections never occur at RHAs","correct":false,"justification":"Some nosocomial infections require reporting to CPias and ARS (e.g. death related to nosocomial infection\")"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"risques-infectio-1","context":null,"enonce":"Which propositions are true?","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Healthcare-associated infections (HAIs) are home care infections","correct":false,"justification":"This term HAIs refers to infections that appear during or during the course of a patient's management (diagnostic, therapeutic, palliative, preventive or educational), if the infection was neither present nor incubated at the beginning of management."},{"idx":1,"proposition":"Nosocomial infections (NOS) are those acquired at the patient's work","correct":false,"justification":"The term IN refers to infections acquired in health facilities: in practice, an infection is often considered nosocomial if it appears more than 48 hours after admission, but this period must be adapted to the incubation period of the disease"},{"idx":2,"proposition":"The definition of nosocomial infections in case of placement of foreign material is based on a period of 6 months","correct":false,"justification":"The definition of some NIs is based on longer delays: 30 days after surgery for surgical site infection 1 year in case of placement of foreign equipment"},{"idx":3,"proposition":"The 3 most frequently isolated microorganisms are Escherichia coli, Staphylococcus aureus and Streptococcus pneumoniae","correct":false,"justification":"Infectious agents responsible: Gram-negative bacilli in 60% of cases, Gram-positive cocci in 30% The 3 most frequently isolated microorganisms are Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa Fungi are becoming increasingly important in NIs"},{"idx":4,"proposition":"Overall, there is an increase in multidrug-resistant bacteria (MDR) and emerging \"Highly Resistant\" Bacteria (BHRe)","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"risques-infectio-2","context":null,"enonce":"Regarding surgical site infections (ISO):","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"The most frequently encountered BMRs are extended-spectrum betalactamase-producing enterobacteriaceae (ESBL) and methicillin-resistant Staphylococcus aureus (MRSA).","correct":true},{"idx":1,"proposition":"eBHRs include carbapenemase-producing Enterococcus faecium and vancomycin-resistant Enterococcus faecium","correct":true},{"idx":2,"proposition":"The presence of local inflammatory signs requiring a resumption of the incision is a sign of infection of the surgical site","correct":true},{"idx":3,"proposition":"Signs of infection observed during re-surgery indicate surgical site infection","correct":true},{"idx":4,"proposition":"A period of one year following the placement of equipment (prosthesis or implant) is compatible with an infection of the surgical site","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"risques-infectio-3","context":null,"enonce":"Which propositions are true?","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"The diagnostic criteria for a nosocomial urinary tract infection are identical to those for a community urinary tract infection","correct":true},{"idx":1,"proposition":"Regression of infectious signs within 48 hours of catheter removal strongly suggests that the infection is catheter-related.","correct":true},{"idx":2,"proposition":"Treatment of a nosocomial infection is always probabilistic without adaptation","correct":false,"justification":"Reassessment and reduction of spectrum if possible upon receipt of bacteriological results"},{"idx":3,"proposition":"Surgical site infection requires specialized management","correct":true},{"idx":4,"proposition":"Catheter-related infection is treated by removing the catheter only","correct":false,"justification":"CATHETER-RELATED INFECTION Catheter removal + broad-spectrum antibiotic therapy secondarily adapted to susceptibility testing"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"risques-infectio-4","context":null,"enonce":"Which propositions are true?","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Prevention of HIAs is essential","correct":true},{"idx":1,"proposition":"Urinary colonizations should be treated with appropriate antibiotic therapy","correct":false,"justification":"NOSOCOMIAL URINARY TRACT INFECTION Colonizations should not be treated with antibiotics except in cases of pregnancy or planned urinary tract intervention"},{"idx":2,"proposition":"In case of urinary tract infection on probe, the bladder tube can be kept in place for 48 hours if antibiotic therapy works","correct":false},{"idx":3,"proposition":"Asepsis is the removal of dirt adhering to a tissue or surface","correct":false,"justification":"DEFINITIONS Asepsis: set of measures to prevent any introduction of infectious agents to inert or biological surfaces"},{"idx":4,"proposition":"Sterilization is the removal of dirt adhering to living tissue or an inert surface","correct":false,"justification":"Cleansing: removal of dirt adhering to living tissue or an inert surface\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"risques-infectio-5","context":null,"enonce":"Which propositions are true?","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Sterilization is the operation that aims to destroy all microorganisms of an object in a sustainable way on an inert medium","correct":true},{"idx":1,"proposition":"Decontamination and disinfection are synonymous","correct":false,"justification":"Decontamination: includes antisepsis and disinfection: temporary elimination of infectious agents"},{"idx":2,"proposition":"Mixing antiseptics of different nature makes it possible to broaden their spectrum","correct":false,"justification":"Rules for the use of antiseptics Avoid simultaneous or successive mixtures of products of different nature For antisepsis of healthy skin, the application of an antiseptic is always preceded by a deterioration phase"},{"idx":3,"proposition":"Chlorhexidine is contraindicated on the skin and reserved for mucous membranes","correct":false},{"idx":4,"proposition":"linen and instruments soiled with blood or any other product of human origin must be transported in leak-proof packaging","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"risques-infectio-6","context":null,"enonce":"Regarding hygiene:","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Alcoholic antiseptic should not be used in newborns","correct":true},{"idx":1,"proposition":"Chlorinated and iodine derivatives have a fairly reduced spectrum (centered on Gram-negative bacilli)","correct":false},{"idx":2,"proposition":"Manuporting is the main mode of cross-transmission of microorganisms","correct":true},{"idx":3,"proposition":"Hand hygiene is the most effective measure to significantly reduce the incidence rate of cross-transmission NIs by reducing transient skin flora by 99%","correct":true},{"idx":4,"proposition":"The friction of the hands must last at the mons 2mn30","correct":false,"justification":"Perform the friction of all areas until complete drying (= 30 seconds)\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"risques-infectio-7","context":null,"enonce":"Regarding the wearing of gloves and additional precautions:","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Wearing gloves is advised to protect the patient from contact with the doctor's skin flora only","correct":false},{"idx":1,"proposition":"Wearing gloves replaces hand hygiene","correct":false},{"idx":2,"proposition":"Hand hygiene should be performed before and after removing gloves","correct":true},{"idx":3,"proposition":"The gloves are worn for about 3 hours, they must be kept from beginning to end with the same patient","correct":false,"justification":"Change gloves between 2 treatments in the same patient, between 2 patients"},{"idx":4,"proposition":"Additional precautions are adapted to the modes of transmission of infections","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"risques-infectio-8","context":null,"enonce":"Regarding additional hygiene precautions:","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"\"Air\" precautions are taken when only surfaces are contaminated","correct":false,"justification":"This is the case of contact precautions"},{"idx":1,"proposition":"Droplet precautions are taken when the patient emits persistent infective particles into the air","correct":false,"justification":"Not persisting in air"},{"idx":2,"proposition":"Air precautions are taken when the patient emits infective particles that do not persist in the air","correct":false,"justification":"Persistent airborne"},{"idx":3,"proposition":"Contact precautions are taken when surfaces are contaminated","correct":true},{"idx":4,"proposition":"15-micrometre particles persist airborne","correct":false,"justification":"These are particles smaller than 5 micrometers.\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"risques-infectio-9","context":null,"enonce":"Concerning additional hygiene precautions","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Tuberculosis imposes air precautions","correct":true,"justification":"This is the case: tuberculosis, measles and chickenpox"},{"idx":1,"proposition":"Flu requires contact precautions","correct":false,"justification":"Droplet precautions"},{"idx":2,"proposition":"RMOs impose air precautions","correct":false,"justification":"Contact precautions are sufficient"},{"idx":3,"proposition":"Pertussis imposes droplet precautions","correct":true,"justification":"This is also the case for influenza, meningococcus, mycoplasma, rubella, mumps, Parvovirus B19 and RSV"},{"idx":4,"proposition":"Dificile clostidiodia requires contact precautions","correct":true,"justification":"This is also the case for eHRBs and BMRs, enteroviruses, RSV, scabies and pediculosis.\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"risques-infectio-10","context":null,"enonce":"Concerning hygiene prevention measures:","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"The patient uses a surgical mask for air and droplet precautions","correct":true},{"idx":1,"proposition":"Carriers apply standard precautions and apron in case of contact precautions","correct":true},{"idx":2,"proposition":"Hand washing with mild soap should precede hydroalcoholic friction","correct":true},{"idx":3,"proposition":"For Clostridioides difficile, conventional disinfectant detergents are sufficient for contact precautions","correct":false,"justification":"For Clostridioides difficile, conventional disinfectant detergents are not effective, use bleach as a disinfectant Protective isolation Protective measure to protect the immunocompromised patient (especially situations of prolonged neutropenia) from external contamination, avoiding contact with infectious agents"},{"idx":4,"proposition":"Limiting the indications for urinary catheters and their duration is useless","correct":false,"justification":"It is an asset in the fight against nosocomial infections.\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"risques-infectio-11","context":null,"enonce":"Regarding urinary tract infections and urinary catheters:","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"For neurological bladders, indwelling catheterization is preferred","correct":false,"justification":"Adverse Events Associated with Care (HIAC) Prefer multi-day survey to indwelling survey for neurological bladders"},{"idx":1,"proposition":"Measuring the voiding residue by ultrasound (bladder scan) rather than by round-trip sampling is a preventive measure for HIAs","correct":true},{"idx":2,"proposition":"Systematically changing the bladder tube (e.g. 1 time every 3 days) helps limit urinal infections","correct":false,"justification":"No systematic change of the bladder tube"},{"idx":3,"proposition":"Urinary catheters are only changed if they leak","correct":false,"justification":"Change if it malfunctions (obstruction, leakage ...) or in case of proven tissue infection after 24 h of effective antibiotic therapy (allows to place the 'clean' probe in an environment with lower inoculum, in the presence of antibiotics)"},{"idx":4,"proposition":"Epidemiological and microbiological monitoring of urinary tract infections to detect epidemic phenomena is important","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"risques-infectio-12","context":null,"enonce":"Which of the following are true?","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Overall, there is an increase in multi-resistant bacteria","correct":true},{"idx":1,"proposition":"The most frequently encountered BMRs are extended-spectrum betalactamase-producing enterobacteriaceae ","correct":true},{"idx":2,"proposition":"The term IN refers to infections acquired in health care facilities","correct":true},{"idx":3,"proposition":"The definition of certain NIs is based on longer deadlines","correct":true},{"idx":4,"proposition":"Mushrooms are taking an increasing place in NIs","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dysphonie-neuro-0","context":null,"enonce":"A few reminders:","item":"dysphonie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Dysphonia (or hoarseness) is a purely objective alteration of the sound support of speech resulting in the isolated or combined impairment of the three acoustic parameters of the voice which are pitch, intensity and timbre","correct":false,"justification":"Dysphonia (or hoarseness) is an objective or subjective alteration of the sound support"},{"idx":1,"proposition":"The voice is a sound produced by the vocal cords under the influence of exhaled air","correct":true},{"idx":2,"proposition":"The larynx is an element of the upper airway","correct":true},{"idx":3,"proposition":"Phonation requires the abduction of the vocal cords and the maintenance of subglottic pressure","correct":false,"justification":"Vocal cord adduction"},{"idx":4,"proposition":"Hypophonia during acute or chronic respiratory failure is a type of dysphonia","correct":false,"justification":"It is an alteration of the voice related to a defect of respiratory capacity so not a dysphonia"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dysphonie-neuro-1","context":null,"enonce":"Regarding the diagnosis:","item":"dysphonie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Open rhinolalia involve hypernasality","correct":true},{"idx":1,"proposition":"Teachers, lawyers, amateur or professional singers are more exposed to functional voice disorders","correct":true},{"idx":2,"proposition":"Dyspnea or associated dysphagia indicates an extensive lesion beyond the vocal cords","correct":true},{"idx":3,"proposition":"Ultrasound is the basic examination to be performed in front of a dysphonia whose evolution is not quickly favorable","correct":false,"justification":"The laryngoscopic examination is the basic examination to be performed in front of a dysphonia whose evolution is not quickly favorable"},{"idx":4,"proposition":"Only the dynamic CT scan in a conscious patient can obtain precise information on the mobility of the larynx and vocal cords","correct":false,"justification":"Only the laryngoscope allows it"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dysphonie-neuro-2","context":null,"enonce":"Regarding the diagnosis:","item":"dysphonie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Dysphagia and a curtain sign are seen in facial nerve paralysis","correct":false,"justification":"Glossopharyngeal nerve paralysis (IX)"},{"idx":1,"proposition":"Velopharyngeal paralysis should be sought by nasal regurgitation and open rhinolalia in particular","correct":true},{"idx":2,"proposition":"Sensory signs are often very marked on the face","correct":false,"justification":"The sensory signs are not very marked: hypoaesthesia or hemianesthesia of the pharynx and veil on a limited area"},{"idx":3,"proposition":"Involvement of the accessory nerve XI (also called \"spinal\") internal results in paralysis of the wings of the nose","correct":false,"justification":"Involvement of the accessory nerve XI (also called \"spinal\") internal results in velopalatine paralysis"},{"idx":4,"proposition":"Stroboscopy allows you to visualize abnormalities of the pharynx","correct":false,"justification":"It allows, by the decomposition of the vibratory movement of the vocal cords, to visualize an anomaly localized at the level of the mucosa of the vocal cord (synechia, fibrous scar, beginning tumor)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dysphonie-neuro-3","context":null,"enonce":"Regarding diagnosis and etiologies:","item":"dysphonie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Laryngeal electromyography is useless and is reserved as a last resort for dysphonia more than 6 months of evolution","correct":false,"justification":"It confirms peripheral neurogenic syndromes (vocal cord paralysis), neuromuscular junction syndromes (myasthenic syndromes) and dystonic syndromes (spasmodic dysphonia)"},{"idx":1,"proposition":"The phoniatric examination consists of recording lip movements to assess a neurological cause","correct":false,"justification":"It consists, in addition to the laryngoscopic examination, in the realization of a voice recording and a study of the objective parameters of the voice"},{"idx":2,"proposition":"The reference imaging examination is ultrasound","correct":false,"justification":"CT scan or magnetic resonance imaging are the two useful tests for etiological diagnosis"},{"idx":3,"proposition":"In unilateral paralysis of the pneumogastric nerve, the voice is typically blown or bitonale","correct":true},{"idx":4,"proposition":"In Dysphonia by velopalatine paralysis, the voice is hoarse, deep and more intense","correct":false,"justification":"In unilateral paralysis, functional signs are reduced to a minimum: nasal voice, discrete swallowing disorders, fluids tending to flow back through the nose"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AVC-urg-0","context":null,"enonce":"About the epidemiology of stroke","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"The average age of stroke is 83 years","correct":false,"justification":"73 years (70 years for men, 76 years for women)"},{"idx":1,"proposition":"The incidence is 150,000 patients per year","correct":true},{"idx":2,"proposition":"50% of strokes are recurrences","correct":false,"justification":"0.25"},{"idx":3,"proposition":"Stroke is the leading cause of acquired motor disability in adults in France","correct":true},{"idx":4,"proposition":"Stroke is the leading cause of death in men","correct":false,"justification":"First cause of death in women, third leading cause of death in men"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"AVC-urg-1","context":null,"enonce":"Regarding the main clinical manifestations of cerebral infarctions according to arterial territories:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"The anterior circulation includes the opthalmic artery, the anterior cerebral artery and the middle cerebral artery.","correct":true,"justification":"Anterior circulation = carotid axes"},{"idx":1,"proposition":"Involvement of the anterior cerebral artery can result in a predominantly brachiofacial motor deficit.","correct":false,"justification":"Predominantly crural. Involvement of the middle (sylvian) cerebral artery results in a predominantly brachiofacial motor deficit."},{"idx":2,"proposition":"Involvement of the vertebrobasilar territory can give Wallenberg syndrome.","correct":true,"justification":"Via an attiente of the PICA (branch of the vertebral artery)"},{"idx":3,"proposition":"In the superficial sylvian artery of the minor hemisphere, there may be motor aphasia and Broca's fluent. ","correct":false,"justification":"Doubly false. It is an attack of the major hemisphere that will give Broca's aphasia. Broca's aphasia is motor and not fluent."},{"idx":4,"proposition":"Involvement of the anterior choroidal artery causes a syndrome of 3 H: hemiplegia, hemianesthesia and lateral hemianopsia homolateral to arterial occlusion. ","correct":false,"justification":"Controlateral to arterial occlusion"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AVC-urg-2","context":null,"enonce":"Regarding infarction of the territory of the middle cerebral artery (Sylvian artery):","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"A total sylvian cerebral infarction combines signs of superficial and deep cerebral infarction, but also a combined deviation of the head and eyes on the contralateral side to the lesion. ","correct":false,"justification":"The conjugated deviation of the head and eyes goes towards the lesion. Everything else in the statement is true."},{"idx":1,"proposition":"When the minor hemisphere is affected in superficial sylvian cerebral infarction, it is Anton-Babinksi syndrome.","correct":true,"justification":"This syndrome includes anosognosia, hemiasomatognosia and hemineglect."},{"idx":2,"proposition":"Deep sylvian cerebral infarction corresponds to an attack of the internal capsule, which causes a proportional massive hemiplegia.","correct":true,"justification":"Hemiplegia is proportional because all pyramidal fibers pass through the inner capsule. There will therefore be no coral or brachiofacial predominance at the clinic."},{"idx":3,"proposition":"There may be a homonymous lateral hemianopsia during a superficial sylvian cerebral infarction.","correct":true,"justification":"Caution: HLH is also present during damage to the posterior cerebral artery"},{"idx":4,"proposition":"Involvement of the minor hemisphere can cause anosognosia (non-recognition of the disorder), hemiasomatognosia (non-recognition of the paralyzed hemibody) and hemineglect","correct":true,"justification":"This is called Anton-Babinski syndrome."}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"AVC-urg-3","context":null,"enonce":"Regarding infarction of the territory of the anterior cerebral artery:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"There is predominantly brachiofacial hemiplegia.","correct":false,"justification":"Coral predominance (involvement of the paracentral lobule)"},{"idx":1,"proposition":"There may be ideomotor apraxia of the hand","correct":true},{"idx":2,"proposition":"There may be a frontal syndrome (adynamia, dysexecutive syndrome)","correct":true},{"idx":3,"proposition":"During unilateral and complete involvement of the anterior cerebral artery, there is an akinetic mutism","correct":false,"justification":"This would be true in the event of a bilateral infringement."},{"idx":4,"proposition":"The anterior cerebral artery and the sylvian artery can be affected at the same time","correct":true,"justification":"Possible in the context of thrombosis of the termination of the internal carotid artery (\"carotid T\")"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"AVC-urg-4","context":null,"enonce":"Regarding infarctions of the arteries vascularizing the brainstem:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"An alternate syndrome is defined by involvement of a cranial nerve on the side of the lesion and involvement of a long (sensory or motor) contralateral pathway to the lesion","correct":true,"justification":"Alternating syndromes are secondary to ischemic brainstem involvement"},{"idx":1,"proposition":"The most common alternate syndrome is protuberantial infarction","correct":false,"justification":"Wallenberg syndrome or infarction of the lateral part of the medulla elongata"},{"idx":2,"proposition":"The \"locked-in syndrome\" is caused by a bilateral infarction of the foot of the bridge (or protuberance)","correct":true},{"idx":3,"proposition":"The only possible movement during a \"locked-in syndrome\" is a horizontal movement of the eyes","correct":false,"justification":"Vertical"},{"idx":4,"proposition":"Brainstem infarctions are caused by damage to the vascularization of the posterior cerebral artery or basilar trunk","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AVC-urg-5","context":null,"enonce":"Regarding Wallenberg syndrome:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"It is an infarction of the lateral part of the medulla elongata (retrobulbar), by occlusion of the artery of the lateral dimple of the medulla elongata (from the posteroinferior cerebellar artery)","correct":true},{"idx":1,"proposition":"There may be a feeling of dizziness, balance problems and posterior headaches","correct":true},{"idx":2,"proposition":"On the side of the lesion, there will be damage to the spinothalamic bundle which causes thermoalgic anesthesia of the hemibody sparing the face","correct":false,"justification":"Alternate syndrome is defined as involvement of a cranial nerve on the side of the lesion and involvement of a long, sensory or motor pathway, contralateral to the injury. The spino-thalamic bundle is a long pathway, so there will be contralateral involvement to the lesion"},{"idx":3,"proposition":"On the side of the lesion, there will be: Claude Bernard-Horner syndrome (involvement of a sympathetic pathway), cerebellar hemisyndrome (involvement of the inferior cerebellar peduncle), vestibular syndrome with rotational nystagmus (involvement of VIII), phonation and swallowing disorders with paralysis of the hemiveil and hemipharynx (involvement of nerves IX and X) and anesthesia of the hemiface (involvement of the descending root of the V).","correct":true},{"idx":4,"proposition":"Wallenberg syndrome is also called alternate sensory syndrome","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AVC-urg-6","context":null,"enonce":"The multideficiency condition caused by the multiplication of small deep infarcts can cause:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"A bulbar syndrome","correct":false,"justification":"A pseudobulbar syndrome = damage to the central motor neurons of the corticobulbar pyramidal bundles"},{"idx":1,"proposition":"Spasmodic laughter and crying","correct":true},{"idx":2,"proposition":"A walk with small steps","correct":true},{"idx":3,"proposition":"Sphincter disorders","correct":true},{"idx":4,"proposition":"Deterioration of cognitive function","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AVC-urg-7","context":null,"enonce":"Regarding the dissection of the cervico-encephalic arteries:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"Neck pain or headache may be present","correct":true,"justification":"This is the essential sign of dissection, to look for in front of any infarction of the young subject (periorbital headache on carotid dissection, posterior on vertebral dissection)"},{"idx":1,"proposition":"There may be Claude Bernard-Horner syndrome","correct":true,"justification":"By pericarotid sympathetic plexus involvement (myosis, ptosis and enophthalmos)"},{"idx":2,"proposition":"There may be paralysis of the lower cranial nerves (IX, X, XI)","correct":true,"justification":"They travel along the internal carotid arer in the posterior subparotid space"},{"idx":3,"proposition":"There may be pulsatile tinnitus","correct":true,"justification":"By perception of the acceleration of blood flow in the intrapetrous carotid artery"},{"idx":4,"proposition":"The symptomatology associates an inconstant triad: neck pain \/ headache, local signs homolateral to dissection, and ischemic signs","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AVC-urg-8","context":null,"enonce":"Regarding the etiologies of stroke:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"80% of strokes are ischemic and 20% are hemorrhagic","correct":true},{"idx":1,"proposition":"Horton's disease can cause ischemic stroke","correct":true,"justification":"Horton's disease is a vasculitis of the large vessels, mainly affecting the encephalic vessels"},{"idx":2,"proposition":"Ischemic strokes caused by cardiac embolism are more common than strokes caused by atherosclerosis","correct":false,"justification":"Atherosclerosis is the leading cause of ischemic stroke (30% of ischemic strokes). Heart emboli cause about 20% of ischemic strokes."},{"idx":3,"proposition":"In 50% of ischemic strokes, the etiology is unknown","correct":false,"justification":"0.25"},{"idx":4,"proposition":"A dissection of the cervicoencephalic arteries should be sought during an ischemic stroke in young subjects","correct":true,"justification":"Always look for a traumatic cause, chronic hypertension or pathology of the arteries (connective tissue disease such as Ehlers-Danlos disease, fibromuscular dysplasia)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AVC-urg-10","context":null,"enonce":"The territories most frequently affected in microangiopathy associated with chronic hypertension, causing intraparenchymal hemorrhage, are:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"Capsulothalamic","correct":true,"justification":"Most frequent location"},{"idx":1,"proposition":"Frontal cortex","correct":false,"justification":"The 3 most frequent locations are, in order of frequency: capsulothalamic, capsulolenticular and cerebellar"},{"idx":2,"proposition":"The brainstem bridge","correct":false},{"idx":3,"proposition":"Capsulolenticular","correct":true},{"idx":4,"proposition":"Cerebellar","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AVC-urg-11","context":null,"enonce":"What is the leading cause of lobar intraparenchymal hemorrhage in the elderly?","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"Chronic hypertension","correct":false,"justification":"Typically deep"},{"idx":1,"proposition":"Long-term oral anticoagulants","correct":false},{"idx":2,"proposition":"Amyloid angiopathy","correct":true,"justification":"Often recurrent"},{"idx":3,"proposition":"Brain tumours","correct":false},{"idx":4,"proposition":"Infective endocarditis","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AVC-urg-13","context":null,"enonce":"Which are MRI sequences that are part of the emergency protocol for a stroke less than 6 hours old?","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"T2•","correct":true,"justification":"Allows to visualize any intraparenchymal hemorrhagic lesion"},{"idx":1,"proposition":"Time of flight","correct":true,"justification":"Angio-MR sequence (MRA) performed without injection of contrast medium, for the study of the branches of the Willis polygon and the visualization of a possible arterial occlusion."},{"idx":2,"proposition":"Infusion","correct":false,"justification":"Visualization of a hypoperfused area: the subtraction between infusion and diffusion makes it possible to identify the area of penumbra where the lesions are potentially reversible under treatment. On the other hand, it is not mandatory in the management of a heart attack less than 6 hours old."},{"idx":3,"proposition":"Broadcast sequence","correct":true,"justification":"Visualizes cerebral infarction very early in the form of systematized hyperintensity"},{"idx":4,"proposition":"T2-FLAIR","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AVC-urg-15","context":null,"enonce":"Regarding the control of blood pressure in the acute phase of a stroke:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"It is necessary to add an IV antihypertensive treatment (nicardipine type) if the BP > 140\/90 mmHg in a cerebral infarction.","correct":false,"justification":"The blood pressure surge is physiological in front of a stroke, to ensure adequate perfusion of the brain. Antihypertensive drugs should be introduced only when the BP > 220\/120 mmHg for cerebral infarction."},{"idx":1,"proposition":"Following treatment with thrombolysis or endovascular thrombectomy, blood pressure below 185\/110 mmHg must be maintained.","correct":true},{"idx":2,"proposition":"In front of intraparenchymal hemorrhage, the target BP is < 140\/90 mmHg","correct":true,"justification":"Increased BP may worsen intraparenchymal hemorrhage"},{"idx":3,"proposition":"High blood pressure should be routinely treated > 140\/90 mmHg in front of stroke","correct":false,"justification":"No, only if it is a hemorrhagic stroke"},{"idx":4,"proposition":"It is necessary to respect the blood pressure surge in front of an ischemic stroke","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AVC-urg-16","context":null,"enonce":"Regarding thrombolysis IV:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"The drug for thrombolysis IV is rt-PA (Recombinant Tissue-Plasminogen Activator, Alteplase)","correct":true},{"idx":1,"proposition":"It can only be introduced if the stroke schedule is known and is less than 4:30 a.m.","correct":false,"justification":"Warning: it is possible to introduce it if there is a FLAIR-diffusion mismatch in MRI on a stroke of indeterminate schedule"},{"idx":2,"proposition":"It induces a risk of angioedema","correct":true,"justification":"Especially in patients treated with ACE inhibitors"},{"idx":3,"proposition":"It induces a high risk of cerebral hemorrhage and gastric hemorrhage","correct":true},{"idx":4,"proposition":"Target blood pressure after IV thrombolysis is 220\/120 mmHg","correct":false,"justification":"TA < 185\/110 mmHg"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"AVC-urg-17","context":null,"enonce":"Regarding the antagonization of anticoagulants in case of intraparenchymal hemorrhage:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"Under VKA, PPSB and vitamin K should be administered urgently, at doses independent of the patient's weight","correct":false,"justification":"Adapted to the patient's weight"},{"idx":1,"proposition":"Under dabigatran, it is necessary to add its antidose which is idarucizumab","correct":true,"justification":"Reminder: Dabigatran is the only AOD that has an antidote"},{"idx":2,"proposition":"Oral anti-Xa may benefit from a specific antidote","correct":false,"justification":"PPSB or FEIBA must be administered urgently"},{"idx":3,"proposition":"When bleeding on antiplatelet agents, platelets can be transfused","correct":false,"justification":"Lack of demonstration of benefit"},{"idx":4,"proposition":"It is possible to add LMWH at isocoagulant dose (in the absence of contraindications) 24 hours after the onset of intraparenchymal hemorrhage","correct":true,"justification":"LMWH or intermittent pneumatic back pressure (standard of care to prevent thromboembolic complications in intracerebral haemorrhage)"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"certificats-psy-0","context":null,"enonce":"Among these proposals, which are principles of organ donation:","item":"certificats","matiere":"psy","propositions":[{"idx":0,"proposition":"Free consent","correct":true,"justification":"Free, enlightened, revocable, special"},{"idx":1,"proposition":"Anonymity","correct":true},{"idx":2,"proposition":"Financial compensation","correct":false,"justification":"It must be free"},{"idx":3,"proposition":"The absence of advertising","correct":true},{"idx":4,"proposition":"Health security","correct":true,"justification":"The donation must be made safely for both parties\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"certificats-psy-1","context":null,"enonce":"Which of the following are true?","item":"certificats","matiere":"psy","propositions":[{"idx":0,"proposition":"The law establishes the principle of inviolability (respect for the body) and non-patrimoniality (free donation) of the human body","correct":true},{"idx":1,"proposition":"Bioethics laws allow the removal of organs and tissues for therapeutic purposes in order to perform transplants and save lives","correct":true},{"idx":2,"proposition":"The state of brain death corresponds to the irreversible and isolated destruction of all intracranial nerve centers following complete brain circulatory arrest","correct":true},{"idx":3,"proposition":"The diagnosis of brain death is clinical","correct":false,"justification":"The diagnosis of brain death includes a clinical aspect and the use of confirmation by a paraclinical examination having medico-legal value in the context of a possible organ donation"},{"idx":4,"proposition":"There is no additional test to be done to diagnose a state of brain death","correct":false,"justification":"The paraclinical examinations to arm the diagnosis of brain death state are either two electroencephalograms (EEG) performed four hours apart under maximum amplification, or cerebral angiography (arteriography of the four cerebral vascular axes or cerebral angiography of easier realization)\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"certificats-psy-2","context":null,"enonce":"Which of the following are true?","item":"certificats","matiere":"psy","propositions":[{"idx":0,"proposition":"The report of brain death must be signed by a doctor","correct":false,"justification":"The report of brain death is signed by two doctors"},{"idx":1,"proposition":"In case of death with \"heart stopped\", the report must be signed by a doctor","correct":true},{"idx":2,"proposition":"Consent to organ removal is no longer revocable when the donor enters the hospital","correct":false,"justification":"Consent to organ or tissue removal may be revoked at any time"},{"idx":3,"proposition":"Patients diagnosed with brain death (EM) are the main potential organ and tissue donors","correct":true},{"idx":4,"proposition":"It may be decided not to remove certain organs if the patient had expressed this wish during his lifetime.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"certificats-psy-3","context":null,"enonce":"Regarding consent or refusal of organ donation","item":"certificats","matiere":"psy","propositions":[{"idx":0,"proposition":"The first kidney transplants were performed in the 1960s and 1970s while the first heart was successfully transplanted in 1967 (Professor Barnard in Cape Town)","correct":true},{"idx":1,"proposition":"The principle of inviolability of the human body means that an individual does not sell his body","correct":false,"justification":"Consent The principle of inviolability of the human body means that an individual cannot be compelled to suffer harm to his or her body."},{"idx":2,"proposition":"In France, the law specifies that organ or tissue removal may be carried out only if the deceased person has not made known his refusal during his lifetime (art.","correct":true},{"idx":3,"proposition":"Any elderly adult may register on the national register of refusals of organ removal","correct":false,"justification":"Anyone over the age of thirteen can register or unsubscribe confidentially on this register"},{"idx":4,"proposition":"In the case of an oral expression of the refusal, the medical team will ask the relatives to specify the circumstances and to sign the transcript that will be made in writing.","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"certificats-psy-5","context":null,"enonce":"Which communicable diseases are urgently detected in the donor?","item":"certificats","matiere":"psy","propositions":[{"idx":0,"proposition":"HIV1 and HIV2","correct":true},{"idx":1,"proposition":"Hepatitis A","correct":false,"justification":"Hepatitis B and C"},{"idx":2,"proposition":"Malaria","correct":false,"justification":"CMV, VRB, Syphilis, Toxoplasmosis, HIV1 and 2, HTLV1 and 2, HBV and HCV"},{"idx":3,"proposition":"Syphilis","correct":true},{"idx":4,"proposition":"Whooping cough","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"certificats-psy-7","context":null,"enonce":"Which of these reflexes can persist even in the event of brain death?","item":"certificats","matiere":"psy","propositions":[{"idx":0,"proposition":"The Achilles reflex","correct":true,"justification":"It is a spinal cord reflex"},{"idx":1,"proposition":"Babinsky's sign","correct":true,"justification":"Spinal cord reflex"},{"idx":2,"proposition":"Reaction myosis","correct":false,"justification":"It is a brainstem reflex. Patients in EME (brain death state) are in areactive mydriasis"},{"idx":3,"proposition":"The sign of lazarus","correct":true,"justification":"This is the abduction or adduction of the arm after nociceptive stimulation"},{"idx":4,"proposition":"The cutaneous-plantar reflex","correct":true,"justification":"Synonym of Babinski's sign\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"certificats-psy-8","context":null,"enonce":"Regarding the diagnosis of EME","item":"certificats","matiere":"psy","propositions":[{"idx":0,"proposition":"The diagnosis of ME is only clinical","correct":false,"justification":"Diagnosis of brain death The diagnosis of ME is primarily clinical but must be confirmed by a paraclinical examination"},{"idx":1,"proposition":"Brain angio-CT is more used than arteriography to confirm an EME","correct":true,"justification":"Cerebral angio-CT is currently the most common examination performed"},{"idx":2,"proposition":"CT angiography is not recommended because it is less specific than arteriography.","correct":false,"justification":"It is a fast and minimally invasive technique with a protocol defined by the French Society of Neuroradiology, Radiology and the ABM"},{"idx":3,"proposition":"The angioscanner is mainly done at portal time to visualize the sinuses","correct":false,"justification":"It is performed at least 6 hours after the clinical diagnosis of ME and includes 4 series of acquisitions, 3 successive and identical after the injection of contrast medium, and a last 60 seconds after the start of the injection"},{"idx":4,"proposition":"CT angiography requires an average blood pressure greater than 65 mmHg","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"certificats-psy-9","context":null,"enonce":"Concerning the sampling in case of EME or stopped heart","item":"certificats","matiere":"psy","propositions":[{"idx":0,"proposition":"The diagnosis of ME is established at the end of the paraclinical examination whose time of realization signs the time of death of the patient","correct":true},{"idx":1,"proposition":"The report of encephalic death must be drawn up and signed by 2 doctors not belonging to the transplant services","correct":true},{"idx":2,"proposition":"Organ harvesting procedure can begin as soon as brain death is suspected","correct":false,"justification":"Once this diagnosis is established, the procedure of organ and tissue removal can be initiated while the organs and tissues are maintained in survival through resuscitation."},{"idx":3,"proposition":"If the heart stops, this organ may be considered to transplant a recipient in need.","correct":false,"justification":"The deceased donor with heart arrested (corpse) 52 Only tissue samples (corneas and skin) are possible in this context"},{"idx":4,"proposition":"For heart-stamped donors, we can do without respect for consent","correct":false,"justification":"Tissue samples are subject to the same legislation as in the case of EM concerning the rules of health safety and consent (search for the non-opposition of the donor on the RNR and with relatives)\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ProtU-nephro-2","context":null,"enonce":"Regarding proteinuria:","item":"ProtU","matiere":"nephro","propositions":[{"idx":0,"proposition":"Isolated tubular proteinurias are very common after age 75","correct":false,"justification":"They are rare and most often accompany Fanconi syndrome"},{"idx":1,"proposition":"Microalbuminuria is specific for glomerular involvement when the patient is diabetic","correct":true},{"idx":2,"proposition":"Microalbuminuria is an independent marker of high cardiovascular risk","correct":true},{"idx":3,"proposition":"Orthostatic proteinuria occurs during puberty","correct":true},{"idx":4,"proposition":"Orthostatic proteinuria requires MRI centered on the hypothalamic-pituitary area","correct":false,"justification":"Orthostatic proteinuria does not require any additional examination"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ProtU-nephro-3","context":null,"enonce":"Regarding vascular thrombosis and coagulation abnormalities in nephrotic syndrome: ","item":"ProtU","matiere":"nephro","propositions":[{"idx":0,"proposition":"Thrombosis concerns only the arterial territory","correct":false},{"idx":1,"proposition":"Venous thrombosis of the renal veins and cerebral venous sinuses may occur ","correct":true},{"idx":2,"proposition":"There is increased urinary loss of procoagulant factors","correct":false,"justification":"Anticoagulant"},{"idx":3,"proposition":"There is an increased synthesis of procoagulant factors (antithrombin III, Protein S ...)","correct":false,"justification":"Antithrombin III and Prot S are anticoag factors. True if Factor V, VIII, fibrinogen ...)"},{"idx":4,"proposition":"Anticoagulant therapy is prescribed if albumin is < 30 g\/L ","correct":false,"justification":"20 g\/L"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"ProtU-nephro-4","context":null,"enonce":"Which of the following are secondary causes of nephrotic syndrome? : ","item":"ProtU","matiere":"nephro","propositions":[{"idx":0,"proposition":"Diabetes","correct":true},{"idx":1,"proposition":"HIV ","correct":true},{"idx":2,"proposition":"Isolated monoclonal gammopathy ","correct":true},{"idx":3,"proposition":"D-penicillamine","correct":true},{"idx":4,"proposition":"Pre-eclampsia ","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"ProtU-nephro-5","context":null,"enonce":"At the biospy of a nephrotic syndrome, we can find:","item":"ProtU","matiere":"nephro","propositions":[{"idx":0,"proposition":"Minimal glomerular lesions ","correct":true},{"idx":1,"proposition":"Extramembranous granular deposits of IgG and C3 without cell proliferation ","correct":true,"justification":"GEM can manifest as nephrotic syndrome"},{"idx":2,"proposition":"Mass deposits of IgA ","correct":true,"justification":"Rare that Berger's disease presents with nephrotic syndrome, svt hematuric syndrome"},{"idx":3,"proposition":"Extracapillary croissants ","correct":false,"justification":"Ds les GNRP"},{"idx":4,"proposition":"Amyloid deposits ","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"ProtU-nephro-6","context":null,"enonce":"Which of the following proposals would be in favor of extracellular hyperhydration?","item":"ProtU","matiere":"nephro","propositions":[{"idx":0,"proposition":"Weight gain","correct":true},{"idx":1,"proposition":"Jugular turgor","correct":true},{"idx":2,"proposition":"Declivated edema","correct":true},{"idx":3,"proposition":"Headache","correct":false,"justification":"Does not fit into this framework"},{"idx":4,"proposition":"Crackling of the 2 pulmonary bases","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"ProtU-nephro-7","context":null,"enonce":"Which of the following propositions concerning physiological proteinuria is or are true?","item":"ProtU","matiere":"nephro","propositions":[{"idx":0,"proposition":"It is by definition < 0.5g\/day","correct":false},{"idx":1,"proposition":"It is composed mainly of light chains","correct":false,"justification":"Especially low molecular weight proteins (< 70kDa)"},{"idx":2,"proposition":"It is composed mainly of low molecular weight proteins","correct":true},{"idx":3,"proposition":"It may be associated with orthostatic hematuria","correct":false,"justification":"No physiologically orthostatic hematuria"},{"idx":4,"proposition":"It can be detected by the urine strip","correct":false,"justification":"BU only detects albumin"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRC-nephro-0","context":null,"enonce":"Regarding general information on chronic kidney disease (CKD) and end-stage renal disease (ESRD):","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"proposition":"Chronic renal failure is defined by the irreversible decrease in glomerular filtration rate","correct":true},{"idx":1,"proposition":"The only treatment for end-stage renal disease is kidney transplantation","correct":false,"justification":"And\/or extrarenal purification (hemodialysis or peritoneal dialysis)"},{"idx":2,"proposition":"End-stage renal disease is more common in men than in women","correct":true},{"idx":3,"proposition":"The leading cause of end-stage renal disease is chronic interstitial nephropathy","correct":false,"justification":"It is vascular and hypertensive nephropathy (25%), followed closely by diabetic nephropathy (22%)"},{"idx":4,"proposition":"Obesity is a risk factor for CKD","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"IRC-nephro-1","context":null,"enonce":"Among these proposals, which are arguments of chronic kidney disease:","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"proposition":"Benign cysts detected on CT","correct":false,"justification":"CT = Scanner. They are often without impact on the kidney"},{"idx":1,"proposition":"Chronic hypocalcemia","correct":true,"justification":"By active vitamin D deficiency due to the absence of renal hydroxylation (in position 1. As a reminder, hepatic hydroxylation is in position 25)"},{"idx":2,"proposition":"Aregenerative anemia","correct":true,"justification":"Default production of erythropoietin. It is often normocytic and normochromic, as well as well tolerated because of progressive installation."},{"idx":3,"proposition":"Recurrent low urinary tract infections","correct":false,"justification":"Generally without impact on the renal parenchyma, unless they are pyelonephritis"},{"idx":4,"proposition":"Kidneys with a major axis of less than 10 cm on ultrasound","correct":true,"justification":"A decrease in the size of the kidneys is a morphological criterion\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRC-nephro-2","context":null,"enonce":"Which propositions are true?","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"proposition":"In some tubulopathies, the diagnosis of CKD is based on the existence of blood ion abnormalities","correct":true},{"idx":1,"proposition":"The GFR can only be estimated by formulas ","correct":false,"justification":"GFR can be measured by measuring the clearance of exogenous tracers filtered as such by the kidney (such as inulin)"},{"idx":2,"proposition":"The Cockcroft and Gault formula is the most accurate for assessing GFR from creatitinemia","correct":false,"justification":"It is much less accurate than MDRD, and CKD-PPE when GFR is greater than 60. But it is calculable without a computer, so potentially requested for examination"},{"idx":3,"proposition":"The deadline to declare kidney disease as chronic is 3 months","correct":true},{"idx":4,"proposition":"There are 5 stages of CKD","correct":true,"justification":"They are differentiated by the GFR: >=90, 60, 45, 30, <15"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRC-nephro-3","context":null,"enonce":"Which propositions are true?","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"proposition":"The incidence of terminal IR is 1200 patients per million inhabitants in metropolitan France","correct":false},{"idx":1,"proposition":"There are areas where there are almost as many transplant patients as hemodialysis patients","correct":true},{"idx":2,"proposition":"An RCM can only be established after three months of GFR decline","correct":true,"justification":"Below 3 months, we can not talk about MRC"},{"idx":3,"proposition":"CKD is accompanied by metabolic alkalosis with increased bicarbonates","correct":false,"justification":"Metabolic acidosis is observed by decreased acid filtration"},{"idx":4,"proposition":"Significantly reduced kidneys are an anamnestic criterion for CKD","correct":false,"justification":"Morphological criterion"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRC-nephro-4","context":null,"enonce":"Which of these proposals are expected complications of IRC?","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"proposition":"Metabolic acidosis","correct":true,"justification":"By decreasing acid filtration, and is aggravated by protein catabolism. There are therapeutic proposals: bicarbonates, Vichy water..."},{"idx":1,"proposition":"A HTA","correct":true,"justification":"Volo-dependent, with consecutive HVG"},{"idx":2,"proposition":"Type 2 diabetes","correct":false,"justification":"Not a consequence, but a common cause"},{"idx":3,"proposition":"Normochrome normocytic aregenerative anemia","correct":true,"justification":"By EPO deficiency"},{"idx":4,"proposition":"Primary hyperparathyroidism","correct":false,"justification":"It is secondary to the decrease in serum calcium (itself due to the deficiency of hydroxylation of 25-OH-VitamineD by the kidney)"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"IRC-nephro-5","context":null,"enonce":"Regarding complications of CKD:","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"proposition":"Hyperuricemia can cause heart problems","correct":true},{"idx":1,"proposition":"Hyperuricemia is never symptomatic","correct":false,"justification":"It is often asymptomatic, but in case of a gout attack, treatment is necessary"},{"idx":2,"proposition":"Hyperphosphremia is often found","correct":true},{"idx":3,"proposition":"Is aimed at a blood pressure control with a BP < 140\/90mmHg in case of albuminuria < 30g \/ 24h","justification":"Small trap: take a good look at the units... (sorry)","correct":false},{"idx":4,"proposition":"IEC and ARA2 are so-called \"nephroprotective\" treatments","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRC-nephro-6","context":null,"enonce":"Which of the following propositions regarding dyalsis and transplantation are true?","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"proposition":"Hemodialysis is the most frequently used replacement technique in France","correct":true,"justification":"True, it is also the most expensive"},{"idx":1,"proposition":"Hemodialysis is based on two types of transfers: conductive and dynamic.","correct":false,"justification":"2 types of exchanges: diffusion and convection"},{"idx":2,"proposition":"Peritoneal dialysis is performed at home and is better tolerated hemodynamically","correct":true},{"idx":3,"proposition":"Peritoneal dialysis is a time-limited technique","correct":true,"justification":"True, mainly because of the alteration of the peritoneum which is a membrane that fibrosis by force"},{"idx":4,"proposition":"Kidney transplantation provides a better life expectancy than dyalsis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IRC-nephro-7","context":null,"enonce":"Which of the following propositions on kidney transplantation are true?","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"proposition":"Cadaveric donors can be heart-stamped","correct":true},{"idx":1,"proposition":"The grafts are managed by the ANSM","correct":false,"justification":"The Biomedicine Agency"},{"idx":2,"proposition":"Induction therapy may be anti-lymphocyte serum, rituximab or corticosteroids","correct":true},{"idx":3,"proposition":"Ciclosporin and tacrolimus are calcineurin inhibitors  ","correct":true},{"idx":4,"proposition":"Belatacept selectively blocks the interaction of CD80\/CD86 antigen-presenting cells with the CD28 molecule of the T cell","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"palpitations-cardio-0","context":null,"enonce":"Regarding palpitations","item":"palpitations","matiere":"cardio","propositions":[{"idx":0,"proposition":"Palpitations are an abnormal perception of normal or abnormal heartbeats","correct":true},{"idx":1,"proposition":"These are objective disorders that may or may not indicate a cardiac abnormality","correct":false,"justification":"Subjective disorders with or without cardiac abnormality"},{"idx":2,"proposition":"Often anxiety-provoking","correct":true},{"idx":3,"proposition":"The diagnosis is made mainly during the interrogation","correct":true},{"idx":4,"proposition":"Look for other symptoms that would immediately change management, such as chest pain, loss of consciousness\/syncope, dyspnea","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"palpitations-cardio-1","context":null,"enonce":"Regarding palpitations","item":"palpitations","matiere":"cardio","propositions":[{"idx":0,"proposition":"A pulse > 150 bpm is a sign of gravity","correct":true},{"idx":1,"proposition":"The initial ECG is often normal","correct":true},{"idx":2,"proposition":"Routine biological tests (ionogram, CBC, blood alcohol level, troponinemia, β-HCG, TSH in particular) are necessary in front of palpitations","correct":true},{"idx":3,"proposition":"Extrasystoles are not a pathological element in themselves, but are a clue to look for underlying heart disease or extracardiac pathology","correct":true},{"idx":4,"proposition":"Isolated extrasystoles may explain palpitations","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"palpitations-cardio-2","context":null,"enonce":"Regarding palpitations","item":"palpitations","matiere":"cardio","propositions":[{"idx":0,"proposition":"Common causes of extrasystoles include alcoholization, lung disease, bronchial neoplasia, hyperthyroidism, electrolyte abnormalities, pregnancy","correct":true},{"idx":1,"proposition":"Cardiac neurosis can cause palpitations but remains a diagnosis of elimination, sometimes self-maintained by management or iterative consultations","correct":true},{"idx":2,"proposition":"The diagnosis of cardiac neurosis is based on a strictly normal ECG at the time of palpitations, often obtained through long-term monitoring","correct":true},{"idx":3,"proposition":"Palpitations are a banal symptom that disappears behind a possible more serious symptom such as syncope, chest pain or dyspnea","correct":true},{"idx":4,"proposition":"The primary objective of management is to rule out signs of severity related to terrain, poor hemodynamic tolerance or immediate registration of ventricular rhythm disorder","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"palpitations-cardio-3","context":null,"enonce":"Regarding palpitations","item":"palpitations","matiere":"cardio","propositions":[{"idx":0,"proposition":"Once the immediate emergency is managed, the next two objectives are the search for heart disease or extracardiac disease and electrocardiographic documentation","correct":true},{"idx":1,"proposition":"Simultaneous ECG documentation of symptoms leads to the notion of electroclinical correlation","correct":true},{"idx":2,"proposition":"Electroclinical correlation may require in order of increasing complexity, standard ECG, Holter 24–96 hours, ambulatory monitoring 21 days, endocavitary electrophysiological study and implantable monitor","correct":true},{"idx":3,"proposition":"The final diagnosis may be limited to sinus tachycardia or extrasystoles whose extracardiac causes must be known.","correct":true},{"idx":4,"proposition":"Among the rhythm disorders responsible for palpitations, atrial fibrillation and flutter are the most common with following junctional tachycardia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrped-ped-0","context":null,"enonce":"Regarding pain in children:","item":"dlrped","matiere":"ped","propositions":[{"idx":0,"proposition":"It often has a triphase presentation: appearance, plateau, disappearance","correct":false,"justification":"Biphasic: acute then prolonged"},{"idx":1,"proposition":"Collaboration with parents is essential for good care","correct":true,"justification":"It's one of the situations where you have to include them"},{"idx":2,"proposition":"The first step in management is pain assessment","correct":true},{"idx":3,"proposition":"Therapy differs from adults and is specific to children","correct":false,"justification":"The therapeutic principles are close to those of adults"},{"idx":4,"proposition":"There is a specific MA for use in paediatrics","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dlrped-ped-1","context":null,"enonce":"From what age a pain self-assessment can be proposed","item":"dlrped","matiere":"ped","propositions":[{"idx":0,"proposition":"1 year","correct":false,"justification":"4 years"},{"idx":1,"proposition":"4 years","correct":true},{"idx":2,"proposition":"8 years","correct":false},{"idx":3,"proposition":"6 years","correct":false},{"idx":4,"proposition":"10 years","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrped-ped-2","context":null,"enonce":"From what age a pain self-assessment is reliable","item":"dlrped","matiere":"ped","propositions":[{"idx":0,"proposition":"1 year","correct":false},{"idx":1,"proposition":"4 years","correct":false},{"idx":2,"proposition":"8 years","correct":false,"justification":"6 years"},{"idx":3,"proposition":"6 years","correct":true},{"idx":4,"proposition":"10 years","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"dlrped-ped-3","context":null,"enonce":"Which of the following propositions concerning pain in children are true?","item":"dlrped","matiere":"ped","propositions":[{"idx":0,"proposition":"Tramadol is indicated in pediatrics for severe pain from the age of 3 years","correct":true,"justification":"True, EVA > 5\/10"},{"idx":1,"proposition":"Paracetamol is indicated in case of neuropathic pain","correct":false,"justification":"False, pain by excess of nociception especially. For neuropathic pain, amitryptilline (antidepressant) or gabapentin (antiepileptic) are used in MA"},{"idx":2,"proposition":"The dosage of paracetamol in children is 60 mg \/ kg \/ day in 4 doses","correct":true,"justification":"True, 15 mg\/kg per dose"},{"idx":3,"proposition":"Paracetamol is contraindicated in newborns","correct":false,"justification":"The AMM authorizes it from birth"},{"idx":4,"proposition":"Codeine is possible from the age of 12 (unless contraindicated)","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrped-ped-4","context":null,"enonce":"Which of the following can be used in a 2-year-old child?","item":"dlrped","matiere":"ped","propositions":[{"idx":0,"proposition":"EVENDOL","correct":true,"justification":"True, always a hetero-evaluation before 4 years"},{"idx":1,"proposition":"Hetero-rating scale","correct":true},{"idx":2,"proposition":"Visual Analogue Scale (EVA)","correct":false,"justification":"Reliable self-assessment from 6 years old"},{"idx":3,"proposition":"Numerical scale","correct":false,"justification":"False"},{"idx":4,"proposition":"Face scale (Wong and Baker)","correct":false,"justification":"Validated self-report scale in adults and the elderly with difficulty using VAS, EN or EVS, e.g. in patients with verbalization difficulties"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"handicapped-mpr-0","context":null,"enonce":"Which propositions are true?","item":"handicapped","matiere":"mpr","propositions":[{"idx":0,"proposition":"The occurrence of a disability or chronic disease in children is a relatively common situation in France","correct":true},{"idx":1,"proposition":"Cerebral palsy is the leading cause of motor disability","correct":true},{"idx":2,"proposition":"Cerebral palsy is related to a brain injury that occurred in the antenatal or perinatal period","correct":true},{"idx":3,"proposition":"The main risk factor for cerebral palsy is genetic deficiency","correct":false,"justification":"The main risk factor for cerebral palsy is prematurity"},{"idx":4,"proposition":"trisomy 21 and fetal alcohol syndrome (FAS) are the leading cause of mental retardation, respectively hereditary and non-hereditary","correct":true,"justification":"V"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"handicapped-mpr-1","context":null,"enonce":"Regarding the generalities of disability in children:","item":"handicapped","matiere":"mpr","propositions":[{"idx":0,"proposition":"Multiple disability is a severe disability associated with severe and long-term impairment with severe or profound mental retardation.","correct":true},{"idx":1,"proposition":"Over-disability is the addition of secondary impairments or behavioural disorders to a pre-existing disability","correct":true},{"idx":2,"proposition":"The child's disabilities are always congenital","correct":false,"justification":"Can be acquired: trauma, iatrogenic, etc."},{"idx":3,"proposition":"The child is an adult in miniature","correct":false,"justification":"The child is a developing being! It is not an adult in miniature"},{"idx":4,"proposition":"The goal of rehabilitation care is to correct the disabling lesion","correct":false,"justification":"The goal of rehabilitation care is to assess and limit the consequences of this lesion and to stimulate the development of the child (brain plasticity)"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"handicapped-mpr-3","context":null,"enonce":"Concerning the management of disability in children:","item":"handicapped","matiere":"mpr","propositions":[{"idx":0,"proposition":"The care of a disabled child must be centered around the medical and psychological","correct":false,"justification":"It must be comprehensive: medically, psychologically, academically and socially."},{"idx":1,"proposition":"Support is personalized","correct":true},{"idx":2,"proposition":"The role of the team is to care for the child and reassure the family","correct":false,"justification":"The role of the team is to support, inform and guide them"},{"idx":3,"proposition":"The doctor specialized in PKD receives the child in his private practice and refers to the hospital if problem","correct":false,"justification":"The doctor specialized in PKD receives the child during outpatient and\/or multidisciplinary consultations in the hospital and in medico-educational structures (SESSAD, CAMPS, IEM, IME)"},{"idx":4,"proposition":"The MDPH must provide unique access to the rights and benefits of persons with disabilities and their families","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dyspnee-pneumo-0","context":null,"enonce":"Regarding the general diagnosis of dyspnea:","item":"dyspnee","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Acute dyspnea is an emergency until proven otherwise","correct":true},{"idx":1,"proposition":"Inspiratory dyspnea indicates cardiac involvement","correct":false,"justification":"It indicates upper airway involvement"},{"idx":2,"proposition":"Orthopnea is a strong sign of heart failure","correct":true},{"idx":3,"proposition":"Wheezing dyspnea is pathognomonic of asthma","correct":false,"justification":"May also sign COPD or heart failure in the elderly"},{"idx":4,"proposition":"A pulmonary embolism is rarely expressed by isolated dyspnea","correct":false,"justification":"This is often the case"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dyspnee-pneumo-1","context":null,"enonce":"Which propositions are true>","item":"dyspnee","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Dyspnea is synonymous with polypnea","correct":false,"justification":"This is different. Dyspnea = SUBJECTIVE discomfort with breathing"},{"idx":1,"proposition":"Smoking is a key criterion of interrogation","correct":true},{"idx":2,"proposition":"Dyspnea is respiratory discomfort for a level of activity that do not normally cause discomfort","correct":true},{"idx":3,"proposition":"Dyspnea and tachypnea are mutually exclusive","correct":false,"justification":"Often associated, but to differentiate semiologically"},{"idx":4,"proposition":"Involuntary respiratory control is found in the brainstem","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dyspnee-pneumo-2","context":null,"enonce":"Which propositions are true?","item":"dyspnee","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Inspiratory dyspnea with horn signs bronchial pathology","correct":false,"justification":"Directs instead to the upper airway"},{"idx":1,"proposition":"Antepnea is a dyspnea that appears when the patient is leaning forward","correct":true},{"idx":2,"proposition":"Tachypnea and polypnea are synonymous","correct":true},{"idx":3,"proposition":"Cyanosis and sweating are signs of acute respiratory distress","correct":true},{"idx":4,"proposition":"A bradypnea corresponds to a FR < 10\/min","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dyspnee-pneumo-3","context":null,"enonce":"Regarding acute dypnea:","item":"dyspnee","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Mottling is a sign of shock","correct":true},{"idx":1,"proposition":"Harzer's sign is a sign of acute right ventricular failure","correct":true},{"idx":2,"proposition":"Dyspnea with prolonged inspiratory time signs obstruction of the VAS","correct":true},{"idx":3,"proposition":"A horn signs the obstruction of the VAS","correct":true},{"idx":4,"proposition":"Right heart failure can cause obstruction of the VAS","correct":false,"justification":"3 etiologies: foreign body, angioedema, laryngitis"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dyspnee-pneumo-4","context":null,"enonce":"Which propositions are true?","item":"dyspnee","matiere":"pneumo","propositions":[{"idx":0,"proposition":"A prolongation of the expiratory time evokes a pathology of the VAS","correct":false,"justification":"Rather bronchi"},{"idx":1,"proposition":"Wheezing and sibilants sign bronchial involvement","correct":true},{"idx":2,"proposition":"Asthma attack is the first etiology of dyspnea with inspiratory prolongation in the elderly","correct":false,"justification":"We think especially in the allergic young subject during an expiratory elongation with hissing and sibilants"},{"idx":3,"proposition":"A context of bed rest reinforces the suspicion of PE","correct":true},{"idx":4,"proposition":"Foamy coughs and sputum point to a cardiac cause","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"dyspnee-pneumo-5","context":null,"enonce":"Which propositions are true?","item":"dyspnee","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Normal auscultation eliminates the diagnosis of PE","correct":false,"justification":"It is often normal in PE"},{"idx":1,"proposition":"Hoover's sign is a sign of chronic respiratory failure","correct":true},{"idx":2,"proposition":"Pursed lip breathing is a sign of heart failure","correct":false,"justification":"Chronic respiratory failure"},{"idx":3,"proposition":"Anginal pain leads to a heart abnormality","correct":true},{"idx":4,"proposition":"Quantifying dyspnea in chronic situations is useless","correct":false,"justification":"This makes it possible to evaluate the evolution and impact of the care"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dyspnee-pneumo-7","context":null,"enonce":"What is the norm of Respiratory Rate (per minute) in a 2-month-old child?","item":"dyspnee","matiere":"pneumo","propositions":[{"idx":0,"proposition":"40–60","correct":false,"justification":"Norm in infants"},{"idx":1,"proposition":"30–50","correct":true,"justification":"True. Norm between 1 and 6 months"},{"idx":2,"proposition":"20–40","correct":false,"justification":"Standard between 6 and 24 months"},{"idx":3,"proposition":"16-30","correct":false,"justification":"Standard between 2 and 12 years"},{"idx":4,"proposition":"12-20","correct":false,"justification":"Standard from 13 years"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dyspnee-pneumo-8","context":null,"enonce":"What is the standard respiratory rate (per minute) in a 6-year-old child?","item":"dyspnee","matiere":"pneumo","propositions":[{"idx":0,"proposition":"40–60","correct":false,"justification":"Norm in infants"},{"idx":1,"proposition":"30–50","correct":false,"justification":"Norm between 1 and 6 months"},{"idx":2,"proposition":"20–40","correct":false,"justification":"Standard between 6 and 24 months"},{"idx":3,"proposition":"16–30","correct":true,"justification":"True, norm between 2 and 12 years"},{"idx":4,"proposition":"12–20","correct":false,"justification":"Standard from 13 years"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"palu-infectio-0","context":null,"enonce":"Regarding malaria:","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":" Any suspicion of malaria is a diagnostic and therapeutic emergency","correct":true,"justification":"See item in the latest edition of the college"},{"idx":1,"proposition":" Diagnosis is based on the combination of a sensitive technique (thick drop or molecular biology) on a thin blood smear","correct":true},{"idx":2,"proposition":"Only Plasmodium falciparum species (> 90% of accesses) can cause severe malaria attacks","correct":false,"justification":"P. knowleso (5% of accesses) too"},{"idx":3,"proposition":"The presence of signs of severity requires transfer to intensive care","correct":true,"justification":"See item in the latest edition of the college"},{"idx":4,"proposition":"Artesunate IV is the standard of care for severe malaria, with quinine used only if artesunate is not immediately available","correct":true,"justification":"See item in the latest edition of the college"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"palu-infectio-1","context":null,"enonce":"Regarding malaria:","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":" Artemisinin-based combinations are indicated as a 1st line in uncomplicated Plasmodium spp. import malaria","correct":true,"justification":"See item in the latest edition of the college"},{"idx":1,"proposition":"Vector control personal protection measures should be explained to any traveller travelling to malaria-endemic areas","correct":true,"justification":"See item in the latest edition of the college"},{"idx":2,"proposition":"In France, the HAS publishes annual health recommendations for travellers for health professionals.","correct":false},{"idx":3,"proposition":"Malaria is a protozoosis caused by a haematozoan of the genus Plasmodium","correct":true},{"idx":4,"proposition":"2 plasmodial species pathogenic to humans","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"palu-infectio-2","context":null,"enonce":"Regarding malaria:","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"The vector of malaria is the male anopheles","correct":false},{"idx":1,"proposition":"Anopheles does not make noise and its bite is painless","correct":true,"justification":"See item in the latest edition of the college"},{"idx":2,"proposition":"Manifestations of malaria are due to erythrocyte schizogonia","correct":true,"justification":"See item in the latest edition of the college"},{"idx":3,"proposition":"The severity of manifestations depends on the species of Plasmodium, parasitemia and host immunity","correct":true},{"idx":4,"proposition":"The clinical manifestations of malaria are mainly those of aregenerative anaemia","correct":false,"justification":"The clinical manifestations of malaria are essentially those of hemolytic anemia: fever, chills (hemolysis releases a pyrogenic substance), progressing by access, interspersed with periods of clinical remission"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"palu-infectio-3","context":null,"enonce":"Regarding malaria:","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Sub-Saharan Africa is the source of 90% of global cases, mostly due to P. knowlesi","correct":false,"justification":"Mostly due to P falciparum"},{"idx":1,"proposition":" Approximately 4,000 cases of imported malaria per year are reported in France","correct":true},{"idx":2,"proposition":"Antimalarial chemoprophylaxis, even if taken correctly, does not completely eliminate the risk","correct":true,"justification":"See item in the latest edition of the college"},{"idx":3,"proposition":"Any fever during a stay in a malaria-endemic area should evoke the diagnosis of malaria","correct":true},{"idx":4,"proposition":"Malaria attacks of Plasmodium falciparum can occur from 7 days after the first exposure in endemic areas and up to 3 months after leaving this area","correct":true,"justification":"See item in the latest edition of the college"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"palu-infectio-4","context":null,"enonce":"Which of the following are true?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Any fever returning from a tropical stay is malaria until proven otherwise.","correct":true},{"idx":1,"proposition":"The annual incidence is about 4000 in France","correct":true},{"idx":2,"proposition":"Malaria is caused by gram-positive bacteria","correct":false,"justification":"It is a protozoosis"},{"idx":3,"proposition":"Plasmodium knowlesi is the most common","correct":false,"justification":"It is rare (less than 1%). It is Plasmodium falciparum the most common (> 90%)"},{"idx":4,"proposition":"The incubation period can be up to 3 months","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"palu-infectio-5","context":null,"enonce":"Which of the following are signs or symptoms of malaria?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Fever & Chill","correct":true},{"idx":1,"proposition":"Jaundice","correct":true},{"idx":2,"proposition":"Thrombocytosis","correct":false,"justification":"Instead, thrombocytopenia is found"},{"idx":3,"proposition":"Sciatica","correct":false,"justification":"No report"},{"idx":4,"proposition":"Conspitation","correct":false,"justification":"Rather, diarrhea is found"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"palu-infectio-6","context":null,"enonce":"Which of the following propositions are true for first-line treatments for malaria?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Without vomiting: Dihydroartemisinin-Piperaquine PO","correct":true,"justification":"True, it is a derivative of artemisinin"},{"idx":1,"proposition":"Without vomiting: Artemether-Lumefantrine PO","correct":true,"justification":"True, it is a derivative of artemisinin"},{"idx":2,"proposition":"With vomiting: Quinine IV + Clindamycin","correct":true},{"idx":3,"proposition":"With vomiting: Artesunate IV","correct":false,"justification":"Treatment of severe malaria (with or without vomiting)"},{"idx":4,"proposition":"Without vomiting: Clindamycin PO","correct":false,"justification":"Clindamycin combines with IV Quinine for the treatment of single bouts with vomiting"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"palu-infectio-7","context":null,"enonce":"Which of the following are biological signs that lead us to consider the case as severe malaria?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Respiratory alkalosis","correct":false,"justification":"Metabolic acidosis"},{"idx":1,"proposition":"Hyperlactatemia","correct":true},{"idx":2,"proposition":"Hyperglycemia beyond 5g\/L","correct":false,"justification":"Hypoglycemia"},{"idx":3,"proposition":"Hyperparasitemia above 2%","correct":false,"justification":"Above 4%"},{"idx":4,"proposition":"Positive qualitative beta-HCG","correct":true,"justification":"True, a malaria attack in a pregnant 🤰 woman should be managed as a severe ⚠ malaria attack."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"palu-infectio-8","context":null,"enonce":"What type of anaemia can be observed in malaria?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Hemolytic","correct":true},{"idx":1,"proposition":"Iron deficiency","correct":false,"justification":"False"},{"idx":2,"proposition":"Folate deficiency","correct":false,"justification":"False"},{"idx":3,"proposition":"Haemorrhagic","correct":false,"justification":"False"},{"idx":4,"proposition":"Power plant","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"palu-infectio-9","context":null,"enonce":"Which of the following are biological signs that lead us to consider the case as severe malaria?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Respiratory alkalosis","correct":false,"justification":"Metabolic acidosis"},{"idx":1,"proposition":"Hyperlactatemia","correct":true},{"idx":2,"proposition":"Hyperglycemia beyond 5g\/L","correct":false,"justification":"Hypoglycemia"},{"idx":3,"proposition":"Hyperparasitemia above 2%","correct":false,"justification":"Above 4%"},{"idx":4,"proposition":"Positive qualitative beta-HCG","correct":true,"justification":"True, a malaria attack in a pregnant 🤰 woman should be managed as a severe ⚠ malaria attack."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"palu-infectio-10","context":null,"enonce":"Which of the following propositions are true for first-line treatments for malaria?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Without vomiting: Dihydroartemisinin-Piperaquine PO","correct":true,"justification":"True, it is a derivative of artemisinin"},{"idx":1,"proposition":"Without vomiting: Artemether-Lumefantrine PO","correct":true,"justification":"True, it is a derivative of artemisinin"},{"idx":2,"proposition":"With vomiting: Quinine IV + Clindamycin","correct":true},{"idx":3,"proposition":"With vomiting: Artesunate IV","correct":false,"justification":"Treatment of severe malaria (with or without vomiting)"},{"idx":4,"proposition":"Without vomiting: Clindamycin PO","correct":false,"justification":"Clindamycin combines with IV Quinine for the treatment of single bouts with vomiting"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"palu-infectio-11","context":null,"enonce":"Which of the following are true?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Fever is classically periodic","correct":true,"justification":"True. Third (J1 J3 J5 J7 J9 etc) for falciparum, vivax and oval. Fourth (J1 J4 J7 J11 etc) for malaria. Every 24h for knowlesii."},{"idx":1,"proposition":"Thrombocytopenia is a sign of severity","correct":false,"justification":"It is almost constant and is not a sign of gravity"},{"idx":2,"proposition":"Thin blood smear - thick drop is done at febrile peaks only","correct":false,"justification":"As a matter of urgency, never wait for a feverish peak."},{"idx":3,"proposition":"The thick drop allows the identification of the species","correct":false,"justification":"The thick drop allows the positive diagnosis of malaria. It is the thin blood smear that allows the identification of the species."},{"idx":4,"proposition":"The thin blood smear is used to measure parasitmeia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"palu-infectio-13","context":null,"enonce":"Which of the following proposals about malaria are true?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is a reportable disease in all circumstances. ","correct":false,"justification":"Only Aboriginal cases are reportable."},{"idx":1,"proposition":"Any fever on return from an endemic country should evoke the diagnosis.","correct":true},{"idx":2,"proposition":"The incubation period for the Falciparum strain varies between a minimum of one week and 3 years.","correct":false,"justification":"False\r\nBetween one week and 3 months maximum"},{"idx":3,"proposition":"The manifestations of malaria are due to the hepatic merozoite form. ","correct":false,"justification":"The manifestations of malaria are due to the erythrocyte schizogony form."},{"idx":4,"proposition":"Antimalarial chemoprophylaxis protects 100% against malaria.","correct":false,"justification":"False, it does not completely eliminate the risk of infection even if properly followed."}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"palu-infectio-14","context":null,"enonce":"Which of the following proposals regarding malaria treatment are true?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Artenimol-piperaquine is the first-line treatment for pregnant women in the 1st trimester","correct":false,"justification":"False, it is contraindicated in the 1st trimester, like all artemisinin derivatives"},{"idx":1,"proposition":"The Artemether-lumefantrine prescription requires the performance of an ECG beforehand. ","correct":true,"justification":"True\r\nIt causes QT prolongation, like all artemisinin derivatives"},{"idx":2,"proposition":"In case of complicated form with vomiting administration of IV Quinine is the first-line treatment ","correct":false,"justification":"False \r\nThis is true in uncomplicated forms\r\nIn severe forms the first-line treatment is Artesunate IV"},{"idx":3,"proposition":"Administration of artesunate requires haematological monitoring one month after discontinuation of treatment ","correct":true,"justification":"True\r\nRisk of delayed hemolysis."},{"idx":4,"proposition":"Doxycycline is the treatment of choice for pregnant women in the first trimester","correct":false,"justification":"False!!\r\nContraindicated in pregnant women"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"palu-infectio-15","context":null,"enonce":"Which of the following proposals regarding malaria prophylaxis are true?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Artenimol-piperaquine should be started on the first day of stay and continued one week after ","correct":false,"justification":"False\r\nIt is not indicated for prophylaxis"},{"idx":1,"proposition":"Mefloquine should be started 10 days before stay and continued 3 weeks after","correct":true},{"idx":2,"proposition":"Mefloquine should be taken daily at the same time throughout the stay ","correct":false,"justification":"False.\r\nOne intake per week"},{"idx":3,"proposition":"Atovaquone-Proguanil must be started on the first day of stay and continued 10 years after ","correct":true},{"idx":4,"proposition":"It is necessary to warn the traveler that any fever within 3 months of returning from an endemic area must be consulted urgently to look for Malaria ","correct":true,"justification":"True\r\nThe incubation period of Falciparum can be up to 3 months"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"palu-infectio-16","context":null,"enonce":"Which of the following proposals about malaria are true?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"A negative blood smear eliminates the diagnosis of malaria.","correct":false,"justification":"False\r\nA negative blood smear and a RDT (rapid diagnostic test) rule out the diagnosis."},{"idx":1,"proposition":"A negative epiasse drip examination eliminates the diagnosis.","correct":true},{"idx":2,"proposition":"A positive blood smear and a positive Rapid Diagnostic Test (RDT) are sufficient to make the diagnosis.","correct":true},{"idx":3,"proposition":"The epiasse drop examination requires expertise on the part of the biologist.","correct":true},{"idx":4,"proposition":"A negative RDT allows him to eliminate the diagnosis of malaria.","correct":false,"justification":"False, it takes a negative RDT + a negative blood smear to rule out the diagnosis."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hypoTh-endoc-0","context":null,"enonce":"Regarding thyroid gland involvement:","item":"hypoTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"The diagnosis of primary hypothyroidism is based primarily on TSH testing","correct":true},{"idx":1,"proposition":"If TSH is elevated, free T3 measurement measures the severity of secretory deficiency","correct":false,"justification":"It is the dosage of free T4 that is carried out"},{"idx":2,"proposition":"Free thyroxine is dosed rather than total T4 because the latter is subject to multiple physiological variations","correct":true},{"idx":3,"proposition":"Normal free T4 indicates frustrated hypothyroidism","correct":true},{"idx":4,"proposition":"TSH is very elevated in subclinical hypothyroidism","correct":false,"justification":"TSH is low"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hypoTh-endoc-1","context":null,"enonce":"Which of the following is (are) correct?","item":"hypoTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Low free T4 and increased TSH indicate overt hypothyroidism","correct":true},{"idx":1,"proposition":"Primary hypothyroidism is the most common","correct":true},{"idx":2,"proposition":"The diagnosis of hypothyroidism is often late because of the highly variable symptoms and clinical signs","correct":false,"justification":"Currently, by the generalization of the TSH assay (systematic assessment or asthenia), the diagnosis is most often early, made at the stage of crude hypothyroidism where only TSH is increased."},{"idx":3,"proposition":"A single moderately increased TSH assay makes it possible to make the diagnosis","correct":false,"justification":"A single moderately increased TSH assay is not sufficient to make the diagnosis of hypothyroidism and therefore justify treatment."},{"idx":4,"proposition":"Thyroid-impaired insufficiency constitutes less than 5% of hypothyroidism","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hypoTh-endoc-2","context":null,"enonce":"Regarding thyrotropic involvement:","item":"hypoTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Thyrotropic insufficiency is very rarely part of a pituitary pathology context","correct":false,"justification":"On the contrary, this is almost always the case"},{"idx":1,"proposition":"T4L is always low in thyrotropic pathology","correct":true},{"idx":2,"proposition":"A slightly elevated TSH (but less than 10-12 mIU\/L) and a low T4L suggest rather a primitive involvement","correct":false,"justification":"In this case, TSH is immunoreactive but biologically inactive and contrasts with low T4L. This painting evokes hypothalamic involvement"},{"idx":3,"proposition":"The diagnosis of thyrotropic insufficiency is based on the determination of the T4L-T3L couple","correct":false,"justification":"Rather on the dosage of the T4L-TSH couple"},{"idx":4,"proposition":"The semeiology of hypothyroidism depends on its depth, age and origin","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hypoTh-endoc-3","context":null,"enonce":"Which of the following is (are) correct?","item":"hypoTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Crude hypothyroidism is the most common form nowadays","correct":true,"justification":"Crude hypothyroidism, called subclinical, is the most common form, it is grouped into 3 categories according to the risk of conversion to overt hypothyroidism"},{"idx":1,"proposition":"Carotinosis can be observed by decreased transformation of carotene into vitamin A","correct":true},{"idx":2,"proposition":"Dry, flaky skin is symptomatic of thyrotoxycosis","correct":false,"justification":"Rather a symptom of hypothyroidism"},{"idx":3,"proposition":"Axillary depilation is promoted by hypothyroidism","correct":true},{"idx":4,"proposition":"Hypothyroidism increases sweating","correct":false,"justification":"sweating is decreased"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"hypoTh-endoc-4","context":null,"enonce":"Which of the following is (are) correct?","item":"hypoTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Hair is dry and brittle in overt hypothyroidism","correct":true},{"idx":1,"proposition":"Laryngeal involvement can result in a hoarse voice","correct":true},{"idx":2,"proposition":"Eustachian tube involvement is possible in hypothyroidism ","correct":true,"justification":"Involvement of the Eustachian tube can induce hearing loss"},{"idx":3,"proposition":"Tendonitis is very rarely due directly to hypothyroidism","correct":true,"justification":"Arthralgia, myalgia and cramps are more often seen"},{"idx":4,"proposition":"Deep primary hypothyroidism can cause hyperploactinemia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hypoTh-endoc-5","context":null,"enonce":"Which of the following are the signs and symptoms found in hypothyroidism?","item":"hypoTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Sweats","correct":false,"justification":"Decreased sweating"},{"idx":1,"proposition":"Tachycardia","correct":false,"justification":"Sign of thyrotoxicosis"},{"idx":2,"proposition":"Weight gain > 10kg","correct":false,"justification":"Not exceeding about 5kg"},{"idx":3,"proposition":"Depressive tendency","correct":true},{"idx":4,"proposition":"Hyponatremia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"hypoTh-endoc-6","context":null,"enonce":"Which of the following are true about Hashimoto's thyroiditis?","item":"hypoTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Goiter is firm","correct":true},{"idx":1,"proposition":"Goiter is regular","correct":false,"justification":"It is irregular"},{"idx":2,"proposition":"Anti-TSH antibodies are found","correct":false,"justification":"Anti-TPO positive antibodies. \r\nIf they are negative (rare), we dose the anti-Tg that are positive."},{"idx":3,"proposition":"It is the most common cause of hypothyroidism in women ♀ ","correct":true},{"idx":4,"proposition":"It can be part of autoimmune polyendocrinopathy","correct":true,"justification":"True, when it is associated with other autoimmune disorders such as vitiligo, celiac disease, Biermer's anemia, then pNEM2 must be suspected."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AP-urg-0","context":null,"enonce":"Which of the following are true?","item":"AP","matiere":"urg","propositions":[{"idx":0,"proposition":"The lifetime prevalence of panic attacks is 3-5%","correct":true},{"idx":1,"proposition":"The predominance is female","correct":true},{"idx":2,"proposition":"The onset of crises is gradual","correct":false,"justification":"The beginning is brutal"},{"idx":3,"proposition":"The peak is reached in 45-60 minutes","correct":false,"justification":"The acme is reached in a few minutes"},{"idx":4,"proposition":"Postcritical asthenia is possible","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"AP-urg-1","context":null,"enonce":"Which of the following are possible treatments for panic attacks or acute anxiety attacks?","item":"AP","matiere":"urg","propositions":[{"idx":0,"proposition":"The introduction of anxiolytics ","correct":true},{"idx":1,"proposition":"Introduction of benzodiazepines","correct":true},{"idx":2,"proposition":"Introduction of antipsychotics","correct":false,"justification":"No indication"},{"idx":3,"proposition":"The introduction of antidepressants","correct":false,"justification":"No indication"},{"idx":4,"proposition":"Room with very loud rock music to distract the patient","correct":false,"justification":"Systematic measures: calming, reassurance, breathing control"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LCA-sp-0","context":null,"enonce":"Which of the following are observational studies?","item":"LCA","matiere":"sp","propositions":[{"idx":0,"proposition":"Randomized controlled clinical trials","correct":false,"justification":"Interventional studies"},{"idx":1,"proposition":"Epidemiological studies","correct":true},{"idx":2,"proposition":"Most cross-sectional studies","correct":true},{"idx":3,"proposition":"Prospective cohort studies","correct":false,"justification":"Not all, there may be human intervention"},{"idx":4,"proposition":"Case-control studies","correct":true,"justification":"True, this is an analytical observational study"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LCA-sp-1","context":null,"enonce":"Which of the following are scientific journals with an impact factor >10 😏?","item":"LCA","matiere":"sp","propositions":[{"idx":0,"proposition":" Nature","correct":true},{"idx":1,"proposition":"New England Journal of Medicine (NEJM)","correct":true},{"idx":2,"proposition":"Interventional Cardiology","correct":false,"justification":"IF of 0.45"},{"idx":3,"proposition":"Medicine\/Science","correct":false,"justification":"As French-language newspapers are rarely cited by the international community (which speaks mainly English), their impact factor remains limited 😕"},{"idx":4,"proposition":"Universal Surgery","correct":false,"justification":"IF of 0.08. Remember especially the major journals: NEMJ, Lancet, Nature, Science, PNAS, etc."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LCA-sp-2","context":null,"enonce":"Which of the following are true about relative risk?","item":"LCA","matiere":"sp","propositions":[{"idx":0,"proposition":"It measures the association between an exposure factor and the event under study","correct":true},{"idx":1,"proposition":"It corresponds to the Odds Ratio (OR) in cohort studies ","correct":false,"justification":"Prospective cohort studies measure risk ratios (RRs). In case-control studies, an Odds Ratio (OR) is measured"},{"idx":2,"proposition":"A relative risk strictly less than 1 is a protective factor","correct":true},{"idx":3,"proposition":"A relative risk greater than 1 is a protective factor","correct":false,"justification":"A risk factor"},{"idx":4,"proposition":"Relative risk is a parameter that is measured in real life at the individual level","correct":false,"justification":"It is a parameter that is calculated in prospective studies"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"lesionart-urg-0","context":null,"enonce":"Which of the following are risk factors for prosthesis infection?","item":"lesionart","matiere":"urg","propositions":[{"idx":0,"proposition":"Obesity","correct":true},{"idx":1,"proposition":"Passive smoking","correct":false,"justification":"Active smoking"},{"idx":2,"proposition":"Cirrhosis","correct":true},{"idx":3,"proposition":"Diabetes","correct":true},{"idx":4,"proposition":"All propositions are true","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"suivinourisson-ophtalmo-1","context":null,"enonce":"General:","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Minor and moderate deficits are the most numerous and include ametropia or refractive disorders","correct":true},{"idx":1,"proposition":"Hyperopia is a refractive disorder","correct":true,"justification":"With myopsy and astigmatism"},{"idx":2,"proposition":"Strabismus does not affect children under 8 years of age","correct":false,"justification":"Several thousand children under the age of 8 are affected by strabismus"},{"idx":3,"proposition":"Severe deficits are very rare in children","correct":true},{"idx":4,"proposition":"It is estimated that 15 to 20% of children under 6 years of age have a visual abnormality","correct":true,"justification":"1 in 6 children"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"suivinourisson-ophtalmo-2","context":null,"enonce":"Epidemiology and vision development:","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"0.4% of children have strabismus","correct":false,"justification":"About 4%"},{"idx":1,"proposition":"50% of children who have strabima are at risk of developing amblyopia if not treated promptly","correct":true},{"idx":2,"proposition":"Screening for visual disorders in children is a public health problem","correct":true},{"idx":3,"proposition":"During the first weeks of life, light reflexes testify to visual sensitivity","correct":true},{"idx":4,"proposition":"The photomotor reflex develops from 2 months","correct":false,"justification":"The photomotor reflex is present from birth but it is slow and of low amplitude"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"suivinourisson-ophtalmo-3","context":null,"enonce":"Regarding the development of the vision:","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The preferential look is developed around the third month","correct":true},{"idx":1,"proposition":"Eye-head-hand coordination appears at week 5","correct":false,"justification":"Eye-head-hand coordination appears around the 4th-5th month"},{"idx":2,"proposition":"The convergence reflex and the fixation reflex appear in the third month","correct":true},{"idx":3,"proposition":"First week: light reflex, photomotor reflex","correct":true},{"idx":4,"proposition":"The pursuit reflex is established around the age of 6 months","correct":false,"justification":"2nd–4th week: continuation reflex established around 2 months of age"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"suivinourisson-ophtalmo-4","context":null,"enonce":"Vision development and prevention:","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Week 4–12: fusion reflex, binocular coordination","correct":true},{"idx":1,"proposition":"The vision of forms is formed around the third month","correct":true},{"idx":2,"proposition":"Month 4–5: Eye-head-hand coordination","correct":true},{"idx":3,"proposition":"From 2 years old: measurable visual acuity","correct":true},{"idx":4,"proposition":"A first antenatal screening is performed by ultrasound during pregnancy","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"suivinourisson-ophtalmo-5","context":null,"enonce":"At what age is the eye tracking reflex established?","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"between the ages of 2 and 4 months","correct":true,"justification":"True, according to the new College of Pediatrics (2021)"},{"idx":1,"proposition":"between the ages of 8 and 12 months","correct":false,"justification":"False"},{"idx":2,"proposition":"between the ages of 12 and 24 months","correct":false,"justification":"False"},{"idx":3,"proposition":"between the ages of 2 and 4 weeks","correct":false,"justification":"False"},{"idx":4,"proposition":"at birth","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"suivinourisson-ophtalmo-6","context":null,"enonce":"At what age does we achieve 10\/10th visual acuity?","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"1 year","correct":false,"justification":"False"},{"idx":1,"proposition":"2 years","correct":false,"justification":"False"},{"idx":2,"proposition":"3 years","correct":false,"justification":"False"},{"idx":3,"proposition":"4 years","correct":true,"justification":"True, according to the new College of Pediatrics (2021). 1 year: visual acuity at 4\/10th, 2 years: visual acuity at 6\/10th, 4 years: visual acuity at 10\/10th. (Note that the old frame of reference gives the age of 6 years for visual acuity at 10\/10th.)"},{"idx":4,"proposition":"6 months","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"oreillons-infectio-0","context":null,"enonce":"Regarding adult mumps ","item":"oreillons","matiere":"infectio","propositions":[{"idx":0,"proposition":" The diagnosis is essentially clinical, but can be supported by molecular biology","correct":true,"justification":"See item in the latest edition of the college"},{"idx":1,"proposition":" There is no specific treatment and prevention is based on vaccination of adults","correct":false},{"idx":2,"proposition":"It is an acute non-contagious viral infection","correct":false,"justification":"Acute, contagious, most often mild viral infection"},{"idx":3,"proposition":" The tank is strictly human","correct":true},{"idx":4,"proposition":"It is a non-immunizing disease ","correct":false,"justification":"Long-lasting immunity after disease"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"oreillons-infectio-2","context":null,"enonce":"Regarding mumps:","item":"oreillons","matiere":"infectio","propositions":[{"idx":0,"proposition":"Healing is spontaneous in 13 to 15 days","correct":false,"justification":"Spontaneous healing in 8 to 10 days"},{"idx":1,"proposition":"Testicular involvement is most often bilateral","correct":false,"justification":"Unilateral"},{"idx":2,"proposition":"Sequellar testicular atrophy is present in 50% of cases but sterility is rare","correct":true},{"idx":3,"proposition":"The eviction of the case is not mandatory and there is no specific measure to be taken vis-à-vis the contact subjects","correct":true},{"idx":4,"proposition":"Pancreatic involvement is exceptional","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"oreillons-infectio-3","context":null,"enonce":"Which of the following are true about mumps?","item":"oreillons","matiere":"infectio","propositions":[{"idx":0,"proposition":"The neurological manifestation may be bacterial meningitis","correct":false,"justification":"Viral meningitis since mumps is caused by an RNA virus"},{"idx":1,"proposition":"The neurological manifestation is common (>25% of mumps cases)","correct":false,"justification":"It is rare, but still possible"},{"idx":2,"proposition":"Mumps puts you at risk for Guillain-Barré syndrome","correct":true},{"idx":3,"proposition":"Mumps puts you at risk of encephalitis","correct":true},{"idx":4,"proposition":"There is no neurological impairment","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"oreillons-infectio-4","context":null,"enonce":"With regard to mumps, what are the exact proposals?","item":"oreillons","matiere":"infectio","propositions":[{"idx":0,"proposition":"Possible clinical pictures include: erythematous angina, mumps parotitis, acute pancreatitis, orchitis and purulent meningitis","correct":false,"justification":"False, mumps gives meningitis which is usually not very symptomatic with few sequelae. Pancreatitis is benign (edematous pancreatitis)"},{"idx":1,"proposition":"Vaccination is important despite the existence of antiviral treatment","correct":false,"justification":"False, there is no specific treatment. The main treatment is preventive by vaccination"},{"idx":2,"proposition":"Preventive treatment consists of 2 vaccinations at 12 and 16-18 months with the MMR vaccine","correct":true,"justification":"True, this is not a reminder. The second injection increases the responder rate."},{"idx":3,"proposition":"The purpose of vaccination is to prevent complications of infection such as: testicular atrophy, sterility, deafness, encephalitis","correct":true,"justification":"True, especially testicular atrophy is present in 50% of orchites"},{"idx":4,"proposition":"None","correct":false,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"oreillons-infectio-5","context":null,"enonce":"With regard to mumps, what are the exact proposals?","item":"oreillons","matiere":"infectio","propositions":[{"idx":0,"proposition":"Possible clinical pictures include: erythematous angina, mumps parotitis, acute pancreatitis, orchitis and purulent meningitis","correct":false,"justification":"False, mumps gives meningitis which is usually not very symptomatic with few sequelae. Pancreatitis is benign (edematous pancreatitis)"},{"idx":1,"proposition":"Vaccination is important despite the existence of antiviral treatment","correct":false,"justification":"False, there is no specific treatment. The main treatment is preventive by vaccination"},{"idx":2,"proposition":"Preventive treatment consists of 2 vaccinations at 12 and 16-18 months with the MMR vaccine","correct":true,"justification":"True, this is not a reminder. The second injection increases the responder rate."},{"idx":3,"proposition":"The purpose of vaccination is to prevent complications of infection such as: testicular atrophy, sterility, deafness, encephalitis","correct":true,"justification":"True, especially testicular atrophy is present in 50% of orchites"},{"idx":4,"proposition":"None","correct":false,"justification":"None"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"oreillons-infectio-6","context":null,"enonce":"What is the incubation period for mumps?","item":"oreillons","matiere":"infectio","propositions":[{"idx":0,"proposition":"2 days","correct":false,"justification":"This is the incubation period of scarlet fever"},{"idx":1,"proposition":"18 days","correct":false,"justification":"This is the incubation period of measles"},{"idx":2,"proposition":"14 days","correct":false,"justification":"This is the incubation period of whooping cough"},{"idx":3,"proposition":"22 days","correct":true},{"idx":4,"proposition":"The incubation period is almost zero (a few hours)","correct":false,"justification":"RNA viruses take time to replicate in enough cells to give a clinical picture"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"oreillons-infectio-7","context":null,"enonce":"Which of the following is true about mumps?","item":"oreillons","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is a Gram-negative bacterium","correct":false},{"idx":1,"proposition":"It is a Cocci Positive Bacterium","correct":false},{"idx":2,"proposition":"It is an anaerobic bacterium","correct":false},{"idx":3,"proposition":"It is a DNA virus","correct":false},{"idx":4,"proposition":"It is an RNA virus","correct":true,"justification":"RNA virus with 22-day incubation"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"accouchementN-gyn-0","context":null,"enonce":"Regarding the Basics of Childbirth: Normal Childbirth","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"The work is composed of two stages: cervical dilation and delivery","correct":false,"justification":"The 4 stages of labour: cervical dilation, descent of presentation into the pelvic canal, delivery, return to normal"},{"idx":1,"proposition":"Dilation of the cervix conditions vaginal delivery","correct":false,"justification":"Commitment conditions vaginal delivery"},{"idx":2,"proposition":"Contraception should be discussed and offered postpartum during the maternity stay","correct":true},{"idx":3,"proposition":"Childbirth requires the passage of two obstacles: the cervix and the perineum","correct":false,"justification":"Childbirth requires the passage of three obstacles: • the cervix: closed during pregnancy, it expands under the influence of uterine contractions • the pelvis: crossing this rigid parade requires constant adaptation of the different parts of the fetus to the container • the perineum: its crossing constitutes expulsion"},{"idx":4,"proposition":"Expulsion occurs under the influence of uterine contractions reinforced by maternal abdominal thrust","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"accouchementN-gyn-1","context":null,"enonce":"Regarding the Anatomy of the Obstetric Pelvic Duct: Normal Childbirth","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"The pelvic girdle consists of 3 bony pieces","correct":false,"justification":"A Maternal pelvis 1 Bone pelvis The pelvic girdle is a symmetrical osteoarticular ring consisting of 4 bony parts and 4 joints: • the 4 bony pieces are: − the 2 coxal bones, − the sacrum, − the coccyx"},{"idx":1,"proposition":"The 4 joints of the pelvis are very mobile","correct":false},{"idx":2,"proposition":"The pelvic girdle has the shape of a funnel with a large lower base the large abdominal cavity with the pelvis through the lower strait (DI)","correct":false,"justification":"The pelvic girdle has the shape of a funnel with a large upper base that communicates the large abdominal cavity with the pelvis through the upper strait (SD)"},{"idx":3,"proposition":"The lower orifice consists of all the middle and lower straits","correct":true},{"idx":4,"proposition":"The upper strait is also called the Demelin \"engagement cylinder\"","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"accouchementN-gyn-2","context":null,"enonce":"Regarding the Anatomy of the Pelvis in Women: Normal childbirth","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"The promontory overlooks the pubic symphysis 8-9.5 cm","correct":true},{"idx":1,"proposition":"Note that the axis of the DS is oblique backwards and upwards","correct":false,"justification":"It should be noted that the axis of the DS is oblique backwards and downwards: it aims at the sacrococcygeal line spacing."},{"idx":2,"proposition":"The axis of the DS targets sacrococcygeal space","correct":true},{"idx":3,"proposition":"The circular section of the pelvic excavation is 18cm anteroposterior","correct":false,"justification":"Its circular section is of constant diameter at the level of all planes (about 12 cm)"},{"idx":4,"proposition":"The middle strait (MD) is an oblique plane passing through the two sciatic spines.","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"accouchementN-gyn-3","context":null,"enonce":"Regarding the Concerning the generalities about normal childbirth: normal childbirth","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"The lower strait (ID) is the lower opening of the pelvic canal","correct":true},{"idx":1,"proposition":"The posterior surface of the lower strait corresponds to the 2 ischia and the tip of the coccyx","correct":true},{"idx":2,"proposition":"The soft pelvis corresponds to Douglas's uterus, bladder and cul-de-sac","correct":false,"justification":"2 Soft pelvis It consists of: • the vagina • the pelvi-perineal diaphragm: musculotendinous hammock which includes: − a deep plane: fibers of the levator of the anus, ischiococcygeal muscles and large sacrosciatic ligament, − a superficial plane: muscles of the superficial perineum"},{"idx":3,"proposition":"The curled up fetus is amalgamated with a cube with 4 poles","correct":false,"justification":"1 Fetal head The fetal head has an ovoid shape with the small end corresponding to the chin and the large end to the occiput (Figure 30"},{"idx":4,"proposition":"The anterior fontannelle is called bregma","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"accouchementN-gyn-5","context":null,"enonce":"Regarding the Concerning the pregnant uterus: normal childbirth","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"The posterior fontanelle is called bregma","correct":false},{"idx":1,"proposition":"The pregnant uterus consists of 3 parts: the body, the lower segment and the cervix","correct":true},{"idx":2,"proposition":"The uterine body, in late pregnancy, has the shape of an ovoid with a large upper end","correct":true},{"idx":3,"proposition":"The axis of the body of the uterus in late pregnancy is always craniocaudal","correct":false,"justification":"Its axis depends on the tone of the anterior abdominal wall"},{"idx":4,"proposition":"In the frontal plane, the uterus is often tilted to the right side","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"accouchementN-gyn-6","context":null,"enonce":"Concerning the basics of normal childbirth","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"At the level of the inner circular layer, the fibers retract to erase the lumen of the vessels in order to reduce the hemorrhage of normal delivery (live ligatures)","correct":false,"justification":"At the level of the plexiform layer, the retraction of the fibers erases the lumen of the vessels, which has the effect of reducing the hemorrhage of normal delivery: this is the phenomenon of living ligatures"},{"idx":1,"proposition":"Uterine contraction is the driving force of childbirth","correct":true},{"idx":2,"proposition":"The mechanical study of uterine contraction requires expensive and rare electrophysiology equipment","correct":false,"justification":"1 Means of study The mechanical study of UC is commonly used in obstetrics thanks to monitors that allow simultaneous recordings of fetal heart rate and uterine contractions: • external tomography allows"},{"idx":3,"proposition":"External tocography makes it possible to note the duration of uterine contractions thanks to an intravenous sensor","correct":false,"justification":"thanks to an external sensor"},{"idx":4,"proposition":"Internal tocography provides basic tone and intrauterine pressure","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"accouchementN-gyn-7","context":null,"enonce":"What is the bi-trochanterian diameter? ","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"9 cm","correct":true,"justification":"These questions may seem tedious, but these measures are worth knowing according to the College"},{"idx":1,"proposition":"7.5 cm","correct":false,"justification":"Sacropubic diameter"},{"idx":2,"proposition":"9.5 cm","correct":false,"justification":"Sternodorsal diameter or bi-acromial diameter after settlement"},{"idx":3,"proposition":"8 cm","correct":false,"justification":"Biiliac diameter"},{"idx":4,"proposition":"12 cm","correct":false,"justification":"Bi-acromial diameter before settlement"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"accouchementN-gyn-8","context":null,"enonce":"What is the bi-iliac distance?","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"12 cm after settlement","correct":false,"justification":"This diameter is not reduced by compaction. It is 8 cm"},{"idx":1,"proposition":"6 cm","correct":false,"justification":"Sorry for these questions, but these measures are to be known according to the college :\/"},{"idx":2,"proposition":"8 cm","correct":true},{"idx":3,"proposition":"9.5 cm","correct":false,"justification":"This is the sterno-dorsal distance as well as the bi-acromial distance after settlement"},{"idx":4,"proposition":"7.5 cm","correct":false,"justification":"Sacropubic diameter"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"accouchementN-gyn-9","context":null,"enonce":"What is the sacropubic diameter? ","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"9 cm","correct":false,"justification":"Bi-trochanterian diameter"},{"idx":1,"proposition":"9.5 cm","correct":false,"justification":"Sternodorsal diameter or bi-acromial diameter after settlement"},{"idx":2,"proposition":"7.5 cm","correct":true,"justification":"None"},{"idx":3,"proposition":"75 mm","correct":true,"justification":"None"},{"idx":4,"proposition":"12 cm","correct":false,"justification":"Bi-acromial diameter before settlement"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"accouchementN-gyn-10","context":null,"enonce":"What is the sacropubic diameter?","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"12 cm","correct":false,"justification":"Bi-acromial diameter"},{"idx":1,"proposition":"9.5 cm","correct":false,"justification":"Sternodorsal diameter or bi-acromial diameter after settlement"},{"idx":2,"proposition":"8 cm","correct":false,"justification":"Sorry for these questions, but these measures are to be known according to the college :\/. 8 cm is the bi-iliac diameter"},{"idx":3,"proposition":"7.5 cm","correct":true},{"idx":4,"proposition":"9 cm","correct":false,"justification":"Bi-trochanterian diameter"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"accouchementN-gyn-11","context":null,"enonce":"What is the sterno-dorsal diameter?","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"9.5 cm","correct":true,"justification":"True! \r\nA bit tedious but to learn!"},{"idx":1,"proposition":"12 cm","correct":false,"justification":"Bi-acromial distance before settlement"},{"idx":2,"proposition":"7.5 cm","correct":false,"justification":"Sacropubic distance"},{"idx":3,"proposition":"8 cm","correct":false,"justification":"Biiliac distance"},{"idx":4,"proposition":"9 cm","correct":false,"justification":"Bi-trochanterian distance"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"accouchementN-gyn-12","context":null,"enonce":"What is the biacromial distance?","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"9 cm","correct":false,"justification":"Bi-trochanterian diameter. Sorry for these questions, but these measures are to be known according to the college :\/"},{"idx":1,"proposition":"12 cm","correct":true,"justification":"True, 9.5 cm after settlement"},{"idx":2,"proposition":"This distance can be reduced by settlement","correct":true},{"idx":3,"proposition":"8 cm","correct":false,"justification":"Biiliac distance"},{"idx":4,"proposition":"8.5 cm after settlement","correct":false,"justification":"9.5 cm after settlement"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"accouchementN-gyn-13","context":null,"enonce":"Which of the following proposals is\/are a risk factor for postpartum haemorrhage?","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Maternal infection","correct":true},{"idx":1,"proposition":"Very fast work","correct":true,"justification":"Very fast or too prolonged work is a ToR"},{"idx":2,"proposition":"Fibroids ","correct":true},{"idx":3,"proposition":"Antenatal corticosteroid treatment","correct":false},{"idx":4,"proposition":"No proposition is true","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"platre-urg-0","context":null,"enonce":"Regarding plasters, which proposals are true?","item":"platre","matiere":"urg","propositions":[{"idx":0,"proposition":"There are two types of plasters: circular and gutter","correct":true},{"idx":1,"proposition":"A cast should never hurt","correct":true,"justification":"Pain = problem = systematic removal of the cast for complete clinical examination"},{"idx":2,"proposition":"Conventionally, the cast contains the fractured limb and the underlying joint only","correct":false,"justification":"Underlying supra joint"},{"idx":3,"proposition":"Conventionally, the fingers of the hand are left free","correct":true},{"idx":4,"proposition":"Conventionally, the toes are left free","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"platre-urg-1","context":null,"enonce":"What are the delays in radiographic control of plaster?","item":"platre","matiere":"urg","propositions":[{"idx":0,"proposition":"J2","correct":true,"justification":"The deadlines mentioned by the college of orthopedics are: J2, J8, J21 and J45"},{"idx":1,"proposition":"J10","correct":false},{"idx":2,"proposition":"J20","correct":false},{"idx":3,"proposition":"J8","correct":true},{"idx":4,"proposition":"J40","correct":false}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"platre-urg-2","context":null,"enonce":"What are the two main etiologies of paresthesias under plaster?","item":"platre","matiere":"urg","propositions":[{"idx":0,"proposition":"Neuromuscular dysjunction","correct":false},{"idx":1,"proposition":"Inflammatory arthralgia","correct":false},{"idx":2,"proposition":"Compression","correct":true,"justification":"Nerve or vascular compression"},{"idx":3,"proposition":"Venous thrombosis","correct":false},{"idx":4,"proposition":"Compartment syndrome","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"iatrogenie-therapeutique-0","context":null,"enonce":"Which of the following are frequently found in DRESS syndrome?","item":"iatrogenie","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Hypereosinophilia","correct":true},{"idx":1,"proposition":"Thrombocytosis","correct":false,"justification":"False"},{"idx":2,"proposition":"Hyperuricemia","correct":false,"justification":"False"},{"idx":3,"proposition":"Mononucleosis syndrome","correct":true},{"idx":4,"proposition":"Hepatic cytolysis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrpsy-psy-0","context":null,"enonce":"Regarding pain in a patient suffering from a psychiatric pathology:","item":"dlrpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Pain is a physical experience","correct":false,"justification":"Sensory and emotional experience"},{"idx":1,"proposition":"It has cognitive components","correct":true,"justification":"On attention and memory for example"},{"idx":2,"proposition":"It has behavioural components","correct":true},{"idx":3,"proposition":"The tools used to measure pain are specific to psychiatry","correct":false,"justification":"There is no specific tool in psychiatry to measure pain"},{"idx":4,"proposition":"Dental pain is often directly related to psychiatric pathology","correct":false,"justification":"No direct link, but an indirect link: psychiatric pathology -> poor hygiene -> no dental care -> dental pain"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dlrpsy-psy-1","context":null,"enonce":"Regarding pain management:","item":"dlrpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"The placebo effect has no place in therapy","correct":false,"justification":"It can be very useful"},{"idx":1,"proposition":"Analgesic treatments are all medicated","correct":false,"justification":"Non-drug treatments have their place"},{"idx":2,"proposition":"The placebo effect is accompanied by the release of endogenous opioids","correct":true},{"idx":3,"proposition":"Tramadol has a dopaminergic effect","correct":false,"justification":"It has a serotonergic action"},{"idx":4,"proposition":"There is an addictive risk if taken care of morphine","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dlrpsy-psy-2","context":null,"enonce":"Regarding acute pain:","item":"dlrpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"It is an alarm signal from the body","correct":true},{"idx":1,"proposition":"It is accompanied by bradychardie","correct":false,"justification":"Tachycardia"},{"idx":2,"proposition":"There are orthosympatic signs","correct":true},{"idx":3,"proposition":"Anxious manifestations make you forget the pain","correct":false,"justification":"They increase the painful sensation"},{"idx":4,"proposition":"It concerns 10% of the general population on the time of life","correct":false,"justification":"Everyone went through periods of acute pain"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"dlrpsy-psy-3","context":null,"enonce":"About chronic pain","item":"dlrpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"It is defined for a duration greater than 1 week","correct":false,"justification":"More than 3 months"},{"idx":1,"proposition":"It affects 20 to 50% of the population","correct":true},{"idx":2,"proposition":"It is accompanied by bipolar disorder","correct":false,"justification":"No, but often depressive symptoms. In addition, the psychiatric reference framework explains that about 50% of bipolar patients have a pain syndrome, mainly neck pain, back pain and arthralgia."},{"idx":3,"proposition":"The flagship treatment is long-term paracetamol","correct":false,"justification":"Not at all (beware of the risk of addiction): it is a multidisciplinary care based on medicamental and non-drug therapies that must be put in place"},{"idx":4,"proposition":"The intensity is often very high","correct":false,"justification":"It is moderate"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcvessie-onco-0","context":null,"enonce":"Which propositions are true?","item":"Kcvessie","matiere":"onco","propositions":[{"idx":0,"proposition":"The average age of reporting a bladder tumour is around 60 years","correct":false,"justification":"Around 70 years"},{"idx":1,"proposition":"Bladder tumours affect both men and women","correct":false,"justification":"4 men for 1 woman"},{"idx":2,"proposition":"Deaths caused by bladder tumors account for 3% of cancer deaths","correct":true},{"idx":3,"proposition":"The main risk factor is alcohol consumption","correct":false,"justification":"It's tobacco"},{"idx":4,"proposition":"It can be recognized as an occupational disease","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcvessie-onco-1","context":null,"enonce":"Which of these proposals are factors that promote squamous cell carcinomas?","item":"Kcvessie","matiere":"onco","propositions":[{"idx":0,"proposition":"Tobacco","correct":false,"justification":"Be careful, it promotes urothelial carcinoma (see the Medline, part \"trap to avoid\", on page 424)"},{"idx":1,"proposition":"Alcohol","correct":false,"justification":"Not cited as a risk factor for bladder tumours"},{"idx":2,"proposition":"Schistosomiasis","correct":true,"justification":"Especially in endemic areas in the Middle East and especially in Egypt"},{"idx":3,"proposition":"Nitrosamines","correct":false,"justification":"Be careful, they promote urothelial carcinoma (see the Medline, part \"trap to avoid\", page 424)"},{"idx":4,"proposition":"Polycyclic aromatics","correct":false,"justification":"Be careful, it promotes urothelial carcinoma (see the Medline, part \"trap to avoid\", on page 424)"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"Kcvessie-onco-2","context":null,"enonce":"Regarding the diagnosis of bladder tumors:","item":"Kcvessie","matiere":"onco","propositions":[{"idx":0,"proposition":"Voiding burns are in the foreground","correct":false,"justification":"There is mainly hematuria"},{"idx":1,"proposition":"Hematuria is often terminal or even total","correct":true},{"idx":2,"proposition":"In case of hematuria, clots can be found","correct":true,"justification":"Unlike hematuria of nephrological origin"},{"idx":3,"proposition":"Patients may describe urges","correct":true},{"idx":4,"proposition":"The TR regains pelvic armour","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcvessie-onco-3","context":null,"enonce":"Regarding urinary cytological:","item":"Kcvessie","matiere":"onco","propositions":[{"idx":0,"proposition":"It is done on an ECBU","correct":true,"justification":"It will perform a cytological examination infondi via cystoscopy, after verification by the ECBU"},{"idx":1,"proposition":"Cystoscopy requires general anesthesia","correct":false,"justification":"Local anesthesia, is done in office"},{"idx":2,"proposition":"Urinary cytology has excellent negative predictive value (NPV)","correct":false,"justification":"An excellent VPP"},{"idx":3,"proposition":"Cytology has excellent positive predictive value","correct":true},{"idx":4,"proposition":"None of these propositions are true","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kcvessie-onco-7","context":null,"enonce":"Which of the following are true?","item":"Kcvessie","matiere":"onco","propositions":[{"idx":0,"proposition":"Follow-up includes regular endoscopic check-ups ","correct":true},{"idx":1,"proposition":"In 90% of cases, bladder tumours present immediately as a bladder tumour that infiltrates the IMTV muscle. ","correct":false,"justification":"MIVs are 20% at diagnosis"},{"idx":2,"proposition":"Survival of patients with MITV is greater than 90% at 5 years","correct":false,"justification":"Less than 50%"},{"idx":3,"proposition":"The main risks of a NMITV are recidivism in the form of one or more MINTVs","correct":true},{"idx":4,"proposition":"The urothelium covers the entire urinary tract","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Kctesticule-onco-0","context":null,"enonce":"Which of the following are true?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"The normal testicle is formed by seminiferous tubules, contained in lobules ","correct":true},{"idx":1,"proposition":" Seminiferous tubules contain four types of cells ","correct":false,"justification":"Two cell types: Leydig and Sertoli"},{"idx":2,"proposition":"Germ cells and Sertoli cells are the two most important cell types","correct":true},{"idx":3,"proposition":" Sperm are produced in the seminiferous tubules","correct":true},{"idx":4,"proposition":" The Leydig cells that produce sperm are present in the stroma","correct":false,"justification":"Androgen production"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Kctesticule-onco-1","context":null,"enonce":"Which of the following propositions are true?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"Non-germline tumours include gonadal stromal tumours ","correct":true},{"idx":1,"proposition":"The Doppler ultrasound makes it possible to define the lymph node and metastatic status of the patient on which the TNM stage of the disease will depend ","correct":true},{"idx":2,"proposition":"Staging of metastatic forms according to the IGCCCG classification ","correct":true},{"idx":3,"proposition":"Diagnosis is based on ultrasound which makes it possible to highlight hyperechoic areas ","correct":true},{"idx":4,"proposition":"More generally, the presence of grade 3 microcalcifications in a patient with gonadal dysgenesis syndrome warrants periodic clinical and ultrasound monitoring.","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"Kctesticule-onco-2","context":null,"enonce":"Which of the following are the side effects of cisplatin?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"Renal toxicity","correct":true},{"idx":1,"proposition":"Peripheral neuropathy","correct":true},{"idx":2,"proposition":"Ototoxicity","correct":true},{"idx":3,"proposition":"Dilated cardiomyopathy","correct":false,"justification":"This is the case of etoposide (inhibitor of topoisomerase type II)"},{"idx":4,"proposition":"Hand-foot syndrome ","correct":false,"justification":"Especially anthracyclines, docetaxel, 5FU and capecitabine"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kctesticule-onco-3","context":null,"enonce":"Which of the following are non-germline tumors?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"Leydig cell tumours","correct":true},{"idx":1,"proposition":"Gonadoblastomas","correct":true},{"idx":2,"proposition":"Pure seminomas","correct":false,"justification":"Germ cell tumours"},{"idx":3,"proposition":"Yolk sac tumour","correct":false,"justification":"Non-seminoma germ cell tumours, AFP synthesis"},{"idx":4,"proposition":"Choriocarcinoma","correct":false,"justification":"Non-seminoma germ cell tumours, hCG synthesis"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kctesticule-onco-4","context":null,"enonce":"Which of the following propositions are true about the extension balance?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"PET-CT is systematic","correct":false,"justification":"The PET-CT has no place in the initial assessment."},{"idx":1,"proposition":"Scrotal MRI should be performed to better characterize the mass ","correct":false,"justification":"False: scrotal MRI does not provide a decisive element to the local assessment."},{"idx":2,"proposition":"Bone scintigraphy is performed at the point of clinical call","correct":true},{"idx":3,"proposition":"The CT-TAP is the reference exam for the extension assessment","correct":true},{"idx":4,"proposition":"Brain imaging should be performed in case of extranodal metastatic disease","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kctesticule-onco-5","context":null,"enonce":"Which of the following should be put in place before taking cisplatin?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"Hyperhydration","correct":true,"justification":"True, renal toxicity"},{"idx":1,"proposition":"Anti-emetics","correct":true,"justification":"True, nausea-vomiting"},{"idx":2,"proposition":"Cardioprotectors","correct":false,"justification":"False"},{"idx":3,"proposition":"Insulin","correct":false,"justification":"False"},{"idx":4,"proposition":"Normacol","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kctesticule-onco-6","context":null,"enonce":"Which of the following proposals must be made before the treatment is implemented?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"Presentation of the file in Multidisciplinary Consultation Meeting (RCP)","correct":true},{"idx":1,"proposition":"Brain MRI","correct":false,"justification":"False"},{"idx":2,"proposition":"Proposal of a gamete collection to CECOS ","correct":true},{"idx":3,"proposition":"Diagnostic announcement according to the recommended modalities","correct":true},{"idx":4,"proposition":"Collection of free and informed consent","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kctesticule-onco-7","context":null,"enonce":"Which of the following are germ cell tumours?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"Embryonic carcinoma","correct":true},{"idx":1,"proposition":"Teratoma","correct":true},{"idx":2,"proposition":"Adenocarcinomas of the rete testis","correct":false},{"idx":3,"proposition":"Sertoli cell tumours","correct":false},{"idx":4,"proposition":"Leydig cell tumours","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kctesticule-onco-8","context":null,"enonce":"Which of the following serum tumor markers are relevant in germ cell tumors of the testicle?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"SCC","correct":false,"justification":"Useless here"},{"idx":1,"proposition":"Alpha-fetoprotein","correct":true},{"idx":2,"proposition":"total hCG","correct":true},{"idx":3,"proposition":"LDH","correct":true},{"idx":4,"proposition":"Ca125","correct":false,"justification":"Useless here"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kctesticule-onco-9","context":null,"enonce":"At what stage is the invasion of the spermatic cord established?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"T1","correct":false,"justification":"Tumor limited to the testicle and epididymis WITHOUT vascular invasion"},{"idx":1,"proposition":"T2","correct":false,"justification":"Tumor limited to the testicle and epididymis WITH vascular invasion OR with invasion of the tunica vaginal"},{"idx":2,"proposition":"T3","correct":true},{"idx":3,"proposition":"T4","correct":false,"justification":"Invasion of the scrotum"},{"idx":4,"proposition":"T5","correct":false,"justification":"No T5. The maximum is T4 (invasion of the scrotum)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"Kctesticule-onco-10","context":null,"enonce":"Which of the following are risk factors for germline testicular tumors?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"Early and regular cannabis use","correct":true},{"idx":1,"proposition":"Down syndrome","correct":true},{"idx":2,"proposition":"History of cryptorchidism","correct":true},{"idx":3,"proposition":"Tobacco","correct":false,"justification":"False"},{"idx":4,"proposition":"Overweight","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"MTEV-cardio-0","context":null,"enonce":"Regarding venous thrombosis and pulmonary embolism","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Pulmonary embolism (PE) is most often a complication of deep vein thrombosis (DVT)","correct":true,"justification":"70% of PEs are secondary to DVT"},{"idx":1,"proposition":"PE causes 5,000 to 10,000 deaths per year in France","correct":true},{"idx":2,"proposition":"PE results in an initial dead space and then a shunt effect by redistribution of blood flow and secondary bronchoconstriction","correct":true,"justification":"As a reminder: shunt effect = unventilated infused, and dead space = ventilated not infused"},{"idx":3,"proposition":"PE results in a picture of hypercapnic hypoxemia with ventilatory alkalosis","correct":false,"justification":"Hypocapnic hypoxemia (by hyperventilation, normocapnia in COPD), with ventilatory alkalosis"},{"idx":4,"proposition":"The hemodynamic consequences of PE (increased cardiac work by increased afterload) appear for obstruction >50-60% of pulmonary circulation","correct":false,"justification":"For obstruction >30%. If the obstruction is >50-60%, cardiogenic shock (drop in cardiac output and hypotension) = acute pulmonary heart is feared"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"MTEV-cardio-2","context":null,"enonce":"About venous thromboembolic disease (VTE)","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"For the diagnosis of DVT, D-Dimer should be age-appropriate","correct":false,"justification":"Age adjustment only in the case of PE and if elderly patient"},{"idx":1,"proposition":"D-Dimer have a PPV (positive predictive value) of 99% for PE and proximal DVT","correct":false,"justification":"A VPN (negative predictive value) of 99%: in case of negativity and low clinical probability, the diagnosis is excluded"},{"idx":2,"proposition":"In a patient suffering from cancer and faced with a suspicion of PE, a CT angiography will be requested immediately regardless of the clinical probability","correct":true,"justification":"DDimers have no value in the case of cancer (false positive)"},{"idx":3,"proposition":"On ECG, an S1Q3 associated with a right axial deviation and a right branch block is specific to pulmonary embolism.","correct":false,"justification":"Signs of suffering of the right heart, they can evoke PE but are not specific"},{"idx":4,"proposition":"In case of high clinical probability, a negative CT angiography does not exclude pulmonary embolism","correct":true,"justification":"This is an indication for ventilation\/perfusion scan or arteriography"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"MTEV-cardio-3","context":null,"enonce":"About venous thromboembolic disease (VTE)","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"In case of superficial venous thrombosis, Doppler ultrasound of the lower limbs is essential ","correct":true,"justification":"It excludes an associated PST"},{"idx":1,"proposition":"In case of distal DVT or spontaneous superficial venous thrombosis, 6 weeks of anticoagulant therapy is recommended","correct":true},{"idx":2,"proposition":"In PE, a cardiac ultrasound may show direct signs, such as a non-enlarged hypokinetic dilated right ventricle ","correct":false,"justification":"This is an indirect sign (acute pulmonary heart)"},{"idx":3,"proposition":"In PE, pulmonary angiography is particularly recommended in case of thrombi in the right atrium","correct":false,"justification":"It is contraindicated in this case"},{"idx":4,"proposition":"Severe PE is defined as a SBP <90 mmHg or a decrease in SBP of 20mmHg for more than 10 minutes","correct":false,"justification":"STEP <90mmHg or drop of 40mmHg for more than 15 minutes"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"MTEV-cardio-4","context":null,"enonce":"About venous thromboembolic disease (VTE)","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"In PE, the early onset of basithoracic pleural pain accompanied by a dry cough should suggest pulmonary infarction ","correct":true},{"idx":1,"proposition":"In case of surgery <3 months and prescription of LMWH, an NFS is recommended in the pretherapeutic workup, then 2 times a week for 1 month, then 1 time per week","correct":true,"justification":"Indications for NFS monitoring in LMWH: chir\/trauma <3 months, UFH\/LMWH <6 months, significant comorbidity at risk"},{"idx":2,"proposition":"The PESI score assesses the risk of developing a chronic pulmonary heart","correct":false,"justification":"The risk of death at 30 days"},{"idx":3,"proposition":"In PE in an 81-year-old patient with cancer and SBP at 85 mmHg, right ventricle ultrasound dysfunction and elevated BNP biomarkers: PE is of intermediate severity","correct":false,"justification":"STEP <90 mmHg = > severe PE"},{"idx":4,"proposition":"In severe PE, LMWH should be initiated as soon as possible in the absence of severe renal impairment","correct":false,"justification":"LMWH is contraindicated in severe PE. UFH is indicated in combination with fibrinolysis"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"MTEV-cardio-6","context":null,"enonce":"Which of these proposals fall within the scope of calculating the Geneva score?","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Epistaxis","correct":false,"justification":"Hemoptysis"},{"idx":1,"proposition":"Age over 55","correct":false,"justification":"65 years, as often in cardiology (it is at this age that it is considered a cardiovascular risk factor)"},{"idx":2,"proposition":"Tobacco","correct":false,"justification":"Neither alcohol, tobacco nor diabetes are recognized risk factors for DVT (Deep Vein Thrombosis) or PE (Pulmonary Embolism)"},{"idx":3,"proposition":"Tachycardia","correct":true},{"idx":4,"proposition":"Pain","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"MTEV-cardio-7","context":null,"enonce":"From what Geneva score do we do without D-Dimer and do we do a CT injected directly?","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"9","correct":false,"justification":"A Geneva score greater than or equal to 11 requires the performance of a chest CT angiography"},{"idx":1,"proposition":"10","correct":false},{"idx":2,"proposition":"11","correct":true},{"idx":3,"proposition":"12","correct":false},{"idx":4,"proposition":"13","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"MTEV-cardio-8","context":null,"enonce":"From what Wells score do we do without D-Dimer and do we do a Doppler ultrasound of the lower limbs directly?","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"1","correct":false,"justification":"A Wells score greater than or equal to 3 is strong. It requires the realization of a venous Doppler ultrasound of the lower limbs"},{"idx":1,"proposition":"2","correct":false},{"idx":2,"proposition":"3","correct":true},{"idx":3,"proposition":"4","correct":false},{"idx":4,"proposition":"5","correct":false}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"MTEV-cardio-9","context":null,"enonce":"Which propositions are true?","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"D-dimer are specific products of fibrin degradation formed under plasmin action","correct":true},{"idx":1,"proposition":"The management of Deep Vein Thrombosis (DVT) is done in cardiovascular service only","correct":false,"justification":"Well-tolerated DVTs can be managed on an outpatient basis"},{"idx":2,"proposition":"A PESI score greater than or equal to 1 is intermediate","correct":true},{"idx":3,"proposition":"A BP (Systolic Blood Pressure) less than 90 mmHg classifies a PE as high risk","correct":true,"justification":"High PESI score: requires thrombolysis"},{"idx":4,"proposition":"The objective, in case of an intermediate PESI score, will be to dissolve the clot","correct":false,"justification":"Management with DOAC (direct oral anticoagulants) aims to prevent the appearance of new clots. DOACs, like VKAs or antiaggregants, are not thrombolytics."}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"MTEV-cardio-10","context":null,"enonce":"Which of these proposals can elevate D-Dimers?","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Pregnancy","correct":true},{"idx":1,"proposition":"Sepsis","correct":true},{"idx":2,"proposition":"A DICV","correct":true},{"idx":3,"proposition":"Coronary artery insufficiency","correct":true},{"idx":4,"proposition":"An extensive hematoma","correct":true,"justification":"All these proposals are true!"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"MTEV-cardio-11","context":null,"enonce":"Which of these propositions are true?","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"The determination of D-dimer has an excellent negative predictive value in ambulatory patients for whom the clinical probability of diagnosis of DVT\/PE is not high.","correct":true},{"idx":1,"proposition":"The so-called \"antiphospholipid\" antibodies are specific for complexes associating anionic phospholipids and proteins which may be β2-glycoprotein I","correct":true},{"idx":2,"proposition":"APS (Anti-Phospholipid Syndrome) is linked to ANCA vasculitis","correct":false,"justification":"APS is linked to systemic lupus (ACAN)"},{"idx":3,"proposition":"Many antibodies\nantiphospholipids may be present transiently and are non-thrombogenic","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"MTEV-cardio-12","context":null,"enonce":"Which of these factors and proteins are involved in mutations that can cause VTE?","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Factor II","correct":true,"justification":"The prothrombin gene (F2 G20210A)"},{"idx":1,"proposition":"Protein C","correct":true},{"idx":2,"proposition":"Factor VIII","correct":false},{"idx":3,"proposition":"The Willebrand factor","correct":false,"justification":"4 proteins and factors to know: Protein C, Protein S, Factor III and Factor V"},{"idx":4,"proposition":"Factor V","correct":true}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"IU-infectio-0","context":null,"enonce":"Which of the following identifies the most common germ in urinary tract infections?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"proposition":"E. coli","correct":true,"justification":"True, in almost 90% of cases"},{"idx":1,"proposition":"S. aureus","correct":false,"justification":"None"},{"idx":2,"proposition":"P. mirabilis","correct":false,"justification":"Comes in second place"},{"idx":3,"proposition":"K. pneumoniae","correct":false,"justification":"None"},{"idx":4,"proposition":"S. saprophyticus","correct":false,"justification":"Especially in young women"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IU-infectio-1","context":null,"enonce":"Which of the following are mandatory examinations in case of suspicion of severe acute pyelonephritis?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"proposition":"NFS-P","correct":true},{"idx":1,"proposition":"Kidney function","correct":true,"justification":"True, Urea and Creatinine"},{"idx":2,"proposition":"RAY","correct":false,"justification":"Useless if you do not think you have to transfuse (this is the general case)"},{"idx":3,"proposition":"Ultrasound of the urinary tract","correct":false,"justification":"We prefer the uroscanner from the outset"},{"idx":4,"proposition":"Blood","correct":true,"justification":"True, before administration of antibiotic therapy (C3G IV + Aminoside IV)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IU-infectio-2","context":null,"enonce":"Which of the following are the probabilistic first-line treatments for severe acute pyelonephritis?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"proposition":"C3G IV","correct":true,"justification":"True, C3G IV + Aminoside"},{"idx":1,"proposition":"Aminoglycoside IV","correct":true},{"idx":2,"proposition":"Amikacin IV","correct":true,"justification":"True, it is the aminoglycoside that is preferred"},{"idx":3,"proposition":"Gentamicin IV","correct":false,"justification":"Amikacin is preferred"},{"idx":4,"proposition":"Fluoroquinolone","correct":false,"justification":"This is the case when it is not serious"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IU-infectio-3","context":null,"enonce":"Which of the following are the probabilistic first-line treatments for severe acute pyelonephritis?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"proposition":"C3G IV","correct":true,"justification":"True, C3G IV + Aminoside"},{"idx":1,"proposition":"Aminoglycoside IV","correct":true},{"idx":2,"proposition":"Amikacin IV","correct":true,"justification":"True, it is the aminoglycoside that is preferred"},{"idx":3,"proposition":"Gentamicin IV","correct":false,"justification":"Amikacin is preferred"},{"idx":4,"proposition":"Fluoroquinolone","correct":false,"justification":"This is the case when it is not serious"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IU-infectio-4","context":null,"enonce":"Which of the following propositions concerning simple acute cystitis are true?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"proposition":"The diagnosis of simple acute cystitis does not require the realization of a urine strip in the young woman","correct":false,"justification":"False"},{"idx":1,"proposition":"ECBU is not necessary in young women without comorbidities  ","correct":true},{"idx":2,"proposition":"First-line treatment is Fosfomycin-tromitamol as a single dose","correct":true},{"idx":3,"proposition":"Recurrence occurs only very rarely ","correct":false,"justification":"False\r\nRecurrence in 20-30% of cases"},{"idx":4,"proposition":"Macroscopic hematuria is a sign of severity","correct":false,"justification":"False\r\nIt is not a sign of the severity of the infection"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"IU-infectio-5","context":null,"enonce":"What is the significant threshold of bacteriuria in humans (with notable exceptions)?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"proposition":"10^3","correct":true,"justification":"True. 10^3 in all cases EXCEPT atypical Enterobacteriaceae (other than E. coli, Enterobacteriaceae, etc.) in women (in this case, the threshold is 10^4)"},{"idx":1,"proposition":"10^2","correct":false,"justification":"False"},{"idx":2,"proposition":"10^4","correct":false,"justification":"This threshold is allowed for atypical enterobacteriaceae in women"},{"idx":3,"proposition":"10^5","correct":false,"justification":"False"},{"idx":4,"proposition":"10^6","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IU-infectio-6","context":null,"enonce":"What is the threshold of significant bacteriuria in women for E. coli?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"proposition":"10^2","correct":false,"justification":"False"},{"idx":1,"proposition":"10^3","correct":true,"justification":"True. 10^3 all the time, except in the case of atypical enterobacteriaceae (other than E. coli, enterobacteriaceae, etc.) in women (threshold of 10^4)"},{"idx":2,"proposition":"10^4","correct":false,"justification":"False"},{"idx":3,"proposition":"10^5","correct":false,"justification":"False"},{"idx":4,"proposition":"10^6","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vieillissement-nephro-0","context":null,"enonce":"Some fundamentals:","item":"vieillissement","matiere":"nephro","propositions":[{"idx":0,"proposition":"Renal aging is the consequence of intrinsic genetic and extrinsic mechanisms, related to environmental factors and comorbidities","correct":true},{"idx":1,"proposition":"Renal aging concerns only endocrine functions","correct":false,"justification":"It concerns all the functions of the kidneys: elimination of waste and toxins, homeostasis, endocrine functions"},{"idx":2,"proposition":"Renal ageing is accompanied by 'physiological' proteinuria","correct":false,"justification":"Renal aging is not accompanied by proteinuria or significant hematuria"},{"idx":3,"proposition":"The finding of proteinuria is always pathological, regardless of age","correct":false,"justification":"There are transient and physiological proteinuria (orthostatic, effort ...)"},{"idx":4,"proposition":"Age-related structural and functional renal changes do not have significant consequences in normal situations","correct":true,"justification":"But they limit the capacity for self-regulation, thus increasing the risk of occurrence of an IRA"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"vieillissement-nephro-1","context":null,"enonce":"Regarding the renal physiology of the elderly:","item":"vieillissement","matiere":"nephro","propositions":[{"idx":0,"proposition":"The determination of serum creatinine gives a poor reflection of renal function in the elderly and overestimates the severity of renal failure","correct":false,"justification":"It most often leads to underestimation of the severity of renal failure"},{"idx":1,"proposition":"The GFR value should be estimated by the CKD-PPE formulas rather than by the MDRD formula which is not very precise after 75 years.","correct":false,"justification":"The GFR value should be estimated by the CKD-PPE or MDRD formulas rather than by the Cockcroft formula, which is imprecise after age 75 and should no longer be used."},{"idx":2,"proposition":"A plasma creatinine value > 135 μmol\/L may indicate severe chronic renal failure (stage IV) in the elderly","correct":true},{"idx":3,"proposition":"The decrease in GFR is continuous and of the order of 10 ml \/ min and per year from adulthood","correct":false,"justification":"Aging is accompanied from adulthood, without threshold effect, by a decrease in the glomerular filtration rate of the order of 0.7ml \/ min \/ year"},{"idx":4,"proposition":"Water-electrolyte disorders are common in the elderly because the adaptive capacities of the kidney are quickly exceeded","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vieillissement-nephro-2","context":null,"enonce":"Regarding physiology:","item":"vieillissement","matiere":"nephro","propositions":[{"idx":0,"proposition":"Osmolar intakes tend to decrease with age","correct":true},{"idx":1,"proposition":"Body composition changes, with a lower percentage of fat mass and an increase in water volume","correct":false,"justification":"Lower percentage of total water and a higher percentage of body fat"},{"idx":2,"proposition":"Hyponatremia increases the risk of falls","correct":true},{"idx":3,"proposition":"The incidence of acute renal failure increases exponentially with age","correct":true},{"idx":4,"proposition":"Rapidly progressive glomerulonephritis syndrome is an urgent indication for renal biopsy","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vieillissement-nephro-3","context":null,"enonce":"Which propositions are true?","item":"vieillissement","matiere":"nephro","propositions":[{"idx":0,"proposition":"Age does not increase the rate of progression of chronic kidney disease","correct":true},{"idx":1,"proposition":"Renal failure alters the pharmacokinetics of all drugs","correct":false,"justification":"Not all but a lot, and you have to be careful!"},{"idx":2,"proposition":"Contraindications to dialysis management should be discussed on a case-by-case basis","correct":true},{"idx":3,"proposition":"The occurrence of certain pathologies may lead to consider the cessation of extrarenal purification\n","correct":true},{"idx":4,"proposition":"Kidney transplantation cannot be performed after age 75","correct":false,"justification":"Must be prosposed if necessary up to 85 years according to the HAS"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"vieillissement-nephro-4","context":null,"enonce":"What is the threshold of red blood cells per mm3 for which we speak of microscopic hematuria?","item":"vieillissement","matiere":"nephro","propositions":[{"idx":0,"proposition":"5 GR\/mm3","correct":false,"justification":"The threshold is 10 GR\/mm3 or 10 to the power of 4 red blood cells per mL"},{"idx":1,"proposition":"10 GR\/mm3","correct":true},{"idx":2,"proposition":"30 GR\/mm3","correct":false},{"idx":3,"proposition":"50 GR\/mm3","correct":false},{"idx":4,"proposition":"100 GR\/mm3","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vieillissement-nephro-5","context":null,"enonce":"Regarding renal aging, which proposal(s) is\/are accurate?","item":"vieillissement","matiere":"nephro","propositions":[{"idx":0,"proposition":"Albuminuria is physiological as long as it remains moderate","correct":false,"justification":"Albuminuria is never physiological"},{"idx":1,"proposition":"Microscopic hematuria is physiological after 80 years","correct":false,"justification":"Hematuria is never physiological"},{"idx":2,"proposition":"The GFR decrease, from the age of 40, is 10 points per year","correct":false,"justification":"The decrease in GFR from the age of 40 is 10 points per decade, or 1 point per year about"},{"idx":3,"proposition":"The decrease in GFR observed with age is about 0.7 per year","correct":true},{"idx":4,"proposition":"The best formula for estimating GFR is the Cockcroft-Gault in the elderly","correct":false,"justification":"We prefer to use MDRD or CKD-Epi"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vieillissement-nephro-6","context":null,"enonce":"What are the exact suggestions regarding kidney size?","item":"vieillissement","matiere":"nephro","propositions":[{"idx":0,"proposition":"The size of the kidneys remains the same from the age of 20","correct":false,"justification":"The size of the kidneys decreases with age, at the expense of the cortex, which remain regular (no notches, no cysts, etc.)"},{"idx":1,"proposition":"The kidneys increase in size with age physiologically","correct":false},{"idx":2,"proposition":"There is a decrease in the size of the kidneys at the expense of the parenchyma","correct":false},{"idx":3,"proposition":"The decrease in kidney size is at the expense of the cortex","correct":true},{"idx":4,"proposition":"The cortex remains regular in physiological situation","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"vieillissement-nephro-7","context":null,"enonce":"Regarding renal aging, which proposals are accurate?","item":"vieillissement","matiere":"nephro","propositions":[{"idx":0,"proposition":"The CKD-Épi formula is preferred to the Cockcroft-Gault formula to estimate the GFR","correct":true},{"idx":1,"proposition":"Creatinineuria increases with age","correct":false,"justification":"It decreases due to the decrease in muscle mass, which can mask kidney failure."},{"idx":2,"proposition":"Creatinineuria decreases due to the decrease in GFR with age","correct":false,"justification":"It is increased by the decrease in GFR, it is decreased by the loss of muscle mass"},{"idx":3,"proposition":"The feeling of thirst is decreased with age","correct":true},{"idx":4,"proposition":"The dilution capacity of urine is increased with age, which increases the risk of dehydration","correct":false,"justification":"The dilution capacity of urine is decreased in the elderly"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"vieillissement-nephro-8","context":null,"enonce":"Regarding renal aging, which proposals are accurate?","item":"vieillissement","matiere":"nephro","propositions":[{"idx":0,"proposition":"GFR decreases by about 0.7 ml\/min\/1m73² per year","correct":true},{"idx":1,"proposition":"GFR decreases by about 10 ml\/min\/1m73² per decade from age 40","correct":true},{"idx":2,"proposition":"The renin angiotensin aldosterone system is potentiated by aging","correct":false,"justification":"RAAS is decreased with age"},{"idx":3,"proposition":"The decrease in the size of the kidneys occurs in the cortex","correct":true},{"idx":4,"proposition":"Chronic kidney disease progresses faster and faster with age","correct":false,"justification":"The MRC continues its course without being impacted by age"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tumefactionpelv-gyn-0","context":null,"enonce":"General:","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"Fibroids are very common","correct":true},{"idx":1,"proposition":"Fibroids are not always symptomatic","correct":true},{"idx":2,"proposition":"Treatment of fibroids is mainly medicated","correct":false,"justification":"Essentially surgical"},{"idx":3,"proposition":"The essential complementary examination is pelvic ultrasound","correct":true},{"idx":4,"proposition":"Tumor markers are to be measured in second line possibly","correct":true,"justification":"As well as CT and MRI"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tumefactionpelv-gyn-1","context":null,"enonce":"General:","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"The 3 most common pelvic swellings are uterine fibroid, ovarian cyst and pregnancy","correct":true,"justification":"Always think about pregnancy in a woman during genital activity"},{"idx":1,"proposition":"The bHCG test is unnecessary in women taking contraception","correct":false,"justification":"Do it quite systematically"},{"idx":2,"proposition":"Uterine fibroids are most often mucous when palpable","correct":false,"justification":"The uterine fibroid, when palpable, is most often subserous (types 5,6,7 according to the FIGO classification) or interstitial (types 3,4)"},{"idx":3,"proposition":"1-2% of women over the age of 35 have uterine fibroids","correct":false,"justification":"It is the most common tumor of the uterus: 20 to 30% of women over 35 years of age have it"},{"idx":4,"proposition":"Fibroids are extremely painful most often","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tumefactionpelv-gyn-2","context":null,"enonce":"Regarding uterine fibroids:","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"Menorrhagia is the main telltale sign of uterine fibroids","correct":true,"justification":"Rules are increased in duration and abundance"},{"idx":1,"proposition":"In menorrhagia indicative of fibroids, menstruation is increased in abundance but not in duration","correct":false,"justification":"Rules are increased in duration and abundance"},{"idx":2,"proposition":"The Huntigton score specifies the number of diaper changes per day","correct":false,"justification":"The number of exchanges per day = Higham score"},{"idx":3,"proposition":"Sometimes endometrial hyperplasia is associated with fibroids","correct":true},{"idx":4,"proposition":"Dysmenorrhea is a sign eliminating the diagnosis of fibroid","correct":false,"justification":"It may be related to a fibroid of the cervix or isthmus interfering with the evacuation of menstrual flow."}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"tumefactionpelv-gyn-3","context":null,"enonce":"Regarding fibroids:","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"A submucosal fibroid is very rarely hemorrhagic","correct":false,"justification":"A submucosal fibroid is often responsible for significant bleeding (especially if an IUD is present), which can lead to hyposideremic microcytic anemia"},{"idx":1,"proposition":"Subserous fibroids rarely cause bleeding","correct":true,"justification":"This is also the case with interstitial fibroids."},{"idx":2,"proposition":"Hyperplasia and nerve compression of a fibroid is the main cause of pain in fibroids","correct":false,"justification":"It is rather aseptic necrobiosis"},{"idx":3,"proposition":"Complications are multiple during pregnancy, often minor and low impact once pregnancy has set in.","correct":true},{"idx":4,"proposition":"Adenomyosis is a very common cause of pelvic tumours","correct":false,"justification":"They are rarely the cause of a pelvic tumor because the uterus is rarely palpable (does not exceed one x2 in size)"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"tumefactionpelv-gyn-4","context":null,"enonce":"About ovarian cysts:","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"Endometrial cancer is a common cause of palpable pelvic tumours","correct":false,"justification":"This is actually a very rare cause, which is then often an endocavitary tumor with cervical stenosis and intrauterine retention."},{"idx":1,"proposition":"Functional ovarian cysts are the most common of a woman's pelvic swellings during genital activity","correct":true},{"idx":2,"proposition":"Functional cysts are always follicular","correct":false,"justification":"Follicular cysts or lutein cysts (of the corpus luteum) whose regression is most often spontaneous"},{"idx":3,"proposition":"Organic cysts are most often malignant","correct":false,"justification":"Most often benign"},{"idx":4,"proposition":"70% of ovarian tumours are malignant or borderline","correct":false,"justification":"20% of ovarian tumours are malignant or borderline, and the risk of cancer increases with age"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tumefactionpelv-gyn-5","context":null,"enonce":"About ovarian cysts:","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"The symptomatology of ovarian cysts is very specific: swelling, cyclical pain and menometrorrhagia","correct":false,"justification":"There is no specific symptomatology of ovarian cysts"},{"idx":1,"proposition":"Ovarian cyst is symptomatic in 10% of cases","correct":false,"justification":"In more than 50% of cases, the ovarian cyst is latent, and is discovered by incidentaloma"},{"idx":2,"proposition":"Sometimes the ovarian cyst is discovered during a complication","correct":true},{"idx":3,"proposition":"Acute pelvic pain from a cyst complication is mild and cyclical","correct":false,"justification":"It is a thunderclap in a serene sky not yielding and amplifying"},{"idx":4,"proposition":"Abdominal-pelvic pain begins abruptly from one second to the next and does not give way, getting worse.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tumefactionpelv-gyn-6","context":null,"enonce":"Regarding complications of ovarian cysts","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"In case of torsion, surgery is urgently needed to untwist the ovary or appendix and remove the cyst","correct":true},{"idx":1,"proposition":"Hysterectomy is preferred in young women to ensure 100% survival","correct":false,"justification":"It is necessary to be conservative in young women, even in case of late gesture and even if the appearance of the ovary is worrying"},{"idx":2,"proposition":"Intracystic hemorrhage often occurs in organ cysts","correct":false,"justification":"More often in functional cysts"},{"idx":3,"proposition":"A tusk is found in one of the two iliac fossa in case of intracystic hemorrhage","correct":true,"justification":"The cul de sac homolateral to pain is filled"},{"idx":4,"proposition":"Peritoneal effusion associated with intracystic hemorrhage is rare and indicates the severity and urgency of management","correct":false,"justification":"It is common to observe an associated peritoneal effusion"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"tumefactionpelv-gyn-7","context":null,"enonce":"Regarding the consultation in a woman with a very painful pelvic swelling:","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"Vaginal touch guides the diagnosis and is often very contributory","correct":false,"justification":"It is the essential examination because it helps to guide the diagnosis but it is often not very contributory because of the pain (see statement)"},{"idx":1,"proposition":"A uterus globally enlarged in volume most often corresponds to one or more interstitial fibroids","correct":true,"justification":"Or subserous"},{"idx":2,"proposition":"The clinical examination is emptied bladder","correct":true,"justification":"So as not to have a bladder globe that would trap us"},{"idx":3,"proposition":"Laterouterine masses in young women are always dependent on the uterus","correct":false,"justification":"Not at all, they can be independent if they interest the ovary for example"},{"idx":4,"proposition":"Transparietal and transvaginal pelvic ultrasound is the additional examination to be requested first","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tumefactionpelv-gyn-8","context":null,"enonce":"Regarding pelvic masses:","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"Solid swellings most often correspond to ovarian cancers","correct":false,"justification":"Solid swellings most often correspond to uterine fibroids and ultrasound specifies their size, number and location"},{"idx":1,"proposition":"IGOF classification maps the uterus","correct":false,"justification":"FIGO"},{"idx":2,"proposition":"Cancer masses are rarely large enough to give pelvic masses","correct":true},{"idx":3,"proposition":"In case of a supposedly benign cyst, a cystectomy or appendectomy is performed depending on the age","correct":true},{"idx":4,"proposition":"Therapeutic abstention is promoted in case of asymptomatic fibroid less than 25 cm","correct":false,"justification":"Less than 10 cm"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tumefactionpelv-gyn-9","context":null,"enonce":"What is the FIGO classification of an intramural uterine fibroid in contact with the endometrium?","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"3","correct":true},{"idx":1,"proposition":"4","correct":false,"justification":"Intramural interstitial fibroid (no contact with the endometrium)"},{"idx":2,"proposition":"7","correct":false,"justification":"Pedunculated subserous fibroma"},{"idx":3,"proposition":"1","correct":false,"justification":"Submural fibroid <50%"},{"idx":4,"proposition":"0","correct":false,"justification":"Intracavitary pedunculated submucosal fibroma"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"tumefactionpelv-gyn-10","context":null,"enonce":"What is the FIGO classification of a pedunculated subserous uterine fibroid?","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"7","correct":true},{"idx":1,"proposition":"4","correct":false,"justification":"Intramural interstitial"},{"idx":2,"proposition":"3","correct":false,"justification":"Intramural interstitial in contact with the endometrium"},{"idx":3,"proposition":"5","correct":false,"justification":"Subserous ≥50% intramural"},{"idx":4,"proposition":"2","correct":false,"justification":"Submucosal ≥50% intramural"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IUgrossesse-infectio-0","context":null,"enonce":"Which of the following propositions are true in pregnant women?","item":"IUgrossesse","matiere":"infectio","propositions":[{"idx":0,"proposition":"Fosfomycin (Monuril) is used as a single dose","correct":true},{"idx":1,"proposition":"Urinary colonizations should be treated probabilistic","correct":false,"justification":"After documentation if asymptomatic"},{"idx":2,"proposition":"Treatment of acute pyelonephritis is always hospitable","correct":false,"justification":"It can be ambulatory (good clinical tolerance, first AS)"},{"idx":3,"proposition":"Acute pyelonephritis requires ultrasound of the urinary tract","correct":true},{"idx":4,"proposition":"Cystitis never recurs","correct":false,"justification":"Recurrence is a common complication"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IUgrossesse-infectio-1","context":null,"enonce":"Which of the following propositions are true in pregnant women?","item":"IUgrossesse","matiere":"infectio","propositions":[{"idx":0,"proposition":"Urinary colonizations should be screened by BU","correct":true},{"idx":1,"proposition":"Urinary colonizations should be screened monthly from the sixth month","correct":false,"justification":"Every month from the third month"},{"idx":2,"proposition":"Urinary colonizations put you at high risk of pyelonephritis","correct":true},{"idx":3,"proposition":"Urinary colonizations should be treated","correct":true},{"idx":4,"proposition":"Ultrasound of the urinary tract is systematic in case of urinary colonizations","correct":false,"justification":"No ultrasound in this case"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IUgrossesse-infectio-2","context":null,"enonce":"Which of the following proposals correspond to a probabilistic antibiotic therapy for cystitis in pregnant 🤰 women?","item":"IUgrossesse","matiere":"infectio","propositions":[{"idx":0,"proposition":"Amoxicillin","correct":false,"justification":"Not indicated in urinary tract infection"},{"idx":1,"proposition":"Amoxicillin - Clavulanic Acid","correct":false,"justification":"Not indicated in urinary tract infection"},{"idx":2,"proposition":"Fosfomycin","correct":true,"justification":"True, in single dose, it is the first-line treatment"},{"idx":3,"proposition":"Ciprofloxacin","correct":true,"justification":"True, this is not the first-line treatment however (rather 3rd-4th line)"},{"idx":4,"proposition":"Pivmecillinam","correct":true,"justification":"True, this is second-line treatment"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"IUgrossesse-infectio-3","context":null,"enonce":"Which of the following proposals corresponds to the bacteriuria threshold requiring antibiotic management in pregnant women?","item":"IUgrossesse","matiere":"infectio","propositions":[{"idx":0,"proposition":"10.2 CFU\/mL","correct":false,"justification":"False"},{"idx":1,"proposition":"10.3 CFU\/mL","correct":false,"justification":"False"},{"idx":2,"proposition":"10.4 CFU\/mL","correct":false,"justification":"False"},{"idx":3,"proposition":"10.5 CFU\/mL","correct":true,"justification":"True, even asymptomatic"},{"idx":4,"proposition":"10.6 CFU\/mL","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IUgrossesse-infectio-4","context":null,"enonce":"Which of the following is the probabilistic first-line treatment of acute pyelonephritis without signs of severity in pregnant 🤰 women?","item":"IUgrossesse","matiere":"infectio","propositions":[{"idx":0,"proposition":"Monuril (Fosfomycin-Trometamol)","correct":false,"justification":"It is the first-line treatment for simple acute cystitis"},{"idx":1,"proposition":"Amoxicillin","correct":false,"justification":"Not part of probabilistic treatments for urinary tract infections"},{"idx":2,"proposition":"Cotrimoxazole","correct":false,"justification":"False"},{"idx":3,"proposition":"Carbapenem","correct":false,"justification":"False"},{"idx":4,"proposition":"None of these proposals","correct":true,"justification":"True. Indeed, the treatment is based on C3G IV (same as for acute pyelonephritis at risk of complication outside pregnancy)"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"IUgrossesse-infectio-5","context":null,"enonce":"Which of the following is true?","item":"IUgrossesse","matiere":"infectio","propositions":[{"idx":0,"proposition":"Cystitis in pregnant women corresponds to simple cystitis","correct":false},{"idx":1,"proposition":"Cystitis in pregnant women corresponds to cystitis at risk of complications","correct":true,"justification":"Cystitis gravidarum is cystitis at risk of complications"},{"idx":2,"proposition":"Cystitis in pregnant women corresponds to complicated cystitis","correct":false},{"idx":3,"proposition":"Cystitis in pregnant women is assimilated to pyelonephritis without gravity","correct":false},{"idx":4,"proposition":"Cystitis in pregnant women is equated with severe pyelonephritis","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"psychotropes-psy-0","context":null,"enonce":"Regarding antipsychotics:","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Antipsychotic treatments are indicated in the treatment of psychotic disorders, by definition","correct":true},{"idx":1,"proposition":"Some antipsychotic treatments are indicated in bipolar disorder","correct":true},{"idx":2,"proposition":"Antipsychotic treatments are antagonists of D1 receptors","correct":false,"justification":"Dopaminergic D2 receptors"},{"idx":3,"proposition":"The combination of several antipsychotics is most often advised to increase the effects","correct":false,"justification":"Monotherapy is preferred in the general context"},{"idx":4,"proposition":"Adherence is a major issue in the drug treatment of psychiatric disorders","correct":true,"justification":"This is why a blood test is interesting to check"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"psychotropes-psy-1","context":null,"enonce":"Regarding antipsychotics and antidepressants","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Conventional antipsychotic treatments are not subject to a specific pre-therapeutic assessment","correct":false,"justification":"NFS-P, Ionogram, Uremia, Creatinine, Hepatic Function, bHCG, ECG and Metabolic Assessment"},{"idx":1,"proposition":"Neuroleptic malignant syndrome concerns antipsychotics","correct":true},{"idx":2,"proposition":"Serotonin syndrome concerns antipsychotics","correct":false,"justification":"Antidepressants"},{"idx":3,"proposition":"Antidepressants are contraindicated in anxiety disorders","correct":false,"justification":"Some of them are."},{"idx":4,"proposition":"Antidepressants increase intrasynaptic monoamine concentrations","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"psychotropes-psy-2","context":null,"enonce":"Which of these proposals designates an adverse effect of antipsychotics?","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Parkinson's syndrome","correct":true},{"idx":1,"proposition":"Syndrome Alzeihmer-like","correct":false,"justification":"Does not exist"},{"idx":2,"proposition":"Metabolic syndrome","correct":true,"justification":"Hence the pre-therapeutic assessment"},{"idx":3,"proposition":"Dystonias","correct":true},{"idx":4,"proposition":"Drowsiness","correct":true,"justification":"This is possible and it is related to the blockage of the a1 and H1 receptors. Example CPR clozapine, drowsiness is a very common disorder."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"psychotropes-psy-3","context":null,"enonce":"Which of these proposals designates an adverse effect of antipsychotics?","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Akinesia","correct":true},{"idx":1,"proposition":"Weight loss","correct":false,"justification":"Metabolic syndrome, hence EAL (Lipid Abnormality Explorations) in pre-therapeutic"},{"idx":2,"proposition":"Dry syndrome","correct":true,"justification":"Atropinic effect"},{"idx":3,"proposition":"Cholestasis hepatitis","correct":true},{"idx":4,"proposition":"Hyperprolactinemia","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"psychotropes-psy-4","context":null,"enonce":"Regarding benzodiazepines:","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"They decrease neuronal excitability","correct":true},{"idx":1,"proposition":"They are anti-GABA","correct":false,"justification":"They facilitate gaba-ergic transmission. GABA, unlike glutamate, is an action potential inhibitor"},{"idx":2,"proposition":"They are anorectic","correct":false,"justification":"They have an orogenic effect that can cause metabolic syndrome"},{"idx":3,"proposition":"They are strongly discouraged in case of respiratory failure","correct":false,"justification":"They are contraindicated in respiratory failure, since their muscle relaxant effect can be very dangerous"},{"idx":4,"proposition":"They lower the epileptogenic threshold","correct":false,"justification":"They have an anti-epileptic action. Clonazepam is also the first-line treatment for status epilepticus. So they increase the epileptogenic threshold"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"psychotropes-psy-5","context":null,"enonce":"Regarding benzodiazepines:","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"They have an amnesiac effect","correct":true},{"idx":1,"proposition":"They are indicated in case of myasthenia gravis","correct":false,"justification":"They are contraindicated in this case, since they have a muscle relaxant effect"},{"idx":2,"proposition":"Their use contraindicates driving","correct":true,"justification":"It is formal and we have an obligation to inform the patient."},{"idx":3,"proposition":"They are indicated in anxiety disorders","correct":true},{"idx":4,"proposition":"Their prescription must be limited to 12 weeks in case of prescription for insomnia","correct":false,"justification":"4 weeks in this case, knowing that it is a very limited indication"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"psychotropes-psy-8","context":null,"enonce":"Which of the following proposals is\/are a non-selective MAOI(s)?","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Fluoxetine","correct":false,"justification":"SSRI"},{"idx":1,"proposition":"Sertraline","correct":false,"justification":"SSRI"},{"idx":2,"proposition":"Clomipramine","correct":false,"justification":"Tricyclic"},{"idx":3,"proposition":"Iproniazid","correct":true},{"idx":4,"proposition":"Paroxetine","correct":false,"justification":"SSRI"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"psychotropes-psy-9","context":null,"enonce":"Which of the following is\/are tricyclic antidepressants?","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Fluoxetine","correct":false,"justification":"SSRI"},{"idx":1,"proposition":"Sertraline","correct":false,"justification":"SSRI"},{"idx":2,"proposition":"Clomipramine","correct":true},{"idx":3,"proposition":"Iproniazid","correct":false,"justification":"Non-selective MAOIs"},{"idx":4,"proposition":"Paroxetine","correct":false,"justification":"SSRI"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"psychotropes-psy-10","context":null,"enonce":"Which of the following is\/are serotonin reuptake inhibitor(s) (SSRIs)?","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Fluoxetine","correct":true},{"idx":1,"proposition":"Sertraline","correct":true},{"idx":2,"proposition":"Clomipramine","correct":false,"justification":"Tricyclic"},{"idx":3,"proposition":"Iproniazid","correct":false,"justification":"Non-selective MAOI"},{"idx":4,"proposition":"Paroxetine","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"psychotropes-psy-12","context":null,"enonce":"Which of the following proposition(s) is true about antidepressants?","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"The time of action is usually 3 weeks","correct":true},{"idx":1,"proposition":"The time for action is immediate","correct":false,"justification":"It is between 2 and 4 weeks"},{"idx":2,"proposition":"The doses required are usually very low","correct":false,"justification":"Doses often need to be increased"},{"idx":3,"proposition":"The mechanism of action of SSRIs is the inhibition of serotonin reuptake","correct":true},{"idx":4,"proposition":"Talking about treatment failure usually requires at least 6 months","correct":false,"justification":"At least 6 weeks"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"psychotropes-psy-13","context":null,"enonce":"Which of the following are included in anticholinergic syndrome?","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Acute urine retention","correct":true,"justification":"True, by inhibiting the parasympathetic system"},{"idx":1,"proposition":"Sinus tachycardia","correct":true,"justification":"True, as opposed to the bradycardizing effects of acetylcholine"},{"idx":2,"proposition":"Dry mouth","correct":true,"justification":"True, by blocking salivary secretions"},{"idx":3,"proposition":"Diarrhoea","correct":false,"justification":"False, rather constipation by antispasmodic action at the level of smooth muscle fibers"},{"idx":4,"proposition":"Bilateral miosis","correct":false,"justification":"False, bilateral mydriasis"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"psychotropes-psy-14","context":null,"enonce":"Which of the following are possible side effects of selective serotonin reuptake inhibitors?","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Hyponatremia","correct":true,"justification":"True, by inappropriate secretion of DHA (especially in the elderly)"},{"idx":1,"proposition":"Tremors","correct":true},{"idx":2,"proposition":"QT prolongation","correct":true},{"idx":3,"proposition":"Sleep Apnea Syndrome (SAS)","correct":false,"justification":"False"},{"idx":4,"proposition":"Bilateral mydriasis","correct":false,"justification":"False, no anticholinergic effect of SSRIs"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"psychotropes-psy-15","context":null,"enonce":"Which of the following proposals are part of the lithium pre-therapeutic assessment? 💉","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Calcemia","correct":true,"justification":"True, because risk of tubulointerstitial nephropathy"},{"idx":1,"proposition":"Blood ionogram ","correct":true,"justification":"True, because risk of kidney side effects"},{"idx":2,"proposition":"TSH","correct":true,"justification":"True, because risk of hypothyroidism"},{"idx":3,"proposition":"ECG","correct":true,"justification":"True, because risk of conduction and repolarization disorders"},{"idx":4,"proposition":"Assessment of renal function","correct":true,"justification":"True, because renal elimination"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"parkinson-neuro-0","context":null,"enonce":"Parkinson's disease is defined by:","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Akinesia","correct":true,"justification":"Akinesia is the only symptom of the Parkinsonian triad that must be systematically present for diagnosis."},{"idx":1,"proposition":"Hyperesthesia","correct":false,"justification":"Bradykinesia"},{"idx":2,"proposition":"Asthenia","correct":false,"justification":"May be present in concomitance but does not fall within the strict framework of Parkinson's disease (triad bradykinesia \/ plastic rigidity \/ resting tremors)"},{"idx":3,"proposition":"plastic rigidity","correct":true},{"idx":4,"proposition":"A resting tremor","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"parkinson-neuro-1","context":null,"enonce":"Regarding Parkinson's disease:","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Key elements of the diagnosis are: the absence of signs other than parkinsonism and the positive and prolonged response from levodopa","correct":true,"justification":"There may be other signs, but no red flags"},{"idx":1,"proposition":"The existence of parkinsonism indicates a cholinergical deficit","correct":false,"justification":"The existence of parkinsonism indicates a dopaminergic deficiency"},{"idx":2,"proposition":"The diagnosis of Parkinson's disease is clinical and does not warrant further examination in case of typical presentation","correct":true,"justification":"Only additional examinations will be done if there are red flags or if there is a diagnostic doubt"},{"idx":3,"proposition":"It is important to exclude Wilson's disease in a young patient (before 40 years) with parkinsonism","correct":true},{"idx":4,"proposition":"Prevalence and incidence increase gradually with age up to age 80","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"parkinson-neuro-2","context":null,"enonce":"Which propositions are true?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"It is the second leading cause of motor disability in the elderly","correct":true,"justification":"The first being stroke"},{"idx":1,"proposition":"The manifestation of signs of the parkinsonian triad is bilateral or symmetrical","correct":false,"justification":"The manifestation of the signs of the parkinsonian triad is asymmetrical"},{"idx":2,"proposition":"Asymmetry persists throughout the disease","correct":true},{"idx":3,"proposition":"Parkinson's disease tremors are present at rest and disappear with movement","correct":true,"justification":"This is the case classically. Keep in mind that tremor can have a postural component"},{"idx":4,"proposition":"Bradykinesia is the slowing down of the execution of a movement and the decrement of the speed","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"parkinson-neuro-3","context":null,"enonce":"Among these proposals, which are diagnostic arguments?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"The progressive appearance of bradycardia","correct":true,"justification":"There are dysautonomic prodromes, but these are not the main diagnostic arguments in the foreground."},{"idx":1,"proposition":"Stiffness and\/or resting tremor","correct":true,"justification":"It is a plastic rigor."},{"idx":2,"proposition":"The asymmetry of parkinsonism","correct":true},{"idx":3,"proposition":"The normality of neurological examination, apart from parkinsonism","correct":true},{"idx":4,"proposition":"Exaggerated osteoarticular reflexes","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"parkinson-neuro-4","context":null,"enonce":"Are causes of symmetric extrapyramidal syndrome:","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Progressive supranuclear palsy","correct":true,"justification":"Mnemonic : VIP"},{"idx":1,"proposition":"Idiopathic Parkinson's disease","correct":false,"justification":"It is an asymmetric extrapyramidal syndrome."},{"idx":2,"proposition":"Iatrogeny","correct":true,"justification":"Ex. neuroleptics"},{"idx":3,"proposition":"Multiple system atrophy","correct":false,"justification":"Asymmetric"},{"idx":4,"proposition":"Vascular Parkinson's","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"parkinson-neuro-5","context":null,"enonce":"Are red flags of Parkinson's disease:","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Cerebellar syndrome","correct":true},{"idx":1,"proposition":"Early dementia","correct":true},{"idx":2,"proposition":"REM sleep disorders","correct":false,"justification":"This is an enunciating sign of Parkinson's disease, and may be present years before the onset of the Parkinsonian triad"},{"idx":3,"proposition":"Pseudobulbar syndrome","correct":true},{"idx":4,"proposition":"Symmetrical tremor","correct":true,"justification":"Tremor is asymmetric in Parkinson's disease"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"parkinson-neuro-6","context":null,"enonce":"Why prescribe a dopaminergic agonist rather than L-DOPA early in a patient under 70 years of age?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Slowing the progression of the disease","correct":false},{"idx":1,"proposition":"Improve cognitive function","correct":false},{"idx":2,"proposition":"Achieve physiological dopaminergic stimulation","correct":false,"justification":"Their action is not to stimulate dopamine neurons but to 'replace' them."},{"idx":3,"proposition":"Delay the onset of motor complications","correct":true,"justification":"True, they work by directly activating receptors downstream of neurons in the substantia nigra."},{"idx":4,"proposition":"Stimulate neuronal regeneration","correct":false,"justification":"No medication can do this"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"parkinson-neuro-7","context":null,"enonce":"Among the following proposals, which are elements that should cast doubt on the diagnosis of Parkinson's disease in the face of parkinsonism syndrome?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"High free cupremia","correct":true,"justification":"True, we think of Wilson's disease"},{"idx":1,"proposition":"Asymmetric resting tremor at 4-6 Hz","correct":false,"justification":"Typical of Parkinson's disease"},{"idx":2,"proposition":"Rapid response to L-DOPA","correct":false,"justification":"Typical of Parkinson's disease"},{"idx":3,"proposition":"Unilateral Babinski sign","correct":true,"justification":"True, it indicates a pyramidal syndrome, which is contrary to Parkinson's disease (which is an involvement of the extrapyramidal pathways)"},{"idx":4,"proposition":"Early oculomotor disorders","correct":true,"justification":"True. No cranial nerve damage classically"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"parkinson-neuro-8","context":null,"enonce":"Which of the following proposals do you prescribe for a 62-year-old patient with Parkinson's disease?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Selective norepinephrine reuptake inhibitor (ISRNA)","correct":false,"justification":"No indication in Parkinson's disease"},{"idx":1,"proposition":"Monoamine oxidase B inhibitor (MAOI-B)","correct":true,"justification":"True, preferred in a subject under 70 years old"},{"idx":2,"proposition":"Dopaminergic agonist","correct":true,"justification":"True, to be preferred in a subject under 70 years, especially in case of Restless Legs Syndrome associated"},{"idx":3,"proposition":"L-DOPA","correct":true,"justification":"True, always possible"},{"idx":4,"proposition":"Anticholinergic","correct":false}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"parkinson-neuro-10","context":null,"enonce":"Which of the following are atypical degenerative parkinsonian syndromes?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Multi-system atrophy","correct":true,"justification":"True, with dysautonomia and pyramid signs"},{"idx":1,"proposition":"Progressive supranuclear palsy","correct":true,"justification":"True, with symmetric parkinsonism"},{"idx":2,"proposition":"Corticobasal degeneration","correct":true,"justification":"True, with apraxia"},{"idx":3,"proposition":"Dementia with Lewy bodies","correct":true,"justification":"True, with cognitive impairment (hallucination and decreased alertness)"},{"idx":4,"proposition":"Amyotrophic lateral sclerosis","correct":false,"justification":"It is an impairment of the motor neuron"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"parkinson-neuro-11","context":null,"enonce":"Which of the following proposals can precede the motor disorders of Parkinson's disease by several years?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Hearing impairment","correct":false,"justification":"No hearing impairment classically"},{"idx":1,"proposition":"Headache","correct":false,"justification":"No headaches classically"},{"idx":2,"proposition":"Sleep disorders","correct":true,"justification":"True, low dopamine decreases motor inhibition during REM sleep. Patients describe animated dreams"},{"idx":3,"proposition":"Impaired sense of smell","correct":true,"justification":"True, is found in many neurodegenerative diseases"},{"idx":4,"proposition":"Constipation","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"parkinson-neuro-12","context":null,"enonce":"Which of the following is\/are recognized risk factors for Parkinson's disease?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Alcohol and tobacco intoxication","correct":false,"justification":"False"},{"idx":1,"proposition":"Obesity","correct":false,"justification":"False"},{"idx":2,"proposition":"High blood pressure","correct":false,"justification":"False"},{"idx":3,"proposition":"Pesticides","correct":true,"justification":"True, this is the only risk factor cited in the college"},{"idx":4,"proposition":"No risk factors are known","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"parkinson-neuro-13","context":null,"enonce":"Which of the following are true about Wilson's disease?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"The most common mode of disclosure in children is liver damage","correct":true},{"idx":1,"proposition":"Late discovery after 35 years is common","correct":false,"justification":"It is often in young adults (before 35 years)"},{"idx":2,"proposition":"Genetic testing can be done without informed consent","correct":false,"justification":"Never genetic testing without free and informed consent"},{"idx":3,"proposition":"Inheritance is autosomal dominant","correct":false,"justification":"Autosomal recessive (chromosome 13)"},{"idx":4,"proposition":"The accumulation of free copper is responsible for organic damage","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"parkinson-neuro-14","context":null,"enonce":"Which of the following are side effects of dopamine agonists?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Vomiting","correct":true},{"idx":1,"proposition":"Hypersexuality","correct":true,"justification":"True, as well as pathological gambling"},{"idx":2,"proposition":"Daytime sleepiness","correct":true},{"idx":3,"proposition":"Nausea","correct":true},{"idx":4,"proposition":"Palpitations","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"parkinson-neuro-15","context":null,"enonce":"Which of the following are synucleinopathies (neurodegenerative diseases characterized by the abnormal accumulation of synuclein protein aggregates)?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Parkinson's disease","correct":true,"justification":"True, the aggregate forms intracytoplasmic Lewy bodies in neurons of the nigrostriatal pathway (and especially in the substantia nigra, in the midbrain)."},{"idx":1,"proposition":"Alzheimer's disease","correct":false,"justification":"Instead, hyperphosphorylated Tau proteins are found in axons and extracellular Ab-42 peptides"},{"idx":2,"proposition":"Multi-system atrophy (AMS)","correct":true,"justification":"True, there is an asymmetric parkinsonism syndrome and dysautonomia. We can find a pyramidal syndrome (with plastic rigidity and positive Babinski). There is no significant impairment of higher functions"},{"idx":3,"proposition":"Dementia with Lewy bodies","correct":true,"justification":"True, there is an asymmetric parkinsonism with significant impairment of cognitive functions"},{"idx":4,"proposition":"Wilson's disease","correct":false,"justification":"There is an increased 24-hour cupruria associated with a decrease in serum cupremia and ceruleoplasminemia. Clinically, Kayser-Fleischer annals are observed at water level (copper deposit)."}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"parkinson-neuro-16","context":null,"enonce":"Which of the following are signs or symptoms of parkinsonism in parkinsonism?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Resting tremor","correct":true},{"idx":1,"proposition":"Spastic rigidity","correct":false,"justification":"Spastic rigidity is part of pyramidal syndrome. Parkinson's syndrome is an extra-pyramidal syndrome in which plastic rigidity is found."},{"idx":2,"proposition":"Myoclonus","correct":false,"justification":"Not in this syndrome"},{"idx":3,"proposition":"Fasciculations","correct":false,"justification":"Not in this syndrome"},{"idx":4,"proposition":"Bradykinesia","correct":true,"justification":"True: slow walking, micrography, hypomimia, etc."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"parkinson-neuro-17","context":null,"enonce":"Which of the following proposals regarding the implantation of a stimulator are true?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"The main objective is to reduce fluctuations related to drug treatments","correct":true},{"idx":1,"proposition":"Deep brain stimulation consists of the implantation of electrodes in basal ganglia by radiological route","correct":false,"justification":"Neurosurgical pathway"},{"idx":2,"proposition":"The nucleus concerned is the caudate nucleus most often","correct":false,"justification":"It is the subthalamic nucleus"},{"idx":3,"proposition":"The electrodes allow high-frequency stimulation that has an inhibitory effect on the affected nucleus","correct":true},{"idx":4,"proposition":"Electrodes stimulate endogenous dopamine production","correct":false,"justification":"They stimulate the subthalamic nucleus which is a powerful inhibitor and therefore helps to alleviate the signs of dopaminergic over-stimulation due to drugs"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"bipolaire-psy-0","context":null,"enonce":"General:","item":"bipolaire","matiere":"psy","propositions":[{"idx":0,"proposition":"The typical onset of bipolar disorder is between the ages of 40 and 50.","correct":false,"justification":"Typical onset of bipolar disorder: 15-25 years"},{"idx":1,"proposition":"The manic episode is a medical-surgical emergency","correct":false,"justification":"Medical emergency. No surgical management on this pathology."},{"idx":2,"proposition":"Manic syndrome has a psychoaffective, psychomotor and phsyiological disturbances component","correct":true},{"idx":3,"proposition":"Diet and sexuality are often disturbed in this disorder","correct":true},{"idx":4,"proposition":"The gold standard treatment for manic episode is lithium","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"bipolaire-psy-1","context":null,"enonce":"Treatments:","item":"bipolaire","matiere":"psy","propositions":[{"idx":0,"proposition":"The only effective thymoregulator in suicide prevention is xeroquel","correct":false,"justification":"It's lithium. Xeroquel is a quetiapine (second generation antipsychotic)"},{"idx":1,"proposition":"The recommended dosage of Depakote is 750 mg\/day","correct":true},{"idx":2,"proposition":"Aripiprazole is a first-generation antipsychotic","correct":false,"justification":"2nd generation antipsychotic"},{"idx":3,"proposition":"Lithium is a treatment for the depressive episode characterized in the context of bipolar illness","correct":true},{"idx":4,"proposition":"Amotrigine is a preventive treatment for depressive episodes in bipolar disease","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"bipolaire-psy-2","context":null,"enonce":"Epidemiology and history:","item":"bipolaire","matiere":"psy","propositions":[{"idx":0,"proposition":"Quetiapine is a first-generation antipsychotic","correct":false,"justification":"Quetiapine = 2nd generation"},{"idx":1,"proposition":"Bipolar disorder is very rare","correct":false,"justification":"Bipolar disorder is a severe, chronic and common psychiatric disorder"},{"idx":2,"proposition":"This disease was discovered by Freud in the 1890s.","correct":false,"justification":"This disease has been described since ancient times and is characterized by pathological changes in mood and energy that can be increased (mania) or decreased (depression)"},{"idx":3,"proposition":"Bipolar disorder is pure genetic in origin but the exact loci are not known","correct":false,"justification":"Bipolar disorder is multifactorial in origin, mixing genetic and environmental risk factors"},{"idx":4,"proposition":"It is considered that 1 to 4% of the general population has typical forms of bipolar disorder.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dvlptbuccoD-cmf-0","context":null,"enonce":"Which of these proposals correspond to the development of the cephalic end?","item":"dvlptbuccoD","matiere":"cmf","propositions":[{"idx":0,"proposition":"Histogenesis","correct":true,"justification":"up to S2. (For information, S = week of development in utero)"},{"idx":1,"proposition":"Viventogenesis","correct":false,"justification":"does not exist"},{"idx":2,"proposition":"Organogenesis","correct":true,"justification":"Between S2 and S8"},{"idx":3,"proposition":"Buccogenesis","correct":false,"justification":"Does not exist"},{"idx":4,"proposition":"Morphogenesis","correct":true,"justification":"From S8 to birth"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"dvlptbuccoD-cmf-1","context":null,"enonce":"Which propositions are true?","item":"dvlptbuccoD","matiere":"cmf","propositions":[{"idx":0,"proposition":"The earlier a developmental abnormality is, the more severe it is","correct":true,"justification":"Generally"},{"idx":1,"proposition":"Phacomastoses are progressive tissue dysplasias that occur during histogenesis","correct":true,"justification":"Cellular abnormalities in primary blastema"},{"idx":2,"proposition":"Dystosis deformities reside mainly in the orbit and ear","correct":false,"justification":"They can sit in the orbit, nose, maxilla or mandibular (but not the ear)"},{"idx":3,"proposition":"The clinical expression of suturary involvement will be immediate in the face","correct":false,"justification":"Late because it is a discontinuous, multifactorial and long-term growth entity"},{"idx":4,"proposition":"The clinical expression of suturary involvement will be rapidly progressive in the cranial vault","correct":true,"justification":"It will be immediate and dependent on the brain"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dvlptbuccoD-cmf-2","context":null,"enonce":"Regarding facial embryology:","item":"dvlptbuccoD","matiere":"cmf","propositions":[{"idx":0,"proposition":"The cephalic tip of the fetus begins to round at S24","correct":false,"justification":"From S4 at the embryo stage"},{"idx":1,"proposition":"The stomodeum is the primitive mouth","correct":true},{"idx":2,"proposition":"The nasofrontal bud will evolve into mandibular buds","correct":false,"justification":"It will give the frontal bud and the internal and external nasal buds"},{"idx":3,"proposition":"Cysts and fistulas result from a disorder of the coalescence of one or more facial buds and ectodermal inclusions at the junction of these structures","correct":true},{"idx":4,"proposition":"Treatment of cysts and fistulas is purely surgical","correct":true,"justification":"Complete excision to avoid recurrence"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"dvlptbuccoD-cmf-3","context":null,"enonce":"Regarding facial slits:","item":"dvlptbuccoD","matiere":"cmf","propositions":[{"idx":0,"proposition":"They result from a lack of attachment of one or more facial buds","correct":true},{"idx":1,"proposition":"They have a social and psychological impact exclusively","correct":false,"justification":"They also impact orofacial function and facial morpjology"},{"idx":2,"proposition":"The stomodeum is permanently obstructed by the pharyngeal membrane","correct":false,"justification":"Provisionally"},{"idx":3,"proposition":"Coloboma is very common","correct":false,"justification":"Very rare malformation (cleft between the upper maxillary bud and the outer nasal bud)"},{"idx":4,"proposition":"The macrostomy is a cleft between the upper and lower maxillary buds","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"dvlptbuccoD-cmf-4","context":null,"enonce":"Regarding lip opalatine clefts:","item":"dvlptbuccoD","matiere":"cmf","propositions":[{"idx":0,"proposition":"Cleft lip and palate are the most common facial clefts","correct":true},{"idx":1,"proposition":"They concern 1 birth in 50000","correct":false,"justification":"One in 750 births"},{"idx":2,"proposition":"Management is surgical exclusively","correct":false,"justification":"It is multidisciplinary: genetic counseling, psychological care, speech therapy, orthodontic follow-up, surgery, etc."},{"idx":3,"proposition":"She is always isolated","correct":false,"justification":"It can be part of a polymalformative syndrome"},{"idx":4,"proposition":"It most often results from an accident during organogenesis between S5 and S7","correct":true,"justification":"Infectious, traumatic, genetic, etc."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"droits-sp-0","context":null,"enonce":"Which of the following are true?","item":"droits","matiere":"sp","propositions":[{"idx":0,"proposition":"Medical confidentiality has been one of the pillars of medical practice since 1980","correct":false,"justification":"Introduction Since Hippocrates, medical secrecy has been one of the pillars of the practice of medicine: \"Admitted inside the houses, my eyes will not see what is happening there, my tongue will silence the secrets that will be entrusted to me...\" Because there is no care without confidences, confidences without trust, trust without secrecy"},{"idx":1,"proposition":"Physician-client privilege has a dual interest: private and public.","correct":true},{"idx":2,"proposition":"The doctor must guarantee secrecy to the person who confides in him","correct":true},{"idx":3,"proposition":"The history of secrecy surrounding the medical act testifies to a complex, sometimes conflictual, triangular relationship between physicians, society and patients","correct":true},{"idx":4,"proposition":"Society or state can never access medical information","correct":false,"justification":"Indeed, in certain circumstances, the law requires or authorizes the disclosure of certain information for a private and\/or public purpose, for example in the context of judicial requisitions.\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"droits-sp-1","context":null,"enonce":"Which of the following are true?","item":"droits","matiere":"sp","propositions":[{"idx":0,"proposition":"The obligation to secrecy is now included in articles 226-13 and 226-14 of the 1994 Criminal Code.","correct":true},{"idx":1,"proposition":"In the penal code, we find the notion of medical confidentiality, reserved for health professionals","correct":false,"justification":"The Penal Code Compared to the old Code, the Penal Code of March 1994 no longer refers to doctors. It concerns any person holding confidential information."},{"idx":2,"proposition":"Revealing secret information can be punished by a fine but not by prison","correct":false,"justification":"Article 226-13: \"The disclosure of information of a secret nature by a person who is the custodian thereof, either by state, or by profession, or because of a function or a temporary mission, is punishable by one year's imprisonment and a fine of 15,000 euros."},{"idx":3,"proposition":"The Act of 8 March 2003 establishes a breach in medical confidentiality by allowing doctors to hand over a file to a judicial police officer, on simple requisition, without violating the principle of secrecy.","correct":true},{"idx":4,"proposition":"Under the 2003 Act, a judicial police officer may compel a doctor to hand over a patient's medical file.","correct":true,"justification":"When the medical file is requisitioned during a criminal case, for example, the seizure must be made in the presence of a doctor who ensures the proper maintenance of medical confidentiality as well as the seizure of the file according to good practices."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"droits-sp-2","context":null,"enonce":"Which of these proposed laws refer to medical confidentiality?","item":"droits","matiere":"sp","propositions":[{"idx":0,"proposition":"The Public Health Code","correct":true,"justification":"Law number 2002-303 of 4 March 2002"},{"idx":1,"proposition":"The Penal Code","correct":true,"justification":"Article 60 (1)"},{"idx":2,"proposition":"The Code of Criminal Procedure","correct":true},{"idx":3,"proposition":"The Code of Ethics of the Ordre des médecins","correct":false,"justification":"It is not a piece of legislation, but several elements have been extracted and inserted into the various codes by the legislator."},{"idx":4,"proposition":"The LFSS","correct":false,"justification":"This is the law on the financing of social security.\""}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"droits-sp-3","context":null,"enonce":"Which of the following are true?","item":"droits","matiere":"sp","propositions":[{"idx":0,"proposition":"Professional secrecy, instituted in the interest of patients, is binding on every doctor under the conditions established by law.","correct":true},{"idx":1,"proposition":"Doctor's assistants are not subject to medical confidentiality if they are not doctors","correct":false,"justification":"The physician must ensure that the persons who assist him in his practice are informed of their obligations with respect to professional secrecy and comply with them"},{"idx":2,"proposition":"The physician must protect against any indiscretion the medical documents concerning the persons he has cared for or examined, regardless of the content and medium of these documents.","correct":true},{"idx":3,"proposition":"When using his experience or documents for scientific publication or teaching purposes, physicians must ensure that identification of persons is not possible.","correct":true},{"idx":4,"proposition":"Publishing a research paper with the name of an explicitly cited patient is illegal","correct":false,"justification":"Failing this, their agreement must be obtained."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"droits-sp-4","context":null,"enonce":"Concerning the case-law on professional secrecy","item":"droits","matiere":"sp","propositions":[{"idx":0,"proposition":"It is binding on all health professionals as well as all professionals involved in the health system.","correct":true},{"idx":1,"proposition":"Medical confidentiality prohibits the doctor from giving the cause of death of a patient to his family","correct":false,"justification":"Secrecy shall not prevent information concerning a deceased person from being delivered to his successors, insofar as it is necessary for them to know the causes of death, to defend the memory of the deceased, or to assert their rights, unless otherwise expressed by the person before his death."},{"idx":2,"proposition":"Case law tends to eliminate the notion of medical confidentiality","correct":false,"justification":"Jurisprudence, both judicial and administrative, has reinforced these provisions by proclaiming that medical confidentiality is of a general and absolute nature, as early as the nineteenth century."},{"idx":3,"proposition":"The doctor is not subject to medical confidentiality if the patient does not request it","correct":false,"justification":"the patient cannot release the doctor from his obligation of secrecy"},{"idx":4,"proposition":"Talking with co-interns about a patient at the staff restaurant is not in contradiction with medical confidentiality","correct":false,"justification":"Secrecy is required with regard to other doctors if they do not contribute to an act of care"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"droits-sp-6","context":null,"enonce":"Regarding the solicitor-client privilege application(s)","item":"droits","matiere":"sp","propositions":[{"idx":0,"proposition":"A doctor working for an insurer is subject to medical secrecy that he shares with his colleagues hospital doctors","correct":false,"justification":"They may not examine the medical file, or question the attending physician of a patient, without the express agreement of the latter."},{"idx":1,"proposition":"The doctor must communicate the medical file to the insurance companies for reimbursement","correct":false,"justification":"It is up to the patient to communicate his personal data to insurance doctors (the law of 4 March 2002 now gives him direct access to his file). Nevertheless, he can be helped by the doctor to fill out certain administrative forms. He remains the holder of all data concerning him."},{"idx":2,"proposition":"The medical officer of the social security is not bound by medical confidentiality","correct":false,"justification":"The exchange of information between the attending physician and the medical officer, who is himself bound to secrecy, is also recognized in the name of the principle of \"shared secrecy\" (medico-social consultation)."},{"idx":3,"proposition":"In criminal matters, the Code of Criminal Procedure allows judges to use coercive means to access medical information and the truth.","correct":true},{"idx":4,"proposition":"The scope of professional secrecy stops at written information. Information seen and heard is not subject to this secrecy.","correct":false,"justification":"Secret information Case law has long been ruling on the extent of professional secrecy, and this consistently, specifying that secrecy concerns all information entrusted, but also everything that may have been seen, heard, understood, or even interpreted during medical practice."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"droits-sp-7","context":null,"enonce":"Which of this information is covered by medical confidentiality?","item":"droits","matiere":"sp","propositions":[{"idx":0,"proposition":"Diagnostics","correct":true},{"idx":1,"proposition":"Medical prescriptions","correct":true},{"idx":2,"proposition":"Confidences of adultery","correct":true},{"idx":3,"proposition":"Medical records","correct":true},{"idx":4,"proposition":"Conversations at home during a visit","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"infnasosin-infectio-0","context":null,"enonce":"Regarding nasal sinus infections","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Nasopharyngitis is almost exclusively viral","correct":true},{"idx":1,"proposition":"Nasopharyngitis is the most common mode of expression of influenza in children","correct":true},{"idx":2,"proposition":"There is often viral sinus involvement in nasopharyngitis, which heals spontaneously","correct":true},{"idx":3,"proposition":"Acute bacterial sinusitis is a rare complication of nasopharyngitis","correct":false},{"idx":4,"proposition":"The presence of sinusitis in immunocompromised patients should suggest a fungal origin (aspergillosis, mucormycosis), especially in case of bone lysis on CT","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"infnasosin-infectio-1","context":null,"enonce":"Regarding nasal sinus infections","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Their transmission is droplet type","correct":true},{"idx":1,"proposition":"Bacterial sinusitis is not contagious","correct":true},{"idx":2,"proposition":"Most acute bacterial sinusitis complicates a viral infection of the upper airways","correct":true},{"idx":3,"proposition":"In case of doubt as to the viral or bacterial origin of acute maxillary sinusitis, clinical reassessment after 2 or 3 days of symptomatic treatment is advised","correct":true},{"idx":4,"proposition":"Imaging has no indication except in cases of unilateral maxillary sinusitis","correct":true}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"infnasosin-infectio-2","context":null,"enonce":"Regarding nasal sinus infections:","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Ethmoidal sinusitis is mainly observed in adults","correct":false},{"idx":1,"proposition":"In case of bacterial infection with frontal, ethmoidal or sphenoidal localization, there is a risk of serious damage to the central nervous system by proximity diffusion","correct":true},{"idx":2,"proposition":"Chronic sinusitis is defined by the persistence of symptoms of nasal obstruction, pain and rhinorrhea for more than 2 weeks","jusification":"Pendant plus de douze semaines","correct":false},{"idx":3,"proposition":"In infants, a picture of gastroenteritis with diarrhea and abdominal pain may be in the foreground","correct":true},{"idx":4,"proposition":"The intensity and impact of symptoms are very variable depending on the individuals and episodes.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infnasosin-infectio-4","context":null,"enonce":"In which case(s) is the sinus scanner systematic for management?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Ethmoidite","correct":true},{"idx":1,"proposition":"Frontal sinusitis","correct":true},{"idx":2,"proposition":"Sphenoid sinusitis","correct":true},{"idx":3,"proposition":"Acute maxillary sinusitis","correct":false,"justification":"False. Sinus CT is indicated only if there is a diagnostic doubt, if there is doubt about complications, if there is resistance to first-line antibiotic treatment, or if it is chronic maxillary sinusitis"},{"idx":4,"proposition":"None. The diagnosis of sinusitis is clinical and only a CT scan is done if there is a diagnostic doubt. ","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infnasosin-infectio-5","context":null,"enonce":"Which of the following are systematic indications for sinus CT?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Chronic unilateral maxillary sinusitis","correct":false,"justification":"Dental panoramic or dentascan, to search for a dental focus"},{"idx":1,"proposition":"Acute maxillary sinusitis","correct":false,"justification":"False, no imaging in this case"},{"idx":2,"proposition":"Frontal sinusitis","correct":true},{"idx":3,"proposition":"Ethmoidal sinusitis","correct":true},{"idx":4,"proposition":"Sphenoidal sinusitis","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infnasosin-infectio-7","context":null,"enonce":"Which of the following are true?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Maxillary sinuses are formed from 3-4 years ","correct":true},{"idx":1,"proposition":"Frontal sinuses form around 5-10 years ","correct":true,"justification":"This is why we see frontal sinusitis only in adolescents\/adults"},{"idx":2,"proposition":"Sphenoid sinuses form around 5-10 years of age ","correct":false,"justification":"False, between 10 and 15 years old. These are the frontal sinuses that form between 5 and 10 years."},{"idx":3,"proposition":"Ethmoidal cells are formed from the first months of life ","correct":true},{"idx":4,"proposition":"Maxillary sinuses are formed from the first months of life ","correct":false,"justification":"From 3 years old. We can therefore not see maxillary sinusitis before 3 years"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"infnasosin-infectio-8","context":null,"enonce":"Which of the following are signs of simple nasopharyngitis?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"One-sided pain","correct":false,"justification":"Sign of sinusitis"},{"idx":1,"proposition":"Throbbing pain","correct":false,"justification":"Sign of sinusitis"},{"idx":2,"proposition":"Incomplete bilateral nasal obstruction","correct":true},{"idx":3,"proposition":"Clear rhinorhea","correct":true,"justification":"True, can then become purulent"},{"idx":4,"proposition":"Acme at night","correct":false,"justification":"Sign of sinusitis"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infnasosin-infectio-9","context":null,"enonce":"Regarding the development of sinuses in children. Which of the following are true?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Maxillary sinuses are present from birth","correct":false,"justification":"False. 3 to 4 years."},{"idx":1,"proposition":"Sphenoid sinuses are present from the age of 5 to 10 years","correct":false,"justification":"False. Sphenoid sinuses are present from the age of 10 to 15 years."},{"idx":2,"proposition":"Ethmoidal cells are present from the age of 3 to 4 years.","correct":false,"justification":"False. Ethmoidal cells are present from the age of 1 month."},{"idx":3,"proposition":"The frontal sinus is present from the age of 5 to 10 years","correct":true},{"idx":4,"proposition":"None of these propositions are true.","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infnasosin-infectio-10","context":null,"enonce":"Which of the following are sinusitis locations requiring Amoxicillin-Clavulanic Acid?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Front","correct":true},{"idx":1,"proposition":"Ethmoidale","correct":true},{"idx":2,"proposition":"Sphenoidal","correct":true},{"idx":3,"proposition":"Maxillary","correct":false,"justification":"Amoxicillin 7J"},{"idx":4,"proposition":"All proposals","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infnasosin-infectio-11","context":null,"enonce":"What type(s) of sinusitis(s) can an infant have?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Maxillary sinusitis","correct":false,"justification":"False. The maxillary sinus is developed from the age of 3-4 years. It is impossible to have maxillary sinusitis before the age of 3."},{"idx":1,"proposition":"Frontal sinusitis","correct":false,"justification":"False. The frontal sinus is present from the age of 5 to 10 years."},{"idx":2,"proposition":"Sphenoidal sinusitis","correct":false,"justification":"False. The sphenoid sinus is present from the age of 10 to 15 years."},{"idx":3,"proposition":"Ethmoidal sinusitis","correct":true,"justification":"True. Ethmoidal cells appear as early as 1 month of age."},{"idx":4,"proposition":"None, sinusitis is not possible before the age of 3 years","correct":false,"justification":"False. Since ethmoid cells exist, it is possible to have ethmoid sinusitis."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"infnasosin-infectio-12","context":null,"enonce":"What sinus involvement(s) requires the realization of a CT scan?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Maxillary ","correct":false,"justification":"False"},{"idx":1,"proposition":"Ethmoidal ","correct":true},{"idx":2,"proposition":"Front","correct":true},{"idx":3,"proposition":"Sphenoid","correct":true},{"idx":4,"proposition":"Bilateral maxilla","correct":false,"justification":"false"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"infnasosin-infectio-13","context":null,"enonce":"Regarding the bacteria responsible for sinusitis. Which of the following are true?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Ethmoiditis is often caused by Moraxella catarrhalis","correct":false,"justification":"False. Moraxella catarrhalis is not a germ that often causes ethmoiditis. On the other hand, it is a germ that can cause maxillary, frontal or sphenoid sinusitis."},{"idx":1,"proposition":"Haemophilis influenzae is a gram-negative cocci","correct":false,"justification":"Haemophilis influenzae is a gram-negative bacillus"},{"idx":2,"proposition":"During acute maxillary sinusitis with dental entrance door, anaerobic germs and Aspergillus can be found.","correct":true,"justification":"True. Aspergillus is mentioned in the Pilly."},{"idx":3,"proposition":"If bone lysis is found on CT scan in the immunocompromised, it is necessary to evoke a fungal infection (Aspergillus and mucormycosis)","correct":true,"justification":"None"},{"idx":4,"proposition":"Streptococcus pyogenes is a gram+ chain cocci on direct examination that often causes maxillary sinusitis","correct":false,"justification":"It is a gram + cocci on direct examination, but it is not a germ that is often involved in maxillary sinusitis. It is a common germ for ethmoidites."}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"risquesRx-sp-0","context":null,"enonce":"Which of these proposals are natural radioactive sources?","item":"risquesRx","matiere":"sp","propositions":[{"idx":0,"proposition":"Cosmic radiation","correct":true},{"idx":1,"proposition":"Medical radiation","correct":false},{"idx":2,"proposition":"Telluric radiation","correct":true,"justification":"From the earth's crust"},{"idx":3,"proposition":"The radiation of the human body","correct":true},{"idx":4,"proposition":"Radioactivity in the air","correct":true,"justification":"Mainly due to Radon"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"risquesRx-sp-1","context":null,"enonce":"Regarding units:","item":"risquesRx","matiere":"sp","propositions":[{"idx":0,"proposition":"The absorbed dose is expressed in Sieverts","correct":false,"justification":"In Gray"},{"idx":1,"proposition":"The effective dose is expressed in Sievert","correct":true},{"idx":2,"proposition":"The equivalent dose is expressed in Sievert","correct":true},{"idx":3,"proposition":"The absorbed dose is expressed in Gray","correct":true},{"idx":4,"proposition":"The equivalent dose is expressed in Gray","correct":false,"justification":"In sievert"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"risquesRx-sp-2","context":null,"enonce":"Regarding deterministic effects:","item":"risquesRx","matiere":"sp","propositions":[{"idx":0,"proposition":"They are constant above a threshold","correct":true},{"idx":1,"proposition":"Severity is independent of dose","correct":false,"justification":"It is proportional"},{"idx":2,"proposition":"The effects are early","correct":true},{"idx":3,"proposition":"They are common in medical imaging","correct":false,"justification":"Truly exceptional"},{"idx":4,"proposition":"They are irreversible","correct":false,"justification":"They are usually reversible"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"risquesRx-sp-3","context":null,"enonce":"Regarding stochastic effects:","item":"risquesRx","matiere":"sp","propositions":[{"idx":0,"proposition":"There is a notion of threshold","correct":false,"justification":"No notion of threshold. It's random"},{"idx":1,"proposition":"Onset is early","correct":false,"justification":"It is delayed"},{"idx":2,"proposition":"Severity is proportional to dose","correct":false,"justification":"It is independent of dose"},{"idx":3,"proposition":"Frequency is proportional to dose ","correct":true},{"idx":4,"proposition":"Cause and effect is easy to establish","correct":false,"justification":"Very difficult"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"pleuresie-pneumo-0","context":null,"enonce":"Which of the following are true?","item":"pleuresie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The space between the two leaflets of the pleura is completely virtual","correct":false,"justification":"There is a pleural fluid of 5 to 20 mL, physiological, which allows the slippage ✌ of both leaflets into the lungs"},{"idx":1,"proposition":"Any unproven exudate should undergo a pleural biopsy","correct":true},{"idx":2,"proposition":"Complicated parapneumonic effusions are evacuated as soon as possible","correct":true},{"idx":3,"proposition":"Any febrile pleural effusion should be punctured urgently\r\n","correct":true},{"idx":4,"proposition":"Any pleural effusion should be punctured","correct":false,"justification":"Not if its cause is known, if a\r\nheart failure is suspected or if effusion is minimal"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pleuresie-pneumo-1","context":null,"enonce":"Which of the following are characteristics of transudates?","item":"pleuresie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Clear liquid","correct":true},{"idx":1,"proposition":"Healthy pleura","correct":true},{"idx":2,"proposition":"High protein content","correct":false,"justification":"Exudate"},{"idx":3,"proposition":"Low LDH","correct":true},{"idx":4,"proposition":"High lymphocytes","correct":false,"justification":"Lymphocyte exudate"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pleuresie-pneumo-2","context":null,"enonce":"What is the triglyceride level that defines the diagnosis of chylothorax?","item":"pleuresie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"1.2 mmol\/L","correct":true},{"idx":1,"proposition":"1.1 g\/L","correct":true},{"idx":2,"proposition":"0.2 mmol\/L","correct":false,"justification":"It really wouldn't be much"},{"idx":3,"proposition":"4.3 g\/L","correct":false,"justification":"It would really be too much"},{"idx":4,"proposition":"There is no such thing as chylothorax","correct":false,"justification":"It's rare but possible"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"pleuresie-pneumo-3","context":null,"enonce":"Among the following propositions, what is the LDH threshold to define an exudate?","item":"pleuresie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"100 g\/L","correct":false,"justification":"2️0️⃣ ⃣0️⃣. The unit is IU\/L"},{"idx":1,"proposition":"200 IU\/L","correct":true},{"idx":2,"proposition":"300 IU\/L","correct":false,"justification":"2️0️⃣ ⃣0️⃣"},{"idx":3,"proposition":"400 IU\/L","correct":false,"justification":"2️0️⃣ ⃣0️⃣"},{"idx":4,"proposition":"500 IU\/L","correct":false,"justification":"2️0️⃣ ⃣0️⃣"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"pleuresie-pneumo-4","context":null,"enonce":"Which of the following are the causes of bilateral transudates?","item":"pleuresie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Heart failure 💟","correct":true,"justification":"True, this is the main cause"},{"idx":1,"proposition":"Nephrotic syndrome","correct":true,"justification":"True, loss of protein and decrease in oncotic pressure"},{"idx":2,"proposition":"Mesothelioma","correct":false,"justification":"It would be an exudate"},{"idx":3,"proposition":"Tuberculosis","correct":false,"justification":"Lymphocyte exudate"},{"idx":4,"proposition":"Pulmonary embolism","correct":false,"justification":"Unless it is bilateral, there would be a unilateral transudate"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LED-immuno-0","context":null,"enonce":"Which of the following are the clinical diagnostic criteria(s) of ACR that would allow you to retain the diagnosis of Lupus?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"Hemolytic anemia","correct":false,"justification":"It is a biological criterion, not a clinical one."},{"idx":1,"proposition":"Leukocytosis","correct":false,"justification":"It is a biological criterion, not a clinical one. In addition, leukopenia is mentioned in the ACR criteria."},{"idx":2,"proposition":"Non-erosive polyarthritis","correct":true,"justification":"Be careful, it must be non-erosive."},{"idx":3,"proposition":"Photosensitivity","correct":true},{"idx":4,"proposition":"Pleurisy","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LED-immuno-1","context":null,"enonce":"Which of the following are the clinical or biological diagnostic criteria(s) of the ACR that would allow you to retain the diagnosis of Lupus?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"Pericarditis","correct":true},{"idx":1,"proposition":"Mouth ulcers","correct":true},{"idx":2,"proposition":"Lymphopenia < 1,500\/mm3 2 times","correct":true},{"idx":3,"proposition":"A VDRLet TPHA+","correct":false,"justification":"We can find a false syphilitic serology (VDRL+ and TPHA-)"},{"idx":4,"proposition":"The presence of FAN","correct":true,"justification":"Without inducing drugs"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"LED-immuno-2","context":null,"enonce":"Which of the following criteria are the biological diagnostic criteria(s) that would allow you to retain the diagnosis of Lupus?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"Leukopenia < 4,000\/mm3 2 times","correct":true},{"idx":1,"proposition":"Lymphopenia < 8,500\/mm3 2 times","correct":false,"justification":"Lymphopenia is defined from < 1,500\/mm3"},{"idx":2,"proposition":"The absence of anti-Sm antibodies","correct":false,"justification":"The presence of anti-Sm antibodies is rare (~20%) but very specific"},{"idx":3,"proposition":"Convulsions","correct":false,"justification":"It is a clinical criterion"},{"idx":4,"proposition":"Proteinuria > 0.5\/day","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LED-immuno-3","context":null,"enonce":"What treatment(s) background and crisis do you propose to treat active class IV lupus nephropathy, without joint involvement?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"NSAIDs","correct":false,"justification":"Unless joint damage"},{"idx":1,"proposition":"High-dose IV corticosteroids","correct":true},{"idx":2,"proposition":"High-dose morphines","correct":false,"justification":"Does not fit into the treatment of lupus. Normally, kidney damage does not hurt"},{"idx":3,"proposition":"Cyclosporine","correct":false,"justification":"Cyclophospamide IV"},{"idx":4,"proposition":"Low-dose IV corticosteroids","correct":false,"justification":"High doses in this case"}],"ts":1621158768,"type":"custom","difficulte":3}
-{"_id":"LED-immuno-4","context":null,"enonce":"Which of the following are true about lupus?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"There is no arthritis but arthralgia","correct":false,"justification":"There can be both."},{"idx":1,"proposition":"Joint damage is usually migratory and fleeting","correct":true},{"idx":2,"proposition":"Joint damage exceptionally affects small joints","correct":false,"justification":"They affect PPIs more than PCAs"},{"idx":3,"proposition":"Jaccoud's hand appearance is a complication of lupus","correct":true,"justification":"True, it is reducible in lupus"},{"idx":4,"proposition":"Arthritis is erosive","correct":false,"justification":"There is no erosive damage"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LED-immuno-5","context":null,"enonce":"Which of the following proposals are part of the biological assessment useful for the positive diagnosis of systemic lupus erythematosus?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"Immunophenotyping of lymphocytes","correct":false,"justification":"False"},{"idx":1,"proposition":"Anti-nuclear antibodies","correct":true,"justification":"True, positive if > 1\/160th"},{"idx":2,"proposition":"Anti-histone antibodies","correct":false,"justification":"False"},{"idx":3,"proposition":"Anti-DNA antibodies","correct":true,"justification":"True, useful for follow-up"},{"idx":4,"proposition":"Anti-Sm antibodies","correct":true,"justification":"True, quite specific"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LED-immuno-6","context":null,"enonce":"Which of the following proposals are contraindicated during pregnancy 🤰?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"IEC","correct":true},{"idx":1,"proposition":"Azathioprine","correct":false,"justification":"Unlike cyclophosphamide, methotrexate or mycophenolate mofetil, azathioprine can be used"},{"idx":2,"proposition":"VKA","correct":true,"justification":"True, to be replaced by LMWH"},{"idx":3,"proposition":"Corticosteroids","correct":false,"justification":"No this"},{"idx":4,"proposition":"Dermocorticoids","correct":false,"justification":"No IC"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LED-immuno-7","context":null,"enonce":"Which of the following are true?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"Class 1 glomerulonephritis is minimal","correct":true},{"idx":1,"proposition":"Class 2 glomerulonephritis is intracapillary proliferation","correct":false,"justification":"It is a mesangial LARP"},{"idx":2,"proposition":"There are 5 classes of lupus glomerulonephritis","correct":false,"justification":"There are 6 (1: minimal lesions, 2: mesangial proliferation, 3: focal proliferation with <50% of affected glomeruli, 4: diffuse proliferation with >50% of affected glomeruli, 5: extramembranous proliferation, 6: sclerotic)"},{"idx":3,"proposition":"Renal involvement affects about 5% of patients","correct":false,"justification":"Between 10 and 40%"},{"idx":4,"proposition":"Class 5 glomerulonephritis is an extramembranous involvement","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LED-immuno-8","context":null,"enonce":"Which of the following are true?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"Native anti-DNA antibodies can be detected by PCR","correct":false,"justification":"Only DNA can be detected by PCR (and RNA for RT-PCR)"},{"idx":1,"proposition":"Native anti-DNA antibodies can be detected in ELISA","correct":true},{"idx":2,"proposition":"Lack of native anti-DNA antibodies eliminates diagnosis of lupus","correct":false,"justification":"Imperfect sensitivity"},{"idx":3,"proposition":"Native anti-DNA antibodies are essential for diagnosis ","correct":false,"justification":"Imperfect sensitivity"},{"idx":4,"proposition":"The level of native anti-DNA antibodies reflects disease activity","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"LED-immuno-9","context":null,"enonce":"Which of the following proposals is part of the first-line background treatment for systemic lupus erythematosus?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"Oral methotrexate","correct":false,"justification":"False"},{"idx":1,"proposition":"Hydroxychloroquine orally","correct":true},{"idx":2,"proposition":"Oral corticosteroid therapy","correct":false,"justification":"False"},{"idx":3,"proposition":"Azathioprine per os","correct":false,"justification":"False"},{"idx":4,"proposition":"Aspirin per os","correct":false,"justification":"False"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"systemesoins-sp-0","context":null,"enonce":"Regarding the Beveridgian model:","item":"systemesoins","matiere":"sp","propositions":[{"idx":0,"proposition":"It was founded by Chancellor Beveridge","correct":false,"justification":"He was a Lord. The Beveridgian system comes from the UK while the Bismarckian system comes from Germany (Chancellor Bismark)"},{"idx":1,"proposition":"Medical care is free for those who work","correct":false,"justification":"Free for all"},{"idx":2,"proposition":"The system is financed by employers' contributions","correct":false,"justification":"By tax"},{"idx":3,"proposition":"It is based on 4 universal principles","correct":false,"justification":"3 principles (the 3 U's): universality, uniqueness and uniformity"},{"idx":4,"proposition":"This is the system in place in Ireland and Finland.","correct":true,"justification":"England, Sweden, Finland, Denmark and Ireland\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"systemesoins-sp-1","context":null,"enonce":"The Bismarckian system:","item":"systemesoins","matiere":"sp","propositions":[{"idx":0,"proposition":"It was founded by Chancellor Bismarck at the end of the 19th century.","correct":true,"justification":"Before the First World War"},{"idx":1,"proposition":"It is reserved for employees","correct":true},{"idx":2,"proposition":"It is managed by the State","correct":false,"justification":"Decentralised management by employees and employers"},{"idx":3,"proposition":"It is implemented in Germany and Austria","correct":true,"justification":"Also in Belgium, the Netherlands, Switzerland and Luxembourg"},{"idx":4,"proposition":"It was originally intended to protect industrial workers.","correct":true}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"systemesoins-sp-2","context":null,"enonce":"Which of these propositions are true?","item":"systemesoins","matiere":"sp","propositions":[{"idx":0,"proposition":"Each country has a system of santoe that has been built according to its political choices and traditions.","correct":true},{"idx":1,"proposition":"Health spending in England was 1.9% of GDP in 2014","correct":false,"justification":"Health expenditure: 9.1% of GDP in 2014"},{"idx":2,"proposition":"The state has a central role in England","correct":true},{"idx":3,"proposition":"The health system is named National Health Service (NHS)","correct":true},{"idx":4,"proposition":"The financing of the system in England is provided by taxes","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"systemesoins-sp-3","context":null,"enonce":"Which of these propositions are true?","item":"systemesoins","matiere":"sp","propositions":[{"idx":0,"proposition":"Healthcare in England is extremely expensive for users","correct":false,"justification":"Health care is almost free for all residents (co-payment for medicines)"},{"idx":1,"proposition":"Doctors are paid based on the medications they prescribe","correct":false,"justification":"Doctors are paid by the NHS according to the number of patients registered and certain procedures they perform."},{"idx":2,"proposition":"Doctors do not have complete freedom of installation","correct":true},{"idx":3,"proposition":"The GP is the mandatory gateway to specialists, hospitalizations, etc.","correct":true},{"idx":4,"proposition":"The English model, however, has the disadvantage of rationing care quantitatively.","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"systemesoins-sp-4","context":null,"enonce":"Which of these propositions are true?","item":"systemesoins","matiere":"sp","propositions":[{"idx":0,"proposition":"In Germany, health spending was 21.1% of GDP in 2014","correct":false,"justification":"Health expenditure = 11.1% of GDP in 2014"},{"idx":1,"proposition":"Public and private funds are in competition with each other and autonomous in their management","correct":true},{"idx":2,"proposition":"The Länder are responsible for hospital planning","correct":true},{"idx":3,"proposition":"Patients are free to choose their insurance fund","correct":true},{"idx":4,"proposition":"There is a regulation of medical demography","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"systemesoins-sp-5","context":null,"enonce":"Which of these propositions are true?","item":"systemesoins","matiere":"sp","propositions":[{"idx":0,"proposition":"The system is liberal and decentralized","correct":true},{"idx":1,"proposition":"The federal state covers major risks (the elderly, the severely disabled, people in need)","correct":true},{"idx":2,"proposition":"Health spending is very low","correct":false,"justification":"Health spending is very high: 17.1% of GDP in 2014 2.2. HEALTH INSURANCE VIA EMPLOYER sickness"},{"idx":3,"proposition":"Health insurance is most often job-related","correct":true},{"idx":4,"proposition":"Health insurance is optional","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"systemesoins-sp-6","context":null,"enonce":"Which of these propositions are true?","item":"systemesoins","matiere":"sp","propositions":[{"idx":0,"proposition":"About 25% of the population is covered by compulsory health insurance","correct":true},{"idx":1,"proposition":"MEDICARE is for the poorest people","correct":false,"justification":"MEDICARE: Elderly and Disabled People"},{"idx":2,"proposition":"MEDICAID is for the elderly and the disabled","correct":false,"justification":"MEDICAID: For the poorest. Financed by federal states (inequalities according to regions)"},{"idx":3,"proposition":"2 to 8% of Americans do not have health insurance in the US","correct":false,"justification":"16-18% of Americans"},{"idx":4,"proposition":"Without health insurance, individuals must pay the full cost of health care","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"systemesoins-sp-7","context":null,"enonce":"Which of these propositions are true?","item":"systemesoins","matiere":"sp","propositions":[{"idx":0,"proposition":"Historically, the health system in France is under the Bismarckian system.","correct":true},{"idx":1,"proposition":"The CMU was created in 1998","correct":true},{"idx":2,"proposition":"The state has an important role","correct":true},{"idx":3,"proposition":"One of the objectives of health policies is to promote health in all living environments","correct":true},{"idx":4,"proposition":"The organization of logical health pathways is one of the objectives of health policies","correct":true,"justification":"TRUE\""}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"systemesoins-sp-8","context":null,"enonce":"Which of these proposals are actors in the health system?","item":"systemesoins","matiere":"sp","propositions":[{"idx":0,"proposition":"The patient","correct":true,"justification":"It is the beneficiary"},{"idx":1,"proposition":"The pharmaceutical industry","correct":true,"justification":"It is the producer of health services and goods"},{"idx":2,"proposition":"The ARS","correct":true,"justification":"It is a public institution"},{"idx":3,"proposition":"Journalists","correct":false,"justification":"Have nothing. Even health journalists are not actors in the healthcare system (role of commentators and not actors)"},{"idx":4,"proposition":"The school doctor","correct":true,"justification":"Of course\""}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"SpA-rhumato-027650","context":null,"enonce":"Which of the following proposals are part of the pre-therapeutic assessment before the introduction of an anti-TNF alpha?","item":"SpA","matiere":"rhumato","propositions":[{"correct":true,"justification":"True (tuberculosis: indeed, the main immune pathway that allows the control of Koch's bacillus is based on TNF-alpha)","idx":0,"proposition":"Chest X-ray"},{"correct":true,"justification":"True, ± BK-tubing or ECBC if spit","idx":1,"proposition":"IDR or Quantiferon"},{"correct":false,"justification":"False","idx":2,"proposition":"Scanner TAP"},{"correct":false,"justification":"False, on the other hand we do: EPP-NFS, HBV-HCV-HIV, ECBU ± sinus-panoramic","idx":3,"proposition":"Hepatic ultrasound"},{"correct":false,"justification":"False","idx":4,"proposition":"Echo-Doppler of the 4 members"}],"ts":1627207663,"type":"custom","difficulte":"2"}
-{"_id":"herpes-infectio-0479a7","context":null,"enonce":"Which of the following propositions regarding herpes virus infections are true?","item":"herpes","matiere":"infectio","propositions":[{"correct":false,"justification":"Very common, 90% of adults are HIV-positive ","idx":0,"proposition":"They are infrequent"},{"correct":true,"justification":" ","idx":1,"proposition":"Transmission can be salivary"},{"correct":false,"justification":"No, only atypical pictures or in some patients who need to document the infection ","idx":2,"proposition":"Diagnosis requires additional examinations "},{"correct":true,"justification":" ","idx":3,"proposition":"Transmission can be mucosal"},{"correct":false,"justification":"Several treatments are available, including Aciclovir, Valaciclovir...","idx":4,"proposition":"There is currently no treatment available"}],"ts":1627682461,"type":"custom","difficulte":"1"}
-{"_id":"AV--ophtalmo-05b5b7","context":null,"enonce":"Which of the following are treatments for atrophic AMD, if any?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Wild AMD ","idx":0,"proposition":"Dynamic phototherapy"},{"correct":false,"justification":"Wild AMD ","idx":1,"proposition":"Anti-VEGF"},{"correct":true,"justification":"True, but a lot of research going on","idx":2,"proposition":"No therapeutics currently"},{"correct":false,"justification":"Part of the package for beginner AMD","idx":3,"proposition":"Zinc"},{"correct":false,"justification":"Part of the package for beginner AMD","idx":4,"proposition":"Lutein"}],"ts":1626279369,"type":"custom","difficulte":"2"}
-{"_id":"tbvisionbrutal-ophtalmo-06b787","context":null,"enonce":"Which of the following are mainly unilateral etiologies?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Bilateral","idx":0,"proposition":"Proliferative diabetic retinopathy"},{"correct":false,"justification":"Bilateral","idx":1,"proposition":"Open glaucoma"},{"correct":false,"justification":"Bilateral","idx":2,"proposition":"Senescent cataract"},{"correct":true,"justification":"True","idx":3,"proposition":"Central retinal vein occlusion"},{"correct":true,"justification":"True","idx":4,"proposition":"Retinal detachment"}],"ts":1626279097,"type":"custom","difficulte":"2"}
-{"_id":"pathoOGE-endoc-099537","context":null,"enonce":"Which of the following proposals are favored in case of cryptorchidism?","item":"pathoOGE","matiere":"endoc","propositions":[{"correct":true,"justification":"True, the RR is increased","idx":0,"proposition":"Testicular cancer"},{"correct":true,"justification":"True","idx":1,"proposition":"Infertility"},{"correct":false,"justification":"No report","idx":2,"proposition":"Phimosis"},{"correct":false,"justification":"No report","idx":3,"proposition":"Paraphimosis"},{"correct":true,"justification":"True","idx":4,"proposition":"Testicular atrophy"}],"ts":1628790706,"type":"custom","difficulte":"2"}
-{"_id":"diabete-endoc-0a3287","context":null,"enonce":"Regarding the complications of diabetes, what are the true propositions?","item":"diabete","matiere":"endoc","propositions":[{"correct":false,"justification":"False, the complications are caused precisely by the excess of glucose in the endothelial cells that saturate their glucose metabolism pathway. Entry into these cells is through transporters that are not dependent on insulin. Insulin acts on GLUT4 receptors that concern adipocytes and rhabdomyocytes.","idx":0,"proposition":"Insulin resistance and then insulinopenia prevent the entry of glucose into the cells, which is the cause of complications of diabetes"},{"correct":true,"justification":"True","idx":1,"proposition":"Prevention of complications starts with good glycemic control"},{"correct":false,"justification":"False, first by the general practitioner. The diabetologist's advice is recommended only in case of complications of diabetes","idx":2,"proposition":"The management of the diabetic patient goes first through the diabetologist"},{"correct":true,"justification":"True, however, it is necessary to look for them immediately in type 2 diabetics","idx":3,"proposition":"Degenerative complications are rare when T1D is diagnosed"},{"correct":false,"justification":"It is annual from diagnosis, regardless of age","idx":4,"proposition":"The fundus is annual from 65 years"}],"ts":1628790833,"type":"custom","difficulte":"2"}
-{"_id":"SPSC-sp-0ac05c","context":null,"enonce":"Which of the following are needed for classic TDPS?","item":"SPSC","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"2 medical certificates"},{"correct":true,"justification":"True, you cannot do SPDT for a minor (only SPDREs or PPOs are possible)","idx":1,"proposition":"Adult patient"},{"correct":true,"justification":"True","idx":2,"proposition":"One-third"},{"correct":false,"justification":"Only for SPDRE","idx":3,"proposition":"A prefectural decree"},{"correct":false,"justification":"Less than 15 days","idx":4,"proposition":"Certificates less than 30 days old"}],"ts":1626430491,"type":"custom","difficulte":"1"}
-{"_id":"antiinf-infectio-107c54","context":null,"enonce":"What is(are) the main toxicity(s) of vancomycin?","item":"antiinf","matiere":"infectio","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"Brain"},{"correct":false,"justification":"Treatment of tuberculosis in particular","idx":1,"proposition":"Hepatic"},{"correct":true,"justification":"Vancomycin is ototoxic (like aminoglycosides) ","idx":2,"proposition":"Hearing"},{"correct":true,"justification":"True, to remember !! Another side effect to remember is the red man syndrome in case of injection too fast. ","idx":3,"proposition":"Kidney"},{"correct":false,"justification":"No digestive absorption","idx":4,"proposition":"Digestive"}],"ts":1627721486,"type":"custom","difficulte":"1"}
-{"_id":"tbrefraction-ophtalmo-116ba8","context":null,"enonce":"Which of the following propositions are true about hyperopia?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is common in children"},{"correct":false,"justification":"This is the case of presbyopia","idx":1,"proposition":"It concerns all persons over 70 years of age"},{"correct":true,"justification":"True, the image forms behind the retina","idx":2,"proposition":"It is due to an eye that is too short"},{"correct":true,"justification":"True","idx":3,"proposition":"It can cause eye strain"},{"correct":false,"justification":"This is the case of myopia","idx":4,"proposition":"It protects against myopia"}],"ts":1626111274,"type":"custom","difficulte":"2"}
-{"_id":"SpA-rhumato-131b3f","context":null,"enonce":"Which of the following are signs of spondyloarthritis?","item":"SpA","matiere":"rhumato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"dactylitis"},{"correct":true,"justification":"True, sacroiliitis, pyalgia, fessalgia","idx":1,"proposition":"inflammatory spinal pain"},{"correct":true,"justification":"True","idx":2,"proposition":"heel pain"},{"correct":false,"justification":"False","idx":3,"proposition":"dry syndrome"},{"correct":false,"justification":"HLA-B27","idx":4,"proposition":"HLA-G"}],"ts":1625562197,"type":"custom","difficulte":"2"}
-{"_id":"tbrefraction-ophtalmo-143140","context":null,"enonce":"Which of the following propositions corresponds to a normal reading of the finest letters in the Parinaud scale?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"P1.5 - P2"},{"correct":false,"justification":"False","idx":1,"proposition":"P0.1 - P0.2"},{"correct":false,"justification":"False","idx":2,"proposition":"P1.5 - P3"},{"correct":false,"justification":"False","idx":3,"proposition":"P3 - P6"},{"correct":false,"justification":"False","idx":4,"proposition":"P30 - P20"}],"ts":1626279570,"type":"custom","difficulte":"2"}
-{"_id":"allergie-pneumo-14481e","context":null,"enonce":"What is the prevalence of allergy (to any substance) in children under 15 years of age?","item":"allergie","matiere":"pneumo","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"3%"},{"correct":false,"justification":"False","idx":1,"proposition":"15%"},{"correct":false,"justification":"False","idx":2,"proposition":"20%"},{"correct":true,"justification":"True, and the prevalence of food allergy is 7% ","idx":3,"proposition":"30%"},{"correct":false,"justification":"False","idx":4,"proposition":"35%"}],"ts":1627680327,"type":"custom","difficulte":"2"}
-{"_id":"ACR-urg-15508b","context":null,"enonce":"Which of the following proposals for particular cardiopulmonary resuscitation situations are true?","item":"ACR","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"In pregnant women (≥20 SA) the uterus should be reclinated to the left during cardiac massage to promote venous return"},{"correct":true,"justification":"True","idx":1,"proposition":"In pregnant women, the heels of the hands are applied higher than in non-pregnant women"},{"correct":false,"justification":"False, by 5 breaths","idx":2,"proposition":"In case of drowning, cardiopulmonary resuscitation should be started with 2 breaths "},{"correct":true,"justification":"True, however, it is necessary to quickly identify rapidly curable etiologies at the origin of an ACR in a traumatic context (compressive pneumothorax, hemorrhagic shock, etc.).","idx":3,"proposition":"RTAs of traumatic origin primarily follow the same recommendations as RTAs of \"medical\" origin"},{"correct":true,"justification":"True","idx":4,"proposition":"Abdominal compression is not indicated in case of drowning"}],"ts":1625734837,"type":"custom","difficulte":"2"}
-{"_id":"SPSC-sp-162b37","context":null,"enonce":"Which of the following proposals are the rights of involuntary hospitalized patients?","item":"SPSC","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Right to vote"},{"correct":true,"justification":"True","idx":1,"proposition":"Right to a lawyer"},{"correct":false,"justification":"False","idx":2,"proposition":"be paid"},{"correct":false,"justification":"False","idx":3,"proposition":"be exempt from hospitalization costs"},{"correct":true,"justification":"True","idx":4,"proposition":"Practicing your religion"}],"ts":1626430508,"type":"custom","difficulte":"1"}
-{"_id":"pancreatiteaigue-HGE-1708c1","context":null,"enonce":"In............ In cases, acute pancreatitis is life-threatening.","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"5%"},{"correct":false,"justification":"","idx":1,"proposition":"10%"},{"correct":true,"justification":"In 20–30% of cases, pancreatitis is severe (necrotizing) and life-threatening.","idx":2,"proposition":"20%"},{"correct":false,"justification":"","idx":3,"proposition":"50%"},{"correct":false,"justification":"","idx":4,"proposition":"70%"}],"ts":1621625177,"type":"custom","difficulte":"1"}
-{"_id":"RCIU-gyn-193ff5","context":null,"enonce":"Which of the following are diseases associated with prematurity?","item":"RCIU","matiere":"gyn","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Diaphragmatic hernia"},{"correct":true,"justification":"True","idx":1,"proposition":"Hyaline membrane disease"},{"correct":false,"justification":"False","idx":2,"proposition":"Hypertrophic pyloric stenosis"},{"correct":true,"justification":"True, 10% of premature babies.","idx":3,"proposition":"Cavitary periventricular leukomalacia"},{"correct":false,"justification":"False","idx":4,"proposition":"Atresia of the bile ducts"}],"ts":1625394216,"type":"custom","difficulte":"2"}
-{"_id":"AV--ophtalmo-1a0834","context":null,"enonce":"Which of the following are true about Stargardt disease?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is macular retinopathy"},{"correct":false,"justification":"False","idx":1,"proposition":"It is a pigmentary retinopathy"},{"correct":false,"justification":"False","idx":2,"proposition":"It is an X-linked retinopathy"},{"correct":true,"justification":"True, autosomal recessive","idx":3,"proposition":"It is an autosomal retinopathy"},{"correct":false,"justification":"False","idx":4,"proposition":"It is a dominant retinopathy"}],"ts":1626111628,"type":"custom","difficulte":"2"}
-{"_id":"prothese-urg-1f47d2","context":null,"enonce":"Which of the following are true?","item":"prothese","matiere":"urg","propositions":[{"correct":true,"justification":"True, unless hemodynamic instability, surgical samples are first taken","idx":0,"proposition":"It is generally forbidden to introduce blind probabilistic antibiotic therapy in case of suspected infection on equipment"},{"correct":true,"justification":"True, alcohol is not","idx":1,"proposition":"Diabetes and obesity are risk factors for prosthetic infection"},{"correct":true,"justification":"True, by vascular involvement","idx":2,"proposition":"Tobacco is a delayed bone consolidation factor"},{"correct":false,"justification":"Three months","idx":3,"proposition":"The average duration of bone consolidation of a talus fracture is about 6 weeks"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"ts":1626002638,"type":"custom","difficulte":"2"}
-{"_id":"contraception-endoc-20447e","context":null,"enonce":"Regarding contraception, which of these answers is\/are true?","item":"contraception","matiere":"endoc","propositions":[{"correct":false,"justification":"False, only progestin-only contraception acts on the tube, which explains the fact that ectopic pregnancies are one of the main adverse effects.","idx":0,"proposition":"Estrogen-progestorative contraception acts on the endometrium, ovary, hormonal feedback to the pituitary gland and fallopian tube"},{"correct":true,"justification":"True, the Pearl Index is an indicator of the number of accidental pregnancies under contraception, the higher it is, the less effective contraception is","idx":1,"proposition":"So-called \"natural\" contraception (withdrawal, temperature measurement) have a high Pearl index"},{"correct":true,"justification":"True, as well as personal or family history of venous thromboembolic disease, history of arterial disease, or cardiovascular risk factors","idx":2,"proposition":"Among the contraindications of estrogen-progestin contraception, we find migraine with aura"},{"correct":true,"justification":"True","idx":3,"proposition":"A copper IUD is placed for 4 to 5 years"},{"correct":false,"justification":"False, taking emergency contraception is unique","idx":4,"proposition":"Following emergency contraception, emergency contraception must be continued for 7 days"}],"ts":1628790601,"type":"custom","difficulte":"1"}
-{"_id":"diarrheeinf-infectio-221d56","context":null,"enonce":"Which of the following propositions are true for oral rehydration solutions (ORS) in children?","item":"diarrheeinf","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"ORS is the only essential treatment for dehydration in children."},{"correct":true,"justification":"True","idx":1,"proposition":"ORS does not stop diarrhoea but can prevent and\/or correct acute dehydration induced by diarrhoea and\/or vomiting, as well as secondary ionic disorders."},{"correct":true,"justification":"True","idx":2,"proposition":"The intake of ORS must be early, at the first symptoms."},{"correct":false,"justification":"Only if on prescription","idx":3,"proposition":"ORS in pharmacies are always reimbursed"},{"correct":false,"justification":"No, on the contrary","idx":4,"proposition":"ORS is contraindicated in cases of vomiting"}],"ts":1627721734,"type":"custom","difficulte":"2"}
-{"_id":"oreillons-infectio-27e28c","context":null,"enonce":"Which of the following are true?","item":"oreillons","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Partotiditis is often bilateral"},{"correct":false,"justification":"No! The only one not reported among the 3 MMR vaccine. ","idx":1,"proposition":"It is a reportable disease"},{"correct":true,"justification":"True","idx":2,"proposition":"Transmission is by air"},{"correct":true,"justification":"True, 1 in 3 cases ","idx":3,"proposition":"It is often asymptomatic"},{"correct":false,"justification":"Treatment is symptomatic only","idx":4,"proposition":"Treatment combines ritonavir and antiplatelet agents"}],"ts":1627726252,"type":"custom","difficulte":"2"}
-{"_id":"nutrigrossesse-endoc-29d360","context":null,"enonce":"What is the blood glucose goal at 2h post-prandial in a pregnant woman with type 2 diabetes?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"correct":true,"justification":"True. College of Gynecology (4th edition)","idx":0,"proposition":"< 1.20g\/L"},{"correct":false,"justification":"Threshold at 1h post-prandial","idx":1,"proposition":"< 1.40g\/L"},{"correct":false,"justification":"Threshold defining fasting type 2 diabetes (twice)","idx":2,"proposition":"< 1.26g\/L"},{"correct":false,"justification":"Threshold 1 hour after an OPGH","idx":3,"proposition":"< 1.80g\/L"},{"correct":false,"justification":"Threshold 2 hours after an OPGH","idx":4,"proposition":"< 1.56g\/L"}],"ts":1626084057,"type":"custom","difficulte":"2"}
-{"_id":"tbvisionbrutal-ophtalmo-29d558","context":null,"enonce":"Which of the following are etiologies of intravitreal hemorrhage?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Proliferative diabetic retinopathy"},{"correct":true,"justification":"True, vein occlusion = blood cannot come out = aneurysm and edema = flammèche and spot hemorrhage, papillary edema, macular edema, cottony nodules, intravitreal hemorrhage","idx":1,"proposition":"Central retinal vein occlusion"},{"correct":false,"justification":"Artery occlusion = blood does not arrive = no bleeding","idx":2,"proposition":"Central retinal artery occlusion"},{"correct":true,"justification":"True, complicated or not retinal detachment.","idx":3,"proposition":"Retinal tear "},{"correct":true,"justification":"True","idx":4,"proposition":"Syndrome de Terson "}],"ts":1626111282,"type":"custom","difficulte":"2"}
-{"_id":"noduleTh-endoc-2a4c68","context":null,"enonce":"Regarding the positive diagnosis of goiter. Which of the following propositions, which one or which are true?","item":"noduleTh","matiere":"endoc","propositions":[{"correct":false,"justification":"False. > 16 mL in adolescents. > 18 mL in adult women and > 20 mL in adult men","idx":0,"proposition":"Thyroid volume > 20 mL in adolescents"},{"correct":true,"justification":"True","idx":1,"proposition":"Thyroid volume > 18 mL in adult women"},{"correct":true,"justification":"True","idx":2,"proposition":"Thyroid volume > 16 mL in adolescents"},{"correct":true,"justification":"True","idx":3,"proposition":"The WHO definition of goiter is palpation of the surface of each lobe that exceeds that of the last phalanx of the thumb."},{"correct":false,"justification":"False. Thumb. ","idx":4,"proposition":"The WHO definition of goiter is palpation of the surface of each lobe that exceeds that of the last phalanx of the index finger."}],"ts":1628790562,"type":"custom","difficulte":"1"}
-{"_id":"diarrheeinf-infectio-2b0914","context":null,"enonce":"Which of the following proposals cause enteroinvasive diarrhea?","item":"diarrheeinf","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Yersinia"},{"correct":false,"justification":"Choleriform diarrhea (secretory mechanism) ➡ fluid diarrhea without fever","idx":1,"proposition":"Cholera"},{"correct":true,"justification":"True","idx":2,"proposition":"Shigella"},{"correct":true,"justification":"True","idx":3,"proposition":"Clostridium difficile"},{"correct":true,"justification":"True","idx":4,"proposition":"Salmonella"}],"ts":1627726371,"type":"custom","difficulte":"1"}
-{"_id":"RCIU-gyn-2b33f3","context":null,"enonce":"Which of the following are signs in favor of ulcerative-necrotizing enterocolitis?","item":"RCIU","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Sensitive abdomen"},{"correct":true,"justification":"True","idx":1,"proposition":"Fever"},{"correct":true,"justification":"True","idx":2,"proposition":"Rectorrhages"},{"correct":true,"justification":"True, which corresponds to air in the intestinal walls observed at ASP","idx":3,"proposition":"Intestinal pneumatosis"},{"correct":true,"justification":"True","idx":4,"proposition":"Occlusive table"}],"ts":1625394265,"type":"custom","difficulte":"2"}
-{"_id":"suiviMIT-infectio-2c4a94","context":null,"enonce":"Which of the following are notifiable diseases?","item":"suiviMIT","matiere":"infectio","propositions":[{"correct":true,"justification":"True, since 2018! ","idx":0,"proposition":"Rubella"},{"correct":true,"justification":"True","idx":1,"proposition":"Listeria"},{"correct":true,"justification":"True","idx":2,"proposition":"Legionellosis"},{"correct":false,"justification":"False. The updated list is available on https:\/\/www.santepubliquefrance.fr\/maladies-a-declaration-obligatoire","idx":3,"proposition":"Covid-19"},{"correct":false,"justification":"False","idx":4,"proposition":"Klebsiella endocarditis"}],"ts":1627722204,"type":"custom","difficulte":"2"}
-{"_id":"IUgrossesse-infectio-2edd6a","context":null,"enonce":"What is the significant bacteriuria threshold to confirm urinary gestational colonization?","item":"IUgrossesse","matiere":"infectio","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"10^2 CFU\/ml"},{"correct":false,"justification":"False","idx":1,"proposition":"10^4 CFU\/ml"},{"correct":false,"justification":"False","idx":2,"proposition":"10^3 CFU\/ml"},{"correct":true,"justification":"True, not to be confused with bacteriuria thresholds cf table p 143 of the pilly ","idx":3,"proposition":"10^5 CFU\/ml"},{"correct":false,"justification":"False","idx":4,"proposition":"10^6 CFU\/ml"}],"ts":1627681514,"type":"custom","difficulte":"2"}
-{"_id":"SPSC-sp-2f33e0","context":null,"enonce":"Which of the following proposals are needed for emergency TDPS?","item":"SPSC","matiere":"sp","propositions":[{"correct":true,"justification":"True, as with classic TDPS","idx":0,"proposition":"One-third"},{"correct":true,"justification":"True, as with all procedures except SPDRE","idx":1,"proposition":"Acceptance by the Institutional Head"},{"correct":false,"justification":"Only one since it is in emergency","idx":2,"proposition":"2 medical certificates"},{"correct":false,"justification":"at 24 hours (with a new certificate)","idx":3,"proposition":"A reassessment at 12 hours"},{"correct":false,"justification":"True for SPDRE","idx":4,"proposition":"An established disturbance of public order"}],"ts":1626430308,"type":"custom","difficulte":"1"}
-{"_id":"pancreatiteaigue-HGE-2f3923","context":null,"enonce":"In.......... of cases, acute pancreatitis is mild ","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"20%"},{"correct":false,"justification":"","idx":1,"proposition":"30%"},{"correct":false,"justification":"","idx":2,"proposition":"50%"},{"correct":true,"justification":"In 70-80% of cases, pancreatitis is benign, edematous (it will heal in a few days)","idx":3,"proposition":"70%"},{"correct":false,"justification":"","idx":4,"proposition":"90%"}],"ts":1621625192,"type":"custom","difficulte":"1"}
-{"_id":"sterilite-endoc-312979","context":null,"enonce":"Which of the following proposals is part of the couple's first-line infertility assessment?","item":"sterilite","matiere":"endoc","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Spermogram in men"},{"correct":false,"justification":"False. J21. Progesterone is used to analyze the presence of ovulation.","idx":1,"proposition":"Progesterone on Day 3"},{"correct":false,"justification":"False. J3. It makes it possible to analyze the ovarian reserve. It is also not systematic in first line, unless indicated: woman > 35 years, ovulation disorders, indication of treatment with ART, history of ovarian aggression and family history of early ovarian failure","idx":2,"proposition":"Estradiol and FSH on Day 21"},{"correct":false,"justification":"False. It is part of the second-line balance sheet and is not reimbursed by social security. ","idx":3,"proposition":"WHA"},{"correct":true,"justification":"True. The examination analyzes the uterus and fallopian tubes","idx":4,"proposition":"Hysterosalpingography"}],"ts":1628790277,"type":"custom","difficulte":"2"}
-{"_id":"prothese-urg-3165ff","context":null,"enonce":"Which of the following are radiological signs of prosthesis infection?","item":"prothese","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Periprosthetic clear border"},{"correct":true,"justification":"True","idx":1,"proposition":"Centrifugal periosteal appositions"},{"correct":false,"justification":"Description of osteoarthritis","idx":2,"proposition":"Diffuse joint pinching with subchondral geodes"},{"correct":true,"justification":"True","idx":3,"proposition":"Poorly defined osteolysis"},{"correct":false,"justification":"","idx":4,"proposition":"Osteophytes"}],"ts":1626004799,"type":"custom","difficulte":"1"}
-{"_id":"pancreatiteaigue-HGE-31a204","context":null,"enonce":"What biological sign generally reflects an obstacle in the ampulla of Vater?","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"Low bilirubin "},{"correct":false,"justification":"","idx":1,"proposition":"Elevation of ASAT"},{"correct":false,"justification":"","idx":2,"proposition":"AST decline"},{"correct":false,"justification":"","idx":3,"proposition":"ALT elevation"},{"correct":true,"justification":"\"The elevation of total bilirubin (> 40 μmol \/ L) generally reflects the blockage of a stone in the ampulla of Vater\" cf College of HGE","idx":4,"proposition":"Elevation of bilirubin "}],"ts":1622048778,"type":"custom","difficulte":"1"}
-{"_id":"tbrefraction-ophtalmo-356a74","context":null,"enonce":"Which of the following is used to measure visual acuity up close?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Visual acuity from afar","idx":0,"proposition":"Monoyer"},{"correct":true,"justification":"True. Near visual acuity (33 cm)","idx":1,"proposition":"Parinaud"},{"correct":false,"justification":"Classification of the different phototypes. From 1 (clear) to 6 (tanned)","idx":2,"proposition":"Fitzpatrick"},{"correct":false,"justification":"Classification of stomach cancers","idx":3,"proposition":"Lauren"},{"correct":false,"justification":"Classification of signs of severity of anaphylaxis","idx":4,"proposition":"Ring and Mesmer"}],"ts":1626279393,"type":"custom","difficulte":"2"}
-{"_id":"pancreatiteaigue-HGE-38b9c6","context":null,"enonce":"What type of kidney failure is most commonly observed?","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":true,"justification":"It is functional in 75% of cases and organic in 25% of cases, it is a pejorative prognostic factor","idx":0,"proposition":"Functional"},{"correct":false,"justification":"","idx":1,"proposition":"Organic"},{"correct":false,"justification":"","idx":2,"proposition":""},{"correct":false,"justification":"","idx":3,"proposition":""},{"correct":false,"justification":"","idx":4,"proposition":""}],"ts":1621625189,"type":"custom","difficulte":"1"}
-{"_id":"SPSC-sp-3a8f5b","context":null,"enonce":"The somatic examination must take place in:","item":"SPSC","matiere":"sp","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"12 hours"},{"correct":true,"justification":"True","idx":1,"proposition":"24 hours"},{"correct":false,"justification":"False","idx":2,"proposition":"48 hours"},{"correct":false,"justification":"False","idx":3,"proposition":"72 hours"},{"correct":false,"justification":"False","idx":4,"proposition":"6 hours"}],"ts":1626430495,"type":"custom","difficulte":"1"}
-{"_id":"allergie-infectio-3c2446","context":null,"enonce":"What is the prevalence of food allergy in children in France?","item":"allergie","matiere":"infectio","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"0.5 %"},{"correct":false,"justification":"False","idx":1,"proposition":"2 %"},{"correct":true,"justification":"True. In France, the prevalence of food allergy is estimated at between 5 and 7% in children.","idx":2,"proposition":"6 %"},{"correct":false,"justification":"False","idx":3,"proposition":"10 %"},{"correct":false,"justification":"False","idx":4,"proposition":"15 %"}],"ts":1627722066,"type":"custom","difficulte":"2"}
-{"_id":"VIH-infectio-3c32e1","context":null,"enonce":"Which of the following are signs or symptoms of primary HIV infection?","item":"VIH","matiere":"infectio","propositions":[{"correct":true,"justification":"True, hepatic cytolysis possible","idx":0,"proposition":"Increase in AST"},{"correct":true,"justification":"True, with AEG possible","idx":1,"proposition":"Fever"},{"correct":false,"justification":"Leukopenia","idx":2,"proposition":"Leukocytosis"},{"correct":true,"justification":"True, in 70% of cases according to the College of Dermatology (2017 edition)","idx":3,"proposition":"Febrile exanthema"},{"correct":true,"justification":"Digestive signs: acute diarrhea, nausea\/vomiting, abdominal pain (non-specific, not very sensitive)","idx":4,"proposition":"Vomit"}],"ts":1627681192,"type":"custom","difficulte":"2"}
-{"_id":"VH-infectio-3d7190","context":null,"enonce":"Which of the viruses that cause viral hepatitis is chronic only in immunosuppression?","item":"VH","matiere":"infectio","propositions":[{"correct":false,"justification":"NO chronic hepatitis ","idx":0,"proposition":"HAV"},{"correct":false,"justification":"Chronicity possible even without immunosuppression, in 5 to 10% in adults (caution 90% in children) ","idx":1,"proposition":"HBV"},{"correct":false,"justification":"Chronicity possible even without immunosuppression, in 75% in adults ","idx":2,"proposition":"HCV"},{"correct":false,"justification":"Possible if co-infection or superinfection with HBV","idx":3,"proposition":"VHD"},{"correct":true,"justification":"True. The virus causes chronic hepatitis only in cases of immunosuppression.","idx":4,"proposition":"HEV"}],"ts":1627682035,"type":"custom","difficulte":"1"}
-{"_id":"tbrefraction-ophtalmo-3e0fb2","context":null,"enonce":"Which of the following propositions are true about the hyperopia of the child?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The image of a point located at infinity is formed behind the retina"},{"correct":true,"justification":"True","idx":1,"proposition":"The farsighted eye is too short"},{"correct":true,"justification":"True","idx":2,"proposition":"The child can compensate for the lack of refractive power of his eye by accommodation"},{"correct":false,"justification":"Concave for myopia, convex for hyperopia","idx":3,"proposition":"Corrective lenses are concave spherical lenses"},{"correct":false,"justification":"Hyperopia and astigmatism, never myopia because there is no adaptation by accommodation","idx":4,"proposition":"Accommodative asthenopia is only possible in case of myopia "}],"ts":1626279383,"type":"custom","difficulte":"2"}
-{"_id":"antithrombotiques-therapeutique-405eed","context":null,"enonce":"Which of the following are true?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The common toxicity of spindle poisons is peripheral neuropathy"},{"correct":true,"justification":"True, it's not nice to see (better to put the varnish) 😫","idx":1,"proposition":"Taxanes can cause onycholysis, which can be prevented by the use of solidifying nail polish"},{"correct":false,"justification":"False. This is the case with taxanes","idx":2,"proposition":"Vinca alkaloids can cause onycholysis, which can be prevented by the use of solidifying nail polish"},{"correct":true,"justification":"True, or also podophyllotoxin","idx":3,"proposition":"Etoposide is also called VP16"},{"correct":true,"justification":"True, another name for adriamycin","idx":4,"proposition":"Doxorubicin is an anthracycline"}],"ts":1629730809,"type":"custom","difficulte":"3"}
-{"_id":"herpes-infectio-42017e","context":null,"enonce":"Which of the following propositions regarding herpes virus infections are true?","item":"herpes","matiere":"infectio","propositions":[{"correct":false,"justification":"Very common, 90% of adults are HIV-positive ","idx":0,"proposition":"They are infrequent"},{"correct":true,"justification":" ","idx":1,"proposition":"Transmission can be salivary"},{"correct":false,"justification":"No, only atypical pictures or in some patients who need to document the infection ","idx":2,"proposition":"Diagnosis requires additional examinations "},{"correct":true,"justification":" ","idx":3,"proposition":"Transmission can be mucosal"},{"correct":false,"justification":"Several treatments are available, including Aciclovir, Valaciclovir...","idx":4,"proposition":"There is currently no treatment available"}],"ts":1627722357,"type":"custom","difficulte":"1"}
-{"_id":"allergie-infectio-42591b","context":null,"enonce":"Which of the following are trophallergenic proteins contained in eggs?","item":"allergie","matiere":"infectio","propositions":[{"correct":false,"justification":"Cow's 🐮 milk ","idx":0,"proposition":"casein"},{"correct":false,"justification":"Cow's 🐄 milk ","idx":1,"proposition":"α-lactalbumin"},{"correct":false,"justification":"Cow's 🐄 🐮 milk ","idx":2,"proposition":"β-lactoglobulin"},{"correct":true,"justification":"True","idx":3,"proposition":"Ovalbumin"},{"correct":true,"justification":"True. Mnemonic means: the two proteins starting with 'ov' = egg 🐣 ","idx":4,"proposition":"ovomucoid"}],"ts":1627726483,"type":"custom","difficulte":"3"}
-{"_id":"ascite-HGE-426acb","context":null,"enonce":"Which of the following are complications of ascites?","item":"ascite","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Umbilical hernia"},{"correct":true,"justification":"True","idx":1,"proposition":"Infection"},{"correct":true,"justification":"True","idx":2,"proposition":"Hepatorenal syndrome"},{"correct":false,"justification":"Possible etiology of ascites","idx":3,"proposition":"Hepatocellular carcinoma"},{"correct":false,"justification":"Possible etiology of ascites","idx":4,"proposition":"Primary biliary cirrhosis"}],"ts":1627327415,"type":"custom","difficulte":"1"}
-{"_id":"pathoOGE-endoc-42909d","context":null,"enonce":"Which of the following are true?","item":"pathoOGE","matiere":"endoc","propositions":[{"correct":false,"justification":"False, the fact that the testicle goes up to the abdomen relieves the patient. In favor of an orchitis. Against a twist","idx":0,"proposition":"The positive Prehn sign is in favor of this diagnosis"},{"correct":true,"justification":"True","idx":1,"proposition":"The cremasterian reflex is abolished on the torsion side"},{"correct":false,"justification":"False, 6 hours after the onset of pain (time before necrosis sets in)","idx":2,"proposition":"Exploration must be done within 24 hours"},{"correct":false,"justification":"False, Surgical emergency: ultrasound should not delay management (not very sensitive and not very specific)","idx":3,"proposition":"Ultrasound is mandatory to make the diagnosis"},{"correct":true,"justification":"True","idx":4,"proposition":"The surgical approach is scrotal"}],"ts":1628790322,"type":"custom","difficulte":"2"}
-{"_id":"hemangiome-dermato-4392cd","context":null,"enonce":"infantile hemangiomas: ","item":"hemangiome","matiere":"dermato","propositions":[{"correct":true,"justification":"True ","idx":0,"proposition":"pale at compression "},{"correct":false,"justification":"False, unlike malignant tumors of infants, hemangiomas are elastic and not indurated ","idx":1,"proposition":"are indurated "},{"correct":true,"justification":"True ","idx":2,"proposition":"have in the majority of cases a phase of spontaneous involution in a few years "},{"correct":false,"justification":"False, they are neither flapping or quivering on palpation, nor blowing on auscultation unlike arteriovenous malformations. ","idx":3,"proposition":"Are flapping "},{"correct":false,"justification":"False, absent at birth, unlike vascular malformations and congenital hemangiomas (Differential diagnosis)  ","idx":4,"proposition":"Present at birth"}],"ts":1625860703,"type":"custom","difficulte":"2"}
-{"_id":"nutrigrossesse-endoc-43de34","context":null,"enonce":"In which case should the dosage of peri-conceptional folic acid be increased?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"correct":true,"justification":"False","idx":0,"proposition":"Obesity"},{"correct":true,"justification":"True","idx":1,"proposition":"Epilepsy"},{"correct":false,"justification":"False","idx":2,"proposition":"Celiac disease"},{"correct":true,"justification":"True, these are the three indications where 5mg\/Day of B9 is administered (instead of 0.4mg\/D)","idx":3,"proposition":"History of spina bifida"},{"correct":false,"justification":"False","idx":4,"proposition":"Severe asthma"}],"ts":1628790860,"type":"custom","difficulte":"2"}
-{"_id":"dlrphysiopath-mpr-4d2988","context":null,"enonce":"Which of the following propositions are true about Paroxysmal Pain Attacks (PDAs)?","item":"dlrphysiopath","matiere":"mpr","propositions":[{"correct":true,"justification":"True. This is the definition of Portenoy, 1990. Not to be confused with poorly controlled background pain, nor with painful bouts at the end of the dose","idx":0,"proposition":"Paroxysmal Pain Attack is a transient exacerbation of pain in patients with a stable chronic pain background, well controlled by opioids."},{"correct":false,"justification":"Any chronic pain","idx":1,"proposition":"They only concern cancer pain"},{"correct":true,"justification":"True, as the name suggests","idx":2,"proposition":"They are short-lived"},{"correct":false,"justification":"Paroxysmal pain attacks (PDA) of cancer justify the use of fast-acting transmucosal morphine. ","idx":3,"proposition":"They are well supported for a morphine Per Os"},{"correct":true,"justification":"True","idx":4,"proposition":"They may be of neuropathic mechanism"}],"ts":1628770943,"type":"custom","difficulte":"2"}
-{"_id":"diplopie-ophtalmo-50ad4e","context":null,"enonce":"Which of the following are true?","item":"diplopie","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"This muscle is the only oculomotor muscle to be innervated by the fourth pair of cranial nerves (trochlear nerve)","idx":0,"proposition":"The superior oblique muscle is innervated by the sixth pair of cranial nerves"},{"correct":true,"justification":"True","idx":1,"proposition":"The superior rectus muscle is innervated by the third pair of cranial nerves"},{"correct":true,"justification":"True","idx":2,"proposition":"The inferior oblique muscle is innervated by the third pair of cranial nerves"},{"correct":true,"justification":"True","idx":3,"proposition":"The superior rectus muscle is innervated by the third pair of cranial nerves"},{"correct":false,"justification":"This muscle is the only oculomotor muscle to be innervated by the sixth pair of cranial nerves (abducens nerve)","idx":4,"proposition":"The lateral rectus muscle is innervated by the third pair of cranial nerves"}],"ts":1626279614,"type":"custom","difficulte":"2"}
-{"_id":"pancreatiteaigue-HGE-50e069","context":null,"enonce":"Which of these endocrine pathologies is complicated in 5 to 10% of cases by acute pancreatitis?","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"Hypothyroidism"},{"correct":false,"justification":"","idx":1,"proposition":"Pituitary adenoma"},{"correct":true,"justification":"via increased serum calcium","idx":2,"proposition":"Hyperparathyroidism"},{"correct":false,"justification":"","idx":3,"proposition":"Hypoparathyroidism"},{"correct":false,"justification":"","idx":4,"proposition":"Hyperthyroidism"}],"ts":1622048766,"type":"custom","difficulte":"1"}
-{"_id":"nutrigrossesse-endoc-537b9a","context":null,"enonce":"What is the blood glucose goal at 1h post-prandial in a pregnant woman with type 2 diabetes?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"< 1.60g\/L"},{"correct":true,"justification":"True","idx":1,"proposition":"< 1.40g\/L"},{"correct":false,"justification":"Goal at 2 hours post-HGPO","idx":2,"proposition":"< 1.53g\/L"},{"correct":false,"justification":"Goal at 1h post-HGPO","idx":3,"proposition":"< 1.80g\/L"},{"correct":false,"justification":"False","idx":4,"proposition":"< 1.20g\/L"}],"ts":1626084028,"type":"custom","difficulte":"2"}
-{"_id":"prothese-urg-53c866","context":null,"enonce":"What is the hip replacement dislocation rate?","item":"prothese","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"2 to 3%"},{"correct":false,"justification":"False","idx":1,"proposition":"0.2 to 0.3 %"},{"correct":false,"justification":"False","idx":2,"proposition":"12 to 13%"},{"correct":false,"justification":"False","idx":3,"proposition":"22 to 23%"},{"correct":false,"justification":"False","idx":4,"proposition":"32 to 33%"}],"ts":1626004790,"type":"custom","difficulte":"1"}
-{"_id":"ascite-HGE-56e3aa","context":null,"enonce":"Which of the following are etiologies of exudative ascites?","item":"ascite","matiere":"HGE","propositions":[{"correct":false,"justification":"Rich in protein","idx":0,"proposition":"An exudate is a low-protein liquid"},{"correct":true,"justification":"True","idx":1,"proposition":"Tuberculosis"},{"correct":true,"justification":"True","idx":2,"proposition":"Pancreatitis"},{"correct":true,"justification":"True","idx":3,"proposition":"Carcinoma"},{"correct":false,"justification":"Transudate","idx":4,"proposition":"Bilharzia"}],"ts":1627327523,"type":"custom","difficulte":"1"}
-{"_id":"AV--ophtalmo-5993aa","context":null,"enonce":"By what is aqueous humor secreted?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Vitreous humour"},{"correct":true,"justification":"True Secreted permanently by ciliary processes, mood \r\naqueous is discharged at the iridocorneal angle through the trabeculum into the canal \r\nof Schlemm which joins the general circulation","idx":1,"proposition":"Ciliary trials"},{"correct":false,"justification":"False","idx":2,"proposition":"Choroid"},{"correct":false,"justification":"False","idx":3,"proposition":"Sclera"},{"correct":false,"justification":"False","idx":4,"proposition":"Zonum"}],"ts":1626111256,"type":"custom","difficulte":"2"}
-{"_id":"antithrombotiques-therapeutique-5c6b3a","context":null,"enonce":"Which of the following propositions, which one or which are true?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"correct":false,"justification":"False. Irreversible 😵","idx":0,"proposition":"Bleomycin causes reversible pulmonary fibrosis"},{"correct":false,"justification":"False. Dose-dependent when the total cumulative dose exceeds 280 mg","idx":1,"proposition":"Bleomycin causes nondose-dependent pulmonary fibrosis"},{"correct":true,"justification":"True","idx":2,"proposition":"A DLCO\/VA ratio < 67% contraindicates the use or continuation of bleomycin"},{"correct":true,"justification":"True, according to Wikipedia; \"Biosynthesis of bleomycin is completed by glycosylation of the aglycones.\"","idx":3,"proposition":"Bleomycin is a chemotherapy that is derived from glycopeptides"},{"correct":false,"justification":"False. Germline testicular cancer","idx":4,"proposition":"Bleomycin is particularly used in metastatic non-germinal testicular cancer"}],"ts":1629730661,"type":"custom","difficulte":"1"}
-{"_id":"tbiono-nephro-5de7f7","context":null,"enonce":"What are the possible causes of hypokalemia?","item":"tbiono","matiere":"nephro","propositions":[{"correct":true,"justification":"True, like any severe undernutrition","idx":0,"proposition":"anorexia nervosa"},{"correct":false,"justification":"False, alkalosis","idx":1,"proposition":"acidosis"},{"correct":true,"justification":"True","idx":2,"proposition":"vomiting or diarrhea"},{"correct":true,"justification":"True, cortisol has a strong affinity for aldosterone receptors","idx":3,"proposition":"hypercorticism"},{"correct":false,"justification":"","idx":4,"proposition":"All the proposals are false."}],"ts":1625678385,"type":"custom","difficulte":"2"}
-{"_id":"nutrigrossesse-endoc-5de9ae","context":null,"enonce":"What is the goal of fasting blood glucose in a pregnant woman with type 2 diabetes?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"> 0.60 g\/L"},{"correct":false,"justification":"False","idx":1,"proposition":"> 0.50 g\/L"},{"correct":false,"justification":"False","idx":2,"proposition":"> 0.40 g\/L"},{"correct":false,"justification":"False","idx":3,"proposition":"> 0.70 g\/L"},{"correct":false,"justification":"False","idx":4,"proposition":"> 0.80 g\/L"}],"ts":1628790112,"type":"custom","difficulte":"2"}
-{"_id":"AV--ophtalmo-5eb207","context":null,"enonce":"Which of the following are treatments for early stage AMD?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Vitamin C"},{"correct":true,"justification":"True","idx":1,"proposition":"Vitamin e"},{"correct":true,"justification":"True","idx":2,"proposition":"Zinc"},{"correct":true,"justification":"True","idx":3,"proposition":"Lutein"},{"correct":false,"justification":"False","idx":4,"proposition":"Magnesium"}],"ts":1626279560,"type":"custom","difficulte":"2"}
-{"_id":"suivinourisson-ophtalmo-5ed67f","context":null,"enonce":"Which of the following are possible genetic causes of hearing loss?","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Possible non-genetic cause ","idx":0,"proposition":"Meningitis"},{"correct":true,"justification":"True, ligament hyperlaxity and bone fragility","idx":1,"proposition":"Glass bone disease"},{"correct":true,"justification":"True, with kidney damage","idx":2,"proposition":"Alport syndrome"},{"correct":false,"justification":"Common but non-genetic cause","idx":3,"proposition":"Serous otitis"},{"correct":true,"justification":"True, no malformation of the ossicles \/ external ear canal","idx":4,"proposition":"Down syndrome"}],"ts":1626111676,"type":"custom","difficulte":"2"}
-{"_id":"diarrheeinf-infectio-5f8bdd","context":null,"enonce":"Which of the following proposals suggest hemolytic uremic syndrome (HUS) in children?","item":"diarrheeinf","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Edema"},{"correct":true,"justification":"True","idx":1,"proposition":"Purpura"},{"correct":true,"justification":"True","idx":2,"proposition":"Pallor"},{"correct":true,"justification":"True","idx":3,"proposition":"Convulsions "},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"ts":1627722342,"type":"custom","difficulte":"2"}
-{"_id":"allergie-infectio-6004e9","context":null,"enonce":"Which of the following identifies the most common perennial pneumallergen?","item":"allergie","matiere":"infectio","propositions":[{"correct":true,"justification":"True. Dermatophagoids pteronyssinus and D. farinae","idx":0,"proposition":"Mites"},{"correct":false,"justification":"False","idx":1,"proposition":"Mould"},{"correct":false,"justification":"False","idx":2,"proposition":"Cockroaches"},{"correct":false,"justification":"False","idx":3,"proposition":"Pets"},{"correct":false,"justification":"These are seasonal allergens.","idx":4,"proposition":"Grass pollen"}],"ts":1627726363,"type":"custom","difficulte":"1"}
-{"_id":"Exprenuptial-gyn-60baf5","context":null,"enonce":"What is the recommended duration of contraception after each dose of chickenpox vaccine in a woman of childbearing potential?","item":"Exprenuptial","matiere":"gyn","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"1 month"},{"correct":false,"justification":"False","idx":1,"proposition":"2 months"},{"correct":true,"justification":"True","idx":2,"proposition":"Three months"},{"correct":false,"justification":"False","idx":3,"proposition":"4 months"},{"correct":false,"justification":"False. Contraception is recommended. ","idx":4,"proposition":"Contraception is not required after the chickenpox vaccine. "}],"ts":1625508823,"type":"custom","difficulte":"2"}
-{"_id":"noduleTh-endoc-6538f0","context":null,"enonce":"Which of the following propositions, which one or which are true?","item":"noduleTh","matiere":"endoc","propositions":[{"correct":false,"justification":"False. This is iodine deficiency. Tobacco, on the other hand, is a factor promoting goiter because it contains thyocyanate which is goitrigen.","idx":0,"proposition":"The first factor favoring goiter is tobacco"},{"correct":false,"justification":"False. Despite the fact that it is goitrigen, it does not increase the risk of thyroid cancer.","idx":1,"proposition":"Tobacco is a risk factor for thyroid cancer"},{"correct":true,"justification":"True","idx":2,"proposition":"Thyroid follicles have receptors for estrogen"},{"correct":true,"justification":"True. Lithium acts as a synthetic antithyroid.","idx":3,"proposition":"Lithium is goitrogenic"},{"correct":false,"justification":"False. 100 to 150 μg\/day for the majority of the population, but 200 to 250 μg\/day for pregnant women.","idx":4,"proposition":"Lithium requirements are 100 to 150 μg\/day for the entire population"}],"ts":1628790850,"type":"custom","difficulte":"1"}
-{"_id":"dlrabdo-HGE-65c0d1","context":null,"enonce":"Abdominal pain of the child: \r\nWhich of the following are true?","item":"dlrabdo","matiere":"HGE","propositions":[{"correct":false,"justification":"False.\r\nIn practice it is a frequent reason ++ consultation in the emergency room (more precisely they come for crying).\r\nNot much effective treatment unfortunately, it's a lot of parental reassurance explaining that it will pass.\r\nIn practice we often offer abdominal massages, and probiotics that have a certain effectiveness.","idx":0,"proposition":"Treatment of infant colic is based on antispasmodics and laxatives."},{"correct":false,"justification":"False.\r\nParacetamol can be used from birth even in premature babies of 500g :).","idx":1,"proposition":"It is contraindicated to use paracetamol to treat abdominal pain in a child under 1 month of age."},{"correct":true,"justification":"True\r\nIn practice this is very common. It remains a diagnosis of elimination so often we make the diagnosis by doing an ultrasound to eliminate appendicitis. It is often secondary to an ENT infection just like primary acute intussusception.","idx":2,"proposition":"Mesenteric adenolympitis is a common cause of abdominal pain in children 2 to 12 years of age."},{"correct":true,"justification":"True","idx":3,"proposition":"Primary acute intussusception usually occurs in a child 2 months to 2 years of age."},{"correct":false,"justification":"False\r\nOn the contrary, we look for a secondary cause in children over 2 years of age.","idx":4,"proposition":"Acute intussusception occurring in a child under 2 years of age should investigate a secondary cause"}],"ts":1621625183,"type":"custom","difficulte":"2"}
-{"_id":"prothese-urg-66a425","context":null,"enonce":"Which of the following are risk factors for prosthesis infection?","item":"prothese","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Rheumatoid arthritis"},{"correct":true,"justification":"True","idx":1,"proposition":"BMI > 40"},{"correct":true,"justification":"True","idx":2,"proposition":"Postoperative hematoma"},{"correct":true,"justification":"True","idx":3,"proposition":"Type 1 diabetes"},{"correct":true,"justification":"True","idx":4,"proposition":"Type 2 diabetes"}],"ts":1626004803,"type":"custom","difficulte":"1"}
-{"_id":"IRA-urg-67e644","context":null,"enonce":"Which of the following are contraindications to non-invasive ventilation?","item":"IRenA","matiere":"urg","propositions":[{"correct":true,"justification":"True, inhalation risk","idx":0,"proposition":"Uncontrollable vomiting"},{"correct":true,"justification":"True, may worsen an undrained pneumothorax","idx":1,"proposition":"Bluffing chest wound"},{"correct":false,"justification":"False, it is precisely one of the formally validated indications of NIV","idx":2,"proposition":"Acute lung oedema with respiratory distress"},{"correct":false,"justification":"False, it may be an indication of NIV. (Table evoking pneumocystosis!) ","idx":3,"proposition":"Hypoxemic acute respiratory failure of the immunocompromised"},{"correct":true,"justification":"True","idx":4,"proposition":"Respiratory exhaustion"}],"ts":1628004822,"type":"custom","difficulte":"2"}
-{"_id":"tbiono-infectio-6b857c","context":null,"enonce":"Which of the following proposals are plasmodial species pathogenic to humans?","item":"tbiono","matiere":"infectio","propositions":[{"correct":true,"justification":"True, responsible for 90% of severe malaria attacks","idx":0,"proposition":"P. falciparum"},{"correct":true,"justification":"True","idx":1,"proposition":"P. vivax"},{"correct":false,"justification":"There are more than 130 different plasmodial species. Only 5 are pathogenic for humans: falciparum, knowlesi, oval, vivax, malariae ","idx":2,"proposition":"P. diploglossi"},{"correct":true,"justification":"True","idx":3,"proposition":"P. malariae"},{"correct":true,"justification":"True","idx":4,"proposition":"P. knowlesi"}],"ts":1625678370,"type":"custom","difficulte":"3"}
-{"_id":"ascite-HGE-709be6","context":null,"enonce":"Which of the following are transudative ascites etiologies?","item":"ascite","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A transudate is low in protein"},{"correct":true,"justification":"True","idx":1,"proposition":"Cirrhosis"},{"correct":true,"justification":"True","idx":2,"proposition":"Nephrotic syndrome"},{"correct":false,"justification":"Exudate","idx":3,"proposition":"Carcinoma"},{"correct":false,"justification":"Exudate","idx":4,"proposition":"Heart failure"}],"ts":1627327490,"type":"custom","difficulte":"1"}
-{"_id":"tbvisionbrutal-ophtalmo-7102fe","context":null,"enonce":"Which of the following are complications of cataract surgery?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True, by Irvine Gass","idx":0,"proposition":"Macular edema"},{"correct":true,"justification":"True, by retinal detachment","idx":1,"proposition":"Intravitreal hemorrhage"},{"correct":true,"justification":"True","idx":2,"proposition":"Endophtamy"},{"correct":false,"justification":"False","idx":3,"proposition":"OACR"},{"correct":false,"justification":"False","idx":4,"proposition":"AMD"}],"ts":1626279300,"type":"custom","difficulte":"2"}
-{"_id":"ectoparasitose-infectio-728822","context":null,"enonce":"What is the treatment for post-treatment eczematization?","item":"ectoparasitose","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Strong dermoticorticoids"},{"correct":true,"justification":"True","idx":1,"proposition":"Emollients"},{"correct":false,"justification":"Useless","idx":2,"proposition":"Antihistamines"},{"correct":false,"justification":"It is necessary to treat","idx":3,"proposition":"Therapeutic abstention"},{"correct":false,"justification":"Alternative to Benzyl Benzoate","idx":4,"proposition":"Permetrine"}],"ts":1627726489,"type":"custom","difficulte":"2"}
-{"_id":"lesionart-urg-7345a4","context":null,"enonce":"Which of the following propositions are true concerning the anterior luxaion of the humerus?","item":"lesionart","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A fall on the hand can be the cause"},{"correct":true,"justification":"True","idx":1,"proposition":"The radial nerve may be damaged"},{"correct":true,"justification":"True","idx":2,"proposition":"The axillary nerve may be damaged"},{"correct":false,"justification":"Possible damage to the nerves of the hand (via brachial plexus injury)","idx":3,"proposition":"We never find hypoaesthesia of the fingers"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"ts":1625930879,"type":"custom","difficulte":"1"}
-{"_id":"prothese-urg-751997","context":null,"enonce":"Which of the following are risk factors for prosthesis infection?","item":"prothese","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Score ASA"},{"correct":true,"justification":"True","idx":1,"proposition":"Diabetes"},{"correct":true,"justification":"True","idx":2,"proposition":"Obesity"},{"correct":true,"justification":"True","idx":3,"proposition":"Cirrhosis"},{"correct":true,"justification":"True","idx":4,"proposition":"Active smoking"}],"ts":1626004801,"type":"custom","difficulte":"1"}
-{"_id":"TED-psy-765b4b","context":null,"enonce":"Which of the following are differential diagnoses of autism spectrum disorder (ASD)?","item":"TED","matiere":"psy","propositions":[{"correct":true,"justification":"Children with intellectual disabilities frequently experience symptoms of ASD (in all 2 clinical areas). A psychometric assessment makes it possible to estimate the patient's IQ and to identify an intellectual disability and its level of severity.","idx":0,"proposition":"Intellectual disability"},{"correct":true,"justification":"The realization of an audiogram or auditory evoked potentials make it possible to eliminate this differential diagnosis","idx":1,"proposition":"Hearing loss and deafness"},{"correct":true,"justification":"Children have difficulties with verbal communication, but the difference with ASD is that children are able to compensate for this deficiency through non-verbal communication and maintained relational skills.","idx":2,"proposition":"Language acquisition disorders"},{"correct":true,"justification":"Patients with ADHD frequently have difficulties in social interactions (mainly related to symptoms of hyperactivity and impulsivity) but no deficit in social or emotional reciprocity, nor in steteotyped or restricted behaviors.","idx":3,"proposition":"ADHD"},{"correct":true,"justification":"Patients with schizophrenia frequently have difficulty in social interactions.","idx":4,"proposition":"Early onset schizophrenia"}],"ts":1625562178,"type":"custom","difficulte":"2"}
-{"_id":"vaccin-infectio-76fb22","context":null,"enonce":"Which of the following are vaccines already delivered at 3 months of age?","item":"vaccin","matiere":"infectio","propositions":[{"correct":false,"justification":"M5 and M12","idx":0,"proposition":"meningococcal C vaccine"},{"correct":true,"justification":"True, M2 M4 M9","idx":1,"proposition":"dTP vaccine"},{"correct":false,"justification":"M12 and M16-18","idx":2,"proposition":"MMR vaccine"},{"correct":true,"justification":"True","idx":3,"proposition":"pneumococcal vaccine"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"ts":1627719948,"type":"custom","difficulte":"2"}
-{"_id":"hyperCa-nephro-774b23","context":null,"enonce":"Which of the following are true?","item":"hyperCa","matiere":"nephro","propositions":[{"correct":true,"justification":"True, acute (emergency) and chronic hypercalcemia ","idx":0,"proposition":"There are 2 main semiological tables of hypercalcemia that are quite distinct and do not involve the same management "},{"correct":false,"justification":"The reference is ionized calcium (active calcium), which is difficult to access. We can still rely on corrected plasma calcium ","idx":1,"proposition":"The reference measure of calcium is plasma calcium"},{"correct":true,"justification":"","idx":2,"proposition":"Acute hypercalcemia crisis is defined as a serum calcium threshold > 3.5 mmol\/L "},{"correct":false,"justification":"QT shortening","idx":3,"proposition":"The repercussions of hypercalcemia on the ECG include QT prolongation, early T waves, tachycardia, BAV. "},{"correct":true,"justification":"","idx":4,"proposition":"In hypercalcemia there is a tendency to extracellular dehydration "}],"ts":1625678409,"type":"custom","difficulte":"2"}
-{"_id":"AV--ophtalmo-795ee4","context":null,"enonce":"Which of the following are the causes of macular pathologies?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Alcohol"},{"correct":true,"justification":"True","idx":1,"proposition":"Chloroquine"},{"correct":true,"justification":"True","idx":2,"proposition":"Diabetes"},{"correct":false,"justification":"Rather the periphery of the retina","idx":3,"proposition":"Retinopathy pigmentosa"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"ts":1626279620,"type":"custom","difficulte":"2"}
-{"_id":"AV--ophtalmo-7ae467","context":null,"enonce":"Which of the following are treatments for early stage AMD?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Vitamin e"},{"correct":true,"justification":"True","idx":1,"proposition":"Vitamin C"},{"correct":false,"justification":"False","idx":2,"proposition":"Vitamin A"},{"correct":false,"justification":"False","idx":3,"proposition":"Thiamine"},{"correct":false,"justification":"False","idx":4,"proposition":"Vitamin B9"}],"ts":1626279355,"type":"custom","difficulte":"2"}
-{"_id":"tbvisionbrutal-ophtalmo-7dc032","context":null,"enonce":"Which of the following are causes of intravitreal hemorrhage?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Retinal tear "},{"correct":true,"justification":"True","idx":1,"proposition":"Retinal detachment"},{"correct":true,"justification":"True","idx":2,"proposition":"Proliferative diabetic retinopathy "},{"correct":false,"justification":"No neovessels = no bleeding","idx":3,"proposition":"OACR"},{"correct":false,"justification":"No neovessels = no bleeding","idx":4,"proposition":"CAM"}],"ts":1626279398,"type":"custom","difficulte":"2"}
-{"_id":"nutriped-nutri-7f3ddf","context":null,"enonce":"When should diversification be introduced?","item":"nutriped","matiere":"nutri","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Between 4 and 6 months"},{"correct":false,"justification":"False","idx":1,"proposition":"Between 2 and 6 months"},{"correct":false,"justification":"False","idx":2,"proposition":"Between 8 and 10 months"},{"correct":false,"justification":"False","idx":3,"proposition":"Between 6 and 8 months"},{"correct":false,"justification":"False","idx":4,"proposition":"From 6 weeks"}],"ts":1625236419,"type":"custom","difficulte":"2"}
-{"_id":"polytrauma-urg-7fe04e","context":null,"enonce":"Which of the following proposals regarding the pre-hospital management of a polytrauma patient are true?","item":"polytrauma","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A tension pneumothorax must be exuffled"},{"correct":false,"justification":"False, it is necessary to put 2 VVP of good caliber <16G","idx":1,"proposition":"Only one PVV must be installed"},{"correct":true,"justification":"True, the indications for intubation in the context of a polytrauma are among others a Glasgow ≤8, respiratory or hemodynamic distress","idx":2,"proposition":"If the patient requires mechanical ventilation, rapid sequence orotracheal intubation should be performed"},{"correct":false,"justification":"False, by noradrenaline","idx":3,"proposition":"Vasopressor therapy with dobutamine should be introduced if hypotension persists despite adequate filling"},{"correct":false,"justification":"False, the reduction of fracture foci is the first step in analgesic treatment of these and prevents fat embolism. They must also be immobilized afterwards to prevent secondary displacement that may be the cause of vascular and\/or nerve damage.","idx":4,"proposition":"In case of fractures, they should not be reduced in pre-hospital"}],"ts":1625734846,"type":"custom","difficulte":"2"}
-{"_id":"noduleTh-endoc-8009df","context":null,"enonce":"Regarding the epidemiology of goiter. Which of the following propositions, which one or which are true?","item":"noduleTh","matiere":"endoc","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"10% of the population has a goiter"},{"correct":false,"justification":"False. 3 women for 1 man.","idx":1,"proposition":"The sex ratio of goiter is 5 women to 1 man"},{"correct":true,"justification":"True","idx":2,"proposition":"The sex ratio of goiter is 3 women to 1 man"},{"correct":false,"justification":"False. Prevalence increases with age.","idx":3,"proposition":"Prevalence decreases with age as there is a decline in TSH synthesis"},{"correct":false,"justification":"False. 10%","idx":4,"proposition":"1% of the population has a goiter"}],"ts":1626084065,"type":"custom","difficulte":"1"}
-{"_id":"AV--ophtalmo-80d213","context":null,"enonce":"Which of the following are part of the posterior segment?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Sclera"},{"correct":true,"justification":"True","idx":1,"proposition":"Choroid"},{"correct":true,"justification":"True","idx":2,"proposition":"Retina"},{"correct":true,"justification":"True","idx":3,"proposition":"Vitreous humour"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"ts":1626279651,"type":"custom","difficulte":"2"}
-{"_id":"anesth-anesth-82c007","context":null,"enonce":"Regarding pre-oxygenation before general anesthesia out of emergency. Which of the following are true?","item":"anesth","matiere":"anesth","propositions":[{"correct":false,"justification":"False. At least 3 minutes of pre-oxygenation. The goal is to achieve a FeO2 ≥ 90%. ","idx":0,"proposition":"The patient is preoxygenated for at least 2 minutes"},{"correct":false,"justification":"False. 90%. This testifies to the almost complete denitrogenation of the lung (= replacement of nitrogen by O2)","idx":1,"proposition":""},{"correct":true,"justification":"True. It is the act of replacing nitrogen with O2. ","idx":2,"proposition":"The goal of pre-oxygenation is to achieve almost complete \"denitrogenation\" of the lung "},{"correct":true,"justification":"True","idx":3,"proposition":"100% FiO2 should be administered during pre-oxygenation"},{"correct":true,"justification":"True. This limits the risk of hypoxemia.","idx":4,"proposition":"The purpose of pre-oxygenation is to saturate the body's oxygen reserves, including the functional residual capacity of the lung, in order to ensure the longest possible safety apnea in case of difficulty accessing the airways during intubation"}],"ts":1628767415,"type":"custom","difficulte":"2"}
-{"_id":"oreillons-infectio-853412","context":null,"enonce":"Which of the following are true for the treatment of mumps parotitis?","item":"oreillons","matiere":"infectio","propositions":[{"correct":false,"justification":"Treatment is symptomatic","idx":0,"proposition":"Amoxicillin - Clavulanic acid for 7 days"},{"correct":false,"justification":"Treatment is symptomatic","idx":1,"proposition":"Fluoroquinolones for 5 days"},{"correct":false,"justification":"Treatment is symptomatic","idx":2,"proposition":"3rd Generation cephalosporin alone for 10 days"},{"correct":false,"justification":"Treatment is symptomatic","idx":3,"proposition":"3rd Generation cephalosporin for 10 days plus Amikacin in single dose"},{"correct":true,"justification":"True, and especially primary prevention through MMR vaccination! ","idx":4,"proposition":"Only symptomatic"}],"ts":1627721105,"type":"custom","difficulte":"2"}
-{"_id":"diplopie-ophtalmo-88e749","context":null,"enonce":"Which of the following are true for trochlear IV nerve palsy?","item":"diplopie","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True, all pitit pitit","idx":0,"proposition":"The trochlear IV nerve is the smallest of the cranial nerves"},{"correct":true,"justification":"True","idx":1,"proposition":"Diplopia is vertical"},{"correct":true,"justification":"True, the healthy eye can go, the affected eye can not","idx":2,"proposition":"Diplopia is maximum at the bottom and inside"},{"correct":false,"justification":"It is very embarrassing: climbing stairs, reading, ...","idx":3,"proposition":"Diplopia is very untroublesome"},{"correct":false,"justification":"The chin is lowered, the head is tilted to the healthy side","idx":4,"proposition":"The compensatory position includes a raised chin"}],"ts":1626111306,"type":"custom","difficulte":"2"}
-{"_id":"ProtU-nephro-8c7f5b","context":null,"enonce":"Which of the following are true?","item":"ProtU","matiere":"nephro","propositions":[{"correct":true,"justification":"True, in nephrotic syndrome there is secondary hyperlipidemia to compensate for the loss of osmole.","idx":0,"proposition":"proteinuria can cause high cholesterol"},{"correct":false,"justification":"False, proteinuria of small proteins is physiological in small amounts","idx":1,"proposition":"Proteinuria is necessarily pathological"},{"correct":true,"justification":"True, if proteinuria is suspected at orthostatism, especially in 12-16 year olds, proteinuria should be measured after 2 hours of clinostatism.","idx":2,"proposition":"Proteinuria can be promoted by infection, fever or orthostatism, etc."},{"correct":true,"justification":"True, urinary protein electrophoresis will determine the content of urinated proteins: mostly albumin or mostly low molecular weight proteins","idx":3,"proposition":"To analyze the content of proteinuria an electrophoresis of urinary proteins is performed"},{"correct":false,"justification":"","idx":4,"proposition":""}],"ts":1625678328,"type":"custom","difficulte":"2"}
-{"_id":"tbrefraction-ophtalmo-8f25a3","context":null,"enonce":"Which of the following proposals can cause eye strain?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Astigmatism"},{"correct":true,"justification":"True","idx":1,"proposition":"Farsightedness"},{"correct":true,"justification":"True","idx":2,"proposition":"Myopia"},{"correct":false,"justification":"Not an ametropia","idx":3,"proposition":"AMD"},{"correct":false,"justification":"Not an ametropia","idx":4,"proposition":"Glaucoma"}],"ts":1626279242,"type":"custom","difficulte":"2"}
-{"_id":"ascite-HGE-8fabb3","context":null,"enonce":"Where is ascites?","item":"ascite","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"In the peritoneum"},{"correct":false,"justification":"","idx":1,"proposition":"In the liver"},{"correct":false,"justification":"","idx":2,"proposition":"In the pleura"},{"correct":false,"justification":"","idx":3,"proposition":"In the pericardium"},{"correct":false,"justification":"","idx":4,"proposition":"In the gallbladder"}],"ts":1627327407,"type":"custom","difficulte":"1"}
-{"_id":"Kcos-onco-953727","context":null,"enonce":"Which of the following proposals are suggestive of a malignant lesion on imagery?","item":"Kcos","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Cortical rupture"},{"correct":true,"justification":"True","idx":1,"proposition":"Periosteal appositions"},{"correct":true,"justification":"True","idx":2,"proposition":"Invasion of soft parts"},{"correct":false,"justification":"Fuzzy boundaries","idx":3,"proposition":"Net limits"},{"correct":true,"justification":"True, these are spiculated multilamellar periosteal appositions","idx":4,"proposition":"Herb fire"}],"ts":1625915713,"type":"custom","difficulte":"1"}
-{"_id":"diarrheeaigue-HGE-98ec63","context":null,"enonce":"With regard to acute diarrhoea in children, what are the right proposals?","item":"diarrheeaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"False, rotavirus viral diarrhea is the most common but vaccination is not part of the schedule (nb: withdrawn for increased risk of intussusception)","idx":0,"proposition":"The most common etiology is rotavirus, which is subject to mandatory vaccination in children under 6 months of age."},{"correct":true,"justification":"True, however it must be remembered that it is contraindicated for children under 2 years of age and contraindicated in general for bloody invasive diarrhea or with high fever","idx":1,"proposition":"Loperamide is a transit retarder"},{"correct":true,"justification":"True, it is necessary to evaluate the child to estimate his degree of dehydration.","idx":2,"proposition":"Symptomatic treatment is mainly aimed at dehydration"},{"correct":false,"justification":"False, there must be liquid stools several times a day (>3\/d in general).","idx":3,"proposition":"Diarrhea is defined by the occurrence of watery stool"},{"correct":false,"justification":"","idx":4,"proposition":"All propositions are true"}],"ts":1621625187,"type":"custom","difficulte":"2"}
-{"_id":"nutrigrossesse-endoc-9930c3","context":null,"enonce":"Which of the following are true?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Insulin resistance during pregnancy is a physiological phenomenon "},{"correct":true,"justification":"True","idx":1,"proposition":"The prevalence of prior diabetes associated with pregnancy is <5%"},{"correct":false,"justification":"Classically in the second half of pregnancy","idx":2,"proposition":"Gestational diabetes typically appears from implantation"},{"correct":false,"justification":"Macrosomia","idx":3,"proposition":"The main risk of gestational diabetes is intrauterine growth restriction (IUGR)"},{"correct":false,"justification":"On risk factor: age >= 35 years, family history of diabetes, history of gestational diabetes, history of macrosome children, BMI >= 25 kg\/m2 ","idx":4,"proposition":"Screening for gestational diabetes is routine"}],"ts":1628790773,"type":"custom","difficulte":"2"}
-{"_id":"PF-neuro-99f1f6","context":null,"enonce":"Which of the following are true?","item":"PF","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The facial nerve emerges from the bulboprotuberantial sulcus to the medial part of the lateral dimple of the medulla elongata"},{"correct":false,"justification":"They penetrate the rock at the level of the internal acoustic meatus","idx":1,"proposition":"The motor fibers of the facial nerve circulate in the pontocerebellar angle and penetrate the rock at the level of the middle acoustic meatus"},{"correct":false,"justification":"Vestibulocochlear nerve VIII","idx":2,"proposition":"They accompany the VI nerve abducens in the rock"},{"correct":true,"justification":"True, also called facial canal","idx":3,"proposition":"In the rock, the facial nerve is contained in the Fallop canal"},{"correct":false,"justification":"It comes out at the level of the stylomastoid foramen. The foramen ovale of the base of the skull (because the interatrial communication of the fetus is also called foramen ovale, be careful not to confuse) allows the mandibular nerve (branch 3 of the trigeminal nerve), the small fearful nerve (branch of the glossopharyngeal nerve IX) and the accesory meningeal artery to pass through. ","idx":4,"proposition":"The facial nerve exits the rock at the foramen ovale"}],"ts":1625921347,"type":"custom","difficulte":"3"}
-{"_id":"SPSC-sp-99fdb2","context":null,"enonce":"How long are the initial medical certificates (C0) valid?","item":"SPSC","matiere":"sp","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"24 hours"},{"correct":false,"justification":"False","idx":1,"proposition":"5 days"},{"correct":true,"justification":"True, medical certificates for TDPS, SSPI and SPDRE must be less than 15 days old","idx":2,"proposition":"15 days"},{"correct":false,"justification":"False","idx":3,"proposition":"31 days"},{"correct":false,"justification":"False","idx":4,"proposition":"6 months"}],"ts":1626430549,"type":"custom","difficulte":"1"}
-{"_id":"diabete-endoc-9a58fe","context":null,"enonce":"Regarding diabetic ketoacidosis, what are the true proposals?","item":"diabete","matiere":"endoc","propositions":[{"correct":true,"justification":"True, abdominal pain, nausea and vomiting are typical of ketoacidosis. Fever can be explained by an infection that would be the trigger for ketoacidosis.","idx":0,"proposition":"It can manifest as febrile abdominal pain"},{"correct":false,"justification":"False, it is first necessary to rehydrate because prolonged hyperglycemia and osmotic polyuria dehydrate. It will be rehydrated with NaCl then NaCl + Glucose to avoid hypoglycemia of insulin. Do not forget also potassium supplementation after checking hypokalemia due to renal leakage of potassium but also insulin therapy","idx":1,"proposition":"Treatment is simply the administration of rapid-acting insulin, as this is an insulin deficiency."},{"correct":true,"justification":"True, it is necessary to do an ECG, check the renal function with the ionogram ","idx":2,"proposition":"Possible complications of ketoacidosis are hypokalemia, renal failure but also cerebral edema"},{"correct":true,"justification":"True, note among others (for the rest of the \"others\" cf College) that arterial blood gas is not necessary","idx":3,"proposition":"The diagnosis is confirmed by a combination of hyperglycemia >2.5 g \/ L, venous pH <7.3 or bicarbonate <18mM and ketone >3mM or ketonuria of +++"},{"correct":true,"justification":"True","idx":4,"proposition":"The care is hospitable"}],"ts":1628790647,"type":"custom","difficulte":"2"}
-{"_id":"palu-infectio-9f3120","context":null,"enonce":"Which of the following are true?","item":"palu","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"  Any suspicion of malaria is a diagnostic and therapeutic emergency"},{"correct":false,"justification":"The HCSP publishes annual health recommendations for travellers for health professionals   ","idx":1,"proposition":"Public Health France publishes annual health recommendations for travellers for health professionals   "},{"correct":true,"justification":"True","idx":2,"proposition":"  Artesunate IV is the standard treatment for severe malaria, with quinine used only if artesunate is not immediately available"},{"correct":false,"justification":"The anophele is a mosquito does not make noise and its bite is painless","idx":3,"proposition":"The anophele is a mosquito that does not make noise and whose bite is very painful"},{"correct":false,"justification":" P. Falciparum is the plasmodial species responsible for severe forms of malaria. P. Knowlesi can give exceptionally. ","idx":4,"proposition":" P. Malariae is the plasmodial species responsible for severe forms of malaria"}],"ts":1627660061,"type":"custom","difficulte":"1"}
-{"_id":"AV--ophtalmo-9fcebb","context":null,"enonce":"Which of the following are possible causes of cataracts?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Long-term corticosteroids"},{"correct":true,"justification":"True","idx":1,"proposition":"Type 2 diabetes"},{"correct":false,"justification":"Hypoparathyroidism","idx":2,"proposition":"Hyperparathyroidism"},{"correct":false,"justification":"Radiation therapy of the facial mass","idx":3,"proposition":"Abdominal radiation therapy"},{"correct":false,"justification":"Chronic uveitis","idx":4,"proposition":"Keratitis"}],"ts":1626279643,"type":"custom","difficulte":"2"}
-{"_id":"lesionart-urg-a046b7","context":null,"enonce":"Which of the following are Ottawa criteria?","item":"lesionart","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Age < 18"},{"correct":false,"justification":"Age > 55","idx":1,"proposition":"Age > 45"},{"correct":true,"justification":"True","idx":2,"proposition":"Normal walking impossible"},{"correct":true,"justification":"True","idx":3,"proposition":"Pain on palpation of the internal malleolus over 6 cm"},{"correct":true,"justification":"True","idx":4,"proposition":"Pain on palpation of the medial malleolus over 6 cm"}],"ts":1625931771,"type":"custom","difficulte":"2"}
-{"_id":"algiespelviennes-gyn-a3beb6","context":null,"enonce":"What is the first-line paraclinical examination to diagnose endometriosis?","item":"algiespelviennes","matiere":"gyn","propositions":[{"correct":false,"justification":"False. 2nd Intention Exam","idx":0,"proposition":"Abdominal-pelvic MRI"},{"correct":false,"justification":"False. 3rd intention exam. This is the gold standard for diagnosis because histological samples can be taken ","idx":1,"proposition":"Diagnostic laparoscopy"},{"correct":true,"justification":"True. This is the first-line paraclinical examination recommended by the CNGOF","idx":2,"proposition":"Pelvic ultrasound"},{"correct":false,"justification":"False. It is not a paraclinical examination. On the other hand, it is a crucial examination for the diagnosis ","idx":3,"proposition":"Vaginal touch"},{"correct":false,"justification":"False. It is not a paraclinical examination. On the other hand, it is a crucial examination for the diagnosis ","idx":4,"proposition":"Speculum examination"}],"ts":1625394306,"type":"custom","difficulte":"2"}
-{"_id":"infdermato-dermato-a46387","context":null,"enonce":"At what size is a canker sore << giant >>? (College of FJA, page 295)","item":"infdermato","matiere":"dermato","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"5 mm"},{"correct":true,"justification":"True","idx":1,"proposition":"10 mm"},{"correct":false,"justification":"False","idx":2,"proposition":"15 mm"},{"correct":false,"justification":"False","idx":3,"proposition":"20 mm"},{"correct":false,"justification":"False","idx":4,"proposition":"25 mm"}],"ts":1625860734,"type":"custom","difficulte":"2"}
-{"_id":"diabete-endoc-a63a53","context":null,"enonce":"Regarding the treatment of type 1 diabetes, what are the right proposals?","item":"diabete","matiere":"endoc","propositions":[{"correct":true,"justification":"True, optimizing glycemic control tends to make lean mass gain weight. (This side effect is no longer mentioned in the new 2019 edition)","idx":0,"proposition":"Weight gain is one of the side effects of insulin"},{"correct":false,"justification":"False, it is necessary to maintain aerobic physical activities despite the risk of hypoglycemia","idx":1,"proposition":"In addition to insulin, aerobic physical activities that promote hypoglycemia should be avoided"},{"correct":false,"justification":"False, it is rather capillary blood glucose, 3 to 4 times a day, mainly before meals but also upon waking, bedtime, before and after physical activities (College of Endoc + Pediatrics)","idx":2,"proposition":"Self-monitoring relies mainly on venous blood glucose "},{"correct":true,"justification":"True, strengthen glycemic monitoring but also do a dosage of ketonuria or ketonemia if prolonged hyperglycemia, abdominal signs or during pregnancy","idx":3,"proposition":"Blood glucose monitoring should be strengthened in case of intercurrent events such as infections, surgery, stress etc."},{"correct":true,"justification":"True","idx":4,"proposition":"Treatment is for life"}],"ts":1628790548,"type":"custom","difficulte":"2"}
-{"_id":"anesth-anesth-a7b305","context":null,"enonce":"Which of the following are true?","item":"anesth","matiere":"anesth","propositions":[{"correct":false,"justification":"False. There are 3 parts to the checklist. - Patient identity verification - Type of intervention - Patient's side ","idx":0,"proposition":"The course of anesthesia depends on a checklist of the HAS which includes 4 parts"},{"correct":false,"justification":"False. These drugs may be administered, but first a hypnotic must be used, then an analgesic and then a curare to facilitate orotracheal intubation.","idx":1,"proposition":"During the induction phase, 3 classes of drugs can be administered: first a curare, then a hypnotic, then an analgesic"},{"correct":false,"justification":"False. An opioid analgesic should be added to reduce pain through endotracheal intubation and the surgical or interventional procedure. Opioids control the neurovegetative response of pain-induced stress (tachycardia, hypertension, vagal shock) that may exist in an artificially sleeping patient. ","idx":2,"proposition":"There is no need to administer opioid analgesia during general anesthesia because the patient is unconscious and does not feel pain."},{"correct":true,"justification":"True","idx":3,"proposition":"During the induction phase, 3 drug classes can be used: hypnotics, opioid analgesics and curare."},{"correct":true,"justification":"True. It is an IV hypnotic antagonist of glutamate NMDA receptors (unlike other hypnotics which are rather GABA A agonists)","idx":4,"proposition":"Ketamine is a hypnotic"}],"ts":1628767271,"type":"custom","difficulte":"2"}
-{"_id":"antiinf-infectio-a801fa","context":null,"enonce":"What is the treatment of choice for a methicillin-resistant Staphylococcus aureus?","item":"antiinf","matiere":"infectio","propositions":[{"correct":true,"justification":"True, no enteral absorption  \r\n(= always by way \r\nparenteral except treatment \r\n, C. difficile colitis). Bactericide. Dependent time activity. FYI, the only beta-lactamine acting on SARMs is ceftaroline.","idx":0,"proposition":"Vancomycin"},{"correct":false,"justification":"Resistance to all beta-lactam (except ceftaroline)","idx":1,"proposition":"Cefotaxime"},{"correct":false,"justification":"Resistance to all beta-lactam (except ceftaroline)","idx":2,"proposition":"Oxacillin"},{"correct":false,"justification":"Resistance to all beta-lactam (except ceftaroline)","idx":3,"proposition":"C36 - aminoglycosides"},{"correct":false,"justification":"No, the reference is vancomycin. SARMs are frequently resistant to fluoroquinolones. ","idx":4,"proposition":"Levofloxacin"}],"ts":1627721536,"type":"custom","difficulte":"1"}
-{"_id":"tbvisionbrutal-ophtalmo-aafd33","context":null,"enonce":"By what is the anterior chamber, forward, delimited?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True. The aqueous humor fills the anterior chamber, bounded by \r\nthe cornea in front and the iris in the back","idx":0,"proposition":"Cornea"},{"correct":false,"justification":"Iris back","idx":1,"proposition":"Iris"},{"correct":false,"justification":"In the anterior chamber but does not delimit it","idx":2,"proposition":"Vitreous humour"},{"correct":false,"justification":"False","idx":3,"proposition":"Sclera"},{"correct":false,"justification":"False","idx":4,"proposition":"Ora Serrata"}],"ts":1626279390,"type":"custom","difficulte":"2"}
-{"_id":"ectoparasitose-infectio-ac2821","context":null,"enonce":"What is the treatment of human scabies?","item":"ectoparasitose","matiere":"infectio","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Oral corticosteroid 14 days"},{"correct":false,"justification":"False","idx":1,"proposition":"Dermocorticoids 21 days"},{"correct":true,"justification":"True","idx":2,"proposition":"Ivermectin taken once, twice, 7 days apart"},{"correct":false,"justification":"Twice because is not active on eggs ","idx":3,"proposition":"Ivermectin as a single dose once"},{"correct":true,"justification":"True, body brushing, leave to act for 24 hours. To be carried out a second time at 2 or 7 days interval. ","idx":4,"proposition":"Benzyl benzoate"}],"ts":1627661866,"type":"custom","difficulte":"2"}
-{"_id":"antiinf-infectio-ae310c","context":null,"enonce":"What is the treatment of choice for a methicillin-sensitive Staphylococcus aureus?","item":"antiinf","matiere":"infectio","propositions":[{"correct":false,"justification":"Poor oral bioavailability (oxacillin, 40%; cloxacillin, \r\n70%), saturable digestive absorption. Became obsolete in France!! ","idx":0,"proposition":"oxacillin orally"},{"correct":true,"justification":"True, it is the smallest 👌 spectrum And the one that acts the fastest. Important in severe situations, e.g. endocarditis! ","idx":1,"proposition":"oxacillin IV"},{"correct":false,"justification":"All these antibiotics have SAMS in their spectrum, but oxacillin IV has the smallest spectrum and is therefore indicated as a first-line treatment. The possible alternative is cefazolin (C1G).","idx":2,"proposition":"Vancomycin "},{"correct":false,"justification":"Spectrum too broad","idx":3,"proposition":"amoxicillin-clavulanic acid"},{"correct":false,"justification":"Works but is not the ATB of choice. Can be used in relay of oxa IV in combination with another PO antibiotic. ","idx":4,"proposition":"fluoroquinolone"}],"ts":1627682449,"type":"custom","difficulte":"1"}
-{"_id":"nvxne-gyn-ae543c","context":null,"enonce":"Which of the following are risk factors for poor adaptation to ectopic life?","item":"nvxne","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Caesarean section"},{"correct":true,"justification":"True","idx":1,"proposition":"Plunger"},{"correct":true,"justification":"True","idx":2,"proposition":"Forceps"},{"correct":true,"justification":"True","idx":3,"proposition":"Maternal anasarcus"},{"correct":true,"justification":"True","idx":4,"proposition":"Very fast work"}],"ts":1625394200,"type":"custom","difficulte":"2"}
-{"_id":"pancreatiteaigue-HGE-b0a7a8","context":null,"enonce":"What is the overall mortality rate from acute pancreatitis?","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"1%"},{"correct":true,"justification":"Overall mortality rate, it can reach 20% for the necrotizing form","idx":1,"proposition":"5%"},{"correct":false,"justification":"","idx":2,"proposition":"10%"},{"correct":false,"justification":"","idx":3,"proposition":"20%"},{"correct":false,"justification":"","idx":4,"proposition":"30%"}],"ts":1621625179,"type":"custom","difficulte":"1"}
-{"_id":"pancreatiteaigue-HGE-b0f705","context":null,"enonce":"True or False: In acute pancreatitis, there is a linear correlation between the rate of lipasemia and the severity of pancreatitis","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"True"},{"correct":false,"justification":"There is no correlation between the rate of lipasemia and the severity of pancreatitis.","idx":1,"proposition":"False"},{"correct":false,"justification":"","idx":2,"proposition":""},{"correct":false,"justification":"","idx":3,"proposition":""},{"correct":false,"justification":"","idx":4,"proposition":""}],"ts":1621625197,"type":"custom","difficulte":"1"}
-{"_id":"sterilite-endoc-b1187a","context":null,"enonce":"Regarding the epidemiology of infertility. Which of the following propositions, which one or which are true?","item":"sterilite","matiere":"endoc","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"40% of infertility is mixed"},{"correct":true,"justification":"True. 20% male alone, 40% mixed cause. ","idx":1,"proposition":"At least 50% of infertility has a male origin"},{"correct":true,"justification":"True","idx":2,"proposition":"20% of infertility is purely female"},{"correct":false,"justification":"False. 5% of couples are infertile","idx":3,"proposition":"5% of couples are infertile"},{"correct":true,"justification":"True. 1\/5 in the College of Gynecology, 1\/7 in the College of Endocrinology","idx":4,"proposition":"1 in 5 to 7 couples are infertile"}],"ts":1628790243,"type":"custom","difficulte":"2"}
-{"_id":"nvxne-gyn-b1af50","context":null,"enonce":"Which of the following are true for congenital adrenal hyperplasia?","item":"nvxne","matiere":"gyn","propositions":[{"correct":false,"justification":"72h of life, up to 5d of life","idx":0,"proposition":"She is screened at 48 hours of life by the Guthrie test"},{"correct":true,"justification":"True","idx":1,"proposition":"The main deficient enzyme is 21-hydroxylase "},{"correct":true,"justification":"True","idx":2,"proposition":"It is autosomal recessive"},{"correct":true,"justification":"True, which causes adrenal hyperplasia","idx":3,"proposition":"Increased secretion of pituitary ACTH is observed"},{"correct":false,"justification":"50 births per year in France. It is very rare. Reminder: the threshold of rare disease is 1\/2000","idx":4,"proposition":"The incidence is 1\/1500"}],"ts":1625394152,"type":"custom","difficulte":"3"}
-{"_id":"pancreatiteaigue-HGE-b207b8","context":null,"enonce":"What CRP threshold directs to severe pancreatitis?","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"CRP >15 mg\/L"},{"correct":false,"justification":"","idx":1,"proposition":"CRP >50 mg\/L"},{"correct":true,"justification":"True","idx":2,"proposition":"CRP >150 mg\/L"},{"correct":false,"justification":"","idx":3,"proposition":"CRP >150 g\/L"},{"correct":false,"justification":"","idx":4,"proposition":"CRP >300 mg\/L"}],"ts":1622048759,"type":"custom","difficulte":"1"}
-{"_id":"diarrheeinf-infectio-b25903","context":null,"enonce":"Which of the following proposals is\/are germ(s) with a secretory mechanism?","item":"diarrheeinf","matiere":"infectio","propositions":[{"correct":false,"justification":"False it has an entero-invasive mechanism, it is E. coli enteroaggregative and E. coli enterotoxigenic which have a secretory mechanism. They are at the origin of TIAC and traveler's diarrhea, turista! ","idx":0,"proposition":"Enteropathogenic E. coli"},{"correct":false,"justification":"Enteroinvasive mechanism","idx":1,"proposition":"Shigella"},{"correct":false,"justification":"Enteroinvasive mechanism","idx":2,"proposition":"Yersinia"},{"correct":false,"justification":"Enteroinvasive mechanism","idx":3,"proposition":"Salmonella"},{"correct":true,"justification":"True, especially aureus which is a toxi infection. Secretory ➡ mechanism fluid diarrhea without fever","idx":4,"proposition":"Sstaphylococcus"}],"ts":1627682721,"type":"custom","difficulte":"2"}
-{"_id":"infdermato-dermato-b51a3a","context":null,"enonce":"Which of the following are true about Candida albicans infections?","item":"infdermato","matiere":"dermato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Candida are mushrooms 🍄 "},{"correct":true,"justification":"True","idx":1,"proposition":"Candida belong to yeasts"},{"correct":false,"justification":"Unicellular","idx":2,"proposition":"Candida are multicellular"},{"correct":true,"justification":"True","idx":3,"proposition":"Candida albicans is never found on healthy skin"},{"correct":true,"justification":"True","idx":4,"proposition":"Candida may cause sepsis in immunocompromised patients"}],"ts":1625860669,"type":"custom","difficulte":"2"}
-{"_id":"AV--ophtalmo-b54787","context":null,"enonce":"Which of the following proposals are validated for the treatment of early forms of AMD? (AREDS-2 study, 2013)","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True, with zeaxantin, lutein, vitamin E and C","idx":0,"proposition":"Zinc"},{"correct":false,"justification":"Vitamin E and C","idx":1,"proposition":"Vitamin A"},{"correct":true,"justification":"True","idx":2,"proposition":"Lutein"},{"correct":false,"justification":"No studies showed a difference in outcome versus placebo","idx":3,"proposition":"Homeopathy"},{"correct":false,"justification":"No reduction in risk of progression","idx":4,"proposition":"Omega-3"}],"ts":1626279575,"type":"custom","difficulte":"2"}
-{"_id":"pancreatiteaigue-HGE-b87b8b","context":null,"enonce":"Renal failure is observed in ....... of cases ","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"5%"},{"correct":false,"justification":"","idx":1,"proposition":"10%"},{"correct":true,"justification":"Renal failure is observed in about 20% of cases, it is a pejorative prognostic factor","idx":2,"proposition":"20%"},{"correct":false,"justification":"","idx":3,"proposition":"50%"},{"correct":false,"justification":"","idx":4,"proposition":"80%"}],"ts":1621625193,"type":"custom","difficulte":"1"}
-{"_id":"vaccin-infectio-b8d2b1","context":null,"enonce":"At what ages is the dTP vaccine injected?","item":"vaccin","matiere":"infectio","propositions":[{"correct":false,"justification":"No vaccine at birth","idx":0,"proposition":"Birth"},{"correct":true,"justification":"True. 1st dose","idx":1,"proposition":"2 months"},{"correct":true,"justification":"True. 2nd dose","idx":2,"proposition":"4 months"},{"correct":true,"justification":"True. Reminder","idx":3,"proposition":"11 months"},{"correct":false,"justification":"No vaccine is recommended at 6 months (5 months = Meningococcal C)","idx":4,"proposition":"6 months"}],"ts":1627726067,"type":"custom","difficulte":"2"}
-{"_id":"tbvisionbrutal-ophtalmo-b93097","context":null,"enonce":"Which of the following are causes of brutal white eye and painless BAV?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Red and painful eye","idx":0,"proposition":"Acute anterior uveitis"},{"correct":true,"justification":"True, attention MS. NORB is painless in 20% of cases.","idx":1,"proposition":"Retrobulbar optic neuritis (NORB) in 20% of cases"},{"correct":false,"justification":"Red and painful eye (on intraocular hypertension)","idx":2,"proposition":"Neovascular glaucoma"},{"correct":true,"justification":"True","idx":3,"proposition":"Retinal detachment"},{"correct":true,"justification":"True","idx":4,"proposition":"Acute anterior ischemic optic neuropathy (AIO-A)"}],"ts":1626279288,"type":"custom","difficulte":"2"}
-{"_id":"AV--ophtalmo-bc2834","context":null,"enonce":"Which of the following are cataract etiologies?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Strong myopia","idx":0,"proposition":"Strong hyperopia"},{"correct":true,"justification":"True, especially posterior uveitis requiring prolonged corticosteroid therapy","idx":1,"proposition":"Chronic uveitis"},{"correct":true,"justification":"True","idx":2,"proposition":"Down syndrome"},{"correct":true,"justification":"True","idx":3,"proposition":"Eye surgery"},{"correct":false,"justification":"False","idx":4,"proposition":"Scleritis"}],"ts":1626279226,"type":"custom","difficulte":"2"}
-{"_id":"tbvisionbrutal-ophtalmo-bccbee","context":null,"enonce":"Which of the following are bilateral etiologies of decreased visual acuity most often?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Unilateral","idx":0,"proposition":"Central retinal artery occlusion"},{"correct":false,"justification":"Unilateral","idx":1,"proposition":"Acute anterior ischemic optic neuropathy"},{"correct":false,"justification":"Unilateral","idx":2,"proposition":"Retrobulbar ocular neuropathy"},{"correct":true,"justification":"True","idx":3,"proposition":"AMD"},{"correct":true,"justification":"True","idx":4,"proposition":"STROKE"}],"ts":1626111732,"type":"custom","difficulte":"2"}
-{"_id":"IUgrossesse-infectio-beb943","context":null,"enonce":"What is the first-line treatment for urinary colonization of pregnancy in case of germ sensitivity?","item":"IUgrossesse","matiere":"infectio","propositions":[{"correct":false,"justification":"3rd line treatment. Avoid during the first two months of pregnancy (embryonic phase)","idx":0,"proposition":"Fosfomycin-Trometamol single dose"},{"correct":true,"justification":"True","idx":1,"proposition":"Amoxicillin for 7 days"},{"correct":false,"justification":"5th line treatment","idx":2,"proposition":"Amoxicillin-Clavulanic Acid for 7 days"},{"correct":false,"justification":"2nd line treatment","idx":3,"proposition":"Pivmecillinam for 7 days"},{"correct":false,"justification":"5th line treatment","idx":4,"proposition":"Nitrofurantoin for 7 days"}],"ts":1627726202,"type":"custom","difficulte":"2"}
-{"_id":"nutrigrossesse-endoc-c26cde","context":null,"enonce":"Which of the following are recommended supplements for pregnant women?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"correct":true,"justification":"True. Folic acid 0.4 mg\/day in all women (increased dosage in case of history of spina bifida or epilepsy)","idx":0,"proposition":"Vitamin B9 in the periconception period"},{"correct":true,"justification":"True. 100,000 IU single dose","idx":1,"proposition":"Vitamin D in the third trimester"},{"correct":false,"justification":"Only in late pregnancy, if taking medication that interferes with vitamin K metabolism","idx":2,"proposition":"Vitamin K in the first trimester"},{"correct":false,"justification":"False, unless there is a deficiency","idx":3,"proposition":"Iron "},{"correct":false,"justification":"False, unless there is a risk of deficiency","idx":4,"proposition":"Iodine"}],"ts":1628790262,"type":"custom","difficulte":"2"}
-{"_id":"tbvisionbrutal-ophtalmo-c3335f","context":null,"enonce":"Ultrasound in mode B conventionally allows to show:","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Intravitreal hemorrhage"},{"correct":false,"justification":"OCT","idx":1,"proposition":"Macular edema"},{"correct":true,"justification":"True","idx":2,"proposition":"Retinal detachment"},{"correct":false,"justification":"False","idx":3,"proposition":"A NOIAA"},{"correct":false,"justification":"Gonioscopy","idx":4,"proposition":"A closure of the iridocorneal angle"}],"ts":1626279167,"type":"custom","difficulte":"2"}
-{"_id":"prothese-urg-c54f8c","context":null,"enonce":"Osteosynthesis:","item":"prothese","matiere":"urg","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Accelerates consolidation"},{"correct":true,"justification":"True","idx":1,"proposition":"Enables faster mobilization"},{"correct":true,"justification":"True","idx":2,"proposition":"Increases functional recovery"},{"correct":true,"justification":"True, centro-medullary nailing for example","idx":3,"proposition":"Can be done in a closed home"},{"correct":true,"justification":"True, the plates","idx":4,"proposition":"Can be done with an open fireplace"}],"ts":1626004794,"type":"custom","difficulte":"1"}
-{"_id":"nutrigrossesse-endoc-c585f4","context":null,"enonce":"Which of the following are recommended vitamins for any woman in periconception and during pregnancy?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"correct":false,"justification":"False. It is teratogenic!","idx":0,"proposition":"Vitamin A"},{"correct":true,"justification":"True","idx":1,"proposition":"Vitamin B9"},{"correct":false,"justification":"Not especially","idx":2,"proposition":"Vitamin C"},{"correct":true,"justification":"True","idx":3,"proposition":"Vitamin d"},{"correct":false,"justification":"Only in case of treatment interfering with vitamin K metabolism","idx":4,"proposition":"Vitamin k"}],"ts":1626084047,"type":"custom","difficulte":"2"}
-{"_id":"prothese-urg-c79452","context":null,"enonce":"Which of the following propositions are true regarding prosthesis wear?","item":"prothese","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is inevitable"},{"correct":true,"justification":"True","idx":1,"proposition":"It can accompany\/cause a loosening of prosthesis "},{"correct":false,"justification":"Mechanics","idx":2,"proposition":"The pain caused is inflammatory"},{"correct":false,"justification":"Macrophages","idx":3,"proposition":"It is linked to lymphocytes"},{"correct":false,"justification":"Treatment = change of prosthesis","idx":4,"proposition":"Treatment is functional most often"}],"ts":1626004792,"type":"custom","difficulte":"1"}
-{"_id":"glaucomechr-ophtalmo-c7f59d","context":null,"enonce":"Which of the following are true?","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Beta-blocker eye drops decrease the secretion of aqueous humor"},{"correct":false,"justification":"Increase resorption","idx":1,"proposition":"Prostaglandin eye drops decrease aqueous humor secretion"},{"correct":true,"justification":"True","idx":2,"proposition":"Alpha 2-adrenergic agonist eye drops decrease aqueous humor secretion"},{"correct":false,"justification":"CI of eye drops also (systemic passage)","idx":3,"proposition":"COPD contraindicates subcutaneous beta-blockers only"},{"correct":true,"justification":"True. 2nd intention = laser trabeculoplasty (modest effect). 3rd line = filtering surgery","idx":4,"proposition":"Medical treatment is offered as a first-line treatment"}],"ts":1626279261,"type":"custom","difficulte":"2"}
-{"_id":"puberte-gyn-c86fea","context":null,"enonce":"Which of the following are true?","item":"puberte","matiere":"gyn","propositions":[{"correct":true,"justification":"True. And this bone age corresponds to the appearance of sesamoid on X-rays of the hand and wrist.","idx":0,"proposition":"Puberty occurs at a bone age of 11 years in girls and 13 years in boys."},{"correct":true,"justification":"True","idx":1,"proposition":"Impubertism is pathological if the X-ray of the child's hand and wrist shows a sesamoid bone."},{"correct":false,"justification":"False. This is for peripheral pubertal delays because we look for ++ the Klinefelter in boys and the Turner in girls which are causes of peripheral pubertal delay.","idx":2,"proposition":"The karyotype is to be done in case of suspicion of peripheral precocious puberty as well as peripheral pubertal delay."},{"correct":true,"justification":"True","idx":3,"proposition":"Undernutrition can be the cause of delayed puberty."},{"correct":true,"justification":"True","idx":4,"proposition":"The association of delayed puberty and bilateral cryptorchidism excludes the diagnosis of simple pubertal delay."}],"ts":1625394184,"type":"custom","difficulte":"1"}
-{"_id":"tbrefraction-ophtalmo-c8c56d","context":null,"enonce":"Which of the following is used to measure visual acuity from afar?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Monoyer"},{"correct":false,"justification":"Near visual acuity (33 cm)","idx":1,"proposition":"Parinaud"},{"correct":false,"justification":"Classification of PAD","idx":2,"proposition":"Leriche and Fontaine"},{"correct":false,"justification":"Classification of genital prolapse","idx":3,"proposition":"Baden-Walker"},{"correct":false,"justification":"Classification of mitral leakage mechanisms","idx":4,"proposition":"Carpentier"}],"ts":1626111660,"type":"custom","difficulte":"3"}
-{"_id":"pancreatiteaigue-HGE-cc6a76","context":null,"enonce":"What pathogens can cause acute pancreatitis?","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"Mumps"},{"correct":false,"justification":"rather HBV","idx":1,"proposition":"Hepatitis C"},{"correct":false,"justification":"rather HBV","idx":2,"proposition":"Hepatitis A "},{"correct":true,"justification":"","idx":3,"proposition":"Coxsackie"},{"correct":true,"justification":"","idx":4,"proposition":"HIV"}],"ts":1622048762,"type":"custom","difficulte":"1"}
-{"_id":"tbrefraction-ophtalmo-d06a57","context":null,"enonce":"Which of the following are possible indications for laser surgery?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Low myopia"},{"correct":true,"justification":"True","idx":1,"proposition":"Strong myopia"},{"correct":true,"justification":"True","idx":2,"proposition":"Farsightedness"},{"correct":true,"justification":"True","idx":3,"proposition":"Astigmatism"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"ts":1626279072,"type":"custom","difficulte":"2"}
-{"_id":"ascite-HGE-d4aef9","context":null,"enonce":"Which of the following are transudative ascites etiologies?","item":"ascite","matiere":"HGE","propositions":[{"correct":false,"justification":"Exudative","idx":0,"proposition":"Right heart failure"},{"correct":true,"justification":"True","idx":1,"proposition":"Hepatic cirrhosis"},{"correct":true,"justification":"True","idx":2,"proposition":"Renal failure"},{"correct":true,"justification":"True","idx":3,"proposition":"Anasarca"},{"correct":true,"justification":"True","idx":4,"proposition":"Hypoalbuminemia"}],"ts":1627327440,"type":"custom","difficulte":"1"}
-{"_id":"MSN-urg-d4f89e","context":null,"enonce":"Which of the following are true in the event of unexpected infant death?","item":"MSN","matiere":"urg","propositions":[{"correct":false,"justification":"There is a systematic assessment to be carried out (HAS 2009)","idx":0,"proposition":"No assessment is systematic"},{"correct":false,"justification":"No, but it is always offered to parents","idx":1,"proposition":"The autopsy is systematic"},{"correct":true,"justification":"True, the prosecutor","idx":2,"proposition":"A suspicious death must lead the doctor to notify the judicial authorities"},{"correct":true,"justification":"True","idx":3,"proposition":"The examination of the child should look for suspicious lesions"},{"correct":true,"justification":"True ","idx":4,"proposition":"If the parents object to the transfer of the body to a referral centre, the doctor must tick the box \"medico-legal obstacle\" "}],"ts":1628004590,"type":"custom","difficulte":"2"}
-{"_id":"KcVADS-onco-d5e4db","context":null,"enonce":"Which of the following are white precancerous lesions?","item":"KcVADS","matiere":"onco","propositions":[{"correct":false,"justification":"It is a red 🚨 mucosal lesion","idx":0,"proposition":"Erythroplasty of Queyrat"},{"correct":true,"justification":"True","idx":1,"proposition":"Leukoplakia"},{"correct":false,"justification":"Not a precancerous 😮 lesion","idx":2,"proposition":"Undifferentiated carcinoma"},{"correct":true,"justification":"True, white reticulate lesion","idx":3,"proposition":"Oral lichen"},{"correct":true,"justification":"True","idx":4,"proposition":"Fluid oral papillomatosis"}],"ts":1621182362,"type":"custom","difficulte":"1"}
-{"_id":"prothese-urg-d66608","context":null,"enonce":"Which of the following are risk factors for prosthesis infection?","item":"prothese","matiere":"urg","propositions":[{"correct":false,"justification":"Rheumatoid arthritis","idx":0,"proposition":"Arthrosis"},{"correct":false,"justification":"High ASA","idx":1,"proposition":"ASA 1"},{"correct":false,"justification":"Active smoking","idx":2,"proposition":"Passive smoking"},{"correct":true,"justification":"True (BMI > 40)","idx":3,"proposition":"BMI > 45"},{"correct":true,"justification":"True","idx":4,"proposition":"Long delay between fracture and operation"}],"ts":1626004785,"type":"custom","difficulte":"1"}
-{"_id":"pancreatiteaigue-HGE-d88ceb","context":null,"enonce":"What does the very high elevation of lipase in pleural or peritoneal fluids mean to you?\r\n","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"Crohn's disease"},{"correct":false,"justification":"","idx":1,"proposition":"Ulcerative colitis"},{"correct":false,"justification":"","idx":2,"proposition":"Infection à CMV"},{"correct":false,"justification":"","idx":3,"proposition":"Chronic pancreatitis"},{"correct":true,"justification":"","idx":4,"proposition":"Chronic fistula"}],"ts":1621625195,"type":"custom","difficulte":"1"}
-{"_id":"suivinourisson-ophtalmo-d8f953","context":null,"enonce":"Screening for deafness in infants is done by:","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Too young to answer 😋 you","idx":0,"proposition":"audiometry"},{"correct":false,"justification":"False","idx":1,"proposition":"The study of the stapedial reflex"},{"correct":true,"justification":"True","idx":2,"proposition":"Oto-acoustic emissions"},{"correct":true,"justification":"True","idx":3,"proposition":"Automated auditory evoked potentials"},{"correct":true,"justification":"True","idx":4,"proposition":"This screening is mandatory"}],"ts":1626111650,"type":"custom","difficulte":"2"}
-{"_id":"anaphylaxie-urg-d9b85d","context":null,"enonce":"Which of the following are true for angioedema?","item":"anaphylaxie","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"He is firm"},{"correct":false,"justification":"No or slightly itchy, unlike urticaria","idx":1,"proposition":"It is very itchy"},{"correct":true,"justification":"True","idx":2,"proposition":"It is non-erythematosus"},{"correct":true,"justification":"True","idx":3,"proposition":"It is poorly limited"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"ts":1622316500,"type":"custom","difficulte":"2"}
-{"_id":"prurit-dermato-da498b","context":null,"enonce":"Which of the following are causes of pruritus sine materia?","item":"prurit","matiere":"dermato","propositions":[{"correct":false,"justification":"Hepatic cholestasis","idx":0,"proposition":"Hepatic cytolysis"},{"correct":false,"justification":"Chronic renal failure","idx":1,"proposition":"Acute renal failure"},{"correct":true,"justification":"True, cutaneous T-cell lymphoma in >50 years","idx":2,"proposition":"Syndrome de Sézary"},{"correct":true,"justification":"True","idx":3,"proposition":"Polycythemia vera"},{"correct":true,"justification":"True, as well as Graves' disease","idx":4,"proposition":"Hypothyroidism"}],"ts":1625860710,"type":"custom","difficulte":"2"}
-{"_id":"anesth-anesth-dc86cc","context":null,"enonce":"Which of the following are true?","item":"anesth","matiere":"anesth","propositions":[{"correct":true,"justification":"True. = Recovery room. Part of the legal obligations with the pre-anesthetic consultation (if scheduled) and the visit. ","idx":0,"proposition":"After surgery, there is a mandatory passage in SSPI (post-interventional monitoring room)"},{"correct":false,"justification":"False. The only exception is the course of a morphine titration: it takes 1 hour of minimum monitoring after the last bolus","idx":1,"proposition":"No minimum monitoring time in IPPS is recommended"},{"correct":true,"justification":"True","idx":2,"proposition":"During morphine titration, there is a monitoring of one hour after the last bolus"},{"correct":false,"justification":"False. 30 minutes BEFORE the incision. As a reminder, antibiotic prophylaxis is administered according to the Altemeier classification. ","idx":3,"proposition":"If there is an indication of antibiotic prophylaxis to cover the surgical procedure, it will be administered 30 minutes after the incision"},{"correct":false,"justification":"False","idx":4,"proposition":"A curare is always essential during the maintenance phase of general anesthesia"}],"ts":1628767879,"type":"custom","difficulte":"2"}
-{"_id":"tbvisionbrutal-ophtalmo-dd3adf","context":null,"enonce":"Which of the following are signs of CRVO at the fundus?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Retinal hemorrhage in flames"},{"correct":true,"justification":"True","idx":1,"proposition":"Retinal hemorrhage in spots"},{"correct":true,"justification":"True","idx":2,"proposition":"Cottony nodules"},{"correct":true,"justification":"True","idx":3,"proposition":"Papillary edema"},{"correct":true,"justification":"True","idx":4,"proposition":"Tortuosity of retinal veins"}],"ts":1626279279,"type":"custom","difficulte":"2"}
-{"_id":"antithrombotiques-therapeutique-dd6669","context":null,"enonce":"The amount of topical corticosteroids on the phalangette of the index finger may cover:","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"A palm of a hand"},{"correct":true,"justification":"True, the phalangette unit of an adult is enough cream to treat the surface of both palms.","idx":1,"proposition":"Two palms"},{"correct":false,"justification":"False","idx":2,"proposition":"Three palms"},{"correct":false,"justification":"False","idx":3,"proposition":"Four palms"},{"correct":false,"justification":"False","idx":4,"proposition":"Five palms"}],"ts":1629730444,"type":"custom","difficulte":"2"}
-{"_id":"tbvisionbrutal-ophtalmo-e015dc","context":null,"enonce":"Which of the following are etiologies of brutal white-eyed and painless BAV?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Central retinal vein occlusion"},{"correct":true,"justification":"True","idx":1,"proposition":"Central retinal artery occlusion"},{"correct":false,"justification":"Painful","idx":2,"proposition":"Angle closure glaucoma"},{"correct":true,"justification":"True","idx":3,"proposition":"Retinal detachment"},{"correct":true,"justification":"True","idx":4,"proposition":"Intravitreal hemorrhage"}],"ts":1626279549,"type":"custom","difficulte":"2"}
-{"_id":"tbrefraction-ophtalmo-e0b3a5","context":null,"enonce":"Which of the following are spherical ametropias?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Myopia"},{"correct":true,"justification":"True","idx":1,"proposition":"Farsightedness"},{"correct":false,"justification":"Non-spherical","idx":2,"proposition":"Astigmatism"},{"correct":false,"justification":"Not an ametropia","idx":3,"proposition":"Chronic glaucoma"},{"correct":false,"justification":"Not an ametropia","idx":4,"proposition":"Keratitis"}],"ts":1626279292,"type":"custom","difficulte":"1"}
-{"_id":"antithrombotiques-therapeutique-e63a3d","context":null,"enonce":"The amount of topical corticosteroids on the phalangette of the index finger corresponds to:","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"0.5 g"},{"correct":false,"justification":"False","idx":1,"proposition":"1 g"},{"correct":true,"justification":"True","idx":2,"proposition":"1.25 g"},{"correct":false,"justification":"False","idx":3,"proposition":"2 g"},{"correct":false,"justification":"False","idx":4,"proposition":"2.5 g"}],"ts":1629730815,"type":"custom","difficulte":"2"}
-{"_id":"vaccin-infectio-e6d0d0","context":null,"enonce":"At 3 months, which vaccines are mandatory?","item":"vaccin","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"whooping cough"},{"correct":true,"justification":"True","idx":1,"proposition":"diphtheria"},{"correct":true,"justification":"True","idx":2,"proposition":"poliomyelitis"},{"correct":true,"justification":"True","idx":3,"proposition":"pneumococcus"},{"correct":true,"justification":"True","idx":4,"proposition":"Haemophilius"}],"ts":1627660491,"type":"custom","difficulte":"2"}
-{"_id":"allergie-infectio-e947b8","context":null,"enonce":"Which of the following are atopic diseases?","item":"allergie","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Atopic dermatitis"},{"correct":false,"justification":"The so-called atopic diseases are: atopic dermatitis, allergic asthma, IgE-mediated food allergy and allergic rhinoconjunctivitis. (College of Pediatrics 2021)","idx":1,"proposition":"Autoimmune dermatosis"},{"correct":false,"justification":"False","idx":2,"proposition":"Bullous pemphigoid"},{"correct":true,"justification":"True","idx":3,"proposition":"Allergic asthma"},{"correct":true,"justification":"True","idx":4,"proposition":"Allergic rhinoconjunctivitis"}],"ts":1627721120,"type":"custom","difficulte":"2"}
-{"_id":"ascite-HGE-eb15da","context":null,"enonce":"Which of the following are common etiologies of ascites?","item":"ascite","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Hepatocellular carcinoma"},{"correct":false,"justification":"Rather straight (we are in the frequent causes)","idx":1,"proposition":"Left heart failure"},{"correct":true,"justification":"True","idx":2,"proposition":"Hepatic cirrhosis"},{"correct":false,"justification":"😋","idx":3,"proposition":"All propositions are true"},{"correct":false,"justification":"Hepatorenal syndrome may be a consequence of ascites","idx":4,"proposition":"Acute renal failure"}],"ts":1627327468,"type":"custom","difficulte":"1"}
-{"_id":"hemangiome-dermato-ec2383","context":null,"enonce":"Which of the following are true?","item":"hemangiome","matiere":"dermato","propositions":[{"correct":true,"justification":"True ","idx":0,"proposition":"Vascular tumors, most often capillaries, are characterized by proliferation of endothelial cells and mainly represented by hemangiomas of the infant"},{"correct":true,"justification":"True ","idx":1,"proposition":"In vascular malformations, endothelial cells are quiescent and may involve blood capillaries, veins, arteriovenous communications or lymphatic vessels."},{"correct":true,"justification":"true ","idx":2,"proposition":"Hemangiomas are benign endothelial cell proliferations that are more common in girls, premature infants and low birth weight infants"},{"correct":true,"justification":"True, superficial forms are willingly more nipple, and in relief than deep hemangiomas ","idx":3,"proposition":"The deep forms of the hemangioma are more elastic in consistency than the superficial forms  "},{"correct":false,"justification":"False, these are hemangiomas and AVMs that are fast flowing. Vascular malformations such as venous angiomas, lymphangiomas or planar angiomas are slow flow","idx":4,"proposition":"All vascular malformation Doppler ultrasounds show a richly vascularized fast-flow lesion"}],"ts":1625860696,"type":"custom","difficulte":"2"}
-{"_id":"vaccin-infectio-eece83","context":null,"enonce":"What vaccinations are mandatory at 2 months?","item":"vaccin","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Dtp"},{"correct":true,"justification":"True","idx":1,"proposition":"Haemophilius influenzae"},{"correct":true,"justification":"True","idx":2,"proposition":"Whooping cough"},{"correct":true,"justification":"True","idx":3,"proposition":"Hepatitis B"},{"correct":true,"justification":"True","idx":4,"proposition":"Pneumococcus"}],"ts":1627720994,"type":"custom","difficulte":"2"}
-{"_id":"AV--ophtalmo-ef0f30","context":null,"enonce":"Which of the following proposals are part of the previous segment?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Iris"},{"correct":true,"justification":"True","idx":1,"proposition":"Crystalline"},{"correct":true,"justification":"True","idx":2,"proposition":"Zonum"},{"correct":true,"justification":"True","idx":3,"proposition":"Ciliary body"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"ts":1626111745,"type":"custom","difficulte":"2"}
-{"_id":"angine-infectio-efe6e4","context":null,"enonce":"Which of the following are causes of tonsillar ulcer?","item":"angine","matiere":"infectio","propositions":[{"correct":false,"justification":"The cavum is the nasopharynx ","idx":0,"proposition":"Cavum tumour"},{"correct":true,"justification":"True","idx":1,"proposition":"Agranulocytosis"},{"correct":false,"justification":"Diphtheria is responsible for pseudomembranous angina ","idx":2,"proposition":"Diphtheria"},{"correct":true,"justification":"True","idx":3,"proposition":"Vincent's angina"},{"correct":true,"justification":"True","idx":4,"proposition":"Syphilis"}],"ts":1627726191,"type":"custom","difficulte":"2"}
-{"_id":"parasitedig-infectio-f151f1","context":null,"enonce":"Which of the following proposals are parasitosis found in metropolitan France?","item":"parasitedig","matiere":"infectio","propositions":[{"correct":false,"justification":"It is present in tropical and subtropical areas: in Africa, South America, Asia and the Mediterranean basin. (Wikipedia) Corsican!! ","idx":0,"proposition":"Bilharzia"},{"correct":false,"justification":"They are present in Africa, Asia, and the Pacific, in tropical areas (more rarely in America)","idx":1,"proposition":"Filariasis"},{"correct":true,"justification":"True","idx":2,"proposition":"Oxyurosis"},{"correct":true,"justification":"True","idx":3,"proposition":"Distomatosis"},{"correct":true,"justification":"True","idx":4,"proposition":"Taenia"}],"ts":1627682302,"type":"custom","difficulte":"2"}
-{"_id":"prothese-urg-f767b7","context":null,"enonce":"From what date is a prosthesis infection considered chronic?","item":"prothese","matiere":"urg","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"7 days"},{"correct":false,"justification":"","idx":1,"proposition":"2 weeks"},{"correct":true,"justification":"True, below = acute. Above = chronic.","idx":2,"proposition":"1 month"},{"correct":false,"justification":"","idx":3,"proposition":"6 months"},{"correct":false,"justification":"Time for nosocomial infection","idx":4,"proposition":"1 year"}],"ts":1626004789,"type":"custom","difficulte":"1"}
-{"_id":"angine-infectio-f77746","context":null,"enonce":"What is the antibiotic therapy to be implemented in case of erythematopultaceous angina with RDT positive, in case of true allergy to beta-lactams?","item":"angine","matiere":"infectio","propositions":[{"correct":false,"justification":"Allergy","idx":0,"proposition":"Amoxicillin"},{"correct":false,"justification":"Allergy to amoxicillin. No indication of this association in tonsillitis (SBHA sensitive to amoxicillin alone)","idx":1,"proposition":"Amoxicillin-clavulanic acid"},{"correct":false,"justification":"Allergy","idx":2,"proposition":"C2G"},{"correct":true,"justification":"True. 3rd intention, if allergy to beta-lactam (<10% resistance)","idx":3,"proposition":"Macrolides"},{"correct":false,"justification":"No indication","idx":4,"proposition":"Glycopeptides"}],"ts":1627721070,"type":"custom","difficulte":"2"}
-{"_id":"glaucomechr-ophtalmo-f89c78","context":null,"enonce":"Which of the following proposals are fundus abnormalities in CAPM?","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Greater than 0.2","idx":0,"proposition":"Cup\/disc ratio less than 0.2 between the 2 eyes"},{"correct":true,"justification":"True","idx":1,"proposition":"Papillary excavation"},{"correct":true,"justification":"True","idx":2,"proposition":"Haemorrhages in flames"},{"correct":false,"justification":"False","idx":3,"proposition":"Dry exudates"},{"correct":false,"justification":"Excavation","idx":4,"proposition":"Papillary edema"}],"ts":1626279567,"type":"custom","difficulte":"2"}
-{"_id":"IUgrossesse-infectio-f9bc55","context":null,"enonce":"Which of the following propositions are true regarding urinary colonization?","item":"IUgrossesse","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"In the general population, screening for urinary colonization of pregnancy is performed by BU."},{"correct":true,"justification":"True ","idx":1,"proposition":"If the BU is positive (leukocytes or nitrites positive), confirmation by ECBU is required."},{"correct":false,"justification":"Not in women for atypical enterobacteriaceae (other than E. coli or enterococci) according to Pilly 2020","idx":2,"proposition":"ECBU is always positive when bacteuria is greater than 10^3 CFU"},{"correct":false,"justification":"ECBU and susceptibility testing are not treated","idx":3,"proposition":"In case of positive BU, treated with 1g of Amoxicillin three times a day for 7 days without ECBU"},{"correct":false,"justification":"ECBU and susceptibility testing are not treated","idx":4,"proposition":"In case of positive BU, treated with 3g in a single dose of Fosfomycin-Trometamol without ECBU"}],"ts":1627720817,"type":"custom","difficulte":"2"}
-{"_id":"SPSC-sp-fba1cc","context":null,"enonce":"Which of the following propositions are true with respect to the interim placement order?","item":"SPSC","matiere":"sp","propositions":[{"correct":true,"justification":"True, or by the public prosecutor in case of emergency","idx":0,"proposition":"It is pronounced by the juvenile judge"},{"correct":true,"justification":"True","idx":1,"proposition":"It may be pronounced, in urgent cases, by the public prosecutor."},{"correct":false,"justification":"15 days","idx":2,"proposition":"It has an initial validity period of 7 days"},{"correct":false,"justification":"Parental authority retained","idx":3,"proposition":"Parents lose parental authority for the duration of the OPP"},{"correct":true,"justification":"True","idx":4,"proposition":"It concerns minors at risk"}],"ts":1626430533,"type":"custom","difficulte":"1"}
-{"_id":"prurit-dermato-fd9a19","context":null,"enonce":"Which of the following proposals are part of the first-line biological assessment in case of pruritus sine materia?","item":"prurit","matiere":"dermato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"TSH"},{"correct":true,"justification":"True","idx":1,"proposition":"Renal assessment"},{"correct":true,"justification":"True","idx":2,"proposition":"Beta-HCG in women of childbearing potential"},{"correct":false,"justification":"Not in the first intention","idx":3,"proposition":"Immunophenotyping of lymphocytes"},{"correct":false,"justification":"Not in the first intention","idx":4,"proposition":"Blood ionogram"}],"ts":1625860682,"type":"custom","difficulte":"2"}
-{"_id":"tbrefraction-ophtalmo-ff333a","context":null,"enonce":"Which of the following is a non-spherical ametropia?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Spherical","idx":0,"proposition":"Myopia"},{"correct":false,"justification":"Spherical","idx":1,"proposition":"Farsightedness"},{"correct":true,"justification":"True","idx":2,"proposition":"Astigmatism"},{"correct":false,"justification":"Not an ametropia","idx":3,"proposition":"OACR"},{"correct":false,"justification":"Not an ametropia","idx":4,"proposition":"CRVO"}],"ts":1626279065,"type":"custom","difficulte":"1"}
-{"_id":"KcUt-onco-0790d8","context":null,"enonce":"Which of the following are organs whose cancers are associated with Lynch syndrome?","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"Ureter","idx":0,"proposition":"Kidney"},{"correct":true,"justification":"True","idx":1,"proposition":"None of the propositions are true"},{"correct":false,"justification":"False","idx":2,"proposition":"ENT"},{"correct":false,"justification":"False","idx":3,"proposition":"Lung"},{"correct":false,"justification":"Liver","idx":4,"proposition":"Spleen"}],"ts":1629829564,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-12d06c","context":null,"enonce":"An MRI finds an endometrial tumor limited to the uterus, invading no neighborhood structure, infiltrating more than 50% of the myometrium. No lymphadenopathy is visualized\r\n\r\nWhat is the FIGO classification at this stage?","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"<50% of myometrium","idx":0,"proposition":"AI"},{"correct":true,"justification":"True, stage I because limited to the body of the uterus. Stage Ib because invades >50% of the myometrium","idx":1,"proposition":"Ib"},{"correct":false,"justification":"The pass is not invaded","idx":2,"proposition":"II"},{"correct":false,"justification":"The vagina is not invaded","idx":3,"proposition":"IIIb"},{"correct":false,"justification":"No distant metastasis","idx":4,"proposition":"Ivb"}],"ts":1629829684,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-18cf14","context":null,"enonce":"Which of the following proposals is part of the endometrial cancer extension assessment? (except stage III FIGO or histological type II lesion)","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Brain CT"},{"correct":false,"justification":"False","idx":1,"proposition":"Bone scintigraphy"},{"correct":false,"justification":"If Stage III on MRI","idx":2,"proposition":"TAP CT if stage II"},{"correct":true,"justification":"True, systematic and necessary for FIGO classification (invasion of the cervix [stage II]? serous or appendages [stage IIIa? of the vagina [stage IIIb]? etc.) ","idx":3,"proposition":"Pelvic MRI"},{"correct":false,"justification":"False","idx":4,"proposition":"Pelvic CT"}],"ts":1629829775,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-1e6d8d","context":null,"enonce":"Which of the following proposals corresponds to the type(s) of cancer for which follow-up by CTS may be useful?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True. In the College of Gynecology, the only place where SCC (Squamous Cell Carcinoma) is cited is for the follow-up of squamous cell carcinomas of the cervix.","idx":0,"proposition":"Squamous cell carcinoma of the cervix"},{"correct":false,"justification":"False","idx":1,"proposition":"Adenocarcinoma of the cervix"},{"correct":false,"justification":"Uterine fibroid","idx":2,"proposition":"Leiomyoma"},{"correct":false,"justification":"False","idx":3,"proposition":"Endometrial adenocarcinoma"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"ts":1629829409,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-2cafcb","context":null,"enonce":"Which of the following are risk factors for endometrial cancer?","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"Hormone-dependent cancer, so the more hormone, the more risk there is (so early puberty, late menopause, hormonal treatments)","idx":0,"proposition":"Late puberty"},{"correct":true,"justification":"True","idx":1,"proposition":"Polycystic Ovary Syndrome"},{"correct":true,"justification":"True","idx":2,"proposition":"Hormonal treatment of menopause"},{"correct":false,"justification":"Nulliparity","idx":3,"proposition":"Multiparity"},{"correct":true,"justification":"True, BMI > 25","idx":4,"proposition":"Overweight"}],"ts":1629829677,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-2ea88e","context":null,"enonce":"Which of the following are organs whose cancers are associated with Lynch syndrome?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Ovaries"},{"correct":true,"justification":"True","idx":1,"proposition":"Stomach"},{"correct":true,"justification":"True, but extremely rare","idx":2,"proposition":"Brain 🧠 "},{"correct":true,"justification":"True, but rare sebaceous tumors","idx":3,"proposition":"Skin "},{"correct":false,"justification":"Heart cells do not renew, or very little. Therefore, there is almost no heart 😊 cancer","idx":4,"proposition":"Heart 💔 "}],"ts":1629829630,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-307058","context":null,"enonce":"Which of the following are indications for colposcopy?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Cytological abnormalities suggestive of low-grade neoplasia on the smear"},{"correct":true,"justification":"True","idx":1,"proposition":"Cytological abnormalities suggestive of high-grade neoplasia on the smear"},{"correct":true,"justification":"True","idx":2,"proposition":"AUC-H cytological abnormalities on smear"},{"correct":false,"justification":"That if HPV test Positive","idx":3,"proposition":"AUC-US cytology abnormalities on smear without HPV test results"},{"correct":false,"justification":"That if HPV test Positive","idx":4,"proposition":"AGC-like cytological abnormalities (ganglion cell atypia) on smear with negative HPV test"}],"ts":1629829697,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-37a804","context":null,"enonce":"Which of the following proposals corresponds to the FIGO stage of invasive endometrioid adenocarcinoma limited to <50% of the endometrium?","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"Insitu carcinoma","idx":0,"proposition":"Stage 0"},{"correct":true,"justification":"True","idx":1,"proposition":"Stage 1A"},{"correct":false,"justification":">50% of endometrial thickness","idx":2,"proposition":"Stage 1B"},{"correct":false,"justification":"Invasion of the pass","idx":3,"proposition":"Stage 2"},{"correct":false,"justification":"Invasion of the vagina","idx":4,"proposition":"Stage 3B"}],"ts":1629829856,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-3eafbc","context":null,"enonce":"A 60-year-old woman comes to your office. She has no family or personal history of cancer. What cancers should she have been screening for until now?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True, screening organized between 50 and 74 years, with a bilateral mammogram with two incidences and double reading, every two years","idx":0,"proposition":"Breast cancer"},{"correct":false,"justification":"It was a joke huh 😅😂","idx":1,"proposition":"Prostate cancer"},{"correct":true,"justification":"True, immunological test (hemocult) every two years between 50 and 74 years","idx":2,"proposition":"Colon cancer"},{"correct":false,"justification":"No organized screening","idx":3,"proposition":"Lung cancer"},{"correct":true,"justification":"True, smear between 25 and 65 years every three years (after 2 normal smears 1 year apart)","idx":4,"proposition":"Cervical cancer"}],"ts":1629829727,"type":"custom","difficulte":"1"}
-{"_id":"KcUt-onco-4b9786","context":null,"enonce":"Which of the following are true?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True, invasion of the serosa, vagina or pelvic nodes.","idx":0,"proposition":"Stage 3 requires a CT scan"},{"correct":false,"justification":"This is the case of 4A. 4B = distant metastases","idx":1,"proposition":"Stage 4B corresponds to rectal metastases"},{"correct":false,"justification":"Stage 0 = carcinoma in situ","idx":2,"proposition":"Stage 0 corresponds to a lack of anapath result"},{"correct":true,"justification":"True","idx":3,"proposition":"Stage 3C2 corresponds to an extension to the lumboaortic nodes"},{"correct":false,"justification":"1A = <50% of the myometrium. 1B = >50% of myometrium","idx":4,"proposition":"Stage 1A corresponds to carcinoma limited to more than 50% of the body"}],"ts":1629829841,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-56138c","context":null,"enonce":"Which of the following proposals for squamous cell carcinoma of the cervix are true?","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"It develops at the expense of the ectocervix","idx":0,"proposition":"It develops at the expense of the endocervix"},{"correct":false,"justification":"It is the majority (70%)","idx":1,"proposition":"It accounts for 20% of cervical cancers "},{"correct":true,"justification":"True","idx":2,"proposition":"CIN1 corresponds to low-grade intraepithelial neoplasia"},{"correct":true,"justification":"True, just like CIN2","idx":3,"proposition":"CIN3 corresponds to high-grade intraepithelial neoplasia"},{"correct":false,"justification":"<5mm. Beyond that, it is invasive","idx":4,"proposition":"Microinvasive carcinoma measures <10mm"}],"ts":1629829851,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-6c47c4","context":null,"enonce":"Which of the following are risk factors for endometrial cancer?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True, especially if mishandled","idx":0,"proposition":"History of hormone replacement therapy for menopause"},{"correct":false,"justification":"Cervix, oropharynx, esophagus","idx":1,"proposition":"History of HPV infection"},{"correct":false,"justification":"Late menopause","idx":2,"proposition":"Early menopause"},{"correct":true,"justification":"True","idx":3,"proposition":"History of tamoxifen treatment"},{"correct":true,"justification":"True","idx":4,"proposition":"Obesity"}],"ts":1629829516,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-7f73ac","context":null,"enonce":"Which of the following are true about cancer of the body of the uterus?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It mainly concerns the endometrium"},{"correct":false,"justification":"This is adenocarcinoma.","idx":1,"proposition":"The most common histological type is squamous cell carcinoma"},{"correct":true,"justification":"True","idx":2,"proposition":"The most common symptom is metrorrhagia in postmenopausal women"},{"correct":true,"justification":"True","idx":3,"proposition":"The endometrium is thickened on intravaginal ultrasound"},{"correct":true,"justification":"True","idx":4,"proposition":"FIGO classification goes up to stage 4B"}],"ts":1629829783,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-8f61b9","context":null,"enonce":"Regarding the FIGO classification for uterine fibroids. Which of the following are true?","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"False. 0 to 2 are submucosal","idx":0,"proposition":"Fibroids 0 to 3 are submucosal"},{"correct":true,"justification":"True. It is fibroids that are most at risk of causing bleeding and long-term iron deficiency anemia. ","idx":1,"proposition":"FIGO fibroids 0 to 2 are at risk of causing iron deficiency anemia"},{"correct":false,"justification":"False. FIGO 7 is a pedunculated subserous fibroid","idx":2,"proposition":"FIGO 7 corresponds to a non-pedunculated subserous fibroid"},{"correct":false,"justification":"False. This is FIGO 6. The FIGO 5 is a fibroid with more than 50% intramural","idx":3,"proposition":"FIGO 5: subserous fibroid with less than 50% intramural"},{"correct":true,"justification":"True","idx":4,"proposition":"FIGO 1: submucosal fibroid with less than 50% intramural"}],"ts":1629829553,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-9df81d","context":null,"enonce":"Which of the following are true about colposcopy?","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"Local anesthesia is sufficient. But if the patient asks for GA, it is possible","idx":0,"proposition":"It requires general 💤 anesthesia"},{"correct":true,"justification":"True. Page 213 of the College of Gynecology (4th edition)","idx":1,"proposition":"It is essential to direct biopsies"},{"correct":true,"justification":"True","idx":2,"proposition":"It requires a binocular 🔎 magnifying glass"},{"correct":false,"justification":"The filter is green 🟢 (sorry for the trap 🙏)","idx":3,"proposition":"The yellow 🟡 filter can be used for vessel observation"},{"correct":true,"justification":"True","idx":4,"proposition":"It is after the application of the acetic acid solution that the cylindrical-squamous junction can be spotted "}],"ts":1629829473,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-a56b20","context":null,"enonce":"At what age should the first cervico-uterine smear be offered?","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"15 years"},{"correct":false,"justification":"False","idx":1,"proposition":"20 years"},{"correct":true,"justification":"True","idx":2,"proposition":"25 years"},{"correct":false,"justification":"False","idx":3,"proposition":"50 years"},{"correct":false,"justification":"False","idx":4,"proposition":"35 years"}],"ts":1629829636,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-abc6ec","context":null,"enonce":"Which of the following proposals corresponds to the type(s) of cancer for which follow-up by CTS may be useful?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True. In the College of Gynecology, the only place where SCC (Squamous Cell Carcinoma) is cited is for the follow-up of squamous cell carcinomas of the cervix.","idx":0,"proposition":"Squamous cell carcinoma of the cervix"},{"correct":false,"justification":"False","idx":1,"proposition":"Adenocarcinoma of the cervix"},{"correct":false,"justification":"Uterine fibroid","idx":2,"proposition":"Leiomyoma"},{"correct":false,"justification":"False","idx":3,"proposition":"Endometrial adenocarcinoma"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"ts":1629829413,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-bd29d0","context":null,"enonce":"Which of the following are true about cervical cancer?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True, 70% of cases","idx":0,"proposition":"Squamous cell carcinoma is the most common pathological expression"},{"correct":false,"justification":"The glands are on the endocervix, so adenocarcinoma concerns the endocervix.","idx":1,"proposition":"Adenocarcinoma concerns the ectocervix"},{"correct":false,"justification":"Columnar epithelium","idx":2,"proposition":"The endocervix consists of a squamous epithelium"},{"correct":true,"justification":"True","idx":3,"proposition":"FIGO III stage has a prognosis of 60% survival at 5 years"},{"correct":true,"justification":"True","idx":4,"proposition":"The incidence of cervical cancer is down slightly in France"}],"ts":1629829331,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-be768e","context":null,"enonce":"Which of the following corresponds to the FIGO stage of invasive endocervix carcinoma limited to the cervix?","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"Intraepithelial (carcinoma is invasive here)","idx":0,"proposition":"Stage 0"},{"correct":true,"justification":"True","idx":1,"proposition":"Stage 1"},{"correct":false,"justification":"Involvement of the vagina (except lower 1\/3 -> stage 3) or a parameter","idx":2,"proposition":"Stage 2"},{"correct":false,"justification":"Involvement of the lower 1\/3 of the vagina or kidney","idx":3,"proposition":"Stage 3"},{"correct":false,"justification":"Metastasis","idx":4,"proposition":"Stage 4"}],"ts":1629829589,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-e481a4","context":null,"enonce":"Which of the following are organs whose cancers are associated with Lynch syndrome?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Rectum"},{"correct":true,"justification":"True","idx":1,"proposition":"Settler"},{"correct":true,"justification":"True","idx":2,"proposition":"Urothelial"},{"correct":true,"justification":"True","idx":3,"proposition":"Endometrium"},{"correct":true,"justification":"True","idx":4,"proposition":"Small intestine"}],"ts":1629829558,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-eca11d","context":null,"enonce":"Which of the following propositions are true about the FIGO stage of endometrial cancers?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"AI: Invasion < 50% of the myometrium"},{"correct":false,"justification":"Bladder and\/or rectal. IVB otherwise","idx":1,"proposition":"VIA: Bladder and\/or hepatic metastasis"},{"correct":true,"justification":"True","idx":2,"proposition":"II: Invasion of the pass"},{"correct":false,"justification":"Loco-regional extension: serous (A), vagina (B), pelvic nodes (C1), or lumboarotic nodes (C2)","idx":3,"proposition":"III: Distant metastasis"},{"correct":false,"justification":"IIIC1: extension to pelvic nodes","idx":4,"proposition":"IIIC1: Extension to lumboaortic nodes"}],"ts":1629829505,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-f52b37","context":null,"enonce":"Which of the following are true?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True, so it must be done outside of menstrual periods","idx":0,"proposition":"The cervico-uterine smear is not interpretable during menstruation"},{"correct":false,"justification":"Vaccines do not target all strains (only oncogenic ones)","idx":1,"proposition":"A well-conducted vaccination against HPV prevents contamination by the virus"},{"correct":false,"justification":"Non-hormone-dependent","idx":2,"proposition":"Cervical cancer is hormone-dependent"},{"correct":true,"justification":"True","idx":3,"proposition":"Endometrial cancer is hormone-dependent"},{"correct":false,"justification":"","idx":4,"proposition":""}],"ts":1629829425,"type":"custom","difficulte":"2"}
-{"_id":"KcUt-onco-f5ff7d","context":null,"enonce":"Which of the following are true about cervical cancer?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A smear that finds atypical glandular cells (AGC) does not require a colposcopy to be performed immediately"},{"correct":true,"justification":"True","idx":1,"proposition":"An irregular red collar on colposcopy is suspicious "},{"correct":false,"justification":"Possible in case of low-grade dysplasia (LIEBG) but not in ISA","idx":2,"proposition":"Withholding from surveillance is possible for adenocarcinoma in situ (AIS)"},{"correct":false,"justification":"It is mainly found at the endocol-exocervix junction (transformation zone)","idx":3,"proposition":"The HPV virus is exclusively found in the deep endocervix"},{"correct":false,"justification":"It is recommended in humans since the new reco HAS","idx":4,"proposition":"HPV vaccination is not recommended in humans"}],"ts":1629829739,"type":"custom","difficulte":"2"}
-{"_id":"330-urg-028095","context":null,"enonce":"Which of the following proposals are part of the mandible retro-dental sector?","item":"traumacrane","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Ramus"},{"correct":true,"justification":"True","idx":1,"proposition":"Condyles"},{"correct":false,"justification":"Dentate sector","idx":2,"proposition":"Symphysis"},{"correct":false,"justification":"Dentate sector. There are some great diagrams here: http:\/\/s3.e-monsite.com\/2011\/02\/15\/18671683osteologie-cranio-faciale-mandibule-pdf.pdf","idx":3,"proposition":"Parasymphysis"},{"correct":true,"justification":"True","idx":4,"proposition":"Angle"}],"ts":1630477808,"type":"custom","difficulte":"2"}
-{"_id":"330-urg-f289d4","context":null,"enonce":"Which of the following proposals are part of the dentate sector of the mandible?","item":"traumacrane","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Mandibular arch"},{"correct":true,"justification":"True","idx":1,"proposition":"Symphysis"},{"correct":true,"justification":"True, mandibular arch = symphysis and horizontal branch (parasymphysis)","idx":2,"proposition":"Parasymphysis"},{"correct":false,"justification":"Retro-dental sector","idx":3,"proposition":"Ramus"},{"correct":false,"justification":"Retro-dental sector. Super Pattern of Death Kills: http:\/\/s3.e-monsite.com\/2011\/02\/15\/18671683osteologie-cranio-faciale-mandibule-pdf.pdf","idx":4,"proposition":"Condyles"}],"ts":1630478083,"type":"custom","difficulte":"2"}
-{"_id":"330-urg-cdd192","context":null,"enonce":"Which of the following proposals are secondary brain aggressions of systemic origin (ACSOS)?","item":"traumacrane","matiere":"urg","propositions":[{"correct":false,"justification":"Secondary brain aggression of neurological origin","idx":0,"proposition":"Cerebral edema"},{"correct":false,"justification":"Secondary brain aggression of neurological origin","idx":1,"proposition":"Intracranial hypertension"},{"correct":true,"justification":"True. Anemia results in a decrease in oxygen transport to the cerebral parenchyma and is therefore deleterious","idx":2,"proposition":"Anaemia"},{"correct":true,"justification":"True. By decreasing cerebral blood flow, low blood pressure weakens the brain cells included in the ischemic penumbra (= the cells that can still be saved)","idx":3,"proposition":"Low blood pressure"},{"correct":true,"justification":"True. Hyperthermia is associated with increased brain metabolism ","idx":4,"proposition":"Hyperthermia"}],"ts":1630478160,"type":"custom","difficulte":"2"}
-{"_id":"359-urg-a38675","context":null,"enonce":"What is Parker's maximum score?","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"3"},{"correct":false,"justification":"","idx":1,"proposition":"6"},{"correct":true,"justification":"True. We will try to evaluate the degree of autonomy of patients thanks to the PARKER score (yes\/no walk (3 pts), with or without technical aid (3 pts), home\/outdoor\/shopping (1\/2\/3 pts) for a maximum of 9 points in autonomous patients)","idx":2,"proposition":"9"},{"correct":false,"justification":"","idx":3,"proposition":"12"},{"correct":false,"justification":"","idx":4,"proposition":"15"}],"ts":1630740219,"type":"custom","difficulte":"1"}
-{"_id":"359-urg-3368a6","context":null,"enonce":"⏰ An open fracture must be managed surgically in the ...","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"30 minutes "},{"correct":false,"justification":"","idx":1,"proposition":"1 hour"},{"correct":false,"justification":"","idx":2,"proposition":"3 hours"},{"correct":true,"justification":"True","idx":3,"proposition":"6 hours"},{"correct":false,"justification":"","idx":4,"proposition":"12 hours "}],"ts":1630740320,"type":"custom","difficulte":"1"}
-{"_id":"359-urg-394141","context":null,"enonce":"You place your patient in the supine position, knee in flexion. You find pain in axial compression of the knee associated with rotational movements. What is this maneuver?","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":"ACL injury","idx":0,"proposition":"Lachman"},{"correct":false,"justification":"ACL injury","idx":1,"proposition":"Jerk Off Test"},{"correct":true,"justification":"True. This test is a sign of internal meniscopathy if the pain appears in external rotation. Conversely if the pain appears in internal rotation","idx":2,"proposition":"Appley's Grinding Test"},{"correct":false,"justification":"patellar pain","idx":3,"proposition":"Manoeuvring of the plough "},{"correct":false,"justification":"joint effusion","idx":4,"proposition":"Sign of the ice cube 🧊"}],"ts":1630740379,"type":"custom","difficulte":"1"}
-{"_id":"359-urg-4673c6","context":null,"enonce":"The cervico-diaphyseal angle is:","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"30 degrees"},{"correct":false,"justification":"False","idx":1,"proposition":"150 degrees"},{"correct":false,"justification":"False","idx":2,"proposition":"90 degrees"},{"correct":false,"justification":"False","idx":3,"proposition":"60 degrees"},{"correct":true,"justification":"True","idx":4,"proposition":"120 degrees"}],"ts":1630740389,"type":"custom","difficulte":"1"}
-{"_id":"359-urg-4a1339","context":null,"enonce":"Normally, the radioulnar index is:","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"Positive"},{"correct":false,"justification":"","idx":1,"proposition":"Nobody"},{"correct":true,"justification":"True, from -1 to -2 mm","idx":2,"proposition":"Negative"},{"correct":false,"justification":"","idx":3,"proposition":"We don't really know what to put as other proposals 😕"},{"correct":false,"justification":"","idx":4,"proposition":"🤷‍♂️🤷‍♂️🤷‍♂️"}],"ts":1630740507,"type":"custom","difficulte":"1"}
-{"_id":"359-urg-ccbf7e","context":null,"enonce":"What is the usual management of a trochanteric fracture? 🤔","item":"Fr","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The goal is to provide podal support as quickly as possible 🚶 ♀️🚶 ♂️"},{"correct":true,"justification":"True","idx":1,"proposition":"Reduction and osteosynthesis"},{"correct":false,"justification":"False, indicated in cervical fractures (depending on the age and condition of the patient)","idx":2,"proposition":"Intermediate hip replacement"},{"correct":false,"justification":"False ✖✖","idx":3,"proposition":"Functional treatment"},{"correct":false,"justification":"False, indicated in cervical fractures (depending on the age and condition of the patient)","idx":4,"proposition":"Total hip replacement"}],"ts":1630740528,"type":"custom","difficulte":"1"}
-{"_id":"359-urg-f6c78d","context":null,"enonce":"Regarding per-trochanterian fractures:","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":"False, most often they are not","idx":0,"proposition":"They are always geared"},{"correct":true,"justification":"True, by definition","idx":1,"proposition":"They are extra-articular"},{"correct":false,"justification":"This is the case with cervical fractures. The posterior circumflex artery is injured in femoral neck fractures, justifying the placement of a total hip replacement (in patients aged + 60 years).","idx":2,"proposition":"They are at risk of aseptic osteonecrosis of the femoral 😲 head"},{"correct":false,"justification":"Most often: reduction + osteosynthesis","idx":3,"proposition":"Functional treatment is sufficient 🤷 ♂️"},{"correct":false,"justification":"Most often: reduction + osteosynthesis. Orthopedic treatment is a waiting treatment (except CI at surgery)","idx":4,"proposition":"Orthopedic treatment is sufficient 🤷 ♂️"}],"ts":1630740806,"type":"custom","difficulte":"1"}
-{"_id":"359-urg-d77845","context":null,"enonce":"Which of the following propositions are true about Garden's classification?","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":"This is the case of the Pauwels classification (stability \/ risk of pseudarthrosis of the fracture). There are 4 in the Garden","idx":0,"proposition":"There are 3 stadiums"},{"correct":false,"justification":"Only femoral neck fractures","idx":1,"proposition":"It is applicable to all fractures of the femur"},{"correct":false,"justification":"Hip\/Front pelvis","idx":2,"proposition":"It requires profile X-rays"},{"correct":true,"justification":"True","idx":3,"proposition":"It is used to predict the survival of the femoral head"},{"correct":true,"justification":"True","idx":4,"proposition":"It takes into account the displacement of fractured bones"}],"ts":1630740863,"type":"custom","difficulte":"1"}
-{"_id":"359-urg-85067e","context":null,"enonce":"Which of the following is the normal version of the radial glenoid?","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"0°"},{"correct":true,"justification":"True","idx":1,"proposition":"10° anteversion"},{"correct":false,"justification":"","idx":2,"proposition":"10° retroversion"},{"correct":false,"justification":"","idx":3,"proposition":"20° retroversion"},{"correct":false,"justification":"","idx":4,"proposition":"20° anteversion"}],"ts":1630740888,"type":"custom","difficulte":"1"}
-{"_id":"71-psy-60846c","context":null,"enonce":"Concerning psychotherapies, which of the following propositions are true?","item":"psychoT","matiere":"psy","propositions":[{"correct":true,"justification":"True, a psychotherapist refers to a psychiatrist, psychologist or someone with necessary training in the field (rarer)","idx":0,"proposition":"A psychiatrist is a psychotherapist"},{"correct":false,"justification":"False, it is by far supportive psychotherapy (think of the number of people who consult a psychologist for an unfortunate life event...)","idx":1,"proposition":"The most practiced psychotherapy in France is T.C.C (Cognitive Behavioral Therapy)"},{"correct":false,"justification":"False, she still has some (anxiety disorders, depressive disorders), but often she is preferred the TCC","idx":2,"proposition":"Analytical psychotherapy no longer has an indication in France"},{"correct":true,"justification":"True, it is THE therapy to favor in front of anxiety disorders (OCD, panic disorders, phobias ....)","idx":3,"proposition":"Cognitive behavioral therapy is very useful and effective on the management of anxiety disorders"},{"correct":false,"justification":"False, we must not confuse the \"defusing\" which is a brief management, directly in post-traumatic, of an EMDR which is a longer-term and often distant management of the trauma","idx":4,"proposition":"EMDR is a psychotherapy called \"defusing\", allowing to take charge in direct post-traumatic, the psychic consequences of a traumatic event"}],"ts":1630772868,"type":"custom","difficulte":"2"}
-{"_id":"69-psy-acf639","context":null,"enonce":"Regarding eating disorders, which of the following propositions, are true?","item":"TCA","matiere":"psy","propositions":[{"correct":false,"justification":"False, it is by far the rarest eating disorder among the 3 main ones (binge eating disorder > bulimia > anorexia)","idx":0,"proposition":"Anorexia nervosa is the most common eating disorder in France."},{"correct":true,"justification":"True. This is a major point, absolutely essential to remember and research, on which I particularly emphasize.","idx":1,"proposition":"Eating disorders are very frequently associated with psychiatric and addictological disorders."},{"correct":true,"justification":"True, a thousand times true, it is the main drug, prescribed outside of oral nutritional supplements.","idx":2,"proposition":"In the management of eating disorders, antidepressants are readily used for their pro-orexigenous or anti-compulsive effect."},{"correct":false,"justification":"False, it is borderline personality disorder (rather in bulimic) or obsessive-compulsive personality disorder (rather in anorexics)","idx":3,"proposition":"The personality disorder most commonly found in eating disorders is antisocial personality disorder."},{"correct":false,"justification":"False, there are a myriad variety of oral nutritional supplements (cakes, biscuits, soups, soups, juices, desserts, flans etc ...)","idx":4,"proposition":"Oral nutritional supplements are only in the form of milk or juice."}],"ts":1630772874,"type":"custom","difficulte":"1"}
-{"_id":"9-psy-d94981","context":null,"enonce":"Which of the following are vulnerability criteria taken into account in criminal law?","item":"certificats","matiere":"psy","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Age 🎅🤶"},{"correct":true,"justification":"True","idx":1,"proposition":"Disabling 🦯 chronic disease"},{"correct":true,"justification":"True","idx":2,"proposition":"Mental"},{"correct":true,"justification":"True","idx":3,"proposition":"Pregnancy 🤰"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"ts":1630772879,"type":"custom","difficulte":"1"}
-{"_id":"68-psy-0dd0ab","context":null,"enonce":"Concerning the psychic disorders of the elderly, which of the following propositions, which one or which are true?","item":"psyage","matiere":"psy","propositions":[{"correct":true,"justification":"True, indeed older people age differently! An 80-year-old person may not have physical or psychological comorbidities (which are the main risk factors for mental disorders) and a 60-year-old person may have them.","idx":0,"proposition":"Age is not a risk factor for depression in the elderly"},{"correct":true,"justification":"True, it is all the more visible in hospitalization","idx":1,"proposition":"Depression of the elderly may be manifested by functional complaints (asthenia, memory complaint, abdominal pain)"},{"correct":true,"justification":"True, if there are more suicide attempts among young people, there are fewer deaths by suicide among young people.","idx":2,"proposition":"The risk of suicide is greater in the elderly than in the young person"},{"correct":true,"justification":"True","idx":3,"proposition":"A severe depressive episode is a risk factor for Alzheimer's disease"},{"correct":true,"justification":"True, frontal tumors, for example, can mimic depression in the elderly","idx":4,"proposition":"Brain imaging can help to seek a differential diagnosis (such as a brain tumor) in the elderly person's depression"}],"ts":1630772886,"type":"custom","difficulte":"1"}
-{"_id":"287-onco-2b543c","context":null,"enonce":"Secondary prevention is used to reduce:","item":"epidemioKc","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Prevalence"},{"correct":false,"justification":"Primary","idx":1,"proposition":"Impact"},{"correct":false,"justification":"Tertiary","idx":2,"proposition":"Disability"},{"correct":false,"justification":"Tertiary","idx":3,"proposition":"Morbidity and mortality"},{"correct":true,"justification":"True","idx":4,"proposition":"It is aimed at high-risk individuals"}],"ts":1630773453,"type":"custom","difficulte":"1"}
-{"_id":"287-onco-072307","context":null,"enonce":"What is the only cancer in humans that can be managed by hormonal treatments?","item":"epidemioKc","matiere":"onco","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"Breast"},{"correct":true,"justification":"True, this is the only :)","idx":1,"proposition":"Prostate"},{"correct":false,"justification":"","idx":2,"proposition":"Settler"},{"correct":false,"justification":"","idx":3,"proposition":"Thyroid"},{"correct":false,"justification":"","idx":4,"proposition":"Pancreas"}],"ts":1630773458,"type":"custom","difficulte":"1"}
-{"_id":"287-onco-366294","context":null,"enonce":"Which of the following are hormone-sensitive cancers?","item":"epidemioKc","matiere":"onco","propositions":[{"correct":false,"justification":"😬😬😬","idx":0,"proposition":"Prostate in women"},{"correct":true,"justification":"True","idx":1,"proposition":"Endometrium in women"},{"correct":false,"justification":"False","idx":2,"proposition":"Adrenal in humans"},{"correct":false,"justification":"False","idx":3,"proposition":"Testicle"},{"correct":true,"justification":"True","idx":4,"proposition":"Breast in women"}],"ts":1630773478,"type":"custom","difficulte":"1"}
-{"_id":"287-onco-bd3506","context":null,"enonce":"Primary prevention is used to reduce:","item":"epidemioKc","matiere":"onco","propositions":[{"correct":false,"justification":"Secondary","idx":0,"proposition":"Prevalence"},{"correct":true,"justification":"True","idx":1,"proposition":"Impact"},{"correct":false,"justification":"Tertiary","idx":2,"proposition":"Disability"},{"correct":false,"justification":"Tertiary","idx":3,"proposition":"Morbidity and mortality"},{"correct":false,"justification":"To the general population","idx":4,"proposition":"It is aimed at high-risk individuals"}],"ts":1630773482,"type":"custom","difficulte":"1"}
-{"_id":"287-onco-2314ef","context":null,"enonce":"What is the primary outcome of national screening campaigns?","item":"epidemioKc","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Mortality decline"},{"correct":false,"justification":"","idx":1,"proposition":"Decrease in morbidity"},{"correct":false,"justification":"","idx":2,"proposition":"Decrease in incidence"},{"correct":false,"justification":"","idx":3,"proposition":"Declining prevalence"},{"correct":false,"justification":"","idx":4,"proposition":"Decrease in healthcare consumption"}],"ts":1630773491,"type":"custom","difficulte":"1"}
-{"_id":"287-onco-56e0a3","context":null,"enonce":"What is the main risk factor for cancer?","item":"epidemioKc","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Age"},{"correct":false,"justification":"","idx":1,"proposition":"Tobacco"},{"correct":false,"justification":"","idx":2,"proposition":"Alcohol"},{"correct":false,"justification":"","idx":3,"proposition":"Pesticides"},{"correct":false,"justification":"","idx":4,"proposition":"Infection par HPV"}],"ts":1630773495,"type":"custom","difficulte":"1"}
-{"_id":"287-onco-c276fe","context":null,"enonce":"Tertiary prevention serves to reduce:","item":"epidemioKc","matiere":"onco","propositions":[{"correct":false,"justification":"Secondary","idx":0,"proposition":"Prevalence"},{"correct":false,"justification":"Primary","idx":1,"proposition":"Impact"},{"correct":true,"justification":"True","idx":2,"proposition":"Morbidity and mortality"},{"correct":true,"justification":"True","idx":3,"proposition":"Disability"},{"correct":true,"justification":"True","idx":4,"proposition":"It is only for the sick individual"}],"ts":1630773499,"type":"custom","difficulte":"1"}
-{"_id":"287-onco-56f80b","context":null,"enonce":"What proportion of cancer is nutrition-related risk factor?","item":"epidemioKc","matiere":"onco","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"5 %"},{"correct":false,"justification":"","idx":1,"proposition":"10 %"},{"correct":true,"justification":"True","idx":2,"proposition":"25 %"},{"correct":false,"justification":"","idx":3,"proposition":"50 %"},{"correct":false,"justification":"","idx":4,"proposition":"1 %"}],"ts":1630773511,"type":"custom","difficulte":"1"}
-{"_id":"287-onco-591f3d","context":null,"enonce":"What is the proportion of preventable cancers (accessible to primary prevention)?","item":"epidemioKc","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"40 %"},{"correct":false,"justification":"","idx":1,"proposition":"10 %"},{"correct":false,"justification":"","idx":2,"proposition":"20 %"},{"correct":false,"justification":"","idx":3,"proposition":"80 %"},{"correct":false,"justification":"","idx":4,"proposition":"100 %"}],"ts":1630773514,"type":"custom","difficulte":"1"}
-{"_id":"74-gastro-b1e42d","context":null,"enonce":"Regarding Gayet-Wernicke encephalopathy. Which of the following propositions, which one or which are true?","item":"OH","matiere":"HGE","propositions":[{"correct":false,"justification":"False. Thiamine. ","idx":0,"proposition":"It is a vitamin B6 deficiency"},{"correct":true,"justification":"True. It is for this reason that chronic alcoholic patients should not be hydrated with G5, but with saline. ","idx":1,"proposition":"It can be aggravated by carbohydrate intake"},{"correct":true,"justification":"True. There may also be oppositional hypertonia","idx":2,"proposition":"The clinical triad includes oculomotor signs (oculomotor paralysis, nystagmus), static cerebellar syndrome, and delirium syndrome."},{"correct":false,"justification":"False. A hypersignal of the mammillary body","idx":3,"proposition":"MRI FLAIR shows a hypersignal of the corpus callosum"},{"correct":false,"justification":"False. It is reversible, unlike Korsakoff syndrome","idx":4,"proposition":"It is an irreversible encephalopathy"}],"ts":1630773568,"type":"custom","difficulte":"1"}
-{"_id":"74-gastro-769984","context":null,"enonce":"Regarding biological markers of excessive alcohol consumption. Which of the following propositions, which one or which are true?","item":"OH","matiere":"HGE","propositions":[{"correct":false,"justification":"False. Macrocytosis","idx":0,"proposition":"Microcytosis is suggestive"},{"correct":true,"justification":"True. Lots of false positives. ","idx":1,"proposition":"MCV is the least sensitive marker"},{"correct":true,"justification":"True. This is CDT (Carbohydrate Deficient Transferrin)","idx":2,"proposition":"Deialylated transferrin is very specific"},{"correct":true,"justification":"True","idx":3,"proposition":"Gamma-GT is elevated without elevation of PALs"},{"correct":true,"justification":"True","idx":4,"proposition":"Macrocytosis is suggestive"}],"ts":1630773590,"type":"custom","difficulte":"1"}
-{"_id":"74-gastro-185e41","context":null,"enonce":"Which of the following are true?","item":"OH","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Simple use is a term used only for the use of alcohol"},{"correct":true,"justification":"True. This is true for both men and women","idx":1,"proposition":"According to new WHO recommendations, simple alcohol use means less than 10 glasses of alcohol are consumed per week "},{"correct":false,"justification":"False. 10 g","idx":2,"proposition":"1 standard glass of alcohol contains 8g of alcohol"},{"correct":true,"justification":"True","idx":3,"proposition":"1 glass of wine of 10 cL corresponds to 10g of alcohol"},{"correct":true,"justification":"True","idx":4,"proposition":"1 glass of whiskey of 2.5 cL corresponds to 10g of alcohol"}],"ts":1630773606,"type":"custom","difficulte":"1"}
-{"_id":"meningite-infectio-ffaa03","context":null,"enonce":"With regard to meningitis, which of the following proposals are accurate?","item":"meningite","matiere":"infectio","propositions":[{"correct":true,"justification":"True, essential and non-debatable point, the greatest urgency in front of a fever in children, adolescents and even young adults is the search for a purpura fulminans (IM \/ IV injection of 2g C3G).","idx":0,"proposition":"It is essential to completely undress any child with unexplained fever and\/or suspected meningitis"},{"correct":true,"justification":"True, overall there are three situations where the lumbar puncture will not be performed: septic shock, coagulation disorders and similar, signs of cerebral engagement \/ seizures or serious alertness disorders.","idx":1,"proposition":"Among the contraindications to lumbar puncture, we have coagulation disorders, thrombocytopenia (<50G \/ L) and signs of cerebral engagement for example."},{"correct":false,"justification":"False, they are to start in probabilistic once the direct examination is carried out (on the blood or the lumbar puncture)","idx":2,"proposition":"Except in the context of purpura fulminans, antibiotic therapy is to be started once the results of the culture with susceptibility testing have been received."},{"correct":false,"justification":"False, three times false. As for the suspicion of myocardial infarction, we CALL the SAMU to request a medical transport, which will go directly to intensive care. And we do the C3G IM in the office!","idx":3,"proposition":"Confirmed or suspected purpura fulminans requires sending the patient to the emergency room with a letter to perform blood cultures and lumbar puncture"},{"correct":false,"justification":"False, it is to be proposed in systematics (I was often fooled by this item)","idx":4,"proposition":"HIV testing, if favourable circumstances, is to be offered to the patient"}],"ts":1630424680,"type":"custom","difficulte":"1"}
-{"_id":"meningite-infectio-4c788d","context":null,"enonce":"You are a pediatric intern and you hospitalized little Franz Oberhauser, an Austrian child on holiday in the Alps 🗻, for a suspicion of meningitis (in front of febrile headaches with meningeal syndrome). The laboratory calls you to send you the results of the lumbar puncture, very favorable to meningococcal 🦠 meningitis. Which of the following results are consistent with meningococcal meningitis?","item":"meningite","matiere":"infectio","propositions":[{"correct":true,"justification":"True, we have a proteinorachy >1g \/ L","idx":0,"proposition":"Proteinorachy at 1.7g\/L"},{"correct":true,"justification":"True, we have a decreased glycorachia, because bacteria consume a lot of sugars","idx":1,"proposition":"Glycorachia <40% of blood glucose"},{"correct":true,"justification":"True, it is a bacterial infection therefore predominant on PNN, this is what also gives the cloudy character of CSF","idx":2,"proposition":"Leukocytosis at 3000\/mm3, predominant on PNN"},{"correct":false,"justification":"False, remember that meningococcal is a gram-negative cocci (diplococcus)","idx":3,"proposition":"Culture of CSF highlighting gram+ cocci"},{"correct":false,"justification":"False, lactates most often indicate a bacterial infection so they are increased here ","idx":4,"proposition":"Lactates <3.2 mmol\/L"}],"ts":1630424811,"type":"custom","difficulte":"1"}
-{"_id":"antiinf-infectio-b6ed99","context":null,"enonce":"Which of the following propositions are true about cefotaxime?","item":"antiinf","matiere":"infectio","propositions":[{"correct":false,"justification":"Time-dependent, bactericidal","idx":0,"proposition":"Concentration-dependent concentration"},{"correct":true,"justification":"True","idx":1,"proposition":"active on streptococci"},{"correct":true,"justification":"True","idx":2,"proposition":"bactericidal on susceptible gram-negative bacilli"},{"correct":false,"justification":"","idx":3,"proposition":"Active on anaerobes"},{"correct":false,"justification":"","idx":4,"proposition":"Active on enterococci"}],"ts":1630586520,"type":"custom","difficulte":"1"}
-{"_id":"antiinf-infectio-7fcad6","context":null,"enonce":"Which of the following are true about amikacin?","item":"antiinf","matiere":"infectio","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"It is a glycopeptide"},{"correct":true,"justification":"True","idx":1,"proposition":"It is an aminoglycoside"},{"correct":false,"justification":"Concentration-dependent","idx":2,"proposition":"It's time dependent"},{"correct":true,"justification":"True","idx":3,"proposition":"It is active on gram-negative bacilli"},{"correct":false,"justification":"Indicated in severe NAPs","idx":4,"proposition":"It is nephrotoxic and therefore contraindicated in case of PNA"}],"ts":1630586499,"type":"custom","difficulte":"1"}
-{"_id":"343-urg-192dab18-c108-408e-8ef0-e461f8fd270e","context":null,"enonce":"Which of the following are criteria for starting emergency dialysis?","item":"IRenA","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Threatening hyperkalemia"},{"correct":false,"justification":"We do not dialysis creat figures","idx":1,"proposition":"Creatinine > 1000 μmol\/L"},{"correct":true,"justification":"True","idx":2,"proposition":"Poor clinical tolerance of uremia"},{"correct":true,"justification":"True","idx":3,"proposition":"Oliguria resistant to loop diuretics with hydro-sodium overload"},{"correct":true,"justification":"True","idx":4,"proposition":"Severe metabolic acidosis"}],"ts":1632068836,"type":"custom","difficulte":"1"}
-{"_id":"152-dermato-dac6c98a-fa9f-4404-8aef-73c57fee9a52","context":null,"enonce":"Substitute general practitioner, you receive Mr Carver, Elliott, 25 years old, who consults you for a \"rotten nail\" of the feet, which persists for several months and which he has never really cared about. The clinical examination reveals a classic dermatophytic onyxis. What do you do? ","item":"infdermato","matiere":"dermato","propositions":[{"correct":true,"justification":"True, it makes perfect sense","idx":0,"proposition":"Looking for dermatophytic intertrigos and other dermatophytic onyxis"},{"correct":false,"justification":"False, this type of examination can be done in a laboratory","idx":1,"proposition":"You write a letter for a dermatologist, for a biopsy of an affected nail"},{"correct":true,"justification":"True, cf. B","idx":2,"proposition":"You make a prescription for a laboratory, for a biopsy of an affected nail"},{"correct":false,"justification":"False, no probabilistic treatment ","idx":3,"proposition":"You make a prescription for an antifungal probabilistic treatment secondarily adapted to the identification of the fungus"},{"correct":true,"justification":"True, cf. D","idx":4,"proposition":"You make a prescription once the fungus is identified for an antifungal"}],"ts":1632069165,"type":"custom","difficulte":"1"}
-{"_id":"pancreatitechr-HGE-39856c","context":null,"enonce":"Which of the following are complications of chronic pancreatitis?","item":"pancreatitechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Pseudocysts"},{"correct":true,"justification":"True","idx":1,"proposition":"Adenocarcinoma"},{"correct":true,"justification":"True","idx":2,"proposition":"Extrinsic compression of the bile ducts"},{"correct":true,"justification":"True","idx":3,"proposition":"Exocrine pancreatic insufficiency"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"ts":1632084203,"type":"custom","difficulte":"1"}
-{"_id":"splenomeg-HGE-6d018b","context":null,"enonce":"When should vaccinations be performed in case of scheduled splenectomy without emergency?","item":"splenomeg","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"2 weeks before surgery"},{"correct":false,"justification":"","idx":1,"proposition":"2 weeks after surgery"},{"correct":false,"justification":"","idx":2,"proposition":"3 weeks before surgery"},{"correct":false,"justification":"","idx":3,"proposition":"4 weeks before surgery"},{"correct":false,"justification":"","idx":4,"proposition":"6 weeks before surgery"}],"ts":1632084222,"type":"custom","difficulte":"1"}
-{"_id":"nutrigrossesse-endoc-6efea1","context":null,"enonce":"Which of the following are some indications of screening for gestational diabetes in a pregnant woman?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Overweight"},{"correct":true,"justification":"True","idx":1,"proposition":"Diabetic father"},{"correct":true,"justification":"True","idx":2,"proposition":"36 years"},{"correct":true,"justification":"True","idx":3,"proposition":"First macrosome child"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"ts":1632119630,"type":"custom","difficulte":"1"}
-{"_id":"nutrigrossesse-endoc-90e68c","context":null,"enonce":"Which of the following are some indications of screening for gestational diabetes in a pregnant woman?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"correct":false,"justification":"From 35 years old inclusive","idx":0,"proposition":"32 years"},{"correct":false,"justification":"First-degree family history","idx":1,"proposition":"Diabetic cousin"},{"correct":false,"justification":"Not in the recos 🤷 ♂️","idx":2,"proposition":"Long-term corticosteroid treatment"},{"correct":false,"justification":"From 25 (overweight)","idx":3,"proposition":"BMI = 23"},{"correct":true,"justification":"True, yepaaa","idx":4,"proposition":"All proposals are wrong"}],"ts":1632119635,"type":"custom","difficulte":"1"}
-{"_id":"menopause-uro-de601c","context":null,"enonce":"Regarding andropause (or age-related testosterone deficiency syndrome), what are the exact proposal(s)?","item":"menopause","matiere":"uro","propositions":[{"correct":false,"justification":"False, it is the testicles, senescent that have trouble secreting, and it will result in hypersecretion of FSH and LH at the pituitary level","idx":0,"proposition":"Andropause is linked to an age-related decrease in FSH and LH secretion."},{"correct":true,"justification":"True, this is the most important thing to remember from this little item. Compare the two and you'll see that it's blatant.","idx":1,"proposition":"Many of the symptoms of andropause are similar to those of menopause"},{"correct":false,"justification":"False, this is a diagnosis that combines clinical signs and a drop in total testosterone.","idx":2,"proposition":"The diagnosis of andropause is biological and based on the dosage, twice, of testosterone"},{"correct":true,"justification":"True, testosterone will act on the prostate and testicles mainly","idx":3,"proposition":"Testosterone treatment involves a prostate and endocrine assessment beforehand"},{"correct":false,"justification":"False, the treatment is administered transdermally or intramuscularly, null trap, but you never know...","idx":4,"proposition":"The treatment of andropause is based on a daily oral intake of free testosterone"}],"ts":1632131083,"type":"custom","difficulte":"1"}
-{"_id":"tbmiction-uro-cd24d9","context":null,"enonce":"Mrs. Marple, a nice patient of 72 years, comes to see you in consultation of general medicine, for urinary problems quite \"shameful\" according to her own words. Indeed, she has had \"urinary leakage\" for several months, occurring with laughter or coughing, but sometimes she feels an urgent need to urinate which has caused \"some accidents\". By quickly going through the patient's file you note as the only antecedent 5 vaginal deliveries and a work in the textile industry. Among the 5 proposals for additional examinations\/opinions, which sequence do you choose?","item":"tbmiction","matiere":"uro","propositions":[{"correct":false,"justification":"False, as soon as there is an emergency we must eliminate a \"local\" cause of irritation of the bladder (cancer, stone etc ...) and this requires at least a urologist opinion","idx":0,"proposition":"Fasting blood glucose, Urine strip - Physiotherapist consultation for pelvic floor strengthening"},{"correct":false,"justification":"False, ditto answer A","idx":1,"proposition":"Fasting blood glucose, Urine strip, ECBU - Renal and bladder ultrasound - Physiotherapist consultation for pelvic floor strengthening"},{"correct":false,"justification":"False, the assessment here is too excessive, in imaging only ultrasound is necessary and the liver and kidney assessment is dispensable.","idx":2,"proposition":"Fasting blood glucose, CBC\/Iono\/Hepatic test\/Renal assessment, BU, ECBU, Urinary cytodiagnosis - Renal and bladder ultrasound + TAP CT - Urologist opinion"},{"correct":true,"justification":"True, no more and no less (here urgency + risk factor with the textile industry)","idx":3,"proposition":"Fasting blood glucose, BU+ECBU, Urinary cytodiagnosis - Renal and bladder ultrasound - Urologist opinion for urethrocystoscopy"},{"correct":false,"justification":"False, an emergency is an emergency diagnosis","idx":4,"proposition":"Voiding schedule and reassessment of symptoms at the next consultation in 3 months"}],"ts":1632131085,"type":"custom","difficulte":"1"}
-{"_id":"tbmiction-uro-16f433","context":null,"enonce":"What do you typically find on a voiding calendar?","item":"tbmiction","matiere":"uro","propositions":[{"correct":true,"justification":"True, everything is true","idx":0,"proposition":"Volume urinated by urination"},{"correct":true,"justification":"True","idx":1,"proposition":"The rating of the voiding requirement"},{"correct":true,"justification":"True","idx":2,"proposition":"Fluid intake and type of beverages"},{"correct":true,"justification":"True","idx":3,"proposition":"Paroxysmal urinary functional signs"},{"correct":true,"justification":"True","idx":4,"proposition":"Bladder leakage and its circumstances"}],"ts":1632131088,"type":"custom","difficulte":"1"}
-{"_id":"soinspal2-soinspal-2a5ab2","context":null,"enonce":"You are an intern in palliative care and you receive the family of Mrs. Onatopp, Xenia, 45 years old, in a situation of palliative care and limitation of care, for small cell lung cancer. Its situation is deteriorating and you have decided to stop subcutaneous hydration and feeding. The family does not understand why you stop this and let Ms. Onatopp \"die\". What is your response to the family? (A correct answer)","item":"soinspal2","matiere":"soinspal","propositions":[{"correct":false,"justification":"False, the benefit here of care is very meagre, and there is a greater risk of adverse effects (false roads, edema ...)","idx":0,"proposition":"\"I understand your outrage and I share it. The patient must benefit from the treatments to the end and I reintroduce nutrition and hydration\""},{"correct":false,"justification":"False, subcutaneous hydration is at risk of edema","idx":1,"proposition":"\"I understand your concern, but eating for her is too risky of false routes and complications. There is no need to continue feeding. However, we can agree on maintaining hydration which is harmless.\""},{"correct":false,"justification":"False, parenteral feeding is at high risk of sepsis","idx":2,"proposition":"\"I understand your fears and doubts, but eating for her has become too difficult and there is a risk of wrong routes for nutrition by mouth. However, we can relay the feeding by vein, to avoid as many complications as possible. There is no need to continue hydration, as the patient has enough fluid reserves in her cells.\""},{"correct":true,"justification":"True, it is the weight of the benefit \/ risk associated with a relay by comfort care","idx":3,"proposition":"\"I understand your doubts and fears, but today this care is more risky, vis-à-vis the benefit that the patient can expect. However, she will be given oral care to prevent her from being disturbed by dry mouth.\""},{"correct":false,"justification":"False, this is a leak of the speech...","idx":4,"proposition":"\"I understand your resentment, but it is not me who decided but my boss, talk to him\""}],"ts":1632131119,"type":"custom","difficulte":"1"}
-{"_id":"soinspal3-soinspal-765f36","context":null,"enonce":"You attend the morning staff, in the palliative care unit, and you discuss with your senior the case of Mrs. Miranda Frost, 92 years old, hospitalized in your department for the palliative management of Amyotrophic Lateral Sclerosis. You decide to set up a situation of deep and continuous sedation maintained until death. What elements do you need to decide and carry out such care?","item":"soinspal3","matiere":"soinspal","propositions":[{"correct":true,"justification":"True, it allows to have a collegial decision, free from any hierarchical pressure","idx":0,"proposition":"A decision by two physicians who are not linked by a hierarchical relationship, approved by the health care team"},{"correct":false,"justification":"False, morphine and MIDAZOLAM, a kind of super-benzodiazepine that causes deep drowsiness, are used.","idx":1,"proposition":"Treatments: most often Propofol and Morphine"},{"correct":true,"justification":"True, they are essential until death to allow patient calming, dignity and a right to comfort","idx":2,"proposition":"Comfort care"},{"correct":true,"justification":"True, it is essential to know how to evoke this decision to relatives before and after the collegial meeting.","idx":3,"proposition":"Information to relatives"},{"correct":true,"justification":"True, it is not because these are treatments that can cause a double effect, that we will let with impunity the adverse effects (especially serious adverse effects) cause an inconvenience for the patient","idx":4,"proposition":"Regular reassessment of efficacy and safety"}],"ts":1632131121,"type":"custom","difficulte":"1"}
-{"_id":"soinspal2-soinspal-76687a","context":null,"enonce":"Regarding care decisions, relating to a palliative care situation, what is the hierarchy vis-à-vis care decision-makers? Rank from most important > least important (only 1 correct answer)","item":"soinspal2","matiere":"soinspal","propositions":[{"correct":false,"justification":"False, cf. D","idx":0,"proposition":"Patient, verbally > Patient via advance directives> Palliative care physician > Attending physician> Trusted person > Relatives"},{"correct":false,"justification":"False, cf. D","idx":1,"proposition":"Patient, verbally > Patient via advance directives> Trusted person > Spouse > Relatives"},{"correct":false,"justification":"False, cf. D","idx":2,"proposition":"Palliative care specialist > Doctor in charge of the patient > Attending physician > Patient, orally > Patient, via advance directives > Trusted person > Relatives"},{"correct":true,"justification":"True, the patient is the first actor of his care it is he who decides in agreement with the doctor who does not CHOOSE FOR HIM. The doctor informs, collects and argues but does not decide. Then the advance directives are authentic, then the person of trust (who testifies to the patient's will), and finally his relatives","idx":3,"proposition":"Patient in person> Patient via advance directives > Trusted person > Relatives"},{"correct":false,"justification":"False, cf. D","idx":4,"proposition":"Patient in person> Patient via advance directives> Attending physician or trusted person > Relatives"}],"ts":1632131125,"type":"custom","difficulte":"1"}
-{"_id":"soinspalped-soinspal-17e284","context":null,"enonce":"Regarding palliative care in pediatrics and neonatology, what are the exact proposal(s)?","item":"soinspalped","matiere":"soinspal","propositions":[{"correct":true,"justification":"True, it is not because he is in palliative care that we should not provide for his needs","idx":0,"proposition":"The child in palliative care, requires educational, social and existential needs"},{"correct":false,"justification":"False, this trap is absolutely to know, there are NO advance directives among minors, simply because advance directives are the will of the person who writes it.","idx":1,"proposition":"If the child is no longer able to express his or her own wishes, we must rely on the advance directives written by the parents."},{"correct":false,"justification":"False, it is the child who has his say and who decides. It is one of the few exceptions in pediatrics","idx":2,"proposition":"The decision of the parents or holders of parental authority takes precedence over that of the child"},{"correct":false,"justification":"False, it mainly concerns the consequences of prematurity","idx":3,"proposition":"Most palliative care in neonatology concerns fetal malformations and chromosic pathologies"},{"correct":true,"justification":"True, it is still a loss and a mourning, so they can intervene in this case too","idx":4,"proposition":"Paediatric palliative care also includes abortions and IMGs"}],"ts":1632131127,"type":"custom","difficulte":"1"}
-{"_id":"soinspal3-soinspal-078d4a","context":null,"enonce":"Regarding euthanasia and assisted suicide, what are the exact answer(s)?","item":"soinspal3","matiere":"soinspal","propositions":[{"correct":true,"justification":"True, you have to know how to evoke and evaluate the three types of pain","idx":0,"proposition":"Faced with a request for assisted suicide or euthanasia it is imperative to seek physical, psychological and existential pain"},{"correct":false,"justification":"False, it is important to know that the Léonetti law dates \"ONLY\" from 2005 and that it has been revised (Leonetti Claeys Law of 2018)","idx":1,"proposition":"The laws that frame the definitions and legislation on euthanasia and assisted suicide date from the twentieth century"},{"correct":false,"justification":"False, the most important thing in this situation is to understand why the patient is making this request.","idx":2,"proposition":"Faced with a situation of request for euthanasia or assisted suicide, the main thing to do is to explain to the patient the illegal nature of the thing"},{"correct":true,"justification":"True, it is totally obvious, that this gesture is criminally reprehensible, that it can lead to professional and legal sanctions, and that it can lead to compensation...","idx":3,"proposition":"If a physician performs an act of euthanasia or assisted suicide in France, he is liable to an infringement of his professional, criminal and civil liability."},{"correct":false,"justification":"False, of course it is false. We hear more often that the patient asks to die rather than to want to be euthanized, the difference is important!","idx":4,"proposition":"There are more requests for euthanasia than requests for death in hospitals "}],"ts":1632131130,"type":"custom","difficulte":"1"}
-{"_id":"dlrped-ped-ce63db","context":null,"enonce":"Which of the following are side effects of morphine in children?","item":"dlrped","matiere":"ped","propositions":[{"correct":false,"justification":"Constipation","idx":0,"proposition":"Diarrhoea"},{"correct":true,"justification":"True","idx":1,"proposition":"Bradypnea"},{"correct":true,"justification":"True","idx":2,"proposition":"Coma"},{"correct":true,"justification":"True","idx":3,"proposition":"Itch"},{"correct":false,"justification":"Urine retention","idx":4,"proposition":"Enuresis"}],"ts":1632131157,"type":"custom","difficulte":"2"}
-{"_id":"dlrped-ped-03234b","context":null,"enonce":"Which of the following can be prescribed for a 2-year-old?","item":"dlrped","matiere":"ped","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Paracetamol"},{"correct":false,"justification":"From 3 years old","idx":1,"proposition":"Tramadol"},{"correct":false,"justification":"From 12 years old","idx":2,"proposition":"Codeine"},{"correct":true,"justification":"True","idx":3,"proposition":"Nalbuphine"},{"correct":true,"justification":"True","idx":4,"proposition":"MEOPA"}],"ts":1632131163,"type":"custom","difficulte":"2"}
-{"_id":"retardSP-ped-feb24c","context":null,"enonce":"At 3 months, the birth weight is:","item":"retardSP","matiere":"ped","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Unchanged"},{"correct":true,"justification":"True","idx":1,"proposition":"Double"},{"correct":false,"justification":"False","idx":2,"proposition":"Triplet"},{"correct":false,"justification":"False","idx":3,"proposition":"Quadruplet"},{"correct":false,"justification":"of 7kg on average","idx":4,"proposition":"From 15kg on average"}],"ts":1632131176,"type":"custom","difficulte":"2"}
-{"_id":"autonomiegeria-mpr-2ec831","context":null,"enonce":"Regarding autonomy and dependence in the elderly, what are the exact proposal(s)?","item":"autonomiegeria","matiere":"mpr","propositions":[{"correct":true,"justification":"True, this is the very definition\r\n","idx":0,"proposition":"A USLD is a residential service for chronic and disabling pathologies, and a UHR is a residential service for chronic and disabling psychiatric pathologies.\r\n"},{"correct":true,"justification":"True, it includes an organization of several face-to-face aids\r\n","idx":1,"proposition":"The SSIAD is a service combining personal assistance and administrative assistance\r\n"},{"correct":true,"justification":"True, it also allows a reassessment of the aid plan to relieve caregivers physically and psychically\r\n","idx":2,"proposition":"\"Respite hospitalizations\" are hospitalizations to allow caregivers to rest\r\n"},{"correct":false,"justification":"False, this MCQ was important to know the classic APA criteria (>60 years, France > 3 months) but also to know the IRM grid. It goes from GIR 6 (autonomous) to GIR 1 (moribund) and the APA is given for GIR 1 to 4.\r\n","idx":3,"proposition":"The APA (Personalized Autonomy Allowance) is available to people over 60 years old, living in France for at least 3 months, being classified in the GIR grid 2 to 6\r\n"},{"correct":true,"justification":"True, three times true. Auxiliaries, remote alarm, carrying meals, housing development, protections, HDJ, temporary accommodation, nursing homes","idx":4,"proposition":"The APA finances numerous physical, material and financial aids\r\n"}],"ts":1632131207,"type":"custom","difficulte":"1"}
-{"_id":"allergie-pneumo-321480","context":null,"enonce":"Which of the following are possible allergens?","item":"allergie","matiere":"pneumo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Animal protein"},{"correct":true,"justification":"True. Allergens are proteins of animal or plant origin.","idx":1,"proposition":"Vegetable protein"},{"correct":false,"justification":"With some exceptions, carbohydrates (lactose in particular) and lipids are not allergenic.","idx":2,"proposition":"Carbohydrate"},{"correct":false,"justification":"False","idx":3,"proposition":"Lipids"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"ts":1632131263,"type":"custom","difficulte":"1"}
-{"_id":"tbsommeil-pneumo-3cd1e7","context":null,"enonce":"At what apnea\/hypopnea index threshold, are we talking about obstructive sleep apnea syndrome?","item":"tbsommeil","matiere":"pneumo","propositions":[{"correct":false,"justification":"False, this is the apnea threshold for the child","idx":0,"proposition":"Apnea index hypopnea at 3"},{"correct":true,"justification":"True","idx":1,"proposition":"Apnea index hypopnea at 5"},{"correct":false,"justification":"False, this is the threshold of severity of sleep apnea","idx":2,"proposition":"Apnea index hypopnea at 30"},{"correct":false,"justification":"False","idx":3,"proposition":"Apnea index hypopnea at 50"},{"correct":false,"justification":"False","idx":4,"proposition":"Index of apnea hypopneas at 100"}],"ts":1632131361,"type":"custom","difficulte":"1"}
-{"_id":"tbsommeil-pneumo-62a040","context":null,"enonce":"Which of the following propositions regarding obstructive sleep apnea syndrome is true?","item":"tbsommeil","matiere":"pneumo","propositions":[{"correct":true,"justification":"True, OSA screening must be carried out in front of a risk terrain (cardiovascular comorbidities, cardiovascular risk factors, metabolic syndrome, respiratory pathologies) and \/ or revealing symptoms (snoring, pauses, suffocation, apnea, nocturia, anxio-depressive syndrome, daytime sleepiness ...)","idx":0,"proposition":"Any obese patient with snoring should be referred for consultation or should perform nocturnal oximetry screening for sleep apnea syndrome"},{"correct":false,"justification":"False, the Epworth score looks for daytime sleepiness. It is pathological when it is greater than 11","idx":1,"proposition":"Epworth score looks for nocturnal symptoms of sleep apnea through interrogation elements"},{"correct":false,"justification":"False, the screening is done by nocturnal oximetry (imagine it as a Holter of SaO2) and the diagnosis is done by ventilatory polygraphy or polysomnography","idx":2,"proposition":"Screening for obstructive sleep apnea syndrome is done by nocturnal ventilatory polygraphy. "},{"correct":true,"justification":"True, it is part of the comorbidities that may indicate bariatric surgery during a BMI >35 especially because its improvement in post-surgery is quite frequent","idx":3,"proposition":"Obstructive sleep apnea syndrome may be an indication for bariatric surgery in case of BMI > 35"},{"correct":true,"justification":"True, fatal risk to the patient due to drowsiness","idx":4,"proposition":"Obstructive sleep apnea syndrome is a temporary contraindication to driving"}],"ts":1632131385,"type":"custom","difficulte":"1"}
-{"_id":"BPCO-pneumo-23d43c","context":null,"enonce":"What is the threshold of the Golde score defining intraalveolar hemorrhage?","item":"BPCO","matiere":"pneumo","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"10"},{"correct":false,"justification":"","idx":1,"proposition":"20"},{"correct":false,"justification":"","idx":2,"proposition":"50"},{"correct":true,"justification":"True","idx":3,"proposition":"100"},{"correct":false,"justification":"","idx":4,"proposition":"500"}],"ts":1632131395,"type":"custom","difficulte":"1"}
-{"_id":"exantheme-dermato-1f19da","context":null,"enonce":"Regarding febrile rashes, which of these propositions are true?","item":"exantheme","matiere":"dermato","propositions":[{"correct":true,"justification":"True, a fever in children is rarely greater than 5 days, Kawasaki syndrome is sought with cardiac ultrasound and CBC","idx":0,"proposition":"A febrile rash of more than 5 days in children should be tested for Kawasaki syndrome"},{"correct":true,"justification":"True, these two forms of rashes are called \"large simulators\", HIV and syphilis can mimic many dermatological pathologies ...","idx":1,"proposition":"An atypical, poorly systematized rash in adults should be reminiscent of HIV or syphilis"},{"correct":false,"justification":"False, it is an erythema called in \"bellows\" (bright red cheeks and edematous) and \"gloves and socks\" (red hands and feet edematous)","idx":2,"proposition":"A so-called \"cervical cache\" erythema is found in Parvovirus B19 infection"},{"correct":true,"justification":"True, this is scarlet fever caused by a Strepto A infection.","idx":3,"proposition":"Of the most common febrile childhood rashes, only one is of bacterial origin"},{"correct":false,"justification":"False, there is only one flare-up during measles with a start behind the ear and a downward path.","idx":4,"proposition":"Unlike rubella, measles progresses in several outbreaks"}],"ts":1632131414,"type":"custom","difficulte":"1"}
-{"_id":"prurit-dermato-9853ca","context":null,"enonce":"Regarding pruritus, what are the exact proposal(s)?","item":"prurit","matiere":"dermato","propositions":[{"correct":true,"justification":"True, it is to be distinguished from physiological pruritus which has no impact.","idx":0,"proposition":"Pruritus is said to be pathological when it causes lesions or functional repercussions"},{"correct":false,"justification":"False, a pruritus sine materia is a pruritus that does not have lesions except those caused by pruritus itself.","idx":1,"proposition":"A pruritus sine materia is a pruritus that does not present lesions and therefore and is synonymous with physiological pruritus"},{"correct":false,"justification":"False, nasty trap, but urticaria and psoriasis have dermatological lesions...","idx":2,"proposition":"Causes of pruritus sine materia frequently include dysthyroidism, medications, parasitosis, hives, psoriasis, cholestasis and hemopathies."},{"correct":true,"justification":"True, no more and no less","idx":3,"proposition":"The assessment of pruritus sine materia includes: NFS, CRP, Iono, BR, BH, TSH, HIV\/HBV\/HCV, abdominal ultrasound, chest X-ray"},{"correct":false,"justification":"False, we will favor topical treatments and if only the pruritus is too intense we can use antihistamines","idx":4,"proposition":"Benzodiazepines are the treatment of choice to soothe the patient to avoid pruritus"}],"ts":1632131417,"type":"custom","difficulte":"1"}
-{"_id":"hemangiome-dermato-cc5714","context":null,"enonce":"Luke Marcheciel is a newborn baby who was born 24 hours ago. While you take the time to reread the letters and you have entrusted the clinical examination of the baby to your outpatient, he comes back proud because he thinks he has diagnosed a hemangioma! Suspicious, you congratulate him, but question his diagnosis. What elements of the clinical picture or examination will refute your external hypothesis?","item":"hemangiome","matiere":"dermato","propositions":[{"correct":true,"justification":"True, a hemangioma usually only sets in after several weeks of life, unlike the vascular malformation that is present from birth.","idx":0,"proposition":"Speed of installation"},{"correct":false,"justification":"False, color has no impact on the diagnosis.","idx":1,"proposition":"A raspberry color of the lesion"},{"correct":true,"justification":"True, a hemangioma is flexible, soft and has no pulsations or internal heat. Unlike vascular malformation","idx":2,"proposition":"A beating, warm and pulsatile mass"},{"correct":true,"justification":"True, varicose veins and vascular malformations are characteristic of congenital malformations ","idx":3,"proposition":"Associated varicose veins"},{"correct":false,"justification":"False, vascular malformation remains stable, unlike hemangioma","idx":4,"proposition":"An expansion of mass in the coming days"}],"ts":1632131420,"type":"custom","difficulte":"1"}
-{"_id":"exantheme-dermato-1e84ac","context":null,"enonce":"During your Saturday standby, you go to your MPR department and you meet Mrs. Jeanne Dorian, 67 years old, who is gradually recovering from her stroke that occurred 1 month ago. She tells you that if the resumption of walking is gradual, she still has a lot of trouble grasping her glass of water with her right hand which is \"paralyzed\". She wonders how she will be able to play the violin with such a weak hand... Link the impact of the disability with the examples from the statement.","item":"exantheme","matiere":"dermato","propositions":[{"correct":false,"justification":"False, Deficiency","idx":0,"proposition":"Hemiplegia = Activity limitation"},{"correct":true,"justification":"True","idx":1,"proposition":"Difficulty grasping the glass of water = Activity limitation"},{"correct":true,"justification":"True","idx":2,"proposition":"Stop playing the violin = Restriction of participation"},{"correct":false,"justification":"False, Activity limitation","idx":3,"proposition":"Difficulty grasping the glass of water = Impairment"},{"correct":false,"justification":"False, Restriction of participation","idx":4,"proposition":"Stop playing the violin = Activity limitation"}],"ts":1632131423,"type":"custom","difficulte":"1"}
-{"_id":"152-dermato-1086b55f-c6b1-4335-a827-6a24c6abb0c6","context":null,"enonce":"Regarding cutaneous-mucosal infections with Candida, what are the exact proposal(s)?","item":"infdermato","matiere":"dermato","propositions":[{"correct":true,"justification":"True, this kind of infection is very common ","idx":0,"proposition":"A perlèche is an intertrigo of the labial commissure, which may be of fungal origin"},{"correct":true,"justification":"True, this semiological finesse is important to distinguish the two causes and allow an adapted antifungal treatment","idx":1,"proposition":"Unlike dermatophytes, nail candidiasis has centrifugal extension and perionyxis"},{"correct":false,"justification":"False, it is necessary to know what is typical of candidiasis (under breast, abdominal fold, intergluteal) and dermatophyte (inguinal)","idx":2,"proposition":"An intertrigo of the inguinal folds is classic of candida infections"},{"correct":false,"justification":"False, one of the most important points of candidiasis is its physiological presence in the digestive and vaginal mucous membranes","idx":3,"proposition":"In front of an infection, vaginosis type, a positive Candida sample signs vaginal candidiasis"},{"correct":false,"justification":"False, these are systemic antifungals.","idx":4,"proposition":"Topical antifungals are mainly based on fluconazole or amphotericin B"}],"ts":1632131429,"type":"custom","difficulte":"1"}
-{"_id":"DBAI-dermato-828ed3","context":null,"enonce":"Regarding autoimmune bullous dermatoses which of these propositions are true?","item":"DBAI","matiere":"dermato","propositions":[{"correct":true,"justification":"True, and far ahead of pemphigus","idx":0,"proposition":"The most common autoimmune bullous dermatosis in France is bullous pemphigoid"},{"correct":true,"justification":"True, which makes it can be confused with Behcet's disease or Cowden syndrome (do not remember Cowden syndrome)","idx":1,"proposition":"Clinically, pemphigus can present only through mouth or genital ulcerations."},{"correct":false,"justification":"False, indeed it is necessary to make several samples, but because there will be one that will be unfixed (for histological analysis) and one that will be fixed to highlight the areas of fixation of antibodies.","idx":2,"proposition":"It is essential to take several samples during the biopsy, with the main purpose of allowing a second opinion in case of diagnostic doubt"},{"correct":true,"justification":"True, these are also the same complications as pressure ulcers if you notice well.","idx":3,"proposition":"The main complications of autoimmune bullous dermatoses are infections, hypothermia, dehydration and undernutrition."},{"correct":false,"justification":"False, it has been shown for years, that local corticosteroid therapy has a similar effectiveness for fewer adverse effects","idx":4,"proposition":"The standard of care is based on systemic corticosteroid therapy"}],"ts":1632131431,"type":"custom","difficulte":"1"}
-{"_id":"TED-psy-5faba8","context":null,"enonce":"Which of the following proposals may be present in a child with autism spectrum disorder?","item":"TED","matiere":"psy","propositions":[{"correct":true,"justification":"When parents smile at their child, the child does not smile at them. This is a very early sign of autism. ","idx":0,"proposition":"Absence or rarity of smiles answers"},{"correct":true,"justification":"True, by social clumsiness","idx":1,"proposition":"Children have difficulty accessing implicit and figurative language"},{"correct":true,"justification":"These are the difficulties in having reciprocal exchanges. The child will also have remarks that are focused on his own interests and does not take into account the point of life or the words of the interlocutor to register in a turn of turn (social clumsiness). ","idx":2,"proposition":"Conversations tend to be focused on the patient's interests"},{"correct":false,"justification":"The child has a lot of difficulty making friends. In addition, they are often not very interested in social relationships with peers (lack of social motivation). ","idx":3,"proposition":"The child has facilities to make friends"},{"correct":true,"justification":"True, very characteristic","idx":4,"proposition":"The child repeatedly uses objects"}],"ts":1632131520,"type":"custom","difficulte":"2"}
-{"_id":"bipolaire-psy-7b3b02","context":null,"enonce":"Which of the following propositions regarding bipolar disorder is true?","item":"bipolaire","matiere":"psy","propositions":[{"correct":true,"justification":"True, hence sometimes the notion of bipolar disorder type III, manic disorders induced by antidepressants etc ...","idx":0,"proposition":"Although a distinction is usually made between type I and type II bipolar disorder, there are bipolar disorders that do not fit into this classification."},{"correct":true,"justification":"True, this is THE prodrome to know in the bipolar patient","idx":1,"proposition":"A manic crisis should be evoked in front of a bipolar patient, with recent insomnia without fatigue"},{"correct":false,"justification":"False, on the contrary, the fact that he is not \"paralyzed\" by depression, will promote the passage to the act","idx":2,"proposition":"In front of a patient with manic syndrome, it is useless to look for suicidal thoughts, since he presents an elation of mood"},{"correct":false,"justification":"False, treatment will be implemented remotely, once bipolar disorder is diagnosed and differential diagnoses have been ruled out.","idx":3,"proposition":"In front of a maniacal patient in the emergency room, lithium treatment must be initiated without delay, because of its long half-life and narrow therapeutic range."},{"correct":true,"justification":"True, as well as regular serum lithium","idx":4,"proposition":"Monitoring of lithium in chronic treatment is based in particular on TSH, urea and annual serum creatinine"}],"ts":1632131527,"type":"custom","difficulte":"1"}
-{"_id":"TED-psy-352349","context":null,"enonce":"Regarding comorbidities with other neurodevelopmental disorders. Which of the following are true?","item":"TED","matiere":"psy","propositions":[{"correct":false,"justification":"40%","idx":0,"proposition":"30% of children with ASD have an intellectual disability"},{"correct":false,"justification":"30%","idx":1,"proposition":"20% of children with ASD have attention deficit hyperactivity disorder"},{"correct":true,"justification":"These are non-verbal ASDs","idx":2,"proposition":"20% of children have oral language acquisition disorders "},{"correct":true,"justification":"True","idx":3,"proposition":"Children often have sleep disorders"},{"correct":false,"justification":"20%","idx":4,"proposition":"10% of children with autism spectrum disorder will have epilepsy at some point in their lives"}],"ts":1632131746,"type":"custom","difficulte":"2"}
-{"_id":"psygrossesse-psy-7ac150","context":null,"enonce":"Which of the following are risk factors for postpartum mental disorders?","item":"psygrossesse","matiere":"psy","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Social precariousness"},{"correct":false,"justification":"Rather single-parent family","idx":1,"proposition":"Large family"},{"correct":false,"justification":"Rather nulliparity","idx":2,"proposition":"Multiparity"},{"correct":true,"justification":"True","idx":3,"proposition":"Denial of pregnancy"},{"correct":true,"justification":"True","idx":4,"proposition":"Family history of psychiatric disorders"}],"ts":1632131753,"type":"custom","difficulte":"2"}
-{"_id":"TED-psy-d0a76a","context":null,"enonce":"Among the following proposals, which additional examinations are part of the assessment to look for differential diagnoses of pervasive developmental disorders?","item":"TED","matiere":"psy","propositions":[{"correct":false,"justification":"Only to make the diagnosis of associated disease. Epilepsy is not a differential diagnosis.","idx":0,"proposition":"Wake and sleep EEG"},{"correct":true,"justification":"To look for deafness or hearing loss","idx":1,"proposition":"Audiogram and PEA"},{"correct":true,"justification":"Search for differential diagnoses and also associated diagnoses","idx":2,"proposition":"Psychomotor assessment"},{"correct":false,"justification":"These are scores to make the positive diagnosis. The ADI-R is a semi-structured interview with parents, which examines the current symptomatology as well as the developmental history of the child. ADOS is a semi-structured observation of the child's symptomatology. ","idx":3,"proposition":"ADI-R and ADOS"},{"correct":false,"justification":"These diagnostic tests are useful for diagnosing ASD syndromes, not for finding a differential diagnosis.","idx":4,"proposition":"Neurological, genetic, metabolic and brain MRI assessments"}],"ts":1632131864,"type":"custom","difficulte":"2"}
-{"_id":"dvlptpsychoMo-psy-d565a7","context":null,"enonce":"Which of the following are true?","item":"dvlptpsychoMo","matiere":"psy","propositions":[{"correct":true,"justification":"True, at the maneuver we can observe a fall behind the head up to 2 months of age","idx":0,"proposition":"The pull-and-sit maneuver is used to evaluate the holding of the head"},{"correct":false,"justification":"False, at 4 months, he sits with support. At 8 months only, without support","idx":1,"proposition":"From 4 months, the child must sit without support"},{"correct":true,"justification":"True, walking alone can be observed from 9 to 18 months.","idx":2,"proposition":"The child can walk alone from 9 months"},{"correct":true,"justification":"True, reflex from bending the fingers to stimulating the palms of the hands or feet","idx":3,"proposition":"The reflex grasping is a reflex of the newborn"},{"correct":false,"justification":"False, she becomes a volunteer around 4-5 months. At 9 months the child can manipulate with 2 hands and also appears the thumb clamp index","idx":4,"proposition":"The grip becomes voluntary from 9 months"}],"ts":1632131939,"type":"custom","difficulte":"2"}
-{"_id":"TED-psy-6aadcb","context":null,"enonce":"Regarding the schooling of patients with ASD, which are true?","item":"TED","matiere":"psy","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"The type of schooling adapted to the child will depend on the level of severity of ASD, the impact\r\nfunctional disorder and associated neurodevelopmental disorders and parental choice."},{"correct":false,"justification":"The children have an ordinary schooling, but there will be adjustments. The Personalized Support Project (PAP) and the Personalized Schooling Project (PPS) specify the arrangements that should allow schooling in an ordinary environment. Some patients will therefore be able to benefit from a School Life Assistant (AVS) when they have learning difficulties or difficulties with autonomy.","idx":1,"proposition":"Patients with mild ASD without another neurodevelopmental disorder\r\nassociated, and with a slight functional impact, have schooling in an ordinary environment, and will have no accommodation."},{"correct":true,"justification":"True","idx":2,"proposition":"Patients with mild ASD, another associated neurodevelopmental disorder (for example, mild intellectual disability), and with mild or moderate functional impact will be enrolled in ULIS (Localized Units for Inclusive Education) classes."},{"correct":true,"justification":"Medical-educational institutes","idx":3,"proposition":"Patients with moderate to severe ASD and another associated neurodevelopmental disorder (e.g., moderate intellectual disability), and with moderate or severe functional impact: IME orientation."},{"correct":false,"justification":"The statement is true, except for the PAP. Simple school arrangements made by the PAP do not need notification to the MDPH: the project is only validated by the school doctor.","idx":4,"proposition":"The implementation of school facilities (PAP, PPS, AVS) and school orientations (ULIS, IME) always require notification from the MDPH, which requires the drafting of a reasoned medical certificate."}],"ts":1632131962,"type":"custom","difficulte":"2"}
-{"_id":"dlrpsy-psy-8fcc57","context":null,"enonce":"Regarding the links between pain and mental health, what are the exact proposition(s)?","item":"dlrpsy","matiere":"psy","propositions":[{"correct":true,"justification":"True, it is quite logical, psychic pain leads to physical pain and vice versa","idx":0,"proposition":"Patients with a characterized depressive episode more often have chronic pain complaints and vice versa"},{"correct":true,"justification":"True, the pathophysiological cause\/consequence is more difficult to pin down, but it does exist...","idx":1,"proposition":"A fibromyalgia patient has a higher risk of developing bipolar disorder than a person without chronic pain"},{"correct":false,"justification":"False, the urgency is the chest pain here that must quickly perform an ECG","idx":2,"proposition":"In front of a patient in the emergency room having a panic attack, who complains of chest pain at the same time, the urgency is to calm the patient by words or by a benzodiazepine"},{"correct":false,"justification":"False, the schizophrenic patient feels the pain but does not recognize it and cannot express it clearly","idx":3,"proposition":"The schizophrenic patient develops anesthesia to pain, which explains why he expresses it less because he feels it less"},{"correct":true,"justification":"True, a bit like the schizophrenic patient, he has trouble expressing his pain clearly and therefore the pain is to be sought!","idx":4,"proposition":"Children with autism spectrum disorder may exhibit withdrawal, aggression or mutilation behaviours in the face of pain"}],"ts":1632131967,"type":"custom","difficulte":"1"}
-{"_id":"somatopsy-psy-cb0582","context":null,"enonce":"Regarding somatoform disorders, which of these propositions are true?","item":"somatopsy","matiere":"psy","propositions":[{"correct":true,"justification":"True, like any psychiatric illness. A child of a depressed parent is more likely to develop depression. Same with somatoform disorder","idx":0,"proposition":"There is polygenic genetic transmission of somatoform disorders "},{"correct":true,"justification":"True, extremely frequent. Any doctor will face this situation at some point.","idx":1,"proposition":"Among the functional signs often expressed in somatoform disorders, we readily find chest and abdominal pain"},{"correct":false,"justification":"False, it is an entire part of it. It is the erroneous belief of being overweight or obese.","idx":2,"proposition":"Dysmorphophobia is not part of somatoform disorders"},{"correct":false,"justification":"False, somatoform disorder is a diagnosis of elimination. Just because a patient has psychiatric disorders doesn't mean they can't have a heart attack or stroke!","idx":3,"proposition":"Faced with a physical complaint in a patient with multiple psychiatric history, it is necessary to know how to quickly evoke somatoform disorders"},{"correct":false,"justification":"False, the patient is convinced that he has a medical pathology, and the perpetuation of negative examinations only reinforces his certainty (the idea that his disease is not known to doctors, is not diagnosable etc ...)","idx":4,"proposition":"It is often recommended to multiply additional examinations and medical opinions in front of a somatoform disorder, to reassure the patient"}],"ts":1632131970,"type":"custom","difficulte":"1"}
-{"_id":"psyage-psy-3a1765","context":null,"enonce":"Concerning mental disorders in the elderly, which of the following propositions are true?","item":"psyage","matiere":"psy","propositions":[{"correct":true,"justification":"True, these units are frequently found in geriatric clusters.","idx":0,"proposition":"The management of patients with chronic psychiatric disorders or psychiatric manifestations of neurodegenerative pathologies can be done in U.C.C (cognitive-behavioral units)"},{"correct":false,"justification":"Wrong, it's the other way around. ","idx":1,"proposition":"Schizophrenia in the elderly will manifest itself by a predominance of negative symptoms and disorganization and a lesser presence of positive symptoms"},{"correct":false,"justification":"False, usually we find delusions of persecution or misidentification","idx":2,"proposition":"In the psychiatric manifestations of neurodegenerative diseases we will find delusional ideas of grandeur or megalomania"},{"correct":false,"justification":"False, usually we start at half dose, to avoid the main side effects","idx":3,"proposition":"To prescribe psychotropic drugs in the elderly, we start at the same dose as in adults, but we increase the doses more gradually."},{"correct":true,"justification":"True, benzodiazepine abuse and addiction is extremely common in the general population.","idx":4,"proposition":"A memory complaint may be related to chronic addiction to benzodiazepines"}],"ts":1632131972,"type":"custom","difficulte":"1"}
-{"_id":"certificats-psy-82219e","context":null,"enonce":"ITT stands for:","item":"certificats","matiere":"psy","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"total incapacity for work"},{"correct":false,"justification":"","idx":1,"proposition":"temporary incapacity for work"},{"correct":false,"justification":"","idx":2,"proposition":"Total temporary incapacity"},{"correct":true,"justification":"True","idx":3,"proposition":"Total incapacity for work"},{"correct":false,"justification":"","idx":4,"proposition":"All proposals are wrong"}],"ts":1632131985,"type":"custom","difficulte":"1"}
-{"_id":"IU-infectio-511764","context":null,"enonce":"What are the additional examinations of acute non-serious pyelonephritis without risk of complications probably diagnosed?","item":"IU","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"DRANK"},{"correct":true,"justification":"True","idx":1,"proposition":"ECBU"},{"correct":false,"justification":"If second episode or hyperalgic form","idx":2,"proposition":"Ultrasound"},{"correct":false,"justification":"If PNA severe or at risk of complication","idx":3,"proposition":"Uroscanner"},{"correct":false,"justification":"If in doubt diagnosis","idx":4,"proposition":"Blood culture"}],"ts":1632212139,"type":"custom","difficulte":"1"}
-{"_id":"PECKc-urg-3d795d","context":null,"enonce":"Which of the following propositions concerning pre-eclampsia are true?","item":"PECKc","matiere":"urg","propositions":[{"correct":false,"justification":"False, in 4 to 12% of pre-eclampsia. Pre-eclampsia affects 3 to 10% of pregnancies. ","idx":0,"proposition":"HELLP syndrome occurs in 4 to 12% of pregnancies"},{"correct":true,"justification":"True","idx":1,"proposition":"Immediate hospitalization is indicated before the discovery of pre-eclampsia"},{"correct":true,"justification":"True","idx":2,"proposition":"In front of any visual abnormality it is necessary to make a fundus in search of hypertensive complications. "},{"correct":true,"justification":"True, others are acute fatty liver disease (SHAG), HUS or thrombotic thrombocytopenic purpura (TTP)","idx":3,"proposition":"One of the differential diagnoses of pre-eclampsia is thrombotic microangiopathy. "},{"correct":false,"justification":"False, it is only necessary to undertake a vascular filling when a risk of hypovolemia is predictable. Overfilling can precipitate the occurrence of an OAP. ","idx":4,"proposition":"Vascular filling of patients with pre-eclampsia is essential. "}],"ts":1632227427,"type":"custom","difficulte":"2"}
-{"_id":"359-urg-95ddc9af-8e9a-4f9f-aa0e-ac7b9b7868fa","context":null,"enonce":"Regarding fractures of the upper end of the femur. Which of the following are true?","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":"External rotation","idx":0,"proposition":"The typical deformation is in Shortening, Internal Rotation, Adduction.\r\n"},{"correct":true,"justification":"The trochanterian massif is mainly trabecular bone.","idx":1,"proposition":"The trochanterian massif is mainly trabecular bone."},{"correct":false,"justification":" Psoas","idx":2,"proposition":"The little trochanter is the insertion site of the gluteus medius"},{"correct":false,"justification":"gluteus medius","idx":3,"proposition":"The great trochanter is the insertion site of the Psoas"},{"correct":false,"justification":"False.","idx":4,"proposition":"During a pertrochanteric fracture, there is a risk of osteonecrosis of the femoral head."}],"ts":1632227502,"type":"custom","difficulte":"1"}
-{"_id":"boiterieped-ortho-4d3340","context":null,"enonce":"Regarding superior femoral epiphysiolysis. Which of the following proposition(s) are true?","item":"boiterieped","matiere":"ortho","propositions":[{"correct":false,"justification":"False. 1st cause","idx":0,"proposition":"It is the second cause of hip lameness during the pubertal period, after osteoarticular infection."},{"correct":true,"justification":"True","idx":1,"proposition":"Being overweight is a risk factor"},{"correct":false,"justification":"False. External rotation. ","idx":2,"proposition":"The patient walks in internal rotation"},{"correct":true,"justification":"True","idx":3,"proposition":"There are two forms: the stable form and the unstable form"},{"correct":true,"justification":"True","idx":4,"proposition":"It is a growing cartilage disease of unknown cause."}],"ts":1632229036,"type":"custom","difficulte":"2"}
-{"_id":"boiterieped-ortho-a970b5","context":null,"enonce":"Among the main germs found in children, we find which germ at what age?","item":"boiterieped","matiere":"ortho","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Kingella kingae in children from 6 months to 4 years"},{"correct":false,"justification":"False. Salmonella sp.","idx":1,"proposition":"Staphylococcus aureus is the majority in children with sickle cell disease"},{"correct":false,"justification":"False. This is Kingella kingae. ","idx":2,"proposition":"Pneumococcus is the most common germ in children from 6 months to 4 years"},{"correct":true,"justification":"True","idx":3,"proposition":"Staphyloccocus aureus is the majority in children over 4 years of age"},{"correct":true,"justification":"True. Infection during childbirth.","idx":4,"proposition":"E. coli and group B streptococcus are the majority in infants less than 3 months of age"}],"ts":1632229134,"type":"custom","difficulte":"2"}
-{"_id":"boiterieped-ortho-6136eb","context":null,"enonce":"Which one(s) is part of the systematic assessment in the face of a suspicion of acute osteoarticular infection in children?","item":"boiterieped","matiere":"ortho","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Ultrasound of the affected joint, often comparative"},{"correct":false,"justification":"False. It is the best test for diagnosing IOA (more sensitive and specific than bone scan), but it is not indicated systematically. ","idx":1,"proposition":"Systematic MRI"},{"correct":true,"justification":"True","idx":2,"proposition":"Blood"},{"correct":true,"justification":"True","idx":3,"proposition":"Systematic block washing with sampling"},{"correct":true,"justification":"True","idx":4,"proposition":"NFS, CRP"}],"ts":1632229169,"type":"custom","difficulte":"2"}
-{"_id":"radiculalgie-ortho-21b8bd","context":null,"enonce":"Which of the following refer to muscles innervated by the median nerve?","item":"radiculalgie","matiere":"ortho","propositions":[{"correct":false,"justification":"Ulnar nerve","idx":0,"proposition":"Interosseous"},{"correct":false,"justification":"Ulnar nerve","idx":1,"proposition":"Earthworms"},{"correct":false,"justification":"Extension is provided by the radial nerve","idx":2,"proposition":"Finger extenders"},{"correct":false,"justification":"Ulnar nerve","idx":3,"proposition":"The adductor of the thumb"},{"correct":true,"justification":"True","idx":4,"proposition":"None of the propositions are true"}],"ts":1632229276,"type":"custom","difficulte":"1"}
-{"_id":"radiculalgie-ortho-ad68a1","context":null,"enonce":"Which of the following propositions refer to muscles of the hypothenar compartment?","item":"radiculalgie","matiere":"ortho","propositions":[{"correct":true,"justification":"True, all the muscles mentioned in these propositions are innervated by the ulnar nerve","idx":0,"proposition":"Opponent of the 5"},{"correct":true,"justification":"True","idx":1,"proposition":"Adductor of the 5"},{"correct":true,"justification":"True","idx":2,"proposition":"Flexor of the 5"},{"correct":false,"justification":"Thenarian Lodge","idx":3,"proposition":"Opponent of the thumb"},{"correct":false,"justification":"Thenarian Lodge","idx":4,"proposition":"Adductor of the thumb"}],"ts":1632229323,"type":"custom","difficulte":"1"}
-{"_id":"radiculalgie-ortho-cced87","context":null,"enonce":"Which of the following are muscles innervated by the ulnar nerve?","item":"radiculalgie","matiere":"ortho","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Short deep flexor of the thumb"},{"correct":false,"justification":"Medial nerve","idx":1,"proposition":"Short superficial flexor of the thumb"},{"correct":false,"justification":"Medial nerve","idx":2,"proposition":"Opponent of the thumb"},{"correct":true,"justification":"True","idx":3,"proposition":"Adductor of the thumb"},{"correct":false,"justification":"Medial nerve","idx":4,"proposition":"Abductor of the thumb"}],"ts":1632229343,"type":"custom","difficulte":"1"}
-{"_id":"radiculalgie-ortho-e83341","context":null,"enonce":"Regarding the gooseneck:","item":"radiculalgie","matiere":"ortho","propositions":[{"correct":false,"justification":"It is the evolution of a mallet finger","idx":0,"proposition":"It is the evolution of a buttonhole finger"},{"correct":true,"justification":"True","idx":1,"proposition":"The ligaments are retracted"},{"correct":true,"justification":"True","idx":2,"proposition":"It reflects the chronic involvement of the IPD extender"},{"correct":false,"justification":"False","idx":3,"proposition":"It reflects chronic involvement of the IPD flexor"},{"correct":false,"justification":"False","idx":4,"proposition":"It reflects chronic involvement of the PPI extender"}],"ts":1632229362,"type":"custom","difficulte":"1"}
-{"_id":"dysphagie-HGE-eaefe0","context":null,"enonce":"Which of the following are true about Zenker's diverticulum?","item":"dysphagie","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The hernia develops in retroesophageal"},{"correct":false,"justification":"Perm","idx":1,"proposition":"Dysphagia is fluctuating"},{"correct":true,"justification":"True","idx":2,"proposition":"It can cause inhalation pneumonitis"},{"correct":true,"justification":"True","idx":3,"proposition":"Nasofibroscopy regains the sign of the tide 🌊"},{"correct":false,"justification":"Surgery: myotomy","idx":4,"proposition":"Treatment relies on PEPs"}],"ts":1632320589,"type":"custom","difficulte":"1"}
-{"_id":"cirrhose-HGE-9de951","context":null,"enonce":"Which hepatitis virus(s) is\/are usually asymptomatic in the acute phase?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"HAV"},{"correct":true,"justification":"True, in 70% of cases","idx":1,"proposition":"HBV"},{"correct":true,"justification":"True, in 80% of cases","idx":2,"proposition":"HCV"},{"correct":false,"justification":"","idx":3,"proposition":"VHD"},{"correct":false,"justification":"","idx":4,"proposition":"HEV"}],"ts":1632320750,"type":"custom","difficulte":"1"}
-{"_id":"hemorroides-HGE-70a76e","context":null,"enonce":"What is the lifetime prevalence of hemorrhoids?","item":"hemorroides","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"5%"},{"correct":true,"justification":"True","idx":1,"proposition":"33%"},{"correct":false,"justification":"","idx":2,"proposition":"50%"},{"correct":false,"justification":"","idx":3,"proposition":"75%"},{"correct":false,"justification":"","idx":4,"proposition":"90%"}],"ts":1632320767,"type":"custom","difficulte":"1"}
-{"_id":"hernie-HGE-46b754","context":null,"enonce":"Regarding hernia, what are the exact answer(s)?","item":"hernie","matiere":"HGE","propositions":[{"correct":true,"justification":"True, unlike ventration","idx":0,"proposition":"It is the passage of abdominal contents through a natural orifice"},{"correct":true,"justification":"True, in front of the coral and umbilical","idx":1,"proposition":"Inguinal hernia is the most common"},{"correct":true,"justification":"True, very common","idx":2,"proposition":"There are 150,000 hernia cures per year"},{"correct":false,"justification":"95%","idx":3,"proposition":"25% of the child's hernias are congenital"},{"correct":false,"justification":"🙃🙃🙈","idx":4,"proposition":"All propositions are true"}],"ts":1632320838,"type":"custom","difficulte":"1"}
-{"_id":"UGD-HGE-e20d82","context":null,"enonce":"Which of the following are possible complications of H. pylori infection?","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Malt lymphoma"},{"correct":true,"justification":"True","idx":1,"proposition":"Peptic ulcer"},{"correct":true,"justification":"True","idx":2,"proposition":"Gastric adenoarcinoma"},{"correct":false,"justification":"H. Pylori 👉 Adenocarcinoma","idx":3,"proposition":"Gastric squamous cell carcinoma"},{"correct":false,"justification":"Chronic","idx":4,"proposition":"Acute viral gastritis without chronicity"}],"ts":1632320884,"type":"custom","difficulte":"1"}
-{"_id":"constipation-HGE-1603af","context":null,"enonce":"Which of the following are true for irritable bowel syndrome (IBS)?","item":"constipation","matiere":"HGE","propositions":[{"correct":false,"justification":"Absent at night, predominates in the morning and post-prandial","idx":0,"proposition":"Pain predominates at night"},{"correct":false,"justification":"Yes, we can have both (typical pain + <3 bowel movements per week)","idx":1,"proposition":"There is no IBS form - Constipation"},{"correct":true,"justification":"True","idx":2,"proposition":"There are no organic abnormalities of the intestine"},{"correct":true,"justification":"True","idx":3,"proposition":"Rest helps calm pain"},{"correct":false,"justification":"Increased pain in post prandial","idx":4,"proposition":"We talk about painful hunger"}],"ts":1632320898,"type":"custom","difficulte":"1"}
-{"_id":"masseabdo-HGE-4ec5a4","context":null,"enonce":"Which of the following is one or more of the potential cause(s) of hepatomegaly?","item":"masseabdo","matiere":"HGE","propositions":[{"correct":true,"justification":"True, these are all causes :)","idx":0,"proposition":"Hemochromatosis"},{"correct":true,"justification":"True","idx":1,"proposition":"Wilson's disease"},{"correct":true,"justification":"True","idx":2,"proposition":"Syndrome de Budd Chiari"},{"correct":true,"justification":"True","idx":3,"proposition":"Liver polycystic disease"},{"correct":true,"justification":"True","idx":4,"proposition":"Prolonged cholestasis"}],"ts":1632320944,"type":"custom","difficulte":"1"}
-{"_id":"lithiaseB-HGE-6107e8","context":null,"enonce":"How does the incidence of lithiasis change with age?","item":"lithiaseB","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It increases"},{"correct":false,"justification":"","idx":1,"proposition":"It decreases"},{"correct":false,"justification":"","idx":2,"proposition":"It does not change"},{"correct":false,"justification":"","idx":3,"proposition":"This has not been studied 🤷 ♂️"},{"correct":false,"justification":"It was necessary to find 4 distractors 😂","idx":4,"proposition":"Studies are contradictory 🤷 ♀️"}],"ts":1632320952,"type":"custom","difficulte":"1"}
-{"_id":"diarrheeaigue-HGE-0573da","context":null,"enonce":"Which of the following are the providers of diarrhoea?","item":"diarrheeaigue","matiere":"HGE","propositions":[{"correct":true,"justification":"True, it is one of the most common treatments for diarrhea^^","idx":0,"proposition":"Amoxicillin + Clavulanic Acid"},{"correct":true,"justification":"True, ISIS to know","idx":1,"proposition":"Statins"},{"correct":true,"justification":"True, so important that it can go so far as to require stopping the treatment","idx":2,"proposition":"Metformin"},{"correct":true,"justification":"True, it is an antimetabolic (the lining of the intestine is renewed very quickly)","idx":3,"proposition":"Colchicine"},{"correct":true,"justification":"True, it's chemotherapy","idx":4,"proposition":"Anthracycline"}],"ts":1632321053,"type":"custom","difficulte":"1"}
-{"_id":"vomisst-HGE-8280d5","context":null,"enonce":"Which of the following are anti-emetic drugs?","item":"vomisst","matiere":"HGE","propositions":[{"correct":false,"justification":"6 effects: anxiolytics, hypnotics, anti-convulsants, orexigen, muscle relaxants, amnesiacs","idx":0,"proposition":"Benzodiazepines"},{"correct":true,"justification":"True, very frequently used","idx":1,"proposition":"Metoclopramide"},{"correct":true,"justification":"True, very frequently used","idx":2,"proposition":"Metopimazine"},{"correct":true,"justification":"True, it is used in particular to counter the adverse effects of chemotherapy","idx":3,"proposition":"Setron"},{"correct":true,"justification":"True, used in combination with others","idx":4,"proposition":"Corticosteroids"}],"ts":1632321099,"type":"custom","difficulte":"1"}
-{"_id":"diarrheeaigue-HGE-7278d2","context":null,"enonce":"Which of the following are signs of dehydration?","item":"diarrheeaigue","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Thirst"},{"correct":true,"justification":"True","idx":1,"proposition":"Dryness of mucous membranes"},{"correct":true,"justification":"True","idx":2,"proposition":"Weight loss"},{"correct":true,"justification":"True","idx":3,"proposition":"Prolonged skin fold"},{"correct":true,"justification":"True","idx":4,"proposition":"Dark circles "}],"ts":1632321106,"type":"custom","difficulte":"1"}
-{"_id":"MICI-HGE-787edd","context":null,"enonce":"Which of the following are tests to request in the face of suspicion of Crohn's disease?","item":"MICI","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Gastro-duodenal endoscopy + systematic staged biopsies"},{"correct":false,"justification":"Biopsies are systematic","idx":1,"proposition":"Colonoscopy + biopsies if macroscopic abnormalities"},{"correct":true,"justification":"True, Essential to assess hail. The 3 systematic examinations are: endoscopy + ileocolonoscopy + entero-MRI. Biopsy is done anywhere it can :)","idx":2,"proposition":"Entero-MRI"},{"correct":false,"justification":"Useless","idx":3,"proposition":"Abdominal PET scan"},{"correct":false,"justification":"Useless","idx":4,"proposition":"Whole body CT"}],"ts":1632321160,"type":"custom","difficulte":"1"}
-{"_id":"cirrhose-HGE-3cb87e","context":null,"enonce":"Which of the following are possible etiologies of cirrhosis?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Autoimmune hepatitis"},{"correct":true,"justification":"True","idx":1,"proposition":"Hemochromatosis"},{"correct":true,"justification":"True","idx":2,"proposition":"Syndrome de Budd-Chiari"},{"correct":true,"justification":"True","idx":3,"proposition":"Wilson's disease"},{"correct":false,"justification":"It is not a cause but a consequence","idx":4,"proposition":"Chronic hepatic encephalopathy"}],"ts":1632321167,"type":"custom","difficulte":"1"}
-{"_id":"splenomeg-HGE-ab52b8","context":null,"enonce":"What is the normal weight of a spleen?","item":"splenomeg","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"25-50g"},{"correct":true,"justification":"True","idx":1,"proposition":"150-250g"},{"correct":false,"justification":"","idx":2,"proposition":"500-1000g"},{"correct":false,"justification":"","idx":3,"proposition":"1500-2000g"},{"correct":false,"justification":"","idx":4,"proposition":"2500-3000g"}],"ts":1632321323,"type":"custom","difficulte":"1"}
-{"_id":"UGD-HGE-5a4124","context":null,"enonce":"Where does typical ulcer pain radiate?","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It does not irradiate"},{"correct":false,"justification":"","idx":1,"proposition":"To the umbilicus"},{"correct":false,"justification":"","idx":2,"proposition":"To the right iliac fossa"},{"correct":false,"justification":"","idx":3,"proposition":"Towards the hypogastrium"},{"correct":false,"justification":"","idx":4,"proposition":"In the back"}],"ts":1632321329,"type":"custom","difficulte":"1"}
-{"_id":"cirrhose-HGE-50ec3b","context":null,"enonce":"Which of the following are possible etiologies of cirrhosis?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Alcohol"},{"correct":true,"justification":"True","idx":1,"proposition":"HBV"},{"correct":true,"justification":"True","idx":2,"proposition":"HCV"},{"correct":false,"justification":"Never chronic hepatitis (but acute hepatitis possible)","idx":3,"proposition":"HAV"},{"correct":true,"justification":"True","idx":4,"proposition":"Non-alcoholic steatohepatitis"}],"ts":1632321339,"type":"custom","difficulte":"1"}
-{"_id":"dysphagie-HGE-d0a0e7","context":null,"enonce":"Which of the following are causes of primitive achalasia?","item":"dysphagie","matiere":"HGE","propositions":[{"correct":true,"justification":"True. Primitive = unknown etiology","idx":0,"proposition":"The etiology is unknown"},{"correct":false,"justification":"Cause of acute gastritis","idx":1,"proposition":"Viral (HSV CMV)"},{"correct":false,"justification":"","idx":2,"proposition":"Long-term PPI"},{"correct":false,"justification":"","idx":3,"proposition":"Hypercalcemia"},{"correct":false,"justification":"","idx":4,"proposition":"Helicobacter Pylori"}],"ts":1632321349,"type":"custom","difficulte":"1"}
-{"_id":"UGD-HGE-5a6da1","context":null,"enonce":"Which of the following are true for gastroduodenal endoscopy in duodenal ulcer?","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True, clinical signs, even typical, are not enough","idx":0,"proposition":"It is essential for the positive diagnosis of ulcer"},{"correct":false,"justification":"Under anesthesia, in a block","idx":1,"proposition":"It is done in the office"},{"correct":false,"justification":"Duodenal ulcers never degenerate into cancers","idx":2,"proposition":"Biopsies remove a tumour"},{"correct":true,"justification":"True","idx":3,"proposition":"In case of hemorrhage, Forrest's classification can be used"},{"correct":false,"justification":"Systematic search for Helicobacter pylori","idx":4,"proposition":"It allows the systematic search for CMV infection"}],"ts":1632321405,"type":"custom","difficulte":"1"}
-{"_id":"diverticulose-HGE-c5177e","context":null,"enonce":"Regarding sigmoid diverticulosis and acute diverticulitis what are the exact proposal(s)?","item":"diverticulose","matiere":"HGE","propositions":[{"correct":true,"justification":"True, you have to enjoy as much as you can 🎉","idx":0,"proposition":"These pathologies are very rare before the age of 30"},{"correct":false,"justification":"Not since the last recommendation in 2017. It is indicated in case of non-response to symptomatic treatment or in case of signs of severity","idx":1,"proposition":"Antibiotic treatment in uncomplicated diverticulitis is routine"},{"correct":false,"justification":"Unnecessary ultrasound. We make the diagnosis on the bio and the angioscan","idx":2,"proposition":"Diagnosis of diverticulitis is based on ultrasound"},{"correct":false,"justification":"Bristol scale = stool 💩 consistency. We are talking here about the Hinchey classification","idx":3,"proposition":"Bristol scale classifies complicated diverticulitis"},{"correct":true,"justification":"True, risk of perforation and peritonitis","idx":4,"proposition":"Active diverticulitis contraindicates colonoscopy"}],"ts":1632321473,"type":"custom","difficulte":"1"}
-{"_id":"lithiaseB-HGE-9be36c","context":null,"enonce":"Which of the following are complications of cholecystectomy?","item":"lithiaseB","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Mortality is extremely low"},{"correct":false,"justification":"Complication of unoperated cholecystitis","idx":1,"proposition":"Cholecystoduodenal fistula"},{"correct":false,"justification":"Complication of unoperated cholecystitis","idx":2,"proposition":"Cholecystocolic fistula"},{"correct":false,"justification":"Complication of unoperated cholecystitis","idx":3,"proposition":"Choleperitoneum"},{"correct":true,"justification":"True, = infection","idx":4,"proposition":"Postoperative abscess"}],"ts":1632321483,"type":"custom","difficulte":"1"}
-{"_id":"ictere-HGE-94e0c1","context":null,"enonce":"Which of the following propositions are true about physiological jaundice in newborns?","item":"ictere","matiere":"HGE","propositions":[{"correct":false,"justification":"False, it appears only after 24 hours of life (free interval)","idx":0,"proposition":"It is congenital"},{"correct":false,"justification":"Before D10","idx":1,"proposition":"It disappears before J20"},{"correct":false,"justification":"Free bilirubin","idx":2,"proposition":"It is a conjugated bilirubin jaundice"},{"correct":true,"justification":"True","idx":3,"proposition":"Stools are normal in colour"},{"correct":true,"justification":"True","idx":4,"proposition":"The neuronal toxicity threshold is 340 micromoles\/litre"}],"ts":1632321513,"type":"custom","difficulte":"1"}
-{"_id":"lithiaseB-HGE-bc7915","context":null,"enonce":"Which of the following are classic signs of cholitis?","item":"lithiaseB","matiere":"HGE","propositions":[{"correct":false,"justification":"Right hypochondrium","idx":0,"proposition":"Pain in left hypochondrium"},{"correct":true,"justification":"True","idx":1,"proposition":"Fever"},{"correct":true,"justification":"True, triad fever pain jaundice","idx":2,"proposition":"Jaundice"},{"correct":true,"justification":"True","idx":3,"proposition":"Biological cholestasis"},{"correct":false,"justification":"to PNN","idx":4,"proposition":"Lymphocyte hyperleukocytosis"}],"ts":1632321522,"type":"custom","difficulte":"1"}
-{"_id":"diverticulose-HGE-4ce4f6","context":null,"enonce":"Which of the following are among the following proposals for complicated diverticulitis?","item":"diverticulose","matiere":"HGE","propositions":[{"correct":false,"justification":"Hinchey Stage Ia = uncomplicated","idx":0,"proposition":"Phlegmon isolated less than 2 cm"},{"correct":true,"justification":"True","idx":1,"proposition":"Fistula"},{"correct":true,"justification":"True","idx":2,"proposition":"Peritonitis"},{"correct":true,"justification":"True","idx":3,"proposition":"Stenosis"},{"correct":true,"justification":"True","idx":4,"proposition":"Abscess larger than 2 cm"}],"ts":1632321912,"type":"custom","difficulte":"1"}
-{"_id":"hernie-HGE-82b0bf","context":null,"enonce":"Which of the following proposals are features of unranged hernia?","item":"hernie","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Impulsive to cough"},{"correct":true,"justification":"True, impulsive = extensive = no strangulation","idx":1,"proposition":"Extensive cough"},{"correct":false,"justification":"Occlusive signs","idx":2,"proposition":"Nausea vomiting"},{"correct":true,"justification":"True","idx":3,"proposition":"Reducible"},{"correct":true,"justification":"True","idx":4,"proposition":"Non-painful"}],"ts":1632321920,"type":"custom","difficulte":"1"}
-{"_id":"diarrheeaigue-HGE-afefbf","context":null,"enonce":"Up to what age is loperamide contraindicated?","item":"diarrheeaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"2 months"},{"correct":false,"justification":"","idx":1,"proposition":"5 years"},{"correct":true,"justification":"True. It is contraindicated before 2 years. Some adapted presentations are valid between 2 and 8 years.","idx":2,"proposition":"2 years"},{"correct":false,"justification":"","idx":3,"proposition":"6 years"},{"correct":false,"justification":"","idx":4,"proposition":"3 years"}],"ts":1632321965,"type":"custom","difficulte":"1"}
-{"_id":"diverticulose-HGE-ea812d","context":null,"enonce":"Which of the following are criteria of severity leading to the treatment of uncomplicated sigmoid diverticulitis with antibiotics?","item":"diverticulose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"PAs < 100 mmHg"},{"correct":false,"justification":"Tachycardia is not a criterion of severity (unless really high)","idx":1,"proposition":"FC > 100 bpm"},{"correct":true,"justification":"True","idx":2,"proposition":"Confusion"},{"correct":true,"justification":"True, these are the qSOFA criteria","idx":3,"proposition":"FR > 22 per minute"},{"correct":true,"justification":"True","idx":4,"proposition":"Immunosuppression"}],"ts":1632321977,"type":"custom","difficulte":"1"}
-{"_id":"ictere-HGE-cb1e74","context":null,"enonce":"Which of the following are etiologies of brown urine jaundice?","item":"ictere","matiere":"HGE","propositions":[{"correct":false,"justification":"No jaundice 🤗","idx":0,"proposition":"Taking rifampicin"},{"correct":true,"justification":"True","idx":1,"proposition":"Conjugated bilirubin jaundice"},{"correct":true,"justification":"True","idx":2,"proposition":"Cholestasis"},{"correct":false,"justification":"Normal urine","idx":3,"proposition":"Gilbert's disease"},{"correct":false,"justification":"Normal urine","idx":4,"proposition":"Criglet-Najjar disease"}],"ts":1632321986,"type":"custom","difficulte":"1"}
-{"_id":"UGD-HGE-50b458","context":null,"enonce":"Which of the following are recognized risk factors for ulcers?","item":"UGD","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"IPP"},{"correct":true,"justification":"True","idx":1,"proposition":"NSAID intake"},{"correct":true,"justification":"True, several causes including PPIs, H. Pylori, autoimmune, ...","idx":2,"proposition":"Atrophic gastritis"},{"correct":true,"justification":"True, over 65","idx":3,"proposition":"Age"},{"correct":false,"justification":"No, but tobacco yes 🚬","idx":4,"proposition":"Alcohol 🍷"}],"ts":1632322001,"type":"custom","difficulte":"1"}
-{"_id":"diverticulose-HGE-65e03a","context":null,"enonce":"Which of the following are included in the treatment of uncomplicated diverticulitis?","item":"diverticulose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Antibiotic therapy if symptomatic treatment failure"},{"correct":true,"justification":"True","idx":1,"proposition":"Paracetamol"},{"correct":true,"justification":"True","idx":2,"proposition":"Oral rehydration"},{"correct":false,"justification":"We don't go straight there^^","idx":3,"proposition":"Laparoscopy explorer if pain persists for > 10 days"},{"correct":false,"justification":"Useless","idx":4,"proposition":"Residue-free diet"}],"ts":1632322008,"type":"custom","difficulte":"1"}
-{"_id":"RGO-HGE-e0c65b","context":null,"enonce":"Which of the following are true for the treatment of GERD without esophagitis that occurs less than once a week?","item":"RGO","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Antacids"},{"correct":true,"justification":"True","idx":1,"proposition":"Alginates"},{"correct":false,"justification":"Not in the first intention. This is the case if GERD happens more than once a week","idx":2,"proposition":"It is based on PPIs"},{"correct":true,"justification":"True","idx":3,"proposition":"H2 Repellent"},{"correct":false,"justification":"False","idx":4,"proposition":"Half-dose PPI for 4 weeks"}],"ts":1632322438,"type":"custom","difficulte":"1"}
-{"_id":"dysphagie-HGE-11ad73","context":null,"enonce":"Which of the following propositions are true about primitive achalasia?","item":"dysphagie","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"We find an aperistalsis"},{"correct":true,"justification":"True","idx":1,"proposition":"There is resting hypertonia of the SIO"},{"correct":false,"justification":"","idx":2,"proposition":"Normal peristaltic waves are found"},{"correct":true,"justification":"True","idx":3,"proposition":"Endoscopy may be normal at first"},{"correct":true,"justification":"True","idx":4,"proposition":"Manometry is the exam of choice for a positive diagnosis"}],"ts":1632322451,"type":"custom","difficulte":"1"}
-{"_id":"cirrhose-HGE-89f46c","context":null,"enonce":"What is the treatment of choice for primary biliary cirrhosis?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":false,"justification":"Autoimmune hepatitis","idx":0,"proposition":"Corticosteroids "},{"correct":true,"justification":"True","idx":1,"proposition":"Ursodeoxycholic acid"},{"correct":false,"justification":"Wilson's disease","idx":2,"proposition":"Copper chelators"},{"correct":false,"justification":"Hemochromatosis","idx":3,"proposition":"Blood subtraction"},{"correct":false,"justification":"NASH","idx":4,"proposition":"Statins"}],"ts":1632325804,"type":"custom","difficulte":"1"}
-{"_id":"pancreatitechr-HGE-e74284","context":null,"enonce":"Which of the following are risk factors for chronic pancreatitis?","item":"pancreatitechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Tobacco 🚬"},{"correct":true,"justification":"True","idx":1,"proposition":"Alcohol 🍷"},{"correct":true,"justification":"True","idx":2,"proposition":"Hypercalcemia"},{"correct":true,"justification":"True","idx":3,"proposition":"Cystic fibrosis"},{"correct":false,"justification":"Nein","idx":4,"proposition":"Chronic hepatitis"}],"ts":1632325864,"type":"custom","difficulte":"1"}
-{"_id":"UGD-HGE-a3a898","context":null,"enonce":"Regarding the incidence of gastric ulcer in developed countries:","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It goes down"},{"correct":false,"justification":"","idx":1,"proposition":"It increases"},{"correct":false,"justification":"","idx":2,"proposition":"It is stable"},{"correct":false,"justification":"It is not a DO disease but epidemiological studies can be done on all diseases","idx":3,"proposition":"It is not calculable because it is not a reportable 😏 disease"},{"correct":false,"justification":"","idx":4,"proposition":"All proposals are wrong"}],"ts":1632325890,"type":"custom","difficulte":"1"}
-{"_id":"pancreatitechr-HGE-bbbf9d","context":null,"enonce":"If chronic pancreatitis is suspected, what is the imaging test to perform as a first-line treatment?","item":"pancreatitechr","matiere":"HGE","propositions":[{"correct":false,"justification":"It is not an imaging 🖼 test","idx":0,"proposition":"Gamma-GT and PAL"},{"correct":true,"justification":"True","idx":1,"proposition":"Abdominal CT angiography"},{"correct":false,"justification":"No longer done (useless in this indication)","idx":2,"proposition":".ASP"},{"correct":false,"justification":"","idx":3,"proposition":"MRI angiography"},{"correct":false,"justification":"","idx":4,"proposition":"PET-Scan"}],"ts":1632334594,"type":"custom","difficulte":"1"}
-{"_id":"diarrheechr-HGE-261c15","context":null,"enonce":"Which of the following should be avoided in case of celiac disease?","item":"diarrheechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Gluten"},{"correct":true,"justification":"True","idx":1,"proposition":"Wheat"},{"correct":true,"justification":"True","idx":2,"proposition":"Barley"},{"correct":false,"justification":"","idx":3,"proposition":"Soybean"},{"correct":true,"justification":"True","idx":4,"proposition":"Rye"}],"ts":1632334724,"type":"custom","difficulte":"1"}
-{"_id":"splenomeg-HGE-b8bef8","context":null,"enonce":"Which of the following are recommended vaccines for splenectomized?","item":"splenomeg","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Anti-pneumococcus"},{"correct":false,"justification":"Live attenuated vaccine","idx":1,"proposition":"Yellow fever"},{"correct":true,"justification":"True","idx":2,"proposition":"Anti-haemophilus B"},{"correct":false,"justification":"Live attenuated vaccine","idx":3,"proposition":"BCG"},{"correct":false,"justification":"Live attenuated vaccine","idx":4,"proposition":"Anti-malarial"}],"ts":1632334750,"type":"custom","difficulte":"1"}
-{"_id":"ascite-HGE-ad5ecc","context":null,"enonce":"What is the PNN threshold that defines an infected ascites fluid? (mm3)","item":"ascite","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"50"},{"correct":false,"justification":"","idx":1,"proposition":"100"},{"correct":false,"justification":"","idx":2,"proposition":"150"},{"correct":false,"justification":"","idx":3,"proposition":"200"},{"correct":true,"justification":"True","idx":4,"proposition":"250"}],"ts":1632334755,"type":"custom","difficulte":"1"}
-{"_id":"ictere-HGE-35ccb5","context":null,"enonce":"Which of the following propositions are true about Gilbert's disease?","item":"ictere","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is a disease with genetic polymorphism"},{"correct":true,"justification":"True","idx":1,"proposition":"It affects about 5% of the population"},{"correct":true,"justification":"True","idx":2,"proposition":"It is an unconjugated bilirubin jaundice"},{"correct":true,"justification":"True, asymptomatic most of the time","idx":3,"proposition":"It is a mild disease"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true "}],"ts":1632334865,"type":"custom","difficulte":"1"}
-{"_id":"RGO-HGE-aa15a1","context":null,"enonce":"What test can determine whether GERD is acidic or non-acidic?","item":"RGO","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"pH-impedancemetry"},{"correct":false,"justification":"","idx":1,"proposition":"Endoscopy"},{"correct":false,"justification":"","idx":2,"proposition":"Fibroscopy"},{"correct":false,"justification":"","idx":3,"proposition":"Scanner"},{"correct":false,"justification":"","idx":4,"proposition":"Urea test"}],"ts":1632334870,"type":"custom","difficulte":"1"}
-{"_id":"cirrhose-HGE-edcf21","context":null,"enonce":"Lille's score includes:","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Billirubine"},{"correct":true,"justification":"True","idx":1,"proposition":"Creatinine emia"},{"correct":true,"justification":"True","idx":2,"proposition":"Albumin"},{"correct":true,"justification":"True","idx":3,"proposition":"The TP"},{"correct":false,"justification":"","idx":4,"proposition":"The ATT"}],"ts":1632335106,"type":"custom","difficulte":"1"}
-{"_id":"vomisst-HGE-19a0c3","context":null,"enonce":"Mallory Weiss syndrome corresponds to a rupture of:","item":"vomisst","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Cardia"},{"correct":false,"justification":"","idx":1,"proposition":"Fundus"},{"correct":false,"justification":"","idx":2,"proposition":"Large curvature"},{"correct":false,"justification":"","idx":3,"proposition":"Small curvature"},{"correct":false,"justification":"","idx":4,"proposition":"Duodenum"}],"ts":1632335118,"type":"custom","difficulte":"1"}
-{"_id":"UGD-HGE-4933d5","context":null,"enonce":"What does bimuthea quadritherapy contain?","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Metronidazole"},{"correct":true,"justification":"True","idx":1,"proposition":"Bismuth salts"},{"correct":true,"justification":"True","idx":2,"proposition":"Tetracycline"},{"correct":true,"justification":"True","idx":3,"proposition":"Curative IPP"},{"correct":false,"justification":"Non-bismutheic therapy: amoxicillin, curative PPI, metronidazole, clarithromycin\/levfloxacin","idx":4,"proposition":"Amoxicillin"}],"ts":1632335153,"type":"custom","difficulte":"1"}
-{"_id":"cirrhose-HGE-dd1d4c","context":null,"enonce":"What is the estimated survival of 1 year for Child Pugh C?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"100 %"},{"correct":false,"justification":"","idx":1,"proposition":"90 %"},{"correct":false,"justification":"","idx":2,"proposition":"80 %"},{"correct":true,"justification":"True","idx":3,"proposition":"45 %"},{"correct":false,"justification":"","idx":4,"proposition":"5 %"}],"ts":1632335171,"type":"custom","difficulte":"1"}
-{"_id":"diverticulose-HGE-39365c","context":null,"enonce":"Which of the following are true for antibiotic treatment of uncomplicated sigmoid diverticulitis?","item":"diverticulose","matiere":"HGE","propositions":[{"correct":false,"justification":"After failure of symptomatic treatment (or in case of signs of severity)","idx":0,"proposition":"It is to be proposed from the outset"},{"correct":false,"justification":"Per Os","idx":1,"proposition":"It is based on augmentin IV"},{"correct":true,"justification":"True","idx":2,"proposition":"Second-line therapy is fluoroquinolones (or C3Gs) combined with metronidazole"},{"correct":true,"justification":"True, 7 days maximum","idx":3,"proposition":"Antibiotic treatment lasts less than 7 days"},{"correct":true,"justification":"True, this is most often the case (oral treatment)","idx":4,"proposition":"Treatment can be done on an outpatient basis"}],"ts":1632335232,"type":"custom","difficulte":"1"}
-{"_id":"ictere-HGE-bb2b61","context":null,"enonce":"What time corresponds to the venous time on the injected scanner?","item":"ictere","matiere":"HGE","propositions":[{"correct":false,"justification":"Excretory time","idx":0,"proposition":"10 mn"},{"correct":false,"justification":"Late time","idx":1,"proposition":"3 min"},{"correct":true,"justification":"True","idx":2,"proposition":"70 seconds"},{"correct":false,"justification":"Arterial weather","idx":3,"proposition":"Thirty seconds"},{"correct":false,"justification":"SPC Time","idx":4,"proposition":"T0"}],"ts":1632335358,"type":"custom","difficulte":"1"}
-{"_id":"lithiaseB-HGE-ce25f8","context":null,"enonce":"Which of the following are ultrasound signs of lithiatic cholecystitis?","item":"lithiaseB","matiere":"HGE","propositions":[{"correct":true,"justification":"True, ultrasound sign of Murphy","idx":0,"proposition":"Increased pain when passing the ultrasound probe"},{"correct":true,"justification":"True","idx":1,"proposition":"Vesicular wall > 4mm"},{"correct":false,"justification":"Calculations are hyperdense","idx":2,"proposition":"Hypodensity representing the calculation"},{"correct":true,"justification":"True","idx":3,"proposition":"Triple sheet appearance"},{"correct":false,"justification":"","idx":4,"proposition":"Absence of shadow cone"}],"ts":1632335366,"type":"custom","difficulte":"1"}
-{"_id":"RGO-HGE-0b0028","context":null,"enonce":"Which of the following are indications for gastroduodenal endoscopy in GERD?","item":"RGO","matiere":"HGE","propositions":[{"correct":false,"justification":"50 years","idx":0,"proposition":"Age > 30"},{"correct":true,"justification":"True","idx":1,"proposition":"Difficulty in swallowing"},{"correct":true,"justification":"True","idx":2,"proposition":"Failure of well-conducted treatment"},{"correct":false,"justification":"False, on the other hand newly discovered asthma (contemporary with GERD may be an extradigestive sign)","idx":3,"proposition":"Allergic asthma diagnosed in childhood"},{"correct":true,"justification":"True","idx":4,"proposition":"Unexplained anemia"}],"ts":1632335379,"type":"custom","difficulte":"1"}
-{"_id":"cirrhose-HGE-d2802c","context":null,"enonce":"Which of the following are signs of hepatic encephalopathy?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Asterixis"},{"correct":true,"justification":"True","idx":1,"proposition":"Insomnia"},{"correct":true,"justification":"True","idx":2,"proposition":"Confusion \/ Delirium"},{"correct":false,"justification":"Syndrome de Korsakoff","idx":3,"proposition":"Fabrications"},{"correct":false,"justification":"Not described in the college","idx":4,"proposition":"Amnesic ictus"}],"ts":1632335401,"type":"custom","difficulte":"1"}
-{"_id":"cirrhose-HGE-fd6866","context":null,"enonce":"Which of the following are signs of portal hypertension?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Ascites"},{"correct":false,"justification":"","idx":1,"proposition":"Asterixis"},{"correct":false,"justification":"","idx":2,"proposition":"Stellar angiomas"},{"correct":true,"justification":"True","idx":3,"proposition":"Splenomegaly"},{"correct":true,"justification":"True","idx":4,"proposition":"Collateral venous circulation"}],"ts":1632335563,"type":"custom","difficulte":"1"}
-{"_id":"vomisst-HGE-e442b1","context":null,"enonce":"Which of the following are true about vomiting during pregnancy?","item":"vomisst","matiere":"HGE","propositions":[{"correct":false,"justification":"In the first quarter","idx":0,"proposition":"They are physiological in the second trimester"},{"correct":true,"justification":"True","idx":1,"proposition":"They disappear spontaneously during pregnancy"},{"correct":false,"justification":"Early signs","idx":2,"proposition":"These are late signs of pregnancy"},{"correct":true,"justification":"True","idx":3,"proposition":"Pre-eclampsia may be accompanied by vomiting"},{"correct":true,"justification":"True","idx":4,"proposition":"Ionic disorders can impact the fetus"}],"ts":1632335570,"type":"custom","difficulte":"1"}
-{"_id":"oeilR-D-ophtalmo-1aebca","context":null,"enonce":"Which of the following propositions are true regarding chemical trauma?","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True, they penetrate longer and deeper into the eye","idx":0,"proposition":"Basic chemical burns are more serious than acid burns "},{"correct":false,"justification":"it is the Roper-Hall classification that is used","idx":1,"proposition":"The ASA classification is suitable for burns of chemical origin"},{"correct":false,"justification":"The classification ranges from grade I to grade IV, with grade I being the best prognosis","idx":2,"proposition":"Grade IV is the best prognosis"},{"correct":true,"justification":"True with absence of limbic ischemia and corneal opacity","idx":3,"proposition":"Grade I is for pure epithelial involvement"},{"correct":false,"justification":"","idx":4,"proposition":"No proposition is true"}],"ts":1632391692,"type":"custom","difficulte":"2"}
-{"_id":"oeilR-D-ophtalmo-0af31f","context":null,"enonce":"In what structure is the origin of the optic nerve inserted?","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"The cornea"},{"correct":false,"justification":"","idx":1,"proposition":"The iris"},{"correct":true,"justification":"","idx":2,"proposition":"The sclera"},{"correct":false,"justification":"","idx":3,"proposition":"The lens"},{"correct":false,"justification":"","idx":4,"proposition":"Other"}],"ts":1632391696,"type":"custom","difficulte":"1"}
-{"_id":"suivinourisson-ophtalmo-e3c3a7","context":null,"enonce":"Which of the following proposals are pathological in 1-year-olds?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":false,"justification":"Up to 18 months","idx":0,"proposition":"No walking"},{"correct":true,"justification":"True","idx":1,"proposition":"No clamp"},{"correct":false,"justification":"It is expected at this age","idx":2,"proposition":"Combines two syllables"},{"correct":true,"justification":"True","idx":3,"proposition":"Don't babble"},{"correct":true,"justification":"True, pathological at any age 🚨","idx":4,"proposition":"No photomotor reflex"}],"ts":1632391730,"type":"custom","difficulte":"2"}
-{"_id":"suivinourisson-ophtalmo-d90f47","context":null,"enonce":"Which of the following are possible infectious causes of prenatal hearing loss? ","item":"suivinourisson","matiere":"ped","propositions":[{"correct":false,"justification":"Mnemonic medium: TORCH (Toxoplasmosis, Mumps, Rubella, CMV, HSV)","idx":0,"proposition":"Maternal dengue infection"},{"correct":true,"justification":"True","idx":1,"proposition":"Infection of the mother with toxoplasmosis"},{"correct":true,"justification":"True","idx":2,"proposition":"Maternal infection with rubella"},{"correct":true,"justification":"True","idx":3,"proposition":"Active infection of the mother with CMV"},{"correct":false,"justification":"Not described in colleges anyway","idx":4,"proposition":"Maternal infection with yellow fever"}],"ts":1632391752,"type":"custom","difficulte":"2"}
-{"_id":"AV--ophtalmo-7a86cf","context":null,"enonce":"Which of the following propositions designate the nerve on which the palpebral occlusion depends?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Facial nerve"},{"correct":false,"justification":"IV nerve, innervates the superior oblique","idx":1,"proposition":"Trochlear nerve"},{"correct":false,"justification":"Nerve VI, innervates the external\/lateral right","idx":2,"proposition":"Nerve abducens"},{"correct":false,"justification":"Nerve III, innervates the upper right, the medial right, the lower right and the inferior oblique","idx":3,"proposition":"Oculomotor nerve"},{"correct":true,"justification":"= facial nerve","idx":4,"proposition":"Nerve VII"}],"ts":1632391784,"type":"custom","difficulte":"2"}
-{"_id":"suivinourisson-ophtalmo-3db61f","context":null,"enonce":"What is the interval for mild hearing loss?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":false,"justification":"light = PAM between 21 and 40 dB; mean = PAM between 41 and 70 dB; severe = PAM between 71 and 90 dB; deep = PAM ≥ 90 dB; total (cophosis) = PAM ≥ 120 dB.","idx":0,"proposition":"None of the proposals"},{"correct":true,"justification":"True","idx":1,"proposition":"between 21 and 40 dB"},{"correct":false,"justification":"average","idx":2,"proposition":"between 41 and 70 dB"},{"correct":false,"justification":"severe","idx":3,"proposition":"between 71 and 90 dB "},{"correct":false,"justification":"Deep","idx":4,"proposition":"between 90 and 120 dB "}],"ts":1632391792,"type":"custom","difficulte":"2"}
-{"_id":"diplopie-ophtalmo-e7c8f3","context":null,"enonce":"What is the field of action of the superior oblique muscle?","item":"diplopie","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Upstairs"},{"correct":false,"justification":"False","idx":1,"proposition":"Inside"},{"correct":false,"justification":"False","idx":2,"proposition":"Out"},{"correct":true,"justification":"True","idx":3,"proposition":"Below and inside"},{"correct":false,"justification":"False","idx":4,"proposition":"Downstairs and outside"}],"ts":1632391799,"type":"custom","difficulte":"2"}
-{"_id":"tbrefraction-ophtalmo-41b5f2","context":null,"enonce":"Which of the following are true?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"It is \"too powerful\"","idx":0,"proposition":"A myopic eye is too convergent "},{"correct":false,"justification":"Too convergent (too powerful)","idx":1,"proposition":"A myopic eye is too divergent"},{"correct":true,"justification":"True","idx":2,"proposition":"A farsighted eye is too divergent"},{"correct":true,"justification":"True","idx":3,"proposition":"A farsighted eye is too short"},{"correct":false,"justification":"It is a question of sphericity, not depth, the refraction of the eye differs according to the plane in which the incident rays are located.","idx":4,"proposition":"An astigmatism eye is too divergent"}],"ts":1632391876,"type":"custom","difficulte":"2"}
-{"_id":"diplopie-ophtalmo-cd64e4","context":null,"enonce":"What is the field of action of the inferior oblique muscle?","item":"diplopie","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Above and inside"},{"correct":false,"justification":"Lateral muscle","idx":1,"proposition":"Out"},{"correct":false,"justification":"Medial muscle","idx":2,"proposition":"Inside"},{"correct":false,"justification":"Superior oblique muscle","idx":3,"proposition":"Below and inside"},{"correct":false,"justification":"Superior rectus muscle","idx":4,"proposition":"Up and outside"}],"ts":1632391882,"type":"custom","difficulte":"2"}
-{"_id":"suivinourisson-ophtalmo-65c36d","context":null,"enonce":"Which of the following are true for congenital hip dislocation (CHL)?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":false,"justification":"Seat presentation is a risk factor","idx":0,"proposition":"There are no known risk factors"},{"correct":true,"justification":"True","idx":1,"proposition":"It must be screened in all children"},{"correct":false,"justification":"Ultrasound (if risk factor or suspicion)","idx":2,"proposition":"Low radiation hip X-ray is the first-line additional examination in case of suspicion of LCH"},{"correct":false,"justification":"Abduction limitation (outward)","idx":3,"proposition":"Adduction limitation is a clinical sign of CHL"},{"correct":true,"justification":"True","idx":4,"proposition":"Limb length asymmetry is a clinical sign of CHL"}],"ts":1632391888,"type":"custom","difficulte":"2"}
-{"_id":"suivinourisson-ophtalmo-6a5605","context":null,"enonce":"Which of the following proposals are correct and expected for a 3-month-old child born at term?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":true,"justification":"True, tachycardia from 150 bpm","idx":0,"proposition":"Resting heart rate at 120 bpm"},{"correct":true,"justification":"True","idx":1,"proposition":"Resting respiratory rate at 40\/min"},{"correct":true,"justification":"True, threshold at 40 mmHg","idx":2,"proposition":"PAM at 55 mmHg"},{"correct":true,"justification":"True, between 2 and 4 ml\/kg\/h","idx":3,"proposition":"Diuresis at 3 ml\/kg\/h"},{"correct":true,"justification":"True, >97%","idx":4,"proposition":"98% SaO2"}],"ts":1632391907,"type":"custom","difficulte":"3"}
-{"_id":"suivinourisson-ophtalmo-63fb64","context":null,"enonce":"Which of the following are true?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"At birth, a baby weighs about 3.5 kg"},{"correct":false,"justification":"This is the size of the newborn. The expected PC is 35 cm","idx":1,"proposition":"At birth, the expected head circumference (CP) is 50 cm"},{"correct":false,"justification":"This is the newborn's PC. The expected size is 50 cm","idx":2,"proposition":"At birth, the expected height is 35 cm"},{"correct":false,"justification":"1m (doubles its birth size)","idx":3,"proposition":"At 4 years old, the child measures about 1m25"},{"correct":true,"justification":"True, triples his birth weight","idx":4,"proposition":"At 1 year, the baby weighs 10 kg"}],"ts":1632391925,"type":"custom","difficulte":"2"}
-{"_id":"suivinourisson-ophtalmo-69fa18","context":null,"enonce":"Which of the following proposals suggest pathological strabismus?","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Rather physiological","idx":0,"proposition":"Convergent Strabismus"},{"correct":true,"justification":"True","idx":1,"proposition":"Divergent Strabismus"},{"correct":false,"justification":"According to the COUF: \"It should be remembered that strabismus is never normal and that any child with strabismus must benefit from a rapid specialized examination. This assertion must be qualified in the baby less than 3 months in whom an intermittent deviation can be tolerated.\" ","idx":2,"proposition":"Intermittent strabismus"},{"correct":true,"justification":"The child's strabismus is only a symptom. Any strabismus must seek an underlying organic pathology.","idx":3,"proposition":"Permanent Strabismus"},{"correct":false,"justification":"Convergent and intermittent strabismus require simple monitoring at the beginning","idx":4,"proposition":"All strabismus are pathological"}],"ts":1632392000,"type":"custom","difficulte":"2"}
-{"_id":"AV--ophtalmo-905a38","context":null,"enonce":"Which of the following proposals are part of the previous segment?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Crystalline"},{"correct":false,"justification":"Posterior segment","idx":1,"proposition":"Sclera"},{"correct":false,"justification":"Posterior segment","idx":2,"proposition":"Choroid"},{"correct":true,"justification":"True","idx":3,"proposition":"Iridorodicorneal angle"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"ts":1632392008,"type":"custom","difficulte":"2"}
-{"_id":"suivinourisson-ophtalmo-b2145f","context":null,"enonce":"What is the formula for estimating the expected head circumference during the first year of life?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"(Size + 2) \/ 10"},{"correct":true,"justification":"True","idx":1,"proposition":"(Size \/ 2) + 10"},{"correct":false,"justification":"False, unisex formula","idx":2,"proposition":"(Size \/ 2) - 10 in girls"},{"correct":false,"justification":"False","idx":3,"proposition":"(Size * 2) + 10 in boys"},{"correct":false,"justification":"False","idx":4,"proposition":"Size - 10"}],"ts":1632392018,"type":"custom","difficulte":"2"}
-{"_id":"suivinourisson-ophtalmo-29e6a5","context":null,"enonce":"What is the expected size at 4 months?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":false,"justification":"Birth size","idx":0,"proposition":"50 cm"},{"correct":true,"justification":"True","idx":1,"proposition":"60 cm"},{"correct":false,"justification":"9 months","idx":2,"proposition":"70 cm"},{"correct":false,"justification":"At 1 year","idx":3,"proposition":"75 cm"},{"correct":false,"justification":"At 4 years old","idx":4,"proposition":"1 m"}],"ts":1632392024,"type":"custom","difficulte":"2"}
-{"_id":"suivinourisson-ophtalmo-ce8370","context":null,"enonce":"What is the interval of profound hearing loss?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":false,"justification":"light = PAM between 21 and 40 dB; mean = PAM between 41 and 70 dB; severe = PAM between 71 and 90 dB; deep = PAM ≥ 90 dB; total (cophosis) = PAM ≥ 120 dB.","idx":0,"proposition":"None of these proposals 🤷 ♀️"},{"correct":false,"justification":"severe","idx":1,"proposition":"between 71 and 90 dB"},{"correct":false,"justification":"Medium","idx":2,"proposition":"between 41 and 70 dB"},{"correct":false,"justification":"Light","idx":3,"proposition":"between 21 and 40 dB"},{"correct":true,"justification":"True","idx":4,"proposition":"between 90 and 120 dB"}],"ts":1632392030,"type":"custom","difficulte":"2"}
-{"_id":"suivinourisson-ophtalmo-a3fc2e","context":null,"enonce":"Which of the following are true for genu varum at 1 year?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":false,"justification":"Reassuring because bilateral","idx":0,"proposition":"Symmetrical character is disturbing"},{"correct":false,"justification":"Normal at this age","idx":1,"proposition":"It is abnormal at this age"},{"correct":false,"justification":"False","idx":2,"proposition":"It justifies a bilateral F+P radiological assessment"},{"correct":true,"justification":"True","idx":3,"proposition":"It corresponds to a normal evolutionary phase of the growing skeleton in most cases"},{"correct":true,"justification":"True","idx":4,"proposition":"It regresses over the years"}],"ts":1632392036,"type":"custom","difficulte":"2"}
-{"_id":"glaucomechr-ophtalmo-155a29","context":null,"enonce":"Which of the following are drugs that decrease the secretion of aqueous humor?","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Beta-blockers"},{"correct":true,"justification":"True","idx":1,"proposition":"Carbonic anhydrase inhibitors"},{"correct":true,"justification":"True","idx":2,"proposition":"Alpha-2-adrenergic agonists"},{"correct":false,"justification":"They increase the elimination of aqueous humor","idx":3,"proposition":"Prostaglandins"},{"correct":false,"justification":"False","idx":4,"proposition":"Corticosteroids"}],"ts":1632392058,"type":"custom","difficulte":"2"}
-{"_id":"suivinourisson-ophtalmo-dc20b7","context":null,"enonce":"Which of the following are risk factors for hearing impairment?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Family history of deafness"},{"correct":true,"justification":"True","idx":1,"proposition":"Perinatal anoxia"},{"correct":true,"justification":"True","idx":2,"proposition":"History of pneumococcal meningitis"},{"correct":true,"justification":"True","idx":3,"proposition":"Recurrent ear infections"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"ts":1632392063,"type":"custom","difficulte":"2"}
-{"_id":"tbauditif-ORL-1ffca1","context":null,"enonce":"Which of the following propositions are true about AEPs?","item":"tbauditif","matiere":"ORL","propositions":[{"correct":false,"justification":"They do not allow it, it is one of their limits. Other limitations: profound deafness hinders the interpretation of latency curves, and the ranges explored concern only the treble","idx":0,"proposition":"They allow a frequency by frequency study"},{"correct":true,"justification":"True, by studying the latencies and conduction delays of the five peaks: I (cochlea), II (auditory nerve), III, IV, V (brainstem)","idx":1,"proposition":"They have topographic value in sensorineural hearing loss"},{"correct":false,"justification":"High frequencies, this is one of their limits","idx":2,"proposition":"They explore bass frequencies"},{"correct":false,"justification":"It is an objective examination, to be used especially in infants or non-cooperating patients","idx":3,"proposition":"This is a subjective examination"},{"correct":true,"justification":"True","idx":4,"proposition":"This is a non-invasive examination"}],"ts":1632408231,"type":"custom","difficulte":"2"}
-{"_id":"tbauditif-ORL-6dcd70","context":null,"enonce":"Which of the following are functions of the outer 👂 ear?","item":"tbauditif","matiere":"ORL","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Mechanical protection of the eardrum"},{"correct":false,"justification":"","idx":1,"proposition":"All proposals"},{"correct":true,"justification":"True","idx":2,"proposition":"Amplification of conversational frequencies"},{"correct":true,"justification":"True","idx":3,"proposition":"Sound localization"},{"correct":false,"justification":"No role of the outer ear in balance. This is the case of the inner ear","idx":4,"proposition":"Equilibration"}],"ts":1632408517,"type":"custom","difficulte":"2"}
-{"_id":"pathosalivaire-ORL-e7f5d3","context":null,"enonce":"Which of the following are true about the parotid gland?","item":"pathosalivaire","matiere":"ORL","propositions":[{"correct":false,"justification":"There are three main salivary glands: parotid, submandibular, sublingual 😊","idx":0,"proposition":"It is one of the two main salivary glands"},{"correct":true,"justification":"True, this is nerve VII","idx":1,"proposition":"It is crossed by the facial nerve "},{"correct":false,"justification":"Steno Canal. Wharton's duct is the duct of the submandibular gland","idx":2,"proposition":"Its excretory canal is the Wharton Canal"},{"correct":true,"justification":"True","idx":3,"proposition":"It is composed of two lobes"},{"correct":false,"justification":"This is the submandibular gland","idx":4,"proposition":"It is the most common site of salivary lithiasis"}],"ts":1632408582,"type":"custom","difficulte":"2"}
-{"_id":"pathosalivaire-ORL-e7abc8","context":null,"enonce":"Regarding the salivary glands, which of the following propositions, which is\/are true?","item":"pathosalivaire","matiere":"ORL","propositions":[{"correct":false,"justification":"False, if the excretory duct of the parotid gland is indeed the Steno duct, it is blocked at the level of the homolateral upper 2nd molar (namely)","idx":0,"proposition":"The excretory duct of the parotid gland is the Steno duct and it plugs at the sublingual wattle."},{"correct":false,"justification":"False, do not confuse the sublingual glands (two small glands under the floor of the mouth) and the accessory salivary glands (there is, indeed, a multitude)","idx":1,"proposition":"There are multitudes of sublingual glands (about a thousand)"},{"correct":true,"justification":"True, these are the two main pathologies to master.","idx":2,"proposition":"While viral sialitis mainly affects the parotid glands, lithiasic sialitis mainly affects the submandibular glands"},{"correct":false,"justification":"False, it is pleomorphic adenoma, and it is a benign 😅 tumor","idx":3,"proposition":"The most common tumor of the parotid is a malignant 😱 tumor"},{"correct":true,"justification":"True, a low risk, but sufficient to indicate surgery for any pleomorphic adenoma.","idx":4,"proposition":"Pleomorphic adenoma has a risk of cancerization"}],"ts":1632408721,"type":"custom","difficulte":"1"}
-{"_id":"pathosalivaire-ORL-bf45f0","context":null,"enonce":"The Steno Canal opens in front:","item":"pathosalivaire","matiere":"ORL","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"of the 1st or 2nd upper molar"},{"correct":false,"justification":"","idx":1,"proposition":"of the 1st or 2nd lower molar"},{"correct":false,"justification":"","idx":2,"proposition":"upper incisors"},{"correct":false,"justification":"","idx":3,"proposition":"of the 1st or 2nd upper premolar"},{"correct":false,"justification":"","idx":4,"proposition":"of the 1st or 2nd lower premolar"}],"ts":1632408750,"type":"custom","difficulte":"2"}
-{"_id":"tbauditif-ORL-2b918b","context":null,"enonce":"Which of the following propositions are true about acoumetry?","item":"tbauditif","matiere":"ORL","propositions":[{"correct":false,"justification":"It is a qualitative measure of hearing (we have no number, the answer is a yes\/no)","idx":0,"proposition":"It is a quantitative measure of hearing"},{"correct":true,"justification":"True, this is its advantage!","idx":1,"proposition":"It can be performed at the patient's bedside"},{"correct":true,"justification":"True, i.e. the patient hears less well in air conduction than in bone conduction (which is not normal)","idx":2,"proposition":"Rinne's test is negative in case of conductive hearing loss"},{"correct":true,"justification":"True","idx":3,"proposition":"Weber's test consists of placing the tuning fork on the vertex"},{"correct":false,"justification":"It is lateralized on the left side","idx":4,"proposition":"The Weber is non-lateralized in case of left unilateral transmission hearing loss"}],"ts":1632409037,"type":"custom","difficulte":"2"}
-{"_id":"tbauditif-ORL-63f986","context":null,"enonce":"Which of the following suggestions can guide you towards right otosclerosis?","item":"tbauditif","matiere":"ORL","propositions":[{"correct":false,"justification":"Weber on the right because right transmission deafness","idx":0,"proposition":"Weber's test is on the left"},{"correct":false,"justification":"Normal otoscopy","idx":1,"proposition":"Otoscopy regains tympanic retraction"},{"correct":true,"justification":"True","idx":2,"proposition":"Tonal audiometry regains right-sided one-sided conductive hearing loss"},{"correct":true,"justification":"True","idx":3,"proposition":"Presence of family history"},{"correct":true,"justification":"True","idx":4,"proposition":"On-off stapedial reflexes"}],"ts":1632409080,"type":"custom","difficulte":"2"}
-{"_id":"pathosalivaire-ORL-035567","context":null,"enonce":"Which of the following propositions are true for pleiomorphic adenoma?","item":"pathosalivaire","matiere":"ORL","propositions":[{"correct":false,"justification":"The parotid is hard","idx":0,"proposition":"It is soft on palpation"},{"correct":true,"justification":"True","idx":1,"proposition":"It is epithelial"},{"correct":true,"justification":"True, as the name suggests (adenoma)","idx":2,"proposition":"It is benign"},{"correct":false,"justification":"It is the most common glandular tumor","idx":3,"proposition":"It is the rarest of the parotid tumors"},{"correct":true,"justification":"True","idx":4,"proposition":"Management is surgical"}],"ts":1632409116,"type":"custom","difficulte":"2"}
-{"_id":"pathosalivaire-ORL-1c2840","context":null,"enonce":"Which of the following propositions are true for pleiomorphic adenoma?","item":"pathosalivaire","matiere":"ORL","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"She is HypoT1 in MRI"},{"correct":true,"justification":"True","idx":1,"proposition":"She is HyperT2 in MRI"},{"correct":false,"justification":"rCDA > 1.3","idx":2,"proposition":"The rCDA is < 1"},{"correct":false,"justification":"Adenoma = benign","idx":3,"proposition":"It is a malignant tumor"},{"correct":false,"justification":"Surgical","idx":4,"proposition":"Management is exclusively drug (antimitotics)"}],"ts":1632409144,"type":"custom","difficulte":"2"}
-{"_id":"pathosalivaire-ORL-3d9194","context":null,"enonce":"Which of the following are true about salivary lithiasis?","item":"pathosalivaire","matiere":"ORL","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Glandular swelling is often per-prandial"},{"correct":true,"justification":"True","idx":1,"proposition":"They are most common in the submandibular gland"},{"correct":true,"justification":"True","idx":2,"proposition":"Sialodochitis is a ductal infection"},{"correct":false,"justification":"Ultrasound or CT scan is enough","idx":3,"proposition":"MRI is often needed to confirm lithiasis"},{"correct":true,"justification":"True","idx":4,"proposition":"Dental panoramic imaging is first-line imaging"}],"ts":1632409178,"type":"custom","difficulte":"2"}
-{"_id":"88-ORL-169262c3-1f06-4854-8c25-751d13933fbe","context":null,"enonce":"Regarding the salivary glands among the following propositions, which one is\/are true?","item":"pathosalivaire","matiere":"ORL","propositions":[{"correct":true,"justification":"True, it is the same radiological semiology for all lithiasis: hyperechoic with posterior umbral cone. This is the case of renal lithiasis and cholelithiasis too 😊","idx":0,"proposition":"The first-line examination for lithiatic sialois is ultrasound to demonstrate hyperechogenicity with posterior shadow cone"},{"correct":false,"justification":"False, they are rare! But this risk of sequelar orchitis is the main justification for mumps 😏 vaccination","idx":1,"proposition":"Viral sialitis is formidable because it frequently leads to sequelar 😱 orchitis."},{"correct":true,"justification":"True, parotid involvement is found in Heerfordt and Mikulicz 🤓 syndromes","idx":2,"proposition":"Bilateral chronic parotid sialosis should suggest sarcoidosis"},{"correct":false,"justification":"False, a biopsy of the salivary glands ACCESSORIES (the famous BGSA)","idx":3,"proposition":"Sjögren's syndrome, a bilateral chronic sialosis, is diagnosed by a biopsy of the main salivary glands"},{"correct":true,"justification":"True, this is an exception in the tumor family...","idx":4,"proposition":"Malignant parotid tumors are most often painful"}],"ts":1632410624,"type":"custom","difficulte":"1"}
-{"_id":"SpA-rhumato-2470b7","context":null,"enonce":"Which of the following are true?","item":"SpA","matiere":"rhumato","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"In chronic inflammatory enterocolopathies, classically, peripheral involvement evolves parallel to digestive involvement, unlike axial involvement which evolves on its own account."},{"correct":false,"justification":"Physical activity and physiotherapy are essential to reduce the progression of ankylosis in a bad position","idx":1,"proposition":"In ankylosing spondylitis, physiotherapy is not essential  "},{"correct":false,"justification":"The syndesmophyte is an ossification of a vertebral enthesis, specific to spondyloarthritis, unlike enthesophytes which can be the result of mechanical overloads ","idx":2,"proposition":"Syndesmophyte is not specific for Spondyloarthritis "},{"correct":false,"justification":"At least 2 NSAIDs should be tried successively over a total of 4 weeks before concluding that they have failed.","idx":3,"proposition":"After 4 weeks of treatment with the same NSAID without results, it can be concluded that the treatment has failed and it is then necessary to move on to background treatments "},{"correct":true,"justification":"","idx":4,"proposition":"Fiessinger-Leroy-Reiter syndrome is the most complete form of reactive arthritis, defined by the urethritis-conjunctivitis triad-arthritis. \r\n"}],"ts":1632417145,"type":"custom","difficulte":"2"}
-{"_id":"arthrose-rhumato-a122e8","context":null,"enonce":"Regarding coxarthrosis, what are the exact proposal(s)?","item":"arthrose","matiere":"rhumato","propositions":[{"correct":true,"justification":"True, congenital hip dislocation and other dysplasias lead to early coxarthrosis","idx":0,"proposition":"A coxarthrosis of the young subject must seek a history of hip dysplasia"},{"correct":false,"justification":"False, it is the coxodynias, which can give projected pain in the knee","idx":1,"proposition":"Differential diagnoses include classical projected gonarthrosis"},{"correct":false,"justification":"False, it is the internal rotation that will lead to a functional limitation of the joint.","idx":2,"proposition":"The clinical examination will look for a limitation of external rotation, the first clinical sign of the functional limitation of the joint"},{"correct":true,"justification":"True, to put it simply, the covers are what allow the good mechanics of the joint","idx":3,"proposition":"The front X-ray and the false profile of Lequesne look for insufficient coverage of the VCE (external cover of the roof of the acetula) and the VCA (anterior coverage of the femoral head)"},{"correct":true,"justification":"True, be careful not to forget the hygiene-dietary rules (regular walking, possibly cane in contra-lateral, weight loss if obesity ...)","idx":4,"proposition":"First-line treatment is based on conventional level 1 analgesics and rehabilitation by physiotherapy"}],"ts":1632417752,"type":"custom","difficulte":"1"}
-{"_id":"arthrite-rhumato-6bcfca","context":null,"enonce":"Which of the following proposition(s) is or is true?","item":"arthrite","matiere":"rhumato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"An effusion of a joint is always the translation of intra-articular suffering"},{"correct":false,"justification":"False. This is ultrasound.","idx":1,"proposition":"MRI is the exam of choice to quickly confirm or rule out joint effusion"},{"correct":true,"justification":"True. Sternoclavicular involvement should be investigated for SAPHO syndrome.","idx":2,"proposition":"SAPHO syndrome includes synovitis, acne, palmoplantar pustulosis, hyperostosis and osteitis"},{"correct":true,"justification":"True","idx":3,"proposition":"Digital osteoarthritis affects the proximal and distal interphalangeal joints with respect for the metacarpophalangeal joints"},{"correct":false,"justification":"False. < 50 g\/L","idx":4,"proposition":"Thrombocytopenia at 70 G \/ L contraindicates joint puncture"}],"ts":1632417942,"type":"custom","difficulte":"2"}
-{"_id":"SpA-rhumato-156150","context":null,"enonce":"How many joints are affected at?","item":"SpA","matiere":"rhumato","propositions":[{"correct":false,"justification":"Oligoarthritis","idx":0,"proposition":"2"},{"correct":false,"justification":"Oligoarthritis","idx":1,"proposition":"3"},{"correct":true,"justification":"True","idx":2,"proposition":"4"},{"correct":false,"justification":"From 4","idx":3,"proposition":"5"},{"correct":false,"justification":"From 4","idx":4,"proposition":"6"}],"ts":1632417987,"type":"custom","difficulte":"1"}
-{"_id":"SpA-rhumato-279546","context":null,"enonce":"Which of the following proposals corresponds to the first-line management of inflammatory spondyloarthritis?","item":"SpA","matiere":"rhumato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"NSAIDs in the absence of contraindications"},{"correct":true,"justification":"True","idx":1,"proposition":"Full diagnostic announcement"},{"correct":false,"justification":"Not in the first intention","idx":2,"proposition":"Anti-TNF alpha"},{"correct":false,"justification":"No MA for spondyloarthritis (except psoriatic arthritis)","idx":3,"proposition":"Methotrexate"},{"correct":false,"justification":"Not in the first intention","idx":4,"proposition":"Salazopyrin"}],"ts":1632418006,"type":"custom","difficulte":"2"}
-{"_id":"rachialgie-rhumato-3940e4","context":null,"enonce":"Which of the following are elements indicating urgent neurosurgical management?","item":"rachialgie","matiere":"rhumato","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"bilateral root involvement"},{"correct":false,"justification":"","idx":1,"proposition":"L4 territory anesthesia"},{"correct":true,"justification":"True","idx":2,"proposition":"cauda equina syndrome"},{"correct":true,"justification":"True","idx":3,"proposition":"Engine deficit≤ 3\/5"},{"correct":false,"justification":"","idx":4,"proposition":"Abolition of the Achilles reflex"}],"ts":1632418034,"type":"custom","difficulte":"1"}
-{"_id":"SpA-rhumato-258c0c","context":null,"enonce":"Which of the following are found in an inflammatory joint puncture fluid?","item":"SpA","matiere":"rhumato","propositions":[{"correct":false,"justification":"Sign infection of ascites fluid","idx":0,"proposition":"More than 250 PNN\/mm3"},{"correct":true,"justification":"True","idx":1,"proposition":"More than 2000 GB\/mL"},{"correct":false,"justification":"More than 40 g\/L of protein","idx":2,"proposition":"Less than 40 g\/L protein"},{"correct":true,"justification":"True","idx":3,"proposition":"Cloudy fluid"},{"correct":false,"justification":"Hemarthrosis","idx":4,"proposition":"> 150 red blood cells"}],"ts":1632418588,"type":"custom","difficulte":"2"}
-{"_id":"rachialgie-rhumato-6d1cf8","context":null,"enonce":"Which of the following proposals can lead to a disco-radicular conflict in case of lumbo-cruralgia L4?","item":"rachialgie","matiere":"rhumato","propositions":[{"correct":true,"justification":"True, foraminal or extraforaminal -> touches the first digit (here L4)","idx":0,"proposition":"foraminal hernia L4-L5 "},{"correct":false,"justification":"foraminal or extraforaminal -> touches the first digit (here L3)","idx":1,"proposition":"foraminal hernia L3-L4"},{"correct":true,"justification":"True, median or paramedian -> touches the second digit (here L4)","idx":2,"proposition":"median hernia L3-L4"},{"correct":false,"justification":"True, median or paramedian -> touches the second digit (here L5)","idx":3,"proposition":"paramedian hernia L4-L5"},{"correct":true,"justification":"True, foraminal or extraforaminal -> touches the first digit (here L4)","idx":4,"proposition":"extraforaminal hernia L4-L5"}],"ts":1632418648,"type":"custom","difficulte":"1"}
-{"_id":"arthrite-rhumato-4c1c2d","context":null,"enonce":"You perform a knee puncture. The liquid returns purulent. On direct examination, gram-positive cocci are observed in clusters. Which germ is most likely to be involved?","item":"arthrite","matiere":"rhumato","propositions":[{"correct":false,"justification":"Diplococcus gram +","idx":0,"proposition":"Streptococcus pyogenes"},{"correct":false,"justification":"Cocci gram + in chains","idx":1,"proposition":"Enterococcus faecalis"},{"correct":false,"justification":"Bacillus gram -","idx":2,"proposition":"Escherichia coli"},{"correct":false,"justification":"Rather found in case of infection associated with care (catheter, tube, etc.). But, indeed, it is a gram cocci + in clusters (this is the case of all staphylococcus).","idx":3,"proposition":"Staphylococcus epidermidis"},{"correct":true,"justification":"True, most likely","idx":4,"proposition":"Staphylococcus aureus"}],"ts":1632418675,"type":"custom","difficulte":"1"}
-{"_id":"SpA-rhumato-b019c5","context":null,"enonce":"How to treat latent tuberculosis before starting biotherapy?","item":"SpA","matiere":"rhumato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Rifampicin + Isoniazid for 3 months"},{"correct":false,"justification":"False","idx":1,"proposition":"Rifampicin + Isoniazid + Ethambutol + Pyrazynamide for 3 months"},{"correct":true,"justification":"True, if allergy to Rifampicin","idx":2,"proposition":"Isoniazid for 9 months"},{"correct":false,"justification":"False","idx":3,"proposition":"It is the same treatment as tuberculosis disease"},{"correct":false,"justification":"Possible treatment 3 weeks after the end of well-conducted TB treatment","idx":4,"proposition":"Biotherapy is contraindicated for life because of the risk of tuberculosis reactivation"}],"ts":1632418696,"type":"custom","difficulte":"2"}
-{"_id":"SpA-rhumato-bfbc33","context":null,"enonce":"Which of the following are true?","item":"SpA","matiere":"rhumato","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"Dactylitis is an inflammatory condition of the entire finger or toe"},{"correct":false,"justification":"In young adults. Forms with late onset (after 45 years) are rare ","idx":1,"proposition":"The majority of cases of spondyloarthropathy begin in the elderly "},{"correct":false,"justification":"To the lower limbs ","idx":2,"proposition":"In spondyloarthritis, all entheses can be affected, but enthesitis preferentially sits in the upper limbs "},{"correct":true,"justification":"","idx":3,"proposition":"The sacroiliitis results in the appearance of pain of the buttock of schedule most often inflammatory"},{"correct":true,"justification":"","idx":4,"proposition":"Entheses are the bony insertions of tendons, ligaments, capsules and fascia."}],"ts":1632418767,"type":"custom","difficulte":"2"}
-{"_id":"SpA-rhumato-7c044d","context":null,"enonce":"Which of the following is the score assessing spondyloarthritis activity?","item":"SpA","matiere":"rhumato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"BASDAI"},{"correct":false,"justification":"Score assessing the functional impact (there is an F in it) of spondyloarthritis (AS for Ankylosing Spondylitis)","idx":1,"proposition":"BASFI"},{"correct":false,"justification":"Activity of rheumatoid arthritis","idx":2,"proposition":"DAS28"},{"correct":false,"justification":"Probability of survival burned patient.","idx":3,"proposition":"ABSI"},{"correct":false,"justification":"Activity of rheumatoid arthritis","idx":4,"proposition":"SDAI"}],"ts":1632418823,"type":"custom","difficulte":"2"}
-{"_id":"anesth-anesth-6b967e","context":null,"enonce":"Which of the following propositions, is\/are true?","item":"anesth","matiere":"anesth","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Local anesthesia can be performed urgently or programmed by any doctor, regardless of his specialty"},{"correct":true,"justification":"True","idx":1,"proposition":"There are 2 loco-regional anesthesia techniques: perimedullary (around the spinal cord) or peripheral (around the nerve)"},{"correct":false,"justification":"False. At least 2 days","idx":2,"proposition":"The anesthesia consultation must be done at least 3 days before surgery"},{"correct":true,"justification":"True","idx":3,"proposition":"The pre-anesthetic visit must be done a maximum of 24 hours before surgery"},{"correct":true,"justification":"True, written consent is only required for certain specific acts: genetic research, clinical trial, organ removal, tissues, cells from living persons, gamete donation and use, sterilization, abortion. ","idx":4,"proposition":"Oral consent is sufficient for anesthesia during surgery outside of emergency situations "}],"ts":1632418829,"type":"custom","difficulte":"1"}
-{"_id":"SpA-rhumato-cbc3f7","context":null,"enonce":"Which of the following are complications of anti-TNF-alpha therapy?","item":"SpA","matiere":"rhumato","propositions":[{"correct":true,"justification":"True, dermatological consultation 1x\/year","idx":0,"proposition":"over-risk of skin cancer"},{"correct":true,"justification":"True, annual influenza and pneumococcal vaccination + discontinuation of therapy in case of infection","idx":1,"proposition":"Over-risk of infection"},{"correct":false,"justification":"False","idx":2,"proposition":"over-allergic risk"},{"correct":false,"justification":"False","idx":3,"proposition":"over-risk liver"},{"correct":false,"justification":"False","idx":4,"proposition":"over-risk of AMD"}],"ts":1632418846,"type":"custom","difficulte":"2"}
-{"_id":"SpA-rhumato-89a4d9","context":null,"enonce":"Which of the following are true?","item":"SpA","matiere":"rhumato","propositions":[{"correct":false,"justification":"False! Red flag, in the first place eliminate an organic cause.","idx":0,"proposition":"In front of back pain, the most likely cause is a static disorder, an X-ray face + profile of the dorsolumbar spine is sufficient"},{"correct":true,"justification":"","idx":1,"proposition":"The search for an indolent or pauci-symptomatic \"sausage\" toe is also very important, justifying the careful examination of patients' feet."},{"correct":false,"justification":"There are 4 stages from 0 to 3 ","idx":2,"proposition":"In conventional radio, the different evolutionary stages of enthesopathy are 3 in number.\r\n"},{"correct":true,"justification":"","idx":3,"proposition":"In the context of spondyloarthritis, there may be anterior acute uveitis, non-granulomatous in most cases, often pauci-symptomatic but sometimes severe. "},{"correct":false,"justification":"False, MRI has no contribution to the diagnosis, if the sacroiliitis is visible on radiography. ","idx":4,"proposition":"In case of sacroiliitis on conventional radio, MRI may have an interest to confirm the diagnosis"}],"ts":1632419243,"type":"custom","difficulte":"2"}
-{"_id":"rachialgie-rhumato-e14165","context":null,"enonce":"Which of the following proposals correspond to the management of common (non-symptomatic) low back pain without red flag, neither deficit nor hyperalgic?","item":"rachialgie","matiere":"rhumato","propositions":[{"correct":false,"justification":"No imaging exam","idx":0,"proposition":"X-ray of the dorsolumbar spine"},{"correct":false,"justification":"No imaging exam","idx":1,"proposition":"Dorsolumbar CT scan"},{"correct":false,"justification":"On the contrary, normal mobilization","idx":2,"proposition":"Bed rest"},{"correct":true,"justification":"True","idx":3,"proposition":"Analgesics level I and II according to the EVA"},{"correct":true,"justification":"True","idx":4,"proposition":"Nonsteroidal anti-inflammatory drugs in the absence of contraindications, suitable for pain"}],"ts":1632419265,"type":"custom","difficulte":"1"}
-{"_id":"vaccin-infectio-8ca8e9","context":null,"enonce":"According to the French vaccination schedule in force since 2018, the MMR vaccination schedule recommended in France includes:","item":"vaccin","matiere":"infectio","propositions":[{"correct":false,"justification":"M12 and M16-18","idx":0,"proposition":"2 doses of primary vaccination at 2 and 4 months"},{"correct":false,"justification":"The dose at 16-18 months is not a booster, but a catch-up. It is part of the basic vaccination schedule","idx":1,"proposition":"1 booster dose at 16-18 months"},{"correct":false,"justification":"M12 and M16-18","idx":2,"proposition":"2 doses at 6 and 12 months"},{"correct":false,"justification":"M12 and M16-18","idx":3,"proposition":"2 doses at 12 months and 6 years"},{"correct":true,"justification":"True","idx":4,"proposition":"2 doses at 12 months and 16-18 months"}],"ts":1632429661,"type":"custom","difficulte":"1"}
-{"_id":"IST-infectio-6d146e","context":null,"enonce":"Which of the following are true about Syphilis?","item":"IST","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The incidence is currently increasing"},{"correct":false,"justification":"It is common ⚠","idx":1,"proposition":"HIV co-infection is rare"},{"correct":true,"justification":"True","idx":2,"proposition":"Transmission can occur transplacentally"},{"correct":false,"justification":"More than one year 📅","idx":3,"proposition":"The infection is said to be late if it is more than a month old"},{"correct":true,"justification":"True","idx":4,"proposition":"The chancre testifies to the replication of treponema at the front door"}],"ts":1632429678,"type":"custom","difficulte":"1"}
-{"_id":"156-infectio-efaacbf6-352e-4e76-9cec-913b380fa662","context":null,"enonce":"With regard to tetanus, at what age are vaccinations associated with diphtheria and poliomyelitis done?","item":"tetanos","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"2-4-11 months"},{"correct":true,"justification":"True","idx":1,"proposition":"6 years"},{"correct":true,"justification":"True","idx":2,"proposition":"13 years"},{"correct":true,"justification":"True","idx":3,"proposition":"25 years and 45 years"},{"correct":true,"justification":"True","idx":4,"proposition":"65 years then every 10 years"}],"ts":1632429815,"type":"custom","difficulte":"1"}
-{"_id":"vaccin-infectio-14491e","context":null,"enonce":"You are following Jean-Paul. He is 75 years old and has type 2 diabetes. He tells you he hasn't had a vaccination in a very long time and asks you which ones he should do. Your answers:","item":"vaccin","matiere":"infectio","propositions":[{"correct":true,"justification":"True, reminders at 6 years, 11-13 years, 25 years, 45 years, 65 years, 75 years and then every 10 years","idx":0,"proposition":"DTP Reminder"},{"correct":true,"justification":"True. Diabetic = immunocompromised = antipneumococcus + antiinfluenza","idx":1,"proposition":"anti-pneumococcal"},{"correct":true,"justification":"True","idx":2,"proposition":"seasonal anti-influenza"},{"correct":false,"justification":"","idx":3,"proposition":"anti-hepatitis B"},{"correct":false,"justification":"","idx":4,"proposition":"anti-meningococcal"}],"ts":1632429844,"type":"custom","difficulte":"1"}
-{"_id":"IU-infectio-a0d66d","context":null,"enonce":"What are the hospitalization criteria for a non-serious NAP?","item":"IU","matiere":"infectio","propositions":[{"correct":true,"justification":"3 reasons: signs of severity, hyperalgic form, non-observant patient","idx":0,"proposition":"A hyperalgic form"},{"correct":true,"justification":"True","idx":1,"proposition":"Doubts about the patient's ability to adhere to antibiotic treatment"},{"correct":false,"justification":"The presence of bacteremia (when tested) does not change management","idx":2,"proposition":"Associated bacteremia"},{"correct":false,"justification":"The intensity of the fever without other argument of sepsis, and without particular terrain, is not in itself an indication of hospitalization","idx":3,"proposition":"A fever > 40°C"},{"correct":false,"justification":"Especially an argument to look for a favoring factor","idx":4,"proposition":"A history of repeated ANP"}],"ts":1632489428,"type":"custom","difficulte":"1"}
-{"_id":"meningite-infectio-603bf3","context":null,"enonce":"Mr. X brings you his 2-year-old son for a fever. \"He's not like usual, he's all grumpy,\" he explains. You notice when you undress the child a necrotic-looking purpura appeared in the morning. What is the course of action?","item":"meningite","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"You contact the SAMU for a medical transfer to the nearest hospital"},{"correct":true,"justification":"True","idx":1,"proposition":"You immediately perform an injection of parenteral C3G IM or IV"},{"correct":false,"justification":"Purpura fulminans = immediate life-threatening emergency, requiring urgent parenteral C3G antibiotic therapy and resuscitation","idx":2,"proposition":"You prescribe symptomatic treatment with paracetamol and ask to see the child again the next day"},{"correct":false,"justification":"Purpura fulminans = immediate life-threatening emergency, requiring urgent parenteral C3G antibiotic therapy and resuscitation","idx":3,"proposition":"You send the child to perform a biology at the local laboratory"},{"correct":false,"justification":"SAMU call for medical transfer","idx":4,"proposition":"You ask the father to take his child to the emergency room right away"}],"ts":1632490034,"type":"custom","difficulte":"1"}
-{"_id":"aNcycle-gyn-f6792f","context":null,"enonce":"Regarding menorrhagia and metrorrhagia, which of these propositions are true?","item":"aNcycle","matiere":"gyn","propositions":[{"correct":false,"justification":"False, we talk about menorrhagia when the Higham score is >100","idx":0,"proposition":"We talk about menorrhagia when the Higham score is >200"},{"correct":true,"justification":"True, these are the main consequences of bleeding.","idx":1,"proposition":"In the face of bleeding of gynecological origin it is essential to assess tolerance by looking for signs of shock and anemia"},{"correct":false,"justification":"False, the main causes of bleeding in the 3rd trimester of pregnancy are placenta previa and retroplacental hematoma","idx":2,"proposition":"In front of a hemorrhage of the 3rd trimester of pregnancy, the main causes of metrorrhagia to evoke are late miscarriage and ectropion"},{"correct":false,"justification":"False, pelvic ultrasound is performed as a first-line procedure, easier to access and practice than pelvic MRI","idx":3,"proposition":"In the event of genital bleeding, the complementary first-line examinations are BHCG, CBC and pelvic MRI"},{"correct":false,"justification":"False, any gynecological bleeding is cancer of the BODY of the uterus until proven otherwise (the endometrium is the cause of gynecological bleeding and is in the uterus not on the cervix)","idx":4,"proposition":"Any postmenopausal gynecological bleeding is cervical cancer until proven otherwise."}],"ts":1632560713,"type":"custom","difficulte":"1"}
-{"_id":"nvxne-gyn-9241a6","context":null,"enonce":"Which of the following proposals are routinely included in the blotting paper biological newborn screening test?","item":"nvxne","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Congenital adrenal hyperplasia"},{"correct":true,"justification":"True","idx":1,"proposition":"Hypothyroidism"},{"correct":true,"justification":"True","idx":2,"proposition":"Cystic fibrosis"},{"correct":true,"justification":"True","idx":3,"proposition":"PKU"},{"correct":false,"justification":"That if risk factor","idx":4,"proposition":"Sickle-cell anemia"}],"ts":1632560989,"type":"custom","difficulte":"2"}
-{"_id":"TED-psy-646a07","context":null,"enonce":"Which of the following proposals are part of the ASD assessment?","item":"TED","matiere":"psy","propositions":[{"correct":true,"justification":"For the assessment of IQ, adaptive behaviour (e.g. Vineland scale) and attentional abilities","idx":0,"proposition":"A psychological assessment"},{"correct":true,"justification":"For the evaluation of verbal and non-verbal language and language pragmatics","idx":1,"proposition":"A speech therapy assessment"},{"correct":true,"justification":"","idx":2,"proposition":"A psychomotor assessment"},{"correct":true,"justification":"Look for epilepsy (present in 20% of ASD)","idx":3,"proposition":"Wake and sleep EEG"},{"correct":true,"justification":"Systematics for the diagnosis of syndromic forms of ASD","idx":4,"proposition":"Brain MRI"}],"ts":1632572219,"type":"custom","difficulte":"2"}
-{"_id":"psygrossesse-psy-21c20a","context":null,"enonce":"Which of the following are true about the baby blues?","item":"psygrossesse","matiere":"psy","propositions":[{"correct":false,"justification":"No treatment, it is physiological","idx":0,"proposition":"It must be treated with SSRIs for 6 weeks"},{"correct":true,"justification":"True","idx":1,"proposition":"Anxiety may be observed"},{"correct":true,"justification":"True","idx":2,"proposition":"Patients do not understand their symptoms (\"I have everything to be happy\")"},{"correct":true,"justification":"True","idx":3,"proposition":"We can find an emotional lability"},{"correct":false,"justification":"It can be very transient and last only a few hours (College of Gynecological)","idx":4,"proposition":"It lasts 2 days minimum"}],"ts":1632572255,"type":"custom","difficulte":"2"}
-{"_id":"dvlptpsychoMo-psy-515600","context":null,"enonce":"Which of the following are true?","item":"dvlptpsychoMo","matiere":"psy","propositions":[{"correct":true,"justification":"True\r\nThink that PC as weight starts with 35 it helps :).\r\n","idx":0,"proposition":"The average parameters of birth of a term newborn are a weight of 3500g, a height of 50cm and a PC at 35cm."},{"correct":false,"justification":"FALSE\r\nIt is doubled at 4 months of life.","idx":1,"proposition":"The birth weight of a child is doubled at 1 year."},{"correct":true,"justification":"True\r\nBetween 20 and 30g per day indeed.","idx":2,"proposition":"During the first trimester of life, an infant is expected to take 25g per day."},{"correct":false,"justification":"False\r\nDefinition of a statural growth anomaly\r\n- Size< -2 DS according to the curves of the general population.\r\n- And\/or size< -1.5 SD relative to genetic target size\r\n- And\/or slowing down (or breaking the growth rate) (< 4cm per year after 4 years)","idx":3,"proposition":"A child with a height of -1.5 DS, has a delay in stature."},{"correct":true,"justification":"True\r\nImportant to know how to calculate. We must be careful because sometimes we can know a statural delay if we rely only on the \"raw\" size, with for example a child at -0.8 DS, which is absolutely normal if we look at that, but if there is a high parental target size, let's admit +2 DS, it will be late (because 2.8 DS difference).\r\nHence the importance of the 3 criteria in the definition.","idx":4,"proposition":"To calculate the genetic target height of a boy, it is necessary to: (Mother's height + father's height)\/2 +6.5"}],"ts":1632572332,"type":"custom","difficulte":"1"}
-{"_id":"certificats-psy-ba9673","context":null,"enonce":"In the case of intentional violence, what is the threshold of days modifying the classification of the offence?","item":"certificats","matiere":"psy","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"5"},{"correct":true,"justification":"True. Below ➡ police court ticket ➡. Above ➡ misdemeanor ➡ criminal court","idx":1,"proposition":"8"},{"correct":false,"justification":"","idx":2,"proposition":"3"},{"correct":false,"justification":"","idx":3,"proposition":"30"},{"correct":false,"justification":"Three months. This is the case for unintentional violence","idx":4,"proposition":"90"}],"ts":1632572338,"type":"custom","difficulte":"1"}
-{"_id":"TED-psy-bd69ef","context":null,"enonce":"Which of the following are true?","item":"TED","matiere":"psy","propositions":[{"correct":true,"justification":"True, defined in repository","idx":0,"proposition":" The prevalence of ASD is 1% and the sex ratio is 4:1 in favour of boys"},{"correct":true,"justification":"True","idx":1,"proposition":" Like all neurodevelopmental disorders, ASD has a multifactorial origin"},{"correct":true,"justification":"That's why we talk about autism spectrum disorders.","idx":2,"proposition":" There is significant clinical heterogeneity of ASD"},{"correct":true,"justification":"","idx":3,"proposition":"Heterogeneity is related to the severity of symptoms in the 2 clinical areas of ASD as well as the presence of comorbidities with other neurodevelopmental disorders"},{"correct":false,"justification":"No, there are children who have a normal IQ (> 70). This is called Asperger's syndrome.","idx":4,"proposition":"All children with autism spectrum disorder have a mental disability"}],"ts":1632572486,"type":"custom","difficulte":"2"}
-{"_id":"bipolaire-psy-53912c","context":null,"enonce":"Which of these propositions are true among bipolar disorder?","item":"bipolaire","matiere":"psy","propositions":[{"correct":false,"justification":"False, bipolar disorder usually appears between 15 and 25 years but it is often diagnosed at more than 30 years ...","idx":0,"proposition":"Bipolar disorder is a disorder that appears around the age of 30"},{"correct":false,"justification":"False, a bipolar disorder type 1 is diagnosed by the presence of a manic episode +\/- a depressive episode! (We cannot talk about bipolar disorder if there is only one depressive episode...)","idx":1,"proposition":"Bipolar disorder type 1 is diagnosed by the presence of a manic episode or a characterized depressive episode."},{"correct":false,"justification":"False, the semiology of a hypomanic syndrome being more frustrating, to speak of a bipolar disorder it is necessary the association of one or more hypomanic episodes and one or more depressive episodes","idx":2,"proposition":"Bipolar disorder type 2 is diagnosed by the presence of one or more hypomanic episodes"},{"correct":true,"justification":"True, lithium is one of the rare cases of the use of a metal as a medicine in medicine. ","idx":3,"proposition":"Treatment of choice for bipolar disorder uses metal-based medication"},{"correct":true,"justification":"True","idx":4,"proposition":"Cognitive remediation is a psychological rehabilitation technique "}],"ts":1632572497,"type":"custom","difficulte":"1"}
-{"_id":"addpsychotropes-psy-d071a7","context":null,"enonce":"Regarding benzodiazepine addiction, which of the following propositions, which one or which are true?","item":"addpsychotropes","matiere":"psy","propositions":[{"correct":true,"justification":"True, these are the main actions of treatments","idx":0,"proposition":"Benzodiazepines are anxiolytic, hypnotic, amnesiac, anticonvulsant and muscle relaxant drugs"},{"correct":true,"justification":"True, this is why there is an addiction to benzodiazepines.","idx":1,"proposition":"Benzodiazepines are part of the treatments with tolerance and withdrawal"},{"correct":true,"justification":"True, the main cause of benzodiazepine addiction is \"automatic\" prescription renewal.","idx":2,"proposition":"When prescribing a benzodiazepine, it should always be considered that it is only a temporary treatment, and should be discontinued."},{"correct":false,"justification":"False, we never put more than one benzodiazepine.","idx":3,"proposition":"For the management of anxiety, a maximum of two anxiolytics can be combined, one short-lived and one long-lived"},{"correct":true,"justification":"True, abrupt withdrawal increases the risk of physical withdrawal syndrome.","idx":4,"proposition":"A gradual cessation is preferred to a sudden withdrawal."}],"ts":1632572500,"type":"custom","difficulte":"1"}
-{"_id":"TED-psy-809b68","context":null,"enonce":"Which of the following are genetic or metabolic diseases causing autism spectrum disorder?","item":"TED","matiere":"psy","propositions":[{"correct":true,"justification":"Rett syndrome is a genetic disease. The disease causes a severe and comprehensive disorder of the development of the central nervous system, occurring only in girls. It results in multiple disabilities with intellectual disability and motor disability, which are often severe. (Source: https:\/\/www.orpha.net\/data\/patho\/Pub\/fr\/Rett-FRfrPub91.pdf)","idx":0,"proposition":"Syndrome de Rett"},{"correct":true,"justification":"Autonomic recessive genetic disease linked to a deficiency of phenylalanine hydroxylase, an enzyme that allows the transformation of phenylalanine into Tyrolean. It is responsible, in the absence of treatment, for severe psychomotor retardation. The disease is screened for blood (Guthrie) on Day 3 by measuring phenylalanine. ","idx":1,"proposition":"PKU"},{"correct":true,"justification":"","idx":2,"proposition":"Abnormality of creatinine metabolism"},{"correct":false,"justification":"Trisomy 21 is not in itself a genetic cause of ASD, but is an associated risk factor. 3% of children with trisomy 21 have ASD (p. 154 8th edition of the College of Pediatrics)","idx":3,"proposition":"Down syndrome"},{"correct":true,"justification":"","idx":4,"proposition":"Fragile X syndrome"}],"ts":1632572506,"type":"custom","difficulte":"2"}
-{"_id":"dvlptpsychoMo-psy-6b5a9f","context":null,"enonce":"Which of the following proposals should be acquired at 2 months?","item":"dvlptpsychoMo","matiere":"psy","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Shake your finger"},{"correct":true,"justification":"True","idx":1,"proposition":"Smile-response"},{"correct":false,"justification":"4 months","idx":2,"proposition":"Holding your head"},{"correct":false,"justification":"4 months","idx":3,"proposition":"Laughing out loud"},{"correct":false,"justification":"6 months","idx":4,"proposition":"Hold seated with support"}],"ts":1632572680,"type":"custom","difficulte":"2"}
-{"_id":"puberte-gyn-34d8ac","context":null,"enonce":"Which of the following are true?","item":"puberte","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The Tanner classification evaluates the appearance of secondary sex characteristics for monitoring the pubertal evolution of girls and boys."},{"correct":true,"justification":"True Hence the boys who often make small in middle school compared to girls 1) their puberty begins physiologically + late, 2) the statural acceleration begins at a later stage of puberty.","idx":1,"proposition":"The acceleration of the rate of stature growth begins at the first signs of puberty in girls (S2) and staggered in boys (G3) and rises up to 8 to 10 cm per year."},{"correct":false,"justification":"The appearance of the sesamoid of the thumb is contemporary with the onset of puberty, at a bone age of 11 years in girls and 13 years in boys.","idx":2,"proposition":"The appearance of the sesamoid of the thumb means that the growth of the child is almost complete."},{"correct":true,"justification":"True","idx":3,"proposition":"Bone maturation in children can be assessed by bone age, which is obtained by taking an X-ray of the left hand and wrist from the front."},{"correct":false,"justification":"Wrong, it's the other way around. Early puberty is defined as breast development in girls before the age of 8 and in boys testicular development before the age of 9.                          Puberty physio in girls 8-13 years, 9-14 years in boys.","idx":4,"proposition":"Precocious puberty is defined as breast development in girls before the age of 9 and in boys testicular development before the age of 8."}],"ts":1632573158,"type":"custom","difficulte":"1"}
-{"_id":"Exprenuptial-gyn-8c92f3","context":null,"enonce":"Which of the following are teratogenic drugs?","item":"Exprenuptial","matiere":"gyn","propositions":[{"correct":false,"justification":"False. A pregnant woman with lupus can continue to take her background treatment.","idx":0,"proposition":"Hydroxychloroquine"},{"correct":false,"justification":"False","idx":1,"proposition":"Corticosteroids"},{"correct":true,"justification":"True. All ACE inhibitors and angiotensin II receptor antagonists (sartans) are contraindicated in the 2nd and 3rd trimesters of pregnancy. They are not contraindicated in the first trimester, but it is not advisable to maintain them during pregnancy. ","idx":2,"proposition":"IEC"},{"correct":true,"justification":"True","idx":3,"proposition":"Valproic acid"},{"correct":true,"justification":"True. Effective contraception should be initiated during this acne treatment, and maintained 4 weeks after stopping treatment.","idx":4,"proposition":"Isotretinoin"}],"ts":1632573167,"type":"custom","difficulte":"2"}
-{"_id":"EI-cardio-659da3","context":null,"enonce":"You have in hospitalization in infectious disease Mrs. Bouvier, Pamela, 76 years old, who has a febrile heart murmur newly appeared for 1 week, poorly tolerated. Although you suspect infective endocarditis, blood cultures persist in coming back negative, and yet you have not initiated any antibiotic therapy 😑. You then think about the causes of negative blood culture endocarditis, what are they? 😏","item":"EI","matiere":"cardio","propositions":[{"correct":true,"justification":"True, the causes of negative blood culture endocarditis are: Whipple, Bartonella, Brucella, Coxiella, Chlamydia, H.A.C.E.K. but also Legionella, Mycoplasma, Rickettsia, Aspergillus, etc....","idx":0,"proposition":"Treponema whipplei endocarditis"},{"correct":true,"justification":"True","idx":1,"proposition":"Bartonella endocarditis"},{"correct":true,"justification":"True","idx":2,"proposition":"Coxiella endocarditis"},{"correct":true,"justification":"True","idx":3,"proposition":"Bacterial endocarditis of the H.A.C.E.K. group"},{"correct":true,"justification":"True","idx":4,"proposition":"Brucella endocarditis"}],"ts":1632762531,"type":"custom","difficulte":"1"}
-{"_id":"EI-cardio-0b77ff","context":null,"enonce":"Which of the following are true for the diagnosis of infective endocarditis? 🤯","item":"EI","matiere":"cardio","propositions":[{"correct":false,"justification":"ETT-Hémoc wesh! Then ETO.","idx":0,"proposition":"CT angiography is the first-line examination"},{"correct":false,"justification":"The ETO is very often done as a second intention, after the ETT","idx":1,"proposition":"ETO is only needed in case of negative 🤷 ♂️ angioscan"},{"correct":false,"justification":"Not always, it is not found in 10% of cases ➡ bacteria of the HACCEK group (slow growing), prior antibiotic therapy, etc. In all cases, blood cultures must be repeated several times 😋","idx":2,"proposition":"Blood cultures always find the germ"},{"correct":true,"justification":"True, they contraindicate thrombolysis in stroke","idx":3,"proposition":"Brain MRI can find mycotic aneurysms"},{"correct":true,"justification":"True","idx":4,"proposition":"The presence of two major criteria (ultrasound + blood culture) make it possible to make the diagnosis of infective endocarditis"}],"ts":1632762644,"type":"custom","difficulte":"1"}
-{"_id":"EI-cardio-7da7a2","context":null,"enonce":"Which bacteria are most common in infective endocarditis? 🙌","item":"EI","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Golden staph"},{"correct":true,"justification":"True","idx":1,"proposition":"Staphylococcus aureus "},{"correct":false,"justification":"Staph > Strepto","idx":2,"proposition":"Streptococcus pneumoniae"},{"correct":false,"justification":"Gram-negative cocci that lead to ear and upper and lower respiratory tract infections","idx":3,"proposition":"Moraxella catarrhalis"},{"correct":false,"justification":"This is not the most common. This germ often has a digestive origin (➡ perform a colonoscopy)","idx":4,"proposition":"Streptococcus D"}],"ts":1632762717,"type":"custom","difficulte":"1"}
-{"_id":"EI-cardio-39c91d","context":null,"enonce":"Which of the following are true?","item":"EI","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The germ mostly found is Staphylococcus aureus"},{"correct":false,"justification":"90% = left heart","idx":1,"proposition":"The right heart is more often affected than the left 💔 heart"},{"correct":true,"justification":"True","idx":2,"proposition":"IV addiction is an important risk factor for endocarditis of the right heart"},{"correct":true,"justification":"True, risk of rupture of mycotic aneurysm","idx":3,"proposition":"IV thrombolysis in stroke is contraindicated (relatively) in case of a history of AE"},{"correct":false,"justification":"If ✅","idx":4,"proposition":"Age is not a risk factor"}],"ts":1632762746,"type":"custom","difficulte":"1"}
-{"_id":"EI-cardio-9a8606","context":null,"enonce":"Which of the following are true about fungal endocarditis?","item":"EI","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"There is frequently a diagnostic delay"},{"correct":false,"justification":"They are very common","idx":1,"proposition":"There are no embolic complications"},{"correct":true,"justification":"True","idx":2,"proposition":"It is often necessary to combine surgical treatment with medical treatment"},{"correct":true,"justification":"True","idx":3,"proposition":"IV addiction is an important risk factor"},{"correct":false,"justification":"Almost all, sorry 🙏","idx":4,"proposition":"All propositions are true"}],"ts":1632762775,"type":"custom","difficulte":"1"}
-{"_id":"EI-cardio-5f83fe","context":null,"enonce":"What is the procedure to take in case of dental avulsion in a patient who has had infective endocarditis and proven allergy to amoxicillin?","item":"EI","matiere":"cardio","propositions":[{"correct":false,"justification":"Sound familiar? 😋 This is the prophylaxis of pneumocytosis in immunocompromised 😉 people","idx":0,"proposition":"Prolonged antibiotic prophylaxis with bactrim 3x per week"},{"correct":false,"justification":"Not in case of proven 🙈 allergy","idx":1,"proposition":"2g of amoxicillin 1 hour before the gesture"},{"correct":true,"justification":"True","idx":2,"proposition":"Clindamycin 1 hour before the procedure"},{"correct":false,"justification":"","idx":3,"proposition":"Levofloxacin 1 day before the gesture"},{"correct":false,"justification":"","idx":4,"proposition":"Metronidazole 1h before the gesture"}],"ts":1632762821,"type":"custom","difficulte":"1"}
-{"_id":"EI-cardio-9a8b5a","context":null,"enonce":"Which of the following are major criteria in infective endocarditis?","item":"EI","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Positive imaging"},{"correct":true,"justification":"True","idx":1,"proposition":"Positive blood culture"},{"correct":false,"justification":"","idx":2,"proposition":"Prolonged fever"},{"correct":false,"justification":"Minor criterion","idx":3,"proposition":"Janeway's Pupura"},{"correct":false,"justification":"Duke Criteria","idx":4,"proposition":"These are the Lauwers criteria."}],"ts":1632762993,"type":"custom","difficulte":"1"}
-{"_id":"EI-cardio-2059a4","context":null,"enonce":"Which of the following are signs or symptoms of infective endocarditis?","item":"EI","matiere":"cardio","propositions":[{"correct":true,"justification":"True, always think about it in front of a prolonged fever! 🚨","idx":0,"proposition":"Prolonged fever"},{"correct":true,"justification":"True","idx":1,"proposition":"Splenic abscess"},{"correct":false,"justification":"Cerebral mycotic aneurysms (these are fake aneurysms eh)","idx":2,"proposition":"Coronary aneurysms"},{"correct":true,"justification":"True","idx":3,"proposition":"Janeway's erythematosus cupboard "},{"correct":false,"justification":"Glomerulonephritis pauci-immune","idx":4,"proposition":"Light chain proteinuria"}],"ts":1632763053,"type":"custom","difficulte":"1"}
-{"_id":"EI-cardio-0b5a45","context":null,"enonce":"Which of the following are true for Libman-Sacks endocarditis?","item":"EI","matiere":"cardio","propositions":[{"correct":false,"justification":"Non-infectious endocarditis","idx":0,"proposition":"It is infective endocarditis"},{"correct":false,"justification":"","idx":1,"proposition":"It is endocarditis of the right heart"},{"correct":false,"justification":"Lupus","idx":2,"proposition":"It complicates Gougerot syndrome"},{"correct":true,"justification":"True, a bit of history 🧐 (from Wikipedia we admit 😇)","idx":3,"proposition":"The lesions were described by Emanuel Libman and Benjamin Sacks in 1924."},{"correct":true,"justification":"True","idx":4,"proposition":"This endocarditis can be asymptomatic"}],"ts":1632763069,"type":"custom","difficulte":"1"}
-{"_id":"EI-cardio-1b5678","context":null,"enonce":"Which heart diseases are at high risk of developing infective endocarditis? 🤔","item":"EI","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Cyanogenic heart disease"},{"correct":true,"justification":"True","idx":1,"proposition":"History of infective endocarditis"},{"correct":true,"justification":"True","idx":2,"proposition":"Biological mitral valve"},{"correct":true,"justification":"True","idx":3,"proposition":"Mechanical aortic valve"},{"correct":true,"justification":"True, hence the need for antibiotic prophylaxis in case of invasive dental procedure","idx":4,"proposition":"All propositions are true"}],"ts":1632763106,"type":"custom","difficulte":"1"}
-{"_id":"EI-cardio-bf9cc3","context":null,"enonce":"What is the mortality rate of fungal endocarditis? 🍄","item":"EI","matiere":"cardio","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"5 %"},{"correct":false,"justification":"","idx":1,"proposition":"20 %"},{"correct":true,"justification":"True","idx":2,"proposition":"> 50%"},{"correct":true,"justification":"True","idx":3,"proposition":"Surgical treatment should be discussed concomitantly with medical treatment"},{"correct":false,"justification":"More reserved prognosis (mortality rate of bacterial AEs around 20%)","idx":4,"proposition":"The prognosis is better than that of bacterial endocarditis"}],"ts":1632763139,"type":"custom","difficulte":"1"}
-{"_id":"EI-cardio-d23456","context":null,"enonce":"Which of the following proposals can result in blood culture negative endocarditis?","item":"EI","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Bartonella"},{"correct":true,"justification":"True","idx":1,"proposition":"Coxiella burnetii"},{"correct":true,"justification":"True","idx":2,"proposition":"Tropheryma whipplei"},{"correct":true,"justification":"True, HACCEK Group","idx":3,"proposition":"H. parainfluenzae"},{"correct":true,"justification":"True, HACECK group","idx":4,"proposition":"Kingella kingae"}],"ts":1632763183,"type":"custom","difficulte":"1"}
-{"_id":"EI-cardio-1107dc","context":null,"enonce":"What is the procedure to take in case of dental avulsion in a patient who has had infective endocarditis?","item":"EI","matiere":"cardio","propositions":[{"correct":false,"justification":"This is the case in prophylaxis of pneumocytosis in immunocompromised people","idx":0,"proposition":"Prolonged antibiotic prophylaxis with bactrim 3x per week"},{"correct":true,"justification":"True, indicated in case of infective endocarditis, cyanogenic heart disease or new valve. If allergy: clindamycin","idx":1,"proposition":"2g of amoxicillin 1 hour before the gesture"},{"correct":false,"justification":"","idx":2,"proposition":"2g of amoxicillin 1 day after the gesture"},{"correct":false,"justification":"Too long, I remind you that beta-lactam have a short lifespan (we made a fairly complete topo on insta, you can find it on the storys on the front page)","idx":3,"proposition":"1g of amoxicillin 1 week before the gesture"},{"correct":false,"justification":"","idx":4,"proposition":"Antibiotic prophylaxis is not necessary"}],"ts":1632763278,"type":"custom","difficulte":"1"}
-{"_id":"suiviMIT-infectio-cc75d9","context":null,"enonce":"Which of the following diseases are notifiable diseases?","item":"suiviMIT","matiere":"infectio","propositions":[{"correct":true,"justification":"True, it is a notifiable disease because it is necessary to identify the food source to limit the risk of epidemic","idx":0,"proposition":"Listeriasis"},{"correct":true,"justification":"True, it is a reportable disease because it is necessary to identify the environmental source to limit the risk of epidemic.","idx":1,"proposition":"Legionellosis"},{"correct":true,"justification":"True since 2021 due to the implantation of this virus in the on of Europe (this is also the case for the tick-borne encephalitis virus which has become the 3rd cause in France of encephalitis)","idx":2,"proposition":"Infection par le virus West Nile"},{"correct":true,"justification":"True, like almost all arbroviruses (Dengue, Yellow fever, Zika) ","idx":3,"proposition":"Chikungunya"},{"correct":false,"justification":"False, invasive meningococcal invasions are reportable","idx":4,"proposition":"Meningitis"}],"ts":1632814922,"type":"custom","difficulte":"1"}
-{"_id":"IBP-infectio-06c351","context":null,"enonce":"In front of bronchiolitis of the child, what are the criteria of severity?","item":"IBP","matiere":"infectio","propositions":[{"correct":false,"justification":"False, it has been changed it is an age of less than 8 weeks","idx":0,"proposition":"Age less than 6 weeks"},{"correct":true,"justification":"True, logically","idx":1,"proposition":"Difficulties of living conditions, precariousness"},{"correct":false,"justification":"False, it has been changed it is below 92%","idx":2,"proposition":"Desaturation below 94%"},{"correct":true,"justification":"True, logically","idx":3,"proposition":"Feeding difficulties"},{"correct":false,"justification":"False, it is severe signs of struggle that count!","idx":4,"proposition":"Signs of respiratory struggle"}],"ts":1632814938,"type":"custom","difficulte":"1"}
-{"_id":"IST-infectio-e8d85a","context":null,"enonce":"What is the first-line treatment for Treponema pallidum infection?","item":"IST","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Penicillin G"},{"correct":false,"justification":"Neisseria gonorrhoeae","idx":1,"proposition":"Ceftriaxone "},{"correct":false,"justification":"Chlamydia trachomatis","idx":2,"proposition":"Doxycycline"},{"correct":false,"justification":"HSV","idx":3,"proposition":"Valaciclovir"},{"correct":false,"justification":"Trichomonas vaginalis","idx":4,"proposition":"Metronidazole "}],"ts":1632814976,"type":"custom","difficulte":"1"}
-{"_id":"154-infectio-32e6bd67-83b7-41b5-9276-29648deb3f86","context":null,"enonce":"While visiting with your favourite outpatient in the infectious diseases department, you go to the room of Mrs. Solitaire, 55, who has gram-negative bacillus bacteremia. Your external will ask you if there is a need to do further examinations to look for a secondary location of bacteremia. You answer him that no, this is not the case here, but that there are certain germs for which it is necessary in case of bacteremia to systematically look for a secondary location or an endovascular relay. What are these germs?","item":"bacteriemie","matiere":"infectio","propositions":[{"correct":false,"justification":"False, we do not systematically look for a secondary location to this germ","idx":0,"proposition":"Enterococcus"},{"correct":false,"justification":"False, we do not systematically look for a secondary location to this germ","idx":1,"proposition":"Pneumococcus"},{"correct":true,"justification":"True, there is a very significant risk of Staphylococcus aureus endocarditis, which requires a transthoracic ultrasound","idx":2,"proposition":"Golden staph"},{"correct":true,"justification":"True, a candida fungemia must be sought for cardio and ocular localization and requires a transthoracic ultrasound and fundus","idx":3,"proposition":"Candida"},{"correct":false,"justification":"False, we do not systematically look for a secondary location of this germ","idx":4,"proposition":"Pseudomonas aeruginosa"}],"ts":1632815353,"type":"custom","difficulte":"1"}
-{"_id":"vaccin-infectio-b00fe5","context":null,"enonce":"Which of the following are viruses against which vaccines exist?","item":"vaccin","matiere":"infectio","propositions":[{"correct":true,"justification":"True, this is a live attenuated vaccine","idx":0,"proposition":"yellow fever"},{"correct":true,"justification":"True, this is a live attenuated vaccine","idx":1,"proposition":"varicella-zoster"},{"correct":true,"justification":"True","idx":2,"proposition":"influenza"},{"correct":false,"justification":"","idx":3,"proposition":"hepatitis C"},{"correct":true,"justification":"True","idx":4,"proposition":"hepatitis B"}],"ts":1632815384,"type":"custom","difficulte":"1"}
-{"_id":"IST-infectio-66fbc1","context":null,"enonce":"What is the first-line treatment for Chlamydia trachomatis infection?","item":"IST","matiere":"infectio","propositions":[{"correct":true,"justification":"True, replaced azithromycin as first-line treatment","idx":0,"proposition":"Doxycycline"},{"correct":false,"justification":"Neisseria gonorrhoeae","idx":1,"proposition":"Ceftriaxone "},{"correct":false,"justification":"HSV","idx":2,"proposition":"Valaciclovir"},{"correct":false,"justification":"Trichomonas vaginalis","idx":3,"proposition":"Metronidazole "},{"correct":false,"justification":"Treponema pallidum ","idx":4,"proposition":"Penicillin G"}],"ts":1632815423,"type":"custom","difficulte":"1"}
-{"_id":"fievreaigue-infectio-b18db5","context":null,"enonce":"While you are an outpatient in your general medicine department, the nurse approaches you by telling you that Mrs. King, Elektra, 55 years old, admitted for 8 days for biological inflammatory syndrome, has a fever of 38.2 ° C.  Not knowing where to start you will see your intern who tells you to apply the rule of P, which makes it easy to look for nosocomial fevers. What are the \"Ps\" that are part of it?","item":"fievreaigue","matiere":"infectio","propositions":[{"correct":true,"justification":"True, the 5P rule is not to know for the ECN but it seems essential to me for your internships. The 5 Ps are Pee (Urinary Tract Infection), Lung (Pneumonitis), Skin (Erysipelas), Phlebitis (DVT) and Peripheral Puncture (Catheter)","idx":0,"proposition":"P for Pee, urinary tract infection"},{"correct":false,"justification":"False, cf. Has","idx":1,"proposition":"P for Prostate, Prostatitis"},{"correct":true,"justification":"True, cf. Has","idx":2,"proposition":"P for Skin, erysipelas"},{"correct":true,"justification":"True, cf. Has","idx":3,"proposition":"P for Phlebitis, Deep vein thrombosis"},{"correct":false,"justification":"False, cf. Has","idx":4,"proposition":"P for \"Pipeau\", factitious fever"}],"ts":1632815474,"type":"custom","difficulte":"1"}
-{"_id":"vaccin-infectio-4cb4b7","context":null,"enonce":"Which of the following are true about influenza vaccination?","item":"vaccin","matiere":"infectio","propositions":[{"correct":false,"justification":"Inert vaccine","idx":0,"proposition":"It is a live attenuated vaccine"},{"correct":false,"justification":"1 annual injection is enough","idx":1,"proposition":"It requires 2 injections 1 month apart"},{"correct":false,"justification":"It is recommended!","idx":2,"proposition":"It is contraindicated in pregnant women"},{"correct":true,"justification":"True","idx":3,"proposition":"It must be renewed every year"},{"correct":true,"justification":"True","idx":4,"proposition":"Immunity appears 10-15 days after vaccination"}],"ts":1632815496,"type":"custom","difficulte":"1"}
-{"_id":"vaccin-infectio-163c08","context":null,"enonce":"Which of the following are true about BCG vaccination?","item":"vaccin","matiere":"infectio","propositions":[{"correct":true,"justification":"True, it is a M. bovis attenuated in its pathogenicity","idx":0,"proposition":"It derives from Mycobacterium bovis"},{"correct":false,"justification":"Intradermal","idx":1,"proposition":"Administration is intramuscular"},{"correct":false,"justification":"Recommended","idx":2,"proposition":"It is mandatory in a child born in a country with a high tuberculosis endemic"},{"correct":false,"justification":"Recommended","idx":3,"proposition":"It is mandatory in a child with a family history of tuberculosis"},{"correct":true,"justification":"True, due to a risk of vaccine disease, as with all live attenuated vaccines","idx":4,"proposition":"It is contraindicated in case of cellular immunosuppression"}],"ts":1632815616,"type":"custom","difficulte":"1"}
-{"_id":"IST-infectio-4aab71","context":null,"enonce":"Which of the following are true about HPV?","item":"IST","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Condylomas are always due to HPV"},{"correct":true,"justification":"True","idx":1,"proposition":"Infection is asymptomatic most of the time"},{"correct":false,"justification":"The treatment of condylomas is based, depending on their size and location, on the use of laser, local treatments (especially imiquimod) or surgery","idx":2,"proposition":"Treatment of warts is based on antivirals such as acyclovir"},{"correct":false,"justification":"Nonavalent vaccine is preferred","idx":3,"proposition":"Bivalent vaccine is preferred in most cases"},{"correct":true,"justification":"The HAS recommended in December 2019 to vaccinate all boys with the same vaccination schedule as in girls: two doses of Gardasil 9 vaccine (M0-M6) in 11-14 years old and catch-up in 15-19 year olds with 3 doses (M0-M2-M6). This recommendation has been in effect since January 1, 2021.","idx":4,"proposition":"Vaccination of boys and girls is recommended"}],"ts":1632815743,"type":"custom","difficulte":"1"}
-{"_id":"160-infectio-23bd82eb-9469-4ab1-928e-ec020e10f6ba","context":null,"enonce":"Regarding measles, which of the following proposition(s) is true?","item":"exanthemeped","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The period of contagiousness extends from 5 days before to 5 days after the rash"},{"correct":true,"justification":"True, these are the white\/bluish rashes on the inner side of the cheek appearing at the 36th hour of the fever and persisting until the rash.","idx":1,"proposition":"Koplik's sign is pathognomonic"},{"correct":false,"justification":"False, NOT pruritic","idx":2,"proposition":"The maculopapular exanthema is itchy and begins behind the ears"},{"correct":true,"justification":"True","idx":3,"proposition":"Biological confirmation can be done by PCR or serology in blood or saliva"},{"correct":false,"justification":"False, up to 5 days after the rash","idx":4,"proposition":"The disease leads to eviction from the community up to 15 days after the eruption"}],"ts":1632816056,"type":"custom","difficulte":"1"}
-{"_id":"IU-infectio-e9b5e0","context":null,"enonce":"Which of the following are criteria for classifying pyelonephritis as at risk? ","item":"IU","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"pregnancy"},{"correct":true,"justification":"","idx":1,"proposition":"male"},{"correct":false,"justification":"Age > 75 (or >65 with +2 Fried criteria), Urinary tree abnormality, pregnancy, IR or severe DI, male sex","idx":2,"proposition":"Type 1 diabetes"},{"correct":true,"justification":"True","idx":3,"proposition":"vesicoureteral reflux"},{"correct":true,"justification":"True","idx":4,"proposition":"post-voiding residue"}],"ts":1632816199,"type":"custom","difficulte":"1"}
-{"_id":"fievreaigue-infectio-5c655b","context":null,"enonce":"With regard to acute fever, which of the following propositions, are true?","item":"fievreaigue","matiere":"infectio","propositions":[{"correct":false,"justification":"False, naughty trap, but to emphasize the importance of qSOFA, easy to perform and of which 2 of the 3 items among the following allows to define a serious sepsis (FR greater than or equal to 22, acute impairment of higher functions, TAs less than or equal to 100mmHg)","idx":0,"proposition":"In the emergency room, an assessment of the potential severity of the fever can be made via the SOFA"},{"correct":true,"justification":"True, let's particularly insist on dehydration especially on fragile grounds (elderly)","idx":1,"proposition":"The main complications of fever itself are dehydration, decompensation of comorbidities and neurological disorders."},{"correct":true,"justification":"True, this is the great fear of gynecologists and attending physicians.","idx":2,"proposition":"Any fever with flu-like illness in pregnant women should be tested for blood culture listerias."},{"correct":false,"justification":"False, it is often in these cases a urinary colonization, it is necessary to know how to look for clinical signs and urinary functional signs","idx":3,"proposition":"A positive ECBU in a febrile elderly should lead to the offer of antibiotic treatment"},{"correct":true,"justification":"True. For once, very tricky painting and already seen in internship","idx":4,"proposition":"A fever in children with abdominal pain and vomiting may indicate pneumonia"}],"ts":1632816327,"type":"custom","difficulte":"1"}
-{"_id":"151-infectio-6f6278ae-1dfa-4c97-a619-452bbe1ce578","context":null,"enonce":"Regarding acute community lung disease, which of these propositions are true?","item":"IBP","matiere":"infectio","propositions":[{"correct":false,"justification":"False, in ambulatory the ONLY necessary examination is chest X-ray","idx":0,"proposition":"During an outpatient consultation at the general practice, additional examinations are limited to chest radiography and minimal inflammatory blood test (CBC, CRP)"},{"correct":false,"justification":"False, ECBC should be prescribed in case of productive cough because they make it very easy to identify germs","idx":1,"proposition":"In standard hospitalization, the biological assessment to identify the infecting germ is mainly based on blood cultures, the yield of ECBC being low, the latter are no longer widely used"},{"correct":true,"justification":"True, the only, the only.","idx":2,"proposition":"The reference antibiotic for pneumococcal pneumonitis is Amoxicillin"},{"correct":false,"justification":"False, it is recalled here that legionellosis is an infection that is transmitted from the environment (here infected water networks) to humans, but that there is no human-to-human transmission.","idx":3,"proposition":"When legionellosis is suspected, in addition to mandatory reporting, the patient should be isolated in a room with additional \"droplet\" type protection. "},{"correct":true,"justification":"True, this is the main complication to look for","idx":4,"proposition":"In case of dyspnea or febrile desaturation or reascent after the start of antibiotic therapy, a chest X-ray should be done to look for pleural effusion"}],"ts":1632816387,"type":"custom","difficulte":"1"}
-{"_id":"159-infectio-c8d6a4f8-c482-4608-aa2e-d52175f992b0","context":null,"enonce":"With regard to whooping cough, which of the following propositions, which one or which are true?","item":"coqueluche","matiere":"infectio","propositions":[{"correct":false,"justification":"False, it's a gram bacillus -! Remember that cocci gram + it is staphylococcal \/ pneumococcus \/ enterococcal \/ streptococcus, bacillus gram + it is Listeria, Cocci gram _ it is meningococcal and gonococcal and the rest or almost it is bacillus gram -!","idx":0,"proposition":"Bordetella Pertussis is a small gram+ bacillus"},{"correct":false,"justification":"False! Big trap that I often got screwed on SIDES, whooping cough usually does NOT give a fever.","idx":1,"proposition":"Pertussis can be confused with CoVID 19 infection or with viral pneumonitis because of symptomatology functional signs ENT-fever-cough-muscle pain"},{"correct":true,"justification":"True, one of the only indications for nasal PCR after CoVID and influenza","idx":2,"proposition":"The diagnosis of pertussis is made by nasal swab PCR"},{"correct":false,"justification":"False, pertussis is a notifiable disease in clustered\/nosocomial cases","idx":3,"proposition":"Pertussis is a reportable disease"},{"correct":true,"justification":"True, it is the strategy of cocooning consisting in vaccinating the entourage of infants not yet vaccinated (vaccination starting at 2 months of life) in order to reduce the risk of potentially serious pertussis in the infant.\r\n","idx":4,"proposition":"Although boosters after age 25 are not mandatory, there is an infant protection strategy based on vaccinating adults and the elderly in preparation for pregnancy."}],"ts":1632816993,"type":"custom","difficulte":"1"}
-{"_id":"IST-infectio-770dbe","context":null,"enonce":"Genital ulcers are mainly due to: (2 responses)","item":"IST","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Treponema pallidum"},{"correct":true,"justification":"True","idx":1,"proposition":"Herpes simplex 1 and 2"},{"correct":false,"justification":"urethritis and cervicitis","idx":2,"proposition":"Chlamydia trachomatis"},{"correct":false,"justification":"urethritis and cervicitis","idx":3,"proposition":"Neisseria gonorrhoeae"},{"correct":false,"justification":"non-sexual acquiring urinary tract infection","idx":4,"proposition":"Escherichia coli"}],"ts":1632817010,"type":"custom","difficulte":"1"}
-{"_id":"158-infectio-857191d9-cbcb-4f43-8b94-dc850d24fca0","context":null,"enonce":"You receive in general medical consultation, the young Jeppe, 16 years old, who comes to see you because he has just changed partners, and that his new partner has told him about the screenings of \"STDs\". You decide to prescribe the standard screening, what tests do you do?","item":"IST","matiere":"infectio","propositions":[{"correct":true,"justification":"True, followed by a VDRL only in case of positivity. ","idx":0,"proposition":"Automated Qualitative Treponemal Test (EIA or ELISA)"},{"correct":false,"justification":"False. Hepatitis B screening is based on HBsAg, HBcAg and HBsAc.","idx":1,"proposition":"HBsAg alone"},{"correct":true,"justification":"True, it is one of the two valid methods to look for local infections (gonococcus, chlamydia) in humans.","idx":2,"proposition":"Urethral swab self-sampling to be brought to the laboratory for Gonococcus and Chlamydia PCR."},{"correct":true,"justification":"True, cf C.","idx":3,"proposition":"Collection of the first urinary stream for Gonococcus and Chlamydia PCR."},{"correct":true,"justification":"Inescapable","idx":4,"proposition":"HIV serology"}],"ts":1632817852,"type":"custom","difficulte":"1"}
-{"_id":"153-infectio-6d7e5573-18e4-4c28-8e31-853cdd9e972a","context":null,"enonce":"You are a general practitioner in office and you receive in consultation Mr Kananga, type 2 diabetic for 40 years who has a superinfected plantar perforating disease. As a result, you explain that he will require hospitalization to assess his infection, with specialized care. But what will this support entail?","item":"IOA","matiere":"infectio","propositions":[{"correct":true,"justification":"True, plantar perforating disease arises from a combination of neuropathy and arterial disease.","idx":0,"proposition":"An evaluation of the vascular trunks with at least one IPS and at most an Echo-Doppler of the lower limbs"},{"correct":true,"justification":"True, the plantar perforating disease signs an imbalance of diabetes, so it is necessary to evaluate the biological impact.","idx":1,"proposition":"A reassessment of diabetes balance by fasting blood glucose and HbA1c"},{"correct":false,"justification":"False, the superficial sample would only show the saprophytic bacteria of the skin, it requires a deep sample, even surgical","idx":2,"proposition":"Bacteriological sampling of the wound by swab"},{"correct":true,"justification":"True, to do at will. ","idx":3,"proposition":"Local management with discharge of the foot and debridage of the wound"},{"correct":true,"justification":"True, do not forget in front of a wound ","idx":4,"proposition":"Reassessment of tetanus vaccination status"}],"ts":1632817886,"type":"custom","difficulte":"1"}
-{"_id":"IST-infectio-931491","context":null,"enonce":"Which of the following propositions are true about syphilitic chancre?","item":"IST","matiere":"infectio","propositions":[{"correct":false,"justification":"Non-painful","idx":0,"proposition":"It is painful"},{"correct":true,"justification":"True","idx":1,"proposition":"It is thoroughly endured"},{"correct":true,"justification":"True, unendured and clean background","idx":2,"proposition":"It is clean"},{"correct":true,"justification":"True","idx":3,"proposition":"It disappears spontaneously"},{"correct":false,"justification":"Associated with one or more lymphadenopathy(s), most often inguinal(s) (depending on the site of the chancre), NOT inflammatory(s) 😬","idx":4,"proposition":"It is accompanied by lymphadenopathy (often inguinal) inflammatory"}],"ts":1632818575,"type":"custom","difficulte":"1"}
-{"_id":"IBP-infectio-db6045","context":null,"enonce":"Which of the following are true?","item":"IBP","matiere":"infectio","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"In the northern hemisphere, influenza is rare in winter"},{"correct":true,"justification":"True","idx":1,"proposition":"Some coronaviruses can infect patients returning from the Arabian Peninsula"},{"correct":false,"justification":"Possible by PCR","idx":2,"proposition":"Diagnosis of certainty of coronavirus infections is impossible"},{"correct":true,"justification":"True","idx":3,"proposition":"PCRs are available for most respiratory viruses"},{"correct":true,"justification":"True, especially in the elderly or immunocompromised","idx":4,"proposition":"These respiratory infections can be life-threatening"}],"ts":1632818635,"type":"custom","difficulte":"1"}
-{"_id":"IST-infectio-a246e0","context":null,"enonce":"In case of late syphilis, the IM injection of penicillin G in the form of delay should be repeated:","item":"IST","matiere":"infectio","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"1 time"},{"correct":false,"justification":"","idx":1,"proposition":"It must not be repeated"},{"correct":false,"justification":"","idx":2,"proposition":"2 times"},{"correct":true,"justification":"True, 3 IM injections 1 week apart","idx":3,"proposition":"3 times"},{"correct":false,"justification":"A little too much anyway 😆","idx":4,"proposition":"5 times"}],"ts":1632818683,"type":"custom","difficulte":"1"}
-{"_id":"153-infectio-2bbd2b4b-b544-49cb-a38e-a8760c67426e","context":null,"enonce":"With regard to Community infectious spondylodiscitis, which of the following proposals are correct?","item":"IOA","matiere":"infectio","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"S. aureus spondylodiscite indicates a probable dermal origin of the infection"},{"correct":true,"justification":"True, like ANY involvement of the spine, it is necessary to look for a lesional syndrome (radiculalgia ...) and \/ or under lesional (urine retention, pyramidal irritation ...)","idx":1,"proposition":"If spondylodiscitis is suspected, always look for signs of spinal cord compression."},{"correct":false,"justification":"False, it's the opposite, tell yourself that infectious lesions in 99% of cases are hyper T2 and hypo T1 on MRI","idx":2,"proposition":"Signs of spondylodiscite on MRI are T1 hypersignal and T2 hyposignal"},{"correct":false,"justification":"False, it is based on penicillin M IV","idx":3,"proposition":"First-line antibiotic therapy is based on IV vancomycin"},{"correct":false,"justification":"False, it is only an analgesic immobilization and it is associated with rehabilitation from the first day","idx":4,"proposition":"Immobilization is necessary at the beginning of treatment to avoid creating a vertebral fracture"}],"ts":1632818827,"type":"custom","difficulte":"1"}
-{"_id":"IU-infectio-e4d8ff","context":null,"enonce":"What are the additional examinations of acute non-serious pyelonephritis with risk of complications probably diagnosed?","item":"IU","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"BU + ECBU"},{"correct":false,"justification":"If in doubt diagnosis","idx":1,"proposition":"Blood culture"},{"correct":true,"justification":"True","idx":2,"proposition":"Uroscanner"},{"correct":true,"justification":"True","idx":3,"proposition":"CRP, urea, creatinine"},{"correct":false,"justification":"If second episode of a non-serious ANP without risk of complication (or hyperalgic form)","idx":4,"proposition":"Renal ultrasound"}],"ts":1632818853,"type":"custom","difficulte":"1"}
-{"_id":"IST-infectio-b4297b","context":null,"enonce":"Urethritis and cervicitis are mainly due to: (2 responses)","item":"IST","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Neisseria gonorrhoeae"},{"correct":true,"justification":"True","idx":1,"proposition":"Chlamydia trachomatis"},{"correct":false,"justification":"","idx":2,"proposition":"Syphilis"},{"correct":false,"justification":"","idx":3,"proposition":"Herpes"},{"correct":false,"justification":"","idx":4,"proposition":"T. vaginalis"}],"ts":1632818858,"type":"custom","difficulte":"1"}
-{"_id":"IU-infectio-7a5d66","context":null,"enonce":"What are the additional tests for a severe acute pyelonephritis probably a diagnosis?","item":"IU","matiere":"infectio","propositions":[{"correct":true,"justification":"True, in all cases in severe NAPs","idx":0,"proposition":"Blood culture"},{"correct":true,"justification":"True","idx":1,"proposition":"BU + ECBU"},{"correct":true,"justification":"True","idx":2,"proposition":"Uroscanner"},{"correct":false,"justification":"Uroscanner","idx":3,"proposition":"MRI of the urinary tract"},{"correct":true,"justification":"True","idx":4,"proposition":"NFS-P"}],"ts":1632818868,"type":"custom","difficulte":"1"}
-{"_id":"158-infectio-03de6997-24c8-428d-961a-c956717ceccd","context":null,"enonce":"With regard to the salpigites, which of these proposals are correct?","item":"IST","matiere":"infectio","propositions":[{"correct":true,"justification":"True, salpingitis causes lateralized pelvic pain.","idx":0,"proposition":"Appendicitis, appendix torsion and ectopic pregnancy are the main differential diagnoses of salpingitis"},{"correct":true,"justification":"True, by definition, one STI always calls for another.","idx":1,"proposition":"Salpingitis is an indication to look for local and general STIs"},{"correct":true,"justification":"True, it is a tubal abscess.","idx":2,"proposition":"Pelvic ultrasound can highlight pyosalpinx"},{"correct":false,"justification":"False, C3G + Doxy + Metronidazole","idx":3,"proposition":"Salpingitis is treated first-line with Metronidazole monotherapy"},{"correct":true,"justification":"True, violin string syndrome, sequelae of chamydia in the liver capsule","idx":4,"proposition":"Complications of salpingitis include Fitz High Curtis syndrome"}],"ts":1632819004,"type":"custom","difficulte":"1"}
-{"_id":"IST-infectio-43783b","context":null,"enonce":"Which of the following are ophthalmological manifestations of secondary syphilis?","item":"IST","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Uveitis"},{"correct":true,"justification":"True","idx":1,"proposition":"Retinitis"},{"correct":false,"justification":"","idx":2,"proposition":"Scleritis"},{"correct":false,"justification":"Only two etiologies to remember for NEC: Sarcoidosis and MS","idx":3,"proposition":"Intermediate uveitis"},{"correct":false,"justification":"","idx":4,"proposition":"Secondary cataract"}],"ts":1632819012,"type":"custom","difficulte":"1"}
-{"_id":"IST-infectio-0b4a9b","context":null,"enonce":"Which of the following are true about neurosyphilis?","item":"IST","matiere":"infectio","propositions":[{"correct":false,"justification":"Not at the primary stage","idx":0,"proposition":"It can be present at all stages of the disease"},{"correct":true,"justification":"True","idx":1,"proposition":"Early neurosyphilis can be expressed as meningitis"},{"correct":false,"justification":"posterior radiculocord syndrome found in TARDIVE neurosyphilis","idx":2,"proposition":"Early neurosyphilis can be expressed in the form of tabes"},{"correct":true,"justification":"True","idx":3,"proposition":"Late neurosyphilis can be expressed as dementia"},{"correct":false,"justification":"LATE form","idx":4,"proposition":"Early neurosyphilis can manifest as memory problems"}],"ts":1632819033,"type":"custom","difficulte":"1"}
-{"_id":"164-infectio-8d14609d-c38c-4a99-9ab1-97380c64aa5e","context":null,"enonce":"What is (are) the possible complication(s) of chickenpox in children?","item":"herpes","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Varicella pneumonia"},{"correct":true,"justification":"True","idx":1,"proposition":"Skin bacterial superinfection"},{"correct":true,"justification":"True","idx":2,"proposition":"Encephalitis "},{"correct":true,"justification":"True","idx":3,"proposition":"Cererebellity"},{"correct":true,"justification":"True","idx":4,"proposition":"Cerebral vasculitis"}],"ts":1632819079,"type":"custom","difficulte":"1"}
-{"_id":"meningite-infectio-97023f","context":null,"enonce":"You are a general practitioner in the countryside. On a beautiful Saturday morning (where you work, because you are motivated and passionate about your job 🔥🚀❤❤), Mrs. Carrière, 32, brings you her son. A very energetic little boy of 13 months, he has had a temperature of 40 ° C for 48 hours. He is grumpy and has vomited 3 times 🤮. On clinical examination he presents axial hypotonia and the fontanelle is bulging. What diagnoses do you mention in view of these elements?","item":"meningite","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Viral meningitis"},{"correct":true,"justification":"True","idx":1,"proposition":"Bacterial meningitis"},{"correct":false,"justification":"Does not explain the bulging fontanel","idx":2,"proposition":"Acute pyelonephritis"},{"correct":false,"justification":"Does not explain the bulging fontanel","idx":3,"proposition":"Acute gastroenteritis "},{"correct":false,"justification":"Does not explain the fever (you may have a fever, but not a fever at 40)","idx":4,"proposition":"Subdural hematoma"}],"ts":1632819096,"type":"custom","difficulte":"1"}
-{"_id":"203-pneumo-49ec1af9-b1b5-41cc-bf14-c84570058d09","context":null,"enonce":"Which of the following propositions are true about the hamartochondrome?","item":"opacitetho","matiere":"pneumo","propositions":[{"correct":false,"justification":"It is the most common benign lung tumor","idx":0,"proposition":"It is a malignant 🚨 tumor"},{"correct":false,"justification":"Often easy diagnosis on pathognomonic CT data of \"popcorn\" appearance, combining calcifications and fat densities","idx":1,"proposition":"The spiculated nodule appearance is pathognomonic 🤔"},{"correct":false,"justification":"Not mandatory in front of the popcorn appearance and the absence of malignancy criteria","idx":2,"proposition":"PET-CT is mandatory"},{"correct":true,"justification":"True","idx":3,"proposition":"PET-CT is negative"},{"correct":true,"justification":"True, note that histological verification (not excision) is desirable","idx":4,"proposition":"Excision is not necessary"}],"ts":1632823013,"type":"custom","difficulte":"1"}
-{"_id":"175-gastro-252b8b1b-a2d4-4e27-a301-e101911a3930","context":null,"enonce":"You are a doctor of the ARS and you are dispatched to the sausage fair of Bourg en Bresse Peyronnas, in front of a strong suspicion of Collective Food Poisoning (at least 30 cases). On the road, you remember in mind which samples you are going to make... What are they?","item":"risquesenvironnemt","matiere":"HGE","propositions":[{"correct":true,"justification":"True, essential to research food origin","idx":0,"proposition":"On-site food sampling"},{"correct":false,"justification":"False, canteens\/catering places are obliged to keep control food, in case all food is eaten","idx":1,"proposition":"In case all the food has already been eaten, you can not take a sample from the food"},{"correct":true,"justification":"True, this is the only indication to vomiting sampling that you need to know for ECN","idx":2,"proposition":"Vomiting sampling of symptomatic persons"},{"correct":true,"justification":"True, logically","idx":3,"proposition":"Stool collection from symptomatic individuals"},{"correct":false,"justification":"False, it's not up to you to do the hygiene surveys of the place!","idx":4,"proposition":"Sampling at storage and refregiration sites"}],"ts":1632826462,"type":"custom","difficulte":"1"}
-{"_id":"189-immuno-b3bd3d0e-1f7a-4ab1-89be-c14818c1f3bc","context":null,"enonce":"During which diseases are ENT involvement observed (rhinitis, sinusitis, nasal polyposis)?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"+++","idx":0,"proposition":"Granulomatosis with polyangiitis"},{"correct":true,"justification":"","idx":1,"proposition":"Eosinophilic granulomatosis with polyangiitis"},{"correct":false,"justification":"Rather a pulmonary involvement type of intraalveolar hemorrhage","idx":2,"proposition":"Microscopic polyarteritis"},{"correct":false,"justification":"","idx":3,"proposition":"Takayasu's disease"},{"correct":false,"justification":"","idx":4,"proposition":"Periarteritis nodosa"}],"ts":1633101186,"type":"custom","difficulte":"1"}
-{"_id":"189-immuno-7c637d6e-286f-4aaf-87e6-7f746d726b5b","context":null,"enonce":"Which of the following are true for periarteritis nodosa?","item":"vascularite","matiere":"immuno","propositions":[{"correct":false,"justification":"In periarteritis nodosa, ANCA is ALWAYS negative","idx":0,"proposition":"C-ANCA are relatively susceptible to this disease"},{"correct":true,"justification":"","idx":1,"proposition":"This is necrotizing vasculitis"},{"correct":true,"justification":"","idx":2,"proposition":"It can cause vascular nephropathy (malignant nephroangiosclerosis) without glomerulonephritis"},{"correct":true,"justification":"","idx":3,"proposition":"Puncture renal biopsy is contraindicated"},{"correct":false,"justification":"There is necrotizing vasculitis of medium-sized vessels","idx":4,"proposition":"Vascular biopsy finds no abnormalities"}],"ts":1633101327,"type":"custom","difficulte":"1"}
-{"_id":"189-immuno-367e27fc-eb3e-4e4e-9f7e-af2f1a4826ba","context":null,"enonce":"Which of the following are true for IgA vasculitis?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"It is also called rheumatoid purpura"},{"correct":true,"justification":"","idx":1,"proposition":"It is also called Henoch Schonlein Syndrome"},{"correct":false,"justification":"It mainly affects children but remains possible in adults","idx":2,"proposition":"It mainly affects men over 50 years of age"},{"correct":true,"justification":"","idx":3,"proposition":"Serum IgA elevation is inconsistent"},{"correct":false,"justification":"","idx":4,"proposition":"All propositions are true"}],"ts":1633101781,"type":"custom","difficulte":"1"}
-{"_id":"189-immuno-15d2db40-10da-493e-8448-083abe391ddd","context":null,"enonce":"Which of the following are true about Takayasu's disease?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"It is granulomatous vasculitis"},{"correct":false,"justification":"It affects large arteries: aorta and its main branches, with a predilection for the carotid territory and subkeyboard","idx":1,"proposition":"It affects the vessels of the microcirculation"},{"correct":false,"justification":"Especially women under 50 (++ different with Horton)","idx":2,"proposition":"It mainly affects men under 50 years of age"},{"correct":true,"justification":"","idx":3,"proposition":"We can find vascular murmurs and an abolition of the pulse"},{"correct":true,"justification":"Blood pressure asymmetry = anisotension","idx":4,"proposition":"We can find a tensional asymmetry and limp of the limbs"}],"ts":1633101902,"type":"custom","difficulte":"1"}
-{"_id":"189-immuno-b528c54d-96c4-468c-934f-46193678962a","context":null,"enonce":"Which of the following are true about Kawasaki disease?","item":"vascularite","matiere":"immuno","propositions":[{"correct":false,"justification":"From 1 to 5 years. Exceptional after!","idx":0,"proposition":"It mainly affects children from 1 to 15 years old"},{"correct":true,"justification":"","idx":1,"proposition":"It is a febrile adenocutaneous-mucosal syndrome"},{"correct":false,"justification":"A palmo-plantar desquamation, often late (the only Kawasaki I saw had no peeling at all but you have to remember what is in the college!)","idx":2,"proposition":"There is a desquamation of the trunk"},{"correct":true,"justification":"","idx":3,"proposition":"Lymphadenopathy is willingly cervical"},{"correct":true,"justification":"","idx":4,"proposition":"There is no biomarker available"}],"ts":1633102191,"type":"custom","difficulte":"1"}
-{"_id":"189-immuno-3a8ec0bd-7f00-4176-b953-05f6bf434626","context":null,"enonce":"Which of the following propositions are true regarding the anatomical pathology expression of giant cell arteritis (Horton's disease)?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"Panarteritis"},{"correct":true,"justification":"","idx":1,"proposition":"Essentially mononuclear inflammatory infiltrate"},{"correct":false,"justification":"It is the INTERNAL elastic limiting that is destroyed (much less solid than the external elastic limiting)","idx":2,"proposition":"Destruction of the external elastic limiter"},{"correct":true,"justification":"","idx":3,"proposition":"Presence of giant cells"},{"correct":false,"justification":"They are found in Goodpasture's disease (vasculitis of microvessels)","idx":4,"proposition":"Presence of anti-MBG antibodies"}],"ts":1633102332,"type":"custom","difficulte":"1"}
-{"_id":"189-immuno-ea0cbbfd-6b16-4e8a-a99e-5a1e170e2cc1","context":null,"enonce":"Which of the following proposals are common features of the 3 ANCA small vessel vasculitis?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"Peripheral neuropathies can be found"},{"correct":false,"justification":"Not microscopic polyangiitis (the term \"granulomatous\" is not found in the name of this vasculitis)","idx":1,"proposition":"They are granulomatous"},{"correct":true,"justification":"","idx":2,"proposition":"They are necrotizing"},{"correct":true,"justification":"","idx":3,"proposition":"Glomerulonephritis is rapidly progressive (GNRP)"},{"correct":true,"justification":"","idx":4,"proposition":"ANCA are not 100% sensitive"}],"ts":1633102382,"type":"custom","difficulte":"1"}
-{"_id":"189-immuno-4ec2174d-80b4-46ab-a9b6-cf14b3f7f19b","context":null,"enonce":"Which of the following proposals are vasculitis concerning the large vessels (aorta and main collaterals)?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"Field: subject willingly elderly, >50 years old","idx":0,"proposition":"Giant cell arteritis"},{"correct":true,"justification":"Field: young woman, < 50 years old ","idx":1,"proposition":"Takayasu's disease"},{"correct":false,"justification":"Medium-gauge arteries","idx":2,"proposition":"Kawasaki disease"},{"correct":false,"justification":"Medium-gauge arteries","idx":3,"proposition":"Periarteritis nodosa"},{"correct":false,"justification":"Anti-MBG antibody vasculitis concerning capillaries","idx":4,"proposition":"Goodpasture disease"}],"ts":1633102409,"type":"custom","difficulte":"1"}
-{"_id":"189-immuno-1dedaf52-8484-427b-8853-a81614d15643","context":null,"enonce":"Which of the following are true regarding the diagnosis of Granumolatosis with Polyangiitis (Wegener)?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"ANCA are found in 90% of systemic forms"},{"correct":false,"justification":"It is the only vasculitis that has ANCA type c (anti-proteinase 3) ","idx":1,"proposition":"ANCA are type p"},{"correct":true,"justification":"True","idx":2,"proposition":"ANCA are directed against the PR3 protein"},{"correct":true,"justification":"True","idx":3,"proposition":"Biopsy finds granulomatous pauci-immune necrotizing vasculitis"},{"correct":true,"justification":"True, it is a pauci-immune vasculitis","idx":4,"proposition":"Direct immunofluorescence on the biopsy piece is negative"}],"ts":1633102423,"type":"custom","difficulte":"1"}
-{"_id":"189-immuno-ddf21ea0-7a00-4a74-8c5f-f5e0be12116f","context":null,"enonce":"Which of the following propositions are true about Behçet's disease?","item":"vascularite","matiere":"immuno","propositions":[{"correct":false,"justification":"It occurs mainly in men from the Mediterranean Basin (Turkey++), the Middle East (Turkey) or the Far East.","idx":0,"proposition":"It affects women more than men"},{"correct":false,"justification":"","idx":1,"proposition":"It predominates in Japan and Australia"},{"correct":false,"justification":"Behçet's disease begins around the age of 30","idx":2,"proposition":"Diagnosis cannot be made before the age of 50"},{"correct":true,"justification":"","idx":3,"proposition":"It combines oral and genital aphthosis, posterior uveitis, and sometimes joint, digestive, cardiac and \/ or cerebral damage"},{"correct":true,"justification":"Bipolar aphthosis with oral and genital involvement","idx":4,"proposition":"Aphthosis is called bipolar"}],"ts":1633102632,"type":"custom","difficulte":"1"}
-{"_id":"189-immuno-2e032cb8-0663-4d5f-af93-715fd0c36ed1","context":null,"enonce":"Which of the following are true about microscopic polyangiitis?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"It is a necrotizing vasculitis"},{"correct":true,"justification":"","idx":1,"proposition":"It is a pauci-immune vasculitis"},{"correct":false,"justification":"It is the only vasculitis of ANCA small vessels that is non-granulomatous. The other two (Granulomatosis with Polyangiitis, and Eosinophilic granulomatous with Polyangiitis) are granulomatous, as their name suggests. Remember: often, EVERYTHING is in the name 😅","idx":2,"proposition":"It is granulomatous vasculitis"},{"correct":false,"justification":"The only vasculitis where c-ANCA is found is granulomatous with polyangiitis (Wegener)","idx":3,"proposition":"ANCA are c-ANCA"},{"correct":true,"justification":"","idx":4,"proposition":"Glomerulonephritis and pulmonary capillaritis are common"}],"ts":1633102649,"type":"custom","difficulte":"1"}
-{"_id":"189-immuno-aa9e77fe-c9dc-4cb7-8fe6-a54e4cc8c9b0","context":null,"enonce":"Which of the following propositions are true about chronic atrophic polychondritis?","item":"vascularite","matiere":"immuno","propositions":[{"correct":false,"justification":"Like Behçet's disease and Cogan syndrome, it affects vessels of all sizes.","idx":0,"proposition":"It is a vasculitis that affects only small vessels"},{"correct":true,"justification":"This is the term used in the college","idx":1,"proposition":"It is an \"exceptional\" disease from an epidemiological point of view"},{"correct":true,"justification":"","idx":2,"proposition":"It is an inflammation of the cartilages of the ears and nose, aortic valves, aorta and trachea"},{"correct":false,"justification":"This is the description of Cogan syndrome, a vasculitis affecting vessels of all caliber (very rare)","idx":3,"proposition":"It is a non-syphilitic interstitial keratitis and audio-vestibular involvement"},{"correct":false,"justification":"This is the case of Behçet's disease","idx":4,"proposition":"It occurs mainly in Turkey"}],"ts":1633102685,"type":"custom","difficulte":"1"}
-{"_id":"189-immuno-9b9111be-bc55-4ccc-ae02-6ed77ab91ff2","context":null,"enonce":"Which of the following are true about Takayasu's disease?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"It is granulomatous vasculitis"},{"correct":false,"justification":"It affects large arteries: aorta and its main branches. She has a predilection for the carotid territory and subkeyboard","idx":1,"proposition":"It affects the vessels of the microcirculation"},{"correct":false,"justification":"Especially women under 50","idx":2,"proposition":"It mainly affects men under 50 years of age"},{"correct":true,"justification":"","idx":3,"proposition":"We can find vascular murmurs and an abolition of the pulse"},{"correct":true,"justification":"","idx":4,"proposition":"We can find a tensional asymmetry and limp of the limbs"}],"ts":1633102697,"type":"custom","difficulte":"1"}
-{"_id":"Kcsein-onco-12e317","context":null,"enonce":"Which of the following propositions are true for a 42-year-old woman with a pathogenic BRAC1 mutation in remission from breast cancer?","item":"Kcsein","matiere":"onco","propositions":[{"correct":true,"justification":"True. Bilateral appendectomy to be offered from age 40 for BRCA1 and age 45 for BRCA2","idx":0,"proposition":"He may be offered an oophorectomy"},{"correct":true,"justification":"True, the relevance of ultrasound is left to the discretion of the radiologist","idx":1,"proposition":"Breast monitoring is done by annual mammography for life, associated or not with an ultrasound (excluding mammectomy)"},{"correct":true,"justification":"True, no genetic testing in miners (unless there is immediate medical necessity, which is not the case for BRCA mutations)","idx":2,"proposition":"Genetic tests in offspring will be offered after they reach the age of majority"},{"correct":false,"justification":"BRCA: ovary and breast mainly","idx":3,"proposition":"The risk of digestive cancer is higher than in the general population"},{"correct":false,"justification":"From 30 years old","idx":4,"proposition":"He should have been offered a bilateral mastectomy from the age of majority."}],"ts":1633111013,"type":"custom","difficulte":"2"}
-{"_id":"Kcsein-onco-2a9316","context":null,"enonce":"Which of the following are breast cancer risk factors?","item":"Kcsein","matiere":"onco","propositions":[{"correct":false,"justification":"False. There is no longer an over-risk of breast cancer when the pill was stopped more than 10 years ago","idx":0,"proposition":"The use of the estrogen-progestin pill 15 years ago"},{"correct":true,"justification":"True, it is a hormone-dependent cancer","idx":1,"proposition":"Late menopause (> 55 years)"},{"correct":false,"justification":"False. It is protective (decrease in the duration of hormonal impregnation)","idx":2,"proposition":"Breastfeeding"},{"correct":true,"justification":"True","idx":3,"proposition":"Late age at first pregnancy (> 30 years)"},{"correct":true,"justification":"True","idx":4,"proposition":"Hormone therapy for menopause"}],"ts":1633111059,"type":"custom","difficulte":"2"}
-{"_id":"Kcsein-onco-7b32fd","context":null,"enonce":"Regarding the epidemiology of breast cancer, which of the following propositions are true?","item":"Kcsein","matiere":"onco","propositions":[{"correct":false,"justification":"False. About 58,000 cases per year (we must retain about 54,000 - 58,000 as an order of magnitude, this figure changes depending on the sources). It is the most common cancer AND the deadliest in women. ","idx":0,"proposition":"There are 78,000 new cases of breast cancer in France per year"},{"correct":true,"justification":"True. The first is lung cancer","idx":1,"proposition":"It is the 2nd most common cancer in France, all sexes combined"},{"correct":true,"justification":"True. It is the deadliest cancer in women. ","idx":2,"proposition":"Breast cancer causes 12,000 deaths per year in France"},{"correct":false,"justification":"False. The 5-year survival rate is 87% and 76% at 10 years. It is a cancer with a high survival rate thanks to mass screening that allows early detection of cancers (at stage N0)","idx":3,"proposition":"The 5-year survival rate is 50%"},{"correct":false,"justification":"False. 1 in 9 women","idx":4,"proposition":"1 in 5 women will develop breast cancer in her lifetime "}],"ts":1633111131,"type":"custom","difficulte":"2"}
-{"_id":"Kcsein-onco-25eb3e","context":null,"enonce":"Regarding the BI-RADS classification of the ACR, which ones are true?","item":"Kcsein","matiere":"onco","propositions":[{"correct":false,"justification":"False. ACR 0 means that further investigation is required. ACR 1 means that the mammogram is normal. ","idx":0,"proposition":"ACR 0 means mammography is normal"},{"correct":true,"justification":"True","idx":1,"proposition":"ACR 3 means that the anomaly is probably benign but requires short-term monitoring (3 or 6 months)"},{"correct":false,"justification":"False. ACR 6 means that there is histological evidence of certainty of the malignancy of the lesion. ","idx":2,"proposition":"ACR 6 means that there is an abnormality suggestive of cancer"},{"correct":true,"justification":"True","idx":3,"proposition":"ACR 4 means that there is an undetermined or suspicious anomaly"},{"correct":true,"justification":"True","idx":4,"proposition":"ACR 5 means that there is an abnormality very suggestive of cancer"}],"ts":1633111177,"type":"custom","difficulte":"2"}
-{"_id":"Kcsein-onco-62a861","context":null,"enonce":"Lymphatic drainage of the breast is done to which site(s)? ","item":"Kcsein","matiere":"onco","propositions":[{"correct":true,"justification":"True. Lymphatic drainage occurs to 3 main sites: axillary caval nodes, upper and subclavicular lymph nodes, and internal mammary chain nodes. ","idx":0,"proposition":"The lymph nodes of the axillary hollow "},{"correct":true,"justification":"True","idx":1,"proposition":"Supra- and subclavicular lymph nodes"},{"correct":false,"justification":"False","idx":2,"proposition":"The lymph nodes of the external breast chain"},{"correct":true,"justification":"True","idx":3,"proposition":"The lymph nodes of the internal breast chain"},{"correct":false,"justification":"False. It is a left supraclavicular lymph node, but it mainly drains the digestive system and is suggestive of digestive cancer (e.g. pancreas, colon). ","idx":4,"proposition":"The ganglion of Troisier"}],"ts":1633111209,"type":"custom","difficulte":"2"}
-{"_id":"Kcsein-onco-88dbf6","context":null,"enonce":"Which of the following are genetic mutation(s) that can cause breast cancer?","item":"Kcsein","matiere":"onco","propositions":[{"correct":true,"justification":"True. It is also a syndrome that causes childhood cancer.","idx":0,"proposition":"Syndrome de Li-Fraumeni"},{"correct":true,"justification":"True. The mutation causes breast and ovarian cancer. ","idx":1,"proposition":"BRCA1"},{"correct":true,"justification":"True. The mutation causes breast and ovarian cancer. ","idx":2,"proposition":"BRCA2"},{"correct":false,"justification":"False. It causes, among other things, colon, endometrial and ovarian cancers.","idx":3,"proposition":"Syndrome de Lynch"},{"correct":false,"justification":"False","idx":4,"proposition":"Neurofibromatosis type 1"}],"ts":1633112962,"type":"custom","difficulte":"2"}
-{"_id":"Kcsein-onco-99b87a","context":null,"enonce":"An ultrasound found an 18mm lesion in the right breast. On clinical examination, you do not find any skin involvement and the lymph node areas are perfectly free. No clinical signs elsewhere. What is the TNM classification of this lesion?","item":"Kcsein","matiere":"onco","propositions":[{"correct":false,"justification":"Mx because we did not make an extension assessment","idx":0,"proposition":"T1N0M0"},{"correct":false,"justification":"No axillary lymph nodes","idx":1,"proposition":"T1N1M0"},{"correct":true,"justification":"True. T1c more precisely (between 1 and 2 cm)","idx":2,"proposition":"T1N0Mx"},{"correct":false,"justification":"<2cm so T1","idx":3,"proposition":"T2N0Mx"},{"correct":false,"justification":"<5cm so not T3","idx":4,"proposition":"T3N0Mx"}],"ts":1633113016,"type":"custom","difficulte":"2"}
-{"_id":"Kcsein-onco-482db4","context":null,"enonce":"Which of the following is the most common histological form of breast cancer?","item":"Kcsein","matiere":"onco","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Lobular carcinoma"},{"correct":false,"justification":"False","idx":1,"proposition":"Localized ductal carcinoma"},{"correct":true,"justification":"True","idx":2,"proposition":"Invasive ductal carcinoma"},{"correct":false,"justification":"False","idx":3,"proposition":"Invasive lobular carcinoma"},{"correct":false,"justification":"False","idx":4,"proposition":"Tuberous adenocarcinoma"}],"ts":1633113129,"type":"custom","difficulte":"2"}
-{"_id":"189-immuno-7c127847-4b56-40c3-a0e5-62c007c4358b","context":null,"enonce":"Which of the following are true for giant cell arteritis (Horton's disease)?","item":"vascularite","matiere":"immuno","propositions":[{"correct":false,"justification":"Over 50 years old","idx":0,"proposition":"It occurs in subjects over 65 years of age"},{"correct":true,"justification":"True","idx":1,"proposition":"It predilection affects the carotid and vertebral territory (including the temporal artery)"},{"correct":true,"justification":"True","idx":2,"proposition":"We can find aortitis"},{"correct":false,"justification":"This is a NOIIA in giant cell arteritis. NORB is found in Multiple Sclerosis","idx":3,"proposition":"There is regularly a NORB"},{"correct":true,"justification":"True","idx":4,"proposition":"Pseudo-rhizomelic arthritis is often associated"}],"ts":1633122410,"type":"custom","difficulte":"1"}
-{"_id":"103-neuro-59bda730-f3aa-4607-8a93-326f39b7c474","context":null,"enonce":"Regarding epilepsy-Absence of the child. Which of the following are true?","item":"epilepsie","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Treatment is Ethosuximide"},{"correct":true,"justification":"True","idx":1,"proposition":"Treatment is usually stopped after puberty"},{"correct":true,"justification":"True","idx":2,"proposition":"A genetic etiology is presumed"},{"correct":true,"justification":"True","idx":3,"proposition":"Attentional disorders are a common comorbidity to always look for in children with this syndrome."},{"correct":true,"justification":"True","idx":4,"proposition":"All of the above answers are true"}],"ts":1633262275,"type":"custom","difficulte":"1"}
-{"_id":"103-neuro-5daa982a-ff8c-4eff-9960-28a6ad23c84a","context":null,"enonce":"Concerning centrotemporal peak epilepsy (CTEP) in children. Which of the following are true?","item":"epilepsie","matiere":"neuro","propositions":[{"correct":true,"justification":"True at Rolandic paroxysm","idx":0,"proposition":"It is a benign partial epilepsy"},{"correct":true,"justification":"Yes: at night","idx":1,"proposition":"This syndrome is morphelic"},{"correct":true,"justification":"True: Oral area, with hypersalivation, speech stoppage, hemifacial clonia, paresthesias of the tongue and gums.","idx":2,"proposition":"The beginning is focal: central opercular"},{"correct":false,"justification":"No, mindfulness syndrome","idx":3,"proposition":"There is a loss of consciousness"},{"correct":false,"justification":"No: before 15 years, and beginning of the syndrome usually around 10 years","idx":4,"proposition":"The prognosis is pretty good, with a cure before 10 years"}],"ts":1633262283,"type":"custom","difficulte":"1"}
-{"_id":"103-neuro-c8817d00-c1b4-4326-ae63-bf60ba1c39bc","context":null,"enonce":"Regarding epilepsy-Absence of the child. Which of the following are true?","item":"epilepsie","matiere":"neuro","propositions":[{"correct":false,"justification":"no 5-10%","idx":0,"proposition":"accounts for 30% of childhood epilepsy "},{"correct":false,"justification":"not favoured by hypERpnea ","idx":1,"proposition":"Are multi-daily absences >10\/d, favored by hypopnea "},{"correct":false,"justification":"nop: 3 cyles \/seconds = 3Hz","idx":2,"proposition":"EEG is characterized by bursts of synchronous generalized polyspike-wave discharges at 3cycles \/ minute"},{"correct":true,"justification":"True","idx":3,"proposition":"It is an epileptic syndrome with a good prognosis, very pharmacosensitive (80%)"},{"correct":false,"justification":"","idx":4,"proposition":"All previous answers are wrong"}],"ts":1633262294,"type":"custom","difficulte":"1"}
-{"_id":"341-urg-70fdb83d-7f7c-4a1d-aacc-b587914d339b","context":null,"enonce":"Which of the following are criteria for lumbar puncture during a febrile seizure in children?","item":"convulsionsped","matiere":"urg","propositions":[{"correct":false,"justification":"no, but it is a criterion for complex febrile seizure <6MONTHS","idx":0,"proposition":"<1year"},{"correct":true,"justification":"True","idx":1,"proposition":">15min"},{"correct":false,"justification":"No ","idx":2,"proposition":"Generalised"},{"correct":true,"justification":"True","idx":3,"proposition":"focal length"},{"correct":true,"justification":"True","idx":4,"proposition":"Bulging of the fontanel and anomaly of the tone"}],"ts":1633265962,"type":"custom","difficulte":"1"}
-{"_id":"341-urg-361c1b63-90a2-42d8-9d7d-26dc05c9ea11","context":null,"enonce":"Which of the following are true about febrile seizures?","item":"convulsionsped","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Febrile seizures affect 5% of children"},{"correct":false,"justification":"No, a febrile seizure is by definition <5 years.","idx":1,"proposition":"A febrile seizure > 15min in a 6-year-old child is complex"},{"correct":true,"justification":"True: psychomotor delay = complex crisis","idx":2,"proposition":"A generalized febrile seizure of 5 minutes, without post-critical deficit, with normal neurological examination in a 2-year-old child who has just acquired standing with supports is a complex febrile crisis and justifies hospitalization."},{"correct":false,"justification":"nop: no PL criteria","idx":3,"proposition":"A generalized febrile attack of 12 minutes with a fever at 41 ° C, in a child of 3 years without post-critical deficit, without particular history, with a normal neurological examination requires a lumbar puncture."},{"correct":false,"justification":"No because > 1 year, <15min, generalized","idx":4,"proposition":"A generalized febrile seizure of 14 minutes with a fever at 42 ° C, in a 4-year-old child without post-critical deficit, without any particular history, with a normal neurological examination is a complex febrile seizure."}],"ts":1633265970,"type":"custom","difficulte":"1"}
-{"_id":"178-mdt-4fd7fa5f-97b6-44b0-9513-1f56f8cfa48a","context":null,"enonce":"Regarding occupational health, what are the exact proposal(s)?","item":"securitepro","matiere":"mdt","propositions":[{"correct":true,"justification":"True, it makes sense. We will determine if a disease is of occupational cause if the disease occurs after exposure (chronological criterion) and if the lesions are semiologically compatible with exposure (semiological criterion)","idx":0,"proposition":"The imputability between disease and exposure is justified by chronological and semiological criteria"},{"correct":false,"justification":"False, it is by far the musculoskeletal disorders (carpal tunnel, meniscal involvement)","idx":1,"proposition":"The most common occupational diseases are occupational cancers"},{"correct":true,"justification":"True, completely! Some workers such as health professionals can contract these pathologies as a result of their work, so it is very clearly occupational ⚒️ diseases!","idx":2,"proposition":"Tuberculosis or viral hepatitis can be considered occupational diseases"},{"correct":true,"justification":"True, from the course.","idx":3,"proposition":"For job retention, the occupational physician may set up job changes, job adjustments or professional reclassifications."},{"correct":true,"justification":"True, if he is dismissed, it will be during the resumption visit that takes place after the resumption of work","idx":4,"proposition":"An employee cannot be dismissed during a work stoppage"}],"ts":1633432723,"type":"custom","difficulte":"1"}
-{"_id":"178-mdt-81952c60-d8e6-4fb5-bfc5-710e265774b8","context":null,"enonce":"Regarding the follow-up visit in occupational medicine, which of these proposals is\/are true?","item":"securitepro","matiere":"mdt","propositions":[{"correct":false,"justification":"Wrong, it's the pre-resumption visit that!","idx":0,"proposition":"The follow-up visit is requested by the general practitioner, the patient or the medical officer of the health insurance"},{"correct":true,"justification":"True, it is done from a work stoppage for more than 1 month, so this is the case","idx":1,"proposition":"The follow-up visit is carried out at the end of a pregnancy\/maternity leave"},{"correct":true,"justification":"True, this is the purpose of the takeover visit","idx":2,"proposition":"The follow-up visit decides whether or not the employee is fit "},{"correct":true,"justification":"True, taken directly from college","idx":3,"proposition":"The resumption visit is done within 8 days of the resumption of work by the employee"},{"correct":false,"justification":"False, it can be decreased","idx":4,"proposition":"When transferring to another position in the company, in case of job adaptation, the salary remains the same for a period of 3 months"}],"ts":1633432884,"type":"custom","difficulte":"1"}
-{"_id":"360-ortho-7c988182-40cc-448f-add4-a333ac69eea3","context":null,"enonce":"Regarding orthopedic treatment, which proposals are true?","item":"Frped","matiere":"ortho","propositions":[{"correct":true,"justification":" True","idx":0,"proposition":"Consolidation of fractures is faster in small children"},{"correct":true,"justification":" True","idx":1,"proposition":"The average duration of consolidation is shorter for epiphyseal detachments "},{"correct":false,"justification":"This is the case for diaphyseal fractures","idx":2,"proposition":"The consolidation of metaphyseal fractures is equivalent to that of adults"},{"correct":true,"justification":"Duration valid for a diaphyseal fracture in a child over 5 years of age (equivalent to adults)","idx":3,"proposition":"Fractures of the 2 bones of the forearm must be immobilized 90 days"},{"correct":false,"justification":"Analgesic immobilization, non-systematic, between 0 and 21 days","idx":4,"proposition":"A lump of butter fracture must be immobilized on average 45 days"}],"ts":1633432938,"type":"custom","difficulte":"1"}
-{"_id":"340-ped-bd88049a-ea0b-419a-afb2-c13869698a18","context":null,"enonce":"Which of the following are systematic additional reviews for INM? (based on HAS, 2009)","item":"MSN","matiere":"ped","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"NFS-P"},{"correct":true,"justification":"True","idx":1,"proposition":"CRP"},{"correct":false,"justification":"False","idx":2,"proposition":"LDH"},{"correct":false,"justification":"False","idx":3,"proposition":"CPK"},{"correct":false,"justification":"False","idx":4,"proposition":"Hepatic test"}],"ts":1633432955,"type":"custom","difficulte":"1"}
-{"_id":"340-ped-2fe0c635-97f9-48ca-88a7-1f888d36f040","context":null,"enonce":"Which of the following propositions are true regarding unexpected infant death?","item":"MSN","matiere":"ped","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"This is, according to the HAs, any \"death occurring suddenly in an infant under 2 years of age when nothing in his known history could have predicted\""},{"correct":true,"justification":"True","idx":1,"proposition":"Deaths that remain unexplained are grouped under the term unexplained IMN."},{"correct":true,"justification":"True","idx":2,"proposition":"In France, approximately 500 infants under 2 years of age die unexpectedly annually"},{"correct":false,"justification":"It is most often an infant aged between 2 and 4 months","idx":3,"proposition":"This is most often an infant between 20 and 24 months of age."},{"correct":false,"justification":"The supine sleeping position is a risk factor for MIN","idx":4,"proposition":"The supine sleeping position is a protective factor of MIN"}],"ts":1633432980,"type":"custom","difficulte":"1"}
-{"_id":"340-ped-3dbf9f4f-9bff-4cfe-9ffb-c34d208b6f57","context":null,"enonce":"Which of the following are\/are risk factors for unexpected infant death?","item":"MSN","matiere":"ped","propositions":[{"correct":false,"justification":"This is the ideal temperature","idx":0,"proposition":"Room at 18-20 degrees"},{"correct":false,"justification":"Cosleeping is indeed not recommended","idx":1,"proposition":"Lack of co-sleeping"},{"correct":false,"justification":"It is absolutely necessary to avoid the supine position","idx":2,"proposition":"Child lying in a supine position"},{"correct":false,"justification":"Soft mattresses and duvets\/blankets should be avoided","idx":3,"proposition":"Use of a firm mattress"},{"correct":true,"justification":"True","idx":4,"proposition":"None of these propositions are true"}],"ts":1633433011,"type":"custom","difficulte":"1"}
-{"_id":"dlrabdo-HGE-266148","context":null,"enonce":"Which of the following are true about pancreatic pain?","item":"dlrabdo","matiere":"HGE","propositions":[{"correct":false,"justification":"It sits mainly in epigastrium (possibly hypochondrium)","idx":0,"proposition":"It sits in the umbilical region most often"},{"correct":true,"justification":"True","idx":1,"proposition":"It is transfixing (radiates to the back)"},{"correct":false,"justification":"This is the case of the pain of the uclera. Pancreatic pain is aggravated by the meal, which can cause a fear of eating and therefore malnutrition","idx":2,"proposition":"She is calmed by the meal "},{"correct":true,"justification":"True, the famous gundog 🐶 position","idx":3,"proposition":"It is calmed by anteflexion"},{"correct":false,"justification":"It is rather cramp-type","idx":4,"proposition":"It is burn-type"}],"ts":1633542981,"type":"custom","difficulte":"1"}
-{"_id":"dlrabdo-HGE-b45fa9","context":null,"enonce":"What is the threshold of days below which abdominal pain is considered acute?","item":"dlrabdo","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"1 day"},{"correct":false,"justification":"","idx":1,"proposition":"3 days"},{"correct":false,"justification":"","idx":2,"proposition":"5 days"},{"correct":true,"justification":"True, according to HGE College","idx":3,"proposition":"7 days"},{"correct":false,"justification":"","idx":4,"proposition":"10 days"}],"ts":1633542993,"type":"custom","difficulte":"1"}
-{"_id":"dlrabdo-HGE-3027df","context":null,"enonce":"Which of the following are endocrinological (and therefore non-digestive) etiologies of abdominal pain?","item":"dlrabdo","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Pheochromocytoma"},{"correct":true,"justification":"True","idx":1,"proposition":"Diabetic ketoacidosis"},{"correct":true,"justification":"True","idx":2,"proposition":"Hypercalcemia"},{"correct":true,"justification":"True","idx":3,"proposition":"Acute adrenal insufficiency"},{"correct":false,"justification":"It is indeed a cause of abdominal pain (always do an ECG) but it is cardiac (not endocrinological, see statement). trap, I grant 💩 you","idx":4,"proposition":"Acute coronary syndrome"}],"ts":1633543032,"type":"custom","difficulte":"1"}
-{"_id":"UGD-HGE-016e64","context":null,"enonce":"The Hiss angle corresponds to:","item":"UGD","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"The lair"},{"correct":false,"justification":"Corresponds to the angle of the lair","idx":1,"proposition":"The angular incissure"},{"correct":false,"justification":"","idx":2,"proposition":"The great curvature"},{"correct":true,"justification":"True. To see it in pictures: https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/57\/Stomach-fr.svg\/1200px-Stomach-fr.svg.png","idx":3,"proposition":"The incisure of the cardia"},{"correct":false,"justification":"That was a tough question, sorry! In addition, it is clearly not mandatory to know, so do not worry if you can not retain 😉 it","idx":4,"proposition":"All proposals are wrong ✖"}],"ts":1633630183,"type":"custom","difficulte":"3"}
-{"_id":"UGD-HGE-a5ae3a","context":null,"enonce":"Which of the following are germs that can cause acute gastritis?","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"HSV"},{"correct":true,"justification":"True","idx":1,"proposition":"CMV"},{"correct":true,"justification":"True, then progresses to chronic gastritis","idx":2,"proposition":"H. Pylori"},{"correct":false,"justification":"Not per se, but induced immunosuppression promotes infection\/reactivation by\/of HSV and CMV","idx":3,"proposition":"HIV"},{"correct":false,"justification":"There are small subtleties 😛","idx":4,"proposition":"All propositions are true"}],"ts":1633630248,"type":"custom","difficulte":"1"}
-{"_id":"UGD-HGE-cc761a","context":null,"enonce":"What is the sex ratio for gastric ulcer?","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"👩 1 - 1 👨"},{"correct":false,"justification":"","idx":1,"proposition":"👩 1 - 2 👨"},{"correct":false,"justification":"","idx":2,"proposition":"👩 1 - 3 👨"},{"correct":false,"justification":"","idx":3,"proposition":"👩 2 - 1 👨"},{"correct":false,"justification":"","idx":4,"proposition":"👩 3 - 1 👨"}],"ts":1633630252,"type":"custom","difficulte":"1"}
-{"_id":"UGD-HGE-845b92","context":null,"enonce":"In the case of a gastric ulcer, treatment with curative PPI lasts for:","item":"UGD","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"4 weeks"},{"correct":false,"justification":"","idx":1,"proposition":"8 weeks"},{"correct":true,"justification":"True. 6 weeks of curative PPIs in addition to Helicobacter Pylori treatment","idx":2,"proposition":"6 weeks"},{"correct":false,"justification":"","idx":3,"proposition":"2 weeks"},{"correct":false,"justification":"","idx":4,"proposition":"10 weeks"}],"ts":1633630320,"type":"custom","difficulte":"1"}
-{"_id":"UGD-HGE-f2707b","context":null,"enonce":"Among the following proposals, which are techniques that could be used for the detection of H. Pylori?","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True, reference technique to control post-treatment disappearance","idx":0,"proposition":"Urea breath test"},{"correct":true,"justification":"True, after biopsy","idx":1,"proposition":"Gastro-duodenal endoscopy + biopsies"},{"correct":true,"justification":"True","idx":2,"proposition":"Blood serology"},{"correct":false,"justification":"It's not the same organ 🙃","idx":3,"proposition":"Cytobacteriological examination of sputum (ECBC)"},{"correct":false,"justification":"It's not the same organ 🙃","idx":4,"proposition":"Bronchoalveolar lavage"}],"ts":1633630378,"type":"custom","difficulte":"1"}
-{"_id":"UGD-HGE-66eaa0","context":null,"enonce":"Which of the following are true about gastritis?","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True, T cell elevation without symptoms","idx":0,"proposition":"Lymphocytic gastritis is often asymptomatic"},{"correct":true,"justification":"True, as well as gastritis under PPI and gastritis due to H. Pylori. These are the three causes of atrophiing gastritis.","idx":1,"proposition":"Autoimmune gastritis can progress to atrophy"},{"correct":false,"justification":"Woman over 50","idx":2,"proposition":"Autoimmune gastritis mainly affects children"},{"correct":false,"justification":"Chronic gastritis. Look for an allergy","idx":3,"proposition":"Eosinophilic gastritis is acute"},{"correct":false,"justification":"All gastritis is at risk of degeneration","idx":4,"proposition":"Granulomatous gastritis has no risk of malignant transformation"}],"ts":1633630503,"type":"custom","difficulte":"1"}
-{"_id":"dvlptbuccoD-cmf-c6f6b2","context":null,"enonce":"Which of the following propositions are true about labialveolar clefts?","item":"dvlptbuccoD","matiere":"cmf","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"They are due to a defect of fusion of the buds of the face in the 1st trimester of pregnancy"},{"correct":false,"justification":"in Q1 ","idx":1,"proposition":"They are due to a defect of fusion of the buds of the face in the 2nd trimester of pregnancy"},{"correct":false,"justification":"Failure to merge the buds of the face in the 1st trimester ","idx":2,"proposition":"They are due to a defect of fusion of the neural crest in the 3rd trimester of pregnancy"},{"correct":false,"justification":"False","idx":3,"proposition":"They are associated with a IUGR"},{"correct":true,"justification":"True, no involvement of the bony palate and veil in the lip and alveolar cleft","idx":4,"proposition":"There are no attacks on the soft palate"}],"ts":1633630514,"type":"custom","difficulte":"2"}
-{"_id":"dvlptbuccoD-cmf-fb30a8","context":null,"enonce":"Which of the following propositions are true regarding the total cleft lip-alveolo-palate?","item":"dvlptbuccoD","matiere":"cmf","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It affects the gum"},{"correct":true,"justification":"True","idx":1,"proposition":"It affects the dental arch"},{"correct":true,"justification":"True","idx":2,"proposition":"It touches the lip"},{"correct":true,"justification":"True","idx":3,"proposition":"She touches the veil of the palace"},{"correct":true,"justification":"True","idx":4,"proposition":"Its management is multidisciplinary"}],"ts":1633630516,"type":"custom","difficulte":"2"}
-{"_id":"tbneuroSegeria-geria-741d2b","context":null,"enonce":"You receive in your general practice Mr. Emiliano Largo, 75 years old, who has just returned from a consultation with an ophthalmologist. He admits, a little embarrassed, that he did not understand what the ophthalmologist told him and that he had understood, however, that he will have cataract surgery on his right eye. You decide to do some therapeutic education. Which of the following proposition(s) are true?","item":"tbneuroSegeria","matiere":"geria","propositions":[{"correct":false,"justification":"False, cataract may be very common, it is a pathology of the lens. The aging of the lens will result more in presbyopia (lack of accommodation that will disrupt near vision)","idx":0,"proposition":"Cataract is a physiological aging of the lens, linked to a clouding of the latter"},{"correct":true,"justification":"True, these are quite characteristic and frequent signs of cataracts (hemeralopia = twilight vision disorder)","idx":1,"proposition":"Apart from decreased visual acuity, cataracts can be characterized by hemeralopia and yellowing of colors."},{"correct":false,"justification":"False, the examination with the slit lamp allows the diagnosis of cataract and specifies its topography, so it makes it possible to distinguish nuclear cataract, posterior subcapsular, cortical or total","idx":2,"proposition":"The slit lamp examination distinguishes a primary or secondary cataract"},{"correct":false,"justification":"False, this seemingly vicious trap between ultrasound in mode A and B makes it possible to return to an important point and misunderstood by students. Mode A ultrasound is a \"profile\" ultrasound that measures the axile length of the eye while mode B ultrasound is a frontal ultrasound that will explore \"the fundus\" of the eye and look for foreign bodies or retinal detachment.","idx":3,"proposition":"Before surgery by phacoemulsification of the lens, certain additional examinations are performed: ultrasound mode B and keratometry"},{"correct":false,"justification":"False, if the most common complication is this one, the most formidable is endophthalmitis!","idx":4,"proposition":"If secondary clouding of the lens is the most common complication, the most formidable complication is retinal detachment"}],"ts":1633630566,"type":"custom","difficulte":"1"}
-{"_id":"pathogeria-geria-315c33","context":null,"enonce":"In your acute geriatric department, you have been hospitalized for a few hours Mr Traveylan, Alec, 88 years old, for acute pneumonia, of viral origin, related to CoVID 19, which led to a decompensation of his chronic heart disease. You ask your outpatient to summarize the overall care of the patient according to the Bouchon model or 1+2+3. Link the right number to the right pathology(s):","item":"pathogeria","matiere":"geria","propositions":[{"correct":true,"justification":"True, the 1 in the Bouchon model corresponds to physiological aging","idx":0,"proposition":"1: Physiological aging"},{"correct":false,"justification":"False, it is physiological aging","idx":1,"proposition":"1: Pathological aging"},{"correct":true,"justification":"True, the n°2 corresponds to chronic pathologies","idx":2,"proposition":"2: Chronic heart disease"},{"correct":true,"justification":"True, the n°3 corresponds to the decompensating factor","idx":3,"proposition":"3: CoVID 19 infection"},{"correct":true,"justification":"True, the n°3 corresponds to the decompensating factor","idx":4,"proposition":"3: Acute heart failure"}],"ts":1633630576,"type":"custom","difficulte":"1"}
-{"_id":"179-mdt-3f31e69d-b184-4031-bce1-2ceec5b3cc80","context":null,"enonce":"Regarding the two types of possible health follow-ups in occupational health, which of the following proposals are accurate?","item":"orgamdt","matiere":"mdt","propositions":[{"correct":false,"justification":"False, hiring and periodic visits must be made by the occupational physician. The nurse can make intermediate visits","idx":0,"proposition":"The follow-up of an employee in a position at risk may include periodic follow-up visits by an occupational nurse"},{"correct":false,"justification":"False, at least every 4 years","idx":1,"proposition":"Periodic follow-up visits shall be carried out at least every two years"},{"correct":false,"justification":"False, for non-at-risk employees, there is no certificate of aptitude","idx":2,"proposition":"For employees in non-high-risk positions, the recruitment examination issues a certificate of suitability for employment"},{"correct":true,"justification":"True, from the course.","idx":3,"proposition":"The prevention information visit is done periodically at least every 5 years"},{"correct":true,"justification":"True, if he is not at risk, all mandatory visits can be made by an intern or a nurse","idx":4,"proposition":"An employee will not necessarily see the occupational physician in his professional life"}],"ts":1633630586,"type":"custom","difficulte":"1"}
-{"_id":"179-mdt-600f6435-24b9-483b-bede-95c749803c72","context":null,"enonce":"Which of the following are true?","item":"orgamdt","matiere":"mdt","propositions":[{"correct":true,"justification":"True, this is part of the non-exhaustive list of roles of the occupational health service.","idx":0,"proposition":"The occupational health service has as its action the prevention of the consumption of toxic substances at work"},{"correct":true,"justification":"True, this is part of the non-exhaustive list of roles of the occupational health service.","idx":1,"proposition":"The occupational health service has as its action the prevention of sexual and moral harassment"},{"correct":false,"justification":"False, naughty trap, there are no psychomotor and occupational therapists ...","idx":2,"proposition":"The occupational health service may consist of nurses, psychologists, psychomotor therapists and occupational therapists."},{"correct":true,"justification":"True, double secret characteristic of the profession","idx":3,"proposition":"The occupational physician is bound by medical and professional secrecy"},{"correct":true,"justification":"True, 2021 College of Occupational Medicine Update","idx":4,"proposition":"The role of the occupational physician is only preventive"}],"ts":1633630591,"type":"custom","difficulte":"1"}
-{"_id":"179-mdt-3d392e71-a80c-4491-a09d-b1871d1b9d1b","context":null,"enonce":"Regarding accidents at work and occupational diseases, what are the possible benefits received by the employee?","item":"orgamdt","matiere":"mdt","propositions":[{"correct":false,"justification":"False, cash benefit = compensation (think of cash as \"pay in cash\")","idx":0,"proposition":"Cash benefit: free care"},{"correct":false,"justification":"False, benefit in kind = free care","idx":1,"proposition":"Benefit in kind: daily allowances"},{"correct":true,"justification":"True, unlike other sick leave","idx":2,"proposition":"Not affected by the waiting day"},{"correct":true,"justification":"True, from the course","idx":3,"proposition":"Possible lifetime or lump sum annuity"},{"correct":false,"justification":"False, nothing to see it is the great war invalids \/ great war maimed","idx":4,"proposition":"Entitlement to the GIG\/GMG pension"}],"ts":1633630594,"type":"custom","difficulte":"1"}
-{"_id":"myasthenie-neuro-8233ec","context":null,"enonce":"Which of the following are possible causes of ptosis?","item":"myasthenie","matiere":"neuro","propositions":[{"correct":false,"justification":"Levator muscle of the eyelid = oculomotor nerve III ","idx":0,"proposition":"Paralysis of the VI abducens nerve"},{"correct":false,"justification":"Levator muscle of the eyelid = oculomotor nerve III ","idx":1,"proposition":"Trochlear IV nerve paralysis"},{"correct":true,"justification":"True","idx":2,"proposition":"Oculomotor nerve paralysis III "},{"correct":true,"justification":"True","idx":3,"proposition":"Sign of Claude-Bernard-Horner"},{"correct":false,"justification":"False","idx":4,"proposition":"Vitamin B9 deficiency"}],"ts":1633965318,"type":"custom","difficulte":"2"}
-{"_id":"myasthenie-neuro-dc1a58","context":null,"enonce":"Which of the following suggests a rapid test in consultation that can support the diagnosis of myasthenia gravis in case of ptosis?","item":"myasthenie","matiere":"neuro","propositions":[{"correct":false,"justification":"Test indicated when a patient suffers from ocular paralysis (and not ptosis). It consists of a graphic recording of ocular motor skills in different positions of the gaze.","idx":0,"proposition":"Test de Lancaster"},{"correct":true,"justification":"True, ptosis decreases after several seconds","idx":1,"proposition":"Ice cube test "},{"correct":false,"justification":"Useless for myasthenia gravis, not in consultation ","idx":2,"proposition":"EEG"},{"correct":false,"justification":"Unnecessary and unchanged\/normal in myasthenia gravis","idx":3,"proposition":"Visual field"},{"correct":false,"justification":"False","idx":4,"proposition":"No proposition is true"}],"ts":1633965489,"type":"custom","difficulte":"2"}
-{"_id":"PF-neuro-2b9390","context":null,"enonce":"Regarding facial paralysis, which of the following propositions, which one or which are true?","item":"PF","matiere":"neuro","propositions":[{"correct":false,"justification":"False, the definition here corresponds to peripheral facial paralysis. We must not forget that we can have central facial paralysis, which corresponds to an attack of the central nervous system.","idx":0,"proposition":"Facial paralysis corresponds to distal involvement of nerve VII"},{"correct":true,"justification":"True, unlike a central facial paralysis where we will have a predominant lower facial involvement.","idx":1,"proposition":"Peripheral facial paralysis is characterized by upper and lower involvement of the face"},{"correct":true,"justification":"True, to have seen him in internship it is all the more bluffing. The eyes open we will have an asymmetry sometimes minimal, and the sign of Charles Bell can be revealed entirely at the closing of the eyes. ","idx":2,"proposition":"The sign of Charles Bell is revealed or increased when a patient is asked to close his eyes"},{"correct":false,"justification":"False, it is done on the healthy side. To help you remember tell you that it is the VII (motor nerve) that is abolished, so you have \"no muscle\" to stretch the mouth on the healthy side. But do not panic, I still confuse today the affected side ...","idx":3,"proposition":"Deviation of the mouth in unilateral peripheral facial paralysis occurs on the paralyzed side"},{"correct":true,"justification":"True, it is the main cause of facial paralysis, but you have to think about all the other causes too.","idx":4,"proposition":"Facial paralysis \"a frigore\" is the most common cause of facial paralysis and is characterized by restoration without sequelae in about 90-95% of cases"}],"ts":1634486613,"type":"custom","difficulte":"1"}
-{"_id":"Kcsein-onco-0012ff","context":null,"enonce":"Regarding tamoxifen, which statement(s) are correct?","item":"Kcsein","matiere":"onco","propositions":[{"correct":false,"justification":"False. In premenopausal women. In postmenopausal women, anti-aromatases are indicated (Anastrozole, Letrozole)","idx":0,"proposition":"Tamoxifen is indicated in postmenopausal women with hormone receptor positive"},{"correct":true,"justification":"True. Tamoxifen increases the risk of endometrial cancer.","idx":1,"proposition":"In case of bleeding during tamoxifen treatment, endometrial cancer should always be ruled out and diagnostic hysteroscopy with biopsy curettage performed."},{"correct":true,"justification":"True","idx":2,"proposition":"Tamoxifen is prescribed for a period of 5 years"},{"correct":true,"justification":"True. Effective contraception is indicated.","idx":3,"proposition":"Tamoxifen is teratogenic"},{"correct":true,"justification":"True","idx":4,"proposition":"Tamoxifen is linked to an over-risk of thromboembolic complications"}],"ts":1634486616,"type":"custom","difficulte":"2"}
-{"_id":"PF-neuro-ae6ca0","context":null,"enonce":"Which of the following are true about Lyme disease?","item":"PF","matiere":"neuro","propositions":[{"correct":true,"justification":"True, and more specifically borreliosis (infectious diseases caused by bacteria carried and transmitted to humans by ticks or lice)","idx":0,"proposition":"It is a spirochetosis"},{"correct":true,"justification":"True, the best way to remember it is to pronounce it (no I'm kidding)","idx":1,"proposition":"It is due to Borrelia burgdorferi"},{"correct":false,"justification":"Pertussis agent","idx":2,"proposition":"It is due to Bordetella pertussis"},{"correct":false,"justification":"Trench fever agent","idx":3,"proposition":"It is due to Bartonella quintana"},{"correct":true,"justification":"True","idx":4,"proposition":"Erythema migrans is looked for"}],"ts":1634486621,"type":"custom","difficulte":"2"}
-{"_id":"329-urg-8ddecff5-a24a-4552-a1fe-7d0254301d78","context":null,"enonce":"Which of the following propositions, is (are) true regarding fat embolism?","item":"polytrauma","matiere":"urg","propositions":[{"correct":true,"justification":"True. CLINICAL diagnosis above all and not paraclinical that will guide. If you ever miss the clinic, the fundus will allow a retrospective diagnosis ","idx":0,"proposition":"The diagnosis is primarily clinical and is based on the discovery of hyperthermia, sinus tachycardia and polypnea a few hours after a limb fracture"},{"correct":false,"justification":"False. In addition there is only hypoxemia that is almost constant ","idx":1,"proposition":"The diagnosis is primarily paraclinical and based on the discovery of thrombocytopenia, hemolytic anemia and arterial hypoxemia. "},{"correct":true,"justification":"True. It can be used to make a retrospective diagnosis when clinical manifestations have been missed. ","idx":2,"proposition":"The fundus can find retinal hemorrhages, cottony nodules and retinal edema"},{"correct":true,"justification":"True! These manifestations are fickle, however. ","idx":3,"proposition":"The Gurd triad is based on the association of lesional pulmonary edema + neuro-psychic manifestations + petechiae of the trunk and mucous membranes "},{"correct":true,"justification":"True! HEMODYNAMICS to be monitored extremely rigorously in the context of (poly)trauma. Fat embolism was the subject of an entire question at ECNI 2021. All this information can be found in the latest college of anesthesia resuscitation p344: https:\/\/www.cnear.fr\/dfasm","idx":4,"proposition":"Preventive treatment is based on immobilization of fracture foci, maintenance of good hemodynamics and the fight against pain  "}],"ts":1634486627,"type":"custom","difficulte":"1"}
-{"_id":"tbmarchegeria-neuro-8b1ae4","context":null,"enonce":"You receive in your acute geriatric department Mr. Dominique Greene, 89 years old, who comes for a classic fall care. You wonder what systematic assessment you are going to make and you note possible examinations \/ supports. What reviews will you NOT incorporate into your systematic review?","item":"tbmarchegeria","matiere":"neuro","propositions":[{"correct":true,"justification":"True, the fall assessment is as follows: Reassessment of the prescription, Evaluation of autonomy and functional independence by ADL and IADL\/\/\/\/\/NFS, CRP, Ionogram, Vitamin D, Blood glucose, Renal work, Liver test, CPK, Troponin, +\/- TSH, Albumin, \/\/\/\/ECG, IPS, Orthostatic hypotension test, +\/- ETT, Holter ECG, Brain imaging if call point","idx":0,"proposition":"MMS"},{"correct":false,"justification":"False","idx":1,"proposition":"Calcemia"},{"correct":true,"justification":"True","idx":2,"proposition":"Blood and urinary toxicants"},{"correct":true,"justification":"True","idx":3,"proposition":"Effort test"},{"correct":false,"justification":"False","idx":4,"proposition":"Orthostatic hypotension test"}],"ts":1634486630,"type":"custom","difficulte":"1"}
-{"_id":"343-urg-aba09f67-6f87-457f-b786-501262657b76","context":null,"enonce":"Among the following proposals, which examination(s) of unscrambling for etiological purposes must \/ must imperatively be carried out in front of any acute renal failure?","item":"IRenA","matiere":"urg","propositions":[{"correct":false,"justification":"iodinated 😬 contrast medium injection","idx":0,"proposition":"uro-scanner"},{"correct":true,"justification":"True, systematic","idx":1,"proposition":"renal ultrasound"},{"correct":false,"justification":"useful only if parenchymal cause (eliminate pre-renal and post-renal cause before)","idx":2,"proposition":"puncture kidney biopsy"},{"correct":false,"justification":"not for etiological purposes","idx":3,"proposition":"Natremiah"},{"correct":true,"justification":"True, systematic","idx":4,"proposition":"Urinary ionogram"}],"ts":1634486632,"type":"custom","difficulte":"1"}
-{"_id":"polytrauma-urg-2e7814","context":null,"enonce":"Which of the following proposals concerning the therapeutic management of a polytrauma patient are true?","item":"polytrauma","matiere":"urg","propositions":[{"correct":true,"justification":"True, A=Airway, B=Breathing, C=Circulation, D=Disability, E=Environment and ensures no source of potential instability is forgotten","idx":0,"proposition":"Treatment of vital distress follows sequence A, B, C, D, E"},{"correct":true,"justification":"True","idx":1,"proposition":"Stage E (Environment) mainly involves the fight against hypothermia"},{"correct":true,"justification":"True","idx":2,"proposition":"Stage D (Disability) focuses on neurological examination"},{"correct":true,"justification":"True","idx":3,"proposition":"The volume of blood lost during the first 6 hours post-traumatic of a femur fracture can reach 2000 mL"},{"correct":false,"justification":"False, hypocalcemia that results from the dilution and presence of citrate in PSL (calcium chelator)","idx":4,"proposition":"A massive transfusion exposes to the risk of hypercalcemia"}],"ts":1634486634,"type":"custom","difficulte":"2"}
-{"_id":"dysphonie-neuro-df181d","context":null,"enonce":"Which of the following are causes of dysphonia with normal and mobile vocal cords?","item":"dysphonie","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Hypothyroidism"},{"correct":true,"justification":"True","idx":1,"proposition":"Hyperandrogenism"},{"correct":false,"justification":"False","idx":2,"proposition":"Rheumatoid arthritis"},{"correct":false,"justification":"It is not dysphonia (differential diagnosis)","idx":3,"proposition":"Rhinolalie"},{"correct":false,"justification":"It is not dysphonia (differential diagnosis), hypophonia is observed","idx":4,"proposition":"Chronic respiratory failure"}],"ts":1634486636,"type":"custom","difficulte":"2"}
-{"_id":"RCIU-gyn-c53a59","context":null,"enonce":"Which of the following are recommendations for pregnant women who are not immune to toxoplasmosis?","item":"RCIU","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Avoid contact with cats 🐱"},{"correct":false,"justification":"Not cited in college","idx":1,"proposition":"Avoid contact with dogs"},{"correct":true,"justification":"True","idx":2,"proposition":"Washing raw fruit"},{"correct":true,"justification":"True","idx":3,"proposition":"Consumption of well-cooked meat"},{"correct":false,"justification":"There is no vaccine against toxoplasmosis","idx":4,"proposition":"Vaccination"}],"ts":1634486638,"type":"custom","difficulte":"2"}
-{"_id":"dysphagie-HGE-7b90f6","context":null,"enonce":"Which of the following can cause lesional esophageal dysphagia?","item":"dysphagie","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Cancer of the cardia"},{"correct":true,"justification":"True","idx":1,"proposition":"Zenker's diverticulum"},{"correct":true,"justification":"True","idx":2,"proposition":"Caustic stenosis"},{"correct":true,"justification":"True","idx":3,"proposition":"Peptic stenosis"},{"correct":false,"justification":"Non-lesional dysphagia: perprandial retrosternal pain","idx":4,"proposition":"Diffuse spasm disease of the esophagus"}],"ts":1634486640,"type":"custom","difficulte":"1"}
-{"_id":"TTTnonmedic-therapeutique-edd5ec","context":null,"enonce":"Which of the following proposals designate types of orthotics?","item":"TTTnonmedic","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True: reduced pain and deformities at rest","idx":0,"proposition":"Resting orthosis"},{"correct":false,"justification":"Does not exist","idx":1,"proposition":"Activity orthosis"},{"correct":true,"justification":"True. Reduces deformation","idx":2,"proposition":"Correction orthosis"},{"correct":false,"justification":"Does not exist","idx":3,"proposition":"Addition orthosis"},{"correct":false,"justification":"Does not exist","idx":4,"proposition":"Addition orthosis"}],"ts":1634486643,"type":"custom","difficulte":"2"}
-{"_id":"ETP-therapeutique-58d28b","context":null,"enonce":"Which of the following proposals correspond to a situation where a doctor can prescribe off-label? 😱","item":"ETP","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Early access"},{"correct":true,"justification":"True","idx":1,"proposition":"Compassionate access"},{"correct":false,"justification":"False","idx":2,"proposition":"Palliative care"},{"correct":false,"justification":"False","idx":3,"proposition":"At the request of the patient"},{"correct":false,"justification":"I kindly remind you that general medicine is a specialty. 😇😇","idx":4,"proposition":"At the request of the specialist when you are a generalist"}],"ts":1634486645,"type":"custom","difficulte":"2"}
-{"_id":"tbconscience-urg-b4a474","context":null,"enonce":"Which of the following are confusogenic molecules due to their anticholinergic activity?","item":"tbconscience","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Metoclopramide"},{"correct":true,"justification":"True, \"Atropine, it drives you crazy!\"","idx":1,"proposition":"Atropine"},{"correct":true,"justification":"True","idx":2,"proposition":"Imipramine antidepressants"},{"correct":false,"justification":"False","idx":3,"proposition":"Paracetamol"},{"correct":false,"justification":"No anticholinergic action. However, it can participate in dehydrating the patient (cause of confusion)","idx":4,"proposition":"Furosemide"}],"ts":1634486647,"type":"custom","difficulte":"2"}
-{"_id":"339-urg-5bebf96e-7264-48df-b909-6627cae65ab6","context":null,"enonce":"Regarding preeclampsia, which of the following are true?","item":"PECKc","matiere":"urg","propositions":[{"correct":true,"justification":"True. Cf. 2020 CNGOF Recommendations. It is routinely put on to prevent complications of eclampsia.","idx":0,"proposition":"IV magnesium sulfate is indicated in all pregnant women with severe pre-eclampsia with at least 1 severity endpoint"},{"correct":true,"justification":"True","idx":1,"proposition":"HELLP syndrome is frequently associated with DIC."},{"correct":true,"justification":"True. Cf. 2020 CNGOF Recommendations. ","idx":2,"proposition":"The anti-hypertensive recommended in first line in front of severe hypertension in pre-eclampsia is labetolol"},{"correct":true,"justification":"True. First-line treatment: labetolol. Second-line therapy: calcium channel blocker (nicardipian) or uradipil, as monotherapy or in combination. ","idx":3,"proposition":"In case of contraindication or failure of first-line antihypertensive therapy, the second-line antihypertensive drug for severe hypertension in pre-eclampsia is a calcium channel blocker (nicardipine) or uradipil"},{"correct":false,"justification":"False. This is a difference with hypertension in adults and hypertension in pregnant women. In adults, it is ≥ 180 mmHg PAS and\/or ≥ 110 mmHg PAD. In pregnant women, it is ≥ 160 mmHg PAS and \/ or ≥ 110 mmHg PAD.","idx":4,"proposition":"Severe hypertension during pregnancy is defined as SBP ≥ 180 and\/or PAD ≥ 110 mmHg"}],"ts":1634486649,"type":"custom","difficulte":"1"}
-{"_id":"ETP-therapeutique-abc05f","context":null,"enonce":"Which of the following are true?","item":"ETP","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The direct toxicity of a drug is dose-dependent 💊"},{"correct":false,"justification":"False","idx":1,"proposition":"Digestive absorption of drugs is age-dependent 👴"},{"correct":true,"justification":"True","idx":2,"proposition":"The hepatic first-pass effect is decreased in the elderly 🧓"},{"correct":false,"justification":"Most are not ➡ always checked on the CRAT website","idx":3,"proposition":"The drugs are for, mostly, fetotoxic 👶"},{"correct":false,"justification":"It decreases by hemodilution ↘","idx":4,"proposition":"Albuminemia increases during pregnancy 🤰 "}],"ts":1634486651,"type":"custom","difficulte":"2"}
-{"_id":"dlrbuccale-neuro-35364b","context":null,"enonce":"Which of the following are true?","item":"dlrbuccale","matiere":"neuro","propositions":[{"correct":true,"justification":"True. Between 5 and 60 minutes for each symptom","idx":0,"proposition":"Symptoms of migraine aura last less than an hour"},{"correct":true,"justification":"True","idx":1,"proposition":"Tension ⚡ headaches have nothing to do with high blood pressure. "},{"correct":true,"justification":"True","idx":2,"proposition":"Headaches due to drug abuse may be due to paracetamol"},{"correct":false,"justification":"This is the case of cluster headache. For tension headaches, it is amitriptyline","idx":3,"proposition":"The background treatment for tension headaches is verapamil"},{"correct":true,"justification":"True","idx":4,"proposition":"Oxygen therapy is part of the treatment of cluster headache crisis"}],"ts":1634486653,"type":"custom","difficulte":"2"}
-{"_id":"PECKc-urg-d8d03c","context":null,"enonce":"Which of the following proposals for pre-eclampsia are criteria for severity?","item":"PECKc","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A PEAK≥160 mmHg and\/or SAR≥110 mmHg"},{"correct":true,"justification":"True. Defined by mechanical hemolysis (schizocytes, LDH ≤ 600 IU\/L, total bilirubin ≥ 12mg\/L), hepatic cytolysis (AST≥70 IU\/L) and thrombocytopenia (≤100 G\/L)","idx":1,"proposition":"HELLP syndrome"},{"correct":false,"justification":"False, nephrotic syndrome with proteinuria ≥5g\/24h","idx":2,"proposition":"Proteinuria ≥300mg\/24h"},{"correct":false,"justification":"False, ≤ 100,000 g\/L","idx":3,"proposition":"Thrombocytopenia from ≤ 30,000 G\/L"},{"correct":true,"justification":"True","idx":4,"proposition":"Fetal impact"}],"ts":1634486658,"type":"custom","difficulte":"2"}
-{"_id":"180-mdt-3bc91e69-0633-492e-af3c-0a2ff655e05c","context":null,"enonce":"Mr. Idaho, Duncan, 35 years old, comes to see you in your office because he would like to be recognized for his chronic lumbosciatica related to his profession, in occupational disease. Which of the following means qualify for recognition as an occupational disease?","item":"APMP","matiere":"mdt","propositions":[{"correct":false,"justification":"False, the presumption of imputability applies to accidents at work and not to occupational diseases. Attention, classic trap in MCQ.","idx":0,"proposition":"Presumption of accountability"},{"correct":true,"justification":"True, if the disease corresponds to the picture (physical injuries, delay etc ...) there is no need for additional evidence","idx":1,"proposition":"Presumption of origin"},{"correct":false,"justification":"False, the occupational physician cannot certify the occupational disease, just with a certificate","idx":2,"proposition":"Certificate from the occupational physician certifying the occupational origin of the disease "},{"correct":true,"justification":"True, the CRRMP allows to debate cases that do not fit completely in the tables or being outside the tables, overall, they will study in detail the links between illness and work and grant or not the disease as occupational or not.","idx":3,"proposition":"Recognition of the file before the Regional Committee for the Recognition of Occupational Diseases (CRRMP)"},{"correct":false,"justification":"False, 100% false.","idx":4,"proposition":"Pathology that started during labour and persisted for more than 5 years"}],"ts":1634486660,"type":"custom","difficulte":"1"}
-{"_id":"masseabdo-HGE-2b2d0f","context":null,"enonce":"Which of the following are contraindications to transparietal PBH?","item":"masseabdo","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"TP < 50%"},{"correct":true,"justification":"True, special threshold to remember","idx":1,"proposition":"Platelets <60,000\/mm3"},{"correct":true,"justification":"True","idx":2,"proposition":"Lengthening of the ATT"},{"correct":true,"justification":"True, these are the 4 contraindications mentioned in the college 😉","idx":3,"proposition":"Ascites"},{"correct":false,"justification":"In this case, On","idx":4,"proposition":"Heterogeneous hepatomegaly"}],"ts":1634486665,"type":"custom","difficulte":"1"}
-{"_id":"splenomeg-HGE-8e0c76","context":null,"enonce":"Which of the following are true for macrophage activation syndrome (SAM)?","item":"splenomeg","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"There is hepatomegaly"},{"correct":true,"justification":"True","idx":1,"proposition":"We find a fever"},{"correct":false,"justification":"Pancytopenia","idx":2,"proposition":"Leukocytosis is found"},{"correct":false,"justification":"Increased","idx":3,"proposition":"We find LDH in free fall"},{"correct":false,"justification":"Increased ferritin","idx":4,"proposition":"Hypoferritinemia"}],"ts":1634486667,"type":"custom","difficulte":"1"}
-{"_id":"ETP-therapeutique-4b7dfc","context":null,"enonce":"Which of the following propositions are true about ALD?","item":"ETP","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Diabetes is ALD"},{"correct":false,"justification":"Each ALD has a fixed term, at the end of which renewal can be requested","idx":1,"proposition":"ALDs are valid for life"},{"correct":true,"justification":"True","idx":2,"proposition":"It is usually requested by the attending physician"},{"correct":false,"justification":"Only for care related to the pathology in question","idx":3,"proposition":"It offers the right to 100% coverage for all care"},{"correct":false,"justification":"False","idx":4,"proposition":"It makes it possible to free oneself from mutual insurance companies"}],"ts":1634486669,"type":"custom","difficulte":"2"}
-{"_id":"diarrheechr-HGE-c192f0","context":null,"enonce":"How many loose\/watery stools per day are we talking about diarrhea?","item":"diarrheechr","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"1"},{"correct":false,"justification":"","idx":1,"proposition":"2"},{"correct":true,"justification":"True, diarhea if > 3 watery\/soft stools per day","idx":2,"proposition":"3"},{"correct":false,"justification":"","idx":3,"proposition":"4"},{"correct":false,"justification":"","idx":4,"proposition":"5"}],"ts":1634486671,"type":"custom","difficulte":"1"}
-{"_id":"ictere-HGE-455ebb","context":null,"enonce":"Which of the following are causes of extrahepatic jaundice?","item":"ictere","matiere":"HGE","propositions":[{"correct":false,"justification":"Head of the pancreas","idx":0,"proposition":"Pancreatic tail cancer"},{"correct":true,"justification":"True","idx":1,"proposition":"Duodenal tumour"},{"correct":true,"justification":"True","idx":2,"proposition":"Gastric tumour"},{"correct":true,"justification":"True","idx":3,"proposition":"Hemolysis"},{"correct":true,"justification":"True","idx":4,"proposition":"Gilbert's disease"}],"ts":1634486672,"type":"custom","difficulte":"1"}
-{"_id":"MICI-HGE-268b78","context":null,"enonce":"Which of the following are signs and\/or symptoms of UC?","item":"MICI","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Chronic dysenteric syndrome"},{"correct":true,"justification":"True","idx":1,"proposition":"Chronic diarrhea"},{"correct":true,"justification":"True","idx":2,"proposition":"Iron deficiency"},{"correct":false,"justification":"The anus is not affected","idx":3,"proposition":"Involvement of the anus"},{"correct":true,"justification":"True","idx":4,"proposition":"The diagnosis is made on a bundle of arguments"}],"ts":1634486674,"type":"custom","difficulte":"1"}
-{"_id":"Frped-urg-b9207b","context":null,"enonce":"Which of the following are true?","item":"Frped","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A \"green wood\" fracture is a fracture where part of the cortical of the bone is ruptured, and the other side of the cortical is continuous."},{"correct":false,"justification":"False. Axial trauma. ","idx":1,"proposition":"A fracture in \"lump of butter\" results from a torsional mechanism"},{"correct":false,"justification":"False. 1st cause. ","idx":2,"proposition":"Traumatology is the second leading cause of death between 1 year and 19 years"},{"correct":true,"justification":"True","idx":3,"proposition":"The occurrence of a fracture in an infant who does not move must give rise to suspicion of abuse. "},{"correct":true,"justification":"True. The water density of the child's bone gives it greater plasticity.","idx":4,"proposition":"Fractures made of green wood and lump of butter are specific to the child"}],"ts":1634486676,"type":"custom","difficulte":"2"}
-{"_id":"choc-urg-fe7d13","context":null,"enonce":"What is the main property of dobutamine?","item":"choc","matiere":"urg","propositions":[{"correct":true,"justification":"True, increased strength of \r\ncontraction. Continuous infusion with the self-pushing syringe","idx":0,"proposition":"Positive ionotrope"},{"correct":false,"justification":"Slightly chronotropic positive","idx":1,"proposition":"Negative chronotropic"},{"correct":false,"justification":"No effect on the conduction velocity of nerve impulses of myocardial muscle fibers","idx":2,"proposition":"Negative domotrope"},{"correct":false,"justification":"Positive ionotrope","idx":3,"proposition":"Negative ionotrope"},{"correct":false,"justification":"","idx":4,"proposition":"All proposals are wrong"}],"ts":1634486677,"type":"custom","difficulte":"1"}
-{"_id":"cirrhose-HGE-bc27a3","context":null,"enonce":"Which of the following are signs of hepatocellular insufficiency?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Stellar angioma"},{"correct":true,"justification":"True","idx":1,"proposition":"Palar erythrosis"},{"correct":false,"justification":"Portal hypertension","idx":2,"proposition":"Ascites"},{"correct":false,"justification":"Portal hypertension","idx":3,"proposition":"Collateral circulation"},{"correct":true,"justification":"True","idx":4,"proposition":"Jaundice"}],"ts":1634486679,"type":"custom","difficulte":"1"}
-{"_id":"dlrbuccale-neuro-54b255","context":null,"enonce":"Which of the following are true about migraines?","item":"dlrbuccale","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Migraine with aura is an independent risk factor for cerebral infarction, especially in women under 45 years of age."},{"correct":true,"justification":"True","idx":1,"proposition":"Migraine with typical aura involves visual, sensory or language disorders of gradual and successive installation"},{"correct":false,"justification":"Visual disturbances","idx":2,"proposition":"Sensory disorders are most common in migraines with aura"},{"correct":false,"justification":"auras can change over the course of life","idx":3,"proposition":"Auras are always the same throughout life"},{"correct":false,"justification":"Less than 15 days per month","idx":4,"proposition":"Episodic migraine lasts less than 25 days a month"}],"ts":1634486680,"type":"custom","difficulte":"2"}
-{"_id":"tbconscience-urg-e6a32c","context":null,"enonce":"Which of the following are true for pellagreal encephalopathy?","item":"tbconscience","matiere":"urg","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"It is due to vitamin B1 deficiency"},{"correct":true,"justification":"True","idx":1,"proposition":"It is due to vitamin B3 deficiency"},{"correct":false,"justification":"False","idx":2,"proposition":"It is due to vitamin B6 deficiency"},{"correct":true,"justification":"True","idx":3,"proposition":"It is due to vitamin PP deficiency"},{"correct":false,"justification":"False","idx":4,"proposition":"No proposition is true"}],"ts":1634486682,"type":"custom","difficulte":"2"}
-{"_id":"TTTnonmedic-therapeutique-9bde80","context":null,"enonce":"Which of the following are true?","item":"TTTnonmedic","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Rest orthoses prevent deformities"},{"correct":true,"justification":"True","idx":1,"proposition":"Resting orthoses reduce pain"},{"correct":false,"justification":"Replacement orthosis","idx":2,"proposition":"The dynamic muscle replacement orthosis is a corrective orthosis"},{"correct":false,"justification":"Canes and wheelchairs are external technical aids","idx":3,"proposition":"The cane is an orthosis"},{"correct":true,"justification":"True","idx":4,"proposition":"The stabilization orthosis allows the maintenance of activity despite an unstable limb"}],"ts":1634486683,"type":"custom","difficulte":"2"}
-{"_id":"MTEV-cardio-430cf9","context":null,"enonce":"One of your patients is being treated with VKA for her PE. VKAs prevent hepatic synthesis of several coagulation factors. Which?","item":"MTEV","matiere":"cardio","propositions":[{"correct":false,"justification":"Factor II, VII, IX and X","idx":0,"proposition":"Factor I"},{"correct":true,"justification":"True","idx":1,"proposition":"Factor II"},{"correct":true,"justification":"True","idx":2,"proposition":"Factor VII"},{"correct":true,"justification":"True","idx":3,"proposition":"Factor IX"},{"correct":false,"justification":"","idx":4,"proposition":"Factor XII"}],"ts":1634486685,"type":"custom","difficulte":"1"}
-{"_id":"ECG-cardio-5aa61a","context":null,"enonce":"Which of the following propositions are found in junctional tachycardia?","item":"ECG","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Regular rhythm"},{"correct":false,"justification":"False","idx":1,"proposition":"Irregular rhythm"},{"correct":false,"justification":"Purposes unless pre-existing branch blog","idx":2,"proposition":"Wide QRS"},{"correct":true,"justification":"True","idx":3,"proposition":"Fine QRS"},{"correct":true,"justification":"True, until you reach maximum heart rate (220 - age)","idx":4,"proposition":"Tachycardia often exceeds 150 bpm"}],"ts":1634486686,"type":"custom","difficulte":"2"}
-{"_id":"85-ORL-cd19be8c-1d32-4770-a405-7552e32cf0be","context":null,"enonce":"A 57-year-old patient comes to see you for a left epistaxis of low abundance \r\n\r\nATCD: Repeated MTEV \r\nTTT: Fluindione \r\n\r\nWhat is the 1st measure to be carried out? ","item":"epistaxis","matiere":"ORL","propositions":[{"correct":true,"justification":"True. In front of an epistaxis: \r\n1. We decoiled by blowing the patient's nose \r\n\r\n2. Bidigital compression is done to try to stop the bleeding","idx":0,"proposition":"Stripping by blowing "},{"correct":false,"justification":"","idx":1,"proposition":"Bidigital compression "},{"correct":false,"justification":"","idx":2,"proposition":"Nasal sinus CT"},{"correct":false,"justification":"","idx":3,"proposition":"Return home"},{"correct":false,"justification":"","idx":4,"proposition":"Prescription of Group O+ phenotyped RGCs"}],"ts":1634486702,"type":"custom","difficulte":"1"}
-{"_id":"tumefactionpelv-gyn-330651","context":null,"enonce":"What does the FIGO 0 classification of a uterine fibroid mean? ","item":"tumefactionpelv","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Fully intracavitary pedunculated submucosal fibroid"},{"correct":false,"justification":"FIGO 7","idx":1,"proposition":"Pedunculated subserous fibroma"},{"correct":false,"justification":"FIGO 3","idx":2,"proposition":"Interstitial fibroid in contact with the endometrium"},{"correct":false,"justification":"FIGO 6","idx":3,"proposition":"Subserous fibroid<50%intracavitary"},{"correct":false,"justification":"FIGO 1","idx":4,"proposition":"Submucosal fibroid<50% intracavitary"}],"ts":1634486705,"type":"custom","difficulte":"2"}
-{"_id":"DgKc-onco-a4d967","context":null,"enonce":"Which of the following propositions are true regarding extemporaneous examination?","item":"DgKc","matiere":"onco","propositions":[{"correct":false,"justification":"It is always complemented by an analysis ","idx":0,"proposition":"The result given is final"},{"correct":false,"justification":"Not fixed","idx":1,"proposition":"The levy is fixed with formalin"},{"correct":false,"justification":"Not fixed","idx":2,"proposition":"The sample is fixed to saline"},{"correct":true,"justification":"True","idx":3,"proposition":"The result must be fast (in less than 30 minutes)"},{"correct":false,"justification":"","idx":4,"proposition":"All proposals are wrong"}],"ts":1634486707,"type":"custom","difficulte":"1"}
-{"_id":"MICI-HGE-53cace","context":null,"enonce":"Regarding the epidemiology of Crohn's disease:","item":"MICI","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The incidence is increasing 📈"},{"correct":false,"justification":"","idx":1,"proposition":"The incidence is decreasing 📉"},{"correct":true,"justification":"True","idx":2,"proposition":" Prevalence is about 1\/1000"},{"correct":false,"justification":"The threshold for rare diseases is 1\/2000","idx":3,"proposition":"It is a rare disease"},{"correct":false,"justification":"About 1\/1000","idx":4,"proposition":" Prevalence is about 1\/6000"}],"ts":1634486708,"type":"custom","difficulte":"1"}
-{"_id":"ictere-HGE-ef3411","context":null,"enonce":"Which of the following are etiologies of jaundice with normal urine?","item":"ictere","matiere":"HGE","propositions":[{"correct":false,"justification":"Brown urine","idx":0,"proposition":"Cholestasis"},{"correct":true,"justification":"True","idx":1,"proposition":"Dyserythropoiesis"},{"correct":true,"justification":"True","idx":2,"proposition":"Hemolysis"},{"correct":true,"justification":"True","idx":3,"proposition":"Beta-glucuronide transferase deficiency"},{"correct":false,"justification":"Rotor syndrome is a benign inherited liver disease characterized by predominantly conjugated chronic hyperbilirubinemia without hemolysis or histological hepatic abnormalities.","idx":4,"proposition":"Syndrome de Rotor"}],"ts":1634486712,"type":"custom","difficulte":"1"}
-{"_id":"NFS-hemato-002159","context":null,"enonce":"Which of the following are the causes of hematocrit elevation?","item":"NFS","matiere":"hemato","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"None of these proposals"},{"correct":false,"justification":"Rather anemia","idx":1,"proposition":"Monoclonal gammopathy"},{"correct":true,"justification":"True, not hemoconcentration","idx":2,"proposition":"Extracellular dehydration"},{"correct":false,"justification":"Normal hematocrit polycythemia","idx":3,"proposition":"Thalassemia"},{"correct":true,"justification":"True. Cause of false polycythemia (ht\/hb increased but normal total mass). It often corresponds to young, sedentary, overweight men and other associated vascular risk factors. The measurement of the globular mass is normal.","idx":4,"proposition":"Syndrome de Gaisbock"}],"ts":1634486714,"type":"custom","difficulte":"2"}
-{"_id":"suivivalv-cardio-40bcff","context":null,"enonce":"You are an intern in cardiology and your outpatient, asks you during the visit what are the main differences between mechanical prostheses and biological prostheses?","item":"suivivalv","matiere":"cardio","propositions":[{"correct":true,"justification":"True, unlike bioprostheses that often have a lifespan of 20 years.","idx":0,"proposition":"Mechanical prostheses have a theoretically unlimited lifespan"},{"correct":false,"justification":"False, because of their limited lifespan, we will rather implement these prostheses in elderly subjects.","idx":1,"proposition":"Biological prostheses are preferred in young subjects because they avoid taking an anticoagulant"},{"correct":false,"justification":"False, there is the same risk regardless of the type of prosthesis","idx":2,"proposition":"The risk of infective endocarditis is greater in front of a mechanical prosthesis than in front of a bioprosthesis"},{"correct":true,"justification":"True, finesse of the college of cardiology that I did not know but that an expert cardiologist could drop in IQ","idx":3,"proposition":"The risk of thromboembolic complications is higher for mitral prostheses than for aortic prostheses"},{"correct":true,"justification":"True, so make sure your patients take their blood thinning treatment!","idx":4,"proposition":"The main risk factor for thromboembolic event on prosthetic valve is insufficient anticoagulant therapy"}],"ts":1634486715,"type":"custom","difficulte":"1"}
-{"_id":"greffe-immuno-1a6e67","context":null,"enonce":"Which of the following are true about corneal transplantation?","item":"greffe","matiere":"immuno","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"There is a risk of immune rejection of the graft"},{"correct":true,"justification":"True","idx":1,"proposition":"There is a risk of cell rejection of the graft"},{"correct":true,"justification":"True","idx":2,"proposition":"HIV serology is mandatory in the donor"},{"correct":false,"justification":"False","idx":3,"proposition":"EBV serology is mandatory in the donor"},{"correct":true,"justification":"True","idx":4,"proposition":"HBV serology is mandatory in the donor"}],"ts":1634486719,"type":"custom","difficulte":"2"}
-{"_id":"Frped-urg-177104","context":null,"enonce":"Regarding the classification of Salter and Harris","item":"Frped","matiere":"urg","propositions":[{"correct":false,"justification":"The trait respects the germinative layer of the growth cartilage: the risk of epiphysiodesis is therefore low","idx":0,"proposition":"A Salter 1 fracture is characterized by a trait passing exclusively through the growth zone, which induces a high risk of epiphysiodesis"},{"correct":false,"justification":"Growth zone and metaphysis","idx":1,"proposition":"A Salter 2 fracture is characterized by a trait passing through the growth zone and the epiphysis "},{"correct":true,"justification":"The trait passes through the growth zone and the epiphysis (the germinative zone of cartilage is located towards the epiphysis)","idx":2,"proposition":"In a Salter 3 fracture, the germinative layer is always crossed by the fracture line "},{"correct":true,"justification":"The line goes from the metaphysis to the epiphysis: it crosses transversely the growth cartilage","idx":3,"proposition":"In a Salter 4 fracture, the fracture line is transverse to the growth cartilage"},{"correct":true,"justification":"It is generally associated with other fractures, in case of compression mechanism (axial trauma)","idx":4,"proposition":"A Salter 5 fracture does not exist in isolation"}],"ts":1634486721,"type":"custom","difficulte":"2"}
-{"_id":"lithiaseB-HGE-a64bfc","context":null,"enonce":"Which of the following are risk factors for lithiasis?","item":"lithiaseB","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Hypertriglyceridemia"},{"correct":true,"justification":"True","idx":1,"proposition":"Pregnancy"},{"correct":true,"justification":"True","idx":2,"proposition":"Overweight"},{"correct":true,"justification":"True","idx":3,"proposition":"Age"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"ts":1634486724,"type":"custom","difficulte":"1"}
-{"_id":"lithiaseB-HGE-29fd53","context":null,"enonce":"Which of the following is the optimal management of asymptomatic cholelithiasis?","item":"lithiaseB","matiere":"HGE","propositions":[{"correct":true,"justification":"True, therapeutic abstention in front of asympatomatic cholelithiasis (80% are asympto)","idx":0,"proposition":"All proposals are wrong"},{"correct":false,"justification":"It is the management of hepatic colic calmed by analgesic \/ NSAIDs \/ antispasmodics","idx":1,"proposition":"Cold cholecystectomy (less than one month)"},{"correct":false,"justification":"This is the management of acute cholecystitis","idx":2,"proposition":"Emergency cholecystectomy"},{"correct":false,"justification":"This is the management of cholitis (with cholecystectomy)","idx":3,"proposition":"ERPC"},{"correct":false,"justification":"Never biliary lithotripsy","idx":4,"proposition":"Lithotripsy"}],"ts":1634486725,"type":"custom","difficulte":"1"}
-{"_id":"diarrheechr-HGE-9b9da3","context":null,"enonce":"Regarding celiac disease:","item":"diarrheechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Prevalence is 1\/1000"},{"correct":true,"justification":"True","idx":1,"proposition":"There is villous atrophy"},{"correct":true,"justification":"True","idx":2,"proposition":"Screening is done the anti-tranglutamase IgA assay"},{"correct":false,"justification":"1%","idx":3,"proposition":"It is always symptomatic"},{"correct":false,"justification":"Confirmation:)","idx":4,"proposition":"Screening is done the anti-endomysium IgA assay"}],"ts":1634486727,"type":"custom","difficulte":"1"}
-{"_id":"tbconscience-urg-33c3e3","context":null,"enonce":"Which of the following proposals are part of the initial assessment recommended urgently in the face of confusion? ","item":"tbconscience","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Capillary blood glucose"},{"correct":true,"justification":"True","idx":1,"proposition":"CRP"},{"correct":false,"justification":"False, renal assessment","idx":2,"proposition":"Hepatic test"},{"correct":false,"justification":"False, CRP lactates","idx":3,"proposition":"CPK"},{"correct":true,"justification":"True","idx":4,"proposition":"Protidemia"}],"ts":1634486728,"type":"custom","difficulte":"2"}
-{"_id":"98-neuro-c8a40380-88e6-4894-83e6-12f9ada7cf35","context":null,"enonce":"Concerning Headaches in children. Which of the following are situations for a Brain Scan indication?","item":"cephalee","matiere":"neuro","propositions":[{"correct":false,"justification":"no, MRI :p CT scan before 3 years ","idx":0,"proposition":"Statural inflection in a 2-year-old child"},{"correct":false,"justification":"no, MRI :p CT scan before 3 years ","idx":1,"proposition":"An abnormality on neurological examination in a 3-month-old child"},{"correct":true,"justification":"True","idx":2,"proposition":"Positional headaches of decubitus, morning with vomiting in jets in a 7-year-old child"},{"correct":true,"justification":"True Occulomotor nerve compression III","idx":3,"proposition":"A progressive appearance of horizontal diplopia of the right eye that converges to the left associated with a headache in a 4-year-old child"},{"correct":true,"justification":"True","idx":4,"proposition":"Statural delay in a 5-year-old child associated with progressive onset headaches"}],"ts":1634486730,"type":"custom","difficulte":"1"}
-{"_id":"176-sp-79f41abb-8da1-4241-ad82-e3951e5bbbaa","context":null,"enonce":"You are a nuclear medicine intern and you receive, Mr. Banner, Bruce, 76 years old, to have him perform a PET-CT, as part of a pulmonary cancer extension assessment. During this examination, you do everything to minimize the body's exposure to ionizing radiation. What factors influence this exposure?","item":"risquesRx","matiere":"sp","propositions":[{"correct":true,"justification":"True, notion of highly fallable course at the ECN","idx":0,"proposition":"Distance from source"},{"correct":true,"justification":"True, notion of highly fallable course at the ECN","idx":1,"proposition":"Type of rays used"},{"correct":false,"justification":"False, it's a stupid distractor because it needed one","idx":2,"proposition":"The dose previously received during a previous exposure"},{"correct":true,"justification":"True, notion of highly fallable course at the ECN","idx":3,"proposition":"Duration of exposure"},{"correct":true,"justification":"True, notion of highly fallable course at the ECN","idx":4,"proposition":"Thickness and composition of any screens"}],"ts":1634486732,"type":"custom","difficulte":"1"}
-{"_id":"pancreatitechr-HGE-c8be19","context":null,"enonce":"Which of the following are true?","item":"pancreatitechr","matiere":"HGE","propositions":[{"correct":false,"justification":"Male","idx":0,"proposition":"The predominance is female 👩"},{"correct":false,"justification":"40 years","idx":1,"proposition":"The average age is 70 years"},{"correct":false,"justification":"In the back","idx":2,"proposition":"Pain radiates hypogastric"},{"correct":true,"justification":"True","idx":3,"proposition":"The pain is calmed by fasting"},{"correct":true,"justification":"True","idx":4,"proposition":"It can be complicated by diabetes"}],"ts":1634486734,"type":"custom","difficulte":"1"}
-{"_id":"Kcprostate-onco-70d9dd","context":null,"enonce":"Which of the following are true about abiraterone acetate?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":true,"justification":"True, by irreversibly blocking CYP17","idx":0,"proposition":"It is a selective inhibitor of androgen synthesis"},{"correct":false,"justification":"False","idx":1,"proposition":"It is an androgen receptor antagonist"},{"correct":false,"justification":"Daily oral form in combination with prednisone (10 mg\/day)","idx":2,"proposition":"It is in the form of subcutaneous injection"},{"correct":true,"justification":"True","idx":3,"proposition":"It improves quality of life"},{"correct":true,"justification":"True","idx":4,"proposition":"It improves overall survival"}],"ts":1634486736,"type":"custom","difficulte":"2"}
-{"_id":"Kcped-onco-4c97fc","context":null,"enonce":"Which of the following designates an essential isotopic examination in the assessment of neuroblastoma?","item":"Kcped","matiere":"onco","propositions":[{"correct":false,"justification":"Possible in the prostate cancer extension assessment","idx":0,"proposition":"PET Choline Scan"},{"correct":false,"justification":"False","idx":1,"proposition":"Bone scintigraphy"},{"correct":true,"justification":"True","idx":2,"proposition":"MIBG scintigraphy"},{"correct":false,"justification":"False","idx":3,"proposition":"PET Glucose Scan"},{"correct":false,"justification":"Not an isotope test","idx":4,"proposition":"TAP CT"}],"ts":1634486739,"type":"custom","difficulte":"2"}
-{"_id":"MTEV-cardio-e66d1e","context":null,"enonce":"One of your patients is being treated with VKA for her PE. VKAs prevent hepatic synthesis of several coagulation factors. Which?","item":"MTEV","matiere":"cardio","propositions":[{"correct":false,"justification":"Factor II, VIII, IX and X","idx":0,"proposition":"Factor III"},{"correct":false,"justification":"","idx":1,"proposition":"Factor VIII"},{"correct":true,"justification":"True","idx":2,"proposition":"Factor VII"},{"correct":true,"justification":"True","idx":3,"proposition":"Factor IX"},{"correct":true,"justification":"True","idx":4,"proposition":"Factor X"}],"ts":1634486741,"type":"custom","difficulte":"1"}
-{"_id":"nvxne-gyn-6cef1c","context":null,"enonce":"Regarding phenylketonuria:","item":"nvxne","matiere":"gyn","propositions":[{"correct":false,"justification":"Autosomal recessive","idx":0,"proposition":"It is transmitted in an autosomal dominant manner"},{"correct":true,"justification":"True","idx":1,"proposition":"It has an impact of 1\/16,000 in France"},{"correct":true,"justification":"True","idx":2,"proposition":"Phenylalanine (Phe) is an essential amino acid "},{"correct":false,"justification":"microcephaly ","idx":3,"proposition":"Macrocephaly may be observed"},{"correct":true,"justification":"True","idx":4,"proposition":"Clinical signs are due to accumulation of neurotoxic products "}],"ts":1634486742,"type":"custom","difficulte":"2"}
-{"_id":"PF-neuro-a63171","context":null,"enonce":"The Ramsay-Hunt area mainly concerns:","item":"PF","matiere":"neuro","propositions":[{"correct":true,"justification":"True. It includes the eardrum, the posterior wall of the external auditory canal, part of the pinna of the ear (the conch) (according to Wikipedia, mentioned on page 84 of the 4th edition of the college of CMF)","idx":0,"proposition":"The outer 👂 ear"},{"correct":false,"justification":"False","idx":1,"proposition":"Language 😝 "},{"correct":false,"justification":"False","idx":2,"proposition":"Vocal cords 🗣"},{"correct":false,"justification":"False","idx":3,"proposition":"The tip of the nose 👃 "},{"correct":false,"justification":"False","idx":4,"proposition":"The between-eyebrows 👀"}],"ts":1634486744,"type":"custom","difficulte":"3"}
-{"_id":"181-infectio-d47885cf-58db-4d49-8dd4-28e2dabcf9f8","context":null,"enonce":"Which of the following are the false causes of increased sedimentation rate?","item":"reactioninfl","matiere":"infectio","propositions":[{"correct":true,"justification":"True, I know it sucks, but there are many PH who do this kind of MCQ because they are simple MCQs... Refer to the table on page 110 of the College of Internal Medicine. To remember this I told myself that it was decreased when there were too many \"normal\" cells (polycythemia, leukocytosis, thrombocytosis) or not enough proteins (hypofibrinogemia, hypogammaglobulinemia). ","idx":0,"proposition":"Anaemia"},{"correct":false,"justification":"False","idx":1,"proposition":"Polycythemia"},{"correct":true,"justification":"True","idx":2,"proposition":"Hypergammaglobulinemia"},{"correct":false,"justification":"False","idx":3,"proposition":"Hypogammaglobulinemia"},{"correct":true,"justification":"True","idx":4,"proposition":"Pregnancy"}],"ts":1634486745,"type":"custom","difficulte":"1"}
-{"_id":"98-neuro-8a87cd9d-5b54-4cbf-bed3-6017fc6c25c5","context":null,"enonce":"Which of the following are causes of idiopathic ICT?","item":"cephalee","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Estrogen-progestin pill"},{"correct":false,"justification":"No hypervitaminosis in water-soluble vitamins (the too full we piss!) --> Here cause of idiopathic HTIC = Hypervitaminosis A","idx":1,"proposition":"Hypervitaminosis B6"},{"correct":true,"justification":"True: cyclines","idx":2,"proposition":"Antibiotic Treatment PO for Acne"},{"correct":true,"justification":"True","idx":3,"proposition":"Addison's disease"},{"correct":false,"justification":"Not idiopathic because anomaly visible on imaging","idx":4,"proposition":"Brain abscess"}],"ts":1634486747,"type":"custom","difficulte":"1"}
-{"_id":"diverticulose-HGE-25e93e","context":null,"enonce":"Which of the following propositions are true about diverticular hemorrhages?","item":"diverticulose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"They give in spontaneously most often"},{"correct":true,"justification":"True","idx":1,"proposition":"They are the cause of a third of lower bleeding"},{"correct":false,"justification":"Very often recurrent","idx":2,"proposition":"They never reoffend"},{"correct":true,"justification":"True","idx":3,"proposition":"They are brutal"},{"correct":false,"justification":"Or by angioscan","idx":4,"proposition":"The positive diagnosis can only be made by colonoscopy"}],"ts":1634486752,"type":"custom","difficulte":"1"}
-{"_id":"tbconscience-urg-f9b6aa","context":null,"enonce":"Which of the following are possible pathophysiological explanations for confusional state?","item":"tbconscience","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Excess dopamine"},{"correct":true,"justification":"True","idx":1,"proposition":"Acetylcholine deficiency"},{"correct":false,"justification":"False","idx":2,"proposition":"Excess acetylcholine"},{"correct":false,"justification":"False","idx":3,"proposition":"Dopamine deficiency"},{"correct":false,"justification":"False","idx":4,"proposition":"Serotonin deficiency"}],"ts":1634486760,"type":"custom","difficulte":"2"}
-{"_id":"suivivalv-cardio-a1f6d9","context":null,"enonce":"Regarding the monitoring of prosthetic heart valves, what are the exact proposal(s)?","item":"suivivalv","matiere":"cardio","propositions":[{"correct":false,"justification":"False, AOD are never indicated in case of prosthetic valves, only VKAs are used","idx":0,"proposition":"Treatment with VKA requires regular INR monitoring, but not treatment with DOAC, which promotes the use of the latter"},{"correct":false,"justification":"False, even if it can indeed be benign, it must know how to look for a prosthesis dysfunction","idx":1,"proposition":"The appearance of a new breath after valve surgery is common and benign"},{"correct":false,"justification":"False, the ECG is totally normal because the prosthesis has no connection with the electrical current of the heart unlike a pacemaker","idx":2,"proposition":"The ECG is classically slightly altered by the functioning of the valve prosthesis"},{"correct":false,"justification":"False, bioprostheses are organic tissue, unlike mechanical prostheses","idx":3,"proposition":"Bioprostheses are highly radiopaque on chest X-ray"},{"correct":true,"justification":"True, the ETT is the monitoring examination but does not allow the fine analysis of the valve or prosthesis","idx":4,"proposition":"ETO is performed in case of suspected thrombosis or prosthesis dysfunction "}],"ts":1634486762,"type":"custom","difficulte":"1"}
-{"_id":"Kcsein-onco-126015","context":null,"enonce":"Which of the following are true?","item":"Kcsein","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Trastuzumab is always combined with chemotherapy"},{"correct":false,"justification":"False. If the HER is 2+ in immunohistochemistry, the FISH analysis should be completed. If it is not amplified in FISH, anti-HER2 treatment is not indicated. ","idx":1,"proposition":"Trastuzumab is still indicated if immunohistochemistry regains HER2 2+"},{"correct":true,"justification":"True","idx":2,"proposition":"The two most commonly used classes of chemotherapy for breast cancer are anthracylins and taxanes"},{"correct":true,"justification":"True","idx":3,"proposition":"Adjuvant radiotherapy is always indicated in a woman who has received conservative breast surgery (lumpectomy) for carcinoma in situ."},{"correct":true,"justification":"True","idx":4,"proposition":"Anti-aromatases may aggravate pre-existing osteoporosis requiring bone densitometry monitoring"}],"ts":1634486764,"type":"custom","difficulte":"2"}
-{"_id":"341-urg-15b407e2-4450-448c-b22b-b9b091a0141f","context":null,"enonce":"Which of the following are risk factors for post-febrile seizure epilepsy?","item":"convulsionsped","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Psychomotor retardation"},{"correct":true,"justification":"True","idx":1,"proposition":"Previous neurological deficit"},{"correct":true,"justification":"True because Complex Febrile Crisis is a fdr","idx":2,"proposition":"Age <1 year during a febrile attack "},{"correct":true,"justification":"True because Complex Febrile Crisis is a fdr","idx":3,"proposition":"Febrile seizure ATCD > 15min"},{"correct":false,"justification":"NOP, not in the criteria","idx":4,"proposition":"Family history of 1st degree epilepsy"}],"ts":1634486765,"type":"custom","difficulte":"1"}
-{"_id":"dysphagie-HGE-3cceca","context":null,"enonce":"Which of the following can cause lesional esophageal dysphagia?","item":"dysphagie","matiere":"HGE","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Scleroderma"},{"correct":false,"justification":"False","idx":1,"proposition":"Lupus"},{"correct":false,"justification":"False","idx":2,"proposition":"Sjögren's syndrome"},{"correct":false,"justification":"False","idx":3,"proposition":"Amyotrophic lateral sclerosis"},{"correct":true,"justification":"True. All these proposals are causes of non-lesional esophageal dysphagia","idx":4,"proposition":"None of these propositions is true"}],"ts":1634486771,"type":"custom","difficulte":"1"}
-{"_id":"341-urg-38251add-fb46-4d27-a4c4-831e10584574","context":null,"enonce":"Which of the following are risk factors for recurrence of febrile seizures?","item":"convulsionsped","matiere":"urg","propositions":[{"correct":false,"justification":"No report","idx":0,"proposition":"Crisis >15min"},{"correct":true,"justification":"True = 1 year and 3 months","idx":1,"proposition":"Crisis <15months"},{"correct":true,"justification":"True","idx":2,"proposition":"Fever at 38°C during the febrile attack"},{"correct":false,"justification":"And no: it's <38.5 ° C, which is logical since the child had a feverish attack on a fever that was not that hot. So it can recur on low fever.","idx":3,"proposition":"Fever at 40°C during the febrile crisis"},{"correct":true,"justification":"True","idx":4,"proposition":"1st degree family history of febrile seizure"}],"ts":1634486773,"type":"custom","difficulte":"1"}
-{"_id":"coma-urg-7b8935","context":null,"enonce":"Which of the following are nerves involved in the corneal reflex?","item":"coma","matiere":"urg","propositions":[{"correct":true,"justification":"True. Also called ophthalmic nerve. It is a mixed nerve involved in the afferent pathway of the corneal reflex.","idx":0,"proposition":"Trigeminal V nerve"},{"correct":false,"justification":"Motor nerve innervating the lateral right (abduction of the eye)","idx":1,"proposition":"Nerve VI abducens"},{"correct":false,"justification":"Motor nerve innervating medial right, inferior oblique, lower right, and superior right","idx":2,"proposition":"Oculomotor nerve III"},{"correct":true,"justification":"True. Mixed nerve involved in the efferent pathway of the corneal reflex","idx":3,"proposition":"Facial nerve VII"},{"correct":false,"justification":"Mixed nerve involved in many reflexes such as the reflex of the palé veil","idx":4,"proposition":"Vagus X nerve"}],"ts":1634486774,"type":"custom","difficulte":"2"}
-{"_id":"181-infectio-2c9e3e51-fc72-4cf6-b041-52a4eeb72c99","context":null,"enonce":"Which of the following are pro-inflammatory cytokines or proteins increased during inflammation?","item":"reactioninfl","matiere":"infectio","propositions":[{"correct":true,"justification":"True, I know it may seem like detail to you, but remember that these are targets of certain biotherapies in chronic inflammatory diseases, so the MCQ can fall...","idx":0,"proposition":"Interleukin 1 and Interleukin 6"},{"correct":true,"justification":"True, see A. even more frequent MCQ on TNF alpha","idx":1,"proposition":"TNF alpha"},{"correct":true,"justification":"True, remember in general that ALL proteins of inflammation are positive except 3: albumin, transthyretin, transferrin.","idx":2,"proposition":"Fraction C3 of the complement"},{"correct":true,"justification":"True, cf D.","idx":3,"proposition":"Fibrinogen"},{"correct":false,"justification":"False, cf D.","idx":4,"proposition":"Transferrin"}],"ts":1634486777,"type":"custom","difficulte":"1"}
-{"_id":"PECKc-urg-6a8c24","context":null,"enonce":"Which of the following are factors in the severity of pre-eclampsia?","item":"PECKc","matiere":"urg","propositions":[{"correct":false,"justification":"False. According to the new 2020 recommendations, it is > 90 μmol\/L. ","idx":0,"proposition":"Creatinine from > 135 μmol\/L"},{"correct":false,"justification":"False. > 2N","idx":1,"proposition":"ASAT \/ ALAT from > 3N"},{"correct":true,"justification":"True","idx":2,"proposition":"Epigastric pain in bar"},{"correct":true,"justification":"True","idx":3,"proposition":"Persistent tinnitus"},{"correct":true,"justification":"True","idx":4,"proposition":"Severe headache that does not respond to treatment"}],"ts":1634486779,"type":"custom","difficulte":"2"}
-{"_id":"PF-neuro-750418","context":null,"enonce":"Which of the following propositions are true about House Brackmann's classification?","item":"PF","matiere":"neuro","propositions":[{"correct":false,"justification":"This is grade 1","idx":0,"proposition":"Grade 0 = normal"},{"correct":true,"justification":"True","idx":1,"proposition":"Grade 2 = discrete deficit, visible during movement"},{"correct":true,"justification":"True","idx":2,"proposition":"Grade 3 = complete palpebral occlusion possible with effort"},{"correct":false,"justification":"complete palpebral occlusion impossible, very asymmetrical movements, severe syncinesis and hypertonia","idx":3,"proposition":"Grade 4 = symmetrical smile"},{"correct":false,"justification":"Grade 6","idx":4,"proposition":"Grade 5 = no movement "}],"ts":1634486781,"type":"custom","difficulte":"2"}
-{"_id":"masseabdo-HGE-23b915","context":null,"enonce":"Which of the following are parasites that can occur as liver nodules?","item":"masseabdo","matiere":"HGE","propositions":[{"correct":true,"justification":"True, hydatid cyst","idx":0,"proposition":"Hydatidosis"},{"correct":true,"justification":"True","idx":1,"proposition":"Amoebose"},{"correct":true,"justification":"True","idx":2,"proposition":"Alveolar echinococcosis"},{"correct":false,"justification":"","idx":3,"proposition":"Toxoplasmosis"},{"correct":false,"justification":"","idx":4,"proposition":"Malaria"}],"ts":1634486782,"type":"custom","difficulte":"1"}
-{"_id":"103-neuro-28d00284-c237-4f5c-a0f2-616a9e47d369","context":null,"enonce":"What are the risk factors for recurrence of a complex febrile seizure in children? ","item":"epilepsie","matiere":"neuro","propositions":[{"correct":true,"justification":"True. To retain these criteria more simply, it is enough to remember that children at risk are those with \"a small brain sensitive to heat\". ","idx":0,"proposition":"Age < 15 months"},{"correct":true,"justification":"True","idx":1,"proposition":"Short time between onset of fever and seizure"},{"correct":true,"justification":"True","idx":2,"proposition":"A family history of febrile seizures"},{"correct":true,"justification":"True. A low fever at the time of the febrile attack testifies to this sensitivity to heat","idx":3,"proposition":"Low fever at the time of the febrile attack (< 38.5°C)"},{"correct":false,"justification":"False. It's a trap. It is a low fever at the time of the seizure that is a recurrence FDR.","idx":4,"proposition":"High fever at the time of the febrile attack (> 40°C)"}],"ts":1634486784,"type":"custom","difficulte":"1"}
-{"_id":"MTEV-cardio-269f74","context":null,"enonce":"About high blood pressure in children\r\nWhich of the following are true?","item":"MTEV","matiere":"cardio","propositions":[{"correct":true,"justification":"True\r\nIn pediatrics we think a lot in percentile and standard deviation.","idx":0,"proposition":"In children, normal BP is below the 90th percentile."},{"correct":true,"justification":"True\r\nHyper important in practice. It gives you a first idea. In practice, still think about taking the size into account because if the child is tall for age, we can find a HTA with this formula which is not necessarily present if we are based on the size.","idx":1,"proposition":"To calculate the systolic blood pressure corresponding to the 95th percentile, one can use the formula: 100 + 2x Age (in years)"},{"correct":true,"justification":"True","idx":2,"proposition":"High blood pressure in children is defined as a BP measurement above the 95th percentile for the child's sex, age and height"},{"correct":false,"justification":"False.\r\nThe prevention of hypertension in children is estimated at 3.5%","idx":3,"proposition":"The prevalence of hypertension in children is estimated at 0.7%"},{"correct":false,"justification":"FAAUUUX\r\nUnlike the adult population, in pediatrics hypertension is always a priori secondary and must lead to the realization of an etiological assessment, which must be all the more exhaustive as the hypertension is of high level and the child is young.\r\n\r\nFor the record, we must not let a hypertension in children linger: last week at the CHU, HTA in a 5-year-old child, we did a Doppler ultrasound in search of stenosis of the renal arteries: highlighting a mass suggestive of neuroblastoma that compressed the renal artery ..","idx":4,"proposition":"As in adults, hypertension is a priori primary and it is necessary to leave a few months before making an etiological assessment."}],"ts":1634486785,"type":"custom","difficulte":"2"}
-{"_id":"polytrauma-urg-017357","context":null,"enonce":"Which of the following proposals concerning the hospital management of a polytrauma patient is (are) true?","item":"polytrauma","matiere":"urg","propositions":[{"correct":false,"justification":"False, the first 15 minutes are devoted to the continuation of the acts of resuscitation initiated in pre-hospital, the conditioning of the patient and the realization of the clinical examination. The bodyCT will only be performed in a 3rd step if the patient has been stabilized. ","idx":0,"proposition":"The first 15 minutes are dedicated to the realization of a bodyCT"},{"correct":false,"justification":"False, everything must be done to fight against hypothermia, which is a contributing factor to bleeding disorders, among other things. ","idx":1,"proposition":"The patient must be put in hypothermia to protect him from brain damage"},{"correct":false,"justification":"False, the nasal route is contraindicated in a patient who has suffered facial or head trauma because of the risk of false route, especially intracerebral in case of ethmoid fracture. ","idx":2,"proposition":"The possible placement of a gastric tube must be done nasally in the context of facial trauma"},{"correct":false,"justification":"False, against tetanus","idx":3,"proposition":"Diphtheria vaccination status should be checked"},{"correct":true,"justification":"True","idx":4,"proposition":"The 2nd phase of care is dedicated to the realization of the biological and radiological assessment"}],"ts":1634486788,"type":"custom","difficulte":"2"}
-{"_id":"295-onco-096e6173-76dd-45a0-acf6-5a938b331d4d","context":null,"enonce":"A 57-year-old patient comes to see you for a left epistaxis of low abundance \r\n\r\nATCD: Repeated MTEV \r\nTTT: Fluindione The patient also explains that he has lost weight and feels tired for 4 months. He also says he has the feeling of an obstruction of his left nasal cavity. \r\n\r\nWhat is the exact answer(s)? ","item":"KcVADS","matiere":"onco","propositions":[{"correct":false,"justification":" FALSE: In front of an epistaxis on bleeding disorder or angiomatosis: we use ABSORBABLE wicks","idx":0,"proposition":"It is necessary to carry out a previous stamping with greasy strands "},{"correct":true,"justification":"True","idx":1,"proposition":"Previous buffering with absorbable wicks must be performed"},{"correct":false,"justification":"FALSE. The INR is within its target (between 2-3 in this VTE situation). We are not dealing with serious bleeding. So no need to stop the VKA","idx":2,"proposition":"If the patient's INR is 2.6, VKAs should be stopped for 24 hours in this patient "},{"correct":true,"justification":"True","idx":3,"proposition":"You mention ethmoid cancer"},{"correct":true,"justification":"True. In front of unilateral epistaxis + progressive nasal obstruction + AEG => Suspicion cancer ETHMOID and CAVUM\r\n\r\nCAVUM cancer is also to be evoked in front of reflex otalgia or seromucosal otitis","idx":4,"proposition":"You mention cancer of the cavum"}],"ts":1634486789,"type":"custom","difficulte":"1"}
-{"_id":"176-sp-bd802839-50c6-4dd0-a484-62a56254efad","context":null,"enonce":"Which of these health security agencies\/health vigilance missions pairs is accurate?","item":"risquesRx","matiere":"sp","propositions":[{"correct":true,"justification":"True, the ANSM's mission is pharmacovigilance, drug dependence, hemovigilance, materiovigilance, reactovigilance, cosmetovigilance, vigilance of tattoo products","idx":0,"proposition":"National Agency for the Safety of Medicines (ANSM) and Drug Dependence"},{"correct":true,"justification":"True, the missions of ANSES are nutrivigilance (including NOCs), toxicovigilance (toxic effects of substances on the body) and veterinary pharmacovigilance","idx":1,"proposition":"National Agency for Food, Environmental and Occupational Health and Safety (ANSES) and Nutrivigilance"},{"correct":false,"justification":"False, the missions of the biomedicine agency focus on biovigilance (organs, tissues, cells), ART","idx":2,"proposition":"Agency for Biomedicine and Haemovigilance"},{"correct":true,"justification":"True, cf C.","idx":3,"proposition":"Agency for Biomedicine and Vigilance with regard to medically assisted procreation"},{"correct":false,"justification":"False, see B","idx":4,"proposition":"National Agency for Food, Environmental and Occupational Health and Safety (ANSES) and Réactovigilance "}],"ts":1634486791,"type":"custom","difficulte":"1"}
-{"_id":"TNC-neuro-9f2e9d","context":null,"enonce":"Which of the following are true?","item":"TNC","matiere":"neuro","propositions":[{"correct":false,"justification":"False, we distinguish precisely degenerative dementias from dementias with a vascular, inflammatory mechanism etc.","idx":0,"proposition":"Degenerative dementia may be due to vascular or inflammatory disease"},{"correct":true,"justification":"True, impaired autonomy is essential to talk about dementia","idx":1,"proposition":"Dementia is defined by impaired cognitive and\/or behavioural function associated with impaired autonomy"},{"correct":true,"justification":"True","idx":2,"proposition":"Alzheimer's disease is the leading cause of dementia"},{"correct":false,"justification":"","idx":3,"proposition":""},{"correct":false,"justification":"","idx":4,"proposition":""}],"ts":1634486793,"type":"custom","difficulte":"2"}
-{"_id":"MICI-HGE-0be4a5","context":null,"enonce":"Which of the following are possible pathological signs in UC?","item":"MICI","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Bifurcations and glandular distortions"},{"correct":true,"justification":"True","idx":1,"proposition":"granite mucosa"},{"correct":true,"justification":"True","idx":2,"proposition":"Lymphoplasmacytic infiltrât of chorion"},{"correct":true,"justification":"True","idx":3,"proposition":"Banal plasmocytosis"},{"correct":true,"justification":"True","idx":4,"proposition":"Cryptic abscess"}],"ts":1634486794,"type":"custom","difficulte":"1"}
-{"_id":"Kcped-onco-0f7f72","context":null,"enonce":"Which of the following are true about neuroblastoma?","item":"Kcped","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is a cancer affecting embryonic stem cells of the neural crest"},{"correct":true,"justification":"True","idx":1,"proposition":"It may be associated with Hirschsprung's disease"},{"correct":false,"justification":"Less than 2 years old. It is mainly found between 1 and 2 years","idx":2,"proposition":"It mainly concerns children under 6 months"},{"correct":true,"justification":"True","idx":3,"proposition":"It is the most common extracranial solid tumor in young children"},{"correct":false,"justification":"There are genetic forms (ALK or PHOX2B gene)","idx":4,"proposition":"It has no genetic component"}],"ts":1634486797,"type":"custom","difficulte":"2"}
-{"_id":"Kcprostate-onco-be97ed","context":null,"enonce":"Which of the following are d'Amico's treatment options for intermediate-risk prostate cancers?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":false,"justification":"Low risk or if probability of survival < 10 years","idx":0,"proposition":"Active surveillance if probability of survival > 10 years"},{"correct":true,"justification":"True. + Cleaning if probability of survival > 10 years","idx":1,"proposition":"Total prostatectomy"},{"correct":true,"justification":"True. Or in combination with hormone therapy for 6 months","idx":2,"proposition":"External beam radiation therapy alone"},{"correct":true,"justification":"True. In gormes of best prognosis (PSA 10-15, GG2 or Gleason 3+4)","idx":3,"proposition":"Brachytherapy"},{"correct":false,"justification":"False","idx":4,"proposition":"Hormone therapy alone"}],"ts":1634486799,"type":"custom","difficulte":"2"}
-{"_id":"nvxne-gyn-272db5","context":null,"enonce":"Which of the following propositions\/are true for biamniotic bichorial pregnancies?","item":"nvxne","matiere":"gyn","propositions":[{"correct":false,"justification":"They can be, but not necessarily","idx":0,"proposition":"The 2 twins are formally monozygotic"},{"correct":false,"justification":"False","idx":1,"proposition":"There is an antenatal risk of transfusion-transfusion syndrome (TTS)"},{"correct":false,"justification":"False, a twin pregnancy is a multiple pregnancy","idx":2,"proposition":"The term multiple pregnancy only applies when the uterus contains 3 or more fetuses."},{"correct":false,"justification":"They can be, but not necessarily","idx":3,"proposition":"The 2 twins are formally heterozygous"},{"correct":true,"justification":"True","idx":4,"proposition":"No proposition is true"}],"ts":1634486800,"type":"custom","difficulte":"1"}
-{"_id":"constipation-HGE-4c6e8d","context":null,"enonce":"Constipation is chronic if greater than:","item":"constipation","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"3 weeks"},{"correct":false,"justification":"","idx":1,"proposition":"6 weeks"},{"correct":false,"justification":"","idx":2,"proposition":"10 days"},{"correct":true,"justification":"True","idx":3,"proposition":"6 months"},{"correct":false,"justification":"","idx":4,"proposition":"1 year"}],"ts":1634486802,"type":"custom","difficulte":"1"}
-{"_id":"tbconscience-urg-6e4230","context":null,"enonce":"Which of the following are signs or symptoms of Korsakoff syndrome?","item":"tbconscience","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"False recognition"},{"correct":true,"justification":"True","idx":1,"proposition":"Fabrications"},{"correct":false,"justification":"False","idx":2,"proposition":"Retrograde amnesia"},{"correct":true,"justification":"True","idx":3,"proposition":"Anterograde amnesia"},{"correct":false,"justification":"It's a diagnosis, not a sign or symptom","idx":4,"proposition":"Amnesic ictus"}],"ts":1634486804,"type":"custom","difficulte":"2"}
-{"_id":"hernie-HGE-ef386c","context":null,"enonce":"Which of the following are risk factors for hernia?","item":"hernie","matiere":"HGE","propositions":[{"correct":false,"justification":"Multiparity","idx":0,"proposition":"Nulliparity"},{"correct":false,"justification":"Obesity or extreme thinness","idx":1,"proposition":"BMI < 25"},{"correct":true,"justification":"True, by abdominal hyperpressure","idx":2,"proposition":"Constipation"},{"correct":false,"justification":"","idx":3,"proposition":"Age 🤶🎅"},{"correct":true,"justification":"True","idx":4,"proposition":"Syndrome de Marfan"}],"ts":1634486806,"type":"custom","difficulte":"1"}
-{"_id":"TNC-neuro-1e2845","context":null,"enonce":"Regarding major neurocognitive disorders, what are the exact proposal(s)?\r\n","item":"TNC","matiere":"neuro","propositions":[{"correct":false,"justification":"A. Wrong, three times wrong! The MMS is a screening examination, the repetition of the latter allows to have an intuition on the evolution of the pathology, certainly, but it is much more advanced neuropsychological tests that allow the diagnosis in addition to the interrogation and the elimination of differential diagnoses\r\n","idx":0,"proposition":"Has. The repetition of MMS (Mini Mental State) makes it possible to make the diagnosis of a major neurocognitive disorder\r\n"},{"correct":true,"justification":"B. True, it makes it possible to rule out an expansive pathology (hematoma, infection, tumor) and to characterize brain damage (hippocampal damage for Alzheimer's and its relatives etc ...)\r\n","idx":1,"proposition":"B. MRI (or failing that, cCT) has an essential place in the evaluation of major neurocognitive disorders\r\n"},{"correct":true,"justification":"C. True, other causes are much rarer\r\n","idx":2,"proposition":"C. Alzheimer's disease and vascular encephalopathies account for the majority of causes of major neurocognitive disorders\r\n"},{"correct":false,"justification":"D. False, it is quite brief (NFS, CRP, TSH, Ionogram, Glycemia, Albuminemia) and the rest is performed on call point\r\n","idx":3,"proposition":"D. First-line laboratory work-up is comprehensive to eliminate all possible differential diagnoses\r\n"},{"correct":true,"justification":"E. True, HDJ memories are becoming more and more present, and allow active management of major neurocognitive disorders","idx":4,"proposition":"E. For the management of major neurocognitive disorders, there are day hospital treatments to perform cognitive remediation\r\n"}],"ts":1634486808,"type":"custom","difficulte":"1"}
-{"_id":"hemorroides-HGE-3a4bd7","context":null,"enonce":"Which of the following are true?","item":"hemorroides","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"These are arterial lakes"},{"correct":true,"justification":"True","idx":1,"proposition":"These are venous lakes"},{"correct":true,"justification":"True","idx":2,"proposition":"They are physiological"},{"correct":false,"justification":"Pain","idx":3,"proposition":"The main symptom is prolapse"},{"correct":false,"justification":"4 grades: no procidence \/ procidence in the lumen of the anuscope \/ reducible \/ irreducible external procidence","idx":4,"proposition":"The classification consists of 6 grades"}],"ts":1634486810,"type":"custom","difficulte":"1"}
-{"_id":"Kcprostate-onco-975d37","context":null,"enonce":"The digital rectal examination finds:","item":"Kcprostate","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It may be normal"},{"correct":true,"justification":"True","idx":1,"proposition":"A hard nodule"},{"correct":false,"justification":"Irregular nodule","idx":2,"proposition":"A regular nodule"},{"correct":true,"justification":"True","idx":3,"proposition":"An evolutionary nodule"},{"correct":false,"justification":"The nodule is non-painful according to the College of Urology (4th edition)","idx":4,"proposition":"A painful nodule"}],"ts":1634486811,"type":"custom","difficulte":"2"}
-{"_id":"pancreatitechr-HGE-450e81","context":null,"enonce":"Which of the following propositions are true about biological examinations?","item":"pancreatitechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Normal apart from flare-ups or complications"},{"correct":true,"justification":"True","idx":1,"proposition":"High γGT and MCV support an alcoholic cause"},{"correct":false,"justification":"Clinical diagnosis","idx":2,"proposition":"Steatorrhea is based on stool culture"},{"correct":true,"justification":"True","idx":3,"proposition":"Signs of inflammation are found during flare-ups"},{"correct":true,"justification":"True","idx":4,"proposition":"Lipasemia is elevated in acute pancreatitis"}],"ts":1634486813,"type":"custom","difficulte":"1"}
-{"_id":"securisation-sp-66835c","context":null,"enonce":"Which of the following propositions are true about MMR?","item":"securisation","matiere":"sp","propositions":[{"correct":true,"justification":"True, text the phrase of the HAS","idx":0,"proposition":"A morbidity and mortality review (MMR) is a collective, retrospective and systemic analysis of cases marked by the occurrence of a death, a complication, or an event that could have caused harm to the patient."},{"correct":true,"justification":"True, text the phrase of the HAS","idx":1,"proposition":"Its objective is to implement and monitor actions to improve patient care and care safety."},{"correct":true,"justification":"True","idx":2,"proposition":"The systemic analysis, conducted during the MMR, is a global analysis of the situation"},{"correct":false,"justification":"The medical-nursing team that brings together professionals, who usually work together, and who contribute to the management of a patient.","idx":3,"proposition":"Only doctors can do it"},{"correct":false,"justification":"","idx":4,"proposition":"All propositions are true"}],"ts":1634486815,"type":"custom","difficulte":"1"}
-{"_id":"343-urg-60b6cc26-c714-4101-9338-a62acfd6e97f","context":null,"enonce":"Which of the following propositions are true about the urinary ionogram?","item":"IRenA","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A plasma urea\/plasma creatinine ratio of less than 50 supports organic AKI"},{"correct":true,"justification":"True","idx":1,"proposition":"A urinary Na\/K ratio greater than 1 is in favor of an organic ARI"},{"correct":false,"justification":"Organic","idx":2,"proposition":"A urinary Na\/K ratio greater than 1 supports a functional ARI"},{"correct":false,"justification":"This is the EF threshold for urea. The threshold for sodium is 1%","idx":3,"proposition":"A sodium excretion fraction of less than 35% would be in favor of a functional origin"},{"correct":true,"justification":"True","idx":4,"proposition":"Natriuresis can only be interpreted if diuretics have not been put in place"}],"ts":1634486817,"type":"custom","difficulte":"1"}
-{"_id":"hemorroides-HGE-44aa8e","context":null,"enonce":"Which of the following are true?","item":"hemorroides","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"About 1 third of adults are affected by hemorrhoids"},{"correct":true,"justification":"True","idx":1,"proposition":"They can be complicated by fissure"},{"correct":true,"justification":"True","idx":2,"proposition":"They can be complicated by fistula"},{"correct":true,"justification":"True","idx":3,"proposition":"Hemorrhoids are not neoplastic"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"ts":1634486819,"type":"custom","difficulte":"1"}
-{"_id":"Kcprostate-onco-ded45d","context":null,"enonce":"Which of the following are true?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"In prostate cancer, the fraction of free PSA is lower than in benign prostatic hyperplasia"},{"correct":true,"justification":"True","idx":1,"proposition":"The actual contribution in clinical practice of urine tests has not been demonstrated"},{"correct":true,"justification":"True, at 1 month most often","idx":2,"proposition":"A high PSA must be almost systematically reassessed"},{"correct":false,"justification":"Urinary condition","idx":3,"proposition":"The USP questionnaire focuses on sexuality"},{"correct":false,"justification":"Sexual state","idx":4,"proposition":"The IIEF questionnaire focuses on urinary symptoms"}],"ts":1634486820,"type":"custom","difficulte":"2"}
-{"_id":"MICI-HGE-0d4a45","context":null,"enonce":"Which of these proposals designate a serious access to RCH?","item":"MICI","matiere":"HGE","propositions":[{"correct":true,"justification":"True, severe acute colitis (Truelove-Witts criteria) can be complicated by: colectasia (dilation) and perforation","idx":0,"proposition":"The Truelove-Witts criteria (💞) define the severe RCH crisis"},{"correct":false,"justification":"Severity criterion = >37.5","idx":1,"proposition":"A temperature of 37.3"},{"correct":true,"justification":"True","idx":2,"proposition":"Important rectorrhages"},{"correct":true,"justification":"True","idx":3,"proposition":"Tachycardia"},{"correct":false,"justification":"Severity criterion below 10g\/L","idx":4,"proposition":"Anemia at 11g\/L"}],"ts":1634486825,"type":"custom","difficulte":"1"}
-{"_id":"Kcprostate-onco-e60651","context":null,"enonce":"The ASP is:","item":"Kcprostate","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A glycoprotein"},{"correct":false,"justification":"False","idx":1,"proposition":"A glycosylated lipid"},{"correct":false,"justification":"False","idx":2,"proposition":"A membrane protein"},{"correct":false,"justification":"False","idx":3,"proposition":"A complex carbohydrate"},{"correct":false,"justification":"False","idx":4,"proposition":"A type of extracellular DNA"}],"ts":1634486832,"type":"custom","difficulte":"1"}
-{"_id":"tbconscience-urg-4c5a75","context":null,"enonce":"Which of the following proposals are necessary to diagnose confusion?","item":"tbconscience","matiere":"urg","propositions":[{"correct":true,"justification":"True. Indeed, confusion is a clinical diagnosis.","idx":0,"proposition":"None of these proposals"},{"correct":false,"justification":"False","idx":1,"proposition":"Capillary blood glucose"},{"correct":false,"justification":"False","idx":2,"proposition":"Ionogram"},{"correct":false,"justification":"False","idx":3,"proposition":"Renal assessment"},{"correct":false,"justification":"False","idx":4,"proposition":"ECG"}],"ts":1634486834,"type":"custom","difficulte":"2"}
-{"_id":"matraitanceped-sp-78fcfd","context":null,"enonce":"Which of the following are true about shaken baby syndrome?","item":"matraitanceped","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It most often occurs before 1 year"},{"correct":false,"justification":"Subdural hematomas of different age","idx":1,"proposition":"There are mainly extradural hematomas"},{"correct":true,"justification":"True","idx":2,"proposition":"The CT scan is the exam of choice for the diagnosis of lesions"},{"correct":true,"justification":"True","idx":3,"proposition":"The absence of bleeding disorders should always be checked"},{"correct":false,"justification":"They can also be cephalic, thoracic, ...","idx":4,"proposition":"The lesions are only cerebral"}],"ts":1634486836,"type":"custom","difficulte":"2"}
-{"_id":"systemeconv-sp-1de8bc","context":null,"enonce":"The flat-rate remuneration of physicians is paid by:","item":"systemeconv","matiere":"sp","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Mutuals"},{"correct":false,"justification":"False","idx":1,"proposition":"private insurance"},{"correct":false,"justification":"False","idx":2,"proposition":"The State"},{"correct":true,"justification":"True","idx":3,"proposition":"Social security"},{"correct":false,"justification":"False","idx":4,"proposition":"The patient"}],"ts":1634486838,"type":"custom","difficulte":"1"}
-{"_id":"HTA-cardio-36d0da","context":null,"enonce":"Regarding resistant hypertension, which of the following propositions are true?","item":"HTA","matiere":"cardio","propositions":[{"correct":false,"justification":"Resistant hypertension = persistent on oral antihypertensive therapy (including at least one diuretic) + HRD well followed","idx":0,"proposition":"It is defined by the persistence of hypertension despite well-followed hygiene-dietary rules."},{"correct":true,"justification":"True","idx":1,"proposition":"It may be due to unknown secondary hypertension."},{"correct":true,"justification":"True","idx":2,"proposition":"The patient's adherence to treatment can be assessed by the Girerd questionnaire."},{"correct":true,"justification":"True: HRD not followed","idx":3,"proposition":"It may be due to excessive consumption of dietary salt."},{"correct":true,"justification":"True","idx":4,"proposition":"A cardiological opinion should be systematically requested in front of a resistant hypertension."}],"ts":1634486840,"type":"custom","difficulte":"1"}
-{"_id":"cirrhose-HGE-d8277e","context":null,"enonce":"Which of the following are possible etiologies of cirrhosis?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":false,"justification":"Possible complication","idx":0,"proposition":"Hepatocellular carcinoma"},{"correct":false,"justification":"Possible complication","idx":1,"proposition":"Umbilical hernia"},{"correct":false,"justification":"Possible complication","idx":2,"proposition":"Ascites"},{"correct":true,"justification":"True","idx":3,"proposition":"Alpha-1-antitrypsin deficiency"},{"correct":true,"justification":"True","idx":4,"proposition":"Primary biliary cirrhosis"}],"ts":1634486843,"type":"custom","difficulte":"1"}
-{"_id":"tbconscience-urg-b3a992","context":null,"enonce":"Which of the following are symptoms or signs of Gayet-Wernicke encephalopathy?","item":"tbconscience","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Delirium"},{"correct":true,"justification":"True","idx":1,"proposition":"Oculomotor paralysis"},{"correct":false,"justification":"Syndrome de Korsakoff","idx":2,"proposition":"Fabrications"},{"correct":false,"justification":"Syndrome de Korsakoff","idx":3,"proposition":"Anterograde amnesia"},{"correct":false,"justification":"False","idx":4,"proposition":"Tremors of the extremities"}],"ts":1634486845,"type":"custom","difficulte":"2"}
-{"_id":"ADP-hemato-30170e","context":null,"enonce":"An X neuroma could mimic lymphadenopathy:","item":"ADP","matiere":"hemato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"From the laterocervical chain"},{"correct":false,"justification":"Two differential diagnoses (DD): brachial plexus schwanoma or lung apex cancer","idx":1,"proposition":"From the supraclavicular chain"},{"correct":false,"justification":"DD of lymphadenopathy concerning this chain: ectopic thyroid, cyst of the thyroglossal tract or laryngocele","idx":2,"proposition":"From the pre-laryngeal chain"},{"correct":false,"justification":"2 schwannomas: that of the XI and that of the superficial cervical plexus","idx":3,"proposition":"From the spinal chain"},{"correct":false,"justification":"FALSE","idx":4,"proposition":"None of these channels"}],"ts":1634486847,"type":"custom","difficulte":"2"}
-{"_id":"hemorroides-HGE-4deb8d","context":null,"enonce":"Which of the following are RHD treatments for hemorrhoidal disease?","item":"hemorroides","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Mucilage"},{"correct":true,"justification":"True","idx":1,"proposition":"Fibers"},{"correct":false,"justification":"Useless","idx":2,"proposition":"Gluten-free diet"},{"correct":false,"justification":"Useless","idx":3,"proposition":"Residue-free diet"},{"correct":false,"justification":"The opposite","idx":4,"proposition":"Fiber-free diet"}],"ts":1634486848,"type":"custom","difficulte":"1"}
-{"_id":"coma-urg-2d0ffe","context":null,"enonce":"Which of the following are etiologies of non-traumatic coma?","item":"coma","matiere":"urg","propositions":[{"correct":false,"justification":"Traumatic cause","idx":0,"proposition":"Subdural hematoma"},{"correct":false,"justification":"Traumatic cause","idx":1,"proposition":"Lefort III untreated"},{"correct":true,"justification":"True","idx":2,"proposition":"Acute adrenal insufficiency"},{"correct":true,"justification":"True, <120 mmol\/L","idx":3,"proposition":"Hyponatremia"},{"correct":true,"justification":"True","idx":4,"proposition":"Carbon monoxide (CO) poisoning"}],"ts":1634486853,"type":"custom","difficulte":"2"}
-{"_id":"PF-neuro-85fd2e","context":null,"enonce":"Which of the following are signs and symptoms of distal (intraparotid) facial nerve involvement?","item":"PF","matiere":"neuro","propositions":[{"correct":false,"justification":"Normal","idx":0,"proposition":"Pathological Schirmer test"},{"correct":false,"justification":"Normal","idx":1,"proposition":"Lowered stapedial reflex"},{"correct":false,"justification":"No hearing impairment because we are downstream","idx":2,"proposition":"Hearing loss"},{"correct":false,"justification":"Normal taste","idx":3,"proposition":"Impairment of taste"},{"correct":true,"justification":"True","idx":4,"proposition":"No proposition is true"}],"ts":1634486855,"type":"custom","difficulte":"2"}
-{"_id":"diarrheechr-HGE-f269c3","context":null,"enonce":"From what time frame do we speak of prolonged diarrhea?","item":"diarrheechr","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"5 days"},{"correct":false,"justification":"","idx":1,"proposition":"10 days"},{"correct":true,"justification":"True","idx":2,"proposition":"2 weeks"},{"correct":false,"justification":"","idx":3,"proposition":"4 weeks"},{"correct":false,"justification":"","idx":4,"proposition":"6 weeks"}],"ts":1634486856,"type":"custom","difficulte":"1"}
-{"_id":"FA-cardio-7b83eb","context":null,"enonce":"Which of the following are the side effects of amiodarone?","item":"FA","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Dysthyroidism"},{"correct":true,"justification":"True","idx":1,"proposition":"Photosensitization"},{"correct":true,"justification":"True","idx":2,"proposition":"Interstitial lung disease"},{"correct":true,"justification":"True","idx":3,"proposition":"Hepatitis"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"ts":1634486859,"type":"custom","difficulte":"2"}
-{"_id":"diarrheechr-HGE-94d219","context":null,"enonce":"Which of the following are extra-digestive signs of celiac disease?","item":"diarrheechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Arthralgia"},{"correct":true,"justification":"True","idx":1,"proposition":"Oral aphthosis"},{"correct":true,"justification":"True","idx":2,"proposition":"Hepatic cytolysis"},{"correct":false,"justification":"No achievement of the ❤","idx":3,"proposition":"Tachycardia"},{"correct":false,"justification":"No achievement of 🌬","idx":4,"proposition":"Dyspnea stage 2-3 NYHA"}],"ts":1634486861,"type":"custom","difficulte":"1"}
-{"_id":"pbsuitescouches-gyn-342de6","context":null,"enonce":"Which of the following proposals are part of the immediate management of postpartum haemorrhage?","item":"pbsuitescouches","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Uterine revision"},{"correct":true,"justification":"True","idx":1,"proposition":"Urinary catheterization"},{"correct":true,"justification":"True","idx":2,"proposition":"Uterine massage"},{"correct":true,"justification":"True","idx":3,"proposition":"Antibiotic prophylaxis"},{"correct":true,"justification":"True","idx":4,"proposition":"IV oxytocin"}],"ts":1634486862,"type":"custom","difficulte":"2"}
-{"_id":"Kcprostate-onco-a85bbb","context":null,"enonce":"Which of the following proposals can increase the PSA?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Benign prostatic hyperplasia"},{"correct":true,"justification":"True","idx":1,"proposition":"Transient inflammation"},{"correct":true,"justification":"True","idx":2,"proposition":"Acute urine retention"},{"correct":true,"justification":"True","idx":3,"proposition":"Digital rectal examination"},{"correct":true,"justification":"True","idx":4,"proposition":"Urinary catheterization"}],"ts":1634486864,"type":"custom","difficulte":"2"}
-{"_id":"ictere-HGE-2a1201","context":null,"enonce":"What time corresponds to the excretory time on the injected scanner?","item":"ictere","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"10 mn"},{"correct":false,"justification":"Late time","idx":1,"proposition":"3 min"},{"correct":false,"justification":"Venous time","idx":2,"proposition":"70 seconds"},{"correct":false,"justification":"Arterial weather","idx":3,"proposition":"Thirty seconds"},{"correct":false,"justification":"SPC Time","idx":4,"proposition":"T0"}],"ts":1634486866,"type":"custom","difficulte":"1"}
-{"_id":"RCIU-gyn-931c3f","context":null,"enonce":"Which of the following proposals are part of probabilistic antibiotic therapy for ulcerative-necrotizing enterocolitis?","item":"RCIU","matiere":"gyn","propositions":[{"correct":true,"justification":"True, cefotaxime","idx":0,"proposition":"C3G"},{"correct":true,"justification":"True, gentamicin","idx":1,"proposition":"Aminoglycoside"},{"correct":true,"justification":"True, metronidazole covers anaerobes","idx":2,"proposition":"Imidazole"},{"correct":false,"justification":"","idx":3,"proposition":"Penicillin"},{"correct":false,"justification":"","idx":4,"proposition":"Tetracycline"}],"ts":1634486868,"type":"custom","difficulte":"2"}
-{"_id":"360-urg-224ce986-3317-4137-bd3f-2916f26df632","context":null,"enonce":"Concerning the fractures of the child, which of the following propositions, which are true?","item":"Frped","matiere":"urg","propositions":[{"correct":false,"justification":"Ultrasound is rare in emergencies. It can be useful for soft tissue lesions","idx":0,"proposition":"Ultrasound is systematic in emergency"},{"correct":true,"justification":"Orthopedic treatment++ in young children <6A, for any diaphyseal \/ metaphyseal FR (PAS for joint fractures: risk of stiffness)","idx":1,"proposition":"For a metaphyseal fracture in a 5-year-old child, first-line treatment is orthopedic, with or without reduction"},{"correct":false,"justification":"No risk of stiffness for non-articular fractures (see College of Pediatrics)","idx":2,"proposition":"For a diaphyseal fracture, prolonged orthopedic treatment induces a risk of stiffness"},{"correct":false,"justification":"In the opposite position of that which caused the fracture (for example, if wrist fracture in hyperextension: immobilization in flexion)","idx":3,"proposition":"Concerning orthopedic treatment: the limb must be immobilized in a neutral position"},{"correct":false,"justification":"Thromboembolic complications are exceptional in children. Anticoagulant therapy will be discussed only in adolescents","idx":4,"proposition":"Anticoagulant therapy is indicated in children in case of cast for more than 21 days"}],"ts":1634486869,"type":"custom","difficulte":"1"}
-{"_id":"98-neuro-3c7174c1-4cbf-4ca0-a4cb-4ea354096802","context":null,"enonce":"Which of the following are causes of idiopathic ICT?","item":"cephalee","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Corticosteroids"},{"correct":true,"justification":"True","idx":1,"proposition":"Obesity"},{"correct":false,"justification":"No, abnormal imaging therefore not idiopathic ","idx":2,"proposition":"Vascular malformation"},{"correct":true,"justification":"True","idx":3,"proposition":"Hypervitaminosis A"},{"correct":false,"justification":"No","idx":4,"proposition":"Hypervitaminosis D"}],"ts":1634486871,"type":"custom","difficulte":"1"}
-{"_id":"vomisst-HGE-b9abb3","context":null,"enonce":"Which of the following are true about Boerhaave syndrome?","item":"vomisst","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"This is a rupture of the cardia"},{"correct":false,"justification":"","idx":1,"proposition":"The tear of the stomach is longitudinal"},{"correct":false,"justification":"","idx":2,"proposition":"Hematemesis is very common"},{"correct":false,"justification":"","idx":3,"proposition":"Hematemesis occurs after vomiting"},{"correct":true,"justification":"True. They all concern Mallory Weiss syndrome","idx":4,"proposition":"None of the propositions are true"}],"ts":1634486873,"type":"custom","difficulte":"1"}
-{"_id":"341-urg-80a2f9f5-bcdc-49d3-97ed-d4835e600608","context":null,"enonce":"Which of the following are the risk factors for prolonged febrile seizures >15 minutes?","item":"convulsionsped","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"1st febrile crisis of his life"},{"correct":true,"justification":"True","idx":1,"proposition":"Personal history of Febrile Crisis > 10min"},{"correct":false,"justification":"","idx":2,"proposition":"Fever >38.5°C during the febrile crisis"},{"correct":false,"justification":"","idx":3,"proposition":"Fever <38.5°C during the febrile crisis"},{"correct":false,"justification":"","idx":4,"proposition":"Age <1 year"}],"ts":1634486874,"type":"custom","difficulte":"1"}
-{"_id":"matraitanceped-sp-fb959e","context":null,"enonce":"Which of the following proposals are included in the para-clinical assessment in case of suspected shaken baby syndrome?","item":"matraitanceped","matiere":"sp","propositions":[{"correct":true,"justification":"True, TP TCA Fibrinogen at least","idx":0,"proposition":"Coagulation balance"},{"correct":true,"justification":"True, differential diagnosis of bone lesions","idx":1,"proposition":"Calcemia"},{"correct":true,"justification":"True, looking for papillary edema and hemorrhages","idx":2,"proposition":"Fundus "},{"correct":false,"justification":"Skeletal X-rays","idx":3,"proposition":"Whole body scanner"},{"correct":false,"justification":"Brain scan","idx":4,"proposition":"Brain MRI"}],"ts":1634486876,"type":"custom","difficulte":"2"}
-{"_id":"dlrbuccale-neuro-884961","context":null,"enonce":"Which of the following are true about migraines?","item":"dlrbuccale","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Their prevalence is 15%"},{"correct":false,"justification":"The opposite: more without aura than with aura","idx":1,"proposition":"There are more migraines with aura than migraines without aura"},{"correct":true,"justification":"True","idx":2,"proposition":"Headaches are often pulsatile"},{"correct":false,"justification":"No MRI for diagnosis","idx":3,"proposition":"The diagnosis is made by MRI"},{"correct":true,"justification":"True","idx":4,"proposition":"Migraine is three times more common in women than in men"}],"ts":1634486879,"type":"custom","difficulte":"2"}
-{"_id":"MSN-urg-57cbf5","context":null,"enonce":"What are the mandatory clinical signs to be able to talk about the severe discomfort of the infant?","item":"MSN","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A change in tone (hypertonia or hypotonia)"},{"correct":false,"justification":"Is not a mandatory clinical sign. It may nevertheless be present during severe discomfort.","idx":1,"proposition":"Signs of respiratory struggle"},{"correct":true,"justification":"True. The 2 obligatory clinical signs are a change in tone and a change in the coloration of the integuments. In the absence of one of these 2 clinical signs, we can not speak of the severe discomfort of the infant.","idx":2,"proposition":"A change in the coloration of the integuments (pallor, cyanosis, sometimes erythrosis)"},{"correct":false,"justification":"Not mandatory.","idx":3,"proposition":"Loss of consciousness"},{"correct":false,"justification":"Not part of the criteria for severe infant discomfort.","idx":4,"proposition":"Tachycardia"}],"ts":1634486882,"type":"custom","difficulte":"2"}
-{"_id":"dysphonie-neuro-54c69f","context":null,"enonce":"Which of the following proposals are part of the supraglottic stage?","item":"dysphonie","matiere":"neuro","propositions":[{"correct":true,"justification":"True, as the name suggests","idx":0,"proposition":"Epiglottis"},{"correct":true,"justification":"True","idx":1,"proposition":"Arthenoids"},{"correct":false,"justification":"Glottic stage","idx":2,"proposition":"Vocal cords"},{"correct":false,"justification":"Subglottic stage","idx":3,"proposition":"Cricoid cartilage"},{"correct":false,"justification":"Laryngeal = airway","idx":4,"proposition":"Oesophagus"}],"ts":1634554044,"type":"custom","difficulte":"2"}
-{"_id":"lithiaseB-HGE-cf9d12","context":null,"enonce":"In cholitis, ERCP (endoscopic retrograde cholangiography) should be done:","item":"lithiaseB","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"In emergency"},{"correct":false,"justification":"","idx":1,"proposition":"Within the week"},{"correct":false,"justification":"","idx":2,"proposition":"Within a month"},{"correct":false,"justification":"","idx":3,"proposition":"As soon as the pain subsides"},{"correct":false,"justification":"","idx":4,"proposition":"ERCP is not done for cholitis"}],"ts":1634554047,"type":"custom","difficulte":"1"}
-{"_id":"Kcprostate-onco-a81a5f","context":null,"enonce":"What is Amico's classification of prostate cancer with a PSA of 15 ng\/mL, a Gleason of 3+3 and a normal TR?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":false,"justification":"Intermediary before the PSA","idx":0,"proposition":"Weak"},{"correct":true,"justification":"True. Low: T1C or T2a AND PSA <= 10 AND Gleason <= 6.  Intermediate: T2b OR 10 > PSA < 20 OR Gleason 7. High: T2c and sup OR PSA >= 20 OR Gleason >= 8","idx":1,"proposition":"Intermediary "},{"correct":false,"justification":"Intermediary before the PSA","idx":2,"proposition":"High"},{"correct":false,"justification":"Intermediary before the PSA","idx":3,"proposition":"Not enough item"},{"correct":false,"justification":"Intermediary before the PSA","idx":4,"proposition":"The elements are contradictory"}],"ts":1634554050,"type":"custom","difficulte":"2"}
-{"_id":"valeurspro-sp-306e7b","context":null,"enonce":"When was the Order of Physicians created in France?","item":"valeurspro","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"1945"},{"correct":false,"justification":"Code of Ethics Revision Date (112 articles)","idx":1,"proposition":"2002"},{"correct":false,"justification":"Date of creation of the Medical Association in Great Britain","idx":2,"proposition":"1858"},{"correct":false,"justification":"In the US","idx":3,"proposition":"1868"},{"correct":false,"justification":"False","idx":4,"proposition":"None of these propositions are true"}],"ts":1634554055,"type":"custom","difficulte":"1"}
-{"_id":"tbsommeil-neuro-f38e91","context":null,"enonce":"Mrs. Clauss, panicked, brings you her 14-year-old son, Santa, who \"can't stay awake during the day.\" She worries because his academic performance is declining and she is afraid he may suffer from sleeping sickness. By argument of frequency and in front of this case what are the 2 pathologies that you will suspect first?","item":"tbsommeil","matiere":"neuro","propositions":[{"correct":false,"justification":"False, a rare disease in France.","idx":0,"proposition":"Narcolepsy or Gelineau disease"},{"correct":false,"justification":"False, even if it can stick in this patient, we find more this pathology in older women.","idx":1,"proposition":"Sleep-onset insomnia"},{"correct":true,"justification":"True, you should always think about eliminating cannabis poisoning.","idx":2,"proposition":"Substance abuse"},{"correct":true,"justification":"True, caricature in the teenager who goes to bed late and gets up early. Highlighted by a sleep diary and treated by hygienic measures and melatonin.","idx":3,"proposition":"Delayed phase syndrome"},{"correct":false,"justification":"False, night owlism does not cause daytime sleepiness","idx":4,"proposition":"Nocturnal parasomnias"}],"ts":1634554065,"type":"custom","difficulte":"1"}
-{"_id":"353-HGE-d936e09a-8167-4757-9f24-20f849e330df","context":null,"enonce":"43-year-old patient, with a history of chronic alcoholism, presents to the emergency room for sudden onset epigastric pain \r\n\r\nWhat will be the exams to be carried out in a first 1 time?   ","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":true,"justification":"True. Lower myocardial infarction is a differential diagnosis to evoke in this situation ","idx":0,"proposition":"ECG"},{"correct":false,"justification":"False. Not right away. It can be done in a 2nd time if we find a cardiac ischemic cause to evaluate hemodynamics","idx":1,"proposition":"ETT"},{"correct":true,"justification":"True. The positive diagnosis of acute pancreatitis is based on the combination of PAIN + LIPASE > 3N. In addition, an associated significant cytolysis is in favor of a biliary origin of this pancreatitis","idx":2,"proposition":"Determination of lipase"},{"correct":false,"justification":"False. It has not been recommended for more than 5 years","idx":3,"proposition":"Determination of amylase"},{"correct":false,"justification":"False. Not right away. In case of confirmed acute pancreatitis, the AP CT scan should be performed at 48h-72h. On the other hand, abdominal ultrasound will be done as soon as the diagnosis is confirmed in order to eliminate a lithiatic cause","idx":4,"proposition":"Abdominal-pelvic CT"}],"ts":1634554069,"type":"custom","difficulte":"1"}
-{"_id":"cirrhose-HGE-5e8541","context":null,"enonce":"Which of the following are signs of hepatocellular insufficiency?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Hepatic encephalopathy"},{"correct":true,"justification":"True","idx":1,"proposition":"Asterixis"},{"correct":true,"justification":"True","idx":2,"proposition":"Jaundice"},{"correct":false,"justification":"Portal hypertension","idx":3,"proposition":"Splenomegaly"},{"correct":false,"justification":"","idx":4,"proposition":"All propositions are true"}],"ts":1634554071,"type":"custom","difficulte":"1"}
-{"_id":"341-urg-3e1c8016-548c-48dd-9c1c-77ea29c286ae","context":null,"enonce":"Which of the following are criteria for lumbar puncture during a febrile seizure in children?","item":"convulsionsped","matiere":"urg","propositions":[{"correct":false,"justification":"<6months","idx":0,"proposition":">6months"},{"correct":false,"justification":"<6months","idx":1,"proposition":"1-5years"},{"correct":true,"justification":"True","idx":2,"proposition":"Post-critical deficit"},{"correct":false,"justification":">15min","idx":3,"proposition":"<15min"},{"correct":true,"justification":"True","idx":4,"proposition":"Meningeal syndrome"}],"ts":1634554073,"type":"custom","difficulte":"1"}
-{"_id":"malaise-urg-8224cd","context":null,"enonce":"Which of the following are true?","item":"malaise","matiere":"urg","propositions":[{"correct":false,"justification":"Much less: 2%","idx":0,"proposition":"Malaise and loss of consciousness account for about 60% of emergency room admissions"},{"correct":true,"justification":"True","idx":1,"proposition":"10 to 20% of syncopes are the expression of a life-threatening pathology in the short or medium term"},{"correct":true,"justification":"True","idx":2,"proposition":"The etiological diagnosis of malaise is primarily clinical"},{"correct":true,"justification":"True","idx":3,"proposition":"Capillary blood glucose and electrocardiogram are systematic"},{"correct":false,"justification":"Over 75","idx":4,"proposition":"The search for orthostatic hypotension is systematic in patients over 35 years of age"}],"ts":1634554075,"type":"custom","difficulte":"2"}
-{"_id":"Kcprostate-onco-33c194","context":null,"enonce":"What is the Amico classification of prostate cancer with a PSA of 8 ng\/mL, a Gleason of 3+3 and a normal TR?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":true,"justification":"True. Low: T1C or T2a AND PSA <= 10 AND Gleason <= 6.  Intermediate: T2b OR 10 > PSA < 20 OR Gleason 7. High: T2c and sup OR PSA >= 20 OR Gleason >= 8\r\n","idx":0,"proposition":"Weak"},{"correct":false,"justification":"Weak","idx":1,"proposition":"Intermediary"},{"correct":false,"justification":"Weak","idx":2,"proposition":"High"},{"correct":false,"justification":"Weak","idx":3,"proposition":"Not enough item"},{"correct":false,"justification":"Weak","idx":4,"proposition":"The elements are contradictory"}],"ts":1634554077,"type":"custom","difficulte":"2"}
-{"_id":"ETP-therapeutique-7364fb","context":null,"enonce":"Which of the following are true? 💊","item":"ETP","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"During treatment during pregnancy, the newborn may show signs of overdose at birth"},{"correct":true,"justification":"True","idx":1,"proposition":"During treatment during pregnancy, the newborn may show signs of withdrawal at birth"},{"correct":true,"justification":"True","idx":2,"proposition":"The pharmacist may substitute an originator by a generic of himself, unless otherwise stated"},{"correct":false,"justification":"Its MA does not require new studies if the molecule is exactly the same.","idx":3,"proposition":"A generic drug is subject to phase III studies before its marketing authorization"},{"correct":true,"justification":"True","idx":4,"proposition":"Adherence is one of the important parameters that determines the effectiveness of the treatments put in place"}],"ts":1634554079,"type":"custom","difficulte":"2"}
-{"_id":"TTTnonmedic-therapeutique-7e8fac","context":null,"enonce":"Which of the following are true?","item":"TTTnonmedic","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Orthopedic insoles are on medical prescription"},{"correct":false,"justification":"False: they are often very analgesic","idx":1,"proposition":"Orthopedic insoles do not have an analgesic effect"},{"correct":true,"justification":"True","idx":2,"proposition":"Standard prostheses are << small appliances>>"},{"correct":false,"justification":"Not in push","idx":3,"proposition":"Rheumatoid arthritis in flare-up is an indication for spa ♨ treatment "},{"correct":true,"justification":"True","idx":4,"proposition":"Upper limb prostheses often have a mainly aesthetic role"}],"ts":1634554081,"type":"custom","difficulte":"2"}
-{"_id":"ictere-HGE-d6cb68","context":null,"enonce":"What time corresponds to the late time on the injected scanner?","item":"ictere","matiere":"HGE","propositions":[{"correct":false,"justification":"Excretory time","idx":0,"proposition":"10 mn"},{"correct":true,"justification":"True","idx":1,"proposition":"3 min"},{"correct":false,"justification":"Venous time","idx":2,"proposition":"70 seconds"},{"correct":false,"justification":"Arterial weather","idx":3,"proposition":"Thirty seconds"},{"correct":false,"justification":"SPC Time","idx":4,"proposition":"T0"}],"ts":1634554083,"type":"custom","difficulte":"1"}
-{"_id":"HTA-cardio-8319a4","context":null,"enonce":"Regarding the assessment to be carried out in front of an essential hypertension of grade 1, among the following additional examinations, which are to be carried out in first intention?","item":"HTA","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"ECG"},{"correct":false,"justification":"If vascular disease documented","idx":1,"proposition":"Doppler echo of ASD."},{"correct":false,"justification":"fundus if grade 2 or 3 hypertension or diabetic hypertensive patient","idx":2,"proposition":"Fundus"},{"correct":true,"justification":"True","idx":3,"proposition":"Serum creatinine assay. "},{"correct":false,"justification":"If cognitive impairment and\/or neurological symptoms.","idx":4,"proposition":"MRI or brain scan"}],"ts":1634554085,"type":"custom","difficulte":"2"}
-{"_id":"Frped-urg-963f0d","context":null,"enonce":"Regarding the classification of Salter and Harris. Which of the following are true?","item":"Frped","matiere":"urg","propositions":[{"correct":true,"justification":"True. Growth cartilage is radiolucent. A non-displaced Salter 1 detachment will only be identifiable on the location of the pain and on the thickening of the soft parts. ","idx":0,"proposition":"A non-displaced Salter 1 detachment is invisible on radiography"},{"correct":true,"justification":"True","idx":1,"proposition":"A Salter V corresponds to a lesion on the germinative layer of cartilage by axial trauma"},{"correct":false,"justification":"False. Growth cartilage and metaphysis.","idx":2,"proposition":"A Salter II corresponds to a trait that passes through the growth cartilage and epiphysis"},{"correct":true,"justification":"True","idx":3,"proposition":"A Salter IV corresponds to a trait that passes through the growth cartilage, epiphysis and metaphysis"},{"correct":false,"justification":"False. Growth cartilage and epiphysis. ","idx":4,"proposition":"A Salter III corresponds to a trait that passes through the growth cartilage and metaphysis"}],"ts":1634554087,"type":"custom","difficulte":"2"}
-{"_id":"pancreatitechr-HGE-0d81ba","context":null,"enonce":"Which of the following are scannographic signs of advanced chronic pancreatitis?","item":"pancreatitechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True, almost pathognomonic","idx":0,"proposition":"Pancreatic calcification"},{"correct":true,"justification":"True, frequent late complication","idx":1,"proposition":"Pseudocysts"},{"correct":false,"justification":"Possible at first","idx":2,"proposition":"Absence of anomaly"},{"correct":true,"justification":"True","idx":3,"proposition":"dilations, ductal irregularities"},{"correct":false,"justification":"Sign of acute pancreatitis rather","idx":4,"proposition":"lithiasis"}],"ts":1634554091,"type":"custom","difficulte":"1"}
-{"_id":"ascite-HGE-02812b","context":null,"enonce":"What is the definition of an infection of ascites fluid that is controlled?","item":"ascite","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"50% drop in 24-hour NPCs"},{"correct":true,"justification":"True","idx":1,"proposition":"50% drop in PNN at 48 hours"},{"correct":false,"justification":"","idx":2,"proposition":"50% drop in PNN at 72h"},{"correct":false,"justification":"","idx":3,"proposition":"100% drop in PNN at 24h"},{"correct":false,"justification":"","idx":4,"proposition":"25% drop in 24-hour PNNs"}],"ts":1634554093,"type":"custom","difficulte":"1"}
-{"_id":"103-neuro-33817097-6648-49ee-aa23-289b30ba47db","context":null,"enonce":"Concerning centrotemporal peak epilepsy (CTEP) in children. Which of the following are true?","item":"epilepsie","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"This syndrome includes 20% of childhood epilepsies"},{"correct":true,"justification":"True","idx":1,"proposition":"Hypersalivation is observed"},{"correct":true,"justification":"True","idx":2,"proposition":"There is a stop of speech"},{"correct":false,"justification":"False: Activated by sleep","idx":3,"proposition":"The EEG is classically in ample and diphasic waves, Centro temporal, calmed by sleep"},{"correct":false,"justification":"not necessarily treatment","idx":4,"proposition":"Treatment should always be undertaken."}],"ts":1634554096,"type":"custom","difficulte":"1"}
-{"_id":"359-urg-6b58fdae-9697-46f6-8046-dcba8345a6f2","context":null,"enonce":"Regarding the reduction criteria to be checked in a fracture of the lower end of the radius, which of the following propositions, which are true?","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":" or null and void","idx":0,"proposition":"Front: a negative radio-ulnar index -2mm non-zero"},{"correct":false,"justification":"False: profile","idx":1,"proposition":"Front: an anteversion of the radial glenoid"},{"correct":false,"justification":"False: inwards","idx":2,"proposition":"Front: Restoration of the bi-styloid line inclined 15° outwards"},{"correct":true,"justification":"True","idx":3,"proposition":"In profile: realignment of the cortical of the 2 radial fragments"},{"correct":true,"justification":"True","idx":4,"proposition":"Front: a negative radio-ulnar index -2mm or zero"}],"ts":1634554098,"type":"custom","difficulte":"1"}
-{"_id":"nvxne-gyn-f0f52f","context":null,"enonce":"What diseases are included in newborn screening?","item":"nvxne","matiere":"gyn","propositions":[{"correct":true,"justification":"True, first disease to look for by the blotting paper test (guthria test)","idx":0,"proposition":"PKU"},{"correct":true,"justification":"True, not included in the blotting paper test but is part of the screening at birth","idx":1,"proposition":"Congenital hip dislocation"},{"correct":true,"justification":"True, is part of the blotting paper test, but is not systematic. Targeted according to parents' origins","idx":2,"proposition":"Sickle-cell anemia"},{"correct":true,"justification":"True, blotting paper test","idx":3,"proposition":"Cystic fibrosis"},{"correct":true,"justification":"True, hence the acoustic otoemission test to be done before discharge from maternity","idx":4,"proposition":"Congenital deafness"}],"ts":1634554100,"type":"custom","difficulte":"2"}
-{"_id":"RGO-HGE-b4e5e3","context":null,"enonce":"How often is endobrachyoesophagus less than 3 centimetres monitored?","item":"RGO","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Every 5 years"},{"correct":false,"justification":"between 3 and 6 cm","idx":1,"proposition":"Every 3 years"},{"correct":false,"justification":"> 6 cm","idx":2,"proposition":"Every 2 years"},{"correct":false,"justification":"An OBE is always monitored","idx":3,"proposition":"No monitoring"},{"correct":false,"justification":"Control every year (2 times in the first year) if low-grade dysplasia","idx":4,"proposition":"Every 6 months"}],"ts":1634554102,"type":"custom","difficulte":"1"}
-{"_id":"Kcped-onco-cbfd97","context":null,"enonce":"Which of the following are biomarkers that can be found disrupted in neuroblastoma?","item":"Kcped","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Urinary catecholamines"},{"correct":true,"justification":"True","idx":1,"proposition":"LDH"},{"correct":true,"justification":"True","idx":2,"proposition":"Ferritin"},{"correct":false,"justification":"False","idx":3,"proposition":"Calcemia"},{"correct":false,"justification":"False","idx":4,"proposition":"Urea"}],"ts":1634554104,"type":"custom","difficulte":"2"}
-{"_id":"TTTnonmedic-therapeutique-74be2c","context":null,"enonce":"Which of the following are true?","item":"TTTnonmedic","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"An orthosis is a device that compensates for an absent or deficient function"},{"correct":false,"justification":"Prosthesis = replaces a missing element","idx":1,"proposition":"A prosthesis is a device that compensates for an absent or deficient function"},{"correct":true,"justification":"True","idx":2,"proposition":"Orthotics are most often custom-made"},{"correct":false,"justification":"By an orthopaedic technician","idx":3,"proposition":"Orthotics are placed by an orthoptist"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"ts":1634554105,"type":"custom","difficulte":"2"}
-{"_id":"coma-urg-23c610","context":null,"enonce":"Which of the following propositions are true regarding decortication?","item":"coma","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The upper limbs are in flexion"},{"correct":false,"justification":"Inflection","idx":1,"proposition":"The upper limbs are in extension"},{"correct":false,"justification":"Extension","idx":2,"proposition":"The lower limbs are in flexion"},{"correct":true,"justification":"True","idx":3,"proposition":"The lower limbs are in extension"},{"correct":false,"justification":"False","idx":4,"proposition":"The head is in extension"}],"ts":1634554109,"type":"custom","difficulte":"2"}
-{"_id":"anemie-hemato-c0519a","context":null,"enonce":"With regard to anaemia in children, what are the right proposals?","item":"anemie","matiere":"hemato","propositions":[{"correct":false,"justification":"False, we judge his tolerance to effort classically during feedings.","idx":0,"proposition":"It is impossible to talk about dyspnea of effort in an infant because he does not have physical activity"},{"correct":true,"justification":"True, at birth the child has a high level of hemoglobin that drops sharply between 3 and 6 months to 9.5 g \/ dL as a low limit. From 6 months his Hb level increases little by little to reach the adult norm from 12 years","idx":1,"proposition":"From 12 years old anemia is considered with adult norms"},{"correct":true,"justification":"True, martial deficiencies of intake may be due to exclusive feeding of breast milk which is low in iron.","idx":2,"proposition":"It is necessary to diversify food intake from 6 months"},{"correct":false,"justification":"","idx":3,"proposition":""},{"correct":false,"justification":"","idx":4,"proposition":""}],"ts":1634554111,"type":"custom","difficulte":"2"}
-{"_id":"Kcsein-onco-1b716e","context":null,"enonce":"Which of the following are criteria for poor prognosis of localized forms? (Cancer Medline, Table 2, page 393, 2018 edition)","item":"Kcsein","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Lymph node invasion (>N0)"},{"correct":false,"justification":"False","idx":1,"proposition":"T1"},{"correct":true,"justification":"True, T2 and beyond = poor prognosis","idx":2,"proposition":"T3"},{"correct":false,"justification":"Good prognosis","idx":3,"proposition":"HER2-"},{"correct":true,"justification":"True, SBR 8 or 9","idx":4,"proposition":"High histological grade"}],"ts":1634554112,"type":"custom","difficulte":"2"}
-{"_id":"Frped-urg-57a8bc","context":null,"enonce":"What are the indications for surgical management of a fracture of the child","item":"Frped","matiere":"urg","propositions":[{"correct":false,"justification":"Orthopedic treatment in 1° intention for any diaphyseal \/ metaphyseal fracture of children under 6 years of age","idx":0,"proposition":"Femoral diaphyseal fracture in a 3-year-old child"},{"correct":true,"justification":"At school age, surgical management is preferred for certain diaphyseal or epiphyseal fractures for a faster resumption of walking (lower limb) or writing (upper limb)","idx":1,"proposition":"A fracture of the 2 bones of the forearm in an 8-year-old child"},{"correct":true,"justification":"Yes, to avoid joint stiffness in case of immobilization","idx":2,"proposition":"A joint fracture"},{"correct":false,"justification":"But surgical indication in the case of a pathological fracture (delayed healing in case of orthopedic treatment)","idx":3,"proposition":"Abuse"},{"correct":true,"justification":"Orthopedic treatment would complicate nursing care, which is already cumbersome in these cases.","idx":4,"proposition":"Polytrauma"}],"ts":1634554114,"type":"custom","difficulte":"2"}
-{"_id":"securisation-sp-e7eb9f","context":null,"enonce":"How many physicians must be present, at a minimum, for CPR:","item":"securisation","matiere":"sp","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"1"},{"correct":false,"justification":"False","idx":1,"proposition":"2"},{"correct":true,"justification":"True, from different specialties","idx":2,"proposition":"3"},{"correct":false,"justification":"False","idx":3,"proposition":"4"},{"correct":false,"justification":"False","idx":4,"proposition":"5"}],"ts":1634554120,"type":"custom","difficulte":"1"}
-{"_id":"anemie-hemato-ae0602","context":null,"enonce":"Which of these diseases can be revealed by peripheral anemia?","item":"anemie","matiere":"hemato","propositions":[{"correct":true,"justification":"True, it gives a central anemia by default of erythroblast production but also gives toxicity to red blood cells that can hemolyze with a reticulocyte response.","idx":0,"proposition":"Thalassemia"},{"correct":false,"justification":"False","idx":1,"proposition":"Iron deficiency"},{"correct":true,"justification":"True, also Minkowski Chauffard disease, autosomal dominant disease. By a membrane defect, RBCs are sequestered in the spleen and hemolyze. Classically manifests itself as jaundice of the newborn.","idx":2,"proposition":"Spherocytosis"},{"correct":true,"justification":"True, it is a thrombotic microangiopathy that by definition gives consumption thrombocytopenia and mechanical hemolytic anemia.","idx":3,"proposition":"Hemolytic uremic syndrome"},{"correct":true,"justification":"True, it is an enzyme deficiency that gives hemolysis when exposed to an oxidative stressor: infection, bean ingestion, drugs such as quinine.","idx":4,"proposition":"G6PD deficiency"}],"ts":1634554122,"type":"custom","difficulte":"2"}
-{"_id":"securisation-sp-8f1a1e","context":null,"enonce":"Which of the following proposals are acts\/consultations for which it is not mandatory to go through the general practitioner to be reimbursed?","item":"securisation","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Psychiatric consultation, up to 25 years"},{"correct":true,"justification":"True","idx":1,"proposition":"ABORTION"},{"correct":true,"justification":"True","idx":2,"proposition":"Urgency"},{"correct":true,"justification":"True","idx":3,"proposition":"Mammography as part of organized screening"},{"correct":false,"justification":"False","idx":4,"proposition":"Cervico-uterine smear at 18 years old"}],"ts":1634554124,"type":"custom","difficulte":"1"}
-{"_id":"PF-neuro-ab3293","context":null,"enonce":"Which of the following are functions performed by the facial VII nerve?","item":"PF","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Motor innervation of the skin muscles of the face"},{"correct":true,"justification":"True","idx":1,"proposition":"Motor innervation of the stapedial muscle"},{"correct":true,"justification":"True","idx":2,"proposition":"Innervation of the lacrimal and submandibular glands"},{"correct":false,"justification":"Sensory innervation","idx":3,"proposition":"Sensory innervation of the Ramsey-Hunt area"},{"correct":false,"justification":"Sensory innervation","idx":4,"proposition":"Sensory innervation of the anterior 2\/3 of the tongue"}],"ts":1634554125,"type":"custom","difficulte":"3"}
-{"_id":"PF-neuro-a149a8","context":null,"enonce":"What is the number of the facial nerve?","item":"PF","matiere":"neuro","propositions":[{"correct":false,"justification":"Trigeminal","idx":0,"proposition":"V"},{"correct":true,"justification":"True","idx":1,"proposition":"VII"},{"correct":false,"justification":"Glossopharyngeal","idx":2,"proposition":"IX"},{"correct":false,"justification":"Optics","idx":3,"proposition":"II"},{"correct":false,"justification":"Hypoglossus","idx":4,"proposition":"XII"}],"ts":1634554130,"type":"custom","difficulte":"1"}
-{"_id":"polytrauma-urg-6a0066","context":null,"enonce":"Which of the following proposals regarding the care of a burn victim are true?","item":"polytrauma","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A 1st degree burn is only painful erythema"},{"correct":false,"justification":"False, 1st degree","idx":1,"proposition":"A 2nd degree burn is only a dolourous erythema"},{"correct":false,"justification":"False, only 2nd degree","idx":2,"proposition":"Phlyctenes and epidermal detachment are present in 2nd and 3rd degree burns"},{"correct":true,"justification":"True","idx":3,"proposition":"Discoloration with vitropressure disappears in the 3rd degree"},{"correct":true,"justification":"True, in addition the appendages no longer adhere","idx":4,"proposition":"A 3rd degree burn is sluggish, dry, cardboard, insensitive and painless"}],"ts":1634554132,"type":"custom","difficulte":"2"}
-{"_id":"MAI-immuno-4f3826","context":null,"enonce":"In which diseases can Rheumatoid Factor (RF) be found?","item":"MAI","matiere":"immuno","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"rheumatoid arthritis"},{"correct":true,"justification":"True","idx":1,"proposition":"systemic lupus erythematosus"},{"correct":true,"justification":"True","idx":2,"proposition":"cryoglobulinemia"},{"correct":true,"justification":"True","idx":3,"proposition":"chronic hepatitis C"},{"correct":true,"justification":"True","idx":4,"proposition":"infective endocarditis"}],"ts":1634554133,"type":"custom","difficulte":"1"}
-{"_id":"pancreatitechr-HGE-25b3f2","context":null,"enonce":"The male\/female sex ratio is:","item":"pancreatitechr","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"1"},{"correct":false,"justification":"","idx":1,"proposition":"2"},{"correct":false,"justification":"","idx":2,"proposition":"8"},{"correct":true,"justification":"True","idx":3,"proposition":"4"},{"correct":false,"justification":"","idx":4,"proposition":"10"}],"ts":1634554135,"type":"custom","difficulte":"1"}
-{"_id":"RGO-HGE-89f0f3","context":null,"enonce":"Which of the following are true for the treatment of mild esophagitis?","item":"RGO","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Treatment relies on PEPs"},{"correct":true,"justification":"True","idx":1,"proposition":"Half-dose PPI for 4 weeks"},{"correct":false,"justification":"Severe esophagitis","idx":2,"proposition":"Full dose PPI for 8 weeks"},{"correct":false,"justification":"Prevention of recurrence (if frequent)","idx":3,"proposition":"PPIs minimum dose"},{"correct":false,"justification":"If symptoms persist","idx":4,"proposition":"Full dose PPI"}],"ts":1634554136,"type":"custom","difficulte":"1"}
-{"_id":"polytrauma-urg-eefefd","context":null,"enonce":"Which of the following propositions concerning polytrauma are true?","item":"polytrauma","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A severely traumatized person is a trauma patient whose violence or mechanism of trauma can result in life-threatening injuries."},{"correct":false,"justification":"False, the leading cause of death","idx":1,"proposition":"Injuries are the second leading cause of death among young people under 40"},{"correct":true,"justification":"True","idx":2,"proposition":"A defect in orientation of a polytrauma patient requiring secondary transfer to a specialized center is associated with excess mortality"},{"correct":true,"justification":"True","idx":3,"proposition":"Vittel's algorithm can be used to define a severe trauma patient and direct it to a structure adapted to its condition"},{"correct":false,"justification":"False, the Glasgow score assesses the severity of head injury. It can be used from the pre-hospital phase","idx":4,"proposition":"The Glasgow score is not usable in the context of polytrauma"}],"ts":1634554138,"type":"custom","difficulte":"1"}
-{"_id":"MICI-HGE-aa9564","context":null,"enonce":"Which of the following proposals are more oriented towards Crohn's disease rather than ulcerative colitis?","item":"MICI","matiere":"HGE","propositions":[{"correct":true,"justification":"True, typical (but not constant) in crohn's","idx":0,"proposition":"Gigantocellullar granulomas without caseous necrosis "},{"correct":true,"justification":"True, continued achievement in UC","idx":1,"proposition":"Discontinuous colonic involvement"},{"correct":true,"justification":"True, non-transmural impairment in UC","idx":2,"proposition":"Transmural involvement"},{"correct":true,"justification":"True","idx":3,"proposition":"Severe ileitis"},{"correct":true,"justification":"True, anus spared in UC","idx":4,"proposition":"Proctological lesions"}],"ts":1634554140,"type":"custom","difficulte":"1"}
-{"_id":"pbsuitescouches-gyn-742f30","context":null,"enonce":"Which of the following proposals are part of the initial additional assessment in case of suspected acute postpartum endometritis?","item":"pbsuitescouches","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"NFS-P"},{"correct":true,"justification":"True","idx":1,"proposition":"Vaginal sampling for bacteriological purposes"},{"correct":true,"justification":"True","idx":2,"proposition":"CRP"},{"correct":false,"justification":"False","idx":3,"proposition":"Thoracoabdom-pelvic CT"},{"correct":false,"justification":"False","idx":4,"proposition":"Peritoneal ultrasound"}],"ts":1634554141,"type":"custom","difficulte":"2"}
-{"_id":"MICI-HGE-a9ec9e","context":null,"enonce":"Which of the following propositions are true regarding UC?","item":"MICI","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Imaging is normal"},{"correct":false,"justification":"This is the case for Crohn's disease","idx":1,"proposition":"The attack is transmural"},{"correct":false,"justification":"Normal MRI","idx":2,"proposition":"MRI is the exam of choice for a positive diagnosis"},{"correct":true,"justification":"True","idx":3,"proposition":"The RCH respects hail"},{"correct":true,"justification":"True","idx":4,"proposition":"Sclerosing cholangitis is a common association"}],"ts":1634554168,"type":"custom","difficulte":"1"}
-{"_id":"MICI-HGE-fedb95","context":null,"enonce":"Which of the following are etiologies of gigantoepithelioid granuloma without caseous necrosis?","item":"MICI","matiere":"HGE","propositions":[{"correct":true,"justification":"True, it is very common not to find caseous necrosis in tuberculosis. But it must also be remembered that this pathology gives caseous necrosis","idx":0,"proposition":"Tuberculosis"},{"correct":true,"justification":"True","idx":1,"proposition":"Crohn's disease"},{"correct":true,"justification":"True","idx":2,"proposition":"Horton's disease"},{"correct":true,"justification":"True","idx":3,"proposition":"Sarcoidosis"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"ts":1634554170,"type":"custom","difficulte":"1"}
-{"_id":"splenomeg-HGE-f19ba4","context":null,"enonce":"Which of the following propositions are true regarding prophylaxis in a splecnectomized?","item":"splenomeg","matiere":"HGE","propositions":[{"correct":false,"justification":"Vaccination is combined with antibiotic prophylaxis with oral penicillin. It is generally recommended until adolescence in children and for one or two years in children.\r\nthe adult. ","idx":0,"proposition":"It is based on C3G"},{"correct":false,"justification":"","idx":1,"proposition":"It is based on vaccination only"},{"correct":true,"justification":"True","idx":2,"proposition":"It is based on oral penicillins and vaccination"},{"correct":false,"justification":"1 or 2 years","idx":3,"proposition":"Oral penicillin is to be taken for 3 months in adults"},{"correct":true,"justification":"True, according to Masson","idx":4,"proposition":"Oral penicillin is usually to be taken until adolescence in children"}],"ts":1634554172,"type":"custom","difficulte":"1"}
-{"_id":"diarrheechr-HGE-aa8237","context":null,"enonce":"Which of the following are causes of malabsorption diarrhea?","item":"diarrheechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Exocrine pancreatic insufficiency"},{"correct":true,"justification":"True","idx":1,"proposition":"Celiac disease"},{"correct":true,"justification":"True","idx":2,"proposition":"IBD"},{"correct":false,"justification":"Exudative diarrhea","idx":3,"proposition":"Lymphangiectasias"},{"correct":false,"justification":"Volumonegic diarrhea","idx":4,"proposition":"Syndrome de Zollinger Ellison"}],"ts":1634554174,"type":"custom","difficulte":"1"}
-{"_id":"vertige-neuro-f6a97a","context":null,"enonce":"Which of the following proposals favor peripheral nystagmus?","item":"vertige","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Horizonto-rotatory"},{"correct":true,"justification":"True","idx":1,"proposition":"No change of meaning depending on the look"},{"correct":true,"justification":"True","idx":2,"proposition":"Inhibitation by eye fixation"},{"correct":false,"justification":"False, rather central nystagmus","idx":3,"proposition":"Pure direction"},{"correct":false,"justification":"False, rather central nystagmus","idx":4,"proposition":"Concerns only one eye"}],"ts":1634554175,"type":"custom","difficulte":"2"}
-{"_id":"ADP-hemato-ef4c7d","context":null,"enonce":"Which of the following are true about tularemia?","item":"ADP","matiere":"hemato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Tularemia is caused by Francisella tularensis"},{"correct":true,"justification":"True","idx":1,"proposition":"Hare hunters are on display"},{"correct":true,"justification":"True","idx":2,"proposition":"It is a reportable disease"},{"correct":false,"justification":"Cervical lymphadenopathy most often (especially in hunters)","idx":3,"proposition":"It presents as spinal lymphadenopathy"},{"correct":false,"justification":"Fluoroquinolones as a first-line treatment","idx":4,"proposition":"It is treated with C3G IM monodose in first line"}],"ts":1634554177,"type":"custom","difficulte":"2"}
-{"_id":"MSN-urg-63c549","context":null,"enonce":"Which of the following are true?","item":"MSN","matiere":"urg","propositions":[{"correct":false,"justification":"Sudden infant death syndrome (SIDS) is an unexpected infant death (MIN) with no etiology found despite extensive investigations.","idx":0,"proposition":"Unexpected infant death (MIN) is sudden infant death syndrome (SIDS) with no etiology found despite exhaustive investigations."},{"correct":true,"justification":"","idx":1,"proposition":"Sudden infant death syndrome accounts for 6% of infant mortality."},{"correct":false,"justification":"Unexpected infant death is defined as a sudden death in a child under 2 years of age, when nothing in its known history could have predicted it.","idx":2,"proposition":"Unexpected infant death is defined as a sudden death in a child under 3 years of age, when nothing in his known history could have predicted it."},{"correct":true,"justification":"","idx":3,"proposition":"Abuse, acute dehydration and bedding accidents are among the most common etiologies of MIN."},{"correct":false,"justification":"The male sex of the infant, a young mother and the winter period are risk factors for sudden infant death syndrome (SIDS).","idx":4,"proposition":"The male sex of the infant, the old age of the mother and the summer period are risk factors for sudden infant death syndrome (SIDS)."}],"ts":1634554179,"type":"custom","difficulte":"2"}
-{"_id":"prothese-urg-8aef22","context":null,"enonce":"Which of the following are complications of centromedullary nail osteosynthesis?","item":"prothese","matiere":"urg","propositions":[{"correct":true,"justification":"True, surgical revision for PTH","idx":0,"proposition":"displacement (scanning) of the cervical screw"},{"correct":true,"justification":"True","idx":1,"proposition":"Vicious Cal in Varus"},{"correct":true,"justification":"True","idx":2,"proposition":"infection"},{"correct":false,"justification":"False","idx":3,"proposition":"Aseptic osteonecrosis of the femoral head"},{"correct":false,"justification":"possible for prostheses","idx":4,"proposition":"dislocation"}],"ts":1634554181,"type":"custom","difficulte":"1"}
-{"_id":"vomisst-HGE-844f29","context":null,"enonce":"Which of the following are complications of repeated vomiting?","item":"vomisst","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Dehydration"},{"correct":true,"justification":"True, inhalation","idx":1,"proposition":"Pneumonia "},{"correct":true,"justification":"True","idx":2,"proposition":"Syndrome de Mallory Weiss"},{"correct":true,"justification":"True","idx":3,"proposition":"Syndrome de Boerhaave"},{"correct":true,"justification":"True","idx":4,"proposition":"Esophagitis"}],"ts":1634554183,"type":"custom","difficulte":"1"}
-{"_id":"TNC-neuro-6a97df","context":null,"enonce":"What elements are part of the C.A.M. classification useful in detecting and reassessing confusion?","item":"TNC","matiere":"neuro","propositions":[{"correct":true,"justification":"True, confusion can settle in a few minutes, hours or days and we are talking about a break with the previous state","idx":0,"proposition":"Brutal start"},{"correct":false,"justification":"Wrong, having a major neurocognitive disorder is different from being confused, certainly, but you can have both!","idx":1,"proposition":"Absence of major neurocognitive disorder"},{"correct":false,"justification":"False, they are not part of the C.A.M. classification.","idx":2,"proposition":"Memory problems"},{"correct":true,"justification":"True, this very item is used very often in emergencies to detect confusion","idx":3,"proposition":"Temporo-spatial disorganization and thought and language "},{"correct":true,"justification":"True, remember that a confusion is equal to a Glasgow at 14!","idx":4,"proposition":"Impaired alertness"}],"ts":1634554185,"type":"custom","difficulte":"1"}
-{"_id":"Kcpancreas-onco-269d2b","context":null,"enonce":"Which of the following are true?","item":"Kcpancreas","matiere":"onco","propositions":[{"correct":false,"justification":"The only clearly established exogenous risk factor for pancreatic adenocarcinoma is tobacco ","idx":0,"proposition":"The only clearly established exogenous risk factor for pancreatic adenocarcinoma is alcohol"},{"correct":true,"justification":"","idx":1,"proposition":"Obesity is a risk factor as it is for many other cancers"},{"correct":true,"justification":"","idx":2,"proposition":"Familial pancreatic cancer"},{"correct":true,"justification":"","idx":3,"proposition":"The existence of an affected first-degree relative and tobacco use increase the risk of developing pancreatic adenocarcinoma by 5"},{"correct":true,"justification":"","idx":4,"proposition":"Pancreatic conditions predisposing to an endogenous risk of pancreatic cancer are diabetes and chronic alcoholic pancreatitis in particular"}],"ts":1634554188,"type":"custom","difficulte":"2"}
-{"_id":"PF-neuro-040284","context":null,"enonce":"Which of the following are factors in poor prognosis for idiopathic (or frigore) paralysis?","item":"PF","matiere":"neuro","propositions":[{"correct":false,"justification":"Poor prognosis factor = quick installation","idx":0,"proposition":"Slow installation"},{"correct":true,"justification":"True","idx":1,"proposition":"Total character from the outset"},{"correct":true,"justification":"True","idx":2,"proposition":"Associated pain"},{"correct":true,"justification":"True","idx":3,"proposition":"Tinnitus"},{"correct":true,"justification":"True","idx":4,"proposition":"Dizziness"}],"ts":1634554190,"type":"custom","difficulte":"2"}
-{"_id":"systemeconv-sp-4378f6","context":null,"enonce":"Which practitioners can set up in sector 2?","item":"systemeconv","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Former Assistant Clinic Managers"},{"correct":true,"justification":"True","idx":1,"proposition":"Former hospital assistants"},{"correct":true,"justification":"True","idx":2,"proposition":"Full-time hospital practitioners"},{"correct":false,"justification":"After 5 years","idx":3,"proposition":"Part-time hospital practitioners after 3 years "},{"correct":false,"justification":"Almost all 😛","idx":4,"proposition":"All propositions are true"}],"ts":1634554194,"type":"custom","difficulte":"1"}
-{"_id":"SII-HGE-ee1808","context":null,"enonce":"Which of the following are relevant tips for the management of irritable bowel syndrome?","item":"SII","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Reduce caffeine"},{"correct":true,"justification":"True","idx":1,"proposition":"Reduce fiber"},{"correct":true,"justification":"True","idx":2,"proposition":"Antispasmodics may be helpful"},{"correct":true,"justification":"True","idx":3,"proposition":"Anti-diarrheals may have their place depending on the type of IBS"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"ts":1634554196,"type":"custom","difficulte":"1"}
-{"_id":"FdRCV-cardio-a515a9","context":null,"enonce":"Which of the following are modifiable cardiovascular risk factors?","item":"FdRCV","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Tobacco"},{"correct":false,"justification":"Not a cardiovascular risk factor","idx":1,"proposition":"Alcohol"},{"correct":false,"justification":"Age, sex and heredity are non-modifiable risk factors","idx":2,"proposition":"Heredity"},{"correct":true,"justification":"True","idx":3,"proposition":"Metabolic syndrome"},{"correct":true,"justification":"True","idx":4,"proposition":"Chronic renal failure"}],"ts":1634554198,"type":"custom","difficulte":"2"}
-{"_id":"choc-urg-a6805c","context":null,"enonce":"What is the most common infectious entry point in case of septic shock?","item":"choc","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Respiratory"},{"correct":false,"justification":"","idx":1,"proposition":"Skin"},{"correct":false,"justification":"","idx":2,"proposition":"Urinary"},{"correct":false,"justification":"Second gateway","idx":3,"proposition":"Hepato-digestive"},{"correct":false,"justification":"","idx":4,"proposition":"ENT"}],"ts":1634554201,"type":"custom","difficulte":"1"}
-{"_id":"Kcsein-onco-ea6e3c","context":null,"enonce":"Which of the following are true?","item":"Kcsein","matiere":"onco","propositions":[{"correct":false,"justification":"False. This is invasive carcinoma of nonspecific type (or invasive ductal carcinoma or invasive ductal adenocarcinoma)","idx":0,"proposition":"The most common type of cancer is invasive lobular carcinoma"},{"correct":false,"justification":"False. 50 to 74 years.","idx":1,"proposition":"Screening is routine for all women who are asymptomatic or without risk factors for BRCA1\/2 between 45 and 75 years of age"},{"correct":true,"justification":"True","idx":2,"proposition":"The most common metastatic sites are the bone, lungs and liver. "},{"correct":false,"justification":"False. It is a humanized antibody (-zumab). The suffix -mumab means that the monoclonal antibody is human. ","idx":3,"proposition":"Trastuzumab is a human monoclonal antibody targeting HER2 "},{"correct":true,"justification":"True","idx":4,"proposition":"Trastuzumab is cardiotoxic"}],"ts":1634554203,"type":"custom","difficulte":"2"}
-{"_id":"PF-neuro-9c4458","context":null,"enonce":"Which of the following are signs of peripheral facial paralysis?","item":"PF","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Sign of Charles Bell"},{"correct":true,"justification":"True","idx":1,"proposition":"Sign of Souques"},{"correct":false,"justification":"Not in the device","idx":2,"proposition":"Automatic-voluntary dissociation"},{"correct":true,"justification":"True","idx":3,"proposition":"Total"},{"correct":true,"justification":"True","idx":4,"proposition":"Dry eye"}],"ts":1634554204,"type":"custom","difficulte":"2"}
-{"_id":"Kcphysiopath-onco-0856de","context":null,"enonce":"Which of the following are carcinogens?","item":"Kcphysiopath","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Asbestos"},{"correct":true,"justification":"True","idx":1,"proposition":"HCV"},{"correct":true,"justification":"True","idx":2,"proposition":"HPV"},{"correct":true,"justification":"True","idx":3,"proposition":"HIV"},{"correct":true,"justification":"True","idx":4,"proposition":"H. pylori"}],"ts":1634554206,"type":"custom","difficulte":"1"}
-{"_id":"antalgie-therapeutique-cabbb5","context":null,"enonce":"Regarding level II analgesics, what are the exact proposal(s)?","item":"antalgie","matiere":"therapeutique","propositions":[{"correct":false,"justification":"False, nefopam (or ACUPAN) is not a level II analgesic, but a co-analgesic.","idx":0,"proposition":"Level II analgesics include codeine, tramadol and nefopam among others"},{"correct":true,"justification":"True, the very definition of level II analgesics being \"weak opioids\".","idx":1,"proposition":"All level II analgesics are opioids. "},{"correct":false,"justification":"False, three times false. This is a mistake that is unfortunately very common, because even if the combinations of level 1 and level 2, specialties such as Lamaline or Izalgi are ALREADY a combination of opium powder and Paracetamol (+\/- caffeine). Prescribing these specialties with Paracetamol leads to an overload of Paracetamol harmful to the liver.","idx":2,"proposition":"It is not forbidden to prescribe combinations of level I and II together, such as Paracetamol + Lamaline or Paracetamol + Izalgi"},{"correct":true,"justification":"True, this is THE drug contraindication of tramadol","idx":3,"proposition":"Tramadol is contraindicated with MAOIs"},{"correct":false,"justification":"False, it is with level III analgesics (strong opioids). For level analgesics it is according to the symptoms","idx":4,"proposition":"The prescription of a laxative is systematic with opioid analgesics of level II"}],"ts":1634554208,"type":"custom","difficulte":"1"}
-{"_id":"souffleped-cardio-18bcc2","context":null,"enonce":"Which of the following proposals should be sought primarily in case of Turner syndrome?","item":"souffleped","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Coarctation of the aorta"},{"correct":false,"justification":"Syndrome de Di-Georges","idx":1,"proposition":"Tetralogy of Fallot"},{"correct":false,"justification":"False","idx":2,"proposition":"Persistent ductus arteriosus"},{"correct":false,"justification":"False","idx":3,"proposition":"Ventricular septal defect"},{"correct":false,"justification":"False","idx":4,"proposition":"Inter-atrial communication"}],"ts":1634554210,"type":"custom","difficulte":"2"}
-{"_id":"cirrhose-HGE-a4c99d","context":null,"enonce":"Maddrey's score includes:","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"TP"},{"correct":true,"justification":"True","idx":1,"proposition":"TQ"},{"correct":true,"justification":"True","idx":2,"proposition":"Total bilirubin"},{"correct":false,"justification":"","idx":3,"proposition":"INR"},{"correct":false,"justification":"","idx":4,"proposition":"Creatinine emia"}],"ts":1634554212,"type":"custom","difficulte":"1"}
-{"_id":"329-urg-bc82f4cf-b2ef-445d-870f-465b1c169705","context":null,"enonce":"Which of the following propositions regarding compartment syndrome is true?","item":"polytrauma","matiere":"urg","propositions":[{"correct":false,"justification":"False. It is an immediate\/early complication that occurs within 24 hours. The development of unbearable pain at the site of the fracture is the diagnostic key to this complication.","idx":0,"proposition":"A. It is a late complication that can occur after fracture of a limb "},{"correct":false,"justification":"False false false !! The pulse is preserved. If they disappear, we should rather suspect acute ischemia of the limb ... or the very late stage of the compartment syndrome... that is, when the patient has lost his leg and is no longer in pain at all. So remember that \"PALOR\" and \"PULSELESSNESS\" are signs too late in the syndrome of the compartments","idx":1,"proposition":"Peripheral pulses are abolished"},{"correct":false,"justification":"False. The figure is correct: it is pathological if > 20 mmHg BUT the diagnosis is CLINICAL +++. So no need to make a pressure measurement to everyone","idx":2,"proposition":"The measurement of a pressure in the compartments > 20 mmHg is essential for diagnosis"},{"correct":true,"justification":"True! Nothing to say! ","idx":3,"proposition":"A discharge aponeurotomy is indicated within 6 hours"},{"correct":true,"justification":"True! It is related to a syndrome of the compartments of the forearm responsible for muscle retraction! Syndrome well to know that can be found in pediatrics when one performs poorly plasters (among others). \r\n\r\nAll this information can be found on page 343 of the last college of anesthesia resuscitation (not essential to read but it is free and online so it is the only one I have on hand","idx":4,"proposition":"Volkmann syndrome is responsible for a claw deformity of the hand "}],"ts":1634554221,"type":"custom","difficulte":"1"}
-{"_id":"cirrhose-HGE-061073","context":null,"enonce":"Which of the following are compatible with cirrhosis?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Decline in TP"},{"correct":true,"justification":"True","idx":1,"proposition":"Decrease in factor V"},{"correct":false,"justification":"Increase in DRI (Decrease in TP)","idx":2,"proposition":"Decrease in DRI"},{"correct":true,"justification":"True","idx":3,"proposition":"Decreased albumin"},{"correct":false,"justification":"Increased free bilirubin","idx":4,"proposition":"Decrease in free bilirubin"}],"ts":1634554223,"type":"custom","difficulte":"1"}
-{"_id":"algiespelviennes-gyn-6c2307","context":null,"enonce":"Regarding endometrioma. Which of the following are true?","item":"algiespelviennes","matiere":"gyn","propositions":[{"correct":true,"justification":"True. Endometrioma is ovarian endometriosis. See HAS 2017 recommendations.","idx":0,"proposition":"Pelvic ultrasound and pelvic MRI have similar performance for the diagnosis of endometriosis"},{"correct":true,"justification":"True","idx":1,"proposition":"If endometriosis is diagnosed, it is necessary to look for associated deep endometriosis"},{"correct":true,"justification":"True","idx":2,"proposition":"Endometrioma is ovarian endometriosis"},{"correct":true,"justification":"True","idx":3,"proposition":"The diagnosis of endometrioma should be made with caution after menopause so as not to ignore a malignant tumor"},{"correct":false,"justification":"False. Not at all. Endometrioma = ovarian endometriosis. Adenomyosis is the presence of endometrial cells in the myometrium.","idx":4,"proposition":"Endometrioma is synonymous with adenomyosis"}],"ts":1634554226,"type":"custom","difficulte":"2"}
-{"_id":"MSN-urg-823cb7","context":null,"enonce":"Which of the following propositions are true about the MIN, when the doctor arrives at home?","item":"MSN","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Resuscitation maneuvers will be interrupted within a reasonable time in the absence of resumption of cardiac activity"},{"correct":false,"justification":"The doctor may propose to the parents, if they wish, to be present during the resuscitation","idx":1,"proposition":"If resuscitation maneuvers are undertaken, parents must leave the room"},{"correct":true,"justification":"True","idx":2,"proposition":"In the presence of the parents if they wish, it is recommended that the deceased child be completely stripped naked to be examined"},{"correct":false,"justification":"Intervention sheet + Examination of the child (as early as possible)","idx":3,"proposition":"No post-mortem gesture should be performed at home"},{"correct":true,"justification":"True","idx":4,"proposition":"The child's body must be transported to an MIN reference centre"}],"ts":1634577360,"type":"custom","difficulte":"2"}
-{"_id":"ictere-HGE-368b2b","context":null,"enonce":"Which of the following are enzymes that sign cholestasis?","item":"ictere","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"STAKE"},{"correct":true,"justification":"True","idx":1,"proposition":"Gamma-GT"},{"correct":false,"justification":"Hepatic cytolysis","idx":2,"proposition":"ASAT"},{"correct":false,"justification":"Hepatic cytolysis","idx":3,"proposition":"ALAT"},{"correct":false,"justification":"Hepatic cytolysis","idx":4,"proposition":"TGO"}],"ts":1634577362,"type":"custom","difficulte":"1"}
-{"_id":"Kcprostate-onco-7174d7","context":null,"enonce":"What is Amico's classification of prostate cancer with a PSA of 18 ng\/mL, a Gleason of 3+5 and a normal TR?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":false,"justification":"Raised in front of the Gleason","idx":0,"proposition":"Weak"},{"correct":false,"justification":"Raised in front of the Gleason","idx":1,"proposition":"Intermediary "},{"correct":true,"justification":"True. Low: T1C or T2a AND PSA <= 10 AND Gleason <= 6.  Intermediate: T2b OR 10 > PSA < 20 OR Gleason 7. High: T2c and sup OR PSA >= 20 OR Gleason >= 8","idx":2,"proposition":"High"},{"correct":false,"justification":"Raised in front of the Gleason","idx":3,"proposition":"Not enough item"},{"correct":false,"justification":"Raised in front of the Gleason","idx":4,"proposition":"The elements are contradictory"}],"ts":1634577364,"type":"custom","difficulte":"2"}
-{"_id":"masseabdo-HGE-fd0599","context":null,"enonce":"Which of the following proposals are additional examinations to be carried out systematically upon discovery of hepatomegaly?","item":"masseabdo","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"NFS-P"},{"correct":true,"justification":"True","idx":1,"proposition":"Transaminases"},{"correct":true,"justification":"True","idx":2,"proposition":"Protein electrophoresis"},{"correct":false,"justification":"Depending on the clinic","idx":3,"proposition":"CRP"},{"correct":true,"justification":"True","idx":4,"proposition":"Billirubine"}],"ts":1634577366,"type":"custom","difficulte":"1"}
-{"_id":"violence-gyn-ec85fb","context":null,"enonce":"With regard to sexual violence, which of these proposals are true?","item":"violence","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"16% of women say they have been raped or attempted rape in their lifetime"},{"correct":true,"justification":"True, DNA being fragile, it is necessary to take samples urgently to detect the presence of DNA to identify the aggressor","idx":1,"proposition":"A rape of less than 72 hours is a therapeutic emergency"},{"correct":false,"justification":"False, the lubricant may destroy the DNA or semen elements present in the vagina and thus \"contaminate\" the samples","idx":2,"proposition":"The clinical examination is done with caution, with a lubricated speculum"},{"correct":false,"justification":"False, the presence of toxic is made only if an element of the anamnesis or clinical examination indicates that there has been a possible consumption of toxics","idx":3,"proposition":"Among the samples systematically taken, we will look for STIs, the presence of pregnancy and the presence of toxic"},{"correct":true,"justification":"True, as well as the medical certificate that will be given to the patient or to the authorities in case of requisition","idx":4,"proposition":"Conventionally, among the documents given to the patient in case of rape there will be a prescription for emergency contraception, a prescription for preventive antibiotic therapy and a work stoppage"}],"ts":1634577371,"type":"custom","difficulte":"1"}
-{"_id":"diarrheechr-HGE-b8ea55","context":null,"enonce":"From what time frame do we talk about chronic diarrhea?","item":"diarrheechr","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"3 days"},{"correct":false,"justification":"","idx":1,"proposition":"5 days"},{"correct":false,"justification":"","idx":2,"proposition":"15 days"},{"correct":true,"justification":"True","idx":3,"proposition":"4 weeks"},{"correct":false,"justification":"","idx":4,"proposition":"6 weeks"}],"ts":1634577374,"type":"custom","difficulte":"1"}
-{"_id":"cirrhose-HGE-2a233f","context":null,"enonce":"Which of the following are signs of hepatic encephalopathy?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True, nycthemeral rhythm reversal","idx":0,"proposition":"Insomnia at night, hypersomnia during the day"},{"correct":true,"justification":"True","idx":1,"proposition":"Coma"},{"correct":true,"justification":"True, pyramid signs possible","idx":2,"proposition":"Babinsky sign"},{"correct":true,"justification":"True","idx":3,"proposition":"Behaviour change"},{"correct":false,"justification":"","idx":4,"proposition":"Jaundice"}],"ts":1634577376,"type":"custom","difficulte":"1"}
-{"_id":"341-urg-efe35975-2a15-49bd-9494-2bfbb644720e","context":null,"enonce":"Which of the following propositions are true with regard to febrile seizures?","item":"convulsionsped","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A generalized febrile attack of 16 minutes with a fever at 41 ° C, in a child of 3 years without post-critical deficit, without particular history, with a normal neurological examination requires a lumbar puncture."},{"correct":true,"justification":"True","idx":1,"proposition":"A generalized febrile attack of 2 minutes with a fever at 38.5 ° C, in a child of 3 months without post-critical deficit, without any particular history, with a normal neurological examination requires a lumbar puncture."},{"correct":true,"justification":"True","idx":2,"proposition":"A generalized febrile attack of 2 minutes with a fever at 38.5 ° C, in a child of 3 months without post-critical deficit, without particular history, with a normal neurological examination requires monitoring of 4 hours in hospital."},{"correct":true,"justification":"True","idx":3,"proposition":"A febrile seizure with a focal onset of 22 minutes with a fever at 38.5 ° C, in a child of 3 years without post-critical deficit, without particular history, with a normal neurological examination requires the introduction of a background epileptic treatment."},{"correct":true,"justification":"True","idx":4,"proposition":"All answers are right"}],"ts":1634577377,"type":"custom","difficulte":"1"}
-{"_id":"RGO-HGE-e71bea","context":null,"enonce":"Which of the following are true for the treatment of severe esophagitis?","item":"RGO","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Treatment relies on PEPs"},{"correct":true,"justification":"True","idx":1,"proposition":"Full dose PPI 8 weeks"},{"correct":false,"justification":"Mild esophagitis","idx":2,"proposition":"Half-dose PPI 4 weeks"},{"correct":false,"justification":"Prevention of recurrence","idx":3,"proposition":"PPIs minimum dose"},{"correct":false,"justification":"False","idx":4,"proposition":"Full dose PPI 4 weeks"}],"ts":1634577379,"type":"custom","difficulte":"1"}
-{"_id":"RCIU-gyn-336276","context":null,"enonce":"Which of the following proposals are among the risk situations where screening for HCV infection is recommended?","item":"RCIU","matiere":"gyn","propositions":[{"correct":false,"justification":"Before 1990","idx":0,"proposition":"Recent transfusion"},{"correct":false,"justification":"Asian origin","idx":1,"proposition":"African descent"},{"correct":true,"justification":"True","idx":2,"proposition":"HCV+ Entourage"},{"correct":true,"justification":"True","idx":3,"proposition":"Drug addiction"},{"correct":true,"justification":"True","idx":4,"proposition":"HIV infection"}],"ts":1634577381,"type":"custom","difficulte":"2"}
-{"_id":"recomedic-therapeutique-bdb5a6","context":null,"enonce":"Which of the following are true?","item":"recomedic","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A generic must have a qualitative composition in active substance equivalent to that of the originator medicinal product "},{"correct":true,"justification":"True","idx":1,"proposition":"A generic must have a quantitative active substance composition equivalent to that of the originator medicinal product "},{"correct":false,"justification":"Same scientific name but trade name (trademark) protected by intellectual property","idx":2,"proposition":"A generic can have the same trade name as the originator drug"},{"correct":true,"justification":"True","idx":3,"proposition":"A generic may be offered by the pharmacist instead of an originator drug"},{"correct":false,"justification":"Excipients differ","idx":4,"proposition":"A generic has excipients exactly identical to the originator drug"}],"ts":1634577382,"type":"custom","difficulte":"2"}
-{"_id":"309-onco-76552a7b-16c5-4b9a-9935-487e7c99d133","context":null,"enonce":"Which of the following proposals regarding breast cancer is true?","item":"Kcsein","matiere":"onco","propositions":[{"correct":true,"justification":"True. Extension assessment to be carried out if invasive cancer T3\/T4 or N+","idx":0,"proposition":"Extension assessment is indicated in case of invasive ductal carcinoma stage T3"},{"correct":true,"justification":"True. The extension assessment is based on: TAP CT + bone scintigraphy OR PET-CT. Chest X-ray + abdo echo + bone scintigraphy is no longer done today (reason why it has disappeared from some referentials)","idx":1,"proposition":"The extension assessment can be based on the couple CT-TAP + bone scintigraphy"},{"correct":true,"justification":"True since the tumor is at the T2N0Mx stage. So no need a priori for an extension assessment if we stick to the recommendations of the reference system","idx":2,"proposition":"A patient with invasive ductal carcinoma of 3 cm on mammogram without lymph node involvement will not need an extension workup (a priori)"},{"correct":false,"justification":"FALSE, archi false!! The risk of lymphedema of the upper limb is major if we do this! This is a contraindication. For information, upper limb lymphedema and its management fell at the 2021 national white competition","idx":3,"proposition":"In case of axillary dissection, radiotherapy of the axillary hollow will be performed in addition "},{"correct":true,"justification":"TRUE: \r\n- Before menopause: anti-estrogens \r\n- After menopause: anti-aromatase \r\n\r\nDiscriminating notion: It is said in the course that anti-estrogens are responsible for endometrial cancers while they have a beneficial action on breast cancer...\r\n\r\nThis is because they act: \r\n- on receptors in the breast as inhibitors to the action of estrogen = rotector role against cancer \r\n\r\n- on endometrial receptors as ACTIVATORS to the action of estrogen = pro-oncogenic","idx":4,"proposition":"The hormone therapy of choice after menopause are anti-aromatase "}],"ts":1634577384,"type":"custom","difficulte":"1"}
-{"_id":"diverticulose-HGE-c4d588","context":null,"enonce":"At what stage of the Hinchey classification is surgery mandatory?","item":"diverticulose","matiere":"HGE","propositions":[{"correct":false,"justification":"Radiological drainage possible (if >3-5 cm depending on the source)","idx":0,"proposition":"Ib"},{"correct":false,"justification":"Radiological drainage possible (if >3-5 cm depending on the source)","idx":1,"proposition":"II"},{"correct":true,"justification":"True, resection surgery (sigmoidectomy)","idx":2,"proposition":"III"},{"correct":false,"justification":"","idx":3,"proposition":"IV"},{"correct":false,"justification":"","idx":4,"proposition":"It is always mandatory"}],"ts":1634577385,"type":"custom","difficulte":"1"}
-{"_id":"systemeconv-sp-4bbb34","context":null,"enonce":"Outside the care pathway, what percentage of the tariff is covered by social security (excluding exceptions such as emergencies)?","item":"systemeconv","matiere":"sp","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"0 %"},{"correct":true,"justification":"True","idx":1,"proposition":"30 %"},{"correct":false,"justification":"","idx":2,"proposition":"15 %"},{"correct":false,"justification":"","idx":3,"proposition":"50 %"},{"correct":false,"justification":"This is the case when it is in the care pathway","idx":4,"proposition":"70 %"}],"ts":1634577387,"type":"custom","difficulte":"1"}
-{"_id":"Exprenuptial-gyn-cc61c0","context":null,"enonce":"Regarding vaccination in pregnant women. Which vaccine(s) are not recommended during pregnancy?","item":"Exprenuptial","matiere":"gyn","propositions":[{"correct":true,"justification":"True. It is not a live vaccine so it is not contraindicated during pregnancy, but it is not recommended to vaccinate pregnant women in France. On the other hand, it is desirable to vaccinate women before or after childbirth. ","idx":0,"proposition":"Whooping cough"},{"correct":true,"justification":"True. It is a live vaccine and therefore contraindicated in pregnant women. On the other hand, it is recommended to vaccinate all women with rubella-negative serology pre-conceptional. Women who have received 2 prior vaccinations should not be vaccinated, regardless of the result of serology if it is performed. Due to the teratogenic risk, it is necessary to ensure the absence of an early pregnancy and to avoid any pregnancy within 2 months of vaccination. ","idx":1,"proposition":"Rubella"},{"correct":true,"justification":"True. It is a live vaccine with a teratogenic risk. Women of childbearing age who have no history of chickenpox should be vaccinated. Vaccination is possible if the pregnancy test is negative. Effective contraception for 3 months is recommended after each dose of vaccine. ","idx":2,"proposition":"Chickenpox"},{"correct":false,"justification":"The flu vaccine is recommended for pregnant women because pregnant women are a population at risk of severe influenza (fetal death and maternal death, refractory hypoxemia, etc.). ","idx":3,"proposition":"Influenza"},{"correct":true,"justification":"True. It is a live vaccine, therefore teratogenic. ","idx":4,"proposition":"Measles"}],"ts":1634577390,"type":"custom","difficulte":"2"}
-{"_id":"ADP-hemato-0527d5","context":null,"enonce":"Which of the following are differential diagnoses (DD) of right supraclavicular lymphadenopathy?","item":"ADP","matiere":"hemato","propositions":[{"correct":false,"justification":"It would give lymphadenopathy of the submandibular chain","idx":0,"proposition":"Mandibular cancer"},{"correct":false,"justification":"Not a DD but a sign + lymphadenopathy would be on the left","idx":1,"proposition":"Digestive cancer"},{"correct":true,"justification":"True","idx":2,"proposition":"Brachial plexus schwannoma"},{"correct":true,"justification":"True","idx":3,"proposition":"Cancer of the pulmonary apex"},{"correct":false,"justification":"It would give pre-laryngeal lymphadenopathy","idx":4,"proposition":"Cyst of the thyroglossal tract"}],"ts":1634577391,"type":"custom","difficulte":"2"}
-{"_id":"droits-sp-10d132","context":null,"enonce":"How many years should a medical record be kept after a person's death?","item":"droits","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"10 years"},{"correct":false,"justification":"False","idx":1,"proposition":"14 years"},{"correct":false,"justification":"False","idx":2,"proposition":"20 years"},{"correct":false,"justification":"False","idx":3,"proposition":"25 years"},{"correct":false,"justification":"False","idx":4,"proposition":"5 years"}],"ts":1634577395,"type":"custom","difficulte":"1"}
-{"_id":"231-cardio-9be21691-9029-415e-8cea-575cd0b315a5","context":null,"enonce":"Which of the following signs indicate the severity of aortic insufficiency?","item":"valvuloP","matiere":"cardio","propositions":[{"correct":false,"justification":"FALSE: The breath of aortic insufficiency is HOLODIASTOLIC decrescendo. The ejective systolic murmur is not a sign of severity but an added noise that can be heard in the IAo","idx":0,"proposition":"Ejective systolic murmur "},{"correct":true,"justification":"True","idx":1,"proposition":"Proto-diastolic gallop (B3)"},{"correct":false,"justification":"FALSE: Abolition of B2 is a criterion of severity of aortic stricture","idx":2,"proposition":"Abolition of B2"},{"correct":false,"justification":"","idx":3,"proposition":"A surface area < 0.6 cm²\/m² at the ETT"},{"correct":true,"justification":"True. In total, the signs of severity of aortic insufficiency are: - apexian flint rolling (= functional mitral narrowing) - protodiastolic gallop (B3) - enlargement of the peak shock - the regurgitated volume > 60 mL at ETT ","idx":4,"proposition":"A regurgitating volume > 60 mL at ETT"}],"ts":1634577397,"type":"custom","difficulte":"1"}
-{"_id":"Kcphysiopath-onco-367503","context":null,"enonce":"Regarding Lynch syndrome:","item":"Kcphysiopath","matiere":"onco","propositions":[{"correct":true,"justification":"True, MisMatch Repair -> we can no longer repair errors😥","idx":0,"proposition":"The gene is caused is part of the MMR system"},{"correct":false,"justification":"Dominant","idx":1,"proposition":"It is autosomal recessive"},{"correct":true,"justification":"True","idx":2,"proposition":"One of the genes involved is MSH2"},{"correct":false,"justification":"","idx":3,"proposition":"All propositions are true"},{"correct":true,"justification":"True","idx":4,"proposition":"The risk of developing colorectal cancer is 70 to 80% over the course of a lifetime."}],"ts":1634577399,"type":"custom","difficulte":"1"}
-{"_id":"cirrhose-HGE-0faf02","context":null,"enonce":"Which of the following are true about Meld's score?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It evaluates the prognosis of cirrhosis"},{"correct":true,"justification":"True","idx":1,"proposition":"It contains bilirubin"},{"correct":true,"justification":"True","idx":2,"proposition":"It includes INR"},{"correct":true,"justification":"True","idx":3,"proposition":"It includes serum creatinine"},{"correct":false,"justification":"This is the case of the score of Lille","idx":4,"proposition":"It contains albumin"}],"ts":1634577400,"type":"custom","difficulte":"1"}
-{"_id":"droits-sp-a08e34","context":null,"enonce":"How many years should a medical record of a minor patient be kept?","item":"droits","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"10 years after reaching the age of majority"},{"correct":true,"justification":"True","idx":1,"proposition":"Until he turned 28"},{"correct":false,"justification":"","idx":2,"proposition":"5 years"},{"correct":false,"justification":"","idx":3,"proposition":"15 years"},{"correct":false,"justification":"","idx":4,"proposition":"25 years"}],"ts":1634577402,"type":"custom","difficulte":"1"}
-{"_id":"diverticulose-HGE-b17750","context":null,"enonce":"Which of the following is an additional examination(s) to be performed to confirm diverticulitis?","item":"diverticulose","matiere":"HGE","propositions":[{"correct":false,"justification":"Useless, we see nothing 🙈","idx":0,"proposition":"Abdominal ultrasound"},{"correct":true,"justification":"True, cornerstone of diagnosis. We see diverticula, a colonic wall > 4mm, and fatty infiltration","idx":1,"proposition":"Abdominal angioscan"},{"correct":false,"justification":"Transaminases are useless. A NFS-P CRP (for PNN hyperleuco and biological inflammatory syndrome) Creatinine (before angioscan) is done. In women of childbearing age who do not have well-followed contraception, it is thought to ask for DDR +\/- b-HCG 🙃","idx":2,"proposition":"NFS CRP Transaminases"},{"correct":false,"justification":"","idx":3,"proposition":"Abdominal-pelvic MRI"},{"correct":false,"justification":"Don't go too far ahead on confirming diverticulitis 😬","idx":4,"proposition":"Digital rectal examination"}],"ts":1634577403,"type":"custom","difficulte":"1"}
-{"_id":"PF-neuro-a0ec41","context":null,"enonce":"Which of the following are true about peripheral facial paralysis?","item":"PF","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The motor deficit is homogeneous"},{"correct":true,"justification":"True","idx":1,"proposition":"There is no automatic-voluntary dissociation"},{"correct":true,"justification":"True","idx":2,"proposition":"It concerns damage to the facial nerve VII"},{"correct":false,"justification":"No dissociation","idx":3,"proposition":"There is a frank automatic-voluntary dissociation"},{"correct":false,"justification":"It is homogeneous (sup + inf)","idx":4,"proposition":"The motor deficit concerns only the lower part of the face"}],"ts":1634577408,"type":"custom","difficulte":"2"}
-{"_id":"lithiaseB-HGE-b87242","context":null,"enonce":"Which of the following are treatments for acute cholecystitis?","item":"lithiaseB","matiere":"HGE","propositions":[{"correct":false,"justification":"Accurate for isolated hepatic colic","idx":0,"proposition":"Therapeutic abstention"},{"correct":true,"justification":"True","idx":1,"proposition":"Antibiotics"},{"correct":true,"justification":"True","idx":2,"proposition":"Filling"},{"correct":true,"justification":"True","idx":3,"proposition":"Emergency cholecystectomy"},{"correct":false,"justification":"Cholangitis","idx":4,"proposition":"ERPC"}],"ts":1634577410,"type":"custom","difficulte":"1"}
-{"_id":"Kcdermato-onco-d2a141","context":null,"enonce":"Which of the following is the main precursor of cutaneous squamous cell carcinomas?","item":"Kcdermato","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Actinic keratosis"},{"correct":false,"justification":"It is the main precursor of mucosal squamous cell carcinomas","idx":1,"proposition":"Leukoplakia"},{"correct":false,"justification":"Bright red erythematous lesion of the glans, well\r\nlimited, sometimes discreetly erosive -> it is carcinoma in situ","idx":2,"proposition":"Erythroplasia of Queyrat"},{"correct":false,"justification":"Benign epithelial tumor due to HPV2","idx":3,"proposition":"Common wart"},{"correct":false,"justification":"Benign epithelial tumor without malignant potential","idx":4,"proposition":"Condyloma"}],"ts":1634577412,"type":"custom","difficulte":"2"}
-{"_id":"Kcdermato-onco-a845ea","context":null,"enonce":"Which of the following are tumours with a risk factor for sun exposure?","item":"Kcdermato","matiere":"onco","propositions":[{"correct":true,"justification":"True, short sun exposure, no precancerous lesion, clear phenotype","idx":0,"proposition":"Basal cell carcinoma"},{"correct":true,"justification":"True, solar burns in childhood","idx":1,"proposition":"Melanoma"},{"correct":true,"justification":"True, chronic and prolonged sun exposure","idx":2,"proposition":"Squamous cell carcinoma"},{"correct":false,"justification":"False","idx":3,"proposition":"Condyloma"},{"correct":false,"justification":"False","idx":4,"proposition":"The nevus"}],"ts":1634577415,"type":"custom","difficulte":"2"}
-{"_id":"Kcprostate-onco-c3a3bc","context":null,"enonce":"Which of the following propositions are true about brachytherapy?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is a permanent implantation of iodine-125 grains perineally under ultrasound control"},{"correct":false,"justification":"This is done under AG or AL","idx":1,"proposition":"Anesthesia is general"},{"correct":false,"justification":"As well as two subgroups of intermediate risks: PSA between 10 and 15 and\/or presence of minority grade 4 (GG2)","idx":2,"proposition":"It concerns the low-risk group of Amico exclusively"},{"correct":true,"justification":"True","idx":3,"proposition":"It is contraindicated if the prostate is more than 60 mL"},{"correct":false,"justification":"This is the standard treatment option with the lowest risk of leading to erectile dysfunction.","idx":4,"proposition":"The risk of erectile dysfunction is maximum "}],"ts":1634577417,"type":"custom","difficulte":"3"}
-{"_id":"systemeconv-sp-7f7ffa","context":null,"enonce":"Which of the following are PSRs for treating physicians?","item":"systemeconv","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Diabetes monitoring"},{"correct":true,"justification":"True","idx":1,"proposition":"Monitoring hypertension"},{"correct":true,"justification":"True","idx":2,"proposition":"Breast cancer screening"},{"correct":false,"justification":"","idx":3,"proposition":"Screening for Alzeihmer's disease"},{"correct":false,"justification":"Prescription of generics (in INN)","idx":4,"proposition":"Prescription of originators"}],"ts":1634577418,"type":"custom","difficulte":"1"}
-{"_id":"choc-urg-b97eef","context":null,"enonce":"Which of the following proposals are shocks with decreased cardiac output?","item":"choc","matiere":"urg","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"Anaphylactic shock"},{"correct":false,"justification":"= Septic shock","idx":1,"proposition":"Vasoplegic shock"},{"correct":false,"justification":"","idx":2,"proposition":"Septic shock"},{"correct":true,"justification":"True, DC = LVEF x FC. Decrease in LVEF in hypovolemic shock","idx":3,"proposition":"Hypovolemic shock"},{"correct":true,"justification":"True, DC = LVEF x FC. Decreased HR in cardiogenic shock","idx":4,"proposition":"Cardiogenic shock"}],"ts":1634577420,"type":"custom","difficulte":"1"}
-{"_id":"HTA-cardio-91445c","context":null,"enonce":"What are the real proposals?","item":"HTA","matiere":"cardio","propositions":[{"correct":false,"justification":"False, renin is the enzyme that cleaves angiotensinogen into angiotensin I. Angiotensinogen is of hepatic origin. Renin is of renal origin","idx":0,"proposition":"Renin is responsible for the secretion of angiotensinogens that will be metabolized to give angiotensin I"},{"correct":true,"justification":"True, renin is secreted in response to sympathetic nervous system stimulation, hypovolemia or increased natriuresis","idx":1,"proposition":"Autonomic neuropathy may decrease renin secretion"},{"correct":false,"justification":"False, angiotensin vasoconstrict large vessels as well as efferent arterioles of the glomeruli","idx":2,"proposition":"Angiotensin II is a powerful vasodilator"},{"correct":true,"justification":"True, angiotensin II stimulates vasoconstriction as well as adrenal aldosterone secretion","idx":3,"proposition":"Angiotensin stimulates the secretion of aldosterone"},{"correct":false,"justification":"","idx":4,"proposition":" "}],"ts":1634577423,"type":"custom","difficulte":"2"}
-{"_id":"IC-cardio-93abcf","context":null,"enonce":"Which of the following are causes of dilated cardiomyopathies?","item":"IC","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Myocarditis"},{"correct":true,"justification":"True","idx":1,"proposition":"Myopericarditis"},{"correct":true,"justification":"True","idx":2,"proposition":"Vitamin B1 deficiency"},{"correct":false,"justification":"Rather hypertrophic cardiomyopathy","idx":3,"proposition":"High blood pressure"},{"correct":false,"justification":"Cause of heart failure","idx":4,"proposition":"Valvular heart disease"}],"ts":1634577425,"type":"custom","difficulte":"2"}
-{"_id":"systemeconv-sp-d68e28","context":null,"enonce":"How many health professionals are there in France approximately?","item":"systemeconv","matiere":"sp","propositions":[{"correct":false,"justification":"This is the approximate number of doctors","idx":0,"proposition":"200 000"},{"correct":false,"justification":"False","idx":1,"proposition":"1 million"},{"correct":true,"justification":"True","idx":2,"proposition":"2 million"},{"correct":false,"justification":"False","idx":3,"proposition":"5 million"},{"correct":false,"justification":"False","idx":4,"proposition":"10 million"}],"ts":1634577427,"type":"custom","difficulte":"1"}
-{"_id":"cirrhose-HGE-56b2e3","context":null,"enonce":"What is the estimated survival of 1 year for Child Pugh A?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"100 %"},{"correct":false,"justification":"This is the case for Child Pugh C","idx":1,"proposition":"45 %"},{"correct":false,"justification":"","idx":2,"proposition":"90 %"},{"correct":false,"justification":"This is the case for Child Pugh B","idx":3,"proposition":"80 %"},{"correct":false,"justification":"","idx":4,"proposition":"5 %"}],"ts":1634577431,"type":"custom","difficulte":"1"}
-{"_id":"103-neuro-d13dad8b-c047-4d22-86ba-572afafe52bb","context":null,"enonce":"Regarding infant epilepsy. Which of the following are true?","item":"epilepsie","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A fall of the head with elevation of the arms must evoke West Syndrome."},{"correct":false,"justification":"False: infantile spasms of West syndrome are to be distinguished from myoclonus","idx":1,"proposition":"Myoclonus in flexion should evoke West Syndrome."},{"correct":false,"justification":"False: EEG hypsarrhythmia","idx":2,"proposition":"Psychomotor regression or stagnation of acquisitions associated with MRI hypsarrhythmia should suggest West Syndrome."},{"correct":true,"justification":"True","idx":3,"proposition":"Dravet syndrome is rare, and usually gives an intellectual disability"},{"correct":true,"justification":"True","idx":4,"proposition":"Dravet syndrome is resistant to treatment"}],"ts":1634577432,"type":"custom","difficulte":"1"}
-{"_id":"Frped-urg-34521e","context":null,"enonce":"Which of the following are true?","item":"Frped","matiere":"urg","propositions":[{"correct":false,"justification":"Traumatology is the leading cause of death between the ages of 1 and 19 years","idx":0,"proposition":"Cancers are the leading cause of death between the ages of 1 and 19"},{"correct":true,"justification":"","idx":1,"proposition":"Before two years any trauma with invoice must always evoke abuse"},{"correct":true,"justification":"","idx":2,"proposition":"Solitary bone cyst is a cause of pathological fracture"},{"correct":true,"justification":"","idx":3,"proposition":"The ligament structures of the child are more resistant than the metaphyses"},{"correct":false,"justification":"They are rarer","idx":4,"proposition":"True sprains and isolated dislocations are more common than fractures"}],"ts":1634577434,"type":"custom","difficulte":"2"}
-{"_id":"RCIU-gyn-0078e7","context":null,"enonce":"Which of the following proposals reduces the risk of hyaline membrane disease in premature infants?","item":"RCIU","matiere":"gyn","propositions":[{"correct":false,"justification":"Used for tocolysis","idx":0,"proposition":"Salbutamol"},{"correct":false,"justification":"Used for tocolysis","idx":1,"proposition":"Anti-calcium"},{"correct":true,"justification":"True","idx":2,"proposition":"Corticosteroids"},{"correct":false,"justification":"False","idx":3,"proposition":"NSAIDs"},{"correct":false,"justification":"Counteracts the risk of hypoglycemia","idx":4,"proposition":"Glucose"}],"ts":1634577437,"type":"custom","difficulte":"2"}
-{"_id":"aNcycle-gyn-c246f6","context":null,"enonce":"Regarding the abnormalities of the menstrual cycle which of these propositions are true?","item":"aNcycle","matiere":"gyn","propositions":[{"correct":false,"justification":"Wrong, it's the other way around. In addition, the terms oligomenorrhea and spaniomenorrhea are synonymous.","idx":0,"proposition":"Hypomenorrhea are too infrequent, while oligomenorrhea are too low periods"},{"correct":true,"justification":"True, this is what corresponds to the rating of the Higham score which must be >100 to talk about menorrhagia","idx":1,"proposition":"To assess the abundance of gynaecological bleeding at the interrogation it is necessary to ask the number of protections used as well as the amount of blood on them."},{"correct":true,"justification":"True, hence the adage \"every woman of childbearing age is pregnant until proven otherwise\"","idx":2,"proposition":"Pregnancy should be systematically considered and ruled out by a BHCG assay"},{"correct":false,"justification":"False, in front of bleeding and a positive pregnancy test, the first cause to eliminate is ectopic pregnancy.","idx":3,"proposition":"Bleeding associated with a positive BHCG assay should eliminate a spontaneous miscarriage as a first line"},{"correct":true,"justification":"True, but also adenomyosis, bleeding disorders etc...","idx":4,"proposition":"Causes of menometrorrhagia include fibroids, myomas or endometrial cancers."}],"ts":1634577439,"type":"custom","difficulte":"1"}
-{"_id":"polytrauma-urg-acf900","context":null,"enonce":"Which of the following proposals regarding the hospital management of a polytraumatized patient are true?","item":"polytrauma","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The biological assessment of a polytrauma patient necessarily contains the grouping and search for RAI"},{"correct":false,"justification":"False, in the middle cerebral arteries","idx":1,"proposition":"Transcranial Doppler looks for cerebral hypoperfusion in the anterior communicating artery. "},{"correct":false,"justification":"False, FAST is a rapid abdominal, pleural and cardiac ultrasound. ","idx":2,"proposition":"FAST ultrasound verifies the integrity of the vascular axes of the 4 limbs"},{"correct":false,"justification":"False, the whole body scanner is performed in 2nd step, without, then with injection of iodinated contrast medium. ","idx":3,"proposition":"The BodyCT, performed during the 3rd phase of management as part of the lesion assessment, is a whole body scanner without injection. "},{"correct":true,"justification":"True","idx":4,"proposition":"The thoracic part of the bodyCT allows among other things to find the 10-20% of pneumothorax that are not visible on the standard X-ray"}],"ts":1634577440,"type":"custom","difficulte":"2"}
-{"_id":"Kcphysiopath-onco-3cf87f","context":null,"enonce":"Which of the following proposals designate oncogenic viruses?","item":"Kcphysiopath","matiere":"onco","propositions":[{"correct":true,"justification":"True, T-cell lymphoma","idx":0,"proposition":"HTLV1"},{"correct":true,"justification":"True","idx":1,"proposition":"HBV"},{"correct":true,"justification":"True","idx":2,"proposition":"EBV"},{"correct":true,"justification":"True","idx":3,"proposition":"HPV"},{"correct":false,"justification":"It's not a virus (sorry 😘)","idx":4,"proposition":"Helicobacter Pylori"}],"ts":1634577442,"type":"custom","difficulte":"1"}
-{"_id":"nvxne-gyn-e942da","context":null,"enonce":"Which of the following are the following proposals for a normal umbilical cord?","item":"nvxne","matiere":"gyn","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"2 arteries and 2 veins"},{"correct":false,"justification":"False","idx":1,"proposition":"3 arteries and 1 vein"},{"correct":false,"justification":"False","idx":2,"proposition":"1 artery and 1 vein"},{"correct":false,"justification":"False","idx":3,"proposition":"1 artery and 2 veins"},{"correct":true,"justification":"True","idx":4,"proposition":"2 arteries and 1 vein"}],"ts":1634577444,"type":"custom","difficulte":"1"}
-{"_id":"ascite-HGE-c20168","context":null,"enonce":"Regarding albumin compensation:","item":"ascite","matiere":"HGE","propositions":[{"correct":false,"justification":"From a certain volume (2L or 5L depending on the source)","idx":0,"proposition":"It is done regardless of the volume of ascites punctured"},{"correct":false,"justification":"Human albumin","idx":1,"proposition":"It is made from calf albumin"},{"correct":false,"justification":"Less than 10 g","idx":2,"proposition":"1 L of ascites corresponds to 20 g of albumin"},{"correct":false,"justification":"","idx":3,"proposition":"It is only below a certain blood pressure threshold"},{"correct":true,"justification":"True","idx":4,"proposition":"All proposals are wrong"}],"ts":1634637669,"type":"custom","difficulte":"1"}
-{"_id":"diarrheechr-HGE-bf894c","context":null,"enonce":"Which of the following are causes of osmotic diarrhea (by attraction of water into the intestinal lumen)?","item":"diarrheechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Taking osmotic laxatives"},{"correct":false,"justification":"Diarrhea due to malabsorption","idx":1,"proposition":"Celiac disease"},{"correct":false,"justification":"No diarrhea","idx":2,"proposition":"Sigmoid"},{"correct":false,"justification":"Diarrhea with normal transit","idx":3,"proposition":"Irritable bowel syndrome"},{"correct":true,"justification":"True","idx":4,"proposition":"Lactase deficiency"}],"ts":1634637671,"type":"custom","difficulte":"1"}
-{"_id":"MSN-urg-1aed96","context":null,"enonce":"Which of the following are true?","item":"MSN","matiere":"urg","propositions":[{"correct":false,"justification":"NIMs would occur more frequently when the socio-economic conditions of the family are unfavourable.","idx":0,"proposition":"NIMs would occur more frequently when the socio-economic conditions of the family are favourable."},{"correct":false,"justification":"Co-sleeping (the fact that the infant sleeps in the same bed as the parents) is a risk factor for MIN.","idx":1,"proposition":"To avoid unexpected infant death, co-sleeping should be encouraged."},{"correct":true,"justification":"True","idx":2,"proposition":"Unexpected infant death most often occurs in infants between 2 and 4 months of age"},{"correct":true,"justification":"","idx":3,"proposition":"In France, approximately 500 infants under 2 years of age die unexpectedly annually"},{"correct":false,"justification":"Between 18 and 20ºC","idx":4,"proposition":"To prevent unexpected infant death, the temperature of the chamber should be maintained at 24ºC."}],"ts":1634637676,"type":"custom","difficulte":"2"}
-{"_id":"pancreatitechr-HGE-cf07cc","context":null,"enonce":"What is the main etiology of chronic calcifying pancreatitis in developed countries?","item":"pancreatitechr","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"Obesity"},{"correct":false,"justification":"","idx":1,"proposition":"Malnutrition"},{"correct":true,"justification":"True","idx":2,"proposition":"Alcohol"},{"correct":false,"justification":"","idx":3,"proposition":"Tobacco"},{"correct":false,"justification":"","idx":4,"proposition":"Genetics"}],"ts":1634637683,"type":"custom","difficulte":"1"}
-{"_id":"PF-neuro-611a47","context":null,"enonce":"Which of the following are signs of facial paralysis?","item":"PF","matiere":"neuro","propositions":[{"correct":false,"justification":"No ptosis but, on the contrary, a difficulty in closing the eye","idx":0,"proposition":"Ptosis of the eye"},{"correct":false,"justification":"False","idx":1,"proposition":"Enlargement of the palpebral cleft"},{"correct":true,"justification":"True","idx":2,"proposition":"Sign of Charles Bell"},{"correct":true,"justification":"True","idx":3,"proposition":"Erasure of forehead wrinkles"},{"correct":true,"justification":"True","idx":4,"proposition":"Eye ectropion "}],"ts":1634637698,"type":"custom","difficulte":"1"}
-{"_id":"Kcprostate-onco-f8920d","context":null,"enonce":"Which of the following are true about abiraterone acetate?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is contraindicated in case of treatment-refractory hypertension"},{"correct":true,"justification":"True","idx":1,"proposition":"The appearance of oedema should be monitored"},{"correct":false,"justification":"It is hepatic","idx":2,"proposition":"Toxicity is renal"},{"correct":false,"justification":"Hypokalemia","idx":3,"proposition":"It can cause hyperkalemia"},{"correct":false,"justification":"The toxicity of prednisone 10mg\/day should be monitored","idx":4,"proposition":"Concomitant corticosteroid therapy is too low to require monitoring"}],"ts":1634637711,"type":"custom","difficulte":"2"}
-{"_id":"lithiaseB-HGE-bb9d49","context":null,"enonce":"What is the proportion of asymptomatic cholelithiasis?","item":"lithiaseB","matiere":"HGE","propositions":[{"correct":false,"justification":"The majority are asympto!","idx":0,"proposition":"0%"},{"correct":true,"justification":"True","idx":1,"proposition":"80%"},{"correct":false,"justification":"","idx":2,"proposition":"20%"},{"correct":false,"justification":"","idx":3,"proposition":"50%"},{"correct":false,"justification":"","idx":4,"proposition":"99%"}],"ts":1634637716,"type":"custom","difficulte":"1"}
-{"_id":"ictere-HGE-38fc66","context":null,"enonce":"Which of the following are true?","item":"ictere","matiere":"HGE","propositions":[{"correct":false,"justification":"Red blood cells","idx":0,"proposition":"Bilirubin is a breakdown product of platelets"},{"correct":true,"justification":"True, upstream of the liver so unconjugated","idx":1,"proposition":"Hemolysis is a possible etiology of unconjugated bilirubin jaundice"},{"correct":true,"justification":"True","idx":2,"proposition":"Gilbert's disease is inherited autosomal recessive"},{"correct":false,"justification":"","idx":3,"proposition":"All propositions are true"},{"correct":false,"justification":"It's in micromoles 😊","idx":4,"proposition":"A normal billirubine is below about 20 millimoles"}],"ts":1634637720,"type":"custom","difficulte":"1"}
-{"_id":"RCIU-gyn-bcb818","context":null,"enonce":"What is the prevalence of pregnant women not immune to toxoplasmosis?","item":"RCIU","matiere":"gyn","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"2%"},{"correct":false,"justification":"False","idx":1,"proposition":"5%"},{"correct":false,"justification":"False","idx":2,"proposition":"12%"},{"correct":false,"justification":"False","idx":3,"proposition":"20%"},{"correct":true,"justification":"True","idx":4,"proposition":"50%"}],"ts":1634637726,"type":"custom","difficulte":"2"}
-{"_id":"greffe-immuno-49d9e1","context":null,"enonce":"Which of the following are true about corneal transplantation?","item":"greffe","matiere":"immuno","propositions":[{"correct":false,"justification":"Existing and mandatory national waiting list","idx":0,"proposition":"Unlike other types of transplants, there is no national waiting list for corneal transplantation."},{"correct":false,"justification":"The eye stays in place, we just scalp the cornea","idx":1,"proposition":"It consists, in the donor, in removing the eyeball"},{"correct":false,"justification":"No impact of age or abnormalities of refraction","idx":2,"proposition":"Myopic corneas cannot be removed"},{"correct":true,"justification":"True","idx":3,"proposition":"The transplant success rate is high (>80%)"},{"correct":true,"justification":"True","idx":4,"proposition":"Hepatitis infection is a contraindication to corneal sampling"}],"ts":1635177954,"type":"custom","difficulte":"2"}
-{"_id":"dlrabdogrossesse-gyn-d4d2f9","context":null,"enonce":"Which of the following propositions are true regarding uterine rupture?","item":"dlrabdogrossesse","matiere":"gyn","propositions":[{"correct":true,"justification":"True. Text the explanatory sentence of the msd manual: https:\/\/www.msdmanuals.com\/fr\/professional\/gyn%C3%A9cologie-et-obst%C3%A9trique\/anomalies-et-complications-du-travail-et-de-accouchement\/rupture-ut%C3%A9rine","idx":0,"proposition":"Uterine rupture is a spontaneous tear of the uterus that can cause the fetus to expel into the peritoneal cavity."},{"correct":true,"justification":"True","idx":1,"proposition":"We think about it especially in case of history of caesarean section"},{"correct":false,"justification":"It is an absolute emergency, putting the child's ⚡ prognosis at stake","idx":2,"proposition":"The vital prognosis of the fetus is not at risk in the short term"},{"correct":false,"justification":"sudden acute pain, uterine deformity, red blood metrorrhagia (arterial) 🔴","idx":3,"proposition":"We find the triad: chronic pain gradually ascending, uterine deformity, metrorrhagia of blackish ⚫ blood"},{"correct":true,"justification":"True","idx":4,"proposition":"Fetal heart rhythm abnormalities are almost always found"}],"ts":1635177965,"type":"custom","difficulte":"2"}
-{"_id":"MSN-urg-34a157","context":null,"enonce":"Which of the following are systematic additional reviews for INM? (based on HAS, 2009)","item":"MSN","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"CT or MRI Brain"},{"correct":true,"justification":"True","idx":1,"proposition":"Chest X-ray"},{"correct":false,"justification":"Front only","idx":2,"proposition":"X-ray of the profile pelvis"},{"correct":false,"justification":"Front only","idx":3,"proposition":"X-ray of the front and profile limbs"},{"correct":true,"justification":"True","idx":4,"proposition":"X-ray of the spine from the front and profile"}],"ts":1635177983,"type":"custom","difficulte":"2"}
-{"_id":"RGO-HGE-4b2478","context":null,"enonce":"How often is endobrachyoesophageal monitoring longer than 6 centimeters?","item":"RGO","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Every 2 years"},{"correct":false,"justification":"Less than 3 cm","idx":1,"proposition":"Every 5 years"},{"correct":false,"justification":"between 3 and 6 cm","idx":2,"proposition":"Every 3 years"},{"correct":false,"justification":"An OBE is always monitored","idx":3,"proposition":"No monitoring"},{"correct":true,"justification":"True","idx":4,"proposition":"An OBE is always monitored"}],"ts":1635177986,"type":"custom","difficulte":"1"}
-{"_id":"MAI-immuno-3e6660","context":null,"enonce":"Which of the following proposals is (are) a marker(s) of organ-specific autoimmune diseases?","item":"MAI","matiere":"immuno","propositions":[{"correct":true,"justification":"True, autoimmune diseases of the intestine","idx":0,"proposition":"Anti-transglutaminase antibodies"},{"correct":false,"justification":"","idx":1,"proposition":"Anti-nuclear antibodies"},{"correct":false,"justification":"","idx":2,"proposition":"Anti-cytoplasmic antibodies of neutrophils"},{"correct":true,"justification":"True, primary biliary cholangitis","idx":3,"proposition":"Anti-mitochondrial antibodies of type M2"},{"correct":false,"justification":"","idx":4,"proposition":"Anti-JO1 antibodies"}],"ts":1635177988,"type":"custom","difficulte":"1"}
-{"_id":"cephalee-neuro-a946d7","context":null,"enonce":"What is the examination to request in first line in case of suspicion of non-traumatic subarachnoid hemorrhage?","item":"cephalee","matiere":"neuro","propositions":[{"correct":false,"justification":"False, rarely in the first intention","idx":0,"proposition":"Brain MRI"},{"correct":false,"justification":"False, IC if signs of commitment or ICH (common in case of subarachnoid hemorrhage)","idx":1,"proposition":"Microbiological"},{"correct":false,"justification":"False, useless for diagnosis","idx":2,"proposition":"Ultrasound of the carotid arteries"},{"correct":false,"justification":"False, not in the first intention","idx":3,"proposition":"Cerebral angiography"},{"correct":true,"justification":"True","idx":4,"proposition":"Brain scan"}],"ts":1635177990,"type":"custom","difficulte":"2"}
-{"_id":"nvxne-gyn-3ed036","context":null,"enonce":"Which of the following propositions are true about transfusion-transfusion syndrome (TTS)?","item":"nvxne","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is also known as feto-fetal transfusion syndrome "},{"correct":true,"justification":"True, 60-100% in severe cases (wikipedia)","idx":1,"proposition":"Morbidity and mortality rate is high"},{"correct":false,"justification":"False","idx":2,"proposition":"It concerns all multiple pregnancies"},{"correct":true,"justification":"True","idx":3,"proposition":"It concerns monochorionic twin pregnancies"},{"correct":true,"justification":"True, before 26 weeks ","idx":4,"proposition":"It appears in the first half of pregnancy "}],"ts":1635177992,"type":"custom","difficulte":"2"}
-{"_id":"puberte-gyn-78f51e","context":null,"enonce":"Which of the following are true?","item":"puberte","matiere":"gyn","propositions":[{"correct":true,"justification":"True. The onset of puberty is defined in girls by the appearance of breasts that occurs physiologically between 8 and 13 years of age.","idx":0,"proposition":"The onset of puberty is defined by the appearance of breasts (thelarche)."},{"correct":false,"justification":"The onset of puberty in boys is defined by the increase in testicular volume (volume > 4ml) observed between 9 and 14 years.","idx":1,"proposition":"The onset of puberty in boys is defined by an increase in the size of the penis."},{"correct":true,"justification":"True","idx":2,"proposition":"Voice molting in boys usually occurs between the ages of 14 and 15."},{"correct":true,"justification":"True On side in SX\/GX-PX Sometimes you can see AX that corresponds to the development of axillary pillosity that we also side in practice?","idx":3,"proposition":"The Tanner classification is used to assess an individual's pubertal development."},{"correct":false,"justification":"FALSE. There is no stage 0 in the Tanner classification. The absence of breast development corresponds to S1.","idx":4,"proposition":"In the Tanner classification, S0 corresponds to the absence of breast development."}],"ts":1635177994,"type":"custom","difficulte":"1"}
-{"_id":"systemeconv-sp-fe31ef","context":null,"enonce":"What is the amount of the medical deductible in the general case for a consultation with a doctor?","item":"systemeconv","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"1 euro"},{"correct":false,"justification":"","idx":1,"proposition":"2 euros"},{"correct":false,"justification":"","idx":2,"proposition":"0.5 euro"},{"correct":false,"justification":"","idx":3,"proposition":"0 euro"},{"correct":false,"justification":"","idx":4,"proposition":"5 eurs"}],"ts":1635177996,"type":"custom","difficulte":"1"}
-{"_id":"asthme-immuno-7c255c","context":null,"enonce":"Which of the following are true?","item":"asthme","matiere":"immuno","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Asthma is often associated with allergic rhinitis"},{"correct":false,"justification":"Per year","idx":1,"proposition":"Asthma is responsible for about 1000 deaths per month"},{"correct":false,"justification":"Chronic inflammatory disease","idx":2,"proposition":"Asthma is a chronic infectious disease"},{"correct":true,"justification":"True","idx":3,"proposition":"Asthma results from an interaction between genes and the environment"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"ts":1635178002,"type":"custom","difficulte":"2"}
-{"_id":"ETP-therapeutique-896ba0","context":null,"enonce":"Which of the following are true?","item":"ETP","matiere":"therapeutique","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Adherence is often better in chronic pathologies than in acute pathologies"},{"correct":true,"justification":"True","idx":1,"proposition":"Adherence is often better in acute pathologies than in chronic pathologies"},{"correct":true,"justification":"True","idx":2,"proposition":"Lack of adherence can cause treatment failure"},{"correct":true,"justification":"True","idx":3,"proposition":"Adherence can be improved by simplifying medication intake"},{"correct":true,"justification":"True","idx":4,"proposition":"Generics can help reduce healthcare costs"}],"ts":1635178007,"type":"custom","difficulte":"2"}
-{"_id":"systemeconv-sp-bac9d1","context":null,"enonce":"Concerning the rest to be charged:","item":"systemeconv","matiere":"sp","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"It corresponds to the user fee"},{"correct":false,"justification":"False","idx":1,"proposition":"It corresponds to the franchise"},{"correct":false,"justification":"False","idx":2,"proposition":"It corresponds to the flat-rate contribution"},{"correct":true,"justification":"True, flat-rate contribution = deductible (it's the same thing)","idx":3,"proposition":"It corresponds to the co-payment + flat-rate participation"},{"correct":false,"justification":"False","idx":4,"proposition":"It corresponds to the flat-rate contribution + medical deductible"}],"ts":1635178009,"type":"custom","difficulte":"1"}
-{"_id":"103-neuro-f1735b9d-423e-45e7-8a6b-84868eea6b25","context":null,"enonce":"Regarding infant epilepsy. Which of the following are true?","item":"epilepsie","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Perinatal asphyxia is an etiology of West Syndrome, and gives it a poor prognosis"},{"correct":false,"justification":"Achromic tasks","idx":1,"proposition":"Bourneville's tuberous sclerosis, which gives brown spots, is a poor prognosis in West Syndrome"},{"correct":true,"justification":"True","idx":2,"proposition":"In 15% of cases, there is no underlying cause of West syndrome: it is therefore idiopathic"},{"correct":true,"justification":"True","idx":3,"proposition":"West syndrome is a therapeutic emergency: the appropriate treatment is often vingabatine"},{"correct":false,"justification":"Asynchronous","idx":4,"proposition":"The EEG characteristic of a West Syndrome gives continuous slow waves, diffuse multifocal peaks, synchronous amplitude, without background activity"}],"ts":1635178015,"type":"custom","difficulte":"1"}
-{"_id":"constipation-HGE-4441ae","context":null,"enonce":"Which of the following are the causes of secondary constipation?","item":"constipation","matiere":"HGE","propositions":[{"correct":false,"justification":"Diarrhoea","idx":0,"proposition":"Hyperthyroidism"},{"correct":false,"justification":"Hypokalemia","idx":1,"proposition":"Hyperkalemia"},{"correct":true,"justification":"True","idx":2,"proposition":"Hypercalcemia"},{"correct":true,"justification":"True","idx":3,"proposition":"Metformin"},{"correct":true,"justification":"True","idx":4,"proposition":"Cauda equina syndrome"}],"ts":1635178018,"type":"custom","difficulte":"1"}
-{"_id":"DgKc-onco-90a41a","context":null,"enonce":"Which of the following proposals make it possible to assess the general condition of the patient?","item":"DgKc","matiere":"onco","propositions":[{"correct":false,"justification":"Diverticulitis","idx":0,"proposition":"Classification de Hinchey"},{"correct":true,"justification":"True","idx":1,"proposition":"WHO classification"},{"correct":true,"justification":"True","idx":2,"proposition":"Performance Status (PS)"},{"correct":false,"justification":"Cirrhosis","idx":3,"proposition":"Child-Pugh"},{"correct":false,"justification":"Alcohol","idx":4,"proposition":"Questionnaire EDAT"}],"ts":1635178020,"type":"custom","difficulte":"1"}
-{"_id":"hemorroides-HGE-73a7e8","context":null,"enonce":"Which of the following are clinical signs of hemorrhoidal thrombosis?","item":"hemorroides","matiere":"HGE","propositions":[{"correct":true,"justification":"True, see permanent","idx":0,"proposition":"The pain is very prolonged"},{"correct":true,"justification":"True","idx":1,"proposition":"The pain is intense"},{"correct":false,"justification":"Brutal pain","idx":2,"proposition":"Pain appears gradually"},{"correct":true,"justification":"True","idx":3,"proposition":"TR regains painful swelling"},{"correct":false,"justification":"","idx":4,"proposition":"TR is contraindicated"}],"ts":1635178022,"type":"custom","difficulte":"1"}
-{"_id":"134-ped-5e35e98a-a8c1-4fd2-a416-8545aa4aebfd","context":null,"enonce":"You are a pediatric intern and the baby in front of you is in pain. What are the analgesic means you can use in this baby?","item":"dlrped","matiere":"ped","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Breastfeeding "},{"correct":false,"justification":"FALSE. The MEOPA has the MA from 1 month","idx":1,"proposition":"MEOPA (MA from birth)"},{"correct":false,"justification":"FALSE. The WMA says that EMLA patches are only possible in a full-term child. Even if in practice it can be prescribed off-label, for the ECNi we must stay on the rules of the CNG which say that we MUST stay on the MA ","idx":2,"proposition":"EMLA patch in premature infants possible according to the MA"},{"correct":false,"justification":"FALSE. Sugar solutions up to 6 months MAXIMUM! ","idx":3,"proposition":"Sugar solutions if it is a 9-month-old infant "},{"correct":true,"justification":"True. Not exceeding 60 mg\/kg\/24h [or even 30 mg\/kg\/24h in the < 1 year or < 10 kg] when taken PO","idx":4,"proposition":"Paracetamol IV or PO (MA from birth)"}],"ts":1635178027,"type":"custom","difficulte":"1"}
-{"_id":"Kcphysiopath-onco-28e4cd","context":null,"enonce":"Which of the following are known carcinogens?","item":"Kcphysiopath","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Asbestos"},{"correct":true,"justification":"True","idx":1,"proposition":"Silica"},{"correct":true,"justification":"True","idx":2,"proposition":"Wood dust"},{"correct":false,"justification":"","idx":3,"proposition":"GMO"},{"correct":false,"justification":"","idx":4,"proposition":"All pesticides"}],"ts":1635178029,"type":"custom","difficulte":"1"}
-{"_id":"souffleped-cardio-39c4ea","context":null,"enonce":"Which of the following proposals should be sought primarily in case of Di-Georges Syndrome?","item":"souffleped","matiere":"cardio","propositions":[{"correct":false,"justification":"Syndrome de Turner","idx":0,"proposition":"Coarctation of the aorta"},{"correct":true,"justification":"True","idx":1,"proposition":"Tetralogy of Fallot"},{"correct":false,"justification":"False","idx":2,"proposition":"Inter-atrial communication"},{"correct":false,"justification":"False","idx":3,"proposition":"Ventricular septal defect"},{"correct":false,"justification":"False","idx":4,"proposition":"Persistent ductus arteriosus"}],"ts":1635178034,"type":"custom","difficulte":"2"}
-{"_id":"TTTnonmedic-therapeutique-d803d8","context":null,"enonce":"Which of the following are true?","item":"TTTnonmedic","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Training to use equipment is part of what is called <<rehabilitation>>"},{"correct":false,"justification":"It's rehabilitation","idx":1,"proposition":"The integration of the equipment into daily life is part of what is called << rehabilitation>>"},{"correct":true,"justification":"True","idx":2,"proposition":"A prosthesis replaces a limb segment"},{"correct":false,"justification":"Not all of course (reading glasses for example)","idx":3,"proposition":"All devices require a medical prescription"},{"correct":true,"justification":"True","idx":4,"proposition":"Most equipment requires monitoring and follow-up"}],"ts":1635178036,"type":"custom","difficulte":"2"}
-{"_id":"diverticulose-HGE-e340aa","context":null,"enonce":"Uncomplicated diverticulitis is, according to Hinchey's classification, stage:","item":"diverticulose","matiere":"HGE","propositions":[{"correct":true,"justification":"True, phlegmon isolated less than 2 cm","idx":0,"proposition":"AI"},{"correct":false,"justification":"Isolated abscess","idx":1,"proposition":"Ib"},{"correct":false,"justification":"Abscess > 2cm","idx":2,"proposition":"II"},{"correct":false,"justification":"Purulent generalized peritonitis ( ➡ surgery)","idx":3,"proposition":"III"},{"correct":false,"justification":"Stercoral peritonitis (➡ surgery)","idx":4,"proposition":"IV"}],"ts":1635178041,"type":"custom","difficulte":"1"}
-{"_id":"183-immuno-1bf99832-5e9f-4ca2-aeee-bb4ca4fa44b4","context":null,"enonce":"You receive in office, little Heathcliff, 1 1\/2 years who presents an acute flare-up of atopic dermatitis. You decide to give some advice to parents...","item":"allergiecut","matiere":"immuno","propositions":[{"correct":true,"justification":"True, it maintains the disease","idx":0,"proposition":"Avoid contact with tobacco"},{"correct":true,"justification":"True, this is THE thing to remember, no herpetic contagion with atopic dermatitis, it gives a Kaposi Juliusberg a very serious form!","idx":1,"proposition":"Avoid herpes contagion at all costs, even in case of simple cold sores"},{"correct":false,"justification":"False, entirely false, there are no contraindications on vaccines","idx":2,"proposition":"Favor vaccines in periods of lull in the dermatological disease"},{"correct":true,"justification":"True, and avoid wool or synthetic clothing","idx":3,"proposition":"Favor cotton clothing"},{"correct":false,"justification":"False, there is no allergenic eviction to do","idx":4,"proposition":"Avoid nuts and exotic fruits, with high allergenic potential"}],"ts":1635178057,"type":"custom","difficulte":"1"}
-{"_id":"valeurspro-sp-c85b3c","context":null,"enonce":"Which of the following proposals are medical or paramedical professions with an order?","item":"valeurspro","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Pharmacist"},{"correct":true,"justification":"True","idx":1,"proposition":"Dentist"},{"correct":true,"justification":"True","idx":2,"proposition":"Doctor"},{"correct":true,"justification":"True","idx":3,"proposition":"Midwife"},{"correct":true,"justification":"True","idx":4,"proposition":"Physiotherapist"}],"ts":1635178058,"type":"custom","difficulte":"1"}
-{"_id":"329-urg-57a40e35-5983-4911-a154-1d31162e9209","context":null,"enonce":"Which of the following propositions, is (are) true regarding fat embolism?","item":"polytrauma","matiere":"urg","propositions":[{"correct":true,"justification":"True. CLINICAL diagnosis above all and not paraclinical that will guide. If you ever miss the clinic, the fundus will allow a retrospective diagnosis ","idx":0,"proposition":"The diagnosis is primarily clinical and is based on the discovery of hyperthermia, sinus tachycardia and polypnea a few hours after a limb fracture"},{"correct":false,"justification":"False. In addition there is only hypoxemia that is almost constant ","idx":1,"proposition":"The diagnosis is primarily paraclinical and based on the discovery of thrombocytopenia, hemolytic anemia and arterial hypoxemia. "},{"correct":true,"justification":"True. It can be used to make a retrospective diagnosis when clinical manifestations have been missed. ","idx":2,"proposition":"The fundus can find retinal hemorrhages, cottony nodules and retinal edema"},{"correct":true,"justification":"True! These manifestations are fickle, however. ","idx":3,"proposition":"The Gurd triad is based on the association of lesional pulmonary edema + neuro-psychic manifestations + petechiae of the trunk and mucous membranes "},{"correct":true,"justification":"True! HEMODYNAMICS to be monitored extremely rigorously in the context of (poly)trauma. Fat embolism was the subject of an entire question at ECNI 2021. All this information can be found in the latest college of anesthesia resuscitation p344: https:\/\/www.cnear.fr\/dfasm","idx":4,"proposition":"Preventive treatment is based on immobilization of fracture foci, maintenance of good hemodynamics and the fight against pain  "}],"ts":1635178061,"type":"custom","difficulte":"1"}
-{"_id":"nvxne-gyn-e5deb9","context":null,"enonce":"In the absence of effective breathing movements, what is the very first resuscitation maneuver to be undertaken in a newborn who is not screaming?","item":"nvxne","matiere":"gyn","propositions":[{"correct":true,"justification":"True, right after drying and stimulation","idx":0,"proposition":"Nasopharyngeal aspiration and stimulation"},{"correct":false,"justification":"Adrenaline administration is a last resort","idx":1,"proposition":"Administration of adrenaline"},{"correct":false,"justification":"False","idx":2,"proposition":"Broncho-aspiration"},{"correct":false,"justification":"If bradycardia persists despite effective ventilation","idx":3,"proposition":"External cardiac massage"},{"correct":false,"justification":"As a second line, after nasopharyngeal aspiration","idx":4,"proposition":"Positive pressure mask ventilation"}],"ts":1635178063,"type":"custom","difficulte":"2"}
-{"_id":"masseabdo-HGE-1ea7fd","context":null,"enonce":"The diagnosis of certainty of hepatomegaly requires:","item":"masseabdo","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"It is purely clinical"},{"correct":true,"justification":"True, ultrasound is necessary and sufficient","idx":1,"proposition":"Ultrasound"},{"correct":false,"justification":"","idx":2,"proposition":"The scanner"},{"correct":false,"justification":"","idx":3,"proposition":"MRI"},{"correct":false,"justification":"","idx":4,"proposition":"PET-SCAN"}],"ts":1635178065,"type":"custom","difficulte":"1"}
-{"_id":"Kcpancreas-onco-001f1c","context":null,"enonce":"Which of the following are true?","item":"Kcpancreas","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"In 20% of cases, PD-NETs are revealed by symptoms related to hormonal secretion "},{"correct":false,"justification":"Pancreatic adenocarcinoma is by far the most common pancreatic tumor (90%)","idx":1,"proposition":"Endocrine tumours are the most common pancreatic tumour tumour "},{"correct":false,"justification":"The average age of onset is between 60 and 70 years","idx":2,"proposition":"The average age of onset is 30 years"},{"correct":true,"justification":"True","idx":3,"proposition":"In France, the incidence of adenocarcinoma of the pancreas has increased significantly over the past 20 years "},{"correct":false,"justification":"Its prognosis is poor with a median survival between 6 and 9 months if the cancer is metastatic and 18 to 24 months if it could be resected","idx":4,"proposition":"The prognosis for adenocarcinoma is very good, unlike neuroendocrine tumors"}],"ts":1635178073,"type":"custom","difficulte":"2"}
-{"_id":"343-urg-c993792c-5133-4af0-9cc7-cd6ba1281abb","context":null,"enonce":"Which of the following proposals for acute renal failure and acute tubular necrosis is true?","item":"IRenA","matiere":"urg","propositions":[{"correct":false,"justification":"Natriuresis in an NTA is increased\r\n\r\nThere is one exception though... NTAs secondary to rhabdomyolysis or iodinated contrast media: natriuresis has collapsed\r\nFor rhabdomyolysis, this is because there is volume depletion activating RAAS --> Na+ reabsorption\r\nFor iodinated contrast media I don't know...","idx":0,"proposition":"Natriuresis has collapsed"},{"correct":false,"justification":"No hypertension, no edema in the NTA! The clinical picture of the different ARIs is to know by heart!","idx":1,"proposition":"Clinically we find hypertension and edema "},{"correct":true,"justification":"True","idx":2,"proposition":"It represents 80% of organic IRAs"},{"correct":true,"justification":"True","idx":3,"proposition":"NSAIDs are one of the causes of NTA"},{"correct":true,"justification":"True","idx":4,"proposition":"In NTA, glomerular flow is decreased due to pre- and post-glomerular vasoconstriction and increased intra-tubular pressure."}],"ts":1635178075,"type":"custom","difficulte":"1"}
-{"_id":"systemeconv-sp-b09344","context":null,"enonce":"Approximately how many doctors are there in France?","item":"systemeconv","matiere":"sp","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"50 000"},{"correct":true,"justification":"True","idx":1,"proposition":"200 000"},{"correct":false,"justification":"False","idx":2,"proposition":"700 000"},{"correct":false,"justification":"False","idx":3,"proposition":"1 million"},{"correct":false,"justification":"This is the approximate number of health professionals","idx":4,"proposition":"2 million"}],"ts":1635178077,"type":"custom","difficulte":"1"}
-{"_id":"diarrheechr-HGE-beb813","context":null,"enonce":"Which of the following are the causes of motor diarrhea?","item":"diarrheechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Hyperthyroidism"},{"correct":true,"justification":"True","idx":1,"proposition":"Functional bowel disorder"},{"correct":false,"justification":"Diarrhea due to malabsorption","idx":2,"proposition":"Celiac disease"},{"correct":false,"justification":"Exudative diarrhea","idx":3,"proposition":"Colitis"},{"correct":false,"justification":"Secretory diarrhea","idx":4,"proposition":"Parasitosis"}],"ts":1635178078,"type":"custom","difficulte":"1"}
-{"_id":"tbconscience-urg-fabdb4","context":null,"enonce":"Which of the following are signs or symptoms of confusion?","item":"tbconscience","matiere":"urg","propositions":[{"correct":false,"justification":"Confusion = acute","idx":0,"proposition":"Gradual start"},{"correct":true,"justification":"True","idx":1,"proposition":"Reversal of the nyctemeral cycle"},{"correct":true,"justification":"True","idx":2,"proposition":"Amnesia"},{"correct":false,"justification":"It is a differential diagnosis","idx":3,"proposition":"Dementia"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"ts":1635178080,"type":"custom","difficulte":"2"}
-{"_id":"RGO-HGE-3ec37b","context":null,"enonce":"What is the frequency of monitoring of endobrachyoesophagus between 3 and 6 centimeters?","item":"RGO","matiere":"HGE","propositions":[{"correct":false,"justification":"Less than 3 cm","idx":0,"proposition":"Every 5 years"},{"correct":true,"justification":"True","idx":1,"proposition":"Every 3 years"},{"correct":false,"justification":"More than 6 cm","idx":2,"proposition":"Every 2 years"},{"correct":false,"justification":"An OBE is always monitored","idx":3,"proposition":"No monitoring"},{"correct":false,"justification":"Control every year (2 times in the first year) if low-grade dysplasia","idx":4,"proposition":"Every 6 months"}],"ts":1635178082,"type":"custom","difficulte":"1"}
-{"_id":"185-immuno-1801eb2d-b34b-4cfe-989e-2651a3255269","context":null,"enonce":"Regarding immune deficiencies, among the pairs type of deficiency - opportunistic pathogens, which one or which are accurate?","item":"immunoD","matiere":"immuno","propositions":[{"correct":true,"justification":"True, humoral deficiency does not lead to opportunistic infections but to severe pneumococcus, meningococcal and haemophilus infections.","idx":0,"proposition":"Humoral deficiency - encapsulated germs"},{"correct":true,"justification":"True, cellular immunodeficiency leads to parasitic, fungal, or viral opportunistic infections","idx":1,"proposition":"Cell deficiency - opportunistic infections"},{"correct":true,"justification":"True, we most often know meningococcal infections but it can also give serious sepsis","idx":2,"proposition":"Complement deficiency - invasive bacterial infections"},{"correct":true,"justification":"True, we know less about this subtlety but it's true","idx":3,"proposition":"Asplenia - Severe malaria"},{"correct":true,"justification":"True, a specificity related to PNN deficiency","idx":4,"proposition":"Phagocytic Deficiency - Pyogenic Infections"}],"ts":1635178084,"type":"custom","difficulte":"1"}
-{"_id":"anemie-hemato-7820fb","context":null,"enonce":"Which of the following are true?","item":"anemie","matiere":"hemato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Folate deficiency is responsible for macrocytic anemia"},{"correct":true,"justification":"True","idx":1,"proposition":"Hemolysis gives macrocytic anemia"},{"correct":false,"justification":"A central cause causes normo- or macrocytic anemia","idx":2,"proposition":"Spinal cord invasion gives microcytic anemia"},{"correct":false,"justification":"Microcytic anemia","idx":3,"proposition":"Iron deficiency gives macrocytic anemia"},{"correct":false,"justification":"Peripheral cause","idx":4,"proposition":"Hemolysis is a central cause of anemia"}],"ts":1635178088,"type":"custom","difficulte":"2"}
-{"_id":"polytrauma-urg-b3fce7","context":null,"enonce":"Which of the following propositions concerning Vittel's algorithm in the context of polytrauma are true?","item":"polytrauma","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Extreme gravity is defined as a Glasgow at 3, a SBP < 65 mmHg and\/or an SpO2 < 80% or impregnable"},{"correct":false,"justification":"False, > 6 meters","idx":1,"proposition":"A fall from a height greater than 4 meters is an element indicating violent kinetics and the need for treatment in a specialized center"},{"correct":true,"justification":"True","idx":2,"proposition":"Another passenger who died in the same vehicle is an element indicating violent kinetics and the need for care in a specialized center"},{"correct":true,"justification":"True","idx":3,"proposition":"A pelvic fracture is an anatomical lesion requiring management in a specialized center"},{"correct":true,"justification":"True","idx":4,"proposition":"A patient with normal vital signs, no evidence of violent kinetics and no anatomical lesions requiring specialized management, but where the shockproof pants are inflated requires transfer to a specialized center. "}],"ts":1635178091,"type":"custom","difficulte":"2"}
-{"_id":"176-sp-c0a84fd5-2f2b-4ca2-b260-ed74ecaf7a05","context":null,"enonce":"Who are the actors involved in the system for reporting serious adverse events associated with care?","item":"risquesRx","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The patient"},{"correct":true,"justification":"True","idx":1,"proposition":"Healthcare professionals and healthcare facilities"},{"correct":true,"justification":"True","idx":2,"proposition":"The regional health agency"},{"correct":true,"justification":"True","idx":3,"proposition":"The High Authority for Health"},{"correct":true,"justification":"True","idx":4,"proposition":"Regional support structure"}],"ts":1635178093,"type":"custom","difficulte":"1"}
-{"_id":"PF-neuro-cb9a3f","context":null,"enonce":"Which of the following are segments crossed by facial nerve VII?","item":"PF","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Labyrinthine segment"},{"correct":true,"justification":"True. It emerges at the level of the stylomastoid foramen","idx":1,"proposition":"Mastoidal segment"},{"correct":true,"justification":"True, we can guess it from the otoscope","idx":2,"proposition":"Tympanic segment"},{"correct":true,"justification":"True","idx":3,"proposition":"Parotid segment"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"ts":1635178108,"type":"custom","difficulte":"2"}
-{"_id":"splenomeg-HGE-4191c2","context":null,"enonce":"When should vaccinations be performed in case of emergency splenectomy?","item":"splenomeg","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"2 weeks after surgery"},{"correct":false,"justification":"This is an emergency splenectomy (no time to wait 2 weeks)","idx":1,"proposition":"2 weeks before surgery"},{"correct":false,"justification":"","idx":2,"proposition":"At the time of the gesture"},{"correct":false,"justification":"","idx":3,"proposition":"4 weeks after surgery"},{"correct":false,"justification":"","idx":4,"proposition":"6 weeks after surgery"}],"ts":1635178110,"type":"custom","difficulte":"1"}
-{"_id":"PF-neuro-0d4256","context":null,"enonce":"Where does the facial nerve emerge from?","item":"PF","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Bulbo-protuberancial furrow"},{"correct":false,"justification":"Emergence of the hypoglossal nerve XII (motor for the muscles of the tongue, passing through the hypoglossal canal)","idx":1,"proposition":"Bulb"},{"correct":false,"justification":"Emergence of oculomotor nerve III (motor, innervates the upper right, lower right, inferior oblique, medial right, passing through the superior orbital fissure)","idx":2,"proposition":"Mesencephalic tegmentum"},{"correct":false,"justification":"Trigeminal nerve V (mixed)","idx":3,"proposition":"Mesencephalo-pontobulbar origin"},{"correct":false,"justification":"Accessory nerve XI (motor)","idx":4,"proposition":"Cervical spinal cord"}],"ts":1635178112,"type":"custom","difficulte":"3"}
-{"_id":"droits-sp-29b55b","context":null,"enonce":"Which of the following propositions are true about the person of trust?","item":"droits","matiere":"sp","propositions":[{"correct":false,"justification":"Anyone","idx":0,"proposition":"It only concerns patients with serious illness"},{"correct":false,"justification":"Not mandatory but recommended ++","idx":1,"proposition":"It is mandatory"},{"correct":true,"justification":"True","idx":2,"proposition":"The designation can be done on plain paper, signed and dated"},{"correct":false,"justification":"Quite possible (especially if the doctor is not treating)","idx":3,"proposition":"The designated person cannot be a doctor"},{"correct":false,"justification":"Writing","idx":4,"proposition":"The designation can be done orally"}],"ts":1637588465,"type":"custom","difficulte":"1"}
-{"_id":"194-rhumato-8373cdc1-ffa1-4939-b6e7-e7ff0071ee7b","context":null,"enonce":"Regarding allopurinol, what are the exact answer(s)?","item":"rhumcrist","matiere":"rhumato","propositions":[{"correct":false,"justification":"False, it is 100mg per day, it is one of the only dosages that is required from you, because it is medico-legal","idx":0,"proposition":"Allopurinol is to be initiated at a dosage of 200mg per day"},{"correct":false,"justification":"False, as we will see below it is the DRESS syndrome. It is Febuxostat that has this type of side effects","idx":1,"proposition":"One of the most serious side effects of allopurinol is the occurrence of digestive disorders"},{"correct":false,"justification":"FALSE, +++ DRESS syndrome is a serious toxiderma and must always be suspected, especially with purveyor treatments such as Bactrim or Allopurinol!","idx":2,"proposition":"A rash after taking allopurinol is common and mild"},{"correct":true,"justification":"True, it is to start during symptomatic hyperuricemia","idx":3,"proposition":"Allopurinol is to be started after the first attack of gout or first uricemic renal colic"},{"correct":true,"justification":"True, they are both hyperuricemic treatments","idx":4,"proposition":"When re-evaluating treatment, it is necessary to look for thiazide diuretics or loop in the patient's prescription"}],"ts":1637588493,"type":"custom","difficulte":"1"}
-{"_id":"235-cardio-fc5d0ed7-df20-4f35-bec2-89e8064a0a40","context":null,"enonce":"Mr MELARK, Peeta, 25 years old, comes to see you in general medicine consultation, because for a few months he has regular palpitations. He explains that he has already consulted a cardiologist who has ruled out all transient and extracardiac causes of palpitations and who would have vaguely told him about Bouveret's disease. He is very anxious because he is afraid of having \"a cardiac arrest\" like his uncle. What can you tell him about Bouveret's disease?","item":"palpitations","matiere":"cardio","propositions":[{"correct":true,"justification":"True, it is one of the two causes of junctional tachycardia with Wolff Parkinson White syndrome.","idx":0,"proposition":"This is a not uncommon cause of junctional tachycardia in young people"},{"correct":false,"justification":"False, these are the ECG features of Brugada syndrome, here in Bouveret's disease we find a fine QRS tachycardia with retrograde P waves","idx":1,"proposition":"The ECG conventionally finds negative T waves in V1 and V2"},{"correct":false,"justification":"False, another feature of Brugada syndrome. Bouveret's disease is benign and does not require defibrillation under any circumstances","idx":2,"proposition":"There is a risk of cardiac syncope and the need for defibrillation"},{"correct":true,"justification":"True, this is the typical symptomatology with pollakuria ","idx":3,"proposition":"The symptomatology is characterized by bouts of palpitations at the beginning and abrupt end"},{"correct":true,"justification":"True, these are two lesser-known methods of vagal maneuvers but which are much easier than carotid massage or eyeballs.","idx":4,"proposition":"A vagal maneuver by inverted Vasalva or ingestion of ice water can make the diagnosis"}],"ts":1637588504,"type":"custom","difficulte":"1"}
-{"_id":"206-pneumo-43d992c6-8838-4a59-910a-c32402f0242b","context":null,"enonce":"You receive in consultation Mr Deux, Ramsès, 75 years old, who is followed in pneumology for idiopathic pulmonary fibrosis. However, he also caught CoVID 3 weeks ago, and he can no longer distinguish between the symptoms of his long CoVID and idiopathic pulmonary fibrosis. What symptoms can you relate to his idiopathic pulmonary fibrosis?","item":"PID","matiere":"pneumo","propositions":[{"correct":true,"justification":"True, quite simple this one, fibrotic patients present a dyspnea of effort becoming easier and easier with time, for an effort less and less important","idx":0,"proposition":"Exertional dyspnea"},{"correct":false,"justification":"False, it is a sign of influenza-like illness, so CoVID!","idx":1,"proposition":"Diffuse myalgia"},{"correct":true,"justification":"True, visible in both cases. Dry cough is clearly distinguished from fibrotic, unlike expectorant wet cough from COPD","idx":2,"proposition":"Dry cough"},{"correct":false,"justification":"False, grumbling is rather COPD! We find under crackling bases in fibrotic. To give you ideas, the ronchis is literally a \"fouling\" of the bronchi","idx":3,"proposition":"Diffuse Ronchis"},{"correct":true,"justification":"True, only extrarespiratory sign","idx":4,"proposition":"Digital Hippocratism"}],"ts":1638198652,"type":"custom","difficulte":"1"}
-{"_id":"151-pneumo-312894cd-b92b-4872-9b34-8fcc6cdb157b","context":null,"enonce":"What is the most common progressive complication of acute community-acquired pneumonia in children?","item":"IBP","matiere":"pneumo","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"The skeptical shock"},{"correct":false,"justification":"False: Exceptional!!","idx":1,"proposition":"Post-pneumococcal hemolytic uremic syndrome"},{"correct":false,"justification":"False","idx":2,"proposition":"Hyponatremia by SIADH (syndrome of inappropriate secretion of anti-diuretic hormone)"},{"correct":true,"justification":"True => p677 in red box ","idx":3,"proposition":"Purulent pleurisy"},{"correct":false,"justification":"False: This is the 2nd most common just after pleurisy ++","idx":4,"proposition":"The abscess"}],"ts":1638198687,"type":"custom","difficulte":"1"}
-{"_id":"206-pneumo-fce640dc-d61e-48cb-8b99-8e7061e612c0","context":null,"enonce":"Regarding additional examinations in diffuse interstitial lung disease, what are the exact proposal(s)?","item":"PID","matiere":"pneumo","propositions":[{"correct":true,"justification":"True, it is characteristic of diffuse interstitial lung diseases, the infiltration being \"around\" the structures where the air passes, it will compress the air and be restrictive","idx":0,"proposition":"EFRs regain a restrictive ventilatory disorder"},{"correct":true,"justification":"True, because of a lower respiratory volume, when there is an effort, the lung can not mobilize additional respiratory volumes","idx":1,"proposition":"There is a classic desaturation on exertion"},{"correct":true,"justification":"True, DLCO explores diffusion abnormalities between the alveolus and capillary transmitted by the interstitium. An abnormality of the alveolus (e.g. OAP), interstitium (PID) or capillary (HTP) can cause a decrease in DLCO","idx":2,"proposition":"DLCO is reduced <70%"},{"correct":false,"justification":"False, the so-called \"honeycomb\" cysts have a subpleural disposition","idx":3,"proposition":"Honeycombs are cysts located in contact with the mediastinum corresponding to bullous structures within the interstitium"},{"correct":true,"justification":"True, it is a highlighting of these anatomical structures, the septas","idx":4,"proposition":"Lines or cross-links are accentuations of anatomical structures that are usually not visible"}],"ts":1638198699,"type":"custom","difficulte":"1"}
-{"_id":"210-hemato-9d99d174-2abc-4174-acae-bbb87c7e960b","context":null,"enonce":"Regarding thrombocytopenia in pregnant women, what are the exact proposal(s)?","item":"thromboP","matiere":"hemato","propositions":[{"correct":true,"justification":"True, it's not noted in the college, but given the prevalence of obesity in the general population I think it's not bad for your patients to retain this as a potential cause. ","idx":0,"proposition":"Pregnancy NASH (Nonalcoholic Steatose Hepatic) is a cause of thrombocytopenia"},{"correct":true,"justification":"True, as well as HBV and HCV","idx":1,"proposition":"Thrombocytopenia in pregnant women should be tested for HIV infection"},{"correct":true,"justification":"True, it's in its name (Hemolysis, Elevated Liver enzymes, Low Platelets)","idx":2,"proposition":"HELLP syndrome is a cause of thrombocytopenia in pre-eclamptic pregnant women"},{"correct":true,"justification":"True, as in the general population, but here there is more often heparin treatment because of the prothrombotic risk","idx":3,"proposition":"Prophylactic treatment with heparin may lead to thrombocytopenia  "},{"correct":true,"justification":"True, in >75% of cases it is physiological","idx":4,"proposition":"The most common cause of thrombocytopenia during pregnancy is benign"}],"ts":1638639296,"type":"custom","difficulte":"1"}
-{"_id":"210-hemato-151f374d-ecba-488d-b5e3-cec6a5396916","context":null,"enonce":"You receive in hematology consultation, Mrs. EVANS Lucy, a 65-year-old patient who consults after he was found at the blood test a thrombocytopenia at 12G \/ L. Your colleague had performed a myelogram on this patient who found a marrow poor in megakaryocytes. What are the possible diagnoses in this patient?","item":"thromboP","matiere":"hemato","propositions":[{"correct":false,"justification":"Evans syndrome corresponds to peripheral autoimmune involvement of platelets and red blood cells. The patient has central thrombocytopenia with us","idx":0,"proposition":"Evans syndrome"},{"correct":true,"justification":"True, as with anemia, deficiency thrombocytopenia is central because it leads to a slowdown in central production.","idx":1,"proposition":"Vitamin B9 deficiency"},{"correct":false,"justification":"False, chronic lymphocytic leukemia causes anemia and not thrombocytopenia ...","idx":2,"proposition":"Chronic lymphocytic leukemia"},{"correct":false,"justification":"False, this is a \"burst\" of platelets in the blood, and not spinal cord damage","idx":3,"proposition":"Thrombotic microangiopathy"},{"correct":true,"justification":"True, here cancer cells take the place of megakaryocytes in the marrow","idx":4,"proposition":"Metastases of breast cancer"}],"ts":1638639402,"type":"custom","difficulte":"1"}
-{"_id":"211-hemato-362343b2-7bd5-4dd7-bec1-8fae473fa469","context":null,"enonce":"Regarding purpuras, what are the elements suggestive of vascular purpura rather than thrombocytopenic purpura?","item":"purpura","matiere":"hemato","propositions":[{"correct":true,"justification":"True, thrombocytopenic purpura is flat a contrario","idx":0,"proposition":"Necrotic purpura"},{"correct":true,"justification":"True, it is also said that purpura is declivated, unlike thrombocytopenic purpura which are diffuse","idx":1,"proposition":"Purpura localized to the lower limbs"},{"correct":false,"justification":"False, the presence of hemorrhages rather indicates thrombocytopenia","idx":2,"proposition":"Purpura associated with clinical bleeding"},{"correct":false,"justification":"False, vascular purpura testifies to an attack of the small vessels with inflammation that leads to localized purpura, unlike thrombocytopenic purpuras which will be in sheets, because of an active hemorrhage.","idx":3,"proposition":"Purpura in tablecloths"},{"correct":true,"justification":"True, purpura will be raised and palpable, unlike thrombocytopenic purpura","idx":4,"proposition":"Infiltrated purpura"}],"ts":1638639614,"type":"custom","difficulte":"1"}
-{"_id":"316-onco-51362943-943d-409b-b604-fce586cc76e3","context":null,"enonce":"Regarding Hodgkin's lymphoma, which propositions are true?","item":"LM","matiere":"onco","propositions":[{"correct":true,"justification":"True, in the young subject (about 25 years) and the elderly (about 80 years)","idx":0,"proposition":"There are 2 peaks of incidence ages "},{"correct":true,"justification":"True, very good effectiveness of treatments ","idx":1,"proposition":"After treatment, about 90% of patients are cured "},{"correct":true,"justification":"True, allows the Ann Arbor classification (which is not the case with Binet's classification in CLL, because the latter is a clinicobiological classification, which does not take into account imaging)","idx":2,"proposition":"PET-FDG is systematic in the extension balance "},{"correct":false,"justification":"False, the most common histological subtype in classical Hodgkin lymphoma is the scleronodular form (67% vs. 25%)","idx":3,"proposition":"Mixed cellularity histological subtype is the most common form of classical Hodgkin lymphoma "},{"correct":true,"justification":"True, for 2\/3 of cases ","idx":4,"proposition":"The localized stage (I\/II in the Ann Arbor classification) is most common at diagnosis "}],"ts":1638983020,"type":"custom","difficulte":"1"}
-{"_id":"316-onco-de63e59e-ab22-4478-8b97-38b5e2d4c59b","context":null,"enonce":"Regarding non-Hodgkin lymphomas, what are the real proposals?","item":"LM","matiere":"onco","propositions":[{"correct":false,"justification":"False, T\/NK lymphomas account for only 15% of non-Hodgkin lymphomas ","idx":0,"proposition":"The majority of non-Hodgkin lymphomas are T-cell lymphomas "},{"correct":true,"justification":"True, it is a diffuse large B-cell lymphoma (CD20+, CD 10+, bcl-). It evolves very quickly (aggressive). There are endemic (African), sporadic (non-African) forms and linked to immune deficiency.","idx":1,"proposition":"EBV infection is a risk factor for Burkitt's lymphoma "},{"correct":true,"justification":"True, 35%. They require quick support","idx":2,"proposition":"One of the most common non-Hodgkin lymphomas is diffuse large cell B-cell lymphoma"},{"correct":false,"justification":"False, compressive syndrome is more common in non-Hodgkin lymphomas ","idx":3,"proposition":"Compressive syndrome is less common than in Hodgkin's lymphoma "},{"correct":true,"justification":"True","idx":4,"proposition":"Burkitt's lymphoma is very aggressive "}],"ts":1638983220,"type":"custom","difficulte":"1"}
-{"_id":"316-onco-3ed10e9c-c91b-435a-a6f8-9b4fb5229964","context":null,"enonce":"Which of the following propositions about malignant lymphomas are true?","item":"LM","matiere":"onco","propositions":[{"correct":false,"justification":"False, they are characteristic of Hodgkin lymphomas","idx":0,"proposition":"The presence of Reed-Sternberg cells is characteristic of non-Hodgkin lymphomas "},{"correct":true,"justification":"True, acquired or congenital immunosuppression ","idx":1,"proposition":"The immunosuppression field promotes malignant lymphomas "},{"correct":false,"justification":"False, the diagnosis is based on lymph node biopsy because histological proof is absolutely necessary ","idx":2,"proposition":"Diagnosis of malignant lymphoma is based on lymph node aspiration "},{"correct":true,"justification":"True","idx":3,"proposition":"Superior cava syndrome is a therapeutic emergency "},{"correct":true,"justification":"True, to be carried out after agreement of the patient!","idx":4,"proposition":"Always think about performing an HIV serology "}],"ts":1638983243,"type":"custom","difficulte":"1"}
-{"_id":"293-onco-82df7023-20dd-4a9c-b7be-834e0f886a88","context":null,"enonce":"Regarding agranulocytosis, which propositions are true?","item":"agranulocytose","matiere":"onco","propositions":[{"correct":true,"justification":"True, especially during a control blood count ","idx":0,"proposition":"It may be of fortuitous discovery "},{"correct":true,"justification":"True","idx":1,"proposition":"The clinical examination is often poor "},{"correct":false,"justification":"False, this is extrinsic accountability. The intrinsic imputability of agranulocytosis to a drug is based on semiology and chronology  ","idx":2,"proposition":"The method of intrinsic imputability of agranulocytosis to a drug is based on pharmacovigilance data"},{"correct":false,"justification":"False, the elevation of PNN occurs 48 hours after the appearance of monocytosis","idx":3,"proposition":"The appearance of monocytosis during follow-up is suggestive of the elevation of ANCs within 24 hours "},{"correct":false,"justification":"False, only if fever is present ","idx":4,"proposition":"Treatment is based on broad-spectrum antibiotic therapy even in the absence of fever "}],"ts":1639132502,"type":"custom","difficulte":"1"}
-{"_id":"Kcprostate-onco-804b46","context":null,"enonce":"Which of the following are true about zoledronic acid?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is a drug for the prevention of complications of bone metastases"},{"correct":true,"justification":"True","idx":1,"proposition":"It is a bisphosphonate inhibiting bone resorption related to osteoclastic activity"},{"correct":true,"justification":"True","idx":2,"proposition":"It is injected in slow IV every month or so."},{"correct":true,"justification":"True","idx":3,"proposition":"Its toxicity is renal"},{"correct":true,"justification":"True","idx":4,"proposition":"There is a risk of osteonecrosis of the jaw and hypocalcemia"}],"ts":1639132529,"type":"custom","difficulte":"2"}
-{"_id":"Kcpancreas-onco-eb7f36","context":null,"enonce":"Which of the following proposals designate cystic tumors of the pancreas that do not develop within the pancreatic ducts?","item":"Kcpancreas","matiere":"onco","propositions":[{"correct":false,"justification":"Not a cystic tumor","idx":0,"proposition":"Adenocarcninoma"},{"correct":true,"justification":"True","idx":1,"proposition":"Serous cystadenoma"},{"correct":true,"justification":"True","idx":2,"proposition":"Mucosal cystadenoma"},{"correct":false,"justification":"They develop within these channels themselves.","idx":3,"proposition":"TIPMP"},{"correct":false,"justification":"Not a cystic tumor","idx":4,"proposition":"Neuroendocrine tumours"}],"ts":1639132555,"type":"custom","difficulte":"2"}
-{"_id":"40-gyn-1d131aab-d226-462e-adfd-6f38370683ed","context":null,"enonce":"Which of the following are true?","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"correct":true,"proposition":"Pregnancy is a cause of amenorrhea","justification":"True"},{"idx":1,"correct":false,"proposition":"In secondary amenorrhea, a low LH, FSH and estradiol assay points to an ovarian cause ","justification":"False, these results point to gonadotropic insufficiency (central origin)"},{"idx":2,"correct":true,"proposition":"A beta hCG test is essential when looking for the etiology of secondary amenorrhea","justification":"True, to eliminate pregnancy, physiological cause of amenorrhea"},{"idx":3,"correct":false,"proposition":"FSH assay is found collapsed in amenorrhea with PCOS as an etiology ","justification":"False, FSH dosage is normal"},{"idx":4,"correct":true,"proposition":"To explore gonadotropic insufficiency, a pituitary MRI is performed","justification":"True"}],"ts":{"$numberLong":"1643453822835"},"type":"custom","difficulte":2}
-{"_id":"239-endoc-033fa0a0-b36b-40f8-a619-9fa3f4db2602","context":null,"enonce":"Regarding thyroid goiters, which propositions are true?","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Estrogen is a goitrogenic factor ","justification":"True"},{"idx":1,"correct":true,"proposition":"If the TSH test comes back high, anti-TPO antibodies are dosed.","justification":"True, to look for Hashimoto's autoimmune hypothyroidism "},{"idx":2,"correct":false,"proposition":"If the TSH test comes back high, anti-TSH receptor antibodies are measured","justification":"False, anti-TSH receptor antibodies are dosed if the TSH dosage comes back low, to eliminate Graves' disease "},{"idx":3,"correct":true,"proposition":"De Quervain's subacute thyroiditis is a cause of goiter","justification":"True"},{"idx":4,"correct":false,"proposition":"A goiter can progress to thyroid cancer in 15% of cases","justification":"False, in only 4 to 5% of cases "}],"ts":{"$numberLong":"1643653345403"},"type":"custom","difficulte":2}
-{"_id":"239-endoc-cffcc69f-64fa-4121-a817-5bcdfebe9e63","context":null,"enonce":"Regarding thyroid nodules, what are the true propositions? (one or more true propositions)","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"Nodule size is synonymous with malignancy ","justification":"False, the size does not presume the malignancy of the nodule "},{"idx":1,"correct":false,"proposition":"The first-line examination in thyroid imaging is the scintigraphy ","justification":"False, the 1st intention examination is ultrasound "},{"idx":2,"correct":false,"proposition":"The determination of calcitonin is always recommended in the first-line assessment when a nodule is discovered","justification":"False, it must be practiced systematically in certain situations only: known hereditary context of medullary thyroid cancer, if suspicion of malignancy of the nodule at cytopuncture and before any intervention for goiter or nodule"},{"idx":3,"correct":false,"proposition":"A nodule with a score of 2 on the Bethesda cytological classification is a malignant nodule ","justification":"False, it is a benign nodule "},{"idx":4,"correct":true,"proposition":"The course of action for a Bethesda 6 non-functional nodule is surgery ","justification":"True"}],"ts":{"$numberLong":"1643653377207"},"type":"custom","difficulte":2}
-{"_id":"239-endoc-56bd348b-be3a-4997-a931-71c161335b1f","context":null,"enonce":"Regarding thyroid cancers, which proposals are true?","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Recurrent paralysis may be a clinical sign allowing the revelation of a thyroid nodule ","justification":"True"},{"idx":1,"correct":false,"proposition":"The most common vesicular carcinomas are differentiated vesicular cancers ","justification":"False, they represent only 5% of thyroid cancers. The most common is differentiated papillary carcinoma (85% of cases)"},{"idx":2,"correct":true,"proposition":"Anaplastic carcinomas require urgent management ","justification":"True"},{"idx":3,"correct":true,"proposition":"Medullary thyroid cancers develop at the expense of calcitonin-secreting C cells ","justification":"True"},{"idx":4,"correct":true,"proposition":"Medullary thyroid cancers can integrate into multiple endocrine neoplasia type 2 (MEN2) ","justification":"True"}],"ts":{"$numberLong":"1643653385795"},"type":"custom","difficulte":2}
-{"_id":"245-endoc-6cb051f5-09a8-4535-86af-946144dcd099","context":null,"enonce":"About diabetes and insulin types","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Insulin intermediate (NPH) is a suspended insulin (powder) that needs to be reconstituted","justification":"TRUE. NPH insulin is a powdered intermediate insulin that is injected subcutaneously"},{"idx":1,"correct":true,"proposition":"Rapid insulin works in 15-30 minutes and lasts about 4-6 hours ","justification":"TRUE! - Rapid insulin: Acts in 15-30 min and lasts 4-6h\r\n- Slow insulin: Acts in 1-2h and lasts 24h = \"insulin to live\""},{"idx":2,"correct":true,"proposition":"Slow insulin can only be injected in SC","justification":"TRUE! Page 280 of the new college (5th edition). Rapid insulin exists in IV\/IM\/SC\/pump form "},{"idx":3,"correct":true,"proposition":"Slow insulin acts in 1-2h","justification":"TRUE, unlike the fast one that acts in less than 30 minutes. Its action lasts 24 hours"},{"idx":4,"correct":true,"proposition":"A type 2 diabetic with HbA1c > 10% and cardinal syndrome will immediately require insulin treatment","justification":"TRUE! Overall here, the patient is unbalanced (HbA1c > 10%) with clinical decompensation (cardinal syndrome). This is an indication to introduce insulin from the outset"}],"ts":{"$numberLong":"1643653432261"},"type":"custom","difficulte":2}
-{"_id":"obesite-endoc-f996942","context":null,"enonce":"Which propositions are true?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"In France, the prevalence of obesity is around 15%","justification":"True"},{"idx":1,"correct":true,"proposition":"We become obese younger and younger","justification":"True"},{"idx":2,"correct":false,"proposition":"Obesity prevalence declines after age 65","justification":"It increases"},{"idx":3,"correct":true,"proposition":"The mutation of the melanocortin receptor would be responsible for less than 5% of severe obesity","justification":"True"},{"idx":4,"correct":false,"proposition":"Global prevalence of obesity declines","justification":"It increases"}],"ts":{"$numberLong":"1647180941945"},"type":"custom","difficulte":2}
-{"_id":"obesite-endoc-b3b8b6b","context":null,"enonce":"What element(s) are complications of obesity?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"Inflammatory joint pain","justification":"Mechanics (osteoarthritis)"},{"idx":1,"correct":true,"proposition":"Daytime sleepiness","justification":"True, OSA"},{"idx":2,"correct":true,"proposition":"Sadness of mood","justification":"True"},{"idx":3,"correct":true,"proposition":"Social isolation","justification":"True"},{"idx":4,"correct":true,"proposition":"Polyuropolydipsic syndrome","justification":"True, diabetes"}],"ts":{"$numberLong":"1647180947478"},"type":"custom","difficulte":2}
-{"_id":"obesite-endoc-e8d5831","context":null,"enonce":"What examinations are systematic in the face of obesity?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Uricemia","justification":"True"},{"idx":1,"correct":true,"proposition":"NFS","justification":"True"},{"idx":2,"correct":false,"proposition":"ETT","justification":"Systematic ECG"},{"idx":3,"correct":false,"proposition":"EFR","justification":"If respiratory elements at the clinic"},{"idx":4,"correct":true,"proposition":"Blood ionogram","justification":"True"}],"ts":{"$numberLong":"1647180958728"},"type":"custom","difficulte":1}
-{"_id":"obesite-endoc-ce8cc5a","context":null,"enonce":"A new patient comes in for consultation and asks you for surgical care. You explain the conditions according to the HAS. Check the true answer(s):","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"BMI > 35 alone","justification":"BMI > 40 alone"},{"idx":1,"correct":false,"proposition":"BMI > 30 with comorbidities","justification":"BMI > 35 with comorbidities"},{"idx":2,"correct":true,"proposition":"BMI > 40 alone","justification":"True"},{"idx":3,"correct":true,"proposition":"Need for management and follow-up of at least 6 months before","justification":"True"},{"idx":4,"correct":false,"proposition":"This care is impossible for minors","justification":"Possible under certain very strict and exceptional conditions"}],"ts":{"$numberLong":"1647180963093"},"type":"custom","difficulte":2}
-{"_id":"obesite-endoc-0fa28f5","context":null,"enonce":"What comorbidities are improved by surgical management of obesity?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"NASH","justification":"True"},{"idx":1,"correct":true,"proposition":"OSA","justification":"True"},{"idx":2,"correct":true,"proposition":"Type 2 diabetes","justification":"True"},{"idx":3,"correct":true,"proposition":"Arthrosis","justification":"True"},{"idx":4,"correct":true,"proposition":"All propositions are true","justification":"True"}],"ts":{"$numberLong":"1647180967075"},"type":"custom","difficulte":2}
-{"_id":"obesite-endoc-681ea02","context":null,"enonce":"What are the contraindications to bariatric surgery?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"persistent eating disorder","justification":"True"},{"idx":1,"correct":true,"proposition":"Prolonged medical follow-up not feasible","justification":"True"},{"idx":2,"correct":true,"proposition":"Unbalanced psychiatric disorders","justification":"True"},{"idx":3,"correct":true,"proposition":"alcohol dependence","justification":"True"},{"idx":4,"correct":true,"proposition":"All propositions are true","justification":"True"}],"ts":{"$numberLong":"1647180972237"},"type":"custom","difficulte":2}
-{"_id":"PRNA-neuro-a70214b","context":null,"enonce":"Which propositions are true?","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"There are 2 consecutive phases in Guillain Barré syndrome","justification":"3 phases "},{"idx":1,"correct":true,"proposition":"The first phase can last up to 4 weeks","justification":"True"},{"idx":2,"correct":false,"proposition":"The third phase can last up to 6 months","justification":"Up to 1 year and a half (18 months). Patients are then hospitalized for a long time (often in MRP wards). After 18 months, the lesions are considered fixed"},{"idx":3,"correct":false,"proposition":"The third phase is the plateau phase","justification":"This is the second phase. It can last up to 3 weeks"},{"idx":4,"correct":false,"proposition":"All propositions are true","justification":"Consequently..."}],"ts":{"$numberLong":"1647285043799"},"type":"custom","difficulte":2}
-{"_id":"PRNA-neuro-f65647f","context":null,"enonce":"What percentage of patients have permanent sequelae (motor deficit, ataxia) of Guillain Barré syndrome?","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"2","justification":""},{"idx":1,"correct":true,"proposition":"15","justification":"True"},{"idx":2,"correct":false,"proposition":"60","justification":""},{"idx":3,"correct":false,"proposition":"80","justification":""},{"idx":4,"correct":false,"proposition":"95","justification":""}],"ts":{"$numberLong":"1647285080759"},"type":"custom","difficulte":1}
-{"_id":"systemeconv-sp-988d73","context":null,"enonce":"Which of the following are PSRs for treating physicians?","item":"systemeconv","matiere":"sp","propositions":[{"idx":0,"correct":true,"proposition":"Tobacco prevention","justification":"True"},{"idx":1,"correct":true,"proposition":"Prevention of addictive behaviors","justification":"True"},{"idx":2,"correct":true,"proposition":"Efficiency in antibiotic prescribing","justification":"True"},{"idx":3,"correct":false,"proposition":"Covid vaccination","justification":"At least, not yet in June 2021"},{"idx":4,"correct":true,"proposition":"Influenza vaccination","justification":"True"}],"ts":{"$numberLong":"1647285118632"},"type":"custom","difficulte":2}
-{"_id":"297-onco-08262a1d-9753-4bea-93ea-a67693fa7ba0","context":null,"enonce":"You are a medical gynecology intern and you receive today Mrs. Z 28 years old to perform a cervical smear as part of cervical cancer screening. \nShe has the following background:\n- type 2 diabetes,\n- a Helicobacter pylori infection treated 2 years ago,\n- a solid organ transplant under immunosuppressive therapy since the age of 24.\nA few days after the consultation you receive the result of the smear: ASC-US.  What is the exact proposal(s)?","item":"KcUt","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"An HPV-HR test should have been performed as a first-line test before smear cytology.","justification":"Fake the patient at 29 years old and cytology on FCU must be performed in first line between 25 and 30 years!"},{"idx":1,"correct":false,"proposition":"Following the result of the smear, an immediate colposcopy should be performed.","justification":"False! If AUC-US = indeterminate = HPV test, if the latter is positive then a colposcopy will be done, otherwise a cytology at 1 year."},{"idx":2,"correct":true,"proposition":"Annual cervical cancer screening is recommended for this patient as part of a specialized follow-up.","justification":"True she is on immunosuppressant +++ = increased risk of cervical cancer or rapid progression to cervical cancer after HPV infection!"},{"idx":3,"correct":false,"proposition":"Type 2 diabetes is a risk factor for cervical cancer.","justification":"False! Risk factor for endometrial cancer!"},{"idx":4,"correct":true,"proposition":"If the smear result had been: LSIL, colposcopy would have been indicated.","justification":"True"}],"ts":{"$numberLong":"1647285664972"},"type":"custom","difficulte":3}
-{"_id":"300-onco-632893fd-1fe3-48c2-a4d4-5e525774a9cc","context":null,"enonce":"What are the risk factors for gastric adenocarcinoma?","item":"Kcestomac","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"Overweight","justification":"False, it is a risk factor for esophageal cancer"},{"idx":1,"correct":true,"proposition":"Sleeve gastrectomy","justification":"True, because partial gastrectomy leads to stagnation of stomach contents in the stump, which will lead to an additional risk of cancer. This is why we do control fibroscopies in the follow-up of sleeve (at 2 and 5 years)"},{"idx":2,"correct":true,"proposition":"Excessive consumption of brine","justification":"True, i.e. salt and nitrites, which partly explains why low socioeconomic status is also a risk factor"},{"idx":3,"correct":true,"proposition":"Biermer's disease","justification":"True, because like all gastritis there is inflammation and therefore a risk of cancerization"},{"idx":4,"correct":false,"proposition":"Presence of chronic GERD for more than 20 years","justification":"False, distractor here"}],"ts":{"$numberLong":"1647285766302"},"type":"custom","difficulte":2}
-{"_id":"300-onco-b79b87d4-f1d4-4803-af95-0fa7180bb8b8","context":null,"enonce":"You receive in digestive oncology consultation Mr RAT, Paddy, 75 years old that you have brilliantly operated on a gastric adenocarcinoma, via a total gastrectomy. You will now explain the necessary elements for the rest of the support","item":"Kcestomac","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Meal splitting (6 to 7 meals per day in small quantities)","justification":"True, simply the stomach can not hold more food, so to avoid dilating the stump, we split the meals"},{"idx":1,"correct":false,"proposition":"Taking proton pump inhibitor therapy","justification":"False, some surgeons can do it, but there is no clear indication."},{"idx":2,"correct":false,"proposition":"Taking carbohydrates every 2 hours to avoid dumping syndrome","justification":"False, completely fanciful! Dumping syndrome corresponds to hypoglycemia related to the delay in the absorption of carbohydrates in the body (basically the pancreas detects carbohydrates in the stomach, and secretes insulin when we have not even sent carbohydrates into the blood, to schematize roughly that's it)"},{"idx":3,"correct":false,"proposition":"Antiplatelet therapy for a period of 6 months","justification":"False, no antiaggregant necessary except possibly in case of postoperative hyperplatektosis and still it is discussed."},{"idx":4,"correct":false,"proposition":"PO Vitamin B12 Supplementation","justification":"Wrong, big trap! It's intramuscular!!! You no longer have a stomach so you can no longer absorb Vitamin B12... (even if you will see that the literature retains that we can supplement PO anyway, but not to ECN)"}],"ts":{"$numberLong":"1647285888967"},"type":"custom","difficulte":2}
-{"_id":"303-onco-0278c1ac-ff46-4ec1-a1cb-2be109ba7087","context":null,"enonce":"What are the signs on pelvic ultrasound of an ovarian tumor in favor of malignancy?","item":"Kcovaire","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Ovarian wall thickening","justification":"True, a thick and irregular wall"},{"idx":1,"correct":false,"proposition":"Multifollicated ovary","justification":"False, it is seen in particular in the hormonal stimulations of ART, to ovulate many oocytes to the patient"},{"idx":2,"correct":true,"proposition":"Bilateral involvement","justification":"True, it often indicates contralateral and advanced involvement"},{"idx":3,"correct":true,"proposition":"Endo or exocystic vegetations","justification":"True, vegetations are often signs of cancer"},{"idx":4,"correct":false,"proposition":"Peripheral hypervascularization","justification":"False it is a central hypervascularization"}],"ts":{"$numberLong":"1647286042051"},"type":"custom","difficulte":2}
-{"_id":"303-onco-9ba29e59-9499-4d1d-b334-0d261d1cd384","context":null,"enonce":"Mrs. DAPHNIS, Chloé, 75 years old, comes to consult you in oncology appointments, because she has just been diagnosed with ovarian cancer. Very familiar with item 303 of the ECN, she asks you questions about the BRCA1 and BRCA2 genes that are predisposing to ovarian cancer. What can you say to him?","item":"Kcovaire","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"BRCA 1 and BRCA 2 genes are oncogenes","justification":"False, these are tumor suppressor genes! Generally oncogenes are autosomal recessive and autosomal tumor suppressor genes dominant, I remembered like that!"},{"idx":1,"correct":true,"proposition":"BRCA 1 and BRCA 2 genes are inherited in an autosomal dominant manner","justification":"True, it is enough to have only one mutated to express the disease"},{"idx":2,"correct":true,"proposition":"There is a higher risk of developing ovarian cancer when you have mutated BRCA1 compared to mutated BRCA2","justification":"True, up to 50% for BRCA versus 25% for BRCA2 (versus about 12% in non-mutated women, and 6% in the general non-mutated population)"},{"idx":3,"correct":true,"proposition":"Any diagnosed ovarian cancer requires testing for mutated BRCA","justification":"True, cancer so rare that it requires genetic research (Lynch and \/ or BRCA often involved)"},{"idx":4,"correct":false,"proposition":"For mutated BRCA, treatment for ovarian cancer is based on targeted monotherapy","justification":"False, there are many targeted therapies with PARP inhibitors but they are in addition to chemotherapy."}],"ts":{"$numberLong":"1647286235201"},"type":"custom","difficulte":2}
-{"_id":"304-onco-678c24c6-186f-415c-a36c-a257bcc41518","context":null,"enonce":"For biopsies of primary and secondary bone cancers, what are the exact answer(s) among the following?","item":"Kcos","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Bone biopsy is an essential act for the characterization and diagnosis of primary bone tumor ","justification":"True, as with almost any cancer! The biopsy is the heart of diagnosing the type of cancer (primary, secondary) and its grade"},{"idx":1,"correct":true,"proposition":"In case of suspicion of primary bone cancer, a Multidisciplinary Consultation Meeting must take place, but the latter must be approved of its specialty in primary bone tumors","justification":"True, completely convoluted sentence, to say that, since these are rare tumors, CPR must be done in a reference center in the field"},{"idx":2,"correct":true,"proposition":"Biopsy samples will be frozen and copies will be stored in the tumour database","justification":"True, as these are rare tumors, they must be frozen to be references and benefit from additional analyzes"},{"idx":3,"correct":true,"proposition":"Biopsy alone can diagnose the severity grade of primary bone cancer","justification":"True, the gradification of cancer severity is based on cyto and histological elements, so the biopsy alone makes the grade"},{"idx":4,"correct":false,"proposition":"High-grade osteosarcoma is more deadly than high-grade chondrosarcoma","justification":"False, both almost always fatal at 5 years, distractor because it was necessary one"}],"ts":{"$numberLong":"1647286381514"},"type":"custom","difficulte":2}
-{"_id":"304-onco-fc6ebd27-387a-435e-992b-fd92dc676c46","context":null,"enonce":"Which of the following are primary bone tumours?","item":"Kcos","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Osteosarcoma","justification":"True, to retain malignant tumors benign tumors for bone tumors there is a small and very simple way, namely, all tumors that end in sarcoma or that include sarcomas are malignant tumors (bone sarcoma, leiomyosarcoma, osteosarcoma, Ewing's sarcoma, chondrosarcoma). Everything else is benign"},{"idx":1,"correct":true,"proposition":"Ewing sarcoma","justification":"True, cf. Has"},{"idx":2,"correct":false,"proposition":"Chordoma","justification":"False, cf. Has"},{"idx":3,"correct":false,"proposition":"Osteochondrome","justification":"False, cf. Has"},{"idx":4,"correct":false,"proposition":"Osteoclastosarcoma","justification":"False, small trap this tumor does not exist"}],"ts":{"$numberLong":"1647286417413"},"type":"custom","difficulte":2}
-{"_id":"306-onco-90102c15-fdf6-4d69-b3e3-9463fbec7c71","context":null,"enonce":"Regarding biopsy in the context of lung cancer diagnosis, what are the exact answer(s)?","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"The biopsy is done under general anesthesia","justification":"False, it can totally be considered under local anesthesia"},{"idx":1,"correct":false,"proposition":"The biopsy is done with a rigid bronchoscope","justification":"False, a flexible bronchoscope is indicated to allow better passage through the bronchi"},{"idx":2,"correct":true,"proposition":"The performance of the biopsy is improved by the realization of a cytological brushing and \/ or a directed lavage for cytological aspiration","justification":"True, it allows for additional cytological analysis and that's just a bonus."},{"idx":3,"correct":false,"proposition":"In some cases, cytological analyses of sputum may point to the type of tumor","justification":"False, there is no indication and no interest in performing it"},{"idx":4,"correct":true,"proposition":"Transparietal needle puncture-biopsy is at risk of pneumothorax","justification":"True, logically, the pleura is on the way"}],"ts":{"$numberLong":"1647286457813"},"type":"custom","difficulte":2}
-{"_id":"306-onco-d42d8a7c-00ac-4ff9-8217-b9d0c59cc0d2","context":null,"enonce":"You are a general practitioner, and you receive Mr PARKER, Peter, 76 years old, for his prescription renewal.\nThis former repairman on the shipyard, smoking like a firefighter, with a smoking rated at 180PA is at risk of lung cancer. You regularly screen for lung cancer, monitoring its respiratory signs and doing repeated imaging tests, but your external who attends your consultation tells you that you must also watch for paraneoplastic syndromes in this case too...\nWhat paraneoplastic syndromes can be found in lung cancer?","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"Syndrome de Sweet","justification":"False, this febrile neutrophilic dermatosis is found mainly in hemopathies, and in no case in lung cancers."},{"idx":1,"correct":true,"proposition":"Syndrome of inappropriate secretion of anti-diuretic hormone","justification":"True, or ex-Schwartz Barttner syndrome, it is characterized by deep hyponatremia"},{"idx":2,"correct":true,"proposition":"Pneumic hypertrophiant osteoarthropathy","justification":"True, or Pierre-Marie syndrome, it will be characterized by a digital hippocratism and pain of the joints of the limbs, with imaging an engainant periodosis."},{"idx":3,"correct":true,"proposition":"Lambert Eaton's pseudomyasthenia gravis","justification":"True, it mimics in every way a myasthenia gravis except that we will not have the antibodies!"},{"idx":4,"correct":false,"proposition":"Syndrome de Stauffer","justification":"False, this hepatomegaly with anicteric cholestasis is found in kidney cancer"}],"ts":{"$numberLong":"1647286506964"},"type":"custom","difficulte":2}
-{"_id":"307-onco-01a87ebd-25c0-4ef8-966d-469a7423e3c4","context":null,"enonce":"You receive in consultation Mr HARKNESS, Jack, 67 years old, completely panicked! Indeed he tells you that his \"PSA is much too high\" and he thinks he has prostate cancer. You try to reassure him by explaining the possible causes of PSA elevation... What are they?","item":"Kcprostate","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Benign prostatic hyperplasia","justification":"True, the prostate is bigger, so it produces more PSA! 1ng\/mL per cm3 of prostate (volume assessed on MRI)"},{"idx":1,"correct":true,"proposition":"Taking testosterone","justification":"True, testosterone stimulates prostate cells and therefore the production of PSA"},{"idx":2,"correct":true,"proposition":"Prostatitis","justification":"True, prostate irritation transiently increases PSA levels"},{"idx":3,"correct":true,"proposition":"Prostate cancer","justification":"True, of course"},{"idx":4,"correct":true,"proposition":"Recent ejaculation","justification":"True, unknown cause, absent from several referentials, but that we must know. Simply because ejaculation stimulates the prostate for protein secretion and therefore stimulates the production of pSA"}],"ts":{"$numberLong":"1647286578844"},"type":"custom","difficulte":2}
-{"_id":"307-onco-c6c5afcc-8b37-41bd-b0ef-0476aaf147b4","context":null,"enonce":"Regarding the prognostic classification of prostate cancer and the appropriate therapeutic options, validate the corresponding couples.","item":"Kcprostate","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Low risk - Brachytherapy","justification":"True, for low risks the possibilities are active surveillance, brachytherapy, radiotherapy, prostatectomy"},{"idx":1,"correct":false,"proposition":"High risk - Total prostatectomy alone","justification":"False, for high risk the only possibility is radiotherapy and hormone therapy for 3 years, or total prostatecomia + lymph node dissection as part of a multimodal treatment"},{"idx":2,"correct":false,"proposition":"Moderate risk - Radiation therapy and hormone therapy for 3 years","justification":"False, for moderate risk the possibilities are prostatectomy and radiotherapy with hormone therapy for 6 months"},{"idx":3,"correct":true,"proposition":"Low Risk - Active Surveillance","justification":"True, see A"},{"idx":4,"correct":false,"proposition":"High Risk - Chemical Castration","justification":"False, treatment of resistant or metastatic forms"}],"ts":{"$numberLong":"1647286684303"},"type":"custom","difficulte":2}
-{"_id":"308-onco-4a47794f-84be-413e-b604-cc82470f098d","context":null,"enonce":"What are the hereditary forms of kidney cancer?","item":"Kcrein","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Bourneville's tuberous sclerosis","justification":"True, one of the two hereditary forms to remember for the ECN, sorry to make a MCQ on it, but it is a small detail to have in mind for a fifteenth question"},{"idx":1,"correct":false,"proposition":"Le syndrome de Cowden","justification":"False, this pathology is at risk of digestive cancer"},{"idx":2,"correct":true,"proposition":"Von Hippel Lindau's disease","justification":"True, one of the two hereditary forms to remember for the ECN, sorry to make a MCQ on it, but it is a small detail to have in mind for a fifteenth question"},{"idx":3,"correct":false,"proposition":"Le syndrome de Pugh-Hurtis-Weisz","justification":"False, does not exist, but remotely resembles Fitz-Hugh-Curtis syndrome, which corresponds to perihepatic violin strings in advanced C. Trachomatis infections."},{"idx":4,"correct":false,"proposition":"The NMS 2","justification":"False, gives thyroid cancers"}],"ts":{"$numberLong":"1647286784133"},"type":"custom","difficulte":2}
-{"_id":"Kcoeso-onco-24eada0","context":null,"enonce":"What are the risk factors for adenocarcinoma of the esophagus?","item":"Kcoeso","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"No proposition is true","justification":"True"},{"idx":1,"correct":false,"proposition":"HPV","justification":"Squamous cell carcinoma"},{"idx":2,"correct":false,"proposition":"Syndrome de Plummer-Vinson","justification":"Squamous cell carcinoma"},{"idx":3,"correct":false,"proposition":"Chest radiation therapy","justification":"Squamous cell carcinoma"},{"idx":4,"correct":false,"proposition":"Hot drinks","justification":"Squamous cell carcinoma"}],"ts":{"$numberLong":"1647286823177"},"type":"custom","difficulte":1}
-{"_id":"Kcoeso-onco-b582d6d","context":null,"enonce":"What are the risk factors for adenocarcinoma of the esophagus?","item":"Kcoeso","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"Being a woman","justification":"Being a man"},{"idx":1,"correct":true,"proposition":"Endobrachyoesophagus","justification":"True"},{"idx":2,"correct":true,"proposition":"Overweight","justification":"True"},{"idx":3,"correct":true,"proposition":"Obesite","justification":"True"},{"idx":4,"correct":true,"proposition":"Tobacco","justification":"True, risk factor for all types of esophageal cancer"}],"ts":{"$numberLong":"1647286841406"},"type":"custom","difficulte":1}
-{"_id":"Kcpulm-onco-1e6705e","context":null,"enonce":"What are the possible markers of neuroendocrine tumors?","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Chromogranin A","justification":"True"},{"idx":1,"correct":true,"proposition":"Synaptophysin","justification":"True"},{"idx":2,"correct":true,"proposition":"CD56","justification":"True"},{"idx":3,"correct":false,"proposition":"ACE","justification":"Colon tumours"},{"idx":4,"correct":false,"proposition":"SCC","justification":"Squamous cell carcinomas"}],"ts":{"$numberLong":"1647286873254"},"type":"custom","difficulte":3}
-{"_id":"Kcpulm-onco-24b2b44","context":null,"enonce":"Regarding TTF1 in cancers:","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Adenocarcinomas are classically TTF1 positive","justification":"True"},{"idx":1,"correct":true,"proposition":"Adenocarcinomas are classically p40 negative","justification":"True"},{"idx":2,"correct":true,"proposition":"TTF1 stands for: Thyroid Transcription Factor-1","justification":"True"},{"idx":3,"correct":false,"proposition":"It is relatively specific to squamous cell carcinomas","justification":"It is found in adenocarcinomas "},{"idx":4,"correct":false,"proposition":"It is a marker of neuroendocrine tumors","justification":"It is found in adenocarcinomas "}],"ts":{"$numberLong":"1647286910321"},"type":"custom","difficulte":3}
-{"_id":"Kcpulm-onco-2b6543e","context":null,"enonce":"What is the overall 5-year survival in percentage for all tumours?","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"17","justification":"True"},{"idx":1,"correct":false,"proposition":"5","justification":""},{"idx":2,"correct":false,"proposition":"85","justification":""},{"idx":3,"correct":false,"proposition":"50","justification":""},{"idx":4,"correct":false,"proposition":"33","justification":""}],"ts":{"$numberLong":"1647286935931"},"type":"custom","difficulte":1}
-{"_id":"Kcpulm-onco-8550f99","context":null,"enonce":"Regarding the left lung:","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"There are two scissures","justification":""},{"idx":1,"correct":false,"proposition":"There is a large and a small split","justification":""},{"idx":2,"correct":true,"proposition":"There are two lobes","justification":"True, there are two lobes (upper and lower, distinguishable with the sign of the cardiac silhouette) separated by a \"large\" split"},{"idx":3,"correct":false,"proposition":"There are three lobes","justification":""},{"idx":4,"correct":false,"proposition":"There are three splits: one large, one medium and one small","justification":""}],"ts":{"$numberLong":"1647286981364"},"type":"custom","difficulte":1}
-{"_id":"Kcpulm-onco-c0d7b4e","context":null,"enonce":"Regarding platinum salts:","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"They are topoisomerase 2 inhibitors","justification":"This is the case of anthracyclines"},{"idx":1,"correct":true,"proposition":"They act throughout the cell cycle","justification":"True"},{"idx":2,"correct":true,"proposition":"Oxaliplatin is used in colorectal cancer","justification":"True, FOLFOX protocol"},{"idx":3,"correct":true,"proposition":"Cisplatin is ototoxic","justification":"True"},{"idx":4,"correct":false,"proposition":"They are all highly neurotoxic","justification":"Especially oxaliplatin which gives neuropathies in the cold"}],"ts":{"$numberLong":"1647287014127"},"type":"custom","difficulte":2}
-{"_id":"PF-neuro-88453b3","context":null,"enonce":"What is the leading cause of facial paralysis?","item":"PF","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"Idiopathic","justification":"True, i.e. a frigore"},{"idx":1,"correct":true,"proposition":"A frigore","justification":"True, i.e. idiopathic"},{"idx":2,"correct":false,"proposition":"SEP","justification":""},{"idx":3,"correct":false,"proposition":"VZV","justification":""},{"idx":4,"correct":false,"proposition":"HIV","justification":""}],"ts":{"$numberLong":"1647287219386"},"type":"custom","difficulte":1}
-{"_id":"163-infectio-06f42df6-e05a-43c7-86dc-c2cd149552ce","context":null,"enonce":"Which of the following are true?","item":"VH","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"The severity of acute hepatitis is based on the value of transaminases ","justification":"False: The assessment of the severity of acute hepatitis (HA) is based on clinico-biological signs reflecting a functional impact: the value of TP and\/or factor V (hemostasis disorders) and the presence of signs of hepatic encephalopathy (severe prognosis).                "},{"idx":1,"correct":true,"proposition":"A PT < 50% requires hospitalization of the patient in a specialized center close to a liver transplant center","justification":"True: acute hepatitis with < PD  50% corresponds to severe HA and requires hospitalization in a specialized center. "},{"idx":2,"correct":true,"proposition":"The definition of fulminant hepatitis is based on the association of a PD < 50% and the installation of hepatic encephalopathy ","justification":"True. HA fulminant = TP < 50% associated with signs of hepatic encephalopathies of recent onset < 2 weeks."},{"idx":3,"correct":false,"proposition":"Sub-fulminant hepatitis develops within less than 2 weeks ","justification":"False. HA fulminant = installation < 2 weeks. Sub-fulminant HA = installation 2 weeks-3 months. "},{"idx":4,"correct":false,"proposition":"All acute hepatitis occurring on a cirrhotic liver is acute alcoholic hepatitis. ","justification":"False. Acute alcoholic hepatitis is a diagnosis to look for but all causes of acute hepatitis can occur in a cirrhotic patient!"}],"ts":{"$numberLong":"1647287376517"},"type":"custom","difficulte":2}
-{"_id":"163-infectio-cd679557-71e2-46b1-af63-9ee2ca1d09a8","context":null,"enonce":"What are the true propositions concerning hypertransaminasemia? ","item":"VH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"There are extrahepatic causes responsible for elevated BP ","justification":"True. These are the differential diagnoses to keep in mind: celiac disease, myopathies, hemolysis, heart damage, violent efforts. "},{"idx":1,"correct":false,"proposition":"The two main causes of BP < 10N (low to moderate) are drug-induced and viral hepatitis. ","justification":"False. The two main causes of BP < 10N: alcohol and metabolic syndrome. "},{"idx":2,"correct":true,"proposition":"Hepatic ultrasound is part of the etiological assessment in front of acute hepatitis with BP > 10N. ","justification":"True. 4 causes to look for acute hepatitis with BP > 10N: viral (=serologies+++), drug\/toxic (paracetamol+++), lithiasis (echo+++) and hepatic hypoxia (Budd Chiari, Heart failure, shock...) "},{"idx":3,"correct":true,"proposition":"Acute hepatitis with a fever > 38.5 should be investigated for acute herpes hepatitis.","justification":"True. HSV PCR to do ++++"},{"idx":4,"correct":false,"proposition":"The majority of viral algae hepatitis is clinically characterized by Caroli's triad: headache, arthralgia, urticaria. ","justification":"False. The majority of acute viral hepatitis is ASYMPTOMATIC. "}],"ts":{"$numberLong":"1647287527559"},"type":"custom","difficulte":2}
-{"_id":"163-infectio-dade0e47-d4f6-4ff5-90d2-a8fc685cfed8","context":null,"enonce":"What are the true propositions concerning hypertransaminasemia? ","item":"VH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"There are extrahepatic causes responsible for elevated BP ","justification":"True. These are the differential diagnoses to keep in mind: celiac disease, myopathies, hemolysis, heart damage, violent efforts. "},{"idx":1,"correct":false,"proposition":"The two main causes of BP < 10N (low to moderate) are drug-induced and viral hepatitis. ","justification":"False. The two main causes of BP < 10N: alcohol and metabolic syndrome. "},{"idx":2,"correct":true,"proposition":"Hepatic ultrasound is part of the etiological assessment in front of acute hepatitis with BP > 10N. ","justification":"True. 4 causes to look for acute hepatitis with BP > 10N: viral (=serologies+++), drug\/toxic (paracetamol+++), lithiasis (echo+++) and hepatic hypoxia (Budd Chiari, Heart failure, shock...) "},{"idx":3,"correct":true,"proposition":"Acute hepatitis with a fever > 38.5 should be investigated for acute herpes hepatitis.","justification":"True. HSV PCR to do ++++"},{"idx":4,"correct":false,"proposition":"The majority of viral algae hepatitis is clinically characterized by Caroli's triad: headache, arthralgia, urticaria. ","justification":"False. The majority of acute viral hepatitis is ASYMPTOMATIC. "}],"ts":{"$numberLong":"1647287541015"},"type":"custom","difficulte":2}
-{"_id":"meningite-infectio-1d2de4e","context":null,"enonce":"Which germs are gram-positive cocci in chains?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Hemolytic alpha streptococcus","justification":"True, is seen in endocarditis"},{"idx":1,"correct":true,"proposition":"Group A hemolytic beta streptococcus","justification":"True, also called pyogenes"},{"idx":2,"correct":true,"proposition":"Group B hemolytic beta streptococcus","justification":"True, also called agalactiæ "},{"idx":3,"correct":true,"proposition":"Gamma hemolytic streptococcus","justification":"True, all streptococci are chained at ECN"},{"idx":4,"correct":false,"proposition":"Staphylococcus epidermis","justification":"In clusters"}],"ts":{"$numberLong":"1647287688709"},"type":"custom","difficulte":1}
-{"_id":"meningite-infectio-7c662c5","context":null,"enonce":"What are gram-negative cocci?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Neiserria meningitidis","justification":"True"},{"idx":1,"correct":true,"proposition":"Neiserria gonorroheæ","justification":"True"},{"idx":2,"correct":true,"proposition":"Moraxella catarrhalis","justification":"True"},{"idx":3,"correct":true,"proposition":"Acinetobacter ","justification":"True"},{"idx":4,"correct":false,"proposition":"Listeria monocytogenes","justification":"Gram-negative bacillus"}],"ts":{"$numberLong":"1647287701943"},"type":"custom","difficulte":1}
-{"_id":"194-rhumato-8adc0ddc-db1e-434e-bca6-d6d4d5100ca1","context":null,"enonce":"You have in hospital, Mr. Langdon, Robert, 55 years old, who presents for a gout attack occurring on his right knee. Which of the short-, medium- and long-term treatment options will you remember?","item":"rhumcrist","matiere":"rhumato","propositions":[{"idx":0,"correct":true,"proposition":"Resting the joint with icing","justification":"True, all non-drug measures are to be preferred because we can always take advantage of them"},{"idx":1,"correct":false,"proposition":"Colchicine started on the second or third day of hospitalization at a maximum dose of 3mg, to take advantage of the decrease in infection","justification":"False, colchicine is to start as early as possible, because it is all the more effective"},{"idx":2,"correct":false,"proposition":"In case of macrolide treatment for digestive infection, there is a contraindication to NSAIDs","justification":"False, a contraindication to colchicine, due to the interaction with cytochromes"},{"idx":3,"correct":true,"proposition":"The therapeutic target of hypouricemic treatment is 360micromoles per liter","justification":"True, which corresponds to the crystallization threshold of sodium urate"},{"idx":4,"correct":true,"proposition":"The patient will have to curb his consumption of alcohol, fast sugar and offal","justification":"True, as well as red meats and seafood"}],"ts":{"$numberLong":"1647369523371"},"type":"custom","difficulte":2}
-{"_id":"Kcpulm-onco-c9c1080","context":null,"enonce":"What is the chemotherapy of choice for lung tumors?","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Platinum salts","justification":"True"},{"idx":1,"correct":false,"proposition":"Bleomycin","justification":"No, especially since it has pulmonary toxicity type of pulmonary fibrosis"},{"idx":2,"correct":false,"proposition":"The 5-FU","justification":""},{"idx":3,"correct":false,"proposition":"Cyclophosphamide","justification":""},{"idx":4,"correct":false,"proposition":"Irinotecan","justification":""}],"ts":{"$numberLong":"1647370167880"},"type":"custom","difficulte":2}
-{"_id":"Kcpulm-onco-efc798a","context":null,"enonce":"Regarding imaging in the diagnostic assessment:","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"Brain MRI is systematic","justification":"ATTENTION: the question concerns the DIAGNOSTIC assessment (and no extension)..."},{"idx":1,"correct":true,"proposition":"To speak of a systematized abnormality, the lesion must be extended to an entire lobe or lung segment","justification":"True"},{"idx":2,"correct":false,"proposition":"Mediastinal lymphadenopathy can easily be confused with blood vessels","justification":"parenchymal lymphadenopathy*"},{"idx":3,"correct":false,"proposition":"Chest CT should be coupled with PET","justification":"In the extension assessment, we do a TEP. But not in the diagnosis"},{"idx":4,"correct":false,"proposition":"All propositions are true","justification":""}],"ts":{"$numberLong":"1647370341425"},"type":"custom","difficulte":1}
-{"_id":"Kcrein-onco-de988e5","context":null,"enonce":"Which of these proposals designates the most common histological type of malignant renal tumor?","item":"Kcrein","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"angiomyolipoma","justification":"Benin"},{"idx":1,"correct":true,"proposition":"clear cell carcinoma","justification":"True"},{"idx":2,"correct":false,"proposition":"adenocarcinoma","justification":"No adenocarcinoma"},{"idx":3,"correct":false,"proposition":"Oncocytoma","justification":"Benin"},{"idx":4,"correct":false,"proposition":"chromophobic carcinoma","justification":"Very rare (about 5%)"}],"ts":{"$numberLong":"1647371254226"},"type":"custom","difficulte":1}
-{"_id":"246-nutri-b64e9d97-ce5f-4b42-9a48-59dacbd12551","context":null,"enonce":"Mr. Williams, Rory, 45 years old, overweight, with a BMI of 27 comes to see you for consultation because \"Enough is enough, I want to eat better!\". He asks you what he should actually do as a meal and what portion of each food he should put on his plate. What do you say to him?","item":"preventionnutri","matiere":"nutri","propositions":[{"idx":0,"correct":true,"proposition":"All-you-can-eat water during and between meals","justification":"True, essential, it is obvious! "},{"idx":1,"correct":false,"proposition":"Starchy foods, one serving per day","justification":"False, starchy foods are \"solid\", this is what allows you to stall during meals, so it is to be private for lunch and dinner"},{"idx":2,"correct":true,"proposition":"5 fruits and vegetables per day","justification":"True, public health message that everyone knows ;)"},{"idx":3,"correct":false,"proposition":"Focus on vegetable fats and saturated fatty acids","justification":"False, small trap here to insist that it is INsaturated fatty acids that are to be preferred (vegetable fats) rather than saturated fatty acids (cold cuts etc ...)"},{"idx":4,"correct":false,"proposition":"3 dairy products per day","justification":"False, recommendation that has been revised downwards, due to a highlighting of dairy lobby, currently it is 2 per day that is recommended for adults"}],"ts":{"$numberLong":"1647371994772"},"type":"custom","difficulte":2}
-{"_id":"247-nutri-9b34f801-52b5-4047-81df-7dd5a393eb97","context":null,"enonce":"Regarding dietary modifications recommended in common clinical situations, what are the following exact pathologie\/dietary recommendations?","item":"MTMV","matiere":"nutri","propositions":[{"idx":0,"correct":true,"proposition":"Hypertriglyceridemia and Decreased consumption of simple carbohydrates and alcohol","justification":"True, we sometimes make a false amalgam between triglycerides = eat fat, but it is especially sugar and alcohol that causes a peak of hypertriglyceridemia"},{"idx":1,"correct":true,"proposition":"Osteoporosis and increased vitamin calcium intake","justification":"True, in a very logical way, a vitaminocalcium intake improves bone remodeling"},{"idx":2,"correct":true,"proposition":"Gastroesophageal reflux disease and limitation of alcohol, chocolate and coffee consumption","justification":"True, quite logical there too, these are hot drinks that can irritate the esophageal mucosa and promote reflux"},{"idx":3,"correct":false,"proposition":"Irritable bowel syndrome and diet with FODMAP exclusion","justification":"False, quite important point, because if the FODMAPs-free diet has been quite popularized lately it is a very very restrictive diet (with exclusion of many foods) which is very restrictive and which should only be considered in case of drug failure and failure of other dietary care."},{"idx":4,"correct":false,"proposition":"Diverticular disease and residue-free diet","justification":"False, it is that in the case of acute diverticulitis that a diet without residues is prescribed."}],"ts":{"$numberLong":"1647372187694"},"type":"custom","difficulte":2}
-{"_id":"248-nutri-f6bd5529-a671-4009-8c76-b7d49f269caa","context":null,"enonce":"Freshly appointed intern in geriatrics in the department of SSR Geriatric of your municipality, you receive in your department Mr Dicarpaccio, Leonardo, 89 years old, hospitalized for 1 week in acute geriatrics for fall with prolonged ground station, complicated bedsores. You look at the file with your senior and you notice that he has not eaten for 1 week. Your boss then tells you at 5pm to prescribe nutritional supplementation while paying attention to inappropriate renutrition syndrome. Thoughtful, you plunge back into the characteristics of this syndrome. What are the clinical and biological signs and what prevention should be applied in case of risk of this syndrome?","item":"denutrition","matiere":"nutri","propositions":[{"idx":0,"correct":true,"proposition":"The syndrome can manifest as edema of the lower limbs","justification":"True, edema of the lower extremities is a clinical sign of severe undernutrition, but also a sign of inappropriate renutrition. In short, watch the legs of your at-risk patients!"},{"idx":1,"correct":true,"proposition":"Biologically, the syndrome is manifested by hypophosphoremia, hypomagnesemia, hypokalemia","justification":"True, the cause of inappropriate renutrition syndrome is an acute consumption of electrolyte reserves provided by the diet, namely phosphorus, magnesium, potassium."},{"idx":2,"correct":false,"proposition":"In case you decide to implement parenteral nutrition, you should adapt the flow of the nasogastric tube starting at a low flow rate.","justification":"False, small trap (because I have often been fooled...) everything is true except that it is ENTERAL nutrition"},{"idx":3,"correct":false,"proposition":"Routine phosphorus supplementation of at-risk patients is sufficient to correct phosphorus deficiencies and dispenses with follow-up biological assessment","justification":"False, preventive supplementation is not like its name... that preventive and does not dispense with biological monitoring every two days of phosphorus"},{"idx":4,"correct":false,"proposition":"Regular weight gain in the first days of renutrition is reassuring","justification":"False, rapid weight gain will most often testify to edema of renutrition raising fears of an inappropriate renutrition syndrome."}],"ts":{"$numberLong":"1647372640612"},"type":"custom","difficulte":2}
-{"_id":"249-nutri-b66daa4a-ca80-4b77-9315-fa8937599576","context":null,"enonce":"Which of the following pathologies are causes of weight loss with hyperphagia?","item":"amaigrissemt","matiere":"nutri","propositions":[{"idx":0,"correct":true,"proposition":"Type 1 diabetes","justification":"True, it is even part of the diagnostic criteria for type 1 diabetes. Weight loss with polyphagia"},{"idx":1,"correct":false,"proposition":"Parkinson's disease","justification":"False, there is most often a deficiency of intake related to swallowing disorders"},{"idx":2,"correct":false,"proposition":"Chronic ethylism","justification":"False, there is most often a normal diet, but with deficiencies."},{"idx":3,"correct":true,"proposition":"Hyperthyroidism","justification":"True, Épinal's image of hyperthyroidism shows a skinny woman eating a lot but losing weight!"},{"idx":4,"correct":true,"proposition":"Taeniosis","justification":"True, since it is the worm that eats everything in the patient's place, the patient is naturally hungry!"}],"ts":{"$numberLong":"1647372697148"},"type":"custom","difficulte":2}
-{"_id":"preventionnutri-nutri-d510224","context":null,"enonce":"1 gram of carbohydrate corresponds to how many kcal?","item":"preventionnutri","matiere":"nutri","propositions":[{"idx":0,"correct":false,"proposition":"1","justification":""},{"idx":1,"correct":false,"proposition":"2","justification":""},{"idx":2,"correct":false,"proposition":"3","justification":""},{"idx":3,"correct":false,"proposition":"5","justification":""},{"idx":4,"correct":true,"proposition":"4","justification":"True, 1g Carbohydrate and protein = 4 Kcal"}],"ts":{"$numberLong":"1647372706669"},"type":"custom","difficulte":3}
-{"_id":"preventionnutri-nutri-7778444","context":null,"enonce":"How many kcal is 1 gram of protein?","item":"preventionnutri","matiere":"nutri","propositions":[{"idx":0,"correct":false,"proposition":"1","justification":""},{"idx":1,"correct":false,"proposition":"10","justification":""},{"idx":2,"correct":false,"proposition":"8","justification":""},{"idx":3,"correct":false,"proposition":"5","justification":""},{"idx":4,"correct":true,"proposition":"4","justification":"True, 1g Carbohydrate and protein = 4 Kcal"}],"ts":{"$numberLong":"1647372711854"},"type":"custom","difficulte":3}
-{"_id":"preventionnutri-nutri-3708c8d","context":null,"enonce":"1 gram of fat corresponds to how many kcal?","item":"preventionnutri","matiere":"nutri","propositions":[{"idx":0,"correct":false,"proposition":"1","justification":""},{"idx":1,"correct":false,"proposition":"4","justification":""},{"idx":2,"correct":true,"proposition":"9","justification":"True"},{"idx":3,"correct":false,"proposition":"15","justification":""},{"idx":4,"correct":false,"proposition":"2","justification":""}],"ts":{"$numberLong":"1647372770086"},"type":"custom","difficulte":3}
-{"_id":"211-hemato-340feaab-4968-4b25-b22b-b8bb0c169338","context":null,"enonce":"You receive in the emergency room, Zenigata, Koichi, 45 years old, a man brought by the PASS, who explains to you that it is a homeless man who spends most of his nights outside. On clinical examination, you notice a perifollicular petechial purpura, as well as many oral hemorrhages with thickening of the gums leading to dental loosening. What pathology do you suspect?","item":"purpura","matiere":"hemato","propositions":[{"idx":0,"correct":false,"proposition":"Osler's endocarditis","justification":"False, Osler's endocarditis would be evoked before a fever with conjunctival purpura."},{"idx":1,"correct":false,"proposition":"Ehlers Danlos disease","justification":"False, it is manifested by ligament and cutaneous hyperlaxity with healing disorders"},{"idx":2,"correct":false,"proposition":"NSAID angiitis","justification":"False, no notion of NSAID consumption"},{"idx":3,"correct":true,"proposition":"Scurvy","justification":"True, here the context of homelessness is favoring vitamin C deficiency. The clinical description shows facilitated bleeding with hyperinfiltration of the gum mimicking a hematological disease with loosening of the teeth."},{"idx":4,"correct":false,"proposition":"AL amyloidosis","justification":"False, it is manifested by a hematoma in glasses"}],"ts":{"$numberLong":"1647372886875"},"type":"custom","difficulte":2}
-{"_id":"281-HGE-bcac4352-1942-459c-8c68-96ebad1fcf46","context":null,"enonce":"You receive in general medical consultation, Mrs. Kyle, Selena, 37 years old, who comes to see you for a table of various gastroenterological symptoms (abdominal pain, bloating, diarrhea), which you attach to a possible irritable bowel syndrome. The very concerned patient asks you if she should have a colonoscopy. To answer his request you explain the different indications of colonoscopy in the context of irritable bowel syndrome.","item":"SII","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"History of colorectal cancer in the father","justification":"True, it is quite logical, generally faced with a history of colorectal cancer, we are not cautious, patients usually have an endoscopic examination to eliminate adenomas, polyps and cancers."},{"idx":1,"correct":true,"proposition":"Age >50","justification":"True, because we join the, the limit of standard screening. Overall, a complete colonoscopy is done to reassure that the symptoms are of functional origin"},{"idx":2,"correct":false,"proposition":"Alternating diarrhea constipation at the level of the clinical picture","justification":"False, symptom intensity (except recent modification) does not count in the decision criteria for colonoscopy"},{"idx":3,"correct":true,"proposition":"Presence of rectal bleeding","justification":"True, very logically, irritable bowel syndrome does not give rectal bleeding"},{"idx":4,"correct":false,"proposition":"Intense abdominal meteorism","justification":"False, symptom intensity (except recent modification) does not count in the decision criteria for colonoscopy"}],"ts":{"$numberLong":"1647534854897"},"type":"custom","difficulte":2}
-{"_id":"cirrhose-HGE-0b5ff08","context":null,"enonce":"Regarding hepatorenal syndrome:","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"It corresponds to a renal failure of functioning origin that does not correct itself despite maximum management","justification":"True"},{"idx":1,"correct":false,"proposition":"It appears at an early stage of cirrhosis","justification":"Advanced stage"},{"idx":2,"correct":false,"proposition":"It is most often observed in cases of severe liver failure with significant ascites and a prothrombin level still above 50%","justification":"Rather when the TP is <50%"},{"idx":3,"correct":false,"proposition":"The long-term treatment is terlipressin and adrenaline","justification":"These are treatments whose beneficial effect is only temporary. The only long-lasting treatment is liver transplantation"},{"idx":4,"correct":true,"proposition":"It may be responsible for hepatic encephalopathy","justification":"True"}],"ts":{"$numberLong":"1647535600068"},"type":"custom","difficulte":1}
-{"_id":"cirrhose-HGE-176d498","context":null,"enonce":"What are the triggers of hepatic encephalopathy?","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"Bacterial infections","justification":"True"},{"idx":1,"correct":true,"proposition":"Digestive bleeding","justification":"True"},{"idx":2,"correct":true,"proposition":"Sedative medications","justification":"True"},{"idx":3,"correct":true,"proposition":"Renal failure","justification":"True"},{"idx":4,"correct":true,"proposition":"Hyponatremia","justification":"True"}],"ts":{"$numberLong":"1647535623053"},"type":"custom","difficulte":1}
-{"_id":"cirrhose-HGE-5a899ba","context":null,"enonce":"What are the triggers of hepatic encephalopathy?","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"Constipation","justification":"True"},{"idx":1,"correct":true,"proposition":"Presence of an acquired TIPS","justification":"True"},{"idx":2,"correct":true,"proposition":"Presence of a spontaneous portosystemic shunt","justification":"True"},{"idx":3,"correct":false,"proposition":"Presence of hyperleukocytosis","justification":"Not a triggering factor in itself (but bacterial infection is one), so it's not a direct link (so not to check)"},{"idx":4,"correct":false,"proposition":"Presence of anemia","justification":"Not a triggering factor in itself (but digestive bleeding is one), so it's not a direct link (so not to check)"}],"ts":{"$numberLong":"1647535646010"},"type":"custom","difficulte":1}
-{"_id":"cirrhose-HGE-f8e0109","context":null,"enonce":"You take care of a patient who complains of a \"bloated belly\". \n\nOn clinical examination you find: 130\/90 mmHg, 75 bpm, apyretic, 99% in ambient air, G15. \n\nNEUROLOGY: the patient is calm, conscious and oriented. You do not find abnormalities in the cranial pairs or other focal neurological deficits. ROTs are normal. No asterixis found, no tremors of the extremities. \n\nCARDIOVASCULAR: Heart sounds are regular without breaths, no signs of left or right heart failure. Peripheral pulses are perceived, no abdominal beating mass. \n\nABSTATIC: the abdomen is tense, depressible and painless. BHAs are correctly perceived. You find a hepatomegaly of hard consistency. No perceived splenomegaly. Presence of abdominal collateral circulation. Presence of dullness declive on percussion. Hernial orifices are free. \n\nMUCOSAL CUTANEOS: stellar angiomas, white nails, palmar erythrosis. \n\nWhat are the exact proposals?\n","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"You suspect hepatocellular insufficiency","justification":"True, in front of stellar angiomas, white nails, palmar erythrosis"},{"idx":1,"correct":true,"proposition":"You suspect portal hypertension","justification":"True, in front of the tense abdomen and declivated dullness (= ascites) and collateral venous circulation"},{"idx":2,"correct":false,"proposition":"You suspect delirium tremens","justification":"No confusion"},{"idx":3,"correct":false,"proposition":"You suspect thrombosis of the inferior vena cava","justification":"Very uncommon + no clinical sign here"},{"idx":4,"correct":false,"proposition":"You suspect encephalopathy","justification":"No neurological signs"}],"ts":{"$numberLong":"1647535741806"},"type":"custom","difficulte":1}
-{"_id":"ictere-HGE-c503890","context":null,"enonce":"Which propositions are true?","item":"ictere","matiere":"HGE","propositions":[{"idx":0,"correct":false,"proposition":"Conjugated bilirubin jaundice is always due to biliary stasis","justification":"Many other causes of increased conjugated bilirubin exist. For example, large hemolysis leads to functional cholestasis "},{"idx":1,"correct":true,"proposition":"Conjugated bilirubin jaundice causes dark urine","justification":"True"},{"idx":2,"correct":true,"proposition":"Free bilirubin jaundice is conventionally accompanied by clear urine","justification":"True"},{"idx":3,"correct":true,"proposition":"Free bilirubin jaundice does not conventionally cause pruritus","justification":"True"},{"idx":4,"correct":false,"proposition":"free bilirubin is eliminated in the urine","justification":"It is transformed by hepatocytes, which eliminate it in the bile"}],"ts":{"$numberLong":"1647535833905"},"type":"custom","difficulte":1}
-{"_id":"BPCO-pneumo-24c3015","context":null,"enonce":"A 70% post-bronchodilator FEV1 classifies COPD as stage:","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"1","justification":""},{"idx":1,"correct":true,"proposition":"2","justification":"True"},{"idx":2,"correct":false,"proposition":"3","justification":""},{"idx":3,"correct":false,"proposition":"4","justification":""},{"idx":4,"correct":false,"proposition":"5","justification":""}],"ts":{"$numberLong":"1647536025221"},"type":"custom","difficulte":1}
-{"_id":"BPCO-pneumo-a766144","context":null,"enonce":"A 10% post-bronchodilator FEV1 classifies COPD as stage:","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"1","justification":""},{"idx":1,"correct":false,"proposition":"2","justification":""},{"idx":2,"correct":false,"proposition":"3","justification":""},{"idx":3,"correct":true,"proposition":"4","justification":"True"},{"idx":4,"correct":false,"proposition":"5","justification":"No stage 5"}],"ts":{"$numberLong":"1647536033856"},"type":"custom","difficulte":1}
-{"_id":"BPCO-pneumo-a5ed1b7","context":null,"enonce":"A 90% post-bronchodilator FEV1 classifies COPD as stage:","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"1","justification":"True"},{"idx":1,"correct":false,"proposition":"2","justification":""},{"idx":2,"correct":false,"proposition":"3","justification":""},{"idx":3,"correct":false,"proposition":"4","justification":""},{"idx":4,"correct":false,"proposition":"5","justification":""}],"ts":{"$numberLong":"1647536038669"},"type":"custom","difficulte":1}
-{"_id":"BPCO-pneumo-aa59a4d","context":null,"enonce":"A 55% post-bronchodilator FEV1 classifies COPD as stage:","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"1","justification":""},{"idx":1,"correct":true,"proposition":"2","justification":"True"},{"idx":2,"correct":false,"proposition":"3","justification":""},{"idx":3,"correct":false,"proposition":"4","justification":""},{"idx":4,"correct":false,"proposition":"5","justification":""}],"ts":{"$numberLong":"1647536044579"},"type":"custom","difficulte":1}
-{"_id":"BPCO-pneumo-dc1d55d","context":null,"enonce":"How many possible stages are there in the COPD GOLD classification based on post-bronchodilator FEV1?","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"1","justification":""},{"idx":1,"correct":false,"proposition":"2","justification":""},{"idx":2,"correct":false,"proposition":"3","justification":""},{"idx":3,"correct":true,"proposition":"4","justification":"True, the cut off are 80%, 50% and 30%"},{"idx":4,"correct":false,"proposition":"5","justification":""}],"ts":{"$numberLong":"1647536050047"},"type":"custom","difficulte":1}
-{"_id":"meningite-infectio-2434d89","context":null,"enonce":"What are gram-positive bacilli?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Corynebacterium diphteriae","justification":"True"},{"idx":1,"correct":true,"proposition":"Listeria monocytogenes","justification":"True"},{"idx":2,"correct":true,"proposition":"Bacillus anthracis","justification":"True"},{"idx":3,"correct":true,"proposition":"Clostridium dificult","justification":"True"},{"idx":4,"correct":true,"proposition":"Clostridium perfringens","justification":"True"}],"ts":{"$numberLong":"1647536328864"},"type":"custom","difficulte":1}
-{"_id":"meningite-infectio-df58822","context":null,"enonce":"What are gram-negative bacilli?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Bartonella ","justification":"True, cat scratch disease"},{"idx":1,"correct":true,"proposition":"Bordetella pertussis","justification":"True, whooping cough"},{"idx":2,"correct":true,"proposition":"Hæmophilus influenzæ","justification":"True, ENT and lung infections"},{"idx":3,"correct":true,"proposition":"Legionnella","justification":"True"},{"idx":4,"correct":false,"proposition":"Listeria monocytogenes","justification":"Gram-positive bacillus"}],"ts":{"$numberLong":"1647536468353"},"type":"custom","difficulte":1}
-{"_id":"VH-infectio-00d8e88","context":null,"enonce":"What are the risk groups for C virus infection? ","item":"VH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Subjects who received blood or blood derivatives before 1992","justification":"True"},{"idx":1,"correct":true,"proposition":"Hemodialysis patients","justification":"True"},{"idx":2,"correct":true,"proposition":"Intravenous drug addicts","justification":"True"},{"idx":3,"correct":true,"proposition":"Subjects originating from a hyperendemic area","justification":"True, Mediterranean basin"},{"idx":4,"correct":true,"proposition":"All propositions are true","justification":"True"}],"ts":{"$numberLong":"1647536737828"},"type":"custom","difficulte":1}
-{"_id":"VH-infectio-43fe210","context":null,"enonce":"What is the preferred marker of HCC?","item":"VH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Alpha-fetoprotein ","justification":"True"},{"idx":1,"correct":false,"proposition":"B-HCG","justification":"Psa a tumor marker"},{"idx":2,"correct":false,"proposition":"Total HCG","justification":"Testicular tumour"},{"idx":3,"correct":false,"proposition":"ACE","justification":"Adenocarcinoma of the lung"},{"idx":4,"correct":false,"proposition":"SCC","justification":"Squamous cell carcinomas"}],"ts":{"$numberLong":"1647537318812"},"type":"custom","difficulte":1}
-{"_id":"272-HGE-b1ab55bd-a3a6-4090-9a0f-b63491c3fe1a","context":null,"enonce":"Which of the following are true?","item":"splenomeg","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"Adrenal tumors may be a differential diagnosis ","justification":"True, only for left adrenal tumors "},{"idx":1,"correct":false,"proposition":"The diagnosis of splenomegaly is mostly ultrasound ","justification":"False, mostly clinical "},{"idx":2,"correct":true,"proposition":"Hypersplenism can cause thrombocytopenia ","justification":"True, it is a sequestration cytopenia "},{"idx":3,"correct":true,"proposition":"Viral hepatitis be a cause of splenomegaly ","justification":"True"},{"idx":4,"correct":true,"proposition":"A splenic infarction can be revealed by left basithoracic pain associated with hyperthermia ","justification":"True"}],"ts":{"$numberLong":"1647537937627"},"type":"custom","difficulte":2}
-{"_id":"radiculalgie-ortho-20b9edc","context":null,"enonce":"What are the secondary causes of carpal tunnel syndrome?","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"correct":true,"proposition":"Repetitive trauma","justification":"True"},{"idx":1,"correct":true,"proposition":"Rheumatoid arthritis","justification":"True"},{"idx":2,"correct":true,"proposition":"Acromegaly","justification":"True"},{"idx":3,"correct":false,"proposition":"Hyperthyroidism","justification":"Hypothyroidism"},{"idx":4,"correct":false,"proposition":"Idiopathic","justification":"It is a primitive cause (and not secondary, so does not answer the question) 😊"}],"ts":{"$numberLong":"1647538494937"},"type":"custom","difficulte":1}
-{"_id":"radiculalgie-ortho-c94726b","context":null,"enonce":"What are the secondary causes of carpal tunnel syndrome?","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"correct":true,"proposition":"Pregnancy","justification":"True"},{"idx":1,"correct":true,"proposition":"Type 2 diabetes","justification":"True"},{"idx":2,"correct":true,"proposition":"Lipoma","justification":"True"},{"idx":3,"correct":true,"proposition":"Lupus","justification":"True"},{"idx":4,"correct":true,"proposition":"Amylose","justification":"True"}],"ts":{"$numberLong":"1647538526765"},"type":"custom","difficulte":1}
-{"_id":"radiculalgie-ortho-3a26f89","context":null,"enonce":"What are the secondary causes of carpal tunnel syndrome?","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"correct":true,"proposition":"Arthrosis","justification":"True"},{"idx":1,"correct":true,"proposition":"Hypothyroidism","justification":"True"},{"idx":2,"correct":false,"proposition":"Down syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Hyperparathyroidism","justification":"Hypothyroidism"},{"idx":4,"correct":true,"proposition":"Drop","justification":"True"}],"ts":{"$numberLong":"1647538535121"},"type":"custom","difficulte":1}
-{"_id":"214-hemato-7cc32a5a-22ce-4b69-ac4d-ddb56ca1dfe5","context":null,"enonce":"What parasitosis is associated with eosinophilia?","item":"hyperEo","matiere":"hemato","propositions":[{"idx":0,"correct":true,"proposition":"Infection à Taenia Solium","justification":"True, the purpose of this hyper catalog MCQ is twofold: knowing which parasitosis give eosinophilia is hard and complex, better to remember those that do not: Malaria, Giardiosis, Amoebiasis. In addition, it also makes it possible to remember which parasite is associated with which disease."},{"idx":1,"correct":false,"proposition":"Infection à Entamoeba Histolytica","justification":"False, amoebiasis does not give hypereosinophilia."},{"idx":2,"correct":true,"proposition":"Infection à Echinococcus Granulosus","justification":"True, cf A. echinococcosis gives eosinophilia "},{"idx":3,"correct":true,"proposition":"Enterobius vermicularis infection","justification":"True, pinworm gives eosinophilia"},{"idx":4,"correct":false,"proposition":"Infection à Giardia Duodenalis","justification":"False, giardiasis gives fatty diarrhea after returning from travel"}],"ts":{"$numberLong":"1647539175444"},"type":"custom","difficulte":2}
-{"_id":"ADP-hemato-120e780","context":null,"enonce":"Cervical lymphadenopathy drains the following territories:","item":"ADP","matiere":"hemato","propositions":[{"idx":0,"correct":true,"proposition":"Scalp","justification":"True"},{"idx":1,"correct":true,"proposition":"ENT spheres","justification":"True"},{"idx":2,"correct":true,"proposition":"Oral spheres","justification":"True"},{"idx":3,"correct":true,"proposition":"Thyroid","justification":"True"},{"idx":4,"correct":false,"proposition":"Mediastinum","justification":"Supraclavicular"}],"ts":{"$numberLong":"1647539194202"},"type":"custom","difficulte":1}
-{"_id":"ADP-hemato-bf37e75","context":null,"enonce":"Supraclavicular lymphadenopathy drains the following territories:","item":"ADP","matiere":"hemato","propositions":[{"idx":0,"correct":true,"proposition":"Lungs","justification":"True"},{"idx":1,"correct":true,"proposition":"Alimentary canal","justification":"True"},{"idx":2,"correct":true,"proposition":"Testicles","justification":"True"},{"idx":3,"correct":false,"proposition":"Upper limbs","justification":"Axillary"},{"idx":4,"correct":false,"proposition":"Breasts","justification":"Axillary"}],"ts":{"$numberLong":"1647539270359"},"type":"custom","difficulte":1}
-{"_id":"ADP-hemato-8a3a267","context":null,"enonce":"Cervical lymphadenopathy drains the following territories:","item":"ADP","matiere":"hemato","propositions":[{"idx":0,"correct":true,"proposition":"Scalp","justification":"True"},{"idx":1,"correct":true,"proposition":"ENT spheres","justification":"True"},{"idx":2,"correct":true,"proposition":"Oral sphere","justification":"True"},{"idx":3,"correct":true,"proposition":"Thyroid","justification":"True"},{"idx":4,"correct":false,"proposition":"Mediastinum","justification":"Supraclavicular"}],"ts":{"$numberLong":"1647539282765"},"type":"custom","difficulte":1}
-{"_id":"ADP-hemato-275c7e9","context":null,"enonce":"Axillary lymphadenopathy drains the following territories:","item":"ADP","matiere":"hemato","propositions":[{"idx":0,"correct":false,"proposition":"Anus","justification":"Inguinal"},{"idx":1,"correct":false,"proposition":"Scrotum","justification":"Inguinal"},{"idx":2,"correct":true,"proposition":"Upper limbs","justification":"True"},{"idx":3,"correct":true,"proposition":"Breasts","justification":"True"},{"idx":4,"correct":false,"proposition":"Lungs","justification":"Supraclavicular"}],"ts":{"$numberLong":"1647539291264"},"type":"custom","difficulte":1}
-{"_id":"ADP-hemato-69c94da","context":null,"enonce":"Inguinal lymphadenopathy drains the following territories:","item":"ADP","matiere":"hemato","propositions":[{"idx":0,"correct":true,"proposition":"Anus","justification":"True"},{"idx":1,"correct":true,"proposition":"Penis","justification":"True"},{"idx":2,"correct":true,"proposition":"Scrotum","justification":"True"},{"idx":3,"correct":true,"proposition":"Vulva","justification":"True"},{"idx":4,"correct":true,"proposition":"Lower limbs","justification":"True"}],"ts":{"$numberLong":"1647539300411"},"type":"custom","difficulte":1}
-{"_id":"226-cardio-55f4abcf-57ce-4044-9f1d-ee7d18d05551","context":null,"enonce":"You have in geriatric hospitalization, Mrs. Everdeen, Katniss, 85 years old, hospitalized for a \"difficult home support\". During your careful clinical examination you will highlight multiple venous lower limb ulcers. The nurse of the service then asks you \"what to do\", what do you decide to do as local treatments?","item":"ulcere","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"For ulcer cleansing, you prefer the use of hydrogen peroxide after careful antisepsis","justification":"False, the \"washing\" of ulcers is done with simple water, antisepsis is a mistake because it will promote more than prevent infections, by modifying the skin flora. It has an indication only in case of bacterial dermohypodermatitis"},{"idx":1,"correct":false,"proposition":"To promote skin budding, you use vaseline tulle with lanolin or Peruvian balm","justification":"False, then we use vaseline tulles or \"greasy dressings\" to bring material to the skin to rebuild, but we must avoid in all cases the use of allergens such as lanolin, Peruvian balsam, fragrances, which can lead to contact dermatitis "},{"idx":2,"correct":false,"proposition":"Hydrocolloid or hydrocellular is a type of dressing that brings \"fat\" to the wound, promoting budding","justification":"False, as seen above, it is the vaseline tulles that have this role. Hydrocolloids are moist dressings with optimal pH that promote budding, through controlled maceration."},{"idx":3,"correct":true,"proposition":"Silver dressings are not systematic in the management of ulcers","justification":"True, to use only in inflammatory ulcers at risk of becoming infectious"},{"idx":4,"correct":true,"proposition":"In the case of this patient, in the absence of PAD with IPS <0.7 venous compression will be systematic","justification":"True, the main treatment for ulcer!"}],"ts":{"$numberLong":"1647539354250"},"type":"custom","difficulte":2}
-{"_id":"226-cardio-704ffab8-3419-4e22-b941-0c63296eb6c4","context":null,"enonce":"Regarding ulcers, what are the main complications of the latter?","item":"ulcere","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Erysipelas or necrotizing fasciitis","justification":"True, this is the main complication to look for, it is a wound that can be the gateway to an erysipelas"},{"idx":1,"correct":true,"proposition":"Very common periostitis","justification":"True, poorly known, but it is a diffusion of inflammation at the level of the underlying periosteum"},{"idx":2,"correct":true,"proposition":"Extracellular dehydration","justification":"True, just like protein malnutrition it is a complication to think about in front of any wound, especially in the elderly and dependent"},{"idx":3,"correct":false,"proposition":"Hemorrhage mainly in the context of an arterial ulcer","justification":"False, hemorrhage is mainly observed in front of venous ulcers and not in front of arterial ulcers"},{"idx":4,"correct":true,"proposition":"Squamous cell carcinoma in front of a chronic ulcer","justification":"True, existing chronic complication in front of a resistant chronic ulcer"}],"ts":{"$numberLong":"1647539428504"},"type":"custom","difficulte":2}
-{"_id":"acroSd-cardio-8281231","context":null,"enonce":"Which of the following are NOT indicators of secondary Raynaud's phenomenon?","item":"acroSd","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Family history","justification":"True"},{"idx":1,"correct":true,"proposition":"Tobacco","justification":"True"},{"idx":2,"correct":true,"proposition":"Damage to the toes","justification":"True"},{"idx":3,"correct":false,"proposition":"Presence of megacapillaries","justification":""},{"idx":4,"correct":false,"proposition":"One-handed","justification":"The factors that are in favor of a secondary Raynaud and to know are: male sex, age of onset > 40 years, unilateral involvement, involvement of the thumb, absence of pulse, abnormal Allen, trophic disorders, absence of summer remission, photosensitivity and presence of mega-capillaries to capillaroscopy. As a P1 DOUBLE WOULD SAY: BY PRIMING HEART!"}],"ts":{"$numberLong":"1647539536753"},"type":"custom","difficulte":1}
-{"_id":"adenomehypoP-endoc-186a012","context":null,"enonce":"Where is IGF1 mainly synthesized? (> 50% of production)","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Liver","justification":"True. IGF-1 production is virtually ubiquitous, but the main producing tissue is the liver (more than 50% of plasma concentrations)"},{"idx":1,"correct":false,"proposition":"Muscle","justification":""},{"idx":2,"correct":false,"proposition":"The kidney","justification":""},{"idx":3,"correct":false,"proposition":"The lung","justification":""},{"idx":4,"correct":false,"proposition":"Spleen","justification":""}],"ts":{"$numberLong":"1647539637011"},"type":"custom","difficulte":1}
-{"_id":"adenomehypoP-endoc-c7a8921","context":null,"enonce":"What are the complications of acromegaly to look for?","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Myocardial hypertrophy","justification":"True"},{"idx":1,"correct":true,"proposition":"Arthropathy","justification":"True"},{"idx":2,"correct":true,"proposition":"Diabetes","justification":"True"},{"idx":3,"correct":true,"proposition":"Sleep apnea syndrome","justification":"True"},{"idx":4,"correct":true,"proposition":"Hepatomegaly","justification":"True"}],"ts":{"$numberLong":"1647539735615"},"type":"custom","difficulte":1}
-{"_id":"obesite-endoc-9b0a4c8","context":null,"enonce":"What proposals are true about the by-pass?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"It is an obstructive method","justification":""},{"idx":1,"correct":true,"proposition":"It is a restrictive method","justification":"True, like gastric band and gastrectomy"},{"idx":2,"correct":false,"proposition":"Vitamin supplementation lasts 6 to 12 months, while the rest of the intestine adapts","justification":"She is for life"},{"idx":3,"correct":false,"proposition":"It causes malabsorption in 2 out of 10 cases","justification":"Always a malabsorption (that's the goal, somewhere)"},{"idx":4,"correct":true,"proposition":"It is a reversible method","justification":"True"}],"ts":{"$numberLong":"1647539864842"},"type":"custom","difficulte":3}
-{"_id":"255-nephro-f8fee290-3905-49f9-bbce-d79c925b3dc7","context":null,"enonce":"You check this noon the biological assessment of several of your patients, including that of Mr Ren, Kylo, 65 years old, known by the service for his chronic renal failure at 19mL \/ min. You then explain to your outpatient that kidney failure is often chronic, when we have arguments for its chronicity such as small kidneys, hypocalcemia and anemia. But the latter tells you that each time in MCQ he is asked for exceptions and that he can never remember them... Can you help?","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Chronic renal failure on Sarcoidosis with hypercalcaemia ","justification":"True, chronic pathologies leading to excess calcium, classically myeloma and sarcoidosis lead to chronic renal failure with hypercalcemia"},{"idx":1,"correct":false,"proposition":"Chronic renal failure on myeloma with polycythemia ","justification":"False, there is no polycythemia in myeloma but anemia"},{"idx":2,"correct":true,"proposition":"Chronic renal failure with increased size of kidneys or kidneys of normal size, on diabetes","justification":"True, just like hydronephrosis, autosomal dominant polycystic kidney disease, amyloidosis or HIV-related nephropathy, diabetes does not cause a decrease in kidney size."},{"idx":3,"correct":false,"proposition":"Chronic renal failure with increased size of the kidneys or kidneys of normal size, on chronic vesicoureteral reflux","justification":"False, it does not cause an increase in kidney size"},{"idx":4,"correct":true,"proposition":"Acute renal failure with hypocalcaemia on tumor lysis syndrome ","justification":"True, but generally the context with the history of serum creatinine makes that we will be less wrong ;)"}],"ts":{"$numberLong":"1647540374531"},"type":"custom","difficulte":2}
-{"_id":"255-nephro-d35e4743-7073-4038-b2e6-da295915b7d3","context":null,"enonce":"What is the biological sign(s) of functional acute renal failure?","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Decrease in plasma urea in favor of plasma serum creatinine","justification":"False, in the context of functional acute renal failure, one literally has a drying of the body. As a result, we \"no longer urinate\" because we have \"not enough water\". Thus the concentrations of urea and serum creatinine will increase because we have more water."},{"idx":1,"correct":true,"proposition":">10 urinary urea concentration compared to plasma urea","justification":"True, simply because the urine that continues to be manufactured, no longer has all the components. In the urine, we have creatinine, urea, sodium and water to dilute all this among others. If we have more water in the urine, it is because the little we have left, we leave it in the blood to avoid complete dehydration. So more water in the urine, we have a concentration of urea in the urine very intense, more intense than in the blood (or there is still a little water)"},{"idx":2,"correct":false,"proposition":"<30 concentration of creatinineuria versus serum creatinine","justification":"False, same principle as for the B"},{"idx":3,"correct":true,"proposition":"Decreased natriuresis","justification":"True, you know as well as me, that extracellular hydration is governed by salt, so if we dehydrate, in fact we lose a lot of salt, which carries water with it. Therefore, we will avoid pissing the salt, to reabsorb the water! CQFD!"},{"idx":4,"correct":true,"proposition":"Secondary hyperaldosteronism","justification":"True, to reabsorb salt, the hormone that makes it possible to do this, is aldosterone!"}],"ts":{"$numberLong":"1647540426693"},"type":"custom","difficulte":2}
-{"_id":"262-nephro-13254ad3-f4be-4074-95e1-c8db8050d9b1","context":null,"enonce":"You are an emergency intern in the emergency department of Ouessant (we can dream a little), and you receive Mr. Jones, Indiana, 39 years old, who back from Peru, did not hydrate well on the plane and has a picture of renal colic with a fever at 39 ° C.  You are looking to do an imaging and you have all the latest devices at home! What do you do?","item":"lithiaseU","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Couple Abdomen without preparation and Renal ultrasound","justification":"False, because here we are in the context of a complicated renal colic (febrile) and in this case there is only one examination to do, cf. C."},{"idx":1,"correct":false,"proposition":"Uro-CT","justification":"False, uro CT is never done in the context of renal colic"},{"idx":2,"correct":true,"proposition":"Abdominopelvic CT without injection","justification":"True, this is the reference examination in front of complicated renal colic "},{"idx":3,"correct":false,"proposition":"Nephro-MRI","justification":"False, it doesn't exist"},{"idx":4,"correct":true,"proposition":"If you receive his partner Marion Ravenwood, pregnant with 8SA, for the same symptoms, you would only have one imaging choice.","justification":"True, namely ultrasound! The rest is irradiating and therefore toxic to the fetus"}],"ts":{"$numberLong":"1647540730578"},"type":"custom","difficulte":2}
-{"_id":"262-nephro-53b6e4ed-95cf-429c-874a-fe87d7082b07","context":null,"enonce":"Regarding the urological treatments of stones what are the exact proposal(s)?","item":"lithiaseU","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Extracorporeal lithotripsy is contraindicated in case of aortic or renal arterial aneurysm","justification":"True, these are wave pulses, so imagine in case of anticoagulant treatment, fetus or arterial aneurysm, the destructive potential that it can have..."},{"idx":1,"correct":true,"proposition":"Ureteroscopy is the treatment of choice in a patient on antiaggregant or anticoagulant","justification":"True, because it is the only one that theoretically does not cause tissue damage "},{"idx":2,"correct":false,"proposition":"In case of obstructive pyelonephritis, urological treatment takes precedence over antibiotic treatment","justification":"Wrong, we are not going to operate in infected urine!"},{"idx":3,"correct":true,"proposition":"Extracorporeal lithotripsy is not very effective in obese patients","justification":"True, because shock waves have a harder time passing"},{"idx":4,"correct":false,"proposition":"Percutaneous nephrolithotomy is the most common treatment performed today.","justification":"False, it is clearly a second-line treatment"}],"ts":{"$numberLong":"1647540825667"},"type":"custom","difficulte":2}
-{"_id":"tbiono-nephro-8bccae6","context":null,"enonce":"Which propositions are true?","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"DHA (vasopressin) is produced by the hypothalamus","justification":"True"},{"idx":1,"correct":false,"proposition":"DHA (vasopressin) is produced by the pituitary gland","justification":""},{"idx":2,"correct":false,"proposition":"DHA (vasopressin) is released from the anterior pituitary gland","justification":"Posterior pituitary gland"},{"idx":3,"correct":false,"proposition":"The role of DHA is sodium reabsorption","justification":"Reabsorption of pure water"},{"idx":4,"correct":true,"proposition":"Diabetes insipidus is central if there is a defect in DHA production","justification":"True"}],"ts":{"$numberLong":"1647541085894"},"type":"custom","difficulte":2}
-{"_id":"autonomiegeria-mpr-20b4bcc","context":null,"enonce":"What activities belong to Katz's ADL? ","item":"autonomiegeria","matiere":"mpr","propositions":[{"idx":0,"correct":true,"proposition":"The toilet ","justification":"True"},{"idx":1,"correct":false,"proposition":"Telephone ","justification":"False, belongs to the IADL "},{"idx":2,"correct":true,"proposition":"Eating ","justification":"True"},{"idx":3,"correct":false,"proposition":"Taking medication ","justification":"False, belongs to the IADL "},{"idx":4,"correct":true,"proposition":"Continence ","justification":"True"}],"ts":{"$numberLong":"1647976997560"},"type":"custom","difficulte":1}
-{"_id":"LCA-sp-20ad854","context":null,"enonce":"You are in the emergency room and you receive Mr. XU Shang-Chi, 23 years old, for an attempt at drug autolysis with benzodiazepines. While he \"slept\" well until now he wakes up restless and sweaty and asks you for \"something to calm him\". In this context, you tell yourself that using a placebo is not a bad idea... But the nurse who is with you, fears a nocebo effect. You scratch your head and try to remember your pharmacology classes on the subject...","item":"LCA","matiere":"sp","propositions":[{"idx":0,"correct":true,"proposition":"If you give the patient PARACETAMOL instead of a benzodiazepine, you are giving an impure placebo.","justification":"True, an impure placebo is a placebo that is composed of another active substance."},{"idx":1,"correct":true,"proposition":"The placebo effect will have to be re-evaluated over time because it is short and runs out over time.","justification":"True, it is very logical because it is related to taking the treatment"},{"idx":2,"correct":false,"proposition":"Factors that condition the placebo effect include the name of the treatment","justification":"False, it includes color, shape, taste but not name"},{"idx":3,"correct":false,"proposition":"Chest pain, paresthesias and dysgeusia are the most common nocebos effects","justification":"False, nasty trap, but if you have understood that it is the administration of the treatment that makes the placebo you will have to logically deduce that the nocebos effects, also related to the taking of the treatment are mainly diarrhea, but also headache and drowsiness."},{"idx":4,"correct":false,"proposition":"The nocebos effects are due to the composition of the placebo","justification":"False, it is related to the administration of the treatment"}],"ts":{"$numberLong":"1647977094920"},"type":"custom","difficulte":2}
-{"_id":"dermatosefaciale-dermato-3905a4d","context":null,"enonce":"What are the different forms of rosacea? ","item":"dermatosefaciale","matiere":"dermato","propositions":[{"idx":0,"correct":true,"proposition":"Hypertrophic form ","justification":"True, hypertrophic form = rhinophyma"},{"idx":1,"correct":true,"proposition":"Rhinophyma ","justification":"True, cf 1"},{"idx":2,"correct":true,"proposition":"Papulo-pustular form ","justification":"True"},{"idx":3,"correct":false,"proposition":"Atrophic form ","justification":"False, no atrophic form in rosacea"},{"idx":4,"correct":true,"proposition":"Paroxysmal vascular form ","justification":"True"}],"ts":{"$numberLong":"1647977139921"},"type":"custom","difficulte":1}
-{"_id":"dermatosefaciale-dermato-870dddf","context":null,"enonce":"What are the treatments for rosacea? ","item":"dermatosefaciale","matiere":"dermato","propositions":[{"idx":0,"correct":false,"proposition":"Dermocorticoids","justification":"False, topical corticosteroids are contraindicated in rosacea because they aggravate it!! "},{"idx":1,"correct":true,"proposition":"Metronidazole gel ","justification":"True, for minor forms "},{"idx":2,"correct":true,"proposition":"Systemic doxycycline","justification":"True, for more diffuse forms and especially ocular "},{"idx":3,"correct":false,"proposition":"Isotretinoin ","justification":"False, acne treatment "},{"idx":4,"correct":false,"proposition":"Benzoyl peroxide ","justification":"False, acne treatment "}],"ts":{"$numberLong":"1647977170682"},"type":"custom","difficulte":2}
-{"_id":"dermatosefaciale-dermato-763a4d0","context":null,"enonce":"What localizations are classically affected in seborrheic dermatitis? ","item":"dermatosefaciale","matiere":"dermato","propositions":[{"idx":0,"correct":true,"proposition":"Nasolabial folds ","justification":"True"},{"idx":1,"correct":false,"proposition":"Palms ","justification":"No, it is a facial dermatosis"},{"idx":2,"correct":false,"proposition":"Upper limbs ","justification":"No, it is a facial dermatosis"},{"idx":3,"correct":true,"proposition":"Scalp ","justification":"True"},{"idx":4,"correct":true,"proposition":"Glabella ","justification":"True"}],"ts":{"$numberLong":"1647977247377"},"type":"custom","difficulte":1}
-{"_id":"AV--ophtalmo-f5b9241","context":null,"enonce":"How many cataract operations per year in France?","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"correct":true,"proposition":"700 000 ","justification":"True, this is the most common surgery!"},{"idx":1,"correct":false,"proposition":"100 000 ","justification":""},{"idx":2,"correct":false,"proposition":"300 000 ","justification":""},{"idx":3,"correct":false,"proposition":"200 000 ","justification":""},{"idx":4,"correct":false,"proposition":"70 000 ","justification":""}],"ts":{"$numberLong":"1647977273349"},"type":"custom","difficulte":2}
-{"_id":"AV--ophtalmo-ce27e9a","context":null,"enonce":"What type of cataract can occur as leukocoria?","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"correct":false,"proposition":"Nuclear","justification":""},{"idx":1,"correct":true,"proposition":"Total","justification":"True, leukocoria is the fact of having the white pupil, and it must worry, especially in the new nose in which it must suspect rare eye tumors"},{"idx":2,"correct":false,"proposition":"Posterior subcapsular","justification":""},{"idx":3,"correct":false,"proposition":"Cortical","justification":""},{"idx":4,"correct":false,"proposition":"No proposition is true","justification":""}],"ts":{"$numberLong":"1647977325393"},"type":"custom","difficulte":3}
-{"_id":"AV--ophtalmo-cf623b9","context":null,"enonce":"What is the form of cataract that is accompanied by index myopia?","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"correct":false,"proposition":"Cortical","justification":"Global BAV"},{"idx":1,"correct":true,"proposition":"nuclear","justification":"True, involvement of the crystalline nucleus, predominance of a decrease in visual acuity (BAV) by far so index myopia"},{"idx":2,"correct":false,"proposition":"Total","justification":"Very severe overall BAV"},{"idx":3,"correct":false,"proposition":"posterior subcapsular","justification":"Saucer opacification in front of the posterior capsule, identical discomfort from far and near. Thinking about the metabolic and iatrogenic origin"},{"idx":4,"correct":false,"proposition":"No","justification":""}],"ts":{"$numberLong":"1647977403876"},"type":"custom","difficulte":1}
-{"_id":"AV--ophtalmo-fce1191","context":null,"enonce":"Among the following proposals concerning the assessment to be carried out pre-operative of a cataract, which are true?\n","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"correct":false,"proposition":"Mode A ultrasound eliminates retinal detachment","justification":"It is the ultrasound in mode B that allows this. See this ultrasound image in mode B: https:\/\/www.realites-ophtalmologiques.com\/wp-content\/uploads\/sites\/4\/2017\/02\/article-du-27_02-702x336.jpg"},{"idx":1,"correct":false,"proposition":"Optical biometry is done by ultrasound in mode A","justification":"Ultrasound mode A = axial ultrasound biometrics. Used to calculate the size of the implant.\nThe most recent technique of ophthalmic biometry is axial ultrasound biometrics. Ultra-difficult question but the college makes the difference."},{"idx":2,"correct":false,"proposition":"Macular OCT is mandatory","justification":"OCT is only useful for retinal conditions"},{"idx":3,"correct":true,"proposition":"Keratometry measures the refractive power of the cornea","justification":"True"},{"idx":4,"correct":true,"proposition":" The normal refractive power of the lens is about 20 diopters","justification":"True"}],"ts":{"$numberLong":"1647977518036"},"type":"custom","difficulte":2}
-{"_id":"IRespA-urg-d89764","context":null,"enonce":"Which of the following propositions concerning the mechanisms involved in hypoxemia are true?","item":"IRespA","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"The shunt effect is the most common mechanism of hypoxemia.","justification":"True"},{"idx":1,"correct":true,"proposition":"Obesite-hypoventilation syndrome may be a cause of alveolar hypoventilation","justification":"True"},{"idx":2,"correct":true,"proposition":"The higher you go, the lower the O2 inspired pressure would be.","justification":"True, PiO2 = FiO2 x (Patm-PH20)"},{"idx":3,"correct":false,"proposition":"A shunt effect corresponds to the presence of well-infused but poorly ventilated lung areas. ","justification":"Wrong, it's the other way around."},{"idx":4,"correct":true,"proposition":"A cause of alveolo-capillary diffusion disorder is pulmonary fibrosis","justification":"True: diffusion depends on the thickness of the different tissues separating the alveolar air from the capillary blood, and fibrosis increases this thickness"}],"ts":{"$numberLong":"1647977647656"},"type":"custom","difficulte":2}
-{"_id":"329-urg-c83f8e1d-b283-441c-b65a-53c0c0c7bb79","context":null,"enonce":"Which of the following propositions regarding post-traumatic rhabdomyolysis are true?","item":"polytrauma","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"It is linked to the destruction of a large number of myocytes and the release of elements of these myocytes into the circulation.","justification":"True! Post-traumatic rhabdomyolysis is, as its name suggests, linked to the destruction of a large number of myocytes in the direct consequences of trauma to the limbs or its complications (compartment syndrome in particular)"},{"idx":1,"correct":true,"proposition":"The hydroelectric disturbances observed are hyperkalemia, hyperphosphoremia, hypocalcemia","justification":"True! Rhabdomyolysis is the bursting of muscle cells. So all the content passes into the blood and we can measure this content via a blood test: \n- Increased K+ and phosphorus\n- Decrease of Ca++ by transfer from the vascular medium to the muscular environment \n- Increased muscle enzymes: CPK, LDH, myoglobin, AST +++, ALT +\/-"},{"idx":2,"correct":true,"proposition":"Acute renal failure complicates about 50% of cases and determines the vital and functional prognosis","justification":"True! Nothing to say "},{"idx":3,"correct":true,"proposition":"Acute renal failure due to post-traumatic rhabdomyolysis is responsible for a sodium ejection fraction < 1% (functional)","justification":"True! There are different causes of rhabdomyolysis. Generally we oppose: \n- Post-traumatic rhabdomyolysis: Which is mainly related to the destruction of myocytes but also favored by HYPOVOLEMIA !! This explains why the observed ARI GENERALLY has a FeNa+ < 1% (functional)! It is the elderly subject who fell and did not manage to get up for 12 hours: he crushed his myocytes on the ground and did not drink. - Infectious\/toxic rhabdomyolysis\/by electrification\/by taking lipid-lowering agents... etc.: Is related to the destruction of myocytes but here the volume is normal. The observed IRA will therefore have a FeNa + > 1% (organic)"},{"idx":4,"correct":true,"proposition":"The treatment is based primarily on crystalloid filling","justification":"True! Treatment is symptomatic above all (filling, hydroelectric rebalancing, extra-renal purification if indicated). SOURCE: College of Anesthesia Resuscitation 2020 Edition page 346"}],"ts":{"$numberLong":"1647977757536"},"type":"custom","difficulte":2}
-{"_id":"IOA-infectio-03dc3f7","context":null,"enonce":"What clinical signs are found in spondylodiscitis? ","item":"IOA","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Spinal mechanical pain ","justification":"False, inflammatory rachialgia, tenacious, without triggering factor and poorly calmed by rest (the suffix \"-ite\" means inflammation)"},{"idx":1,"correct":true,"proposition":"Major vertebral stiffness ","justification":"True"},{"idx":2,"correct":true,"proposition":"Fever","justification":"True, in 50% of cases at diagnosis"},{"idx":3,"correct":false,"proposition":"Effusion ","justification":"False, no effusion in spondylodiscitis, rather in peripheral septic arthritis "},{"idx":4,"correct":true,"proposition":"Radicular pain ","justification":"True, these are complications of inflammatory spinal pain "}],"ts":{"$numberLong":"1647977800178"},"type":"custom","difficulte":1}
-{"_id":"IOA-infectio-44980e8","context":null,"enonce":"What is the reference imaging test in the diagnosis of spondylodiscitis? ","item":"IOA","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Standard X-rays ","justification":"False, radio-signs shifted by 3-4 weeks, they are often normal at diagnosis "},{"idx":1,"correct":true,"proposition":"MRI ","justification":"True"},{"idx":2,"correct":false,"proposition":"Scanner","justification":"False, indicated only to guide a puncture-biopsy or if contraindication of MRI "},{"idx":3,"correct":false,"proposition":"Technetium scintigraphy ","justification":"False, lower specificity than MRI. Used if contraindicated to MRI"},{"idx":4,"correct":false,"proposition":"Ultrasound","justification":"False"}],"ts":{"$numberLong":"1647989201097"},"type":"custom","difficulte":2}
-{"_id":"radiculalgie-ortho-e16c5af","context":null,"enonce":"Regarding syringomyelia:","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"correct":true,"proposition":"Syringomyelic syndrome reflects the involvement of spinothalamic fibers that decuss at the level of each metamer","justification":"True, they are more sensitive to compression by fluid inside the spinal cord"},{"idx":1,"correct":false,"proposition":"The initial sensory deficit relates to proprioception","justification":"On thermo-algic sensitivity (first involvement of spinothalamic \/ extra-lemniscale fibers)"},{"idx":2,"correct":true,"proposition":"Arnold-Chiari malformation is the main cause of synringomyelia","justification":"True"},{"idx":3,"correct":true,"proposition":"The topography of the lesion syndrome is said to be \"cape\"","justification":"True, cause of upper limb deficit without lower limb deficit (excluding sublesional syndrome)"},{"idx":4,"correct":false,"proposition":"All propositions are true","justification":""}],"ts":{"$numberLong":"1647989307833"},"type":"custom","difficulte":3}
-{"_id":"212-hemato-e1e83d1d-f317-42e6-b197-b20f81b10aac","context":null,"enonce":"Which of the following propositions about Willebrand disease are true?","item":"hemorragie","matiere":"hemato","propositions":[{"idx":0,"correct":true,"proposition":"There may be a decrease in factor VIII in Willebrand disease ","justification":"True because von Willebrand factor transports and stabilizes factor VIII"},{"idx":1,"correct":false,"proposition":"Willebrand disease is defined by a von Willebrand factor level < 50%","justification":"False, by a von Willebrand factor rate < 30%"},{"idx":2,"correct":false,"proposition":"Willebrand disease is a pathology of coagulation ","justification":"False, it is a pathology of primary hemostasis "},{"idx":3,"correct":true,"proposition":"Von Willebrand factor allows platelets to adhere to each other and to collagen under endothelial","justification":"True"},{"idx":4,"correct":false,"proposition":"Boys are more affected than girls ","justification":"False, sex ratio = 1"}],"ts":{"$numberLong":"1647989361348"},"type":"custom","difficulte":2}
-{"_id":"212-hemato-60df0653-28c6-4f42-b7a6-5e27e02c2015","context":null,"enonce":"Which of the following propositions about hemophilia are true?","item":"hemorragie","matiere":"hemato","propositions":[{"idx":0,"correct":false,"proposition":"The hemostasis assessment finds a prolongation of the TCA and a decrease of the TP ","justification":"False, only an isolated prolongation of the TCA because only the endogenous pathway is affected "},{"idx":1,"correct":true,"proposition":"Externalized bleeding can be a symptom ","justification":"True"},{"idx":2,"correct":false,"proposition":"Hemophilia is the most common inherited bleeding disorder ","justification":"False, it is Willebrand disease "},{"idx":3,"correct":true,"proposition":"Drugs depressing hemostasis are contraindicated in hemophiliacs ","justification":"True"},{"idx":4,"correct":true,"proposition":"Arthropathy can be a complication of hemophilia ","justification":"True, it is a hemophilic arthropathy secondary to the aggression of cartilage by blood waste and their degradation "}],"ts":{"$numberLong":"1647989465566"},"type":"custom","difficulte":2}
-{"_id":"212-hemato-6c0d2f4c-23e6-4000-b912-331e1bd91e05","context":null,"enonce":"Regarding hypovitaminosis K, what are the true propositions?","item":"hemorragie","matiere":"hemato","propositions":[{"idx":0,"correct":false,"proposition":"Factor V is a vitamin K-dependent factor ","justification":"False, vitamin K-independent; it is the X, IX, VII, and II (we can retain the year 1972) which are vitamin-K dependent"},{"idx":1,"correct":false,"proposition":"The majority of vitamin K intake is endogenous via the intestinal flora ","justification":"False, the majority of vitamin K intake is exogenous via diet (70% intake)"},{"idx":2,"correct":true,"proposition":"One of the differential diagnoses is hepatocellular insufficiency ","justification":"True, the 2 diagnoses are differentiated by the determination of factor V, vitamin K-independent"},{"idx":3,"correct":true,"proposition":"The TCA is lengthened and the PT is decreased at hemostasis ","justification":"True"},{"idx":4,"correct":false,"proposition":"C- and S-clotting proteins are vitamin K-independent ","justification":"False, they are vitamin K-dependent "}],"ts":{"$numberLong":"1647989513495"},"type":"custom","difficulte":2}
-{"_id":"293-onco-f8ec25de-86dd-46cb-a3d4-bad97cebe6b3","context":null,"enonce":"Regarding the assessment to be carried out in case of fever during drug agranulocytosis, what are the true proposals?","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"It is carried out urgently ","justification":"True"},{"idx":1,"correct":true,"proposition":"It includes blood cultures ","justification":"True"},{"idx":2,"correct":true,"proposition":"It includes an ECBU ","justification":"True"},{"idx":3,"correct":true,"proposition":"It has a chest X-ray ","justification":"True"},{"idx":4,"correct":true,"proposition":"It may include stool farming depending on the orientation ","justification":"True"}],"ts":{"$numberLong":"1647989801476"},"type":"custom","difficulte":2}
-{"_id":"MM-onco-c8cf4e6","context":null,"enonce":"You are an intern and your intern has asked you to present a slideshow on the topic of myeloma. By having you recite it asks you what are the clinical forms of myeloma besides symptomatic multiple myeloma. You hesitate, and mentally try to summarize each clinical form in one sentence. Which of the following are the exact proposals?","item":"MM","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Indolent multiple myeloma has no clinical involvement and only biological abnormalities","justification":"True, as its name suggests, indolent myeloma has no active clinical form, however it has a poor prognosis because it is at risk of progression to multiple myeloma"},{"idx":1,"correct":true,"proposition":"A solitary plasmacytoma will be associated with a negative myelogram","justification":"True, a plasmacytoma is by definition a tumor isolated (like a sarcoma) in a tissue, and therefore without invasion of the spinal cord."},{"idx":2,"correct":false,"proposition":"Mild chain multiple myeloma causes monoclonal peak at serum protein electrophoresis","justification":"False, light chain myeloma does NOT cause monoclonal spike on serum protein electrophoresis"},{"idx":3,"correct":false,"proposition":"POEMS syndrome corresponds to a monoclonal gammopathy associated with bone lyses at the punch","justification":"Wrong, I admit this question is hard, because most of you will never have heard of POEMS: it is a form of myeloma with osteocondensation associated with splenomegaly, neuropathy and endocrine damage. It is rank C."},{"idx":4,"correct":false,"proposition":"Waldenström's disease is a form of myeloma with osteocondensing lyses","justification":"False, Waldenström's disease is the MAIN differential diagnosis of myeloma"}],"ts":{"$numberLong":"1647989981915"},"type":"custom","difficulte":2}
-{"_id":"Kcpulm-onco-be5ba0c","context":null,"enonce":"What is the percentage survival of patients with lung cancer treated at stage I, at 5 years?","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"90","justification":"True"},{"idx":1,"correct":false,"proposition":"50","justification":""},{"idx":2,"correct":false,"proposition":"33","justification":""},{"idx":3,"correct":false,"proposition":"17","justification":""},{"idx":4,"correct":false,"proposition":"5","justification":""}],"ts":{"$numberLong":"1647990009582"},"type":"custom","difficulte":1}
-{"_id":"Kcpulm-onco-c49f4d3","context":null,"enonce":"What is the survival of patients with lung cancer treated at the metastatic stage (V), at 5 years, in percentage?","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"5","justification":"True"},{"idx":1,"correct":false,"proposition":"17","justification":""},{"idx":2,"correct":false,"proposition":"90","justification":""},{"idx":3,"correct":false,"proposition":"55","justification":""},{"idx":4,"correct":false,"proposition":"62","justification":""}],"ts":{"$numberLong":"1647990026363"},"type":"custom","difficulte":1}
-{"_id":"antiinf-infectio-340c9ef","context":null,"enonce":"Which propositions are true?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"β-lactam is useless on mycoplasmas","justification":"True because they don't have a wall"},{"idx":1,"correct":true,"proposition":"Glycopeptides are useless on BGN","justification":"True because the molecule does not pass the outer membrane"},{"idx":2,"correct":true,"proposition":"C3G is useless on listeria","justification":"True"},{"idx":3,"correct":false,"proposition":"Metronidazole is useless on anaerobes","justification":"This is its main indication"},{"idx":4,"correct":false,"proposition":"Penems are useless on Pseudomonas aeruginosa","justification":"Only ertapeneme that does not work on enterococci and on Pseudomonas"}],"ts":{"$numberLong":"1648068839376"},"type":"custom","difficulte":1}
-{"_id":"antiinf-infectio-3b5c018","context":null,"enonce":"Which ones are concentration-dependent?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Fluoroquinolones","justification":"True"},{"idx":1,"correct":true,"proposition":"Aminoglycosides","justification":"True"},{"idx":2,"correct":true,"proposition":"Metronidazole","justification":"True"},{"idx":3,"correct":false,"proposition":"Glycopeptide","justification":""},{"idx":4,"correct":false,"proposition":"Betalactam","justification":""}],"ts":{"$numberLong":"1648068902231"},"type":"custom","difficulte":1}
-{"_id":"antiinf-infectio-549afa6","context":null,"enonce":"Imipenème is associated with:","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"epileptic seizures","justification":"True"},{"idx":1,"correct":false,"proposition":"strokes","justification":""},{"idx":2,"correct":false,"proposition":"DVT","justification":""},{"idx":3,"correct":true,"proposition":"Anti-pseudomonas activity","justification":"True, unlike ertapeneme"},{"idx":4,"correct":false,"proposition":"amyloidosis","justification":""}],"ts":{"$numberLong":"1648068939898"},"type":"custom","difficulte":3}
-{"_id":"antiinf-infectio-895e6c4","context":null,"enonce":"What is the target of aminoglycosides?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"The ribosome","justification":"True"},{"idx":1,"correct":false,"proposition":"The wall","justification":"Beta-lactam"},{"idx":2,"correct":false,"proposition":"DNA","justification":""},{"idx":3,"correct":false,"proposition":"the plasma membrane","justification":""},{"idx":4,"correct":false,"proposition":"Chaperone proteins","justification":""}],"ts":{"$numberLong":"1648068967532"},"type":"custom","difficulte":3}
-{"_id":"antiinf-infectio-d2f18c9","context":null,"enonce":"Which ones are bacteriostatic?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Erythromycin","justification":"True"},{"idx":1,"correct":true,"proposition":"Tetracycline","justification":"True"},{"idx":2,"correct":false,"proposition":"Fluoroquinolone","justification":"Concentration-dependent bactericide"},{"idx":3,"correct":false,"proposition":"C3G","justification":"Time-dependent bactericidal"},{"idx":4,"correct":false,"proposition":"Aminoglycosides","justification":"Concentration-dependent bactericide"}],"ts":{"$numberLong":"1648069168479"},"type":"custom","difficulte":1}
-{"_id":"palu-infectio-1ae043f","context":null,"enonce":"What is the weekly malaria chemoprophylaxis?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Atovaquone-proguanil ","justification":"Daily"},{"idx":1,"correct":false,"proposition":"Doxycycline","justification":"Daily"},{"idx":2,"correct":true,"proposition":"Mefloquine","justification":"True"},{"idx":3,"correct":false,"proposition":"Quinine","justification":"Cure"},{"idx":4,"correct":false,"proposition":"Artenimol-piperaquine","justification":"Cure"}],"ts":{"$numberLong":"1648069276516"},"type":"custom","difficulte":3}
-{"_id":"palu-infectio-274ba52","context":null,"enonce":"Which of the following proposals for protective measures against Anopheles bites is recommended?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Use of antihistamines","justification":""},{"idx":1,"correct":false,"proposition":"Using a fan","justification":""},{"idx":2,"correct":true,"proposition":"wearing loose and covering clothing","justification":"True"},{"idx":3,"correct":true,"proposition":"Use of household repellents and insecticides","justification":"True"},{"idx":4,"correct":true,"proposition":"mosquito net","justification":"True"}],"ts":{"$numberLong":"1648069311137"},"type":"custom","difficulte":1}
-{"_id":"vaccin-infectio-0744772","context":null,"enonce":"Against which germs is the hexavalent vaccine, administered in children under 1 year of age at M2 M4 and M11?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Haemophilus influenzae de type B","justification":"True"},{"idx":1,"correct":true,"proposition":"Poliomyelitis","justification":"True"},{"idx":2,"correct":false,"proposition":"Meningococcal C","justification":""},{"idx":3,"correct":false,"proposition":"Pneumococcus","justification":"It does not fit into the hexavalent (it is all alone)"},{"idx":4,"correct":false,"proposition":"Measles","justification":"MMR to M12 and M16-18"}],"ts":{"$numberLong":"1648073294937"},"type":"custom","difficulte":1}
-{"_id":"vaccin-infectio-36ae313","context":null,"enonce":"Against which germs is the hexavalent vaccine, administered in children under 1 year of age at M2 M4 and M11?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Diphtheria","justification":"True"},{"idx":1,"correct":true,"proposition":"Tetanus","justification":"True"},{"idx":2,"correct":true,"proposition":"Poliomyelitis","justification":"True"},{"idx":3,"correct":true,"proposition":"Whooping cough","justification":"True"},{"idx":4,"correct":true,"proposition":"HBV","justification":"True"}],"ts":{"$numberLong":"1648073313121"},"type":"custom","difficulte":1}
-{"_id":"vaccin-infectio-6f2a904","context":null,"enonce":"A patient wants to go to Cameroon for 6 months. What vaccination(s) do you prescribe?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"yellow fever","justification":"True"},{"idx":1,"correct":true,"proposition":"typhoid","justification":"True"},{"idx":2,"correct":false,"proposition":"tick-borne encephalitis","justification":""},{"idx":3,"correct":true,"proposition":"hepatitis A","justification":"True"},{"idx":4,"correct":false,"proposition":"malaria","justification":"No malaria vaccine"}],"ts":{"$numberLong":"1648073460655"},"type":"custom","difficulte":1}
-{"_id":"vaccin-infectio-92834c9","context":null,"enonce":"What situations are at risk of invasive pneumococcal disease, and therefore constitute an indication for preventive vaccination against pneumococcus?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"asplenia","justification":"True"},{"idx":1,"correct":true,"proposition":"sickle-cell anemia","justification":"True"},{"idx":2,"correct":false,"proposition":"thalassemia","justification":""},{"idx":3,"correct":false,"proposition":"lead poisoning","justification":""},{"idx":4,"correct":true,"proposition":"HIV","justification":"True"}],"ts":{"$numberLong":"1648073507783"},"type":"custom","difficulte":1}
-{"_id":"voyagetrop-infectio-a884433","context":null,"enonce":"For which stays is the yellow fever vaccine mandatory?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Pilgrimage to Mecca","justification":"Tetravalent meningococcal vaccine ACYW135 conjugate"},{"idx":1,"correct":true,"proposition":"Amazonia","justification":"True"},{"idx":2,"correct":true,"proposition":"Intertropical Africa","justification":"True"},{"idx":3,"correct":false,"proposition":"India","justification":"typhoid"},{"idx":4,"correct":false,"proposition":" Pakistan and Philippines","justification":"Japanese encephalitis vaccine"}],"ts":{"$numberLong":"1648074365899"},"type":"custom","difficulte":1}
-{"_id":"voyagetrop-infectio-b328067","context":null,"enonce":"What is the probability of death during a tropical trip?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"1\/10","justification":""},{"idx":1,"correct":false,"proposition":"1\/100","justification":""},{"idx":2,"correct":false,"proposition":"1\/1000","justification":""},{"idx":3,"correct":false,"proposition":"1\/10 000","justification":""},{"idx":4,"correct":true,"proposition":"1\/100 000","justification":"True"}],"ts":{"$numberLong":"1648074390002"},"type":"custom","difficulte":3}
-{"_id":"voyagetrop-infectio-ce0f36d","context":null,"enonce":"What propositions are true about typhoid fever?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"The tank is human only","justification":"True"},{"idx":1,"correct":false,"proposition":"The virus involved is Typhus viridae","justification":"Salmonella enterica: it is a baceria"},{"idx":2,"correct":false,"proposition":"Transmission is sexual","justification":"Faecal-oral transmission"},{"idx":3,"correct":true,"proposition":"Incubation is 10 days to 3 weeks","justification":"True"},{"idx":4,"correct":false,"proposition":"The vaccine is in one dose, valid for life","justification":"True for yellow fever. The salmonella vaccine is not very effective, and must be redone every 3 years"}],"ts":{"$numberLong":"1648074421985"},"type":"custom","difficulte":2}
-{"_id":"vaccin-infectio-d53bba7","context":null,"enonce":"How many dose(s) for yellow fever vaccine?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Two","justification":""},{"idx":1,"correct":true,"proposition":"Just one","justification":"True"},{"idx":2,"correct":false,"proposition":"Three","justification":""},{"idx":3,"correct":false,"proposition":"Four","justification":""},{"idx":4,"correct":false,"proposition":"Five","justification":""}],"ts":{"$numberLong":"1648074630870"},"type":"custom","difficulte":2}
-{"_id":"vaccin-infectio-d9e313c","context":null,"enonce":"Regarding typhoid vaccination:","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Vaccination protects in 100% of cases from the occurrence of salmonellosis","justification":"60% effectiveness, than against certain strains"},{"idx":1,"correct":false,"proposition":"vaccination must be renewed every ten years","justification":"every three years"},{"idx":2,"correct":true,"proposition":"vaccination does not protect against Salmonella enterica serotypes of Salmonella enterica paratyphi A and B","justification":"True"},{"idx":3,"correct":false,"proposition":"Vaccination is mandatory for healthcare workers","justification":"microbiology laboratory personnel in contact with stool"},{"idx":4,"correct":true,"proposition":"Vaccination for typhoid is possible from the age of two","justification":"True"}],"ts":{"$numberLong":"1648074679342"},"type":"custom","difficulte":2}
-{"_id":"voyagetrop-infectio-271d030","context":null,"enonce":"What pathologies do ticks have as a vector?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Lyme disease","justification":"True"},{"idx":1,"correct":true,"proposition":"Tick-borne encephalitis","justification":"True, as the name suggests. No trap here"},{"idx":2,"correct":true,"proposition":"Tularemia","justification":"True"},{"idx":3,"correct":true,"proposition":"Mediterranean spotted fever","justification":"True"},{"idx":4,"correct":false,"proposition":"Dengue fever","justification":"Aedes"}],"ts":{"$numberLong":"1648074794492"},"type":"custom","difficulte":1}
-{"_id":"voyagetrop-infectio-46aa966","context":null,"enonce":"What pathologies do Aedes have as a vector?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Trench fever","justification":"Lice"},{"idx":1,"correct":true,"proposition":"Dengue fever","justification":"True"},{"idx":2,"correct":true,"proposition":"Yellow fever","justification":"True"},{"idx":3,"correct":true,"proposition":"Zika","justification":"True"},{"idx":4,"correct":false,"proposition":"Relapsing fever","justification":"Lice"}],"ts":{"$numberLong":"1648074842021"},"type":"custom","difficulte":1}
-{"_id":"196-rhumato-b3dfb19c-dd4d-4b49-b9f6-8758af4553d1","context":null,"enonce":"In what situations can joint fluid be inflammatory? ","item":"arthrite","matiere":"rhumato","propositions":[{"idx":0,"correct":true,"proposition":"Rheumatoid arthritis","justification":"True"},{"idx":1,"correct":false,"proposition":"Meniscal lesions","justification":"False, mechanical liquid "},{"idx":2,"correct":false,"proposition":"Arthrosis ","justification":"False, mechanical liquid "},{"idx":3,"correct":true,"proposition":"Microcrystalline arthropathy ","justification":"True, we also find in the joint fluid micro-crystals (urate, PPCa, Ca phosphate ...)"},{"idx":4,"correct":true,"proposition":"Septic arthritis","justification":"True. The causes of inflammatory fluid (i.e. with more than 2000 cells per mL) are: septic arthritis, gout, chondrocalcinosis, RA, spondyloarthritis, ... Causes of mechanical fluid: osteoarthritis and meniscus injury"}],"ts":{"$numberLong":"1648137860834"},"type":"custom","difficulte":1}
-{"_id":"198-rhumato-5414b63c-022c-415c-94de-d3981fe575e9","context":null,"enonce":"Which of the following can be part of the pre-therapeutic assessment prior to the initiation of targeted therapy? ","item":"bioT","matiere":"rhumato","propositions":[{"idx":0,"correct":true,"proposition":"Serum protein electrophoresis (EPS)","justification":"True"},{"idx":1,"correct":true,"proposition":"HIV serology","justification":"True, with HBV and HCV serology"},{"idx":2,"correct":true,"proposition":"X-ray of the front chest","justification":"True"},{"idx":3,"correct":true,"proposition":"Detection of peripheral lymphadenopathy","justification":"True"},{"idx":4,"correct":true,"proposition":"Lipid profile ","justification":"True, for anti-IL6 and anti-JAK treatment"}],"ts":{"$numberLong":"1648137947902"},"type":"custom","difficulte":2}
-{"_id":"osteoporose-rhumato-9e2ef66","context":null,"enonce":"From what score can we speak of densitometric osteoporosis in adults? ","item":"osteoporose","matiere":"rhumato","propositions":[{"idx":0,"correct":false,"proposition":"T-score< -1","justification":""},{"idx":1,"correct":false,"proposition":"Z-score ≤ -2.5","justification":"False, the Z score is used in children who have not reached the peak of bone mass. "},{"idx":2,"correct":false,"proposition":"Z-score < -1","justification":""},{"idx":3,"correct":true,"proposition":"T-score≤ -2.5","justification":"True, according to the WHO. "},{"idx":4,"correct":false,"proposition":"T-score≤ -3","justification":""}],"ts":{"$numberLong":"1648137981430"},"type":"custom","difficulte":1}
-{"_id":"osteoporose-rhumato-2f492f9","context":null,"enonce":"Which of the following fractures are severe? ","item":"osteoporose","matiere":"rhumato","propositions":[{"idx":0,"correct":true,"proposition":"Fracture of the upper end of the femur ","justification":"True, the famous EFSF"},{"idx":1,"correct":true,"proposition":"Fracture of the upper extremity of the humerus ","justification":"True"},{"idx":2,"correct":false,"proposition":"Wrist fracture ","justification":"False, frequent but not severe fracture "},{"idx":3,"correct":true,"proposition":"Vertebra fracture ","justification":"True, also called vertebral settlement"},{"idx":4,"correct":true,"proposition":"Fracture of the pelvis ","justification":"True. The complete list: vertebral, pelvis \/ pelvis \/ sacrum, upper end of humerus, upper end of femur"}],"ts":{"$numberLong":"1648138313902"},"type":"custom","difficulte":1}
-{"_id":"osteoporose-rhumato-0cc8304","context":null,"enonce":"Which osteoporosis treatments are osteotrainers? (one or more correct answers)","item":"osteoporose","matiere":"rhumato","propositions":[{"idx":0,"correct":false,"proposition":"Raloxifene ","justification":"False, it is a selective estrogen receptor modulator (SERM), which slows bone resorption. Contraindicated after 70 years. Not active on peripheral bones"},{"idx":1,"correct":false,"proposition":"Bisphosphonate","justification":"False, it is an anti-osteoclastic treatment, slowing bone resorption "},{"idx":2,"correct":false,"proposition":"Menopausal hormone therapy (THM)","justification":"False, it is a treatment that slows bone resorption"},{"idx":3,"correct":false,"proposition":"Denosumab ","justification":"False, it is an anti-RANK-L antibody (biotherapy), which slows bone resorption "},{"idx":4,"correct":true,"proposition":"Teriparatide","justification":"True, it is a recombinant fragment of PTH, which stimulates bone formation. Trade name = Forsteo. One subcutaneous injection every day at the same time for 18 months"}],"ts":{"$numberLong":"1648138419671"},"type":"custom","difficulte":2}
-{"_id":"osteoporose-rhumato-d844f87","context":null,"enonce":"What biological arguments are in favor of osteomalacia? ","item":"osteoporose","matiere":"rhumato","propositions":[{"idx":0,"correct":true,"proposition":"Hypocalcemia","justification":"True"},{"idx":1,"correct":true,"proposition":"Hypophosphatemia ","justification":"True"},{"idx":2,"correct":false,"proposition":"Decrease in alkaline phosphatases ","justification":"False, they are increased "},{"idx":3,"correct":true,"proposition":"Collapsed vitamin D ","justification":"True"},{"idx":4,"correct":false,"proposition":"Hypercalciuria ","justification":"False, we will rather have hypocalciuria. According to the college: Osteomalacia is a diffuse, rarefizing, weakening osteopathy of bone tissue characterized histologically by a significant delay in mineralization of the newly formed organic matrix, which leads to an accumulation of osteoid tissue. The biological arguments are: a decrease in serum calcium and phosphatemia; an increase in alkaline phosphatase; a collapse of 25(OH)-vitamin D (reserve form) < 5 ng\/ml; hypocalciuria and hyperparathyroidism secondary to hypocalcaemia."}],"ts":{"$numberLong":"1648138559883"},"type":"custom","difficulte":1}
-{"_id":"arthrite-rhumato-fc4bb96","context":null,"enonce":"What elements are in favor of an inflammatory joint fluid? ","item":"arthrite","matiere":"rhumato","propositions":[{"idx":0,"correct":false,"proposition":"Low-cell fluid ","justification":"False, cell-rich liquid "},{"idx":1,"correct":true,"proposition":"Purulent liquid ","justification":"True"},{"idx":2,"correct":true,"proposition":"Presence of calcium pyrophosphate crystals ","justification":"True"},{"idx":3,"correct":false,"proposition":"Leukocytes < 2,000\/mm3","justification":"False, Leukocytes > 2,000\/mm3"},{"idx":4,"correct":true,"proposition":"Presence of germs ","justification":"True, on direct examination or after cultivation"}],"ts":{"$numberLong":"1648139254534"},"type":"custom","difficulte":1}
-{"_id":"PR-rhumato-703e654","context":null,"enonce":"A DAS28 to 3.0 score defines rheumatoid arthritis: ","item":"PR","matiere":"rhumato","propositions":[{"idx":0,"correct":false,"proposition":"In remission","justification":"False, in remission 👉 DAS28 < 2.6"},{"idx":1,"correct":false,"proposition":"Very active ","justification":"false, very active 👉 DAS28 > 5.1"},{"idx":2,"correct":true,"proposition":"Low level of activity","justification":"True, low activity 👉 level 2.6 < DAS28 < 3.2"},{"idx":3,"correct":false,"proposition":"Moderately active ","justification":"False, moderately active 👉 3.2 < DAS28 < 5.1"},{"idx":4,"correct":false,"proposition":"None of the previous answers","justification":"False "}],"ts":{"$numberLong":"1648139346291"},"type":"custom","difficulte":2}
-{"_id":"PR-rhumato-4788d72","context":null,"enonce":"Which of the following are possible extra-articular manifestations of RA? ","item":"PR","matiere":"rhumato","propositions":[{"idx":0,"correct":true,"proposition":"Asthenia","justification":"True"},{"idx":1,"correct":true,"proposition":"Secondary Sjögren's syndrome ","justification":"True"},{"idx":2,"correct":true,"proposition":"Diffuse interstitial lung disease ","justification":"True, hence a systematic chest X-ray to discover RA"},{"idx":3,"correct":false,"proposition":"Digital gooseneck deformations","justification":"False, osteoarticular manifestation of RA"},{"idx":4,"correct":true,"proposition":"Rheumatoid nodules","justification":"True"}],"ts":{"$numberLong":"1648139396428"},"type":"custom","difficulte":2}
-{"_id":"SpA-rhumato-98d439f","context":null,"enonce":"What can be the extra-articular disorders of spondyloarthritis? ","item":"SpA","matiere":"rhumato","propositions":[{"idx":0,"correct":true,"proposition":"Anterior uveitis ","justification":"True"},{"idx":1,"correct":true,"proposition":"Psoriasis ","justification":"True"},{"idx":2,"correct":false,"proposition":"Coxite","justification":"False, joint involvement of the coxofemoral joint "},{"idx":3,"correct":true,"proposition":"Crohn's disease ","justification":"True"},{"idx":4,"correct":false,"proposition":"Fessalgia ","justification":"False, pain reflecting joint involvement of the sacroiliac "}],"ts":{"$numberLong":"1648139485072"},"type":"custom","difficulte":2}
-{"_id":"rhumcrist-rhumato-258371e","context":null,"enonce":"What can be the manifestations of gout? ","item":"rhumcrist","matiere":"rhumato","propositions":[{"idx":0,"correct":true,"proposition":"Tophus","justification":"True, the famous gouty tophus"},{"idx":1,"correct":true,"proposition":"Renal colic ","justification":"True, radio-transparent lithiasis with uric acid (represents 10% of urolithiasis)"},{"idx":2,"correct":false,"proposition":"Dactylitis ","justification":"False, hallux dactylitis should not be confused with gouty attacks of MTP1. Dactylitis is found in spondyloarthritis for example"},{"idx":3,"correct":false,"proposition":"Radiopaque lithiasis ","justification":"False, radio-transparent lithiasis"},{"idx":4,"correct":true,"proposition":"Acute access of the first TPM ","justification":"True"}],"ts":{"$numberLong":"1648139578089"},"type":"custom","difficulte":2}
-{"_id":"SDRC-rhumato-df74a22","context":null,"enonce":"What elements can be found when diagnosing complex regional pain syndrome (CRPS)? ","item":"SDRC","matiere":"rhumato","propositions":[{"idx":0,"correct":false,"proposition":"Inflammatory joint fluid","justification":"False, mechanical fluid, with less than 2000 elements (other causes: osteoarthritis, meniscalgia)"},{"idx":1,"correct":false,"proposition":"Augmented CRP","justification":"False, normal CRP, no biological abnormalities in CRPS"},{"idx":2,"correct":true,"proposition":"Regional bone demineralization ","justification":"True, on radiography"},{"idx":3,"correct":true,"proposition":"Hyperfixation to the 3 stages of scintigraphy ","justification":"True"},{"idx":4,"correct":false,"proposition":"MRI always normal ","justification":"False, may be normal but sometimes presence of edema especially osteomedullary "}],"ts":{"$numberLong":"1648139641131"},"type":"custom","difficulte":1}
-{"_id":"meningite-neuro-1cc9e59","context":null,"enonce":"Which tumors can classically give paraneoplastic syndromes responsible for autoimmune encephalitis?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"Small cell lung cancer","justification":"True. These are CBPC, testicular and ovarian cancers, and hemopathies and related diseases (thymoma)"},{"idx":1,"correct":true,"proposition":"Gonad cancers","justification":"True"},{"idx":2,"correct":true,"proposition":"Lymphoma","justification":"True"},{"idx":3,"correct":true,"proposition":"Thymoma","justification":"True"},{"idx":4,"correct":true,"proposition":"Leukaemia","justification":"True"}],"ts":{"$numberLong":"1648139843845"},"type":"custom","difficulte":3}
-{"_id":"meningite-infectio-eef0ae7","context":null,"enonce":"What are the 2 most common germs found in meningitis in children under 2 months of age?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Escherichia coli","justification":"True, by contamination by proximity to the digestive tract during childbirth most often"},{"idx":1,"correct":false,"proposition":"Neisseria meningitdis","justification":"False, it's between 18 and 25 years old"},{"idx":2,"correct":true,"proposition":"Streptococcus agalactiae","justification":"True, also called group B beta-hemolytic streptococcus (SBHB), hence the importance of systematically looking for it before delivery via a vaginal swab"},{"idx":3,"correct":false,"proposition":"Haemophilus influenzae","justification":"False, it is rather in the child over 2 years old unvaccinated"},{"idx":4,"correct":false,"proposition":"Streptococcus pneumoniae","justification":"False, it is rather in children between 1 and 2 years, then in adults over 25 years"}],"ts":{"$numberLong":"1648140165907"},"type":"custom","difficulte":1}
-{"_id":"meningite-infectio-54298ea","context":null,"enonce":"You are a country doctor in a very under-endowed area thanks to your CEPA, and you are called for Monique, a farmer, 48 years old, who has been feverish since this morning, and has small crimson spots, all black, hollow, trunk multiplying at high speed. His cat, who is a fine semiologist, has noticed that they do not fade when he presses on them to chase them away. Her husband is warming up the engine of the 308 a little tired to transport it to the emergency room when you arrive aboard your brand new 🛵 Vespa. What are the real propositions?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"It is a vital emergency, her husband cannot transport her, medical transport is needed","justification":"True, it is a purpura fulminans 👉 we inject the C3G that is in our emergency bag and we call the 15"},{"idx":1,"correct":true,"proposition":"It is a legal obligation for any liberal doctor to have on him enough to perform an IM injection of C3G in this type of situation","justification":"True, even ophthalmologists and psychiatrists!"},{"idx":2,"correct":true,"proposition":"If you don't have C3G, you can inject amoxicillin IM","justification":"True, it's not as good, but it's much better than nothing."},{"idx":3,"correct":false,"proposition":"You call the multi-purpose medicine at the nearest clinic to hospitalize the patient as soon as possible","justification":"False, this patient must be hospitalized urgently in intensive care or intensive care"},{"idx":4,"correct":false,"proposition":"You need to put on an FFP2 mask to protect yourself","justification":"False, it is an isolation droplets, a surgical mask will be enough"}],"ts":{"$numberLong":"1648140307802"},"type":"custom","difficulte":1}
-{"_id":"meningite-infectio-9a61490","context":null,"enonce":"Which of these CSF biochemistries are normal?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Rock water, 0 element, glycorachia at 0.9 x glycemia, 0.20g\/L proteinorachia, 0.25mM lactates","justification":"True, standards are \na) < 5 figurative elements (without PNN or red blood cells, with 60% lymphocytes and 40% monocytes), \nb) glycorachia greater than 2\/3 x blood glucose\nc) a proteinorachia of less than 0.40 g \/ L\n(d) a lactatorachia less than 3.2 mM"},{"idx":1,"correct":false,"proposition":"Rock water, 4 elements (1 red blood cell, 3 monocytes), glycorachia at 0.7 x glycemia, 0.5g\/L proteinorachia, 0.25mM lactates","justification":"False, the presence of red blood cells can make suspect a traumatic PL (bad external bouuuh! [this is not true]). In addition, we have a little too much protein"},{"idx":2,"correct":false,"proposition":"Cloud, 500 elements (majority of PNN), glycorachia at 0.2 x glycemia, 1.50g\/L proteinorachy, 5.43mM lactates","justification":"False, and it is even very suggestive of purulent meningitis (in view of PNN, glycorachia, significant proteinorachia and lactates)"},{"idx":3,"correct":false,"proposition":"Rock water, 500 elements (mostly lymphocytes and monocytes), glycorachia at 0.5 x glycemia, 1.20g\/L proteinorachia, 3.2mM lactates","justification":"False, and it's quite suggestive of lymphocytic meningitis"},{"idx":4,"correct":true,"proposition":"Rock water, 4 elements (2 lymphocytes, 2 monocytes), glycorachia at 0.7 x glycemia, 0.35g\/L proteinorachia, 3.0mM lactates","justification":"True"}],"ts":{"$numberLong":"1648140453286"},"type":"custom","difficulte":1}
-{"_id":"meningite-neuro-25e0156","context":null,"enonce":"What are the two infectious agents that cause rhombencephalitis?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"CMV","justification":""},{"idx":1,"correct":true,"proposition":"VZV","justification":"True, children who have chickenpox often walk not straight! It's benign and it regresses alone most often"},{"idx":2,"correct":false,"proposition":"Streptococcus B","justification":""},{"idx":3,"correct":false,"proposition":"HSV","justification":""},{"idx":4,"correct":true,"proposition":"Listeria monocytogenes","justification":"True: in front of a pregnant woman who does not walk straight, before fetal alcohol syndrome, look for listeriosis!"}],"ts":{"$numberLong":"1648140518659"},"type":"custom","difficulte":1}
-{"_id":"meningite-neuro-9f3de61","context":null,"enonce":"Which of these patients need a check-up before their lumbar puncture? Which exam is it?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"An 18-year-old woman, with no history, with normal clinical and neurological examination other than stiff neck, photophonophobia, and fever","justification":"No, it can be assumed that she has a TP > 50%, a TCA < 1.5, and platelets greater than 50G\/L since she has no particular history"},{"idx":1,"correct":true,"proposition":"An 82-year-old man on RIVAROXABAN","justification":"True, it must be made sure that it has a TP > 50%, a TCA < 1.5, and platelets greater than 50G \/ L"},{"idx":2,"correct":false,"proposition":"A 3-month-old child with clonic movements of the right hand since this morning associated with high fever and photophonophobia","justification":"False, he has a typical picture of meningitis and, before 5 years, the only signs of localization that should have an MRI performed are hemicorporal crises"},{"idx":3,"correct":true,"proposition":"A 35-year-old adult with clonic movements of the right hand since this morning associated with stiff neck and fever","justification":"True, in humans over 5 years of age, any sign of localization must have a cMRI performed before PL to avoid engagement"},{"idx":4,"correct":true,"proposition":"A 4-year-old child with twitching of the upper and lower right limbs associated with a sunset gaze","justification":"True, it has a sign of localization (clonies of the right hemibody). He also has a sign of HTIC, which must also have an imaging assessment done before the PL"}],"ts":{"$numberLong":"1648140663980"},"type":"custom","difficulte":1}
-{"_id":"meningite-neuro-2e5fb4e","context":null,"enonce":"In which cases should a first dose of antibiotic therapy be given before PL in front of a meningitis chart?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"Hospital care impossible in less than 60 minutes","justification":"That's 90.... (sorry)"},{"idx":1,"correct":true,"proposition":"Hemodynamic instability","justification":"True, it sucks, we are close to the cata, we go into cowboy mode (we do hemocs quickly done before anyway)"},{"idx":2,"correct":true,"proposition":"Known and uncorrectable hemostasis abnormality","justification":"True, you need a PT, a TCA, and normal platelets before going"},{"idx":3,"correct":false,"proposition":"Isolated rapidly worsening alertness disorders","justification":"False! Not as long as they are isolated (so not associated with hemodynamic disorders)"},{"idx":4,"correct":true,"proposition":"Indication for prior brain imaging","justification":"True! Always do antibiotics before imaging. Indications for brain imaging:\n-signs of HTIC\n-hemicorporeal seizures before 5 years\n-focal or generalised seizures after 5 years \/ signs of localization"}],"ts":{"$numberLong":"1648140800489"},"type":"custom","difficulte":2}
-{"_id":"meningite-neuro-1d8800a","context":null,"enonce":"What elements are part of encephalitic syndrome?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"Neck stiffness","justification":"False, in meningeal syndrome"},{"idx":1,"correct":true,"proposition":"Impaired consciousness","justification":"True, these are globally the contraindications relating to PL in front of meningoencephalitis: signs of localization, vigilance disorders (rarely isolated), delirium syndrome, epileptic seizures (most often partial), neurovegetative disorders"},{"idx":2,"correct":true,"proposition":"Signs of localization","justification":"True, cf 2"},{"idx":3,"correct":true,"proposition":"Pulse irregularity","justification":"True, neurovegetative disorder"},{"idx":4,"correct":false,"proposition":"Phonophobia without photophobia","justification":"Distractor, photophonophobia is in meningeal syndrome"}],"ts":{"$numberLong":"1648140860574"},"type":"custom","difficulte":1}
-{"_id":"meningite-infectio-5437a70","context":null,"enonce":"Regarding precautions for meningococcal meningitis:","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Caregivers should wear FFP2 before the first dose of antibiotic","justification":"Caregivers must wear a surgical mask for up to 24 hours after the first dose of antibiotic. We are on an additional droplet protection "},{"idx":1,"correct":false,"proposition":"Caregivers should wear FFP2 for up to 24 hours after the first dose of antibiotic","justification":"surgical mask"},{"idx":2,"correct":false,"proposition":"Caregivers should wear FFP2 for up to 48 hours after the first dose of antibiotic","justification":"surgical mask up to 24h"},{"idx":3,"correct":true,"proposition":"Antibiotic prophylaxis should be available to caregivers who have practiced mouth-to-mouth and those who have spent at least one hour with the patient without a mask","justification":"True"},{"idx":4,"correct":false,"proposition":"Caregivers must wear a surgical mask until the first dose of antibiotic","justification":"24 hours later"}],"ts":{"$numberLong":"1648140997631"},"type":"custom","difficulte":2}
-{"_id":"meningite-neuro-6691ea3","context":null,"enonce":"In front of a typical picture of pure encephalitis without associated meningitis in pregnant women, probabilistic treatment will include:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"VALGANCICLOVIR","justification":"We are not trying to cover the CVMP:) It is HSV that gives encephalitis"},{"idx":1,"correct":true,"proposition":"AMOXICILLIN","justification":"True, to cover listeria because she is pregnant; If it wasn't, it would be debatable."},{"idx":2,"correct":false,"proposition":"CEFTRIAXONE","justification":"We do not try to cover streptococcus or meningococcal in encephalitis"},{"idx":3,"correct":true,"proposition":"ACICLOVIR","justification":"True, to cover HSV Let's go IV (and therefore not VALACICLOVIR)"},{"idx":4,"correct":false,"proposition":"DEXAMETHASONE","justification":"False. Indeed, in the pilly 2021, the indications for corticosteroid therapy are very clear (and do not include HSV encephalitis): diagnosis of pneumococcal or meningococcal meningitis of adults or tuberculous meningoencephalitis. (This proposal was counted true by mistake until May 14, 2022, when an external reported the error, thanks to her!)"}],"ts":{"$numberLong":"1648141102864"},"type":"custom","difficulte":2}
-{"_id":"grossessepatho-gyn-25777c0","context":null,"enonce":"What statements are true about Listeria monocytogenes?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"correct":true,"proposition":"Gram-positive bacillus","justification":"True"},{"idx":1,"correct":false,"proposition":"Gram-negative bacillus","justification":""},{"idx":2,"correct":false,"proposition":"Gram-positive cocci","justification":""},{"idx":3,"correct":false,"proposition":"Gram-negative cocci","justification":""},{"idx":4,"correct":false,"proposition":"Mycobacterium","justification":""}],"ts":{"$numberLong":"1648167451770"},"type":"custom","difficulte":1}
-{"_id":"grossessepatho-gyn-23204b6","context":null,"enonce":"What statements are true about Listeria monocytogenes?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"correct":true,"proposition":"It is a bacillus with facultative intracellular development","justification":"True"},{"idx":1,"correct":false,"proposition":"He is killed by the cold","justification":"It is able to multiply at low temperatures (4°C)."},{"idx":2,"correct":true,"proposition":"It has natural resistance to cephalosporins","justification":"Yes, this bata**🙄. But it can be beamed with amox (+genta, for good measure). Germs naturally resistant to C3G are LLEIA (as in Star Wars): Legionella, Listeria, Enterococci, Intracellular (-> macrolides) and Strict anaerobes (-> metronidazole)"},{"idx":3,"correct":true,"proposition":"It can colonize food and contaminate the cold chain","justification":"True, possible TIAC agent#montDOr"},{"idx":4,"correct":true,"proposition":"It is a reportable infection","justification":"True"}],"ts":{"$numberLong":"1648167501493"},"type":"custom","difficulte":2}
-{"_id":"grossessepatho-gyn-9817ce2","context":null,"enonce":"What statements are true about Listeria monocytogenes?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"correct":true,"proposition":"It can cross the intestinal barrier","justification":"True"},{"idx":1,"correct":true,"proposition":"It can cross the blood-brain barrier","justification":"True"},{"idx":2,"correct":true,"proposition":"It can cross the placental barrier","justification":"True"},{"idx":3,"correct":true,"proposition":"Immunosuppression worsens Listeria infection","justification":"True, at the same time it's pretty much always true, huh, \"immunosuppression worsens...\""},{"idx":4,"correct":true,"proposition":"Mortality can reach 45% in Listeria septicaemia","justification":"True, rare but serious infection"}],"ts":{"$numberLong":"1648167555096"},"type":"custom","difficulte":2}
-{"_id":"grossessepatho-gyn-4d383f5","context":null,"enonce":"How do you get contaminated with Listeria?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"correct":true,"proposition":"Cheeses made from raw milk except pressed pasta","justification":"True"},{"idx":1,"correct":true,"proposition":"Unpasteurized dairy products","justification":"True"},{"idx":2,"correct":true,"proposition":"Uncooked deli meats","justification":"True"},{"idx":3,"correct":false,"proposition":"Hot baths","justification":"Legionella"},{"idx":4,"correct":true,"proposition":"Listeria does not alter the taste of food","justification":"True"}],"ts":{"$numberLong":"1648167583765"},"type":"custom","difficulte":1}
-{"_id":"meningite-neuro-a45136c","context":null,"enonce":"Which of the following are sequelae of herpetic meningitis? (one or more true propositions)","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"Anxiodepressive disorders","justification":"True"},{"idx":1,"correct":true,"proposition":"Syndrome de Klüver-Bucy","justification":"True, it is most often secondary to a viral infection (reminder: hyperorality, hyperphagia, hypersexuality)"},{"idx":2,"correct":true,"proposition":"Syndrome de Korsakoff","justification":"True, memory disorders in general, which can go as far as Korsakoff with anterograde amnesia and fantasies"},{"idx":3,"correct":true,"proposition":"Character change","justification":"True, we also retain epilepsies"},{"idx":4,"correct":false,"proposition":"Schizophrenia","justification":""}],"ts":{"$numberLong":"1648204309635"},"type":"custom","difficulte":2}
-{"_id":"lesionart-urg-02c7ce3","context":null,"enonce":"Which tests concern the subspinatus and small round muscles? (one or more correct answers)","item":"lesionart","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"Leg","justification":""},{"idx":1,"correct":false,"proposition":"Jobe","justification":"Supraspinatus"},{"idx":2,"correct":false,"proposition":"Jerk test","justification":"LCA"},{"idx":3,"correct":false,"proposition":"Belly press","justification":"Subscapular"},{"idx":4,"correct":false,"proposition":"Throw up","justification":"Subscapular"}],"ts":{"$numberLong":"1648240036882"},"type":"custom","difficulte":1}
-{"_id":"lesionart-urg-98a899f","context":null,"enonce":"What tests can highlight an acromioclavicular conflict?","item":"lesionart","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"Cross-arm test","justification":""},{"idx":1,"correct":false,"proposition":"Throw up","justification":"Subscapular"},{"idx":2,"correct":false,"proposition":"Hawkins","justification":"Subacromial conflict"},{"idx":3,"correct":false,"proposition":"Neer","justification":"Subacromial conflict"},{"idx":4,"correct":false,"proposition":"Jobe","justification":"Supraspinatus"}],"ts":{"$numberLong":"1648240183936"},"type":"custom","difficulte":1}
-{"_id":"lesionart-urg-d48f2f1","context":null,"enonce":"What tests concern the subscapularis muscle? (one or more true answers)","item":"lesionart","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"Throw up","justification":""},{"idx":1,"correct":true,"proposition":"Belly press","justification":""},{"idx":2,"correct":false,"proposition":"Leg","justification":"Subspinatus and small round"},{"idx":3,"correct":false,"proposition":"Jobe","justification":"Supraspinatus"},{"idx":4,"correct":false,"proposition":"None of these proposals","justification":""}],"ts":{"$numberLong":"1648240194931"},"type":"custom","difficulte":1}
-{"_id":"lesionart-urg-e3ecab9","context":null,"enonce":"What tests concern the supraspinatus muscle? (one or more correct answers)","item":"lesionart","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"Jobe","justification":""},{"idx":1,"correct":false,"proposition":"Leg","justification":"Under spiny and small round"},{"idx":2,"correct":false,"proposition":"Hawkins","justification":"Searches for subacromial conflict"},{"idx":3,"correct":false,"proposition":"Subscapular","justification":"Gerber and Belly press"},{"idx":4,"correct":false,"proposition":"Grinding test","justification":"Concerns the Menisci"}],"ts":{"$numberLong":"1648240207229"},"type":"custom","difficulte":1}
-{"_id":"lesionart-urg-4e59d14","context":null,"enonce":"Regarding knee ligaments, which proposals are true?","item":"lesionart","matiere":"urg","propositions":[{"idx":0,"correct":false,"proposition":"LLI prevents external rotation","justification":"This is the case of the PAPI"},{"idx":1,"correct":true,"proposition":"LLE prevents varus","justification":""},{"idx":2,"correct":false,"proposition":"IPO prevents valgus","justification":"It prevents internal rotation. Valgus is countered by the LLI"},{"idx":3,"correct":true,"proposition":"PCL is extrasynovial","justification":""},{"idx":4,"correct":false,"proposition":"PAPI can cause Segond's fracture","justification":"This is the case of the LCA"}],"ts":{"$numberLong":"1648240417063"},"type":"custom","difficulte":1}
-{"_id":"adenomehypoP-endoc-5724093","context":null,"enonce":"What are the complications of acromegaly to look for?","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"Type 1 diabetes","justification":"Secondary diabetes or glucose intolerance"},{"idx":1,"correct":false,"proposition":"Goiter with thyroid adenoma","justification":"It is multinodular goiters that are common"},{"idx":2,"correct":true,"proposition":"Colon polyps","justification":"True"},{"idx":3,"correct":true,"proposition":"Splenomegaly","justification":"True"},{"idx":4,"correct":true,"proposition":"Increased basal cardiac output","justification":"True"}],"ts":{"$numberLong":"1648241013929"},"type":"custom","difficulte":1}
-{"_id":"noduleTh-endoc-2a22c68","context":null,"enonce":"What are the etiologies of white scintigraphy with increased T4L?","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":" De Quervain's thyroiditis","justification":"True"},{"idx":1,"correct":true,"proposition":"Iodine overload","justification":"True"},{"idx":2,"correct":false,"proposition":"Multinodular goiter","justification":"Scintigraphy that fixes heterogeneously"},{"idx":3,"correct":false,"proposition":"All propositions are true","justification":""},{"idx":4,"correct":false,"proposition":"Non-productive papillary carcinoma","justification":"Normal T4L"}],"ts":{"$numberLong":"1648241353500"},"type":"custom","difficulte":1}
-{"_id":"noduleTh-endoc-45f7340","context":null,"enonce":"What propositions are true about ARI therapy?","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"The molecule used is iodine-123","justification":"This is iodine-131"},{"idx":1,"correct":true,"proposition":"The molecule used is iodine-131","justification":"True"},{"idx":2,"correct":true,"proposition":"It allows the targeted destruction of thyroid residue","justification":"True"},{"idx":3,"correct":true,"proposition":"Thyroid residues are able to selectively capture iodine-131","justification":"True"},{"idx":4,"correct":false,"proposition":"Treatment is indicated in all patients who have undergone total thyroidectomy","justification":"Treatment is only indicated in patients who have undergone total thyroidectomy and are at high risk of recurrence"}],"ts":{"$numberLong":"1648241407210"},"type":"custom","difficulte":3}
-{"_id":"noduleTh-endoc-4820ce4","context":null,"enonce":"You explain to your patient the need for thyroid surgery (total thyroidectomy), and inform them of the potential complications of the procedure:","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Hypocalcemia","justification":"True"},{"idx":1,"correct":true,"proposition":"Dysphonia","justification":"True"},{"idx":2,"correct":true,"proposition":"Anaesthetic risks","justification":"True"},{"idx":3,"correct":false,"proposition":"Phrenic nerve damage","justification":"The phrenic nerve originates from C4 and innervates the diaphragm. Not to be confused with laryngeal nerves"},{"idx":4,"correct":false,"proposition":"Hyperparathyroidism ","justification":"Hypoparathyroidism 👉 hypocalcemia"}],"ts":{"$numberLong":"1648241458824"},"type":"custom","difficulte":1}
-{"_id":"noduleTh-endoc-4b59b7f","context":null,"enonce":"From what size, in centimeters, is a thyroid nodule rather suspicious?","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"2","justification":""},{"idx":1,"correct":true,"proposition":"3","justification":"True, table 16.1 of item 'Nodule'"},{"idx":2,"correct":false,"proposition":"4","justification":""},{"idx":3,"correct":false,"proposition":"5","justification":""},{"idx":4,"correct":false,"proposition":"6","justification":""}],"ts":{"$numberLong":"1648241566769"},"type":"custom","difficulte":1}
-{"_id":"VIH-infectio-129471a","context":null,"enonce":"Who is the definitive host of Toxoplasma gondii?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"The cat","justification":"True"},{"idx":1,"correct":false,"proposition":"Beef","justification":""},{"idx":2,"correct":false,"proposition":"The dog","justification":""},{"idx":3,"correct":false,"proposition":"The rabbit","justification":""},{"idx":4,"correct":false,"proposition":"The human being","justification":"It is an intermediate host"}],"ts":{"$numberLong":"1648241914736"},"type":"custom","difficulte":2}
-{"_id":"VIH-infectio-242ce69","context":null,"enonce":"What are the typical aspects of brain toxoplasmosis on MRI?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Multiple abscesses","justification":"True"},{"idx":1,"correct":false,"proposition":"White matter hyperintensity","justification":""},{"idx":2,"correct":true,"proposition":"Roundel appearance","justification":"True"},{"idx":3,"correct":false,"proposition":"Comet tail sign","justification":"Sign of a meningioma"},{"idx":4,"correct":true,"proposition":"Hypointense halo around T1 abscesses","justification":"True, corresponds to edema"}],"ts":{"$numberLong":"1648241963731"},"type":"custom","difficulte":1}
-{"_id":"VIH-infectio-2c43b53","context":null,"enonce":"What are the possible clinical forms of toxoplasmosis in immunocompromised people?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Brain","justification":"True, especially if CD4 < 200"},{"idx":1,"correct":true,"proposition":"ocular","justification":"True, type of chorioretininte"},{"idx":2,"correct":true,"proposition":"pulmonary","justification":"True, type of interstitial lung disease"},{"idx":3,"correct":true,"proposition":"Disseminated","justification":"True"},{"idx":4,"correct":false,"proposition":"hepatic","justification":""}],"ts":{"$numberLong":"1648242009032"},"type":"custom","difficulte":3}
-{"_id":"VIH-infectio-5498342","context":null,"enonce":"What elements are part of the table of primary toxoplasmosis infection of the immunocompetent subject?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"fever","justification":"True"},{"idx":1,"correct":true,"proposition":"asthenia","justification":"True"},{"idx":2,"correct":true,"proposition":"Possible eosinophilia","justification":"True"},{"idx":3,"correct":true,"proposition":"mononucleosis syndrome","justification":"True"},{"idx":4,"correct":true,"proposition":"chorioretinitis","justification":"True, 5-10% of cases"}],"ts":{"$numberLong":"1648242059737"},"type":"custom","difficulte":1}
-{"_id":"VIH-infectio-84e7d87","context":null,"enonce":"Regarding HIV testing in pregnant women:","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"It is mandatory","justification":"It is recommended"},{"idx":1,"correct":false,"proposition":"It is done in the third trimester","justification":"In Q1"},{"idx":2,"correct":true,"proposition":"HIV does not cause embryofetal disease","justification":"True"},{"idx":3,"correct":true,"proposition":" The risk of transmission is 0.3% if the mother's viral load is undetectable","justification":"True"},{"idx":4,"correct":false,"proposition":"HIV infection warrants emergency IMG","justification":"No damage to the fetus but possible contamination"}],"ts":{"$numberLong":"1648242278375"},"type":"custom","difficulte":1}
-{"_id":"VIH-infectio-a45461f","context":null,"enonce":"In how many cases, in general, is the primary toxoplasmosis infection of the immunocompetent subject symptomatic?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Never","justification":""},{"idx":1,"correct":true,"proposition":"20 %","justification":"True"},{"idx":2,"correct":false,"proposition":"70 %","justification":""},{"idx":3,"correct":false,"proposition":"90 %","justification":""},{"idx":4,"correct":false,"proposition":"Always","justification":""}],"ts":{"$numberLong":"1648242291512"},"type":"custom","difficulte":1}
-{"_id":"VIH-infectio-f8a606f","context":null,"enonce":"Toxoplasma gondii is:","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"A parasite","justification":"True"},{"idx":1,"correct":true,"proposition":"A cosmopolitan protozoan","justification":"True"},{"idx":2,"correct":true,"proposition":"A zoonosis","justification":"True"},{"idx":3,"correct":false,"proposition":"Arbovirus","justification":""},{"idx":4,"correct":false,"proposition":"A virus","justification":""}],"ts":{"$numberLong":"1648242321156"},"type":"custom","difficulte":1}
-{"_id":"meningite-infectio-2ffe642","context":null,"enonce":"What meningitis causes normoglycorachic CSF?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Listeriosis","justification":"Hypoglycorachia"},{"idx":1,"correct":true,"proposition":"HSV","justification":"All viral meningitis"},{"idx":2,"correct":false,"proposition":"Carcinoma meningitis","justification":"Often hypoglycorachia"},{"idx":3,"correct":true,"proposition":"Syphillis","justification":"True"},{"idx":4,"correct":true,"proposition":"Lyme disease","justification":"True"}],"ts":{"$numberLong":"1648242484265"},"type":"custom","difficulte":2}
-{"_id":"meningite-infectio-3d3ce05","context":null,"enonce":"Anissa, 12, is on holiday in Corsica when she is hospitalized in intensive care for meningococcal meningitis. With regard to public health aspects, which proposals are true?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Her nanny, who looks after her 4 hours a day, and who last saw her 12 days ago, must benefit from antibiotic propylaxis.","justification":"Cf 4"},{"idx":1,"correct":false,"proposition":"His mother, who is allergic to quinolones which are the antibiotic of choice, may receive cefotaxime instead.","justification":"Cf 4"},{"idx":2,"correct":false,"proposition":"His father, who is allergic to quinolones and C3G, will receive the last line of antibiotic prophylaxis: rifampicin.","justification":"Cf 4"},{"idx":3,"correct":true,"proposition":"His brother, who is allergic to rifampicin which is the antibiotic prophylaxis of choice, may receive a single dose of C3G or quinolone.","justification":"True, antibiotic prophylaxis of meningococcal meningitis:\n1) Applies to individuals who have spent more than one hour within one metre of the case in the 10 days prior to diagnosis\n2) applies to caregivers who have practiced mouth-to-mouth, or have intubated\/aspirated the patient without a surgical mask\n\nand \n\n3) consists of RIFAMPICIN 600mg x 2 per day for 2 days (or 10mg\/kg per dose but not exceeding 600mg per dose) as a first line\n4) may consist of CEFTRIAXONE 250mg IV single dose (125mg in children) or CIPROFLOXACIN 500mg PO single dose (20mg\/kg in children)"},{"idx":4,"correct":false,"proposition":"Children in the household will be offered to vaccinate them, but not adults because catch-up only takes place until 25 years of age.","justification":"False, we vaccinate the whole household"}],"ts":{"$numberLong":"1648242611509"},"type":"custom","difficulte":2}
-{"_id":"voyagetrop-infectio-1b73087","context":null,"enonce":"What are arboviruses?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Malaria","justification":""},{"idx":1,"correct":true,"proposition":"Dengue fever ","justification":"True"},{"idx":2,"correct":true,"proposition":"Chikungunya","justification":"True"},{"idx":3,"correct":true,"proposition":"Zika","justification":"True"},{"idx":4,"correct":true,"proposition":"Yellow fever","justification":"List: Japanese encephalitis\nTick-borne Encephalitis\nWest-Nile encephalitis\nDengue fever \nChikungunya\nZika\nYellow fever\n"}],"ts":{"$numberLong":"1648243065363"},"type":"custom","difficulte":2}
-{"_id":"voyagetrop-infectio-1cbe999","context":null,"enonce":"What are the diseases with faecal-oral transmission?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"HAV","justification":"True"},{"idx":1,"correct":false,"proposition":"HBV","justification":"Virus encapsulated and therefore fragile in the external environment (just like HCV and VHD)"},{"idx":2,"correct":true,"proposition":"HEV","justification":"True"},{"idx":3,"correct":true,"proposition":"Enterotoxigenic E. coli","justification":"Turista "},{"idx":4,"correct":true,"proposition":"Typhoid","justification":"True, Salomonella enterica"}],"ts":{"$numberLong":"1648243150119"},"type":"custom","difficulte":1}
-{"_id":"voyagetrop-infectio-2d831bb","context":null,"enonce":"What is the clinic of the typhoid fever invasion phase?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"High fever but not yet on plateau","justification":"True"},{"idx":1,"correct":true,"proposition":"digestive disorders","justification":"True"},{"idx":2,"correct":true,"proposition":"neurological disorders","justification":"True"},{"idx":3,"correct":false,"proposition":"Tuphos","justification":"State phase: Plateau fever at 40°C, Tuphos, dig disorders, rash, Duguet's angina (ulcerations)\n"},{"idx":4,"correct":false,"proposition":"rash","justification":""}],"ts":{"$numberLong":"1648243199089"},"type":"custom","difficulte":2}
-{"_id":"voyagetrop-infectio-5d41b9e","context":null,"enonce":"What are the infectious etiologies to evoke in case of diarrhea in return from tropical countries if the patient is apyeric?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Shigella","justification":"Glairo-bloody diarrhea"},{"idx":1,"correct":true,"proposition":"Intestinal ameobosis","justification":"True"},{"idx":2,"correct":true,"proposition":"Giardiosis","justification":"True"},{"idx":3,"correct":true,"proposition":"Cholera","justification":"True"},{"idx":4,"correct":false,"proposition":"Closridium difficile","justification":"Febrile diarrhea: Salmonellosis, Shigellosis, Campylobacter, Clostridium difficile, Viral hepatitis, Malaria, Primary HIV infection"}],"ts":{"$numberLong":"1648243300228"},"type":"custom","difficulte":1}
-{"_id":"voyagetrop-infectio-687dd75","context":null,"enonce":"How to confirm typhoid fever?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Serology","justification":""},{"idx":1,"correct":false,"proposition":"PCR","justification":""},{"idx":2,"correct":true,"proposition":"Coproculture if diarrhea","justification":"True"},{"idx":3,"correct":false,"proposition":".EPS","justification":"It is not a parasite"},{"idx":4,"correct":true,"proposition":"Blood culture","justification":"True"},{"idx":5,"correct":false,"proposition":"Microbiological","justification":""},{"idx":6,"correct":false,"proposition":"Rectal swab","justification":""},{"idx":7,"correct":false,"proposition":"Liver biopsy","justification":""},{"idx":8,"correct":false,"proposition":"C3G Proof Treatment","justification":"Does not confirm positive infection"}],"ts":{"$numberLong":"1648243321801"},"type":"custom","difficulte":2}
-{"_id":"voyagetrop-infectio-6a28938","context":null,"enonce":"What is the vector of leishmaniasis?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Aedes","justification":"Arbovirus, stings during the day"},{"idx":1,"correct":false,"proposition":"Anopheles female","justification":"Malaria, bites at night"},{"idx":2,"correct":true,"proposition":"Female sandfly","justification":"True, bites at night"},{"idx":3,"correct":false,"proposition":"Culex","justification":"West-Nile viral encephalitis \/ Japanese, bites at night"},{"idx":4,"correct":false,"proposition":"Tick","justification":"Borreliosis, Rickettsia, Tick-borne viral encephalitis"}],"ts":{"$numberLong":"1648243354556"},"type":"custom","difficulte":2}
-{"_id":"voyagetrop-infectio-d81d46c","context":null,"enonce":"What are the two mandatory vaccinations for travellers that can be requested at customs when travelling to endemic areas?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Yellow fever vaccine","justification":"True, in intertropical Africa and the Amazon"},{"idx":1,"correct":true,"proposition":"ACYW135 meningococcal vaccine","justification":"True, during a pilgrimage to Mecca (recommended otherwise) "},{"idx":2,"correct":false,"proposition":"BCG vaccine","justification":""},{"idx":3,"correct":false,"proposition":"MMR vaccine","justification":""},{"idx":4,"correct":false,"proposition":"Rabies vaccine","justification":""}],"ts":{"$numberLong":"1648243558972"},"type":"custom","difficulte":1}
-{"_id":"voyagetrop-infectio-d977907","context":null,"enonce":"What are the two leading tropical causes of fever after returning from a stay in the tropics?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Malaria","justification":"True"},{"idx":1,"correct":true,"proposition":"Dengue fever","justification":"True"},{"idx":2,"correct":false,"proposition":"Typhoid fever","justification":""},{"idx":3,"correct":false,"proposition":"Turista","justification":"Cause of diarrhea without fever during travel"},{"idx":4,"correct":false,"proposition":"Tuberculosis","justification":""}],"ts":{"$numberLong":"1648243580285"},"type":"custom","difficulte":1}
-{"_id":"voyagetrop-infectio-dab31b0","context":null,"enonce":"What is the most common cause of non-febrile diarrhea when returning from a trip to tropical countries?\n","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"HIV","justification":"Diarrhea from primary HIV infection is febrile"},{"idx":1,"correct":false,"proposition":"Cholera","justification":"Rarer"},{"idx":2,"correct":false,"proposition":"Salmonella","justification":"Febrile diarrhea"},{"idx":3,"correct":true,"proposition":"Giardiasis","justification":"True, test treatment with Metronidazole, diagnosis with EPS"},{"idx":4,"correct":false,"proposition":"Dengue fever","justification":"Febrile arbovirus, no diarrhea classically"}],"ts":{"$numberLong":"1648243611692"},"type":"custom","difficulte":1}
-{"_id":"meningite-infectio-4a04b58","context":null,"enonce":"What are the infectious agents that can give acute encephalitis accompanied by single nucleosic syndromes?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"CMV","justification":"True"},{"idx":1,"correct":true,"proposition":"HSV","justification":"True"},{"idx":2,"correct":false,"proposition":"VZV","justification":"Does not give mononucleosic syndrome."},{"idx":3,"correct":true,"proposition":"EBV","justification":"True"},{"idx":4,"correct":false,"proposition":"HHV-6","justification":"HHV6 does give a mononucleosis syndrome but classically no encephalitis."}],"ts":{"$numberLong":"1648296142741"},"type":"custom","difficulte":2}
-{"_id":"meningite-infectio-4d1795f","context":null,"enonce":"The mother of 8-month-old Josephine wants to take her on a pilgrimage to Mecca. What can you tell him about vaccination?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Mecca is located in the meningitis belt","justification":"That's the whole point."},{"idx":1,"correct":true,"proposition":"Her daughter may be offered a meningococcal C conjugate vaccine","justification":"Yes, absolutely. Mandatory vaccination for children born since January 1, 2018 is also mandatory, with a dose at the age of 5 months and a booster at the age of 1 year. Catching up until the age of 24 is possible."},{"idx":2,"correct":true,"proposition":"Her daughter may be offered a polysaccharide vaccine against meningococci A and C","justification":"Yes, because the area it crosses also has a circulation of serotype A, and this from 6 months"},{"idx":3,"correct":false,"proposition":"All propositions are true","justification":""},{"idx":4,"correct":false,"proposition":"Daughter may be offered a meningococcal B protein vaccine","justification":"False, only in immunocompromised patients (allogeneic HSCT, asplenia, properdin deficiency, terminal complement deficiency)"}],"ts":{"$numberLong":"1648296450642"},"type":"custom","difficulte":2}
-{"_id":"creatplus-nephro-0","context":null,"enonce":"Concerning the main generalities:","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"The value of creatinine in plasma is inversely related to the Glomerular Filtration Rate"},{"idx":1,"correct":false,"proposition":"The more kidney function increases, the more serum creatinine increases","justification":"Increased creatinine signs a deterioration in kidney function"},{"idx":2,"correct":false,"proposition":"The value of creatinine in plasma depends only on renal function","justification":"Also muscle production of creatinine"},{"idx":3,"correct":false,"proposition":"Creatinine is a perfect marker of kidney function","justification":"Very imperfect because dependent on muscle function, very variable from one individual to another"},{"idx":4,"correct":false,"proposition":"A value of 150 μmol\/L is normal in women","justification":"Acceptable values: between 50 and 90 μmol\/L in women and between 80 and 115 μmol\/L in men"}],"ts":1621158768,"type":"custom","difficulte":1}
-{"_id":"creatplus-nephro-1","context":null,"enonce":"Regarding the estimation of creatinine clearance:","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"The formula of Cockcroft and Gault was established in antiquity","justification":"Renal physiology was still largely unknown until the Renaissance. Cockroft and Gault's formula was published in 1976."},{"idx":1,"correct":false,"proposition":"The Cockcroft and Gault formula allows direct estimation of GFR","justification":"It is an estimate of creatinine clearance which is itself an estimate of GFR"},{"idx":2,"correct":false,"proposition":"The Cockcroft and Gault formula takes as a parameter the rate of muscle mass and the height of the patient","justification":"4 parameters of age, sex, weight and serum creatinine"},{"idx":3,"correct":true,"proposition":"The result obtained through the Cockcroft and Gault is not indexed to body surface area"},{"idx":4,"correct":false,"proposition":"The formula of Cockroft and Gault is recommended in the elderly","justification":"Poor performance in the elderly and obese subject"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"creatplus-nephro-2","context":null,"enonce":"Which propositions are true?","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"The MDRD and CKD-EPI formulas estimate a GFR that is indexed to body surface area"},{"idx":1,"correct":false,"proposition":"MDRD and CKD-EPI include weight, sex, age and serum creatinine","justification":"Ethnicity, not weight"},{"idx":2,"correct":false,"proposition":"CKD-PPE is more recommended than MDRD for high serum creatinine values","justification":"This is the case for low values of creat"},{"idx":3,"correct":false,"proposition":"note that they cannot be used: in children (use Boyd's formula)","justification":"It should be noted that they can not be used: in children use Schwartz's formula!"},{"idx":4,"correct":true,"proposition":"Chapter 15): GFR is normal between 90 and 120 ml\/min\/1.73 m2; Between 60 to 89 ml\/min\/1.73 m2, chronic renal failure is mild"}],"ts":1621158768,"type":"custom","difficulte":2}
-{"_id":"creatplus-nephro-4984954","context":null,"enonce":"The Cockcroft formula takes into account: ","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Creatinineuria ","justification":"False, serum creatinine "},{"idx":1,"correct":false,"proposition":"Urea ","justification":"False "},{"idx":2,"correct":true,"proposition":"Weight ","justification":"True: serum creatinine, age, sex and weight "},{"idx":3,"correct":true,"proposition":"Sex ","justification":"True "},{"idx":4,"correct":true,"proposition":"Age ","justification":"True "}],"ts":{"$numberLong":"1648917814798"},"type":"custom","difficulte":2}
-{"_id":"epidemioKc-onco-d319e00","context":null,"enonce":"Mass cancer screening in France is justified if:","item":"epidemioKc","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"cancer is common OR serious","justification":"AND"},{"idx":1,"correct":false,"proposition":"The short pre-clinical phase","justification":"As a result, we would not have time to detect him that he would already be there"},{"idx":2,"correct":true,"proposition":"the cost of testing is considered acceptable by society ","justification":"And more precisely, by the representatives of the company"},{"idx":3,"correct":false,"proposition":"The overall survival gain has been proven in France by serious studies","justification":"Not in France. Most often, these are international studies"},{"idx":4,"correct":false,"proposition":"No proposition is true","justification":""}],"ts":{"$numberLong":"1649540587683"},"type":"custom","difficulte":1}
-{"_id":"TTTperso-therapeutique-bc6d110","context":null,"enonce":"You receive in general medical consultation, Mr BINDINGOF, Isaac, 83 years old, who has just moved into France, so this is the first time you see him in consultation. He presents you with a prescription \"as long as the arm\" including no less than 18 drugs. Among these are 5 anti-hypertensives, 3 analgesics, 4 psychotropic drugs, creams \/ ointments, a statin and so on! You break your head and decide to review this prescription a little... What do you do?","item":"TTTperso","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"Check that the patient is taking his treatments and following non-drug measures","justification":"True, this is the MAIN measure to be carried out before prescribing \"triple therapy for everything\" as we often say in general medicine. In addition, the patient will not often spontaneously say that he does not take his treatments... It must be seen that a prescription with 18 drugs is an ordeal for the patient who will often take according to his moods! (Situation experienced during internship)"},{"idx":1,"correct":false,"proposition":"Spontaneous discontinuation of benzodiazepines due to low level of evidence in the elderly","justification":"False... Even if we do not like benzodiazepines too much (and rightly so!) for their risk of sedation, falling, in the elderly, we must not make a sudden stop! It is necessary to reduce the doses, space the doses, in short to make a long and tedious weaning but it must be done!"},{"idx":2,"correct":true,"proposition":"Check the dosages of treatments, to look for a minimum effective dosage","justification":"True, some drugs require dosage adjustment due to the physiological aging of the body. We will therefore think about evaluating kidney function with a small blood test well felt, and liver function also, even if it is more complicated."},{"idx":3,"correct":false,"proposition":"Do not prescribe tablets in the face of the risk of false routes","justification":"False, even if often true in geriatrics or nursing homes, advanced age alone is not a contraindication to taking tablets! The risk of false routes and swallowing disorders must be assessed before"},{"idx":4,"correct":true,"proposition":"Check the MA of treatments to avoid off-label therapies","justification":"True, it is better to prescribe \"safe\" treatments in the elderly and not to try too much off-label or off-recommendations. In fact, at ECNs, it is always true that one should not prescribe off-label."}],"ts":{"$numberLong":"1650729648994"},"type":"custom","difficulte":2}
-{"_id":"atherome-cardio-f9e4ab4","context":null,"enonce":"Regarding therapeutics: ","item":"atherome","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"It is not necessary to remove or treat all modifiable risk factors","justification":"False "},{"idx":1,"correct":true,"proposition":"Aspirin and statins help reduce inflammation. ","justification":"True "},{"idx":2,"correct":false,"proposition":"Statins reduce the accumulation of LDL but not stabilize plaques. ","justification":"False, they are used to reduce the accumulation of LDL, stabilize plaques, regression of the volume of plaques. "},{"idx":3,"correct":true,"proposition":"Antihypertensive treatments reduce mechanical stress.","justification":"True, blood pressure puts mechanical stress on blood vessels"},{"idx":4,"correct":false,"proposition":"When rupture of plaque, antiplatelet and heparin drugs must be used, but not urgently.","justification":"False, urgently. "}],"ts":{"$numberLong":"1650729794161"},"type":"custom","difficulte":2}
-{"_id":"ulcere-cardio-11e7a91","context":null,"enonce":"What arguments are in favor of an arterial leg ulcer? ","item":"ulcere","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Lengthening of the TRC ","justification":"True, skin coloration depends on the oxygenation of the blood, therefore arterial blood"},{"idx":1,"correct":true,"proposition":"Decreased skin heat ","justification":"True, in obliterating PAD the limbs are cold because they are not vascularized (they are also very painful and hard, and there is no pulse, but we go astray)"},{"idx":2,"correct":false,"proposition":"History of deep vein thrombosis ","justification":"False, in favor of a venous ulcer "},{"idx":3,"correct":false,"proposition":"White atrophy ","justification":"False, in favor of a venous ulcer "},{"idx":4,"correct":true,"proposition":"Gradient erythrocyanosis ","justification":"True"}],"ts":{"$numberLong":"1650729887982"},"type":"custom","difficulte":1}
-{"_id":"ulcere-cardio-c9769d7","context":null,"enonce":"What arguments are in favor of a venous leg ulcer? ","item":"ulcere","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Perileolar ulcer ","justification":"True"},{"idx":1,"correct":false,"proposition":"Abolition of peripheral pulse ","justification":"False, in favor of an arterial ulcer "},{"idx":2,"correct":false,"proposition":"Hollow ulcer ","justification":"False, in favor of an arterial ulcer "},{"idx":3,"correct":true,"proposition":"Mild pain ","justification":"True"},{"idx":4,"correct":true,"proposition":"Ochre dermatitis ","justification":"True"}],"ts":{"$numberLong":"1650729918853"},"type":"custom","difficulte":1}
-{"_id":"valvuloP-cardio-ee19d65","context":null,"enonce":"About the Carpentier classification: ","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"It is used for the classification of aortic insufficiency. ","justification":"False, in the MITRAL inadequacies. "},{"idx":1,"correct":true,"proposition":"Type I corresponds to mitral valves that remain in the same plane as the ring. ","justification":"True. "},{"idx":2,"correct":false,"proposition":"Type II corresponds to at least one valve exceeding the plane of the ring, the valve play is then decreased. ","justification":"False, valve play is increased in type II. "},{"idx":3,"correct":true,"proposition":"Type IIIa corresponds to a valve set decreased in systole and diastole. ","justification":"True. "},{"idx":4,"correct":false,"proposition":"Type IIIb corresponds to a valvular set decreased in systole and diastole. ","justification":"False, type IIIb = systolic restrictive. "}],"ts":{"$numberLong":"1650730077973"},"type":"custom","difficulte":2}
-{"_id":"191-immuno-d2e0e8f1-7e14-4445-a3a3-23eed8b19ae6","context":null,"enonce":"Which of the following proposals about Horton's disease or giant cell arteritis is true?","item":"ACG","matiere":"immuno","propositions":[{"idx":0,"correct":false,"proposition":"Horton's disease affects the large vessels, including the carotid vessels, aorta and femoral vessels.","justification":"False, large vessels are represented by the carotids, aorta and iliac arteries. "},{"idx":1,"correct":true,"proposition":"Horton's disease headaches are temporal, beating, with hyperesthesia of the scalp","justification":"True, this is also called the comb sign (when patients paint themselves, it hurts, because of hyperesthesia)! To look for during the clinical examination"},{"idx":2,"correct":false,"proposition":"A decrease in visual acuity occurring during headache should suggest a CRAO","justification":"False! It's NOIAA! To better remember:\n- OACR is an ischemic occlusion of the vessel responsible for the vascularization of the retina, the central artery of the retina, completely painless because the retina is not sensorily innervated,\n-NAOA is an acute ischemia of the head of the optic nerve, by occlusion of the posterior ciliary artery which is also a terminal branch of the internal carotid artery. It is also painless. The BAV is always total (\"blackout\"), while the OACR can sometimes leave a very diminished vision.\n\nRemember the NOIAA because it is the real emergency in Horton's disease (general corticosteroid +++)"},{"idx":3,"correct":false,"proposition":"Corticosteroid therapy is imperative after biopsy of the temporal artery, because the latter may be negativated by the treatment","justification":"False, even if corticosteroid therapy may negative the biopsy, in case of strong clinical suspicion, or clinical emergency, treatment should be initiated"},{"idx":4,"correct":true,"proposition":"The biopsy conventionally finds a giganto cell epitheloid granuloma without caseous necrosis with edematous panarteritis and rupture of the internal elastic limiting ","justification":"True, to know by heart in detail, because this item falls ALL the time"}],"ts":{"$numberLong":"1650731444577"},"type":"custom","difficulte":2}
-{"_id":"LED-immuno-4787b2e","context":null,"enonce":"What are the biological signs in favor of a PAS?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"correct":true,"proposition":"Thrombocytopenia","justification":"In 20% of cases"},{"idx":1,"correct":true,"proposition":"Anaemia","justification":"True"},{"idx":2,"correct":true,"proposition":"Dissociated syphilitic serology","justification":"VDRL positive (contains phospholipids) and TPHA negative"},{"idx":3,"correct":false,"proposition":"Leukopenia","justification":"Sign of lupus"},{"idx":4,"correct":false,"proposition":"Hypereosinophilia","justification":"No link to an APS"}],"ts":{"$numberLong":"1650731481567"},"type":"custom","difficulte":2}
-{"_id":"MAI-immuno-97ecdf8","context":null,"enonce":"Which of the following are the causes of polyclonal hypergammaglobulinemia?","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"correct":true,"proposition":"AA amyloidosis","justification":"True, proposition of rank C (the rest is rank A)"},{"idx":1,"correct":true,"proposition":"Autoimmune hepatitis","justification":"True, IgG"},{"idx":2,"correct":true,"proposition":"Primary biliary cirrhosis","justification":"True, IgM"},{"idx":3,"correct":false,"proposition":"Myeloma","justification":"Monoclonal"},{"idx":4,"correct":false,"proposition":"Myasthenia","justification":"No hypergamma + autoantibodies (therefore monoclonal)"}],"ts":{"$numberLong":"1650731557645"},"type":"custom","difficulte":1}
-{"_id":"MAI-immuno-c5eda7e","context":null,"enonce":"Which of the following are the causes of polyclonal hypergammaglobulinemia?","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"correct":true,"proposition":"HIV","justification":"True"},{"idx":1,"correct":true,"proposition":"Syndrome de Gougerot","justification":"True"},{"idx":2,"correct":true,"proposition":"Chronic bacterial infections","justification":"True"},{"idx":3,"correct":true,"proposition":"Systemic lupus","justification":"True"},{"idx":4,"correct":true,"proposition":"Sarcoidosis","justification":"True"}],"ts":{"$numberLong":"1650731614589"},"type":"custom","difficulte":1}
-{"_id":"MAI-immuno-ff9aa13","context":null,"enonce":"Which of the following tests are useful for suspected dermatomyositis?","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"correct":true,"proposition":"Electromyogram","justification":"True, finds a myogenic syndrome"},{"idx":1,"correct":true,"proposition":"Muscle biopsy","justification":"True, confirms the diagnosis"},{"idx":2,"correct":true,"proposition":"Muscle MRI","justification":"True, allows to target the biopsy"},{"idx":3,"correct":true,"proposition":"PET-CT","justification":"True, allows you to look for cancer. About 20% of dermatomyositis are paraneoplastic"},{"idx":4,"correct":false,"proposition":"Determination of anti-M2 antibodies","justification":"Antibodies for primary biliary cirrhosis"}],"ts":{"$numberLong":"1650731691914"},"type":"custom","difficulte":3}
-{"_id":"asthme-immuno-a5fd823","context":null,"enonce":"What are the clinical symptoms of allergic rhinitis? ","item":"asthme","matiere":"immuno","propositions":[{"idx":0,"correct":true,"proposition":"Itch ","justification":"PAREO symptoms: \n-Itch \n-Anosmia \n-Rhinorrhea \n- Sneezing \n- Nasal obstruction \n+ possible eye symptoms (conjunctivitis) "},{"idx":1,"correct":true,"proposition":"Nasal obstruction ","justification":""},{"idx":2,"correct":false,"proposition":"Dyspnoea ","justification":""},{"idx":3,"correct":false,"proposition":"Cough ","justification":""},{"idx":4,"correct":false,"proposition":"Wheezing ","justification":""}],"ts":{"$numberLong":"1650731754704"},"type":"custom","difficulte":1}
-{"_id":"EI-infectio-9f0b1af","context":null,"enonce":"\nWhat are the infectious agents responsible for infective endocarditis? \n","item":"EI","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Oral streptococci mostly 20%. ","justification":"False, second at 20% behind Staphylococcus aureus. "},{"idx":1,"correct":true,"proposition":"Staphylococcus aureus at 30%. ","justification":"True. "},{"idx":2,"correct":false,"proposition":"E. coli at 13%. ","justification":"False, Streptococcus gallolyticus 13%. "},{"idx":3,"correct":true,"proposition":"Enterococci and coagulase-negative Staphylococci equal (10%). ","justification":"True. "},{"idx":4,"correct":false,"proposition":"Blood cultures are negative in only 2% of cases. ","justification":"False, in 5-10% of cases. It is necessary to specify \"endocarditis research\" on the request to the lab so that the culture is prolonged!"}],"ts":{"$numberLong":"1650991867694"},"type":"custom","difficulte":2}
-{"_id":"EI-infectio-eb2e51a","context":null,"enonce":"Among these pathologies, which belong to group A of infectious endocarditis said to be at high risk of infective endocarditis? ","item":"EI","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Valvular heart disease. ","justification":"False. "},{"idx":1,"correct":true,"proposition":"A mitral biological prosthesis. ","justification":"True, all prostheses in all positions!"},{"idx":2,"correct":true,"proposition":"A mitral mechanical prosthesis. ","justification":"See 2"},{"idx":3,"correct":false,"proposition":"A history of 1st degree infective endocarditis. ","justification":"False, personal ATCD. "},{"idx":4,"correct":false,"proposition":"Non-cyanogenic ischemic heart disease.","justification":"False, NOT cyanogenic = NOT high risk (except atrial septal defect). "}],"ts":{"$numberLong":"1650992114355"},"type":"custom","difficulte":2}
-{"_id":"VH-infectio-50ad7d9","context":null,"enonce":"What are the extrahepatic complications of HCV?","item":"VH","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Panarteritis nodosa","justification":"This is one of the possible complications of HBV infection"},{"idx":1,"correct":true,"proposition":"Cryoglobulinemia","justification":""},{"idx":2,"correct":true,"proposition":"Lymphoma","justification":""},{"idx":3,"correct":true,"proposition":"Glomerular syndrome","justification":"By secondary GEM for example"},{"idx":4,"correct":false,"proposition":"HCV is not accompanied by extrahepatic involvement","justification":""}],"ts":{"$numberLong":"1650992151023"},"type":"custom","difficulte":1}
-{"_id":"VIH-infectio-1205f9f","context":null,"enonce":"What is the treatment to be systematically initiated in a child born to an HIV+ mother?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Ziduvodine for 4 weeks","justification":"True"},{"idx":1,"correct":false,"proposition":"Ziduvodine single dose","justification":""},{"idx":2,"correct":false,"proposition":"Ritonavir for 4 weeks","justification":""},{"idx":3,"correct":false,"proposition":"Tenofovir for 4 weeks","justification":""},{"idx":4,"correct":false,"proposition":"There is no systematic treatment","justification":""}],"ts":{"$numberLong":"1650992178349"},"type":"custom","difficulte":2}
-{"_id":"VIH-infectio-5907f43","context":null,"enonce":"Which infectious pathologies are favored by the AIDS stage?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Influenza","justification":"True"},{"idx":1,"correct":true,"proposition":"Pneumococcal pneumonia","justification":"True"},{"idx":2,"correct":true,"proposition":"HBV","justification":"True"},{"idx":3,"correct":true,"proposition":"HCV","justification":"True"},{"idx":4,"correct":false,"proposition":"HEV","justification":"The full list: Pneumococcal pneumonia, influenza, STIs in general, HBV and HCV"}],"ts":{"$numberLong":"1650992192745"},"type":"custom","difficulte":2}
-{"_id":"antiinf-infectio-16eba0e","context":null,"enonce":"For which germs is the addition of clavulanic acid useless?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"MRSA","justification":"True, because modification of the target (not a production of penicillinase)"},{"idx":1,"correct":true,"proposition":"Pneumococcus of decreased sensitivity to penicillins","justification":"True, because modification of the target (not a production of penicillinase)"},{"idx":2,"correct":false,"proposition":"E. Coli","justification":""},{"idx":3,"correct":false,"proposition":"Klebsiella pneumoniae","justification":""},{"idx":4,"correct":true,"proposition":"Pseudomonas aeruginosa","justification":"Pyo never sensitive to either amox or augmentin so adding unnecessary clavulanic acid"}],"ts":{"$numberLong":"1650992209569"},"type":"custom","difficulte":2}
-{"_id":"antiinf-infectio-9a63b1a","context":null,"enonce":"Which bacteria are most sensitive to amoxicillin?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Group 1 Enterobacteriaceae","justification":"True"},{"idx":1,"correct":false,"proposition":"Group 2 Enterobacteriaceae","justification":"Susceptible to augmentin and cephalosporins"},{"idx":2,"correct":false,"proposition":"Group 3 Enterobacteriaceae","justification":"C3G sensitive only"},{"idx":3,"correct":true,"proposition":"Proteus miribilis","justification":"True"},{"idx":4,"correct":true,"proposition":"Salmonella","justification":"True"}],"ts":{"$numberLong":"1650992238458"},"type":"custom","difficulte":1}
-{"_id":"bacteriemie-infectio-7015de0","context":null,"enonce":"What are the modalities of vascular filling?","item":"bacteriemie","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"By csristalloïde","justification":""},{"idx":1,"correct":true,"proposition":"Per salted serum 0.9% generally ","justification":""},{"idx":2,"correct":false,"proposition":"By colloids ","justification":"Colloids have no demonstrated efficacy in this indication but an increased risk of acute renal failure. We NEVER tick colloids at the ECN (they are almost no longer used in practice, except by people very specialized in very specialized indications)"},{"idx":3,"correct":true,"proposition":"The flow rate is about 500mL in 15 min","justification":"True, in adults. In children, 20mL\/kg is retained in the syringe."},{"idx":4,"correct":true,"proposition":"Filling is done in free flow","justification":"True in adults. A filling (unlike hydration) is done in free flow on a track of good caliber. This makes about 500mL of solute pass in 15 minutes"}],"ts":{"$numberLong":"1650992316552"},"type":"custom","difficulte":1}
-{"_id":"infdermato-infectio-b98bdfb","context":null,"enonce":"How long is eviction in impetigo after starting treatment?","item":"infdermato","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"No eviction recommended","justification":""},{"idx":1,"correct":false,"proposition":"24 h","justification":""},{"idx":2,"correct":false,"proposition":"48 h","justification":""},{"idx":3,"correct":true,"proposition":"72 hrs","justification":"As in scabies 🤗"},{"idx":4,"correct":false,"proposition":"5 days","justification":""}],"ts":{"$numberLong":"1650992427044"},"type":"custom","difficulte":1}
-{"_id":"meningite-infectio-b044cc9","context":null,"enonce":"Neurology intern brilliantly received at ECN, you receive a 40-year-old patient with fibromyalgia, irritable bowel syndrome, and psychogenic non-epileptic seizures. She consults you for a heterogeneous table. It reports:\n-severe pain in the territories C7 left, T10 bilateral, L3 right, S1 right;\n-bilateral facial paralysis;\n-a history of red ring that spread quickly following a walk in the forest in Alsace 6 months ago.\nShe is convinced she has Lyme disease. What do you propose to him?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"In view of the field, it is very likely that his symptoms are part of a somatoform disorder, so you refer him to a specialized psychiatrist colleague and avoid multiplying unnecessary examinations because it increases the symptoms","justification":"False! It's a typical picture! Multiradicular involvement + bilateral FP in the aftermath of erythema migrans!\nIf we should not multiply the examinations in a patient with a somatoform disorder, most patients with this type of disorder also have poorly managed organic comorbidities, and rectifying these treatments reduces psychiatric symptoms!"},{"idx":1,"correct":true,"proposition":"You offer to perform a lumbar puncture, and you expect to come across normoglycorachic lymphocytic meningitis","justification":"Exactly the CSF of Lyme meningitis"},{"idx":2,"correct":true,"proposition":"You propose to perform a Lyme serology and a PCR on CSF + blood","justification":"True, that's how secondary phase diagnosis is made."},{"idx":3,"correct":false,"proposition":"Neurological damage to Lyme is conventionally installed in the tertiary phase, it's too early","justification":"No, it's good from the secondary phase"},{"idx":4,"correct":false,"proposition":"There is no Lyme disease in Alsace","justification":"Unfortunate! https:\/\/www.santepubliquefrance.fr\/les-actualites\/2021\/borreliose-de-lyme-donnees-epidemiologiques-2020"}],"ts":{"$numberLong":"1650992461374"},"type":"custom","difficulte":2}
-{"_id":"meningite-infectio-cdf9772","context":null,"enonce":"Regarding the treatment of bacterial meningitis:","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Probabilistic treatment of meningitis depends on direct examination of the PL","justification":"Ben, voui"},{"idx":1,"correct":false,"proposition":"If direct examination for PL is negative, dexamethasone + C3G + amoxicillin + gentamicin is most often offered","justification":"Ohla, the Sécu is good, but the selection of resistant germs, less! This is what is proposed in case of strong suspicion of listeriosis. For \"simple\" meningitis, we are satisfied with C3G + dexa, it covers pneumococcus and meningococcal"},{"idx":2,"correct":false,"proposition":"If direct examination of PL finds diplococci, regardless of their Gram, we will propose a C3G IV for 14 days and dexamethasone 4 days","justification":"It's almost true:\n-Gram-negative diplococcus: meningococcal -> C3G IV 4-7d + dexa 4d\n-Gram-positive diplococcus: pneumococcus -> C3G IV 10-14d + dexa 4d\nAnd if you ever get it out (unlikely):\n-gram-positive bacillus: listeria -> amoxicillin 21d + gentamicin 5d"},{"idx":3,"correct":true,"proposition":"In the presence of a C3G-resistant pneumococcus, potentiation with vancomycin","justification":"True, we speak of resistance when the MIC is greater than 0.5"},{"idx":4,"correct":true,"proposition":"The doses of C3G are: Cefotaxime 300mg\/kg\/day IVSE after a bolus of 50mg\/kg over 1h, or in 4 IVL Ceftriaxone 100mg\/kg\/day in 2 IVL","justification":"True, it seems that we must know them"}],"ts":{"$numberLong":"1650992477408"},"type":"custom","difficulte":1}
-{"_id":"otite-infectio-a10ffc9","context":null,"enonce":"What are the risk factors for impaired pneumococcus for penicillin (PSDP) in children?","item":"otite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"less than 18 months of age","justification":"Less than a year and a half"},{"idx":1,"correct":true,"proposition":"Community life","justification":"Easier to be in contact with a resistant germ in community (in the same way, there are more MRSA in hospitals than in the Aveyron countryside [heart on it by the way])"},{"idx":2,"correct":true,"proposition":"recent history of acute otitis media","justification":"Reinfection with treatment-resistant germs given at previous AOM"},{"idx":3,"correct":true,"proposition":"taking penicillin less than 3 months ago","justification":"Selection of the resistant strain that took a few months to reproduce and give the new otitis"},{"idx":4,"correct":false,"proposition":"taking fluoroquinolones less than 3 months ago","justification":"No report"}],"ts":{"$numberLong":"1650992499951"},"type":"custom","difficulte":2}
-{"_id":"reactioninfl-infectio-1d32c16","context":null,"enonce":"Which bacterial infections are not responsible for neutrophil polynucleosis?","item":"reactioninfl","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Tuberculosis","justification":""},{"idx":1,"correct":true,"proposition":"Syphilis","justification":""},{"idx":2,"correct":true,"proposition":"Brucellosis","justification":""},{"idx":3,"correct":true,"proposition":"Whooping cough","justification":""},{"idx":4,"correct":true,"proposition":"Typhoid fever","justification":"Conventionally, bacterial infections are accompanied by a reaction of the innate immune system that recruits neutrophils to fight bacteria. However, in some cases (tuberculosis, brucellosis, syphilis, whooping cough or thyphoid fever infections), there is no polynucleosis but rather hyperlymphocytosis. This is an interesting feature to keep in mind, both for the NEC and for future clinical practice."}],"ts":{"$numberLong":"1650992515319"},"type":"custom","difficulte":1}
-{"_id":"risques-infectio-2740fee","context":null,"enonce":"What are the national structures for the control of nosocomial infections? ","item":"risques","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Ministry of Health","justification":"It is he who implements the plan to fight against NI"},{"idx":1,"correct":true,"proposition":"InVS","justification":"The National Institute for Health Surveillance is a network for the Alert, Investigation and Surveillance of nosocomial infections"},{"idx":2,"correct":false,"proposition":"BLINKING ","justification":"The Centre for Coordination and Control of NI is a regional network."},{"idx":3,"correct":false,"proposition":"EOHH","justification":"The Hospital Hygiene Operational Team acts, as its name suggests, at the local level"},{"idx":4,"correct":false,"proposition":"ANSM","justification":"The ANSM's mission is not to fight against nosocomial infections."}],"ts":{"$numberLong":"1650992526165"},"type":"custom","difficulte":1}
-{"_id":"vaccin-infectio-47bdef6","context":null,"enonce":"At what age is the pertussis vaccine booster?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"6 years","justification":""},{"idx":1,"correct":true,"proposition":"25 years","justification":"True, and then we reassess if the patient is in a cocooning (takes care of a child under 6 months)"},{"idx":2,"correct":false,"proposition":"65 years","justification":""},{"idx":3,"correct":false,"proposition":"15 years","justification":""},{"idx":4,"correct":false,"proposition":"8 months","justification":""}],"ts":{"$numberLong":"1650992572619"},"type":"custom","difficulte":2}
-{"_id":"vaccin-infectio-6570733","context":null,"enonce":"What are the contraindications of BCG? ","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"HIV infection ","justification":"Live vaccines contraindicated in immunosuppression "},{"idx":1,"correct":true,"proposition":"Pregnancy ","justification":"Live vaccines contraindicated in pregnancy "},{"idx":2,"correct":true,"proposition":"In a renal transplant patient ","justification":"Live vaccines contraindicated"},{"idx":3,"correct":false,"proposition":"Splenectomized patient ","justification":"No contraindications to live vaccines "},{"idx":4,"correct":false,"proposition":"Renal failure ","justification":"No contraindications to live vaccines "}],"ts":{"$numberLong":"1650992585499"},"type":"custom","difficulte":1}
-{"_id":"vaccin-infectio-b7ff63b","context":null,"enonce":"What is pneumococcal polysaccharide vaccine?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Unconjugated pneumococcal vaccine VP23","justification":"True"},{"idx":1,"correct":false,"proposition":"Pneumococcal vaccine VP23 conjugate","justification":""},{"idx":2,"correct":false,"proposition":"Unconjugated pneumococcal vaccine VP13","justification":""},{"idx":3,"correct":false,"proposition":"Pneumococcal vaccine VP13 conjugate","justification":""},{"idx":4,"correct":false,"proposition":"None of these proposals","justification":""}],"ts":{"$numberLong":"1650992604507"},"type":"custom","difficulte":3}
-{"_id":"voyagetrop-infectio-3317499","context":null,"enonce":"What is found in the biology of dengue?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Leukopenia","justification":"True"},{"idx":1,"correct":true,"proposition":"Thrombocytopenia","justification":"True"},{"idx":2,"correct":false,"proposition":"Cytolysis","justification":"No cytolysis"},{"idx":3,"correct":false,"proposition":"Augmented CRP","justification":"No inflammatory syndrome"},{"idx":4,"correct":false,"proposition":"Augmented VS","justification":"No inflammatory syndrome"}],"ts":{"$numberLong":"1650992615887"},"type":"custom","difficulte":3}
-{"_id":"voyagetrop-infectio-374e11c","context":null,"enonce":"What does Caroli's triad contain, which corresponds to the pre-icteric phase of infection with a hepatotropic virus?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Hives","justification":"True"},{"idx":1,"correct":true,"proposition":"Influenza-like illness","justification":"True"},{"idx":2,"correct":true,"proposition":"Arthralgia","justification":"True"},{"idx":3,"correct":false,"proposition":"Mononucleoside syndrome","justification":"It's a clinical triad"},{"idx":4,"correct":false,"proposition":"Maculopapular exanthema","justification":"No rash in viral hepatitis most often"}],"ts":{"$numberLong":"1650992632124"},"type":"custom","difficulte":2}
-{"_id":"voyagetrop-infectio-76afc43","context":null,"enonce":"Loperamide, anti-diarrheal retarder, is contraindicated below:","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"6 months","justification":""},{"idx":1,"correct":true,"proposition":"2 years","justification":"True, it is also contraindicated in case of invasive diarrhea (dysenteric syndrome) because it decreases the elimination of the bacteria  "},{"idx":2,"correct":false,"proposition":"10 years","justification":""},{"idx":3,"correct":false,"proposition":"18 years","justification":""},{"idx":4,"correct":false,"proposition":"It is allowed at all ages","justification":""}],"ts":{"$numberLong":"1650992656690"},"type":"custom","difficulte":1}
-{"_id":"voyagetrop-infectio-7b7b003","context":null,"enonce":"Which specific vaccine should be recommended when travelling to Eastern European countries (especially Austria) and Asia?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Tick-borne encephalitis","justification":"True"},{"idx":1,"correct":false,"proposition":"Japanese encephalitis","justification":"Pakistan and the Philippines"},{"idx":2,"correct":false,"proposition":"Typhoid fever","justification":"Intertropical Africa and the Amazon"},{"idx":3,"correct":false,"proposition":"Rabies","justification":"Adventurous stays in Asia, Africa including North Africa, South America...\n"},{"idx":4,"correct":false,"proposition":"HAV","justification":"Precarious hygiene conditions in an endemic country"}],"ts":{"$numberLong":"1650992677686"},"type":"custom","difficulte":1}
-{"_id":"peritonite-urg-42b9ab7","context":null,"enonce":"Regarding the nasogastric tube in case of occlusion:","item":"peritonite","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"The nasogastric tube most often suppresses nausea","justification":""},{"idx":1,"correct":true,"proposition":"The nasogastric tube most often suppresses vomiting","justification":""},{"idx":2,"correct":true,"proposition":"The nasogastric tube does not contraindicate oral hydration","justification":""},{"idx":3,"correct":false,"proposition":"Nasogastric tube contraindicates oral liquid feeding","justification":"The nasogastric tube does not contraindicate hydration or oral fluid feeding, but occlusion may contraindicate them depending on its severity"},{"idx":4,"correct":false,"proposition":"The nasogastric tube should always be placed if the patient pulls it off.","justification":"Not systematically: we must first understand the reason for the patient's reaction and reassess the benefit\/risk ratio"}],"ts":{"$numberLong":"1651256519002"},"type":"custom","difficulte":2}
-{"_id":"tbauditif-ORL-6b9fdc6","context":null,"enonce":"Where is the acoustic-facial package?","item":"tbauditif","matiere":"ORL","propositions":[{"idx":0,"correct":true,"proposition":"Ahead of the pontocerebellar angle","justification":""},{"idx":1,"correct":true,"proposition":"Behind the sphenoid sinus","justification":""},{"idx":2,"correct":false,"proposition":"It crosses the external carotid artery","justification":"Everything is explained here 👉 https:\/\/www.researchgate.net\/figure\/Croisement-entre-lAICA-gauche-fleche-rouge-et-le-paquet-acoustico-facial-fleche_fig3_281713908"},{"idx":3,"correct":true,"proposition":"In front of the cerebellum","justification":""},{"idx":4,"correct":true,"proposition":"Behind the temporal lobe","justification":""}],"ts":{"$numberLong":"1651256644273"},"type":"custom","difficulte":2}
-{"_id":"IBP-pneumo-18545ca","context":null,"enonce":"What is (are) the clinical sign(s) of hypercapnia? (one or more propositions are true)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"Costal draw","justification":"This is a sign of struggle. Signs of struggle are: tachypnea, pulling (supraclavicular, sussternal or intercostal), abdominal exhalation and flapping of the wings of the nose. More than their presence, it is their intensity that makes the seriousness of the attack."},{"idx":1,"correct":true,"proposition":"Sweats","justification":""},{"idx":2,"correct":true,"proposition":"Asterixis","justification":""},{"idx":3,"correct":false,"proposition":"Cyanosis ","justification":"Sign of hypoxia"},{"idx":4,"correct":false,"proposition":"Paradoxical breathing","justification":"This is a sign of bankruptcy. The signs of bankruptcy are: thoraco-abdominal swing, bradypnea (therefore hypercapnia and hypoxemia), neurological involvement (confusion, asterixis), hemodynamic involvement (cyanosis, paradoxical pulse, hypertension)."}],"ts":{"$numberLong":"1651261628146"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-1f21066","context":null,"enonce":"What is the main infectious agent of winter bronchiolitis, involved in 60 to 90% of cases according to the authors? (one or more propositions are true)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"VRS","justification":""},{"idx":1,"correct":false,"proposition":"Morbilivirus","justification":""},{"idx":2,"correct":false,"proposition":"Myxovirus","justification":""},{"idx":3,"correct":false,"proposition":"Haemophilius","justification":""},{"idx":4,"correct":false,"proposition":"Staphylococcus","justification":""}],"ts":{"$numberLong":"1651261664020"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-342f81e","context":null,"enonce":"What treatments are not indicated for bronchiolitis?","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"Nose wash","justification":""},{"idx":1,"correct":true,"proposition":"Mucolytic","justification":""},{"idx":2,"correct":true,"proposition":"Oral corticosteroids","justification":""},{"idx":3,"correct":true,"proposition":"Antibiotics ","justification":""},{"idx":4,"correct":true,"proposition":"Inhaled corticosteroids","justification":""}],"ts":{"$numberLong":"1651261755070"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-3bcb3ff","context":null,"enonce":"The duration of treatment for pneumococcal pneumonitis is classically : (one or more propositions are true)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"7 days","justification":""},{"idx":1,"correct":false,"proposition":"14 days","justification":""},{"idx":2,"correct":false,"proposition":"21 days","justification":""},{"idx":3,"correct":false,"proposition":"5 days","justification":""},{"idx":4,"correct":false,"proposition":"4 to 6 weeks","justification":""}],"ts":{"$numberLong":"1651261795471"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-480355a","context":null,"enonce":"At what age is the first booster of pneumococcal vaccine in children?","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"M2","justification":"First dose"},{"idx":1,"correct":false,"proposition":"M4","justification":"Second dose"},{"idx":2,"correct":true,"proposition":"M11","justification":"First reminder"},{"idx":3,"correct":false,"proposition":"6 years","justification":"Second reminder"},{"idx":4,"correct":false,"proposition":"12 years","justification":"Third reminder. The next ones are at 25, 45, then every ten years from 65."}],"ts":{"$numberLong":"1651261814957"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-7b9f693","context":null,"enonce":"In case of bronchiolitis, what are the systematic complementary examinations?","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"No further examination","justification":"Non-severe form without sign of severity = no additional examination."},{"idx":1,"correct":false,"proposition":"Blood","justification":""},{"idx":2,"correct":false,"proposition":"ECBC","justification":""},{"idx":3,"correct":false,"proposition":"Multiplex PCR","justification":""},{"idx":4,"correct":false,"proposition":"Pneumococcal antigenacuria","justification":""}],"ts":{"$numberLong":"1651261879310"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-81cad68","context":null,"enonce":"Which of the following germs are responsible for atypical bacterial pneumonitis? (one or more true propositions)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":" Mycoplasma pneumoniae","justification":""},{"idx":1,"correct":true,"proposition":"Chlamydophila psittaci","justification":""},{"idx":2,"correct":true,"proposition":"Chlamydophila pneumoniae","justification":""},{"idx":3,"correct":true,"proposition":"Coxiella burnetti","justification":"Q fever"},{"idx":4,"correct":false,"proposition":"Legionella pneumophila","justification":"It is not an atypical germ. The picture is close to that of pneumococcus."}],"ts":{"$numberLong":"1651261897995"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-834d7e1","context":null,"enonce":"In obstructive CKD, the indication for long-term home oxygen therapy is based on the result of 2 blood gas measurements performed at rest, in ambient air, in a steady state, at least 2 weeks apart. Which of the following are indications for long-term oxygen therapy reimbursed by social security? (one or more propositions are true)\n\n","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"PaO2 at 52 mmHg","justification":"PaO2 < 55 mmHg"},{"idx":1,"correct":true,"proposition":"PaO2 at 43 mmHg","justification":"PaO2 < 55 mmHg"},{"idx":2,"correct":false,"proposition":"PaO2 at 68 mmHg with a hematocrit of 58%","justification":"PaO2 is greater than 60 mmHg, so no indication."},{"idx":3,"correct":true,"proposition":"PaO2 at 58mmHg with a hematocrit of 58%","justification":"PaO2 between 55 and 60 mmHg with the presence of polycythemia (hematocrit > 55%)"},{"idx":4,"correct":true,"proposition":"PaO2 at 58mmHg with signs of right heart failure","justification":"PaO2 between 55 and 60 mmHg with clinical signs of right ventricular failure"}],"ts":{"$numberLong":"1651261992060"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-c272764","context":null,"enonce":"What are the 4 germs responsible for post-influenza pneumonia?","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Pneumococcus","justification":"The clinic corresponds to an influenza episode followed by worsening after 5-7 days."},{"idx":1,"correct":true,"proposition":"Staphylococcus","justification":"It is therefore necessary to initiate active antibiotic therapy on staphylococcus, such as Augmentin or C3G IV."},{"idx":2,"correct":true,"proposition":"Haemophilius influenzae","justification":""},{"idx":3,"correct":true,"proposition":"S. pyogenes","justification":""},{"idx":4,"correct":false,"proposition":"Anaerobes","justification":""}],"ts":{"$numberLong":"1651262056366"},"type":"custom","difficulte":2}
-{"_id":"IBP-pneumo-d72b812","context":null,"enonce":"Which proposals are true about the CAP?","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":" The essential chest X-ray","justification":""},{"idx":1,"correct":true,"proposition":"Reassessment is systematic after 48-72 hours of antibiotic therapy","justification":""},{"idx":2,"correct":true,"proposition":"If worsening or no improvement, look for a loco-regional complication  ","justification":""},{"idx":3,"correct":false,"proposition":"It is mandatory and systematic to test for HIV for pneumonia, especially if pneumocystosis","justification":"No. It is mandatory to PROPOSE screening. This is different"},{"idx":4,"correct":false,"proposition":"The three nosological entities of bronchopulmonary infections are nasopharyngitis, acute bronchitis, acute exacerbation of chronic obstructive pulmonary disease ","justification":"Acute bronchitis \/ COPD exacerbation \/ CABG"}],"ts":{"$numberLong":"1651262082601"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-f30d46f","context":null,"enonce":"What are the physical signs found classically during a PAC? (one or more propositions are true)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Crackling","justification":""},{"idx":1,"correct":true,"proposition":"Decreased vesicular murmur","justification":""},{"idx":2,"correct":true,"proposition":"Tubal murmur","justification":""},{"idx":3,"correct":true,"proposition":"Increased vocal vibration","justification":""},{"idx":4,"correct":true,"proposition":"Dull on percussion","justification":"All these signs are markers of alveolar condensation (the alveoli fill with pus from bacteria)."}],"ts":{"$numberLong":"1651262124252"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-fbfc86b","context":null,"enonce":"What is lingula? (one or more propositions are true)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"Right lower lobe of the lung","justification":""},{"idx":1,"correct":false,"proposition":"Middle lobe of the lung","justification":""},{"idx":2,"correct":false,"proposition":"Right upper lobe of the lung","justification":""},{"idx":3,"correct":false,"proposition":"Left chamber of the heart 💞","justification":""},{"idx":4,"correct":true,"proposition":"Lower upper lobe of left lung","justification":"The lingula is part of the upper lobe of the left lung. It is located in the caudal (lower) part of this lobe and is ventilated by the lingular bronchus, a segmental (3rd generation) bronchus that branches off from the upper lobar bronchus of the left lung.\n\nIt corresponds in a way to the topographical situation of the middle lobe of the right lung. Unlike the right lung, which has 3 lobes (upper, middle and lower), the left lung has only two lobes (upper and lower). This is due to the presence of the heart which occupies a large volume on this side of the rib cage. However, the upper lobe of the left lung is anatomically divided into two subsets.\n\n(According to Wikipedia, content shared without modifications, licensed under CC https:\/\/creativecommons.org\/licenses\/by-sa\/3.0\/deed.fr)"}],"ts":{"$numberLong":"1651262133066"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-fc91755","context":null,"enonce":"What are the two treatments of choice for inhalation pneumonitis?","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Augmentin ","justification":" Anaerobes and Enterobacteriaceae should be targeted."},{"idx":1,"correct":true,"proposition":"C3G + Metronidazole","justification":""},{"idx":2,"correct":false,"proposition":"Fluoroquinolones","justification":""},{"idx":3,"correct":false,"proposition":"Macrolides","justification":""},{"idx":4,"correct":false,"proposition":"Vancomycin","justification":""}],"ts":{"$numberLong":"1651262250865"},"type":"custom","difficulte":1}
-{"_id":"IBP-infectio-a75cb68","context":null,"enonce":"What are the additional examinations carried out on an outpatient basis during a CAP? (one or more true propositions)","item":"IBP","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"None","justification":"Chest X-ray is necessary for the diagnosis of CAP"},{"idx":1,"correct":true,"proposition":"Chest X-ray","justification":""},{"idx":2,"correct":false,"proposition":"Blood culture","justification":"Only in case of hospitalization"},{"idx":3,"correct":false,"proposition":"ECBC","justification":"Only in case of hospitalization"},{"idx":4,"correct":false,"proposition":"Pneumococcal antigenacuria","justification":"Unlike legionella antigenuria (which is performed upon hospitalization), pneumococcal antigenuria is reserved for hospitalization in intensive care."}],"ts":{"$numberLong":"1651262366871"},"type":"custom","difficulte":1}
-{"_id":"IBP-infectio-f265741","context":null,"enonce":"Legionella is naturally resistant:","item":"IBP","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Aux C3G","justification":""},{"idx":1,"correct":false,"proposition":"To fluoroquinolones","justification":"It is a possible treatment"},{"idx":2,"correct":false,"proposition":"To macrolides","justification":"It is a possible treatment"},{"idx":3,"correct":false,"proposition":"With rifampicin","justification":"It is a possible treatment"},{"idx":4,"correct":true,"proposition":"Aux C2G","justification":""}],"ts":{"$numberLong":"1651262472663"},"type":"custom","difficulte":1}
-{"_id":"IBP-infectio-f295a3a","context":null,"enonce":"What is the classic clinical presentation of acute bronchitis? (one or more propositions are true)","item":"IBP","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Dry cough","justification":""},{"idx":1,"correct":true,"proposition":"Prolonged cough","justification":""},{"idx":2,"correct":true,"proposition":"Sputum secondarily purulent","justification":"Which are not synonymous with bacterial superinfection"},{"idx":3,"correct":false,"proposition":"Crackling on auscultation","justification":"No crackling, no fireplace. We can have some aspecific bronchial rales."},{"idx":4,"correct":false,"proposition":"Dull on percussion","justification":"No dullness, by tympanism."}],"ts":{"$numberLong":"1651262515495"},"type":"custom","difficulte":1}
-{"_id":"antiinf-infectio-3bf3663","context":null,"enonce":"Which of the following proposals are part of the amoxicillin\/clavulanic acid spectrum?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Streptococcus","justification":"The entire spectrum of amoxicillin (pneumococcus, enterococci faecalis, listeria, meningococcus, borrelia, group 1 enterobacteriaceae) and the addition of a penicillinase-sensitive inhibitor (methicillin-sensitive staphylococcus, haemophilius, moraxella, E. coli, group 2 enterobacteriaceae)"},{"idx":1,"correct":false,"proposition":"Chlamydia","justification":"Chlamydia is a bacterium sensitive to macrolides (clarithromycin, erythromycin), tetracyclines, fluoroquinolones"},{"idx":2,"correct":true,"proposition":"Pneumococcus","justification":""},{"idx":3,"correct":false,"proposition":"Legionella","justification":"The three families used for the treatment of legionellosis are macrolides, fluoroquinolones, and rifampicin (never monotherapy)"},{"idx":4,"correct":true,"proposition":"SAMS","justification":""}],"ts":{"$numberLong":"1651262526137"},"type":"custom","difficulte":1}
-{"_id":"purpura-hemato-7672927","context":null,"enonce":"What evidence supports idiopathic thrombocytopenic purpura (ITP)?","item":"purpura","matiere":"hemato","propositions":[{"idx":0,"correct":true,"proposition":"the non-infiltrated nature of purpuric lesions","justification":"True"},{"idx":1,"correct":true,"proposition":"presence of thrombocytopenia on NFS-P","justification":"True"},{"idx":2,"correct":true,"proposition":"lack of a specific history","justification":"True"},{"idx":3,"correct":false,"proposition":"the presence of organomegaly","justification":"What we do not have in an ITP: organomegaly, abnormality of the blood smear, DIC, Hepatocellular insufficiency, ... Immunological thrombocytopenic purpura (ITP) is an autoimmune pathology characterized by isolated thrombocytopenia of < 100 G \/ L. It is a diagnosis of elimination, but also the first to evoke in front of isolated thrombocytopenia."},{"idx":4,"correct":false,"proposition":"an age between 9 and 15 years","justification":"Peak between 2 and 5 years. Second peak, less important, after 60 years."}],"ts":{"$numberLong":"1651262718282"},"type":"custom","difficulte":2}
-{"_id":"purpura-hemato-e5f097e","context":null,"enonce":"What tests are unnecessary in the diagnosis of ITP?","item":"purpura","matiere":"hemato","propositions":[{"idx":0,"correct":true,"proposition":"Bleeding time","justification":"True, Table IV, page 291 of the College of Internal Medicine, 3rd edition "},{"idx":1,"correct":true,"proposition":"Complement Dosage","justification":"True"},{"idx":2,"correct":true,"proposition":"Dosage of TPO","justification":"True"},{"idx":3,"correct":true,"proposition":"Search for cross-linked platelets","justification":"True"},{"idx":4,"correct":false,"proposition":"TSH and antithyroid antibodies","justification":"Systematic review, with: CBC, Pap smear, PPE, HIV HBV HCV serology, liver test, ANA, Creatinine, PT TCA Fibrinogen, RAI grouping"}],"ts":{"$numberLong":"1651262758450"},"type":"custom","difficulte":2}
-{"_id":"IC-cardio-947e141","context":null,"enonce":"Mrs. Minerva McGonagall has dyspnea when she puts on her cape but also permanent fatigue of rest. What is its NYHA stadium? ","item":"IC","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"Stage I. ","justification":"False. "},{"idx":1,"correct":false,"proposition":"Stage II. ","justification":"False. "},{"idx":2,"correct":false,"proposition":"Stage III. ","justification":"False. "},{"idx":3,"correct":true,"proposition":"Stage IV. ","justification":"True, dyspnea of rest and for minimal effort. "},{"idx":4,"correct":false,"proposition":"Stage V. ","justification":"False, only 4 stages in the NYHA classification. "}],"ts":{"$numberLong":"1651263411917"},"type":"custom","difficulte":2}
-{"_id":"dermatosefaciale-dermato-3bb5f2a","context":null,"enonce":"What is the main risk of seborrheic dermatitis?","item":"dermatosefaciale","matiere":"dermato","propositions":[{"idx":0,"correct":true,"proposition":"Blepharitis","justification":"If eye damage"},{"idx":1,"correct":false,"proposition":"Facial paralysis","justification":""},{"idx":2,"correct":false,"proposition":"Uveitis","justification":""},{"idx":3,"correct":false,"proposition":"Cancerization","justification":""},{"idx":4,"correct":false,"proposition":"Upper airway obstruction","justification":""}],"ts":{"$numberLong":"1651263549698"},"type":"custom","difficulte":1}
-{"_id":"addpsychotropes-psy-e6e39e7","context":null,"enonce":"Regarding buprenorphine and pregnancy:","item":"addpsychotropes","matiere":"psy","propositions":[{"idx":0,"correct":true,"proposition":"In opioid substitution therapy, discontinuation of buprenorphine for pregnancy is not warranted","justification":""},{"idx":1,"correct":true,"proposition":"Buprenorphine can be used regardless of the term of pregnancy","justification":""},{"idx":2,"correct":false,"proposition":"The amount of buprenorphine ingested via milk is too much for the newborn","justification":"It is very weak, it can be used during breastfeeding without worry, unlike opiates, which it helps prevent the consumption ;)"},{"idx":3,"correct":true,"proposition":"Published data in women exposed to buprenorphine during pregnancy are numerous and reassuring","justification":""},{"idx":4,"correct":false,"proposition":"Neonatal opioid withdrawal syndrome is rare with chronic buprenorphine use until delivery","justification":"It is common but not serious most of the time"}],"ts":{"$numberLong":"1651263616815"},"type":"custom","difficulte":2}
-{"_id":"deuil-psy-147e3c0","context":null,"enonce":"What are the risk factors for pathological bereavement?","item":"deuil","matiere":"psy","propositions":[{"idx":0,"correct":true,"proposition":"Violent death","justification":"True"},{"idx":1,"correct":true,"proposition":"Suicide","justification":"True"},{"idx":2,"correct":true,"proposition":"Death of a child","justification":"True"},{"idx":3,"correct":true,"proposition":"Strong attachment to the deceased","justification":"True"},{"idx":4,"correct":true,"proposition":"Repetition of deaths of loved ones in a short time","justification":"True - basically, anything that makes you say \"Ouch, this is even worse than I imagined\", is worth"}],"ts":{"$numberLong":"1651263695966"},"type":"custom","difficulte":1}
-{"_id":"tabac-psy-6c1aacd","context":null,"enonce":"Concerning smoking status ","item":"tabac","matiere":"psy","propositions":[{"idx":0,"correct":true,"proposition":"A non-smoker has smoked less than 100 cigarettes in his lifetime ","justification":""},{"idx":1,"correct":false,"proposition":"The withdrawal period allowed to define an ex-smoker is 6 months ","justification":"False, commonly accepted time = 12 months "},{"idx":2,"correct":true,"proposition":"An active smoker is a smoker who has not been weaned for 12 months ","justification":""},{"idx":3,"correct":true,"proposition":"An ex-smoker is a smoker who has totally and permanently quit smoking for a certain period of time.","justification":""},{"idx":4,"correct":false,"proposition":"All propositions are true ","justification":""}],"ts":{"$numberLong":"1651264066225"},"type":"custom","difficulte":2}
-{"_id":"tabac-psy-8b79e60","context":null,"enonce":"What are the 2 most important questions of the Fagerström test? ","item":"tabac","matiere":"psy","propositions":[{"idx":0,"correct":false,"proposition":"Which cigarette would you give up the hardest? ","justification":""},{"idx":1,"correct":false,"proposition":"Do you smoke at shorter intervals in the early morning hours than in the rest of the day? ","justification":""},{"idx":2,"correct":true,"proposition":"How many cigarettes do you smoke per day? ","justification":"These 2 questions are the most important because they are the most sensitive and specific, and constitute the simplified Fagerström test. "},{"idx":3,"correct":true,"proposition":"How soon after waking up do you smoke your 1st cigarette? ","justification":""},{"idx":4,"correct":false,"proposition":"Do you find it difficult to abstain from smoking in places where it is prohibited? ","justification":""}],"ts":{"$numberLong":"1651264097472"},"type":"custom","difficulte":1}
-{"_id":"tabac-psy-d861c72","context":null,"enonce":"Concerning the epidemiology of tobacco consumption ","item":"tabac","matiere":"psy","propositions":[{"idx":0,"correct":false,"proposition":"The proportion of smokers increased between 2016 and 2018","justification":"False in overall decrease"},{"idx":1,"correct":false,"proposition":"Occasional smoking is predominant ","justification":"Predominant daily smoking "},{"idx":2,"correct":true,"proposition":"Smoking prevalence higher among men ","justification":""},{"idx":3,"correct":false,"proposition":"The decrease in smoking prevalence is faster among women ","justification":"Faster in humans "},{"idx":4,"correct":false,"proposition":"Tobacco experimentation is done for the first time around 12 years old ","justification":"Around 14 years old "}],"ts":{"$numberLong":"1651264145789"},"type":"custom","difficulte":1}
-{"_id":"adenomehypoP-endoc-6c9106a","context":null,"enonce":"Regarding the physiology of GH, indicate the exact answers:","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"Secretion is constant and mainly diurnal","justification":""},{"idx":1,"correct":true,"proposition":"The secretion is pulsatile and mainly nocturnal ","justification":"True, hence the myth (not so mythological as that) that we grow up at night 😊\nThis myth is also due to the fact that the intervertebral discs decompress at night which makes it possible to gain a few centimeters."},{"idx":2,"correct":true,"proposition":"Secretion is stimulated by ghrelin ","justification":"True, produced by the stomach (when we eat, we grow!)"},{"idx":3,"correct":true,"proposition":"Secretion is stimulated by GHRH","justification":"True, produced at the hypothalamic level. It is decreased by somatostatin. According to Wikipedia: Somatostatin, also called GHIH or SRIF, is a protein hormone that inhibits growth hormone. It exists in two active forms, produced by an alternative cleavage of the same pre-protein: one of 14 amino acids, another of 28 amino acids."},{"idx":4,"correct":false,"proposition":"Secretion is hypothalamic","justification":"Pituitary"}],"ts":{"$numberLong":"1651264310802"},"type":"custom","difficulte":2}
-{"_id":"diabete-endoc-66cce82","context":null,"enonce":"Which of the following are sulfonamides?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Gliclazide","justification":"Most common"},{"idx":1,"correct":true,"proposition":"Glimepiride","justification":""},{"idx":2,"correct":true,"proposition":"Glibenclamide","justification":""},{"idx":3,"correct":false,"proposition":"Liraglutide","justification":"Analogue of GLP1, like all drugs that end in -tide."},{"idx":4,"correct":false,"proposition":"Gliptins","justification":"Gliptins are inhibitors of DPP4 (they are, like GLP1 analogues, incretins)."}],"ts":{"$numberLong":"1651264331766"},"type":"custom","difficulte":1}
-{"_id":"diabete-endoc-b8a22c9","context":null,"enonce":"Which anti-diabetic treatments are incretins?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Liraglutide","justification":"Analogues GLP-1"},{"idx":1,"correct":true,"proposition":"Exenatide","justification":"Analogues GLP-1"},{"idx":2,"correct":true,"proposition":"Dulaglutide","justification":"Analogues GLP-1"},{"idx":3,"correct":true,"proposition":"Gliptins","justification":"IDPP4 "},{"idx":4,"correct":false,"proposition":"Repaglinide","justification":"Glinides are insulin-secreting hypoglycemic secretors. \n\nThomas Marc and Redwane Rakza made an excellent recap: \n\nInsulin-sensitizer:\n• Biguanides = Metformin\n\nInsulin secretors hypoglycemic agents:\n• Sulfonamides = Gliclazide, Glimepiride, Glibenclamide\n• Glinide = Repaglinide\n\nIncretins:\n• GLP-1 analogues = Liraglutide, exenatide, dulaglutide\n• IDPP4 = -gliptin\n\nA-glucosidase inhibitors:\n• Acarbose, Miglitol"}],"ts":{"$numberLong":"1651264533504"},"type":"custom","difficulte":1}
-{"_id":"hypoGly-endoc-0d57d7c","context":null,"enonce":"What symptoms are adrenergic signs in hypoglycemia? ","item":"hypoGly","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Tremors ","justification":"Adrenergic signs are also those found in stressful situations;)"},{"idx":1,"correct":false,"proposition":"Sensory disorders ","justification":"Neuroglucopenic disorders! "},{"idx":2,"correct":false,"proposition":"Visual disturbances ","justification":"Neuroglucopenic disorders! "},{"idx":3,"correct":false,"proposition":"Confusion ","justification":"Neuroglucopenic disorders! "},{"idx":4,"correct":true,"proposition":"Nausea ","justification":""}],"ts":{"$numberLong":"1651264569861"},"type":"custom","difficulte":2}
-{"_id":"noduleTh-endoc-7f40b2c","context":null,"enonce":"What are the etiologies of white scintigraphy?","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"De Quervain's thyroiditis","justification":"True, the thyroid is homogeneously destroyed"},{"idx":1,"correct":true,"proposition":"Iodine overload","justification":"True, the thyroid cannot bind labeled iodine, since its receptors are saturated"},{"idx":2,"correct":false,"proposition":"Graves' disease","justification":"Homogeneous hyperfixation"},{"idx":3,"correct":false,"proposition":"Nodular goiter","justification":"Heterogeneous hyperfixation"},{"idx":4,"correct":true,"proposition":"Central hypothyroidism","justification":"True"}],"ts":{"$numberLong":"1651264738445"},"type":"custom","difficulte":1}
-{"_id":"noduleTh-endoc-a6824b5","context":null,"enonce":"What thyroid volumes define a goiter? ","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"> 18 mL in adolescents ","justification":""},{"idx":1,"correct":true,"proposition":"> 16 mL in adolescents","justification":""},{"idx":2,"correct":false,"proposition":"> 25 mL in men","justification":"> 20 mL in men "},{"idx":3,"correct":false,"proposition":"> 20 mL in women ","justification":""},{"idx":4,"correct":true,"proposition":"> 18 mL in women ","justification":""}],"ts":{"$numberLong":"1651264763305"},"type":"custom","difficulte":2}
-{"_id":"noduleTh-endoc-aa38a2c","context":null,"enonce":"What are the etiologies of white scintigraphy with normal TSH and T4L?","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Moderate iodine contamination","justification":"True"},{"idx":1,"correct":true,"proposition":"Ectopic thyroid","justification":"True, rare +++"},{"idx":2,"correct":false,"proposition":"Postpartum thyroiditis","justification":"Increased T4L"},{"idx":3,"correct":false,"proposition":"Fake thyrotoxicosis by hidden intake of levothyrox","justification":"Increased T4L"},{"idx":4,"correct":false,"proposition":"Paraneoplastic secretion of T4L","justification":"Increased T4L"}],"ts":{"$numberLong":"1651264785513"},"type":"custom","difficulte":3}
-{"_id":"nutrigrossesse-endoc-4132468","context":null,"enonce":"What does not cross the blood-placental barrier?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"glucose","justification":""},{"idx":1,"correct":false,"proposition":"Ketones","justification":""},{"idx":2,"correct":false,"proposition":"free fatty acids","justification":""},{"idx":3,"correct":false,"proposition":"amino acids","justification":""},{"idx":4,"correct":true,"proposition":"insulin","justification":"True"}],"ts":{"$numberLong":"1651264819416"},"type":"custom","difficulte":3}
-{"_id":"certificats-psy-6693e90","context":null,"enonce":"What are the positive signs of death among the following propositions?","item":"certificats","matiere":"psy","propositions":[{"idx":0,"correct":true,"proposition":"Cooling","justification":"Early sign"},{"idx":1,"correct":true,"proposition":"Lividity","justification":"Early sign"},{"idx":2,"correct":true,"proposition":"Rigidity","justification":"Early sign"},{"idx":3,"correct":true,"proposition":"Green task","justification":"Late sign"},{"idx":4,"correct":true,"proposition":"Phlyctenes","justification":"Late sign"}],"ts":{"$numberLong":"1651264870701"},"type":"custom","difficulte":1}
-{"_id":"tbrefraction-ophtalmo-76be448","context":null,"enonce":"What are the possible complications of high myopia?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"idx":0,"correct":true,"proposition":"Chronic glaucoma","justification":"True"},{"idx":1,"correct":true,"proposition":"Retinal detachment","justification":"True"},{"idx":2,"correct":true,"proposition":"Cataract","justification":"True"},{"idx":3,"correct":false,"proposition":"Early presbyopia","justification":"Myopic are rather protected from early presbyopia"},{"idx":4,"correct":false,"proposition":"Uveitis","justification":"No report"}],"ts":{"$numberLong":"1651264892658"},"type":"custom","difficulte":1}
-{"_id":"tbvisionbrutal-ophtalmo-c05fd30","context":null,"enonce":"What is a rupture of the Bruch membrane?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"correct":true,"proposition":"Choroid rupture","justification":"True, another guy who liked his last name too much"},{"idx":1,"correct":false,"proposition":"Sclera rupture","justification":""},{"idx":2,"correct":false,"proposition":"vitreous mood breakdown","justification":""},{"idx":3,"correct":false,"proposition":"Rupture of the lens","justification":""},{"idx":4,"correct":false,"proposition":"rupture of the uvea","justification":""}],"ts":{"$numberLong":"1651264919384"},"type":"custom","difficulte":3}
-{"_id":"tbvisionbrutal-ophtalmo-ffda27e","context":null,"enonce":"What is the definition of iridodialysis?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"correct":true,"proposition":"It is the disinsertion of the base of the iris","justification":"True"},{"idx":1,"correct":false,"proposition":"This is the rupture of the iris sphincter","justification":""},{"idx":2,"correct":false,"proposition":"This is the subluxation of the lens","justification":""},{"idx":3,"correct":false,"proposition":"It is a rapid increase in the iridocorneal angle","justification":""},{"idx":4,"correct":false,"proposition":"It is an erosion of the cornea","justification":""}],"ts":{"$numberLong":"1651264997777"},"type":"custom","difficulte":1}
-{"_id":"SPSC-sp-d6aac22","context":null,"enonce":"What are the essential documents for the establishment of an ASPDREu? ","item":"SPSC","matiere":"sp","propositions":[{"idx":0,"correct":true,"proposition":"Municipal by-law","justification":"True"},{"idx":1,"correct":true,"proposition":"1 certificate or medical opinion outside the premises","justification":"True"},{"idx":2,"correct":false,"proposition":"1 certificate or medical opinion within the establishment","justification":""},{"idx":3,"correct":false,"proposition":"2 off-site medical certificate or opinion","justification":"ASPDT"},{"idx":4,"correct":false,"proposition":"No proposition is true","justification":""}],"ts":{"$numberLong":"1651265070435"},"type":"custom","difficulte":1}
-{"_id":"progrossesse-sp-dbe209b","context":null,"enonce":"Which propositions are true?","item":"progrossesse","matiere":"sp","propositions":[{"idx":0,"correct":true,"proposition":"The employer has the obligation to reclassify a pregnant woman if she is exposed to certain occupational risks","justification":"True"},{"idx":1,"correct":true,"proposition":"The employer cannot dismiss an employee during pregnancy","justification":"True"},{"idx":2,"correct":false,"proposition":"The employer cannot dismiss an employee during the 3 months following the maternity leave","justification":"During the month following maternity leave"},{"idx":3,"correct":false,"proposition":"The pregnant woman is obliged to inform her employer of the pregnancy","justification":"No, but it is advisable to do so if there is a need to arrange the workstation"},{"idx":4,"correct":true,"proposition":"The employer may dismiss a pregnant woman if there is serious professional misconduct. The dismissal then takes effect as soon as protection ends.","justification":"True"}],"ts":{"$numberLong":"1651265113157"},"type":"custom","difficulte":1}
-{"_id":"278-HGE-c2e25675-4cc4-4664-8b8e-35cc9a5a5bc1","context":null,"enonce":"Regarding chronic pancreatitis, which propositions are true?","item":"pancreatitechr","matiere":"HGE","propositions":[{"idx":0,"correct":false,"proposition":"About 80% of heavy drinkers will develop chronic pancreatitis ","justification":"False, less than 5%. On the other hand, 80% of chronic pancreatitis is linked to excessive alcohol consumption for more than 10 years. "},{"idx":1,"correct":true,"proposition":"Pancreatic pain can lead to weight loss ","justification":"True, by dietary restriction because diet triggers pain "},{"idx":2,"correct":true,"proposition":"Pain is often present in the early phase of the disease ","justification":"True, and it tends to disappear in the evolution towards the late phase. "},{"idx":3,"correct":false,"proposition":"Pancreatic exocrine insufficiency leads to diabetes ","justification":"False, diabetes is secondary to pancreatic endocrine insufficiency "},{"idx":4,"correct":true,"proposition":"Exocrine pancreatic insufficiency involves steatorrhea confirmed by a lowered assay of fecal elastase on a stool sample ","justification":"True"}],"ts":{"$numberLong":"1651265283240"},"type":"custom","difficulte":2}
-{"_id":"PRNA-neuro-0deff1e","context":null,"enonce":"What are the criteria for poor prognosis for Guilain-Barré syndromes?","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"A very rapid worsening phase","justification":"True"},{"idx":1,"correct":true,"proposition":"initial bilateral facial involvement","justification":"True"},{"idx":2,"correct":false,"proposition":"an age greater than 40 years","justification":"60 years"},{"idx":3,"correct":true,"proposition":"nerve unexcitability at the ENMG","justification":"True"},{"idx":4,"correct":true,"proposition":"prolonged ventilation","justification":"True, and always true, regardless of the disease"}],"ts":{"$numberLong":"1652794699863"},"type":"custom","difficulte":1}
-{"_id":"PRNA-neuro-15739f7","context":null,"enonce":"When should physiotherapy be started?","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"Back home","justification":""},{"idx":1,"correct":true,"proposition":"Upon resuscitation","justification":"True, always in real, because limits stiffness and, once the patient is conscious, atrophy"},{"idx":2,"correct":false,"proposition":"In SRH","justification":""},{"idx":3,"correct":false,"proposition":"There is no physiotherapy indicated","justification":""},{"idx":4,"correct":false,"proposition":"All proposals are wrong","justification":""}],"ts":{"$numberLong":"1652794862305"},"type":"custom","difficulte":3}
-{"_id":"PRNA-neuro-35ba0e2","context":null,"enonce":"What is the percentage of PRNAI deaths in studies?","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"0","justification":""},{"idx":1,"correct":true,"proposition":"5","justification":"True"},{"idx":2,"correct":false,"proposition":"18","justification":""},{"idx":3,"correct":false,"proposition":"30","justification":""},{"idx":4,"correct":false,"proposition":"52","justification":""}],"ts":{"$numberLong":"1652794875455"},"type":"custom","difficulte":1}
-{"_id":"PRNA-neuro-4dfee32","context":null,"enonce":"What propositions are true regarding lumbar puncture in PRNAI?","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"Meningitis on Lyme disease or HIV can give a similar picture","justification":"True"},{"idx":1,"correct":true,"proposition":"Lumbar puncture may show albuminocytological dissociation","justification":"True (this is a significant increase in albumin levels while cytology is normal)"},{"idx":2,"correct":true,"proposition":"Lumbar puncture may be normal","justification":"True"},{"idx":3,"correct":false,"proposition":"There are between 4 and 50 nucleated elements per mL of spinal fluid","justification":"It's in MS"},{"idx":4,"correct":false,"proposition":"There are oligoclonal bands with normal glycorachia","justification":"It's in MS"}],"ts":{"$numberLong":"1652794936126"},"type":"custom","difficulte":2}
-{"_id":"PRNA-neuro-84aa854","context":null,"enonce":"Regarding EMG in PRNAI:","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"Segmental demyelination occurs","justification":"True"},{"idx":1,"correct":true,"proposition":"There is a prolongation of latencies","justification":"True, because myelin participates in the conduction velocity but not in the amplitude of the signal"},{"idx":2,"correct":true,"proposition":"Normal amplitudes are found in the demyelinating form","justification":"True, cf 2"},{"idx":3,"correct":true,"proposition":"Decreased amplitudes are found in the AMAN form","justification":"True"},{"idx":4,"correct":true,"proposition":"There is a decrease in conduction velocity","justification":"True"}],"ts":{"$numberLong":"1652794999245"},"type":"custom","difficulte":2}
-{"_id":"deficitMo-neuro-50d755f","context":null,"enonce":"What is just in front of the fourth ventricle?","item":"deficitMo","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"Vermis","justification":"It is located behind"},{"idx":1,"correct":true,"proposition":"The bridge","justification":"Synonyms = metencephalon, protrusion"},{"idx":2,"correct":false,"proposition":"The cerebellar hemispheres ","justification":"Back, on either side of the vermis"},{"idx":3,"correct":false,"proposition":"The atlas","justification":"We are far away (it's C1)"},{"idx":4,"correct":false,"proposition":"The axis","justification":"Ditto (it's C2)"}],"ts":{"$numberLong":"1652795109373"},"type":"custom","difficulte":2}
-{"_id":"deficitMo-neuro-99b9301","context":null,"enonce":"What are the causes of painful III paralysis?","item":"deficitMo","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":" Aneurysm of a. posterior cerebral","justification":"True"},{"idx":1,"correct":true,"proposition":"Supraclinoid internal carotid aneurysm","justification":"True"},{"idx":2,"correct":true,"proposition":"Horton's disease","justification":"True"},{"idx":3,"correct":true,"proposition":"Syndrome de Tolosa-Hunt","justification":"Rank C"},{"idx":4,"correct":false,"proposition":"Carotid dissection","justification":"Gives a Claude Bernard Hoerner "}],"ts":{"$numberLong":"1652795152716"},"type":"custom","difficulte":3}
-{"_id":"deficitMo-neuro-a62cc05","context":null,"enonce":"What does the famous midbrain aqueduct, also called Sylvius Aqueduct, do?","item":"deficitMo","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"He buys a Nimbus 2000 from Harry Potter","justification":"A bit of jokes in this world of bullies 😂😂"},{"idx":1,"correct":true,"proposition":"It connects 3rd to 4th ventricle","justification":"Exactly. It connects the 3rd ventricle, which is in the brain, to the fourth ventricle, which is in the cerebellum. To do this, it navigates to the posterior part of the midbrain."},{"idx":2,"correct":false,"proposition":"It connects the bridge to the midbrain","justification":""},{"idx":3,"correct":false,"proposition":"It connects the occipital lobe to the cerebellar hemispheres","justification":""},{"idx":4,"correct":false,"proposition":"It connects the vermis to the cervical marrow","justification":""}],"ts":{"$numberLong":"1652795174687"},"type":"custom","difficulte":1}
-{"_id":"epilepsie-neuro-01d1ad7","context":null,"enonce":"What is the definition of a tonic crisis?","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"Sustained segmental muscle contractions","justification":"True"},{"idx":1,"correct":false,"proposition":"Repetitive and rhythmic segmental muscle twitches","justification":"Clonies"},{"idx":2,"correct":false,"proposition":"Contraction of agonist and antagonist muscles, alone or in bursts","justification":"Myoclonus"},{"idx":3,"correct":false,"proposition":"Loss of consciousness","justification":""},{"idx":4,"correct":false,"proposition":"Loss of contact","justification":""}],"ts":{"$numberLong":"1652795251612"},"type":"custom","difficulte":1}
-{"_id":"epilepsie-neuro-77a7d5a","context":null,"enonce":"What is the definition of a myoclonic crisis?","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"Sustained segmental muscle contractions","justification":"Tonic crisis"},{"idx":1,"correct":false,"proposition":"Repetitive and rhythmic segmental muscle twitches","justification":"Clonic seizure"},{"idx":2,"correct":true,"proposition":"Contraction of agonist and antagonist muscles, alone or in bursts","justification":"True"},{"idx":3,"correct":false,"proposition":"Loss of consciousness","justification":""},{"idx":4,"correct":false,"proposition":"Loss of contact","justification":"Epilepsy absence"}],"ts":{"$numberLong":"1652795297782"},"type":"custom","difficulte":1}
-{"_id":"meningite-neuro-02954de","context":null,"enonce":"Which of the following are true about herpetic meningoencephalitis? (one or more propositions are correct)","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"It is exceptional in an immunocompetent subject","justification":"Quite common (in the rarity of meningitis): this is the first cause of clear fluid meningoencephalitis."},{"idx":1,"correct":false,"proposition":"Treatment is based on IV aciclovir for 5 days","justification":"3 weeks"},{"idx":2,"correct":false,"proposition":"Treatment is based on IV valganciclovir","justification":"Aciclovir IV for 3 weeks"},{"idx":3,"correct":false,"proposition":"T1 and T2 hyposignals are found on temporal MRI","justification":"Hyposignal T1, hypersignal T2 and Flair"},{"idx":4,"correct":true,"proposition":"No proposition is true","justification":""}],"ts":{"$numberLong":"1652795341782"},"type":"custom","difficulte":1}
-{"_id":"meningite-neuro-29996b8","context":null,"enonce":"What is Kluver-Bucy syndrome?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"Memory problems","justification":"➡︎ By temporal lobe injury: Herpetic meningoencephalitis +++"},{"idx":1,"correct":true,"proposition":"Hyperorality","justification":""},{"idx":2,"correct":true,"proposition":"Hypersexuality","justification":""},{"idx":3,"correct":false,"proposition":"Hypersomnia ","justification":"Hypersomnia is found in Kleine-Levin syndrome, of unknown cause."},{"idx":4,"correct":false,"proposition":"Sudden aphasia","justification":""}],"ts":{"$numberLong":"1652795696055"},"type":"custom","difficulte":3}
-{"_id":"meningite-neuro-4b0be55","context":null,"enonce":"We often hear that clear fluid meningitis is not serious. Nevertheless:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"10% of children die, and 2% of adults","justification":"It's the other way around"},{"idx":1,"correct":true,"proposition":"40% of patients will have neuropsychological sequelae","justification":"True"},{"idx":2,"correct":true,"proposition":"The causative agent is not found in one out of two cases","justification":"True"},{"idx":3,"correct":false,"proposition":"25% are HIV-related","justification":"No, 25% are related to HSV, remember that 90-100% of adults are infected with HSV"},{"idx":4,"correct":false,"proposition":"25% are related to CMV","justification":"Cf 4"}],"ts":{"$numberLong":"1652795740396"},"type":"custom","difficulte":1}
-{"_id":"meningite-neuro-5c07535","context":null,"enonce":"Which of the following are signs of seriousness requiring hospitalization in intensive care in case of meningitis? (one or more propositions are correct)","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"Extensive and necrotic purpura","justification":"It's called a purpura fulminans, it falls every year, and it's the only thing that can take you to court as an outsider if you don't think about it. All right? 0:)"},{"idx":1,"correct":true,"proposition":"Glasgow less than 9","justification":""},{"idx":2,"correct":true,"proposition":"Signs of brainstem suffering","justification":""},{"idx":3,"correct":false,"proposition":"All meningitis is managed in intensive care","justification":"Benign viral meningitis is usually managed on an outpatient basis. Bacterial meningitis can be managed in conventional medicine, intensive care unit, or intensive care."},{"idx":4,"correct":false,"proposition":"Thrombocytopenia with platelets below 100G\/L","justification":""}],"ts":{"$numberLong":"1652795836241"},"type":"custom","difficulte":1}
-{"_id":"meningite-neuro-93e97ca","context":null,"enonce":"What are the notifiable etiologies of meningitis or meningoencephalitis?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"HIV","justification":""},{"idx":1,"correct":true,"proposition":"Listeria","justification":""},{"idx":2,"correct":true,"proposition":"Meningococcus","justification":""},{"idx":3,"correct":false,"proposition":"Syphilis","justification":"Syphilis has been a long time since 😊 OD"},{"idx":4,"correct":false,"proposition":"Borrelia","justification":"The complete and up-to-date list is available here: https:\/\/www.santepubliquefrance.fr\/maladies-a-declaration-obligatoire\/liste-des-maladies-a-declaration-obligatoire"}],"ts":{"$numberLong":"1652795852041"},"type":"custom","difficulte":1}
-{"_id":"meningite-neuro-9d749db","context":null,"enonce":"What elements are part of the semiology of autoimmune encephalitis?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"Meningeal syndrome","justification":"No, it is most often absent"},{"idx":1,"correct":true,"proposition":"Subacute onset","justification":"Or even acute"},{"idx":2,"correct":true,"proposition":"Anterograde amnesia","justification":"True"},{"idx":3,"correct":true,"proposition":"Temporal epilepsy","justification":"Yes, they are also called limbic encephalitis because they mainly affect the internal temporal lobe (so also give visual hallucinations, such as frontotemporal dementia :) )"},{"idx":4,"correct":false,"proposition":"Drowsiness","justification":"Rather behavioral disorders"}],"ts":{"$numberLong":"1652795935316"},"type":"custom","difficulte":1}
-{"_id":"meningite-neuro-cd621e3","context":null,"enonce":"Which of the following proposals promote invasive pneumococcal disease? (one or more propositions are correct)","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"HIV","justification":""},{"idx":1,"correct":true,"proposition":"Asplenia","justification":""},{"idx":2,"correct":true,"proposition":"Sickle-cell anemia","justification":"Sickle cell disease is a cause of functional asplenia by multiple spleen infarction leading to either splenic sequestration of immune cells or cessation of their splenic production\/maturation"},{"idx":3,"correct":true,"proposition":"Nephrotic syndrome","justification":"By leakage of immunoglobulins"},{"idx":4,"correct":false,"proposition":"External hearing implant","justification":"Only the cochlear implant is a risk factor"}],"ts":{"$numberLong":"1652796014075"},"type":"custom","difficulte":1}
-{"_id":"EDC-psy-01145be","context":null,"enonce":"What are the four true propositions?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"correct":true,"proposition":"Adjustment disorder is rare in children","justification":"Fortunately:)"},{"idx":1,"correct":true,"proposition":"The allowance for the supervision of a disabled child (AEEH) is allocated by the MDPH","justification":""},{"idx":2,"correct":false,"proposition":" ADHD is statistically linked to the occurrence of OCD and ASD","justification":"TBI (conduct disorder) and\/or OD (Defiant Opposition Disorder) can be found in children\nIn adults, there is an increased risk of other pathologies such as mood disorders and delusional disorders, but this is outside your program."},{"idx":3,"correct":true,"proposition":"Methylphenidate is the standard drug treatment for ADHD","justification":"Yes, it is an amphetamine derivative prescribed on secure prescription for 28 days, with a prescription limited to certain professionals: psychiatrists and child psychiatrists, neurologists, and pediatricians"},{"idx":4,"correct":true,"proposition":"Educational assistance in an open environment is provided at the parents' home, at home","justification":""}],"ts":{"$numberLong":"1654455771432"},"type":"custom","difficulte":1}
-{"_id":"EDC-psy-1c3ffc4","context":null,"enonce":"A suicide:","item":"EDC","matiere":"psy","propositions":[{"idx":0,"correct":true,"proposition":"Is a survivor of a suicide attempt","justification":"At least one: 80% of TS are recurrences"},{"idx":1,"correct":false,"proposition":"Is a person with suicidal ideation","justification":""},{"idx":2,"correct":false,"proposition":"Is a person in a suicidal crisis","justification":"After the suicidal crisis"},{"idx":3,"correct":false,"proposition":"Is a person with a high RUD","justification":"Not necessarily, but at least moderate, because a history of TS is a major FdR of suicide, so increases the R"},{"idx":4,"correct":false,"proposition":"All proposals are wrong","justification":""}],"ts":{"$numberLong":"1654455865165"},"type":"custom","difficulte":1}
-{"_id":"EDC-psy-7229865","context":null,"enonce":"What do you find during a panic attack?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"correct":false,"proposition":"Gradual onset of symptoms","justification":"Brutal"},{"idx":1,"correct":true,"proposition":"Catastrophic cognitions","justification":""},{"idx":2,"correct":true,"proposition":"Derealization","justification":""},{"idx":3,"correct":true,"proposition":"Depersonalization","justification":""},{"idx":4,"correct":false,"proposition":"Ideas of ruin","justification":"Delusional idea, often present in melancholic depressions"}],"ts":{"$numberLong":"1654455890304"},"type":"custom","difficulte":1}
-{"_id":"EDC-psy-af8c816","context":null,"enonce":"Regarding generalized anxiety disorder (GAD):","item":"EDC","matiere":"psy","propositions":[{"idx":0,"correct":false,"proposition":"Frequency is higher in men than in women","justification":""},{"idx":1,"correct":true,"proposition":"Asthenia can be found","justification":""},{"idx":2,"correct":true,"proposition":"We can find difficulties of an intellectual nature","justification":"It's hard to perform intellectually when you're anxious, remember your last staff presentation..."},{"idx":3,"correct":false,"proposition":"Anxiety is anticipatory between paroxysmal episodes","justification":"There are no paroxysmal episodes. Anxiety is continuous, not associated with identified triggering events, excessive and uncontrollable."},{"idx":4,"correct":true,"proposition":"We talk about GAD after 6 months","justification":""}],"ts":{"$numberLong":"1654455943682"},"type":"custom","difficulte":1}
-{"_id":"asthme-immuno-b2b7c8e","context":null,"enonce":"What are the symptoms found in asthma? ","item":"asthme","matiere":"immuno","propositions":[{"idx":0,"correct":true,"proposition":"Dyspnoea ","justification":""},{"idx":1,"correct":true,"proposition":"Cough ","justification":""},{"idx":2,"correct":false,"proposition":"Spittle ","justification":"Everything is true except sputum (page 78 of the pneumo college). "},{"idx":3,"correct":true,"proposition":"Whistles ","justification":""},{"idx":4,"correct":true,"proposition":"Chest tightness ","justification":""}],"ts":{"$numberLong":"1654456012873"},"type":"custom","difficulte":2}
-{"_id":"grossessepatho-gyn-e8a0686","context":null,"enonce":"What is the definition of RPM (premature rupture of membranes)?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"correct":true,"proposition":"Rupture of membranes occurring before the start of labour","justification":""},{"idx":1,"correct":false,"proposition":"Rupture of membranes occurring before release","justification":"It doesn't make too much sense, right? 😅 How can the baby get out without breaking the membrane?"},{"idx":2,"correct":false,"proposition":"Rupture of membranes occurring before engagement","justification":"Ditto"},{"idx":3,"correct":false,"proposition":"Rupture of membranes occurring for more than 12 hours before delivery","justification":""},{"idx":4,"correct":false,"proposition":"Rupture of membranes occurring for more than 24 hours before delivery","justification":""}],"ts":{"$numberLong":"1654456345973"},"type":"custom","difficulte":1}
-{"_id":"tbpaupieres-ophtalmo-826a0cf","context":null,"enonce":"Regarding eyelid pathologies, what are the exact proposal(s)?","item":"tbpaupieres","matiere":"ophtalmo","propositions":[{"idx":0,"correct":true,"proposition":"A stye usually manifests as a painful pustule, centered on an eyelash.","justification":"True, this is the definition of stye"},{"idx":1,"correct":true,"proposition":"Chalazion usually manifests as inflammation of the Meibomus gland","justification":"True, this is the definition of chalazion"},{"idx":2,"correct":true,"proposition":"Chalazion or stye does not cause decreased vision","justification":"True, unlike differential diagnoses"},{"idx":3,"correct":true,"proposition":"Blepharitis or dacryocystitis is a differential diagnosis","justification":"True, it is the case"},{"idx":4,"correct":false,"proposition":"Treatment of chalazion is based on antibiotics","justification":"False, based on corticosteroids"}],"ts":{"$numberLong":"1658600098910"},"type":"custom","difficulte":2}
-{"_id":"353-HGE-c7327398-fd52-48e3-a256-2363d7b601f7","context":null,"enonce":"Regarding acute pancreatitis, which propositions are true?","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"Acute pancreatitis is a common digestive emergency ","justification":"True"},{"idx":1,"correct":false,"proposition":"The most common form of acute pancreatitis is acute necrotizing pancreatitis","justification":"False, 80% of cases of acute pancreatitis are benign and are described as edematous "},{"idx":2,"correct":true,"proposition":"They may be accompanied by vomiting related to a reflex ileus","justification":"True"},{"idx":3,"correct":true,"proposition":"Lower myocardial infarction may be a differential diagnosis of acute pancreatitis","justification":"True"},{"idx":4,"correct":true,"proposition":"Diagnosis is based on a combination of suggestive abdominal pain and lipasemia > 3N ","justification":"True"}],"ts":{"$numberLong":"1659649552819"},"type":"custom","difficulte":2}
-{"_id":"UGD-HGE-1325963","context":null,"enonce":"Which of these proposals are not risk factors for peptic ulcers? (three proposals expected)","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"Alcohol","justification":""},{"idx":1,"correct":true,"proposition":"coffee","justification":""},{"idx":2,"correct":true,"proposition":"GERD ","justification":""},{"idx":3,"correct":false,"proposition":"tobacco","justification":"It is indeed a risk factor for ulcers. Other risk factors to be aware of are: H. pylori, NSAIDs and Aspirin, Zollinger-Ellison Syndrome, genetic predispositions and certain vasculitis"},{"idx":4,"correct":false,"proposition":"Syndrome de Zollinger-Ellison","justification":"Gastrinoma 👉 gastrin 👉 hypersecretion decrease in pH (which therefore becomes more acidic) 👉 multiple and recurrent ulcers"}],"ts":{"$numberLong":"1659649562960"},"type":"custom","difficulte":1}
-{"_id":"UGD-HGE-54f13ae","context":null,"enonce":"Acute gastritis due to H. pylori is most often: (only one response expected)","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"asymptomatic","justification":""},{"idx":1,"correct":false,"proposition":"responsible for nausea","justification":""},{"idx":2,"correct":false,"proposition":"responsible for vomiting","justification":""},{"idx":3,"correct":false,"proposition":"responsible for cancer","justification":""},{"idx":4,"correct":false,"proposition":"responsible for diarrhoea","justification":""}],"ts":{"$numberLong":"1659649565886"},"type":"custom","difficulte":1}
-{"_id":"UGD-HGE-5a08d2b","context":null,"enonce":"Zollinger-Ellison syndrome is secondary to:","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"Gastrinoma ","justification":"It is an endocrine tumor that lowers the pH of the stomach and can cause recurrent postbulbar multiple ulcers."},{"idx":1,"correct":false,"proposition":"insulinoma","justification":""},{"idx":2,"correct":false,"proposition":"Biermer","justification":""},{"idx":3,"correct":false,"proposition":"cholangiocarcinoma","justification":""},{"idx":4,"correct":false,"proposition":"Pancreatic adenoma","justification":""}],"ts":{"$numberLong":"1659649569778"},"type":"custom","difficulte":1}
-{"_id":"UGD-HGE-62b3ad3","context":null,"enonce":"In what proportion of cases, on average, does H. pylori infection progress to acute gastritis?","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"100%","justification":"Almost all HP infections progress to acute gastritis"},{"idx":1,"correct":false,"proposition":"50%","justification":""},{"idx":2,"correct":false,"proposition":"20%","justification":""},{"idx":3,"correct":false,"proposition":"5%","justification":""},{"idx":4,"correct":false,"proposition":"70%","justification":""}],"ts":{"$numberLong":"1659649576490"},"type":"custom","difficulte":1}
-{"_id":"UGD-HGE-7703c3b","context":null,"enonce":"Zollinger-Ellison syndrome is accompanied by a: (only one expected response)","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"Hypergastrenemia ","justification":""},{"idx":1,"correct":false,"proposition":"Hyperinsulinemia","justification":""},{"idx":2,"correct":false,"proposition":"Hyperglucagonemia","justification":""},{"idx":3,"correct":false,"proposition":"Hypersomatostatinemia","justification":""},{"idx":4,"correct":false,"proposition":"Peripheral hypercorticism","justification":""}],"ts":{"$numberLong":"1659649582790"},"type":"custom","difficulte":1}
-{"_id":"UGD-HGE-8787993","context":null,"enonce":"Which gastritis are at risk for gastric adenocarcinoma?","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"HP atrophic gastritis","justification":"Only atrophic gastritis is at risk of gastric adenocarcinoma"},{"idx":1,"correct":true,"proposition":"Biermer's disease (autoimmune atrophic gastritis)","justification":""},{"idx":2,"correct":false,"proposition":"Tuberculosis granulomatous gastritis","justification":""},{"idx":3,"correct":false,"proposition":"Idiopathic gastritis","justification":""},{"idx":4,"correct":false,"proposition":"Eosinophilic gastritis","justification":""}],"ts":{"$numberLong":"1659649585902"},"type":"custom","difficulte":2}
-{"_id":"UGD-HGE-b98c0f5","context":null,"enonce":"An ulcer, by definition, reaches up to: (only one expected response)","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"The Muscularous","justification":""},{"idx":1,"correct":false,"proposition":"submucosa","justification":"Ulceration "},{"idx":2,"correct":false,"proposition":"the mucosa ","justification":"Erosion "},{"idx":3,"correct":false,"proposition":"The Serous","justification":""},{"idx":4,"correct":false,"proposition":"None of these proposals are accurate","justification":""}],"ts":{"$numberLong":"1659649588649"},"type":"custom","difficulte":1}
-{"_id":"UGD-HGE-cb393e7","context":null,"enonce":"What is the preferred location of H. pylori in the stomach? (only one answer expected)","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"The lair","justification":""},{"idx":1,"correct":false,"proposition":"Fundus","justification":""},{"idx":2,"correct":false,"proposition":"The cardia","justification":""},{"idx":3,"correct":false,"proposition":"The pylorus","justification":""},{"idx":4,"correct":false,"proposition":"The body","justification":""}],"ts":{"$numberLong":"1659649602829"},"type":"custom","difficulte":1}
-{"_id":"UGD-HGE-e583b68","context":null,"enonce":"H. pylori infection in childhood occurs mainly by: (only one response expected)","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"Oral","justification":""},{"idx":1,"correct":false,"proposition":"Sexual","justification":""},{"idx":2,"correct":false,"proposition":"sanguine","justification":""},{"idx":3,"correct":false,"proposition":"matero-fetal","justification":""},{"idx":4,"correct":false,"proposition":"no exact proposal","justification":""}],"ts":{"$numberLong":"1659649607099"},"type":"custom","difficulte":1}
-{"_id":"ascite-HGE-b558070","context":null,"enonce":"In addition to evacuative punctures, the treatment of ascites is based on:","item":"ascite","matiere":"HGE","propositions":[{"idx":0,"correct":false,"proposition":"Sodium diet","justification":"to avoid because promotes undernutrition"},{"idx":1,"correct":false,"proposition":"Water restriction","justification":"No indication here"},{"idx":2,"correct":true,"proposition":"Low-sodium diet","justification":"True, to maintain for life"},{"idx":3,"correct":true,"proposition":"Spironolactone, or even furosemide in case of insufficient response","justification":"True, to decrease gradually when ascites is controlled, until a complete stop. To be resumed if ascites reappears."},{"idx":4,"correct":false,"proposition":"Hydroxychlorothiazide","justification":"No indication here"}],"ts":{"$numberLong":"1659649616775"},"type":"custom","difficulte":2}
-{"_id":"ACR-urg-c22021f","context":null,"enonce":"In xxx of the cases, cardiocirculatory arrest is related to a ventricular rhythm disorder. xxx corresponds to:\n","item":"ACR","matiere":"urg","propositions":[{"idx":0,"correct":false,"proposition":"100%","justification":""},{"idx":1,"correct":true,"proposition":"1\/3","justification":""},{"idx":2,"correct":false,"proposition":"0% (never)","justification":""},{"idx":3,"correct":false,"proposition":"2\/3","justification":""},{"idx":4,"correct":false,"proposition":"No proposition is true","justification":""}],"ts":{"$numberLong":"1659649630583"},"type":"custom","difficulte":2}
-{"_id":"IRespA-urg-5373e5c","context":null,"enonce":"What causes hypoxemia?","item":"IRespA","matiere":"urg","propositions":[{"idx":0,"correct":false,"proposition":"dead space","justification":"hypercapnia"},{"idx":1,"correct":true,"proposition":"Arterial hypoventilation","justification":""},{"idx":2,"correct":true,"proposition":"True shunt","justification":""},{"idx":3,"correct":true,"proposition":"shunt effect","justification":""},{"idx":4,"correct":true,"proposition":"Diffusion disorders","justification":""}],"ts":{"$numberLong":"1659649732742"},"type":"custom","difficulte":1}
-{"_id":"IRespA-urg-9e429fb","context":null,"enonce":"What are the different clinical signs of struggle to look for in favor of ARD?","item":"IRespA","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"Superficial polypnea","justification":"= Tachynea"},{"idx":1,"correct":true,"proposition":"Recruitment of accessory respiratory muscles","justification":"= Suprasternal, supraclavicular and intercostal draw"},{"idx":2,"correct":true,"proposition":"Active abdominal exhalation","justification":""},{"idx":3,"correct":true,"proposition":"Flapping of the nose ales","justification":""},{"idx":4,"correct":true,"proposition":"All propositions are true","justification":"Not to be confused with signs of bankruptcy:\n- Paradoxical abdominal breathing (= thoraco-abdominal swing);\n- Hypoxemia with cyanosis;\n- Hypercapnia with neurological impact (G < 15)"}],"ts":{"$numberLong":"1659649742962"},"type":"custom","difficulte":1}
-{"_id":"PNO-urg-57d6983","context":null,"enonce":"What advice should I give to patients with pneumothorax?","item":"PNO","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"Smoking cessation","justification":"tobacco = risk factor ++"},{"idx":1,"correct":false,"proposition":"Rest","justification":"No interest"},{"idx":2,"correct":false,"proposition":" limitation of physical activities","justification":"No interest"},{"idx":3,"correct":true,"proposition":" For flights in pressurized aircraft, a delay of 2 to 3 weeks is recommended after a PNO","justification":"without, however, formal proof of this period"},{"idx":4,"correct":true,"proposition":"definitive contraindication of diving if detection of bullous lesions in spontaneous PNO ATCD lengths","justification":""}],"ts":{"$numberLong":"1659649767393"},"type":"custom","difficulte":3}
-{"_id":"SCA-urg-36df92a","context":null,"enonce":"What are the treatments of a coronary patient after revascularization of an ST+ SCA? ","item":"SCA","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"Aspirin ","justification":""},{"idx":1,"correct":true,"proposition":"ACE inhibitor ","justification":""},{"idx":2,"correct":false,"proposition":"Calcium channel blocker","justification":"Not indicated: we are talking here about the famous C-BASIC ☺️"},{"idx":3,"correct":true,"proposition":"Statine ","justification":""},{"idx":4,"correct":true,"proposition":"P2Y12 inhibitor","justification":""}],"ts":{"$numberLong":"1659649803259"},"type":"custom","difficulte":1}
-{"_id":"anaphylaxie-urg-f833c07","context":null,"enonce":"Regarding Ring and Meisner's classification:","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"correct":false,"proposition":"Grade II = Mucocutaneous signs (urticaria, angioedema)","justification":"Grade I"},{"idx":1,"correct":false,"proposition":"Grade III = Moderate multi-organ involvement (mucocutaneous signs, respiratory tightness, tachycardia, hypotension < 20 mmHg)","justification":"Grade II"},{"idx":2,"correct":false,"proposition":"Grade IV = Severe multi-organ disease (respiratory distress, severe bronchospasm, laryngeal oedema, collapse, bradycardia)","justification":"Grade III"},{"idx":3,"correct":false,"proposition":"Grade I = Cardiac arrest","justification":"Grade IV"},{"idx":4,"correct":true,"proposition":"No proposition is true","justification":""}],"ts":{"$numberLong":"1659649813896"},"type":"custom","difficulte":1}
-{"_id":"choc-urg-882e4fc","context":null,"enonce":"What signs are in favor of a hypovolemic cause?","item":"choc","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"polytraumatized with abdominal pain and defense","justification":""},{"idx":1,"correct":true,"proposition":"Signs of extracellular dehydration","justification":""},{"idx":2,"correct":false,"proposition":"Increased pulsed pressure (PAs - PAd)","justification":""},{"idx":3,"correct":true,"proposition":"Decreased pulsed pressure (PAs - PAd)","justification":""},{"idx":4,"correct":true,"proposition":"Pallor","justification":""}],"ts":{"$numberLong":"1659649818295"},"type":"custom","difficulte":1}
-{"_id":"intox-urg-7c4d137","context":null,"enonce":"What are the clinical signs consistent with heroin poisoning?","item":"intox","matiere":"urg","propositions":[{"idx":0,"correct":false,"proposition":"Polypnea","justification":""},{"idx":1,"correct":false,"proposition":"Agitation","justification":""},{"idx":2,"correct":false,"proposition":"delirium","justification":""},{"idx":3,"correct":false,"proposition":"Hallucinations","justification":""},{"idx":4,"correct":true,"proposition":"None of these proposals","justification":"Hypotonic calm coma. Tight miosis. Bradypnea. This is common to benzodiazepine or opioid poisoning (such as heroin).\nConversely, SSRIs\/Tricyclics\/Atropine\/Cocaine\/Amphetamines cause restless coma with mydriasis, hypertonia and ROT vivid"}],"ts":{"$numberLong":"1659649823578"},"type":"custom","difficulte":1}
-{"_id":"polytrauma-urg-707af75","context":null,"enonce":"The hemodynamic profile of a severe burn is close to shock:","item":"polytrauma","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"hypovolemic ","justification":"by creating a third sector"},{"idx":1,"correct":false,"proposition":"septic","justification":""},{"idx":2,"correct":false,"proposition":"anaphylactic","justification":""},{"idx":3,"correct":false,"proposition":"cardiogenic","justification":""},{"idx":4,"correct":false,"proposition":"None of the proposals","justification":""}],"ts":{"$numberLong":"1659649836286"},"type":"custom","difficulte":1}
-{"_id":"260-nephro-16a8c6af-841a-4dad-b490-9df054b4ad99","context":null,"enonce":"It's 4am and you're called by internal medicine for a 50-year-old patient, with chronic alcoholism being weaned improvised by the patient. \n\nThe patient has rapidly deteriorated neurologically (GSC 4), he presents with respiratory failure with PaO2 52 mHg pCO2 60. \n\nOn biology you note: \n- Hb 7 g\/dL, VGM 93 fL, \n- Platelets 25 g \/ L, \n- Schizocytes with a smear,  \n- LDH 245, collapsed haptoglobin, \n- Acute renal failure with serum creatinine 235 \n- Normal vitamin B12, slightly decreased B9\n\nYou take him in intensive care and do the necessary resuscitatory measures\nAt D+2, while you are trying to lift the sedations to assess neurological functions, the patient has a seizure","item":"nephroPvascu","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Thrombotic microangiopathy is possible","justification":"TRUE. Mechanical hemolytic anemia with thrombocytopenia and acute renal failure + neurological picture. So it's quite possible!"},{"idx":1,"correct":true,"proposition":"A dosage of complement and ADAMTS13 is relevant","justification":"TRUE! - Supplement to know if it is consumed or not (especially in atypical HUS): mutations will cause endothelial lesions by deposition of pieces of supplements that wander. \n\n- ADAMTS13 is a metalloprotease that cleaves the Willebrand factor that wanders in small pieces in the microcirculation of organs. The problem... it is that these small pieces of Willebrand factor attach the platelets nearby --> Obstruction of the lumen of the vessels"},{"idx":2,"correct":true,"proposition":"Thrombotic microangiopathy is characterized by obstruction of the lumen of capillaries and arterioles","justification":"True. "},{"idx":3,"correct":false,"proposition":"HUS is characterized by a neurological picture in the 1st plane","justification":"FALSE! HUS = acute renal failure table"},{"idx":4,"correct":true,"proposition":"TTP is characterized by a neurological picture in the 1st plane","justification":"TRUE! TTP = neurological picture "}],"ts":{"$numberLong":"1659649967156"},"type":"custom","difficulte":3}
-{"_id":"266-nephro-6bc58133-150e-45fd-8a8e-6f40bdab76ea","context":null,"enonce":"What is found in the laboratory workup of primary hyperparathyroidism? ","item":"hyperCa","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Low phosphatemia","justification":"True, phosphatemia is low because PTH decreases phosphate reabsorption "},{"idx":1,"correct":false,"proposition":"High phosphatemia ","justification":"False, see proposal A"},{"idx":2,"correct":true,"proposition":"High calciuria ","justification":"True, because it is adapted to hypercalcemia caused by primary hyperparathyroidism"},{"idx":3,"correct":false,"proposition":"Low calciuria","justification":"False, see proposal B"},{"idx":4,"correct":false,"proposition":"Low serum calcium","justification":"False, in primary hyperparathyroidism, serum calcium is elevated "}],"ts":{"$numberLong":"1659649972639"},"type":"custom","difficulte":2}
-{"_id":"IRC-nephro-5b1867a","context":null,"enonce":"What disorders of phospho-calcium metabolism can be found in chronic renal failure?  ","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Secondary hyperparathyroidism","justification":"True"},{"idx":1,"correct":false,"proposition":"Hypercalcemia ","justification":"False hypocalcemia leading to secondary hyperparathyroidism "},{"idx":2,"correct":true,"proposition":"Hyperphosphatemia ","justification":"True, by decreasing renal excretion of phosphates"},{"idx":3,"correct":true,"proposition":"Vitamin D deficiency","justification":"True"},{"idx":4,"correct":false,"proposition":"Normophosphatemia ","justification":"False, hypophosphatemia "}],"ts":{"$numberLong":"1659649978785"},"type":"custom","difficulte":1}
-{"_id":"IRC-nephro-f5c1bb1","context":null,"enonce":"What can be the heart damage of chronic renal failure?","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Right ventricular hypertrophy ","justification":"False, left ventricular hypertrophy! "},{"idx":1,"correct":true,"proposition":"Coronary calcifications ","justification":"True"},{"idx":2,"correct":true,"proposition":"Valve calcifications ","justification":"True "},{"idx":3,"correct":true,"proposition":"Ischemic heart disease ","justification":"True"},{"idx":4,"correct":false,"proposition":"None of the previous proposals ","justification":""}],"ts":{"$numberLong":"1659650003078"},"type":"custom","difficulte":1}
-{"_id":"creatplus-nephro-3f88ac9","context":null,"enonce":"The CKD-EPI and MDRD formulas take these factors into account: ","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Age ","justification":"True "},{"idx":1,"correct":true,"proposition":"Ethnic group ","justification":"True "},{"idx":2,"correct":false,"proposition":"Weight ","justification":"False, it is the Cockcroft that takes into account the weight. Cachexia or obesity are not factors that are taken into account for the calculation of GFR by the CKD-Epi or MDRD formulas"},{"idx":3,"correct":true,"proposition":"Creatinine emia ","justification":"True "},{"idx":4,"correct":false,"proposition":"BMI ","justification":"False, for the same reason that weight is wrong"}],"ts":{"$numberLong":"1659650056794"},"type":"custom","difficulte":2}
-{"_id":"creatplus-nephro-5f05ddf","context":null,"enonce":"What are the arguments in favor of an AKI in the face of elevated serum creatinine? ","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Kidneys of decreased size ","justification":"False, rather in favor of an IRC "},{"idx":1,"correct":true,"proposition":"Recent elevation of serum creatinine ","justification":""},{"idx":2,"correct":true,"proposition":"Recent shock context ","justification":""},{"idx":3,"correct":false,"proposition":"History of kidney disease","justification":"False, rather in favor of an IRC "},{"idx":4,"correct":false,"proposition":"Normochrome normocytic aregenerative anemia ","justification":"False, rather in favor of CKD except in the case of hemolytic uremic syndrome or hemorrhagic shock"}],"ts":{"$numberLong":"1659650060722"},"type":"custom","difficulte":1}
-{"_id":"creatplus-nephro-633c494","context":null,"enonce":"What parameters are taken into account in the calculation of GFR by the CKD-PPE formula? ","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Age","justification":""},{"idx":1,"correct":false,"proposition":"Weight ","justification":"False, not used for MDRD and CKD-PPE, but it is used in Cockcroft and Gault's formula "},{"idx":2,"correct":true,"proposition":"Ethnic group ","justification":""},{"idx":3,"correct":true,"proposition":"Creatinine emia ","justification":""},{"idx":4,"correct":true,"proposition":"Sex","justification":""}],"ts":{"$numberLong":"1659650063817"},"type":"custom","difficulte":1}
-{"_id":"creatplus-nephro-66d0c1d","context":null,"enonce":"What CKDs can occur with large or normal sized kidneys?","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Autosomal dominant polycystic disease","justification":""},{"idx":1,"correct":false,"proposition":"Hemorrhagic shock ","justification":"False, cause of acute renal failure with anemia "},{"idx":2,"correct":true,"proposition":"Diabetes ","justification":"Common cause ++"},{"idx":3,"correct":false,"proposition":"Sepsis ","justification":"False, cause of IRA"},{"idx":4,"correct":true,"proposition":"Amylose","justification":""}],"ts":{"$numberLong":"1659650067235"},"type":"custom","difficulte":2}
-{"_id":"creatplus-nephro-6f3dade","context":null,"enonce":"In which cases can I have CKD without hypocalcemia?","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Rhabdomyolysis ","justification":"False, cause of AKI with hypocalcemia "},{"idx":1,"correct":true,"proposition":"Myeloma ","justification":""},{"idx":2,"correct":false,"proposition":"Tumor lysis syndrome","justification":"False, cause of AKI with hypocalcemia "},{"idx":3,"correct":false,"proposition":"HIV-associated kidney disease","justification":"False, gives rather CKD with large kidneys but with hypocalcemia "},{"idx":4,"correct":true,"proposition":"Sarcoidosis ","justification":""}],"ts":{"$numberLong":"1659650070642"},"type":"custom","difficulte":2}
-{"_id":"creatplus-nephro-d092d39","context":null,"enonce":"In which cases is it not possible to estimate GFR by MDRD and CKD-PPE? ","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"In children ","justification":"True, use of Schwartz's formula up to about 15 years (the exact age varies in practice depending on the morphology)"},{"idx":1,"correct":true,"proposition":"In a subject with decompensated hepatic cirrhosis","justification":"This situation is conducive to acute renal failure (first functional and then organic if not managed) which makes the calculation of GFR not recommended"},{"idx":2,"correct":true,"proposition":"In an amputee","justification":"True, because significant muscular atrophy "},{"idx":3,"correct":true,"proposition":"In a pregnant woman","justification":"The GFR is physiologically changed in pregnant women, the calculation by these formulas will find an underestimated result"},{"idx":4,"correct":true,"proposition":"In a quadriplegic subject ","justification":""}],"ts":{"$numberLong":"1659650222786"},"type":"custom","difficulte":1}
-{"_id":"hyperCa-nephro-79edce6","context":null,"enonce":"What are the causes explaining, between them, 80% of hypercalcemia?\n","item":"hyperCa","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Neoplasia","justification":""},{"idx":1,"correct":false,"proposition":"granulomatosis","justification":"Rarer"},{"idx":2,"correct":true,"proposition":"hyperparathyroidism","justification":""},{"idx":3,"correct":false,"proposition":"hypothyroidism","justification":"No hypercalcemia classically"},{"idx":4,"correct":false,"proposition":"vitamin D poisoning","justification":"Very rare"}],"ts":{"$numberLong":"1659650228674"},"type":"custom","difficulte":1}
-{"_id":"tbiono-nephro-0e8c009","context":null,"enonce":"Natrimia:","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Is increased in case of edema","justification":""},{"idx":1,"correct":false,"proposition":"Is decreased in case of edema","justification":"Edema are markers of extracellular hydration status (HEC: extracellular hyperhydration). Since natremia is an indicator of intracellular hydration status, it is not influenced by the absence or presence of edema."},{"idx":2,"correct":true,"proposition":"Is increased in case of intracellular dehydration","justification":""},{"idx":3,"correct":false,"proposition":"Is decreased in case of intracellular dehydration","justification":""},{"idx":4,"correct":true,"proposition":"Provides information on extracellular osmolarity","justification":"Indeed, to calculate the extracellular osmolarity, the formula is used: Osm = 2Na + Glucose (normal: 285 mOsm \/ L)"}],"ts":{"$numberLong":"1659650233555"},"type":"custom","difficulte":1}
-{"_id":"tbiono-nephro-12e59dc","context":null,"enonce":"What causes ketoacidosis? ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Biguanide poisoning ","justification":"False, responsible for lactic acidosis "},{"idx":1,"correct":true,"proposition":"Alcohol ","justification":""},{"idx":2,"correct":true,"proposition":"Fasting ","justification":""},{"idx":3,"correct":true,"proposition":"Diabetes ","justification":""},{"idx":4,"correct":false,"proposition":"Methanol poisoning ","justification":"False, is not responsible for ketoacidosis "}],"ts":{"$numberLong":"1659650243958"},"type":"custom","difficulte":1}
-{"_id":"tbiono-nephro-388e646","context":null,"enonce":"What abnormalities are in favor of ketoacidosis? ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Positive urinary anion hole ","justification":"False, the urinary anion hole is not used during metabolic acidosis with indosed substances "},{"idx":1,"correct":false,"proposition":"Normal plasma anion hole ","justification":"False, the plasma anion hole is increased "},{"idx":2,"correct":true,"proposition":"Positive ketone ","justification":""},{"idx":3,"correct":true,"proposition":"Increased plasma anion hole ","justification":""},{"idx":4,"correct":true,"proposition":"Ketonurie","justification":""}],"ts":{"$numberLong":"1659650246660"},"type":"custom","difficulte":1}
-{"_id":"tbiono-nephro-7380a56","context":null,"enonce":"Which blood gas elements support hyperchloremic metabolic acidosis of tubular origin? (one or more exact propositions)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Normal plasma anion hole","justification":""},{"idx":1,"correct":false,"proposition":"Negative urinary anion hole ","justification":"False, it is negative when the origin is digestive. Here the urinary anion hole must be positive "},{"idx":2,"correct":false,"proposition":"PCO2 at 50 mmHg ","justification":"False, PCO2 in metabolic acidosis is decreased to compensate "},{"idx":3,"correct":false,"proposition":"Bicarbonates at 35 mmol\/L","justification":"False, bicarbonate is decreased in metabolic acidosis "},{"idx":4,"correct":true,"proposition":"Arterial pH = 7.35","justification":"True, the pH to be in acidosis must be less than 7.38"}],"ts":{"$numberLong":"1659650275135"},"type":"custom","difficulte":1}
-{"_id":"tbiono-nephro-8389ace","context":null,"enonce":"Are signs of hyperkalemia on ECG: (one or more exact proposals)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"QT prolongation","justification":"QT is unchanged in hyperkalemia"},{"idx":1,"correct":true,"proposition":"Atrioventricular block","justification":"Type 1 (PR elongation)"},{"idx":2,"correct":true,"proposition":"Atrioventricular block","justification":"The pointed head (pointed T waves) of the grandfather (elongation of the PR) widens the priest (widening of the QRS) without his fart (disappearance of the P wave)."},{"idx":3,"correct":true,"proposition":"Ventricular fibrillation","justification":""},{"idx":4,"correct":false,"proposition":"U-waves","justification":"Hypokalemia"}],"ts":{"$numberLong":"1659650293572"},"type":"custom","difficulte":1}
-{"_id":"tbiono-nephro-892a38f","context":null,"enonce":"Water constitutes about X of the weight in an adult: (one or more exact propositions)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"40%","justification":""},{"idx":1,"correct":false,"proposition":"50%","justification":""},{"idx":2,"correct":false,"proposition":"90%","justification":""},{"idx":3,"correct":true,"proposition":"60%","justification":"You won't forget it like that 🤗"},{"idx":4,"correct":false,"proposition":"80%","justification":""}],"ts":{"$numberLong":"1659650301217"},"type":"custom","difficulte":1}
-{"_id":"tbiono-nephro-92f7ba9","context":null,"enonce":"Regarding proximal tubular acidosis type 2? (one or more exact propositions)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"It is due to a defect in proximal secretion of bicarbonates ","justification":"False, proximal tubular reabsorption defect of bicarbonates"},{"idx":1,"correct":true,"proposition":"The anionic hole is little modified ","justification":""},{"idx":2,"correct":true,"proposition":"We can find phospho-gluco-amino diabetes ","justification":"True, it's Fanconi syndrome "},{"idx":3,"correct":true,"proposition":"Acetazolamide may be responsible ","justification":""},{"idx":4,"correct":false,"proposition":"Potassium is increased","justification":"False, it is low and is aggravated by the contribution of alkaline "}],"ts":{"$numberLong":"1659650308279"},"type":"custom","difficulte":2}
-{"_id":"tbiono-nephro-a768686","context":null,"enonce":"What are the abnormalities found in respiratory acidosis being compensated? (one or more exact propositions)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Arterial pH = 7.45","justification":"False, it is an alkalosis "},{"idx":1,"correct":true,"proposition":"Venous pH = 7.36","justification":""},{"idx":2,"correct":false,"proposition":"Bicarbonate = 21 mmol\/L","justification":"False, decreased bicarbonate in metabolic acidosis "},{"idx":3,"correct":true,"proposition":"PCO2 = 50 mmHg","justification":"True, increased PCO2 by hypoventilation "},{"idx":4,"correct":false,"proposition":"None of the previous proposals true ","justification":""}],"ts":{"$numberLong":"1659650314676"},"type":"custom","difficulte":1}
-{"_id":"tbiono-nephro-cd9edaf","context":null,"enonce":"Which of the etiologies responsible for hypotonic hyponatremia (< 285 mOsm\/L), which is (are) associated with a normal extracellular hydration state? (one or more exact propositions)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Nephrotic syndrome","justification":"The extracellular compartment is increased, with the presence of edema, ascites, pleurisy, pegardic effusion, etc."},{"idx":1,"correct":false,"proposition":"Chronic diarrhea","justification":"The extracellular compartment is decreased. We have dehydration (skin fold, hypotension, tachycardia, ...)"},{"idx":2,"correct":true,"proposition":"Hypocortisolism","justification":"These are the three causes to know hyponatremia (Na < 135) hypotonic hypotonic (Osm < 285) with normal extracellular sector (no edema, no skin fold)."},{"idx":3,"correct":true,"proposition":"SIADH","justification":""},{"idx":4,"correct":true,"proposition":"Hypothyroidism","justification":""}],"ts":{"$numberLong":"1659650321310"},"type":"custom","difficulte":1}
-{"_id":"tbiono-nephro-dbe9188","context":null,"enonce":"A repetitive discharge of muscle fibers (in a muscle disease) or neurons (in epilepsy) can be caused by several situations. Which? (one or more exact propositions)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"A failure to activate Na+ channels","justification":"To be in a situation of repetitive discharge, the membrane potential must increase. So whether there is an exit of the anions, or an entry of the cations (to go from -70, i.e. the basic membrane potential, to a higher potential). So we want to open the K+ channels, lower the operation of the Na+\/K+ pump, close the Cl- channels."},{"idx":1,"correct":true,"proposition":"A lack of inactivation of Na+ channels","justification":""},{"idx":2,"correct":true,"proposition":"A failure to activate K+ channels","justification":"True. If the K+ channels no longer open, the K+ remains in the cell and increases the membrane potential"},{"idx":3,"correct":false,"proposition":"A K+ channel inactivation defect","justification":"If the K+ channels remain open, all the K+ will come out, there will be much fewer cations in the cell, the membrane potential will decrease"},{"idx":4,"correct":true,"proposition":"A lack of permeability of Cl- channels","justification":"True, the lower the Cl- enters, the less the membrane potential decreases."}],"ts":{"$numberLong":"1659650332049"},"type":"custom","difficulte":2}
-{"_id":"tbiono-nephro-e955e06","context":null,"enonce":"How to tell the difference between potomania and diabetes insipidus? (one or more exact propositions)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"DHA test ","justification":"If diabetes insipidus is peripheral, it's not going to change anything"},{"idx":1,"correct":false,"proposition":"Diuretic test","justification":""},{"idx":2,"correct":true,"proposition":"Fluid restriction test","justification":"True. If polyuria stops: potomania. Otherwise: diabetes insipidus."},{"idx":3,"correct":false,"proposition":"Troponin Determination","justification":""},{"idx":4,"correct":false,"proposition":"Insulin hypoglycemia","justification":""}],"ts":{"$numberLong":"1659650338384"},"type":"custom","difficulte":2}
-{"_id":"tbiono-nephro-f0e8ff6","context":null,"enonce":"What changes can lead to membrane hyperpolarization? (one or more exact propositions)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Increased Na+\/K+ ATPase pump activity","justification":"True"},{"idx":1,"correct":false,"proposition":"Opening of Na+ channels","justification":"The opening of the Na+ channels causes Na+ to enter the cell, which participates in depolarization. "},{"idx":2,"correct":true,"proposition":"Opening of K+ channels","justification":"True. Hyperpolarization is an increase in the absolute value of the membrane voltage = the membrane potential becomes super negative. In general, a normal resting potential is considered to be around -70 mV. For it to decrease even more, it is necessary: either that there is an exit of cations (i.e. K+ or Na+) or that there is an entry of anions (i.e. Cl-). For potassium to leave the cell, there must be an opening of the K+ channels (the ions come out on their own because they are much more concentrated in the cell than outside). For the Na+ to come out, the Na+\/K+ ATP pump must work more (it brings out Na+ to bring in K+).\n\n"},{"idx":3,"correct":false,"proposition":"Channel fitting Cl-","justification":"The anions (chlorine) would have to enter the cell to increase the anions and thus lower the membrane potential, making the cell hyper-polarized"},{"idx":4,"correct":false,"proposition":"Hypothermia","justification":""}],"ts":{"$numberLong":"1659650346073"},"type":"custom","difficulte":3}
-{"_id":"tbiono-nephro-fd49e86","context":null,"enonce":"What are the signs of intracellular hyperhydration? (one or more exact propositions)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Jugular turgor","justification":"It is a sign of extracellular hyperhydration"},{"idx":1,"correct":true,"proposition":"Headache","justification":""},{"idx":2,"correct":true,"proposition":"Impaired alertness","justification":""},{"idx":3,"correct":false,"proposition":"Ascites","justification":"It is a sign of extracellular hyperhydration"},{"idx":4,"correct":true,"proposition":"Epileptic seizure","justification":""}],"ts":{"$numberLong":"1659650352500"},"type":"custom","difficulte":1}
-{"_id":"rhumcrist-rhumato-0211898","context":null,"enonce":"You receive in consultation Mr DESBOIS Robin, 76 years old, who describes himself as a \"bon vivant\". He limps when he arrives at your consultation and has his right foot bare. He says that the pain started in the middle of the night, and that since then he throws him, whether he walks or not. You examine it and brilliantly diagnose a first attack of gout on the 1st metatarsophalangeal, which you treat just as well. You see him again two weeks later at your consultation, to talk to him about the rest. What are the real propositions? (one or more exact propositions)  ","item":"rhumcrist","matiere":"rhumato","propositions":[{"idx":0,"correct":false,"proposition":"In this patient, you need to wait for 2 gout attacks before introducing treatment","justification":"False, hypouricemic treatment is introduced at the first gout attack"},{"idx":1,"correct":true,"proposition":"Foods rich in uric acid are organ meats and seafood","justification":"True, foods rich in purines and suppliers of uric acids are organ meats, brewer's yeast, seafood, tea, strong alcohol, sodas and beer even without alcohol."},{"idx":2,"correct":false,"proposition":"This patient is advised to stop beer, but he can continue non-alcoholic beer.","justification":"False, cf. B."},{"idx":3,"correct":false,"proposition":"If treatment is introduced, the uric acid target will be 70mg\/L","justification":"The target is 60mg\/L one of the few standards that we must know by heart!"},{"idx":4,"correct":true,"proposition":"In this patient we will choose Allopurinol or Febuxostat as background treatment","justification":"True, these are the two background treatment options"}],"ts":{"$numberLong":"1659650374745"},"type":"custom","difficulte":2}
-{"_id":"rhumcrist-rhumato-b751e4a","context":null,"enonce":"You have introduced a background treatment with ALLOPURINOL, and you explain to the patient the side effects of this treatment and in particular serious side effects, requiring a consultation in the emergency room. Which of the side effects described below may be attributable to ALLOPURINOL? (one or more exact propositions)  ","item":"rhumcrist","matiere":"rhumato","propositions":[{"idx":0,"correct":false,"proposition":"Kaposi's syndrome","justification":"False, Distractor"},{"idx":1,"correct":true,"proposition":"Syndrome de Lyell","justification":"True, there is a concern for a serious allergic reaction during treatment with ALLOPURINOL. These are not the only side effects (neutropenia, digestive disorders), but they are essential to remember"},{"idx":2,"correct":false,"proposition":"Lofgren's syndrome","justification":"False, Distractor"},{"idx":3,"correct":false,"proposition":"Syndrome de Sézary","justification":"False, Distractor"},{"idx":4,"correct":true,"proposition":"Syndrome de Stevens Johnson","justification":"True, there is a concern for a serious allergic reaction during treatment with ALLOPURINOL. These are not the only side effects (neutropenia, digestive disorders), but they are essential to remember"}],"ts":{"$numberLong":"1659650384512"},"type":"custom","difficulte":2}
-{"_id":"BPCO-pneumo-037abca","context":null,"enonce":"In which cases may alpha-1-antitrypsin be indicated? (one or more exact propositions)  ","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Early COPD (before age 45)","justification":""},{"idx":1,"correct":false,"proposition":"Smoking COPD ","justification":"COPD with little or no smoking "},{"idx":2,"correct":true,"proposition":"Family history of emphysema ","justification":""},{"idx":3,"correct":false,"proposition":"Predominant bronchitis phenotype ","justification":"Predominant emphysema phenotype "},{"idx":4,"correct":false,"proposition":"None of the previous answers are true ","justification":""}],"ts":{"$numberLong":"1659650395071"},"type":"custom","difficulte":2}
-{"_id":"BPCO-pneumo-0e64030","context":null,"enonce":"What non-drug measures are indicated for the treatment of COPD? (one or more exact propositions)  ","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"Pneumococcal vaccination ","justification":"False, drug measure "},{"idx":1,"correct":true,"proposition":"Adapted physical activity ","justification":""},{"idx":2,"correct":true,"proposition":"Smoking cessation ","justification":""},{"idx":3,"correct":false,"proposition":"Short-acting bronchodilators if dyspnea ","justification":"False, drug measure "},{"idx":4,"correct":true,"proposition":"Bronchial drainage physiotherapy ","justification":""}],"ts":{"$numberLong":"1659650401886"},"type":"custom","difficulte":1}
-{"_id":"BPCO-pneumo-41274c6","context":null,"enonce":"What are the differential diagnoses of COPD? (one or more exact propositions)  ","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Asthma ","justification":""},{"idx":1,"correct":false,"proposition":"Pulmonary fibrosis ","justification":""},{"idx":2,"correct":true,"proposition":"Cystic fibrosis","justification":""},{"idx":3,"correct":true,"proposition":"Dilation of the bronchi ","justification":""},{"idx":4,"correct":false,"proposition":"All previous answers are true ","justification":""}],"ts":{"$numberLong":"1659650407801"},"type":"custom","difficulte":1}
-{"_id":"BPCO-pneumo-6c99d7c","context":null,"enonce":"Which antibiotics are used as a 1st line in an exacerbation of COPD? (one or more exact propositions)  ","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Amoxicillin - clavulanic acid ","justification":""},{"idx":1,"correct":false,"proposition":"3rd generation cephalosporins ","justification":"Reserved for special cases, not systematic "},{"idx":2,"correct":true,"proposition":"Pristamycin ","justification":""},{"idx":3,"correct":true,"proposition":"Macrolides ","justification":""},{"idx":4,"correct":false,"proposition":"Fluoroquinolones active on pneumococcus ","justification":"Reserved for special cases, not systematic "}],"ts":{"$numberLong":"1659650415491"},"type":"custom","difficulte":1}
-{"_id":"BPCO-pneumo-8145f7a","context":null,"enonce":"What are the possible treatments for COPD? (one or more exact propositions)  ","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Beta-2 bronchodilators agonists ","justification":""},{"idx":1,"correct":false,"proposition":"Antitussives ","justification":"NO interest in COPD"},{"idx":2,"correct":true,"proposition":"Anticholinergic ","justification":""},{"idx":3,"correct":false,"proposition":"Anti-leukotrienes ","justification":"NO interest in COPD"},{"idx":4,"correct":true,"proposition":"Corticosteroids","justification":""}],"ts":{"$numberLong":"1659650421687"},"type":"custom","difficulte":1}
-{"_id":"BPCO-pneumo-96b95e9","context":null,"enonce":"What results of EFR can be found in COPD? (one or more exact propositions)  ","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"FEV1\/FVC < 0.7 prebronchodilator ","justification":""},{"idx":1,"correct":false,"proposition":"FEV1\/FVC > 0.7 post-bronchodilator ","justification":"False, rather found in asthma which is a reversible TVO "},{"idx":2,"correct":true,"proposition":"FEV1\/ FVC < 0.7 post bronchodilator ","justification":""},{"idx":3,"correct":true,"proposition":"CPT> 120% ","justification":"CPT> 120% defines chest distention, possibly found in COPD "},{"idx":4,"correct":false,"proposition":"CPT < 80% ","justification":"CPT< 80% defines a TVR! COPD is an ORT "}],"ts":{"$numberLong":"1659650428957"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-24e9115","context":null,"enonce":"What is the systematic screening offered for any pneumonia? (only one answer expected)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"HIV","justification":""},{"idx":1,"correct":false,"proposition":"EBV","justification":""},{"idx":2,"correct":false,"proposition":"HPV","justification":""},{"idx":3,"correct":false,"proposition":"CMV","justification":""},{"idx":4,"correct":false,"proposition":"HHV6","justification":""}],"ts":{"$numberLong":"1659650434110"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-39d3126","context":null,"enonce":"What are the 3 criteria for hospitalization of bronchiolitis? (HAS 2019, included in the College of Pediatrics 2021)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"age < 8 weeks","justification":""},{"idx":1,"correct":true,"proposition":"SaO2< 92%","justification":""},{"idx":2,"correct":true,"proposition":"Feeding difficulties","justification":""},{"idx":3,"correct":false,"proposition":"respiratory rate greater than 30 per minute","justification":"No cut-off for respiratory rate in 2021 College of Pediatrics"},{"idx":4,"correct":false,"proposition":"heart rate greater than 150 per minute","justification":"No cut-off for heart rate in 2021 College of Pediatrics"}],"ts":{"$numberLong":"1659650440957"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-583248f","context":null,"enonce":"What germs can cause community-acquired acute pneumonia? (one or more exact propositions)  ","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"SARS-CoV2","justification":""},{"idx":1,"correct":true,"proposition":"Streptococcus pneumoniae ","justification":""},{"idx":2,"correct":true,"proposition":"Chlamydophila psittaci","justification":""},{"idx":3,"correct":true,"proposition":"Legionnella pneumoniae ","justification":""},{"idx":4,"correct":true,"proposition":"VRS ","justification":""}],"ts":{"$numberLong":"1659650451510"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-6e0267f","context":null,"enonce":"From what age can we no longer talk about bronchiolitis? (only one answer expected)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"12 months","justification":""},{"idx":1,"correct":false,"proposition":"24 months","justification":""},{"idx":2,"correct":true,"proposition":"36 months","justification":"From three years old 👼"},{"idx":3,"correct":false,"proposition":"4 years","justification":""},{"idx":4,"correct":false,"proposition":"5 years","justification":""}],"ts":{"$numberLong":"1659650462231"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-6ea47c9","context":null,"enonce":"What are the four different causes of excavated pneumonia?","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Bronchial cancer","justification":""},{"idx":1,"correct":true,"proposition":"Tuberculosis","justification":""},{"idx":2,"correct":true,"proposition":"Aspergillosis","justification":""},{"idx":3,"correct":true,"proposition":"Histoplasmosis","justification":"It is a fungus of the sweet name of Histoplasma capsulatum "},{"idx":4,"correct":false,"proposition":"Staphylococcal","justification":""}],"ts":{"$numberLong":"1659650473662"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-82ed9d6","context":null,"enonce":"What are the two treatments of choice for a CAP by superinfection of influenza?\n","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Augmentin ","justification":"to touch Staph Aureus"},{"idx":1,"correct":true,"proposition":"C3G IV","justification":"to touch Staph Aureus"},{"idx":2,"correct":false,"proposition":"Amoxicillin","justification":""},{"idx":3,"correct":false,"proposition":"Macrolides","justification":""},{"idx":4,"correct":false,"proposition":"Fluoroquinolones","justification":""}],"ts":{"$numberLong":"1659650479395"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-8d57dcd","context":null,"enonce":"What are the 3 entities of adult community lower respiratory infections?","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Acute bronchitis ","justification":""},{"idx":1,"correct":true,"proposition":"Acute exacerbation of COPD","justification":""},{"idx":2,"correct":true,"proposition":"Community-acquired acute pneumonia ","justification":""},{"idx":3,"correct":false,"proposition":"Acute ventilator-related pneumonia ","justification":"False, nosocomial infection! "},{"idx":4,"correct":false,"proposition":"None of the previous answers ","justification":""}],"ts":{"$numberLong":"1659650489532"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-9a78142","context":null,"enonce":"What clinical signs support acute bronchitis? (one or more exact propositions)  ","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Dry then productive cough ","justification":""},{"idx":1,"correct":true,"proposition":"Bronchial rails ","justification":""},{"idx":2,"correct":false,"proposition":"Crackling moans in a hearth ","justification":"Their absence is an important negative sign "},{"idx":3,"correct":true,"proposition":"No polypnea ","justification":""},{"idx":4,"correct":false,"proposition":"Dyspnoea ","justification":"No dyspnea, no physical signs usually apart from fever and viral symptoms "}],"ts":{"$numberLong":"1659650495692"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-b83bbef","context":null,"enonce":"What is the probabilistic antibiotic combination of choice in ICU\/REA of a CAP in a non-immunocompromised patient? (only one exact answer)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"C3G + Macrolide IV","justification":""},{"idx":1,"correct":false,"proposition":"Piperacillin-Tazobactam + Carbapenem","justification":"This is a relatively useless combination since it covers the same germs"},{"idx":2,"correct":false,"proposition":"Carbapenem + Macrolide IV","justification":"This combination targets P. aeruginosa. It is therefore only put in place in case of risk factors (bronchiectasis, bronchial dilation, cystic fibrosis, immunosuppression, ...)"},{"idx":3,"correct":false,"proposition":"C3G + Macrolide IV + Cotrimoxazole","justification":"Cotrimoxazole is added for immunosuppression only."},{"idx":4,"correct":false,"proposition":"Augmentin","justification":"It is the antibiotic of choice for the elderly (outpatient or hospitalized)"}],"ts":{"$numberLong":"1659650507742"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-dbe42ea","context":null,"enonce":"What are the treatments for acute bronchitis in healthy adults? (one or more exact propositions)  ","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Antipyretics ","justification":"In particular paracetamol "},{"idx":1,"correct":false,"proposition":"Antibiotics ","justification":"Absence of antibiotics as a rule "},{"idx":2,"correct":false,"proposition":"Corticosteroids ","justification":"Not recommended and potentially harmful"},{"idx":3,"correct":false,"proposition":"NSAIDs ","justification":"Not recommended and potentially harmful"},{"idx":4,"correct":false,"proposition":"Expectorants ","justification":"Not recommended and potentially harmful"}],"ts":{"$numberLong":"1659650523344"},"type":"custom","difficulte":1}
-{"_id":"IBP-pneumo-e7bd581","context":null,"enonce":"What are the criteria for CRB 65? (one or more exact propositions)  ","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Confusion ","justification":""},{"idx":1,"correct":false,"proposition":"Heart rate> 100 bpm ","justification":"No heart rate in this score! "},{"idx":2,"correct":false,"proposition":"Respiratory rate≥ 22\/min ","justification":"FR ≥ 30\/min "},{"idx":3,"correct":true,"proposition":"Age ≥ 65 ","justification":""},{"idx":4,"correct":true,"proposition":"PITCH < 90 mmHg or PAD ≤ 60 mmHg ","justification":""}],"ts":{"$numberLong":"1659650533064"},"type":"custom","difficulte":1}
-{"_id":"IRespiC-pneumo-6c04b76","context":null,"enonce":"What consequences can chronic respiratory failure have? (one or more exact propositions)  ","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Increased risk of thrombosis ","justification":"Chronic hypoxemia is compensated by polycythemia that leads to blood hyperviscosity and an increased risk of thrombosis "},{"idx":1,"correct":true,"proposition":"Edema ","justification":"Declated oedema due to fluid retention attributed to an abnormality in the regulation of natriuretic factor or as a result of pulmonary hypertension "},{"idx":2,"correct":true,"proposition":"Pulmonary hypertension ","justification":""},{"idx":3,"correct":true,"proposition":"Acute respiratory failure ","justification":"Due to decompensation of chronic respiratory failure "},{"idx":4,"correct":false,"proposition":"Anaemia ","justification":""}],"ts":{"$numberLong":"1659650539209"},"type":"custom","difficulte":2}
-{"_id":"IRespiC-pneumo-6e486d5","context":null,"enonce":"What etiologies of chronic respiratory failure are RVCs? (one or more exact propositions)  ","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"Cystic fibrosis ","justification":"Mixed disorder: restrictive and obstructive "},{"idx":1,"correct":true,"proposition":"Obesity hypoventilation syndrome ","justification":""},{"idx":2,"correct":true,"proposition":"Kyphoscoliosis ","justification":""},{"idx":3,"correct":true,"proposition":"Myasthenia ","justification":""},{"idx":4,"correct":true,"proposition":"Idiopathic pulmonary fibrosis ","justification":""}],"ts":{"$numberLong":"1659650549235"},"type":"custom","difficulte":1}
-{"_id":"IRespiC-pneumo-8523434","context":null,"enonce":"Which etiologies of respiratory failure are mixed ventilatory disorders? (two answers expected)","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"COPD ","justification":"False, it's a TVO! "},{"idx":1,"correct":false,"proposition":"Amyotrophic lateral sclerosis ","justification":"False, it's a TVR! "},{"idx":2,"correct":true,"proposition":"Dilation of the extensive bronchi ","justification":""},{"idx":3,"correct":false,"proposition":"Poliomyelitis ","justification":"False, it's a TVR! "},{"idx":4,"correct":true,"proposition":"Cystic fibrosis","justification":""}],"ts":{"$numberLong":"1659650561099"},"type":"custom","difficulte":1}
-{"_id":"IRespiC-pneumo-98df853","context":null,"enonce":"What are the main causes of exacerbation of chronic respiratory failure? (one or more exact propositions)  ","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Bronchitis ","justification":"The 3 main causes of exacerbation to look for: \n- Lower respiratory infections: pneumonia, bronchitis \n- Dysfunction of the left ventricle (pulmonary edema) and rhythm disorders \n-Pulmonary embolism "},{"idx":1,"correct":true,"proposition":"Pulmonary embolism ","justification":""},{"idx":2,"correct":true,"proposition":"Heart rhythm disorders ","justification":""},{"idx":3,"correct":true,"proposition":"Pulmonary edema ","justification":""},{"idx":4,"correct":true,"proposition":"Pneumonia ","justification":""}],"ts":{"$numberLong":"1659650570317"},"type":"custom","difficulte":1}
-{"_id":"IRespiC-pneumo-ba39f89","context":null,"enonce":"What are the treatments for chronic respiratory failure? (one or more exact propositions)  ","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Long-term oxygen therapy ","justification":""},{"idx":1,"correct":true,"proposition":"Non-invasive ventilation ","justification":""},{"idx":2,"correct":true,"proposition":"Smoking cessation","justification":""},{"idx":3,"correct":true,"proposition":"Respiratory rehabilitation ","justification":""},{"idx":4,"correct":false,"proposition":"None of the answers ","justification":""}],"ts":{"$numberLong":"1659650576332"},"type":"custom","difficulte":1}
-{"_id":"dyspnee-pneumo-0bfedf5","context":null,"enonce":"Which of the following conditions are etiologies of acute dyspnea (and not chronic dyspnea)? (one or more exact propositions)  ","item":"dyspnee","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"COPD","justification":"Chronic dyspnea"},{"idx":1,"correct":true,"proposition":"Obstruction of the upper airway by a foreign body ","justification":""},{"idx":2,"correct":true,"proposition":"Pulmonary embolism ","justification":""},{"idx":3,"correct":false,"proposition":"Emphysema ","justification":"Chronic dyspnea"},{"idx":4,"correct":false,"proposition":"None of the previous proposals ","justification":""}],"ts":{"$numberLong":"1659650615477"},"type":"custom","difficulte":1}
-{"_id":"asthme-immuno-ef46d3c","context":null,"enonce":"What is the prevalence of asthma in adults in France? ","item":"asthme","matiere":"immuno","propositions":[{"idx":0,"correct":false,"proposition":"50% ","justification":""},{"idx":1,"correct":false,"proposition":"12% ","justification":""},{"idx":2,"correct":false,"proposition":"24% ","justification":""},{"idx":3,"correct":true,"proposition":"6% ","justification":"True. "},{"idx":4,"correct":false,"proposition":"80% ","justification":""}],"ts":{"$numberLong":"1659650632987"},"type":"custom","difficulte":2}
-{"_id":"RCIU-gyn-5e29e10","context":null,"enonce":"What is the proportion of disharmonious IUGR?","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"correct":false,"proposition":"20 %","justification":"This is the proportion of IUGR harmonious"},{"idx":1,"correct":false,"proposition":"30 %","justification":""},{"idx":2,"correct":false,"proposition":"50 %","justification":""},{"idx":3,"correct":false,"proposition":"5 %","justification":""},{"idx":4,"correct":true,"proposition":"80 %","justification":"True"}],"ts":{"$numberLong":"1659653661045"},"type":"custom","difficulte":1}
-{"_id":"RCIU-gyn-69330e9","context":null,"enonce":"What is Manning's score for?","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"correct":true,"proposition":"Studying fetal distress","justification":"True"},{"idx":1,"correct":false,"proposition":"Look for oligohydramnios","justification":"Is done on ultrasound by quantifying amniotic fluid"},{"idx":2,"correct":false,"proposition":"Looking for placental insufficiency","justification":"Is done with Doppler of the uterine arteries"},{"idx":3,"correct":false,"proposition":"Looking for an increase in placental resistance","justification":"Fetal umbilical Doppler"},{"idx":4,"correct":false,"proposition":"Looking for brain sparing secondary to hypoxia","justification":"Fetal cerebral Doppler"}],"ts":{"$numberLong":"1659653665810"},"type":"custom","difficulte":3}
-{"_id":"grossessepatho-gyn-1caf0d8","context":null,"enonce":"How many AS is Rophylac injected in Rh- patients?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"correct":false,"proposition":"12","justification":""},{"idx":1,"correct":true,"proposition":"28","justification":"True"},{"idx":2,"correct":false,"proposition":"36","justification":""},{"idx":3,"correct":false,"proposition":"Just before giving birth","justification":""},{"idx":4,"correct":false,"proposition":"It is only offered to Rh+ patients","justification":"Rophylac aims to prevent immunization of Rh- mothers against Rh+ fetuses (among others). It is therefore never offered to Rh+ patients, who cannot be immunized against the Rh antigen, since they are constitutionally carriers of it."}],"ts":{"$numberLong":"1659653673664"},"type":"custom","difficulte":3}
-{"_id":"grossessepatho-gyn-d997391","context":null,"enonce":"What is the prevalence of premature rupture of membranes (RPM)?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"correct":true,"proposition":"About 5%","justification":""},{"idx":1,"correct":false,"proposition":"About 25%","justification":""},{"idx":2,"correct":false,"proposition":"About 45%","justification":""},{"idx":3,"correct":false,"proposition":"About 65%","justification":""},{"idx":4,"correct":false,"proposition":"About 85%","justification":""}],"ts":{"$numberLong":"1659653677997"},"type":"custom","difficulte":1}
-{"_id":"grossessepatho-gyn-f9f0714","context":null,"enonce":"What antibiotics is Listeria naturally resistant to?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"correct":true,"proposition":"cephalosporins","justification":"True"},{"idx":1,"correct":true,"proposition":"oxacillin","justification":"True"},{"idx":2,"correct":true,"proposition":"lincosamides ","justification":"True"},{"idx":3,"correct":false,"proposition":"Amoxicillin","justification":""},{"idx":4,"correct":false,"proposition":"These are acquired resistances","justification":"Acquired resistance to L. monocytogenes is exceptional"}],"ts":{"$numberLong":"1659653687392"},"type":"custom","difficulte":1}
-{"_id":"TTTperso-therapeutique-dbf3ceb","context":null,"enonce":"Which of the following treatments are nephrotoxic?","item":"TTTperso","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"Tacrolimus","justification":"True, just like cyclosporine, immunosuppressants have an effect on kidney vessels and tubules."},{"idx":1,"correct":true,"proposition":"Cisplatin","justification":"True, THE anti-cancer treatment that causes tubulopathies. Do not forget other treatments that can be nephrotoxic such as Methotrexate, Gemcitabine or Mithomycin C"},{"idx":2,"correct":true,"proposition":"Warfarin","justification":"True, warfarin gives tubulopathies!"},{"idx":3,"correct":true,"proposition":"NSAIDs","justification":"True, more than classic, overall you can forget the NSAIDs that give vascular, interstitial and glomerular damage"},{"idx":4,"correct":true,"proposition":"Aminoglycosides","justification":"True, very classic case of tubular toxicity!"}],"ts":{"$numberLong":"1659653716362"},"type":"custom","difficulte":2}
-{"_id":"antithrombotiques-therapeutique-0ffff35","context":null,"enonce":"Regarding VKAs:","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"Fluindione is no longer given as a first-line treatment","justification":"It is no longer administered at all, EXCEPT in patients who are already on fluindione and who are stable."},{"idx":1,"correct":true,"proposition":"INR measurement reflects the dose ingested 3 to 5 days in advance","justification":"This is the time it takes for the liver to make clotting factors."},{"idx":2,"correct":true,"proposition":"Vitamin K antagonists have many drug interactions","justification":""},{"idx":3,"correct":false,"proposition":"There are no contraindications to VKAs","justification":""},{"idx":4,"correct":false,"proposition":"Renal failure is a contraindication to VKAs","justification":"VKAs are metabolized by the liver 🍻"}],"ts":{"$numberLong":"1659653721280"},"type":"custom","difficulte":1}
-{"_id":"antithrombotiques-therapeutique-2930e2f","context":null,"enonce":"Level 2 analgesic medications include:","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"codeine","justification":"Molecule = Dihydrocodeine"},{"idx":1,"correct":true,"proposition":"Tramadol","justification":"Tramadol is a molecule with both opioid properties (by acting directly on mu receptors) and pro-norepinephrine\/serotonin. It can be combined with paracetamol."},{"idx":2,"correct":false,"proposition":"aspirin","justification":""},{"idx":3,"correct":false,"proposition":"Nefopam","justification":"Nephopam, like NSAIDs, nalbuphin and paracetamol, are level 1 analgesics."},{"idx":4,"correct":true,"proposition":"Opium","justification":"Lamalin, for example, is a specialty that includes opium and paracetamol."}],"ts":{"$numberLong":"1659653725835"},"type":"custom","difficulte":1}
-{"_id":"antithrombotiques-therapeutique-4ef4d2a","context":null,"enonce":"What are the side effects of corticosteroids?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"correct":false,"proposition":"Hyperkalemia","justification":"Hypokalemia"},{"idx":1,"correct":false,"proposition":"Hypernatremia","justification":""},{"idx":2,"correct":false,"proposition":"Hyponatremia","justification":"No action on sodium"},{"idx":3,"correct":false,"proposition":"Hypophosphatemia","justification":"No action on phosphate"},{"idx":4,"correct":true,"proposition":"Hypercalciuria","justification":"It is a cause of hypercalciuria with normal serum calcium"}],"ts":{"$numberLong":"1659653730419"},"type":"custom","difficulte":1}
-{"_id":"antithrombotiques-therapeutique-7c5b0b7","context":null,"enonce":"Regarding oral antidiabetics:","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"correct":false,"proposition":"Sulphonylureas stimulate insulin production","justification":"They stimulate its secretion! And it's not the same 😬"},{"idx":1,"correct":true,"proposition":"Sulfonamides stimulate insulin secretion","justification":""},{"idx":2,"correct":true,"proposition":"DPP4 inhibitors are gliptins","justification":""},{"idx":3,"correct":false,"proposition":"Biguanides stimulate insulin secretion","justification":"Metformin is an insulin-sensitizer. It does not work in the pancreas. This is why there is no risk of hypoglycemia"},{"idx":4,"correct":false,"proposition":"SGLT2 inhibitors are contraindicated in renal impairment with GFR < 70","justification":"They are contraindicated from a GFR < 45 (nasty trap, I admit... but useful! You won't forget it now!)"}],"ts":{"$numberLong":"1659653736350"},"type":"custom","difficulte":1}
-{"_id":"antithrombotiques-therapeutique-82b2378","context":null,"enonce":"Regarding statins:","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"If transaminase levels are above three times normal, statins should not be introduced","justification":""},{"idx":1,"correct":true,"proposition":"Iatrogenic diabetes is one of the side effects of statins","justification":""},{"idx":2,"correct":true,"proposition":"Statins should not be used at the same time as fibrates","justification":""},{"idx":3,"correct":false,"proposition":"CPK on statins is monitored","justification":"They are monitored under fibrates, if the patient complains of myalgia"},{"idx":4,"correct":false,"proposition":"The second-line anti-lipidemic is the PCSK9 inhibitor","justification":"This is ezetimibe, which is a therapeutic alternative in case of intolerance to statins."}],"ts":{"$numberLong":"1659653739454"},"type":"custom","difficulte":1}
-{"_id":"antithrombotiques-therapeutique-967a418","context":null,"enonce":"Side effects of potassium-sparing diuretics include:","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"hyperkalemia","justification":""},{"idx":1,"correct":false,"proposition":"hypernatremia","justification":""},{"idx":2,"correct":true,"proposition":"gynecomastia","justification":""},{"idx":3,"correct":true,"proposition":"metabolic acidosis","justification":"Overall, we can remember that H+ ions (which acidify the blood) go where potassium goes (it's very schematic, but it works 😉)"},{"idx":4,"correct":false,"proposition":"Ventilatory alkalosis","justification":""}],"ts":{"$numberLong":"1659653742433"},"type":"custom","difficulte":1}
-{"_id":"antithrombotiques-therapeutique-b175762","context":null,"enonce":"During an accident of anticoagulants (hemorrhage under VKA with very high INR), the administration of vitamin K acts by:","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"correct":false,"proposition":"Immediately","justification":""},{"idx":1,"correct":false,"proposition":"30 minutes","justification":""},{"idx":2,"correct":false,"proposition":"2 to 4 hours","justification":""},{"idx":3,"correct":true,"proposition":"8 to 12 hours","justification":"Unlike CCP infusion which acts immediately. It is therefore necessary to control the action of the latter about 30 minutes after the end of the infusion by an INR assay."},{"idx":4,"correct":false,"proposition":"Vitamin K administration has no place in the management","justification":""}],"ts":{"$numberLong":"1659653757000"},"type":"custom","difficulte":1}
-{"_id":"antithrombotiques-therapeutique-bcf2417","context":null,"enonce":"What is the pre-therapeutic assessment of direct oral anticoagulant anti-IIa (dabigratran)?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"Complete blood count","justification":"We will not give it if its hemoglobin is at 5 😅"},{"idx":1,"correct":true,"proposition":"Creatinine","justification":"Contraindicated in renal impairment"},{"idx":2,"correct":true,"proposition":"TCA","justification":"We will not give it if its TCA is at 5 😅"},{"idx":3,"correct":false,"proposition":"Factor II","justification":""},{"idx":4,"correct":false,"proposition":"Factor X","justification":""}],"ts":{"$numberLong":"1659653768729"},"type":"custom","difficulte":1}
-{"_id":"antithrombotiques-therapeutique-dc91f81","context":null,"enonce":"The contraindication(s) of B-blockers is:","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"Raynaud's syndrome","justification":""},{"idx":1,"correct":true,"proposition":"Deep Bradycardia","justification":""},{"idx":2,"correct":true,"proposition":"Asthma","justification":""},{"idx":3,"correct":true,"proposition":"Acute heart failure","justification":""},{"idx":4,"correct":true,"proposition":"All propositions are true","justification":""}],"ts":{"$numberLong":"1659653776188"},"type":"custom","difficulte":1}
-{"_id":"iatrogenie-therapeutique-2efc9d0","context":null,"enonce":"Which of the following combinations Adverse reaction - Inducer drug(s) are accurate?","item":"iatrogenie","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"QT prolongation - Neuroleptics","justification":"True, this is why we do an ECG in psychiatry before administering psychotropic drugs!"},{"idx":1,"correct":false,"proposition":"Hyperlipidemia - Allopurinol","justification":"False, allopurinol on the other hand is at risk of hepatitis and allergic reaction!"},{"idx":2,"correct":true,"proposition":"Rhabdomyolysis - Fibrates","justification":"True, just like statins, fibrates are also at risk for rhabdomyolysis"},{"idx":3,"correct":true,"proposition":"Tendinopathy - Fluoroquinolones","justification":"True, one of the most well-known side effects!"},{"idx":4,"correct":true,"proposition":"Syndrome de Lyell\/Stevens Johnson - Lamotrigine","justification":"True, lamotrigine is a very allergenic treatment                                                                                                                 "}],"ts":{"$numberLong":"1659653781933"},"type":"custom","difficulte":2}
-{"_id":"iatrogenie-therapeutique-430b699","context":null,"enonce":"You receive in consultation, Mr BRISANCHOYEUR, Archibald, 54 years old, in whom you prescribe for the first time morphine. As a result, you make a prescription for narcotics. What are the particularities of this order?","item":"iatrogenie","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"It is printed on watermarked paper","justification":"True, to secure it!"},{"idx":1,"correct":true,"proposition":"The prescription period is usually 28 days, but it can be 14 days or 7 days","justification":"True, it is indeed possible"},{"idx":2,"correct":false,"proposition":"Renewal is possible, but only once","justification":"Wrong, we can't renew it!"},{"idx":3,"correct":false,"proposition":"If the new order is drafted before the end of the period covered by the previous one, it is therefore null and void.","justification":"False, it will be in addition to the previous ordinance"},{"idx":4,"correct":false,"proposition":"The overlap of two prescriptions is possible for a shorter period of 3 days","justification":"False overlap is prohibited!"}],"ts":{"$numberLong":"1659653784992"},"type":"custom","difficulte":2}
-{"_id":"iatrogenie-therapeutique-56a8a9d","context":null,"enonce":"Regarding adverse drug reactions and pharmacovigilance, what are the exact answer(s)?","item":"iatrogenie","matiere":"therapeutique","propositions":[{"idx":0,"correct":false,"proposition":"Immuno-allergic side effects are most often predictable","justification":"False, it is the opposite, they are usually unpredictable because allergies are never predicted in advance."},{"idx":1,"correct":false,"proposition":"DRESS syndrome is a bullous rash secondary to medication","justification":"False, it's Lyell syndrome! DRESS syndrome is manifested by erythroderma with eosinophil infiltration"},{"idx":2,"correct":false,"proposition":"The declaration of adverse drug reactions is done on the ANSM website","justification":"False, it is carried out on the website of the CRPV (regional pharmacovigilance center) which transmits the notifications to the ANSM which, it, will evaluate the notifications"},{"idx":3,"correct":true,"proposition":"Almost half of the medicines sold on the Internet in Europe, apart from legal sites are fake","justification":"True, a point that reminds us that counterfeit medicines are a global scourge, with very lucrative markets..."},{"idx":4,"correct":true,"proposition":"If the damage related to a medical accident due to the therapeutic hazard exceeds 24%, the patient will be compensated by ONIAM","justification":"True, from the College of Pharmacology and Public Health"}],"ts":{"$numberLong":"1659653788936"},"type":"custom","difficulte":2}
-{"_id":"usagemedic-therapeutique-0ee5023","context":null,"enonce":"Melting Pot n°2! Which of the following proposals concerning pharmacology are true?","item":"usagemedic","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"Patients can report adverse drug reactions online","justification":"True, essential information that often falls into MCQ"},{"idx":1,"correct":true,"proposition":"One of the quality criteria of an ordinance is its computer writing and not its handwritten writing.","justification":"True, very logical when we see the hieroglyphs of some"},{"idx":2,"correct":true,"proposition":"3% of hospitalizations are due to adverse drug reactions","justification":"True, small epidemiological figure that is good to keep in mind"},{"idx":3,"correct":false,"proposition":"The MIC of antibiotics is the maximum inhibitory concentration, which is equivalent to its bactericidal or bacteriostatic effect","justification":"False, the MIC is the MINIMUM inhibitory concentration, the lower it is, the more powerful the antibiotic is and allows to define if the bacterium is sensitive, intermediate or resistant"},{"idx":4,"correct":false,"proposition":"Prescription of unfractionated heparin leads to pharmacokinetic monitoring","justification":"False, it is a dosage of activity, anti Xa activity so a pharmacodynamic monitoring"}],"ts":{"$numberLong":"1659653792815"},"type":"custom","difficulte":2}
-{"_id":"usagemedic-therapeutique-d9118cd","context":null,"enonce":"Melting pot! Which of the following proposals concerning pharmacology are correct?","item":"usagemedic","matiere":"therapeutique","propositions":[{"idx":0,"correct":false,"proposition":"INR is a pharmacokinetic follow-up","justification":"False, this is a pharmacodynamic follow-up. Pharmacodynamic monitoring aims to see the effectiveness of the treatment while pharmacokinetic monitoring aims to see the concentration of the drug"},{"idx":1,"correct":true,"proposition":"The equilibrium dose is usually reached at 5 half-lives","justification":"True, this is the commonly accepted dose of equilibrium"},{"idx":2,"correct":true,"proposition":"The prescription of oral NEFOPAM as an analgesic is an off-label prescription","justification":"True, this is one of the best known off-label prescriptions. If you look in VIDAL you will not find an oral dosage."},{"idx":3,"correct":false,"proposition":"The use of certain psychoactive drugs must be declared to the ANSM","justification":"False, it must be declared to the regional pharmacovigilance centre"},{"idx":4,"correct":false,"proposition":"WHO's list of essential medicines is updated every 5 years","justification":"False, every two years or so"}],"ts":{"$numberLong":"1659653796256"},"type":"custom","difficulte":2}
-{"_id":"matraitanceped-sp-79b1b49","context":null,"enonce":"What are the risk factors for child maltreatment?","item":"matraitanceped","matiere":"sp","propositions":[{"idx":0,"correct":false,"proposition":"The Baby Blues","justification":"False, the Baby Blues is physiological and does not lead in any case to an excess risk of abuse unlike postpartum depression"},{"idx":1,"correct":true,"proposition":"A history of childhood abuse in one of the parents","justification":"True, as is often said, parents reproduce what they went through together."},{"idx":2,"correct":false,"proposition":"Disadvantaged social class","justification":"False, trap, abuse affects all social classes without exception"},{"idx":3,"correct":true,"proposition":"Addiction to a psychoactive substance in one of the parents","justification":"True, do not forget alcohol and nicotine, which can be the cause of abuse"},{"idx":4,"correct":true,"proposition":"Child placed in an incubator at birth","justification":"True, a separation at birth, or a complicated end of pregnancy increases the stress of the couple and can be the cause of abuse"}],"ts":{"$numberLong":"1659653806470"},"type":"custom","difficulte":2}
-{"_id":"matraitanceped-sp-ef9c96a","context":null,"enonce":"Regarding child abuse, what are the exact answer(s)?","item":"matraitanceped","matiere":"sp","propositions":[{"idx":0,"correct":true,"proposition":"A fracture in a child of non-walking age is abuse until proven otherwise","justification":"True, great pediatric adage, always have it in mind."},{"idx":1,"correct":true,"proposition":"Dropping out of school can be a sign of abuse","justification":"True, we often see a sharp break in academic results."},{"idx":2,"correct":false,"proposition":"Legally, it is mandatory during the consultation to have the adult always in the company of the child","justification":"False, the doctor (even general practitioner) can see the child alone if he wishes"},{"idx":3,"correct":false,"proposition":"In case of strong suspicion of ill-treatment with alleged perpetrator in the child's home, information of concern must be sent to the CRIP","justification":"False, in this case, the life of the child is in danger and the doctor must, for the survival of the child, contact the hospital and make a report to the public prosecutor."},{"idx":4,"correct":true,"proposition":"The physician may be liable if he or she directly or indirectly names the alleged perpetrator of the abuse","justification":"True, never name someone or their role (father, mother) in a certificate, mark \"the aggressor\""}],"ts":{"$numberLong":"1659653813058"},"type":"custom","difficulte":2}
-{"_id":"CCR-onco-9429409","context":null,"enonce":"What should lead to the prescription of a microsatellite instability test?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Colorectal cancer < age 60","justification":""},{"idx":1,"correct":false,"proposition":"Colorectal cancer < 80","justification":""},{"idx":2,"correct":true,"proposition":"Multiple synchronous cancers of the Lynch syndrome spectrum in the same patient","justification":""},{"idx":3,"correct":true,"proposition":"Multiple metachronous cancers of the Lynch syndrome spectrum in the same patient","justification":"The three things to know are: \n- Colorectal cancer < 60 years, \n- Multiple cancers (synchronous or metachronous) of the Lynch syndrome spectrum in the same patient, \n- Colorectal cancer + family history of Lynch syndrome spectrum cancer (at least one first-degree relative< 50 years or two related, first or second degree relatives, regardless of age) "},{"idx":4,"correct":false,"proposition":"Ovarian cancer","justification":""}],"ts":{"$numberLong":"1659653909804"},"type":"custom","difficulte":2}
-{"_id":"Kcsein-onco-024ddf3","context":null,"enonce":"The most common histological type in breast cancer is:","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"invasive ductal carcinoma","justification":""},{"idx":1,"correct":false,"proposition":"ductal carcinoma in situ","justification":"does not exist"},{"idx":2,"correct":false,"proposition":"carcinoma in situ","justification":""},{"idx":3,"correct":false,"proposition":"anaplastic carcinoma","justification":""},{"idx":4,"correct":false,"proposition":"lobular carcinoma","justification":""}],"ts":{"$numberLong":"1659653913577"},"type":"custom","difficulte":2}
-{"_id":"TTTKc-onco-9b09865","context":null,"enonce":"Side effects of cisplatin are:","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Renal failure","justification":""},{"idx":1,"correct":false,"proposition":"Hepatic impairment","justification":"Renal failure"},{"idx":2,"correct":true,"proposition":"Nausea and vomiting","justification":""},{"idx":3,"correct":true,"proposition":"Tinnitus","justification":"and deafness (high ototoxicity)"},{"idx":4,"correct":false,"proposition":"Urinary burns","justification":"Cisplatin:\n- hematological toxicity\n- nausea\/vomiting\n- peripheral neuropathy\n- kidney damage\n- ototoxicity\nno alopecia (cyclophosphamide, irinotecan, anthracycline, etoposide, paclitaxel, docetaxel, 5FU)\nno hand-foot syndrome (anthracycline, docetaxel, 5fu, capecitabine)\nno diarrhoea (oxaliplatin, irinotecan, anthracycline, paclitaxel, docetaxel, 5FU)\nno cardiac involvement (anthracycline and 5FU)\nno skin necrosis if extravasation (antracycline)"}],"ts":{"$numberLong":"1659653919722"},"type":"custom","difficulte":2}
-{"_id":"epidemioKc-onco-8307e01","context":null,"enonce":"Which propositions are true?","item":"epidemioKc","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Cancer is the leading cause of death in France","justification":""},{"idx":1,"correct":false,"proposition":"Cardiovascular diseases are the third leading cause of death in France","justification":"The second"},{"idx":2,"correct":true,"proposition":"Cancer incidence higher in men than in women","justification":"Cancer is still a predominantly male disease"},{"idx":3,"correct":false,"proposition":" Cancer mortality rises steadily for both men and women","justification":"It decreases"},{"idx":4,"correct":false,"proposition":"Cancer incidence is 0 before the age of 5","justification":""}],"ts":{"$numberLong":"1659653926671"},"type":"custom","difficulte":2}
-{"_id":"epidemioKc-onco-aba8b45","context":null,"enonce":"What is the global incidence of cancer in 2018?","item":"epidemioKc","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"18 million new cases","justification":""},{"idx":1,"correct":false,"proposition":"48 million new cases","justification":""},{"idx":2,"correct":false,"proposition":"8 million new cases","justification":""},{"idx":3,"correct":false,"proposition":"1 million new cases","justification":""},{"idx":4,"correct":false,"proposition":"180 million new cases","justification":""}],"ts":{"$numberLong":"1659653930392"},"type":"custom","difficulte":2}
-{"_id":"epidemioKc-onco-d83e770","context":null,"enonce":"What is the global mortality of cancers in 2018?","item":"epidemioKc","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":" 9.6 million deaths","justification":""},{"idx":1,"correct":false,"proposition":" 96 million deaths","justification":""},{"idx":2,"correct":false,"proposition":" 960 million deaths","justification":""},{"idx":3,"correct":false,"proposition":"0.6 million deaths","justification":""},{"idx":4,"correct":false,"proposition":" 59 million deaths","justification":""}],"ts":{"$numberLong":"1659653935012"},"type":"custom","difficulte":2}
-{"_id":"AOMI-cardio-6b5f4cd","context":null,"enonce":"Which IPS are to be considered normal:","item":"AOMI","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"0,65","justification":"No. > 0.9"},{"idx":1,"correct":false,"proposition":"0,85","justification":"No. > 0.9"},{"idx":2,"correct":true,"proposition":" 0,95","justification":""},{"idx":3,"correct":true,"proposition":"1,25","justification":"N: 0.9-1.3 (1.4 depending on sources)"},{"idx":4,"correct":false,"proposition":"1,45","justification":"N < 1.3 (or 1.4 depending on the source)"}],"ts":{"$numberLong":"1659654838634"},"type":"custom","difficulte":1}
-{"_id":"ECG-cardio-7fbfcc8","context":null,"enonce":"Which of the following leads will show an elevation in a high outboard SCA ST+? (one or more exact propositions)","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"I and aVL","justification":""},{"idx":1,"correct":false,"proposition":"V1, V2 and V3","justification":""},{"idx":2,"correct":false,"proposition":"II, III and aVF","justification":""},{"idx":3,"correct":false,"proposition":"V5 and V6","justification":""},{"idx":4,"correct":false,"proposition":"V7, V8 and V9","justification":""}],"ts":{"$numberLong":"1659654854936"},"type":"custom","difficulte":1}
-{"_id":"FA-cardio-f75a430","context":null,"enonce":"What is the molecule of choice to slow down poorly tolerated atrial fibrillation (OAP) in acute?","item":"FA","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Digoxin ","justification":""},{"idx":1,"correct":false,"proposition":"Verapamil ","justification":"Calcium channel blockers are contraindicated in heart failure (whether acute or chronic)"},{"idx":2,"correct":false,"proposition":"Diltiazem ","justification":"Calcium channel blockers are contraindicated in heart failure (whether acute or chronic)"},{"idx":3,"correct":false,"proposition":"β-blocker","justification":"It can worsen acute heart failure"},{"idx":4,"correct":false,"proposition":"None, do not slow down atrial fibrillation since the patient is in OAP","justification":"On the contrary, the patient is in OAP because the left atrium contracts too quickly and uncontrollably for the atrial systole to be effective. The heart rate needs to drop so that the mitral valve stays open longer, so that blood has more time to pass into the left ventricle."}],"ts":{"$numberLong":"1659654859939"},"type":"custom","difficulte":1}
-{"_id":"FdRCV-cardio-3198858","context":null,"enonce":"Which cardiovascular risk factors are modifiable? ","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"Age","justification":"Non-modifiable cardiovascular risk factor "},{"idx":1,"correct":true,"proposition":"Diabetes ","justification":""},{"idx":2,"correct":true,"proposition":"Tobacco","justification":""},{"idx":3,"correct":false,"proposition":"Alcohol","justification":"Alcohol is not a cardiovascular risk factor! "},{"idx":4,"correct":true,"proposition":"High blood pressure ","justification":""}],"ts":{"$numberLong":"1659654873804"},"type":"custom","difficulte":1}
-{"_id":"HTA-cardio-35c961d","context":null,"enonce":"Angiotensin II: (one or more exact proposals)","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"Is ionotropic negative","justification":""},{"idx":1,"correct":true,"proposition":"Is ionotropic positive","justification":""},{"idx":2,"correct":false,"proposition":"Is ionotrope indifferent","justification":""},{"idx":3,"correct":true,"proposition":"Stimulates adrenal release of aldosterone","justification":""},{"idx":4,"correct":false,"proposition":"Stimulates adrenal release of renin","justification":""}],"ts":{"$numberLong":"1659654879167"},"type":"custom","difficulte":1}
-{"_id":"HTA-cardio-4aae21a","context":null,"enonce":"Regarding DHA:","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"This hormone is released by the hypothalamus into the pituitary gland","justification":""},{"idx":1,"correct":true,"proposition":"This hormone stored in the pituitary gland","justification":""},{"idx":2,"correct":false,"proposition":"This hormone is the main hormone regulating blood pressure","justification":"It is rather aldosterone 😉"},{"idx":3,"correct":true,"proposition":"This hormone can be released inappropriately ","justification":"This is the famous SIADH"},{"idx":4,"correct":false,"proposition":"This hormone can cause hypertonic hyponatremia","justification":"Hypotonic hyponatremia (plasma osmolarity < 285)"}],"ts":{"$numberLong":"1659654882654"},"type":"custom","difficulte":1}
-{"_id":"HTA-cardio-7ccf194","context":null,"enonce":"What are the side effects of beta-blockers? (one or more exact propositions)","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Bradycardia","justification":""},{"idx":1,"correct":true,"proposition":"Worsening asthma","justification":"Active asthma is also a contraindication"},{"idx":2,"correct":true,"proposition":"Impotence","justification":""},{"idx":3,"correct":false,"proposition":"Cough","justification":"They are found more in IEC\/ARA2"},{"idx":4,"correct":false,"proposition":"All propositions are true","justification":""}],"ts":{"$numberLong":"1659654887087"},"type":"custom","difficulte":1}
-{"_id":"HTA-cardio-b974000","context":null,"enonce":"Which of the following diuretics is not contraindicated in chronic renal failure with GFR < 30? (one or more exact propositions)","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Furosemide","justification":""},{"idx":1,"correct":true,"proposition":"Loop diuretic","justification":""},{"idx":2,"correct":false,"proposition":"Thiazide","justification":""},{"idx":3,"correct":false,"proposition":"Spironolactone","justification":""},{"idx":4,"correct":false,"proposition":"Aldactone","justification":""}],"ts":{"$numberLong":"1659654896056"},"type":"custom","difficulte":1}
-{"_id":"HTA-cardio-b993adc","context":null,"enonce":"Your patient, Roberta, 62, comes to your office smiling. She feels very well and has no history other than high blood pressure that you brilliantly diagnosed several months ago. It is under ACE inhibitor (ACE inhibitor) and calcium channel blocker (CI). However, its last blood pressure self-measurement that it presents to you is at 146\/89 mm of mercury. How do you adapt the treatment in this patient in order to balance her high blood pressure? (one or more exact propositions)","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"Maintaining the same treatment, it will settle down over time","justification":""},{"idx":1,"correct":true,"proposition":"Addition of a thiazide diuretic","justification":"It is the triple therapy of choice"},{"idx":2,"correct":false,"proposition":"Addition of a loop diuretic","justification":"Not conventionally used in hypertension, except for example in cases of renal failure and heart failure."},{"idx":3,"correct":false,"proposition":"Adding an ARA2","justification":"We avoid associating IEC and ARA2"},{"idx":4,"correct":false,"proposition":"Addition of a central antihypertensive drug","justification":"Only considered after trying triple therapy containing thiazide"}],"ts":{"$numberLong":"1659655091884"},"type":"custom","difficulte":1}
-{"_id":"HTA-cardio-bfa0e97","context":null,"enonce":"What elements are found in the Kirkendall classification (hypertensive retinopathy)?","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Retinal hemorrhages","justification":"Stage 2"},{"idx":1,"correct":true,"proposition":"Arterial narrowing","justification":"Stage 1"},{"idx":2,"correct":true,"proposition":"Dry exudates","justification":"Stage 2"},{"idx":3,"correct":true,"proposition":"Cottony nodules","justification":"Stage 2"},{"idx":4,"correct":true,"proposition":"Papillary edema","justification":"Stage 3"}],"ts":{"$numberLong":"1659655098263"},"type":"custom","difficulte":2}
-{"_id":"HTA-cardio-ded0c0a","context":null,"enonce":"What are the adrenal pathologies associated with hypertension?","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Conn's adenoma","justification":""},{"idx":1,"correct":true,"proposition":"Pheochromocytoma","justification":""},{"idx":2,"correct":true,"proposition":"Congenital adrenal hypoplasia","justification":"We do not see this pathology at the ECN! This is congenital adrenal hyPERplasia"},{"idx":3,"correct":false,"proposition":"Cushing's disease","justification":"It is a pituitary pathology and not adrenal (as the question asks)"},{"idx":4,"correct":false,"proposition":"None of these proposals","justification":""}],"ts":{"$numberLong":"1659655102796"},"type":"custom","difficulte":1}
-{"_id":"HTA-cardio-fa2adb0","context":null,"enonce":"Where is renal sodium reabsorption most important?","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"proximal tube","justification":"Nearly 70% of reabsorbed sodium is reabsorbed at the beginning 😉"},{"idx":1,"correct":false,"proposition":"Collector tube","justification":""},{"idx":2,"correct":false,"proposition":"distal tube","justification":""},{"idx":3,"correct":false,"proposition":"Henlé branch","justification":""},{"idx":4,"correct":false,"proposition":"everywhere and nowhere at once 🤷 ♂️","justification":"I admit that we were not very inspired for the last proposal 😬😬"}],"ts":{"$numberLong":"1659655109717"},"type":"custom","difficulte":1}
-{"_id":"IC-cardio-a5db2f1","context":null,"enonce":"What are the signs visible on chest X-ray when heart failure is suspected? ","item":"IC","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"A pneumothorax. ","justification":"False. "},{"idx":1,"correct":true,"proposition":"Cardiomegaly, defined as a cardiothoracic ratio (RCT) > 0.5. ","justification":"True. "},{"idx":2,"correct":false,"proposition":"A vascular redistribution from the vertices to the base. ","justification":"False, from the bottom to the top. "},{"idx":3,"correct":true,"proposition":"An interstitial syndrome with Kerley B-lines. ","justification":"True. "},{"idx":4,"correct":false,"proposition":"A pulmonary embolism. ","justification":"False. "}],"ts":{"$numberLong":"1659655113711"},"type":"custom","difficulte":2}
-{"_id":"IC-cardio-ee77668","context":null,"enonce":"What are the additional tests to be performed when heart failure is suspected? ","item":"IC","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"ECG ","justification":"True. "},{"idx":1,"correct":true,"proposition":"NT\/pro-BNP. ","justification":"True. "},{"idx":2,"correct":true,"proposition":"ETT. ","justification":"True, indispensable +++. "},{"idx":3,"correct":true,"proposition":"NFS, blood ionogram, serum creatinine, liver test, TSH, serum iron, ferritin, CST. ","justification":"True. "},{"idx":4,"correct":true,"proposition":"Chest X-ray. ","justification":"True. "}],"ts":{"$numberLong":"1659655117752"},"type":"custom","difficulte":2}
-{"_id":"MTEV-cardio-cdd6faa","context":null,"enonce":"What are the possible complications of DVT?","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Pulmonary embolism","justification":""},{"idx":1,"correct":true,"proposition":"STROKE","justification":"Possible via a permeable foramen oval. This is called a paradoxical embolism"},{"idx":2,"correct":true,"proposition":"Acute ischemia","justification":""},{"idx":3,"correct":true,"proposition":"Chronic venous insufficiency","justification":""},{"idx":4,"correct":true,"proposition":"Post-thrombotic syndrome","justification":""}],"ts":{"$numberLong":"1659655120959"},"type":"custom","difficulte":1}
-{"_id":"acroSd-cardio-65e17db","context":null,"enonce":"What is the balance sheet of a secondary Raynaud?","item":"acroSd","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"NAA","justification":""},{"idx":1,"correct":true,"proposition":"Capillaroscopy","justification":"These are the two systematic complementary reviews."},{"idx":2,"correct":false,"proposition":"ACAN","justification":""},{"idx":3,"correct":false,"proposition":"EPP","justification":""},{"idx":4,"correct":false,"proposition":"Renal assessment","justification":""}],"ts":{"$numberLong":"1659655124486"},"type":"custom","difficulte":1}
-{"_id":"palpitations-cardio-33c21f9","context":null,"enonce":"In what type of tachycardia can we see a pre-excitation delta wave and a short PR space < 120 ms? ","item":"palpitations","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"Atrial fibrillation (AF). ","justification":"False. "},{"idx":1,"correct":true,"proposition":"Wolf Parkinson White syndrome. ","justification":"True, on the resting ECG. "},{"idx":2,"correct":false,"proposition":"Myocardial infarction. ","justification":"False. "},{"idx":3,"correct":false,"proposition":"Atrial tachycardia. ","justification":"False. "},{"idx":4,"correct":false,"proposition":"Ventricular tachycardia. ","justification":"False. "}],"ts":{"$numberLong":"1659655130431"},"type":"custom","difficulte":2}
-{"_id":"palpitations-cardio-356d1f9","context":null,"enonce":"What can be the causes of palpitations? ","item":"palpitations","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Taking stimulants. ","justification":"True. "},{"idx":1,"correct":true,"proposition":"Alcohol. ","justification":"True. "},{"idx":2,"correct":true,"proposition":"Pregnancy. ","justification":"True. "},{"idx":3,"correct":true,"proposition":"Hyperthyroidism. ","justification":"True. "},{"idx":4,"correct":true,"proposition":"Sleep apnea syndrome. ","justification":"True. "}],"ts":{"$numberLong":"1659655134454"},"type":"custom","difficulte":2}
-{"_id":"palpitations-cardio-8e094ed","context":null,"enonce":"Until proven otherwise, any regular tachycardia with wide QRS is: ","item":"palpitations","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"Atrial tachycardia. ","justification":"False, with QRS fines. "},{"idx":1,"correct":true,"proposition":"Ventricular tachycardia. ","justification":"True +++. "},{"idx":2,"correct":false,"proposition":"A torsade de pointe. ","justification":"False, polymorphic tachycardia. "},{"idx":3,"correct":false,"proposition":"Junctional tachycardia. ","justification":"False, there is regular tachycardia with fine QRS but we always think first of ventricular tachycardia. "},{"idx":4,"correct":false,"proposition":"Ventricular fibrillation. ","justification":"False, anarchic rapid ventricular activity. "}],"ts":{"$numberLong":"1659655147136"},"type":"custom","difficulte":2}
-{"_id":"palpitations-cardio-f13386e","context":null,"enonce":"Until proven otherwise, any irregular tachycardia with fine QRS is: ","item":"palpitations","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"A torsade de pointe. ","justification":"False. "},{"idx":1,"correct":false,"proposition":"Ventricular fibrillation ","justification":"False, with wide QRS. "},{"idx":2,"correct":false,"proposition":"Atrial tachycardia ","justification":"False, regular tachycardia. "},{"idx":3,"correct":true,"proposition":"Atrial fibrillation (AF) ","justification":"True. "},{"idx":4,"correct":true,"proposition":"In the AM, there is a tremulation of the baseline. ","justification":"True. "}],"ts":{"$numberLong":"1659655150282"},"type":"custom","difficulte":2}
-{"_id":"valvuloP-cardio-f9064c7","context":null,"enonce":"What are the etiologies of primary mitral insufficiency among those proposed below? ","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Dystrophic mitral insufficiency. ","justification":"True. "},{"idx":1,"correct":false,"proposition":"Chronic left ventricular remodeling post-infarction. ","justification":"False. "},{"idx":2,"correct":false,"proposition":"Dilated cardiomyopathy. ","justification":"False. "},{"idx":3,"correct":true,"proposition":"Rheumatic mitral insufficiency. ","justification":"True. "},{"idx":4,"correct":false,"proposition":"Idiopathic mitral insufficiency. ","justification":"False. "}],"ts":{"$numberLong":"1659655153255"},"type":"custom","difficulte":2}
-{"_id":"IBP-infectio-d48f3cf","context":null,"enonce":"What propositions are true regarding the epidemiology of infectious agents? (one or more propositions are true)","item":"IBP","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Enterobacteriaceae are the bacteria most often found in community urinary tract infections","justification":"Like E. coli, Klebsiella, Proteus mirabilis, etc."},{"idx":1,"correct":false,"proposition":"Meningococci are the bacteria most often found in bacterial meningitis in a 30-year-old adult","justification":"Meningococcal = 18 to 25 years. After that, it's pneumococcus."},{"idx":2,"correct":false,"proposition":"Meningococci are the bacteria most often found in bacterial pneumonia","justification":"Meningococci are not involved in pneumonia at all."},{"idx":3,"correct":false,"proposition":"Listeria is the bacteria most often found in pneumonia after age 50","justification":"Listeria is found mainly in meningitis after 50 years"},{"idx":4,"correct":true,"proposition":"Staphylococci are frequently found in post-influenza pneumonia","justification":""}],"ts":{"$numberLong":"1659655502805"},"type":"custom","difficulte":1}
-{"_id":"IST-infectio-3e9f1c2","context":null,"enonce":"Which of the following proposals may be responsible for genital ulceration? (one or more answers are correct)","item":"IST","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Behçet","justification":"Oral and genital canker sore is characteristic"},{"idx":1,"correct":true,"proposition":"Syphilis","justification":"The famous syphilitic chancre"},{"idx":2,"correct":false,"proposition":"Gonococcus","justification":"Gonococcus gives high STIs or ervicites with urethritis, yellow-green purulent leucorrhoea, urination burns, etc. No ulcerations at the rendezvous"},{"idx":3,"correct":true,"proposition":"Herpes simplex virus 2","justification":""},{"idx":4,"correct":true,"proposition":"Chlamydia ","justification":"The primary chlamydia lesion is usually genital site with small, non-indurated papule, often erosive, painless, rapidly limiting. Sound like syphilis? Is it a potential differential diagnosis:)"}],"ts":{"$numberLong":"1659655521089"},"type":"custom","difficulte":1}
-{"_id":"IST-infectio-9458444","context":null,"enonce":"Which of the following are causes of TPHA- \/ VDRL+? (one or more answers are correct)","item":"IST","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"lupus ","justification":""},{"idx":1,"correct":true,"proposition":"SAPL","justification":""},{"idx":2,"correct":true,"proposition":"mycoplasma lung infections","justification":""},{"idx":3,"correct":true,"proposition":"Lyme disease","justification":""},{"idx":4,"correct":true,"proposition":"pregnancy","justification":""}],"ts":{"$numberLong":"1659655562536"},"type":"custom","difficulte":1}
-{"_id":"IST-infectio-cde6850","context":null,"enonce":"Which of the following are characteristic of trichomonas? (one or more answers are correct)","item":"IST","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Abundant leucorrhoea","justification":""},{"idx":1,"correct":true,"proposition":"Greenish leucorrhoea","justification":""},{"idx":2,"correct":true,"proposition":"dyspareunia","justification":""},{"idx":3,"correct":true,"proposition":"Malodorous leucorrhoea","justification":"smell of fresh plaster"},{"idx":4,"correct":true,"proposition":"raspberry neck","justification":""}],"ts":{"$numberLong":"1659655566197"},"type":"custom","difficulte":1}
-{"_id":"IU-infectio-1cadac3","context":null,"enonce":"What are the risk factors for urinary tract infection in women?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"spermicides","justification":""},{"idx":1,"correct":true,"proposition":"Pre-menstrual period","justification":""},{"idx":2,"correct":true,"proposition":"pregnancy","justification":""},{"idx":3,"correct":false,"proposition":"BPH","justification":"A priori, women do not have a prostate 🤭 (sorry for the trap, but it is important to read the statements. Often, in the annals, we make stupid mistakes because we did not read the question correctly)"},{"idx":4,"correct":false,"proposition":"prostate cancer","justification":"A priori, women do not have a prostate 🤭 (sorry for the trap, but it is important to read the statements. Often, in the annals, we make stupid mistakes because we did not read the question correctly)"}],"ts":{"$numberLong":"1659655569460"},"type":"custom","difficulte":1}
-{"_id":"IU-infectio-2ff5a38","context":null,"enonce":"Which propositions are true?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Physiologically, urine is sterile","justification":""},{"idx":1,"correct":true,"proposition":"only the distal urethra is colonized by perineal flora","justification":""},{"idx":2,"correct":false,"proposition":"Hematogenous infection is the main cause of cystitis","justification":"It is rather an ascending infection ++ from the distal urethra"},{"idx":3,"correct":true,"proposition":"Being a woman, especially postmenopausal, is a risk factor for UTI","justification":""},{"idx":4,"correct":true,"proposition":"BPH is a risk factor for UTI","justification":"All causes of obstructive uropathy (BPH, stenosis, cancer) are risk factors"}],"ts":{"$numberLong":"1659655573434"},"type":"custom","difficulte":1}
-{"_id":"IU-infectio-338afe9","context":null,"enonce":"The hematuria at the BU is positive if:","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"> 10^4\/mL","justification":"Positive hematuria if > 10^4\/mL = 10\/mm3"},{"idx":1,"correct":false,"proposition":"> 10^2\/mL","justification":""},{"idx":2,"correct":false,"proposition":"> 10^3\/mL","justification":""},{"idx":3,"correct":false,"proposition":"> 10^5\/mL","justification":""},{"idx":4,"correct":false,"proposition":"> 10^6\/mL","justification":""}],"ts":{"$numberLong":"1659655579867"},"type":"custom","difficulte":2}
-{"_id":"IU-infectio-51049db","context":null,"enonce":"Which antibiotics are effective on EBLSE-producing beta-lactamase-producing enterobacteriaceae? (four proposals expected)","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Carbapenem","justification":""},{"idx":1,"correct":true,"proposition":"Fosfomycin-Trometamol","justification":""},{"idx":2,"correct":false,"proposition":"Cefotaxime","justification":"Beta-lactams do not work (except Piperacillin-Tazobactam, Carbapenem and Cefoxitin)"},{"idx":3,"correct":true,"proposition":"Nitrofurantoin","justification":""},{"idx":4,"correct":true,"proposition":"Pivmecillinam ","justification":""}],"ts":{"$numberLong":"1659655587369"},"type":"custom","difficulte":1}
-{"_id":"IU-infectio-538285e","context":null,"enonce":"Which bacteria do not produce nitrites?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Staphylococci","justification":"And especially S. saprophyticus (young woman)"},{"idx":1,"correct":true,"proposition":"Enterococci","justification":"PMAs do not produce them"},{"idx":2,"correct":true,"proposition":"Pseudomonas æruginosa","justification":"Aerobic BGN does not produce it, most often"},{"idx":3,"correct":true,"proposition":"Acinetobacter","justification":""},{"idx":4,"correct":false,"proposition":"E. Coli","justification":"That's a lot of nitrites + to the bu :)"}],"ts":{"$numberLong":"1659655591202"},"type":"custom","difficulte":1}
-{"_id":"IU-infectio-54b6d63","context":null,"enonce":"How long is treatment with Pivmecillinam? ","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"5D","justification":"This is the probabilistic second-line treatment for simple acute cystitis. No systematic follow-up consultation (only if the patient's need is felt)"},{"idx":1,"correct":false,"proposition":"10D","justification":""},{"idx":2,"correct":false,"proposition":"7D","justification":""},{"idx":3,"correct":false,"proposition":"Single dose","justification":""},{"idx":4,"correct":false,"proposition":"Until ECBU negativation","justification":"In simple acute cystitis, there is never ECBU"}],"ts":{"$numberLong":"1659655593998"},"type":"custom","difficulte":1}
-{"_id":"IU-infectio-585d246","context":null,"enonce":"The control of the negativation of the ECBU is indicated in case of: ","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"pregnancy","justification":""},{"idx":1,"correct":true,"proposition":"persistence of symptoms","justification":""},{"idx":2,"correct":true,"proposition":"early recurrence","justification":""},{"idx":3,"correct":false,"proposition":"Severe NAP","justification":""},{"idx":4,"correct":false,"proposition":"NAP with risk of complication","justification":""}],"ts":{"$numberLong":"1659655597047"},"type":"custom","difficulte":1}
-{"_id":"IU-infectio-73c9d2b","context":null,"enonce":"What is the pathology that does not require ECBU?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"simple acute cystitis","justification":""},{"idx":1,"correct":false,"proposition":"Non-serious NAP","justification":""},{"idx":2,"correct":false,"proposition":"NAP without risk of complication","justification":""},{"idx":3,"correct":false,"proposition":"Recurrent cystitis","justification":""},{"idx":4,"correct":false,"proposition":"Cystitis at risk of complications","justification":""}],"ts":{"$numberLong":"1659655614478"},"type":"custom","difficulte":1}
-{"_id":"IU-infectio-79cab7c","context":null,"enonce":"S. saprophyticus is naturally resistant to: (only one response expected)","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"fosfomycin-trometamol","justification":""},{"idx":1,"correct":false,"proposition":"nitrofurantoin","justification":"First-line treatment in young women with nitrite negative"},{"idx":2,"correct":false,"proposition":"Augmentin","justification":""},{"idx":3,"correct":false,"proposition":"Pivmécilliam","justification":""},{"idx":4,"correct":false,"proposition":"No natural resistance","justification":""}],"ts":{"$numberLong":"1659655630724"},"type":"custom","difficulte":1}
-{"_id":"IU-infectio-9d3bfde","context":null,"enonce":"The urinary tract infection is:","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"The 1st cause of community infection","justification":""},{"idx":1,"correct":true,"proposition":"The 1st cause of nosocomial infection","justification":""},{"idx":2,"correct":false,"proposition":"The prerogative of male individuals","justification":"The sex ratio is in favor of women F >> H"},{"idx":3,"correct":true,"proposition":"1\/3 of women will have a urinary tract infection","justification":""},{"idx":4,"correct":false,"proposition":"recurrent if there are more than 3 episodes per year","justification":"More than 4 episodes per year (more than one every 3 months). Severe if more than one episode per month."}],"ts":{"$numberLong":"1659655634152"},"type":"custom","difficulte":1}
-{"_id":"IU-infectio-acd0e8a","context":null,"enonce":"What are the 3 clinical forms of cystitis to identify in order to adapt the management? ","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Simple acute cystitis","justification":"3 notions to remember and differentiate. The care follows directly from this:)"},{"idx":1,"correct":true,"proposition":"Cystitis at risk of complications","justification":""},{"idx":2,"correct":true,"proposition":"Recurrent cystitis","justification":""},{"idx":3,"correct":false,"proposition":"Severe NAP","justification":""},{"idx":4,"correct":false,"proposition":"NAP without risk of complication","justification":""}],"ts":{"$numberLong":"1659655641284"},"type":"custom","difficulte":1}
-{"_id":"IU-infectio-adb99f5","context":null,"enonce":"What is the only mandatory examination to perform in case of simple hyperalgic NAP? (apart from BU and ECBU)","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Doppler ultrasound of the urinary tract","justification":""},{"idx":1,"correct":false,"proposition":"NFS","justification":"If risk of complication"},{"idx":2,"correct":false,"proposition":"CRP","justification":"If risk of complication"},{"idx":3,"correct":false,"proposition":"Uroscanner","justification":"If risk of complications, at a distance from the episode"},{"idx":4,"correct":false,"proposition":"Blood culture","justification":"Only done if there is a diagnostic doubt"}],"ts":{"$numberLong":"1659655659308"},"type":"custom","difficulte":1}
-{"_id":"IU-infectio-b5052ad","context":null,"enonce":"What are the two indications to treat asymptomatic bacteriuria?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Elderly","justification":""},{"idx":1,"correct":true,"proposition":"Pregnant woman","justification":""},{"idx":2,"correct":true,"proposition":"Scheduled invasive urological surgery","justification":""},{"idx":3,"correct":false,"proposition":"diabetic","justification":""},{"idx":4,"correct":false,"proposition":"Neurological bladder","justification":""}],"ts":{"$numberLong":"1659655663564"},"type":"custom","difficulte":1}
-{"_id":"IU-infectio-d87beaf","context":null,"enonce":"What are the four causes of aseptic leukocyturia?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Urogenital tuberculosis","justification":""},{"idx":1,"correct":true,"proposition":"Bladder cancer","justification":""},{"idx":2,"correct":true,"proposition":"Renal colic","justification":""},{"idx":3,"correct":true,"proposition":"Interstitial nephropathy","justification":""},{"idx":4,"correct":false,"proposition":"Diabetes","justification":"We will rather find a microalbuminuria in case of significant 😊 renal damage"}],"ts":{"$numberLong":"1659655671823"},"type":"custom","difficulte":1}
-{"_id":"IU-infectio-f77b2b0","context":null,"enonce":"The ECBU is done by: ","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"I don't care","justification":""},{"idx":1,"correct":false,"proposition":"Start of jet","justification":""},{"idx":2,"correct":false,"proposition":"End of jet","justification":""},{"idx":3,"correct":true,"proposition":"Jet medium","justification":"Before any ATB, after a peritoneal toilet, in non-sterile condition, 4 hours after the last urination, and in the middle of the jet"},{"idx":4,"correct":false,"proposition":"We don't really have an idea for the fifth proposal 🤷 ♂️","justification":"The main thing is to remember that it is not at the beginning of the jet, unlike the samples for sexually transmitted 😊 infections (it is on this notion that you can be trapped)"}],"ts":{"$numberLong":"1659655685928"},"type":"custom","difficulte":1}
-{"_id":"antiinf-infectio-f4bf340","context":null,"enonce":"Regarding cyclines, which proposals are true?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"They can cause photosensitivity","justification":""},{"idx":1,"correct":true,"proposition":"They have an almost complete absorption orally (PO)","justification":""},{"idx":2,"correct":true,"proposition":"They are contraindicated during pregnancy","justification":""},{"idx":3,"correct":true,"proposition":"They are active on plasmodium","justification":"Doxycycline is used to prevent malaria. It is taken 1x \/ D during the stay and 4 weeks after the return."},{"idx":4,"correct":true,"proposition":"They work by inhibiting protein synthesis","justification":""}],"ts":{"$numberLong":"1659655691411"},"type":"custom","difficulte":1}
-{"_id":"fievreimmunoD-infectio-34e4657","context":null,"enonce":"\nConcerning the neu\nRegarding febrile neutropenia: \nRegarding febrile neutropenia: \n\nRegarding febrile neutropenia: \n","item":"fievreimmunoD","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"It is defined by neutropenia (PNN < 500\/mm3) or fever. ","justification":"False, AND. "},{"idx":1,"correct":true,"proposition":"The digestive tract is the majority gateway. ","justification":"True, then skin, central venous catheters and lungs. "},{"idx":2,"correct":false,"proposition":"The clinical examination is often rich in clinical signs. ","justification":"False, often poor because no inflammatory focus. "},{"idx":3,"correct":true,"proposition":"Central venous catheters promote infections. ","justification":"True. "},{"idx":4,"correct":false,"proposition":"Chest X-rays often show a focus at the onset of fever. ","justification":"False, 40% of neutropenic patients with pneumonia have a normal chest X-ray at the onset of fever (see PILLY p 327). "}],"ts":{"$numberLong":"1659655703959"},"type":"custom","difficulte":2}
-{"_id":"fievreimmunoD-infectio-5944311","context":null,"enonce":"What are the 3 therapeutic emergencies? What are the 3 therapeutic emergencies? ","item":"fievreimmunoD","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Any fever in asplenic ","justification":"True "},{"idx":1,"correct":false,"proposition":"Cardiogenic shock ","justification":"False "},{"idx":2,"correct":true,"proposition":"Sepsis or septic shock ","justification":"True "},{"idx":3,"correct":false,"proposition":"Febrile lymphopenia ","justification":"False "},{"idx":4,"correct":true,"proposition":"Febrile neutropenia ","justification":"True "}],"ts":{"$numberLong":"1659655707842"},"type":"custom","difficulte":2}
-{"_id":"meningite-infectio-168661f","context":null,"enonce":"Which of the following are viruses that can cause encephalitis? (one or more propositions are correct)","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"measles","justification":""},{"idx":1,"correct":true,"proposition":"VZV","justification":"We also find: mumps, HIV, EBV and CMV."},{"idx":2,"correct":true,"proposition":"HSV","justification":"HSV1 > HSV2. Involvement occurs mainly in the temporal lobes"},{"idx":3,"correct":true,"proposition":"Rabies","justification":""},{"idx":4,"correct":false,"proposition":"Novovirus","justification":"He has diarrhea. 💩 Enteroviruses can cause meningitis"}],"ts":{"$numberLong":"1659655713171"},"type":"custom","difficulte":2}
-{"_id":"meningite-infectio-4cee171","context":null,"enonce":"Which of the following proposals are part of the semiology of herpetic meningoencephalitis? (one or more propositions are correct)","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Progressive onset of symptomatology in 15 days","justification":"Brutal"},{"idx":1,"correct":true,"proposition":"Impaired alertness","justification":""},{"idx":2,"correct":true,"proposition":"Memory disorders","justification":""},{"idx":3,"correct":true,"proposition":"febrile confusion","justification":""},{"idx":4,"correct":false,"proposition":"absence of fever most often","justification":"Most often, fever is high"}],"ts":{"$numberLong":"1659655716067"},"type":"custom","difficulte":1}
-{"_id":"meningite-infectio-d4b7a0c","context":null,"enonce":"Which of the following proposals corresponds to the meningococcal serotype mainly responsible for meningitis? (only one exact proposal)","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Has","justification":""},{"idx":1,"correct":true,"proposition":"B","justification":""},{"idx":2,"correct":false,"proposition":"C","justification":"Meningo C vaccine is mandatory"},{"idx":3,"correct":false,"proposition":"D","justification":""},{"idx":4,"correct":false,"proposition":"E","justification":""}],"ts":{"$numberLong":"1659655727347"},"type":"custom","difficulte":2}
-{"_id":"voyagetrop-infectio-7eb84d2","context":null,"enonce":"What should we mention if urticaria in return from tropical travel?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Schistosomosis in invasion","justification":"True"},{"idx":1,"correct":true,"proposition":"Pre-icteric viral hepatitis","justification":"True, Caroli's triad"},{"idx":2,"correct":true,"proposition":"Rickettsiosis","justification":"True"},{"idx":3,"correct":false,"proposition":"Legionellosis","justification":""},{"idx":4,"correct":false,"proposition":"Listeria","justification":""}],"ts":{"$numberLong":"1659655730701"},"type":"custom","difficulte":2}
-{"_id":"voyagetrop-infectio-c018ce9","context":null,"enonce":"What is special about colonic amoebosis?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"No fever","justification":"True, unlike hepatic amoebosis. Treatments, clinical presentation and prognosis differ"},{"idx":1,"correct":false,"proposition":"No diarrhoea","justification":""},{"idx":2,"correct":false,"proposition":"No abdominal pain","justification":""},{"idx":3,"correct":false,"proposition":"No incubation period","justification":""},{"idx":4,"correct":false,"proposition":"No contagiousness possible","justification":""}],"ts":{"$numberLong":"1659655734797"},"type":"custom","difficulte":1}
-{"_id":"pathoOGE-endoc-7d63967","context":null,"enonce":"What additional examinations do you want to perform in front of a torsion of the spermatic cord?","item":"pathoOGE","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"Abdomen without preparation","justification":""},{"idx":1,"correct":false,"proposition":"Scrotal ultrasound","justification":""},{"idx":2,"correct":true,"proposition":"None","justification":"Given the urgency of torsion of the spermatic cord, no additional examination is necessary, unless there is a diagnostic doubt"},{"idx":3,"correct":false,"proposition":"Abdominopelvic CT scan","justification":""},{"idx":4,"correct":false,"proposition":"Pelvic MRI","justification":""}],"ts":{"$numberLong":"1672049654320"},"type":"custom","difficulte":1}
-{"_id":"pathoOGE-endoc-e4a925b","context":null,"enonce":"How quickly should testicular torsion be treated?","item":"pathoOGE","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"1h","justification":""},{"idx":1,"correct":false,"proposition":"2h","justification":""},{"idx":2,"correct":true,"proposition":"6am","justification":"Torsion of the spermatic cord is an emergency, which must be treated surgically within 6 hours. Beyond that, arterial ischemia can become irreversible."},{"idx":3,"correct":false,"proposition":"12:00","justification":""},{"idx":4,"correct":false,"proposition":"24h","justification":""}],"ts":{"$numberLong":"1673803987562"},"type":"custom","difficulte":2}
-{"_id":"pathoOGE-endoc-ba32a9a","context":null,"enonce":"What germs can be responsible for Fournier's gangrene?","item":"pathoOGE","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Streptococcus","justification":""},{"idx":1,"correct":true,"proposition":"Pseudomonas aeruginosa","justification":""},{"idx":2,"correct":false,"proposition":"Golden staph","justification":""},{"idx":3,"correct":true,"proposition":"E. Coli","justification":""},{"idx":4,"correct":false,"proposition":"All answers are true","justification":""}],"ts":{"$numberLong":"1673805791264"},"type":"custom","difficulte":2}
-{"_id":"HBP-uro-0c8a594","context":null,"enonce":"In a patient with lower urinary tract symptoms (UAB), what are the differential diagnoses of benign prostatic hyperplasia? (one or more exact propositions)","item":"HBP","matiere":"uro","propositions":[{"idx":0,"correct":true,"proposition":"urinary tract infection","justification":"You have to do an ECBU"},{"idx":1,"correct":true,"proposition":"urethral stenosis","justification":"At the slightest doubt, it is necessary to perform a urethral fibroscopy"},{"idx":2,"correct":true,"proposition":"bladder hypoactivity","justification":"The presence of peripheral neurological pathology must suggest bladder hypoactivity, objectified to the urodynamic balance (BUD)"},{"idx":3,"correct":true,"proposition":"Type 2 diabetes","justification":"To be eliminated by a blood test"},{"idx":4,"correct":true,"proposition":"prostate cancer","justification":"To be eliminated by a digital rectal examination, and a PSA in case of doubt (which must be normal in BPH)"}],"ts":{"$numberLong":"1673806110645"},"type":"custom","difficulte":1}
-{"_id":"HBP-uro-144f8db","context":null,"enonce":"What are the side effects of treatment with alfuzosin (alpha-blocker)?","item":"HBP","matiere":"uro","propositions":[{"idx":0,"correct":true,"proposition":"orthostatic hypotension","justification":"AE of alpha-blockers: HO, anejucalation, IC before eye surgery"},{"idx":1,"correct":true,"proposition":"anejaculation","justification":""},{"idx":2,"correct":false,"proposition":"libido disorder","justification":"5-alpha-reductase inhibitor AEs: libido\/erectile dysfunction. Divides PSA by 2"},{"idx":3,"correct":false,"proposition":"retrograde ejaculation","justification":"AEs of phospho-di-esterase 5 (IPDE5) inhibitors"},{"idx":4,"correct":false,"proposition":"division of the PSA by 2","justification":""}],"ts":{"$numberLong":"1673806235076"},"type":"custom","difficulte":1}
-{"_id":"HBP-uro-23f6ec2","context":null,"enonce":"Which of the following are exact in benign prostatic hyperplasia? ","item":"HBP","matiere":"uro","propositions":[{"idx":0,"correct":true,"proposition":"The clinical complaint is not proportional to the volume of the prostate","justification":""},{"idx":1,"correct":true,"proposition":"The digital rectal exam finds a flexible prostate","justification":""},{"idx":2,"correct":false,"proposition":"Digital rectal examination is usually painful","justification":"TR: flexible, painless, smooth, regular, disappearance of the median groove"},{"idx":3,"correct":false,"proposition":"A post-voiding residue is a disorder of the voiding phase","justification":"Impact on the lower urinary tract: voiding phase (dysuria, weak stream) and post-voidition (drops, post-voiding residue)."},{"idx":4,"correct":false,"proposition":"ECBU is routine to rule out bladder cancer","justification":"It eliminates an infection"}],"ts":{"$numberLong":"1673806339480"},"type":"custom","difficulte":1}
-{"_id":"HBP-uro-524b407","context":null,"enonce":"What are the risk factors for clinical progression of benign prostatic hyperplasia?","item":"HBP","matiere":"uro","propositions":[{"idx":0,"correct":false,"proposition":"Age over 30","justification":"Age over 60"},{"idx":1,"correct":true,"proposition":"Volume >31mL","justification":""},{"idx":2,"correct":true,"proposition":"The PSA > 1.6","justification":""},{"idx":3,"correct":false,"proposition":"An IPSS score greater than 2","justification":"The IPSS score is to be done systematically but is not a risk factor for complications"},{"idx":4,"correct":false,"proposition":"All proposals are accurate","justification":""}],"ts":{"$numberLong":"1673806639852"},"type":"custom","difficulte":3}
+{"_id":"annales-2018-dp-1-qi-1","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What are the elements (present or to be sought at the interrogation and clinical examination) that can evoke a malignant tumor of the kidney? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Smoking","justification":"Tobacco is indeed a risk factor for kidney (as well as bladder) cancer."},{"idx":1,"correct":true,"proposition":"Chronic high blood pressure","justification":""},{"idx":2,"correct":false,"proposition":"Long-term calcium channel blocker treatment","justification":""},{"idx":3,"correct":false,"proposition":"A family history of multiple endocrine neoplasia","justification":""},{"idx":4,"correct":true,"proposition":"Low back pain","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-2","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"Which exam(s) are you asking for as a first line? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Urinary cytology with pathological examination","justification":"It is indeed a first-line examination"},{"idx":1,"correct":true,"proposition":"Cytobacteriological examination of urine","justification":""},{"idx":2,"correct":false,"proposition":"Serum erythropoietin assay","justification":""},{"idx":3,"correct":true,"proposition":"Abdominopelvic CT scan with and without contrast injection","justification":""},{"idx":4,"correct":false,"proposition":"Ultrasound-guided puncture of the mass","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-3","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"On the cut shown below, what are the true propositions?  (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"This is an abdominal CT scan with injection","justification":""},{"idx":1,"correct":false,"proposition":"This is a coronal cup","justification":"Axial cut"},{"idx":2,"correct":false,"proposition":"Structure number 1 is the inferior vena cava","justification":"Aorta"},{"idx":3,"correct":true,"proposition":"The cut passes through the third duodenum","justification":""},{"idx":3,"correct":false,"proposition":"The number 2 corresponds to the inferior mesenteric artery","justification":"superior"}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-4","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What are the real propositions? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The patient must receive red blood cells","justification":""},{"idx":1,"correct":false,"proposition":"The patient must receive platelet pellets","justification":""},{"idx":2,"correct":false,"proposition":"In case of transfusion of red blood cells, you would prescribe O-negative pellets","justification":""},{"idx":3,"correct":false,"proposition":"A search result for irregular agglutinins less than 48 h old must be available","justification":""},{"idx":4,"correct":false,"proposition":"Since 2003, there has been no risk of transmission of infectious pathogens through red blood cell transfusion","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-5","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What is the real proposal(s)? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"This is acute renal failure","justification":""},{"idx":1,"correct":false,"proposition":"The glomerular filtration rate must be recalculated","justification":""},{"idx":2,"correct":false,"proposition":"An obstacle on the contralateral kidney is likely","justification":""},{"idx":3,"correct":true,"proposition":"It may be functional renal failure","justification":""},{"idx":4,"correct":true,"proposition":"An ionogram should be prescribed on a urine sample","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-6","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What are the exact proposals? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"He has moderate chronic renal failure","justification":""},{"idx":1,"correct":true,"proposition":"His antihypertensive treatment must include an inhibitor of the renin-angiotensin system","justification":""},{"idx":2,"correct":false,"proposition":"The LDL cholesterol target to be achieved is 1.3 g\/L","justification":""},{"idx":3,"correct":false,"proposition":"He must follow a diet containing no more than 1.5 g\/kg of protein weight","justification":""},{"idx":4,"correct":false,"proposition":"It is necessary to advocate a diet low in fast sugars","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-7","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What risk(s) does he run? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Gradual decrease in diuresis","justification":""},{"idx":1,"correct":true,"proposition":"Increased cardiovascular risk","justification":""},{"idx":2,"correct":true,"proposition":"Hyperphosphoremia","justification":""},{"idx":3,"correct":true,"proposition":"Erectile dysfunction","justification":""},{"idx":4,"correct":true,"proposition":"Contralateral kidney cancer","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-8","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What is the true answer(s)? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The ALD file is completed by the patient and validated by the medical specialist","justification":""},{"idx":1,"correct":true,"proposition":"The attending physician must specify in the request the protocol of care envisaged including treatments, examinations and consultations","justification":""},{"idx":2,"correct":true,"proposition":"The care protocol must be validated by the medical officer of the Health Insurance","justification":""},{"idx":3,"correct":false,"proposition":"In case of coverage in ALD, remains the responsibility of the patient only the co-payment","justification":""},{"idx":4,"correct":false,"proposition":"The third-party payer is the part of the care paid by the insured whether or not he is registered in ALD","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-9","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What is your interpretation of the electrocardiogram below? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Sinus rhythm","justification":""},{"idx":1,"correct":false,"proposition":"Sino-auricular block","justification":""},{"idx":2,"correct":false,"proposition":"T-waves suggestive of hyperkalemia","justification":""},{"idx":3,"correct":false,"proposition":"Expanded QRS Complexes","justification":""},{"idx":4,"correct":true,"proposition":"Left ventricular hypertrophy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-10","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"To reduce edematous syndrome, what do you recommend at this stage? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A low-salt diet (less than 6 g\/d)","justification":""},{"idx":1,"correct":false,"proposition":"Water restriction","justification":""},{"idx":2,"correct":true,"proposition":"A loop diuretic (furosemide)","justification":""},{"idx":3,"correct":false,"proposition":"A thiazide diuretic (hydrochlorothiazide)","justification":""},{"idx":4,"correct":false,"proposition":"Blood ultrafiltration (start of hemodialysis)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-11","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What are the possible cause(s) in the context of the new biological abnormality observed? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Excessive calcium intake","justification":""},{"idx":1,"correct":false,"proposition":"Taking furosemide","justification":""},{"idx":2,"correct":true,"proposition":"Chronic renal failure","justification":"This is a POSSIBLE (but rare) cause of hypercalcemia by tertiary hyperparathyroidism, one really needs to read the statements carefully and take them to the first degree. It should be remembered, however, that chronic renal failure is mainly a source of hypocalcaemia."},{"idx":3,"correct":false,"proposition":"Secondary hyperparathyroidism","justification":"Normal serum calcium"},{"idx":4,"correct":true,"proposition":"Bone metastases from kidney cancer","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-12","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What additional examination(s) do you recommend to explore this biological anomaly? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Ionized serum calcium","justification":""},{"idx":1,"correct":false,"proposition":"Test de PAK","justification":""},{"idx":2,"correct":true,"proposition":"PTH assay","justification":""},{"idx":3,"correct":false,"proposition":"PTHrp assay","justification":""},{"idx":4,"correct":true,"proposition":"Bone scintigraphy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-13","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"Which proposals are correct? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Metastatic cancer is a contraindication to dialysis","justification":""},{"idx":1,"correct":false,"proposition":"Haemodialysis confers survival advantage over peritoneal dialysis","justification":""},{"idx":2,"correct":false,"proposition":"The preparation of an arteriovenous fistula (AVF) is contraindicated given the prognosis","justification":""},{"idx":3,"correct":true,"proposition":"A tunneled central venous catheter may be placed to initiate hemodialysis","justification":""},{"idx":4,"correct":false,"proposition":"A transplant from a cadaveric donor must be discussed","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-14","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"In general, regarding living donors, what are the real proposals? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Only people with a genetic link to the recipient can be donors","justification":""},{"idx":1,"correct":true,"proposition":"Transplantation can be done in incompatible ABO condition","justification":""},{"idx":2,"correct":false,"proposition":"Rhesus compatibility must be respected","justification":""},{"idx":3,"correct":false,"proposition":"HLA incompatibility between donor and recipient is a formal contraindication","justification":""},{"idx":4,"correct":false,"proposition":"The donor is remunerated on a basis proportional to the recipient's waiting time","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-1","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"What additional examination(s) do you prescribe in early pregnancy? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Cervico-uterine smear","justification":""},{"idx":1,"correct":true,"proposition":"Hbs antigen","justification":""},{"idx":2,"correct":true,"proposition":"Fasting blood glucose","justification":""},{"idx":3,"correct":false,"proposition":"Pulmonary function tests","justification":""},{"idx":4,"correct":true,"proposition":"Cytobacteriological examination of urine","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-2","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"Regarding trisomy 21 screening in this case, what is (are) the exact proposal(s)? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Nuchal translucency measurement is performed on an axial section of the fetus","justification":""},{"idx":1,"correct":true,"proposition":"Combined first trimester screening takes into account gestational age","justification":""},{"idx":2,"correct":false,"proposition":"Integrated sequential screening of the second trimester is not possible due to Turner syndrome","justification":""},{"idx":3,"correct":false,"proposition":"The patient's age is taken into account for the calculation of the combined risk of the first trimester","justification":""},{"idx":4,"correct":false,"proposition":"Total hCG is considered for combined first trimester screening","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-3","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"What is the exact proposal(s)? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"This is a toxoplasma seroconversion","justification":""},{"idx":1,"correct":true,"proposition":"The initiation of treatment with spiramycin is lawful","justification":""},{"idx":2,"correct":true,"proposition":"Amniocentesis should be offered at least 4 weeks after the expected date of seroconversion","justification":""},{"idx":3,"correct":false,"proposition":"IgG avidity test is indicated","justification":""},{"idx":4,"correct":false,"proposition":"Cross-reaction with other infectious agents may explain this serological result","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-4","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"You start treatment with spiramycin. Regarding this molecule and the pharmacological class to which it belongs, which is (are) the exact proposal(s)?  What is the exact proposal(s)? B. The genome of ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Spiramycin has a parasiticidal action on Toxoplasma gondii","justification":"Macrolides are parasitostatic"},{"idx":1,"correct":true,"proposition":"Spiramycin acts by inhibition of bacterial proteins by binding to a ribosomal subunit"},{"idx":2,"correct":true,"proposition":"Spiramycin is active on Mycoplasma hominis"},{"idx":3,"correct":true,"proposition":"P. aeruginosa is naturally resistant"},{"idx":4,"correct":true,"proposition":"The therapeutic class is used in the treatment of pertussis"}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-5","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"You decide to look for mother-to-fetal transmission of T. gondii. What are the exact proposal(s)?","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"You perform a choriocentesis","justification":""},{"idx":1,"correct":true,"proposition":"The genome is sought in amniotic fluid","justification":"By amniocentesis"},{"idx":2,"correct":false,"proposition":"A search for specific IgG is performed on fetal blood","justification":""},{"idx":3,"correct":false,"proposition":"Chorioretinitis should be tested by fetal ultrasound","justification":""},{"idx":4,"correct":false,"proposition":"Anemia should be sought by measuring brain velocities in Doppler","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-6","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"You perform an amniocentesis. The same evening, the patient comes to see you for abdominal pain that has lasted for several hours. There is no vaginal discharge and no bleeding. The patient is apyretic and normotensive. The cervix is shortened to the vaginal touch and measures 18mm. What treatment(s) do you introduce? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Betamethasone","justification":""},{"idx":1,"correct":true,"proposition":"Continuation of spiramycin treatment","justification":""},{"idx":2,"correct":false,"proposition":"Indomethacin","justification":""},{"idx":3,"correct":true,"proposition":"Atosiban","justification":""},{"idx":4,"correct":true,"proposition":"Magnesium sulphate","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-7","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"After 24 hours of hospitalization, the patient notices losses of smelly fluid through the vagina. Uterine contractions have resumed and are painful. The temperature is 39.3°C.  She gets chills. Cardiotocographic recording shows fetal tachycardia and 5 uterine contractions every 10 minutes. What is the most likely diagnosis?","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Acute appendicitis","justification":""},{"idx":1,"correct":false,"proposition":"Acute pyelonephritis","justification":""},{"idx":2,"correct":false,"proposition":"Listeriosis","justification":""},{"idx":3,"correct":false,"proposition":"Toxoplasma sepsis","justification":""},{"idx":4,"correct":true,"proposition":"Chorioamnionitis","justification":"Most likely given the context (amniocentesis, fever)."}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-8","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"In front of this chorioamnionitis and the presence of fetal heart rhythm abnormalities, you perform an emergency caesarean section under general anesthesia. As soon as the child is extracted, heavy bleeding of endouterine origin is observed. Manual delivery of the placenta is performed and the hysterotomy is sutured. The uterus remains soft and significant bleeding persists externalized vaginally despite the infusion of oxytocics. The patient is hemodynamically stable. What therapeutic option(s) can be used in this situation? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Mifepristone infusion","justification":""},{"idx":1,"correct":true,"proposition":"Ligation of uterine arteries","justification":""},{"idx":2,"correct":false,"proposition":"Methotrexate infusion","justification":""},{"idx":3,"correct":true,"proposition":"Sulprostone infusion","justification":""},{"idx":4,"correct":false,"proposition":"Ligation of the external iliac arteries","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-9","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"An infusion of sulprostone is initiated. One Hemocue reveals a hemoglobin level of 6 g\/dL. Blood loss is estimated at 1500 ml. Blood pressure is 100\/60 and heart rate is 130 beats per minute (bpm). A biological assessment is carried out. The anesthesiologist orders labile blood products in a life-threatening emergency. After 30 minutes, the bleeding seems to dry up and the results of the laboratory workup are available: Leukocytes 15.2 G\/L. Platelets 70 G\/L. Haemoglobin 5.7 g\/dL. Prothrombin level 60%. Activated cephalin time 32\/30. Fibrinogenemia 0.5 g\/L. D-Dimers elevated. Which of the elements of this assessment is included in the definition of biological disseminated intravascular coagulation (DIC)? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Platelets","justification":""},{"idx":1,"correct":false,"proposition":"Leukocytes","justification":""},{"idx":2,"correct":true,"proposition":"Fibrinogen","justification":""},{"idx":3,"correct":true,"proposition":"D-dimer","justification":""},{"idx":4,"correct":false,"proposition":"Haemoglobin","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-10","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"Taking into account the biological assessment, a transfusion of a platelet concentrate and 4 red blood cells is performed as well as an injection of 1.5 g of fibrinogen. One hour after birth, the bleeding has now dried up. The patient is monitored for 3 hours in the recovery room before being transferred to intensive care. The caesarean section allowed the birth of a girl weighing 790 grams who was immediately supported by the neonatal team. The clinical examination at 5 minutes of life is as follows: respiratory rate 70 \/ minute, intercostal and suprasternal pull, intense xyphoidian funnel, moderate fluttering of the wings of the nose, expiratory whining with the stethoscope, paradoxical respiration, generalized cyanosis, hypotonia, oxygen requirements (02) at 50% to maintain a 90% saturometry. About the neonatal clinical condition, which is the exact proposal(s)?","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This is transient respiratory distress","justification":""},{"idx":1,"correct":false,"proposition":"The Apgar score is not interpretable in case of prematurity","justification":""},{"idx":2,"correct":true,"proposition":"This child's oxygen needs are a sign of severity","justification":""},{"idx":3,"correct":true,"proposition":"Silverman's score is 8","justification":""},{"idx":4,"correct":false,"proposition":"Generalized cyanosis is in favor of anemia of the newborn","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-11","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"The child's respiratory condition improves but after 36 hours in neonatology, his condition deteriorates sharply. A chest X-ray is performed. What diagnosis(s) can you retain from the interpretation of this shot?","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left fluid pleural effusion","justification":""},{"idx":1,"correct":false,"proposition":"Left retrocardiac atelectasis","justification":""},{"idx":2,"correct":true,"proposition":"Right pneumothorax","justification":""},{"idx":3,"correct":false,"proposition":"Left diaphragmatic hernia","justification":""},{"idx":4,"correct":false,"proposition":"Right pneumoperitoneum","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-12","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"You diagnose a right pneumothorax. After exsufflation of the latter, the respiratory condition of the child improves markedly. In addition, at 48 hours of the caesarean section, the mother complains of chest pain. In this patient, which pathology(s) should you eliminate first? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Acute cardiogenic edema","justification":""},{"idx":1,"correct":true,"proposition":"Aortic dissection","justification":""},{"idx":2,"correct":false,"proposition":"Bacterial pneumonitis","justification":""},{"idx":3,"correct":false,"proposition":"Pericarditis","justification":""},{"idx":4,"correct":true,"proposition":"Pulmonary embolism","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-13","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"In addition to the chest doubt, the patient complains of dyspnea. Blood pressure is at 130\/70 mmHg. The pulses are symmetrical. The temperature is 37.5 ° C.  You decide to immediately perform an emergency pulmonary angiography. What anomaly(s) do you identify on these 3 shots? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Dilation of the left ventricle","justification":""},{"idx":1,"correct":false,"proposition":"Ascending aorta dissection","justification":""},{"idx":2,"correct":true,"proposition":"Acute pulmonary heart","justification":""},{"idx":3,"correct":true,"proposition":"Bilateral pulmonary embolism","justification":""},{"idx":4,"correct":false,"proposition":"Pneumomediastinum","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-14","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"A pulmonary embolism is diagnosed. Heparin therapy at curative dose is introduced. The patient is transferred back to the maternity ward after 48 hours. She wants to breastfeed but worries because she has cold sores. What do you say about breastfeeding? (one or more correct answers) ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Breastfeeding is possible despite heparin treatment","justification":""},{"idx":1,"correct":false,"proposition":"Breastfeeding is not possible, as the child is premature","justification":""},{"idx":2,"correct":false,"proposition":"Herpes labialis contraindicates breastfeeding","justification":""},{"idx":3,"correct":false,"proposition":"She won't have a milk rush due to Turner syndrome","justification":""},{"idx":4,"correct":false,"proposition":"Breastfeeding is not recommended in this patient due to complications of childbirth","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-1","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"For the evaluation of dependence, which of the following proposals, which corresponds to an instrumental function? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Wash","justification":""},{"idx":1,"correct":true,"proposition":"Shopping","justification":""},{"idx":2,"correct":true,"proposition":"Prepare a meal","justification":""},{"idx":3,"correct":false,"proposition":"Dress","justification":""},{"idx":4,"correct":true,"proposition":"Manage your medications","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-2","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"A dependent patient can benefit from the personalized autonomy allowance.  Select the right proposal(s) from the following: ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It concerns patients over 60 years of age","justification":""},{"idx":1,"correct":false,"proposition":"It is assigned to GIR 5 and 6 according to the AGGIR grid","justification":""},{"idx":2,"correct":true,"proposition":"Its amount depends on the level of dependency","justification":""},{"idx":3,"correct":true,"proposition":"Its amount depends on individual income","justification":""},{"idx":4,"correct":true,"proposition":"It also concerns patients in nursing homes","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-3","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The IADL (Instrumental activities of daily living) scale is 6\/8. The patient is not very informative, but she says she is tired as soon as she tries to make an effort. She comes accompanied by her daughter who finds her mother sad, and who mentions the progressive appearance of anterograde memory disorders, forcing her to note the information. She has trouble finding certain objects, or the names of her children that she sometimes confords, which saddens her. A month ago, she got lost in a neighborhood she knew well before, which worried her daughter and justified the consultation. The neurological examination is normal, without pyramidal syndrome or parkinsonism. The MMS is at 23\/30, with a reminder of the 3 words at 2\/3. Regarding the evaluation of recent memory in the neuropsychological assessment, the encoding is normal but the patient has a deficit of free recall well corrected by the indication (reactivity 87.5%). The Front Efficiency Fast Battery (BREF) is 15\/18. You mention a major neurocognitive disorder according to DSM 5. Which of the following criterion(s) are actually part of it? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Slow progressive evolution","justification":""},{"idx":1,"correct":true,"proposition":"Decline in at least one cognitive domain","justification":""},{"idx":2,"correct":true,"proposition":"Memory impairment","justification":""},{"idx":3,"correct":true,"proposition":"Interference of cognitive impairment with autonomy","justification":""},{"idx":4,"correct":false,"proposition":"Worsening of disorders during confusional episodes","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-4","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"Brain MRI shows Fazekas stage III vascular leukopathy, with two lacunar ischemic vascular sequelae, as well as Scheltens stage I hippocampal atrophy. The neuropsychological assessment shows a visuo-verbal impairment of subcortical profile, and a dyseexecutive syndrome. Which of the following diagnose(s) do you mention? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Alzheimer's disease","justification":""},{"idx":1,"correct":true,"proposition":"Cerebrovascular disease","justification":""},{"idx":2,"correct":false,"proposition":"Chronic hydrocephalus","justification":""},{"idx":3,"correct":true,"proposition":"Depression","justification":""},{"idx":4,"correct":false,"proposition":"Frontotemporal lobar degeneration","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-5","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"You are diagnosed with major neurocognitive disorder of cerebrovascular origin and depressive syndrome. Which of the following elements of processing are you starting at this stage?","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Balance of cardiovascular risk factors","justification":""},{"idx":1,"correct":false,"proposition":"Acetylcholine esterase inhibitor","justification":""},{"idx":2,"correct":true,"proposition":"Psychological follow-up","justification":""},{"idx":3,"correct":false,"proposition":"Legal protection","justification":"The patient remains autonomous with an MMS score that does not seem to put her at risk."},{"idx":4,"correct":true,"proposition":"Personalized autonomy allowance","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-6","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The patient is sedentary, weighs 70 kgs for 1.52 m or a body mass index of 30 kg \/ m2. Blood pressure is 133\/65 mmHg, heart rate is 45\/min. Her daughter tells you that the patient always has a slow pulse when she takes her constants at home, between 40 and 50\/min. The systolic pressure index is 1.2. HbA1C 7.9%, albumin 31 g\/l, CRP 2 mg\/L (normal 5), hemoglobin 12 g\/dL. Regarding the cardiovascular risk factors of this patient, what measure(s) are you taking? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Low-calorie diet","justification":""},{"idx":1,"correct":false,"proposition":"Low carbohydrate diet","justification":""},{"idx":2,"correct":true,"proposition":"High protein diet","justification":""},{"idx":3,"correct":false,"proposition":"Sodium diet","justification":""},{"idx":4,"correct":true,"proposition":"Adapted physical activity","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-7","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"Regarding the systolic pressure index (SPI), which proposal(s) is(are) right? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It allows the screening of arterial disease obliterans of the lower limbs","justification":""},{"idx":1,"correct":false,"proposition":"Its measurement is contraindicated in case of critical ischemia","justification":""},{"idx":2,"correct":true,"proposition":"It is calculated as the ratio of ankle blood pressure to humeral blood pressure.","justification":""},{"idx":3,"correct":true,"proposition":"An SPI greater than 1.30 reflects incompressible, rigid and calcified arteries","justification":""},{"idx":4,"correct":true,"proposition":"It makes it possible to follow the evolution of arterial disease obliterating the lower limbs","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-8","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The patient also reports three recent falls, while her daughter specifies that she did not fall before. The patient mentions a dizzying sensation during the first fall, fleeting, but evokes above all a clumsiness each time, as when she stumbled into the edge of a sidewalk. ENT explorations carried out in the city are normal. You perform a search for orthostatic hypotension. Choose the right proposal(s) from the following:","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Negative research eliminates orthostatic hypotension","justification":""},{"idx":1,"correct":false,"proposition":"An acceleration of the heart rate > 100\/min evokes dysautonomia","justification":""},{"idx":2,"correct":true,"proposition":"A decrease in systolic blood pressure 20 mmHg at orthostatism confirms the diagnosis","justification":""},{"idx":3,"correct":false,"proposition":"The absence of symptoms at orthostatism rules out the diagnosis","justification":""},{"idx":4,"correct":true,"proposition":"An isolated decrease in diastolic blood pressure of > 1O mmHg at orthostatism confirms the diagnosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-9","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"You confirm orthostatic hypotension in this patient. Which of the following factors, in the case of this patient, may have contributed to this? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Non-insulin-dependent diabetes","justification":""},{"idx":1,"correct":false,"proposition":"High blood pressure","justification":""},{"idx":2,"correct":true,"proposition":"Calcium channel blocker","justification":""},{"idx":3,"correct":false,"proposition":"Sedentary lifestyle","justification":""},{"idx":4,"correct":false,"proposition":"Hemoglobin level","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-10","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The systolic pressure index is 1.2.What therapeutic measure(s) in first line do you take regarding this orthostatic hypotension? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Class 2 venous compression","justification":""},{"idx":1,"correct":false,"proposition":"Addition of midodrine","justification":""},{"idx":2,"correct":false,"proposition":"Addition of fludrocortisone","justification":""},{"idx":3,"correct":false,"proposition":"Discontinuation of antihypertensive therapy","justification":""},{"idx":4,"correct":true,"proposition":"Regular physical activity","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-11","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"What abnormality(s) do you notice on this ECG? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Sinus rhythm","justification":""},{"idx":1,"correct":true,"proposition":"Second degree atrioventricular block","justification":""},{"idx":2,"correct":false,"proposition":"Paroxysmal sinoatrial block","justification":""},{"idx":3,"correct":true,"proposition":"Left axis of QRS","justification":""},{"idx":4,"correct":true,"proposition":"Right branch block","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-12","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"In view of the entire file, what anomaly(s) are you looking for on the holter requested by the attending physician? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Sinus dysfunction","justification":""},{"idx":1,"correct":true,"proposition":"Paroxysmal atrial fibrillation","justification":""},{"idx":2,"correct":false,"proposition":"Paroxysmal ventricular tachycardia","justification":""},{"idx":3,"correct":false,"proposition":"Ischemic heart disease","justification":""},{"idx":4,"correct":true,"proposition":"High-grade atrioventricular block","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-13","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The holter shows sinus dysfunction (high-degree sinoatrial block) and nodal dysfunction (BAV2 Mobitz 2) with long periods of bradycardia between 35 and 40 per minute, without AF. Which treatment(s) do you decide? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Double chamber pacemaker installation","justification":""},{"idx":1,"correct":false,"proposition":"Discontinuation of calcium channel blocker","justification":"-dipine is not bradycardial (non-cardio-selective)."},{"idx":2,"correct":false,"proposition":"Curative anticoagulant treatment","justification":""},{"idx":3,"correct":false,"proposition":"Amiodarone","justification":""},{"idx":4,"correct":false,"proposition":"Therapeutic abstention and monitoring","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-14","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"Finally, tests show a creatinine clearance of 27 mL\/min. You recover a value a year ago at 29 mL \/ min whose vascular and diabetic origin had been retained. What impact does this information have on your current or future treatment? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Contraindication to angiotensin-converting enzyme inhibitor therapy","justification":""},{"idx":1,"correct":true,"proposition":"Contraindication to bisphosphonate therapy if indicated","justification":"Car DFG30."},{"idx":2,"correct":false,"proposition":"Contraindication to a high protein diet","justification":""},{"idx":3,"correct":false,"proposition":"Contraindication to treatment with denosumab if indicated","justification":""},{"idx":4,"correct":false,"proposition":"Contraindication to pravastatin","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-1","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"This patient consumed 1 glass of whisky per day and 75 cl of wine per day. He has been weaned for 3 months following the discovery of cirrhosis. About cirrhosis, what is the exact proposal(s)?","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Has a histological definition","justification":""},{"idx":1,"correct":true,"proposition":"Is a fibrous scar of the hepatic parenchyma","justification":""},{"idx":2,"correct":false,"proposition":"Is an irreversible disease","justification":""},{"idx":3,"correct":true,"proposition":"May be asymptomatic","justification":""},{"idx":4,"correct":true,"proposition":"Can be diagnosed without liver biopsy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-2","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The clinical examination is unremarkable. He has no sign of portal hypertension, no sign of severe sepsis. The biological balance shows: Na at 135mmol \/ L, K at 3.7mmol \/ L, CRP at 15mg \/ L, creatinine at 80 μmol \/ L, urea at 6.1 mmol \/ L, Hb at 137g \/ L, platelets at 120G \/ L, PNN at 7.45G \/ L, TP at 43%, TCA at 35\/28, AST at 69Ul \/ L, ALT at 33IU \/ L, Alkaline phosphatase at 146U \/ L,  gammaGT at 236 IU\/L. The patient has abundant daily sputum. In front of dyspnea, you realize the arterial blood gases in ambient air: pH at 7.49, PCO2 at 29mmHg, P02 at 75mmHg, HCO3- at 22mmol. What is your interpretation (only one answer)? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Compensated metabolic alkalosis","justification":""},{"idx":1,"correct":false,"proposition":"Decompensated metabolic alkalosis","justification":""},{"idx":2,"correct":false,"proposition":"Decompensated mixed alkalosis","justification":""},{"idx":3,"correct":false,"proposition":"Compensated respiratory alkalosis","justification":""},{"idx":4,"correct":true,"proposition":"Decompensated respiratory alkalosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-3","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"Chest X-ray shows a left basal opacity. You complete by performing a chest scan. What is the real proposal(s)?","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The mark A corresponds to the arch of the aorta","justification":""},{"idx":1,"correct":false,"proposition":"Benchmark B corresponds to the trunk of the pulmonary artery","justification":""},{"idx":2,"correct":false,"proposition":"The C mark corresponds to the left stem bronchus","justification":""},{"idx":3,"correct":false,"proposition":"Coordinate system D corresponds to the esophagus","justification":""},{"idx":4,"correct":false,"proposition":"The mark E corresponds to the inferior vena cava","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-4","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The mediastinal window shows lymphadenopathy. Here is a chest window computed tomography section. What do you observe? (one or more correct answers) ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Micronodules","justification":""},{"idx":1,"correct":false,"proposition":"Intralobular cross-linking","justification":""},{"idx":2,"correct":false,"proposition":"From the honeycomb","justification":""},{"idx":3,"correct":false,"proposition":"An aspect in << release of balloons>>","justification":""},{"idx":4,"correct":true,"proposition":"A nodule of about 3 cm","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-5","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"What diagnostic hypothesis(s) can explain the entire thoracic clinico-radiological picture? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Diffuse bronchiolitis","justification":""},{"idx":1,"correct":false,"proposition":"Stage I pulmonary carcinoma","justification":""},{"idx":2,"correct":false,"proposition":"Carcinomatous lymphangitis","justification":""},{"idx":3,"correct":false,"proposition":"Hypersensitivity pneumonitis","justification":""},{"idx":4,"correct":true,"proposition":"Pulmonary tuberculosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-6","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"You suspect a tuberculosis miliary. How do you make the first-line diagnosis (one or more correct answers)? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Examination of sputum addressed in mycobacteriology for acid-alcohol-resistant bacilli (BAAR)","justification":""},{"idx":1,"correct":true,"proposition":"Cytobacteriological examination of urine addressed in mycobacteriology for acid-alcohol-resistant bacilli (RBBA)","justification":""},{"idx":2,"correct":false,"proposition":"Bronchoalveolar lavage addressed in mycobacteriology in search of acid-alcohol-resistant bacilli (BAAR)","justification":"Not in the first intention. It is done if the patient does not spit, the gastric tubing is negative, and the supiscion is diagnosis is strong."},{"idx":3,"correct":false,"proposition":"Lymph node puncture by bronchial endoscopic ultrasound addressed in mycobacteriology in search of acid-alcohol-resistant bacilli (BAAR)","justification":""},{"idx":4,"correct":false,"proposition":"Transthoracic puncture guided by CT scan of the mass addressed in mycobacteriology in search of acid-alcohol-resistant bacilli (BAAR)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-7","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"Sputum analysis shows 10 to 100 BAAR\/field live. You retain the diagnosis of miliary tuberculosis to M. tuberculosis. Which examination(s) should be taken into consideration in your pre-therapeutic assessment? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hepatic test","justification":""},{"idx":1,"correct":true,"proposition":"Creatinine","justification":""},{"idx":2,"correct":true,"proposition":"Ophthalmological examination","justification":""},{"idx":3,"correct":false,"proposition":"Pulmonary function testing","justification":""},{"idx":4,"correct":true,"proposition":"HIV serology","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-8","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"What anti-TB treatment(s) will you offer this patient as a first-line treatment? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Isoniazid (INH)","justification":""},{"idx":1,"correct":false,"proposition":"Streptomycin","justification":""},{"idx":2,"correct":true,"proposition":"Ethambutol (EMB)","justification":""},{"idx":3,"correct":true,"proposition":"Rifampicin (RMP)","justification":""},{"idx":4,"correct":false,"proposition":"Pyrazinamide (PZA)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-9","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"What is (are) the other measure(s) to put in place in this patient? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Inhaled corticosteroid therapy","justification":""},{"idx":1,"correct":true,"proposition":"Request 100% coverage for long-term illness","justification":""},{"idx":2,"correct":true,"proposition":"Respiratory isolation","justification":""},{"idx":3,"correct":true,"proposition":"Anonymous notification to the Regional Health Agency (ARS)","justification":""},{"idx":4,"correct":false,"proposition":"Anonymous notification to the Tuberculosis Centre (CLAT) of the department of the case of domicile","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-10","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"You start a combination of isoniazid, rifampicin and ethambutol. After 2 weeks, the patient leaves the hospital. You follow him every month in consultation, but you have doubts about the patient's compliance with the treatment. How do you monitor its observance? (one or more correct answers) ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Staining of teeth","justification":""},{"idx":1,"correct":true,"proposition":"Urine staining","justification":""},{"idx":2,"correct":false,"proposition":"Determination of uricemia","justification":"The patient is not taking pyrazinamide."},{"idx":3,"correct":false,"proposition":"Determination of transaminases","justification":""},{"idx":4,"correct":false,"proposition":"Color vision","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-11","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The patient wonders about the role of his profession in the occurrence of tuberculosis. You consult the table of occupational diseases 40b of the general scheme. This table indicates that (one or more correct answers):","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Your patient's condition is in the list of conditions that can be recognized as an occupational disease","justification":""},{"idx":1,"correct":false,"proposition":"The period of care indicates that the patient must have been exposed for more than 6 months to be recognized as an occupational disease","justification":""},{"idx":2,"correct":true,"proposition":"Your patient's profession is in the exhaustive list of works","justification":""},{"idx":3,"correct":false,"proposition":"The patient can be directly recognized as an occupational disease","justification":""},{"idx":4,"correct":true,"proposition":"The application for recognition as an occupational disease must go before the regional committee for the recognition of occupational diseases","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-12","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The patient asks you what advantage he can benefit from in case of a possible recognition as an occupational disease? (one or more correct answers) ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An impossibility of dismissal","justification":""},{"idx":1,"correct":false,"proposition":"Compensation for damage to possible secondary family cases","justification":""},{"idx":2,"correct":false,"proposition":"Better compensation for sick leave","justification":""},{"idx":3,"correct":true,"proposition":"100% coverage of treatments","justification":""},{"idx":4,"correct":true,"proposition":"A pension based on last salary and disability rate","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-13","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"What is your interpretation of these pulmonary function tests (one or more correct answers)? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Obstructive ventilatory syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Restrictive ventilatory syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Chest distension"},{"idx":3,"correct":true,"proposition":"Carbon monoxide diffusion disorder","justification":""},{"idx":4,"correct":false,"proposition":"Normal functional explorations","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-14","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The chest computed tomography no longer finds the abnormalities previously described and the pulmonary parenchyma appears normal. On the other hand, there is abnormal dilation of the pulmonary arteries. You suspect pulmonary hypertension associated with portal hypertension. In which group of the International Clinical Classification of Pulmonary Hypertension will you classify this patient? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Group 1","justification":""},{"idx":1,"correct":false,"proposition":"Group 2","justification":""},{"idx":2,"correct":false,"proposition":"Group 3","justification":""},{"idx":3,"correct":false,"proposition":"Group 4","justification":""},{"idx":4,"correct":false,"proposition":"Group 5","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-1","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"On the wrist x-rays performed in the emergency room, what is(are) the exact proposal(s)?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The radial glenoid is anteverted","justification":""},{"idx":1,"correct":true,"proposition":"The radius fracture is extra-articular","justification":""},{"idx":2,"correct":false,"proposition":"The bistyloid line is verticalized","justification":""},{"idx":3,"correct":false,"proposition":"There is an excess length of the radius compared to the ulna","justification":""},{"idx":4,"correct":true,"proposition":"The fracture of the radius has a metaphyseal site","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-2","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"On clinical examination, what element(s) do you find if the radius fracture is uncomplicated?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A medial bayonet face deformation","justification":""},{"idx":1,"correct":true,"proposition":"A deformation on the back of a fork","justification":""},{"idx":2,"correct":false,"proposition":"A hypoesthesia of the pulp of the first 3 fingers","justification":""},{"idx":3,"correct":false,"proposition":"An elective pain of the anatomical snuffbox","justification":""},{"idx":4,"correct":true,"proposition":"A protrusion of the styloid of the ulna","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-3","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"During the initial clinical examination, the patient fails to perform active flexion of the interphalangienoe joint of the thumb. What is the exact proposal(s)?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This may be due to compression of the median nerve in the wrist.","justification":""},{"idx":1,"correct":true,"proposition":"This must evoke a cause other than the fracture itself.","justification":""},{"idx":2,"correct":false,"proposition":"This may be due to paralysis of the long abductor of the thumb.","justification":""},{"idx":3,"correct":false,"proposition":"This may be due to paralysis of the opponent of the thumb","justification":""},{"idx":4,"correct":true,"proposition":"This may be due to damage to the tendon of the long flexor of the thumb.","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-4","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Which imaging examination(s) prescribed in first line seem to you relevant for his functional impotence of the lower right limb?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Computed tomography of the pelvis and right hip","justification":""},{"idx":1,"correct":true,"proposition":"X-ray of the front pelvis","justification":""},{"idx":2,"correct":true,"proposition":"X-ray of the right hip in profile","justification":""},{"idx":3,"correct":false,"proposition":"Bone scintigraphy","justification":""},{"idx":4,"correct":false,"proposition":"Angiocomputed tomography of the pelvis and right lower limb","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-5","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"In view of the X-ray of the pelvis attached, what is the exact proposal?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This is a type 1 fracture according to Garden's classification","justification":""},{"idx":1,"correct":false,"proposition":"This is a type 2 fracture according to Garden's classification","justification":""},{"idx":2,"correct":false,"proposition":"This is a type 3 fracture according to Garden's classification","justification":""},{"idx":3,"correct":false,"proposition":"This is a type 4 fracture according to Garden's classification","justification":""},{"idx":4,"correct":true,"proposition":"Garden's classification does not apply for this type of fracture","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-6","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"In view of the attached radiography of the pelvis, what is (are) the exact proposal(s)?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"There is a deformation in coxa vara","justification":"The angle between the head and the diaphysis is well reduced."},{"idx":1,"correct":false,"proposition":"There are gaps in << the >> punch of the left iliac wing","justification":""},{"idx":2,"correct":false,"proposition":"This is a sub-capital divide","justification":""},{"idx":3,"correct":true,"proposition":"It is a fracture of the trochanterian massif","justification":""},{"idx":4,"correct":false,"proposition":"There is a loss of congruence of the right coxofemoral joint","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-7","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"You explain to the patient that she has a fracture of the proximal femur that requires surgery. The patient is reluctant to have an intervention for fear of possible complications. Which proposal(s) is (are) accurate?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"In the absence of intervention, fracture consolidation is possible","justification":""},{"idx":1,"correct":true,"proposition":"In the absence of intervention, there is a major risk of death related to complications of decubitus","justification":""},{"idx":2,"correct":true,"proposition":"The intervention is necessary to allow a rapid verticalization of the patient","justification":""},{"idx":3,"correct":true,"proposition":"The increase in the time before the intervention modifies the morbidity and mortality in the aftermath of the intervention","justification":""},{"idx":4,"correct":true,"proposition":"Stabilization surgery can effectively fight pain","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-8","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Regarding anesthesia, what can you say to this patient? (one or more correct answers)","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The choice between general or locoregional anaesthesia has no real influence on postoperative morbidity and mortality","justification":""},{"idx":1,"correct":true,"proposition":"It will be mandatory to place a venous catheter and that the patient remains fasting whether it is a general or locoregional anesthesia","justification":""},{"idx":2,"correct":false,"proposition":"There is no cardiac risk under regional anaesthesia","justification":""},{"idx":3,"correct":false,"proposition":"If the anaesthetist opts for regional anesthesia, the patient is not required to stay in the recovery room","justification":""},{"idx":4,"correct":true,"proposition":"Several analgesics are usually used multimodally to reduce morphine consumption postoperatively.","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-9","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Prior to her fall, the patient was travelling to the home without technical assistance. For the past few months, she had been using a cane for walks and when she went shopping, she used a rollator. What is the exact proposal(s)? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Parker's mobility score takes into account walking outside the home","justification":""},{"idx":1,"correct":false,"proposition":"Parker's mobility score is a quality of life score","justification":""},{"idx":2,"correct":true,"proposition":"Parker's mobility score ranges from O to 9","justification":""},{"idx":3,"correct":false,"proposition":"Parker mobility score takes into account the location of the fracture line","justification":""},{"idx":4,"correct":false,"proposition":"After a fracture of the upper extremity of the femur, recovery of the anterior Parker mobility score is the rule","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-10","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Which of the following leads to delay the surgical management of the patient? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The patient's refusal to be operated on","justification":""},{"idx":1,"correct":false,"proposition":"Antiplatelet therapy","justification":""},{"idx":2,"correct":false,"proposition":"A cutaneous opening next to the ulnar styloid","justification":""},{"idx":3,"correct":true,"proposition":"Hyperkalemia with ECG changes","justification":""},{"idx":4,"correct":false,"proposition":"A venous ulcer of the right leg","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-11","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"In this patient, you opted for proximal femur osteosynthesis using intramedullary material. Following such an intervention, what is (are) the exact proposal(s)? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"There is a significant risk of dislocation","justification":""},{"idx":1,"correct":true,"proposition":"The risk of infection at the surgical site is low","justification":""},{"idx":2,"correct":true,"proposition":"The primary complication is the vicious callus.","justification":""},{"idx":3,"correct":false,"proposition":"If after one month, the fracture is not consolidated, it is a delay in consolidation","justification":""},{"idx":4,"correct":true,"proposition":"If after 8 months the fracture is not consolidated, it is pseudarthrosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-12","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Days after osteosynthesis, the patient slips on the wet floor on her way to the toilet and falls again. The patient complains of increased pain in the right hip. You take x-rays of the pelvis and right hip. What is the exact proposal(s)? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"There is a secondary displacement compared to intraoperative reduction plates","justification":""},{"idx":1,"correct":false,"proposition":"There is a dislocation of the right hip","justification":""},{"idx":2,"correct":false,"proposition":"There is a break in the hardware","justification":""},{"idx":3,"correct":false,"proposition":"There is a high risk of osteonecrosis of the femoral head","justification":""},{"idx":4,"correct":true,"proposition":"There is a decrease in the effectiveness of action of ilio-psoas","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-13","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"During her fall, the patient also complains of spinal pain that you locate mainly at the thoracolumbar junction and which is accompanied by more diffuse pain. An MRI is performed. There is no transitional anomaly. In view of this review, what is the exact proposal(s)? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"There is a deformation of the vertebral body of T12","justification":""},{"idx":1,"correct":false,"proposition":"This is a sequence in T1","justification":""},{"idx":2,"correct":false,"proposition":"There is an antelisthesis of L4 on L5","justification":""},{"idx":3,"correct":true,"proposition":"The T12 fracture is recent","justification":""},{"idx":4,"correct":true,"proposition":"There are signs of disc degeneration between L 1 and L2","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-14","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"The patient is reoperated on the right hip. In the aftermath of the intervention, she presents a state of agitation. Which element(s) of the clinical examination do you think is important in the etiological search for this state of agitation? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Performing a digital rectal exam","justification":""},{"idx":1,"correct":true,"proposition":"Abdominal palpation","justification":""},{"idx":2,"correct":true,"proposition":"Examination of cranial pairs","justification":""},{"idx":3,"correct":true,"proposition":"A measurement of capillary blood glucose","justification":""},{"idx":4,"correct":false,"proposition":"Performing the clock test","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-1","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Which of the following is(are) one or more criteria for severity of acute bronchiolitis in this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"His premature birth","justification":""},{"idx":1,"correct":false,"proposition":"Intercostal draw","justification":""},{"idx":2,"correct":true,"proposition":"Respiratory rate","justification":""},{"idx":3,"correct":false,"proposition":"High temperature","justification":"The criteria are very specific. Temperature is not one of them."},{"idx":4,"correct":true,"proposition":"His eating difficulties","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-2","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"In this child, which is (are) the essential examination(s) ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Multiplex PCR for respiratory viruses","justification":""},{"idx":1,"correct":false,"proposition":"A rapid flu test","justification":""},{"idx":2,"correct":true,"proposition":"A chest X-ray","justification":""},{"idx":3,"correct":false,"proposition":"An arterial blood gas","justification":""},{"idx":4,"correct":false,"proposition":"A cardiac ultrasound","justification":"Careful! The new HAS 2019 recommendation taken up in the R2C colleges of pediatrics make this proposal obsolete."}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-3","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"In front of this chest X-ray, what is(are) the exact answer(s)? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Presence of chest distension","justification":""},{"idx":1,"correct":false,"proposition":"Presence of pleural effusion","justification":""},{"idx":2,"correct":true,"proposition":"Presence of pneumomediastinum","justification":""},{"idx":3,"correct":true,"proposition":"Presence of mean lobar alveolar condensation","justification":"Medium lobe because erases the edges of the heart"},{"idx":4,"correct":false,"proposition":"The upper left arc is not visible","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-4","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"The child is hospitalized for 4 rounds for the treatment of bronchiolitis complicated by pneumornediastin. It was fed the first two days by nasogastric tube. Infusion was not necessary. His respiratory signs are improving. While he was out, he presents vomiting followed twelve hours later by profuse diarrhea with a temperature of 37.3 ° C.  What is the possible cause(s) of this acute diarrhoea? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Adenovirus infection","justification":""},{"idx":1,"correct":true,"proposition":"Norovirus infection","justification":""},{"idx":2,"correct":true,"proposition":"C.","justification":""},{"idx":3,"correct":false,"proposition":"Enterovirus infection","justification":"He didn't get antibiotics. He is not feverish."},{"idx":3,"correct":false,"proposition":"RSV infection","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-5","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Regarding the episode of acute gastroenteritis of viral origin, which is(are) the exact statement(s)? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is an infection preventable by droplet precautions << >>","justification":""},{"idx":1,"correct":true,"proposition":"It is a certain nosocomial infection","justification":""},{"idx":2,"correct":false,"proposition":"The germ responsible for diarrhea is resistant to hydroalcoholic fluids (SHA)","justification":""},{"idx":3,"correct":false,"proposition":"It is necessary to make a declaration to the ARS (Regional Health Agency) of this infection","justification":""},{"idx":4,"correct":true,"proposition":"It is a manu-supported infection","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-6","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Given the severity of the picture, intravenous rehydration is decided. A blood sample is taken at the time of the infusion. The results of this assessment are as follows: natremia 125 mmol \/ L, serum potassium 3.7 mmol \/ l, blood glucose 7.4 mmol \/ L. What is (are) the possible diagnosis(s) in this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cystic fibrosis","justification":""},{"idx":1,"correct":true,"proposition":"Oral rehydration with pure water given by parents","justification":""},{"idx":2,"correct":false,"proposition":"Intravenous rehydration with a solution not rich enough in sodium","justification":""},{"idx":3,"correct":false,"proposition":"Ulcerative-necrotizing enterocolitis","justification":""},{"idx":4,"correct":false,"proposition":"Hemolytic uremic syndrome (HUS)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-7","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"At the end of the infusion, the child makes clonic movements of the 4 limbs for 1 minute. It has no post-critical deficit. Which of the following diagnoses can be considered in this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A complex febrile convulsion","justification":""},{"idx":1,"correct":true,"proposition":"An occasional seizure related to hyponatremia","justification":""},{"idx":2,"correct":false,"proposition":"West syndrome-type epilepsy","justification":""},{"idx":3,"correct":true,"proposition":"Cerebral venous thrombosis","justification":""},{"idx":4,"correct":false,"proposition":"Streptococcal B meningitis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-8","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"After a few days, his clinical condition has improved and you prepare the discharge, he weighs 6000g and by taking the health record you find that he has not been followed since his arrival in France and that no vaccination has been carried out. You worry about his psychomotor development. What are the expected acquisitions for his age? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Stacks two cubes","justification":"1 year"},{"idx":1,"correct":false,"proposition":"Repeats one syllable","justification":"6 months"},{"idx":2,"correct":false,"proposition":"Picks up objects with thumb-index clip","justification":"9 months"},{"idx":3,"correct":true,"proposition":"Play with his hands L","justification":""},{"idx":4,"correct":true,"proposition":"Laughs out loud","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-9","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Given the vaccine delay and its age, which of the following vaccines, is the one to be prioritized? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Influenza","justification":""},{"idx":1,"correct":true,"proposition":"Pneumococcus","justification":""},{"idx":2,"correct":true,"proposition":"Haemophilius","justification":""},{"idx":3,"correct":true,"proposition":"Meningococcal B","justification":""},{"idx":4,"correct":true,"proposition":"Measles","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-10","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Before the outing, which of the following dietary tips do you give to parents? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Use sterilized baby bottles","justification":""},{"idx":1,"correct":true,"proposition":"Bottles can be prepared with tap water","justification":""},{"idx":2,"correct":false,"proposition":"In case of family history of allergy, the introduction of peanut should be postponed","justification":""},{"idx":3,"correct":false,"proposition":"Cow's milk can replace infant milk from the age of 1 year","justification":""},{"idx":4,"correct":false,"proposition":"It will be necessary to give 5 fruits and vegetables per day 1 month after the beginning of diversification","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-11","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"You see him again 2 months later for a new episode of respiratory discomfort. Parents tell you he's been cluttered and coughing since his last episode. Its weight is 6,100 g. What is (are) the possible diagnosis(s) given the history of this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Infant asthma","justification":""},{"idx":1,"correct":true,"proposition":"Cystic fibrosis","justification":""},{"idx":2,"correct":false,"proposition":"Coarctation of the aorta","justification":""},{"idx":3,"correct":true,"proposition":"Immunodeficiency","justification":""},{"idx":4,"correct":false,"proposition":"Eosinophilic esophagitis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-12","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"You suspect an immune deficiency. If confirmed, what vaccine(s) would be contraindicated in this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Injectable flu","justification":""},{"idx":1,"correct":true,"proposition":"Chickenpox","justification":""},{"idx":2,"correct":false,"proposition":"Pneumococcus","justification":""},{"idx":3,"correct":false,"proposition":"Meningococcal C","justification":""},{"idx":4,"correct":false,"proposition":"Hepatitis B","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-13","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"No newborn screening was offered to this child. For children born in French maternity wards, newborn screening for cystic fibrosis: ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Requires signed parental consent for potential genetic research","justification":""},{"idx":1,"correct":false,"proposition":"Is proposed on the first day of life in case of delay in the emission of meconium","justification":""},{"idx":2,"correct":true,"proposition":"Is proposed on the third day of life","justification":""},{"idx":3,"correct":false,"proposition":"Consists of the analysis of the CFTR gene when the immunoreactive trypsin assay is below the threshold of positivity","justification":""},{"idx":4,"correct":true,"proposition":"Is sensitive but not very specific","justification":"There are many false positives but few false negatives: this is what we expect from a screening test (we do not want to miss a disease)."}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-14","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"This child has a homozygous delta-F508 mutation. What support do you implement? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Daily chest physiotherapy sessions","justification":""},{"idx":1,"correct":false,"proposition":"Normal power supply","justification":""},{"idx":2,"correct":false,"proposition":"Interruption of breastfeeding","justification":""},{"idx":3,"correct":true,"proposition":"Oral supplementation of fat-soluble vitamins","justification":""},{"idx":4,"correct":true,"proposition":"Standard vaccination schedule","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-1","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"The examination of the perianal region finds the following externalization at the pushing efforts.  Which of the following is correct? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The radial appearance of the folds is in favor of hemorrhoidal prolapse","justification":""},{"idx":1,"correct":false,"proposition":"The appearance of the lesion is in favor of cancer","justification":""},{"idx":2,"correct":false,"proposition":"The existence of haemorrhages on contact with or at the time of exemptions is in favour of cancerous degeneration.","justification":""},{"idx":3,"correct":true,"proposition":"The painless nature of the swelling is not in favor of hemorrhoidal thrombosis","justification":""},{"idx":4,"correct":false,"proposition":"This is a total externalized prolapse of the rectum","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-2","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"You mention hemorrhoidal prolapse. Regarding your therapeutic care, what is (are) the exact proposal(s)?","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Regularization of transit is necessary to limit hemorrhoidal manifestations","justification":""},{"idx":1,"correct":false,"proposition":"This patient must be operated urgently, he risks thrombosis quickly","justification":""},{"idx":2,"correct":true,"proposition":"The regularization of transit and hygiene-dietary rules may be sufficient to relieve the patient","justification":""},{"idx":3,"correct":true,"proposition":"If he remains embarrassed after medical care, surgery may be considered","justification":""},{"idx":4,"correct":false,"proposition":"Hemorrhoids are a risk factor for cancer","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-3","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"Regarding the care and follow-up of the patient, what is (are) the exact proposal(s)? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Once the hygiene-dietary rules are established, if the patient is relieved, there are no other examinations to perform","justification":""},{"idx":1,"correct":false,"proposition":"Surgery should be planned as soon as possible, there is no need to continue pre-operative explorations","justification":""},{"idx":2,"correct":true,"proposition":"The presence of rectal bleeding requires a colonoscopy","justification":""},{"idx":3,"correct":false,"proposition":"To authenticate bleeding, the patient may be offered a stool blood test.","justification":""},{"idx":4,"correct":false,"proposition":"In this context of symptomatic hemorrhoidal disease, colonoscopy can only be considered once the hemorrhoidal problem has been resolved.","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-4","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"A colonoscopy under general anesthesia is performed. It highlights at the level of the sigmoid colon the following image that is not passable. Which of the following proposals concerning iconography is (are) accurate? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is an irregular and ulcerated lesion suggestive of a malignant tumor","justification":""},{"idx":1,"correct":false,"proposition":"It is an inflammatory colonic diverticulum","justification":""},{"idx":2,"correct":false,"proposition":"The mucosa around the lesion is inflammatory and suggestive of chronic inflammatory bowel disease","justification":""},{"idx":3,"correct":true,"proposition":"This lesion may explain the patient's increased constipation in recent months.","justification":""},{"idx":4,"correct":false,"proposition":"Endoscopic removal of the lesion is necessary to perform a total colonoscopy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-5","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"The biopsy confirms that it is a well-differentiated lieberkhunian adenocarcinoma. Which of the following proposals concerning the extension and pre-therapeutic assessment is (are) accurate? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The thoraco-abdomino-pelvic CT scan is the reference examination for the extension assessment of this colon cancer","justification":""},{"idx":1,"correct":false,"proposition":"The PET scan must be performed to detect locations not seen on the scanner","justification":""},{"idx":2,"correct":false,"proposition":"The patient cannot be operated on if the colonoscopy is not complete","justification":""},{"idx":3,"correct":false,"proposition":"The determination of CA 125 and CA 19.9 markers is indicated","justification":""},{"idx":4,"correct":true,"proposition":"It is necessary to schedule a new pre-operative anesthesia consultation","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-6","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"There are no metastases. Which of the following proposals for patient care is correct? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The patient's file must imperatively be presented in a multidisciplinary consultation meeting (RCP) before any treatment","justification":""},{"idx":1,"correct":true,"proposition":"Surgery is the gold standard treatment for non-metastatic colon cancer and the only curative option","justification":""},{"idx":2,"correct":false,"proposition":"Preoperative radiotherapy may be offered to improve the chances of local control of this advanced cancer","justification":""},{"idx":3,"correct":true,"proposition":"Chemotherapy may be indicated post-operative depending on the results of the histopathological examination of the operating room","justification":""},{"idx":4,"correct":false,"proposition":"Intraperitoneal intraperitoneal chemohyperthermia can be performed to prevent loco-regional recurrence","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-7","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"You are planning a colectomy. Which of the proposals for the rules of cancer surgery is correct? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A colectomy with tumour safety margins of at least 5 cm is required","justification":""},{"idx":1,"correct":true,"proposition":"A lymph node dissection requires at least 12 lymph nodes for proper assessment of lymph node status","justification":""},{"idx":2,"correct":true,"proposition":"A colectomy with restoration of digestive continuity and without stoma is the rule in this situation apart from the emergency or an intraoperative abnormality","justification":""},{"idx":3,"correct":false,"proposition":"A stoma must be performed because the tumor has evolved and chemotherapy must be started quickly","justification":""},{"idx":4,"correct":true,"proposition":"In case of discovery of peritoneal carcinomatosis during the intervention, it is allowed to postpone the colectomy and to discuss the patient's file again in multidisciplinary consultation meeting","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-8","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"The patient is operated in good conditions, with a restoration of continuity at the same time operative. The report of the histopathological examination concludes that circumlateral adenocarcinoma invades the sub-serosa. There is an invaded lymph node out of the 13 examined. There are vascular embols and perinervous sheaths. There is instability of micro-satellites. Which of the proposals concerning the stage of the disease and its prognosis is (are) accurate? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is a pT3N1 tumour","justification":""},{"idx":1,"correct":true,"proposition":"It is stage III colon cancer","justification":""},{"idx":2,"correct":false,"proposition":"The prognosis for overall survival at 5 years is 95%","justification":""},{"idx":3,"correct":true,"proposition":"The presence of vascular emboli is a factor of poor prognosis","justification":""},{"idx":4,"correct":false,"proposition":"Peri-nervous sheathing has no impact on prognosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-9","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"The postoperative period is marked by the appearance of a fever at 38.5 ° C on the 5th day.   Which of the following is correct?","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is necessary to evoke a complication type of anastomotic fistula","justification":""},{"idx":1,"correct":true,"proposition":"A complete blood count is indicated","justification":""},{"idx":2,"correct":true,"proposition":"A cytobacteriological examination of urine is indicated in this patient who has undergone urinary catheterization for his procedure","justification":""},{"idx":3,"correct":false,"proposition":"A determination of D-dimer must be carried out","justification":""},{"idx":4,"correct":true,"proposition":"Palpation of the abdominal scar is essential","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-10","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"A wall abscess was removed. The sequels are ultimately simple. The patient leaves the ward on Day 7. Regarding the continuation of the care during the first year, which proposal(s) is(are) accurate? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A colonoscopy should be performed within 6 months as the initial examination was not complete","justification":""},{"idx":1,"correct":true,"proposition":"Given lymph node invasion, adjuvant chemotherapy is indicated","justification":""},{"idx":2,"correct":false,"proposition":"Given the importance of parietal (subserosa) involvement, postoperative radiotherapy should be offered","justification":""},{"idx":3,"correct":true,"proposition":"As part of the patient's management, his colon cancer enters the list of conditions eligible for 100% coverage","justification":""},{"idx":4,"correct":false,"proposition":"Clinical and ultrasound monitoring should be semi-annually","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-11","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"What is the element of anamnesis that makes you propose to the patient an onco-genetic consultation? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Age","justification":""},{"idx":1,"correct":false,"proposition":"The stenosing character of the tumor","justification":""},{"idx":2,"correct":false,"proposition":"Localization in the sigmoid colon","justification":""},{"idx":3,"correct":false,"proposition":"The presence of vascular emboli on histological examination","justification":""},{"idx":4,"correct":true,"proposition":"The instability of micro-satellites","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-12","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"Which of the following cancers is (are) on the narrow spectrum of Lynch syndrome? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cancer of the urinary excretory tract","justification":"Two mnemonics: GOBES and VICE (see the mnemo means tab)"},{"idx":1,"correct":false,"proposition":"Breast cancer","justification":""},{"idx":2,"correct":true,"proposition":"Endometrial cancer","justification":""},{"idx":3,"correct":false,"proposition":"Thyroid cancer","justification":""},{"idx":4,"correct":true,"proposition":"Small intestine cancer","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-13","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"Finally the patient receives adjuvant chemotherapy that he tolerates well. He wishes to resume his professional activity within a month of the end of his chemotherapy. What can you offer him as a doctor? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Encourage them to file an application for recognition as a disabled worker (RQTH)","justification":""},{"idx":1,"correct":false,"proposition":"Write him a certificate of aptitude for the resumption of his professional activity","justification":""},{"idx":2,"correct":true,"proposition":"Send it now to the occupational physician of his company for a pre-resumption visit","justification":""},{"idx":3,"correct":true,"proposition":"Prescribe part-time for therapeutic reasons","justification":""},{"idx":4,"correct":false,"proposition":"Submit an application for an adult disabled allowance (AAH)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-14","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"A year later, the surveillance scanner shows the following image. Regarding this iconography, which is (are) the exact proposal(s)? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is a CT scan injected at arterial time","justification":""},{"idx":1,"correct":true,"proposition":"We individualize on this picture the spleen","justification":""},{"idx":2,"correct":true,"proposition":"A hypodense image compatible with liver metastasis is found","justification":""},{"idx":3,"correct":true,"proposition":"This lesion is located in the left liver","justification":""},{"idx":4,"correct":true,"proposition":"The stomach is visible in this picture","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-15","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"This is actually a single liver metastasis of his colorectal cancer. Which of the following proposals for the management of this patient is correct? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"His file must be represented in a multidisciplinary consultation meeting (RCP)","justification":""},{"idx":1,"correct":true,"proposition":"Excision surgery can treat this patient curatively","justification":""},{"idx":2,"correct":true,"proposition":"A preoperative PET scan may be indicated to ensure the absence of further distant metastases","justification":""},{"idx":3,"correct":true,"proposition":" Chemotherapy may be offered to assess the tumor's response to treatment","justification":""},{"idx":4,"correct":false,"proposition":"In this patient already operated on the colon, an intervention on the liver is no longer possible","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-1","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"Regarding the facial nerve, which proposals are accurate? (one or more possible answers) ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" It has a vegetative action","justification":""},{"idx":1,"correct":false,"proposition":"Its sensory ganglion is the trigeminal ganglion","justification":""},{"idx":1,"correct":false,"proposition":"His elbow separates his first portion from his second","justification":"It separates the second portion from the third"},{"idx":1,"correct":true,"proposition":"It innervates the stirrup muscle","justification":""},{"idx":1,"correct":true,"proposition":"It includes an intrapetrous position","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-2","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"During peripheral facial paralysis: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The motor deficit is homogeneous affecting both the upper and lower territory","justification":""},{"idx":1,"correct":false,"proposition":"There is an automatic-voluntary dissociation","justification":""},{"idx":2,"correct":true,"proposition":"We can observe a sign of Charles-Bell","justification":""},{"idx":3,"correct":true,"proposition":"We can observe a sign of the eyelashes of Souques","justification":""},{"idx":4,"correct":false,"proposition":"Facial features are deflected to the paralyzed side","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-3","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"What are the additional examinations that you will carry out initially? ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Bilateral otoscopy","justification":""},{"idx":1,"correct":true,"proposition":"Examination of other cranial pairs","justification":""},{"idx":2,"correct":true,"proposition":"Tonal audiometry","justification":""},{"idx":3,"correct":true,"proposition":"Search for stapedial reflexes","justification":""},{"idx":4,"correct":true,"proposition":"Speech audiometry","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-4","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"What diagnosis do you evoke in front of this aspect? ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Seromucosal otitis","justification":""},{"idx":1,"correct":false,"proposition":"Fibroadhesive otitis","justification":""},{"idx":2,"correct":false,"proposition":"Earwax cap","justification":""},{"idx":3,"correct":true,"proposition":"Cholesteatoma","justification":""},{"idx":4,"correct":false,"proposition":"Retraction bag","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-5","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You diagnose a cholesteatoma. You perform a tonal audiometry of which here is the result. These curves are characteristic of: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Right-hand transmission hearing loss","justification":""},{"idx":1,"correct":false,"proposition":"Left sensorineural hearing loss","justification":""},{"idx":2,"correct":false,"proposition":"Left mixed deafness","justification":""},{"idx":3,"correct":true,"proposition":"Left transmission hearing loss","justification":""},{"idx":4,"correct":false,"proposition":"Righteous sensorineural hearing loss","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-6","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You diagnose left-handed conductive hearing loss. You perform an acoumetry. What is the exact proposal(s): ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"In the Weber test, the sound is lateralized on the left side.","justification":""},{"idx":1,"correct":false,"proposition":"Weber's test will be said to be positive","justification":"Weber is neither positive nor negative: he is either lateralized or non-lateralized."},{"idx":2,"correct":true,"proposition":"Rinne's test will be said to be negative","justification":""},{"idx":3,"correct":true,"proposition":"In the Rinne test, bone conduction will be better than air conduction","justification":""},{"idx":4,"correct":false,"proposition":"Stageian reflexes will be present","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-7","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"Regarding the innervation of the face and neck:","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A section of the right hypoglossal nerve will cause during protraction a deviation of the tongue to the left","justification":""},{"idx":1,"correct":false,"proposition":"The levator muscle of the upper eyelid is innervated by the trochlear nerve","justification":""},{"idx":2,"correct":false,"proposition":"A section of the right vagus nerve at the mediastinal level will lead to paralysis of the right hemilarynx","justification":""},{"idx":3,"correct":true,"proposition":"A section of the left cervical sympathetic trunk will lead to Claude Bernard-Homer syndrome","justification":""},{"idx":4,"correct":true,"proposition":"The lateral rectus muscle is innervated by the abducens nerve","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-8","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"The clinical examination of this patient shows that when the eyes are closed, his left eye does not close completely and that the deviation of the mouth is well obfecled at rest. You propose as early management:","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Facial electrotherapy","justification":""},{"idx":1,"correct":false,"proposition":"Oral amoxicillin","justification":""},{"idx":2,"correct":true,"proposition":"Eye care","justification":""},{"idx":3,"correct":false,"proposition":"Antiviral treatment with valaciclovir","justification":""},{"idx":4,"correct":true,"proposition":"Facial physiotherapy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-9","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You carry out as an additional examination (an expected answer): ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Schüller incidence radiography","justification":""},{"idx":1,"correct":true,"proposition":"Scanning of the two rocks without injection of contrast medium","justification":""},{"idx":2,"correct":false,"proposition":"Bone scintigraphy","justification":""},{"idx":3,"correct":false,"proposition":"Early auditory evoked potentials","justification":""},{"idx":4,"correct":false,"proposition":"Microbiological","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-10","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You perform a scan of both rocks without injection. On this scanner section of the left rock: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Arrow 1 designates the vestibule","justification":""},{"idx":1,"correct":true,"proposition":"Arrow 1 points to the cochlea","justification":""},{"idx":2,"correct":true,"proposition":"2 refers to the internal auditory canal","justification":""},{"idx":3,"correct":false,"proposition":"2 refers to the eardrum box","justification":""},{"idx":4,"correct":false,"proposition":"3 refers to the internal carotid artery","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-11","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You propose as support for this chollessteatoma (an expected response): ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Treatment with amoxicillin-clavulanic acid for fifteen days","justification":""},{"idx":1,"correct":false,"proposition":"An instillation of ofloxacin in ear drops, one dose twice daily for one month","justification":""},{"idx":2,"correct":false,"proposition":"A 6-month consultation for a new otoscopy","justification":""},{"idx":3,"correct":true,"proposition":"Surgical treatment","justification":""},{"idx":4,"correct":false,"proposition":"Iterative aspirations under a microscope","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-12","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You operated on this patient by performing a first time of tympanoplasty. You then discuss with him the continuation of his care: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The patient is at risk of residual cholesteatoma","justification":""},{"idx":1,"correct":true,"proposition":"Monitoring will include regular audiogram","justification":""},{"idx":2,"correct":true,"proposition":"The patient is at risk of recurrent cholesteatoma","justification":""},{"idx":3,"correct":true,"proposition":"Monitoring will include regular imaging","justification":""},{"idx":4,"correct":true,"proposition":"Monitoring will include regular otoscopy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-13","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"The patient does not return to the various follow-up consultations you have scheduled. Three years after the surgery, he consults you again urgently for a large vertigo of sudden beginning, appeared since the day before, accompanied by nausea and vomiting. You are diagnosed with left harmonious vestibular syndrome. You will find at the clinical examination: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A right horizontal-rotational nystagmus","justification":""},{"idx":1,"correct":true,"proposition":"During nystagmus, a slow deviation of the eyes to the left","justification":""},{"idx":2,"correct":false,"proposition":"A blind walk deviated to the right","justification":""},{"idx":3,"correct":true,"proposition":"At the maneuver of the outstretched arms, a deviation of the index fingers to the left","justification":""},{"idx":4,"correct":false,"proposition":"Nystagmus persists with eye fixation","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-14","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"On otoscopy, you visualize a recurrence of cholesteatoma. Clinical examination shows no involvement of the other cranial pairs. The audiogram shows bone conduction similar to that existing post-operatively. The most likely diagnosis is ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left vestibular neuritis","justification":""},{"idx":1,"correct":false,"proposition":"Right Wallenberg syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Thrombosis of the left internal auditory artery","justification":""},{"idx":3,"correct":true,"proposition":"Lysis of the left lateral semicircular canal","justification":""},{"idx":4,"correct":false,"proposition":"Spontaneous fracture of the left rock","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-15","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You suspect lysis of the left lateral semicircular canal. You prescribe as additional examinations ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Standard X-ray incidence << rock in orbit >>","justification":""},{"idx":1,"correct":true,"proposition":"Videonystagmography","justification":""},{"idx":2,"correct":true,"proposition":"Left rock scanner without injection","justification":""},{"idx":3,"correct":false,"proposition":"Microbiological","justification":""},{"idx":4,"correct":false,"proposition":"Electromyogram of the face","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-1","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"You want to specify the abnormalities found on the blood count. What additional examinations are you requesting? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Determination of vitamin B9","justification":"Anemia is not microcytic"},{"idx":1,"correct":false,"proposition":"TSH test","justification":"Anemia is not normocytic"},{"idx":2,"correct":false,"proposition":"Determination of vitamin B12","justification":"Anemia is not microcytic"},{"idx":3,"correct":true,"proposition":"Determination of ferritinemia","justification":""},{"idx":4,"correct":true,"proposition":"CRP testing","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-2","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"What can be the reasons for the hyperplatektosis? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Vitamin deficiency","justification":""},{"idx":1,"correct":true,"proposition":"Iron deficiency","justification":""},{"idx":2,"correct":true,"proposition":"Inflammatory syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Beginning myeloproliferative syndrome","justification":""},{"idx":4,"correct":false,"proposition":"Hemolysis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-3","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"You examine the patient. He has left axillary lymphadenopathy. It has no hepatosplenomêgalie. Blood pressure is at 130\/70. The temperature is 37.1°C at the time of the examination. It has very pale skin and you notice a slight thoracic collateral circulalion. You suspect superior cava syndrome. What signs will you look for in favor of this diagnosis? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Shortness of breath when lying down","justification":""},{"idx":1,"correct":false,"proposition":"Stellar angiomas","justification":"This is a sign of hepatocellular insufficiency."},{"idx":2,"correct":true,"proposition":"Jugular turgor","justification":""},{"idx":3,"correct":true,"proposition":"An edema filling the supraclavicular hollows","justification":""},{"idx":4,"correct":false,"proposition":"Edema of the lower limbs","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-4","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"He actually does not tolerate the lying position well and sleeps with 2 pillows. Suspecting lymphoma pathology, you refer the patient for hospitalization in hematology. A PET scan is performed quickly. About this review, which propositions are true? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The marker used is iron-based","justification":"It is glucose-based"},{"idx":1,"correct":true,"proposition":"This is an examination indicated in the initial assessment of aggressive lymphomas","justification":""},{"idx":2,"correct":true,"proposition":"Tumor metabolism is evaluated by the SUV (Standard Uptake Value)","justification":""},{"idx":3,"correct":true,"proposition":"The patient must be fasting","justification":""},{"idx":4,"correct":false,"proposition":"The patient should be infused with glucose serum","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-5","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"What is your interpretation? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"There is supra- and subdiaphragmatic lymph node involvement","justification":""},{"idx":1,"correct":false,"proposition":"There is myocardial involvement","justification":""},{"idx":2,"correct":true,"proposition":"It is compatible with an Ann Arbor Stage II","justification":""},{"idx":3,"correct":false,"proposition":"There are many artifacts that hinder interpretation","justification":""},{"idx":4,"correct":false,"proposition":"There is probable damage to the urinary tract","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-6","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"The PET scan shows hypermetabolic axillary and mediastinal lymphadenopathy (SUV> 10). What exploration modalities do you choose in this context? (one or more possible answers)","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" Biopsy of axillary lymphadenopathy","justification":""},{"idx":1,"correct":false,"proposition":"Cytopuncture of axillary lymphadenopathy","justification":""},{"idx":2,"correct":false,"proposition":"Axillary dissection with extemporaneous examination","justification":""},{"idx":3,"correct":false,"proposition":"Immediate fixing of the levy","justification":""},{"idx":4,"correct":false,"proposition":"Mediastinoscopy and mediastinal mass sampling","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-7","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"You perform a biopsy of an axillary lymph node. The histological report comes back to you: large cells with destroyed architecture, tumor cells expressing CD20. What is the most likely histological diagnosis? (only one answer expected) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Hodgkin's disease","justification":""},{"idx":1,"correct":true,"proposition":"Diffuse large cell non-Hodgkin B-cell lymphoma","justification":""},{"idx":2,"correct":false,"proposition":"T-cell lymphoma","justification":""},{"idx":3,"correct":false,"proposition":"Follicular lymphoma","justification":""},{"idx":4,"correct":false,"proposition":"Sarcoidosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-8","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"The diagnosis of diffuse large cell B-cell lymphoma is retained. You perform an osteomedullary biopsy and lumbar puncture which are normal. You want to calculate the usual prognostic score (IPI for international prognostic index) in this patient. What do you need? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Sex","justification":""},{"idx":1,"correct":true,"proposition":"Age","justification":""},{"idx":2,"correct":true,"proposition":"Ann Arbor Clinical Stage","justification":""},{"idx":3,"correct":false,"proposition":"Beta2 microglobulin","justification":""},{"idx":4,"correct":true,"proposition":"LDH","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-9","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"What do you offer the patient before starting treatment? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hepatitis B and C serologies","justification":""},{"idx":1,"correct":false,"proposition":"Brain MRI","justification":""},{"idx":2,"correct":true,"proposition":"Cardiac ultrasound with ejection fraction measurement","justification":""},{"idx":3,"correct":false,"proposition":"HLA typing","justification":""},{"idx":4,"correct":true,"proposition":"Sperm cryopreservation at CECOS","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-10","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"You are starting immunochemotherapy such as rituximab, doxorubicin, vindesine, cyclophosphamide, bleomycin and prednisone. What are the classic side effects of doxorubicin (anthracycline): (one or more possible responses)","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cardiomyopathy","justification":""},{"idx":1,"correct":true,"proposition":"Extensive skin necrosis in case of extravasation","justification":""},{"idx":2,"correct":false,"proposition":"Pulmonary fibrosis","justification":""},{"idx":3,"correct":false,"proposition":"Dysthyroidism","justification":""},{"idx":4,"correct":true,"proposition":"Alopecia","justification":"Non-alopecic chemotherapies to know for NEC are platinum salts, 5-FU and methotrexate."}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-11","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"Rituximab: (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Is a mouse monoclonal antibody","justification":"xi = chimerical"},{"idx":1,"correct":false,"proposition":"Is an antibody recognizing CD34 surface antigen","justification":""},{"idx":2,"correct":true,"proposition":"May cause viral hepatitis reactivations","justification":""},{"idx":3,"correct":true,"proposition":"May cause cytokine release syndrome on first infusion","justification":""},{"idx":4,"correct":true,"proposition":"Causes B-cell","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-12","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"At 10 days of chemotherapy, the patient who is at home, calls you because he is feverish with several temperature peaks at 39 ° C and chills. The blood count carried out the day before shows Hemoglobin 91 g \/ dL, Leukocytes 1.8 G \/ L, neutrophils 0.4 G \/ L, Lymphocytes 1.2 GIL, Monocytes 0.2 G \/ L, Platelets 50 G \/ L. What are the proposals that apply to the blood count? (one or more correct answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Pancytopenia","justification":""},{"idx":1,"correct":true,"proposition":"Neutropenia","justification":""},{"idx":2,"correct":true,"proposition":"Lymphopenia","justification":""},{"idx":3,"correct":false,"proposition":"Monocytosis","justification":""},{"idx":4,"correct":true,"proposition":"Thrombocytopenia","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-13","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"What attitude do you adopt? ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"You prescribe antibiotic therapy with amoxicillin","justification":""},{"idx":1,"correct":false,"proposition":"You resume corticosteroid therapy","justification":""},{"idx":2,"correct":false,"proposition":"You make him do a chest x-ray in town in emergency","justification":""},{"idx":3,"correct":true,"proposition":"You hospitalize him urgently","justification":""},{"idx":4,"correct":false,"proposition":"You ask him to contact you again after 12 hours of antibiotic treatment","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-14","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"When he arrives in the hematology department, what examinations must be carried out urgently? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Blood","justification":""},{"idx":0,"correct":true,"proposition":"ECBU","justification":""},{"idx":0,"correct":false,"proposition":"Myelogram","justification":""},{"idx":0,"correct":false,"proposition":"Microbiological","justification":""},{"idx":0,"correct":false,"proposition":"LDH","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-15","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"After taking blood cultures and an ECBU, what therapeutic attitude do you adopt? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Protective Custody","justification":""},{"idx":1,"correct":false,"proposition":"Antibiotic therapy started after blood culture results","justification":""},{"idx":2,"correct":false,"proposition":"Intravenous antifungal","justification":""},{"idx":3,"correct":false,"proposition":"Corticosteroid therapy","justification":""},{"idx":4,"correct":false,"proposition":"Transfusion of red blood cells","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-1","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"What late complication(s) may result from contusive eye trauma? Decreased mydriasis of the photomotor reflex","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Retinal detachment","justification":""},{"idx":1,"correct":false,"proposition":"Retinal edema","justification":""},{"idx":2,"correct":true,"proposition":"Ocular hypertonia","justification":""},{"idx":3,"correct":true,"proposition":"A cataract","justification":""},{"idx":4,"correct":true,"proposition":"Mydriasis with decreased photomotor reflex","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-2","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"Which symptom(s) would be suggestive of a cataract?","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Photophobia","justification":""},{"idx":1,"correct":true,"proposition":"A monocular diplopia","justification":""},{"idx":2,"correct":false,"proposition":"Metamorphopsies","justification":""},{"idx":3,"correct":false,"proposition":"Phosphenes","justification":""},{"idx":4,"correct":false,"proposition":"Visual field amputation","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-3","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"Which symptom(s) would be suggestive of retinal detachment? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Photophobia","justification":""},{"idx":1,"correct":false,"proposition":"A monocular diplopia","justification":""},{"idx":2,"correct":false,"proposition":"Lagophthalmos","justification":""},{"idx":3,"correct":true,"proposition":"Phosphenes","justification":""},{"idx":4,"correct":true,"proposition":"Visual field amputation","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-4","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"Your clinical examination regains a visual acuity measured at 10\/10 P2 with a correction in glasses of -1 (-0.50 to 85 °) in the right eye, and << see the hand move >> with -3 (-0.75 to 75 °) on the left eye. What refractive disorder(s) is present in this patient ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Low myopia"},{"idx":1,"correct":false,"proposition":"Strong myopia"},{"idx":2,"correct":false,"proposition":"Hyperopia"},{"idx":3,"correct":false,"proposition":"Unepresbyopia"},{"idx":4,"correct":true,"proposition":"Astigmatism"}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-5","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"Intraocular pressure is measured at 18 mm Hg in the right eye and 20 mm Hg in the left eye. The examination of the anterior segment of the right eye is without departure. Examination of the anterior segment of the left eye finds a deep anterior chamber and a total white cataract. The examination of the eye food is unremarkable on the right side and not visible on the left side. What other abnormality(s) of traumatic origin could you find in the anterior segment of the left eye? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A miosis","justification":""},{"idx":1,"correct":true,"proposition":"Subluxation of the lens","justification":""},{"idx":2,"correct":true,"proposition":"Iridodialysis","justification":""},{"idx":3,"correct":true,"proposition":"A rupture of the iris sphincter","justification":""},{"idx":4,"correct":false,"proposition":"Central corneal opacification","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-6","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"What additional examination(s) are you requesting to clarify the condition of the eye structures of the left eye? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An examination of the visual field","justification":""},{"idx":1,"correct":false,"proposition":"Optical coherence tomography (macular OCT).","justification":""},{"idx":2,"correct":true,"proposition":"An ocular ultrasound in mode B","justification":""},{"idx":3,"correct":false,"proposition":"Keratometry","justification":""},{"idx":4,"correct":false,"proposition":"An orbital scanner","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-7","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"What examination(s) are needed before cataract surgery? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Pachymetry","justification":""},{"idx":1,"correct":true,"proposition":"Keratometry","justification":""},{"idx":2,"correct":false,"proposition":"A corneal topography","justification":""},{"idx":3,"correct":true,"proposition":"A measurement of the axial length of the eye","justification":""},{"idx":4,"correct":false,"proposition":"A kinetic Goldmann visual field","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-8","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The ultrasound is without particularity to the left eye. You offer the patient cataract surgery on his left eye. What explanation(s) do you give to the patient? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Surgery is performed during a traditional 2-day hospitalization","justification":"Outpatient, without hospitalization"},{"idx":1,"correct":true,"proposition":"Anesthesia is most often local or locoregional","justification":""},{"idx":2,"correct":true,"proposition":"Visual recovery cannot be estimated because the fundus is not visible","justification":"It is necessary to see the state of the retina (which echo B does not allow) to have a prognosis of visual recovery."},{"idx":3,"correct":true,"proposition":"Complications are rare but can lead to loss of function of the eye","justification":""},{"idx":4,"correct":false,"proposition":"The absence of lens will be corrected by a corrective lens","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-9","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The cataract operation does not go as planned. At the time of phacoemulsification, there is a large posterior capsular rupture.  What is (are) the possibility(s) of correction of aphakia in this case?","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Placement of a multifocal implant in the capsular bag","justification":""},{"idx":1,"correct":true,"proposition":"Placement of an anterior chamber implant ","justification":""},{"idx":2,"correct":false,"proposition":"Placement of a monofocal implant in the capsular bag","justification":""},{"idx":3,"correct":true,"proposition":"A correction by a contact lens","justification":""},{"idx":4,"correct":true,"proposition":"A correction by glasses","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-10","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The operation finally tennine well and an anterior chamber implant is placed. Three weeks after the operation the patient consults urgently for a decrease in visual acuity of the left eye associated with a white and painless eye with a calm anterior segment. What diagnosis(s) do you mention?","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Retinal detachment"},{"idx":1,"correct":false,"proposition":"Acute anterior uveitis","justification":""},{"idx":2,"correct":false,"proposition":"Acute post-operative endophthalmitis","justification":""},{"idx":3,"correct":true,"proposition":"Macular edema"},{"idx":4,"correct":false,"proposition":"A clouding of the posterior capsule","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-11","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The visual acuity of the left eye is measured at 5\/10 Parinaud 5 with a correction. Intraocular pressure is measured at 20 mm Hg and examination of the anterior segment is unremarkable. Examination of the fundus finds a loss of foveolar reflection. Which additional exam(s) are you requesting:","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An examination of the visual field","justification":""},{"idx":1,"correct":false,"proposition":"An ultrasound in mode B","justification":""},{"idx":2,"correct":true,"proposition":"Macular optical coherence tomography (OCT)","justification":"We want to see the macula to objectify an edema of Irvin Gass."},{"idx":3,"correct":false,"proposition":"Visual evoked potentials","justification":""},{"idx":4,"correct":false,"proposition":"An electroretinogram","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-12","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"A macular optical coherence tomography (OCT) scan is performed. There is a post-operative macular edema of cataract surgery, which is (are) the exact proposal(s)? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is of infectious origin","justification":""},{"idx":1,"correct":false,"proposition":"It is accompanied by hemorrhages and cottony nodules","justification":""},{"idx":2,"correct":true,"proposition":"It is of inflammatory origin","justification":""},{"idx":3,"correct":true,"proposition":"It occurs in post-operative weeks or months","justification":""},{"idx":4,"correct":true,"proposition":"Local or loco-regional anti-inflammatory treatment is often effective","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-13","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The patient consults again 3 years later because his visual acuity has deteriorated. It is quantifiable with the left eye at 1\/1O Parinaud 5 with the best optical correction. In this context of post-traumatic cataract and anterior chamber implant, what diagnosis(s) can (s) be evoked to explain this decrease in visual acuity? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Posterior vitreous detachment","justification":""},{"idx":1,"correct":true,"proposition":"Corneal edema","justification":""},{"idx":2,"correct":false,"proposition":"Peritasicular drusens","justification":""},{"idx":3,"correct":true,"proposition":"Retinal detachment","justification":""},{"idx":4,"correct":false,"proposition":"Bacterial endophthalmitis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-1","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"After listening to the patient, you seek clarification of certain symptoms.  It seems important to you to look for the presence (or absence) of: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Epistaxis","justification":""},{"idx":1,"correct":true,"proposition":"Arthralgia","justification":""},{"idx":2,"correct":true,"proposition":"Red eye","justification":""},{"idx":3,"correct":true,"proposition":"Hemoptysis","justification":""},{"idx":4,"correct":true,"proposition":"Dyspnoea","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-2","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"The patient confirms the presence of arthralgia. He had no epistaxis or red eye episodes. On the other hand, it is dyspneic and the Sp02 taken during the consultation is 94% in ambient air. Blood pressure is measured at 110\/65 mmHg. The pulse is at 85\/minute. You propose to the patient to carry out biological analyzes. You ask the nurse to sample: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A C-reactive protein assay","justification":""},{"idx":1,"correct":true,"proposition":"Blood cultures","justification":""},{"idx":2,"correct":true,"proposition":"A search for antinuclear antibodies","justification":""},{"idx":3,"correct":false,"proposition":"An anticardiolipin antibody assay","justification":""},{"idx":4,"correct":true,"proposition":"A plasma creatinine assay","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-3","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"With the clinical context, these results point you towards ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Sjögren's syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Systemic lupus","justification":""},{"idx":2,"correct":false,"proposition":"An antiphospholipid antibody syndrome","justification":""},{"idx":3,"correct":true,"proposition":"Vasculitis","justification":""},{"idx":4,"correct":false,"proposition":"Sarcoidosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-4","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You turn to vasculitis and decide to hospitalize the patient in the internal medicine department. The rest of the results arrive quickly especially the C-reactive protein which is at 451 mg \/ L. The available results are shown here. Chronic inflammation alone allows you to explain: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Microcytosis","justification":""},{"idx":1,"correct":true,"proposition":"Thrombocytosis","justification":""},{"idx":2,"correct":false,"proposition":"Eosinophilia","justification":""},{"idx":3,"correct":true,"proposition":"The increase in alpha-2 globulins","justification":""},{"idx":4,"correct":false,"proposition":"Lymphopenia","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-5","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"With regard to ANCAs, it is true that: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"They are looking for each other in direct immunofluorescence","justification":"Indirect (direct FI refers to solid biopsies)."},{"idx":1,"correct":true,"proposition":"They are mainly directed against myeloperoxidase or proteinase 3","justification":""},{"idx":2,"correct":false,"proposition":"They are directed against the cytoplasm of eosinophilic polynuclear","justification":"PNN"},{"idx":3,"correct":false,"proposition":"They are directed against the cytoplasm of Hep-2 cells","justification":""},{"idx":4,"correct":false,"proposition":"Their positivity in this patient would direct you to vasculitis with deposits of immune complexes","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-6","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"The ANCA result and urine strip are shown below. You think you need to:","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Perform an emergency kidney biopsy","justification":""},{"idx":1,"correct":false,"proposition":"Perform an arteriogram before renal biopsy","justification":""},{"idx":2,"correct":false,"proposition":"Contraindicate renal biopsy since ANCA are positive","justification":""},{"idx":3,"correct":true,"proposition":"Perform a kidney ultrasound before biopsy","justification":""},{"idx":4,"correct":false,"proposition":"Perform a uroscan before the biopsy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-7","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You propose an emergency renal biopsy puncture. This will be carried out: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Under general anesthesia","justification":"local"},{"idx":1,"correct":true,"proposition":"After obtaining the patient's blood type","justification":"It will be necessary to think about also ticking the RAI if they are proposed"},{"idx":2,"correct":true,"proposition":"With a non-fixed sample for immunofluorescence","justification":""},{"idx":3,"correct":false,"proposition":"Preferably scan-guided","justification":""},{"idx":4,"correct":false,"proposition":"With a sample for electron microscopy (EM)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-8","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You receive the report of the ACB: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"This is a histology compatible with pauci-immune vasculitis","justification":""},{"idx":1,"correct":false,"proposition":"The medullary part of the sample allowed the analysis of the glomeruli","justification":"This is the cortical part"},{"idx":2,"correct":false,"proposition":"There is mesangial proliferation","justification":"mesangium is fine"},{"idx":3,"correct":false,"proposition":"There are endomembranous deposits of imrrunoglobulins","justification":"All antibodies are negative"},{"idx":4,"correct":false,"proposition":"There are signs of vascular nephropathy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-9","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"This renal histology is consistent with pauciimmune vasculitis. You propose to treat the patient with: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Venous corticosteroids","justification":""},{"idx":1,"correct":true,"proposition":"Plasmapheresis (plasma exchange)","justification":""},{"idx":2,"correct":true,"proposition":"Ivermectin","justification":""},{"idx":3,"correct":true,"proposition":"Cyclophosphamide","justification":""},{"idx":4,"correct":false,"proposition":"Aspirin anti-aggregating dose (AAP)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-10","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"In this context, you choose a therapeutic protocol combining cyclophosphamide, corticosteroid therapy and plasmapheresis. You want to inform the patient about the potential toxicities of cyciophosphamide. You explain the risk(s) of:","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Increased renal impairment","justification":""},{"idx":1,"correct":true,"proposition":"Hemorrhagic cystitis"},{"idx":2,"correct":true,"proposition":"Infection"},{"idx":3,"correct":true,"proposition":"Infertility"},{"idx":4,"correct":true,"proposition":"Myelodysplasia"}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-11","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You ask for a chest scan. In these images, you can distinguish: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Cross-linking","justification":""},{"idx":1,"correct":true,"proposition":"Frosted glass","justification":""},{"idx":2,"correct":false,"proposition":"Excavated nodules","justification":""},{"idx":3,"correct":true,"proposition":"Condensations","justification":""},{"idx":4,"correct":false,"proposition":"From the honeycomb","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-12","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"The patient's situation improves after 6 plasma exchanges, corticosteroid therapy (performed by infusion and then relayed at 1 mg \/ kg \/ day orally) and cyclophosphamide. You added cotrimoxazole (trimethoprim-sulfamethoxazole) at a dose appropriate to renal function on day one and the patient received ivennecline at an appropriate dose. It is apyretic, dyspnea has disappeared as well as ENT symptoms. Plasma creatinine stabilizes at 140 μmol\/L. CRP is less than 5 mg\/L. The patient's blood count, 2 weeks before the start of treatment, finds: PNN at 15.87 G \/ L, PNE at 0 G \/ L, PNB at 0 G \/ L, Lymphocytes at 0.84 G \/ L and Monocytes at 0.84 G \/ L. You think the results are related to: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"a martial deficiency","justification":""},{"idx":1,"correct":true,"proposition":"cyclophosphamide","justification":""},{"idx":2,"correct":true,"proposition":"corticosteroid therapy","justification":""},{"idx":3,"correct":false,"proposition":"an infection","justification":""},{"idx":4,"correct":false,"proposition":"cotrimoxazole","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-13","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"Twenty-eight days after the start of treatment, the patient presents with a rash of sudden onset whose photographs are shown to you. C-reactive protein, which was less than 5 mg\/L 72 hours previously, is at 115 mg\/L. Hemoglobin is at 13.5 g \/ dL, platelets at 480 G \/ L, leukocytes at 14 G \/ L (including 10 G \/ L neutrophils, 2 G \/ L eosinophils and 0.9 G \/ L lymphocytes), creatinine is stable at 140 μmol \/ L, AST are at 350 Ul \/ l, ALT at 390 IU \/ L,  gammaglutamyltransferases (GGT) at 390 IU\/L and alkaline phosphatases at 140 IU\/L. Emergency liver ultrasound is normal. You mention ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A relapse of vasculitis","justification":""},{"idx":1,"correct":false,"proposition":"Generalized acute exanthematous pustulosis","justification":""},{"idx":1,"correct":true,"proposition":"A DRESS Syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Angiocholitis","justification":""},{"idx":1,"correct":false,"proposition":"A parasitic infection on corticosteroids","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-14","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You mention a synctome of hypersensitivity to cotrimoxazole that you stop immediately. The patient's vaccination record tells you that he received a BCG vaccination at 1 month of age (the subsequent tuberculin tests were all negative), a measles-mumps-rubella vaccination (2 injections), and a diphtheria-tetanus-pertussis-poliomyelitis vaccination whose last booster was made when the patient was 25 years old. He tells you that he has never had chickenpox. For prophylactic purposes, you advise vaccinating the patient with ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"An influenza vaccination around October","justification":""},{"idx":1,"correct":true,"proposition":"An anti-pneumococcal vaccination with 2 injections","justification":""},{"idx":2,"correct":false,"proposition":"Vaccination against chickenpox","justification":""},{"idx":3,"correct":true,"proposition":"A DTP booster in the context of immunosuppression","justification":""},{"idx":4,"correct":false,"proposition":"A reminder from BCG","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-1","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"Regarding legislation on sexual violence, what is the exact proposal(s)? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Rape is sexual assault","justification":""},{"idx":1,"correct":true,"proposition":"Forced fellatio can be considered rape","justification":""},{"idx":2,"correct":false,"proposition":"Rape does not exist between spouses","justification":""},{"idx":3,"correct":true,"proposition":"Rape is any act of sexual penetration carried out under threat, coercion or surprise","justification":"This is the definition in the Penal Code."},{"idx":4,"correct":false,"proposition":"A vulvar caress can be considered rape","justification":"No penetration = not rape."}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-2","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"This girl is alone, tells you she is ashamed, and wishes that neither her parents nor anyone around her knew what happened. What is the course of action? (only one exact answer) ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"You don't look at her until she files a complaint","justification":""},{"idx":1,"correct":true,"proposition":"You ask him to bring an adult of his choice to participate in his care","justification":""},{"idx":2,"correct":false,"proposition":"You tell his parents","justification":""},{"idx":3,"correct":false,"proposition":"You only do the integumentary examination but not the gynecological examination","justification":""},{"idx":4,"correct":false,"proposition":"You immediately notify the police","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-3","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"The victim was joined by the 40-year-old mother of a friend. The victim asks you for a medical certificate. What is the exact proposal(s)? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This document is essential if she wishes to file a complaint","justification":""},{"idx":1,"correct":true,"proposition":"You give him the medical certificate, in the presence of the adult of his choice","justification":""},{"idx":2,"correct":false,"proposition":"You give the medical certificate to the judicial police officer on duty at the police station","justification":""},{"idx":3,"correct":false,"proposition":"In case of judicial requisition, you give this certificate to the judicial police officer only if the young woman agrees","justification":""},{"idx":4,"correct":false,"proposition":"If the filing of a complaint is uncertain, the issuance of a medical certificate is not possible","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-4","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"What is (are) the method(s) of drafting the medical certificate? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The medical editor mentions his identity","justification":""},{"idx":1,"correct":false,"proposition":"The victim must prove his identity to the doctor by giving him an identity document","justification":""},{"idx":2,"correct":false,"proposition":"The doctor certifies that the facts reported are credible","justification":""},{"idx":3,"correct":true,"proposition":"The absence of gynaecological traumatic injury must be mentioned in the certificate","justification":""},{"idx":4,"correct":false,"proposition":"Sexual violence results in total incapacity for work of more than eight days","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-5","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"At the end of the clinical examination, which additional examination(s) do you request?","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Determination of b-HCG","justification":""},{"idx":1,"correct":true,"proposition":"HIV serology 1 and 2","justification":""},{"idx":2,"correct":true,"proposition":"HBV serology","justification":""},{"idx":3,"correct":true,"proposition":"HCV serology","justification":""},{"idx":4,"correct":true,"proposition":"Syphilis serology","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-7","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"The information you give her persuades the girl to file a complaint to complete your judicial report. You contact the Police. The judicial police officer (OPJ) explains that a police team will come to bring you a document and wait at the hospital for the end of your examination. What is this document? (only one exact answer) ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An interim care order","justification":""},{"idx":1,"correct":false,"proposition":"A letter rogatory","justification":""},{"idx":2,"correct":false,"proposition":"A report of filing a complaint","justification":""},{"idx":3,"correct":true,"proposition":"A judicial requisition","justification":""},{"idx":4,"correct":false,"proposition":"An extract from the criminal record","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-8","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"You are requisitioned by the judicial police officer to carry out the examination of the victim and any useful samples. In this context, what sample(s) can you carry out? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Bite swabs","justification":""},{"idx":1,"correct":true,"proposition":"Swabs at the vaginal level","justification":""},{"idx":2,"correct":true,"proposition":"Anal swabs","justification":""},{"idx":3,"correct":true,"proposition":"Swabs at the mouth level","justification":""},{"idx":4,"correct":false,"proposition":"Swabs from the nasal cavities","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-9","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"At the end of your examination, the judicial police officer wants to know the number of days of total incapacity for work. Regarding total incapacity for work in the criminal sense for this patient, what is (are) the exact proposal(s)? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Total incapacity for work must be mentioned on the medical certificate","justification":""},{"idx":1,"correct":true,"proposition":"Total incapacity for work in the criminal sense corresponds to functional discomfort in carrying out the gestures of daily life","justification":""},{"idx":2,"correct":false,"proposition":"Total incapacity for work in the criminal sense corresponds to the number of days of absence from work","justification":""},{"idx":3,"correct":false,"proposition":"Total incapacity for work does not apply to minors","justification":""},{"idx":4,"correct":false,"proposition":"Total incapacity for work only makes sense if it is strictly greater than 8 days","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-10","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"What treatment(s) can you urgently prescribe to this girl, with her agreement and that of the adult accompanying her? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"HPV vaccination","justification":""},{"idx":1,"correct":true,"proposition":"Triple anti-retroviral therapy","justification":""},{"idx":2,"correct":true,"proposition":"Emergency contraception","justification":""},{"idx":3,"correct":false,"proposition":"Antidepressant treatment that inhibits serotonin reuptake","justification":""},{"idx":4,"correct":true,"proposition":"Azithromycin antibiotic prophylaxis","justification":"In prevention of infection with Chlamydia trachomatis (in 2022, treatment is based on Doxycicline 8 days)."}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-11","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"What element(s) should be included in the information to be provided to the victim? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Known side effects of treatments","justification":""},{"idx":1,"correct":true,"proposition":"Methods of monitoring processing","justification":""},{"idx":2,"correct":true,"proposition":"Risks in case of refusal of treatment","justification":""},{"idx":3,"correct":true,"proposition":"Contact details of a victim support association","justification":""},{"idx":4,"correct":true,"proposition":"The need for safe sex during HAART","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-12","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"Four days later, the victim has side effects following taking triple antiretroviral therapy. She is furious because she says she was not informed of these effects. Regarding medical information, what is the exact proposal(s)? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The burden of proof of information lies with the patient initiating a procedure","justification":""},{"idx":1,"correct":true,"proposition":"The information must be delivered orally","justification":""},{"idx":2,"correct":false,"proposition":"The information must be provided in writing","justification":"It is possible but not necessary."},{"idx":3,"correct":true,"proposition":"Information must be fair, clear and appropriate","justification":""},{"idx":4,"correct":false,"proposition":"A confirmation of the delivery of the information must be signed by the patient","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-13","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"The girl comes back to see you, pregnant with 9 weeks of amenorrhea, as a result of sexual violence, she tells you. What is the exact proposal(s) ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Parental consent is required to carry out a voluntary termination of pregnancy","justification":""},{"idx":1,"correct":false,"proposition":"The girl may be accompanied by an adult of her choice for the different stages of the voluntary termination of pregnancy","justification":""},{"idx":2,"correct":false,"proposition":"The girl can benefit from a voluntary termination of pregnancy by medical means","justification":"The limit is 7 SA for the drug route. This duration may change in the coming months\/years, remember to check the latest recommendations of the HAS (and do not hesitate to let us know this proposal if it becomes true)."},{"idx":3,"correct":false,"proposition":"The girl can wait up to a term of 16 weeks of amenorrhea to request a voluntary termination of pregnancy","justification":""},{"idx":4,"correct":false,"proposition":"Due to the context, the cooling-off period is cancelled","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-1","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"In the table of this patient, which of the following parameter(s) is (are) suggestive of sepsis with poor prognosis? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Temperature","justification":""},{"idx":1,"correct":true,"proposition":"Respiratory rate","justification":""},{"idx":2,"correct":false,"proposition":"Heart rate","justification":""},{"idx":3,"correct":false,"proposition":"Blood pressure","justification":""},{"idx":4,"correct":true,"proposition":"Score de Glasgow","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-2","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"What is your immediate attitude? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"High concentration mask oxygen therapy","justification":""},{"idx":1,"correct":false,"proposition":"Establishment of a central venous first route","justification":""},{"idx":2,"correct":false,"proposition":"Filling with synthetic macromolecules (1L on the first hour)","justification":"Colloids are no longer used to fill patients (very limited indications in intensive care, this is not to be known for NEC)."},{"idx":3,"correct":false,"proposition":"Administration of vasopressive amines","justification":""},{"idx":4,"correct":false,"proposition":"Antibiotic therapy with ceftriaxone","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-3","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"Which of the following exam(s) is part of your first-line assessment? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Chest X-ray","justification":""},{"idx":1,"correct":false,"proposition":"Bronchoalveolar lavage","justification":""},{"idx":2,"correct":false,"proposition":"Coproculture","justification":""},{"idx":3,"correct":true,"proposition":"Blood","justification":""},{"idx":4,"correct":true,"proposition":"Legionella antigenacuria","justification":"As well as pneumococcus"}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-4","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The CBC targets anemia at 121 g\/L, leukocytosis at 4600 G\/L (including 3800 PNN), CRP at 254 mg\/L and PCT at 3.5 μg\/L. The ionogram is normal, kidney function is normal. Arterial blood gases under nasal oxygen 6L\/min are: pH 7.45 - pC02 30 mmHg - p02 65 mmHg - HC03- 25 mmol \/ L. A chest CT scan is performed immediately. What is your interpretation of this scanner? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Interstitial syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Pleural effusion","justification":""},{"idx":2,"correct":true,"proposition":"Alveolar condensation","justification":""},{"idx":3,"correct":false,"proposition":"Pericardial effusion","justification":""},{"idx":4,"correct":false,"proposition":"Caves","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-5","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"Blood cultures are ongoing and legionella antigenuria is negative. Which of the following infectious agents may be responsible for this picture at this stage of your investigations?","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Streptococcus pneumoniae","justification":""},{"idx":1,"correct":true,"proposition":"Legionnella pneumophila","justification":"Which would be serotype 2 here (not detected by antigenuria, which can also be falsely negative)."},{"idx":2,"correct":false,"proposition":"Clostridium dificult","justification":""},{"idx":3,"correct":true,"proposition":"Pneumocystis jirovecii","justification":""},{"idx":4,"correct":true,"proposition":"Myxovirus influenzae","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-6","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The patient is immediately transferred to intensive care where he is immediately intubated in the face of respiratory exhaustion. Do you prescribe anti-infective treatment(s) at this stage?","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cefotaxime","justification":""},{"idx":1,"correct":false,"proposition":"Amoxicillin","justification":""},{"idx":2,"correct":true,"proposition":"Spiramycin","justification":""},{"idx":3,"correct":true,"proposition":"Oseltamivir","justification":""},{"idx":4,"correct":false,"proposition":"Pristinamycin","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-7","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The probabilistic anti-infective treatment implemented combines cefotaxime, spiramycin and oseltamivir. A bronchoalveolar lavage is quickly performed. It highlights many cysts of Pneumocystis jirovecii. How do you adjust your treatment knowing that you are diagnosed with pneumocystosis? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Intravenous fluconazole","justification":""},{"idx":1,"correct":true,"proposition":"High-dose intravenous cotrimoxazole","justification":""},{"idx":2,"correct":false,"proposition":"Fidaxomicin aerosol","justification":""},{"idx":3,"correct":true,"proposition":"Corticosteroid therapy","justification":"PAO2 is less than 70 mmHg. Corticosteroid therapy will reduce fibrosis due to inflammatory overstimulation."},{"idx":4,"correct":false,"proposition":"Intravenous ketoprofen","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-8","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"In view of this diagnosis, an HIV serology has been performed and is positive. What additional exam(s) do you perform?","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"CD4\/CD8 lymphocyte subpopulations","justification":""},{"idx":1,"correct":true,"proposition":"HIV viral load","justification":""},{"idx":2,"correct":false,"proposition":"Hepatitis E virus (HEV) serology","justification":""},{"idx":3,"correct":true,"proposition":"Toxoplasmosis serology","justification":""},{"idx":4,"correct":false,"proposition":"Syphilis serology","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-9","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"With cotrimoxazole and corticosteroids, the patient's condition improves rapidly and he is extubated after 48 hours. He began to refeed orally. No other infectious agents were identified in all the samples taken. CD4 count is 19\/mm3 (4.8%) and viral load is 159,000 copies\/ml. On Day 4 of the management, concerning antiretroviral treatment, which of the following proposals is accurate? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Introduction of dual therapy with protease inhibitor and entry inhibitor","justification":""},{"idx":1,"correct":false,"proposition":"Introduction of triple therapy with protease inhibitors and two non-nucleoside reverse transcriptase inhibitors","justification":""},{"idx":2,"correct":false,"proposition":"Introduction of triple therapy with protease inhibitor and two nucleoside reverse transcriptase inhibitors","justification":""},{"idx":3,"correct":false,"proposition":"Introduction of triple therapy with integrase inhibitor and two nucleoside reverse transcriptase inhibitors","justification":""},{"idx":4,"correct":true,"proposition":"No antiretroviral therapy at this stage","justification":"We'll let him recover from his lung infection first ☺️"}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-10","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The trend continues to be favourable with cotrimoxazole. Corticosteroids were discontinued on Day 6 and antiretroviral therapy was not initiated. On Day 10 of the treatment, the fever reappears with a scarlatiniform rash of the trunk and face. What is (are) your hypothesis(s)? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Pneumocystis resistance to cotrimoxazole","justification":""},{"idx":1,"correct":true,"proposition":"Allergy to cortimoxazole","justification":""},{"idx":2,"correct":false,"proposition":"Rebound of pneumocystosis following discontinuation of corticosteroids","justification":""},{"idx":3,"correct":false,"proposition":"Immune restoration syndrome","justification":"Antiretrovirals have not yet been started."},{"idx":4,"correct":false,"proposition":"Staphylococcal toxic shock syndrome","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-11","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The hypothesis of an allergy to cotrimoxazole is retained. What sign(s) of gravity are you looking for? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Positive Nikolsky sign","justification":""},{"idx":1,"correct":false,"proposition":"Maculopapular rash","justification":"This is not especially a sign of gravity"},{"idx":2,"correct":true,"proposition":"Edema of the face","justification":""},{"idx":3,"correct":true,"proposition":"Associated mucosal erosions","justification":""},{"idx":4,"correct":false,"proposition":"Hearing loss","justification":"No report"}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-12","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"There is no sign of severity and the rash regresses within a few days following the reduction of cotrimoxazole doses. You decide on Day 15 to introduce antiretroviral treatment. Which of the following will be useful for the choice of initial antiretroviral therapy? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Search for the HLA B57*01 allele","justification":""},{"idx":1,"correct":true,"proposition":"Genotypic HIV resistance test","justification":""},{"idx":2,"correct":true,"proposition":"Hepatitis B serology","justification":""},{"idx":3,"correct":false,"proposition":"Syphilis serology","justification":""},{"idx":4,"correct":false,"proposition":"Plasma testing of antiretrovirals","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-13","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The result of HBV serology is as follows: HBsAg positive, HBeAg positive, anti-HBc IgM negative, anti-HBc IgG positive, anti-HBe antibodies and HBs negative. HBV DNA PCR is high (10 million Ul\/ml) and transaminases are 2.5 times the norm. Which of the following is correct?","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is probably acute hepatitis B","justification":""},{"idx":1,"correct":true,"proposition":"It is a hepatitis B virus without pre-core mutation","justification":"The HBe antigen is positive so it is not mutated"},{"idx":2,"correct":true,"proposition":"Antiretroviral therapy should ideally include tenofovir","justification":""},{"idx":3,"correct":false,"proposition":"Ribavirin should be added to antiretroviral therapy","justification":"ribavirin is active against HCV"},{"idx":4,"correct":false,"proposition":"HBV serovaccination should also be given to the patient","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-14","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"Triple antiretroviral therapy is initiated on Day 15. Which of the following proposals for support after D15 is correct? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Continuation of cotrimoxazole treatment at current doses for another week","justification":""},{"idx":1,"correct":true,"proposition":"Secondary prophylaxis (after the end of attack therapy) low-dose anti-pneumocystosis ar cotrimoxazole","justification":""},{"idx":2,"correct":false,"proposition":"Initiation of primary prophylaxis of esophageal candidiasis with fluconazole","justification":""},{"idx":3,"correct":false,"proposition":"Initiation of primary anti-toxoplasmosis prophylaxis with low-dose pyrimethamine","justification":""},{"idx":4,"correct":false,"proposition":"Maintenance of primary toxoplasmosis and secondary pneumocystosis prophylaxis for 2 years","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-15","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"What other measure(s) can you personally take? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Information for sexual partners","justification":""},{"idx":1,"correct":false,"proposition":"Nominative declaration to the ARS","justification":"anonymous"},{"idx":2,"correct":true,"proposition":"Declaration of long-term illness (100%)","justification":"ALD 7"},{"idx":3,"correct":false,"proposition":"Declaration to occupational medicine","justification":""},{"idx":4,"correct":true,"proposition":"Proposal for psychological follow-up","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-1","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Which lesional location(s) do you think are likely? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left Thalamic","justification":""},{"idx":1,"correct":true,"proposition":"Left frontal","justification":""},{"idx":2,"correct":false,"proposition":"Right midbrain","justification":""},{"idx":3,"correct":false,"proposition":"Left Capsular","justification":""},{"idx":4,"correct":true,"proposition":"Left parietal","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-2","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What is your immediate care ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Realization of a Doppler ultrasound of the supra-aortic trunks","justification":""},{"idx":1,"correct":true,"proposition":"Support by the neurovascular sector","justification":""},{"idx":2,"correct":true,"proposition":"Performing a brain MRI","justification":""},{"idx":3,"correct":false,"proposition":"Initiation of antihypertensive therapy","justification":"High blood pressure figures are tolerated in ischemic stroke."},{"idx":4,"correct":false,"proposition":"Initiation of antiplatelet therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-3","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What sequence(s) should the MRI include? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"T1 with gadolinium injection","justification":""},{"idx":0,"correct":false,"proposition":"T2","justification":""},{"idx":0,"correct":true,"proposition":"T2 FLAIR","justification":""},{"idx":0,"correct":true,"proposition":"Broadcast sequence (DWI)","justification":""},{"idx":0,"correct":true,"proposition":"3D TOF (angio-MRI, Time Of Flight)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-4","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Here are two images of the MRI performed: ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left sylvian hypersignal in FLAIR sequence","justification":""},{"idx":1,"correct":true,"proposition":"Right occipital hypersignal in FLAIR sequence","justification":""},{"idx":2,"correct":true,"proposition":"Left sylvian hypersignal in diffusion sequence","justification":""},{"idx":3,"correct":false,"proposition":"Right silvian hypersignal in diffusion sequence","justification":""},{"idx":4,"correct":false,"proposition":"Left sylvian hyposignal in scattering sequence","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-5","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Brain MRI reveals a recent lesion visible in diffusion sequence in the superficial left sylvian territory. It also finds a hypersignal in FLAIR sequence in the right, ancient occipital territory. There is no bleeding lesion or obstruction of the proximal large vessels. In view of these MRI results and the clinical context, which pathophysiological hypothesis do you think is most likely? (only one answer expected) ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left carotid dissection","justification":""},{"idx":1,"correct":false,"proposition":"Microangiopathy","justification":""},{"idx":2,"correct":false,"proposition":"Cerebral arteritis","justification":""},{"idx":3,"correct":true,"proposition":"Embologenic heart disease","justification":""},{"idx":4,"correct":false,"proposition":"Atheroma","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-6","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What is your immediate therapeutic proposal? (only one answer expected) ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Parenteral antiplatelet agents","justification":""},{"idx":1,"correct":false,"proposition":"Unfractionated parenteral hypocoagulant heparin","justification":""},{"idx":2,"correct":false,"proposition":"New oral anticoagulants","justification":""},{"idx":3,"correct":true,"proposition":"Intravenous thrombolysis by rt PA","justification":""},{"idx":4,"correct":false,"proposition":"Thrombectomy","justification":"We are not in a case of late time. In addition, the clot is not proximal, which would make thrombectomy complicated."}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-7","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Following the MRI, the patient was admitted to the neurovascular unit (UNV) and underwent intravenous thrombotyposis. The motor deficit has partially recovered, phasic disorders persist. What is(are) the element(s) of your prescription during the first 24 hours? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Antihypertensive treatment","justification":""},{"idx":1,"correct":false,"proposition":"Lift allowed","justification":""},{"idx":2,"correct":true,"proposition":"Subcutaneous insulin therapy if blood glucose above 1.8 g\/L","justification":""},{"idx":3,"correct":false,"proposition":"Transcranial Doppler","justification":""},{"idx":4,"correct":true,"proposition":"Multiple daily clinical monitoring by NIHSS score","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-8","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"At 48 hours of evolution, the patient remains aphasiac. There persists a predominant distal right brachial motor deficit and oral feeding is resumed without discomfort. He did not present any complications. What is (are) the objective(s) of physiotherapy management at this stage? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Analytical reinforcement of motor skills","justification":""},{"idx":1,"correct":false,"proposition":"Breathing decluttering exercises","justification":""},{"idx":2,"correct":false,"proposition":"Sensory awakening work","justification":""},{"idx":3,"correct":false,"proposition":"Deep transverse massages","justification":""},{"idx":4,"correct":false,"proposition":"Passive mobilizations of the lower right limb","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-9","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"To confirm your main etiological hypothesis, you prescribe ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A Doppler ultrasound of the supra-aortic trunks","justification":""},{"idx":1,"correct":true,"proposition":"A trans-thoracic cardiac ultrasound","justification":""},{"idx":2,"correct":true,"proposition":"Transesophageal cardiac ultrasound","justification":""},{"idx":3,"correct":true,"proposition":"An ECG holter","justification":""},{"idx":4,"correct":false,"proposition":"A tensional holter","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-10","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"This patient has Broca's aphasia. Which characteristic(s) are compatible with this diagnosis?","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Presence of paraphasies"},{"idx":1,"correct":true,"proposition":"Impaired fluence"},{"idx":2,"correct":true,"proposition":"Normal comprehension"},{"idx":3,"correct":false,"proposition":"Normal written expression"},{"idx":4,"correct":false,"proposition":"Agnosia"}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-11","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"The holter ECG shows paroxysmal atrial fibrillation. Cardiac ultrasound (transthoracic and transesophageal) and Doppler ultrasound of the supraaortic trunks are normal. The lipid and glycemic balance is normal. Blood pressure normalized. What is (are) the element(s) of your exit prescription? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"ACE inhibitor","justification":""},{"idx":1,"correct":false,"proposition":"Statine","justification":""},{"idx":2,"correct":true,"proposition":"Oral anticoagulant","justification":""},{"idx":3,"correct":false,"proposition":"Antiplatelet agent","justification":""},{"idx":4,"correct":false,"proposition":"Loop diuretic","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-12","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What is(are) your non-drug prescription (s)? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Speech therapy","justification":""},{"idx":1,"correct":true,"proposition":"Work stoppage","justification":""},{"idx":1,"correct":false,"proposition":"First category invaladity","justification":"Not acute because the patient can continue to recover"},{"idx":1,"correct":false,"proposition":"Safeguarding justice","justification":""},{"idx":1,"correct":true,"proposition":"Physiotherapy assessment","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-13","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"You see the patient again in follow-up consultation at 3 months. There is still clumsiness in the right hand and a reduction in fluency, as well as fatigability. He is autonomous for most activities of daily living but has not been able to resume his professional activity. He also complains of attention and sleep disorders, his weight is 65 kg. He continues his anticoagulantoral treatment with anti-vitamin K. What is your diagnostic orientation in the face of this clinical evolution (only one expected response) ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Recurrent ischemic stroke","justification":""},{"idx":1,"correct":false,"proposition":"Side effects of drug treatment","justification":""},{"idx":2,"correct":false,"proposition":"Vascular epilepsy","justification":""},{"idx":3,"correct":true,"proposition":"Depressive syndrome","justification":""},{"idx":4,"correct":false,"proposition":"Deficiency","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-14","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What medico-social measure(s) can you propose? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Constitution of a file with the Departmental House of Disabled Persons for allocation of the Disabled Adult Allowance (AAH)","justification":""},{"idx":1,"correct":true,"proposition":"Preparation of a file with the Departmental House of Persons with Disabilities for recognition of quality disabled worker","justification":""},{"idx":2,"correct":false,"proposition":"First category invaladity","justification":""},{"idx":2,"correct":true,"proposition":"Renewal of the stoppage of work","justification":""},{"idx":2,"correct":false,"proposition":"Declaration of occupational disease","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-15","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Regarding his long-term oral anticoagulant treatment, which is(are) the exact proposal(s)? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The target INR is between 2.5 and 3.5","justification":""},{"idx":1,"correct":true,"proposition":"The INR control must be at least monthly","justification":""},{"idx":2,"correct":true,"proposition":"An INR around 2 allows dental care","justification":""},{"idx":3,"correct":true,"proposition":"In case of hemorrhage, PPSB acts faster than vitamin K","justification":""},{"idx":4,"correct":false,"proposition":"In case of INR at 5, vitamin K intake is recommended","justification":"If he is asymptomatic, he simply has to skip a catch."}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-1","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"What diagnosis(s) do you suspect? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Guttate psoriasis","justification":""},{"idx":1,"correct":false,"proposition":"Erythema multiforme","justification":""},{"idx":2,"correct":false,"proposition":"Primary HIV infection","justification":""},{"idx":3,"correct":true,"proposition":"Secondary syphilis","justification":""},{"idx":4,"correct":false,"proposition":"Dermatophytia","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-2","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"You suspect secondary syphilis. Which symptom(s) or examination sign(s) presented by the patient is (are) suggestive with this diagnosis? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The localization on the trunk of the eruption","justification":""},{"idx":1,"correct":true,"proposition":"Asthenia","justification":""},{"idx":2,"correct":true,"proposition":"Polyadenopathy","justification":""},{"idx":3,"correct":true,"proposition":"Transient nature of trunk rash","justification":""},{"idx":4,"correct":false,"proposition":"Apyrexia","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-3","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"Which of the following symptoms can also be highlighted in secondary syphilis? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Polyarthralgia","justification":""},{"idx":1,"correct":true,"proposition":"Facial paralysis","justification":""},{"idx":2,"correct":true,"proposition":"Hearing loss","justification":""},{"idx":3,"correct":true,"proposition":"Uveitis","justification":"This is the famous 'big simulator'"},{"idx":4,"correct":false,"proposition":"Recurrent cystitis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-4","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"To reinforce your diagnosis, you look for the existence of symptomatic primary syphilis that preceded the current rash. Which of the following proposals for syphilitic chancro is (are) accurate? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is painful","justification":""},{"idx":1,"correct":true,"proposition":"It is most often unique","justification":""},{"idx":2,"correct":true,"proposition":"It is accompanied by lymphadenopathy","justification":""},{"idx":3,"correct":false,"proposition":"It is soft in consistency","justification":"It is endured"},{"idx":4,"correct":true,"proposition":"It can be of pharyngeal localization","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-5","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"You do not find at the interrogation any element in favor of a syphilitic chancre. The patient informs you, however, that he was diagnosed with syphilis 10 years ago and that he received treatment. Which of the following tests do you request to confirm the diagnosis of secondary syphilis?","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"TPHA","justification":""},{"idx":1,"correct":false,"proposition":"Blood count","justification":""},{"idx":2,"correct":false,"proposition":"Skin biopsy","justification":""},{"idx":3,"correct":true,"proposition":"VDRL","justification":""},{"idx":4,"correct":false,"proposition":"Cultivation of a swab made on the palm","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-6","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"The TPHA is positive (+++) and the VDRL is 1\/64. In context, what interpretation(s) do you make of it? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Previously treated syphilis serological scar","justification":""},{"idx":1,"correct":false,"proposition":"Very early syphilis","justification":""},{"idx":2,"correct":false,"proposition":"False positive","justification":""},{"idx":3,"correct":true,"proposition":"Untreated secondary syphilis","justification":""},{"idx":4,"correct":false,"proposition":"Non-venereal treponematosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-7","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"Apart from syphilis, what is the situation(s) where a VDRL can be positive?","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Lupus","justification":""},{"idx":1,"correct":true,"proposition":"Anti-phospholipid antibody syndrome","justification":""},{"idx":2,"correct":true,"proposition":"Non-venereal treponematosis","justification":""},{"idx":3,"correct":true,"proposition":"Leprosy","justification":""},{"idx":4,"correct":true,"proposition":"Borreliosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-8","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"Apart from syphilis, what is the situation(s) where APHD can be positive? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Lupus","justification":""},{"idx":1,"correct":false,"proposition":"Anti-phospholipid antibody syndrome","justification":""},{"idx":2,"correct":true,"proposition":"Non-venereal treponematosis","justification":""},{"idx":3,"correct":false,"proposition":"Leprosy","justification":""},{"idx":4,"correct":false,"proposition":"Borreliosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-9","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"You are looking for another sexually transmitted disease(s) in this patient. Which exam(s) are you requesting? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hepatitis B serology","justification":""},{"idx":1,"correct":false,"proposition":"Serology Mycoplasma hominis","justification":"We don't track that"},{"idx":2,"correct":false,"proposition":"Serology Chlamydia trachomatis","justification":"Is done by PCR"},{"idx":3,"correct":false,"proposition":"Serology Neisseria gonorrhoae","justification":"Is done by PCR"},{"idx":4,"correct":true,"proposition":"HIV serology","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-10","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"Because the patient is HIV-negative, what treatment(s) do you put in place, in the absence of drug allergy, to treat secondary syphilis?","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Ceftriaxone 500 mg, single intramuscular administration","justification":"Treatment of gonococci"},{"idx":1,"correct":false,"proposition":"Azithromycin 1 g, single oral administration","justification":"Treatment of Chlamydia trachomatis (today it is Doxycicline 8 days in first line)"},{"idx":2,"correct":true,"proposition":"Benzathine benzylpenicillin G 2.4 MUI, single intramuscular administration","justification":""},{"idx":3,"correct":false,"proposition":"Penicillin G 20 MUI, intravenous administration for 15 days","justification":"Neurosyphilis"},{"idx":4,"correct":false,"proposition":"Doxycycline 200 mg, single oral administration","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-11","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"The patient received a single injection of benzathine benzylpeflicillin G 2.4 MUI. A few hours later, he complained of headaches and myalgia. The temperature is 38°C and lesions on the palms and plants appear more numerous and larger. What diagnosis(s) do you mention? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Drug urticaria","justification":""},{"idx":1,"correct":false,"proposition":"Fixed pigmented erythema","justification":""},{"idx":2,"correct":false,"proposition":"Taxidermy with macula-papular exanthema type","justification":""},{"idx":3,"correct":true,"proposition":"Reaction to treponeme lysis","justification":""},{"idx":4,"correct":false,"proposition":"Drug-induced hypersensitivity syndrome (DRESS)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-12","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"In order to ensure the effectiveness of benzathine benzylpenicillin G 2,4 MIU treatment, when should you recheck TPHA and VDRL in this patient? (one or more correct answers) ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"15 days","justification":""},{"idx":1,"correct":false,"proposition":"1 month","justification":""},{"idx":2,"correct":false,"proposition":"Serological monitoring is not necessary","justification":""},{"idx":3,"correct":true,"proposition":"6 months","justification":""},{"idx":4,"correct":true,"proposition":"1 year","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-13","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"The questioning of the patient taught you about the existence of several partners in the previous months, without protection from sexual intercourse. Only his most recent partner was able to be contacted by the patient and present for consultation. The last unprotected sex between them was 3 weeks ago. TPHA and VDRL are negative. What is the possible interpretation(s) of the partner's serology? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" Absence of syphilis","justification":""},{"idx":1,"correct":true,"proposition":"Very recent syphilis","justification":""},{"idx":2,"correct":false,"proposition":"Secondary syphilis","justification":""},{"idx":3,"correct":false,"proposition":"Tertiary syphilis","justification":""},{"idx":4,"correct":false,"proposition":"Non-venereal treponematosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-14","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"What can you offer this partner? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A serological check 3 months later","justification":""},{"idx":1,"correct":true,"proposition":"An injection of benzathine benzylpenicillin G, after checking for allergy","justification":""},{"idx":2,"correct":false,"proposition":"Serological control is not necessary","justification":""},{"idx":3,"correct":true,"proposition":"Protected sex","justification":""},{"idx":4,"correct":false,"proposition":"Sexual abstinence","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-15","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"You see the patient again 6 months after treatment of secondary syphilis with benzathine benzylpenicillin G 2.4 M. It is asymptomatic and the rash is gone. The VDRL is 1\/16, the TPHA is positive (+). As a reminder, in pre-therapeutics, the TPHA was positive (+++) and the VDRL was 1\/64. What interpretation(s) do you make? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Recontamination","justification":""},{"idx":1,"correct":false,"proposition":"Treatment resistance","justification":""},{"idx":2,"correct":true,"proposition":"Healing","justification":""},{"idx":3,"correct":false,"proposition":"Non-venereal treponematosis","justification":""},{"idx":4,"correct":false,"proposition":"Need for a new injection of benzathine benzylpenicillin G 2,4 MIU","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-1","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"Which additional exam(s) are you considering? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Serum vitamin B12 assay","justification":""},{"idx":1,"correct":true,"proposition":"Reticulocyte count","justification":""},{"idx":2,"correct":true,"proposition":"Myelogram","justification":"The statement does not speak of first intention, so it is true since the myelogram is well envisaged in the prse in charge of a potentially central anemia."},{"idx":3,"correct":false,"proposition":"Tongue biopsy","justification":""},{"idx":4,"correct":true,"proposition":"Serum vitamin 89","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-2","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The reticulocyte count is 70 OOO\/mm3. A myelogram is performed. The examination finds the presence of a rich marrow, with erythroblasts of large size, an asynchrony of nucleocytoplasmic maturation, the presence of giant metamyelocytes and hypersegmented polynuclear cells. There is no excess of blasts. What is your diagnosis? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Myelodysplastic syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Acute leukemia","justification":""},{"idx":2,"correct":false,"proposition":"Bone marrow suppression","justification":""},{"idx":3,"correct":true,"proposition":"Megaloblastic anemia","justification":""},{"idx":4,"correct":false,"proposition":"Anemia","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-3","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The requested assessment finds a serum concentration of vitamin B12 at 75 ng \/ L (N>200). The dosage of vitamin B9 is normal. Which additional exam(s) do you prescribe to complete the assessment? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Determination of anti-transglutaminase antibodies","justification":""},{"idx":1,"correct":false,"proposition":"Determination of anti-nuclear antibodies","justification":""},{"idx":2,"correct":false,"proposition":"Enteroscanner with contrast injection","justification":""},{"idx":3,"correct":true,"proposition":"Determination of anti-intrinsic factor antibodies","justification":""},{"idx":4,"correct":true,"proposition":"Upper GI endoscopy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-4","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"Anti-intrinsic factor antibodies are absent and upper gastrointestinal endoscopy finds pallor of the mucous membrane of the antrum and gastric body with excessive visibility of the small vessels. There is no esophagitis. Samples taken from the gastric body and the antrum reveal a rarefaction of the density of the glands with the presence of sectors of the epithelium consisting of intestinal type cells. Absence of visible pathogen. There is in the chorion a moderate lymphoplasmacytic infiltrate without neutrophil polynuclear. What is the real proposal(s)? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Pangastric glandular atrophy","justification":""},{"idx":1,"correct":true,"proposition":"Biermer's disease","justification":""},{"idx":2,"correct":false,"proposition":"Lymphocytic gastritis","justification":""},{"idx":3,"correct":false,"proposition":"Active inflammatory gastritis","justification":""},{"idx":4,"correct":true,"proposition":"Chronic gastritis with intestinal metaplasia","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-5","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"What is (are) in this patient the predisposing factor(s) to this atrophic pangastritis with intestinal metaplasia? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An autoimmune pathology","justification":""},{"idx":0,"correct":true,"proposition":"the sequelae of a Helicobacter pylori infection","justification":""},{"idx":0,"correct":true,"proposition":"Tobacco","justification":""},{"idx":0,"correct":false,"proposition":"An autoimmune pathology","justification":""},{"idx":0,"correct":false,"proposition":"Taking proton pump inhibitors","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-6","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"What consequence(s) does this atrophic gastritis with intestinal metaplasia expose? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Risk of gastric adenocarcinoma","justification":""},{"idx":1,"correct":true,"proposition":"Iron deficiency","justification":""},{"idx":2,"correct":false,"proposition":"Gastric lymphoma","justification":""},{"idx":3,"correct":false,"proposition":"Duodenal ulcer","justification":""},{"idx":4,"correct":true,"proposition":"Gastric ulcer","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-7","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"Seven years later, the then 58-year-old patient consulted the Emergency Department for ascites of progressive onset within 15 days. It has appeared for 3 years a non-insulin-requiring diabetes treated with metformin. He drinks about 2 bottles of wine a day. The patient always takes esomeprazole 40 mg daily and an IM injection of vitamin 812 every month. No control endoscopy was performed. The biological assessment shows: Leukocyles at 7700\/mm3, neutrophils at 3200\/mm3, polynuclear eosinophils at 200\/mm3, lymphocytes at 3500\/mm3, hemoglobin at 9.3 g\/dL, MCV at 82 μ3 platelets at 110 0OO\/mm3, AST at 56 IU (N<40), ALT at 43 IU (N<40), TP at 54%, Total bilirubinemia at 87 μmol\/l. You perform an ascites puncture of which here are the results: proteins at 15g \/ L and elements: 500 \/ mm3 including 70% neutrophils, 20% lymphocytes, 10% monocytes. What diagnosis do you make?","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Peritoneal carcinomatosis"},{"idx":1,"correct":true,"proposition":"Ascites fluid infection on cirrhosis","justification":"Because PNN > 250\/mm3"},{"idx":2,"correct":false,"proposition":"Peritoneal tuberculosis"},{"idx":3,"correct":false,"proposition":"Rupture of a pancreatic pseudocyst","justification":""},{"idx":4,"correct":false,"proposition":"Rupture of hepatocellular carcinoma in the peritoneum","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-8","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"You are diagnosed with ascites fluid infection. Which probabilistic antibiotic therapy(s) is\/are recommended as a first-line treatment? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Amoxicillin-clavulanic acid","justification":"Possible oral alternative"},{"idx":1,"correct":false,"proposition":"Vancomycin","justification":""},{"idx":2,"correct":false,"proposition":"Amikacin","justification":""},{"idx":3,"correct":false,"proposition":"Erythromycin","justification":""},{"idx":3,"correct":true,"proposition":"Cefotaxime","justification":"In the first intention"}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-9","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"How will you confirm the diagnosis of cirrhosis with certainty in this patient? (one or more correct answers) ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Non-invasive fibrosis test","justification":""},{"idx":1,"correct":true,"proposition":"Hepatic ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Liver biopsy under ultrasound control","justification":"Contraindicated by ascites"},{"idx":3,"correct":true,"proposition":"Transjugular liver biopsy","justification":"Confirmatory diagnosis of cirrhosis is histological"},{"idx":4,"correct":false,"proposition":"Liver CT scan","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-10","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"As part of the screening for viral hepatitis, what test(s) do you perform on this patient?","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Serology of viral hepatitis A","justification":""},{"idx":1,"correct":true,"proposition":"HBs antigen"},{"idx":2,"correct":true,"proposition":"Serology of viral hepatitis C (HCV)","justification":""},{"idx":3,"correct":false,"proposition":"Hepatitis B virus viral load","justification":""},{"idx":4,"correct":true,"proposition":"Hepatitis C virus viral load","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-11","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The evolution of the episode is favorable under antibiotics. The patient no longer has ascites. You set up a long-term follow-up. What measure(s) do you propose? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Screening for hepatocellular carcinoma","justification":""},{"idx":1,"correct":true,"proposition":"Screening for portal hypertension","justification":""},{"idx":2,"correct":true,"proposition":"Secondary prevention of ascites fluid infection","justification":""},{"idx":3,"correct":true,"proposition":"Screening for ENT cancers","justification":""},{"idx":4,"correct":true,"proposition":"Gastric cancer screening","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-12","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"How do you screen for hepatocellular carcinoma (single response)? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Liver ultrasound every 6 months","justification":""},{"idx":1,"correct":false,"proposition":"Liver ultrasound every year","justification":""},{"idx":2,"correct":false,"proposition":"Liver CT scan every 6 months","justification":""},{"idx":3,"correct":false,"proposition":"Liver scan every year","justification":""},{"idx":4,"correct":false,"proposition":"Serum alpha-fetoprotein assay annually","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-13","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"During follow-up, a 2 cm segment IV hepatic nodule is highlighted. You perform a CT scan to characterize it. What CT characteristic(s) are you looking for in favor of hepatocellular carcinoma? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Spontaneously hyperdense","justification":""},{"idx":1,"correct":true,"proposition":"Spontaneously hypodense","justification":""},{"idx":2,"correct":true,"proposition":"Contrast taking at arterial time","justification":""},{"idx":3,"correct":false,"proposition":"Hyperdensity at portal time","justification":"Hypodensity (washing, wash-out)"},{"idx":4,"correct":true,"proposition":"Hypodensity at portal time","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-14","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The CT scan reveals a spontaneously hypodense tumor, taking the contrast at arterial time and washing at portal time. The diagnosis of hepatocellular carcinoma is made. Which first-line treatment(s) will be discussed? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hepatic resection","justification":""},{"idx":1,"correct":false,"proposition":"Intravenous chemotherapy","justification":""},{"idx":2,"correct":false,"proposition":"Intra-arterial chemotherapy","justification":""},{"idx":3,"correct":true,"proposition":"Percutaneous ablation","justification":"By radio frequency"},{"idx":4,"correct":false,"proposition":"External beam radiation therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-15","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The patient is treated with radiofrequency. Two years later, his liver function deteriorated with the onset of refractory ascites. He also has a recurrence of his hepatocellular carcinoma as a new 3 cm nodule. He is 62 years old and you mention the possibility of a liver transplant. What are the prerequisites? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Effective alcohol withdrawal","justification":""},{"idx":1,"correct":false,"proposition":"Effective smoking cessation","justification":""},{"idx":2,"correct":true,"proposition":"Absence of extrahepatic cancer","justification":""},{"idx":3,"correct":true,"proposition":"Absence of extrahepatic metastasis of hepatocellular carcinoma","justification":""},{"idx":4,"correct":false,"proposition":"Absence of endoscopic portal hypertension","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-1","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Which of the following diagnoses can explain this picture? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Attention deficit disorder with or without hyperactivity","justification":""},{"idx":1,"correct":true,"proposition":"Characterized depressive episode","justification":""},{"idx":2,"correct":true,"proposition":"Hypochondria","justification":""},{"idx":3,"correct":false,"proposition":"Conversion hysteria","justification":""},{"idx":4,"correct":true,"proposition":"Persistent delusional disorder of somatic type","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-2","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"At Mrs. B's insistence, the general practitioner finally agreed to prescribe a brain scan without injection. In the event of hypochondria (or excessive fear of having a disease), indicate the exact proposal(s). ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The prescription of this examination may maintain the disorder","justification":""},{"idx":1,"correct":false,"proposition":"The normality of this examination will provide lasting reassurance to the patient.","justification":""},{"idx":2,"correct":false,"proposition":"The normality of this examination is necessary to confirm the diagnosis","justification":""},{"idx":3,"correct":false,"proposition":"An abnormality on this examination would rule out the diagnosis of hypochondria","justification":""},{"idx":4,"correct":true,"proposition":"The doctor-patient relationship may have influenced this prescribing decision","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-3","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The brain scan without injection performed during the week shows no abnormalities. Mrs. B consults the same doctor again and asks him to prescribe this examination again. She considers it to be << false results >> and explains that they want to make <<her look crazy but that they have not closed everything >>. Mrs. B states that she has a metal object in her brain following surgery. This object is not mentioned in the report of the scanner, so it would be according to her images of someone else. She wants to perform a new scanner in another radiology practice. We note in the words of Mrs. B.: ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A tendency to mythomania","justification":"The patient does not seem to be hiding the truth: she really believes what she says."},{"idx":1,"correct":true,"proposition":"Impaired judgment","justification":""},{"idx":2,"correct":false,"proposition":"Cenesthetic hallucinations","justification":""},{"idx":3,"correct":true,"proposition":"Delusions of persecution","justification":""},{"idx":4,"correct":false,"proposition":"Borderline personality traits","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-4","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The general practitioner having refused to prescribe a new scanner, Mrs. B decides to consult the same day at the emergency reception service (SAU) closest to her home. She refuses the nurse to take vital constants and threatens to commit suicide << like my father >> she says, if she is not examined by a neurosurgeon. When she is told that there is no neurosurgeon in the facility, Mrs. B gets up and walks to the exit without a word. Which of the following indicates a high suicidal risk in Mrs. B.?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The presence of suicidal threats","justification":""},{"idx":1,"correct":true,"proposition":"The absence of relatives at his side","justification":""},{"idx":2,"correct":true,"proposition":"The presence of delusions","justification":""},{"idx":3,"correct":false,"proposition":"Taking estrogen-progestogens","justification":""},{"idx":4,"correct":true,"proposition":"His father's suicide","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-5","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The reception and orientation nurse tries to restrain Mrs. B but she threatens her with a pair of scissors that she has taken out of her bag. Which of the following is correct about physical restraint? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is justified by the immediate self-aggressive risk","justification":""},{"idx":1,"correct":true,"proposition":"It is justified by the immediate hetero-aggressive risk","justification":""},{"idx":2,"correct":false,"proposition":"It must be prescribed by a psychiatrist","justification":""},{"idx":3,"correct":false,"proposition":"She requires an admission measure in psychiatric care under duress","justification":""},{"idx":4,"correct":false,"proposition":"It must be declared secondarily to the liberty and detention judge","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-6","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Faced with self-threatening and hetero-aggressive threats, it is decided to resort to physical restraint. As the patient refuses any oral sedative treatment, an intramuscular injection of a sedative antipsychotic is prescribed. Which of the following considerations led to a preference for the class of antipsychotics over that of benzodiazepines in this case?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Electrocardiogram not performed","justification":""},{"idx":1,"correct":true,"proposition":"Better intramuscular absorption","justification":""},{"idx":2,"correct":false,"proposition":"Better respiratory tolerance","justification":"It is true that they do not have respiratory adverse effects but this is not at all a consideration to take into account since the patient has no respiratory history."},{"idx":3,"correct":false,"proposition":"Young age","justification":""},{"idx":4,"correct":false,"proposition":"Lower risk of dependence","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-7","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Once Mrs. B is sedated, the physical restraint is lifted. The inventory of his belongings does not show any other dangerous object and makes it possible to find the report of the scanner. Upon awakening, psychiatric advice is sought. Mrs. B again exposes her conviction of having been deceived by the radiology office in front of the absence of metallic foreign body. She explains that << they are in cahoots with the intermeditators who point my thoughts... but I'm not going to obey them even if they mess me up... I'm not going to kill my mother... unless she's in them...I mean my mother is me actually... >>. We note in the words of Mrs. B.:","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hermetic speech","justification":"Incomprehensible and several degrees above"},{"idx":1,"correct":true,"proposition":"Neologism","justification":"Intermediator"},{"idx":2,"correct":true,"proposition":"Paralogism","justification":""},{"idx":3,"correct":false,"proposition":"Dreamlike","justification":""},{"idx":4,"correct":true,"proposition":"Hallucinations","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-8","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Which of the following mental disorders could explain the entire clinical picture?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Depressive episode with psychotic features","justification":"No symptoms of depression"},{"idx":1,"correct":true,"proposition":"Schizophrenia","justification":""},{"idx":2,"correct":false,"proposition":"Persistent delusional disorder","justification":""},{"idx":3,"correct":true,"proposition":"Encephalitis","justification":""},{"idx":4,"correct":false,"proposition":"Dissociative disorders","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-9","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The patient agrees to provide contact information for her mother who goes to the emergency room. She is received alone and then with her daughter who is told of the need for psychiatric hospitalization in another institution. The patient is reluctant to hospitalize in psychiatry but would accept to be hospitalized for << extraction of intermeditation electrodes >>. What orientation(s) do you recommend?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Admission to voluntary psychiatric care","justification":""},{"idx":1,"correct":true,"proposition":"Admission to Conventional Third Party Psychiatric Care (PTDC)","justification":""},{"idx":2,"correct":false,"proposition":"Admission to Psychiatric Care at the Request of a Third Party in Emergency (UTDPS)","justification":""},{"idx":3,"correct":false,"proposition":"Admission to psychiatric care for imminent peril (SPPI)","justification":""},{"idx":4,"correct":false,"proposition":"Admission to psychiatric care by decision of the representative of the state (SPDRE)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-10","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The anamnesis is completed in the psychiatric ward where Mrs. B was hospitalized at the request of a third party. Mrs. B, who lives with her mother, has been complaining of trouble concentrating and paying attention for more than a year and has sometimes been soliloquizing for at least six months. She no longer goes out and has gradually abandoned her usual activities, especially social ones. Unemployed after the non-renewal of a COD, she has not taken any steps to find work. The diagnosis of schizophrenia is made and pharmacological treatment is indicated. Which of the following should be part of the pre-therapeutic assessment:","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Blood pressure measurement","justification":""},{"idx":1,"correct":true,"proposition":"Blood glucose measurement","justification":""},{"idx":2,"correct":true,"proposition":"Lipid profile","justification":""},{"idx":3,"correct":false,"proposition":"Proteinuria","justification":""},{"idx":4,"correct":false,"proposition":"Electroencephalogram","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-11","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The pre-therapeutic assessment performed shows no abnormality and Mrs. B is not pregnant. Treatment with oral risperidone is started. After 4 weeks of treatment, neurological examination now shows a marked tremor of the extremities and a bilateral and symmetrical cogwheel. Mrs. B is less vehement but remains determined to obtain the surgical extraction of the device that she believes would have been implanted to manipulate it. Which of the following hypotheses could explain the persistence of positive symptoms? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Absence of associated psychotherapy","justification":"This cannot be a cause of persistence of hallucinations."},{"idx":1,"correct":false,"proposition":"Lack of actual treatment","justification":"The patient is hospitalized and the actual intake of treatments is monitored."},{"idx":2,"correct":true,"proposition":"Hidden cannabis intake","justification":""},{"idx":3,"correct":true,"proposition":"Comorbid neurological disorder","justification":""},{"idx":4,"correct":false,"proposition":"Partial dopaminergic agonist properties of the molecule","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-12","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The same treatment is continued for 4 more weeks. Mrs. B continues to report a manipulation of her thoughts but no longer plans to resort to surgery and recognizes that the treatment does her good. The discourse and thought remain disorganized but the first home leaves went well and a release is envisaged. Faced with the persistence of cognitive complaints about attention and concentration, a neuropsychological assessment is carried out which shows a marked alteration of executive functions. To what can you attribute this objective alteration? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Schizophrenic disorder","justification":""},{"idx":1,"correct":true,"proposition":"To an unknown addictive comorbidity","justification":""},{"idx":2,"correct":false,"proposition":"Iatrogenic hyperprolactinemia","justification":""},{"idx":3,"correct":false,"proposition":"The stress of hospitalization","justification":""},{"idx":4,"correct":false,"proposition":"Extrapyramidal syndrome","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-13","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Given the persistence of hallucina1ions and disorganization after several months of treatment, it was decided to replace risperidone with another atypical antipsychotic. After 3 months of treatment with olazanpine at optimal dosage, Mrs. B's disorders remain very disabling. You decide to change the antipsychotic treatment again. Which of the following options should be considered first? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Replacement with aripiprazole","justification":""},{"idx":1,"correct":true,"proposition":"Replacement with clozapine","justification":""},{"idx":2,"correct":false,"proposition":"Replacement with a typical antipsychotic","justification":""},{"idx":3,"correct":false,"proposition":"Potentiation by the addition of a typical antipsychotic","justification":""},{"idx":4,"correct":false,"proposition":"Potentiation by the addition of a thymoregulator","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-14","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Which of the following is an advantage(s) of clozapine therapy in this patient ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Superior efficacy to other antipsychotics in treatment resistance","justification":""},{"idx":1,"correct":false,"proposition":"Lower risk of inducing metabolic syndrome","justification":"The risk is increased"},{"idx":2,"correct":true,"proposition":"Lower risk of extrapyramidal side effects","justification":""},{"idx":3,"correct":true,"proposition":"Reducing the risk of suicide","justification":""},{"idx":4,"correct":false,"proposition":"Possibility of resorting to a delayed form in case of poor compliance","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-15","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The symptomatology improves markedly with clozapine until Mrs. B considers working again. Which of the following measures can (which) specifically promote this project?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cognitive remediation","justification":""},{"idx":1,"correct":true,"proposition":"Application for recognition of the status of disabled worker","justification":""},{"idx":2,"correct":false,"proposition":"Application for guardianship","justification":""},{"idx":3,"correct":true,"proposition":"Use of an Establishment and Work Assistance Service","justification":""},{"idx":4,"correct":false,"proposition":"Search for a home of life","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-1","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Among the risks associated with this trip, what are the 2 potentially most serious? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Turista (traveller's diarrhea)","justification":""},{"idx":1,"correct":true,"proposition":"Traffic accidents","justification":"Accidents in the broad sense are the leading cause of death when travelling abroad"},{"idx":2,"correct":false,"proposition":"Dengue fever","justification":""},{"idx":3,"correct":false,"proposition":"Rickettsiosis","justification":""},{"idx":4,"correct":true,"proposition":"Malaria","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-2","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"What is (are) the possible preventive attitude(s) for this stay vis-à-vis the malaria risk? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"No chemoprophylaxis","justification":""},{"idx":1,"correct":true,"proposition":"Atovaquone-proguanil chemoprophylaxis","justification":"Daily intake from the first day + one week after return"},{"idx":2,"correct":false,"proposition":"Mefloquine chemoprophylaxis","justification":"She has a psychiatric history, which contraindicates mefloquine"},{"idx":3,"correct":true,"proposition":"Doxycycline chemoprophylaxis","justification":""},{"idx":4,"correct":false,"proposition":"Chloroquine-proguanil chemoprophylaxis","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-3","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"What information(s) do you give him about the yellow fever vaccine?","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Vaccine done in an approved center","justification":""},{"idx":1,"correct":true,"proposition":"Vaccine to be recorded on a WHO-approved international immunization record","justification":""},{"idx":2,"correct":false,"proposition":"Vaccine valid for 10 years","justification":""},{"idx":3,"correct":true,"proposition":"Live attenuated virus vaccine","justification":""},{"idx":4,"correct":false,"proposition":"Vaccine that should not be given on the same day as typhoid vaccine","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-4","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"The patient travels to Côte d'Ivoire 🇨🇮 with antimalarial chemoprophylaxis with doxycycline. What should she remember as information about taking this medicine? (one or more answers are true) ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Daily intake","justification":""},{"idx":1,"correct":false,"proposition":"To start 1 month before departure","justification":"From the first day of departure"},{"idx":2,"correct":false,"proposition":"To be stopped on the day of return to France","justification":""},{"idx":3,"correct":true,"proposition":"To be stopped if pregnancy occurs","justification":""},{"idx":4,"correct":false,"proposition":"Must be combined with mefloquine due to prolonged stay","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-5","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Three months later, on the day of her return to France, the patient comes to your office because, for 2 days, she has not felt well and has pollakiuria with urination burns. During your discussion, she tells you that she had abdominal pain and diarrhea for a few days a little more than a month before her return that led her to stop doxycycline, thinking that this drug was the cause. Which of the following clinical signs is the most important to collect when deciding what to do? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Number of urination per day","justification":""},{"idx":1,"correct":false,"proposition":"Blood in urine","justification":""},{"idx":2,"correct":false,"proposition":"Existence of urgency","justification":""},{"idx":3,"correct":false,"proposition":"Date of last urinary tract infection","justification":""},{"idx":4,"correct":true,"proposition":"Presence of fever","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-6","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"The patient is not febrile and you are moving towards simple cystitis. The urine strip is positive. At this stage, what is the most relevant complementary examination? B. Search for ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"CRP","justification":""},{"idx":1,"correct":false,"proposition":"Chlamydia search","justification":""},{"idx":2,"correct":false,"proposition":"ECBU","justification":"Simple cystitis does not require ECBU (unlike cystitis at risk of complications)"},{"idx":3,"correct":true,"proposition":"No exam","justification":""},{"idx":4,"correct":false,"proposition":"NFS","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-7","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"You do not carry out any additional examination. Which of the following treatment options will you choose as a first-line treatment for this patient? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Fosfomycin-trometamol single dose","justification":""},{"idx":1,"correct":false,"proposition":"Ofloxacin single dose","justification":""},{"idx":2,"correct":false,"proposition":"Ciprofloxacin 5 days","justification":""},{"idx":3,"correct":false,"proposition":"Pivmecillinam 5 days","justification":""},{"idx":4,"correct":false,"proposition":"Nitrofurantoin 5 days","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-8","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"What other recommendation(s) do you make? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Do a follow-up ECBU in 72 hours (3 days)","justification":""},{"idx":1,"correct":true,"proposition":"Drink and urinate regularly","justification":""},{"idx":2,"correct":false,"proposition":"Take cranberry juice daily","justification":"This advice is relevant in case of recurrent cystitis (we are in the case of simple cystitis)"},{"idx":3,"correct":false,"proposition":"Do a vesicorenal ultrasound at a distance from the current episode","justification":""},{"idx":4,"correct":false,"proposition":"Abstaining from sex for 10 days","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-9","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Ten days later, the patient returns to your office with her partner. She tells you that the urinary signs disappeared 2 days after the treatment but that, for 4 days, she had several outbreaks of high fever with chills and sweats. She complains of stubborn headaches, nausea and abdominal pain with loose stools. The patient is apyretic, her clinical examination is normal, there is in particular no meningeal syndrome. Which of the following diagnoses should you mention first in this patient? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Malaria","justification":""},{"idx":1,"correct":false,"proposition":"Acute pyelonephritis","justification":""},{"idx":2,"correct":false,"proposition":"Dengue fever","justification":""},{"idx":3,"correct":false,"proposition":"Typhoid fever","justification":""},{"idx":4,"correct":false,"proposition":"Chikungunya","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-10","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Which of the following clinical elements supports the diagnosis of malaria in this patient? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"3 months stay in Ivory Coast","justification":""},{"idx":1,"correct":true,"proposition":"Digestive disorders","justification":""},{"idx":2,"correct":false,"proposition":"Cystitis preceding this febrile episode","justification":"There is no link between cystitis and malaria"},{"idx":3,"correct":true,"proposition":"Discontinuation of doxycycline 1 month before returning to France","justification":""},{"idx":4,"correct":true,"proposition":"Fever progressing in peaks","justification":"Periodic\/intermittent fever is common in malaria."}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-11","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"You urgently carry out a check-up on this patient, the results of which are as follows. Which one(s) is the most suggestive of malaria diagnosis? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Hemoglobin: 10.8 g\/dL","justification":""},{"idx":1,"correct":true,"proposition":"Blisters: 45 g\/L","justification":""},{"idx":2,"correct":false,"proposition":"CRP to 95","justification":""},{"idx":3,"correct":false,"proposition":"ALAT to 1.2","justification":""},{"idx":4,"correct":false,"proposition":"Kalemia at 3.3 mmol\/L","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-12","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Which exam(s) will allow you to make the diagnosis of malaria now? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Blood","justification":""},{"idx":1,"correct":false,"proposition":"Malaria blood serology","justification":""},{"idx":2,"correct":true,"proposition":"Rapid test for HRP2 antigen","justification":""},{"idx":3,"correct":true,"proposition":"Blood smear","justification":""},{"idx":4,"correct":false,"proposition":"Procalcitonin","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-13","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"The blood smear is 0.5% positive for Plasmodium falciparum. The patient does not vomit and wishes to go home. What first-line care do you offer her knowing that she is not pregnant? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Quinine","justification":""},{"idx":1,"correct":false,"proposition":"Atovaquone + proguanil","justification":""},{"idx":2,"correct":true,"proposition":"Artenimol-piperaquine","justification":""},{"idx":3,"correct":true,"proposition":"Artemether-lumefantrine","justification":""},{"idx":4,"correct":false,"proposition":"Outpatient treatment","justification":"Her platelets are less than 50 G \/ L (question 11) so she has a hospitalization criterion. The statement is misleading because the patient's wish is always important and it is he who has the last word (we can not force this patient to be hospitalized), but the question is specifically about \"what we offer her\": we offer her hospitalization."}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-14","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"You cannot treat this patient on an outpatient basis. Why (one or more possible answers)? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"CRP 95 mg\/L","justification":""},{"idx":1,"correct":false,"proposition":"0.5% parasitemia","justification":""},{"idx":2,"correct":true,"proposition":"45 G\/L blisters","justification":""},{"idx":3,"correct":false,"proposition":"Haemoglobin at 10.8 g\/dL","justification":""},{"idx":4,"correct":false,"proposition":"Treatment with artenimol-piperaquine","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-15","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"After 3 days of hospitalization, the patient is apyretic with a negative thick drip smear and can be discharged. At what time(s) do you organise biological controls?","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"On the 5th day of the start of treatment"},{"idx":1,"correct":true,"proposition":"On the 7th day of the start of treatment","justification":"J3, J7, J28 😊 . It fell twice, so that's to know."},{"idx":2,"correct":false,"proposition":"On day 14 of the start of treatment"},{"idx":3,"correct":false,"proposition":"On the 21st day of the start of treatment"},{"idx":4,"correct":true,"proposition":"On the 28th day of the start of treatment"}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-1","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Which clinical sign(s) would direct you to Pancoast-Tobias syndrome? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"An alteration of the general condition","justification":""},{"idx":1,"correct":true,"proposition":"A deficit of the interosseous muscles of the hand","justification":"There are 4 palmar interosseous and 4 dorsal interosseous. They are innervated by the C8 Th1 ulnar nerve, which is affected in Pancoast-Tobias syndrome."},{"idx":2,"correct":false,"proposition":"Diplopia","justification":"It is a symptom found in alternating syndromes for example"},{"idx":3,"correct":false,"proposition":"Irradiation of pain in the thumb","justification":"The ulnar nerve innervates the fifth finger and medial half of the fourth."},{"idx":4,"correct":true,"proposition":"The association a ptosis","justification":"Ptosis - Myosis - Enophtalmos is part of another syndrome 😉"}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-2","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The patient does not have an impairment in the general condition. Which of the following signs is the one that points to a joint cause of pain? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Limiting passive lateral rotation","justification":""},{"idx":1,"correct":false,"proposition":"Localization of pain on the anterior side of the shoulder","justification":""},{"idx":2,"correct":false,"proposition":"Worsening pain in abduction","justification":""},{"idx":3,"correct":true,"proposition":"Presence of joint effusion","justification":"Joint effusion is often a sign of a local inflammatory cause"},{"idx":4,"correct":false,"proposition":"Pain on palpation of the delto-pectoral sulcus","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-3","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Which of these muscles is (are) part of the rotator cuff? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The supraspinatus tendon","justification":""},{"idx":1,"correct":false,"proposition":"The large round tendon","justification":"The little circle is one of them. Unfortunately, you have to learn these muscles - this question often falls, whether in IQ or PD."},{"idx":2,"correct":false,"proposition":"The tendon of the deltoid","justification":""},{"idx":3,"correct":true,"proposition":"Subscapularis tendon","justification":""},{"idx":4,"correct":true,"proposition":"The infraspinatus tendon ","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-4","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The clinical examination reveals an active abduction of normal but painful amplitude of the shoulder. There is a painful arc with active abduction pain between 60 ° and 120 °. The lateral rotation is of normal and symmetrical amplitude. The passive elevation of the upper limb in internal rotation and antepulsion is painful. The following clinical maneuver is painful while other cuff muscle tensioning maneuvers are painless. Which tendon is responsible?","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The supraspinatus tendon","justification":"This is Jobe's maneuver"},{"idx":1,"correct":false,"proposition":"The large round tendon","justification":""},{"idx":2,"correct":false,"proposition":"The tendon of the deltoid","justification":""},{"idx":3,"correct":false,"proposition":"Subscapularis tendon","justification":""},{"idx":4,"correct":false,"proposition":"The infraspinatus tendon ","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-5","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"You do a standard X-ray to the patient (below). Which of these proposals is the exact answer(s)? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"There is a decrease in the height of the space under acromial","justification":""},{"idx":1,"correct":false,"proposition":"There is osteoarthritis","justification":""},{"idx":2,"correct":false,"proposition":"There is calcification of the rotator cuff tendons","justification":""},{"idx":3,"correct":true,"proposition":"X-ray is normal","justification":""},{"idx":4,"correct":false,"proposition":"There is osteolysis of the major tubercle","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-6","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"At this stage of management, which additional imaging test(s) of the right shoulder can you request? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Scanner","justification":""},{"idx":1,"correct":true,"proposition":"MRI","justification":"MRI and ultrasound are the two tests that directly visualize the tendons."},{"idx":2,"correct":false,"proposition":"Arthro-MRI","justification":""},{"idx":3,"correct":false,"proposition":"Arthroscanner","justification":""},{"idx":4,"correct":true,"proposition":"Echography","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-7","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The sonographer answers that it is an unruptured tendinopathy of the supraspinatus. You prescribe shoulder rehabilitation. In this patient, what is(are) the objective(s) of physiotherapy? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Strengthen the deltoid","justification":""},{"idx":1,"correct":true,"proposition":"Strengthen the latissimus dorsi","justification":""},{"idx":2,"correct":false,"proposition":"Increase passive range of motion","justification":"The question insists on 'this patient' who does not have passive range of motion."},{"idx":3,"correct":true,"proposition":"Reduce pain","justification":""},{"idx":4,"correct":true,"proposition":"Provide educational advice","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-8","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"After a month and 15 sessions of physiotherapy, the patient is still as painful when raising the shoulder. Which strategy(s) is relevant? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"You check if the patient is observant","justification":""},{"idx":1,"correct":true,"proposition":"You check the tolerance of the sessions","justification":""},{"idx":2,"correct":true,"proposition":"You strengthen analgesic care","justification":""},{"idx":3,"correct":false,"proposition":"You request a shoulder scan","justification":"The CT scan is not very useful for the study of tendons, MRI is preferred."},{"idx":4,"correct":true,"proposition":"You check your differential diagnoses","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-9","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The patient was able to return to work. Trying to catch up with a slide on a scaffolding, he has complete functional impotence of the right upper limb. Here is the front X-ray of the right shoulder. What element(s) does it bring you? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"There is a fracture of the surgical cervix of the humerus","justification":""},{"idx":1,"correct":true,"proposition":"There is an anteroinferior glenohumeral dislocation","justification":""},{"idx":2,"correct":false,"proposition":"There is an acromioclavicular disjunction","justification":""},{"idx":3,"correct":false,"proposition":"There is a fracture of a displaced rib","justification":""},{"idx":4,"correct":false,"proposition":"There is a notch of Malgaigne","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-10","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Before proceeding to reduce this dislocation, you examine the sensitivity of the stump of the shoulder. An isolated abnormality at this level is in favor of nerve damage: ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"axillary","justification":""},{"idx":1,"correct":false,"proposition":"supraspinatus","justification":""},{"idx":2,"correct":false,"proposition":"long thoracic","justification":""},{"idx":3,"correct":false,"proposition":"radial","justification":""},{"idx":4,"correct":false,"proposition":"musculocutaneous","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-11","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The patient did not have associated nerve damage prior to external manoeuvring reduction of the glenohumeral joint. The review of awareness after reduction is not changed. You set up an immobiliatlon by an elbow brace to the body. You see the patient again a month later. On clinical examination, you notice the following: passive mobility is not diminished, the right arm in anterior elevation and internal rotation, the patient can not resist the force of abbaissement that you exert, when he wants to bring his hand to the mouth, you observe that the patient is forced to raise his elbow laterally above the level of his hand. In addition, the arm placed in external rotation elbows to the body, there is an automatic internal rotation. Passive external rotation is not increased. The patient retains the possibility of taking off the hand placed in the back at the lumbosacral junction. There is no abnormality during thwarted active flexion of the elbow when the palms are up. Given the data of the clinical examination, you mention the possibility of a rupture of one or more of the following elements: (one or more true propositions)","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Supraspinatus","justification":""},{"idx":1,"correct":false,"proposition":"Pectoralis Major","justification":""},{"idx":2,"correct":true,"proposition":"Infraspinatus","justification":""},{"idx":3,"correct":true,"proposition":"Teres minor (small round)","justification":""},{"idx":4,"correct":false,"proposition":"Subscapular","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-12","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Given the functional discomfort, rotator cuff repair surgery is offered to the patient. While waiting for the consultation of the anaesthetist, the patient asks you a few questions. Which of the following answers you could give is correct? ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"For this scheduled procedure, the anesthesia consultation can take place until the day before the intervention","justification":""},{"idx":1,"correct":false,"proposition":"You will see either a doctor or a nurse anaesthetist for this consultation","justification":""},{"idx":2,"correct":true,"proposition":"You will not necessarily have to take a blood test before the procedure","justification":""},{"idx":3,"correct":true,"proposition":"If you do not wish to have locoregional anesthesia, you can refuse it","justification":"It is always the patient who decides!"},{"idx":4,"correct":false,"proposition":"As you are taking aspirin for the heart, it will in any case be necessary to stop it between 5 and 7 days before the procedure","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-13","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The patient is now in the post-interventional monitoring room following his surgery, which took place without incident anesthetic and surgically. He expresses pain at 8 out of 10 on the numerical scale and asks to be relieved. Which multimodal analgesia(s) are indicated in this context, among the analgesia represented in the figure below? PCA: patient-controlled analgesia (or PDA) ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Has","justification":""},{"idx":1,"correct":false,"proposition":"B","justification":""},{"idx":0,"correct":false,"proposition":"C","justification":""},{"idx":1,"correct":false,"proposition":"D","justification":""},{"idx":0,"correct":true,"proposition":"E","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-14","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Morphine titration was initiated because it was severe pain. It was relayed by patient-controlled analgesia (PCA) with paracetamol and nefopam as part of multimodal postoperative analgesia. It has been effective. The ACP was arrested on the second day. On the third day, the patient again complains of pain, the intensity of which is measured at 54 mm on a visual analogue scale, and he wishes to be relieved. His current analgesic treatment includes paracetamol and nefopam. Which treatment(s) is (are) indicated in the context of multimodal analgesia in this context? ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Tramadol","justification":""},{"idx":1,"correct":false,"proposition":"Ketoprofen (NSAIDs)","justification":""},{"idx":2,"correct":false,"proposition":"Oxycodone","justification":""},{"idx":3,"correct":false,"proposition":"Transcutaneous electrical nerve stimulation (TENS)","justification":""},{"idx":4,"correct":true,"proposition":"Application of refrigeration","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-15","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"After 5 months of rehabilitation, the patient has regained satisfactory active and passive mobility and he hardly complains of pain. He questions you about the resumption of his work because he fears that he will not be able to continue his activity. In agreement with your patient, you wish to contact his occupational physician. Which element(s) is (are) relevant to transmit to the occupational physician? ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"None, so as not to break medical confidentiality","justification":""},{"idx":1,"correct":true,"proposition":"Functional sequelae on the shoulder","justification":""},{"idx":2,"correct":true,"proposition":"The initial lesion assessment","justification":""},{"idx":3,"correct":false,"proposition":"A certificate of aptitude for his position","justification":""},{"idx":4,"correct":true,"proposition":"Possible extra-occupational risk factors","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-1","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Which of the following clinical elements is present in the observation?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Spatial disorientation","justification":"'She thinks she is at home'"},{"idx":1,"correct":true,"proposition":"Zoopsies","justification":"'Scaring away cockroaches' 🐾"},{"idx":2,"correct":true,"proposition":"Disturbance of attention","justification":"'You have to repeat it several times because it seems elsewhere'"},{"idx":3,"correct":false,"proposition":"Tachypsychia","justification":""},{"idx":4,"correct":false,"proposition":"Mental automatism","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-2","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Faced with this state of agitation, which of the following elements present in the observation, which one (directs) towards a delirium rather than an acute psychotic state?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Spatial disorientation","justification":""},{"idx":1,"correct":false,"proposition":"Delusions of persecution","justification":"These are characteristic of the LFS"},{"idx":2,"correct":true,"proposition":"Abrupt onset in a post-operative context","justification":"The postoperative context points much more towards confusion (known link between confusion and surgery) than towards EPA (no known link between EPA and surgery)"},{"idx":3,"correct":false,"proposition":"Major anxiety","justification":"Anxiety is found in both etiologies. This is a characteristic of agitation."},{"idx":4,"correct":true,"proposition":"Fluctuation of symptoms","justification":"The EPA does not fluctuate, or does not fluctuate, or little"}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-3","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Which of the following clinical elements would be in favor of delirium syndrome?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Time disorientation","justification":"This is characteristic"},{"idx":1,"correct":true,"proposition":"Hyperthermia","justification":"This can be a confusing trigger"},{"idx":2,"correct":true,"proposition":"Predominance of visual hallucinations","justification":"Visual (rather than auditory) hallucinations are often found in confusion."},{"idx":3,"correct":false,"proposition":"Psychiatric history","justification":""},{"idx":4,"correct":true,"proposition":"Reversal of the nycthemeral rhythm","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-4","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The agitation is fluctuating but she does not repeat her hetero-aggressive threats and agrees to be escorted back to her room. She remains disoriented in space and time. At this stage, which of the following additional examinations is essential to carry out immediately? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Alcohol","justification":""},{"idx":1,"correct":false,"proposition":"Search for urinary toxicants","justification":""},{"idx":2,"correct":true,"proposition":"Capillary blood glucose","justification":"Any acute and non-systematized neurological signs should be investigated for hypoglycemia as a first-line treatment."},{"idx":3,"correct":false,"proposition":"Injected brain scan","justification":""},{"idx":4,"correct":false,"proposition":"Blood ionogram","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-5","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Capillary blood glucose is 3.8 mmol\/L. Which of the following causes should be mentioned in front of the clinical picture presented by the patient? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Alcohol withdrawal","justification":""},{"idx":1,"correct":true,"proposition":"Adverse effects of opioid analgesics","justification":""},{"idx":2,"correct":false,"proposition":"Hypoglycaemia","justification":"Blood sugar is normal"},{"idx":3,"correct":true,"proposition":"Subacute subdural hematoma","justification":""},{"idx":4,"correct":true,"proposition":"Hyponatremia","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-6","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Physical examination shows sweating, tachycardia and tremor of extremities. The neurological examination cannot be continued due to increased agitation. The patient nevertheless accepts oral treatment. What do you recommend? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Benzodiazepine therapy","justification":"We start on an alcoholic withdrawal in view of the clinical description and the context of the patient."},{"idx":1,"correct":false,"proposition":"Treatment with sedative neuroleptic","justification":""},{"idx":2,"correct":true,"proposition":"Brain scan without injection as soon as possible","justification":""},{"idx":3,"correct":true,"proposition":"Constant behavioural monitoring","justification":""},{"idx":4,"correct":false,"proposition":"Request for psychiatric opinion","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-7","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Given the delirium syndrome and the context of fall with scalp wound, a brain scan is prescribed urgently after benzodiazepine sedation. The brain scan is normal but biology shows a moderate elevation of gamma-glutamyl-transpeptidase (GGT) and transaminases (predominant on AST) contrasting with a normal level of alkaline phosphatase, as well as an elevation of mean corpuscular volume. The blood ionogram and serum calcium are normal. CPKs are quietly increased. The temperature is 37.8 °C.  The patient is no longer agitated but still disoriented, anxious and continues to make delusional remarks. What do you recommend in the immediate future? (one or more responses) ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Thiamine","justification":""},{"idx":1,"correct":true,"proposition":"Hydration","justification":""},{"idx":2,"correct":false,"proposition":"Valproic acid","justification":""},{"idx":3,"correct":false,"proposition":"Physical restraint","justification":"The patient is no longer agitated"},{"idx":4,"correct":false,"proposition":"Antipsychotic","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-8","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"You have set up intravenous hydration treatment and administration of vitamin B1 and Diazepam. Which of the following clinical and biological elements is part of the monitoring of delirium tremens?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Blood pressure"},{"idx":1,"correct":true,"proposition":"Heart rate"},{"idx":2,"correct":true,"proposition":"Temperature","justification":"The patient is subfebrile. The normalization of its temperature is monitored. This parameter is not part of the Cushman score (but it is still checked in the delirium tremens) 😉"},{"idx":3,"correct":false,"proposition":"Haemoglobin"},{"idx":4,"correct":false,"proposition":"Gamma-glutamyl-transpeptidase","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-9","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The evolution of delirium is favorable in a few days and an addictological consultation is organized. The patient reports excessive daily alcohol consumption but says she has not lost control of her consumption and does not need addiction management. Which of the following attitudes you could adopt to promote patient adherence, which are specifically motivational interviewing techniques? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Explain the link between alcohol consumption and delirium tremens episode","justification":""},{"idx":1,"correct":false,"proposition":"Explain other risks associated with alcohol consumption","justification":""},{"idx":2,"correct":true,"proposition":"Ask the patient what her alcohol consumption brings","justification":""},{"idx":3,"correct":true,"proposition":"Talk about ambivalence to change as normal","justification":""},{"idx":4,"correct":false,"proposition":"Introduce drug treatments to help maintain abstinence","justification":"Motivational interviewing meets a very specific definition."}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-10","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The patient is followed by her general practitioner with a goal of complete abstinence. However, she was unable to stop drinking for more than five days. Which of the following classes of drugs can be prescribed as an aid to maintain abstinence? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A selective serotonin reuptake inhibitor","justification":""},{"idx":1,"correct":false,"proposition":"A benzodiazepine","justification":""},{"idx":2,"correct":true,"proposition":"An opioid antagonist","justification":""},{"idx":3,"correct":false,"proposition":"A thymoregulator","justification":""},{"idx":4,"correct":false,"proposition":"An anticonvulsant","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-11","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Management by the general practitioner continues, but without a significant reduction in alcohol consumption. She continues to drink one and a half bottles of wine a day. The patient often comes to the consultations having been drinking. She then cries a lot, says she is sad, lacking appetite and blaming herself. What therapeutic strategy(s) is (are) indicated for this patient? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Outpatient care in an addiction center","justification":""},{"idx":1,"correct":false,"proposition":"Emergency psychiatric hospitalization","justification":""},{"idx":2,"correct":false,"proposition":"Prescribing an antidepressant","justification":"The description does not meet the DSM-5 criteria for depression."},{"idx":3,"correct":true,"proposition":"Cognitive Behavioural Therapy","justification":""},{"idx":4,"correct":true,"proposition":"Scheduled hospitalization for alcohol withdrawal","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-12","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The patient is cared for in a CSAPA (center for care, support and prevention in addiction) and a scheduled withdrawal has made it possible to obtain complete abstinence from alcohol for 3 months. Despite this, she continues to suffer from a deep malaise and tells her doctor that she can no longer bear to live alone, that she feels tired in the morning and needs several hours to prepare. It is very difficult to make decisions, she is incompetent in all areas and has a strong tendency to eat between meals to the point of having gained 5 kilos for 2 months. In addition, she worries almost all day and excessively for various reasons and takes more than an hour before falling asleep. She goes out little and sees very few people because she dreads all the encounters and is afraid of not being up to it. What diagnostic criterion(s) of severe depression do you identify among the symptoms presented by this patient:","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Self-depreciation","justification":"Minor criterion"},{"idx":1,"correct":false,"proposition":"Feeling lonely","justification":"Feeling lonely is not a DSM-5 criterion. Wicked trap 🙈"},{"idx":2,"correct":true,"proposition":"Cognitive impairment","justification":"Minor criterion"},{"idx":3,"correct":true,"proposition":"Overeating","justification":"Minor criterion"},{"idx":4,"correct":true,"proposition":"Slowdown","justification":"Minor criterion"}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-13","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"What other diagnosis(s) does the patient's clinical picture suggest? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Generalized anxiety disorder (GAD)","justification":""},{"idx":1,"correct":true,"proposition":"Social phobia","justification":""},{"idx":2,"correct":false,"proposition":"Agoraphobia","justification":""},{"idx":3,"correct":false,"proposition":"Syndrome de Korsakoff","justification":""},{"idx":4,"correct":false,"proposition":"Schizoid personality disorder","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-14","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"A prescription of antidepressant monotherapy (escitalopram) was implemented 4 months ago and has achieved complete remission of the depressive episode for 3 months now. The patient remained abstinent in alcohol 🍷. However, she remains very anxious in many situations of everyday life. What therapeutic orientation(s) is (are) indicated at this stage?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Gradual discontinuation of escitalopram","justification":""},{"idx":1,"correct":true,"proposition":"Cognitive Behavioural Therapy","justification":""},{"idx":2,"correct":false,"proposition":"EMDR","justification":""},{"idx":3,"correct":false,"proposition":"Beta-blocker","justification":""},{"idx":4,"correct":false,"proposition":"Sedating neuroleptic","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-15","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"After 12 months of treatment with escitalopram and maintenance of a complete and stable remission of the depressive episode, what argument(s) can justify the extension of this long-term treatment? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Identification of a history of depressive episodes","justification":""},{"idx":1,"correct":false,"proposition":"Identification of a history of manic episode","justification":""},{"idx":2,"correct":false,"proposition":"Signs of drug withdrawal occurring when you forget to take","justification":"There is no withdrawal syndrome"},{"idx":3,"correct":true,"proposition":"Severe generalized anxiety disorder","justification":""},{"idx":4,"correct":false,"proposition":"Avoidant personality disorder","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-16","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The patient consults a year later. She has not taken an antidepressant for 6 months, but takes alprazolam in varying doses prescribed by another doctor every day. What therapeutic strategy(s) can be proposed to limit the risk of benzodiazepine dependence in this patient? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Information on the risks of chronic benzodiazepine use","justification":""},{"idx":1,"correct":true,"proposition":"Participation in a mutual aid group (GEM)","justification":"Doubt on this question: there is no mention of these GEM in the college 🤷 ♂️ But we decide to tick it just since it seems logical."},{"idx":2,"correct":false,"proposition":"Extension of the prescription of alprazolam at a stable dose to achieve complete remission","justification":""},{"idx":3,"correct":false,"proposition":"Replacement of alprazolam with a benzodiazepine with a shorter half-life","justification":"The shorter the half-life, the higher the risk."},{"idx":4,"correct":true,"proposition":"Information on non-drug therapeutic alternatives","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-1","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Regarding the confusion in this situation, what is(are) the exact answer(s)? (one or more true propositions)","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"It can persist for several days","justification":"This is called post-critical confusion, which lasts a few minutes to a few hours."},{"idx":1,"correct":false,"proposition":"It may be followed by persistent cognitive impairment","justification":""},{"idx":2,"correct":true,"proposition":"It is manifested by a spontaneous language disorder","justification":""},{"idx":3,"correct":true,"proposition":"Its association with temporospatial disorientation is constant","justification":""},{"idx":4,"correct":true,"proposition":"It is manifested in particular by behavioral disorders","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-2","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Regarding the mechanism of this loss of knowledge, what is (are) the right proposal(s)? (one or more true propositions)","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"You mention the diagnosis of tonic-clonic seizure because witnesses report convulsive movements"},{"idx":1,"correct":false,"proposition":"You retain the diagnosis of tonic-clonic seizure since the patient reported a loss of urine","justification":""},{"idx":2,"correct":false,"proposition":"The absence of tongue bite makes it possible to rule out the diagnosis of tonic-clonic seizure","justification":""},{"idx":3,"correct":false,"proposition":"The fact that the patient says she does not remember anything supports a psychogenic origin of the loss of consciousness","justification":""},{"idx":4,"correct":true,"proposition":"The existence of confusion during the management by the SAMU makes you evoke a tonic-clonic epileptic seizure","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-3","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"What element(s) would be in favor of convulsive syncope? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Extreme pallor","justification":""},{"idx":1,"correct":true,"proposition":"Immediate resumption of normal consciousness","justification":""},{"idx":2,"correct":false,"proposition":"Duration of loss of consciousness of at least five minutes","justification":"Rather epilepsy"},{"idx":3,"correct":false,"proposition":"Clonic shaking of all four limbs","justification":"Not the four members 😉"},{"idx":4,"correct":false,"proposition":"Loss of urine","justification":"It is not discriminatory."}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-4","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"During the interrogation, you learn that the patient is sometimes surprised in the morning by jolts of the upper limbs. She even suddenly dropped the cup of coffee she was holding as the movement was so abrupt. Regarding this symptom, you mention:  ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Tetany","justification":""},{"idx":1,"correct":false,"proposition":"Tics","justification":""},{"idx":2,"correct":false,"proposition":"Physiological myoclonus","justification":""},{"idx":3,"correct":true,"proposition":"Epileptic myoclonus","justification":""},{"idx":4,"correct":false,"proposition":"Psychogenic manifestations","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-5","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"You integrate this symptom into your syndromic reasoning. What is the exact proposal(s):","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"This symptom calls into question the diagnosis of an epileptic mechanism concerning the episode of loss of consciousness","justification":""},{"idx":1,"correct":false,"proposition":"This symptom associated with the clinical suspicion of tonic-clonic seizure is in favor of secondarily generalized partial epilepsy","justification":""},{"idx":2,"correct":true,"proposition":"This symptom associated with clinical suspicion of tonic-clonic seizure is in favor of idiopathic generalized epilepsy","justification":""},{"idx":3,"correct":false,"proposition":"This symptom requires psychiatric advice","justification":""},{"idx":4,"correct":true,"proposition":"This symptom should cause the interrogation to look for photosensitivity","justification":"Triggering at light exposure."}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-6","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"You remember the existence of epileptic myoclonus. Regarding epileptic myoclonus, which is (are) the exact proposal(s)? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"They can be observed during generalized epilepsy","justification":""},{"idx":1,"correct":true,"proposition":"They can be observed during partial epilepsies","justification":""},{"idx":2,"correct":true,"proposition":"They are favored by lack of sleep","justification":""},{"idx":3,"correct":true,"proposition":"They are favored by intermittent light stimulation","justification":""},{"idx":4,"correct":false,"proposition":"They can occur in the absence of concomitant epileptic discharge on the electroencephalogram","justification":"It would be bad luck anyway 🤔"}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-7","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"In the first hours of your care, which additional examination(s) for etiological purposes will you perform? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A brain MRI","justification":"Not in the first hours but it is systematic in a second time."},{"idx":1,"correct":false,"proposition":"A lumbar puncture","justification":"The repetition of symptoms is not in favor of an infectious origin."},{"idx":2,"correct":true,"proposition":"An electroeneghalogram","justification":"We will look for a background 😉 activity"},{"idx":3,"correct":false,"proposition":"A search for toxicants in urine","justification":"The repetition of symptoms is not in favor."},{"idx":4,"correct":false,"proposition":"A brain angiography","justification":"We can consider a CT scan, but not a CT angiography (we do not think of ischemia in front of this table)."}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-8","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"You have to perform an electroencephalogram one hour after admission. What characteristic(s) do you remember at the seventh second of the recording? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Generalized epileptic discharge"},{"idx":1,"correct":false,"proposition":"A physiological trace (normal rhythm)"},{"idx":2,"correct":false,"proposition":"Discharge characteristic of an absence"},{"idx":3,"correct":true,"proposition":"One landfill recorded on all leads (lines)"},{"idx":4,"correct":false,"proposition":"A discharge characteristic of a partial crisis"}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-9","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"A brain MRI is performed remotely, what do you expect (indicate the exact proposal(s))? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"It will be normal in case of idiopathic generalized epilepsy","justification":""},{"idx":1,"correct":true,"proposition":"An MRI abnormality is not necessarily responsible for epilepsy","justification":""},{"idx":2,"correct":false,"proposition":"An MRI abnormality will prove that the patient's symptoms are epileptic","justification":""},{"idx":3,"correct":false,"proposition":"The absence of abnormalities on MRI will make it possible to reject the diagnosis of epilepsy in this patient","justification":""},{"idx":4,"correct":false,"proposition":"The presence of an abnormality on MRI will prove that epilepsy is of partial origin in this patient","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-10","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Brain MRI is normal. What is the diagnosis? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":" Rolandic paroxysmic epilepsy ","justification":""},{"idx":1,"correct":true,"proposition":"Benign juvenile myoclonic epilepsy","justification":""},{"idx":2,"correct":false,"proposition":" Temporal partial epilepsy","justification":""},{"idx":3,"correct":false,"proposition":" Cryptogenic epilepsy","justification":""},{"idx":4,"correct":false,"proposition":"Convulsive syncope","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-11","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"You have retained the diagnosis of benign juvenile myoclonic epilepsy. You discuss with the patient the initiation of background antiepileptic therapy. What is the exact proposal(s)? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"There is no indication for background anti-epileptic treatment as she had only one generalized seizure","justification":""},{"idx":1,"correct":false,"proposition":"The benign nature of epilepsia justifies therapeutic abstention","justification":""},{"idx":2,"correct":true,"proposition":"The prescription of background anti-epileptic treatment must be accompanied by therapeutic education","justification":""},{"idx":3,"correct":false,"proposition":"Prescription of background antiepileptic therapy contraindicates oral contraception","justification":""},{"idx":4,"correct":true,"proposition":"The prescription must be maintained over the long term to prevent the recurrence of its pathology","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-12","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Treated for 18 months with lamotrigine, she has never reoffended. She wants to pass her driver's license. What is the exact answer(s) regarding driving? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Driving a public transit vehicle is definitely contraindicated","justification":""},{"idx":1,"correct":false,"proposition":"Driving a light vehicle is possible without restriction","justification":""},{"idx":2,"correct":true,"proposition":"The physician must inform the patient of the regulatory procedures","justification":""},{"idx":3,"correct":false,"proposition":"Driving will be possible with a certificate from the attending physician","justification":""},{"idx":4,"correct":false,"proposition":"Taking antiepileptic treatment prohibits driving","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-13","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"She asks you about her contraception. What is the exact answer(s)? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Oral contraception is contraindicated","justification":""},{"idx":1,"correct":false,"proposition":"Lamotrigine is an enzyme inducer of estrogen-progestin contraceptives","justification":""},{"idx":2,"correct":false,"proposition":"You recommend stopping antiepileptic treatment","justification":""},{"idx":3,"correct":true,"proposition":"You authorize the contraception of his choice","justification":""},{"idx":4,"correct":false,"proposition":"You recommend a change in antiepileptic treatment","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-14","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Five years later, the patient expresses a desire for pregnancy and wishes to have information. What is the exact answer(s)? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Genetic counseling should be offered","justification":""},{"idx":1,"correct":false,"proposition":"The context of pregnancy makes you offer dual therapy","justification":""},{"idx":2,"correct":true,"proposition":"You set up folic acid supplementation","justification":""},{"idx":3,"correct":false,"proposition":"Close ultrasound monitoring will be necessary during the last trimester of pregnancy","justification":""},{"idx":4,"correct":false,"proposition":"Under treatment the risk of malformation is higher than that of the general population","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-1","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"In the emergency room, the patient is taken care of. The clinical examination, supplemented by imaging, confirms a closed fracture of the right wrist requiring surgery. The wounds of the upper limbs are to be sutured. The caregiver washes his hands according to the following steps. Which of the following suggestions for standard hygiene precautions for performing sutures in emergency rooms is correct?","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Wearing a surgical mask for the operator is recommended","justification":""},{"idx":1,"correct":false,"proposition":"The friction of the hands in 6 steps with a hydro-alcoholic solution, before the treatment, is in accordance with the recommendations","justification":""},{"idx":2,"correct":false,"proposition":"The duration of hand rubbing should last at least one minute","justification":"30 seconds ⌛ (painful trap)"},{"idx":3,"correct":true,"proposition":"Wearing a pair of goggles is recommended","justification":""},{"idx":4,"correct":true,"proposition":"Gloves are required","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-2","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The wounds were sutured. You ask the patient about his vaccination status that he does not know. What modality(s) of prevention of the risk of infection do you implement?","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"You give him an injection of 250 IU of tetanus immunoglobulins in the emergency room","justification":""},{"idx":1,"correct":true,"proposition":"You give him an injection of a dose of vaccine containing tetanus valence in the emergency room","justification":""},{"idx":2,"correct":false,"proposition":"You start antibiotic therapy with amoxicillin and clavulanic acid for a period of 10 days","justification":""},{"idx":3,"correct":true,"proposition":"You are planning a tetanus vaccination booster for this patient","justification":""},{"idx":4,"correct":true,"proposition":"You are planning a new consultation for wound healing monitoring in a week 1 1","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-3","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"You inform the patient of the need for surgery followed by hospitalization to treat their wrist fracture. The patient refuses surgery and hospitalization. Which of the following proposals regarding patient information and consent is accurate? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The patient's low level of understanding of the French language exempts the physician from obtaining the patient's consent","justification":""},{"idx":1,"correct":true,"proposition":"The doctor must inform this patient of the expected benefits and possible risks of the surgical procedure","justification":""},{"idx":2,"correct":false,"proposition":"The status of illegal alien exempts the doctor from obtaining the patient's consent","justification":""},{"idx":3,"correct":true,"proposition":"The physician must ensure the patient's understanding by asking him to say what he has understood","justification":""},{"idx":4,"correct":true,"proposition":"The presence of the interpreter is recommended during the interview with the patient","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-4","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The exchange with the patient highlights that his refusal is mainly motivated by the cost of surgery and hospitalization. His hospitalization costs will be covered under which device?","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Universal Health Protection (PUMa)","justification":""},{"idx":1,"correct":false,"proposition":"Complementary Universal Health Coverage (CMUc)","justification":""},{"idx":2,"correct":false,"proposition":"Assistance to complementary health (ACS)","justification":""},{"idx":3,"correct":false,"proposition":"Active solidarity income (RSA)","justification":""},{"idx":3,"correct":true,"proposition":"State Medical Aid (AME)","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-5","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"This patient meets the conditions to benefit from the State Medical Aid (AME) but he has not, to date, submitted an application. Which of the following proposals for AME is correct?","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The AME application must have been filed on the day of hospitalization","justification":""},{"idx":1,"correct":false,"proposition":"The hospital fee will remain the responsibility of the patient because he had not submitted an application for AME prior to his entry into the hospital","justification":""},{"idx":2,"correct":false,"proposition":"The AME will only allow him to access free emergency care","justification":""},{"idx":3,"correct":false,"proposition":"The AME will allow him to be reimbursed 100% of a medical consultation but he will have to advance the costs","justification":"No need to advance fees"},{"idx":4,"correct":true,"proposition":"The AME will allow him to be exempted from the medical deductible","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-6","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"Following the information provided, the patient finally accepts the surgery and hospitalization. He was therefore taken to the operating room for an orthopedic procedure. Arriving at the operating room, the team uses the patient safety checklist << the operating room >> (2016 version) of the High Authority for Health (HAS). Which of the following proposals regarding the patient safety <<checklist in the >> operating room is which one is correct? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The checklist is a barrier to recovery according to Reason's model","justification":"This is the famous model in Gruyère 🧀"},{"idx":1,"correct":false,"proposition":"The checklist checks safety points of care at 4 key moments of surgery: before anesthetic induction, before, during and after surgery","justification":""},{"idx":2,"correct":true,"proposition":"The checklist promotes the sharing of information through cross-checking","justification":""},{"idx":3,"correct":true,"proposition":"The checklist significantly reduces postoperative morbidity and mortality","justification":""},{"idx":4,"correct":false,"proposition":"The checklist must be co-signed by the surgeon, anaesthetist and patient as soon as they wake up","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-7","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The immediate aftermath of surgery is simple. The patient is now hospitalized. He is quickly seen by the mobile addiction team. The patient's clinical condition is stable and satisfactory. Postoperative pain is well controlled. There are no other notable clinical signs. Which of the following addiction consumption evaluation questionnaires is indicated in this patient? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The Fagerstrom test","justification":""},{"idx":1,"correct":false,"proposition":"Cushman's score","justification":""},{"idx":2,"correct":true,"proposition":"The CAST questionnaire","justification":""},{"idx":3,"correct":true,"proposition":"The AUDIT questionnaire","justification":""},{"idx":4,"correct":false,"proposition":"The SPICES score","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-8","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"During the appointment with the addictologist, in the presence of the translator, the patient reports an alcohol consumption equivalent to 6 standard drinks every day. He feels the need to have a first drink in the morning and has already been injured in a context of alcoholization in the last 12 months. The addictologist uses the AUDIT test. These elements of consumption are in favor (one or more possible answers): ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Alcohol dependence ","justification":""},{"idx":1,"correct":false,"proposition":"The indication of a brief intervention only","justification":""},{"idx":2,"correct":true,"proposition":"Specialized addictological care","justification":""},{"idx":3,"correct":true,"proposition":"A risk of withdrawal syndrome","justification":""},{"idx":4,"correct":true,"proposition":"Misuse of alcohol","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-9","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"As part of the prevention of alcohol withdrawal syndrome, the doctor of the department prescribes treatment with diazepam. The doctor on call is called during the following night because the patient has a state of convulsive status requiring a transfer to intensive care for 48 hours, lengthening the duration of hospitalization of this patient. Consultation of the patient's file during management by the doctor on duty shows that the patient has not received his diazepam treatment. You have no further information at this stage. How can we qualify this situation (one or more possible answers)? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A risky event","justification":""},{"idx":1,"correct":true,"proposition":"An adverse event associated with care","justification":""},{"idx":2,"correct":true,"proposition":"A serious adverse event","justification":""},{"idx":3,"correct":true,"proposition":"A preventable adverse event","justification":""},{"idx":4,"correct":false,"proposition":"An unexpected side effect","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-10","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"As part of the quality approach within the department, it is decided to investigate the causes responsible for the occurrence of this adverse event. Which method(s) is (are) suitable? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A clinical audit","justification":""},{"idx":1,"correct":false,"proposition":"A clinical path","justification":""},{"idx":2,"correct":false,"proposition":"An analysis of failure modes, their effects and criticality","justification":""},{"idx":3,"correct":true,"proposition":"A mortality and morbidity review","justification":""},{"idx":4,"correct":false,"proposition":"A review of the relevance of care","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-11","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The analysis of this event in mortality and morbidity review aims to (one or more possible responses):","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Setting a priori the optimal care pathway","justification":"The MMR (Mortality and Morbidity Review) is carried out a posteriori, that is to say after the event has taken place."},{"idx":1,"correct":true,"proposition":"Carry out a collective analysis integrating all the professionals concerned by the event","justification":""},{"idx":2,"correct":false,"proposition":"Identify the culprit(s) at the origin of the fault","justification":"This is absolutely not the objective of quality approaches."},{"idx":3,"correct":true,"proposition":"Implement prevention, recovery or mitigation actions ","justification":""},{"idx":4,"correct":true,"proposition":"Identify root causes","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-12","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The ALARM method was used to identify the causes of this care-associated adverse event. The causes identified are as follows. First, a computer failure did not make it possible to carry out a computerized prescription. The prescription was made in a paper file that turned out to be that of a patient other than Mr. B. The prescription was made at the end of the morning nurses' shift. However, the computer failure was quickly resolved and the afternoon shift nurses were not informed of the computer failure. In the end, the computer failure concerned only Mr B.'s prescriptions. The prescriptions of the other patients of the department could be made on computer as is customary in this department. The patient did not speak French, and in the absence of an interpreter during hospitalization, there was a lack of communication. The nursing team was understaffed due to multiple work stoppages in the context of an influenza epidemic. The analysis of causes finds related factors (one or more possible answers):","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"To the work environment","justification":""},{"idx":1,"correct":true,"proposition":"To the organization of the service","justification":""},{"idx":2,"correct":true,"proposition":"How the team works","justification":""},{"idx":3,"correct":true,"proposition":"Patient characteristics","justification":""},{"idx":4,"correct":false,"proposition":"In the international context","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-13","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"Following this adverse event associated with care, what should be done (one or more possible responses):","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Inform the patient that they have experienced an unwanted event","justification":""},{"idx":1,"correct":false,"proposition":"Explain to the patient that this event would not have occurred if they did not consume so much alcohol daily","justification":""},{"idx":2,"correct":true,"proposition":"Inform the patient that every effort has been made to understand the causes of this event and prevent it from happening again","justification":""},{"idx":3,"correct":false,"proposition":"Minimize the importance of this event as it has no sequelae","justification":""},{"idx":4,"correct":false,"proposition":"Offer, if necessary, spiritual support","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-1","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"Which of the following clinical signs are the ones that immediately point to a surgical emergency:","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The sudden onset of pain","justification":"The criteria for a surgical emergency include: high and sudden abdominal pain, contracture (defense to a lesser extent), signs of hypovolemic shock (tachycardia, hypotension), signs of septic shock (fever), etc. "},{"idx":1,"correct":false,"proposition":"Lack of defense or contracture","justification":""},{"idx":2,"correct":false,"proposition":"The analgesic position in a gun dog","justification":"This points to acute pancreatitis"},{"idx":3,"correct":false,"proposition":"The 2 episodes of vomiting","justification":"Vomiting is not a surgical emergency"},{"idx":4,"correct":false,"proposition":"The onset of periumbilical pain","justification":"Periumbilical pain is not a worrying localization"}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-2","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"Which of the following diagnoses you think is most likely (an expected answer):","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Acute bowel obstruction","justification":""},{"idx":1,"correct":false,"proposition":"Sigmoid diverticulitis","justification":"The location of pain is not in favor (classically in left iliac fossa \/ left flank)"},{"idx":2,"correct":false,"proposition":"Infectious ileitis","justification":"Ileitis is much less likely than occlusion."},{"idx":3,"correct":false,"proposition":"Acute cholecystitis","justification":"The localization of the pain is not in favor (classically in right hypochondrium)"},{"idx":4,"correct":false,"proposition":"Acute salpingitis","justification":"We think rather of a digestive pathology here."}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-3","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"The pulse is at 98 beats per minute, the BP at 110\/80 mmHg and the temperature at 37.8 °C.  Regarding emergency care, what is (are) the real proposal(s)? (one or more true answers)","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Nasogastric tube placement","justification":"Systematics in case of suspected occlusion"},{"idx":1,"correct":false,"proposition":"Placement of a urinary catheter","justification":""},{"idx":2,"correct":true,"proposition":"Placement of a peripheral venous line","justification":"Good caliber track"},{"idx":3,"correct":true,"proposition":"Level 3 analgesic treatment","justification":"In view of the EVA"},{"idx":4,"correct":true,"proposition":"Blood type and rhesus"}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-4","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"Which examination(s) do you think are useful for the management of this patient?","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Abdominal ultrasound","justification":""},{"idx":1,"correct":true,"proposition":"Abdominopelvic CT scan with contrast injection","justification":""},{"idx":2,"correct":false,"proposition":"Entero-MRI","justification":""},{"idx":3,"correct":false,"proposition":"X-ray of abdomen without face preparation","justification":"No longer 😊 done"},{"idx":4,"correct":false,"proposition":"Esogastric endoscopy","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-5","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"An abdomino-pelvic CT scan is performed. Which of the following is correct?","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"It is an abdominal CT scan with injection, arterial time","justification":"The spleen is no longer tabby 👉 it is not arterial"},{"idx":1,"correct":false,"proposition":"This is an axial cut","justification":"Coronal Cup"},{"idx":2,"correct":false,"proposition":"The superior mesenteric artery is clouded and visible on this picture","justification":""},{"idx":3,"correct":true,"proposition":"A digestive loop is distended","justification":""},{"idx":4,"correct":true,"proposition":"There is a peritoneal effusion","justification":"Next to the liver"}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-6","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"The CT scan confirms the hypothesis of a small bowel occlusion on flange with suffering of a small loop and presence of a peritoneal effusion. What do you propose at this stage? ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Check the blood ionogram to adapt the ionic intake","justification":""},{"idx":1,"correct":false,"proposition":"Hospitalization, fasting, continuation of analgesic treatment and transit accelerators, clinical and biological reassessment at 24 h","justification":"Occlusion on flange + digestive suffering does not allow to wait"},{"idx":2,"correct":true,"proposition":"Contact the surgical and anesthetic team for emergency intervention","justification":""},{"idx":3,"correct":true,"proposition":"Starting intravenous probabilistic antibiotic therapy","justification":""},{"idx":4,"correct":false,"proposition":"Perform a rectosigmoidoscopy to lift the flange","justification":"Can be done in the volvulus of the sigmoid"}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-7","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"You decide to operate on the patient. A laparotomy is performed, you discover a flange responsible for strangulation of the ileum with ischemia of the small intestine for about 1 meter. Which of the following suggestions regarding your care is true? ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Section as quickly as possible of the flange responsible for strangulation","justification":""},{"idx":1,"correct":false,"proposition":"Rapid resection of the ischemic digestive segment to avoid bacterial translocation","justification":""},{"idx":2,"correct":true,"proposition":"Installation of moist and warm compresses in contact with the ischemic intestine and reassess its recoloration and vitality after a few minutes","justification":""},{"idx":3,"correct":true,"proposition":"The entire small intestine should be unwound to look for other flanges that may cause occlusions","justification":""},{"idx":4,"correct":true,"proposition":"You have informed the patient of the possibility of a stoma after the procedure","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-8","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"You perform a resection-anastomosis of the hail. The patient is renourished on day 2. On the 5th day, she complains of diffuse abdominal pain, predominant at the periumbilical level. The temperature is 38.5 °C.  The examination finds a painful arch at the level of the operative scar. Which of the following diagnoses can you mention?","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"A wall abscess"},{"idx":1,"correct":true,"proposition":"An anastomotic fistula"},{"idx":2,"correct":false,"proposition":"Early recurrence of flange occlusion","justification":""},{"idx":3,"correct":true,"proposition":"A covered evisceration"},{"idx":4,"correct":false,"proposition":"A bladder globe "}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-9","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"What test(s) do you request to support your diagnosis? (one or more responses)","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"No further examination","justification":""},{"idx":1,"correct":false,"proposition":"A suprapubic ultrasound","justification":""},{"idx":2,"correct":true,"proposition":"An abdominal CT scan with injection","justification":""},{"idx":3,"correct":false,"proposition":"An abdominal x-ray without preparation","justification":""},{"idx":4,"correct":false,"proposition":"A rectosigmoidoscopy to remove an anastomotic fistula","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-10","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"The abdominal CT scan ordered urgently shows a wall abscess. The abscess is evacuated. The patient leaves the ward with local care at home with a 5-week absence from work. Why should she see the occupational physician again when resuming (one or more possible answers):","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Because the event occurred in the workplace","justification":""},{"idx":1,"correct":true,"proposition":"Because it's a stop of more than 30 days","justification":"The three situations that require a follow-up visit are: occupational disease, stoppage > 30J, maternity leave."},{"idx":2,"correct":true,"proposition":"To adapt the workstation if necessary","justification":""},{"idx":3,"correct":false,"proposition":"To approve!' Imputability of the accident at work","justification":""},{"idx":4,"correct":false,"proposition":"To determine the rate of disability related to the work-related accident","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-11","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"She is seen again in consultation at his request 6 months later for the appearance of a << ball >> in front of his scar. On examination, there is an impulsive cough swelling, not painful. Which of the following diagnoses can be mentioned?","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A covered evisceration","justification":"The peritoneum does not 👉 hold evisceration. According to the College of Digestive Surgery: 'Early post-operative injury'"},{"idx":1,"correct":true,"proposition":"An uncomplicated eventration","justification":"The peritoneum holds 👉 ventration. According to the College of Digestive Surgery: 'Hernia through an opening secondary to a previous incision'"},{"idx":2,"correct":false,"proposition":"A recurrence of the wall abscess","justification":""},{"idx":3,"correct":false,"proposition":"A keloid scar","justification":""},{"idx":4,"correct":false,"proposition":"A parietal lipoma","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-12","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"Given the impulsive nature of coughing and not painful, you evoke an uncomplicated eventration. Do you inform the patient that? ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Wearing a restraint belt for 6 months prevents their occurrence","justification":""},{"idx":1,"correct":true,"proposition":"An eventration always occurs on an acquired aponeurotic orifice","justification":"This is the definition 😊"},{"idx":2,"correct":true,"proposition":"Surgery is responsible for venting in the majority of cases","justification":"It is exceptionally post-traumatic."},{"idx":3,"correct":false,"proposition":"She should have had a work stoppage of at least 3 months to prevent the ventration","justification":""},{"idx":4,"correct":true,"proposition":"The occurrence of a parietal abscess is a risk factor for the occurrence of eventration","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-13","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"You propose to the patient a surgical cure of the eventration. But she refuses this intervention. Three years later, she was admitted urgently for acute abdominal pain. Which of the following proposals will direct you towards the diagnosis of strangled ventration? ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Painful swelling","justification":""},{"idx":1,"correct":true,"proposition":"Irreducibility of eventration","justification":""},{"idx":2,"correct":true,"proposition":"Occurrence of iterative vomiting","justification":""},{"idx":3,"correct":false,"proposition":"Conjunctival jaundice","justification":""},{"idx":4,"correct":true,"proposition":"Loss of impulsivity at cough","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-14","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"You make the diagnosis of strangulated ventration and the patient is operated urgently. There is no digestive suffering and the fascia is closed by a simple suture. The postoperative follow-up is simple and the patient leaves the service at 5 quality of general practitioner, you see the patient again 8 days later at home and you inform her ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"That, in its situation, the aponeurotic suture guarantees the absence of recurrence in 90% of cases","justification":""},{"idx":1,"correct":false,"proposition":"That the wearing of a restraint belt is recommended 24 hours a day","justification":""},{"idx":2,"correct":true,"proposition":"That it would be advisable to contact the occupational physician of his company","justification":""},{"idx":3,"correct":true,"proposition":"That in case of recurrence of its eventration, the installation of a parietal reinforcement prosthesis would be recommended","justification":""},{"idx":4,"correct":false,"proposition":"That you cannot ask his surgeon for his entire hospitalization file because of medical confidentiality","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-1","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"Which of the following are the clinically severe symptoms(s) you are looking for in this child:  ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The child does not respond to the pain","justification":"In both children and adults, it is a sign of clinical seriousness"},{"idx":1,"correct":true,"proposition":"Heart rate is at 60 beats per minute","justification":"The threshold is 80 bpm"},{"idx":2,"correct":true,"proposition":"Breathing is irregular","justification":""},{"idx":3,"correct":true,"proposition":"She has fever and a rash that persists on vitropressure","justification":"The rash that persists with vitropressure is purpura, i.e. blood extravasation (blood coming out of the vessels). Any febrile purpura is a fulminans purpura until proven otherwise, and requires the introduction of antibiotic therapy as a matter of absolute urgency (even before bacteriological sampling if these delay management)."},{"idx":4,"correct":false,"proposition":"There is a notion of recent travel","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-2","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"There is no rash or fever. In the absence of a verbal and motor response described by the mother as well as breathing that you hear as very slow and noisy, you send a team home. On the spot the doctor notes: a heart rate at 80 \/ min, a respiratory rate at 10 \/ min, a pink but sleepy child with a Glasgow score at 11, the temperature is at 36.2 ° C, skin recoloration is immediate and blood pressure is 102\/61 mmHg. The pupils are symmetrical and responsive, the nape is flexible. The mother does not report any unusual items in the previous days (no fever, no trauma). Which diagnosis(s) are compatible with this clinical picture? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Bacterial meningitis","justification":"The pupils are symmetrical and responsive, the nape is flexible."},{"idx":1,"correct":true,"proposition":"Trauma inflicted","justification":""},{"idx":2,"correct":true,"proposition":"Status epilepticus","justification":"a pink but sleepy child with a Glasgow score of 11"},{"idx":3,"correct":true,"proposition":"Exogenous poisoning","justification":""},{"idx":4,"correct":true,"proposition":"Hereditary abnormality of metabolism","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-3","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"Regarding the hypothesis of a inflicted head trauma, what is (are) the exact proposal(s) in this pathology? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The age of the child is evocative","justification":""},{"idx":1,"correct":false,"proposition":"The absence of impact on the skull excludes this diagnosis","justification":""},{"idx":2,"correct":false,"proposition":"Disorders of consciousness are rare","justification":""},{"idx":3,"correct":true,"proposition":"The break of the cranial perimeter curve is suggestive","justification":""},{"idx":4,"correct":true,"proposition":"Look for a subdural hematoma","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-4","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"As a general rule, under what circumstances can bradypnea be observed in children? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"In case of opiate poisoning","justification":""},{"idx":1,"correct":false,"proposition":"In case of metabolic acidosis","justification":"Polypnea"},{"idx":2,"correct":true,"proposition":"In case of hypoxia","justification":""},{"idx":3,"correct":false,"proposition":"In case of carbon monoxide poisoning","justification":"Neurological impairment"},{"idx":4,"correct":false,"proposition":"In case of paracetamol poisoning","justification":"Liver damage"}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-5","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The arterial gas balance made under oxygen is as follows: pH 7.26, PCO2 66 mmHg, Bicarbonates 24 mmol \/ L, HbCO 3%, PO2 90 mmHg. How do you interpret this balance sheet (only one answer)? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Compensated respiratory acidosis","justification":""},{"idx":1,"correct":true,"proposition":"Uncompensated respiratory acidosis","justification":"Acidosis because pH<7.35 (or 7.38 depending on the source). Respiratory because the drop in pH is caused by the increase in pCO2 (which is > 45). Not compensated because the pH is acidic."},{"idx":2,"correct":false,"proposition":"Compensated metabolic acidosis","justification":""},{"idx":3,"correct":false,"proposition":"Uncompensated metabolic acidosis","justification":""},{"idx":4,"correct":false,"proposition":"Mixed acidosis","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-6","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The child is admitted to the emergency room where you decide to perform a brain scan and prescribe a urine toxicity test. Which symptom(s) is compatible with drug poisoning? (one or more exact propositions)","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Urinary retention","justification":""},{"idx":1,"correct":true,"proposition":"Cyanosis","justification":""},{"idx":2,"correct":false,"proposition":"Hives","justification":""},{"idx":3,"correct":true,"proposition":"Nausea and vomiting","justification":""},{"idx":4,"correct":false,"proposition":"Pupillary asymmetry","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-7","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"Here are the growth curves that you reconstitute in the health record. What diagnostic hypothesis(s) can (s) be evoked when reading these curves?","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Hydrocephalus"},{"idx":1,"correct":false,"proposition":"Craniopharyngioma"},{"idx":2,"correct":true,"proposition":"Congenital immunodeficiency","justification":""},{"idx":3,"correct":false,"proposition":"Syndrome de Turner"},{"idx":4,"correct":true,"proposition":"Psychosocial dwarfism"}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-8","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The search for toxic substances finds cannabis. The mother reports that her husband had friends the day before and that it is possible that they had left cannabis resin on the coffee table that the child would have ingested at the time. You also note on clinical examination gingival hypertrophy, cavities, pallor, some petechiae in the lower limbs. What first-line investigation(s) is (are) necessary in view of these growth charts and clinical signs?","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"A complete blood count","justification":"Because of petechiae and pallor"},{"idx":1,"correct":false,"proposition":"An X-ray of a skull","justification":""},{"idx":2,"correct":false,"proposition":"A weight assay of immunoglobulins","justification":""},{"idx":3,"correct":false,"proposition":"A FSH-LH assay","justification":""},{"idx":4,"correct":false,"proposition":"A CMV serology","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-9","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The complete blood count shows a hemoglobin of 9.8 g\/dL, with a MCV of 68 fL, the platelet count of 525 G\/L. Which of the following do you think is the most likely diagnosis based on history, clinical signs and laboratory results? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Nutritional deficiency","justification":"Anemia is probably iron deficiency"},{"idx":1,"correct":false,"proposition":"Crohn's disease","justification":""},{"idx":2,"correct":false,"proposition":"Cystic fibrosis","justification":""},{"idx":3,"correct":false,"proposition":"Biermer's disease","justification":"Anemia would be rather macrocytic"},{"idx":4,"correct":false,"proposition":"Hepatocellular insufficiency","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-10","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The dietary survey confirms your hypothesis of serious deficiency on an inadequate diet, since the child drinks only semi-skimmed cow's milk, sugary drinks and nibbles cakes. Regarding the recommended dietary and vitamin allowances at this age, which is (are) accurate? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Fluoride supplementation is recommended for all children from birth","justification":"You don't have teeth at birth 🦷😬"},{"idx":1,"correct":false,"proposition":"A vitamin C supplement is necessary in winter","justification":""},{"idx":2,"correct":false,"proposition":"Growing up milk can be replaced by cow's milk from 18 months","justification":""},{"idx":3,"correct":false,"proposition":"Breastfeeding provides adequate iron intake at this age","justification":""},{"idx":4,"correct":true,"proposition":"Infant formulas are fortified with vitamin D","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-11","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"You consult his health record. At 2 months: hexavalent and pneumococcal conjugate vaccine with 13 valences. at 6 months: hexavalent and pneumococcal conjugate vaccine with 13 valences. At 7 months: meningococcal C. vaccination at 12 months: hexavalent and pneumococcal conjugate vaccine with 13 valences. There has been no medical examination since the age of 12 months. Regarding the vaccination recommendations in force for this 18-month-old infant, what is the exact proposal(s)? (one or more true propositions)","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Meningococcal C vaccine is missing","justification":"Two in total"},{"idx":1,"correct":true,"proposition":"One dose of hepatitis vaccine is missing","justification":"3 total"},{"idx":2,"correct":true,"proposition":"At least one dose of measles\/mumps\/rubella (MMR) vaccine is missing","justification":"2 in total, at 12 then 16-18 months"},{"idx":3,"correct":false,"proposition":"One dose of 23-valent pneumococcal polysaccharide vaccine is missing","justification":"13 valances"},{"idx":4,"correct":false,"proposition":"Missing dose of varicella vaccine","justification":"No mandatory varicella vaccine, nor recommended at this age (it is in adolescents and adults who were not infected in childhood)"}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-12","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"You are also worried about the psychomotor development of this 18-month-old child, who has very little stimulation from parents and spends her days in front of the television screen. Which of these propositions is (are) accurate?","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Walking must be acquired","justification":""},{"idx":1,"correct":true,"proposition":"The child knows how to drink alone","justification":""},{"idx":2,"correct":false,"proposition":"Their language must be at least 100 words long","justification":""},{"idx":3,"correct":true,"proposition":"It combines 2 to 3 words","justification":""},{"idx":4,"correct":true,"proposition":"The child can stack 2 cubes","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-13","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"This child's language is dissyllabic, she does not associate two words and does not react to the call of her name. She stands alone and takes a few steps when invited but is spontaneously << very calm >>. Which of the following investigations should be carried out in the first line? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"An ENT consultation for audiometry","justification":"Deafness must be eliminated in front of this clinical description. It is a common cause of delayed psychomotor development."},{"idx":1,"correct":false,"proposition":"A CPK assay","justification":""},{"idx":2,"correct":false,"proposition":"Evoked potentials of the brainstem","justification":""},{"idx":3,"correct":false,"proposition":"An electromyogram","justification":""},{"idx":4,"correct":false,"proposition":"An ophthalmological examination","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-14","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The ENT consultation finds normal hearing, you retain a deficiency origin to this psychomotor delay. Faced with this table of accidental poisoning and serious deficiency of food intake, irregular medical monitoring (with vaccination delay), what step(s) do you think is necessary? (one or more true propositions)","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A phone call from the gendarmerie","justification":"This is not the regulatory route"},{"idx":1,"correct":true,"proposition":"A report to the public prosecutor","justification":""},{"idx":2,"correct":false,"proposition":"A report to the Regional Health Agency","justification":"The ARS is not concerned"},{"idx":3,"correct":false,"proposition":"Worrying information at the High Authority of Health (HAS)","justification":"The HAS is not concerned"},{"idx":4,"correct":false,"proposition":"A phone call to the child's doctor and the Maternal Child Protection","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-15","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"You write a judicial report. Which of the following is correct? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The name of the medical writer(s) must remain anonymous","justification":"It must be clearly identified"},{"idx":1,"correct":false,"proposition":"He must suggest the person responsible for the abuse","justification":"It must be objective and descriptive"},{"idx":2,"correct":false,"proposition":"It must be given to both parents","justification":"Parents may be informed, unless the child is in the best interests of the contrary"},{"idx":3,"correct":true,"proposition":"It must mention the identity of the persons holding parental authority","justification":""},{"idx":4,"correct":false,"proposition":"Parents must be informed of the report","justification":"Unless otherwise interested of the child"}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-1","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"What element(s) do you look for in the clinical examination of the patient who may participate in infertility? ","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Positive Prehn's sign","justification":"We do not think of acute orchitis in this context"},{"idx":1,"correct":true,"proposition":"Unilateral gynecomastia","justification":""},{"idx":2,"correct":true,"proposition":"Cryptorchidism","justification":""},{"idx":3,"correct":true,"proposition":"Hair abnormality","justification":""},{"idx":4,"correct":false,"proposition":"Ligament hyperlaxity","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-2","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The patient has already made a spermogram after 4 days of abstinence of which he shows you the results: ejaculated volume at 5 ml, sperm concentration: 2 million \/ ml, total sperm motility: 10%, 75% spermatozoa, 1% normal forms. What are the exact proposal(s)?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"There is hypospermia","justification":"Threshold at 1.5 mL"},{"idx":1,"correct":true,"proposition":"There is oligospermia","justification":"Threshold at 15 million\/mL"},{"idx":2,"correct":true,"proposition":"There is teratospermia","justification":"1% is not much 😉"},{"idx":3,"correct":false,"proposition":"There is necrospermia","justification":"Well, we don't know what the 75% means (are these normal or dead spermatozoa?), so we don't tick"},{"idx":4,"correct":true,"proposition":"There is asthenospermia","justification":"10% mobility is not much at all 😅"}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-3","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"No etiology is found to these spermogram abnormalities explaining infertility and pregnancy is obtained by intracytoplasmic injection of spermatozoa. The 1 trimester of pregnancy passes without difficulty except for nausea and some bleeding of red blood. The patient consults at 27 SA because her last two urine strips showed the presence of leukocytes and nitrites. She has no fever, no urinary symptoms apart from slight cough leakage. She has had a recurrent cough since the beginning of winter. She therefore restricts herself from drinking to limit leakage. What is the most likely diagnosis? (only one answer expected)","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Urogenital tuberculosis","justification":""},{"idx":1,"correct":false,"proposition":"Cystitis","justification":""},{"idx":2,"correct":true,"proposition":"Urinary colonization","justification":""},{"idx":3,"correct":false,"proposition":"Molar pregnancy","justification":""},{"idx":4,"correct":false,"proposition":"Bladder lithiasis","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-4","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"You have a cytobacteriological examination of urine performed which shows: 42000 red blood cells \/ ml, 12000 leukocytes per mL, and 10 power 5 E. Coli \/ mL in culture. What do you do?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Amoxicillin treatment should be started as a first-line treatment","justification":""},{"idx":1,"correct":false,"proposition":"First-line fosfomycin-trometamol therapy should be started","justification":""},{"idx":2,"correct":true,"proposition":"It is necessary to wait for the results of the susceptibility test to treat","justification":""},{"idx":3,"correct":false,"proposition":"Intravenous dual antibiotic therapy is needed","justification":""},{"idx":4,"correct":true,"proposition":"There is a risk of acute pyelonephritis if left untreated","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-5","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"Escherichia coli colonization recurs several times during pregnancy and required 4 lines of antibiotic treatment. The patient gives birth at 38 SA+ 4 J of a little girl of 4180 g vaginally without episiotomy. Three weeks later, she consults for an alteration of the general condition, a fever at 38.8 ° C, urinary functional signs such as pollakiuria and leakage with effort and pain that she has difficulty systematizing but predominant in the right hemiabdomen. Her daughter is formula-fed and is doing well. What diagnosis(s) are possible at this stage? ","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Cystitis","justification":""},{"idx":1,"correct":true,"proposition":"Endometritis","justification":""},{"idx":2,"correct":true,"proposition":"Pyelonephritis","justification":""},{"idx":3,"correct":false,"proposition":"Renal colic","justification":""},{"idx":4,"correct":true,"proposition":"Pelvic thrombophlebitis","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-6","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"On clinical examination the vaginal touch is painless, the breasts are flexible, there is pain at the shaking of the right lumbar fossa with a painful path radiating in addition pubic. Cardiopulmonary auscultation finds a decrease in vesicular murmur in the right base. The patient is febrile at 38.7°C, heart rate is 132\/min and blood pressure is 87\/53 mmHg. Which exam(s) are you asking for as a first line?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Doppler ultrasound of the lower limbs","justification":""},{"idx":1,"correct":true,"proposition":"Cytobacteriological examination of urine","justification":""},{"idx":2,"correct":true,"proposition":"Renal imaging"},{"idx":3,"correct":false,"proposition":"D-dimer"},{"idx":4,"correct":true,"proposition":"Blood"}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-7","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The imagery is as follows. Which proposal(s) is the exact proposal(s): (one or more expected proposals)","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"These are cuts of abdominal-pelvic CT scan after injection of contrast medium","justification":""},{"idx":1,"correct":true,"proposition":"There is dilation of the right pyelocalicial cavities","justification":""},{"idx":2,"correct":false,"proposition":"There is a right pyelic calculation","justification":""},{"idx":3,"correct":true,"proposition":"There is a right ureteral calculus","justification":""},{"idx":4,"correct":false,"proposition":"There is a syndrome of right kidney mass","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-8","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The abdominopelvic CT scan therefore shows a dilation of the right pyelocalicial cavities upstream of a 7 mm ureteral stone. Direct examination of urine shows the presence of leukocytes, red blood cells and gram-negative bacilli. As she returned from the CT scan, the patient's blood pressure dropped to 65\/30 mmHg and the lumbar fossa pain intensified. Her state of consciousness is normal, she has some mottling on her knees. What therapeutic measure(s) is possible in the first line? ","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"No measures should delay surgical management","justification":""},{"idx":1,"correct":true,"proposition":"Crystalloid-like solute filling","justification":""},{"idx":2,"correct":false,"proposition":"Parenteral bi-antibiotic therapy with fluoroquinolone and aminoglycoside","justification":""},{"idx":3,"correct":true,"proposition":"Parenteral bi-antibiotic therapy with beta-lactam and aminoglycoside","justification":""},{"idx":4,"correct":true,"proposition":"Administration of vasopressive drug type noradrenaline","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-9","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The patient responds well to crystalloid filling and her blood pressure is now stabilized at 100\/58 mmHg. What additional therapeutic measure do you propose in this context? (only one answer expected)","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Nonsteroidal anti-inflammatory drugs","justification":""},{"idx":1,"correct":true,"proposition":"Urine drainage by JJ or ureteral tube","justification":""},{"idx":2,"correct":false,"proposition":"Urine drainage by bladder tube alone","justification":""},{"idx":3,"correct":false,"proposition":"Ureteroscopy for stone extraction after 48 h of effective antibiotic therapy","justification":""},{"idx":4,"correct":false,"proposition":"Ureteral drainage by JJ tube after 48 h of effective antibiotic therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-10","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"After the placement of a JJ tube (non-purulent urine) and 72 hours of adapted antibiotic therapy, the patient's clinical condition improves and she can go home. You see it again in consultation 1 month later and the CT scan without injection shows that the stone has been pushed back into the upper calyx. It always measures 7 mm and its density is 1050 UH. The JJ tube is quite poorly tolerated with pollakiuria and almost permanent pain. What are the possible measures for the continuation of the care (one or more correct answers):","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"JJ probe removal and monitoring","justification":""},{"idx":1,"correct":true,"proposition":"Extracorporeal lithotripty","justification":""},{"idx":2,"correct":true,"proposition":"Ureteroscopy extraction","justification":""},{"idx":3,"correct":false,"proposition":"Percutaneous nephrolithotomy","justification":""},{"idx":4,"correct":false,"proposition":"Iterative changes to the JJ probe","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-11","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"You finally decide to perform a flexible ureteroscopy with extraction of all the lithiasic fragments that are sent for analysis. Given the elements at your disposal, what is the most likely majority component of this calculation? ","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Calcium oxalate","justification":""},{"idx":1,"correct":false,"proposition":"Struvite","justification":""},{"idx":2,"correct":false,"proposition":"Medicated lithiasis","justification":""},{"idx":3,"correct":false,"proposition":"Cystine","justification":""},{"idx":4,"correct":false,"proposition":"Uric acid","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-12","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"Infrared spectrophotometry concludes that it is a calculation composed of 75% whewellite (calcium oxalate monohydrate), 25% wedellite (calcium oxalate dihydrate). What can be the contributing factor(s) of such a calculation in this patient?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Primary hyperparathyroidism","justification":""},{"idx":1,"correct":false,"proposition":"Hypocalciuria"},{"idx":2,"correct":false,"proposition":"Recurrent urinary tract infections","justification":""},{"idx":3,"correct":true,"proposition":"Inadequate water intake","justification":""},{"idx":4,"correct":false,"proposition":"Protein intakes too low","justification":"Too important"}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-13","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The first-line etiological assessment you prescribed is normal. What recurrence prevention measure(s) are you putting in place?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Decreased calcium intake (< 400 mg\/d)","justification":"800-1000 mg\/day"},{"idx":1,"correct":true,"proposition":"Decrease in sodium intake (6 g\/d)","justification":""},{"idx":2,"correct":false,"proposition":"Hydration for a diuresis volume of about 1 L","justification":"2L"},{"idx":3,"correct":false,"proposition":"Alkalization of urine"},{"idx":4,"correct":false,"proposition":"Weekly antibiotic prophylaxis","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-14","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The patient comes back to see you 4 years later because she thinks her stones are recurring. However, she experienced a second pregnancy without lithiasis recurrence and gave birth without difficulty to a little boy weighing 3560 grams 18 months ago. For the past few weeks, she has felt embarrassed by a bladder stone that frequently makes her want to urinate day and night. She feels pelvic heaviness aggravated by prolonged standing. Her needs are so urgent that she can't always restrain herself. On the other hand, his cough leaks disappeared except possibly in the morning when he woke up. Sexual intercourse is unpleasant. What is the most likely diagnostic hypothesis?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Lithiasis enclosed in the urethra","justification":""},{"idx":1,"correct":false,"proposition":"Urinary tract infection","justification":""},{"idx":2,"correct":true,"proposition":"Genital prolapse","justification":""},{"idx":3,"correct":false,"proposition":"Carcinoma in situ","justification":""},{"idx":4,"correct":true,"proposition":"uterine fibroid","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-15","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"Your clinical examination confirms the presence of a grade 3 anterior colpocele. What is the most plausible explanation for the disappearance of stress urinary incontinence: (one exact proposition)","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Lithiasis enclosed in the urethra","justification":""},{"idx":1,"correct":false,"proposition":"Childbirth-related synechia","justification":""},{"idx":2,"correct":true,"proposition":"Plication of the urethra by the colpocele","justification":""},{"idx":3,"correct":false,"proposition":"Sequelae of urinary tract infections","justification":""},{"idx":4,"correct":false,"proposition":"Urethral calcification by calcium oxalate","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-1","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"What is the most relevant information to look for during the interview or clinical examination? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Abdominal pain","justification":"The main question is: is it a GEU? The absence of abdominal pain would then be very reassuring."},{"idx":1,"correct":false,"proposition":"An open neck","justification":""},{"idx":2,"correct":false,"proposition":"Abundant metrorrhagia","justification":""},{"idx":3,"correct":false,"proposition":"A uterus too large for the term","justification":""},{"idx":4,"correct":false,"proposition":"An exacerbation of sympathetic signs of pregnancy","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-2","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"In this patient, physical examination reveals moderate pain caused in the defenseless right iliac fossa. Blood pressure is at 130\/70 mmHg. The heart rate is at 80 bpm. The uterus is impalpable due to the patient's overweight. On examination under speculum, moderate red bleeding comes from the endocervix. At vaginal touch, there is no mass, but palpation of the right cul-de-sac triggers moderate pain. Which diagnosis do you prefer at this stage of management? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Ectopic pregnancy","justification":"Priority is always given to the most serious and urgent 😉"},{"idx":1,"correct":false,"proposition":"Non-progressive intrauterine pregnancy","justification":""},{"idx":2,"correct":false,"proposition":"Molar pregnancy","justification":""},{"idx":3,"correct":false,"proposition":"Active intrauterine pregnancy","justification":""},{"idx":4,"correct":false,"proposition":"Spontaneous abortion in progress","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-3","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Following your clinical examination, you decide to perform an endovaginal pelvic ultrasound. Which ultrasound sign(s) would be compatible with the diagnosis of ectopic pregnancy?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Thickening of the endometrium","justification":""},{"idx":1,"correct":true,"proposition":"Absence of effusion in the rectouterine cul-de-sac (Douglas)","justification":""},{"idx":2,"correct":true,"proposition":"Absence of visible right laterouterine mass","justification":""},{"idx":3,"correct":true,"proposition":"Corpus luteum on the right ovary","justification":""},{"idx":4,"correct":true,"proposition":"Hypoechoic intrauterine image without hyperechoic crown","justification":"Everything is 'compatible'"}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-4","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"The pelvic ultrasound you perform shows uterine emptiness, no intra-abdominal effusion and no visible adnexal mass. Plasma HCG is measured at 900 IU\/L. What therapeutic strategy do you adopt (only one expected response)?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Intramuscular injection of methotrexate on an outpatient basis","justification":""},{"idx":1,"correct":false,"proposition":"Laparoscopy explorer","justification":""},{"idx":2,"correct":false,"proposition":"Administration of oral misoprostol on an outpatient basis","justification":""},{"idx":3,"correct":true,"proposition":"Expectancy and reassessment within 48 h with new HCG assay and control ultrasound","justification":""},{"idx":4,"correct":false,"proposition":"Endorish aspiration with sending of samples in anatomical pathology for chorionic villus testing","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-5","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"You see the patient again two days later. She still feels a slight pain in the right iliac fossa. Minimal metrorrhagia persist. The HCGs are at 1200 in the same laboratory. The control ultrasound reveals this time a hematosalpinx of 20mm on the right, without visible embryo and without abdominal effusion. Your increased suspicion of ectopic pregnancy therefore leads you to prescribe methotrexate. Which proposals are correct?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Folic acid should be systematically combined","justification":""},{"idx":1,"correct":true,"proposition":"A transient increase in HCG is usual","justification":""},{"idx":2,"correct":false,"proposition":"It may be accompanied by hand-foot syndrome","justification":""},{"idx":3,"correct":true,"proposition":"The success rate is correlated with the HCG rate","justification":""},{"idx":4,"correct":false,"proposition":"A tubal rupture can occur","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-6","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"What advice(s) do you give to the patient? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Absolute contraindication to microprogestogens","justification":""},{"idx":1,"correct":false,"proposition":"Need for early pelvic ultrasound in case of new pregnancy","justification":"We have not found this notion even if it would seem logical 🤔 to us"},{"idx":2,"correct":false,"proposition":"Respect a minimum of 6 months after the injection of methotrexate to start a new pregnancy","justification":"The recommended period is 3 months"},{"idx":3,"correct":true,"proposition":"Smoking cessation","justification":"Always always"},{"idx":4,"correct":false,"proposition":"Perform a hysterosalpingography to assess tubal patency","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-7","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Two years after the management of this ectopic pregnancy, the patient returns to consult as part of the follow-up of a new pregnancy. This pregnancy is desired. It is at 12 SA. She has no symptoms. It brings you the result of the early pregnancy assessment prescribed by its general practitioner: blood group O rhesus negative, negative search for irregular agglutinins, rubella serology IgG +, serology toxoplasmosis IgG + \/ lgM-, HBsAg-, TPHA-VDRL-, HIV serology- You take the opportunity to perform a urine strip, it reveals 2 blood crosses and 2 protein crosses, no leukocytes or nitrites. Blood pressure is measured at 130\/80 mmHg. What is (are) your prescription(s)? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Quantification of urinary red blood cells by ECBU","justification":"Positive BU -> ECBU of confirmation and precision"},{"idx":1,"correct":true,"proposition":"Renal ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Cystoscopy","justification":""},{"idx":3,"correct":true,"proposition":"Proteinuria\/creatinine ratio","justification":""},{"idx":4,"correct":false,"proposition":"Uroscanner","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-8","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"The next day (12+1 SA), you receive the results of the prescribed examinations. The ECBU is sterile 3 but confirms a red blood cell rate of 10 red blood cells\/mm. The proteinuria\/creatinine ratio is 40 mg\/mmol. Ultrasound shows the absence of kidney malformation and normal-sized kidneys without macroscopic cysts as well as a bladder without abnormalities. The plasma creatinine assay is 50 micromoL\/L. What etiology(ies) is (are) compatible with the whole picture presented by this patient?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Pre-eclampsia"},{"idx":1,"correct":true,"proposition":"Alport syndrome"},{"idx":2,"correct":false,"proposition":"Stenosis of the renal arteries","justification":""},{"idx":3,"correct":true,"proposition":"lgA nephropathy"},{"idx":4,"correct":false,"proposition":"Autosomal dominant polycystic disease","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-9","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Given the probable existence of nephropathy pre-existing to pregnancy, a consultation with a nephrologist is scheduled. In the absence of renal failure, the latter provides for a renal biopsy to be performed once the pregnancy is over. \nThe monitoring of pregnancy subsequently proves satisfactory, especially in terms of blood pressure. At 31 weeks, the patient consults for decreased fetal active movements. She is also asymptomatic. Its temperature is 37 °C.  His blood pressure is 140\/80 mmHg. The uterine height is measured at 26 cm. His osteotendinous reflexes are normal. Fetal cardio monitoring is normal. \nYou perform a fetal ultrasound. Fetal biometrics include: biparietal diameter at 258 percentile, cephalic perimeter at 308 percentile, abdominal perimeter at 58 percentile, femur length 48 percentile, fetal weight estimate at 38 percentile. The uterine Doppler has a decreased diastole on both sides, without notch. The umbilical Doppler has zero diastole. The cerebral Doppler has an increased diastole. There is no visible fetal malformation. The amount of amniotic fluid is decreased. \nWhat argument(s) support(s) the hypothesis of a vasculo-placental cause that can explain these biometrics?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Decreased diastole on uterine Doppler","justification":""},{"idx":1,"correct":true,"proposition":"Decreased amount of amniotic fluid","justification":""},{"idx":2,"correct":false,"proposition":"Absence of uterine Doppler \"notch\"","justification":"It is a present notch that directs us to a vascular cause"},{"idx":3,"correct":true,"proposition":"Preserved cephalic biometrics","justification":""},{"idx":4,"correct":true,"proposition":"Increased diastole on cerebral Doppler","justification":"This is a sign of brain adaption"}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-10","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Given this small fetus for gestational age, you decide to hospitalize the patient for fetal heart rate monitoring 3 times a day. What therapeutic measure(s) do you decide to implement? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Fetal lung maturation corticosteroid therapy","justification":"<34 Ltd"},{"idx":1,"correct":false,"proposition":"Tocolysis by atosiban","justification":""},{"idx":2,"correct":false,"proposition":"Magnesium sulphate","justification":"< 32 SA if imminent delivery for the baby potit or if neuros signs in front of pre-eclampsia for the mother potitis"},{"idx":3,"correct":false,"proposition":"Central antihypertensive","justification":""},{"idx":4,"correct":false,"proposition":"Low-dose aspirin","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-11","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"After 24 hours of hospitalization, the patient's condition deteriorates. Blood pressure is now measured at 150\/100 mmHg. The patient complains of headache and epigastric pain. His diuresis is quantified at 200 ml since his hospitalization. The reflexes are sharp, diffused and polykinetic. Cardiofetal monitoring is not very oscillating with decelerations. You perform an emergency biological assessment, the results are as follows: platelets 60 G \/ L, hemoglobin 9 g \/ dL, schizocytes positive, haptoglobin 0.2 g \/ l, asat 230 IU \/ L, ALAT 340 IU \/ L. What are the priority therapeutic measures (one or more exact answers)? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Second injection of corticosteroids","justification":""},{"idx":1,"correct":true,"proposition":"Prevention of eclampsia by magnesium sulfate","justification":""},{"idx":2,"correct":true,"proposition":"Fetal extraction","justification":"This is an absolute emergency"},{"idx":3,"correct":false,"proposition":"Transfusion of red blood cells","justification":""},{"idx":4,"correct":false,"proposition":"Intravenous antihypertensive","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-12","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"An emergency caesarean section is performed. The patient gives birth to a 1020 g girl cared for by the neonatal team. Breastfeeding is maternal. At 72 hours, maternal progress is satisfactory. High blood pressure has disappeared, as have headaches. Osteotendinous reflexes have normalized. Diuresis resumed normally. Maternal work-up also improved in the first 48 hours after delivery with the disappearance of HELLP syndrome. On day 4, the patient presents with fever at 38.5°C and significant hypogastric pelvic pain. His blood pressure is 130\/70 mmHg and his pulse is 90 bpm. Examination with the speculum reveals smelly lochia mixed with blood in small quantities. The caesarean section scar is clean. The breasts are tense, painful as a whole, without inflammatory cupboard or palpable mass. There is no axillary lymphadenopathy. The patient has not had a venous route or urinary catheter for 48 hours. No preventive anticoagulant therapy was initially initiated due to HELLP syndrome. What is the diagnosis you mention first? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Salpingitis","justification":""},{"idx":1,"correct":false,"proposition":"Pelvic abscess","justification":""},{"idx":2,"correct":true,"proposition":"Endometritis","justification":""},{"idx":3,"correct":false,"proposition":"Pelvic thrombophlebitis","justification":""},{"idx":4,"correct":false,"proposition":"Following an intraoperative perforation","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-13","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"You perform a pelvic ultrasound in front of this suspicion of endometritis. A small placental retention measured 15 mm in sagittal section of the uterus is observed. What is (are) the element(s) of your therapeutic management? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Ceftriaxone and intravenous metronidazole","justification":"It's augmentin now (new reco 2021)"},{"idx":1,"correct":true,"proposition":"Endouterine aspiration in the operating room","justification":""},{"idx":2,"correct":false,"proposition":"Stopping breastfeeding","justification":""},{"idx":3,"correct":false,"proposition":"Methotrexate","justification":""},{"idx":4,"correct":true,"proposition":"Low molecular weight heparin at prophylactic dose","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-14","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Three days after starting treatment with antibiotics and heparin therapy at a prophylactic dose, pelvic pain persists, as does fever. The patient is still bloated. You request a CT scan with contrast injection. What is the most likely diagnosis?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Textiloma"},{"idx":1,"correct":false,"proposition":"Urolithiasis enclosed in the lower right ureter","justification":""},{"idx":2,"correct":false,"proposition":"Acute appendicitis"},{"idx":3,"correct":true,"proposition":"Thrombosis of the right ovarian vein","justification":""},{"idx":4,"correct":false,"proposition":"Left pelvic abscess"}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-15","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"In addition to the patient's personal and family thrombotic history, what additional risk factor(s) do you identify in this context of right ovarian vein thrombosis?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Primiparity","justification":""},{"idx":1,"correct":false,"proposition":"The context of prematurity","justification":""},{"idx":2,"correct":true,"proposition":"The patient's body mass index","justification":""},{"idx":3,"correct":true,"proposition":"Caesarean section","justification":""},{"idx":4,"correct":true,"proposition":"Postpartum endometritis","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-16","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Knowing that serum creatinine is controlled at 70 micromol \/ L and that the patient wishes to continue breastfeeding, what is your anticoagulant prescription for this thrombophlebitis of the right ovarian vein ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Fluindione","justification":""},{"idx":1,"correct":false,"proposition":"Acenochocoumarol","justification":""},{"idx":2,"correct":false,"proposition":"Warfarin","justification":""},{"idx":3,"correct":true,"proposition":"Enoxaparin at a hypocoagulant dose","justification":"LMWH then AVK relay"},{"idx":4,"correct":false,"proposition":"Cellar filter","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-1","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"In view of the context, which diagnosis is to be mentioned in the first intention? ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Bladder lithiasis","justification":""},{"idx":1,"correct":true,"proposition":"Cystitis","justification":""},{"idx":2,"correct":false,"proposition":"Pyelonephritis","justification":""},{"idx":3,"correct":false,"proposition":"Renal tumour","justification":""},{"idx":4,"correct":false,"proposition":"Urothelial tumour","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-2","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What is (are) the element(s) to be collected during the interrogation in this context of discovery of hematuria? (one or more true propositions) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"History of gross hematuria","justification":""},{"idx":1,"correct":true,"proposition":"Presence of proteinuria on the strip","justification":""},{"idx":2,"correct":false,"proposition":"Exposure to lead","justification":"No report"},{"idx":3,"correct":true,"proposition":"Family history of hematuria","justification":""},{"idx":4,"correct":false,"proposition":"Family history of bladder cancer","justification":"We do not start at all on a bladder cancer, which is not a hereditary pathology"}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-3","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"The ECBU you prescribed to the patient currently finds: red blood cells 150,000\/ml; leukocytes< 1,000\/ml, sterile culture. There was a proteinuria with 2 crosses to the strip but the urine was concentrated. Her blood pressure is currently at 150\/90 mmHg in your consulting room. Her urinary beta-HCG is negative (the last menstrual period started 8 days ago). What biological examination(s) do you prescribe for this patient at this stage: (one or more expected proposals) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Serum creatinine with glomerular filtration rate calculation","justification":""},{"idx":1,"correct":true,"proposition":"Proteinuria and creatinineuria on urine specimen","justification":""},{"idx":2,"correct":false,"proposition":"Crystalluria","justification":""},{"idx":3,"correct":false,"proposition":"Urinary cytology","justification":""},{"idx":4,"correct":false,"proposition":"Urinary pH","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-4","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What imaging test(s) do you prescribe for this patient at this stage? ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Uroscanner ","justification":""},{"idx":1,"correct":false,"proposition":"Endovaginal pelvic ultrasound","justification":""},{"idx":2,"correct":true,"proposition":"Renal and bladder ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"uro-MRI","justification":""},{"idx":2,"correct":false,"proposition":"Retrograde cystography and voiding","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-5","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What is the action to take in the face of the discovery of this high blood pressure in this patient? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Prescription of amlodipine pending the results of biological tests","justification":""},{"idx":1,"correct":true,"proposition":"Request for outpatient self-measurement of blood pressure measurements","justification":""},{"idx":2,"correct":false,"proposition":"Prescription of an anxiolytic","justification":""},{"idx":3,"correct":false,"proposition":"Need to see the patient again within 48 hours for blood pressure control","justification":""},{"idx":4,"correct":true,"proposition":"Reassessment of blood pressure after discontinuation of ibuprofen","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-6","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"The results of the prescribed examinations are as follows: Na 142 mmol\/L; K 4 mmol\/L, 2); proteinuria 2.5 g\/24 h, selective; serum creatinine 90 μmol\/L (DFG CKD-EPI at 71 mL\/min\/1.73 m^2 ECBU red blood cells 200,000\/mL, leukocytes< 1,000\/ml. Renal ultrasound finds kidneys of 118 mm and 122 mm respectively on the right and left with a cyst of the upper right pole of 1 cm. They are well differentiated, the cortical thickness is 22 mm, homogeneous. His ambulatory blood pressure is 150\/90 mmHg on average despite stopping ibuprofen. She describes asthenia and a recent loss of her hair that she links to strong tensions at work. You refer the patient to a nephrologist with other laboratory tests. Which examination(s) is the most relevant exam(s) given the context in this patient?","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"NFS, platelets","justification":""},{"idx":1,"correct":true,"proposition":"Plasma protein immunoelectrophoresis","justification":""},{"idx":2,"correct":false,"proposition":"Determination of parathyroid hormone and 250H vitamin D","justification":""},{"idx":3,"correct":true,"proposition":"Anti-nuclear factors, anti-DNA antibodies","justification":""},{"idx":4,"correct":true,"proposition":"Dosage C3, C4, CH50","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-7","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"Your additional assessment is as follows: leukocytes 3.50 G \/ L, Hb 9 g \/ dL, VGM 92 fi; e platelets 200 G\/L, reticulocytes 250 G\/L, anti-nuclear factors positive at 1\/160 with native anti-DNA antibodies at 40 Ul\/ml, C3 0.5 g\/L (0.8-1.6); C4 0.08 g\/L (0.17-0.53), CH50 40 50 CRP 7 mg\/L; HCV and HIV negative serologies; HBV serology: anti-HBs 100 Ul\/ml antibodies, negative anti-HBc antibodies. What is (are) in favor of a diagnosis of systemic lupus? ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Leukopenia","justification":""},{"idx":1,"correct":true,"proposition":"Consumption of the supplement","justification":""},{"idx":2,"correct":true,"proposition":"Regenerative anemia","justification":""},{"idx":3,"correct":false,"proposition":"Inflammatory syndrome","justification":""},{"idx":4,"correct":true,"proposition":"Microscopic hematuria","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-8","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What are the possible causes of this anemia in this context (one or more correct answers)? ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Chronic renal failure","justification":""},{"idx":1,"correct":false,"proposition":"Immunological thrombocytopenic purpura","justification":""},{"idx":2,"correct":true,"proposition":"Coombs-positive hemolytic anemia","justification":""},{"idx":3,"correct":false,"proposition":"Thrombotic microangiopathy","justification":""},{"idx":4,"correct":true,"proposition":"Acute gynecological bleeding","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-9","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What extrarenal clinical signs will you look for in the context of this probable lupus flare-up? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Mouth ulcers","justification":""},{"idx":1,"correct":true,"proposition":"Erythema nodosum","justification":""},{"idx":2,"correct":true,"proposition":"Polyarthritis","justification":""},{"idx":3,"correct":false,"proposition":"Scleroditactyly","justification":""},{"idx":4,"correct":true,"proposition":"Vulvar ulcerations","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-10","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"The patient has non-erosive mouth ulcers and arthritis of the hands and you are diagnosed with systemic lupus. What is the most appropriate course of action for this patient at this stage? (Only one response is expected.) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Biological monitoring as a first step","justification":""},{"idx":1,"correct":true,"proposition":"Performing a transparietal renal biopsy puncture","justification":""},{"idx":2,"correct":false,"proposition":"Realization of a uroscanner","justification":""},{"idx":3,"correct":false,"proposition":"Performing a renal angiography","justification":""},{"idx":4,"correct":false,"proposition":"No need for renal histological confirmation in this context of leupic nephropathy","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-11","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"You decide to perform a kidney biopsy on this patient. She is hospitalized in nephrology. His clinical examination regained a blood pressure of 155\/90 mmHg. She is apyretic but has had voiding burns for 48 hours. Its biological balance finds: leukocytes 3.8 G \/ L, Hb 9.4 g \/ dL, VGM 88 fL, platelets 220 G \/ L, Na 142 mmol \/ L, K 3.7 mmol \/ L; 2 ); serum creatinine 99 μmol\/L (glomerular filtration rate CKD-EPI at 63 ml\/min\/1.73 m^2 proteinuria 2.2 g\/24 h, selective; ECBU red blood cells 300,000\/ml; leukocytes 20,000\/ml; many live Gram-negative bacilli. You decide to treat 48 hours this probable cystitis before performing the renal biopsy puncture and normalizing his blood pressure. What are the elements of your therapeutic care? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Treatment with metronidazole","justification":""},{"idx":1,"correct":false,"proposition":"Treatment with single-dose ofloxacin","justification":""},{"idx":2,"correct":false,"proposition":"Amoxicillin treatment","justification":""},{"idx":3,"correct":true,"proposition":"Treatment with fosfomycin-trometamol","justification":""},{"idx":4,"correct":false,"proposition":"Treatment with gentamicin","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-12","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What are the possible basic histological elements in this patient given her clinicobiological presentation? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Dominant mesangial deposits of immunoglobulin A and complement","justification":""},{"idx":1,"correct":true,"proposition":"Extra-capillary proliferation","justification":""},{"idx":2,"correct":true,"proposition":"Endocapillary proliferation","justification":""},{"idx":3,"correct":true,"proposition":"Extramembranous immunoglobulin and complement deposits in immunofluorescence","justification":""},{"idx":4,"correct":false,"proposition":"Glomerular deposits of dominant C3","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-13","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"Here is the report of your patient's renal biopsy: 8 mm renal cortical fragment containing 15 glomeruli including 1 sealing loaf; Optical microscopy: 10 glomeruli out of 15 are the site of endocapillary proliferation, presence of extra-capillary proliferations on 3 glomeruli, voluminous endomembranous deposits along the glomerular capillaries making << wireloops >>; - polymorphic interstitial infiltrate on about 30% of the cortical surface; - no vascular lesions or tubular lesions, presence of haematic cylinders in some tubular lumen; - immunofluorescence:  granular deposits of Ig G, lgM, C3 and C1q to 3+ mesangial and 2+ endomembranous on all glomeruli, no extramembranous deposits, fibrin deposits on 4 out of 18 glomeruli. What is your diagnosis?","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Extramembranous lupus glomerulonephritis","justification":""},{"idx":1,"correct":false,"proposition":"Pure mesangial lupus glomerulonephritis","justification":""},{"idx":2,"correct":true,"proposition":"Diffuse proliferative lupus glomerulonephritis","justification":""},{"idx":3,"correct":false,"proposition":"Tubulointerstitial lupus nephritis","justification":""},{"idx":4,"correct":false,"proposition":"Focal proliferative lupus glomerulonephritis","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-14","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"Your patient therefore has a systemic lupus flare-up with hemolytic anemia, polyarthritis, canker sores, alopecia and class IV lupus glomerulonephritis (diffuse proliferative). What are the treatment options for attack therapy in this patient? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A course of infliximab","justification":"It's an alpha anti-TNF, nothing to see"},{"idx":1,"correct":false,"proposition":"A course of rituximab","justification":"It's an anti-CD20, nothing to see"},{"idx":2,"correct":true,"proposition":"bolus of methylprednisolone then prednisone 1 mg\/kg","justification":""},{"idx":3,"correct":true,"proposition":"mycophenolate mofetil","justification":""},{"idx":4,"correct":true,"proposition":"cyclophosphamide","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-15","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"You start the attack treatment which is well tolerated including corticosteroid therapy in high doses. His blood pressure is 145\/90 mmHg on ramipril that you started before the kidney biopsy. His renal assessment before discharge is as follows: serum creatinine 97 μmol \/ L (filtration rate 2 glomerular CKD-EPI at 65 ml \/ min \/ 1.73 m ^ 2 ), proteinuria 2.2 g \/ 24 h; ECBU red blood cells 350000\/ml. What are the different possible therapeutic measures before returning home? (one or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Amlodipine in combination with ramipril","justification":""},{"idx":1,"correct":true,"proposition":"Hydroxychloroquine","justification":""},{"idx":2,"correct":true,"proposition":"Cholecalciferol","justification":""},{"idx":3,"correct":true,"proposition":"Hydrochlorothiazide in combination with ramipril","justification":""},{"idx":4,"correct":false,"proposition":"Candesartan in combination with ramipril","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-1","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"What are you looking for in interrogation to explore this anomaly? (One or more correct answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Recent extended stay at altitude","justification":""},{"idx":1,"correct":true,"proposition":"Tobacco use"},{"idx":2,"correct":true,"proposition":"Alcohol consumption"},{"idx":3,"correct":true,"proposition":"Recent fever"},{"idx":4,"correct":true,"proposition":"Recent weight gain"}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-2","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"On clinical examination, what signs would point you to primary polycythemia? (one or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Palar erythrosis","justification":""},{"idx":1,"correct":true,"proposition":"Aquagenic pruritus","justification":""},{"idx":2,"correct":false,"proposition":"Conjunctival hyperemia","justification":""},{"idx":3,"correct":false,"proposition":"Exertional dyspnea","justification":""},{"idx":4,"correct":false,"proposition":"Splenomegaly","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-3","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"You make a blood count that shows: GR 6.9 T\/L; haemoglobin 18.7 g\/dL, haematocrit 57%; MCV 83 fL, MCHC 33 g\/dL, reticulocytes 80 G\/L, leukocytes 12.6 G\/L, neutrophils 10.4 G\/L, eosinophil polynuclear 0.3 G\/L, basophilic polynuclear 0.05 G\/L, lymphocytes 1.25 G\/L, monocytes 0.6 G\/L, platelets 534 G\/L. What does this blood count show? (one or more possible answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Polycythemia","justification":""},{"idx":1,"correct":false,"proposition":"Hyperreticulocytosis","justification":""},{"idx":2,"correct":false,"proposition":"Hyperchromia","justification":""},{"idx":3,"correct":false,"proposition":"Microcytosis","justification":""},{"idx":4,"correct":true,"proposition":"Thrombocytosis","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-4","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"You find on examination a splenomegaly with a costal overhang of 2 cm and the notion of aquagenic pruritus. Which of the following tests are useful in this patient to support the diagnosis of polycythemia vera (one or more answers are possible)?","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Erythropoietin Dosage","justification":""},{"idx":1,"correct":false,"proposition":"Myelogram","justification":""},{"idx":2,"correct":true,"proposition":"JAK2 mutation search","justification":""},{"idx":3,"correct":false,"proposition":"Culture of erythroid progenitors","justification":""},{"idx":4,"correct":false,"proposition":"Isotopic globular mass","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-5","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"You see the patient again with the results of your tests. He has a JAK2 mutation and erythropoietin levels are plummeted. The patient, worried, asks you about complications that may occur. What do you say to him (One or more possible answers here)?","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Venous thrombosis","justification":""},{"idx":1,"correct":true,"proposition":"Arterial thrombosis","justification":""},{"idx":2,"correct":false,"proposition":"Lysis syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Disseminated intravascular coagulation","justification":""},{"idx":4,"correct":true,"proposition":"Gout attack","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-6","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"About polycythemia vera, which propositions are true? (One or more possible answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"It is a clonal disease of mature hematopoietic cells","justification":""},{"idx":1,"correct":true,"proposition":"This is a myeloproliferative syndrome","justification":""},{"idx":2,"correct":false,"proposition":"There is an erythroblastic maturation blockade","justification":""},{"idx":3,"correct":false,"proposition":"Circulating erythroblasts are observed","justification":""},{"idx":4,"correct":true,"proposition":"There is spontaneous growth of erythroblastic progenitors in vitro","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-7","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"The patient asks you about the principles of treatment. What kind of care do you discuss with him? (One or more correct answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Bleedings","justification":""},{"idx":1,"correct":true,"proposition":"Acetyl-salicylic acid","justification":""},{"idx":2,"correct":false,"proposition":"Anticoagulants","justification":""},{"idx":3,"correct":false,"proposition":"Mdt","justification":""},{"idx":4,"correct":false,"proposition":"Repeated blood donations at EFS","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-8","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"The patient had initial bleeding and is currently on antiaggregants. Three months later, your patient comes to see you 48 hours after returning from vacation in the West Indies. He has a painful left calf that has been swollen for 24 hours. What clinical elements will support your suspicion of deep vein thrombosis (phlebitis)? (One or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Calf pressure pain","justification":""},{"idx":1,"correct":true,"proposition":"Increased calf circumference","justification":""},{"idx":2,"correct":false,"proposition":"Calf contracture","justification":""},{"idx":3,"correct":false,"proposition":"Decreased pediosus pulse","justification":""},{"idx":4,"correct":true,"proposition":"Dilation of superficial veins","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-9","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"What are the risk factors for phlebitis in this patient? (One or more correct answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Obesity","justification":""},{"idx":1,"correct":false,"proposition":"Long-term antiplatelet agent","justification":""},{"idx":2,"correct":false,"proposition":"High blood pressure (hypertension)","justification":""},{"idx":3,"correct":false,"proposition":"Hypercholesterolemia","justification":""},{"idx":4,"correct":true,"proposition":"Air travel","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-10","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"The clinical examination is not very specific. Which tests are useful for diagnosis? (One or more possible answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Pulmonary angiography","justification":""},{"idx":1,"correct":true,"proposition":"Doppler ultrasound of the lower limbs","justification":""},{"idx":2,"correct":false,"proposition":"Phlebography of the lower limbs","justification":""},{"idx":3,"correct":false,"proposition":"TP, TCA, fibrin","justification":""},{"idx":4,"correct":false,"proposition":"Search for protein C and S deficiency","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-11","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"Doppler ultrasound confirmed the existence of sural phlebitis. What therapeutic attitudes are possible in this patient? (One or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Direct oral anticoagulants","justification":""},{"idx":1,"correct":false,"proposition":"Acetylsalicylic acid and clopidogrel","justification":""},{"idx":2,"correct":true,"proposition":"Low molecular weight heparin","justification":""},{"idx":3,"correct":false,"proposition":"Strict bed rest","justification":""},{"idx":4,"correct":true,"proposition":"Venous compression","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-12","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"You have opted for LMWH treatment with early relay with vitamin K antagonist (warfarin). What recommendations do you give your patient in relation to this treatment? (one or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Wearing a card mentioning the treatment on oneself","justification":""},{"idx":1,"correct":true,"proposition":"Taking warfarin at a fixed time","justification":""},{"idx":2,"correct":false,"proposition":"Follow a strict diet","justification":"This is not a strict diet: just avoid a few foods that interfere with hepatic enzyme metabolism."},{"idx":3,"correct":false,"proposition":"Strict cessation of alcohol consumption","justification":""},{"idx":4,"correct":true,"proposition":"Prohibition of intramuscular injections","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-13","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"During his follow-up, the patient calls you because his control INR is 5.5. He found no bleeding signs. What do you do? ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"You hospitalize him","justification":""},{"idx":1,"correct":true,"proposition":"You ask him to skip a catch","justification":""},{"idx":2,"correct":false,"proposition":"You prescribe vitamin K orally","justification":""},{"idx":3,"correct":false,"proposition":"You prescribe protamine sulfate","justification":""},{"idx":4,"correct":true,"proposition":"You recheck the INR the next day","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-14","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"Your patient has been transferred to a city 500 km from your home. You have no news for several years. Then, a doctor who sees him for the first time calls you because the patient is referred to him for discomfort. The blood count shows: Hb 10 g\/dL, MCV 83 fL, leukocytes 3 G\/L, PNN 0.8 G\/L, lymphocytes 1 G\/L, monocytes 0.2 G\/L, blast cells 1 G\/L, platelets 86 G\/L. What abnormalities do you see on this blood count? (One or more correct answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Neutropenia","justification":""},{"idx":1,"correct":true,"proposition":"Thrombocytopenia","justification":""},{"idx":2,"correct":false,"proposition":"Balanced myelemia","justification":""},{"idx":3,"correct":true,"proposition":"Pancytopenia","justification":""},{"idx":4,"correct":false,"proposition":"Microcytic anemia","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-15","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"What diagnoses do you mention in this context? (One or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Transformation into acute leukemia","justification":""},{"idx":1,"correct":false,"proposition":"Progression to myelofibrosis","justification":""},{"idx":2,"correct":false,"proposition":"Syndrome de Richter","justification":""},{"idx":3,"correct":false,"proposition":"Transformation into chronic myelogenous leukemia","justification":""},{"idx":4,"correct":false,"proposition":"Progression to myeloid splenomegaly","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-1","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The nurse on the unit gives you the following information: blood pressure at 95\/55mmHg, temperature at 39°C and heart rate at 110\/min. Dyspnea is in the foreground. On pulmonary auscultation, you find a decrease in the vesicular murmur of the base of the left lung. Which of the following proposals is (are) the element(s) in favor of pleural effusion in this patient?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Noise added to left one-sided crackling type","justification":""},{"idx":1,"correct":true,"proposition":"Dull percussion at the left base","justification":""},{"idx":2,"correct":false,"proposition":"Increased vocal vibration","justification":""},{"idx":3,"correct":false,"proposition":"Noise added to expiratory sibilant type","justification":""},{"idx":4,"correct":false,"proposition":"Chest distension","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-2","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"You get more information for this patient who lives alone at home independently. He has a history of NYHA stage III heart failure on ischemic and hypertensive heart disease. The nurse had her daughter on the phone telling her that her father has not been elected as usual for 48 hours, with incoherent words. \nAt careful pulmonary auscultation, you find noises added to type of unilateral crackles in the left base. Vocal vibrations are increased in the left base. He has no signs of right heart failure. \nWhich of the following is the most likely etiology(s) of the pulmonary picture? (one or more exact propositions)","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Acute pericarditis"},{"idx":1,"correct":false,"proposition":"Pulmonary embolism"},{"idx":2,"correct":true,"proposition":"Community-acquired bacterial pneumonia","justification":""},{"idx":3,"correct":false,"proposition":"Pneumothorax"},{"idx":4,"correct":true,"proposition":"Community-acquired viral pneumonia","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-3","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"To assess the seriousness of this patient, which element seems most important?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Looking for a sign of neurological focus","justification":""},{"idx":1,"correct":false,"proposition":"Purpura search","justification":""},{"idx":2,"correct":true,"proposition":"Respiratory rate measurement","justification":""},{"idx":3,"correct":false,"proposition":"Diuresis measurement","justification":""},{"idx":4,"correct":false,"proposition":"Search for a paradoxical pulse","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-4","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The patient has a respiratory rate of 35\/min and his saturation is measured at 94% in ambient air. You suspect acute lobar pneumonia. Which of the following additional examinations should be carried out immediately? (one or more exact propositions)","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Blood gas","justification":""},{"idx":1,"correct":true,"proposition":"ECG","justification":""},{"idx":2,"correct":false,"proposition":"D-Dimers","justification":""},{"idx":3,"correct":true,"proposition":"X-ray of the front chest","justification":""},{"idx":4,"correct":true,"proposition":"Blood","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-5","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"Biological samples are in progress and chest X-ray shows alveolar opacity of the left base associated with low pleural effusion. Arterial blood gases show: PaO 62 mmHg; PaCO 28 mmHg; lactate 1.3 mmol\/L; pH 7.46. Which of the following propositions in this patient is(s) the correct statement(s)? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"You immediately think of a pulmonary embolism","justification":""},{"idx":1,"correct":false,"proposition":"You think it's consistent with the diagnosis of pneumonia","justification":""},{"idx":2,"correct":false,"proposition":"You think the value of lactate points to acute community-acquired pneumonia","justification":""},{"idx":3,"correct":false,"proposition":"You think pleural effusion may explain the gasometric shunt effect","justification":""},{"idx":4,"correct":false,"proposition":"You suspect a sampling error","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-6","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"Given the context of falling, you examine the musculoskeletal system. Your exam finds pain in your right hip. You suspect a fracture of the right femoral neck because there are: (one or more possible answers) ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Functional impotence of the right lower limb","justification":""},{"idx":1,"correct":true,"proposition":"Pain on palpation of the right great trochanter","justification":""},{"idx":2,"correct":false,"proposition":"Internal rotation of the right hip","justification":""},{"idx":3,"correct":false,"proposition":"A psoitis on the right side","justification":""},{"idx":4,"correct":false,"proposition":"Shortening of the lower right limb","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-7","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The hip X-ray does not show a fracture of the femoral neck. The blood count shows leukocytes at 15 G\/L, hemoglobin at 10 g\/dL and platelets at 349 G\/L. The serum creatinine is 75 micromol\/L. What care do you start with this patient? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Nasal oxygen","justification":""},{"idx":1,"correct":true,"proposition":"Peripheral venous route","justification":""},{"idx":2,"correct":false,"proposition":"Intravenous ciprofloxacin","justification":""},{"idx":3,"correct":true,"proposition":"Low molecular weight heparin at preventive dose","justification":""},{"idx":4,"correct":false,"proposition":"Isotonic saline in venous infusion 3 liters \/ day","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-8","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"Which of the following other measures is the most important to put in place? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Prevention of swallowing disorders","justification":""},{"idx":1,"correct":false,"proposition":"Prevention of dehydration","justification":""},{"idx":2,"correct":true,"proposition":"Pressure ulcer prevention","justification":"It is an early complication and carries great morbidity"},{"idx":3,"correct":false,"proposition":"Urinary catheter placement","justification":""},{"idx":4,"correct":false,"proposition":"Oral care","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-9","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"During the first 24 hours of hospitalization, the patient has incoherent words. He believes he is in 1939. At times, on the contrary, it seems well suited. It is most often drowsy. When you enter the room, he does not remember seeing you in the morning and does not know that he is hospitalized. You mention a delirium syndrome. Which semiological element(s) present in the observation is (are) in favor of this diagnostic hypothesis? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Attentional disorders","justification":""},{"idx":1,"correct":true,"proposition":"Fluctuations in unrest","justification":""},{"idx":2,"correct":false,"proposition":"Phasia disorders","justification":""},{"idx":3,"correct":false,"proposition":"Memory disorder","justification":""},{"idx":4,"correct":false,"proposition":"Apathy","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-10","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The patient was put on oxygen and antibiotic therapy was started. The next morning the nurse finds that the patient is getting worse. What sign(s) would be in favor of hypercapnia? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The presence of low blood pressure","justification":""},{"idx":1,"correct":false,"proposition":"The presence of ample dyspnea","justification":""},{"idx":2,"correct":true,"proposition":"Deepening confusion","justification":""},{"idx":3,"correct":true,"proposition":"The presence of sweat","justification":""},{"idx":4,"correct":true,"proposition":"An asterixis","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-11","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"Finally, the patient evolves favorably on the respiratory plan in your 3 days with apyrexia and a reduction in respiratory rate. However, he has not eaten anything in the last 3 days and you fear the presence of protein-energy malnutrition (MPE). Which of the following proposals regarding its nutritional status is the right proposal(s)?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"His nutritional status may not have deteriorated sufficiently in 3 days","justification":""},{"idx":1,"correct":false,"proposition":"The determination of blood albumin is essential to determine the nutritional status","justification":""},{"idx":2,"correct":false,"proposition":"Lack of power over the last 3 days can define an MPE","justification":""},{"idx":3,"correct":false,"proposition":"MPE can be defined according to HAS by weight loss over the past year","justification":""},{"idx":4,"correct":true,"proposition":"A body mass index < 21 kg\/m^2 defines MPE","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-12","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"On the 4th day, your patient can get up but the bipodal support is painful preventing walking and the unipodal support on the right is impossible. A second hip X-ray is re-read normally. \nWhich of the following proposals regarding his condition is(s) the correct statement(s) at this stage? (one or more exact propositions)","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"You prescribe a bone scan","justification":""},{"idx":1,"correct":false,"proposition":"You suspect a simple bruise","justification":""},{"idx":2,"correct":true,"proposition":"You are looking for an ilio- or ischiopubic branch fracture","justification":""},{"idx":3,"correct":true,"proposition":"You prescribe a scanograhie of the pelvis and hips","justification":""},{"idx":4,"correct":false,"proposition":"You prescribe an X-ray of the right knee","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-13","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The CT scan revealed a fracture of the right iliopubic branch. The evolution is favorable under analgesic treatment and active early mobilization in one week. You plan to return home. What element(s) should be assessed before considering a return home?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"ADL","justification":""},{"idx":1,"correct":true,"proposition":"IADL","justification":""},{"idx":2,"correct":false,"proposition":"MNA","justification":""},{"idx":3,"correct":true,"proposition":"Fried's criteria","justification":""},{"idx":4,"correct":false,"proposition":"Geriatric depression scale","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-14","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"You have assessed their basic activities of daily living (ADL score). What element(s) constitutes this score? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"His ability to shop without help","justification":""},{"idx":1,"correct":false,"proposition":"Its ability to answer the phone without aids","justification":""},{"idx":2,"correct":false,"proposition":"Its ability to use public transport without aids","justification":""},{"idx":3,"correct":true,"proposition":"Its ability to eat without aids","justification":""},{"idx":4,"correct":false,"proposition":"Their ability to manage medications without aids","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-15","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"You measure their current ADL (Basic Activities of Daily Living) score at 4\/6, and their iso-resource group (GIR) at 4. What is the correct interpretation(s)?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The ADL score shows that there is an addiction for one's instrumental activities of daily living","justification":""},{"idx":1,"correct":false,"proposition":"The GIR is associated with the ADL level","justification":"At the AGGIR grid"},{"idx":2,"correct":true,"proposition":"The ADL score does not measure the presence of a cognitive disorder","justification":""},{"idx":3,"correct":true,"proposition":"Cognitive impairment is taken into account in the measurement of the GIR","justification":""},{"idx":4,"correct":true,"proposition":"It seems likely that he will obtain financial assistance for his home helpers","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-1","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"What semeiological element(s) are you looking for in favor of a cardiac cause of dyspnea in this patient? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Morning cough and sputum","justification":""},{"idx":1,"correct":false,"proposition":"Digital Hippocratism","justification":""},{"idx":2,"correct":false,"proposition":"Cough during exertion and decubitus","justification":""},{"idx":3,"correct":false,"proposition":"Gravity of the hypochondrium right to effort","justification":""},{"idx":4,"correct":false,"proposition":"Palpitations at the effrt","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-2","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The patient lives on the 38th floor with elevator. He does not present respiratory discomfort for everyday gestures. On the other hand, it signals dyspnea when walking uphill at normal speed (4 km \/ h). \nAt what stage of the NYHA does this description fit?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"I"},{"idx":1,"correct":true,"proposition":"II"},{"idx":2,"correct":false,"proposition":"III"},{"idx":3,"correct":false,"proposition":"IV"},{"idx":4,"correct":false,"proposition":"Unclassifiable with available data","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-3","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The patient has NYHA stage II dyspnea. Cardiac auscultation reveals mitral insufficiency. On which auscultatory anomaly(ies) is this diagnosis based?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Protodiastolic murmur","justification":""},{"idx":1,"correct":false,"proposition":"Mesosystolic strengthening breath","justification":""},{"idx":2,"correct":true,"proposition":"Holosystolic murmur","justification":""},{"idx":3,"correct":false,"proposition":"Raspy tone","justification":""},{"idx":4,"correct":false,"proposition":"Abolition of B1","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-4","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The general practitioner refers the patient to a cardiology consultation. While waiting for his appointment, the patient is admitted to the emergency room for acute dyspnea. The emergency physician evokes an acute edema of the lung (OAP) cardigenic. What is the main semeiological argument for this diagnosis?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"oxygen desaturation (SpO2)"},{"idx":1,"correct":false,"proposition":"focus of crackling rales"},{"idx":2,"correct":true,"proposition":"Complete intolerance to supine position"},{"idx":3,"correct":false,"proposition":"chest tightness"},{"idx":4,"correct":false,"proposition":"jugular turgor","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-5","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The clinical examination finds bilateral crackling rales going back to mid-field. Routine laboratory tests (blood count, platelets, blood ionogram, urea and serum creatinine) have been taken and you are waiting for the results. What is (are) the additional examination(s) essential before starting treatment? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Electrocardiogram","justification":""},{"idx":1,"correct":false,"proposition":"Determination of BNP or NT-proBNP","justification":""},{"idx":2,"correct":false,"proposition":"Determination of D-dimer","justification":""},{"idx":3,"correct":false,"proposition":"Pulmonary angio-CT","justification":""},{"idx":4,"correct":false,"proposition":"Echocardiography","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-6","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"A chest X-ray is performed. What abnormality(s) present on this picture is (are) in favor of the diagnosis of heart failure?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Cardiomegaly"},{"idx":1,"correct":true,"proposition":"Right pleural effusion"},{"idx":2,"correct":false,"proposition":"Vascular redistribution at the bases","justification":""},{"idx":3,"correct":true,"proposition":"Kerley Lines"},{"idx":4,"correct":false,"proposition":"Pericardial effusion"}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-7","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The electrocardiogram does not show an argument in favor of an acute coronary syndrome. The presence of orthopnea, diffuse subcrackling rales halfway up the pulmonary fields with bilateral radiological alveolar syndrome was sufficient for the diagnosis of acute pulmonary edema. Blood pressure is at 140\/90 mmHg, heart rate is at 110 beats\/min, there is no mottling or cooling of the extremities. Treatment with furosemide and oxygen therapy are started. Which complementary treatment(s) should be prescribed urgently? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Nitrates by intravenous infusion with an electric syringe","justification":""},{"idx":1,"correct":false,"proposition":"Dobutamine intravenous infusion with an electric syringe","justification":""},{"idx":2,"correct":false,"proposition":"Bisoprolol orally in small doses","justification":""},{"idx":3,"correct":false,"proposition":"Unfractionated intravenous heparin for 2.5x control ACT","justification":""},{"idx":4,"correct":false,"proposition":"Isotonic salted serum infusion 1 Uj","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-8","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The response to treatment is quickly favorable. An electrocardiogram is recorded again. What is the interpretation of this electrocardiogram?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Normal electrocardiogram"},{"idx":1,"correct":true,"proposition":"Sequelae of myocardial infarction","justification":""},{"idx":2,"correct":false,"proposition":"Full right branch block","justification":""},{"idx":3,"correct":true,"proposition":"Sinus rhythm"},{"idx":4,"correct":false,"proposition":"Left posterior hemibloc (fascicular block)","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-9","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"An echocardiogram is performed with the following results: - dilation of the left ventricle with alteration of the ejection fraction to 30%; - Akinesia of the lower wall with hypokinesia of the lateral wall of the left ventricle; - dilation of the left atrium and right ventricle; - elevation of the filling pressures of the left ventricle; - moderate mitral leakage (grade II) of restrictive mechanism associated with dilation of the mitral ring. Systolic pulmonary arterial pressure is estimated to be elevated. What is (are) the contribution(s) of this echocardiography concerning the diagnosis?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Mitral insufficiency is ischemic","justification":""},{"idx":1,"correct":true,"proposition":"The patient presented with an unnoticed myocardial infarction","justification":""},{"idx":2,"correct":true,"proposition":"The current picture of heart failure is due to ischemic heart disease","justification":""},{"idx":3,"correct":false,"proposition":"The current picture of heart failure is valvular cause","justification":""},{"idx":4,"correct":false,"proposition":"The patient developed pulmonary embolism","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-10","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"It is an ischemic heart disease with mitral leakage secondary to an unnoticed inferior myocardial infarction, complicated by heart failure with impaired ejection fraction. Which of the following decisions is, at this stage, the most important for this patient? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Confirmation of pulmonary hypertension by right catheterization","justification":""},{"idx":1,"correct":true,"proposition":"Search for viability and myocardial ischemia of the left ventricle","justification":""},{"idx":2,"correct":false,"proposition":"Analysis of the possibility of mitral plasty surgery","justification":""},{"idx":3,"correct":false,"proposition":"Pre-heart transplant assessment","justification":""},{"idx":4,"correct":false,"proposition":"Metabolic stress test (with gas analysis and V02 calculation)","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-11","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The search for myocardial ischemia is positive in the anteroseptal territory and leads to the realization of a coronary angiography. This examination reveals critical stenosis of the anterior interventricular coronary artery that is treated by angioplasty (percutaneous coronary intervention) and placement of a stent (stent). \nWhat is (are) the therapeutic adaptation(s) to be made before returning home?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Introduce a bradycardial calcium channel blocker (diltiazem or verapamil)","justification":""},{"idx":1,"correct":false,"proposition":"Initiate triple antithrombotic therapy (e.g. aspirin+apixaban+clopidogrel)","justification":""},{"idx":2,"correct":false,"proposition":"Combine ezetimibe with rosuvastatin","justification":""},{"idx":3,"correct":true,"proposition":"Introduce a beta oral blocker in progressive doses","justification":""},{"idx":4,"correct":true,"proposition":"Prescribe cardiac rehabilitation","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-12","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The patient discharges the hospital with carvedilol, enalapril, aspirin, prasugrel, rosuvastatin, furosemide, potassium salts and metformin. It is reviewed periodically to gradually increase the doses of carvedilol and enalapril to the target doses. Four months after revascularization, he is still dyspneic on exertion at NYHA stage II. He describes a first episode of brief loss of consciousness when climbing stairs, 30 minutes after taking his treatment. The search for orthostatic arterial hypotension is negative. The electrocardiogram is not changed. Echocardiography shows the persistence of systolic dysfunction with a stationary left ventricle ejection fraction at 30%, mitral leakage has not evolved and remains moderate (grade II). What is (are) the therapeutic adaptation(s) to be made to manage heart failure and its consequences? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Introduce a mineralocorticoid receptor antagonist","justification":""},{"idx":1,"correct":false,"proposition":"Implant a defibrillator","justification":""},{"idx":2,"correct":false,"proposition":"Reduce the dosages of enalapril and carvedilol","justification":""},{"idx":3,"correct":false,"proposition":"Implement ventricular resynchronization by biventricular stimulator","justification":""},{"idx":4,"correct":false,"proposition":"Prohibit excessive alcohol consumption","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-13","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"A few months later the patient presents a brutal, intense pain in the lower right limb which wakes him up at 6 am. He consults you at noon. The pain is intolerable agitating the patient, the foot is livid and cold with functional impotence. You will only find the femoral pulse in the right lower limb. You observe a discrete bilateral perimalleolar edema, taking the bucket. Skin sensitivity is decreased on the right side of the knee to the foot. Palpation of the calf is painful. What is the diagnosis to evoke in this patient? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Gout attack","justification":""},{"idx":1,"correct":false,"proposition":"Deep vein thrombosis of the lower limb","justification":""},{"idx":2,"correct":false,"proposition":"Paralyzing sciatica","justification":""},{"idx":3,"correct":false,"proposition":"Cholesterol crystal embolism","justification":""},{"idx":4,"correct":true,"proposition":"Acute ischemia of the lower limb","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-14","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"In front of this brutal clinical picture you retain the occurrence of acute limb ischemia. What is (are) the sign(s) of gravity?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The presence of edema"},{"idx":1,"correct":true,"proposition":"The presence of a sensory and motor deficit","justification":""},{"idx":2,"correct":true,"proposition":"Pain at the pressure of muscle masses","justification":""},{"idx":3,"correct":true,"proposition":"A long delay in handling","justification":""},{"idx":4,"correct":true,"proposition":"The level of arterial obstruction","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-15","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"What additional diagnostic examination do you propose to this patient before entrusting him to the surgical team? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"No further examination","justification":""},{"idx":1,"correct":false,"proposition":"CT angiography (CT scan)","justification":""},{"idx":2,"correct":false,"proposition":"Arteriography","justification":""},{"idx":3,"correct":false,"proposition":"MRI angiography","justification":""},{"idx":4,"correct":false,"proposition":"Ultrasound-Doppler","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-16","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The surgical team will immediately take care of the patient to perform emergency revascularization. What is (are) the modality(s) of care to be put in place immediately?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Lower limb elevation","justification":"This will further decrease the arterial influx. On the contrary, they must be put in the unslid position."},{"idx":1,"correct":true,"proposition":"Unfractionated heparin with an electric syringe after an intravenous bolus","justification":""},{"idx":2,"correct":true,"proposition":"Stage 3 analgesic","justification":""},{"idx":3,"correct":true,"proposition":"Protection of the limb by avoiding compression points","justification":""},{"idx":4,"correct":true,"proposition":"Intravenous arterial vasodilator therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-17","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"What risk(s) is (s) to which the patient is exposed due to the occurrence of this acute ischemia? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Hypokalemia","justification":""},{"idx":1,"correct":true,"proposition":"Metabolic acidosis","justification":""},{"idx":2,"correct":true,"proposition":"Acute renal failure","justification":""},{"idx":3,"correct":true,"proposition":"Heart rhythm disorders","justification":""},{"idx":4,"correct":false,"proposition":"Acute liver failure","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-1","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"What are the diagnoses to evoke in front of dysphonia (one or more expected responses) in this patient? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Polyp of vocal folds (vocal cords)","justification":""},{"idx":1,"correct":false,"proposition":"Intracordal nodule","justification":""},{"idx":2,"correct":true,"proposition":"Cancer of the vocal folds (vocal cords)","justification":""},{"idx":3,"correct":true,"proposition":"Unilateral laryngeal immobility","justification":""},{"idx":4,"correct":false,"proposition":"Oropharyngeal cancer","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-2","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"Which of the following risk factors promote the development of vocal fold cancer (one or more expected responses)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Isolated ethyl poisoning","justification":""},{"idx":1,"correct":true,"proposition":"Alcohol and tobacco poisoning","justification":""},{"idx":2,"correct":true,"proposition":"Isolated tobacco poisoning","justification":""},{"idx":3,"correct":false,"proposition":"Infection à Hu man Papilloma Virus","justification":""},{"idx":4,"correct":false,"proposition":"Infection à Epstein Barr Virus","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-3","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"The patient is seen in consultation with 0RL. Among the following tests, which are those that make it possible to evoke the diagnosis of laryngeal cancer during a 0RL consultation (one or more expected answers):","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Acoustic voice analysis","justification":""},{"idx":1,"correct":true,"proposition":"Laryngeal fibroscopy","justification":""},{"idx":2,"correct":true,"proposition":"Indirect LaryngoscoP.ie","justification":""},{"idx":3,"correct":false,"proposition":"Laryngeal videostroboscopy","justification":""},{"idx":4,"correct":false,"proposition":"Panendoscopy of the upper aerodigestive tract","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-4","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"You are moving towards the diagnosis of laryngeal cancer. Which of the following functional signs is related to a significant spread of cancer (one or more expected responses)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Otalgia right reflex","justification":""},{"idx":1,"correct":true,"proposition":"Dysphagia to solids","justification":""},{"idx":2,"correct":true,"proposition":"Laryngeal dyspnea","justification":""},{"idx":3,"correct":true,"proposition":"Bloody Spit","justification":""},{"idx":4,"correct":true,"proposition":"Swallowing disorders with false routes mainly when ingesting fluids","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-5","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"During the clinical examination of the patient, what are the essential gestures to be performed (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Dental examination","justification":""},{"idx":1,"correct":true,"proposition":"Complete inspection of the oropharynx and oral cavity","justification":""},{"idx":2,"correct":true,"proposition":"Endooral palpation","justification":""},{"idx":3,"correct":false,"proposition":"Otoscopy","justification":""},{"idx":4,"correct":true,"proposition":"Precise examination of lymph node areas","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-6","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"You highlight cervical lymphadenopathy. What are the elements to be specified during the clinical examination (one or more expected answers)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Seat"},{"idx":1,"correct":true,"proposition":"Waist"},{"idx":2,"correct":true,"proposition":"Deep infiltration"},{"idx":3,"correct":true,"proposition":"Skin condition in relation to"},{"idx":4,"correct":false,"proposition":"Compression of the internal jugular vein","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-7","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"At the end of your clinical examination, you perform a pharyngolaryngeal nasofibroscopy. You highlight a tumor of the right hemilarynx with the presence of several right cervical lymphadenopathy. What are the important elements missing from the description of your clinical examination (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Tumour colour","justification":""},{"idx":1,"correct":true,"proposition":"Macroscopic appearance of the tumour","justification":""},{"idx":2,"correct":true,"proposition":"Mobility of the right arytenoid","justification":""},{"idx":3,"correct":true,"proposition":"Mobility of the right vocal fold","justification":""},{"idx":4,"correct":true,"proposition":"Tumour size","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-8","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"For this patient, what are the examinations you request as part of the locoregional and general extension assessment (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"PET scanner","justification":""},{"idx":1,"correct":false,"proposition":"Ultrasound of the vessels of the neck","justification":""},{"idx":2,"correct":false,"proposition":"Cervical MRI","justification":""},{"idx":3,"correct":true,"proposition":"Cervico-thoracic CT with injection","justification":""},{"idx":4,"correct":true,"proposition":"Panendoscopy of the upper aerodigestive tract under general anesthesia","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-9","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"You decide to perform a panendoscopy of the upper aerodigestive tract under general anesthesia. An anesthesia consultation is mandatory. What are the characteristics of this consultation (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"It is governed by a decree of the Public Health Code","justification":""},{"idx":1,"correct":false,"proposition":"It is performed by the anaesthetist who will practice anesthesia during surgery","justification":""},{"idx":2,"correct":true,"proposition":"Informing the patient about the anesthesia procedure is mandatory","justification":""},{"idx":3,"correct":false,"proposition":"It is performed by any doctor regardless of his specialty","justification":""},{"idx":4,"correct":true,"proposition":"It is performed at least 48 hours before panendoscopy","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-10","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"Which of the following biological examinations is essential before performing panendoscopy? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Calcium phosphate balance","justification":""},{"idx":1,"correct":false,"proposition":"Carcinoembryonic antigen (CEA) test","justification":""},{"idx":2,"correct":false,"proposition":"Determination of transaminases","justification":""},{"idx":3,"correct":false,"proposition":"CRP testing","justification":""},{"idx":4,"correct":true,"proposition":"Haemostasis assessment including INR, TCA, p lacquettes","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-11","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"The cervico-thoracic CT scan was performed. What are the exact proposals (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"1 refers to cricoid cartilage","justification":""},{"idx":1,"correct":true,"proposition":"1 refers to thyroid cartilage","justification":""},{"idx":2,"correct":false,"proposition":"2 refers to epiglottic cartilage","justification":""},{"idx":3,"correct":true,"proposition":"2 refers to the laryngeal tumour","justification":""},{"idx":4,"correct":true,"proposition":"3 refers to the sternocleidostoid muscle","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-12","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"At the end of all the examinations performed, the final diagnosis is a moderately differentiated squamous cell carcinoma of the right hemianx classified T3N2bM0. What are the mandatory rules to respect for the management of a patient with carcinoma (one or more expected responses)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Decision on taking charge in a multidisciplinary consultation meeting (RCP)","justification":""},{"idx":1,"correct":true,"proposition":"Management defined in agreement with the patient","justification":""},{"idx":2,"correct":true,"proposition":"Care at an authorized facility","justification":""},{"idx":3,"correct":true,"proposition":"Mandatory notification consultation","justification":""},{"idx":4,"correct":true,"proposition":"Application for inclusion on the list of long-term conditions made by the attending physician","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-13","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"During the multidisciplinary consultation meeting, it was decided to propose a laryngeal preservation strategy with two chemotherapy courses combining cisplatin, 5FU, Docetaxel. Which of the following complications could be related to cisplatin (one or more expected responses)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Renal failure","justification":""},{"idx":1,"correct":true,"proposition":"Hearing loss","justification":""},{"idx":2,"correct":false,"proposition":"Mucite","justification":"The college of oncology does not report it! We were as surprised as you probably are now 😖."},{"idx":3,"correct":true,"proposition":"Dysesthesia of the extremities","justification":""},{"idx":4,"correct":true,"proposition":"Nausea, vomiting","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-14","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"Because of the 5FU treatment, what toxicity do you monitor first? (Only one answer expected)","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Neurological toxicity","justification":""},{"idx":1,"correct":false,"proposition":"Liver toxicity","justification":""},{"idx":2,"correct":true,"proposition":"Cardiac toxicity","justification":"Beware of coronary spasms"},{"idx":3,"correct":false,"proposition":"Digestive toxicity","justification":""},{"idx":4,"correct":false,"proposition":"Renal toxicity","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-15","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"After two courses of chemotherapy, a regression of tumor volume greater than 50% associated with remobilization of the right hemilarynx was highlighted. was decided to perform cetuximab-sensitized radiotherapy. What are the complications of radiotherapy that could be observed in the medium or long term (one or more expected responses)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Hyposialia","justification":""},{"idx":1,"correct":true,"proposition":"Hypothyroidism","justification":""},{"idx":2,"correct":true,"proposition":"Laryngeal edema","justification":""},{"idx":3,"correct":true,"proposition":"Laryngeal dyspnea","justification":""},{"idx":4,"correct":true,"proposition":"Cervical sclerosis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-1","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"What is your main diagnostic hypothesis? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Obliterating arterial disease of the lower limbs","justification":"This is the typical presentation"},{"idx":1,"correct":false,"proposition":"Narrow lumbar canal","justification":""},{"idx":2,"correct":false,"proposition":"Lombosciatica","justification":""},{"idx":3,"correct":false,"proposition":"Hypokalemia","justification":""},{"idx":4,"correct":false,"proposition":"Deep vein thrombosis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-2","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You suspect arterial disease obliterating the lower limbs. Which of the following semiological elements will guide the diagnosis towards this hypothesis? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Occurrence of pain when walking","justification":""},{"idx":1,"correct":true,"proposition":"Symptomatology type of calf cramp","justification":""},{"idx":2,"correct":false,"proposition":"Reduction of pain by leaning forward","justification":"This is the description of the famous shopping cart sign, found in the narrowed lumbar canal"},{"idx":3,"correct":false,"proposition":"Disappearance of pain gradually for several hours","justification":"Decrease in pain at cessation of exertion in PAD. It is the onset of pain that is progressive."},{"idx":4,"correct":true,"proposition":"Faster onset of symptoms when the patient climbs a slope","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-3","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"The interrogation confirms the appearance of a pain when walking with a cramp type localized in the right calf. The pain manifests itself early when the patient climbs a slope, thus supporting your diagnostic hypothesis of arterial obliterating disease of the lower limbs. On clinical examination, the patient measures 1.77 m, weighs 70 kg and the blood pressure is 134\/68 mmHg in both arms. Abdominal palpation does not perceive pulsatile or expansive mass. At the level of the lower left limb all peripheral pulses are found, the popliteal pulse seems however too well perceived. At the level of the lower right limb, only the femoral pulse is found. At auscultation you will find only a right cervical murmur and a murmur in the upper 1\/3 of the left thigh. On the data of this clinical examination, which is(are) the arterial atheromatous lesion(s) that you should suspect?","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Stenosis of the right external iliac artery","justification":""},{"idx":1,"correct":true,"proposition":"Left common femoral artery stenosis","justification":"The perception of a murmur on auscultation points to stenosis of the artery. Not to be confused with an obliteration, which corresponds to a total stenosis, that is to say that the blood does not pass at all. At the auscultation of an obliteration, we do not find a breath. On palpation of an obliteration, no pulse is found."},{"idx":2,"correct":true,"proposition":"Right common femoral artery stenosis","justification":"No pulse = total stenosis."},{"idx":3,"correct":true,"proposition":"Left popliteal artery aneurysm","justification":"Pulse too well perceived = aneurysm"},{"idx":4,"correct":false,"proposition":"Left leg artery stenosis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-4","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You mention the existence of a stenosis of the left femoral artery, a left popliteal aneurysm and a right femoral obliteration-reinjection. To confirm the diagnosis of obliterating arterial disease of the lower limbs you perform a measurement of the Systolic Pressure Index (SPI) in the ankle. The SPI is 0.67 at the lower right limb and 0.85 at the left lower limb. What are the semiological value and limitations of this parameter? (one or more correct answers). ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"When the SNI is less than 0.90, it confirms the diagnosis of peripheral arterial disease","justification":"The SPI standard is between 0.9 and 1.3 (1.4 is found as the higher standard in some sources). Below 0.9, he signs an AOMI. Above 1.3 (or 1.4), it signs arterial incompressibility (found in diabetic patients and chronic renal failure dialysis) due to mediacalcosis (calcification of the media, the intermediate tunica of the vessels, between the intima and the weed). An IPS below 0.7 indicates severe PAD."},{"idx":1,"correct":true,"proposition":"When the SNI is less than 0.90, it indicates an over-risk of cardiovascular morbidity and mortality","justification":""},{"idx":2,"correct":true,"proposition":"When the SPI is greater than 1.40, it indicates arterial stiffness associated with mediacalcosis","justification":""},{"idx":3,"correct":true,"proposition":"The presence of a mediacalcosis requires the use of toe pressure and not ankle pressure for the calculation of the IPS","justification":"This is the way we have found to counter the mediacalcolsis. The arteries of the toe are less prone to medicalcolsis. However, it should not be forgotten that it is physiological that the pressure of the toe is lower than the pressure of the ankle. The standard is therefore lower. Indeed, in case of taking the voltage of the ortel, the standard of the IPS is then 0.7"},{"idx":4,"correct":false,"proposition":"ABI should be measured in patients suspected of acute sensory-motor ischemia to confirm diagnosis","justification":"Acute limb ischemia is a medical-surgical, functional and even vital emergency. No examination should slow down management."}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-5","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"To specify the arterial lesion assessment, which is (are) the additional first-line examination(s) you are requesting? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"arteriography of the aorta and lower limbs","justification":""},{"idx":1,"correct":true,"proposition":"Doppler ultrasound of the abdominal aorta and arteries of the lower limbs","justification":"Makes it possible to precisely identify lesions, to evaluate the degree of stenosis and to objectify functional adaptation."},{"idx":2,"correct":true,"proposition":"a Doppler ultrasound of arterial axes for cervico-encephalic purposes","justification":"In the previous questions, the patient has a cervical murmur. It must therefore be explored."},{"idx":3,"correct":false,"proposition":"angio-MRI of the arterial axes for cervico-encephalic","justification":""},{"idx":4,"correct":false,"proposition":"CT angiography of the aorta and lower limbs","justification":"Is done pre-operatively of a revascularization"}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-6","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You asked in first intention the realization of a Doppler ultrasound of the axes for cervico-encephalic use, the aorta and the lower limbs to specify the arterial lesions. This objective examination an atheromatous overload at the level of the arterial axes of the supra-aortic trunks without significant stenosis. The abdominal aorta is regular and measures 28 mm in anteroposterior diameter. There is an obliteration of the right femoral artery with reinjection of the popliteal artery. There is also stenosis in the middle third of the left femoral artery. The left popliteal artery is regular and measures 13 mm in diameter in its widest dimension. Given the absence of a threatening lesion, you decide to treat this patient medically. What therapeutic measure(s) are you going to put in place? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Statine","justification":"Drug treatment of intermittent claudication is based on anti-platelet aggregation (by aspirin at anti-aggregating dose), an inhibitor of the converting enzyme (ACE inhibitor, the patient is already on perindopril for his hypertension, so we will keep it), and a statin (with an LDLc goal of less than 0.7 g \/ L because we are in secondary prevention,  the lesions are already there). It is associated with therapeutic education (sports activity, smoking cessation, Mediterranean diet, ...) and rehabilitation to progressive effort. Finally, we can discuss a gesture of revascularization."},{"idx":1,"correct":false,"proposition":"Beta-blocker to replace perindopril","justification":"ACE inhibitor is the treatment of choice in PAD"},{"idx":2,"correct":true,"proposition":"Antiplatelet agent","justification":"Treatment formally indicated from the stage of intermittent claudication. It is discussed in case of completely asymptomatic PAD (rare case)."},{"idx":3,"correct":false,"proposition":"Direct oral anticoagulant","justification":"We are not dealing with a coagulation problem. Neither AOD nor Heparin are therefore indicated. Indeed, in the arterial circuit, it is mainly a problem of primary hemostasis (platelet aggregation and formation of a thrombus) that may arise."},{"idx":4,"correct":false,"proposition":"Low molecular weight heparin","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-7","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"In addition to drug treatment, what advice(s) will you give to your patient? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Smoking cessation","justification":"The patient still smokes"},{"idx":1,"correct":false,"proposition":"Low-calorie diet","justification":"He is not overweight"},{"idx":2,"correct":false,"proposition":"Strict salt-free diet","justification":"His high blood pressure seems to be under control. Even if this were not the case, we would potentially advise a low-sodium (<6g\/D) and unsodized (<4g\/D) diet. The latter, the soda diet, is reserved for cases of cirrhosis with refractory ascites for example."},{"idx":3,"correct":false,"proposition":"Hypoglycemic diet","justification":"He is not diabetic"},{"idx":4,"correct":true,"proposition":"30-minute walk a day 5 times a week","justification":"That's 150 minutes of physical activity per week"}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-8","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You see the patient again after 6 months of treatment and prescribe a treadmill walking test. Regarding this review, what is the exact proposal(s)? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"It makes it possible to assess the disability related to arterial disease obliterans of the lower limbs ","justification":"The shorter the patient can walk, the greater the disability."},{"idx":1,"correct":false,"proposition":"It makes it possible to measure in a standardized way the distance traveled in 6 minutes","justification":"This proposal refers to the 6-minute walking test (TM6), useful in pulmonology. It consists of measuring the distance that a patient can travel in 6 minutes. Here, the test of walking on a treadmill is something else entirely: the patient puts himself on a treadmill advancing at 3.2km\/h with a slope of 10%, and he walks as long as possible (no time limit)."},{"idx":2,"correct":true,"proposition":"It allows a reassessment of SNPs after walking","justification":"The SPI is evaluated after walking and compared to that at rest."},{"idx":3,"correct":false,"proposition":"It is only intended for patients with mediacalcosis","justification":"There is no real connection with medicalcosis 😅"},{"idx":4,"correct":true,"proposition":"It allows the evaluation of the functional value of collateral circulation","justification":"The longer the patient can walk, the more the collateral circulation ensures a satisfactory locum function."}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-9","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"The walking test shows only moderate functional disability, compatible with continued medical treatment. The cardiologist consulted beforehand performed a stress ultrasound on dobutamine which does not show signs of myocardial ischemia. Resting echocardiography is also normal, with the exception of the presence of dilatation of the left atrium. Smoking cessation is ongoing. The patient is treated with atorvastatin, aspirin and perindopril. A year later, he consulted the cardiologist for palpitations that had been evolving episodically for several weeks. What is the possible cause(s) of palpitations in this patient? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Atrial tachycardia","justification":"Atrial tachycardia can cause palpitations (this is what you can feel after a 100m sprint at the end of D4 🤭 #vecu)."},{"idx":1,"correct":true,"proposition":"Atrial extrasystoles","justification":"If there are many and as a result, it is possible to feel palpitations. This is also the case for ventricular extrasystoles."},{"idx":2,"correct":false,"proposition":"Paroxysmal atrioventricular block","justification":"We find rather a bradycardia. It is not a cause of palpitation."},{"idx":3,"correct":true,"proposition":"Atrial fibrillation","justification":"First etiology to look for in case of palpitations."},{"idx":4,"correct":false,"proposition":"Ventricular fibrillation","justification":"Ventricular fibrillation never returns to normal on its own, and leads to cardiorespiratory arrest quickly and death if left untreated. If the patient had had VF, we would know."}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-10","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"An electrocardiogram is performed, of which here is the trace.","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"junctional tachycardia"},{"idx":1,"correct":true,"proposition":"atrial fibrillation"},{"idx":2,"correct":false,"proposition":"Atrial Flutter"},{"idx":3,"correct":false,"proposition":"atrial extrasystoles"},{"idx":4,"correct":false,"proposition":"sinus tachycardia"}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-11","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"Which factor(s) were considered to assess the thromboembolic risk of atrial fibrillation in this patient? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Peripheral arterial disease (PAD)","justification":""},{"idx":1,"correct":false,"proposition":"Smoking","justification":""},{"idx":2,"correct":true,"proposition":"History of high blood pressure (hypertension)","justification":""},{"idx":3,"correct":true,"proposition":"Age","justification":""},{"idx":4,"correct":false,"proposition":"The recent nature of atrial fibrillation (AF)","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-12","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"Renal function is normal and treatment with direct oral anticoagulant with apixaban is started due to age over 65 years, high blood pressure and peripheral arterial disease. The very reliable interrogation of the patient makes it possible to specify that palpitations occur in episodes whose duration varies between 6 and 72 hours. How to qualify this atrial fibrillation according to the data collected (only one answer)?","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Persistent","justification":""},{"idx":1,"correct":false,"proposition":"Perm","justification":""},{"idx":2,"correct":false,"proposition":"Isolated","justification":""},{"idx":3,"correct":true,"proposition":"Paroxysmal","justification":"Spontaneous reduction in less than 7 days (here 'between 6 and 72 hours' according to the statement)."},{"idx":4,"correct":false,"proposition":"Resistant","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-13","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"This is paroxysmal atrial fibrillation. You decide to prescribe a beta-blocker to slow the frequency of atrial fibrillation. After 3 days of treatment, the patient presents to the emergency room for lipothymia and exertional dyspnea. The electrocardiogram shows only sinus bradycardia at 42 beats \/ minute. Blood pressure is normal, the patient is asymptomatic to decubitus, there is no sign of low flow, diuresis is preserved, pulmonary auscultation is normal. What is your care? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Modification of treatment and return home","justification":""},{"idx":1,"correct":true,"proposition":"Suspension of beta-blocker and resumed at reduced doses","justification":"It is probably the introduction of the beta-blocker that is at the origin of bradycardia, therefore of the patient's symptomatology. We therefore stop the offending drug, with a wash-out period, then resume in small doses when the patient stabilizes, finding a dose that optimizes the benefit\/risk balance."},{"idx":2,"correct":false,"proposition":"Placement of a percutaneous electrosystolic training probe","justification":""},{"idx":3,"correct":false,"proposition":"Isoprenaline infusion","justification":""},{"idx":4,"correct":false,"proposition":"Installation of a permanent pacemaker","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-14","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"This is an adverse reaction of the beta-blocker whose dosage was not adequate. After dose reduction, the situation stabilizes favorably. Treatment with direct oral anticoagulant is continued. A few weeks later, the patient presents again for an attack of atrial fibrillation prolonged for more than 4 days but perfectly well tolerated under beta-blocker. You offer him an electrical cardioversion scheduled for the coming weeks. What will be the condition(s) for achieving this electrical cardioversion? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Previous transesophageal echocardiography","justification":"ETO is not useful if cardioversion is covered by 3 weeks of anticoagulation before."},{"idx":1,"correct":false,"proposition":"Relay of direct oral anticoagulant by low molecular weight heparin at curative dose","justification":"We are very happy with the AOD 😊. Furthermore, LMWHs do not have MA in atrial fibrillation. So, at the ECN, you should never tick them! The HnF will then be used."},{"idx":2,"correct":false,"proposition":"Realization at low energy under light sedation by midazolam","justification":"Must be done under general anesthesia (an external electric shock, it hurts a lot!). 😰"},{"idx":3,"correct":true,"proposition":"Anesthesia consultation","justification":"The medico-legal delay of an anesthesia consultation is at least 48 hours. The pre-anesthetic visit is carried out a few hours before."},{"idx":4,"correct":false,"proposition":"Weekly INR check for a target between 2 and 3","justification":"DOACs do not have biological monitoring parameters, which is sometimes problematic (when one needs to measure its effect exactly, for example when introducing a drug known for its enzymatic inducing effect)."}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-15","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"Electrical cardioversion is successfully performed two weeks later. Antiarrhythmic treatment is undertaken by flecainide which makes the symptoms disappear. The patient asks you about stopping direct oral anticoagulant therapy now that the atrial fibrillation has disappeared. What do you say to him (one correct answer)? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Discontinuation of direct oral anticoagulant therapy 4 weeks after cardioversion","justification":"This proposition would have been true if he had a CHADS-VASc at 0, or if he was under 65 and a purely isolated AF."},{"idx":1,"correct":false,"proposition":"Discontinuation of direct oral anticoagulant therapy if long-term Holter recording is normal","justification":""},{"idx":2,"correct":true,"proposition":"Indefinite maintenance of direct oral anticoagulant therapy","justification":"Its CHADS-VASc at 3 requires long-term anticoagulation."},{"idx":3,"correct":false,"proposition":"Discontinuation of direct oral anticoagulant therapy after 12 months without documented relapse of atrial fibrillation","justification":""},{"idx":4,"correct":false,"proposition":"Discontinuation of direct oral anticoagulant therapy if echocardiography shows haemodynamic efficacy of atrial systole","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-16","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You continued the anticoagulant treatment. The patient asks you about the reasons for the occurrence of atrial fibrillation in his case. What do you say (one or more exact answers)? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is an arrhythmia frequently associated with arterial disease obliterans of the lower limbs","justification":"No report 😅🤭"},{"idx":1,"correct":false,"proposition":"It is a consequence of his smoking","justification":"Questionable proposal. Smoking is indeed a predisposing factor to heart disease, but establishing a direct link between FA tobacco 👉 seems too bold."},{"idx":2,"correct":true,"proposition":"It is a common arrhythmia in case of high blood pressure","justification":"High blood pressure is the leading cause of atrial fibrillation."},{"idx":3,"correct":false,"proposition":"It is an arrhythmia favored by its sedentary lifestyle","justification":"No report, especially in this patient who is neither diabetic nor overweight."},{"idx":4,"correct":true,"proposition":"It is an arrhythmia frequently associated with sleep apnea syndrome.","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-1","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"What pathology(s) does the gynecological clinical examination (inspection, speculum examination and vaginal examination) allow you to eliminate with certainty? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"An endometrial polyp","justification":""},{"idx":1,"correct":false,"proposition":"A uterine fibroid","justification":""},{"idx":2,"correct":true,"proposition":"Vaginal cancer","justification":""},{"idx":3,"correct":false,"proposition":"Cervical dysplasia","justification":"The diagnosis of cervical dyaplsia is pathological pathology."},{"idx":4,"correct":false,"proposition":"Malignant tumor of the ovary","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-2","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"On examination, the vaginal wall is unremarkable and the cervix is normal. Which additional exam(s) do you prescribe as a first-line treatment?","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"An x-ray of the abdomen without preparation","justification":"Hardly ticks anymore..."},{"idx":1,"correct":true,"proposition":"An abdominopelvic ultrasound","justification":"The king first-line examination in gynecology 👑"},{"idx":2,"correct":false,"proposition":"An abdomino-pelvic CT scan","justification":""},{"idx":3,"correct":false,"proposition":"Abdominopelvic magnetic resonance imaging","justification":""},{"idx":4,"correct":false,"proposition":"Hysterosalpingography","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-3","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"A pelvic ultrasound is performed. It reveals a cystic right ovarian mass of about 6 cm with vascularized vegetation, a left hydrosalpinx and a left ovary carrying cystic formation with pure fluid content. The endometrial thickness is 18 mm with hypervascularization. There is also minimal peritoneal fluid effusion. What argument(s) is (or are) in favor of a malignant pathology? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Peritoneal effusion","justification":"It is minimal 👉 osef"},{"idx":1,"correct":false,"proposition":"The size of the right adnexal lesion","justification":"The size less than 7cm is a reassuring element."},{"idx":2,"correct":false,"proposition":"Left tubal lesion","justification":""},{"idx":3,"correct":false,"proposition":"Left ovarian lesion","justification":"Cystic nature is reassuring"},{"idx":4,"correct":true,"proposition":"The existence of vascularized vegetation on the right annex","justification":"The intense vascularization of a lesion is often in favor of malignancy (by secretion of VEGF from tumor cells)."}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-4","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"In this context, the right ovarian lesion as well as the endometrial thickness worry you. What other imaging exam(s) will you perform? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Abdominopelvic magnetic resonance imaging with Gadolinium injection","justification":""},{"idx":1,"correct":false,"proposition":"A brain scan","justification":""},{"idx":2,"correct":false,"proposition":"Fluoro-Deoxy-Glucose positron emission tomography","justification":""},{"idx":3,"correct":false,"proposition":"A bone scan","justification":""},{"idx":4,"correct":false,"proposition":"A liver ultrasound","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-5","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Along with the MRI you request. What biological marker(s) will you dose for this patient? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Ca 125","justification":"Ovarian cancer marker"},{"idx":1,"correct":false,"proposition":"Alfa-fetoprotein","justification":""},{"idx":2,"correct":false,"proposition":"Beta-HCG","justification":"Look at the patient's 😉 age (and don't blame yourself for checking it, but make sure you NEVER get caught up in this trap 🤗)"},{"idx":3,"correct":false,"proposition":"Ca 19.9","justification":"Marker of ovarian cancer. ACE and HE4 would be added. Note that the use of these markers is discussed."},{"idx":4,"correct":false,"proposition":"SCC","justification":"Marker of squamous cell cancers"}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-6","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"The results of the markers: \n\nCA 15.3: 25U\/mL \n\nCA 125: 40 Ul\/ml. \n\nA pelvic MRI is performed. The radiologist confirms the strong suspicion of malignant lesion of the right ovary and endometrium, as well as the a priori benign nature of the lesions of the left appendix. What do you do to support the diagnosis? (one or more possible answer(s)) ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Puncture of the peritoneal effusion vaginally","justification":""},{"idx":1,"correct":false,"proposition":"Right ultrasound-guided ovarian biopsy vaginally","justification":""},{"idx":2,"correct":true,"proposition":"Diagnostic hysteroscopy","justification":"For the endometrium"},{"idx":3,"correct":true,"proposition":"Laparoscopy explorer","justification":"For the ovary"},{"idx":4,"correct":false,"proposition":"Right ovarian biopsy under CT scan","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-7","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Laparoscopy is performed. What do you expect? (one or more possible answer(s)) ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Surgical removal of the right ovary","justification":""},{"idx":1,"correct":false,"proposition":"Staging swab","justification":""},{"idx":2,"correct":false,"proposition":"Surgical endometrial sampling","justification":"The endometrium is not removed directly."},{"idx":3,"correct":true,"proposition":"Assessment of the resectability of lesions","justification":""},{"idx":4,"correct":true,"proposition":"Assessment of peritoneal extension of the disease","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-8","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Laparoscopy did not show peritoneal extension. The histological results of the endometrial sample are: grade II invasive endometrioid adenocarcinoma. The histological results of the right adnexal swab: an intraovarian endometrioid adenocarcinoma lesion without extension to the surface or tubal wall. What treatment should be performed? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A total hysterectomy with bilateral appendectomy","justification":""},{"idx":1,"correct":false,"proposition":"Expanded colpohysterectomy with bilateral appendectomy","justification":"The cervix is healthy. There is no indication to remove it."},{"idx":2,"correct":false,"proposition":"Abdominopelvic external beam radiation therapy combined with concomitant chemotherapy","justification":""},{"idx":3,"correct":false,"proposition":"Neoadjuvant chemotherapy","justification":""},{"idx":4,"correct":false,"proposition":"Tamoxifen-based hormone therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-9","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Regarding the epidemiological data of the type of endometrial cancer (endometrioid) of this patient, what is(are) the exact statement(s)?","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"It is the most common gynecological (pelvic) cancer","justification":""},{"idx":1,"correct":true,"proposition":"It is a cancer of epithelial origin","justification":""},{"idx":2,"correct":true,"proposition":"It is a hormone-dependent cancer","justification":""},{"idx":3,"correct":false,"proposition":"It is a cancer of poor prognosis","justification":""},{"idx":4,"correct":true,"proposition":"Tamoxifen is a risk factor","justification":"Because hormone-dependent cancer"}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-10","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"The patient's file is presented at a multidisciplinary consultation meeting (RCP). Regarding CPR, what is(es) the correct answer(s)? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is not mandatory pre-operative","justification":"Except in very special cases (emergency for example), CPR is mandatory"},{"idx":1,"correct":false,"proposition":"It is the referring surgeon who proposes a therapeutic strategy","justification":""},{"idx":2,"correct":true,"proposition":"Doctors from three different specialties must be present","justification":""},{"idx":3,"correct":false,"proposition":"The support person can attend CPR","justification":"It's a meeting between doctors"},{"idx":4,"correct":true,"proposition":"Decisions must be based on a repository","justification":"The decision is based on the objective data of science"}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-11","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"The patient's attending physician applies for admission to a long-term condition (ALDI. Which of the following is correct? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The care protocol must be drawn up by the attending physician, in consultation with the patient and the other corresponding physician(s) involved in the follow-up.","justification":""},{"idx":1,"correct":false,"proposition":"ALD recognition allows 100% coverage of all health costs","justification":""},{"idx":2,"correct":false,"proposition":"The patient will be able to enjoy the benefits of her ALD for life","justification":""},{"idx":3,"correct":true,"proposition":"ALD recognition commits the patient to respond to the controls carried out by her health insurance organization","justification":""},{"idx":4,"correct":false,"proposition":"Part of the fee overruns billed by health professionals may be covered by the ALD.","justification":"Fee overruns are not covered by ALD."}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-12","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Given the carcinological history of the patient and her family, what is (or are) the exact proposal(s)?","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A family predisposition is strongly suspected","justification":""},{"idx":1,"correct":false,"proposition":"A pelvic ultrasound is indicated in her daughter","justification":""},{"idx":2,"correct":false,"proposition":"A CA15.3 assay is indicated in his daughter","justification":""},{"idx":3,"correct":true,"proposition":"An onco-genetic consultation should be recommended","justification":""},{"idx":4,"correct":true,"proposition":"A search for microsatellite instability is done on operating room","justification":"Lynch syndrome is suspected. We therefore look for the corresponding mutations on the operating room."}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-13","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Which familial form do you suspect first?","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Un syndrome de Lynch"},{"idx":1,"correct":false,"proposition":"A BRCA1 mutation"},{"idx":2,"correct":false,"proposition":"A BRCA2 mutation"},{"idx":3,"correct":false,"proposition":"A mutation in the PTEN gene"},{"idx":4,"correct":false,"proposition":"Un syndrome de Li-Fraumeni"}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-14","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"At the end of her treatment, the patient is considered in complete remission. What monitoring do you put in place for the first two years? (one or more possible answers) ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A biannual clinical examination","justification":""},{"idx":1,"correct":false,"proposition":"A semi-annual assay of the serum marker CA 15.3","justification":"This is the CA 125 test for ovarian 🤭 cancer"},{"idx":2,"correct":false,"proposition":"An annual pelvic thoracoabdomino CT scan","justification":"No indication for systematic imaging"},{"idx":3,"correct":false,"proposition":"A biannual abdominal-pelvic ultrasound","justification":"No indication for systematic imaging"},{"idx":4,"correct":false,"proposition":"An annual mammogram","justification":"She had breast cancer 👉 Annual mammogram for life."}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-1","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"In front of this sleep disorder, you must look for Theo:","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"An adjustment disorder","justification":"It cannot be eliminated in the face of compatible symptoms and lack of information on the duration of the disorders. There are many possible triggering factors (domestic violence, moving, entry into a small section)."},{"idx":1,"correct":false,"proposition":"Early schizophrenia","justification":""},{"idx":2,"correct":true,"proposition":"Obstructive sleep apnea syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Oppositional disorder with provocation","justification":"Sleep disorders are against this diagnosis. Irritability and anger do not seem to be taken to extremes and can be explained by lack of sleep."},{"idx":4,"correct":true,"proposition":"Reactive attachment disorder","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-2","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Among the symptoms presented by Theo, which is an obstructive sleep apnea syndrome? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Irritability","justification":""},{"idx":1,"correct":true,"proposition":"Snoring","justification":""},{"idx":2,"correct":true,"proposition":"Daytime sleepiness","justification":""},{"idx":3,"correct":false,"proposition":"Difficulty falling asleep","justification":""},{"idx":4,"correct":false,"proposition":"Refusal to sleep alone","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-3","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"In the context of this sleep disorder, what do you recommend at first?","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Sleep hygiene tips","justification":""},{"idx":1,"correct":true,"proposition":"Behavioural measures","justification":""},{"idx":2,"correct":false,"proposition":"A prescription for melatonin","justification":""},{"idx":3,"correct":false,"proposition":"A prescription of anti-histamine for hypnotic purposes","justification":""},{"idx":4,"correct":false,"proposition":"A sleep cure","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-4","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"You gave Theo's mother advice about sleep hygiene and how to behave with him. Six months later, you see the child again in consultation because the drowsiness is more and more marked. His school entry went well but, at times, he falls asleep in class. These phases are interspersed with phases of significant irritability associated with relational difficulties with other students. This boy is now 3 years and 6 months old, 1 meter tall and weighs 22 kilograms. The rest of the somatic clinical examination is normal. Faced with this drowsiness, among the following proposals, which is the most relevant in the first line? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A psychological assessment","justification":""},{"idx":1,"correct":false,"proposition":"Ventilatory polygraphy","justification":""},{"idx":2,"correct":false,"proposition":"A brain MRI","justification":""},{"idx":3,"correct":true,"proposition":"An ENT consultation","justification":""},{"idx":4,"correct":false,"proposition":"An electrocardiogram","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-5","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"The ENT consultation diagnoses obstructive sleep apnea syndrome and finds tonsillar hypertrophy and vegetations. Theo is operated on and the drowsiness disappears. Two years later, you see Theo again in consultation at the request of the teacher who describes a very difficult behavior: he never sits, does not wait his turn in class activities, does not respect the instructions and is very slow in his school work. The mother reports that he very often loses his belongings. Theo now sleeps in his own bed but demands a night light. Besides, he wets the bed. During your consultation, he does not hold in place and cuts you off. You suspect attention deficit hyperactivity disorder (ADHD). Your diagnostic hypothesis for ADHD is based on:","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Impulsivity"},{"idx":1,"correct":true,"proposition":"Motor instability"},{"idx":2,"correct":true,"proposition":"Nocturnal enuresis","justification":"About 10% of children with isolated primary nocturnal enuresis have attention deficit hyperactivity disorder (ADHD)."},{"idx":3,"correct":true,"proposition":"Slow execution","justification":"Inattention syndrome"},{"idx":4,"correct":false,"proposition":"Fear of the dark"}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-6","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Apart from being overweight, the rest of your physical exam is normal. To support your diagnosis of ADHD, you propose: ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"An ophthalmological consultation","justification":""},{"idx":1,"correct":true,"proposition":"A questionnaire to be completed by the mother","justification":""},{"idx":2,"correct":true,"proposition":"A questionnaire to be completed by the teacher","justification":""},{"idx":3,"correct":false,"proposition":"A genetic assessment","justification":""},{"idx":4,"correct":false,"proposition":"A brain MRI","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-7","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"The diagnosis of ADHD is confirmed. There is no associated learning disability. At this stage, you recommend: ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" Psychotherapy","justification":""},{"idx":1,"correct":false,"proposition":"Treatment with methylphenidate","justification":"This treatment is only possible from the age of 6. Theo is only 5 years old at this question. In addition, it is proposed as a second intention."},{"idx":2,"correct":true,"proposition":"Cognitive remediation","justification":""},{"idx":3,"correct":false,"proposition":"Speech therapy","justification":""},{"idx":4,"correct":false,"proposition":"Open educational assistance (AEMO)","justification":"AEMO is decided by a juvenile judge in special cases such as abuse."}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-8","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Six months later, Theo is 6 years old and faced with the little evolution of his disorders, you decide to prescribe methylphenidate. This molecule: ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Is a derivative of amphetamines","justification":""},{"idx":1,"correct":true,"proposition":"Is contraindicated before 6 years","justification":""},{"idx":2,"correct":false,"proposition":"Can be prescribed for up to 3 months","justification":"28 days, no limit on the total duration of treatment."},{"idx":3,"correct":true,"proposition":"Can be renewed by the general practitioner","justification":"Today, this proposition is true. Since 2021, the prescription and renewal of methylphenidate can be initiated by any neurologist, psychiatry or pediatrician and renewed by any doctor."},{"idx":4,"correct":false,"proposition":"Is prescribed without taking into account school holidays","justification":"We reduce during school holidays"}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-9","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"A few weeks after the introduction of the treatment, you see Theo and his mother again in consultation. Which of the following symptoms reported by his mother can methylphenidate be attributed to? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Increased appetite","justification":"Rather anorexia at lunch"},{"idx":1,"correct":true,"proposition":"Abdominal pain","justification":""},{"idx":2,"correct":true,"proposition":"Headaches","justification":""},{"idx":3,"correct":false,"proposition":"A sad mood","justification":""},{"idx":4,"correct":true,"proposition":"Difficulty falling asleep","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-10","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Three years later, Theo is admitted to the pediatric emergency room for a major attack of agitation at home. In a fit of anger, he broke his tablet and threatened to jump out of the window. He has just learned from his mother that his father, whom he did not know, committed suicide. You learn on this occasion that his mother lives with a new spouse and that intra-family relations are very tense, especially between Theo and his stepfather. Theo is now 9 years old and is enrolled in CE2. When you meet him, alone, he is calm and tells you about his discomfort. Overweight is manifest and badly experienced. Between sobs, he says: <<I'm tired of it, it's been going on too long. I can't take it anymore. >> In pediatric emergencies, management includes: ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A prescription of an anti-histamine for anxiolytic purposes","justification":"It is described as calm at present."},{"idx":1,"correct":false,"proposition":"A prescription of a benzodiazepine for anxiolytic purposes","justification":""},{"idx":2,"correct":true,"proposition":"A referral to hospitalization","justification":""},{"idx":3,"correct":false,"proposition":"A report","justification":""},{"idx":4,"correct":false,"proposition":"A summons from the father-in-law","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-11","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Which of the following proposals is one or more of Theo's emergency hospitalization objectives? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Prevention of suicidal risk","justification":""},{"idx":1,"correct":true,"proposition":"Prolonged clinical observation","justification":""},{"idx":2,"correct":false,"proposition":"Reassessment of ADHD treatment","justification":"This is not an indication for emergency hospitalization"},{"idx":3,"correct":true,"proposition":"Distancing intra-family tensions","justification":""},{"idx":4,"correct":false,"proposition":"Multidisciplinary assessment","justification":"This is not an indication for emergency hospitalization"}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-12","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Theo is hospitalized in pediatrics. During an interview, he described sexual touching by his stepfather but refused to be told about it to his mother. Faced with this situation ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"You avoid informing the mother","justification":""},{"idx":1,"correct":true,"proposition":"You make a report even if the mother objects","justification":""},{"idx":2,"correct":true,"proposition":"You make a report even without Theo's agreement","justification":""},{"idx":3,"correct":false,"proposition":"You identify the father-in-law on your certificate as responsible for the facts","justification":""},{"idx":4,"correct":false,"proposition":"You avoid transcribing Theo's words word for word","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-13","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"To whom do you address your report?","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"To the Child Social Assistance (ASE)","justification":""},{"idx":1,"correct":false,"proposition":"To the social worker of the paediatric department","justification":""},{"idx":2,"correct":false,"proposition":"To the regional health agency (ARS)","justification":""},{"idx":3,"correct":true,"proposition":"To the public prosecutor","justification":""},{"idx":4,"correct":false,"proposition":"Maternal and Child Protection (PMI)","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-14","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"The mother's spouse admits the facts and is incarcerated. A few weeks after his release from the hospital, Theo says he is reassured but remains sad and worried about his future. He is still treated with methylphenidate, which allows him to be calmer, but still has great academic difficulties. He has few classmates and often misses school due to somatic complaints. In view of this clinical picture, which diagnosis(s) should be mentioned?","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Depression","justification":""},{"idx":1,"correct":true,"proposition":"School phobia","justification":""},{"idx":2,"correct":false,"proposition":"Schizotypal personality disorder","justification":"A minor patient is not diagnosed with a personality disorder."},{"idx":3,"correct":false,"proposition":"Autism spectrum disorder","justification":""},{"idx":4,"correct":false,"proposition":"Conduct disorder","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-15","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Which of the following measures, due to his situation and his difficulties at school, which can be put in place for Theo? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"An individualized reception project (PAI)","justification":"The PAI makes it possible to arrange Theo's reception by informing his pedagogical managers of his pathology."},{"idx":1,"correct":true,"proposition":"Open educational assistance (AEMO)","justification":"Theo has been put in danger and his current social context is difficult. Mentioning an AEMO will allow the juvenile judge to assess the need for support for Theo."},{"idx":2,"correct":true,"proposition":"An allowance for the education of disabled children (AEEH)","justification":"The request is made to the MDPH."},{"idx":3,"correct":true,"proposition":"A personalized support project (PAP)","justification":"The PAP concerns learning disabilities, from which Theo seems to suffer."},{"idx":4,"correct":true,"proposition":"A school life assistant (AVS)","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-1","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What is the BMI (body mass index) in rounded value of this patient? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"25","justification":""},{"idx":1,"correct":true,"proposition":"30","justification":""},{"idx":2,"correct":false,"proposition":"35","justification":""},{"idx":3,"correct":false,"proposition":"40","justification":""},{"idx":4,"correct":false,"proposition":"45","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-2","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Which is (are) the most likely diagnostic hypothesis(s) in front of this clinical picture?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Stasis dermohypodermatitis","justification":""},{"idx":1,"correct":true,"proposition":"Bacterial dermohypodermatitis","justification":""},{"idx":2,"correct":false,"proposition":"Necrotizing fasciitis","justification":""},{"idx":3,"correct":false,"proposition":"Lymphangitis","justification":""},{"idx":4,"correct":false,"proposition":"Erythema nodosum","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-3","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What clinical characteristic(s) is (are) in favor of non-necrotizing bacterial dermohypodermatitis? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Brutal start","justification":""},{"idx":1,"correct":false,"proposition":"Slow expansion","justification":"Expansion is fast"},{"idx":2,"correct":false,"proposition":"Centripetal evolution of skin lesions","justification":"Centrifugal evolution"},{"idx":3,"correct":false,"proposition":"Severe spontaneous pain","justification":"Palpation pain"},{"idx":4,"correct":true,"proposition":"Demonstration of intertoe intertrigo","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-4","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What comorbidity(ies) present in this patient is(are) a risk factor(s) for the occurrence of bacterial dermohypoderma? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Obesity","justification":""},{"idx":1,"correct":false,"proposition":"Diabetes","justification":"Risk factor for necrotizing dermohypodermitis."},{"idx":2,"correct":true,"proposition":"Venous insufficiency","justification":""},{"idx":3,"correct":false,"proposition":"History of phlebitis","justification":""},{"idx":4,"correct":false,"proposition":"High blood pressure","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-5","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"You have several elements to orient you towards bacterial dermohypodermatitis especially as you find an intertrigo of the 2 feet. What gesture(s) do you perform in front of this lesion?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Search for an increase in local skin temperature","justification":""},{"idx":1,"correct":true,"proposition":"Stripping of a small bullous detachment within the erythematous zone","justification":""},{"idx":2,"correct":false,"proposition":"Bacteriological swab of the most inflammatory area of erythema","justification":""},{"idx":3,"correct":true,"proposition":"Marking erythema contours with felt","justification":""},{"idx":4,"correct":true,"proposition":"Investigation of lymphadenopathy","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-6","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Palpation of the inguinal folds objective left inguinal lymphadenopathy. What is (are) the most likely cause(s) of this left inguinal lymphadenopathy?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Concomitant inflammatory pathology of the small pelvis","justification":""},{"idx":1,"correct":false,"proposition":"Concomitant inflammatory pathology of the perineal region","justification":""},{"idx":2,"correct":false,"proposition":"Concomitant or perianal lesion","justification":""},{"idx":3,"correct":true,"proposition":"Satellite lymphadenopathy of dermohypodermatitis","justification":""},{"idx":4,"correct":false,"proposition":"Sentinel lymphadenopathy of lymphoma","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-7","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What is essential to achieve before starting the therapeutic management of this dermohypodermitis? (only one answer expected)","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Blood","justification":"Namely: blood cultures are positive in less than 5% of cases and are only to be performed in a particular context (bite, travel, occurring in an aquatic environment, post-traumatic, immunosuppression, nosocomial context, signs of clinical or biological seriousness)."},{"idx":1,"correct":false,"proposition":"Skin biopsy with culture","justification":""},{"idx":2,"correct":false,"proposition":"Doppler ultrasound of the leg","justification":""},{"idx":3,"correct":false,"proposition":"Left leg scanner"},{"idx":4,"correct":true,"proposition":"No additional assessment is essential","justification":"The form is typical and uncomplicated 👉 no additional examination. The diagnosis is clinical."}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-8","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Which infectious agent(s) is (are) most likely to be involved? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Streptococcus pyogenes","justification":""},{"idx":0,"correct":false,"proposition":"coagulase-negative staphylococcus","justification":"These are low-virulent staphylococci that are present on the skin commensally. These are often contaminants (S. Epidermidis ++)."},{"idx":0,"correct":false,"proposition":"Candida albicans","justification":""},{"idx":0,"correct":false,"proposition":"Pseudomonas ","justification":""},{"idx":0,"correct":false,"proposition":"Escherichia coli","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-9","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What is your first-line anti-infectious therapeutic option(s) (knowing that you decide to treat her at home because of the lack of signs of severity and that she has no known allergy)?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Oral amoxicillin","justification":""},{"idx":0,"correct":false,"proposition":"Amoxicillin - Clavulanic Acid Orally"},{"idx":0,"correct":false,"proposition":"Pristinamycin orally (PO)","justification":"It is a treatment to be used in case of allergy to amoxicillin."},{"idx":0,"correct":false,"proposition":"Oral clindamycin","justification":"It is a treatment to be used in case of allergy to amoxicillin."},{"idx":0,"correct":false,"proposition":"3rd generation cephalosporin as intramuscular injection","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-10","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What associated treatment do you prescribe?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Paracetamol","justification":""},{"idx":1,"correct":false,"proposition":"Nonsteroidal anti-inflammatory drugs","justification":""},{"idx":2,"correct":false,"proposition":"Calciparin curative dose","justification":""},{"idx":3,"correct":true,"proposition":"Rest with elevation of the left leg","justification":"This helps to evacuate the edema that accompanies the inflammatory phenomenon."},{"idx":4,"correct":true,"proposition":"Treatment of intertrigo","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-11","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"You treat it with amoxicillin and paracetamol and plan to see it again 2 days later. Indeed, this patient is exposed to the risk of evolution to a necrotizing form. What is (are) the risk factor(s) of such a development? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Obesity","justification":"According to HAS, the risk factors for progression to a necrotizing form are: diabetes, nonsteroidal anti-inflammatory drugs, immunosuppression (corticosteroids, chemotherapy, immunosuppressants, chronic renal failure, cirrhosis), malnutrition, age over 60 years, intravenous drug addiction, venous insufficiency, peripheral arterial disease (PAD) and obesity. In children, chickenpox is the main risk factor for DHBN. The recommendation is here: https:\/\/www.has-sante.fr\/upload\/docs\/application\/pdf\/2019-04\/prise_en_charge_des_infections_cutanees_bacteriennes_courantes_recommandations.pdf"},{"idx":1,"correct":true,"proposition":"Diabetes","justification":""},{"idx":2,"correct":false,"proposition":"Smoking","justification":""},{"idx":3,"correct":true,"proposition":"Arterial disease of the lower limbs","justification":""},{"idx":4,"correct":true,"proposition":"Taking nonsteroidal anti-inflammatory drugs","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-12","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Under treatment, dermohypodermatitis disappears. You see the patient again 3 months later because her company sends her to do an accounting in Abidjan in Côte d'Ivoire for 3 weeks. She has never traveled to Africa. What vaccination(s) do you offer? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Update of its diphtheria-tetanus-polio vaccines","justification":""},{"idx":1,"correct":true,"proposition":"Hepatitis A vaccine","justification":""},{"idx":2,"correct":true,"proposition":"Meningitis vaccine ACYW135","justification":"This proposal is contentious. This vaccine is indicated in case of close and prolonged contact with the local population in an epidemic\/endemic area. Is this the case in the case of public accounting? It's hard to know 🤷 ♂️."},{"idx":3,"correct":true,"proposition":"Yellow fever vaccine","justification":""},{"idx":4,"correct":false,"proposition":"Cholera vaccine","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-13","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"You decide to prescribe atovaquone-proguanil for malaria chemoprophylaxis for this 3-week trip. How long do you write on the prescription? (only one answer expected) ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"3 weeks","justification":""},{"idx":1,"correct":true,"proposition":"4 weeks","justification":"Atovaquone-Proguanil: Length of stay + 1 week (daily dose)"},{"idx":2,"correct":false,"proposition":"5 weeks","justification":""},{"idx":3,"correct":false,"proposition":"6 weeks","justification":""},{"idx":4,"correct":false,"proposition":"7 weeks","justification":"Mefloquine: 1 week before + Length of stay + 3 weeks (weekly intake). \n\nDoxycycline: Length of stay + 4 weeks\/1 month (daily intake)"}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-14","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Upon her return from Côte d'Ivoire, the patient consults you again. She is doing well and the stay went well. She was even able to spend the last weekend in a bush camp. She describes rudimentary facilities with poor hygiene conditions, especially on bedding. Since her return, she has slept poorly due to pruritus of her forearms, wrists and fingers. One of her colleagues with whom she shared the same room has the same symptoms. On examination you see especially scratching lesions especially in interdigital spaces. She did not change personal care products. Which pathology do you think is most likely in this context? (only one answer expected)","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Atopic dermatitis","justification":""},{"idx":1,"correct":false,"proposition":"Pediculosis","justification":""},{"idx":2,"correct":true,"proposition":"Scabies","justification":""},{"idx":3,"correct":false,"proposition":"Larva Migrans","justification":""},{"idx":4,"correct":false,"proposition":"Contact dermatitis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-15","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"You mention a scabies that is confirmed by the visualization of parasites with a dermoscope. What do you recommend? (one or more correct answers) ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Treatment with ivermectin","justification":""},{"idx":1,"correct":true,"proposition":"Treatment to be renewed at 7 days","justification":""},{"idx":2,"correct":true,"proposition":"Washing clothes at least 60 °C in a long cycle","justification":""},{"idx":3,"correct":true,"proposition":"Treatment at the same time of his colleague","justification":""},{"idx":4,"correct":false,"proposition":"2-week absence from work","justification":"Eviction from the community is up to 3 days after the start of treatment if common scabies (which seems to be the case here)."}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-1","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You notice the lesion opposite. You mention (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Squamous cell carcinoma","justification":"The lesion is regular. The patient is young. The area of attack is not classic."},{"idx":1,"correct":false,"proposition":"A canker sore","justification":""},{"idx":2,"correct":true,"proposition":"A hemorrhagic bubble","justification":""},{"idx":3,"correct":false,"proposition":"A bite","justification":""},{"idx":4,"correct":false,"proposition":"An angioma","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-2","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"This is an oral hemorrhagic bubble. Given this lesion, which etiology is most likely? ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Severe thrombocytopenia","justification":""},{"idx":1,"correct":false,"proposition":"Willebrand disease","justification":"Willebrand disease is a pathology of primary hemostasis that is accompanied by a normal platelet count. This is a possible etiology but unlikely given the age of the patient."},{"idx":2,"correct":false,"proposition":"Hemophilia","justification":""},{"idx":3,"correct":false,"proposition":"Vitamin K deficiency","justification":""},{"idx":4,"correct":false,"proposition":"Protein C deficiency","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-3","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You mention severe thrombocytopenia. What other bleeding signs are you looking for? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A purpura","justification":"Purpura will then be thrombocytopenic: petechial, mucocutaneous, non-infiltrated, on the trunk and upper limbs as well as on the lower limbs."},{"idx":1,"correct":true,"proposition":"Gingivorragies","justification":""},{"idx":2,"correct":false,"proposition":"Hemarthrosis","justification":"Hemarthrosis is deep bleeding. It therefore evokes a pathology of coagulation."},{"idx":3,"correct":true,"proposition":"An epistaxis","justification":""},{"idx":4,"correct":true,"proposition":"A melena","justification":"Melena testifies to mucosal involvement, which is readily found in thrombocytopenia."}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-4","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"On examination, you actually find purpura. What are the expected characteristics of purpura in this context? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Painful","justification":""},{"idx":1,"correct":false,"proposition":"Necrotic","justification":""},{"idx":2,"correct":true,"proposition":"Petechial","justification":""},{"idx":3,"correct":false,"proposition":"Infiltrated","justification":""},{"idx":4,"correct":true,"proposition":"Associated with bruising","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-5","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"What first-line exams will you request? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Complete blood count","justification":"We want to know hemoglobin. Be careful, the NFS does not provide information on the platelets (it is the NFS-P that counts the platelets!)."},{"idx":1,"correct":false,"proposition":"INR","justification":"Bleeding disorders are not suspected."},{"idx":2,"correct":false,"proposition":"TP, TCA, fibrinogen","justification":"Bleeding disorders are not suspected."},{"idx":3,"correct":false,"proposition":"D-dimer","justification":"We have no arguments for a potential DICV here."},{"idx":4,"correct":false,"proposition":"Reticulocytes","justification":"It will be asked if there is anemia."}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-6","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"The CBC shows: red blood cells 2.24 T\/L, hemoglobin 76 g\/L, hematocrit 22.1%, MCV 98.7 fL, MCDC 34.4 g\/dL, leukocytes 1.3 G\/L, neutrophils 0.4 G\/L, lymphocytes 0.5 G\/L, monocytes 0.05 G\/L, blasts 0.35 G\/L, platelets 9 G\/L, reticulocytes 45 T\/L. Describe this NFS: ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Neutropenia","justification":"neutrophils 0.4 G\/L when normal is > 1.5 G\/L"},{"idx":1,"correct":false,"proposition":"Hyperlymphocytosis","justification":"lymphocytes 0.5 G\/L when normal is > 1.5 G\/L"},{"idx":2,"correct":true,"proposition":"Thrombocytopenia","justification":"9 G\/L blisters with a normal > 150 G\/L"},{"idx":3,"correct":true,"proposition":"Normochrome anemia","justification":"Normochrome because CCMH between 32 and 36"},{"idx":4,"correct":false,"proposition":"Regenerative anemia","justification":"reticulocytes 45 T\/L while we speak of regenerative above 120-150."}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-7","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"What diagnoses do you mention? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Idiopathic bone marrow suppression","justification":""},{"idx":1,"correct":false,"proposition":"Aggressive lymphoma","justification":""},{"idx":2,"correct":false,"proposition":"Immunological thrombocytopenic purpura","justification":""},{"idx":3,"correct":true,"proposition":"Acute leukemia","justification":"The circulating blasts direct us directly to leukemia."},{"idx":4,"correct":false,"proposition":"Chronic myeloid leukemia","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-8","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You receive the hemostasis assessment. It shows: TP at 50%, TCA ratio 1.1, fibrinogen 0.88 g \/ l. How do you complete the hemostasis assessment? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The determination of D-dimer","justification":"The TP is decreased, the TCA begins to increase, the fibrinogen is low 👉 red alert CIVD! The dosage of D-Dimer will allow us to base the diagnosis."},{"idx":1,"correct":false,"proposition":"The search for circulating anticoagulant","justification":""},{"idx":2,"correct":true,"proposition":"Determination of factor V","justification":"The TP is low, so factor VII is decreased. The determination of factor V will allow us to know if the decrease in factor VII comes from the liver (hepatocellular insufficiency) or from the synthesis of vitamin-dependent factors (X, IX, VII, II)."},{"idx":3,"correct":false,"proposition":"Anti-Xa activity","justification":""},{"idx":4,"correct":false,"proposition":"Determination of factor VIII","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-9","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You suspect acute myelogenous leukemia. You perform a myelogram. What are you waiting for? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Poor marrow","justification":""},{"idx":1,"correct":true,"proposition":"The presence of more than 20% of myeloblasts","justification":""},{"idx":2,"correct":false,"proposition":"An increase in the number of myelocytes and metamyelocytes","justification":"Myelocytes and metamyelocytes are greatly reduced"},{"idx":3,"correct":true,"proposition":"Decreased or absent megakaryocytes","justification":""},{"idx":4,"correct":true,"proposition":"The presence of blasts with Auer bodies","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-10","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"Mr. R. does have acute myelogenous leukemia. What should you do? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Emergency hospitalization","justification":""},{"idx":1,"correct":true,"proposition":"Protective Custody","justification":""},{"idx":2,"correct":true,"proposition":"A multidisciplinary consultation meeting to decide on therapeutic conduct","justification":""},{"idx":3,"correct":true,"proposition":"Perform an ad consultation","justification":""},{"idx":4,"correct":true,"proposition":"Apply for ALD","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-11","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"Mr. R.'s file was presented in PCR, which offers him to participate in a randomized phase therapeutic protocol. He is given information with a consent form. Who should sign it? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The patient","justification":""},{"idx":1,"correct":true,"proposition":"The local investigating physician","justification":"There are two signatures: that of the patient and that of his investigator."},{"idx":2,"correct":false,"proposition":"The intern in charge of the patient","justification":""},{"idx":3,"correct":false,"proposition":"The support person","justification":""},{"idx":4,"correct":false,"proposition":"The pharmacist who dispenses the study products","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-12","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"Treatment is started and he needs a red blood cell transfusion. What biological tests should be performed before transfusion? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"ABO Rhesus Group","justification":""},{"idx":1,"correct":true,"proposition":"Rhesus-KEL phenotyping","justification":""},{"idx":2,"correct":true,"proposition":"Irregular agglutinin (RAI) testing","justification":""},{"idx":3,"correct":false,"proposition":"EBV Serology","justification":""},{"idx":4,"correct":false,"proposition":"CMV Serology","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-13","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"Mr. R.'s uncle was infected during a transfusion in 1984. Mr. R. therefore wished to know what checks had been carried out on the red blood cells. Which of the following are true? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The products are all leukocyte-free","justification":""},{"idx":1,"correct":false,"proposition":"The products are all irradiated","justification":"For the premature, for the patient in SCID (and not DICV), ..."},{"idx":2,"correct":true,"proposition":"Products are tested for HIV","justification":"HIV1 and 2"},{"idx":3,"correct":true,"proposition":"Products are tested for hepatitis B and C","justification":""},{"idx":4,"correct":false,"proposition":"Products are tested for CMV","justification":"The products are tested for HIV, HTLV, HCV, HBV, and syphilis."}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-14","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"What are the legal provisions for transfusion? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The nurse must verify the conformity of the product received","justification":""},{"idx":1,"correct":true,"proposition":"A doctor must be available quickly","justification":""},{"idx":2,"correct":false,"proposition":"Pellets must be transfused within one hour of arrival in the department","justification":"Within 6 hours"},{"idx":3,"correct":true,"proposition":"The nurse checks the identity match between the patient and the group card","justification":""},{"idx":4,"correct":true,"proposition":"The nurse checks the match between the group card and the cap pocket","justification":"The famous ultimate bedside test."}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-15","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You prescribe the transfusion of 2 phenotyped red blood cells. The nurse performs the test on a test cardboard before the transfusion. The result is: {pos = presence of agglutinates, neg = absence of agglutinates}. Which propositions are true? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The patient is group A","justification":"The card contains anti-A antibodies. They react with the patient's 👉 blood it is group 🅰 ."},{"idx":1,"correct":false,"proposition":"The patient is Rhesus positive","justification":""},{"idx":2,"correct":false,"proposition":"The red blood cell group is identical to that of the patient","justification":""},{"idx":3,"correct":true,"proposition":"The red blood cell is compatible with the patient","justification":""},{"idx":4,"correct":true,"proposition":"The patient can be transfused without further prior examination","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-1","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"In view of this clinical picture, which is (are) the diagnostic hypothesis(s) to evoke? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Fracture of the upper end of the femur","justification":"It would then be Garden 2."},{"idx":1,"correct":true,"proposition":"Fracture of the sacrum","justification":"The patient's symptoms are: foot levator\/lowering deficit, electrical pain + paresthesia of the right lower limb. These symptoms can be part of the nosological framework of damage to the L5-S1 roots, following a fracture of the sacrum or femur."},{"idx":2,"correct":false,"proposition":"Coxofemoral dislocation","justification":"Statement: 'The inspection does not find a vicious attitude of the lower limb.'"},{"idx":3,"correct":true,"proposition":"Adductor rupture","justification":"Trauma in abduction 👉 possible tearing of the adductors."},{"idx":4,"correct":false,"proposition":"Removal of the distal insertion of the iliopsoas","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-2","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Which exam(s) should I request in the first line?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"X-ray of the front pelvis","justification":""},{"idx":1,"correct":true,"proposition":"X-ray of the thoracolumbar spine","justification":"She probably fell on her back and she has a pain in the lower 👉 limb lower lumbar vertebral fracture?"},{"idx":2,"correct":false,"proposition":"Thoraco-abdomino-pelvic CT scan","justification":""},{"idx":3,"correct":false,"proposition":"MRI of the pelvis","justification":""},{"idx":4,"correct":false,"proposition":"Ultrasound of the coxofemoral joint","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-3","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"After a 2-hour decubitus rest in the emergency room, the patient wants to get back on her feet. She says she finds her right leg and foot still numb. She still can't lift or extend her foot. X-rays of the pelvis and thoracolumbar spine are performed. Given the clinical and radiological evidence available for this patient, what is the most likely diagnostic hypothesis? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A fracture of the spine","justification":"No fractures are visualized"},{"idx":1,"correct":false,"proposition":"A fracture of an ischiopubic branch","justification":"No fractures are visualized"},{"idx":2,"correct":false,"proposition":"A fracture of the upper end of the femur","justification":"No fractures are visualized"},{"idx":3,"correct":false,"proposition":"Damage to the obturator nerve","justification":"This nerve arises from the L2, L3 and L4 roots of the lumbar plexus. His sensory-motor innervation stops at the knee."},{"idx":4,"correct":true,"proposition":"Damage to the sciatic nerve","justification":"This corresponds to the symptomatology."}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-4","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"On X-rays, no fractures were observed. Nerve damage has been suggested. The patient was discharged from the emergency room the same day and you will see her at home 3 days after her fall. On inspection, you notice visible skin signs in the following photo. On clinical examination, the patient complains of having a cotton leg and right foot and localized pain in the sole of the right foot. The right patellar reflex is present, the right Achilles absent while it is present on the left. In distality, there is difficulty raising and lowering the tip of the right foot. Motor testing during knee extension, abduction and right hip extension are possible against resistance and are normal. You notice weakness in the flexion of the leg on the right thigh. She has hypoaesthesia of her right leg. There is no vesico-sphincter disorder. Given the clinical evidence you have, what type(s) of neurological impairment(s) can you discuss? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Monoradiculopathy","justification":"The involvement of a single root (L5 or S1) does not explain all the symptomatology. The infringement is therefore more distorted."},{"idx":1,"correct":false,"proposition":"Polyradiculopathy","justification":"The involvement of several roots would give a more proximal symptomatology."},{"idx":2,"correct":true,"proposition":"Monotroncular involvement","justification":"Absent right Achilles reflex (carried by the root S1) + difficulty raising and lowering the tip of the foot (involvement of the fibular nerve, branch of the sciatic nerve, which comes from the root L5) = involvement of the sciatic nerve = monotroncular involvement."},{"idx":3,"correct":false,"proposition":"Incomplete paraparesis","justification":"Paraparesis is bilateral. However, the symptoms here are one-sided."},{"idx":4,"correct":false,"proposition":"Cauda equina syndrome","justification":"No sphincter bladder disorders, no proximal involvement, no arguments 😅."}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-5","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Three days after the trauma, in the context of sciatic monotroncular involvement, which examination would be most likely to change the management of this patient? (only one answer expected) ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A lumbar spinal CT scan","justification":""},{"idx":1,"correct":false,"proposition":"Sacco-radiculography","justification":""},{"idx":2,"correct":false,"proposition":"A perineal electromyogram","justification":""},{"idx":3,"correct":false,"proposition":"An electromyogram of the lower limbs","justification":""},{"idx":4,"correct":true,"proposition":"An ultrasound of the right buttock and right thigh","justification":"The patient has a hematoma of the thigh, probably compressible 👉 we will try to see if this is really the case 😉"}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-6","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Ultrasound of the right buttock showed a hematoma that was evacuated because it compressed the sciatic nerve. You want to prescribe a right foot lifter-type technical aid. Which of the following regulatory elements for non-molded orthotics is(are) accurate:","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"They require a request for prior agreement","justification":""},{"idx":1,"correct":true,"proposition":"They are available from pharmacists","justification":""},{"idx":2,"correct":false,"proposition":"They are prescribed on a major appliance form.","justification":""},{"idx":3,"correct":true,"proposition":"They are prescribed on a simple prescription","justification":""},{"idx":4,"correct":false,"proposition":"They are fully reimbursed by the health insurance fund","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-7","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"You decide to prescribe rehabilitation sessions on an outpatient basis at home. Among these elements, which is (are) mandatory on the prescription for the physiotherapist:","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Total number of sessions","justification":""},{"idx":1,"correct":true,"proposition":"The mention << at home>>","justification":""},{"idx":2,"correct":true,"proposition":"The region and\/or pathology to be treated","justification":""},{"idx":3,"correct":true,"proposition":"The mention << Masso-kinesitherapy>>","justification":""},{"idx":4,"correct":false,"proposition":"The physiotherapy technique used","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-8","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"You follow your patient in regular consultation every month. Which of the following clinical or paraclinical elements is useful for monitoring recovery from this traumatic truncal nerve injury?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Electromyogram","justification":"As for most peripheral nerve damage, the EMG will make it possible to follow the (potention of) evolution with the monitoring of the speeds \/ amplitudes of the impulse."},{"idx":1,"correct":true,"proposition":"Motor clinical testing","justification":""},{"idx":2,"correct":true,"proposition":"Sensory clinical testing","justification":""},{"idx":3,"correct":false,"proposition":"Ultrasound","justification":""},{"idx":4,"correct":false,"proposition":"Muscle electrostimulation","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-9","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"You see the patient again in consultation 3 months after the initial trauma. She always has an abnormal gait. In the oscillating phase of walking on flat ground, the tip of the right foot is constantly lowered, it raises the knee higher than it does at the same phase on the left side. Which of these statements is (are) accurate?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"This is a waddling approach","justification":""},{"idx":1,"correct":true,"proposition":"This is a steppage approach","justification":""},{"idx":2,"correct":false,"proposition":"This is a hot step","justification":""},{"idx":3,"correct":false,"proposition":"This is an earlier greeting","justification":""},{"idx":4,"correct":false,"proposition":"This is a mowing process","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-10","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"The patient is increasingly anxious about walking due to her right sciatica neurological injury. She clings the tip of her right foot into a loose carpet at home, as she walked through a dark hallway. She stumbles and falls again. She can no longer support the right side because of pain. Here is the x-ray of the pelvis taken in the emergency room. What can you say from the X-ray? (one or more correct answers) ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Right sacrarian-iliac disjunction","justification":""},{"idx":1,"correct":false,"proposition":"Garden 3 fracture of the right femoral neck","justification":""},{"idx":2,"correct":true,"proposition":"Right ischiopubic branch fracture","justification":""},{"idx":3,"correct":false,"proposition":"Right pertrochanteric fracture","justification":""},{"idx":4,"correct":false,"proposition":"Fracture of the right little trochanter","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-11","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Which of the various factors that may have contributed to this patient's fall, which do you consider to be an intrinsic factor(s) of falling? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Faulty lighting","justification":"Environmental factor"},{"idx":1,"correct":true,"proposition":"Damage to the sciatic nerve","justification":""},{"idx":2,"correct":false,"proposition":"The poorly fixed carpet","justification":"Environmental factor"},{"idx":3,"correct":true,"proposition":"Age-related macular degeneration","justification":""},{"idx":4,"correct":false,"proposition":"The orthosis (calf-plant lifter) ineffective","justification":"Walking disorder = predisposing factor"}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-12","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Which of the following is considered an activity limitation in this patient? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A decrease in the range of motion of the right hip","justification":"Impairment"},{"idx":1,"correct":false,"proposition":"Pain when walking","justification":"Impairment"},{"idx":2,"correct":true,"proposition":"Difficulty climbing stairs","justification":""},{"idx":3,"correct":false,"proposition":"A sensory disorder of the sole of the right foot","justification":"Impairment"},{"idx":4,"correct":true,"proposition":"Reduced walking performance","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-13","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"You want to improve the patient's balance and walking disorders. Which of the following health professionals will contribute to the improvement of these symptoms?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Orthoptist"},{"idx":1,"correct":false,"proposition":"Speech therapist"},{"idx":2,"correct":true,"proposition":"Podo-orthotist"},{"idx":3,"correct":true,"proposition":"Physiotherapist"},{"idx":4,"correct":true,"proposition":"Psychomotor therapist"}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-14","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Given the patient's age, which insurance organization(s) will contribute to the patient's care?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Supplementary health fund","justification":""},{"idx":1,"correct":true,"proposition":"Caisse primaire d'assurance maladie","justification":""},{"idx":2,"correct":false,"proposition":"Communal social action services","justification":""},{"idx":3,"correct":false,"proposition":"Aid for the autonomy of the departmental council","justification":"APA is not insurance 😉"},{"idx":4,"correct":false,"proposition":"National Fund for Solidarity and Autonomy"}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-1","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"Among the following acrosyndromes, and at this stage of the semiological description, which one (or which) is (are) compatible with the clinical picture reported by Mrs. X.? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Acrocyanosis","justification":""},{"idx":1,"correct":true,"proposition":"Raynaud's phenomenon","justification":""},{"idx":2,"correct":true,"proposition":"Erythermalgia","justification":""},{"idx":3,"correct":false,"proposition":"Chilblains","justification":""},{"idx":4,"correct":false,"proposition":"Digital necrosis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-2","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"She tells you that these episodes are clearly triggered by the cold, and presents you at the consultation a photograph taken during one of these episodes. With this new information, the possible diagnosis(s) is: ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Secondary Raynaud's phenomenon","justification":""},{"idx":1,"correct":true,"proposition":"Raynaud's disease","justification":""},{"idx":2,"correct":false,"proposition":"Erythermalgia","justification":""},{"idx":3,"correct":false,"proposition":"Fine fibre neuropathy","justification":""},{"idx":4,"correct":false,"proposition":"Acrocyanosis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-3","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"You are diagnosed with Raynaud's phenomenon. What elements are to be looked for during the interrogation? (one or more expected answers) ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A cyanic phase","justification":""},{"idx":1,"correct":true,"proposition":"Damage to the toes","justification":""},{"idx":2,"correct":true,"proposition":"Thumb damage","justification":""},{"idx":3,"correct":true,"proposition":"A painful erythematous phase","justification":""},{"idx":4,"correct":false,"proposition":"Worsening when taking paracetamol","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-4","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"On physical examination of the patient, you note: \n\n- whitening of the hand after compression of the ulnar and radial arteries and << pumping maneuvers >>, then obtaining a recoloration of the hand in 3 seconds following the relaxation of the ulnar artery; and in 4 seconds after the relaxation of the radial artery; \n\n- the absence of paresthesias of the fingers at the percussion of the anterior surface of the wrist or during the forced flexion of the wrist. \n\nThe patient's physical examination favours (one or more correct answers)","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"From a normal Allen maneuver","justification":"The cut-off is 7-10 seconds."},{"idx":1,"correct":false,"proposition":"Thrombosis of the radial artery","justification":""},{"idx":2,"correct":false,"proposition":"A positive Tinel sign","justification":""},{"idx":3,"correct":false,"proposition":"From compression of the median nerve to carpal tunnel","justification":""},{"idx":4,"correct":false,"proposition":"A positive Phalen sign","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-5","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"What semiological element(s) are you looking for in favor of a secondary Raynaud's phenomenon? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Dry oral or ocular syndrome","justification":""},{"idx":1,"correct":true,"proposition":"Photosensitivity","justification":""},{"idx":2,"correct":true,"proposition":"Muscle pain","justification":""},{"idx":3,"correct":true,"proposition":"Scleroditactyly","justification":""},{"idx":4,"correct":true,"proposition":"Telangiectasias","justification":"Telangiectasias would be part of cutaneous scleroderma (CREST syndrome)."}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-6","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"When questioned by Mrs. X., she explains that these symptoms began around the age of 30, and occur every winter. She has no notable personal history, but her sister and mother have the same type of clinical manifestations. Thumbs are spared. It does not describe any other symptoms. On physical examination, you do not find trophic disorder, sclerodactyly or telangiectasia, peripheral pulses are perceived in all 4 limbs, and you do not notice audible murmur on auscultation of arterial pathways. Which clinical element(s) is compatible with Raynaud's disease (essential Raynaud's phenomenon)? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The age of onset of symptoms","justification":"We start to ask ourselves questions after 35 years."},{"idx":1,"correct":true,"proposition":"Family history","justification":""},{"idx":2,"correct":true,"proposition":"Winter upsurge","justification":""},{"idx":3,"correct":true,"proposition":"Lack of thumb involvement","justification":""},{"idx":3,"correct":true,"proposition":"Bilateral Achievement","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-7","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"In the clinical situation of Mrs. X., which additional examination(s) do you prescribe? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"X-ray of the spine from the front centered on C7","justification":""},{"idx":1,"correct":false,"proposition":"Chest x-ray from the front","justification":""},{"idx":2,"correct":false,"proposition":"Ultrasound-Doppler of the arteries of the upper limbs","justification":""},{"idx":3,"correct":false,"proposition":"Cryoglobulinemia detection","justification":""},{"idx":4,"correct":true,"proposition":"Antinuclear antibody testing","justification":"As well as a capillaroscopy."}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-8","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"Antinuclear antibodies are 1\/80. You retain the diagnosis of essential Raynaud's phenomenon (Raynaud's disease) and propose symptomatic management. Five years later, Mrs. X. is referred to you by her doctor for a fever that has been evolving for 4 weeks. This fever is irregular, oscillating with a temperature of 37.9 ° C in the morning but higher in the evening, can rise up to 39 ° C and associated with sweating. Mrs. X. is tired, she has lost 2 kg since the beginning of this fever. She has no other symptoms. She lives in an urban setting, has never travelled abroad, and does not take any treatment. The clinical picture currently presented by the patient is compatible with: (one or more exact answers) ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A solid cancer","justification":""},{"idx":1,"correct":false,"proposition":"A familial Mediterranean fever","justification":"The picture does not stick: it is rather that of a teenager."},{"idx":2,"correct":true,"proposition":"An infectious disease","justification":""},{"idx":3,"correct":true,"proposition":"Lymphoma","justification":""},{"idx":4,"correct":true,"proposition":"Takayasu's disease","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-9","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"In the clinical situation of the patient, what biological abnormality(s) would be suggestive of an inflammatory syndrome? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Increased albumin","justification":"Increase in all proteins except transport proteins: albumin, transferrin and transtyretrin."},{"idx":1,"correct":false,"proposition":"Decreased haptoglobin","justification":""},{"idx":2,"correct":true,"proposition":"Increased fibrinogen","justification":""},{"idx":3,"correct":true,"proposition":"Decreased transferrin","justification":""},{"idx":4,"correct":true,"proposition":"Increase in alpha2-globulins","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-10","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"On physical examination of the patient in the supine position, you perceive a mass of the left hypochondrium lowering on deep inhalation. Which of the following proposals do you think is accurate given this new clinical element?","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"This clinical finding is common in a young, thin patient","justification":""},{"idx":1,"correct":false,"proposition":"This clinical finding makes an infectious cause less likely","justification":"Many infections can be accompanied by splenomegaly: mononucleosis syndrome (HIV, CMV, toxoplasmosis, ...), endocarditis, hepatitis, malaria, ..."},{"idx":2,"correct":false,"proposition":"This clinical finding makes an autoimmune cause less likely ","justification":"Lupus, sarcoidosis and rheumatoid arthritis (to name only the less rare) are often accompanied by splenomegaly."},{"idx":3,"correct":true,"proposition":"This clinical finding can be observed in cases of liver disease","justification":"👉 This is a sign of portal hypertension."},{"idx":4,"correct":true,"proposition":"This clinical finding should suggest a haemological pathy","justification":"Including lymphomas."}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-11","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"On cardiac auscultation of Mrs. X., you perceive a systolic murmur at 2\/6. This heart murmur was not known until now. There is no associated diastolic murmur, heart sounds are regular, there are no signs of associated heart failure. You suspect infective endocarditis. What element(s) are you looking for to support your suspected diagnosis?","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Purpura of the lower limbs","justification":"Vascular pupura is an immunological manifestation"},{"idx":1,"correct":true,"proposition":"Purplish nodules of the pulp of the fingers ","justification":"This is called Osler's False Panaris (pathognomonic sign of infective endocarditis)."},{"idx":2,"correct":true,"proposition":"Proteinuria the urine strip","justification":""},{"idx":3,"correct":false,"proposition":"Distal paresthesias of the lower limbs","justification":""},{"idx":4,"correct":false,"proposition":"Red and painful eye","justification":"Roth's nodules can be observed at the back of the eye, but without affecting the anterior chamber."}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-12","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"At this stage of the treatment, which examination(s) do you think are justified?","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Angiotensin-converting enzyme assay","justification":""},{"idx":1,"correct":false,"proposition":"PET-scanner"},{"idx":2,"correct":true,"proposition":"Blood"},{"idx":3,"correct":false,"proposition":"Antibodiesanti-pegtidescitrullinated (anti-CCP)","justification":""},{"idx":4,"correct":true,"proposition":"Transthoracic cardiac ultrasound","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-13","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"Three blood cultures with aero-anaerobic cultures remain sterile, the good quality transthoracic cardiac ultrasound is normal, showing no vegetation image or significant valve abnormality. Which of the following proposals do you think is correct? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The realization of a trans-esophageal cardiac ultrasound is justified","justification":"The description of ETT is very reassuring. Blood cultures are negative. It is lawful to stop there."},{"idx":1,"correct":true,"proposition":"The realization of a thoraco-abdomino-pelvic CT scan is justified","justification":""},{"idx":2,"correct":true,"proposition":"The realization of viral serologies (HIV and EBV) is justified","justification":""},{"idx":3,"correct":false,"proposition":"A therapeutic test with corticosteroids is justified","justification":""},{"idx":4,"correct":false,"proposition":"A therapeutic test with antibiotics is justified","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-14","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"HIV serology is negative, and EBV serology supports ancient immunity. A thoraco-abdomino-pelvic CT scan shows supracentimetric mediastinal lymphadenopathy and splenomegaly. Which of the following tests do you think is the most relevant way to advance in the diagnostic investigation of the patient? (only one answer expected) ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Search for anti-neutrophil cytoplasmic antibodies (ANCA)","justification":""},{"idx":1,"correct":false,"proposition":"lmmunophenotyping lymphocyte","justification":""},{"idx":2,"correct":false,"proposition":"Plasma LDH determination","justification":""},{"idx":3,"correct":false,"proposition":"Splenic biopsy","justification":"A spleen is not biopsied because there is too great a risk of bleeding."},{"idx":4,"correct":true,"proposition":"Mediastinal lymph node biopsy","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-15","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"A diagnosis of diffuse large cell B-cell lymphoma is made by a lymph node biopsy performed by mediastinoscopy. An implantable chamber is placed and immunochemotherapy treatment with R-CHOP (rituximab - cyclophosphamide, hydroxydoxorubicin, vincristine and prednisone) is started. \n\nWhile the first 2 treatment cycles were uncomplicated, the patient ° presents on Day 10 of the 3rd treatment cycle a fever at 39 ° C with chills. You see her in an emergency consultation. Blood pressure is 130\/70 mmHg, heart rate is 95\/minute. The patient does not have a neurological disorder, the skin examination, especially with regard to the implantable chamber is normal, there is no obvious functional or physical respiratory, digestive or urinary sign. Your physical exam is normal. A blood count taken in town the same morning shows the following results: white blood cells 1.8 G\/L, hemoglobin 104 g\/L, mean corpuscular volume 85 fL, platelets 97 G\/L, leukocyte formula: neutrophils 0.4 G\/L eosinophilic polynuclear 0.1 G\/L, basophilic polynuclear 0.9 G\/L, lymphocytes 0.9 G\/L, monocytes 0.3 G\/L. What examination(s) do you perform before starting antibiotic therapy in your patient? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Aspergillary antigenemia","justification":""},{"idx":1,"correct":false,"proposition":"Blood smear looking for Jolly's bodies","justification":""},{"idx":2,"correct":true,"proposition":"Blood cultures on the periphery and on the central venous catheter","justification":""},{"idx":3,"correct":false,"proposition":"Chest X-ray","justification":""},{"idx":4,"correct":false,"proposition":"Thoraco-abdominal CT scan","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-16","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"Outpatient care is offered. Treatment with amoxicillin\/clavulanic acid + ciprofloxacin is started urgently. The fever disappears within 24 hours. Samples taken before the start of treatment remain sterile, and treatment is continued for 7 days. \n\nThree weeks later, the patient sees you again because of the onset of a fever at 39.5°C associated with the next rash. Which of the following may be present in your patient in case of drug reaction syndrome with eosinophilia and systemic signs (DRESS)? (one or more expected answers)","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Extensive skin detachment","justification":""},{"idx":1,"correct":true,"proposition":"eosinophilia> 1500\/mm3","justification":""},{"idx":2,"correct":true,"proposition":"elevation of transaminases with decrease of TP","justification":""},{"idx":3,"correct":true,"proposition":"acute renal failure","justification":""},{"idx":4,"correct":true,"proposition":"diffuse lymphadenopathy","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-1","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"Which additional examination should be carried out first at this stage?","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Chest x-ray from the front","justification":""},{"idx":1,"correct":false,"proposition":"Echocardiography","justification":""},{"idx":2,"correct":false,"proposition":"Chest CT scan","justification":""},{"idx":3,"correct":true,"proposition":"Electrocardiogram","justification":""},{"idx":4,"correct":false,"proposition":"Arterial blood gas","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-2","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"In the event of a myocardial infarction, which early life-threatening complication should you keep in mind as a priority during your initial management? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Cardiogenic shock","justification":"It is less early, less serious, and less common than ventricular fibrillation."},{"idx":1,"correct":false,"proposition":"Septal rupture","justification":""},{"idx":2,"correct":false,"proposition":"Pericarditis","justification":""},{"idx":3,"correct":true,"proposition":"Ventricular fibrillation","justification":""},{"idx":4,"correct":false,"proposition":"Intraventricular thrombosis ","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-3","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"The interrogation reveals that the pain is chronic, evolving crescendo for 3 months. The electrocardiogram performed immediately does not show an argument in favor of acute coronary syndrome. On physical examination, you find dyspnea at the slightest effort with appearance of edema of the bilateral lower limbs, a gain of 6 kg in 10 days as well as jugular turgor with hepatojugular reflux. The life constants are: BP 95\/65 mmHg, heart rate 112 beats\/min, OPS 98% ambient air, temperature 36.6 °C.  What are the two most likely diagnoses compatible with this clinical picture? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Acute edema of the lung","justification":"There would be no signs of right heart failure (OMI, TJ, RHJ)."},{"idx":1,"correct":true,"proposition":"Pericardial tamponade","justification":""},{"idx":2,"correct":false,"proposition":"Myocardial infarction","justification":""},{"idx":3,"correct":true,"proposition":"Recurrent pulmonary embolisms","justification":""},{"idx":4,"correct":false,"proposition":"Aortic dissection","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-4","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"By resuming your physical examination, the intern reports observing a paradoxical pulse. Which of the following proposals corresponds to the description of a paradoxical pulse? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Pulse attenuated one out of two heartbeats","justification":""},{"idx":1,"correct":false,"proposition":"Expiratory pulse depression","justification":""},{"idx":2,"correct":true,"proposition":"Inspiratory pulse depression","justification":"Sign of tamponade."},{"idx":3,"correct":false,"proposition":"Pulse perception after the second heart sound","justification":""},{"idx":4,"correct":false,"proposition":"Increased pulse sitting leaning forward","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-5","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"Inspiratory pulse depression confirms the paradoxical pulse. In this context, you ask for a front chest X-ray and echocardiography. What anomaly(s) do you identify on this shot taken in bed ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Right pleural effusion","justification":"We distinguish the pleural cul de sac."},{"idx":1,"correct":true,"proposition":"Cardiomegaly","justification":""},{"idx":2,"correct":false,"proposition":"Aspect of double aortic contour","justification":""},{"idx":3,"correct":false,"proposition":"Protrusion of the lower left arch of the cardiac silhouette","justification":"We asked a radiology PU-PH for his opinion on these two proposals. His answer: the protrusions of the heart arches correspond to cardiomegaly, but only when it is the heart that exceeds its usual size. We can not speak strictly of protrusion here, since the paradoxical pulse directs you to a pericardial effusion. "},{"idx":4,"correct":false,"proposition":"Protrusion of the lower right arch of the cardiac silhouette","justification":"We asked a radiology PU-PH for his opinion on these two proposals. His answer: the protrusions of the heart arches correspond to cardiomegaly, but only when it is the heart that exceeds its usual size. We can not speak strictly of protrusion here, since the paradoxical pulse directs you to a pericardial effusion. "}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-6","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"On echocardiography, there is a circumferential pericardial effusion of great abundance with hemodynamic impact and a scalloped appearance of the serosa. You retain the diagnosis of pericardial tamponade. What element(s) is (are) involved in the pathophysiology of tamponade? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Decreased systolic ejection volume of the left ventricle","justification":""},{"idx":1,"correct":true,"proposition":"Compression of the right ventricle","justification":""},{"idx":2,"correct":false,"proposition":"Compensatory bradycardia","justification":""},{"idx":3,"correct":true,"proposition":"Increased intrapericardial pressures","justification":""},{"idx":4,"correct":false,"proposition":"Shunt effect","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-7","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"What is (are) the therapeutic measure(s) to be applied urgently in front of this tamponade? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Pericardial drainage","justification":""},{"idx":1,"correct":false,"proposition":"Intravenous infusion of nitrates","justification":"It's not an OAP"},{"idx":2,"correct":false,"proposition":"Infusion of catecholamines (dobutamine or noradrenaline)","justification":""},{"idx":3,"correct":false,"proposition":"Volume depletion","justification":"It's not an OAP"},{"idx":4,"correct":false,"proposition":"Parenteral anticoagulation","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-8","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"You transfer the patient for emergency drainage to the cardiac surgery block. 1,000 mL of bloody fluid was punctured. The pathologist identifies the presence of tumor cells of adenocarcinomatous nature. She was then admitted to intensive care. Which underlying primary tumor can you end up with a significant probability? (one or more correct answer(s)) ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Breast cancer","justification":""},{"idx":1,"correct":false,"proposition":"Melanoma","justification":"It is not adenocarcinoma"},{"idx":2,"correct":true,"proposition":"Lung cancer","justification":""},{"idx":3,"correct":false,"proposition":"Cavum cancer","justification":"It is not adenocarcinoma"},{"idx":4,"correct":false,"proposition":"Cervical cancer","justification":"It is not adenocarcinoma"}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-9","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"A chest CT scan identifies in addition to neoplastic pericarditis in particular: a left hilar tumor mass extending to the apico-dorsal segment of the culmen associated with homolateral mediastinal adenomegaly, bilateral pleural effusion. What is the stage of the disease?","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"1","justification":""},{"idx":0,"correct":false,"proposition":"2","justification":""},{"idx":0,"correct":false,"proposition":"3a","justification":""},{"idx":0,"correct":false,"proposition":"3b","justification":""},{"idx":0,"correct":true,"proposition":"4","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-10","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"In the case of primary stage IV bronchial adenocarcinoma, what extension assessment do you request in the absence of a new symptom (one or more correct response(s))?","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Brain CT scan","justification":""},{"idx":1,"correct":false,"proposition":"Abdominopelvic CT scan","justification":""},{"idx":2,"correct":false,"proposition":"Bone scintigraphy","justification":""},{"idx":3,"correct":false,"proposition":"Panendoscopy","justification":""},{"idx":4,"correct":true,"proposition":"None","justification":"The tumour is stage IV (disseminated). The extension assessment has no therapeutic impact."}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-11","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"What is the reference oncological treatment for this stage IV bronchial cancer (one or more possible response(s))? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Pneumo-pleuro-pericardectomy","justification":""},{"idx":1,"correct":false,"proposition":"Mediastinal radiation therapy","justification":""},{"idx":2,"correct":true,"proposition":"Systemic chemotherapy","justification":""},{"idx":3,"correct":false,"proposition":"Intrapericardial chemotherapy","justification":""},{"idx":4,"correct":true,"proposition":"Supportive care","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-12","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"The general condition being preserved, you retain an indication of systemic treatment of metastatic first-line associated with palliative care. What will you look for on the pathological report of pericardial drainage fluid to guide the choice of systemic treatment (one or more possible answers)? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"EGFR activating mutation","justification":""},{"idx":1,"correct":true,"proposition":"Expression de PDL1","justification":""},{"idx":2,"correct":true,"proposition":"Mutation de BRAF","justification":""},{"idx":3,"correct":true,"proposition":"Translocation of ALK","justification":""},{"idx":4,"correct":false,"proposition":"Nothing in particular, chemotherapy being based on a doublet of conventional drugs","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-13","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"In the absence of targetable molecular alteration and expression of PDL1, you retain the indication of chemotherapy with carboplatin \/ paclitaxel. What is(s) the main expected side effect(s) of carboplatin of which you inform the patient? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Asthenia","justification":"the 2"},{"idx":1,"correct":true,"proposition":"Stomatitis","justification":"the 2"},{"idx":2,"correct":true,"proposition":"Cytopenia","justification":"the 2"},{"idx":3,"correct":true,"proposition":"Peripheral neuropathy","justification":"paclitaxel"},{"idx":4,"correct":false,"proposition":"Hearing loss","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-14","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"Finally the situation is complicated with a DICD not allowing to start chemotherapy. You move towards exclusive palliative care and decide to hospitalize the patient in a palliative care unit. Regarding palliative care units (PHUs), what is(are) the exact statement(s)? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Their mission is to admit patients in end-of-life situations and who present a complex situation of care","justification":""},{"idx":1,"correct":false,"proposition":"The essential criterion for a patient to be admitted to USP is that his survival is estimated at less than three months","justification":""},{"idx":2,"correct":true,"proposition":"The main objective of a USP treatment is to improve the patient's quality of life","justification":""},{"idx":3,"correct":true,"proposition":"Chemotherapy treatments can be continued even while the patient is hospitalized in USP","justification":""},{"idx":4,"correct":false,"proposition":"The visit of children under 10 years old is not allowed in USP","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-15","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"After a few days of hospitalization in the palliative care unit, the situation, although precarious, stabilized and the patient expressed the wish to return home. What element(s) could jeopardize the organization of this return home? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Physical or moral exhaustion of loved ones","justification":""},{"idx":1,"correct":false,"proposition":"The need for 3 electric syringes","justification":""},{"idx":2,"correct":true,"proposition":"A refusal of the family to consider death at home","justification":""},{"idx":3,"correct":false,"proposition":"The need for morphine treatment at a high dosage","justification":""},{"idx":4,"correct":true,"proposition":"A lack of mobilization of the attending physician","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-1","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What therapeutic care do you offer for this diabetes? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"800 kcal\/d and low-carbohydrate diet","justification":""},{"idx":1,"correct":true,"proposition":"Low-calorie diet (30% reduction in current intake) and low in fast sugars","justification":""},{"idx":2,"correct":false,"proposition":"Metformin therapy","justification":"We always start with hygiene measures in type 2 diabetes."},{"idx":3,"correct":false,"proposition":"Treatment with slow insulin and basal bolus","justification":""},{"idx":4,"correct":true,"proposition":"Physical activity","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-2","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"You recover the following balance: creatinine at 130 μmol \/ L or a glomerular filtration rate CKD-PPE estimated at 52 ml \/ min \/ 1.73 m ^2 \nUrine strip: protein three cross, red blood cells three cross, leukocytes negative, nitrites negative, ketone bodies negative. What biological tests are needed at this stage? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Renin aldosterone dosage","justification":""},{"idx":1,"correct":true,"proposition":"Cytobacteriological examination of urine","justification":""},{"idx":2,"correct":true,"proposition":"24-hour proteinuria","justification":""},{"idx":3,"correct":false,"proposition":"Anti-neutrophil cytoplasmic antibodies (ANCA)","justification":""},{"idx":4,"correct":false,"proposition":"Anti-PLA2R antibodies","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-3","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"The results are as follows: \nECBU: red blood cells at 80,000\/ml, leukocytes< 1000\/ml, negative culture over 24 h. \n24-hour proteinuria: 2.5 g\/d composed of 70% albumin. \nWhat are the additional examinations to be carried out in the face of these anomalies? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" Fundus","justification":""},{"idx":1,"correct":true,"proposition":"Vesicorenal ultrasound with arterial Doppler","justification":""},{"idx":2,"correct":false,"proposition":"Accessory salivary gland biopsy","justification":""},{"idx":3,"correct":false,"proposition":"Renal MRI angiography","justification":""},{"idx":4,"correct":false,"proposition":"Uroscanner","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-4","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"The fundus finds arterial stiffness with sign of crossing without further lesion. Renal Doppler ultrasound finds normal-sized kidneys without dilation of the pyelocalicial cavities. There is a simple kidney cyst of 1 cm on the right and one of 4 mm on the left. The Doppler analysis is not very contributory given the morphotype of the patient but the radiologist indicates that he does not find an indirect sign for significant renal arterial stenosis. \nThere is a 12 mm tissue-like image at the lower bladder bottom. In addition, despite the appropriate hygiene measures, diabetes control is unsatisfactory and you start treatment with metformin at a dose of 500 mg at a frequency of 3 times \/ day. Given these results, what can be the causes of this hematuria (one or more correct answers)?","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Polycystic kidney disease","justification":""},{"idx":1,"correct":false,"proposition":"Diabetic glomerular nephropathy","justification":"Hematuria is not found in diabetic glomerular nephropathy"},{"idx":2,"correct":true,"proposition":"lgA nephropathy","justification":""},{"idx":3,"correct":true,"proposition":"Urothelial tumour","justification":"The ultrasound imagining orients us somewhat."},{"idx":4,"correct":true,"proposition":"Extramembranous glomerulonephritis","justification":"GEM can be accompanied by hematuria"}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-5","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What tests are needed to explore this hematuria at this stage? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Puncture kidney biopsy","justification":""},{"idx":1,"correct":true,"proposition":"Bladder fibroscopy","justification":""},{"idx":2,"correct":true,"proposition":"Urinary cytology on fresh urine with histopathological examination","justification":""},{"idx":3,"correct":true,"proposition":"Uroscanner","justification":""},{"idx":4,"correct":false,"proposition":"Ascending urethrocystography and voiding","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-6","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"You decide to do urinary cytology and bladder fibroscopy. \nRegarding the possible realization of the uroscanner in your patient, which proposals are accurate (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"This examination is contraindicated in this patient","justification":""},{"idx":1,"correct":true,"proposition":"Metformin should be stopped on the day of the exam","justification":"It will be reintroduced on Day 2."},{"idx":2,"correct":false,"proposition":"Hydration by glucose solute is to be expected before the examination","justification":""},{"idx":3,"correct":true,"proposition":"Oral hydration is to be expected before the examination","justification":""},{"idx":4,"correct":false,"proposition":"There is a risk of acute interstitial nephritis","justification":"There is a risk of acute tubular necrosis."}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-7","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"The uroscanner did not find any other urothelial lesions. Cystoscopy confirmed the existence of the polyp and a transurethral resection of the bladder polyp was performed. Anatomical pathology has shown that it is a low-grade urothelial carcinoma pTa. What is the exact proposal regarding his tumor? (an expected response) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is an invasive tumor infiltrating the muscle","justification":"From T2"},{"idx":1,"correct":false,"proposition":"This is carcinoma in situ","justification":"Tis"},{"idx":2,"correct":false,"proposition":"It is a tumor infiltrating the chorion","justification":"T1"},{"idx":3,"correct":true,"proposition":"It is a non-invasive papillary tumour","justification":""},{"idx":4,"correct":false,"proposition":"It is an epidermoid tumor","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-8","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"In the absence of diabetic retinopathy, you decide to perform a kidney biopsy. The pathology report is as follows: \n8 mm renal cortical fragment containing 12 glomeruli including 2 sclerotic glomeruli. \nThe remaining 10 glomeruli exhibit nodular mesangial expansion with thickening of the basement membranes. \nThere is moderate arteriolar hyalinosis and interstitial fibrosis affecting 20% of the parenchyma of the biopsy. \nThe coloration by Congo red is negative. \nThe immunofluorescence study does not find significant deposits in the glomeruli. \nWhat is the most likely diagnosis (only one response expected) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Pauciimmune glomerulonephritis","justification":""},{"idx":1,"correct":false,"proposition":"Nephroangiosclerosis","justification":""},{"idx":2,"correct":false,"proposition":"Renal amyloidosis","justification":""},{"idx":3,"correct":true,"proposition":"Diabetic glomerulosclerosis","justification":""},{"idx":4,"correct":false,"proposition":"Membranoproliferative glomerulonephritis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-9","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"Your patient therefore has diabetic glomerulosclerosis. Its renal function stabilizes at 135 μmol\/I (DFG CKD EPI = 50 ml\/min\/1.73 m^22). What is the stage of his chronic kidney disease? (an expected response) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Stage 2","justification":""},{"idx":1,"correct":true,"proposition":"Stage 3A","justification":""},{"idx":2,"correct":false,"proposition":"Stage 1","justification":""},{"idx":3,"correct":false,"proposition":"Stage 3B","justification":""},{"idx":4,"correct":false,"proposition":"Stage 4","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-10","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What are the treatment targets in this patient at this stage? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Proteinuria < 0.5 g\/24 hours","justification":""},{"idx":1,"correct":false,"proposition":"Negativation of hematuria","justification":"Hematuria is not a nephrological cause. It comes from his tumor."},{"idx":2,"correct":false,"proposition":"Blood pressure less than or equal to 120\/70 mmHg","justification":""},{"idx":3,"correct":false,"proposition":"Protein intake less than 0.6 g\/kg\/day","justification":""},{"idx":4,"correct":true,"proposition":"Salt intake close to 6 g\/24 hours","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-11","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"Which of the following molecules can be prescribed as a first-line treatment for this patient for high blood pressure? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"ACE inhibitor (ACE inhibitor)","justification":""},{"idx":1,"correct":true,"proposition":"Angiotensin II receptor antagonist (ARA2)","justification":""},{"idx":2,"correct":true,"proposition":"Angiotensin-thiazide receptor antagonist association","justification":"As a second line (amlodipine does not seem to be sufficient here)."},{"idx":3,"correct":true,"proposition":"Thiazide","justification":""},{"idx":4,"correct":false,"proposition":"Beta-blocker","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-12","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What therapies are possible in this patient to reduce cardiovascular risk? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Clopidogrel","justification":""},{"idx":1,"correct":false,"proposition":"Effective anticoagulation","justification":""},{"idx":2,"correct":true,"proposition":"Statine","justification":""},{"idx":3,"correct":false,"proposition":"Allopurinol","justification":""},{"idx":4,"correct":false,"proposition":"Fibrate","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-13","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"You have prescribed an angiotensin 2-thiazide receptor antagonist combination. You see him again in nephrology consultation two months later with a control biological assessment. He tells you that he was bedridden for a few days due to sciatica and that he took ibuprofen in self-medication. His blood pressure is 122\/73 mmHg, his heart rate is 82\/min. The electrocardiogram is normal. The blood test is as follows: Na 140 mmol\/L, K 5.5 mmol\/L, HCO3 21 mmol\/L, urea 18 mmol\/L, creatinine 212 μmol\/L. What are the factors that may have favored this acute renal failure (one or more exact responses) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Taking nonsteroidal anti-inflammatory drugs","justification":""},{"idx":1,"correct":false,"proposition":"Intracellular dehydration","justification":""},{"idx":2,"correct":true,"proposition":"Stenosis of the renal arteries","justification":""},{"idx":3,"correct":true,"proposition":"Treatment with angiotensin 2 and thiazide receptor antagonist","justification":""},{"idx":4,"correct":false,"proposition":"Metformin therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-14","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What is your therapeutic attitude? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Stop ibuprofen","justification":""},{"idx":1,"correct":true,"proposition":"Suspend angiotensin receptor antagonist 2","justification":""},{"idx":2,"correct":true,"proposition":"Suspend thiazide","justification":""},{"idx":3,"correct":false,"proposition":"Infusion of calcium gluconate ampoule IVD","justification":""},{"idx":4,"correct":false,"proposition":"Replace metformin with a sulphonylurea","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-15","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"Her kidney function has improved thanks to your treatment and her serum creatinine has stabilized at 140 μmol\/L. You want to formally rule out stenosis of the renal arteries. What imaging tests are appropriate for this patient at this stage? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Renal Doppler ultrasound","justification":"Been there, done that 🤷 ♂️"},{"idx":1,"correct":true,"proposition":"Renal angiography","justification":""},{"idx":2,"correct":false,"proposition":"Kidney scan with captopril test","justification":""},{"idx":3,"correct":true,"proposition":"Renal MRI angiography","justification":""},{"idx":4,"correct":false,"proposition":"Renal arteriography","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-16","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"You have performed the following radiological examination. What are the exact proposals? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Arrow 1 corresponds to the small intestine","justification":"It is rather the colon (the colonist is the most peripheral, if there is nothing on the right 👉 it is the colon 💩!)."},{"idx":1,"correct":true,"proposition":"Arrow 2 corresponds to the superior mesenteric vein","justification":""},{"idx":2,"correct":false,"proposition":"Arrow 3 corresponds to the pylorus","justification":"This is the pancreas. We are too low for the stomach."},{"idx":3,"correct":true,"proposition":"Arrow 4 corresponds to the right renal artery","justification":""},{"idx":4,"correct":true,"proposition":"The examination is done at an arterial phase","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-17","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"The examination performed does not find significant stenosis. What advice do you give to your patient following this episode? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Hydration by Vichy water 2 liters \/ day","justification":""},{"idx":1,"correct":true,"proposition":"Drinks of at least 1 liter\/day and suitable for 24-hour diuresis","justification":""},{"idx":2,"correct":true,"proposition":"Suspend angiotensin II receptor antagonist and thiazide in dehydration","justification":""},{"idx":3,"correct":false,"proposition":"Hydration by low mineralized water 2 liters \/ day","justification":""},{"idx":4,"correct":true,"proposition":"Formal contraindication to nonsteroidal anti-inflammatory drugs","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-1","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"During your first consultation, what element(s) could guide you towards secondary obesity? ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"His waistline","justification":""},{"idx":1,"correct":false,"proposition":"An acanthosis nigricans","justification":"Acanthosis nigricans is an aspecific sign of insulin resistance."},{"idx":2,"correct":true,"proposition":"Colored stretch marks from the root of the limbs","justification":"The famous 'purple stretch marks'."},{"idx":3,"correct":true,"proposition":"Edema of the lower limbs","justification":"Extracellular hyperhydration is not classic."},{"idx":4,"correct":true,"proposition":"Bruising of the forearms","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-2","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"Waist circumference is measured at 102 cm and hip circumference at 128 cm. There is no acanthosis nigricans. You notice some stretch marks that the patient reports as related to her weight changes. His blood pressure is measured at 140\/84 mmHg. You prescribe an initial biological assessment. What will it include in the first intention? (one or more correct answers) ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Free thyroxine","justification":""},{"idx":1,"correct":true,"proposition":"Fasting blood glucose","justification":""},{"idx":2,"correct":true,"proposition":"Lipid profile","justification":""},{"idx":3,"correct":true,"proposition":"Uricemia","justification":"Uricemia is part of the list of the systematic bio assessment in front of adult obesity in the college 🤷 ♂️ (page 357 of the 2021 edition)."},{"idx":4,"correct":false,"proposition":"24-hour urinary free cortisol","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-3","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"You see her again a month later, the weight is the same and the patient explains that she is very interested in bariatric surgery and wants more information. Which proposal(s) is (are) accurate?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"he sleep apnea syndrome is a contraindication to performing bariatric surgery","justification":""},{"idx":1,"correct":true,"proposition":"bariatric surgery has no indication when the BMI is less than 35 kg\/m2","justification":""},{"idx":2,"correct":false,"proposition":"Gastric banding is the technique that has shown the most effective","justification":""},{"idx":3,"correct":true,"proposition":"bariatric surgery cannot be performed until summer","justification":""},{"idx":4,"correct":true,"proposition":"Gastric bypass is responsible for weight loss through both restriction and malabsorption"}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-5","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"It presents the results of the prescribed biological assessment: \n\nnatremia 138 mmol\/L; \n\nserum potassium level 3.2 mmol\/L; \n\nfasting blood glucose 1.16 g\/L (6.38 mmol\/L); \n\ntotal cholesterol 1.83 g\/L (N: 1.8-2.4); \n\ntriglycerides 2.58 g\/L (N: 0.7-1.5); \n\nHDL-cholesterol 0.40 g\/L (N: 0.45-0.90); \n\nLDL-cholesterol 0.91 g\/L (N: 0.6-1.6); \n\nAST 38 IU\/L (N < 20); ALT 65 IU\/L (N< 40). \n\nYou suspect Cushing's syndrome. What arguments point to this hypothesis? (one or more correct answers) ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Blood sugar","justification":"Hyperglycemia can quite fit into the nosological framework of a common obesity and does not particularly point to a Cushing's syndrome."},{"idx":1,"correct":true,"proposition":"Potassium levels","justification":""},{"idx":2,"correct":false,"proposition":"Blood triglyceride levels","justification":"Hypertriglyceridemia can quite fit into the nosological framework of a common obesity and does not particularly point to a Cushing's syndrome."},{"idx":3,"correct":false,"proposition":"LDL-cholesterol levels","justification":"LDL-cholesterol levels are normal here."},{"idx":4,"correct":false,"proposition":"The level of transaminases","justification":"Cytolysis can quite fit into the nosological framework of a common obesity and does not particularly point to a Cushing's syndrome."}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-6","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"What biological tests can you order to support your diagnostic hypothesis? (one or more correct answers) ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Plasma cortisol at 8 o'clock","justification":""},{"idx":1,"correct":false,"proposition":"Plasma ACTH at 8 o'clock","justification":""},{"idx":2,"correct":false,"proposition":"Dosage of ACTH at midnight","justification":""},{"idx":3,"correct":true,"proposition":"Salivary cortisol at midnight","justification":""},{"idx":4,"correct":true,"proposition":"Dexamethasone minute brake test","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-7","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"She tells you that she had an abdominal CT scan a few weeks ago because of abdominal pain. Two sections are reproduced below. Arrows with numbers represent anatomical structures. What is the exact answer(s)? ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"1 represents the right adrenal","justification":""},{"idx":1,"correct":false,"proposition":"2 represents the transverse colon","justification":"Stomach (we are too high to see the transverse colon, we do not see small intestine or right\/left colon)."},{"idx":2,"correct":true,"proposition":"3 represents the spleen","justification":""},{"idx":3,"correct":false,"proposition":"4 represents the inferior vena cava","justification":"This is the aorta. The VCI is very prominent."},{"idx":4,"correct":true,"proposition":"5 represents the body of the pancreas","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-8","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The abdominal CT scan she performed was normal. The report you gave him gives the following results: salivary cortisol at midnight at 4 times normal. You have confirmed hypercortisolism by a 24-hour urine free cortisol assay with a result of 245 μg\/24 hours (N < 60). ACTH was dosed at 85 pg\/mL (N: 10-50). Which exam(s) can you now prescribe? ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A metopirone test","justification":""},{"idx":1,"correct":true,"proposition":"A test at the CRH","justification":"The increase in cortisol after a CRH injection may confirm the pituitary origin of the hypersecretion (versus a paraneoplastic origin)."},{"idx":2,"correct":false,"proposition":"A dosage of delta 4 androstenedione","justification":""},{"idx":3,"correct":true,"proposition":"Pituitary MRI","justification":""},{"idx":4,"correct":false,"proposition":"Insulin hypoglycemia","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-9","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The CRH test shows a marked elevation of ACTH and cortisol. A section of the pituitary MRI you prescribed is reproduced below. Arrows with letters represent anatomical structures. Which structure(s) is correctly identified?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A represents the third ventricle","justification":""},{"idx":1,"correct":true,"proposition":"B represents the optical chiasm","justification":""},{"idx":2,"correct":true,"proposition":"C represents pituitary adenoma","justification":""},{"idx":3,"correct":false,"proposition":"D represents the cavernous sinus","justification":""},{"idx":4,"correct":true,"proposition":"E represents the left internal carotid artery","justification":"She makes a little bow of families (that's why we see her twice 🥐)"}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-10","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"In front of this pituitary macroadenoma, you want to complete your biological assessment. Which of the following proposals do you think is relevant to prescribe in this context? ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"T4 assay","justification":"TSH + T4 assay"},{"idx":1,"correct":false,"proposition":"DHA Testing","justification":"DHA is secreted by the post-pituitary gland."},{"idx":2,"correct":false,"proposition":"GnRH testing","justification":""},{"idx":3,"correct":false,"proposition":"Dosage de la POMC","justification":"Almost never doses."},{"idx":4,"correct":true,"proposition":"Prolactin Determination","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-11","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The complementary balance shows: TSH 1.1 mIU\/L (N: 0.4-4); T4 14.8 pmol\/L (N: 8-20); estradiol 10 pg\/ml (N: 40-150); FSH 0, 1 IU\/L (N: 2-6); LH 0.5 IU\/L (N: 2-8); prolactin 30 μg\/L (N 25). What elements do you mention about this assessment? (one or more correct answers)","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Central hypothyroidism","justification":""},{"idx":1,"correct":true,"proposition":"Disconnection hyperprolactinemia","justification":"We speak of disconnection because < 100 μg\/L. Beyond that, we can talk about a prolactinoma."},{"idx":2,"correct":true,"proposition":"Hypogonadotropic hypogonadism","justification":""},{"idx":3,"correct":true,"proposition":"Pituitary anterior insufficiency","justification":"To check each time you have a deficiency of a lineage, it is an anterior pituitary insufficiency. Not to be confused with panhypopituitarism."},{"idx":4,"correct":false,"proposition":"Somatotropic deficiency","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-12","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"To assess the impact of this Cushing's syndrome, you prescribe a bone densitometry, the results of which are reproduced below.\nWhich of the following is correct?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"There is trabecular osteoporosis","justification":""},{"idx":1,"correct":true,"proposition":"The risk of spinal fracture (RA) is 73%","justification":""},{"idx":2,"correct":true,"proposition":"The disorders observed may be increased by estrogenic deficiency","justification":""},{"idx":3,"correct":true,"proposition":"The observed disorders may be increased by hyperprolactinemia","justification":""},{"idx":4,"correct":false,"proposition":"The observed disorders may be increased by obesity","justification":"Obesity does not lead to osteoporosis. It is even sometimes considered a protective factor: more fatty 👉 tissue more protection of the bone in case of trauma."}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-13","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"You retain the diagnosis of corticotropic macro-adenoma and entrust the patient to your neurosurgeon colleague who practices his public activity at the CHU. He performed a rhinoseptal resection of this adenoma a few days later. There is no intraoperative incident and the neurosurgeon considers its excision satisfactory. In the recovery room, the patient quickly desaturates and presents a state of shock. Resuscitation measures are started immediately. However, the patient died a few minutes later. In this context, the neurosurgeon would like to perform a scientific autopsy to know the exact causes of death. What is (are) the procedure(s) to be carried out before this autopsy can be carried out ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Querying the automated national register of refusals","justification":""},{"idx":1,"correct":false,"proposition":"Judicial report to the public prosecutor","justification":""},{"idx":2,"correct":true,"proposition":"Obtaining the approval of a pathologist to perform the autopsy","justification":""},{"idx":3,"correct":false,"proposition":"Search for an organ donor card in the patient","justification":""},{"idx":4,"correct":true,"proposition":"Interview with the family to seek the non-opposition of the patient during her lifetime","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-14","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The patient's family wishes to obtain a medical certificate. For what reason(s) can the doctor write it?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"To find out the cause of death","justification":""},{"idx":1,"correct":true,"proposition":"To defend the memory of the deceased","justification":""},{"idx":2,"correct":false,"proposition":"To provide a comprehensive list of the patient's history","justification":""},{"idx":3,"correct":false,"proposition":"To rule out a suicide"},{"idx":4,"correct":true,"proposition":"To assert the rights of the family","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-15","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The scientific autopsy performed reveals a massive proximal pulmonary embolism of both branches of the pulmonary artery. The family decides to initiate proceedings. What type(s) of responsibility can be engaged then?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Criminal liability of the physician","justification":""},{"idx":1,"correct":false,"proposition":"No-fault liability of the physician","justification":"The patient died."},{"idx":2,"correct":true,"proposition":"Physician's civil liability","justification":"It will be engaged in case of detachable fault of the establishment."},{"idx":3,"correct":true,"proposition":"Administrative responsibility of the institution","justification":""},{"idx":4,"correct":true,"proposition":"Disciplinary responsibility of the physician","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-1","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Which diagnosis do you mention as a priority?","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Infantile hemangioma"},{"idx":1,"correct":false,"proposition":"Planar angioma"},{"idx":2,"correct":false,"proposition":"Syndrome de Kasabach-Merritt","justification":""},{"idx":3,"correct":false,"proposition":"Venous angioma"},{"idx":4,"correct":false,"proposition":"Lymphangioma"}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-2","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"You suspect an infantile hemangioma. What is (are) the semiological element(s) that you will find at Romain's clinical examination? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A blowing character to auscultation","justification":""},{"idx":1,"correct":false,"proposition":"A shudder on palpation","justification":""},{"idx":2,"correct":true,"proposition":"An elastic consistency on palpation","justification":""},{"idx":3,"correct":false,"proposition":"A flat character on palpation","justification":""},{"idx":4,"correct":false,"proposition":"Hypertrophy of the hemiface on inspection","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-3","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Romain's parents ask you about the evolution and possible complications to expect from this infantile hemangioma. What do you say to them? (one or more correct answers) ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A histological examination of the lesion makes it possible to better specify the chances of spontaneous involution","justification":""},{"idx":1,"correct":true,"proposition":"A growth phase may occur during the next few months","justification":""},{"idx":2,"correct":true,"proposition":"There is a risk of amblyopia","justification":"Given the location of this hemangioma, there is a risk that it covers the eye of little Theo and that this leads to functional 😥 amblyopia."},{"idx":3,"correct":true,"proposition":"The lesion may ulcerate","justification":""},{"idx":4,"correct":true,"proposition":"Complete disappearance without sequelae occurs in 50% of cases","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-4","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Parents are concerned about the risk of growth of the lesion and the risk of functional amblyopia by occlusion of the cleft palpebral, and ask if treatment will then be offered for Romain. What do you say to them? (one or more correct answers) ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Treatment with propranolol will be offered","justification":""},{"idx":1,"correct":false,"proposition":"Pulsed dye laser treatment will be offered","justification":""},{"idx":2,"correct":false,"proposition":"Embolization treatment in interventional radiology will be proposed","justification":""},{"idx":3,"correct":false,"proposition":"Surgical treatment will be offered","justification":""},{"idx":4,"correct":false,"proposition":"Low molecular weight heparin therapy will be proposed","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-5","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Following a phase of growth of the lesion and the risk of impact on the palpebral opening, treatment with propranolol was put in place, allowing the complete disappearance of the lesion, without sequelae. You see Romain again in consultation at the age of 18 months because he has for several weeks an itchy skin involvement predominant on the face, and his sleep is disturbed. It is apyretic with conservation of the general condition. What semiological element(s) do you identify on this image?","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Xerosis","justification":"Hard to see in this photo."},{"idx":1,"correct":true,"proposition":"Erythema","justification":""},{"idx":2,"correct":false,"proposition":"Excoriations","justification":"Hard to see in this photo."},{"idx":3,"correct":false,"proposition":"Exanthema","justification":""},{"idx":4,"correct":false,"proposition":"Enanthemum","justification":"No mucous membrane is seen."}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-6","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Which of the following interrogation elements is relevant, if present, to support the diagnosis you suspect in Romain? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"History of asthma in Romain's father","justification":""},{"idx":1,"correct":false,"proposition":"History of psoriasis in Romain's mother","justification":"Psoriasis is not affected by atopic risk."},{"idx":2,"correct":true,"proposition":"Cow's milk protein allergy in Romain's brother","justification":""},{"idx":3,"correct":false,"proposition":"Recent pruritus in several family members","justification":"We are not looking for scabies but rather eczema (= atopic dermatitis) 😅"},{"idx":4,"correct":false,"proposition":"Frequent herpetic recurrences in Romain's mother","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-7","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"You are diagnosed with atopic dermatitis motivating local corticosteroid therapy. What attitude(s) of prevention and prophylaxis do you put in place? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Adapt the vaccination schedule according to the evolution of the pathology","justification":""},{"idx":1,"correct":false,"proposition":"Prophylaxis of herpes superinfections with aciclovir","justification":""},{"idx":2,"correct":false,"proposition":"Prevention of superinfection by regular use of antiseptics","justification":""},{"idx":3,"correct":true,"proposition":"Daily use of fragrance-free emollients on body and face","justification":""},{"idx":4,"correct":true,"proposition":"Maintain a cool temperature in the room","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-8","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"You see again urgently Romain 1 month later for a predominant rash on the trunk, appeared the night before, in a context of fever up to 39 ° C for 2 days, without alteration of the general condition. The temperature measured in the office is 37.2 ° C (last taken of paracetamol 24 hours ago). The clinical examination, apart from the skin examination, is unremarkable. What diagnosis(s) do you mention?","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Food allergies"},{"idx":1,"correct":false,"proposition":"Syndrome de Kaposi-Juliusberg","justification":""},{"idx":2,"correct":false,"proposition":"Measles"},{"idx":3,"correct":true,"proposition":"Infantile roseola"},{"idx":4,"correct":false,"proposition":"Epidemic megalerythema"}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-9","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"You mention an infantile roseola (or sudden exanthema of the infant). What is the causative infectious agent? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Epstein-Barr virus"},{"idx":1,"correct":false,"proposition":"HSV-1 (herpes simplex virus)","justification":""},{"idx":2,"correct":false,"proposition":"Group A streptococcus"},{"idx":3,"correct":true,"proposition":"HHV-6 (herpes virus type 6)"},{"idx":4,"correct":false,"proposition":"Parvovirus B19"}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-10","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"What recommendation(s) and\/or prescription(s) do you make to parents regarding the management of Romain roseola? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Eviction from the nursery for 10 days","justification":""},{"idx":1,"correct":false,"proposition":"Realization of a urine strip for proteinuria in 3 weeks","justification":""},{"idx":2,"correct":false,"proposition":"Prescription of ibuprofen","justification":""},{"idx":3,"correct":true,"proposition":"Prescription of paracetamol 15 mg\/kg every 4 to 6 hours, if fever rises","justification":""},{"idx":4,"correct":false,"proposition":"Prescription of a 17-butyrate hydrocortisone cream with 1 application per day on the body for 5 days","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-11","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"After this intercurrent infectious episode, atopic dermatitis experienced a spontaneously favorable evolution. Now 5 years old and enrolled in kindergarten, he is brought to you by his parents for skin and hair lesions evolving for a few weeks. What diagnosis(s) do you evoke in front of these facial and scalp lesions? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Psoriasis"},{"idx":1,"correct":false,"proposition":"Seborrheic dermatitis"},{"idx":2,"correct":true,"proposition":"Dermatophyte infection"},{"idx":3,"correct":false,"proposition":"Trichotillomania"},{"idx":4,"correct":false,"proposition":"Plate pelade"}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-12","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Examination with Wood's lamp shows yellow-green fluorescence of the hairs in favor of microsporic ringworm. What do you do while waiting for the result of cultivation? (only one answer expected) ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Therapeutic abstention","justification":""},{"idx":1,"correct":true,"proposition":"Prescription of local antifungals only","justification":"To be introduced after sampling to maximize their profitability."},{"idx":2,"correct":false,"proposition":"Prescription of systemic antifungals only","justification":""},{"idx":3,"correct":false,"proposition":"Prescription of local and systemic antifungals","justification":""},{"idx":4,"correct":false,"proposition":"Prescription of an antiseptic only","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-13","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"In front of this microsporic ringworm with a very extensive alopecic plaque associated with several lesions of dermatophytosis of the hairless skin, you begin, without waiting for the results of the culture, a treatment combining local and systemic antifungals. Which systemic antifungal will you prescribe, as a first intention, to Romain? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Ketoconazole","justification":""},{"idx":1,"correct":false,"proposition":"ltraconazole","justification":""},{"idx":2,"correct":true,"proposition":"Griseofulvin","justification":"Treatment of moths of choice in children."},{"idx":3,"correct":false,"proposition":"Amphotericin B","justification":""},{"idx":4,"correct":false,"proposition":"Caspofungin","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-14","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"The result of the culture comes back positive 3 weeks later to Microsporum canis. How could Romain be contaminated? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"By a dog","justification":""},{"idx":1,"correct":true,"proposition":"By a cat","justification":""},{"idx":2,"correct":false,"proposition":"By a land turtle","justification":""},{"idx":3,"correct":false,"proposition":"By a classmate","justification":""},{"idx":4,"correct":false,"proposition":"By the ground","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-1","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"The doctor evokes the hypothesis of domestic violence. Which element(s) of the statement is (are) in favor of this hypothesis? ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The presence of bruises of different ages","justification":""},{"idx":1,"correct":true,"proposition":"An incompatibility between a fall from stairs and the lesions observed","justification":""},{"idx":2,"correct":true,"proposition":"Emergency room admission time","justification":""},{"idx":3,"correct":false,"proposition":"The age of the patient","justification":""},{"idx":4,"correct":true,"proposition":"Sleep disorders","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-2","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"Ms. X confirms that she was physically abused by her spouse the day before. She states that he took her by the neck, that she tried to protect herself by putting his hand in front of her face, but took several punches to the left hemiface. During this episode there was forced sex. Mrs. X came tonight because she was home alone, but does not plan to file a complaint because she does not want marital separation. The doctor considers whether to notify the public prosecutor. What criteria in the statement support compliance with the patient's choice not to file a complaint? (one or more correct answers) ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The age of the patient","justification":""},{"idx":1,"correct":true,"proposition":"The absence of cognitive impairment","justification":""},{"idx":2,"correct":false,"proposition":"The presence of bruises of different ages","justification":""},{"idx":3,"correct":true,"proposition":"The absence of imminent danger at home","justification":""},{"idx":4,"correct":false,"proposition":"The occurrence of sexual violence associated with physical violence","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-3","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"As Mrs. X is of age, without physical or psychological vulnerability, and not wishing to file a complaint, the doctor decided to respect her request and not to make a judicial report. What paraclinical element(s) can (s) be part of the management of this patient in the emergency room?","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Taking photographic photographs to document traumatic bodily injuries","justification":""},{"idx":1,"correct":false,"proposition":"Whole-body X-rays looking for fractures of different ages","justification":""},{"idx":2,"correct":false,"proposition":"A brain scan","justification":"Traumatic brain injury without loss of consciousness, without headache, without Master > 1 criteria."},{"idx":3,"correct":false,"proposition":"A fundus","justification":""},{"idx":4,"correct":false,"proposition":"A CPK blood test for muscle bruises","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-4","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"Here is the picture of the arm of the outer face of the left arm. Which proposal(s) is true?","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"This lesion may correspond to the imprint of the pulp of a finger on the arm.","justification":""},{"idx":1,"correct":false,"proposition":"This lesion is recent in appearance","justification":""},{"idx":2,"correct":true,"proposition":"This lesion is older than those found in the left hemiface"},{"idx":3,"correct":false,"proposition":"This lesion may correspond to friction of the arm against a hard plane","justification":""},{"idx":4,"correct":true,"proposition":"This injury may correspond to a direct blow with an object on the arm.","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-5","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"The doctor proposes to make a descriptive medical certificate. What should be mentioned? (one or more correct answers)","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The alleged date of the last episode of violence suffered by Ms X","justification":"In quotation marks"},{"idx":1,"correct":true,"proposition":"The objective account of the violence suffered by Mrs. X","justification":"In quotation marks"},{"idx":2,"correct":true,"proposition":"Description of all visible traumatic injuries","justification":""},{"idx":3,"correct":false,"proposition":"Ms. X's gynaecological history","justification":"This is irrelevant."},{"idx":4,"correct":true,"proposition":"The psychological symptoms resulting from the violence suffered by Ms X","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-6","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"The psychological repercussions resulting from the violence must be investigated and mentioned on the descriptive medical certificate. What symptoms should the doctor look for when questioning Mrs. X to assess these repercussions and manage them? (one or more correct answers)","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Generalized anxiety"},{"idx":1,"correct":true,"proposition":"Nightmares"},{"idx":2,"correct":false,"proposition":"A quirk of contact"},{"idx":3,"correct":false,"proposition":"Auditory hallucinations","justification":""},{"idx":4,"correct":true,"proposition":"Avoidance pipes"}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-7","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"During the interrogation, Mrs. X explains that she has been disturbed for several months in a disturbed sleep, with bad dreams where she sees herself pursued by a threatening shadow. She wakes up early, little rested, but cannot sleep during the day, always awake, jumping at the slightest noise. She gets angry more easily with her children. During the day, when she goes shopping, she makes detours to avoid passing in front of her husband's work and gym, to be sure not to cross him. Eventually, she ends up falling asleep, exhausted, in front of the television at night.\nMrs. X puts all this down to tensions in her work, and a recent family bereavement.\nShe explains that apart from a few episodes of slapping and forced sex, she has never been a victim of violence by her husband. When she hears about domestic violence, she doesn't feel concerned.\nAmong the elements of the interrogation, what symptoms are suggestive of post-traumatic stress disorder? (one or more correct answers)","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Sleep disorders"},{"idx":1,"correct":true,"proposition":"Avoidance lines"},{"idx":2,"correct":true,"proposition":"Denial of violence"},{"idx":3,"correct":true,"proposition":"Irritability"},{"idx":4,"correct":true,"proposition":"Hypervigilance"}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-8","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"After a full information provided by the doctor, Mrs. X agrees to file a complaint. The doctor calls the judicial police officer on duty at the police station, who goes to the hospital to receive Ms. X's complaint. A gynaecological examination as well as medico-legal samples are requested on judicial requisition. These samples: ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Are analyzed urgently at the hospital laboratory at the request of the medical examiner","justification":""},{"idx":1,"correct":true,"proposition":"Aim to highlight the DNA of the perpetrator","justification":""},{"idx":2,"correct":true,"proposition":"Must be duplicated","justification":""},{"idx":3,"correct":true,"proposition":"Are placed under seal by the judicial police officer","justification":""},{"idx":4,"correct":true,"proposition":"Are elements of the judicial procedure","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-9","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"In the requisition, the judicial police officer asks you to set the ITT resulting from the violence. What does this acronym mean? ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Total temporary incapacity","justification":"To avoid melting, we now speak of Total Functional Deficit (FTD)."},{"idx":1,"correct":true,"proposition":"Total incapacity for work","justification":""},{"idx":2,"correct":false,"proposition":"Temporary impossibility of work","justification":""},{"idx":3,"correct":false,"proposition":"Inability to work fully","justification":""},{"idx":4,"correct":false,"proposition":"Total impossibility of work","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-10","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"What will be the purpose of the ITT (total incapacity for work) assessment for a victim of violence? (one or more correct answers) ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"To classify the criminal offence of which she was a victim","justification":""},{"idx":1,"correct":false,"proposition":"Obtain emergency social housing more quickly if they leave home","justification":""},{"idx":2,"correct":false,"proposition":"To determine the duration of the prescribed absence from work following his injuries","justification":""},{"idx":3,"correct":true,"proposition":"To enable the magistrate to know the repercussions of the violence suffered on the state of health","justification":""},{"idx":4,"correct":true,"proposition":"To determine the competent court to try the perpetrator of the violence","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-11","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"In the case of Ms. X, solicitor-client privilege: (one or more correct answers) ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Is, unless otherwise specified, an obligation of the health professional","justification":""},{"idx":1,"correct":false,"proposition":"Allows the transmission of medical information about her to a police officer by telephone","justification":""},{"idx":2,"correct":false,"proposition":"Allows the transmission of medical information concerning her to her spouse","justification":""},{"idx":3,"correct":true,"proposition":"Persists in case of judicial requisition for all medical information that does not concern the questions of requisition","justification":""},{"idx":4,"correct":true,"proposition":"Allows the patient to be personally transmitted of the descriptive medical certificate upon discharge from the hospital if she does not wish to file a complaint","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-12","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"Three weeks after Ms. X went to the emergency room, her husband, from whom she had separated, sent a letter to the hospital to complain about the medical certificate drawn up on requisition, which had been sent to her by her lawyer. He explains that the doctor did not put the story of the violence in the conditional and that he considers himself wrongly accused. In this context, what medical liability(s) can (s) be engaged? ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Disciplinary responsibility","justification":""},{"idx":1,"correct":true,"proposition":"Civil liability","justification":"If the fault is detachable from the service."},{"idx":2,"correct":true,"proposition":"Criminal liability","justification":""},{"idx":3,"correct":true,"proposition":"Administrative responsibility","justification":""},{"idx":4,"correct":false,"proposition":"No-fault liability","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-13","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"Eleven weeks later, Ms. X returned to the hospital because she knew she was pregnant as a result of the sexual violence she had reported during admission. She wishes to benefit from a voluntary termination of pregnancy. What is the real proposal(s)? ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The doctor is obliged to inform the police of this pregnancy","justification":""},{"idx":1,"correct":false,"proposition":"A voluntary medical termination of pregnancy may be proposed to Mrs. X","justification":""},{"idx":2,"correct":true,"proposition":"Two consultations are offered before the voluntary termination of pregnancy","justification":""},{"idx":3,"correct":false,"proposition":"The consent of Mrs X's spouse is required for the initiation of the procedure","justification":""},{"idx":4,"correct":false,"proposition":"The agreement of the public prosecutor is necessary for the initiation of the procedure","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-1","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"What is (are) the criterion(s) of severity in this febrile child? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"His plainty cry","justification":""},{"idx":1,"correct":false,"proposition":"Age","justification":"The severity criteria for acute bronchiolitis in infants are: FR > 60\/min, HR > 180\/min, pauses in breathing, signs of struggle, SpO2 < 92%, anorexia."},{"idx":2,"correct":true,"proposition":"His heart rate","justification":""},{"idx":3,"correct":true,"proposition":"His breathing rate","justification":""},{"idx":4,"correct":false,"proposition":"Its skin recoloration time","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-2","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"Given this clinical picture, what action do you take immediately? (only one answer expected)","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"NaCl bolus 0.9% 20 mL\/kg","justification":""},{"idx":1,"correct":false,"proposition":"Microbiological","justification":""},{"idx":2,"correct":false,"proposition":"Capillary blood glucose","justification":""},{"idx":3,"correct":false,"proposition":"Blood lonogram","justification":""},{"idx":4,"correct":false,"proposition":"Paracetamol 15 mg\/kg","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-3","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You have done vascular filling with 0.9% NaCl. Fifteen minutes later, his constants are as follows: heart rate 150 beats per minute, respiratory rate 70 per minute, temperature 39.1 ° C, skin recoloration time at 1 second. Chest auscultation regains a symmetrical vesicular murmur and a systolic murmur at 2\/6. Abdominal palpation is normal and otoscopy shows a hypervascularized right eardrum. The child is reactive, without hypotonia. \nWhat is the most likely diagnosis? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Purulent acute otitis media","justification":""},{"idx":1,"correct":false,"proposition":"Acute bronchiolitis","justification":""},{"idx":2,"correct":true,"proposition":"Acute pneumonia","justification":"High fever and lack of sibilants point more towards pneumonia."},{"idx":3,"correct":false,"proposition":"Infective endocarditis","justification":""},{"idx":4,"correct":false,"proposition":"Purulent meningitis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-4","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You mention pneumococcal pneumonia. Which of the following is(s) in favor of this diagnosis?","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The presence of nasopharyngitis","justification":""},{"idx":1,"correct":false,"proposition":"Age","justification":""},{"idx":2,"correct":true,"proposition":"The brutal beginning","justification":""},{"idx":3,"correct":false,"proposition":"A family storytelling","justification":""},{"idx":4,"correct":true,"proposition":"Poor food intake","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-5","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"Chest X-ray shows systematized opacity of the right upper lobe with an aerial bronchogram. What is your assessment? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Blood ionogram","justification":""},{"idx":1,"correct":false,"proposition":"Legionella antigen in urine","justification":""},{"idx":2,"correct":true,"proposition":"Blood","justification":""},{"idx":3,"correct":false,"proposition":"Pneumococcal PCR on nasopharyngeal secretions","justification":""},{"idx":4,"correct":false,"proposition":"Hepatic test","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-6","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"The blood test shows the following results: \n\nhemoglobin 115 g\/L, \n\nleukocytes 20 G\/L with 75% neutrophils, \n\nplatelets 400 G\/L, \n\nCRP 250 mg\/l, \n\nnatremia 129 mmol\/l, potassium 3.7 mmol\/l, \n\nurea 1.5 mmol\/l, creatinine 30 micromoles\/l. \n\nWhat pathophysiological elements are likely involved in this hyponatremia? (one or more correct answers)","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A secretion of antidiuretic hormone","justification":""},{"idx":1,"correct":false,"proposition":"Adrenal insufficiency","justification":""},{"idx":2,"correct":true,"proposition":"Extracellular dehydration","justification":""},{"idx":3,"correct":false,"proposition":"An unsuitable infusion","justification":""},{"idx":4,"correct":false,"proposition":"Postpneumoccoccal glomerulonephritis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-7","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You mention acute hyponatremia in a context of possible extracellular dehydration and DHA secretion complicating acute pneumonia. You set up an infusion adapted to ionic disorders. Which of the following offers do you offer antibiotic therapy?","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Intravenous amoxicillin","justification":""},{"idx":1,"correct":false,"proposition":"Dual therapy amoxicillin and macrolide","justification":""},{"idx":2,"correct":false,"proposition":"Oral amoxicillin","justification":""},{"idx":3,"correct":false,"proposition":"Intravenous cefotaxima","justification":""},{"idx":4,"correct":false,"proposition":"Macrolide per os","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-8","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You have started treatment with amoxicillin 90 mg\/kg\/day intravenously. 72 hours later, the infant remains feverish at 39.5°C.  You make an X-ray of the chest, interpret the images you see. ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Shot made in the supine position","justification":""},{"idx":1,"correct":false,"proposition":"Strictly frontal impact","justification":""},{"idx":2,"correct":true,"proposition":"Presence of right fluid pleural effusion","justification":"We do not see a Damoiseau line because the child is lying, so the fluid is behind the pulmonary parenchyma and corresponds to the opacity of the lung."},{"idx":3,"correct":true,"proposition":"Presence of a right perihilar opacity","justification":""},{"idx":4,"correct":false,"proposition":"Abnormal enlargement of the upper mediastinum","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-9","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You carry the diagnosis of purulent pleurisy and adapt your antibiotic therapy. Which germ(s) should or should be covered by this antibiotic therapy?  ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Staphylococcus aureus","justification":"Staphylococcus aureus infection is a common cause of purulent pleurisy."},{"idx":1,"correct":true,"proposition":"Streptococcus pneumoniae","justification":""},{"idx":2,"correct":true,"proposition":"Streptococcus pyogenes","justification":""},{"idx":3,"correct":false,"proposition":"Mycoplasma pneumoniae","justification":""},{"idx":4,"correct":false,"proposition":"Non-typeable Haemophilus","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-10","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"The evolution is favorable under antibiotic therapy and the child is released from hospitalization 7 days later. He returned to the emergency room at 9 months of age for cough with fever at 38.2°C and difficulty breathing. The parents report that he presented with a febrile cough at the age of 7 months treated with oral antibiotic therapy. Weight gain between 6 and 9 months was 750 g. \n\nAt auscultation, you hear bilateral sibillants. You perform a chest X-ray that shows a systematized focus of the lower left lobe with aerial bronchogram. Faced with this recurrence, what is (are) the cause(s) to evoke? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Infant asthma","justification":"Infant asthma has a new definition: three episodes of wheezing dyspnea before 12 months, or two episodes + atopy (personal or family) before 12 months."},{"idx":1,"correct":true,"proposition":"Immunodeficiency","justification":""},{"idx":2,"correct":false,"proposition":"Intrabronchial foreign body","justification":""},{"idx":3,"correct":false,"proposition":"Congenital lung malformation","justification":""},{"idx":4,"correct":true,"proposition":"Cystic fibrosis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-11","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"What additional examination(s) do you do on this child? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Pulmonary function tests","justification":"He is a little young to blow into a tube 😇. EFRs, in fact, are not feasible for 3 to 6 years."},{"idx":1,"correct":true,"proposition":"Chest CT scan","justification":""},{"idx":2,"correct":false,"proposition":"Bronchial endoscopy","justification":""},{"idx":3,"correct":true,"proposition":"Immune investigation","justification":""},{"idx":4,"correct":false,"proposition":"PH-metry","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-12","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"For the exploration of an immune deficiency, what is your first-line assessment?","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Weight determination of immunoglobulins","justification":""},{"idx":1,"correct":false,"proposition":"Lymphocyte phenotyping","justification":"Lymphocyte phenotyping detects membrane antigens (CD4, CD8, CD19, CD20, etc.) of lymphocytes to know if they are B, T, NK lymphocytes or other. It is, in this situation, a second-line examination."},{"idx":2,"correct":true,"proposition":"Post-vaccination serology"},{"idx":3,"correct":false,"proposition":"Exploring complement pathways","justification":""},{"idx":4,"correct":false,"proposition":"Determination of lgE"}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-13","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"To explore the possibility of immune deficiency, the assessment includes a weight assay of immunoglobulins and post-vaccination serologies. The complete blood count was normal. Here are the results available at this stage: IgG 1 g\/L (N 3.3-6.2), lgA 0.2 g\/L (N 0.2-0.8), lgM 0.7 g\/L (0.5-1.3). Post-vaccination serologies reveal a defect in the production of specific antibodies. Which diagnosis do you think is most likely? (only one answer expected) ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Common variable immunodeficiency","justification":""},{"idx":1,"correct":false,"proposition":"Combined immunodeficiency","justification":""},{"idx":2,"correct":false,"proposition":"Severe combined immunodeficiency","justification":""},{"idx":3,"correct":false,"proposition":"CD40 ligand deficiency","justification":""},{"idx":4,"correct":false,"proposition":"Absence of immune deficiency","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-14","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You confirm the diagnosis of variable common immunodeficiency. As the vaccination schedule was respected until the age of 9 months, which vaccine(s) are indicated for this child for the next 6 months? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Measles-mumps-rubella","justification":"This vaccine is a live attenuated vaccine. It is contraindicated in case of immunosuppression."},{"idx":1,"correct":true,"proposition":"Polysaccharide pneumococcal","justification":""},{"idx":2,"correct":true,"proposition":"Meningococcal C","justification":""},{"idx":3,"correct":false,"proposition":"Chickenpox","justification":""},{"idx":4,"correct":true,"proposition":"Hepatitis B","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-1","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"Which of the following proposals concerning the etiology of malaise would you provide discriminating information?","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The slow return to consciousness","justification":""},{"idx":1,"correct":false,"proposition":"Urine loss","justification":"Urine loss is not to be considered as a distinguishing element between the cardiac or epileptic origin of the malaise."},{"idx":2,"correct":false,"proposition":"Abdominal pain","justification":""},{"idx":3,"correct":false,"proposition":"The localization of hematomas of the limbs","justification":""},{"idx":3,"correct":true,"proposition":"The bite of the lateral edge of the tongue","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-2","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The dislocation is managed orthopedically. You hospitalize him for monitoring and assessment of the malaise. \n\nThe first night of hospitalization is difficult with constant wandering. The next morning, the staff noticed agitation and she tore off her drip. She does not see the point and wants to leave the institution. You notice a tremor of the upper limbs when maintaining the attitude. Objective examination (difficult given the patient's weak cooperation) seems normal except for an abolition of Achilles reflexes. The interrogation is difficult. Spontaneously, his speech is disjointed and incoherent. Which of the following suggestions regarding your diagnostic orientation on its current condition is compatible with this table?","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Pre delirium tremens","justification":""},{"idx":1,"correct":false,"proposition":"Status epilepticus","justification":""},{"idx":2,"correct":false,"proposition":"Parkinson's syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Amnesic ictus","justification":""},{"idx":3,"correct":true,"proposition":"Mental confusion","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-3","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"What additional biological examination(s) are you performing at this stage to advance on the etiological context of this patient? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Complete blood count","justification":""},{"idx":1,"correct":true,"proposition":"Transaminases","justification":"An increase in OGT\/AST greater than that of TGP\/ALT may indicate chronic alcohol poisoning."},{"idx":2,"correct":true,"proposition":"Glycemia","justification":""},{"idx":3,"correct":true,"proposition":"Natremiah","justification":""},{"idx":4,"correct":false,"proposition":"Sedimentation rate","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-4","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The patient remains agitated and not very compliant. At this stage, biological results show MCV at 114μm (N < 100), TGO (aspartame aminotransferase) at 155 (N < 40), TGP (alanine aminotransferase) at 63 (N < 40), zero ethylemia and natremia at 134 mmol \/ L. What non-biological examination should be performed at this stage and during the day (only one response expected):","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Brain scan","justification":""},{"idx":1,"correct":false,"proposition":"Doppler echo of supra-aortic trunks","justification":""},{"idx":2,"correct":false,"proposition":"Electroencephalogram","justification":""},{"idx":3,"correct":false,"proposition":"Electroneuromyogram","justification":""},{"idx":4,"correct":false,"proposition":"Abdominal ultrasound","justification":"Abdominal ultrasound could give arguments for cirrhosis (bumpy liver, increased hepatic arrow, hyperechogenicity of the parenchyma, signs of portal hypertension) but, in front of the neurological signs and the context of fall (and potential head trauma), brain scan is more priority."}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-5","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The brain scan reveals diffuse and age-significant atrophy. An electroencephalogram is performed but is artefacted by the patient's movements and does not allow reliable interpretation. Which of the following therapeutic proposals are you putting in place at this stage? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Hydration based on glucose serum","justification":"Glucose increases the use of vitamin B1 and therefore the risk of Gayet-Wernicke encephalopathy. The patient must be hydrated with 0.9% NaCl."},{"idx":1,"correct":false,"proposition":"Anti-staphylococcal antibiotic therapy","justification":""},{"idx":2,"correct":false,"proposition":"Parenteral neuroleptic","justification":""},{"idx":3,"correct":true,"proposition":"Vitamin supplementation","justification":""},{"idx":4,"correct":true,"proposition":"Parenteral benzodiazepine","justification":"The patient appears to have symptoms of alcohol withdrawal, which therefore requires an emergency pharmacological prerisk. The patient's lack of compliance and the need for rehydration (so the patient will have a venous line in all cases) directs us towards a parenteral route."}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-6","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"Concomitantly with the placement of the venous line, she presents a loss of consciousness with a period of generalized hypertonia and movements of the 4 limbs. She is receiving an intravenous benzodiazepine. The awakening is gradual. \n\nIn the hours that followed, confusion and agitation increased; The patient is covered in sweat, she makes incoherent remarks. Blood pressure is at 180\/110 mmHg. The heart rate is at 110\/min. The temperature is 38.5 °C.  The clinical examination is difficult but finds no obvious signs of neurological focus. \n\nWhich of the following diagnostic proposals is (are) accurate? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Acute delirious puff","justification":""},{"idx":1,"correct":false,"proposition":"Idiopathic generalized epilepsy","justification":""},{"idx":2,"correct":false,"proposition":"Toxic encephalopathy","justification":""},{"idx":3,"correct":true,"proposition":"Symptomatic seizure","justification":"The first part of the statement refers to an epileptic seizure secondary to alcohol withdrawal."},{"idx":4,"correct":true,"proposition":"Delirium tremens","justification":"Confusion, agitation, sweating, and incoherent remarks point to a delirium tremens."}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-7","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The clinical course under treatment is partially favorable. The patient is less agitated but confusion persists. You have contacted his doctor who confirms a significant and daily alcohol consumption, active smoking and social precariousness. By putting the patient in orthostatism, standing appears very unstable and walking is impossible without the help of a third party. During the examination, you notice multidirectional nystagmus and bilateral limitation of eye abduction. \n\nWhich of the following diagnostic hypotheses is compatible with the clinical picture? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Combined sclerosis of the spinal cord","justification":""},{"idx":1,"correct":false,"proposition":"Herpetic encephalitis","justification":""},{"idx":2,"correct":false,"proposition":"Paraneoplastic encephalitis","justification":""},{"idx":3,"correct":true,"proposition":"Gayet-Wernicke encephalopathy","justification":""},{"idx":4,"correct":false,"proposition":"Status epilepticus with confusional expression","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-8","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"You mention the diagnosis of Gayet-Wernicke encephalopathy. In general, concerning the pathophysiological mechanism(s) that could explain or increase the symptoms of this pathology, which proposal(s) is(are) accurate? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Recent intake of isolated glucose serum","justification":""},{"idx":1,"correct":false,"proposition":"Presence of specific antibodies","justification":""},{"idx":2,"correct":true,"proposition":"Thiamine (vitamin B1) deficiency","justification":""},{"idx":3,"correct":false,"proposition":"Cobalamin (vitamin B12) deficiency","justification":""},{"idx":4,"correct":true,"proposition":"Inadequate dietary intake","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-9","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"A brain MRI is performed. What is the sequence shown below? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Diffusion","justification":""},{"idx":1,"correct":false,"proposition":"T2 FLAIR","justification":"The gray matter (in the periphery) is white, the white matter (in medial) is gray 👉 It is a T2. The liquids are black 👉 It is a T2 FLAIR."},{"idx":2,"correct":false,"proposition":"T2","justification":"The median hypersignal that we see is not CSF, it is a hypersignal of the mammillary bodies that is readily found in deficiency encephalopathies."},{"idx":3,"correct":false,"proposition":"T1 with gadolinium injection","justification":""},{"idx":4,"correct":false,"proposition":"TOF (Time Of Flight) (Angio-MRI)","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-10","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"Which of the following proposals for these MRIs is the visible anomaly? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Involvement of medial thalami","justification":"The thalami (plural of thalamus) are just opposite the lateral ventricles and the third ventricle. We can see in the first axial section that they are in hypersignal."},{"idx":1,"correct":true,"proposition":"Hypersignal in the periphery of the third ventricle","justification":"This hypersignal indicates an attack of the thalami."},{"idx":2,"correct":true,"proposition":"Periaqueductal hypersignal","justification":"The Sylvius aqueduct (synonymous with the midbrain aqueduct) is the small pipe that allows CSF communication between the third ventricle (located in the brain) and the fourth ventricle (located between the cerebellum and the brainstem). It is observed on the second axial section: it is in hypersignal (= we have a problem 😥)."},{"idx":3,"correct":false,"proposition":"Protuberantial lesion","justification":"The protuberance is synonymous with the bridge, which is the intermediate structure of the brainstem, making the link between the medulla elongata (synonym of myelencephalon) and the midbrain. We see it in the coronal cup: no hyper\/hypo-signal, everything is fine 👌"},{"idx":4,"correct":false,"proposition":"Damage to white matter","justification":"The white substance is gray on all cuts: there is no hypersignal, everything is fine 👌"}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-11","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"You have been diagnosed with Gayet-Wernicke encephalopathy. Which of the following processing proposals are you putting in place now? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Hypertonic solution infusion","justification":""},{"idx":1,"correct":false,"proposition":"Intravenous antiepileptic drugs","justification":""},{"idx":2,"correct":false,"proposition":"Antiplatelet agent","justification":""},{"idx":3,"correct":true,"proposition":"Intravenous vitamin B1 supplementation","justification":"⚠ Single-answer question."},{"idx":4,"correct":false,"proposition":"Parenteral benzodiazepine","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-12","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The clinical course is favorable after three weeks of hospitalization. She therefore presented neurological complications of chronic alcoholism. Biological parameters are standardized except for MCV at 104 μm3. She seems to you to have understood the need for a definitive and total weaning. She keeps an abnormal neuropsychological assessment for her age with some visuospatial disorders, judgment and working memory. Walking is limited in terms of perimeter, cautious with widening of the lifting polygon, and tendency to hang the forefoot. \n\nWhat is (are) your hypothesis(s) to explain the gait disorders presented by this patient? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Apraxia when walking","justification":""},{"idx":1,"correct":true,"proposition":"Static cerebellar syndrome","justification":"Argued by the enlargement of the lift polygon"},{"idx":2,"correct":false,"proposition":"Lacunar syndrome","justification":""},{"idx":3,"correct":true,"proposition":"Polyneuropathy","justification":"Eroded by the deficit of foot lifters"},{"idx":4,"correct":false,"proposition":"Alcoholic myopathy","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-13","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"You have been able to gather some social information: the patient lives alone, has no close relative, has been unemployed for 9 months. Regarding medico-social care, what approach(s) will you take? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Application for a disabled adult allowance","justification":"The AAH concerns people who have never worked, with a very high rate of disability. That is not the case here."},{"idx":1,"correct":true,"proposition":"Follow-up by the sector social worker","justification":""},{"idx":2,"correct":true,"proposition":"Proposal for a legal protection measure","justification":""},{"idx":3,"correct":false,"proposition":"Application for long-term illness with Social Security","justification":""},{"idx":4,"correct":false,"proposition":"Temporary suspension of driver's licence","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-14","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"You have not heard from this patient again. Six months later, your psychiatrist colleague calls you about him. She is treated in psychiatric emergency for << delirium >>. You go to see it and see a seemingly normal reasoning but you are amazed by its familiarity. It presents significant memory disorders predominant on recent facts but also on older facts. The patient repeatedly asks you about her immediate future when you have already answered the same question several times. \n\nWhich of the following diagnostic proposals is accurate? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Acute drunkenness","justification":""},{"idx":1,"correct":true,"proposition":"Syndrome de Korsakoff","justification":""},{"idx":2,"correct":false,"proposition":"Paraneoplastic encephalitis","justification":""},{"idx":3,"correct":false,"proposition":"Vascular dementia","justification":""},{"idx":4,"correct":false,"proposition":"Status epilepticus with confusional expression","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-15","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"Which of the following propositions, are the semiological argument(s) that characterize Korsakoff syndrome? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Oculomotor disorders","justification":"Gayet-Wernicke encephalopathy"},{"idx":1,"correct":false,"proposition":"Spasmodic laughter and crying","justification":"Lacunar syndrome"},{"idx":2,"correct":true,"proposition":"Anterograde amnesia","justification":""},{"idx":3,"correct":true,"proposition":"Fabulations","justification":""},{"idx":4,"correct":true,"proposition":"False acknowledgements","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-1","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"After quickly collecting the history and circumstances of occurrence of epistaxis, what is (are) the gesture (s) that you practice quickly? ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Removal of clots by blowing their nose","justification":""},{"idx":1,"correct":true,"proposition":"Digital nasal compression for ten minutes","justification":""},{"idx":2,"correct":true,"proposition":"Establishment of a venous line","justification":""},{"idx":3,"correct":true,"proposition":"Blood group samples","justification":""},{"idx":4,"correct":true,"proposition":"Assessment of the presence of posterior hemorrhage by pharyngeal examination","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-2","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Regarding the vascularization of the nasal cavities, what is(are) the exact answer(s)?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Branches of the internal carotid artery vascularize the lower turbinate","justification":""},{"idx":1,"correct":true,"proposition":"Vascularization comes mainly from the branches of the external carotid artery","justification":""},{"idx":2,"correct":true,"proposition":"The main artery is the sphenopalatine artery","justification":""},{"idx":3,"correct":false,"proposition":"The anterior ethmoidal artery is the terminal branch of the external carotid artery","justification":""},{"idx":4,"correct":true,"proposition":"The facial artery participates in the vascularization of the nasal cavities","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-3","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Which element(s) are you looking for during the interrogation?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The unilateral or bilateral nature of the bleeding","justification":""},{"idx":1,"correct":true,"proposition":"A history of perforation of the nasal septum","justification":""},{"idx":2,"correct":true,"proposition":"The date and value of the last INR","justification":""},{"idx":3,"correct":true,"proposition":"The side with which epistaxis began","justification":""},{"idx":4,"correct":true,"proposition":"The abundance of epistaxis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-4","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"On clinical examination, the patient is pale and sweaty. The epistaxis is both anterior and posterior. Blood pressure is at 150\/95 mmHg with a regular heart rate at 124\/min. The temperature is 37.5 °C and oxygen saturation is 98%. \n\nWhat is (are) the element(s) in favor of severe epistaxis in this patient?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Pallor","justification":""},{"idx":1,"correct":true,"proposition":"Sweats","justification":""},{"idx":2,"correct":true,"proposition":"Heart rate","justification":""},{"idx":3,"correct":false,"proposition":"Blood pressure","justification":""},{"idx":4,"correct":false,"proposition":"Previous bleeding","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-5","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"You take a biological sample. Which biological parameter(s) are you asking for at this stage?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Ferritin","justification":""},{"idx":1,"correct":true,"proposition":"Coagulation assessment including TP, INR, TCA","justification":""},{"idx":2,"correct":true,"proposition":"HR Group, RAI","justification":""},{"idx":3,"correct":true,"proposition":"Creatinine emia","justification":""},{"idx":4,"correct":true,"proposition":"Blood count","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-6","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"A few minutes later, blood pressure is 85\/55 mmHg and heart rate is 130\/min. The patient has some mottling at the knees. What measure(s) do you propose at this stage? (one or more correct answers) ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Find the cause of epistaxis","justification":"That is not the urgency here. The patient who appears to be in hemorrhagic shock must first be stabilized."},{"idx":1,"correct":true,"proposition":"Vascular filling by isotonic saline","justification":""},{"idx":2,"correct":true,"proposition":"Dry up the bleeding","justification":""},{"idx":3,"correct":false,"proposition":"Introducing intravenous noradrenaline as a continuous infusion","justification":""},{"idx":4,"correct":false,"proposition":"Perform an arteriogram","justification":"It is (almost) never possible to perform interventional radiology on an unstable patient."}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-7","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Vascular filling stabilized hemodynamics. The mottling has disappeared. You want to locate the origin of epistaxis at the level of the nasal cavities. \n\nWhat step(s) is necessary to localize the bleeding? (one or more correct answers) ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"You blow the patient's nose to evacuate the clots","justification":"Step 1"},{"idx":1,"correct":true,"proposition":"You introduce a wick impregnated with local vasoconstrictor into the hemorrhagic nasal cavity","justification":"Step 2"},{"idx":2,"correct":true,"proposition":"You explore the nasal cavity as a whole","justification":"Step 3"},{"idx":3,"correct":false,"proposition":"You perform an arteriogram","justification":""},{"idx":4,"correct":false,"proposition":"You request a non-injected CT scan of the facial mass","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-8","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"The patient is calm and after your endonasal examination you observe unilateral bleeding from the vascular spot. The INR is at 2.5. The rest of the balance sheet is pending. What is (are) the possible option(s) to stop the bleeding? ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Installation of a double-balloon probe","justification":""},{"idx":1,"correct":true,"proposition":"Primary electrical cauterization of hemorrhagic vessels","justification":"This is a bleeding of the vascular 👉 task cauterization is to be done in first intention."},{"idx":2,"correct":true,"proposition":"Intravenous vitamin K prescription","justification":"The IV route is used here because it is a serious hemorrhage. The patient is not asymptomatic."},{"idx":3,"correct":false,"proposition":"The return home will be authorized in the absence of recurrence of the epistaxis after a surveillance of a few hours","justification":""},{"idx":4,"correct":false,"proposition":"Posterior dabbing with a greasy strand","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-9","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"You performed cauterization of the vascular spot. Despite this, epistaxis persisted. You observe significant bleeding without being able to locate the exact origin. What is your immediate attitude? (only one exact answer) ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Previous tamponade with a greasy strand or hemostatic swab","justification":""},{"idx":1,"correct":false,"proposition":"Anteroposterior buffering by double balloon probe","justification":"As a second intention."},{"idx":2,"correct":false,"proposition":"Discontinuation of vitamin K antagonists","justification":"It's been a long time since we stopped them (and even poured them out)."},{"idx":3,"correct":false,"proposition":"Ligation of ethmoidal arteries","justification":"As a last resort."},{"idx":4,"correct":false,"proposition":"Arteriography with selective embolization","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-10","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Despite a well-performed previous tamponade, you observe an early recurrence of epistaxis. What is your attitude? (only one exact answer) ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Arteriography with selective embolization","justification":""},{"idx":1,"correct":false,"proposition":"Endonasal ligation of the sphenopalatine artery","justification":"Third intention"},{"idx":2,"correct":false,"proposition":"Anterior ethmoidal artery ligation","justification":"Last intention"},{"idx":3,"correct":false,"proposition":"Posterior ethmoidal artery ligation","justification":""},{"idx":4,"correct":true,"proposition":"Anteroposterior buffering by double balloon probe","justification":"This is the second step"}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-11","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"You have managed to dry up epistaxis, and you decide to look for the etiology. Regarding epistaxis << >> symptom, which is (are) the diagnosis(s) that you can evoke? ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Septal perforation","justification":""},{"idx":1,"correct":true,"proposition":"Complication of endonasal surgery","justification":""},{"idx":2,"correct":true,"proposition":"Tumor cause","justification":""},{"idx":3,"correct":false,"proposition":"Willebrand disease","justification":"It is necessary to differentiate epistaxis << symptom >> (local cause) from epistaxis << epiphenomenon >> (general cause) of which Willebrand and Rendu-Osler disease are part."},{"idx":4,"correct":false,"proposition":"Rendu-Osier disease","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-12","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Regarding epistaxis of general origin (<< epistaxis epiphenomenon >>), what is (are) the diagnosis (s) that you can evoke?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Thrombopathy","justification":""},{"idx":1,"correct":false,"proposition":"Hemophilia","justification":"Bleeding disorders are expressed more by deep bleeding. In addition, the advanced age and the fact that it is a woman lead us to count this false proposition."},{"idx":2,"correct":true,"proposition":"Granulomatosis with polyangiitis","justification":""},{"idx":3,"correct":false,"proposition":"A rheumatoid purpura","justification":"She's a bit old 🤭"},{"idx":4,"correct":true,"proposition":"HTA at 250\/120 mmHg","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-13","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"During the etiological assessment, you ask for a scan of the sinuses. On this coronal CT scan of the sinuses, which is (are) the exact proposal(s):","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"1 represents the right maxillary sinus","justification":""},{"idx":1,"correct":true,"proposition":"2 represents the lower right horn","justification":""},{"idx":2,"correct":true,"proposition":"3 represents the middle left horn","justification":""},{"idx":3,"correct":false,"proposition":"4 represents a tumor mass","justification":""},{"idx":4,"correct":false,"proposition":"4 represents the left posterior turbeach","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-1","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"She consults for a rather dry cough evolving for 3 months. This cough has become very disabling and wakes her up at night. You mention the possibility of a cough with ACE inhibitors. Which of the following answers is correct about IEC cough?","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It contraindicates angiotensin inhibitors II","justification":""},{"idx":1,"correct":false,"proposition":"It is dependent on the dose used","justification":""},{"idx":2,"correct":true,"proposition":"It can affect 5% or more of patients treated with ACE inhibitors","justification":""},{"idx":3,"correct":true,"proposition":"It is linked to a class effect","justification":""},{"idx":4,"correct":false,"proposition":"It usually occurs after an infectious episode","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-2","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You stop its ACE inhibitor and replace it with an angiotensin II inhibitor. The cough decreases in a few days and will disappear in less than 15 days. She has no sputum. The patient nevertheless complains of discomfort during exercise with a feeling of shortness of breath when walking flat quickly and when she climbs a slight slope, which she has noticed for several months when she returns home. You rate his dyspnea in his medical record by the chronic dyspnea scale of modified MRC (modified scale of Medical Research Counci\/). This scale assesses the impact of physical activity on dyspnea. What is the mMRC stage of this patient? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Stage 0","justification":"everything is fine we are oklm (important effort like everyone else, even Benzema)"},{"idx":1,"correct":true,"proposition":"Stage 1","justification":"a feeling of shortness of breath when walking flat fast and when climbing a slight slope = mMRC 1"},{"idx":2,"correct":false,"proposition":"Stage 2","justification":"a feeling of shortness of breath when walking with people of his age"},{"idx":3,"correct":false,"proposition":"Stage 3","justification":"a feeling of shortness of breath when walking after a few minutes flat"},{"idx":4,"correct":false,"proposition":"Stage 4","justification":"a feeling of shortness of breath preventing him from going out"}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-3","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You examine the patient. Cardiac auscultation is normal. Pulmonary auscultation finds a diffuse decrease in vesicular murmur without sibilant or crackling. Vocal vibrations are transmitted. The percussion of the thorax is generally tympanic. There is no sign of heart failure either right or left. She weighs 44 kg and is 1.55 m tall. Which clinical sign(s) testify to chest distention? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Hoover's sign","justification":"When the patient inhales, the transverse diameter (from right to left) of the chest decreases, whereas normally it should increase."},{"idx":1,"correct":false,"proposition":"Pilgrim edema","justification":""},{"idx":2,"correct":false,"proposition":"Cyanotic lips","justification":""},{"idx":3,"correct":true,"proposition":"Barrel thorax","justification":""},{"idx":4,"correct":false,"proposition":"Digital Hippocratism","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-4","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You carry out a spirometry of which here is the report. Which of the following proposal(s) is correct:","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"You can affirm the existence of an obstructive syndrome","justification":""},{"idx":1,"correct":true,"proposition":"CVL is higher than FVC","justification":""},{"idx":2,"correct":true,"proposition":"There is a significant lack of reversibility","justification":""},{"idx":3,"correct":false,"proposition":"You can claim chronic respiratory failure","justification":""},{"idx":4,"correct":false,"proposition":"You can affirm chest distension","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-5","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You complete the examinations with a front chest x-ray and more complete pulmonary function tests (RFS). Taking into account clinical history, clinical examination, imaging and EFRs, it is true that: ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"You can claim chronic respiratory failure","justification":""},{"idx":1,"correct":true,"proposition":"You can affirm chest distension","justification":""},{"idx":2,"correct":true,"proposition":"You mention COPD"},{"idx":3,"correct":true,"proposition":"You suspect emphysema"},{"idx":4,"correct":false,"proposition":"You prescribe long-term oxygen therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-6","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"Given the clinical chest distension, chest distension on the lung X-ray with flattening of the diaphragmatic cupolas and EFRs you retain the diagnosis of COPD, probably in connection with emphysema, especially since there is an impairment of the diffusion. You explain to the patient that this disease is directly related to smoking and that quitting smoking will be essential. You assess his pharmacological\/nicotine dependence via the Fagerström test. \n\nWhich element(s) is (are) in favor of a strong pharmacological dependence? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Inhale smoke completely","justification":""},{"idx":1,"correct":false,"proposition":"Smoking brown tobacco","justification":""},{"idx":2,"correct":true,"proposition":"Smoking more than 30 cigarettes a day","justification":""},{"idx":3,"correct":true,"proposition":"Smoking a cigarette as soon as you wake up","justification":""},{"idx":4,"correct":false,"proposition":"Roll your own cigarettes","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-7","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"After assessing her tobacco use and conducting a motivational interview, you find that the patient is motivated to quit smoking completely. She has a significant pharmacological dependence on nicotine with the first cigarette smoked within 5 minutes after waking up and again between 21 and 30 cigarettes a day. She does not consume other psychoactive products. You first prescribe nicotine substitutes in oral form. \n\nWhat is the exact proposal(s)? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"He will have to be prescribed a dose of 10 mg per day of nicotine","justification":""},{"idx":1,"correct":false,"proposition":"There is no support or refund","justification":""},{"idx":2,"correct":true,"proposition":"Nicotine substitutes have few side effects","justification":""},{"idx":3,"correct":true,"proposition":"Nicotine replacement therapy is more effective than placebo in cases of physical dependence","justification":""},{"idx":4,"correct":false,"proposition":"Nicotine substitutes are prescribed in his off-label case because of the cardiovascular history","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-8","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"The patient will be able to quit smoking overnight, thanks in part to nicotine substitutes that you will be able to stop very gradually. She has never had an acute episode of worsening respiratory disease to date. As part of the treatment of his GCP0, what measure(s) to accompany the pharmacological management will you put in place? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Work stoppage","justification":""},{"idx":1,"correct":true,"proposition":"Physical Activity Tips","justification":""},{"idx":2,"correct":false,"proposition":"Low salt diet","justification":""},{"idx":3,"correct":false,"proposition":"Eviction of latex","justification":""},{"idx":4,"correct":true,"proposition":"Annual influenza and pneumococcal vaccinations","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-9","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You carry out the necessary vaccinations. Regarding his drug treatments, what is (are) the exact proposal(s)? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"You contraindicate its beta-blocker treatment","justification":"The patient does not have asthma."},{"idx":1,"correct":true,"proposition":"You prescribe a short-acting bronchodilator on demand","justification":"Every COPD patient should carry their BDCA."},{"idx":2,"correct":true,"proposition":"You prescribe a long-acting bronchodilator once or twice a day","justification":""},{"idx":3,"correct":false,"proposition":"You prescribe an inhaled corticosteroid as part of a fixed combination","justification":""},{"idx":4,"correct":false,"proposition":"You prescribe loop diuretics in moderate doses","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-10","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"Despite the treatments put in place, the patient still has dyspnea of the mMRC stage. You are considering pulmonary rehabilitation. Regarding the latter, its effectiveness has been demonstrated on:","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Exercise capacity","justification":""},{"idx":1,"correct":true,"proposition":"Consumption of care","justification":""},{"idx":2,"correct":true,"proposition":"Dyspnea","justification":""},{"idx":3,"correct":true,"proposition":"Quality of life","justification":""},{"idx":4,"correct":false,"proposition":"FEV1","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-11","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"The patient benefited greatly from pulmonary rehabilitation. Two years later, she is retired and comes to see you again in consultation because she feels much more breathless for a few days while her condition was quite stable until then. This increase in dyspnea is associated with the reappearance of a cough and purulent sputum. You suspect an exacerbation of COPD. What is the exact proposal(s)?","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The majority of COPD exacerbations are infectious (viral, bacterial, or mixed)","justification":""},{"idx":1,"correct":false,"proposition":"The first exacerbation is usually not serious","justification":""},{"idx":2,"correct":true,"proposition":"The diagnosis of exacerbation is based on increased dyspnea, cough and\/or sputum","justification":""},{"idx":3,"correct":true,"proposition":"The main argument in favor of a bacterial infection is sputum purulence","justification":""},{"idx":4,"correct":false,"proposition":"The bacteria most often involved are Haemophilus influenzae, Pseudomonas aeruginosa and Moraxella catarrhalis","justification":"The 3 bacteria to know are: Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. Pseudomonas aeruginosa is rarer, but more serious."}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-12","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"She was admitted to the emergency room of the hospital. The nurse who takes care of her calls you because she is worried. You will find paradoxical abdominal breathing on clinical examination. Regarding paradoxical abdominal breathing, what is (are) the true proposition(s)? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"It is defined as the receding of the anterior wall of the abdomen during inspiration instead of the expected abdominal expansion","justification":""},{"idx":1,"correct":false,"proposition":"This is an active abdominal exhalation","justification":""},{"idx":2,"correct":true,"proposition":"Its presence indicates the absence of participation of the diaphragm in the ventilation which is then taken care of by the extra-diaphragmatic inspiratory muscles","justification":"That's what makes it serious."},{"idx":3,"correct":true,"proposition":"Its finding requires the admission of the patient to a structure where ventilatory assistance can be set up without delay.","justification":""},{"idx":4,"correct":true,"proposition":"Its presence raises fears of short-term failure","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-13","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You will immediately transfer the patient to respiratory intensive care. Chest X-ray does not find an infectious focus or pneumothorax. Analysis of blood gases in ambient air shows a pH of 7.35, a PaO at 50 mmHg and a PaCO2 at 48 mmHg, HCO3- at 26 mmol \/ L.  What treatment(s) will you put in place? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Nebulizing bronchodilators","justification":""},{"idx":1,"correct":true,"proposition":"Systematic antibiotic therapy","justification":"The patient shows signs of severity. This is an indication for antibiotic therapy."},{"idx":2,"correct":true,"proposition":"Chest physiotherapy","justification":"Chest physiotherapy is offered acutely in case of significant bronchial secretions."},{"idx":3,"correct":true,"proposition":"Oxygen therapy with a titrated oxygen flow rate to obtain a pulsed oxygen saturation (Sp02) between 88% and 92%","justification":""},{"idx":3,"correct":false,"proposition":"3-week systemic corticosteroid therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-14","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"The evolution is favorable with the treatment implemented without the need for mechanical ventilation. She can be discharged from hospital 8 days later. She gradually returns to her usual state. You see her again 6 months later because she has just presented some sputum of pure blood during a coughing effort. She has no other symptoms elsewhere. His dyspnea is not increased. What is the exact proposal(s)? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"In the context of this patient, bronchial cancer must be ruled out until proven otherwise.","justification":""},{"idx":1,"correct":false,"proposition":"The administration of vitamin K should be carried out as a matter of urgency as a matter of principle","justification":""},{"idx":2,"correct":false,"proposition":"Taking the antiaggregant may be the cause of hemoptysis in this context of COPD","justification":"⚠ Recurrent pitfall: COPD is not a cause of hemoptysis."},{"idx":3,"correct":true,"proposition":"Chest computed tomography injected with arterial time is the key examination and will be performed if possible even before a bronchial endoscopy.","justification":""},{"idx":4,"correct":true,"proposition":"Despite good tolerance, management should be considered an emergency","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-1","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"What element(s) are you looking for questioning about these pains to advance in your diagnostic hypotheses? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Belt irradiation","justification":""},{"idx":1,"correct":false,"proposition":"Association with headache","justification":"He's a little too young for a Horton 😅"},{"idx":2,"correct":true,"proposition":"Decrease during meals","justification":""},{"idx":3,"correct":true,"proposition":"Acute or progressive affixing mode","justification":""},{"idx":4,"correct":false,"proposition":"Improvement through arm elevation","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-2","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"In this patient, what etiology(s) should you mention? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Bronchial cancer","justification":""},{"idx":1,"correct":true,"proposition":"Spondyloarthritis","justification":""},{"idx":2,"correct":false,"proposition":"Thoracic aorta dissection","justification":""},{"idx":3,"correct":false,"proposition":"Sequelae of vertebral growth epiphysitis","justification":""},{"idx":4,"correct":true,"proposition":"Duodenal ulcer","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-3","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"The pain settled gradually over two months. Which element(s) point to the inflammatory nature of the pain in this patient? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Persistence despite rest","justification":""},{"idx":1,"correct":true,"proposition":"Awakening at night","justification":""},{"idx":2,"correct":false,"proposition":"Difficulty falling asleep","justification":""},{"idx":3,"correct":false,"proposition":"Progressive worsening of pain","justification":""},{"idx":4,"correct":true,"proposition":"Improvement after one hour of activity in the morning","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-4","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"On clinical examination, the pain is maximum on palpation of the spinous located opposite the two points of scapula. At what spinal level does this localization correspond? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"1st thoracic vertebra","justification":""},{"idx":1,"correct":false,"proposition":"2nd thoracic vertebra"},{"idx":2,"correct":false,"proposition":"4th thoracic vertebra"},{"idx":3,"correct":true,"proposition":"7th thoracic vertebra","justification":"🤷‍♂️"},{"idx":4,"correct":false,"proposition":"11th thoracic vertebra","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-5","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"In front of this inflammatory back pain located at the level of the 7th thoracic vertebra, what are you looking for in priority at the clinical examination? (one or more correct answers)","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Sign of Lasègue","justification":""},{"idx":1,"correct":true,"proposition":"Hypoaesthesia band"},{"idx":2,"correct":true,"proposition":"Abnormality of spine statics"},{"idx":3,"correct":true,"proposition":"Hyperthermia","justification":""},{"idx":4,"correct":false,"proposition":"Sign of Hoffman","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-6","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"What exam(s) do you prescribe in the first line for this patient? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"D-dimer","justification":""},{"idx":0,"correct":true,"proposition":"CRP","justification":""},{"idx":0,"correct":true,"proposition":"Complete blood count","justification":""},{"idx":0,"correct":false,"proposition":"TSH","justification":""},{"idx":0,"correct":false,"proposition":"PSA","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-7","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"There is no inflammatory syndrome and the CBC is without abnormalities. A systematic ECG is normal. Why do you decide to do imaging tests? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The duration of symptom evolution","justification":"< 3 months"},{"idx":1,"correct":false,"proposition":"The age of the patient","justification":""},{"idx":2,"correct":true,"proposition":"The localization of pain","justification":""},{"idx":3,"correct":true,"proposition":"The schedule of pain","justification":""},{"idx":4,"correct":false,"proposition":"History of ulcer","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-8","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"In this patient with inflammatory back pain with a normal biological assessment, which imaging examination seems most relevant to you at this stage? (only one answer expected) ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Chest X-ray","justification":""},{"idx":1,"correct":false,"proposition":"Cardiac ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Thoraco-abdomino-pelvic CT scan","justification":""},{"idx":3,"correct":true,"proposition":"Spinal MRI","justification":""},{"idx":4,"correct":false,"proposition":"Bone scintigraphy","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-9","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"MRI of the entire spine performed quickly is normal. At the follow-up consultation one month later, the back pain gradually and spontaneously improved within a month. The patient makes an appointment with you three months later because he has had pain in his right knee for 2 days. What are you looking for on the physical exam? (one or more correct answers) ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Clinostatism","justification":""},{"idx":1,"correct":true,"proposition":"A knee injury","justification":""},{"idx":2,"correct":true,"proposition":"A patellar shock","justification":""},{"idx":3,"correct":false,"proposition":"A plantar skin reflex","justification":""},{"idx":4,"correct":true,"proposition":"Pain of the lateral edge of the knee during its extension (sign of the windshield wiper)","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-10","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"There is patellar shock of the right knee. The patient has a temperature of 37.3 °C. You are wondering about performing a knee puncture. What is the true statement? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is necessary to puncture the knee because there is an effusion","justification":""},{"idx":1,"correct":false,"proposition":"Do not puncture the knee because the pain has been evolving for less than 7 days","justification":""},{"idx":2,"correct":false,"proposition":"Do not puncture the knee because the temperature is normal","justification":""},{"idx":3,"correct":false,"proposition":"Do not puncture the knee because the patient is young","justification":""},{"idx":4,"correct":false,"proposition":"Do not puncture the knee because there is a risk of infecting the knee","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-11","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"You decide to perform a joint puncture of the right knee. Which statement(s) is the correct statement(s)?","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The patient must be seated","justification":""},{"idx":1,"correct":true,"proposition":"The procedure requires an antiseptic skin preparation","justification":""},{"idx":2,"correct":false,"proposition":"Prophylactic antibiotic therapy is needed","justification":""},{"idx":3,"correct":true,"proposition":"Cytological examination of the fluid is essential","justification":""},{"idx":4,"correct":false,"proposition":"Written consent from the patient must be obtained prior to the procedure","justification":"There are very few actions that require written consent. Punctures are not part of it (except genetic test)."}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-12","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"The joint puncture fluid has 5500\/mm3 leukocytes. Germs are not found on direct examination or after cultivation. There are no microcrystals.\nWhich etiology(ies) is(are) the most likely?","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A flare-up of osteoarthritis"},{"idx":1,"correct":false,"proposition":"One drop"},{"idx":2,"correct":true,"proposition":"Spondyloarthritis"},{"idx":3,"correct":false,"proposition":"Lupus"},{"idx":4,"correct":false,"proposition":"Osteonecrosis"}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-13","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"You suspect spondyloarthritis. What are you doing to support this diagnosis? (one or more correct answers) ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Search for a rocking fessalgia","justification":""},{"idx":1,"correct":true,"proposition":"Search for heel pain","justification":""},{"idx":2,"correct":true,"proposition":"Search for familial psoriasis","justification":""},{"idx":3,"correct":true,"proposition":"Looking for a history of finger in << sausage>>","justification":""},{"idx":4,"correct":false,"proposition":"Conducting an NSAID test","justification":"Ulcer history makes prescribing NSAIDs somewhat annoying 🤭"}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-14","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"The search for the HLA B27 gene is positive. The patient is worried and asks you questions. What do you say to him? (one or more correct answers) ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The presence of HLA B27 in the blood is variable over the course of life","justification":"Either the protein is there or it is not."},{"idx":1,"correct":false,"proposition":"The presence of HLA B27 requires the protection of your partner during sexual intercourse","justification":""},{"idx":2,"correct":false,"proposition":"You have to do the research in your children","justification":""},{"idx":3,"correct":true,"proposition":"HLA B27 is present in more than 90% of patients with ankylosing spondylitis","justification":""},{"idx":4,"correct":true,"proposition":"The vast majority of HLA B27+ subjects will never have spondyloarthritis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-15","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"The patient asks you for advice regarding his long-term management. What measure(s) do you recommend? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Gluten-free diet","justification":""},{"idx":1,"correct":true,"proposition":"Regular physical activity","justification":""},{"idx":2,"correct":true,"proposition":"Smoking cessation","justification":""},{"idx":3,"correct":false,"proposition":"Nonsteroidal anti-inflammatory drugs for flare-ups","justification":"He cannot be recommended NSAIDs per se because of his history of ulcer."},{"idx":4,"correct":false,"proposition":"Eviction of cow's milk","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-1","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":"What elements of the interrogation are you looking for to support this diagnosis? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":" Spasmodic abdominal pain","justification":""},{"idx":1,"correct":true,"proposition":"Glairo-bloody emissions","justification":""},{"idx":2,"correct":false,"proposition":"Presence of watery stools","justification":""},{"idx":3,"correct":true,"proposition":"oozing","justification":""},{"idx":4,"correct":true,"proposition":"Description of spurs","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-2","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" The patient reports spurs relieved by glairo-bloody emissions, which reinforces your hypothesis of proctitis. You learn that the patient has unprotected sex with episodic male partners. What arguments are you looking for in favor of an infectious etiology? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Polyarthralgia","justification":""},{"idx":1,"correct":false,"proposition":"Mouth ulcers","justification":""},{"idx":2,"correct":true,"proposition":"Mucopurulent anal discharge","justification":""},{"idx":3,"correct":true,"proposition":"Inguinal lymphadenopathy","justification":""},{"idx":4,"correct":true,"proposition":"Fever","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-3","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" The patient describes tenesmus but no muco-purulent discharge. There is no fever or deterioration in the general condition. The weight is 65 kg for a height of 1m70. The clinical examination does not find inguinal lymphadenopathy. The abdominal wall is not sensitive. What, at this stage, are the etiological hypotheses concerning this suspicion of proctitis? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Salmonella infection","justification":""},{"idx":1,"correct":false,"proposition":"Shigella infection","justification":""},{"idx":2,"correct":true,"proposition":"Ulcerative colitis","justification":""},{"idx":3,"correct":true,"proposition":"Sexually transmitted infection","justification":""},{"idx":4,"correct":true,"proposition":"Amoebiasis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-4","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" What are the additional first-line examinations to be performed? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Coproculture","justification":""},{"idx":1,"correct":true,"proposition":"Microbiological collection by rectal swab","justification":""},{"idx":2,"correct":true,"proposition":"Recto-sigmoidoscopy with biopsy for histopathological examination","justification":""},{"idx":3,"correct":true,"proposition":"Stool parasitology","justification":""},{"idx":4,"correct":true,"proposition":"HIV serology","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-5","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" Rectal swab with PCR examination does not find Chlamydia trachomatis or Neisseria gonorrhoeae. HIV serology is negative. Parasitological examination of stool is negative. Endoscopic examination shows a rectal mucosa of granite appearance with erosions that bleed on contact with the endoscope. The lesions do not extend beyond the rectosigmoid hinge and the sigmoid mucosa is normal. Histological examination shows glandular distortions, cryptic abscesses and an inflammatory infiltrate of the chorion, consisting of lymphoplasmocytes and polynuclear cells. The diagnosis of ulcerative colitis is retained. You propose treatment with 5-amino-salicylates rectally. What information do you give the patient about their illness? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Treatment can cure the disease permanently","justification":""},{"idx":1,"correct":true,"proposition":"A severe pancolic flare-up is possible","justification":""},{"idx":2,"correct":true,"proposition":"The risk of colorectal cancer is increased compared to the general population","justification":""},{"idx":3,"correct":false,"proposition":"The risk of primary biliary cirrhosis is increased compared to the general population","justification":""},{"idx":4,"correct":false,"proposition":"The risk of diverticular disease is increased compared to the general population","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-6","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" The patient received maintenance therapy with 5 amino-salicylate suppository for 18 months. A few months later, after a period during which he was asymptomatic without treatment, he reported the presence of blood accompanying the stool for 15 days, without abdominal pain. What data do you seek, during the interrogation, in favor of a hemorrhoidal pathology at the origin of bleeding? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Bleeding after defecation","justification":""},{"idx":1,"correct":true,"proposition":"Presence of pain per and post defecatory","justification":""},{"idx":2,"correct":false,"proposition":"Presence of mucus in the stool","justification":""},{"idx":3,"correct":true,"proposition":"Exemption from hard stools","justification":""},{"idx":4,"correct":false,"proposition":"Presence of spontaneous anal discharge containing traces of blood","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-7","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" A colonoscopy is therefore performed and shows cicatricial proctitis and congestive hemorrhoids without procidence in the lumen of the anal canal. What support do you envisage? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Rectal derivatives 5 amino-salicylates","justification":""},{"idx":1,"correct":true,"proposition":"Laxatives based on mucilages","justification":""},{"idx":2,"correct":true,"proposition":"Lubricating suppositories","justification":""},{"idx":3,"correct":false,"proposition":"Short course of nonsteroidal anti-inflammatory drugs","justification":""},{"idx":4,"correct":false,"proposition":"Surgical consultation to consider hemorrhoidectomy","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-8","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" The symptomatology improved after a few days of treatment with lubricating suppositories and mucilage-based laxatives. During the follow-up, you carry out an assessment that objective: Hemoglobin: 14 g \/ dL \/ VGM: 85 fL \/ Leukocytes: 8.5 G \/ L \/ Polynuclear neutrophils: 5.3 G \/ L \/ Lymphocytes: 2.8 g \/ L \/ CRP: 6 mg \/ L \/ Ferritinemia: 80 μg \/ L (N: 50 -200 μg \/ L) \/ AST: 52 IU (N<35). What do you suspect?","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Hepatic colic","justification":""},{"idx":1,"correct":false,"proposition":"Cholangitis","justification":""},{"idx":2,"correct":false,"proposition":"Primary biliary cholangitis","justification":""},{"idx":3,"correct":false,"proposition":"Autoimmune hepatitis","justification":""},{"idx":4,"correct":true,"proposition":"Primary sclerosing cholangitis","justification":"This question was a hidden QRU"}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-9","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" You suspect primary sclerosing cholangitis. What diagnostic tests do you perform as a first-line treatment? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Hepatobiliary ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"Biliary scintigraphy","justification":""},{"idx":2,"correct":true,"proposition":"Bili-MRI","justification":""},{"idx":3,"correct":false,"proposition":"High endoscopic echo","justification":""},{"idx":4,"correct":false,"proposition":"Endoscopic retrograde cholangiopancreatography","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-10","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" Bili-MRI and ultrasound show a succession of dilatations and strictures of the bile duct, which suggests primitive sclerosing cholangitis. The patient is lost to follow-up and consults the emergency room 5 years later for jaundice associated with chills. Its vital parameters are: PA 130\/80 mmHg, FC92\/min, temperature 38.7°C.  There is no marbling. The biological assessment shows:Leukocytes 14 G\/LPolynuclear neutrophils 11.3 G\/LLymphocytes 2.6 G\/LCRP: 98 mg\/LASAT: 356 IU (N<35)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Bili-MRI","justification":""},{"idx":1,"correct":false,"proposition":"Upper endoscopic echoendoscopy","justification":""},{"idx":2,"correct":true,"proposition":"Hepatobiliary ultrasound","justification":""},{"idx":3,"correct":false,"proposition":"Liver CT scan","justification":""},{"idx":4,"correct":false,"proposition":"Endoscopic retrograde cholangiography","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-11","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" Hepatobiliary ultrasound shows dilation of the intra- and extra-hepatic bile ducts upstream of stenosis of the main bile duct. What support do you offer? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Corticosteroid therapy","justification":""},{"idx":1,"correct":true,"proposition":"Antibiotic therapy","justification":"This proposal was essential"},{"idx":2,"correct":false,"proposition":"Cholecystectomy","justification":""},{"idx":3,"correct":false,"proposition":"Ursodeoxycolic acid","justification":""},{"idx":4,"correct":true,"proposition":"Endoscopic retrograde cholangiography","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-12","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" In this patient, which antibiotics are essential in the first line? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Clindamycin","justification":""},{"idx":1,"correct":true,"proposition":"Cefotaxime","justification":""},{"idx":2,"correct":false,"proposition":"Amoxicillin","justification":""},{"idx":3,"correct":false,"proposition":"Vancomycin","justification":""},{"idx":4,"correct":false,"proposition":"Gentamicin","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-13","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" You choose antibiotic therapy with cefotaxime and intravenous metronidazole. Which of the bacteria potentially involved in this infection is naturally resistant to the selected antibiotic therapy? (only one answer expected)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Enterococcus faecalis","justification":"This question was a QRU"},{"idx":1,"correct":false,"proposition":"Escherichia coli","justification":""},{"idx":2,"correct":false,"proposition":"Klebsiella pneumoniae","justification":""},{"idx":3,"correct":false,"proposition":"Streptococcus mitis","justification":""},{"idx":4,"correct":false,"proposition":"Bacteroides fragilis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-14","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" In addition to antibiotic therapy, with a view to stenting, the patient benefits from endoscopic retrograde cholangiopancreatography. The latter shows biliary stenosis with dilation of the bile ducts upstream. What are the following structures? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"1 is the gallbladder","justification":""},{"idx":1,"correct":false,"proposition":"2 is the common hepatic duct","justification":""},{"idx":2,"correct":false,"proposition":"3 is the fourth portion of the duodenum","justification":""},{"idx":3,"correct":true,"proposition":"4 corresponds to an intrahepatic bile duct","justification":""},{"idx":4,"correct":false,"proposition":"5 is the main pancreatic duct","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-1","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" As part of its follow-up, you request a blood count that shows: red blood cells 3.1 T\/L, hemoglobin 105 g\/L, MCV 105 fl, MCHC 32 g\/dl, leukocytes 4.8 G\/L, neutrophils 2.8 G\/L, eosinophilic polynuclear 0.2 G\/L, lymphocytes 1.4 G\/L, monocytes 0.4 G\/L, platelets 152 G\/L.","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Reticulocytes","justification":""},{"idx":1,"correct":false,"proposition":"Creatinine emia","justification":""},{"idx":2,"correct":false,"proposition":"GammaGT","justification":""},{"idx":3,"correct":false,"proposition":"Dosage vitamins B9 and B12","justification":""},{"idx":4,"correct":false,"proposition":"Ferritinemia","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-2","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The assessment you had done shows reticulocytes at 2.5%. Which exams do you think are relevant? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"TSH","justification":""},{"idx":1,"correct":true,"proposition":"Creatinine clearance","justification":""},{"idx":2,"correct":false,"proposition":"Direct Coombs test","justification":""},{"idx":3,"correct":true,"proposition":"Dosage vitamins B9 and B12","justification":""},{"idx":4,"correct":false,"proposition":"Ferritinemia","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-3","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The assessment carried out shows a normal TSH, the creatinine clearance evaluated on serum creatinine is normal and dosages of vitamins B9 and B12 within normal limits. You write her a letter for a hematologist, whom she does not decide to consult until 6 months later. The NFS made on the day of the consultation shows: red blood cells 2.1 T\/L, hemoglobin 79 g\/L, MCV 110 fl, MCDC 34.3 g\/dl, reticulocytes 33 G\/L, leukocytes 3.9 G\/L, neutrophils 1.7 G\/L, eosinophils 0.2 G\/L, lymphocytes 1.4 G\/L, monocytes 0.6 G\/L, platelets 112 G\/L. On reading the blood smear, lecytologist notes signs of dysgranulopoiesis but no blast. What are the reasons for diagnosing myelodysplasia? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"history of chemotherapy","justification":""},{"idx":1,"correct":false,"proposition":"dyslipidemia treated with simvastatin","justification":""},{"idx":2,"correct":false,"proposition":"chronic alcoholism","justification":""},{"idx":3,"correct":true,"proposition":"dysgranulopoiesis on the blood smear","justification":""},{"idx":4,"correct":true,"proposition":"progressive worsening of cytopenias","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-4","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" Which exams do you think are indicated at this stage? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Osteomedullary biopsy","justification":""},{"idx":1,"correct":true,"proposition":"Myelogram","justification":""},{"idx":2,"correct":true,"proposition":"Medullary karyotype","justification":""},{"idx":3,"correct":false,"proposition":"Hemoglobin electrophoresis","justification":""},{"idx":4,"correct":false,"proposition":"Search for the BCR-ABL1 transcript","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-5","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The myelogram shows a rich marrow with granular line 40%, of which 8% blasts, erythroblastic line 45%, lymphocytes 10%, monocytes 5%. Megakaryocytes are numerous. There are signs of dyserythropoiesis, dysgranulopoiesis, and dysmegakaryopoiesis. What diagnoses do you mention? (one or more correct answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"acute myelogenous leukemia","justification":""},{"idx":1,"correct":false,"proposition":"chronic myelogenous leukemia","justification":""},{"idx":2,"correct":true,"proposition":"refractory anemia with excess blasts","justification":""},{"idx":3,"correct":false,"proposition":"megakaryoblastic leukemia","justification":""},{"idx":4,"correct":false,"proposition":"myeloma","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-6","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" It is therefore a refractory anemia with excess blasts type 1.At first, you decide to transfuse the patient. She was never transfused and did not become pregnant. What needs to be done? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the determination of the ABO Rhesus group must be carried out on two different samples","justification":""},{"idx":1,"correct":false,"proposition":"compatibility must be determined twice on the same sample","justification":""},{"idx":2,"correct":true,"proposition":"a search for irregular agglutinins is justified","justification":""},{"idx":3,"correct":false,"proposition":"the determination of the ABO group is sufficient for globular concentrates","justification":""},{"idx":4,"correct":false,"proposition":"the patient must receive irradiated red blood cells","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-7","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" You propose to your patient to participate in a clinical trial testing a hypomethylating agent, an investigational drug that does not have the MA. About the patient's consent, what propositions are true? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"consent to participate in the trial may be given orally","justification":""},{"idx":1,"correct":true,"proposition":"consent must be signed by the patient and physician","justification":""},{"idx":2,"correct":true,"proposition":"consent must be signed without constraint and preceded by informed information","justification":""},{"idx":3,"correct":true,"proposition":"the information given to the patient before the possible signing of the consent can be given to him without the presence of a third party","justification":""},{"idx":4,"correct":false,"proposition":"Free and informed consent commits the patient to participate in the trial until its completion","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-8","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The hypomethylating investigational medicinal product has already been tested in phase I and its dose and pharmacokinetics have been determined. The trial you are proposing to your patient is a phase II trial. Which propositions are true? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"a phase II trial may include randomization","justification":""},{"idx":1,"correct":true,"proposition":"a phase II trial evaluates the effectiveness of a drug","justification":""},{"idx":2,"correct":true,"proposition":"a phase II trial must conventionally, if successful, be followed by a phase III trial to obtain a marketing authorization","justification":""},{"idx":3,"correct":true,"proposition":"phase II trials can test drug combinations","justification":""},{"idx":4,"correct":false,"proposition":"patients in phase II trials are generally advanced\/refractory","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-9","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The patient agrees to the clinical trial. It is warned of the risk of worsening cytopenias induced by the proposed treatment. What types of infections does severe neutropenia expose the patient to? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Bacterial pneumonia","justification":""},{"idx":1,"correct":false,"proposition":"Influenza","justification":""},{"idx":2,"correct":true,"proposition":"Gingivostomatitis","justification":""},{"idx":3,"correct":false,"proposition":"Pneumocystis jirovecii infection","justification":""},{"idx":4,"correct":true,"proposition":"Cellulitis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-10","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" During this treatment exposing to a risk of thrombocytopenia, what semiological elements would suggest a risk of serious bleeding? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Purpura of the lower limbs","justification":""},{"idx":1,"correct":true,"proposition":"Intraoral hemorrhagic bubbles","justification":""},{"idx":2,"correct":false,"proposition":"Gingivoragies brushing teeth","justification":""},{"idx":3,"correct":false,"proposition":"Conjunctival hemorrhage","justification":""},{"idx":4,"correct":true,"proposition":"Bleeding at the back of the eye","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-11","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" She receives 6 monthly cures quite well tolerated but she remains cytopenic. She is rehospitalized one week before her 7th cure for alteration of the general condition with dyspnea of recent installation. The CBC shows hemoglobin at 65 g\/L, leukocytes at 98 G\/L with 80% myeloid blasts and platelets at 15 G\/L. The patient was admitted to the emergency department and transfused overnight. The next morning, she is very dyspneic. What are the two most likely diagnostic hypotheses to explain this dyspnea?","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"alveolar proteinosis","justification":""},{"idx":1,"correct":true,"proposition":"pulmonary edema of overload","justification":""},{"idx":2,"correct":false,"proposition":"pulmonary edema post-transfusion lesional","justification":""},{"idx":3,"correct":true,"proposition":"pulmonary leukostasis","justification":""},{"idx":4,"correct":false,"proposition":"plasma hyperviscosity","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-12","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The diagnosis finally retained is that of pulmonary edema of overload and dyspnea regresses rapidly under diuretic treatment. The patient is transferred to haematology for the management of her transformation into acute leukaemia. A hemostasis assessment shows: TP 30%, TCA patient\/control ratio 1.8, fibrinogen 0.7 g \/ l. D-dimer is at 9000 ng\/ml.How do you interpret this hemostasis assessment in this context? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Hepatocellular insufficiency","justification":""},{"idx":1,"correct":false,"proposition":"Acquired Willebrand disease","justification":""},{"idx":2,"correct":false,"proposition":"Antiphospholipid syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Disseminated intravascular coagulation","justification":""},{"idx":4,"correct":false,"proposition":"Cold agglutinin disease","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-13","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The diagnosis of DICD is mentioned, so the patient leaves the clinical trial. A cytoreductive treatment is started to try to reduce blast proliferation. The patient becomes oliguric and serum creatinine doubles in 24 hours. Which diagnosis do you think is most likely?","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Rapidly progressive glomerulonephritis","justification":""},{"idx":1,"correct":false,"proposition":"Thrombotic microangiopathy","justification":""},{"idx":2,"correct":true,"proposition":"Tumor lysis syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Rhabdomyolysis","justification":""},{"idx":4,"correct":false,"proposition":"Thrombosis of a renal artery","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-14","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" A tumor lysis syndrome is evoked, what biological argument(s) would be in favor of this diagnosis? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Hypokalemia","justification":""},{"idx":1,"correct":true,"proposition":"Hypocalcemia","justification":""},{"idx":2,"correct":true,"proposition":"Hyperuricemia","justification":""},{"idx":3,"correct":false,"proposition":"Hypophosphoremia","justification":""},{"idx":4,"correct":false,"proposition":"Hyperbilirubinemia","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-1","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" Express in pack-years the smoking consumption of this man (only one answer expected)","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"54","justification":""},{"idx":1,"correct":false,"proposition":"44","justification":""},{"idx":2,"correct":false,"proposition":"27","justification":""},{"idx":3,"correct":false,"proposition":"22","justification":""},{"idx":4,"correct":false,"proposition":"14","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-2","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" With the elements you have, what hypothesis(s) diagnosis (s) do you retain?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Upper airway infection","justification":""},{"idx":1,"correct":false,"proposition":"Acute respiratory failure","justification":""},{"idx":2,"correct":true,"proposition":"Exacerbation of chronic bronchitis","justification":""},{"idx":3,"correct":false,"proposition":"Alveolar pneumonia","justification":""},{"idx":4,"correct":false,"proposition":"Influenza","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-3","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" What element(s) would be important to define the antibiotic therapeutic strategy?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Exact volume of sputum","justification":""},{"idx":1,"correct":true,"proposition":"Presence of exertional dyspnea","justification":""},{"idx":2,"correct":true,"proposition":"Presence of resting dyspnea","justification":""},{"idx":3,"correct":false,"proposition":"Excessive alcohol consumption","justification":""},{"idx":4,"correct":false,"proposition":"Winter context","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-4","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" During a new interrogation, the patient reports dyspnea of effort for a few months. Which of the following antibiotics are indicated at this stage?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Levofloxacin","justification":""},{"idx":1,"correct":false,"proposition":"Amoxicillin","justification":""},{"idx":2,"correct":false,"proposition":"Metronidazole","justification":""},{"idx":3,"correct":false,"proposition":"Cefotaxime","justification":""},{"idx":4,"correct":false,"proposition":"Cotrimoxazole","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-5","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" His condition improved after 7 days of amoxicillin. What do you foresee in the course of this episode?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Respiratory function tests","justification":""},{"idx":1,"correct":false,"proposition":"Allergological assessment","justification":""},{"idx":2,"correct":false,"proposition":"Lung scintigraphy","justification":""},{"idx":3,"correct":true,"proposition":"Pneumococcal vaccination","justification":""},{"idx":4,"correct":true,"proposition":"Annual influenza vaccination","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-6","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" The patient is not seen again at the end of the episode. Six months after this first visit, he became unwell at home and was referred by his entourage to the emergency department. On clinical examination, the pulse is at 110 bpm, the temperature at 38.5 ° C, the blood pressure at 120\/70mmHg, the respiratory rate at 32 cycles \/ min with a saturation in ambient air of 91% initially. You mention pneumonia. Which clinical sign(s) would be in favor of this hypothesis?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"A hotbed of crackling","justification":""},{"idx":1,"correct":false,"proposition":"the presence of sibilants","justification":""},{"idx":2,"correct":false,"proposition":"decreased vocal vibration","justification":""},{"idx":3,"correct":false,"proposition":"A percussion tympanism","justification":""},{"idx":4,"correct":true,"proposition":"tubal murmur","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-7","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" You have heard a focus of apical crackling upright. What is your assessment? (one or more correct answers)","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"venous Doppler of the lower limbs","justification":""},{"idx":1,"correct":false,"proposition":"a lung scan","justification":""},{"idx":2,"correct":true,"proposition":"chest x-ray","justification":""},{"idx":3,"correct":false,"proposition":"bronchial fibroscopy","justification":""},{"idx":4,"correct":false,"proposition":"bronchoalveolar lavage","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-8","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" The chest X-ray is as follows: What is your interpretation?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Systematized impairment","justification":""},{"idx":1,"correct":false,"proposition":"Left upper lobar involvement","justification":""},{"idx":2,"correct":true,"proposition":"Alveolar syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Miliaria","justification":""},{"idx":4,"correct":false,"proposition":"Pneumothorax","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-9","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" What biological assessment do you prescribe?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Blood platelet count","justification":""},{"idx":1,"correct":true,"proposition":"Blood ionogram - serum creatinine","justification":""},{"idx":2,"correct":true,"proposition":"Blood","justification":""},{"idx":3,"correct":false,"proposition":"Pneumococcal antigenemia","justification":""},{"idx":4,"correct":true,"proposition":"Cytobacteriological examination of sputum","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-10","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" The laboratory assessment shows a biological inflammatory syndrome (CRP at 275 mg \/ L) with hyperleukocytosis. Biological kidney function is normal. Arterial lagazometrics is as follows: pH 7.48, PaO2 66 mmHg, PaCO 2 34 mmHg, HCO 3- 27 mmol \/ L.Regarding the cytobacteriological examination of sputum, which parameter(s) will encourage you to consider this examination as quality and reliable?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Monomicrobial character","justification":""},{"idx":1,"correct":false,"proposition":"Number of polynuclear units less than 25 per field","justification":""},{"idx":2,"correct":false,"proposition":"Number of bacterial colonies at 10 3 per m L","justification":""},{"idx":3,"correct":true,"proposition":"Number of epithelial cells less than 10 per field","justification":""},{"idx":4,"correct":false,"proposition":"Sampling in sputum medium","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-11","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" Under 1 L\/min of nasal oxygen, saturation rises to 94% and respiratory rate drops to 22\/min. What is your attitude towards this patient? (one or more correct answers)","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Hospitalization in the medical department","justification":""},{"idx":1,"correct":false,"proposition":"Isolation \"air\"","justification":""},{"idx":2,"correct":false,"proposition":"Vancomycin treatment","justification":""},{"idx":3,"correct":false,"proposition":"Treatment with oseltamivir","justification":""},{"idx":4,"correct":false,"proposition":"Intravenous corticosteroid therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-12","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" A chest CT scan has been requested by your colleague on duty who also introduces treatment with amoxicillin-clavulanic acid. What is your interpretation of the image?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Alveolar condensation","justification":""},{"idx":1,"correct":false,"proposition":"Caves","justification":""},{"idx":2,"correct":false,"proposition":"Scissurite","justification":""},{"idx":3,"correct":false,"proposition":"Miliaria","justification":""},{"idx":4,"correct":true,"proposition":"Emphysema","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-13","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" Two blood cultures are gram-positive diplococcus. Which antibiotic therapy(s) do you think are the most suitable at present?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Levofloxacin","justification":""},{"idx":1,"correct":false,"proposition":"Cefotaxime + spiramycin","justification":""},{"idx":2,"correct":false,"proposition":"Azithromycin","justification":""},{"idx":3,"correct":true,"proposition":"Amoxicillin","justification":""},{"idx":4,"correct":false,"proposition":"Amoxicillin + clavulanic acid","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-14","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" Your patient's condition improves after 7 days of amoxicillin. As he goes home, he tells you that he worked for 30 years in insulation until his retirement, and handled a lot of asbestos. What pathology(s) can be related to this exposure to asbestos?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Pleural mesothelioma","justification":""},{"idx":1,"correct":false,"proposition":"Melanoma","justification":""},{"idx":2,"correct":true,"proposition":"Lung cancer","justification":""},{"idx":3,"correct":false,"proposition":"Ethmoid cancer","justification":""},{"idx":4,"correct":true,"proposition":"Asbestosis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-15","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" An objective control CT scan of bilateral non-calcified pleural plaques that had not been seen on the previous CT scan. Pleural plaques in a context of exposure to asbestos are the subject of an occupational disease table with a treatment period of 40 years. Can the patient claim recognition as an occupational disease?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"No, because he is retired","justification":""},{"idx":1,"correct":false,"proposition":"No because he smoked","justification":""},{"idx":2,"correct":false,"proposition":"No because it is ethyl","justification":""},{"idx":3,"correct":true,"proposition":"Yes because of the principle of presumption of origin","justification":""},{"idx":4,"correct":true,"proposition":"Yes because it does not exceed the support time","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-1","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" What is (are) the semeiological data(s) to be specified at the interrogation that would direct you towards the diagnosis of arteriopathy obliterans of the lower limbs?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the occurrence of this pain when walking","justification":"This proposal was essential"},{"idx":1,"correct":false,"proposition":"The characteristics of this pain type of electric shocks s","justification":""},{"idx":2,"correct":false,"proposition":"the disappearance of pain at elevation of the lower limbs","justification":""},{"idx":3,"correct":false,"proposition":"the later onset of pain when walking on hills than when walking on flat ground","justification":""},{"idx":4,"correct":true,"proposition":"the onset of pain for a constant walking distance on flat ground","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-2","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" In this patient, the pain occurs when walking, only in the lower right limb, for a fixed distance on flat ground that he estimates at 350 meters with a cramp type sitting at the calf. You notice the presence of a right iliac murmur and a murmur in the lower 1\/3 of the left thigh. Femoral pulses are perceived on both the right and the left. The left popliteal pulse is very easily found it appears ample, the right popliteal pulse is not perceived. In distality you perceive only the left posterior tibial pulse and the left pedinous pulse. On these data you evoke the presence of an obliterating arterial disease of the lower limbs. Which arterial lesion(s) do you suspect based on these clinical data?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Right iliac stenosis","justification":""},{"idx":1,"correct":true,"proposition":"right femoral obliteration","justification":""},{"idx":2,"correct":false,"proposition":"obliteration of right leg arteries","justification":""},{"idx":3,"correct":true,"proposition":"Left femoral stenosis","justification":""},{"idx":4,"correct":true,"proposition":"Left popliteal aneurysm","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-3","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" The clinical examination data led you to suspect the existence of right iliac stenosis, right femoral obliteration, left femoral stenosis and left popliteal aneurysm. What are the first two tests you need to order to confirm your diagnosis of peripheral arterial disease and to locate the arterial lesions you suspected?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"arteriogram of the lower limbs","justification":""},{"idx":1,"correct":true,"proposition":"a measurement of ankle systolic pressure indexes","justification":""},{"idx":2,"correct":true,"proposition":"arterial Doppler ultrasound of the lower limbs","justification":""},{"idx":3,"correct":false,"proposition":"angiography of the lower limbs","justification":""},{"idx":4,"correct":false,"proposition":"MRI of the lower limbs","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-4","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" The measurement of ankle pressure indexes confirmed the diagnosis of peripheral arterial disease obliterating the lower limbs (humeral systolic pressure at 166mmHg in the right arm and 162 mmHg in the left arm with systolic pressure in the right ankle at 114 mmHg: IPS at 0.69 on the right and systolic pressure in the left ankle at 132 mmHg:  IPS at 0.80 on the left). The Doppler ultrasound of the aorta and lower limbs shows: a normal aorta (antero-posterior diameter at 22 mm), a stenosis at 50% of the right external iliac artery, an obliteration of the right femoral artery with reinjection of the popliteal artery. The left femoral artery has a non-significant stenosis and the other arterial axes on the left are the site of diffuse atheromatous overload but without significant obstructive lesion. The left popliteal artery is not aneurysmal. The examination does not retain significant lesion of the leg arteries on the right or left. There is obliterating arterial disease of the lower extremities. What is the element that allows you to say that it is at the stage of exercise ischemia?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"the value of the patient's estimated walking distance below the threshold of 500 meters","justification":""},{"idx":1,"correct":true,"proposition":"symptomatic character to intermittent claudication type","justification":""},{"idx":2,"correct":false,"proposition":"ankle systolic pressure greater than 50 mmHg","justification":""},{"idx":3,"correct":false,"proposition":"the value of the ankle pressure indexes less than 0.90","justification":""},{"idx":4,"correct":false,"proposition":"the existence of humeral anisotension","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-5","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" In this symptomatic patient at the claudication stage, additional examinations objectified ankle systolic pressures greater than 50 mmHg and SNPIs <0.90 confirming the diagnosis of peripheral arterial disease of the lower limbs at the stage of exercise ischemia. There is no aneurysmal lesion, there is 50% right iliac stenosis and right femoral obliteration. The assessment of vascular risk factors in this former smoker did not find diabetes. What therapeutic strategies are possible at this stage? (one or more expected answers)","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"gait rehabilitation","justification":""},{"idx":1,"correct":false,"proposition":"Revascularization","justification":""},{"idx":2,"correct":true,"proposition":"Anti-aggregant treatment with aspirin","justification":""},{"idx":3,"correct":true,"proposition":"statin therapy","justification":""},{"idx":4,"correct":false,"proposition":"anticoagulant therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-6","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" The patient begins gait rehabilitation. He now receives atorvastatin, acetyl-salicylic acid, indapamide, fluoxetine and lercanidipine. He returned for consultation 3 months later. He performed a self-measurement cycle, the averaged values are 139\/64 mmHgThe blood pressure is measured at 160\/80 mmHg at the beginning of the consultation and then at 146\/60 mmHg symmetrically 15 minutes later. At this stage, what type(s) of high blood pressure can be suspected in this patient?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Systolic hypertension","justification":""},{"idx":1,"correct":false,"proposition":"Resistant HTA","justification":""},{"idx":2,"correct":false,"proposition":"Masked HTA","justification":""},{"idx":3,"correct":false,"proposition":"Systolo-diastolic hypertension","justification":""},{"idx":4,"correct":false,"proposition":"HTA << white coat>>","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-7","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" A biological assessment carried out before this visit shows: Na 130 mmol \/ L, K 3.4 mmol \/ L, serum creatinine 75 μmol \/ L. LDL cholesterol is 0.90 g \/ L.Among the treatments taken by the patient, which drug (s) can (can) explain the abnormalities of the ionogram?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"indapamide","justification":""},{"idx":1,"correct":false,"proposition":"atorvastatin","justification":""},{"idx":2,"correct":true,"proposition":"fluoxetine","justification":""},{"idx":3,"correct":false,"proposition":"acetyl salicylic acid","justification":""},{"idx":4,"correct":false,"proposition":"lercanidipine","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-8","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" Regarding the management of high blood pressure, what change(s) do you make to this patient's prescription?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Indapamide judgment","justification":""},{"idx":1,"correct":false,"proposition":"Lercanidipine stop","justification":""},{"idx":2,"correct":false,"proposition":"Prescription of furosemide","justification":""},{"idx":3,"correct":true,"proposition":"prescription of an ACE inhibitor","justification":""},{"idx":4,"correct":false,"proposition":"Prescription of a beta-blocker","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-9","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" You replace indapamide with an ACE inhibitor. In addition, what other measure(s) do you propose to this patient?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"the prescription of potassium supplementation","justification":""},{"idx":1,"correct":false,"proposition":"the decrease in beverages to 0.75 liters per day","justification":""},{"idx":2,"correct":false,"proposition":"increased sodium intake","justification":""},{"idx":3,"correct":true,"proposition":"Annual flu vaccination","justification":""},{"idx":4,"correct":true,"proposition":"decreased alcohol consumption","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-10","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" What is the most suitable test to evaluate the effectiveness of antihypertensive treatment in this patient? (only one exact answer)","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"resting electrocardiogram","justification":""},{"idx":1,"correct":true,"proposition":"Voltage self-measurement","justification":""},{"idx":2,"correct":false,"proposition":"echocardiography","justification":""},{"idx":3,"correct":false,"proposition":"24-hour voltage recording (MAPA)","justification":""},{"idx":4,"correct":false,"proposition":"24-hour electrocardiographic recording (Holter)","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-11","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" What is (are) the expected benefit(s) of your care?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"decreased risk of stroke","justification":""},{"idx":1,"correct":true,"proposition":"decreased risk of heart failure","justification":""},{"idx":2,"correct":false,"proposition":"decreased risk of aortic valve disease","justification":""},{"idx":3,"correct":true,"proposition":"decrease in cardiovascular mortality","justification":""},{"idx":4,"correct":false,"proposition":"Decreased thromboembolic venous risk","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-12","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" The patient is currently being treated with ACE inhibitor and calcium channel blocker for antihypertensive purposes. Self-measurement shows an average blood pressure of 158\/72 mmHg.What are you looking for at the origin of this therapeutic ineffectiveness in this patient? (one or more correct answers)","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"fibromuscular dysplasia of the renal arteries","justification":""},{"idx":1,"correct":true,"proposition":"alcohol abuse","justification":""},{"idx":2,"correct":true,"proposition":"non-adherence","justification":""},{"idx":3,"correct":true,"proposition":"sleep apnea syndrome","justification":""},{"idx":4,"correct":true,"proposition":"improper use of the blood pressure self-measuring device","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-13","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" Poor blood pressure control was linked to medication non-adherence. The patient received therapeutic education. During the first check-up visit to his general practitioner, the blood pressure self-measurement values are in the objectives. Biological abnormalities are normalized. You renew his treatment. What follow-up do you propose to this patient? (one or more correct answers)","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"annual echocardiography","justification":""},{"idx":1,"correct":false,"proposition":"a stress test every two years","justification":""},{"idx":2,"correct":false,"proposition":"a monthly consultation with the general practitioner","justification":""},{"idx":3,"correct":true,"proposition":"an annual blood ionogram","justification":""},{"idx":4,"correct":true,"proposition":"Blood pressure monitoring by self-measurement","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-1","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" Here is the dermatological aspect of the patient. What semiological characteristics do you find on the 2 photos? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"èrythema","justification":""},{"idx":1,"correct":true,"proposition":"Papules","justification":""},{"idx":2,"correct":true,"proposition":"Dander","justification":""},{"idx":3,"correct":false,"proposition":"annular lesions","justification":""},{"idx":4,"correct":false,"proposition":"Vesicles","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-2","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" From your semiological analysis and the history of this patient, which dermatological diagnosis seems to you to be the most likely? (only one response expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Atopic dermatitis","justification":""},{"idx":1,"correct":false,"proposition":"maculopapular exanthema with bisoprolol","justification":""},{"idx":2,"correct":false,"proposition":"pityriasis rosé of Gibert","justification":""},{"idx":3,"correct":true,"proposition":"psoriasis","justification":""},{"idx":4,"correct":false,"proposition":"Mycosis fungoides","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-3","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You remember the diagnosis of psoriasis. How do you assess the intensity, severity and impact of it? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"PASI score","justification":""},{"idx":1,"correct":false,"proposition":"Genetic analysis for determination of susceptibility genes","justification":""},{"idx":2,"correct":true,"proposition":"dermatology life quality index (DLQI) score","justification":""},{"idx":3,"correct":false,"proposition":"rheumatoid factor test","justification":""},{"idx":4,"correct":true,"proposition":"radiography of the pelvis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-4","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You suspect the association with psoriatic arthritis. What semiological and anamnestic elements would be in favor of this association? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the existence of heel pain","justification":""},{"idx":1,"correct":true,"proposition":"nail damage","justification":""},{"idx":2,"correct":true,"proposition":"scalp involvement","justification":""},{"idx":3,"correct":false,"proposition":"high PASI score","justification":""},{"idx":4,"correct":false,"proposition":"Late onset in adulthood","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-5","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" The PASI score is 22 (severe form) and the DLQI shows a profound alteration in the quality of life of this patient. At this stage, psoriatic arthritis is not confirmed. Blood ionogram, kidney function and liver function are normal. What are the treatment options available as a first-line treatment? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Local treatment with betamethasone and calcipotriol","justification":""},{"idx":1,"correct":true,"proposition":"UVB phototherapy","justification":""},{"idx":2,"correct":false,"proposition":"local treatment with vitamin D analogue","justification":""},{"idx":3,"correct":true,"proposition":"methotrexate","justification":""},{"idx":4,"correct":false,"proposition":"biotherapy","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-6","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" The patient living in a rural area far from a phototherapy center, he asks you for an effective treatment because he is very affected by the extension of his dermatosis which confines him to his home. Which treatment do you prefer for this patient? (only one answer expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Spa","justification":""},{"idx":1,"correct":false,"proposition":"hydroxychloroquine","justification":""},{"idx":2,"correct":true,"proposition":"methotrexate","justification":""},{"idx":3,"correct":false,"proposition":"cyclosporine","justification":""},{"idx":4,"correct":false,"proposition":"salazopyrin","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-7","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" The patient's hypertension makes you prefer methotrexate to ciclosporin. You start treatment with 17.5 mg methotrexate weekly. You see the patient again after 3 months, the PASI score (Psoriasis Area and Severity Index) is 15, the heel pain is less intense but the patient still has hip pain for which he regularly takes NSAIDs. You are considering the use of biotherapy. What elements are part of your pre-therapeutic assessment? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"IGRA (quantiferon®) test","justification":""},{"idx":1,"correct":true,"proposition":"HIV testing serology","justification":""},{"idx":2,"correct":true,"proposition":"hepatitis B and C screening serologies","justification":""},{"idx":3,"correct":true,"proposition":"Verification of vaccinations","justification":""},{"idx":4,"correct":false,"proposition":"Thoraco-abdomino-pelvic CT scan","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-8","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" What three biotherapies are you considering for this patient?","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Anti-CD20","justification":""},{"idx":1,"correct":true,"proposition":"Anti-IL-12\/IL-23","justification":""},{"idx":2,"correct":true,"proposition":"Anti-IL-17","justification":""},{"idx":3,"correct":true,"proposition":"Anti-TNFalpha","justification":""},{"idx":4,"correct":false,"proposition":"Anti-PD-1","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-9","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You have chosen to introduce an anti-IL17 biotherapy.What other elements should be considered in the management of psoriasis? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Dieting","justification":""},{"idx":1,"correct":true,"proposition":"Limiting alcohol intake","justification":""},{"idx":2,"correct":false,"proposition":"Valsartan stop","justification":""},{"idx":3,"correct":true,"proposition":"Bisoprolol replacement","justification":""},{"idx":4,"correct":true,"proposition":"seasonal influenza vaccination","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-10","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You see the patient again 1 year later, he followed your advice, lost 5 kgs. Psoriasis was greatly improved by an anti IL-17. As the prescription has not been renewed, the patient has not received any treatment for 4 months. He complains of persistent pain in his right foot (see photo). What diagnosis do you envisage for the involvement of the right big toe? (only one answer expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"whitlow","justification":""},{"idx":1,"correct":false,"proposition":"Primary herpes infection","justification":""},{"idx":2,"correct":false,"proposition":"chronic candidosis dactylitis","justification":""},{"idx":3,"correct":true,"proposition":"onycho-pachydermo-periostitis","justification":""},{"idx":4,"correct":false,"proposition":"drop","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-11","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" What test do you request in first line to confirm the diagnosis of onycho-pachydermo-periostitis? (only one answer expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"X-ray of the feet","justification":""},{"idx":1,"correct":false,"proposition":"MRI right big toe","justification":""},{"idx":2,"correct":false,"proposition":"ultrasound of soft parts","justification":""},{"idx":3,"correct":false,"proposition":"rheumatoid factor test","justification":""},{"idx":4,"correct":false,"proposition":"CRP test","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-12","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" The X-ray of the feet confirms your hypothesis. In association with the resumption of anti-IL-17, you have infiltrated cortisonic derivatives and prescribed non-steroidal anti-inflammatory drugs on demand. During a biological assessment to monitor the treatment, you find a high ferritinemia greater than 600 ng\/ml (N: 30-300). What is the most likely cause? (only one answer expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Hereditary hemochromatosis","justification":""},{"idx":1,"correct":false,"proposition":"Psoriasis","justification":""},{"idx":2,"correct":true,"proposition":"Metabolic syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Beginning hepatic cirrhosis","justification":""},{"idx":4,"correct":false,"proposition":"Excessive meat consumption","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-13","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You consider that the metabolic syndrome that this patient presents is the most likely cause of this hyperferritinemia. What therapeutic measure(s) do you propose in the context of this patient?","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"low-calorie diet","justification":""},{"idx":1,"correct":true,"proposition":"Replacement of glibenclamide with metformin","justification":""},{"idx":2,"correct":false,"proposition":"Limiting daily dietary intake of iron to less than 5 mg\/d","justification":""},{"idx":3,"correct":false,"proposition":"bloodletting","justification":""},{"idx":4,"correct":false,"proposition":"treatment with deferoxamine","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-1","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" For this patient, what information available makes you suspect sleep apnea syndrome? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Daytime sweating","justification":""},{"idx":1,"correct":true,"proposition":"Systemic arterial hypertension","justification":""},{"idx":2,"correct":true,"proposition":"Obesity","justification":""},{"idx":3,"correct":true,"proposition":"Nocturnal snoring","justification":""},{"idx":4,"correct":true,"proposition":"Decreased libido","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-2","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You perform a nocturnal polygraph that targets a hypopnea apnea index of 55\/h and confirms severe obstructive sleep apnea syndrome. What treatments do you offer as a first-line treatment? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Bariatric surgery","justification":""},{"idx":1,"correct":false,"proposition":"Inhaled bronchodilators","justification":""},{"idx":2,"correct":true,"proposition":"Continuous positive airway pressure","justification":""},{"idx":3,"correct":true,"proposition":"Hygiene-dietary rules","justification":""},{"idx":4,"correct":false,"proposition":"Pulmonary rehabilitation","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-3","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" As part of his profession as a bus driver, what measures do you recommend? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"A work stoppage at the beginning of the care","justification":""},{"idx":1,"correct":false,"proposition":"Outplacement","justification":""},{"idx":2,"correct":true,"proposition":"A wakefulness maintenance test after 1 month of well-conducted treatment","justification":""},{"idx":3,"correct":false,"proposition":"Information about his sleep apnea from his employer","justification":""},{"idx":4,"correct":false,"proposition":"Stopping amlodipine","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-4","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Despite the appropriate and effective management of sleep apnea syndrome for several months, your patient's wife sees no improvement in their sex life. What clinical elements would point to the existence of hypogonadism in this patient? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Baldness","justification":""},{"idx":1,"correct":true,"proposition":"Gynecomastia","justification":""},{"idx":2,"correct":false,"proposition":"An enlarged prostate","justification":""},{"idx":3,"correct":true,"proposition":"The absence of morning erection","justification":""},{"idx":4,"correct":false,"proposition":"Night cramps","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-5","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Testicular palpation reveals small testicles, he has gynecomastia and states that he does not have a morning erection. You strongly suspect acquired male hypogonadism. Which biological examination, for diagnostic purposes, is the most relevant at this stage? (only one answer expected)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Total testosteronemia","justification":""},{"idx":1,"correct":false,"proposition":"PSA assay","justification":""},{"idx":2,"correct":false,"proposition":"Prolactin dosage","justification":""},{"idx":3,"correct":false,"proposition":"cortisol at 8am","justification":""},{"idx":4,"correct":false,"proposition":"spermogram and spermocytogram","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-6","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You prescribe a total testosterone assay performed one morning on an empty stomach whose result is: 1.2 ng \/ mL (N: 4-10). What are the two tests that you must imperatively prescribe to advance in your diagnostic process?","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"LH","justification":""},{"idx":1,"correct":false,"proposition":"Free testosterone","justification":""},{"idx":2,"correct":true,"proposition":"Prolactin","justification":""},{"idx":3,"correct":false,"proposition":"Sulfate de DHEA","justification":""},{"idx":4,"correct":false,"proposition":"hCG","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-7","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Here are the results of this assessment: LH 3.3 IU\/L ( N: 2.1 - 6.3); prolactin 54 μg\/L (N < 20). At this stage, what is the most relevant imaging test? (only one answer expected)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"MRI of the hypothalamic-pituitary region","justification":""},{"idx":1,"correct":false,"proposition":"Testicular ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Prostatic ultrasound","justification":""},{"idx":3,"correct":false,"proposition":"Abdominopelvic CT scan","justification":""},{"idx":4,"correct":false,"proposition":"Thyroid ultrasound","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-8","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You request an MRI of the hypothalamic-pituitary region, a section of which is shown below. Which of the following are true? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"This is a coronal cup","justification":""},{"idx":1,"correct":false,"proposition":"This is a sequence in T2","justification":""},{"idx":2,"correct":true,"proposition":"There is pituitary adenoma","justification":""},{"idx":3,"correct":false,"proposition":"The arrow indicates the hypothalamus","justification":""},{"idx":4,"correct":false,"proposition":"There is an attack of the optic chiasma","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-9","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Among the elements at your disposal, which can guide you towards the diagnosis of acromegaly in this patient? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"High blood pressure","justification":""},{"idx":1,"correct":true,"proposition":"Sleep apnea syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Obesity","justification":""},{"idx":3,"correct":false,"proposition":"Low libido","justification":""},{"idx":4,"correct":true,"proposition":"Excessive sweating","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-10","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You recover the IGF1 test that you requested as part of the pituitary assessment. It returns moderately increased for the age of the patient. In order to establish your diagnosis of acromegaly, you perform oral induced hyperglycemia (OPGH) with 75 grams of glucose whose results are as follows:","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Changes in GH testing during OPGH are sufficient to confirm the diagnosis of acromegaly","justification":""},{"idx":1,"correct":false,"proposition":"Concomitant testing of IGF1 and GH is necessary to diagnose acromegaly","justification":""},{"idx":2,"correct":false,"proposition":"Diagnosis of acromegaly is based on concomitant blood glucose and GH testing during OPGH","justification":""},{"idx":3,"correct":false,"proposition":"Concomitant insulin and GH testing is necessary to diagnose acromegaly","justification":""},{"idx":4,"correct":false,"proposition":"The concomitant discovery of diabetes mellitus prevents the interpretation of the GH assay","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-11","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You have been diagnosed with acromegaly and diabetes mellitus. He was cared for and considered cured of his acromegaly. His diabetes persists. Among the following biological results, what would be the two elements expected in the context of type 2 diabetes of recent discovery?","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Triglycerides at 2.40 g\/L (N: 0.6 - 1.6)","justification":""},{"idx":1,"correct":false,"proposition":"HDL-C at 0.68 g\/L (N > 0.35)","justification":""},{"idx":2,"correct":false,"proposition":"LDL-C at 1.85 g\/L (N: 0.6 - 1.6)","justification":""},{"idx":3,"correct":false,"proposition":"AST at 85 IU\/L (N < 35) and ALT at 35 IU\/L (N < 40)","justification":""},{"idx":4,"correct":true,"proposition":"HbA1c at 8.5% (N < 7%)","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-12","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Metformin was introduced about one year after diagnosis. HbA1c is now at 7.3%, with late morning blood glucose levels at 2.30 g\/L. His current BMI is 28.5 kg\/m 2.Which of the following treatment options do you think is the most relevant?","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Adding a rapid-acting insulin injection before breakfast","justification":""},{"idx":1,"correct":true,"proposition":"Addition of sitagliptin","justification":"This question was a single answer, as indicated in the statement"},{"idx":2,"correct":false,"proposition":"Addition of acarbose","justification":""},{"idx":3,"correct":false,"proposition":"Addition of an analogue of GLP1","justification":""},{"idx":4,"correct":false,"proposition":"Adding a slow insulin injection at bedtime","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-13","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" His treatment was intensified by the addition of sitagliptin. Which of the following elements from his medical history constitute an issue in order to validate or not his fitness to drive buses?","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Metformin treatment","justification":""},{"idx":1,"correct":false,"proposition":"treatment of high blood pressure","justification":""},{"idx":2,"correct":false,"proposition":"History of acromegaly","justification":""},{"idx":3,"correct":false,"proposition":"Treatment with sitagliptin","justification":""},{"idx":4,"correct":true,"proposition":"sleep apnea syndrome","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-14","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" He complains of edema of the lower limbs which he attributes to amlodipine. He wants to stop this treatment. What therapeutic classes can be indicated for him in first line? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"central antihypertensive drug","justification":""},{"idx":1,"correct":true,"proposition":"ACE inhibitor","justification":""},{"idx":2,"correct":true,"proposition":"Sartan","justification":""},{"idx":3,"correct":false,"proposition":"beta-blocker","justification":""},{"idx":4,"correct":false,"proposition":"thiazide diuretic","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-1","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" What measures do you take in the emergency room, when the patient is admitted? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"intravenous analgesic","justification":""},{"idx":1,"correct":false,"proposition":"Treatment with vasopressive amines","justification":""},{"idx":2,"correct":false,"proposition":"placement of a urinary catheter","justification":""},{"idx":3,"correct":true,"proposition":"nasogastric tube placement","justification":""},{"idx":4,"correct":true,"proposition":"vascular filling","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-2","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" Regarding the abdominal contracture of this patient, what are the exact proposals? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"there is peritoneal irritation","justification":""},{"idx":1,"correct":true,"proposition":"It's a surgical emergency","justification":""},{"idx":2,"correct":false,"proposition":"  It may be related to significant desydratation","justification":""},{"idx":3,"correct":true,"proposition":"it is invincible on palpation","justification":""},{"idx":4,"correct":false,"proposition":"it is voluntary, in reaction to abdominal palpation","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-3","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" What diagnoses do you mention at this stage? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"a perforated ulcer","justification":""},{"idx":1,"correct":true,"proposition":"diverticular perforated peritonitis","justification":""},{"idx":2,"correct":false,"proposition":"hepatic colic","justification":""},{"idx":3,"correct":false,"proposition":"acute pyelonephritis","justification":""},{"idx":4,"correct":true,"proposition":"appendicular peritonitis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-4","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" What biological tests do you prescribe urgently? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"blood type and search for irregular agglutinins","justification":""},{"idx":1,"correct":false,"proposition":"serology Helicobacter pylori","justification":""},{"idx":2,"correct":true,"proposition":"Blood","justification":""},{"idx":3,"correct":true,"proposition":"serum creatinine","justification":""},{"idx":4,"correct":true,"proposition":"TP and TCA","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-5","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" What additional examination do you request to establish your etiological diagnosis? (only one answer expected)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Abdominopelvic ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"X-ray of the abdomen without preparation","justification":""},{"idx":2,"correct":true,"proposition":"Abdomino-pelvic CT scan","justification":""},{"idx":3,"correct":false,"proposition":"Gastro-duodenal fibroscopy","justification":""},{"idx":4,"correct":false,"proposition":"chest X-ray","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-6","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" Here are some scannographic sections:What are the exact proposals? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"it is an abdominopelvic scan in axial section (transverse)","justification":""},{"idx":1,"correct":false,"proposition":"the number 1 corresponds to the uterus","justification":""},{"idx":2,"correct":true,"proposition":"the number 2 corresponds to an effusion in Douglas' cul de sac","justification":""},{"idx":3,"correct":true,"proposition":"The number 3 corresponds to an appendicular stercolith","justification":""},{"idx":4,"correct":false,"proposition":"The right kidney is visible in one of these pictures","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-7","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" About this scannographic section:What are the exact proposals? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the aorta is visible","justification":""},{"idx":1,"correct":false,"proposition":"there is a pneumoperitoneum","justification":""},{"idx":2,"correct":false,"proposition":"the number 4 corresponds to the left kidney","justification":""},{"idx":3,"correct":true,"proposition":"  The number 5 corresponds to a fluid effusion","justification":""},{"idx":4,"correct":false,"proposition":"There is a cluster of slender loops","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-8","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" About digestive vascular anatomy, what are the exact answers? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the celiac trunk gives rise to the left gastric artery, the common hepatic artery and the splenic artery","justification":""},{"idx":1,"correct":true,"proposition":"the Riolan arch is an anastomosis between the upper and lower mesenteric territory","justification":""},{"idx":2,"correct":true,"proposition":"The appendix is vascularized by an arterial branch from the superior mesenteric artery","justification":""},{"idx":3,"correct":false,"proposition":"the right colon is vascularized by the inferior mesenteric artery","justification":""},{"idx":4,"correct":false,"proposition":"The inferior mesenteric vein drains into the inferior vena cava","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-9","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" You are diagnosed with acute generalized peritonitis of appendicular origin. What are the main principles of management of this pathology? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The surgery may be postponed for a few hours under the guise of antibiotic therapy","justification":""},{"idx":1,"correct":true,"proposition":"At this stage, intravenous broad-spectrum antibiotic therapy should be prescribed.","justification":""},{"idx":2,"correct":true,"proposition":"A peritoneal toilet with saline will be systematically performed","justification":""},{"idx":3,"correct":false,"proposition":"An appendectomy and resection of the cecum more or less extensive to the ascending colon must be performed","justification":""},{"idx":4,"correct":true,"proposition":"The appendix is systematically sent to the Anatomical Pathology Laboratory","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-10","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient receives an emergency appendectomy with peritoneal toilet. She has a postoperative antibiotic therapy for 5 days paramoxicillin-clavulanic acid, adapted to the identification of a multisensitive Escherichia coli isolated in samples taken intraoperatively. The postoperative follow-up is simple. Discharge is allowed on the 6th postoperative day. The patient is urgently readmitted 48 hours later for hyperthermia at 38.5 ° C associated with abdominal pain. The digital rectal examination objective a painful pelvic mass. What is the most likely diagnosis? (only one answer expected)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"pyelonephritis","justification":""},{"idx":1,"correct":true,"proposition":"a Douglassian abscess","justification":""},{"idx":2,"correct":false,"proposition":"phlebitis of the ovarian vein","justification":""},{"idx":3,"correct":false,"proposition":"a wall abscess","justification":""},{"idx":4,"correct":false,"proposition":"ulcer perforation","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-11","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient quickly benefits from an abdominopelvic CT scan confirming the diagnosis of abscesses at the pelvic level, measured at 6 cm. (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"  there is no need to hospitalize the patient","justification":""},{"idx":1,"correct":true,"proposition":"drainage is required to drain the abscess","justification":""},{"idx":2,"correct":true,"proposition":"a bacteriological sample of the contents of the abscess must be taken","justification":""},{"idx":3,"correct":true,"proposition":"  Percutaneous radio-guided drainage is possible","justification":""},{"idx":4,"correct":false,"proposition":"Antibiotic therapy with amoxicillin-clavulanic acid should be resumed","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-12","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient is hospitalized. The abscess is drained under CT control. Antibiotic therapy is adapted to bacteriological samples taken during drainage. There is no need to reoperate the patient. Six months later, she consults for the appearance of an umbilical swelling, appeared at the level of an incision scar. What signs point to uncomplicated eventration? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"swelling is expandable to cough","justification":""},{"idx":1,"correct":false,"proposition":"swelling is inflammatory","justification":""},{"idx":2,"correct":false,"proposition":"swelling is irregular","justification":""},{"idx":3,"correct":true,"proposition":"swelling is reducible","justification":""},{"idx":4,"correct":false,"proposition":"swelling is painful","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-13","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient asks you about this eventration, what can you tell her? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The risk of strangulation increases with the size of the collar","justification":""},{"idx":1,"correct":true,"proposition":"An intervention can be scheduled to close the parietal defect","justification":""},{"idx":2,"correct":false,"proposition":"spontaneous closure is still possible","justification":""},{"idx":3,"correct":true,"proposition":"ventration may increase in size over time","justification":""},{"idx":4,"correct":true,"proposition":"  An intervention prevents the risk of strangulation","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-14","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient prefers not to consider intervention. Five years later, she was referred to the emergency room for a sudden abdominal pain syndrome, associated with vomiting and stopping gas. On clinical examination, the abdomen is weathered, sensitive as a whole. The umbilical ventration has increased in volume, it is reducible. What is the most likely diagnosis? (only one answer expected)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Flanged occlusion","justification":""},{"idx":1,"correct":false,"proposition":"Recurrent appendicitis on stump","justification":""},{"idx":2,"correct":false,"proposition":"Recurrent peritonitis on appendicular stump release","justification":""},{"idx":3,"correct":false,"proposition":"Strangulation on ventration","justification":""},{"idx":4,"correct":false,"proposition":"hepatic colic","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-15","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient is operated urgently for a flange occlusion. It is not necessary to do digestive resection and the postoperative follow-up is simple. What information can you give to the patient post-operatively? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"A new occlusion is no longer to be feared because the flange has been severed","justification":""},{"idx":1,"correct":true,"proposition":"Eventration can still occur on the scars of this procedure","justification":""},{"idx":2,"correct":true,"proposition":"Low molecular weight heparin at a prophylactic dose is indicated postoperatively","justification":""},{"idx":3,"correct":false,"proposition":"Rapid resumption of oral feeding is possible with a residue-free diet during the 20 post-operative days","justification":""},{"idx":4,"correct":true,"proposition":" The resumption of transit is favored by the rapid resumption of physical activity","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-1","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" With the elements of pulmonary auscultation that you have, what are the two most likely diagnostic hypotheses?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"neuromuscular diseases","justification":""},{"idx":1,"correct":true,"proposition":"left heart failure","justification":""},{"idx":2,"correct":false,"proposition":"diffuse interstitial lung disease","justification":""},{"idx":3,"correct":false,"proposition":"asthma","justification":""},{"idx":4,"correct":true,"proposition":"chronic obstructive pulmonary disease (COPD)","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-2","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" In the context of this chronic dyspnea, which additional examination(s) do you request in first line?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"X-ray of standing chest","justification":""},{"idx":1,"correct":false,"proposition":"Chest CT angiography with pulmonary arterial time","justification":""},{"idx":2,"correct":false,"proposition":"D-Dimers","justification":""},{"idx":3,"correct":false,"proposition":"PET scanner","justification":""},{"idx":4,"correct":false,"proposition":"CRP","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-3","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":"    CBC is normal. The chest x-ray requested is below.   As part of the assessment of this chronic dyspnea, you perform the following examination:","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"There is a disorder in the diffusion of carbon monoxide","justification":""},{"idx":1,"correct":false,"proposition":"there is reversibility of FEV1 after taking beta2 mimetics","justification":""},{"idx":2,"correct":false,"proposition":"The exam, to be interpretable, requires smoking cessation for at least two days.","justification":""},{"idx":3,"correct":false,"proposition":"the FEV1\/FVC ratio is not interpretable","justification":""},{"idx":4,"correct":true,"proposition":"there is chest distension","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-4","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" You associate, in a second step, a plethysmography to the volume flow loop previously realized. What is (are) the additional information(s) provided by this review?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"There is a disorder in the diffusion of carbon monoxide","justification":""},{"idx":1,"correct":true,"proposition":"It makes it possible to measure non-mobilizable lung volumes","justification":""},{"idx":2,"correct":true,"proposition":"total lung capacity is significantly increased","justification":""},{"idx":3,"correct":true,"proposition":"the residual volume is significantly increased","justification":""},{"idx":4,"correct":true,"proposition":"You can say that there is no restrictive syndrome","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-5","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" In addition, to complete the EFRs, a carbon monoxide diffusion test (DLCO) was performed. It is 55% theoretical. Based on all the elements you now have available, what diagnosis(s) do you remember?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"asthma","justification":""},{"idx":1,"correct":false,"proposition":"chronic bronchitis","justification":""},{"idx":2,"correct":true,"proposition":"chronic obstructive pulmonary disease (COPD)","justification":""},{"idx":3,"correct":false,"proposition":"amyotrophic lateral sclerosis","justification":""},{"idx":4,"correct":false,"proposition":"Hyperventilation syndrome","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-6","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" This patient therefore suffers from COPD. What therapeutic strategy(s) can you implement at this stage as background treatment?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"home nebulizations of short-acting beta2 mimetics","justification":"This proposal is unacceptable"},{"idx":1,"correct":true,"proposition":"inhaled treatment with a long-acting bronchodilator","justification":""},{"idx":2,"correct":false,"proposition":"inhaled therapy with a combination of two inhaled long-acting bronchodilators","justification":""},{"idx":3,"correct":false,"proposition":"inhaled therapy with a fixed combination of inhaled corticosteroid and long-acting beta2 mimetic","justification":"This proposal is also unacceptable."},{"idx":4,"correct":false,"proposition":"oral corticosteroids of 1 mg\/kg for 15 days before new EFRs","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-7","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" Another essential step in its management is to consider quitting smoking as soon as possible. The patient seems motivated and asks you about nicotine substitutes. Regarding these nicotine substitutes, which is (are) the right answer(s)?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"None of these nicotine substitutes are covered by health insurance","justification":""},{"idx":1,"correct":false,"proposition":"A cardiological assessment must be carried out prior to prescription","justification":""},{"idx":2,"correct":true,"proposition":"they have few side effects at recommended doses","justification":""},{"idx":3,"correct":true,"proposition":"their dosage must be adapted to the consumption of cigarettes","justification":""},{"idx":4,"correct":false,"proposition":"Only the cutaneous form by patch is effective","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-8","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" The patient also described during questioning daytime asthenia responsible for a lack of enthusiasm and drowsiness that she considered normal. You mention the possibility of sleep apnea syndrome. The patient does not know if she is snoring. What signs do you look for besides daytime sleepiness to get arguments in favor of diagnosing sleep apnea syndrome? Give the answer(s) right.","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Uncontrollable cravings during the day","justification":""},{"idx":1,"correct":true,"proposition":"morning headaches","justification":""},{"idx":2,"correct":true,"proposition":"feelings of suffocation during sleep","justification":""},{"idx":3,"correct":true,"proposition":"difficulty concentrating","justification":""},{"idx":4,"correct":true,"proposition":"nocturnal polyuria","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-9","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" You decide to make a ventilatory polygraph recording of which you have attached an extract of its nocturnal trace. What is (are) the exact answer(s)?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"  This trace shows obstructive sleep apnea","justification":""},{"idx":1,"correct":false,"proposition":"This examination also includes an electroencephalogram","justification":""},{"idx":2,"correct":true,"proposition":"Oxygen saturation varies during this recording","justification":""},{"idx":3,"correct":false,"proposition":"This trace shows central sleep apnea","justification":""},{"idx":4,"correct":true,"proposition":"This plot shows that the thoraco-abdominal movements are in phase opposition during the phases of cessation of nasal flow","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-10","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" After complete analysis of this recording, you were able to calculate a hypopnea apnea index greater than 60\/h. Give the right answer.","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"the patient is not obese, so you do not remember the diagnosis of obstructive sleep apnea syndrome","justification":""},{"idx":1,"correct":true,"proposition":"you are considering the installation of a continuous positive airway pressure device","justification":""},{"idx":2,"correct":false,"proposition":"you are considering hygiene measures alone for three months before a new inspection","justification":""},{"idx":3,"correct":false,"proposition":"you are considering a diuretic test before a new control at one month","justification":""},{"idx":4,"correct":false,"proposition":"you prescribe low doses of benzodiazepines","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-11","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" She had recently benefited from a chest CT scan that she shows you. This confirms the predominant emphysema lesions at the top. This scanner also makes it possible to discover a nodule measured at 6 mm in its largest axis at the level of the lower left lobe (arrow). What are the criteria in favor of the benign nature of this nodule? Give the right answer(s)","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"its size","justification":""},{"idx":1,"correct":true,"proposition":"its regular contour","justification":""},{"idx":2,"correct":false,"proposition":"the patient's smoking","justification":""},{"idx":3,"correct":false,"proposition":"the diagnosis of COPD in this patient","justification":""},{"idx":4,"correct":false,"proposition":"the absence of calcification in its center","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-12","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" Regarding the management of this nodule, what will you propose? (one or more correct answers)","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"positron emission tomography","justification":""},{"idx":1,"correct":false,"proposition":"a biopsy under CT scan","justification":""},{"idx":2,"correct":true,"proposition":"A scanner check in several months","justification":""},{"idx":3,"correct":false,"proposition":"an interferon release test even in the absence of tuberculosis contagion","justification":""},{"idx":4,"correct":false,"proposition":"Excision surgery from the outset","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-13","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" A follow-up by control scanner was carried out. This monitoring is reassuring without any evolution of the nodule. Two years after initial management, the patient uses her continuous positive airway pressure (CPAP) machine very regularly and has benefited greatly symptomatically. His dyspnea is improved by taking a long-acting beta2-mimetic. She still pursues a smoking of the order of 5 cigarettes \/ day. She has no other comorbidities and is not taking any other treatment. Its EFRs are stable. You lose sight of it. She comes back to see you in consultation four years later because for about 3 days she has a worsening of her respiratory symptoms with an increase in dyspnea and the appearance of dirty sputum while she had no sputum before. Pulmonary auscultation findbilateral ronchi. The respiratory rate is 12\/min at rest. Air saturation is 96% at rest, there are no signs of respiratory distress. You prescribe appropriate antibiotic therapy. What other treatment(s) is (are) justified in the management of this COPD exacerbation? ","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"short-acting beta2 agonists","justification":"This proposal is essential"},{"idx":1,"correct":false,"proposition":"inhaled corticosteroids","justification":""},{"idx":2,"correct":false,"proposition":"home oxygen therapy to be re-evaluated in one month","justification":""},{"idx":3,"correct":false,"proposition":"oral corticosteroid therapy of 1 mg\/kg per day for 15 days","justification":"This proposal is unacceptable"},{"idx":4,"correct":false,"proposition":"non-invasive ventilation (NIV)","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-14","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" It improves and returns to its basic state thanks to your treatment. In the following year she experienced at least two more similar episodes of COPD exacerbation. Her dyspnea is stage I of MRCD. To adapt his background treatment, what do you prescribe? Give the right answer(s)","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"inhaled therapy with a combination of two inhaled long-acting bronchodilators","justification":""},{"idx":1,"correct":true,"proposition":"inhaled therapy with a fixed combination of an inhaled corticosteroid and a long-acting beta2","justification":""},{"idx":2,"correct":false,"proposition":"inhaled therapy with a combination of two long-acting bronchodilators and an inhaled corticosteroid","justification":""},{"idx":3,"correct":false,"proposition":"oral corticosteroid therapy of 0.5 mg\/kg for one month before new EFRs","justification":""},{"idx":4,"correct":true,"proposition":"pulmonary rehabilitation","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-15","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" You want the patient to undertake pulmonary rehabilitation. You have also prescribed inhaled treatment with a combination of an inhaled corticosteroid and a long-acting beta2-mimetic. What side effects are common with this type of inhaled treatment? Give the right answer(s)","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"dysphonia","justification":""},{"idx":1,"correct":true,"proposition":"Oral mycosis","justification":""},{"idx":2,"correct":false,"proposition":"peptic ulcer","justification":""},{"idx":3,"correct":true,"proposition":"tremors","justification":""},{"idx":4,"correct":false,"proposition":"systemic hypertension","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-16","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" The patient continued to smoke for another two years and eventually stopped. She is 75 years old. Unfortunately very gradually his respiratory condition worsened and dyspnea only progressed. She is now dyspneic for moderate efforts of daily life. She had not wanted to do pulmonary rehabilitation. She has not had a new exacerbation for at least a year. You produce arterial blood gases at rest: pH 7.40; PaO 2 54 mmHg; PaCO2 42 mmHg; bicarbonates 26 mmol \/ l.Blood gases made three weeks apart under the same conditions are identical. She always puts on her CPAP well. You have achieved a nocturnal saturation that shows a regular pattern but a low saturation of the order of 89% all night. What can you conclude from the data you have available? Give the correct answer(s).","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It's too late to consider pulmonary rehabilitation","justification":""},{"idx":1,"correct":false,"proposition":"It will be necessary to make a blood gas while she sleeps","justification":""},{"idx":2,"correct":false,"proposition":"It will be necessary to replace CPAP with nocturnal oxygen therapy","justification":""},{"idx":3,"correct":false,"proposition":"The patient is on an indication for ambulation oxygen therapy only","justification":""},{"idx":4,"correct":true,"proposition":"The patient is undergoing long-term oxygen therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-17","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" The patient is undergoing long-term oxygen therapy. This will be implemented alone during the day and associated with CPAP at night. Give the correct answer(s) regarding long-term oxygen therapy.","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Its main purpose is to avoid the occurrence of right heart failure","justification":""},{"idx":1,"correct":true,"proposition":"It must be at least 15 hours out of 24","justification":""},{"idx":2,"correct":false,"proposition":"it will impose the institutionalization of the patient given her age","justification":""},{"idx":3,"correct":true,"proposition":"it will be necessary to ensure, during its implementation, that PaCO 2 remains stable","justification":""},{"idx":4,"correct":false,"proposition":"It is not covered by health insurance","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-1","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" What can you conclude from these clinical elements? (one or more possible answers)","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The clinical picture suggests polyarthritis","justification":""},{"idx":1,"correct":true,"proposition":"He has asthenia","justification":""},{"idx":2,"correct":true,"proposition":"The interrogation of his wife can provide elements of etiological orientation","justification":""},{"idx":3,"correct":true,"proposition":"the clinical picture is compatible with a depressive syndrome","justification":""},{"idx":4,"correct":true,"proposition":"An associated weight loss should be sought","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-2","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" The weight in consultation is 68 kg. He announces a usual weight of 70 kg, relatively stable in recent years, and he has not recently changed his eating habits. It is 1.75 m tall. The body mass index (BMI) is 22.2 kg\/m2. Which proposal(s) is (are) the exact proposal(s)?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"his weight loss corresponds to the definition of voluntary weight loss","justification":""},{"idx":1,"correct":false,"proposition":"his BMI corresponds to a phenotypic criterion of undernutrition","justification":""},{"idx":2,"correct":true,"proposition":"the presence of tachycardia would constitute an element of orientation","justification":""},{"idx":3,"correct":true,"proposition":"A sadness of mood must be sought","justification":""},{"idx":4,"correct":true,"proposition":"the existence of associated diarrhoea is a discriminating element of interrogation","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-3","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" There is no mood sadness, or anything else in favor of a depressive syndrome. However, there has been a decrease in libido for several months. What question(s) should you ask to look for hypogonadism?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"depilation","justification":""},{"idx":1,"correct":false,"proposition":"dysuria","justification":""},{"idx":2,"correct":true,"proposition":"erectile dysfunction","justification":""},{"idx":3,"correct":true,"proposition":"gynecomastia","justification":""},{"idx":4,"correct":false,"proposition":"increased muscle mass","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-4","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" Mr. R. has erectile dysfunction, depilation, predominant in the lower limbs, as well as a diffuse brown coloration, especially of the face, neck, back of the hands, forearms, and oral mucosa. What biological abnormality(s) can be associated with the abnormal skin coloration observed in this patient?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"low 8-hour cortisol level with high 8-hour plasma ACTH assay","justification":""},{"idx":1,"correct":false,"proposition":"increased 24-hour cortisoluria with low plasma ACTH assay","justification":""},{"idx":2,"correct":false,"proposition":"hypercalcemia with increased PTH","justification":""},{"idx":3,"correct":true,"proposition":"elevated transferrin saturation coefficient (TSC) with increased ferritin","justification":""},{"idx":4,"correct":false,"proposition":"Tricytopenia with increased erythropoietin","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-5","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" The examination reveals a firm hepatomegaly at 2 finger crossings. The spleen is not palpable. You do not notice jaundice or stellar angioma. There is no abdominal collateral venous circulation. Abdominal percussion does not show dullness declivated. There is no palpable lymphadenopathy. Mr. R. consumes 3 glasses of red wine at the evening meal. What interpretation(s) can you make of this clinical picture? (one or more possible answers)","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"absence of signs of portal hypertension excludes hepatic cirrhosis","justification":""},{"idx":1,"correct":false,"proposition":"absence of signs of hepatocellular insufficiency excludes hepatic cirrhosis","justification":""},{"idx":2,"correct":true,"proposition":"It is necessary to look for hepatojugular reflux","justification":""},{"idx":3,"correct":false,"proposition":"the patient's BMI points to metabolic syndrome","justification":""},{"idx":4,"correct":false,"proposition":"The patient's daily consumption of pure alcohol is 15 grams per day","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-6","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" The analyses show: ALT 105 IU\/L (normal: 8-35), AST 55 IU\/L (normal: 6-25), gamma-glutamyl-transpeptidase 60 IU\/L (normal < 40), alkaline phosphatase 173 IU\/L (normal: 35-105), TP 65%. The blood count is normal. A liver ultrasound shows hepatomegaly with hypertrophy of the left lobe and hepatic dysmorphism with heterogeneous parenchyma and irregularity of the hepatic contours (bumpy appearance). Absence of portal flow reversal or splenomegaly. Which exam(s) are you requesting?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"hepatitis B serology","justification":""},{"idx":1,"correct":true,"proposition":"transferrin saturation coefficient","justification":""},{"idx":2,"correct":false,"proposition":"Anti-cytoplasmic antibodies of neutrophils","justification":""},{"idx":3,"correct":true,"proposition":"hepatitis C serology","justification":""},{"idx":4,"correct":true,"proposition":"anti-smooth muscle antibodies (anti-LKM1)","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-7","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" In this patient, who most likely has cirrhosis, the biological assessment reveals: transferrin saturation coefficient 80%, ferritin 2450 μg \/ L, search for anti-HCV antibodies negative, HBs antigen: negative, anti-HBs antibodies: positive with rate at 100 IU \/ L, anti-HBc antibody: negative. Against this background, you also prescribe serum protein electrophoresis. What is your interpretation of this electrophoresis? (one or more correct answers) ","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"polyclonal hypergammaglobulinemia","justification":""},{"idx":1,"correct":false,"proposition":"monoclonal gammopathy","justification":""},{"idx":2,"correct":false,"proposition":"hyper-alpha2-globulinemia","justification":""},{"idx":3,"correct":true,"proposition":"beta-gamma block","justification":""},{"idx":4,"correct":true,"proposition":"hypoalbuminemia","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-8","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" Which condition(s) or situation(s) could be responsible for the results of the martial assessment observed in this patient?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"inflammatory syndrome","justification":""},{"idx":1,"correct":false,"proposition":"non-alcoholic steatohepatitis","justification":""},{"idx":2,"correct":false,"proposition":"rhabdomyolysis","justification":""},{"idx":3,"correct":true,"proposition":"Genetic hemochromatosis","justification":""},{"idx":4,"correct":false,"proposition":"hyperthyroidism","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-9","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" You mention genetic hemochromatosis. Genetic analysis reveals a homozygous C282Y mutation in the HFE gene. Regarding the joint pain of which he complains, what elements would lead to an osteo-articular attack of his hemochromatosis? (one or more possible answers)","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Metacarpophalangeal involvement","justification":""},{"idx":1,"correct":true,"proposition":"Pseudo-gout attacks","justification":""},{"idx":2,"correct":false,"proposition":"erosion of distal interphalangeal","justification":""},{"idx":3,"correct":true,"proposition":"Radiological calcium border","justification":""},{"idx":4,"correct":true,"proposition":"  osteophytosis in hook of the heads of the metacarpals","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-10","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" What examination(s) do you ask Mr. R to assess the possible impact of his hemochromatosis?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"trans-thoracic cardiac ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"coronary angiography","justification":""},{"idx":2,"correct":false,"proposition":"Whole body bone scintigraphy","justification":""},{"idx":3,"correct":true,"proposition":"testosteronemia","justification":""},{"idx":4,"correct":true,"proposition":"bone densitometry","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-11","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" The results of the examinations are as follows:- trans-thoracic cardiac ultrasound: left ventricular ejection fraction 65%, normal filling pressures, undilated heart chambers, absence of valvular heart disease;- testosteronemia (total): 0.5 ng \/ mL (normal: 2.5 - 10); - vitamin D 10 ng \/ mL, serum calcium 2.2 mmol \/ L, phosphoremia 1.1 mmol \/ L;- bone densitometry: T-score at -2 at the lumbar spine, T-score at -1.8 at the femoral neck.- as a reminder,  the biological assessment has previously highlighted: transferrin saturation coefficient 80%, ferritin 2450 μg\/L, negative anti-HCV antibody test, HBs antigen: negative, anti-HBs antibodies: positive with 100 IU\/L level, anti-HBc antibodies: negative. What measure(s) should be put in place? ","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"vaccination against hepatitis B","justification":""},{"idx":1,"correct":false,"proposition":"vitamin C supplementation","justification":""},{"idx":2,"correct":true,"proposition":"vitamin D supplementation","justification":""},{"idx":3,"correct":true,"proposition":"Avoidance of alcohol","justification":""},{"idx":4,"correct":false,"proposition":"oral iron chelator","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-12","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" Vitamin D supplementation is implemented, and you inform Mr. R of the importance of stopping alcohol consumption during pathology. You also start a depletive treatment with bloodletting. Regarding the methods, objectives and elements of bloodletting monitoring that you are going to set up at Mr. R, which is (are) accurate?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Initially monthly rhythm in the attack phase","justification":""},{"idx":1,"correct":true,"proposition":"regular monitoring of ferritinemia","justification":""},{"idx":2,"correct":false,"proposition":"annual liver biopsy","justification":""},{"idx":3,"correct":true,"proposition":"suspension of bleeding if the blood haemoglobin test falls below 11 g\/dL","justification":""},{"idx":4,"correct":true,"proposition":"Initiation of bloodletting in a hospital setting","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-13","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" Mr. R. asks you about the mechanisms behind his disease and iron metabolism. Which proposal(s) is(are) accurate?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Iron absorption occurs mainly in the ileum","justification":""},{"idx":1,"correct":false,"proposition":"Hepcidin is increased during genetic hemochromatosis","justification":""},{"idx":2,"correct":true,"proposition":"Hepcidin inhibits the absorption of iron by the enterocyte","justification":""},{"idx":3,"correct":true,"proposition":"Hepcidin inhibits the release of iron by macrophages","justification":""},{"idx":4,"correct":false,"proposition":"Hepcidin is made by the kidney","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-14","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" What genetic counseling will you offer Mr. R about his relatives? (one or more possible answers)","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"his 3 children must have a search for HFE mutation within the year","justification":""},{"idx":1,"correct":false,"proposition":"C282Y heterozygosity is associated with a minor form with moderate iron overload","justification":""},{"idx":2,"correct":true,"proposition":"his children have a one in 2 risk of being homozygous if his wife is heterozygous","justification":""},{"idx":3,"correct":true,"proposition":"Genetic testing in relatives is covered by health insurance","justification":""},{"idx":4,"correct":false,"proposition":"the attending physician should contact the patient's siblings for CST, ferritin and HFE genetic testing","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-15","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" What follow-up exam(s) do you propose to Mr. R?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"liver ultrasound every 6 months","justification":"This question has been rescinded"},{"idx":1,"correct":false,"proposition":"beta-2 microglobulin every 6 months","justification":"This question has been rescinded"},{"idx":2,"correct":true,"proposition":"blood count before bleeding","justification":"This question has been rescinded"},{"idx":3,"correct":false,"proposition":"Cardiac MRI with annual iron overload measurement","justification":"This question has been rescinded"},{"idx":4,"correct":true,"proposition":"regular gastro-duodenal endoscopy","justification":"This question has been rescinded"}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-1","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" What is most suggestive of the central origin of facial paralysis?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Asymmetry of the mouth with sagging of the labial commissure","justification":""},{"idx":1,"correct":true,"proposition":"Facial asymmetry more marked during voluntary movements than during automatic movements","justification":""},{"idx":2,"correct":false,"proposition":"Deviation of the tongue to the left during protraction","justification":""},{"idx":3,"correct":false,"proposition":"Sign of Souque's eyelashes during forced occlusion of the eyes","justification":""},{"idx":4,"correct":false,"proposition":"Left hearing loss","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-2","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" What element(s) of favorable prognosis do you retain in this patient?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Age","justification":""},{"idx":1,"correct":true,"proposition":"Incomplete upper limb deficit","justification":""},{"idx":2,"correct":false,"proposition":"The moderate nature of proprioceptive sensory disorders","justification":""},{"idx":3,"correct":true,"proposition":"The ability to sit still","justification":""},{"idx":4,"correct":false,"proposition":"The presence of swallowing disorders","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-3","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" Given the clinical elements, which of the professionals mentioned below will you solicit?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Physiotherapist","justification":""},{"idx":1,"correct":true,"proposition":"Occupational therapist","justification":""},{"idx":2,"correct":true,"proposition":"Speech therapist","justification":""},{"idx":3,"correct":false,"proposition":"Prosthetist","justification":""},{"idx":4,"correct":false,"proposition":"Podo-orthotist","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-4","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" You have asked a physiotherapist, an occupational therapist and a speech therapist for the patient's rehabilitation program. After the speech-language pathologist has carried out an initial assessment, what elements will he have to work on to improve the patient's health? (one or more correct answers)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"On the motor skills of the face","justification":""},{"idx":1,"correct":true,"proposition":"On the phases of swallowing","justification":""},{"idx":2,"correct":true,"proposition":"On the adaptation of meal textures","justification":""},{"idx":3,"correct":false,"proposition":"On the improvement of language disorders","justification":""},{"idx":4,"correct":true,"proposition":"On improving articulation","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-5","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" His rehabilitation is going normally and you are planning a therapeutic weekend. Given the age and fragility of the patient, you are considering a nursing visit morning and evening. His wife asks you about the necessary elements for this therapeutic outing. She is also worried because the arrangements for her Sunday are not made. What information can you provide? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Nursing care is covered by the health insurance fund","justification":""},{"idx":1,"correct":false,"proposition":"It will have to send the medical transport vouchers issued for the weekend to the departmental home for disabled people","justification":""},{"idx":2,"correct":true,"proposition":"If necessary, she can call her doctor or an emergency department during the weekend.","justification":""},{"idx":3,"correct":true,"proposition":"An occupational therapist will be able to best define with her the arrangements of her home","justification":""},{"idx":4,"correct":false,"proposition":"To make adjustments to her home, she will have to call on the departmental home for people with disabilities.","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-6","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" Seven weeks after admission, the patient falls. He has left hip pain. The hospital student reports the data of his clinical examination to you. What proposals are compatible with a fracture of the upper end of the left femur? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Absence of deformation","justification":""},{"idx":1,"correct":false,"proposition":"A vicious attitude in irreducible internal rotation","justification":""},{"idx":2,"correct":true,"proposition":"An externally rotating left lower limb","justification":""},{"idx":3,"correct":true,"proposition":"Shortening of the lower left limb","justification":""},{"idx":4,"correct":true,"proposition":"A left lower limb in adduction","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-7","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" You ask for X-rays as follows:What is your diagnosis?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"normal x-rays","justification":""},{"idx":1,"correct":true,"proposition":"basicervical fracture","justification":""},{"idx":2,"correct":false,"proposition":"Iliopubic branch fracture","justification":""},{"idx":3,"correct":false,"proposition":"Subtrochanteric fracture","justification":""},{"idx":4,"correct":false,"proposition":"Garden 1 cervical fracture","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-8","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" The radiologist sends you his report with a diagnosis of coxarthrosis associated with a basicervical fracture. What proposals can treat both fracture and coxarthrosis? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Head of spinal cord nailing","justification":""},{"idx":1,"correct":false,"proposition":"Osteosynthesis by dynamic plate screw","justification":""},{"idx":2,"correct":false,"proposition":"Intermediate hip replacement","justification":""},{"idx":3,"correct":true,"proposition":"Total hip replacement","justification":""},{"idx":4,"correct":false,"proposition":"Trans-skeletal traction","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-9","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" The patient received a total left hip replacement. Postoperatively, he presented with a hematoma of the thigh that required the cessation of anticoagulation and the transfusion of 2 red blood cells. He is transferred to the neurological follow-up care unit with his blood type card. On arrival a biological assessment shows: albumin 35 g \/ L (34-50); Calcium 1.90 mmol\/L (2.08-2.65); serum folate 7.9 nmol\/L (normal if greater than 12); vitamin B12 371 pmol\/L (156-672); Ultrasensitive TSH 0.460 mIU\/L (0.400-4.00). In view of these elements and for the purpose of prevention, which of the following treatments are you prescribing immediately?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Calcium","justification":""},{"idx":1,"correct":false,"proposition":"Alendronate","justification":""},{"idx":2,"correct":true,"proposition":"Vitamin d","justification":""},{"idx":3,"correct":false,"proposition":"Denosumab","justification":""},{"idx":4,"correct":false,"proposition":"Hormone therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-10","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" The patient is treated with calcium 1 g per day and vitamin D3 100,000 IU every 15 days for 3 months. Ten days after surgery a parapixaban treatment is resumed. Five days later, he has a very marked increase in the hematoma of the left thigh associated with a feeling of fatigue and a great mucocutaneous pallor. His blood pressure is at 100\/50mmHg his heart rate at 74 beats per minute. Its temperature is 37.2°C.What additional examinations do you prescribe urgently? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Complete blood count","justification":""},{"idx":1,"correct":false,"proposition":"Pelvic X-ray","justification":""},{"idx":2,"correct":true,"proposition":"Thigh scanner","justification":""},{"idx":3,"correct":true,"proposition":"Search for irregular agglutinins","justification":""},{"idx":4,"correct":false,"proposition":"INR","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-11","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" Faced with the situation you evoke acute bleeding and ask the nurse to urgently order 3 red blood cells. The search for irregular agglutinins is negative. Which proposal(s) apply to your patient?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"you ask the patient for permission to consider a transfusion","justification":""},{"idx":1,"correct":false,"proposition":"you write a prescription for long-term illness (ALD) for 3 red blood cells","justification":""},{"idx":2,"correct":false,"proposition":"In this context of multiple transfusion you ask for compatible pellets","justification":""},{"idx":3,"correct":false,"proposition":"you check the patient's bedside Rhesus D compatibility with the Beth-Vincent test","justification":""},{"idx":4,"correct":false,"proposition":"You ask for irradiated red blood cells in front of this context of fragility","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-12","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" When administering the third red blood cell, the nurse calls you because the patient shivers, and his temperature is at 39.2°C.What proposals apply to your patient? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"You stop the transfusion without delay","justification":""},{"idx":1,"correct":true,"proposition":"You will need to make a haemovigilance declaration","justification":""},{"idx":2,"correct":true,"proposition":"You call the blood transfusion centre","justification":""},{"idx":3,"correct":true,"proposition":"You address the blood bag that passed at the time of the febrile episode to the laboratory according to the local procedure","justification":""},{"idx":4,"correct":true,"proposition":"You have blood cultures taken","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-13","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" The bleeding episode is controlled and there were no other post-transfusion complications. The patient can resume walking after 3 weeks and is considering returning home. Which of the following suggestions concerning the information you should include on the physiotherapy prescription apply to your patient? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"If the prescription is at home it must include the number of sessions","justification":""},{"idx":1,"correct":true,"proposition":"If the prescription is in the physiotherapist's office, it must include the mention \"physiotherapy treatments (or sessions)\"","justification":""},{"idx":2,"correct":false,"proposition":"If you want to insist on the recovery of hip joint amplitudes, you must precisely define on the prescription the number of sessions spent on this goal","justification":""},{"idx":3,"correct":true,"proposition":"If you want physiotherapy at home you must explicitly stipulate this on the prescription","justification":""},{"idx":4,"correct":true,"proposition":"If you want rehabilitation of the lower right limb and left hemiplegia you can register it on the same prescription","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-14","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" You are considering home help. Which of the following proposals do you consider for your patient? (one or more exact proposals)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Applying for a disabled adult allowance","justification":""},{"idx":1,"correct":true,"proposition":"Application for a personalized autonomy allowance","justification":""},{"idx":2,"correct":false,"proposition":"Applying for a special education allowance","justification":""},{"idx":3,"correct":false,"proposition":"Application for compensation benefit","justification":""},{"idx":4,"correct":true,"proposition":"Applying for a home help","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-1","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" Controls report an initial loss of consciousness estimated at 2 minutes. The patient has a motor response adapted to simple commands, opens his eyes to demand, reveals his identity and is correctly located in time and space. The case is a 38-year-old man with no known medical history. How much do you estimate his score in Glasgow? (only one answer expected)","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"14","justification":""},{"idx":1,"correct":false,"proposition":"12","justification":""},{"idx":2,"correct":false,"proposition":"10","justification":""},{"idx":3,"correct":false,"proposition":"8","justification":""},{"idx":4,"correct":false,"proposition":"6","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-2","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" You estimate the Glasgow score at 14.Which of the following proposition(s) is true for this patient?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"There is an indication of cranioencephalic CT","justification":""},{"idx":1,"correct":false,"proposition":"The score is modified by the existence of an initial loss of consciousness","justification":""},{"idx":2,"correct":true,"proposition":"The score must be reassessed upon arrival at the hospital","justification":""},{"idx":3,"correct":false,"proposition":"There is an indication for airway protection by intubation","justification":""},{"idx":4,"correct":true,"proposition":"The score could be altered by taking psychotropic drugs","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-3","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The patient mainly complains of pain in the right lower limb and right upper limb. In the right upper limb there is a deformity of the arm. The patient has functional impotence. You suspect a fracture of the humerus and seek to rule out paralysis of the radial nerve. To do this, what do you test specifically? (one or more correct answers)","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Altered sensitivity of the medial edge of the hand","justification":""},{"idx":1,"correct":false,"proposition":"Altered sensitivity of the thumb pulp","justification":""},{"idx":2,"correct":true,"proposition":"A deficit of active extension of the thumb","justification":""},{"idx":3,"correct":true,"proposition":"A deficit of active wrist extension","justification":""},{"idx":4,"correct":false,"proposition":"A deficit of active abduction\/adduction of long fingers","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-4","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" At the level of the right knee, there is a large anterior wound, and a free bone fragment of the femoral condyle is externalized. Distal pulses are well perceived. Which of the following actions do you think is appropriate and to be implemented on the spot as a first intention?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Wound cleansing with an alcoholic antiseptic solution","justification":""},{"idx":1,"correct":true,"proposition":"Rinsing the wound with saline","justification":""},{"idx":2,"correct":false,"proposition":"Placing and tightening a tourniquet at the root of the thigh","justification":""},{"idx":3,"correct":true,"proposition":"Alignment of the lower limb in a splint","justification":""},{"idx":4,"correct":true,"proposition":"Moderately compressive sterile dressing","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-5","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The patient is unable to lift his leg by holding the knee in extension. A photograph of the wound is shown below. Which of the following applies?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"This is a joint wound","justification":""},{"idx":1,"correct":false,"proposition":"This is a punctiform wound","justification":""},{"idx":2,"correct":true,"proposition":"A rupture of the extender apparatus is suspected","justification":""},{"idx":3,"correct":true,"proposition":"The mobilization of the knee in flexion puts tension on the skin banks","justification":""},{"idx":4,"correct":true,"proposition":"Management of this wound requires extensive surgical debridement","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-6","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" Haemodynamic stability of the patient was achieved with the infusion of 750 ml of crystalloid during transport. Which of the following anamnestic and clinical elements is (are) in favor of performing a whole body scan?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"The estimated speed at the time of the accident was 75 km\/h","justification":""},{"idx":1,"correct":false,"proposition":"The patient has a Glasgow score calculated at 14","justification":""},{"idx":2,"correct":false,"proposition":"There is a joint wound of the right knee","justification":""},{"idx":3,"correct":true,"proposition":"An evolution requiring the introduction of vasopressive amines","justification":""},{"idx":4,"correct":false,"proposition":"Seat belt use","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-7","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" X-rays of the right knee front and profile as well as frontal reconstructions of the CT scan are attached. Which of the following is (are) correct?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"There is a fracture involving the tip of the patella","justification":""},{"idx":1,"correct":false,"proposition":"There is a supracondylar fracture of the distal femur","justification":""},{"idx":2,"correct":true,"proposition":"There is a fracture of the lateral femoral condyle","justification":""},{"idx":3,"correct":false,"proposition":"There is a fracture of the proximal metaphysis of the tibia","justification":""},{"idx":4,"correct":true,"proposition":" There is an ascent of the patella","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-8","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The whole body scanner finds no lesions other than those of the limbs. Injuries to the right knee and arm were managed in the operating room. At the knee, it was indeed a fracture of the lateral condyle, which was reinserted and osteosynthesized, and a fracture of the tip of the patella which was equivalent to an avulsion of the patellar ligament at the tip of the patella. Due to the articular nature of the lateral ducondyle fracture, you postpone the resumption of support during the 3rd postoperative month. To promote skin healing, you limit flexion to 90° during the first month after surgery. Post-operatively, you inform the patient of the progressive risks. What are the exact proposition(s) regarding the risk of postoperative stiffness?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"The limitation of the prescribed flexion is intended to promote the healing of the intra- and extra-articular elements","justification":""},{"idx":1,"correct":true,"proposition":"The intra-articular nature of the lesion increases the risk of stiffness","justification":""},{"idx":2,"correct":false,"proposition":"In the absence of complex regional pain syndrome type 1, there should be no loss of long-term mobility","justification":""},{"idx":3,"correct":true,"proposition":"The existence of a significant limitation of the flexion amplitude to 6 weeks after surgery may lead to discussion of mobilization under anesthesia","justification":""},{"idx":4,"correct":true,"proposition":"The persistence of stiffness beyond 3 months can be recovered by surgery","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-9","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" For his rehabilitation, he is cared for in a follow-up care and rehabilitation department in a day hospital and wonders about the long-term goals of this treatment. Which of the following information(s) is (are) accurate and that you can give him?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"The knee will have to bend at least 110° for it to descend the stairs normally","justification":""},{"idx":1,"correct":true,"proposition":"A strengthening of the thigh muscles is necessary to ensure good stability in the phase of support to walking","justification":""},{"idx":2,"correct":true,"proposition":"The work of endurance to the effort will facilitate its resumption of activity","justification":""},{"idx":3,"correct":false,"proposition":"An evaluation of his workstation by the departmental home for disabled people will have to be organized","justification":""},{"idx":4,"correct":true,"proposition":"A regular assessment of participation restrictions will be made by a physical medicine and rehabilitation doctor throughout his recovery.","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-10","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" Which of the following proposals is (are) the professional(s) who you think should be solicited for the rehabilitation of this patient?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"physiotherapist","justification":""},{"idx":1,"correct":true,"proposition":"occupational therapist","justification":""},{"idx":2,"correct":false,"proposition":"psychomotor therapist","justification":""},{"idx":3,"correct":false,"proposition":"Pedo-orthotist","justification":""},{"idx":4,"correct":true,"proposition":"Adapted physical activity teacher","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-11","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" During the consultation he asks you about his professional future because he is worried. His accident is an accident at work (commuting accident). He has still not received daily allowance. Which of the following is (are) the exact answer(s)?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Knee pain may persist despite good consolidation","justification":""},{"idx":1,"correct":false,"proposition":"You confirm that his daily allowances will not be paid until he is released from hospital.","justification":""},{"idx":2,"correct":true,"proposition":"If he retains sequelae, he may request an evaluation which may give rise to compensation by the health insurance fund.","justification":""},{"idx":3,"correct":false,"proposition":"The adaptation of one's workstation may be carried out by the health insurance fund.","justification":""},{"idx":4,"correct":true,"proposition":"If necessary, the departmental home for disabled people may award him a certificate of disabled worker status.","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-12","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" After two months, he was allowed to gradually resume support on the lower right limb. During follow-up, the patient complains of the gradual appearance of pain in the upper left limb, with an impression of numbness of the fingers. The phenomena are increased at the end of the day when he leans on his English cane. Which of the following elements of the clinical examination is (are) in favor of carpal tunnel syndrome?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Percussion next to the flexion fold of the wrist triggers pain","justification":""},{"idx":1,"correct":false,"proposition":"Painful phenomena increase when bending the elbow","justification":""},{"idx":2,"correct":false,"proposition":"Pain predominates in the last two fingers","justification":""},{"idx":3,"correct":true,"proposition":"Prolonged wrist flexion increases pain","justification":""},{"idx":4,"correct":false,"proposition":"  There is amyotrophy of the hypothenar eminence","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-13","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The situation does not improve despite the gradual abandonment of the English cane on the left with persistent pain and paresthesias in the left hand. You suspect a comprehension of the ulnar nerve. What test do you prescribe to determine its location and impact? (only one answer expected)","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Ultrasound of the wrist","justification":""},{"idx":1,"correct":false,"proposition":"X-rays of the elbow and wrist","justification":""},{"idx":2,"correct":true,"proposition":"Comparative electroneuromyogram of the two upper limbs","justification":""},{"idx":3,"correct":false,"proposition":"Dynamic X-rays of the cervical spine","justification":""},{"idx":4,"correct":false,"proposition":"Cervical MRI","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-14","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The electromyogram confirmed compression of the ulnar nerve but the symptoms gradually improved with the disappearance of paresthesia. The evolution of pain and strength was favorable to the lower right limb after 4 months of rehabilitation but he remains embarrassed for the descent of the stairs because the flexion of the knee reaches only 100 °. However, you are concerned because it retains pain in the upper right limb. Yet you notice a very good evolution both in the strength and amplitudes of the shoulder and elbow which have returned to normal. You gave him a prescription for physiotherapy sessions without specifying the number. Among the following proposals, which is (are) the one (s) you can make for his outpatient follow-up?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Physiotherapy may also be accompanied by balneotherapy despite the absence of specific mention on the prescription","justification":""},{"idx":1,"correct":false,"proposition":"The conditions of management of occupational therapy are no different from physiotherapy-balneotherapy","justification":""},{"idx":2,"correct":true,"proposition":"The physiotherapist will be able to adapt the number of sessions by himself without this posing any problem of coverage by the social security","justification":""},{"idx":3,"correct":false,"proposition":"It is not necessary to see the surgeon again before 18 months given the severity of the fractures","justification":""},{"idx":4,"correct":false,"proposition":"Physiotherapy can be performed at home despite the absence of specific mention on the prescription","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-15","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" Since the patient fails to carry a load on the right side at 6 months postoperatively, you decided to refer him back to the surgeon. Here is the radiographic aspect on front and profile images. Which proposal(s) is (are) true?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"This is hypertrophic pseudarthrosis","justification":""},{"idx":1,"correct":true,"proposition":"The chances of spontaneous consolidation at this stage are minimal in the absence of intervention","justification":""},{"idx":2,"correct":false,"proposition":"This is the normal course of a fracture after osteosynthesis.","justification":""},{"idx":3,"correct":false,"proposition":"This is a vicious aspect of callus","justification":""},{"idx":4,"correct":true,"proposition":"The osteosynthesis material in place is a centromedullary nail","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-1","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" What do you think is the most important thing to collect during questioning? (only one answer expected)","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"a family history of systemic inflammatory disease","justification":""},{"idx":1,"correct":false,"proposition":"A triggering factor","justification":""},{"idx":2,"correct":false,"proposition":"a cardiovascular history","justification":""},{"idx":3,"correct":false,"proposition":"A recent trip","justification":""},{"idx":4,"correct":true,"proposition":"the pain schedule","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-2","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" What is (are) the element(s) that orient you towards an inflammatory nature of pain?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Awakenings at the end of the night","justification":""},{"idx":1,"correct":false,"proposition":"difficulty falling asleep","justification":""},{"idx":2,"correct":false,"proposition":"10-minute morning stiffness","justification":""},{"idx":3,"correct":true,"proposition":"persistence of pain at rest","justification":""},{"idx":4,"correct":false,"proposition":"progressive worsening of pain during the day","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-3","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Joint pain is inflammatory. What are the three most likely diagnoses in this patient to explain all the symptoms?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"rheumatoid arthritis","justification":""},{"idx":1,"correct":true,"proposition":"scleroderma","justification":""},{"idx":2,"correct":false,"proposition":"a drop","justification":""},{"idx":3,"correct":true,"proposition":"lung cancer","justification":""},{"idx":4,"correct":false,"proposition":"myeloma","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-4","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Your clinical examination objective the abnormalities visualized in the following photograph. What do you suspect (one or more possible answers)?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Tophus","justification":""},{"idx":1,"correct":true,"proposition":"rheumatoid nodules","justification":""},{"idx":2,"correct":false,"proposition":"erythema nodosum","justification":""},{"idx":3,"correct":false,"proposition":"Heberden's nodules","justification":""},{"idx":4,"correct":false,"proposition":"multiple abscesses","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-5","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You prescribe a biological assessment. Which of the following proposals do you think is relevant at this stage?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"HLA typing","justification":""},{"idx":1,"correct":true,"proposition":"CRP","justification":""},{"idx":2,"correct":false,"proposition":"Antiphospholipid antibodies","justification":""},{"idx":3,"correct":true,"proposition":"anti-citrullinated peptide (ACPA) antibodies","justification":""},{"idx":4,"correct":true,"proposition":"anti-nuclear antibodies","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-6","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" The immunological assessment shows: negative anti-citrullinated peptide antibodies (ACPA), anti-nuclear antibodies positive at 1\/80 without specificity, a rheumatoid factor positive. CRP is 60 mg\/L.Given all the clinical and paraclinical information available at this stage, what is the most likely diagnosis?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"a drop","justification":""},{"idx":1,"correct":true,"proposition":"rheumatoid arthritis","justification":""},{"idx":2,"correct":false,"proposition":"psoriatic arthritis","justification":""},{"idx":3,"correct":false,"proposition":"lupus","justification":""},{"idx":4,"correct":false,"proposition":"scleroderma","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-7","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Faced with this distal, bilateral and symmetrical polyarthritis, the presence of rheumatoid nodules and the positivity of rheumatoid factor, you have made the diagnosis of rheumatoid arthritis and started a background treatment with methotrexate. The patient has progressive dyspnea stage 2 on the modified Medical Research Council (mMRC) scale that has been on for six months now. The objective auscultation of the dry crackling of the two bases. The rest of the chest examination is normal. The heart rate is regular without any particular breath. What do you suspect first (only one answer expected)?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"chronic bronchitis","justification":""},{"idx":1,"correct":false,"proposition":"pleural effusion","justification":""},{"idx":2,"correct":false,"proposition":"infectious pneumonia","justification":""},{"idx":3,"correct":true,"proposition":"diffuse interstitial lung disease","justification":""},{"idx":4,"correct":false,"proposition":"diaphragmatic paralysis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-8","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Faced with this suspicion of diffuse interstitial lung disease, what are the two most relevant complementary examinations?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"bronchial fibroscopy with LBA","justification":""},{"idx":1,"correct":true,"proposition":"EFRs with DLCO measurement","justification":""},{"idx":2,"correct":true,"proposition":"a chest CT scan","justification":""},{"idx":3,"correct":false,"proposition":"echocardiography","justification":""},{"idx":4,"correct":false,"proposition":"a pulmonary ventilation\/perfusion scan","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-9","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You complete your approach by performing a chest CT scan, a section of which is attached. What basic lesion(s) do you observe on this scanner?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"pleural effusion","justification":""},{"idx":1,"correct":false,"proposition":"condensation erasing vascular structures","justification":""},{"idx":2,"correct":false,"proposition":"micronodules","justification":""},{"idx":3,"correct":true,"proposition":"intralobular cross-linking","justification":""},{"idx":4,"correct":true,"proposition":"traction bronchiectasis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-10","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You perform pulmonary function tests:What is (are) the exact answer(s)?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Diffusion disorder","justification":""},{"idx":1,"correct":false,"proposition":"obstructive syndrome","justification":""},{"idx":2,"correct":true,"proposition":"restrictive syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Significant reversibility","justification":""},{"idx":4,"correct":false,"proposition":"shunt","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-11","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You are diagnosed with diffuse interstitial lung disease related to rheumatoid arthritis. Two years later, on the blood test, isolated neutropenia was found at 789\/mm3. The patient is asthenic. He has no fever. On examination, you find splenomegaly. Which diagnosis do you think is most likely?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"rheumatoid vasculitis","justification":""},{"idx":1,"correct":false,"proposition":"schistosomiasis","justification":""},{"idx":2,"correct":false,"proposition":"Gaucher disease","justification":""},{"idx":3,"correct":false,"proposition":"hairy cell leukemia","justification":""},{"idx":4,"correct":true,"proposition":"Felty's syndrome","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-12","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You are diagnosed with Felty's syndrome. The patient is now being treated with immunosuppressants. He contacts you again after 3 months of treatment due to a worsening of dyspnea for two days with dyspnea at the slightest effort. The respiratory rate is 35 cycles per minute, hemodynamics are stable. Saturation is 95% under 6 liters of oxygen per minute. Pulmonary auscultation finds bilateral crackling at the bases. Vocal vibrations are unchanged and chest percussion is normal. What are the three diagnoses that you first mention in the face of this brutal decompensation?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"pulmonary embolism","justification":""},{"idx":1,"correct":false,"proposition":"lung cancer","justification":""},{"idx":2,"correct":false,"proposition":"pneumothorax","justification":""},{"idx":3,"correct":true,"proposition":"pneumocystosis","justification":""},{"idx":4,"correct":true,"proposition":"community-acquired acute pneumonia","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-13","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Given the severity of the patient, you hospitalize him. The temperature is 38.6°C.  An X-ray of the chest in bed is performed while sitting. What do you see? (one or more correct answers)","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"right pleural effusion","justification":""},{"idx":1,"correct":false,"proposition":"left apical pneumothorax","justification":""},{"idx":2,"correct":false,"proposition":"cardiomegaly","justification":""},{"idx":3,"correct":true,"proposition":"Alveolar opacities on the left","justification":""},{"idx":4,"correct":true,"proposition":"Bilateral interstitial opacities","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-14","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Severity criteria dictate that you transfer your patient to critical care. What sample(s) do you take to make the microbiological diagnosis of this infectious pneumonitis?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Legionella antigenuria","justification":""},{"idx":1,"correct":true,"proposition":"Blood","justification":""},{"idx":2,"correct":true,"proposition":"Multiplex PCR on nasopharyngeal swab","justification":""},{"idx":3,"correct":true,"proposition":"cytobacteriological examination of sputum","justification":""},{"idx":4,"correct":true,"proposition":"pneumococcal antigenuria","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-15","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" While waiting for microbiological results, which probabilistic antibiotic therapy do you prescribe? (one or more correct answers)","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Spiramycin intravenously","justification":""},{"idx":1,"correct":false,"proposition":"intravenous amoxicillin","justification":""},{"idx":2,"correct":true,"proposition":"intravenous cefotaxime","justification":""},{"idx":3,"correct":false,"proposition":"Intravenous ciprofloxacin","justification":""},{"idx":4,"correct":false,"proposition":"intravenous metronidazole","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-16","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" The microbiological balance is negative. Nevertheless, the patient's course is favorable after 7 days of treatment with cefotaxime and spiramycin. The patient returns home but is unable to leave easily due to fatigue. It retains bronchial congestion. You decide to continue chest physiotherapy. What elements must be included on the prescription? (one or more correct answers)","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the mention << home physiotherapy>>","justification":""},{"idx":1,"correct":false,"proposition":"the number of sessions you plan","justification":""},{"idx":2,"correct":false,"proposition":"diagnosis and type of pneumonia","justification":""},{"idx":3,"correct":false,"proposition":"the frequency of sessions per week","justification":""},{"idx":4,"correct":true,"proposition":"the mention << seven days a week>> if you consider weekend care necessary","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-1","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Faced with this complicated fall from a head trauma, what elements justify the realization of an emergency brain scan? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Age","justification":""},{"idx":1,"correct":false,"proposition":"Suspected syncope","justification":""},{"idx":2,"correct":true,"proposition":"Taking anticoagulant","justification":""},{"idx":3,"correct":true,"proposition":"Confusion","justification":""},{"idx":4,"correct":false,"proposition":"Polypathology","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-2","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Which proposals are correct regarding the brain scan? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Old bifrontal subdural collection","justification":""},{"idx":1,"correct":true,"proposition":"Subcortical atrophy","justification":""},{"idx":2,"correct":false,"proposition":"Signs of intracranial hypertension","justification":""},{"idx":3,"correct":true,"proposition":"Recent subdural hemorrhage","justification":""},{"idx":4,"correct":false,"proposition":"Right occipital old ischemic sequelae","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-3","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Among the tests requested, the INR is 2.1. What therapeutic measures are you putting in place regarding anticoagulant treatment? (one or more possible answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"  Intravenous vitamin K prescription","justification":""},{"idx":1,"correct":true,"proposition":"Prescription of concentrate of prothrombin complexes","justification":""},{"idx":2,"correct":true,"proposition":"Discontinuation of coumadin treatment","justification":""},{"idx":3,"correct":false,"proposition":"Prescription of an antiplatelet agent","justification":""},{"idx":4,"correct":false,"proposition":"Prescription of a low molecular weight heparin at a prophylactic dose","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-4","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" You stop coumadin, inject vitamin K and concentrate of prothrombin complexes intravenously. What monitoring measures do you put in place? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Platelet count at 30 minutes","justification":""},{"idx":1,"correct":true,"proposition":"INR check at 30 minutes","justification":""},{"idx":2,"correct":false,"proposition":"Anti-Xa activity","justification":""},{"idx":3,"correct":true,"proposition":"INR control at 6 a.m.","justification":""},{"idx":4,"correct":false,"proposition":"Factor V assay at 6 o'clock","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-5","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" The controlled INR at 30 minutes is 1.1. As part of the exploration of the patient's chest pain, you perform an ECG and chest X-ray. What etiological diagnosis do you retain for this chest pain? (only one exact answer)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Pulmonary embolism","justification":""},{"idx":1,"correct":false,"proposition":"Pneumonia of the right base","justification":""},{"idx":2,"correct":true,"proposition":"Rib fracture","justification":""},{"idx":3,"correct":false,"proposition":"Pneumothorax","justification":""},{"idx":4,"correct":false,"proposition":"Acute coronary syndrome","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-6","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Biologically, you note a natremia at 128 mmol \/ L. What additional elements can be used to explore this result? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Urinary ionogram","justification":""},{"idx":1,"correct":true,"proposition":"Protidemia","justification":""},{"idx":2,"correct":false,"proposition":"Serum anti-diuretic hormone assay","justification":""},{"idx":3,"correct":false,"proposition":"Total cholesterolemia","justification":""},{"idx":4,"correct":false,"proposition":"Proteinuria","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-7","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Protein and blood sugar are normal. The appearance of the serum is normal. You conclude hypoosmotic hyponatremia.   Kidney function is normal. The urinary ionogram reveals: natriuresis 60 mmol \/ L; kaliuresis 30 mmol\/L; urinary urea 250 mmol\/L.What are the two etiologies you mention at this stage?","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Syndrome of inappropriate DHA secretion related to serotonin reuptake inhibitor therapy","justification":""},{"idx":1,"correct":true,"proposition":"Syndrome of inappropriate DHA secretion related to chronic subdural hematoma","justification":""},{"idx":2,"correct":false,"proposition":"Potomania","justification":""},{"idx":3,"correct":false,"proposition":"Water retention related to calcium channel blocker treatment","justification":""},{"idx":4,"correct":false,"proposition":"Syndrome of inappropriate DHA secretion related to pleural effusion","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-8","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" What therapeutic measures do you take with regard to this hyponatremia? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Water restriction","justification":""},{"idx":1,"correct":false,"proposition":"NaCl infusion 9‰ 1000 ml\/24h","justification":""},{"idx":2,"correct":false,"proposition":"Treatment with loop diuretic","justification":""},{"idx":3,"correct":false,"proposition":"Sodium intake per os at 12 g \/ 24 hours","justification":""},{"idx":4,"correct":true,"proposition":"Discontinuation of serotonin reuptake inhibitor therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-9","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" You suspect syncope. Returning to the interrogation, the patient's daughter tells you that this is the second episode of sudden discomfort in a month, but her mother was not injured last time. What abnormalities do you notice on the ECG (same trace as question 5)? (one or more possible answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Full left branch block","justification":""},{"idx":1,"correct":true,"proposition":"Full right branch block","justification":""},{"idx":2,"correct":true,"proposition":"Left anterior hemiblock","justification":""},{"idx":3,"correct":false,"proposition":"Left posterior hemiblock","justification":""},{"idx":4,"correct":false,"proposition":"Atrial fibrillation","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-10","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" What diagnosis do you mention in priority in this patient regarding the etiology of her syncopes?","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Tight aortic stricture","justification":""},{"idx":1,"correct":false,"proposition":"Severe pulmonary embolism","justification":""},{"idx":2,"correct":true,"proposition":"Atrioventricular block of the paroxysmal 3rd degree","justification":""},{"idx":3,"correct":false,"proposition":"Paroxysmal ventricular tachycardia","justification":""},{"idx":4,"correct":false,"proposition":"Orthostatic hypotension","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-11","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Since her admission, the patient has spoken incoherently. The neurological condition is different from the usual state according to her daughter. What elements will you look for in favor of a delirium syndrome? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Fluctuations in unrest","justification":""},{"idx":1,"correct":false,"proposition":"Absences","justification":""},{"idx":2,"correct":true,"proposition":"Language disorders","justification":""},{"idx":3,"correct":true,"proposition":"Amnesia","justification":""},{"idx":4,"correct":true,"proposition":"Visual hallucinations","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-12","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" You are diagnosing confusion. What factors do you mention to explain the appearance of delirium syndrome? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Subdural hematoma","justification":""},{"idx":1,"correct":true,"proposition":"Head trauma","justification":""},{"idx":2,"correct":false,"proposition":"Depressive syndrome","justification":""},{"idx":3,"correct":true,"proposition":"Chest pain","justification":""},{"idx":4,"correct":false,"proposition":"Sleep disorders","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-13","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" What therapeutic measure(s) are you putting in place regarding this delirium syndrome?","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Continued treatment with benzodiazepine at the same dosage","justification":""},{"idx":1,"correct":false,"proposition":"Melatonin addition","justification":""},{"idx":2,"correct":false,"proposition":"Increased benzodiazepine treatment to cover nycthémère","justification":""},{"idx":3,"correct":true,"proposition":"Daily reminders on temporo-spatial orientation","justification":""},{"idx":4,"correct":true,"proposition":"Analgesic treatment with paracetamol","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-14","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" The patient presents with significant false routes to saliva and during the water test. His daughter tells you that her mother had no difficulty swallowing her meals before this fall. What complications can occur because of these swallowing disorders? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Undernutrition","justification":""},{"idx":1,"correct":true,"proposition":"Death","justification":""},{"idx":2,"correct":false,"proposition":"Dysarthria","justification":""},{"idx":3,"correct":true,"proposition":"Pneumonia","justification":""},{"idx":4,"correct":false,"proposition":"Aphasia","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-15","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" What measures do you put in place to avoid complications related to swallowing disorders? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Meals in the supine position at 45 °","justification":""},{"idx":1,"correct":true,"proposition":"Meal with head tilted forward","justification":""},{"idx":2,"correct":true,"proposition":"Cold drinks","justification":""},{"idx":3,"correct":true,"proposition":"Drinks","justification":""},{"idx":4,"correct":false,"proposition":"Food with small pieces","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-1","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" What semiological elements are present in this patient? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"A fatigability suggestive of diabetic neuropathy","justification":""},{"idx":1,"correct":true,"proposition":"pyramidal syndrome","justification":""},{"idx":2,"correct":false,"proposition":"mowing","justification":""},{"idx":3,"correct":true,"proposition":"peripheral neurological clinical syndrome","justification":""},{"idx":4,"correct":false,"proposition":"myasthenic syndrome","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-2","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" This patient has signs and symptoms consistent with diabetic neuropathy. Which ones are compatible with this diagnosis? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"  Very lively and diffused patellar tendon reflexes","justification":""},{"idx":1,"correct":true,"proposition":"Normal tendon reflexes in the upper limbs","justification":""},{"idx":2,"correct":true,"proposition":"Abolished Achileo tendon reflexes","justification":""},{"idx":3,"correct":true,"proposition":"Hypoaesthesia of both feet","justification":""},{"idx":4,"correct":false,"proposition":"Unilateral sensory deficit up to the umbilicus","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-3","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" To confirm the lesional location that best explains the clinical picture, which additional examination is most relevant? (only one answer expected)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Bone marrow MRI","justification":""},{"idx":1,"correct":false,"proposition":"Electroneuromyogram","justification":""},{"idx":2,"correct":false,"proposition":"Brain MRI","justification":""},{"idx":3,"correct":false,"proposition":"Driving evoked potentials","justification":""},{"idx":4,"correct":false,"proposition":"Spinal scanner","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-4","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" You have requested a spinal cord MRI :P the following proposals, which ones are correct? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"This is a coronal cup","justification":""},{"idx":1,"correct":true,"proposition":"An intramedullary hypersignal is observed next to thoracic vertebrae","justification":""},{"idx":2,"correct":true,"proposition":"The intramedullary signal suggests an inflammatory lesion","justification":""},{"idx":3,"correct":true,"proposition":"This is a T2-weighted cut","justification":""},{"idx":4,"correct":false,"proposition":"  There is a mass effect on the spinal cord","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-5","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" In the light of the inflammatory involvement of the dorsal marrow in relation to the 5th thoracic vertebra, what additional examinations could confirm the etiology of this central neurological disease? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Brain MRI","justification":""},{"idx":1,"correct":false,"proposition":"Electroneuromyogram","justification":""},{"idx":2,"correct":false,"proposition":"Somesthetic evoked potentials","justification":""},{"idx":3,"correct":true,"proposition":"Microbiological","justification":""},{"idx":4,"correct":false,"proposition":"Serum CRP assay","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-6","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" A brain MRI is performed. It is an MRI in axial section weighted in T2 at the subtentorial level and axial FLAIR at the supratentorial level. Which of the following are true? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Abnormal images are visualized in hyposignal","justification":""},{"idx":1,"correct":false,"proposition":"Hypersignals suggest multiple metastatic lesions","justification":""},{"idx":2,"correct":true,"proposition":"At least one subcortical lesion is visualized","justification":""},{"idx":3,"correct":true,"proposition":" At least one periventricular lesion is visualized","justification":""},{"idx":4,"correct":true,"proposition":" The largest lesion, in subtentorial, affects a cerebellar peduncle","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-7","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" A study of cerebrospinal fluid was performed. The main results are as follows:P roteinorachia: 0.68 g \/ LCellules: 0 red blood cells; 6 mononuclear cellsGlycorachia: 0.90 g \/ LIndex IgG: 0.92Oligoclonal appearance with at least 9 supernumerary bands of IgG.Regarding this analysis of cerebrospinal fluid, what are the exact answers? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Proteinrachia is normal","justification":""},{"idx":1,"correct":true,"proposition":"There is an intrathecal synthesis of IgG","justification":""},{"idx":2,"correct":false,"proposition":"There are arguments in favor of bacterial meningitis","justification":""},{"idx":3,"correct":true,"proposition":"Elevated glycorachia is compatible with the context of diabetes","justification":""},{"idx":4,"correct":true,"proposition":"Cellularity is compatible with a diagnosis of multiple sclerosis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-8","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" What diagnoses do you retain to explain all the clinical, radiological and biological data in this file? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Intramedullary tumour","justification":""},{"idx":1,"correct":true,"proposition":"Polyneuropathy","justification":""},{"idx":2,"correct":false,"proposition":"Biermer's disease","justification":""},{"idx":3,"correct":true,"proposition":"Multiple sclerosis","justification":""},{"idx":4,"correct":false,"proposition":"Acute polyradiculoneuritis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-9","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" In addition to a picture of polyneuropathy, this patient has multiple sclerosis (MS). You tell him this diagnosis. He asks you questions about MS. Which of the following are true? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The primary progressive form is more common in the beginning of the disease","justification":""},{"idx":1,"correct":true,"proposition":"MS is more common in Caucasian women","justification":""},{"idx":2,"correct":true,"proposition":"The presence of cognitive disorders, during illness, is common","justification":""},{"idx":3,"correct":false,"proposition":"The association of MS and type I diabetes is linked to chance","justification":""},{"idx":4,"correct":true,"proposition":"The risk of MS in siblings is increased compared to the general population","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-10","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" During his medical follow-up, the patient reports a few months later to be constipated. He sometimes needs to empty his bladder in two or three steps. His libido is diminished. Which of the following are true? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The patient has symptoms of overactive bladder","justification":""},{"idx":1,"correct":true,"proposition":"The post-voiding residue must be measured","justification":""},{"idx":2,"correct":false,"proposition":"You first mention prostatic hypertrophy","justification":""},{"idx":3,"correct":false,"proposition":"The decrease in libido is directly related to his spinal cord damage","justification":""},{"idx":4,"correct":true,"proposition":"Constipation may be related to MS","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-11","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" In general, regarding neuroperineal disorders, which proposals are accurate? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Overactive bladder is mainly manifested by voiding emergencies","justification":""},{"idx":1,"correct":false,"proposition":"First-line drug therapy for overactive bladder relies on alpha-blockers","justification":""},{"idx":2,"correct":true,"proposition":"  Dysuria can be confirmed by flowmetry","justification":""},{"idx":3,"correct":true,"proposition":"In case of post-voiding residues, intermittent self-sounding should be preferred.","justification":""},{"idx":4,"correct":true,"proposition":"Both multiple sclerosis and diabetes can impair erectile abilities","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-12","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" This patient has primary progressive MS. It has no background treatment. You see him again six months later. He tells you that he has been feeling particularly tired for a few months and that he is << stiff >>. You observe spasticity of the posterior laloge of the right leg. What support do you offer? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"You are initiating corticosteroid therapy with prednisolone","justification":""},{"idx":1,"correct":false,"proposition":"You contraindicate the resumption of physical activity","justification":""},{"idx":2,"correct":true,"proposition":"You are discussing an antispastic treatment (baclofene)","justification":""},{"idx":3,"correct":false,"proposition":"You gradually introduce pregabalin therapy","justification":""},{"idx":4,"correct":true,"proposition":"You prescribe physiotherapy","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-13","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" An electroneuromyogram is performed in this patient given the context of diabetes. The results are as follows: normal sensory and motor conduction velocities to all four limbs. The amplitude of the motor and sensory potentials is halved. The tracings in detection are in favor of neurogenic involvement. What syndromic diagnosis do you remember? (only one answer expected)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Axonal involvement","justification":""},{"idx":1,"correct":false,"proposition":"Demyelinating involvement","justification":""},{"idx":2,"correct":false,"proposition":"Myogenic involvement","justification":""},{"idx":3,"correct":false,"proposition":"Motor plate involvement","justification":""},{"idx":4,"correct":false,"proposition":"Anterior horn involvement","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-14","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" What medico-social measures should be put in place for this patient? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"MDPH file for applying for a mobility inclusion card","justification":""},{"idx":1,"correct":false,"proposition":"Invalidity second category","justification":""},{"idx":2,"correct":true,"proposition":"Application for ALD for MS","justification":""},{"idx":3,"correct":false,"proposition":"MDPH file for allocation of human aids","justification":""},{"idx":4,"correct":false,"proposition":"Outplacement","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-1","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" The NFS finds: hemoglobin 10.5 g\/dL, MCV 70 fL, reticulocytes 10 G\/L. What is the most likely diagnosis?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"non-regenerative microcytic anemia","justification":""},{"idx":1,"correct":false,"proposition":"regenerative microcytic anemia","justification":""},{"idx":2,"correct":false,"proposition":"regenerative macrocytic anemia","justification":""},{"idx":3,"correct":false,"proposition":"non-regenerative macrocytic anemia","justification":""},{"idx":4,"correct":false,"proposition":"normocytic regenerative anemia","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-2","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" What proposals can explain this non-regenerative microcytic anemia? (one or more correct answers)","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"chronic hemolysis","justification":""},{"idx":1,"correct":false,"proposition":"Folate deficiency","justification":""},{"idx":2,"correct":true,"proposition":"Iron deficiency","justification":""},{"idx":3,"correct":true,"proposition":"celiac disease","justification":""},{"idx":4,"correct":true,"proposition":"Helicobacter pylori infection","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-3","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" By plotting the staturo-weight curve, you notice an absence of weight gain for 3 months, without stature break in this young girl previously having a growth curve on the median in weight and height. What are the plausible diagnostic hypotheses? (one or more correct answers)","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"simple pubertal delay","justification":""},{"idx":1,"correct":false,"proposition":"growth hormone deficiency","justification":""},{"idx":2,"correct":true,"proposition":"celiac disease","justification":""},{"idx":3,"correct":true,"proposition":"Crohn's disease","justification":""},{"idx":4,"correct":false,"proposition":"hypothyroidism","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-4","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" During interrogation, the mother finds that her daughter eats little at home and sorts her food. What element(s) is (are) in favor of a restrictive eating disorder?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"relational impoverishment","justification":""},{"idx":1,"correct":true,"proposition":"physical hyperactivity","justification":""},{"idx":2,"correct":true,"proposition":"Concerns about his weight","justification":""},{"idx":3,"correct":false,"proposition":"Disinterest in schooling","justification":""},{"idx":4,"correct":true,"proposition":"wish to eat << healthy>>","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-5","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" School absenteeism is important. The girl says that in addition to fatigue, she often has headaches. What element(s) are you looking for in the interrogation that will make you mention secondary headaches?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"occurrence with cough","justification":""},{"idx":1,"correct":false,"proposition":"occurred mainly on weekends","justification":""},{"idx":2,"correct":true,"proposition":"always occurred on the same side","justification":""},{"idx":3,"correct":true,"proposition":"morning vomiting","justification":""},{"idx":4,"correct":false,"proposition":"associated abdominal pain","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-6","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" The headaches are bifrontal, lasting between 10 minutes and 2 hours, relieved with paracetamol that she has been taking about 2 times a month for more than a year. She is not bothered by noise or light. What can it be? One or more exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"typical migraine without aura","justification":""},{"idx":1,"correct":false,"proposition":"Analgesic abuse","justification":""},{"idx":2,"correct":true,"proposition":"tension headaches","justification":""},{"idx":3,"correct":false,"proposition":"chronic migraine","justification":""},{"idx":4,"correct":false,"proposition":"bilateral frontal sinusitis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-7","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" On clinical examination, you notice a small breast bud with enlargement of the areola, the absence of pubic hair, it is not settled. Regarding pubertal development in this patient, which is the exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Tanner Stadium is S2P0","justification":""},{"idx":1,"correct":false,"proposition":"Tanner stadium is S1P0","justification":""},{"idx":2,"correct":true,"proposition":"Tanner Stadium is S2P1","justification":""},{"idx":3,"correct":false,"proposition":"she has a delayed puberty","justification":""},{"idx":4,"correct":false,"proposition":"She has a thelarche premature","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-8","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" In front of these persistent headaches, you have a brain MRI performed, the image of which is here. Which proposal(s) is the exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"legend 1 corresponds to the stem of the pituitary gland","justification":""},{"idx":1,"correct":false,"proposition":"Legend 2 corresponds to the third ventricle","justification":""},{"idx":2,"correct":true,"proposition":"legend 3 corresponds to the corpus callosum","justification":""},{"idx":3,"correct":false,"proposition":"Legend 4 corresponds to the cerebellar vermis","justification":""},{"idx":4,"correct":true,"proposition":"Legend 5 corresponds to the sphenoid sinus","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-9","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" Brain MRI is normal. The ingesta evaluated by the dietician are lower than the average energy requirement. What is the average energy requirement of a 12-year-old girl? (only one answer expected)","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"1200 kcal\/d","justification":""},{"idx":1,"correct":false,"proposition":"1700 kcal\/d","justification":""},{"idx":2,"correct":true,"proposition":"2200 kcal\/d","justification":""},{"idx":3,"correct":false,"proposition":"2700 kcal\/d","justification":""},{"idx":4,"correct":false,"proposition":"3200 kcal\/d","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-10","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" In front of microcytic anemia and the absence of weight gain, you evoke celiac disease. Which proposal(s) is the exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"you find the child too old to discuss this diagnosis","justification":""},{"idx":1,"correct":true,"proposition":"you prescribe an anti-transglutaminase IgA assay","justification":""},{"idx":2,"correct":false,"proposition":"you prescribe an anti-endomysium IgG test","justification":""},{"idx":3,"correct":false,"proposition":"you prescribe the anti-gliadin IgA test","justification":""},{"idx":4,"correct":false,"proposition":"you are doing a proof treatment excluding gluten","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-11","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" The dosage of anti-transglutaminase IgA is not in favor of the diagnosis of celiac disease, you now evoke Crohn's disease.Which element(s) would be the element(s) to look for in favor of this diagnostic hypothesis?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Arthralgia","justification":""},{"idx":1,"correct":true,"proposition":"oral aphthosis","justification":""},{"idx":2,"correct":false,"proposition":"alopecia","justification":""},{"idx":3,"correct":false,"proposition":"episodes of hematemesis","justification":""},{"idx":4,"correct":true,"proposition":"erythema nodosum","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-12","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" What would be the biological element(s) in favor of the diagnosis of Crohn's disease?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Augmented CRP","justification":""},{"idx":1,"correct":true,"proposition":"hypoalbuminemia","justification":""},{"idx":2,"correct":false,"proposition":"increased fecal elastase","justification":""},{"idx":3,"correct":true,"proposition":"increased fecal calprotectin","justification":""},{"idx":4,"correct":false,"proposition":"positive anti-nuclear factors","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-13","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" The diagnosis of Crohn's disease was ruled out in the absence of normal inflammatory syndrome, faecal calprotectin and albuminemia. You finally retain the diagnosis of isolated iron deficiency in front of a ferritinemia at 3 ng \/ mL.What element (s) do you seek at the interrogation to explain this disorder in this patient?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"presence of menorrhagia","justification":""},{"idx":1,"correct":true,"proposition":"Replacement of meat products with pulses","justification":""},{"idx":2,"correct":false,"proposition":"insufficient consumption of oranges","justification":""},{"idx":3,"correct":false,"proposition":"intensive sports practice","justification":""},{"idx":4,"correct":false,"proposition":"excessive consumption of milk products","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-14","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" She reports not consuming any meat products. Regarding martial supplementation, what is (are) the exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The initial prescription is preferably in injectable form","justification":""},{"idx":1,"correct":true,"proposition":"Treatment may result in black stool staining","justification":""},{"idx":2,"correct":true,"proposition":"It is best to divide the daily dose into 3 doses","justification":""},{"idx":3,"correct":true,"proposition":"A reticulocyte seizure usually occurs around day 10 of treatment","justification":""},{"idx":4,"correct":true,"proposition":"The duration of supplementation will be at least 3 months","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-1","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" Which diagnosis is most likely? (only one answer expected)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Acute benzodiazepine poisoning","justification":""},{"idx":1,"correct":false,"proposition":"Acute amphetamine poisoning","justification":""},{"idx":2,"correct":true,"proposition":"Acute opioid poisoning","justification":""},{"idx":3,"correct":false,"proposition":"acute intoxication with antidepressants","justification":""},{"idx":4,"correct":false,"proposition":"acute lithium poisoning","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-2","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" Which of the following is more suggestive of opioid poisoning?","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"pupillary examination","justification":""},{"idx":1,"correct":false,"proposition":"the depth of coma","justification":""},{"idx":2,"correct":false,"proposition":"Discovery on public roads","justification":""},{"idx":3,"correct":true,"proposition":"respiratory rate","justification":""},{"idx":4,"correct":false,"proposition":"temperature","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-3","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" A coma by opioid overdose is diagnosed. What elements are part of the immediate drug treatment? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Naloxone","justification":""},{"idx":1,"correct":false,"proposition":"Flumazenil","justification":""},{"idx":2,"correct":false,"proposition":"N-acetyl-cysteine","justification":""},{"idx":3,"correct":false,"proposition":"Atropine","justification":""},{"idx":4,"correct":false,"proposition":"Buprenorphine","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-4","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" After a bolus of naloxone the patient wakes up, naloxone is kept in continuous infusion for a few hours. He reveals that he had bought 50 mg of methadone hydrochloride on the street where he has been living for 3 days, following his release from prison. He was incarcerated for a robbery. He doesn't understand what happened to him because, before entering prison two years ago, he had been taking 80 mg of methadone a day for several months. He was able to stop this treatment in prison, he says proudly: \"It was not easy, especially with the pain.\" But he admits to having \"plunged\" as soon as he left not having been able to control his desire for products. The health care team finds it a little odd. Which of the following elements of the observation are diagnostic criteria for opioid dependence? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Robberies to obtain the product","justification":""},{"idx":1,"correct":true,"proposition":"Abdominal pain between doses","justification":""},{"idx":2,"correct":false,"proposition":"The episode of overdose","justification":""},{"idx":3,"correct":true,"proposition":"Consumption continues despite negative consequences","justification":""},{"idx":4,"correct":true,"proposition":"Craving","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-5","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" To take stock of the social situation of this patient, what needs to be specified? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"nationality","justification":""},{"idx":1,"correct":true,"proposition":"housing conditions","justification":""},{"idx":2,"correct":true,"proposition":"Health coverage","justification":""},{"idx":3,"correct":true,"proposition":"its resources and assistance","justification":""},{"idx":4,"correct":false,"proposition":"criminal record","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-6","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient is homeless. What options can be considered to relocate him? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Hospitalization in psychiatry","justification":""},{"idx":1,"correct":false,"proposition":"Hospitalization in addictological follow-up care","justification":""},{"idx":2,"correct":true,"proposition":"Solicitation of a bed halte health care","justification":""},{"idx":3,"correct":false,"proposition":"Solicitation of a nursing home","justification":""},{"idx":4,"correct":true,"proposition":"Solicitation of associative hosting","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-7","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" A few weeks later, the patient is housed in a Residential and Social Reintegration Centre (CHRS). He consults in addictology because \"decidedly, with heroin, it does not go anymore! \". He consumes 2 to 3 grams per day in sniffing or more rarely in injection. He went to see a doctor in town who advised him to withdraw or substitute treatment. Suspicious, he wants a second opinion on the resumption of methadone hydrochloride. Which of the following statements are true? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It is too risky given the history of overdose","justification":""},{"idx":1,"correct":false,"proposition":"It should be avoided in favor of clonidine withdrawal","justification":""},{"idx":2,"correct":true,"proposition":"It is possible with psychosocial support","justification":""},{"idx":3,"correct":false,"proposition":"It can be initiated by the town doctor","justification":""},{"idx":4,"correct":true,"proposition":"It is part of an overall risk reduction strategy","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-8","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient now lives with a 23-year-old woman, with whom he has been shopping for three months. She occasionally uses heroin sniffing and does not think she needs treatment. She regularly visits a centre where she is given information on the risk of overdose. Which of the following are appropriate risk and harm reduction strategies in this context? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Condom distribution","justification":""},{"idx":1,"correct":true,"proposition":"The realization of serologies HIV, HVB, HVC","justification":""},{"idx":2,"correct":true,"proposition":"Recovery of used consumer equipment","justification":""},{"idx":3,"correct":true,"proposition":"Distribution of sterile syringes","justification":""},{"idx":4,"correct":false,"proposition":"Testing of products consumed","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-9","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient has been stabilized for 2 years by treatment with 80 mg of methadone hydrochloride per day. It is his attending physician who reproduces. Last week, he was on vacation and the patient had to deal with a replacement. He was questioned about his drinking, particularly alcohol and tobacco. The patient admitted to regularly drinking two to three beers every night. In order to reduce his cravings for alcohol, the patient asks if he could benefit from treatment like one of his friends who has managed to be weaned. What are the two molecules that could have been prescribed to his friend to help him reduce alcohol consumption?","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Nalmefene","justification":""},{"idx":1,"correct":false,"proposition":"Acamprosate","justification":""},{"idx":2,"correct":true,"proposition":"Baclofen","justification":""},{"idx":3,"correct":false,"proposition":"Naltrexone","justification":""},{"idx":4,"correct":false,"proposition":"Disulfiram","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-10","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient recalls that his friend received nalmefene treatment; He therefore wishes to obtain some. The patient's general practitioner's substitute explains the incompatibility of nalmefene with methadone, and offers acamprosate treatment after weaning. At the next consultation, the patient explains to his doctor that he thinks the replacement \"is in cahoots with the pharmaceutical industry\". He noted certain clues that support his idea. \"He would have done better to help me quit smoking,\" he told his doctor. He says he has smoked two packs a day for 10 years. He only supports cigarettes that he makes himself – \"It's safer,\" he says – and also the electronic cigarette. Which of the following signs of tobacco addiction is most severe? (only one answer expected)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The need to smoke several times a day","justification":""},{"idx":1,"correct":false,"proposition":"Continued consumption despite negative consequences","justification":""},{"idx":2,"correct":true,"proposition":"Smoking your first cigarette when you wake up","justification":""},{"idx":3,"correct":false,"proposition":"Smoking rolled cigarettes","justification":""},{"idx":4,"correct":false,"proposition":"Denial of his smoking problem","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-11","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient is severely addicted to tobacco. He agrees to a treatment. Which treatments have a marketing authorization in this indication? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Nicotine replacement by patch","justification":""},{"idx":1,"correct":true,"proposition":"nicotine replacement by gum","justification":""},{"idx":2,"correct":true,"proposition":"varenicline","justification":""},{"idx":3,"correct":false,"proposition":"Baclofen","justification":""},{"idx":4,"correct":false,"proposition":"e-cigarettes","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-12","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" Two years later, the patient presented to the emergency room of the hospital because he was not feeling well. He has now been living alone for several months. He has not resumed heroin and is still taking methadone hydrochloride treatment. His partner left him because she could no longer stand his << laziness >> and his lack of motivation to do the markets. She also blamed him for his lack of emotions. He is not well, according to him, since a doctor finally acceded to his request for nalmefene, which he did not support. He often repeats \"evil is not fun\" with a knowing tune and sometimes fabricates new words. He doesn't see anyone anymore. He has trouble washing. Which psychiatric syndrome dominates this clinical picture? (only one answer expected)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"A depressive syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Korsakoff's syndrome","justification":""},{"idx":2,"correct":true,"proposition":"A negative syndrome in schizophrenia","justification":""},{"idx":3,"correct":false,"proposition":"A positive syndrome in schizophrenia","justification":""},{"idx":4,"correct":false,"proposition":"A syndrome of disorganization in the context of schizophrenia","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-13","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The picture is mainly dominated by a negative syndrome suggestive of a schizophrenic disorder. What semiological elements are in favor of this syndrome? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Sadness","justification":""},{"idx":1,"correct":true,"proposition":"Emotional blunting","justification":""},{"idx":2,"correct":true,"proposition":"Aboulia","justification":""},{"idx":3,"correct":true,"proposition":"Social withdrawal","justification":""},{"idx":4,"correct":false,"proposition":"Neologism","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-14","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient claims that \"he was very harmed.\" He doesn't know who but he has researched the internet and knows \"now what really happened, and everything is connected\". He pauses in his speech and does not finish his sentences, but does not wish to say more because one could hear him and take it at him. In front of this clinical picture evolving for more than 6 months and the entire history of the patient we can conclude to a diagnosis of schizophrenia. What elements in favor of this diagnosis are in the observation? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Dams","justification":""},{"idx":1,"correct":true,"proposition":"Delusions","justification":""},{"idx":2,"correct":false,"proposition":"Acoustico-verbal hallucinations","justification":""},{"idx":3,"correct":false,"proposition":"Ideo-affective discordance","justification":""},{"idx":4,"correct":false,"proposition":"Catatonic syndrome","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-15","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient agrees to take treatment. Which of the following proposals apply to the antipsychotic treatment you are going to offer this patient? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"it must be based on a second-generation antipsychotic","justification":""},{"idx":1,"correct":false,"proposition":"It must be combined with an anticholinergic corrector","justification":""},{"idx":2,"correct":false,"proposition":"  It must be prescribed in delayed injectable form","justification":""},{"idx":3,"correct":false,"proposition":"it must have a sedative component","justification":""},{"idx":4,"correct":true,"proposition":"It must be prescribed after analysis of an electrocardiogram","justification":""}],"type":"dp"}
+{"_id":"annales-2016-qi-1","context":null,"enonce":"A study was carried out by drawing lots from the electoral lists 5,000 subjects aged 40 to 60.  Whether or not these subjects had diabetes was investigated by taking their medical history, treatments taken and measuring their fasting blood glucose. Which of the following is correct about this study?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"This is a cross-sectional study"},{"idx":1,"correct":false,"proposition":"This is a randomized study"},{"idx":2,"correct":true,"proposition":"This is an observational study"},{"idx":3,"correct":true,"proposition":"This study will estimate the prevalence of diabetes in this population"},{"idx":4,"correct":false,"proposition":"This study will estimate the case fatality associated with diabetes in this population"}],"type":"qi"}
+{"_id":"annales-2016-qi-3","context":null,"enonce":"Primary enuresis is when:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"The child is over 5 years old"},{"idx":1,"correct":false,"proposition":"This enuresis has no identified cause"},{"idx":2,"correct":true,"proposition":"The child was never clean at night"},{"idx":3,"correct":false,"proposition":"The child sleeps too much"},{"idx":4,"correct":false,"proposition":"The child gets up at night to drink"}],"type":"qi"}
+{"_id":"annales-2016-qi-4","context":null,"enonce":"A 3-year-old child is brought to the emergency room by his parents for diarrhea for 2 days associated with a fever at 40 ° C.  You learn that he returned from Senegal 3 days before. Which additional examination(s) do you think are etiologically justified in view of the whole clinical picture?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"A blood culture"},{"idx":1,"correct":false,"proposition":"Malaria serology"},{"idx":2,"correct":true,"proposition":"A rapid diagnostic test for malaria"},{"idx":3,"correct":true,"proposition":"A search for parasites in the stool"},{"idx":4,"correct":true,"proposition":"A stool culture"}],"type":"qi"}
+{"_id":"annales-2016-qi-5","context":null,"enonce":"As part of the procedure before the Conciliation and Compensation Commission (CCI), following a medical accident, compensation from the National Office for Medical Accident Compensation (ONIAM) can be obtained if one or more conditions are met.  Which one(which)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Prior application of the administrative responsibility of the hospital"},{"idx":1,"correct":true,"proposition":"Harm directly related to medical care"},{"idx":2,"correct":true,"proposition":"The absence of culpable liability"},{"idx":3,"correct":true,"proposition":"Damage with a Violation of Physical or Mental Integrity (AIPP) greater than or equal to 25%"},{"idx":4,"correct":true,"proposition":"A cessation of professional activities greater than or equal to 6 months over a period of 12 months"}],"type":"qi"}
+{"_id":"annales-2016-qi-6","context":null,"enonce":"A 3-year-old child with normal psychomotor development is usually able to:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Reproduce a round"},{"idx":1,"correct":true,"proposition":"Reproduce a stroke"},{"idx":2,"correct":false,"proposition":"Reproduce a diamond"},{"idx":3,"correct":false,"proposition":"Reproduce a square"},{"idx":4,"correct":false,"proposition":"Reproduce a cross"}],"type":"qi"}
+{"_id":"annales-2016-qi-7","context":null,"enonce":"When a mother has gestational diabetes, there is an increased risk of:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Post-term delivery"},{"idx":1,"correct":false,"proposition":"That the newborn is hypotrophic (small for gestational age)"},{"idx":2,"correct":true,"proposition":"Dystocia"},{"idx":3,"correct":true,"proposition":"Free bilirubin jaundice in newborns"},{"idx":4,"correct":false,"proposition":"Neonatal hyperglycemia"}],"type":"qi"}
+{"_id":"annales-2016-qi-8","context":null,"enonce":"A 10-month-old infant with normal psychomotor development should:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Standing with support"},{"idx":1,"correct":true,"proposition":"Repeat a syllable"},{"idx":2,"correct":true,"proposition":"Seated by yourself"},{"idx":3,"correct":true,"proposition":"Moving on the ground"},{"idx":4,"correct":true,"proposition":"Worrying at the sight of an unfamiliar face"}],"type":"qi"}
+{"_id":"annales-2016-qi-9","context":null,"enonce":"What is (are) the complication(s) associated with prematurity?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Ulcerative-necrotizing enterocolitis"},{"idx":1,"correct":true,"proposition":"Retinopathy"},{"idx":2,"correct":true,"proposition":"Periventricular leukomalacia"},{"idx":3,"correct":false,"proposition":"Dilation of the bronchi"},{"idx":4,"correct":false,"proposition":"The atrioventricular canal"}],"type":"qi"}
+{"_id":"annales-2016-qi-10","context":null,"enonce":"You are seeing a 12-year-old obese teenager. The body mass index curve shows a rebound in adiposity at age 3. There is an acceleration of the stature growth curve. On examination, you will see purple stretch marks on the flanks and thickened, rough skin on the neck. His parents report that he is constipated. Which additional exam(s) do you prescribe?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"TSH, T4"},{"idx":1,"correct":false,"proposition":"Urinary free cortisol"},{"idx":2,"correct":false,"proposition":"Plasma IGF 1"},{"idx":3,"correct":false,"proposition":"Testosteronemia"},{"idx":4,"correct":true,"proposition":"None of the previous exams"}],"type":"qi"}
+{"_id":"annales-2016-qi-11","context":null,"enonce":"A child who has just been born is said:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Premature if born at a gestational age less than 37 weeks of amenorrhea"},{"idx":1,"correct":true,"proposition":"Hypotrophic if its measurements are strictly less than at least two standard deviations from the reference curves"},{"idx":2,"correct":true,"proposition":"Post-mature if born at a gestational age greater than or equal to 42 weeks of amenorrhea"},{"idx":3,"correct":false,"proposition":"Newborn in the first three months of life"},{"idx":4,"correct":true,"proposition":"Very premature if born at a gestational age of less than 32 weeks of amenorrhea"}],"type":"qi"}
+{"_id":"annales-2016-qi-12","context":null,"enonce":"All newborns should be routinely screened for:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Cystic fibrosis"},{"idx":1,"correct":false,"proposition":"Congenital diabetes"},{"idx":2,"correct":true,"proposition":"Congenital hypothyroidism"},{"idx":3,"correct":true,"proposition":"Congenital adrenal hyperplasia"},{"idx":4,"correct":false,"proposition":"Thalassemia"}],"type":"qi"}
+{"_id":"annales-2016-qi-13","context":null,"enonce":"At the maternity discharge examination, a healthy full-term child must have:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"A closed posterior fontanel"},{"idx":1,"correct":true,"proposition":"A popliteal angle less than or equal to 90°"},{"idx":2,"correct":false,"proposition":"A disappearance of automatic walking"},{"idx":3,"correct":true,"proposition":"An eye chase"},{"idx":4,"correct":false,"proposition":"A smile-response"}],"type":"qi"}
+{"_id":"annales-2016-qi-14","context":null,"enonce":"A 55-year-old patient with breast cancer with bone metastases under pamidronate treatment consults you. She has had endooral bone exposure for several weeks, following the avulsion of a mobile tooth. She has no other medical history. You mention the diagnosis(s) of:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Osteoradionecrosis"},{"idx":1,"correct":true,"proposition":"Bone metastasis"},{"idx":2,"correct":false,"proposition":"Osteoma"},{"idx":3,"correct":true,"proposition":"Osteochimionecosis"},{"idx":4,"correct":false,"proposition":"Ameloblastoma"}],"type":"qi"}
+{"_id":"annales-2016-qi-15","context":null,"enonce":"A 56-year-old patient, a tobacco user since the age of 16, consults you because of the appearance for 1 month and a half of lingual ulceration. The elements that guide you towards the diagnosis of squamous cell carcinoma are:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Peripheral halo erythematosus"},{"idx":1,"correct":true,"proposition":"Lesional induration"},{"idx":2,"correct":true,"proposition":"Contact bleeding"},{"idx":3,"correct":false,"proposition":"Feverish"},{"idx":4,"correct":true,"proposition":"Indurated homolateral group II cervical lymphadenopathy"}],"type":"qi"}
+{"_id":"annales-2016-qi-16","context":null,"enonce":"In a displaced right zygomatomaxillary fracture, you are looking for hypoesthesia in the following territory(s):","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Upper right eyelid"},{"idx":1,"correct":false,"proposition":"Tip of the nose"},{"idx":2,"correct":true,"proposition":"Teeth number 11, 12 and 13"},{"idx":3,"correct":true,"proposition":"Right half of the upper lip"},{"idx":4,"correct":false,"proposition":"Cornea of the right eye"}],"type":"qi"}
+{"_id":"annales-2016-qi-17","context":null,"enonce":"The walls of the orbit consist of:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Sphenoid bone"},{"idx":1,"correct":true,"proposition":"The ethmoid bone"},{"idx":2,"correct":true,"proposition":"Zygomatic bone"},{"idx":3,"correct":true,"proposition":"The maxillary bone"},{"idx":4,"correct":true,"proposition":"Frontal bone"}],"type":"qi"}
+{"_id":"annales-2016-qi-18","context":null,"enonce":"The uvule:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Helps to delimit the isthmus of the throat"},{"idx":1,"correct":true,"proposition":"May be hypertrophic and responsible for snoring"},{"idx":2,"correct":true,"proposition":"May be bifid in a submucosal slit"},{"idx":3,"correct":true,"proposition":"Is essential in the mechanisms of swallowing"},{"idx":4,"correct":false,"proposition":"Is devoid of any muscle structure"}],"type":"qi"}
+{"_id":"annales-2016-qi-19","context":null,"enonce":"Ameloblastoma:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Is an odontogenic tumor"},{"idx":1,"correct":false,"proposition":"Is a non-epithelial tumor"},{"idx":2,"correct":true,"proposition":"Is characterized by local aggressiveness"},{"idx":3,"correct":true,"proposition":"Is prone to recurrence"},{"idx":4,"correct":true,"proposition":"Gives a multilocular lytic radiological image"}],"type":"qi"}
+{"_id":"annales-2016-qi-20","context":null,"enonce":"With which diagnosis(s) is compatible the following assessment: serum calcium 2.80 mmol \/ L; phosphoremia 0.6 mmol\/L (normal values 0.80 to 1.45); PTH 3 pmol\/L (normal values 1.2 to 5.8)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Primary hyperparathyroidism"},{"idx":1,"correct":false,"proposition":"Secondary hyperparathyroidism"},{"idx":2,"correct":false,"proposition":"Vitamin D poisoning"},{"idx":3,"correct":false,"proposition":"Paraneoplastic hyperparathyroidism"},{"idx":4,"correct":false,"proposition":"Myeloma"}],"type":"qi"}
+{"_id":"annales-2016-qi-21","context":null,"enonce":"What examination(s) can you request for the diagnosis of corticotropic deficiency in a patient who has had corticosteroid therapy at a dose of 1 mg\/kg\/day of prednisone for 4 months?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"ACTH dosage only"},{"idx":1,"correct":true,"proposition":"ACTH and cortisol assay at 8 h"},{"idx":2,"correct":false,"proposition":"Renin dosage"},{"idx":3,"correct":true,"proposition":"Ordinary synacthene test"},{"idx":4,"correct":false,"proposition":"24-hour urinary free cortisol"}],"type":"qi"}
+{"_id":"annales-2016-qi-23","context":null,"enonce":"Among the following proposals, which non-pharmacological therapeutic (s) can (s) be prescribed in the chronic phase of osteoarthritis (at a distance from a flare-up)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Landfill"},{"idx":1,"correct":true,"proposition":"Adapted physical activity"},{"idx":2,"correct":true,"proposition":"Crenotherapy"},{"idx":3,"correct":true,"proposition":"Muscle building"},{"idx":4,"correct":false,"proposition":"Immobilization"}],"type":"qi"}
+{"_id":"annales-2016-qi-24","context":null,"enonce":"A 76-year-old patient, living alone in a single-storey house, had surgery for a total hip replacement on the right. She has lost weight by 1 kg since the procedure. However, she keeps a good appetite, is not afraid of falling and walks with a cane on the left. She plans to have cataract surgery. She consults 3 months after the intervention for pain in the right hip. What is (are) the sign(s) you are looking for in favor of a prosthesis infection visible on a prosthetic hip X-ray?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"A peri-prosthetic border"},{"idx":1,"correct":false,"proposition":"Parrot beaks"},{"idx":2,"correct":true,"proposition":"Osteolysis"},{"idx":3,"correct":true,"proposition":"Endorsed geodes"},{"idx":4,"correct":true,"proposition":"Periosteal appositions"}],"type":"qi"}
+{"_id":"annales-2016-qi-25","context":null,"enonce":"Diabetic retinopathy, at the stage of \"rare micro-aneurysms\":","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Is associated with macular edema"},{"idx":1,"correct":false,"proposition":"Contraindicates the rapid achievement of strict normoglycemia"},{"idx":2,"correct":false,"proposition":"Indicates laser photocoagulation in preparation for pregnancy"},{"idx":3,"correct":false,"proposition":"Must be checked at three months"},{"idx":4,"correct":true,"proposition":"May be observed as soon as diabetes is diagnosed"}],"type":"qi"}
+{"_id":"annales-2016-qi-26","context":null,"enonce":"Orthostatic proteinuria:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Disappears after 2 hours of clinostatism"},{"idx":1,"correct":true,"proposition":"Observed during puberty"},{"idx":2,"correct":false,"proposition":"Persists after age 25"},{"idx":3,"correct":false,"proposition":"Is associated with high cardiovascular risk"},{"idx":4,"correct":true,"proposition":"Is not pathological"}],"type":"qi"}
+{"_id":"annales-2016-qi-28","context":null,"enonce":"Hypoglycemia in type 2 diabetes:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Are a potential side effect of all anti-diabetics"},{"idx":1,"correct":true,"proposition":"On sulfonamide, are more common in cases of renal failure"},{"idx":2,"correct":false,"proposition":"On metformin, are more common in heart failure"},{"idx":3,"correct":true,"proposition":"Are facilitated by taking alcohol"},{"idx":4,"correct":false,"proposition":"Are responsible for the majority of cardiovascular events in diabetics"}],"type":"qi"}
+{"_id":"annales-2016-qi-29","context":null,"enonce":"Obesity:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Concerns 15% of the adult French population"},{"idx":1,"correct":true,"proposition":"Is considered a low-grade inflammatory disease"},{"idx":2,"correct":true,"proposition":"Is accompanied by an increase in lean body mass"},{"idx":3,"correct":false,"proposition":"Is associated with decreased resting metabolism"},{"idx":4,"correct":true,"proposition":"With a well-followed diet, the expected weight loss is of the order of 15% at 2 years"}],"type":"qi"}
+{"_id":"annales-2016-qi-30","context":null,"enonce":"What is (are) the pathology(s) associated with a \"white\" scintigraphy in the presence of an increased free T4?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"De Quervain's thyroiditis"},{"idx":1,"correct":true,"proposition":"Iodine overload"},{"idx":2,"correct":false,"proposition":"Graves' disease"},{"idx":3,"correct":false,"proposition":"Multinodular goiter"},{"idx":4,"correct":true,"proposition":"Factitious thyrotoxicosis"}],"type":"qi"}
+{"_id":"annales-2016-qi-31","context":null,"enonce":"On a systematic count carried out in a 63-year-old patient, you find: leukocytes 7.2 G \/ L; neutrophils 47%; lymphocytes 45%; monocytes 8%;  haemoglobin 14.4 g\/dL; VGM 89 fL; CCMH 33 g\/100 mL; platelets 755 G\/L. You mention:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Iron deficiency"},{"idx":1,"correct":false,"proposition":"Taking corticosteroids"},{"idx":2,"correct":true,"proposition":"An asplenism"},{"idx":3,"correct":true,"proposition":"An essential thrombocythemia"},{"idx":4,"correct":false,"proposition":"Active smoking"}],"type":"qi"}
+{"_id":"annales-2016-qi-32","context":null,"enonce":"A 74-year-old woman has the following blood count: leukocytes 2.1 G\/L; neutrophils 0.7 G\/L; lymphocytes 1.4 G\/L; hemoglobin 8.5 g\/dLv VGM 104 fL; blisters 567 G\/L. The myelogram returns to a marrow of normal richness with 3% blasts and signs of dysmegakaryopoiesis. Which diagnosis(s) evokes this table?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Acute myelogenous leukemia"},{"idx":1,"correct":true,"proposition":"A 5q- syndrome"},{"idx":2,"correct":false,"proposition":"Refractory anemia with excess blasts"},{"idx":3,"correct":false,"proposition":"A myeloproliferative syndrome"},{"idx":4,"correct":true,"proposition":"Myelodysplastic syndrome"}],"type":"qi"}
+{"_id":"annales-2016-qi-33","context":null,"enonce":"Metabolic adaptations observed during a hunger strike include:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Stimulation of gluconeogenesis"},{"idx":1,"correct":false,"proposition":"A brake of adipocyte lipolysis"},{"idx":2,"correct":true,"proposition":"A decrease in resting energy metabolism"},{"idx":3,"correct":true,"proposition":"Nitrogen savings"},{"idx":4,"correct":true,"proposition":"Increased ketogenesis"}],"type":"qi"}
+{"_id":"annales-2016-qi-34","context":null,"enonce":"A 28-year-old patient comes to your consultation for a gradual installation fatigue over several weeks. She is out of breath at the effort and is very embarrassed in her activity as a cleaning lady. The clinical examination finds only a mucocutaneous pallor. A first assessment finds: leukocytes 7.6 G \/ L, neutrophils 62%, eosinophilic polynuclear 2%;  lymphocytes 33%; monocytes 3%; haemoglobin 9.7 g\/dL; VGM 76 fL; CCMH 31.2 g\/dL;  platelets 633 G\/L; reticulocytes 67 G\/L. Which of the following results explains the abnormalities of the blood count?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Ferritinemia increased"},{"idx":1,"correct":true,"proposition":"Lowered ferritinemia"},{"idx":2,"correct":false,"proposition":"Increased serum iron and normal transferrin"},{"idx":3,"correct":false,"proposition":"Collapsed vitamin B12"},{"idx":4,"correct":false,"proposition":"Hb A2 at 10.2% on hemoglobin electrophoresis"}],"type":"qi"}
+{"_id":"annales-2016-qi-35","context":null,"enonce":"As part of the monitoring of synthetic antithyroid therapy, it is interesting to measure:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Creatinine"},{"idx":1,"correct":false,"proposition":"CPK"},{"idx":2,"correct":true,"proposition":"Blood count"},{"idx":3,"correct":false,"proposition":"CRP"},{"idx":4,"correct":true,"proposition":"Transaminases"}],"type":"qi"}
+{"_id":"annales-2016-qi-36","context":null,"enonce":"Excess glucocorticoids cause:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Hyperglycaemia"},{"idx":1,"correct":false,"proposition":"Hypercalcemia"},{"idx":2,"correct":false,"proposition":"Hyperprotidemia"},{"idx":3,"correct":true,"proposition":"Hypokalemia"},{"idx":4,"correct":false,"proposition":"Hypernatremia"}],"type":"qi"}
+{"_id":"annales-2016-qi-37","context":null,"enonce":"Polyclonal gammopathy:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Is common during lupus"},{"idx":1,"correct":true,"proposition":"Is common during sarcoidosis"},{"idx":2,"correct":false,"proposition":"Is usually seen during type 2 diabetes"},{"idx":3,"correct":false,"proposition":"May occur during AL amyloidosis"},{"idx":4,"correct":true,"proposition":"May occur during chronic liver disease"}],"type":"qi"}
+{"_id":"annales-2016-qi-39","context":null,"enonce":"When monitoring differentiated papillary thyroid cancer with lymph node invasion, it is customary to use the following monitoring parameters:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Abdominal ultrasound"},{"idx":1,"correct":true,"proposition":"Cervical ultrasound"},{"idx":2,"correct":true,"proposition":"Iodine whole body scintigraphy"},{"idx":3,"correct":false,"proposition":"Bone scintigraphy"},{"idx":4,"correct":false,"proposition":"Thoraco-abdominopelvic CT"}],"type":"qi"}
+{"_id":"annales-2016-qi-40","context":null,"enonce":"The clinical symptomatology of Willebrand disease is dominated by:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"A petechial purpura"},{"idx":1,"correct":true,"proposition":"Epistaxis"},{"idx":2,"correct":true,"proposition":"Meno-metrorrhagia"},{"idx":3,"correct":false,"proposition":"Hemathosis"},{"idx":4,"correct":false,"proposition":"Muscle hematomas"}],"type":"qi"}
+{"_id":"annales-2016-qi-43","context":null,"enonce":"Malignant humoral hypercalcemia: B. Is due to hypersecretion of ","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Is one of the causes of hypercalcemia of myeloma"}],"type":"qi"}
+{"_id":"annales-2016-qi-44","context":null,"enonce":"Regarding primary amenorrhea, which is (are) the exact proposal(s)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"It is characterized by the absence of secondary sexual characteristics after 16 years in young girls"},{"idx":1,"correct":false,"proposition":"It is more common than secondary amenorrhea"},{"idx":2,"correct":true,"proposition":"It can be linked to a central cause"},{"idx":3,"correct":true,"proposition":"It requires in its etiological assessment a dosage of gonadotropins"},{"idx":4,"correct":true,"proposition":"Associated with an absence of secondary sexual characteristics, it may be due to a syndrome"},{"idx":5,"correct":true,"proposition":"de Turner"}],"type":"qi"}
+{"_id":"annales-2016-qi-45","context":null,"enonce":"What is (are) the exact proposal(s) regarding menopause?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"It is characterized by a stop of the rules"},{"idx":1,"correct":true,"proposition":"She is suspected in front of climacteric signs"},{"idx":2,"correct":false,"proposition":"His progestogen treatment will reinstate withdrawal hemorrhages"},{"idx":3,"correct":false,"proposition":"It must lead to the prescription of a bone densitometry"},{"idx":4,"correct":true,"proposition":"Its risks are mainly osteoporosis"}],"type":"qi"}
+{"_id":"annales-2016-qi-46","context":null,"enonce":"Regarding the semiology of sensitivity, what following statement(s) is (are) true?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Sensory extinction is seen in parietal lobe involvement (parietal syndrome)"},{"idx":1,"correct":false,"proposition":"Romberg's sign testifies to the involvement of small amylin nerve fibers"},{"idx":2,"correct":false,"proposition":"Involvement of the left ulnar nerve can cause hypoaesthesia of the first 3 fingers of the left hand"},{"idx":3,"correct":true,"proposition":"Involvement of a thalamus causes contralateral hypoaesthesia in all modes (thalamic syndrome)"},{"idx":4,"correct":true,"proposition":"Alternate sensory syndrome is a sign of brainstem involvement"}],"type":"qi"}
+{"_id":"annales-2016-qi-47","context":null,"enonce":"What following statement(s) is (are) true regarding the semiology of the cerebellum?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"The Stewart-Holmes maneuver highlights a delay in contraction of agonist muscles"},{"idx":1,"correct":false,"proposition":"Static cerebellar syndrome is linked to damage to the cerebellar hemispheres"},{"idx":2,"correct":true,"proposition":"Hypermetry of the right upper limb may be due to damage to the right cerebellar hemisphere"},{"idx":3,"correct":true,"proposition":"There is hypotonia in cerebellar syndrome"},{"idx":4,"correct":false,"proposition":"The voice may be paretic in case of cerebellar damage"}],"type":"qi"}
+{"_id":"annales-2016-qi-48","context":null,"enonce":"A 55-year-old patient comes to consultation for vision disorders, he has had two traffic accidents because he did not see the priorities on the right. You will focus your clinical examination on the exploration of the visual field. Regarding this patient, what is (are) the exact proposal(s)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"He may have a right homonymous lateral hemianopsia"},{"idx":1,"correct":true,"proposition":"He may have bitemporal hemianopsia"},{"idx":2,"correct":true,"proposition":"If his lesion is intracranial, it may be in left retrochiasmatic"},{"idx":3,"correct":true,"proposition":"If his lesion is intracranial, it may be at the level of the chiasma"},{"idx":4,"correct":false,"proposition":"If his lesion is intracranial, it may be at the right occipital level"}],"type":"qi"}
+{"_id":"annales-2016-qi-49","context":null,"enonce":"An alternate syndrome:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Refers to hemispheric brain damage"},{"idx":1,"correct":false,"proposition":"Corresponds to involvement of a long pathway homolateral to the lesion and a contralateral cranial nerve"},{"idx":2,"correct":true,"proposition":"There is an alternate sensory syndrome in Wallenberg syndrome"},{"idx":3,"correct":true,"proposition":"May be caused by a brainstem infarction"},{"idx":4,"correct":true,"proposition":"May include diplopia"}],"type":"qi"}
+{"_id":"annales-2016-qi-50","context":null,"enonce":"The peripheral nerve(s) most often compressed in case of prolonged immobilization is (are):","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"The median nerve at the carpal tunnel"},{"idx":1,"correct":true,"proposition":"The ulnar nerve at the elbow"},{"idx":2,"correct":false,"proposition":"The fibular nerve in the popliteal fossa"},{"idx":3,"correct":true,"proposition":"The radial nerve in the humeral gutter"},{"idx":4,"correct":false,"proposition":"The sciatic nerve in the lower third of the thigh"}],"type":"qi"}
+{"_id":"annales-2016-qi-51","context":null,"enonce":"False food routes can be prevented by:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"The taking of meals by the patient himself"},{"idx":1,"correct":false,"proposition":"The use of liquid food"},{"idx":2,"correct":false,"proposition":"The lying position, on the right side during meals"},{"idx":3,"correct":true,"proposition":"The use of a notched glass"},{"idx":4,"correct":true,"proposition":"Anteflexion of the head when swallowing"}],"type":"qi"}
+{"_id":"annales-2016-qi-52","context":null,"enonce":"Regarding Parsonage-Turner syndrome, quote the exact proposal(s):","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Initial pains are centered on the shoulder"},{"idx":1,"correct":false,"proposition":"The motor deficit is present from the beginning"},{"idx":2,"correct":false,"proposition":"The motor deficit concerns the C8-T1 roots"},{"idx":3,"correct":false,"proposition":"Sensory disorders are important"},{"idx":4,"correct":true,"proposition":"Amyotrophy is classic in the evolution"}],"type":"qi"}
+{"_id":"annales-2016-qi-53","context":null,"enonce":"What is (are) the typical clinical sign(s) to consider treatment without additional examination in case of vulvovaginal mycosis?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Vulvovaginal pruritus"},{"idx":1,"correct":true,"proposition":"Erythema vulvaris"},{"idx":2,"correct":false,"proposition":"Speculum examination: lilac collar"},{"idx":3,"correct":false,"proposition":"Greyish leucorrhoea"},{"idx":4,"correct":false,"proposition":"Inguinal lymphadenopathy"}],"type":"qi"}
+{"_id":"annales-2016-qi-54","context":null,"enonce":"Regarding typical absence epilepsy, what is (are) the exact answer(s)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"The definition is clinical and electroencephalographic"},{"idx":1,"correct":false,"proposition":"Is characterized by generalized peak wave discharges at 6 Hz"},{"idx":2,"correct":false,"proposition":"Often has atonic seizures"},{"idx":3,"correct":true,"proposition":"EEG discharges are synchronous and symmetrical"},{"idx":4,"correct":true,"proposition":"May be associated with generalized tonic-clonic seizures"}],"type":"qi"}
+{"_id":"annales-2016-qi-55","context":null,"enonce":"Which of the following proposals can (which) correspond to dysautonomic impairment?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Fragile and brittle appendages"},{"idx":1,"correct":true,"proposition":"Orthostatic hypotension"},{"idx":2,"correct":false,"proposition":"Headaches"},{"idx":3,"correct":true,"proposition":"Constipation"},{"idx":4,"correct":false,"proposition":"Anorexia"}],"type":"qi"}
+{"_id":"annales-2016-qi-56","context":null,"enonce":"Zollinger-Ellison syndrome is related to hypergastrinemia secondary to gastrinoma.  In which condition(s) should this diagnosis be evoked? nor ","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"In case of multiple duodenal ulcers"},{"idx":1,"correct":true,"proposition":"In case of recurrent duodenal ulcer or resistant to medical treatment"},{"idx":2,"correct":true,"proposition":"In case of duodenal ulcer associated with gastric or jejunal ulcers"},{"idx":3,"correct":true,"proposition":"In case of duodenal ulcer associated with diarrhea"},{"idx":4,"correct":true,"proposition":"In case of duodenal ulcer occurring without taking aspirin, nonsteroidal anti-inflammatory drug,"}],"type":"qi"}
+{"_id":"annales-2016-qi-57","context":null,"enonce":"What is (are) the exact answer(s) regarding the practical modalities of performing the immunological test for occult bleeding in the stool?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"It is necessary to follow a diet excluding foods rich in tryptophan three days before"},{"idx":1,"correct":true,"proposition":"It is the attending physician who gives the test to the patient"}],"type":"qi"}
+{"_id":"annales-2016-qi-58","context":null,"enonce":"What is (are) the condition(s) for performing a colonoscopy under general anesthesia?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Colonoscopy can be done in outpatient care"},{"idx":1,"correct":false,"proposition":"All antiplatelet therapy must be stopped before the examination"},{"idx":2,"correct":false,"proposition":"Anesthesia can be performed by the gastroenterologist"},{"idx":3,"correct":false,"proposition":"Colic preparation requires a purge over three days"},{"idx":4,"correct":true,"proposition":"A residue-free diet is prescribed for a few days before the exam"}],"type":"qi"}
+{"_id":"annales-2016-qi-59","context":null,"enonce":"Which of the following treatments has (have) a Marketing Authorization (MA) to help maintain abstinence?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Tiapride"},{"idx":1,"correct":true,"proposition":"Acamprosate"},{"idx":2,"correct":true,"proposition":"Naltrexone"},{"idx":3,"correct":false,"proposition":"Clonidine"},{"idx":4,"correct":true,"proposition":"Disulfiram"}],"type":"qi"}
+{"_id":"annales-2016-qi-60","context":null,"enonce":"What characteristic(s) is suggestive of cirrhotic ascites?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Ascites of citrin appearance"},{"idx":1,"correct":false,"proposition":"Hemorrhagic ascites"},{"idx":2,"correct":true,"proposition":"Protein-poor ascites"},{"idx":3,"correct":false,"proposition":"Ascites of chylous appearance"},{"idx":4,"correct":false,"proposition":"Ascites rich in amylase"}],"type":"qi"}
+{"_id":"annales-2016-qi-61","context":null,"enonce":"Regarding the serum total PSA (Prostate Specific Antigen):","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Its increase involves performing endorectal prostate ultrasound as a diagnosis"},{"idx":1,"correct":true,"proposition":"Its dosage is not of interest for subjects whose life expectancy is less than 10 years"},{"idx":2,"correct":false,"proposition":"Its dosage must be carried out annually from the age of 50 as part of a mass screening"},{"idx":3,"correct":false,"proposition":"Its increase implies the systematic realization of the determination of its free fraction"},{"idx":4,"correct":true,"proposition":"Its increase should lead to discuss the realization of prostate biopsies"}],"type":"qi"}
+{"_id":"annales-2016-qi-63","context":null,"enonce":"The initial assessment of urinary incontinence systematically includes:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"An ECBU"},{"idx":1,"correct":false,"proposition":"A Pad-Test"},{"idx":2,"correct":false,"proposition":"A urodynamic balance sheet"},{"idx":3,"correct":false,"proposition":"Static and dynamic pelvic MRI"},{"idx":4,"correct":true,"proposition":"A measurement of the post-void residue by ultrasound"}],"type":"qi"}
+{"_id":"annales-2016-qi-64","context":null,"enonce":"Irritative clinical signs of benign prostatic hyperplasia include:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"A delay in starting urination"},{"idx":1,"correct":true,"proposition":"A pollakiuria"},{"idx":2,"correct":false,"proposition":"A weak urinary stream"},{"idx":3,"correct":false,"proposition":"The presence of lagging drops"},{"idx":4,"correct":true,"proposition":"An emergency room"}],"type":"qi"}
+{"_id":"annales-2016-qi-65","context":null,"enonce":"About the pathophysiology of renal colic, what are the true propositions?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"The pain is induced by irritation of the superior ureteral nerve"},{"idx":1,"correct":true,"proposition":"Intracavitary hyperpressure stimulates intrarenal synthesis of prostaglandin E2"},{"idx":2,"correct":true,"proposition":"Nausea and vomiting trigger the secretion of anti-diuretic hormone (ADH)"},{"idx":3,"correct":false,"proposition":"The dilation underlying the obstacle is related to the relaxation of ureteral smooth muscle fibers"},{"idx":4,"correct":false,"proposition":"The tensioning of the pyel-calycal cavities is responsible for a rapid decrease"},{"idx":5,"correct":false,"proposition":"glomerular filtration rate"}],"type":"qi"}
+{"_id":"annales-2016-qi-66","context":null,"enonce":"Regarding this X-ray section:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"This is an abdominal CT scan injected into coronal sections"},{"idx":1,"correct":true,"proposition":"This is an injected abdominal CT scan, at a late time"},{"idx":2,"correct":false,"proposition":"The left adrenal gland is visible"},{"idx":3,"correct":true,"proposition":"There is a left kidney tumor"},{"idx":4,"correct":true,"proposition":"The left renal vein is visible"}],"type":"qi"}
+{"_id":"annales-2016-qi-67","context":null,"enonce":"Normal sexuality includes the following phases:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"The excitement phase"},{"idx":1,"correct":true,"proposition":"The phase of desire"},{"idx":2,"correct":true,"proposition":"The orgasm phase"},{"idx":3,"correct":true,"proposition":"The plateau phase"},{"idx":4,"correct":true,"proposition":"The resolution phase"}],"type":"qi"}
+{"_id":"annales-2016-qi-68","context":null,"enonce":"In acute urethritis in men, clinical examination includes:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Research to interrogation of a contaminating report"},{"idx":1,"correct":true,"proposition":"A digital rectal exam"},{"idx":2,"correct":false,"proposition":"Scrotal transillumination"},{"idx":3,"correct":true,"proposition":"The search for urethral discharge"},{"idx":4,"correct":true,"proposition":"The search for rectal inflammation"}],"type":"qi"}
+{"_id":"annales-2016-qi-69","context":null,"enonce":"The presence of isolated leukocyturia without germs should suggest:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Urogenital tuberculosis"},{"idx":1,"correct":false,"proposition":"Urolithiasis"},{"idx":2,"correct":true,"proposition":"Interstitial cystitis"},{"idx":3,"correct":false,"proposition":"Diabetes mellitus"},{"idx":4,"correct":true,"proposition":"A bladder tumour"}],"type":"qi"}
+{"_id":"annales-2016-qi-70","context":null,"enonce":"The electrocardiographic signs of hyperkalemia are:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Sharp T-waves"},{"idx":1,"correct":true,"proposition":"Atrioventricular block"},{"idx":2,"correct":true,"proposition":"Shortening QT space"},{"idx":3,"correct":true,"proposition":"QRS lengthening"},{"idx":4,"correct":false,"proposition":"Increase in U-wave"}],"type":"qi"}
+{"_id":"annales-2016-qi-71","context":null,"enonce":"Which of these terms designates the suspension of all motor and language activity that can be observed following psychological shock?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Stupor"},{"idx":1,"correct":false,"proposition":"Dumbness"},{"idx":2,"correct":false,"proposition":"Amiemia"},{"idx":3,"correct":false,"proposition":"Negativism"},{"idx":4,"correct":false,"proposition":"Bradypsychia"}],"type":"qi"}
+{"_id":"annales-2016-qi-72","context":null,"enonce":"What is (are) the positive symptom(s) of schizophrenia?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"The delirium of persecution"},{"idx":1,"correct":false,"proposition":"The alogy"},{"idx":2,"correct":true,"proposition":"Hallucinations"},{"idx":3,"correct":false,"proposition":"Emotional blunting"},{"idx":4,"correct":false,"proposition":"Dams"}],"type":"qi"}
+{"_id":"annales-2016-qi-73","context":null,"enonce":"In generalized anxiety disorder, anxiety is associated with:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Muscle tension"},{"idx":1,"correct":true,"proposition":"Psychasthenia"},{"idx":2,"correct":false,"proposition":"Pessimism"},{"idx":3,"correct":true,"proposition":"The hustle and bustle"},{"idx":4,"correct":true,"proposition":"Sleep disorders"}],"type":"qi"}
+{"_id":"annales-2016-qi-74","context":null,"enonce":"Social phobia includes:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Fear of being alone"},{"idx":1,"correct":true,"proposition":"Avoidance of feared situations"},{"idx":2,"correct":false,"proposition":"Lack of awareness of the morbid nature of the disorders"},{"idx":3,"correct":true,"proposition":"A fear of being observed by others"},{"idx":4,"correct":false,"proposition":"A feeling of inferiority"}],"type":"qi"}
+{"_id":"annales-2016-qi-75","context":null,"enonce":"Lithium is:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Used in the form of salts"},{"idx":1,"correct":false,"proposition":"An antiepileptic drug"},{"idx":2,"correct":true,"proposition":"A thymoregulator"},{"idx":3,"correct":false,"proposition":"An antidepressant"},{"idx":4,"correct":true,"proposition":"A metal"}],"type":"qi"}
+{"_id":"annales-2016-qi-76","context":null,"enonce":"School phobia in children and adolescents:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Concerns 3 to 5% of 12 to 19 year olds"},{"idx":1,"correct":false,"proposition":"Most often involves erythrophobia"},{"idx":2,"correct":true,"proposition":"Is associated with poor academic performance"},{"idx":3,"correct":true,"proposition":"Leads to a major risk of dropping out of school"},{"idx":4,"correct":false,"proposition":"Evolves into a social phobia in 65% of cases"}],"type":"qi"}
+{"_id":"annales-2016-qi-77","context":null,"enonce":"What therapeutic strategy(s) to recommend as a first line in the face of post-traumatic stress disorder in adults?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Debriefing"},{"idx":1,"correct":true,"proposition":"Psychotherapy"},{"idx":2,"correct":false,"proposition":"Benzodiazepine"},{"idx":3,"correct":false,"proposition":"Serotonin reuptake inhibitor"},{"idx":4,"correct":false,"proposition":"Hydroxyzine"}],"type":"qi"}
+{"_id":"annales-2016-qi-78","context":null,"enonce":"Among the possible proposals, which is (are) the possible cause(s) of pulmonary arterial hypertension?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Left heart failure"},{"idx":1,"correct":true,"proposition":"Taking benfluorex"},{"idx":2,"correct":true,"proposition":"Systemic scleroderma"},{"idx":3,"correct":true,"proposition":"Genetic origin"},{"idx":4,"correct":true,"proposition":"HIV infection"}],"type":"qi"}
+{"_id":"annales-2016-qi-79","context":null,"enonce":"A 72-year-old patient is hospitalized for the first acute pulmonary edema. Which of the following tests is (are) the one that may be useful to clarify the etiology of his left heart failure?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Determination of BNP"},{"idx":1,"correct":false,"proposition":"Stress test with oxygen consumption measurement"},{"idx":2,"correct":true,"proposition":"Echocardiography"},{"idx":3,"correct":true,"proposition":"Coronary angiography"},{"idx":4,"correct":false,"proposition":"Right catheterization"}],"type":"qi"}
+{"_id":"annales-2016-qi-80","context":null,"enonce":"Regarding heart failure, which is (are) the exact proposal(s)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Prevalence of heart failure increases with age"},{"idx":1,"correct":false,"proposition":"Heart failure with preserved ejection fraction is more common in young subjects"},{"idx":2,"correct":false,"proposition":"About one in 5 patients die 5 years after diagnosis"},{"idx":3,"correct":true,"proposition":"Sudden death is a common mode of death"},{"idx":4,"correct":true,"proposition":"Hospitalization for acute heart failure is a factor of severity"}],"type":"qi"}
+{"_id":"annales-2016-qi-81","context":null,"enonce":"A 65-year-old patient consults her doctor because she is increasingly short of breath during exercise. Which examination(s) can be requested as a first-line test for the diagnosis of heart failure?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"A BNP assay"},{"idx":1,"correct":false,"proposition":"A stress test"},{"idx":2,"correct":true,"proposition":"Transthoracic echocardiography"},{"idx":3,"correct":false,"proposition":"A cardiac MRI"},{"idx":4,"correct":false,"proposition":"Straight catheterization"}],"type":"qi"}
+{"_id":"annales-2016-qi-82","context":null,"enonce":"Which of the following proposals is (are) characteristic of the venous origin of a leg ulcer?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Location at the forefoot"},{"idx":1,"correct":true,"proposition":"Malleolar location"},{"idx":2,"correct":true,"proposition":"Presence of a phlebecatic crown of the plantar arch"},{"idx":3,"correct":false,"proposition":"Necrotic character"},{"idx":4,"correct":false,"proposition":"Tendon exposure"}],"type":"qi"}
+{"_id":"annales-2016-qi-84","context":null,"enonce":"What therapeutic is (are) indicated for chronic venous insufficiency at the malleolar ulcer stage and secondary to varicose disease?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Anticoagulant"},{"idx":1,"correct":false,"proposition":"Vasodilator"},{"idx":2,"correct":true,"proposition":"Class III elastic compression"},{"idx":3,"correct":true,"proposition":"Varicose vein surgery (stripping +\/- crossectomy)"},{"idx":4,"correct":true,"proposition":"Local care"}],"type":"qi"}
+{"_id":"annales-2016-qi-85","context":null,"enonce":"Regarding the interpretation of this electrocardiogram and among the following propositions, which one (are) accurate?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Sinus dysfunction"},{"idx":1,"correct":false,"proposition":"Second degree atrioventricular block"},{"idx":2,"correct":true,"proposition":"Atrioventricular dissociation"},{"idx":3,"correct":false,"proposition":"2:1 conductive atrial flutter to the ventricles"},{"idx":4,"correct":true,"proposition":"Third-degree atrioventricular block"}],"type":"qi"}
+{"_id":"annales-2016-qi-86","context":null,"enonce":"A 70-year-old patient presents to the emergency room for palpitations that have been progressing for a week. He is dyspneic when climbing a floor. The electrocardiogram shows fine QRS atrial fibrillation with a ventricular cadence of 130 per minute. Blood pressure is at 140\/90 mmHg, saturation (SpO) is at 92%. The rest of the clinical examination is normal. Chest X-ray is normal. Blood ionogram, urea and serum creatinine are normal. Which of the following immediate therapeutic proposals is (are) accurate?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Amiodarone venous"},{"idx":1,"correct":false,"proposition":"Same-day electrical cardioversion"},{"idx":2,"correct":true,"proposition":"Unfractionated heparin via venous route"},{"idx":3,"correct":true,"proposition":"Digitoxin via venous route"},{"idx":4,"correct":false,"proposition":"Venous furosemide"}],"type":"qi"}
+{"_id":"annales-2016-qi-87","context":null,"enonce":"A 66-year-old patient presents for consultation because her mother had age-related macular degeneration. She wishes to know which symptom(s) suggestive of this disease should lead her to consult urgently. What can you say to him?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Myodesopsias"},{"idx":1,"correct":true,"proposition":"Central scotomome"},{"idx":2,"correct":true,"proposition":"Metamorphopsies"},{"idx":3,"correct":false,"proposition":"Phosphenes"},{"idx":4,"correct":false,"proposition":"Bitemporal hemianopsia"}],"type":"qi"}
+{"_id":"annales-2016-qi-88","context":null,"enonce":"Which of the following ametropia can (may) lead to monocular diplopia?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Myopia"},{"idx":1,"correct":true,"proposition":"Reverse astigmatism"},{"idx":2,"correct":false,"proposition":"Presbyopia"},{"idx":3,"correct":false,"proposition":"Farsightedness"},{"idx":4,"correct":true,"proposition":"Irregular astigmatism"}],"type":"qi"}
+{"_id":"annales-2016-qi-89","context":null,"enonce":"A 74-year-old patient is referred to you for possible cataract surgery. What can be the functional sign(s) related to the development of a cataract?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Central scotomome"},{"idx":1,"correct":true,"proposition":"Decrease in visual acuity predominant by far"},{"idx":2,"correct":false,"proposition":"Myodesopsias"},{"idx":3,"correct":true,"proposition":"Photophobia"},{"idx":4,"correct":false,"proposition":"Phosphenes"}],"type":"qi"}
+{"_id":"annales-2016-qi-90","context":null,"enonce":"In front of an eye redness occurring in a few days, in the absence of eye trauma, what are the elements that could point to acute anterior uveitis in a 30-year-old patient?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Identical, limiting ocular history under local corticosteroid treatment"},{"idx":1,"correct":true,"proposition":"History of low back pain"},{"idx":2,"correct":true,"proposition":"History of parotitis"},{"idx":3,"correct":true,"proposition":"History of bipolar aphthosis"},{"idx":4,"correct":false,"proposition":"History of diabetes in the family"}],"type":"qi"}
+{"_id":"annales-2016-qi-92","context":null,"enonce":"A patient presents to the emergency room following a brawl two hours ago. He complains of pain in his right eye, and describes a decrease in visual acuity. What would be the eye lesions to be feared in this context?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Corneal wound"},{"idx":1,"correct":true,"proposition":"Subluxation or dislocation of the lens"},{"idx":2,"correct":true,"proposition":"Ocular hypertonia by recoil of the iridocorneal angle"},{"idx":3,"correct":true,"proposition":"Dehiscence or detachment of the retina"},{"idx":4,"correct":false,"proposition":"Internuclear ophthalmoplegia"}],"type":"qi"}
+{"_id":"annales-2016-qi-93","context":null,"enonce":"Polyclonal hypergammaglobulinemia is (one or more exact answers):","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"A marker of inflammatory syndrome"},{"idx":1,"correct":true,"proposition":"Common during systemic lupus erythematosus"},{"idx":2,"correct":false,"proposition":"Common in multiple myeloma"},{"idx":3,"correct":true,"proposition":"Common during Sjögren's syndrome"},{"idx":4,"correct":true,"proposition":"Common during sarcoidosis"}],"type":"qi"}
+{"_id":"annales-2016-qi-95","context":null,"enonce":"The biological marker(s) observed during macrophage activation syndrome is:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Thrombocytopenia"},{"idx":1,"correct":true,"proposition":"Hypofibrinogenemia"},{"idx":2,"correct":true,"proposition":"Hypertryglyceridemia"},{"idx":3,"correct":true,"proposition":"Hyperferritinemia"},{"idx":4,"correct":false,"proposition":"Hyperleukocytosis"}],"type":"qi"}
+{"_id":"annales-2016-qi-96","context":null,"enonce":"An increase in the blood level of eosinophils may be observed in the following situation(s):","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Hodgkin's disease"},{"idx":1,"correct":false,"proposition":"Malaria"},{"idx":2,"correct":true,"proposition":"Systemic vasculitis"},{"idx":3,"correct":true,"proposition":"Ascariasis"},{"idx":4,"correct":true,"proposition":"Adrenal insufficiency"}],"type":"qi"}
+{"_id":"annales-2016-qi-97","context":null,"enonce":"Of the following infections, indicate the one (s) due to Staphylococcus aureus.","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Toxic shock"},{"idx":1,"correct":true,"proposition":"Catheter infection"},{"idx":2,"correct":true,"proposition":"Pneumonia"},{"idx":3,"correct":true,"proposition":"Spondylodiscite"},{"idx":4,"correct":false,"proposition":"Erysipelas"}],"type":"qi"}
+{"_id":"annales-2016-qi-98","context":null,"enonce":"What is (are) the symptom(s) encountered during pertussis?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Fever"},{"idx":1,"correct":true,"proposition":"Cough for several weeks"},{"idx":2,"correct":true,"proposition":"Emetogenic coughing fits"},{"idx":3,"correct":true,"proposition":"Syncopal cough"},{"idx":4,"correct":false,"proposition":"Hemoptysis"}],"type":"qi"}
+{"_id":"annales-2016-qi-99","context":null,"enonce":"Which of the following viruses can induce congenital viral infections? D.","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Rubella virus"},{"idx":1,"correct":true,"proposition":"Cytomegalovirus (CMV)"},{"idx":2,"correct":true,"proposition":"Varicella zoster virus (VZV)"},{"idx":3,"correct":true,"proposition":"Herpes simplex virus (HSV)"},{"idx":4,"correct":false,"proposition":"Papillomavirus"}],"type":"qi"}
+{"_id":"annales-2016-qi-100","context":null,"enonce":"A pregnant woman (11 weeks of amenorrhea), recently immigrated, was for several hours in contact with a little boy who developed the next day a febrile rash suggestive of rubella. This woman immediately consults her doctor. It has no notion of a previous vaccination. The rubella serology performed the same day is positive (presence of IgG) according to the validated standards of the laboratory. What can be concluded about the risk of congenital rubella related to the described exposure (indicate the correct answer(s))?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"A rubella IgM assay on the same serum of the patient is necessary before any interpretation"},{"idx":1,"correct":false,"proposition":"Rubella serology on a second serum of the patient is necessary before any interpretation"},{"idx":2,"correct":true,"proposition":"The patient is protected against rubella infection"},{"idx":3,"correct":false,"proposition":"The patient has biological signs of primary rubella infection"},{"idx":4,"correct":false,"proposition":"Further testing is useful following current exposure"}],"type":"qi"}
+{"_id":"annales-2016-qi-101","context":null,"enonce":"Which proposal(s) is (are) the right proposal(s) concerning the action to be taken in the event of an accident involving exposure to blood by needlesticks?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Making the wound bleed"},{"idx":1,"correct":true,"proposition":"Clean the wound with running water"},{"idx":2,"correct":false,"proposition":"Use of hydroalcoholic solution"},{"idx":3,"correct":false,"proposition":"Dakin disinfection"},{"idx":4,"correct":false,"proposition":"Consultation with a referring physician to discuss the implementation of treatment"},{"idx":5,"correct":false,"proposition":"antiretroviral within one month"}],"type":"qi"}
+{"_id":"annales-2016-qi-102","context":null,"enonce":"In front of axillary lymphadenopathy, unilateral, fistulized, evolving for three weeks in a 55-year-old woman, which cause(s) among the following seems to you (seem) compatible with this diagnosis? C. Primary infection with ","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Syphilis"},{"idx":1,"correct":false,"proposition":"Breast cancer"}],"type":"qi"}
+{"_id":"annales-2016-qi-103","context":null,"enonce":"What is (are) the mechanism(s) involved in mononucleosis syndrome?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Proliferation of neutrophils"},{"idx":1,"correct":true,"proposition":"Activation of the lymphocyte immune response in response to an infectious agent in general viral"},{"idx":2,"correct":false,"proposition":"Monoclonal proliferation of a lymphocyte line"},{"idx":3,"correct":false,"proposition":"Proliferation of macrophage antigen-presenting cells"},{"idx":4,"correct":true,"proposition":"Activation of T cells"}],"type":"qi"}
+{"_id":"annales-2016-qi-104","context":null,"enonce":"Which of the following proposal(s) on smoking is (are) erroneous?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"The minimum board has 5 questions"},{"idx":1,"correct":false,"proposition":"Fagerström's test evaluates pharmacological dependence on nicotine"},{"idx":2,"correct":false,"proposition":"Tobacco is estimated to kill 70,000 to 80,000 people a year in France"},{"idx":3,"correct":false,"proposition":"Second-hand smoke is a causal factor in sudden infant death syndrome"},{"idx":4,"correct":false,"proposition":"Smoking during pregnancy increases the risk of low birth weight"}],"type":"qi"}
+{"_id":"annales-2016-qi-105","context":null,"enonce":"A 28-year-old woman, a non-smoker, underwent a chest x-ray as part of the assessment of a deterioration in the general condition associated with dyspnea and dysphonia. Which of the following proposals(s) is the right proposal(s)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Left inferior lobar atelectasis"},{"idx":1,"correct":true,"proposition":"Aortopulmonary window filling"},{"idx":2,"correct":true,"proposition":"Anterior mediastinal mass"},{"idx":3,"correct":true,"proposition":"Probable phrenic paralysis"},{"idx":4,"correct":true,"proposition":"Probable recurrent paralysis"}],"type":"qi"}
+{"_id":"annales-2016-qi-106","context":null,"enonce":"What are the right answers regarding this pulmonary function test?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"VEMS\/FVC post-bronchodilation ratio of 63"},{"idx":1,"correct":false,"proposition":"FEV1\/FVC ratio pre-bronchodilation at 73"},{"idx":2,"correct":false,"proposition":"Restrictive ventilatory disorder"},{"idx":3,"correct":false,"proposition":"Completely reversible obstructive ventilatory disorder"},{"idx":4,"correct":true,"proposition":"Significantly reversible obstructive ventilatory disorder"}],"type":"qi"}
+{"_id":"annales-2016-qi-107","context":null,"enonce":"During sarcoidosis, histological analysis of hilar lymphadenopathy conventionally shows epithelioid and gigantocellular granulomas. Which of the following conditions can (may) show a similar appearance?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Asthma"},{"idx":1,"correct":true,"proposition":"Common variable immunodeficiency"},{"idx":2,"correct":true,"proposition":"Lymphoma"},{"idx":3,"correct":false,"proposition":"Scleroderma"},{"idx":4,"correct":true,"proposition":"Silicosis"}],"type":"qi"}
+{"_id":"annales-2016-qi-109","context":null,"enonce":"Regarding the scanner cut below, what is (are) the exact statement(s)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"There is a subcarenary mass"},{"idx":1,"correct":true,"proposition":"There is a mass in the mediastinum"},{"idx":2,"correct":false,"proposition":"You first request a transparietal needle puncture to obtain a diagnosis of certainty"},{"idx":3,"correct":false,"proposition":"You mention the diagnosis of germ cell tumour"},{"idx":4,"correct":false,"proposition":"You mention the diagnosis of neurogenic tumor"}],"type":"qi"}
+{"_id":"annales-2016-qi-110","context":null,"enonce":"Which of the following can be a direct addressee(s) of a patient's cause of death?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"His beneficiaries, unless refused by the patient before his death"},{"idx":1,"correct":false,"proposition":"The patient's notary"},{"idx":2,"correct":false,"proposition":"The lawyer appointed by the patient's beneficiaries"},{"idx":3,"correct":false,"proposition":"The patient's attending physician"},{"idx":4,"correct":false,"proposition":"The doctor mandated by the death insurance company"}],"type":"qi"}
+{"_id":"annales-2016-qi-111","context":null,"enonce":"What is (are) the circumstance(s) that should lead the physician to check the medical-legal obstacle box on a death certificate:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Sudden death in young adults"},{"idx":1,"correct":true,"proposition":"Suicide by hanging"},{"idx":2,"correct":true,"proposition":"Highway accident"},{"idx":3,"correct":false,"proposition":"Natural death expected in hospital"},{"idx":4,"correct":true,"proposition":"Sudden death syndrome of the child"}],"type":"qi"}
+{"_id":"annales-2016-qi-112","context":null,"enonce":"Regarding the exchange of medical information, what is (are) the exact answer(s)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Physicians must ensure that professional secrecy is respected by their non-physician collaborators: secretaries and nurses"},{"idx":1,"correct":false,"proposition":"The sharing of medical information between healthcare professionals is limited to diagnostic information"},{"idx":2,"correct":true,"proposition":"Treating physicians may exchange information concerning a patient whom they treat together unless the latter objects to it."},{"idx":3,"correct":true,"proposition":"The transmission of medical information between doctors can lead to prosecution for non-compliance with medical confidentiality"},{"idx":4,"correct":false,"proposition":"A doctor can only provide medical information about a patient to another healthcare professional"}],"type":"qi"}
+{"_id":"annales-2016-qi-113","context":null,"enonce":"Which of the following proposals falls within the remit of the High Authority for Health (HAS)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Certification of health facilities"},{"idx":1,"correct":true,"proposition":"Development of clinical practice guidelines"},{"idx":2,"correct":false,"proposition":"Collect and track adverse drug and health product events"},{"idx":3,"correct":false,"proposition":"Give authorization for the establishment of a phase III randomized therapeutic trial"},{"idx":4,"correct":true,"proposition":"Management of indicators for the improvement of the quality and safety of care (IPAQSS)"}],"type":"qi"}
+{"_id":"annales-2016-qi-114","context":null,"enonce":"Which of the following people can be an investigator in a clinical research study?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"A general practitioner"},{"idx":1,"correct":false,"proposition":"A medical intern as part of his thesis"},{"idx":2,"correct":true,"proposition":"A public health physician"},{"idx":3,"correct":false,"proposition":"A midwife as part of her final thesis"},{"idx":4,"correct":true,"proposition":"A pharmacist"}],"type":"qi"}
+{"_id":"annales-2016-qi-115","context":null,"enonce":"About the national program of indicators for the improvement of the quality and safety of care (IPAQSS), which of the following proposals, which is (are) accurate?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"It is managed by the High Authority of Health (HAS)"},{"idx":1,"correct":true,"proposition":"It is based on indicators that are reported by the institutions"},{"idx":2,"correct":true,"proposition":"One of the indicators collected relates to the maintenance of the patient's record"},{"idx":3,"correct":true,"proposition":"It includes the nosocomial infections dashboard"},{"idx":4,"correct":false,"proposition":"Indicators collected by institutions under this program are confidential"}],"type":"qi"}
+{"_id":"annales-2016-qi-116","context":null,"enonce":"Which of the following measures constitutes a secondary prevention measure in oncology?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Offer hepatitis B vaccination to all children"},{"idx":1,"correct":true,"proposition":"Offer a blood test in the stool regularly, from the age of 50"},{"idx":2,"correct":true,"proposition":"Have a mammogram regularly, from the age of 50"},{"idx":3,"correct":true,"proposition":"Regularly perform a cervico-vaginal smear"},{"idx":4,"correct":false,"proposition":"Promoting smoking cessation"}],"type":"qi"}
+{"_id":"annales-2016-qi-117","context":null,"enonce":"Which of the following areas of responsibility is covered by the Regional Health Agencies (RHAs)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Regional health security"},{"idx":1,"correct":false,"proposition":"Authorization to practice for liberal practitioners"},{"idx":2,"correct":true,"proposition":"The organization of the provision of care according to the needs of the population"},{"idx":3,"correct":true,"proposition":"Prevention actions in the region"},{"idx":4,"correct":false,"proposition":"Maternal and child protection"}],"type":"qi"}
+{"_id":"annales-2016-qi-118","context":null,"enonce":"Verapamil (Isoptine®) and diltiazem (Bitildiem®):","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Are brakers at the atrioventricular node"},{"idx":1,"correct":true,"proposition":"Are brakers of the atrial knot"},{"idx":2,"correct":false,"proposition":"The usual digestive effect is diarrhea"},{"idx":3,"correct":true,"proposition":"May cause edema of the lower limbs"},{"idx":4,"correct":false,"proposition":"Are inotropic indifferent"}],"type":"qi"}
+{"_id":"annales-2016-qi-120","context":null,"enonce":"Thiazide diuretics:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Can be used in heart failure"},{"idx":1,"correct":true,"proposition":"May increase uricemia"},{"idx":2,"correct":false,"proposition":"May decrease serum calcium"},{"idx":3,"correct":false,"proposition":"May cause gynecomastia"},{"idx":4,"correct":false,"proposition":"Have a brutal and rapid effect on diuresis"}],"type":"qi"}
+{"_id":"annales-2017-qi-III","context":null,"enonce":"The Mini Nutritionna\/Assessment (or MNA) nutritional test:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Is a test with a total score out of 30 points","justification":""},{"idx":1,"correct":true,"proposition":"Is a test that defines malnutrition if the score is less than 23 5 points","justification":""},{"idx":2,"correct":true,"proposition":"Is a test that defines malnutrition if the score is less than 17 points","justification":""},{"idx":3,"correct":false,"proposition":"Is a test that requires the calculation of body mass index","justification":""},{"idx":4,"correct":true,"proposition":"Is a test that takes into account the presence of neuropsychological problems","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-III","context":null,"enonce":"A woman of Martinican origin has just given birth. The child's father is also of Martinican origin. The child has a cleft lip and palate. With regard to regulatory newborn screening of this child, what is the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Phenylketonuria is the only disease of amino acid and organic acid metabolism currently being screened for newborn in France","justification":"Now there is the MCAD deficiency"},{"idx":1,"correct":false,"proposition":"General screening test can detect hypothyroidism of pituitary origin","justification":""},{"idx":2,"correct":true,"proposition":"This couple can refuse the screening after information","justification":""},{"idx":3,"correct":true,"proposition":"Completion before 48 h of life decreases the sensitivity and\/or specificity of the screening test","justification":""},{"idx":4,"correct":false,"proposition":"Targeted screening for sickle cell disease is not indicated in this child","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-1","context":null,"enonce":"A 14-month-old infant comes to see for repeated cold episodes. The nose runs, then he coughs day and night, wakes up several times at night and is sometimes very short of breath. These episodes have been monthly since the age of 6 months, when he had bronchiolitis that was easy to treat. It has good growth in staturo-weight and << everything is going well >> between episodes. On this day, you see only clear rhinitis. The rest of the exam is normal. What do you offer?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Continue nose washes","justification":""},{"idx":1,"correct":false,"proposition":"Do chest physiotherapy sessions","justification":""},{"idx":2,"correct":true,"proposition":"Prescribe a frontal chest x-ray","justification":""},{"idx":3,"correct":false,"proposition":"Starting a long-acting bronchodilator","justification":""},{"idx":4,"correct":true,"proposition":"Start inhaled corticosteroid therapy","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-2","context":null,"enonce":"A 5-year-old boy, feverish at 38 ° C comes for respiratory discomfort with his chest X-ray requested by his doctor. He has had a cold for 3 days. In this context, which diagnosis(s) should be mentioned?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Left pleurisy","justification":""},{"idx":1,"correct":false,"proposition":"Interstitial lung disease","justification":""},{"idx":2,"correct":true,"proposition":"Myocarditis","justification":""},{"idx":3,"correct":true,"proposition":"Pericarditis","justification":""},{"idx":4,"correct":false,"proposition":"Lymphoma","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-3","context":null,"enonce":"A 2-month-old girl comes for consultation in December for respiratory discomfort. You refer him to pediatric emergencies. What element(s) of your review led you to this decision?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"A heart rate of 120\/min","justification":""},{"idx":1,"correct":true,"proposition":"A catch of 2 feedings in the last 24 hours","justification":""},{"idx":2,"correct":false,"proposition":"Audible hissing sounds outside of auscultation","justification":""},{"idx":3,"correct":false,"proposition":"A flapping of the wings of the nose","justification":""},{"idx":4,"correct":true,"proposition":"A respiratory rate of 65\/min","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-4","context":null,"enonce":"In a pregnant woman who had severe pre-eclampsia at 30 weeks of amenorrhea, which of the following is (are) correct about the use of low-dose aspirin?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"This treatment prevents any recurrence of pre-eclampsia","justification":""},{"idx":1,"correct":true,"proposition":"This treatment should be started preferentially before 15 weeks of amenorrhea","justification":""},{"idx":2,"correct":false,"proposition":"This treatment is administered according to the Doppler of the uterine arteries","justification":""},{"idx":3,"correct":false,"proposition":"This treatment includes 500 mg of aspirin","justification":""},{"idx":4,"correct":false,"proposition":"This treatment must be maintained until the end","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-5","context":null,"enonce":"What are (are) the possible antihypertensive treatment(s) during pregnancy?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Calcium channel blockers","justification":""},{"idx":1,"correct":false,"proposition":"Diuretics","justification":""},{"idx":2,"correct":true,"proposition":"Central antihypertensives","justification":""},{"idx":3,"correct":true,"proposition":"Blockers","justification":""},{"idx":4,"correct":false,"proposition":"IEC","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-7","context":null,"enonce":"What is (are) the factor(s) of poor prognosis of breast cancer?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"The inflammatory character","justification":""},{"idx":1,"correct":true,"proposition":"The absence of estrogen hormone receptors","justification":""},{"idx":2,"correct":true,"proposition":"Vascular emboluses","justification":""},{"idx":3,"correct":false,"proposition":"The association of an important intraductal component with the infiltrating component","justification":""},{"idx":4,"correct":true,"proposition":"High histological grade","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-8","context":null,"enonce":"In the most common form of trisomy 21 in the fetus, which is (are) the exact proposition(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"The measurement of nuchal translucency is usually increased","justification":""},{"idx":1,"correct":true,"proposition":"The free fraction of beta HCG is conventionally increased in the 1st trimester","justification":""},{"idx":2,"correct":false,"proposition":"PAPP-A (pregnancy associated placenta protein A) is classically decreased in the 2nd trimester","justification":""},{"idx":3,"correct":false,"proposition":"Alphafetoprotein in the 1st trimester is increased","justification":""},{"idx":4,"correct":true,"proposition":"All fetal cells are affected","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-9","context":null,"enonce":"In newborns the risk of nuclear jaundice:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Is absent in full-term infants","justification":""},{"idx":1,"correct":true,"proposition":"Increases if jaundice begins before the 24th hour of life","justification":""},{"idx":2,"correct":false,"proposition":"Is less important in premature infants","justification":""},{"idx":3,"correct":false,"proposition":"Is linked to the neurotoxicity of conjugated bilirubin","justification":""},{"idx":4,"correct":false,"proposition":"Rarely engages long-term neurological prognosis","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-10","context":null,"enonce":"A 53-year-old patient consults you for abnormalities of the blood count which shows: leukocytes 18.4 G \/ L; neutrophils 5.4 G\/L; eosinophilic polynuclear 0.2 G\/L; lymphocytes 12.3 G\/L; monocytes 0.5 G\/L; haemoglobin 13.5 g\/dL; VGM 84 fL; blisters 256 G\/L. Clinical examination found isolated centimetric cervical lymphadenopathy. Matutes' score is 5\/5. How do you complete your balance sheet?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Thoraco-abdominopelvic CT scan with iodinated contrast medium injection","justification":""},{"idx":1,"correct":false,"proposition":"PET-scanner","justification":""},{"idx":2,"correct":true,"proposition":"Serum protein electrophoresis","justification":""},{"idx":3,"correct":true,"proposition":"Direct Coombs test","justification":""},{"idx":4,"correct":false,"proposition":"Lymph node biopsy with histological examination","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-11","context":null,"enonce":"A 63-year-old patient consults you for intense asthenia. She has a mucocutaneous pallor. The clinical examination does not find hepatosplenomegaly. A first biological assessment shows: leukocytes 2.5 G \/ L; PNN 1.2 G\/L; lymphocytes 1.1 G\/L; monocytes 0.2 G\/L; Hb 8.3 g\/dL; VGM 109 fL; reticulocytes 22 G\/L; blisters 90 G\/L. Blood biochemistry finds: AST 23 IU\/L; ALT 27 IU\/L; total bilirubin 45 μmol\/L; free bilirubin 42 μmol \/ L; LDH 820 IU\/L; haptoglobin 0.1 g\/L. You mention:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Evans syndrome","justification":""},{"idx":1,"correct":true,"proposition":"Myelodysplastic syndrome","justification":""},{"idx":2,"correct":true,"proposition":"Biermer's disease","justification":""},{"idx":3,"correct":false,"proposition":"A MAT","justification":""},{"idx":4,"correct":false,"proposition":"Multiple myeloma","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-12","context":null,"enonce":"ACE inhibitors can cause: ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Functional acute renal failure (AIRD)","justification":""},{"idx":1,"correct":false,"proposition":"Hypokalemia","justification":""},{"idx":2,"correct":true,"proposition":"Bradykinin angioedema","justification":""},{"idx":3,"correct":false,"proposition":"Increased resistance of the glomerular efferent arteriole","justification":""},{"idx":4,"correct":true,"proposition":"A decrease in glomerular filtration pressure","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-13","context":null,"enonce":"What lesion(s) can be observed on the renal biopsy during rapidly progressive glomerulonephritis?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Linear deposition of IgG in immunofluorescence","justification":""},{"idx":1,"correct":true,"proposition":"Granular deposits of IgG in immunofluorescence","justification":""},{"idx":2,"correct":false,"proposition":"Congo red birefringent fibrillar deposits","justification":""},{"idx":3,"correct":true,"proposition":"Extracapillary croissants","justification":""},{"idx":4,"correct":true,"proposition":"Microvascular lesions with fibrinoid necrosis","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-14","context":null,"enonce":"In the context of the constitution of an expert group before the marketing of a new molecule, in which of the following situations can an expert doctor have a link of interest?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"If he worked for 30 years in the industry developing the molecule until he retired 2 years ago","justification":""},{"idx":1,"correct":true,"proposition":"If he has been paid by the pharmaceutical industry to teach general practitioners","justification":""},{"idx":2,"correct":false,"proposition":"If it has already published results questioning the interest of this new molecule, as part of a research program funded by public funds","justification":""},{"idx":3,"correct":true,"proposition":"If he has been paid by the manufacturer to include patients in phase III trials that evaluated this new molecule","justification":""},{"idx":4,"correct":true,"proposition":"If the son of this doctor is a medical delegate for the industry marketing the molecule","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-15","context":null,"enonce":"Areas of interest to indicators for improving the quality and safety of care (IPAQSS) include:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"The rate of methicillin-resistant staphylococci","justification":""},{"idx":1,"correct":true,"proposition":"Keeping the patient record","justification":""},{"idx":2,"correct":true,"proposition":"Operating compliance of PCRs in oncology","justification":""},{"idx":3,"correct":false,"proposition":"Screening for nutritional disorders","justification":""},{"idx":4,"correct":false,"proposition":"Surgical site infections","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-16","context":null,"enonce":"Which of the following proposals on the roles played by Regional Health Agencies (RHAs) at the regional level is correct?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"They are responsible for health monitoring and security at the regional level","justification":""},{"idx":1,"correct":true,"proposition":"They are responsible for prevention and health promotion","justification":""},{"idx":2,"correct":false,"proposition":"They are responsible for university preventive medicine","justification":""},{"idx":3,"correct":true,"proposition":"They are responsible for providing care in each health territory of the region.","justification":""},{"idx":4,"correct":true,"proposition":"They are responsible for the accreditation of medical internship sites in the region.","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-17","context":null,"enonce":"Which of the following study designs would allow us to study the relationship between coffee consumption and the risk of developing Alzheimer's disease?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"The follow-up of a cohort of several thousand patients with Alzheimer's disease","justification":""},{"idx":1,"correct":true,"proposition":"A study in which subjects with Alzheimer's disease and an equivalent number of subjects without dementia would be included","justification":""},{"idx":2,"correct":true,"proposition":"A study conducted on a population of subjects over 60 years of age free of dementia at baseline and followed for 10 years or more","justification":""},{"idx":3,"correct":false,"proposition":"A comprehensive study based on data on notifiable diseases","justification":""},{"idx":4,"correct":false,"proposition":"A study of the prevalence of coffee consumption in a representative sample of the general population","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-18","context":null,"enonce":"Infantile hemangiomas:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Appear in the perinatal period","justification":""},{"idx":1,"correct":true,"proposition":"May have skin, subcutaneous or combination (cutaneous and subcutaneous) development","justification":""},{"idx":2,"correct":true,"proposition":"At risk of ulceration and superficial necrosis","justification":""},{"idx":3,"correct":false,"proposition":"Affect boys more frequently","justification":""},{"idx":4,"correct":false,"proposition":"Are rarer than vascular malformations","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-19","context":null,"enonce":"Among the following examinations, which is the most efficient for the analysis of the morphology of a tooth root?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Orthopantomogram (dental panoramic)","justification":""},{"idx":1,"correct":false,"proposition":"Occlusal bitten cliché","justification":""},{"idx":2,"correct":false,"proposition":"Blondeau incidence (nose-chin-plate incidence)","justification":""},{"idx":3,"correct":true,"proposition":"Retro-alveolar image","justification":""},{"idx":4,"correct":false,"proposition":"Low-facing incidence","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-20","context":null,"enonce":"Which of the following imaging tests shows the temporomandibular joints?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Dental panoramic picture (orthopantomogram)","justification":""},{"idx":1,"correct":true,"proposition":"Low-side incidence","justification":""},{"idx":2,"correct":true,"proposition":"Teleradiography of the skull in profile","justification":""},{"idx":3,"correct":true,"proposition":"Computed tomography of the face (CT)","justification":""},{"idx":4,"correct":true,"proposition":"Nuclear magnetic resonance imaging (MRI)","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-21","context":null,"enonce":"For skin tumours of the face, please indicate the exact proposal(s):","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Tobacco is the main risk factor for developing basal cell carcinoma","justification":""},{"idx":1,"correct":true,"proposition":"Squamous cell carcinomas are more lymphophilic than basal cell carcinomas","justification":""},{"idx":2,"correct":false,"proposition":"Melanoma is a tumor exclusively with a cutaneous starting point","justification":""},{"idx":3,"correct":false,"proposition":"Melanomas are more common than basal cell carcinomas","justification":""},{"idx":4,"correct":true,"proposition":"The treatment of skin cancers is mainly based on surgery","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-22","context":null,"enonce":"A professional hockey player fell on the ice with a mandibular impact. The orthopantomogram performed is as follows: ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"There is a bifocal fracture of the mandible","justification":""},{"idx":1,"correct":false,"proposition":"One of the fracture features passes through the left mandibular neck","justification":""},{"idx":2,"correct":false,"proposition":"A fracture line passes through tooth No. 37","justification":""},{"idx":3,"correct":true,"proposition":"A fracture line passes behind tooth No. 33","justification":""},{"idx":4,"correct":true,"proposition":"Tooth No. 38 is missing","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-23","context":null,"enonce":"Regarding the anatomy of the eyelids:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Lacrimal punctums are lateral","justification":""},{"idx":1,"correct":true,"proposition":"The elevator muscle of the upper eyelid is inserted on the tarsus","justification":""},{"idx":2,"correct":true,"proposition":"Both eyelids delimit the palpebral cleft","justification":""},{"idx":3,"correct":true,"proposition":"The orbicular muscle of the eye is innervated by the facial nerve","justification":""},{"idx":4,"correct":false,"proposition":"The upper eyelid lift muscle is innervated by the facial nerve","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-24","context":null,"enonce":"You see a 6-month-old infant with no history before a one-month trip to Côte d'Ivoire (group 3 countries). What malaria prevention measure(s) are you prescribing for this infant?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"The use of an insecticide-treated net","justification":""},{"idx":1,"correct":true,"proposition":"The use of skin repellents","justification":""},{"idx":2,"correct":false,"proposition":"Chemoprophylaxis with chloroquine and proguanil","justification":""},{"idx":3,"correct":false,"proposition":"Chemoprophylaxis with atovaquone-proguanil","justification":""},{"idx":4,"correct":false,"proposition":"Chemoprophylaxis with artemeter-lumefantrine","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-25","context":null,"enonce":"Which of the following occupations is associated with an increased risk of bladder cancer?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Plasterer","justification":""},{"idx":1,"correct":true,"proposition":"Dye industry worker","justification":""},{"idx":2,"correct":true,"proposition":"Foundry worker","justification":""},{"idx":3,"correct":false,"proposition":"Baker","justification":""},{"idx":4,"correct":false,"proposition":"Nurse","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-26","context":null,"enonce":"In the context of a work stoppage relating to an occupational disease, indicate the exact proposal(s):","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"The occupational physician receives the obligatory employee during his return to work during his return to work.","justification":""},{"idx":1,"correct":false,"proposition":"The pre-recovery visit makes it possible to determine the date of consolidation of the disease","justification":""},{"idx":2,"correct":true,"proposition":"The pre-resumption visit makes it possible to plan a possible shift adjustment when work resumes","justification":""},{"idx":3,"correct":false,"proposition":"A systematic visit at the initiative of the occupational physician is planned one month after the resumption","justification":""},{"idx":4,"correct":false,"proposition":"The follow-up visit may be carried out by the attending physician at the request of the employer in the absence of the occupational physician.","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-27","context":null,"enonce":"Which of the following can be seen in a woman with polycystic ovary syndrome? Indicate the correct answer(s):","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Hirsutism","justification":""},{"idx":1,"correct":true,"proposition":"Normal estradiol","justification":""},{"idx":2,"correct":true,"proposition":"Increased testosterone","justification":""},{"idx":3,"correct":true,"proposition":"Normal FSH","justification":""},{"idx":4,"correct":true,"proposition":"Increased prolactin","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-28","context":null,"enonce":"In diabetic retinopathy:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Decreased visual acuity is early by macular edema","justification":""},{"idx":1,"correct":false,"proposition":"Retinal microaneurysms are mostly peripheral","justification":""},{"idx":2,"correct":true,"proposition":"In the absence of diabetic retinopathy, ophthalmological monitoring should be annual","justification":""},{"idx":3,"correct":true,"proposition":"The management of a diabetic involves glycemic and arterial blood pressure control","justification":""},{"idx":4,"correct":false,"proposition":"Laser photocoagulation treatment is indicated only for complicated stages of retinal detachment","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-29","context":null,"enonce":"A patient is treated by his ophthalmologist for primary open-angle glaucoma. You are his general practitioner, he asks you for information about his disease. What is (are) the element(s) you can give it?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Central visual acuity is affected only late.","justification":""},{"idx":1,"correct":true,"proposition":"The main element of follow-up is the examination of the visual field.","justification":""},{"idx":2,"correct":false,"proposition":"Monitoring of the retinal periphery is a major component of monitoring.","justification":""},{"idx":3,"correct":true,"proposition":"The patient should warn any new doctor of his glaucoma because some local treatments have systemic effects.","justification":""},{"idx":4,"correct":true,"proposition":"Monitoring of intraocular pressure is useful but not sufficient to judge the effectiveness of treatment.","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-30","context":null,"enonce":"In front of a non-traumatic acute neck pain in a 30-year-old woman, you can immediately realize in first intention?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"A prescription of NSAIDs","justification":""},{"idx":1,"correct":false,"proposition":"A physiotherapy prescription","justification":""},{"idx":2,"correct":false,"proposition":"Corticosteroid infiltration","justification":""},{"idx":3,"correct":false,"proposition":"Spinal manipulation","justification":""},{"idx":4,"correct":false,"proposition":"A flexible neck brace prescription","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-31","context":null,"enonce":"A 30-year-old patient, of normal build and with normal physical activity and diet, has type 1 diabetes that has been evolving for 5 years. Indicate the exact proposal(s):","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"The daily dose of insulin is usually 0.5 to 0.7 units\/kg weight\/day","justification":""},{"idx":1,"correct":true,"proposition":"Insulin glargine is given once a day","justification":""},{"idx":2,"correct":false,"proposition":"Basal insulin should be discontinued in case of fasting examination","justification":""},{"idx":3,"correct":true,"proposition":"Rapid insulin can be used occasionally to correct hyperglycemia","justification":""},{"idx":4,"correct":true,"proposition":"The dosage of prandial insulin depends on the amount of carbohydrates ingested during the meal","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-32","context":null,"enonce":"What is the correct answer(s) regarding the pathophysiology of asthma?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Activation of nerve fibers responsible for bronchodilation","justification":""},{"idx":1,"correct":false,"proposition":"Overexpression of interleukin 10 (IL-10) and TNFa","justification":""},{"idx":2,"correct":true,"proposition":"Inflammation TH2","justification":""},{"idx":3,"correct":true,"proposition":"Bronchial remodeling","justification":""},{"idx":4,"correct":false,"proposition":"Vascular remodeling","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-33","context":null,"enonce":"A 15-year-old girl consults for coughing and wheezing. You learn from the interrogation that these symptoms are intermittent and occur preferentially at the end of the night and in the morning. Which exam(s) do you perform as a first-line test?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"ECG","justification":""},{"idx":1,"correct":false,"proposition":"Total IgE","justification":""},{"idx":2,"correct":false,"proposition":"D-dimer","justification":""},{"idx":3,"correct":false,"proposition":"Pertussis serology","justification":""},{"idx":4,"correct":true,"proposition":"Spirometry","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-34","context":null,"enonce":"What is the exact proposal(s) regarding thyroid physiology?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"TSH stimulates thyroocyte proliferation","justification":""},{"idx":1,"correct":true,"proposition":"Triiodothyronine is the active hormone","justification":""},{"idx":2,"correct":true,"proposition":"Thyroid hormones increase bone turnover","justification":""},{"idx":3,"correct":false,"proposition":"Thyroid hormones are vasoconstrictors","justification":""},{"idx":4,"correct":true,"proposition":"Thyroid hormones increase gluconeogenesis","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-35","context":null,"enonce":"You asked for a TSH test in a 34-year-old woman, in front of weight loss. TSH is indosable. What additional examination(s) would you like before treatment?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Free T4 assay","justification":""},{"idx":1,"correct":false,"proposition":"Thyroglobulin testing","justification":""},{"idx":2,"correct":false,"proposition":"Determination of anti-thyroperoxidase antibodies","justification":""},{"idx":3,"correct":true,"proposition":"Determination of anti-TSH receptor antibodies","justification":""},{"idx":4,"correct":false,"proposition":"Thyrocalcitonin dosage","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-36","context":null,"enonce":"Damage to the right trigeminal nerve can manifest as: ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"An abolition of the right corneal reflex","justification":""},{"idx":1,"correct":false,"proposition":"Right facial paralysis","justification":""},{"idx":2,"correct":true,"proposition":"Amyotrophy of the right masseter muscle","justification":""},{"idx":3,"correct":false,"proposition":"A hypoaesthesia of the right masseterine notch","justification":""},{"idx":4,"correct":false,"proposition":"An agueusia of the anterior 2\/3 of the right hemi-tongue","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-37","context":null,"enonce":"A 30-year-old motorcyclist patient is hospitalized following a road accident. Which immediate sign(s) is compatible with complete spinal cord syndrome level T10?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Motor deficit of the four members","justification":""},{"idx":1,"correct":false,"proposition":"Suspended motor deficit of the upper limbs","justification":""},{"idx":2,"correct":false,"proposition":"Normal sensitivity above the umbilicus","justification":""},{"idx":3,"correct":true,"proposition":"Acute urine retention","justification":""},{"idx":4,"correct":true,"proposition":"Abolition of tendon reflexes in the lower limbs","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-38","context":null,"enonce":"A cerebral infarction in the territory of the left middle cerebral artery in a right-handed person may be responsible for the following sign(s). ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Aphasia","justification":""},{"idx":1,"correct":false,"proposition":"Horizontal diplopia","justification":""},{"idx":2,"correct":false,"proposition":"Left hemineglect","justification":""},{"idx":3,"correct":false,"proposition":"Left homonymous lateral hemianopsia","justification":""},{"idx":4,"correct":false,"proposition":"Right central facial paralysis","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-39","context":null,"enonce":"Regarding narcolepsy, what statement(s) is(are) accurate? ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Defined by a sudden loss of tone","justification":""},{"idx":1,"correct":false,"proposition":"Is characterized by excess irrepressible daytime sleepiness","justification":""},{"idx":2,"correct":true,"proposition":"May be associated with cataplexy","justification":""},{"idx":3,"correct":false,"proposition":"Temporal signal abnormalities are frequently found on MRI","justification":""},{"idx":4,"correct":false,"proposition":"There may be sleep paralysis","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-40","context":null,"enonce":"A 37-year-old man has been presenting urgently for a red and painful right eye for 24 hours. With correction, you measure a visual acuity of 12\/10 from afar and Parinaud 2 up close to both eyes. What are the possible etiologies of the symptoms described by this patient?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Allergic conjunctivitis","justification":""},{"idx":1,"correct":true,"proposition":"Scleritis","justification":""},{"idx":2,"correct":true,"proposition":"Foreign body in the conjunctival cul-de-sac","justification":""},{"idx":3,"correct":false,"proposition":"Intravitreal hemorrhage","justification":""},{"idx":4,"correct":false,"proposition":"Retinal vasculitis","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-41","context":null,"enonce":"A 62-year-old patient, hyperopic and of Asian origin, has a narrow iridocorneal angle. She has not yet received a preventive laser iridotomy. What factor(s) could (could) promote the occurrence of an acute hypertonia attack by closing the angle?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Taking morphine","justification":""},{"idx":1,"correct":false,"proposition":"Taking p aracetamol","justification":""},{"idx":2,"correct":true,"proposition":"Taking atropine","justification":""},{"idx":3,"correct":true,"proposition":"Instillation in the eyes of tropicamide","justification":""},{"idx":4,"correct":false,"proposition":"Instillation in the eyes of pilocarpine","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-42","context":null,"enonce":"A 90-year-old man with chronic renal failure has a 60 mm major axis erythematous cupboard in the mid-thoracic region. The lesion is asymptomatic and has been evolving for 30 years. What diagnosis do you remember?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Bowen's disease","justification":""},{"idx":1,"correct":false,"proposition":"Plaque psoriasis","justification":""},{"idx":2,"correct":false,"proposition":"Superficial extension melanoma","justification":""},{"idx":3,"correct":true,"proposition":"Superficial basal cell carcinoma","justification":""},{"idx":4,"correct":false,"proposition":"Chronic lichenified eczema","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-44","context":null,"enonce":"A 45-year-old man consults in front of the appearance of erythematous lesions infiltrated of the right cheek appeared for a few weeks. The general condition is preserved. What diagnoses can you evoke in front of this table? Cutaneous sarcoidosis Among these proposals concerning the bacterial species Escherichia coli, which is (are) accurate?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"This bacterial species is part of the family of enterobacteriaceae","justification":""},{"idx":1,"correct":true,"proposition":"It can be responsible for hemolytic uremic syndrome -","justification":""},{"idx":2,"correct":false,"proposition":"C.","justification":""},{"idx":3,"correct":false,"proposition":"It is sensitive to amoxicillin in less than 10% of cases","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-45","context":null,"enonce":"Which of the following proposals on mother-to-child transmission of HIV is the right one: ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"The risk of transmission is greater in the first trimester of pregnancy","justification":""},{"idx":1,"correct":true,"proposition":"Risk is related to maternal plasma HIV load during childbirth","justification":""},{"idx":2,"correct":true,"proposition":"Antiretroviral therapy should be started in the mother as soon as HIV infection is diagnosed","justification":""},{"idx":3,"correct":false,"proposition":"A caesarean section must be performed there to prevent transmission.","justification":""},{"idx":4,"correct":true,"proposition":"Antiretroviral therapy should be started at birth in the child to prevent transmission","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-46","context":null,"enonce":"In the context of community-acquired acute pneumonia, what is the true proposition(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Hyponatremia is specific to legionellosis","justification":""},{"idx":1,"correct":false,"proposition":"B.","justification":""},{"idx":2,"correct":false,"proposition":"Pneumococcal pneumonia and legionellosis are notifiable diseases","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-47","context":null,"enonce":"A 42-year-old woman with Hodgkin's disease started pneumocystosis prophylaxis with ® trimethoprim sulfamethoxazole (Bactrim) for 10 days. She presents to the emergency room with a picture of painful acute febrile exanthema accompanied by pharyngitis and burning eyes. The examination shows the following lesions. What diagnosis do you mention?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Syndrome de Stevens Johnson","justification":""},{"idx":1,"correct":true,"proposition":"Toxic epidermal necrolysis (Lyell's syndrome)","justification":""},{"idx":2,"correct":false,"proposition":"Pemphigus induced","justification":""},{"idx":3,"correct":false,"proposition":"Staphylococcal epidermolysis","justification":""},{"idx":4,"correct":false,"proposition":"Erythema multiforme","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-49","context":null,"enonce":"In the face of a hemorrhagic syndrome, which is (are) the element(s) that point to an abnormality of primary hemostasis ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Mucocutaneous hemorrhages","justification":""},{"idx":1,"correct":true,"proposition":"Delayed bleeding","justification":""},{"idx":2,"correct":true,"proposition":"Petechial purpura","justification":""},{"idx":3,"correct":false,"proposition":"Hemarthrosis","justification":""},{"idx":4,"correct":false,"proposition":"Hematoma of the psoas","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-50","context":null,"enonce":"A 23-year-old patient is hospitalized against a background of pancytopenia. You mention the diagnosis of acute pro-myelocytic leukemia in front of the presence of numerous bruises. Which abnormality(s) of hemostasis is (are) compatible with this diagnosis?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"A hypofibrinogenem","justification":""},{"idx":1,"correct":false,"proposition":"An increase in antithrombin levels","justification":""},{"idx":2,"correct":true,"proposition":"A decrease in factor V levels","justification":""},{"idx":3,"correct":true,"proposition":"An extension of the Cephalin Time + activateun","justification":""},{"idx":4,"correct":true,"proposition":"An increase in D-Dimer","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-51","context":null,"enonce":"A 58-year-old patient, a 35-PA smoker, consults for progressive onset dyspnea during the last semester. This dyspnea is accompanied by a dry cough. Pulmonary and cardiac auscultation is unremarkable. Here are his EFRs. What is your conclusion(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Obstructive ventilatory disorder","justification":""},{"idx":1,"correct":false,"proposition":"FEV1\/FVC ratio pre-bronchodilation to III","justification":""},{"idx":2,"correct":false,"proposition":"Partially reversible restrictive ventilatory disorder","justification":""},{"idx":3,"correct":true,"proposition":"Restrictive ventilatory disorder","justification":""},{"idx":4,"correct":false,"proposition":"These EFRs are compatible with a GOLD II stage COPD","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-52","context":null,"enonce":"Which of the following proposals regarding risk factors for lung cancer is the right one?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Exposure to asbestos is considered a risk factor","justification":""},{"idx":1,"correct":false,"proposition":"It is the primary current, which is the main carcinogenic risk factor related to passive smoking","justification":""},{"idx":2,"correct":true,"proposition":"The spouse (non-smoker) of a smoker has a 20-30% increased risk of lung cancer","justification":""},{"idx":3,"correct":false,"proposition":"Carbon monoxide (CO), resulting from incomplete carbon combustion, is considered a risk factor","justification":""},{"idx":4,"correct":false,"proposition":"Alkaline persulfates used by hairdressers are considered a risk factor","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-53","context":null,"enonce":"Which of the following proposals regarding transudative pleural effusions is(are) accurate?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"They can be consecutive to bacterial pneumonia","justification":""},{"idx":1,"correct":true,"proposition":"They can be consecutive to a pulmonary embolism","justification":""},{"idx":2,"correct":false,"proposition":"They can be consecutive to viral pneumonia","justification":""},{"idx":3,"correct":false,"proposition":"They may be consecutive to metastatic effusion","justification":""},{"idx":4,"correct":true,"proposition":"They may be consecutive to pulmonary atelectasis","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-54","context":null,"enonce":"About cholitis, what is the exact proposal(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"It results in the successive appearance of three signs: pain, pruritus, jaundice","justification":""},{"idx":1,"correct":true,"proposition":"There is most often an increase in predominantly conjugated bilirubinemia","justification":""},{"idx":2,"correct":true,"proposition":"At first, there may be cytolysis greater than 5 times the upper limit of normal","justification":""},{"idx":3,"correct":true,"proposition":"It may reveal a pancreatic tumour","justification":""},{"idx":4,"correct":true,"proposition":"Endoscopic retrograde biliary disobstruction with sphincterotomy should be discussed urgently","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-55","context":null,"enonce":"Secondary hypertension with low renin, hypokalaemia and kaliuresis > 20 mmol\/L may be linked to 11 ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Renal artery stenosis","justification":""},{"idx":1,"correct":true,"proposition":"Excessive consumption of licorice A deficiency of b-hydroxy-dehydrogenase","justification":""},{"idx":2,"correct":true,"proposition":"C.","justification":""},{"idx":3,"correct":true,"proposition":"Liddle's syndrome","justification":""},{"idx":4,"correct":false,"proposition":"21-hydroxylase deficiency","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-56","context":null,"enonce":"In front of renal colic, what are the factors of gravity requiring a urological opinion (one or more possible correct answers)? Rossess, ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Single kidney","justification":""},{"idx":1,"correct":true,"proposition":"Pregnancy","justification":""},{"idx":2,"correct":true,"proposition":"Anuria","justification":""},{"idx":3,"correct":true,"proposition":"Fever","justification":""},{"idx":4,"correct":false,"proposition":"Haematuria","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-57","context":null,"enonce":" What biological abnormality(ies) is present in systemic lupus erythematosus?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Presence of circulating immune complexes","justification":""},{"idx":1,"correct":false,"proposition":"Thrombocytosis","justification":""},{"idx":2,"correct":true,"proposition":"Coombs test positive","justification":""},{"idx":3,"correct":true,"proposition":"Spontaneous prolongation of the TCA","justification":""},{"idx":4,"correct":true,"proposition":"Polyclonal increase in gamma globulins","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-59","context":null,"enonce":"About gastrointestinal stromal tumours (GIST), which is (are) the exact proposal(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"They most often develop in the muscular layer","justification":""},{"idx":1,"correct":true,"proposition":"The stomach is the most common primitive location of GIST","justification":""},{"idx":2,"correct":true,"proposition":"GISTs are frequently diagnosed incidentally during a digestive endoscopy","justification":""},{"idx":3,"correct":false,"proposition":"They do not metastasize","justification":""},{"idx":4,"correct":false,"proposition":"They are characterized in immunohistochemistry by the expression of c-kit (CD117)","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-60","context":null,"enonce":"Which vessel(s) are directly related to the pancreas?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"The portal vein","justification":""},{"idx":1,"correct":true,"proposition":"The superior mesenteric vein","justification":""},{"idx":2,"correct":false,"proposition":"The inferior mesenteric artery","justification":""},{"idx":3,"correct":false,"proposition":"Gastroduodenal artery","justification":""},{"idx":4,"correct":true,"proposition":"Splenic vein","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-61","context":null,"enonce":"About acromegaly: ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"The absence of a decrease in GH during OGGH is characteristic","justification":""},{"idx":1,"correct":true,"proposition":"It is a cause of diabetes","justification":""},{"idx":2,"correct":true,"proposition":"It is a cause of heart failure","justification":""},{"idx":3,"correct":true,"proposition":"It is a cause of carpal tunnel syndrome","justification":""},{"idx":4,"correct":true,"proposition":"GIgAntism testifies to an onset of the disease before puberty","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-62","context":null,"enonce":"Which of the following pathologies is (are) the cause(s) of high blood pressure? Indicate the correct answer(s): ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Pheochromocytoma","justification":""},{"idx":1,"correct":true,"proposition":"Primary hyperaldosteronism","justification":""},{"idx":2,"correct":true,"proposition":"Cushing's syndrome","justification":""},{"idx":3,"correct":true,"proposition":"Hypothyroidism","justification":""},{"idx":4,"correct":true,"proposition":"Primary hyperparathyroidism","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-63","context":null,"enonce":"Which of the following factors is(are) a scannographic criterion(s) for severity of acute pancreatitis?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Dilation of the main pancreatic duct","justification":""},{"idx":1,"correct":false,"proposition":"A functional ileus","justification":""},{"idx":2,"correct":true,"proposition":"The presence of intrapancreatic necrosis","justification":""},{"idx":3,"correct":true,"proposition":"The presence of extrapancreatic necrosis","justification":""},{"idx":4,"correct":false,"proposition":"Cholelithiasis","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-65","context":null,"enonce":"Ms. X., aged 39, a right hemiplegic and aphasiac, was incenced for incapacity (impossibility of professional redeployment in the bank where she worked). For what objective(s) can it solicit the Departmental House of People with Disabilities?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Obtain a PCH (Disability Compensation Benefit)","justification":""},{"idx":1,"correct":true,"proposition":"Obtaining recognition as a disabled worker (ROTH)","justification":""},{"idx":2,"correct":false,"proposition":"Obtaining a disability pension (Pl)","justification":""},{"idx":3,"correct":true,"proposition":"Getting a disability card","justification":""},{"idx":4,"correct":true,"proposition":"Get a parking card","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-66","context":null,"enonce":"A 70-year-old woman has been complaining of pruritus for 6 months and has had a generalized itchy rash for 15 days. The blood count finds a count of eosinophilic polynuclear 3. A skin biopsy is performed in the peribullous zone at 1,000\/mm (photo below). What will direct cutaneous immunofluorescence show?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Granular deposits of lgG and C3 at the dermal-epidermal junction","justification":""},{"idx":1,"correct":false,"proposition":"Linear IgA deposits along the dermo-e p idermal junction","justification":""},{"idx":2,"correct":true,"proposition":"Linear deposits of lgG and C3 along the dermal-epidermal junction","justification":""},{"idx":3,"correct":false,"proposition":"Intraepidermal deposits of lgG and C3 mesh","justification":""},{"idx":4,"correct":false,"proposition":"LgG deposits around vessels","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-67","context":null,"enonce":"A 26-year-old patient has just returned from a 3-week stay in Indonesia where he tells you that he walked barefoot on the beaches a lot. He has the lesion below which is very itchy to the point of preventing him from sleeping. Which pathology is most likely? (only one exact answer) ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Cutaneous leishmaniasis","justification":""},{"idx":1,"correct":false,"proposition":"Erysipelas","justification":""},{"idx":2,"correct":true,"proposition":"Larva migrans cutaneous","justification":""},{"idx":3,"correct":false,"proposition":"Pyoderma","justification":""},{"idx":4,"correct":false,"proposition":"Cutaneous mycosis","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-68","context":null,"enonce":"A 42-year-old woman with no medical history comes to see you for a picture of nasopharyngitis with a fever above 38.5 ° C evolving for six days despite symptomatic treatment. There is a predominant bilateral purulent rhinorrhea on the right associated with pharyngitis. She complains of a unilateral headache located on the face, just above the right eye, which interferes with sleep. Orbital and periorbital examination is normal. What care seems acceptable to you in the first line? (one or more correct answers) ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Carrying out a microbiological sample","justification":""},{"idx":1,"correct":false,"proposition":"Amoxicillin treatment","justification":""},{"idx":2,"correct":false,"proposition":"Treatment with amoxicillin-clavulanic acid","justification":""},{"idx":3,"correct":false,"proposition":"Treatment with levofloxacin","justification":""},{"idx":4,"correct":false,"proposition":"Non-steroidal anti-inflammatory","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-69","context":null,"enonce":"A 63-year-old patient is referred to you in a context of asthenia. She has already seen a doctor who prescribed serum protein 1 electrophoresis, the result of which is as follows. What diagnosis(s) do you evoke in front of these elements?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Giant cell arteritis (Horton's disease)","justification":""},{"idx":1,"correct":true,"proposition":"Chronic liver disease","justification":""},{"idx":2,"correct":true,"proposition":"Sjogren's syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Myeloma at lgG","justification":""},{"idx":4,"correct":false,"proposition":"Light chain myeloma","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-70","context":null,"enonce":"A 32-year-old patient consults for a cough. His chest x-ray is as follows. What abnormality(s) do you notice on the chest X-ray?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Hilar lymphadenopathy","justification":""},{"idx":1,"correct":true,"proposition":"Signs of pulmonary arterial hypertension","justification":""},{"idx":2,"correct":true,"proposition":"An interstitial syndrome","justification":""},{"idx":3,"correct":false,"proposition":"A pneumothorax","justification":""},{"idx":4,"correct":false,"proposition":"An airy bronchogramma","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-71","context":null,"enonce":"A patient comes to the emergency room because he is worried about the appearance of these tongue lesions that he has noted for 48 hours. He has no history, does not complain about anything else. He is apyretic, his blood pressure is 120\/70 mmHg. Which exam(s)? Ask yourself ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Blood","justification":""},{"idx":1,"correct":false,"proposition":"Determination of vitamin B12 (cobalamin)","justification":""},{"idx":2,"correct":false,"proposition":"Microbiological","justification":""},{"idx":3,"correct":true,"proposition":"Blood count","justification":""},{"idx":4,"correct":false,"proposition":"Lingual swab for herpes virus","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-72","context":null,"enonce":"Hypersexuality is frequently observed during certain disorders. Which one(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Manic syndrome","justification":""},{"idx":1,"correct":true,"proposition":"Frontal syndrome","justification":""},{"idx":2,"correct":true,"proposition":"Syndrome de Klein-Levin","justification":""},{"idx":3,"correct":false,"proposition":"Schizophrenic syndrome","justification":""},{"idx":4,"correct":false,"proposition":"Parkinson's disease treated with dopamine agonists","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-73","context":null,"enonce":"Regarding denial of pregnancy, what is (are) the exact proposal(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"It is defined by the lack of awareness of pregnancy beyond 22 weeks of amenorrhea","justification":""},{"idx":1,"correct":false,"proposition":"It most often appears in women with a history of psychiatric disorders","justification":""},{"idx":2,"correct":false,"proposition":"Clinically, the usually observable manifestations of pregnancy are not apparent or absent","justification":""},{"idx":3,"correct":true,"proposition":"A differential diagnosis is pregnancy deliberately concealed from the entourage","justification":""},{"idx":4,"correct":false,"proposition":"Progression to puerperal psychosis is common","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-74","context":null,"enonce":"What is(are) the typical characteristic(s) of hepatocellular carcinoma in sectional imaging?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Contrast taking at arterial time","justification":""},{"idx":1,"correct":true,"proposition":"Washing at portal time","justification":""},{"idx":2,"correct":false,"proposition":"Centripetal filling","justification":""},{"idx":3,"correct":false,"proposition":"Spontaneously hyperdense appearance on computed tomography","justification":""},{"idx":4,"correct":false,"proposition":"Lump contrast capture","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-75","context":null,"enonce":"A 45-year-old man arrives at the emergency room with severe lower back pain. He is very stiff and has a fever. Which imaging test(s) do you think are useful to support your suspected diagnosis?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"An X-ray of the lumbar spine from the front and profile","justification":""},{"idx":1,"correct":false,"proposition":"X-rays of 3\/4 of the lumbar spine","justification":""},{"idx":2,"correct":false,"proposition":"A CT scan","justification":""},{"idx":3,"correct":true,"proposition":"An MRI","justification":""},{"idx":4,"correct":false,"proposition":"A PET scanner","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-76","context":null,"enonce":"Which of the following proposals for fluorescein eye drops is accurate? Fluorescein is a fluorescent eye drop, which essentially allows us to explore the","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Can be used to check the integrity of the corneal endothelium","justification":""},{"idx":1,"correct":true,"proposition":"Can be used to highlight a transfixing corneal wound","justification":""},{"idx":2,"correct":false,"proposition":"Can be used to highlight herpetic keratitis","justification":""},{"idx":3,"correct":false,"proposition":"Can be used as an anesthetic before removal of a corneal foreign body","justification":""},{"idx":4,"correct":false,"proposition":"Can be used to highlight dry eye","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-77","context":null,"enonce":"Regarding the following iconography, which is (are) the exact proposal(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":" Arrow 1 denotes the ascending horacic aorta e","justification":""},{"idx":1,"correct":true,"proposition":"Arrow 2 designates the superior vena cava","justification":""},{"idx":2,"correct":false,"proposition":"Arrow 3 designates the left inferior pulmonary vein","justification":""},{"idx":3,"correct":false,"proposition":"There is a dissection of the ascending thoracic aorta","justification":""},{"idx":4,"correct":true,"proposition":"There is a proximal pulmonary embolism","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-78","context":null,"enonce":"Regarding the use of adrenaline during cardiac arrest, which is the exact proposal(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"In case of asystole, the first dose is 1 mg intravenously","justification":""},{"idx":1,"correct":false,"proposition":"If no venous line is available, injection through the intubation tube is possible","justification":""},{"idx":2,"correct":false,"proposition":"Control of heart rate effectiveness 5 min after first injection","justification":""},{"idx":3,"correct":true,"proposition":"In case of asystole, the injection of adrenaline most often leads to ventricular fibrillation","justification":""},{"idx":4,"correct":false,"proposition":"In case of ventricular fibrillation, adrenaline administration should be started after the fifth external electric shock","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-79","context":null,"enonce":"A patient benefits from aortic valve replacement with a new generation double-finned mechanical prosthesis. Its rhythm is sinus. Which of the following is (are) accurate in this patient?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"It must be treated with vitamin K antagonist for life","justification":""},{"idx":1,"correct":true,"proposition":"The effective target INR of vitamin K therapy is between 2 and 3","justification":""},{"idx":2,"correct":false,"proposition":"In case of labile INRs, it is possible to replace the antivitamin K with a direct oral anticoagulant","justification":""},{"idx":3,"correct":true,"proposition":"Antibiotic prophylaxis is essential before a dental avulsion","justification":""},{"idx":4,"correct":false,"proposition":"Vitamin K treatment should be suspended before dental scaling","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-80","context":null,"enonce":"A patient consults you for a recent dyspnea of exertion. You find a heart murmur. What is (are) the argument(s) in favor of mitral insufficiency?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":" The tone of the breath is often in steam jet","justification":""},{"idx":1,"correct":false,"proposition":" The breath is diastolic","justification":""},{"idx":2,"correct":true,"proposition":"The irradiation of the breath is done towards the armpit","justification":""},{"idx":3,"correct":false,"proposition":"The breath is accompanied by the abolition of the 82","justification":""},{"idx":4,"correct":false,"proposition":"The breath is accompanied by a fixed doubling of the 82 in children","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-81","context":null,"enonce":"Which of the following proposals concerning pharmacovigilance is true?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"It is based on spontaneous patient notification","justification":""},{"idx":1,"correct":true,"proposition":"It is based on spontaneous notification from health professionals","justification":""},{"idx":2,"correct":false,"proposition":"Spontaneous notifications cannot lead to the withdrawal of a medicinal product from the market","justification":""},{"idx":3,"correct":true,"proposition":"Accountability uses chronological and semiological criteria","justification":""},{"idx":4,"correct":true,"proposition":"Accountability estimates the causal link between a drug and an adverse reaction","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-82","context":null,"enonce":"Indicate the true answer(s) regarding temporary use authorizations for a medicinal product ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Can be nominative or cohort","justification":""},{"idx":1,"correct":true,"proposition":"Are given for serious situations","justification":""},{"idx":2,"correct":false,"proposition":"Do not require clinical studies","justification":""},{"idx":3,"correct":false,"proposition":"Allow for early availability after marketing authorisation","justification":""},{"idx":4,"correct":false,"proposition":"Avoid the application for marketing authorisation","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-83","context":null,"enonce":"Indicate the true answer(s) for pharmacological therapeutic monitoring based on pharmacokinetic parameters. Pharmacological therapeutic monitoring can be useful:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"To prevent auditory toxicity of aminoglycosides ","justification":""},{"idx":1,"correct":false,"proposition":"In order to prevent ineffectiveness of Tramadol","justification":""},{"idx":2,"correct":false,"proposition":"In order to understand the therapeutic success of morphine [>","justification":""},{"idx":3,"correct":true,"proposition":"To verify lithium adherence","justification":""},{"idx":4,"correct":true,"proposition":"To prevent ineffectiveness of tacrolimus","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-84","context":null,"enonce":"Which of the following drug classes is(s) nephrotoxic at usual doses ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":" Aminoglycosides","justification":""},{"idx":1,"correct":false,"proposition":"Statins","justification":""},{"idx":2,"correct":false,"proposition":"Nonsteroidal anti-inflammatory drugs","justification":""},{"idx":3,"correct":false,"proposition":"Corticosteroids","justification":""},{"idx":4,"correct":false,"proposition":"Antiparkinsonians","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-85","context":null,"enonce":"• Direct tubular toxicity.","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Synovitis"},{"idx":1,"correct":true,"proposition":"Erosions"},{"idx":2,"correct":true,"proposition":"Joint effusion"},{"idx":3,"correct":true,"proposition":"A pinching of the joint spacers","justification":""},{"idx":4,"correct":false,"proposition":"Inflammation of the epiphyses","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-86","context":null,"enonce":"You receive in consultation a 28-year-old patient who performed a CT scan of the junction a posteriori thoraco-lumbar (between TS and L2) 2 months ago. She discovered that she was pregnant at the time of the scan. She asks for your opinion on the rest of her pregnancy ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"You reassure her, the FCETUS running little risk since outside the irradiation field","justification":""},{"idx":1,"correct":false,"proposition":"You reassure her because in view of the type of examination carried out, the dose received by the fetus is necessarily less than 10 mGy, threshold of appearance of radiation-induced risks in the unborn child","justification":""},{"idx":2,"correct":true,"proposition":"You reassure her because in view of the type of examination carried out, the dose received by the fetus is necessarily less than 100 mGy, threshold of appearance of radiation-induced risks in the unborn child","justification":""},{"idx":3,"correct":false,"proposition":"You request a dosimetric expertise and wait for the result before pronouncing an opinion","justification":""},{"idx":4,"correct":false,"proposition":"You explain the risks associated with the examination and discuss with her a possible medical termination of pregnancy","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-87","context":null,"enonce":"The maximum passive joint amplitudes of this patient's right knee are represented by the photos below. Which of the following is (are) accurate? ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"The patient has an extension of 30°","justification":""},{"idx":1,"correct":false,"proposition":"The patient has a recurvatum of 30 degrees","justification":""},{"idx":2,"correct":true,"proposition":"The patient has a 30° injury","justification":""},{"idx":3,"correct":true,"proposition":"The patient has a joint stroke of 70 degrees","justification":""},{"idx":4,"correct":false,"proposition":"The patient has a flexion of 100°","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-88","context":null,"enonce":"The maximum passive joint amplitudes of this patient's right knee are represented by the photos below. Which of the following is correct? Maximum flexion Maximum extension ° Indicate true response(s) regarding adverse effects of opioid analgesics: ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Visual disturbances","justification":""},{"idx":1,"correct":true,"proposition":"Nausea","justification":""},{"idx":2,"correct":false,"proposition":"Diarrhoea","justification":""},{"idx":3,"correct":true,"proposition":"Itch","justification":""},{"idx":4,"correct":true,"proposition":"Acute urine retention","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-89","context":null,"enonce":"In front of a clinical picture of agitation, which is (are} the exact proposal(s) on the use of antipsychotics for sedative purposes?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Are useful for all degrees of stirring severity","justification":""},{"idx":1,"correct":false,"proposition":"Decrease alertness","justification":""},{"idx":2,"correct":false,"proposition":"Are to be associated with benzodiazepines","justification":""},{"idx":3,"correct":true,"proposition":"Should not be prescribed for angle-closure glaucoma","justification":""},{"idx":4,"correct":true,"proposition":"Cannot be used in case of long QT","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-90","context":null,"enonce":"What medication(s) can cause agitation in the elderly?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Corticosteroids","justification":""},{"idx":1,"correct":true,"proposition":"Antidepressants","justification":""},{"idx":2,"correct":false,"proposition":"Vitamin D","justification":""},{"idx":3,"correct":true,"proposition":"Benzodiazepines","justification":""},{"idx":4,"correct":true,"proposition":"Anticholinergics","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-91","context":null,"enonce":"A 66-year-old man, with no particular history, is hospitalized after suddenly presenting a transient loss of vision in the right eye, spontaneously regressive after 3 minutes. The interrogation finds asthenia and temporal headaches for 3 weeks. Your clinical examination is normal. A biological assessment was performed: blood ionogram, blood glucose, renal function, normal blood count, CRP 67mg\/L. What do you urgently ask for before instituting a specific treatment?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Brain scan","justification":""},{"idx":1,"correct":false,"proposition":"Fluorescein retinal angiography","justification":""},{"idx":2,"correct":false,"proposition":"Microbiological","justification":""},{"idx":3,"correct":false,"proposition":"Determination of anti-cytoplasmic antibodies of neutrophils (ANCA)","justification":""},{"idx":4,"correct":true,"proposition":"None of these exams","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-92","context":null,"enonce":"Which element(s) should evoke the secondary character of a bilateral Raynaud's phenomenon ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Occurring after 40 years"},{"idx":1,"correct":false,"proposition":"Revelation by an attack of the indexes and majors","justification":""},{"idx":2,"correct":true,"proposition":"Presence of telangiectasias"},{"idx":3,"correct":true,"proposition":"Thumb damage"},{"idx":4,"correct":true,"proposition":"Presence of retractile scars on the pulp of the index fingers","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-93","context":null,"enonce":"You present the daughter of a palliative care patient at an advanced stage with family solidarity leave. Which statement(s) is the correct statement(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Is for a duration of 6 months","justification":""},{"idx":1,"correct":false,"proposition":"Is intended for any employee close to the patient","justification":""},{"idx":2,"correct":true,"proposition":"Is unpaid","justification":""},{"idx":3,"correct":true,"proposition":"Guarantees to return to work under the same conditions","justification":""},{"idx":4,"correct":true,"proposition":"Allows the daughter of the p atiente to say p dare to p lus of tem p s with her mother","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-94","context":null,"enonce":"According to the law concerning the person of trust, which is (are) the correct statement(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"It has decision-making power","justification":""},{"idx":1,"correct":true,"proposition":"It must be obligatorily designated in writing","justification":""},{"idx":2,"correct":true,"proposition":"It is consulted when the patient is no longer able to express his will","justification":""},{"idx":3,"correct":false,"proposition":"Its designation is obligatory","justification":""},{"idx":4,"correct":false,"proposition":"It can be the private nurse or the patient's attending physician","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-95","context":null,"enonce":"Concerning the characteristic(s) of breakthrough pain: ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"They are characterized by quick installation","justification":""},{"idx":1,"correct":true,"proposition":"They are characterized by a short duration","justification":""},{"idx":2,"correct":true,"proposition":"They have variable intensity","justification":""},{"idx":3,"correct":true,"proposition":"They may have a neuropathic origin","justification":""},{"idx":4,"correct":false,"proposition":"They impose an increase in the background treatment of pain","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-96","context":null,"enonce":"Which of the following proposals is(s) the risk factor(s) of complicated bereavement?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"A recent bereavement","justification":""},{"idx":1,"correct":true,"proposition":"Early loss of a first-degree relative","justification":""},{"idx":2,"correct":false,"proposition":"The advanced age of the bereaved","justification":""},{"idx":3,"correct":false,"proposition":"Social precariousness","justification":""},{"idx":4,"correct":true,"proposition":"The suddenness of death","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-97","context":null,"enonce":"During the assessment of the extension of clinically localized cancers of the larynx and hypopharynx, which is (are) the recommended examination(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Esophageal endoscopy","justification":""},{"idx":1,"correct":true,"proposition":"Head and neck CT","justification":""},{"idx":2,"correct":false,"proposition":"Head and neck MRI","justification":""},{"idx":3,"correct":false,"proposition":"FDG PET","justification":""},{"idx":4,"correct":false,"proposition":"Bone scintigraphy","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-98","context":null,"enonce":"In front of this table of palmar keratoderma evolving for 3 months, what diagnosis (s) is (are) to consider?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Hyperkeratotic scabies","justification":""},{"idx":1,"correct":false,"proposition":"Primary syphilis","justification":""},{"idx":2,"correct":true,"proposition":"Contact eczema","justification":""},{"idx":3,"correct":true,"proposition":"Syndrome de Sézary","justification":""},{"idx":4,"correct":true,"proposition":"Psoriasis","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-99","context":null,"enonce":"Which of the following dual antihypertensive therapies is (are) most often discouraged?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Hydrochlorothiazide and furosemide","justification":""},{"idx":1,"correct":true,"proposition":"Acebutolol and verapamil","justification":""},{"idx":2,"correct":true,"proposition":"Amlodipine and diltiazem","justification":""},{"idx":3,"correct":true,"proposition":"Candesartan and spironolactone","justification":""},{"idx":4,"correct":true,"proposition":"Perindopril and valsartan","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-100","context":null,"enonce":"Which diagnosis(s) is (are) classified as somatoform disorders?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Somatization","justification":""},{"idx":1,"correct":false,"proposition":"Post-traumatic stress disorder","justification":""},{"idx":2,"correct":false,"proposition":"Histerionic personality","justification":""},{"idx":3,"correct":true,"proposition":"Conversion disorder","justification":""},{"idx":4,"correct":true,"proposition":"Pain disorder No real difficulty here, we find the complete list of somatoform disorders in the College of Psychiatry Symptoms affecting several bodily domains before the age of 30 Neurological symptoms Pain without organic substrate maintained by stress Mistaken belief of having a non-psychiatric illness","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-101","context":null,"enonce":"For polycystic ovary syndrome, indicate the correct answer(s) ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"This is the most common cause of dysovulation","justification":""},{"idx":1,"correct":true,"proposition":"It is often associated with resistance to the action of insulin","justification":""},{"idx":2,"correct":true,"proposition":"Acne is common","justification":""},{"idx":3,"correct":true,"proposition":"The presence of more than 12 follicles is a diagnostic criterion","justification":""},{"idx":4,"correct":false,"proposition":"It is associated with thyroid cysts","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-102","context":null,"enonce":"A 3-month-old infant is brought by his parents to the pediatric emergency room for laryngeal dyspnea that has gradually worsened since the age of one month. Since delivery, the infant has not had a break in the staturo-weight curve, it is apyretic admission. In front of this laryngeal dyspnea, what etiology do you mention in the first place?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Laryngomalacia","justification":""},{"idx":1,"correct":false,"proposition":"A laryngeal diastema","justification":""},{"idx":2,"correct":false,"proposition":"Laryngitis","justification":""},{"idx":3,"correct":true,"proposition":"Subglottic angioma","justification":""},{"idx":4,"correct":false,"proposition":"A laryngeal foreign body","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-103","context":null,"enonce":"One patient, aged 45, has chronic cholesteatomatous otitis. He asks you what risk(s) is (are) leaving this lesion in place? You answer that this exposes him to a risk of: ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Peripheral facial paralysis","justification":""},{"idx":1,"correct":true,"proposition":"Conductive hearing loss"},{"idx":2,"correct":true,"proposition":"Perilymphatic fistula"},{"idx":3,"correct":true,"proposition":"Labyrinthitis"},{"idx":4,"correct":true,"proposition":"Meningitis"}],"type":"qi"}
+{"_id":"annales-2017-qi-104","context":null,"enonce":"Concerning the rapid diagnostic test (RDT) for screening in the context of angina. What is the real proposal(s)? D. Its positivity is in group A hemolytic bihemolytic streptococcus","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"It is made at any age","justification":""},{"idx":1,"correct":false,"proposition":"It has a specificity of 70%","justification":""},{"idx":2,"correct":true,"proposition":"The result is obtained after a duration of about 5 min","justification":""},{"idx":3,"correct":true,"proposition":"Its positivity is in favor of group A hemolytic B streptococcus","justification":""},{"idx":4,"correct":false,"proposition":"A shipment to the bacteriology laboratory is necessary to have the result","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-105","context":null,"enonce":"About risk factors for ENT cancer ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"EBV is a risk factor for cavum cancer","justification":""},{"idx":1,"correct":true,"proposition":"HPV is a risk factor for tonsillar cancer","justification":""},{"idx":2,"correct":false,"proposition":"Tobacco is a risk factor for ethmoid sinus cancer","justification":""},{"idx":3,"correct":false,"proposition":"Wood dust is a risk factor for maxillary sinus cancer","justification":""},{"idx":4,"correct":true,"proposition":"Alcohol and tobacco are risk factors for tonsillar cancer It is a multiple choice to which the table is reapplied<< Four complications of chronic otitis to control>> seen page 119 .","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-106","context":null,"enonce":"A patient consults for left sublobular induration. His GP ordered a head and neck MRI. He comes back to you with the MRI data. What can you tell him about the imagery below?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"It is a T1 sequence without gadolinium injection","justification":""},{"idx":1,"correct":false,"proposition":"The 1 corresponds to the right sphenoidal sinus","justification":""},{"idx":2,"correct":true,"proposition":"The 2 corresponds to the right parotid gland","justification":""},{"idx":3,"correct":true,"proposition":"There is a left parotid tumor","justification":""},{"idx":4,"correct":false,"proposition":"There is a tumor of the left submandibular gland","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-107","context":null,"enonce":"Regarding the 1+2+3 Bouchon rule in the elderly:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"It is not usable in very old individuals (> 90 years)","justification":""},{"idx":1,"correct":false,"proposition":"It allows the calculation of comorbidities","justification":""},{"idx":2,"correct":true,"proposition":"The<< 3 >> corresponds to an acute pathogen","justification":""},{"idx":3,"correct":false,"proposition":"It helps explain atypical clinical presentations in the elderly","justification":""},{"idx":4,"correct":true,"proposition":"It helps explain the accumulation of diseases during aging","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-108","context":null,"enonce":"Immobilization syndrome is a common complication in subjects over 75 years of age. Which of the following is true?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Associated with a risk of excess mortality","justification":""},{"idx":1,"correct":true,"proposition":"Increases the risk of dehydration","justification":""},{"idx":2,"correct":true,"proposition":"Occurs from the first hour of immobilization","justification":""},{"idx":3,"correct":false,"proposition":"Is explained by musculoskeletal aging","justification":""},{"idx":4,"correct":true,"proposition":"Increases the risk of venous insufficiency","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-109","context":null,"enonce":"You see an 85-year-old patient in the emergency room for a fall from her height with a head trauma while she usually takes anticoagulant treatment with vitamin K antagonist. The clinical examination is normal and the INR is 6.2. Which of the following proposals do you think corresponds to his management in the emergency room before any examination?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"No indication for a brain CT scan","justification":""},{"idx":1,"correct":true,"proposition":"Immediate brain computed tomography","justification":""},{"idx":2,"correct":false,"proposition":"Brain computed tomography scheduled within 48 hours","justification":""},{"idx":3,"correct":false,"proposition":"Administration of vitamin K and concentrates of prothrombin complexes","justification":""},{"idx":4,"correct":true,"proposition":"Administration of vitamin K alone","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-110","context":null,"enonce":"Age-related macular degeneration: ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Causes decreased peripheral vision","justification":""},{"idx":1,"correct":false,"proposition":"Is linked to abnormalities of the retinal pigment epithelium","justification":""},{"idx":2,"correct":true,"proposition":"May result in distorted images","justification":""},{"idx":3,"correct":true,"proposition":"Is confirmed at the fundus","justification":""},{"idx":4,"correct":false,"proposition":"Is favored by chronic alcoholism","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-111","context":null,"enonce":"The Mini Nutritionna\/Assessment (or MNA) nutritional test:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Is a test with a total score out of 30 points","justification":""},{"idx":1,"correct":true,"proposition":"Is a test that defines malnutrition if the score is less than 23 5 points","justification":""},{"idx":2,"correct":true,"proposition":"Is a test that defines malnutrition if the score is less than 17 points","justification":""},{"idx":3,"correct":false,"proposition":"Is a test that requires the calculation of body mass index","justification":""},{"idx":4,"correct":true,"proposition":"Is a test that takes into account the presence of neuropsychological problems","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-112","context":null,"enonce":"About cervical swelling, what is (are) the exact item(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"A cyst of the thyroglossal tract is mobile to swallowing","justification":""},{"idx":1,"correct":false,"proposition":"Right supraclavicular lymphadenopathy may be indicative of kidney cancer","justification":""},{"idx":2,"correct":true,"proposition":"Superficial renitent swelling localized to the anterior edge of the sternocleidomastoid muscle is suggestive of an amygdaloid cyst","justification":""},{"idx":3,"correct":false,"proposition":"Brachial plexus schwannoma is a differential diagnosis of submandibular lymphadenopathy","justification":""},{"idx":4,"correct":true,"proposition":"Accessory nerve schwannoma is a differential diagnosis of spinal lymphadenopathy","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-114","context":null,"enonce":"You had seen Mrs. V., 22 years old, for iron deficiency anaemia in connection with heavy periods. She was put on estrogen-progestin by her gynecologist and you prescribed martial replacement therapy. After 4 months of treatment you see it again with the following assessment: red blood cells %; 5.57 T\/L; hemoglobin 125 g\/L - hematocrit 39 VGM 70 fL; HCMC 32 g\/dL; leukocytes 5 g\/L - platelets 270 G\/L. Ferritin is at 40 ng\/mL (normal > 30). The CRP is 3 mg\/L. What is(are) your hypothesis(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Mrs. V. did not take her martial treatment","justification":""},{"idx":1,"correct":false,"proposition":"Mrs. V. has probable sickle cell disease","justification":""},{"idx":2,"correct":true,"proposition":"Mrs. V. has probable heterozygous thalassemia","justification":""},{"idx":3,"correct":false,"proposition":"Mrs. V. has not yet replenished her iron reserves","justification":""},{"idx":4,"correct":false,"proposition":"Mrs. V. has an added inflammatory pathology","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-115","context":null,"enonce":"High-grade glioblastoma is discovered in an 80-year-old person, otherwise free of pathology and whose general condition is good. It is an incurable cancer disease, with a median survival of about 15 months, with a combination of high-dose corticosteroid therapy for antiedematous, radiotherapy and anti-angiogenic chemotherapy. The aim of treatments is to slow down the tumor evolution. ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"This is an acute care approach, delaying entry into palliative care","justification":""},{"idx":1,"correct":false,"proposition":"This is an unreasonable obstinacy, given the incurability of the disease and the poor prognosis.","justification":""},{"idx":2,"correct":true,"proposition":"This is an acute care approach, to be conducted within a palliative care approach","justification":""},{"idx":3,"correct":true,"proposition":"This is an acute care approach, the objectives of which must be discussed and validated with the patient.","justification":""},{"idx":4,"correct":false,"proposition":"This is comfort care, the objective of which is to avoid unnecessary suffering","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-116","context":null,"enonce":"A 50-year-old patient consults you for a certificate of non-contraindication the practice of sport. You hear a diastolic heart murmur, maximal at the third left intercostal space, best perceived in the forward leaning position. What is(are) the possible cause(s) of this breath ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Aortic bicuspid"},{"idx":1,"correct":false,"proposition":"Mitral valve dystrophy","justification":""},{"idx":2,"correct":true,"proposition":"Ankylosing spondylitis"},{"idx":3,"correct":false,"proposition":"Rope break"},{"idx":4,"correct":true,"proposition":"Aortic annuloectasian disease","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-117","context":null,"enonce":"Regarding imaging of pancreatic tumors, what is(are) the exact answer(s)?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"In front of jaundice, the first intention examination is the MRI to visualize the bile ducts","justification":""},{"idx":1,"correct":true,"proposition":"In case of suspicion of pancreatic cancer, it is the CT scan with injection of contrast medium that is the first-line examination","justification":""},{"idx":2,"correct":true,"proposition":"If pancreatic cancer is suspected, the CT scan should look for direct (tumor) and indirect (dilation of the bile ducts and\/or Wirsung's duct) signs.","justification":""},{"idx":3,"correct":false,"proposition":"The tumor of the pancreas is sometimes difficult to highlight in CT and it will then be necessary to complete with a retrograde cholangiopancreatography endoscopic (ERCP)","justification":""},{"idx":4,"correct":false,"proposition":"Most pancreatic cancers are diagnosed incidentally on imaging","justification":""},{"idx":5,"correct":false,"proposition":"abdominal performed for another indication","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-118","context":null,"enonce":"A 6-month-old child has a break in the curve of his head circumference with a macrocrania. You ask him for a transfontanelar ultrasound. Which item(s) is the correct item(s)? Has.","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"This examination makes it possible to analyze the infratentorial compartment better than the supratentorial compartment","justification":""},{"idx":1,"correct":false,"proposition":"This examination is impossible, the fontanelles are closed at his age","justification":""},{"idx":2,"correct":true,"proposition":"This test can detect hydrocephalus","justification":""},{"idx":3,"correct":true,"proposition":"This test can detect an intracranial tumor","justification":""},{"idx":4,"correct":true,"proposition":"This examination has operator-dependent sensitivity and specificity","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-119","context":null,"enonce":"What is the diagnostic criterion(s) to make the diagnosis of celiac disease without performing an intestinal biopsy? ","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Anti-transglutaminase IgA greater than 10 times normal","justification":""},{"idx":1,"correct":false,"proposition":"anti-transglutaminase lgG greater than 10 times normal","justification":""},{"idx":2,"correct":false,"proposition":"Presence of anti-endom IgA at a significant level","justification":""},{"idx":3,"correct":false,"proposition":"Presence of anti-gliadin IgA at a significant level","justification":""},{"idx":4,"correct":false,"proposition":"Presence of a HLA DO2 or DO8 group This is an interesting MCQ, the appropriate answer is to be found in pediatrics. We distinguish","justification":""},{"idx":5,"correct":false,"proposition":"2 steps to the diagnosis of celiac disease","justification":""}],"type":"qi"}
+{"_id":"annales-2017-qi-120","context":null,"enonce":"What symptoms make you suspect rhegmatogenous retinal detachment?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Phosphenes","justification":""},{"idx":1,"correct":false,"proposition":"Photophobia","justification":""},{"idx":2,"correct":true,"proposition":"Amputation of the visual field in the sector","justification":""},{"idx":3,"correct":true,"proposition":"Myodesopsias","justification":""},{"idx":4,"correct":false,"proposition":"Isolated central scotomome","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-1","context":null,"enonce":"In front of a febrile roseoliform exanthema of the child, the main etiologies are (one or more exact answers):","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A sudden exanthema","justification":""},{"idx":1,"correct":false,"proposition":"An epidemic megalerythema","justification":"Morbiliform"},{"idx":2,"correct":true,"proposition":"Rubella","justification":""},{"idx":3,"correct":false,"proposition":"Infectious mononucleosis","justification":"Morbiliform or scarlatiniform"},{"idx":4,"correct":false,"proposition":"Un syndrome de Kawasaki","justification":"Morbiliform or scarlatiniform"}],"type":"qi"}
+{"_id":"annales-2018-qi-2","context":null,"enonce":"About heart failure, which proposal(s) is true?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Cardiac auscultation may show a burst of B2 at the aortic focus in pulmonary arterial hypertension","justification":"At the pulmonary focus"},{"idx":1,"correct":true,"proposition":"Cardiac auscultation may reveal a murmur of mitral insufficiency related to the dilation of the mitral ring","justification":""},{"idx":2,"correct":false,"proposition":"Jugular turgor is a peripheral sign of left heart failure","justification":"right"},{"idx":3,"correct":false,"proposition":"Peripheral edema is soft, blue and painful","justification":"soft, white, painless, declivated (so to look for in the lower back in a lying patient) and taking the bucket (unlike inflammatory edema, for example during bacterial dermohypoderma)"},{"idx":4,"correct":true,"proposition":"Crackling or subcrackling rails are often bilateral","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-3","context":null,"enonce":"A 70-year-old patient presents to the emergency room for chest pain and dyspnea. Give the exact proposal(s): ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"1 corresponds to the ascending aorta","justification":"Superior vena cava"},{"idx":1,"correct":true,"proposition":"2 corresponds to the esophagus","justification":""},{"idx":2,"correct":true,"proposition":"3 corresponds to the descending aorta","justification":""},{"idx":3,"correct":false,"proposition":"4 corresponds to a pulmonary embolism in the left pulmonary artery","justification":"right"},{"idx":4,"correct":false,"proposition":"4 corresponds to a dissection of the pulmonary artery","justification":"This is the thrombus"}],"type":"qi"}
+{"_id":"annales-2018-qi-4","context":null,"enonce":"What is the true answer(s) regarding the management of diffuse bronchiectasis in adults (outside the context of cystic fibrosis) responsible for repeated infectious episodes:","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Daily bronchial drainage"},{"idx":1,"correct":false,"proposition":"Systemic corticosteroid therapy"},{"idx":2,"correct":false,"proposition":"Pulmonary lobectomy","justification":"The breach is diffuse"},{"idx":3,"correct":false,"proposition":"Systematic quarterly antibiotic therapy","justification":""},{"idx":4,"correct":false,"proposition":"Anti-inflammatory treatment with fluoroquinolone","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-5","context":null,"enonce":"You see a 70-year-old man in the winter. He has stage 1 dyspnea of mMRC associated with chronic cough without sputum. It presents a smoking of the order of 25 pack-years still pursued. He tells the notion of asthma in early childhood and has long suffered from seasonal grass pollen rhinitis. He has no other background. His pulmonary auscultation, the day you see him, is normal. It performs pulmonary function tests (EFR). Give the correct answer(s):","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Given these RFEs, the patient must be hospitalized","justification":""},{"idx":1,"correct":false,"proposition":"A methacholine bronchial hyperreactivity test should be performed","justification":"This is done when the suspiscion of asthma is very high despite a significantly non-reversible TVO."},{"idx":2,"correct":true,"proposition":"Clinical history and EFRs are consistent with asthma","justification":"Significant but not complete reversible TVO"},{"idx":3,"correct":true,"proposition":"Clinical history and EFRs are consistent with COPD","justification":"Significant but not complete reversible TVO"},{"idx":4,"correct":false,"proposition":"A treatment can only be put in place once smoking has been definitively stopped","justification":"We must indeed stop smoking but we start treating as soon as possible"}],"type":"qi"}
+{"_id":"annales-2018-qi-6","context":null,"enonce":"A 58-year-old patient comes to your hospital's emergency room for expectoration of two glasses of red blood during a coughing effort. She had never coughed up blood. She is on aspirin aimed at anti-aggregating for coronary artery disease. His clinical examination is normal, his blood pressure is 132\/79 mmHg, the heart rate is 80\/min. Chest X-ray does not show any abnormalities. Give the correct answer(s): ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"You hospitalize the patient","justification":""},{"idx":1,"correct":false,"proposition":"You set up a vascular filling","justification":"It is neither tachycardium nor hypotensive. So no filling at this stage."},{"idx":2,"correct":false,"proposition":"You prescribe an intravenous vasoconstrictor agent such as telipressin","justification":"His coronary artery disease contraindicates this treatment"},{"idx":3,"correct":true,"proposition":"You prescribe an injected chest CT scan with arterial time acquisition after checking for contraindications","justification":"The master examination in case of hemoptysis"},{"idx":4,"correct":false,"proposition":"You reassure the patient and explain that it is normal to bleed on antiaggregants","justification":"Not at all normal"}],"type":"qi"}
+{"_id":"annales-2018-qi-7","context":null,"enonce":"A 70-year-old woman consults for non-pruritic skin lesions that appeared several days ago, localized on the upper back (photo 1), in the scalp and in the axillary folds. She has been complaining for several months of painful oral lesions that interfere with feeding (photo 2). Nikolsky's sign is positive. His history includes high blood pressure treated with lercanidipine for 2 years and a drop treated with allopurinol for 1 year. What diagnosis do you mention? ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Pemphigus vulgaris","justification":"The picture is typical. It is a differential diagnosis of autoimmune bullous dermatoses."},{"idx":1,"correct":false,"proposition":"Bullous pemphigoid","justification":""},{"idx":2,"correct":false,"proposition":"Syndrome de Stevens-Johnson","justification":""},{"idx":3,"correct":false,"proposition":"Erythema multiforme","justification":""},{"idx":4,"correct":false,"proposition":"Fixed pigmented erythema","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-8","context":null,"enonce":"You see a 65-year-old man in consultation with isolated dyspnea of stage II of the mMRC classification. He is diabetic treated with metformin. He is also treated for hypertension with an angiotensin II antagonist. He has a smoking evaluated at 20 packs-year stopped 10 years ago. No other environmental and occupational exposures are known. The clinical examination finds crackling at both bases on auscultation. The rest of the exam is normal. The blood ionogram is normal. Complete blood counts are normal. The autoimmune balance is normal. You have a chest CT scan and pulmonary function tests (joints). Among the following proposals, which diagnosis do you think is the most likely?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Emphysema"},{"idx":1,"correct":true,"proposition":"Idiopathic pulmonary fibrosis","justification":"Cross-linking at the bases is very suggestive of this diagnosis."},{"idx":2,"correct":false,"proposition":"Heart failure"},{"idx":3,"correct":false,"proposition":"Cystic fibrosis"},{"idx":4,"correct":false,"proposition":"Drug pneumonitis"}],"type":"qi"}
+{"_id":"annales-2018-qi-9","context":null,"enonce":"A 35-year-old woman has been presenting for a week with fever at 38.5 ° C, arthralgia of the knees and ankles and a rash on the legs (photo). Which of the following proposals, which diagnosis(s) do you retain?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Erythema multiforme","justification":""},{"idx":1,"correct":false,"proposition":"Ersipelas","justification":""},{"idx":2,"correct":true,"proposition":"Erythema nodosum","justification":"This is the typical photo of erythema nodosum"},{"idx":3,"correct":false,"proposition":"Fixed pigmented erythema","justification":""},{"idx":4,"correct":false,"proposition":"Rheumatoid purpura","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-10","context":null,"enonce":"A 17-year-old girl consults for painful lesions of the labial commissures appeared 2 weeks before, which do not heal under topical corticosteroids. The rest of the exam is normal. Which of the following is the most likely diagnosis?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Candidiasis","justification":""},{"idx":1,"correct":false,"proposition":"Herpes","justification":""},{"idx":2,"correct":false,"proposition":"Syphilis","justification":""},{"idx":3,"correct":false,"proposition":"Dermatophytia","justification":""},{"idx":4,"correct":true,"proposition":"Impetigo","justification":"Lesions of crustose, meliceric and perioral appearance (or sitting on the face)."}],"type":"qi"}
+{"_id":"annales-2018-qi-11","context":null,"enonce":"A 55-year-old patient with hyperlymphocytosis at 25 G \/ L without cytopenia is referred to you with a diagnosis of chronic lymphocytic leukemia on lymphocyte immunophenotyping. On clinical examination, the patient is in excellent general condition and there is polyadenopathy 1.5-2 cm in diameter in all lymph node areas. What review is needed at this stage? (only one answer)","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"None","justification":"The diagnosis is made."},{"idx":1,"correct":false,"proposition":"A PET scanner","justification":""},{"idx":2,"correct":false,"proposition":"Echocardiography","justification":""},{"idx":3,"correct":false,"proposition":"A myelogram","justification":""},{"idx":4,"correct":false,"proposition":"A bone scan","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-12","context":null,"enonce":"A 25-year-old man consults you because of abdominal pain. The examination is normal apart from a palpable spleen at the end of inspiration. The blood count shows: leukocytes 14 G\/L, PNN 8 G\/L, myelocytes 1 G\/L, metamyelocytes 1 G\/L, monocytes 1 G\/L, lymphocytes 3 G\/L and platelets 510 G\/L. You suspect chronic myeloid leukemia. What biological tests do you prescribe to confirm your diagnostic hypothesis? (one or more possible answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Leukocyte immunophenotyping on blood","justification":""},{"idx":1,"correct":false,"proposition":"Search for Jolly's body with a smear","justification":""},{"idx":2,"correct":true,"proposition":"Search for the BCR-ABL transcript","justification":"We think of an CML"},{"idx":3,"correct":false,"proposition":"Gumprecht's search for shadows","justification":""},{"idx":4,"correct":false,"proposition":"Search for a JAK2 mutation","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-13","context":null,"enonce":"Which of the following statements about weakening osteopathy is?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Primary hyperparathyroidism preferentially affects the cortical bone","justification":""},{"idx":1,"correct":false,"proposition":"Treatment of hypothyroidism increases the risk of osteoporotic fracture","justification":""},{"idx":2,"correct":false,"proposition":"Cortisonic osteoporosis mainly affects the cortical bone","justification":"Trabecular bone"},{"idx":3,"correct":true,"proposition":"Estrogen deficiency is responsible for osteoclastic hyperactivity","justification":""},{"idx":4,"correct":false,"proposition":"Treatment with bisphosphonate increases osteoblast activity","justification":"Only teriparatide (FORSTEO) has this effect. It is indicated in case of two vertebral fractures."}],"type":"qi"}
+{"_id":"annales-2018-qi-14","context":null,"enonce":"A 50-year-old woman arrives at the emergency room for discomfort. She has no particular history but describes fatigue that quickly appeared. The clinical examination is normal apart from a conjunctival subictera. The blood count shows hemoglobin 90 g\/L, red blood cells 2.7 T\/L, hematocrit 27%, MCV 102 fL, MCHC 33 g\/dL, leukocytes 8 G\/L, neutrophils 5 G\/L, lymphocytes 2.3 G\/L, monocytes 0.7 G\/L. Which biological tests do you think are relevant to prescribe as a first-line treatment? (one or more possible answers)","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"C-reactive protein (CRP)"},{"idx":1,"correct":false,"proposition":"Serum iron"},{"idx":2,"correct":false,"proposition":"Serum protein electrophoresis","justification":""},{"idx":3,"correct":true,"proposition":"Reticulocytes","justification":"Hemolytic anemia is being tested."},{"idx":4,"correct":true,"proposition":"LDH"}],"type":"qi"}
+{"_id":"annales-2018-qi-16","context":null,"enonce":"Which of the following infectious diseases is(are) reportable in France?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Rubella"},{"idx":1,"correct":true,"proposition":"Plague"},{"idx":2,"correct":true,"proposition":"Tuberculosis"},{"idx":3,"correct":true,"proposition":"Legionellosis"},{"idx":4,"correct":false,"proposition":"Invasive pneumococcal disease"}],"type":"qi"}
+{"_id":"annales-2018-qi-18","context":null,"enonce":"A 62-year-old man with no medical history has a spontaneous deep hematoma of the psoas muscle. The CBC shows hemoglobin at 90 g\/L and platelets at 170 G\/L. Its hemostasis assessment is as follows: TCA ratio at 2, 1, TP at 78% and fibrinogen at 3.1g \/ L. Mixing the patient's plasma with normal plasma does not correct the TCA (Rosner index of 28 for a normal < 15). The determination of endogenous pathway factors reveals a factor VIII at 4%. What hypothesis(s) do you retain? (one or more possible answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The presence of a lupus-type anticoagulant","justification":"Factor VIII is decreased"},{"idx":1,"correct":false,"proposition":"Constitutional hemophilia A","justification":"The addition of plasma did not correct it"},{"idx":2,"correct":true,"proposition":"The presence of an anti-factor VIII antibody","justification":""},{"idx":3,"correct":false,"proposition":"Willebrand disease type 1","justification":"The rate <10% is too low for a type 1"},{"idx":4,"correct":false,"proposition":"Acquired hemophilia B","justification":"Refers to factor IX and not factor VIII"}],"type":"qi"}
+{"_id":"annales-2018-qi-19","context":null,"enonce":"A patient is brought unconscious by firefighters to the emergency room following a road accident. She has a polytrauma for which a brain and thoraco-abdomino-pelvic CT scan are urgently performed. She has a fractured spleen that requires surgery. When she arrives, her husband tells you that she is about 8 weeks pregnant with amenorrhea. The radiation dose received is 10 mGy. What risk(s) is (are) related to the accident and the care?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Developmental delay","justification":""},{"idx":1,"correct":false,"proposition":"Brain malformation","justification":""},{"idx":2,"correct":true,"proposition":"Abortion","justification":"Law of all or laughs)"},{"idx":3,"correct":false,"proposition":"Stunting","justification":""},{"idx":4,"correct":false,"proposition":"Retroplacental hematoma","justification":"In the third quarter"}],"type":"qi"}
+{"_id":"annales-2018-qi-20","context":null,"enonce":"A patient comes to your office for a preconception consultation. She is 32 years old, nulligeste. She has been followed for a year for well-balanced high blood pressure on perindopril, one tablet a day. She has estrogen-progestin contraception, which she plans to stop at the end of her platelet. She weighs 81 kg for a height of 1 m 68. She consumes 5 cigarettes a day but would like to quit. What do you foresee at the end of the consultation? (One or more correct answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Rubella serology","justification":""},{"idx":1,"correct":true,"proposition":"Smoking cessation aid by nicotine replacement therapy","justification":""},{"idx":2,"correct":false,"proposition":"Cervico-uterine smear if it is more than one year old","justification":"3 years (5 years for HPV test)"},{"idx":3,"correct":true,"proposition":"Prescription of folate at a dose of 5 mg\/day","justification":"Obesity makes us tick this dosage"},{"idx":4,"correct":true,"proposition":"Discontinuation of perindopril treatment and switching to another antihypertensive drug","justification":"ACE\/ARA2\/Diuretics are contraindicated"}],"type":"qi"}
+{"_id":"annales-2018-qi-21","context":null,"enonce":"A 28-year-old woman consults for palpation of swelling in the upper outer quadrant of the right breast. She is worried because her mother and maternal aunt had breast cancer at 55 and 60 respectively. On clinical examination, you palpate a round and regular swelling of 15 mm, not adherent to the deep and superficial planes. There is no inflammation or skin retraction in the regard. No suspicious lymphadenopathy is palpated in the axillary and supraclavicular lymph node areas. Which exam(s) should be requested as a first intention?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A breast ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"A chest x-ray","justification":""},{"idx":2,"correct":false,"proposition":"A dosage of CA 15-3","justification":""},{"idx":3,"correct":false,"proposition":"A breast MRI","justification":""},{"idx":4,"correct":false,"proposition":"A mammogram","justification":"The breasts are too dense before the age of 30, so an ultrasound is done."}],"type":"qi"}
+{"_id":"annales-2018-qi-22","context":null,"enonce":"A 38-year-old woman consults 3 months after her third delivery for a contraceptive request. She had a caesarean section after her first two deliveries were vaginal. She has just stopped breastfeeding her child because she has to resume her professional activity. In her history, she reports uterine perforation during the insertion of an intrauterine device 7 years ago, phlebitis under plaster 10 years ago and cervical laser treatment 4 years ago for cervical dysplasia related to human papillomavirus infection. She does not smoke but << vape >> from time to time. The last cervical smear, performed in early pregnancy, was normal. What contraceptive method(s) is (are) conceivable for this woman?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Levonorgestrel intrauterine device","justification":""},{"idx":1,"correct":true,"proposition":"Copper intrauterine device","justification":""},{"idx":2,"correct":false,"proposition":"Transdermal patch releasing norelgestromin and ethinyl estradiol","justification":"She has a history of DVT"},{"idx":3,"correct":true,"proposition":"Tubal sterilization by laparoscopy","justification":""},{"idx":4,"correct":true,"proposition":"Subcutaneous device releasing etonogestrel","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-23","context":null,"enonce":"Faced with a suspicion of metallic intraocular foreign body, which examination(s) do you propose urgently?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"An orbital scanner","justification":"The reference exam."},{"idx":1,"correct":false,"proposition":"An MRI","justification":""},{"idx":2,"correct":false,"proposition":"An X-ray of the orbit","justification":"We can't really see anything 🤷 ♂️"},{"idx":3,"correct":false,"proposition":"Fluorescein angiography","justification":""},{"idx":4,"correct":false,"proposition":"A measurement of intraocular pressure","justification":"This is contraindicated: by pressing, we increase the IOP, which is dangerous."}],"type":"qi"}
+{"_id":"annales-2018-qi-24","context":null,"enonce":"What is the exact proposal(s) concerning voluntary termination of pregnancy (IVG) in France?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A woman under guardianship can request an abortion","justification":""},{"idx":1,"correct":true,"proposition":"A woman can request complete anonymity for the performance of an abortion","justification":""},{"idx":2,"correct":false,"proposition":"IUD placement is contraindicated in the immediate aftermath of a surgical abortion","justification":""},{"idx":3,"correct":false,"proposition":"Prostaglandins cannot be used in cases of hereditary porphyria","justification":"Is it for anti-progesterone:)"},{"idx":4,"correct":false,"proposition":"A psychosocial interview must be systematically carried out before the abortion is carried out","justification":"Only in minors. It is always proposed"}],"type":"qi"}
+{"_id":"annales-2018-qi-25","context":null,"enonce":"A chalazion :","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Is an infection of a pilosebaceous follicle of the eyelids","justification":"Inflammation"},{"idx":1,"correct":true,"proposition":"Is a resorption granuloma of a meibomian gland of the eyelids","justification":""},{"idx":2,"correct":true,"proposition":"Treated with corticosteroid ointment","justification":""},{"idx":3,"correct":false,"proposition":"Treated with systemic antibiotics","justification":"Stye (local route)"},{"idx":4,"correct":true,"proposition":"May require a surgical incision","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-26","context":null,"enonce":"What are the possible etiologies of decreased visual acuity associated with eye redness (several exact responses)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Acute glaucoma crisis due to angle closure","justification":""},{"idx":1,"correct":true,"proposition":"Anterior uveitis","justification":""},{"idx":2,"correct":false,"proposition":"Central retinal artery occlusion","justification":""},{"idx":3,"correct":true,"proposition":"Neovascular glaucoma","justification":""},{"idx":4,"correct":false,"proposition":"Retinal vasculitis","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-27","context":null,"enonce":"In case of myopia (one or more exact answers):","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" The optical system formed by the eye is too convergent","justification":""},{"idx":1,"correct":false,"proposition":"Distance vision is better than near vision without correction","justification":"The opposite:)"},{"idx":2,"correct":true,"proposition":"Light rays focus in front of the retina","justification":""},{"idx":3,"correct":true,"proposition":"A divergent lens can be used for correction","justification":"Lowers the refractive power that is too strong in myopia (and glass convergent for hyperopia)"},{"idx":4,"correct":true,"proposition":"The risk of retinal detachment may be increased","justification":"As well as chronic glaucoma"}],"type":"qi"}
+{"_id":"annales-2018-qi-28","context":null,"enonce":"A 75-year-old patient has had left knee pain for several months. During interrogation, these pains are also present at night. The patient gets up 3 times a night to urinate. On clinical examination, the knee appears enlarged in volume compared to the opposite side. There is amyotrophy of the left thigh. Simple X-rays were performed regaining an osteolytic appearance. The patient brings you a TOM and an MRI of the left knee. What is the real proposal(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A secondary localization of prostate origin typically has an osteolytic appearance on the X-ray and CT scan.","justification":"Osteocondensant in three out of four cases."},{"idx":1,"correct":true,"proposition":"The appearance of the cortical is suggestive of a malignant lesion","justification":""},{"idx":2,"correct":true,"proposition":"There are periosteal appositions","justification":"They are observed on the first scanner, infero-lateral:)"},{"idx":3,"correct":true,"proposition":"There is an invasion of soft parts","justification":""},{"idx":4,"correct":false,"proposition":"On the bone level, this lesion remains confined to the metaphysis","justification":"It extends everywhere"}],"type":"qi"}
+{"_id":"annales-2018-qi-29","context":null,"enonce":"You take care of an 83-year-old patient, well surrounded, on Day 2 of a knee replacement. The Redon drains were removed without problems. She has a knee increased in volume, very edematous and inflammatory. The scar is beautiful, non-inflammatory. What is the exact proposal(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Outpatient care is possible","justification":""},{"idx":1,"correct":true,"proposition":"The electrotherapy techniques practiced by the physiotherapist will aim to reduce edema","justification":"We are sceptical about this proposal. There is nothing on the new colleges, so we can forget 🙃 about it"},{"idx":2,"correct":true,"proposition":"The prescription of English cane could be made by the liberal physiotherapist after discharge from the hospital","justification":""},{"idx":3,"correct":false,"proposition":"Your physiotherapy prescription must mention the physiotherapy techniques to be used.","justification":""},{"idx":4,"correct":false,"proposition":"The adaptation of the home must be done after writing a file with the MDPH","justification":"The application will have to be made to the General Council to obtain an APA"}],"type":"qi"}
+{"_id":"annales-2018-qi-30","context":null,"enonce":"You are taking care of a 32-year-old patient, computer scientist, whose smoking is estimated at 15 packs \/ year, without medical or surgical history, victim of a road accident responsible for a severe spinal cord injury by cervical fracture C5 osteosynthesizer anterior on April 30, 2018. As weaning from mechanical ventilation was difficult, he was tracheostomized on May 21, 2018 after orotracheal intubation. Weaning was then carried out on May 29. When he arrived, he was eupneic. He has a right trochanter eschar, stage 4 with a loss of substance to the bone. The background of the eschar is fibrinous, and purulent secretions are very abundant without inflammatory skin signs. What is the exact proposal(s):","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Tracheal stenosis is a complication of prolonged orotracheal intubation","justification":""},{"idx":1,"correct":false,"proposition":"You prefer for the treatment of this pressure ulcer a combination of local antiseptics and dry dressings.","justification":"No antiseptic"},{"idx":2,"correct":false,"proposition":"The presence of this pressure ulcer contraindicates wheelchair placement","justification":"Not at all, it is necessary to mobilize the patient to avoid the development of a new pressure ulcer."},{"idx":3,"correct":false,"proposition":"The lesion being of spinal cord level C6 you expect anesthesia from the lateral edge of the forearm in anatomical position","justification":"C6 is healthy:)"},{"idx":4,"correct":true,"proposition":"The request for long-term illness can be made by the attending physician","justification":"It is even he who does it most of the time"}],"type":"qi"}
+{"_id":"annales-2018-qi-31","context":null,"enonce":"A 70-year-old patient falls down the stairs. He has trauma to his right ankle. In view of the following X-rays, which are the true proposition(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The lateral collateral ligament is probably ruptured","justification":"The mechanism is in eversion so it is the medial that breaks"},{"idx":1,"correct":true,"proposition":"Tibio-tal ratios are normal","justification":""},{"idx":2,"correct":false,"proposition":"The distal tibio-fibular ligament is probably intact","justification":""},{"idx":3,"correct":true,"proposition":"There is a suprasyndesmotic fracture of the malleola. Side","justification":""},{"idx":4,"correct":true,"proposition":"There is a risk of major skin pain on the medial side of the ankle","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-32","context":null,"enonce":"You prescribe a series knee articulated orthosis to one of your patients with a knee sprain. Check the correct prescription principle(s) for this type of medical device. ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is prescribed on a simple prescription","justification":""},{"idx":1,"correct":false,"proposition":"It is prescribed on a large apparatus form","justification":"It's a small ;)"},{"idx":2,"correct":false,"proposition":"It is refunded at 100% of its purchase price","justification":"65%"},{"idx":2,"correct":true,"proposition":"All specialists can prescribe it","justification":""},{"idx":2,"correct":false,"proposition":"Physiotherapists can prescribe it","justification":"It is articulated so no"}],"type":"qi"}
+{"_id":"annales-2018-qi-33","context":null,"enonce":"Regarding carpal tunnel syndrome, which is (are) the true proposition(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is most often idiopathic","justification":""},{"idx":1,"correct":true,"proposition":"It is more common during pregnancy","justification":""},{"idx":2,"correct":false,"proposition":"The electromyogram is essential for diagnosis","justification":""},{"idx":3,"correct":false,"proposition":"It can cause a deficit of the long flexor of the thumb","justification":"This is the short flexor"},{"idx":4,"correct":false,"proposition":"It may lead to an abolition of the pen-radial reflex","justification":"Radial pen = C6 = radial nerve"}],"type":"qi"}
+{"_id":"annales-2018-qi-35","context":null,"enonce":"You examine an ankle. Which characteristic(s) related to the anatomical structure pointed out is (are) correct?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This is the tendon of the extensor muscle of the toes","justification":""},{"idx":1,"correct":false,"proposition":"This is the tendon of the fibular muscle","justification":""},{"idx":2,"correct":true,"proposition":"This is the tendon of the anterior tibial muscle","justification":""},{"idx":3,"correct":true,"proposition":"The corresponding muscle is innervated by the deep fibular nerve","justification":"Like all muscles of the anterior compartment of the leg"},{"idx":4,"correct":true,"proposition":"The corresponding muscle is innervated by the roots L4 and L5","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-36","context":null,"enonce":"A young patient of 34 years comes to consult you for inflammatory low back pain that has appeared for 6 months. You suspect spondyloarthritis and have prescribed an MRI of the sacroiliac joints. What is (are) the exact proposal(s) regarding the MRI it brings you?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This is a T1-weighted sequence","justification":""},{"idx":1,"correct":true,"proposition":"There is a saturation of the fat signal","justification":"T2 FAT-SAT"},{"idx":2,"correct":true,"proposition":"There is bilateral sacroiliitis","justification":""},{"idx":3,"correct":false,"proposition":"There is MODIC1 type L5-S1 disc disease","justification":"This classification is for disk degeneration"},{"idx":4,"correct":true,"proposition":"This is a coronal plan","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-38","context":null,"enonce":"A 30-year-old patient arrives at the emergency room because he has just hurt his finger very much by grabbing the jersey of another player during a rugby 🏉 match. What is (are) the exact proposal(s) concerning the radiography of the hand that you have performed?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"We visualize a fracture of the base of the thumb","justification":""},{"idx":1,"correct":false,"proposition":"We visualize a fracture of a metacarpal","justification":""},{"idx":2,"correct":true,"proposition":"We visualize a phalanx fracture","justification":""},{"idx":3,"correct":true,"proposition":"Traumatic injury is the tearing of a long flexor tendon","justification":""},{"idx":4,"correct":false,"proposition":"Interphalangeal dislocation is seen","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-39","context":null,"enonce":"In case of paralysis of the oculomotor nerve (III), you may encounter on examination: ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A defect in elevation of the eye","justification":""},{"idx":1,"correct":false,"proposition":"A miosis","justification":"Mydriasis"},{"idx":2,"correct":true,"proposition":"A defect of adduction of the eye","justification":"Internal rectus muscle is innervated by the III"},{"idx":3,"correct":false,"proposition":"Exophthalmos","justification":"The ptosis will give a false enophtalmos rather"},{"idx":4,"correct":true,"proposition":"A ptosis","justification":"The eyelid levator"}],"type":"qi"}
+{"_id":"annales-2018-qi-40","context":null,"enonce":"A 62-year-old patient has a history of essential hypertension treated as monotherapy for 2 years and active smoking (45 packs-year). For about two weeks, he has been complaining of daily headaches that settle willingly in the second part of the night. At first, they gradually faded during the morning. For about 3 days, they have been constant. These headaches are described as diffuse in helmets, fluctuate in intensity, are accentuated by physical activity. He also complains of inappetence and nausea that are also gradually evolving. The patient is apyretic. What syndrome do you evoke in front of this painting?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Migraine sickness","justification":""},{"idx":1,"correct":false,"proposition":"Daily chronic headaches","justification":""},{"idx":2,"correct":false,"proposition":"Meningeal syndrome of infectious origin","justification":""},{"idx":3,"correct":true,"proposition":"Intracranial hypertension","justification":"This is the typical picture"},{"idx":4,"correct":false,"proposition":"Meningeal syndrome related to subarachnoid hemorrhage (SAH)","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-41","context":null,"enonce":"A 59-year-old patient saw a tremor in the last three fingers of his right hand that his entourage also noticed when walking. It swings the upper right limb less to walking. On examination, you notice that the tremor disappears with outstretched arms. You perceive that passive mobilization of the right elbow is more difficult and mobilization of the right shoulder is painful. Osteotendinous reflexes are normal. This type of tremor is probably aggravated by what? ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Emotion","justification":"Stress increases it"},{"idx":1,"correct":true,"proposition":"Mental arithmetic","justification":""},{"idx":2,"correct":false,"proposition":"Writing","justification":""},{"idx":3,"correct":false,"proposition":"The movement","justification":""},{"idx":4,"correct":false,"proposition":"Sleep","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-42","context":null,"enonce":"Which of the following applies(s) to a central neurological bladder?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Spinal cord injury above the sacral centers","justification":""},{"idx":1,"correct":false,"proposition":"Detrusor hypoactivity","justification":"Acute urine retention is observed in peripheral disorders"},{"idx":2,"correct":true,"proposition":"Incontinence","justification":"No vesicosphincter dyssinergeria"},{"idx":3,"correct":true,"proposition":"Risk of ureterobesical reflux","justification":""},{"idx":4,"correct":false,"proposition":"Low intravesical pressures","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-44","context":null,"enonce":"Which of the following biological signs points you to iatrogenic adrenal insufficiency in a 38-year-old patient with a history of Crohn's disease treated for 5 years with 10 mg\/Day prednisone?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Natrimia at 128 mmol\/L","justification":""},{"idx":1,"correct":false,"proposition":"Kaliemia at 5.8 mmol\/L","justification":""},{"idx":2,"correct":true,"proposition":"Fasting blood glucose at 3 mmol\/L","justification":""},{"idx":3,"correct":false,"proposition":"Plasma ACTH at 8 hours at 585 pg\/ml (N: 10 - 20)","justification":""},{"idx":4,"correct":false,"proposition":"Urinary free cortisol at 25 μg\/24 hours (N: < 90)","justification":"It is used for hypercortiscime, and not for hypo (because there is no lower threshold) ☺️"}],"type":"qi"}
+{"_id":"annales-2018-qi-45","context":null,"enonce":"You see a 15-day-old newborn who has an isolated fever at 38.2 ° C and a general condition preserved: ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"You reassure parents about the benign nature of this fever during viral epidemics","justification":"Its age makes it possible to consider the hypothesis of a late bacterial neonatal infection."},{"idx":1,"correct":false,"proposition":"The flu test is not informative at this age","justification":"It is quite informative"},{"idx":2,"correct":true,"proposition":"The urine strip is not informative at this age","justification":""},{"idx":3,"correct":true,"proposition":"Cytobacteriological examination of urine is systematic","justification":""},{"idx":4,"correct":true,"proposition":"The realization of a lumbar puncture is systematic","justification":"He has 15 days he 👉 has the right to a complete check-up and hospital supervision"}],"type":"qi"}
+{"_id":"annales-2018-qi-46","context":null,"enonce":"The lesions in the photo below should evoke (only one expected response) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Polygenic hypercholesterolemia","justification":""},{"idx":1,"correct":false,"proposition":"Familial combined hyperlipidemia","justification":""},{"idx":2,"correct":true,"proposition":"Homozygous familial hypercholesterolemia","justification":"Tendon xanthomas -> problem of significant LDL -> homozygous familial hypercholesterolemia"},{"idx":3,"correct":false,"proposition":"Dysbetalipoproteinemia","justification":""},{"idx":4,"correct":false,"proposition":"A syndrome of familial hyperchylomicronemia","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-47","context":null,"enonce":"A 4-year-old efant presents to the emergency room for painful lameness without fever. What is the exact proposal(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Presence of a lump of butter fracture","justification":""},{"idx":1,"correct":false,"proposition":"Presence of a green wood fracture","justification":"No break in continuity"},{"idx":2,"correct":false,"proposition":"Presence of a hair fracture","justification":""},{"idx":3,"correct":true,"proposition":"Presence of traumatic curve","justification":"Fibula"},{"idx":4,"correct":false,"proposition":"Presence of a Salter II","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-48","context":null,"enonce":"In front of a lesion of the tongue, which is (are) the clinical sign(s) that will orient (steer) towards a malignant origin?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Indurated injury","justification":""},{"idx":1,"correct":false,"proposition":"Painful lesion","justification":"Pain does not point to one cause over another"},{"idx":2,"correct":true,"proposition":"Bleeding on contact when palpating the lesion","justification":""},{"idx":3,"correct":true,"proposition":"Submucosal induration","justification":""},{"idx":4,"correct":true,"proposition":"Presence of associated leukoplakia","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-49","context":null,"enonce":"You intervene at the home of an infant found dead by his parents a few minutes ago: ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"You ask to be accompanied by the police","justification":""},{"idx":1,"correct":false,"proposition":"You do not have to sign the death certificate before admission to the hospital","justification":""},{"idx":2,"correct":false,"proposition":"You write a report to the Public Prosecutor","justification":""},{"idx":3,"correct":true,"proposition":"You propose to the parents to perform an autopsy in search of the causes of death","justification":""},{"idx":4,"correct":false,"proposition":"The transfer of the body must be done to a forensic institute","justification":"Emergency College: 'It is recommended that the medical first responders or the regulation of Centre 15 contact an MIN reference centre as soon as possible in order to organise the immediate transfer of the child to this structure' (and not a forensic institute)"}],"type":"qi"}
+{"_id":"annales-2018-qi-50","context":null,"enonce":"You explain to young parents whose child has a first febrile episode the measure(s) to take during this episode: ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Drug treatment is required for temperatures above 39°C","justification":"No drug is introduced on a temperature value"},{"idx":1,"correct":false,"proposition":"Drinking is necessary every hour as long as the fever persists","justification":"It is necessary for the goodwill of the child"},{"idx":2,"correct":false,"proposition":"Cool wraps should be used if the child is uncomfortable","justification":""},{"idx":3,"correct":true,"proposition":"The use of ibuprofen is possible only after 3 months","justification":""},{"idx":4,"correct":false,"proposition":"Keep the child out of the community for the duration of the fever","justification":"There is no such recommendation"}],"type":"qi"}
+{"_id":"annales-2018-qi-51","context":null,"enonce":"Regarding cervical swelling, which proposal(s) is (are)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A cyst of the thyroglossal tract is mobile to swallowing","justification":""},{"idx":1,"correct":false,"proposition":"Right supraclavicular lymphadenopathy may be indicative of genitourinary cancer","justification":"Left (third ganglion)"},{"idx":2,"correct":true,"proposition":"Superficial renitent swelling localized to the anterior edge of the sternocleidomastoid muscle is suggestive of an amygdaloid cyst","justification":""},{"idx":3,"correct":false,"proposition":"Brachial plexus schwannoma is a differential diagnosis of submandibular lymphadenopathy","justification":"The mandible and arm are relatively far from each other ☺️"},{"idx":4,"correct":true,"proposition":"Accessory nerve schwannoma is a differential diagnosis of spinal lymphadenopathy","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-52","context":null,"enonce":"Regarding the peritonsillar phlegmon, which is (are) the exact item(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The abscess is localized at the level of the lateropharyngeal space","justification":""},{"idx":1,"correct":true,"proposition":"There may exist trismus","justification":"The retrostylian gives a torticollis:)"},{"idx":2,"correct":true,"proposition":"The anterior pillar of the palace veil is enlarged","justification":""},{"idx":3,"correct":false,"proposition":"In adults, hospitalization is systematic","justification":""},{"idx":4,"correct":false,"proposition":"The drainage of the abscess is done either by puncture or by no incision under general anesthesia","justification":"Not under GA;) It is done in two seconds in the emergency room, under AL"}],"type":"qi"}
+{"_id":"annales-2018-qi-53","context":null,"enonce":"Regarding benign paroxysmal positional vertigo, what is(are) the exact item(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" It lasts less than one minute","justification":""},{"idx":1,"correct":false,"proposition":"It follows vestibular ischemia","justification":"lithiasis of one of the ciruclair ducts"},{"idx":2,"correct":true,"proposition":"It is treated with vestibular physiotherapy","justification":""},{"idx":3,"correct":false,"proposition":"It is associated with tinnitus","justification":"no appendix signs (no hearing loss, no nausea, ...)"},{"idx":4,"correct":true,"proposition":"There is a triggering positional factor","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-55","context":null,"enonce":"A 62-year-old patient has hyponatremia of progressive onset. It appears clinically euvolemic. His blood test is as follows: Na 125 mmol\/L - K 4 mmol\/L - chlorine 110 mmol\/L - HCO3- 25 mmol\/L - blood glucose 5 mmol\/L - protein 67 g\/L - urea 4 mmol\/L and serum creatinine 78 μmol\/L. Urine balance: Na 100 mmol\/L - K 25 mmol\/L - urea 350 mmol\/L and creatinine 8 mmol\/L. What is(are) the possible cause(s) of this biological table? (one or more correct answers)","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"SIADH","justification":"Plasma hyposmolarity, euvolemic patient and urinary hyperosmolarity make the diagnosis"},{"idx":1,"correct":false,"proposition":"Tea and toast syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Furosemide","justification":""},{"idx":3,"correct":false,"proposition":"Amlodipine","justification":""},{"idx":4,"correct":false,"proposition":"Lithium","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-56","context":null,"enonce":"An 86-year-old patient is hospitalized for hematemesis. It is known to have viral hepatitis B, not followed. His family describes a bloody vomiting equivalent in volume to that of a basin. On examination, he presents ascites and asterixis. Systolic blood pressure is 55 mmHg. Which of the following is associated with a poor prognosis? ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Age","justification":""},{"idx":1,"correct":false,"proposition":"Hematemesis volume","justification":"This is not a factor of poor prognosis because the estimate is not reliable"},{"idx":2,"correct":true,"proposition":"Blood pressure","justification":""},{"idx":3,"correct":true,"proposition":"Hepatic encephalopathy","justification":""},{"idx":4,"correct":true,"proposition":"Ascites","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-57","context":null,"enonce":"A 62-year-old patient has the following laboratory work: Na 142 mmol\/L - K 5.7 mmol\/L - chlorine 110 mmol\/L - HCO3- 18 mmol\/L - protein 88 g\/L - urea 20 mmol\/L - serum creatinine 170 μmol\/L. Which drug(s) can (can) give this biological table? (one or more correct answers)","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Ibuprofen ","justification":""},{"idx":1,"correct":true,"proposition":"Candesartan","justification":""},{"idx":2,"correct":true,"proposition":"Amiloride","justification":""},{"idx":3,"correct":false,"proposition":"Amlodipine","justification":"It does not act on the kidney"},{"idx":4,"correct":false,"proposition":"Prednisone","justification":"We would then find hypokalemia (by aldosterone-like effect on mineralocorticoid receptors)."}],"type":"qi"}
+{"_id":"annales-2018-qi-58","context":null,"enonce":"You take care of a 67-year-old patient in the emergency room whose reason for entry is right calf pain. The interrogation and clinical examination find a progressive cancer during treatment and a localized tenderness along the right deep venous network. The rest of the exam is unremarkable. You use a simplified clinical prediction model of deep vein thrombosis (DVT) that indicates a DVT probability of 17%. You ask for a venous Doppler ultrasound of the lower limbs to confirm this suspicion of DVT. Which of the following is correct:","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Post-test likelihood of DVT depends on the sensitivity of venous Doppler ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"The pre-test probability of DVT depends on the specificity of venous Doppler ultrasound","justification":""},{"idx":2,"correct":true,"proposition":"Post-DVT probability depends on venous Doppler ultrasound likelihood ratio","justification":""},{"idx":3,"correct":true,"proposition":"Post-test probability of DVT depends on the intrinsic performance of venous Doppler ultrasound","justification":""},{"idx":4,"correct":true,"proposition":"The post-test probability of DVT can be determined graphically using the Fagan nomogram","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-59","context":null,"enonce":"A 43-year-old patient consults for moderate hyperferritinemia at 2 times the normal discovered on a systematic assessment carried out by occupational medicine. It is asymptomatic. Which element(s) will orient towards metabolic hepatosiderosis?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"High transferrin saturation coefficient","justification":"would lead to hemoichromatosis"},{"idx":1,"correct":true,"proposition":"Overweight","justification":""},{"idx":2,"correct":true,"proposition":"Hypertriglyceridemia","justification":""},{"idx":3,"correct":false,"proposition":"Graves' disease","justification":""},{"idx":4,"correct":false,"proposition":"History of colon cancer","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-60","context":null,"enonce":"In front of sigmoid diverticulitis, an injected abdominal tomography CT scan is performed. Can it show (one or more exact answers)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Addition images containing air at the anti-mesenteric edge of the colon","justification":""},{"idx":1,"correct":false,"proposition":"Thinning of the colonic wall","justification":""},{"idx":2,"correct":true,"proposition":"An infiltration of fat around a diverticulum","justification":""},{"idx":3,"correct":true,"proposition":"A thickening of the colonic wall","justification":""},{"idx":4,"correct":true,"proposition":"Pylephlebitis","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-61","context":null,"enonce":"In which situation(s) does a patient benefit from an exemption from co-payment (based on Social Security tariffs)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Care of any minor children","justification":""},{"idx":1,"correct":true,"proposition":"Care, whatever it may be, to subjects benefiting from State Medical Aid (AME)","justification":""},{"idx":2,"correct":false,"proposition":"Care, whatever it is, for pregnant women from the 4th month of pregnancy","justification":"From the sixth month for pregnancy care"},{"idx":3,"correct":true,"proposition":"Performing a mammogram as part of the national screening program","justification":""},{"idx":4,"correct":false,"proposition":"Additional tests performed as part of participation in a clinical trial","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-62","context":null,"enonce":"A 48-year-old patient has been presenting for a few weeks headaches that lead to the diagnosis of high blood pressure. The average outpatient blood pressure is 177\/92 mmHg. Its biological balance is as follows: Na 142 mmol \/ L, K 3.4 mmol \/ L, Creatinine 70 μmol \/ I, Calcemia 2.5 mmol \/ L. Diuresis of 24 h: 1 400 ml. urinary lonogram: Na 180 mmol\/L, K 50 mmol\/L, proteinuria< 0.01 g\/1. In view of this assessment, what is (are) the cause (s) that you must mention for this high blood pressure?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Renal arterial stenosis","justification":""},{"idx":1,"correct":false,"proposition":"Syndrome de Gitelman","justification":""},{"idx":2,"correct":true,"proposition":"Primary hyperaldosteronism","justification":""},{"idx":3,"correct":true,"proposition":"Chronic licorice consumption","justification":""},{"idx":4,"correct":false,"proposition":"Pheochromocytoma","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-63","context":null,"enonce":"Which tumor marker is of interest in screening, diagnosis, prognosis and monitoring of the cancer of which it is specific? (1 response expected)","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"ACE","justification":""},{"idx":1,"correct":false,"proposition":"Alpha FP","justification":""},{"idx":2,"correct":false,"proposition":"hCG","justification":""},{"idx":3,"correct":false,"proposition":"CA125","justification":""},{"idx":4,"correct":true,"proposition":"PSA","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-64","context":null,"enonce":"Under the law of 2 February 2022 known as the Claeys-Leonetti << law>> when a patient can no longer express himself, a treatment that appears useless, disproportionate or when it has no other effect than the sole artificial maintenance of life, may be suspended at the end of a collegial procedure defined by regulation. Which element(s) are (s) provided for in this procedure?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Consultation of advance directives if they exist","justification":""},{"idx":1,"correct":true,"proposition":"The opinion of at least one consultant","justification":""},{"idx":2,"correct":true,"proposition":"A discussion with the healthcare team present","justification":""},{"idx":3,"correct":false,"proposition":"Information from the on-call director if this procedure takes place on weekends","justification":"He is not part of the medical team"},{"idx":4,"correct":true,"proposition":"The decision must be recorded in the medical record","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-65","context":null,"enonce":"On what means(s) is the assessment of the qualitative dimension of pain based?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Questionnaire DN4","justification":"Only qualitative questionnaire in the list of proposals"},{"idx":1,"correct":false,"proposition":"doloplus questionnaire","justification":""},{"idx":2,"correct":false,"proposition":"Algoplus scale","justification":""},{"idx":3,"correct":false,"proposition":"Analogue visual scale","justification":""},{"idx":4,"correct":false,"proposition":"Digital scale","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-66","context":null,"enonce":"By what therapeutic means(s) can neuropathic pain be managed as a first line?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A tricyclic antidepressant"},{"idx":1,"correct":true,"proposition":"An antiepileptic drug of the class Gabapentinoids","justification":""},{"idx":2,"correct":false,"proposition":"Morphine"},{"idx":3,"correct":true,"proposition":"Transcutaneous electrical stimulation","justification":""},{"idx":4,"correct":false,"proposition":"Spinal cord stimulation"}],"type":"qi"}
+{"_id":"annales-2018-qi-67","context":null,"enonce":"A 55-year-old patient is being treated in a palliative care unit for a terminal course of respiratory failure complicating major emphysema. Her main complaint is an increase in her dyspnea. How to manage this dyspnea? (one or more correct answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Assessment of the symptom by a visual analogue scale","justification":""},{"idx":1,"correct":false,"proposition":"Adaptation of oxygen therapy flow rate so that arterial oxygen saturation is greater than 95%","justification":""},{"idx":2,"correct":true,"proposition":"Introduction or increase of opioid therapy","justification":"It is a treatment for dyspnea in palliative care"},{"idx":3,"correct":true,"proposition":"Comfortable patient installation","justification":""},{"idx":4,"correct":false,"proposition":"Deep and continuous sedation from the outset until death","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-68","context":null,"enonce":"Can obesity surgery such as a longitudinal gastrectomy be proposed (one or more exact answers)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"In adolescents from 15 years of age if their BMI is greater than 40","justification":""},{"idx":1,"correct":true,"proposition":"In a 55-year-old adult, OSA device, with a BMI > 35","justification":""},{"idx":2,"correct":false,"proposition":"in case of severe eating disorder","justification":"This is a contraindication"},{"idx":3,"correct":true,"proposition":"If the subject has understood and accepts post-operative medical and surgical follow-up for life","justification":""},{"idx":4,"correct":true,"proposition":"If the patient has received clear and complete information about the operative risks","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-69","context":null,"enonce":"A 52-year-old patient with no particular history has high blood pressure, proteinuria of 2g \/ 24 h, hematuria at 105 red blood cells \/ ml with serum creatinine at 130 μmol \/ L. His vesicorenal ultrasound is normal. Here is the report of his renal biopsy: cortical fragment comprising 15 glomeruli including 4 sclerotic glomeruli. The permeable glomeruli exhibit mesangial and endocapillary proliferation. Moderate arteriolosclerosis lesions. Lesions of tubular atrophy and interstitial fibrosis on approximately 20% of the parenchyma. Immunofluorescence finds deposits of IgA to +++ in the mesangium and C3 to 1+ in the vessels and glomeruli. What is (are) the possible diagnosis(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Tubulointerstitial nephropathy","justification":"No leukocyturia, proteinuria > 1g\/24h"},{"idx":1,"correct":false,"proposition":"Lupus nephropathy class IV","justification":""},{"idx":2,"correct":false,"proposition":"Pauciimmune glomerulonephritis","justification":""},{"idx":3,"correct":true,"proposition":"IgA nephropathy","justification":"This is the typical picture"},{"idx":4,"correct":false,"proposition":"Nephroangiosclerosis","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-71","context":null,"enonce":"As a young general practitioner, you are seeing for the first time a 52-year-old patient who complains of insomnia, anxious ruminations, loss of vital momentum and family and professional disinvestment. He indicates that his symptoms appeared 6 months ago, following the arrival of a new team leader who constantly remarks, about his slow work and lack of intellectual abilities. He even reports insults hurled at him several times, when he was alone with his boss. This patient has no notable medical history, apart from depression reactive to a divorce, 10 years ago. The patient asks you to make a declaration of occupational disease. What do you need to indicate on the initial medical certificate?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The existence of a depressive syndrome","justification":"'Insomnia, anxious ruminations, loss of vital momentum and family and professional disinvestment'"},{"idx":1,"correct":true,"proposition":"The date you first noticed the pathology","justification":""},{"idx":2,"correct":false,"proposition":"History of depressive syndrome","justification":"Only the medical information that is needed is shared"},{"idx":3,"correct":false,"proposition":"The existence of harassment by a colleague","justification":""},{"idx":4,"correct":false,"proposition":"The name of the head of department","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-72","context":null,"enonce":"A 12-year-old patient is admitted to the pediatric emergency department with meningeal syndrome. He is installed in an examination room by a nursing assistant and the nurse comes to take his temperature and blood pressure. The intern then comes to examine the child and suspects an invasive meningococcal infection, which will be confirmed by CSF (meningococcal C) analysis. The nurse, aged 30, comes to see the intern saying she is worried because she is pregnant and she wonders what she should do because she took care of the child without a mask and is not vaccinated against meningococcus. What measure(s) should be proposed to it","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Vaccination with meningococcal C conjugate vaccine","justification":""},{"idx":1,"correct":false,"proposition":"Prophylaxis with oral rifampicin for 5 days","justification":""},{"idx":2,"correct":false,"proposition":"Rifampicin prophylaxis per for 2 days","justification":""},{"idx":3,"correct":true,"proposition":"Reassure them that there is no risk of contamination","justification":"It is not contact case because the contact with the child lasted only a few minutes (less than 30-60 minutes)"},{"idx":4,"correct":false,"proposition":"Prophylaxis with ceftriaxone injection","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-74","context":null,"enonce":"What vaccinations are mandatory for a nurse working in a hospital in a care unit (one or more possible answers)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Pneumococcal vaccination","justification":""},{"idx":1,"correct":true,"proposition":"Vaccination against diphtheria, tetanus and poliomyelitis","justification":""},{"idx":2,"correct":false,"proposition":"Vaccination against hepatitis A","justification":""},{"idx":3,"correct":false,"proposition":"Pertussis vaccination","justification":""},{"idx":4,"correct":true,"proposition":"Vaccination against hepatitis B","justification":"These are the only two mandatory vaccines for caregivers"}],"type":"qi"}
+{"_id":"annales-2018-qi-75","context":null,"enonce":"Regarding acute peritonitis, which proposal(s) do you retain?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The abdominal CT scan is the reference morphological examination for diagnosis","justification":""},{"idx":1,"correct":true,"proposition":"Surgical treatment should include washing of the peritoneal cavity","justification":""},{"idx":2,"correct":true,"proposition":"The 3 most common causes are appendicitis, peptic ulcer, diverticulum colic","justification":""},{"idx":3,"correct":true,"proposition":"The evolving risk of peritonitis is septic shock","justification":""},{"idx":4,"correct":false,"proposition":"Peritonitis is always linked to digestive perforation","justification":"Not primary peritonitis"}],"type":"qi"}
+{"_id":"annales-2018-qi-76","context":null,"enonce":"Regarding acute bowel obstruction, what is the exact information(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A functional occlusion may be caused by a hydroelectrolyte disorder","justification":""},{"idx":1,"correct":true,"proposition":"A peritoneal flange can lead to occlusion by strangulation","justification":""},{"idx":2,"correct":true,"proposition":"Strangulation occlusion threatens gut vitality within hours","justification":""},{"idx":3,"correct":true,"proposition":"The abdominal CT scan with contrast injection is the reference exam","justification":""},{"idx":4,"correct":true,"proposition":"Colon cancer is the leading cause of obstruction colonic occlusion","justification":"Fecal impaction is the leading cause of rectal 💩 obstruction"}],"type":"qi"}
+{"_id":"annales-2018-qi-77","context":null,"enonce":"Regarding occlusive syndrome: (one or more exact answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Stopping materials is a physical sign absent in 30% of cases","justification":""},{"idx":1,"correct":false,"proposition":"Abdominal pain is still the initial symptom","justification":""},{"idx":2,"correct":false,"proposition":"The seat of abdominal pain signs the seat of the obstacle","justification":""},{"idx":3,"correct":true,"proposition":"Repeated and frequent vomiting temporarily relieves abdominal pain in small intestine occlusions","justification":""},{"idx":4,"correct":true,"proposition":"The shutdown of the gas is the essential functional sign for diagnosis","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-78","context":null,"enonce":"Mr. M., 58 years old, is referred to you for anomalies in the martial record. In his history, there is only diabetes diagnosed 3 months ago. On clinical examination, the temperature is 37.3 °C.  You notice hepatomegaly evaluated at 5 cm under the right costal awning. His martial assessment is presented below: Transferrin saturation coefficient (TSC) at 62%, ferritin at 1,200 ng\/ml (normal 30 to 300 mg\/ml). Which of the following proposals could explain the abnormalities of the martial assessment presented in this clinical context?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Inflammatory syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Dysmetabolic hepatosiderosis","justification":""},{"idx":2,"correct":true,"proposition":"Genetic hemochromatosis","justification":"High CSE makes the diagnosis."},{"idx":3,"correct":false,"proposition":"Myelodysplasia","justification":""},{"idx":4,"correct":false,"proposition":"Macrophage activation syndrome","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-79","context":null,"enonce":"When admitting a polytrauma patient in severe hemorrhagic shock (one or more exact answers):","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A bodyscan is essential and must be carried out urgently","justification":""},{"idx":1,"correct":true,"proposition":"A fast-echo performed at the patient's bed is enough to affirm hemoperitoneum","justification":""},{"idx":2,"correct":false,"proposition":"An emergency laparotomy is indicated to affirm the abdominal origin of hemorrhagic shock","justification":""},{"idx":3,"correct":true,"proposition":"In case of massive hemoperitoneum, the << damage control technique >> is the reference technique","justification":""},{"idx":4,"correct":false,"proposition":"The <<damage control>> technique aims to control bleeding and at the same time treat digestive lesions","justification":"Only control bleeding to save the patient's life. We will take care of the rest in a second time."}],"type":"qi"}
+{"_id":"annales-2018-qi-80","context":null,"enonce":"Mr. M., 22 years old, consults urgently because of asthenia associated with a fever at 39 ° C evolving for 72 hours. He complains of odynophagia and diffuse myalgia. On clinical examination, you find cervical lymphadenopathy and splenomegaly through the finger. A blood test was performed in the city and shows the following results: Haemoglobin 13.2 g\/dl, MCV 89 fl, platelets 120 G\/L, leukocytes 10.6 G\/L, neutrophils 1.6 G\/L, basophils 0, 1 G\/L, eosinophils 0.4 G\/L, lymphocytes 8 G\/L, monocytes 0.5 G\/L. Blood smear: presence of many large lymphocytes with hyperbasophilic cytoplasm. Which of the following complementary examinations do you think should be carried out as a first-line treatment in this clinical context?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Myelogram"},{"idx":1,"correct":false,"proposition":"Lymphocyte immunophenotyping","justification":""},{"idx":2,"correct":true,"proposition":"Antigenemia p24"},{"idx":3,"correct":true,"proposition":"MNI test"},{"idx":4,"correct":false,"proposition":"Cytomegalovirus (CMV) serology","justification":"Does not give lymphadenopathy or angina (p. 178 of the R2C College of Hematology)"}],"type":"qi"}
+{"_id":"annales-2018-qi-82","context":null,"enonce":"Ms. M., aged 58, is referred to internal medicine for a fever at 38.5 ° C associated with the following rash, present for 3 weeks. She also has paresthesias of the 2 feet. You mention: (one or more exact answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cryoglobulinemic vasculitis","justification":""},{"idx":1,"correct":false,"proposition":"Immunological thrombocytopenic purpura (ITP)","justification":"Purpura is rather vascular here"},{"idx":2,"correct":true,"proposition":"Microscopic polyangiitis","justification":""},{"idx":3,"correct":false,"proposition":"Giant cell arteritis","justification":"Vasculitis of the large vessels do not give purpura"},{"idx":4,"correct":false,"proposition":"Behçet's disease","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-83","context":null,"enonce":"About breath in mitral insufficiency, which is (are) the exact proposition(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is ejective mesosystolic","justification":""},{"idx":1,"correct":true,"proposition":"It is most often in steam jet","justification":""},{"idx":2,"correct":true,"proposition":"It may be associated with mesodiastolic rolling","justification":""},{"idx":3,"correct":true,"proposition":"It is most often of apexoaxillary site","justification":""},{"idx":4,"correct":false,"proposition":"It radiates to the carotids","justification":"This is the case of the RA"}],"type":"qi"}
+{"_id":"annales-2018-qi-84","context":null,"enonce":"A 42-year-old patient is admitted for chest pain. After interpreting this electrocardiogram, indicate the exact proposal(s): ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This is acute pericarditis","justification":""},{"idx":1,"correct":true,"proposition":"This is an acute coronary syndrome","justification":""},{"idx":2,"correct":true,"proposition":"There are mirror images","justification":""},{"idx":3,"correct":false,"proposition":"There is a complete left branch block","justification":""},{"idx":4,"correct":false,"proposition":"This is a Wolff-Parkinson-White syndrome","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-85","context":null,"enonce":"A 62-year-old patient is admitted for lipothymia. After interpreting this electrocardiogram, indicate the exact proposal(s). ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"There is sinus dysfunction","justification":""},{"idx":1,"correct":false,"proposition":"There is an atrioventricular block of the first degree","justification":""},{"idx":2,"correct":true,"proposition":"There is a right branch block","justification":""},{"idx":3,"correct":true,"proposition":"There is a BAV 2 for 1","justification":""},{"idx":4,"correct":false,"proposition":"There is a complete atrioventricular block","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-86","context":null,"enonce":"In a clinical trial, randomization of the evaluated treatment is intended to be first and foremost:","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Establish comparable groups based on potential confounders","justification":""},{"idx":1,"correct":false,"proposition":"Conclude a difference with a statistical significance level of 5%","justification":""},{"idx":2,"correct":false,"proposition":"Mitigate sampling fluctuations","justification":"Fluctuations are mitigated by increasing the sample size (to approximate the size of the source population)"},{"idx":3,"correct":false,"proposition":"Keep subjects in ignorance of the treatment allocated for the duration of the study","justification":"This is the role of the blind"},{"idx":4,"correct":false,"proposition":"Reduce the number of subjects needed","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-88","context":null,"enonce":"In the following list of bacterial infections, which bacterial infection(s) is (are) not usually associated with hyperleukocytosis?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Gram-negative liver abscess","justification":""},{"idx":1,"correct":false,"proposition":"Acute pyelonephritis","justification":""},{"idx":2,"correct":true,"proposition":"Typhoid fever","justification":"The third to know is brucellosis 🦠"},{"idx":3,"correct":false,"proposition":"Pneumococcal lung infection","justification":""},{"idx":4,"correct":true,"proposition":"Tuberculosis","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-91","context":null,"enonce":"In the absence of a statistically significant difference in the primary outcome between the two groups of a prospective randomised placebo-controlled trial, mention should be made of: ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The risk of statistical error of the second kind (beta)","justification":""},{"idx":1,"correct":true,"proposition":"The lack of effect of the treatment","justification":"Oupsi doupsi"},{"idx":2,"correct":true,"proposition":"A lack of statistical power","justification":"Due to lack of subjects in the study"},{"idx":3,"correct":false,"proposition":"Non-inferiority of the treatment assessed","justification":""},{"idx":4,"correct":false,"proposition":"The risk of statistical error of the first kind (alpha)","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-92","context":null,"enonce":"The association, at autopsy, of a recent, bilateral and multi-focal subdurai hematoma and bilateral retinal hemorrhages in a 6-month-old baby with no particular history suggests the diagnosis of: (one or more exact answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Sudden infant death syndrome","justification":""},{"idx":1,"correct":true,"proposition":"Shaken baby syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Syndrome de Silverman","justification":""},{"idx":3,"correct":false,"proposition":"Rupture of cerebral arteriovenous malformation","justification":""},{"idx":4,"correct":false,"proposition":"Accidental head injury","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-93","context":null,"enonce":"The administrative part of the death certificate, electronically or on paper, is transmitted: (one or more correct answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"At the town hall of the place of death","justification":"who issues the burial permit"},{"idx":1,"correct":false,"proposition":"At the National Institute of Health and Medical Research (INSERM)","justification":""},{"idx":2,"correct":true,"proposition":"To the funeral home manager mandated by the family","justification":"to proceed with burial"},{"idx":3,"correct":false,"proposition":"To the public prosecutor","justification":""},{"idx":4,"correct":false,"proposition":"To the family of the deceased","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-94","context":null,"enonce":"Congenital long QT syndrome is an inherited rhythm disorder of autosomal dominant inheritance that predisposes to sudden death in childhood and can be managed preventively. This pathology is very heterogeneous at the genetic level. What is the exact proposal(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The genes involved code for ion channels","justification":""},{"idx":1,"correct":false,"proposition":"Long QT syndrome is most often associated with a congenital heart defect","justification":""},{"idx":2,"correct":false,"proposition":"The genetic evaluation of this pathology is done by the study of the karyotype","justification":""},{"idx":3,"correct":true,"proposition":"The diagnosis in an index case must lead to information to the relatives","justification":"through the patient (the doctor cannot contact the relatives himself because of medical confidentiality)"},{"idx":4,"correct":false,"proposition":"Molecular predictive diagnosis is not allowed in minor children in this situation","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-95","context":null,"enonce":"The drafting of a descriptive medical certificate requires the evaluation of the ITT in the criminal sense of the term. What is the meaning of this acronym?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Total incapacity for work","justification":""},{"idx":1,"correct":false,"proposition":"Temporary total incapacity","justification":""},{"idx":2,"correct":false,"proposition":"Total temporary incapacity","justification":""},{"idx":3,"correct":false,"proposition":"Inability to work fully","justification":""},{"idx":4,"correct":false,"proposition":"Total temporary incapacity","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-97","context":null,"enonce":"In this family with no particular history, 3 boys were diagnosed with fragile X syndrome (III-3, III-7 and III-11). What is the exact proposal(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Boys III-3, III-7 and III-11 carry a complete mutation in the FMR1 gene","justification":""},{"idx":1,"correct":false,"proposition":"Girl III-2 with mild intellectual disability is likely a heterozygous carrier of a premutation","justification":""},{"idx":2,"correct":true,"proposition":"The III-6 girl has a one in 2 risk of being a heterozygous carrier of a premutation or a complete mutation","justification":""},{"idx":3,"correct":true,"proposition":"Women II-1, II-4, and II-7 have an increased risk of premature ovarian failure","justification":""},{"idx":4,"correct":true,"proposition":"Subject I-2 is a hemizygous carrier of a premutation","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-98","context":null,"enonce":"The objectives of the forensic care of a victim of sexual violence are: (one or more exact answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Describe traumatic bodily injury","justification":""},{"idx":1,"correct":false,"proposition":"Determine if the person consented at the time of the facts","justification":"😨😨"},{"idx":2,"correct":false,"proposition":"Determine if victim impact statements are credible","justification":""},{"idx":3,"correct":true,"proposition":"Set up multidisciplinary care","justification":""},{"idx":4,"correct":true,"proposition":"Take DNA samples","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-99","context":null,"enonce":"What are the possible therapeutic strategies for asthma and chronic obstructive pulmonary disease (COPD)? (one or more correct answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Long-term inhaled corticosteroid therapy monotherapy in COPD","justification":""},{"idx":1,"correct":true,"proposition":"Continuous inhaled corticosteroid monotherapy for asthma","justification":""},{"idx":2,"correct":false,"proposition":"Long-acting long-acting beta-2 agonist as monotherapy for asthma","justification":"Every asthmatic should have his inhaled corticosteroid close to him."},{"idx":3,"correct":true,"proposition":"Combination of inhaled corticosteroid and long-acting beta-2 agonist inhaled as background therapy for asthma","justification":""},{"idx":4,"correct":true,"proposition":"Long-acting beta-2 agonist monotherapy in COPD","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-101","context":null,"enonce":"You receive the result of a blood ionogram showing a serum potassium level of 6 mmol \/ L. What iatrogenic cause(s) can you mention?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Long-term oral corticosteroid therapy","justification":""},{"idx":1,"correct":true,"proposition":"Angiotensin II antagonist","justification":""},{"idx":2,"correct":true,"proposition":"Mineralocorticoid receptor blocker","justification":""},{"idx":3,"correct":true,"proposition":"ACE inhibitor","justification":""},{"idx":4,"correct":false,"proposition":"Loop diuretic","justification":"Hypokalaemic agents"}],"type":"qi"}
+{"_id":"annales-2018-qi-102","context":null,"enonce":"About drug antidotes:","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Protamine sulfate neutralizes the anticoagulant activity of heparin","justification":""},{"idx":1,"correct":true,"proposition":"Naloxone is a specific antagonist of morphinomimetics","justification":""},{"idx":2,"correct":false,"proposition":"Prothrombin factors are the antidote for clopidogrel","justification":"For anticoagulants"},{"idx":3,"correct":false,"proposition":"N-acetyl-cysteine is the antidote to acetylsalicylic acid","justification":"Paracetamol"},{"idx":4,"correct":true,"proposition":"Flumazenil is an antagonist of benzodiazepines and related molecules","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-103","context":null,"enonce":"A 23-year-old woman is hospitalized in psychiatry for a state of psychomotor arousal evolving for a week, with disinhibition having led to reckless spending and risky sexual behavior. She has not slept for 72 hours but shows no fatigue and undertakes to present herself to each of the patients of the department. If you were to opt for monotherapy, which of these options would seem appropriate to you?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Lithium"},{"idx":1,"correct":false,"proposition":"Valproic acid","justification":"She is a woman of childbearing age"},{"idx":2,"correct":true,"proposition":"Risperidone"},{"idx":3,"correct":false,"proposition":"Carbamazepine"},{"idx":4,"correct":true,"proposition":"Quetiapine"}],"type":"qi"}
+{"_id":"annales-2018-qi-104","context":null,"enonce":"About the decision on medical termination of pregnancy (IMG) (one or more exact answers): ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Any request for IMG must be the subject of an opinion from the Multidisciplinary Center for Prenatal Diagnosis (CPDPN)","justification":""},{"idx":1,"correct":false,"proposition":"There is a list of pathologies for which there is a medical indication for IMG","justification":"No clear list"},{"idx":2,"correct":true,"proposition":"The admissibility of the claim is based on the demonstration of a << high probability of a particularly serious and incurable condition at the time of diagnosis>>","justification":""},{"idx":3,"correct":true,"proposition":"A reflection period should be offered to the pregnant woman between the diagnosis of the condition and the possible realization of the IMG","justification":""},{"idx":4,"correct":true,"proposition":"An IMG can be carried out after consultation with the FNDCP until the end","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-105","context":null,"enonce":"A 31-year-old woman describes the sudden onset of intense fatigue a month ago accompanied by deep sadness. She addresses a lot of blame, especially not being able to take care of her 2-month-old daughter, is very slow down and often wakes up in the middle of the night. Li then sometimes has suicidal thoughts. Which of the following characteristics can (can) be indicative of bipolar mood disorder?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Female sex","justification":""},{"idx":1,"correct":true,"proposition":"Postpartum context","justification":""},{"idx":2,"correct":true,"proposition":"Melancholic features","justification":""},{"idx":3,"correct":true,"proposition":"Brutal start","justification":""},{"idx":4,"correct":false,"proposition":"Suicidal ideation","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-106","context":null,"enonce":"Which of the following signs and symptoms is more common in the elderly compared to young adults?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" Somatic complaints","justification":""},{"idx":1,"correct":false,"proposition":"Feelings of guilt","justification":""},{"idx":2,"correct":false,"proposition":"Self-depreciation","justification":""},{"idx":3,"correct":false,"proposition":"Suicidal ideation","justification":""},{"idx":4,"correct":false,"proposition":"Sexual disorders","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-107","context":null,"enonce":"Which of the following signs can be a symptom(s) due to withdrawal from an opiate substance?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Constipation","justification":"Opiates make constipation"},{"idx":1,"correct":true,"proposition":"Bilateral mydriasis","justification":""},{"idx":2,"correct":false,"proposition":"Hallucinations","justification":""},{"idx":3,"correct":true,"proposition":"Vomiting","justification":""},{"idx":4,"correct":true,"proposition":"High blood pressure","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-108","context":null,"enonce":"In front of a patient with a disorder related to alcohol use and opposed to the idea of addictological care, what attitude(s) characterize motivational interviewing?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":" Giving the patient a case for change","justification":""},{"idx":1,"correct":true,"proposition":"Let the patient explain what alcohol brings","justification":""},{"idx":2,"correct":false,"proposition":"Exposing the patient to situations at risk of excessive consumption","justification":""},{"idx":3,"correct":true,"proposition":"Identify the patient's personal reasons for change","justification":""},{"idx":4,"correct":false,"proposition":"Emphasize to the patient the risks associated with alcohol consumption","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-109","context":null,"enonce":"A 69-year-old patient comes in for an annual visit to his new GP. Clinical examination reveals a pulse rate of 45 beats per minute. Name the drug(s) likely to be involved in this context: ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Selective beta-blocker","justification":""},{"idx":1,"correct":true,"proposition":"Class III antiarrhythmic","justification":""},{"idx":2,"correct":false,"proposition":"Dihydropyridine group calcium channel blocker","justification":"They are not bradycardic, to the contaire of verapamil\/diltiazem"},{"idx":3,"correct":true,"proposition":"Anticholinesterase","justification":""},{"idx":4,"correct":false,"proposition":"Inhaled rapid-acting, short-acting beta-2 mimetic bronchodilator","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-110","context":null,"enonce":"About trisomy 21 syndrome (one or more exact answers): ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It most often results from a maternal meiotic accident","justification":""},{"idx":1,"correct":false,"proposition":"When combined with a chromosomal formula 46,XX,der(14,21),+21, it does not require a family survey","justification":""},{"idx":2,"correct":false,"proposition":"Its post-natal diagnosis can be confirmed rapidly by molecular biology","justification":""},{"idx":3,"correct":true,"proposition":"Its risk of recurrence is close to 1\/100 to 1\/200 for a couple who had a first child affected","justification":""},{"idx":4,"correct":false,"proposition":"Its risk is decreased by advanced maternal age at the time of conception","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-111","context":null,"enonce":"About histological lesions of glomerulopathies (one or more exact answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Diagnosis of minimal glomerular lesions requires electron microscopy examination","justification":"There is no need to go all the way to the MO. We can be satisfied with the normality of the PBR in MO and MF and the clinical context."},{"idx":1,"correct":true,"proposition":"Segmental and focal hyalinosis may be primary in adults","justification":""},{"idx":2,"correct":true,"proposition":"Membranoproliferative glomerulopathy is characterized by double contours of the glomerular basement membrane","justification":""},{"idx":3,"correct":true,"proposition":"Deposits << humps >> are present in acute post-infectious glomerulonephritis","justification":""},{"idx":4,"correct":true,"proposition":"Diabetes can lead to glomerulopathy","justification":"Proteinuria without hematuria with fundus involvement"}],"type":"qi"}
+{"_id":"annales-2018-qi-112","context":null,"enonce":"Histological diagnosis of prostate adenocarcinoma on biopsy mapping (one or more exact responses): ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Typically requires six biopsy samples","justification":"12"},{"idx":1,"correct":true,"proposition":"May affirm extra-prostatic involvement","justification":""},{"idx":2,"correct":false,"proposition":"Requires biopsy of seminal vesicles","justification":""},{"idx":3,"correct":true,"proposition":"Is specified in his prognosis by Gleason's architectural score","justification":"It's ISUP now:)"},{"idx":4,"correct":false,"proposition":"Is specified in its prognosis by the proliferation index","justification":"Prognosis = ISPU"}],"type":"qi"}
+{"_id":"annales-2018-qi-113","context":null,"enonce":"During surgery, an extemporaneous examination on a tissue sample is requested. The sample must be sent to the pathology laboratory (one or more exact answers)","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"at +4°C","justification":"at room temperature"},{"idx":1,"correct":false,"proposition":"At -20°C"},{"idx":2,"correct":false,"proposition":"Immersed in formalin"},{"idx":3,"correct":true,"proposition":"Without fixing liquid"},{"idx":4,"correct":false,"proposition":"Accompanied by a consent sheet"}],"type":"qi"}
+{"_id":"annales-2018-qi-114","context":null,"enonce":"On a liver biopsy puncture, the diagnosis of acute alcoholic hepatitis (one or more exact answers) is retained ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Neutrophil inflammation","justification":""},{"idx":1,"correct":true,"proposition":"Bloated hepatocytes","justification":""},{"idx":2,"correct":false,"proposition":"Councilman bodies","justification":"Mallory's bodies"},{"idx":3,"correct":false,"proposition":"Cirrhosis","justification":"We are in Acute"},{"idx":4,"correct":false,"proposition":"Cholestasis","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-116","context":null,"enonce":"Regarding Alzheimer's disease, what statement(s) is(are) correct?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Diagnosis is often late","justification":""},{"idx":1,"correct":false,"proposition":"This is a secondary dementia","justification":""},{"idx":2,"correct":false,"proposition":"Behavioural disorders often occur early in the illness","justification":""},{"idx":3,"correct":false,"proposition":"Dubois' 5-word test makes it possible to make the diagnosis","justification":""},{"idx":4,"correct":false,"proposition":"It evolves by flare-up leading to iterative hospitalizations","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-117","context":null,"enonce":"Regarding organ ageing, which is the right proposal(s)? ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is marked by a decrease in maximum capacities","justification":""},{"idx":1,"correct":false,"proposition":"It is mainly due to oxidative stress","justification":"telomere shortening"},{"idx":2,"correct":false,"proposition":"This is a concept without scientific evidence","justification":""},{"idx":3,"correct":true,"proposition":"It is characterized by a reduction in functional reserve capacities","justification":""},{"idx":4,"correct":false,"proposition":"It makes it possible to judge the autonomy of the individual","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-118","context":null,"enonce":"Regarding fragility syndrome, which proposal(s) is(are) right?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is a concept without a precise definition","justification":"Criteria of Fried coughed cough"},{"idx":1,"correct":false,"proposition":"It makes it possible to evaluate the functional reserves of the organs","justification":""},{"idx":2,"correct":true,"proposition":"It is associated with a risk of addiction","justification":""},{"idx":3,"correct":false,"proposition":"It is associated with the risk of pressure ulcers during hospitalization","justification":"There is no definite association in the college between these two elements."},{"idx":4,"correct":false,"proposition":"It is associated with an increased risk of myocardial infarction","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-119","context":null,"enonce":"You take care of an 85-year-old patient for head trauma on vitamin K antagonization (VKA) prescribed for atrial fibrillation. The INR is at 2.9. There is petechia on the brain scan. Which of the following proposals do you retain for your therapeutic care?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" Immediate administration of prothrombin complex concentrate","justification":""},{"idx":1,"correct":false,"proposition":"Administration of vitamin K in 4 hours","justification":""},{"idx":2,"correct":false,"proposition":"Systematic control brain scan in 6 hours","justification":"Only if clinical worsening."},{"idx":3,"correct":false,"proposition":"Discontinuation of vitamin K antagonist with heparin relay at curative dose","justification":""},{"idx":4,"correct":true,"proposition":"Discontinuation of vitamin K antagonist","justification":""}],"type":"qi"}
+{"_id":"annales-2018-qi-120","context":null,"enonce":"Which of the following criteria(s) testify to severe malnutrition in the elderly?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"10% weight loss in 1 month","justification":""},{"idx":1,"correct":false,"proposition":"vitamin K administration in 4 hours","justification":""},{"idx":2,"correct":false,"proposition":"Scamer < systematic control in 6 hours","justification":""},{"idx":3,"correct":false,"proposition":"discontinuation of vitamin K antagonist with heparin relay at an effective dose","justification":""},{"idx":4,"correct":true,"proposition":"discontinuation of vitamin K antagonist","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-1","context":null,"enonce":"Regarding cadaveric lividities, what is (are) the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"They correspond to a blow to the corpse","justification":""},{"idx":1,"correct":true,"proposition":"They correspond to a blood sweat through the vessels after death","justification":""},{"idx":2,"correct":true,"proposition":"They are one of the indicators of the movement of the body after death","justification":"They do not correspond to the parts that are detached in the new position of the body."},{"idx":3,"correct":false,"proposition":"They allow an accurate estimation of the post-mortem time","justification":"The estimate is not very precise (several hours of differential)."},{"idx":4,"correct":false,"proposition":"They are greenish in colour in case of fatal carbon monoxide poisoning","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-2","context":null,"enonce":"Regarding functional dependence in the elderly, which proposal(s) is(are) right?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is measured by the AGGIR grid in clinical practice","justification":""},{"idx":1,"correct":true,"proposition":"It is present if an individual can no longer take public transport","justification":""},{"idx":2,"correct":true,"proposition":"It is present in case of urinary incontinence","justification":""},{"idx":3,"correct":false,"proposition":"It is present in case of decrease in walking speed","justification":"It is a criterion of fragility"},{"idx":4,"correct":true,"proposition":"It can get worse suddenly","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-3","context":null,"enonce":"Acquired epithelial dysplasia is (one or more exact answers):","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A particular form of hyperplasia","justification":""},{"idx":1,"correct":false,"proposition":"A particular form of metaplasia","justification":""},{"idx":2,"correct":true,"proposition":"Synonym of intraepithelial neoplasia","justification":"According to Anapath's college: \"dysplasia (acquired epithelial): morphological alterations testifying to the existence of a neoplastic process at an early, non-invasive stage.\" No crossing of the basement membrane."},{"idx":3,"correct":true,"proposition":"A pre-cancerous lesion","justification":"Anapath College: \"Acquired dysplasia results from genetic abnormalities that alter proliferation control and cell maturation.\" "},{"idx":4,"correct":true,"proposition":"A potentially reversible lesion","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-4","context":null,"enonce":"About antenatal screening for trisomy 21 syndrome, which proposal(s) is (are) accurate?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Amniocentesis for fetal karyotyping is recommended for any pregnant woman over 38 years of age","justification":""},{"idx":1,"correct":true,"proposition":"Combined first trimester screening includes nuchal translucency measurement around 12 weeks of amenorrhea"},{"idx":2,"correct":true,"proposition":"Screening should be offered to all pregnant women","justification":"But it is not obligatory"},{"idx":3,"correct":false,"proposition":"Non-invasive prenatal screening (NIPT) is recommended for ultrasound diagnosis at 24 weeks of pregnancy of an atrioventricular canal","justification":""},{"idx":4,"correct":true,"proposition":"Medical termination of pregnancy for trisomy 21 syndrome is authorized in France until term","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-5","context":null,"enonce":"About Fragile X Syndrome: (one or more correct answers)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" There is never a father-son transmission","justification":""},{"idx":1,"correct":true,"proposition":"There is a correlation between the size of maternal premutation and the risk of having a child with fragile X syndrome","justification":""},{"idx":2,"correct":true,"proposition":"A father carrying the premutation oblIgAtoire transmits his premutation to all his daughters","justification":""},{"idx":3,"correct":true,"proposition":"A woman carrying the premutation in the heterozygous state can develop FXTAS (Fragile X Tremor Ataxia Syndrome) in adulthood.","justification":""},{"idx":4,"correct":true,"proposition":"A man carrying the premutation can develop FXTAS (Fragile X Tremor Ataxia Syndrome) in adulthood.","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-6","context":null,"enonce":"Cat scratch disease: (one or more exact answers)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"can be confirmed by serology","justification":""},{"idx":1,"correct":true,"proposition":"can be confirmed by PCR on lymph node biopsy product","justification":""},{"idx":2,"correct":false,"proposition":"is usually secondary to a cat flea bite","justification":""},{"idx":3,"correct":true,"proposition":"is usually characterized by large lymphadenopathy with a tendency to fistulization","justification":""},{"idx":4,"correct":false,"proposition":"is due to Bartonella bacilliformis","justification":"Bartonella henselae is a Gram-negative bacillus (BGN)."}],"type":"qi"}
+{"_id":"annales-2020-qi-7","context":null,"enonce":"Regarding pelvic endometriosis, what is the exact answer(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is an autosomal recessive disease","justification":"The relative risk for family history is 5. However, it is not a monogenic disease."},{"idx":1,"correct":true,"proposition":"Normal pelvic ultrasound does not eliminate the diagnosis","justification":""},{"idx":2,"correct":true,"proposition":"It can lead to tubal infertility","justification":""},{"idx":3,"correct":true,"proposition":"It leads to early menopause","justification":"The college (2021 version) does not report early menopause in the chapter on endometriosis."},{"idx":4,"correct":true,"proposition":"It can lead to deep dyspareunia","justification":"And no intromission dyspaneuria."}],"type":"qi"}
+{"_id":"annales-2020-qi-8","context":null,"enonce":"A 65-year-old patient is monitored annually for bicuspid aortic insufficiency. He recently developed exertional dyspnea in stage II of the NYHA (New York Heart Association) classification. An echocardiogram is performed, what is (are) the exact proposal(s) concerning this examination in this indication?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Echocardiography helps quantify the extent of leakage","justification":""},{"idx":1,"correct":true,"proposition":"Echocardiography may show dilation of the left ventricle","justification":""},{"idx":2,"correct":true,"proposition":"Echocardiography should look for dilation of the ascending aorta","justification":""},{"idx":3,"correct":false,"proposition":"Echocardiography should evaluate aortic valve cord injuries","justification":"The aortic valve has no cords (mitral and tricuspid valve contreatment)."},{"idx":4,"correct":true,"proposition":"Echocardiography is an essential element to pose the surgical indication","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-9","context":null,"enonce":"A 69-year-old patient underwent surgery for an aortic bicuspid with valve leakage. A bioprosthesis has been placed. Regarding bioprosthetic valves, which is (are) the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Bioprostheses are most often made of titanium or carbon","justification":""},{"idx":1,"correct":false,"proposition":"Bioprostheses require definitive anticoagulant treatment","justification":""},{"idx":2,"correct":true,"proposition":"The durability of bioprostheses is limited","justification":""},{"idx":3,"correct":false,"proposition":"Wearing a bioprosthetic valve prevents the occurrence of endocarditis","justification":""},{"idx":4,"correct":true,"proposition":"Bioprostheses are most often mounted on a metal frame","justification":"This allows the surgeon to make sutures easier."}],"type":"qi"}
+{"_id":"annales-2020-qi-10","context":null,"enonce":"Regarding focal nodular hyperplasia of the liver, which is (are) the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is a tumor with malignant potential requiring a curative resection","justification":""},{"idx":1,"correct":true,"proposition":"Three to five minutes after the CT scan of contrast medium, the lesion loses its enhancement","justification":"UFH receives only arterial blood (and nothing from the portal vein), so there is an early arterial enhancement and then a very progressive peripheral lavage that then leaves a central scar appearance."},{"idx":2,"correct":false,"proposition":"In a woman, it contraindicates any estrogen-progestin treatment","justification":"This proposition would be true if it concerned hepatic adenoma."},{"idx":3,"correct":true,"proposition":"From a histological point of view, it corresponds to a nodular reorganization of an area of hepatic parenchyma","justification":""},{"idx":4,"correct":false,"proposition":"In case of diagnostic certainty, it requires annual monitoring by liver MRI","justification":"No monitoring required."}],"type":"qi"}
+{"_id":"annales-2020-qi-12","context":null,"enonce":"A 45-year-old man consults for an uncomplicated right inguinal hernia. Generated by the regular externalization of this hernia, he wishes to have surgery. You are his general practitioner, you inform him that: (one or more exact answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Surgical treatment is indicated only if the volume of the hernia no longer allows its reintegration","justification":""},{"idx":1,"correct":true,"proposition":"The presence of pain signs symptomatic hernia and indicates surgical treatment","justification":""},{"idx":2,"correct":true,"proposition":"In case of surgery by first inguinal route, the intervention can be performed under local anesthesia","justification":""},{"idx":3,"correct":true,"proposition":"In case of laparoscopic first, the repair is done with a prosthesis","justification":""},{"idx":4,"correct":false,"proposition":"The interposition of a non-absorbable material eliminates the risk of recurrence","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-13","context":null,"enonce":"In lupus nephropathies: (one or more exact answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Mesangial deposits of C1q can be found","justification":""},{"idx":1,"correct":false,"proposition":"Extracapillary proliferation can be seen in class II","justification":"Class II = deposition + mesangial blooms."},{"idx":2,"correct":false,"proposition":"Mesangial hypercellularity in more than half of the glomeruli corresponds to a class IV","justification":"Endocapillary\/extracapillary proliferation."},{"idx":3,"correct":true,"proposition":"Immunoglobulin deposits can be mesangial or extramembranous","justification":"extramembranous = class V"},{"idx":4,"correct":true,"proposition":"Onset before age 15 is a criterion for poor renal prognosis","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-14","context":null,"enonce":"You receive in the emergency room of your hospital a 32-year-old woman who has just attempted suicide by ingesting liquid Destop (soda pipe unblocker). She is conscious. You must: (one or more correct answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Place the patient in a supine position to facilitate intubation if necessary","justification":""},{"idx":1,"correct":false,"proposition":"Place a gastric tube to evacuate caustic fluid","justification":"Especially not because there is a risk of digestive perforation."},{"idx":2,"correct":true,"proposition":"Do an examination of the oral cavity and the ENT sphere","justification":""},{"idx":3,"correct":false,"proposition":"Schedule upper endoscopy within 3 hours of patient admission","justification":"CT injected at H+3 and H+6 from ingestion (not management)"},{"idx":4,"correct":false,"proposition":"Administering activated charcoal","justification":"No antidote"}],"type":"qi"}
+{"_id":"annales-2020-qi-15","context":null,"enonce":"A first-semester intern takes up his duties in a new CHU. He is seen in consultation by the occupational physician. What is (are) the objective(s) of this consultation?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" Trace the previous occupational exposures of this intern","justification":""},{"idx":1,"correct":true,"proposition":"Find out if the intern is not suffering from a dangerous condition for his professional entourage","justification":""},{"idx":2,"correct":true,"proposition":"Check the status of the intern vis-à-vis mandatory vaccinations and recommended for caregivers","justification":""},{"idx":3,"correct":false,"proposition":"Check if the intern has sufficient knowledge to ensure its service","justification":""},{"idx":4,"correct":false,"proposition":"Inform the intern's manager of his\/her medical history","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-16","context":null,"enonce":"A patient, aged 56, has been off work for 6 months after the discovery of non-insulin-dependent diabetes complicated by arterial disease of the lower limbs. This patient is a mason in the building. What are the measures that could help him stay in employment? (one or more possible answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A therapeutic part-time resumption","justification":""},{"idx":1,"correct":false,"proposition":"A third-class disability application","justification":""},{"idx":2,"correct":true,"proposition":"An application for recognition as a disabled worker","justification":""},{"idx":3,"correct":true,"proposition":"A pre-resumption visit to the occupational physician","justification":""},{"idx":4,"correct":false,"proposition":"An extension of sick leave until retirement age","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-17","context":null,"enonce":"Which cancer(s) is (are) staged by the FIGO classification?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Endometrium"},{"idx":1,"correct":false,"proposition":"Multiple myeloma"},{"idx":2,"correct":true,"proposition":"Cervix"},{"idx":3,"correct":true,"proposition":"Ovary"},{"idx":4,"correct":false,"proposition":"Breast"}],"type":"qi"}
+{"_id":"annales-2020-qi-18","context":null,"enonce":"A 32-year-old patient has had renal colic for 3 years. He weighs 75 kg and his blood pressure is 121\/76 mmHg. It presents bilateral calculations of 3 to 8 mm visible to the scanner, density 1000 UH. \n\nIts biological balance shows: Na 142 mmol \/ L, K 4 mmol \/ L, protein 67 g \/ L, serum creatinine 70 μmol \/ L, serum calcium 2.5 mmol \/ L. Diuresis of 24 hours: 1000 mL. \n\n24-hour urinary lonogram shows natriuresis at 200 mmol\/L, kaliuresis at 35 mmol\/L and hypercalciuria. \n\nWhat is (are) the risk factor(s) for lithiasis in this patient?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"High kaluuresis ","justification":""},{"idx":1,"correct":true,"proposition":"Insufficient diuresis","justification":"At least 2 liters per day is recommended."},{"idx":2,"correct":false,"proposition":"Hypercalcemia","justification":""},{"idx":4,"correct":true,"proposition":"Hypercalciuria","justification":""},{"idx":5,"correct":true,"proposition":"Excessive salt intake","justification":"17 mmol NaCl = 1 g NaCl ingested. 200\/17 gives about 200\/20 = 10 g of NaCl per day. This is much more than the 6g \/ D indicated in a patient for secondary prevention of lithiasis."}],"type":"qi"}
+{"_id":"annales-2020-qi-19","context":null,"enonce":"An 88-year-old patient is referred to the emergency room for confusion during a heat wave. He lives in a nursing home. Its usual treatment is amlodipine, metformin, candesartan, furosemide. Its constants are: blood pressure 100\/70 mmHg, heart rate 92\/min, temperature 37.2 °C.  Its biological balance shows: Na 152 mmol\/L, K 5.7 mmol\/L, Chlorine 95 mmol\/L, HCO3- 14 mmol\/L, protein 88 g\/L, urea 20 mmol\/L, serum creatinine 170 μmol\/L. What is the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" The plasma anion hole is 43 mmol\/L (potassium not taken into account)","justification":""},{"idx":1,"correct":false,"proposition":"There is pure intracellular dehydration","justification":""},{"idx":2,"correct":true,"proposition":"Lactic acidosis should be sought","justification":""},{"idx":3,"correct":true,"proposition":"Renal failure explains the decrease in bicarbonates","justification":"Renal failure leads to decreased clearance of potassium and protons. The latter are buffered into the plasma by the bicarbonates, whose concentration then decreases."},{"idx":4,"correct":true,"proposition":"Candesartan promoted hyperkalaemia and acute renal failure","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-20","context":null,"enonce":"A 68-year-old patient is referred to the emergency room for acute kidney failure by his general practitioner. He is hypertensive and diabetic. He has asthenia and diffuse myalgia.\n\nIts constants are: blood pressure 150\/85 mmHg, heart rate 70\/min, temperature 37.7 °C.\n\nRenal ultrasound is normal.\n\nIts biological balance finds:\n• haemoglobin 10.5 g\/dL\n• leukocytes 8 G\/L\n• Na 141 mmol\/L, K 4.2 mmol\/L, Cl 100 mmol\/L, HCO3- 22 mmol\/L, protein 68 g\/L\n• urea 23 mmol \/ L, serum creatinine 350 μmol \/ L\n• urine strip: 2+ proteins, 3+ red blood cells, negative leukocytes, negative nitrites;\n• urine test: Na 100 mmol\/L, K 34 mmol\/L, urea 150 mmol\/L, creatinine 4 mmol\/L, proteinuria 1.5 g\/1.\nWhich proposal(s) is the exact proposal(s) at this stage?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"There is a functional part to his acute renal failure","justification":""},{"idx":1,"correct":false,"proposition":"It may be acute tubular necrosis","justification":"Acute tubular necrosis does not normally regain hematuria or proteinuria."},{"idx":2,"correct":true,"proposition":"It may be rapidly progressive glomerulonephritis","justification":""},{"idx":3,"correct":false,"proposition":"It is necessary to evoke a diabetic nephropathy","justification":""},{"idx":4,"correct":false,"proposition":"It is necessary to evoke a myeloma tubulopathy","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-21","context":null,"enonce":" Which proposal(s) regarding classification bias in analytical (or etiological) epidemiological studies is\/are correct?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Ranking biases may be differential between cases and controls","justification":"That is, the bias is not as strong between cases and controls. That is a possible situation."},{"idx":1,"correct":false,"proposition":"Ranking bias can be controlled for by multivariate analysis","justification":""},{"idx":2,"correct":false,"proposition":"The random selection of controls within a general population avoids ranking bias","justification":""},{"idx":3,"correct":true,"proposition":"Memory bias is a special case of ranking bias","justification":""},{"idx":4,"correct":true,"proposition":"The use of standardized and validated questionnaires makes it possible to limit the risk of ranking bias","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-22","context":null,"enonce":"A 62-year-old man is seeing positive hepatitis C (HCV) serology. Transaminases are raised to twice normal. Which exam(s) are you asking for as a first line?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Liver biopsy","justification":""},{"idx":1,"correct":true,"proposition":"Non-invasive liver fibrosis tests","justification":""},{"idx":2,"correct":true,"proposition":"Hepatic ultrasound","justification":""},{"idx":3,"correct":false,"proposition":"Upper GI endoscopy","justification":""},{"idx":4,"correct":true,"proposition":"HCV viral load","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-23","context":null,"enonce":"Which proposal(s) regarding the informational performance of a test is(are) accurate?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The sensitivity of a test is the conditional probability that the test will be positive if the subject is free of the disease","justification":"Se = T+ \/ M+"},{"idx":1,"correct":true,"proposition":"The specificity of a test is estimated by the proportion of true negatives among subjects free of the disease","justification":"Spe = T- \/ M-"},{"idx":2,"correct":true,"proposition":"The likelihood ratio of a positive test is equal to the ratio of the probability that the test will be positive in a sick subject to the probability that the test will be positive in a subject free of the disease under study","justification":"RV+ = Se \/ (1-Spe). Now, 1-Spe = 1- (T-\/M-). i.e. 1-Spe = T+\/M-. So RV+ = (T+\/M+) \/ (T+\/M-)"},{"idx":3,"correct":false,"proposition":"The likelihood ratio of a negative test is equal to the ratio of sensitivity to specificity","justification":"RV- = (1-Se)\/Spe"},{"idx":4,"correct":true,"proposition":"Negative predictive value is the conditional probability of being free of the disease if the test is negative","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-24","context":null,"enonce":"A 62-year-old patient consults you for pain that has been evolving for 5 days. This pain is permanent, intense and upsets the sitting position. On clinical examination, you perceive a left perianal inflammatory swelling. Inspection of the margin shows nothing in particular. Digital rectal examination is impossible because of pain. What etiology(s) do you mention?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"An fissure","justification":""},{"idx":1,"correct":false,"proposition":"Hemorrhoid thrombosis","justification":"The margin is described as normal. The pain has been permanent for five days (it is gradually decreasing in hemorrhoidal thrombosis)."},{"idx":2,"correct":false,"proposition":"Herpes","justification":""},{"idx":3,"correct":true,"proposition":"A perianal abscess","justification":""},{"idx":4,"correct":false,"proposition":"Chlamydia","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-25","context":null,"enonce":"An X-ray of the entire spine is requested as part of an abnormality of spinal statics. What is (are) the exact proposal(s) concerning this spinal deformity?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"She is left thoracic","justification":""},{"idx":1,"correct":true,"proposition":"There is a rotation of the vertebral bodies","justification":""},{"idx":2,"correct":false,"proposition":"It is, until proven otherwise, idiopathic scoliosis","justification":""},{"idx":3,"correct":false,"proposition":"It is associated with a rocker of the pelvis","justification":""},{"idx":4,"correct":true,"proposition":"Expert advice is needed","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-26","context":null,"enonce":"You are following a 22-year-old patient with a complete block of 21-hydroxylase, with a severe mutation on both alleles. She asks you about the risk of having a child with the same condition with her partner who has no particular history. Knowing that the frequency of heterozygosity in the general population is 1 in 50, what is the exact proposition?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"1 of 2","justification":""},{"idx":1,"correct":false,"proposition":"1 of 4","justification":""},{"idx":2,"correct":false,"proposition":"1 of 25","justification":""},{"idx":3,"correct":false,"proposition":"1 in 50","justification":""},{"idx":4,"correct":true,"proposition":"1 in 100","justification":"The mother will necessarily transmit her relief. So everything depends on the probability of the father to transmit his. The risk of it being heterozygous is 1 in 50. The risk that it will transmit its allele, if it is heterozygous, is 1\/2. 1\/50 * 1\/2 = 1\/100."}],"type":"qi"}
+{"_id":"annales-2020-qi-27","context":null,"enonce":"In a 68-year-old patient, with which etiology(ies) can this skin lesion be associated?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Polygenic hypercholesterolemia","justification":""},{"idx":1,"correct":true,"proposition":"Familial combined hyperlipidemia","justification":""},{"idx":2,"correct":true,"proposition":"Heterozygous familial hypercholesterolemia","justification":""},{"idx":3,"correct":false,"proposition":"A syndrome of familial hyperchylomicronemia","justification":"Clinical signs of hypertrygliceridemia: eruptive xanthomatosis, hepatosplenomegaly, acute pancreatitis (if > 10g\/L), retinal lipemia, abdominal pain."},{"idx":4,"correct":true,"proposition":"An etiology unrelated to dyslipidemia","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-28","context":null,"enonce":"A 6-year-old boy consults for the sudden appearance of diffuse edema within 10 days of a viral episode. His blood pressure is 100\/60 mmHg. The urine strip finds a three-choice proteinuria (+++) without hematuria. Blood urea and creatinine are normal. What is the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Diagnosis of pure nephrotic syndrome is most likely","justification":""},{"idx":1,"correct":false,"proposition":"You have to look for schizocytes","justification":""},{"idx":2,"correct":true,"proposition":"An albuminemia assay is essential","justification":""},{"idx":3,"correct":false,"proposition":"A renal biopsy is indicated before treatment","justification":""},{"idx":4,"correct":false,"proposition":"A hemostasis assessment must be done","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-29","context":null,"enonce":"In a patient with recent parkinsonism syndrome, what element(s) will make you remember a diagnosis other than Parkinson's disease?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A good response to dopatherapy","justification":""},{"idx":1,"correct":true,"proposition":"Falls","justification":""},{"idx":2,"correct":true,"proposition":"Dysautonomia","justification":""},{"idx":3,"correct":true,"proposition":"Cognitive impairment","justification":""},{"idx":4,"correct":false,"proposition":"A slow tremor of 4 - 6 Hz","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-30","context":null,"enonce":"A 25-year-old patient arrives at the emergency room because he has just violently twisted his ankle during a basketball game. His ankle is edematous. What is the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The presence of a sub-lateral malleolar bruise makes the radiographic assessment essential","justification":"It is not the bruise but the pain that falls within Ottawa's criteria"},{"idx":1,"correct":true,"proposition":"The impossibility of taking three steps makes the radiographic assessment essential","justification":""},{"idx":2,"correct":true,"proposition":"Pain of the base of the 5th metatarsal should suggest a tearing of the insertion of the short fibular tendon","justification":""},{"idx":3,"correct":true,"proposition":"An x-ray of the ankle showing a medial malleolar fracture without fracture of the lateral malleolus should be supplemented by an x-ray of the entire leg","justification":"The famous Maisonneuve 😋 fractures"},{"idx":4,"correct":true,"proposition":"A talo-crural effusion is at best visible on the front X-ray","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-31","context":null,"enonce":"On this X-ray of the pelvis from the front, to which anatomical structures do the numbers correspond? (one or more correct answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The number 1 corresponds to the acetabulum","justification":""},{"idx":1,"correct":false,"proposition":"The number 2 corresponds to the major tubercle","justification":"Grand trochanter"},{"idx":2,"correct":false,"proposition":"The number 3 corresponds to the third left obturator foramen","justification":"It's the second (or the first, it depends how you count) 😬"},{"idx":3,"correct":true,"proposition":"The number 4 corresponds to the first left sacred fora men","justification":""},{"idx":4,"correct":true,"proposition":"The number 5 corresponds to the right iliopubic branch","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-32","context":null,"enonce":"A quadriplegic patient complains of feeling the two angles of his jaw differently. Do you consider that it is an attack of the following neurological structure(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Facial nerve","justification":""},{"idx":1,"correct":true,"proposition":"C3 metamer","justification":""},{"idx":2,"correct":false,"proposition":"From the maxillary nerve","justification":""},{"idx":3,"correct":true,"proposition":"C2 metamer","justification":""},{"idx":4,"correct":false,"proposition":"Hypoglossal nerve","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-33","context":null,"enonce":"A patient has ankle pain with swelling following a mild sprain that occurred 3 weeks ago and for which she had not consulted. You suspect complex regional pain syndrome (CRPS) type 1. Which of these proposals concerning the CRPS is the true proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The edema of the SDRC does not take the bucket","justification":""},{"idx":1,"correct":true,"proposition":"CRPS is associated with joint effusion","justification":""},{"idx":2,"correct":false,"proposition":"CRPS is associated with biological inflammatory syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Scintigraphy is essential for diagnosis","justification":""},{"idx":4,"correct":true,"proposition":"X-ray may be normal","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-34","context":null,"enonce":"What are the possible etiologies of eye redness (one or more exact answers)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Acute glaucoma crisis due to angle closure","justification":""},{"idx":1,"correct":false,"proposition":"Obliteration of the central artery of the retina","justification":""},{"idx":2,"correct":true,"proposition":"Infectious keratitis","justification":""},{"idx":3,"correct":false,"proposition":"Posterior uveitis","justification":""},{"idx":4,"correct":true,"proposition":"Corneal ulcer","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-35","context":null,"enonce":"Which of the following are suggestive of an allergic etiology in conjunctivitis? (one or more correct answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Ocular pruritus","justification":"Pruritus strongly evokes an allergy. Pollen-allergic externals (like me) have a distinct advantage here 😅."},{"idx":1,"correct":false,"proposition":"Unilateral infringement","justification":""},{"idx":2,"correct":false,"proposition":"Abundant eye secretions","justification":"Secretions are often abundant in conjunctivitis, whatever their origins."},{"idx":3,"correct":true,"proposition":"Seasonal recurrence","justification":""},{"idx":4,"correct":true,"proposition":"Atopic terrain","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-36","context":null,"enonce":"In case of myopia: (one or more exact answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The optical system formed by the eye is too convergent","justification":""},{"idx":1,"correct":false,"proposition":"Distance vision is better than near vision without correction","justification":""},{"idx":2,"correct":true,"proposition":"Light rays focus in front of the retina","justification":""},{"idx":3,"correct":true,"proposition":"A divergent lens can be used for correction","justification":""},{"idx":4,"correct":true,"proposition":"The risk of retinal detachment may be increased","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-37","context":null,"enonce":"What is the exact proposal(s) regarding vaginal infection with Trichomonas vaginalis?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Upper genital infection is frequently associated","justification":""},{"idx":1,"correct":true,"proposition":"Leucorrhoea has a foul smell","justification":""},{"idx":2,"correct":true,"proposition":"Leucorrhoea are greenish in color","justification":""},{"idx":3,"correct":false,"proposition":"\"Clue-cells\" are visible under a microscope","justification":"This is true with Gardenerella vaginalis infections"},{"idx":4,"correct":false,"proposition":"Treatment includes fluconazole","justification":"👉 Metronidazole "}],"type":"qi"}
+{"_id":"annales-2020-qi-38","context":null,"enonce":"Which of the following infections is (are) the one that can (can) classically be associated with eosinophilia?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Loase","justification":""},{"idx":1,"correct":true,"proposition":"Strongyloidiasis","justification":""},{"idx":2,"correct":false,"proposition":"Pneumocystosis","justification":""},{"idx":3,"correct":false,"proposition":"Malaria","justification":""},{"idx":4,"correct":true,"proposition":"Schistosomosis","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-39","context":null,"enonce":"Which of the following proposals on antibiotic treatment for strep throat is, which is (are) accurate: ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The main goal of treatment is to reduce the risk of post-strep throat glomerulonephritis","justification":"The risk of glomerulonephritis is not diminished by drug treatment (but other complications, such as rheumatic fever, are)."},{"idx":1,"correct":false,"proposition":"One of the goals is to reduce the duration of symptoms by 3 to 4 days","justification":"The duration of symptoms is reduced by a maximum of 48 hours according to studies."},{"idx":2,"correct":true,"proposition":"The first-line treatment is amoxicillin","justification":""},{"idx":3,"correct":false,"proposition":"In case of allergy to first-line treatment, one possibility is levofloxacin","justification":""},{"idx":4,"correct":false,"proposition":"It is necessary to detect the contamination of the close entourage by a Rapid Diagnostic Test (RDT)","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-40","context":null,"enonce":"A young West Indian woman is referred to you by occupational medicine for abnormalities of the blood count. The CBC shows: red blood cells 5.17 T\/L, hematocrit 38.9%, Hb 124 g\/L, MCV 75 fL, MCDC 32 g\/dL, leukocytes 4.0 G\/L, platelets 232 G\/L. What do you do? (only one answer expected)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Determination of ferritinemia","justification":""},{"idx":1,"correct":false,"proposition":"Hemoglobin electrophoresis","justification":"Main lure here 👉 but it is first necessary to dose the ferritinemia before thinking of thalassemia 🤭."},{"idx":2,"correct":false,"proposition":"Determination of reticulocytes","justification":""},{"idx":3,"correct":false,"proposition":"No balance sheet","justification":""},{"idx":4,"correct":false,"proposition":"Oral iron prescription","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-41","context":null,"enonce":"A 70-year-old man consults for a diffuse itchy rash that appeared 48 hours ago, initially on the trunk. He has been widowed for 2 years and has an estimated active smoking of 45 packs years. His history includes plaque psoriasis since the age of 40 localized to the elbows, treated with topical corticosteroids and chronic obstructive pulmonary disease since the age of 55. He has been receiving amoxicillin-clavulanic acid treatment for bronchial superinfection for 10 days. The temperature is at 37.8 degrees Celsius, without alteration of the general condition. Examination of the mucous membranes is normal. There is no sign of Nikolsky. There is no peripheral lymphadenopathy or hepatosplenomegaly. The blood count, liver test and renal function are unremarkable. What diagnosis do you mention? (one or more correct answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Maculopapular exanthema of drug origin","justification":""},{"idx":1,"correct":false,"proposition":"Secondary syphilis","justification":""},{"idx":2,"correct":false,"proposition":"Measles","justification":""},{"idx":3,"correct":false,"proposition":"Acute generalized exanthematous pustulosis","justification":""},{"idx":4,"correct":false,"proposition":"Erythrodermic psoriasis","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-42","context":null,"enonce":"A 35-year-old man, with no particular history, has been complaining for 3 months of redness, heat and intense pain such as burns of both feet. Symptoms appear abruptly, often after exposure to heat, and usually disappear about 1 hour later. What diagnosis do you mention?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Raynaud's syndrome","justification":""},{"idx":1,"correct":true,"proposition":"Erythermalgia","justification":""},{"idx":2,"correct":false,"proposition":"Acrocyanosis","justification":""},{"idx":3,"correct":false,"proposition":"Acrocholosis","justification":"Acrocholosis is mainly observed during certain neurological pathologies such as peripheral neuropathies. Heat sensitization is observed, without any dermatological expression."},{"idx":4,"correct":false,"proposition":"Chilblains","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-43","context":null,"enonce":"Which pleural effusion(s) should be punctured urgently?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Fluid pleural effusion in a context of suspected pulmonary embolism","justification":""},{"idx":1,"correct":false,"proposition":"Fluid pleural effusion in acute heart failure","justification":""},{"idx":2,"correct":true,"proposition":"Fluid pleural effusion in an infectious context","justification":""},{"idx":3,"correct":true,"proposition":"Fluid pleural effusion suspected of hemothorax","justification":""},{"idx":4,"correct":false,"proposition":"Fluid pleural effusion suspected of neoplasia","justification":"This is not an emergency."}],"type":"qi"}
+{"_id":"annales-2020-qi-44","context":null,"enonce":"What main etiology(ies) may be responsible for chronic cough?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Active smoking","justification":""},{"idx":1,"correct":false,"proposition":"Treatment with calcium channel blocker","justification":"By IEC\/ARA2."},{"idx":2,"correct":true,"proposition":"Uncontrolled gastroesophageal reflux disease asthma","justification":""},{"idx":3,"correct":true,"proposition":"GERD","justification":""},{"idx":4,"correct":true,"proposition":"Chronic sinusitis","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-45","context":null,"enonce":"About heart failure, what is the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Its prevalence increases with the age of the population","justification":""},{"idx":1,"correct":true,"proposition":"Ejection fraction is the parameter used to characterize the systolic function of heart failure","justification":""},{"idx":2,"correct":true,"proposition":"Heart failure with preserved systolic function is mainly linked to left ventricular filling disorder","justification":""},{"idx":3,"correct":true,"proposition":"Heart failure with preserved systolic function is very often associated with hypertension","justification":"HTA 👉 Hypertrophic cardiomyopathy 👉 Heart failure with LVEF preserved."},{"idx":4,"correct":false,"proposition":"Heart failure with preserved systolic function is usually associated with","justification":""},{"idx":5,"correct":false,"proposition":"dilation of the left ventricle","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-46","context":null,"enonce":" What are the functional or clinical sign(s) of faecal incontinence?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Liquid oozing","justification":"Fecal incontinence = loss of uncontrolled stool."},{"idx":1,"correct":false,"proposition":"The impossibility of distinguishing the passage of gases and stool","justification":"Not related to faecal incontinence (which is the loss of uncontrolled stool). This proposal refers instead to incontinence, which corresponds to a completely different semiological framework."},{"idx":2,"correct":false,"proposition":"The emission of more than three bowel movements per day","justification":"This corresponds to the definition of diarrhea, of which fecal incontinence is a differential diagnosis to be aware of."},{"idx":3,"correct":true,"proposition":"Loss of the sensation of exonerating need","justification":""},{"idx":4,"correct":false,"proposition":"Urge to defecate","justification":"Tenesmus \/ Epreinte 👉 they are part of the rectal 💩 syndrome"}],"type":"qi"}
+{"_id":"annales-2020-qi-47","context":null,"enonce":"Regarding protein-energy malnutrition, which proposal(s) is(are) accurate?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"It reduces the speed of healing of chronic wounds","justification":""},{"idx":1,"correct":true,"proposition":"It is measured by the evolution of the weight over the last 6 months","justification":""},{"idx":2,"correct":false,"proposition":"It is diagnosed by a MNA score less than 21\/30","justification":""},{"idx":3,"correct":true,"proposition":"It reduces the speed of healing of chronic wounds","justification":""},{"idx":4,"correct":false,"proposition":"It is a consequence of physiological aging","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-48","context":null,"enonce":"Regarding successful ageing, which proposal(s) is\/are right ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Psychosocial determinants are major factors","justification":""},{"idx":1,"correct":false,"proposition":"It occurs only in individuals with a long life expectancy","justification":""},{"idx":2,"correct":false,"proposition":"It cannot exist in individuals with addiction","justification":""},{"idx":3,"correct":true,"proposition":"It partly has a genetic basis","justification":""},{"idx":4,"correct":false,"proposition":"It is superimposed on healthy aging","justification":"It's not just health in life 😉"}],"type":"qi"}
+{"_id":"annales-2020-qi-49","context":null,"enonce":"A bronchioloalveolar lavage with hyperlymphocytosis is seen when: (one or more responses) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Langheransian histiocytosis","justification":"Increase in NNCs"},{"idx":1,"correct":false,"proposition":"Active smoking","justification":"Increase in NNCs"},{"idx":2,"correct":true,"proposition":"Sarcoidosis","justification":"Increase in CD4+"},{"idx":3,"correct":true,"proposition":"Tuberculosis","justification":"Presence of lymphocytes"},{"idx":4,"correct":false,"proposition":"Alveolar hemorrhage","justification":"Presence of sideraphagous"}],"type":"qi"}
+{"_id":"annales-2020-qi-51","context":null,"enonce":"Investors want to estimate the prevalence of diabetes in a French city among subjects aged 18 or older. They draw lots from a representative sample of the subjects registered on the electoral list of that city. Random participants are invited to participate in this study. Which proposal(s) is (are) accurate?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"This is a descriptive epidemiology study","justification":""},{"idx":1,"correct":false,"proposition":"The subjects on the voters list of this city constitute the target population","justification":"Target population = subjects aged 18 or over living in the French city in question"},{"idx":2,"correct":false,"proposition":"Subjects refusing to participate may cause ranking bias","justification":""},{"idx":3,"correct":false,"proposition":"This is a randomized study","justification":""},{"idx":4,"correct":true,"proposition":"This is a cross-sectional study","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-54","context":null,"enonce":"Regarding the medical information transmitted to the patient, which is (are) the right proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The transmission of medical information must be mentioned in the medical record","justification":""},{"idx":1,"correct":true,"proposition":"Information must be clear, fair and appropriate","justification":""},{"idx":2,"correct":false,"proposition":"Proof that the medical information has been issued must be provided by the patient","justification":""},{"idx":3,"correct":true,"proposition":"The patient has the right to refuse to be informed","justification":""},{"idx":4,"correct":false,"proposition":"The physician has the right to refuse to inform a patient","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-55","context":null,"enonce":"A 33-year-old man, driving school instructor, consults for low back pain that has appeared for four months and wakes him up in the morning. You want to eliminate spondyloarthritis. What visible sign(s) on the standard lumbar spine X-ray might be in favor of this diagnosis?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Erosions of the vertebral plateaus","justification":""},{"idx":1,"correct":true,"proposition":"Thin, vertical bone bridges at the periphery of intervertebral discs","justification":""},{"idx":2,"correct":false,"proposition":"Disc pinches","justification":"Sign of osteoarthritis"},{"idx":3,"correct":true,"proposition":"Fusions of zygapophyseal line spacing","justification":""},{"idx":4,"correct":true,"proposition":"A square appearance of the vertebral bodies on profile X-rays","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-56","context":null,"enonce":"A 55-year-old patient comes to consult for pain of the anterior surface of the right thigh radiating to the knee appeared for 5 months. Its body mass index is measured at 32 kg\/m^2. An X-ray of the front pelvis is performed. What diagnosis do you mention on imaging? (only one answer expected)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Coxarthrosis","justification":""},{"idx":1,"correct":false,"proposition":"Fracture due to bone failure","justification":""},{"idx":2,"correct":false,"proposition":"Rheumatoid Coxite","justification":""},{"idx":3,"correct":false,"proposition":"Lysis of the acetabulum","justification":""},{"idx":4,"correct":false,"proposition":"The x-ray is normal, so you evoke cruralgia","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-57","context":null,"enonce":"A 57-year-old patient suffered trauma to her right ankle following a fall. She was unable to regain support on her lower limb when she stood up. She complains of elective pain in the posterior part of the fibula. You have had x-rays of your right ankle. What is the real proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"There is a trans-syndesmotic fibular fracture line","justification":""},{"idx":1,"correct":false,"proposition":"There is a fracture of the distal 1\/3 of the tibial diaphysis","justification":""},{"idx":2,"correct":false,"proposition":"There is a fracture of the neck of the talus","justification":""},{"idx":3,"correct":true,"proposition":"There is a tibio-fibular diastasis","justification":""},{"idx":4,"correct":false,"proposition":"There is a tibiotalar dislocation","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-59","context":null,"enonce":"A 45-year-old woman consults you following a skiing accident 3 days after the trauma. She complains of pain in the inner side of the left knee during flexion\/extension. You do not find patellar shock. You cause this pain on palpation visualized in this photo, as well as in valgus. There is no previous laxity. What is your diagnosis(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A complex regional pain syndrome","justification":""},{"idx":1,"correct":false,"proposition":"A fracture of the medial tibial plateau","justification":""},{"idx":2,"correct":false,"proposition":"A sprain of the anteroexternal cruciate ligament","justification":""},{"idx":3,"correct":true,"proposition":"A sprained medial collateral ligament","justification":"This is the right place and this is the right clinic 😉 Elective pain on flexion\/extension eliminates the fracture. The lack of laxity makes a sprain of the cruciate ligaments unlikely. As for CRPS, we are only 3 days away from trauma and there are no clinical arguments in favor."},{"idx":4,"correct":false,"proposition":"A fracture of the medial edge of the patella","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-60","context":null,"enonce":"A 35-year-old man consults you for a foot falling to the right. He explains that he was crouched for a long time for work. Achilles and quadricipital reflexes are preserved. The manual test finds a right hip abduction at 5\/5, a right leg extension at 5\/5, right foot lifters at 3\/5. The sensitivity of the back of the foot is impaired, while the cutaneous areas of the sole of the foot are respected. The lumbosacral and right hip mobilities are free. What is your most likely diagnosis?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A tendon rupture of a levator muscle in the right foot","justification":"This would not explain the sensory impairment."},{"idx":1,"correct":true,"proposition":"Damage to the right fibular nerve","justification":"This is the right territory 😉: affecting the lifters of the foot (at the motor level) and the back of the foot (at the sensory level)."},{"idx":2,"correct":false,"proposition":"Damage to the right tibial nerve","justification":"The numerous branches of the tibial nerve mainly innervate the muscles and skin of the calf (thus the posterior part of the leg), as well as the sole of the foot. This is not the right semiology!"},{"idx":3,"correct":false,"proposition":"Damage to the right obturator nerve","justification":"The right obturator nerve essentially innervates the thigh, at the motor and sensory level."},{"idx":4,"correct":false,"proposition":"An attack of the right L5 root","justification":"Root involvement is made very unlikely by the highly targeted involvement of a single nervous territory (that of the right fibular)."}],"type":"qi"}
+{"_id":"annales-2020-qi-62","context":null,"enonce":"You see a 63-year-old patient in consultation. A former English teacher, he is being treated for hypertension by an ACE inhibitor. He complains of stage 1 dyspnea of MRD. It has no other functional signs. He weighs 82 kg and is 171 cm tall. In terms of chest examination, palpation and percussion are normal. Auscultation finds bilateral but predominant crackles in the right base. The clinical examination is also strictly normal. He benefited from EFR. You do not yet have imaging tests that will of course be important. \nIn the light of these initial results, which diagnosis do you think is most likely? (only one answer expected)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Heart failure","justification":"This is the main distractor here, but is made less likely by the absence of signs of right heart failure, the lack of correlation between stage 1 dyspnea and the presence of crackling at rest (i.e. crackling is therefore not related to OAP, since the patient is dyspneic only with sustained effort),  the absence of a clear etiology to heart failure (no ACS, no alcohol consumption, etc.). All these arguments make REIT more likely."},{"idx":1,"correct":true,"proposition":"Idiopathic pulmonary fibrosis","justification":""},{"idx":2,"correct":false,"proposition":"Chronic obstructive pulmonary disease","justification":""},{"idx":3,"correct":false,"proposition":"Pleural effusion"},{"idx":4,"correct":false,"proposition":"Asthma"}],"type":"qi"}
+{"_id":"annales-2020-qi-64","context":null,"enonce":"What are the indications for the implementation of oral corticosteroid therapy when a diagnosis of sarcoidosis is highlighted? (one or more correct answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The presence of erythema nodosum","justification":""},{"idx":1,"correct":false,"proposition":"The presence of mediastinal lymphadenopathy exceeding 2 cm in diameter","justification":"The lymphadenopathy of sarcoidosis is not compressive. So OSEF frankly 😂."},{"idx":2,"correct":false,"proposition":"The presence of non-disabling arthralgia","justification":""},{"idx":3,"correct":true,"proposition":"The occurrence of central facial paralysis","justification":""},{"idx":4,"correct":true,"proposition":"The occurrence of hepatic cholestasis with gammaGT and alkaline phosphatases > 2N","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-65","context":null,"enonce":"AL amyloidosis can be revealed as: (one or more possible responses)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Spontaneous hematomas of the eyelids","justification":""},{"idx":1,"correct":true,"proposition":"From macroglossia"},{"idx":2,"correct":true,"proposition":"Polyadenopathy"},{"idx":3,"correct":true,"proposition":"Heart failure"},{"idx":4,"correct":true,"proposition":"Edema of the lower limbs","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-66","context":null,"enonce":"In a 40-year-old patient who has had deep vein thrombosis, what risk factors for venous thrombosis are you looking for? (one or more possible answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Smoking","justification":"It is a risk factor for arterial damage (venous thrombosis is an attack of the veins)."},{"idx":1,"correct":false,"proposition":"High blood pressure","justification":"It is a risk factor for arterial damage (venous thrombosis is an attack of the veins)."},{"idx":2,"correct":true,"proposition":"Air travel of more than 6 hours","justification":""},{"idx":3,"correct":false,"proposition":"Dyslipidemia","justification":"It is a risk factor for arterial damage (venous thrombosis is an attack of the veins)."},{"idx":4,"correct":true,"proposition":"Estrogen-progestin therapy","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-67","context":null,"enonce":"You see in consultation a patient of 34 years, without particular history for the discovery of a splenomegaly exceeding the costal rim of 3 cm. What abnormalities of the blood count could point you to a particular etiology? (one or more possible answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A haemoglobin of 11.5 g\/dl","justification":"Splenic sequestration of red blood cells and platelets is a consequence of splenomegaly (i.e. any splenomegaly, whatever its cause, is accompanied by anemia and thrombocytopenia distribution) and does not point us towards etiology."},{"idx":1,"correct":true,"proposition":"Reticulocytes at 200 G\/L","justification":""},{"idx":2,"correct":false,"proposition":"130 G\/L blisters","justification":""},{"idx":3,"correct":true,"proposition":"Lymphocytes at 13 G\/L","justification":""},{"idx":4,"correct":true,"proposition":"The presence of 2% myelocytes and 3% metamyelocytes","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-68","context":null,"enonce":"In case of exophthalmos, what are the clinical elements that would direct you to a Basedowian origin? (one or more correct answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Retraction of the upper eyelid","justification":""},{"idx":1,"correct":true,"proposition":"Diplopia by involvement of the inferior rectus muscle","justification":""},{"idx":2,"correct":false,"proposition":"Male","justification":""},{"idx":3,"correct":false,"proposition":"Unilateral infringement","justification":""},{"idx":4,"correct":true,"proposition":"Painless nature of exophthalmos","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-69","context":null,"enonce":"What pathology can result in myodesopsia? (only one exact answer) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Macular edema","justification":"Macular edema can give metamorphopsis (for example, in diabetic retinopathy or in AMD) but not myodesopsia."},{"idx":0,"correct":false,"proposition":"Anterior uveitis","justification":""},{"idx":0,"correct":false,"proposition":"Dry syndrome","justification":""},{"idx":0,"correct":false,"proposition":"Nuclear cataract","justification":""},{"idx":0,"correct":true,"proposition":"Retinal detachment","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-70","context":null,"enonce":"Your 66-year-old patient recently received BCG therapy and surgery for a vegetative tumour of the bladder underground, whose histology had concluded that there was high-grade urothelial carcinoma that deeply infiltrated the chorion (T1bG3). You have not yet applied to the health insurance fund for a long-term illness. He was a worker in a dye factory his entire career, until his retirement at age 60. Several of his former colleagues have been recognized as having an occupational disease for the same pathology. He wondered what recognition as an occupational disease would currently bring him, to know whether it was worthwhile to apply for it. What do you say to him? (one or more possible answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Increased daily allowances","justification":"A priori, he is not on sick leave 🤷 ♂️ If he were in AT, he would have an increase in daily allowances."},{"idx":1,"correct":true,"proposition":"A pension, depending on the degree of disability","justification":""},{"idx":2,"correct":false,"proposition":"A conviction of the employer for inexcusable fault","justification":""},{"idx":3,"correct":false,"proposition":"Compensation from the Asbestos Victims Compensation Fund (FIVA)","justification":""},{"idx":4,"correct":true,"proposition":"An exemption from user fees","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-71","context":null,"enonce":"Mrs. D., aged 27, gave birth vaginally 6 weeks ago to a girl weighing 3120 g who is doing well. She describes difficulties in caring for her child. Which of the following symptoms suggest postpartum depression?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Irritability","justification":""},{"idx":1,"correct":false,"proposition":"Temporo-spatial disorientation","justification":""},{"idx":2,"correct":true,"proposition":"Anxiety","justification":""},{"idx":3,"correct":true,"proposition":"Feeling of incapacity","justification":""},{"idx":4,"correct":false,"proposition":"Delirium of negation of the child","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-72","context":null,"enonce":"A 67-year-old woman with autosomal dominant polycystic kidney disease has reached the stage of end-stage renal disease and wants to be transplanted from a cadaveric donor. What is the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"She is past the age limit for kidney transplantation","justification":""},{"idx":1,"correct":false,"proposition":"There is a low risk of recurrence of polycystic disease on the transplant","justification":""},{"idx":2,"correct":false,"proposition":"The donor will necessarily be of the same sex","justification":""},{"idx":3,"correct":true,"proposition":"His risk of cancer will increase after transplantation","justification":""},{"idx":4,"correct":false,"proposition":"Its cardiovascular risk will decrease after transplantation","justification":"The cardiovascular risk is increased after transplantation, especially because of immunosuppressants. It is one of the leading causes of mortality in chronic transplant patients."}],"type":"qi"}
+{"_id":"annales-2020-qi-73","context":null,"enonce":"As part of the law of 2 February 2022 known as the Leonetti-Claeys law<<>>, the legislator has given the right to a patient with a serious and incurable condition to benefit from deep and continuous sedation until death if he decides to stop treatment with the consequence of a short-term commitment of his vital prognosis and unbearable suffering. What deadline has been adopted by the High Authority for Health to define this << short term >>?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Less than 48 hours","justification":""},{"idx":1,"correct":false,"proposition":"Less than 7 days","justification":""},{"idx":2,"correct":true,"proposition":"A few hours to a few days","justification":""},{"idx":3,"correct":false,"proposition":"A few days to a few weeks","justification":""},{"idx":4,"correct":false,"proposition":"1 to 6 months","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-74","context":null,"enonce":"Regarding the physiology of the larynx, what are the exact proposals? (one or more expected answers)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The vibration of the vocal folds is carried out thanks to the pressure under glottigue","justification":""},{"idx":1,"correct":true,"proposition":"The intrinsic muscles are innervated by the inferior laryngeal nerve","justification":""},{"idx":2,"correct":false,"proposition":"Laryngeal dystonia is a common cause of unilateral laryngeal immobility","justification":""},{"idx":3,"correct":true,"proposition":"Unilateral laryngeal immobility may be related to cricoarytenoid dislocation","justification":""},{"idx":4,"correct":true,"proposition":"Multiple sclerosis can lead to unilateral laryngeal immobility","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-75","context":null,"enonce":"Regarding the functional assessment of hearing, what are the exact proposals? (one or more correct answers)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"In the presence of sensorineural hearing loss, the Weber is lateralized on the deaf side","justification":""},{"idx":1,"correct":true,"proposition":"The Rinne test compares the transmission of sounds in air and bone conduction","justification":""},{"idx":2,"correct":false,"proposition":"Tonal audiometry is sufficient to analyze hearing acuity","justification":""},{"idx":3,"correct":true,"proposition":"In the presence of sensorineural hearing loss, the air and bone curves are superimposed","justification":""},{"idx":4,"correct":true,"proposition":"Impedancemetry is used to analyze the function of the tympano-ossicular system","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-76","context":null,"enonce":"A 59-year-old man has dysuria with an indurated nodule, painless occupying less than half of the right prostate lobe on digital rectal examination. The PSA value is 7 ng\/ml What is the evolutionary risk of this disease entity according to the D'Amico classification? (only one answer expected) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Low-risk prostate cancer","justification":""},{"idx":1,"correct":false,"proposition":"Intermediate-risk prostate cancer","justification":""},{"idx":2,"correct":false,"proposition":"High-risk prostate cancer","justification":""},{"idx":3,"correct":false,"proposition":"It is probably not a cancer and the d'Amico classification does not apply","justification":""},{"idx":4,"correct":true,"proposition":"This question cannot be answered with the elements of the statement alone.","justification":"We are missing the Gleason. If it is 3+3 👉 the risk is low. Note that the Gleason has recently been replaced by the ISUP score. This IQ therefore loses some of its interest 😬."}],"type":"qi"}
+{"_id":"annales-2020-qi-77","context":null,"enonce":"A young woman aged 35, practicing the profession of hairdresser consults you for increased lower limb pain at the end of the day and in the pre-menstrual period. These pains are type of heaviness of both legs. On clinical examination, there are no varicose veins but simple telangectasias and vesper edema. You remember the diagnosis of functional venous insufficiency.\n\nWhat measure(s) do you propose for this patient?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Wearing elastic compression","justification":""},{"idx":1,"correct":false,"proposition":"Stripping by bilateral stripping","justification":""},{"idx":2,"correct":false,"proposition":"Echosclerorosis of the great saphenous veins","justification":""},{"idx":3,"correct":true,"proposition":"Regular walking","justification":""},{"idx":4,"correct":true,"proposition":"Elevation of the legs of the bed","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-78","context":null,"enonce":"A 56-year-old patient consults with the results of an abdominopelvic CT scan with injection performed to explore left abdominal pain. The CT scan finds a left renal cyst of 2.9 cm, hyperdense not raising after injection of contrast medium, with thin partitions and fine parietal calcifications. What is your treatment option?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Renal lumpectomy","justification":""},{"idx":1,"correct":true,"proposition":"No treatment or monitoring","justification":"It is an incidentaloma that requires no treatment or supervision."},{"idx":2,"correct":false,"proposition":"Simple left nephrectomy","justification":""},{"idx":3,"correct":false,"proposition":"Left enlarged nephrectomy","justification":""},{"idx":4,"correct":false,"proposition":"Scannographic monitoring every year","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-79","context":null,"enonce":"What is(are) the correct statement(s) regarding permanent tubal sterilization?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"It can be performed in a single woman","justification":""},{"idx":1,"correct":false,"proposition":"It can be performed on a minor woman if both parents (or legal guardians) sign the authorization to operate","justification":""},{"idx":2,"correct":true,"proposition":"It can be performed in a woman who has never had an intrauterine device","justification":""},{"idx":3,"correct":false,"proposition":"It must be carried out after a reflection period of 3 months","justification":"The cooling-off period is... 🌟 4 months ⭐ (do not rage, life is too short)."},{"idx":4,"correct":true,"proposition":"It can be performed in a woman who has never had a child","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-80","context":null,"enonce":"A 65-year-old man consults you for a congenital thoracic nevus that has recently changed, with the appearance of pigment strengthening on two distinct areas. This hyperpigmentation would have started 2 years ago on the lateral edge and, since this summer, the patient has noticed the appearance of a central strengthening of the pigmentation that has become nodular. You suspect a degeneration of this pigment lesion which measures 4 x 3 cm. What is your attitude in the first intention towards this lesion? (only one answer expected) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Prescribing a PET scan","justification":""},{"idx":1,"correct":false,"proposition":"Prescription of a right axillary ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Pigmented nodule biopsy","justification":"This attitude is possible in the face 😊."},{"idx":3,"correct":true,"proposition":"Excision of the entire lesion with a margin of 1 cm","justification":"Suspicion of melanoma 👉 excision then histopathological study. The narrowest margins are chosen. A rework may be carried out depending on the histopathological 🔬 study."},{"idx":4,"correct":false,"proposition":"Excision of the entire lesion with a margin of 2 cm","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-81","context":null,"enonce":"You see in consultation M. P., 35 years old, 3 months from a head trauma. He was hit on a bicycle by a car. He suffered a brief loss of consciousness. The brain CT imaging assessment was without abnormalities. Since then, he complains of concentration difficulties that hinder him in his daily professional life, in particular, and his wife evokes a very marked irritability. What is the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"These symptoms correspond to a subjective syndrome of head trauma","justification":""},{"idx":1,"correct":true,"proposition":"Irritability can be part of dysexecutive semiology","justification":""},{"idx":2,"correct":false,"proposition":"These symptoms require a brain MRI","justification":"No brain MRI in the absence of clinical signs of calling."},{"idx":3,"correct":false,"proposition":"Professional prosecution is compromised","justification":"This proposition is too definitive to be true."},{"idx":4,"correct":true,"proposition":"A thorough neuropsychological evaluation is recommended","justification":"This assessment will be able to objectify the disorders as well as quantify them. It will make it possible to offer appropriate care."}],"type":"qi"}
+{"_id":"annales-2020-qi-83","context":null,"enonce":"A patient describes very severe pain in the right hemiface accompanied by rubefaction of the face and tearing. You mention cluster headache. Which proposal(s) concerning this diagnosis is (are) accurate?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It mainly affects women","justification":""},{"idx":1,"correct":false,"proposition":"It is treated with carbamazepine","justification":"A mnemonic means: \"AVF is rare, you will not see a thousand (verapamil).\" 😍"},{"idx":2,"correct":false,"proposition":"It affects alternately the right and left hemiface","justification":""},{"idx":3,"correct":true,"proposition":"It is treated by inhalation of oxygen","justification":""},{"idx":4,"correct":false,"proposition":"It is treated by thermocoagulation of the Gasser lymph node","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-84","context":null,"enonce":"Which of the following parasitosis is transmitted through skin contact (walking barefoot, swimming)? ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Ascariasis","justification":""},{"idx":1,"correct":true,"proposition":"Strongyloidiasis (anguillulosis)","justification":"barefoot walking"},{"idx":2,"correct":true,"proposition":"Schistosomosis (schistosomiasis)","justification":"bathing"},{"idx":3,"correct":false,"proposition":"Hydatidosis (echinococcosis)","justification":""},{"idx":4,"correct":false,"proposition":"Teniosis","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-85","context":null,"enonce":"In the following list of bacterial infections, which one or are the ones that do not usually cause hyperleucytosis?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Typhoid fever","justification":""},{"idx":1,"correct":false,"proposition":"Necrotizing dermohypodermatitis","justification":""},{"idx":2,"correct":false,"proposition":"Gram-negative liver abscess","justification":""},{"idx":3,"correct":false,"proposition":"Acute pyelonephritis","justification":""},{"idx":4,"correct":true,"proposition":"Pulmonary tuberculosis","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-87","context":null,"enonce":"What element(s) is (are) part of the diagnosis of conversion disorder?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Neurological symptoms","justification":""},{"idx":1,"correct":true,"proposition":"Psychological factor found","justification":""},{"idx":2,"correct":false,"proposition":"Histerionic personality","justification":""},{"idx":3,"correct":false,"proposition":"Simulation","justification":"Patients do not simulate. Their symptoms are sincere."},{"idx":4,"correct":false,"proposition":"Erotomania","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-90","context":null,"enonce":"You receive in the emergency room a 22-year-old patient brought by paramedics, who intervened at home at 9:30 p.m. on a call from her boyfriend. He found his girlfriend in a stuporous and confused state, two hours after an argument that took him out of the house. He doesn't know what happened during those two hours. You find a patient agitated. She aggressively answers your questions and yells that she wants to leave the hospital, struggling violently. You objectify reactive intermediate pupils and phlebotomies on both anterior surfaces of the wrists, the depth of which you cannot determine because of agitation. Which of the following proposals for the management of this patient is: ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The clinical picture makes you reject the hypothesis of benzodiazepine poisoning","justification":"This hypothesis cannot be eliminated."},{"idx":1,"correct":false,"proposition":"You must respect the patient's wishes and let her out","justification":""},{"idx":2,"correct":false,"proposition":"You must physically restrain the patient without chemical restraint","justification":""},{"idx":3,"correct":true,"proposition":"You mention possible alcohol consumption","justification":""},{"idx":4,"correct":false,"proposition":"The patient must be seen immediately by psychiatrists","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-91","context":null,"enonce":"A 25-year-old patient is hospitalized in hematology in the context of induction chemotherapy for acute lymphoblastic leukemia. On call, you are called at 8 p.m. because she \"does not breathe well\". You find a patient lying in bed, restless, polypneic with a supraclavicular pull and a thoraco-abdominal, cyanotic and marbled swing. Vital parameters are: heart rate at 125\/min, blood pressure at 95\/60 mmHg, respiratory rate at 38\/min, SpO2 at 87% under 2 L\/min of oxygen to the nasal glasses. What are you doing while waiting for the mobile resuscitation team? (one or more correct answers)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"You increase the O2 to 5 L\/min with glasses","justification":""},{"idx":1,"correct":false,"proposition":"You increase the O2 to 10 L\/min with glasses","justification":""},{"idx":2,"correct":true,"proposition":"You change the nasal glasses for a high-concentration face mask","justification":""},{"idx":3,"correct":false,"proposition":"You place the patient in the Trendelenburg position","justification":""},{"idx":4,"correct":true,"proposition":"You place the patient in a semi-seated position","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-93","context":null,"enonce":"Regarding immunohistochemistry during an histopathological examination, it is true that: (one or more exact answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It can be done extemporaneously","justification":""},{"idx":1,"correct":true,"proposition":"It is most often done on frozen samples","justification":""},{"idx":2,"correct":true,"proposition":"It highlights proteins","justification":""},{"idx":3,"correct":true,"proposition":"It can be quantitative","justification":"Either directly under the microscope (manual counting) or via flow cytometry techniques."},{"idx":4,"correct":true,"proposition":"It may be for prognostic purposes","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-94","context":null,"enonce":"A 22-year-old patient is referred for consultation by her general practitioner because of an abnormal blood count, which is presented to you below. The patient is asymptomatic, has no fever or other symptoms suggestive of an infectious episode, significant cutaneous or joint signs. The physical examination is normal, and finds no palpable lymphadenopathy or organomegaly.\nWhich of the following explorations do you carry out in 1st intention in this patient?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Hemostasis assessment"},{"idx":1,"correct":true,"proposition":"Hepatic test"},{"idx":2,"correct":false,"proposition":"Myelogram"},{"idx":3,"correct":false,"proposition":"Anti-native DNA antibodies"},{"idx":4,"correct":false,"proposition":"Thoraco-abdomino-pelvic CT scan","justification":"The systematic first-line assessment in front of isolated thrombocytopenia reminiscent of ITP is: CBC on citrated tube (if suspected of false thrombocytopenia with EDTA), a blood smear, a PPE, HIV HBV HCV serologies, a liver test, NAAs, a renal assessment (creatinine, hematuria), a hemostasis assessment (TP, TCA, fibrinogen), grouping and RAI (in severe forms). According to the PNDS of the HAS: https:\/\/www.has-sante.fr\/upload\/docs\/application\/pdf\/2017-06\/dir36\/pnds-_purpura_thrombopenique_immunologique.pdf"}],"type":"qi"}
+{"_id":"annales-2020-qi-95","context":null,"enonce":"Which of the following proposals can (may) constitute a criminal offence that can be charged against a doctor?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Writing a false certificate","justification":""},{"idx":1,"correct":false,"proposition":"Lack of information provided to the patient","justification":"Ordinal and civil offense, but not criminal."},{"idx":2,"correct":true,"proposition":"Non-assistance to a person in danger","justification":""},{"idx":3,"correct":true,"proposition":"The technical fault","justification":""},{"idx":4,"correct":true,"proposition":"Intentional homicide","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-96","context":null,"enonce":"A 15-year-old woman consults for heavy menstruation for 10 to 15 days a month since menarche. Which additional exam(s) do you prescribe as a first-line treatment?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Bleeding time","justification":"Really no longer done at the ECN (especially in the first line) 😅"},{"idx":1,"correct":false,"proposition":"Antithrombin III assay","justification":""},{"idx":2,"correct":false,"proposition":"Plasma Factor V assay","justification":""},{"idx":3,"correct":true,"proposition":"Complete blood and platelet count","justification":""},{"idx":4,"correct":true,"proposition":"Plasma determination of Willebrand factor ","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-97","context":null,"enonce":"You welcome to the emergency room Mrs. X. aged 75, referred by her doctor because of a picture of acute anuric renal failure in a context of diarrhea. Blood sugar levels measured in the city 3 hours earlier were 6.9 mmol\/L. At the time of the transfer to her bed in a cubicle, she suddenly loses consciousness. His pulse is no longer perceived. The scope is not yet plugged in. Which of the following proposals regarding its management is (are) accurate?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"You start by ventilating it with a balloon","justification":""},{"idx":1,"correct":true,"proposition":"You massage it right away","justification":""},{"idx":2,"correct":false,"proposition":"You immediately inject 1 mg of adrenaline","justification":""},{"idx":3,"correct":true,"proposition":"You have the external defibrillator brought in immediately","justification":""},{"idx":4,"correct":true,"proposition":"You prescribe intravenous calcium","justification":"Calcium gluconate has a cardioprotective function in hyperkalemia. In case of taking digitalis, magnesium chloride should rather be prescribed."}],"type":"qi"}
+{"_id":"annales-2020-qi-98","context":null,"enonce":"A 73-year-old man presents for dermatology for itchy skin lesions evolving for 2 years having started in the groin and pubis, with recent extension to the upper limbs, face and neck, despite treatment with antihistamines and very strong local dermocorticosteroids (clobetasol). The history includes untreated hypertension, prostatectomy for adenoma he was 3 years old and left total nephrectomy for kidney cancer he was 5 years old. Which test will be most cost-effective to confirm the diagnosis you suspect?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Cutaneous histology","justification":"Bullous dermatosis is not suspected in front of this table."},{"idx":1,"correct":false,"proposition":"Direct cutaneous immunofluorescence","justification":"Bullous dermatosis is not suspected in front of this table."},{"idx":2,"correct":false,"proposition":"Complete blood count","justification":""},{"idx":3,"correct":false,"proposition":"Search for clonality in the skin by PCR","justification":""},{"idx":4,"correct":true,"proposition":"Mycological skin sampling","justification":"Dermatophytosis is suspected here. The most cost-effective examination is therefore a mycological sample to find out what we are ⚔ fighting against."}],"type":"qi"}
+{"_id":"annales-2020-qi-99","context":null,"enonce":"A 45-year-old man consults you for dyspnea of effort. On cardiac auscultation, you find a proto-meso-diastolic murmur better perceived when sitting. Blood pressure is 120\/40 mmHg in both arms. Neck inspection finds synchronous pulse beats. What is your diagnosis?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Benign acute pericarditis","justification":""},{"idx":1,"correct":true,"proposition":"Aortic insufficiency","justification":""},{"idx":2,"correct":false,"proposition":"Mitral prolapse or Barlow's disease","justification":""},{"idx":3,"correct":false,"proposition":"!right heart failure","justification":""},{"idx":4,"correct":false,"proposition":"Aortic coarctation","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-100","context":null,"enonce":"As a general practitioner, you detect an HIV infection in a 27-year-old butcher. Several butchers work in his butcher shop and they share knives. Which prevention measure should you propose first (only one expected response)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Prescription of sick leave until an undetectable viral load is obtained","justification":""},{"idx":1,"correct":false,"proposition":"Tell the patient to inform other butchers of their HIV status","justification":""},{"idx":2,"correct":true,"proposition":"Recommend the use of strictly personal knives","justification":"Primary prevention measures are more urgent to put in place than secondary prevention measures (telling colleagues that they should be tested)."},{"idx":3,"correct":false,"proposition":"Inform other butchers yourself of this HIV status","justification":""},{"idx":4,"correct":false,"proposition":"Request the patient's invalidity from the medical officer","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-101","context":null,"enonce":"A 4-year-old boy is brought to the emergency room for a hematemesis that occurred in a context of rheumatoid purpura started 3 days earlier. Upon diagnosis, he complained of abdominal pain that was treated symptomatically. His heart rate is 120 beats per minute, his systolic blood pressure is 110 mmHg, his temperature is 37.1°C.  Abdominal palpation is painful, defenseless. What is the most likely diagnosis?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Acute intussusception","justification":"No hematemesis in IIA."},{"idx":1,"correct":false,"proposition":"Duodenal ulcer","justification":"This potit patient has no reason to have a duodenal 🤷 ♂️ ulcer"},{"idx":2,"correct":false,"proposition":"Swallowed epistaxis","justification":"The college reminds us several times: a swallowed epistaxis is not a cause of hematemesis but a differential diagnosis!"},{"idx":3,"correct":false,"proposition":"Esophagitis","justification":"This potit patient has no reason to have esophagitis 🤷 ♂️"},{"idx":4,"correct":true,"proposition":"Hematoma of the gastric wall","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-102","context":null,"enonce":"A 68-year-old man consults his GP for a recent onset resting tremor. The clinical examination shows a slowdown at the initiation of movements and a phenomenon of << cogwheel >> at the wrists. What medication(s) should you look for before making a definitive diagnosis?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Selective 5-hydroxytryptamine-1D receptor agonists (triptans)","justification":"Triptans are not a classic cause of iatrogenic parkinsonism syndrome."},{"idx":1,"correct":true,"proposition":"Certain intestinal motor stimulants, such as metoclopramide","justification":""},{"idx":2,"correct":true,"proposition":"Neuroleptics of the phenothiazine class","justification":""},{"idx":3,"correct":true,"proposition":"Some antihistamines for systemic use, such as alimemazine","justification":""},{"idx":4,"correct":true,"proposition":"Neuroleptics of the butyrophenone class","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-103","context":null,"enonce":"A young man consults the emergency room following an assault. His attacker stabbed him in the face. It has a transfixing jugal wound of 5 cm, above the lateral canthus (see diagram). What anatomical elements can be damaged by this wound? (one or more expected answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The frontal branch of the facial nerve","justification":""},{"idx":1,"correct":true,"proposition":"The parotid salivary duct","justification":""},{"idx":2,"correct":true,"proposition":"The oral branch of the facial nerve","justification":""},{"idx":3,"correct":true,"proposition":"The facial artery"},{"idx":4,"correct":false,"proposition":"The infraorbital nerve"}],"type":"qi"}
+{"_id":"annales-2020-qi-104","context":null,"enonce":"A 79-year-old man with Parkinson's disease has intense and continuous suprapubic pain. He has not been able to urinate for several hours. Palpation shows a rounded suprapubic mass, matte to percussion. It is treated with dopaminergics (levodopa-benserazide), sympathomimetic (midodrine) for orthostatic hypotension and alpha-blocker (tamsulosin). After bladder probing, what modification(s) of the drug treatment do you propose?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Decrease in the dosage of levodopa-benserazide","justification":""},{"idx":1,"correct":false,"proposition":"Discontinuation of tamsulosin"},{"idx":2,"correct":true,"proposition":"Discontinuation of midodrine"},{"idx":3,"correct":false,"proposition":"Introduction of furosemide"},{"idx":4,"correct":false,"proposition":"Introduction of a beta-blocker","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-106","context":null,"enonce":"A 34-year-old woman was diagnosed with pulmonary tuberculosis. A triple antibiotic therapy (rifampicin, isoniazid, pyrazinamide) is implemented. Its only usual treatment is oral contraception (levonorgestrel, ethinyl estradiol). What advice(s) do you have?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Use a mechanical contraceptive method for the duration of rifampicin treatment","justification":""},{"idx":1,"correct":false,"proposition":"Replace current contraception with a progestin","justification":"Rifampicin is an enzyme inducer that reduces the effectiveness of oral contraception."},{"idx":2,"correct":true,"proposition":"Inform about the risk of reducing the contraceptive effectiveness of an estrogen-progestin","justification":""},{"idx":3,"correct":false,"proposition":"Increase the dose of ethinyl estradiol","justification":""},{"idx":4,"correct":false,"proposition":"Regularly dose plasma rifampicin","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-107","context":null,"enonce":"A vestibular schwannoma can be diagnosed before: (one or more expected responses) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" Sudden deafness","justification":""},{"idx":1,"correct":false,"proposition":"Unilateral conductive hearing loss of slowly progressive evolution","justification":"Deafness is conductive."},{"idx":2,"correct":true,"proposition":"Facial paralysis","justification":""},{"idx":3,"correct":true,"proposition":"Ataxia with frustrated walking","justification":"Vestibular 👉 involvement Ataxia with light walking (= frustrated)."},{"idx":4,"correct":false,"proposition":"Minimal otolicorrhea","justification":"It's a bit far from the external 😉 ear canal"}],"type":"qi"}
+{"_id":"annales-2020-qi-108","context":null,"enonce":"A 75-year-old patient complains of a cough, with colored sputum, in a context of fever evolving for 72 hours. Her doctor did not notice any signs of seriousness and prescribed probabilistic clarithromycin antibiotics. Its usual treatment is limited to ezetimibe-simvastatin and low-dose acetylsalicylic acid. What advice(s) could you make?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"No therapeutic modification","justification":""},{"idx":1,"correct":true,"proposition":"Discontinuation of simvastatin for the duration of clarithromycin treatment","justification":"Macrolides are enzyme inhibitors. There is no risk in stopping statins for a few days."},{"idx":2,"correct":false,"proposition":"Discontinuation of acetylsalicylic acid for the duration of treatment with clarithromycin","justification":""},{"idx":3,"correct":false,"proposition":"Decrease in ezetimibe dosage during treatment with clarithromycin","justification":""},{"idx":4,"correct":false,"proposition":"Replacement of clarithromycin with erythromycin","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-109","context":null,"enonce":"Speech therapy sessions may be prescribed in case of: (one or more expected responses) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Severe bilateral deafness of the child","justification":""},{"idx":1,"correct":true,"proposition":"Stuttering in an adult","justification":""},{"idx":2,"correct":true,"proposition":"Decreased post-traumatic oral opening","justification":""},{"idx":3,"correct":true,"proposition":"Meniere's disease after an acute phase","justification":""},{"idx":3,"correct":true,"proposition":"acquisition of an esophageal voice","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-11","context":null,"enonce":"Jules, 7, is scheduled to have surgery for phimosis. The preoperative hemostasis assessment shows: Quick time (TQ) = 12.5 s; control= 11.5 s; ratio: 1.08; cephalin time with activator (TCA) = 59 s; control= 32 s; ratio: 1.84; fibrinogen 2.8 g\/L (standards: 2-4 g\/L); blisters 290 G\/L. \n\nWhat are the diagnostic hypotheses to be formulated in Jules in front of this hemostasis assessment? (one or more correct answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Willebrand disease","justification":""},{"idx":1,"correct":true,"proposition":"Factor XI deficiency","justification":"TCA: factor VIII (hemophilia A, Willebrand disease because this factor is protected by Willebrand factor), factor IX (hemophilia B), factor XI and factor XII."},{"idx":2,"correct":false,"proposition":"Protein C deficiency","justification":""},{"idx":3,"correct":true,"proposition":"Hemophilia A","justification":""},{"idx":4,"correct":true,"proposition":"Hemophilia B","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-111","context":null,"enonce":"A woman of Martinican origin has just given birth. The child's father is also of Martinican origin. The child has a cleft lip and palate. With regard to regulatory newborn screening of this child, what is the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Phenylketonuria is the only disease of amino acid and organic acid metabolism currently being screened for newborn in France","justification":"Now there is the MCAD deficiency"},{"idx":1,"correct":false,"proposition":"General screening test can detect hypothyroidism of pituitary origin","justification":""},{"idx":2,"correct":true,"proposition":"This couple can refuse the screening after information","justification":""},{"idx":3,"correct":true,"proposition":"Completion before 48 h of life decreases the sensitivity and\/or specificity of the screening test","justification":""},{"idx":4,"correct":false,"proposition":"Targeted screening for sickle cell disease is not indicated in this child","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-112","context":null,"enonce":"You receive a 3-month-old infant for a systematic visit. He was born at term after a normal pregnancy. You saw him at the age of 2 months for his vaccinations, his examination was normal. He is very awake but moves spontaneously very little. What proposal(s) is (are) in favor of peripheral neurological involvement?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Essentially axial hypotonia","justification":""},{"idx":1,"correct":true,"proposition":"Normal head circumference","justification":""},{"idx":2,"correct":false,"proposition":"Presence of oculomotor disorders","justification":""},{"idx":3,"correct":true,"proposition":"Presence of smile response","justification":""},{"idx":4,"correct":false,"proposition":"Presence of dysmorphic signs","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-114","context":null,"enonce":"You organize the care pathway of a 90-year-old patient, previously autonomous and living at home, admitted following a fracture of the upper end of the femur operated the day before with the placement of an intermediate prosthesis without surgical complications. Which proposal(s) are (are) part of your care?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Immediate resumption of walking","justification":""},{"idx":1,"correct":true,"proposition":"Preventive anticoagulation for a period of 45 days","justification":""},{"idx":2,"correct":false,"proposition":"Routine prescription of oral nutritional supplements","justification":""},{"idx":3,"correct":false,"proposition":"Prescribing benzodiazepines to ensure restful sleep","justification":""},{"idx":4,"correct":true,"proposition":"Prescription of bisphosphonates in case of femoral T-score ≤ -1","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-115","context":null,"enonce":" Which symptom(s) is part of the clinical picture of a hypomanic episode?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Disorganization of thought","justification":"Disorganization of thought is classically not found in bipolarity (rather a symptom of schizophrenia)."},{"idx":1,"correct":true,"proposition":"Distractibility","justification":""},{"idx":2,"correct":false,"proposition":"Suicidal ideation","justification":"The presence of suicidal ideation classifies the clinical picture in the manic phase."},{"idx":3,"correct":true,"proposition":"Megalomaniac ideas","justification":""},{"idx":4,"correct":true,"proposition":"Irritability","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-116","context":null,"enonce":"In front of a twelve-month-old child, what proposal(s) do you remember as a warning sign of a neurodevelopmental disorder?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" A lack of joint attention","justification":""},{"idx":1,"correct":false,"proposition":"Separation anxiety","justification":"This is quite normal at this age."},{"idx":2,"correct":false,"proposition":"A lack of daytime cleanliness","justification":""},{"idx":3,"correct":true,"proposition":"A lack of smile-response","justification":""},{"idx":4,"correct":true,"proposition":"An absence of nycthemeral periodicity of sleep","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-117","context":null,"enonce":"A 34-year-old patient complains of excessive anxiety. Which of the following symptoms specifically points to a diagnosis of generalized anxiety disorder?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" Irritability","justification":""},{"idx":1,"correct":true,"proposition":"A delay in falling asleep of more than 1 hour"},{"idx":2,"correct":false,"proposition":"Significant anxiety when speaking in public","justification":"This proposal refers to social phobia."},{"idx":3,"correct":true,"proposition":"A fatIgAbility","justification":""},{"idx":4,"correct":false,"proposition":"A sad mood for two weeks following an emotional breakdown","justification":"This proposal refers to the characterized depressive episode."}],"type":"qi"}
+{"_id":"annales-2020-qi-118","context":null,"enonce":"The mother of a 17-year-old patient smoking cannabis asks you about the risks associated with this use, acute or chronic. What information(s) is(are) accurate about this?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Possible occurrence of delirium","justification":""},{"idx":1,"correct":true,"proposition":"Possible occurrence of a withdrawal syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Increased risk of status seizure","justification":""},{"idx":3,"correct":true,"proposition":"Increased risk of bronchopulmonary disease","justification":""},{"idx":4,"correct":true,"proposition":"Risk of precipitating entry into schizo p hrenia in vulnerable individuals","justification":""}],"type":"qi"}
+{"_id":"annales-2020-qi-120","context":null,"enonce":"You are the general practitioner of Mr. M., 75 years old, who has been suffering for 3 years from small cell lung cancer. He is also followed by a mobile palliative care team for the management of very disabling pain related to bone metastases. The patient lives at home with his wife. With your agreement, the mobile team doctor came to see the patient at home because of an increase in the pain picture. He decided to modify the analgesic treatment by introducing corticosteroids and increasing the opioid treatment. 48 hours later, during her visit to her home, the liberal nurse calls you because she suspects an overdose with opioids. What is the most important question to ask?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Does the patient have a miosis?","justification":""},{"idx":1,"correct":false,"proposition":"Did the patient vomit that night?","justification":""},{"idx":2,"correct":true,"proposition":"What is the patient's respiratory rate?","justification":""},{"idx":3,"correct":false,"proposition":"Is the patient drowsy?","justification":""},{"idx":4,"correct":false,"proposition":"Is the patient painful?","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-2","context":null,"enonce":" In consultation with his parents, you will see a 16-year-old teenager who has been suffering from generalized tonic-clonic seizures since the age of 12. Her epilepsy is poorly balanced by treatment (valproate). They ask you about his academic orientation, because he must choose a professionalizing path. They considered several possibilities. Among those they mention to you, which one (which) do you advise against (one or more expected proposals)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"tiler","justification":""},{"idx":1,"correct":false,"proposition":"Delivery driver","justification":""},{"idx":2,"correct":false,"proposition":"carpenter","justification":""},{"idx":3,"correct":false,"proposition":"car mechanic","justification":""},{"idx":4,"correct":false,"proposition":"roofer","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-3","context":null,"enonce":" Regarding AA amyloidosis, what is (are) the exact proposal(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"the kidney is frequently affected","justification":""},{"idx":1,"correct":false,"proposition":"the heart is frequently affected","justification":""},{"idx":2,"correct":false,"proposition":"the peripheral nerve is frequently affected","justification":""},{"idx":3,"correct":false,"proposition":"it is linked to an accumulation of IgA","justification":""},{"idx":4,"correct":false,"proposition":"Diagnosis can be made on a salivary gland biopsy","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-4","context":null,"enonce":" Regarding mutations in the APC gene in familial adenomatous polyposis syndrome, which proposals are correct? (one or more proposals expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Pathogenic mutations in this gene are expressed in the heterozygous state","justification":""},{"idx":1,"correct":false,"proposition":"A colonoscopy may be offered to minors","justification":""},{"idx":2,"correct":false,"proposition":"Genetic exploration must be offered to relatives","justification":""},{"idx":3,"correct":false,"proposition":"Upper gastrointestinal involvement is possible and warrants gastroscopy","justification":""},{"idx":4,"correct":false,"proposition":"Mutations in this gene predispose to breast cancer","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-5","context":null,"enonce":" Regarding cadaveric lividities, which is (are) the exact proposal(s):","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"They are dependent on the type of insects present on the corpse","justification":""},{"idx":1,"correct":false,"proposition":"They are less marked in case of internal bleeding at the time of death","justification":""},{"idx":2,"correct":false,"proposition":"They are non-existent in melanoderma individuals","justification":""},{"idx":3,"correct":false,"proposition":"They are one of the indicators of the post-mortem time","justification":""},{"idx":4,"correct":false,"proposition":"They are due to a passive phenomenon of blood sweating after death","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-6","context":null,"enonce":" A 42-year-old patient has cervical angioedema. The blood laboratory test shows a deficiency of C1 esterase inhibitor. Which drug(s) is (are) likely to be involved?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"proton pump inhibitors","justification":""},{"idx":1,"correct":false,"proposition":"calcium channel blockers","justification":""},{"idx":2,"correct":false,"proposition":"Selective competitive bradykinin receptor antagonist type 2","justification":""},{"idx":3,"correct":false,"proposition":"sartans","justification":""},{"idx":4,"correct":false,"proposition":"ACE inhibitors","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-7","context":null,"enonce":" Mr. C., 60 years old, is followed by his general practitioner whom he declared as a general practitioner. The latter has just diagnosed him with chronic obstructive pulmonary disease. The patient presents an active smoking quantified at 45 pack-years. He has just been admitted to long-term illness. He has no other pathology and is totally autonomous. Which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It is exempt from the flat-rate contribution of € 1 per consultation","justification":""},{"idx":1,"correct":false,"proposition":"He is exempt from the co-payment for all medical examinations that he will have to carry out","justification":""},{"idx":2,"correct":false,"proposition":"It benefits from a management of nicotine substitutes","justification":""},{"idx":3,"correct":false,"proposition":"He benefits from 100% coverage of his ambulance transport for all his consultations","justification":""},{"idx":4,"correct":false,"proposition":"In case of hospitalization, the hospital package may be reimbursed, in part or in full, by its complementary health","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-8","context":null,"enonce":" You receive a 70-year-old patient with a history of myocardial infarction, who has uncontrolled epistaxis. What will be the elements of your care? (one or more expected answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"you ask him not to blow his nose","justification":""},{"idx":1,"correct":false,"proposition":"you set up a venous line","justification":""},{"idx":2,"correct":false,"proposition":"you perform an ECG","justification":""},{"idx":3,"correct":false,"proposition":"You request a CT scan of the facial mass","justification":""},{"idx":4,"correct":false,"proposition":"embolization will be the first-line treatment","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-9","context":null,"enonce":" Here is an X-ray of the elbow in profile made in the context of a trauma. What is (are) the exact element(s) of radioanatomy?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"1 corresponds to the radius neck","justification":""},{"idx":1,"correct":false,"proposition":"2 corresponds to the olecranium","justification":""},{"idx":2,"correct":false,"proposition":"3 corresponds to the capitulum","justification":""},{"idx":3,"correct":false,"proposition":"4 corresponds to the ulna","justification":""},{"idx":4,"correct":false,"proposition":"5 corresponds to the coracoid process","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-10","context":null,"enonce":" A 45-year-old patient has weakness of the left hemibody predominant in the arm. His entourage tells you that he hit his left side several times when crossing the doors of his home. The bilateral and simultaneous tactile stimulation of the 2 upper limbs is not perceived on the left while the right and left stimulations are perfectly identified when the stimulation is done only on one side. By asking the patient to stare at your nose and alternately mobilizing your hands, he cannot discern the movements of your right hand while your left hand is perfectly perceived. The osteotendinous reflexes are more vivid on the left than on the right. The plantar skin reflex is extended to the left. Which clinical sign(s) should be mentioned?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"left hemicorporeal hypoaesthesia","justification":""},{"idx":1,"correct":false,"proposition":"Left sensory extinction","justification":""},{"idx":2,"correct":false,"proposition":"Left homonymous lateral hemianopsia","justification":""},{"idx":3,"correct":false,"proposition":"left pyramidal syndrome","justification":""},{"idx":4,"correct":false,"proposition":"extrapyramidal syndrome","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-11","context":null,"enonce":" One patient is being followed for minimal corticosteroid-dependent glomerular lesions syndrome. He suddenly relapses to the decline of corticosteroids. He gained 10 kg in 1 week. Its biology is as follows: albuminemia 12g \/ l, urea 25 mmol \/ l, serum creatinine 160 micromol \/ l, natriuresis 12 mmol \/ l, kaliuresis 35 mmol \/ l. ECBU: red blood cells <1000 \/ ml, leukocytes <1000 \/ ml, sterile in 24h. What is the most likely cause of acute renal failure in this patient?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"functional renal impairment by relative (or effective) hypovolemia","justification":""},{"idx":1,"correct":false,"proposition":"Functional renal impairment by true hypovolemia","justification":""},{"idx":2,"correct":false,"proposition":"thrombosis of renal veins","justification":""},{"idx":3,"correct":false,"proposition":"glomerular extracapillary proliferation","justification":""},{"idx":4,"correct":false,"proposition":"Extramembranous deposits","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-12","context":null,"enonce":" Which of the following symptoms is (are) part of the diagnosis of obsessive-compulsive disorder?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Ideative obsessions","justification":""},{"idx":1,"correct":false,"proposition":"fear of committing a reprehensible act in spite of oneself","justification":""},{"idx":2,"correct":false,"proposition":"Reference ideas","justification":""},{"idx":3,"correct":false,"proposition":"suicidal ruminations","justification":""},{"idx":4,"correct":false,"proposition":"verification rituals","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-13","context":null,"enonce":" You suspect multiple myeloma in a 58-year-old patient who comes to see you for impaired general condition and bone pain. It has a peak of monoclonal appearance at electrophoresis. Which exams do you think are relevant to perform? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Bone densitometry","justification":""},{"idx":1,"correct":false,"proposition":"A myelogram","justification":""},{"idx":2,"correct":false,"proposition":"Determination of serum calcium","justification":""},{"idx":3,"correct":false,"proposition":"Serum albumin determination","justification":""},{"idx":4,"correct":false,"proposition":"Determination of beta2 microglobulinemia","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-14","context":null,"enonce":" Regarding small cell lung cancers, what is (are) the exact answer(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"They represent 35% of all bronchial cancers","justification":""},{"idx":1,"correct":false,"proposition":"These are willingly cancers with proximal localization on the airways","justification":""},{"idx":2,"correct":false,"proposition":"They are readily accompanied by superior cava syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Paraneoplastic syndromes are exceptional in this histological form","justification":""},{"idx":4,"correct":false,"proposition":"Treatment is more often surgical in locally advanced forms","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-15","context":null,"enonce":" Mrs. F, 22, has a microcytic iron deficiency anemia of gynecological origin. You prescribe a martial treatment per os. What do you say to him? (one or more possible answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"An oral treatment of 1 month is usually sufficient to correct the iron deficiency","justification":""},{"idx":1,"correct":false,"proposition":"Martial supplementation will be continued until serum iron normalizes","justification":""},{"idx":2,"correct":false,"proposition":"Treatment can lead to digestive disorders","justification":""},{"idx":3,"correct":false,"proposition":"vitamin C increases oral iron absorption","justification":""},{"idx":4,"correct":false,"proposition":"oral iron causes stool discoloration","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-16","context":null,"enonce":" With regard to thyroid goiters, which proposition(s) is(are) true?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Iodine deficiency is a risk factor for simple goiter","justification":""},{"idx":1,"correct":false,"proposition":"Tobacco promotes the occurrence of goiters","justification":""},{"idx":2,"correct":false,"proposition":"A scintigraphy is the first-line examination in front of a goiter","justification":""},{"idx":3,"correct":false,"proposition":"The cervico-thoracic CT scan is used to diagnose plunging goiters","justification":""},{"idx":4,"correct":false,"proposition":"the blood test of TSH is essential in the goiter assessment","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-17","context":null,"enonce":" Which of the following proposals regarding indications for bariatric surgery is (are) true?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"BMI should be greater than 40 kg\/m2 or 35 kg\/m2 if there is associated co-morbidity","justification":""},{"idx":1,"correct":false,"proposition":"The indication for bariatric surgery should be taken in a multidisciplinary consultation meeting for all patients","justification":""},{"idx":2,"correct":false,"proposition":"Surgery can only be offered after failure of well-conducted medical care for at least 6 months","justification":""},{"idx":3,"correct":false,"proposition":"the patient must be over 21 years of age","justification":""},{"idx":4,"correct":false,"proposition":"the patient must agree to be followed for life","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-18","context":null,"enonce":" With regard to liver tumours, which is (are) the true proposition(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Hepatic adenoma has a hypodense, heterogeneous appearance with fleeting arterial enhancement on injected CT","justification":""},{"idx":1,"correct":false,"proposition":"focal nodular hyperplasia is characterized by the presence of a hypo-intense central scar on T1 MRI","justification":""},{"idx":2,"correct":false,"proposition":"On CT scan, the hemangioma is characterized by a << >> clod enhancement after injection of contrast medium","justification":""},{"idx":3,"correct":false,"proposition":"In the context of chronic liver disease, the first diagnosis to evoke in front of an isolated nodule on CT scan is hepatocellular carcinoma","justification":""},{"idx":4,"correct":false,"proposition":"MRI is used to characterize liver tumours","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-19","context":null,"enonce":" A patient, whom you have been following for a long time for her active non-progressive multiple sclerosis (MS) and who does not tolerate her treatment, consults you with a scientific article talking about a new treatment that has just been put on the market and that allows good control of flare-ups. She would like to hear from you. You see that this is a non-inferiority trial conducted in patients with non-progressive active MS compared to a reference treatment currently available to this patient. The authors of the study considered that a 10% increase in relapses compared to the standard of care was acceptable as long as there was also a decrease in adverse events. This is a sufficiently powered test with no obvious bias. The relative risk (RR) of relapse is 1.03 (95% confidence interval [1.01-1.06]), and the RR of adverse event is 0.95 (95% confidence interval [0.87-1.02]). The authors conclude that their treatment is interesting because it is non-inferior and without over-risk of adverse events. What can you tell your patient based on these results? (one or more proposals expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"New treatment controls flare-ups in an acceptable way","justification":""},{"idx":1,"correct":false,"proposition":"New treatment puts less risk of adverse events","justification":""},{"idx":2,"correct":false,"proposition":"The new treatment may be interesting for your patient","justification":""},{"idx":3,"correct":false,"proposition":"Only a superiority trial would make it possible to evaluate the interest of this new treatment","justification":""},{"idx":4,"correct":false,"proposition":"A statistical test of non-inferiority is missing to conclude that the treatment is worthwhile","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-20","context":null,"enonce":" A colleague wants to set up a study on a new preventive treatment for flare-ups in Crohn's disease. It is a known molecule, already used in other inflammatory diseases and without known serious adverse effects. The study sponsor has sent them documents to fill out and your colleague is asking for your opinion on the regulatory procedures. What do you say to this colleague? (one or more proposals expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"This is a minimal-risk interventional study","justification":""},{"idx":1,"correct":false,"proposition":"The favourable opinion of a Committee for the Protection of Persons (CPP) is necessary","justification":""},{"idx":2,"correct":false,"proposition":"The authorization of the National Agency for the Safety of Medicines and Health Products (ANSM) is necessary","justification":""},{"idx":3,"correct":false,"proposition":"An information sheet for the patient on the risks involved is necessary","justification":""},{"idx":4,"correct":false,"proposition":"A phase 1 study is required beforehand","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-21","context":null,"enonce":" A patient consults for the renewal of his glasses. Your clinical examination reveals acuity at 10\/10 th Parinaud 2 in both eyes with the following correction: - 8 (-1 to 150 °) in the right eye and -9 (-1.25 to 135 °) in the left eye. What are the risks associated with its ametropia? (one or more expected answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"chronic angle-closure glaucoma","justification":""},{"idx":1,"correct":false,"proposition":"retinal detachment","justification":""},{"idx":2,"correct":false,"proposition":"cataract","justification":""},{"idx":3,"correct":false,"proposition":"macular atrophy","justification":""},{"idx":4,"correct":false,"proposition":"accommodative strabismus","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-22","context":null,"enonce":" You are called to the home of a 10-year-old child who has acute hives 4 days after a booster vaccine. The lesions are diffuse in the chest and limbs, and rapidly migratory, which impresses the mother of the child. Pulmonary auscultation is free. Blood pressure is at 105\/70 mm Hg. What do you offer? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Oral corticosteroid therapy oral solution","justification":""},{"idx":1,"correct":false,"proposition":"H1 antihistamine oral solution once daily","justification":""},{"idx":2,"correct":false,"proposition":"Transfer to emergency department for a few hours of monitoring","justification":""},{"idx":3,"correct":false,"proposition":"Dermocorticoid class 2 for the duration of symptoms","justification":""},{"idx":4,"correct":false,"proposition":"Remote allergological investigation of the current acute episode","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-24","context":null,"enonce":" You take care of a patient in intensive care. He is married and has 3 children, one of whom is a minor. He designated his only brother as a trusted person. He did not write advance directives. Unfortunately, its clinical situation becomes extremely pejorative with an almost non-existent recovery capacity. You decide to initiate a reflection on a possibility of limitation of processing, in order to avoid unreasonable obstinacy. As part of this reflection, you initiate a collegial procedure as provided for by law. Which person should be consulted in the context of this collegial procedure to seek the wishes expressed by the patient?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"His only brother","justification":""},{"idx":1,"correct":false,"proposition":"The 2 adult children","justification":""},{"idx":2,"correct":false,"proposition":"His wife","justification":""},{"idx":3,"correct":false,"proposition":"His notary","justification":""},{"idx":4,"correct":false,"proposition":"The minor child","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-26","context":null,"enonce":" A 25-year-old woman, hairdresser, has erythematous and pruritic dermatitis of the hands, located in particular between the fingers, reminiscent of allergic contact dermatitis. What element(s) reinforces the hypothesis of work-related allergic contact dermatitis?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"regular use of products containing allergens in the workplace","justification":""},{"idx":1,"correct":false,"proposition":"similar injuries in co-workers","justification":""},{"idx":2,"correct":false,"proposition":"the presence of positive skin prick tests","justification":""},{"idx":3,"correct":false,"proposition":"regression of injuries during leave","justification":""},{"idx":4,"correct":false,"proposition":"the appearance of lesions from the first days of her apprenticeship as a hairdresser","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-28","context":null,"enonce":" In the context of palliative care, the High Authority for Health defines a concept of vital prognosis << in the short term >>. Which of the following best fits this definition?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"from seconds to minutes","justification":""},{"idx":1,"correct":false,"proposition":"from a few minutes to a few hours","justification":""},{"idx":2,"correct":false,"proposition":"from a few hours to a few days","justification":""},{"idx":3,"correct":false,"proposition":"from a few days to a few weeks","justification":""},{"idx":4,"correct":false,"proposition":"from a few weeks to a few months","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-29","context":null,"enonce":" A young man of 23 years comes to your office in a painting of asthenia and myalgia; it has no history. On examination, you notice erythematous angina, cervical and axillary lymphadenopathy of one or two centimeters, soft, mobile and painless. What are the biological arguments in favor of infectious mononucleosis? (one or more possible answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":">10% hyperbasophilic polymorphic lymphocyte cells","justification":""},{"idx":1,"correct":false,"proposition":"> 50% lymphocytes in the leukocyte formula","justification":""},{"idx":2,"correct":false,"proposition":"Hepatic cytolysis","justification":""},{"idx":3,"correct":false,"proposition":"Hepatic cholestasis","justification":""},{"idx":4,"correct":false,"proposition":"Thrombocytosis","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-30","context":null,"enonce":" During the clinical examination of a 62-year-old patient treated for high blood pressure and who consults you for the occurrence of pain in the lower right limb when walking, you have measured humeral pressure in both arms as well as distal pressures and established the value of systolic ankle pressure indexes:  humeral pressures at 162\/72 mmHg on the right and 158\/70 mmHg on the left arm; left ankle pressure at 148 mmHg (systolic left ankle pressure index at 0.93); right ankle pressures at 120 mmHg (systolic left ankle pressure index at 0.75). What can you say from these results? (one or more expected answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"the treatment of hypertension is not suitable","justification":""},{"idx":1,"correct":false,"proposition":"This patient is a carrier of arterial disease of the lower limbs","justification":""},{"idx":2,"correct":false,"proposition":"This limping patient is in the stage of exercise ischemia","justification":""},{"idx":3,"correct":false,"proposition":"This patient has significant anisotension","justification":""},{"idx":4,"correct":false,"proposition":"This patient is suspected of aortic dissection","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-31","context":null,"enonce":" You have been following Mr. X in consultation for 2 years. This 62-year-old patient has a subrenal abdominal aortic aneurysm. The last ultrasound assessment carried out 6 months ago did not show any evolution of the aneurysm which had been measured at 41 mm anteroposterior diameter. He presents today in emergency for the occurrence for more than an hour of a dull and continuous abdomino-lumbar pain. Gentle abdominal palpation is difficult. You find all the peripheral pulses. Blood pressure is measured at 140\/70 mmHg in both arms and heart rate is steady at 76 beats per minute. What management strategy do you propose to this patient? (only one answer expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Emergency exploratory laparotomy","justification":""},{"idx":1,"correct":false,"proposition":"Emergency Aortic Doppler Ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"emergency arteriogram of the aorta","justification":""},{"idx":3,"correct":false,"proposition":"emergency aortic angiography","justification":""},{"idx":4,"correct":false,"proposition":"Intensive Care Monitoring","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-33","context":null,"enonce":" You see in the early afternoon at your office a young man of 17 years who has a fever at 39 ° C since this morning. He is brought by his mother who prefers to come to your house because she lives next door, while the hospital is 1 kilometer away. He tells you that he has had a headache for several hours despite taking paracetamol. He vomited recently when he didn't eat anything at noon. The temperature is 39.2°C.  He has trouble bringing his chin back to the sternum, can't help but bend his lower limbs and says he is bothered by street noise. There are no skin abnormalities. What do you do very quickly? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Blood culture collection","justification":""},{"idx":1,"correct":false,"proposition":"Performing a lumbar puncture","justification":""},{"idx":2,"correct":false,"proposition":"Administration of one gram of ceftriaxone intramuscularly","justification":""},{"idx":3,"correct":false,"proposition":"Administration of oral or intravenous dexamethasone","justification":""},{"idx":4,"correct":false,"proposition":"Call to Centre 15 (UAS)","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-34","context":null,"enonce":" A 25-year-old woman consults with her 27-year-old husband for a desire for pregnancy. It reports regular cycles of 28 days and periods lasting 4 days. They have been in a relationship for five years and have been trying unsuccessfully to get pregnant for two years (stopping the pill and regular sex). This man has no history and he does not smoke. This woman has never smoked and was operated on for appendicular peritonitis at the age of 16, by laparoscopy. The clinical examination of this man shows normal hair and genitals (testicles and penis) of normal appearance and volume. He is 1m80 tall and weighs 74 kg. The clinical examination of this woman objectifies the scars of laparoscopy, normal breasts and normal external genitalia; She is 1m67 tall and weighs 59 kg. The examination of the cervix under speculum is normal, as is the vaginal examination which does not objectify any abnormality. Among all the examinations that you could prescribe for this interfility assessment, and taking into account your observation (interrogation and clinical examination of this couple), what are the two most important examinations to prescribe to determine the continuation of the care?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Antral follicle count by pelvic ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"Spermogram and spermocytogram","justification":""},{"idx":2,"correct":false,"proposition":"Hormonal plasma assays of the woman (FSH, LH, E2, AMH) on the third day of the cycle","justification":""},{"idx":3,"correct":false,"proposition":"Hysterosalpingography","justification":""},{"idx":4,"correct":false,"proposition":"Bacteriological, mycological and parasitological vaginal samples","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-35","context":null,"enonce":" A 40-year-old patient presents to the emergency room. He is known to be diabetic but adherence to treatment is poor. His left foot is deformed. The patient does not complain of pain. At the opening of the dressing, there is purulent discharge and a foul odor. On inspection, the patient is marbled. Blood pressure is at 80\/40mmHg. On palpation of the leg, you find a crackling and the local aspect is as follows. Which of the following proposals do you think is appropriate to the situation?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The absence of pain is an element of good prognosis","justification":""},{"idx":1,"correct":false,"proposition":"Mottling and general signs indicate a therapeutic emergency","justification":""},{"idx":2,"correct":false,"proposition":"The functional prognosis of the leg is exceeded","justification":""},{"idx":3,"correct":false,"proposition":"The introduction of antibiotic therapy will be done after deep samples are taken in the operating room","justification":""},{"idx":4,"correct":false,"proposition":"The prognosis is life-threatening","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-36","context":null,"enonce":" A 42-year-old woman consults for difficulty falling asleep that has lasted for years. She feels very tense and constantly worries \"about everything and nothing,\" she says. This makes her irritable and tiresome. What is the most likely diagnosis?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Depressive episode characterized with anxious characteristics","justification":""},{"idx":1,"correct":false,"proposition":"Adjustment insomnia","justification":""},{"idx":2,"correct":false,"proposition":"Generalized anxiety disorder","justification":""},{"idx":3,"correct":false,"proposition":"Panic disorder","justification":""},{"idx":4,"correct":false,"proposition":"Avoidant personality disorder","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-37","context":null,"enonce":" You see a 25-year-old patient in the emergency room who has a traumatic wound on the lateral side of the knee. A photograph of the lesion is attached. On clinical examination, the patient has a motor deficit of dorsal flexion of the ankle and foot. There is also hypoaesthesia of the back of the foot. Given the location of the wound, which lesion do you suspect in the first place?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Trunk of the sciatic nerve","justification":""},{"idx":1,"correct":false,"proposition":"Common fibular nerve","justification":""},{"idx":2,"correct":false,"proposition":"Anterior tibial tendon","justification":""},{"idx":3,"correct":false,"proposition":"Proximal insertion of the long fibular muscle","justification":""},{"idx":4,"correct":false,"proposition":"Clean extensor muscle of hallux","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-38","context":null,"enonce":" A 45-year-old woman consults for pelvic heaviness associated with moderate and intermittent left lower back pain. In her history, you note two vaginal deliveries, a cholecystectomy and a pollen allergy without associated asthma. His last cervical smear was two years ago and he was normal. She has contraception by copper intrauterine device. Clinical examination by abdominal palpation and objective vaginal examination a mobile pelvic mass of 10 cm, without ascites clinically identifiable with abdominal palpation. Vaginal secretions are normal in appearance. She weighs 62 kg for 1m59. The urine strip does not objectify leukocytes, red blood cells or nitrites and the search for beta-hCG is negative. What are the two most likely diagnoses?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Polymyomatous uterus","justification":""},{"idx":1,"correct":false,"proposition":"Endometrial adenocarcinoma","justification":""},{"idx":2,"correct":false,"proposition":"Pyosalpinx","justification":""},{"idx":3,"correct":false,"proposition":"Ovarian tumour","justification":""},{"idx":4,"correct":false,"proposition":"Uterine adenomyosis","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-39","context":null,"enonce":" An 85-year-old woman with a history of breast neoplasia consults for right thigh pain. These pains are permanent. X-rays of the right femur were performed. Which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"There is weakening of the right proximal femur","justification":""},{"idx":1,"correct":false,"proposition":"There are osteocondensing ranges","justification":""},{"idx":2,"correct":false,"proposition":"There are osteolytic beaches","justification":""},{"idx":3,"correct":false,"proposition":"There are periosteal appositions","justification":""},{"idx":4,"correct":false,"proposition":"There are multiple areas of disappearance of cortical","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-40","context":null,"enonce":" Regarding the osteology of the facial massif: (one or more expected answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"1 refers to the temporal bone","justification":""},{"idx":1,"correct":false,"proposition":"2 refers to the frontal bone","justification":""},{"idx":2,"correct":false,"proposition":"3 refers to the infraorbital foramen","justification":""},{"idx":3,"correct":false,"proposition":"4 refers to zygomatic bone","justification":""},{"idx":4,"correct":false,"proposition":"5 refers to the mandibular condyle","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-41","context":null,"enonce":" You receive a young woman victim of a sports accident, she has a periorbital hematoma. What clinical elements point you to a fracture of the floor of the orbit? (one or more expected answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"inferior palpebral emphysema","justification":""},{"idx":1,"correct":false,"proposition":"conjunctival hemorrhage","justification":""},{"idx":2,"correct":false,"proposition":"diplopia","justification":""},{"idx":3,"correct":false,"proposition":"hypoaesthesia of the wing of the nose","justification":""},{"idx":4,"correct":false,"proposition":"epistaxis","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-42","context":null,"enonce":" A 5-year-old child fell on his chin, he has a 1 cm wound, you want to eliminate a fracture of the mandibular condyle. What are you looking for at the clinical examination? (one or more expected answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"hypoaesthesia of the lower lip","justification":""},{"idx":1,"correct":false,"proposition":"an otorragia","justification":""},{"idx":2,"correct":false,"proposition":"stomatorragia","justification":""},{"idx":3,"correct":false,"proposition":"a limitation of the mouth opening","justification":""},{"idx":4,"correct":false,"proposition":"laterodeviation in the mouth opening","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-43","context":null,"enonce":" An 18-year-old patient is transferred from orthopaedic surgery to follow-up care and orthopaedic rehabilitation. He was operated on 5 days before a major exostosis of the tibiotal joint as part of Bessel Hagen disease (multiple exostosis disease). He wears a resin immobilization for 6 weeks. The pain is localized throughout the leg but predominates at the ankle. The rating on the numerical scale is 6\/10. The pain is not relieved by level 1 analgesics at an effective dose. Which of the following proposals should you mention?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Compression under resin","justification":""},{"idx":1,"correct":false,"proposition":"Hey intra-articular morrhage","justification":""},{"idx":2,"correct":false,"proposition":"Complex regional pain syndrome type 1","justification":""},{"idx":3,"correct":false,"proposition":"Surgical site infection","justification":""},{"idx":4,"correct":false,"proposition":"Venous thrombosis of the leg","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-44","context":null,"enonce":" A chronic low back pain patient enters a physical medicine and rehabilitation department for a multi-professional rehabilitation programme. He has been suffering from low back pain for 5 years. These continued after acute low back pain at his workplace. Which of the following applies(s) to the management of this patient?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The physiotherapist can work on isometric strengthening of the abdominal strap muscles","justification":""},{"idx":1,"correct":false,"proposition":"Ergotherapy has a role in the management of","justification":""},{"idx":2,"correct":false,"proposition":"The realization of plantar orthotics by an orthopaedic technician is indicated","justification":""},{"idx":3,"correct":false,"proposition":"CBT (cognitive behavioural therapies) can be used to better manage pain","justification":""},{"idx":4,"correct":false,"proposition":"You can apply to the social security fund to apply for recognition of disabled workers.","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-45","context":null,"enonce":" A 25-year-old patient presents for consultation for inflammatory arthralgia evolving for 6 months. She has Hashimoto's thyroiditis currently substituted with levothyroxine. She has no other symptoms to report and the clinical examination is poor, showing no synovitis. An immunological assessment was performed: - negative anti-CCP antibodies - rheumatoid factor positive >3N - anti-positive anti-nuclear antibodies - anti-SSA and anti-SSB positive >3N - negative native anti-DNA The search for antiphospholipids is positive anti-cardiolipin type (IgG and IgM positive >3N) without anti-b2GPI or circulating anticoagulant. The diagnosis of rheumatoid arthritis can be made","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"None of the propositions are true","justification":""},{"idx":1,"correct":false,"proposition":"The diagnosis of Sjögren's syndrome can be affirmed","justification":""},{"idx":2,"correct":false,"proposition":"Antiaggregant therapy should be introduced","justification":""},{"idx":3,"correct":false,"proposition":"It will be necessary to recontrol the anti-phospholipids at 3 months","justification":""},{"idx":4,"correct":false,"proposition":"The diagnosis of lupus may be suspected","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-47","context":null,"enonce":" Which of the following proposals characterizes COPD?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The constant association with chronic bronchitis","justification":""},{"idx":1,"correct":false,"proposition":"An incompletely reversible obstructive syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Often accelerated decline in respiratory function","justification":""},{"idx":3,"correct":false,"proposition":"Smoking cessation cure","justification":""},{"idx":4,"correct":false,"proposition":"A beneficial effect of mumomotor drugs","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-48","context":null,"enonce":" In a 40-year-old man complaining of a tendency to doze off during the day, what symptom(s) correspond to the diagnosis of narcolepsy?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"continuous and increasing sleepiness during the day","justification":""},{"idx":1,"correct":false,"proposition":"hypnopompic hallucinations","justification":""},{"idx":2,"correct":false,"proposition":"repeated bouts of abrupt abolition of muscle tone without altered consciousness","justification":""},{"idx":3,"correct":false,"proposition":"Hypnagogic hallucinations","justification":""},{"idx":4,"correct":false,"proposition":"transient complete paralysis occurring at the beginning of the night","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-49","context":null,"enonce":" A ten-year-old has been repeating regularly for more than two years that he has << stomach ache >>. These abdominal complaints, without identified triggering factor, have been the subject of numerous assessments that have shown no cause of injury. Which of the following diagnostic proposals is the most likely?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"excessive fear of having a disease (hypochondria)","justification":""},{"idx":1,"correct":false,"proposition":"disorder with functional neurological symptomatology (conversion disorder)","justification":""},{"idx":2,"correct":false,"proposition":"somatic symptomatological disorder (somatoform pain disorder)","justification":""},{"idx":3,"correct":false,"proposition":"simulation","justification":""},{"idx":4,"correct":false,"proposition":"factitious disorder","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-50","context":null,"enonce":" What type(s) of event(s) experienced can (can) lead to the development of post-traumatic stress disorder?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Receiving a letter of dismissal without having been prepared","justification":""},{"idx":1,"correct":false,"proposition":"verbal abuse and insults on the phone by an unhappy customer","justification":""},{"idx":2,"correct":false,"proposition":"Serious car accident without physical injury","justification":""},{"idx":3,"correct":false,"proposition":"Direct witness to the sudden death of a loved one by heart attack","justification":""},{"idx":4,"correct":false,"proposition":"Assault by a dog with severe bites","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-52","context":null,"enonce":" You see a 23-year-old patient who complains of nocturnal dyspnea episodes 2 to 3 times a week. These episodes almost always occur around 5 a.m. She sometimes uses a salbutamol spray, which relieves her within minutes. She lives in a seemingly healthy apartment and has no pets at home. It is also sometimes hampered by a shortness of breath in its activities. She does not complain of any other symptoms. She has no other history and does not smoke. When you see her in consultation, her auscultation is normal. Which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"A nocturnal ventilatory polygraph recording should be performed","justification":""},{"idx":1,"correct":false,"proposition":"An allergy assessment including prick-tests to the main pneumallergens is necessary","justification":""},{"idx":2,"correct":false,"proposition":"A diagnosis of asthma seems likely","justification":""},{"idx":3,"correct":false,"proposition":"an oral corticosteroid test should be undertaken","justification":""},{"idx":4,"correct":false,"proposition":"Pulmonary function testing is indicated","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-53","context":null,"enonce":" Regarding confusion in subjects over 75 years of age, which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It can be seen in case of meningoencephalitis","justification":""},{"idx":1,"correct":false,"proposition":"An organic etiology is rarely objectified","justification":""},{"idx":2,"correct":false,"proposition":"It is indicative of a decrease in cognitive reserves","justification":""},{"idx":3,"correct":false,"proposition":"It can be complicated by transient urinary incontinence","justification":""},{"idx":4,"correct":false,"proposition":"It can be complicated by bedsores","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-54","context":null,"enonce":" You see a 9-month-old infant due to contact with his uncle who was hospitalized 15 days ago for tuberculosis with a cave. Her uncle spent 8 days at the child's home 2 months ago. The child was vaccinated with BCG at one month of age. The child's chest x-ray is normal. Regarding the care of the child, which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"performing a tuberculin RDI","justification":""},{"idx":1,"correct":false,"proposition":"Performing an in vitro interferon gamma release test","justification":""},{"idx":2,"correct":false,"proposition":"realization of gastric tubing in search of BAAR","justification":""},{"idx":3,"correct":false,"proposition":"Prescription for prophylactic treatment with isoniazid and rifampicin","justification":""},{"idx":4,"correct":false,"proposition":"performing a chest CT scan","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-55","context":null,"enonce":" In anticipation of a caesarean section, a hemostasis assessment reveals a PT at 110%, a TCA ratio of 1.4 (42 seconds for a control at 30 seconds) and a fibrinogen at 3.5 g \/ l. Counts and platelets are normal. The patient has no history or clinical signs. What analysis would you ask for in the first line? (only one answer expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Determination of factor II","justification":""},{"idx":1,"correct":false,"proposition":"Determination of factor XIII","justification":""},{"idx":2,"correct":false,"proposition":"TCA correction test (sick TCA + control)","justification":""},{"idx":3,"correct":false,"proposition":"Platelet aggregation test","justification":""},{"idx":4,"correct":false,"proposition":"Determination of endogenous pathway factors","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-56","context":null,"enonce":" A 5-year-old child has febrile exanthema and vomiting. There are large, uniform bright red congestive tablecloths with no healthy skin gaps that predominate at the bending folds. Examination of the mouth and throat shows a partially depapillated saburral tongue and swollen and inflammatory tonsils. The temperature is 39.5°C.  The rapid diagnostic test for streptococcus A is positive. Which proposal(s) is (are) accurate regarding care?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"amoxicillin antibiotic therapy for 6 days","justification":""},{"idx":1,"correct":false,"proposition":"School eviction for 6 days","justification":""},{"idx":2,"correct":false,"proposition":"search for group A streptococcus in the patient's siblings","justification":""},{"idx":3,"correct":false,"proposition":"search for proteinuria at a distance from infection","justification":""},{"idx":4,"correct":false,"proposition":"Oral antibiotic prophylaxis in the 80-year-old grandmother","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-57","context":null,"enonce":" When monitoring a patient's pregnancy, intestinal hyperechogenicity was detected on the second morphological ultrasound of the fetus. The assessment of suspicion of cystic fibrosis led to demonstrate in the fetus the presence in the homozygous state of the p.Phe508del mutation at the CFTR locus. Which proposal(s) is (are) the exact proposal(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Full information about cystic fibrosis should be offered to this woman","justification":""},{"idx":1,"correct":false,"proposition":"Cystic fibrosis is a reportable disease","justification":""},{"idx":2,"correct":false,"proposition":"Recourse to medical termination of pregnancy is possible","justification":""},{"idx":3,"correct":false,"proposition":"A possible negative opinion of a CPDPN (Multidisciplinary Center for Prenatal Diagnosis) cannot be appealed","justification":""},{"idx":4,"correct":false,"proposition":"The patient can apply to the CPDPN (Multidisciplinary Center for Prenatal Diagnosis) through her gynecologist","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-58","context":null,"enonce":" A 15-day-old newborn is brought in for discomfort. On examination, there is mucocutaneous jaundice and the stool has been discolored for several days according to the parents. He has not regained his birth weight and has difficulty sucking. His capillary blood glucose is 0.3 g \/ L. What is (are) the possible diagnosis (s) in front of this whole table?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"viral hepatitis B","justification":""},{"idx":1,"correct":false,"proposition":"Neonatal diabetes","justification":""},{"idx":2,"correct":false,"proposition":"hypothyroidism","justification":""},{"idx":3,"correct":false,"proposition":"congenital adrenal hyperplasia","justification":""},{"idx":4,"correct":false,"proposition":"Insufficient energy intake","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-59","context":null,"enonce":" An 11-month-old infant is brought to the emergency room for functional impotence of the right lower limb without any notion of trauma. On examination the mobilization of the right lower limb is very painful and the joint amplitudes impossible to evaluate, there is a bruise on the right cheek The X-ray shows a fracture of the right femur. You suspect abuse. The child is kept at home by his paternal grandmother. What do you do? (one or more exact propositions)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Reporting to the public prosecutor","justification":""},{"idx":1,"correct":false,"proposition":"Taking pictures of the bruise","justification":""},{"idx":2,"correct":false,"proposition":"referral to the Brigade for the Protection of Minors","justification":""},{"idx":3,"correct":false,"proposition":"drafting an interim care order","justification":""},{"idx":4,"correct":false,"proposition":"Medical interrogation of grandmother","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-60","context":null,"enonce":" An infant born prematurely at 36 SA is brought to the emergency room at 4 months of age for bronchiolitis. His respiratory rate is 55 per minute, his heart rate is 140 beats per minute, his temperature is 38.2°C.  On clinical examination, there is intercostal pulling, cyanosis and intense cough. Parents report that he drinks about 120 mL of milk out of the 180 mL he used to drink. What is the main criterion of severity in this child? (only one answer expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"prematurity","justification":""},{"idx":1,"correct":false,"proposition":"intense cough","justification":""},{"idx":2,"correct":false,"proposition":"Intercostal draw","justification":""},{"idx":3,"correct":false,"proposition":"cyanosis","justification":""},{"idx":4,"correct":false,"proposition":"reduced food intake","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-61","context":null,"enonce":" Mrs. T. 57 years old, diabetic, consults you for her annual ophthalmological check-up. The diagnosis of diabetic retinopathy is based on the examination of the fundus, we can find: (one or more exact proposals)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Cottony nodules","justification":""},{"idx":1,"correct":false,"proposition":"Microaneurysms","justification":""},{"idx":2,"correct":false,"proposition":"Choroidal neovascularization","justification":""},{"idx":3,"correct":false,"proposition":"Intraretinal hemorrhages","justification":""},{"idx":4,"correct":false,"proposition":"Pre-retinal hemorrhages","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-62","context":null,"enonce":" In ophthalmology, about macular edema: (one or more exact answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"There is an increase in macular thickness in optical coherence tomography","justification":""},{"idx":1,"correct":false,"proposition":"The decrease in visual acuity is usually brutal","justification":""},{"idx":2,"correct":false,"proposition":"It can occur during diabetic retinopathy","justification":""},{"idx":3,"correct":false,"proposition":"It is visible after occlusion of the central artery of the retina","justification":""},{"idx":4,"correct":false,"proposition":"It can occur after cataract surgery","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-63","context":null,"enonce":" Ms. R., 42, is being treated for multiple sclerosis. It is sent to the ophthalmologist for assessment. Multiple sclerosis can cause: (one or more exact propositions)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Internuclear ophthalmoplegia","justification":""},{"idx":1,"correct":false,"proposition":"Nystagmus","justification":""},{"idx":2,"correct":false,"proposition":"An occlusion of the central artery of the retina","justification":""},{"idx":3,"correct":false,"proposition":"Retinal detachment","justification":""},{"idx":4,"correct":false,"proposition":"Increased retro-ocular pain during eye movements","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-64","context":null,"enonce":" A 70-year-old woman presents to the emergency room for a rash (see photograph) that appeared a week ago. She has been complaining of pruritus for 3 months. She is a widow, mother of 5 children and lives alone at home. She has no medical follow-up or background treatment. Which of the following tests will be most useful in confirming the diagnosis you suspect?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":" Direct immunofluorescence on skin biopsy","justification":""},{"idx":1,"correct":false,"proposition":"Indirect immunofluorescence on blood sample","justification":""},{"idx":2,"correct":false,"proposition":"Parasitological skin sampling for sarcoptes","justification":""},{"idx":3,"correct":false,"proposition":"Ferritinemia","justification":""},{"idx":4,"correct":false,"proposition":"Complete blood count","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-65","context":null,"enonce":" A patient is accompanied by her roommate to the emergency room at 2:00 a.m. Clinical examination suggests meningitis. The results of the lumbar puncture are: leukocytes 10,000 \/ ml; proteinorachy 2.8 g \/ l; glycorachia 0.8 mmol \/ l (blood glucose at 6 mmol \/ l); Gram-negative cocci in diplococci on direct examination. Which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"You will report this case as soon as confirmed by the microbiological culture","justification":""},{"idx":1,"correct":false,"proposition":"One of the objectives of mandatory disease reporting is epidemiological surveillance","justification":""},{"idx":2,"correct":false,"proposition":"One of the objectives of reporting is to initiate preventive measures","justification":""},{"idx":3,"correct":false,"proposition":"you prescribe precautions such as << Air>>","justification":""},{"idx":4,"correct":false,"proposition":"you initiate antibiotic prophylaxis for the patient's roommate","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-66","context":null,"enonce":" A 28-year-old patient comes to the emergency room with a very painful erection that has been going on for 9 hours now. What are the main possible causes of such a state? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Sickle-cell anemia","justification":""},{"idx":1,"correct":false,"proposition":"Trauma on flaccid penis","justification":""},{"idx":2,"correct":false,"proposition":"Testicular cancer","justification":""},{"idx":3,"correct":false,"proposition":"Intracavernous injection of prostaglandins","justification":""},{"idx":4,"correct":false,"proposition":"Multiple myeloma","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-67","context":null,"enonce":" What is (are) the true proposal(s) concerning the urodynamic balance?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It includes flowmetry","justification":""},{"idx":1,"correct":false,"proposition":"It gives information about bladder sensitivity","justification":""},{"idx":2,"correct":false,"proposition":"It includes a measurement of the post-voiding residue","justification":""},{"idx":3,"correct":false,"proposition":"It gives information on bladder compliance","justification":""},{"idx":4,"correct":false,"proposition":"It is performed under anesthesia","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-68","context":null,"enonce":" An 80-year-old patient is admitted for a hip fracture. He is being treated for ischemic heart disease with aspirin (75 mg\/day) combined with beta-blocker therapy. He has no other antecedent. His consciousness is normal and he is not confused. Its vital parameters are normal. Regarding the intensity of his pain, what is or are the scale(s) usable in this clinical context?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"DN4 scale","justification":""},{"idx":1,"correct":false,"proposition":"The analogue visual scale","justification":""},{"idx":2,"correct":false,"proposition":"the numerical scale of 0-10","justification":""},{"idx":3,"correct":false,"proposition":"The simple verbal scale","justification":""},{"idx":4,"correct":false,"proposition":"Behavioral Pain Scale (BPS)","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-69","context":null,"enonce":" You receive Mrs. V., 67 years old, for a table of alteration of the general condition associated with the following rash, which has been evolving for 4 weeks: Which of the following diagnoses seems compatible with the above clinical presentation?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"immunological thrombocytopenic purpura","justification":""},{"idx":1,"correct":false,"proposition":"IgA vasculitis","justification":""},{"idx":2,"correct":false,"proposition":"Purpura fulminans","justification":""},{"idx":3,"correct":false,"proposition":"Microscopic polyangiitis","justification":""},{"idx":4,"correct":false,"proposition":"vasculitis with anti-glomerular basement membrane antibodies","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-70","context":null,"enonce":" On an anatomo-pathological account of bronchoalveolar lavage, it is specified that the Golde score is equal to 5. Regarding Golde's score, check the exact proposal(s):","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"This is a histoprognostic score","justification":""},{"idx":1,"correct":false,"proposition":"It evaluates the amount of lymphocytes","justification":""},{"idx":2,"correct":false,"proposition":"It evaluates hemosiderin overload","justification":""},{"idx":3,"correct":false,"proposition":"It is based on a count of red blood cells","justification":""},{"idx":4,"correct":false,"proposition":"The result indicates intraalveolar hemorrhage in this patient","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-71","context":null,"enonce":" What is (are) the true proposal(s) concerning spinal anesthesia?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"This is perimedullary anesthesia","justification":""},{"idx":1,"correct":false,"proposition":"It is a loco-regional anesthesia","justification":""},{"idx":2,"correct":false,"proposition":"the anesthetic is given directly into the cerebrospinal fluid","justification":""},{"idx":3,"correct":false,"proposition":"It can be performed at the thoracic level","justification":""},{"idx":4,"correct":false,"proposition":"Respiratory complications are among the risks associated with this technique","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-73","context":null,"enonce":" A 30-year-old patient underwent a scheduled cholecystectomy surgery. He goes to the emergency room 72 hours after the procedure because he is not feeling well. The HR is at 115\/min, the BP is at 85\/35 mmHg, the FR is at 30\/min, the SpO2 is at 94% in ambient air. The patient is stuporous and the diuresis of the last hours is zero. What type of shock seems most likely to you? (only one answer expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"it is probably hypovolemic shock","justification":""},{"idx":1,"correct":false,"proposition":"it is probably cardiogenic shock","justification":""},{"idx":2,"correct":false,"proposition":"it is probably hemorrhagic shock","justification":""},{"idx":3,"correct":false,"proposition":"it is probably septic shock","justification":""},{"idx":4,"correct":false,"proposition":"it is probably an obstructive shock","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-74","context":null,"enonce":" What biological abnormality(s) usually accompanies moderate vitamin D deficiency in adults?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"hypocalcemia","justification":""},{"idx":1,"correct":false,"proposition":"hypercalciuria","justification":""},{"idx":2,"correct":false,"proposition":"hypercortisolemia","justification":""},{"idx":3,"correct":false,"proposition":"elevation of parathyroid hormone","justification":""},{"idx":4,"correct":false,"proposition":"hypomagnesemia","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-76","context":null,"enonce":" What clinical element(s) does (make) refute the diagnosis of Parkinson's disease at the beginning of the disease?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"swallowing problems","justification":""},{"idx":1,"correct":false,"proposition":"cognitive impairment","justification":""},{"idx":2,"correct":false,"proposition":"Falls","justification":""},{"idx":3,"correct":false,"proposition":"Impaired sense of smell","justification":""},{"idx":4,"correct":false,"proposition":"bradykinesia","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-77","context":null,"enonce":" Regarding meningiomas, what is (are) the exact answer(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"they develop from astrocytes","justification":""},{"idx":1,"correct":false,"proposition":"There is a female predominance","justification":""},{"idx":2,"correct":false,"proposition":"Their discovery is often fortuitous","justification":""},{"idx":3,"correct":false,"proposition":"they can develop as part of neurofibromatosis type 1","justification":""},{"idx":4,"correct":false,"proposition":"The peak incidence is around 40 years","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-78","context":null,"enonce":" Which proposal(s) for cotrimoxazole is (are) correct?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Cotrimoxazole is a combination of 2 anti-infective agents","justification":""},{"idx":1,"correct":false,"proposition":"Its bioavailability is excellent","justification":""},{"idx":2,"correct":false,"proposition":"It is eliminated through urine","justification":""},{"idx":3,"correct":false,"proposition":"It is naturally active on staphylococci and Escherichia coli","justification":""},{"idx":4,"correct":false,"proposition":"Cotrimoxazole may have an anti-parasitic action","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-79","context":null,"enonce":" An 85-year-old diabetic, hypertensive patient is hospitalized in front of the sudden appearance of a predominant rash with large folds of flexion and which gradually generalizes. The patient is dehydrated, her temperature is 38.5 ° C.  She has neutrophil hyperleukocytosis (8500\/mm3). The biological balance is also normal. The entourage tells you that she presented a picture of acute bronchitis 3 weeks ago. In the face of a persistent cough, treatment with amoxicillin combined with codeine and prednisolone was introduced 48 hours ago. His son tells you that his mother has already had many allergic reactions to antibiotics.","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"A maculopapular exanthema","justification":""},{"idx":1,"correct":false,"proposition":"acute generalized exanthematous pustulosis","justification":""},{"idx":2,"correct":false,"proposition":"drug hypersensitivity syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Stevens Johnson syndrome","justification":""},{"idx":4,"correct":false,"proposition":"a flare-up of pustular psoriasis","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-80","context":null,"enonce":" A 38-year-old patient underwent surgery for a non-functional pituitary macroadenoma, expressing beta-LH to immunohistochemistry, without markers of tumor aggressiveness. The postoperative period was marked by the occurrence of corticotropic insufficiency. Which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"treatment should include fludrocortisone","justification":""},{"idx":1,"correct":false,"proposition":"treatment should include hydrocortisone","justification":""},{"idx":2,"correct":false,"proposition":"The dosage of the treatment is adjusted according to the results of the cortisolemia at 8h","justification":""},{"idx":3,"correct":false,"proposition":"The return to normal of corticotropic function should be controlled by the 24-hour cortisolurie assay","justification":""},{"idx":4,"correct":false,"proposition":"Substitution of this deficiency renders annual influenza vaccination ineffective","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-81","context":null,"enonce":" Regarding the characteristics of carcinoma in situ, which is (are) the exact proposition(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It can interest the entire height of the epithelium","justification":""},{"idx":1,"correct":false,"proposition":"It carries a risk of metastases","justification":""},{"idx":2,"correct":false,"proposition":"It crosses the basement membrane","justification":""},{"idx":3,"correct":false,"proposition":"It is destined to remain non-invasive","justification":""},{"idx":4,"correct":false,"proposition":"He has an excellent prognosis after treatment","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-82","context":null,"enonce":" Regarding the prefixes\/suffixes used in TNM classifications, which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"c gives stage to clinical examination","justification":""},{"idx":1,"correct":false,"proposition":"p gives the postoperative stage","justification":""},{"idx":2,"correct":false,"proposition":"x means unrated or unknown","justification":""},{"idx":3,"correct":false,"proposition":"R gives stage after radiation therapy","justification":""},{"idx":4,"correct":false,"proposition":"gives it stage after neoadjuvant treatment","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-84","context":null,"enonce":" Which of the following recommended treatment options for impaired ejection fraction heart failure, in addition to certain beta-blockers, has (have) demonstrated a decrease in mortality?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Henlé's loop diuretics","justification":""},{"idx":1,"correct":false,"proposition":"mineralocorticoid receptor antagonists","justification":""},{"idx":2,"correct":false,"proposition":"angiotensin-converting enzyme II inhibitors","justification":""},{"idx":3,"correct":false,"proposition":"digitalis","justification":""},{"idx":4,"correct":false,"proposition":"implantable defibrillators","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-85","context":null,"enonce":" A 58-year-old patient, a former carpenter, is referred for unilateral nasal obstruction and you mention the diagnosis of adenocarcinoma of the ethmoid. Which proposals are correct? (one or more expected answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"there may be repeated epistaxis homolateral to obstruction","justification":""},{"idx":1,"correct":false,"proposition":"It is a disease entered in the schedule of occupational diseases","justification":""},{"idx":2,"correct":false,"proposition":"Cervical lymphadenopathy is common at the time of diagnosis","justification":""},{"idx":3,"correct":false,"proposition":"the tumour may be masked by a reactive polyp","justification":""},{"idx":4,"correct":false,"proposition":"the presence of exophthalmos would be a sign of an advanced tumor","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-86","context":null,"enonce":" One patient had a brief loss of consciousness. You question him and the witnesses. What are the arguments in favor of syncope? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Brief, low-amplitude muscle twitching of the shoulders 20 seconds after loss of consciousness","justification":""},{"idx":1,"correct":false,"proposition":"inability to get up on one's own after returning to consciousness","justification":""},{"idx":2,"correct":false,"proposition":"prolonged drowsiness after return to consciousness","justification":""},{"idx":3,"correct":false,"proposition":"feeling strange before loss of consciousness","justification":""},{"idx":4,"correct":false,"proposition":"palpitations before loss of consciousness","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-87","context":null,"enonce":" A couple consults you because of a pregnancy project. The woman is 32 years old and the man is on chronic hemodialysis due to X-linked Alport syndrome. What are the exact proposals? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Man cannot transmit the disease if they have a son","justification":""},{"idx":1,"correct":false,"proposition":"the child will necessarily carry a trait of the disease","justification":""},{"idx":2,"correct":false,"proposition":"It is better to resort to postnatal diagnosis if it is a son","justification":""},{"idx":3,"correct":false,"proposition":"It is better to resort to prenatal diagnosis if it is a girl","justification":""},{"idx":4,"correct":false,"proposition":"Hemodialysis of the husband contraindicates the plan of pregnancy","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-88","context":null,"enonce":" What is the main reason for chronic kidney disease to shorten life expectancy? (only one answer expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Increased vascular risk","justification":""},{"idx":1,"correct":false,"proposition":"increased risk of cardiac conduction disorder","justification":""},{"idx":2,"correct":false,"proposition":"increased risk of heart rhythm disorder","justification":""},{"idx":3,"correct":false,"proposition":"Increased risk of cancer","justification":""},{"idx":4,"correct":false,"proposition":"Increased risk of infection","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-89","context":null,"enonce":" A 42-year-old man was admitted to intensive care 48 hours ago for shock complicating acute pneumococcal pneumonia. Despite the correction of hemodynamic failure, it remains oliguric, and serum creatinine has increased from 78 μmol\/L at intake to 134 μmol\/L. What is (are) the exact proposal(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"there is acute renal failure","justification":""},{"idx":1,"correct":false,"proposition":"Acute tubular necrosis should be mentioned","justification":""},{"idx":2,"correct":false,"proposition":"It is necessary to evoke a cortical necrosis","justification":""},{"idx":3,"correct":false,"proposition":"It is necessary to evoke a secondary renal localization of the infection","justification":""},{"idx":4,"correct":false,"proposition":"a renal ultrasound should be performed","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-90","context":null,"enonce":" In what situations is anemia of central origin? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Vitamin B12 deficiency","justification":""},{"idx":1,"correct":false,"proposition":"Iron deficiency","justification":""},{"idx":2,"correct":false,"proposition":"Autoimmune hemolytic anemia","justification":""},{"idx":3,"correct":false,"proposition":"Myelodysplastic syndrome","justification":""},{"idx":4,"correct":false,"proposition":"Multiple myeloma","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-91","context":null,"enonce":" Your 55-year-old patient has been a cashier in a supermarket chain for 30 years. He has incomplete paraplegia following a road accident that occurred during his vacation 8 months ago. He is currently still on sick leave. What accompanying measures do you recommend? (one or more proposals expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Request an appointment at Pôle emploi","justification":""},{"idx":1,"correct":false,"proposition":"apply for recognition of the status of disabled worker","justification":""},{"idx":2,"correct":false,"proposition":"apply for disability","justification":""},{"idx":3,"correct":false,"proposition":"request a pre-resumption visit with your occupational physician","justification":""},{"idx":4,"correct":false,"proposition":"Request recognition in a commuting accident","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-92","context":null,"enonce":" A 25-year-old patient, smoker (10 cigarettes a day since the age of 15), is referred for consultation for symmetrical polyarthritis affecting the wrists, proximal interphalangeal, and metacarpophalangeal, present for 2 months. She has a history of pericarditis 6 months before your consultation, which has improved on nonsteroidal anti-inflammatory drugs. However, she retains a persistent deep inspiration discomfort. She tells you that she has been sensitive to cold since the age of 15 (with fingers that turn white), and also sensitivity to the sun since she took the last summer of significant \"sunburn\" on the face and décolleté, while she had little exposure. She does not have a feeling of dry eye or dry mouth. The biological analyses are as follows:","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The whole is in favor of inflammatory myopathy","justification":""},{"idx":1,"correct":false,"proposition":"the diagnosis of lupus can be affirmed even in the absence of native anti-DNA antibodies","justification":""},{"idx":2,"correct":false,"proposition":"The whole is in favor of rheumatoid arthritis","justification":""},{"idx":3,"correct":false,"proposition":"there is probably a secondary Sjögren's syndrome","justification":""},{"idx":4,"correct":false,"proposition":"there may be a congenital C4 deficiency","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-93","context":null,"enonce":" What biological abnormality(s) may be related to an inflammatory syndrome?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Thrombocytopenia","justification":""},{"idx":1,"correct":false,"proposition":"increase in alpha-2 globulins","justification":""},{"idx":2,"correct":false,"proposition":"hypoalbuminemia","justification":""},{"idx":3,"correct":false,"proposition":"hyperferritinemia","justification":""},{"idx":4,"correct":false,"proposition":"decrease in transferrin","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-94","context":null,"enonce":" A 48-year-old woman consults for paresthesias of the anterior surface of the thigh. You suspect cruralgia. What is (are) the true statement(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It can be caused by a foraminal disc herniation L5-S1","justification":""},{"idx":1,"correct":false,"proposition":"It can be caused by a paramedian disc herniation L4-L5","justification":""},{"idx":2,"correct":false,"proposition":"A motor deficit of the quadriceps can be observed","justification":""},{"idx":3,"correct":false,"proposition":"The pain may radiate to the anterior surface of the tibia","justification":""},{"idx":4,"correct":false,"proposition":"It can be caused by reducing the size of an osteoarthritic conjugation foramen","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-95","context":null,"enonce":" Regarding the judicial report, which is (are) the exact proposal(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It can only be performed by a health professional","justification":""},{"idx":1,"correct":false,"proposition":"It is one of the authorized derogations from professional secrecy","justification":""},{"idx":2,"correct":false,"proposition":"It is done orally during a telephone communication to the public prosecutor","justification":""},{"idx":3,"correct":false,"proposition":"If written by a doctor, it increases the punishment of the perpetrator","justification":""},{"idx":4,"correct":false,"proposition":"It makes it possible to warn the judicial authorities of suspected violence in a minor","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-96","context":null,"enonce":" Regarding the autopsy, which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"A medical autopsy may be requested by the doctor in order to investigate the causes of death","justification":""},{"idx":1,"correct":false,"proposition":"The family of the deceased may refuse to have a forensic autopsy of the body performed","justification":""},{"idx":2,"correct":false,"proposition":"The family of the deceased is the recipient of the conclusions of a medico-legal autopsy","justification":""},{"idx":3,"correct":false,"proposition":"Medical autopsy is governed by the same laws as organ harvesting","justification":""},{"idx":4,"correct":false,"proposition":"Family cannot see body before medical autopsy","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-97","context":null,"enonce":" In case of metastatic pulmonary adenocarcinoma, the search for therapeutic molecular targets: (one or more exact answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"is systematic","justification":""},{"idx":1,"correct":false,"proposition":"can be made from formalin-fixed biopsy material and included in paraffin","justification":""},{"idx":2,"correct":false,"proposition":"can be done from frozen biopsy material","justification":""},{"idx":3,"correct":false,"proposition":"determines the therapeutic choice of first-line treatment","justification":""},{"idx":4,"correct":false,"proposition":"requires prior morphological pathological examination","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-98","context":null,"enonce":" For osteosarcoma of the lower end of the femur, check the exact proposal(s):","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It consists of a proliferation of osteoblasts","justification":""},{"idx":1,"correct":false,"proposition":"The most frequent metastases are pulmonary","justification":""},{"idx":2,"correct":false,"proposition":"Its diagnosis requires a histo-radiological confrontation","justification":""},{"idx":3,"correct":false,"proposition":"Its diagnosis requires molecular confirmation","justification":""},{"idx":4,"correct":false,"proposition":"Surgical treatment from the outset is recommended","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-99","context":null,"enonce":" An 89-year-old patient comes to consultation for a fall. He has had three falls in the past year. What factor(s) will you look for at the interrogation and clinical examination as a risk factor for osteoporosis in the elderly?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Obesity (body mass index > 30)","justification":""},{"idx":1,"correct":false,"proposition":"Smoking","justification":""},{"idx":2,"correct":false,"proposition":"Vitamin D deficiency","justification":""},{"idx":3,"correct":false,"proposition":"Chronic alcoholism","justification":""},{"idx":4,"correct":false,"proposition":"Sedentary lifestyle","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-100","context":null,"enonce":" A patient has a fracture of the third thoracic vertebra and a fracture of the first lumbar vertebra. What are the elements in favor of vertebral fractures due to bone failure? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Disappearance of a thorny","justification":""},{"idx":1,"correct":false,"proposition":"Fracture of the third thoracic vertebra","justification":""},{"idx":2,"correct":false,"proposition":"Fracture of the first lumbar vertebra","justification":""},{"idx":3,"correct":false,"proposition":"Disappearance of the anterior cortical of the vertebral body","justification":""},{"idx":4,"correct":false,"proposition":"Respect for the pedicles of the fractured vertebra","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-101","context":null,"enonce":" Which first-line examination(s) for etiological purposes should be requested in the face of hyperferritinemia? (one or more expected answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Transferrin saturation coefficient","justification":""},{"idx":1,"correct":false,"proposition":"Fasting blood glucose","justification":""},{"idx":2,"correct":false,"proposition":"Abdominal CT scan","justification":""},{"idx":3,"correct":false,"proposition":"Liver biopsy","justification":""},{"idx":4,"correct":false,"proposition":"Triglyceride levels","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-103","context":null,"enonce":" Which semiological element(s) of imagery enter into the definition of a fluid pleural effusion?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"In radiography, it is a declivated opacity, basi-thoracic if the patient is standing","justification":""},{"idx":1,"correct":false,"proposition":"In radiography, in case of partitioned effusion, the internal limit of opacity can become convex","justification":""},{"idx":2,"correct":false,"proposition":"In radiography, there is an airy bronchogram within the abnormal opacity","justification":""},{"idx":3,"correct":false,"proposition":"There is an erasure of the diaphragm in radiography","justification":""},{"idx":4,"correct":false,"proposition":"Pleural ultrasound is the technique of choice for the diagnosis of fluid effusion in a lying patient","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-104","context":null,"enonce":" Among the following proposals, what is the main clinical manifestation of an infection of the gastric mucosa by Helicobacter pylori? (only one answer expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"motor diarrhea","justification":""},{"idx":1,"correct":false,"proposition":"fever","justification":""},{"idx":2,"correct":false,"proposition":"dyspeptic syndrome","justification":""},{"idx":3,"correct":false,"proposition":"vomiting","justification":""},{"idx":4,"correct":false,"proposition":"pyrosis","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-105","context":null,"enonce":" A 48-year-old non-diabetic patient experienced multiple episodes of hypoglycemia. What proposals are in favour of hypoglycaemia by hidden injections of rapid insulin? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"C-peptide increased during hypoglycemia","justification":""},{"idx":1,"correct":false,"proposition":"Weight gain","justification":""},{"idx":2,"correct":false,"proposition":"Pro-insulin increased during hypoglycemia","justification":""},{"idx":3,"correct":false,"proposition":"No sign of neuroglucopenia during episodes","justification":""},{"idx":4,"correct":false,"proposition":"Low cortisol during hypoglycemia","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-106","context":null,"enonce":" A 6-year-old boy is brought to a dermatology consultation by his mother. He lives in rural areas and attends school. He has been presenting for 1 month alopecic plaques that continue to spread despite the prescription of topical corticosteroids. What diagnosis(s) do you mention?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Kerion","justification":""},{"idx":1,"correct":false,"proposition":"Scalp psoriasis","justification":""},{"idx":2,"correct":false,"proposition":"Alopecia","justification":""},{"idx":3,"correct":false,"proposition":"Seborrheic dermatitis","justification":""},{"idx":4,"correct":false,"proposition":"False asbestos moth","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-107","context":null,"enonce":" Which bacterium(s) are the main responsible bacteria(s) for acute purulent otitis media?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Streptococcus pneumoniae","justification":""},{"idx":1,"correct":false,"proposition":"Haemophilus influenzae","justification":""},{"idx":2,"correct":false,"proposition":"Pseudomonas aeruginosa","justification":""},{"idx":3,"correct":false,"proposition":"Bordetella pertussis","justification":""},{"idx":4,"correct":false,"proposition":"Coxiella burnetii","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-108","context":null,"enonce":" Which of the following infectious agents is usually associated with a biological mononucleosis syndrome?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"HIV","justification":""},{"idx":1,"correct":false,"proposition":"Toxoplasma gondii","justification":""},{"idx":2,"correct":false,"proposition":"Pneumocystis jirovecii","justification":""},{"idx":3,"correct":false,"proposition":"Gardnerella vaginalis","justification":""},{"idx":4,"correct":false,"proposition":"CMV","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-111","context":null,"enonce":" You receive the result of the first toxoplasmosis screening serology of a patient who is 12 weeks pregnant with amenorrhea (AS). This is positive with the presence of IgM and IgG. Which proposals are correct? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"an IgG avidity test should be prescribed","justification":""},{"idx":1,"correct":false,"proposition":"It may be a primary infection in early pregnancy","justification":""},{"idx":2,"correct":false,"proposition":"it may be an old infection prior to the period of conception","justification":""},{"idx":3,"correct":false,"proposition":"amniocentesis with toxoplasma testing should be performed","justification":""},{"idx":4,"correct":false,"proposition":"the risk of mother-to-child transmission is high","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-112","context":null,"enonce":" You are caring for a patient who opens their eyes to verbal stimulation, has an appropriate motor response to a painful stimulus, and responds confusedly. Regarding its Glasgow score, which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It takes into account brainstem reflexes","justification":""},{"idx":1,"correct":false,"proposition":"This is a comatose patient","justification":""},{"idx":2,"correct":false,"proposition":"the opening of the eyes is rated 3","justification":""},{"idx":3,"correct":false,"proposition":"motor skills are rated 4","justification":""},{"idx":4,"correct":false,"proposition":"The total score is 11","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-113","context":null,"enonce":" When faced with this type of lesion in a child, what is the main diagnostic hyothesis? (only one exact answer)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"polygenic hypercholesterolemia","justification":""},{"idx":1,"correct":false,"proposition":"heterozygous familial hypercholesterolemia","justification":""},{"idx":2,"correct":false,"proposition":"homozygous familial hypercholesterolemia","justification":""},{"idx":3,"correct":false,"proposition":"dysbetaliboproteinemia","justification":""},{"idx":4,"correct":false,"proposition":"familial hyperchylomicronemia syndrome","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-114","context":null,"enonce":" What are the possible side effects of strong opioids? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Constipation","justification":""},{"idx":1,"correct":false,"proposition":"Nausea","justification":""},{"idx":2,"correct":false,"proposition":"Drowsiness","justification":""},{"idx":3,"correct":false,"proposition":"Organic renal failure","justification":""},{"idx":4,"correct":false,"proposition":"Heart failure","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-115","context":null,"enonce":" Regarding Takayasu's disease, what are the exact proposals? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It can be revealed by high blood pressure","justification":""},{"idx":1,"correct":false,"proposition":"it can give carotidodynias","justification":""},{"idx":2,"correct":false,"proposition":"It affects 9 women for 1 man","justification":""},{"idx":3,"correct":false,"proposition":"It can affect adults of any age","justification":""},{"idx":4,"correct":false,"proposition":"It belongs to the group of vasculitis of medium-sized vessels","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-116","context":null,"enonce":" About bacterial endocarditis, which is (are) the exact proposal(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":" It occurs more frequently on an injured valve than on a healthy valve","justification":""},{"idx":1,"correct":false,"proposition":"It occurs more frequently in valvular heart disease of the right heart than of the left heart","justification":""},{"idx":2,"correct":false,"proposition":"The elemental lesion is composed of fibrinoplatelet debris","justification":""},{"idx":3,"correct":false,"proposition":"It occurs preferentially on an atrial septal defect","justification":""},{"idx":4,"correct":false,"proposition":"Patients with prosthetic valves are at higher risk of endocarditis","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-117","context":null,"enonce":" The diagnosis of brain death requires: (one or more exact answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Check the absence of spontaneous breathing by extubating the patient","justification":""},{"idx":1,"correct":false,"proposition":"Check for the absence of brain activity by a brain MRI with injection","justification":""},{"idx":2,"correct":false,"proposition":"Eliminate hypothermia","justification":""},{"idx":3,"correct":false,"proposition":"To be ascertained by a doctor practicing outside the establishment where the patient is hospitalized","justification":""},{"idx":4,"correct":false,"proposition":"To verify clinical or paraclinical criteria established by decree","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-118","context":null,"enonce":" About sickle cell disease, which is (are) the exact proposal(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It is a disease of membrane origin of the red blood cell","justification":""},{"idx":1,"correct":false,"proposition":"It is the most common genetic pathology of red blood cells in the world","justification":""},{"idx":2,"correct":false,"proposition":"Sick subjects are heterozygous for the causal mutation","justification":""},{"idx":3,"correct":false,"proposition":"Sickle cell screening is offered to all children born in France","justification":""},{"idx":4,"correct":false,"proposition":"A sick person who unites with a spouse from northern Europe has a high risk of having a sick child","justification":""}],"type":"qi"}
+{"_id":"annales-2022-qi-120","context":null,"enonce":" In case of sarcoidosis, what are the exact answers regarding the granuloma? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"it contains T cells","justification":""},{"idx":1,"correct":false,"proposition":"it contains epithelial cells","justification":""},{"idx":2,"correct":false,"proposition":"It is a tuberculoid granuloma","justification":""},{"idx":3,"correct":false,"proposition":"It can be seen on skin samples of erythema nodosum","justification":""},{"idx":4,"correct":false,"proposition":"It can be seen on accessory salivary gland samples","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-2","context":null,"enonce":"A 30-year-old woman consults following an episode of spontaneous deep vein thrombosis. At the interrogation, you find a history of pulmonary embolism at age 50 in the mother. You suspect constitutional thrombophilia. Which analysis(s) do you think are relevant?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The determination of protein Ce of protein S","justification":""},{"idx":1,"correct":false,"proposition":"Determination of factor V","justification":""},{"idx":2,"correct":true,"proposition":"The search for a mutation of the II factor","justification":""},{"idx":3,"correct":true,"proposition":"The dosage of antithrombin","justification":""},{"idx":4,"correct":false,"proposition":"The determination of D-dimer","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-3","context":null,"enonce":"Mr. R., 54 years old, comes to consult for the discovery of a lump in the groin. On examination, you palpate a left inguinal lymphadenopathy 2.5 cm in diameter. What should your clinical examination include? (one or more possible answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Inspection of the skin of the entire left lower limb","justification":""},{"idx":1,"correct":true,"proposition":"An anal examination","justification":""},{"idx":2,"correct":true,"proposition":"Palpation of all lymph node areas","justification":""},{"idx":3,"correct":true,"proposition":"Inspection and palpation of the external genitalia","justification":""},{"idx":4,"correct":true,"proposition":"The search for splenomegaly","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-4","context":null,"enonce":"A 45-year-old man consults the emergency room for severe pain in his right wrist that woke him up this morning. You find hyperthermia at 38.5 ° C.  The wrist is red, warm and very swollen. You suspect septic arthritis. Which of the following proposition(s) is (are) correct?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Standard radiography should be performed","justification":""},{"idx":1,"correct":true,"proposition":"Joint puncture is useful and easy to perform in emergency","justification":""},{"idx":2,"correct":false,"proposition":"Ultrasound is specific to the diagnosis","justification":""},{"idx":3,"correct":false,"proposition":"MRI is part of the systematic assessment","justification":""},{"idx":4,"correct":true,"proposition":"The scintigraphy may be indicated in a second step to look for osteitis","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-5","context":null,"enonce":"A young student wakes up the day after a party with toxic abuse and notices a deficit in her right arm. You mention paralysis of the right radial nerve by compression at the tricipital gutter. Which of the following proposals corresponds to this diagnosis?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Gooseneck deficiency","justification":""},{"idx":1,"correct":false,"proposition":"Triceps brachial muscle deficiency","justification":""},{"idx":2,"correct":false,"proposition":"A sensory deficit of the entire posterior surface of the forearm","justification":""},{"idx":3,"correct":true,"proposition":"Brachioradial muscle deficiency","justification":""},{"idx":4,"correct":false,"proposition":"An abolition of the cubito-pronator reflex","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-6","context":null,"enonce":"The diagnosis of childhood autism spectrum disorder is based on:","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A normal intellectual level","justification":""},{"idx":1,"correct":true,"proposition":"Fears unusual for age","justification":""},{"idx":2,"correct":false,"proposition":"A sadness of mood","justification":""},{"idx":3,"correct":true,"proposition":"Circumscribed and persevering interests","justification":""},{"idx":4,"correct":true,"proposition":"A deficit of social reciprocity","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-7","context":null,"enonce":"An 8-year-old child comes to your consultation for swallowing pain, earache and fever. Examination of the objective throat of inflammatory tonsils. What is your attitude?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"You have a sample for streptococcus and rhinovirus PCR taken at the laboratory","justification":""},{"idx":1,"correct":false,"proposition":"You perform a strep rapid diagnostic test in the office","justification":""},{"idx":2,"correct":false,"proposition":"You prescribe symptomatic treatment with Ketoprofen","justification":""},{"idx":3,"correct":false,"proposition":"You prescribe amoxicillin + clavulanic acid as a first line","justification":""},{"idx":4,"correct":false,"proposition":"You prescribe in-the-ear antibiotic therapy","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-8","context":null,"enonce":"Among the following proposals concerning the entourage of a patient with meningococcal meningitis, indicate which one(s) is\/are right.","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Ciprofloxacin is a second-line antibiotic prophylaxis","justification":""},{"idx":1,"correct":true,"proposition":"Antibiotic prophylaxis aims to eradicate pharyngeal carriage in contact subjects","justification":""},{"idx":2,"correct":false,"proposition":"Antibiotic prophylaxis is offered up to 1 month after last contact with the index case","justification":""},{"idx":3,"correct":true,"proposition":"Antibiotic prophylaxis is based primarily on rifampicin","justification":""},{"idx":4,"correct":true,"proposition":"Vaccination may be offered in combination with antibiotic prophylaxis","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-10","context":null,"enonce":"A 92-year-old patient has seen this tumor develop on the left nasal wing for a few months. The tumor is nodular, with bleeding ulceration on the surface. The patient is in good general condition, with no notable history. She worked as a farmer for 50 years. What is your diagnosis?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":" Nodular basal cell carcinoma","justification":""},{"idx":1,"correct":false,"proposition":"Merkel's carcinoma","justification":""},{"idx":2,"correct":false,"proposition":"Achromic nodular melanoma","justification":""},{"idx":3,"correct":false,"proposition":"Squamous cell carcinoma","justification":""},{"idx":4,"correct":false,"proposition":"Dubreuilh's melanoma","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-11","context":null,"enonce":"A 64-year-old man has this chronic rash reaching 45% of the body surface area, evolving for about ten years. He has a history of hypertension treated with losartan, hydrochlorothiazide and atenolol, and smoking valued at 25 pack-years, as well as daily alcohol consumption. Which of the following measures do you think is appropriate for the management of this patient?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Smoking cessation","justification":"There are relatively few situations where this proposal is not checked off at EDN"},{"idx":1,"correct":true,"proposition":"Discontinuation of atenolol","justification":""},{"idx":2,"correct":false,"proposition":"Replacement of sartan with a calcium channel blocker","justification":""},{"idx":3,"correct":false,"proposition":"Very strong local dermocorticotherapy with clobetasol 30 grams per day","justification":""},{"idx":4,"correct":false,"proposition":"TL01 UVB Phototherapy (narrow spectrum)","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-13","context":null,"enonce":"You receive a feverish 16-month-old infant in the emergency room, whose mother is worried because she finds him tired. Which of the following is(are) in favor of a serious infection?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Fever above 39.5°C","justification":""},{"idx":1,"correct":false,"proposition":"Lack of response to paracetamol","justification":""},{"idx":2,"correct":true,"proposition":"Anorexia","justification":""},{"idx":3,"correct":true,"proposition":"Hypotonia","justification":""},{"idx":4,"correct":false,"proposition":"Enanthemum","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-14","context":null,"enonce":"An 80-year-old patient consults his general practitioner at the request of his wife for an annual check-up. What symptom(s) could you link to age-related androgen deficiency?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Sadness of mood","justification":""},{"idx":1,"correct":false,"proposition":"Haematuria","justification":""},{"idx":2,"correct":true,"proposition":"Gynecomastia","justification":""},{"idx":3,"correct":true,"proposition":"Abdominal obesity","justification":""},{"idx":4,"correct":false,"proposition":"Dysuria","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-15","context":null,"enonce":"A 67-year-old patient consults a urologist because his father and brother have prostate cancer. What symptom(s) would be in favor of prostate cancer?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Erectile dysfunction","justification":""},{"idx":1,"correct":false,"proposition":"Stress urinary incontinence","justification":""},{"idx":2,"correct":false,"proposition":"Terminal hematuria","justification":""},{"idx":3,"correct":true,"proposition":"Dysuria","justification":""},{"idx":4,"correct":true,"proposition":"Initial hematuria","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-16","context":null,"enonce":"What advantage(s) does permanent implant brachytherapy offer in prostate cancer compared to conventional irradiation?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Non-invasive treatment","justification":""},{"idx":1,"correct":false,"proposition":"Outpatient treatment","justification":""},{"idx":2,"correct":true,"proposition":"Higher dose delivered to the tumour","justification":""},{"idx":3,"correct":true,"proposition":"Better protection of healthy tissue","justification":""},{"idx":4,"correct":true,"proposition":"Lower risk of sequelae erectile dysfunction","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-17","context":null,"enonce":"Ms. M., 35 years old, presents for a dull pain in her right calf that has existed since the previous evening. During the interrogation, you find the existence of arterial disease of the lower limbs in the father of this patient, which led to a leg amputation at the age of 78. Despite this hereditary history, Ms. M. reports smoking quantified at half a pack of cigarettes a day since the age of 18. You also find Raynaud's syndrome in the patient's mother. Ms. M. has no treatment and has just presented a spontaneous miscarriage for which she remained hospitalized 24 hours. Clinical examination reveals an increase in the circumference of the edema of the right calf by 1 cm compared to the contralateral calf. There is also an increase in skin heat in the right lower limb as well as an increase in the visibility of the superficial veins and pain on deep palpation of the calf. In this patient, what element(s) should be taken into account to establish the clinical probability score?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Family history of vascular pathology","justification":""},{"idx":1,"correct":false,"proposition":"Increased right calf circumference by 1 cm","justification":""},{"idx":2,"correct":true,"proposition":"Pain on deep palpation","justification":""},{"idx":3,"correct":true,"proposition":"Increased visibility of superficial veins","justification":""},{"idx":4,"correct":true,"proposition":"Recent hospitalization of 24 hours","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-19","context":null,"enonce":"A 45-year-old woman consults for a right parotid mass. Which of the following criteria is (are) that directs you towards the diagnosis of pleomorphic adenoma?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Epidemiological criterion","justification":""},{"idx":1,"correct":true,"proposition":"Indurated lesion sometimes bumpy","justification":""},{"idx":2,"correct":true,"proposition":"Absence of facial paralysis","justification":""},{"idx":3,"correct":false,"proposition":"Algic character","justification":""},{"idx":4,"correct":true,"proposition":"Spontaneous hyper signal in T2 sequence on MRI","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-20","context":null,"enonce":" What element(s) contraindicate(s) the organization of palliative care care at home?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The fact that the patient is a child","justification":""},{"idx":1,"correct":true,"proposition":"Lack of consent and consent of the patient","justification":""},{"idx":2,"correct":false,"proposition":"The fact that the patient lives in a building without an elevator","justification":""},{"idx":3,"correct":false,"proposition":"The fact that the patient has more than 2 electric syringes","justification":""},{"idx":4,"correct":false,"proposition":"The fact that the patient lives alone at home","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-21","context":null,"enonce":"On what argument(s) do you assess the seriousness of an epistaxis?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Abundance","justification":""},{"idx":1,"correct":true,"proposition":"Associated comorbidities","justification":""},{"idx":2,"correct":true,"proposition":"Tachycardia","justification":""},{"idx":3,"correct":true,"proposition":"Presence of sweat","justification":""},{"idx":4,"correct":true,"proposition":"Recurrent bleeding","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-22","context":null,"enonce":"In order to avoid any << unreasonable obstinacy>> and in accordance with the terms of the law of 2 February 2022 known as the Leonetti-Claeys <<>> law, a treatment may be suspended or not undertaken, in accordance with the patient's will if the following condition(s) is (are) respected.","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"It is useless","justification":""},{"idx":1,"correct":true,"proposition":"It is disproportionate","justification":""},{"idx":2,"correct":true,"proposition":"It has no other effect than the only artificial maintenance of life","justification":""},{"idx":3,"correct":false,"proposition":"It can lead to a double effect","justification":""},{"idx":4,"correct":false,"proposition":"It is not scientifically proven","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-23","context":null,"enonce":"A 44-year-old man's bank check revealed hypokalemia at 3.2 mmol \/ L. What is the exact proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The patient must be hospitalized in an emergency","justification":""},{"idx":1,"correct":false,"proposition":"A urine ionogram on a sample should be requested","justification":""},{"idx":2,"correct":true,"proposition":"Hypokalaemia poses a risk of complete arrhythmia by atrial fibrillation","justification":""},{"idx":3,"correct":true,"proposition":"In case of associated high blood pressure, it is necessary to look for a chronic intake of licorice","justification":""},{"idx":4,"correct":true,"proposition":"In case of associated high blood pressure, it is necessary to seek a cocaine intake","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-24","context":null,"enonce":" What advice(s) can you give to a 78-year-old man with hypertension effectively treated with a low-salt diet and ACE inhibitor, and who is worried about the announcement in the media of an impending heat wave?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Drink enough","justification":""},{"idx":0,"correct":true,"proposition":"To suspend your salt-free diet during the heat wave","justification":""},{"idx":0,"correct":true,"proposition":"Watch your weight during the heat wave","justification":""},{"idx":0,"correct":true,"proposition":"Quantify your diuresis during the heat wave","justification":""},{"idx":0,"correct":false,"proposition":"Bring urine strips to measure daily urine density","justification":"Let's not go that far anyway 😂"}],"type":"qi"}
+{"_id":"annales-2019-qi-25","context":null,"enonce":" What is(are) the characteristic(s) of therapeutic part-time?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"It can be prescribed by the general practitioner","justification":""},{"idx":1,"correct":false,"proposition":"It may be prescribed by the occupational physician","justification":""},{"idx":2,"correct":true,"proposition":"It may be refused by the employer","justification":""},{"idx":3,"correct":false,"proposition":"It can last a maximum of 3 years","justification":""},{"idx":4,"correct":true,"proposition":"It can correspond to a recovery of 80 percent of a full-time equivalent.","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-26","context":null,"enonce":"A 38-year-old woman is hospitalized after an emergency caesarean section at 36 weeks of amenorrhea for severe pre-eclampsia with HELLP syndrome. She is anuric upon admission. Which additional examination is a priority?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Abdominopelvic CT angiography","justification":""},{"idx":1,"correct":false,"proposition":"Angio-lRM of the renal arteries","justification":""},{"idx":2,"correct":true,"proposition":"Renal and urinary tract ultrasound","justification":""},{"idx":3,"correct":false,"proposition":"Pelvic ultrasound","justification":""},{"idx":4,"correct":false,"proposition":"Renal perfusion scintigraphy","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-27","context":null,"enonce":"A 45-year-old woman has been consulting for persistent pelvic pain for a few weeks. She tells you that her last period was 3 weeks ago and she reports a few episodes of bleeding between periods, but very few. An endovaginal pelvic ultrasound was performed. This objective a moderate fluid effusion in the Douglas cul-de-sac and a heterogeneous right adnexal swelling measuring 3 cm of major axis, painful at the passage of the ultrasound probe. The objective clinical examination a flexible, slightly sensitive abdomen in the iliac fossa, defenseless. Blood pressure is 120\/60 mmHg. The temperature is 37.3°C.  The heart rate is 65 bpm. What plasma dosage(s) do you prescribe as a first-line treatment?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"CA 125","justification":""},{"idx":1,"correct":true,"proposition":"B-HCG","justification":"Any woman of childbearing age ..."},{"idx":2,"correct":false,"proposition":"HE4","justification":""},{"idx":3,"correct":false,"proposition":"Ca 19-9","justification":""},{"idx":4,"correct":false,"proposition":"CRP","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-28","context":null,"enonce":"You receive a patient suffering for 2 weeks from a depressive syndrome. He tells you that he has been working more than 50 hours a week for months, regularly bringing home work and feeling << drained >>. In addition, he tells you that his executive reproaches him daily and unjustified since he refused his advances. He wishes to apply for recognition as an occupational disease. Which element(s) do you indicate on the initial medical certificate?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Burnout in a context of work overload","justification":"Burnout is not, today, a recognized pathology"},{"idx":1,"correct":false,"proposition":"Sexual and psychological harassment"},{"idx":2,"correct":true,"proposition":"Depressive syndrome"},{"idx":3,"correct":false,"proposition":"Reactive anxio-depressive syndrome following sexual insistence","justification":""},{"idx":4,"correct":false,"proposition":"The precise date of the advances of its executive","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-29","context":null,"enonce":"At 25 years old, you have just passed your passage in the 38th cycle and you arrive in a new city as a first-semester intern, in the adult emergency room of the CHU. You had never been seen in school medicine or occupational medicine before, and you lost your health record a long time ago. You have no notable history, other than atopy in childhood, and two unreported blood-exposure accidents during your surgical rotations. You are summoned for an occupational medicine consultation. What should the occupational physician do (one or more exact proposals)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Look for latex irritation dermatitis due to a history of atopy","justification":""},{"idx":1,"correct":true,"proposition":"Performs an anti-Hbs antibody test to check for immunization against hepatitis B virus","justification":""},{"idx":2,"correct":true,"proposition":"Require you to be vaccinated with the dTP vaccine","justification":""},{"idx":3,"correct":false,"proposition":"Require you to get a flu shot","justification":"Flu vaccine is highly recommended but not mandatory"},{"idx":4,"correct":true,"proposition":"Perform an HIV serology"}],"type":"qi"}
+{"_id":"annales-2019-qi-30","context":null,"enonce":"You are seeing a 40-year-old patient with non-calcifying rotator cuff tendinopathy in the right shoulder. She is right-handed and works as an oyster worker. She explains that she has to handle bags of oysters weighing 20 kg to unload the barge, which leads her to have to abduct her shoulders. In her history, she is followed for well-balanced insulin-dependent diabetes. She quit smoking 3 months ago and started learning tennis. Which element(s) is (are) in favor of a potential occupational origin of his pathology?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Pathology is lateralized on the dominant limb","justification":""},{"idx":1,"correct":false,"proposition":"Diabetes is well balanced","justification":""},{"idx":2,"correct":false,"proposition":"You noticed the pathology while it was active","justification":""},{"idx":3,"correct":true,"proposition":"The patient is under 50 years of age","justification":""},{"idx":4,"correct":true,"proposition":"The gestures performed are at risk for the rotator cuff","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-31","context":null,"enonce":"A 75-year-old woman has been consulting for bleeding externalized through the vagina for two months. She weighs 89 kg for 1 m 50. In her history, there are two vaginal deliveries and high blood pressure. She does not smoke and has no allergy. What is the most likely diagnosis?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Malignant tumor of the ovary","justification":""},{"idx":1,"correct":false,"proposition":"Malignant tumor of the cervix","justification":""},{"idx":2,"correct":false,"proposition":"Malignant tumor of the fallopian tube","justification":""},{"idx":3,"correct":false,"proposition":"Malignant tumor of the vagina","justification":""},{"idx":4,"correct":true,"proposition":"Malignant endometrial tumour","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-32","context":null,"enonce":"A 27-year-old pregnant woman is seeking urination burns that have been ongoing for 24 hours. She is at 23 weeks of amenorrhea. This is her first pregnancy. She has no allergies and no history. The objective clinical examination a pain at the shaking of the right lumbar fossa. On vaginal touch, the cervix is long, posterior and closed. Blood pressure is 125\/65 mmHg. His heart rate is 78 bpm. Its temperature is 38.1 °C.  The urine strip objectifies the presence of proteins, leukocytes, blood and nitrites. A cytobacteriological examination of urine was prescribed. Direct examination shows 10,000\/mL leukocytes and gram-negative bacilli. Which antibiotic treatment is most relevant at this stage?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Ofloxacin","justification":""},{"idx":1,"correct":false,"proposition":"Amoxicillin-clavulanic acid","justification":""},{"idx":2,"correct":false,"proposition":"Fosfomycin","justification":""},{"idx":3,"correct":false,"proposition":"Amikacin","justification":""},{"idx":4,"correct":true,"proposition":"Cefotaxime","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-33","context":null,"enonce":"Which of the following pathologies can (may) promote the appearance of cataracts?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Hyperthyroidism","justification":""},{"idx":1,"correct":true,"proposition":"Diabetes","justification":""},{"idx":2,"correct":true,"proposition":"Down syndrome","justification":""},{"idx":3,"correct":true,"proposition":"Horton's disease","justification":""},{"idx":4,"correct":false,"proposition":"Steinert's myopathy","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-34","context":null,"enonce":"A 72-year-old patient has bilateral primary open-angle glaucoma treated with eye drops based on prostaglandin analogues and beta-blockers (fixed combination). Which of the following tests may have been used for the diagnosis of his glaucoma (one or more exact proposals)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Tonometry","justification":""},{"idx":1,"correct":true,"proposition":"Gonioscopy","justification":""},{"idx":2,"correct":false,"proposition":"Keratometry","justification":""},{"idx":3,"correct":true,"proposition":"Automated perimetry","justification":""},{"idx":4,"correct":true,"proposition":"Optical coherence tomography","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-35","context":null,"enonce":"You are following Mrs. F., aged 32, for chronic thrombocytopenic purpura progressing by flare-ups. Her platelet count remains around 20 G\/L. What advice(s) do you give to this patient?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Do not take acetylsalicylic acid","justification":""},{"idx":1,"correct":false,"proposition":"Do not take paracetamol","justification":""},{"idx":2,"correct":false,"proposition":"Do not take antibiotics","justification":""},{"idx":3,"correct":true,"proposition":"Avoid intramuscular injections","justification":""},{"idx":4,"correct":false,"proposition":"Prohibit subcutaneous injections","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-36","context":null,"enonce":"A 67-year-old patient arrives at the emergency department with fever at 39°C with chills of sudden onset. He is very asthenic. His wife who accompanied him found him pale and tired for several days. The first results on the hospital server show hemoglobin: 8.2 g \/ dL, leukocytes 2.8 G \/ L, polynuclear 0.41 G \/ L, platelets 36 G \/ L, reticulocytes 20 G \/ L. The automaton has not returned a formula and the smear has not yet been read. Which diagnosis(s) is compatible? (one or more exact propositions)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Bone marrow suppression","justification":""},{"idx":1,"correct":true,"proposition":"Acute leukemia","justification":""},{"idx":2,"correct":true,"proposition":"Myelodysplastic syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Chronic lymphocytic leukemia","justification":""},{"idx":4,"correct":true,"proposition":"Hodgkin's disease","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-37","context":null,"enonce":"A 19-year-old patient is referred to you for consultation because of repeated episodes of upper airway infection (ear infections, sinusitis) and bronchitis, with multiple antibiotic therapies (5 to 10 per year) in the last five years. A serum protein electrophoresis performed in the city shows the following results albumin 44 g \/ L - alpha1-globulins 2.61 g \/ L - alpha2-globulins 4.7 g \/ L - beta1-globulins 3.8 g \/ L - gamma globulins 3 g \/ L. blood lymphocyte immunophenotyping finds a decrease in switched memory B lymphocytes, without associated T-cell deficiency. To which of the following microorganism(s) does your patient have an increased susceptibility?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Streptococcus pneumoniae"},{"idx":1,"correct":false,"proposition":"Candida albicans","justification":""},{"idx":2,"correct":false,"proposition":"Mycobacterium tuberculosis"},{"idx":3,"correct":false,"proposition":"Pneumocystis jirovecii"},{"idx":4,"correct":false,"proposition":"Giardia lamblia"}],"type":"qi"}
+{"_id":"annales-2019-qi-38","context":null,"enonce":"A 62-year-old patient is referred by her general practitioner to the emergency department for pallor. The blood count is below. \n Reticulocytes are at 40 G\/L. You mention: (one or more expected answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Iron deficiency"},{"idx":1,"correct":false,"proposition":"Thrombotic microangiopathy","justification":""},{"idx":2,"correct":false,"proposition":"G6PD deficiency"},{"idx":3,"correct":false,"proposition":"Evans syndrome"},{"idx":4,"correct":true,"proposition":"Myelodysplasia"}],"type":"qi"}
+{"_id":"annales-2019-qi-39","context":null,"enonce":"A 37-year-old patient suffered a sprained right ankle 4 months ago. She complains of pain in the lower right limb when walking with allodynia of the upper surface of the right foot, equine varus of the right foot when walking, and edema of the foot. You mention a complex regional pain syndrome. What technique(s) can (s) be used by the physiotherapist?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Gain in range of motion","justification":""},{"idx":1,"correct":false,"proposition":"Work in charge","justification":""},{"idx":2,"correct":true,"proposition":"Skin desensitization","justification":""},{"idx":3,"correct":true,"proposition":"Triceps stretching","justification":""},{"idx":4,"correct":true,"proposition":"Balneotherapy","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-40","context":null,"enonce":"About the decision on medical termination of pregnancy (IMG), which is (are) the exact proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The couple can make the IMG decision on their own if the disease is particularly severe","justification":""},{"idx":1,"correct":false,"proposition":"Serious and incurable diseases are listed in a list giving entitlement to an IMG","justification":""},{"idx":2,"correct":false,"proposition":"IMG is only allowed if it is certain that the unborn child has the disease","justification":""},{"idx":3,"correct":true,"proposition":"The IMG is authorized by law with no term limit","justification":""},{"idx":4,"correct":true,"proposition":"The particular severity of a disease meets certain objective criteria such as the risk of premature death or cognitive impairment.","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-41","context":null,"enonce":"A young man of 25 years old consults you for acute low back pain occurred when getting up from his bed, radiating above 2 knees. He is addicted to the hard drugs he injects. All mobility of the spine is limited, pain in standing position is evaluated with an EN (numerical scale) of 7\/10. You find on the general examination a systolic heart murmur. He tells you that he has been coughing for several days. What do you suspect in this patient? (one or more possible answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Lumbago","justification":""},{"idx":1,"correct":true,"proposition":"Endocarditis","justification":""},{"idx":2,"correct":true,"proposition":"Cauda equina syndrome","justification":""},{"idx":3,"correct":true,"proposition":"Spondylodiscite","justification":""},{"idx":4,"correct":false,"proposition":"Ankylosing spondylitis","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-42","context":null,"enonce":"An 84-year-old man is referred to you after falling from bed. You have an x-ray of the pelvis. What is the real proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"There is a fracture of the right femoral neck","justification":""},{"idx":1,"correct":false,"proposition":"There is a fracture of the left trochanterian massif","justification":""},{"idx":2,"correct":false,"proposition":"There is a dislocation of the left coxofemoral joint","justification":""},{"idx":3,"correct":false,"proposition":"There is a fracture of the pubic symphysis","justification":""},{"idx":4,"correct":false,"proposition":"There is a fracture of the right shutter frame","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-43","context":null,"enonce":"The assessment of a bilateral form of breast cancer in a 42-year-old woman revealed a pathogenic BRCA1 mutation. What is the exact proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"High risk of ovarian cancer may warrant oophorectomy","justification":""},{"idx":1,"correct":false,"proposition":"Breast monitoring relies on simple breast ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"The risk of early breast cancer justifies genetic analysis in her underage daughters","justification":""},{"idx":3,"correct":true,"proposition":"The breast risk of recurrence may justify mastectomy","justification":""},{"idx":4,"correct":false,"proposition":"She is at high risk for colon cancer","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-44","context":null,"enonce":"It is necessary to offer an oncogenetic consultation in the following situation(s):","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"In a patient with a breast tumor at age 35","justification":""},{"idx":1,"correct":true,"proposition":"Faced with the existence of a bilateral breast tumor","justification":""},{"idx":2,"correct":true,"proposition":"In front of the existence of polyfocal colonic malignancies","justification":""},{"idx":3,"correct":false,"proposition":"Faced with the existence of an ovarian tumor in a 74-year-old woman","justification":""},{"idx":4,"correct":true,"proposition":"In a subject with a hundred polyps on the entire colonic frame","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-45","context":null,"enonce":"A general practitioner is required by a gendarme, a judicial police officer, to note the death of a 62-year-old man, who was not his patient, discovered in the barn of his house, with a ballistic trauma of the cephalic end, with an entrance hole visibly under the chin. A firearm is located along the body. The gendarme found a suicidal writing in the house. The constable informs the doctor that there will be no investigation. Which proposal(s) is the right proposal?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"In the absence of an investigation announced by the gendarme, the doctor does not have to check << medical-legal obstacle >> on the death certificate","justification":"Checking this box is a medical decision based on medical arguments"},{"idx":1,"correct":true,"proposition":"The doctor must examine the body for an exit hole for the projectile","justification":""},{"idx":2,"correct":true,"proposition":"The appearance of cadaveric lividities on the body will allow the doctor to support the hypothesis of a suicide","justification":"Cadaveric lividities not corresponding to pressure points may indicate secondary displacement of the body"},{"idx":3,"correct":true,"proposition":"The presence of recent bruises on the wrists and forearms goes against the hypothesis of suicide","justification":"We can think that these are traces of fights"},{"idx":4,"correct":false,"proposition":"An immediate putting in beer in a simple coffin must be requested in this context","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-46","context":null,"enonce":"The genital lesion that typically occurs at the time of a girl's first sexual intercourse is (only one response):","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A contuse laceration of the osterious fork","justification":""},{"idx":1,"correct":true,"proposition":"A complete tear of the posterior part of the hymen","justification":""},{"idx":2,"correct":false,"proposition":"A superficial cut from the vestibule","justification":""},{"idx":3,"correct":false,"proposition":"Diffuse erythema of the labia minora","justification":""},{"idx":4,"correct":false,"proposition":"A bilateral contagious wound of the vaginal walls behind the hymen","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-47","context":null,"enonce":"A judicial police officer takes a victim to a general medical office for the doctor to examine upon request. She says she has been subjected to domestic violence. Which proposal(s) is the right proposal?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The physician may refuse to respond to the requisition if he has no training in forensic medicine","justification":""},{"idx":1,"correct":false,"proposition":"Only a judicial police officer may request a doctor to examine a victim","justification":""},{"idx":2,"correct":false,"proposition":"The refusal to respond to the requisition is likely to engage the administrative liability of the doctor","justification":""},{"idx":3,"correct":true,"proposition":"The requested physician is released from the obligation of professional secrecy in the specific context of the mission entrusted to him","justification":""},{"idx":4,"correct":false,"proposition":"A copy of the report issued is given to the victim in person to assert what is right.","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-48","context":null,"enonce":"A patient with advanced left gonarthrosis for which a surgical indication has been decided in a CHU, understands upon waking that the knee prosthesis was placed by mistake on the right side. What are the right proposals? (One or more correct answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Side error is medical malpractice","justification":""},{"idx":1,"correct":true,"proposition":"The criminal liability of the surgeon may be engaged","justification":""},{"idx":2,"correct":false,"proposition":"It is not a medical fault because the prosthesis has been positioned according to the rules of the art","justification":""},{"idx":3,"correct":true,"proposition":"This situation may lead to an amicable settlement","justification":""},{"idx":4,"correct":false,"proposition":"The administrative responsibility of the establishment may be engaged for failure to organize the service","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-49","context":null,"enonce":"The shared medical record can be created by: (one or more exact answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The patient","justification":""},{"idx":1,"correct":false,"proposition":"The patient's designated support person","justification":""},{"idx":2,"correct":true,"proposition":"The holder of parental authority for a minor patient","justification":""},{"idx":3,"correct":true,"proposition":"The patient's attending physician","justification":""},{"idx":4,"correct":true,"proposition":"Social assistance for the patient","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-51","context":null,"enonce":"A 52-year-old patient is being treated with inhaled corticosteroids (fluticasone) for asthma. Her doctor prescribes antimycotic treatment (itraconazole) and a short course of oral corticosteroids for an asthma exacerbation triggered by an infection. What is(are) the iatrogenic risk(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Increased plasma concentrations of inhaled corticosteroid","justification":""},{"idx":1,"correct":false,"proposition":"Risk of developing a cushingoid syndrome","justification":""},{"idx":2,"correct":true,"proposition":"Increased plasma concentrations of oral corticosteroid","justification":""},{"idx":3,"correct":false,"proposition":"Risk of developing adrenal insufficiency","justification":""},{"idx":4,"correct":false,"proposition":"Low risk of drug interaction with itraconazole","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-52","context":null,"enonce":"A 75-year-old patient is treated with cholesterol-lowering (simvastatin) and vitamin K antagonist (warfarin). Her doctor prescribed macrolide antibiotics (clarithromycin) for acute bronchitis. What risk(s) can (s) be increased by a drug interaction?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Risk of tendinopathy","justification":""},{"idx":1,"correct":true,"proposition":"Risk of rhabdomyolysis","justification":""},{"idx":2,"correct":true,"proposition":"Increased risk of bleeding","justification":""},{"idx":3,"correct":true,"proposition":"Risk of potentially fatal arrhythmia","justification":""},{"idx":4,"correct":false,"proposition":"Decrease in lipid-lowering effect","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-53","context":null,"enonce":"About substances used for doping purposes in sport:","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Early baldness may be a sign of chronic anabolic androgenic steroid administration","justification":""},{"idx":1,"correct":true,"proposition":"Beta-2 agonists exert an anabolic effect in high doses resulting in an increase in muscle mass","justification":""},{"idx":2,"correct":true,"proposition":"Beta-blockers are prohibited in competition in some sports","justification":""},{"idx":3,"correct":true,"proposition":"The occurrence of a pulmonary embolism in a professional cyclist should be investigated for taking erythropoietin receptor agonist","justification":""},{"idx":4,"correct":false,"proposition":"Caffeine is prohibited","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-54","context":null,"enonce":"About the mechanisms of action of antibiotics:","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Penicillin inhibits penicillin-binding proteins (PLPs), enzymes of the peptidoglycan biosynthesis pathway","justification":""},{"idx":1,"correct":true,"proposition":"Macrolides inhibit bacterial protein synthesis by binding to the ribosome","justification":""},{"idx":2,"correct":true,"proposition":"Fluoroquinolones inhibit the replication, transcription, repair and recombination of bacterial DNA","justification":""},{"idx":3,"correct":true,"proposition":"Glycopeptides inhibit cell wall synthesis of bacteria","justification":""},{"idx":4,"correct":true,"proposition":"Trimetroprim-sulfamethoxazole is a folic acid inhibitor","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-55","context":null,"enonce":"An 80-year-old patient is brought by his daughter for consultation for signs of nocturnal agitation attributed to repeated nightmares. He had been treated with bromazepam for several years but he reports that he stopped this medicine two weeks ago. What clinical sign(s) associated with a withdrawal syndrome are you looking for?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Headache","justification":""},{"idx":1,"correct":true,"proposition":"Motor incoordination","justification":""},{"idx":2,"correct":false,"proposition":"Hypothermia","justification":""},{"idx":3,"correct":false,"proposition":"Bradycardia","justification":""},{"idx":4,"correct":false,"proposition":"Tremors","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-56","context":null,"enonce":"Regarding testicular germ cell tumors, it is true that: (one or more answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"They represent the first solid cancer in 20-year-old men","justification":""},{"idx":1,"correct":true,"proposition":"They may be associated with a serum increase in total HCG.","justification":""},{"idx":2,"correct":false,"proposition":"Biopsy is needed before orchiectomy","justification":""},{"idx":3,"correct":false,"proposition":"They are often associated with inguinal lymphadenopathy","justification":""},{"idx":4,"correct":true,"proposition":"They are often associated with lumbo-aortic lymphadenopathy.","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-57","context":null,"enonce":"You receive a 25-year-old woman for the implementation of estrogen-progestin contraception combining ethinyl estradiol and levonorgestrel. What contraindication(s) are you looking for in questioning and clinical examination?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Family history of deep vein thrombosis","justification":""},{"idx":1,"correct":true,"proposition":"Severe high blood pressure","justification":""},{"idx":2,"correct":false,"proposition":"History of ectopic pregnancy","justification":""},{"idx":3,"correct":true,"proposition":"Migraine with focal neurological signs","justification":""},{"idx":4,"correct":true,"proposition":"Familial hypercholesterolemia","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-58","context":null,"enonce":"Regarding the diagnosis of lymph node Hodgkin lymphoma, it is true that (one or more answers):","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" It usually requires a biopsy removed from a lymph node","justification":""},{"idx":1,"correct":false,"proposition":"The levy must be fixed in full immediately","justification":""},{"idx":2,"correct":true,"proposition":"It is based on the identification of Reed-Sternberg cells","justification":""},{"idx":3,"correct":true,"proposition":"A national pathological network for proofreading has been set up by INCa","justification":""},{"idx":4,"correct":true,"proposition":"it requires immunohistochemical labeling","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-59","context":null,"enonce":"Among the bone tumors for which a biopsy is necessary for diagnosis there are (one or more responses):","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Chondrosarcoma","justification":""},{"idx":1,"correct":false,"proposition":"Non-ossifying fibroid","justification":""},{"idx":2,"correct":false,"proposition":"Osteoid osteoma","justification":""},{"idx":3,"correct":true,"proposition":"Osteosarcoma","justification":""},{"idx":4,"correct":true,"proposition":"Giant bone cell tumour","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-60","context":null,"enonce":"Among the following, which criterion(s) is (are) part of the criteria of fragility of the elderly subject according to Fried?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Unintentional weight gain","justification":"Unintentional weight loss"},{"idx":1,"correct":true,"proposition":"Feeling tired","justification":""},{"idx":2,"correct":true,"proposition":"Decreased walking speed","justification":""},{"idx":3,"correct":false,"proposition":"Attentional disorders","justification":"The other 2 are: decreased muscle strength and decreased physical activity"},{"idx":4,"correct":false,"proposition":"Vesico-sphincter disorders","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-61","context":null,"enonce":"Regarding the first-line management of urinary incontinence in the elderly, which of the following proposal(s) is (are) correct?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Wearing protective gear","justification":""},{"idx":1,"correct":true,"proposition":"Implementation of scheduled urination","justification":""},{"idx":2,"correct":true,"proposition":"Bladder anticholinergics for emergency","justification":""},{"idx":3,"correct":false,"proposition":"Placement of an indwelling urinary catheter","justification":""},{"idx":4,"correct":false,"proposition":"Transcutaneous electrical stimulation of the pudendal nerve","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-62","context":null,"enonce":"Ms B., 57, is employed by a taps-making company. She has subscribed to a mutual health insurance. She lives in a rural area in metropolitan France, without the possibility of personal transport. As a general practitioner, you had already referred her to a cardiology consultation in the past. You now consider that a new cardiology consultation is necessary and you refer it to the cardiologist who follows Mrs. B. As the cardiologist's office is located 50 km from the patient's home, the cardiologist offers a teleconsultation. Ms. B. is not recognized as having a long-term illness. This cardiologist is conventionné, sector 1. Which of the following proposition(s) is the exact proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Ms. B. will receive an Internet link inviting her to connect at the scheduled time of the appointment to a secure site or application","justification":""},{"idx":1,"correct":true,"proposition":"The cardiologist must request and obtain Ms. B.'s consent before conducting the teleconsultation","justification":""},{"idx":2,"correct":false,"proposition":"As part of this teleconsultation, the cardiologist will not be able to write a prescription for treatment or additional examination","justification":""},{"idx":3,"correct":true,"proposition":"Mrs. B. will be reimbursed by the Health Insurance","justification":""},{"idx":4,"correct":false,"proposition":"The price of the teleconsultation is freely set by this cardiologist","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-63","context":null,"enonce":"You take care of a 52-year-old patient in the emergency room of the hospital for right calf pain. Your elements of interrogation and clinical examination lead you to hypothesize a deep vein thrombosis (DVT). As part of your diagnostic approach, you use a simplified clinical prediction model of DVT. The probability of DVT predicted by the model is high at 53 You decide to order an additional imaging test to confirm or refute your diagnostic hypothesis of DVT. Which of the following statements(are) the exact proposition(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The pre-test probability of DVT is implicitly estimated from your subjective impression.","justification":""},{"idx":1,"correct":true,"proposition":"The post-test probability of DVT depends on the pre-test probability and the informational characteristics intrinsic to the prescribed imaging test.","justification":""},{"idx":2,"correct":false,"proposition":"The pre-test probability of DVT is estimated from the positive and negative predictive values of the prescribed imaging examination.","justification":""},{"idx":3,"correct":true,"proposition":"The post-test probability of DVT depends on the likelihood ratios of the imaging test.","justification":""},{"idx":4,"correct":true,"proposition":"The more the plausibility ratio of the exam tends towards O, the more the post-test probability of DVT will tend towards 0","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-64","context":null,"enonce":"A 65-year-old man has nodular basal cell carcinoma (BCC) of the forehead 1 cm in diameter. What is the exact proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"CBC develops on pre-existing actinic keratosis","justification":""},{"idx":1,"correct":true,"proposition":"CBC occurs in photo-exposed areas","justification":""},{"idx":2,"correct":true,"proposition":"Surgery is the first-line treatment","justification":""},{"idx":3,"correct":false,"proposition":"The evolutionary risk is the appearance of visceral metastases","justification":""},{"idx":4,"correct":false,"proposition":"Debulking chemotherapy may be offered","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-65","context":null,"enonce":"What is your interpretation of this electrocardiogram recorded in a 50-year-old type II diabetic patient admitted to the emergency room for a sudden onset respiratory gene? (only one answer)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"CBC develops on pre-existing actinic keratosis","justification":""},{"idx":1,"correct":true,"proposition":"CBC occurs in photo-exposed areas","justification":""},{"idx":2,"correct":true,"proposition":"Surgery is the first-line treatment","justification":""},{"idx":3,"correct":false,"proposition":"The evolutionary risk is the appearance of visceral metastases","justification":""},{"idx":4,"correct":false,"proposition":"Debulking chemotherapy may be offered","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-66","context":null,"enonce":"A 75-year-old patient presents to the emergency room for difficulty breathing. Here is his chest x-ray from the front standing. What element(s) are you visualizing?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Cardiomegaly","justification":""},{"idx":1,"correct":true,"proposition":"A fracture of the left collarbone","justification":""},{"idx":2,"correct":false,"proposition":"Left pleural effusion","justification":""},{"idx":3,"correct":true,"proposition":"Perihilar alveolar opacities","justification":""},{"idx":4,"correct":false,"proposition":"A pneumothorax","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-68","context":null,"enonce":"A depressive episode characterized postpartum:","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Occurs mainly between 3 and 6 weeks after delivery","justification":""},{"idx":1,"correct":true,"proposition":"Affects nearly 25% of women who have given birth","justification":""},{"idx":2,"correct":true,"proposition":"Is unknown in 50% of cases"},{"idx":3,"correct":false,"proposition":"Is most often associated with psychotic features","justification":""},{"idx":4,"correct":true,"proposition":"Is at high risk of progression to bipolar disorder","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-69","context":null,"enonce":"Dyspnea with prolonged expiratory time can evoke","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Acute edema of the lung","justification":""},{"idx":1,"correct":false,"proposition":"A pneumothorax","justification":""},{"idx":2,"correct":true,"proposition":"An asthma exacerbation","justification":""},{"idx":3,"correct":true,"proposition":"An exacerbation of chronic obstructive pulmonary disease","justification":""},{"idx":4,"correct":false,"proposition":"Laryngeal tumour","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-70","context":null,"enonce":"Which clinical and paraclinical sign(s) suggestive of severity in a patient with pneumothorax?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Cyanosis","justification":""},{"idx":1,"correct":true,"proposition":"Polypnea > 30\/min","justification":""},{"idx":2,"correct":false,"proposition":"Reduction or abolition of vesicular murmur","justification":""},{"idx":3,"correct":false,"proposition":"Hypotension with systolic blood pressure less than or equal to 90 mmHg","justification":""},{"idx":4,"correct":false,"proposition":"Percussion tympanism","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-71","context":null,"enonce":"A 65-year-old woman consults for a dry cough evolving for 2 months; This cough wakes her up at night. She has been being treated for high blood pressure for a few months. She never smoked. She has no other history. To specifically explore this cough, which propositions are accurate (one or more exact answers)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Uncontrolled high blood pressure is a common cause of chronic cough","justification":""},{"idx":1,"correct":true,"proposition":"Looking for the prescription of an ACE inhibitor on its prescription","justification":""},{"idx":2,"correct":true,"proposition":"Looking for gastroesophageal reflux symptoms","justification":""},{"idx":3,"correct":true,"proposition":"Looking for sibilants pulmonary auscultation","justification":""},{"idx":4,"correct":false,"proposition":"Looking for a calcium channel blocker prescription on your prescription","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-72","context":null,"enonce":"A 16-year-old girl has these facial lesions that have been evolving for a few months (photo). Which of the following proposals, which diagnosis(s) do you retain?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Sarcoidosis","justification":""},{"idx":1,"correct":false,"proposition":"Papulopustular Rosacea","justification":""},{"idx":2,"correct":true,"proposition":"Polymorphic juvenile acne","justification":""},{"idx":3,"correct":false,"proposition":"Discoid lupus","justification":""},{"idx":4,"correct":false,"proposition":"Seborrheic dermatitis","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-73","context":null,"enonce":"Which of the following proposals regarding the complications of prolonged use of estrogen-progestin contraception is (are) accurate?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Subsequent decrease in fertility","justification":""},{"idx":1,"correct":false,"proposition":"Increased triglycerides","justification":""},{"idx":2,"correct":false,"proposition":"Increased risk of ovarian cancer","justification":""},{"idx":3,"correct":false,"proposition":"Increased risk of endometrial cancer","justification":""},{"idx":4,"correct":false,"proposition":"Increased risk of ectopic pregnancy","justification":""},{"idx":5,"correct":false,"proposition":"-miscarriage","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-74","context":null,"enonce":"Which of the following viruses is sexually transmittable?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Adenovirus","justification":""},{"idx":1,"correct":false,"proposition":"Influenza virus","justification":""},{"idx":2,"correct":true,"proposition":"Hepatitis A virus","justification":""},{"idx":3,"correct":true,"proposition":"Hepatitis B virus","justification":""},{"idx":4,"correct":true,"proposition":"Hepatitis C virus","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-75","context":null,"enonce":"A 26-year-old patient presents to the emergency department at 28 weeks of amenorrhea for headache and edema of the lower limbs. His blood pressure checked three times at rest is 160\/110 mmHg. You prescribe antihypertensive treatment. Which of the following medicinal products is authorised during pregnancy?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Urapidil","justification":""},{"idx":1,"correct":false,"proposition":"Enalapril","justification":""},{"idx":2,"correct":false,"proposition":"lndapamide","justification":""},{"idx":3,"correct":true,"proposition":"Nicardipine","justification":""},{"idx":4,"correct":true,"proposition":"Methyldopa","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-76","context":null,"enonce":"A 75-year-old patient has right papillary edema with a significant decrease in visual acuity. He complains of fatigue and weight loss for 3 months and headaches. Which of the following tests allows you to confirm your main diagnostic hypothesis?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Optical coherence tomography","justification":""},{"idx":1,"correct":false,"proposition":"Sedimentation rate","justification":""},{"idx":2,"correct":false,"proposition":"CRP","justification":""},{"idx":3,"correct":true,"proposition":"Temporal artery biopsy","justification":"This is the only test that can CONFIRM Horton's hypothesis"},{"idx":4,"correct":false,"proposition":"Retinal angiography","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-77","context":null,"enonce":"Three months after cataract surgery, a 72-year-old patient complains of myodesopsia. Which of the following signs could lead to fear of retinal detachment? (one or more answers are correct)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Dyschromatopsia","justification":""},{"idx":1,"correct":false,"proposition":"Phosphenes","justification":""},{"idx":2,"correct":false,"proposition":"Lagophthalmos","justification":""},{"idx":3,"correct":false,"proposition":"Visual field amputation","justification":""},{"idx":4,"correct":false,"proposition":"Ptosis","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-78","context":null,"enonce":"A young woman has reducible bilateral exophthalmos. In the following list, which examination(s) are necessary for the diagnosis of Graves' disease?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Thyroid scintigraphy","justification":""},{"idx":1,"correct":false,"proposition":"Kinetic perimetry","justification":""},{"idx":2,"correct":false,"proposition":"Orbital CT scan without injection of iodinated contrast medium","justification":""},{"idx":3,"correct":true,"proposition":"Anti-TSH receptor antibodies (TRAK)","justification":"Graves' disease = Hyperthyroidism by activation of TRAK receptors"},{"idx":4,"correct":false,"proposition":"Anti-thyroglobulin (TG) antibodies","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-79","context":null,"enonce":"What are the possible etiologies of decreased visual acuity associated with eye redness? (one or more correct answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Acute glaucoma crisis due to angle closure","justification":""},{"idx":1,"correct":true,"proposition":"Anterior uveitis","justification":""},{"idx":2,"correct":false,"proposition":"Central retinal artery occlusion (OACR)","justification":""},{"idx":3,"correct":false,"proposition":"Neovascular glaucoma","justification":""},{"idx":4,"correct":false,"proposition":"Retinal vasculitis","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-80","context":null,"enonce":"Which of the following clinical elements points to adhesive capsulitis of the shoulder?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"A lateral rotation at 0°","justification":""},{"idx":1,"correct":true,"proposition":"A traumatic trigger","justification":""},{"idx":2,"correct":false,"proposition":"Shoulder swelling","justification":""},{"idx":3,"correct":false,"proposition":"Redness of the shoulder","justification":""},{"idx":4,"correct":false,"proposition":"History of diabetes","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-81","context":null,"enonce":"You examine a 40-year-old patient after the harvest. He complains of a muscle control disorder to raise his right foot to walking. He has a sensory disorder of the first dorsal interosseous space. There is a step to walking, the Trendelenburg test is without abnormality, the fibular muscles are rated at 5\/5 in the motor test. What is your diagnosis(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Damage to the tibial nerve in the leg","justification":""},{"idx":1,"correct":false,"proposition":"Damage to the superficial fibular nerve","justification":""},{"idx":2,"correct":true,"proposition":"Deep fibular nerve damage","justification":""},{"idx":3,"correct":false,"proposition":"An attack of the root L4"},{"idx":4,"correct":false,"proposition":"Damage to the S1 root"}],"type":"qi"}
+{"_id":"annales-2019-qi-82","context":null,"enonce":"An 80-year-old patient comes to consult because she has left wrist pain for several years but is now very disabling. What is (are) the exact proposal(s) concerning the wrist X-ray that it brings you?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"There is rhizarthrosis","justification":""},{"idx":1,"correct":true,"proposition":"There is scaphotrapezian osteoarthritis","justification":""},{"idx":2,"correct":false,"proposition":"There is chondrocalcinosis","justification":""},{"idx":3,"correct":false,"proposition":"There is necrosis of lunatum","justification":""},{"idx":4,"correct":false,"proposition":"There is an old fracture of the scaphoid","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-83","context":null,"enonce":"A 20-year-old patient arrives at the emergency room because she had a ski fall the previous weekend and has persistent severe knee pain that prevents support. What is the exact proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"A knee effusion on a profile X-ray may suggest an acute rupture of the anterior cruciate ligament","justification":""},{"idx":1,"correct":true,"proposition":"X-rays of a spontaneously reduced patellofemoral dislocation may be normal","justification":""},{"idx":2,"correct":false,"proposition":"A fracture of the tibial plateau visible on the X-ray requires further exploration by an MRI","justification":""},{"idx":3,"correct":false,"proposition":"Arthroscan exploration of a chondral knee injury requires the injection of intra-articular gadolinium salt","justification":""},{"idx":4,"correct":false,"proposition":"Ultrasound is a good examination to study the knee extensor apparatus","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-85","context":null,"enonce":"During amyotrophic lateral sclerosis, you may observe the following clinical sign(s)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Hypoaesthesia of the lower limbs","justification":""},{"idx":1,"correct":true,"proposition":"Cognitive impairment","justification":""},{"idx":2,"correct":true,"proposition":"Slurred speech","justification":""},{"idx":3,"correct":false,"proposition":"Vesico-sphincter disorders","justification":""},{"idx":4,"correct":true,"proposition":"Scattered fasciculations","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-86","context":null,"enonce":"A 3-week-old newborn is brought by his parents to his pediatrician because his stool is discolored. The clinical examination finds jaundice. What is the exact proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"This clinical situation is an emergency","justification":""},{"idx":1,"correct":false,"proposition":"There is a risk of neurological complication by nuclear jaundice","justification":""},{"idx":2,"correct":false,"proposition":"Phototherapy should be done as soon as possible","justification":""},{"idx":3,"correct":false,"proposition":"Breastfeeding should be interrupted so as not to aggravate jaundice","justification":""},{"idx":4,"correct":false,"proposition":"Mother-child ABO compatibility must be checked","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-87","context":null,"enonce":"Which of the following applies(s) to NPH insulin?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Its duration of action is about 12 hours","justification":""},{"idx":1,"correct":true,"proposition":"It is an insulin suspension","justification":""},{"idx":2,"correct":false,"proposition":"It should not be injected into a venous","justification":""},{"idx":3,"correct":false,"proposition":"It should not be combined with rapid insulin","justification":""},{"idx":4,"correct":false,"proposition":"It should not be prescribed to pregnant women","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-89","context":null,"enonce":"You refer a 47-year-old patient to the surgeon because of an isolated thyroid nodule, without satellite lymphadenopathy, which measures 38 x 25 x 23 mm in diameter. It is rated TIRADS 3 on ultrasound but interferes with swallowing. A surgical indication is made (right thyroid lobo-isthmectomy). What is (are) the possible event(s) in the postoperative period?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Hypoparathyroidism","justification":""},{"idx":1,"correct":false,"proposition":"Hypothyroidism","justification":""},{"idx":2,"correct":false,"proposition":"Left recurrent paralysis","justification":""},{"idx":3,"correct":true,"proposition":"Dysphonia","justification":""},{"idx":4,"correct":true,"proposition":"Tabulation of thyroidectomy if the nodule is papillary cancer","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-91","context":null,"enonce":"A 42-year-old patient consults you for retrosternal chest pain and nocturnal regurgitation. The cardiovascular balance is negative. What is (are) the argument(s) in favor of a primitive achalasia?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Upper gastrointestinal endoscopy revealing stenosis of the lower esophagus","justification":""},{"idx":1,"correct":false,"proposition":"Presence of dysphagia only for solids","justification":""},{"idx":2,"correct":true,"proposition":"Regurgitation of food residues","justification":""},{"idx":3,"correct":false,"proposition":"Presence of iron deficiency anemia","justification":""},{"idx":4,"correct":false,"proposition":"Presence of propagated peristaltic waves with significant hyperpressure of the sphincter on an esophageal manometry","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-92","context":null,"enonce":"What diagnosis(s) is (are) to evoke in a 2-year-old child who has functional impotence of the lower limb of sudden onset without notion of trauma in a non-febrile context?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"A fracture on tumor","justification":""},{"idx":1,"correct":false,"proposition":"Juvenile osteoarthritis","justification":""},{"idx":2,"correct":false,"proposition":"Epiphysiolysis of the femoral head","justification":""},{"idx":3,"correct":true,"proposition":"A fracture by trauma inflicted","justification":""},{"idx":4,"correct":false,"proposition":"Higher femoral osteonecrosis","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-93","context":null,"enonce":"In front of a table of acute maxillary sinusitis, which is (are) the element (s) that orient (s) towards a bacterial origin?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Increased infraorbital sinus pain despite symptomatic treatment prescribed for at least 48 hours","justification":""},{"idx":1,"correct":true,"proposition":"One-sided and throbbing pain","justification":""},{"idx":2,"correct":true,"proposition":"Increased pain during trunk anteflexion","justification":""},{"idx":3,"correct":false,"proposition":"Pain increasing during the morning","justification":""},{"idx":4,"correct":false,"proposition":"Increase in rhinorrhea over time","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-94","context":null,"enonce":"A 76-year-old patient is referred for dysphagia. Which element(s) would orient (s) towards the diagnosis of Zenker's diverticulum?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Presence of regurgitation of undigested food","justification":""},{"idx":1,"correct":true,"proposition":"Fluctuating dysphagia","justification":""},{"idx":2,"correct":true,"proposition":"Sign of the << tide >> to nasofibroscopy","justification":""},{"idx":3,"correct":true,"proposition":"Presence of a nocturnal cough","justification":""},{"idx":4,"correct":false,"proposition":"Presence of dysphonia","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-96","context":null,"enonce":"A 45-year-old patient consults for persistent low back pain for 3 months with macroscopic hematuria. The following imaging is performed. What is the exact proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"This is an abdominal MRI","justification":""},{"idx":1,"correct":true,"proposition":"This is a coronal cup","justification":""},{"idx":2,"correct":true,"proposition":"This is imaging with contrast injection","justification":""},{"idx":3,"correct":true,"proposition":"There is a tumor of the right kidney","justification":""},{"idx":4,"correct":false,"proposition":"There is a left pyelocalicial dilation","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-97","context":null,"enonce":"On this CT scan of the abdomen: (one or more exact answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The structure designated by the number 1 is a hepatic vein","justification":""},{"idx":1,"correct":false,"proposition":"The structure designated by the number 2 is the portal vein","justification":""},{"idx":2,"correct":true,"proposition":"The structure designated by the number 3 is the aorta","justification":""},{"idx":3,"correct":true,"proposition":"The structure designated by the number 4 is the spleen","justification":""},{"idx":4,"correct":false,"proposition":"The structure designated by the number 5 is the stomach","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-98","context":null,"enonce":"In hepatic computed tomography, in typical forms, after intravenous injection of iodinated contrast medium, which proposal(s) is(are) exact?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"A hemangioma becomes opaque through the periphery","justification":""},{"idx":1,"correct":true,"proposition":"Hepatocellular carcinoma increases with arterial time","justification":""},{"idx":2,"correct":true,"proposition":"Hepatocellular carcinoma is the site of late-time wash-out","justification":""},{"idx":3,"correct":false,"proposition":"A biliary cyst rises at portal time","justification":""},{"idx":4,"correct":false,"proposition":"A metastasis rises intensely at the portal time","justification":"hypodense all the time"}],"type":"qi"}
+{"_id":"annales-2019-qi-99","context":null,"enonce":"Ms. C., with no particular background, is a senior executive, an employee in a company and benefits from a mutual insurance company. Mrs. C. made an appointment directly with a cardiologist in sector 1, outside the framework of the coordinated care pathway. Which of the following is correct?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The Health Insurance will only reimburse 30% of the basic fee of the consultation","justification":""},{"idx":1,"correct":true,"proposition":"Ms C. will have a flat-rate contribution of one euro for this consultation","justification":""},{"idx":2,"correct":false,"proposition":"The Health Insurance will refuse to reimburse the drugs prescribed by this cardiologist","justification":""},{"idx":3,"correct":true,"proposition":"The cardiologist is authorized to practice an excess fee of up to 60 euros","justification":""},{"idx":4,"correct":false,"proposition":"The amount reimbursed by Social Security will be 11.51 euros","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-100","context":null,"enonce":"What adjuvant therapeutic management(s) will you offer to a 53-year-old patient with invasive adenocarcinoma of non-specific type of right breast, triple negative, pT2N+MO after conservative surgery and right axillary dissection?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Radiotherapy"},{"idx":1,"correct":true,"proposition":"Chemotherapy"},{"idx":2,"correct":false,"proposition":"Hormone therapy"},{"idx":3,"correct":false,"proposition":"Trastuzumab"},{"idx":4,"correct":false,"proposition":"Complementary clavicular dissection","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-101","context":null,"enonce":"A patient is admitted to an identified palliative care bed for the management of amyotrophic lateral sclerosis. The patient is at a terminal stage of his disease. It benefits from nutrition, hydration by a gastrostomy device and non-invasive ventilation. After meeting the patient, the family asks to see you to discuss the principle of deep and continuous sedation until death as described in the law of February 2, 2022. What is the exact information(s) you can give the family about this sedation?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"It may accelerate the occurrence of death"},{"idx":1,"correct":false,"proposition":"Its objective is to accelerate the occurrence of death"},{"idx":2,"correct":false,"proposition":"It can be implemented at the request of the family under certain conditions"},{"idx":3,"correct":false,"proposition":"When a patient suffering from a serious and incurable condition decides to stop treatment and this cessation is life-threatening in the short term and is likely to cause unbearable suffering, he may request it."},{"idx":4,"correct":false,"proposition":"It is systematic as soon as a patient enters the agonic phase","justification":"Not at all systematic. It is the result of a multidisciplinary exchange between caregivers"}],"type":"qi"}
+{"_id":"annales-2019-qi-102","context":null,"enonce":" i You are caring for a 71-year-old patient in good general condition for Gleason 7 (3+4) prostate adenocarcinoma, initial PSA at 8 ng\/ml, clinical stage T2NOMO, recently discovered. Which therapeutic option(s) do you choose?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Cryotherapy","justification":""},{"idx":1,"correct":true,"proposition":"Radical prostatectomy","justification":""},{"idx":2,"correct":true,"proposition":"Long exclusive hormone therapy","justification":""},{"idx":3,"correct":true,"proposition":"Exclusive external beam radiation therapy","justification":""},{"idx":4,"correct":false,"proposition":"Transurethral prostate resection","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-103","context":null,"enonce":"A 60-year-old type 2 diabetic patient has mixed dyslipidemia. Its balance is as follows: LDL cholesterol 2.9 g\/L (7.54 mmol\/L); HDL cholesterol 0.32 g\/L (0.78 mmol\/L); apo B 1.8 g\/L (normal< 1.2 g\/L); triglycerides 2.5 g\/L (2.75 mmol\/L). This lesion located on the major must evoke: (one or more exact answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Combined hyperlipidemia entangled with type 2 diabetes","justification":""},{"idx":1,"correct":false,"proposition":"Dysbetalipoproteinemia entangled with type 2 diabetes","justification":""},{"idx":2,"correct":true,"proposition":"Nephrotic syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Lipoid necrobiosis","justification":""},{"idx":4,"correct":true,"proposition":"Heterozygous familial hypercholesterolemia + type 2 diabetes","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-104","context":null,"enonce":"A 27-year-old woman is hospitalized urgently for pain in the right flank and nausea progressing for 24 hours. She is at 25 weeks of amenorrhea (AS). When it arrives, you notice a temperature of 38.5 ° C.  The pain radiates into the right lumbar fossa. You must (one or more correct answers):","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Make a urine strip to look for an infection","justification":""},{"idx":1,"correct":true,"proposition":"evoke appendicitis because in the 2nd trimester of pregnancy the coecal bottom is repressed in the right flank","justification":""},{"idx":2,"correct":false,"proposition":"initiate non-steroidal anti-inflammatory therapy in principle","justification":""},{"idx":3,"correct":true,"proposition":"request an abdominal ultrasound","justification":""},{"idx":4,"correct":false,"proposition":"Start antibiotic therapy in emergency","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-106","context":null,"enonce":"Which of the following occupational exposures result in a proven excess risk of lung cancer (one or more possible responses)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Silica","justification":""},{"idx":1,"correct":true,"proposition":"Asbestos fibres","justification":""},{"idx":2,"correct":true,"proposition":"Polycyclic aromatic hydrocarbons","justification":""},{"idx":3,"correct":false,"proposition":"Aromatic amines","justification":""},{"idx":4,"correct":false,"proposition":"Formalin","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-107","context":null,"enonce":"A 41-year-old patient, with no medical or surgical history, has epigastralgia and must undergo a digestive endoscopy. The anaesthetist ordered a blood count and hemostasis tests. Haemoglobin is 12.1 g\/dL, platelets 151 G\/L. Leukocytes are at 7.5 G\/L. The TCA is 1.7 times the control, the TP is 97%. She never had a bleeding episode. These results are consistent with:","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Vitamin K deficiency","justification":""},{"idx":1,"correct":false,"proposition":"A circulating anticoagulant of the lip type","justification":""},{"idx":2,"correct":true,"proposition":"Hereditary factor XII deficiency","justification":""},{"idx":3,"correct":true,"proposition":"Hereditary factor XI deficiency","justification":""},{"idx":4,"correct":false,"proposition":"An anti-factor VII antibody","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-108","context":null,"enonce":"You are called to the neurovascular intensive care unit for a 37-year-old patient who has had a transient ischemic attack. By examining it, you notice lesions on the thighs. These are: (one exact answer)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Purpura","justification":""},{"idx":1,"correct":false,"proposition":"Confluent telangiectasias","justification":""},{"idx":2,"correct":false,"proposition":"Stretch marks","justification":""},{"idx":3,"correct":true,"proposition":"A livedo","justification":""},{"idx":4,"correct":false,"proposition":"Bruising","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-109","context":null,"enonce":"A 57-year-old man is hospitalized urgently for left iliac fossa pain and hyperthermia. You see it in the emergency room and suspect acute diverticulitis of the sigmoid. You ask: (one or more correct answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A picture of the abdomen without preparation standing from the front to visualize the colonic frame and possible liquid levels","justification":""},{"idx":1,"correct":false,"proposition":"An abdominal CT scan without injection because sepsis increases the risk of kidney failure","justification":""},{"idx":2,"correct":false,"proposition":"A water-soluble enema, to eliminate another pathology with similar symptomatology, and avoid a barium in case of diverticular perforation","justification":""},{"idx":3,"correct":true,"proposition":"An abdominal CT scan with contrast medium injection, after checking for severe renal impairment or a history of severe allergy to contrast medium","justification":""},{"idx":4,"correct":false,"proposition":"A rectosigmoidoscopy because the risk of perforation is less than with a long colonoscopy, and this examination makes it possible to formally eliminate the presence of colon cancer","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-110","context":null,"enonce":"Which of the following antimalarials for prophylaxis should only be continued one week after returning from an area at risk of malaria infection?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Chloroquine","justification":""},{"idx":1,"correct":false,"proposition":"Chloroquine-proguanil","justification":""},{"idx":2,"correct":true,"proposition":"Atovaquone-proguanil","justification":""},{"idx":3,"correct":false,"proposition":"Cyclines","justification":""},{"idx":4,"correct":false,"proposition":"Mefloquine","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-111","context":null,"enonce":"Which of the following bacteria has natural resistance to third-generation cephalosporins?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Golden staph","justification":""},{"idx":1,"correct":false,"proposition":"Klebsiella pneumoniae","justification":""},{"idx":2,"correct":false,"proposition":"Escerichia coli","justification":""},{"idx":3,"correct":false,"proposition":"Pneumococcus","justification":""},{"idx":4,"correct":true,"proposition":"Listeria monocytogenes","justification":"Mnemo: Princess LLEIA (Listeria, Legionella, Enterococcus, Intracellular, Anaerobic)"}],"type":"qi"}
+{"_id":"annales-2019-qi-112","context":null,"enonce":"You are reading an article reporting the results of a randomized, double-blind clinical trial, comparing two groups of patients, treated with either a new or a reference drug","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Beyond statistical significance, it is essential to assess the clinical relevance of the observed difference in effect","justification":""},{"idx":1,"correct":false,"proposition":"Randomization increases risk of bias when interpreting results","justification":""},{"idx":2,"correct":false,"proposition":"The double-blind technique is a method that aims to reduce bias in the realization and interpretation of the results of a clinical trial","justification":""},{"idx":3,"correct":false,"proposition":"The Transparency Commission of the HAS (Haute Autorité de Santé) can participate in the statistical analysis of this clinical trial on French territory","justification":""},{"idx":4,"correct":true,"proposition":"The statistical significance of the difference in effect of the two drugs is necessary to establish the superiority of therapeutic efficacy of the new drug","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-113","context":null,"enonce":"In this family, the diagnosis of cystic fibrosis (frequency 1\/3000 in the population) was confirmed and 2 composite heterozygous mutations in the CFTR gene were identified in the young woman 11-2. What is the exact proposal(s)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The risk of cystic fibrosis transmission for couples 11-1 and 11-2 is about 1\/60","justification":""},{"idx":1,"correct":true,"proposition":"The future risk for the II-3 free sister of having an affected child is about 1\/120","justification":""},{"idx":2,"correct":false,"proposition":"I-4's spouse is pregnant. The a priori risk that the unborn child is affected is about 1\/240","justification":""},{"idx":3,"correct":false,"proposition":"The woman II-3 can directly exercise a right of access to the medical file of her sister II-2","justification":""},{"idx":4,"correct":false,"proposition":"The I-1 woman refused the genetic test for heterozygosity for herself. The I-2 subject can directly transmit his own results to the children of I-1","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-114","context":null,"enonce":"Social phobias:","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Are specific forms of phobias","justification":""},{"idx":1,"correct":false,"proposition":"Mostly start from the age of 20","justification":""},{"idx":2,"correct":false,"proposition":"May manifest as delusions of persecution","justification":""},{"idx":3,"correct":true,"proposition":"Can manifest as fear of eating in public","justification":""},{"idx":4,"correct":true,"proposition":"Warrant treatment with antidepressants in severe forms","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-116","context":null,"enonce":"Regarding urothelial histological bladder carcinomas, which proposal(s) is(are) accurate?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"They are detected with good sensitivity by urinary cytology","justification":""},{"idx":1,"correct":false,"proposition":"They are low-grade when they are carcinomas in situ","justification":""},{"idx":2,"correct":false,"proposition":"They are associated with bladder schistosomiasis in Africa","justification":""},{"idx":3,"correct":true,"proposition":"Grade has little interest for tumors infiltrating the muscular.","justification":""},{"idx":4,"correct":false,"proposition":"They can be classified T2 on endoscopic resection chips","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-117","context":null,"enonce":"Regarding the diagnosis of cirrhosis on a liver biopsy: (one or more exact answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"This is a stage 4 of the METAVIR classification","justification":""},{"idx":1,"correct":true,"proposition":"There are almost no false positives","justification":""},{"idx":2,"correct":false,"proposition":"There are almost no false negatives","justification":"Yes, we can tap next to it"},{"idx":3,"correct":true,"proposition":"Diagnostic performance depends on the size of the sample","justification":""},{"idx":4,"correct":false,"proposition":"Diagnostic performance is better in micronodular cirrhosis","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-118","context":null,"enonce":"Which of the following treatments may be responsible for delirium by its anticholinergic property?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Antiparkinsonian tropatepine","justification":""},{"idx":1,"correct":true,"proposition":"Antiemetic metoclopramide","justification":""},{"idx":2,"correct":true,"proposition":"Antihistamine H1 hydroxyzine","justification":""},{"idx":3,"correct":false,"proposition":"Acetylcholine esterase inhibitor donepezil","justification":""},{"idx":4,"correct":true,"proposition":"Antispasmodic oxybutynin","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-119","context":null,"enonce":"For vesicular or follicular thyroid carcinomas: (one or more exact answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"They account for less than 5% of thyroid cancers","justification":""},{"idx":1,"correct":false,"proposition":"They are frequently associated with multiple endocrine neoplasia type 2 (MEN-2)","justification":""},{"idx":2,"correct":true,"proposition":"They usually diffuse through the blood","justification":""},{"idx":3,"correct":true,"proposition":"The sensitivity of the diagnosis of malignancy by cyto-puncture is good","justification":""},{"idx":4,"correct":true,"proposition":"It is more common in men over 70","justification":""}],"type":"qi"}
+{"_id":"annales-2019-qi-120","context":null,"enonce":"Regarding confusion, which proposal(s) is(are) right?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"It is a rapidly evolving dementia","justification":""},{"idx":1,"correct":true,"proposition":"It is most often linked to an organic cause","justification":""},{"idx":2,"correct":false,"proposition":"It can manifest itself only in the form of drowsiness","justification":""},{"idx":3,"correct":true,"proposition":"It corresponds to the acute decompensation of brain function","justification":""},{"idx":4,"correct":true,"proposition":"It is more common in the elderly","justification":""}],"type":"qi"}
+{"_id":"psygrossesse-psy-0","context":null,"enonce":"General:","item":"psygrossesse","matiere":"psy","propositions":[{"idx":0,"proposition":"Perinatal psychiatric disorders are mainly characterized depressive episodes","correct":true},{"idx":1,"proposition":"Seeking and preventing a risk of suicide and\/or infanticide is an imperative","correct":true},{"idx":2,"proposition":"In cases of severe postpartum depressive episode, the use of a joint mother-child hospitalization unit is currently recommended.","correct":true},{"idx":3,"proposition":"* In cases of depressive episodes with psychotic symptoms, management may be close outpatient","correct":false},{"idx":4,"proposition":"* In case of serious maternal failure or in case of immediate danger to the baby (risk of infanticide), hospitalization of both must be carried out urgently","correct":false}],"type":"custom"}
+{"_id":"psygrossesse-psy-1","context":null,"enonce":"Regarding mental disorders of pregnancy and postpartum:","item":"psygrossesse","matiere":"psy","propositions":[{"idx":0,"proposition":"Postpartum blues is a condition that we do not know how to treat at present","correct":false},{"idx":1,"proposition":"Psychotropic treatments should be prescribed with caution","correct":true},{"idx":2,"proposition":"Pregnancy and the arrival of a child are essential stages in a woman's life and involve profound physiological and psycho-social changes, which are to be considered as major stressors.","correct":true},{"idx":3,"proposition":"The perinatal period is a period of particular vulnerability for psychiatric disorders","correct":true},{"idx":4,"proposition":"There are no known risk factors","correct":false,"justification":"They exist and must be evaluated and detected as early as possible by the various partners in care in the perinatal period (attending physician, gynaecologist-obstetrician, midwife, maternal and child protection services, psychiatrist)"}],"type":"custom"}
+{"_id":"psygrossesse-psy-2","context":null,"enonce":"Regarding the management of per-pregnancy disorders:","item":"psygrossesse","matiere":"psy","propositions":[{"idx":0,"proposition":"An \"early prenatal interview\" is systematically offered in the 4th month of pregnancy","correct":true},{"idx":1,"proposition":"Every pregnant woman should be informed about the risks of taking addictive substances during pregnancy","correct":true},{"idx":2,"proposition":"Blame for risky behaviour allows for more effective cessation and should be preferred in emergency cases such as pregnancy.","correct":false,"justification":"We must avoid any guilt and stigmatization that only have opposite effects to those sought"},{"idx":3,"proposition":"Treatment of a maternal addictive disorder involves evaluating the benefits of withdrawal versus psychotropic treatment","correct":true},{"idx":4,"proposition":"The evaluation of associated psychiatric comorbidities must lead to a proposal for specialized follow-up","correct":true}],"type":"custom"}
+{"_id":"psygrossesse-psy-3","context":null,"enonce":"Regarding the management of anxious trooubles:","item":"psygrossesse","matiere":"psy","propositions":[{"idx":0,"proposition":"Pregnancy anxiety disorders are often the expression of pre-existing anxiety disorders","correct":true},{"idx":1,"proposition":"The postpartum period is a period conducive to the physiological compensation of anxiety disorders thanks to the major release of endorphins","correct":false,"justification":"The postpartum period is a period conducive to their aggravation, especially regarding obsessive-compulsive disorder (OCD)"},{"idx":2,"proposition":"Consultation with the Reference Centre for Teratogens will allow a safer prescription in case of need for psychotropic treatment","correct":true},{"idx":3,"proposition":"Abrupt cessation of treatment upon discovery of pregnancy is not recommended","correct":true},{"idx":4,"proposition":"The possible occurrence of transient neonatal disorders will be systematically taken into account when examining the newborn of each patient who has received psychotropic treatment during pregnancy.","correct":true}],"type":"custom"}
+{"_id":"psygrossesse-psy-4","context":null,"enonce":"Regarding the treatment of psychiatric disorders in pregnant women:","item":"psygrossesse","matiere":"psy","propositions":[{"idx":0,"proposition":"The prescription of benzodiazepines is totally contraindicated in pregnant women","correct":false,"justification":"Anxiolytics The prescription of benzodiazepines is to be avoided if possible, but if the clinical situation requires it then benzodiazepines with short half-life are to be preferred in particular Oxazepam (Seresta®)"},{"idx":1,"proposition":"Benzodiazepines also contraindicate breastfeeding","correct":false,"justification":"Breastfeeding is possible with these molecules prescribed in low doses"},{"idx":2,"proposition":"Serotonin reuptake inhibitors (SRIs) in pregnant women should be preferred over other anti-depressants","correct":true},{"idx":3,"proposition":"Both first and second generation antipsychotics can be used","correct":true},{"idx":4,"proposition":"No thymoregulators can be prescribed in pregnant women","correct":false,"justification":"The most documented thymoregulators, recommended and can be prescribed in pregnant women are: olanzapine (Zyprexa®) and lamotrigine (Lamictal®)"}],"type":"custom"}
+{"_id":"comportementadd-psy-0","context":null,"enonce":"Which of these proposals are behavioral addictions?","item":"comportementadd","matiere":"psy","propositions":[{"idx":0,"proposition":"Compulsive shopping","correct":true},{"idx":1,"proposition":"Sports addiction","correct":true},{"idx":2,"proposition":"Aversion to TV series","correct":false,"justification":"Behavioral addiction is not defined by a lack of behavior"},{"idx":3,"proposition":"Gambling while travelling","correct":false,"justification":"Simple gambling is not an addiction. It is the repetition of behavior despite negative consequences and the inability to control it that make it an addiction."},{"idx":4,"proposition":"Uncontrolled and negative sexual activities","correct":true}],"type":"custom"}
+{"_id":"comportementadd-psy-2","context":null,"enonce":"General information on behavioral addictions:","item":"comportementadd","matiere":"psy","propositions":[{"idx":0,"proposition":"The only behavioral addiction found in the DSM-5 is sex addiction.","correct":false,"justification":"Only one is officially defined in international classifications: gambling disorder also called \"pathological gambling\" (ICD-10, DSM-IV) or \"pathological gambling\" (DSM-5)"},{"idx":1,"proposition":"The mechanisms of behavioural addiction share the pathophysiological basis described in illicit substance use disorders","correct":true},{"idx":2,"proposition":"One of the main systems involved in these disorders is the serotonin reward system.","correct":false,"justification":"The dopaminergic reward system"},{"idx":3,"proposition":"In addictive disorders, the homeostasis of neurotransmission networks is disrupted","correct":true},{"idx":4,"proposition":"Behavioral addictions are of multifactorial origin","correct":true}],"type":"custom"}
+{"_id":"comportementadd-psy-3","context":null,"enonce":"Regarding risk factors and the impact of behavioral addictions:","item":"comportementadd","matiere":"psy","propositions":[{"idx":0,"proposition":"Behavioral addictions have a zero genetic component in view of the almost total impact of the environment","correct":false,"justification":"There are genetic predisposing factors (estimated heritability of 40-60% for addictive disorders), but also other individual risk factors (gender, age, sensation-seeking personality traits or impulsivity)"},{"idx":1,"proposition":"Psychiatric comorbidities are an important risk factor","correct":true},{"idx":2,"proposition":"Anxiety disorders are a risk factor for behavioral addictions","correct":true},{"idx":3,"proposition":"Attention deficit disorder predisposes to behavioral addictions only when there is hyperactivity","correct":false,"justification":"Even without hyperactivity"},{"idx":4,"proposition":"Definition Games of chance and gambling are games for which the subject irreversibly bets a good based on chance","correct":true}],"type":"custom"}
+{"_id":"comportementadd-psy-4","context":null,"enonce":"Regarding JHA:","item":"comportementadd","matiere":"psy","propositions":[{"idx":0,"proposition":"By definition, it is impossible to predict or control the outcome of a JHA.","correct":true},{"idx":1,"proposition":"There are phenomenological similarities, neurocognitive, neurobiological and therapeutic similarities between pathological gambling and other addictive behaviors","correct":true},{"idx":2,"proposition":"Gambling behavior is motivated solely by the hope of making money","correct":false,"justification":"Gambling behavior is motivated by different reasons: hope to earn money, search for thrills (especially feeling the \"thrill\", or thrill), desire to relieve negative emotions, search for social connections"},{"idx":3,"proposition":"A pathological gambler is invaded by urge to play, called \"craving\"","correct":true},{"idx":4,"proposition":"JHA is very unpopular and not very present in France because it is associated with alcoholism","correct":false,"justification":"In France, in 2014, three-quarters of French people between the ages of 15 and 75 said they had already played a JHA in their life, with just over half saying they had played it in the year."}],"type":"custom"}
+{"_id":"comportementadd-psy-5","context":null,"enonce":"Regarding JHA:","item":"comportementadd","matiere":"psy","propositions":[{"idx":0,"proposition":"Expenditures related to the practice of JHA represented 0.8% of annual household expenditures in 2012, in France","correct":true},{"idx":1,"proposition":"More than half of players spend less than 100 euros per year","correct":true},{"idx":2,"proposition":"The most represented games are blackjack and poker","correct":false,"justification":"Lottery games, \"hard\" (bars-tobacco)"},{"idx":3,"proposition":"Online games are mainly about horse betting","correct":false,"justification":"Online games (7.3% of players, a third of whom are mobile) are more concerned with poker and sports betting."},{"idx":4,"proposition":"The prevalence of pathological gambling in France is estimated to be 0.5% in the general population","correct":true}],"type":"custom"}
+{"_id":"anesth-anesth-0","context":null,"enonce":"Regarding generalities:","item":"anesth","matiere":"anesth","propositions":[{"idx":0,"proposition":"The practice of anesthesia is governed by the decree of 5 December 1335","correct":false,"justification":"December 5, 1994: it is a relatively recent specialty"},{"idx":1,"proposition":"Anesthesia consultation, pre-anesthetic visit and immediate post-operative monitoring are mandatory","correct":true},{"idx":2,"proposition":"General anesthesia is defined by irreversible loss of consciousness","correct":false,"justification":"The loss is reversible, otherwise it would be problematic x)"},{"idx":3,"proposition":"GA is broken down into 4 phases: falling asleep, unconscious, waking up, opening the eyes","correct":false,"justification":"3 phases: induction, maintenance and awakening"},{"idx":4,"proposition":"The purpose of locoregional anesthesia (ALR) is to transiently interrupt the transmission of nerve conduction while preserving the state of consciousness.","correct":true}],"type":"custom"}
+{"_id":"anesth-anesth-1","context":null,"enonce":"Which propositions are true?","item":"anesth","matiere":"anesth","propositions":[{"idx":0,"proposition":"ALRs are less regulated than MAs","correct":false,"justification":"They are subject to the same regulatory obligations"},{"idx":1,"proposition":"A distinction is made between perimedullary ALR (around the peripheral nerve) or peripheral ALR (around the spinal cord)","correct":false},{"idx":2,"proposition":"IN ALR, the local anesthetic is injected by MI, SC or IV","correct":false,"justification":"Local anesthesia is defined as the administration of a local anesthetic by infiltration or topically (by contact) in relation to the area to be operated or analgesive. IV injection is at risk of cardiology or neurological disorders."},{"idx":3,"proposition":"Transdural analgesia is the gold standard technique for ensuring quality analgesia during obstetric labour","correct":false,"justification":"Epidural analgesia"},{"idx":4,"proposition":"In 2010, more than 11 million procedures of anaesthesia were recorded in France","correct":true}],"type":"custom"}
+{"_id":"anesth-anesth-2","context":null,"enonce":"Regarding the consutlation:","item":"anesth","matiere":"anesth","propositions":[{"idx":0,"proposition":"About 2% of anhestesic procedures are treated on an outpatient basis","correct":false,"justification":"43%, almost half"},{"idx":1,"proposition":"In case of unscheduled intervention (emergency), the pre-anesthetic visit replaces the consultation","correct":true},{"idx":2,"proposition":"The purpose of the consultation is to carry out a medical evaluation of the patient","correct":true},{"idx":3,"proposition":"Anaesthetic risk is assessed according to the ASA (American Society of Anesthesiologists) classification","correct":true},{"idx":4,"proposition":"Patient information is an issue in consultation so that the patient can formulate informed consent","correct":true}],"type":"custom"}
+{"_id":"anesth-anesth-3","context":null,"enonce":"Regarding the GA and the ALR:","item":"anesth","matiere":"anesth","propositions":[{"idx":0,"proposition":"The pre-anesthetic visit takes place a few days (maximum 7) before the scheduled procedure under anesthesia","correct":false,"justification":"A few hours before. The objective is to confirm the information"},{"idx":1,"proposition":"General anesthesia (GA) is defined as a reversible loss of consciousness induced by the administration of a hypnotic often combined with an analgesic agent","correct":true},{"idx":2,"proposition":"A benzodiazepine is frequently used to cause muscle paralysis facilitating tracheal intubation and surgery.","correct":false,"justification":"This is the role of curare most often"},{"idx":3,"proposition":"ALR techniques are indicated in the surgical setting only","correct":false,"justification":"ALR techniques are indicated in the anesthetic context (allowing surgical intervention) but also for analgesic purposes (intraoperative, post-operative, obstetrical, etc.)"},{"idx":4,"proposition":"Local anesthesia is defined by the administration of a local anesthetic either by infiltration (intradermal, subcutaneous or diusion plane) or topically (by contact) in relation to the area to be operated or analgesia","correct":true}],"type":"custom"}
+{"_id":"anesth-anesth-4","context":null,"enonce":"Regarding general anesthesia: ","item":"anesth","matiere":"anesth","propositions":[{"idx":0,"proposition":"A delay of a few hours is recommended between the anesthesia consultation and scheduled surgery","correct":false,"justification":"A few days before (< 48h if possible)"},{"idx":1,"proposition":"There are 3 phases in general anesthesia: Maintenance -> Induction -> Awakening","correct":false,"justification":"Well 3 phases, but the order is: Induction -> Maintenance -> Awakening"},{"idx":2,"proposition":"Curare allows relaxation of all the muscles of the human body.","correct":false,"justification":"Trap;) not of the heart (which is a skeletal muscle but not governed by the motor plate)"},{"idx":3,"proposition":"A passage to the SSPI is mandatory for any general anesthesia or regional loco, even if the patient was conscious","correct":true,"justification":"According to decree, any surgical procedure with the use of an anesthetic product requires postoperative monitoring (AG and ALR included)"},{"idx":4,"proposition":"In general, morphine is THE drug used to put the patient to sleep during general anesthesia.","correct":false,"justification":"It is the hypnotic that puts the patient to sleep in general (propofol IV \/ inhaled halogenated ...)"}],"type":"custom"}
+{"_id":"anesth-anesth-5","context":null,"enonce":"A patient must undergo a scheduled endoscopy in 48 hours, but he goes on a trip in 24 hours, what are the true answers.","item":"anesth","matiere":"anesth","propositions":[{"idx":0,"proposition":"It is necessary to postpone endoscopy.","correct":true,"justification":"Not within the deadline for the anesth consultation, postponement of the mandatory endoscopy"},{"idx":1,"proposition":"He can have his pre-anesthetic consultation now and have the endoscopy right after.","correct":false,"justification":"Scheduled surgery. It would have been true in a hurry."},{"idx":2,"proposition":"He may have a pre-anesthetic visit before having his endoscopy right after","correct":false},{"idx":3,"proposition":"If he had had his anesthesia consultation 24 hours ago, he can do the endoscopy in 24 hours (48 hours after consultation) and directly jump on his plane just after the endoscopy","correct":false,"justification":"Use of anesthetic products, so mandatory passage to SSPI"},{"idx":4,"proposition":"If he had been able to have his endoscopy, the patient would have had a pre-anesthetic visit a few hours before the endoscopy.","correct":true,"justification":"Visit pre anesth qq hours before the act, to check that there have been no new events."}],"type":"custom"}
+{"_id":"anesth-anesth-6","context":null,"enonce":"What is the minimum conditioning in a patient who will undergo general anesthesia?","item":"anesth","matiere":"anesth","propositions":[{"idx":0,"proposition":"A peripheral venous route","correct":true},{"idx":1,"proposition":"Venous saturation with O2","correct":false,"justification":"False. It is a pulsed oxygen saturation (SpO2)"},{"idx":2,"proposition":"A measurement of the concentration of O2, CO2, NO and anesthetic gas of the inhaled and exhaled gases","correct":false,"justification":"False. The fraction in NO is not measured"},{"idx":3,"proposition":"Scope","correct":true},{"idx":4,"proposition":"Conditioning in anesthesia is called multiparametric monitoring","correct":true}],"type":"custom"}
+{"_id":"voyagetrop-infectio-0","context":null,"enonce":"Which of these trips are considered to be very risky?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"proposition":"Young adults on an unorganized trip to India for 4 weeks","correct":true},{"idx":1,"proposition":"Hitchhiking travellers in Eastern Europe","correct":false,"justification":"3 types of travellers most at risk: young adults travelling unorganized to India or Sub-Saharan Africa for a stay of several weeks, immunocompromised people and people who have emigrated to France and stayed in their country of origin when it is a source of endemic"},{"idx":2,"proposition":"Patients with diabetes","correct":false},{"idx":3,"proposition":"People over 75 years of age","correct":false},{"idx":4,"proposition":"People infected with hepatitis B","correct":false}],"type":"custom"}
+{"_id":"voyagetrop-infectio-1","context":null,"enonce":"Among these proposals, which are the first and second causes of medical repatriation or death during a stay in a tropical zone?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"proposition":"HIV infection","correct":false},{"idx":1,"proposition":"Tuberculosis","correct":false},{"idx":2,"proposition":"Cardiovascular events","correct":true},{"idx":3,"proposition":"Traumatic events","correct":true},{"idx":4,"proposition":"Terrorist attacks","correct":false}],"type":"custom"}
+{"_id":"voyagetrop-infectio-2","context":null,"enonce":"What are the main preventive measures?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"proposition":"Updating the vaccination schedule","correct":true},{"idx":1,"proposition":"Travel to Australia requires yellow fever vaccine","correct":false,"justification":"The endemic areas of yellow fever are intertropical Africa, South America and the Amazon region. In this case, the vaccine is recommended"},{"idx":2,"proposition":"Vector protection measures are advised in malaria prevention","correct":true},{"idx":3,"proposition":"Food hygiene helps limit the risk of turista and faecal diseases","correct":true},{"idx":4,"proposition":"Traveller education during consultation is essential","correct":true}],"type":"custom"}
+{"_id":"HBP-uro-1","context":null,"enonce":"Abstention\/monitoring is indicated in case of:","item":"HBP","matiere":"uro","propositions":[{"idx":0,"proposition":"Uncomplicated BPH","correct":true},{"idx":1,"proposition":"Moderate SBAU with return on quality of life","correct":false,"justification":"Medical or surgical treatment"},{"idx":2,"proposition":"SBAU severe","correct":false,"justification":"Surgical treatment"},{"idx":3,"proposition":"Moderate SBAUs with no clear impact on quality of life","correct":true,"justification":"And patient preference"},{"idx":4,"proposition":"Minimal SBAUs without impaired quality of life","correct":true}],"type":"custom"}
+{"_id":"HBP-uro-2","context":null,"enonce":"Regarding BPH management:","item":"HBP","matiere":"uro","propositions":[{"idx":0,"proposition":"α-blockers are effective after 6 months of treatment","correct":false,"justification":"This is the case for 5-alpha reductase inhibitors. A-blockers are effective in 48 hours"},{"idx":1,"proposition":"After TURP or AVH, the prostate adenoma should be sent to anatomical pathology in search of prostate cancer","correct":true},{"idx":2,"proposition":"The main side effect of surgical management is the spread of cancer","correct":false,"justification":"The main side effect is retrograde ejaculation"},{"idx":3,"proposition":"Prostate cancer screening by TR and annual PSA is recommended in patients aged 30 to 50 years in the general population","correct":false,"justification":"Screening for prostate cancer by TR and an annual PSA is recommended in patients aged 50 to 75 years or from 45 years in case of risk factors (Afro-Caribbean origin, family history)"},{"idx":4,"proposition":"Benign prostatic hyperplasia (BPH) is a subvesical obstacle to urine flow","correct":true}],"type":"custom"}
+{"_id":"HBP-uro-3","context":null,"enonce":"Regarding BPH:","item":"HBP","matiere":"uro","propositions":[{"idx":0,"proposition":"BPH is a common benign condition","correct":true},{"idx":1,"proposition":"BPH is hyperplasia of the glands in the marginal zone of the prostate","correct":false,"justification":"It corresponds to hyperplasia of the glands of the periurethral prostate (transition zone of the prostate)"},{"idx":2,"proposition":"The symptomatology may be stable or worsen more or less rapidly","correct":true},{"idx":3,"proposition":"There is a clear parallelism between the volume of BPH and the severity of SBAUs","correct":false,"justification":"There is no parallelism between the volume of BPH and the severity of SBAUs"},{"idx":4,"proposition":"BPH is hyperplasia of the transition zone of the prostate surrounding the subbladder urethra","correct":true}],"type":"custom"}
+{"_id":"HBP-uro-4","context":null,"enonce":"Regarding BPH:","item":"HBP","matiere":"uro","propositions":[{"idx":0,"proposition":"The evolution of a prostate adenoma does not systematically lead to the appearance of complications","correct":true},{"idx":1,"proposition":"BPH cannot be latent, it is always symptomatic, especially from the age of 70","correct":false,"justification":"BPH may be latent and responsible only for functional discomfort"},{"idx":2,"proposition":"BPH never escalates into prostate cancer","correct":true},{"idx":3,"proposition":"Prostate cancer is developed from the transition zone of the prostate","correct":false,"justification":"Prostate cancer, developed from the peripheral area of the prostate, is therefore often sought when diagnosed with BPH."},{"idx":4,"proposition":"BPH is multifactorial","correct":true}],"type":"custom"}
+{"_id":"autonomiegeria-mpr-0","context":null,"enonce":"For the following definitions, check the correct answer(s):","item":"autonomiegeria","matiere":"mpr","propositions":[{"idx":0,"proposition":"Autonomy and dependence are two opposite terms","correct":false},{"idx":1,"proposition":"Autonomy is the person's ability to move","correct":false,"justification":"Autonomy refers to the person's ability to make a free choice."},{"idx":2,"proposition":"Addiction is defined by the need for human help","correct":true},{"idx":3,"proposition":"The assessment of dependence in the elderly must be systematic during its management","correct":true},{"idx":4,"proposition":"The assessment of dependence in the elderly is part of the personalized health project","correct":true}],"type":"custom"}
+{"_id":"tbnutrigeria-nutri-0","context":null,"enonce":"Which propositions are true?","item":"tbnutrigeria","matiere":"nutri","propositions":[{"idx":0,"proposition":"A person is said to be \"old\" after the age of 50 or 55","correct":false,"justification":"A person is said to be \"old\" after the age of 70 or 75"},{"idx":1,"proposition":"Sarcopenic obesity is defined by BMI ≥ 30 and sarcopenia\n","correct":true},{"idx":2,"proposition":"An undernourished obese is defined by a BMI ≥ 30 and a criterion of undernutrition","correct":false,"justification":"Obese undernourished BMI ≥ 30 and a criterion of undernutrition"},{"idx":3,"proposition":"Decreased muscle performance signs probable sarcopenia","correct":false,"justification":"Severe sarcopenia (see Table 11.1, page 155, College of Nutrition, 3rd edition)"},{"idx":4,"proposition":"Entry into an institution is one of the criteria of fragility","correct":true}],"type":"custom"}
+{"_id":"tbnutrigeria-nutri-1","context":null,"enonce":"Which of these proposals make it possible to define undernutrition?","item":"tbnutrigeria","matiere":"nutri","propositions":[{"idx":0,"proposition":"Weight loss greater than or equal to 15% in 3 months","correct":false,"justification":"Weight loss greater than or equal to 5% in 1 month or 10% in 6 months"},{"idx":1,"proposition":"Weight loss greater than or equal to 15% in 6 months","correct":false},{"idx":2,"proposition":"Weight loss greater than or equal to 5% in 1 month","correct":true},{"idx":3,"proposition":"A BMI < 21 kg\/m2","correct":true},{"idx":4,"proposition":"An albuminemia < 35 g\/L","correct":true}],"type":"custom"}
+{"_id":"tbnutrigeria-nutri-2","context":null,"enonce":"Which of these proposals make it possible to define severe undernutrition?","item":"tbnutrigeria","matiere":"nutri","propositions":[{"idx":0,"proposition":"Weight loss greater than or equal to 15% in 3 months","correct":false,"justification":"Weight loss greater than or equal to 10% in 1 month or 15% in 6 months"},{"idx":1,"proposition":"A BMI < 19 kg\/m2","correct":false,"justification":"BMI< 17kg\/m2"},{"idx":2,"proposition":"A global NAM < 17","correct":false,"justification":"Undernutrition criterion"},{"idx":3,"proposition":"Weight loss greater than or equal to 15% in 6 months","correct":true},{"idx":4,"proposition":"Weight loss greater than or equal to 5% in 1 month","correct":false,"justification":"Undernutrition criterion"}],"type":"custom"}
+{"_id":"tbnutrigeria-nutri-3","context":null,"enonce":"Which propositions are true?","item":"tbnutrigeria","matiere":"nutri","propositions":[{"idx":0,"proposition":"BMI increases with age, reaching about 26–27 on average between the ages of 70 and 80","correct":true},{"idx":1,"proposition":"There are changes in body composition during aging: fat mass increases, muscle mass decreases.","correct":true},{"idx":2,"proposition":"Muscle mass decreases by about 40% between the ages of 20 and 80","correct":true},{"idx":3,"proposition":"Energy consumption increases as we age","correct":false,"justification":"It decreases"},{"idx":4,"proposition":"The prevalence of obesity increases with age with a peak of 20–23% at age 55–65 years, then gradually decreases.","correct":true}],"type":"custom"}
+{"_id":"tbnutrigeria-nutri-4","context":null,"enonce":"Among these proposals, which are pathologies of which obesity could be a protective factor?","item":"tbnutrigeria","matiere":"nutri","propositions":[{"idx":0,"proposition":"Osteroporosis","correct":true,"justification":"Decreased risk of fracture (mechanical protective role of adipose tissue in case of trauma, stimulating pressure of weight on bone structure and hormonal effect related to the transformation of adrenal androgens into estrogens by adipose tissue)"},{"idx":1,"proposition":"Adrenal insufficiency","correct":false},{"idx":2,"proposition":"Type 2 diabetes","correct":false,"justification":"Risk factor"},{"idx":3,"proposition":"Respiratory failure","correct":false,"justification":"Risk factor"},{"idx":4,"proposition":"Arthrosis","correct":false,"justification":"Risk factor"}],"type":"custom"}
+{"_id":"hemangiome-dermato-0","context":null,"enonce":"Regarding angiomas:","item":"hemangiome","matiere":"dermato","propositions":[{"idx":0,"proposition":"vascular tumors are most often capillary","correct":true},{"idx":1,"proposition":"The term 'angioma' is a generic term for vascular tumours such as hemangiomas and vascular malformations such as CAVs.","correct":true},{"idx":2,"proposition":"The main vascular tumor is angiocarcinoma of the elderly","correct":false,"justification":"Hemangiomas in infants"},{"idx":3,"proposition":"The prevalence of infant hemangiomas is 0.01%","correct":false,"justification":"Most common childhood tumours, with a prevalence of 10%"},{"idx":4,"proposition":"Hemangioma is a malignant tumor and a diagnostic emergency","correct":false,"justification":"Benign skin proliferations of vascular endothelial cells, non-congenital, more common in girls, premature infants and low birth weight infants"}],"type":"custom"}
+{"_id":"hemangiome-dermato-1","context":null,"enonce":"Which propositions are true?","item":"hemangiome","matiere":"dermato","propositions":[{"idx":0,"proposition":"The origin of infant hemangiomas is unknown","correct":true},{"idx":1,"proposition":"The endothelium is proliferating in malformations","correct":false,"justification":"Quiescant"},{"idx":2,"proposition":"Biopsy is usually unnecessary in typical uncomplicated hemangioma","correct":true},{"idx":3,"proposition":"Hemangioma is often present at birth","correct":false,"justification":"Often absent"},{"idx":4,"proposition":"The hemangioma is non-blowing on auscultation","correct":true}],"type":"custom"}
+{"_id":"hemangiome-dermato-2","context":null,"enonce":"Regarding hemangiomas:","item":"hemangiome","matiere":"dermato","propositions":[{"idx":0,"proposition":"Hemangiomas are the most common tumours in children, with a prevalence of 10%","correct":true},{"idx":1,"proposition":"Deep hemangiomas are arterial and present with bright red swelling","correct":false,"justification":"bluish swelling or normal skin colour"},{"idx":2,"proposition":"Deep hemangiomas are more elastic in consistency than superficial forms","correct":true},{"idx":3,"proposition":"Subcutaneous hemangiomas are always clinically diagnosed only","correct":false,"justification":"The clinic is sometimes non-specific: imaging may be necessary"},{"idx":4,"proposition":"Doppler ultrasound shows a richly vascularized tumor","correct":true}],"type":"custom"}
+{"_id":"hemangiome-dermato-3","context":null,"enonce":"Regarding the evolution of hemangiomas:","item":"hemangiome","matiere":"dermato","propositions":[{"idx":0,"proposition":"Management of hemangiomas is surgical","correct":false,"justification":"Hemangiomas regress completely and the majority require no treatment"},{"idx":1,"proposition":"The variation in the evolution of hemangiomas is important depending on the individual","correct":false,"justification":"Their natural history is stereotyped and is an important part of the diagnosis"},{"idx":2,"proposition":"Hemangiomas are absent at birth","correct":true},{"idx":3,"proposition":"The growth phase begins between the 3rd and 6th month of life","correct":false,"justification":"A beginning in the first days\/weeks of life"},{"idx":4,"proposition":"The increase in size is quite rapid during the first 5 to 6 months","correct":true}],"type":"custom"}
+{"_id":"polytrauma-urg-0","context":null,"enonce":"Regarding the key points:","item":"polytrauma","matiere":"urg","propositions":[{"idx":0,"proposition":"The life-threatening prognosis of severe trauma is still at stake","correct":true,"justification":"By definition, a severely traumatized person is a trauma patient whose violence or mechanism of trauma may result in life-threatening injuries."},{"idx":1,"proposition":"The first 15 minutes in the hospital are spent performing standard X-rays and a biological work-up","correct":false,"justification":"The first fifteen minutes of hospital care are devoted to clinical assessment and conditioning"},{"idx":2,"proposition":"The first 30 minutes in the hospital are devoted to the radiographic assessment including the CT scan","correct":false,"justification":"TDM does not enter the process of the first 30 minutes"},{"idx":3,"proposition":"Whole body computed tomography with contrast injection should be performed in all severe trauma patients whose haemodynamic status has been stabilized","correct":true},{"idx":4,"proposition":"Pre-hospital management includes an assessment of the haemodynamic, infectious, urinary and orthopaedic impact of lesions","correct":false,"justification":"What interests us urgently is the hemodynamic, ventilatory and neurological repercussions"}],"type":"custom"}
+{"_id":"polytrauma-urg-1","context":null,"enonce":"Regarding the management of polytrauma patients:","item":"polytrauma","matiere":"urg","propositions":[{"idx":0,"proposition":"Coagulopathy must be managed early","correct":true},{"idx":1,"proposition":"Hemodynamic failure is managed by the treatment of hemorrhagic shock","correct":true,"justification":"Mostly"},{"idx":2,"proposition":"Surgical management prioritizes bleeding lesions","correct":true},{"idx":3,"proposition":"Treatment of ventilatory failure involves orotracheal intubation","correct":true},{"idx":4,"proposition":"Treatment of neurological failure involves orotracheal intubation","correct":true}],"type":"custom"}
+{"_id":"polytrauma-urg-2","context":null,"enonce":"What are the roles of the witness of an accident?","item":"polytrauma","matiere":"urg","propositions":[{"idx":0,"proposition":"Protect","correct":true,"justification":"avoid the \"super-accident\", protect yourself, remove the injured person(s) from the traumatic agent"},{"idx":1,"proposition":"Treat","correct":false},{"idx":2,"proposition":"Alert","correct":true,"justification":"call 15 (Samu-SMUR), 18 (Firefighters), look for help around you."},{"idx":3,"proposition":"Rescue","correct":true,"justification":"compression of active bleeding, lateral safety position (PLS), basic cardiopulmonary resuscitation (CPR)"},{"idx":4,"proposition":"Accompany","correct":false,"justification":"The 3 essential roles of the first link in the chain of survival are: Protect, Alert, Rescue"}],"type":"custom"}
+{"_id":"PECKc-urg-0","context":null,"enonce":"Which of the following propositions concerning pre-eclampsia are true?","item":"PECKc","matiere":"urg","propositions":[{"idx":0,"proposition":"Pre-eclampsia is defined by the combination of blood pressure ≥140\/90 mmHg and proteinuria ≥ 300 mg\/24h occurring at any time during pregnancy","correct":false,"justification":"False, occurring from 20SA"},{"idx":1,"proposition":"Pre-eclampsia is said to be early when it occurs before 34 SA","correct":true},{"idx":2,"proposition":"In the majority of cases, pre-eclampsia disappears before the end of the 6th postpartum week","correct":true},{"idx":3,"proposition":"Pre-eclampsia affects less than 1% of pregnancies","correct":false,"justification":"False, 3 to 10% of pregnancies"},{"idx":4,"proposition":"A woman who has already had pre-eclampsia will have a decreased risk of pre-eclampsia for a later pregnancy.","correct":false,"justification":"False, increased risk"}],"type":"custom"}
+{"_id":"PECKc-urg-1","context":null,"enonce":"Which of the following proposals for the treatment of pre-eclampsia are true?","item":"PECKc","matiere":"urg","propositions":[{"idx":0,"proposition":"The only effective treatment is delivery of the placenta.","correct":true},{"idx":1,"proposition":"It is recommended to use calcium sulfate during the appearance of severe neurosensory signs and during eclampsia.","correct":false,"justification":"False, magnesium sulfate"},{"idx":2,"proposition":"IV nicardipine is the attack treatment for pre-eclampsia with a SBP of 190 mmHg.","correct":true,"justification":"True, for a SBP > 180 mmHg or a > 140mmHg MPA, the attack treatment is Nicardipine IV bolus of 0.5 to 1 mg, then infusion of 4-7 mg over 30 min. Evaluation of the efficacy and safety of the treatment after 30 min."},{"idx":3,"proposition":"Blood pressure objectives are a PAD between 80 and 105 mmHg.","correct":true},{"idx":4,"proposition":"Perindopril is part of the antihypertensive therapeutic arsenal in pre-eclampsia","correct":false,"justification":"False. All ACE inhibitors and angiotensin II receptor antagonists (sartans or ARA II) are contraindicated in the 2nd and 3rd trimesters of pregnancy!! Perindopril is an ACE inhibitor, and therefore contraindicated! They are contraindicated because they can induce acute renal failure in the fetus, resulting in oligo-amnios."}],"type":"custom"}
+{"_id":"APMP-mdt-0","context":null,"enonce":"Concerning accidents at work:","item":"APMP","matiere":"mdt","propositions":[{"idx":0,"proposition":"It is an accident caused by work","correct":true,"justification":"Any accident at the workplace is considered a TA, it also concerns the home-to-work journey or accidents in common areas (toilets, cafeteria)"},{"idx":1,"proposition":"The TA only concerns the company's employees","correct":false,"justification":"It also concerns stagaire pupils, people under contract, temporary workers, etc."},{"idx":2,"proposition":"TA is defined by its suddenness","correct":true,"justification":"This is particularly relevant for differentiation with PD"},{"idx":3,"proposition":"The maternality of the accidental event refers to the material that caused the accident","correct":false,"justification":"These are the precise conditions, localizable in time and space, in which TA occurs."},{"idx":4,"proposition":"Accidents occurring during strikes are TAs","correct":false,"justification":"There is suspension of the employment contract, so it is not a TA"}],"type":"custom"}
+{"_id":"APMP-mdt-1","context":null,"enonce":"Regarding accountability:","item":"APMP","matiere":"mdt","propositions":[{"idx":0,"proposition":"The insured must provide proof of this in the TAs","correct":false,"justification":"There is a presumption of accountability"},{"idx":1,"proposition":"The insured must provide proof in the PM","correct":true,"justification":"Via the classification tables for example which will determine the minimum exposure times"},{"idx":2,"proposition":"In the TA, imputability is established by the occupational physician","correct":false,"justification":"The CPAM medical officer is responsible for determining accountability"},{"idx":3,"proposition":"Relapses and late complications of TAs are covered by the presumption of initial imputability","correct":false,"justification":"The presumption of imputability applies only to initial injuries and direct complications"},{"idx":4,"proposition":"No one can dispute a TA and its accountability","correct":false,"justification":"Within the time limits, the employer and the CPAM may contest the imputability of a TA"}],"type":"custom"}
+{"_id":"APMP-mdt-2","context":null,"enonce":"Concerning occupational diseases: ","item":"APMP","matiere":"mdt","propositions":[{"idx":0,"proposition":"The installation of PM is often brutal","correct":false,"justification":"Progressive and insidious unlike TAs which are sudden"},{"idx":1,"proposition":"The only way to recognize PM is the array system","correct":false,"justification":"There is an ancillary system with the Regional Committee for the Recognition of Occupational Diseases which will in particular recognize as PM pathologies in workers who do not meet the criteria set out in the tables"},{"idx":2,"proposition":"There are 362 PM tables","correct":false,"justification":"114"},{"idx":3,"proposition":"The CMI has 5 components","correct":false,"justification":"3 components"},{"idx":4,"proposition":"It is the victim who must notify the employer","correct":true,"justification":"Unlike the AT, it is not the employer but the employee who must send the declaration of PM to the CPAM within 15 days of the finding of the disease."}],"type":"custom"}
+{"_id":"Kcoeso-onco-0","context":null,"enonce":"Which of the following are true?","item":"Kcoeso","matiere":"onco","propositions":[{"idx":0,"proposition":"Esophageal cancers are the most common digestive cancers","correct":false,"justification":"This is the 4th digestive cancer after colorectal, pancreatic and stomach cancer"},{"idx":1,"proposition":"Esophageal cancers are most often excellent prognosis","correct":false,"justification":"The prognosis is often poor"},{"idx":2,"proposition":"Esophageal cancers affect 75% of men","correct":true},{"idx":3,"proposition":"Esophageal cancers more common in the northwest","correct":true},{"idx":4,"proposition":"None of the propositions are true","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"Kcoeso-onco-1","context":null,"enonce":"What is the risk of malignant transformation of an endobrachyoesophagus (EBO) during life?","item":"Kcoeso","matiere":"onco","propositions":[{"idx":0,"proposition":"0%","correct":false,"justification":"False"},{"idx":1,"proposition":"10%","correct":true,"justification":"True. College of HGE (4th edition)"},{"idx":2,"proposition":"50%","correct":false,"justification":"False"},{"idx":3,"proposition":"80%","correct":false,"justification":"False"},{"idx":4,"proposition":"100%","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"Kcoeso-onco-2","context":null,"enonce":"Which of the following are true about Plummer-Vinson syndrome?","item":"Kcoeso","matiere":"onco","propositions":[{"idx":0,"proposition":"It has hypochromic microcytic anemia","correct":true,"justification":"True, ferriprive"},{"idx":1,"proposition":"It has koilonychia","correct":true},{"idx":2,"proposition":"It affects humans 🕺 more often","correct":false,"justification":"It affects women 💃 more often"},{"idx":3,"proposition":"It has glossitis","correct":true},{"idx":4,"proposition":"It is also called \"Kelly-Paterson syndrome\"","correct":true,"justification":"True. It is a risk factor for squamous cell cancer of the esophagus"}],"type":"custom"}
+{"_id":"Kcoeso-onco-3","context":null,"enonce":"Which of the following are true about endobrachyoesophagus?","item":"Kcoeso","matiere":"onco","propositions":[{"idx":0,"proposition":"Its other name is Barrett's esophagus","correct":true},{"idx":1,"proposition":"Monitoring is done, in the absence of dysplasia, every year","correct":false,"justification":"Every 2, 3 or 5 years depending on the length of metaplasia"},{"idx":2,"proposition":"Monitoring involves only a clinical examination","correct":false,"justification":"Fibroscopy with biopsies"},{"idx":3,"proposition":"Suspected low-grade dysplasia involves fibroscopic control after 6 months of PPI","correct":false,"justification":"Low-grade dysplasia involves fibroscopic control after 2-3 months of double-dose PPI"},{"idx":4,"proposition":"It is an important risk factor for adenocarcinoma of the esophagus","correct":true,"justification":"True. And no squamous cell carcinoma"}],"type":"custom"}
+{"_id":"Kcoeso-onco-4","context":null,"enonce":"Which of the following are risk factors for squamous cell cancer of the esophagus?","item":"Kcoeso","matiere":"onco","propositions":[{"idx":0,"proposition":"Tobacco 🚬","correct":true},{"idx":1,"proposition":"Alcohol 🥃","correct":true},{"idx":2,"proposition":"Cold 🧊 drinks ","correct":false,"justification":"Hot 🥵 drinks"},{"idx":3,"proposition":"Infection par HPV","correct":true},{"idx":4,"proposition":"Caustic esophagitis after several decades of evolution","correct":true}],"type":"custom"}
+{"_id":"Kcoeso-onco-5","context":null,"enonce":"What is the 5-year survival of esophageal tumors?","item":"Kcoeso","matiere":"onco","propositions":[{"idx":0,"proposition":"15%","correct":true,"justification":"True, it is a tumor of poor prognosis 😕"},{"idx":1,"proposition":"50%","correct":false,"justification":"False"},{"idx":2,"proposition":"80%","correct":false,"justification":"False"},{"idx":3,"proposition":"90%","correct":false,"justification":"False"},{"idx":4,"proposition":"95%","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"Kcovaire-onco-0","context":null,"enonce":"Which of the following are true?","item":"Kcovaire","matiere":"onco","propositions":[{"idx":0,"proposition":"About 10% of ovarian cancers occur in a context of genetic predisposition","correct":true},{"idx":1,"proposition":"It ranks 5th in cancer deaths in women","correct":true},{"idx":2,"proposition":" About 5-10% of women will have an ovarian tumor in their lifetime, and it is most often a benign ovarian cyst.","correct":true},{"idx":3,"proposition":"The ovary is a complex organ that is home to many different cell types ","correct":true},{"idx":4,"proposition":"Mature dermoid cysts or teratomas derive from a highly differentiated cell","correct":false,"justification":"Mature dermoid or teratoma cysts derive from a multipotent cell that can be the source of different tissues present within the cyst"}],"type":"custom"}
+{"_id":"Kcovaire-onco-1","context":null,"enonce":"Which of the following are formal contraindications in case of suspicion of ovarian cancer?","item":"Kcovaire","matiere":"onco","propositions":[{"idx":0,"proposition":"Transparietal biopsy of the ovary","correct":true,"justification":"True, Risk of Dissemination"},{"idx":1,"proposition":"Transvaginal ovarian biopsy","correct":true,"justification":"True, Risk of Dissemination"},{"idx":2,"proposition":"Transureteral biopsy of the ovary","correct":true,"justification":"True, impossible to do"},{"idx":3,"proposition":"Exploratory coeolioscopy","correct":false,"justification":"This is what is done in the first line"},{"idx":4,"proposition":"Diagnostic and therapeutic abstention","correct":true,"justification":"True, except in very special cases (end of life), it is necessary to explore urgently because the prognosis is very poor"}],"type":"custom"}
+{"_id":"CCR-onco-0","context":null,"enonce":"Which of the following proposals fall within the scope of Lynch syndrome?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"proposition":"Liver","correct":false,"justification":"No but possible for the bile ducts"},{"idx":1,"proposition":"Colon","correct":true},{"idx":2,"proposition":"Lung","correct":false,"justification":"False"},{"idx":3,"proposition":"ENT","correct":false,"justification":"Lynch syndrome: mainly colon, endometrium, small intestine and excretory urinary tract"},{"idx":4,"proposition":"Excretory urinary tract","correct":true}],"type":"custom"}
+{"_id":"CCR-onco-1","context":null,"enonce":"Which of the following proposals are part of the assessment of the extension of adenocarcinoma of the cecum?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"proposition":"Colonic endoscopic ultrasound","correct":false,"justification":"Not in the extension balance sheet"},{"idx":1,"proposition":"Thoracoab-abdominopelvic CT angiography","correct":true},{"idx":2,"proposition":"Positron emission tomography","correct":false,"justification":"Not in the first intention. Can be done in case of an increase in CEB"},{"idx":3,"proposition":"Dosage of CEA","correct":true,"justification":"True. An elevation of the CEA suggests a metastasis that will be sought by PET-CT"},{"idx":4,"proposition":"Cerebral magnetic resonance imaging","correct":false,"justification":"However, a liver MRI injected with gadolinium can be performed with a chest CT scan without injection, if an injected TDP-TAP is contraindicated (renal failure for example)"}],"type":"custom"}
+{"_id":"CCR-onco-2","context":null,"enonce":"Which of the following are true for preoperative measures in a patient with adenocarcinoma of the cecum?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"proposition":"Information with informed consent","correct":true,"justification":"True, as always"},{"idx":1,"proposition":"Preoperative immunonutrition","correct":true,"justification":"True because all surgical procedures are at risk of malnutrition. In case of oncological digestive surgery, a supply of micronutrients to begin 7 days before the intervention, is recommended to limit infectious complications and postoperative mortality."},{"idx":2,"proposition":"Colic preparation","correct":false,"justification":"Unnecessary in the case of laparotomy or laparoscopy."},{"idx":3,"proposition":"Ad consultation","correct":true},{"idx":4,"proposition":"ALD Application","correct":true}],"type":"custom"}
+{"_id":"CCR-onco-3","context":null,"enonce":"Which of the following propositions are true regarding the monitoring of Lynch syndrome-prone patients who have previously had resected colonic adenocarcinoma?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"proposition":"A gynecological examination","correct":true,"justification":"True, for Lynch syndrome (endometrial cancer)"},{"idx":1,"proposition":"A carcinoembryonic antigen assay","correct":true},{"idx":2,"proposition":"A colonoscopy with chromoendoscopy","correct":true,"justification":"True, for Lynch syndrome"},{"idx":3,"proposition":"A thoraco-abdomino-pelvic CT scan","correct":true},{"idx":4,"proposition":"A urine strip","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"CCR-onco-4","context":null,"enonce":"Which of the following are true about Lynch syndrome?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"proposition":"There are more polyps in the lining of the colon than in Familial Adenomatous Polyposis (FAP)","correct":false,"justification":"No, there are fewer"},{"idx":1,"proposition":"The risk of developing CRC during life is about 70% in humans","correct":true},{"idx":2,"proposition":"The risk of developing CRC during life is about 70% in women","correct":false,"justification":"About 50%"},{"idx":3,"proposition":"In the majority of cases, cancer develops in the sigmoid","correct":false,"justification":"At the level of the right colon"},{"idx":4,"proposition":"The positive relative risk is only for colon tumours","correct":false,"justification":"Also cancer of the urinary tract, small intestine, endometrium. Also from the ovary, stomach, bile ducts, pancreas and brain"}],"type":"custom"}
+{"_id":"CCR-onco-5","context":null,"enonce":"In case of stage T3 N+ stage T3 N+ lieberkühnian adenocarcinoma surgically resected, what postoperative treatment(s) do you prescribe?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"proposition":"External beam radiation therapy","correct":false,"justification":"False"},{"idx":1,"proposition":"Radiochemotherapy","correct":false,"justification":"False"},{"idx":2,"proposition":"Chemotherapy","correct":true,"justification":"True, this is the only adjuvant therapy in stage 3 colonic adenocarcinoma (i.e., which are N+). 5-FU and oxaliplatin are preferred"},{"idx":3,"proposition":"None of the answers are accurate","correct":false,"justification":"False"},{"idx":4,"proposition":"No adjuvant therapy","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"CCR-onco-6","context":null,"enonce":"Which of the following are true in cases of adenocarcinoma of the cecum with negative extension assessment?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"proposition":"Surgical removal of colonic tumor","correct":true},{"idx":1,"proposition":"None of these proposals","correct":false,"justification":"False"},{"idx":2,"proposition":"Radiochemotherapy alone","correct":false,"justification":"False"},{"idx":3,"proposition":"Endoscopic resection","correct":false,"justification":"The cecum is far too far."},{"idx":4,"proposition":"Radio frequency","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"CCR-onco-7","context":null,"enonce":"Which of the following are true about Lynch syndrome?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"proposition":"There are more polyps in the lining of the colon than in Familial Adenomatous Polyposis (FAP)","correct":false,"justification":"No, there are fewer"},{"idx":1,"proposition":"The risk of developing CRC during life is about 70% in humans","correct":true},{"idx":2,"proposition":"The risk of developing CRC during life is about 70% in women","correct":false,"justification":"About 50%"},{"idx":3,"proposition":"In the majority of cases, cancer develops in the sigmoid","correct":false,"justification":"At the level of the right colon"},{"idx":4,"proposition":"The positive relative risk is only for colon tumours","correct":false,"justification":"Also cancer of the urinary tract, small intestine, endometrium. Also from the ovary, stomach, bile ducts, pancreas and brain"}],"type":"custom"}
+{"_id":"CCR-onco-8","context":null,"enonce":"Which of the following are true about Lynch syndrome?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"proposition":"It is also called HNPCC Syndrome","correct":true,"justification":"True, for Hereditary Non Polyposis Colorectal Cancer"},{"idx":1,"proposition":"It is responsible for 25% of colorectal cancers","correct":false,"justification":"4% of CRC, it is the most common form of hereditary cancers"},{"idx":2,"proposition":"The abnormality is expressed on the genes of the mismatch repair proteins","correct":true,"justification":"True, MMR (MisMatch Repair) genes. Mainly MLH1 and MSH2"},{"idx":3,"proposition":"Its transmission is autosomal dominant","correct":true},{"idx":4,"proposition":"Replication errors are mostly found on chromosome 6 and 18","correct":false,"justification":"They are found at the level of micro-satellite sequences (DNA sequences formed by a repetition of patterns), which themselves are found in all chromosomes"}],"type":"custom"}
+{"_id":"lithiaseU-nephro-0","context":null,"enonce":"Among these proposals, which favor the occurrence of renal colic?","item":"lithiaseU","matiere":"nephro","propositions":[{"idx":0,"proposition":"Long-term travel","correct":true},{"idx":1,"proposition":"Immobilization","correct":true},{"idx":2,"proposition":"The cold","correct":false,"justification":"Heat, on the other hand, is a contributing factor"},{"idx":3,"proposition":"Renal failure","correct":false,"justification":"It can, however, cause kidney failure, in very rare cases"},{"idx":4,"proposition":"Dehydration","correct":true}],"type":"custom"}
+{"_id":"lithiaseU-nephro-1","context":null,"enonce":"Regarding epidemiology:","item":"lithiaseU","matiere":"nephro","propositions":[{"idx":0,"proposition":"Urolithiasis affects 50% of the population in France","correct":false,"justification":"Between 5 and 10%. It is a common disease"},{"idx":1,"proposition":"She never reoffends","correct":false,"justification":"It recurs in 50% of cases if preventive treatment is not put in place"},{"idx":2,"proposition":"Uric acid calculus is the most common","correct":false,"justification":"Calcium lithiasis is the most common. It represents 80% of urolithiasis"},{"idx":3,"proposition":"Infectious stones account for 5% of urolithiasis","correct":true},{"idx":4,"proposition":"Calcium lithiasis is usually idiopathic","correct":true}],"type":"custom"}
+{"_id":"lithiaseU-nephro-2","context":null,"enonce":"What are the elements of gravity to look for?","item":"lithiaseU","matiere":"nephro","propositions":[{"idx":0,"proposition":"Anuria","correct":true,"justification":"It is then a question of acute obstructive renal failure"},{"idx":1,"proposition":"Pregnancy","correct":true,"justification":"It is one of the three risk areas: pregnancy, kidney transplantation and kidney failure."},{"idx":2,"proposition":"The epileptic field","correct":false,"justification":"Is not a particular terrain"},{"idx":3,"proposition":"Fever","correct":true,"justification":"Sign obstructive pyelonephritis"},{"idx":4,"proposition":"Pollakiuria","correct":false,"justification":"Doesn't matter. It is a normal sign associated with"}],"type":"custom"}
+{"_id":"Kcdermato-onco-0","context":null,"enonce":"Which of the following are true about melanoma?","item":"Kcdermato","matiere":"onco","propositions":[{"idx":0,"proposition":"The incidence is increasing","correct":true,"justification":"True, the incidence of melanoma doubles almost every 10 years 😱"},{"idx":1,"proposition":"Mortality is on the rise","correct":true,"justification":"True, mortality increases less than incidence, which can be attributed to earlier 😊 diagnosis."},{"idx":2,"proposition":"The clear phenotype ⚪ is not a risk factor","correct":false,"justification":"False, it is indeed a risk factor"},{"idx":3,"proposition":"The main prognostic index is the Breslow index","correct":true},{"idx":4,"proposition":"The main prognostic index is the Clark index","correct":false,"justification":"This is the Breslow index"}],"type":"custom"}
+{"_id":"Kcdermato-onco-1","context":null,"enonce":"Which of the following propositions are true about the halo nevus?","item":"Kcdermato","matiere":"onco","propositions":[{"idx":0,"proposition":"Its other name is the nevus of Ota","correct":false,"justification":"The Ota nevus is a birth nevus 👼 with a distribution in unilateral rule, superimposed on the territories of the two upper branches of the trigeminal. The other name for the halo nevus is the Sutton nevus"},{"idx":1,"proposition":"There is a development of an achromic halo (white)","correct":true},{"idx":2,"proposition":"The halo observed is due to cytotoxic inflammatory infiltrate","correct":true},{"idx":3,"proposition":"This nevus remains for life","correct":false,"justification":"It disappears completely"},{"idx":4,"proposition":"It occurs at birth","correct":false,"justification":"It occurs mostly around the second decade and on the trunk. A later onset or irregular appearance of the halo should lead to fear of melanoma. (cf College of Dermatology, 7th edition, page 305). It is the Ota nevus or Mongolian blue spot that occurs from birth 👼"}],"type":"custom"}
+{"_id":"Kcdermato-onco-4","context":null,"enonce":"Which skin carcinoma should suggest a budding, ulcerated and crusty lesion in an elderly person who has worked outdoors all his life?","item":"Kcdermato","matiere":"onco","propositions":[{"idx":0,"proposition":"Squamous cell carcinoma","correct":true,"justification":"True. These are the 3 characteristics that make you think of a squamous cell tumor"},{"idx":1,"proposition":"Basal cell carcinoma","correct":false,"justification":"Raised skin nodule. We think about it especially in front of a short and intense sun ☀ exposure"},{"idx":2,"proposition":"Melanoma","correct":false,"justification":"It is not cutaneous carcinoma. Melanoma is developed from melanocytes"},{"idx":3,"proposition":"Wart","correct":false,"justification":"False, it is not a carcinoma"},{"idx":4,"proposition":"Nevus","correct":false,"justification":"False, it is not a carcinoma"}],"type":"custom"}
+{"_id":"Kcdermato-onco-5","context":null,"enonce":"Which of the following are true?","item":"Kcdermato","matiere":"onco","propositions":[{"idx":0,"proposition":"Bowen's disease is invasive squamous cell carcinoma","correct":false,"justification":"It is a squamous cell carcinoma in situ"},{"idx":1,"proposition":"Squamous cell carcinoma is squamous cell carcinoma in situ","correct":false,"justification":"Epidermoid and squamous cell are synonymous 😊"},{"idx":2,"proposition":"Basal cell carcinoma does not have a precancerous lesion","correct":true,"justification":"True, unlike squamous cell carcinoma"},{"idx":3,"proposition":"The evolution of invasive squamous cell carcinoma is first done in the lymph nodes","correct":true,"justification":"True. Stereotyped evolution: lung blood ➡ ➡ nodes ➡ then other organs"},{"idx":4,"proposition":"Hematogenous metastatic course is more common for cutaneous squamous cell carcinomas than for mucosal squamous cell carcinomas","correct":false,"justification":"It is more common for mucosal squamous cell carcinomas"}],"type":"custom"}
+{"_id":"souffleped-cardio-0","context":null,"enonce":"Regarding heart murmurs in children","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"The discovery of a heart murmur is a very common possibility in children","correct":true},{"idx":1,"proposition":"A third noise or B3 is common at the apex in children (50% of cases), it is physiological","correct":true},{"idx":2,"proposition":"There is a correlation between the intensity of a breath and the severity of the underlying disease","correct":false,"justification":"It should be noted that there is often no correlation between the intensity of a breath and the severity of the underlying disease."},{"idx":3,"proposition":"Often there is no functional sign","correct":true},{"idx":4,"proposition":"Exertional dyspnea is the most common symptom","correct":true}],"type":"custom"}
+{"_id":"souffleped-cardio-1","context":null,"enonce":"Regarding heart murmurs in children","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"Chest pain is exceptionally of cardiac origin in children, unlike in adults","correct":true},{"idx":1,"proposition":"Abnormalities of physical examination, such as hypertension and absence of femoral pulse, immediately point to aortic coarctation","correct":true},{"idx":2,"proposition":"The heart rate is all the faster the older the child is","correct":false,"justification":"The heart rate is all the faster the younger the child is"},{"idx":3,"proposition":"The QRS axis is straighter than in adults, the PR delay is shorter","correct":true},{"idx":4,"proposition":"The echocardiogram-Doppler is the key diagnostic test","correct":true}],"type":"custom"}
+{"_id":"souffleped-cardio-2","context":null,"enonce":"Regarding heart murmurs in children","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"In newborns (from birth to the end of the 2nd month), a very early breath is less pathological than when it is heard after a few days","correct":false,"justification":"In newborns (from birth to the end of the 2nd month) 1 Isolated breath in a newborn A very early murmur is more pathological than when it is heard after a few days"},{"idx":1,"proposition":"It is necessary to perform a cardiac ultrasound before leaving the maternity in case of breath heard on Day 1 or Day 2","correct":true},{"idx":2,"proposition":"Transposition of the great vessels is the most common cause of neonatal cyanosis","correct":true},{"idx":3,"proposition":"Transposition of the large vessels represents the very type of neonatal cardiology emergency","correct":true},{"idx":4,"proposition":"Regarding the transposition of the large vessels, anatomical correction surgery must be performed in the first 15 days of life","correct":true}],"type":"custom"}
+{"_id":"souffleped-cardio-3","context":null,"enonce":"Regarding heart murmurs in children","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"Early surgery is imperative for infants with large shunts, especially IVC","correct":true},{"idx":1,"proposition":"Anorganic or innocent breaths are very common in children","correct":true},{"idx":2,"proposition":"In case of innocent breathing, no therapy, or supervision, or restriction of activity, is justified, and these children can lead a strictly normal life.","correct":true},{"idx":3,"proposition":"In case of innocent breath it is useful to see the child periodically in consultation","correct":false,"justification":"It is useless and even harmful to see the child periodically in consultation"},{"idx":4,"proposition":"Asymptomatic systolic murmurs discovered in infancy most often correspond to anorganic murmurs, or \"innocent\" or \"functional\" murmurs.","correct":true}],"type":"custom"}
+{"_id":"souffleped-cardio-5","context":null,"enonce":"What are the two physiological shunts in the fetal circulation?","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"Foramen oval","correct":true},{"idx":1,"proposition":"Round Foramen","correct":false,"justification":"False. The round foramen is a round foramen is a foramen of the middle stage of the base of the skull."},{"idx":2,"proposition":"Ventricular septal defect","correct":false,"justification":"False. It is pathological"},{"idx":3,"proposition":"Pulmonary canal","correct":false,"justification":"False"},{"idx":4,"proposition":"Ductus arteriosus","correct":true}],"type":"custom"}
+{"_id":"souffleped-cardio-6","context":null,"enonce":"Which of the following are cyanogenic heart diseases?","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"Transposition of the large vessels","correct":true},{"idx":1,"proposition":"Tetralogy of Fallot","correct":true,"justification":"True, the leading cause of cyanogenic heart disease in children according to the College of Pediatrics"},{"idx":2,"proposition":"Pulmonary stenosis","correct":false,"justification":"Non-cyanogen"},{"idx":3,"proposition":"Persistent ductus arteriosus","correct":false,"justification":"Non-cyanogen"},{"idx":4,"proposition":"Coarctation of the aorta","correct":false,"justification":"Non-cyanogen"}],"type":"custom"}
+{"_id":"souffleped-cardio-8","context":null,"enonce":"What heart defects form a left-right shunt?","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"Ventricular septal defect","correct":true},{"idx":1,"proposition":"Tetralogy of Fallot","correct":false,"justification":"False. It causes an obstacle of the right heart."},{"idx":2,"proposition":"Transposition of the large vessels","correct":false,"justification":"False. It causes poor connections in the heart."},{"idx":3,"proposition":"Patent ductus arteriosus","correct":true},{"idx":4,"proposition":"Pulmonary valve stenosis","correct":false,"justification":"False. It causes an obstacle of the right heart."}],"type":"custom"}
+{"_id":"souffleped-cardio-9","context":null,"enonce":"Which of the following are non-cyanogenic heart diseases?","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"Tetralogy of Fallot","correct":false,"justification":"Cyanogen"},{"idx":1,"proposition":"Transposition of the large vessels","correct":false,"justification":"Cyanogen"},{"idx":2,"proposition":"Persistent ductus arteriosus","correct":true},{"idx":3,"proposition":"Ventricular septal defect","correct":true},{"idx":4,"proposition":"Inter-atrial communication","correct":true}],"type":"custom"}
+{"_id":"souffleped-cardio-10","context":null,"enonce":"What is the prevalence of congenital heart disease in live births?","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"0,08%","correct":false,"justification":"None"},{"idx":1,"proposition":"0,8%","correct":true},{"idx":2,"proposition":"2%","correct":false,"justification":"None"},{"idx":3,"proposition":"4%","correct":false,"justification":"None"},{"idx":4,"proposition":"6%","correct":false,"justification":"None"}],"type":"custom"}
+{"_id":"contraception-gyn-0","context":null,"enonce":"Which of the following are true?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"The Pearl Index (PI) is the number of pregnancies that occurred in 100 women exposed to the method studied for 1 year","correct":true},{"idx":1,"proposition":"The higher the Pearl Index (PI), the more effective the contraceptive method concerned","correct":false,"justification":"It's the other way around. The lower it is, the more effective the contraceptive method."},{"idx":2,"proposition":"The patch is a progestin-only contraception","correct":false,"justification":"Oestro-progestin"},{"idx":3,"proposition":"The ring is an estrogen-progestin contraception","correct":true},{"idx":4,"proposition":"Macro-progestogens have no MA for contraception","correct":true,"justification":"Their prescription is off-label. No study has calculated a Pearl index."}],"type":"custom"}
+{"_id":"contraception-gyn-1","context":null,"enonce":"Which of the following proposals are part of the follow-up assessment in a woman on an estrogen-progestogen contraceptive?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"Fasting blood glucose","correct":true},{"idx":1,"proposition":"Total cholesterol","correct":true},{"idx":2,"proposition":"HDL cholesterol","correct":true},{"idx":3,"proposition":"Creatinine","correct":false,"justification":"No impact on kidney function"},{"idx":4,"proposition":"Triglycerides","correct":true}],"type":"custom"}
+{"_id":"contraception-gyn-3","context":null,"enonce":"After unprotected sex, how soon should levonorgestrel be taken?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"Within 24 hours","correct":false,"justification":"Within 72 hours"},{"idx":1,"proposition":"Within 48 hours","correct":false,"justification":"Within 72 hours"},{"idx":2,"proposition":"Within 72 hours","correct":true},{"idx":3,"proposition":"Within 5 days","correct":false,"justification":"This is true for EllaOne®, Ulipristal Acetate"},{"idx":4,"proposition":"It is not emergency contraception","correct":false,"justification":"Norlevo® is an emergency contraception consisting of a 2nd generation progestin (levonorgestrel 1.5 mg)"}],"type":"custom"}
+{"_id":"contraception-gyn-4","context":null,"enonce":"What is the concentration of ethinyl estradiol (EE) of a so-called \"normodosed\" contraception (in micrograms)?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"10","correct":false,"justification":"False"},{"idx":1,"proposition":"20","correct":false,"justification":"False"},{"idx":2,"proposition":"30","correct":false,"justification":"False"},{"idx":3,"proposition":"40","correct":false,"justification":"False"},{"idx":4,"proposition":"50","correct":true,"justification":"True: the pill is called \"normo-dosed\" if it contains 50 μg of EE"}],"type":"custom"}
+{"_id":"contraception-gyn-5","context":null,"enonce":"What emergency contraception is administered 4 days after sexual intercourse?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"EllaOne®","correct":true},{"idx":1,"proposition":"Norlevo®","correct":false},{"idx":2,"proposition":"Levonorgestrel ","correct":false,"justification":"max within 72h"},{"idx":3,"proposition":"Ulipristal Acetate","correct":true},{"idx":4,"proposition":"Copper IUDs","correct":true}],"type":"custom"}
+{"_id":"contraception-gyn-6","context":null,"enonce":"Which of the following are absolute contraindications (ICs) of estrogen-progestogen contraceptives (OCCs)?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"Severe unbalanced hypertension","correct":true},{"idx":1,"proposition":"Family history of VTE","correct":false,"justification":"Not an absolute CI if it is family, personal only. Family = relative (we will not CI a COP to a patient because her older sister had phlebitis at 65 years after 8 hours of plane returning from Reunion ^^)"},{"idx":2,"proposition":"Obesity","correct":false,"justification":"It is a relative IC"},{"idx":3,"proposition":"Migraine with aura","correct":true},{"idx":4,"proposition":"All propositions are true","correct":false,"justification":"The absolute ICs of COP are: ischemic heart disease, complicated valvular heart disease, ischemic stroke ATCD, migraine with aura, porphyrias \/ connective tissue (lupus are hormone-dependent),\r\nPersonal ATCD or venous (DVT or PE) or arterial TED accident\r\nmajor surgery with prolonged immobilization, hereditary or acquired predisposition to thrombosis (AV), tobacco > 15 cigarettes \/ day if > 35 years, severe unbalanced hypertension or FdR CV, confirmed or suspected pregnancy, breastfeeding < 6S postpartum, severe dyslipidemia, active viral hepatitis, severe or recent liver disease (including cirrhosis), benign hepatic tumor, malignant or suspected breast tumor, uterus, meningioma, pituitary tumor (on a case-by-case basis) and non-genital hemorrhages Diagnosed."}],"type":"custom"}
+{"_id":"contraception-gyn-7","context":null,"enonce":"Which of the following have a Pearl Index (PI) of less than 1?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"Condom","correct":false,"justification":"IP to 2"},{"idx":1,"proposition":"Progestin-only subcutaneous implant","correct":true,"justification":"True, one of the contraceptives with the lowest Pearl index"},{"idx":2,"proposition":"Progrestin only","correct":true},{"idx":3,"proposition":"\"Withdraw\"","correct":false,"justification":"Does not work\/little. Not recommended"},{"idx":4,"proposition":"Intrauterine device (IUD)","correct":true,"justification":"True. IP = 0.6 for classics. IP = 0.2 for impregnated IUDs"}],"type":"custom"}
+{"_id":"contraception-gyn-8","context":null,"enonce":"How soon should ulipristal be taken after unprotected sex?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"24h","correct":false,"justification":"5 days"},{"idx":1,"proposition":"48h","correct":false,"justification":"5 days"},{"idx":2,"proposition":"5 days","correct":true},{"idx":3,"proposition":"10 days","correct":false,"justification":"5 days"},{"idx":4,"proposition":"It is a progesterone receptor antagonist","correct":true}],"type":"custom"}
+{"_id":"contraception-gyn-9","context":null,"enonce":"Among the following proposals, which are part of the biological assessment to be prescribed essential before starting estrogen-progestin contraception in a woman without personal or family history of metabolic or thromboembolic disease, who does not smoke and whose clinical examination is normal?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"No assessment is essential","correct":true,"justification":"True. In a person with no personal or family history of metabolic or thromboembolic disease, who does not smoke and whose clinical examination is normal, the laboratory assessment can be performed 3 to 6 months after prescription."},{"idx":1,"proposition":"NFS-P","correct":false,"justification":"False"},{"idx":2,"proposition":"Assessment of renal function","correct":false,"justification":"False"},{"idx":3,"proposition":"Cholesterol","correct":false,"justification":"False"},{"idx":4,"proposition":"Fasting blood glucose","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"contraception-gyn-10","context":null,"enonce":"Which of the following are true about emergency contraception? (one or more exact propositions)","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"It is free","correct":false,"justification":"Free only for minors. Reimbursed at 65% for adults, if medical prescription."},{"idx":1,"proposition":"It can be issued to minors free of charge, anonymously and without a doctor's prescription, regardless of the medication used.","justfication":"Contrairement à ce que l'on peut trouver dans certaines sources, l'ulipristal est bien disponible sans ordonnance d'après cette fiche de la HAS (mise à jour en 2019) : https:\/\/webzine.has-sante.fr\/upload\/docs\/application\/pdf\/2015-07\/contraception_urgence_officine_maj_juillet2015.pdf Si elle n'est plus valide, n'hésitez pas à nous prévenir en signalant la QI :)","correct":true},{"idx":2,"proposition":"They are only dispensed in pharmacies","correct":false,"justification":"Or in a CeGIDD, in a family planning or education center, with the school nurse or academic medicine"},{"idx":3,"proposition":"Ulipristal has no contraindication (CI)","correct":false,"justification":"Two ICs: Allergy to one of the components and pregnancy. In addition, it is not recommended in cases of severe hepatic impairment and severe asthma insufficiently controlled by oral glucocorticoid. After taking UPA, breastfeeding not recommended for one week (during this period, express and discard breast milk in order to maintain lactation stimulation). (according to HAS)"},{"idx":4,"proposition":"None of the propositions are true","correct":false,"justification":"Almost none 😜"}],"type":"custom"}
+{"_id":"contraception-gyn-11","context":null,"enonce":"Which of the following are true for intrauterine devices (IUDs)?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"It is a long-acting contraception","correct":true,"justification":"True, about 5 years"},{"idx":1,"proposition":"It can be placed by a midwife","correct":true,"justification":"True, L-5134 of the CSP: \"The insertion of intrauterine contraceptives can only be performed by a doctor or midwife.\""},{"idx":2,"proposition":"Wilson's disease is a contraindication to the copper IUD","correct":true},{"idx":3,"proposition":"Monitoring is every six months","correct":false,"justification":"Annual monitoring"},{"idx":4,"proposition":"It is not refunded","correct":false,"justification":"It is refunded. It is proposed as a first-line treatment for multiparous women with stable sex lives"}],"type":"custom"}
+{"_id":"contraception-gyn-12","context":null,"enonce":"Which of the following are true for intrauterine devices (IUDs)?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"The Pearl Index of the progesterone IUD is less than 0.5","correct":true},{"idx":1,"proposition":"The Pearl number of the copper IUD is less than 0.5","correct":false,"justification":"IP = 0.6"},{"idx":2,"proposition":"It is a mechanical contraception","correct":true},{"idx":3,"proposition":"A history of ectopic pregnancy is a contraindication (CI)","correct":true},{"idx":4,"proposition":"Taking chronic NSAIDs is a contraindication (CI)","correct":false,"justification":"Not an IC"}],"type":"custom"}
+{"_id":"contraception-gyn-13","context":null,"enonce":"Which of the following are true about progestin-only contraception?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"They have the same contraindications (CI) as estrogen-progestogens","correct":false,"justification":"No metabolic or cardiovascular IC"},{"idx":1,"proposition":"The cycle disorders they can cause are sometimes poorly tolerated","correct":true},{"idx":2,"proposition":"Their tolerance to forgetfulness is 12 hours","correct":false,"justification":"3 hours for progestin-based contraceptives"},{"idx":3,"proposition":"The micropill should be taken every day","correct":true,"justification":"True, even during menstruation"},{"idx":4,"proposition":"Personal history of ectopic pregnancy (GEU) is part of the contraindications (CI)","correct":true}],"type":"custom"}
+{"_id":"contraception-endoc-0","context":null,"enonce":"Which of the following proposals concerning estrogen-progestogen is (are) correct?","item":"contraception","matiere":"endoc","propositions":[{"idx":0,"proposition":"They are also called combined oral contraceptives or combination pills and are composed of a synthetic or natural estrogen and a progestin","correct":true},{"idx":1,"proposition":"Ethinyl-estradiol is a synthetic estrogen","correct":true,"justification":"It can be replaced by 17β-estradiol"},{"idx":2,"proposition":"The dosage of synthetic estrogen ranges from 15 to 50 μg","correct":true},{"idx":3,"proposition":"Estrogens and progestins may contain a natural estrogen, estradiol","correct":true},{"idx":4,"proposition":"The dose of estradiol in estrogen-progestogens is conventionally 1.5 mg","correct":true}],"type":"custom"}
+{"_id":"contraception-endoc-1","context":null,"enonce":"Which of the following is (are) correct?","item":"contraception","matiere":"endoc","propositions":[{"idx":0,"proposition":"The first generation progestinfs are levonorgestrel and norgstrel","correct":false,"justification":"1st generation = norethisterone and lynestrenol"},{"idx":1,"proposition":"The third generation progestogens are gestodene and norgestimate","correct":true},{"idx":2,"proposition":"Chlormadinone acetate is a toxic element contraindicated in humans","correct":false,"justification":"Chlormadinone acetate is not toxic at all and is used in combination pills"},{"idx":3,"proposition":"Nomegestrol acetate is in combination with levonorgestrel most often","correct":false,"justification":"It is a progestin in combination with estradiol most often in estrogen-progestin pills"},{"idx":4,"proposition":"Cyproterone acetate is a progestin used in combination pills","correct":true}],"type":"custom"}
+{"_id":"contraception-endoc-2","context":null,"enonce":"Which of the following proposals regarding progestogens is (are) accurate?","item":"contraception","matiere":"endoc","propositions":[{"idx":0,"proposition":"The first generation progestins were obtained from the testosterone molecule","correct":true},{"idx":1,"proposition":"Second-generation progestogens are gonans","correct":true},{"idx":2,"proposition":"Third-generation progestogens have a very high affinity for the progesterone receptor and a lower affinity for the androgen receptor","correct":true},{"idx":3,"proposition":"3rd generation progestogens have very minor antigonadotropic activity","correct":false,"justification":"Their antigonadotropic activity is very high and has reduced the dose of ethinylloestradiol used"},{"idx":4,"proposition":"The androgenic effect of 3rd generation progestins is major","correct":false,"justification":"They have a lesser androgenic effect, on the contrary"}],"type":"custom"}
+{"_id":"dlrabdogrossesse-gyn-0","context":null,"enonce":"Among these proposals, which fall into the triad of symptoms of retroplacental hematoma:","item":"dlrabdogrossesse","matiere":"gyn","propositions":[{"idx":0,"proposition":"Vomiting","correct":false,"justification":"Abdominal pain in stabbing, uterine contracture, metrorrhagia"},{"idx":1,"proposition":"Abdominal defense","correct":false},{"idx":2,"proposition":"Metrorrhagia","correct":true},{"idx":3,"proposition":"Palpitations","correct":false},{"idx":4,"proposition":"Balance disorders","correct":false}],"type":"custom"}
+{"_id":"dlrabdogrossesse-gyn-1","context":null,"enonce":"Regarding acute abdominal pain in pregnant women:","item":"dlrabdogrossesse","matiere":"gyn","propositions":[{"idx":0,"proposition":"Abdominopelvic pain without metrorrhagia in the 1st trimester may be a telltale sign of an ectopic pregnancy","correct":true},{"idx":1,"proposition":"The severity argument suggests a retroplacental hematoma in the 2nd and 3rd trimesters","correct":true},{"idx":2,"proposition":"Retroplacental hematoma is to be evoked systematically in the 2nd half of pregnancy","correct":true},{"idx":3,"proposition":"Retroplacental hematoma is life-threatening for the fetus","correct":true},{"idx":4,"proposition":"The HELLP Syndrome is to be evoked in case of epigatric pain or right hypochondrium","correct":true}],"type":"custom"}
+{"_id":"dlrabdogrossesse-gyn-2","context":null,"enonce":"Which propositions are true?","item":"dlrabdogrossesse","matiere":"gyn","propositions":[{"idx":0,"proposition":"HELLP syndrome is life-threatening for mother and fetus","correct":true},{"idx":1,"proposition":"Pregnancy can mask an abdominal defense","correct":true},{"idx":2,"proposition":"Salpingitis is a common and relatively benign algic etiology in pregnant women","correct":false,"justification":"Salpingitis and endometritis DO NOT exist in pregnant women!"},{"idx":3,"proposition":"Diagnostic criteria for UTI are extremely different in pregnant women compared to non-pregnant women","correct":false,"justification":"The diagnostic criteria are identical"},{"idx":4,"proposition":"Urinary pathologies have no impact on pregnancy","correct":false,"justification":"Careful! Urinary pathologies can trigger a threat of premature delivery"}],"type":"custom"}
+{"_id":"dlrabdogrossesse-gyn-3","context":null,"enonce":"Which of these propositions are true?","item":"dlrabdogrossesse","matiere":"gyn","propositions":[{"idx":0,"proposition":"Pregnancy drastically reduces the frequency of urinary tract infections","correct":false,"justification":"Caution: Pregnancy increases the frequency of urinary tract infections"},{"idx":1,"proposition":"PAD and UTI is a common association","correct":true},{"idx":2,"proposition":"Uro-scanner is contraindicated in pregnant women","correct":false,"justification":"Renal colic: The uro-scanner is possible if the ultrasound is not contributory"},{"idx":3,"proposition":"A pyelocalicial dilation of 100 mm is physiological and frequent in pregnant women, especially on the left","correct":false,"justification":"Be careful, a physiological moderate pyelocalicial dilation (< 20 mm) is common in pregnant women, especially on the right because of the physiological dextrorotation of the uterus"},{"idx":4,"proposition":"Injected abdominal CT scan is strictly contraindicated during pregnancy","correct":false,"justification":"Ultrasound is not always very effective because of pregnancy and injected abdominal CT is possible at any age of pregnancy (benefit\/risk ratio)\""}],"type":"custom"}
+{"_id":"dlrabdogrossesse-gyn-4","context":null,"enonce":"Which statements are true?","item":"dlrabdogrossesse","matiere":"gyn","propositions":[{"idx":0,"proposition":"Digestive pathologies can trigger a threat of premature delivery","correct":true},{"idx":1,"proposition":"Uterine palpation is looking for uterine contracture or deformity of the uterus","correct":true},{"idx":2,"proposition":"Cardiotocographic recording is done from 25 SA","correct":true},{"idx":3,"proposition":"Retroplacental hematoma is ultrasound diagnosis","correct":false,"justification":"Retroplacental hematoma is exceptionally seen in ultrasound, the diagnosis is clinical"},{"idx":4,"proposition":"The BU always shows the presence of blood in case of metrorrhagia","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"dlrabdogrossesse-gyn-5","context":null,"enonce":"Regarding acute abdominopelvic pain in pregnant women:","item":"dlrabdogrossesse","matiere":"gyn","propositions":[{"idx":0,"proposition":"Ultrasound of the cervix is indicated only in case of imminent threat of delivery","correct":false},{"idx":1,"proposition":"Renal and abdominal ultrasounds are made difficult by pregnancy","correct":true},{"idx":2,"proposition":"In the absence of an identified etiology, the patient is redirected to her general practitioner with a close consultation.","correct":false},{"idx":3,"proposition":"The 4 major etiological families are obstetrical, urinary, gynecological and digestive","correct":true},{"idx":4,"proposition":"Urinary causes are only very rarely due to pain of this type","correct":false}],"type":"custom"}
+{"_id":"dlrabdogrossesse-gyn-6","context":null,"enonce":"Which of the following are signs or symptoms of uterine rupture?","item":"dlrabdogrossesse","matiere":"gyn","propositions":[{"idx":0,"proposition":"It is especially to be evoked in a nulliparous woman","correct":false,"justification":"Especially in case of uterine scars (history of caesarean section in particular)"},{"idx":1,"proposition":"Red-blooded metrorrhagia","correct":true},{"idx":2,"proposition":"Pain outside of work","correct":false,"justification":"Exceptional outside of work, it is especially during work that we evoke a uterine rupture"},{"idx":3,"proposition":"Brutal pain","correct":true,"justification":"True ++"},{"idx":4,"proposition":"Uterine deformity","correct":true}],"type":"custom"}
+{"_id":"dlrabdogrossesse-gyn-7","context":null,"enonce":"Which of the following proposals is(are) possible cause(s) of acute abdominal pain in pregnant women?","item":"dlrabdogrossesse","matiere":"gyn","propositions":[{"idx":0,"proposition":"Endometritis ","correct":false,"justification":"rather in the postpartum period"},{"idx":1,"proposition":"Salpingitis","correct":false,"justification":"not found in pregnant women"},{"idx":2,"proposition":"Ectopic pregnancy ","correct":true,"justification":"True, especially in the first trimester, to evoke systematically"},{"idx":3,"proposition":"HELPP Syndrome","correct":true,"justification":"True especially in the context of hypertension or preeclampsia"},{"idx":4,"proposition":"Uterine rupture ","correct":true,"justification":"True, especially in cases of sudden pain, red blood metrorrhagia and uterine deformity"}],"type":"custom"}
+{"_id":"dlrbuccale-neuro-0","context":null,"enonce":"Regarding primary headaches:","item":"dlrbuccale","matiere":"neuro","propositions":[{"idx":0,"proposition":"Primary headaches are far more common than secondary headaches","correct":true},{"idx":1,"proposition":"They often evolve by paroxysmal crises and less often in a continuous and daily mode","correct":true},{"idx":2,"proposition":"The diagnosis of a primary headache is clinical, based on questioning in particular","correct":true},{"idx":3,"proposition":"Additional examinations show an inflammatory syndrome in 60% of cases","correct":false,"justification":"Complementary examinations are by definition normal"},{"idx":4,"proposition":"Primary headaches are mild and do not require management","correct":false,"justification":"Although benign, primary headaches and essential facial neuralgia have a significant impact on quality of life"}],"type":"custom"}
+{"_id":"dlrbuccale-neuro-1","context":null,"enonce":"Regarding headaches:","item":"dlrbuccale","matiere":"neuro","propositions":[{"idx":0,"proposition":"There is no specific treatment for migraine","correct":false,"justification":"The management of migraine is based on non-specific treatments (paracetamol, aspirin, nonsteroidal anti-inflammatory drugs [NSAIDs]) and specific treatments (triptans)"},{"idx":1,"proposition":"Subarachnoid hemorrhage is a secondary headache etiology","correct":true},{"idx":2,"proposition":"Facial and cranial neuralgia are responsible for electrical discharges in the territory of a sensory nerve","correct":true},{"idx":3,"proposition":"The main causes of headaches occurring less than 15 days a month are intracranial hypertension and meningitis","correct":false,"justification":"Headaches < 15 days a month: the main causes are migraine and episodic tension headache"},{"idx":4,"proposition":"Chronic daily headache (CCQ) is the leading cause of headache occurring more than 15 days per month for at least 3 months","correct":true}],"type":"custom"}
+{"_id":"dlrbuccale-neuro-2","context":null,"enonce":"Regarding migraines:","item":"dlrbuccale","matiere":"neuro","propositions":[{"idx":0,"proposition":"\"Short-term\" chronic daily headaches (QCDs) are seizures lasting less than 30 minutes a day","correct":false,"justification":"\"Short-term\" CCQ: seizures lasting less than 4 hours a day"},{"idx":1,"proposition":"The main causes of QCC are cluster headache and trigeminal neuralgia","correct":false,"justification":"Chronic migraine or, more rarely, chronic tension headache, both with or without medication abuse"},{"idx":2,"proposition":"With a prevalence of 75%, migraine is one of the most common neurological conditions","correct":false,"justification":"With a prevalence of 15%, migraine is one of the most common neurological conditions"},{"idx":3,"proposition":"Migraine without aura is a more common cause of CCQ than migraine with aura","correct":true},{"idx":4,"proposition":"Some patients have only one variety of migraine attacks and others have both (with and without aura)","correct":true}],"type":"custom"}
+{"_id":"dlrbuccale-neuro-4","context":null,"enonce":"Which of the following propositions are true about reversible cerebral vasoconstriction syndrome?","item":"dlrbuccale","matiere":"neuro","propositions":[{"idx":0,"proposition":"It can be promoted by SSRIs","correct":true},{"idx":1,"proposition":"It can be triggered by the Valsalva maneuver","correct":true},{"idx":2,"proposition":"It can be triggered by coitus","correct":true},{"idx":3,"proposition":"It can be complicated by cerebral ischemia","correct":true},{"idx":4,"proposition":"It can be complicated by cerebral hemorrhage","correct":true}],"type":"custom"}
+{"_id":"dlrbuccale-neuro-5","context":null,"enonce":"Which of the following propositions are true about reversible cerebral vasoconstriction syndrome?","item":"dlrbuccale","matiere":"neuro","propositions":[{"idx":0,"proposition":"It can be promoted by SSRIs","correct":true},{"idx":1,"proposition":"It can be triggered by the Valsalva maneuver","correct":true},{"idx":2,"proposition":"It can be triggered by coitus","correct":true},{"idx":3,"proposition":"It can be complicated by cerebral ischemia","correct":true},{"idx":4,"proposition":"It can be complicated by cerebral hemorrhage","correct":true}],"type":"custom"}
+{"_id":"violence-sp-0","context":null,"enonce":"Which of the following are true?","item":"violence","matiere":"sp","propositions":[{"idx":0,"proposition":"Sexual violence is any sexual assault committed with violence, coercion, threat or surprise","correct":true},{"idx":1,"proposition":"Rape is any act of sexual penetration of any kind, committed by violence, coercion, threat or surprise.","correct":true},{"idx":2,"proposition":"The competent court to try marital rape is the administrative court","correct":false,"justification":"Penalty: jurisdiction: crime: Assize Court 15 years imprisonment 20 years if aggravating circumstances (rape by spouse or common-law partner ...)"},{"idx":3,"proposition":"The limitation period is 5 years","correct":false,"justification":"Limitation period: 10 years if adult victim 20 years if rape committed when the victim was a minor In France:"},{"idx":4,"proposition":"In France, there were 980 rapes in 2014 (about 3 per day)","correct":false,"justification":"12,700 rapes\""}],"type":"custom"}
+{"_id":"violence-sp-1","context":null,"enonce":"Which of the following are true?","item":"violence","matiere":"sp","propositions":[{"idx":0,"proposition":"16% of women and 5% of men report having been raped or attempted rape in their lifetime","correct":true},{"idx":1,"proposition":"Sexual assault is a non-penetrative act committed by violence, coercion, threat or susception.","correct":true},{"idx":2,"proposition":"Sexual assault is a crime","correct":true},{"idx":3,"proposition":"The jurisdiction that judges sexual assaults is the criminal court","correct":true},{"idx":4,"proposition":"The penalty for sexual assault is a fine of up to 100,000 euros (but no prison sentence)","correct":false,"justification":"Penalty: offenses: (minimum) 5 years in prison € 75,000 fine these penalties vary the prison sentence depending on 7 to 1 0 years, and the fine to € 100,000 of \"aggravating situations\": increase of possible\""}],"type":"custom"}
+{"_id":"violence-sp-2","context":null,"enonce":"Concerning sexual violence and harassment","item":"violence","matiere":"sp","propositions":[{"idx":0,"proposition":"There were 26,700 sexual assaults in 2014","correct":true},{"idx":1,"proposition":"Sexual harassment is the infliction of non-consensual touching (without penetration) of a person.","correct":false,"justification":"Definition: Imposing connotations or intimidating on a person who repeatedly engage in sexual comments or behaviours that violate their dignity or create a hostile situation"},{"idx":2,"proposition":"Sexual harassment is a crime punishable by law","correct":false,"justification":"Qualification: misdemeanour"},{"idx":3,"proposition":"The competent court to deal with sexual harassment cases is the Assize Court only","correct":false,"justification":"Jurisdiction: Jurisdiction of High Court If sexual harassment at work: (private sector) Administrative Court (public sector)"},{"idx":4,"proposition":"Penalties can be up to 2 years in prison and a fine of €30,000 (without aggravating circumstances)","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"violence-sp-4","context":null,"enonce":"During the somatic examination of a rape victim, we look for:","item":"violence","matiere":"sp","propositions":[{"idx":0,"proposition":"Virology status","correct":true,"justification":"VIh and Hepatitis B in particular"},{"idx":1,"proposition":"Traumatic injuries","correct":true},{"idx":2,"proposition":"An inspection of the hymen","correct":true,"justification":"It will have to be carefully described in the medical record"},{"idx":3,"proposition":"Hemmoragy mucous membranes","correct":true},{"idx":4,"proposition":"A breast nodule on palpation","correct":false,"justification":"Never breast palpation spontaneously, unless clearly urgent and informed agreement of the patient\""}],"type":"custom"}
+{"_id":"violence-sp-5","context":null,"enonce":"Which of the following are true?","item":"violence","matiere":"sp","propositions":[{"idx":0,"proposition":"Dealing with sexual assault\/rape is an emergency","correct":true},{"idx":1,"proposition":"If the rape victim is a minor, contact the legal guardians and the public prosecutor.","correct":true},{"idx":2,"proposition":"If the person is of age, the information of the Public Prosecutor is done only with the agreement of the patient","correct":true},{"idx":3,"proposition":"Psychological examination of rape victim looks for suicidal risk and acute stress","correct":true},{"idx":4,"proposition":"Samples are taken with sterile gloves in duplicate for DNA (spermatozoa)","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"violence-sp-6","context":null,"enonce":"What are the biological elements to be systematically sought, within a reasonable time, in the event of rape?","item":"violence","matiere":"sp","propositions":[{"idx":0,"proposition":"HIV, HAV, HBV, HCV, TPHA-VDRL serology","correct":false,"justification":"By VHA"},{"idx":1,"proposition":"Beta-HCG","correct":true,"justification":"Qualitative at first, most often"},{"idx":2,"proposition":"Troponin US","correct":false,"justification":"No use except clinical orientation"},{"idx":3,"proposition":"GFR calculation","correct":false,"justification":"No interest except clinic orientation"},{"idx":4,"proposition":"Serology Chlamydia","correct":false,"justification":"Local sampling for chlamydia and gonococci but never blood serology\""}],"type":"custom"}
+{"_id":"violence-gyn-0","context":null,"enonce":"Concerning sexual violence","item":"violence","matiere":"gyn","propositions":[{"idx":0,"proposition":"Rape is defined as any act of sexual penetration carried out against the will of the person by surprise, threat, violence or coercion.","correct":true},{"idx":1,"proposition":"Lack of consent results exclusively from physical violence","correct":false,"justification":"Lack of consent may result from physical or moral violence"},{"idx":2,"proposition":"Victims of sexual abuse have experienced criminal violence that must be handled in the most professional manner","correct":true},{"idx":3,"proposition":"6% of women report having experienced forced or attempted forced sex in their lifetime","correct":false,"justification":"Epidemiology: 16% of women report having experienced forced or attempted forced sex in their lifetime"},{"idx":4,"proposition":"Oral penetration is sexual violence but not rape","correct":false,"justification":"Oral penetration is called rape because it involves a sexual organ and an orifice."}],"type":"custom"}
+{"_id":"violence-gyn-1","context":null,"enonce":"Concerning the care of victims of sexual violence","item":"violence","matiere":"gyn","propositions":[{"idx":0,"proposition":"Taking samples to identify the perpetrator is crucial","correct":true},{"idx":1,"proposition":"The doctor must write an initial medical certificate","correct":true},{"idx":2,"proposition":"Rapes dating back more than 5 days require emergency care with samples and declaration to the prosecutor","correct":false,"justification":"It is the recent aggression of less than 72 hours that requires urgent care, in particular because it allows samples to be taken."},{"idx":3,"proposition":"Medical consultation with genito-anal examination should be carried out with maximum competence","correct":true},{"idx":4,"proposition":"After explaining the objectives of the medical examination, it must be carried out in a welcoming, well-lit room","correct":true}],"type":"custom"}
+{"_id":"violence-gyn-2","context":null,"enonce":"The interrogation of rape victims makes it possible to specify:","item":"violence","matiere":"gyn","propositions":[{"idx":0,"proposition":"Number of abusers","correct":true,"justification":"Difficult question to ask, like many others, but necessary"},{"idx":1,"proposition":"The relationship is a question that does not arise","correct":false,"justification":"Absolutely not!"},{"idx":2,"proposition":"The victim's behaviour after the assault is unnecessary","correct":false,"justification":"If she has lost consciousness, changed her clothes or made a toilet, the medical management changes"},{"idx":3,"proposition":"The date and time of the assault","correct":true},{"idx":4,"proposition":"The victim's medical-surgical history","correct":true}],"type":"custom"}
+{"_id":"VH-infectio-0","context":null,"enonce":"Which propositions are true?","item":"VH","matiere":"infectio","propositions":[{"idx":0,"proposition":"The Maddreay score calculates the probability of contracting viral hepatitis","correct":false,"justification":"Maddrey's score defines the severity of alcoholic hepatitis"},{"idx":1,"proposition":"There is never a severe form of HEV infection","correct":false,"justification":"Fulminant hepatitis in pregnant women"},{"idx":2,"proposition":"The hepatitis B virus has a diameter of 2 microns","correct":false,"justification":"Viruses are smaller than cells (so about ten ometers). HBV is 47 ometers in diameter"},{"idx":3,"proposition":"Mutated pre-C HCV viruses cause more severe chronic hepatitis than non-mutated viruses","correct":true},{"idx":4,"proposition":"Hepatitis is said to be chronic when it lasts more than 3 months","correct":false,"justification":"Acute < 6 months. Chronic> 6 months."}],"type":"custom"}
+{"_id":"VH-infectio-1","context":null,"enonce":"Regarding HAV:","item":"VH","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is a DNA virus","correct":false,"justification":"HAV is an RNA virus"},{"idx":1,"proposition":"It is a reportable disease","correct":true},{"idx":2,"proposition":"There is never chronic hepatitis","correct":true},{"idx":3,"proposition":"There is never a severe form","correct":false,"justification":"There may be, but very rarely, fulminant hepatitis"},{"idx":4,"proposition":"Incubation is 48 hours","correct":false,"justification":"Incubation is between 10 and 45 days"}],"type":"custom"}
+{"_id":"VH-infectio-2","context":null,"enonce":"A positive HBs antigen can be found in case of:","item":"VH","matiere":"infectio","propositions":[{"idx":0,"proposition":"Acute and active hepatitis B","correct":true},{"idx":1,"proposition":"Immunoprotective vaccination against HEV","correct":false,"justification":"HBs antigen signs the presence of HBV"},{"idx":2,"proposition":"HBV vaccination","correct":false,"justification":"HBs antigen signs the presence of HBV"},{"idx":3,"proposition":"Active chronic hepatitis B","correct":true},{"idx":4,"proposition":"Hepatitis B cured","correct":false,"justification":"HBs antigen signs the presence of HBV"}],"type":"custom"}
+{"_id":"VH-infectio-3","context":null,"enonce":"Regarding the transmission of hepatitis viruses:","item":"VH","matiere":"infectio","propositions":[{"idx":0,"proposition":"HAV is not transmitted from mother to child during pregnancy","correct":true,"justification":"No mother-to-child transmission"},{"idx":1,"proposition":"HBV can be transmitted during sex","correct":true,"justification":"This is the case for all viruses are HEV"},{"idx":2,"proposition":"HCV is not affected by fecal-oral transmission","correct":true},{"idx":3,"proposition":"Blood transmission is possible for all hepatitis viruses","correct":true},{"idx":4,"proposition":"HEV cannot be transmitted during sexual intercourse","correct":true}],"type":"custom"}
+{"_id":"VH-infectio-4","context":null,"enonce":"Which of the following designates active hepatitis B?","item":"VH","matiere":"infectio","propositions":[{"idx":0,"proposition":"HBsAg negative \/ Anti-HBs Ac negative \/ HBeAg negative \/ Anti-HBc Ac negative","correct":false,"justification":"HBsAg negative so no virus"},{"idx":1,"proposition":"HBsAg negative \/ Ac anti-HBs positive \/ HBeAg negative \/ Ac anti-HBc negative","correct":false,"justification":"HBsAg negative so no virus"},{"idx":2,"proposition":"HBsAg negative \/ Ac anti-HBs positive \/ HBeAg negative \/ Ac anti-HBc cloudy","correct":false,"justification":"HBsAg negative so no virus"},{"idx":3,"proposition":"HBsAg positive \/ Anti-HBs ac negative \/ HBeAg negative \/ Positive anti-HBc Ac","correct":true},{"idx":4,"proposition":"HBsag positive \/ anti-HBs ac negative \/ HBeAg positive \/ positive anti-HBc ac","correct":true}],"type":"custom"}
+{"_id":"gynecomastie-endoc-0","context":null,"enonce":"Which propositions are true?","item":"gynecomastie","matiere":"endoc","propositions":[{"idx":0,"proposition":"It signs an androgen\/estrogen imbalance","correct":true},{"idx":1,"proposition":"It signs an increase in androgen or a decrease in estrogen","correct":false,"justification":"The opposite: an increase in estrogen and\/or a decrease in androgens"},{"idx":2,"proposition":"Parapubertal gynecomastia must evoke a gonadotropic tumor","correct":false,"justification":"It is physiological and regresses spontaneously"},{"idx":3,"proposition":"The different etiologies are all endogenous","correct":false,"justification":"There are also many exogenous etiologies: alcohol, drug addiction, iatrogeny, etc."},{"idx":4,"proposition":"An increase in hCG should be investigated for testicular choriocarcinoma","correct":true}],"type":"custom"}
+{"_id":"gynecomastie-endoc-1","context":null,"enonce":"Which of these proposals can cause gynecomastia?","item":"gynecomastie","matiere":"endoc","propositions":[{"idx":0,"proposition":"Decreased testosterone production","correct":true},{"idx":1,"proposition":"Inhibition of aromatization of androgens into estrogens","correct":false,"justification":"Decreased estrogen"},{"idx":2,"proposition":"Ectopic increase in estrogen production","correct":true},{"idx":3,"proposition":"The genetic absence or decrease of estrogen receptors","correct":false,"justification":"No effect"},{"idx":4,"proposition":"Iatrogenic decrease in androgen receptor availability","correct":true}],"type":"custom"}
+{"_id":"gynecomastie-endoc-2","context":null,"enonce":"Which of these proposals can cause gynecomastia?","item":"gynecomastie","matiere":"endoc","propositions":[{"idx":0,"proposition":"Hypogonadism","correct":true},{"idx":1,"proposition":"Hyperthyroidism","correct":true},{"idx":2,"proposition":"Syndrome de Klinefelter","correct":true},{"idx":3,"proposition":"Syndrome de Turner","correct":false,"justification":"Patients are women"},{"idx":4,"proposition":"Hyperprolactinemia","correct":true}],"type":"custom"}
+{"_id":"gynecomastie-endoc-3","context":null,"enonce":"What element(s) are included in the biological assessment of gynecomastia:","item":"gynecomastie","matiere":"endoc","propositions":[{"idx":0,"proposition":"hCG","correct":true},{"idx":1,"proposition":"NFS-P","correct":false,"justification":"The assessment contains (according to the College of Endocrinology): hCG, estradiol, testoserone, LH, FSH, Prolactin, TSH, Liver enzyme, Ionogram and Creatitine"},{"idx":2,"proposition":"Ferritin","correct":false},{"idx":3,"proposition":"DHEA","correct":false},{"idx":4,"proposition":"Lipase","correct":false}],"type":"custom"}
+{"_id":"gynecomastie-endoc-4","context":null,"enonce":"Which propositions are true?","item":"gynecomastie","matiere":"endoc","propositions":[{"idx":0,"proposition":"Adipomastia is a subcutaneous fat deposit next to the nipple","correct":true},{"idx":1,"proposition":"An increase in estrogen is a sign of Leydig cell tumor","correct":true},{"idx":2,"proposition":"An increase in estrogen may be a sign of a malignant adrenocortical carcinoma","correct":true},{"idx":3,"proposition":"Spironolactone can cause gynecomastia","correct":true},{"idx":4,"proposition":"A karyotype 47,XXY signs Klinefelter syndrome","correct":true}],"type":"custom"}
+{"_id":"Sdmononuc-hemato-0","context":null,"enonce":"Regarding mononucleosis syndrome:","item":"Sdmononuc","matiere":"hemato","propositions":[{"idx":0,"proposition":"The diagnosis of mononucleosis syndrome is clinical","correct":false,"justification":"The diagnosis of mononucleosis syndrome is made on the leukocyte formula of the blood count"},{"idx":1,"proposition":"The diagnosis is made on a blood count showing a proportion > 5% of mononuclear cells in the leukocyte population","correct":false,"justification":"Diagnosis is made on the blood count and the leukocyte formula: proportion > 50% of mononuclear cells in the leukocyte population; and proportion > 10% of activated lymphocytes (increased size, polymorphs, basophilic staining)."},{"idx":2,"proposition":"Mononucleosis syndrome shows intense activation of cellular immunity","correct":true,"justification":"T cells are activated by a virus, most often"},{"idx":3,"proposition":"The presence on physical examination of lymphadenopathy and\/or angina should be sought on clinical examination.","correct":true,"justification":"TRUE. In EBV infection, fever and influenza-like syndrome are found with, on clinical examination, erythematous, erythematopultaceous or pseudomembranous angina, lymphadenopathy predominant in the cervical and posterior, splenomegaly and \/ or hepatomegaly (more rarely)"},{"idx":4,"proposition":"Other biological abnormalities can lead to a misdiagnosis of mononucleosis syndrome by the laboratory, especially in acute leukemia.","correct":true,"justification":"TRUE. Confusion between circulating blasts and activated T cells. In acute lymphoblastic leukemia, lymphocytes are immature and monomorphic."}],"type":"custom"}
+{"_id":"Sdmononuc-hemato-1","context":null,"enonce":"Regarding mononucleosis syndrome:","item":"Sdmononuc","matiere":"hemato","propositions":[{"idx":0,"proposition":"An HIV infection is to be evoked systematically","correct":true,"justification":"TRUE. It's rarer than toxoplasmosis, CMV or EBV, but it's also much more serious."},{"idx":1,"proposition":"Some drug hypersensitivity reactions (to sulfonamides, ß-lactams, certain anticonvulsants...) can result in a mononucleosis syndrome","correct":true,"justification":"TRUE. This is the DRESS syndrome"},{"idx":2,"proposition":"A mononucleosis syndrome may accompany a DRESS syndrome (Drug Rash with hyperEosinophilia and Systemic Symptoms)","correct":true,"justification":"TRUE. Some drugs induce a viral reaction against certain viruses (present but asymptomatic), including EBV and CMV, causing severe toxiderma and containing a mononucleosic syndrome: this is the DRESS syndrome"},{"idx":3,"proposition":"The most common cause is primary infection with Epstein Barr virus.","correct":true,"justification":"TRUE. The Epstein Barr Virus (EBV) is the cause of infectious mononucleosis, or MNI. It is a DNA virus. The other two main causes are CMV infection (DNA virus too) and toxoplasmosis (intracellular parasitic zoonosis)"},{"idx":4,"proposition":"In the face of a mononucleosic syndrome, to look for primary EBV infection, a first-line serological search is carried out","correct":false,"justification":"First, a MNI-test is performed. This agglutination test is fast for diagnostic orientation, but not very sensitive."}],"type":"custom"}
+{"_id":"Sdmononuc-hemato-2","context":null,"enonce":"About CMV: ","item":"Sdmononuc","matiere":"hemato","propositions":[{"idx":0,"proposition":"Transmission occurs through contact with infected shedding","correct":true},{"idx":1,"proposition":"It is the leading cause of mononucleosis syndrome","correct":false,"justification":"This is the second cause. The first cause is NIM (infectious mononucleosis), caused by the EBV virus."},{"idx":2,"proposition":"It is an RNA virus","correct":false,"justification":"DNA viruses"},{"idx":3,"proposition":"There is systematic screening for pregnancy","correct":false,"justification":"No systematic organized screening"},{"idx":4,"proposition":"In pregnancy, seroconversion can be serious\/fatal to the fetus","correct":true}],"type":"custom"}
+{"_id":"Sdmononuc-hemato-3","context":null,"enonce":"About EBV:","item":"Sdmononuc","matiere":"hemato","propositions":[{"idx":0,"proposition":"It is the leading cause of mononucleosis syndrome","correct":true},{"idx":1,"proposition":"The virus has a tropism for B lymphocytes causing lymph node hyperplasia","correct":true},{"idx":2,"proposition":"It is a DNA virus","correct":true},{"idx":3,"proposition":"Transmission is sexual most of the time","correct":false,"justification":"Mostly salivary transmission"},{"idx":4,"proposition":"The MNI-test has low specificity and high sensitivity","correct":false,"justification":"Low sensitivity. The College of Hematology does not mention its specificity"}],"type":"custom"}
+{"_id":"Sdmononuc-hemato-4","context":null,"enonce":"Regarding the ancillary causes of mononucleosis syndrome:","item":"Sdmononuc","matiere":"hemato","propositions":[{"idx":0,"proposition":"It can reveal HIV infection","correct":true},{"idx":1,"proposition":"Rickettsiosis are parasites that can cause this syndrome","correct":false,"justification":"These are bacteria"},{"idx":2,"proposition":"Hepatitis B and C viruses can cause this syndrome","correct":true},{"idx":3,"proposition":"Malaria is a possible cause","correct":true},{"idx":4,"proposition":"SCA ST+ can be accompanied by this syndrome because of muscle soreness","correct":false,"justification":"Nothing to see"}],"type":"custom"}
+{"_id":"herpes-infectio-0","context":null,"enonce":"Which of these virus proposals are not herpes viruses?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"HIV","correct":true},{"idx":1,"proposition":"VZV","correct":false},{"idx":2,"proposition":"EBV","correct":false},{"idx":3,"proposition":"Covid-19","correct":true},{"idx":4,"proposition":"CMV","correct":false}],"type":"custom"}
+{"_id":"herpes-infectio-1","context":null,"enonce":"Which of these virus proposals are not herpes viruses?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"HPV","correct":true},{"idx":1,"proposition":"CMV","correct":false},{"idx":2,"proposition":"HSV1","correct":false},{"idx":3,"proposition":"HSV2","correct":false},{"idx":4,"proposition":"HBV","correct":true}],"type":"custom"}
+{"_id":"herpes-infectio-2","context":null,"enonce":"Regarding herpes viruses:","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"These viruses are DNA","correct":true},{"idx":1,"proposition":"These viruses are double-stranded RNA","correct":false},{"idx":2,"proposition":"These viruses are single-stranded RNA","correct":false},{"idx":3,"proposition":"These viruses are enveloped","correct":true},{"idx":4,"proposition":"These viruses are naked","correct":false}],"type":"custom"}
+{"_id":"herpes-infectio-3","context":null,"enonce":"Which of these proposals are factors promoting primary post-infection reactivation?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"Stress","correct":true},{"idx":1,"proposition":"Prolonged exposure to the sun","correct":true,"justification":"For cutaneous tropism viruses such as HSV and VZV"},{"idx":2,"proposition":"Significant asthenia","correct":true},{"idx":3,"proposition":"The rules","correct":true},{"idx":4,"proposition":"Weekly sport","correct":false,"justification":"Unless it is a factor of major stress"}],"type":"custom"}
+{"_id":"herpes-infectio-4","context":null,"enonce":"Regarding the VZV:","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"It's the shingles virus only","correct":false,"justification":"Chickenpox too"},{"idx":1,"proposition":"Incubation of chickenpox is about 21 days","correct":false,"justification":"14 days after the Pilly 2020"},{"idx":2,"proposition":"Chickenpox is accompanied by a fever","correct":false,"justification":"True fever at 38°C-39°C"},{"idx":3,"proposition":"Rashes may be maculopapular at first","correct":true,"justification":"Scattered vesicles and pruritus with possible scratching lesions are then observed."},{"idx":4,"proposition":"Healing takes about 10 days","correct":true}],"type":"custom"}
+{"_id":"herpes-infectio-5","context":null,"enonce":"Which of these propositions is true?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"Herpes viruses are the second most common entity in infectious encephalitis","correct":false,"justification":"Herpes virus = first cause of infectious encephalitis"},{"idx":1,"proposition":"EBV is the most common cause of viral encephalitis.","correct":false,"justification":"HSV"},{"idx":2,"proposition":"HSV is responsible for about 33% of viral encephalitis","correct":true},{"idx":3,"proposition":"Primary HSV-1 infection is preferentially sexual","correct":false,"justification":"HSV-1 = oropharyngeal. HSV-2 = sexual."},{"idx":4,"proposition":"HSV-2 is more frequently responsible for encephality than HSV-1","correct":false,"justification":"HSV1 = 95% of HSV encephalitis"}],"type":"custom"}
+{"_id":"herpes-infectio-6","context":null,"enonce":"Which area(s) is\/are respected by chickenpox?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"The face","correct":false,"justification":"Only the extremities of the limbs are respected by chickenpox"},{"idx":1,"proposition":"Back","correct":false},{"idx":2,"proposition":"Hands","correct":true},{"idx":3,"proposition":"The belly","correct":false},{"idx":4,"proposition":"Buttocks","correct":false}],"type":"custom"}
+{"_id":"herpes-infectio-7","context":null,"enonce":"Which propositions are true?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"In case of genital lesions due to HSV-2 concomitant with late pregnancy, caesarean section is recommended","correct":true},{"idx":1,"proposition":"Aciclovir is an inhibitor of HSV DNA polymerase","correct":true},{"idx":2,"proposition":"Aciclovir will be phosphated 3 times before use","correct":true,"justification":"The active metabolite is therefore aciclovir-triphosphate"},{"idx":3,"proposition":"Valaciclovir is a predrug","correct":true,"justification":"It is better absorbed"},{"idx":4,"proposition":"All propositions are true","correct":true}],"type":"custom"}
+{"_id":"herpes-infectio-8","context":null,"enonce":"Which pathology(s) is\/are favored by HHV8?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"Ewing's sarcoma","correct":false,"justification":"Kaposi's sarcoma"},{"idx":1,"proposition":"HIV co-infection","correct":false,"justification":"The repository does not mention it in any case"},{"idx":2,"proposition":"Castleman's disease","correct":true},{"idx":3,"proposition":"Purulent meningitis","correct":false,"justification":"Viral meningitis is clear fluid most often"},{"idx":4,"proposition":"Acute anterior uveitis","correct":false}],"type":"custom"}
+{"_id":"herpes-infectio-9","context":null,"enonce":"Which elements of the blood count are greatly increased in case of infectious mononucleosis (EBV)?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"Monocytes","correct":false},{"idx":1,"proposition":"Lymphocytes","correct":true,"justification":"These are the hyperbasophilic lymphocytes"},{"idx":2,"proposition":"Neutrophils","correct":false},{"idx":3,"proposition":"Polynuclear eosinophils.","correct":false},{"idx":4,"proposition":"Leukocytes","correct":true,"justification":"And more specifically, lymphocytes"}],"type":"custom"}
+{"_id":"herpes-infectio-10","context":null,"enonce":"How many viruses are there belonging to the group of Herpes Viruses?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"5","correct":false},{"idx":1,"proposition":"6","correct":false},{"idx":2,"proposition":"7","correct":false},{"idx":3,"proposition":"8","correct":true,"justification":"VZV (varicella-zoster), CMV, EBV (mononucleosis), HSV1, HSV2, HHV6 (Castleman and Kaposi), HHV7, HHV8"},{"idx":4,"proposition":"9","correct":false}],"type":"custom"}
+{"_id":"herpes-infectio-11","context":null,"enonce":"Which of the following propositions about chickenpox are true?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"The elementary lesion is a vesicle","correct":true},{"idx":1,"proposition":"There are different age elements","correct":true},{"idx":2,"proposition":"Mucosa involvement may be found","correct":true},{"idx":3,"proposition":"Pruritus is absent","correct":false,"justification":"Pruritus is very present"},{"idx":4,"proposition":"Fever is absent","correct":false,"justification":"It can be very important"}],"type":"custom"}
+{"_id":"herpes-infectio-12","context":null,"enonce":"Which of the following propositions about chickenpox are true?","item":"herpes","matiere":"infectio","propositions":[{"idx":0,"proposition":"The causative agent is HSV2","correct":false,"justification":"The causative agent is herpes virus type 3 or VZV (Shingles and Chickenpox virus)"},{"idx":1,"proposition":"It is contagious until D + 2 of the beginning of the eruption","correct":false,"justification":"Until the appearance of crusts in practice"},{"idx":2,"proposition":"Transmission is possible by droplets","correct":true},{"idx":3,"proposition":"Transmission is possible through direct contact","correct":true,"justification":"True, with mucocutaneous lesions"},{"idx":4,"proposition":"Incubation is about 4 weeks","correct":false,"justification":"About 2 weeks of incubation"}],"type":"custom"}
+{"_id":"preventionpsy-psy-0","context":null,"enonce":"General:","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"There are several types of risk factors: * social, * psychological, * biological","correct":true},{"idx":1,"proposition":"The age of the individual has little impact on his or her likelihood of developing a psychiatric disorder","correct":false,"justification":"Some risk factors are more specifically related to the age of the individual"},{"idx":2,"proposition":"Any situation of social and family isolation is a risk factor for psychiatric disorder","correct":true},{"idx":3,"proposition":"Any stressful social environment is a risk factor for psychiatric disorder","correct":true},{"idx":4,"proposition":"Primary prevention does not exist in psychiatry","correct":false,"justification":"There are three types of prevention: * primary prevention is the set of acts aimed at reducing the risk of new cases appearing (incidence)"}],"type":"custom"}
+{"_id":"preventionpsy-psy-1","context":null,"enonce":"General:","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Mental health is an integral part of health","correct":true},{"idx":1,"proposition":"Mental health is defined by the College of Physicians as \"a state of well-being in which a person can achieve self-fulfillment, overcome the normal stresses of life, perform productive work and contribute to the life of his community\"","correct":false,"justification":"The MDG does not make a definition. The latter comes from the WHO and is accurate"},{"idx":2,"proposition":"Psychiatric disorders are most often genetic in origin","correct":false,"justification":"Multifactorial and non-unique origin"},{"idx":3,"proposition":"Analytical epidemiology assesses the frequency and impact of psychiatric disorders","correct":false,"justification":"This is the role of descriptive epidemiology, while analytical epidemiology is concerned with the correlation and causal relationships between several variables (e.g. alcohol consumption and incidence of schizophrenia)."},{"idx":4,"proposition":"In France, about 3 million people suffer from a psychiatric disorder","correct":false,"justification":"In France, almost one in five people suffer from at least one psychiatric disorder, or 12 million people"}],"type":"custom"}
+{"_id":"preventionpsy-psy-2","context":null,"enonce":"On the impact of psychiatric pathologies:","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"The prevalence of psychiatric disorders in general practice is about 25%","correct":true},{"idx":1,"proposition":"Psychiatry pathologies are the 3rd most common disease, after cancer and cardiovascular diseases","correct":true},{"idx":2,"proposition":"Psychiatric disorders are a major cause of disability","correct":true},{"idx":3,"proposition":"Psychiatric disorders have no impact on mortality","correct":false,"justification":"They are associated with high mortality"},{"idx":4,"proposition":"The resulting socio-economic repercussions make it a major public health issue","correct":true}],"type":"custom"}
+{"_id":"preventionpsy-psy-3","context":null,"enonce":"Regarding analytical epidemiology:","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Analytical epidemiology identifies vulnerability, risk and prevention factors","correct":true},{"idx":1,"proposition":"A genetic factor is defined as a characteristic regarding DNA material and may be heritable","correct":true},{"idx":2,"proposition":"Genetic and environmental factors are distinct and mutually exclusive","correct":false,"justification":"Genetic and environmental factors can interact"},{"idx":3,"proposition":"A risk factor (genetic and\/or environmental) increases the likelihood of developing a disease","correct":true},{"idx":4,"proposition":"There are also genetic and\/or environmental protective factors that decrease the likelihood of disease occurring.","correct":true}],"type":"custom"}
+{"_id":"preventionpsy-psy-5","context":null,"enonce":"Regarding prevention:","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"According to the WHO: \"Prevention is the set of measures aimed at avoiding or reducing the number and severity of diseases, accidents and disabilities\"","correct":true},{"idx":1,"proposition":"Primary prevention is directly aimed at reducing prevalence","correct":false,"justification":"Primary prevention is the set of acts aimed at reducing the risk of new cases (= incidence and not prevalence, which can only be reduced by cure or time)"},{"idx":2,"proposition":"Primary prevention aims globally to improve the quality of life and living conditions of individuals","correct":true},{"idx":3,"proposition":"Primary prevention of psychiatric disorders, says WHO, should also aim to strengthen social integration","correct":true},{"idx":4,"proposition":"The objective of secondary prevention is to reduce the prevalence of a disease in a population","correct":true}],"type":"custom"}
+{"_id":"preventionpsy-psy-7","context":null,"enonce":"Regarding adolescence:","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"This is a critical period for psychic development","correct":true},{"idx":1,"proposition":"Harassment at work explains almost all possible psychiatric pathologies of adolescents","correct":false,"justification":"False for two reasons: we talk about school bullying at this age (except in special cases), and bullying is not the main risk factor for neurodevelopmental disorders (even if it is a very strong risk factor)"}],"type":"custom"}
+{"_id":"preventionpsy-psy-8","context":null,"enonce":"Which pathologies are more common in women?","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"CAW","correct":true},{"idx":1,"proposition":"Chronic hallucinatory psychosis","correct":true},{"idx":2,"proposition":"Conduct disorder","correct":true},{"idx":3,"proposition":"Schyzophrenia","correct":false,"justification":"Sex ratio almost to 1"},{"idx":4,"proposition":"Depression","correct":true,"justification":"Sex ratio at 1.7 F\/H"}],"type":"custom"}
+{"_id":"preventionpsy-psy-9","context":null,"enonce":"Which pathologies are more common in men?","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"CAW","correct":false,"justification":"Plûtot in girls"},{"idx":1,"proposition":"Erotomanic delirium","correct":false,"justification":"Rather in the female sex"},{"idx":2,"proposition":"Social phobia","correct":false,"justification":"Rather in the female sex"},{"idx":3,"proposition":"Conduct disorder","correct":true},{"idx":4,"proposition":"Delirium of claim","correct":true}],"type":"custom"}
+{"_id":"preventionpsy-psy-11","context":null,"enonce":"What are the real proposals regarding primary prevention?","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"It decreases morbidity and mortality directly","correct":false,"justification":"It aims to reduce the incidence of"},{"idx":1,"proposition":"It increases the general quality of life of individuals","correct":true},{"idx":2,"proposition":"It directly decreases the prevalence","correct":false,"justification":"It is secondary prevention that aims to reduce the prevalence"},{"idx":3,"proposition":"It directly reduces disability","correct":false,"justification":"This is the case of tertiary prevention"},{"idx":4,"proposition":"It is part of general public health actions","correct":true}],"type":"custom"}
+{"_id":"preventionpsy-psy-12","context":null,"enonce":"Which propositions are true?","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Mental health is the absence of mental disorders","correct":false,"justification":"A much more complex definition given by the WHO and which boils down to the sufficient degree of adaptation to the social group"},{"idx":1,"proposition":"Mental health is \"a state of well-being in which a person can achieve self-fulfillment, overcome the normal stresses of life, perform productive work and contribute to the life of his or her community.\"","correct":true},{"idx":2,"proposition":"Only biological and social factors impact mental health ","correct":false,"justification":"3 factors: biological, psychological and social"},{"idx":3,"proposition":"Psychiatric disorders affect 1 in 2 French people","correct":false,"justification":"12% of the population. 25% of consultations in general practice"},{"idx":4,"proposition":"Psychiatric disorders are the 8th type of disease in terms of prevalence","correct":false}],"type":"custom"}
+{"_id":"valeurspro-sp-0","context":null,"enonce":"Regarding the code of medical ethics:","item":"valeurspro","matiere":"sp","propositions":[{"idx":0,"proposition":"The committee for the protection of persons makes it possible to involve citizens in ethical reflection.","correct":false,"justification":"It is the National Consultative Ethics Committee (CCNE) whose one of its objectives is to involve citizens in ethical reflection."},{"idx":1,"proposition":"Medical ethics is the \"set of rules and duties that govern medical practice and individual relationships vis-à-vis the practice concerning their patients and colleagues\"","correct":true},{"idx":2,"proposition":"The ethical principles in the medical field are: Primum non nocere, beneficence, patient autonomy and justice\/equity.","correct":true},{"idx":3,"proposition":"It serves as a reference for criminal courts","correct":false,"justification":"It serves as a reference for the judicial bodies of doctors, the Order but first and foremost as a guide to doctors in their daily practice, at the service of patients. 23 iKB PUBLIC HEALTH 2.CODE OF MEDICAL ETHICS 2.1. HISTORY The Hippocratic Oath: from the Code of Ethics"},{"idx":4,"proposition":"The Hippocratic Oath has nothing to do with the Code of Ethics","correct":false,"justification":"Always used to take an oath of the Code of Ethics: 1st version"}],"type":"custom"}
+{"_id":"valeurspro-sp-1","context":null,"enonce":"Regarding the patient's freedoms:","item":"valeurspro","matiere":"sp","propositions":[{"idx":0,"proposition":"He is free to choose his doctor","correct":true},{"idx":1,"proposition":"He is free to refuse care","correct":true},{"idx":2,"proposition":"He is free to choose his medication","correct":false,"justification":"He is completely free to refuse to take medication if he does not want to. He cannot, however, oblige a doctor to prescribe a specific medicinal product."},{"idx":3,"proposition":"It is free to require the prescription of originators instead of generics","correct":false,"justification":"He can ask. The doctor can accept if necessary. But he is in no way entitled to oblige the doctor"},{"idx":4,"proposition":"His freedom is reinforced by the doctor's duty to inform","correct":true}],"type":"custom"}
+{"_id":"valeurspro-sp-2","context":null,"enonce":"Which of the following are true?","item":"valeurspro","matiere":"sp","propositions":[{"idx":0,"proposition":"Medical ethics is the \"set of duties imposed on professionals in the exercise of their profession\" ","correct":true},{"idx":1,"proposition":"Deontology brings together the elements of a discourse on duties","correct":true},{"idx":2,"proposition":"Medical ethics concerns the doctor who exercises a profession in the strict sense of the term, to which French laws have given for nearly two centuries a monopoly in the field of health","correct":true},{"idx":3,"proposition":"The patient has the fundamental freedom to choose his or her physician and to accept or refuse care ","correct":true},{"idx":4,"proposition":"Medical acts cannot be tried by a court because it does not have the jurisdiction to do so. ","correct":false,"justification":"May be tried at the criminal, civil, administrative or disciplinary level"}],"type":"custom"}
+{"_id":"antalgie-therapeutique-0","context":null,"enonce":"Regarding the basics:","item":"antalgie","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Drugs used to treat nociceptive pain are classified into three tiers by WHO","correct":true},{"idx":1,"proposition":"Co-analgesic drugs are contraindicated when administering true analgesic","correct":false,"justification":"Specific drugs for neuropathic pain as well as so-called \"coanalgesic\" drugs can be combined with analgesics at WHO levels"},{"idx":2,"proposition":"Non-drug therapies are useless in times of crisis and should be reserved for cold periods","correct":false,"justification":"Non-drug therapies, alone or as part of multimodal analgesia in combination with drug therapies, can reduce the intensity of acute or chronic pain"},{"idx":3,"proposition":"The benefit\/risk balance should be evaluated before the administration of analgesic therapies, except in case of 10\/10 pain.","correct":false,"justification":"It should be systematically evaluated"},{"idx":4,"proposition":"Pain relief is a fundamental right of every person","correct":true}],"type":"custom"}
+{"_id":"antalgie-therapeutique-1","context":null,"enonce":"Major bases:","item":"antalgie","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"The source of the pain will need to be treated before the pain itself is treated","correct":true},{"idx":1,"proposition":"Placebos have no effect on acute pain","correct":false,"justification":"There is no ethical or scientific rationale for using placebos, even though 30-70% of patients seem sensitive to them to varying degrees."},{"idx":2,"proposition":"Optimal treatment results from a proprietary medication approach that relieves pain","correct":false,"justification":"Optimal treatment results from the combination of several approaches, both drug and non-drug, ideally coordinated by a multidisciplinary team"},{"idx":3,"proposition":"Non-therapeutic approaches have several interests, so that of limiting iatrogeny","correct":true,"justification":"It would allow an improvement in analgesia as well as a reduction in side effects via a decrease in the doses of each drug"},{"idx":4,"proposition":"The source of the pain will need to be treated concomitantly with the pain itself","correct":true}],"type":"custom"}
+{"_id":"antalgie-therapeutique-3","context":null,"enonce":"Which propositions are true?","item":"antalgie","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"The WHO established a 3-tiered conceptual model in 1986 to guide pain management.","correct":true},{"idx":1,"proposition":"Therapeutic pain management always begins at level 1 and then increases in step until it reaches the desired effectiveness","correct":false,"justification":"Not at all. We go directly to the most suitable level"},{"idx":2,"proposition":"NSAIDs are contraindicated postoperatively if clearance < 50 ml\/min","correct":true},{"idx":3,"proposition":"The choice of level is based on the assessment of the intensity of the pain","correct":true},{"idx":4,"proposition":"Moderate pain assessed between 3 and 7 requires a level 3 analgesic","correct":false,"justification":"Moderate pain is 4 to 6\/10 and requires a level 2"}],"type":"custom"}
+{"_id":"puberte-gyn-0","context":null,"enonce":"General:","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"Puberty in girls begins with the appearance of the breast bud","correct":true},{"idx":1,"proposition":"The absence of breast development at the age of 13 makes it possible to define a pubertal delay","correct":true},{"idx":2,"proposition":"Primary amenorrhea at the age of 15 can define delayed puberty","correct":true},{"idx":3,"proposition":"Puberty lasts an average of 2 years","correct":false,"justification":"On average 4 years"},{"idx":4,"proposition":"Puberty includes accelerated growth rate","correct":true}],"type":"custom"}
+{"_id":"puberte-gyn-1","context":null,"enonce":"Regarding the gonadotropic axis:","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"The gonadotropic axis is functional for the first time during puberty","correct":false,"justification":"This gonadotropic axis is functional during intrauterine life and for a few weeks after birth"},{"idx":1,"proposition":"\"Mini puberty\" is seen during the few weeks postpartum in infants","correct":true},{"idx":2,"proposition":"During childhood, the gonadotropic axis is inhibited","correct":true},{"idx":3,"proposition":"Puberty is the consequence of the pulsatile secretion of GnRH by pituitary neurons","correct":false,"justification":"GnRH is secreted by hypothalamic neurons"},{"idx":4,"proposition":"The gonadal steroid is estradiol in girls","correct":true,"justification":"And testosterone in the boy"}],"type":"custom"}
+{"_id":"puberte-gyn-2","context":null,"enonce":"Regarding the onset of puberty","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"The age of onset of puberty depends on genetic factors only","correct":false,"justification":"Also environmental factors, especially nutrition and energy expenditure"},{"idx":1,"proposition":"Obese children have puberty later than children in the general population","correct":false,"justification":"Earlier"},{"idx":2,"proposition":"Excessive physical exertion or lack of sleep induces delayed puberty","correct":true},{"idx":3,"proposition":"In girls, the first sign of puberty is enlarged breasts","correct":true},{"idx":4,"proposition":"In boys, the first sign of puberty is increased muscle volume","correct":false,"justification":"Increased testicular volume"}],"type":"custom"}
+{"_id":"puberte-gyn-3","context":null,"enonce":"Regarding the clinical signs of puberty:","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"Pubarche is the appearance of pubic hair","correct":true,"justification":"And it's not a sign of puberty"},{"idx":1,"proposition":"Llyel stages follow breast development","correct":false,"justification":"Tanner Stadium (not Turner, mind you)"},{"idx":2,"proposition":"The stage S2 or appearance of the breast bud corresponds to the telarche","correct":true},{"idx":3,"proposition":"Stage S2 occurs on average at the age of 16","correct":false,"justification":"Rather 10– or 11 years"},{"idx":4,"proposition":"The vulva changes from the horizontal to the vertical position","correct":false,"justification":"It changes from the vertical position to the horizontal position, the labia minora develop, the clitoral volume increases"}],"type":"custom"}
+{"_id":"puberte-gyn-4","context":null,"enonce":"Clinical signs of puberty:","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"The onset of menstruation is the first stage of puberty","correct":false,"justification":"First breast development and then changes in the vulva"},{"idx":1,"proposition":"In France, the average age of menarche is 16.9 years","correct":false,"justification":"12.5 years on average"},{"idx":2,"proposition":"An irregularity of the cycles during the first 2 years after menarche should lead to explore the pathology","correct":false,"justification":"It's physiological"},{"idx":3,"proposition":"In boys, Tanner's stadiums range from G1 to G3","correct":false,"justification":"From G1 (G for Gonad) to G5"},{"idx":4,"proposition":"The development of testicular size begins on average around the age of 11.5 years","correct":true}],"type":"custom"}
+{"_id":"puberte-gyn-5","context":null,"enonce":"General:","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"Testicular volume greater than 4 mL or height greater than 2.5 cm is in favour of early puberty","correct":true},{"idx":1,"proposition":"Normal adult testicular volume is greater than 35 mL","correct":false,"justification":"Greater than 16 mL"},{"idx":2,"proposition":"The onset of puberty coincides with the appearance of capitatum","correct":false,"justification":"The onset of puberty coincides with the appearance of the sesamoid of the thumb, on the bone age X-ray performed on the left wrist in right-handed people and vice versa."},{"idx":3,"proposition":"At puberty, there is an acceleration of the growth rate from 5 mm\/year to 9 mm\/year","correct":false,"justification":"From 5 or 6 cm\/year to 7 to 9 cm\/year"},{"idx":4,"proposition":"The peak of growth occurs in the girl around the age of 12","correct":true,"justification":"And 14 years for the boy"}],"type":"custom"}
+{"_id":"puberte-gyn-6","context":null,"enonce":"Regarding pubertal growth and precocious puberty:","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"Total pubertal growth averages 25 cm in boys","correct":true,"justification":"And 20cm in girls"},{"idx":1,"proposition":"Final height is reached on average at 21 years in boys","correct":false,"justification":"At 16 for girls and 18 for boys"},{"idx":2,"proposition":"There is during puberty a major increase in lean mass compared to fat mass, in girls","correct":false,"justification":"Especially fat mass in girls"},{"idx":3,"proposition":"When breast development occurs before the age of 8 in girls, it is called precocious puberty","correct":true,"justification":"And it's 9 years in the boy"},{"idx":4,"proposition":"Precocious puberty affects 15% of boys today","correct":false,"justification":"It is rather rare: 0.2% of girls and 0.05% of boys"}],"type":"custom"}
+{"_id":"puberte-gyn-7","context":null,"enonce":"Regarding precocious puberty and advanced puberty:","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"Precocious puberty is 10 times more common in boys than in girls","correct":false,"justification":"Converse: it is 10 times more common in girls than in boys"},{"idx":1,"proposition":"Puberty is said to be advanced when it occurs between 8 and 10 years of age in girls","correct":true,"justification":"And between 9 and 11 years old in boys"},{"idx":2,"proposition":"Advanced puberty is as pathological as precocious puberty","correct":false,"justification":"It is not pathological at all"},{"idx":3,"proposition":"Precocious puberty is of central or hypothalamic-pituitary origin","correct":false,"justification":"Precocious puberty can be a \"true\" puberty of central or hypothalamic-pituitary origin or a \"pseudo puberty\" of peripheral origin, either of gonadal or adrenal origin"},{"idx":4,"proposition":"Precocious puberty is not pathological","correct":false,"justification":"Precocious puberty is idiopathic in 90% of cases in girls, it is pathological in 66% of cases in boys"}],"type":"custom"}
+{"_id":"puberte-gyn-9","context":null,"enonce":"Which of these proposals are possible etiologies of precocious puberty?","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"Optic chiasma glioma","correct":true,"justification":"Which impacts the pituitary gland"},{"idx":1,"proposition":"History of brain radiation therapy","correct":true},{"idx":2,"proposition":"Type 2 diabetes","correct":false},{"idx":3,"proposition":"Syndrome de Turner","correct":false,"justification":"No puberty"},{"idx":4,"proposition":"Syndrome de McCune-Albright","correct":true,"justification":"Associated with café au lait spots and fibrous bone dysplasia. Resulting from a mutation in the GNAS gene\""}],"type":"custom"}
+{"_id":"puberte-gyn-10","context":null,"enonce":"Regarding puberty:","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"The main impact of precocious puberty in the long term is the permanent small size","correct":true},{"idx":1,"proposition":"Pubertal delay should be evoked in boys in the absence of an increase in testicular volume at the age of 14 years","correct":true},{"idx":2,"proposition":"Pubertal delay is always acquired","correct":false,"justification":"Pubertal delay can be congenital or acquired"},{"idx":3,"proposition":"A family investigation is necessary in case of pubertal delay","correct":true,"justification":"At the interrogation ++"},{"idx":4,"proposition":"Pubertal delay is always of central origin","correct":false,"justification":"Pubertal delay can be of central or peripheral origin"}],"type":"custom"}
+{"_id":"PeCKc-onco-0","context":null,"enonce":"Among these proposals, which are times of the announcement device?","item":"PeCKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Caregiver accompaniment time","correct":true},{"idx":1,"proposition":"Medical time","correct":true},{"idx":2,"proposition":"The patient's time","correct":false},{"idx":3,"proposition":"Time for questions","correct":false},{"idx":4,"proposition":"Shock time","correct":false,"justification":"The 4 times of an announcement consultation are, in order: the medical time, the time of caregiver accompaniment, the time of support care and the time of articulation with the city medicine"}],"type":"custom"}
+{"_id":"PeCKc-onco-1","context":null,"enonce":"Which of these proposals belongs to level 3 analgesics?","item":"PeCKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Paracetamol","correct":false,"justification":"Level 1"},{"idx":1,"proposition":"NSAIDs","correct":false,"justification":"Level 2"},{"idx":2,"proposition":"Tramadol","correct":false,"justification":"Level 2"},{"idx":3,"proposition":"Oxycodone","correct":true},{"idx":4,"proposition":"Fentanyl","correct":true}],"type":"custom"}
+{"_id":"PeCKc-onco-2","context":null,"enonce":"Which of these proposals is(are) supportive care?","item":"PeCKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Social monitoring","correct":true},{"idx":1,"proposition":"Psychological support","correct":true},{"idx":2,"proposition":"Anti-emetic treatment of chemotherapy","correct":true},{"idx":3,"proposition":"Hormone therapy for breast cancer","correct":false,"justification":"It is a basic disease treatment"},{"idx":4,"proposition":"Pain management","correct":true}],"type":"custom"}
+{"_id":"PeCKc-onco-3","context":null,"enonce":"Which of these proposals concerning medical information are true?","item":"PeCKc","matiere":"onco","propositions":[{"idx":0,"proposition":"It must be appropriate","correct":true},{"idx":1,"proposition":"It must go into scientific details","correct":false,"justification":"It must be fair but understandable"},{"idx":2,"proposition":"It must be loyal","correct":true},{"idx":3,"proposition":"Information must be repeated","correct":true,"justification":"And we must ensure that the patient has understood and integrated it by asking him to reformulate"},{"idx":4,"proposition":"The information must be verified with relatives before being delivered to the patient","correct":false,"justification":"Medical confidentiality contravenes this proposal"}],"type":"custom"}
+{"_id":"PeCKc-onco-4","context":null,"enonce":"Regarding taking oral morphine:","item":"PeCKc","matiere":"onco","propositions":[{"idx":0,"proposition":"It is contraindicated except in end-of-life care","correct":false,"justification":"It is an essential treatment for pain"},{"idx":1,"proposition":"It is usually established at a dose of 10 mg \/ day","correct":false,"justification":"Instead, it is introduced at 60 mg\/D."},{"idx":2,"proposition":"There is no maximum dose common to all patients","correct":true,"justification":"The dose-efficacy-tolerability relationship varies greatly from one patient to another. It is therefore important to frequently evaluate efficacy and tolerability, and to adapt the dosage gradually according to the patient's needs. There is no maximum dose, as long as adverse effects can be controlled."},{"idx":3,"proposition":"The only effect of morphine is analgesic","correct":false},{"idx":4,"proposition":"The main side effect is digestive","correct":true,"justification":"Morphine is constipative"}],"type":"custom"}
+{"_id":"PeCKc-onco-5","context":null,"enonce":"Regarding Supportive Oncology Care:","item":"PeCKc","matiere":"onco","propositions":[{"idx":0,"proposition":"It facilitates the use of active euthanasia","correct":false,"justification":"Absolutely not. Active euthanasia is illegal in France"},{"idx":1,"proposition":"It makes it possible to stop all treatments","correct":false,"justification":"We do not stop medications that have a positive effect on patient comfort"},{"idx":2,"proposition":"They are set up exclusively at the patient's home","correct":false,"justification":"Possible also in the hospital, or with relatives for example"},{"idx":3,"proposition":"They call for more pain management","correct":false,"justification":"No more \"than elsewhere\", pain management is still essential"},{"idx":4,"proposition":"All proposals are wrong","correct":true,"justification":"The main goal is to improve the patient's comfort of life through better control of symptoms."}],"type":"custom"}
+{"_id":"traumacrane-urg-0","context":null,"enonce":"Which of the following propositions are true about Lefort's classification?","item":"traumacrane","matiere":"urg","propositions":[{"idx":0,"proposition":"Lefort III corresponds to an abnormal mobility of the upper dental arch compared to the base of the skull","correct":true},{"idx":1,"proposition":"Lefort III corresponds to an abnormal mobility of the dental arch superior compared to the eyebrow arch","correct":false,"justification":"Relative to the base of the skull"},{"idx":2,"proposition":"Lefort II corresponds to an abnormal mobility of the upper dental arch compared to the cheekbones","correct":true},{"idx":3,"proposition":"The most common fracture is the Lefort I","correct":false,"justification":"This is the Lefort II"},{"idx":4,"proposition":"The most serious fracture is the Lefort II","correct":false,"justification":"This is the Lefort III"}],"type":"custom"}
+{"_id":"traumacrane-urg-1","context":null,"enonce":"Which of the following are innervated by the mandibular V3 portion of the trigeminal nerve?","item":"traumacrane","matiere":"urg","propositions":[{"idx":0,"proposition":"Chin","correct":true},{"idx":1,"proposition":"Upper lip","correct":false,"justification":"Infraorbital nerve V2"},{"idx":2,"proposition":"Temporal muscle","correct":true},{"idx":3,"proposition":"Masseter muscle","correct":true},{"idx":4,"proposition":"Medial cheek","correct":false,"justification":"Lateral cheek (zygomatic process)"}],"type":"custom"}
+{"_id":"infdermato-infectio-0","context":null,"enonce":"Regarding mucocutaneous infections","item":"infdermato","matiere":"infectio","propositions":[{"idx":0,"proposition":"Pyogen skin infections are mainly due to Staphylococcus aureus and Streptococcus pyogenes (also called ß-hemolytic group C streptococcus)","correct":false,"justification":"From Group A"},{"idx":1,"proposition":" Impetigo is a contagious infection of the epidermis due to S.aures or S. pyogènes","correct":true},{"idx":2,"proposition":"Local treatment is most often sufficient in impetigo","correct":true},{"idx":3,"proposition":"Folliculitis and boils are infections of the pilosebaceous follicle","correct":true},{"idx":4,"proposition":"General antibiotic therapy is indicated in boils of the face because of the risk of malignant staphylococcal disease","correct":true}],"type":"custom"}
+{"_id":"infdermato-infectio-1","context":null,"enonce":"Regarding mucocutaneous infections","item":"infdermato","matiere":"infectio","propositions":[{"idx":0,"proposition":"The skin abscess is most often linked to S. pyogènes","correct":false,"justification":"The skin abscess is most often linked to S. aureus"},{"idx":1,"proposition":"The treatment of abscesses is essentially based on antibiotic therapy","correct":false,"justification":"Treatment is essentially surgical"},{"idx":2,"proposition":"Erysipelas is a necrotizing dermohypodermatitis mainly due to S. Aureus","correct":false,"justification":"Erysipelas is a non-necrotizing dermo-hypodermatitis mainly due to Streptococcus pyogenes"},{"idx":3,"proposition":"Diagnosis is clinical for erysipelas","correct":true},{"idx":4,"proposition":"Treatment of erysipelas is surgical","correct":false,"justification":"It is based on antibiotic therapy"}],"type":"custom"}
+{"_id":"infdermato-infectio-2","context":null,"enonce":"Regarding mucocutaneous infections","item":"infdermato","matiere":"infectio","propositions":[{"idx":0,"proposition":"Superficial mycoses are frequent and benign infections of the epidermis and appendages due to fungi","correct":true},{"idx":1,"proposition":"The diagnosis of mycoses is essentially microbiological","correct":false},{"idx":2,"proposition":"In France, community Staphylococcus aureus are sensitive to methicillin in > 95% of cases and the reference antibiotic is penicillin M (cloxacillin)","correct":true,"justification":"TRUE (or Oxacillin)"},{"idx":3,"proposition":"Streptococcus pyogenes is 100% sensitive to penicillin and the reference antibiotic is amoxicillin","correct":true},{"idx":4,"proposition":"In case of allergy to ß-lactam in staphylococcal or streptococcal infections, pristinamycin or clindamycin is used.","correct":true}],"type":"custom"}
+{"_id":"infdermato-infectio-3","context":null,"enonce":"Which of the following propositions are true for osteitis of the foot in diabetic patients?","item":"infdermato","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is common in diabetes","correct":true},{"idx":1,"proposition":"It predominates at the heel","correct":false,"justification":"From the forefoot"},{"idx":2,"proposition":"It is due to vascular involvement only","correct":false,"justification":"Not only: neuropathic impairment too"},{"idx":3,"proposition":"It exposes to a risk of amputation","correct":true},{"idx":4,"proposition":"None of the propositions are true","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"infdermato-infectio-4","context":null,"enonce":"Which of the following propositions are true about impetigo?","item":"infdermato","matiere":"infectio","propositions":[{"idx":0,"proposition":"S. aureus and S. pyogenes are the two most common germs found in impetigos","correct":true},{"idx":1,"proposition":"Diagnosis requires bacteriological sampling before starting antibiotic therapy","correct":false,"justification":"The diagnosis of impetigo is clinical"},{"idx":2,"proposition":"Impetigo is not contagious","correct":false,"justification":"Impetigo is contagious"},{"idx":3,"proposition":"Treatment of simple impetigo is based on doxycycline","correct":false,"justification":"Fusidic acid in topical application"},{"idx":4,"proposition":"Soap helps loosen bacteria","correct":true,"justification":"True, and water rinse them. Daily washing with soap and water of the lesions is a measure to advise in all cases"}],"type":"custom"}
+{"_id":"infdermato-dermato-1","context":null,"enonce":"Regarding mucocutaneous infections","item":"infdermato","matiere":"dermato","propositions":[{"idx":0,"proposition":"There is no fever in impetigos","correct":true},{"idx":1,"proposition":"Ecthyma is a common pathology of precariousness","correct":true},{"idx":2,"proposition":"Complications of ecthyma include post-strep throat and rheumatic fever","correct":true},{"idx":3,"proposition":"Control of proteinuria 3 weeks after the infectious episode is necessary","correct":true},{"idx":4,"proposition":"Folliculitis is inflammatory papulopustulous in nature","correct":true}],"type":"custom"}
+{"_id":"infdermato-dermato-2","context":null,"enonce":"Regarding mucocutaneous infections","item":"infdermato","matiere":"dermato","propositions":[{"idx":0,"proposition":"The boil is a deep but non-necrotizing infection of the pilosebaceous follicle","correct":false,"justification":"It is necrotizing"},{"idx":1,"proposition":"Handling of boils by the patient should be avoided","correct":true},{"idx":2,"proposition":"For boils, oral systemic antibiotic therapy if necessary should be active on S. Aureus","correct":true},{"idx":3,"proposition":"Panari is an elementary lesion of the erythematous, edematous and painful nail fold","correct":true},{"idx":4,"proposition":"Incision and drainage in case of purulent collection of a panari are necessary","correct":true}],"type":"custom"}
+{"_id":"agranulocytose-onco-0","context":null,"enonce":"Which of these propositions are true?","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"Agranulocytosis can be toxic or infectious","correct":false,"justification":"There are two possible causes of agranulocytosis: either it is immunoallergic or it is toxic. Infections do not cause agranulocytosis, on the contrary, there is an increase in PNN as part of the immune response"},{"idx":1,"proposition":"True agranulocytosis is defined by a PNN threshold of less than 1 G\/L","correct":false,"justification":"The threshold for true agranulocytosis is set at 0.2G\/L. Deep neutropenia is defined at 0.5G\/L"},{"idx":2,"proposition":"Neutropenia corresponds to ANCs less than 1 G\/L","correct":false,"justification":"The threshold for neutropenia is set at 1.5 G\/L"},{"idx":3,"proposition":"Agranulocytosis corresponds to a sharp and dangerous drop in the number of monocytes in the blood","correct":false,"justification":"Monocytosis (i.e. dendritic cells and macrophages) do not fit into the definitional framework of agranulocytosis. Agranulocytosis is defined by the fall of neutrophils (PNNs) in the blood"},{"idx":4,"proposition":"Agranulocytosis accounts for less than 3% of iatrogenic accidents","correct":true,"justification":"The college reports 2.4%"}],"type":"custom"}
+{"_id":"agranulocytose-onco-1","context":null,"enonce":"Which of these propositions are true?","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"Agranulocytosis is objectivable by a hemogram","correct":true,"justification":"True agranulocytosis is observed when the PNN is less than 0.2 G\/L. However, we can speak of agranulocytosis in case of PNN less than 0.5 G \/ L (which is the threshold for severe neutropenia, grade IV);  The risk of infection is then very important."},{"idx":1,"proposition":"5% of deaths are observed even with optimal care","correct":true},{"idx":2,"proposition":"The main complication is hemostatic","correct":false,"justification":"It is infectious"},{"idx":3,"proposition":"Toxic agranulocytosis most often affects a single cell line","correct":false,"justification":"This is the case of immunoallergic (iatrogenic) agranulocytosis. Toxic agranulocytosis often leads to pancytopenia"},{"idx":4,"proposition":"Toxic agranulocytosis is now less common than drug-induced agranulocytosis","correct":false,"justification":"Drug agranulocytosis is acute, brutal and has given the phenomenon its formidable reputation; But it has actually become a minority today, since the eviction of pyramidon and phenylbutazone derivatives."}],"type":"custom"}
+{"_id":"agranulocytose-onco-2","context":null,"enonce":"Which of these proposals are causes of agranulocytosis?","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"Bone marrow suppression","correct":true},{"idx":1,"proposition":"Acute leukemia","correct":true},{"idx":2,"proposition":"Bone metastasis","correct":false,"justification":"Bone metastases that do not affect flat bones (sternum, hip bones and vertebrae) cannot have any impact on the bone marrow since there are no more in these bones. Vertebral metastases very rarely have spinal cord invasion."},{"idx":3,"proposition":"Drug iatrogenesis","correct":true},{"idx":4,"proposition":"Myelodysplastic syndromes","correct":true}],"type":"custom"}
+{"_id":"agranulocytose-onco-3","context":null,"enonce":"At what threshold, in G\/L, can we speak of severe neutropenia (i.e. agranulocytosis)?","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"1.5","correct":false,"justification":"Threshold for neutropenia"},{"idx":1,"proposition":"1","correct":false},{"idx":2,"proposition":"0.5","correct":true,"justification":"It is from here that the risk of infection becomes extremely high."},{"idx":3,"proposition":"0.2","correct":false,"justification":"This is the threshold of \"true agranulocytosis\""},{"idx":4,"proposition":"0.1","correct":false}],"type":"custom"}
+{"_id":"agranulocytose-onco-4","context":null,"enonce":"From what threshold, in G \/ L, can we speak of true agranulocytosis?","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"1.5","correct":false,"justification":"Alone for neutropenia"},{"idx":1,"proposition":"1","correct":false},{"idx":2,"proposition":"0.5","correct":false,"justification":"Threshold for severe neutropenia (stage IV)"},{"idx":3,"proposition":"0.2","correct":true,"justification":"This is the threshold of \"true agranulocytosis\""},{"idx":4,"proposition":"0.1","correct":false}],"type":"custom"}
+{"_id":"agranulocytose-onco-5","context":null,"enonce":"Which of these molecules are most likely to cause drug agranulocytosis?","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"Amoxicillin","correct":false},{"idx":1,"proposition":"Tamoxifen","correct":false},{"idx":2,"proposition":"Synthetic anti-thyroid drugs","correct":true,"justification":"The drugs most prone to drug agranulocytosis are: antipsychotics (especially clozapine), synthetic antithyroid drugs, allopurinol and colchicine, sulfonamide antibiotics (e.g. cotrimoxazole, aka bactrim) and anti-epileptic drugs."},{"idx":3,"proposition":"NSAIDs","correct":false},{"idx":4,"proposition":"None of these proposals","correct":false}],"type":"custom"}
+{"_id":"agranulocytose-onco-6","context":null,"enonce":"Which of these molecules are most likely to cause drug agranulocytosis?","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"PPIs","correct":false},{"idx":1,"proposition":"Methotrexate","correct":false},{"idx":2,"proposition":"La L-Tyroxine","correct":false},{"idx":3,"proposition":"Clozapine","correct":true,"justification":"The drugs most prone to drug agranulocytosis are: antipsychotics (especially clozapine), synthetic antithyroid drugs, allopurinol and colchicine, sulfonamide antibiotics (e.g. cotrimoxazole, aka bactrim) and anti-epileptic drugs."},{"idx":4,"proposition":"None of these proposals","correct":false}],"type":"custom"}
+{"_id":"agranulocytose-onco-7","context":null,"enonce":"Which of these propositions are true?","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"Neutropenia is rare in collagenosis","correct":false,"justification":"Collagenosis = connective tissue. It is very common. It is one of the classic biological signs in lupus"},{"idx":1,"proposition":"Most often, agranulocytosis is accompanied by a fall in other blood lines","correct":true,"justification":"Indeed, agranulocytosis is most often toxic (vs immunoallergic) and is accompanied by thrombocytopenia and anemia."},{"idx":2,"proposition":"In toxic agranulocytosis, the megakaryocytic lineage is respected","correct":false,"justification":"This type of agranulocytosis results in pancytopenia if left untreated. Initially, it is often accompanied by anemia and thrombocytopenia."},{"idx":3,"proposition":"Drug agranulocytosis is peripheral agranulocytosis","correct":true},{"idx":4,"proposition":"Toxic agranulocytosis is central agranulocytosis","correct":true}],"type":"custom"}
+{"_id":"agranulocytose-onco-8","context":null,"enonce":"Regarding toxic agranulocytosis:","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"It is often due to radiation therapy","correct":false,"justification":"It is often chemotherapy that is involved. Indeed, these molecules inhibit cell division and therefore have an impact on all cell types that divide a lot. The bone marrow, which produces several billion red blood cells, platelets and immune cells every day, is therefore a target (often collateral and non-voluntary from a therapeutic point of view) of chemotherapy."},{"idx":1,"proposition":"It is unpredictable","correct":false,"justification":"It is predictable: we know the impact that molecules will have before administering them."},{"idx":2,"proposition":"It is time-dependent exclusively","correct":false,"justification":"It is mostly dose-dependent"},{"idx":3,"proposition":"It can lead to pancytopenia","correct":true},{"idx":4,"proposition":"Its mechanism is peripheral","correct":false,"justification":"Central mechanism by direct toxicity"}],"type":"custom"}
+{"_id":"agranulocytose-onco-9","context":null,"enonce":"Regarding immunoallergic agranulocytosis:","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"It concerns classical drug agranulocytosis","correct":true},{"idx":1,"proposition":"Its beginning is often brutal","correct":true},{"idx":2,"proposition":"The mechanism is peripheral","correct":true},{"idx":3,"proposition":"It is dose-dependent","correct":false,"justification":"No, it is independent of dose."},{"idx":4,"proposition":"It can take place when a drug is first introduced","correct":false,"justification":"An external gave us this sentence in the college: College of Hematology (2020 edition; page 122): \"toxicity may be due to treatment over a period of several days (even if first introduction of the drug)\". Warning: this sentence means that toxicity occurs after the first intake (because the cells must be sensitized a first time) but can occur during the first PERIOD of introduction (for example after ten days of treatment with amoxicillin) :) Good luck!!"}],"type":"custom"}
+{"_id":"agranulocytose-onco-10","context":null,"enonce":"Regarding myelogram and osteomedullary biopsy:","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"proposition":"It is necessary for the diagnosis of toxic agranulocytosis","correct":false,"justification":"The blood count, knowledge of the drug and temporality are enough most of the time"},{"idx":1,"proposition":"It shows, in both types of agranulocytosis, a decrease in the richness of the marrow","correct":true},{"idx":2,"proposition":"BOM is done on long bones","correct":false,"justification":"Flat bones, often the sternum"},{"idx":3,"proposition":"It requires general anhesesia","correct":false,"justification":"It is not so painful but it causes a very unpleasant feeling of \"aspiration\""},{"idx":4,"proposition":"All proposals are wrong","correct":false}],"type":"custom"}
+{"_id":"diarrheechr-HGE-0","context":null,"enonce":"About chronic diarrhea","item":"diarrheechr","matiere":"HGE","propositions":[{"idx":0,"proposition":"In clinical practice, diarrhea, according to the WHO, is when there are at least 3 very soft to watery stools per day.","correct":true},{"idx":1,"proposition":"Chronic acute diarrhea is said to occur for more than a month","correct":false,"justification":"Diarrhea is said to be acute when it evolves for less than 2 weeks, prolonged when it evolves for 2 to 4 weeks, chronic when it evolves for more than a month"},{"idx":2,"proposition":"A polyexemption related to a dyschesic syndrome and \/ or a pelvic static disorder: • fecal incontinence; • False diarrhea of constipated are the three differential diagnoses to rule out","correct":true},{"idx":3,"proposition":"Nocturnal stools reflect the organic nature of diarrhea","correct":true},{"idx":4,"proposition":"It is important to look at weight, height, body mass index and weight loss kinetics when weight loss is lost","correct":true}],"type":"custom"}
+{"_id":"diarrheechr-HGE-1","context":null,"enonce":"About chronic diarrhea","item":"diarrheechr","matiere":"HGE","propositions":[{"idx":0,"proposition":"In front of any motor diarrhea it will be necessary to look for hyperthyroidism","correct":true},{"idx":1,"proposition":"Celiac disease is one of the most common causes of chronic diarrhea","correct":true},{"idx":2,"proposition":"Celiac disease is diagnosed in particular thanks to anticorsantigliadin and anti-endomysium","correct":false,"justification":"An antitransglutaminase and anti-endomysium"},{"idx":3,"proposition":"Functional chronic motor diarrhea is generally easily improved by slowing down transit","correct":true},{"idx":4,"proposition":"The appearance of moderate diarrhea without significant biological abnormality in an adult with no personal history of functional intestinal disorders should suggest, among other hypotheses, pancreatic cancer and\/or carcinomosis.","correct":true}],"type":"custom"}
+{"_id":"diarrheechr-HGE-2","context":null,"enonce":"About chronic diarrhea","item":"diarrheechr","matiere":"HGE","propositions":[{"idx":0,"proposition":"In case of diarrhea on return from travel it is necessary to look for chronic parasitosis","correct":true},{"idx":1,"proposition":"During motor diarrhea, watery stools typically occur upon waking and post-prandial","correct":true},{"idx":2,"proposition":"The transit time of carmine red is accelerated during motor diarrhea","correct":true},{"idx":3,"proposition":"Malabsorption diarrhea can be responsible for deficiencies and weight loss despite preserved food intakes","correct":true},{"idx":4,"proposition":"The stools are distributed over the day, voluminous, sometimes visibly greasy in osmotic diarrhea","correct":false,"justification":"This is the case for diarrhoea due to malabsorption"}],"type":"custom"}
+{"_id":"diarrheechr-HGE-3","context":null,"enonce":"Which of the following proposals should be avoided in the case of a gluten-free diet?","item":"diarrheechr","matiere":"HGE","propositions":[{"idx":0,"proposition":"Wheat","correct":true},{"idx":1,"proposition":"Rice","correct":false},{"idx":2,"proposition":"Maize","correct":false},{"idx":3,"proposition":"Rye","correct":true},{"idx":4,"proposition":"Barley","correct":true,"justification":"Wheat, rye, barley and oats"}],"type":"custom"}
+{"_id":"Kcrein-onco-2","context":null,"enonce":"Among these organs, which are preferentially the site of metastases of kidney cancers?","item":"Kcrein","matiere":"onco","propositions":[{"idx":0,"proposition":"Bone","correct":true},{"idx":1,"proposition":"Bladder","correct":false},{"idx":2,"proposition":"Liver","correct":true},{"idx":3,"proposition":"Lungs","correct":true,"justification":"The 5 locations to remember are: CNS, Liver, Lungs, Bones, Lymph nodes. The most affected lymph nodes are those of the renal hilum and those of the retroperitoneum. Also to remember: kidney tumors have an accentuated tropism for the two glands that are the adrenal glands and the prostate."},{"idx":4,"proposition":"EMB","correct":false}],"type":"custom"}
+{"_id":"hemoptysie-pneumo-0","context":null,"enonce":"Which of these proposals designates a criterion of severity of hemoptysis?","item":"hemoptysie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Less than 9 g\/dL hemoglobin","correct":false},{"idx":1,"proposition":"A hemoglobin less than 11 g\/dL in a woman who had a real period 1 week ago","correct":false,"justification":"The severity of hemoptysis is not at all in the loss of hemoglobin. It is very rare, impossible way for hemoptysis to cause hemodynamic instability of any kind. The main severity is asphyxiation."},{"idx":2,"proposition":"Bulky bleeding","correct":true,"justification":"It is often said that it is important at more than 250 mL"},{"idx":3,"proposition":"Orthostatic hypotension","correct":false},{"idx":4,"proposition":"All propositions are true","correct":false}],"type":"custom"}
+{"_id":"hemoptysie-pneumo-1","context":null,"enonce":"Which of the following are true?","item":"hemoptysie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"A hemoptysis is a nosebleed","correct":false,"justification":"This is epistaxis"},{"idx":1,"proposition":"An epistaxis is digestive bleeding","correct":false,"justification":"This is the hematemesis"},{"idx":2,"proposition":"A rectal bleeding is bleeding from the rectum","correct":true,"justification":"True, sorry for the ease but we had to find a fifth proposal 😅"},{"idx":3,"proposition":"A hematemesis is digestive bleeding ","correct":true},{"idx":4,"proposition":"A hemoptysis is bleeding from the respiratory mucous membranes","correct":true}],"type":"custom"}
+{"_id":"hemoptysie-pneumo-3","context":null,"enonce":"Which of the following is the possible cause of death for haemoptysis?","item":"hemoptysie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Hemorrhagic 🩸 shock","correct":false,"justification":"Too little blood lost"},{"idx":1,"proposition":"Cardiogenic 💘 shock","correct":false,"justification":"No cardiac impact"},{"idx":2,"proposition":"Asphyxia 🌬","correct":true},{"idx":3,"proposition":"Digestive obstruction by posterior passage of blood","correct":false,"justification":"Blood is expectorated during reflex coughing efforts most often"},{"idx":4,"proposition":"There are no deaths due to hemoptysis","correct":false,"justification":"It's rare but possible"}],"type":"custom"}
+{"_id":"hemoptysie-pneumo-4","context":null,"enonce":"Regarding hemoptysis:","item":"hemoptysie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The main causes of hemoptysis are COPD and right heart failure","correct":false,"justification":"Bronchiectasis, bronchopulmonary cancers, tuberculosis, aspergillomas are the main causes of hemoptysis"},{"idx":1,"proposition":"The management of severe hemoptysis is multidisciplinary involving pulmonologists, resuscitators, radiologists but never thoracic surgeons","correct":false,"justification":"Sometimes, when the EAB does not work, surgical management is required"},{"idx":2,"proposition":"Bronchial artery embolization is central to the management of severe hemoptysis","correct":true},{"idx":3,"proposition":"Hemoptysis corresponds to bleeding, externalized or not, of the nasal mucosa","correct":false,"justification":"Hemoptysis corresponds to bleeding, externalized or not, from the subglottic airways"},{"idx":4,"proposition":"Hemoptysis reflects the existence of an abnormality in the bronchi","correct":false,"justification":"Hemoptysis indicates the existence of an abnormality that can sit on all floors of the respiratory system"}],"type":"custom"}
+{"_id":"hemoptysie-pneumo-5","context":null,"enonce":"Which of the following are the severity elements of hemoptysis?","item":"hemoptysie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Hypotension","correct":false,"justification":"Severity is judged on asphyxiation and not hemodynamic involvement (there is classically none. When there is, it is caused by asphyxiation)"},{"idx":1,"proposition":"Tachycardia","correct":false,"justification":"Severity is judged on asphyxiation and not hemodynamic involvement (there is classically none. When there is, it is caused by asphyxiation)"},{"idx":2,"proposition":"Bleeding > 200 mL","correct":true},{"idx":3,"proposition":"Uncontrollable desaturation","correct":true},{"idx":4,"proposition":"Hemoptysis is never serious","correct":false,"justification":"It can go as far as death by asphyxiation"}],"type":"custom"}
+{"_id":"hemoptysie-pneumo-6","context":null,"enonce":"Which of the following are common causes of hemoptysis?","item":"hemoptysie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Bronchopulmonary cancer","correct":true},{"idx":1,"proposition":"chronic obstructive pulmonary disease","correct":false,"justification":"No hemoptysis"},{"idx":2,"proposition":"Sarcoidosis","correct":false,"justification":"Not described in colleges"},{"idx":3,"proposition":"Aspergillosis","correct":true},{"idx":4,"proposition":"Pulomaire embolism","correct":true,"justification":"True, this is one of the criteria of the Geneva Score"}],"type":"custom"}
+{"_id":"hemoptysie-pneumo-7","context":null,"enonce":"Which of the following are true?","item":"hemoptysie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Haemoptysis is to be distinguished from haematemesis and epistaxis, based on the clinic","correct":true,"justification":"False"},{"idx":1,"proposition":"A hemoptysis < 20mL is benign","correct":false,"justification":"A hemoptysis should always be considered an emergency"},{"idx":2,"proposition":"The management of severe hemoptysis is multidisciplinary involving pulmonologists, resuscitators, radiologists and sometimes thoracic surgeons","correct":true,"justification":"False"},{"idx":3,"proposition":"Bronchial artery embolization is central to the management of severe hemoptysis","correct":true,"justification":"False"},{"idx":4,"proposition":"It reflects the existence of an abnormality that can sit on all floors of the respiratory system","correct":true,"justification":"False"}],"type":"custom"}
+{"_id":"Kcsein-onco-0","context":null,"enonce":"Which of the following immunotherapies is conditioned by HER2 overexpression?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Cetuximab","correct":false,"justification":"EGF-R inhibitor (especially colorectal cancer or lung tumours)"},{"idx":1,"proposition":"Bevacizumab","correct":false,"justification":"Direct anti-EGF. Used, according to Wikipedia, in colorectal cancer, lung, breast, kidney and ovarian cancers, and glioblastoma"},{"idx":2,"proposition":"Trastuzumab","correct":true,"justification":"True, it's the anti-HER2 antibody"},{"idx":3,"proposition":"Pembrolizumab","correct":false,"justification":"Anti-PDL1 (melanoma, Hodgkin's disease and non–small cell lung tumours)"},{"idx":4,"proposition":"Ipilimumab","correct":false,"justification":"Anti-CTLA4 (melanoma and high-grade kidney tumour)"}],"type":"custom"}
+{"_id":"Kcsein-onco-1","context":null,"enonce":"Which of the following are true?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Breast cancer is the most common cancer in women","correct":true},{"idx":1,"proposition":"Breast cancer is part of mass screening","correct":true},{"idx":2,"proposition":"Breast cancer does not affect men","correct":false,"justification":"It is much rarer than in women but there are"},{"idx":3,"proposition":"Breast cancer is the second leading cause of cancer death in women","correct":false,"justification":"It is the leading cause of cancer death in women"},{"idx":4,"proposition":"Breast cancer can affect women at any age","correct":true}],"type":"custom"}
+{"_id":"Kcsein-onco-2","context":null,"enonce":"What is the TNM stage of a 3-centimetre invasive ductal carcinoma with mobile axillary lymphadenopathy without metastatic extension?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"T2N1M0","correct":true,"justification":"True. Tumor > 2 and ≤ 5cm. Mobile homolateral axillary lymphadenopathy. No distant metastasis."},{"idx":1,"proposition":"T3N2M0","correct":false,"justification":"False"},{"idx":2,"proposition":"T2N2M0","correct":false,"justification":"False"},{"idx":3,"proposition":"T3N2M0","correct":false,"justification":"False"},{"idx":4,"proposition":"T1N2M0","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"Kcsein-onco-3","context":null,"enonce":"Which of the following are possible options for breast cancer extension assessment?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Chest X-ray + abdominal ultrasound + bone scintigraphy","correct":true},{"idx":1,"proposition":"Chest X-ray + bone scintigraphy","correct":false,"justification":"You have to see the belly:)"},{"idx":2,"proposition":"TED-CT","correct":true},{"idx":3,"proposition":"Brain MRI","correct":false,"justification":"Only on point of call"},{"idx":4,"proposition":"CT-TAP and bone scintigraphy","correct":true}],"type":"custom"}
+{"_id":"Kcsein-onco-4","context":null,"enonce":"Which of the following are true about the BRCA1 mutation?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Inheritance is autosomal dominant","correct":true},{"idx":1,"proposition":"Inheritance is autosomal recessive","correct":false,"justification":"False"},{"idx":2,"proposition":"The risk of transmission to offspring is about 25%","correct":false,"justification":"False"},{"idx":3,"proposition":"The risk of transmission to offspring is about 50%","correct":true},{"idx":4,"proposition":"None of the propositions are true","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"Kcsein-onco-5","context":null,"enonce":"Inflammatory carcinoma directly classifies the tumour into:","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"T4a","correct":false,"justification":"Wall infiltration alone"},{"idx":1,"proposition":"T4b","correct":false,"justification":"Skin infiltration alone"},{"idx":2,"proposition":"T4c","correct":false,"justification":"Infiltration of the wall and skin"},{"idx":3,"proposition":"T4d","correct":true,"justification":"True, inflammatory carcinoma"},{"idx":4,"proposition":"T5","correct":false,"justification":"The T5 does not exist. It is T4d which is the maximum"}],"type":"custom"}
+{"_id":"Kcsein-onco-7","context":null,"enonce":"Which of the following are expected toxicities during anthracycline treatment?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Bladder toxicity","correct":false,"justification":"False"},{"idx":1,"proposition":"Heart failure","correct":true,"justification":"True, by dilated cardiomyopathy"},{"idx":2,"proposition":"Coronary vasospasm","correct":false,"justification":"False"},{"idx":3,"proposition":"Encephalopathy","correct":false,"justification":"False"},{"idx":4,"proposition":"Hand-foot syndrome","correct":true}],"type":"custom"}
+{"_id":"Kcsein-onco-8","context":null,"enonce":"Which of the following are poor prognosis criteria?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Hormone receptor positive","correct":false,"justification":"It is a criterion of good prognosis because accessible to hormonal treatment"},{"idx":1,"proposition":"SBR III","correct":true,"justification":"True, also called Elston and Ellis. Grade III is the maximum grade"},{"idx":2,"proposition":"HER2 overexpressed","correct":true},{"idx":3,"proposition":"Lymph node invasion","correct":true},{"idx":4,"proposition":"Ki67% = 70%","correct":true}],"type":"custom"}
+{"_id":"Kcsein-onco-10","context":null,"enonce":"You biopsy a macroscopic lesion of the right breast. Which of the following propositions should appear in the histopathological report?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"The expression of PD-L1","correct":false,"justification":"Useless in breast cancer"},{"idx":1,"proposition":"SAR status","correct":false,"justification":"Not wanted for breast cancer (but lung or colorectal tumours)"},{"idx":2,"proposition":"HER2 status","correct":true,"justification":"True, as well as the Ki67 proliferation index"},{"idx":3,"proposition":"The SBR grade","correct":true,"justification":"True, also called Elston Ellis grade"},{"idx":4,"proposition":"The degree of expression of hormone receptors","correct":true,"justification":"True, prognostic and therapeutic goal (if positive, adjuvant hormone therapy will be prescribed)"}],"type":"custom"}
+{"_id":"Kcsein-onco-11","context":null,"enonce":"Which of the following are histological and immunohistochemical criteria useful for better characterizing the tumor?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Overexpression of HER-2","correct":true},{"idx":1,"proposition":"Proliferation index (percentage of cells expressing Ki67)","correct":true},{"idx":2,"proposition":"Expression of estrogen receptors","correct":true},{"idx":3,"proposition":"Expression of progresterone receptors","correct":true},{"idx":4,"proposition":"Classification BI-RADS","correct":false,"justification":"Radiological classification"}],"type":"custom"}
+{"_id":"Kcsein-onco-12","context":null,"enonce":"Among the following proposals, what are the essential steps before therapeutic management?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Discussion in Multidisciplinary Consultation Meeting","correct":true},{"idx":1,"proposition":"Ad consultation in the rules of the art","correct":true},{"idx":2,"proposition":"Request for ALD by a specialist","correct":false,"justification":"False. A request must be made for ALD, but it is the attending physician who makes the request"},{"idx":3,"proposition":"Work stoppage","correct":false,"justification":"False. Discuss with patient. It is not essential."},{"idx":4,"proposition":"Genetic testing for BRCA1\/2 mutations","correct":false,"justification":"False. Not at all systematic."}],"type":"custom"}
+{"_id":"Kcsein-onco-13","context":null,"enonce":"Which of the following proposals are included in conventional adjuvant chemotherapy for breast cancer?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Anthracycline","correct":true},{"idx":1,"proposition":"Taxane","correct":true},{"idx":2,"proposition":"Topoisomerase II inhibitors","correct":true,"justification":"True, these are anthracyclines"},{"idx":3,"proposition":"Polymerase inhibitors ","correct":false,"justification":"False. Taxanes are inhibitors of depolymerization"},{"idx":4,"proposition":"Antifolic","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"diplopie-ophtalmo-0","context":null,"enonce":"Which of the following are diagnoses to evoke in front of a non-painful binocular diplopia?","item":"diplopie","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Head trauma ","correct":true,"justification":"True, with isolated involvement of the abducens nerve (which innervates the lateral right)."},{"idx":1,"proposition":"Diabetes","correct":true,"justification":"True, with common oculomotor nerve involvement. Pain is very inconsistent in diabetics"},{"idx":2,"proposition":"Occipital cerebral hemorrhage","correct":false,"justification":"No diplopia in this territory"},{"idx":3,"proposition":"Myasthenia","correct":true,"justification":"True, with the features of myasthenia gravis (ptosis, increased at the end of the day, etc.)"},{"idx":4,"proposition":"Ischemic stroke of the brainstem","correct":true}],"type":"custom"}
+{"_id":"diplopie-ophtalmo-1","context":null,"enonce":"Which of the following are causes of painful diplopia?","item":"diplopie","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Myasthenia","correct":false,"justification":"No pain"},{"idx":1,"proposition":"Graves' disease","correct":false,"justification":"Classically non-painful exophthalmos"},{"idx":2,"proposition":"Giant cell arteritis","correct":true,"justification":"True, or Horton's disease"},{"idx":3,"proposition":"Type 2 diabetes","correct":true},{"idx":4,"proposition":"Cataract","correct":false,"justification":"No pain"}],"type":"custom"}
+{"_id":"diplopie-ophtalmo-2","context":null,"enonce":"Which of the following are true?","item":"diplopie","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The common oculomotor nerve innervates the superior rectus muscle","correct":true,"justification":"True, it also innervates the inferior rectus muscle, the inferior oblique muscle, and the medial rectus muscle. It is the nerve that innervates the most muscle of oculomotricity. It also innervates the eyelid levator and ensures the parasympathetic innervation of the pupil"},{"idx":1,"proposition":"The abducens nerve innervates the medial rectus muscle","correct":false,"justification":"As its name suggests, it deals with the abduction of the eye. It therefore innervates the lateral right"},{"idx":2,"proposition":"The trochlear nerve innervates the superior oblique muscle","correct":true,"justification":"True. This is the only muscle it innervates"},{"idx":3,"proposition":"The common ocular motor nerve ensures parasympathetic innervation of the pupil","correct":true},{"idx":4,"proposition":"The trochlear nerve innervates the levator muscle of the eyelid","correct":false,"justification":"It is the oculomotor nerve that innervates the levator muscle of the eyelid"}],"type":"custom"}
+{"_id":"diplopie-ophtalmo-3","context":null,"enonce":"Which of the following are diagnoses to evoke in front of painful binocular diplopia?","item":"diplopie","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"An aneurysm of the carotid end","correct":true,"justification":"True, the aneurysm can reach the common oculomotor nerve. The latter ensuring the parasympathetic innervation of the pupil, its involvement can cause mydriasis (intrinsic involvement)"},{"idx":1,"proposition":"Diabetes","correct":true,"justification":"True, it is the most common even if the pain is inconstant, as always in diabetics"},{"idx":2,"proposition":"Claude-Bernard-Horner syndrome (CBH)","correct":false,"justification":"There is no diplopia in CBH. There is ptosis, myosis, and enophthalmos. Normally, there is no pain either (unless combined with carotid dissection)"},{"idx":3,"proposition":"A stroke","correct":true,"justification":"True, any focal neurological deficit must evoke a stroke"},{"idx":4,"proposition":"All these propositions are accurate","correct":false,"justification":"Not the HBC"}],"type":"custom"}
+{"_id":"diplopie-ophtalmo-4","context":null,"enonce":"Which of the following are true?","item":"diplopie","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The medial rectus muscle is innervated by the third pair of cranial nerves","correct":true},{"idx":1,"proposition":"The lateral rectus muscle is innervated by the third pair of cranial nerves","correct":false,"justification":"The lateral right is the only oculomotor muscle to be innervated by the VI pair (abducens nerve)"},{"idx":2,"proposition":"The inferior oblique muscle is innervated by the third pair of cranial nerves","correct":true},{"idx":3,"proposition":"The superior oblique muscle is innervated by the fourth pair of cranial nerves","correct":true,"justification":"True, the trochlear nerve"},{"idx":4,"proposition":"The superior rectus muscle is innervated by the fourth pair of cranial nerves","correct":false,"justification":"It is innervated by the common oculomotor nerve (third pair of cranial nerves)"}],"type":"custom"}
+{"_id":"diplopie-ophtalmo-5","context":null,"enonce":"Which of the following are causes of binocular diplopies?","item":"diplopie","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Ophthalmic nerve II paralysis","correct":false,"justification":"Paralysis of III, IV or VI"},{"idx":1,"proposition":"Paralysis of the VI abducens nerve","correct":true},{"idx":2,"proposition":"Myasthenia","correct":true},{"idx":3,"proposition":"Corneal pillowcase","correct":false,"justification":"Monocular diplopia"},{"idx":4,"proposition":"Nuclear cataract","correct":false,"justification":"Monocular diplopia"}],"type":"custom"}
+{"_id":"diplopie-ophtalmo-6","context":null,"enonce":"Which of the following are causes of monocular diplopies?","item":"diplopie","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Significant astigmatism","correct":true},{"idx":1,"proposition":"Keratoconus","correct":true},{"idx":2,"proposition":"Cortical cataract","correct":false,"justification":"Nuclear cataract"},{"idx":3,"proposition":"Traumatic iridodialysis","correct":true},{"idx":4,"proposition":"Intracranial hypertension ","correct":false,"justification":"Binocular diplopia"}],"type":"custom"}
+{"_id":"glomeruloP-nephro-0","context":null,"enonce":"Regarding the basics:","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"Glomerular nephropathies are chronic diseases","correct":false,"justification":"There are acute and chronic glomerular nephropathies"},{"idx":1,"proposition":"Glomerular nephropathy is always the consequence of genetic diseases","correct":false,"justification":"Not always. They can be related to a metabolic, autoimmune, infectious disease, etc."},{"idx":2,"proposition":"Kidney damage may or may not be isolated","correct":true},{"idx":3,"proposition":"Diagnosis of glomerular nephropathies is based on Magnetic Resonance Imaging","correct":false,"justification":"Diagnosis is based on histology\/anapath"},{"idx":4,"proposition":"Diagnosis of glomerular nephropathy is based on identification of glomerular syndrome","correct":true}],"type":"custom"}
+{"_id":"glomeruloP-nephro-1","context":null,"enonce":"Regarding the diagnosis:","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"A glomerular pathology is evoked in front of proteinuria and \/ or hematuria","correct":true},{"idx":1,"proposition":"The presence of hypertension or edema eliminates the diagnosis of glomerular syndrome","correct":false,"justification":"Three signs may be associated with hematuria and\/or proteinuria: hypertension; Edema; renal impairment"},{"idx":2,"proposition":"In IgA nephropathy, there is no hematuria","correct":false,"justification":"The main symptom is recurrent macroscopic hematuria to which may be added microscopic hematuria"},{"idx":3,"proposition":"Nephrotic syndrome combines proteinuria greater than 3g per 24h and albuminemia less than 30 g \/ L","correct":true},{"idx":4,"proposition":"HIVAN is a nephropathy associated with the HIV virus","correct":true}],"type":"custom"}
+{"_id":"glomeruloP-nephro-2","context":null,"enonce":"Among these proposals, which correspond to a glomerular syndrome:","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"Recurrent macroscopic hematuria syndrome","correct":true},{"idx":1,"proposition":"Acute nephritic syndrome","correct":true},{"idx":2,"proposition":"Proximal tubular syndrome","correct":false,"justification":"It does not exist"},{"idx":3,"proposition":"Le syndrome de Fanconi","correct":false,"justification":"It is an abnormality of proximal renal tubular reabsorption"},{"idx":4,"proposition":"The nephrotic syndrone","correct":true}],"type":"custom"}
+{"_id":"glomeruloP-nephro-3","context":null,"enonce":"Regarding the diagnosis:","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"Measuring ANCA tests the diagnostic hypothesis of lupus","correct":false,"justification":"For lupus, anti-nuclear antibodies and native anti-DNA are measured"},{"idx":1,"proposition":"Antiplatelet agents should be discontinued in case of renal biopsy","correct":true,"justification":"Stop several days before the gesture: 5 days for aspirin and 10 days for clopidogrel"},{"idx":2,"proposition":"In case of hemostasis disorder, it is possible to perform a transjugular PBR","correct":true},{"idx":3,"proposition":"Anti-glomerular basement membrane antibodies (MBG) test the diagnostic hypothesis of Alport syndrome","correct":false,"justification":"These antibodies are an argument for Goodpasture's disease"},{"idx":4,"proposition":"PBR is indicated in most glomerular nephropathy syndromes","correct":true,"justification":"Except for children between 1 and 10 years with pure nephrotic syndrome, hereditary glomerulopathies already documented, etc. (cf item 258, 8th edition of the college p. 151)"}],"type":"custom"}
+{"_id":"glomeruloP-nephro-4","context":null,"enonce":"Secondary causes of GEM are:","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"Solid cancers","correct":true},{"idx":1,"proposition":"Lupus","correct":true},{"idx":2,"proposition":"NSAIDs ","correct":true},{"idx":3,"proposition":"Infectious causes such as HBV, HCV, syphilis, leprosy, filariasis ","correct":true},{"idx":4,"proposition":"We then find antibodies against PLA2-R. ","correct":false,"justification":"Primitive Qd"}],"type":"custom"}
+{"_id":"glomeruloP-nephro-5","context":null,"enonce":"Regarding the histology of glomerular syndromes:","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"Deposits are found in glomerulonephritis of ANCA vasculitis ","correct":false,"justification":"Hence < pauci > imminune"},{"idx":1,"proposition":"Sirius red colorartion allows you to see amyloid deposits ","correct":false,"justification":"Red Congo, Sirius for hepatic regeneration nodules"},{"idx":2,"proposition":"There is cell proliferation and deposits in the LGM","correct":false},{"idx":3,"proposition":"Linear IgA deposits along MBG are found in Goodpasture disease ","correct":false,"justification":"IgG"},{"idx":4,"proposition":"Accumulation of glycosylated extracellular matrix is found in diabetic nephropathy ","correct":true}],"type":"custom"}
+{"_id":"glomeruloP-nephro-6","context":null,"enonce":"Regarding IgA nephropathies: ","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"The primary form is called Berger's disease, it is the most common glomerulonephritis in the world","correct":true},{"idx":1,"proposition":"It mainly affects older women","correct":false,"justification":"Young men"},{"idx":2,"proposition":"IgA deposits can be secondary to diseases such as cirrhosis, IBD, spondyloartritis or bullous dermatosis","correct":true},{"idx":3,"proposition":"After liver transplantation, there is recurrence on the graft, without loss of the latter ","correct":true},{"idx":4,"proposition":"High blood pressure is a factor in poor prognosis","correct":false}],"type":"custom"}
+{"_id":"glomeruloP-nephro-7","context":null,"enonce":"Which of the following are prognostic factors for mesangial IgA glomerulonephritis?","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"The stage of renal failure at diagnosis","correct":true},{"idx":1,"proposition":"The severity of hypertension","correct":true,"justification":"True, a progression factor"},{"idx":2,"proposition":"The importance of proteinuria","correct":true,"justification":"True, a progression factor"},{"idx":3,"proposition":"Female sex","correct":false,"justification":"Male sex"},{"idx":4,"proposition":"The importance of glomerular sclerosis and interstitial fibrosis","correct":true,"justification":"True, at PBR"}],"type":"custom"}
+{"_id":"glomeruloP-nephro-9","context":null,"enonce":"Which of the following propositions regarding rapidly progressive glomerulonephritis (GNRP) are true?","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"They are usually characterized by severe endocapillary lesions","correct":false,"justification":"Extracapillary blooms"},{"idx":1,"proposition":"Immunofluorescence makes it possible to differentiate the 3 types of GNRP","correct":true,"justification":"True. Type 1: Goodpasture syndrome (IgG on MBG with linear deposition). Type 2: associated with deposits of IgG immunoglobulin complexes (rheumatoid purpura, LES, mixed cryoglobulinemia). Type 3: associated with vasculitis (Wegener and Polyangiitis) where ANCA is found"},{"idx":2,"proposition":"Goodpasture disease is linked to anti-PLA2R antibodies","correct":false,"justification":"This is the case of primary extramembranous glomerulonephritis (GEM)"},{"idx":3,"proposition":"Rheumatoid purpura is a cause of GNRP","correct":true,"justification":"True, IgA nephropathy"},{"idx":4,"proposition":"Depositions are linear in immunofluorescence in GEM","correct":false,"justification":"This is the case in Goodpasture syndrome"}],"type":"custom"}
+{"_id":"glomeruloP-nephro-10","context":null,"enonce":"Which of the following propositions about Goodpasture's syndrome are true?","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"It is a cause of pneumorenal syndrome","correct":true},{"idx":1,"proposition":"The antibody is directed against the alpha 3 chain of collagen IV","correct":true},{"idx":2,"proposition":"Treatment is based on corticosteroids, plasma exchange and cyclophosphamide","correct":true},{"idx":3,"proposition":"Renal prognosis is generally good","correct":false,"justification":"Unfortunately, renal replacement often happens quickly"},{"idx":4,"proposition":"There is frequently a biological inflammatory syndrome","correct":true}],"type":"custom"}
+{"_id":"glomeruloP-nephro-11","context":null,"enonce":"Which of the following proposals should be sought in the face of suspected glomerulonephritis?","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"Hearing loss","correct":true,"justification":"True, Alport syndrome"},{"idx":1,"proposition":"Macroscopic hematuria","correct":true,"justification":"True, glomerulonephritis with mesangial deposits of IgA"},{"idx":2,"proposition":"Lithium treatment","correct":false,"justification":"Responsible for tubulointerstitial nephritis, but not glomerular syndrome"},{"idx":3,"proposition":"Chronic hepatitis C","correct":true,"justification":"True, cryoglobulinemia (GNRP type 2) may be complicated."},{"idx":4,"proposition":"Periarteritis nodosa","correct":false,"justification":"No glomerular involvement, rather vascular nephropathy, unlike ANCA vasculitis (Wegener and Polyangiitis) which can make GNRP type 3"}],"type":"custom"}
+{"_id":"BK-infectio-1","context":null,"enonce":"About tuberculosis","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"Diagnosis of latent TB infection is based on the tuberculin RDI or interferon gamma test","correct":true},{"idx":1,"proposition":"Primary tuberculosis infection most often asymptomatic","correct":true},{"idx":2,"proposition":"Tuberculosis disease represents the clinical expression of infection, pulmonary or extrapulmonary","correct":true},{"idx":3,"proposition":"Pulmonary tuberculosis is the most common form","correct":true},{"idx":4,"proposition":"Extrapulmonary tuberculosis is highly contagious","correct":false,"justification":"Extrapulmonary tuberculosis is non-contagious"}],"type":"custom"}
+{"_id":"BK-infectio-2","context":null,"enonce":"About tuberculosis","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"The dissemination of a tuberculosis miliary is by lymphoid route","correct":false,"justification":"Miliarius tuberculosis = blood-borne dissemination"},{"idx":1,"proposition":"The declaration is mandatory to the ARS","correct":true},{"idx":2,"proposition":"Tuberculosis is a long-term condition","correct":true},{"idx":3,"proposition":"2nd line anti-tuberculosis drugs: are to be reserved for multidrug-resistant tuberculosis","correct":true},{"idx":4,"proposition":"Multidrug-resistant forms are those resistant to isoniazid and spiramycin.","correct":false,"justification":"Multi-resistance = isoniazid resistance +"}],"type":"custom"}
+{"_id":"BK-infectio-3","context":null,"enonce":"About tuberculosis","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is the 3rd leading cause of death from infectious disease in the world","correct":true},{"idx":1,"proposition":"ƒƒ in active tuberculosis, BK will have 3 phenotypes in 3 compartments: intracellular in macrophages, extracellular within the caseum, extracellular in caves","correct":true},{"idx":2,"proposition":"ƒƒ The cave is the main support for human-to-human transmission of BK through the air","correct":true},{"idx":3,"proposition":"Only 10% of individuals exposed to BK inoculum develop primary TB infection","correct":false,"justification":"Only 1\/3 of individuals exposed to BK inoculum develop primary TB infection"},{"idx":4,"proposition":"HAART makes it possible to detect the emrgence of naturally resistant mutants crossed","correct":true}],"type":"custom"}
+{"_id":"BK-infectio-4","context":null,"enonce":"Which of the following proposals are part of the tuberculosis complex?","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":" Mycobacterium tuberculosis","correct":true},{"idx":1,"proposition":"M. avium","correct":false,"justification":"M. tuberculosis, M. bovis, M. africanum"},{"idx":2,"proposition":"Mr. Bovis","correct":true},{"idx":3,"proposition":"Mr. africanum","correct":true},{"idx":4,"proposition":"M. pneumoniae","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"BK-infectio-5","context":null,"enonce":"To which organism(s) should TB infection be reported?","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"Tuberculosis Control Centre (CLAT)","correct":true,"justification":"True, urgently, nominative declaration that will investigate the case and the entourage"},{"idx":1,"proposition":"Directorate-General for Health","correct":false,"justification":"False"},{"idx":2,"proposition":"Regional Pharmacovigilance Centre (CRPV)","correct":false,"justification":"False"},{"idx":3,"proposition":"Regional Health Agency (ARS)","correct":true,"justification":"True, anonymous statement"},{"idx":4,"proposition":"Hospital management","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"BK-infectio-6","context":null,"enonce":"Which of the following propositions are true about quantiferon?","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"Its other name is IDR","correct":false,"justification":"The RDI is another immunological test. The other name for Quantiferon is the interferon gamma release test."},{"idx":1,"proposition":"It is very specific to infection with the tuberclosis complex","correct":true,"justification":"True. 98% specificity for tuberculosis complex bacteria: M. tuberculosis, M. bovis and M. africanum"},{"idx":2,"proposition":"He signs a tuberculosis disease","correct":false,"justification":"It signs a tuberculosis infection (including latent infection)."},{"idx":3,"proposition":"Positivity to this test does not give an indication of the recent or old nature of the infection","correct":true},{"idx":4,"proposition":"Positivity to this test is not influenced by BCG vaccination","correct":true,"justification":"True, unlike the IDR"}],"type":"custom"}
+{"_id":"BK-infectio-7","context":null,"enonce":"Which of the following propositions are true about tuberculosis?","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"Tuberculosis is the third leading cause of death from infectious disease worldwide","correct":true},{"idx":1,"proposition":"The annual incidence in children under 15 years of age in France is about 250","correct":true},{"idx":2,"proposition":"The proportion of direct tests positive is identical in children and adults","correct":false,"justification":"Much rarer to find BAAR in sputum in children, microscopic examination is positive in less than 20% of children with tuberculosis-disease. The culture is positive in less than 50% of cases.\r\nDespite this low profitability, microbiological research is systematic in the face of any suspicion of tuberculosis-disease. Their positivity will require screening around the child."},{"idx":3,"proposition":"In case of infection, the child under 2 years of age is more at risk of progressing immediately to tuberculosis-disease","correct":true},{"idx":4,"proposition":"The risk of transmission is zero if the patient has pulmonary tuberculosis with negative direct examination","correct":false,"justification":"Pulmonary tuberculosis = air isolation"}],"type":"custom"}
+{"_id":"BK-infectio-8","context":null,"enonce":"Which of the following propositions are true about tuberculosis?","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"Tuberculosis is the third leading cause of death from infectious disease worldwide","correct":true},{"idx":1,"proposition":"The annual incidence in children under 15 years of age in France is about 250","correct":true},{"idx":2,"proposition":"The proportion of direct tests positive is identical in children and adults","correct":false,"justification":"Much rarer to find BAAR in sputum in children, microscopic examination is positive in less than 20% of children with tuberculosis-disease. The culture is positive in less than 50% of cases.\r\nDespite this low profitability, microbiological research is systematic in the face of any suspicion of tuberculosis-disease."},{"idx":3,"proposition":"In case of infection, the child under 2 years of age is more at risk of progressing immediately to tuberculosis-disease","correct":true},{"idx":4,"proposition":"The risk of transmission is zero if the patient has pulmonary tuberculosis with negative direct examination","correct":false,"justification":"Pulmonary tuberculosis = air isolation"}],"type":"custom"}
+{"_id":"BK-infectio-9","context":null,"enonce":"Which of the following propositions are true about tuberculosis?","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"Tuberculosis is the third leading cause of death from infectious disease worldwide","correct":true},{"idx":1,"proposition":"The annual incidence in children under 15 years of age in France is about 250","correct":true},{"idx":2,"proposition":"The proportion of direct tests positive is identical in children and adults","correct":false,"justification":"Much rarer to find BAAR in sputum in children, microscopic examination is positive in less than 20% of children with tuberculosis-disease. The culture is positive in less than 50% of cases.\r\nDespite this low profitability, microbiological research is systematic in the face of any suspicion of tuberculosis-disease."},{"idx":3,"proposition":"In case of infection, the child under 2 years of age is more at risk of progressing immediately to tuberculosis-disease","correct":true},{"idx":4,"proposition":"The risk of transmission is zero if the patient has pulmonary tuberculosis with negative direct examination","correct":false,"justification":"Pulmonary tuberculosis = air isolation"}],"type":"custom"}
+{"_id":"BK-infectio-10","context":null,"enonce":"Which of the following propositions are true about tuberculosis?","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"Tuberculosis is the third leading cause of death from infectious disease worldwide","correct":true},{"idx":1,"proposition":"The annual incidence in children under 15 years of age in France is about 250","correct":true},{"idx":2,"proposition":"The proportion of direct tests positive is identical in children and adults","correct":false,"justification":"Much rarer to find BAAR in sputum in children, microscopic examination is positive in less than 20% of children with tuberculosis-disease. The culture is positive in less than 50% of cases.\r\nDespite this low profitability, microbiological research is systematic in the face of any suspicion of tuberculosis-disease."},{"idx":3,"proposition":"In case of infection, the child under 2 years of age is more at risk of progressing immediately to tuberculosis-disease","correct":true},{"idx":4,"proposition":"The risk of transmission is zero if the patient has pulmonary tuberculosis with negative direct examination","correct":false,"justification":"Pulmonary tuberculosis = air isolation"}],"type":"custom"}
+{"_id":"BK-infectio-11","context":null,"enonce":"Which of the following propositions are true about tuberculosis?","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"Tuberculosis is the third leading cause of death from infectious disease worldwide","correct":true},{"idx":1,"proposition":"The annual incidence in children under 15 years of age in France is about 250","correct":true},{"idx":2,"proposition":"The proportion of direct tests positive is identical in children and adults","correct":false,"justification":"Much rarer to find BAAR in sputum in children, microscopic examination is positive in less than 20% of children with tuberculosis-disease. The culture is positive in less than 50% of cases.\r\nDespite this low profitability, microbiological research is systematic in the face of any suspicion of tuberculosis-disease."},{"idx":3,"proposition":"In case of infection, the child under 2 years of age is more at risk of progressing immediately to tuberculosis-disease","correct":true},{"idx":4,"proposition":"The risk of transmission is zero if the patient has pulmonary tuberculosis with negative direct examination","correct":false,"justification":"Pulmonary tuberculosis = air isolation"}],"type":"custom"}
+{"_id":"BK-infectio-13","context":null,"enonce":"Which of the following are true for preventing transmission of TB during hospitalization?","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"Permanent wearing of a surgical mask by the patient in his room","correct":false,"justification":"Not so alone"},{"idx":1,"proposition":"Wearing an FFP2 mask by anyone entering the patient's room","correct":true},{"idx":2,"proposition":"In case of leaving the room, wearing a surgical mask by the patient","correct":true},{"idx":3,"proposition":"Removal of mask worn by staff before leaving the patient's room","correct":false,"justification":"Right at the exit"},{"idx":4,"proposition":"Single room with negative pressure for the patient","correct":true}],"type":"custom"}
+{"_id":"soinspal3-soinspal-0","context":null,"enonce":"Which of the following proposals designate countries that allow euthanasia?","item":"soinspal3","matiere":"soinspal","propositions":[{"idx":0,"proposition":"No country","correct":false,"justification":"Euthanasia is authorized in Switzerland, Holland, Belgium, Luxembourg and 3 American states"},{"idx":1,"proposition":"Sweden","correct":false,"justification":"False"},{"idx":2,"proposition":"Brazil","correct":false,"justification":"None"},{"idx":3,"proposition":"Belgium","correct":true,"justification":"None"},{"idx":4,"proposition":"Switzerland","correct":true,"justification":"None"}],"type":"custom"}
+{"_id":"soinspal3-soinspal-1","context":null,"enonce":"Which of the following corresponds to a Rudkin score of 4?","item":"soinspal3","matiere":"soinspal","propositions":[{"idx":0,"proposition":"The patient is drowsy","correct":false,"justification":"Rudkin 2"},{"idx":1,"proposition":"The patient is awake","correct":false,"justification":"Rudkin 1"},{"idx":2,"proposition":"The patient does not respond to mild tactile stimulation and has his eyes closed","correct":false,"justification":"Rudkin 5"},{"idx":3,"proposition":"The patient responds to mild tactile stimulation and has his eyes closed","correct":true,"justification":"Rudkin 4"},{"idx":4,"proposition":"The patient has his eyes closed but answers the call","correct":false,"justification":"Rudkin 3"}],"type":"custom"}
+{"_id":"soinspal3-soinspal-2","context":null,"enonce":"Which of the following are true?","item":"soinspal3","matiere":"soinspal","propositions":[{"idx":0,"proposition":"An experience described as unbearable does not justify sedation in itself","correct":true},{"idx":1,"proposition":"Induction of sedation in adults is medically indicated only","correct":true},{"idx":2,"proposition":"The procedure for making a decision on sedation is the sole responsibility of the attending physician","correct":false,"justification":"The sedation decision-making procedure is collegial"},{"idx":3,"proposition":"The method of sedation is based on ketamine","correct":false,"justification":"The method of sedation is based on midazolam IV 1mg"},{"idx":4,"proposition":"Sedation decreases alertness and can lead to loss of consciousness","correct":true}],"type":"custom"}
+{"_id":"soinspal3-soinspal-3","context":null,"enonce":"Which of the following proposals designate countries that allow physician-assisted suicide?","item":"soinspal3","matiere":"soinspal","propositions":[{"idx":0,"proposition":"Switzerland","correct":true},{"idx":1,"proposition":"England","correct":false,"justification":"False"},{"idx":2,"proposition":"The France","correct":false,"justification":"False"},{"idx":3,"proposition":"Spain","correct":false,"justification":"False"},{"idx":4,"proposition":"The Netherlands","correct":true,"justification":"Countries that allow euthanasia are also those that allow physician-assisted suicide: Switzerland, Luxembourg, Belgium, Holland and 3 American states"}],"type":"custom"}
+{"_id":"pancreatiteaigue-HGE-0","context":null,"enonce":"Regarding acute pancreatitis","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"idx":0,"proposition":"There are 2 forms: acute benign pancreatitis, called edematous, and acute necrotizing pancreatitis, potentially serious","correct":true},{"idx":1,"proposition":"The migration of a gallstone into the common bile duct or chronic and prolonged alcohol consumption, account for 80% of the causes","correct":true},{"idx":2,"proposition":"The clinical examination also looks for signs of severity, including visceral failure: polypnea, sign of extracellular dehydration, blood pressure instability and tachycardia, disorientation","correct":true},{"idx":3,"proposition":"Determination of pancreatic enzymes in the blood The determination of amylase should be preferred","correct":false,"justification":"Determination of pancreatic enzymes in the blood The determination of lipase should be preferred (better sensitivity and specificity), with a threshold of 3 N; that of amylasemia must be abandoned"},{"idx":4,"proposition":"The elevation of lipasemia is early, sometimes fleeting, reaching a maximum in 4 to 8 hours","correct":false,"justification":"The elevation of lipasemia is early, sometimes fleeting, reaching a maximum in 24 to 48 hours"}],"type":"custom"}
+{"_id":"pancreatiteaigue-HGE-3","context":null,"enonce":"Which of the following are true?","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"idx":0,"proposition":"The incidence of acute pancreatitis is higher in men than in women","correct":true,"justification":"True, 30 per 100,000 in men vs. 20 per 100,000 in women"},{"idx":1,"proposition":"There are two forms to distinguish in acute pancreatitis (AP): edematous and necrotizing","correct":true},{"idx":2,"proposition":"The analgesic position is in gun dog ","correct":true},{"idx":3,"proposition":"To establish with certainty the diagnosis of acute pancreatitis, imaging is necessary","correct":false,"justification":"False, the diagnosis of certainty is made by the combination of typical abdominal pain and lipasemia > 3N"},{"idx":4,"proposition":"The Balthazar score is predictive of mortality and is based on a CT scan comprising a sequence with contrast injection","correct":true,"justification":"True, the CT scan is performed at best 48 to 72 hours after the onset of symptoms. Contrast medium injection assesses pancreatic necrosis"}],"type":"custom"}
+{"_id":"pancreatiteaigue-urg-1","context":null,"enonce":"Regarding acute pancreatitis","item":"pancreatiteaigue","matiere":"urg","propositions":[{"idx":0,"proposition":"Organ failure is defined as cardiovascular shock, renal failure, Glasgow score < 13, thrombocytopenia < 80,000\/mm3 or gastrointestinal bleeding","correct":true},{"idx":1,"proposition":"Necrosis is defined by the presence of gangrenous pancreatic tissue","correct":false,"justification":"Necrosis is defined by the presence of invasive pancreatic tissue"},{"idx":2,"proposition":"The diagnosis of necrosis is established by the presence of focal or diffuse areas that do not take the contrast at the arterial time of a CT scan with injection of contrast medium","correct":true},{"idx":3,"proposition":"Hemorrhagic lesions in the pancreas or surrounding tissues are possible","correct":true},{"idx":4,"proposition":"Pseudocysts • A pseudocyst is a collection of pancreatic fluid, circumscribed by a wall, without epithelium","correct":true}],"type":"custom"}
+{"_id":"pancreatiteaigue-urg-2","context":null,"enonce":"Regarding acute pancreatitis","item":"pancreatiteaigue","matiere":"urg","propositions":[{"idx":0,"proposition":"The fluid of pseudocysts is most often inflammatory in nature rich in pancreatic enzymes and tissue and necrotic debris can superinfect","correct":true},{"idx":1,"proposition":"The formation of pseudocysts requires several hours","correct":false,"justification":"The formation of pseudocysts requires several weeks"},{"idx":2,"proposition":"Severe acute forms of pancreatitis represent, depending on the series, 10 to 30% of pancreatitis","correct":true},{"idx":3,"proposition":"• Cholelithiasis and alcohol poisoning are the most common causes of pancreatitis, observed in 35-45% of cases for each of them","correct":true},{"idx":4,"proposition":"• Drug and toxic etiologies are rare","correct":false}],"type":"custom"}
+{"_id":"pancreatiteaigue-urg-3","context":null,"enonce":"Regarding chronic pancreatitis","item":"pancreatiteaigue","matiere":"urg","propositions":[{"idx":0,"proposition":"The reason for APs in the emergency department is most often acute abdominal pain syndrome","correct":true},{"idx":1,"proposition":"Diagnosis in the emergency department is based on a combination of intense epigastric abdominal pain with posterior irradiation and elevated amylasemia (> 3N)","correct":false,"justification":"Diagnosis in the emergency department is based on a combination of intense epigastric abdominal pain with posterior irradiation and elevated lipasemia (> 3N)"},{"idx":2,"proposition":"• Normal amylasemia does not exclude diagnosis","correct":true},{"idx":3,"proposition":"Chest X-ray is systematic at admission and looks for pleural effusions","correct":true},{"idx":4,"proposition":"• Pancreatic imaging is requested urgently systematically","correct":false}],"type":"custom"}
+{"_id":"amaigrissemt-nutri-0","context":null,"enonce":"Which propositions are true?","item":"amaigrissemt","matiere":"nutri","propositions":[{"idx":0,"proposition":"Weighing should be a systematic part of any clinical examination","correct":true},{"idx":1,"proposition":"Changing clothing sizes, belt circumference and previous photographs can help the practitioner in the absence of prior weight available.","correct":true},{"idx":2,"proposition":"The SEFI score is used to assess food intake","correct":true},{"idx":3,"proposition":"A SEFI < 9 defines undernutrition","correct":false,"justification":"A SEFI < 7 signs a risk of undernutrition"},{"idx":4,"proposition":"Skin examination makes it possible to objectify possible melanoderma","correct":true,"justification":"Or on the contrary a depigmentation, a conjunctival jaundice, a pallor"}],"type":"custom"}
+{"_id":"amaigrissemt-nutri-1","context":null,"enonce":"What is the correct BMI formula?","item":"amaigrissemt","matiere":"nutri","propositions":[{"idx":0,"proposition":"Weight in kg \/ height in m","correct":false},{"idx":1,"proposition":"Weight in kg \/ height in cm squared","correct":false},{"idx":2,"proposition":"Weight in kg \/ height in m squared","correct":true},{"idx":3,"proposition":"Weight in g \/ height in m squared","correct":false},{"idx":4,"proposition":"Weight in kg \/ the square of the height in meters","correct":true}],"type":"custom"}
+{"_id":"amaigrissemt-nutri-2","context":null,"enonce":"What are the possible etiologies of weight loss with involuntary food restriction?","item":"amaigrissemt","matiere":"nutri","propositions":[{"idx":0,"proposition":"A gastric bypass","correct":false,"justification":"No dietary restrictions in general"},{"idx":1,"proposition":"An ENT pathology","correct":false,"justification":"Rather a voluntary dietary restriction"},{"idx":2,"proposition":"An infectious pathology","correct":true},{"idx":3,"proposition":"Cancer","correct":true},{"idx":4,"proposition":"Hyperthyroidism","correct":false,"justification":"Weight loss without dietary restriction"}],"type":"custom"}
+{"_id":"amaigrissemt-nutri-3","context":null,"enonce":"What are the possible etiologies of weight loss without dietary restriction?","item":"amaigrissemt","matiere":"nutri","propositions":[{"idx":0,"proposition":"Decompensated diabetes","correct":true},{"idx":1,"proposition":"Hyperthyroidism","correct":true},{"idx":2,"proposition":"Anorexia nervosa","correct":false,"justification":"There is voluntary dietary restriction"},{"idx":3,"proposition":"Septic arthritis","correct":false,"justification":"Some inflammatory pathologies induce weight loss with involuntary food restriction"},{"idx":4,"proposition":"ENT Pathology","correct":false,"justification":"Weight loss with voluntary dietary restriction"}],"type":"custom"}
+{"_id":"tbmictionped-ped-0","context":null,"enonce":"General:","item":"tbmictionped","matiere":"ped","propositions":[{"idx":0,"proposition":"This is a very rare reason for consultation.","correct":false,"justification":"It is very common"},{"idx":1,"proposition":"The consultation is always conducted by a uro-pediatrician","correct":false,"justification":"Often the general practitioner in first consultation"},{"idx":2,"proposition":"About 12% of children aged 6 to 8 have urinary leakage","correct":true},{"idx":3,"proposition":"Urinary leakage is exclusively nocturnal from 6 years old","correct":false,"justification":"Daytime or nocturnal"},{"idx":4,"proposition":"The cause is most often organic","correct":false,"justification":"Functional"}],"type":"custom"}
+{"_id":"tbmictionped-ped-1","context":null,"enonce":"Regarding urination:","item":"tbmictionped","matiere":"ped","propositions":[{"idx":0,"proposition":"Physiological urination should result in complete emptying of the bladder","correct":true},{"idx":1,"proposition":"During urination, destrusor contracts","correct":true},{"idx":2,"proposition":"During urination, bladder sphictera contract","correct":false,"justification":"They relax in harmony with the contraction of the detrusor"},{"idx":3,"proposition":"The acquisition of voiding control is contemporary with birth","correct":false,"justification":"Usually between 18 months and 3 years"},{"idx":4,"proposition":"The diagnosis of a voiding disorder is clinical","correct":true}],"type":"custom"}
+{"_id":"tbmictionped-ped-2","context":null,"enonce":"Regarding the voiding catalogue:","item":"tbmictionped","matiere":"ped","propositions":[{"idx":0,"proposition":"It makes it possible to objectify certain urinary disorders","correct":true},{"idx":1,"proposition":"It quantifies the severity of the emergency","correct":true},{"idx":2,"proposition":"It takes place over 5 days","correct":false,"justification":"48 hours"},{"idx":3,"proposition":"It differentiates between the organic or functional nature of leaks","correct":false,"justification":"Above all, it allows to objectify the urinary disorder and to quantify the urgency"},{"idx":4,"proposition":"It requires increased patient compliance","correct":true}],"type":"custom"}
+{"_id":"tbmictionped-ped-3","context":null,"enonce":"Which of these proposals is\/are malformative uropathy(s)?","item":"tbmictionped","matiere":"ped","propositions":[{"idx":0,"proposition":"Lupus nephropathy","correct":false,"justification":"Not uropathy and not malformative"},{"idx":1,"proposition":"Epispadias","correct":true,"justification":"It occurs as a result of a defective migration of the primordial genital tubercles to the cloacal membrane, and therefore a malformation of the genital tubercle, around the 5th week of gestation."},{"idx":2,"proposition":"Micropenis","correct":false,"justification":"Not a uropathic malformation"},{"idx":3,"proposition":"Renal failure","correct":false,"justification":"Perhaps a consequence"},{"idx":4,"proposition":"Bladder tumour","correct":false,"justification":"Not a malformation"}],"type":"custom"}
+{"_id":"tbmictionped-ped-4","context":null,"enonce":"Regarding the clinical examination:","item":"tbmictionped","matiere":"ped","propositions":[{"idx":0,"proposition":"A urine strip is performed to rule out diabetes","correct":false,"justification":"To eliminate an infection"},{"idx":1,"proposition":"The search for a bladder globe is systematic","correct":true},{"idx":2,"proposition":"The appearance of the urinary stream is important to assess","correct":true},{"idx":3,"proposition":"The search for a fecal impaction is done at the digital rectal exam","correct":false,"justification":"The search for stercoral congestion is done on abdominal palpation"},{"idx":4,"proposition":"None of the propositions are true","correct":false,"justification":"FALSE"}],"type":"custom"}
+{"_id":"tbmictionped-ped-5","context":null,"enonce":"Regarding acute urine retention in children:","item":"tbmictionped","matiere":"ped","propositions":[{"idx":0,"proposition":"It is a therapeutic emergency ","correct":true},{"idx":1,"proposition":"It is defined by a complete and painful inability to urinate for more than 6 hours","correct":false,"justification":"For more than 12 hours"},{"idx":2,"proposition":"First-line treatment is ureteral catheterization","correct":false,"justification":"These are the measures to stimulate urination"},{"idx":3,"proposition":"Second-line treatment is suprapubic catheterization ","correct":false,"justification":"This is the simple ureteral probing"},{"idx":4,"proposition":"One of the possible etiologies is the adverse drug effect","correct":true}],"type":"custom"}
+{"_id":"tbmictionped-ped-6","context":null,"enonce":"Regarding the diagnosis:","item":"tbmictionped","matiere":"ped","propositions":[{"idx":0,"proposition":"Permanent leaks with preserved urination point to ureteral ectopic abouchement","correct":true},{"idx":1,"proposition":"Dysuria may point to a urinary disorder of the lower apparatus","correct":true,"justification":"No vesicosphincter dyssynergy"},{"idx":2,"proposition":"Isolated nocture enuresis is often of very little concern","correct":true},{"idx":3,"proposition":"Oxyurosis is an infectious cause of voiding disorders","correct":true},{"idx":4,"proposition":"Detrusorian hyperactivity causes pollakiuria","correct":true}],"type":"custom"}
+{"_id":"tbmictionped-ped-7","context":null,"enonce":"Regarding the diagnosis:","item":"tbmictionped","matiere":"ped","propositions":[{"idx":0,"proposition":"Pathology of the valves of the posterior urethra causes permanent leakage","correct":false,"justification":"Cause of dysuria"},{"idx":1,"proposition":"Functional detrusor hyperactivity causes emergency","correct":true},{"idx":2,"proposition":"Pollakiurias are often accompanied by urgency","correct":true},{"idx":3,"proposition":"A neuro-orthopedic disorder can cause emergency","correct":true},{"idx":4,"proposition":"Dysuria may be due to hyperactivity of the functional detrusor","correct":false,"justification":"Rather vesicosphincter dyssynergy"}],"type":"custom"}
+{"_id":"tbmictionped-ped-8","context":null,"enonce":"Regarding enuresis: ","item":"tbmictionped","matiere":"ped","propositions":[{"idx":0,"proposition":"It is associated with ADHD in 45% of cases","correct":false,"justification":"10% of cases"},{"idx":1,"proposition":"The positive diagnosis is made by flow-volume curve","correct":false,"justification":"Clinical diagnosis"},{"idx":2,"proposition":"It is said to be isolated when there are no daytime symptoms","correct":true},{"idx":3,"proposition":"It mainly concerns children under 5 years of age","correct":false,"justification":"More than 5 years"},{"idx":4,"proposition":"The leak is unintentional","correct":true}],"type":"custom"}
+{"_id":"peritonite-urg-0","context":null,"enonce":"Regarding acute peritonitis","item":"peritonite","matiere":"urg","propositions":[{"idx":0,"proposition":"The natural course of peritonitis is marked by a septic state that can be accompanied by septic shock that is often fatal.","correct":true},{"idx":1,"proposition":"In patients with underlying diseases, the occurrence of peritonitis often results in abrupt decompensation of the picture with an inaugural state of shock or multiple organ failure.","correct":true},{"idx":2,"proposition":"The maximum frequency of postoperative peritonitis occurs between 5 and 7 days after the procedure","correct":true},{"idx":3,"proposition":"Biological examinations are mainly used to assess the impact of the infection and to make a pre-operative assessment","correct":true},{"idx":4,"proposition":"In case of suspicion of peritonitis, as in the face of any suspicion of sepsis, blood cultures should be taken","correct":true}],"type":"custom"}
+{"_id":"peritonite-urg-1","context":null,"enonce":"Regarding acute peritonitis","item":"peritonite","matiere":"urg","propositions":[{"idx":0,"proposition":"The terrain plays an essential prognostic role: age, comorbidity, immunosuppression, undernutrition, obesity","correct":true},{"idx":1,"proposition":"The more proximal a perforation, the higher the septic risk","correct":false,"justification":"The more distal a perforation, the higher the septic risk (colonic stercoral peritonitis)"},{"idx":2,"proposition":"Postoperative peritonitis is a good prognosis","correct":false,"justification":"Postoperative peritonitis has a poor prognosis and the time to reintervention plays a major role"},{"idx":3,"proposition":"Regardless of the origin of peritonitis, the main prognostic factor is the precocity of surgical treatment","correct":true},{"idx":4,"proposition":"Other main diagnoses are mesenteric ischemia, chronic pancreatic (check for amylasemia), occlusions","correct":false,"justification":"Other main diagnoses are mesenteric ischemia, acute pancreatitis (lipasemia), occlusions"}],"type":"custom"}
+{"_id":"peritonite-urg-2","context":null,"enonce":"Regarding acute peritonitis","item":"peritonite","matiere":"urg","propositions":[{"idx":0,"proposition":"In case of spontaneous infection of ascites fluid, it is recommended to use macrolides combined with vascular albumin filling","correct":false,"justification":"In case of spontaneous infection of ascites fluid, it is recommended to use a 3rd generation cephalosporin, combined with vascular albumin filling"},{"idx":1,"proposition":"In case of infection on peritoneal dialysis, intraperitoneal antibiotic therapy is oriented on staphylococci, gram-negative and Candida (Vancomycin + aminoglycosides)","correct":true},{"idx":2,"proposition":"Removal of the dialysis catheter should be discussed according to the course","correct":true},{"idx":3,"proposition":"Treatment of secondary and tertiary peritonitis combines resuscitation and emergency surgical treatment","correct":true},{"idx":4,"proposition":"For localized forms with abscess formation, radiological or surgical drainage is useful and should be associated with the control of the causal focus by antibiotic therapy","correct":true}],"type":"custom"}
+{"_id":"peritonite-HGE-0","context":null,"enonce":"Regarding acute peritonitis","item":"peritonite","matiere":"HGE","propositions":[{"idx":0,"proposition":"Peritonitis is an acute inflammation of the peritoneum, localized or generalized, the cause of which is most often infectious","correct":true},{"idx":1,"proposition":"The diagnosis must therefore be rapid and treatment is an emergency in the vast majority of surgical cases","correct":true},{"idx":2,"proposition":"The Hamburg classification separates peritonitis into 5 classes according to the origin of the infection","correct":false,"justification":"The Hamburg classification separates peritonitis into 3 classes according to the origin of the infection"},{"idx":3,"proposition":"Secondary peritonitis accounts for 5% of acute peritonitis","correct":false,"justification":"Secondary peritonitis accounts for 90% of acute peritonitis"},{"idx":4,"proposition":"Primary peritonitis is due to a monobacterial spontaneous infection of the peritoneum of hematogenous origin or by translocation","correct":true}],"type":"custom"}
+{"_id":"peritonite-HGE-1","context":null,"enonce":"Regarding acute peritonitis","item":"peritonite","matiere":"HGE","propositions":[{"idx":0,"proposition":"Treatment of primary peritonitis is surgical","correct":false,"justification":"It is primarily medical, based on antibiotic therapy"},{"idx":1,"proposition":"The most common causes of primary peritonitis are ascites infection in cirrhosis; staphylococcus infection via the peritoneal catheter in patients with peritoneal dialysis; pneumococcal spontaneous peritonitis","correct":true},{"idx":2,"proposition":"Secondary peritonitis is related to the spread of a localized abdominal infection or perforation of a digestive viscera","correct":true},{"idx":3,"proposition":"Tertiary peritonitis corresponds to persistent abdominal infections despite treatment (adapted antibiotic therapy and eradication of the primary abdominal focus by one or more interventions)","correct":true},{"idx":4,"proposition":"The diagnosis of peritonitis is radiological","correct":false,"justification":"BDiagnostic positive The diagnosis of peritonitis is clinical and usually easy"}],"type":"custom"}
+{"_id":"peritonite-HGE-2","context":null,"enonce":"Regarding acute peritonitis","item":"peritonite","matiere":"HGE","propositions":[{"idx":0,"proposition":"Paraclinical examinations are useful to clarify the origin of peritonitis and \/ or plan management; under no circumstances should they delay treatment","correct":true},{"idx":1,"proposition":"The diagnosis of peritonitis is quickly made on physical examination in front of the presence of peritoneal signs","correct":true},{"idx":2,"proposition":"Contracture is the essential sign of acute peritonitis","correct":true},{"idx":3,"proposition":"Peritoneal signs may be moderate or absent, especially in the elderly, or malnourished","correct":true},{"idx":4,"proposition":"All peritonitis is accompanied by pneumoperitoneum","correct":false,"justification":"Be careful, not all peritonitis is accompanied by a pneumoperitoneum"}],"type":"custom"}
+{"_id":"peritonite-HGE-3","context":null,"enonce":"Regarding acute peritonitis","item":"peritonite","matiere":"HGE","propositions":[{"idx":0,"proposition":"The abdominal CT scan is the best examination when the clinical examination is doubtful (immunocompromised, asthenic peritonitis of the old man, obesity, post-operative peritonitis, traumatized abdomen)","correct":true},{"idx":1,"proposition":"The interrogation looks for a history of ulcer, recent use of gastrotoxic drugs","correct":true},{"idx":2,"proposition":"In an ulcer perforation generalized or localized contracture to the hypogastric region with defense in the rest of the abdomen","correct":false},{"idx":3,"proposition":"Upper GI endoscopy is formally contraindicated in peritonitis caused by ulcer perforation","correct":true},{"idx":4,"proposition":"There is no pneumoperitoneum in appendicular peritonitis","correct":true}],"type":"custom"}
+{"_id":"RAU-urg-0","context":null,"enonce":"Which of the following are acute urine retention etiologies?","item":"RAU","matiere":"urg","propositions":[{"idx":0,"proposition":"Prostatitis","correct":true},{"idx":1,"proposition":"Enlarged prostate","correct":true},{"idx":2,"proposition":"Ureteral stenosis","correct":false,"justification":"Urethral stenosis, classic !!"},{"idx":3,"proposition":"Cholinergic drugs","correct":false,"justification":"Anticholinergic"},{"idx":4,"proposition":"Morphine","correct":true}],"type":"custom"}
+{"_id":"RAU-urg-1","context":null,"enonce":"Which of the following are contraindications to suprapubic catheterization?","item":"RAU","matiere":"urg","propositions":[{"idx":0,"proposition":"VKAs","correct":false},{"idx":1,"proposition":"Presence of laparotomy scars","correct":false,"justification":"True\r\nOn \r\nThe elimination of the presence of an intestinal loop by ultrasound is necessary beforehand"},{"idx":2,"proposition":"Hemostasis disorders","correct":false},{"idx":3,"proposition":"History of bladder tumours","correct":false},{"idx":4,"proposition":"All propositions are true","correct":true}],"type":"custom"}
+{"_id":"RAU-urg-2","context":null,"enonce":"Which of the following proposals designates a contraindication(s) to bladder probing?","item":"RAU","matiere":"urg","propositions":[{"idx":0,"proposition":"Urinary tract infection","correct":true,"justification":"True, this is the only relative IC"},{"idx":1,"proposition":"Absence of globe","correct":false,"justification":"CI of suprapubic catheterization"},{"idx":2,"proposition":"Hemostasis disorders","correct":false,"justification":"CI of suprapubic catheterization"},{"idx":3,"proposition":"Amyotrophic lateral sclerosis","correct":false,"justification":"False"},{"idx":4,"proposition":"Anticholinergic therapy","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"RAU-urg-3","context":null,"enonce":"Which of the following are absolute contraindications to bladder probing?","item":"RAU","matiere":"urg","propositions":[{"idx":0,"proposition":"Urethral stenosis","correct":true},{"idx":1,"proposition":"Trauma to the urethra","correct":true},{"idx":2,"proposition":"Fracture of the pelvis","correct":true,"justification":"True, these are the three absolute contraindications to bladder probing"},{"idx":3,"proposition":"Urinary tract infection","correct":false,"justification":"Relative CI"},{"idx":4,"proposition":"All propositions are true","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"RAU-urg-4","context":null,"enonce":"Which of the following are true?","item":"RAU","matiere":"urg","propositions":[{"idx":0,"proposition":"A full bladder differentiates acute urine retention from anuria ","correct":false,"justification":"Anuria (= no urine secreted by the kidney) is a differential diagnosis and something else"},{"idx":1,"proposition":"Anuria is painful","correct":false,"justification":"False"},{"idx":2,"proposition":"Anuria is urination <200 ml\/24","correct":true},{"idx":3,"proposition":"Anuria is not accompanied by bladder globe","correct":true},{"idx":4,"proposition":"Ultrasound makes the difference between anuria and RAU","correct":true}],"type":"custom"}
+{"_id":"RAU-urg-5","context":null,"enonce":"Which of the following are absolute contraindications to suprapubic catheterization?","item":"RAU","matiere":"urg","propositions":[{"idx":0,"proposition":"Absence of globe","correct":true},{"idx":1,"proposition":"Vascular bypass surgery in the suprapubic region","correct":true,"justification":"True, these are the two absolute ICs of suprapubic catheterization."},{"idx":2,"proposition":"Hemostasis disorder","correct":false,"justification":"Relative CI"},{"idx":3,"proposition":"History of bladder tumours","correct":false,"justification":"Relative CI"},{"idx":4,"proposition":"All propositions are true","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"voiesIV-cardio-0","context":null,"enonce":"Concerning venous surroundings","item":"voiesIV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Peripheral venous tracts are used to infuse drugs with low venotoxicity","correct":true},{"idx":1,"proposition":"The most common immediate complication is puncture failure","correct":true},{"idx":2,"proposition":"The complications of these venous approaches although relatively rare constitute because of the number of catheters used a frequent problem","correct":true},{"idx":3,"proposition":"The monitoring of these venous surroundings in search of complications is therefore the domain of the doctor's daily life.","correct":true},{"idx":4,"proposition":"In addition, in order to limit this iatrogenic risk as much as possible, the first peripheral installation must be systematic","correct":false,"justification":"In addition, in order to limit this iatrogenic risk as much as possible, the doctor must constantly ask himself the question of the indication to maintain these venous approaches in place."}],"type":"custom"}
+{"_id":"voiesIV-cardio-1","context":null,"enonce":"Concerning the venous surroundings","item":"voiesIV","matiere":"cardio","propositions":[{"idx":0,"proposition":"The term peripheral venous catheter is used when the end is placed in the superior or inferior vena cava","correct":false,"justification":"The term central venous catheter is used when the tip is placed in a \"central\" vein, i.e. the superior or inferior vena cava."},{"idx":1,"proposition":"The central venous tracts are reserved for toxic products for the veins (chemotherapy, some antibiotics) only","correct":false,"justification":"Central venous lines are reserved for vein toxicants but can also be used for long-term infusions or in patients with \"poor\" peripheral venous capital."},{"idx":2,"proposition":"in the first superficial ways The most common complication is the wound of the vein that will cause a hematoma","correct":true},{"idx":3,"proposition":"If this wound is not diagnosed promptly, an extravenous infusion may occur","correct":true},{"idx":4,"proposition":"The most common complication is puncture failure","correct":true}],"type":"custom"}
+{"_id":"voiesIV-cardio-2","context":null,"enonce":"Concerning venous surroundings","item":"voiesIV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Learned societies recommend the use of ultrasound and the performance of ultrasound-guided puncture for the approach of the internal jugular vein","correct":true},{"idx":1,"proposition":"The catheter (and\/or the guide used for its placement) can perforate the vein and have an aberrant path in the soft parts","correct":true},{"idx":2,"proposition":"A Pneumothorax may result from puncture of the pleural dome during an attempt to puncture the subclavian vein","correct":true},{"idx":3,"proposition":"Air embolism can occur during catheter placement when the lumen of the vein is in communication with atmospheric air","correct":true},{"idx":4,"proposition":"This risk is all the more important as the mediastinal pressure is lower than atmospheric pressure","correct":true}],"type":"custom"}
+{"_id":"voiesIV-cardio-3","context":null,"enonce":"Concerning the complications of venous surroundings","item":"voiesIV","matiere":"cardio","propositions":[{"idx":0,"proposition":"The contributing factors of an infection include the duration of maintenance of the venous line, manipulations, loss of tightness of the occlusive dressing","correct":true},{"idx":1,"proposition":"Monitoring and complications of venous approaches ²²Ä Deep catheters: infection starting with a central venous line is rare","correct":false,"justification":"Surveillance and complications of venous approaches ²²Ä Deep catheters: infection starting with a central venous line is relatively common since the coordination center for the control of nosocomial infections estimates that the prevalence is of the order of 2% of carriers of a central venous line"},{"idx":2,"proposition":"In addition to the general factors favoring infection, the occurrence of this complication directly depends on the duration of use of the catheter and","correct":true},{"idx":3,"proposition":"The catheter can be colonized by skin germs during placement or subsequent manipulations: this is contamination by the extraluminal route","correct":true},{"idx":4,"proposition":"The endoluminal pathway will be likely to be colonized during microbial contamination from taps and tubing that will be connected to the catheter.","correct":true}],"type":"custom"}
+{"_id":"otite-infectio-0","context":null,"enonce":"About acute otitis media","item":"otite","matiere":"infectio","propositions":[{"idx":0,"proposition":"Acute otitis media is a very common infection","correct":true},{"idx":1,"proposition":"Streptococcus pneumoniae and Staphyloccocus Aureus represent the two main bacterial etiologies","correct":false,"justification":"Haemophilius influenzae and Streptococcus pneumoniae"},{"idx":2,"proposition":"The diagnosis of purulent AOM should be evoked in front of fever and earache","correct":true},{"idx":3,"proposition":"The diagnosis is confirmed by performing an otoscopy showing inflammatory signs of the eardrum","correct":true},{"idx":4,"proposition":"After the age of 2, the majority of purulent AOMs heal spontaneously","correct":true}],"type":"custom"}
+{"_id":"otite-infectio-2","context":null,"enonce":"Concerning infectious otitis","item":"otite","matiere":"infectio","propositions":[{"idx":0,"proposition":"Otitis externa is an inflammation of the skin of the external auditory canal","correct":true},{"idx":1,"proposition":" Seromucosal otitis corresponds to chronic retrotympanic effusion","correct":true},{"idx":2,"proposition":" In nasopharyngitis, the viral infection also affects the lining of the inner, middle and outer ear.","correct":false,"justification":"Viral infection also affects the lining of the middle ear"},{"idx":3,"proposition":"It is much less common after the age of 6","correct":true},{"idx":4,"proposition":" Externalized mastoiditis with purulent retro-auricular collection is exceptional","correct":true}],"type":"custom"}
+{"_id":"otite-infectio-3","context":null,"enonce":"Concerning infectious otitis","item":"otite","matiere":"infectio","propositions":[{"idx":0,"proposition":"In case of purulent AOM in a child > 2 years, antibiotic therapy is recommended from the outset","correct":false},{"idx":1,"proposition":"If the evolution is favorable, systematic control of eardrums at the end of treatment is not necessary","correct":true},{"idx":2,"proposition":"In case of otitis externa, the fever is usually very high","correct":false,"justification":"No fever in otitis externa"},{"idx":3,"proposition":"Seromucosal otitis (OSM) is defined by the existence of chronic inflammation, evolving for more than 3 months, of the middle ear with closed eardrum","correct":true},{"idx":4,"proposition":"Seromucosal otitis is unlateral in the vast majority of cases","correct":false,"justification":"It is bilateral in the vast majority of cases"}],"type":"custom"}
+{"_id":"otite-infectio-4","context":null,"enonce":"Which of the following are indications for antibiotic therapy for acute otitis media?","item":"otite","matiere":"infectio","propositions":[{"idx":0,"proposition":"Children under two years of age, systematically","correct":true,"justification":"True, systematic in children under two years of age"},{"idx":1,"proposition":"Children under two years of age, with mild symptoms","correct":true,"justification":"True, regardless of the severity of symptoms for children < 2 years (in 1st line Amoxicillin PO 2-3 taken \/ D, 80 to 90 mg \/ kg \/ Day)"},{"idx":2,"proposition":"Child over two years of age, in case of severe symptoms","correct":true},{"idx":3,"proposition":"Children over two years of age, with mild symptoms","correct":false,"justification":"False, if noisy symptoms"},{"idx":4,"proposition":"Systematics whatever the age","correct":false,"justification":"In children > 2 years of age, antibiotic therapy is introduced if AOM is poorly tolerated or in case of treatment failure or complication"}],"type":"custom"}
+{"_id":"otite-infectio-5","context":null,"enonce":"What antibiotic therapy should be prescribed for otitis-conjunctivitis syndrome in a patient with no particular allergy?","item":"otite","matiere":"infectio","propositions":[{"idx":0,"proposition":"C3G","correct":false},{"idx":1,"proposition":"Fluoroquinolones ","correct":false},{"idx":2,"proposition":"Aminoglycosides","correct":false},{"idx":3,"proposition":"Pristinamycin ","correct":false},{"idx":4,"proposition":"Amoxicillin-clavulanic acid ","correct":true,"justification":"The SOC strongly suggests Hameophilus influenzae infection"}],"type":"custom"}
+{"_id":"otite-infectio-6","context":null,"enonce":"Which of the following is the recommended duration of antibiotic therapy for acute otitis media in children under two years of age?","item":"otite","matiere":"infectio","propositions":[{"idx":0,"proposition":"8-10 D","correct":true},{"idx":1,"proposition":"2- 3 D","correct":false,"justification":"False"},{"idx":2,"proposition":"5 D ","correct":false,"justification":"In children over two years of age"},{"idx":3,"proposition":"15-17 D","correct":false,"justification":"False"},{"idx":4,"proposition":"21-23 J","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"otite-infectio-7","context":null,"enonce":"Which germ is most often incriminated in front of otitis-conjunctivitis syndrome?","item":"otite","matiere":"infectio","propositions":[{"idx":0,"proposition":"Streptococcus pneumoniae","correct":false,"justification":"False"},{"idx":1,"proposition":"Haemophilus influenzae","correct":true},{"idx":2,"proposition":"Branhamella catarrhalis","correct":false,"justification":"False"},{"idx":3,"proposition":"Staphylococcus aureus ","correct":false,"justification":"False"},{"idx":4,"proposition":"Neisseria meningitidis","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"otite-infectio-8","context":null,"enonce":"Which of the following proposals lead to serous otitis?","item":"otite","matiere":"infectio","propositions":[{"idx":0,"proposition":"Episodes of vertigo","correct":false,"justification":"Refer to a Menieree"},{"idx":1,"proposition":"Nasopharyngeal obstruction","correct":true,"justification":"True, chronic"},{"idx":2,"proposition":"Family history of deafness","correct":false,"justification":"Genetic cause"},{"idx":3,"proposition":"Otorrhea","correct":false,"justification":"Otitis externa, tympanic perforation or cholesteatoma"},{"idx":4,"proposition":"Disappearance of the luminous 🔅 triangle","correct":true}],"type":"custom"}
+{"_id":"tbmarche-ortho-0","context":null,"enonce":"The range of motion required for walking is as follows:","item":"tbmarche","matiere":"ortho","propositions":[{"idx":0,"proposition":"Hip: 100 degrees flexion and 30 degrees extension","correct":false,"justification":"It's the opposite: 30° bending and 100° extension"},{"idx":1,"proposition":"The knee: 0° extension and 70° flexion","correct":true},{"idx":2,"proposition":"Dorsal ankle flexion: 1°","correct":false,"justification":"10°"},{"idx":3,"proposition":"plantar flexion of the ankle: 15°","correct":true},{"idx":4,"proposition":"Toe extension: 100 degrees","correct":false}],"type":"custom"}
+{"_id":"tbmarche-ortho-1","context":null,"enonce":"Regarding walking and balance disorders","item":"tbmarche","matiere":"ortho","propositions":[{"idx":0,"proposition":"Joint movements necessary to go up and down the stairs by chaining the stairs: hip flexion 110 ° and extension 10 °","correct":true},{"idx":1,"proposition":"Joint debate required to sit: 90° for hip and knee flexion","correct":true},{"idx":2,"proposition":"The quadricpes is a braking muscle when taking support in the support phase","correct":true},{"idx":3,"proposition":"The anterior tibial is a propellant muscle at the beginning of the support phase and a muscle","correct":false,"justification":"He is a brakeman"},{"idx":4,"proposition":"The gluteus medius and the tensor of the facia lata are lateral stabilizing muscles of the flexed knee","correct":true}],"type":"custom"}
+{"_id":"tbmarche-ortho-2","context":null,"enonce":"Regarding walking and balancing disorders:","item":"tbmarche","matiere":"ortho","propositions":[{"idx":0,"proposition":"The essential muscles of standing are the antigravity muscles, namely the extensors of the lower limb and the paravertebrals.","correct":true},{"idx":1,"proposition":"During a dodge lameness, there is a decrease in the time of monopdal support and the downforce on the side of pain","correct":true},{"idx":2,"proposition":"Steppage is related to a deficit of the muscles of the posterior compartment of the leg","correct":false},{"idx":3,"proposition":"A loss of quadriceps strength is at the origin of a lameness with greeting","correct":true},{"idx":4,"proposition":"Damage to the posterior tibial nerve causes stepping","correct":false,"justification":"common or superficial fibular nerve"}],"type":"custom"}
+{"_id":"tbmarche-neuro-0","context":null,"enonce":"Regarding walking and balance disorders:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"Walking, a highly automated motor production, largely escapes conscious control","correct":true},{"idx":1,"proposition":"Romberg's sign is the aggravation of instability at the closing of the eyes and signs the sensory origin of ataxia","correct":true,"justification":"It can be vestibular or proprioceptive ataxia"},{"idx":2,"proposition":"Postural reflexes are impaired in case of damage to the basal ganglia or frontal regions","correct":true},{"idx":3,"proposition":"Almost all drugs prescribed in the field of neuropsychiatry can induce low blood pressure and attentional disorders that can increase the risk of falls.","correct":true},{"idx":4,"proposition":"The walk is classically drunk, the lifting polygon is widened, the tightrope walk is altered early during proprioceptive impairment","correct":false,"justification":"This is the cerebellous syndrome"}],"type":"custom"}
+{"_id":"tbmarche-neuro-1","context":null,"enonce":"Regarding walking and balance disorders:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"Peripheral vestibular syndrome is noisy, manifested as rotational vertigo accompanied by vomiting and vegetative signs","correct":true},{"idx":1,"proposition":"In vestibular syndrome the abnormalities of walking and balance are lateralized from the side of the slow saccade of nystagmus, to the healthy side","correct":false,"justification":"Abnormalities in walking and balance are well lateralized on the side of the slow saccade of nystagmus, but this is the diseased side"},{"idx":2,"proposition":"Romberg's test is very disturbed, aggravated markedly when the eyes close during proprioceptive ataxia","correct":true},{"idx":3,"proposition":"During proprioceptive ataxia, posture reflexes are disturbed, the polygon is enlarged.","correct":false,"justification":"The polygon is well enlarged but posture reflexes are normal."},{"idx":4,"proposition":"During proprioceptive impairment, walking is heelating, ground support is poorly controlled and contact is sometimes violent.","correct":true}],"type":"custom"}
+{"_id":"tbmarche-neuro-2","context":null,"enonce":"Regarding walking and balance disorders:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"The sequelae of stroke are essentially in the form of hemiparesis or hemiplegia causing mowing, the homolateral upper limb being fixed in abduction.","correct":false,"justification":"In the sequelae of stroke, the homolateral upper limb is fixed in adduction"},{"idx":1,"proposition":"Paraparesis with spasticity is secondary to spinal cord disorders: multiple sclerosis, myelitis, tumor or mechanical compression, and hereditary spastic paraparesis.","correct":true},{"idx":2,"proposition":"Lower limb dystonias are always bilateral","correct":false,"justification":"They can be unilateral or bilateral"},{"idx":3,"proposition":"A dopa-sensitivity test should be performed in front of dystonia, most often","correct":true},{"idx":4,"proposition":"In Huntington's chorea, gait and balance disorders are complex: severe impairment of the postural reflexes, akinetic syndrome, axial and limb choreodystonic movement","correct":true}],"type":"custom"}
+{"_id":"tbmarche-neuro-3","context":null,"enonce":"Regarding hypokinetic motor disorders:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"In Parkinson's disease, levodopa-induced dyskinesias induce imbalances when walking","correct":true},{"idx":1,"proposition":"Chronic hydrocephalus in adults is clinically characterized by the Hakim and Adams triad: walking and balance disorders, sphincter disorders and dementia.","correct":true},{"idx":2,"proposition":"In chronic hydrocephalus of adults, there is an enlargement of the lifting polygon and freezing in 2-3% of cases","correct":false,"justification":"There is an enlargement of the lift polygon and freezing in 20 to 30% of cases"},{"idx":3,"proposition":"The diagnosis of chronic hydrocephalus in adults is based on brain MRI which shows tetraventricular dilation with little cortical atrophy and T2 hyposignal ranges around the ventricles","correct":true},{"idx":4,"proposition":"Treatment of chronic adult hydrocephalus consists of a ventriculoperitoneal bypass that results in inconsistent improvement in motor and cognitive disorders","correct":true}],"type":"custom"}
+{"_id":"tbmarche-neuro-4","context":null,"enonce":"Regarding normal walking:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"The oscillating phase concerns 60% of the running time","correct":false,"justification":"Oscillating phase = 40%; Support phase = 60%"},{"idx":1,"proposition":"The beginning of the walking cycle begins with an attack through the heel","correct":true},{"idx":2,"proposition":"For normal walking, you need a hip extension at 10° and a hip flexion at 30°","correct":true},{"idx":3,"proposition":"For normal walking, you need a knee flexion at 70° and a knee extension at 10°","correct":false,"justification":"A knee extension of 0° is required. Beyond this angle, we speak of recurvatum of the knee which is abnormal when walking."},{"idx":4,"proposition":"For normal walking, you need a plantar ankle flexion of 15° and a dorsal flexion of 10°","correct":true}],"type":"custom"}
+{"_id":"tbmarche-neuro-7","context":null,"enonce":"Postural reflexes are modified by lesions in which part(s) of the brain?","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"Lesions of the basal ganglia","correct":true},{"idx":1,"proposition":"Deep left parietal","correct":false},{"idx":2,"proposition":"Frontal regions","correct":true},{"idx":3,"proposition":"Brain stem","correct":false},{"idx":4,"proposition":"Occipital cortex","correct":false}],"type":"custom"}
+{"_id":"tbmarche-neuro-8","context":null,"enonce":"Regarding ataxias:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"Ataxia can be of vestibular, proprioceptive or cerebellar origin","correct":true},{"idx":1,"proposition":"A worsening of balance disorders when closing the eyes (Romberg's sign) is a sign of cerebellar syndrome","correct":false,"justification":"Closing the eyes eliminates sensory afferents from the eyes that help keep balance. There will be a worsening of balance if there is a vestibular syndrome or proprioception disorder."},{"idx":2,"proposition":"Kinetic cerebellar ataxia is secondary to vermis injury","correct":false,"justification":"Cerebellar hemispheres. Vermis = static"},{"idx":3,"proposition":"Cerebellar ataxia is multidirectional in the Romberg test","correct":true},{"idx":4,"proposition":"The walk is classically drunk, the lifting polygon is widened, the tightrope walk is altered early during cerebellar syndrome","correct":true}],"type":"custom"}
+{"_id":"tbmarche-neuro-9","context":null,"enonce":"Are causes of cerebellar ataxia:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"Multiple sclerosis","correct":true},{"idx":1,"proposition":"Vertebrobasilar territory stroke with AIPD","correct":true},{"idx":2,"proposition":"Alcohol","correct":true,"justification":"Think of your friends in the evening;)"},{"idx":3,"proposition":"Creutzfeldt-Jakob disease","correct":true},{"idx":4,"proposition":"Paraneoplastic syndrome","correct":true}],"type":"custom"}
+{"_id":"tbmarche-neuro-10","context":null,"enonce":"Regarding ataxias:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"Biermer's disease can cause proprioceptive ataxia","correct":true,"justification":"Biermer's disease is an autoimmune disease with antibodies to intrinsic factor, which inhibits the absorption of vitamin B12. This vitamin B12 deficiency induces combined sclerosis of the spinal cord: posterior cordonal syndrome (proprioceptive ataxia, Romberg's sign, deep sensitivity disorders) and pyramidal syndrome by lateral cord damage (bilateral Babinski's sign, exaggerated ROT)."},{"idx":1,"proposition":"During vestibular ataxia, walking is in a star pattern ","correct":true},{"idx":2,"proposition":"During proprioceptive ataxia, walking is tillering, ground support is poorly controlled, ground contact is sometimes violent and the lift polygon is increased","correct":true},{"idx":3,"proposition":"MS can cause cerebellar ataxia and proprioceptive ataxia","correct":true,"justification":"Cerebellar ataxia by cerebellum damage and proprioceptive ataxia by posterior cord involvement of the spinal cord"},{"idx":4,"proposition":"Damage to the cerebellum worm can cause static cerebellar ataxia","correct":true}],"type":"custom"}
+{"_id":"tbmarche-neuro-11","context":null,"enonce":"Regarding dystonias","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"It is a hyperkinetic motor disorder","correct":true},{"idx":1,"proposition":"Dystonias are only caused by prolonged use of L-Dopa in Parkinson's disease","correct":false,"justification":"They can be caused by inherited generalized dystonias and neonatal anoxia"},{"idx":2,"proposition":"A painful equine varus foot is dystonia","correct":true},{"idx":3,"proposition":"A \"heron\" walk is dystonia","correct":true},{"idx":4,"proposition":"If there is the presence of dystonia, a dopa-sensitivity test should be done","correct":true}],"type":"custom"}
+{"_id":"tbmarche-neuro-12","context":null,"enonce":"Regarding the Hakim and Adams triad in chronic hydrocephalus in adults:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"There are sphincter disorders","correct":true},{"idx":1,"proposition":"There is a dementia syndrome of the subcorticofrontal type","correct":true},{"idx":2,"proposition":"There is a loss of arm swing when walking","correct":false,"justification":"The arm swing is preserved"},{"idx":3,"proposition":"There is an enlargement of the lift polygon when walking","correct":true},{"idx":4,"proposition":"There may be freezing when walking","correct":true,"justification":"Just like late-onset Parkinson's disease"}],"type":"custom"}
+{"_id":"tbmarche-neuro-13","context":null,"enonce":"Regarding the physiology of walking:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"The quadriceps is a braking muscle during the support phase","correct":true},{"idx":1,"proposition":"The anterior tibial muscle shortens the limb during the oscillating phase","correct":true},{"idx":2,"proposition":"A dorsal flexion of 10° is necessary for normal walking","correct":true},{"idx":3,"proposition":"The triceps sural allows a propulsion of the limb at the end of the support phase","correct":true},{"idx":4,"proposition":"A toe extension is not necessary for normal walking","correct":false}],"type":"custom"}
+{"_id":"tbmarche-neuro-14","context":null,"enonce":"Which anomaly(s) is\/are likely to cause a start of walking by an attack by the tip of the foot?","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"Equine fixed from the ankle","correct":true,"justification":"This is the main etiology"},{"idx":1,"proposition":"A Tredelenburg lameness","correct":false},{"idx":2,"proposition":"A steppage","correct":true,"justification":"By foot lifters' deficit"},{"idx":3,"proposition":"Spasticity of the triceps sural ","correct":true,"justification":"May also cause knee recurvatum"},{"idx":4,"proposition":"Spasticity of the quadriceps","correct":false}],"type":"custom"}
+{"_id":"tbmarche-neuro-16","context":null,"enonce":"Regarding the physiology of walking:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"Walking is controlled by subcortical circuits, including basal ganglia, brainstem and spinal cord regions.","correct":true},{"idx":1,"proposition":"The stride is defined as a succession of 2 steps","correct":true,"justification":"2 steps = 1 walking cycle; about 1.4m"},{"idx":2,"proposition":"The gluteal medius muscle is a stabilizer of the hip","correct":true,"justification":"Just like the tensor of the fascia lata"},{"idx":3,"proposition":"The walking speed is 2 m\/s","correct":false,"justification":"1 m\/s"},{"idx":4,"proposition":"There is always at least 1 ground support when walking","correct":true,"justification":"Unlike the race"}],"type":"custom"}
+{"_id":"soinspalrea-anesth-1","context":null,"enonce":"Which propositions are true? (one or more correct answers)","item":"soinspalrea","matiere":"anesth","propositions":[{"idx":0,"proposition":"Management in intensive care involves continuous monitoring of vital functions and, where appropriate, the use of methods of replacement of failing organs","correct":true},{"idx":1,"proposition":"Resuscitation is based on active therapies only","correct":false,"justification":"Supportive care should always be continued"},{"idx":2,"proposition":"Unreasonable obstinacy is defined by the initiation or continuation of a curative therapy not desired by the family.","correct":false,"justification":"Unreasonable obstinacy is defined as the initiation or continuation of a curative therapy or diagnostic strategy (and this is why unreasonable obstinacy is more inclusive than therapeutic relentlessness) that is unnecessary and unjustified in terms of prognosis in terms of survival or quality of life."},{"idx":3,"proposition":"Palliative care is acute care delivered in a comprehensive approach to the person with a terminal illness","correct":false,"justification":"It must concern all chronically ill patients (especially cancers, whatever their phase of the disease)"},{"idx":4,"proposition":"An LATA involves the cessation of all care and replacement of organs, regardless of the LATA made.","correct":false,"justification":"A LATA defines ethically authorized care (light monitoring at least, replacement of organs if decided)"}],"type":"custom"}
+{"_id":"vertige-neuro-0","context":null,"enonce":"Regarding physiological reminders:","item":"vertige","matiere":"neuro","propositions":[{"idx":0,"proposition":"Vertigo is an illusion of movement of the environment exclusively, without subjective movement","correct":false,"justification":"Vertigo is an illusion of movement, either of the patient or of the environment, which most often results in an impression of rotation or sometimes linear displacement"},{"idx":1,"proposition":"The impression of displacement is always rotating","correct":false,"justification":"Rotatory or linear"},{"idx":2,"proposition":"The peripheral vestibular system consists of the semicircular canals, utricle and saccule","correct":true},{"idx":3,"proposition":"The ampullary ridges of the semicircular canals detect the rotational movements of the head","correct":true},{"idx":4,"proposition":"The otolithic macules of the utricle and saccule detect linear head movements and gravity direction","correct":true}],"type":"custom"}
+{"_id":"vertige-neuro-1","context":null,"enonce":"Regarding vertigo:","item":"vertige","matiere":"neuro","propositions":[{"idx":0,"proposition":"Information from the posterior labyrinth is conveyed in the twelfth cranial nerve","correct":false,"justification":"Cochleovestibular nerve = VIIIth cranial nerve"},{"idx":1,"proposition":"The vestibular nuclei are closely connected with the vestibular cerebellum","correct":true},{"idx":2,"proposition":"An acute or subacute lesional process of one of the vestibular structures leads to asymmetric functioning, resulting in the appearance of acute vestibular syndrome","correct":true},{"idx":3,"proposition":"Chronic involvement of vestibular structures is mainly manifested by nystagmus","correct":false,"justification":"Essentially by vestibular ataxia"},{"idx":4,"proposition":"The duration and frequency of seizures make it possible to classify dizziness into four categories useful for diagnosis.","correct":true,"justification":"This is the determining element of the interrogation that makes it possible to classify vertigo into four categories very useful in terms of etiological diagnosis."}],"type":"custom"}
+{"_id":"vertige-neuro-3","context":null,"enonce":"Regarding posture disorders in the context of peripheral vestibular syndrome:","item":"vertige","matiere":"neuro","propositions":[{"idx":0,"proposition":"A vestibular syndrome usually gives postural disorders aggravated by closing the eyes","correct":true},{"idx":1,"proposition":"A normal subject holds more than 6 seconds with his eyes closed standing in static without moving his feet","correct":true},{"idx":2,"proposition":"In case of proprioceptive disorders, the oscillations of the body are in all directions","correct":true},{"idx":3,"proposition":"In case of vestibular involvement, there is a slow deviation of the axis of the body towards the back","correct":false,"justification":"In case of vestibular involvement, there is a slow deviation of the axis of the body always on the same side (lateral)"},{"idx":4,"proposition":"In case of vestibular involvement, the lateral deviation of the axis of the body contributes to the fact that the subject does not remain on the same line but moves in a star","correct":true}],"type":"custom"}
+{"_id":"vertige-neuro-4","context":null,"enonce":"Which of these structures make up the vestibular system?","item":"vertige","matiere":"neuro","propositions":[{"idx":0,"proposition":"The saccule","correct":true},{"idx":1,"proposition":"The right ventricle","correct":false},{"idx":2,"proposition":"The stirrup","correct":false,"justification":"Inner ear"},{"idx":3,"proposition":"The rock","correct":false},{"idx":4,"proposition":"Semicircular canals","correct":true,"justification":"The peripheral vestibular system consists of the semicircular canals, utricle and saccule"}],"type":"custom"}
+{"_id":"tbdecubitus-mpr-0","context":null,"enonce":"Regarding generalities:","item":"tbdecubitus","matiere":"mpr","propositions":[{"idx":0,"proposition":"The decubitus is without consequences during a night's sleep in the healthy subject","correct":true},{"idx":1,"proposition":"Decubitus and hypomobility are the cause of complications in bedridden patients","correct":true},{"idx":2,"proposition":"Decubitus has no impact on sensory functions","correct":false,"justification":"We have an impoverishment of sensory afferents"},{"idx":3,"proposition":"Reduced effort induces cardiorespiratory maladaptation","correct":true},{"idx":4,"proposition":"Prolonged decubitus causes amyotrophy","correct":true}],"type":"custom"}
+{"_id":"tbdecubitus-mpr-1","context":null,"enonce":"Regarding general complications:","item":"tbdecubitus","matiere":"mpr","propositions":[{"idx":0,"proposition":"Bone resorption leads to hypercalciuria","correct":true},{"idx":1,"proposition":"There is a neuropsychological impact that is sometimes significant","correct":true},{"idx":2,"proposition":"The complications of hypomobility and decubitus can be distinguished according to their precocity and their local, regional or general character.","correct":true},{"idx":3,"proposition":"Muscle retractions are early complications","correct":false,"justification":"Late"},{"idx":4,"proposition":"Constipation is an early complication of decubitus","correct":true}],"type":"custom"}
+{"_id":"tbdecubitus-mpr-2","context":null,"enonce":"Among these proposals, which are early complications:","item":"tbdecubitus","matiere":"mpr","propositions":[{"idx":0,"proposition":"Thromboembolic","correct":true},{"idx":1,"proposition":"Cardiac maladaptation","correct":true},{"idx":2,"proposition":"Osteoporosis","correct":false,"justification":"Late"},{"idx":3,"proposition":"Mental","correct":false,"justification":"Late"},{"idx":4,"proposition":"False roads","correct":true}],"type":"custom"}
+{"_id":"tbdecubitus-mpr-3","context":null,"enonce":"Which of these proposals are late complications of decubitus?","item":"tbdecubitus","matiere":"mpr","propositions":[{"idx":0,"proposition":"Muscle retractions","correct":true},{"idx":1,"proposition":"Gastric reflux","correct":false,"justification":"Precocious, but present all the time"},{"idx":2,"proposition":"Nerve compressions","correct":false,"justification":"Precocious, but present all the time"},{"idx":3,"proposition":"Dysuria","correct":false,"justification":"Precocious, but present all the time"},{"idx":4,"proposition":"Mental","correct":true}],"type":"custom"}
+{"_id":"tbdecubitus-mpr-4","context":null,"enonce":"What medical circumstances really require bed rest?","item":"tbdecubitus","matiere":"mpr","propositions":[{"idx":0,"proposition":"Coma","correct":true},{"idx":1,"proposition":"The consequences of certain surgeries","correct":true},{"idx":2,"proposition":"Bi-maleolar fracture","correct":false,"justification":"No prolonged decubitus"},{"idx":3,"proposition":"Paraplegia","correct":false,"justification":"Must move via adapted means"},{"idx":4,"proposition":"Shock","correct":true}],"type":"custom"}
+{"_id":"tbdecubitus-mpr-5","context":null,"enonce":"Regarding complications of bed rest:","item":"tbdecubitus","matiere":"mpr","propositions":[{"idx":0,"proposition":"Complications are predictable and often prevented by appropriate therapeutic care, undertaken from the beginning of the decubitus position","correct":true},{"idx":1,"proposition":"Neurological deficit with disorders of trunk tone is a pathology inducing a decubitus for life","correct":false,"justification":"Only at the initial stage. It must then be put an end to it by appropriate means"},{"idx":2,"proposition":"Immobility promotes venous stasis and the occurrence of thromboembolic disease with a risk of pulmonary embolism","correct":true},{"idx":3,"proposition":"Dehydration promotes VTE","correct":true},{"idx":4,"proposition":"Preventive treatment of VTE relies on low molecular weight heparins (LMWH)","correct":true}],"type":"custom"}
+{"_id":"cirrhose-HGE-0","context":null,"enonce":"Which of the following are true?","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"proposition":"The definition of cirrhosis is clinical","correct":false,"justification":"It is histological"},{"idx":1,"proposition":"The definition of cirrhosis is biological","correct":false,"justification":"It is histological"},{"idx":2,"proposition":"The definition of cirrhosis is pathological","correct":true,"justification":"True, it's the same"},{"idx":3,"proposition":"The definition of cirrhosis is histological 🔬","correct":true},{"idx":4,"proposition":"The definition of cirrhosis is radiographic","correct":false,"justification":"It is histological"}],"type":"custom"}
+{"_id":"cirrhose-HGE-1","context":null,"enonce":"Which of the following are included in the calculation of Maddrey's score?","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"proposition":"Prothrombin levels","correct":true,"justification":"True, unless it is < 30% (because the score is then always greater than 32)"},{"idx":1,"proposition":"Total bilirubin","correct":true},{"idx":2,"proposition":"Albumin","correct":false,"justification":"The Maddrey score is a prognostic score assessing the severity of alcoholic hepatitis. Score = TP * 4.6 + (Total bilirubin \/ 17)"},{"idx":3,"proposition":"Factor V","correct":false,"justification":"TP * 4.6+ (Total Bilirubin \/ 17)"},{"idx":4,"proposition":"LDL cholesterol","correct":false,"justification":"TP * 4.6+ (Total Bilirubin \/ 17)"}],"type":"custom"}
+{"_id":"cirrhose-HGE-2","context":null,"enonce":"Which of the following are ultrasound (or Doppler echo) signs of cirrhosis?","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"proposition":"Dilation of the umbilical vein","correct":true,"justification":"True. More specifically, a repermeabilization of this vein (collateral circulation set up because circulation within the liver is too difficult)"},{"idx":1,"proposition":"Bumpy liver contours","correct":true},{"idx":2,"proposition":"Presence of peritoneal effusion (ascites)","correct":true},{"idx":3,"proposition":"Portal hypertension","correct":true},{"idx":4,"proposition":"Hepatic impairment","correct":false,"justification":"It is a biological 🩸 sign"}],"type":"custom"}
+{"_id":"cirrhose-HGE-3","context":null,"enonce":"Which of the following are biological signs of cirrhosis? 💉","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"proposition":"Low prothrombin (PT) levels","correct":true},{"idx":1,"proposition":"Increase in Leiden factor V","correct":false,"justification":"Decrease"},{"idx":2,"proposition":"Decrease in INR","correct":false,"justification":"Increase"},{"idx":3,"proposition":"Decreased albumin","correct":true},{"idx":4,"proposition":"Increase in billirubine","correct":true}],"type":"custom"}
+{"_id":"cirrhose-HGE-4","context":null,"enonce":"Which of the following are included in the Child Pugh calculation?","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"proposition":"Prothrombin levels","correct":true,"justification":"True. TP > 50%: 1 point. TP 40-50%: 2 points. TP <40%: 3 points"},{"idx":1,"proposition":"Presence of meningitis","correct":false,"justification":"Encephalopathy. Absence: 1 point. Mild to moderate: 2 points. Severe: 3 points."},{"idx":2,"proposition":"Leiden factor V","correct":false,"justification":"Does not fit into the calculation. The 5 things to consider are: ascites, bilirubin, encephalopathy, prothrombin and albumin levels."},{"idx":3,"proposition":"Albumin","correct":true,"justification":"True. In g\/L. Albumin> 35 : 1 point. Albumin 28-35: 2 points. Albumin< 28: 3 points."},{"idx":4,"proposition":"Free bilirubin","correct":false,"justification":"It is the total bilirubin that is taken into account. < 35: 1 point. 35-50: 2 points. >50: 3 points."}],"type":"custom"}
+{"_id":"cirrhose-HGE-5","context":null,"enonce":"Which of the following are signs of portal hypertension?","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"proposition":"Stellar angioma","correct":false,"justification":"Sign of hepatocellular insufficiency"},{"idx":1,"proposition":"Jaundice","correct":false,"justification":"Sign of hepatocellular insufficiency (increased bilirubin)"},{"idx":2,"proposition":"Hypogonadism","correct":false,"justification":"Sign of hepatocellular insufficiency"},{"idx":3,"proposition":"Ascites","correct":true,"justification":"True, by increasing hydrostatic pressure (increased resistance of hepatic capillaries)"},{"idx":4,"proposition":"Splenomegaly","correct":true}],"type":"custom"}
+{"_id":"LLC-onco-0","context":null,"enonce":"Which of the following are true for chronic lymphocytic leukemia?","item":"LLC","matiere":"onco","propositions":[{"idx":0,"proposition":"Most often it is a hematological disease of the child","correct":false,"justification":"Haemopathy in the elderly"},{"idx":1,"proposition":"The diagnosis can be made incidentally on the blood count","correct":true},{"idx":2,"proposition":"Complications include autoimmune","correct":true},{"idx":3,"proposition":"Prague is feared to be transformed","correct":false,"justification":"Richter transformation (5-10% of CLL results in aggressive Non-Hodgkin lymphoma)"},{"idx":4,"proposition":"Binet's classification has 5 possibilities, from A to E","correct":false,"justification":"3: Binet A, Binet B and Binet C (most pejorative)"}],"type":"custom"}
+{"_id":"LLC-onco-1","context":null,"enonce":"What is the Binet stage of a patient in whom there are only 2 axillary lymphadenopathies without hepatomegaly or splenomegaly, without biological abnormalities (except hyperlymphocytosis)?","item":"LLC","matiere":"onco","propositions":[{"idx":0,"proposition":"Binet A","correct":true,"justification":"True. <3 lymph node areas affected, no anemia, no thrombocytopenia."},{"idx":1,"proposition":"Binet B","correct":false,"justification":"False"},{"idx":2,"proposition":"Binet C","correct":false,"justification":"False"},{"idx":3,"proposition":"Not enough evidence to conclude","correct":false,"justification":"False"},{"idx":4,"proposition":"The elements are discordant","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"LLC-onco-2","context":null,"enonce":"What is the Binet stage of a patient with 2 left axillary lymphadenopathy, 2 left inguinal lymphadenopathy, 4 right cervical lymphadenopathy, hepatomegaly and splenomegaly, without biological abnormalities (except hyperlymphocytosis)?","item":"LLC","matiere":"onco","propositions":[{"idx":0,"proposition":"Binet A","correct":false,"justification":"False"},{"idx":1,"proposition":"Binet B","correct":true,"justification":"True. >= 3 lymph node areas affected, without anemia or thrombocytopenia"},{"idx":2,"proposition":"Binet C","correct":false,"justification":"False"},{"idx":3,"proposition":"Not enough evidence to conclude","correct":false,"justification":"False"},{"idx":4,"proposition":"The elements are discordant","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"LLC-onco-3","context":null,"enonce":"Which of the following are true?","item":"LLC","matiere":"onco","propositions":[{"idx":0,"proposition":"At the time of diagnosis, 1\/3 of patients are BINET A ","correct":false,"justification":"70 to 80% of patients are in Binet A at the time of diagnosis"},{"idx":1,"proposition":"Binet's classification is exclusively clinical","correct":false,"justification":"Clinico-biological (anemia or Binet C thrombocytopenia ➡)"},{"idx":2,"proposition":"Binet A stage does not require treatment most often","correct":true,"justification":"True. Clinicobiological surveillance every 6 months"},{"idx":3,"proposition":"CLL is the most common childhood leukemia","correct":false,"justification":"It is not found in children. The median age at diagnosis is 72 years."},{"idx":4,"proposition":"The discovery of CLL is most often fortuitous","correct":true,"justification":"True. During a blood test"}],"type":"custom"}
+{"_id":"LLC-onco-5","context":null,"enonce":"Which of the following proposals are poor prognosis?","item":"LLC","matiere":"onco","propositions":[{"idx":0,"proposition":"Binet A","correct":false,"justification":"Good prognosis"},{"idx":1,"proposition":"CD38 expression on CLL cells","correct":true},{"idx":2,"proposition":"Doubling time of blood lymphocytosis less than 36 months","correct":false,"justification":"Less than 12 months"},{"idx":3,"proposition":"Somatic mutation of the immunoglobulin heavy chain gene (LHIVG)","correct":false,"justification":"Good prognosis criterion"},{"idx":4,"proposition":"del11q","correct":true,"justification":"True, more exactly dell(11q22.3)"}],"type":"custom"}
+{"_id":"LLC-onco-6","context":null,"enonce":"What is the Binet stage of a patient in whom there is no axillary lymphadenopathy but hepatomegaly and splenomegaly, and anemia <10g\/dL?","item":"LLC","matiere":"onco","propositions":[{"idx":0,"proposition":"Binet A","correct":false,"justification":"False"},{"idx":1,"proposition":"Binet B","correct":false,"justification":"False"},{"idx":2,"proposition":"Binet C","correct":true,"justification":"True. Anemia directly classifies CLL as stage C"},{"idx":3,"proposition":"Not enough evidence to conclude","correct":false,"justification":"False"},{"idx":4,"proposition":"The elements are discordant","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"LLC-onco-7","context":null,"enonce":"What is the Binet stage of a patient in whom there is no axillary lymphadenopathy but hepatomegaly and splenomegaly, without biological abnormalities (except hyperlymphocytosis)?","item":"LLC","matiere":"onco","propositions":[{"idx":0,"proposition":"Binet A","correct":true,"justification":"True. <3 lymph node areas affected, no anemia, no thrombocytopenia."},{"idx":1,"proposition":"Binet B","correct":false,"justification":"False"},{"idx":2,"proposition":"Binet C","correct":false,"justification":"False"},{"idx":3,"proposition":"Not enough evidence to conclude","correct":false,"justification":"False"},{"idx":4,"proposition":"The elements are discordant","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"SMP-onco-0","context":null,"enonce":"Which of the following is one or more visible complications in polycythemia vera?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"Acute lymphoblastic leukemia","correct":false,"justification":"Acute myelogenous leukemia"},{"idx":1,"proposition":"Secondary myelofibrosis","correct":true},{"idx":2,"proposition":"Lymphoma","correct":false,"justification":"No transformation into lymphoma"},{"idx":3,"proposition":"Secondary hemochromatosis","correct":false,"justification":"Rather, there is a martial deficiency due to bloodletting"},{"idx":4,"proposition":"Leg ulcers under Phosphorus 32","correct":false,"justification":"Phosphorus-32 is no longer used in France because of its highly leukeogenic potential. It is hydroxycarbamide (prescribed in +60 years or in case of history of thrombosis) that has skin side effects"}],"type":"custom"}
+{"_id":"SMP-onco-1","context":null,"enonce":"Which of the following is the minor criterion for polycythemia vera according to WHO (2016)?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"Palpable splenomegaly","correct":false,"justification":"False"},{"idx":1,"proposition":"Myelogram disorders","correct":false,"justification":"False. Major criterion (rich myelogram)"},{"idx":2,"proposition":"Spontaneous growth of medullary erythroblastic progenitors","correct":false,"justification":"False"},{"idx":3,"proposition":"Myelemia","correct":false,"justification":"False"},{"idx":4,"proposition":"Low serum erythropoietin (EPO) dosage","correct":true}],"type":"custom"}
+{"_id":"SMP-onco-3","context":null,"enonce":"Which of the following proposals makes it possible to define a polycythemia with certainty?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"Mean corpuscular volume (MCV)","correct":false,"justification":"None"},{"idx":1,"proposition":"Total corpuscular volume (VGT)","correct":true,"justification":"True, this is the reference examination (isotopic measurement). By definition, the measurement of blood mass is increased: we speak of true polycythemia when the total corpuscular volume is 25% higher than the normal value."},{"idx":2,"proposition":"Hematocrit","correct":false,"justification":"None"},{"idx":3,"proposition":"Hemoglobin level","correct":false,"justification":"None"},{"idx":4,"proposition":"Chromia","correct":false,"justification":"None"}],"type":"custom"}
+{"_id":"SMP-onco-4","context":null,"enonce":"Which of the following are clinical signs in favor of polycythemia vera?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"Splenomegaly","correct":true,"justification":"True, related to myeloproliferative syndrome (just like water pruritus)"},{"idx":1,"proposition":"Venous or arterial thrombosis","correct":true,"justification":"True, related to blood hyperviscosity"},{"idx":2,"proposition":"Adenomegaly","correct":false,"justification":"False"},{"idx":3,"proposition":"Erythrosis of the face","correct":true,"justification":"True, appeared gradually"},{"idx":4,"proposition":"Concomitant amyloidosis","correct":false,"justification":"No relationship described between these two pathologies in the college"}],"type":"custom"}
+{"_id":"SMP-onco-5","context":null,"enonce":"Which of the following are true for the V617F mutation in JAK2?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"This is a constitutional genetic anomaly","correct":false,"justification":"No, it's an acquired mutation"},{"idx":1,"proposition":"It may be present in circulating polynuclear drugs","correct":true},{"idx":2,"proposition":"It is mandatory at the diagnosis of polycythemia vera","correct":false,"justification":"There are other mutations that can induce a primitive polycythemia (mutation of exon 12 of JAK2, mutation of CARL, mutation of MPL ...). They are much rarer"},{"idx":3,"proposition":"It is present in about half of cases of essential thrombocythemia","correct":true},{"idx":4,"proposition":"It is not found in chronic myelogenous leukemia","correct":true}],"type":"custom"}
+{"_id":"SMP-onco-6","context":null,"enonce":"Which of the following are the causes of false polycythemia?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"Hemoconcentration","correct":true},{"idx":1,"proposition":"Splenomegaly","correct":false,"justification":"There is red blood cell sequestration and hemodilution, so rather anemia (often moderate with a small hemolytic component of stasis). For information, a voluminous splenomegaly can sequester up to 25% of the total blood mass."},{"idx":2,"proposition":"Thalassemia minor","correct":true,"justification":"True, it is often microcytic"},{"idx":3,"proposition":"Thrombotic Microangiopathy","correct":false,"justification":"None"},{"idx":4,"proposition":"Acute bleeding","correct":false,"justification":"In acute cases, there is no impact on the CBC (equivalent loss of red blood cells and plasma). Prolonged, we find anemia"}],"type":"custom"}
+{"_id":"SMP-onco-7","context":null,"enonce":"Which of the following are the major criteria for polycythemia vera according to WHO (2016)?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"Palpable splenomegaly","correct":false,"justification":"Does not fall within the scope of the WHO 2016 criteria because it is not very specific"},{"idx":1,"proposition":"Thrombocytosis","correct":false,"justification":"Does not fall within the scope of the WHO 2016 criteria because it is not very sensitive (only 2\/3 of patients) and not very specific (many differential diagnoses)"},{"idx":2,"proposition":"Desaturation","correct":false,"justification":"There is no hypoxia"},{"idx":3,"proposition":"Mutation de JAK2","correct":true,"justification":"True, mutation V617F for example"},{"idx":4,"proposition":"Myeloid hypertrophy on bone marrow biopsy","correct":true,"justification":"True, we find panmyelosis"}],"type":"custom"}
+{"_id":"SMP-onco-8","context":null,"enonce":"Which of the following are causes of moderate polynucleosis?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"Pregnancy","correct":true},{"idx":1,"proposition":"Corticosteroid treatment","correct":true},{"idx":2,"proposition":"Hemolysis regeneration","correct":true},{"idx":3,"proposition":"Viral infection","correct":false,"justification":"In this case, it is mostly lymphocytosis. Polynucleosis is found in bacterial infections."},{"idx":4,"proposition":"Taking acetylsalicylic acid ","correct":false,"justification":"NSAIDs do not cause polynucleosis, on the contrary"}],"type":"custom"}
+{"_id":"SMP-onco-10","context":null,"enonce":"Which of the following propositions are true regarding the etiology of CML?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"None of these propositions are true","correct":false,"justification":"False"},{"idx":1,"proposition":"It may be secondary to exposure to ionizing radiation","correct":true},{"idx":2,"proposition":"It may be secondary to exposure to benzene","correct":true,"justification":"True, these are the only two occupational diseases in the PM tables."},{"idx":3,"proposition":"It may be secondary to exposure to statins","correct":false,"justification":"False"},{"idx":4,"proposition":"It may be secondary to exposure to cocaine","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"SMP-onco-11","context":null,"enonce":"Which of the following are true about myelofibrosis?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"Secondary myelofibrosis can complicate all myeloproliferative neoplasias","correct":true},{"idx":1,"proposition":"In polycythemia vera, this course is more common in case of bloodletting treatment","correct":true},{"idx":2,"proposition":"The diagnosis is made on the appearance of poor marrow to the myelogram","correct":false,"justification":"We do not see the appearance of the bone marrow on the myelogram but on the osteospinal cord biopsy. Abnormalities of the medullary structure are observed.  Myelofibrosis is an abnormality highlighted by specific stains, which can evolve in several stages (reticulin stained by silver derivatives, collagen visible with trichrome, or sclerosing and then willingly mutilating) and often prevents aspiration of bone marrow juice."},{"idx":3,"proposition":"In primary myelofibrosis, the JAK2 mutation is found in about 50% of cases","correct":true},{"idx":4,"proposition":"There is targeted therapy with JAK2 inhibitor","correct":true,"justification":"True, ruxolitinib"}],"type":"custom"}
+{"_id":"hypoGly-endoc-0","context":null,"enonce":"What is the most common cause of tumor hypoglycemia in adults?","item":"hypoGly","matiere":"endoc","propositions":[{"idx":0,"proposition":"Insulinoma","correct":true,"justification":"Insulinoma is a benign tumor"},{"idx":1,"proposition":"Adrenaloma","correct":false},{"idx":2,"proposition":"Hepatocellular carcinoma","correct":false},{"idx":3,"proposition":"Pituitary glioma","correct":false},{"idx":4,"proposition":"Stomach tumours","correct":false}],"type":"custom"}
+{"_id":"hypoGly-endoc-1","context":null,"enonce":"Regarding the diagnosis of hypoglycemia:","item":"hypoGly","matiere":"endoc","propositions":[{"idx":0,"proposition":"It is based on Whipple's triad","correct":true,"justification":"Whipple's Triad: Sign of neuroglucopenia + Low venous blood glucose < 0.50 g\/L (2.75mmol\/L) + Symptoms disappear during re-sugaringnot to be confused with Whipple's disease, infection caused by the intracellular bacterium Tropheryma whipplei"},{"idx":1,"proposition":"Normalization of blood glucose should lead to correction of symptoms","correct":true,"justification":"Indeed, as indicated in the reference system, the diagnosis of hypoglycemia is based on Whipple's triad which involves a correction of symptoms after normalization of blood glucose"},{"idx":2,"proposition":"Signs of insulinopenia are in the foreground","correct":false,"justification":"Signs of neuroglucopenia (i.e. NS dysfunction) are in the foreground"},{"idx":3,"proposition":"Low capillary glucose measurement is the basis of diagnosis","correct":false,"justification":"It is the measurement of venous blood glucose that must be performed in order to be able to make a diagnosis of hypoglycemia"},{"idx":4,"proposition":"A blood glucose level of 0.4 g\/L is used to diagnose hypoglycemia","correct":false,"justification":"An isolated low blood sugar is not enough to carry the diagnosis, it is necessary to find the elements of the triad of Whipple"}],"type":"custom"}
+{"_id":"hypoGly-endoc-3","context":null,"enonce":"Which of these proposals are signs of adrenergic reaction to hypoglycemia?","item":"hypoGly","matiere":"endoc","propositions":[{"idx":0,"proposition":"Anxiety","correct":true},{"idx":1,"proposition":"Slurred speech","correct":false,"justification":"This is a sign of neuroglucopenia"},{"idx":2,"proposition":"The paleur","correct":true},{"idx":3,"proposition":"Tachycardia","correct":true},{"idx":4,"proposition":"Visual disturbances","correct":false,"justification":"These are signs of neuroglucopenia"}],"type":"custom"}
+{"_id":"hypoGly-endoc-4","context":null,"enonce":"Which of these proposals are signs of neuroglucopenia?","item":"hypoGly","matiere":"endoc","propositions":[{"idx":0,"proposition":"Anxiety","correct":false,"justification":"It's an adrenergic sign"},{"idx":1,"proposition":"Diplopia","correct":true},{"idx":2,"proposition":"Limb paresthesias","correct":true},{"idx":3,"proposition":"Bradycardia","correct":false,"justification":"This is a sign of the adrenergic reaction"},{"idx":4,"proposition":"Delirium","correct":true,"justification":"Possible coma"}],"type":"custom"}
+{"_id":"hypoGly-endoc-5","context":null,"enonce":"Regarding hypoglycemia, which of the following propositions are true?","item":"hypoGly","matiere":"endoc","propositions":[{"idx":0,"proposition":"Whipple's triad, essential to the DG, includes: neurovegetative syndrome, blood glucose < 0.5 g \/ L and correction of symptoms after normalization of blood glucose.","correct":false,"justification":"Whipple's triad, essential for the DG, includes: NEUROGLUCOPENIC syndrome*, a blood glucose < 0.5 g \/ L and a correction of symptoms after normalization of blood glucose."},{"idx":1,"proposition":"Functional hypoglycemia, synonymous with idiopathic hyperketotic hypoglycemia, is characterized in particular by its appearance during a short fast.","correct":false},{"idx":2,"proposition":"Hypoglycemia in a child with soft and bulky hepatomegaly suggests glycogen storage disease.","correct":true,"justification":"None"},{"idx":3,"proposition":"Hypoglycemia associated with multiple organ failure suggests a deficit in the β oxidation of fatty acids. ","correct":true,"justification":"None"},{"idx":4,"proposition":"Hypoglycemia associated with multiple organ failure suggests primary adrenal insufficiency.","correct":true,"justification":"None"}],"type":"custom"}
+{"_id":"VIH-infectio-0","context":null,"enonce":"Which of the following are true for progressive multifocal leukoencephalopathy (PML)?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is common between 200 and 400 circulating CD4 lynphocytes","correct":false,"justification":"From <100"},{"idx":1,"proposition":"It is a demyelinating condition ","correct":true},{"idx":2,"proposition":"There is a deficit that is only sensory","correct":false,"justification":"It can be sensitive and\/or motor, depending on the fibers that are demyelinated"},{"idx":3,"proposition":"We can find a cerebellar syndrome","correct":true},{"idx":4,"proposition":"It is classically fever-free","correct":true,"justification":"True, no fever, headache, or intracranial hypertension"}],"type":"custom"}
+{"_id":"VIH-infectio-1","context":null,"enonce":"What is the prevalence of HIV in France?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"20 000","correct":false,"justification":"False"},{"idx":1,"proposition":"150 000","correct":true,"justification":"True and an incidence of about 6400 cases per year"},{"idx":2,"proposition":"500 000","correct":false,"justification":"False"},{"idx":3,"proposition":"1 500 000","correct":false,"justification":"False"},{"idx":4,"proposition":"5 000 000","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"VIH-infectio-2","context":null,"enonce":"Which of the following are true?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"Triple therapy is to be continued for about 15 years","correct":false,"justification":"It is to be continued for life"},{"idx":1,"proposition":"PML is most often accompanied by fever","correct":false,"justification":"Classically no fever, no HTIC, no headache"},{"idx":2,"proposition":"We can find a mononucleosis syndrome","correct":true,"justification":"True, just as in EBV, CMV, toxoplasmosis and DRESS syndrome"},{"idx":3,"proposition":"The risk of mother-to-child transmission is almost zero when management is adapted","correct":true,"justification":"True, it is 0.3%"},{"idx":4,"proposition":"All live attenuated vaccines are contraindicated in HIV patients","correct":false,"justification":"Not if CD4 LTs are greater than 200, except for BCG (always contraindicated in HIV patients)"}],"type":"custom"}
+{"_id":"VIH-infectio-3","context":null,"enonce":"Which of the following are true about HIV?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"HIV-2 is more common than HIV-1","correct":false,"justification":"It's the other way around"},{"idx":1,"proposition":"Tenofovir is a reverse transcriptase inhibitor","correct":true},{"idx":2,"proposition":"Kaposi's disease requires the patient to offer an HIV diagnostic test","correct":true},{"idx":3,"proposition":"HIV, untreated, induces a significant decrease in LT CD8 helpers, up to the AIDS stage","correct":false,"justification":"These are the LT CD4 (helpers). CD8 LTs are cytotoxic lymphocytes"},{"idx":4,"proposition":"Primary infection is most often accompanied by thrombocytosis","correct":false,"justification":"Rather, cytopenia is observed: thrombocytopenia and leukopenia predominant on lymphocytes"}],"type":"custom"}
+{"_id":"VIH-infectio-4","context":null,"enonce":"What is the incubation period for HIV?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"Between 2 and 3 days","correct":false,"justification":"This is the case of scarlet fever"},{"idx":1,"proposition":"Between 5 and 6 days","correct":false,"justification":"This is the case of whooping cough"},{"idx":2,"proposition":"Between 10 and 14 days","correct":true},{"idx":3,"proposition":"Between 18 and 20 days ","correct":false,"justification":"This is the case of rubella"},{"idx":4,"proposition":"Between 22 and 23 days","correct":false,"justification":"This is the case with mumps"}],"type":"custom"}
+{"_id":"VIH-infectio-5","context":null,"enonce":"Which of the following are verified types of HIV transmission?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"Sanguine","correct":true},{"idx":1,"proposition":"Sexual","correct":true},{"idx":2,"proposition":"Salivary","correct":false,"justification":"False"},{"idx":3,"proposition":"Materno-fetal","correct":true},{"idx":4,"proposition":"Contact","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"VIH-infectio-6","context":null,"enonce":"What is the CD4 LT threshold below which the AIDS stage is defined?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"100","correct":false,"justification":"False"},{"idx":1,"proposition":"200","correct":true,"justification":"True, it is from this threshold that most opportunistic infections can occur."},{"idx":2,"proposition":"50","correct":false,"justification":"False"},{"idx":3,"proposition":"400","correct":false,"justification":"False"},{"idx":4,"proposition":"600","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"VIH-infectio-7","context":null,"enonce":"What is the annual incidence of HIV in France?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"1 000","correct":false,"justification":"6400"},{"idx":1,"proposition":"6 400","correct":true},{"idx":2,"proposition":"10 000","correct":false,"justification":"6400"},{"idx":3,"proposition":"64 000","correct":false,"justification":"6400"},{"idx":4,"proposition":"100 000","correct":false,"justification":"6400"}],"type":"custom"}
+{"_id":"VIH-infectio-8","context":null,"enonce":"Which of the following proposals are NRTIs (Nucleoside Reverse Transcriptase Inhibitors)?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"Ritonavir","correct":false,"justification":"Protease inhibitor"},{"idx":1,"proposition":"Tenofovir","correct":true},{"idx":2,"proposition":"Emtricitabine","correct":true},{"idx":3,"proposition":"Atazanavir","correct":false,"justification":"Protease inhibitor"},{"idx":4,"proposition":"Efavirenz","correct":false,"justification":"NNRTI (Non-Nucleoside Reverse Transcriptase Inhibitor). IC during pregnancy 🤰"}],"type":"custom"}
+{"_id":"VIH-infectio-9","context":null,"enonce":"Which of the following proposals are NNRTIs (Non-Nucleoside Reverse Transcriptase Inhibitors)?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"Ritonavir","correct":false,"justification":"Protease inhibitor"},{"idx":1,"proposition":"Emtricitabine","correct":false,"justification":"Nucleoside reverse transcriptase inhibitor (NRTI)"},{"idx":2,"proposition":"Tenofovir","correct":false,"justification":"Nucleoside reverse transcriptase inhibitor"},{"idx":3,"proposition":"Efavirenz","correct":true},{"idx":4,"proposition":"Nevirapine","correct":true}],"type":"custom"}
+{"_id":"VIH-infectio-10","context":null,"enonce":"Which of the following are protease inhibitors?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"Tenofovir","correct":false,"justification":"NRTI (Nucleoside Reverse Transcriptase Inhibitor)"},{"idx":1,"proposition":"Ritonavir","correct":true},{"idx":2,"proposition":"Atazanovir","correct":true},{"idx":3,"proposition":"Efavirenz","correct":false,"justification":"NNRTI (Non-Nucleoside Reverse Transcriptase Inhibitor)"},{"idx":4,"proposition":"Rilpivirine","correct":false,"justification":"NNRTI (Non-Nucleoside Reverse Transcriptase Inhibitor)"}],"type":"custom"}
+{"_id":"VIH-infectio-11","context":null,"enonce":"Which of the following are true about HIV and TB?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"proposition":"HIV-TB co-infection is common","correct":true},{"idx":1,"proposition":"Mother-to-child transmission of the virus is impossible","correct":false,"justification":"Very low risk (0.3%) if properly managed, but not impossible"},{"idx":2,"proposition":"Announcing the diagnosis to a teenager is useless as long as he is a minor","correct":false,"justification":"Diagnosis, treatment and prevention of essential complications at any age"},{"idx":3,"proposition":"Curative treatment for tuberculosis does not differ in HIV+ subjects from that recommended in non-HIV patients","correct":true},{"idx":4,"proposition":"Rifampicin interacts with many protease inhibitors","correct":true,"justification":"True. Pilly 2020: \"Drug interactions between antiretrovirals and rifampicin\""}],"type":"custom"}
+{"_id":"compressionmed-neuro-0","context":null,"enonce":"Which propositions are true?","item":"compressionmed","matiere":"neuro","propositions":[{"idx":0,"proposition":"Non-traumatic spinal cord compressions are extremely rare","correct":false,"justification":"Non-traumatic compressions of the spinal cord and cauda equina represent a frequent clinical situation whose diagnosis must be made very early at the onset of signs in order to limit the pathophysiological and functional consequences"},{"idx":1,"proposition":"Extradural compressions are the most common, with in particular vertebral metastases","correct":true},{"idx":2,"proposition":"Intramedullary compressions are the most common","correct":false,"justification":"Intramedullary: rarer (example: ependymoma)"},{"idx":3,"proposition":"The only reference test is the non-injected CT scan","correct":false,"justification":"The analysis of the level of the lesion is decisive to guide the level explored by the only reference examination that is magnetic resonance imaging (MRI)"},{"idx":4,"proposition":"The spinal cord extends in adults from the foramen magnum to the intervertebral disc L4","correct":false,"justification":"The medulla arises from the emergence of C1 and ends at the level of the intervertebral discs L1-L2"}],"type":"custom"}
+{"_id":"compressionmed-neuro-1","context":null,"enonce":"Regarding some definitions:","item":"compressionmed","matiere":"neuro","propositions":[{"idx":0,"proposition":"Below the T12 vertebra, there can be no spinal cord compression","correct":false,"justification":"Below the L2 vertebra, there can therefore be no spinal cord compression, it is a cauda equina syndrome"},{"idx":1,"proposition":"The lesional syndrome corresponds to the involvement at the site of the compression and the extent in height of the involvement of the gray matter and or several contiguous roots","correct":true},{"idx":2,"proposition":"The sublesional syndrome corresponds to the expression of the involvement of the long descending and ascending pathways at the level of the lesion","correct":true},{"idx":3,"proposition":"Tetraplegia is a deficit or loss of motor and sensory functions in the lumbar segments of the spinal cord","correct":false,"justification":"Tetraplegia (preferred term to quadriplegia): this term corresponds to a deficit or loss of motor and sensory functions in the cervical segments of the spinal cord due to damage to the neurax inside the spinal canal"},{"idx":4,"proposition":"Paraplegia is a deficit or loss of motor and\/or sensory functions in the thoracic, lumbar and sacral segments of the ME","correct":true}],"type":"custom"}
+{"_id":"compressionmed-neuro-3","context":null,"enonce":"Regarding the initial management of patients:","item":"compressionmed","matiere":"neuro","propositions":[{"idx":0,"proposition":"ASIA Grade E corresponds to normal sensory and motor functions","correct":true},{"idx":1,"proposition":"The systematization of the examination of the spinal cord injury, including the examination of the sacral sphere, makes it possible to identify initial prognostic factors for recovery","correct":true},{"idx":2,"proposition":"Additional motor testing of non-key muscles is optional","correct":false,"justification":"Must complete the minimum standard exam"},{"idx":3,"proposition":"A proprioception assessment should be performed","correct":true},{"idx":4,"proposition":"The assessment of spasticity is made by the modified Allen scale","correct":false,"justification":"an assessment of spasticity (modified Ashworth scale, Penn spasm scale) and its impact on motor control and functionality"}],"type":"custom"}
+{"_id":"compressionmed-neuro-4","context":null,"enonce":"What are their proposals?","item":"compressionmed","matiere":"neuro","propositions":[{"idx":0,"proposition":"Spinal cord compressions most often produce incomplete pictures when the diagnosis is not too late","correct":true},{"idx":1,"proposition":"Cauda equina syndrome should be suspected and investigated during any sciatica","correct":true},{"idx":2,"proposition":"Cauda equina syndrome is never lateralized","correct":false,"justification":"Cauda equina syndrome may be lateralized and incomplete"},{"idx":3,"proposition":"The great specificity of spinal cord injuries is to be at the origin of a table of multi-organ and multi-system deficiencies","correct":true},{"idx":4,"proposition":"Management of spinal cord injuries is the responsibility of physical medicine and rehabilitation services","correct":true}],"type":"custom"}
+{"_id":"compressionmed-neuro-5","context":null,"enonce":"Regarding patient care:","item":"compressionmed","matiere":"neuro","propositions":[{"idx":0,"proposition":"The rehabilitation scheme for non-traumatic spinal cord injuries follows the same principles as that for traumatic injuries","correct":true},{"idx":1,"proposition":"The spinal cord injury is a major risk of esores from 3 months post-accident","correct":false,"justification":"From the initial phase and throughout the patient's life"},{"idx":2,"proposition":"The pathophysiology of pressure ulcers in the medulla injured is related to sensory disorders alone","correct":false,"justification":"The pathophysiology of pressure ulcers in the medulla-injured is related to the sensory and motor disorders induced by the spinal injury but also to the associated vegetative paralysis (lack of microcirculatory adaptation to pressure)"},{"idx":3,"proposition":"The incidence and prevalence of pressure ulcers is in the order of 0.3%","correct":false,"justification":"The incidence and prevalence of pressure ulcers, whether acute or chronic, are in the order of 30%, and pressure ulcers are one of the leading causes of re-hospitalization in spinal cord injuries."},{"idx":4,"proposition":"Chest involvement (Th6 and above) is characterized by sympathetic and parasympathetic involvement","correct":false,"justification":"Sympathetic impairment and parasympathetic preservation"}],"type":"custom"}
+{"_id":"compressionmed-neuro-6","context":null,"enonce":"Regarding support:","item":"compressionmed","matiere":"neuro","propositions":[{"idx":0,"proposition":"The interruption of the efferent pathways of the baro-reflex is the cause of major orthostatic hypotension when the attack is above T6","correct":true},{"idx":1,"proposition":"Prevention of OH requires progressive verticalization on inclined plane","correct":true},{"idx":2,"proposition":"Thromboembolic risk requires prevention by LMWH for at least 8 weeks post-accident","correct":true},{"idx":3,"proposition":"Vesicosphincter disorders are rare in this type of lesion","correct":false,"justification":"These disorders are still today one of the leading causes of morbidity and rehospitalizations justifying specialized care and long-term follow-up."},{"idx":4,"proposition":"In the initial phase, especially during the subacute installation of a spinal cord injury or cauda equina, bladder symptoms are non-existent","correct":false,"justification":"In the initial phase, especially during the subacute installation of a spinal cord injury or cauda equina, acute retention is the rule"}],"type":"custom"}
+{"_id":"compressionmed-neuro-7","context":null,"enonce":"Which of the following proposals are in favor of spinal cord compression?","item":"compressionmed","matiere":"neuro","propositions":[{"idx":0,"proposition":"Spastic paraparesis","correct":true},{"idx":1,"proposition":"Babinski's sign","correct":true},{"idx":2,"proposition":"Sensory level","correct":true},{"idx":3,"proposition":"Inexhaustible epileptoid trepidation","correct":true},{"idx":4,"proposition":"Bilateral cogwheel","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"compressionmed-neuro-8","context":null,"enonce":"Which of the following proposals can lead to a disco-radicular conflict in case of lumbo-cruralgia L4?","item":"compressionmed","matiere":"neuro","propositions":[{"idx":0,"proposition":"Foraminal hernia L4-L5 ","correct":true},{"idx":1,"proposition":"Foraminal hernia L3-L4","correct":false,"justification":"Foraminal or extraforaminal hernia X-Y = > X key"},{"idx":2,"proposition":"A median or paramedian hernia L3-L4","correct":true},{"idx":3,"proposition":"A median or paramedian hernia L4-L5","correct":false,"justification":"Median or paramedian hernia X-Y = > touch Y"},{"idx":4,"proposition":"An extraforaminal hernia L4-L5","correct":true}],"type":"custom"}
+{"_id":"diarrheeaigue-HGE-0","context":null,"enonce":"Regarding acute diarrhoea","item":"diarrheeaigue","matiere":"HGE","propositions":[{"idx":0,"proposition":"Diarrhea is defined in adults by the emission of too frequent, too abundant stools, of abnormal consistency (liquid or very soft), and weight greater than 30 g \/ d","correct":false,"justification":"Definitions Diarrhoea is defined in adults by the emission of stools that are too frequent, too abundant, of abnormal consistency (liquid or very soft), and of weight greater than 300 g \/ day"},{"idx":1,"proposition":"Diarrhea is said to be acute when it has progressed for less than 2 weeks","correct":true},{"idx":2,"proposition":"In the majority of cases, acute diarrhea is sudden onset","correct":true},{"idx":3,"proposition":"It is then most often due to an infection, usually lasts less than a week and recurrences in the short term","correct":false,"justification":"It is then most often due to an infection, usually lasts less than a week and does not recur in the short term."},{"idx":4,"proposition":"A dysenteric syndrome is defined by bloody and glairous evacuations that can be dissociated from the materials","correct":true}],"type":"custom"}
+{"_id":"diarrheeaigue-HGE-1","context":null,"enonce":"Regarding acute diarrhoea","item":"diarrheeaigue","matiere":"HGE","propositions":[{"idx":0,"proposition":"When it involves afecal evacuations, dysenteric syndrome indicates a distal colonic organic lesion","correct":true},{"idx":1,"proposition":"Acute diarrhea most often regresses spontaneously or under symptomatic treatment within 3 days","correct":true},{"idx":2,"proposition":"Digestive losses due to diarrhea include water, sodium (about 50 mmol\/L), potassium and bicarbonates","correct":true},{"idx":3,"proposition":"Physical examination of the abdomen is most often normal or shows only diffuse tenderness on abdominal palpation","correct":true},{"idx":4,"proposition":"In infants, dehydration can cause: apathy, difficulty waking up with moans, unusual behavior and bradypnea","correct":false,"justification":"When it involves afecal evacuations, dysenteric syndrome indicates a distal colonic organic lesion"}],"type":"custom"}
+{"_id":"rachialgie-rhumato-0","context":null,"enonce":"Regarding generalities about rachialgia:","item":"rachialgie","matiere":"rhumato","propositions":[{"idx":0,"proposition":"The infectious origin of spinal pain is the most common","correct":false,"justification":"Rachialgia, whether cervical, thoracic or lumbar, is a symptom whose etiology can be extremely varied, even if the degenerative origin (often called \"common\" vertebral pathology) is, by far, the most frequent"},{"idx":1,"proposition":"Neck pain is extremely common pain of the cervical spine","correct":true},{"idx":2,"proposition":"Torticollis is an acute cervical pain syndrome with associated muscle contracture","correct":true,"justification":"A distinction is made between torticollis, which is an acute cervical pain syndrome with associated muscle contracture, and subacute or chronic neck pain, most often of degenerative origin."},{"idx":3,"proposition":"The so-called \"common\" neck pain is related to osteoarthritis or disc disease lesions","correct":true},{"idx":4,"proposition":"Discopathic lesions are always symptomatic","correct":false,"justification":"In the majority of cases, it is asymptomatic, and this notion must be present in mind so as not to attribute the symptomatology too easily to radiographic abnormalities."}],"type":"custom"}
+{"_id":"rachialgie-rhumato-1","context":null,"enonce":"Concerning common neck pain:","item":"rachialgie","matiere":"rhumato","propositions":[{"idx":0,"proposition":"\"Common\" neck pain is cervical pain related to degenerative discovertebral mechanical lesions","correct":true},{"idx":1,"proposition":"Common circles check for the absence of general signs or a particular general context","correct":true},{"idx":2,"proposition":"Common low back pain is an inflammatory lesion","correct":false,"justification":"Mechanical injuries"},{"idx":3,"proposition":"Spinal muscles can be painful on palpation","correct":true},{"idx":4,"proposition":"A median and impulsive low back pain in a person between 20 and 60 years of age points to an inflammatory origin","correct":false,"justification":"Rather of mechanical origin"}],"type":"custom"}
+{"_id":"rachialgie-rhumato-2","context":null,"enonce":"Regarding common neck pain:","item":"rachialgie","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Standard X-ray In front of a common neck pain is necessary to eliminate any inflammatory, infectious or neoplastic process","correct":false,"justification":"In front of a simple torticollis, acute neck pain, or a recurrence of chronic neck pain known and already explored, without any red flag, there is no need to perform imaging"},{"idx":1,"proposition":"Dynamic images (in flexion and profile extension) are useful if there is a traumatic history when X-rays are indicated","correct":true},{"idx":2,"proposition":"MRI is contraindicated in front of neck pain because useless","correct":false,"justification":"It is only useful in front of red flags,"},{"idx":3,"proposition":"In the disc origin, pain is little present, if at all","correct":false,"justification":"The picture is often very algic, with cervical stiffness and contracture, analgesic attitude, impulsivity"},{"idx":4,"proposition":"Degenerative\/osteoarthritis origin is the most common","correct":true}],"type":"custom"}
+{"_id":"rachialgie-rhumato-3","context":null,"enonce":"Which propositions are true?","item":"rachialgie","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Senile kyphosis known as \"Schmorl\" is linked to Scheuermann's disease","correct":true},{"idx":1,"proposition":"Senile kyphosis is still symptomatic","correct":false,"justification":"It is rarely symptomatic"},{"idx":2,"proposition":"Herniated discs may be asymptomatic","correct":true,"justification":"They are in the majority of cases"},{"idx":3,"proposition":"Scoliosis promotes costovertebral osteoarthritis","correct":true,"justification":"Just as hip dysplasia promotes coxarthrosis; and varus\/valgus gonarthrosis"},{"idx":4,"proposition":"\"Common\" low back pain is lumbar spine pain related to degenerative discovertebral mechanical injuries","correct":true}],"type":"custom"}
+{"_id":"rachialgie-rhumato-4","context":null,"enonce":"Which of the following proposals are in favour of common low back pain?","item":"rachialgie","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Long-term corticosteroid use","correct":false,"justification":"False"},{"idx":1,"proposition":"Freedom from HIV infection","correct":true},{"idx":2,"proposition":"Immunosuppression","correct":false,"justification":"False"},{"idx":3,"proposition":"Lack of weight loss","correct":true},{"idx":4,"proposition":"Cauda equina syndrome","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"rachialgie-rhumato-6","context":null,"enonce":"Which of the following proposals are in favour of common low back pain?","item":"rachialgie","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Chest pain","correct":false,"justification":"False"},{"idx":1,"proposition":"The mechanical schedule of pain","correct":true},{"idx":2,"proposition":"Structural deformation","correct":false,"justification":"False"},{"idx":3,"proposition":"35 years","correct":true},{"idx":4,"proposition":"The absence of fever","correct":true}],"type":"custom"}
+{"_id":"coma-urg-0","context":null,"enonce":"Which of the following are mixed nerves?","item":"coma","matiere":"urg","propositions":[{"idx":0,"proposition":"Olfactory nerve I","correct":false,"justification":"Sensory nerve"},{"idx":1,"proposition":"Optic nerve II","correct":false,"justification":"Sensory nerve"},{"idx":2,"proposition":"Trigeminal V nerve","correct":true},{"idx":3,"proposition":"Nerve VI abducens","correct":false,"justification":"Motor nerve (lateral straight, abduction of the eye)"},{"idx":4,"proposition":"Facial nerve VII ","correct":true}],"type":"custom"}
+{"_id":"coma-urg-3","context":null,"enonce":"Which of the following propositions are true regarding decebration?","item":"coma","matiere":"urg","propositions":[{"idx":0,"proposition":"The upper limbs are in flexion","correct":false,"justification":"Extension"},{"idx":1,"proposition":"The upper limbs are in extension","correct":true},{"idx":2,"proposition":"The lower limbs are in flexion","correct":false,"justification":"Extension"},{"idx":3,"proposition":"The lower limbs are in extension","correct":true},{"idx":4,"proposition":"The head is flexed","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"coma-urg-4","context":null,"enonce":"Which of the following proposals are involved in the reflex of the veil of the palate 👄?","item":"coma","matiere":"urg","propositions":[{"idx":0,"proposition":"Glossopharyngeal nerve IX","correct":true,"justification":"True. Mixed nerve involved in the afferent pathway of this reflex"},{"idx":1,"proposition":"Vagus X nerve","correct":true,"justification":"True. Mixed nerve involved in the efferent pathway of this reflex"},{"idx":2,"proposition":"Spinal nerve XI","correct":false,"justification":"Mixed nerve"},{"idx":3,"proposition":"Nerve XII hypoglossus","correct":false,"justification":"False"},{"idx":4,"proposition":"Craniooccipital nerve XIII","correct":false,"justification":"This nerve does not exist, it is invented 🧙 ♂️"}],"type":"custom"}
+{"_id":"coma-urg-5","context":null,"enonce":"Which of the following are attenuated forms of coma? (Emergency MedLine)","item":"coma","matiere":"urg","propositions":[{"idx":0,"proposition":"Obnubilation","correct":true},{"idx":1,"proposition":"Confusion","correct":true},{"idx":2,"proposition":"Anxiety","correct":false,"justification":"False"},{"idx":3,"proposition":"Profuf asthenia","correct":false,"justification":"False"},{"idx":4,"proposition":"Stupor","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"grippe-infectio-0","context":null,"enonce":"Regarding influenza virus infection","item":"grippe","matiere":"infectio","propositions":[{"idx":0,"proposition":"It presents an epidemic with a seasonal rhythm autumn-winter","correct":true},{"idx":1,"proposition":"It has a strict human-to-human transmission","correct":true},{"idx":2,"proposition":"The high attack rate in case of close and repeated contact","correct":true,"justification":"In epidemiology, the attack rate (ATR) is an indicator used to characterize the morbidity of an epidemic. It most often corresponds to a cummule incidence rate"},{"idx":3,"proposition":"Transmission mainly within the family and in communities","correct":true},{"idx":4,"proposition":"Influenza is a disease circulating in 2 modes: seasonal and pandemic","correct":true}],"type":"custom"}
+{"_id":"grippe-infectio-1","context":null,"enonce":"Regarding influenza infection","item":"grippe","matiere":"infectio","propositions":[{"idx":0,"proposition":"During an epidemic season, about 10% of the world's population is infected","correct":true},{"idx":1,"proposition":"Children play a major role in the spread of an epidemic","correct":true,"justification":"Being often asymptomptopopatic, they play the role of healthy carriers"},{"idx":2,"proposition":"Influenza easily decompensates an underlying medical condition","correct":true,"justification":"This is why people at risk (elderly or immunocompromised) should be monitored."},{"idx":3,"proposition":"Secondary bacterial pneumonia (post influenza) is found particularly in the elderly","correct":true},{"idx":4,"proposition":"Chest X-ray will be systematically useful","correct":false,"justification":"Chest X-ray will be useful in for differential diagnosis or in case of complications"}],"type":"custom"}
+{"_id":"grippe-infectio-2","context":null,"enonce":"About the flu virus","item":"grippe","matiere":"infectio","propositions":[{"idx":0,"proposition":"Staphylococcus aureus, Haemophilus influenzae and pneumococcus are the main bacteria implicated in bacterial superinfection","correct":true},{"idx":1,"proposition":"Microbiological tests have no indication for uncomplicated seasonal influenza","correct":true},{"idx":2,"proposition":"The reference method of virus detection is antigen detection by ELISA","correct":false,"justification":"The reference method is PCR"},{"idx":3,"proposition":"Serology has no interest","correct":true},{"idx":4,"proposition":"An inflammatory syndrome (high CRP) can appear in case of bacterial superinfection and is very specific","correct":false,"justification":"An inflammatory syndrome (elevated CRP) may occur in case of bacterial superinfection. But beware, this is not at all a specific sign"}],"type":"custom"}
+{"_id":"grippe-infectio-3","context":null,"enonce":"Regarding influenza virus infection","item":"grippe","matiere":"infectio","propositions":[{"idx":0,"proposition":"Rest at home and, where appropriate, a work stoppage are to be prescribed","correct":true},{"idx":1,"proposition":"Analgesics and antipyretics are prescribed if poorly tolerated fever","correct":true,"justification":"Paracetamol is the molecule of choice"},{"idx":2,"proposition":"NSAIDs and corticosteroids should be avoided","correct":true},{"idx":3,"proposition":"Cough suppressants and bronchial thinners are ineffective in treating influenza","correct":true},{"idx":4,"proposition":"If bacterial pulmonary superinfection characterized, antibiotic therapy targeting Haemophilius Influenzae should be prescribed","correct":true}],"type":"custom"}
+{"_id":"grippe-infectio-4","context":null,"enonce":"Which of the following statements about influenza are true?","item":"grippe","matiere":"infectio","propositions":[{"idx":0,"proposition":"Transmission is strictly human-to-human ","correct":true},{"idx":1,"proposition":"Direct transmission by air is via aerosols ","correct":false,"justification":"False.\r\nVia droplets."},{"idx":2,"proposition":"Contagiousness of the subject is defined as 1 day before the onset of symptoms to 6 days after. ","correct":true},{"idx":3,"proposition":"The incubation period is 1-3 days.","correct":true},{"idx":4,"proposition":"Bacterial superinfection usually occurs between the 5th and 7th day after the onset of symptoms.","correct":true}],"type":"custom"}
+{"_id":"adenomehypoP-endoc-0","context":null,"enonce":"Regarding the compression of the optical chiasm:","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"proposition":"Pituitary tumor syndrome can compress the optic pathways","correct":true},{"idx":1,"proposition":"Visual acuity is most often lowered","correct":false,"justification":"Visual acuity is most often normal due to the absence of involvement of the central visual field; sometimes it is reduced in case of very large and long neglected lesions"},{"idx":2,"proposition":"Fundus examination is normal most often","correct":true},{"idx":3,"proposition":"The study of the visual field with the Goldman apparatus finds a superior temporal quadranopsia","correct":true},{"idx":4,"proposition":"Emergency imaging allows diagnosis by showing an adenoma in the process of necrosis or hemorrhage","correct":true}],"type":"custom"}
+{"_id":"adenomehypoP-endoc-1","context":null,"enonce":"Regarding the diagnosis of pituitary adenomas:","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"proposition":"The indication of CT scan of the pituitary region is currently limited to bone impact analysis of macroadenomas","correct":true},{"idx":1,"proposition":"Magnetic resonance imaging (MRI) is the gold standard test for exploring the hypothalamic-pituitary region","correct":true},{"idx":2,"proposition":"In T2 weighting, adenomas can be hypo, iso or more often hyperintense","correct":true},{"idx":3,"proposition":"After injection, the microadenoma appears hypointense to the rest of the pituitary gland which takes the contrast homogeneously in T1","correct":true},{"idx":4,"proposition":"Dynamic shots are used to analyze differences in contrast taking","correct":true}],"type":"custom"}
+{"_id":"adenomehypoP-endoc-2","context":null,"enonce":"Which of the following are dosages to look for corticotropic insufficiency after pituitary surgery for cortisolic adenoma?","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"proposition":"Urinary free cortisol for 24h","correct":false,"justification":"Used for hypercorticism"},{"idx":1,"proposition":"Cortisolemia at 8 a.m.","correct":true,"justification":"True, there is a physiological peak, which disappears in case of corticotropic insufficiency"},{"idx":2,"proposition":"Cortisolemia at any time","correct":false,"justification":"False, difficult to interpret"},{"idx":3,"proposition":"Braking test","correct":false,"justification":"False, hypercorticism screening test"},{"idx":4,"proposition":"None of the propositions are true","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"adenomehypoP-endoc-3","context":null,"enonce":"Which of the following are pathologies that fall within the scope of an NMS 1?","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"proposition":"Macroprolactinoma","correct":true,"justification":"Pituitary adenomas are part of the MEN1 spectrum"},{"idx":1,"proposition":"Parathyroid adenoma","correct":true},{"idx":2,"proposition":"Hyperthyroidism","correct":false,"justification":"False"},{"idx":3,"proposition":"Wilson's disease","correct":false,"justification":"False"},{"idx":4,"proposition":"Adisson's disease","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"adenomehypoP-endoc-4","context":null,"enonce":"Which of the following are signs or symptoms of Cushing's syndrome?","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"proposition":"Android obesity","correct":true},{"idx":1,"proposition":"Muscle hypertrophy","correct":false,"justification":"Muscular"},{"idx":2,"proposition":"Bison hump","correct":true},{"idx":3,"proposition":"Acanthosis nigricans","correct":true},{"idx":4,"proposition":"Hyperkeratosis","correct":false,"justification":"Capillary fragility"}],"type":"custom"}
+{"_id":"adenomehypoP-endoc-5","context":null,"enonce":"Which of the following are signs or symptoms of Cushing's syndrome?","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"proposition":"Gynoid obesity","correct":false,"justification":"Android obesity"},{"idx":1,"proposition":"Muscular","correct":true,"justification":"True, sign of the stool"},{"idx":2,"proposition":"Facial erythrosis","correct":true},{"idx":3,"proposition":"White vertegures","correct":false,"justification":"Purple stretch marks"},{"idx":4,"proposition":"Psychic hyperactivity","correct":false,"justification":"False, rather a depressive tendency"}],"type":"custom"}
+{"_id":"adenomehypoP-endoc-6","context":null,"enonce":"Which of the following are plasma assays that can confirm Cushing's syndrome?","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"proposition":"Dexamethasone Brake Test","correct":true},{"idx":1,"proposition":"24-hour cortisol assay","correct":true},{"idx":2,"proposition":"Urinary free cortisol","correct":false,"justification":"Screening test"},{"idx":3,"proposition":"Determination of ACTH","correct":false,"justification":"Test that determines the etiology of Cushing"},{"idx":4,"proposition":"Cortisol assay at 8 a.m.","correct":false,"justification":"Not very informative because physiological peak at 8 am"}],"type":"custom"}
+{"_id":"IRespiC-pneumo-0","context":null,"enonce":"Regarding chronic respiratory failure or CKD","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Chronic respiratory failure (CKD) is defined by the inability of the respiratory system to provide haematosis","correct":true},{"idx":1,"proposition":"The main clinical sign of chronic respiratory failure is dyspnea","correct":true},{"idx":2,"proposition":"Chronic respiratory failure is the common evolutionary term for many respiratory diseases","correct":true},{"idx":3,"proposition":"His prognosis is benign","correct":false,"justification":"His prognosis is severe"},{"idx":4,"proposition":"Comorbidities, depending on the etiology of CKD, are common and should be systematically sought","correct":true}],"type":"custom"}
+{"_id":"IRespiC-pneumo-1","context":null,"enonce":"Regarding chronic respiratory failure or CKD","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The withdrawal of a possible tobacco intoxication is secondary because the attack is already at an advanced stage","correct":false,"justification":"Quitting from possible tobacco intoxication is essential"},{"idx":1,"proposition":"Patients with chronic respiratory failure are at risk of decompensation (acute respiratory failure), which has significant morbidity and mortality","correct":true},{"idx":2,"proposition":"Assessment of pulmonary arterial pressure should be sought during follow-up","correct":true},{"idx":3,"proposition":"The existence of a decrease in the partial pressure of oxygen (PaO2) in the arterial blood (hypoxemia) is necessary to speak of chronic respiratory failure","correct":true},{"idx":4,"proposition":" The realization of blood gas is therefore essential to make the diagnosis of chronic respiratory failure (CKD)","correct":true}],"type":"custom"}
+{"_id":"IRespiC-pneumo-2","context":null,"enonce":"Regarding chronic respiratory failure or CKD","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The most common cause of CKD (75% of cases) is COPD","correct":true},{"idx":1,"proposition":"Hypoxia is a decrease in the distribution of oxygen to tissues","correct":true},{"idx":2,"proposition":"We speak of shunt effect when certain lung units are ventilated normally but poorly infused","correct":true,"justification":"Or when some lung units are infused normally but poorly ventilated"},{"idx":3,"proposition":"The passage of gases (O2 and CO2) through the alveolo-capillary membrane depends on the thickness of the membrane and its surface but also on the integrity of the pulmonary vascular bed","correct":true},{"idx":4,"proposition":"Polycythemia is an adaptive, inconstant phenomenon that aims to compensate for the decrease in oxygen saturation to maintain arterial content of O2 (CaO2), due to the production by the liver of erythropoietin (EPO),","correct":false,"justification":"Polycythemia It aims to maintain normal arterial oxygen transport  adaptive, inconsistent phenomenon  aims to compensate for the decrease in oxygen saturation to maintain arterial O2 (CaO2) content  due to the kidney's production of erythropoietin (EPO), in response to chronic hypoxemia  leads to blood hyperviscosity and an increased risk of arterial or venous thrombosis"}],"type":"custom"}
+{"_id":"IRespiC-pneumo-3","context":null,"enonce":"Regarding chronic respiratory failure or CKD","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Only the presence of chronic hypoxemia is necessary for the diagnosis of CKD but most CKD is complicated in the long term by alveolar hypoventilation and therefore hypercapnia","correct":true},{"idx":1,"proposition":"The capnia of some patients can thus be established, chronically, at high levels (> 60 mmHg)","correct":true},{"idx":2,"proposition":"Hypercapnia is extremely harmful even with normal pH","correct":false,"justification":"Hypercapnia is not or only slightly harmful as long as the pH remains normal"},{"idx":3,"proposition":"CKD is the common evolutionary term for many respiratory diseases","correct":true},{"idx":4,"proposition":"Lung exchanger involvement is by far the leading cause of CKD","correct":true}],"type":"custom"}
+{"_id":"IRespiC-pneumo-4","context":null,"enonce":"Regarding chronic respiratory failure or CKD","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Depending on the etiologies, EFRs show obstructive ventilatory disorder (OVD) defined by a FEV1\/FVC ratio < 70%, a restrictive ventilatory disorder (RVC) defined by a CPT < 80%) or a mixed ventilatory disorder","correct":true},{"idx":1,"proposition":"The most effective way to correct hypoxemia related to lung exchanger involvement is long-term oxygen therapy (OLD).","correct":true},{"idx":2,"proposition":"Ventilatory pump refers to the different structures surrounding the lung exchanger and involved in chest amplification and therefore lung ventilation.","correct":true},{"idx":3,"proposition":"The operation of the ventilatory pump can be altered by different mechanisms sometimes associated:  decrease in ventilatory control (stroke)  neuromuscular pathologies: spinal lesions, myopathies, amyotrophic lateral sclerosis  increase in the load imposed by the chest wall   chest deformity morbid obesity and obesity\/hypoventilation syndrome (increasingly common cause of CKD by damage to the ventilatory pump)An accident cerebral vascular can lead to alteration of the ventilatory pump","correct":true},{"idx":4,"proposition":"The main mechanism responsible for hypoxemia is the reduction of alveolar ventilation (alveolar hypoventilation)","correct":true}],"type":"custom"}
+{"_id":"IRespiC-pneumo-5","context":null,"enonce":"Regarding chronic respiratory failure or CKD","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Only the presence of chronic hypoxemia is necessary for the diagnosis of CKD","correct":true},{"idx":1,"proposition":"Lung exchanger involvement is by far the leading cause of CKD","correct":true},{"idx":2,"proposition":"The operation of the ventilatory pump can be altered by different mechanisms sometimes associated such as the decrease in ventilatory control related to a stroke","correct":true},{"idx":3,"proposition":"In CKD related to ventilatory pump involvement, PaCO2 is increased very early in the course of the disease","correct":true},{"idx":4,"proposition":"The most effective way to correct hypercapnia (and hypoxemia) is oxygen therapy but non-invasive ventilation.","correct":false,"justification":"The most effective way to correct hypercapnia (and hypoxemia) is not oxygen therapy but mechanical ventilation that replaces the \"pump function\" that is defective."}],"type":"custom"}
+{"_id":"IRespiC-pneumo-6","context":null,"enonce":"Regarding chronic respiratory failure or CKD","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Cyanosis reflects the existence in the integuments of a high amount of hemoglobin desaturated with oxygen","correct":true},{"idx":1,"proposition":"The diagnosis of CKD is confirmed by the measurement of arterial blood gases showing PaO2 < 70 mmHg twice (steady state)","correct":true},{"idx":2,"proposition":"Pulmonary function tests play a pivotal role in the etiological orientation of a patient with CKD","correct":true},{"idx":3,"proposition":"Obstructive ventilatory disorder (OSVD) is characterized by a FEV1\/FVC ratio <40%","correct":false,"justification":"obstructive ventilatory disorder (OPT) are characterized by a FEV1\/FVC ratio <70%"},{"idx":4,"proposition":"it is by definition obstructive CKD","correct":true}],"type":"custom"}
+{"_id":"IRespiC-pneumo-7","context":null,"enonce":"Regarding chronic respiratory failure or CKD","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"proposition":"BCPO is the leading cause of restrctive CKD","correct":false,"justification":"Obstructive"},{"idx":1,"proposition":"The NFS will look for anemia during CKD","correct":false,"justification":"NFS will look for polycythemia"},{"idx":2,"proposition":"A normal ECG does not rule out proven right ventricular failure","correct":true},{"idx":3,"proposition":"The 6-minute walking test and the cardiorespiratory stress test in particular allow a prognostic evaluation of patients with chronic respiratory failure","correct":true},{"idx":4,"proposition":"Right cardiac catheterization confirms PH and the exact level of right pressures","correct":true}],"type":"custom"}
+{"_id":"IRenA-urg-0","context":null,"enonce":"Which propositions are true?","item":"IRenA","matiere":"urg","propositions":[{"idx":0,"proposition":"An AKI can complicate underlying chronic kidney disease, for example after injection of iodinated contrast media or taking nonsteroidal anti-inflammatory drugs","correct":true},{"idx":1,"proposition":"Acute renal failure is never accompanied by anemia","correct":false,"justification":"AKI may be associated with anemia, in cases of acute hemolysis or hemorrhagic shock themselves causing AKI"},{"idx":2,"proposition":"Early and sometimes profound hypocalcemia may be present during ARI","correct":true,"justification":"Especially in case of rhabdomyolysis"},{"idx":3,"proposition":"In obstructive ARIs, the patient is always anuric","correct":false,"justification":"The obstacle may not be complete"},{"idx":4,"proposition":"In practice in front of any ARI, imaging of the urinary tract is essential to visualize the pyel-calicial cavities and in case of dilation, look for an obstacle","correct":true}],"type":"custom"}
+{"_id":"IRenA-urg-1","context":null,"enonce":"Which of these pathologies can cause chronic kidney failure without kidneys of reduced size?","item":"IRenA","matiere":"urg","propositions":[{"idx":0,"proposition":"Myeloma","correct":true,"justification":"The 4 pathologies are: diabetes, amyloidosis, myeloma and autosomal dominant polycystic kidney disease (PKAD)"},{"idx":1,"proposition":"High blood pressure","correct":false},{"idx":2,"proposition":"A kidney tumour","correct":false,"justification":"Be careful, the question is in the plural. A kidney tumor usually involves only one kidney"},{"idx":3,"proposition":"Amyloidosis","correct":true},{"idx":4,"proposition":"Extracellular hyperhydration","correct":false}],"type":"custom"}
+{"_id":"IRenA-urg-2","context":null,"enonce":"Which of these pathologies can cause obstructive kidney failure?","item":"IRenA","matiere":"urg","propositions":[{"idx":0,"proposition":"One-sided calculation on a single functional kidney ","correct":true},{"idx":1,"proposition":"Prostate cancer","correct":true},{"idx":2,"proposition":"Retroperitoneal liposclerosis","correct":true,"justification":"Be careful, in this case, dilation may be lacking because the urinary tract is enclosed in fibrosis"},{"idx":3,"proposition":"Thoracic aortic aneurysm","correct":false,"justification":"It's upstream"},{"idx":4,"proposition":"Bladder tumour","correct":true}],"type":"custom"}
+{"_id":"IRenA-urg-3","context":null,"enonce":"Let PUF be the glomerular transcapillary pressure gradient, and K the filtration coefficient, how is the GFR calculated?","item":"IRenA","matiere":"urg","propositions":[{"idx":0,"proposition":"GFR = UFP + K","correct":false,"justification":"GFR = UFP x K"},{"idx":1,"proposition":"GFR = UFP x K","correct":true},{"idx":2,"proposition":"GFR = PUF\/K","correct":false},{"idx":3,"proposition":"GFR = PUF - K","correct":false},{"idx":4,"proposition":"GFR = PUF x 10 + K","correct":false}],"type":"custom"}
+{"_id":"IRenA-urg-4","context":null,"enonce":"Which of these proposals can cause extracellular dehydration that can induce functional renal failure?","item":"IRenA","matiere":"urg","propositions":[{"idx":0,"proposition":"Extensive skin burns","correct":true},{"idx":1,"proposition":"Severe nephrotic syndrome","correct":false,"justification":"It is a cause of true or effective hypovolemia, but not of extracellular dehydration (the latter are due to losses). See page 221 of the CUEN"},{"idx":2,"proposition":"Taking NSAIDs","correct":false},{"idx":3,"proposition":"Adrenal insufficiency","correct":true,"justification":"Induces kidney loss"},{"idx":4,"proposition":"Profuse diarrhea","correct":true}],"type":"custom"}
+{"_id":"IRenA-urg-5","context":null,"enonce":"Among these proposals, which can cause hypovolemia (real or effective) that can induce functional renal failure?","item":"IRenA","matiere":"urg","propositions":[{"idx":0,"proposition":"Decompensated hepatic cirrhosis","correct":true},{"idx":1,"proposition":"Lithium","correct":false},{"idx":2,"proposition":"Congestive heart failure","correct":true,"justification":"This is cardio-renal syndrome"},{"idx":3,"proposition":"Cardiogenic shock","correct":true},{"idx":4,"proposition":"Internal gastrointestinal bleeding","correct":true}],"type":"custom"}
+{"_id":"tbneuroSegeria-geria-1","context":null,"enonce":"Regarding epidemiology:","item":"tbneuroSegeria","matiere":"geria","propositions":[{"idx":0,"proposition":"20% of people over 85 years of age are affected by presbycusis","correct":false,"justification":"About 60% of people over 85"},{"idx":1,"proposition":"There are approximately 120,000 hearing-impaired people in France","correct":false,"justification":"Between 4 and 6 million"},{"idx":2,"proposition":"85% of people over 60 have visual impairments","correct":false,"justification":"60% of over 60s"},{"idx":3,"proposition":"There are 207,000 blind (or deeply visually impaired) people in France","correct":true},{"idx":4,"proposition":"Total anosmia affects 10 to 15% of people over 80 years of age","correct":true}],"type":"custom"}
+{"_id":"tbneuroSegeria-geria-2","context":null,"enonce":"Regarding the management of disorders:","item":"tbneuroSegeria","matiere":"geria","propositions":[{"idx":0,"proposition":"There is no drug treatment for taste disorders","correct":true},{"idx":1,"proposition":"There is no drug treatment for smell disorders","correct":true},{"idx":2,"proposition":"The treatment of glaucoma involves the normalization of intraocular pressure by adrenergic agonists for example","correct":true},{"idx":3,"proposition":"The hearing aid is indicated as soon as the loss exceeds 5 dB between 1000 and 2000 Hz","correct":false,"justification":"Exceeds 30 dB"},{"idx":4,"proposition":"Prevention of diabetic retinopathy requires monitoring of glyccated hemoglobin every 3 months","correct":true}],"type":"custom"}
+{"_id":"infmigrant-infectio-0","context":null,"enonce":"Regarding the basics:","item":"infmigrant","matiere":"infectio","propositions":[{"idx":0,"proposition":"Infectious pathologies of migrants are all imported pathologies","correct":false,"justification":"No. It can also be pathologies acquired on French territory"},{"idx":1,"proposition":"Prevalences of HPV infection, EBV and hepatitis C are higher in migrant populations than in the general population","correct":false,"justification":"No, but this is the case for HIV infection, tuberculosis and hepatitis B."},{"idx":2,"proposition":"The metropolitan France has 11.2 million migrants mainly from sub-Saharan Africa","correct":false,"justification":"5.3 million migrants mainly from Africa and Europe"},{"idx":3,"proposition":"Infectious diseases acquired in metropolitan France are linked to changes in environment and unfavourable socio-economic conditions","correct":true},{"idx":4,"proposition":"Infectious diseases acquired in metropolitan France mainly concern political refugees","correct":false,"justification":"Infectious import pathologies concern: migrant workers and their families who have just arrived in France, political refugees, illegal immigrants, migrants returning regularly to their country of origin"}],"type":"custom"}
+{"_id":"infmigrant-infectio-1","context":null,"enonce":"Which propositions are true?","item":"infmigrant","matiere":"infectio","propositions":[{"idx":0,"proposition":"Pneumococcal infection is particularly serious in sickle cell patients","correct":true},{"idx":1,"proposition":"HIV infection and tuberculosis are often acquired in France","correct":true},{"idx":2,"proposition":"HIV, HBV, HCV serology and the interferon gamma test are to be performed as a first-line","correct":true},{"idx":3,"proposition":"The hemogram looking for eosinophilia is performed in first line","correct":false,"justification":"No. It depends on the context"},{"idx":4,"proposition":"Fasting blood glucose is performed when diabetes risk factors are present","correct":true}],"type":"custom"}
+{"_id":"infmigrant-infectio-2","context":null,"enonce":"Regarding support:","item":"infmigrant","matiere":"infectio","propositions":[{"idx":0,"proposition":"Social Security Health Examination Centers also offer a free health check-up","correct":true},{"idx":1,"proposition":"CeGIDD, CLAT and PASS carry out a large part of the health check-ups in migrants","correct":true},{"idx":2,"proposition":"Hepatitis should be systematically evoked in front of any fever with a history of a stay in an endemic area","correct":false,"justification":"Tuberculosis must be eliminated"},{"idx":3,"proposition":"Amoebosis can be hepatic (non-febrile diarrhea) or colic (painful and febrile hepatomegaly)","correct":false,"justification":"Colic form = non-febrile diarrhea. Hepatic form = painful and febrile hepatomegaly"},{"idx":4,"proposition":"The colonic form of aemobosis involves PNN hyperleukocytosis","correct":false,"justification":"This is the hepatic form"}],"type":"custom"}
+{"_id":"pathofer-HGE-0","context":null,"enonce":"Regarding iron metabolism in the body","item":"pathofer","matiere":"HGE","propositions":[{"idx":0,"proposition":"The body contains 3 to 4 g of iron","correct":true},{"idx":1,"proposition":"The majority of functional iron is in heme form in hemoglobin (2.5 g)","correct":true},{"idx":2,"proposition":"In the physiological state, the body does not absorb iron","correct":false,"justification":"About 10% of dietary iron is absorbed (± 1 mg\/d), which compensates for natural losses"},{"idx":3,"proposition":"Absorption is carried out by the enterocytes of the ileum","correct":false,"justification":"Absorption is carried out by the enterocytes of the duodenum and the proximal part of the jejunum"},{"idx":4,"proposition":"Another route of entry of iron into plasma is the recycling of erythrocytes by macrophages","correct":true}],"type":"custom"}
+{"_id":"pathofer-HGE-1","context":null,"enonce":"Concerning iron metabolism","item":"pathofer","matiere":"HGE","propositions":[{"idx":0,"proposition":"In the plasma sector, iron is supported by ferritin","correct":false,"justification":"In the plasma sector, iron is supported by transferrin"},{"idx":1,"proposition":"The regulation of iron metabolism is done at the level of absorption","correct":true},{"idx":2,"proposition":"Hepcidin, synthesized by the liver, will inhibit ferroportin inhibiting the export of iron to plasma by enterocytes and macrophages","correct":true},{"idx":3,"proposition":"Iron blocked in intestinal cells blocked by hepcidin will be eliminated by desquamation of enterocytes","correct":true},{"idx":4,"proposition":"The iron reserve in the body is between 0 and 1 g of iron, stored as transferrin","correct":false,"justification":"The iron reserve in the body is between 0 and 1 g of iron, stored in the form of ferritin, mainly in the liver, bone marrow and spleen"}],"type":"custom"}
+{"_id":"pathofer-HGE-2","context":null,"enonce":"Concerning iron pathologies","item":"pathofer","matiere":"HGE","propositions":[{"idx":0,"proposition":"Transferrin testing is the first-line test for assessing iron stock","correct":false,"justification":"It is the determination of ferritin that is the first-line examination to evaluate the iron stock"},{"idx":1,"proposition":"Ferritin is the storage protein of iron","correct":true},{"idx":2,"proposition":"The transferrin saturation coefficient is calculated from serum iron and transferrin","correct":true},{"idx":3,"proposition":"Under normal conditions, more than 80% of transferrin binding sites are occupied by iron","correct":false,"justification":"Under normal conditions, 20-45% of transferrin binding sites are occupied by iron"},{"idx":4,"proposition":"The transferrin saturation coefficient increases earlier than ferritin in hemochromatosis","correct":true}],"type":"custom"}
+{"_id":"pathofer-HGE-3","context":null,"enonce":"Concerning iron pathologies","item":"pathofer","matiere":"HGE","propositions":[{"idx":0,"proposition":"Iron deficiency affects nearly 10% of people in industrialized countries","correct":true},{"idx":1,"proposition":"Iron deficiency is marked by several successive stages: depletion of the iron stock, alteration of erythropoiesis resulting in microcytosis without anemia, then hypochromic and microcytic sideropene anemia ","correct":true,"justification":"Microcytic = > mean corpuscular volume [MCV] < 80 μ3\/fl"},{"idx":2,"proposition":"Iron deficiency can result from 3 mechanisms, which can be associated: malabsorption, lack of intake, excessive losses","correct":true},{"idx":3,"proposition":"In menopausal men and women, the origin of bleeding explaining iron deficiency is essentially digestive","correct":true},{"idx":4,"proposition":"In premenopausal women, the origin of the bleeding explaining the iron deficiency is primarily gynecological","correct":true}],"type":"custom"}
+{"_id":"pathofer-HGE-4","context":null,"enonce":"Regarding digestive explorations as part of the assessment of iron deficiency anemia:","item":"pathofer","matiere":"HGE","propositions":[{"idx":0,"proposition":"In the absence of signs of orientation, it should include upper endoscopy at any age and systematic colonoscopy after 50 years.","correct":true},{"idx":1,"proposition":"Duodenal biopsies should be routinely performed if gastroduodenal endoscopy is unremarkable.","correct":true},{"idx":2,"proposition":"Exploration of the small intestine by enteroscopy is systematic in case of colonoscopy without particularity","correct":false,"justification":"As a first line, the hail will be explored by videosendoscopic capsule."},{"idx":3,"proposition":"The endoscopic capsule is considered only after performing one or two upper endoscopies and a total colonoscopy","correct":true},{"idx":4,"proposition":"Total colonoscopy is contraindicated in subjects under 50 years of age","correct":false,"justification":"No contraindication of age"}],"type":"custom"}
+{"_id":"pathofer-HGE-5","context":null,"enonce":"Concerning the absoption of iron","item":"pathofer","matiere":"HGE","propositions":[{"idx":0,"proposition":"In the physiological state, the body absorbs 3-4 grams of iron every day","correct":false,"justification":"The body absorbs almost no iron (1mg). It is the iron stock that is 3-4 grams."},{"idx":1,"proposition":"Hepcidin inhibits ferroportin","correct":true},{"idx":2,"proposition":"Hepcidin is produced by the kidney","correct":false,"justification":"Produced by the liver and allows the homeostasis of iron metabolism by inhibiting the absorption of iron in the body. It blocks ferroportin, which normally allows iron to pass from the intracellular space of the enterocyte to the plasma sector."},{"idx":3,"proposition":"Transferrin is the storage form of iron ","correct":false,"justification":"This is ferritin. Transferrin transports iron in the plasma sector"},{"idx":4,"proposition":"Iron absorption occurs in the duodenum and proximal jejunum","correct":true}],"type":"custom"}
+{"_id":"pathofer-HGE-6","context":null,"enonce":"At what stage is hemocromatosis treated?","item":"pathofer","matiere":"HGE","propositions":[{"idx":0,"proposition":"Stage 0","correct":false,"justification":"Hemocromatosis is started at stage 2. The treatment is done by blood subtraction with an induction phase (frequency up to 1x \/ week) then a maintenance phase (every 1, 2, 3 ... month)"},{"idx":1,"proposition":"Stage 1","correct":false},{"idx":2,"proposition":"Stage 2","correct":true},{"idx":3,"proposition":"Stage 3","correct":false},{"idx":4,"proposition":"Stage 4","correct":false}],"type":"custom"}
+{"_id":"pathofer-HGE-7","context":null,"enonce":"What are the non-sideric causes of hyperferritininemia?","item":"pathofer","matiere":"HGE","propositions":[{"idx":0,"proposition":"Renal failure","correct":false,"justification":"Not related to ferritin metabolism"},{"idx":1,"proposition":"Hepatic cytolysis","correct":true},{"idx":2,"proposition":"An inflammatory syndrome","correct":true},{"idx":3,"proposition":"Misuse of alcohol","correct":true},{"idx":4,"proposition":"Colon cancer","correct":false,"justification":"Not related to ferritin metabolism"}],"type":"custom"}
+{"_id":"pathofer-HGE-8","context":null,"enonce":"Which of the following foods provides the most iron in the same amount ingested?","item":"pathofer","matiere":"HGE","propositions":[{"idx":0,"proposition":"Beef","correct":true,"justification":"It contains heme iron"},{"idx":1,"proposition":"Spinach","correct":false,"justification":"Contains a lot of iron but very little is absorbed"},{"idx":2,"proposition":"Lenses","correct":false,"justification":"Contains a lot of iron but very little is absorbed"},{"idx":3,"proposition":"Egg","correct":false},{"idx":4,"proposition":"Milk","correct":false}],"type":"custom"}
+{"_id":"HTA-cardio-0","context":null,"enonce":"Concerning hypertension","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"High blood pressure is the leading cause of death worldwide","correct":true},{"idx":1,"proposition":"Only 50% of hypertensive patients have their hypertension controlled under treatment","correct":false,"justification":"Much less: 50% of hypertensive patients know this, of which 80% are treated, and among treated patients, only 50% achieve their goals"},{"idx":2,"proposition":"Repeated stress promotes hypertension","correct":true},{"idx":3,"proposition":"A blood pressure of 166\/94 corresponds to moderate high blood pressure","correct":true,"justification":"Either a grade 2: PAS 160-179 or PAD 100-109 (between PAS and PAD, the highest grade is retained)"},{"idx":4,"proposition":"A blood pressure of 135\/83 is considered optimal","correct":false,"justification":"A voltage is optimal below 120\/80, the proposed voltage is considered \"normal high\""}],"type":"custom"}
+{"_id":"HTA-cardio-1","context":null,"enonce":"Concerning hypertension","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"A blood pressure at 181\/99 should be confirmed by ambulatory self-measurement before a consultation at 1 month, in order to confirm the diagnosis before initiating treatment","correct":false,"justification":"In case of grade 3 hypertension (>180\/110), treatment should be initiated promptly"},{"idx":1,"proposition":"Blood pressure norms measured in MAPA at night are <130\/80","correct":false},{"idx":2,"proposition":"A measurement by MAPA is systematically indicated to confirm hypertension","correct":false,"justification":"Only in cases of BP variability, inconsistencies between clinical involvement and measurements, resistant hypertension, suspected sleep apnea syndrome, pregnant woman or suspected episodes of orthostatic hypotension"},{"idx":3,"proposition":"The systematic secondary HTA research assessment includes a 12-lead ECG","correct":false,"justification":"The ECG is performed as part of the impact assessment of hypertension: search for left ventricular hypertrophy"},{"idx":4,"proposition":"In patients over 65 years of age, hypertension is more common in women","correct":true}],"type":"custom"}
+{"_id":"HTA-cardio-2","context":null,"enonce":"Concerning hypertension","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"The assessment carried out systematically upon discovery of hypertension includes a fundus","correct":false,"justification":"This is only performed in case of hypertensive emergency, grade 3 hypertension or diabetes"},{"idx":1,"proposition":"High blood pressure is the leading cause of AF","correct":true,"justification":"It also increases the thromboembolic risk associated with AF"},{"idx":2,"proposition":"A Sokolow index > 45 mm on the ECG indicates left ventricular hypertrophy","correct":false},{"idx":3,"proposition":"High blood pressure can lead to chronic kidney failure, which itself aggravates hypertension","correct":true},{"idx":4,"proposition":"In the assessment of arterial hypertension, the measurement of albuminuria should only be performed in non-proteinuric diabetics","correct":true}],"type":"custom"}
+{"_id":"HTA-cardio-3","context":null,"enonce":"Concerning hypertension","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"In case of NOIA (anterior ischemic optic neuropathy) due to arteriosclerosis (hypertension among others), fluorescein angiography shows associated choroidal ischemia","correct":false,"justification":"This sign is in favor of an arteritic cause: gigantocellular arteritis (Horton's disease, to be evoked absolutely in case of NOIA)"},{"idx":1,"proposition":"Hypertensive retinopathy is minimally symptomatic, except in cases of severe or prolonged hypertension","correct":true,"justification":"Late visual acuity decrease\/ only if hypertensive flare-up"},{"idx":2,"proposition":"Hypertensive choroidal disease is detected in particular by the presence of a sign of crossing at the fundus","correct":false,"justification":"This sign concerns arteriosclerosis. Hypertensive choroidopathy is characterized in particular by Elschnig's spots (small deep pigmented spots)"},{"idx":3,"proposition":"In ocular involvement of arterial hypertension, retinal hemorrhages correspond to grade II of arterial disease","correct":false,"justification":"Grade 2 hypertensive retinopathy"},{"idx":4,"proposition":"In case of hypertension, aspirin is recommended for primary prevention for all patients","correct":false,"justification":"Recommended only for primary prevention or diabetes, not recommended for severe uncontrolled hypertension (risk of cerebral hemorrhage)"}],"type":"custom"}
+{"_id":"HTA-cardio-4","context":null,"enonce":"Concerning hypertension","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Regarding the treatment of hypertension, verapamil bisoprolol is a possible dual therapy","correct":false,"justification":"Verapamil is a bradycardial calcium channel blocker: it is contraindicated in combination with beta-blockers. Only the combination between dihydropyridine calcium channel blockers and beta-blockers is possible"},{"idx":1,"proposition":"During the first 6 months of hypertension management, until the blood pressure goal is reached, a monthly consultation is recommended","correct":true},{"idx":2,"proposition":"An early sign of renal involvement secondary to hypertension is the appearance of microalbuminuria (> 300 mg\/24 h)","correct":false},{"idx":3,"proposition":"High blood pressure can lead indirectly to renal failure via atheromatous stenosis of the renal artery or cholesterol embolisms","correct":true},{"idx":4,"proposition":"In a patient over 80 years of age, the recommended blood pressure goal is a PAS < 150, or <145 in blood pressure self-measurement","correct":true}],"type":"custom"}
+{"_id":"HTA-cardio-5","context":null,"enonce":"Concerning hypertension ","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Dual antihypertensive therapy is possible from the outset in case of grade 2\/3 blood pressure","correct":true,"justification":"TA >160\/100"},{"idx":1,"proposition":"In case of blood pressure objectives reached, follow-up consultations are recommended every year","correct":false,"justification":"Every 3 to 6 months"},{"idx":2,"proposition":"Resistant hypertension should be verified by ambulatory blood pressure self-measurement or ABMD","correct":true},{"idx":3,"proposition":"A resistant hypertension can be explained by a poor measurement, for example a cuff too small on a large arm","correct":true},{"idx":4,"proposition":"Renal Doppler ultrasound is part of the systematic review of secondary hypertension","correct":false,"justification":"It is made in case of suspicion of secondary hypertension only (resistant hypertension for example)"}],"type":"custom"}
+{"_id":"HTA-cardio-6","context":null,"enonce":"Concerning hypertension","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Black patients are more sensitive to beta-blockers","correct":false,"justification":"More sensitive to thiazides or calcium channel blockers, less sensitive to beta-blockers"},{"idx":1,"proposition":"In case of albuminuria, the blood pressure objective to be achieved is <130\/80","correct":true,"justification":"And an RAS blocker is routinely recommended"},{"idx":2,"proposition":"Secondary hypertension concerns 5-20% of hypertension, and the majority are curable","correct":false,"justification":"Less than half of the causes are curable"},{"idx":3,"proposition":"A resistant hypertension must be suspected in case of severe hypertension from the outset, hyperkalemia, clinical sign (para-umbilical murmur for example)","correct":false,"justification":"Hypokalemia!"},{"idx":4,"proposition":"Dysthyroidism is a rare cause of secondary hypertension","correct":true}],"type":"custom"}
+{"_id":"HTA-cardio-7","context":null,"enonce":"Concerning secondary hypertension","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Renal parenchymal causes constitute the 1st cause of secondary hypertension","correct":true},{"idx":1,"proposition":"A renovascular hypertension should be evoked especially in case of unexplained flash OAP","correct":true,"justification":"Flash OAP = abrupt, rapidly evolving, with preserved systolic function and little impaired heart on post-crisis cardiac ultrasound"},{"idx":2,"proposition":"In case of secondary renovascular hypertension, revascularization is systematically indicated","correct":false,"justification":"Only if fibrodysplastic origin, non-systematic if atheromatous origin !!"},{"idx":3,"proposition":"Hypokalemia is constant in primary hyperaldosteronism","correct":false,"justification":"50% of cases: normokalemia!"},{"idx":4,"proposition":"The combined dosage of aldosterone-renin should be done in situation of normovolemia, normokalemia, fasting, at 8-10am (among others)","correct":true}],"type":"custom"}
+{"_id":"HTA-cardio-8","context":null,"enonce":"Concerning secondary hypertension","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"In case of bilateral adrenal hyperplasia, treatment includes high-dose spironolactone","correct":true,"justification":"Surgery is not recommended in this case"},{"idx":1,"proposition":"Renin tumors give a picture of secondary hyperaldosteronism","correct":true,"justification":"That is to say with a high renin (primary = low renin while high aldosterone)"},{"idx":2,"proposition":"Cushing's disease may be secondary to a secreting adrenal tumor","correct":false,"justification":"Cushing's syndrome (hypercorticism) may be due to an adrenal tumor, but Cushing's disease characterizes a corticotropic pituitary adenoma!"},{"idx":3,"proposition":"A pheochromocytoma can be integrated into a genetic syndrome, including neurofibromatosis type 1","correct":true,"justification":"Recklingshausen neurofibromatosis"},{"idx":4,"proposition":"A hypertension with a continuous left mesodiatostolic parasternal murmur should suggest an aortic coarctation","correct":false,"justification":"Continuous mesosystolic murmur"}],"type":"custom"}
+{"_id":"HTA-cardio-9","context":null,"enonce":"Regarding malignant hypertension and acute hypertensive crisis","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"proposition":"A hypertensive crisis is defined as a > 180 SBP or > 120 PAD with life-threatening organ involvement","correct":false,"justification":"The item concerns hypertensive urgency. A hypertensive crisis is a BP >180\/110 in a normothendu subject, without visceral impact: it is not an emergency"},{"idx":1,"proposition":"Malignant hypertension with stage 3 or 4 hypertensive retinopathy is a hypertensive emergency","correct":true,"justification":"So with hemorrhages, exudates, or papillary edema at the back of the eye"},{"idx":2,"proposition":"Malignant hypertension can be complicated by CRVO (central retinal vein occlusion) or acute renal failure, among others.","correct":true},{"idx":3,"proposition":"Malignant hypertension can be caused by a bladder globe","correct":true},{"idx":4,"proposition":"In the treatment of hypertensive emergency without OAP, filling is indicated in combination with antihypertensive therapy","correct":true,"justification":"There is extracellular dehydration with hyperaldosteronism secondary to hypokalaemia: filling (cautious: 500-1500cc of ISS) breaks the vicious circle"}],"type":"custom"}
+{"_id":"dlrabdo-HGE-0","context":null,"enonce":"Regarding acute abdominal and lumbar pain","item":"dlrabdo","matiere":"HGE","propositions":[{"idx":0,"proposition":"• Abdominal pain is said to be acute if it elapses less than 24 hours between the onset of symptoms and the first consultation","correct":false},{"idx":1,"proposition":"Any acute abdominal pain can be a symptom of a life-threatening surgical emergency.","correct":true},{"idx":2,"proposition":"Transfixing epigastric pain suggests hepato-biliary origin","correct":false,"justification":"rather pancreatic"},{"idx":3,"proposition":"Pain relief through diet evokes an ulcerative origin","correct":true},{"idx":4,"proposition":"Pain relief by vomiting suggests a pacreatic origin","correct":false,"justification":"of occlusvial origin"}],"type":"custom"}
+{"_id":"dlrabdo-HGE-1","context":null,"enonce":"Regarding acute abdominal and lumbar pain","item":"dlrabdo","matiere":"HGE","propositions":[{"idx":0,"proposition":"In women, it is always necessary to think about an ectopic pregnancy (and, more generally, gynecological conditions)","correct":true},{"idx":1,"proposition":"The diagnosis of acute pancreatitis is made in front of amylasemia greater than three times normal","correct":false,"justification":"Lipasemia > 3 times normal"},{"idx":2,"proposition":"The clinical examination should look for an interventional scar, defense or contracture","correct":true},{"idx":3,"proposition":"Pelvic touching should be systematic","correct":true},{"idx":4,"proposition":"Abdominal CT scan should be preferred to any other radiological investigation in case of unexplained acute abdominal pain","correct":true}],"type":"custom"}
+{"_id":"dlrabdo-HGE-2","context":null,"enonce":"Regarding acute abdominal and lumbar pain, which propositions are true?","item":"dlrabdo","matiere":"HGE","propositions":[{"idx":0,"proposition":"Blood cultures should be performed in case of fever with chills or greater than 39 ° C","correct":true},{"idx":1,"proposition":"Urine strips (± ECBU) are used to rule out a urinary cause","correct":true},{"idx":2,"proposition":"In front of any acute epigastric abdominal pain, an ECG should be performed","correct":true},{"idx":3,"proposition":"Ultrasound is useful in case of suspected biliopancreatic, gynecological or urinary cause","correct":true},{"idx":4,"proposition":"The site of hepatobiliary pain is hypogastric or hypochondrical right","correct":false}],"type":"custom"}
+{"_id":"ascite-HGE-0","context":null,"enonce":"Regarding ascites:","item":"ascite","matiere":"HGE","propositions":[{"idx":0,"proposition":"Ascites is defined as peritoneal fluid effusion","correct":true},{"idx":1,"proposition":"The formal argument of the positive diagnosis is the demonstration of fluid by the puncture of the abdominal cavity","correct":true},{"idx":2,"proposition":"An increase in volume of the abdomen with a declivable abdominal dullness, mobilizable, drawing a concave curve at the top on the subject in supine position strongly evokes ascites","correct":true},{"idx":3,"proposition":"The puncture of ascites fluid should be done at a point at the junction of the outer third and the middle third of the line joining the left anterosuperior iliac spine and the umbilicus, and in full dullness","correct":true},{"idx":4,"proposition":"Puncture fluid can be made bloody by accidentally passing through a blood vessel from the wall","correct":true}],"type":"custom"}
+{"_id":"ascite-HGE-1","context":null,"enonce":"Regarding ascites:","item":"ascite","matiere":"HGE","propositions":[{"idx":0,"proposition":"Ascites fluid from a breach of the hepatic lymphatic ducts is low in protein and chylomicrons","correct":false,"justification":"Ascites fluid from a breach of the hepatic lymphatic ducts is rich in protein (> 30 g\/L) but not in chylomicrons"},{"idx":1,"proposition":"Cancers of the digestive system (with the exception of hepatocellular carcinoma) and ovarian cancer are common causes of peritoneal carcinomatosis","correct":true},{"idx":2,"proposition":"Ascites fluid contains only cells, in case of peritoneal carcinomatosis","correct":false,"justification":"Ascites fluid is often rich in protein (> 25 g\/L) and cells"},{"idx":3,"proposition":"Peritoneal mesothelioma is a very rare cause of ascites","correct":true},{"idx":4,"proposition":"The main factor promoting peritoneal mesothelioma is exposure to asbestos fibers","correct":true}],"type":"custom"}
+{"_id":"ascite-HGE-2","context":null,"enonce":"Regarding ascites in tuberculosis:","item":"ascite","matiere":"HGE","propositions":[{"idx":0,"proposition":"Ascites is a cardinal manifestation of peritoneal tuberculosis that may be associated with digestive or other organ tuberculosis.","correct":true},{"idx":1,"proposition":"The fluid is frequently rich in protein (> 25 g\/L) but low in leukocytes (< 100\/mm3) in peritoneal tuberculosis","correct":false,"justification":"The fluid is frequently rich in protein (> 25 g\/L) and leukocytes (> 1,000\/mm3)"},{"idx":2,"proposition":"The search for BK by direct examination is usually negative","correct":true},{"idx":3,"proposition":"Determination of the enzyme adenosine deaminase in ascites may be useful","correct":true},{"idx":4,"proposition":"The diagnosis is made by biopsy of the peritoneum under laparoscopy on possible peritoneal granulations with evidence of tuberculous granulomas and culture revealing BK","correct":true}],"type":"custom"}
+{"_id":"ascite-HGE-3","context":null,"enonce":"Regarding ascites:","item":"ascite","matiere":"HGE","propositions":[{"idx":0,"proposition":"In case of infected ascites, antibiotic therapy with quinololes or beta-lactam should be urgently started","correct":true},{"idx":1,"proposition":"Isolated left heart failure, peritoneal carcinomatosis and cirrohsis are the 3 main causes of ascites","correct":false,"justification":"Right heart failure or global heart failure"},{"idx":2,"proposition":"Effective treatment of ascites fluid infection should decrease the level of PNN by at least 25% in the ascites fluid","correct":false,"justification":"At least 50%"},{"idx":3,"proposition":"Ascites complicating heart failure is rich in protein > 25 g \/ L and low in leukocytes","correct":true},{"idx":4,"proposition":"Ascites may cause parietal hernia","correct":true}],"type":"custom"}
+{"_id":"HTAP-cardio-0","context":null,"enonce":"Regarding pulmonary arterial hypertension (PH)","item":"HTAP","matiere":"cardio","propositions":[{"idx":0,"proposition":"PH is defined by a mean mPAP pulmonary arterial pressure of 15mmHg or higher","correct":false,"justification":"25mmHg or more"},{"idx":1,"proposition":"PAH corresponds to group 2 PH in the WHO classification","correct":false,"justification":"PAH corresponds to group 1 of this classification"},{"idx":2,"proposition":"Pulmonary PH is PH with an OPAP (pulmonary arterial pressure occlude) of 25mmHg or less","correct":false,"justification":"15mmHg or less"},{"idx":3,"proposition":"Group 5 of the WHO classification corresponds to a precapillary PH","correct":true,"justification":"All PH is precapillary except group 2 (left heart disease)"},{"idx":4,"proposition":"PAH (group 1 PH) mainly affects women","correct":true,"justification":"2 times more women affected than men"}],"type":"custom"}
+{"_id":"HTAP-cardio-1","context":null,"enonce":"About PH","item":"HTAP","matiere":"cardio","propositions":[{"idx":0,"proposition":"PAH (PH group 1) may be associated with connective tissue disease, e.g. Eisenmenger syndrome","correct":false,"justification":"Eisenmenger syndrome is not connective tissue disease, it is severe cyanogenic heart disease (which may also be associated with PAH)"},{"idx":1,"proposition":"The spontaneous course of PAH, if left untreated, is fatal in 60% of cases","correct":false,"justification":"100% of cases"},{"idx":2,"proposition":"Tricuspid valvular heart disease can be complicated by group 2 PAH","correct":false,"justification":"Aortic or mitral valve disease, but not tricuspid"},{"idx":3,"proposition":"Group 2 of PH is the 1st cause of PH","correct":true,"justification":"These are left heart disease"},{"idx":4,"proposition":"Group 3 consists of chronic post-embolic PH","correct":false,"justification":"By respiratory diseases"}],"type":"custom"}
+{"_id":"HTAP-cardio-2","context":null,"enonce":"About PH","item":"HTAP","matiere":"cardio","propositions":[{"idx":0,"proposition":"HIV-associated PH is group 5 PH","correct":false,"justification":"Group 1"},{"idx":1,"proposition":"Pulmonary artery arteritis gives group 4 PH","correct":true,"justification":"Pulmonary arterial endovascular obstacle"},{"idx":2,"proposition":"Dialysis CKD can give group 5 PH","correct":true},{"idx":3,"proposition":"The most common call sign of PH is cough","correct":false,"justification":"Dyspnea (exertion and rest)"},{"idx":4,"proposition":"Auscultation is normal for a long time in PH","correct":true,"justification":"Analogy with pulmonary embolism: dyspnea with normal auscultation"}],"type":"custom"}
+{"_id":"HTAP-cardio-3","context":null,"enonce":"About PH","item":"HTAP","matiere":"cardio","propositions":[{"idx":0,"proposition":"The breath associated with PH is a protosystolic murmur","correct":false,"justification":"Has a holosystolic murmur (tricuspid insufficiency) increased on deep inspiration = sign of Carvalho"},{"idx":1,"proposition":"If PH is suspected, B4 noise on auscultation should be sought for a differential diagnosis","correct":false,"justification":"A B4 (straight gallop) suggests right heart failure that may be due to PH"},{"idx":2,"proposition":"HTP is particularly associated with negative T waves in V1-V2","correct":true},{"idx":3,"proposition":"Routine screening for PH in patients with diffuse lupus erythematosus is recommended","correct":false,"justification":"In scleroderma patients"},{"idx":4,"proposition":"Maximum tricuspid regurgitation rate > 3.4m\/s on cardiac ultrasound supports PH","correct":true}],"type":"custom"}
+{"_id":"HTAP-cardio-4","context":null,"enonce":"About PH","item":"HTAP","matiere":"cardio","propositions":[{"idx":0,"proposition":"Postitive NO vasomotricity test is an indication for oral calcium channel blockers","correct":true,"justification":"It predicts a favorable therapeutic response to these"},{"idx":1,"proposition":"For PH, transthoracic cardiac ultrasound is indicated only if left cardiopathic etiology is suspected.","correct":false,"justification":"Baseline non-invasive examination, systematic if PH is suspected"},{"idx":2,"proposition":"In the diagnostic approach of PH, etiological groups 2 and 3 should be sought as a priority.","correct":true,"justification":"These are the most frequent: we then look for group 4, then finally 5\/1 (elimination diagnostics)"},{"idx":3,"proposition":"Isolated OSA may explain PH","correct":false},{"idx":4,"proposition":"In case of PAH, at EFR, flow rates and volumes are normal but the DLCO is lowered","correct":true,"justification":"3 causes of lowering DLCO: emphysema, PAH and thromboembolic pulmonary vascular involvement"}],"type":"custom"}
+{"_id":"HTAP-cardio-5","context":null,"enonce":"About PH","item":"HTAP","matiere":"cardio","propositions":[{"idx":0,"proposition":"The PAH assessment includes HBV\/HCV\/HIV serology and an autoimmune assessment ","correct":true},{"idx":1,"proposition":"Arterial gas is always impaired in HTP","correct":false,"justification":"Arterial gas is often normal or with very moderate hypoxemia; Hypocapnia is quite common due to alveolar hyperventilation; Deep hypoxemia is possible in severe or complicated forms (e.g. reopening of the foramen ovale with right-left shunt or interatrial septal defect)"},{"idx":2,"proposition":"PAH is possible in children","correct":true,"justification":"Congenital heart disease"},{"idx":3,"proposition":"A typical sign of PH in an 8-year-old child is oxygen-refractory cyanosis","correct":false,"justification":"This is typical in newborns: in children, the signs are syncope, dyspnea, behavioral disorders or malaise"},{"idx":4,"proposition":"PH with dyspnea that slightly limits usual physical activities but does not persist at rest corresponds to NYHA grade 1","correct":false,"justification":"NYHA 2"}],"type":"custom"}
+{"_id":"angine-infectio-0","context":null,"enonce":"Concerning angina","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"ƒAngina is a benign pathology of spontaneously favorable evolution in the vast majority of cases","correct":true},{"idx":1,"proposition":"ƒƒAntibiotic therapy is indicated in group A streptococcal tonsillitis","correct":true},{"idx":2,"proposition":"ƒIn practice, group A streptococcus should be tested for when the MacIsaac clinical score is ≥ 4 in adults","correct":false},{"idx":3,"proposition":"ƒƒ Antibiotic therapy is indicated in case of streptococcal infection detected in RDT: augmentin in 1st line","correct":false},{"idx":4,"proposition":"It is an inflammation of infectious origin of the tonsils (tonsillitis) and \/ or the entire oropharynx (pharyngitis)","correct":true}],"type":"custom"}
+{"_id":"angine-infectio-1","context":null,"enonce":"Concerning angina","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"Group B ß-hemolytic streptococcus is the first bacterial agent responsible for angina","correct":false,"justification":"This is Pyogenic Streptococcus (group A)"},{"idx":1,"proposition":"ƒThe diagnosis of diphtheria requires mandatory reporting to the ARS, additional droplet-type precautions and eviction from the community","correct":true},{"idx":2,"proposition":"No clinical sign is strictly discriminating between viral or bacterial etiology","correct":true},{"idx":3,"proposition":"Only SBHA angina is common, other bacterial causes are exceptional","correct":true},{"idx":4,"proposition":"Symptomatic treatment with analgesic and antipyretic is to be considered in all cases ","correct":true}],"type":"custom"}
+{"_id":"angine-infectio-2","context":null,"enonce":"Concerning angina","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"In adults, the MacIsaac score has a good positive predictive value","correct":false,"justification":"In adults, the MacIsaac score has a good negative predictive value"},{"idx":1,"proposition":"In adults, a clinical score of Mac Isaac < 2 has a negative predictive value > 95% to eliminate the streptococcal origin of angina","correct":true},{"idx":2,"proposition":"All strains of SBHA have rheumatogenic or nephritogenic potential","correct":false,"justification":"Only certain strains of SBHA have rheumatogenic or nephritogenic potential"},{"idx":3,"proposition":"Scarlet fever is one of the toxic complications","correct":true},{"idx":4,"proposition":"There is no indication for antibiotic therapy for acute tonsillitis in children under 3 years of age","correct":true}],"type":"custom"}
+{"_id":"angine-infectio-3","context":null,"enonce":"Concerning tonsillitis","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"Antibiotic therapy is only of interest in SBHA angina","correct":true,"justification":"The goal is essentially to prevent complications"},{"idx":1,"proposition":"ƒƒ The strains of SBHA responsible for RAA are very rare in metropolitan France, but more frequent in the DOM-TOM","correct":true},{"idx":2,"proposition":"Antibiotic treatment involves individual and collective risks: adverse effects and bacterial resistance in particular","correct":true},{"idx":3,"proposition":"The risk of AAF is prevented even in case of late antibiotic therapy (up to Day 9 after the onset of symptoms)","correct":true},{"idx":4,"proposition":"Only documented SBHA tonsillitis should be treated with antibiotic therapy","correct":true}],"type":"custom"}
+{"_id":"angine-infectio-4","context":null,"enonce":"Regarding angina in children, which is the exact proposal(s)?","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"In front of angina, it is necessary to perform an RDT because no clinical sign allows to move towards a bacterial or viral etiology","correct":false,"justification":"False, clinically bacterial angina is more brutal, painful, gives a higher fever and more extra ENT sign than viral angina. But only a microbiological examination can conclude."},{"idx":1,"proposition":"RDT should always be performed in children","correct":false,"justification":"False, <3 years the etiology is mainly viral. The RDT is only performed above 3 years"},{"idx":2,"proposition":"Extra-ENT symptoms of group A streptococcus infection include: abdominal pain, vomiting, non-painful ADP","correct":false,"justification":"False, infectious lymphadenopathy is painful"},{"idx":3,"proposition":"Faced with a suspicion of angina, look for signs of locoregional complications such as torticollis.","correct":true,"justification":"True, torticollis would sign a retropharyngeal abscess. It is also necessary to look for a trismus that signs an amygdala phlegmon."},{"idx":4,"proposition":"None of the propositions are true","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"angine-infectio-5","context":null,"enonce":"Which of the following are the objectives of antibiotic treatment for strep throat?","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"Reduction of cough duration","correct":true},{"idx":1,"proposition":"Reduction of complications","correct":true,"justification":"This is the main objective"},{"idx":2,"proposition":"Reduce viral carriage","correct":false,"justification":"Bacterial carriage"},{"idx":3,"proposition":"No antibiotic therapy is indicated in this case","correct":false,"justification":"Amoxicillin streptococcus ➡"},{"idx":4,"proposition":"Achieving the patient's request","correct":false,"justification":"We do not prescribe antibiotics because the patient asks us to, but because it is justified:)"}],"type":"custom"}
+{"_id":"angine-infectio-7","context":null,"enonce":"What is the antibiotic therapy to be implemented in case of erythematopultaceous angina with positive RDT, in first line?","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"Amoxicillin","correct":true},{"idx":1,"proposition":"Amoxicillin-clavulanic acid","correct":false,"justification":"No indication"},{"idx":2,"proposition":"C2G","correct":false,"justification":"2nd intention, if allergy to amoxicillin (risk cross-allergy <5%)"},{"idx":3,"proposition":"Macrolides","correct":false,"justification":"3rd intention, if allergy to beta-lactam (<10% resistance)"},{"idx":4,"proposition":"Glycopeptides","correct":false,"justification":"No indication"}],"type":"custom"}
+{"_id":"angine-infectio-8","context":null,"enonce":"What is the recommended average duration of eviction from the community in case of angina?","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"6 hours","correct":false,"justification":"False"},{"idx":1,"proposition":"48 hours","correct":true},{"idx":2,"proposition":"1 week","correct":false,"justification":"False"},{"idx":3,"proposition":"3 weeks","correct":false,"justification":"False"},{"idx":4,"proposition":"No eviction","correct":false,"justification":"Contagiousness by coughing"}],"type":"custom"}
+{"_id":"angine-infectio-9","context":null,"enonce":"Which of the following is a reportable cause of pseudomembranous angina?","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"Diphtheria","correct":true},{"idx":1,"proposition":"Group A beta-hemolytic streptococcus","correct":false,"justification":"False"},{"idx":2,"proposition":"Staphylococcus aureus","correct":false,"justification":"False"},{"idx":3,"proposition":"Adenovirus","correct":false,"justification":"False"},{"idx":4,"proposition":"EBV","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"angine-infectio-10","context":null,"enonce":"Which of the following proposals are indications for making a TDR?","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"Mac Isaac score = 4 in adults","correct":true},{"idx":1,"proposition":"Mac Isaac score = 2 in adults","correct":true},{"idx":2,"proposition":"Mac Isaac score = 1 in adults","correct":false,"justification":"TDR if MacIsaac at least equal to 2"},{"idx":3,"proposition":"6 years old","correct":true},{"idx":4,"proposition":"6-month-old baby","correct":false,"justification":"RDT if child > 3 years old"}],"type":"custom"}
+{"_id":"angine-infectio-11","context":null,"enonce":"What is the antibiotic therapy to be implemented in case of erythematopultaceous angina with positive RDT, in case of true allergy to amoxicillin?","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"Amoxicillin","correct":false,"justification":"Allergy"},{"idx":1,"proposition":"Amoxicillin-clavulanic acid","correct":false,"justification":"Allergy to amoxicillin. No indication of this association in tonsillitis (SBHA sensitive to amoxicillin alone)"},{"idx":2,"proposition":"C2G","correct":true},{"idx":3,"proposition":"Macrolides","correct":false,"justification":"3rd intention, if allergy to beta-lactam (<10% resistance)"},{"idx":4,"proposition":"Glycopeptides","correct":false,"justification":"No indication"}],"type":"custom"}
+{"_id":"angine-infectio-12","context":null,"enonce":"Which of the following are viral causes of angina?","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"Streptococcus","correct":false,"justification":"Strepto is a bacterium"},{"idx":1,"proposition":"Bartonella henselae\r\n","correct":false,"justification":"It is a gram-negative bacillus"},{"idx":2,"proposition":"EBV","correct":true},{"idx":3,"proposition":"HSV","correct":true},{"idx":4,"proposition":"Echovirus","correct":true}],"type":"custom"}
+{"_id":"OH-gastro-0","context":null,"enonce":"Concerning simple use:","item":"OH","matiere":"HGE","propositions":[{"idx":0,"proposition":"The term 'use' corresponds to abstinence","correct":false,"justification":"Abstinence is non-use"},{"idx":1,"proposition":"It is recommended to consume no more than 21 drinks on average per week for men","correct":false},{"idx":2,"proposition":"It is recommended to consume no more than 5 drinks on average per week for women","correct":false,"justification":"ATTENTION: new recommendation in 2019 -> single use = no more than 10 drinks per week for everyone (woman and man)"},{"idx":3,"proposition":"Simple use: one alcohol-free day per week","correct":true,"justification":"Be careful though, if the patient drinks a bottle of wine a day except Wednesday (a day without alcohol) it is not simple use"},{"idx":4,"proposition":"A standard glass of France corresponds to bar doses and contains 10 grams of pure alcohol","correct":true}],"type":"custom"}
+{"_id":"OH-gastro-1","context":null,"enonce":"Regarding the terms used:","item":"OH","matiere":"HGE","propositions":[{"idx":0,"proposition":"Risky use (risky consumption) corresponds to consumption above the recommended thresholds, likely to cause physical, psychological or social damage","correct":true},{"idx":1,"proposition":"Harmful or harmful use refers to consumption that has adverse consequences for health, physical or mental, but in the absence of criteria of dependence.","correct":true},{"idx":2,"proposition":"Addiction defines a type of relationship marked by an inability to reduce consumption and a behavioral obligation","correct":true},{"idx":3,"proposition":"Signs of withdrawal are mostly psychological","correct":false,"justification":"The signs are psychological and physical"},{"idx":4,"proposition":"Harmful health consequences sign alcohol dependence","correct":false,"justification":"Addiction can lead to®negative (harmful) consequences, but not necessarily, especially at the beginning \/ I formulated it backwards"}],"type":"custom"}
+{"_id":"OH-gastro-2","context":null,"enonce":"Regarding alcohol:","item":"OH","matiere":"HGE","propositions":[{"idx":0,"proposition":"Excessive consumption covers all misuse","correct":true},{"idx":1,"proposition":"Alcoholism is an outdated term that often corresponds to severe addictions","correct":true},{"idx":2,"proposition":"We talk about alcoholism when we exceed 3 drinks a day","correct":false,"justification":"We no longer talk about alcoholism"},{"idx":3,"proposition":"It is estimated that in France 6 million people consume alcohol daily.","correct":true},{"idx":4,"proposition":"Regular alcohol consumption decreases in France but occasional alcoholization increases","correct":true}],"type":"custom"}
+{"_id":"OH-gastro-3","context":null,"enonce":"What test(s) are used to screen for alcohol addiction?","item":"OH","matiere":"HGE","propositions":[{"idx":0,"proposition":"FACE","correct":true},{"idx":1,"proposition":"Framingham","correct":false,"justification":"Framingham is an overall coronary risk score"},{"idx":2,"proposition":"Fägerstrom","correct":false,"justification":"Fagerström's test can detect tobacco addiction"},{"idx":3,"proposition":"AUDIT-C","correct":true},{"idx":4,"proposition":"Horn","correct":false,"justification":"Tobacco"}],"type":"custom"}
+{"_id":"OH-gastro-5","context":null,"enonce":"What signs accompany a delirium tremens?","item":"OH","matiere":"HGE","propositions":[{"idx":0,"proposition":"A commotion","correct":true},{"idx":1,"proposition":"Catatonia","correct":false,"justification":"Rather a agitation with incoherent remarks"},{"idx":2,"proposition":"Delusions","correct":true},{"idx":3,"proposition":"Reversal of the nycthemeral rhythm","correct":true},{"idx":4,"proposition":"Fever","correct":true}],"type":"custom"}
+{"_id":"OH-gastro-6","context":null,"enonce":"What signs or symptoms are consistent with Korsakoff's Syndrome?","item":"OH","matiere":"HGE","propositions":[{"idx":0,"proposition":"Vitamin B1 deficiency","correct":true},{"idx":1,"proposition":"Fabulations","correct":true},{"idx":2,"proposition":"Retrograde memory loss","correct":false,"justification":"Anterograde memory loss (almost) exclusively"},{"idx":3,"proposition":"Brainstem damage classically","correct":false,"justification":"Not classically: damage to the mammillary bodies (structures that are part of the hypothalamus and involved in memory, especially in the Papez circuit)"},{"idx":4,"proposition":"A very advanced age","correct":false,"justification":"Often in the \"young\" subject (can start in the forties)"}],"type":"custom"}
+{"_id":"OH-gastro-7","context":null,"enonce":"Regarding Gayet-Wernicke encephalopathy:","item":"OH","matiere":"HGE","propositions":[{"idx":0,"proposition":"It cannot give Korsakoff syndrome","correct":false,"justification":"Most Korsakoff syndromes are due to untreated (or poorly) Gayet Wernicke's encephalopathy"},{"idx":1,"proposition":"There is a cerebellar syndrome explaining frequent nystagmus","correct":false,"justification":"Cerebellous syndrome (which is static) explains the problems with walking and coordination. Nystagmus, like oculomotor palsy or diplopia, are separate signs found in Gayet-Wernicke encephalopathy."},{"idx":2,"proposition":"It is due to vitamin B6 deficiency","correct":false,"justification":"Vitamin B1 deficiency"},{"idx":3,"proposition":"Carbohydrate recharge must be done urgently ","correct":false,"justification":"Glucose promotes B1 deficiency (alcohol is sweet)"},{"idx":4,"proposition":"It is a therapeutic emergency","correct":true}],"type":"custom"}
+{"_id":"OH-gastro-8","context":null,"enonce":"Regarding alcohol withdrawal syndrome:","item":"OH","matiere":"HGE","propositions":[{"idx":0,"proposition":"It is constant","correct":false,"justification":"A significant proportion of patients do not experience withdrawal syndrome"},{"idx":1,"proposition":"Hypersomnia is observed","correct":false,"justification":"Rather insomnia"},{"idx":2,"proposition":"We find a HTA","correct":true},{"idx":3,"proposition":"We can objectify tachycardia","correct":true},{"idx":4,"proposition":"Depression is common","correct":false,"justification":"Not depression but anxiety, frustration, etc."}],"type":"custom"}
+{"_id":"OH-gastro-9","context":null,"enonce":"Which of the following are included in healthy alcohol consumption? 🍷","item":"OH","matiere":"HGE","propositions":[{"idx":0,"proposition":"2 drinks per day maximum 🥃🥃","correct":true,"justification":"True. Attention ⚠, new recs in 2019: more distinction man 👨 woman 👩, 2 drinks max per occasion of drinking, no alcohol every day, and no more than 10 🔟 drinks per week."},{"idx":1,"proposition":"No more than 6 glasses per drinking occasion ","correct":false,"justification":"No more than two"},{"idx":2,"proposition":"At least one alcohol-free day per week","correct":true},{"idx":3,"proposition":"No more than 26 drinks on average per week for men ","correct":false,"justification":"The new recs do not make a distinction M\/F. No more than 10 drinks per week"},{"idx":4,"proposition":"No more than 10 standard drinks per week","correct":true,"justification":"The links of the new reco: https:\/\/www.drogues.gouv.fr\/actualites\/sante-publique-france-presente-nouvelles-recommandations-lalimentation-y-compris-lalcool"}],"type":"custom"}
+{"_id":"drogues-psy-0","context":null,"enonce":"Regarding cannabis and cocaine:","item":"drogues","matiere":"psy","propositions":[{"idx":0,"proposition":"The active substance in cocaine is tetra-hydrocannabinol (THC)","correct":false,"justification":"It is the active ingredient of Cannabis"},{"idx":1,"proposition":"Withdrawal syndrome is a disorder related to the use of an addictive substance","correct":true,"justification":""},{"idx":2,"proposition":"Cannabis can induce a psychotic disorder, an anxiety disorder, and even a delirium","correct":true},{"idx":3,"proposition":"For cannabis, treatment of intoxication and withdrawal are symptomatic","correct":true},{"idx":4,"proposition":"Cocaine is a drug while cannabis is not","correct":false,"justification":"Both are uh yes it's not very discriminating"}],"type":"custom"}
+{"_id":"drogues-psy-1","context":null,"enonce":"Regarding cannabis:","item":"drogues","matiere":"psy","propositions":[{"idx":0,"proposition":"The action of cannabis is mainly the rapid and fleeting over-release of serotonin","correct":false,"justification":"It acts on the cannabinoid receptors CB1 and CB2 that regulate glutamatergic and GABA neurotransmission and also potentiates dopamine release"},{"idx":1,"proposition":"Marijuana is the most THC-laden presentation","correct":false,"justification":"In order of increasing concentration of Delta9-THC: * herb (marijuana), resin (hashish), * * oil, rarer"},{"idx":2,"proposition":"Cannabis is mostly smoked in the form of cigarettes mixed with tobacco","correct":true,"justification":"This is the famous joints"},{"idx":3,"proposition":"Cannabis is the most commonly used illicit substance in France","correct":true},{"idx":4,"proposition":"Regular consumption is mostly female, regardless of age group","correct":false,"justification":"Regular consumption is mostly male"}],"type":"custom"}
+{"_id":"drogues-psy-2","context":null,"enonce":"Regarding cannabis:","item":"drogues","matiere":"psy","propositions":[{"idx":0,"proposition":"The effects of cannabis appear about 15 to 20 minutes after consumption if smoked","correct":true},{"idx":1,"proposition":"The effects fade in about 10 minutes","correct":false,"justification":"The effects fade in several hours: about 4 hours for the consumption of a conventional dose"},{"idx":2,"proposition":"The extent of cannabis' effects depends on tolerance, age, sex and individual genetic susceptibilities","correct":false,"justification":"The extent of the effects of cannabis depends on the dose used, the mode of consumption and individual factors such as the rate of absorption, tolerance"},{"idx":3,"proposition":"Acute cannabis intoxication can lead to conjunctival hyperemia","correct":true},{"idx":4,"proposition":"Regular use of cannabis leads to a tolerance phenomenon that decreases the feeling of well-being and forces to increase doses","correct":true}],"type":"custom"}
+{"_id":"drogues-psy-3","context":null,"enonce":"Which of these proposals are symptoms of cannabis withdrawal syndrome?","item":"drogues","matiere":"psy","propositions":[{"idx":0,"proposition":"Irritability","correct":true},{"idx":1,"proposition":"Insomnia","correct":true},{"idx":2,"proposition":"Polyphagia","correct":false,"justification":"Rather anorexia and weight loss"},{"idx":3,"proposition":"Excessive sweating","correct":true},{"idx":4,"proposition":"Fever","correct":true}],"type":"custom"}
+{"_id":"drogues-psy-4","context":null,"enonce":"Regarding withdrawal syndrome and the consequences of cannabis:","item":"drogues","matiere":"psy","propositions":[{"idx":0,"proposition":"Complications related to cannabis use cannot occur with the first dose","correct":false,"justification":"They can occur from the first intake"},{"idx":1,"proposition":"The dose threshold defining risky consumption is more than 3 joints per week (two days apart on average)","correct":false,"justification":"No known threshold"},{"idx":2,"proposition":"90% of cannabis users report cannabis withdrawal symptoms","correct":false,"justification":"10 to 40%"},{"idx":3,"proposition":"The withdrawal syndrome more often concerns heavy and regular consumption","correct":true},{"idx":4,"proposition":"Most symptoms appear within 24 to 72 hours after stopping consumption","correct":true}],"type":"custom"}
+{"_id":"drogues-psy-5","context":null,"enonce":"Regarding the consequences of cannabis:","item":"drogues","matiere":"psy","propositions":[{"idx":0,"proposition":"Sleep disorders related to withdrawal syndrome can last a month","correct":true},{"idx":1,"proposition":"Cannabis poisoning delirium sets in just at the end of the withdrawal syndrome","correct":false,"justification":"It settles in a few hours or days and tends to have a fluctuating evolution throughout the day."},{"idx":2,"proposition":"A psychotic disorder may develop during or shortly after acute intoxication","correct":true},{"idx":3,"proposition":"The clinical symptomatology of cannabis-induced psychotic disorder is similar to that of psychotic disorder","correct":true},{"idx":4,"proposition":"Treatment of induced psychotic disorder involves stopping intoxication only (antipsychotics are contraindicated)","correct":false,"justification":"Treatment involves stopping intoxication and possibly treatment with antipsychotics"}],"type":"custom"}
+{"_id":"drogues-psy-6","context":null,"enonce":"General information about cannabis:","item":"drogues","matiere":"psy","propositions":[{"idx":0,"proposition":"Chronic intoxication can lead to impaired cognitive performance, social disinterest, decreased performance at work or school.","correct":true},{"idx":1,"proposition":"A cannabis-induced psychotic disorder may develop during or shortly after acute intoxication (and up to a month after)","correct":true},{"idx":2,"proposition":"The management of dependency is comprehensive: psychiatric, general medical, school and social","correct":true},{"idx":3,"proposition":"Cognitive-behavioral and family psychotherapies have shown their effectiveness","correct":true},{"idx":4,"proposition":"Fewer than one million people are regular cannabis users in France","correct":false,"justification":"More than one million people"}],"type":"custom"}
+{"_id":"drogues-psy-8","context":null,"enonce":"Regarding cocaine:","item":"drogues","matiere":"psy","propositions":[{"idx":0,"proposition":"There are 400,000 people affected by a cocaine use problem in France","correct":true},{"idx":1,"proposition":"The onset of effects and felt effects is 2 to 4 hours in all cases","correct":false,"justification":"The onset of effects and the effects experienced depend on the route of administration, the individuals and the dose consumed"},{"idx":2,"proposition":"Complications related to cocaine use can occur from the first dose","correct":true},{"idx":3,"proposition":"There is no known dose threshold below which there is little or no risk","correct":true},{"idx":4,"proposition":"The dose threshold below which there is no risk is one intake per year, which is very difficult to respect given the addictive potential of cocaine.","correct":false,"justification":"There is no known dose threshold below which there is little or no risk"}],"type":"custom"}
+{"_id":"pericardite-cardio-0","context":null,"enonce":"About pericarditis","item":"pericardite","matiere":"cardio","propositions":[{"idx":0,"proposition":"The performance of an ECG and echocardiography is systematic in the face of suspicion of pericarditis","correct":true},{"idx":1,"proposition":"The key symptom is prolonged chest pain, resistant to trinitrine, increased in decubitus, deep inhalation and coughing, calmed by sitting forward (anteflexion)","correct":true},{"idx":2,"proposition":"The absence of pericardial friction eliminates the diagnosis of pericarditis","correct":false,"justification":"Its absence does not eliminate the diagnosis. In practice, it is actually very rare to hear it."},{"idx":3,"proposition":"Pleural effusion eliminates diagnosis","correct":false,"justification":"An associated pleural effusion may be found."},{"idx":4,"proposition":"Holzman's stage II corresponds to negative T-waves ","correct":false,"justification":"Stage I: concave ST elevation upwards, positive T waves on the first day. Stage II: flat T-waves between the 24th and 48th hours. Stage III: negative T-waves in the first week. Stage IV: normalization in the first month"}],"type":"custom"}
+{"_id":"pericardite-cardio-1","context":null,"enonce":"About pericarditis","item":"pericardite","matiere":"cardio","propositions":[{"idx":0,"proposition":"Chest X-ray is normal most often","correct":true},{"idx":1,"proposition":"Echocardiography assesses the abundance, topography and hemodynamic tolerance of pericardial effusion and confirms the diagnosis of possible tamponade","correct":true},{"idx":2,"proposition":"Echocardiography makes it possible to visualize, if necessary, a possible mass localized in the pericardial cavity","correct":true,"justification":"For example, metastasis or clot"},{"idx":3,"proposition":"MRI has the advantage of visualizing the pericardial cavity without injection of contrast medium or irradiation","correct":true},{"idx":4,"proposition":"Pericardial puncture is to be considered in the presence of abundant pericardial effusion, symptomatic, despite a well-conducted medical treatment for a month","correct":false,"justification":"For a week. One month is far too long"}],"type":"custom"}
+{"_id":"pericardite-cardio-2","context":null,"enonce":"About pericarditis","item":"pericardite","matiere":"cardio","propositions":[{"idx":0,"proposition":"Surgical pericardial drainage is preferred in case of suspicion of acute purulent pericarditis","correct":true},{"idx":1,"proposition":"Pericardial fluid is collected for cytological and microbiological analysis","correct":true},{"idx":2,"proposition":"Once the diagnosis is established, hospitalization is systematic","correct":false,"justification":"Once the diagnosis is made, hospitalization should not be systematic and depends on the case"},{"idx":3,"proposition":"Hospitalization is done in case of predictive factors of a non-idiopathic origin or risk of complications","correct":true},{"idx":4,"proposition":"In nine out of ten cases, the cause is viral or unknown (acute idiopathic pericarditis)","correct":true}],"type":"custom"}
+{"_id":"pericardite-cardio-4","context":null,"enonce":"Regarding acute pericarditis","item":"pericardite","matiere":"cardio","propositions":[{"idx":0,"proposition":"During HIV infection, the occurrence of pericarditis with pericardial effusion is common","correct":true},{"idx":1,"proposition":"The progression is common to tamponade, recurrence or pericardial constriction in case of tuberculous pericarditis","correct":true},{"idx":2,"proposition":"In case of tuberculous pericarditis, treatment is symptomatic","correct":false,"justification":"Treatment is etiologic (anti-tuberculosis)"},{"idx":3,"proposition":"Primary pericardial tumours (primary pericardial mesothelioma) are 4 times more common than metastases","correct":false,"justification":"Primary pericardial tumours (primary pericardial mesothelioma) are rare, 40 times less common than metastases"},{"idx":4,"proposition":"The most common secondary tumours are bronchial cancers, breast cancers, melanomas and leukemias.","correct":true}],"type":"custom"}
+{"_id":"pericardite-cardio-5","context":null,"enonce":"About pericarditis","item":"pericardite","matiere":"cardio","propositions":[{"idx":0,"proposition":"Hemorrhagic pericardial effusion is extremely rare","correct":false,"justification":"Hemorrhagic pericardial effusion is common, as is tamponade in neoplastic pericarditis"},{"idx":1,"proposition":"The diagnosis of neoplastic pericarditis is confirmed by imaging","correct":false,"justification":"Ultrasound, CT and\/or MRI = evoke the diagnosis. Confirmation is pathomopathological\/biological"},{"idx":2,"proposition":"Analysis of pericardial puncture fluid or pericardial biopsy are essential for diagnosing malignancy","correct":true},{"idx":3,"proposition":"In case of tamponade, emergency pericardial puncture is necessary","correct":true},{"idx":4,"proposition":"Recurrence of pericardial effusion is frequent and requires clinical and echocardiographic follow-up","correct":true}],"type":"custom"}
+{"_id":"pericardite-cardio-6","context":null,"enonce":"Regarding the treatment of acute pericarditis","item":"pericardite","matiere":"cardio","propositions":[{"idx":0,"proposition":"Nonsteroidal anti-inflammatory drugs are prescribed in benign acute pericarditis","correct":true,"justification":"Ibuprofen and Aspirin"},{"idx":1,"proposition":"Colchicine alone or in combination with ibuprofen, calms pain and reduces recurrence","correct":true},{"idx":2,"proposition":"Colchicine is contraindicated in severe renal impairment","correct":true},{"idx":3,"proposition":"NSAID\/Aspirin treatment is stopped after 14 days if there are no complications","correct":false,"justification":"The cessation of NSAID or aspirin treatment is done gradually after one month, preferably after performing an echocardiogram that ensures the absence of pericardial effusion"},{"idx":4,"proposition":"Corticosteroids are not indicated in acute benign pericarditis due to the risk of viral replication","correct":true}],"type":"custom"}
+{"_id":"psyado-psy-0","context":null,"enonce":"Concerning the main generalities:","item":"psyado","matiere":"psy","propositions":[{"idx":0,"proposition":"The prevalence of ADHD in the general population is 5%","correct":false,"justification":"These disorders have a high prevalence in the pediatric (and not general) population: 5% for ADHD, 3% for TOD and 1.5% for TBI."},{"idx":1,"proposition":"Normal adolescence is defined primarily by endocrine criteria (puberty)","correct":true},{"idx":2,"proposition":"Puberty is earlier in boys than in girls","correct":false,"justification":"As a reminder: at 10-11 years for girls, and at 12-13 years for boys"},{"idx":3,"proposition":"The integration of body changes due to puberty is not always obvious","correct":true},{"idx":4,"proposition":"Sexual urges appear at puberty","correct":true}],"type":"custom"}
+{"_id":"psyado-psy-1","context":null,"enonce":"Regarding ADHD and TOP:","item":"psyado","matiere":"psy","propositions":[{"idx":0,"proposition":"ADHD (Attention Deficit Hyperactivity Disorder) is considered a neurodevelopmental disorder","correct":true},{"idx":1,"proposition":"The TOP is the Opposition Disorder with Provocation","correct":true},{"idx":2,"proposition":"\"Adolescent Behavioral Disorders\" begin around puberty","correct":false,"justification":"Although the title of the item is \"Adolescent behavioural disorders\", these behavioural disorders usually begin in childhood"},{"idx":3,"proposition":"ADHD affects 5% of children and adolescents","correct":true},{"idx":4,"proposition":"Inattention syndrome is only visible in a school setting","correct":false,"justification":"It is visible from the age of walking and in private life situations. But it is true that the syndrome of inattention becomes more visible in elementary school, when the child is confronted with situations requiring an effort of concentration."}],"type":"custom"}
+{"_id":"psyado-psy-2","context":null,"enonce":"Regarding ADHD:","item":"psyado","matiere":"psy","propositions":[{"idx":0,"proposition":"When inattention syndrome is predominant, diagnosis is often late","correct":true},{"idx":1,"proposition":"The disorder usually begins in childhood","correct":true},{"idx":2,"proposition":"The sex ratio of ADHD is about the same as that of conduct disorders.","correct":true},{"idx":3,"proposition":"The etiology is multifactorial","correct":true},{"idx":4,"proposition":"There is a genetic risk factor","correct":true}],"type":"custom"}
+{"_id":"psyado-psy-3","context":null,"enonce":"Regarding risk factors and protective factors:","item":"psyado","matiere":"psy","propositions":[{"idx":0,"proposition":"Smoking during pregnancy is a risk factor for behavioural disorders","correct":true},{"idx":1,"proposition":"Alcohol use during pregnancy is not a recognized risk factor","correct":false,"justification":"Alcohol consumption during pregnancy is totally a risk factor"},{"idx":2,"proposition":"Home placement or educational neglect are protective factors","correct":false,"justification":"Negative life events during early childhood: sexual abuse, educational and emotional neglect, physical and\/or psychological maltreatment, foster care, etc. are all risk factors for the development of TBI"},{"idx":3,"proposition":"Overly rigorous and rigid educational rules are mainly associated with TOPs and TCs.","correct":true},{"idx":4,"proposition":"Dating other adolescent offenders is a risk factor for TC","correct":true}],"type":"custom"}
+{"_id":"psyado-psy-5","context":null,"enonce":"Which of these proposals fall within the framework of a hyperactivity syndrome?","item":"psyado","matiere":"psy","propositions":[{"idx":0,"proposition":"Urgency","correct":false,"justification":"Falls within the framework of an impulsivity syndrome"},{"idx":1,"proposition":"Hostility","correct":false,"justification":"Falls within the framework of the opposition-provocation syndrone"},{"idx":2,"proposition":"Motor instability","correct":true},{"idx":3,"proposition":"Procrastination","correct":true},{"idx":4,"proposition":"Lack of productivity","correct":true}],"type":"custom"}
+{"_id":"psyado-psy-6","context":null,"enonce":"Which of these proposals fall within the framework of an inattention syndrome?","item":"psyado","matiere":"psy","propositions":[{"idx":0,"proposition":"The rapid drop in concentration","correct":true},{"idx":1,"proposition":"Disorganization","correct":false},{"idx":2,"proposition":"Distractibility","correct":true},{"idx":3,"proposition":"Disability","correct":false,"justification":"Falls within the framework of an opposition-provocation syndicate"},{"idx":4,"proposition":"Non-compliance with standards","correct":false,"justification":"Falls within the framework of an antisocial behaviour syndrome"}],"type":"custom"}
+{"_id":"psyado-psy-7","context":null,"enonce":"Regarding pharmacological treatment:","item":"psyado","matiere":"psy","propositions":[{"idx":0,"proposition":"It is set up in first intention most often","correct":false,"justification":"As a second line, except in cases of emergency"},{"idx":1,"proposition":"Risperidone can be given from 1 year","correct":false,"justification":"MA risperidone = from 5 years. AMM Cyamémazine = from 3 years."},{"idx":2,"proposition":"Risperidone is a background treatment","correct":false,"justification":"Short treatment for persistent aggressiveness in a patient with 'below-average intellectual functioning'"},{"idx":3,"proposition":"Methylphenidate is a treatment for TODs","correct":false,"justification":"ADHD"},{"idx":4,"proposition":"Cyamémazine is contraindicated in children (before puberty)","correct":false,"justification":"MA from 3 years old"}],"type":"custom"}
+{"_id":"retardSP-ped-0","context":null,"enonce":"Which of these proposals correspond to normal parameters?","item":"retardSP","matiere":"ped","propositions":[{"idx":0,"proposition":"Height at birth: 50 cm","correct":true},{"idx":1,"proposition":"Cranial circumference at birth: 35 cm","correct":true},{"idx":2,"proposition":"Weight at 9 months: 4 kg","correct":false,"justification":"9 kg"},{"idx":3,"proposition":"Height at 2 years is double height at birth","correct":false,"justification":"This is the case of the size at 4 years"},{"idx":4,"proposition":"Weight at 9 months: 9 kg","correct":true}],"type":"custom"}
+{"_id":"retardSP-ped-1","context":null,"enonce":"Which of these proposals correspond to normal parameters?","item":"retardSP","matiere":"ped","propositions":[{"idx":0,"proposition":"Size at 4 months: 60 cm","correct":true},{"idx":1,"proposition":"Cranial circumference at birth: 75 cm","correct":false,"justification":"Around 35 cm"},{"idx":2,"proposition":"Weight at 4 years: 21 kg","correct":false,"justification":"16 kg"},{"idx":3,"proposition":"The head circumvention at 4 years is around 50 cm","correct":true},{"idx":4,"proposition":"Weight at 1 year is triple the weight at 4 months","correct":false,"justification":"Triple the birth weight"}],"type":"custom"}
+{"_id":"retardSP-ped-2","context":null,"enonce":"Which of these proposals correspond to normal parameters?","item":"retardSP","matiere":"ped","propositions":[{"idx":0,"proposition":"Birth weight: 3.5 kg","correct":true},{"idx":1,"proposition":"Weight at 4 years: 16 kg","correct":true},{"idx":2,"proposition":"Head circumference at 9 months: 45 cm","correct":true},{"idx":3,"proposition":"Size at 4 months: 60 cm","correct":true},{"idx":4,"proposition":"Weight at 4 months: double the birth weight","correct":true}],"type":"custom"}
+{"_id":"retardSP-ped-3","context":null,"enonce":"Regarding the growth of the child:","item":"retardSP","matiere":"ped","propositions":[{"idx":0,"proposition":"Infants should take 25 g per day","correct":true},{"idx":1,"proposition":"Infants gain about 25 cm in the first year","correct":true},{"idx":2,"proposition":"Height, weight and PC parameters should be measured at each consultation","correct":true},{"idx":3,"proposition":"Growth at -1.5 SD is normal","correct":true},{"idx":4,"proposition":"Growth at 3 DS is normal","correct":false,"justification":"Between -2 and 2 DS"}],"type":"custom"}
+{"_id":"retardSP-ped-4","context":null,"enonce":"What proposals fall within the definition of stunting in stature?","item":"retardSP","matiere":"ped","propositions":[{"idx":0,"proposition":"A size less than -1DS","correct":false},{"idx":1,"proposition":"BMI below the 10th percentile","correct":false,"justification":"Below 3rd percentile"},{"idx":2,"proposition":"Increased growth speed","correct":false,"justification":"Slow growth rate"},{"idx":3,"proposition":"Statural growth less than or equal to -1.5 SD (relative to genetic target size)","correct":true},{"idx":4,"proposition":"A size less than -3 DS","correct":true,"justification":"It must be at least less than -2 DS"}],"type":"custom"}
+{"_id":"retardSP-ped-5","context":null,"enonce":"Regarding the etiologies of failure to thrive:","item":"retardSP","matiere":"ped","propositions":[{"idx":0,"proposition":"Congenital hypothyroidism is routinely screened at 3 days of life","correct":true},{"idx":1,"proposition":"The screening test for congenital hypothyroidism is the Tanner test","correct":false,"justification":"Test de Guthrie"},{"idx":2,"proposition":"Congenital GH deficiency is not symptomatic at birth","correct":true},{"idx":3,"proposition":"Simple delay in puberty is the most common cause of statural delay in adolescence","correct":true,"justification":"Common in boys, but rare in girls"},{"idx":4,"proposition":"Pituitary imaging makes it possible to confirm the diagnosis of craniopharyngioma","correct":true}],"type":"custom"}
+{"_id":"retardSP-ped-7","context":null,"enonce":"Which of these proposals can cause statural stunting?","item":"retardSP","matiere":"ped","propositions":[{"idx":0,"proposition":"Hypothyroidism","correct":true},{"idx":1,"proposition":"Hypercorticism","correct":true},{"idx":2,"proposition":"Brain tumour","correct":true},{"idx":3,"proposition":"Growth hormone resistance","correct":true},{"idx":4,"proposition":"Delayed puberty","correct":true}],"type":"custom"}
+{"_id":"retardSP-ped-8","context":null,"enonce":"In Turner syndrome:","item":"retardSP","matiere":"ped","propositions":[{"idx":0,"proposition":"Support is 75%","correct":false,"justification":"100 %. It's an off-list ALD"},{"idx":1,"proposition":"Growth hormone is started in childhood","correct":true},{"idx":2,"proposition":"Growth hormone is started at puberty","correct":false,"justification":"It is the estrogen replacement that is prescribed around the normal age of puberty"},{"idx":3,"proposition":"Diagnostic confirmation is done by karyotype","correct":true},{"idx":4,"proposition":"Diagnostic certainty is done on X-chromosome sequencing","correct":false,"justification":"No sequencing. Turner syndrome is the absence of the X chromosome"}],"type":"custom"}
+{"_id":"retardSP-ped-9","context":null,"enonce":"At 1 year, the birth weight is:","item":"retardSP","matiere":"ped","propositions":[{"idx":0,"proposition":"Unchanged","correct":false,"justification":"False"},{"idx":1,"proposition":"Double","correct":false,"justification":"at 4 months"},{"idx":2,"proposition":"Triplet","correct":true,"justification":"True, about 10kg"},{"idx":3,"proposition":"Quadruplet","correct":false,"justification":"False"},{"idx":4,"proposition":"Quintuplet","correct":false,"justification":"Around 4 years: about 16 kg for a child with a birth weight of 3.5 kg"}],"type":"custom"}
+{"_id":"dlrphysiopath-mpr-0","context":null,"enonce":"Regarding acute and chronic pain:","item":"dlrphysiopath","matiere":"mpr","propositions":[{"idx":0,"proposition":"The best assessment of pain remains the patient's self-assessment","correct":true},{"idx":1,"proposition":"Self-assessment or hetero-evaluation requires the rigorous use of validated scales","correct":true},{"idx":2,"proposition":"Hetero-assessment is used routinely in all patients","correct":false,"justification":"Hetero-assessment is only used if the patient cannot communicate"},{"idx":3,"proposition":"Pain is an important clinical sign and should never be masked by the use of analgesics","correct":false,"justification":"Pain must be treated effectively as soon as possible"},{"idx":4,"proposition":"Chronic pain is a real disease with considerable health and economic repercussions","correct":true,"justification":"Cf College of MPR"}],"type":"custom"}
+{"_id":"dlrphysiopath-mpr-1","context":null,"enonce":"Regarding acute and chronic pain:","item":"dlrphysiopath","matiere":"mpr","propositions":[{"idx":0,"proposition":"Chronic pain is defined as a course greater than 1 month","correct":false,"justification":"We talk about chronic pain, when it has been evolving for more than 3 months"},{"idx":1,"proposition":"Neuropathic pain is secondary to nerve damage and is often chronic","correct":true},{"idx":2,"proposition":"Mixed pain accounts for 25% of chronic pain","correct":true},{"idx":3,"proposition":"Pain is a dynamic phenomenon that evolves over time","correct":true},{"idx":4,"proposition":"In communicating adults, acute pain is assessed using quantitative self-report scales","correct":true,"justification":"Cf College of MPR"}],"type":"custom"}
+{"_id":"dlrphysiopath-mpr-2","context":null,"enonce":"Regarding pain rating scales:","item":"dlrphysiopath","matiere":"mpr","propositions":[{"idx":0,"proposition":"The most used are the visual analogue scale (EVA), the digital scale (EN) and the simple verbal scale (EVS)","correct":true,"justification":"Cf College of MPR"},{"idx":1,"proposition":"EVA uses a graduation from 0 (no pain) to 10 (maximum bearable pain)","correct":false,"justification":"EVA uses a graduation from 0 (no pain) to 100 (maximum sustainable pain)"},{"idx":2,"proposition":"The EN rates pain from 0 (no pain) to 100 (maximum conceivable pain)","correct":false,"justification":"The EN scores pain from 0 (no pain) to 10 (maximum conceivable pain) and the EVS scores pain in 5 categories: 0 (no pain), 1 (low), 2 (moderate), 3 (intense), 4 (very intense), VAS rates pain from 0 to 100"},{"idx":3,"proposition":"Rating scales are not sufficient to assess chronic pain","correct":true,"justification":"These scales are insufficient for the assessment of chronic pain, which must take into account not only the intensity of the pain but all the dimensions of pain and its impact on quality of life."},{"idx":4,"proposition":"The search for a neuropathic component to pain is essential","correct":true,"justification":"Neuropathic pain is to be sought, it testifies to the lesion of the somatosensory system and responds to a specific treatment involving in particular antidepressants and antiepileptics"}],"type":"custom"}
+{"_id":"dlrphysiopath-mpr-3","context":null,"enonce":"Regarding acute and chronic pain:","item":"dlrphysiopath","matiere":"mpr","propositions":[{"idx":0,"proposition":"The diagnosis of neuropathic pain is based on the use of specific scales (DN4, S-LANSS, NPQ), the most widely used in France is the DN4 questionnaire.","correct":true,"justification":"Cf College of MPR"},{"idx":1,"proposition":"The DN4 questionnaire has 100 items to check","correct":false,"justification":"The DN4 questionnaire has 10 items to check"},{"idx":2,"proposition":"The DN4 questionnaire is completed by the patient","correct":false,"justification":"The practitioner questions the patient himself and completes the questionnaire"},{"idx":3,"proposition":"If the patient's DN4 score is greater than or equal to 4, the test is positive with significant sensitivity and specificity","correct":true},{"idx":4,"proposition":"The most frequent etiologies of neuropathic pain are radiculalgia (sciatica, cervicobrachial neuralgia), shingles or diabetes.","correct":true}],"type":"custom"}
+{"_id":"dlrphysiopath-rhumato-0","context":null,"enonce":"Regarding acute and chronic pain","item":"dlrphysiopath","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Chronic pain triggers a diagnostic approach that will clarify the presence of an underlying lesion","correct":false,"justification":"Acute pain triggers a diagnostic approach that will clarify the presence of an underlying lesion"},{"idx":1,"proposition":"Chronic pain corresponds to disease pain, i.e. a complex, biopsychosocial pathology","correct":true},{"idx":2,"proposition":"Inflammatory pain is often daytime pain","correct":false,"justification":"Inflammatory pain is often nocturnal pain (but nocturnal pain can also be of mechanical origin, for example in low back pain)"},{"idx":3,"proposition":"An inflammatory schedule pain is a pain that sets in in the second part of the night","correct":true},{"idx":4,"proposition":"The fibers that transmit the nociceptive message are fibers A and C","correct":true}],"type":"custom"}
+{"_id":"dlrphysiopath-rhumato-1","context":null,"enonce":"Regarding acute pain","item":"dlrphysiopath","matiere":"rhumato","propositions":[{"idx":0,"proposition":"The modulation of nociceptive messages is subject to control systems of segmental and supraspinal origin","correct":true},{"idx":1,"proposition":"To assess pain, the diagnostic approach is based on the definition of the type of pain, knowledge of the mechanisms generating the pain and the intensity of the pain.","correct":true},{"idx":2,"proposition":"To determine the intensity of pain, multidimensional scales are used to estimate pain in a global way","correct":false,"justification":"To determine pain intensity, one-dimensional pain scales are used to estimate pain holistically."},{"idx":3,"proposition":"the preferred scale is the numerical scale EN","correct":true},{"idx":4,"proposition":"The simple visual scale consists of 4 items, rated: 1: Low; 2: Moderate; 3: Intense; 4: Extremely intense","correct":false,"justification":"The simple visual scale consists of five items, rated: 0: Absent; 1: Low; 2: Moderate; 3: Intense; 4: Extremely intense"}],"type":"custom"}
+{"_id":"dlrphysiopath-neuro-0","context":null,"enonce":"Regarding acute and chronic pain","item":"dlrphysiopath","matiere":"neuro","propositions":[{"idx":0,"proposition":"Pain is an unpleasant sensory and emotional experience, associated with, or described in terms of, present or potential tissue damage.","correct":true},{"idx":1,"proposition":"Pain is sometimes objectivable","correct":false,"justification":"Pain is always subjective"},{"idx":2,"proposition":"There are two main routes of transmission of somesthetic information: the lateral lemniscal system and the medial lemniscal system","correct":false,"justification":"There are two main routes of transmission of somesthetic information: the lemniscal system and the extralemniscal system"},{"idx":3,"proposition":"The lemniscal system corresponds to epicritical and proprioceptive sensitivities","correct":true},{"idx":4,"proposition":"The extralemniscal system corresponds to protopathic, nociceptive and thermal sensitivities","correct":true}],"type":"custom"}
+{"_id":"dlrphysiopath-neuro-1","context":null,"enonce":"Regarding acute and chronic pain","item":"dlrphysiopath","matiere":"neuro","propositions":[{"idx":0,"proposition":"The neospinothalamic bundle rather connected to the Aδ fibers joins the ventro-postero-lateral nucleus of the thalamus before reaching the somatosensory cortex","correct":true},{"idx":1,"proposition":"The paleospinothalamic bundle rather connected to the C fibers joins the medial thalamus with a relay to the limbic structures and the frontal cortex","correct":true},{"idx":2,"proposition":"Diffuse inhibitory control of nociception-induced pain allows attention to be focused on the new painful area","correct":true},{"idx":3,"proposition":"Nociceptors can release neurotransmitters as well as substance P which has a vasodilating action and promotes the secretion of histamine, serotonin sensitizing neighboring nociceptors","correct":true},{"idx":4,"proposition":"It is neurogenic inflammation that causes primary hyperalgesia","correct":true}],"type":"custom"}
+{"_id":"dlrphysiopath-neuro-2","context":null,"enonce":"Regarding acute and chronic pain","item":"dlrphysiopath","matiere":"neuro","propositions":[{"idx":0,"proposition":"NSAIDs act on the synthesis of prostaglandins by inhibiting the action of cyclooxygenase (COX)","correct":true},{"idx":1,"proposition":"GABA has an algesic action","correct":false,"justification":"Analgesic function"},{"idx":2,"proposition":"Tissue damage leads to the secretion of analgesic substances such as opioid peptides","correct":true},{"idx":3,"proposition":"Serotonin (5-HT), dopamine and norepinephrine are largely involved in pain regulation by activating ascending neurons","correct":false,"justification":"Serotonin (5-HT), dopamine and norepinephrine are largely involved in pain regulation via descending inhibitory controls. This is the << gate control >>: they activate the A-alpha fibers which, in turn, inhibit the A-dela and C fibers (carriers of nociception) in the spinal cord."},{"idx":4,"proposition":"The routes of transmission of the nociceptive message are lemniscal","correct":false,"justification":"What to remember The routes of transmission of the nociceptive message are extralemniscal"}],"type":"custom"}
+{"_id":"dlrphysiopath-neuro-3","context":null,"enonce":"Regarding acute and chronic pain","item":"dlrphysiopath","matiere":"neuro","propositions":[{"idx":0,"proposition":"The main excitatory neurotransmitters of pain are adrenaline and corticosteroids glutamate, aspartate and substance P","correct":false,"justification":"These are glutamate, aspartate and substance P"},{"idx":1,"proposition":"Acute pain is an often helpful symptom","correct":true,"justification":"It will be necessary to quickly determine the origin and nature in order to implement the appropriate treatment to remove the cause (if possible) and the complete disappearance of the pain."},{"idx":2,"proposition":"In case of severe pain, a strong analgesic treatment, including strong opioid, is often useful","correct":true},{"idx":3,"proposition":"The pain is chronic if its duration is longer than 8 weeks","correct":false,"justification":"The pain is chronic if its duration is longer than 3 or 6 months"},{"idx":4,"proposition":"Chronic pain is a syndrome, multifactorial and complex, associating physical but also psychic, behavioral and social manifestations","correct":true}],"type":"custom"}
+{"_id":"dlrphysiopath-neuro-4","context":null,"enonce":"Among these structures, at what level do the fibers of the lemniscale pathway decuss?","item":"dlrphysiopath","matiere":"neuro","propositions":[{"idx":0,"proposition":"The bulb","correct":true},{"idx":1,"proposition":"The brain stem","correct":true,"justification":"The fibers of the lemniscale pathway decuss at the buble, which is the lower part of the brainstem"},{"idx":2,"proposition":"The thalamus","correct":false},{"idx":3,"proposition":"Cervical cord","correct":false},{"idx":4,"proposition":"Hypothalamus","correct":false}],"type":"custom"}
+{"_id":"dlrphysiopath-neuro-5","context":null,"enonce":"Through which structures do the fibers of the lemniscale pathway pass?","item":"dlrphysiopath","matiere":"neuro","propositions":[{"idx":0,"proposition":"The anterior horn of the spinal cord","correct":false,"justification":"These are sensory fibers (mainly Abeta) so they pass not the posterior horn of the spinal cord"},{"idx":1,"proposition":"Hypothalamus","correct":false,"justification":"They pass through the Ventro-Postero-Lateral nucleus of the thalamus"},{"idx":2,"proposition":"The gracile nucleus","correct":true},{"idx":3,"proposition":"The cuneiform nucleus","correct":true},{"idx":4,"proposition":"The pre-central gyrus","correct":false,"justification":"It is the post-central gyrus that is sensitive. The pre-central gyrus is motor"}],"type":"custom"}
+{"_id":"dlrphysiopath-neuro-6","context":null,"enonce":"Which of these sensitivities are conveyed by extra-lemniscal routes?","item":"dlrphysiopath","matiere":"neuro","propositions":[{"idx":0,"proposition":"Nociception","correct":true,"justification":"There are three according to the College of Neurology: protopathic, nociception, thermal"},{"idx":1,"proposition":"Epicritics","correct":false,"justification":"A-beta fibres: leminscale route"},{"idx":2,"proposition":"Proprioception","correct":false,"justification":"A-beta fibres: lemniscale route"},{"idx":3,"proposition":"Protophatic","correct":true},{"idx":4,"proposition":"Thermoalgic","correct":true}],"type":"custom"}
+{"_id":"DE-uro-0","context":null,"enonce":"Regarding the anatomy of the penis:","item":"DE","matiere":"uro","propositions":[{"idx":0,"proposition":"The corpora cavernosa is an active vascular sponge consisting of smooth muscle cells surrounded by connective and elastic supporting tissue","correct":true},{"idx":1,"proposition":"Around the corpora cavernosa, the albuginea is a poorly stretched and resistant membrane","correct":true},{"idx":2,"proposition":"The albuginary muscle contracts rhythmically allowing the expulsion of semen during ejaculation","correct":false,"justification":"The bulbo-spongy muscle, which surrounds the initial part of the albuginea (= the bulb)"},{"idx":3,"proposition":"The glans is the terminal part of the corpus spongiosum that caps the distal end of the corpora cavernosa","correct":true},{"idx":4,"proposition":"The vascularization of the penis is largely anastomosed between the network of spongy arteries and dorsal arteries of the penis","correct":true}],"type":"custom"}
+{"_id":"DE-uro-1","context":null,"enonce":"Regarding erection:","item":"DE","matiere":"uro","propositions":[{"idx":0,"proposition":"Venous drainage is provided by a deep network","correct":true},{"idx":1,"proposition":"Pudendal veins flow into the external iliac veins","correct":false,"justification":"EMB drainage is through the internal iliac veins"},{"idx":2,"proposition":"Pro-erectile innervation comes from the orthosympatic system","correct":false,"justification":"Pro-erectile innervation comes from the parasympathetic system and NANC (non-adrenergic and non-cholinergic: essentially nitrergic [NO])"},{"idx":3,"proposition":"Pro-erectile innervation is of sacral origin S2-S4","correct":true},{"idx":4,"proposition":"In the flaccid state, adrenergic sympathetic innervation keeps the smooth muscle contracted limiting the opening of the sinusoid spaces","correct":true}],"type":"custom"}
+{"_id":"DE-uro-3","context":null,"enonce":"Regarding patient care:","item":"DE","matiere":"uro","propositions":[{"idx":0,"proposition":"Age is an independent risk factor for erectile dysfunction","correct":true},{"idx":1,"proposition":"It is estimated that about 10% of couples have active sexuality by age 70.","correct":false,"justification":"70% of couples"},{"idx":2,"proposition":"ED is a sentinel symptom of cardiovascular disease and especially coronary artery disease","correct":true},{"idx":3,"proposition":"The prevalence of ED increases in comorbidities such as hypertension, diabetes, dyslipidemia and obesity","correct":true},{"idx":4,"proposition":"ED is an isolated sexual disorder, barring chance","correct":false,"justification":"There is a common association between ED and other sexual disorders"}],"type":"custom"}
+{"_id":"progrossesse-sp-0","context":null,"enonce":"Which of these proposals are CMR substances (carcinogenic, mutagenic, reprotoxic)?","item":"progrossesse","matiere":"sp","propositions":[{"idx":0,"proposition":"Alcohol","correct":false},{"idx":1,"proposition":"Fulfuryl alcohol","correct":true},{"idx":2,"proposition":"Arsenic","correct":true},{"idx":3,"proposition":"Tobacco","correct":false,"justification":"Not in the CMR list"},{"idx":4,"proposition":"Nickel","correct":true}],"type":"custom"}
+{"_id":"progrossesse-sp-1","context":null,"enonce":"Which of these proposals are physical risks for pregnant women?","item":"progrossesse","matiere":"sp","propositions":[{"idx":0,"proposition":"Hyberbaria","correct":true},{"idx":1,"proposition":"Cosmic radiation","correct":true,"justification":"Work in aircraft in flight for example"},{"idx":2,"proposition":"Heavy load port","correct":false,"justification":"Not a physical risk"},{"idx":3,"proposition":"Pesticide exposure","correct":false,"justification":"Chemical risk"},{"idx":4,"proposition":"Exposure to rubella","correct":false,"justification":"Biological risk\""}],"type":"custom"}
+{"_id":"progrossesse-sp-2","context":null,"enonce":"Which statements are true?","item":"progrossesse","matiere":"sp","propositions":[{"idx":0,"proposition":"It is strictly forbidden to expose an unprotected pregnant woman to rubella","correct":true},{"idx":1,"proposition":"It is strictly forbidden to expose an unprotected pregnant woman to toxoplasmosis","correct":true},{"idx":2,"proposition":"Jackhammer work is not contraindicated in women before the 10th SA","correct":false,"justification":"Jackhammer work: generally forbidden to women, especially if they are pregnant."},{"idx":3,"proposition":"Care shall be taken to ensure that exposure does not exceed 1 mSv if it is necessary for use","correct":true},{"idx":4,"proposition":"If she so requests, the pregnant woman or a woman who has given birth may request to move to a temporary day shift.","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"progrossesse-sp-3","context":null,"enonce":"What are the real propositions?","item":"progrossesse","matiere":"sp","propositions":[{"idx":0,"proposition":"There is no legal obligation to declare the pregnancy to the employer","correct":true},{"idx":1,"proposition":"Declaring the pregnancy to the employer can lead to the implementation of optimized working conditions","correct":true},{"idx":2,"proposition":"A pregnant woman is not allowed to work for more than 5 consecutive days","correct":true},{"idx":3,"proposition":"The maximum working time is 40 hours\/week at the beginning of pregnancy","correct":true},{"idx":4,"proposition":"From 6 months, the maximum weekly working time is 35 hours","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"progrossesse-sp-4","context":null,"enonce":"Regarding pregnancy and labour:","item":"progrossesse","matiere":"sp","propositions":[{"idx":0,"proposition":"If pregnancy leads to maladjustment to the position, dismissal is possible","correct":false,"justification":"No dismissal during pregnancy and maternity leave"},{"idx":1,"proposition":"Breastfeeding in the labour establishment is not possible","correct":false,"justification":"Possible"},{"idx":2,"proposition":"Maternity leave in its classic form is 24 weeks in total","correct":false,"justification":"The duration of maternity leave is: 6 weeks before the expected date of delivery and 10 weeks after"},{"idx":3,"proposition":"Prenatal leave is typically 6 weeks","correct":true},{"idx":4,"proposition":"Maternity leave is extended in the event of multiple births","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"pso-dermato-0","context":null,"enonce":"Regarding the basics of psoriaris:","item":"pso","matiere":"dermato","propositions":[{"idx":0,"proposition":"Psoriasis is an erythematosquamous dermatosis","correct":true},{"idx":1,"proposition":"Psoriasis is characterized by decelerated epidermal renewal and therefore hypoproliferation","correct":false,"justification":"Accelerated epidermal renewal with hyperproliferation and keratinocyte differentiation disorders"},{"idx":2,"proposition":"There is no genetic component that has been found until today","correct":false,"justification":"It involves, on a particular genetic terrain, complex interactions between the immune system, epidermal cells (keratinocytes) and vessels"},{"idx":3,"proposition":"The histopathological examination is mandatory to consider the diagnosis","correct":false,"justification":"Histopathological examination of a psoriatic lesion skin biopsy may be useful but is usually not necessary"},{"idx":4,"proposition":"The prevalence of psoriasis in the general population is about 2%","correct":true}],"type":"custom"}
+{"_id":"pso-dermato-1","context":null,"enonce":"What is found during the histopathological examination?","item":"pso","matiere":"dermato","propositions":[{"idx":0,"proposition":"An acanthosis is the thickening of the epidermis","correct":true},{"idx":1,"proposition":"T-cell micro-abscesses","correct":false,"justification":"neutrophil microabscesses"},{"idx":2,"proposition":"Bacterial inflammatory infiltrates (often Staphylococcus aureus)","correct":false,"justification":"inflammatory lymphocyte infiltrate"},{"idx":3,"proposition":"Dilated neoformed vessels","correct":true},{"idx":4,"proposition":"Hypokeratosis with parakeratosis","correct":false,"justification":"Hyperkeratosis and parakeratosis"}],"type":"custom"}
+{"_id":"pso-dermato-2","context":null,"enonce":"Regarding psoriasis:","item":"pso","matiere":"dermato","propositions":[{"idx":0,"proposition":"Many susceptibility genes have been identified","correct":true},{"idx":1,"proposition":"Some psoriasis in children begins as a result of nasopharyngeal infectious episodes","correct":true},{"idx":2,"proposition":"Infectious episodes have no impact on already established psoriasis","correct":false,"justification":"They can aggravate already known psoriasis"},{"idx":3,"proposition":"The occurrence or worsening of psoriasis during HIV infection is possible","correct":true},{"idx":4,"proposition":"Beta-blockers are an inducing or aggravating factor in psoriasis","correct":true}],"type":"custom"}
+{"_id":"pso-dermato-3","context":null,"enonce":"Regarding psoriasis risk factors:","item":"pso","matiere":"dermato","propositions":[{"idx":0,"proposition":"Stopping systemic corticosteroids often stops psoriasis","correct":false,"justification":"Significant rebound possible or even development of severe forms (erythrodermic psoriasis, generalized pustular psoriasis) when stopping general corticosteroid therapy"},{"idx":1,"proposition":"Emotional shock has no impact on psoriasis","correct":false,"justification":"Possible role of emotional shock and trauma in triggering illness or flare-ups"},{"idx":2,"proposition":"Psychological stress could induce increased secretion of neurotransmitters with pro-inflammatory activity","correct":true},{"idx":3,"proposition":"Alcohol and tobacco are recognized factors of severity and therapeutic resistance","correct":true},{"idx":4,"proposition":"Overweight is a protective factor","correct":false,"justification":"Overweight is a factor of resistance to treatment"}],"type":"custom"}
+{"_id":"pso-dermato-4","context":null,"enonce":"Regarding the diagnosis:","item":"pso","matiere":"dermato","propositions":[{"idx":0,"proposition":"The diagnosis of psoriasis is a pathological diagnosis","correct":false,"justification":"Clinical diagnosis"},{"idx":1,"proposition":"Skin biopsy is indicated only in case of diagnostic doubt in front of atypical lesions","correct":true},{"idx":2,"proposition":"The elementary lesion is a poorly limited tense bubble","correct":false,"justification":"Well-limited erythematosqal papule"},{"idx":3,"proposition":"The size of the lesions is always less than 5 mm","correct":false,"justification":"The size of the lesions is variable"},{"idx":4,"proposition":"An AEG associated with elementary lesions strongly points to psoriasis","correct":false,"justification":"In the usual psoriasis, the general condition is not impaired"}],"type":"custom"}
+{"_id":"matraitanceped-sp-0","context":null,"enonce":"Child abuse is:","item":"matraitanceped","matiere":"sp","propositions":[{"idx":0,"proposition":"Failure to respect the rights and basic needs of the child","correct":true},{"idx":1,"proposition":"Parental neglect","correct":false,"justification":"Do not confuse abuse with neglect"},{"idx":2,"proposition":"Refusal on the part of schooling in a classical school","correct":false,"justification":"Homeschooling is possible, legal and must be a respected choice"},{"idx":3,"proposition":"Non-respect for the child's desires","correct":false,"justification":"Their basic needs and rights"},{"idx":4,"proposition":"More common in cases of prematurity or disability","correct":true}],"type":"custom"}
+{"_id":"matraitanceped-sp-1","context":null,"enonce":"What are the risk factors for child maltreatment?","item":"matraitanceped","matiere":"sp","propositions":[{"idx":0,"proposition":"Prematurity","correct":true},{"idx":1,"proposition":"Disability","correct":true},{"idx":2,"proposition":"Obesity","correct":false,"justification":"Not recognized"},{"idx":3,"proposition":"Female sex","correct":false,"justification":"Not in the repository"},{"idx":4,"proposition":"Behavioural disorders","correct":true}],"type":"custom"}
+{"_id":"matraitanceped-sp-2","context":null,"enonce":"What are the risk factors for parental abuse?","item":"matraitanceped","matiere":"sp","propositions":[{"idx":0,"proposition":"Their young age","correct":true},{"idx":1,"proposition":"Unemployment","correct":true},{"idx":2,"proposition":"Addictions","correct":true},{"idx":3,"proposition":"History of childhood abuse","correct":true},{"idx":4,"proposition":"Fatigue","correct":false,"justification":"Not a risk factor every parent is tired"}],"type":"custom"}
+{"_id":"matraitanceped-sp-3","context":null,"enonce":"What examinations are to be carried out in case of suspicion of abuse?","item":"matraitanceped","matiere":"sp","propositions":[{"idx":0,"proposition":"A hemostasis assessment is useless and only delays the real management","correct":false,"justification":"Eliminates a hemostasis disorder that can explain the lesions"},{"idx":1,"proposition":"NFS and CRP\/VS","correct":false,"justification":"Useless in this case"},{"idx":2,"proposition":"Calcium phosphate balance","correct":true,"justification":"Eliminates rickets"},{"idx":3,"proposition":"X-rays of the skeleton","correct":true,"justification":"Looking for silverman's syndrome"},{"idx":4,"proposition":"A thyroid test","correct":false,"justification":"Useless because would not explain common signs of abuse"}],"type":"custom"}
+{"_id":"matraitanceped-sp-4","context":null,"enonce":"Which propositions are true?","item":"matraitanceped","matiere":"sp","propositions":[{"idx":0,"proposition":"Abuse is a life-threatening emergency","correct":false,"justification":"With some exceptions, it is mainly a medico-legal emergency (see KB page 271)"},{"idx":1,"proposition":"The MIC is descriptive and photographs of the lesions must be attached","correct":true},{"idx":2,"proposition":"Administrative reporting is reserved for serious cases","correct":false,"justification":"Systematics if situations of concern"},{"idx":3,"proposition":"Judicial reporting is reserved for serious cases","correct":true},{"idx":4,"proposition":"Shaken baby syndrome affects children under 1 year of age","correct":true}],"type":"custom"}
+{"_id":"matraitanceped-sp-5","context":null,"enonce":"Which propositions are true?","item":"matraitanceped","matiere":"sp","propositions":[{"idx":0,"proposition":"The PMI service is under the Ministry of Social Welfare","correct":false,"justification":"Departmental service (this ministry does not exist)"},{"idx":1,"proposition":"The PMI is responsible for ensuring the health protection of mothers and children","correct":true},{"idx":2,"proposition":"The accompaniment is psychological and social","correct":false,"justification":"Medical and pedagogical too"},{"idx":3,"proposition":"PMI manages administrative reports","correct":true},{"idx":4,"proposition":"PMI trains psychologists","correct":false,"justification":"No, but childminders yes"}],"type":"custom"}
+{"_id":"tbconscience-urg-0","context":null,"enonce":"Which of the following are true for Gayet-Wernicke encephalopathy?","item":"tbconscience","matiere":"urg","propositions":[{"idx":0,"proposition":"It is due to vitamin B1 deficiency","correct":true},{"idx":1,"proposition":"It is due to vitamin B3 deficiency","correct":false,"justification":"False"},{"idx":2,"proposition":"It is due to vitamin B9 deficiency","correct":false,"justification":"False"},{"idx":3,"proposition":"It is due to vitamin B6 deficiency","correct":false,"justification":"False"},{"idx":4,"proposition":"It is due to vitamin B12 deficiency","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"choc-urg-0","context":null,"enonce":"Regarding the basics of shock:","item":"choc","matiere":"urg","propositions":[{"idx":0,"proposition":"Shock is responsible for tissue hypoxia","correct":true},{"idx":1,"proposition":"Lactatemia has no relation to the severity of organ failure","correct":false,"justification":"Shock is responsible for organ failure(s) and elevated lactatemia (> 2 mmol\/L) whose magnitude is proportional to the severity"},{"idx":2,"proposition":"The diagnosis of shock is biological","correct":false,"justification":"Diagnosis is essentially clinical"},{"idx":3,"proposition":"Shock is defined by the combination of hypotension AND at least 1 organ failure","correct":true},{"idx":4,"proposition":"There are two types of shocks: hypovolemic and distributive","correct":false,"justification":"4 types of shock: hypovolemic, cardigenic, septic, anaphylactic"}],"type":"custom"}
+{"_id":"choc-urg-2","context":null,"enonce":"What is the dosage of volume expansion to prescribe in a child in hypovolemic shock?","item":"choc","matiere":"urg","propositions":[{"idx":0,"proposition":"NaCl 0,9 % 20 ml\/kg","correct":true,"justification":"True, not exceeding 500 ml per filling"},{"idx":1,"proposition":"NaCl 0.9% 120 ml\/kg","correct":false,"justification":"False"},{"idx":2,"proposition":"NaCl 0.9% 200 ml\/kg","correct":false,"justification":"False"},{"idx":3,"proposition":"NaCl 0,9 % 2000 ml\/kg","correct":false,"justification":"False"},{"idx":4,"proposition":"NaCl 0.9% 2 ml\/kg","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"soinspalped-soinspal-0","context":null,"enonce":"Which of the following are possible indications for the implementation of palliative care in paediatrics?","item":"soinspalped","matiere":"soinspal","propositions":[{"idx":0,"proposition":"Cancer in remission","correct":false,"justification":"This is not an indication according to the college"},{"idx":1,"proposition":"The entourage of a child who died suddenly and unexpectedly","correct":true,"justification":"True, like road accidents or stillbirths"},{"idx":2,"proposition":"Disabling mitochondrial metabolic diseases","correct":true},{"idx":3,"proposition":"Acute infectious meningitis","correct":false,"justification":"A cure exists"},{"idx":4,"proposition":"Cystic fibrosis","correct":true}],"type":"custom"}
+{"_id":"bacteriemie-infectio-0","context":null,"enonce":"Regarding bacteremia and fungemia","item":"bacteriemie","matiere":"infectio","propositions":[{"idx":0,"proposition":"Diagnosis is based on 2 to 3 pairs of well-filled blood cultures (10 mL), which must be performed before any antibiotic therapy","correct":true},{"idx":1,"proposition":"ƒƒ The term \"sepsis\" is no longer used","correct":true},{"idx":2,"proposition":"The incidence of bacteremia\/fungal among hospitalized patients is 1%","correct":true},{"idx":3,"proposition":"A quarter of bacteremia\/fungal infections are associated with signs of hemodynamic distress (sepsis, septic shock)","correct":true},{"idx":4,"proposition":"Blood cultures do not need to be particularly performed at peak fever, hypothermia and\/or chills","correct":true}],"type":"custom"}
+{"_id":"bacteriemie-infectio-1","context":null,"enonce":"Regarding bacteremia, sepsis and fungalemia","item":"bacteriemie","matiere":"infectio","propositions":[{"idx":0,"proposition":"The bacteriology laboratory must be informed of the clinical context, and of the possible search for particular infectious agents in case of emocultures.","correct":true},{"idx":1,"proposition":"In endocarditis, blood cultures are incubated for 10 days (slow-growing microbe), hence the importance of notifying the laboratory of the search for endocarditis","correct":true},{"idx":2,"proposition":"Any foreign material must be suspected in the absence of any other obvious cause","correct":true},{"idx":3,"proposition":"Any bacteremia with sepsis is a therapeutic emergency","correct":true},{"idx":4,"proposition":"ƒƒ If a foreign material is at the origin of bacteremia, its removal is most often necessary sometimes urgently, to hope to obtain a cure","correct":true}],"type":"custom"}
+{"_id":"bacteriemie-infectio-2","context":null,"enonce":"Regarding infections by S.aureurs","item":"bacteriemie","matiere":"infectio","propositions":[{"idx":0,"proposition":"aureus are serious infections, by: ƒƒ high frequencyInfetions by s; AUREUS ARE serious infections due to the frequency of spetic metastasis","correct":true},{"idx":1,"proposition":"Any infection with S. aureus must therefore perform a complete clinical examination in search of secondary septic locations (heart, bone, ...) and must systematically perform an echocardiogram in search of endocarditis","correct":true},{"idx":2,"proposition":"Antibiotic therapy is usually IV monotherapy with penicillin M or cefazolin (SASM) or vancomycin or daptomycin (MRSA)","correct":true},{"idx":3,"proposition":"Initial dual therapy is often required in these infections","correct":false,"justification":"Initial dual therapy is only necessary in case of signs of severity (association with gentamicin) or suspicion of endocarditis on prosthetic valve (combination with gentamicin then rifampicin)"},{"idx":4,"proposition":"The persistence of positivity is blood cultures is in favor of the existence of secondary septic localizations or endovascular infection,","correct":true}],"type":"custom"}
+{"_id":"classifpsy-psy-0","context":null,"enonce":"DSM and CIM:","item":"classifpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Diseases are organized by the International Classification of Diseases, currently in its version 5 (ICD 5)","correct":false,"justification":"The current version is 10 (ICD 10)"},{"idx":1,"proposition":"A specific classification system for mental disorders has been defined by the American Psychiatric Association","correct":true},{"idx":2,"proposition":"The current DSM is DSM-4.5","correct":false,"justification":"Currently in its version 5, translated into French (DSM-5)"},{"idx":3,"proposition":"DSM-5 is more widely used than ICD-10 for clinical research in psychiatry","correct":true},{"idx":4,"proposition":"The DSM-5 allows the scoring of medical acts in psychiatry","correct":false,"justification":"The DSM-5 also refers to routine clinical practice, while ICD-10 remains the France reference for the rating of acts in hospitals."}],"type":"custom"}
+{"_id":"classifpsy-psy-1","context":null,"enonce":"Regarding the psychiatric clinic:","item":"classifpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"A sign is an \"objective\" clinical observation","correct":true},{"idx":1,"proposition":"A symptom is a \"subjective\" experience described by the patient","correct":true},{"idx":2,"proposition":"A syndrome is a set of symptoms","correct":false,"justification":"A syndrome is a set of signs and symptoms forming a recognizable set"},{"idx":3,"proposition":"The psychiatric examination is essentially clinical","correct":true},{"idx":4,"proposition":"Semeiological analysis in psychiatry consists of exploring eight domains of the patient's lived experience and behaviour.","correct":true}],"type":"custom"}
+{"_id":"classifpsy-psy-2","context":null,"enonce":"Semiological data in psychiatry:","item":"classifpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"The evolution of the symptomatology over time unfortunately does not bring additional elements to the clinical reflection","correct":false,"justification":"It is also important to explore."},{"idx":1,"proposition":"Personal hygiene can be indicative of carelessness (with indifference and lack of care)","correct":true},{"idx":2,"proposition":"An amimic expression signs the disappearance of all mimicry","correct":true},{"idx":3,"proposition":"Discourse is the quality of language (lexical field, vocabulary, etc.)","correct":false,"justification":"Discourse is the association of language and thought"},{"idx":4,"proposition":"The neologism is the invention of words","correct":true}],"type":"custom"}
+{"_id":"classifpsy-psy-3","context":null,"enonce":"Semiology in psychiatry:","item":"classifpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"The form of speech can be altered in its continuity with inconsistencies","correct":true},{"idx":1,"proposition":"Fading is the gradual cessation of the patient's speech","correct":true},{"idx":2,"proposition":"Fading can go as far as a dam","correct":true},{"idx":3,"proposition":"The content of the speech is most often uninteresting","correct":false,"justification":"The content of the speech can find: delusions, worries and worries, obsessions, revivals and flashbacks, phobic ideas, ideas related to anticipatory anxiety, ideas related to mood (negative, devaluation, incurability etc.), ..."},{"idx":4,"proposition":"Illusions are distorted perceptions","correct":true}],"type":"custom"}
+{"_id":"classifpsy-psy-5","context":null,"enonce":"Psychiatric semiology:","item":"classifpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Anhedonia refers more specifically to the loss of the ability to experience pleasure","correct":true},{"idx":1,"proposition":"Hyperthymia is a form of hypersexuality","correct":false,"justification":"Hyperthymia is a euphoric mood"},{"idx":2,"proposition":"Increased mood is very rarely associated with hypertune","correct":false,"justification":"This is a common association"},{"idx":3,"proposition":"Hypertune is a hypersensitivity to context and atmosphere","correct":true},{"idx":4,"proposition":"Aboulie and apragmatism are synonymous","correct":false,"justification":"Aboulie is to be distinguished from apragmatism (difficulty in initiating an action due to lack of planning)"}],"type":"custom"}
+{"_id":"GEU-gyn-0","context":null,"enonce":"Regarding the generalities of UEGs:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"The most common presentation of GEU is implantation on the ovary","correct":false,"justification":"The most frequent presentation is tubal pregnancy with implantation that begins in the tube: in its ampullary part in 75% of cases, isthmian in 20% of cases, or even pavilion for 3% of GEU"},{"idx":1,"proposition":"The rarest presentation of GEU is pavilion nesting","correct":false,"justification":"More rarely, implantation can occur in the interstitial part of the uterus, on the ovary or in the abdomen and exceptionally in the cervix (cervical pregnancy) or in a rudimentary uterine horn in case of malformed uterus"},{"idx":2,"proposition":"Heterotopic pregnancy is the coexistence of two simultaneous pregnancies: an intrauterine pregnancy and a GEU","correct":true},{"idx":3,"proposition":"The main risk factor for heterotopic pregnancy is advanced age","correct":false,"justification":"The main risk factor for the latter is medically assisted procreation"},{"idx":4,"proposition":"EMG is a relative non-life-threatening emergency most often","correct":false,"justification":"The GEU, when it is evolved, is therefore the very example of the vital emergency and remains a major cause of maternal mortality in the world.\""}],"type":"custom"}
+{"_id":"GEU-gyn-1","context":null,"enonce":"Regarding the evolution and FDR of EMGs:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"The incidence of EMGs has declined significantly in developed countries","correct":false,"justification":"The incidence of ectopic pregnancies has increased in developed countries, accounting for 2% of pregnancies in France"},{"idx":1,"proposition":"Morbidity and mortality has increased significantly in recent years","correct":false,"justification":"Morbidity and mortality has been significantly reduced thanks to the possibilities of early diagnosis and effective and less invasive treatments such as drug treatment or laparoscopy."},{"idx":2,"proposition":"There are no demonstrated risk factors for GEU","correct":false,"justification":"The risk factors for GEU are therefore all factors altering tubal motility: • upper genital infections (IGH), endometriosis, tubal or abdominal surgery atcd, etc."},{"idx":3,"proposition":"Tuberculosis may be a cause of damage to the tubal wall","correct":true},{"idx":4,"proposition":"Schistosomiasis may be a cause of tubal wall ateration","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"GEU-gyn-2","context":null,"enonce":"Regarding EMGs:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"High maternal age is a risk factor for GEU","correct":true},{"idx":1,"proposition":"The intrauterine device leads to a relative risk of GEU of 0.3 and therefore makes it a protective factor","correct":false,"justification":"intrauterine device (risk relative to 3)"},{"idx":2,"proposition":"IVF patients cannot have a GEU because the injection is uterine","correct":false,"justification":"For these patients, we must think about heterotopic pregnancies"},{"idx":3,"proposition":"The diagnosis of GEU should be discussed in any woman of childbearing potential presenting to the emergency room for pelvic pain and\/or metrorrhagia","correct":true},{"idx":4,"proposition":"In a woman of childbearing age who has pelvic pain, we can do without a clinical examination and do a pelvic ultrasound directly.","correct":false,"justification":"Clinical examination, pelvic ultrasound and plasma βHCG assay (not set = 0) should be performed\""}],"type":"custom"}
+{"_id":"GEU-gyn-4","context":null,"enonce":"Concerning the diagnosis of GEU","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Vaginal touch is always normal at Douglas' cul-de-sac","correct":false,"justification":"At the posterior vaginal cul-de-sac (Douglas), touch can cause sharp tenderness indicating peritoneal irritation related to hemoperitoneum"},{"idx":1,"proposition":"Uterine emptiness with normal βHCG is the main indirect sign of GEU","correct":false,"justification":"Uterine emptiness with βHCG greater than 1,500 IU\/L is the main (indirect) sign of GEU"},{"idx":2,"proposition":"GEU is never visible on endovaginal ultrasound","correct":false,"justification":"The GEU may be visible on endovaginal ultrasound as a \"laterouterine mass\" (Figure 2"},{"idx":3,"proposition":"The laterouterine mass is exceptionally located on the side of the corpus luteum","correct":false,"justification":"In 90% of cases, the laterouterine mass is located on the side of the corpus luteum"},{"idx":4,"proposition":"The presence of blood in Morrison's space is a sign of a large hemoperitoneum","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"GEU-gyn-5","context":null,"enonce":"Regarding BHCG and GEU:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"The BHCG test is urgently requested in any patient of childbearing age who presents pelvic signs","correct":true},{"idx":1,"proposition":"If βHCG is above 1,500 IU\/L with uterine acuity on ultrasound, the diagnosis of GEU is very likely","correct":true},{"idx":2,"proposition":"βHCG less than 1,500 IU\/L eliminates the diagnosis of GEU","correct":false},{"idx":3,"proposition":"In intrauterine pregnancy, BHCG levels remain stable from the first days of pregnancy","correct":false,"justification":"Indeed, in intrauterine pregnancy βHCG levels double in this time interval"},{"idx":4,"proposition":"In case of spontaneous miscarriage, BHCG remains stable for several weeks","correct":false,"justification":"In case of spontaneous miscarriage, they decrease\""}],"type":"custom"}
+{"_id":"GEU-gyn-6","context":null,"enonce":"What does the preoperative assessment of a patient suspected of GEU contain:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"NFS","correct":true,"justification":"Standard balance sheet"},{"idx":1,"proposition":"TP\/TCA","correct":true},{"idx":2,"proposition":"Rhesus RAI Group","correct":true},{"idx":3,"proposition":"Hepatic test","correct":false,"justification":"With some exceptions"},{"idx":4,"proposition":"Anesthetic consultation","correct":true}],"type":"custom"}
+{"_id":"GEU-gyn-7","context":null,"enonce":"Which of these proposals are differential diagnoses of GEU in beta-HCG negative?","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Cervical tumour","correct":true},{"idx":1,"proposition":"Spontaneous miscarriage","correct":false,"justification":"b-HCG is positive"},{"idx":2,"proposition":"Hydatidiform mole","correct":false,"justification":"b-HCG is positive"},{"idx":3,"proposition":"Intrauterine pregnancy","correct":false,"justification":"b-HCG is positive"},{"idx":4,"proposition":"Hemorrhagic cyst of the corpus luteum","correct":true}],"type":"custom"}
+{"_id":"GEU-gyn-8","context":null,"enonce":"Regarding EMM:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"In GEU, βHCG levels show insufficient ascent or stagnate","correct":true},{"idx":1,"proposition":"In case of suspicion of GEU, the BHCG assay is to be completed by a preoperative assessment","correct":true},{"idx":2,"proposition":"A hemoCue® is to be performed if the patient has clinical or ultrasound signs of severity","correct":true},{"idx":3,"proposition":"If the mother's Rhesus is negative, the spouse's blood type should be requested for the prevention of alloimmunization (anti-D Ig)","correct":true},{"idx":4,"proposition":"The affirmation of the diagnosis of GEU goes through BHCG","correct":false,"justification":"If the patient presents clinical signs of severity and in case of diagnostic doubt, it is the emergency laparoscopy that will affirm the diagnosis\""}],"type":"custom"}
+{"_id":"GEU-gyn-9","context":null,"enonce":"Which of these criteria fall within the definition of surgical emergency in case of GEU?","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Anuria","correct":false,"justification":"3 criteria: hemodynamic instability, abdominal defense and hemoperitoneum on echo"},{"idx":1,"proposition":"Abdominal defense","correct":true},{"idx":2,"proposition":"Iliac fossa pain greater than 7\/10","correct":false},{"idx":3,"proposition":"From blood in Morrison's space to ultrasound","correct":true,"justification":"Sign a hemoperitoneum"},{"idx":4,"proposition":"Hemodynamic instability","correct":true}],"type":"custom"}
+{"_id":"GEU-gyn-10","context":null,"enonce":"Regarding GEU support:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"The presence of unsafe pain makes the diagnosis of surgical emergency","correct":false,"justification":"The presence of only one of these severity criteria defines surgical urgency: • hemodynamic instability, • hemoperitoneum on ultrasound and • abdominal defense"},{"idx":1,"proposition":"Surgical treatment is performed urgently after conditioning the patient with 2VPP and an infusion of macromolecules","correct":true},{"idx":2,"proposition":"Surgery is always the treatment for GEUs, even asymptomatic","correct":false,"justification":"If the patient is pauci or asymptomatic, surgery remains indicated if she refuses or if she has a contraindication to methotrexate treatment or if outpatient follow-up is difficult"},{"idx":3,"proposition":"Laparoscopy confirms the diagnosis and specifies the location of the pregnancy","correct":true},{"idx":4,"proposition":"Salpingectomy treatment is the gold standard in young patients","correct":false,"justification":"Conservative treatment or salpingotomy should always be preferred if it extracts the pregnancy and stops bleeding.\""}],"type":"custom"}
+{"_id":"GEU-gyn-11","context":null,"enonce":"Regarding the treatment of GEUs:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"A postoperative βHCG assay is performed until negativation","correct":true},{"idx":1,"proposition":"If bleeding is too great, radical treatment (salpingectomy) is performed.","correct":true},{"idx":2,"proposition":"If the couple wishes to become pregnant, salpingectomy should be preferred so as not to alter fertility.","correct":false,"justification":"If the couple wishes a pregnancy, it is necessary to favor conservative treatment so as not to alter fertility"},{"idx":3,"proposition":"The risk of treatment failure with salpingotomy is about 65%","correct":false,"justification":"The risk of treatment failure with salpingotomy is about 6-15%"},{"idx":4,"proposition":"In case of asymptomatic GEU, drug therapy with methotrexate 1mg\/kg may be considered","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"GEU-gyn-13","context":null,"enonce":"Regarding the non-surgical management of GEUs:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"If the first injection fails, we go directly to surgical treatment","correct":false,"justification":"If this fails, a second injection of methotrexate or laparoscopy may be performed."},{"idx":1,"proposition":"After an injection of methotrexate, it is normal to have abdominal pain, which should not lead to worry or to consult again","correct":false,"justification":"Finally, the patient must consult urgently in case of significant abdominal pain or discomfort because it occurs in rare cases a tubal rupture after injection of methotrexate with indication of emergency surgery"},{"idx":2,"proposition":"Given the seriousness of EOGs, therapeutic abstention is never a good solution","correct":false,"justification":"In some exceptional cases, if the patient is asymptomatic, the initial βHCG level is less than 1,000 IU \/ L and the kinetics of βHCG shows a progressive and constant decrease, therapeutic abstention can be discussed subject to good compliance of the patient (βHCG assay every 48 hours and clinical and ultrasound controls once a week)"},{"idx":3,"proposition":"The patient should be informed of the risk of failure of medical and surgical treatments","correct":true},{"idx":4,"proposition":"The patient's blood type is of no interest if the management is not surgical","correct":false,"justification":"It is necessary to remember to check the blood group of the patient in order to prevent if necessary the anti-D alloimmunization (not put = zero)\""}],"type":"custom"}
+{"_id":"GEU-gyn-14","context":null,"enonce":"Regarding the ectopic pregnancy clinic:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Delayed periods","correct":true,"justification":"Clinical triad of GEU: 1. Delayed menstruation (witness to pregnancy), 2. Metrorrhagia (witness of haematosalpinx secondary to erosion of tubal vessels), 3. Lateralized pelvic pain (but not necessarily on the GEU side)"},{"idx":1,"proposition":"Metrorrhagia","correct":true,"justification":"None"},{"idx":2,"proposition":"Lateralized pelvic pain","correct":true,"justification":"None"},{"idx":3,"proposition":"Sometimes there may be the presence of a tusk that testifies to a hemoperitoneum","correct":true,"justification":"None"},{"idx":4,"proposition":"A lateoterine TR mass painful in 50% of cases.","correct":false,"justification":"On TV, not on TR"}],"type":"custom"}
+{"_id":"GEU-gyn-16","context":null,"enonce":"Which of the following proposals are part of the pre-therapeutic assessment of methotrexate?","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"NFS","correct":true,"justification":"True, thrombocytopenia and leukopenia possible under methotrexate"},{"idx":1,"proposition":"TP, TCA, Groupage, RAI","correct":false,"justification":"Not for the assessment of methotrexate treatment, but it should be done for the assessment of the impact of the GEU in case of bleeding"},{"idx":2,"proposition":"Hepatic test","correct":true,"justification":"True. Hepatic failure is a contraindication"},{"idx":3,"proposition":"Creatinemia, urea","correct":true,"justification":"True. Renal failure is a contraindication"},{"idx":4,"proposition":"Blood ionogram","correct":true,"justification":"True, frequent vomiting or diarrhea in methotrexate treatment"}],"type":"custom"}
+{"_id":"GEU-gyn-19","context":null,"enonce":"Regarding medical treatment with methotrexate for GEU. Which of the following are true?","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"It is an antimetabolite treatment of nucleic acids","correct":true,"justification":"True. Specifically, it is a folic acid antagonist that inhibits folic acid reduction and tissue cell proliferation."},{"idx":1,"proposition":"Methotrexate is most often injected into the GEU, directly into the tube, under ultrasound or laparoscopic control.","correct":false,"justification":"The injection is mainly done in one dose intramuscularly. This technique is rarely used for methotrexate"},{"idx":2,"proposition":"It is recommended if the β-HCG level is > 5000 IU\/L","correct":false},{"idx":3,"proposition":"It is recommended if the hematosalpinx is < 4 cm","correct":true},{"idx":4,"proposition":"It is possible as a first-line treatment in an obese grade 2 woman with a haematosalpinx > 4 cm","correct":false,"justification":"Grade 3 (morbid obesity)"}],"type":"custom"}
+{"_id":"GEU-gyn-20","context":null,"enonce":"Regarding complementary examinations in the GEU, which proposal(s) are true?","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"β-HCG double every 48 hours in a GEU","correct":false,"justification":"The β-HCG doubles every 48 hours in a normal pregnancy. In GEU, the kinetics of β-HCG stagnate, have insufficient elevation or fall."},{"idx":1,"proposition":"If the β-HCG is negative, the diagnosis of GEU can be ruled out with certainty.","correct":true,"justification":"No b-HCG = No GEU. As for the 🍫"},{"idx":2,"proposition":"In front of any abdominal pain in women of childbearing age, it is necessary to dose the β-HCG to eliminate a GEU. ","correct":true,"justification":"Subcortical reflex. Just like malaria and fever after a blah blah..."},{"idx":3,"proposition":"Pelvic ultrasound is not systematic in the diagnosis of GEU. ","correct":false,"justification":"Pelvic ultrasound is systematic in the diagnosis of GEU. She looks for direct and indirect signs of GEU."},{"idx":4,"proposition":"Diagnostic laparoscopy is sometimes indicated in case of doubtful diagnosis in a symptomatic patient.","correct":true}],"type":"custom"}
+{"_id":"GEU-gyn-21","context":null,"enonce":"Regarding implantation:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"It takes place only in the uterine cavity.","correct":false,"justification":"It can take place anywhere: in the fallopian tube, in the uterine cavity, and even in the ovary (very rare)."},{"idx":1,"proposition":"It takes place at 1 SA. ","correct":false,"justification":"No, it takes place 7 days after fertilization. Fertilization occurs at 2 SA, so implantation occurs at 3 SA."},{"idx":2,"proposition":"Implantation is the fact that the embryo implants in the uterine cavity.","correct":true},{"idx":3,"proposition":"It takes place 7 days after fertilization.","correct":true},{"idx":4,"proposition":"More rarely, implantation may occur in the interstitial part of the uterus, on the ovary or in the abdomen and exceptionally in the cervix. ","correct":true}],"type":"custom"}
+{"_id":"GEU-gyn-22","context":null,"enonce":"Which of the following are true?","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Heterotopic pregnancy is the coexistence of two simultaneous pregnancies ","correct":true,"justification":"Specifically, it is having a GEU and an intrauterine pregnancy at the same time."},{"idx":1,"proposition":"Ectopic pregnancy is the implantation of the egg outside the uterus","correct":true},{"idx":2,"proposition":"During a GEU, the most frequent location of implantation is at the isthmian level.","correct":false,"justification":"At the ampullary level: 70% (the most frequent). At the isthmian level: 20%."},{"idx":3,"proposition":"The main risk factor for heterotypic pregnancy is medically assisted reproduction.","correct":true},{"idx":4,"proposition":"The incidence of ectopic pregnancies has increased in developed countries, accounting for 15% of pregnancies in France","correct":false,"justification":"2% of pregnancies in France"}],"type":"custom"}
+{"_id":"aNcycle-gyn-0","context":null,"enonce":"Regarding premenstrual syndrome (PMS):","item":"aNcycle","matiere":"gyn","propositions":[{"idx":0,"proposition":"Premenstrual syndrome (PMS) is an extremely rare functional discomfort","correct":false,"justification":"It is the most frequently reported functional impairment by women (30-40%)"},{"idx":1,"proposition":"PMS is a set of clinical signs of interest to the genital tract, appearing in the days before menstruation to disappear at the beginning or during menstruation","correct":false,"justification":"It is a set of benign manifestations that can interest all devices, and whose only common point is their cyclical nature, appearing in the days before menstruation to disappear at the beginning or during menstruation"},{"idx":2,"proposition":"The evolution of PMS is punctuated by the events of psycho-affective life and episodes of genital life","correct":true},{"idx":3,"proposition":"Premenstrual syndrome is intractable","correct":false,"justification":"Several treatments exist, more or less effective"},{"idx":4,"proposition":"The pathophysiology is poorly known but interstitial tissue edema seems to play a role","correct":true}],"type":"custom"}
+{"_id":"aNcycle-gyn-1","context":null,"enonce":"Regarding the management of premenstrual syndrome (PMS)","item":"aNcycle","matiere":"gyn","propositions":[{"idx":0,"proposition":"There are three main signs: breast, abdomino-pelvic and psychic","correct":true},{"idx":1,"proposition":"The elimination of psychoactive substances such as coffee are part of the treatment","correct":true},{"idx":2,"proposition":"Diuretics have no place in therapeutic management","correct":false,"justification":"They are useful in case of predominant edema"},{"idx":3,"proposition":"Synthetic progestogens are useful in the management of","correct":true},{"idx":4,"proposition":"In case of isolated mastodynia, local progesterone preparations can be used","correct":true}],"type":"custom"}
+{"_id":"aNcycle-gyn-2","context":null,"enonce":"Regarding premenstrual syndrome (PMS):","item":"aNcycle","matiere":"gyn","propositions":[{"idx":0,"proposition":"Selective serotonin reuptake inhibitors (SSRIs) are effective on premenstrual, physical and emotional symptoms","correct":true},{"idx":1,"proposition":"Anxiolytics are not recommended systematically, especially because of the risk of tolerance and dependence","correct":true},{"idx":2,"proposition":"PMS is common and affects 30-40% of women","correct":true},{"idx":3,"proposition":"The three main clinical components are: headache, fatigue and somnolence","justification":"Premenstrual syndrome is common (30–40%). The three main clinical components are: mastodynia, abdominal bloating and mood disorders. The diagnosis is clinical: appearance of symptoms in the premenstrual period.","correct":false},{"idx":4,"proposition":"The diagnosis is affirmed by biology","correct":false}],"type":"custom"}
+{"_id":"IOA-infectio-0","context":null,"enonce":"Which of the following proposals designate antibiotics with good diffusion in the bone?","item":"IOA","matiere":"infectio","propositions":[{"idx":0,"proposition":"Amoxicillin","correct":false,"justification":"None"},{"idx":1,"proposition":"Amoxicillin-clavulanic acid","correct":false,"justification":"None"},{"idx":2,"proposition":"Aminoglycosides","correct":false,"justification":"None"},{"idx":3,"proposition":"2nd generation cephalosporin","correct":false,"justification":"None"},{"idx":4,"proposition":"None of these proposals","correct":true,"justification":"True. Antibiotics with good bone diffusion = fluoroquinolone, rifampicin, fusidic acid, clindamycin, cyclins"}],"type":"custom"}
+{"_id":"IOA-infectio-1","context":null,"enonce":"Which of the following are antibiotics with good diffusion in the bone?","item":"IOA","matiere":"infectio","propositions":[{"idx":0,"proposition":"Rifampicin","correct":true},{"idx":1,"proposition":"fluoroquinolone","correct":true},{"idx":2,"proposition":"fusidic acid","correct":true},{"idx":3,"proposition":"Cyclins","correct":true},{"idx":4,"proposition":"clindamycin ","correct":true,"justification":"True, FRACC (because they shatter bone): Fluoroquinolones, Rifampicin, Fusidic acid, Cyclines, Clindamycin"}],"type":"custom"}
+{"_id":"IOA-infectio-2","context":null,"enonce":"Which of the following propositions are true about spondylodiscitis?","item":"IOA","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is the most common osteoarticular infection (IOA)","correct":false,"justification":"It is a very rare IOA"},{"idx":1,"proposition":"The attack is most often cervical","correct":false,"justification":"The most common involvement is lumbar"},{"idx":2,"proposition":"The lymphatic pathway is most often involved","correct":false,"justification":"It is the blood-borne route that is the most common"},{"idx":3,"proposition":"Surgical management is contraindicated","correct":false,"justification":"False"},{"idx":4,"proposition":"None of these propositions are true","correct":true}],"type":"custom"}
+{"_id":"atherome-cardio-0","context":null,"enonce":"Concerning cardiovascular diseases","item":"atherome","matiere":"cardio","propositions":[{"idx":0,"proposition":"Cardiovascular diseases are the leading cause of death worldwide","correct":true,"justification":"According to the 2017 WHO report"},{"idx":1,"proposition":"Cardiovascular mortality is steadily increasing in France.","correct":false,"justification":"Plateau phase \/ slight decrease (progress in management and prevention)"},{"idx":2,"proposition":"There is an ongoing epidemiological transition in developing countries, with an increase in the prevalence and incidence of atheromatous diseases","correct":true,"justification":"In particular because of the lack of prevention and management of risk factors"},{"idx":3,"proposition":"Variations in CV disease prevalence are less related to environmental and lifestyle factors than to genetic differences","correct":false,"justification":"These variations are more related to environmental factors and lifestyle."},{"idx":4,"proposition":"In France, CV diseases cause one in three deaths","correct":true}],"type":"custom"}
+{"_id":"atherome-cardio-1","context":null,"enonce":"Concerning cardiovascular diseases","item":"atherome","matiere":"cardio","propositions":[{"idx":0,"proposition":"There is a difference in incidence between the sexes, which decreases with age","correct":true},{"idx":1,"proposition":"The prevalence of cardiovascular disease increases with the age of the population","correct":true,"justification":"Significant risk from age 50 in men\/age 60 in women"},{"idx":2,"proposition":"CV mortality is higher in Southern Europe than in Northern Europe","correct":false,"justification":"Higher mortality in North\/Western Europe (non-Mediterranean diet)"},{"idx":3,"proposition":"Atherogenesis begins in childhood","correct":true},{"idx":4,"proposition":"The increase in the thickness of the wall by increasing the volume of the plates is associated with an increase in the diameter of the vessel","correct":true,"justification":"In order to compensate (initially) for the reduction in light gauge"}],"type":"custom"}
+{"_id":"atherome-cardio-3","context":null,"enonce":"About atherosclerosis","item":"atherome","matiere":"cardio","propositions":[{"idx":0,"proposition":"Atheroma can also alter the parietal structure of the vessel and destroy the extracellular matrix, which can promote the formation of an aneurysm","correct":true,"justification":"Among others at the level of the abdominal aorta"},{"idx":1,"proposition":"Treatment of high blood pressure helps prevent the development of atheroma","correct":true,"justification":"By reducing the mechanical stresses applied to enfothelium"},{"idx":2,"proposition":"Atheroma develops mainly near turbulent arterial flows: ostium, bifurcation, mechanical stress zone","correct":true},{"idx":3,"proposition":"Atheroma reaches small arteries","correct":false,"justification":"Atheroma affects large and medium arteries : mainly the aorta and its branches"},{"idx":4,"proposition":"Atheromatous plaques lead to a tendency to vasoconstriction and vascular spasm","correct":true,"justification":"Remodeling prevents the passage and action of NO"}],"type":"custom"}
+{"_id":"atherome-cardio-4","context":null,"enonce":"About atherosclerosis","item":"atherome","matiere":"cardio","propositions":[{"idx":0,"proposition":"Predisposing factors for atherosclerosis include obesity, physical inactivity, stress and psychosocial conditions.","correct":true},{"idx":1,"proposition":"Polyatheromatous disease is an atheromatous involvement of at least two different arterial territories","correct":true,"justification":"Symptomatic or not"},{"idx":2,"proposition":"Atheromatous involvement may or may not be symptomatic","correct":true},{"idx":3,"proposition":"Frequent associations require screening for lesions of other arterial territories, whenever an atheromatous lesion is discovered","correct":true,"justification":"Minimum work-up: clinical (including BP), ECG, IPS measurement, EAL, fasting blood glucose"},{"idx":4,"proposition":"The atheromatous localization most frequently associated with coronary involvement are the arteries of the lower limbs (PAD)","correct":true,"justification":"Strong association with coronary artery disease PAD"}],"type":"custom"}
+{"_id":"SDRC-rhumato-0","context":null,"enonce":"Regarding the basics of CRPS type 1:","item":"SDRC","matiere":"rhumato","propositions":[{"idx":0,"proposition":"It was called causalgia","correct":false,"justification":"Its former name was algodystrophy."},{"idx":1,"proposition":"Hand-shoulder syndrome is typical after stroke","correct":true,"justification":"Hemiplegic stroke"},{"idx":2,"proposition":"The definition of CRPS is radiological","correct":false,"justification":"It is purely clinical"},{"idx":3,"proposition":"There are 4 types of CRPS","correct":false,"justification":"2 types. Type 2 is associated with nerve damage, unlike type 1"},{"idx":4,"proposition":"The evolution of type 1 CRPS is spontaneously favorable in 10% of cases","correct":false,"justification":"In 90% of cases, but the evolution lasts several months"}],"type":"custom"}
+{"_id":"SDRC-rhumato-1","context":null,"enonce":"Regarding CRPS:","item":"SDRC","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Trophic disorders and aponeurotic retractions may be observed in CRPS type 1","correct":true,"justification":"This happens in about 10% of cases"},{"idx":1,"proposition":"The pain is constant in CRPS: it is intermittent with inflammatory rhythm","correct":false,"justification":"The pain is continuous, disproportionate to the triggering event"},{"idx":2,"proposition":"CRPS is never seen in young people under the age of 20","correct":false,"justification":"CRPS is possible at any age, but remains exceptional in adolescents and children"},{"idx":3,"proposition":"The pathophysiology of CRPS includes neurological dysfunction of the peripheral, medullary and cerebral nervous systems","correct":true},{"idx":4,"proposition":"The most common triggers of CRPS1 are central neurological disorders","correct":false,"justification":"Traumatic triggers are predominant"}],"type":"custom"}
+{"_id":"SDRC-rhumato-2","context":null,"enonce":"Regarding triggers and the CRPS clinic:","item":"SDRC","matiere":"rhumato","propositions":[{"idx":0,"proposition":"CRPS associated with pregnancy mainly affects the shoulder","correct":false,"justification":"The hip"},{"idx":1,"proposition":"The severity of CRPS 1 is proportional to the severity of the triggering factor","correct":false,"justification":"No correlation found"},{"idx":2,"proposition":"Stroke or MS can cause CRPS","correct":true,"justification":"Type 1 most often"},{"idx":3,"proposition":"The diagnosis is made according to the Budapest criteria","correct":true,"justification":"Criteria of pain, various sensory symptoms, vasomotors, sudomotor players, trophic (...) and exclusion of differential diagnoses"},{"idx":4,"proposition":"Typically, in post-traumatic, CRPS is composed of two phases","correct":false,"justification":"3 phases: inflammatory hot phase, pure dystrophic cold phase and atrophic phase (in practice, these three phases are rarely found)"}],"type":"custom"}
+{"_id":"SDRC-rhumato-3","context":null,"enonce":"Regarding the diagnosis of CRPS type 1:","item":"SDRC","matiere":"rhumato","propositions":[{"idx":0,"proposition":"The joint space is the site of erosions in advanced forms","correct":false,"justification":"Line spacing is always respected"},{"idx":1,"proposition":"MRI confirms diagnosis of CRPS 1","correct":false,"justification":"Clinical diagnosis, and low specificity of MRI (17% according to the college of MPR)"},{"idx":2,"proposition":"CRPS type 1 leads to an increase in CRP","correct":false,"justification":"No biological abnormalities, except due to the trigger. In any case, a biological inflammatory syndrome must seek a differential diagnosis."},{"idx":3,"proposition":"Normal MRI rules out diagnosis of CRPS","correct":false,"justification":"MRI can be normal, without questioning the diagnosis"},{"idx":4,"proposition":"MRI is the gold standard exam but it is not systematic","correct":true,"justification":"This is indeed the reference examination, and no imaging is systematic: the diagnosis is clinical, the complementary examinations aim to exclude differential diagnoses and are guided by the clinic"}],"type":"custom"}
+{"_id":"SDRC-rhumato-4","context":null,"enonce":"Regarding the management of CRPS type 1:","item":"SDRC","matiere":"rhumato","propositions":[{"idx":0,"proposition":"The only curative treatment that has been shown to be effective in CRPS1 is vitamin C","correct":false,"justification":"It is the only preventive treatment that has been shown to be effective."},{"idx":1,"proposition":"Analgesics are an effective curative treatment","correct":false,"justification":"It is symptomatic treatment, not curative. In addition, drug treatments are not very effective in CRPS, although they are necessary."},{"idx":2,"proposition":"Occupational therapy is indicated as a first-line treatment in case of upper limb involvement","correct":true,"justification":"Cf the college of MPR"},{"idx":3,"proposition":"Total rest is indicated during the hot phase","correct":false,"justification":"Rest must be kept to a minimum: rehabilitation is started as early as possible"},{"idx":4,"proposition":"Bisphosphonates have an early indication in severe forms or to treat signs of neurogenic inflammation","correct":true,"justification":"In IV\/PO. Neurogenic signs of inflammation include pain and neuropathic sensory signs."}],"type":"custom"}
+{"_id":"meningite-neuro-0","context":null,"enonce":"Regarding meningeal syndrome:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"The majority of acute meningitis and meningoencephalitis are infectious by contamination of the CSF with an infectious agent","correct":true},{"idx":1,"proposition":"Meningeal syndrome is characterized by the inconsistent association of the triad of headache, vomiting and meningeal stiffness","correct":true},{"idx":2,"proposition":"A meningeal syndrome should be evoked in front of a whiny child, presenting cries on mobilization (skin hyperesthesia), behavioral changes, unusual drowsiness interspersed with periods of agitation","correct":true},{"idx":3,"proposition":"Abnormal tension of the fontanel can be found in case of meningeal syndrome of the infant ","correct":true},{"idx":4,"proposition":"In children, clinical signs may be more crude with an infectious syndrome often in the background","correct":true}],"type":"custom"}
+{"_id":"meningite-neuro-1","context":null,"enonce":"Regarding meningitis and meningoencephalitis:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"In adult bacterial meningitis, 95% of patients have at least two of the following signs: headache, fever, stiff neck, impaired alertness","correct":true,"justification":"However, diagnosis is more difficult at extreme ages."},{"idx":1,"proposition":"Bone marrow aspiration is the key test to confirm the diagnosis of meningitis","correct":false,"justification":"Lumbar puncture (LP) is the key test to confirm the diagnosis of meningitis"},{"idx":2,"proposition":"An EEG showing a slow trace with diffuse periodic slow waves is in favor of encephalitis ","correct":true},{"idx":3,"proposition":"Herpetic meningoencephalitis is a diagnostic and therapeutic emergency because there is a risk of serious sequelae","correct":true},{"idx":4,"proposition":"Normal CSF, including HSV PCR examination, early in the disease does not exclude the diagnosis of herpetic meningoencephalitis.","correct":true,"justification":"HSV PCR in CSF can be negative for up to 4 days and should be repeated if clinically suspected."}],"type":"custom"}
+{"_id":"meningite-neuro-2","context":null,"enonce":"Regarding meningitis and meningoencephalitis:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"Cerebrospinal fluid (CSF) analysis can tell the difference between meningitis and meningoencephalitis","correct":false,"justification":"This difference is clinical"},{"idx":1,"proposition":"Droplet precautions should be instituted until meningococcal meningitis has been ruled out and\/or during the first 24 hours of antibiotic therapy.","correct":true},{"idx":2,"proposition":"Faced with clinical suspicion, lumbar puncture (LP) is the key examination, to be performed urgently","correct":true},{"idx":3,"proposition":"Taking antiplatelet agents does not contraindicate PL","correct":true,"justification":"On the other hand, taking anticoagulants is a contraindication."},{"idx":4,"proposition":"Venous glucose is performed concomitantly with the PL for a correct interpretation of glycorachia","correct":true}],"type":"custom"}
+{"_id":"meningite-neuro-3","context":null,"enonce":"Regarding meningitis and meningoencephalitis:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"The macroscopic aspect of the CSF provides a 1st etiological information: if it is cloudy on the different tubes, it evokes elevated leukocytorachia and therefore purulent meningitis","correct":true},{"idx":1,"proposition":"Antibiotic therapy should be initiated prior to PL if purpura fulminans is suspected","correct":true},{"idx":2,"proposition":"Probabilistic treatment of a bacterial meningitis chart is dominated by IV C3G and that of an encephalitis chart by amoxicillin-aciclovir","correct":true},{"idx":3,"proposition":"In case of purpura fulminans, it is essential to make an IV or IM injection of ceftriaxone pre-hospital","correct":true},{"idx":4,"proposition":"In case of meningococcal meningitis, antibiotic prophylaxis of contact subjects (± vaccination) and case reporting are essential.","correct":true}],"type":"custom"}
+{"_id":"meningite-neuro-4","context":null,"enonce":"Regarding the meninges:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"The pia mater is directly attached to the bone","correct":false,"justification":"It is the most in-depth layer, directly covering the central nervous system."},{"idx":1,"proposition":"The arachnoid is the outermost layer","correct":false,"justification":"The arachnoid is the middle layer, between the dura mater (attached to the bone) and the pia mater (acolated to the CNS)."},{"idx":2,"proposition":"The dura mater directly covers the brain and spinal cord","correct":false,"justification":"This is the case of the pia mater."},{"idx":3,"proposition":"The dura mater is pachymeninge","correct":true},{"idx":4,"proposition":"The arachnoid and pia mater form leptomeninge","correct":true}],"type":"custom"}
+{"_id":"meningite-neuro-5","context":null,"enonce":"Regarding the LCS:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"It is contained in the subdural space","correct":false,"justification":"It is contained in the subarachnoid space (between the arachnoid and the pia mater, that is, between the two leptomeninges)."},{"idx":1,"proposition":"The study of the contents of the CSF by lumbar puncture, together with clinical examination, allows the diagnosis of meningitis","correct":true},{"idx":2,"proposition":"The study of the contents of CSF by lumbar puncture, together with clinical examination, allows the diagnosis of meningoencephalitis","correct":true},{"idx":3,"proposition":"The majority of acute meningitis and meningoencephalitis are infectious by contamination of the CSF with an infectious agent","correct":true},{"idx":4,"proposition":"An increase in lactates is suggestive of a bacterial infection","correct":true,"justification":"Suggestive of bacteria: hyperproteinrachia, hypoglycorachia (relative to blood glucose), hyperlactatemia, nuclei elements > 1000 (with PNN) and cloudy CSF."}],"type":"custom"}
+{"_id":"meningite-neuro-6","context":null,"enonce":"Regarding the clinical examination:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"Brudzinski's sign corresponds to an involuntary flexion of the lower limbs following the anterior forced flexion of the neck","correct":true,"justification":"This is a sign that can accompany meningeal syndrome"},{"idx":1,"proposition":"Kernig's sign is an inability to sit without bending the knees and painful resistance to full extension of the lower limb when the thigh is flexed.","correct":true,"justification":"This is a sign that can accompany meningeal syndrome"},{"idx":2,"proposition":"In a patient with meningeal syndrome, live ROT may be found","correct":true},{"idx":3,"proposition":"In a patient with meningeal syndrome, hypoaesthesia of the lower limbs may be found","correct":false,"justification":"Rather, diffuse cutaneous hyperesthesia is found."},{"idx":4,"proposition":"The meningitic line of Trousseau corresponds to the fact that the drawing of a line on the skin with a foam tip reveals a line first white, which then reddens and disappears late","correct":true,"justification":"This is a sign that can accompany meningeal syndrome"}],"type":"custom"}
+{"_id":"meningite-neuro-7","context":null,"enonce":"These signs and symptoms, which are part of encephalitic syndrome, include:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"Disorders of consciousness","correct":true,"justification":"To varying degrees, from simple drowsiness to deep coma"},{"idx":1,"proposition":"Photo-phonophobia","correct":false,"justification":"Part of meningeal syndrome (inflammation of the meninges) and not encephalitic syndrome (inflammation of the brain)"},{"idx":2,"proposition":"Signs of focus","correct":true,"justification":"For example, motor deficit, cranial pair paralysis, aphasia, abnormal movements"},{"idx":3,"proposition":"Nausea and vomiting","correct":false,"justification":"Meningeal syndrome (inflammation of the meninges) and not encephalitic syndrome (inflammation of the brain) are part of."},{"idx":4,"proposition":"Status epilepticus","correct":true}],"type":"custom"}
+{"_id":"meningite-neuro-8","context":null,"enonce":"Regarding purpura fulminans:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"Purpura fulminans is defined by the presence of at least 1 necrotic or ecchymotic element greater than 3mm","correct":true},{"idx":1,"proposition":"The 2 germs most often involved in purpura fulminans are meningococcal and pneumococcus.","correct":true,"justification":"But more often meningococcal"},{"idx":2,"proposition":"CSF should always be collected before antibiotics are introduced in front of purpura fulminans","correct":false,"justification":"When managing purpura fulminans pre-hospital, antibiotics should be given before CSF is collected."},{"idx":3,"proposition":"It is necessary to administer 1g of C3G IV or IM","correct":false,"justification":"2g (doses are to be known for iNECs)"},{"idx":4,"proposition":"Meningococcal is a gram-positive diplococcus","correct":false,"justification":"Gram-negative diplococcus. The gram-positive diploma is a pneumococcus."}],"type":"custom"}
+{"_id":"meningite-neuro-9","context":null,"enonce":"Regarding meningeal syndrome:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"The 2 diagnoses to evoke are infectious meningitis and subarachnoid hemorrhage","correct":true},{"idx":1,"proposition":"This is the triad of meningeal stiffness + headache (with photophonophobia) + jet vomiting","correct":true},{"idx":2,"proposition":"Kernig's sign corresponds to an involuntary flexion of the hip and knee in response to a forced flexion of the neck","correct":false,"justification":"This is Brudzinski's sign"},{"idx":3,"proposition":"Brudzinski's sign corresponds to painful resistance to full knee extension when the hip is flexed","correct":false,"justification":"This is the Kerning sign"},{"idx":4,"proposition":"Meningeal stiffness is a contracture of the paravertebral muscles in response to pain","correct":true}],"type":"custom"}
+{"_id":"meningite-neuro-11","context":null,"enonce":"Are signs of severity during meningitis \/ meningoencephalitis:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"Glaswgow ≤ 13","correct":false},{"idx":1,"proposition":"Signs of focus","correct":true},{"idx":2,"proposition":"Hemodynamic instability","correct":true,"justification":"Evoking septic shock"},{"idx":3,"proposition":"Signs of brainstem suffering","correct":true},{"idx":4,"proposition":"Extensive purpura","correct":true,"justification":"Evoking purpura fulminans"}],"type":"custom"}
+{"_id":"meningite-neuro-12","context":null,"enonce":"Are the antibiotic (s) authorized before a purpura fulminans","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"Ceftriaxone","correct":true,"justification":"MI or IV"},{"idx":1,"proposition":"Amoxicillin","correct":true,"justification":"As a last resort"},{"idx":2,"proposition":"Fluoroquinolone","correct":false,"justification":"There are only 3 antibiotics allowed: ceftriaxone, cefotaxime and amoxicillin"},{"idx":3,"proposition":"Amoxicillin-clavulanic acid (Augmentin)","correct":false,"justification":"Amoxicillin"},{"idx":4,"proposition":"Cefotaxime","correct":true}],"type":"custom"}
+{"_id":"meningite-neuro-13","context":null,"enonce":"What are the situations where a lumbar puncture is not done before starting the treatment of meningitis?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"Purpura fulminans","correct":true,"justification":"On the other hand, in hospital it is necessary to do blood cultures before antibiotic treatment. In out-of-hospital blood cultures, blood cultures are not done."},{"idx":1,"proposition":"Signs of cerebral engagement","correct":true},{"idx":2,"proposition":"If the transfer to the hospital is less than 120 minutes","correct":false,"justification":"More than 90 minutes (120 minutes is for SCA ST+)"},{"idx":3,"proposition":"Taking antiplatelet agent","correct":false,"justification":"Anticoagulant only"},{"idx":4,"proposition":"Glasgow score ≤ 11","correct":false,"justification":"No longer a contraindication if isolated"}],"type":"custom"}
+{"_id":"meningite-neuro-14","context":null,"enonce":"Regarding the CSF of purulent meningitis","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"CRL is predominantly PNN","correct":true,"justification":"NN> 50% = purulent meningitis; lymphocytes > 50% = clear fluid meningitis"},{"idx":1,"proposition":"Glycorachia is > 2\/3 x blood glucose","correct":false,"justification":"This is glycorachia in normal CSF. In purulent meningitis, glycorachia is < 0.4 x blood glucose (very specific for a bacterial cause)"},{"idx":2,"proposition":"Proteinorachy is < 1 g \/ L","correct":false},{"idx":3,"proposition":"On direct examination, we will always find gram-positive cocci","correct":false,"justification":"There are two bacteria that are most often involved: meningococcal (gram-negative diplococcus) and pneumococcus (gram-positive diplococcus). These are encapsulated bacteria."},{"idx":4,"proposition":"Lactatopachia is > 3.2 mmol\/L","correct":true}],"type":"custom"}
+{"_id":"meningite-neuro-15","context":null,"enonce":"Etiologies causing glycorachia < 0.4 x blood glucose with clear fluid meningitis:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"Listeria","correct":true,"justification":"Gram-positive bacillus"},{"idx":1,"proposition":"Tuberculosis","correct":true},{"idx":2,"proposition":"Syphilis","correct":false,"justification":"Glycorachia > 2\/3 x blood glucose"},{"idx":3,"proposition":"Leptospirosis","correct":false,"justification":"Glycorachia > 2\/3 x blood glucose"},{"idx":4,"proposition":"Cryptocoque","correct":true,"justification":"The causes of glycorachia < 0.4 x blood glucose with clear fluid CSF are: listeria, tuberculosis, cryptococcus and carcinomatous meningitis"}],"type":"custom"}
+{"_id":"meningite-neuro-17","context":null,"enonce":"What germs give normoglycorachic lymphocytic meningitis?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"Listeria","correct":false,"justification":"Hypoglycorachic lymphocytic meningitis, hypoglycorachic purulent meningitis, or hypoglycorachic variegated meningitis"},{"idx":1,"proposition":"Tuberculosis","correct":false,"justification":"Hypoglycorachic lymphocytic meningitis"},{"idx":2,"proposition":"Spirochetes (lyme, syphilis and leptospirosis)","correct":true},{"idx":3,"proposition":"HPV","correct":true},{"idx":4,"proposition":"Malaria","correct":true}],"type":"custom"}
+{"_id":"meningite-neuro-18","context":null,"enonce":"Regarding pneumococcal mennigitis:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"It is the leading cause of purulent meningitis in all age groups.","correct":false,"justification":"Meningococcal disease is most often involved in 15- to 24-year-olds. Pneumococcus is most often involved in other age groups. Meningococcal is transferred by close relation and by saliva, I let you use your imagination;)"},{"idx":1,"proposition":"20% of pneumococci have a change in PLP target","correct":true,"justification":"They are therefore resistant to penicillins (amoxicillin). We therefore use C3G as a first line because we want to cover resistant germs in the face of a potentially very serious infection."},{"idx":2,"proposition":"Pneumococcal infection is promoted by a meningeal breach","correct":true,"justification":"Always look for a notion of head trauma during interrogation."},{"idx":3,"proposition":"Complement protein deficiency promotes pneumococcal purulent meningitis","correct":true,"justification":"In a subject with pneumococcal meningitis or sepsis, it is necessary to look for a complement protein deficiency"},{"idx":4,"proposition":"There is often a carriage of pneumococcus at the ENT level","correct":true}],"type":"custom"}
+{"_id":"meningite-neuro-19","context":null,"enonce":"Regarding the latency time of a meningococcal infection:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"7 days","correct":false},{"idx":1,"proposition":"14 days","correct":false},{"idx":2,"proposition":"28 days","correct":false},{"idx":3,"proposition":"10 days","correct":true,"justification":"It is for this reason that the definition of the contact case is anyone who has had a contact of < 1m for > 1h for the last 10 days. These contact cases should be treated with antibiotic prophylaxis and vaccination to eradicate meningococcal carriage."},{"idx":4,"proposition":"48h","correct":false}],"type":"custom"}
+{"_id":"meningite-infectio-0","context":null,"enonce":"Which of the following are situations where a brain scan must be performed before the lumbar puncture?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"proposition":"Hemiplegia","correct":true,"justification":"True, sign of localization"},{"idx":1,"proposition":"Glasgow = 12","correct":false,"justification":"Glasgow less than 12 (from Glasgow = 11)"},{"idx":2,"proposition":"Convulsive seizures (after 5 years)","correct":true},{"idx":3,"proposition":"Effective anticoagulation","correct":true},{"idx":4,"proposition":"Taking antiplatelet agents","correct":false,"justification":"Not a PL IC, and no need to scan"}],"type":"custom"}
+{"_id":"meningite-infectio-1","context":null,"enonce":"What is the main pathogen responsible for primary purulent meningitis in young immunocompetent adults?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"proposition":"Pneumococcus","correct":false,"justification":"None"},{"idx":1,"proposition":"Listeria monocytogenes","correct":false,"justification":"None"},{"idx":2,"proposition":"Herpes simplex virus 1","correct":false,"justification":"None"},{"idx":3,"proposition":"Herpes simplex virus 2","correct":false,"justification":"None"},{"idx":4,"proposition":" Meningococcus","correct":true}],"type":"custom"}
+{"_id":"meningite-infectio-2","context":null,"enonce":"Which of the following proposals are found in a normal CSL?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"proposition":"< 5 elements \/ mm3","correct":true},{"idx":1,"proposition":"Glycorachia < 2\/3 of venous blood glucose ","correct":false,"justification":"Glycorachia >2\/3 of venous blood glucose"},{"idx":2,"proposition":"Proteinorachy < 0.4 g\/L ","correct":true},{"idx":3,"proposition":"Lactatopachia < 3.2 mmol\/l ","correct":true},{"idx":4,"proposition":"A direct gram-negative staining examination","correct":true}],"type":"custom"}
+{"_id":"responsabilite-sp-2","context":null,"enonce":"Which of these responsibilities lead to a sanction of the doctor?","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"Criminal liability","correct":true,"justification":"3 types of responsibilities can lead to a sanction of the doctor: criminal, ordinal and disciplinary"},{"idx":1,"proposition":"Ordinal responsibility","correct":true},{"idx":2,"proposition":"Disciplinary responsibility","correct":true},{"idx":3,"proposition":"Civil liability","correct":false,"justification":"Leads to compensation to the patient but not to a sanction to the physician"},{"idx":4,"proposition":"Administrative responsibility","correct":false,"justification":"Leads to compensation for the patient but not to a sanction for the doctor.\""}],"type":"custom"}
+{"_id":"responsabilite-sp-3","context":null,"enonce":"Which of these proposals are reprehensible from a criminal point of view?","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"Fake certificates","correct":true},{"idx":1,"proposition":"Euthanasia","correct":true},{"idx":2,"proposition":"Refusal to perform an abortion","correct":false,"justification":"The conscience clause makes it possible not to perform an abortion but obliges the practitioner to re-direct the patient to a colleague who will receive her within a reasonable time."},{"idx":3,"proposition":"Non-assistance to a person in danger","correct":true},{"idx":4,"proposition":"Breach of solicitor-client privilege","correct":true}],"type":"custom"}
+{"_id":"responsabilite-sp-4","context":null,"enonce":"Which of these proposals refer to an exemption from medical liability?","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"Paid leave","correct":false,"justification":"Whether the doctor is in clinical practice or not does not exempt medical liability in all cases (non-assistance to a person in danger for example)"},{"idx":1,"proposition":"Leave without pay","correct":false},{"idx":2,"proposition":"Cases of force majeure","correct":true,"justification":"See KB Public Health (page 144)"},{"idx":3,"proposition":"Alteration of the doctor's consciousness","correct":true},{"idx":4,"proposition":"Fatigue","correct":false,"justification":"Does not allow an exemption from medical liability\""}],"type":"custom"}
+{"_id":"responsabilite-sp-5","context":null,"enonce":"Before which court is a contravention judged?","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"The Police Court","correct":true},{"idx":1,"proposition":"The Court of Justice","correct":false},{"idx":2,"proposition":"The Assize Court","correct":false,"justification":"Place where crimes are tried"},{"idx":3,"proposition":"The Criminal Court","correct":false,"justification":"Place where crimes are tried"},{"idx":4,"proposition":"The Administrative Tribunal","correct":false}],"type":"custom"}
+{"_id":"responsabilite-sp-6","context":null,"enonce":"In the event of a complaint, the Public Prosecutor's Office must prove:","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"The doctor's fault","correct":true},{"idx":1,"proposition":"Harm to the patient","correct":true},{"idx":2,"proposition":"The correlation between physician's fault and patient harm","correct":false,"justification":"It must be causality"},{"idx":3,"proposition":"The solvency of the doctor or hospital","correct":false,"justification":"Not the fact of the public prosecutor"},{"idx":4,"proposition":"The Public Prosecutor's Office is represented by the Public Prosecutor","correct":true}],"type":"custom"}
+{"_id":"responsabilite-sp-7","context":null,"enonce":"Regarding medical liability","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"Criminal law is the application of the rules contained in the Penal Code","correct":true,"justification":"1"},{"idx":1,"proposition":"Criminal liability is based on fault (not error)","correct":true,"justification":"1"},{"idx":2,"proposition":"The Penal Code defines 2 types of offences: misdemeanours and crimes","correct":false,"justification":"The Penal Code defines 3 types of offenses: Contraventions (rare in the medical field), Misdemeanors and Crimes"},{"idx":3,"proposition":"The dismissal is decided by the gendarme receiving the complaint","correct":false,"justification":"The Prosecutor decides on the Republic: If it is necessary to continue (If the case of investigations, request expert opinions ...) the prosecution, or if there is no need is not in a state to be judged, the investigating judge intervenes to expedite"},{"idx":4,"proposition":"If one of the 2 parties is not satisfied with the judgment, he can appeal the decision","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"responsabilite-sp-8","context":null,"enonce":"The limitation period for contraventions is:","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"1 year","correct":true,"justification":"Be careful, there has been a reform of the limitation periods. It is now: 1 year for misdemeanors, 6 years for misdemeanors, and 20 years for general crimes."},{"idx":1,"proposition":"3 years","correct":false,"justification":"for offences"},{"idx":2,"proposition":"5 years","correct":false},{"idx":3,"proposition":"10 years","correct":false},{"idx":4,"proposition":"20 years","correct":false,"justification":"For general crimes (30 years for serious crimes such as terrorism)"}],"type":"custom"}
+{"_id":"responsabilite-sp-9","context":null,"enonce":"The statute of limitations for misdemeanours is:","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"1 year","correct":false,"justification":"For contraventions"},{"idx":1,"proposition":"6 years","correct":true,"justification":"Be careful, there has been a reform of the limitation periods. It is now: 1 year for misdemeanors, 6 years for misdemeanors, and 20 years for general crimes."},{"idx":2,"proposition":"5 years","correct":false},{"idx":3,"proposition":"10 years","correct":false},{"idx":4,"proposition":"15 years","correct":false}],"type":"custom"}
+{"_id":"responsabilite-sp-10","context":null,"enonce":"The statute of limitations for general crimes is:","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"1 year","correct":false,"justification":"For contraventions"},{"idx":1,"proposition":"5 years","correct":false},{"idx":2,"proposition":"6 years","correct":false,"justification":"for offences"},{"idx":3,"proposition":"10 years","correct":false},{"idx":4,"proposition":"20 years","correct":true}],"type":"custom"}
+{"_id":"responsabilite-sp-11","context":null,"enonce":"Regarding medical liability","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"The Code of Medical Ethics provides for the rights and duties of physicians towards their patients but also towards their colleagues.","correct":true,"justification":"1"},{"idx":1,"proposition":"The Code of Ethics has no legal value","correct":false,"justification":"This code is itself inserted into the Public Health Code (Articles R. 4127-1 to R. 4127112)"},{"idx":2,"proposition":"Disciplinary misconduct occurs when the physician's conduct undermines the interests governing the profession","correct":true,"justification":"1"},{"idx":3,"proposition":"There is a list of sets of possible disciplinary offences","correct":false,"justification":"No list (as in the Penal Code) can therefore cover all disciplinary offences."},{"idx":4,"proposition":"Medical malpractice may be subject to both the ordinal jurisdiction and the ordinary courts","correct":true,"justification":"1"}],"type":"custom"}
+{"_id":"responsabilite-sp-12","context":null,"enonce":"Among these proposals, what are the penalties incurred during a disciplinary sanction decided by the Order of Physicians","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"Warning","correct":true},{"idx":1,"proposition":"Blame","correct":true},{"idx":2,"proposition":"Temporary disqualification","correct":true},{"idx":3,"proposition":"Permanent prohibition to practise in a given region","correct":false,"justification":"No sanction limited to one region"},{"idx":4,"proposition":"Public apology","correct":false,"justification":"This is not a possible sanction.\""}],"type":"custom"}
+{"_id":"responsabilite-sp-13","context":null,"enonce":"Regarding the fundamentals of medical liability","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"The Civil Code governs the liability of doctors practising in private practice","correct":true,"justification":"1"},{"idx":1,"proposition":"Civil liability is demonstrated by the existence of a fault of the doctor and a prejudice for the patient","correct":false,"justification":"Civil liability is based on the existence of a fault of a damage of a causal link (or damage) between the 2, link that will have to be proven by the victim A distinction is made between:"},{"idx":2,"proposition":"Patient dissatisfaction often stems from a lack of communication with the doctor","correct":true,"justification":"1"},{"idx":3,"proposition":"The physician is no longer the one who makes decisions alone that he imposes on the patient","correct":true,"justification":"1"},{"idx":4,"proposition":"The distinction between major tort and contractual nature is important","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"ADP-hemato-0","context":null,"enonce":"Regarding superficial lymphadenopathy:","item":"ADP","matiere":"hemato","propositions":[{"idx":0,"proposition":"Lymphadenopathy is an enlargement of more than 1 cm of a lymph node (or node)","correct":true},{"idx":1,"proposition":"Infectious etiologies are the most common, followed by cancers and lymphomas","correct":true},{"idx":2,"proposition":"All lymph node areas should be examined to determine whether it is localized lymphadenopathy or polyadenopathy, as the diagnostic approach is different","correct":true,"justification":"TRUE. In the case of polyadenopathy, a blood count should be performed to look for acute leukemia, CLL or mononucleosis syndrome"},{"idx":3,"proposition":"Any lymphadenopathy whose diagnosis is not quickly specified justifies a cytopuncture, or even a biopsy or surgical excision for analysis","correct":true,"justification":"TRUE. Cytopuncture is the examination of choice in single lymphadenopathy. For poly-adenopathy, if the blood count is not sufficient, lymph node biopsy is preferred"},{"idx":4,"proposition":"Non-infectious lymphadenopathy is mainly represented by hematological malignancies (lymphomas, leukemias) and cancer metastases.","correct":true}],"type":"custom"}
+{"_id":"ADP-hemato-2","context":null,"enonce":"Additional examinations are indicated in case of:","item":"ADP","matiere":"hemato","propositions":[{"idx":0,"proposition":"Bulky lymphadenopathy > 1.5 cm","correct":false,"justification":"Lymphadenopathy is said to be voluminous if > 2 cm. Conf College of Infectiology"},{"idx":1,"proposition":"Lack of etiology at the end of the clinical examination","correct":true},{"idx":2,"proposition":"An alteration of the general condition","correct":true,"justification":"Refers to neoplasia"},{"idx":3,"proposition":"Very red lymphadenopathy","correct":false,"justification":"Inflammatory etiology ++"},{"idx":4,"proposition":"Soft lymphadenopathy","correct":false,"justification":"TRUE. It is a hard lymphadenopathy that will rather direct to cancer"}],"type":"custom"}
+{"_id":"ADP-hemato-3","context":null,"enonce":"Which of the following proposals point to cancerous lymphadenopathy?","item":"ADP","matiere":"hemato","propositions":[{"idx":0,"proposition":"Size greater than 2cm in inguinal region ","correct":true,"justification":"True, but it doesn't have to be"},{"idx":1,"proposition":"Fixed","correct":true},{"idx":2,"proposition":"Flexible","correct":false,"justification":"Motionless"},{"idx":3,"proposition":"Fluctuating","correct":false,"justification":"Always present, and growing"},{"idx":4,"proposition":"Painless","correct":true}],"type":"custom"}
+{"_id":"ADP-hemato-4","context":null,"enonce":"Which of the following are possible causes of inflammatory lymphadenopathy?","item":"ADP","matiere":"hemato","propositions":[{"idx":0,"proposition":"Cat scratch disease","correct":true},{"idx":1,"proposition":"Brucellosis","correct":true},{"idx":2,"proposition":"Rubella","correct":true},{"idx":3,"proposition":"Parvovirus B19","correct":true},{"idx":4,"proposition":"EBV","correct":true}],"type":"custom"}
+{"_id":"tbrefraction-ophtalmo-0","context":null,"enonce":"General:","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Light propagates in a straight line in space, but when it encounters a surface separating two transparent media of different index, its direction changes: this phenomenon of deflection is called refraction","correct":true},{"idx":1,"proposition":"Light rays pass through refractive surfaces and refractive media, the whole of which constitutes the dioptric apparatus of the eye.","correct":true},{"idx":2,"proposition":"The two most important refractive elements of the eye are the cornea (on average 42 diopters) and the lens (about 20 diopters)","correct":true},{"idx":3,"proposition":"The total convergence power of the eye is about 12 diopters","correct":false,"justification":"The eye is therefore a complex optical system composed of several diopters, whose total convergence power is about 60 diopters."},{"idx":4,"proposition":"In the optically normal or emmetropic eye, parallel rays focus on the retina, spontaneously giving a clear image.","correct":true}],"type":"custom"}
+{"_id":"tbrefraction-ophtalmo-1","context":null,"enonce":"General:","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"In hyperopia, the image of an object located at infinity is not formed on the retina and it is therefore seen blurred","correct":false,"justification":"Myopia"},{"idx":1,"proposition":"Myopia and hyperopia are so-called punctiform ametropia","correct":false,"justification":"Myopia and hyperopia are so-called spherical ametropia, the optical anomaly being the same regardless of the plane in which the light ray is located"},{"idx":2,"proposition":"The punctum remotum is defined by the closest point that the eye can see clearly without accommodating","correct":false,"justification":"The punctum remotum is defined by the farthest point that the eye can see clearly without accommodating (to infinity for the emmetropic eye)"},{"idx":3,"proposition":"The main ametropias are glaucoma and AMD","correct":false,"justification":"The main ametropias are myopia, hyperopia and astigmatism"},{"idx":4,"proposition":"In hyperopia, the image is formed virtually behind the retina","correct":true}],"type":"custom"}
+{"_id":"tbrefraction-ophtalmo-2","context":null,"enonce":"Regarding ametropia and visual acuity:","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Astigmatism is a disease of the elderly","correct":false,"justification":"Appears at the same time as other ametropia"},{"idx":1,"proposition":"In myopia, the refraction of the eye is not the same depending on the plane in which the incident rays are located.","correct":false,"justification":"Astigmatism"},{"idx":2,"proposition":"Visual acuity (VA) is the discriminating power of the eye","correct":true},{"idx":3,"proposition":"VA is one of the functional parameters (along with color vision and contrast vision) specific to the macula.","correct":true},{"idx":4,"proposition":"Distance VA is measured with the Menetrier scale","correct":false,"justification":"The VA from afar is measured with scales, the most used in France is that of Monoyer (1875), graduated in tenths"}],"type":"custom"}
+{"_id":"tbrefraction-ophtalmo-3","context":null,"enonce":"Regarding ametropia and presbyopia:","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The lens is suspended inside the globe by a set of fibers constituting an elastic ligament, the zonule.","correct":true},{"idx":1,"proposition":"When the zonule contracts, it increases the convergence power of the lens","correct":false,"justification":"When she relaxes"},{"idx":2,"proposition":"The amplitude of accommodation is defined by the difference in the dioptric power of the eye in distance and near vision","correct":true},{"idx":3,"proposition":"Symptoms of presbyopia usually begin to appear in patients after the age of 80","correct":false,"justification":"After the age of 40"},{"idx":4,"proposition":"Presbyopia is responsible for a decrease in visual acuity in distance vision such as hyperopia","correct":false,"justification":"Presbyopia is responsible for decreased visual acuity in near vision"}],"type":"custom"}
+{"_id":"tbrefraction-ophtalmo-4","context":null,"enonce":"Regarding refractive abnormalities:","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Presbyopia must be compensated by the addition of a correction consisting of convex spherical glasses","correct":true},{"idx":1,"proposition":"at age 60: frequent addition of 3 diopters","correct":true},{"idx":2,"proposition":"In a healthy and emmetropic subject, VA is spontaneously satisfactory","correct":true},{"idx":3,"proposition":"In a refractive anomaly, the VA can be improved by wearing an optical correction","correct":true},{"idx":4,"proposition":"The myopic eye is an eye too convergent","correct":true}],"type":"custom"}
+{"_id":"appendicite-urg-0","context":null,"enonce":"Regarding acute appendicitis","item":"appendicite","matiere":"urg","propositions":[{"idx":0,"proposition":"It is an inflammation of the ileocecal appendix of unpredictable course (inflammation, abscess, perforation)","correct":true},{"idx":1,"proposition":"There is no anatomo-clinical parallelism","correct":true},{"idx":2,"proposition":"In the face of abdominal pain, no clinical signs or symptoms (including fever or apyrexia) have sufficient individual diagnostic value to confirm or exclude a diagnosis of appendicitis (HAS, strong agreement)","correct":true},{"idx":3,"proposition":"Ultrasound is the preferred examination in children, young subjects, women of childbearing age","correct":true},{"idx":4,"proposition":"The non-visualization of the appendix on ultrasound does not exclude appendicitis","correct":true}],"type":"custom"}
+{"_id":"appendicite-urg-1","context":null,"enonce":"Regarding acute appendicitis","item":"appendicite","matiere":"urg","propositions":[{"idx":0,"proposition":"As soon as complicated appendicitis is suspected, the CT scan then becomes the first-line examination.","correct":true},{"idx":1,"proposition":"The CT scan must be performed within 24 hours with clinical signs of severity or occurring on fragile ground","correct":false,"justification":"The examination must be carried out within 4 hours with clinical signs of severity or occurring on fragile ground, and within 24 hours for suspicions of uncomplicated appendicitis"},{"idx":2,"proposition":"The appendicular abscess is suspected before: a tusk that may extend to the right flank and hypogestrium, general signs marked with a fever above 38.5 ° C, and transit disorders suggestive of occlusion","correct":true},{"idx":3,"proposition":"The appendicular plastron is marked by persistent pain, fever and biological inflammatory syndrome.","correct":true},{"idx":4,"proposition":"Appendicitis can be immediately revealed in the form of peritonitis","correct":true}],"type":"custom"}
+{"_id":"appendicite-urg-2","context":null,"enonce":"Regarding acute appendicitis","item":"appendicite","matiere":"urg","propositions":[{"idx":0,"proposition":"Intussusception of the infant should be discussed in case of abdominal pain with vomiting","correct":true},{"idx":1,"proposition":"In children, right base pneumonitis is a differential diagnosis that can be expressed by abdominal pain in a febrile context","correct":true},{"idx":2,"proposition":"In adults celiac disease should be evoked on recurrent abdominal pain, diarrhea and scannographic data","correct":false,"justification":"Crohn's disease should be discussed on recurrent abdominal pain, diarrhea and scannographic data"},{"idx":3,"proposition":"A right colonic tumor and other causes of febrile occlusion should be evoked in the elderly","correct":true},{"idx":4,"proposition":"Treatment of acute appendicitis is surgical","correct":true}],"type":"custom"}
+{"_id":"appendicite-urg-3","context":null,"enonce":"Regarding acute appendicitis","item":"appendicite","matiere":"urg","propositions":[{"idx":0,"proposition":"Treatment is based on appendectomy within 2 hours in case of uncomplicated acute appendicitis","correct":true},{"idx":1,"proposition":"The operating time includes an exploration of the peritoneal cavity and the realization of bacteriological samples","correct":true},{"idx":2,"proposition":"The surgical piece must be sent to pathology","correct":true},{"idx":3,"proposition":"In case of peritonitis or suspicion of gangrenous appendicitis, surgery is indicated urgently, combined with antibiotic therapy","correct":true},{"idx":4,"proposition":"Water-electrolyte rehydration in case of complication is necessary","correct":true}],"type":"custom"}
+{"_id":"appendicite-HGE-0","context":null,"enonce":"Regarding appendicitis:","item":"appendicite","matiere":"HGE","propositions":[{"idx":0,"proposition":"Its risk is the progression to perforation and peritonitis which is life-threatening.","correct":true},{"idx":1,"proposition":"Acute appendicitis is the most common surgical emergency in France","correct":true},{"idx":2,"proposition":"The majority of cases of acute appendicitis occur in women over 40 years of age","correct":false,"justification":"The majority of cases occur in adolescents and young adults between the 2nd and 3rd decade with a male predominance"},{"idx":3,"proposition":"The incidence of perforation is 70 to 80% in children and 30% in the elderly","correct":true},{"idx":4,"proposition":"The typical pain of appendicitis begins in the left iliac fossa","correct":false,"justification":"Starts right in the right iliac fossa (FID) and gradually increases in intensity over the first 24 hours"}],"type":"custom"}
+{"_id":"appendicite-HGE-1","context":null,"enonce":"Regarding acute appendicitis:","item":"appendicite","matiere":"HGE","propositions":[{"idx":0,"proposition":"Palpation regains pain caused or maximum IDF defense at the rovsing point","correct":false,"justification":"Maximum at Macburney point"},{"idx":1,"proposition":"The NFS shows polynuclear hyperleukocytosis (> 10,000\/mm3) (80% of cases)","correct":true},{"idx":2,"proposition":"A negative urine strip eliminates a urinary tract infection","correct":true},{"idx":3,"proposition":"β-HCG are dosed in women of childbearing potential to rule out the possibility of an ectopic pregnancy","correct":true},{"idx":4,"proposition":"Ultrasound is preferred as a first-line approach in women","correct":true}],"type":"custom"}
+{"_id":"appendicite-HGE-2","context":null,"enonce":"Regarding acute appendicitis:","item":"appendicite","matiere":"HGE","propositions":[{"idx":0,"proposition":"The abdominal CT scan has become the reference complementary examination for any abdominal emergency in case of diagnostic doubt, due to a positive predictive value close to 100%","correct":false,"justification":"The abdominal CT scan has become the reference complementary examination for any abdominal emergency in case of diagnostic doubt, due to a negative predictive value close to 100% – that is, the visualization of a normal appendix on the CT scan eliminates the diagnosis of appendicitis"},{"idx":1,"proposition":"CT scan is indicated as a first-line test in the elderly","correct":true},{"idx":2,"proposition":"On imaging, the diagnosis is based on an increase in size of the appendix and its wall, an infiltration of the fat of the mesoappendage and the possible presence of stercolith","correct":true},{"idx":3,"proposition":"In front of abdominal pain suggestive of appendicitis, the concomitant absence of a defense in the right iliac fossa, a leukocytosis greater than 10 × 10^9 cells \/ L and a CRP greater than 8 mg \/ L makes the diagnosis of acute appendicitis unlikely","correct":true},{"idx":4,"proposition":"In the face of abdominal pain suggestive of appendicitis, the combination of a defense in the right iliac fossa, leukocytosis greater than 10 × 109 cells \/ L and a CRP greater than 8 mg \/ L in young men makes the diagnosis of acute appendicitis very likely","correct":true}],"type":"custom"}
+{"_id":"appendicite-HGE-3","context":null,"enonce":"Regarding acute appendicitis: ","item":"appendicite","matiere":"HGE","propositions":[{"idx":0,"proposition":"In the face of abdominal pain, no biological parameter (leukocytes, PNN, CRP) has an individual diagnostic value high enough to confirm or exclude a diagnosis of appendicitis","correct":true},{"idx":1,"proposition":"In case of pelvic appendicitis the pains are localized to the left hypogastric region ","correct":false,"justification":"The pains, localized to the right hypogastric region, are in the foreground, most often associated with a febricle"},{"idx":2,"proposition":"In case of subhepatic appendicitis the symptoms are those of acute cholecystitis: pain of the right hypochondrium, fever and defense","correct":true},{"idx":3,"proposition":"The patient sometimes has an analgesic position in psoitis in case of subhepatic appendicitis","correct":true},{"idx":4,"proposition":"In case of meso celiac appendicitis the appendix is located in the middle of a digestive loop and its inflammation is at the origin of a more or less important reflex ileus in a febrile context","correct":true}],"type":"custom"}
+{"_id":"coqueluche-infectio-0","context":null,"enonce":"About whooping cough","item":"coqueluche","matiere":"infectio","propositions":[{"idx":0,"proposition":"Disease caused by Bordetella pertussis","correct":true},{"idx":1,"proposition":"In France, the reservoir of the disease is in adults and the elderly ","correct":true},{"idx":2,"proposition":"The reference identification technique is immunostaining","correct":false,"justification":"Reference identification technique: PCR"},{"idx":3,"proposition":"Fluoroquinolones are the basis of curative antibiotic therapy and antibiotic prophylaxis","correct":false,"justification":"Macrolides are the basis of curative antibiotic therapy and antibiotic prophylaxis"},{"idx":4,"proposition":"Bordetella pertussisest is a gram postive cocci","correct":false,"justification":"Bordetella pertussis = pertussis agent, gram-negative bacillus"}],"type":"custom"}
+{"_id":"coqueluche-infectio-1","context":null,"enonce":"About whooping cough","item":"coqueluche","matiere":"infectio","propositions":[{"idx":0,"proposition":"Transmission is strictly human-to-human, airborne.","correct":true},{"idx":1,"proposition":"The attack rate is high (75%) in case of close and repeated contact","correct":true},{"idx":2,"proposition":"Transmission is mainly intra-family and intra-community","correct":true},{"idx":3,"proposition":"Children are the reservoir of contamination in the world","correct":true},{"idx":4,"proposition":"Infant mortality remains low","correct":false,"justification":"Infant mortality is high (malnutrition, respiratory complications)"}],"type":"custom"}
+{"_id":"coqueluche-infectio-2","context":null,"enonce":"About whooping cough","item":"coqueluche","matiere":"infectio","propositions":[{"idx":0,"proposition":"Maternal antibodies do not protect the infant from disease (apart from vaccination during pregnancy, not recommended in France)","correct":true},{"idx":1,"proposition":"Fever is relatively high","correct":false,"justification":"Fever is ABSENT"},{"idx":2,"proposition":"the adult form is atypical, readily attenuated by residual immunity","correct":true},{"idx":3,"proposition":"Main symptom is cough organized in paroxysmal fits with difficulty of inspiratory recovery or chronic spasmodic cough","correct":true},{"idx":4,"proposition":"There is hyperlymphocytosis at the NFS often > 10 G \/ L, suggestive, but inconstant","correct":true}],"type":"custom"}
+{"_id":"coqueluche-infectio-3","context":null,"enonce":"About whooping cough","item":"coqueluche","matiere":"infectio","propositions":[{"idx":0,"proposition":"There is no inflammatory syndrome","correct":true},{"idx":1,"proposition":"ƒƒ ACE inhibitors can cause prolonged coughing","correct":true},{"idx":2,"proposition":"While stereotyped 3-phase evolution is common in unvaccinated infants, it is not always identifiable in adults.","correct":true},{"idx":3,"proposition":"There is an Ineffectiveness of treatment on symptoms when prescribed in the fifths phase","correct":true},{"idx":4,"proposition":"The alternative if contraindication macrolides is cotrimoxazole for 14 days","correct":true}],"type":"custom"}
+{"_id":"arthrite-rhumato-0","context":null,"enonce":"Regarding effusions:","item":"arthrite","matiere":"rhumato","propositions":[{"idx":0,"proposition":"A joint effusion can be physiological","correct":false,"justification":"It is always the expression of intra-articular suffering"},{"idx":1,"proposition":"Physiological joint fluid has a nutritious function for cartilage","correct":true},{"idx":2,"proposition":"The diagnosis of joint effusion is always clinical","correct":false,"justification":"For the shoulder and hip, the diagnosis is mainly ultrasound or radiological"},{"idx":3,"proposition":"A patellar shock at the knee signs an effusion","correct":true},{"idx":4,"proposition":"MRI is the exam of choice to objectify an effusion in the deep joints","correct":false,"justification":"Rather ultrasound in this case of use. MRI does not provide additional information (except in the case of hemarthrosis)."}],"type":"custom"}
+{"_id":"arthrite-rhumato-1","context":null,"enonce":"Regarding the diagnosis of joint effusion","item":"arthrite","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Involvement of the proximal and distal interphalangeal joints and respect for metacarpophalangeal refers to rheumatoid arthritis","correct":false,"justification":"Towards digital osteoarthritis. There is respect for distal interphalangeal in rheumatoid arthritis"},{"idx":1,"proposition":"MRI can identify the etiology of effusion in most cases","correct":false,"justification":"No. Only if hemarthrosis"},{"idx":2,"proposition":"Arthritis with a digestive infection 2 weeks ago suggests septic arthritis","correct":false,"justification":"Reactive arthritis (absence of germs in the joint)"},{"idx":3,"proposition":"A hygroma is a special type of effusion","correct":false,"justification":"Hygroma = Bursitis. This is an attack of the periarticular structures"},{"idx":4,"proposition":"Viral arthritis is typically polyarticular","correct":true}],"type":"custom"}
+{"_id":"arthrite-rhumato-2","context":null,"enonce":"Which propositions are true?","item":"arthrite","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Bursitis may be punctured","correct":true,"justification":"However, a joint puncture is contraindicated in this case to avoid joint contamination."},{"idx":1,"proposition":"Hip pain should evoke a knee injury, by projection of pain. ","correct":false,"justification":"It's the opposite: a hip injury can be depressed by gonalgia"},{"idx":2,"proposition":"The diagnosis of rheumatoid arthritis can only be made after 6 weeks of evolution","correct":true},{"idx":3,"proposition":"During a joint puncture, biochemical analysis is systematic","correct":false,"justification":"Non-systematic"},{"idx":4,"proposition":"In fibromyalgia, the pain is brutal","correct":false,"justification":"Most often, they arrive gradually"}],"type":"custom"}
+{"_id":"convulsionsped-urg-0","context":null,"enonce":"Which of the following are true?","item":"convulsionsped","matiere":"urg","propositions":[{"idx":0,"proposition":"Non-febrile seizures require EEG 🧠 exploration within a week","correct":true},{"idx":1,"proposition":"Febrile seizures require a lumbar puncture if the age is less than 9 months 👶","correct":true},{"idx":2,"proposition":"The most common cause is epilepsy-absence","correct":false,"justification":"The most common cause is hyperthermic seizure"},{"idx":3,"proposition":"Simple seizures never recur","correct":false,"justification":"Simple seizures recur in 20 to 30% of cases"},{"idx":4,"proposition":"Cerebral thrombophlebitis are rare causes of seizures 🤕","correct":true}],"type":"custom"}
+{"_id":"LA-onco-0","context":null,"enonce":"What is the annual incidence per 100,000 inhabitants of acute leukaemia?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"1","correct":false},{"idx":1,"proposition":"5","correct":true},{"idx":2,"proposition":"100","correct":false},{"idx":3,"proposition":"1 000","correct":false},{"idx":4,"proposition":"10 000","correct":false}],"type":"custom"}
+{"_id":"LA-onco-1","context":null,"enonce":"Which propositions are true? ","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"AML mainly affects children","correct":false,"justification":"Especially the elderly"},{"idx":1,"proposition":"ALL mainly affects the elderly","correct":false,"justification":"ALL mainly affects children"},{"idx":2,"proposition":"Leukemias are the most common cancers in children","correct":true,"justification":"With intracranial tumors"},{"idx":3,"proposition":"AMLs concern blasts (CS-M)","correct":true},{"idx":4,"proposition":"ALL involves lymphoid precursors (L-CS)","correct":true}],"type":"custom"}
+{"_id":"LA-onco-2","context":null,"enonce":"Which of these proposals are etiological factors for leukemia?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"HTLV1","correct":true},{"idx":1,"proposition":"EBV","correct":true,"justification":"Especially in case of immunosuppression (in transplant recipients for example)"},{"idx":2,"proposition":"Down syndrome","correct":true},{"idx":3,"proposition":"Syndrome de Klinefelter","correct":false},{"idx":4,"proposition":"Syndrome de Li-Fraumeni","correct":true}],"type":"custom"}
+{"_id":"LA-onco-4","context":null,"enonce":"Regarding the different forms of leukemia:","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Monoblastic AML is accompanied by frank hyperleukocytosis","correct":true},{"idx":1,"proposition":"Post-chemotherapy AML does not typically find karyotype abnormalities","correct":false,"justification":"We often find a complex karyotype"},{"idx":2,"proposition":"ALL with Philadelphia chromosome finds a translocation 11;14","correct":false,"justification":"There is a translocation 9;22 (BCR ABL). Translocation 11;14 is a factor in good prognosis for multiple myeloma"},{"idx":3,"proposition":"Burkitt's ALL may be accompanied by tumor lysis syndrome","correct":true},{"idx":4,"proposition":"Most acute leukemias are rapidly fatal without treatment","correct":true}],"type":"custom"}
+{"_id":"LA-onco-5","context":null,"enonce":"Which of the following are causes of thrombocytosis?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Myeloproliferative syndrome","correct":true},{"idx":1,"proposition":"Cancers","correct":true},{"idx":2,"proposition":"Iron deficiency","correct":true},{"idx":3,"proposition":"Vitamin B12 overdose","correct":false,"justification":"Does not have this effect, it is not integrated by the marrow"},{"idx":4,"proposition":"Chronic alcoholism","correct":false,"justification":"Thrombocytopenia of central origin"}],"type":"custom"}
+{"_id":"LA-onco-6","context":null,"enonce":"Which of the following are classic ways of revealing acute leukemia?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Spinal cord compression","correct":true},{"idx":1,"proposition":"Bone marrow failure","correct":true},{"idx":2,"proposition":"Mediastinal syndrome","correct":true},{"idx":3,"proposition":"Splenomegaly","correct":true},{"idx":4,"proposition":"Hepatomegaly","correct":true}],"type":"custom"}
+{"_id":"LA-onco-7","context":null,"enonce":"Which of the following are factors in poor prognosis for AML?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Complex karyotype","correct":true},{"idx":1,"proposition":"Relapse","correct":true},{"idx":2,"proposition":"Pulmonary invasive aspergillosis","correct":true},{"idx":3,"proposition":"No compatible donor","correct":true},{"idx":4,"proposition":"Severe undernutrition","correct":true}],"type":"custom"}
+{"_id":"LA-onco-8","context":null,"enonce":"Which of the following are causes of pancytopenia?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"B9 deficiency","correct":true},{"idx":1,"proposition":"B12 deficiency","correct":true},{"idx":2,"proposition":"Medullary invasion of clonal proliferation","correct":true},{"idx":3,"proposition":"Iron deficiency","correct":false,"justification":"False"},{"idx":4,"proposition":"Post-chemotherapy aplasia","correct":true}],"type":"custom"}
+{"_id":"LA-onco-9","context":null,"enonce":"Regarding promyelocytic myeloid leukemia (AML 3), which propositions are true?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Is often associated with DICD","correct":true},{"idx":1,"proposition":"A t(9;22) translocation is often found at the karyotype","correct":false,"justification":"t(15;17)\r\nThe translocation t(9;22) corresponds to the Philadelphia chromosome found in 2 pathologies: ALL with Philadelphia chromosome and CML with Philadelphia chromosome"},{"idx":2,"proposition":"Its treatment is based on ATRA (all-trans retinoid acid)","correct":true,"justification":"True, 5-year relapse-free survival of 80%"},{"idx":3,"proposition":"Gingival hypertrophy is often found","correct":false,"justification":"False. It is in monoblastic myeloid leukemia (AML5)"},{"idx":4,"proposition":"Pancytopenia is often found on a blood count","correct":true,"justification":"None"}],"type":"custom"}
+{"_id":"LA-onco-11","context":null,"enonce":"Regarding monoblastic leukemia (AML5). Which of the following are true?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Is often associated with DICD","correct":false,"justification":"False. DICD is often associated with promyelocyte leukemia (AML3)"},{"idx":1,"proposition":"Leukemides can be found","correct":true,"justification":"True. Leukemides are a cutaneous localization of blasts."},{"idx":2,"proposition":"There is often a meningeal involvement which justifies prophylaxis. ","correct":true},{"idx":3,"proposition":"It often includes leukostasis syndrome, which can cause acute respiratory distress, impaired consciousness and epilepsy through damage to the pulmonary and cerebral capillaries.","correct":true,"justification":"Leukostasis syndrome is common in monoblastic leukemia. It appears when there is hyperleucytosis > 100 G \/ L"},{"idx":4,"proposition":"There can be gingival hypertrophy","correct":true}],"type":"custom"}
+{"_id":"LA-onco-12","context":null,"enonce":"Which of the following are tests to clarify the diagnosis of acute leukemia?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Immunophenotyping of blasts","correct":true,"justification":"True, performed on spinal cord puncture but can also be performed on circulating blasts"},{"idx":1,"proposition":"Myelogram","correct":true,"justification":"True, indispensable: allows to affirm leukemia and to type it"},{"idx":2,"proposition":"Molecular biology analysis of bone marrow cells","correct":true},{"idx":3,"proposition":"Cytogenetics","correct":true},{"idx":4,"proposition":"Measurement of Ki67 cellular activity","correct":false,"justification":"Not for leukemias"}],"type":"custom"}
+{"_id":"LA-onco-13","context":null,"enonce":"Which additional examination(s) are systematically part of the assessment of complications of acute leukaemia?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Systematic lumbar puncture","correct":false,"justification":"False. PL is systematic even in the absence of signs of call of meningeal invasion only in case of ALL, monoblastic LA and hyperleukocyte LA (hematic college 3rd edition)"},{"idx":1,"proposition":"Fibrinogen","correct":true,"justification":"True. Necessary for the review of the DIC."},{"idx":2,"proposition":"LDH determination","correct":true,"justification":"True. To look for tumor lysis syndrome. The amount of LDH is proportional to lysis syndrome."},{"idx":3,"proposition":"Complete liver test","correct":true,"justification":"True. It is necessary to look for a secondary localization of blasts."},{"idx":4,"proposition":"Bone marrow biopsy","correct":false,"justification":"False. It is useless unless spinal aspiration is impossible or unless there is a suspicion of associated myelofibrosis."}],"type":"custom"}
+{"_id":"LA-onco-14","context":null,"enonce":"A myelogram would show what abnormalities in acute myeloid leukemia?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Auer's bodies","correct":true,"justification":"True. These are small red sticks that are specific to AML"},{"idx":1,"proposition":"Presence of 15% blasts","correct":false,"justification":"False. By definition, acute leukemia present ≥ 20% of bone marrow blasts"},{"idx":2,"proposition":"Positive myeloperoxidase enzyme activity","correct":true},{"idx":3,"proposition":"Small and medium-sized blasts","correct":false,"justification":"Small and medium-sized blasts are suggestive of ALL"},{"idx":4,"proposition":"Granulations","correct":true}],"type":"custom"}
+{"_id":"LA-onco-16","context":null,"enonce":"Which of the following proposals, which, independently of others, can the diagnosis of acute leukaemia be affirmed?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Immunophenotyping of circulating lymphocytes","correct":false,"justification":"Evocative but not affirmative"},{"idx":1,"proposition":"Myelogram with cytological examination","correct":true,"justification":"True, it is the only examination that can confirm the diagnosis"},{"idx":2,"proposition":"Complete blood count","correct":false,"justification":"May be sufficient in CLL"},{"idx":3,"proposition":"Karyotype on blood","correct":false,"justification":"False"},{"idx":4,"proposition":"Puncture of lymphadenopathy","correct":false,"justification":"May help in lymphoma"}],"type":"custom"}
+{"_id":"tbpaupieres-ophtalmo-0","context":null,"enonce":"Regarding the basics of anatomy:","item":"tbpaupieres","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The eyelids, upper and lower, have the essential role of protecting the eyeball","correct":true},{"idx":1,"proposition":"They are composed of an anterior plane and a posterior plane","correct":true},{"idx":2,"proposition":"The anterior plane is purely cutaneous","correct":false,"justification":"anterior cutaneous plane"},{"idx":3,"proposition":"The posterior plane is tarsoconjunctival","correct":true},{"idx":4,"proposition":"The conjunctiva is reflected at the conjunctival cul-de-sac and then lines the eyeball (bulbar conjunctiva)","correct":true}],"type":"custom"}
+{"_id":"tbpaupieres-ophtalmo-1","context":null,"enonce":"Regarding anatomy and physiology:","item":"tbpaupieres","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The eyelids contain Durkeim's glands that secrete lipids used in tears.","correct":false,"justification":"Meibomian glands"},{"idx":1,"proposition":"Tears are eliminated either by evaporation or by drainage to the nose through the excretory tear ducts.","correct":true},{"idx":2,"proposition":"The two tear points, lower and upper, are visible on the free edges in the vicinity of the inner canthus","correct":true},{"idx":3,"proposition":"Insufficient secretion does not lead to any particular symptom","correct":false,"justification":"Insufficient secretion can lead to dry ocular syndrome"},{"idx":4,"proposition":"The palpebral closure is provided by the orbicular muscle of the eyelids innervated by the trigeminal","correct":false,"justification":"The palpebral closure is provided by the orbicular muscle of the eyelids innervated by the VII (facial nerve)"}],"type":"custom"}
+{"_id":"tbpaupieres-ophtalmo-2","context":null,"enonce":"Regarding anatomy and stye:","item":"tbpaupieres","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The opening of the eyelids is related to the levator muscle of the upper eyelid, innervated by the III (common ocular motor)","correct":true},{"idx":1,"proposition":"The stye is a boil of the free edge of the eyelid centered on a pilosebaceous follicle of the eyelash","correct":true},{"idx":2,"proposition":"The stye corresponds to a parasitic infection","correct":false,"justification":"It corresponds to a bacterial infection, most often Staphylococcus aureus, of the pilosebaceous follicle"},{"idx":3,"proposition":"The stye is painless almost systematically","correct":false,"justification":"It develops within a few days and can lead to sharp pain."},{"idx":4,"proposition":"Treatment of stye is purely symptomatic pending spontaneous healing","correct":false,"justification":"Treatment consists of eye drops or antibiotic ointment for 8 days"}],"type":"custom"}
+{"_id":"tbpaupieres-ophtalmo-3","context":null,"enonce":"About Chalazion","item":"tbpaupieres","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Chalazion is an inflammatory granuloma developed on a meibomian gland","correct":true},{"idx":1,"proposition":"Chalazon is a bacterial infection, most commonly due to Staphylococcus aureus","correct":false,"justification":"Most of the time, there is no infection and the secretions contained in the chalazion are purely sebaceous"},{"idx":2,"proposition":"Chalazon presents clinically as a painful swelling of the eyelid most often","correct":true},{"idx":3,"proposition":"Chalazon heals in 3 to 5 days of antibiotic therapy","correct":false,"justification":"It can evolve over a longer period than stye, up to several weeks"},{"idx":4,"proposition":"First-line treatment is the application of local corticosteroid ointment combined with eyelid care","correct":true}],"type":"custom"}
+{"_id":"tbpaupieres-ophtalmo-4","context":null,"enonce":"Concerning entropion and chalazion:","item":"tbpaupieres","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"In Chalazion, if corticosteroids are not effective, antibiotics are prescribed","correct":false,"justification":"If this treatment is not effective and if the chalazion progresses to the encystement, it is sometimes necessary to make an incision of the meibomian gland under local anesthesia."},{"idx":1,"proposition":"Incising the Meibomian gland then allows, with a scalpel, to incise the chalazion to express the sebum","correct":true},{"idx":2,"proposition":"In case of surgery, the gland is left without suture and antiseptic eye drops are prescribed for 8 days","correct":true},{"idx":3,"proposition":"Surgery is contraindicated in case of anti-thrombotic treatment","correct":false,"justification":"No big ships at all. The most common complication is low bleeding that usually breaks away within minutes by simple compression."},{"idx":4,"proposition":"Entropion is the tilting of the eyelid towards the conjunctiva","correct":true}],"type":"custom"}
+{"_id":"tbpaupieres-ophtalmo-5","context":null,"enonce":"Regarding entropion and ptosis:","item":"tbpaupieres","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Entropion can lead to a chronic red and painful eye","correct":true},{"idx":1,"proposition":"Senile entropion is the tilting from the lower eyelid to the eyeball, resulting in friction of the eyelashes on the conjunctiva and cornea.","correct":true},{"idx":2,"proposition":"Senile ectropion is linked to sagging skin tissue","correct":true},{"idx":3,"proposition":"Watery eyes eliminate diagnosis of ectropion","correct":false,"justification":"It can lead to corneal exposure and tearing by rocking of the lower tear point which then no longer collects tears, and consequently a red and chronic painful eye"},{"idx":4,"proposition":"Ptosis is an involuntary, unexplained and permanent miosis","correct":false,"justification":"The ptosis is defined by a too low position of the free edge of the upper eyelid, the ptosis can be:"}],"type":"custom"}
+{"_id":"purpura-hemato-0","context":null,"enonce":"Regarding child and adult purpura","item":"purpura","matiere":"hemato","propositions":[{"idx":0,"proposition":"Purpura is an elementary lesion of the skin or mucous membrane by extravasation of blood into the dermis or chorion.","correct":true},{"idx":1,"proposition":"Purpura is a flat or infiltrated lesion that does not fade with vitropression","correct":true},{"idx":2,"proposition":"The three semiological forms of a purpura: petechiae, ecchymosis, vibicies","correct":true},{"idx":3,"proposition":"Purpura disappears spontaneously without sequelae","correct":true},{"idx":4,"proposition":"It is difficult to distinguish it from telangectasias not both fading to vitropression","correct":false,"justification":"with possible • Elementary lesions possibly associated • Macules, papules, more rarely nodules"}],"type":"custom"}
+{"_id":"purpura-hemato-1","context":null,"enonce":"About purpura fulminans","item":"purpura","matiere":"hemato","propositions":[{"idx":0,"proposition":"Purpura should always suggest invasive meningococcal infection","correct":true},{"idx":1,"proposition":"Hospitalization is urgently provided if extensive and\/or necrotic purpura","correct":true},{"idx":2,"proposition":"Meningococcal is the most frequently involved germ","correct":true},{"idx":3,"proposition":"There is a systemic picture in the foreground with sepsis severe beremic ± septic shock ± disorders of consciousness","correct":true},{"idx":4,"proposition":"In children the picture is crude, petechiae of rapid onset, deceptive infectious syndrome with little fever, sometimes drome hypothermia)","correct":true}],"type":"custom"}
+{"_id":"purpura-hemato-2","context":null,"enonce":"About purpura","item":"purpura","matiere":"hemato","propositions":[{"idx":0,"proposition":"In case of a platelet count > 100,000\/mm3 thrombocytopenia is not attributable in purpura, it is necessary to look for another cause (thrombosis, vasculitis)","correct":true},{"idx":1,"proposition":"Purpura fulminans requires immediate antiobiotic treatment and urgent management in an intensive care unit","correct":true},{"idx":2,"proposition":"A platelet count must be done in front of all purpura to rule out thrombotic origin","correct":true},{"idx":3,"proposition":"A platelet count below 40000\/mm3 indicates the imputability of thrombocytopenia in purpura","correct":false,"justification":"30000\/mm3"},{"idx":4,"proposition":"In case of major thrombocytopenia or DIC, the prognosis is determined by the risk of visceral haemorrhage, especially meningeal hemorrhage","correct":true}],"type":"custom"}
+{"_id":"purpura-infectio-0","context":null,"enonce":"About purpura","item":"purpura","matiere":"infectio","propositions":[{"idx":0,"proposition":"There are two main types of purpura: thrombocytopenic purpura and vascular purpura","correct":true},{"idx":1,"proposition":"Thrombocytopenic purpura is petechial (lesions < 3 mm) and\/or ecchymotic, not infiltrated","correct":true},{"idx":2,"proposition":"Vascular purpura is petechial, infiltrated, sometimes necrotic or ecchymotic","correct":true},{"idx":3,"proposition":"Any febrile purpura justifies emergency hospitalization and the implementation of additional precautions Droplets until the elimination of a (meningococcus)","correct":true},{"idx":4,"proposition":"The presence of at least one ecchymotic element ≥ 3 cm and \/ or necrotic evokes purpura fulminans and justifies the pre-hospital administration in extreme urgency of a first injection of injectable 3rd generation cephalosporin","correct":false,"justification":"The presence of contagiousness minus an ecchymotic element ≥ 3 mm"}],"type":"custom"}
+{"_id":"purpura-infectio-1","context":null,"enonce":"About purpura","item":"purpura","matiere":"infectio","propositions":[{"idx":0,"proposition":"Any purpura associated with fever requires hospitalization","correct":true},{"idx":1,"proposition":"Purpura fulminans requires pre-hospital therapeutic management (antibiotic therapy) in extreme urgency","correct":true},{"idx":2,"proposition":"Any extensive thrombocytopenic purpura indicates a bleeding risk","correct":true},{"idx":3,"proposition":"Purpura is an extravasation of red blood cells in the superficial dermis entering tahes that do not fade with vitropression.","correct":true},{"idx":4,"proposition":"The presence of at least one ecchymotic element ≥ 3 mm and\/or necrotic is a sign of severity","correct":false}],"type":"custom"}
+{"_id":"purpura-infectio-2","context":null,"enonce":"About purpura","item":"purpura","matiere":"infectio","propositions":[{"idx":0,"proposition":"Purpura in adults and children is of central origin rarely, or of peripheral origin most often","correct":true},{"idx":1,"proposition":"There are 3 mechanisms of peripheral thrombocytopenia on a pathophysiological level: destruction (most frequent), consumption (DIC), sequestration (hypersplenism)","correct":true},{"idx":2,"proposition":"Hepatitis B and C cause vascular purpura","correct":true},{"idx":3,"proposition":"EBV, CMV viruses cause thrombocytopenic purpura","correct":false},{"idx":4,"proposition":"Hematopoietic tuberculosis causes thrombocytopenic cental purpura","correct":true}],"type":"custom"}
+{"_id":"SMD-onco-0","context":null,"enonce":"Regarding myelodysplastic syndrome, which propositions are true?","item":"SMD","matiere":"onco","propositions":[{"idx":0,"proposition":"This is a clonal hematological disease","correct":true},{"idx":1,"proposition":"It becomes common after age 60","correct":true},{"idx":2,"proposition":"It is idiopathic in about 5% of cases","correct":false,"justification":"It is most often idiopathic, in about 85% of cases"},{"idx":3,"proposition":"Clonal involvement involves peripheral hematopoietic stem cells","correct":false,"justification":"Hematopoietic stem cells are medullary"},{"idx":4,"proposition":"We talk about spinal cord abortion","correct":true}],"type":"custom"}
+{"_id":"SMD-onco-1","context":null,"enonce":"Which of these proposals are possible causes of myelodysplastic syndrome?","item":"SMD","matiere":"onco","propositions":[{"idx":0,"proposition":"Fanconi anemia","correct":true},{"idx":1,"proposition":"Hypothyroidism","correct":false,"justification":"Not on the college list"},{"idx":2,"proposition":"Chemotherapy","correct":true},{"idx":3,"proposition":"Benzene poisoning","correct":true},{"idx":4,"proposition":"There are no genetic causes","correct":false,"justification":"There are many genetic causes: trisomy 21, Fanconi anemia, Kostmann's neutropenia, neurofibromatosis."}],"type":"custom"}
+{"_id":"SMD-onco-2","context":null,"enonce":"Which of these genetic diseases can cause myelodysplastic syndrome?","item":"SMD","matiere":"onco","propositions":[{"idx":0,"proposition":"Fragile X syndrome","correct":false},{"idx":1,"proposition":"Le syndrome de Lyell","correct":false,"justification":"Is not a genetic disease and does not cause myelodysplastic syndrome. It is a bullous dermatosis of drug etiology, characterized by acute necrosis of the epidermis over the entire height of the mucous body."},{"idx":2,"proposition":"Neurofibromatosis","correct":true},{"idx":3,"proposition":"Trisomy 18","correct":false},{"idx":4,"proposition":"Kostmann's neutropenia","correct":true,"justification":"The genetic causes listed in the college are: trisomy 21, Fanconi anemia, Kostmann's neutropenia, neurofibromatosis."}],"type":"custom"}
+{"_id":"SMD-onco-3","context":null,"enonce":"Regarding additional examinations in the context of myelodysplastic syndrome, which proposals are true?","item":"SMD","matiere":"onco","propositions":[{"idx":0,"proposition":"The blood count shows anemia in most cases","correct":true,"justification":"The blood count may also show thrombocytopenia and leukopenia predominant on the PNN"},{"idx":1,"proposition":"In case of monocytosis > 0.5g \/ L, we speak of CMML (Chronic Myelomonocytic Leukemia)","correct":false,"justification":"We talk about CMML during monocytosis > 1g \/ L"},{"idx":2,"proposition":"Myelogram shows poor marrow in 90% of cases","correct":false,"justification":"In about 80% of cases, the marrow is rich or normal, which raises suspicions of spinal cord abortion."},{"idx":3,"proposition":"Anemia is aregenerative","correct":true},{"idx":4,"proposition":"Anemia is microcytic","correct":false,"justification":"Anemia is macrocytic most often. It can be normocytic."}],"type":"custom"}
+{"_id":"SMD-onco-4","context":null,"enonce":"Which of these proposals are recognized treatments in case of low risk?","item":"SMD","matiere":"onco","propositions":[{"idx":0,"proposition":"Hypomethylating agents","correct":false,"justification":"It is the first-line treatment in case of high risk"},{"idx":1,"proposition":"Chemotherapy","correct":false,"justification":"Chemotherapy concerns high risks"},{"idx":2,"proposition":"Therapeutic abstention","correct":false,"justification":"The risk of transition to acute myeloid leukemia is 30% and the impact of anemia can be significant."},{"idx":3,"proposition":"EPO","correct":true},{"idx":4,"proposition":"Lenalidomide","correct":true}],"type":"custom"}
+{"_id":"SMD-onco-5","context":null,"enonce":"Which of the following are true for secondary acute leukemias?","item":"SMD","matiere":"onco","propositions":[{"idx":0,"proposition":"Prognosis is favourable","correct":false,"justification":"Unfavourable"},{"idx":1,"proposition":"The prognosis is unfavourable","correct":true},{"idx":2,"proposition":"The prognosis is unchanged from that of the myelodysplasia that precedes it","correct":false,"justification":"More unfavorable"},{"idx":3,"proposition":"Allogeneic hematopoietic stem cell transplantation is a curative treatment","correct":true},{"idx":4,"proposition":"Lack of remission after induction is a poor prognosis criterion","correct":true}],"type":"custom"}
+{"_id":"SMD-onco-6","context":null,"enonce":"Which of the following proposals promote the onset of myelodysplastic syndrome?","item":"SMD","matiere":"onco","propositions":[{"idx":0,"proposition":"Type 2 diabetes","correct":false,"justification":"The FDRs are: previous chemotherapy, previous radiotherapy, toxic intake, acquired hematopathy, genetic causes (trisomy 21 or Fanconi anemia for example)"},{"idx":1,"proposition":"Thiazide diuretics","correct":false,"justification":"False"},{"idx":2,"proposition":"Solid cancer (untreated)","correct":false,"justification":"False"},{"idx":3,"proposition":"Chemotherapy","correct":true},{"idx":4,"proposition":"Radiotherapy","correct":true}],"type":"custom"}
+{"_id":"Kcphysiopath-onco-0","context":null,"enonce":"Which of these proposals are part of the three stages of carcinogenesis?","item":"Kcphysiopath","matiere":"onco","propositions":[{"idx":0,"proposition":"Promotion","correct":true,"justification":"Step 2"},{"idx":1,"proposition":"Initiation","correct":true,"justification":"Step 1"},{"idx":2,"proposition":"Development","correct":false,"justification":"Step 3 is progression"},{"idx":3,"proposition":"Progression","correct":true,"justification":"Step 3"},{"idx":4,"proposition":"The beginning","correct":false,"justification":"Step 1 is initiation"}],"type":"custom"}
+{"_id":"Kcphysiopath-onco-2","context":null,"enonce":"Which cancers predispose to BRCA1 or BRCA2 mutations?","item":"Kcphysiopath","matiere":"onco","propositions":[{"idx":0,"proposition":"Prostate cancer","correct":true,"justification":"For BRCA2"},{"idx":1,"proposition":"Breast cancer","correct":true,"justification":"For BRCA1\/2"},{"idx":2,"proposition":"Endometrial cancer","correct":false},{"idx":3,"proposition":"Ovarian cancer ","correct":true,"justification":"For BRCA1\/2"},{"idx":4,"proposition":"Colon cancer","correct":false}],"type":"custom"}
+{"_id":"Kcphysiopath-onco-3","context":null,"enonce":"Concerning occupational cancers:","item":"Kcphysiopath","matiere":"onco","propositions":[{"idx":0,"proposition":"Their number is overestimated","correct":false,"justification":"It is assumed to be vastly underestimated"},{"idx":1,"proposition":"4 to 8.5% of cancers are of occupational origin","correct":true},{"idx":2,"proposition":"Women are more affected than men","correct":false,"justification":"Men are more affected than women"},{"idx":3,"proposition":"The majority of occupational cancers compensated in France are linked to previous exposure to asbestos","correct":true},{"idx":4,"proposition":"Secondary prevention is to be prioritized","correct":false,"justification":"Primary prevention"}],"type":"custom"}
+{"_id":"Kcphysiopath-onco-4","context":null,"enonce":"Concerning occupational cancers:","item":"Kcphysiopath","matiere":"onco","propositions":[{"idx":0,"proposition":"Mesothelioma is the most represented cancer","correct":true},{"idx":1,"proposition":"Occupational exposures to carcinogens are more common in women","correct":false,"justification":"More common in men"},{"idx":2,"proposition":"All occupational cancers are recognized as such","correct":false,"justification":"They are vastly underestimated"},{"idx":3,"proposition":"Exposure to wood dust should be accompanied by an ENT examination and naso-fibroscopy regularly","correct":true},{"idx":4,"proposition":"Prevention and follow-up stops at retirement","correct":false,"justification":"Post-occupational supervision must be provided by the doctor chosen by the insured person"}],"type":"custom"}
+{"_id":"Kcphysiopath-onco-5","context":null,"enonce":"Which of these proposals are proto-oncogenes?","item":"Kcphysiopath","matiere":"onco","propositions":[{"idx":0,"proposition":"RAS","correct":true},{"idx":1,"proposition":"BRCA1","correct":false,"justification":"It is an anti-oncogene"},{"idx":2,"proposition":"p53","correct":false,"justification":"It is an anti-oncogene"},{"idx":3,"proposition":"BRAF","correct":true},{"idx":4,"proposition":"TGF-alpha","correct":true}],"type":"custom"}
+{"_id":"Kcphysiopath-onco-6","context":null,"enonce":"Which of these proposals are anti-oncogenes?","item":"Kcphysiopath","matiere":"onco","propositions":[{"idx":0,"proposition":"ERB","correct":false,"justification":"It is a proto-oncogene"},{"idx":1,"proposition":"HER2","correct":false,"justification":"It is a proto-oncogene"},{"idx":2,"proposition":"p21","correct":true},{"idx":3,"proposition":"BRCA2","correct":true},{"idx":4,"proposition":"NF1","correct":true}],"type":"custom"}
+{"_id":"DgKc-onco-1","context":null,"enonce":"Regarding excision surgery:","item":"DgKc","matiere":"onco","propositions":[{"idx":0,"proposition":"R0 means that the quality of resection is not determined ","correct":false,"justification":"R0 status refers to a resection with healthy margins"},{"idx":1,"proposition":"Surgery is a marginal therapy compared to chemotherapy","correct":false,"justification":"Surgery is still the first-line management in most non-metastatic cancers (breast, lung, liver, colon, skin, etc.)"},{"idx":2,"proposition":"Surgery is done by the oncologist","correct":false,"justification":"Oncology is a medical specialty. The surgery is done by the surgeon of the organ concerned"},{"idx":3,"proposition":"There are 3 R statuses: R1, R2 and R3","correct":false,"justification":"R0, R1 and R2"},{"idx":4,"proposition":"R2 status refers to resections in which margins are macroscopically invaded. ","correct":true}],"type":"custom"}
+{"_id":"DgKc-onco-2","context":null,"enonce":"Regarding TNMs:","item":"DgKc","matiere":"onco","propositions":[{"idx":0,"proposition":"pTNM is measured post-chemotherapy ","correct":false,"justification":"p means that it is an anatomopathological observation"},{"idx":1,"proposition":"The usTNM is measured with MRI ","correct":false,"justification":"Thanks to ultrasound, as the name suggests."},{"idx":2,"proposition":"TNM is a prognostic grade","correct":true},{"idx":3,"proposition":"Almost all types of cancer have a TNM grade","correct":true},{"idx":4,"proposition":"TNM cannot, without definition, be measured after neoadjuvant chemotherapy ","correct":false,"justification":"Yes, it's the yTNM"}],"type":"custom"}
+{"_id":"DgKc-onco-3","context":null,"enonce":"Regarding TNM:","item":"DgKc","matiere":"onco","propositions":[{"idx":0,"proposition":"The cTNM classification is clinical or radiological","correct":true},{"idx":1,"proposition":"The pTNM classification is anatomo-pathological.","correct":true},{"idx":2,"proposition":"The most reliable classification is the usTNM","correct":false,"justification":"This is pTNM. Histological evidence is often the most accurate"},{"idx":3,"proposition":"The N goes from N0 to N4 inclusive","correct":false,"justification":"4 possibility: N0, N1, N2 or N3"},{"idx":4,"proposition":"The M is binary: M0 or M1","correct":true,"justification":"M0: no distant metastasis. M1: distant metastasis(s)"}],"type":"custom"}
+{"_id":"DgKc-onco-4","context":null,"enonce":"Which of these proposals corresponds to a WHO 2 stage?","item":"DgKc","matiere":"onco","propositions":[{"idx":0,"proposition":"A person bedridden less than half of his time","correct":true},{"idx":1,"proposition":"A person who is autonomous but cannot work","correct":true},{"idx":2,"proposition":"A person who is permanently bedridden or in a chair","correct":false,"justification":"This is stage 4. It is then totally dependent"},{"idx":3,"proposition":"It is capable of activity comparable to that before the disease","correct":false,"justification":"This is the stadium at"},{"idx":4,"proposition":"She is able to carry out a job","correct":false,"justification":"This is stage 1"}],"type":"custom"}
+{"_id":"hemorragiedig-HGE-0","context":null,"enonce":"Regarding digestive bleeding:","item":"hemorragiedig","matiere":"HGE","propositions":[{"idx":0,"proposition":"Before age 80, upper gastrointestinal bleeding is more common in men","correct":true},{"idx":1,"proposition":"Lower bleeding accounts for 40% of gastrointestinal bleeding","correct":false,"justification":"Lower bleeding accounts for 20% of gastrointestinal bleeding"},{"idx":2,"proposition":"Lower gastrointestinal bleeding is more common in women","correct":false,"justification":"They are more common in men"},{"idx":3,"proposition":"The most common cause of upper gastrointestinal bleeding is peptic ulcer disease.","correct":true},{"idx":4,"proposition":"Lower gastrointestinal bleeding is of hail origin in more than 80% of cases ","correct":false,"justification":"Lower gastrointestinal hemorrhages are most often of colo-rectal or origin"}],"type":"custom"}
+{"_id":"hemorragiedig-HGE-1","context":null,"enonce":"Regarding digestive bleeding: ","item":"hemorragiedig","matiere":"HGE","propositions":[{"idx":0,"proposition":"The risk of ulcerative complications is multiplied by 3 to 4 in patients on NSAIDs and that of fatal ulcer complications by a factor of 7 to 8","correct":true},{"idx":1,"proposition":"Gastrointestinal bleeding-related deaths increase in patients treated with NSAIDs","correct":true},{"idx":2,"proposition":"Some risk factors further increase the risk of bleeding complications with NSAIDs such as age > to 65 years, excessive alcohol consumption","correct":true},{"idx":3,"proposition":"Compared to non-selective NSAIDs, anti-COX-2 drugs reduce the risk of serious gastrointestinal events (bleeding, perforations, strictures) by 50%.","correct":true},{"idx":4,"proposition":"The risk of digestive toxicity of aspirin is dose-independent","correct":false,"justification":"The risk of digestive toxicity of aspirin increases with dose"}],"type":"custom"}
+{"_id":"hemorragiedig-HGE-2","context":null,"enonce":"Regarding digestive bleeding:","item":"hemorragiedig","matiere":"HGE","propositions":[{"idx":0,"proposition":"Aspirin has high-dose antiplatelet effects","correct":false,"justification":"Aspirin has low-dose antiplatelet effects"},{"idx":1,"proposition":"There would be in patients treated with serotonergics a blockade of the reuptake of serotonin by platelets inducing a disorder of primary hemostasis","correct":true},{"idx":2,"proposition":"Helicobacter pylori infection is an independent risk factor for ulcerative upper gastrointestinal bleeding","correct":true},{"idx":3,"proposition":"Mortality from upper gastrointestinal bleeding is 1-3%","correct":false,"justification":"Mortality from upper gastrointestinal bleeding is 3-10%"},{"idx":4,"proposition":"Haemorrhage-related mortality is constantly increasing","correct":false,"justification":"It goes down"}],"type":"custom"}
+{"_id":"hemorragiedig-HGE-3","context":null,"enonce":"Regarding digestive bleeding:","item":"hemorragiedig","matiere":"HGE","propositions":[{"idx":0,"proposition":"In front of a hematemesis and a melena the origin of the bleeding is usually upstream of the right colonic angle","correct":true},{"idx":1,"proposition":"Rectorrhage is usually a sign of lower gastrointestinal bleeding","correct":true},{"idx":2,"proposition":"In front of a hemorrhagic shock without externalization of blood it is necessary to evoke in principle a digestive hemorrhage, especially of the upper digestive tract","correct":true},{"idx":3,"proposition":"The amount of externalized bloody fluid is a reliable outcome","correct":false,"justification":"To assess the immediate severity of bleeding, the amount of externalised bloody fluid is a poor outcome. Pay attention to signs of shock."},{"idx":4,"proposition":"Hemodynamic impact assessment is the best way to assess the immediate severity of bleeding","correct":true}],"type":"custom"}
+{"_id":"hemorragiedig-urg-0","context":null,"enonce":"Regarding digestive bleeding","item":"hemorragiedig","matiere":"urg","propositions":[{"idx":0,"proposition":"They are considered by definition high when the lesion is located upstream of the Treitz angle (duodenum-jejunum junction), and low downstream of this zone.","correct":true},{"idx":1,"proposition":"The incidence of high HD is estimated at 100 to 150\/100,000 per year","correct":true},{"idx":2,"proposition":"The incidence remains high despite therapeutic progress on HD-generating pathologies, due to the aging of the population and the greater use of NSAIDs & anti-thrombotics","correct":true},{"idx":3,"proposition":"Mallory-Weiss syndrome is a tear of the mucosa in the cardia following iterative vomiting","correct":true},{"idx":4,"proposition":"Acute hemorrhagic gastritis and duodenitis correspond to multiple ulcerations and are favored by taking NSAIDs or tobacco.","correct":false,"justification":"Acute hemorrhagic gastritis and duodenitis correspond to multiple ulcerations and are favored by taking NSAIDs or alcohol"}],"type":"custom"}
+{"_id":"hemorragiedig-urg-1","context":null,"enonce":"Regarding digestive bleeding","item":"hemorragiedig","matiere":"urg","propositions":[{"idx":0,"proposition":"Hemobilia is a common cause associating high HD, biliary pain and jaundice","correct":false,"justification":"Hemophilia is a rare cause combining high HD, biliary pain and jaundice"},{"idx":1,"proposition":"The risk of HD occurring in patients with cirrhosis is the same regardless of the severity of the cirrhosis","correct":false,"justification":"The risk of HD in patients with cirrhosis increases with severity of cirrhosis"},{"idx":2,"proposition":"The intensity of clinical signs depends on how quickly the bleeding builds","correct":true},{"idx":3,"proposition":"In subjects with cirrhosis, the pulse should be interpreted according to the intake of beta-blockers, the presence of a withdrawal syndrome in case of alcoholism, and the existence of a possible associated infection","correct":true},{"idx":4,"proposition":"The active nature of the hemorrhage is assessed by the evolution of hemodynamic parameters under filling, and possibly by repeated gastric lavages.","correct":true}],"type":"custom"}
+{"_id":"hemorragiedig-urg-2","context":null,"enonce":"Regarding digestive bleeding","item":"hemorragiedig","matiere":"urg","propositions":[{"idx":0,"proposition":"Initial hematocrit is an excellent reflection of blood loss","correct":false,"justification":"Initial hematocrit is not a good reflection of blood loss, until physiological hemodilution or vascular filling has occurred."},{"idx":1,"proposition":"Upper GI endoscopy is the key examination","correct":true},{"idx":2,"proposition":"Endoscopy should be performed best in the first 24 hours after the onset of bleeding because the early examination improves diagnostic performance","correct":true},{"idx":3,"proposition":"The time to perform a gastro-duodenal endoscopy is 6 hours in case of associated cirrhosis","correct":false,"justification":"This period is 12 hours in case of associated cirrhosis"},{"idx":4,"proposition":"The endoscopy procedure is possibly preceded by an injection of gentamycin 250 mg IV route in the 30 minutes preceding the examination.","correct":false,"justification":"Possibly preceded by an injection of erythromycin 250 mg IV route (unless contraindicated, QT prolongation on ECG) within 30 minutes prior to examination"}],"type":"custom"}
+{"_id":"hemorragiedig-urg-3","context":null,"enonce":"Regarding digestive bleeding","item":"hemorragiedig","matiere":"urg","propositions":[{"idx":0,"proposition":"Endoscopy is performed as soon as possible when high active HD is suspected","correct":true},{"idx":1,"proposition":"It affirms the cause of bleeding in 90% of cases, assesses the risk of bleeding recurrence, and allows possible hemostatic treatment","correct":true},{"idx":2,"proposition":"Sometimes the CT scan is indicated in case of severe HD (abundant externalization and hemodynamic impact) and: – high HD presumption but FOGD not available immediately, – or suspicion of aorto-duodenal fistula","correct":true},{"idx":3,"proposition":"Mortality from PH-related hemorrhages is about 20%, while mortality from ulcerative bleeding is about 5%.","correct":true},{"idx":4,"proposition":"Hemorrhagic recurrence is an independent severity factor","correct":true}],"type":"custom"}
+{"_id":"hemorragiedig-urg-4","context":null,"enonce":"Regarding digestive bleeding","item":"hemorragiedig","matiere":"urg","propositions":[{"idx":0,"proposition":"Prognostic factors for high HD in general are related to the abundance of bleeding, its active nature and the terrain","correct":true},{"idx":1,"proposition":"For ulcerative hemorrhages, the endoscopic appearance of the ulcer is assessed by Forrest's classification","correct":true},{"idx":2,"proposition":"Adherent clots (IIb) are at intermediate risk of recurrence","correct":true},{"idx":3,"proposition":"Ulcers with pigmented spots (Ic) or clean bottom (III) are at low risk of bleeding","correct":false,"justification":"Ulcers with pigmented spots (IIc) or clean bottom (III) are at low risk of bleeding"},{"idx":4,"proposition":"Three quarters of HDs stop spontaneously","correct":true}],"type":"custom"}
+{"_id":"DT-cardio-0","context":null,"enonce":"Regarding chest pain","item":"DT","matiere":"cardio","propositions":[{"idx":0,"proposition":"Early postprandial chest pain points to gastroesophageal reflux disease or peptic ulcer disease","correct":false,"justification":"Gastroesophageal reflux disease or angina. A peptic ulcer is rather associated with a late postprandial doulor"},{"idx":1,"proposition":"Chest pain yielding to trinitrine in less than 3 minutes may suggest pericarditis","correct":true,"justification":"By lowering the parietal tension and friction"},{"idx":2,"proposition":"In the case of pericarditis, pain is triggered by anteflexion","correct":false,"justification":"Relieved by anteflexion"},{"idx":3,"proposition":"A normal intercritical ECG eliminates the diagnosis of acute coronary syndrome","correct":false,"justification":"Caution: a normal intercritical ECG does not eliminate the diagnosis, and a left branch block should be considered as an equivalent of SCA with ST segment elevation. Ischemia in the territory of the circumflex artery can be electrically mute!"},{"idx":4,"proposition":"A paradoxical pulse, i.e. decreased on inspiration, is a sign of hemodynamic gravity","correct":true}],"type":"custom"}
+{"_id":"DT-cardio-1","context":null,"enonce":"Regarding chest pain","item":"DT","matiere":"cardio","propositions":[{"idx":0,"proposition":"Hyperkalemia is a cause of ST elevation","correct":true},{"idx":1,"proposition":"ST elevation associated with PQ undershift suggests left ventricle aneurysm","correct":false,"justification":"Pericarditis"},{"idx":2,"proposition":"In pulmonary pain associated with dyspnea, an elevation of a pulmonary cupola on chest X-ray suggests a pulmonary embolism","correct":true},{"idx":3,"proposition":"Cardiomegaly symmetrical on chest X-ray suggests left heart failure","correct":false,"justification":"A pericardial effusion. Cardiomegaly of left heart failure is asymmetric"},{"idx":4,"proposition":"A negative troponin assay should be systematically repeated","correct":false,"justification":"Only in case of chest pain that started less than 6 hours ago"}],"type":"custom"}
+{"_id":"DT-cardio-2","context":null,"enonce":"Regarding chest pain","item":"DT","matiere":"cardio","propositions":[{"idx":0,"proposition":"Chest pain with dyspnea and normal chest x-ray must necessarily evoke the diagnosis of aortic dissection","correct":false,"justification":"Pulmonary embolism"},{"idx":1,"proposition":"On blood gas, a hypoxemia hypocapnia combination characterizes a shunt effect","correct":true,"justification":"Pulmonary embolism must then be systematically evoked"},{"idx":2,"proposition":"Arterial gas is systematically indicated in front of chest pain","correct":false,"justification":"Only in case of arterial oxygen saturation <95%, brady^nea or tachypnea"},{"idx":3,"proposition":"A T1 T4 negative T wave on ECG characterizes ischemia of the right ventricle","correct":true,"justification":"Sign seen among others in the massive EP, reflecting a suffering of the right heart"},{"idx":4,"proposition":"Distal pulmonary embolisms are painful","correct":true,"justification":"Because of the pulmonary infarction they cause. Proximal PE is rather associated with inaugural shock"}],"type":"custom"}
+{"_id":"DT-cardio-3","context":null,"enonce":"Regarding chest pain","item":"DT","matiere":"cardio","propositions":[{"idx":0,"proposition":"Dissection of the descending aorta is associated with a risk of tamponade and shock","correct":false,"justification":"This concerns the dissection of the ascending aorta"},{"idx":1,"proposition":"The first risk factor for aortic dissection is high blood pressure","correct":true,"justification":"It is present in more than 80% of cases"},{"idx":2,"proposition":"Faced with a suspicion of acute pericarditis, echocardiography and troponin testing should be performed","correct":true},{"idx":3,"proposition":"In case of chest pain, pericarditis is a diagnosis of elimination","correct":true,"justification":"Benign cause: serious causes must first be eliminated"},{"idx":4,"proposition":"Cardiomegaly with a \"carafe\" appearance on X-ray raises fears of aortic dissection","correct":false,"justification":"A tamponade"}],"type":"custom"}
+{"_id":"DT-cardio-4","context":null,"enonce":"Regarding chest pain","item":"DT","matiere":"cardio","propositions":[{"idx":0,"proposition":"The DAILY\/STANFORD classification is the reference classification for aortic dissection","correct":true},{"idx":1,"proposition":"Infectious pneumonia is constantly accompanied by chest pain","correct":false,"justification":"Only in case of parietal contact (the pleura is innervated, but not the pulmonary parenchyma)"},{"idx":2,"proposition":"Some severe pulmonary arterial hypertension gives anginal pain ","correct":true,"justification":"By ischemic suffering of the right ventricle"},{"idx":3,"proposition":"Chest pain may be due to vesicular lithiasis","correct":true,"justification":"Projection of abdominal pain"},{"idx":4,"proposition":"Tietze syndrome is a form of tracheobronchitis associated with chest pain","correct":false,"justification":"Parietal pain of the chondrocostal or sternoclavicular joint"}],"type":"custom"}
+{"_id":"DT-cardio-5","context":null,"enonce":"Regarding chest pain","item":"DT","matiere":"cardio","propositions":[{"idx":0,"proposition":"Chest pain caused by pericarditis is not influenced by breathing","correct":false},{"idx":1,"proposition":"Psychogenic pain is rare","correct":false,"justification":"Extremely common (1\/4 of chest pain in the emergency room), they remain however a diagnosis of elimination"},{"idx":2,"proposition":"Absence of effusion on transthoracic echocardiography excludes diagnosis of pericarditis","correct":false,"justification":"Possible dry pericarditis"},{"idx":3,"proposition":"Esophageal spasm may be associated with anginal pain yielding to nitrates","correct":true},{"idx":4,"proposition":"A pneumothorax is to be evoked in case of chest pain with signs of severity","correct":true,"justification":"Pneumothorax suffocating. Other etiologies to be mentioned in priority in case of signs of severity: ACS, massive PE, tamponade, aortic dissection"}],"type":"custom"}
+{"_id":"anaphylaxie-urg-0","context":null,"enonce":"Which of the following are blood tests to be performed urgently (after drug management)? (one or more expected answers)","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"proposition":"Tryptase","correct":true},{"idx":1,"proposition":"Hepatic test","correct":false,"justification":"Urgently unnecessary"},{"idx":2,"proposition":"Total IgE","correct":false,"justification":"Urgently unnecessary"},{"idx":3,"proposition":"Ionogram","correct":false,"justification":"Urgently unnecessary"},{"idx":4,"proposition":"Renal assessment","correct":false,"justification":"Urgently unnecessary"}],"type":"custom"}
+{"_id":"anaphylaxie-urg-2","context":null,"enonce":"After an injection of IM adrenaline, symptoms persist. How often should the adrenaline injection be repeated?","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"proposition":"After 30 seconds","correct":false,"justification":"False"},{"idx":1,"proposition":"After 1 minute","correct":false,"justification":"False"},{"idx":2,"proposition":"After 5 minutes","correct":true},{"idx":3,"proposition":"After 10 minutes","correct":false,"justification":"False"},{"idx":4,"proposition":"After 15 minutes","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"anaphylaxie-urg-3","context":null,"enonce":"What is the preferred route to introduce adrenaline?","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"proposition":"Per Os","correct":false,"justification":"False"},{"idx":1,"proposition":"Intramuscular","correct":true},{"idx":2,"proposition":"None of these proposals","correct":false,"justification":"False"},{"idx":3,"proposition":"Subcutaneous","correct":false,"justification":"False"},{"idx":4,"proposition":"Nebulization","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"anaphylaxie-urg-4","context":null,"enonce":"What type of reaction causes anaphylaxis, according to the classification of Gell and Coombs?","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"proposition":"Type I","correct":true},{"idx":1,"proposition":"Type III","correct":false,"justification":"False"},{"idx":2,"proposition":"Type II","correct":false,"justification":"False"},{"idx":3,"proposition":"Type IV","correct":false,"justification":"False"},{"idx":4,"proposition":"Type V","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"anaphylaxie-urg-6","context":null,"enonce":"What is a grade II severity according to the Ring and Messmer classification?","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"proposition":"Generalized mucocutaneous signs","correct":false,"justification":"Grade I"},{"idx":1,"proposition":"Moderate multi-organ involvement","correct":true,"justification":"True, with mucocutaneous signs, arterial hypotension and unusual tachycardia, bronchial hyperresponsiveness (cough, ventilatory difficulty)"},{"idx":2,"proposition":"Severe life-threatening multi-organ disease","correct":false,"justification":"Grade III"},{"idx":3,"proposition":"Cardiocirculatory inefficiency and respiratory arrest","correct":false,"justification":"Grade IV"},{"idx":4,"proposition":"None of the proposals","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"anaphylaxie-urg-7","context":null,"enonce":"What is a grade IV severity according to the Ring and Messmer classification?","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"proposition":"Generalized mucocutaneous signs","correct":false,"justification":"Grade I"},{"idx":1,"proposition":"Moderate multi-organ involvement","correct":false,"justification":"Grade II"},{"idx":2,"proposition":"Severe life-threatening multi-organ disease","correct":false,"justification":"Grade III"},{"idx":3,"proposition":"Cardiocirculatory inefficiency and respiratory arrest","correct":true,"justification":"True, requiring cardiopulmonary resuscitation maneuvers"},{"idx":4,"proposition":"None of the proposals","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"anaphylaxie-urg-8","context":null,"enonce":"Which cells degranulate massively during anaphylaxis?","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"proposition":"Lymphocytes B","correct":false,"justification":"False, anaphylaxis is a reaction of innate immunity"},{"idx":1,"proposition":"T cells","correct":false,"justification":"False, anaphylaxis is a reaction of innate immunity"},{"idx":2,"proposition":"All these cells at the same time","correct":false,"justification":"False"},{"idx":3,"proposition":"Basophilic polynuclear","correct":true},{"idx":4,"proposition":"Mast cells","correct":true}],"type":"custom"}
+{"_id":"anaphylaxie-urg-9","context":null,"enonce":"What is a grade I severity according to the Ring and Messmer classification?","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"proposition":"Generalized mucocutaneous signs","correct":true,"justification":"True, erythema, urticaria, with or without angioneurotic edema"},{"idx":1,"proposition":"Moderate multi-organ involvement","correct":false,"justification":"Grade II"},{"idx":2,"proposition":"Severe life-threatening multi-organ disease","correct":false,"justification":"Grade III"},{"idx":3,"proposition":"Cardiocirculatory inefficiency and respiratory arrest","correct":false,"justification":"Grade IV"},{"idx":4,"proposition":"None of the proposals","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"SII-HGE-0","context":null,"enonce":"About functional colopathy","item":"SII","matiere":"HGE","propositions":[{"idx":0,"proposition":"Irritable bowel syndrome (IBS), a preferable designation to functional colopathy, is one of the first reasons for consultation in gastroenterology","correct":true},{"idx":1,"proposition":"IBS is defined by the coexistence of chronic abdominal pain and fluctuating transit disorders (constipation, diarrhea, alternation of both).","correct":true},{"idx":2,"proposition":"This condition does not engage the prognosis but considerably alters the quality of life of patients and has a strong medico-economic impact","correct":true},{"idx":3,"proposition":"The prevalence of IBS in the general population ranges from 40 to 50% in all countries of the world","correct":false,"justification":"The prevalence of IBS in the general population ranges from 10 to 15% in all countries of the world"},{"idx":4,"proposition":"There is a female predominance, 70% of consultants are women","correct":true}],"type":"custom"}
+{"_id":"SII-HGE-1","context":null,"enonce":"About functional colopathy","item":"SII","matiere":"HGE","propositions":[{"idx":0,"proposition":"There is visceral hypersensitivity in at least 60% of patients","correct":true,"justification":"2020-02-03 00:00:00"},{"idx":1,"proposition":"Regular exposure to stressful events are factors associated with greater severity of symptoms","correct":true},{"idx":2,"proposition":"Abdominal pain is the main symptom of IBS and the main reason for consultation","correct":true},{"idx":3,"proposition":"An colscopy should be performed in front of a family history of cancer or colorectal adenomas","correct":true},{"idx":4,"proposition":"An age > 40 years (in the absence of a complete colonoscopy since the onset of symptoms) is an indication for colonoscopy","correct":false,"justification":"Age > 50 years (in the absence of a complete colonoscopy since onset of symptoms)"}],"type":"custom"}
+{"_id":"SII-HGE-2","context":null,"enonce":"About functional colopathy","item":"SII","matiere":"HGE","propositions":[{"idx":0,"proposition":"Resistance to symptomatic treatment or recent change in symptoms are incdications for colonoscopy","correct":true},{"idx":1,"proposition":"The presence of warning signs such as overt digestive bleeding or weight loss are indications for colonoscopy","correct":true},{"idx":2,"proposition":"Abdominal bloating is the second main reason for consultation","correct":true},{"idx":3,"proposition":"Bloating may be aggravated transiently by the emission of gas and\/or stool","correct":false,"justification":"It can be improved transiently by the emission of gases and\/or stool"},{"idx":4,"proposition":"Transit disorders are constant","correct":true}],"type":"custom"}
+{"_id":"ictere-HGE-0","context":null,"enonce":"Concerning jaundice","item":"ictere","matiere":"HGE","propositions":[{"idx":0,"proposition":"Normal bilirubinemia is less than 20 μmol\/L","correct":true},{"idx":1,"proposition":"Jaundice occurs when bilirubinemia exceeds 60 μmol\/L","correct":false,"justification":"Jaundice occurs when bilirubinemia exceeds 40 μmol\/L"},{"idx":2,"proposition":"A light jaundice, or beginner, is visible next to the ocular sclera, the lightest place of the integuments","correct":true},{"idx":3,"proposition":"In healthy subjects, bilirubin circulates in plasma in 2 forms","correct":true,"justification":"Non-conjugated and conjugated"},{"idx":4,"proposition":"In healthy subjects, plasma total bilirubin is almost exclusively represented by unconjugated bilirubin","correct":true}],"type":"custom"}
+{"_id":"ictere-HGE-1","context":null,"enonce":"Concerning jaundice","item":"ictere","matiere":"HGE","propositions":[{"idx":0,"proposition":"The main causes of conjugated bilirubin jaundice are hyperhemolysis and dyserythropoiesis","correct":false,"justification":"These are causes of unconjugated bilirubin jaundice (also the case of decreased activity of bilirubin glucuronide transferase)"},{"idx":1,"proposition":"Urine is normal in colour in case of unconjugated bilirubin jaundice (free)","correct":true},{"idx":2,"proposition":"Gilbert's syndrome is a totally benign and very common condition linked to partial glycuronyl transferase deficiency.","correct":true},{"idx":3,"proposition":"Crigler-Najjar syndrome is an exceptional, often very serious condition due to an absence or collapse of glucuronyl transferase activity.","correct":true},{"idx":4,"proposition":"Crigler-Najjar syndrome is inherited genetically in an autosomal dominant manner","correct":false,"justification":"It is transmitted genetically in an autosomal recessive manner"}],"type":"custom"}
+{"_id":"ictere-HGE-2","context":null,"enonce":"Concerning jaundice","item":"ictere","matiere":"HGE","propositions":[{"idx":0,"proposition":"Cholestasis is the most common mechanism of conjugated bilirubin jaundice","correct":true},{"idx":1,"proposition":"Cholestasis is defined by decreased bile secretion","correct":true},{"idx":2,"proposition":"Cholestasis is mainly manifested by a concomitant increase in serum alkaline phosphatase and γ-GT","correct":true},{"idx":3,"proposition":"Isolated elevation of γ-GT or alkaline phosphatases does not indicate cholestasis","correct":true},{"idx":4,"proposition":"Small bile duct involvement must be diffuse to result in jaundice","correct":true}],"type":"custom"}
+{"_id":"handicap-mpr-0","context":null,"enonce":"Concerning the ICF:","item":"handicap","matiere":"mpr","propositions":[{"idx":0,"proposition":"The ICF was adopted by WHO in 2001","correct":true},{"idx":1,"proposition":"The CIF was adopted by the European Union in 2002 and enshrined in French law.","correct":true},{"idx":2,"proposition":"ICF allows for a holistic approach to all aspects of a disease","correct":true},{"idx":3,"proposition":"The ICF applies only to children and the elderly","correct":false,"justification":"to all"},{"idx":4,"proposition":"The ICF is a participatory model","correct":true}],"type":"custom"}
+{"_id":"handicap-mpr-1","context":null,"enonce":"Regarding the PCH and the ICF:","item":"handicap","matiere":"mpr","propositions":[{"idx":0,"proposition":"Depending on the person's life project, a compensation plan is developed that translates into a disability compensation benefit (PCH)","correct":true},{"idx":1,"proposition":"The CNSA acts at the national level","correct":true},{"idx":2,"proposition":"The MDPH acts at the national level","correct":false,"justification":"At the local level"},{"idx":3,"proposition":"The ICF model distinguishes between two levels of disease expression: functional and social.","correct":false,"justification":"4 levels: lesional, clinical, functional and social"},{"idx":4,"proposition":"Impairment refers to alterations in an anatomical function or structure, such as a significant deviation or loss","correct":true}],"type":"custom"}
+{"_id":"handicap-mpr-2","context":null,"enonce":"General generalities:","item":"handicap","matiere":"mpr","propositions":[{"idx":0,"proposition":"Activity refers to the execution of a task in everyday life","correct":true},{"idx":1,"proposition":"Personal factors include age, gender and physical condition","correct":true},{"idx":2,"proposition":"Impairment refers to the inability to perform an action","correct":false,"justification":"Impairment refers to alterations in an anatomical function or structure, such as a significant deviation or loss"},{"idx":3,"proposition":"In practice, the most common impairments that cause functional limitations are neurological and musculoskeletal impairments.","correct":true},{"idx":4,"proposition":"A limitation of joint amplitudes can be quantified in degrees using a goniometer","correct":true}],"type":"custom"}
+{"_id":"obesite-endoc-0","context":null,"enonce":"What is the prevalence of overweight in France?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"proposition":"0.15","correct":false,"justification":"The prevalence of overweight (BMI between 25 and 30) is about 35% in France"},{"idx":1,"proposition":"0.2","correct":false},{"idx":2,"proposition":"0.25","correct":false},{"idx":3,"proposition":"0.3","correct":false},{"idx":4,"proposition":"0.35","correct":true}],"type":"custom"}
+{"_id":"obesite-endoc-2","context":null,"enonce":"Which of these proposals are complications of adult obesity?","item":"obesite","matiere":"endoc","propositions":[{"idx":1,"proposition":"OSA","correct":true,"justification":"With hypopnea index greater than or equal to 5 (severe if greater than or equal to 30)"},{"idx":2,"proposition":"Hyperuricemia","correct":true,"justification":"With gout attack"},{"idx":3,"proposition":"Bipolar disorder","correct":false,"justification":"Not a known risk factor"},{"idx":4,"proposition":"Osteoporosis ","correct":false,"justification":"In this particular case, it is rather a protective factor."}],"type":"custom"}
+{"_id":"obesite-endoc-3","context":null,"enonce":"Among these proposals, which indicate the carrying out of additional examinations in an overweight minor?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"proposition":"The presence of a family history of diabetes ","correct":true},{"idx":1,"proposition":"The presence of a family history of dyslipidemia ","correct":true},{"idx":2,"proposition":"Melanoma","correct":false},{"idx":3,"proposition":"Psychomotor retardation","correct":true},{"idx":4,"proposition":"Behavioural disorder with opposition","correct":false}],"type":"custom"}
+{"_id":"obesite-endoc-4","context":null,"enonce":"Which of these proposals are the causes of secondary obesity?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"proposition":"Hypothyroidism","correct":true},{"idx":1,"proposition":"Addison's disease","correct":false,"justification":"Primary adrenal insufficiency. It results in hypotension and hyperpigmentation and can be complicated by acute adrenal insufficiency with cardiovascular collapse."},{"idx":2,"proposition":"Syndrome de Kallman","correct":false,"justification":"A genetic disease of the development of the olfactory system characterized by the association of hypogonadotrophic hypogonadism due to gonadotropin-releasing hormone deficiency (GnRH) and anosmia or hyposmia."},{"idx":3,"proposition":"Taking neuroleptics","correct":true},{"idx":4,"proposition":"Taking sulfonamides","correct":true}],"type":"custom"}
+{"_id":"obesite-endoc-5","context":null,"enonce":"Which of the following are complications of obesity?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"proposition":"Type 2 diabetes","correct":true},{"idx":1,"proposition":"Gonarthrosis","correct":true},{"idx":2,"proposition":"Depressive syndrome","correct":true},{"idx":3,"proposition":"Obstructive ventilatory disorder","correct":false,"justification":"Restrictive ventilatory disorder rather!"},{"idx":4,"proposition":"High blood pressure","correct":true}],"type":"custom"}
+{"_id":"obesite-endoc-6","context":null,"enonce":"Which of the following are true?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"proposition":"Obesity is defined as a BMI > 25kg\/m squared","correct":false,"justification":"BMI > 25 -> Overweight\r\nBMI > 30 -> Obesity"},{"idx":1,"proposition":"First-line treatment is dominated by anorectic molecules","correct":false,"justification":"False, they are not indicated in the medical care (attention!). Lifestyle change and hygiene-dietary rules are the first-line measures."},{"idx":2,"proposition":"Treatment can be surgical in case of grade 3 obesity","correct":true,"justification":"True especially with a bypass or a sleeve-gastrectomy!"},{"idx":3,"proposition":"Treatment may be surgical in cases of grade 2 obesity under certain conditions","correct":true},{"idx":4,"proposition":"Android obesity is more at cardiovascular risk than gynoid obesity","correct":true}],"type":"custom"}
+{"_id":"myasthenie-neuro-0","context":null,"enonce":"Regarding the clinical diagnosis of myasthenia gravis:","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"The diagnosis of myasthenia gravis must be evoked in front of fluctuating sensory-motor signs from the age of 40","correct":false,"justification":"The diagnosis of myasthenia gravis should be evoked in front of exclusively muscular signs and symptoms"},{"idx":1,"proposition":"Muscle disorders are constant over time","correct":false,"justification":"Fluctuating = fatigability"},{"idx":2,"proposition":"Only the muscles directly put into action during the effort are at the origin of the symptoms","correct":false,"justification":"The symptoms may be related to muscles directly activated during the effort or to remote muscles not directly involved in the effort."},{"idx":3,"proposition":"The only symptom is muscle weakness of the limbs","correct":false,"justification":"Diagnosis can be made on ptosis"},{"idx":4,"proposition":"There may be swallowing problems","correct":true}],"type":"custom"}
+{"_id":"myasthenie-neuro-1","context":null,"enonce":"Regarding the positive diagnosis of myasthenia gravis:","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Unilateral ptosis should suspect myasthenia gravis of the eye and palpebral muscles","correct":true},{"idx":1,"proposition":"Damage to the eye muscles cannot result in diplopia","correct":false,"justification":"Diplopia possible, most often intermittent"},{"idx":2,"proposition":"Damage to the bulbar innervation muscles induces, among other things, swallowing, phonation and chewing disorders","correct":true},{"idx":3,"proposition":"Myasthenia gravis affects only the proximal muscles","correct":false,"justification":"The involvement predominates on the proximal muscles, but can more rarely affect the distal musculature also"},{"idx":4,"proposition":"The Barré event is normally held 2 min 30 ","correct":true}],"type":"custom"}
+{"_id":"myasthenie-neuro-3","context":null,"enonce":"Regarding pathologies associated with myasthenia gravis:","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"The diagnostic sensitivity of the ENMG is 98%","correct":false,"justification":"It does not exceed 75%"},{"idx":1,"proposition":"When myasthenia gravis is diagnosed, a CT scan or chest MRI should be prescribed to explore the thymic compartment for thymic hyperplasia or thymoma.","correct":true},{"idx":2,"proposition":"Thymic hyperplasia is found in 90% of myasthenia gravis cases","correct":false,"justification":"65% of cases"},{"idx":3,"proposition":"Thymomas can be mild or malignant and need to be operated on","correct":true},{"idx":4,"proposition":"Thymic hyperplasia corresponds to a macroscopically normal thymus but microscopically characterized by a proliferation of germinal follicles with a clear center","correct":true}],"type":"custom"}
+{"_id":"myasthenie-neuro-4","context":null,"enonce":"Which of the following are symptoms or signs of early generalized myasthenia gravis?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Paralysis of nerve XII (hypogloss)","correct":false,"justification":"Cranial nerves are respected in myasthenia gravis"},{"idx":1,"proposition":"Swallowing disorders","correct":true,"justification":"True, it is a sign of severity (like dyspnea and dysphonia)"},{"idx":2,"proposition":"Muscle fatigability of the upper limbs","correct":true},{"idx":3,"proposition":"Muscular atrophy of the limbs","correct":false,"justification":"No amyotrophy because it is a non-total damage to the neuromuscular junction. Amyotrophy is observed in motor deficits by damage to the second motor neuron. Be careful ⚠, in myasthenia gravis in the late stage, when they are severe and chronic, selective muscular atrophy can be seen."},{"idx":4,"proposition":"Falling head forward","correct":true,"justification":"True, this is the Dropped-Head Syndrome 😌. It is also seen in amyotrophic lateral sclerosis."}],"type":"custom"}
+{"_id":"myasthenie-neuro-5","context":null,"enonce":"Which of the following propositions are true for the first-line management of generalized myasthenia gravis?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Treatment with pyridostigmine-type anticholinesterase","correct":true},{"idx":1,"proposition":"A background treatment with corticosteroid therapy","correct":false,"justification":"Third line (after pyridostigmine and thymectomy)"},{"idx":2,"proposition":"A course of immunoglobulins IV","correct":false,"justification":"It is a treatment for myasthenic crisis"},{"idx":3,"proposition":"A remission of the list of contraindicated drugs","correct":true},{"idx":4,"proposition":"Treatment with benzodiazepine if needed","correct":false,"justification":"Benzodiazepine have a muscle relaxant effect that contraindicate them in myasthenia gravis"}],"type":"custom"}
+{"_id":"myasthenie-neuro-6","context":null,"enonce":"Which of the following proposals about electroneuromyogram (ENMG) are true?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"It may be normal","correct":true,"justification":"True. This is the case for all examinations whose sensitivity is less than 100%"},{"idx":1,"proposition":"It can objectify a decrement after repetitive stimulation at 3 Hz","correct":true},{"idx":2,"proposition":"Motor conduction velocities are normal","correct":true,"justification":"True, otherwise we come across a differential diagnosis (demyelinating pathology such as polyradiculoneuropathies)"},{"idx":3,"proposition":"It is most often associated with motor evoked potentials","correct":false,"justification":"Useless in diagnosis"},{"idx":4,"proposition":"Sensitivity increases in clinically healthy territories","correct":false,"justification":"It must be done on affected territories"}],"type":"custom"}
+{"_id":"myasthenie-neuro-7","context":null,"enonce":"Which of the following are true?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"It is an autoimmune pathology","correct":true},{"idx":1,"proposition":"It is a pathology that affects the neuromuscular junction","correct":true},{"idx":2,"proposition":"None of the proposals are accurate","correct":false,"justification":"None"},{"idx":3,"proposition":"It predominates in children","correct":false,"justification":"It mainly affects adults"},{"idx":4,"proposition":"There is a decrement in ENMG","correct":true,"justification":"True, at repetitive stimulation at 3 Hz"}],"type":"custom"}
+{"_id":"myasthenie-neuro-8","context":null,"enonce":"Which of the following are true?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Myasthenia gravis is linked to a pre-synaptic block of the neuromuscular junction","correct":false,"justification":"False"},{"idx":1,"proposition":"Myasthenia gravis is related to a postsynaptic block of the neuromuscular junction","correct":true,"justification":"True since this concerns acetylcholine receptors"},{"idx":2,"proposition":"Myasthenia gravis usually begins after an infection","correct":false,"justification":"This is the case of Guillain-Barré syndrome (acute inflammatory polyradiculoneuritis)"},{"idx":3,"proposition":"None of the propositions are true","correct":false,"justification":"False"},{"idx":4,"proposition":"Myasthenia gravis is an autoimmune disease","correct":true}],"type":"custom"}
+{"_id":"myasthenie-neuro-9","context":null,"enonce":"Which of the following are myasthenia gravis abnormalities that can be seen in a chest CT scan?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Interstitial pulmonary fibrosis","correct":false,"justification":"Not associated with myasthenia gravis"},{"idx":1,"proposition":"Tuberculous cavern","correct":false,"justification":"Not associated with myasthenia gravis"},{"idx":2,"proposition":"Thymoma","correct":true,"justification":"True, in 15% of myasthenia gravis"},{"idx":3,"proposition":"Thymic hyperplasia","correct":true,"justification":"True, in 65% of myasthenia gravis"},{"idx":4,"proposition":"Pulmonary hypertension","correct":false,"justification":"Not seen on chest CT scan + is not associated with myasthenia gravis"}],"type":"custom"}
+{"_id":"myasthenie-neuro-10","context":null,"enonce":"Which of the following are additional tests for myasthenia gravis?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Anti-actin antibodies","correct":false,"justification":"It is not dosed in this disease"},{"idx":1,"proposition":"Anti-RAC antibodies","correct":true,"justification":"True. They have a sensitivity of about 80%, and are very specific."},{"idx":2,"proposition":"ENMG","correct":true,"justification":"True, we are looking for a decrement to repetitive stimulation at 3 Hz"},{"idx":3,"proposition":"Muscle biopsy","correct":false,"justification":"Useless in this pathology"},{"idx":4,"proposition":"Thoracic CT","correct":true,"justification":"True, looking for thymoma or thymic hyperplasia"}],"type":"custom"}
+{"_id":"myasthenie-neuro-11","context":null,"enonce":"In what proportion of myasthenia gravis is associated thymic hyperplasia found?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"45%","correct":false,"justification":"False"},{"idx":1,"proposition":"55%","correct":false,"justification":"False"},{"idx":2,"proposition":"65%","correct":true},{"idx":3,"proposition":"75%","correct":false,"justification":"False"},{"idx":4,"proposition":"85%","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"myasthenie-neuro-12","context":null,"enonce":"Which of the following proposals are in favor of a cholinergic crisis?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Sweats","correct":true,"justification":"True, muscarinic sign"},{"idx":1,"proposition":"Diarrhoea","correct":true,"justification":"True, muscarinic sign"},{"idx":2,"proposition":"Mydriasis","correct":false,"justification":"Rather, a miosis is found in parasympathetic hyperactivation"},{"idx":3,"proposition":"Swallowing disorders","correct":false,"justification":"Rather, they are found in myasthenic seizures."},{"idx":4,"proposition":"Fasciculations","correct":true,"justification":"True, nicotinic sign"}],"type":"custom"}
+{"_id":"myasthenie-neuro-13","context":null,"enonce":"What is the minimum percentage decrease in the amplitude of the muscle evoked potential necessary to evoke a decrement at the ENMG?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"10 %","correct":true,"justification":"True. A decrement at the ENMG is significant if it is greater than or equal to 10%"},{"idx":1,"proposition":"20 %","correct":false,"justification":"False"},{"idx":2,"proposition":"30 %","correct":false,"justification":"False"},{"idx":3,"proposition":"40 %","correct":false,"justification":"False"},{"idx":4,"proposition":"50 %","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"myasthenie-neuro-14","context":null,"enonce":"Which of the following are signs or symptoms of myasthenia gravis?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Ptosis","correct":true},{"idx":1,"proposition":"Areflexia","correct":false,"justification":"No central reach"},{"idx":2,"proposition":"Dyspnoea","correct":true,"justification":"True, it's a sign of gravity"},{"idx":3,"proposition":"Nasoneous voice","correct":true},{"idx":4,"proposition":"Difficulty in swallowing","correct":true,"justification":"True, it's a sign of gravity"}],"type":"custom"}
+{"_id":"myasthenie-neuro-15","context":null,"enonce":"In what proportion of myasthenia gravis is an associated thymoma?","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"10%","correct":false,"justification":"False"},{"idx":1,"proposition":"15%","correct":true},{"idx":2,"proposition":"20%","correct":false,"justification":"False"},{"idx":3,"proposition":"25%","correct":false,"justification":"False"},{"idx":4,"proposition":"30%","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"diabete-endoc-0","context":null,"enonce":"Which of these patients have an HbA1c goal of 7% or less? ","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"Seniors whose life expectancy is considered satisfactory","correct":true},{"idx":1,"proposition":"Most patients with T2DM","correct":true},{"idx":2,"proposition":"Patients before considering pregnancy","correct":false,"justification":"Target <= 6.5%"},{"idx":3,"proposition":"Patients with moderate CKD","correct":true},{"idx":4,"proposition":"Newly diagnosed T2DM with life expectancy >15 years and no history","correct":false,"justification":"Target <= 6.5%"}],"type":"custom"}
+{"_id":"diabete-endoc-1","context":null,"enonce":"Which of these patients have an HbA1c goal of 6.5% or less? ","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"Limited life expectancy (< 5 years)","correct":false,"justification":"Target <= 8%"},{"idx":1,"proposition":"Frail elderly","correct":false,"justification":"Target <= 8%"},{"idx":2,"proposition":"Patients before considering pregnancy","correct":true},{"idx":3,"proposition":"Patients during pregnancy","correct":true,"justification":"With fasting blood glucose levels< 0.95 g \/ L and 2h post prandial < 1.20 g \/ L"},{"idx":4,"proposition":"Recent stroke","correct":false,"justification":"Target <= 8% (patient categories with advanced cardiovascular complications)"}],"type":"custom"}
+{"_id":"diabete-endoc-2","context":null,"enonce":"Which of these patients have an HbA1c goal of 8% or less? ","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"Most patients with T2DM","correct":false,"justification":"Target <= 7%"},{"idx":1,"proposition":"Sick and dependent elderly people","correct":false,"justification":"Objective< 9% and\/or pre-prandial capillary blood glucose between 1 and 2 g\/L"},{"idx":2,"proposition":"Patients with microvascular complications","correct":false},{"idx":3,"proposition":"Myocardial infarction with heart failure","correct":true,"justification":"Group of patients with a history of advanced macrovascular complications"},{"idx":4,"proposition":"Moderate KDI","correct":false,"justification":"Moderate CKD: target <= 7%. Severe or terminal CKD: target <= 8%"}],"type":"custom"}
+{"_id":"diabete-endoc-3","context":null,"enonce":"What are the goals of a type 2 diabetic patient during pregnancy?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"HbA1C< 7%","correct":false,"justification":"HbA1c < 6.5%"},{"idx":1,"proposition":"HbA1C < 8%","correct":false,"justification":"HbA1c < 6.5%"},{"idx":2,"proposition":"Fasting blood glucose levels< 0.95 g\/L","correct":true},{"idx":3,"proposition":"Postprandial blood glucose levels <= 1.25 g\/L","correct":false,"justification":"Postprandial blood glucose levels at two hours < 1.20 g\/L"},{"idx":4,"proposition":"Blood sugar > 0.4 g\/L","correct":false,"justification":"There is no goal or monitoring of nighttime blood glucose"}],"type":"custom"}
+{"_id":"diabete-endoc-4","context":null,"enonce":"Which propositions are true?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"NPH insulins are intermediate-acting insulins","correct":true,"justification":"Approximately 12 hours of action"},{"idx":1,"proposition":"Insulins are contraindicated during pregnancy","correct":false},{"idx":2,"proposition":"Metformin is the only antidiabetic drug to lose weight","correct":false,"justification":"These are GLP1 agonists"},{"idx":3,"proposition":"Insulin doses are less than 1 U\/kg most often ","correct":true},{"idx":4,"proposition":"Insulins are preferred to metformin in case of pregnancy or breastfeeding","correct":true}],"type":"custom"}
+{"_id":"diabete-endoc-5","context":null,"enonce":"Which of the following are possible causes of polyuro-polydipsic syndrome?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"Diabetes","correct":true},{"idx":1,"proposition":"Malignant HTA","correct":true,"justification":"True, hyper-filtration due to high pressure"},{"idx":2,"proposition":"Inappropriate secretion of DHA","correct":false,"justification":"Pure water retention"},{"idx":3,"proposition":"Hypercalcemia","correct":true,"justification":"True, diabetes insipidus"},{"idx":4,"proposition":"Benign prostatic hyperplasia","correct":false,"justification":"No polydipsia"}],"type":"custom"}
+{"_id":"diabete-endoc-8","context":null,"enonce":"Regarding the paediatric peculiarities of diabetes, which proposals are true?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"An acanthosis nigricans is a peculiarity of T1D","correct":false,"justification":"An acanthosis nigricans and a polycystic ovary syndrome should suspect insulin resistance and in particular T2DM (rare ++ in T1D)"},{"idx":1,"proposition":"Vaginal yeast infections should suggest T2DM","correct":true},{"idx":2,"proposition":"HbA1c ≥ 8.5% is a diagnostic criterion for T2DM","correct":false,"justification":"False, the diagnosis of T2DM is made on venous blood glucose"},{"idx":3,"proposition":"The presence of autoantibodies does not rule out the presence of T2DM","correct":false,"justification":"The presence of autoantibodies eliminates the presence of T2DM and points to T1D"},{"idx":4,"proposition":"Drug therapies that have marketing authorisation for T2DM in children are sulphonylureas and insulin.","correct":false,"justification":"Drug therapies that have MAiD in the treatment of T2DM in children are metformin and insulin"}],"type":"custom"}
+{"_id":"diabete-endoc-9","context":null,"enonce":"Regarding the paediatric peculiarities of diabetes, which proposals are true?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"The finding of a blood glucose > 2.5 g \/ L must make a urine strip in search of ketone bodies.","correct":true,"justification":"None"},{"idx":1,"proposition":"Among the complications of ketoacidosis, cerebral edema has a mortality of 25%.","correct":true,"justification":"None"},{"idx":2,"proposition":"Regarding the management of cerebral edema complicating ketoacidosis, it is essential to confirm its presence by a brain scan before starting treatments.","correct":false,"justification":"If clinical suspicion:\r\n1. 30% decrease infusion rate\r\n2. Mannitol injection 20%\r\n3. Elevation of the patient's head\r\n4. Brain scan in a stable child on mannitol"},{"idx":3,"proposition":"Neuroglucopenic syndrome occurs quickly for blood glucose levels < 0.7 g \/ L in diabetics.","correct":false,"justification":"Blood glucose < 0.7 g\/L: Neurovegetative SD ++\r\n< 0.54 g\/L: Neuroglucopenic Sd ++"},{"idx":4,"proposition":"In a diabetic child who is unconscious during hypoglycemia, it is recommended as a first line to inject him with Glucagon.","correct":true,"justification":"Glucagon 0.5 mg if < 25Kg \/ 1 mg if > 25 Kg"}],"type":"custom"}
+{"_id":"diabete-endoc-10","context":null,"enonce":"Which of the following proposals can be used to diagnose diabetes?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"2 fasting blood glucose levels > 1.26 g\/L","correct":true,"justification":"True it is the gold standard"},{"idx":1,"proposition":"Fasting blood glucose > 2 g\/L at any time of the day ","correct":false,"justification":"False, association with symptoms of hyperglycemia is necessary"},{"idx":2,"proposition":"Blood glucose > 2 g\/L at 2 hours from OGGH 75g","correct":true},{"idx":3,"proposition":"HbA1c > 7%","correct":false,"justification":"HbA1c is not used in France for the diagnosis of TD"},{"idx":4,"proposition":"Fasting blood glucose > 2 g\/L at any time of day associated with polyuria","correct":true,"justification":"True, associated with one or more symptoms of hyperglycemia (polyuria, polydipsia, polyphagia, ...)"}],"type":"custom"}
+{"_id":"diabete-endoc-14","context":null,"enonce":"Which of the following are true about type 1 diabetes?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"Alpha-pancreatic cells are destroyed by autoantibodies","correct":false,"justification":"These are the Beta-pancreatic cells that secrete insulin!"},{"idx":1,"proposition":"It is an autoimmune disease","correct":true},{"idx":2,"proposition":"It can occur at any age","correct":true,"justification":"True, although it is more common to diagnose it in young people"},{"idx":3,"proposition":"The HLA DR2 gene is a protective factor","correct":true},{"idx":4,"proposition":"The sex ratio is very close to 1","correct":true}],"type":"custom"}
+{"_id":"diabete-endoc-15","context":null,"enonce":"Which of the following proposals designate drugs that can cause hypoglycemia?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"Metformin","correct":false,"justification":"No hypoglycaemia on metformin #safe"},{"idx":1,"proposition":"Sulfonamides","correct":true,"justification":"This is thanks to the discovery of a PU of Réa de Montpellier who realized that his patients had unexplained manifestations under Sulfonamides (then used as ATB).\r\nBy measuring their blood sugar he realized this unsuspected therapeutic action."},{"idx":2,"proposition":"DPP4 inhibitors","correct":false,"justification":"False"},{"idx":3,"proposition":"Somastatin","correct":false,"justification":"False, it is not an antidiabetic"},{"idx":4,"proposition":"Insulin","correct":true}],"type":"custom"}
+{"_id":"Hu-nephro-0","context":null,"enonce":"Regarding the basics of nephrological (or renal) hematuria:","item":"Hu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Urological hematuria corresponds to an anatomical lesion","correct":true,"justification":"Communication of a urinary tract (between the calyx and the prostatic urethra) and one or more blood vessels"},{"idx":1,"proposition":"Nephrological hematuria is most often due to tubular disease","correct":false,"justification":"It is most often a disease of the glomerulus"},{"idx":2,"proposition":"Alport syndrome is a congenital anomaly in the composition of the basement membrane","correct":true},{"idx":3,"proposition":"Red blood cells have a diameter of 70 mm","correct":false,"justification":"We are several orders of magnitude lower; the diameter of red blood cells is 7 μM"},{"idx":4,"proposition":"Macroscopic hematuria of glomerular origin does not find clots or voiding burns","correct":true}],"type":"custom"}
+{"_id":"Hu-nephro-1","context":null,"enonce":"Regarding generalities:","item":"Hu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Hematuria can be the consequence of a urological condition","correct":true},{"idx":1,"proposition":"The main etiology of urological hematuria is taking anticoagulant therapy","correct":false,"justification":"The main etiologies of these hematuria are urinary tract infections and neoplasias. We also find renal lithiasis."},{"idx":2,"proposition":"Nephrological hematuria is most often glomerular","correct":true},{"idx":3,"proposition":"Microscopic hematuries can be objectivized by confocal or two-photon microscope only","correct":false,"justification":"Not at all. We discover them on BU."},{"idx":4,"proposition":"Diagnosis of hematuria is based on quantitative cytological examination of urine","correct":true}],"type":"custom"}
+{"_id":"Hu-nephro-2","context":null,"enonce":"Which propositions are true?","item":"Hu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Hematuria is defined as the presence of more than 50 red blood cells per mL","correct":false,"justification":"That's more than 10,000 red blood cells per mL. It is quite physiological to have some red blood cells that cross the barrier of the glomerulus."},{"idx":1,"proposition":"Quantitative cytological examination of urine eliminates false hematuria","correct":true,"justification":"See item in the last (8th) edition of the college p.111"},{"idx":2,"proposition":"A red coloration of urine is the pathognomonic sign of hematuria ","correct":false,"justification":"There are many other causes of red urine: hemoglobinuria, myoglobinuria, porphyria, metronidazole, rifampicin, beets, ..."},{"idx":3,"proposition":"Initial macroscopic hematuria is often cervico-prostatic","correct":true},{"idx":4,"proposition":"Nephrological hematuria finds associated lower back pain most often","correct":false,"justification":"No lower back pain, no clots, no fever, no burning urination"}],"type":"custom"}
+{"_id":"Hu-nephro-3","context":null,"enonce":"Which propositions are true?","item":"Hu","matiere":"nephro","propositions":[{"idx":0,"proposition":"One of the main causes of mascroscopic hematuria of glomerular origin is IgA deposition nephropathy","correct":true},{"idx":1,"proposition":"Associated with significant alteration of GFR, glomerular mascrocopic hematuria indicates an imperative and urgent renal biopsy","correct":true,"justification":"And this because of the need to quickly treat the causes of extracapillary proliferative glomerulonephritis"},{"idx":2,"proposition":"The most common etiologies of microscopic hematuria due to glomerular nephropathics are trauma and cysts.","correct":false,"justification":"These are diseases of the basement membranes (Sd d'Alport for example) and Berger's disease"},{"idx":3,"proposition":"Renal ultrasound with bladder time is indicated in case of microscopic hematuria after 50 years","correct":true},{"idx":4,"proposition":"The presence of haematic cylinders and\/or deformed red blood cells points to a glomerular cause","correct":true}],"type":"custom"}
+{"_id":"Hu-nephro-4","context":null,"enonce":"Which of the following propositions point to a nephrological origin of hematuria?","item":"Hu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Terminal location","correct":false,"justification":"Total"},{"idx":1,"proposition":"Presence of clots","correct":false,"justification":"No clots in nephrological hematuria"},{"idx":2,"proposition":"Presence of hematic cylinders","correct":true},{"idx":3,"proposition":"Proteinuria","correct":true},{"idx":4,"proposition":"None of these proposals","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"TdC-cardio-0","context":null,"enonce":"Regarding conduction disorders","item":"TdC","matiere":"cardio","propositions":[{"idx":0,"proposition":"The nodal tissue that constitutes NS and NAV is contrasted with the \"Purkinje\" tissue that makes up the bundle of His, the branches and the Purkinje network.","correct":true},{"idx":1,"proposition":"Sinus dysfunction and BAV can be symptomatic unlike branch blocks which are never symptomatic if isolated","correct":true},{"idx":2,"proposition":"NS is under close dependence on the autonomic nervous system","correct":true},{"idx":3,"proposition":"NS is vascularized by a branch of the left coronary artery or circumflex artery","correct":false,"justification":"NS is vascularized by a branch of the right coronary artery or circumflex artery"},{"idx":4,"proposition":"Sinuslae dysfunction or DS may follow a bradycardial medication","correct":true}],"type":"custom"}
+{"_id":"TdC-cardio-1","context":null,"enonce":"Regarding conduction disorders","item":"TdC","matiere":"cardio","propositions":[{"idx":0,"proposition":"In case of DS, an escape rhythm may hatch in the atrium or NAV (emergency rhythm)","correct":true},{"idx":1,"proposition":"The bundle of His is the only communication between atrium and ventricles and travels through the membranous septum","correct":true},{"idx":2,"proposition":"BAV is common in the elderly","correct":true},{"idx":3,"proposition":"The AV Node is also under close dependence on the autonomic nervous system","correct":true},{"idx":4,"proposition":"NAV is most often vascularized by a branch of the left coronary artery that arises from the cross of the furrows (artery of the NAV)","correct":false,"justification":"NAV is most often vascularized by a branch of the right coronary artery that arises from the cross of the furrows (artery of the NAV)"}],"type":"custom"}
+{"_id":"TdC-cardio-2","context":null,"enonce":"Regarding cardiac conduction disorders","item":"TdC","matiere":"cardio","propositions":[{"idx":0,"proposition":"In the case of a full nodal BAV, an escape rhythm may hatch in the His beam at a frequency between 35 and 50 bpm","correct":true},{"idx":1,"proposition":"In case of BAV in the beam of His or infrahissian, the escape rate is unstable and slower (15 to 30 bpm), which makes the gravity of this localization","correct":true},{"idx":2,"proposition":" The bundle of His is divided into right and left branches which are subdivided into thin and thick anterior hemi-branches or hemi-branches.","correct":true},{"idx":3,"proposition":"The branches are very highly sensitive to the effects of the autonomic nervous system","correct":false,"justification":"The branches are not very sensitive to the effects of the autonomic nervous system"},{"idx":4,"proposition":"In the branch block, there is a slowdown or interruption of conduction in a branch","correct":true}],"type":"custom"}
+{"_id":"TdC-cardio-3","context":null,"enonce":"About BAVs","item":"TdC","matiere":"cardio","propositions":[{"idx":0,"proposition":"A BAV can be totally asymptomatic, this is of course the case of the BAV of the first degree and most blocks of the second degree)","correct":true},{"idx":1,"proposition":"Nodal blocks are often responsible for first-degree BAVs or Möbitz I type second-degree BAVs","correct":true},{"idx":2,"proposition":"Blocks in the bundle of His or infra-hissians occur beforehand on branch blocks or BAVs of the second degree of type Möbitz I","correct":false,"justification":"Blocks in the His or infra-hissian bundle occur beforehand on branch blocks or second-degree BAVs of the Möbitz II type."},{"idx":3,"proposition":"At BAV III, the exhaust is wide (40%) or thin (60%)","correct":true},{"idx":4,"proposition":"Block is sometimes promoted by beta-blockers or reperfusion;  in the latter case, the BAV contraindicates beta-blockers","correct":true}],"type":"custom"}
+{"_id":"TdC-cardio-4","context":null,"enonce":"Regarding conduction disorders","item":"TdC","matiere":"cardio","propositions":[{"idx":0,"proposition":"In BAVs, the width of the QRS often gives the seat of the block","correct":true},{"idx":1,"proposition":"The 24-hour ECG (Holter) is very helpful and non-traumatic","correct":true},{"idx":2,"proposition":"A branch block is always asymptomatic if isolated","correct":true},{"idx":3,"proposition":"A branch block is often of fortuitous discovery","correct":true},{"idx":4,"proposition":"The isolated left branch block can be benign and considered a variant of normal, whether complete or incomplete.","correct":false,"justification":"The isolated right branch block can be benign and considered a variant of normal, whether complete or incomplete"}],"type":"custom"}
+{"_id":"TdC-cardio-5","context":null,"enonce":"Regarding conduction disorders","item":"TdC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Right branch block is almost always seen in most congenital heart defects affecting the right ventricle","correct":true},{"idx":1,"proposition":"The left branch block is never considered benign.","correct":true},{"idx":2,"proposition":"A left branch block is observed in 10% of cases of anterior infacrtus, with uni-, biou trifascicular block type, either pre-existing or acquired during infarction","correct":true},{"idx":3,"proposition":"A prolonged sinus arrest or complete BSA are the cause of asystole or simple bradycardia thanks to an escape for example atrial","correct":true},{"idx":4,"proposition":"A progressive elongation of the PR until the observation of a single blocked P wave followed by a conducted P wave with a shorter PR interval signs a second degree BAV mobitz 2","correct":false,"justification":"BAV of the second degree type Möbitz I or Luciani-Wenckebach: – progressive prolongation of PR until the observation of a single blocked P wave followed by a conducted P wave with a shorter PR interval; – often associated with a 2:1 BAV; – as a rule, nodal seat and most often QRS duration < 120 ms (fine QRS)"}],"type":"custom"}
+{"_id":"nephroPvascu-nephro-0","context":null,"enonce":"Concerning the main generalities:","item":"nephroPvascu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Vascular nephropathies include heterogeneous diseases characterized by damage to the renal vessels.","correct":true},{"idx":1,"proposition":"Nephroangiosclerosis involves the small vessels of the kidney","correct":true},{"idx":2,"proposition":"High blood pressure is very rarely associated with these diseases","correct":false,"justification":"It is often very present. It can be either the cause or the consequence"},{"idx":3,"proposition":"Vascular nephropathies can be classified according to their rate of evolution","correct":true},{"idx":4,"proposition":"These diseases can be classified according to the arterial territory affected.","correct":true}],"type":"custom"}
+{"_id":"nephroPvascu-nephro-1","context":null,"enonce":"Which of these nephropathies are rapidly progressive or acute?","item":"nephroPvascu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Stenosis of the renal artery","correct":false,"justification":"Chronic course"},{"idx":1,"proposition":"Anti-phospholipid syndrome in all cases","correct":false,"justification":"Chronic course"},{"idx":2,"proposition":"Macroscopic periarteritis nodosa","correct":true,"justification":"Affects medium-grade arterioles"},{"idx":3,"proposition":"Cholesterol crystal emboli disease","correct":true,"justification":"Affects small intrarenal arterioles"},{"idx":4,"proposition":"Thrombotic microangiopathy syndrome","correct":true}],"type":"custom"}
+{"_id":"nephroPvascu-nephro-2","context":null,"enonce":"Regarding etiologies:","item":"nephroPvascu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Thrombotic microangiopathy syndrome belongs to the group of chronic or slow-growing NVs","correct":false,"justification":"It belongs to the group of acute or rapidly progressive NV"},{"idx":1,"proposition":"Moschowitz syndrome preferentially affects children","correct":false,"justification":"Mostly affects adults. Cerebral damage is at the forefront."},{"idx":2,"proposition":"Hemolytic uremic syndrome preferentially affects children","correct":true,"justification":"Kidney damage is at the forefront"},{"idx":3,"proposition":"Hemolytic uremic syndrome is, most often, due to toxins produced by enterobacteriaceae that destroy the endothelium","correct":true},{"idx":4,"proposition":"HUS is the leading cause of acute renal failure in children aged 1 to 3 years","correct":true}],"type":"custom"}
+{"_id":"nephroPvascu-nephro-3","context":null,"enonce":"Regarding hemolytic uremic syndrome (HUS) in children:","item":"nephroPvascu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Post-diarrheal HUS is a reportable disease in all cases","correct":false,"justification":"Only when the patient is under 15 years of age"},{"idx":1,"proposition":"The infectious agent most often involved is Shillega","correct":false,"justification":"This is Escherichia coli"},{"idx":2,"proposition":"HUS starts slowly and gradually with low back pain","correct":false,"justification":"The onset is brutal with diarrhea, fever, acute renal failure and anuria"},{"idx":3,"proposition":"Renal biopsy is indicated in emergency in front of a supiscion of HUS","correct":false,"justification":"It is most often useless in children"},{"idx":4,"proposition":"Treatment is purely symptomatic most often","correct":true}],"type":"custom"}
+{"_id":"nephroPvascu-nephro-4","context":null,"enonce":"Regarding malignant nephroangiosclerosis","item":"nephroPvascu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Malignant nephroangiosclerosis is the renal consequence of malignant hypertension by ischemic lesions","correct":true},{"idx":1,"proposition":"HTA generates a significant natriuresis called \"pressure\"","correct":true},{"idx":2,"proposition":"Paradoxical hypovolemia puts the renin angiotensin (RAS) system to rest","correct":false,"justification":"On the contrary, it activates it"},{"idx":3,"proposition":"HTA and SRA maintain a vicious circle","correct":true},{"idx":4,"proposition":"Blood renin and asdosterone are very low","correct":false,"justification":"They are increased because of hypovolemia"}],"type":"custom"}
+{"_id":"nephroPvascu-nephro-5","context":null,"enonce":"Regarding nephoangiosclerosis due to malignant hypertension:","item":"nephroPvascu","matiere":"nephro","propositions":[{"idx":0,"proposition":"Malignant hypertension is clinically defined","correct":true},{"idx":1,"proposition":"Proteinuria and renal failure are observed","correct":true},{"idx":2,"proposition":"Secondary hyperaldosteronism causes hyperkalemia","correct":false,"justification":"Hypokalemia"},{"idx":3,"proposition":"PBR is indicated in diagnostic emergency","correct":false,"justification":"It is contraindicated as long as hypertension is not controlled"},{"idx":4,"proposition":"Treatment of malignant hypertension is a medical emergency","correct":true}],"type":"custom"}
+{"_id":"Sdocclusif-HGE-0","context":null,"enonce":"The positive diagnosis of an occlusive syndrome is based on a combination of the following functional and clinical signs: ","item":"Sdocclusif","matiere":"HGE","propositions":[{"idx":0,"proposition":"Abdominal pain","correct":true},{"idx":1,"proposition":"Shutting down materials but not gases","correct":false,"justification":"Shutdown of substances and gases"},{"idx":2,"proposition":"Nausea or vomiting","correct":true},{"idx":3,"proposition":"Abdominal meteorism","correct":true},{"idx":4,"proposition":"Diarrhoea","correct":false}],"type":"custom"}
+{"_id":"Sdocclusif-HGE-1","context":null,"enonce":"Regarding occlusive syndrome:","item":"Sdocclusif","matiere":"HGE","propositions":[{"idx":0,"proposition":"Bowel obstruction is one of the most common reasons for emergency hospitalization in surgical settings","correct":true},{"idx":1,"proposition":"The most specific sign is the cessation of transit and in particular gases","correct":true},{"idx":2,"proposition":"Stool transit can be temporarily preserved","correct":true},{"idx":3,"proposition":"Vomiting may be late in case of high and progressive obstacle","correct":false,"justification":"Vomiting may be late in case of low and progressive obstruction"},{"idx":4,"proposition":"Meteorism may be minimal in case of low occlusion","correct":false,"justification":"Meteorism may be minimal in case of high occlusion"}],"type":"custom"}
+{"_id":"Sdocclusif-HGE-2","context":null,"enonce":"Regarding occlusive syndrome:","item":"Sdocclusif","matiere":"HGE","propositions":[{"idx":0,"proposition":"Flanged occlusion is the most common cause of colon occlusion","correct":false,"justification":"It is the most common cause of small bowel occlusion"},{"idx":1,"proposition":"Volvulus of the pelvic colon occurs most often in postpartum women","correct":false,"justification":"Volvulus of the sigmoid most often in the elderly ( > 70 years)"},{"idx":2,"proposition":"It is possible to perform a diagnostic endoscopy. ","correct":false,"justification":"Contraindicated: risk of perforation. Endoscopy only indicated for placement of colonic or duodenal prosthesis or treatment of a sigmoid volvulus."},{"idx":3,"proposition":"The CT scan is the reference morphological examination","correct":true},{"idx":4,"proposition":"In case of high occlusion the hydroaeric levels are multiple, central and wider than high","correct":true,"justification":"Signs present qd standing. Lying down: presence of conniving valves (spring aspects). Look for abdominal scars, palpate hernial orifices and perform a digital rectal examination."}],"type":"custom"}
+{"_id":"Sdocclusif-urg-0","context":null,"enonce":"About occlusive syndrome","item":"Sdocclusif","matiere":"urg","propositions":[{"idx":0,"proposition":"The occlusive syndrome, defined by an interruption of normal intestinal transit with a cessation of materials and gases, is a diagnostic and therapeutic emergency","correct":true},{"idx":1,"proposition":"Small bowel occlusions are observed at any age, colonic occlusions are more frequent beyond 50 years","correct":true},{"idx":2,"proposition":"The volvulus corresponds to a twisting of a digestive loop on a vascular axis","correct":true},{"idx":3,"proposition":"Most often, the patient is seen in the emergency room for abdominal pain syndrome","correct":true},{"idx":4,"proposition":"Shutting down of materials and gases can be replaced by false diarrhea (downstream segment emptying)","correct":true}],"type":"custom"}
+{"_id":"Sdocclusif-urg-1","context":null,"enonce":"About occlusive syndrome","item":"Sdocclusif","matiere":"urg","propositions":[{"idx":0,"proposition":"imaging is systematically indicated when occlusion is suspected","correct":true},{"idx":1,"proposition":"The abdominal CT scan is the reference exam","correct":true},{"idx":2,"proposition":"Moderate renal impairment secondary to dehydration is not a contraindication to injection","correct":true},{"idx":3,"proposition":"The sensitivity and specificity of the CT scan is greater than 95% to make a positive diagnosis of an occlusion","correct":true},{"idx":4,"proposition":"In case of occlusion of the small intestine, the CT scan shows a dilation of more than 5 cm of the small loop and more than 9 cm in case of colonic occlusion","correct":false,"justification":"In case of occlusion of the small intestine, the CT scan shows a dilation of more than 2.5 cm of the small loop and more than 6 cm in case of colonic occlusion"}],"type":"custom"}
+{"_id":"Sdocclusif-urg-2","context":null,"enonce":"About occlusive syndrome","item":"Sdocclusif","matiere":"urg","propositions":[{"idx":0,"proposition":"A caecal distention of more than 9 cm should raise fears of a perforation","correct":true},{"idx":1,"proposition":"The place of ultrasound is very limited. In occlusive syndrome, it can nevertheless be useful in children (intussusception)","correct":true},{"idx":2,"proposition":"Absence of peristalsis and hypoechoic parietal thickening are signs of intestinal distress","correct":true},{"idx":3,"proposition":"In case of occlusion of the small intestine the clinical signs are in the foreground with: – a sharp pain of sudden onset, – abundant vomiting, – and a rapid alteration of the general condition","correct":true},{"idx":4,"proposition":"The shutdown of materials and gases is not very clear in case of hail obstruction","correct":true}],"type":"custom"}
+{"_id":"Sdocclusif-urg-3","context":null,"enonce":"Which of the following is a first-line recommended examination(s) for the diagnosis of an occlusive syndrome?","item":"Sdocclusif","matiere":"urg","propositions":[{"idx":0,"proposition":"A snapshot of the abdomen without preparation of face and profile","correct":false,"justification":"False"},{"idx":1,"proposition":"An endoscopy","correct":false,"justification":"False"},{"idx":2,"proposition":"Enteroscopy","correct":false,"justification":"False"},{"idx":3,"proposition":"A colonoscopy","correct":false,"justification":"False"},{"idx":4,"proposition":"A CT-TAP","correct":true,"justification":"True, this is the only indicated examination recommended in first line"}],"type":"custom"}
+{"_id":"IVeinC-cardio-0","context":null,"enonce":"Regarding the veins of the lower limbs and varicose veins","item":"IVeinC","matiere":"cardio","propositions":[{"idx":0,"proposition":"The veins of both superficial and deep networks of the lower limbs are provided with valves","correct":true},{"idx":1,"proposition":"The superficial femoral vein is a deep proximal vein ","correct":true},{"idx":2,"proposition":"The popliteal vein is a distal vein","correct":false,"justification":"Proximal vein"},{"idx":3,"proposition":"Venous insufficiency is defined by obstruction of the venous system, with or without valve dysfunction","correct":false,"justification":"It's the opposite: Valvular dysfunction, with or without obstruction of the venous system"},{"idx":4,"proposition":"A varicose vein is defined by a permanent venous dilation of more than 3mm in orthostatism","correct":true}],"type":"custom"}
+{"_id":"IVeinC-cardio-1","context":null,"enonce":"Regarding chronic venous insufficiency","item":"IVeinC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Varicose veins affect 30 to 60% of the population of industrialized countries","correct":true},{"idx":1,"proposition":"Chronic venous insufficiency affects both men and women","correct":false,"justification":"4 times more women than men"},{"idx":2,"proposition":"Primary venous insufficiency is promoted by post-thrombotic syndrome","correct":false,"justification":"By definition, post-thrombotic syndrome is the cause of secondary venous insufficiency"},{"idx":3,"proposition":"Cockett syndrome refers to the compression of the left common iliac vein by a pelvic tumor, which can result in iliofemoral thrombosis. ","correct":false,"justification":"Compression of the left common iliac vein by the right common iliac artery"},{"idx":4,"proposition":"Obesity and constipation promote chronic venous insufficiency","correct":true}],"type":"custom"}
+{"_id":"IVeinC-cardio-2","context":null,"enonce":"Regarding chronic venous insufficiency","item":"IVeinC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Telangiectasia is defined by a diameter <1 mm","correct":true,"justification":"And a reticular vein by a diameter between 1 and 3 mm"},{"idx":1,"proposition":"Symptoms are aggravated by contact with the cold, when walking, or when elevating the legs","correct":false,"justification":"These symptoms are calmed by contact with the cold, when walking, or when raising the legs."},{"idx":2,"proposition":"The clinical examination of varicose veins is performed in the supine position","correct":false,"justification":"The clinical examination of varicose veins is performed in a standing position, at best on a platform with altered unipodal support, in order to highlight ambulatory venous hyperpressure"},{"idx":3,"proposition":"Venous ulcer is the most common cause of leg ulcer","correct":true},{"idx":4,"proposition":"Typically, the venous ulcer is perimalleolar, round or oval in shape, little algic","correct":true}],"type":"custom"}
+{"_id":"IVeinC-cardio-3","context":null,"enonce":"Regarding chronic venous insufficiency","item":"IVeinC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Corona phlebectatica is a therapeutic emergency","correct":false,"justification":"This is a very early cutaneous clinical sign of venous insufficiency. Not to be confused with phlegmatia cerulea (ischemic DVT, therapeutic emergency)"},{"idx":1,"proposition":"Hemorrhagic ruptures of varicose veins are common","correct":false,"justification":"Classics but rare"},{"idx":2,"proposition":"Stasis dermohypodermatitis has an initial course by inflammatory flare-ups","correct":true,"justification":"Then sequelar sclerosis"},{"idx":3,"proposition":"Eczema secondary to venous stasis predominates in the upper 1\/3 of the leg","correct":false,"justification":"1\/3 lower"},{"idx":4,"proposition":"Atrophic dermatitis concerns advanced old venous insufficiency, and fears the occurrence of a venous ulcer","correct":true}],"type":"custom"}
+{"_id":"IVeinC-cardio-4","context":null,"enonce":"Regarding chronic venous insufficiency","item":"IVeinC","matiere":"cardio","propositions":[{"idx":0,"proposition":"In case of septic venous thrombosis, class 2 venous compression is indicated","correct":false,"justification":"In this case, venous compression is contraindicated"},{"idx":1,"proposition":"Compressive bands should be preferred in case of venous ulcer","correct":true},{"idx":2,"proposition":"Compression should be worn within two months of an episode of deep vein leg thrombosis","correct":false,"justification":"Compression must be worn within two years, usually by Class II compression socks"},{"idx":3,"proposition":"In case of chronic venous insufficiency, and especially in the ulcer stage, venous restraint must be worn daily and for life","correct":true},{"idx":4,"proposition":"In cases of peripheral arterial disease (PAD), compression is contraindicated if the systolic pressure index (SPI) is less than 0.09","correct":false,"justification":"Compression is contraindicated if the systolic pressure index (SPI) is less than 0.5. It should be reduced to a maximum of 30 mmHg for patients with an SNI between 0.5 and 0.9"}],"type":"custom"}
+{"_id":"denutrition-nutri-0","context":null,"enonce":"Among these proposals, which are situations of lack of inputs?","item":"denutrition","matiere":"nutri","propositions":[{"idx":0,"proposition":"The young","correct":true},{"idx":1,"proposition":"Celiac disease","correct":false,"justification":"This is an increase in losses by malabsorption, according to the College of Nutrition (2019 edition, page 134)"},{"idx":2,"proposition":"Diabetes","correct":false,"justification":"Increased losses via urine"},{"idx":3,"proposition":"Post-stroke sequella swallowing disorders","correct":true},{"idx":4,"proposition":"Extensive burns","correct":false,"justification":"Increased protein losses via skin tissue"}],"type":"custom"}
+{"_id":"denutrition-nutri-1","context":null,"enonce":"Which of these proposals are situations of increased losses?","item":"denutrition","matiere":"nutri","propositions":[{"idx":0,"proposition":"Bedsores","correct":true,"justification":"Protein loss via damaged skin coating"},{"idx":1,"proposition":"Vomiting","correct":true},{"idx":2,"proposition":"Zenker's diverticulum","correct":false,"justification":"May cause an obstacle of the upper digestive tract, and therefore a limitation of the intake"},{"idx":3,"proposition":"Taking neurolpetics","correct":false,"justification":"May have as an adverse effect anorexia and therefore a decrease in intake"},{"idx":4,"proposition":"Nephrotic syndrome","correct":true,"justification":"Protein loss"}],"type":"custom"}
+{"_id":"denutrition-nutri-2","context":null,"enonce":"Which propositions are true?","item":"denutrition","matiere":"nutri","propositions":[{"idx":0,"proposition":"Lean mass is mainly represented by skeletal muscle","correct":true},{"idx":1,"proposition":"Lean body mass is the body's main protein store","correct":true},{"idx":2,"proposition":"The lean butse is the compartment most affected by nutrition","correct":true},{"idx":3,"proposition":"Fat mass disappears in case of malnutrition","correct":false,"justification":"The metabolism is protein in case of prolonged youth"},{"idx":4,"proposition":"Undernutrition affects the elderly only","correct":false,"justification":"Higher prevalence at the extreme ages of life (infants and the elderly) but also exists between the two"}],"type":"custom"}
+{"_id":"denutrition-nutri-3","context":null,"enonce":"Which propositions are true?","item":"denutrition","matiere":"nutri","propositions":[{"idx":0,"proposition":"A BMI below 16 indicates undernutrition","correct":true},{"idx":1,"proposition":"A BMI below 18.5 indicates undernutrition","correct":false,"justification":"He makes her suspect only"},{"idx":2,"proposition":"Unintentional weight loss of more than 5% in 6 months is a sign of undernutrition","correct":false},{"idx":3,"proposition":"An involuntary weight loss greater than or equal to 15% in 6 months is a sign of severe undernutrition","correct":true},{"idx":4,"proposition":"Without inflammatory syndrome, a serum albumin less than 50 g \/ L suggests severe malnutrition","correct":false,"justification":"The thresholds are 30 g\/L for undernutrition and 20 g\/L for severe undernutrition"}],"type":"custom"}
+{"_id":"secu-sp-0","context":null,"enonce":"Which of these proposals are social risks?","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"Motherhood","correct":true,"justification":"Includes social and medical benefits related to maternity"},{"idx":1,"proposition":"Housing","correct":true,"justification":"Housing allowances"},{"idx":2,"proposition":"Addiction","correct":true,"justification":"Personalized autonomy allowance (APA)"},{"idx":3,"proposition":"Sexual harassment","correct":false,"justification":"It is a crime. It is its consequences on employment or health that are social risks."},{"idx":4,"proposition":"Poverty","correct":true}],"type":"custom"}
+{"_id":"secu-sp-1","context":null,"enonce":"Which of these propositions are true?","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"Social protection refers to all collective pension schemes that enable individuals or households to cope financially with the consequences of social risks.","correct":true},{"idx":1,"proposition":"Social risks are situations that can lead to a decrease in resources or an increase in expenses within a household","correct":true},{"idx":2,"proposition":"In France, there is only one social protection body (unlike Germany or the USA)","correct":false,"justification":"There is not just one social protection body but several: mutual societies, private insurance, social security, etc."},{"idx":3,"proposition":"Social Security was founded in 1981 on the occasion of the election of Francois Mitterand","correct":false,"justification":"On 4 and 19 October 1945, two ordinances instituted \"an organization of Social Security intended to guarantee workers and their families against risks of any kind likely to reduce or eliminate their earning capacity\"."},{"idx":4,"proposition":"Social security is the main source of social protection.","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"secu-sp-2","context":null,"enonce":"Which of these propositions are true?","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"Social security consists of two main schemes: general and SNCF.","correct":false,"justification":"It consists of four main schemes: the general scheme the agricultural scheme the social scheme the special schemes for self-employed persons and civil servants (non-agricultural self-employed persons) 2.2. HISTORY-MAIN REFORMS"},{"idx":1,"proposition":"Social security is created in 1954","correct":false,"justification":"Creation in 1945 (ordinances of 4 and 19 October) according to 3 principles: Equal access to care Quality of care Solidarity"},{"idx":2,"proposition":"The 1967 ordinance saw the creation of the 3 autonomous branches: sickness, old age, family","correct":true},{"idx":3,"proposition":"80% of French people are covered by the general scheme","correct":true},{"idx":4,"proposition":"The CNAMTS manages the risk of maternity only","correct":false,"justification":"Manages sickness, maternity, disability, death and, as part of a separate management, occupational accidents"}],"type":"custom"}
+{"_id":"secu-sp-3","context":null,"enonce":"Regarding the organization of social security:","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"The sickness branch is managed by the CNAMTS only","correct":false,"justification":"CNAMTS, CPAM and CGSS"},{"idx":1,"proposition":"There are 166 CRAMs (1 for about 2 departments)","correct":false,"justification":"16"},{"idx":2,"proposition":"The old-age branch is managed by the CNAV and CARSAT","correct":true},{"idx":3,"proposition":"The family branch is managed by CAF and CNAF","correct":true},{"idx":4,"proposition":"The recovery branch is managed by the URSSAF","correct":false,"justification":"The URSSAF is responsible for collecting contributions and social contributions but it is the ACOSS that manages and coordinates the URSSAF\""}],"type":"custom"}
+{"_id":"secu-sp-4","context":null,"enonce":"Regarding other schemes:","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"The agricultural scheme is managed by the MSA","correct":true,"justification":"The Mutualité Sociale Agricole"},{"idx":1,"proposition":"The agricultural scheme is a special scheme","correct":false,"justification":"3 types of special regimes: the civil service, public establishments and enterprises and 'others'"},{"idx":2,"proposition":"The RSI is the regime of computer scientists","correct":false,"justification":"This is the regime for the self-employed"},{"idx":3,"proposition":"The current trend is towards an increase in special diets","correct":false,"justification":"Rather to their decrease\/disappearance"},{"idx":4,"proposition":"The public service plan is managed by the IHR","correct":false,"justification":"The RSI is the regime for the self-employed\""}],"type":"custom"}
+{"_id":"secu-sp-5","context":null,"enonce":"Concerning the different social protection schemes","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"The agricultural scheme covers material risks linked to the weather","correct":false,"justification":"It covers farmers and agricultural employees"},{"idx":1,"proposition":"The agricultural scheme is administered by the Ministry of Agriculture","correct":false,"justification":"It is managed by the Mutualité Sociale Agricole (MSA)"},{"idx":2,"proposition":"The MSA collects the contributions itself","correct":true},{"idx":3,"proposition":"The MSA operates as a \"one-stop shop\": all benefits (sickness, family, old age) are covered by the MSA","correct":true},{"idx":4,"proposition":"The IHR covers graphic designers and computer scientists","correct":false,"justification":"It covers craftsmen, traders, industrialists and liberal professions\""}],"type":"custom"}
+{"_id":"secu-sp-6","context":null,"enonce":"Regarding the sources of financing of the social security system:","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"There are 5 sources of funding","correct":false,"justification":"There are 3: social contributions, taxes and public contributions"},{"idx":1,"proposition":"VAT contributes directly to the financing of social security","correct":false,"justification":"The taxes and taxes allocated to the financing of social security are: compulsory levies, general taxes, the CSG, the CRDS and taxes on alcohol, tobacco and medicines."},{"idx":2,"proposition":"Social contributions are paid directly to the Ministry of Health","correct":false,"justification":"Social contributions (employer and employee) are paid to the URSSAF"},{"idx":3,"proposition":"The CRDS was created in 1996","correct":true,"justification":"Its scope of levies is wider than that of the CSG"},{"idx":4,"proposition":"The CSG only concerns employees on permanent contracts","correct":false,"justification":"It concerns all the incomes of people living in France (including pensioners for example)\""}],"type":"custom"}
+{"_id":"secu-sp-7","context":null,"enonce":"Concerning the different schemes and the financing of social protection","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"The IHR operates as a one-stop shop for collecting contributions and paying benefits.","correct":true},{"idx":1,"proposition":"The Social Security Financing Act has been in place since 1945","correct":false,"justification":"Established in 1996"},{"idx":2,"proposition":"The LFSS aims to control social and health spending","correct":true},{"idx":3,"proposition":"The National Health Insurance Expenditure Target (ONDAM) is approved by Parliament each year","correct":true},{"idx":4,"proposition":"In 2015, the expenditure of the various basic social security schemes was more than €500 billion.","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"secu-sp-8","context":null,"enonce":"Which of these costs are covered by the sickness branch of social security?","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"Disability-related costs","correct":true},{"idx":1,"proposition":"Thermal cures","correct":true},{"idx":2,"proposition":"Hospitalization costs","correct":true},{"idx":3,"proposition":"Laboratory tests","correct":true},{"idx":4,"proposition":"Transportation costs","correct":true}],"type":"custom"}
+{"_id":"secu-sp-9","context":null,"enonce":"Concerning the reimbursement of social protection","item":"secu","matiere":"sp","propositions":[{"idx":0,"proposition":"The social security deficit is of the order of 10 million euros per year","correct":false,"justification":"The deficit of the general scheme, for all risks, was 6.8 billion euros in 2015: This is the famous \"hole\" of the social security"},{"idx":1,"proposition":"The amount of the reimbursement is made on the basis of conventional or regulatory tariffs","correct":true},{"idx":2,"proposition":"The assumption of certain expenses is subject to the agreement of the medical officer of the CPAM","correct":true},{"idx":3,"proposition":"The co-payment is the amount covered by the mutual insurance company","correct":false,"justification":"Rest at the expense of the insured after reimbursement by !' Health insurance on the \"compulsory\" part"},{"idx":4,"proposition":"Co-payment applies to all reimbursable medical expenses","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"allergie-infectio-0","context":null,"enonce":"Which of the following is a type 2 reaction (according to Gell and Coombs)?","item":"allergie","matiere":"infectio","propositions":[{"idx":0,"proposition":"Immediate IgE-mediated hypersensitivity","correct":false,"justification":"This is type 1"},{"idx":1,"proposition":"Hypersensitivity due to IgM and IgG mediated cytotoxicity","correct":true,"justification":"True. Type 2 (drug allergy)"},{"idx":2,"proposition":"Hypersensitivity mediated by immune complexes","correct":false,"justification":"Type 3 (pneumonia)"},{"idx":3,"proposition":"Depot, T-cell mediated hypersensitivity","correct":false,"justification":"Type 4 (eczema)"},{"idx":4,"proposition":"Immediate IgG-mediated hypersensitivity","correct":false,"justification":"Type 1. It is mediated by IgE"}],"type":"custom"}
+{"_id":"allergie-infectio-1","context":null,"enonce":"Which of the following is a type 3 reaction (according to Gell and Coombs)?","item":"allergie","matiere":"infectio","propositions":[{"idx":0,"proposition":"Immediate IgE-mediated hypersensitivity","correct":false,"justification":"This is type 1"},{"idx":1,"proposition":"Hypersensitivity due to IgM and IgG mediated cytotoxicity","correct":false,"justification":"Type 2 (drug allergy)"},{"idx":2,"proposition":"Hypersensitivity mediated by immune complexes","correct":true,"justification":"True. Type 3 (pneumonia)"},{"idx":3,"proposition":"Depot, T-cell mediated hypersensitivity","correct":false,"justification":"Type 4 (eczema)"},{"idx":4,"proposition":"B-cell mediated hypersensitivity","correct":false,"justification":"These lymphocytes do not mediate any hypersensitivity reaction"}],"type":"custom"}
+{"_id":"allergie-infectio-2","context":null,"enonce":"Which of the following is a type 4 reaction (according to Gell and Coombs)?","item":"allergie","matiere":"infectio","propositions":[{"idx":0,"proposition":"Immediate IgE-mediated hypersensitivity","correct":false,"justification":"Type 1"},{"idx":1,"proposition":"Hypersensitivity due to IgM and IgG mediated cytotoxicity","correct":false,"justification":"Type 2 (drug allergy)"},{"idx":2,"proposition":"Hypersensitivity mediated by immune complexes","correct":false,"justification":"Type 3 (pneumonia)"},{"idx":3,"proposition":"Depot, T-cell mediated hypersensitivity","correct":true,"justification":"True. Type 4 (eczema)"},{"idx":4,"proposition":"Depot, B-lymphocyte-mediated hypersensitivity","correct":false,"justification":"These lymphocytes do not mediate any hypersensitivity reaction"}],"type":"custom"}
+{"_id":"allergie-infectio-3","context":null,"enonce":"Which of the following are true?","item":"allergie","matiere":"infectio","propositions":[{"idx":0,"proposition":"Atopy is a genetically determined ability to produce IgE against certain allergens","correct":true},{"idx":1,"proposition":"Sensitization is a positive reaction to a known allergen","correct":true},{"idx":2,"proposition":"Allergy is biological in definition","correct":false,"justification":"The definition of allergy is clinical. This is a manifestation of exposure to a sensitized allergen"},{"idx":3,"proposition":"The preferred treatment is the eviction of the allergen","correct":true},{"idx":4,"proposition":"Binet's classification makes it possible to differentiate the different mechanisms of immunological hypersensitivity","correct":false,"justification":"This is the classification of Gell and Coombs. Binet's classification is a prognostic score for CLL (Chronic Lymphocytic Leukemia)"}],"type":"custom"}
+{"_id":"allergie-infectio-4","context":null,"enonce":"Which of the following is a type 1 reaction (according to Gell and Coombs)?","item":"allergie","matiere":"infectio","propositions":[{"idx":0,"proposition":"Immediate IgE-mediated hypersensitivity","correct":true,"justification":"True. This is type 1"},{"idx":1,"proposition":"Hypersensitivity due to IgM and IgG mediated cytotoxicity","correct":false,"justification":"Type 2 (drug allergy)"},{"idx":2,"proposition":"Hypersensitivity by immune complexes","correct":false,"justification":"Type 3 (pneumonia)"},{"idx":3,"proposition":"Depot, T-cell mediated hypersensitivity","correct":false,"justification":"Type 4 (eczema)"},{"idx":4,"proposition":"Hypersensitivity due to IgE-mediated cytotoxicity","correct":false,"justification":"It is mediated by IgG and IgM"}],"type":"custom"}
+{"_id":"TS-urg-0","context":null,"enonce":"Which of the following are true?","item":"TS","matiere":"urg","propositions":[{"idx":0,"proposition":" 10% of HCW patients commit suicide ","correct":true},{"idx":1,"proposition":"Like any crisis, the suicidal crisis reflects a moment of rupture in the balance of the subject with himself and with his environment.","correct":true},{"idx":2,"proposition":"Support and closeness to family, a loved one, a spouse and social relationships are risk factors","correct":false,"justification":"These are protective factors"},{"idx":3,"proposition":"Never ask a patient if they are having suicidal thoughts, as there is a risk of encouraging them to do so.","correct":false},{"idx":4,"proposition":"The search for protective factors allows the identification of members of the patient's entourage who can be caregivers","correct":true}],"type":"custom"}
+{"_id":"TS-urg-1","context":null,"enonce":"Which of the following are true?","item":"TS","matiere":"urg","propositions":[{"idx":0,"proposition":" The most common mode of suicide is hanging ","correct":true},{"idx":1,"proposition":" The incidence of suicide increases with age, and men over 85 are the most affected ","correct":true},{"idx":2,"proposition":" The France is one of the most affected European countries, with 16.2 suicides per 100,000 inhabitants ","correct":true},{"idx":3,"proposition":"Women most often resort to drug autointoxication","correct":true},{"idx":4,"proposition":" Suicide is the act of deliberately killing oneself ","correct":true}],"type":"custom"}
+{"_id":"TS-urg-2","context":null,"enonce":"Which of the following are true?","item":"TS","matiere":"urg","propositions":[{"idx":0,"proposition":" 10% of HCW patients commit suicide ","correct":true},{"idx":1,"proposition":"Like any crisis, the suicidal crisis reflects a moment of rupture in the balance of the subject with himself and with his environment.","correct":true},{"idx":2,"proposition":"Support and closeness to family, a loved one, a spouse and social relationships are risk factors","correct":false,"justification":"These are protective factors"},{"idx":3,"proposition":"Never ask a patient if they are having suicidal thoughts, as there is a risk of encouraging them to do so.","correct":false},{"idx":4,"proposition":"The search for protective factors allows the identification of members of the patient's entourage who can be caregivers","correct":true}],"type":"custom"}
+{"_id":"TS-urg-3","context":null,"enonce":"Which of the following are true?","item":"TS","matiere":"urg","propositions":[{"idx":0,"proposition":" The most common mode of suicide is hanging ","correct":true},{"idx":1,"proposition":" The incidence of suicide increases with age, and men over 85 are the most affected ","correct":true},{"idx":2,"proposition":" The France is one of the most affected European countries, with 16.2 suicides per 100,000 inhabitants ","correct":true},{"idx":3,"proposition":"Women most often resort to drug autointoxication","correct":true},{"idx":4,"proposition":" Suicide is the act of deliberately killing oneself ","correct":true}],"type":"custom"}
+{"_id":"TS-urg-4","context":null,"enonce":"Which of the following are true?","item":"TS","matiere":"urg","propositions":[{"idx":0,"proposition":" 10% of HCW patients commit suicide ","correct":true},{"idx":1,"proposition":"Like any crisis, the suicidal crisis reflects a moment of rupture in the balance of the subject with himself and with his environment.","correct":true},{"idx":2,"proposition":"Support and closeness of family, relative, spouse and social relationships are risk factors","correct":false,"justification":"These are protective factors"},{"idx":3,"proposition":"Never ask a patient if they are having suicidal thoughts, as there is a risk of encouraging them to do so.","correct":false,"justification":"Clinical experience shows that asking the question usually has the effect of relieving the suicidal person, by offering to talk openly about suicide and to clearly express his suicidal ideations."},{"idx":4,"proposition":"The search for protective factors allows the identification of members of the patient's entourage who can be caregivers","correct":true}],"type":"custom"}
+{"_id":"TS-urg-5","context":null,"enonce":"Which of the following are true?","item":"TS","matiere":"urg","propositions":[{"idx":0,"proposition":"The most common mode of suicide is hanging ","correct":true},{"idx":1,"proposition":"Incidence of suicide increases with age","correct":true},{"idx":2,"proposition":"The France is one of the most affected European countries, with 16.2 suicides per 100,000 inhabitants ","correct":true},{"idx":3,"proposition":"Women most often resort to drug autointoxication","correct":true},{"idx":4,"proposition":"Suicide is the act of deliberately killing oneself","correct":true}],"type":"custom"}
+{"_id":"TS-urg-6","context":null,"enonce":"Which of the following are true?","item":"TS","matiere":"urg","propositions":[{"idx":0,"proposition":"Suicide is the leading cause of death for young adults (25-35 years) ","correct":true},{"idx":1,"proposition":"Suicide is the leading cause of death among adolescents (15-24 years)","correct":false,"justification":"This is the second, after trauma"},{"idx":2,"proposition":"There are about 10,000 suicides a year in France","correct":true},{"idx":3,"proposition":"There is about 1 suicide every 4 minutes","correct":false,"justification":"1 suicide every 40 minutes, 1 TS every 4 minutes"},{"idx":4,"proposition":"There is about 1 suicide attempt every 4 minutes","correct":true}],"type":"custom"}
+{"_id":"TS-urg-7","context":null,"enonce":"Regarding suicide attempts:","item":"TS","matiere":"urg","propositions":[{"idx":0,"proposition":"Hospitalization is systematic in case of suicidal ideation","correct":false,"justification":"Hospitalization 🏥 occurs when UDR is elevated, if TS is proven, or when there is no viable alternative."},{"idx":1,"proposition":"Suicide by firearm is non-existent 🔫","correct":false,"justification":"It happens and they mostly concern adult men"},{"idx":2,"proposition":"Symptomatic treatments (hypnotics, sedatives, anxiolytics) are contraindicated in adolescents","correct":false,"justification":"They are not systematic, but possible"},{"idx":3,"proposition":"HCW recidivism rate is zero","correct":false,"justification":"40% in the year"},{"idx":4,"proposition":"None of the propositions are true","correct":true}],"type":"custom"}
+{"_id":"TS-urg-8","context":null,"enonce":"Which of the following are true?","item":"TS","matiere":"urg","propositions":[{"idx":0,"proposition":"3.9% of the population had suicidal ideation (SDI) in the year.","correct":true},{"idx":1,"proposition":"There are 10,000 suicide attempts (HCPs) per year in France","correct":false,"justification":"10,000 suicides per year in France, 100,000 TS"},{"idx":2,"proposition":"Rigel's pre-suicidal syndrome corresponds to a state of deep calm before suicide","correct":true},{"idx":3,"proposition":"Suicidal ideation is impossible before 10 years 👦","correct":false,"justification":"Quite infrequent, but can appear as early as 5 years. The preferred means are hanging or defenestration."},{"idx":4,"proposition":"In adolescents, there are mainly IMVs (80% of cases)","correct":true}],"type":"custom"}
+{"_id":"AES-infectio-0","context":null,"enonce":"During an EAS:","item":"AES","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is an accident at work","correct":true,"justification":"It must be declared as such"},{"idx":1,"proposition":"The risk of hepatitis B transmission is zero with effective vaccination","correct":true,"justification":"It is considered null and void."},{"idx":2,"proposition":"The risk of HIV transmission is 10%","correct":false,"justification":"This risk is estimated at 0.3%"},{"idx":3,"proposition":"The declaration of accident at work must be made within 72 hours","correct":false,"justification":"Within 48 hours maximum by the victim"},{"idx":4,"proposition":"The risk of HCV transmission is 45%","correct":false,"justification":"The overall risk is estimated at 3%"}],"type":"custom"}
+{"_id":"AES-infectio-1","context":null,"enonce":"What are the first steps to take in case of EAS? ","item":"AES","matiere":"infectio","propositions":[{"idx":0,"proposition":"Washing with hydro-alcoholic solution","correct":false,"justification":"Cleaning with soap and water"},{"idx":1,"proposition":"Report the occupational disease within 48 hours","correct":false,"justification":"An accident at work is declared"},{"idx":2,"proposition":"Antiseptic rinsing should last 30 seconds","correct":false,"justification":"First, clean with soap and water. Then rinse with an antiseptic for several minutes. It is important that all patient cells that can be removed are removed."},{"idx":3,"proposition":"We go to the occupational medicine that will take care of us","correct":false,"justification":"Occupational medicine has a preventive and not curative role"},{"idx":4,"proposition":"Washing should be done with water and mild soap","correct":true}],"type":"custom"}
+{"_id":"AES-infectio-2","context":null,"enonce":"The risk of an ESA is significant if:","item":"AES","matiere":"infectio","propositions":[{"idx":0,"proposition":"The sting is deep","correct":true,"justification":"None"},{"idx":1,"proposition":"The needle is hollow","correct":true,"justification":"There are only 3 important risks: the needle is deep, the needle is hollow, and the needle is intramuscular (arterial or venous)"},{"idx":2,"proposition":"The needle is intramuscular ","correct":false,"justification":"The needle is intravascular (arterial or venous)"},{"idx":3,"proposition":"The cut is done with a scalpel","correct":false,"justification":"This is an intermediate risk"},{"idx":4,"proposition":"Mucocutaneous exposure with a contact time > 15 minutes","correct":false,"justification":"This is an intermediate risk"}],"type":"custom"}
+{"_id":"AES-infectio-3","context":null,"enonce":"Regarding the ESA. Which of the following are true?","item":"AES","matiere":"infectio","propositions":[{"idx":0,"proposition":"The declaration of accident at work is mandatory within 24 hours","correct":false,"justification":"The declaration of work accident is mandatory within 48 hours"},{"idx":1,"proposition":"An initial medical certificate describing the injury and expressly stating that it is an accident with risk of HIV seroconversion is mandatory","correct":true,"justification":"None"},{"idx":2,"proposition":"Post-exposure treatment is 28 days","correct":true,"justification":"None"},{"idx":3,"proposition":"HCV seroconversion rate is 3%","correct":true,"justification":"None"},{"idx":4,"proposition":"The HIV seroconversion rate is 3%","correct":false,"justification":"The HIV seroconversion rate is 0.3%"}],"type":"custom"}
+{"_id":"AES-infectio-4","context":null,"enonce":"The declaration of a compulsory work accident must be made in:","item":"AES","matiere":"infectio","propositions":[{"idx":0,"proposition":"24h","correct":false,"justification":"None"},{"idx":1,"proposition":"48h","correct":true,"justification":"None"},{"idx":2,"proposition":"72h","correct":false,"justification":"None"},{"idx":3,"proposition":"12:00","correct":false,"justification":"None"},{"idx":4,"proposition":"60h","correct":false,"justification":"None"}],"type":"custom"}
+{"_id":"AES-infectio-6","context":null,"enonce":"Regarding the cleaning of the wound following an accident of exposure to blood, which proposal(s) are true?","item":"AES","matiere":"infectio","propositions":[{"idx":0,"proposition":"The wound must be made to bleed","correct":false,"justification":"Absolutely not! This can create a capillary breach and promote infection by passing into the systemic circulation."},{"idx":1,"proposition":"Cleaning with running water and soap","correct":true,"justification":"We are looking for an effect of cleansing and elimination of organic matter brought by the accident"},{"idx":2,"proposition":"Cleaning with hydro-alcoholic solution","correct":false,"justification":"Cleaning with dakin soap or other..."},{"idx":3,"proposition":"Rinsing","correct":true,"justification":"None"},{"idx":4,"proposition":"Antisepsis: Bleach with 2.5% active chlorine diluted 1\/5 or 1\/10, Dakin solution, or failing that alcohol at 70 ° or polyvidone iodine, with a maximum contact of 5 minutes","correct":false,"justification":"It takes a contac of more than 5 minutes! The rest of the statement is true."}],"type":"custom"}
+{"_id":"AES-infectio-7","context":null,"enonce":"Regarding the cleaning of the wound following an accident of exposure to blood, which proposal(s) are true?","item":"AES","matiere":"infectio","propositions":[{"idx":0,"proposition":"The wound must be made to bleed","correct":false,"justification":"Absolutely not! This can create a capillary breach and promote infection by passing into the systemic circulation."},{"idx":1,"proposition":"Cleaning with running water and soap","correct":true,"justification":"We are looking for an effect of cleansing and elimination of organic matter brought by the accident"},{"idx":2,"proposition":"Cleaning with hydro-alcoholic solution","correct":false,"justification":"Cleaning with dakin soap or other..."},{"idx":3,"proposition":"Rinsing","correct":true,"justification":"None"},{"idx":4,"proposition":"Antisepsis: Bleach with 2.5% active chlorine diluted 1\/5 or 1\/10, Dakin solution, or failing that alcohol at 70 ° or polyvidone iodine, with a maximum contact of 5 minutes","correct":false,"justification":"It takes a contac of more than 5 minutes! The rest of the statement is true."}],"type":"custom"}
+{"_id":"AES-infectio-8","context":null,"enonce":"After an accident of exposure to blood with a high risk of HIV infection, the duration of TPE is:","item":"AES","matiere":"infectio","propositions":[{"idx":0,"proposition":"60 days","correct":false,"justification":"60 days"},{"idx":1,"proposition":"35 days","correct":false,"justification":"35 days"},{"idx":2,"proposition":"28 days","correct":true,"justification":"None"},{"idx":3,"proposition":"15 days","correct":false,"justification":"None"},{"idx":4,"proposition":"7 days","correct":false,"justification":"None"}],"type":"custom"}
+{"_id":"AES-infectio-9","context":null,"enonce":"Regarding HIV seroconversion rate","item":"AES","matiere":"infectio","propositions":[{"idx":0,"proposition":"The seroconversion rate is estimated to be 1% after insertive anal intercourse","correct":false,"justification":"The seroconversion rate is estimated to be 1% after susceptible anal intercourse"},{"idx":1,"proposition":"The seroconversion rate is estimated to be 1% after insertive vaginal intercourse","correct":false,"justification":"The seroconversion rate is estimated to be 0.1% after insertive vaginal intercourse"},{"idx":2,"proposition":"The seroconversion rate is estimated at 0.3% after an AES","correct":true},{"idx":3,"proposition":"The risk of HIV transmission through non-traumatic vaginal sex is zero when the infected partner is on antiretroviral therapy, an HIV load that has not been detectable for more than 6 months","correct":true},{"idx":4,"proposition":"The seroconversion rate is estimated to be 1% after susceptible anal intercourse","correct":true}],"type":"custom"}
+{"_id":"menopause-uro-0","context":null,"enonce":"General generalities:","item":"menopause","matiere":"uro","propositions":[{"idx":0,"proposition":"LAD (age-related androgen deficiency) is an age-associated biochemical syndrome,","correct":true},{"idx":1,"proposition":"LAD is consistent in men over 70","correct":false,"justification":"LAD is inconsistent although it is common (10–20% of men after age 50, and up to 50% after age 70)"},{"idx":2,"proposition":"The depth of LAD varies from one subject to another, and its onset is very gradual.","correct":true},{"idx":3,"proposition":"Decreasing nocturnal or morning erections is an essential call sign","correct":true},{"idx":4,"proposition":"During LAD, erectile dysfunction is functional in origin","correct":false,"justification":"Organic origin"}],"type":"custom"}
+{"_id":"menopause-uro-1","context":null,"enonce":"Which proposition(s) is\/are true?","item":"menopause","matiere":"uro","propositions":[{"idx":0,"proposition":"The erection is generally longer to obtain despite ever greater stimuli","correct":true},{"idx":1,"proposition":"Detumescence is slower","correct":false,"justification":"Detumescence is faster and the refractory phase lengthens"},{"idx":2,"proposition":"Libido does not drop, but abilities do","correct":false,"justification":"A decrease in libido should be sought during questioning, as well as a reduction in the frequency of sexual intercourse"},{"idx":3,"proposition":"The quality of orgasm remains the same but its occurrence is slower","correct":false,"justification":"An alteration in the quality of orgasm is sometimes associated with these disorders"},{"idx":4,"proposition":"Semen volume is increased most of the time","correct":false,"justification":"Rather, there is a reduction in volume and low sperm expulsion"}],"type":"custom"}
+{"_id":"menopause-uro-2","context":null,"enonce":"Regarding explorations:","item":"menopause","matiere":"uro","propositions":[{"idx":0,"proposition":"Sarcopenia is rare and never severe","correct":false,"justification":"The decrease in muscle mass corresponds to sarcopenia and can be severe (up to 40%) accompanied by muscle weakness"},{"idx":1,"proposition":"Skin atrophy eliminates the diagnosis of LAD","correct":false,"justification":"Goes with hormonal drop"},{"idx":2,"proposition":"It is recommended to try to perform a bioavailable testosterone assay","correct":true,"justification":"TRUE: Sex Hormone Binding Globulin (SHBG) and albumin must also be measured with total testosteronemia to estimate the bioavailable concentration"},{"idx":3,"proposition":"Total testosterone dosage cannot be used as a rough value for bioavailable testosterone","correct":false,"justification":"When this assay is not possible, the determination of total testosterone should be used as an approximate value of bioavailable testosterone."},{"idx":4,"proposition":"Testosterone dosage should be carried out in the evening at midnight","correct":false,"justification":"The dosage should be carried out between 8 a.m. and 10 a.m."}],"type":"custom"}
+{"_id":"menopause-uro-3","context":null,"enonce":"Regarding support:","item":"menopause","matiere":"uro","propositions":[{"idx":0,"proposition":"A new dosage of bioavailable testosterone 2 to 4 weeks after the first is recommended","correct":true},{"idx":1,"proposition":"Advanced age (over 75 years) contraindicates treatments for LAAD","correct":false,"justification":"The patient should be treated if there are one or more deficiencies in the androgen-dependent systems and a lower than normal testosterone level. Age is not a contraindication at all."},{"idx":2,"proposition":"There is no pre-therapeutic assessment specific to the treatment","correct":false,"justification":"If. It includes prostate evaluation (IPSS score, digital rectal examination and total PSA assay), endocrine laboratory work (hematocrit, lipid profile, liver test, blood glucose) and bone densitometry in case of deep LAD or clinical call points"},{"idx":3,"proposition":"Treatment is based on the administration of natural testosterone to the patient until a plasma concentration is obtained as close as possible to physiological secretion.","correct":true},{"idx":4,"proposition":"The only possible route of administration of testosterone is IM","correct":false,"justification":"Transdermal or intramuscular according to the College of Urology (5th edition, page 239)"}],"type":"custom"}
+{"_id":"EDC-psy-0","context":null,"enonce":"General information on the characterized depressive episode:","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"Depressive disorder is associated with a major suicidal risk","correct":true},{"idx":1,"proposition":"A depressive episode characterized is defined in particular by a break with the previous state","correct":true},{"idx":2,"proposition":"Symptoms must be present every day for 6 consecutive days","correct":false,"justification":"present almost every day for at least 2 consecutive weeks"},{"idx":3,"proposition":"The significant increase or decrease in weight or appetite is a symptom of a characterized depressive episode","correct":true},{"idx":4,"proposition":"Psychomotor slowdown is always present","correct":false,"justification":"agitation or psychomotor slowdown"}],"type":"custom"}
+{"_id":"EDC-psy-1","context":null,"enonce":"What symptoms are associated with the rupture of the previous state to define the characterized depressive episode?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"feelings of worthlessness or guilt","correct":true},{"idx":1,"proposition":"impaired concentration or indecision","correct":true},{"idx":2,"proposition":"Thoughts of death or suicidal","correct":true},{"idx":3,"proposition":"Hyperconcentration","correct":false,"justification":"Indecision or alteration of concentration"},{"idx":4,"proposition":"Hypersomnia","correct":true,"justification":"or insomnia"}],"type":"custom"}
+{"_id":"EDC-psy-2","context":null,"enonce":"Regarding the management of the characterized depressive state:","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"The only complication is the risk of suicide","correct":false,"justification":"Complications are mainly represented by the risk of suicide, socio-professional disintegration, depressive recurrences and psychiatric and non-psychiatric comorbidities"},{"idx":1,"proposition":"Drug treatments have no place in the management","correct":false,"justification":"For moderate to severe forms, drug treatment is always necessary: antidepressant (1st line SSRI) for at least 6 months"},{"idx":2,"proposition":"ECT is indicated in the most severe forms of depressive episode","correct":true},{"idx":3,"proposition":"Management is often combined with supportive psychotherapy","correct":true},{"idx":4,"proposition":"Characterized depressive disorder is a common psychiatric disorder associated with a high risk of suicide","correct":true}],"type":"custom"}
+{"_id":"EDC-psy-3","context":null,"enonce":"Regarding the epidemiology of the characterized depressive episode:","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"The characterized depressive episode is an isolated psychiatric disorder most often","correct":false,"justification":"The characterized depressive episode fits into different nosographic entities (characterized depressive disorder, bipolar disorder) or can be comorbid of another psychiatric disorder (anxiety disorders, addictive disorders) or a non-psychiatric disorder"},{"idx":1,"proposition":"The term \"depression\" corresponds in the current DSM-5 classification to the characterized depressive episode (formerly \"major depressive episode\")","correct":true},{"idx":2,"proposition":"WHO records more than 100 million cases of characterized depressive episodes worldwide each year.","correct":true},{"idx":3,"proposition":"30-50% of suicide attempts in France are secondary to a characterized depressive episode","correct":true},{"idx":4,"proposition":"The first characterized depressive episode occurs in adolescence most often","correct":false,"justification":"The first characterized depressive episode can occur at any age"}],"type":"custom"}
+{"_id":"EDC-psy-4","context":null,"enonce":"Regarding the presentation of the characterized depressive episode:","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"The first EDC occurs more frequently in young adults","correct":true},{"idx":1,"proposition":"It is more common in men","correct":false,"justification":"It is more common in women from adolescence with a sex ratio of 1\/2 (1 man to 2 women)"},{"idx":2,"proposition":"A depressive syndrome can be evoked in case of pathological sadness of mood and a drop in energy","correct":true},{"idx":3,"proposition":"It is one of the rare psychiatric pathologies whose interindividual variability of symptoms is almost zero.","correct":false,"justification":"It is characterized by a constellation of symptoms and signs, which varies from one subject to another."},{"idx":4,"proposition":"Psychomotor slowdown or agitation may alternate or be associated","correct":true}],"type":"custom"}
+{"_id":"EDC-psy-5","context":null,"enonce":"What symptoms are not compatible with a first EDC?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"Tachycardia","correct":false,"justification":"Possible neuro-vegetative sign. Congruent of anxiety"},{"idx":1,"proposition":"An asymmetrical abolition of reflexes","correct":true,"justification":"Must evoke a neurological differential diagnosis"},{"idx":2,"proposition":"Enuresia","correct":false,"justification":"Possible"},{"idx":3,"proposition":"An extension of RCP","correct":true,"justification":"Must have a pyramidal syndrome sought"},{"idx":4,"proposition":"A cogwheel","correct":true,"justification":"Must have extrapyramidal syndrome sought"}],"type":"custom"}
+{"_id":"EDC-psy-6","context":null,"enonce":"Which of these propositions are true?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"Negativism translates into active resistance exclusively","correct":false,"justification":"Both passive and active resistance"},{"idx":1,"proposition":"Anhedonia is an intense feeling of sadness","correct":false,"justification":"Anhedonia is the inability to feel emotions"},{"idx":2,"proposition":"Bradypsychia is the inability to express one's thoughts with fluidity","correct":false,"justification":"Bradypsychia is the slowness of reflection"},{"idx":3,"proposition":"Amoemia is the absence of the usual facial expression","correct":true},{"idx":4,"proposition":"Mutism is the voluntary loss of language","correct":false,"justification":"The absence of language is involuntary"}],"type":"custom"}
+{"_id":"EDC-psy-7","context":null,"enonce":"Regarding OCD:","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"First-line management is by CBT","correct":true,"justification":"SSRIs are to be reserved for chronic, resistant and disabling forms."},{"idx":1,"proposition":"The 'obsessive' part corresponds to the act of avoidance","correct":false,"justification":"Obsessive = thought. Compulsive = act in reaction to thought."},{"idx":2,"proposition":"The most recurring themes are the 'washer', the 'magician' and the 'recuperator'","correct":false,"justification":"Washer \/ Checker \/ Conjurer"},{"idx":3,"proposition":"It is a rare disorder, found in 3% of adolescents","correct":false,"justification":"OCD is considered common and is found in both adolescents and adults."},{"idx":4,"proposition":"SSRIs should be prescribed at a minimum dose","correct":false,"justification":"Doses are high or maximum for at least 12 weeks, and up to 2 years"}],"type":"custom"}
+{"_id":"EDC-psy-8","context":null,"enonce":"Regarding depression:","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"Melancholy is an EDC due to alcohol","correct":false,"justification":"It is a possible characteristic of EDC (such as psychotic, mixed, anxious, catatonic, etc.) that defines a maximum EDC, with major suicidal risk, deep sadness, etc."},{"idx":1,"proposition":"Cotard's syndrome is a delusional syndrome during a melancholic EDC","correct":true},{"idx":2,"proposition":"A mixed EDC finds a manic association","correct":true},{"idx":3,"proposition":"A catatonic EDC may regain echolalia or echopraxia","correct":true},{"idx":4,"proposition":"An EDC may be associated with a schizophrenic disorder","correct":true,"justification":"Psychiatric comorbidity is not uncommon"}],"type":"custom"}
+{"_id":"EDC-psy-9","context":null,"enonce":"In which pathologies is CBT psychotherapy indicated?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"The characterized depressive episode","correct":false,"justification":"Treatment of EDC = SSRIs + Supportive Psychotherapy"},{"idx":1,"proposition":"Phobic disorder","correct":true},{"idx":2,"proposition":"Le PTSD","correct":true},{"idx":3,"proposition":"Generalized anxiety disorder","correct":true},{"idx":4,"proposition":"Adjustment disorder","correct":false,"justification":"Not in first line given the short duration"}],"type":"custom"}
+{"_id":"EDC-psy-10","context":null,"enonce":"Regarding treatments for anxiety, which proposals are true?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"Hypnotics are contraindicated in adolescents","correct":true},{"idx":1,"proposition":"Hypnotics are potentiators of GABA","correct":true},{"idx":2,"proposition":"Zolpidem is a benzodiazepine","correct":false,"justification":"Zolpidem = Hypnotic"},{"idx":3,"proposition":"Oxazepam is the shortest-lived benzodiazepine","correct":true},{"idx":4,"proposition":"OSA is a relative contraindication to benzodiazepine","correct":false,"justification":"Absolute contraindication: severe respiratory failure, OSA, myasthenia gravis, hepatic impairment"}],"type":"custom"}
+{"_id":"EDC-psy-11","context":null,"enonce":"What symptoms lead to post-traumatic stress disorder?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"Flashbacks","correct":true},{"idx":1,"proposition":"Anxious ruminations ","correct":false,"justification":"Rather to classify in the symptoms of anxiety. The 3 symptoms of repetition syndrome are flashbacks, revivals and nightmares."},{"idx":2,"proposition":"Hypervigilence","correct":true},{"idx":3,"proposition":"Hallucinations","correct":true},{"idx":4,"proposition":"Sleep disorders","correct":true}],"type":"custom"}
+{"_id":"EDC-psy-12","context":null,"enonce":"Which of these proposals are found in post-traumatic stress disorder?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"Avoidance syndrome","correct":true},{"idx":1,"proposition":"Depressive syndrome","correct":false,"justification":"Is apart"},{"idx":2,"proposition":"Neuro-cognitive hyperactivation syndrome","correct":false,"justification":"This is neuro-vegetative hyperactivation syndrome"},{"idx":3,"proposition":"Avoidance syndrome","correct":true},{"idx":4,"proposition":"Heteroaggressive syndrome","correct":false,"justification":"Heteroaggressiveness is a consequence of PTSD"}],"type":"custom"}
+{"_id":"EDC-psy-13","context":null,"enonce":"Which of these proposals are predictive factors for EDC's recurrence?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"Female sex","correct":true},{"idx":1,"proposition":"The Late Age of the First EDC","correct":false,"justification":"Rather early age"},{"idx":2,"proposition":"A very low intensity of the first episode","correct":false,"justification":"A very high intensity of the first episode increases the risk of relapse"},{"idx":3,"proposition":"Non-psychiatric comorbidity","correct":true,"justification":"The sicker you are, the more likely you are to redo an EDC"},{"idx":4,"proposition":"EDC's Family History","correct":true}],"type":"custom"}
+{"_id":"EDC-psy-14","context":null,"enonce":"Which of the following proposals fall within the scope of diagnosing the characterized depressive episode?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"proposition":"The feeling of omnipotence","correct":false,"justification":"Feelings of worthlessness or guilt"},{"idx":1,"proposition":"Impaired concentration or indecision","correct":true,"justification":"None"},{"idx":2,"proposition":"Thoughts of death or suicidal ","correct":true,"justification":"None"},{"idx":3,"proposition":"Lack of functional impact","correct":false,"justification":"Clinically significant suffering or impaired functioning"},{"idx":4,"proposition":"The absence of non-psychiatric medical causes and the absence of toxic causes ","correct":true,"justification":"None"}],"type":"custom"}
+{"_id":"parasitedig-infectio-0","context":null,"enonce":"Which of the following are true about amoebose?","item":"parasitedig","matiere":"infectio","propositions":[{"idx":0,"proposition":"Hypereosinophilia","correct":false,"justification":"Not in ameobosis"},{"idx":1,"proposition":"It is due to Entamoeba histolytica","correct":true},{"idx":2,"proposition":"The intestinal form is accompanied by fever","correct":false,"justification":"No, this is the case with the hepatic form"},{"idx":3,"proposition":"Treatment of the intestinal form is based on Metronidazole and Tiliquinol ","correct":true,"justification":"True. Tiliquinol is a contact antiamibian"},{"idx":4,"proposition":"Hepatic form induces hyperneutrophilia","correct":true}],"type":"custom"}
+{"_id":"parasitedig-infectio-1","context":null,"enonce":"Which of the following are true about oxyurosis?","item":"parasitedig","matiere":"infectio","propositions":[{"idx":0,"proposition":"Brain damage can be found","correct":false,"justification":"False, unlike cysticercosis (by tapeworm)"},{"idx":1,"proposition":"The worm involved is a nematode","correct":true,"justification":"True, i.e. it is a roundworm"},{"idx":2,"proposition":"The interrogation mainly finds a pruritus of the back","correct":false,"justification":"Pruritus is mostly anal"},{"idx":3,"proposition":"Storytelling is important","correct":true,"justification":"True, especially in children"},{"idx":4,"proposition":"Treatment is based on Albendazole","correct":true,"justification":"True, as for ascariasis"}],"type":"custom"}
+{"_id":"parasitedig-infectio-3","context":null,"enonce":"Which of the following propositions are true concerning Giardiosis?","item":"parasitedig","matiere":"infectio","propositions":[{"idx":0,"proposition":"The protozoan involved is Giardia duodenalis","correct":true},{"idx":1,"proposition":"It is always symptomatic","correct":false,"justification":"Often asymptomatic"},{"idx":2,"proposition":"Diagnosis is based on serology","correct":false,"justification":"It is based on parasitological stool examination (PSE) and PCR"},{"idx":3,"proposition":"Treatment is based on Ivermectin","correct":false,"justification":"Metronidazole PO 5 days"},{"idx":4,"proposition":"The examination does not find fever","correct":true,"justification":"True. There are loose stools without fever"}],"type":"custom"}
+{"_id":"parasitedig-infectio-4","context":null,"enonce":"Which of the following propositions are true about ascariases?","item":"parasitedig","matiere":"infectio","propositions":[{"idx":0,"proposition":"The worms concerned are plathelmintes","correct":false,"justification":"They are nemathelmintes"},{"idx":1,"proposition":"Worms are visible only under a confocal 🔬 microscope","correct":false,"justification":"Visible to the naked eye"},{"idx":2,"proposition":"A bioclinical Löffler syndrome can be observed","correct":true,"justification":"True. Löffler syndrome or Loeffler syndrome, is characterized by the presence of parahilar or subclavicular pulmonary infiltrates, labile, most often related to mechanical and allergic phenomena secondary to the presence of parasite larvae in the pulmonary alveoli. These radiological images are associated with blood eosinophilia."},{"idx":3,"proposition":"Treatment is based on Metronidazole","correct":false,"justification":"Treatment is based on Albendazole PO (or Flubendazole PO)"},{"idx":4,"proposition":"Hypereosinophilia can be found","correct":true,"justification":"True, but it is rare"}],"type":"custom"}
+{"_id":"suivivalv-cardio-0","context":null,"enonce":"Concerning the monitoring of vascular prosthesis wearers","item":"suivivalv","matiere":"cardio","propositions":[{"idx":0,"proposition":"Mechanical heart valves require definitive anticoagulant treatment with vitamin K (risk of thrombosis of the prosthetic valve) and therefore expose to the risks of this treatment","correct":true},{"idx":1,"proposition":"Mechanical valves have excellent durability","correct":true},{"idx":2,"proposition":"Biological valves are most often animal valves (especially pigs)","correct":true},{"idx":3,"proposition":"The biological prosthesis does not require anticoagulants beyond the 3rd post-operative month","correct":true},{"idx":4,"proposition":"The durability of biological prostheses is poor","correct":true}],"type":"custom"}
+{"_id":"suivivalv-cardio-1","context":null,"enonce":"Concerning the monitoring of vascular prosthesis wearers","item":"suivivalv","matiere":"cardio","propositions":[{"idx":0,"proposition":"There is a major risk of infective endocarditis (IE) regardless of the type of prosthesis, mechanical or biological,","correct":true},{"idx":1,"proposition":"Thromboembolic complications are the most common complications of prosthetic valves","correct":true},{"idx":2,"proposition":"Thromeboembolic complications are more common in the first year after surgery, before endothelialization of the prosthesis, but the risk persists beyond","correct":true},{"idx":3,"proposition":"The risk is lower for mitral prostheses than for aortic prostheses","correct":false},{"idx":4,"proposition":"Embolisms are most often cerebral","correct":true}],"type":"custom"}
+{"_id":"suivivalv-cardio-2","context":null,"enonce":"Concerning the monitoring of vascular porthesis carrier","item":"suivivalv","matiere":"cardio","propositions":[{"idx":0,"proposition":"Hospitalization for emergency reoperation is required for valve change in case of acute denture thrombosis","correct":true},{"idx":1,"proposition":"In case of prosthesis dysfunction of lesser gravity, the patient will have to be reoperated in a deliasis of one month","correct":false,"justification":"In case of less serious prosthesis dysfunction, anticoagulant treatment should be rebalanced with transient transition to heparin if necessary"},{"idx":2,"proposition":"The differential diagnosis of prosthetic thrombosis with infective endocarditis is sometimes difficult, especially since a fever is possible in prosthesis thrombosis","correct":true},{"idx":3,"proposition":"The diagnosis of disinsertion of a porthesis is made by the ETT and especially by the ETO:","correct":true},{"idx":4,"proposition":"Postoperative mediastinitis is one of the leading causes of early mortality from valve surgery","correct":true}],"type":"custom"}
+{"_id":"suivivalv-infectio-0","context":null,"enonce":"Concerning the survival of vascular prosthesis wearers","item":"suivivalv","matiere":"infectio","propositions":[{"idx":0,"proposition":"Mechanical heart valves require definitive anticoagulant treatment, by vitamin K or LMWH and therefore exposing to the risks of this treatment","correct":false,"justification":"No MA for LMWH in this indication. However, they remain an \"acceptable alternative\" in practice."},{"idx":1,"proposition":"Mechanical valves have excellent durability and should, in principle, last the patient's entire life.","correct":true,"justification":"This is the principle of mechanical valves versus biological valves."},{"idx":2,"proposition":"Biological valves are, most often, animal valves (pigs in particular)","correct":true,"justification":"For biological valves, bovine pericardium or porcine aortic valve can also be used."},{"idx":3,"proposition":"The biological prosthesis does not require anticoagulants beyond the 3rd post-operative month.","correct":true},{"idx":4,"proposition":"The durability of biological prostheses of the order of 55 years","correct":false,"justification":"10-20 years of lifespan (varies according to sources)"}],"type":"custom"}
+{"_id":"suivivalv-infectio-1","context":null,"enonce":"Concerning the monitoring of vascular prosthesis wearers","item":"suivivalv","matiere":"infectio","propositions":[{"idx":0,"proposition":"There is a major risk of infective endocarditis (IE) regardless of the type of prosthesis, mechanical or biological,","correct":true},{"idx":1,"proposition":"Thromboembolic complications are among the most common complications of prosthetic valves","correct":true,"justification":"Especially the 1st post-operative year."},{"idx":2,"proposition":"Thromboembolic complications are more common in the first year after surgery, before endothelialization of the prosthesis, but the risk persists beyond","correct":true},{"idx":3,"proposition":"The risk is lower for mitral prostheses than for aortic prostheses","correct":false,"justification":"The risk is higher: for mitral prostheses (which operate at low pressures) than for aortic prostheses; for antique prostheses than for double-finned prostheses; in case of atrial fibrillation (AF), or left ventricular dysfunction"},{"idx":4,"proposition":"Embolisms are most often cerebral","correct":true}],"type":"custom"}
+{"_id":"suivivalv-infectio-2","context":null,"enonce":"Concerning the monitoring of vascular prosthesis wearers","item":"suivivalv","matiere":"infectio","propositions":[{"idx":0,"proposition":"Hospitalization for emergency reoperation is required for valve change in case of acute denture thrombosis","correct":true},{"idx":1,"proposition":"In case of less serious prosthesis dysfunction, the patient should be reoperated within one month","correct":false,"justification":"In case of less serious prosthesis dysfunction, anticoagulant treatment should be rebalanced with transient transition to heparin if necessary"},{"idx":2,"proposition":"The differential diagnosis of prosthesis thrombosis with infective endocarditis is sometimes difficult, especially since a fever is possible in prosthesis thrombosis","correct":true},{"idx":3,"proposition":"The diagnosis of disinsertion of a prosthesis is made by the ETT and especially by the ETO","correct":true},{"idx":4,"proposition":"Postoperative mediastinitis is one of the leading causes of early mortality from valve surgery","correct":true,"justification":"20% of deaths"}],"type":"custom"}
+{"_id":"suivivalv-infectio-3","context":null,"enonce":"Concerning the monitoring of vascular prosthesis wearers","item":"suivivalv","matiere":"infectio","propositions":[{"idx":0,"proposition":"All anticoagulants are authorized in bioprostheses from 3 months post-op as part of a non-valvular indication (e.g. AF)","correct":true,"justification":"Even AODs"},{"idx":1,"proposition":"For mechanical valves and bioprostheses, cardiac Doppler ultrasound monitoring is done every 1 to 2 years","correct":false,"justification":"For mechanical valves: every 1 to 2 years \/ For bioprostheses: at M3, 1 year, 5 years and then every year if there is no sign of degradation or infection."},{"idx":2,"proposition":"It is unnecessary to prescribe an antiplatelet agent in the case of a post-op thromboembolic complication under effective INR.","correct":false,"justification":"Antiplatelet indications: if TAVI (lifetime), if stent placement or thromboembolic complications under effective INR."},{"idx":3,"proposition":"There is no self-measurement of the INR to date.","correct":false,"justification":"CoaguCheck (same principle as the blood glucose monitoring device): 50% of patients use it"},{"idx":4,"proposition":"The fibrous Pannis is an atrial connective tissue covering the aortic prosthesis and performing extravalvular stenosis.","correct":false,"justification":"Atrial connective tissue if mitral valve, ventricular connective tissue if aortic valve."}],"type":"custom"}
+{"_id":"ACG-immuno-0","context":null,"enonce":"Among these proposals, which are symptoms that can be found in case of Horton's disease?","item":"ACG","matiere":"immuno","propositions":[{"idx":0,"proposition":"Diplopia","correct":true},{"idx":1,"proposition":"Hyperesthesia of the scalp","correct":true},{"idx":2,"proposition":"A sign of the Shopping Cart","correct":false,"justification":"It can be found in osteoarthritis or shrinking lumbar canal syndrome"},{"idx":3,"proposition":"A sign from Claude Bernard Hoerner","correct":false,"justification":"CBH = ptosis, myosis, enophthalmos. It is found in case of involvement of the sympathetic pupillary territory homolateral to the symptoms and has nothing to do with GCAs."},{"idx":4,"proposition":"Temporal or occipital headaches","correct":true}],"type":"custom"}
+{"_id":"ACG-immuno-1","context":null,"enonce":"Among these proposals, which are symptoms that can be found in case of Horton's disease?","item":"ACG","matiere":"immuno","propositions":[{"idx":0,"proposition":"A NOIAA","correct":true,"justification":"Acute anterior ischemic optic neuropathy"},{"idx":1,"proposition":"A non-ischemic NORB","correct":false,"justification":"Non-ischemic NORB = nerve damage = sign of MS"},{"idx":2,"proposition":"Transient amaurosis","correct":true,"justification":"It is transient blindness. Patients describe a falling veil. It's painless"},{"idx":3,"proposition":"Occlusion of the branches of the retinal artery","correct":false,"justification":"Not branches, only central artery"},{"idx":4,"proposition":"An indomitable migraine","correct":false,"justification":"There are no migraines, but temporo-occipital headaches"}],"type":"custom"}
+{"_id":"ACG-immuno-2","context":null,"enonce":"What organs can be affected by Horton's disease when isolated?","item":"ACG","matiere":"immuno","propositions":[{"idx":0,"proposition":"Kidneys","correct":false,"justification":"No renal damage classically"},{"idx":1,"proposition":"The brain","correct":true,"justification":"Headache"},{"idx":2,"proposition":"The lymphatic network","correct":false,"justification":"This is not described in the College of Internal Medicine"},{"idx":3,"proposition":"EMBs","correct":false,"justification":"Not described"},{"idx":4,"proposition":"Lungs","correct":true,"justification":"Chronic cough"}],"type":"custom"}
+{"_id":"ACG-immuno-3","context":null,"enonce":"Regarding temporal artery biopsy:","item":"ACG","matiere":"immuno","propositions":[{"idx":0,"proposition":"It is carried out in strict condition of asepty in the operating room","correct":false,"justification":"Is done, conventionally, in the service (with satisfactory conditions of asepsis of course)"},{"idx":1,"proposition":"It is done under general anesthesia","correct":false,"justification":"A simple local anesthesia is sufficient, as during sutures in the emergency room."},{"idx":2,"proposition":"It is done before any corticosteroid therapy","correct":false,"justification":"Biopsy should not delay starting treatment, especially if eye signs occur"},{"idx":3,"proposition":"It must be long enough, more than 1 cm","correct":true},{"idx":4,"proposition":"In some cases, ultrasound may be preferred.","correct":true,"justification":"Ultrasound gives interesting results, but there is greater inter-operator variability"}],"type":"custom"}
+{"_id":"opacitetho-pneumo-0","context":null,"enonce":"Which of the following are true?","item":"opacitetho","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Peripheral lesions are generally not accessible in bronchial endoscopy","correct":true,"justification":"Bronchial endoscopy = paramedian lesions"},{"idx":1,"proposition":"Diagnosis of peripheral lesions is based on CT","correct":false,"justification":"Diagnosis of peripheral lesions is based on transparietal needle puncture"},{"idx":2,"proposition":"The diagnostic discussion is based on the location of the lesion in one of the 2 mediastinal compartments","correct":false,"justification":"There are 9 lodges in the mediastinum"},{"idx":3,"proposition":"CT scan is the key examination for anterior and middle mediastinum masses","correct":true},{"idx":4,"proposition":"Ultrasound is the reference examination for the diagnosis of masses of the posterior mediastinum","correct":false,"justification":"This is MRI for masses of the posterior mediastinum"}],"type":"custom"}
+{"_id":"opacitetho-pneumo-1","context":null,"enonce":"Which of the following proposals favor the benignity of a micronodule?","item":"opacitetho","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Only biology makes it possible to have a diagnosis of certainty.","correct":false,"justification":"Only pathology (histology) can"},{"idx":1,"proposition":"Weak PET fixation","correct":true},{"idx":2,"proposition":"The absence of evolution at 2 years","correct":true},{"idx":3,"proposition":"Irregular contours","correct":false,"justification":"Malignancy criteria: high size, irregular contours, spiculate, attractants"},{"idx":4,"proposition":"Localized in the upper lobes","correct":false,"justification":"Malignancy criterion"}],"type":"custom"}
+{"_id":"opacitetho-pneumo-2","context":null,"enonce":"Which of the following are true?","item":"opacitetho","matiere":"pneumo","propositions":[{"idx":0,"proposition":"A micronodule is less than 3 mm in size","correct":true},{"idx":1,"proposition":"A mass has a size greater than 3\r\ncm","correct":true},{"idx":2,"proposition":"A mass has a size greater than 30\r\ncm","correct":false,"justification":"3 cm"},{"idx":3,"proposition":"A nodule is between 30 mm and 3 cm","correct":false,"justification":"Between 3 mm and 3 cm"},{"idx":4,"proposition":"A nodule is between 3 mm and 13 cm","correct":false,"justification":"Between 3 mm and 3 cm"}],"type":"custom"}
+{"_id":"tbsommeil-pneumo-0","context":null,"enonce":"Regarding sleep apnea syndrome","item":"tbsommeil","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Sleep Apnea Syndrome (SAS) is a real public health problem","correct":true},{"idx":1,"proposition":"It is an underdiagnosed condition","correct":true},{"idx":2,"proposition":"OSA mainly results in the presence of nocturnal hypersomnia and nocturnal snoring in a patient who is frequently overweight but","correct":false,"justification":"OSA mainly results in the presence of daytime hypersomnia and nocturnal snoring in a patient who is frequently but not systematically overweight."},{"idx":3,"proposition":"The diagnosis of certainty is based on polygraphy during sleep","correct":true},{"idx":4,"proposition":"Continuous positive airway pressure (CPAP) treatment with the nasal mask is the most effective treatment for OSA","correct":true}],"type":"custom"}
+{"_id":"tbsommeil-pneumo-1","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The effectiveness of CPAP treatment is conditioned by initial therapeutic education as well as by the quality of its adherence and patient follow-up _ _","correct":true},{"idx":1,"proposition":"Central sleep apnea syndrome (SACS) and periodic ventilation which are due to instability of the ventilatory control during sleep and which is observed in particular in advanced respiratory insufficiency","correct":false,"justification":"Central sleep apnea syndrome (SACS) and periodic ventilation which are due to instability of ventilatory control during sleep and which is observed in particular in advanced heart failure"},{"idx":2,"proposition":"OSA and SACS have a very different nocturnal oximetry profile","correct":false,"justification":"OSA and SACS have a similar nocturnal oximetry profile"},{"idx":3,"proposition":"Pure alveolar hypoventilation manifests itself in oximetry by deep and sustained desaturations, most often contemporary with REM sleep periods","correct":true},{"idx":4,"proposition":"A central appnea is the cessation of the naso-oral airflow for at least 10 seconds with no ventilatory efforts during apnea","correct":true}],"type":"custom"}
+{"_id":"tbsommeil-pneumo-2","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Mixed apnea begins as a central apnea and ends with breathing efforts","correct":true},{"idx":1,"proposition":"The severity of OSA is based on AHI or apnnea index is hypopnea","correct":true},{"idx":2,"proposition":"We talk about severe OSA for an AHI ≥ 60","correct":false,"justification":"Severe OSA is called for AHI ≥ 30 The importance of daytime sleepiness should also be considered in assessing severity."},{"idx":3,"proposition":"Obesity, especially abdominal obesity, is a major risk factor for OSA","correct":true},{"idx":4,"proposition":"There is no parallelism between the prevalence of obsity and the severity of OSA","correct":false,"justification":"The prevalence of OSA increases with the severity of obesity (60-80% of morbidly obese patients have OSA)"}],"type":"custom"}
+{"_id":"tbsommeil-psy-0","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"psy","propositions":[{"idx":0,"proposition":"The prescription of hypnotic is recommended as a first-line treatment in the treatment of chronic insomnia in adults","correct":false,"justification":"Hypnotic prescription is not recommended as a first-line treatment for chronic insomnia in adults"},{"idx":1,"proposition":"The prescription of hypnotic should only be done for a short time in the context of transient acute insomnia","correct":true},{"idx":2,"proposition":"The presence of restless legs syndrome should systematically be sought in front of a complaint of chronic insomnia with difficulty falling asleep in adults","correct":true},{"idx":3,"proposition":"Obstructive sleep apnea syndrome should always be evoked in the face of a complaint of excessive daytime sleepiness and snoring","correct":true},{"idx":4,"proposition":"Severe drowsiness in young subjects should suggest central hypersomnia","correct":true}],"type":"custom"}
+{"_id":"tbsommeil-psy-1","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"psy","propositions":[{"idx":0,"proposition":"Normal sleep occurs at night, it lasts on average 7 to 8 hours, with large interindividual variations","correct":true,"justification":"It is suspected that these inter-individual variations are largely genetic."},{"idx":1,"proposition":"The reference test for the study of sleep is the EEG during sleep","correct":false,"justification":"The reference examination for the study of sleep is polysomnography"},{"idx":2,"proposition":"The alternation of sleep cycles can be visualized by means of the hypnogram","correct":true},{"idx":3,"proposition":"The complaint of insomnia is extremely common in the general population: 30% of adults have experienced transient insomnia during their lifetime, and 10% chronic insomnia","correct":true},{"idx":4,"proposition":"Prevalence is higher in males and increases with age","correct":false,"justification":"Prevalence is higher in women and increases with age"}],"type":"custom"}
+{"_id":"tbsommeil-psy-2","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"psy","propositions":[{"idx":0,"proposition":"The diagnosis of insomnia is clinical","correct":true},{"idx":1,"proposition":"Insomnia is a subjective complaint that is not defined by the objective duration of sleep","correct":true},{"idx":2,"proposition":"Insomnia must be responsible for a negative daytime impact on the subject's activities","correct":true,"justification":"It is associated with functional symptoms"},{"idx":3,"proposition":"Actimetry is a tool that makes it possible to assess sleep-wake rhythms under standardized conditions","correct":false,"justification":"This tool makes it possible to appreciate sleep-wake rhythms in ecological conditions"},{"idx":4,"proposition":"The drug approach is the first-line treatment for chronic insomnia","correct":false,"justification":"The non-drug approach is the first-line treatment for chronic insomnia"}],"type":"custom"}
+{"_id":"tbsommeil-psy-3","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"psy","propositions":[{"idx":0,"proposition":"Insomnia disorder must be distinguished from the insomnia 'symptom', which is then one of the clinical manifestations of another etiology.","correct":true},{"idx":1,"proposition":"Symptoms such as dyspnea, pollakiuria, gastroesophageal reflux, or pain can cause sleep disorders","correct":true,"justification":"The sleep disorder is then secondary"},{"idx":2,"proposition":"Restless Legs Syndrome (RLS) is most often associated with a complaint of sudden awakenings in the early morning","correct":false,"justification":"Restless Legs Syndrome (RLS) is most often associated with a complaint of insomnia falling asleep and maintaining"},{"idx":3,"proposition":"The diagnosis of restless legs syndrome is clinical and defined by the presence of unpleasant sensations in the legs responsible for an irrepressible need to mobilize them.","correct":true},{"idx":4,"proposition":"Electromyogram of the lower limbs reveals numerous abnormalities in restless legs syndrome","correct":false,"justification":"An electromyogram of the lower limbs is not indicated to explore an RLS, if performed it reveals no abnormality"}],"type":"custom"}
+{"_id":"tbsommeil-psy-4","context":null,"enonce":"Which propositions are true?","item":"tbsommeil","matiere":"psy","propositions":[{"idx":0,"proposition":"Treatment of insomniac disorder relies on CBT","correct":true},{"idx":1,"proposition":"The prescription of hypnotic is not recommended as a first-line treatment in the treatment of chronic insomnia in adults.","correct":true},{"idx":2,"proposition":"The prescription of hypnotic is contraindicated in case of insomnia in adults","correct":false,"justification":"It should only be done for a short time in the context of transient acute insomnia."},{"idx":3,"proposition":"OSA only affects adolescents over the age of 16","correct":false,"justification":"They can also be found in children"},{"idx":4,"proposition":"Narcolepsy is central hypersomnia","correct":true}],"type":"custom"}
+{"_id":"tbsommeil-psy-5","context":null,"enonce":"Regarding sleep physiology: ","item":"tbsommeil","matiere":"psy","propositions":[{"idx":0,"proposition":"The homeostatic, accumulative process increases throughout wakefulness and decreases during sleep.","correct":true},{"idx":1,"proposition":"There are two processes: C and S","correct":true,"justification":"Circadian and HomeoStatic"},{"idx":2,"proposition":"The biological clock is located in the basal ganglia","correct":false,"justification":"It is located in the suprachiasmatic nuclei"},{"idx":3,"proposition":"The biological clock modulates states of alertness but also other parameters including hormonal secretions, internal temperature, cell division cycles and mood.","correct":true},{"idx":4,"proposition":"The ultradian rhythm of alertness is faster than the circadian rhythm","correct":true}],"type":"custom"}
+{"_id":"tbsommeil-psy-6","context":null,"enonce":"Which of these proposals are included in sleep polysomnography?","item":"tbsommeil","matiere":"psy","propositions":[{"idx":0,"proposition":"ECG","correct":false,"justification":"There is a monitor of cardiorespiratory parameters but not as advanced as an ECG"},{"idx":1,"proposition":"EMG","correct":true},{"idx":2,"proposition":"EOG","correct":true},{"idx":3,"proposition":"EEG","correct":true},{"idx":4,"proposition":"Video recording","correct":true}],"type":"custom"}
+{"_id":"tbsommeil-psy-7","context":null,"enonce":"Regarding the types of sleep:","item":"tbsommeil","matiere":"psy","propositions":[{"idx":0,"proposition":"There are two main types of sleep: slow wave sleep and deep sleep.","correct":true,"justification":"Slow wave sleep, on the other hand, ranges from light to deep."},{"idx":1,"proposition":"Slow wave sleep is characterized by increased EEG activity","correct":false,"justification":"On the contrary, in slow-wave sleep, EEG activity gradually decreases"},{"idx":2,"proposition":"REM sleep is characterized by an EEG state close to wakefulness","correct":true},{"idx":3,"proposition":"Slow-wave sleep accounts for more than 50% of total sleep","correct":true},{"idx":4,"proposition":"REM sleep is accompanied by rapid eye movements","correct":true}],"type":"custom"}
+{"_id":"tbsommeil-psy-8","context":null,"enonce":"Which propositions are true?","item":"tbsommeil","matiere":"psy","propositions":[{"idx":0,"proposition":"The alternation of sleep cycles can be visualized by means of the hypnogram.","correct":true},{"idx":1,"proposition":"There are 5 stages of slow-wave sleep","correct":false,"justification":"3 stages of slow wave sleep: light, moderate, deep."},{"idx":2,"proposition":"30% of the general population complains of chronic insomnia.","correct":false,"justification":"0.1"},{"idx":3,"proposition":"The sleep agenda is conventionally done over 3 nights","correct":false,"justification":"Several weeks"},{"idx":4,"proposition":"Polysomnography is not recommended when exploring primary insomnia.","correct":true}],"type":"custom"}
+{"_id":"tbsommeil-neuro-0","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"neuro","propositions":[{"idx":0,"proposition":"Slow-wave sleep is subdivided into three stages, of increasing depth, defined on ECG criteria.","correct":false,"justification":"Slow wave sleep is subdivided into three stages, of increasing depth, defined on EEG criteria"},{"idx":1,"proposition":"The amount of slow delta waves during sleep reflects the depth of sleep and is regulated in a homeostatic way","correct":true},{"idx":2,"proposition":"Circadian sleep pressure is highest between 1 a.m. and 5 a.m.","correct":true},{"idx":3,"proposition":"Serotonin is the main hormone regulating chronobiological rhythms","correct":false,"justification":"Melatonin is the main hormone regulating chronobiological rhythms"},{"idx":4,"proposition":"Insomnia is dissatisfaction with the quantity or quality of sleep with daytime repercussions","correct":true}],"type":"custom"}
+{"_id":"tbsommeil-neuro-1","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"neuro","propositions":[{"idx":0,"proposition":"Insomnia can be secondary to a psychiatric pathology","correct":true},{"idx":1,"proposition":"Psychophysiological insomnia is the most common primary chronic insomnia","correct":true},{"idx":2,"proposition":"Treatment of insomnia in children and adolescents should be etiological","correct":true},{"idx":3,"proposition":"In children and infants, the therapeutic approach is often behavioral and educational in first line","correct":true},{"idx":4,"proposition":"Drug treatments are often overprescribed and should be avoided","correct":true}],"type":"custom"}
+{"_id":"tbsommeil-neuro-2","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"neuro","propositions":[{"idx":0,"proposition":"The main differential diagnosis is circadian rhythm phase delay which can be confused with insomnia of sleep initiation or falling asleep.","correct":true},{"idx":1,"proposition":"Regardless of the nosological framework used, the diagnosis and evaluation of insomnia is essentially based on the questioning of the patient","correct":true},{"idx":2,"proposition":"Sleep aggenda is an essential tool for the assessment of insomnia and its management","correct":true},{"idx":3,"proposition":"The sleep diary often highlights discrepancies between the patient's overall appreciation of his sleep disorders and their reality.","correct":true},{"idx":4,"proposition":"Actimetric recording makes it possible to establish the activity-rest rhythm over several weeks","correct":true}],"type":"custom"}
+{"_id":"tbsommeil-neuro-3","context":null,"enonce":"Regarding sleep disorders","item":"tbsommeil","matiere":"neuro","propositions":[{"idx":0,"proposition":"Polysomnography in the laboratory is still necessary for diagnosis","correct":false,"justification":"Laboratory polysomnography Not necessary for diagnosis but indicated punctually to eliminate a specific etiology including"},{"idx":1,"proposition":"Melatonin is a hypnotic substance","correct":false,"justification":"It also exerts a hypnogenic effect but should not be considered a hypnotic substance"},{"idx":2,"proposition":"Immediate-release melatonin can be used to improve sleep-onset insomnia at night","correct":true},{"idx":3,"proposition":"Extended-release melatonin (Circadin®) may be used to improve sleep-maintaining insomnia (intrasleep wakefulness)","correct":true},{"idx":4,"proposition":"Hypnotics are indicated in the treatment of transient or occasional insomnia for a limited time","correct":true}],"type":"custom"}
+{"_id":"deuil-psy-0","context":null,"enonce":"Regarding definitions:","item":"deuil","matiere":"psy","propositions":[{"idx":0,"proposition":"Grief is a physiological process","correct":true},{"idx":1,"proposition":"Persistent complex bereavement is the persistence, for more than 12 months (or 6 months for children), of severe and disabling psychiatric symptoms.","correct":true},{"idx":2,"proposition":"Psychiatric disorders occurring during bereavement have a specific management","correct":false,"justification":"When a psychiatric disorder is identified as a result of bereavement, in particular a characterized depressive episode, it should be managed in the same way as if it had occurred in another context."},{"idx":3,"proposition":"Grief corresponds to the reactions that the body develops as a result of the announcement of the death of a person we have already met","correct":false,"justification":"Definition Grief refers to the reactions: * emotional, * cognitive, * behavioral, * and sociocultural, to the loss by death of a loved one to whom one was significantly attached (such as a parent, a spouse, a friend)"},{"idx":4,"proposition":"It is classic to distinguish 3 phases in the grieving process","correct":true}],"type":"custom"}
+{"_id":"deuil-psy-1","context":null,"enonce":"Which propositions are true?","item":"deuil","matiere":"psy","propositions":[{"idx":0,"proposition":"Grief is a stressor that exposes to biological, psychological and social changes","correct":true},{"idx":1,"proposition":"Bereavement is a risk factor for the occurrence of decompensations of existing pathologies","correct":true},{"idx":2,"proposition":"Psychological reactions usually disappear within a few hours","correct":false},{"idx":3,"proposition":"Children don't feel grief","correct":false,"justification":"Grief in children and adolescents may manifest as a moderate initial reaction, and then they experience the full effects later"},{"idx":4,"proposition":"The impact of grief is purely psychiatric in children","correct":false,"justification":"The child may also manifest polymorphic symptoms of cognitive appearance (regression in acquisitions for example) or non-psychiatric (enuresis for example)"}],"type":"custom"}
+{"_id":"deuil-psy-2","context":null,"enonce":"Which proposals are correct?","item":"deuil","matiere":"psy","propositions":[{"idx":0,"proposition":"The elderly are no longer at risk of pathological bereavement from the age of 60","correct":false,"justification":"The elderly are particularly at risk of a marked depressive episode and the risk of suicide is all the higher as one ages, especially in men"},{"idx":1,"proposition":"Despite the pain of grief, most people adapt to the loss and cravings of the deceased and continue to live satisfactorily.","correct":true},{"idx":2,"proposition":"Normal grief lasts on average 1 to 2 week(s)","correct":false,"justification":"Normal grief lasts on average 2 to 3 months, but will depend on the bond of attachment that united the bereaved to the deceased, the age of the deceased, and the circumstances of the death"},{"idx":3,"proposition":"Persistent complex grief occurs when a subject has experienced the death of a loved one and has clinically significant symptoms after more than one year.","correct":true},{"idx":4,"proposition":"The characteristic symptoms of persistent complex grief are those of nostalgia related to the state of withdrawal of the deceased and invasive ruminations","correct":true}],"type":"custom"}
+{"_id":"vaccin-sp-0","context":null,"enonce":"Concerning vaccination","item":"vaccin","matiere":"sp","propositions":[{"idx":0,"proposition":"Subcutaneous vaccination is done in the deltoid region","correct":true},{"idx":1,"proposition":"Flu vaccination can be done without a doctor's prescription","correct":true},{"idx":2,"proposition":"Attenuated vaccines are most often effective at a single dose, whereas inactivated vaccines must be administered multiple times.","correct":true},{"idx":3,"proposition":"Measles, mumps and rubella vaccine is an inactivated vaccine","correct":false,"justification":"These are attenuated live vaccines"},{"idx":4,"proposition":"Contraindications of vaccination should be systematically sought","correct":true}],"type":"custom"}
+{"_id":"vaccin-sp-1","context":null,"enonce":"Concerning vaccination","item":"vaccin","matiere":"sp","propositions":[{"idx":0,"proposition":"Live vaccines are generally contraindicated in cases of congenital or acquired immunosuppression.","correct":true},{"idx":1,"proposition":"Serious complications of vaccination are exceptional","correct":true},{"idx":2,"proposition":"The hepatitis B vaccine is a mandatory vaccine","correct":true,"justification":"Mandatory since the law of 1 January 2018"},{"idx":3,"proposition":"The measles, mumps and rubella vaccine is a mandatory attenuated vaccine before 2 years of age","correct":true,"justification":"Since January 2018, vaccination against tuberculosis is mandatory and helps prevent severe forms of the disease"},{"idx":4,"proposition":"No proposition is true","correct":false}],"type":"custom"}
+{"_id":"vaccin-sp-2","context":null,"enonce":"Concerning vaccination","item":"vaccin","matiere":"sp","propositions":[{"idx":0,"proposition":"Pneumocooccal vaccination is recommended for all children before 2 years of age","correct":true},{"idx":1,"proposition":"Flu vaccination is recommended from November to March (to be done as soon as possible)","correct":true},{"idx":2,"proposition":"Vacciantion against pneumococcus is strongly recommended in spelonectomized subjects","correct":true},{"idx":3,"proposition":"BCG is a live attenuated vaccine","correct":true},{"idx":4,"proposition":"The flu vaccine is an attenuated live vaccine","correct":false,"justification":"It is an inactivated vaccine"}],"type":"custom"}
+{"_id":"vaccin-infectio-0","context":null,"enonce":"Concerning vaccination","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"proposition":"The vaccines provide protection against a large number of serious diseases for non-existent or benign side effects","correct":true},{"idx":1,"proposition":" Vaccination not only prevents the vaccinated person from the disease, but also prevents the circulation of the disease in the population, provided that vaccination coverage is sufficient.","correct":true},{"idx":2,"proposition":" Live vaccines usually do not need a booster; they are contraindicated in immunocompromised patients","correct":true},{"idx":3,"proposition":"Tenuated vaccines require several administrations close together during primary vaccination","correct":false},{"idx":4,"proposition":" Polysaccharide vaccines (pneumococcus, meningococcus, Haemophilus influenzae, Salmonella typhi) are more effective in their so-called \"conjugate\" form, which should be preferred","correct":true}],"type":"custom"}
+{"_id":"vaccin-infectio-1","context":null,"enonce":"Concerning vaccination","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Vaccination is active immunoprophylaxis","correct":true},{"idx":1,"proposition":"Serotherapy is an active humoral immunoprophylaxis","correct":false,"justification":"Serotherapy is passive humoral immunoprophylaxis"},{"idx":2,"proposition":"Vaccine provides immediate but transient protection","correct":false},{"idx":3,"proposition":"Pneumococcal vaccines and most meningococcal vaccines have several antigenic valences of the pathogen, allowing vaccination against several serogroups","correct":true},{"idx":4,"proposition":"Attenuated vaccines produce rapid protection is durable","correct":true}],"type":"custom"}
+{"_id":"vaccin-infectio-2","context":null,"enonce":"Concerning vaccination and catching up on vaccinations","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Only conjugate vaccines can eliminate carriage (pharyngeal for example for pneumococcus)","correct":true},{"idx":1,"proposition":"The subcutaneous route is generally more effective than the intramuscular route","correct":false,"justification":"The intramuscular route is generally more effective than the subcutaneous route"},{"idx":2,"proposition":"In an adult or child of unknown vaccination status, a complete age-sensitive regimen is delayed at the outset.","correct":true},{"idx":3,"proposition":"For diphtheria and tetanus, we can use the anti-tetanus antibody assay after a 1st injection: if the titer is high, the subject has already been vaccinated and we can schedule a booster at the ages provided for in the schedule","correct":true},{"idx":4,"proposition":"All vaccines are given SC or IM (in the deltoid), except BCG (intradermal)","correct":true}],"type":"custom"}
+{"_id":"vaccin-infectio-3","context":null,"enonce":"Which of the following are recommended vaccines for splenectomized patients?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Pneumococcal vaccine","correct":true,"justification":"True, encapsulated germ"},{"idx":1,"proposition":"Seasonal influenza vaccine","correct":true,"justification":"True, patient at risk of severe form"},{"idx":2,"proposition":"Haemophilus vaccine","correct":true,"justification":"True, encapsulated germ"},{"idx":3,"proposition":"Meningococcal vaccine","correct":true,"justification":"True, encapsulated germ"},{"idx":4,"proposition":"Covid19 vaccine","correct":true,"justification":"True, patient at risk of severe form"}],"type":"custom"}
+{"_id":"vaccin-infectio-4","context":null,"enonce":"At 3 months, which vaccines have been injected?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"proposition":"rubella","correct":false,"justification":"M12 and M16-18"},{"idx":1,"proposition":"mumps","correct":false,"justification":"M12 and M16-18"},{"idx":2,"proposition":"measles","correct":false,"justification":"M12 and M16-18"},{"idx":3,"proposition":"hepatitis B","correct":true},{"idx":4,"proposition":"Poliomyelitis ","correct":true}],"type":"custom"}
+{"_id":"vaccin-infectio-5","context":null,"enonce":"Which of the following proposals are contraindicated in immunocompromised patients (CD4 < 200)?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"proposition":"MMR vaccine","correct":true,"justification":"True, live attenuated IC vaccine if CD4 < 200"},{"idx":1,"proposition":"Tuberculosis vaccine (BCG)","correct":true,"justification":"True, always CI in HIV patients with CD4 < 200"},{"idx":2,"proposition":"DTP vaccine","correct":false,"justification":"Inert vaccine"},{"idx":3,"proposition":"Leptospirosis vaccine","correct":false,"justification":"Inert vaccine"},{"idx":4,"proposition":"Pertussis vaccine","correct":false,"justification":"Internal vaccine"}],"type":"custom"}
+{"_id":"vaccin-infectio-6","context":null,"enonce":"At what ages is it recommended to inject the pertussis vaccine?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"proposition":"2 months ","correct":true,"justification":"True, 1st dose"},{"idx":1,"proposition":"4 months","correct":true,"justification":"True, 2nd dose"},{"idx":2,"proposition":"11 months","correct":true,"justification":"True, reminder"},{"idx":3,"proposition":"16-18 months","correct":false,"justification":"16-18 months: MMR (2nd dose)"},{"idx":4,"proposition":"3 years","correct":false,"justification":"No vaccine at 3 years"}],"type":"custom"}
+{"_id":"vaccin-infectio-7","context":null,"enonce":"Which of the following are mandatory vaccines in the second month of life?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"proposition":"DTPaP","correct":true,"justification":"True. 2 months, 4 months, 11 months (booster) and 6 years (booster)"},{"idx":1,"proposition":"Haemophilus inflenzae B","correct":true,"justification":"True. 2 months, 4 months, 11 months (booster)"},{"idx":2,"proposition":"MMR","correct":false,"justification":"To M12 and M16-18"},{"idx":3,"proposition":"Meningococcal C","correct":false,"justification":"To M5 and M12"},{"idx":4,"proposition":"Pneumococcus","correct":true,"justification":"True. M2, M4, M11 (reminder)"}],"type":"custom"}
+{"_id":"IVG-gyn-1","context":null,"enonce":"Regarding abortion and the morning-after pill:","item":"IVG","matiere":"gyn","propositions":[{"idx":0,"proposition":"The Veil law is definitively renewed from 1979","correct":true},{"idx":1,"proposition":"The doctor must obtain the authorization of one of the two parents which is mandatory","correct":false,"justification":"The doctor must endeavour to obtain the authorization of one of the parents or the legal representative, or verify that this has been done during the social consultation. But this authorization is not mandatory. However, the minor must be accompanied by an adult."},{"idx":2,"proposition":"In the absence of parental consent, an abortion may be performed solely by an adult accompanied by an adult.","correct":true},{"idx":3,"proposition":"If the person is a foreigner, the abortion can only be performed if he or she has been living in France for more than 3 months.","correct":false,"justification":"For foreign women: abortion is no longer subject to any condition of duration and regularity of stay in France"},{"idx":4,"proposition":"The law requires pharmacists to dispense the morning-after pill free of charge to minors","correct":true}],"type":"custom"}
+{"_id":"IVG-gyn-2","context":null,"enonce":"Concerning reception facilities:","item":"IVG","matiere":"gyn","propositions":[{"idx":0,"proposition":"The reception centre must ensure a correct reception with respect for confidentiality","correct":true},{"idx":1,"proposition":"Abortion care facilities operate seasonally","correct":false,"justification":"Structures must ensure fast deadlines with weekly operation all year round"},{"idx":2,"proposition":"An abortion can only be performed in an establishment with a surgical technical platform","correct":false,"justification":"Up to 12 weeks, they can be carried out in a simple sound establishment with a gynecology-obstetrics department"},{"idx":3,"proposition":"Abortions must be taken care of in a structure with a surgical technical platform when they are between 12 and 14 SA","correct":true},{"idx":4,"proposition":"Reception centers are required, by the HAS, to have at least one ultrasound machine with a vaginal probe","correct":true}],"type":"custom"}
+{"_id":"IVG-gyn-3","context":null,"enonce":"Regarding abortion in practice:","item":"IVG","matiere":"gyn","propositions":[{"idx":0,"proposition":"Anyone requesting an abortion must get a consultation appointment within 30 days of their call","correct":false,"justification":"Within 5 days of his call"},{"idx":1,"proposition":"The earlier abortion occurs during pregnancy, the lower the risk of complications","correct":true},{"idx":2,"proposition":"Access to abortion must therefore be simple and fast in all circumstances","correct":true},{"idx":3,"proposition":"Abortions require 24-hour hospitalization for monitoring and psychological support","correct":false,"justification":"Except in exceptional cases, abortions must be performed on an outpatient basis or in a day hospital (stay of less than 12 hours). This in a concern for confidentiality in particular"},{"idx":4,"proposition":"A psychosocial interview is systematically offered for adults","correct":true}],"type":"custom"}
+{"_id":"IVG-gyn-4","context":null,"enonce":"Which propositions are true?","item":"IVG","matiere":"gyn","propositions":[{"idx":0,"proposition":"The psychosocial interview is mandatory for adults","correct":false,"justification":"It is not mandatory but it is proposed"},{"idx":1,"proposition":"Psychosocial retention is compulsory for minors","correct":true},{"idx":2,"proposition":"We must try to understand the reasons for the failure of current contraception or its absence","correct":true},{"idx":3,"proposition":"Gestational age is deduced from the interrogation or ultrasound","correct":true},{"idx":4,"proposition":"The subsequent contraceptive method must be prescribed from the visit preceding the abortion","correct":false,"justification":"It is discussed and discussed, but it is by no means mandatory (neither to prescribe it, nor that the patient accepts it)"}],"type":"custom"}
+{"_id":"IVG-gyn-5","context":null,"enonce":"Regarding the initial consultation:","item":"IVG","matiere":"gyn","propositions":[{"idx":0,"proposition":"The cooling-off period is 7 days and must be respected in all circumstances","correct":false,"justification":"There is no longer a mandatory reflection period of 7 days (or 48 hours) between the two consultations."},{"idx":1,"proposition":"All propositions are true","correct":false,"justification":""},{"idx":2,"proposition":"All patients should have Rhesus groupage and RAI","correct":true},{"idx":3,"proposition":"If Rhesus is positive, a prophylactive injection of anti-D gamma globulins should be performed","correct":false,"justification":"If the Rhesus is negative, a prevention of Rhesus immunization by an injection of gamma globulins anti-D, should be carried out at the time of the act"},{"idx":4,"proposition":"The initial certificate of request for abortion must be given to the patient if the doctor agrees to perform the abortion","correct":true}],"type":"custom"}
+{"_id":"IVG-gyn-6","context":null,"enonce":"Regarding the second abortion consultation:","item":"IVG","matiere":"gyn","propositions":[{"idx":0,"proposition":"The second consultation is carried out 21 days after the initial consultation","correct":false,"justification":"7 days after the initial consultation, which corresponds to the cooling-off period"},{"idx":1,"proposition":"The patient must confirm the abortion request in writing during the second consultation","correct":true},{"idx":2,"proposition":"If the patient is a minor, she must present the certificate of social maintenance","correct":true},{"idx":3,"proposition":"The second consultation is when the abortion is performed","correct":false,"justification":"This is a confirmatory consultation. Abortion is performed at the third consultation"},{"idx":4,"proposition":"A surgical abortion can do without a pre-anhesthesic consultation since anhesthesia is local","correct":false,"justification":"Pre-anesthetic consultation necessary in case of surgical abortion. They are also not reserved for general anesthesia."}],"type":"custom"}
+{"_id":"IVG-gyn-8","context":null,"enonce":"Concerning abortion techniques","item":"IVG","matiere":"gyn","propositions":[{"idx":0,"proposition":"Post-abortion consultation is done between the 14th and 21st day after the act","correct":true},{"idx":1,"proposition":"It is impossible to perform an abortion under general anesthesia","correct":false,"justification":"In all cases where possible, women must be able to choose the technique, medical or surgical, as well as the mode of anesthesia, local or general."},{"idx":2,"proposition":"Surgery involves dilation of the cervix and evacuation of uterine contents by aspiration","correct":true},{"idx":3,"proposition":"A medicated cervical preparation can help with cervical dilation in surgical technique","correct":true},{"idx":4,"proposition":"The medical technique is based on the combination of antiprogesterone and prostaglandins","correct":true}],"type":"custom"}
+{"_id":"usagemedic-therapeutique-0","context":null,"enonce":"Which of the following are complications of low molecular weight heparins?","item":"usagemedic","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Thrombocytopenia","correct":true},{"idx":1,"proposition":"Decreased creatinine","correct":true},{"idx":2,"proposition":"Skin necrosis","correct":true,"justification":"True, at the injection site. Patients are therefore asked to vary the injection sites as much as possible."},{"idx":3,"proposition":"Hemolytic anemia","correct":false,"justification":"Not described"},{"idx":4,"proposition":"Neutrophilia","correct":false,"justification":"Not described"}],"type":"custom"}
+{"_id":"usagemedic-therapeutique-1","context":null,"enonce":"Which of the following are drug causes of MAT?","item":"usagemedic","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"NSAIDs","correct":false,"justification":"Functional IR, glomerular involvement and allergic nephritis"},{"idx":1,"proposition":"Interferon","correct":false,"justification":"Glomerular involvement"},{"idx":2,"proposition":"Clopidogrel","correct":true},{"idx":3,"proposition":"Ciclosporin","correct":true},{"idx":4,"proposition":"Mycophenolic acid","correct":false,"justification":"No kidney damage"}],"type":"custom"}
+{"_id":"usagemedic-therapeutique-2","context":null,"enonce":"Which of the following are drug causes of functional renal failure?","item":"usagemedic","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Paracetamol","correct":false,"justification":"Hepatic elimination"},{"idx":1,"proposition":"IEC","correct":true,"justification":"True, by inhibition of vasoconstriction of efferent arteriole"},{"idx":2,"proposition":"Cisplatin","correct":false,"justification":"Renal organ failure due to direct tubular toxicity"},{"idx":3,"proposition":"NSAIDs","correct":true},{"idx":4,"proposition":"Diuretics","correct":true,"justification":"True, not hypovolemia"}],"type":"custom"}
+{"_id":"epidemio-sp-0","context":null,"enonce":"Regarding general information on epidemiological investigations:","item":"epidemio","matiere":"sp","propositions":[{"idx":0,"proposition":"Epidemiology is a discipline that deals with health problems within a population","correct":true,"justification":"TRUE. This is the description given in the Public Health KB"},{"idx":1,"proposition":"An experiment is any investigation where the attribution of exposure is controlled by the proponent alone.","correct":false,"justification":"An experiment is any investigation where the attribution of exposure is controlled by the investigator."},{"idx":2,"proposition":"In epidemiology, studies are most often experimental","correct":false,"justification":"They are rare in epidemiology because the exposure of subjects to a particular factor often cannot be controlled."},{"idx":3,"proposition":"Experimental studies may or may not be randomized","correct":true},{"idx":4,"proposition":"Observational surveys are very rare in epidemiology","correct":false,"justification":"Observational surveys are often the only possible ones. Their interpretation is often more difficult, but they have the advantage of reflecting more faithfully the real situation of the subjects of a population.\""}],"type":"custom"}
+{"_id":"epidemio-sp-1","context":null,"enonce":"Regarding observational epidemiology:","item":"epidemio","matiere":"sp","propositions":[{"idx":0,"proposition":"Prevalence is a parameter from analytical epidemiology","correct":false,"justification":"Descriptive epidemiology, incidence and evolution"},{"idx":1,"proposition":"Incidence is a parameter from evaluative epidemiology","correct":false,"justification":"Descriptive epidemiology, prevalence and evolution"},{"idx":2,"proposition":"The cohort study is part of analytical epidemiology","correct":true},{"idx":3,"proposition":"There are 2 types of observational epidemiology: descriptive and analytical","correct":false,"justification":"3: descriptive, analytical and evaluative"},{"idx":4,"proposition":"There are 3 types of analytical studies: cohorts, case-controls and cross-sectional studies","correct":true}],"type":"custom"}
+{"_id":"pathogeria-geria-1","context":null,"enonce":"Among these proposals, which ones designate markers of fragility of the elderly?","item":"pathogeria","matiere":"geria","propositions":[{"idx":0,"proposition":"Programmed weight loss","correct":false,"justification":"A marker of fragility only when it is involuntary"},{"idx":1,"proposition":"A muscle test < 3\/5","correct":false,"justification":"It's pathological when it's so pathological. But decreased grip strength (with normal testing) is a marker"},{"idx":2,"proposition":"Sedentary lifestyle","correct":true},{"idx":3,"proposition":"Poor endurance","correct":true},{"idx":4,"proposition":"Accelerated walking speed","correct":false,"justification":"It is slowed down"}],"type":"custom"}
+{"_id":"pathogeria-geria-2","context":null,"enonce":"Regarding the cork model:","item":"pathogeria","matiere":"geria","propositions":[{"idx":0,"proposition":"The 1 concerns the decompensating factor","correct":false,"justification":"Physiological aging"},{"idx":1,"proposition":"The 2 corresponds to the chronic disease","correct":true},{"idx":2,"proposition":"The 2 corresponds to acute stress","correct":false,"justification":"It's the 3"},{"idx":3,"proposition":"The 3 corresponds to physiological aging","correct":false,"justification":"Acute stress = Decompensating factor"},{"idx":4,"proposition":"The 2 corresponds to the decompensating factor","correct":false,"justification":"3"}],"type":"custom"}
+{"_id":"securisation-sp-1","context":null,"enonce":"Regarding the PACTE:","item":"securisation","matiere":"sp","propositions":[{"idx":0,"proposition":"It is the Certified Advancement Program in Technical and Experience","correct":false,"justification":"This is the Continuous Improvement Program of Teamwork"},{"idx":1,"proposition":"It is proposed by the Ministry of Health","correct":false,"justification":"By the HAS (sorry for the trap)"},{"idx":2,"proposition":"The primary issue is patient safety","correct":true},{"idx":3,"proposition":"The primary challenge is to reduce EIAS to an acceptable level.","correct":true,"justification":"i.e. to ensure patient safety"},{"idx":4,"proposition":"It was proposed in 1996","correct":false,"justification":"2015"}],"type":"custom"}
+{"_id":"securisation-sp-2","context":null,"enonce":"Regarding team accreditation","item":"securisation","matiere":"sp","propositions":[{"idx":0,"proposition":"Debriefing is the short sharing of information before team action","correct":false,"justification":"Debriefing: Short information sharing after the team action."},{"idx":1,"proposition":"Team accreditation has been launched by the ANSM","correct":false,"justification":"Launched by the HAS"},{"idx":2,"proposition":"Physician accreditation involves an evaluative component and a cognitive component","correct":true},{"idx":3,"proposition":"Team accreditation is complemented by a collective work dimension","correct":true},{"idx":4,"proposition":"Team accreditation has been launched by the HAS","correct":true}],"type":"custom"}
+{"_id":"recherche-sp-1","context":null,"enonce":"Regarding the formulation of the scientific question:","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"It must respect the PACOTI elements","correct":false,"justification":"This is PICOT, for P = study population, I = the type of intervention, C = the comparison group, O = outcome (= outcome) and T = type of study"},{"idx":1,"proposition":"There must be an element of comparison\/control","correct":true},{"idx":2,"proposition":"The outcome must be clear","correct":true},{"idx":3,"proposition":"The population studied may be vague (for example: seniors)","correct":false,"justification":"The type of population must be extremely well detailed."},{"idx":4,"proposition":"The design of the study is chosen according to the question","correct":true}],"type":"custom"}
+{"_id":"recherche-sp-2","context":null,"enonce":"Regarding literature search and Clinical Research Methodology hypotheses","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"HO: alternative hypothesis (which we wish to reject)","correct":false,"justification":"HO: null hypothesis"},{"idx":1,"proposition":"H1: alternative hypothesis that we wish to demonstrate","correct":true},{"idx":2,"proposition":"Documentary research is a process of identifying relevant information","correct":true},{"idx":3,"proposition":"Literature search should aim for completeness","correct":true},{"idx":4,"proposition":"The formulation of the research question is an essential step","correct":true}],"type":"custom"}
+{"_id":"recherche-sp-3","context":null,"enonce":"Which of these proposals are secondary sources of information?","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"Nature Medicine","correct":false,"justification":"Primary source"},{"idx":1,"proposition":"The HAS","correct":true,"justification":"Produces professional recommendations"},{"idx":2,"proposition":"The ANSM","correct":true,"justification":"Produces professional recommendations on the use of the drug"},{"idx":3,"proposition":"NICE in the United States","correct":false,"justification":"NICE is in England. It is indeed a secondary source (equivalent to HAS)"},{"idx":4,"proposition":"AHRQ in England","correct":false,"justification":"The AHRQ is in the USA. It is indeed a secondary source (equivalent to HAS)\""}],"type":"custom"}
+{"_id":"recherche-sp-4","context":null,"enonce":"Which of these proposals are part of 'grey literature'?","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"The INSERM journal","correct":false,"justification":"It is a secondary source"},{"idx":1,"proposition":"Conference proceedings","correct":true},{"idx":2,"proposition":"BMJ Summaries","correct":false,"justification":"It is a primary source"},{"idx":3,"proposition":"Publications of learned societies","correct":false,"justification":"It is a secondary source"},{"idx":4,"proposition":"Government documents","correct":true}],"type":"custom"}
+{"_id":"recherche-sp-5","context":null,"enonce":"Concerning the bibliographic search of Methodology in clinical research","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"The primary sources are the recommendations of the HAS (in France)","correct":false,"justification":"Primary sources are accessible reports Either in the form of a summary in electronic banks: study, data Or in full by the search of the periodical (paid access most often)"},{"idx":1,"proposition":"Accessibility to primary sources is extremely simple (internet search)","correct":false,"justification":"Accessibility to primary sources is problematic: cost of subscriptions, time needed for research, need for training, etc. 2.3.2. Secondary sources"},{"idx":2,"proposition":"Secondary sources convey information directly from research laboratories","correct":false,"justification":"Secondary sources convey information previously digested by an intermediary Syntheses, literature reviews, meta-analyses, professional recommendations The intermediaries are mainly:"},{"idx":3,"proposition":"The journal Prescrire is independent of the pharmaceutical industry","correct":true},{"idx":4,"proposition":"\"Grey literature\" refers to publications funded by the pharmaceutical industry","correct":false,"justification":"The search for \"grey literature\": literature not indexed in conventional channels of information dissemination (congresses, government documents, unpublished studies, other unconventional documents)\""}],"type":"custom"}
+{"_id":"recherche-sp-7","context":null,"enonce":"Which of these propositions are true?","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"OPHANET is a research server on diseases concerning orphans","correct":false,"justification":"Open access rare disease and orphan drug information server for professionals and the general public"},{"idx":1,"proposition":"ORPHANET is a non-scientifically validated portal set up by patients","correct":false,"justification":"Global Reference Portal on Rare Diseases"},{"idx":2,"proposition":"Comprehensive and effective keyword research is important to find relevant results","correct":true},{"idx":3,"proposition":"Reading the summaries of the publications allows you to make a first sort","correct":true},{"idx":4,"proposition":"The abundance of references requires a critical mind at all times","correct":true}],"type":"custom"}
+{"_id":"recherche-sp-9","context":null,"enonce":"Regarding the different types of research","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"Routine care research is a type of non-interventional research","correct":false,"justification":"Intervention research because there are specific monitoring modalities"},{"idx":1,"proposition":"Biomedical research is a type of intervention research","correct":true},{"idx":2,"proposition":"Biomedical research focuses on health products only","correct":false,"justification":"May also include things other than health products"},{"idx":3,"proposition":"Biomedical research involves action on the person","correct":true,"justification":"It is a type of intervention research"},{"idx":4,"proposition":"Randomized controlled tests (RCTs) are interventional","correct":true}],"type":"custom"}
+{"_id":"recherche-sp-10","context":null,"enonce":"Which of these propositions are true?","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"Sample research is generally non-interventional","correct":true},{"idx":1,"proposition":"Data research is generally non-interventional","correct":true},{"idx":2,"proposition":"Biomedical research is carried out on human beings with a view to developing biological or medical knowledge","correct":true},{"idx":3,"proposition":"Biomedical research involves sick people only","correct":false,"justification":"Involves an action on the person (healthy or sick) who habitually takes care of modifies the RESEARCH"},{"idx":4,"proposition":"Routine care research is an assessment of current medical practices","correct":true}],"type":"custom"}
+{"_id":"recherche-sp-12","context":null,"enonce":"Which of these propositions are true?","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"The preclinical phase takes place in vitro (cells or cell cultures) and\/or in vivo (animal)","correct":true},{"idx":1,"proposition":"Clinical trials are organized in 3 phases","correct":false,"justification":"Clinical trials are organized in 4 phases (see table) In total, 10 to 15 years are needed for the research and development of a new drug. PHASES OF THE CLINICAL TRIAL POPULATION OBJECTIVES l F#iB PHASE I PHASE IL Healthy volunteers ■ Safety (maximum tolerated dose) Small number in some (Patients ■ Toxicity cases, in ■ Pharmacokinetics oncology for example) Patients (effective dose) Small number ■ Pharmacodynamics ■ Efficacy PHASE Ill Patients Large comparative number ■ Efficacy ■ Toxicity Ratio ■ benefit\/risk PHASE IV General population ■ Pharmacovigilance of new ■ Research After MA indications = study of the fate of the drug in the body: absorption, metabolism, pharmacokinetics distribution and elimination Pharmacodynamics Toxicity MA = Authorization = side effects of Marketing = effect of the drug on the body 0 (.9 LJ. J a: (.9 LJ. J a: CO 0 z a: LJ. J > in z 0 fC = 0 LJ. J @ 228 ITEM 18 1 THE METHODOLOGY OF EXPERIMENTAL AND CLINICAL RESEARCH 4.2. REGULATORY FRAMEWORK FOR THERAPEUTIC TRIALS The founding texts 4.2.1. The founding texts:"},{"idx":2,"proposition":"In total, it takes between 10 and 15 years to develop a new drug","correct":true},{"idx":3,"proposition":"Phase 2 involving patients with small numbers of patients","correct":true},{"idx":4,"proposition":"The objective of Phase 3 is to assess the benefit\/risk balance","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"Kcpancreas-onco-0","context":null,"enonce":"Which of the following are true?","item":"Kcpancreas","matiere":"onco","propositions":[{"idx":0,"proposition":"Cephalic duodenopancreatectomy (CPD) is the gold standard of care for tail pancreatic tumours","correct":false,"justification":"pancreatic head tumour = cephalic duodenopancreatectomy"},{"idx":1,"proposition":"Cephalic duodenopancreatectomy (CPD) is the standard of care for tumours of the body of the pancreas","correct":false,"justification":"pancreatic head tumour = cephalic duodenopancreatectomy"},{"idx":2,"proposition":"Cephalic duodenopancreatectomy (CPD) is the standard of care for pancreatic head tumours","correct":true},{"idx":3,"proposition":"Left splenopancreatectomy is the standard of care for left pancreatic tumours","correct":true},{"idx":4,"proposition":"Left splenopancreatectomy is the standard of care for pancreatic head tumours","correct":false,"justification":"left pancreatic tumour = left splenopancreatectomy"}],"type":"custom"}
+{"_id":"Kcpancreas-onco-1","context":null,"enonce":"Which of the following are true?","item":"Kcpancreas","matiere":"onco","propositions":[{"idx":0,"proposition":"Serous cystadenoma degenerates only exceptionally","correct":true},{"idx":1,"proposition":"Mucinous cystadenoma never degenerates","correct":false,"justification":"It can degenerate"},{"idx":2,"proposition":"Cystic tumors of the pancreas are most often of incidental discovery","correct":true},{"idx":3,"proposition":"Ultrasound is the exam of choice to study cystic tumors of the pancreas","correct":false,"justification":"First-line examinations are CT and MRI"},{"idx":4,"proposition":"Mucosal cystadenoma does not communicate with the main pancreatic duct","correct":true}],"type":"custom"}
+{"_id":"Kcpancreas-onco-2","context":null,"enonce":"Which of the following are useful markers for the diagnosis and\/or monitoring of neuroendocrine tumours?","item":"Kcpancreas","matiere":"onco","propositions":[{"idx":0,"proposition":"Ca 15-3","correct":false,"justification":"False"},{"idx":1,"proposition":"Amylasemia","correct":false,"justification":"This dosage should no longer be done (College of HGE, 4th edition)"},{"idx":2,"proposition":"Chromogranin A","correct":true,"justification":"True. It is a general marker of all neuroendocrine tumors. The college of HGE (4th edition) does not report other markers to be measured"},{"idx":3,"proposition":"Alpha feto protein ","correct":false,"justification":"False"},{"idx":4,"proposition":"TP53","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"Kcpancreas-onco-3","context":null,"enonce":"Which of the following are true for endocrine pancreatic tumors?","item":"Kcpancreas","matiere":"onco","propositions":[{"idx":0,"proposition":"Pancreatic neuroendocrine tumors are malignant in more than 60% of cases","correct":true,"justification":"True (outside insulinoma)"},{"idx":1,"proposition":"Symptoms are related to hormonal secretion","correct":true},{"idx":2,"proposition":"Gastrinoma causes maladaptive organic hypoglycemia","correct":false,"justification":"This is the case with insulinoma. Gastrinoma causes recurrent OGD ulcers and diarrhea"},{"idx":3,"proposition":"Necrolytic erythema migrans may be a sign of glucagonoma","correct":true},{"idx":4,"proposition":"No additional imaging is required","correct":false,"justification":"Spiral TAP CT +\/- Abdo MRI (liver metastases) +\/- endoscopic ultrasound (if little or not visible)"}],"type":"custom"}
+{"_id":"Kcos-onco-0","context":null,"enonce":"Which of the following are tumors that preferentially metastasize to the bones?","item":"Kcos","matiere":"onco","propositions":[{"idx":0,"proposition":"Thyroid","correct":true},{"idx":1,"proposition":"Kidney","correct":true},{"idx":2,"proposition":"Lung","correct":true},{"idx":3,"proposition":"Breast","correct":true},{"idx":4,"proposition":"Brain","correct":false,"justification":"Brain tumors hardly metastasize"}],"type":"custom"}
+{"_id":"EI-cardio-0","context":null,"enonce":"About infective endocarditis","item":"EI","matiere":"cardio","propositions":[{"idx":0,"proposition":"The appearance or increase of a heart murmur in a febrile context is very suggestive of the diagnosis","correct":true},{"idx":1,"proposition":"The diagnosis should also be evoked in front of a stroke, purpura or febrile low back pain.","correct":true},{"idx":2,"proposition":"Fever is the most constant symptom","correct":true},{"idx":3,"proposition":"The absence of breath makes it possible to exclude the diagnosis","correct":false,"justification":"However, the absence of breath does not exclude the diagnosis"},{"idx":4,"proposition":"Any febrile heart failure should suggest the diagnosis of endocarditis","correct":true}],"type":"custom"}
+{"_id":"EI-cardio-1","context":null,"enonce":"About infective endocarditis","item":"EI","matiere":"cardio","propositions":[{"idx":0,"proposition":"The two pillars of AE diagnosis are blood cultures and echocardiography","correct":true},{"idx":1,"proposition":"Blood cultures isolate the responsible microorganism in 100% of cases","correct":false,"justification":"They make it possible to isolate the responsible microorganism in 90% of cases"},{"idx":2,"proposition":"They should be repeated for 2 or 3 days if the initial blood cultures are negative, especially in subjects who have received antibiotics.","correct":true},{"idx":3,"proposition":"The suspicion of AE is to be reported to the microbiology laboratory, because it sometimes takes a long culture time for microorganisms with difficult growth (HACEK group, Brucella, deficient streptococci, yeasts)","correct":true},{"idx":4,"proposition":"Echocardiography affirms the diagnosis in front of one of the characteristic lesions: vegetation, abscess, valve perforation or disinsertion of prosthesis","correct":true}],"type":"custom"}
+{"_id":"EI-cardio-2","context":null,"enonce":"About infective endocarditis","item":"EI","matiere":"cardio","propositions":[{"idx":0,"proposition":"Vegetation is identified by transthoracic echocardiography (ETT) or transesophageal ultrasound (TEO) especially in case of valve prosthesis","correct":true},{"idx":1,"proposition":"The periannular abscess, on native valve or prosthesis, is present in 30% of cases, most often visible in ETT","correct":false,"justification":"The periannular abscess, on native valve or prosthesis, is present in 30% of cases, most often visible in ETO and on the aortic ring rather than mitral"},{"idx":2,"proposition":"Gastric fibroscopy or colonoscopy in case of germ of digestive origin are performed in search of the front door","correct":true},{"idx":3,"proposition":"The clinical manifestations of endocarditis are very varied, not very specific and can affect several organs","correct":true},{"idx":4,"proposition":"Diagnostic classification of infectious endocarditis based on Jones criteria","correct":false,"justification":"Classification de Duke"}],"type":"custom"}
+{"_id":"EI-infectio-0","context":null,"enonce":"About infective endocarditis","item":"EI","matiere":"infectio","propositions":[{"idx":0,"proposition":"Infective endocarditis (IE) is a rare but serious infection","correct":true},{"idx":1,"proposition":"Staphylococci (mainly Staphylococcus aureus) and streptococci are responsible for 50% of cases of infectious endocarditis","correct":false,"justification":"0.8"},{"idx":2,"proposition":"The rapid initiation of antibiotic therapy is crucial even before blood culture is performed","correct":false,"justification":"The identification of the causative infectious agent is crucial for diagnosis and treatment: 3 aero-anaerobic blood cultures should be collected before any antibiotic therapy in case of suspicion of AE"},{"idx":3,"proposition":"When AE is suspected, an echocardiogram should be performed as soon as possible and repeated if the first is negative.","correct":true},{"idx":4,"proposition":"Renal (glomerulonephritis) and digestive complications are the most frequent and serious complications","correct":false,"justification":"Cerabral and cardiac complications are the most frequent and serious complications"}],"type":"custom"}
+{"_id":"EI-infectio-1","context":null,"enonce":"About infective endocarditis","item":"EI","matiere":"infectio","propositions":[{"idx":0,"proposition":"Management of patients with AE without signs of severity can now be ambulatory","correct":false,"justification":"The management is hospitable and must involve an experienced multidisciplinary team"},{"idx":1,"proposition":"Indications for antibiotic prophylaxis of infective endocarditis are restricted to invasive dental procedures","correct":true},{"idx":2,"proposition":"Infective endocarditis (IE) is an infection of one or more heart valves, native or prosthetic, most often by bacteria, more rarely by a fungus","correct":true},{"idx":3,"proposition":"Right heart valves are affected more often (90% of cases) than left heart valves","correct":false,"justification":"The valves of the infectious left heart are more often affected (90% of cases) than the valves of the right heart (mainly tricuspid valve in case of drug addiction)"},{"idx":4,"proposition":"Bacterial grafting at the endocardium level results in the development of infectious lesions associating vegetations and progressive lesions consisting of fibrin clusters.","correct":true}],"type":"custom"}
+{"_id":"EI-infectio-2","context":null,"enonce":"About infective endocarditis","item":"EI","matiere":"infectio","propositions":[{"idx":0,"proposition":"It affects men more than women and is more common before age 70.","correct":false,"justification":"After 70 years TRUE"},{"idx":1,"proposition":"Predisposing factors are intravenous drug addiction, prosthetic heart valves, degenerative valve sclerosis.","correct":true},{"idx":2,"proposition":"Oral streptococci have supplanted staphylococci and are in first place in the distribution of infectious agents responsible for AEs","correct":false,"justification":"Staphylococci occupy the 1st place"},{"idx":3,"proposition":"The most frequent streptococci are oral streptococci, of oral origin, and Streptococcus gallolyticus","correct":true},{"idx":4,"proposition":"In 40-50% of cases, blood cultures remain negative and the causative agent may not be identified","correct":false,"justification":"In only 5 to 10% of cases"}],"type":"custom"}
+{"_id":"tbmiction-uro-0","context":null,"enonce":"Regarding the basics of urinary incontinence:","item":"tbmiction","matiere":"uro","propositions":[{"idx":0,"proposition":"The diagnosis of urinary incontinence is clinical","correct":true},{"idx":1,"proposition":"Urinary incontinence is defined as a subjective feeling of urinary loss","correct":false,"justification":"Urinary incontinence is defined as an involuntary loss of urine, objectively demonstrable, constituting a social and\/or hygiene problem."},{"idx":2,"proposition":"It is first and foremost a deficiency","correct":true},{"idx":3,"proposition":"For women, it is a major public health problem","correct":true},{"idx":4,"proposition":"Urinary incontinence in men is due to prostate pathology in 95% of cases","correct":false,"justification":"Especially iatrogenic and prostate"}],"type":"custom"}
+{"_id":"tbmiction-uro-1","context":null,"enonce":"For UI and EUI (effort):","item":"tbmiction","matiere":"uro","propositions":[{"idx":0,"proposition":"It is defined as \"involuntary loss of urine through the urethra\"","correct":true},{"idx":1,"proposition":"Overactive bladder urinary incontinence is due to sphincter insufficiency","correct":false,"justification":"Sphincter insufficiency = UI of cerco-cystoptosis\/hypermobility origin. It is a type of UI in itself"},{"idx":2,"proposition":"Effort UI is human specific","correct":false,"justification":"It is more common in women, especially postmenopausal women, with a history of obstetric trauma"},{"idx":3,"proposition":"There are two types of mechanisms explaining SUI: cervicocystoptosis\/urethral hypermobility (HMU) and sphincter insufficiency (SI)","correct":true},{"idx":4,"proposition":"There is no etiology specific to the SUI","correct":false,"justification":"Many possible etiologies: trauma, trophic disorders, urological disorders, neurological disorders, etc."}],"type":"custom"}
+{"_id":"tbmiction-uro-2","context":null,"enonce":"Regarding the interrogation:","item":"tbmiction","matiere":"uro","propositions":[{"idx":0,"proposition":"SUI is an involuntary loss preceded by an urgent and uninhibited need from the outset","correct":false,"justification":"This is the case with overactive bladder UI"},{"idx":1,"proposition":"Bladder hyperactivity UI is an involuntary loss of urine without feeling of craving","correct":false,"justification":"There is the feeling of urge"},{"idx":2,"proposition":"Obesity promotes SUI","correct":true},{"idx":3,"proposition":"Intense sports activity protects against UI","correct":false,"justification":"RR is greater than 1"},{"idx":4,"proposition":"Drug treatments must be identified because some aggravate the voiding status and in particular anticholinergics and opioids (decrease in bladder contraction)","correct":true}],"type":"custom"}
+{"_id":"addpsychotropes-psy-0","context":null,"enonce":"General:","item":"addpsychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Addiction is often the result of inappropriate prescriptions","correct":true},{"idx":1,"proposition":"Among psychotropic drugs, benzodiazepines and related have a very marked addictive potential","correct":true},{"idx":2,"proposition":"About 2% of women in France have been prescribed benzodiazepines or related benzodiazepines","correct":false,"justification":"About 12%"},{"idx":3,"proposition":"Harmful use results in medical complications or prolonged social repercussions","correct":true},{"idx":4,"proposition":"Dependence is defined by an inability to stop use because the desire to stop is not present","correct":false,"justification":"Dependence is defined by an inability to stop benzodiazepine use, either because of signs of withdrawal or because of excessive cravings."}],"type":"custom"}
+{"_id":"addpsychotropes-psy-1","context":null,"enonce":"Regarding the effect of benzodiazepines:","item":"addpsychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"In case of dependence, there is a risk of withdrawal syndrome at the sudden cessation of consumption","correct":true},{"idx":1,"proposition":"Benzodiazepines are GABA-A agonists","correct":true},{"idx":2,"proposition":"In therapy, benzodiazepines are used exclusively for sedative purposes","correct":false,"justification":"In therapeutics, benzodiazepines are used for anxiolytic, sedative and hypnotic purposes, but also muscle relaxant and anticonvulsant"},{"idx":3,"proposition":"Benzodiazepines and related drugs are among the most prescribed psychotropic treatments in France and Europe","correct":true},{"idx":4,"proposition":"3 benzodiazepines or related benzodiazepines are currently marketed in France","correct":false,"justification":"There are 22"}],"type":"custom"}
+{"_id":"addpsychotropes-psy-2","context":null,"enonce":"Regarding the consequence of benzodiazepine addiction:","item":"addpsychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Benzodiazepines are anorectic","correct":false,"justification":"They are orogenic and require a check-up (EAL and blood glucose)"},{"idx":1,"proposition":"60% of benzodiazepine or related users are women","correct":true},{"idx":2,"proposition":"Prescriptions rarely exceed 2 months","correct":false,"justification":"Half of the subjects treated with this type of molecule are treated for a period of more than two years"},{"idx":3,"proposition":"In case of significant disturbances of alertness, benzodiazepine poisoning is a vital emergency","correct":true},{"idx":4,"proposition":"It is very clearly established an increase in the risk of dementia type Alzheimer's disease in case of prolonged use of benzodiazepines","correct":false,"justification":"French authors have recently found an increased risk of Alzheimer's dementia in case of prolonged use of benzodiazepines, but these results are still debated internationally."}],"type":"custom"}
+{"_id":"autoformation-sp-0","context":null,"enonce":"Concerning continuing training","item":"autoformation","matiere":"sp","propositions":[{"idx":0,"proposition":"Article analysis is a standardised method of analysing a study in order to assess its quality and to be able to define the level of evidence.","correct":true},{"idx":1,"proposition":"Assessing the conflicts of interest of the CPP is done by the AGREE grid (second version)","correct":false,"justification":"Assessing quality"},{"idx":2,"proposition":"The AGREE grid is used to develop a method for creating CPRs","correct":true},{"idx":3,"proposition":"Advances in medical knowledge require an effort of synthesis","correct":true},{"idx":4,"proposition":"The only method to develop recommendations is the PRC","correct":false,"justification":"There are several methods, 2 will be presented: Consensus Conference (CC) Recommendations for Clinical Practice\""}],"type":"custom"}
+{"_id":"autoformation-sp-1","context":null,"enonce":"Concerning consensus conferences","item":"autoformation","matiere":"sp","propositions":[{"idx":0,"proposition":"Consensus conference begins with the presentation of expert reports synthesizing knowledge at a public conference","correct":true},{"idx":1,"proposition":"The second step in a consensus conference is the drafting of recommendations by a multidisciplinary jury in a public manner.","correct":false,"justification":"Then the drafting of recommendations by a multidisciplinary jury behind closed doors 3.2.2. The 1. The promoter actors"},{"idx":2,"proposition":"The promoter of consensus conferences are either university hospitals or pharmaceutical companies","correct":false,"justification":"It is in practice either a scholar, an organization of health professionals, insurance organization of a health health organization, a public association, a patient society, an industrialist. .. Its role: the initiative"},{"idx":3,"proposition":"The promoter does not have the opportunity to choose the theme of the reflection","correct":false,"justification":"He chooses the theme and signals"},{"idx":4,"proposition":"The promoter provides the financial means","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"autoformation-sp-2","context":null,"enonce":"Concerning consensus conferences ","item":"autoformation","matiere":"sp","propositions":[{"idx":0,"proposition":"The organizing committee is composed of members from the promoter","correct":false,"justification":"Persons nominated by the sponsor (usually 5 to 10 members), but independent of the sponsor"},{"idx":1,"proposition":"A leader (the President of the organizing committee) is designated to organize and coordinate the meetings","correct":true},{"idx":2,"proposition":"The jury of a consensus conference is composed of 5 researchers and doctors","correct":false,"justification":"8 to 16 members, multiprofessional methodologists, researchers, other ethical, economic: physicians, and multidisciplinary representatives or legislative professionals, health, representatives of the general public"},{"idx":3,"proposition":"The jury is coordinated by a president, appointed by the organizing committee (sometimes in consultation with the promoter)","correct":true},{"idx":4,"proposition":"Jury members must have no financial or professional interest (no conflict of interest)","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"autoformation-sp-3","context":null,"enonce":"Concerning consensus conferences ","item":"autoformation","matiere":"sp","propositions":[{"idx":0,"proposition":"The bibliographic group provides an objective analysis of the literature, literature analysis without interpretation of the results","correct":true},{"idx":1,"proposition":"The experts are chosen by the organizing committee","correct":true},{"idx":2,"proposition":"Experts must have particular expertise on the theme of the conference (recent works and publications)","correct":true},{"idx":3,"proposition":"The composition of the expert panel must be representative of the diversity of opinions on the subject","correct":true},{"idx":4,"proposition":"The expert group must present its results orally to the jury","correct":false,"justification":"Provide a text gathering the information (from their experience and literature) to answer\""}],"type":"custom"}
+{"_id":"autoformation-sp-4","context":null,"enonce":"Regarding recommendations for clinical practice ","item":"autoformation","matiere":"sp","propositions":[{"idx":0,"proposition":"The CPM is an analysis of the extensive literature by a working group that drafts the recommendations","correct":true},{"idx":1,"proposition":"The subject to be dealt with must be sufficiently broad","correct":true},{"idx":2,"proposition":"Literature data must be diverse and dispersed","correct":true},{"idx":3,"proposition":"We make a PRC when there is a lot of controversy on the subject","correct":false,"justification":"There is little controversy"},{"idx":4,"proposition":"Proponent takes the lead in developing recommendations","correct":true}],"type":"custom"}
+{"_id":"autoformation-sp-6","context":null,"enonce":"Concerning links and conflicts of interest","item":"autoformation","matiere":"sp","propositions":[{"idx":0,"proposition":"The concept of a link of interests covers the interests or activities, past or present, patrimonial, professional or family, of the expert in relation to the object of the expert opinion entrusted to him.","correct":true},{"idx":1,"proposition":"A conflict of interest arises from a situation in which the links of interest of an expert are by their nature or to call into question his impartiality or independence.","correct":true},{"idx":2,"proposition":"The declaration of links of interest is optional if one has nothing to reproach oneself with.","correct":false,"justification":"It is mandatory"},{"idx":3,"proposition":"The declaration of links of interests concerns direct and indirect links","correct":true},{"idx":4,"proposition":"The declaration of links of interest concerns only physicians","correct":false,"justification":"It must be carried out by any expert called upon to draw up expertise in the field of health and health safety\""}],"type":"custom"}
+{"_id":"autoformation-sp-7","context":null,"enonce":"Concerning links of interest and their impacts","item":"autoformation","matiere":"sp","propositions":[{"idx":0,"proposition":"The declaration of links of interest engages the responsibility of the order of physicians which must ensure that it is updated","correct":false,"justification":"It engages the responsibility of the declarant, who must ensure that it is sincere, up-to-date (continuous updating) and exhaustive"},{"idx":1,"proposition":"The anteriority of the links to be declared is 15 years","correct":false,"justification":"The anteriority of the links to be declared is 5 years"},{"idx":2,"proposition":"The longer a collaboration lasts, the stronger the impact of the link of interest will be.","correct":true},{"idx":3,"proposition":"Too strong links of interest can lead to erroneous expert conclusions","correct":true},{"idx":4,"proposition":"The stronger a healthcare professional's interests, the more patients trust him\/her.","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"dyslip-cardio-0","context":null,"enonce":"About Dyslipidemia","item":"dyslip","matiere":"cardio","propositions":[{"idx":0,"proposition":"LDL-cholesterol is the most powerful cardiovascular lipid risk factor","correct":true},{"idx":1,"proposition":"Pure hypercholesterolemia affects 10% of 35-64 year olds.","correct":false,"justification":"30% ! All dyslipidemias combined, 51% of this population is concerned"},{"idx":2,"proposition":"The LDLc level is calculated with the Friedewald formula only if the triglyceride level is greater than 4g\/L","correct":false,"justification":"Less than 4g\/L, or 4.6 mmol\/L"},{"idx":3,"proposition":"An EAL is routinely requested for an overweight individual (BMI >25)","correct":false,"justification":"Systematic in case of obesity (BMI >30)"},{"idx":4,"proposition":"If a screening EAL is abnormal, it should be repeated","correct":true,"justification":"It is then associated with a measurement of fasting blood glucose"}],"type":"custom"}
+{"_id":"dyslip-cardio-1","context":null,"enonce":"About Dyslipidemia","item":"dyslip","matiere":"cardio","propositions":[{"idx":0,"proposition":"Tuberous xanthomas are a clinical sign of hypertriglyceridemia","correct":false,"justification":"Hypercholesterolemia"},{"idx":1,"proposition":"During an EAL, in the creaming test, a cloudy subnatant indicates an abnormality in the chylomicronemia level","correct":false,"justification":"An anomaly in the VLDL level. A creamy supernatant indicates an abnormality in the rate of chylomicronemia."},{"idx":2,"proposition":"In the Frederickson classification, dyslipidemia of phenotype IIA is pure hypercholesterolemia","correct":true,"justification":"High LDL, clear serum"},{"idx":3,"proposition":"<b>Chronic<\/b> renal failure is a cause of secondary hypercholesterolemia","correct":true},{"idx":4,"proposition":"Loop diuretics are an iatrogenic cause of mixed dyslipidemia","correct":false,"justification":"On the other hand, thiazides are"}],"type":"custom"}
+{"_id":"dyslip-cardio-2","context":null,"enonce":"About Dyslipidemia","item":"dyslip","matiere":"cardio","propositions":[{"idx":0,"proposition":"Primary monogeneic hypercholesterolemia by mutation of the LDL-cholesterol receptor is inherited autosomal dominant","correct":true,"justification":"The involvement can be heterozygous (50% functional receptors) or homozygous (0% functional, severe++)"},{"idx":1,"proposition":"Familial combined hyperlipidemia affects 1 to 2% of the general population in France","correct":true,"justification":"And 10-11% of patients who had a myocardial infarction before 60 years"},{"idx":2,"proposition":"According to the HAS 2017, the LDL-cholesterol objective to be achieved in case of moderate cardiovascular risk is a level below 1.3","correct":true,"justification":"Attention, the thresholds recommended by the ESC are different"},{"idx":3,"proposition":"In a patient with a SCORE calculated at 7% who has not reached his LDL-cholesterol goal, lipid-lowering drug therapy is indicated from the outset","correct":true,"justification":"Here, the cardiovascular risk is high (5-10%): drug treatment from the outset"},{"idx":4,"proposition":"The combination statin + fibrate is recommended from the outset in case of mixed dyslipidemia","correct":false,"justification":"The combination statin + fibrate is classically at risk and strongly discouraged"}],"type":"custom"}
+{"_id":"dyslip-cardio-3","context":null,"enonce":"About Dyslipidemia","item":"dyslip","matiere":"cardio","propositions":[{"idx":0,"proposition":"Initiation of lipid-lowering drug therapy is not recommended for primary prevention in patients over 80 years of age","correct":true},{"idx":1,"proposition":"Statins induce a decrease in triglyceride levels","correct":true,"justification":"Decrease of 10-15% on average"},{"idx":2,"proposition":"Statins are contraindicated in pregnancy","correct":true},{"idx":3,"proposition":"Cholestyramine induces myalgia ","correct":false,"justification":"This concerns statins, ezetimibe and fibrates. Cholestyramine induces digestive disorders."},{"idx":4,"proposition":"Treatment with fibrates is indicated in 1°intention in a patient with a triglyceride level of 3 g \/ L","correct":false,"justification":"Fibrates are indicated only after failure of hygienic measures, or in case of isolated severe hypertriglyceridemia"}],"type":"custom"}
+{"_id":"dyslip-cardio-4","context":null,"enonce":"About Dyslipidemia","item":"dyslip","matiere":"cardio","propositions":[{"idx":0,"proposition":"Gemfibrozil + Simvastatin is not recommended","correct":false,"justification":"It is absolutely contraindicated!! And the combination of a statin with any other fibrate is not recommended"},{"idx":1,"proposition":"A monitoring EAL is indicated 4 weeks after initiation of lipid-lowering therapy to assess effects","correct":false,"justification":"12-24 weeks in case of low\/moderate cardiovascular risk, 8-12 weeks if high\/very high"},{"idx":2,"proposition":"When the LDL-c objective is reached, a control EAL is scheduled every 3 years (except comorbidities)","correct":false,"justification":"Every year"},{"idx":3,"proposition":"CPK testing is recommended before statin initiation, 8 weeks after any dose change, and then 1 time per year","correct":false,"justification":"This concerns the control of liver function. CPK testing is only recommended in case of muscle pain or risk factor for muscle damage"},{"idx":4,"proposition":"In case of increase in CPK < 5 times normal on statins with moderate myalgia, treatment can be continued","correct":true,"justification":"CPKs are rechecked at one week. In case of severe myalgia, statins are discontinued"}],"type":"custom"}
+{"_id":"MAI-immuno-0","context":null,"enonce":"About autoimmune diseases","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"Their prevalence varies greatly from one pathology to another, but taken together, they would affect about 1% of the population of industrialized countries. ","correct":false},{"idx":1,"proposition":"Given the extreme diversity of the repertoire of these antigen receptors, the appearance of lymphocytes recognizing antigens of the self is statistically inevitable.","correct":true},{"idx":2,"proposition":"Pathological autoimmunity is the result of a breakdown in immunological tolerance","correct":true},{"idx":3,"proposition":"The presence of isolated autoimmune biology (e.g. isolated positivity from anti-nuclear antibody testing) poses the inevitable diagnosis of autoimmune disease","correct":false,"justification":"The presence of isolated autoimmune biology (e.g. isolated positivity from an anti-nuclear antibody test) without clinical or other biological manifestations is not sufficient to define an autoimmune disease as such."},{"idx":4,"proposition":"The term \"overlap syndrome\" refers to patients who meet the criteria for classification of several autoimmune diseases at once.","correct":true}],"type":"custom"}
+{"_id":"MAI-immuno-1","context":null,"enonce":"Regarding autoimmune diseases:","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"Autoimmune dysthyroidism is very common in the general population, while primary ANCA vasculitis is very rare.","correct":true},{"idx":1,"proposition":"According to the European definition, a pathology is said to be \"rare\" when its prevalence is less than 50\/100,000 (i.e. affects less than 1 in 2,000 people)","correct":true},{"idx":2,"proposition":"Autoimmune diseases are multifactorial pathologies, which result from the complex interaction between a genetic terrain at risk and environmental factors favoring","correct":true},{"idx":3,"proposition":"The existence of a genetic predisposition to autoimmune diseases is attested ","correct":true},{"idx":4,"proposition":"In the majority of cases, autoimmune diseases are monogenic","correct":false,"justification":"In the majority of cases, autoimmune diseases are called \"polygenic\", because the genetic terrain favoring these diseases is determined by the polymorphisms of many genes each conferring only a low to moderate excess risk of developing the disease"}],"type":"custom"}
+{"_id":"MAI-immuno-3","context":null,"enonce":"Regarding autoimmune diseases:","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"Anti-nuclear antibodies are encountered in about 10% of healthy subjects","correct":true},{"idx":1,"proposition":"aPLs are common during systemic lupus (30-80%) but can be present in many connective tissue diseases such as RA and systemic scleroderma","correct":true},{"idx":2,"proposition":"The Rheumatoid Factor was classically sought after by Elisa","correct":false,"justification":"By the Waaler-Rose reaction and the latex test"},{"idx":3,"proposition":"Anti-CCP are positive in 30% of RA that are negative for RF","correct":true},{"idx":4,"proposition":"The joint positivity of RF and anti-CCP confers a very good positive predictive value for the diagnosis of RA, but with a sensitivity not exceeding 40-50%","correct":true}],"type":"custom"}
+{"_id":"MAI-immuno-4","context":null,"enonce":"Which of the following are possible complications of Sjögren's syndrome?","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"Sensory neuropathy","correct":true},{"idx":1,"proposition":"Pneumonia","correct":true,"justification":"True, by lymphocyte infiltrates"},{"idx":2,"proposition":"Glomerular syndrome","correct":false,"justification":"No, however, we can sometimes observe a tubulointerstitial syndrome by lymphocyte infiltration (significant diapedesis)"},{"idx":3,"proposition":"Parotitis","correct":false,"justification":"False"},{"idx":4,"proposition":"Valvular heart disease","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"MAI-immuno-5","context":null,"enonce":"Which of the following are causes of dry syndrome?","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"Prolonged fever","correct":false,"justification":"False"},{"idx":1,"proposition":"Head and neck radiation therapy","correct":true},{"idx":2,"proposition":"The characterized depressive episode","correct":false,"justification":"Not directly. But some psychotropic treatments can cause dry syndrome."},{"idx":3,"proposition":"Sarcoidosis","correct":true},{"idx":4,"proposition":"Benign prostatic hyperplasia","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"MAI-immuno-6","context":null,"enonce":"What types of ACAN are found in Sjögren's syndrome?","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"Native anti-DNA","correct":false,"justification":"Rather in the case of lupus (useful in follow-up)"},{"idx":1,"proposition":"Anti-centromeres","correct":false,"justification":"anti-SSA or anti-SSB"},{"idx":2,"proposition":"Soluble anti-nuclear","correct":true},{"idx":3,"proposition":"Fluorescence is speckled","correct":true},{"idx":4,"proposition":"Fluorescence is homogeneous","correct":false,"justification":"Rather in favor of native anti-DNA (lupus)"}],"type":"custom"}
+{"_id":"MAI-immuno-7","context":null,"enonce":"Which of the following are additional tests useful in the diagnosis of Sjögren's syndrome?","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"Schirmer's test to objectify xerophthalmia","correct":true},{"idx":1,"proposition":"None of these proposals","correct":false,"justification":"False"},{"idx":2,"proposition":"Parotid biopsy","correct":false,"justification":"Accessory salivary glands are biopsy"},{"idx":3,"proposition":"The search for anti-CPP","correct":false,"justification":"Useless in this case (useful in rheumatoid arthritis)"},{"idx":4,"proposition":"ACAN's research","correct":true,"justification":"True, anti-SSA are quite sensitive"}],"type":"custom"}
+{"_id":"MAI-immuno-8","context":null,"enonce":"Which of the following proposals can cause polyclonal hypergammaglobulinemia greater than 20 G\/l?","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"sarcoidosis","correct":true},{"idx":1,"proposition":"leishmaniasis ","correct":true,"justification":"True, when visceral"},{"idx":2,"proposition":"hepatitis C","correct":false,"justification":"None"},{"idx":3,"proposition":"lupus","correct":false,"justification":"None"},{"idx":4,"proposition":"autoimmune hepatitis","correct":true}],"type":"custom"}
+{"_id":"MAI-immuno-9","context":null,"enonce":"Which of the following proposals are possibly associated with Sjögren's syndrome?","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"Septic arthritis","correct":false,"justification":"False"},{"idx":1,"proposition":"Lupus","correct":true},{"idx":2,"proposition":"Autoimmune thyoiditis","correct":true},{"idx":3,"proposition":"Osteonecrosis of the femoral head","correct":false,"justification":"False"},{"idx":4,"proposition":"AL amyloidosis","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"TED-psy-0","context":null,"enonce":"Regarding ASD:","item":"TED","matiere":"psy","propositions":[{"idx":0,"proposition":"Children with Autism Spectrum Disorder (ASD) have deficits in communication only","correct":false,"justification":"Children with Autism Spectrum Disorder (ASD) have deficits in 3 clinical domains: (1) Verbal and nonverbal communication abnormalities (2) abnormal reciprocal social interactions and (3) Restricted and repetitive behaviours, interests and activities"},{"idx":1,"proposition":"The prevalence of ASD is 0.01% in the general population","correct":false,"justification":"ASD prevalence is 1% and sex ratio is 4:1 in favour of boys"},{"idx":2,"proposition":"Diagnosis of ASD is done clinically in a single consultation","correct":false,"justification":"The diagnostic evaluation is based on the patient's current symptomatology as well as his developmental trajectory over time. It is a dynamic diagnosis"},{"idx":3,"proposition":"ASD has a multifactorial origin","correct":true},{"idx":4,"proposition":"Management of patients with ASD really begins at puberty","correct":false,"justification":"Management of patients with ASD should be early, intensive, multidisciplinary and adapted to the clinical profile of each child"}],"type":"custom"}
+{"_id":"TED-psy-1","context":null,"enonce":"Regarding ASD:","item":"TED","matiere":"psy","propositions":[{"idx":0,"proposition":"Autism is a neurodevelopmental disorder","correct":true},{"idx":1,"proposition":"ASD is the presence of persistent deficits in ideation and social behaviour","correct":false,"justification":"This syndrome corresponds to the presence of persistent deficits in 3 clinical domains: * abnormalities in verbal and non-verbal communication * abnormality of reciprocal social interactions * restricted and repetitive nature of behaviors, interests and activities"},{"idx":2,"proposition":"The prevalence of ASD in the general population is 1%","correct":true},{"idx":3,"proposition":"The sex ratio of ASD is 4 boys to one girl","correct":true},{"idx":4,"proposition":"Childhood affected by ASD seeks to attract the attention of others","correct":false,"justification":"It does not seek to draw the attention of others to an object or situation"}],"type":"custom"}
+{"_id":"TED-psy-2","context":null,"enonce":"Regarding the signs of ASD:","item":"TED","matiere":"psy","propositions":[{"idx":0,"proposition":"One of the symptoms of the autistic child is that he does not respond when called even insistently.","correct":true},{"idx":1,"proposition":"The child only participates in games that do not require interaction with adults","correct":false,"justification":"No reciprocal social games, with adults or children"},{"idx":2,"proposition":"Relational isolation is often found","correct":true},{"idx":3,"proposition":"The child has an aversion to all objects and does not tolerate physical contact with them","correct":false,"justification":"Repetitive use of objects: the child tends to line up his toys or other objects, spin the wheel of a small car, etc."},{"idx":4,"proposition":"Verbal stereotypies are a sign that can point to autism","correct":true}],"type":"custom"}
+{"_id":"TED-psy-3","context":null,"enonce":"Regarding ASD:","item":"TED","matiere":"psy","propositions":[{"idx":0,"proposition":"Autism severity levels are assessed based on impact on parents, social interactions, and school adjustment","correct":false,"justification":"These levels of severity are determined from the intensity of autistic symptoms and their functional impact."},{"idx":1,"proposition":"40% of patients with ASD have an intellectual disability","correct":true},{"idx":2,"proposition":"15% of children with ASD have attention deficit hyperactivity disorder (ADHD)","correct":false,"justification":"Double: 30%"},{"idx":3,"proposition":"20% of patients with ASD have impaired acquisition of motor coordination","correct":true},{"idx":4,"proposition":"The presence of genetic disease (such as Rett syndrome) eliminates the diagnosis of ASD","correct":false,"justification":"Many genetic (such as Rett syndrome or fragile X syndrome) and metabolic diseases are associated with ASD."}],"type":"custom"}
+{"_id":"TED-psy-4","context":null,"enonce":"Which of the following proposals are structures dedicated to the management of ASD at home?","item":"TED","matiere":"psy","propositions":[{"idx":0,"proposition":"SESSAD","correct":true,"justification":"Education and home care services"},{"idx":1,"proposition":"CMP","correct":false,"justification":"Medical and psychological centres. It is not home care, but close to home."},{"idx":2,"proposition":"CMPP","correct":false,"justification":"Psycho-pedagogical medical centres. Not at home."},{"idx":3,"proposition":"CAMSP","correct":false,"justification":"Centre for Early Medico-Social Action. Not at home."},{"idx":4,"proposition":"IME","correct":false,"justification":"Medical-educational institutes. Not at home. These are structures whose mission is to take care of patients with intellectual disabilities, and whose missions are education, care, and general education."}],"type":"custom"}
+{"_id":"noduleTh-endoc-1","context":null,"enonce":"Regarding goiters:","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"The main goitrogenic factor is iodine deficiency","correct":true,"justification":"Even relative iodine deficiency is a risk factor"},{"idx":1,"proposition":"The recommended iodine intake in a pregnant woman is higher than in the general population","correct":true,"justification":"Normal population: 100-150μg in adults, In pregnant women: 200-250μg"},{"idx":2,"proposition":"The genetic factor is zero","correct":false,"justification":"A family predisposition is often found. Several susceptibility genes have been identified but it is a multigenic condition that does not warrant screening."},{"idx":3,"proposition":"The first-line bioassay is T4-L","correct":false,"justification":"This is the TSH test. If it is abnormal, free T4 is dosed to quantify the extent of hormonal dysfunction."},{"idx":4,"proposition":"A goiter and increased TSH makes suspect a disease of Graves.","correct":false,"justification":"TSH is lowered in Graves' disease. This biological context makes us suspect rather an autoimmune thyoiriditis of Hashimoto, which leads us to perform an assay of anti-thyroperoxidase antibodies (anti-TPO), then, in case of negativity, anti-thyroglobulin antibodies (anti-Tg)."}],"type":"custom"}
+{"_id":"noduleTh-endoc-2","context":null,"enonce":"Regarding thyroid nodules:","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"A thyroid nodule is a localized enlargement of the thyroid gland","correct":true},{"idx":1,"proposition":"The majority of nodules are malignant and require surgical management","correct":false,"justification":"95% of thyroid nodules are benign"},{"idx":2,"proposition":"About 10% of thyroid nodules are hyperfunctional","correct":true,"justification":"They are therefore at risk of hyperthyroidism"},{"idx":3,"proposition":"Transition to malignancy of a benign nodule is exceedingly rare","correct":true},{"idx":4,"proposition":"It is a male-dominated pathology","correct":false,"justification":"As for the goiter, the sex ratio is 3-4F\/1H"}],"type":"custom"}
+{"_id":"noduleTh-endoc-3","context":null,"enonce":"Regarding thyroid nodules:","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"It is not necessary to explore nodules less than 1 cm in diameter except in special circumstances.","correct":true},{"idx":1,"proposition":"The first-line biological assessment is the TSH assay","correct":true},{"idx":2,"proposition":"Ultrasound uses very low frequency probes","correct":false,"justification":"Low frequency probes allow deep penetration. The thyroid being superficial, very high frequency probes are used, which also have the advantage of making images of better definition."},{"idx":3,"proposition":"An isolated low TSH strongly points to a functional adenoma","correct":true},{"idx":4,"proposition":"Hyperfunctional nodules that cause hyperthyroidism are treated with surgery","correct":true}],"type":"custom"}
+{"_id":"noduleTh-endoc-4","context":null,"enonce":"Regarding thyroid cancers:","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"5-year survival is extremely low","correct":false,"justification":"The overall prognosis is good, with a 10-year survival greater than 90%"},{"idx":1,"proposition":"Differentiated papillary carcinomas are the most common vesicular carcinomas","correct":true,"justification":"In 85% of cases. Differentiated vesicular carcinomas constitute 5% of cases while the rest is represented by poorly differentiated and oncocytic carcinomas, and anaplastic carcinomas"},{"idx":2,"proposition":"Surgery is the first-line treatment for virtually all thyroid cancers.","correct":true},{"idx":3,"proposition":"Papillary or vesicular differentiated thyroid cancers never recur","correct":false,"justification":"Papillary or vesicular differentiated thyroid cancers can recur in the long term, requiring prolonged monitoring"},{"idx":4,"proposition":"Cervical recurrences are treated with hormone therapy","correct":false,"justification":"Surgery remains the best treatment for local recurrences, supplemented by radioactive iodine when these recurrences fix."}],"type":"custom"}
+{"_id":"noduleTh-endoc-5","context":null,"enonce":"Which propositions are true?","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Toxic adenoma causes hypothyroidism","correct":false,"justification":"Hyperthyroidism"},{"idx":1,"proposition":"Benign adenoma is accompanied by euthyroidism","correct":true},{"idx":2,"proposition":"Papillary carcinoma may be accompanied by euthyroidism","correct":true},{"idx":3,"proposition":"A benign goiter is accompanied by euthyroidism","correct":true},{"idx":4,"proposition":"An over-functional nodule is accompanied by hyperthyroidism","correct":true}],"type":"custom"}
+{"_id":"noduleTh-endoc-6","context":null,"enonce":"Regarding IRA-therapy:","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Pregnancy is contraindicated","correct":true},{"idx":1,"proposition":"Breastfeeding is allowed","correct":false,"justification":"Breastfeeding is contraindicated"},{"idx":2,"proposition":"Iodine-139 is used","correct":false,"justification":"Iodine-139 is a very rare isotope not used at all in medicine. Iodine-131 is used."},{"idx":3,"proposition":"The treatment is done over one week in day hospital (outpatient)","correct":false,"justification":"Hospitalization in radio-protected rooms"},{"idx":4,"proposition":"It is a complementary treatment to surgical management","correct":true}],"type":"custom"}
+{"_id":"noduleTh-endoc-7","context":null,"enonce":"Regarding malignant nodules and cancers:","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"A male sex directs to a malignant nodule","correct":true},{"idx":1,"proposition":"40% of nodules are malignant","correct":false,"justification":"95% of thyroid nodules are benign"},{"idx":2,"proposition":"Papillary cancers have a pretty good prognosis","correct":true,"justification":"Papillary carcinomas constitute 85% of differentiated carcinomas, they have an excellent prognosis (95% survival at 10 years), it is the only form observed in young people and follow-up is carried out using thyroglobulin"},{"idx":3,"proposition":"Vesicular carcinomas can be encapsulated or invasive","correct":true},{"idx":4,"proposition":"Ac Anti-TPO is dosed for follow-up","correct":false,"justification":"Anti-Tg for follow-up, anti-TPO are indicated in particular for the etiological assessment of hypothyroidism"}],"type":"custom"}
+{"_id":"Fr-urg-0","context":null,"enonce":"Which of the following are true?","item":"Fr","matiere":"urg","propositions":[{"idx":0,"proposition":"Up to age 40, the annual incidence of distal radius fractures is higher in women","correct":false,"justification":"Up to age 40, the annual incidence of distal radius fractures is higher in men"},{"idx":1,"proposition":"There is no link between the quality of anatomical reduction and functional outcome","correct":false,"justification":"There is a parallelism between the quality of the anatomical reduction and the functional result"},{"idx":2,"proposition":"Fractures of the distal end of the radius are fractures mainly involving the proximal epiphysis","correct":false,"justification":"Fractures of the distal end of the radius are fractures mainly involving the metaphysis but can also concern the distal epiphysis"},{"idx":3,"proposition":"The distal epiphysis is articular with the head of the ulna and the first row of the carpus  ","correct":true},{"idx":4,"proposition":"It is necessary to oppose extra-articular fractures which are the prerogative of the elderly subject and which most often follow a low-energy trauma, complex joint fractures affecting more readily the young subject and resulting from a high-energy trauma","correct":true}],"type":"custom"}
+{"_id":"veilleSP-sp-0","context":null,"enonce":"Which propositions are true?","item":"veilleSP","matiere":"sp","propositions":[{"idx":0,"proposition":"Health safety is the protection of health against the risks induced by the metabolism of infectious agents","correct":false,"justification":"It is the protection against the risks induced by the functioning of the company"},{"idx":1,"proposition":"A health crisis is an unforeseen and complex situation","correct":true},{"idx":2,"proposition":"A health crisis is always of proven seriousness","correct":false,"justification":"Not always proven. It may only be potential"},{"idx":3,"proposition":"A health crisis requires immediate action","correct":true},{"idx":4,"proposition":"The means of managing health crises is exceptional","correct":false}],"type":"custom"}
+{"_id":"veilleSP-sp-2","context":null,"enonce":"Which propositions are true?","item":"veilleSP","matiere":"sp","propositions":[{"idx":0,"proposition":"Cosmetovigilance only concerns consmetic products sold in pharmacies","correct":false,"justification":"All cosmetic products are concerned"},{"idx":1,"proposition":"Manufacturers report any adverse reaction to the ANSM directly","correct":false,"justification":"To the DGCCRF first"},{"idx":2,"proposition":"The Biomedicine Agency is the authority that deals with biovigilance","correct":true},{"idx":3,"proposition":"Reactovigilance concerns radiation risks","correct":false,"justification":"In vitro diagnostic devices"},{"idx":4,"proposition":"Materiovigilance is organized around 4 levels of procedure","correct":true,"justification":"Minor, major, critical incidents and the overall assessment"}],"type":"custom"}
+{"_id":"deficitMoSembre-neuro-0","context":null,"enonce":"General:","item":"deficitMoSembre","matiere":"neuro","propositions":[{"idx":0,"proposition":"Disorders of motility or sensitivity of a limb are very rare","correct":false,"justification":"Limb motility or sensitivity disorders are common reasons for consultation, sometimes in emergency situations"},{"idx":1,"proposition":"This type of disorder must be referred directly to hospital neurologists in view of the potential seriousness","correct":false,"justification":"Every physician must know how to guide his diagnosis: by distinguishing between a deficit due to impairment of motor or sensitivity pathways and a disorder of non-neurological origin"},{"idx":2,"proposition":"There are four major neurological motor syndromes","correct":true},{"idx":3,"proposition":"Syndromic diagnosis makes it possible to establish the topographic diagnosis of the attack","correct":true},{"idx":4,"proposition":"Involvement of the first motor neuron is responsible for pyramidal syndrome","correct":true}],"type":"custom"}
+{"_id":"deficitMoSembre-neuro-1","context":null,"enonce":"Regarding the central and peripheral origins:","item":"deficitMoSembre","matiere":"neuro","propositions":[{"idx":0,"proposition":"In pyramidal syndrome, the lesion may be in the cerebral hemisphere, brain stem or spinal cord","correct":true},{"idx":1,"proposition":"Lumbar spinal cord involvement is peripheral involvement","correct":false,"justification":"Power plant"},{"idx":2,"proposition":"Central involvement is characterized by the presence of an extrapyramidal syndrome","correct":false,"justification":"The central involvement is characterized by the presence of a pyramidal syndrome: the motor deficit predominates on the extensor muscles of the upper limbs (radial, interosseous) and the shortening muscles of the lower limbs (psoas, anterior hamstring)"},{"idx":3,"proposition":"A spastic deficit is always of peripheral origin","correct":false,"justification":"Remember A spastic deficit is always of central origin"},{"idx":4,"proposition":"A flaccid deficit is always of peripheral origin","correct":false,"justification":"Most often but not always"}],"type":"custom"}
+{"_id":"deficitMoSembre-neuro-2","context":null,"enonce":"Regarding the neurological semiology of motor deficits:","item":"deficitMoSembre","matiere":"neuro","propositions":[{"idx":0,"proposition":"The RCP is in flexion in pyramidal syndrome","correct":false,"justification":"It is the only syndrome where it is in extension = Babinski's sign"},{"idx":1,"proposition":"Hemiplegia reflects damage to the central nervous system above the cervical cord (included)","correct":true},{"idx":2,"proposition":"Alternate motor syndrome is the combination of hemiparesis or hemiplegia and contralateral involvement of a motor cranial nerve (III, VII, XII)","correct":true},{"idx":3,"proposition":"Tetraplegia reflects damage to the thoracic or lumbar spinal cord","correct":false,"justification":"It reflects damage to the upper cervical spinal cord or brain stem"},{"idx":4,"proposition":"Paraplegia reflects damage to the motor cortex","correct":false,"justification":"It reflects low, thoracic or terminal cone cervical involvement, the spinal cord ending at the L1-L2 level"}],"type":"custom"}
+{"_id":"deficitMoSembre-neuro-3","context":null,"enonce":"Regarding motor impairments:","item":"deficitMoSembre","matiere":"neuro","propositions":[{"idx":0,"proposition":"When the lesion is small and\/or spares sensory structures, the motor deficit can be isolated","correct":true},{"idx":1,"proposition":"Peripheral neurogenic syndrome is characterized by impairment of voluntary and reflex motor skills","correct":true},{"idx":2,"proposition":"Spontaneous fasciculations may be observed upon inspection in peripheral neurogenic syndrome","correct":true},{"idx":3,"proposition":"There is no amyotrophy in perpipheric neurogenic syndrome","correct":false,"justification":"Abolition of osteotendinous reflexes and Amyotrophy of affected muscles when motor deficit is prolonged"},{"idx":4,"proposition":"There are three main types of diffuse neuropathies depending on the mode of installation","correct":true}],"type":"custom"}
+{"_id":"deficitMoSembre-neuro-4","context":null,"enonce":"Which propositions are true?","item":"deficitMoSembre","matiere":"neuro","propositions":[{"idx":0,"proposition":"Acute polyradiculoneuritis has unilateral involvement","correct":false,"justification":"Bilateral"},{"idx":1,"proposition":"Acute polyradiculoneuritis has symmetrical involvement","correct":true},{"idx":2,"proposition":"Acute polyradiculoneuritis is exclusively proximal","correct":false,"justification":"proximal and distal"},{"idx":3,"proposition":"Multiple mononeuropathies are multiple truncal disorders","correct":true},{"idx":4,"proposition":"Focal neuropathies are related to the involvement of a root, plexus or trunk responding to a precise systematization","correct":true}],"type":"custom"}
+{"_id":"deficitMoSembre-neuro-5","context":null,"enonce":"Concerning motor and sensory impairments:","item":"deficitMoSembre","matiere":"neuro","propositions":[{"idx":0,"proposition":"Myogenic syndrome is characterized by a motor deficit of varied topography","correct":true},{"idx":1,"proposition":"Myogenic syndrome affects the distal muscles","correct":false,"justification":"in principle rather proximal"},{"idx":2,"proposition":"In case of complete transverse involvement of the spinal cord, in addition to motor deficit (tetra or paraplegia), there is a sensory level with a lesional and sublesional syndrome","correct":true},{"idx":3,"proposition":"Hemi-marrow syndrome (Brown-Séquard syndrome) has a very high localizing value","correct":true},{"idx":4,"proposition":"Plexic involvement corresponds to the involvement of a single dermatome","correct":false,"justification":"The sensory territory corresponds to the involvement of several dermatomes"}],"type":"custom"}
+{"_id":"pathosalivaire-ORL-0","context":null,"enonce":"General:","item":"pathosalivaire","matiere":"ORL","propositions":[{"idx":0,"proposition":"Sialitis is an inflammation of the salivary glands","correct":true},{"idx":1,"proposition":"Sialitis can have an infectious component","correct":true},{"idx":2,"proposition":"Sialoses are parasitic infections","correct":false,"justification":"Global hypertrohpia"},{"idx":3,"proposition":"Sialoses are global hypertrophies","correct":true},{"idx":4,"proposition":"Slave glands can be the site of tumors","correct":true}],"type":"custom"}
+{"_id":"pathosalivaire-ORL-1","context":null,"enonce":"Regarding tumors:","item":"pathosalivaire","matiere":"ORL","propositions":[{"idx":0,"proposition":"Tumors can be diagnosed by ultrasound","correct":false,"justification":"Difficult to formally diagnose a tumor, except by histological examination"},{"idx":1,"proposition":"An isolated non-inflammatory swelling evokes a tumor in first line","correct":true},{"idx":2,"proposition":"Tumours of the main salivary glands sometimes appear for several years","correct":true},{"idx":3,"proposition":"Differential diagnoses are numerous and must be eliminated","correct":false,"justification":"They are relatively rare (mastoiditis, transverse apopysis of the atlas, etc.)"},{"idx":4,"proposition":"The most common parotid tumors are pleomorphic adenomas","correct":true}],"type":"custom"}
+{"_id":"pathosalivaire-ORL-2","context":null,"enonce":"Regarding tumors:","item":"pathosalivaire","matiere":"ORL","propositions":[{"idx":0,"proposition":"Treatment of pleomorphic adenoma is surgical","correct":true},{"idx":1,"proposition":"Post-surgery monitoring of pleomorphic adenoma is unnecessary","correct":false,"justification":"Prolonged because it exsites a small risk of cancerization"},{"idx":2,"proposition":"Tubular adenoma is a malignant tumor","correct":false,"justification":"Benign"},{"idx":3,"proposition":"Malignant tumors account for 50% of tumors","correct":false,"justification":"8 to 18%"},{"idx":4,"proposition":"In children, almost 50% of parotid tumors are malignant","correct":true}],"type":"custom"}
+{"_id":"ISurR-endoc-0","context":null,"enonce":"Regarding acute adrenal insufficiency:","item":"ISurR","matiere":"endoc","propositions":[{"idx":0,"proposition":"This is a vital emergency","correct":true},{"idx":1,"proposition":"Treatment is started as soon as the hromonal assays have validated the diagnosis.","correct":false,"justification":"Treatment is urgent even without diagnostic certainty. Hormonal assays can be carried out secondarily."},{"idx":2,"proposition":"Hemoconcentration is found in primary adrenal insufficiency","correct":true},{"idx":3,"proposition":"Hyponatremia is specific for primary adrenal insufficiency","correct":false,"justification":"No, but hyperkalemia yes, due to aldosterone deficiency"},{"idx":4,"proposition":"Biology regains metabolic alkalosis","correct":false,"justification":"Metabolic acidode is found in blood gases"}],"type":"custom"}
+{"_id":"ISurR-endoc-1","context":null,"enonce":"Regarding the symptoms of acute adrenal insufficiency:","item":"ISurR","matiere":"endoc","propositions":[{"idx":0,"proposition":"Extracellular dehydration is often marked","correct":true,"justification":"These include a skin fold and hypotension up to collapse"},{"idx":1,"proposition":"Hypernatremia can lead to confusion and seizures","correct":false,"justification":"It is hyponatremia and hypoglycemia that have these effects."},{"idx":2,"proposition":"The presence of fever eliminates the diagnosis of adrenal insufficiency","correct":false,"justification":"Fever may be present, it may be part of an infection that has precipitated decompensation"},{"idx":3,"proposition":"Associated urinary disorders confirm the picture","correct":false},{"idx":4,"proposition":"Myalgia may be part of the picture","correct":true}],"type":"custom"}
+{"_id":"ISurR-endoc-2","context":null,"enonce":"Regarding the diagnosis of acute adrenal insufficiency:","item":"ISurR","matiere":"endoc","propositions":[{"idx":0,"proposition":"The positive diagnosis is pathological","correct":false,"justification":"It is biological (determination of cortisol and ATCH). In children, renin is additionally dosed."},{"idx":1,"proposition":"Known chronic adrenal insufficiency renders hormone testing unnecessary","correct":true,"justification":"Hormonal dosages are of no interest if adrenal insufficiency is known"},{"idx":2,"proposition":"Cortisolemia collapsed in acute adrenal insufficiency","correct":true},{"idx":3,"proposition":"ACTH collapsed in primary adrenal insufficiency","correct":false,"justification":"It is greatly increased in primary adrenal insufficiency"},{"idx":4,"proposition":"Complete adrenal enzyme block (21-hydroxylase) is an etiology of acute adrenal insufficiency","correct":true}],"type":"custom"}
+{"_id":"ISurR-endoc-3","context":null,"enonce":"Regarding the management of acute adrenal insufficiency:","item":"ISurR","matiere":"endoc","propositions":[{"idx":0,"proposition":"It is done in clinical medicine","correct":false,"justification":"The patient is transferred to emergency or intensive care"},{"idx":1,"proposition":"At the patient's home, 100mg of hydrocortisone is injected","correct":true,"justification":"In IV or IM. failing that, in SC. A patient with known adrenal insufficiency should have at least two packs of Hydrocortisone 100 mg with him and know how to make an SC injection of hydrocortisone in case of Emergency."},{"idx":2,"proposition":"In hospitals, dehydration is compensated by filling with 0.9% NaCl","correct":true},{"idx":3,"proposition":"Hydroelectrolyte disorders are compensated by the administration of potassium and bicarbonates","correct":false,"justification":"No potassium supplementation, because hyperkalemia (+++)"},{"idx":4,"proposition":"Maintenance therapy is 100 mg per 24 hours as an IV infusion","correct":true}],"type":"custom"}
+{"_id":"ISurR-endoc-4","context":null,"enonce":"Regarding adrenal insufficiency, which propositions are true?","item":"ISurR","matiere":"endoc","propositions":[{"idx":0,"proposition":"Melanoderma is specific for secondary adrenal insufficiency.","correct":false,"justification":"Melanoderma (due to excess ACTH) is specific for primary adrenal insufficiency, it is a clinical element that can help guide the diagnosis"},{"idx":1,"proposition":"In children, the treatment of adrenal insufficiency can not correct the signs of hyperandrogenism in the long term, in case of deficiency of 21 hydroxylase","correct":false,"justification":"The absence of signs of long-term hyperandrogenism is one of the objectives of treatment in case of 21 hydroxylase deficiency"},{"idx":2,"proposition":"In the biological follow-up of the treatment of chronic adrenal insufficiency in children, it is recommended to measure cortisol and plasma ACTH","correct":false,"justification":"Clinical monitoring +++"},{"idx":3,"proposition":"In the case of acute adrenal insufficiency in a newborn or infant, persistent cholestatic jaundice may be found.","correct":true,"justification":"Hypoglycemia, hypotonia, convulsions, low blood pressure and persistent cholestatic jaundice"},{"idx":4,"proposition":"Acute adrenal insufficiency can be triggered in older children by abruptly discontinuation of long-term, high-dose inhaled corticosteroid therapy.","correct":true,"justification":"Abrupt cessation of corticosteroid treatment p.o., inhaled (high-dose and prolonged Fluticosone) or topically applied (large area)"}],"type":"custom"}
+{"_id":"IST-infectio-0","context":null,"enonce":"Which of the following are etiologies of false syphilitic serology?","item":"IST","matiere":"infectio","propositions":[{"idx":0,"proposition":"Leprosy","correct":true},{"idx":1,"proposition":"Lupus","correct":true},{"idx":2,"proposition":"HSV meningitis","correct":false,"justification":"No report"},{"idx":3,"proposition":"HHV-8","correct":false,"justification":"No report"},{"idx":4,"proposition":"Leptospirosis","correct":true}],"type":"custom"}
+{"_id":"IST-infectio-1","context":null,"enonce":"Which of the following are true about Chlamydia trachomatis?","item":"IST","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is the leading cause of bacterial STIs in Europe","correct":true},{"idx":1,"proposition":"The incidence is more common between 15 and 34 years of age in women","correct":true},{"idx":2,"proposition":"Peak incidence occurs later in humans","correct":true,"justification":"True, between 20 and 39 years old"},{"idx":3,"proposition":"It is a gram-positive bacillus","correct":false,"justification":"The gram is negative, like many bacillus (except Clostidioides, Listeria and Tropheryma)"},{"idx":4,"proposition":"Carriage is never asymptomatic in humans","correct":false,"justification":"In 10% of cases, it is"}],"type":"custom"}
+{"_id":"IST-infectio-2","context":null,"enonce":"Which of the following is the first-line treatment for N. gonorrhoeae?","item":"IST","matiere":"infectio","propositions":[{"idx":0,"proposition":"None of the proposals","correct":true,"justification":"True, indeed, it is Ceftriaxone in IM monodose of 500 mg"},{"idx":1,"proposition":"Metronidazole","correct":false,"justification":"False"},{"idx":2,"proposition":"Imidazole","correct":false,"justification":"False"},{"idx":3,"proposition":"Doxycycline","correct":false,"justification":"False"},{"idx":4,"proposition":"C3G IV","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"glaucomechr-ophtalmo-0","context":null,"enonce":"General:","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"CAPG is defined as progressive optic neuropathy","correct":true},{"idx":1,"proposition":"It is the widely predominant clinical form of all glaucoma in Western countries.","correct":true},{"idx":2,"proposition":"CAPG mainly affects the population over 40 years of age","correct":true},{"idx":3,"proposition":"It is the second leading cause of blindness in Western countries (after AMD) and the leading cause of irreversible blindness worldwide.","correct":true},{"idx":4,"proposition":"CAPM has no known risk factor","correct":false,"justification":"CAPG has several risk factors such as age or ethnicity"}],"type":"custom"}
+{"_id":"glaucomechr-ophtalmo-1","context":null,"enonce":"Risk factors and epidemiology","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Prevalence is about 10% after age 85","correct":true},{"idx":1,"proposition":"Ocular hypertonia is not a known risk factor","correct":false,"justification":"ocular hypertonia: increased intraocular pressure (IOP) beyond two standard deviations is a risk factor"},{"idx":2,"proposition":"Ocular hypertonia is a known cause of CAPG","correct":false,"justification":"a risk factor but not the cause of CAPM"},{"idx":3,"proposition":"Direct family history confers a 3-fold higher risk of developing CAPM for offspring","correct":true},{"idx":4,"proposition":"No genes predisposing to CAPG were found","correct":false,"justification":"Genes have been identified but their research has no clinical application at the moment"}],"type":"custom"}
+{"_id":"glaucomechr-ophtalmo-2","context":null,"enonce":"General:","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Melanoderma patients have a 3-fold higher risk of developing CAPM","correct":true},{"idx":1,"proposition":"Myopia regardless of its intensity multiplies by three the risk of developing a CAPM","correct":true},{"idx":2,"proposition":"Cardiovascular and metabolic diseases are not proven risk factors","correct":false,"justification":"Other risk factors such as diabetes, cardiovascular diseases are described but much less well supported than those retained above"},{"idx":3,"proposition":"The pathophysiology of CAPM is part of neurodegenerative diseases","correct":true},{"idx":4,"proposition":"There are about 1 million ganglion cells in each eye","correct":true}],"type":"custom"}
+{"_id":"glaucomechr-ophtalmo-3","context":null,"enonce":"General and pathophysiology:","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"After 40 years, the simple fact of aging leads to the loss of about 8000 ganglion cells per year","correct":true},{"idx":1,"proposition":"CAPG is the sudden and fleeting loss of retinal cells whose impact is spread over time","correct":false,"justification":"CAPM is actually the accelerated loss of these optical fibers compared to age-related physiological loss."},{"idx":2,"proposition":"An open angle is observed in gonioscopy (visibility of the pigmented trabeculum of more than 180 °)","correct":true},{"idx":3,"proposition":"Visual acuity drops steadily and aggravates myopia already often present","correct":false,"justification":"Visual acuity is not affected, except in the late stages of the disease or in case of other associated eye pathology (cataract, age-related macular degeneration)"},{"idx":4,"proposition":"High-pressure CAPM is extremely rare","correct":false,"justification":"It accounts for about 70% of CAPM cases in Western populations."}],"type":"custom"}
+{"_id":"glaucomechr-ophtalmo-4","context":null,"enonce":"Regarding the diagnosis of CAPM:","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"It is characterized by progressive optic neuropathy with structural and\/or functional abnormalities","correct":true},{"idx":1,"proposition":"Increased papillary excavation accompanies loss of the neuroretinal ring","correct":true},{"idx":2,"proposition":"An asymmetry of this ratio greater than 0.2 between the two eyes is suspicious of glaucoma","correct":true},{"idx":3,"proposition":"OCT can calculate areas and volumes at a resolution of about 5 microns","correct":true},{"idx":4,"proposition":"OCT has no place in CAPG","correct":false,"justification":"It is useful for the positive diagnosis and differential diagnosis of CAPM as well as for the evaluation of the follow-up and effectiveness of the treatments put in place."}],"type":"custom"}
+{"_id":"glaucomechr-ophtalmo-5","context":null,"enonce":"Regarding the CAPG:","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Central visual acuity is affected very late","correct":true},{"idx":1,"proposition":"The key examination is the visual field performed today with automated static perimetry (PSA)","correct":true},{"idx":2,"proposition":"The PSA takes about 30 minutes per eye and is performed by an orthoptist","correct":false,"justification":"This exam, which today takes about 5 minutes per eye, requires good cooperation and understanding of the test."},{"idx":3,"proposition":"The alteration of the visual field is mainly marked by the appearance of scotomas","correct":true},{"idx":4,"proposition":"The usual form of CAPM occurs untreated with IOP greater than 21 mmHg","correct":true}],"type":"custom"}
+{"_id":"glaucomechr-ophtalmo-6","context":null,"enonce":"The CAPG:","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Normal pressure CAPM accounts for approximately 70% of CAPM cases in Asian populations","correct":true},{"idx":1,"proposition":"Alterations in structure and function are substantially the same as high-pressure CAPM","correct":true},{"idx":2,"proposition":"Unlike the classic form of CAPG, normal IOP CAPM occurs untreated with IOP less than or equal to 21 mmHg","correct":true},{"idx":3,"proposition":"CAPG is a risk factor for retinal vein occlusions","correct":true},{"idx":4,"proposition":"Ocular hypertonia is defined as IOP greater than 15 mmHg","correct":false,"justification":"Ocular hypertonia It is defined as IOP greater than 21 mmHg, an open angle in gonioscopy and the absence of optic neuropathy"}],"type":"custom"}
+{"_id":"PID-pneumo-0","context":null,"enonce":"About PIDs","item":"PID","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Diffuse interstitial lung disease (PID) brings together many entities whose common point is to give diffuse infiltrative opacities on the chest X-ray","correct":true},{"idx":1,"proposition":"Acute IRS is dominated by infectious and hemodynamic causes","correct":true},{"idx":2,"proposition":"Bronchoalveolar lavage is the key examination during acute febrile PID","correct":true},{"idx":3,"proposition":"Cardiology is essential during acute febrile IRS","correct":false,"justification":"Cardiology is essential during acute non-febrile IRS"},{"idx":4,"proposition":"Sub-acute or chronic PID are dominated by sarcoidosis, idiopathic pulmonary fibrosis and pulmonary fibrosis associated with connective tissue","correct":true}],"type":"custom"}
+{"_id":"PID-pneumo-1","context":null,"enonce":"About PIDs","item":"PID","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Clinical presentation and EFRs of IRS are indiscriminate","correct":true},{"idx":1,"proposition":"Chest CT is the cornerstone of the etiological orientation of sub-acute or chronic IRS","correct":true},{"idx":2,"proposition":"PIDs have in common to chest imaging DIFFUSE, non-systematized, bilateral and symmetrical parenchymal opacities","correct":true},{"idx":3,"proposition":"The diagnostic approach and management are fundamentally different, depending on whether you are dealing with acute PID or sub-acute or chronic PID (PID-SC)","correct":true},{"idx":4,"proposition":"The LBA is very effective for the diagnosis of infections and allows diagnostic guidance in other cases","correct":true}],"type":"custom"}
+{"_id":"PID-pneumo-2","context":null,"enonce":"About PIDs","item":"PID","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The analysis of the predominant lesions, their topography and associated lesions makes it possible to define radiological profiles (patterns) which each have an etiological orientation value.","correct":true},{"idx":1,"proposition":"The diagnostic approach uses histology very frequently","correct":false,"justification":"Histology is used in less than 10% of IRS"},{"idx":2,"proposition":"The complexity of the reasoning in the face of IRS justifies that the vast majority of cases are the subject of a multidisciplinary discussion","correct":true},{"idx":3,"proposition":"1 Idiopathic pulmonary fibrosis (IPF) The most common IRS of unknown cause after sarcoidosis","correct":true},{"idx":4,"proposition":"Hypersensitivity pneumonitis rare in smokers","correct":true}],"type":"custom"}
+{"_id":"arthrose-rhumato-0","context":null,"enonce":"Regarding the main generalities on osteoarthritis:","item":"arthrose","matiere":"rhumato","propositions":[{"idx":0,"proposition":"It mainly affects the spine, knees, hips and hands","correct":true},{"idx":1,"proposition":"It affects articular cartilage only","correct":false,"justification":"It is a disease of all joint tissues affecting primarily articular cartilage, but also the synovial membrane and subchondral bone"},{"idx":2,"proposition":"It causes inflammatory pain","correct":false,"justification":"When it becomes symptomatic, it causes mechanical pain and functional disability"},{"idx":3,"proposition":"It affects about 1% of the French population","correct":false,"justification":"Prevalence of about 10%"},{"idx":4,"proposition":"Excess cardiovascular mortality is observed in gonarthrosic patients","correct":true}],"type":"custom"}
+{"_id":"arthrose-rhumato-1","context":null,"enonce":"Regarding histo-anatomy:","item":"arthrose","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Chondrocytes are in charge of the production and degradation of the extracellular matrix of cartilage","correct":true},{"idx":1,"proposition":"The extracellular matrix is composed of more than 10% water","correct":false,"justification":"This matrix is composed of more than 80% water and a network of collagen and proteoglycans, strongly hydrophilic"},{"idx":2,"proposition":"The interactions between bone and cartilage are very important and allow the passage of nutrients and different mediators","correct":true},{"idx":3,"proposition":"The inner surface of the joint capsule is lined with the synovial membrane responsible for the production of synovial fluid","correct":true},{"idx":4,"proposition":"Cancellous bone provides nutrients for articular cartilage","correct":false,"justification":"It is the synovial membrane that takes care of it"}],"type":"custom"}
+{"_id":"arthrose-rhumato-2","context":null,"enonce":"Regarding coxarthrosis:","item":"arthrose","matiere":"rhumato","propositions":[{"idx":0,"proposition":"The pain is due to inflammation of the cartilage","correct":false,"justification":"Pain is a poorly understood phenomenon in osteoarthritis and complex since cartilage is not innervated. It is rather a suffering of the subchondral bone that is responsible for the pain"},{"idx":1,"proposition":"Coxarthrosis refers to gonalgia due to osteoarthritis","correct":false,"justification":"Osteoarthritis of the coxofemoral joint"},{"idx":2,"proposition":"Functional limitation is the most common reason for consultation","correct":false,"justification":"It's the pain"},{"idx":3,"proposition":"The most specific localization of coxarthrosis pain is in the groin crease","correct":true},{"idx":4,"proposition":"Mechanical knee pain is very specific to gonarthrosis","correct":false,"justification":"Careful! The pain of coxarthrosis can be said to be \"projected\" in front of the knee, which can be misleading"}],"type":"custom"}
+{"_id":"arthrose-rhumato-3","context":null,"enonce":"Which of the following proposals could correspond to an installed coxarthrosis?","item":"arthrose","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Knee pain","correct":true},{"idx":1,"proposition":"Pain when mobilizing internally rotates","correct":true},{"idx":2,"proposition":"Mowing","correct":false,"justification":"Is rather seen in the after-effects of stroke (stiffness of the knee, hypertonia of the quadriceps \/ triceps sural which gives an attitude of the foot in varus)"},{"idx":3,"proposition":"Dodge limp","correct":true},{"idx":4,"proposition":"Steppage","correct":false,"justification":"Rather seen in Charcot-Marie-Tooth or in peripheral neurological disorders, where there is a defect in dorsiflexion of the foot"}],"type":"custom"}
+{"_id":"confusiongeria-neuro-0","context":null,"enonce":"Concerning cognitive disorders in the elderly","item":"confusiongeria","matiere":"neuro","propositions":[{"idx":0,"proposition":"The most common cause of dementia is Alzheimer's disease","correct":true},{"idx":1,"proposition":"Demeance includes deterioration in cognition","correct":true},{"idx":2,"proposition":"Dementia includes loss of independence","correct":true},{"idx":3,"proposition":"Demence includes sleep disorders","correct":false},{"idx":4,"proposition":"In the predemential phase of Alzheimer's disease the most common clinical sign is forgetfulness","correct":true}],"type":"custom"}
+{"_id":"confusiongeria-neuro-1","context":null,"enonce":"The histological stigmas of Alzheimer's disease are","item":"confusiongeria","matiere":"neuro","propositions":[{"idx":0,"proposition":"Amyloid plaques","correct":true},{"idx":1,"proposition":"fibrinoid necrosis","correct":false},{"idx":2,"proposition":"Cell loss","correct":true},{"idx":3,"proposition":"Neurofibillary degeneration","correct":true},{"idx":4,"proposition":"caseous necrosis","correct":false}],"type":"custom"}
+{"_id":"confusiongeria-neuro-2","context":null,"enonce":"The minimum balance sheet of a demence shall include","item":"confusiongeria","matiere":"neuro","propositions":[{"idx":0,"proposition":"A spinal cord MRI","correct":false},{"idx":1,"proposition":"A brain MRI","correct":true},{"idx":2,"proposition":"a biological assessment","correct":true},{"idx":3,"proposition":"a neuropsychological assessment","correct":true},{"idx":4,"proposition":"An occupational therapy consultation","correct":false}],"type":"custom"}
+{"_id":"confusiongeria-neuro-3","context":null,"enonce":"About Alzheimer's disease","item":"confusiongeria","matiere":"neuro","propositions":[{"idx":0,"proposition":"Carriage of homozygosity for apolipoprotein E ε4 allele is a risk factor for Alzheimer's disease","correct":true},{"idx":1,"proposition":"abnormal accumulation of β-amyloid proteins (Aβ-42) in extracellular clusters characterizes Alzheimer's disease","correct":true},{"idx":2,"proposition":"Low level of education protects against Alzheimer's disease","correct":false,"justification":"it is a risk factor"},{"idx":3,"proposition":"Analysis of cerebrospinal fluid found during Alzheimer's disease finds a massive decrease in AB42 and an increase in TAU-p","correct":true},{"idx":4,"proposition":"The diagnosis of certainty of Alzheimer's disease is based on neuropathology (post mortem)","correct":true}],"type":"custom"}
+{"_id":"confusiongeria-neuro-4","context":null,"enonce":"Which of the following proposals are mandatory and systematic in the first instance?","item":"confusiongeria","matiere":"neuro","propositions":[{"idx":0,"proposition":"Biology: NFS, CRP, TSH, ionogram, Blood glucose, Calcemia","correct":true},{"idx":1,"proposition":"HIV serology","correct":false,"justification":"Non-systematic"},{"idx":2,"proposition":"HBV, HCV and HEV serology","correct":false,"justification":"Not recommended. The recommended serologies according to the context are: HIV, Syphilis, B9 and B12"},{"idx":3,"proposition":"Brain MRI with sections passing through the axis of the hippocampuses","correct":true},{"idx":4,"proposition":"No additional examination is mandatory","correct":false,"justification":"False, on the other hand this is the case of typical Parkinson's disease"}],"type":"custom"}
+{"_id":"confusiongeria-neuro-5","context":null,"enonce":"Which of the following proposals can be found in Alzheimer's disease?","item":"confusiongeria","matiere":"neuro","propositions":[{"idx":0,"proposition":"Temporo-spatial disorientation","correct":true},{"idx":1,"proposition":"Visuopraxic disorder with errors when copying the MMSE figure","correct":true,"justification":"True, by parietal involvement"},{"idx":2,"proposition":"Delayed recall disruption during the 5-word test, normalized by indication","correct":false,"justification":"There is no problem of restitution or access to information in Alzheimer's disease"},{"idx":3,"proposition":"Delayed recall disruption during the 5-word test, little improved by cueing","correct":true,"justification":"True, related to an encoding problem"},{"idx":4,"proposition":"Difficulty with motor sequences during the BREF (Fast Battery of Frontal Efficiency)","correct":false,"justification":"As its name suggests, it would be found in frontal syndromes"}],"type":"custom"}
+{"_id":"deficitMo-neuro-0","context":null,"enonce":"General","item":"deficitMo","matiere":"neuro","propositions":[{"idx":0,"proposition":"A neurological deficit is the loss of function related to a temporary dysfunction (transient deficit) or lesional (permanent deficit) of a region of the nervous system","correct":true},{"idx":1,"proposition":"A recent neurological deficit (less than 1 month) is a common reason for emergency room and neurology visits","correct":true},{"idx":2,"proposition":"A recent neurological deficit most often indicates an attack of the central nervous system but can also be caused by an attack of the peripheral nervous system, the neuromuscular or muscular junction","correct":true},{"idx":3,"proposition":"A recent neurological deficit is a sign of entry into a chronic disease and is therefore never urgent.","correct":false,"justification":"A recent neurological deficit may be a sign of a serious neurological problem requiring specific and urgent treatment, but may also be a mode of entry into a chronic neurological disease."},{"idx":4,"proposition":"Any recent neurological deficit of sudden onset should lead to suspicion of a stroke","correct":true}],"type":"custom"}
+{"_id":"deficitMo-neuro-1","context":null,"enonce":"Concerning basic semiology:","item":"deficitMo","matiere":"neuro","propositions":[{"idx":0,"proposition":"In the case of central nervous system involvement, the lesion is located on the roots, plexuses, nerve trunks, neuromuscular junction or muscles","correct":false,"justification":"Peripheral nervous system"},{"idx":1,"proposition":"Damage to the peripheral nervous system is evoked in front of the involvement of a hemibody (motor or sensory)","correct":false,"justification":"Damage to the central nervous system is evoked in the face of such an attack"},{"idx":2,"proposition":"The homonymous lateral hemianopsia is a sign of involvement of the frontal cortex","correct":false,"justification":"Homonymous lateral hemianopsia is a sign of retrochiasmatic involvement"},{"idx":3,"proposition":"The sign of Babinski is an interesting sign the spinal cord","correct":false,"justification":"Babinski's sign = pyramid sign = central involvement"},{"idx":4,"proposition":"Damage to the peripheral nervous system is evoked in front of fasciculations","correct":true}],"type":"custom"}
+{"_id":"deficitMo-neuro-2","context":null,"enonce":"Concerning etiologies and differential diagnoses:","item":"deficitMo","matiere":"neuro","propositions":[{"idx":0,"proposition":"Involvement of the neuromuscular or muscular junction is evoked in front of pure motor impairment","correct":true},{"idx":1,"proposition":"The clinical analysis must make it possible to define the syndrome","correct":true},{"idx":2,"proposition":"There is no non-neurological differential diagnosis of recent neurological deficit","correct":false,"justification":"Metabolic, psychiatry, orthopedics, etc."},{"idx":3,"proposition":"A cuff rupture can mimic a recent neurological deficit","correct":true},{"idx":4,"proposition":"Speech disorders always have a neurological origin","correct":false,"justification":"For speech, balance and vision disorders, the cause may be non-neurological, of local origin: ENT"}],"type":"custom"}
+{"_id":"deficitMo-neuro-3","context":null,"enonce":"Concerning the main generalities:","item":"deficitMo","matiere":"neuro","propositions":[{"idx":0,"proposition":"A deficit can have a psychogenic origin, it is then a conversion disorder","correct":false,"justification":"It is then a somatomorphic disorder: motor or sensory territory a little \"aberrant\", non-anatomical, with discordance of the clinical examination, changing complaints, \"beautiful indifference\"... Somatoform disorders can be part of different contexts: hysterical (conversion), simulation, depressive syndrome..."},{"idx":1,"proposition":"The mode of installation of the deficit is a major element of diagnostic orientation","correct":true},{"idx":2,"proposition":"The study of the anamnesis must be particularly careful","correct":true},{"idx":3,"proposition":"Age The older the patient, the more frequent the vascular causes","correct":true},{"idx":4,"proposition":"Complementary neurological examinations are guided by topographic diagnosis","correct":true}],"type":"custom"}
+{"_id":"MSN-urg-0","context":null,"enonce":"What is the corrected QT threshold to suspect long QT syndrome?","item":"MSN","matiere":"urg","propositions":[{"idx":0,"proposition":"400 ms","correct":false,"justification":"None"},{"idx":1,"proposition":"420 ms","correct":false,"justification":"None"},{"idx":2,"proposition":"430 ms","correct":false,"justification":"None"},{"idx":3,"proposition":"440 ms","correct":true,"justification":"None"},{"idx":4,"proposition":"460 ms","correct":false,"justification":"None"}],"type":"custom"}
+{"_id":"KcVADS-onco-0","context":null,"enonce":"Which of these generalities are true?","item":"KcVADS","matiere":"onco","propositions":[{"idx":0,"proposition":"EBV is an important risk factor for cavum cancer","correct":true},{"idx":1,"proposition":"Unilateral earache can sometimes be the only symptom of VADS cancer","correct":true},{"idx":2,"proposition":"HPV is a very important risk factor for oropharyngeal tumors","correct":true},{"idx":3,"proposition":"HPV-induced oropharyngeal tumors are favored by sex","correct":false,"justification":"Favored by genito-oral relationships"},{"idx":4,"proposition":"The most common histological type of sinus tumours is undifferentiated carcinoma","correct":false,"justification":"This is the case of the cavum. For the nasal cavity and sinuses, we mainly find adenocarcinomas"}],"type":"custom"}
+{"_id":"KcVADS-onco-1","context":null,"enonce":"Which of these generalities are true?","item":"KcVADS","matiere":"onco","propositions":[{"idx":0,"proposition":"Cervical radiation therapy can induce hypothyroidism","correct":true},{"idx":1,"proposition":"MRI is mainly indicated in the assessment of extension of tumors under the hyoid bone ","correct":false,"justification":"Above the hyoid bone (oral cavity, cavum, sinuses, nasal cavity, oropharynx): MRI. Below: Scan"},{"idx":2,"proposition":"The CT scan is mainly indicated in the assessment of extension of tumors above the hyoid bone ","correct":false,"justification":"Above the hyoid bone: MRI. Below (larynx, hypopharynx): CT scan"},{"idx":3,"proposition":"The localization of VADS tumors is often bilateral","correct":false,"justification":"Often almost exclusively unilateral. The accompanying symptoms are therefore also unilateral."},{"idx":4,"proposition":"Upper endoscopy is systematic","correct":true}],"type":"custom"}
+{"_id":"KcVADS-onco-2","context":null,"enonce":"Which of these specialties are absolutely necessary for the holding of a CPR?","item":"KcVADS","matiere":"onco","propositions":[{"idx":0,"proposition":"The surgeon","correct":true},{"idx":1,"proposition":"The radiotherapist","correct":false,"justification":"Three specialties: surgery, oncology, and radiology"},{"idx":2,"proposition":"The radiologist","correct":true},{"idx":3,"proposition":"The medical oncologist","correct":true},{"idx":4,"proposition":"ENT","correct":false}],"type":"custom"}
+{"_id":"KcVADS-onco-3","context":null,"enonce":"Regarding the tumor of the cacum:","item":"KcVADS","matiere":"onco","propositions":[{"idx":0,"proposition":"The cavum is the new name for the oropharynx","correct":false,"justification":"The cavum is the new name for the nasopharynx (or nasopharynx)"},{"idx":1,"proposition":"It is specifically promoted by HPV infection","correct":false,"justification":"EBV"},{"idx":2,"proposition":"This is most often adenocarcinoma","correct":false,"justification":"Undifferentiated carcinoma"},{"idx":3,"proposition":"It represents 30 to 50% of VADS tumors","correct":false,"justification":"Less than 1%"},{"idx":4,"proposition":"Examination of the ear can find unilateral seromucosal otitis","correct":true,"justification":"Sometimes it's the only symptom"}],"type":"custom"}
+{"_id":"KcVADS-onco-4","context":null,"enonce":"Which of the following is the most common histological type of ethmoid tumor?","item":"KcVADS","matiere":"onco","propositions":[{"idx":0,"proposition":"Squamous cell carcinoma","correct":false,"justification":"Common in tumors of the oral cavity, oropharynx, larynx and hypopharynx"},{"idx":1,"proposition":"Adenocarcinoma","correct":true,"justification":"True, common in nasal cavity and sinus tumors"},{"idx":2,"proposition":"Undifferentiated carcinoma","correct":false,"justification":"Common in EBV-induced cavum tumors"},{"idx":3,"proposition":"Carcinoma in situ","correct":false,"justification":"It is not a histological type but a stage T"},{"idx":4,"proposition":"None of these propositions are accurate","correct":false,"justification":"Adenocarcinoma is the most common hystrophological type of ethmoid tumors."}],"type":"custom"}
+{"_id":"KcVADS-onco-5","context":null,"enonce":"Regarding the epidemiology of VADS tumors, which proposals are true?","item":"KcVADS","matiere":"onco","propositions":[{"idx":0,"proposition":"These tumours most often occur in women","correct":false,"justification":"False, in humans in 80% of cases."},{"idx":1,"proposition":"The peak frequency is between 60 and 70 years.","correct":true,"justification":"The peak frequency is between 60 and 70 years (except HPV-related oropharyngeal cancers)"},{"idx":2,"proposition":"They are often associated with a low socio-economic level.","correct":true,"justification":"They are often associated with a low socio-economic level."},{"idx":3,"proposition":"They are most often located at the level of the cavum.","correct":false,"justification":"False, cavum in < 1% of cases. Most often in the larynx (35%)."},{"idx":4,"proposition":"There is currently a decrease in the incidence of these tumours in humans.","correct":true,"justification":"There is currently a decrease in the incidence in humans of these tumors due to the decrease in alcohol and tobacco intoxication."}],"type":"custom"}
+{"_id":"KcVADS-onco-6","context":null,"enonce":"Regarding the cancer risk factors of VADS, which proposals are accurate? ","item":"KcVADS","matiere":"onco","propositions":[{"idx":0,"proposition":"Alcohol","correct":true,"justification":"Alcohol"},{"idx":1,"proposition":"Tobacco ","correct":true,"justification":"Tobacco"},{"idx":2,"proposition":"CMV infection ","correct":false,"justification":"Not CMV but EBV for cavum cancer and HPV for oropharynx."},{"idx":3,"proposition":"Poor oral hygiene","correct":true,"justification":"Poor oral hygiene"},{"idx":4,"proposition":"Exposure to wood dust","correct":true,"justification":"Exposure to wood dust (possible recognition as an occupational disease)"}],"type":"custom"}
+{"_id":"KcVADS-onco-7","context":null,"enonce":"Which of the following are true?","item":"KcVADS","matiere":"onco","propositions":[{"idx":0,"proposition":"Ethmoid cancers are frequently associated with EBV. ","correct":false,"justification":"False, these are nasopharyngeal cancers."},{"idx":1,"proposition":"Cavum cancers are usually squamous cell carcinoma. ","correct":false,"justification":"False, they are most often UCNT type (undifferenciated carcinoma of nasopharyngeal type)"},{"idx":2,"proposition":"Alcohol and tobacco are the most common risk factors for head and neck cancers.","correct":true,"justification":"Alcohol and tobacco are the most common risk factors for head and neck cancers."},{"idx":3,"proposition":"Adenocarcinoma of the ethmoid is considered an occupational disease.","correct":true,"justification":"Ethmoid adenocarcinoma is considered an occupational disease (occupational exposure to wood dust)"},{"idx":4,"proposition":"VADS cancers are the 5th most common cancer in France.","correct":true,"justification":"VADS cancers are the 5th most common cancer in France."}],"type":"custom"}
+{"_id":"Kcped-onco-0","context":null,"enonce":"What is the annual incidence of childhood cancer in France?","item":"Kcped","matiere":"onco","propositions":[{"idx":0,"proposition":"1200","correct":false},{"idx":1,"proposition":"2400","correct":true},{"idx":2,"proposition":"4800","correct":false},{"idx":3,"proposition":"9600","correct":false},{"idx":4,"proposition":"19200","correct":false}],"type":"custom"}
+{"_id":"Kcped-onco-1","context":null,"enonce":"What is the approximate cure rate for childhood and adolescent tumors?","item":"Kcped","matiere":"onco","propositions":[{"idx":0,"proposition":"0.2","correct":false},{"idx":1,"proposition":"0.4","correct":false},{"idx":2,"proposition":"0.6","correct":false},{"idx":3,"proposition":"0.8","correct":true},{"idx":4,"proposition":"1","correct":false}],"type":"custom"}
+{"_id":"Kcped-onco-2","context":null,"enonce":"About childhood cancers:","item":"Kcped","matiere":"onco","propositions":[{"idx":0,"proposition":"Have very slow and pauci-symptomatic growth","correct":false,"justification":"They are indeed pauci-symptomatic, but their growth is very fast (in general, much more than adult tumors)"},{"idx":1,"proposition":"Are characterized by a profuse AEG","correct":false,"justification":"Except in some leukemias, there is a general condition fairly well preserved"},{"idx":2,"proposition":"Result in disparate and non-specific clinical signs","correct":false},{"idx":3,"proposition":"Are mostly glioblastomas","correct":false,"justification":"Hematological tumours in the foreground"},{"idx":4,"proposition":"Are relatively good prognosis","correct":true}],"type":"custom"}
+{"_id":"Kcped-onco-3","context":null,"enonce":"Which of the following are elements of Claude Bernard Horner syndrome?","item":"Kcped","matiere":"onco","propositions":[{"idx":0,"proposition":"Profuf asthenia","correct":false,"justification":"False, this does not fit into the definition of CBH"},{"idx":1,"proposition":"Congenital cataract","correct":false,"justification":"False, this does not fit into the definition of CBH"},{"idx":2,"proposition":"Unilateral mydriasis","correct":false,"justification":"It is a myosis of the affected eye that falls within the definition of CBH"},{"idx":3,"proposition":"Pseudo-enophtalmos","correct":true},{"idx":4,"proposition":"Sign of Charles-Bell","correct":false,"justification":"The CBH includes: ptosis, myosis and enophtalmos, all on the same side"}],"type":"custom"}
+{"_id":"Kcped-onco-4","context":null,"enonce":"Which of the following are true about Lactate Dehydrogenase?","item":"Kcped","matiere":"onco","propositions":[{"idx":0,"proposition":"It is often used as a marker of tissue damage","correct":true},{"idx":1,"proposition":"It catalyzes the conversion of pyruvate to lactate","correct":true},{"idx":2,"proposition":"It is an extracellular protein","correct":false,"justification":"Intracellular enzyme"},{"idx":3,"proposition":"It is specific to the human being","correct":false,"justification":"LDH are enzymes found in a wide variety of organisms, both plant and animal."},{"idx":4,"proposition":"It is abundant in red blood cells and can therefore be used to guide hemolysis","correct":true}],"type":"custom"}
+{"_id":"boiterieped-ortho-0","context":null,"enonce":"The basics:","item":"boiterieped","matiere":"ortho","propositions":[{"idx":0,"proposition":"Lameness corresponds to an asymmetrical approach","correct":true},{"idx":1,"proposition":"Additional examinations will be requested based on the data collected by the clinic","correct":true,"justification":"1"},{"idx":2,"proposition":"The age of the child is the determining factor that points towards one pathology rather than another.","correct":true},{"idx":3,"proposition":"In view of the emergency that is not vital, we start by questioning the patient","correct":true},{"idx":4,"proposition":"Episodes of fever strongly point to an infectious phenomenon","correct":true,"justification":"1"}],"type":"custom"}
+{"_id":"boiterieped-ortho-1","context":null,"enonce":"Regarding interrogation and clinical examination:","item":"boiterieped","matiere":"ortho","propositions":[{"idx":0,"proposition":"The precise origin of the lameness is difficult to trace in small children","correct":true},{"idx":1,"proposition":"The observation of lameness: in the shoulder lameness or equilibration that reflects a pathology of the hip, the child transfers his center of gravity to each support on the side of the physiological hip","correct":false,"justification":"The observation of lameness: in the shoulder lameness or equilibration that reflects a pathology of the hip, the child transfers his center of gravity to each support on the side of the pathological hip"},{"idx":2,"proposition":"Dodge lameness is analgesic","correct":true},{"idx":3,"proposition":"A skin lesion points to endocrine pathology","correct":false,"justification":"Infectious"},{"idx":4,"proposition":"The tibial diaphysis is palpated with particular attention to detect a possible fracture of the acetabulum","correct":false,"justification":"Possible subperiosteal fracture"}],"type":"custom"}
+{"_id":"boiterieped-ortho-2","context":null,"enonce":"Regarding pain in small children:","item":"boiterieped","matiere":"ortho","propositions":[{"idx":0,"proposition":"In hip diseases, adduction and external rotation are impossible","correct":false,"justification":"In hip disease, abduction and internal rotation are limited"},{"idx":1,"proposition":"The neurological examination looks for an equine walk, tests muscle tone, muscle strength, osteotendinous reflections","correct":true},{"idx":2,"proposition":"Refusal to sit is sometimes the only objective sign","correct":true,"justification":"1"},{"idx":3,"proposition":"The disease area is more easily identifiable in small children than in adolescents","correct":false,"justification":"Much simpler in adolescents"},{"idx":4,"proposition":"Hip pathologies are often responsible for projected heel pain","correct":false,"justification":"At the knee"}],"type":"custom"}
+{"_id":"boiterieped-ortho-3","context":null,"enonce":"Concerning paraclinical examinations:","item":"boiterieped","matiere":"ortho","propositions":[{"idx":0,"proposition":"Biological examination is systematic in search of an inflammatory syndrome","correct":true},{"idx":1,"proposition":"The best test to identify a joint effusion is the x-ray at the hip","correct":false,"justification":"It is the ultrasound that best visualizes a joint effusion at the hip or ankle"},{"idx":2,"proposition":"Ultrasound can objectify an effusion of soft parts","correct":true},{"idx":3,"proposition":"Comparative images are only justified in case of doubt about an image of osteolysis, or edema of the soft parts","correct":true,"justification":"1"},{"idx":4,"proposition":"MRI is indicated as a first-line test when the suspicion of ligament rupture is moderate to strong","correct":false,"justification":"First an ultrasound"}],"type":"custom"}
+{"_id":"boiterieped-ortho-4","context":null,"enonce":"Regarding osteoarticular infections:","item":"boiterieped","matiere":"ortho","propositions":[{"idx":0,"proposition":"CT scans and MRIs are not routine","correct":true},{"idx":1,"proposition":"An infectious assessment is essential in case of suspicion of osteoarticular infection","correct":true},{"idx":2,"proposition":"The puncture for bacteriological research is urgent in case of doubt about osteoarticular infection","correct":true},{"idx":3,"proposition":"Lameness in a febrile context is suspected of tendon rupture in the first place","correct":false,"justification":"Ë Lameness in a febrile context is due to an osteoarticular infection until proven otherwise"},{"idx":4,"proposition":"Bacteriological samples must be taken under general anesthesia, as a matter of urgency","correct":true,"justification":"1"}],"type":"custom"}
+{"_id":"boiterieped-ortho-5","context":null,"enonce":"Which propositions are true?","item":"boiterieped","matiere":"ortho","propositions":[{"idx":0,"proposition":"An osteochondritis of the hip is febrile and concerns the child between 8 and 10 years","correct":false,"justification":"Non-febrile and between 3 and 8 years old"},{"idx":1,"proposition":"Epiphysiolysis is rare before 10 years","correct":true},{"idx":2,"proposition":"Infantile cerebral hemiplegia can occur at any age in childhood","correct":true},{"idx":3,"proposition":"Congenital hip dislocation is very common before 3 years of age","correct":true},{"idx":4,"proposition":"Transient acute synovitis is very febrile at peak","correct":false,"justification":"No fever most often"}],"type":"custom"}
+{"_id":"boiterieped-ortho-6","context":null,"enonce":"Regarding the IOA:","item":"boiterieped","matiere":"ortho","propositions":[{"idx":0,"proposition":"CT scans and MRIs are not routine","correct":true},{"idx":1,"proposition":"An infectious assessment is essential in case of suspicion of osteoarticular infection","correct":true,"justification":"CRP in particular"},{"idx":2,"proposition":"The puncture for bacteriological research is urgent in case of doubt about osteoarticular infection","correct":true,"justification":"Can be done under GA"},{"idx":3,"proposition":"Lameness in a febrile context is suspected of tendon rupture in the first place","correct":false,"justification":"Lameness in a febrile context is due to an osteoarticular infection until proven otherwise"},{"idx":4,"proposition":"Initial antibiotic therapy is urgent, intravenous and adapted to the susceptibility test","correct":false,"justification":"It is initially probabilistic"}],"type":"custom"}
+{"_id":"zoonose-infectio-0","context":null,"enonce":"Concerning zoonoses","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Zoonoses are infectious diseases transmitted to humans, either directly by an animal or indirectly via vectors. ","correct":true},{"idx":1,"proposition":"In metropolitan France, the most frequent zoonoses are Lyme borreliosis, pasteurellosis, toxoplasmosis and cat's scratch disease.","correct":true},{"idx":2,"proposition":"Brucellosis has been controlled and is currently almost non-existent in France","correct":true,"justification":"See item in the latest edition of the college"},{"idx":3,"proposition":"Slow incubation is characteristic of pasteurellosis","correct":false,"justification":"It is the speed of incubation is characteristic of pasteurellosis"},{"idx":4,"proposition":"In 10% of cases of pasteurellosis, an ophthalmic form combining conjunctivitis and pretrageal lymphadenopathy is described, mainly in children","correct":true}],"type":"custom"}
+{"_id":"zoonose-infectio-1","context":null,"enonce":"Regarding cat scratch disease:","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"The cat flea is the vector of cat scratch disease","correct":true},{"idx":1,"proposition":"In humans, from the inoculation lesion, the bacterium will multiply in a relay ganglion","correct":true,"justification":"See item in the latest edition of the college"},{"idx":2,"proposition":"Lymphadenopathy is a sign of an inflammatory reaction with caseous granuloma","correct":false,"justification":"This lymphadenopathy is the site of an inflammatory reaction with epithelioid granuloma without caseous necrosis"},{"idx":3,"proposition":"This disease is more common in children and young adults, with an incubation of 2-3 days on average.","correct":false,"justification":"Incubation of 2-3 weeks on average"},{"idx":4,"proposition":"In half of the cases, there is a primary papular erythematous lesion located in the lymphatic drainage territory of the skin lesion","correct":true}],"type":"custom"}
+{"_id":"zoonose-infectio-2","context":null,"enonce":"Regarding Lyme borreliosis:","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Man is mainly stung during walks in fortê","correct":true},{"idx":1,"proposition":"From the inoculation point, the bacterium migrates and multiplies in the dermis (erythema migrans)","correct":true,"justification":"See item in the latest edition of the college"},{"idx":2,"proposition":"In a second step, it can spread through the blood and reach the central and peripheral nervous system, meninges and large joints.","correct":true,"justification":"See item in the latest edition of the college"},{"idx":3,"proposition":"A large proportion of infections are inapparent, leaving the only trace of their occurrence being the detection of specific antibodies","correct":true,"justification":"See item in the latest edition of the college"},{"idx":4,"proposition":"The vast majority of diagnoses are made in the tertiary phase of the disease","correct":false,"justification":"The vast majority of diagnoses are made in the primary phase of the disease"}],"type":"custom"}
+{"_id":"zoonose-infectio-3","context":null,"enonce":"Regarding the Q fever:","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Humans are contaminated either by the digestive tract (consumption of raw milk) or by inhalation (inhalation of aerosols from elements contaminated by the bacteria: straw, manure, etc.)","correct":true,"justification":"See item in the latest edition of the college"},{"idx":1,"proposition":"Ticks cannot transmit the bacteria","correct":false,"justification":"Ticks can eventually transmit the bacteria"},{"idx":2,"proposition":"It is an exclusive disease of the Mediterranean basin and the Caribbean, more common in rural areas","correct":false,"justification":"It is a cosmopolitan disease, more common in rural areas"},{"idx":3,"proposition":"About 95% of infections will remain asymptomatic","correct":false,"justification":"About 60% of infections will remain asymptomatic"},{"idx":4,"proposition":"It is the fever Q eagle that is by far the most common clinical form of the disease","correct":true,"justification":"See item in the latest edition of the college"}],"type":"custom"}
+{"_id":"zoonose-infectio-4","context":null,"enonce":"Which of the following are directly transmitted 🐩➡👩 pathologies?","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Toxoplasmosis","correct":true,"justification":"True, from the chat 🐱"},{"idx":1,"proposition":"Brucellosis","correct":true},{"idx":2,"proposition":"Pasteurellosis","correct":true},{"idx":3,"proposition":"Tularemia","correct":true},{"idx":4,"proposition":"All propositions are true","correct":true}],"type":"custom"}
+{"_id":"zoonose-infectio-6","context":null,"enonce":"Which of the following are directly transmitted 🐩➡👩 pathologies?","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Toxoplasmosis","correct":true,"justification":"True, from the chat 🐱"},{"idx":1,"proposition":"Brucellosis","correct":true},{"idx":2,"proposition":"Pasteurellosis","correct":true},{"idx":3,"proposition":"Tularemia","correct":true},{"idx":4,"proposition":"All propositions are true","correct":true}],"type":"custom"}
+{"_id":"zoonose-infectio-7","context":null,"enonce":"Which of the following are vector-borne pathologies?","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Q fever 🤒 ","correct":false,"justification":"Transmission is direct"},{"idx":1,"proposition":"Leishmaniasis","correct":true},{"idx":2,"proposition":"Lyme disease","correct":true,"justification":"True, via ticks 🦟"},{"idx":3,"proposition":"Tularemia","correct":false,"justification":"Transmission is direct"},{"idx":4,"proposition":"Brucellosis","correct":false,"justification":"Transmission is direct"}],"type":"custom"}
+{"_id":"zoonose-infectio-8","context":null,"enonce":"Which of the following are possible heart effects of Lyme disease?","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Myocarditis","correct":true,"justification":"True, it is rarer than the BAV"},{"idx":1,"proposition":"Atrioventricular block","correct":true},{"idx":2,"proposition":"Sino-atrial block","correct":false,"justification":"BAV"},{"idx":3,"proposition":"Syndrome de Brugada","correct":false,"justification":"It is a genetic disease"},{"idx":4,"proposition":"Coronary spasm","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"zoonose-infectio-9","context":null,"enonce":"Which of the following propositions are true regarding rabies 🐕 🦺?","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is due to Lyssavirus","correct":true,"justification":"True. Lyssaviruses are a genus of viruses in the family Rhabdoviridae, order Mononegavirales, which includes rabies virus and related viruses. In 2017, this genus has at least 14 members, the first known serotype of which is the rabies virus or RABV for RABies Virus, responsible for human rabies."},{"idx":1,"proposition":"Serotherapy is possible ","correct":true},{"idx":2,"proposition":"Incubation does not exceed 2 days","correct":false,"justification":"It can sometimes be long ⏳"},{"idx":3,"proposition":"Wound management involves washing with soap, antiseptic and trimming","correct":true},{"idx":4,"proposition":"Vaccination should be carried out urgently if the patient is no longer immunized 🚨 ","correct":true}],"type":"custom"}
+{"_id":"zoonose-infectio-10","context":null,"enonce":"Which of the following are signs or symptoms of congenital toxoplasmosis in a newborn?","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Birth weight> 3.5 kg","correct":false,"justification":"Rather prematurity so a low birth weight"},{"idx":1,"proposition":"Intrauterine growth restriction","correct":true},{"idx":2,"proposition":"Jaundice","correct":true},{"idx":3,"proposition":"Hepatosplenomegaly","correct":true},{"idx":4,"proposition":"Respiratory distress","correct":false}],"type":"custom"}
+{"_id":"zoonose-infectio-11","context":null,"enonce":"Which of the following are true about the Zika virus?","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is transmitted by an Aedes mosquito","correct":true,"justification":"True. Tiger mosquito = Aedes albopictus"},{"idx":1,"proposition":"It is teratogenic","correct":true},{"idx":2,"proposition":"Erythema migrans may be observed","correct":false,"justification":"NO, this is the case for Lyme disease"},{"idx":3,"proposition":"MS can be seen","correct":false,"justification":"A Guillain-Barré"},{"idx":4,"proposition":"It is a reportable disease","correct":true}],"type":"custom"}
+{"_id":"zoonose-infectio-12","context":null,"enonce":"Which of the following are true?","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"A zoonosis is a disease that can be transmitted from animals to humans","correct":true},{"idx":1,"proposition":"Brucellosis is transmitted by only one vector","correct":false,"justification":"Direct transmission"},{"idx":2,"proposition":"Erythema migrans is found in Lyme disease","correct":true},{"idx":3,"proposition":"Tularemia is classically apyretic","correct":false,"justification":"Fever is high"},{"idx":4,"proposition":"Q fever is caused by Coxiella Burnetii","correct":true}],"type":"custom"}
+{"_id":"immunoD-immuno-1","context":null,"enonce":"Which of the following are encapsulated bacteria?","item":"immunoD","matiere":"immuno","propositions":[{"idx":0,"proposition":"Neisseria gonorrhoeae","correct":true},{"idx":1,"proposition":"Neisseria meningitidis","correct":true},{"idx":2,"proposition":"Staphylococcus aureus","correct":false,"justification":"Staphylococci are not encapsulated"},{"idx":3,"proposition":"Haemophilus influenzae","correct":true},{"idx":4,"proposition":"Escherichia coli","correct":false,"justification":"The 3 to remember are: Haemophilus, Neisseria, Streptococcus"}],"type":"custom"}
+{"_id":"constipation-HGE-0","context":null,"enonce":"About constipation","item":"constipation","matiere":"HGE","propositions":[{"idx":0,"proposition":"Constipation is a symptom that corresponds to a dissatisfaction of the patient during defecation","correct":true},{"idx":1,"proposition":"The chronic nature of constipation is defined by a duration of symptom evolution greater than 6 weeks","correct":false,"justification":"According to international criteria (Rome criteria), the chronic nature of constipation is defined as a duration of symptom evolution greater than 6 months"},{"idx":2,"proposition":"There is a female predominance","correct":true},{"idx":3,"proposition":"In drug addicts and especially morphine addicts, constipation is almost constant","correct":true},{"idx":4,"proposition":"Hyperactivity corresponds to an increase in segmental contractions in the sigmoid region, which slow down the progression of materials","correct":true}],"type":"custom"}
+{"_id":"constipation-HGE-1","context":null,"enonce":"The elements that point to distal constipation are:","item":"constipation","matiere":"HGE","propositions":[{"idx":0,"proposition":"Pushing efforts","correct":true},{"idx":1,"proposition":"The absence of exonerating need","correct":true},{"idx":2,"proposition":"Shortened exemption time","correct":false,"justification":"It is extended"},{"idx":3,"proposition":"Less than 3 bowel movements per week","correct":false,"justification":"This is the case for transit constipation"},{"idx":4,"proposition":"Sensation of a gene at the passage of stool or incomplete evacuation","correct":true}],"type":"custom"}
+{"_id":"constipation-HGE-2","context":null,"enonce":"About constipation","item":"constipation","matiere":"HGE","propositions":[{"idx":0,"proposition":"Daily fibre intake should be greater than 5 g\/d","correct":false,"justification":"Must be greater than 15 g\/d"},{"idx":1,"proposition":"Recent constipation or worsening of chronic constipation should investigate an organic cause","correct":true},{"idx":2,"proposition":"Osmotic laxatives are the first-line treatment for any constipation","correct":true},{"idx":3,"proposition":"In case of transit conservation, rectal laxatives are often necessary","correct":false,"justification":"This is the case for distal constipation"},{"idx":4,"proposition":"Certain medications can cause constipation such as anti-depressants and opiates","correct":true}],"type":"custom"}
+{"_id":"intox-urg-0","context":null,"enonce":"What is the antidote to iron poisoning?","item":"intox","matiere":"urg","propositions":[{"idx":0,"proposition":"No known antidote","correct":false,"justification":"False, chelator of iron"},{"idx":1,"proposition":"Iron chelator","correct":true},{"idx":2,"proposition":"Alkaline diuresis","correct":false,"justification":"Salicylated poisoning"},{"idx":3,"proposition":"Hyperbaric chamber oxygen","correct":false,"justification":"CO poisoning"},{"idx":4,"proposition":"Hydroxocobalamin (vitamin B12)","correct":false,"justification":"Fire smoke poisoning (cyanide)"}],"type":"custom"}
+{"_id":"intox-urg-1","context":null,"enonce":"What is the antidote to paracetamol poisoning?","item":"intox","matiere":"urg","propositions":[{"idx":0,"proposition":"None","correct":false,"justification":"False"},{"idx":1,"proposition":"N-acetylcysteine","correct":true},{"idx":2,"proposition":"Antidigoxin Fab","correct":false,"justification":"Digitalis poisoning"},{"idx":3,"proposition":"Repeated activated charcoal","correct":false,"justification":"Phenobarbital or theophylline poisoning"},{"idx":4,"proposition":"Hemodialysis","correct":false,"justification":"Lithium poisoning"}],"type":"custom"}
+{"_id":"intox-urg-2","context":null,"enonce":"What is the antidote to benzodiazepine poisoning?","item":"intox","matiere":"urg","propositions":[{"idx":0,"proposition":"Flumazenil","correct":true},{"idx":1,"proposition":"Naloxone","correct":false,"justification":"Opioid poisoning"},{"idx":2,"proposition":"Glucagon","correct":false,"justification":"Beta-blocker poisoning"},{"idx":3,"proposition":"Insulin","correct":false,"justification":"Calcium channel blocker poisoning"},{"idx":4,"proposition":"No known antidote","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"intox-urg-3","context":null,"enonce":"Which of the following are systematic additional examinations in case of suspicion of acute intoxication?","item":"intox","matiere":"urg","propositions":[{"idx":0,"proposition":"Electrocardiogram 💓","correct":true},{"idx":1,"proposition":"Capillary 🧁 blood glucose","correct":true},{"idx":2,"proposition":"Chest ☢ X-ray","correct":false,"justification":"On sign of respiratory complication"},{"idx":3,"proposition":"Brain 🧠 computed tomography","correct":false,"justification":"If alertness disorder"},{"idx":4,"proposition":"No review is systematic","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"intox-urg-4","context":null,"enonce":"Which of the following proposals are providers of serotonin syndrome?","item":"intox","matiere":"urg","propositions":[{"idx":0,"proposition":"LSD","correct":false,"justification":"Sympathomimetic syndrome"},{"idx":1,"proposition":"Anti-histamines","correct":false,"justification":"Anticholinergic syndrome"},{"idx":2,"proposition":"Antidepressants that inhibit serotonin reuptake","correct":true},{"idx":3,"proposition":"Specific serotonin reuptake agonist","correct":true},{"idx":4,"proposition":"Benzodiazepine","correct":false,"justification":"Opioid syndrome (narcotic)"}],"type":"custom"}
+{"_id":"intox-urg-5","context":null,"enonce":"Which of the following proposals are providers of sympathomimetic syndrome?","item":"intox","matiere":"urg","propositions":[{"idx":0,"proposition":"Xantines","correct":true},{"idx":1,"proposition":"Cocaine","correct":true},{"idx":2,"proposition":"Amphetamines","correct":true},{"idx":3,"proposition":"LSD","correct":true},{"idx":4,"proposition":"Atropine","correct":false,"justification":"Anticholinergic syndrome"}],"type":"custom"}
+{"_id":"intox-urg-6","context":null,"enonce":"Which of the following are the providers of anticholinergic syndrome?","item":"intox","matiere":"urg","propositions":[{"idx":0,"proposition":"Atropine","correct":true},{"idx":1,"proposition":"Anti-histamines","correct":true},{"idx":2,"proposition":"Anti-parkinsonians","correct":true},{"idx":3,"proposition":"Tryciclic anti-depressants","correct":true},{"idx":4,"proposition":"Heroin","correct":false,"justification":"Opioid syndrome (narcotic)"}],"type":"custom"}
+{"_id":"intox-urg-7","context":null,"enonce":"Which of the following are true?","item":"intox","matiere":"urg","propositions":[{"idx":0,"proposition":"Poisoning is the leading cause of hospital admission for adults under 30 years of age","correct":true,"justification":"True, this is exactly what is written in the college of anesthesia-resuscitation (2018 edition, page 365)"},{"idx":1,"proposition":"The ECG is done on the call point","correct":false,"justification":"It is systematic"},{"idx":2,"proposition":"CO2 poisoning accounts for 4,000 to 8,000 victims each year in France","correct":false,"justification":"False, it is at the CO (note that it is written 4000 in the college of resuscitation, and 8000 in the college of emergencies)"},{"idx":3,"proposition":"The incidence of poisoning is drastically decreasing","correct":false,"justification":"On the rise"},{"idx":4,"proposition":"The most frequent etiology is represented by voluntary intoxication with psychotropic drugs.","correct":true,"justification":"True, exactly the sentence of the Emergency Medline"}],"type":"custom"}
+{"_id":"hyperEo-hemato-0","context":null,"enonce":"About eosinophils","item":"hyperEo","matiere":"hemato","propositions":[{"idx":0,"proposition":"Hypereosinophilia is defined as an absolute number of eosinophilic polynuclear > 5 G\/L, confirmed on a second sample","correct":false,"justification":"Hypereosinophilia is defined by an absolute number of eosinophilic polynuclear > 0.5 G \/ L, confirmed on a second sample"},{"idx":1,"proposition":"The main causes of eosinophilia are, in order of frequency: allergic, infectious (parasitic), more rarely neoplastic (hematological malignancy, cancer) or related to a systemic disease","correct":true},{"idx":2,"proposition":"Major eosinophilia, whatever the cause, can have harmful consequences on the functioning of different organs and in particular the heart","correct":true,"justification":"TRUE. Activated NEPs release mediators (ationic proteins, toxic oxygen metabolites), toxic to certain organs, including the heart"},{"idx":3,"proposition":"A careful interrogation must seek in particular the possibility of giardosis","correct":false,"justification":"In particular, a helmintis is sought"},{"idx":4,"proposition":"Among parasitosis, only helminthoses cause eosinophilia","correct":false,"justification":"It is most often a helminthosis, but other parasites may be involved"}],"type":"custom"}
+{"_id":"hyperEo-hemato-1","context":null,"enonce":"About eosinophils","item":"hyperEo","matiere":"hemato","propositions":[{"idx":0,"proposition":"Hypereosinophil is found in some hemopathies","correct":true,"justification":"Mainly Hodgkin's disease, T-cell lymphomas, especially cutaneous, or myeloproliferative syndromes"},{"idx":1,"proposition":"The interrogation will have to look in particular for elements towards a parasitic attack such as the consumption of undercooked meat or a stay in a tropical zone","correct":true},{"idx":2,"proposition":"In case of eosinophilia with signs of severity, the patient must be put under emergency outpatient treatment","correct":false,"justification":"The patient must be hospitalized urgently with a specialized opinion"},{"idx":3,"proposition":"The introduction of new medicinal products and the taking of medicinal products must be sought at the interrogation","correct":true,"justification":"The imputability of a drug in the development of EO is difficult to prove, proof is sometimes provided only with the slow and gradual disappearance of HE after eviction of the drug"},{"idx":4,"proposition":"Hypereosinophilia> 1 G\/L for >3 months are signs of severity","correct":false,"justification":"Hypereosinophilia> 1.5 G\/L for >6 months"}],"type":"custom"}
+{"_id":"hyperEo-hemato-2","context":null,"enonce":"The first-line assessment of an asymptomatic patient who has stayed in the tropics will be completed by","item":"hyperEo","matiere":"hemato","propositions":[{"idx":0,"proposition":"Total igE assays","correct":false,"justification":"The IgE assay is not in 1st intention but after the antiparasitic treatment of test of a chronic HE according to the college of hematology"},{"idx":1,"proposition":"Total IgA determination","correct":false},{"idx":2,"proposition":"Parasitological examination of stool to be repeated three times","correct":true},{"idx":3,"proposition":"Serology schistosomiasis, fillariosis, stronglyoidosis","correct":true},{"idx":4,"proposition":"A specialized opinion is mandatory","correct":false,"justification":"It is desirable but not mandatory"}],"type":"custom"}
+{"_id":"SpA-rhumato-0","context":null,"enonce":"Regarding the basics of SpA:","item":"SpA","matiere":"rhumato","propositions":[{"idx":0,"proposition":"The 5 spondyloarthritis are: ankylosing spondylitis, psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory enterocolopathies and undifferentiated SpA","correct":true},{"idx":1,"proposition":"The overall prevalence of all spondyloarthritis is 0.35% in France","correct":true},{"idx":2,"proposition":"The majority of cases begin in young adults (before thirty-five or forty years of age)","correct":true},{"idx":3,"proposition":"The sex ration is 2 women for 1 man","correct":false,"justification":"Sex ratio of 1.5 men to 1 woman"},{"idx":4,"proposition":"Entheses are the bone insertions of organs on bones","correct":false,"justification":"Rather tendons, ligaments, capsules and fascia on the bones"}],"type":"custom"}
+{"_id":"SpA-rhumato-1","context":null,"enonce":"Regarding the sacro-illite:","item":"SpA","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Sacroiliitis is a pain of the buttock of mechanical schedule","correct":false,"justification":"Inflammatory"},{"idx":1,"proposition":"Fessalgia is always unilateral","correct":false,"justification":"Either unilateral, bilateral or rocking"},{"idx":2,"proposition":"Pyalgia never radiates","correct":false,"justification":"If. It can radiate below the gluteal fold and be confused with truncated sciatica"},{"idx":3,"proposition":"Neurological signs associated with this pyalgia can be found","correct":false,"justification":"No neurogenic or root character in pure sacroillitis"},{"idx":4,"proposition":"We manage to trigger these pains by shearing maneuvers of the sacroiliacs","correct":true}],"type":"custom"}
+{"_id":"SpA-rhumato-2","context":null,"enonce":"Regarding clinical signs:","item":"SpA","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Psoriatic arthritis may be accompanied by arthritis of the distal interphalengals","correct":true,"justification":"Not seen in osteoarthritis or RA"},{"idx":1,"proposition":"The characteristic involvement of spondyloarthritis is the distal fracture of the femur","correct":false,"justification":"This is the enthesite"},{"idx":2,"proposition":"Only the entheses of the lower limbs and back are affected","correct":false,"justification":"All entheses can potentially be reached"},{"idx":3,"proposition":"The most frequent and characteristic condition is heel pain","correct":true},{"idx":4,"proposition":"Talalaga is unilateral most often","correct":false,"justification":"Bilateral and rocking"}],"type":"custom"}
+{"_id":"SpA-rhumato-3","context":null,"enonce":"Regarding the associated signs and symptoms:","item":"SpA","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Dactylitis is pathognomonic of spondyloarthritis","correct":false,"justification":"Can be seen in many other pathologies!"},{"idx":1,"proposition":"SpA has purely rheumatological manifestations","correct":false,"justification":"In psoriatic arthritis: dermal involvement. In SpA associated with enterocolopathy: digestive involvement. etc"},{"idx":2,"proposition":"Acute anterior uveitis is, most often, non-granulomatous","correct":true},{"idx":3,"proposition":"Acute anterior uveitis can be either unilateral or bilateral","correct":true},{"idx":4,"proposition":"Acute anterior uveitis is never inaugural","correct":false,"justification":"Its prevalence is 20% and it can quite be inaugural"}],"type":"custom"}
+{"_id":"SpA-rhumato-4","context":null,"enonce":"Regarding ankylosing spondylitis:","item":"SpA","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Psoriasis precedes the onset of psoriatic arthritis by 10 years in most cases","correct":true},{"idx":1,"proposition":"Ankylosing spondylitis is the most typical and severe form of SpA","correct":true},{"idx":2,"proposition":"Peripheral syndrome is clinically predominant","correct":false,"justification":"Pelvirachidal involvement is at the forefront"},{"idx":3,"proposition":"The ossification of entheses is not always painful","correct":true,"justification":"It is most often said that said"},{"idx":4,"proposition":"The extrarheumatic sign in the foreground is acute anterior uveitis","correct":true}],"type":"custom"}
+{"_id":"SpA-rhumato-5","context":null,"enonce":"Which propositions are true?","item":"SpA","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Fiessinger-Leroy-Reiter syndrome is the most complete form of reactive arthritis and is defined by the urethritis-conjunctivitis-arthritis triad","correct":true},{"idx":1,"proposition":"10% of patients have an HLA-27 gene","correct":false,"justification":"50 to 95% of them"},{"idx":2,"proposition":"Undifferentiated SpA are SpA that meet the criteria of the ESSG for example","correct":true},{"idx":3,"proposition":"Peripheral enthesitis is the most common clinical sign","correct":true},{"idx":4,"proposition":"Undifferentiated SpA is most often benign","correct":true}],"type":"custom"}
+{"_id":"tbiono-nephro-0","context":null,"enonce":"At the clinical examination of a 75-year-old patient at the UAA you find a BP at 106\/67 mm Hg in the supine position and 85\/45 mm Hg in the standing position and a skin fold. NFS = Hb: 16 g\/dL, pq: 250 G\/L, leuko: 9.6 G\/L. Natraemia: 115 mmol\/L. Kaliemia: 3.5 mmol\/L. Protidemia 90 g\/L. What is the state of hydration? ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"No hydration disorder","correct":false},{"idx":1,"proposition":"Extracellular dehydration ","correct":true,"justification":"Skin fold, hypototension, hyperprotidemia"},{"idx":2,"proposition":"Extracellular hyperhydration ","correct":false},{"idx":3,"proposition":"Intracellular dehydration ","correct":false},{"idx":4,"proposition":"Intracellular hyperhydration ","correct":true,"justification":"Hyponatremia"}],"type":"custom"}
+{"_id":"tbiono-nephro-1","context":null,"enonce":"Formula for calculating plasma osmolarity: ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"Na + K + blood sugar","correct":false},{"idx":1,"proposition":"Na + K + blood sugar + urea","correct":false},{"idx":2,"proposition":"Na + Cl + blood sugar ","correct":false},{"idx":3,"proposition":"Na x 2 + blood sugar ","correct":true},{"idx":4,"proposition":"(Na + K) x 2 + blood glucose ","correct":false}],"type":"custom"}
+{"_id":"tbiono-nephro-2","context":null,"enonce":"Analyze this GDS: pH = 7.20 pCO2 = 45 mmHg pO2 = 75 mmHg HCO3 = 17 mmol\/L. ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"Ventilatory acidosis with metabolic compensation because bicarbonates are elevated","correct":false},{"idx":1,"proposition":"Metabolic acidosis with ventlatory compensation because capnia is elevated ","correct":false},{"idx":2,"proposition":"Mixed, ventilatory and metabolic acidosis ","correct":false},{"idx":3,"proposition":"We speak of acidosis when the pH is < 7.38 ","correct":false},{"idx":4,"proposition":"In case of simple metabolic acidosis, the expected PaO2 is = 1.5 x HCO3+ 8 ( +\/2 ) ","correct":true}],"type":"custom"}
+{"_id":"tbiono-nephro-3","context":null,"enonce":"Which of the following are etiologies of inappropriate hypothalamic secretion of DHA?","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"Haloperidol","correct":true},{"idx":1,"proposition":"Vincristine","correct":true},{"idx":2,"proposition":"Assisted ventilation with PEEP","correct":true},{"idx":3,"proposition":"Tuberculosis","correct":true},{"idx":4,"proposition":"Lymphoma","correct":false,"justification":"Cause of paraneoplastic syndrome (ectopic tumor secretion of ADH, or ADH-like substance)"}],"type":"custom"}
+{"_id":"tbiono-nephro-4","context":null,"enonce":"Which of the following are true?","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"Water makes up 60% of body weight","correct":true},{"idx":1,"proposition":"Posm = [Na+ x 2] + Blood glucose (mmol\/L)","correct":true},{"idx":2,"proposition":"Posm = [Na+ x 2] + Blood glucose (mmol\/L) + Kaliemia","correct":false,"justification":"The two possible formulas for calculating plasma osmolarity are: P = 2Na + Glc or P = 2Na + Glc + Urea"},{"idx":3,"proposition":"Posm = [Na+ x 2] + Blood glucose (mmol\/L) + Chloremia","correct":false,"justification":"The two possible formulas for calculating plasma osmolarity are: P = 2Na + Glc or P = 2Na + Glc + Urea"},{"idx":4,"proposition":"Posm = [Na+ x 2] + Blood glucose (mmol\/L) + Uric acid","correct":false,"justification":"The two possible formulas for calculating plasma osmolarity are: P = 2Na + Glc or P = 2Na + Glc + Urea"}],"type":"custom"}
+{"_id":"tbiono-nephro-5","context":null,"enonce":"Which of the following are etiologies of inappropriate hypothalamic secretion of DHA?","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"Traumatic brain injury","correct":true},{"idx":1,"proposition":"Carbamazepine","correct":true},{"idx":2,"proposition":"Bronchial carcinomas","correct":false,"justification":"It is indeed a cause of DHA secretion, but the secretion is ectopic (paraneoplastic syndrome) and not pituitary"},{"idx":3,"proposition":"Theophylline","correct":false,"justification":"It potentiates the effect of DHA (such as chlorpropamide or clofibrate) but does not cause more secretion"},{"idx":4,"proposition":"Acute respiratory failure","correct":true}],"type":"custom"}
+{"_id":"tbiono-nephro-6","context":null,"enonce":"Which of the following are causes of isotonic hyponatremia?","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"Hyperglycaemia","correct":false,"justification":"Hypertonic hyponatremia"},{"idx":1,"proposition":"Severe hyperprotidemia","correct":true},{"idx":2,"proposition":"Hyperlipidemia","correct":true},{"idx":3,"proposition":"Hypocalcemia","correct":false,"justification":"No impact on osmolarity"},{"idx":4,"proposition":"Isotonic hyponatremia is not possible","correct":false,"justification":"Isotonic hyponatremia called \"pseudohyponatremia\", are those that are associated with severe hyperlipidemia or hyperprotidemia and do not darken with any intracellular hydration disorder."}],"type":"custom"}
+{"_id":"tbiono-nephro-8","context":null,"enonce":"Which of the following proposals can aggravate severe hypokalemia?","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"KCl IV in isotonic saline","correct":false,"justification":"This is the right care. It must not exceed 20 mmol \/ h and under rhythmic supervision"},{"idx":1,"proposition":"KCl IV in G5","correct":true},{"idx":2,"proposition":"IV insulin-glucose","correct":true},{"idx":3,"proposition":"Du Kayexalate de Calcium","correct":true},{"idx":4,"proposition":"Du DIFFU-K per os","correct":false,"justification":"Not recommended in case of severity, but does not aggravate it"}],"type":"custom"}
+{"_id":"tbiono-nephro-9","context":null,"enonce":"Which of the following are clinical signs of intracellular dehydration?","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"Dark circles","correct":false,"justification":"Extracellular dehydration"},{"idx":1,"proposition":"Dryness of mucous membranes","correct":true},{"idx":2,"proposition":"Anorexia","correct":false,"justification":"False"},{"idx":3,"proposition":"Disorders of consciousness","correct":true},{"idx":4,"proposition":"Skin fold","correct":false,"justification":"Extracellular dehydration"}],"type":"custom"}
+{"_id":"tbiono-nephro-10","context":null,"enonce":"Which of the following may be ECG abnormalities secondary to hypokalemia?","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"Subsidence of the T wave","correct":true},{"idx":1,"proposition":"J wave","correct":false,"justification":"False"},{"idx":2,"proposition":"QT at 340 ms","correct":false,"justification":"Normal"},{"idx":3,"proposition":"Left anterior hemiblock","correct":false,"justification":"False"},{"idx":4,"proposition":"Atrial fibrillation","correct":true}],"type":"custom"}
+{"_id":"valvuloP-cardio-0","context":null,"enonce":"Regarding aortic stricture","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"Bicuspidism is the most common etiology between 35 and 65 years of age","correct":true},{"idx":1,"proposition":"Bicuspidism is a \"progressive\" malformation that eventually leads to aortic narrowing in adulthood.","correct":true},{"idx":2,"proposition":"The bicuspid valve is often associated with an aneurysm of the ascending aorta","correct":true},{"idx":3,"proposition":"Post-rheumatic acquired aortic stricture is a very common etiology in France","correct":false,"justification":"Post-rheumatic RA has become rare in developed countries"},{"idx":4,"proposition":"The prevalence of degenerative aortic valve narrowing decreases with age","correct":false,"justification":"Prevalence increases with age and, in fact, is by far the most common cause of aortic valve narrowing"}],"type":"custom"}
+{"_id":"valvuloP-cardio-1","context":null,"enonce":"Regarding aortic stricture","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"The main etiology of RA is degenerative in the majority of cases after 65-70 years","correct":true},{"idx":1,"proposition":"In the presence of an obstacle to ventricular ejection, there is the appearance of left intraventricular hyperpressure with ventriculo-aortic systolic pressure gradient: PVG > PAorta","correct":true},{"idx":2,"proposition":"The pressure gradient VG-aorta is lower the tighter the aortic narrowing","correct":false,"justification":"The tighter the AR, the greater the pressure gradient"},{"idx":3,"proposition":"When the VG-aorta pressure gradient reaches 4 mmHg, the AR is considered tight","correct":false,"justification":"it is when the VG-aorta pressure gradient reaches 40 mmHg that the RA is considered tight"},{"idx":4,"proposition":"Patients with AR maintain normal systolic performance for a long time","correct":true}],"type":"custom"}
+{"_id":"valvuloP-cardio-2","context":null,"enonce":"Regarding aortic stricture","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"Initially, overall LV systolic performance is most often normal in a patient with AR.","correct":true},{"idx":1,"proposition":"Systolic performance of the ventricle can normalize as soon as the aortic obstacle is removed","correct":true,"justification":"By valve replacement"},{"idx":2,"proposition":"ARs are symptomatic from the outset","correct":false,"justification":"The onset of symptoms in the presence of tight AR is preceded by a long asymptomatic period that can last several years"},{"idx":3,"proposition":"Cough, anginal pain and edema are the three main symptoms of aortic narrowing","correct":false,"justification":"The three main symptoms are: stress angina, stress syncope and exertional dyspnea."},{"idx":4,"proposition":"When symptoms appear, the prognosis may be life-threatening","correct":true}],"type":"custom"}
+{"_id":"valvuloP-cardio-3","context":null,"enonce":"Regarding aortic stricture","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"We find at auscultation a mesosystolic murmur, intense, soft, grating, maximum in the 2nd left intercostal space, radiating into the left armpit","correct":false,"justification":"The murmur is mesosystolic, ejectional, intense, rough, raspy at the maximum at the right intercostal 2nd space, radiating into the vessels of the neck"},{"idx":1,"proposition":"In advanced cases, there is a widening of the peak shock that is deflected at the top and left","correct":false,"justification":"The deviation of the tip shock is at the bottom and left signifying the dilation of the left ventricle"},{"idx":2,"proposition":"There is potential atrial fibrillation, usually poorly tolerated","correct":true,"justification":"It can be inaugural and revealed the RA"},{"idx":3,"proposition":"Symptomatic tight AR is never complicated by sudden death","correct":false,"justification":"This is why the vital prognosis can be engaged according to hemodynamic tolerance"},{"idx":4,"proposition":"Chest X-ray may be strictly normal","correct":true,"justification":"Sometimes it shows cardiomegaly is pulmonary overload"}],"type":"custom"}
+{"_id":"valvuloP-cardio-5","context":null,"enonce":"Regarding aortic stricture","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"The size of the aorta is important to evaluate, especially in case of biscupidia in the preoperative assessment to know if an associated gesture on the aorta may be necessary","correct":true},{"idx":1,"proposition":"Catheterization is performed systematically","correct":false,"justification":"Catheterization is not usually performed"},{"idx":2,"proposition":"Angina can be seen in AR in the absence of any direct coronary involvement","correct":true,"justification":"Angina is functional"},{"idx":3,"proposition":"The place of the coroCT scan as a replacement for preoperative coronary angiography is established","correct":false,"justification":"Coronary angiography is still preferred"},{"idx":4,"proposition":"The scanner reliably assesses the size of the aorta","correct":true}],"type":"custom"}
+{"_id":"valvuloP-cardio-6","context":null,"enonce":"Regarding aortic stricture","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"Replacement with mechanical prosthesis requires lifelong anticoagulant treatment","correct":true},{"idx":1,"proposition":"A biological prosthesis, indicated in the patient is young, avoids anticoagulant treatment ","correct":false,"justification":"The biological prosthesis avoids anticoagulant treatment well but is indicated in patients over 65 years of age because there is a risk of degeneration within 10–15 years"},{"idx":2,"proposition":"The indication of percutaneous aortic valve cannot be carried without the approval of an experienced medical-surgical team and only after a multidisciplinary discussion in dedicated staff in trained teams","correct":true},{"idx":3,"proposition":"Any symptomatic tight aortic stricture should be operated on in view of the existing life-threatening risk and virtually without age limit, subject to a general condition preserved","correct":true},{"idx":4,"proposition":"In case of asymptomatic tight RA according to the interrogation, a surgical valve replacement is systematically proposed","correct":false,"justification":"In case of asymptomatic tight AR according to the interrogation, a stress test is proposed to check that the patient is really asymptomatic and thus detect false asymtomatics that are related to surgery: if blood pressure does not rise during the stress test or decreases with effort, the operative indication can be discussed"}],"type":"custom"}
+{"_id":"valvuloP-cardio-7","context":null,"enonce":"Regarding mitral insufficiency","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"Mitral insufficiency is a leak in the mitral valve resulting in blood backflow from the left ventricle to the left atrium during diastole","correct":false,"justification":"The backflow of blood from the left ventricle to the left atrium is during systole"},{"idx":1,"proposition":"In type III MI according to the Carpentier classification: at least one valve protrudes beyond the plane of the ring during ventricular systole","correct":false,"justification":"type II: at least one valve protrudes beyond the ring plane during ventricular systole"},{"idx":2,"proposition":"Rheumatic etiology has become rare in developed countries","correct":true},{"idx":3,"proposition":"The combination of stenosis and mitral insufficiency is referred to as mitral disease.","correct":true},{"idx":4,"proposition":"Dystrophic mitral insufficiency is a very common etiology","correct":true}],"type":"custom"}
+{"_id":"valvuloP-cardio-9","context":null,"enonce":"Regarding mitral insufficiency","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"Severe MI may be asymptomatic","correct":true},{"idx":1,"proposition":"The onset of dyspnea is often brutal","correct":false,"justification":"The onset of dyspnea is slow and progressive"},{"idx":2,"proposition":"On examination, there is a deflection and lowering of the peak shock if there is a dilation of the LV","correct":true,"justification":"Left deviation"},{"idx":3,"proposition":"Auscultation contains a systolic murmur of maximum regurgitation at the tip","correct":true,"justification":"Irradiating into the armpit"},{"idx":4,"proposition":"ECG remains normal for a long time in moderate MI","correct":true}],"type":"custom"}
+{"_id":"valvuloP-cardio-10","context":null,"enonce":"Regarding mitral insufficiency","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"On radiography, cardiomegaly by dilation of the VD is found even in moderate MI","correct":false,"justification":"RT is often normal in MIs. In severe and advanced MI, cardiomegaly may be observed by LV hypertrophy"},{"idx":1,"proposition":"ETT is the key test for positive diagnosis and etiological diagnosis","correct":true},{"idx":2,"proposition":"The mitral leakage is confirmed by a holosystolic Doppler signal behind the mitral floor recorded in pulsed, continuous and color Doppler","correct":true},{"idx":3,"proposition":"The mechanism must be specified by echocardiography (according to the Carpentier classification)","correct":true},{"idx":4,"proposition":"ETT is a fundamental examination for the diagnosis of MI on endocarditis, highlighting sometimes very fine vegetations","correct":false,"justification":"ETO is a fundamental examination for the diagnosis of MI on endocarditis, highlighting vegetations sometimes very fine and impossible to see in ETT"}],"type":"custom"}
+{"_id":"valvuloP-cardio-11","context":null,"enonce":"Regarding mitral insufficiency","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"Coronary angiography is systematic as part of the preoperative assessment when a surgical indication is retained in case of cardiovascular FDR","correct":true},{"idx":1,"proposition":"The gradation of MI is based on the calculation of the regurgitating fraction","correct":true},{"idx":2,"proposition":"Right catheterization allows the measurement of cardiac output by thermodilution and the measurement of straight pressures (capillary and pulmonary pressures)","correct":true},{"idx":3,"proposition":"The main interest of the test is to unmask symptoms and understand them in patients who say they are asymptomatic.","correct":true},{"idx":4,"proposition":"The stress test with VO2 measurement makes it possible to better assess the patient's exercise capacity","correct":true}],"type":"custom"}
+{"_id":"valvuloP-cardio-12","context":null,"enonce":"Regarding mitral insufficiency","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"A low maximum O2 consumption < 15 mL\/kg\/min indicates poor tolerance of MI","correct":true},{"idx":1,"proposition":"Stress echocardiography makes it possible to assess the leakage during exercise, its possible increase, its impact (increase in PAPs> 60 mmHg)","correct":true},{"idx":2,"proposition":"In general, gradually formed MIs are well tolerated for a long time, and signs of heart failure appear late.","correct":true},{"idx":3,"proposition":"On the contrary, MI of sudden onset (rupture of ropes, endocarditis, MI on infarction) are generally poorly tolerated and quickly evolve towards the appearance of a picture of edema of the lung","correct":true},{"idx":4,"proposition":"Complications of MI include infective endocarditis","correct":true}],"type":"custom"}
+{"_id":"valvuloP-cardio-13","context":null,"enonce":"Regarding mitral insufficiency","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"The appearance of atrial fibrillation or atrial flutter can lead to cardiac decompensation","correct":true},{"idx":1,"proposition":"Heart failure is late onset in chronic MI but can occur rapidly in acute MI. It can be favored by a rhythm disorder","correct":true},{"idx":2,"proposition":"Always look for signs of other associated pathologies (e.g. stigmata of Marfan's disease)","correct":true},{"idx":3,"proposition":"If mitral leakage is significant and responsible for functional symptomatology, it is urgent to consider surgery","correct":true},{"idx":4,"proposition":"In case of acute MI, treatment for OAP or shock should be initiated, and emergency surgery should be discussed.","correct":true}],"type":"custom"}
+{"_id":"valvuloP-cardio-14","context":null,"enonce":"Regarding Aortic Narrowing, which propositions are true?","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"Monckeberg's disease is synonymous with calcified aortic narrowing (CAR)","correct":true,"justification":"None"},{"idx":1,"proposition":"Aortic narrowing leads to an increase in afterload and thus induces a decrease in the ventriculo-aortic gradient.","correct":false,"justification":"Aortic narrowing leads to an increase in afterload and thus induces an increase* in the ventriculo-aortic gradient."},{"idx":2,"proposition":"Aortic narrowing is well tolerated for a long time, until an advanced stage with the appearance of stress symptoms such as exertional angina, exertional dyspnea and intermittent claudication of the lower limbs.","correct":false,"justification":"The clinical triad of tight aortic stricture is: stress angina, stress syncope, exertional dyspnoea"},{"idx":3,"proposition":"Criteria for tight aortic narrowing on cardiac Doppler ultrasound include: a mean gradient > 40 mmHg and an aortic surface area > 1 cm2 (0.6 cm2\/m2 body surface area)","correct":false,"justification":"Aortic surface <* 1 cm2 (0.6 cm2\/m2 body surface area)"},{"idx":4,"proposition":"It is possible to find on the ECG: left ventricular hypertrophy, left atrial hypertrophy, conduction disorder (BAV 1 and left branch block), as well as a rhythm disorder (atrial fibrillation).","correct":true,"justification":"None"}],"type":"custom"}
+{"_id":"lithiaseB-HGE-0","context":null,"enonce":"About cholelithiasis and its complications","item":"lithiaseB","matiere":"HGE","propositions":[{"idx":0,"proposition":"The frequency of vesicular lithiasis in Western countries is about 20%","correct":true},{"idx":1,"proposition":"The frequency increases with age to reach 60% after 80 years","correct":true},{"idx":2,"proposition":"•Almost 90% of subjects with a gallbladder never have any symptoms","correct":false},{"idx":3,"proposition":"A gallstone complicates this in 20% of cases, this complication is the migration of the stone into the cystic duct or the main bile duct","correct":true},{"idx":4,"proposition":"• It can therefore be estimated that 2 to 4% of French people are likely to develop at least one complication requiring an exploration of the bile duct","correct":true}],"type":"custom"}
+{"_id":"lithiaseB-HGE-2","context":null,"enonce":"Concerning vesicular lithiasis and its complications","item":"lithiaseB","matiere":"HGE","propositions":[{"idx":0,"proposition":"Despite its frequency, screening for vesicular lithiasis is not indicated","correct":true},{"idx":1,"proposition":"The incidental discovery of an asymptomatic gallstone does not lead, in most cases, to any treatment","correct":true},{"idx":2,"proposition":"The most typical symptom is hepatic colic","correct":true},{"idx":3,"proposition":"Hepatic colic is due to the sudden tension of the bile ducts, by permanent blockage of a stone, either in the cystic duct or in the main bile duct","correct":false,"justification":"It is due to the sudden tension of the bile ducts, by transient blockage of a stone, either in the cystic duct or in the bile duct"},{"idx":4,"proposition":"Typically, hepatic colic is a sudden pain often intense, permanent, sitting in the epigastrium (2\/3 of cases) or the right hypochondrium","correct":true}],"type":"custom"}
+{"_id":"lithiaseB-HGE-3","context":null,"enonce":"About cholelithiasis and its complications","item":"lithiaseB","matiere":"HGE","propositions":[{"idx":0,"proposition":"Treatment of cholecystitis is cholecystectomy without delay","correct":true},{"idx":1,"proposition":"Clinical manifestations can be of varying severity, and are: colic, cholitis, cholecystitis","correct":true},{"idx":2,"proposition":"Cholangio-MRI and endoscopic ultrasound are the most sensitive tests to detect a stone of the main bile duct","correct":true},{"idx":3,"proposition":"Acute cholitis lithiasis results in the successive appearance of 3 signs","correct":true},{"idx":4,"proposition":"Cholitis is apyretic most often","correct":false,"justification":"Fever is one of the 3 signs"}],"type":"custom"}
+{"_id":"dvlptpsychoMo-psy-0","context":null,"enonce":"General:","item":"dvlptpsychoMo","matiere":"psy","propositions":[{"idx":0,"proposition":"ASD is a neurodevelopmental disorder","correct":true},{"idx":1,"proposition":"ADHD is a neurodevelopmental disorder","correct":true},{"idx":2,"proposition":"Video game addiction is a neurodevelopmental disorder","correct":false,"justification":"Video game addiction does not fall within this framework"},{"idx":3,"proposition":"These disorders have a prevalence of about 10% in the general population in France","correct":true},{"idx":4,"proposition":"These disorders are more common in girls than boys","correct":false,"justification":"It's the opposite: they are more common in boys"}],"type":"custom"}
+{"_id":"dvlptpsychoMo-psy-1","context":null,"enonce":"Regarding neurodevelopmental disorders:","item":"dvlptpsychoMo","matiere":"psy","propositions":[{"idx":0,"proposition":"The management of these patients is done by the psychiatrist only","correct":false,"justification":"Multidisciplinary care is very important"},{"idx":1,"proposition":"The origin of these disorders is essentially genetic","correct":false,"justification":"It is multifactorial and unknown. The genetic part is surely non-zero."},{"idx":2,"proposition":"Neurodevelopmental disorders are often associated with other psychiatric disorders","correct":true},{"idx":3,"proposition":"These disorders are common in the general population (~10%) and more common in boys than girls.","correct":true},{"idx":4,"proposition":"Neurodevelopmental disorders are defined in particular by their functional impact","correct":true}],"type":"custom"}
+{"_id":"dvlptpsychoMo-psy-3","context":null,"enonce":"Regarding the impact of parents and child development:","item":"dvlptpsychoMo","matiere":"psy","propositions":[{"idx":0,"proposition":"There is very little inter-individual variability in child development","correct":false,"justification":"Inter-individual variability is important"},{"idx":1,"proposition":"Developmental age is measured directly by automatic standardized tools","correct":false,"justification":"Tests measure skills. Developmental age is based on statistics: 95% of children have acquired these skills at this age"},{"idx":2,"proposition":"Early parent-child interactions have little impact on child development, which is essentially controlled by genetics.","correct":false,"justification":"They have an important role in the development of the child"},{"idx":3,"proposition":"It is very pathological for a child aged 6 months to show anxious manifestations in moments of separation from his parents","correct":false,"justification":"Quite physiological in most cases. The College of Psychiatry indicates that it is physiological until the age of 1 year"},{"idx":4,"proposition":"Separation anxiety is an anxiety disorder that appears in situations of separation from parents at a young age","correct":true}],"type":"custom"}
+{"_id":"dvlptpsychoMo-psy-4","context":null,"enonce":"Which propositions are true?","item":"dvlptpsychoMo","matiere":"psy","propositions":[{"idx":0,"proposition":"Psychologists have no role to play in these pathologies","correct":false,"justification":"Psychologists can intervene in the raliization of assessment, for psychotherapy and learning"},{"idx":1,"proposition":"The functional impact corresponds to the difficulties in carrying out actions in one or more given areas","correct":true},{"idx":2,"proposition":"A deficit in the development of a domain is said to be \"specific\" when it is not explained by another disorder","correct":true},{"idx":3,"proposition":"Children with hearing loss frequently have oral language delay","correct":true},{"idx":4,"proposition":"There are several levels of severity of intellectual disability","correct":true}],"type":"custom"}
+{"_id":"exantheme-dermato-0","context":null,"enonce":"Regarding scarlet fever:","item":"exantheme","matiere":"dermato","propositions":[{"idx":0,"proposition":"It is due to group A streptococcus","correct":true},{"idx":1,"proposition":"It affects the newborn and the infant","correct":false,"justification":"Child between 5 and 10 years"},{"idx":2,"proposition":"The incubation period is about one week","correct":false,"justification":"2 to 4 days"},{"idx":3,"proposition":"It is usually apyretic","correct":false,"justification":"High fever"},{"idx":4,"proposition":"Eruptions predominate at the limbs","correct":false,"justification":"With large folds"}],"type":"custom"}
+{"_id":"exantheme-dermato-1","context":null,"enonce":"Regarding Kawasaki Syndrome:","item":"exantheme","matiere":"dermato","propositions":[{"idx":0,"proposition":"This is acute systemic vasculitis","correct":true},{"idx":1,"proposition":"It affects the pre-pubert teenager","correct":false,"justification":"Children under 5 years of age"},{"idx":2,"proposition":"Fever is usually absent","correct":false,"justification":"AEG + Fever > 38.5 degrees celsius"},{"idx":3,"proposition":"Biology shows inflammatory syndrome","correct":true},{"idx":4,"proposition":"There is no enanthema","correct":false,"justification":"Cheílite and raspberry tongue"}],"type":"custom"}
+{"_id":"exantheme-dermato-2","context":null,"enonce":"Regarding staphylococcal epidermolysis:","item":"exantheme","matiere":"dermato","propositions":[{"idx":0,"proposition":"It is also called staphylococcal scarlet fever","correct":true},{"idx":1,"proposition":"The bacterium secretes mainly exotocins","correct":false,"justification":"This is the case of streptococci. Staphylococci secrete enterotoxins, also called TSST1"},{"idx":2,"proposition":"It only affects newborns","correct":false,"justification":"Also: infants, young children or immunocompromised adults"},{"idx":3,"proposition":"Exanthemas begin at the level of the large folds","correct":true},{"idx":4,"proposition":"Treatment is symptomatic","correct":false,"justification":"Antibiotic (oxacillin)"}],"type":"custom"}
+{"_id":"exantheme-dermato-3","context":null,"enonce":"Regarding morbiliform exanthemas:","item":"exantheme","matiere":"dermato","propositions":[{"idx":0,"proposition":"Measles is caused by morbilivirus","correct":true},{"idx":1,"proposition":"Infectious mononucleosis is caused by HCV","correct":false,"justification":"Epstein Barr virus (EBV)"},{"idx":2,"proposition":"Epidemic megalerythema has a fracture-type rheumatological component ","correct":false,"justification":"Arthralgia"},{"idx":3,"proposition":"Kawasaki syndrome cannot give morbiliform exanthema","correct":false,"justification":"This is one of the causes (but rare)"},{"idx":4,"proposition":"The incubation of measles is about a month","correct":false,"justification":"Between 10 and 12 days"}],"type":"custom"}
+{"_id":"NFS-hemato-0","context":null,"enonce":"Concerning the blood count","item":"NFS","matiere":"hemato","propositions":[{"idx":0,"proposition":"Its indications are very numerous and go far beyond the framework of hematological pathologies","correct":true},{"idx":1,"proposition":"This is the most prescribed exam in France","correct":true},{"idx":2,"proposition":"It is made from a blood sample taken by venipuncture and collected in a tube containing a dry anticoagulant type EDTA","correct":true},{"idx":3,"proposition":"It aims to provide quantitative information on blood cells but also qualitative information","correct":true},{"idx":4,"proposition":"Accurate identification of cells and their possible abnormalities requires a good quality blood smear","correct":true}],"type":"custom"}
+{"_id":"NFS-hemato-1","context":null,"enonce":"About the blood count","item":"NFS","matiere":"hemato","propositions":[{"idx":0,"proposition":"Normal values vary by age, gender and ethnicity","correct":true},{"idx":1,"proposition":"Thrombocytopenia <200 G\/L should always be checked on the blood smear examination","correct":false,"justification":"We speak of thrombocytopenia if < 150 G \/ L (serious if <50 G \/ L)"},{"idx":2,"proposition":"The lower limit of hemoglobin (anemia) is as follows: Newborn: 14 g\/L ● Adult male: 13 g\/L ● Adult female: 12 g\/L","correct":false,"justification":"The limits are: Newborn: 140 g\/L Adult male: 130 g\/L Adult female: 120 g\/L Pregnant woman (from the second trimester of pregnancy): 105 g\/L"},{"idx":3,"proposition":"MCV can be calculated as the ratio of hematocrit to red blood cell count.","correct":true},{"idx":4,"proposition":"The normal value of MCV is 60 to 80 fl","correct":false,"justification":"The normal value is 80 to 100 fl in adults"}],"type":"custom"}
+{"_id":"NFS-hemato-2","context":null,"enonce":"Concerning the blood count","item":"NFS","matiere":"hemato","propositions":[{"idx":0,"proposition":"MCV < 80 fl signs microcytosis in adults","correct":true,"justification":"In children, the only one is at 70 fl"},{"idx":1,"proposition":"CCMH is the Average Corpuscular Hemoglobin Concentration","correct":true},{"idx":2,"proposition":"CCMH normal values range from 32 to 46 g\/dL","correct":false,"justification":"Normal values range from 32 to 36 g\/dL"},{"idx":3,"proposition":"The leukocyte formula, expressed in %, has no interest taken in isolation","correct":true},{"idx":4,"proposition":"Preference should be given to absolute values concerning the leukocyte formula","correct":true}],"type":"custom"}
+{"_id":"NFS-hemato-3","context":null,"enonce":"Concerning the blood count","item":"NFS","matiere":"hemato","propositions":[{"idx":0,"proposition":"Normal TGMH values are 27 to 32 pg per cell","correct":true},{"idx":1,"proposition":"Any thrombocytopenia without bleeding signs should be investigated for false thrombocytopenia with EDTA by platelet agglutination","correct":true},{"idx":2,"proposition":"A hemoglobin level < 60 g \/ L or poorly tolerated requires urgent management by a specialist","correct":true},{"idx":3,"proposition":"Anemia is defined as a decrease in CCMH concomitant with clinical signs","correct":false,"justification":"Anemia is defined as a decrease in hemoglobin at the hemogram, after eliminating false anemia by hemodilution"},{"idx":4,"proposition":"Microcytic anemias (MCV < 80 fl) reflect a disorder of hemoglobin synthesis","correct":true,"justification":"The most common cause is iron deficiency"}],"type":"custom"}
+{"_id":"NFS-hemato-4","context":null,"enonce":"Concerning the blood count","item":"NFS","matiere":"hemato","propositions":[{"idx":0,"proposition":"The most common microcytic anemias are hyposideremic anemias due to iron deficiency.","correct":true},{"idx":1,"proposition":"Macrocytic anemias (MCV > 100 fl) first evoke 3 major etiologies: Ethylism, vitamin B12 deficiency, myelodysplastic syndrome","correct":true},{"idx":2,"proposition":"Regenerative anemia with reticulocytes < 150 G\/L reflects periperic involvement","correct":false,"justification":"They reflect a central attack"},{"idx":3,"proposition":"Viral infections do not usually result in neutrophil polynucleosis apart from superinfection","correct":true},{"idx":4,"proposition":"Myelemia is the passage into the blood of immature forms of the granular line of the spinal cord","correct":true}],"type":"custom"}
+{"_id":"NFS-hemato-5","context":null,"enonce":"About hemogrammme","item":"NFS","matiere":"hemato","propositions":[{"idx":0,"proposition":"Significant myelemia is pathological","correct":true},{"idx":1,"proposition":"Blood erythroblastosis (erythroblastemia) corresponds to the passage into the blood of erythroblasts","correct":true},{"idx":2,"proposition":"Erythromyelemia is the combination of myelemia and blood erythroblastosis","correct":true},{"idx":3,"proposition":"The two main etiologies of eosinophilia are parasitic and allergic etiologies","correct":true},{"idx":4,"proposition":"True hyperlymphocytosis is defined as an increase in the absolute number of blood lymphocytes","correct":true}],"type":"custom"}
+{"_id":"NFS-hemato-7","context":null,"enonce":"Which of the following are causes of false anemia?","item":"NFS","matiere":"hemato","propositions":[{"idx":0,"proposition":"Hypothyroidism","correct":false,"justification":"True anemia"},{"idx":1,"proposition":"Heart failure 💓","correct":true},{"idx":2,"proposition":"Pregnancy 🤰 ","correct":true},{"idx":3,"proposition":"Stay at altitude ⛰","correct":false,"justification":"Rather a polycythemia"},{"idx":4,"proposition":"Monoclonal hypergammaglobulinemia","correct":true}],"type":"custom"}
+{"_id":"TTTperso-therapeutique-0","context":null,"enonce":"Which of the following are healthcare professionals?","item":"TTTperso","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Orthoptist","correct":true},{"idx":1,"proposition":"Occupational therapist","correct":true},{"idx":2,"proposition":" Prosthetist","correct":true},{"idx":3,"proposition":"Dietitian","correct":true},{"idx":4,"proposition":"Pharmacy preparer","correct":true}],"type":"custom"}
+{"_id":"TTTperso-therapeutique-1","context":null,"enonce":"Which of the following are enzyme inhibitors?","item":"TTTperso","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Amiodarone","correct":true},{"idx":1,"proposition":"Carbamazepine","correct":false,"justification":"Inductor"},{"idx":2,"proposition":"Ciclosporin","correct":true},{"idx":3,"proposition":"Orange juice","correct":false,"justification":"No effect"},{"idx":4,"proposition":"Phenobarbital","correct":false,"justification":"Inductor"}],"type":"custom"}
+{"_id":"TTTperso-therapeutique-2","context":null,"enonce":"Which of the following are enzyme inducers?","item":"TTTperso","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Phenobarbital","correct":true},{"idx":1,"proposition":"Tobacco","correct":true},{"idx":2,"proposition":"Grapefruit juice","correct":false,"justification":"Enzyme inhibitor"},{"idx":3,"proposition":"Fifampicin","correct":true},{"idx":4,"proposition":"St. John's wort","correct":true}],"type":"custom"}
+{"_id":"sterilite-endoc-0","context":null,"enonce":"How long does it take to affirm a couple's infertility?","item":"sterilite","matiere":"endoc","propositions":[{"idx":0,"proposition":"Three months","correct":false,"justification":"A couple is considered infertile in the absence of pregnancy after 1 year of unprotected sex"},{"idx":1,"proposition":"6 months","correct":false},{"idx":2,"proposition":"1 year","correct":true},{"idx":3,"proposition":"18 months","correct":false},{"idx":4,"proposition":"2 years","correct":false}],"type":"custom"}
+{"_id":"sterilite-endoc-1","context":null,"enonce":"How many couples in France consult for pregnancy?","item":"sterilite","matiere":"endoc","propositions":[{"idx":0,"proposition":"0.05","correct":false,"justification":"In France, one in seven couples (14%) consult for children"},{"idx":1,"proposition":"0.14","correct":true},{"idx":2,"proposition":"0.21","correct":false},{"idx":3,"proposition":"1 of 7","correct":true},{"idx":4,"proposition":"1 of 12","correct":false}],"type":"custom"}
+{"_id":"sterilite-endoc-2","context":null,"enonce":"Regarding certain definitions:","item":"sterilite","matiere":"endoc","propositions":[{"idx":0,"proposition":"The term sterility can only be used if the situation of infertility is definitive ","correct":true},{"idx":1,"proposition":"A bilaterally castrated person is sterile","correct":true},{"idx":2,"proposition":"A postmenopausal woman is said to be infertile","correct":false,"justification":"A postmenopausal woman is said to be sterile, the term infertility is reserved for couples"},{"idx":3,"proposition":"The fecundability of the woman per cycle is about 75% per exposure cycle.","correct":false,"justification":"At best, fecundability is 25% per cycle."},{"idx":4,"proposition":"Fertility is a term defined in the context of a couple.","correct":true}],"type":"custom"}
+{"_id":"sterilite-endoc-3","context":null,"enonce":"Regarding the epidemiology of the origin of infertility:","item":"sterilite","matiere":"endoc","propositions":[{"idx":0,"proposition":"She is feminine half the time","correct":false,"justification":"1\/3 female, 1\/3 male and 1\/3 of shared origin"},{"idx":1,"proposition":"It is only very rarely shared","correct":false,"justification":"Infertility is shared in 1\/3 of cases"},{"idx":2,"proposition":"It is of male origin in about 33% of cases","correct":true},{"idx":3,"proposition":"It is of shared origin in 80% of cases","correct":false,"justification":"In a third"},{"idx":4,"proposition":"She is rarely of female origin","correct":false}],"type":"custom"}
+{"_id":"sterilite-endoc-4","context":null,"enonce":"Regarding the interrogation:","item":"sterilite","matiere":"endoc","propositions":[{"idx":0,"proposition":"The frequency of reporting needs to be addressed","correct":true,"justification":"In particular, whether they are regular or episodic"},{"idx":1,"proposition":"Gynecological history will need to be clarified","correct":true},{"idx":2,"proposition":"Pelvic pain in women may suggest endometriosis","correct":true},{"idx":3,"proposition":"It is not important to look for a possible history of abortion, especially in the presence of the husband","correct":false,"justification":"This is not at all useless since there can be consequences. On the other hand, it will obviously be necessary to discuss it alone with the patient, at first."},{"idx":4,"proposition":"Libido disorders cannot impact fertility","correct":false,"justification":"Libido disorders can decrease the frequency of sexual intercourse"}],"type":"custom"}
+{"_id":"sterilite-endoc-5","context":null,"enonce":"Regarding first-line hormonal exploration in women:","item":"sterilite","matiere":"endoc","propositions":[{"idx":0,"proposition":"In case of irregularity of the cycle, the dose is mainly LH","correct":false,"justification":"The first attempt is to clarify the origin of the irregularity"},{"idx":1,"proposition":"In case of irregularity of the cycle, the FSG is mainly dosed","correct":false,"justification":"The first attempt is to clarify the origin of the irregularity"},{"idx":2,"proposition":"Estradiol (E4), LH, FSH and prolactin are dosed","correct":false,"justification":"Indeed we dose LH, FSH and Prolactin. It is not estradiol E4 but estradiol E2!"},{"idx":3,"proposition":"The objective in case of regular cycle and to determine their ovulatory character (or not)","correct":true,"justification":"If the cycles are regular, we try to clarify their character \novulatory by plasma progesterone assay, on Day 22-Day 23 of the cycle"},{"idx":4,"proposition":"A carbohydrate balance is systematic","correct":false,"justification":"Not systematic but depending on the clinic"}],"type":"custom"}
+{"_id":"sterilite-endoc-6","context":null,"enonce":"Regarding the spermogram:","item":"sterilite","matiere":"endoc","propositions":[{"idx":0,"proposition":"It is a very informative examination in humans","correct":true},{"idx":1,"proposition":"It should be done after 1 week of abstinence","correct":false,"justification":"3 days of abstinence is enough"},{"idx":2,"proposition":"A normal volume is between 1.5 and 6 mL","correct":true,"justification":"Below we talk about hypospermia and above we talk about hyperspermia"},{"idx":3,"proposition":"Mobility of less than 30% defines asthenospermia","correct":true,"justification":"Thinking about asthenia -> fatigue"},{"idx":4,"proposition":"Vitality below 80% defines necrospermia","correct":false,"justification":"Necrospermia is defined by a rate <58% of living forms"}],"type":"custom"}
+{"_id":"BPCO-pneumo-0","context":null,"enonce":"About COPD","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"proposition":"COPD is a common disease, causing morbidity, mortality and high health costs","correct":true},{"idx":1,"proposition":"COPD is defined by the presence of chronic respiratory symptoms and permanent bronchial restriction","correct":false,"justification":"It is defined as the presence of chronic respiratory symptoms (at least one among cough, sputum, exercise dyspnea, repeated or dragging lower respiratory infections) and permanent bronchial obstruction: there is an obstructive ventilatory disorder (defined by a FEV1\/FVC ratio<0.70) that persists after taking bronchodilators"},{"idx":2,"proposition":"The main risk factor is smoking","correct":true},{"idx":3,"proposition":"Occupational exposures may also be involved","correct":true},{"idx":4,"proposition":"The main symptom is early dyspnea","correct":false,"justification":"The main symptom is dyspnea but it is late often underestimated"}],"type":"custom"}
+{"_id":"BPCO-pneumo-1","context":null,"enonce":"About COPD","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The main differential diagnoses are asthma and bronchial dilatations","correct":true},{"idx":1,"proposition":"Spirometric assessment of bronchial obstruction severity is based on FEV1 measurement in the absence of any medication","correct":false,"justification":"Spirometric assessment of bronchial obstruction severity is based on FEV1 measurement after bronchodilator"},{"idx":2,"proposition":"pulmonary rehabilitation is an integral part of treatment","correct":true},{"idx":3,"proposition":"COPD is a chronic respiratory disease defined by the existence of chronic respiratory symptoms (at least one among cough, sputum, exercise dyspnea, repeated or dragging) and reversible obstruction","correct":false,"justification":"Frequent chronic respiratory disease, defined as the existence of chronic respiratory symptoms (at least one among cough, sputum, exercise dyspnoea, repeated or dragging) and permanent and progressive airway obstruction = obstructive ventilatory disorder (OVD) not completely reversible"},{"idx":4,"proposition":"Obstructive ventilatory disorder (OSVD) is defined as a FEV1\/FVC ratio < 0.7 (or < 70%)","correct":true}],"type":"custom"}
+{"_id":"BPCO-pneumo-2","context":null,"enonce":"About COPD","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Chronic bronchitis is a daily or near-daily productive cough lasting at least 3 months a year and for at least two consecutive years","correct":true},{"idx":1,"proposition":"Emphysema without TVO is not COPD","correct":true},{"idx":2,"proposition":"− Asthma should be evoked when there is a very significant reversibility of bronchial obstruction (increase in FEV1 of more than 400 ml),","correct":true},{"idx":3,"proposition":"− The \"frequent exacerbator\" phenotype is an element in assessing the severity of COPD","correct":true},{"idx":4,"proposition":"The severity of exacerbations: 1 exacerbation \/ year requiring hospitalization is an element of poor prognosis","correct":true}],"type":"custom"}
+{"_id":"BPCO-pneumo-3","context":null,"enonce":"About COPD","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"proposition":"COPD is a major health problem affecting 5-10% of the population over 45 years old","correct":true},{"idx":1,"proposition":"Worldwide, COPD is on the rise and is expected to be the 3rd or 4th leading cause of death by 2030","correct":true},{"idx":2,"proposition":"Exposure to occupational air contaminants is implicated as a risk factor for COPD","correct":true},{"idx":3,"proposition":"At least 15% of COPD are occupational","correct":true},{"idx":4,"proposition":"Alpha-1 antitrypsin deficiency is the only identified genetic risk factor for COPD","correct":true}],"type":"custom"}
+{"_id":"BPCO-pneumo-4","context":null,"enonce":"About COPD","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The severity of TVO assessed by VEMS post BD makes this simple measure an important prognostic factor","correct":true},{"idx":1,"proposition":"Parameters such as dyspnoea intensity and undernutrition are also strongly predictive of COPD-related mortality.","correct":true},{"idx":2,"proposition":"Spirometry allows the diagnosis of certainty, helps in differential diagnosis with asthma, evaluates severity, participates in therapeutic choices","correct":true},{"idx":3,"proposition":"Obstructive TV rises after BD administration","correct":false,"justification":"This TVO persists after BD administration. He gets up in case of asthma:)"},{"idx":4,"proposition":"The severity of bronchial obstruction varies depending on the value of post-BD FEV1","correct":true}],"type":"custom"}
+{"_id":"BPCO-pneumo-5","context":null,"enonce":"About COPD","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"proposition":"reversibility is studied by performing a 1st spirometry before the administration of fast-acting BD and a 2nd spirometry 10 minutes after","correct":true},{"idx":1,"proposition":"The measurement of carbon monoxide transfer capacity (which reflects the available gas exchange surface) makes it possible to evaluate alveolar destruction","correct":true},{"idx":2,"proposition":"Any value of DLCO (or OBT) < 50% of the predicted value is considered pathological","correct":false,"justification":"Any value of DLCO (or OBT) < 70% of the predicted value is considered pathological"},{"idx":3,"proposition":"Chest X-ray has no interest in the positive diagnosis of COPD","correct":true},{"idx":4,"proposition":"Chest X-ray may suggest associated heart disease","correct":true}],"type":"custom"}
+{"_id":"dermatosefaciale-dermato-0","context":null,"enonce":"Regarding the generalities of facial dermatoses:","item":"dermatosefaciale","matiere":"dermato","propositions":[{"idx":0,"proposition":"Acne is a chronic inflammatory dermatosis of the pilosebaceous follicle","correct":true},{"idx":1,"proposition":"Sebum secretion is triggered and maintained mainly by dihydrotestosterone","correct":true},{"idx":2,"proposition":"Circulating androgens are often increased in acne","correct":false,"justification":"Circulating androgens are present at normal levels and acne results only from a particular sensitivity of androgen receptors present on sebocytes and keratinocytes (peripheral hyperandrogenism)"},{"idx":3,"proposition":"The formation of comedo is due to hyperproliferation of keratinocytes of the pilosebaceous follicle","correct":true},{"idx":4,"proposition":"The anaerobic flora of the sebaceous follicles is dominated by a gram-positive bacterium Propionibacterium acnes","correct":true}],"type":"custom"}
+{"_id":"dermatosefaciale-dermato-1","context":null,"enonce":"Which propositions are true?","item":"dermatosefaciale","matiere":"dermato","propositions":[{"idx":0,"proposition":"Acne is an infectious disease","correct":false,"justification":"Acne is not an infectious disease but an inflammatory disease of the pilosebaceous follicle"},{"idx":1,"proposition":"The diagnosis is clinical","correct":true},{"idx":2,"proposition":"Seborrhea is an abnormally thin aspect of the skin","correct":false,"justification":"Oily and shiny skin appearance"},{"idx":3,"proposition":"Acne mainly affects areas low in sebaceous glands such as the face and back","correct":false,"justification":"Affects areas rich in sebaceous glands: central part of the face (nose, forehead, chin, cheeks) and upper thoracic region (neck, back and anterior surface of the chest)"},{"idx":4,"proposition":"Ironed comedones are small papules of 2 to 3 mm of normal skin color","correct":true}],"type":"custom"}
+{"_id":"dermatosefaciale-dermato-2","context":null,"enonce":"Regarding acne:","item":"dermatosefaciale","matiere":"dermato","propositions":[{"idx":0,"proposition":"Closed comedones correspond to \"blackheads\"","correct":false,"justification":"These are the open comedones"},{"idx":1,"proposition":"Open comedones correspond to the accumulation of oxidized keratinocytes within the dilated orifice of the infudibular duct","correct":true},{"idx":2,"proposition":"Open comedones are on the order of a centimeter","correct":false,"justification":"These are infracentimetric lesions, between 1 and 3 mm"},{"idx":3,"proposition":"The natural course of open comedones is inflammation in any case","correct":false,"justification":"can spontaneously expel or become inflamed"},{"idx":4,"proposition":"Inflammatory papules progress to resorption or pustule formation","correct":true}],"type":"custom"}
+{"_id":"dermatosefaciale-dermato-3","context":null,"enonce":"Regarding the basic lesions of acne:","item":"dermatosefaciale","matiere":"dermato","propositions":[{"idx":0,"proposition":"Pustules are usually derived from papules","correct":true},{"idx":1,"proposition":"The contents of pustules are inflammatory by accumulation of lymphocytes","correct":false,"justification":"Polynuclides"},{"idx":2,"proposition":"Deep inflammatory lesions give papules","correct":false,"justification":"Nodules larger than 10mm reaching the dermis"},{"idx":3,"proposition":"The nodules are of the order of a centimeter and reach the dermis","correct":true},{"idx":4,"proposition":"Papules give scars","correct":false,"justification":"These are the nodules"}],"type":"custom"}
+{"_id":"dermatosefaciale-dermato-4","context":null,"enonce":"Regarding the different clinical forms of acne:","item":"dermatosefaciale","matiere":"dermato","propositions":[{"idx":0,"proposition":"Juvenile combination acne is the most common form of acne","correct":true},{"idx":1,"proposition":"Juvenile mixed acne occurs in late adolescence","correct":false,"justification":"Occurs around the time of puberty"},{"idx":2,"proposition":"Exogenous acne has a predominance of open comedones","correct":true},{"idx":3,"proposition":"Acne in adult women appears after about 25 years","correct":true},{"idx":4,"proposition":"Adult female acne concerns women who did not have acne during adolescence only","correct":false,"justification":"Most of the time, juvenile acne extending into adulthood"}],"type":"custom"}
+{"_id":"PRNA-neuro-0","context":null,"enonce":"Which of the following is true for acute inflammatory polyradiculoneuritis?","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"proposition":"This is Guillain-Barré syndrome","correct":true},{"idx":1,"proposition":"The incidence is 5 per 100","correct":false,"justification":"1 per 100,000"},{"idx":2,"proposition":"The lesions affect the motor neurons of the precentral cortex","correct":false,"justification":"Root of nerves and their nerve trunks downstream"},{"idx":3,"proposition":"The prognosis is poor","correct":true},{"idx":4,"proposition":"The prevalence is 2 million in France","correct":false,"justification":"No prevalence reported in college"}],"type":"custom"}
+{"_id":"PRNA-neuro-1","context":null,"enonce":"In Guillain-Barré:","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"proposition":"The incidence is about 1 in 100,000","correct":true},{"idx":1,"proposition":"Cytomegalovirus infection may precede Guillain-Barré syndrome","correct":true},{"idx":2,"proposition":"Epstein-Barr virus infection often causes an axonal form of GBS","correct":false,"justification":"Demyelinating form"},{"idx":3,"proposition":"Campylobacter jejuni often causes an AMAN-like demyelinating form of GBS","correct":false,"justification":"Amonal form of AMAN type"},{"idx":4,"proposition":"The lesions affect in particular the roots of the nerves","correct":true}],"type":"custom"}
+{"_id":"PRNA-neuro-2","context":null,"enonce":"Regarding Guillain-Barré syndromes (GBS):","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"proposition":"They evolve in 8 phases more or less long (about 1 year in total)","correct":false,"justification":"3 phases: extension, plateau, recovery. The duration of each of these phases varies"},{"idx":1,"proposition":"The diagnosis is confirmed by MRI and biopsy","correct":false,"justification":"Clinic + ENMG"},{"idx":2,"proposition":"Acute axonal motor neuropathies are pure motor","correct":true},{"idx":3,"proposition":"Acute motor axonal neuropathies (AMAN) are at risk of intubation","correct":false,"justification":"Usually not"},{"idx":4,"proposition":"Sensory-motor GBS is demyelinating","correct":true}],"type":"custom"}
+{"_id":"PRNA-neuro-3","context":null,"enonce":"Regarding the extension phase of Guillain-Barré syndrome:","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"proposition":"It lasts less than 4 weeks","correct":true},{"idx":1,"proposition":"Its evolution is always ascending","correct":false,"justification":"True for the sensory form, but false for the motor form"},{"idx":2,"proposition":"The motor impairment is unilateral and not very severe most often","correct":false,"justification":"Relatively symmetrical, extensive and severe, it predominates proximal and then affects the extremities"},{"idx":3,"proposition":"Motor involvement begins in the extremities and then goes up","correct":false,"justification":"First proximal and then affects the extremities"},{"idx":4,"proposition":"1-5% of patients should be on assisted ventilation","correct":false,"justification":"15 to 30%"}],"type":"custom"}
+{"_id":"PRNA-neuro-4","context":null,"enonce":"Regarding the plateau phase of Guillain-Barré Syndrome:","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"proposition":"One-third of patients are bedridden","correct":true},{"idx":1,"proposition":"75% of patients can walk","correct":false,"justification":"One-third"},{"idx":2,"proposition":"One hundredth of patients require respiratory support","correct":false,"justification":"One-third"},{"idx":3,"proposition":"Tendon reflexia in deficit territories fades rapidly ","correct":false,"justification":"It persists throughout the plateau phase"},{"idx":4,"proposition":"It lasts from 5 to 25 days","correct":false,"justification":"It can last up to several months in some cases. It's very variable"}],"type":"custom"}
+{"_id":"PRNA-neuro-5","context":null,"enonce":"Which of the following propositions about Miller-Fischer syndrome are true?","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"proposition":"Anti-Gq1b antibodies are found","correct":true},{"idx":1,"proposition":"There is a progressive fatigability throughout the day","correct":false,"justification":"Not classic in the Miller-Fischer"},{"idx":2,"proposition":"It is a dysimmune disease","correct":true},{"idx":3,"proposition":"We find ataxia","correct":true},{"idx":4,"proposition":"Facial paralysis is found","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"vomisst-HGE-0","context":null,"enonce":"Regarding vomiting","item":"vomisst","matiere":"HGE","propositions":[{"idx":0,"proposition":"Vomiting can be provoked or spontaneous","correct":true},{"idx":1,"proposition":"Nausea is a painless disagrable subjective sensation originating from the upper digestive tract.","correct":true},{"idx":2,"proposition":"Differential BDiagnostics • Regurgitation: passive rise of gastric contents Regurgy","correct":true},{"idx":3,"proposition":"• Merycism or rumination: are involuntary rises in the mouth of recently ingested food that is then swallowed again after chewing","correct":false},{"idx":4,"proposition":"Upper GI endoscopy is necessary to confirm the diagnosis and, if necessary, to perform hemostasis; Rupture of the oesin case of Mallory-Weiss syndrome","correct":true}],"type":"custom"}
+{"_id":"vomisst-HGE-1","context":null,"enonce":"Among the complications of vomiting","item":"vomisst","matiere":"HGE","propositions":[{"idx":0,"proposition":"Vinson Pulmmer Syndrome","correct":false},{"idx":1,"proposition":"Karatgener syndrome","correct":false},{"idx":2,"proposition":"Hydro-electric disorders","correct":true},{"idx":3,"proposition":"Mallory Weiss syndrome","correct":true},{"idx":4,"proposition":"Rupture of the esopaph","correct":true}],"type":"custom"}
+{"_id":"vomisst-HGE-2","context":null,"enonce":"Regarding vomiting","item":"vomisst","matiere":"HGE","propositions":[{"idx":0,"proposition":"Chronic vomiting is vomiting that lasts more than 7 days","correct":true},{"idx":1,"proposition":"Drug use may be accompanied by vomiting (cannabis), as well as withdrawal syndrome (heroin)","correct":true},{"idx":2,"proposition":"The evaluation of the metabolic impact of vomiting is systematic","correct":true},{"idx":3,"proposition":"Vomiting should be sought for pregnancy, adrenal insufficiency and intracranial hypertension","correct":true},{"idx":4,"proposition":"Vomiting related to chemotherapy can be treated with antihistamines","correct":false,"justification":"Chemotherapy-related vomiting can be treated on a case-by-case basis by:"}],"type":"custom"}
+{"_id":"vomisst-HGE-3","context":null,"enonce":"Which of the following proposals is expected in case of pyloric stenosis?","item":"vomisst","matiere":"HGE","propositions":[{"idx":0,"proposition":"Hypochloremic metabolic alkalosis","correct":true},{"idx":1,"proposition":"Hypochloraemic metabolic acidosis","correct":false},{"idx":2,"proposition":"Hypochloraemic respiratory alkalosis","correct":false},{"idx":3,"proposition":"Hyperchloremic respiratory alkalosis","correct":false},{"idx":4,"proposition":"Hyperchloremic metabolic alkalosis","correct":false}],"type":"custom"}
+{"_id":"vomisst-HGE-4","context":null,"enonce":"Which of the following are ultrasound signs in favor of pyloric stenosis?","item":"vomisst","matiere":"HGE","propositions":[{"idx":0,"proposition":"Peritoneal effusion","correct":false},{"idx":1,"proposition":"Pyloric canal lengthening","correct":true},{"idx":2,"proposition":"Roundel appearance","correct":true,"justification":"True. The signs are: \"roundel\" appearance, thickening of the muscle ≥ 4 mm, lengthening of the pyloric canal and gastric stasis (College of Pediatrics, 2021)"},{"idx":3,"proposition":"Mesenteric lymph nodes","correct":false,"justification":"False"},{"idx":4,"proposition":"Hypertrophy of the pylorus","correct":true}],"type":"custom"}
+{"_id":"vomisst-HGE-5","context":null,"enonce":"Which of the following are ultrasound signs in favor of pyloric stenosis?","item":"vomisst","matiere":"HGE","propositions":[{"idx":0,"proposition":"Peritoneal effusion","correct":false},{"idx":1,"proposition":"Pyloric canal lengthening","correct":true},{"idx":2,"proposition":"Roundel appearance","correct":true,"justification":"True. The signs are: \"roundel\" appearance, thickening of the muscle ≥ 4 mm, lengthening of the pyloric canal and gastric stasis (College of Pediatrics, 2021)"},{"idx":3,"proposition":"Mesenteric lymph nodes","correct":false},{"idx":4,"proposition":"Hypertrophy of the pylorus","correct":true}],"type":"custom"}
+{"_id":"sexualite-psy-0","context":null,"enonce":"General:","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"All sexual disorders are of the order of psychiatric pathology","correct":false,"justification":"They may be related to non-psychiatric pathologies or psychological disorders"},{"idx":1,"proposition":"Hypersexuality is considered addictive behavior","correct":true},{"idx":2,"proposition":"Hypersexuality can be iatrogenic","correct":true},{"idx":3,"proposition":"Sexual health is a state of physical, mental and social well-being in the field of sexuality","correct":true},{"idx":4,"proposition":"'Normal' sexuality requires a positive and respectful approach to sexuality and sexual relationships","correct":true}],"type":"custom"}
+{"_id":"sexualite-psy-1","context":null,"enonce":"Regarding 'normal' sexuality:","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"The excitation phase is characterized in men by the establishment of erection","correct":true},{"idx":1,"proposition":"The sexual relationship is preceded by a phase of sexual desire consisting of sexual and erotic thoughts or imaginative fantasies.","correct":true},{"idx":2,"proposition":"The orgasm phase consists of several successive phases in men","correct":false,"justification":"It is often unique in humans"},{"idx":3,"proposition":"In men, orgasm and ejaculation usually coincide","correct":true,"justification":"But this is not always the case"},{"idx":4,"proposition":"Vaginal or clitoral stimulation is the same","correct":false,"justification":"The vaginal or clitoral difference corresponds to different stimulation modalities, but is underpinned by the same anatomophysiological entity (glans or pillars of the clitoris)"}],"type":"custom"}
+{"_id":"sexualite-psy-2","context":null,"enonce":"Regarding sexual disorders:","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"Notions of deviance, normality of sexual performance, and behavioral role identity can vary across cultures and times.","correct":true},{"idx":1,"proposition":"The interview is a fundamental moment in the assessment of a sexual complaint","correct":true},{"idx":2,"proposition":"The interview must look for all history of psychiatric disorders","correct":true},{"idx":3,"proposition":"Nocturnal penile plethysmography and cavernography (venous leakage, Peyronie) are almost no longer used in common practice.","correct":true},{"idx":4,"proposition":"Sexual conduct disorders are classically distinguished into six pathophysiological categories","correct":false,"justification":"3: sexual dysfunction, paraphilic disorders, and hypersexuality"}],"type":"custom"}
+{"_id":"sexualite-psy-3","context":null,"enonce":"Regarding sexual dysfunction","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"Sexual dysfunctions often correspond to one of the phases of sexual intercourse (desire, arousal, or orgasm)","correct":true},{"idx":1,"proposition":"Sexual pain is not a real sexual dysfunction","correct":false,"justification":"Sexual pain is part of sexual dysfunction"},{"idx":2,"proposition":"A fairly high proportion of men and women in the general population suffer from sexual dysfunction (5-35% depending on type and sex)","correct":true},{"idx":3,"proposition":"Comorbid psychiatric disorders have little impact on sexual dysfunction and should not be considered in etiological research","correct":false,"justification":"A comorbid psychiatric disorder is found in 30% of cases – depressive or anxiety disorder, addictive disorder, anorexia nervosa, etc."},{"idx":4,"proposition":"Non-psychiatric differential diagnoses are to be systematically sought by a systematic clinical examination","correct":true}],"type":"custom"}
+{"_id":"sexualite-psy-5","context":null,"enonce":"Which of these propositions are true?","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"Exhibitionism is the act of being excited to show one's body to one's partner(s)","correct":false,"justification":"It is sexual arousal caused by exposing one's body to strangers in public places."},{"idx":1,"proposition":"Exhibitionism is the act of being sexually aroused by objects","correct":false},{"idx":2,"proposition":"Exhibitionism is being sexually aroused by showing one's body to strangers in public places.","correct":true},{"idx":3,"proposition":"Fetishism is being sexually aroused by humiliating others","correct":false,"justification":"Fetishism is sexual arousal caused by visual and\/or physical contact with a specific object, body part or situation."},{"idx":4,"proposition":"Masochism is always pathological","correct":false,"justification":"Pathological if it meets the 4 criteria of the DSM"}],"type":"custom"}
+{"_id":"sexualite-psy-6","context":null,"enonce":"Which of these proposals can promote sexual conduct disorder?","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"An anxiety disorder","correct":true},{"idx":1,"proposition":"A characterized depressive episode","correct":true},{"idx":2,"proposition":"Anorexia","correct":true},{"idx":3,"proposition":"Bipolar disorder","correct":true},{"idx":4,"proposition":"Schizophrenic disorder","correct":true,"justification":"Any history of psychiatric disorder can promote sexual conduct disorder"}],"type":"custom"}
+{"_id":"sexualite-psy-7","context":null,"enonce":"Which of these proposals can promote sexual conduct disorder?","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"A HTA","correct":true},{"idx":1,"proposition":"OSA","correct":true},{"idx":2,"proposition":"Adrenal insufficiency","correct":true},{"idx":3,"proposition":"A twin pregnancy","correct":false,"justification":"In any case, it is not mentioned in the colleges"},{"idx":4,"proposition":"Hypoprolactinemia","correct":false,"justification":"Rather, it is hyperprolactinemia, which may be responsible for secondary amenorrhea or erectile dysfunction."}],"type":"custom"}
+{"_id":"sexualite-psy-8","context":null,"enonce":"What propositions are part of classic sexual behavior in both sexes?","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"The phase of desire","correct":true},{"idx":1,"proposition":"The regret phase","correct":false,"justification":"Desire -> Arousal -> Plateau -> Orgasm -> Resolution -> Refractory period (in men only)"},{"idx":2,"proposition":"The refractory period","correct":false,"justification":"In humans only"},{"idx":3,"proposition":"The orgasm phase, which always corresponds to ejaculation in men","correct":false,"justification":"Most often yes, but not always"},{"idx":4,"proposition":"The Resolving Phase","correct":true}],"type":"custom"}
+{"_id":"sexualite-psy-9","context":null,"enonce":"What is the neurotransmitter most involved in the refractory period?","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"Serotonin","correct":false,"justification":"These are endorphins. Researchers believe that serotonin curbs arousal and desire"},{"idx":1,"proposition":"Dopamine","correct":false,"justification":"Dopamine increases arousal and desire"},{"idx":2,"proposition":"Le GABA","correct":false,"justification":"College does not report GABA role in sexuality"},{"idx":3,"proposition":"Glutamate","correct":false},{"idx":4,"proposition":"Endorphins","correct":true}],"type":"custom"}
+{"_id":"sexualite-psy-10","context":null,"enonce":"What is the neurotransmitter that curbs arousal and desire?","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"Serotonin","correct":true,"justification":"Researchers believe that serotonin curbs arousal and desire"},{"idx":1,"proposition":"Dopamine","correct":false,"justification":"Dopamine increases arousal and desire"},{"idx":2,"proposition":"Le GABA","correct":false,"justification":"College does not report GABA role in sexuality"},{"idx":3,"proposition":"Glutamate","correct":false},{"idx":4,"proposition":"Endorphins","correct":false,"justification":"Endorphins are involved in the refractory phase mainly"}],"type":"custom"}
+{"_id":"sexualite-psy-12","context":null,"enonce":"Which of these proposals can cause hypersexuality?","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"Untreated Parkinson's disease","correct":false,"justification":"However, some dopamingergic agonists used in the treatment of Parkinson's disease can cause hypersexuality."},{"idx":1,"proposition":"A manic episode","correct":true},{"idx":2,"proposition":"A frontal syndrome","correct":true},{"idx":3,"proposition":"A temporal syndrome","correct":true},{"idx":4,"proposition":"An occipital syndrome","correct":false,"justification":"Frontal and temporal syndromes can cause hypersexuality. But not occipital syndrome."}],"type":"custom"}
+{"_id":"radiculalgie-ortho-0","context":null,"enonce":"In symptomatic radiculalgia, the pain is:","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"Calmed by rest","correct":false,"justification":"Through activity"},{"idx":1,"proposition":"Awakening in the second part of the night","correct":true},{"idx":2,"proposition":"Maximum in the evening","correct":false,"justification":"Maximum in the morning or at night"},{"idx":3,"proposition":"Compounded by activity","correct":false,"justification":"Aggravated by rest"},{"idx":4,"proposition":"Morning rusting of more than 30 minutes","correct":true}],"type":"custom"}
+{"_id":"radiculalgie-ortho-1","context":null,"enonce":"Which of these proposals refer to mechanical pain?\r\n","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"Maximum at the end of the day","correct":true},{"idx":1,"proposition":"Relieved by rest","correct":true},{"idx":2,"proposition":"No nocturnal awakening","correct":true,"justification":"Or positional awakening in the first part of the night"},{"idx":3,"proposition":"Compounded by activity","correct":true},{"idx":4,"proposition":"Without morning rusting","correct":true}],"type":"custom"}
+{"_id":"radiculalgie-ortho-2","context":null,"enonce":"Which muscles are affected by a C5 deficiency?","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"Deltoide","correct":true},{"idx":1,"proposition":"Brachial biceps","correct":true,"justification":"The biceps is innervated by C5 and C6, like the deltoide"},{"idx":2,"proposition":"Brachial","correct":true,"justification":"innervated by C5 C6 as well."},{"idx":3,"proposition":"The triceps brachial","correct":false},{"idx":4,"proposition":"Quadriceps","correct":false}],"type":"custom"}
+{"_id":"radiculalgie-ortho-3","context":null,"enonce":"Regarding the brachial plexus:","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"The tricipital reflex is C8 dependent","correct":false,"justification":"C7"},{"idx":1,"proposition":"The anterior surface of the arm is innervated by C6\r\n","correct":true},{"idx":2,"proposition":"Outer side of the forearm is innervated by C7","correct":false,"justification":"By C6, which innervates the front of the arm, the outer surface of the forearm and the thumb"},{"idx":3,"proposition":"The brachial plexus is notably composed of C7 and C8","correct":true},{"idx":4,"proposition":"The roots of the brachial plexus are mostly sensitive","correct":false,"justification":"Sensory-motor"}],"type":"custom"}
+{"_id":"radiculalgie-ortho-4","context":null,"enonce":"Which fingers are innervated by C7:","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"The thumb","correct":false,"justification":"C6"},{"idx":1,"proposition":"The index","correct":true},{"idx":2,"proposition":"The middle finger","correct":true},{"idx":3,"proposition":"The ring finger","correct":true,"justification":"C7 = the 3 medial fingers, especially the middle finger"},{"idx":4,"proposition":"The little finger","correct":false}],"type":"custom"}
+{"_id":"radiculalgie-ortho-5","context":null,"enonce":"Regarding the upper limb:","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"The posterior side of the arm and forearm is innervated by C7","correct":true},{"idx":1,"proposition":"The three middle fingers (especially the middle finger) are innervated by C8","correct":false,"justification":"By C7, which also innervates the posterior surface of the arm and forearm (the root arrives from the back)"},{"idx":2,"proposition":"C8 innervates the lateral side of the arm and forearm","correct":false,"justification":"Medial side of the arm and forearm, as well as the 4th and 5th fingers"},{"idx":3,"proposition":"The Deltoid allows the abduction of the arm\r\n","correct":true},{"idx":4,"proposition":"The biceps brachial is innervated by C8","correct":false,"justification":"By C6"}],"type":"custom"}
+{"_id":"radiculalgie-ortho-6","context":null,"enonce":"Regarding the roots of the upper limb:","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"The Brachial allows the flexion of the elbow\r\n","correct":true},{"idx":1,"proposition":"The Triceps brachial allows the extension of the hand\r\n","correct":false,"justification":"Elbow extension since it is a muscle of the arm (and not the forearm)"},{"idx":2,"proposition":"Interosseous muscles are innervated by C8","correct":true},{"idx":3,"proposition":"The Bicipital reflex is dependent on C5","correct":true},{"idx":4,"proposition":"The Bicipital reflex is only dependent on C6","correct":false,"justification":"Bicipital = C5 and\/or C6"}],"type":"custom"}
+{"_id":"radiculalgie-ortho-7","context":null,"enonce":"Regarding sensory territories and reflexes:","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"The Stylo-radial reflex is C6 dependent","correct":true},{"idx":1,"proposition":"The Tricipital reflex is C7 dependent","correct":true},{"idx":2,"proposition":"The Cubito-pronator reflex is dependent on C7","correct":false,"justification":"C8"},{"idx":3,"proposition":"The front of the thigh is innervated by S1\r\n","correct":false,"justification":"Anterior surface of the thigh = L3. Posterior side of the thigh = S1"},{"idx":4,"proposition":"The medial side of the knee is innervated by L3","correct":true,"justification":"This is where C3 ends."}],"type":"custom"}
+{"_id":"radiculalgie-ortho-8","context":null,"enonce":"Regarding the sensory territories of the leg:","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"The outer thigh is innervated by L4","correct":true},{"idx":1,"proposition":"The anterior side of the knee is innervated by L4","correct":true},{"idx":2,"proposition":"The anteromedial side of the leg is innervated by L3","correct":false,"justification":"L3 stops at the medial surface of the knee after passing through the anterior surface of the thigh. It is L4 that innervates the anteromedial surface of the knee"},{"idx":3,"proposition":"The posterior side of the thigh is innervated by L2","correct":false,"justification":"Posterior thigh = L5 and S1"},{"idx":4,"proposition":"The lateral side of the leg is innervated by S1","correct":false,"justification":"It's L5. S1 innervates the posterior side of the leg"}],"type":"custom"}
+{"_id":"radiculalgie-ortho-9","context":null,"enonce":"Regarding the sensory territories of the leg and the patellar reflex:","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"proposition":"The back of the foot and the big toe are innervated by L5","correct":true},{"idx":1,"proposition":"The posterior side of the thigh is innervated by L4","correct":false,"justification":"Posterior thigh = L5 and S1"},{"idx":2,"proposition":"The posterior side of the leg is innervated by S1","correct":true},{"idx":3,"proposition":"The sole of the foot and the 5th toe are innervated by L4","correct":false,"justification":"S1"},{"idx":4,"proposition":"The Patellar reflex is dependent on the root L3 ","correct":true}],"type":"custom"}
+{"_id":"risquesenvironnemt-HGE-0","context":null,"enonce":"Regarding the bases of risks related to the consumption of water or food:","item":"risquesenvironnemt","matiere":"HGE","propositions":[{"idx":0,"proposition":"Encapsulated commercial water bottles do not normally contain bacteria, viruses or parasites","correct":true},{"idx":1,"proposition":"Transmission of intestinal infections through food is impossible","correct":false,"justification":"by food: very common"},{"idx":2,"proposition":"Swimming is not a vector of transmission until you drink the water","correct":false,"justification":"During swimming (in swimming pools, fresh water or at sea), contact with dirty water is a vector of transmission"},{"idx":3,"proposition":"Human-to-human transmission can be reduced by simple hygiene measures","correct":true},{"idx":4,"proposition":"Food can be vectors of toxins responsible for digestive tables generally brief and benign","correct":true}],"type":"custom"}
+{"_id":"risquesenvironnemt-HGE-1","context":null,"enonce":"Which propositions are true?","item":"risquesenvironnemt","matiere":"HGE","propositions":[{"idx":0,"proposition":"Certain foods are responsible for poisoning","correct":true},{"idx":1,"proposition":"Any TIAC must be declared to the departmental health authority","correct":true},{"idx":2,"proposition":"Only the physician must make the mandatory declaration of TIAC","correct":false,"justification":"This declaration is also mandatory for the person in charge of the premises where the patients are located."},{"idx":3,"proposition":"Mandatory reporting is unnecessary from a health point of view, its only function being administrative","correct":false,"justification":"It is this that makes it possible to decide, if necessary, on an epidemiological inquiry"},{"idx":4,"proposition":"The main causes of TIAC reported in France are Escherichia Coli","correct":false,"justification":"These are, in order of frequency, salmonella (70% of TIAC), Clostridium perfringens and Staphylococcus aureus"}],"type":"custom"}
+{"_id":"rhumcrist-rhumato-0","context":null,"enonce":"Regarding the generalities of gout:","item":"rhumcrist","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Gout is intermittent inflammatory rheumatism, in countries with high GDP, the most prevalent","correct":true},{"idx":1,"proposition":"Chronic arthropathies are due to dysregulation of renal purification","correct":false,"justification":"This is due to intra-articular and bony tophus"},{"idx":2,"proposition":"The diagnosis of gout is made by the detection of strongly birefringent tapered microcrystals in the joint fluid","correct":true},{"idx":3,"proposition":"The genetic component of gout is zero","correct":false,"justification":"It is a polygenic disease with several predisposing genes"},{"idx":4,"proposition":"The usual terrain is the young vegan woman","correct":false,"justification":"The middle-aged man with too much calorie diet and too much animal protein"}],"type":"custom"}
+{"_id":"rhumcrist-rhumato-1","context":null,"enonce":"Regarding the diagnosis of gout:","item":"rhumcrist","matiere":"rhumato","propositions":[{"idx":0,"proposition":"The symptomatological peak is reached in about 31 days","correct":false,"justification":"Peak of symptoms in 24 hours"},{"idx":1,"proposition":"The skin coating is unchanged","correct":false,"justification":"There is swelling and local redness, a sign of inflammation"},{"idx":2,"proposition":"The most frequent localization is the first metatarsophalangeal","correct":true},{"idx":3,"proposition":"The resolution of the crisis necessarily requires drug treatment associated with good hydration","correct":false,"justification":"Resolution is spontaneous but can be shortened by NSAIDs"},{"idx":4,"proposition":"Any patient who has uricemia greater than 60 mg\/L is at risk of gout","correct":true}],"type":"custom"}
+{"_id":"rhumcrist-rhumato-2","context":null,"enonce":"Which propositions are true?","item":"rhumcrist","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Joint ultrasound is unnecessary in this context","correct":false,"justification":"This is very useful in the absence of specific radiographic signs. We can see a \"double contour\" aspect"},{"idx":1,"proposition":"The female predominance of chondrocalcinosis decreases with age","correct":true},{"idx":2,"proposition":"CCP rheumatism is never asymptomatic","correct":false,"justification":"It happens that it is"},{"idx":3,"proposition":"Diagnosis is based on cubic deposits in articular cartilage that are not refrigent","correct":true},{"idx":4,"proposition":"In apatitic rheumatism, the diagnosis can be made by anamnesis","correct":true}],"type":"custom"}
+{"_id":"nutriped-nutri-0","context":null,"enonce":"Regarding the diet of the infant:","item":"nutriped","matiere":"nutri","propositions":[{"idx":0,"proposition":"The only diet of the baby under 5 months is milk","correct":true,"justification":"Maternal or not"},{"idx":1,"proposition":"Breastfeeding is ideal and sufficient","correct":true},{"idx":2,"proposition":"Breastfeeding strengthens the mother-child bond","correct":true},{"idx":3,"proposition":"For 100 kcal, a 1st age milk contains about 3kg of cow's milk protein","correct":false,"justification":"Between 2 and 3 grams"},{"idx":4,"proposition":"Low sodium is less than 1 mg of salt per 100 kcal","correct":false,"justification":"Low sodium: < 39 mg\/100 kcal"}],"type":"custom"}
+{"_id":"nutriped-nutri-1","context":null,"enonce":"General information about infant:","item":"nutriped","matiere":"nutri","propositions":[{"idx":0,"proposition":"Never force a healthy baby to finish rations if he seems full.","correct":true},{"idx":1,"proposition":"Growth charts for weight and height confirm the baby's good nutrition","correct":true},{"idx":2,"proposition":"During the first three years of life, the child multiplies his weight by 4","correct":true},{"idx":3,"proposition":"The brain grows 30 to 200 grams between 0 and 3 years","correct":false,"justification":"From 300 to 1000g"},{"idx":4,"proposition":"During the first three years of life, the child multiplies his height by four","correct":false,"justification":"Step 2"}],"type":"custom"}
+{"_id":"nutriped-nutri-2","context":null,"enonce":"Regarding the infant:","item":"nutriped","matiere":"nutri","propositions":[{"idx":0,"proposition":"Daily energy requirements vary little in the first 36 months","correct":true,"justification":"90 to 100 kcal\/kg"},{"idx":1,"proposition":"Diversification is a stage arriving at the third week of life","correct":false,"justification":"From the 6th or 7th month"},{"idx":2,"proposition":"There are three types of external breastfeeding: 1st age milk, 2nd age milk and growth formulas","correct":true,"justification":"Growth preparation = 3rd age"},{"idx":3,"proposition":"Nitrogen absorbed = nitrogen ingested urinary nitrogen","correct":false,"justification":"Nitrogen absorbed = nitrogen ingested faecal nitrogen"},{"idx":4,"proposition":"Nitrogen retained = nitrogen absorbed urinary nitrogen","correct":true}],"type":"custom"}
+{"_id":"nutriped-nutri-3","context":null,"enonce":"Regarding the infant:","item":"nutriped","matiere":"nutri","propositions":[{"idx":0,"proposition":"AaE can be provided by sources with complementary chemical indices","correct":true},{"idx":1,"proposition":"For premature or very low birth weight children, we have milks covering their specific needs such as milk with non-hydrolyzed proteins","correct":true},{"idx":2,"proposition":"Food diversification involves stages of gradual substitution","correct":true,"justification":"Like slow-digesting sugars, fiber, different proteins, etc."},{"idx":3,"proposition":"The second category of foods to introduce, after slow-digesting sugars, is those rich in fast sugars.","correct":false,"justification":"First the fibers. They also provide water, minerals and vitamins"},{"idx":4,"proposition":"Fibers are responsible for fermentation","correct":true}],"type":"custom"}
+{"_id":"nutriped-nutri-4","context":null,"enonce":"Regarding the infant and the baby:","item":"nutriped","matiere":"nutri","propositions":[{"idx":0,"proposition":"The interest of fiber is also to provide water, minerals, vitamins provided that we respect certain ways of cooking them","correct":true},{"idx":1,"proposition":"Fiber also has the interest of regulating the glycemic response, therefore hunger, and limiting the absorption of cholesterol","correct":true},{"idx":2,"proposition":"At 6 months a baby will be able to receive, instead of a bottle of milk at noon, a vegetable puree and dairy","correct":true},{"idx":3,"proposition":"Cooked cheeses can be introduced around 6 months of age","correct":false,"justification":"Around 9 months for cooked pasta, around 12 months for fermented pasta"},{"idx":4,"proposition":"There is no danger in leaving the bottle for several months or even years as breakfast","correct":true}],"type":"custom"}
+{"_id":"nutriped-nutri-5","context":null,"enonce":"Regarding the baby and child:","item":"nutriped","matiere":"nutri","propositions":[{"idx":0,"proposition":"With diversification, fat intake increases from 50% to 30-35% of the daily energy intake","correct":true},{"idx":1,"proposition":"Iron is provided by meat exclusively","correct":false,"justification":"Also by fortified cereals or so-called 3rd age or growth milks that are fortified with iron"},{"idx":2,"proposition":"Eggs are a source of protein but do not contain vitamins","correct":false,"justification":"Eggs provide a lot of vitamins, proteins and cholesterol"},{"idx":3,"proposition":"During diversification, you have to be very careful not to introduce too much protein","correct":false,"justification":"What you really need to pay attention to is sugar+sodium+calories"},{"idx":4,"proposition":"Carbohydrate food excesses have no impact in view of age","correct":false,"justification":"May cause early adiposity rebound"}],"type":"custom"}
+{"_id":"nutriped-nutri-6","context":null,"enonce":"Regarding the adolescent:","item":"nutriped","matiere":"nutri","propositions":[{"idx":0,"proposition":"Adolescence is a period of nutritional risk","correct":true},{"idx":1,"proposition":"Adolescent obesity all began at puberty","correct":false,"justification":"Too often obesity is discovered in adolescents that began long before"},{"idx":2,"proposition":"Obesity usually begins between 3 and 5 years of age when the child should start to be lean","correct":true,"justification":"While the child is normal\/coated, and this explains most of the obesity seen in adolescence"},{"idx":3,"proposition":"It is useful or even imperative to develop the habit of regular physical activity","correct":true},{"idx":4,"proposition":"One in two teenagers admits they don't like looking at themselves in a mirror or having their picture taken","correct":true,"justification":"and 63% of girls say they want to lose weight"}],"type":"custom"}
+{"_id":"nutriped-nutri-7","context":null,"enonce":"Regarding the adolescent:","item":"nutriped","matiere":"nutri","propositions":[{"idx":0,"proposition":"It is recommended to administer vitamin D supplementation every 3 months during the peripubertal period","correct":false,"justification":"At least once a year"},{"idx":1,"proposition":"It is recommended to provide at least 100g of calcium per day","correct":false,"justification":"At least 1g or 1000mg"},{"idx":2,"proposition":"The recommended intake of iron is in the range of 15 to 22 mg\/day","correct":true,"justification":"Higher in girls than boys"},{"idx":3,"proposition":"It is recommended to take a dairy product at each meal including snack","correct":true},{"idx":4,"proposition":"Snacking is to be formally discouraged","correct":true}],"type":"custom"}
+{"_id":"nutrigrossesse-endoc-1","context":null,"enonce":"Which of the following are risk factors for gestational diabetes?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"idx":0,"proposition":"Maternal age over 35 years","correct":true},{"idx":1,"proposition":"A first-degree family history of type 2 diabetes","correct":true},{"idx":2,"proposition":"A diet rich in fat","correct":false},{"idx":3,"proposition":"Lupus in the mother","correct":false},{"idx":4,"proposition":"Diabetes in the grandfather","correct":false}],"type":"custom"}
+{"_id":"nutrigrossesse-endoc-4","context":null,"enonce":"Regarding gestational diabetes:","item":"nutrigrossesse","matiere":"endoc","propositions":[{"idx":0,"proposition":"Often, it is a diabetes present before but asymptomatic","correct":true},{"idx":1,"proposition":"It is conventionally revealed in the third trimester","correct":false,"justification":"It is conventionally revealed in the second trimester"},{"idx":2,"proposition":"Screening is systematic","correct":false,"justification":"It is now done on risk factor: age over 35, overweight or obesity, personal or family history of diabetes or macrosomia"},{"idx":3,"proposition":"It concerns 15% of pregnancies 🤰 ","correct":false,"justification":"3 to 6%"},{"idx":4,"proposition":"There is an increased risk of macrosomia","correct":true}],"type":"custom"}
+{"_id":"nutrigrossesse-endoc-7","context":null,"enonce":"At what time of pregnancy is OGGH for gestational diabetes indicated? ","item":"nutrigrossesse","matiere":"endoc","propositions":[{"idx":0,"proposition":"Between 24 and 28 SA","correct":true,"justification":"True, only indicated if fasting blood glucose < 0.92g\/L (threshold of gestational diabetes in the first trimester"},{"idx":1,"proposition":"Between 22 and 28 SA","correct":false,"justification":"False"},{"idx":2,"proposition":"Between 24 and 38 SA","correct":false,"justification":"False"},{"idx":3,"proposition":"Between 20 and 24 SA","correct":false,"justification":"False"},{"idx":4,"proposition":"None of the above answers are accurate","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"epidemioKc-onco-0","context":null,"enonce":"Concerning the epidemiology of cancers","item":"epidemioKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Breast cancer is the leading cause of cancer death in women","correct":true},{"idx":1,"proposition":"It is a major public health problem for all industrialized countries.","correct":true},{"idx":2,"proposition":"5-year survival rate (all cancers) = 73%","correct":false},{"idx":3,"proposition":"Cancer is the 1st leading cause of death in humans","correct":true},{"idx":4,"proposition":"Lung cancer is the 1st leading cause of cancer death in men","correct":true}],"type":"custom"}
+{"_id":"epidemioKc-onco-1","context":null,"enonce":"Concerning the epidemiology and prevention of cancer","item":"epidemioKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Prematured mortality from cancer is twice as high in men as in women","correct":true},{"idx":1,"proposition":"Between 1980 and 2015, the overall incidence of cancer has increased since 1980 (+109% in both men and women)","correct":true},{"idx":2,"proposition":"Tobacco is a factor on which we can act","correct":true},{"idx":3,"proposition":"Prevention must contribute to reducing inequalities in the face of cancer","correct":true},{"idx":4,"proposition":"At least 1\/3 of cancers are preventable, the main risk factor being alcohol","correct":false}],"type":"custom"}
+{"_id":"epidemioKc-onco-2","context":null,"enonce":"Concerning the epidemiology and prevention of cancer","item":"epidemioKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Alcohol is responsible for 15,000 cancer deaths","correct":true},{"idx":1,"proposition":"The consumption of fruits and vegetables is associated with a reduced risk of several cancers: oral cavity, pharynx, larynx, esophagus, stomach","correct":true},{"idx":2,"proposition":"Eating salt and salty foods increases the risk of stomach cancer","correct":true},{"idx":3,"proposition":"Eating red meat and deli meats is associated with an increased risk of colorectal cancer","correct":true},{"idx":4,"proposition":"Infectious agents are responsible for 76% of cancers worldwide","correct":false,"justification":"They are responsible for 16%"}],"type":"custom"}
+{"_id":"epidemioKc-onco-3","context":null,"enonce":"A 57-year-old patient comes to your office.\r\nWhich of the following are screenings that she could have benefited from?","item":"epidemioKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Mass breast cancer screening","correct":true},{"idx":1,"proposition":"Endometrial cancer screening","correct":false,"justification":"False"},{"idx":2,"proposition":"Individual cervical cancer screening","correct":true},{"idx":3,"proposition":"Mass screening for colon cancer","correct":true},{"idx":4,"proposition":"Mass screening for ovarian cancer","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"TCA-psy-0","context":null,"enonce":"General generalities:","item":"TCA","matiere":"psy","propositions":[{"idx":0,"proposition":"There are two eating disorders: anorexia and bulimia","correct":false,"justification":"There are also binge eating, atypical disorders such as nocturnal eating syndrome and food intake disorders such as pica."},{"idx":1,"proposition":"It is important to eliminate non-psychiatric medical causes before any TCA","correct":true},{"idx":2,"proposition":"Psychiatric comorbidities are extremely rare and minor in intensity","correct":false},{"idx":3,"proposition":"Suicidal risk should be systematically assessed","correct":true,"justification":"TCA are among the psychiatric disorders with the highest mortality (about 10% of patients, half of whom by suicide)"},{"idx":4,"proposition":"It is never necessary to hospitalize these patients whose care is done on a long-term outpatient basis","correct":false,"justification":"Hospitalization criteria, especially for anorexia must be known"}],"type":"custom"}
+{"_id":"TCA-psy-1","context":null,"enonce":"Which propositions are true?","item":"TCA","matiere":"psy","propositions":[{"idx":0,"proposition":"Diet belongs to the instinctual functions of mammals","correct":true},{"idx":1,"proposition":"The etiopathogenesis of TCA is still poorly understood","correct":true},{"idx":2,"proposition":"The lifetime prevalence of anorexia nervosa is estimated to be more than 6% in Caucasian women","correct":false,"justification":"Its lifetime prevalence is estimated at 0.6% in the Caucasian adult population"},{"idx":3,"proposition":"The sex ratio of anorexia is 1 man to 8 women","correct":true},{"idx":4,"proposition":"Anorexia is not a fatal disease","correct":false,"justification":"Mortality is estimated at 1% per year"}],"type":"custom"}
+{"_id":"AOMI-cardio-0","context":null,"enonce":"Concerning arteriopathy obliterans","item":"AOMI","matiere":"cardio","propositions":[{"idx":0,"proposition":"After coronary and cerebral involvement, PAD is by its frequency the third localization of atherosclerosis","correct":true},{"idx":1,"proposition":"It is, in its symptomatic form, 3 to 4 times more common in women than in men","correct":false,"justification":"3 to 4 times more common in men"},{"idx":2,"proposition":"The peak of presentation is between 60 and 75 years in humans","correct":true,"justification":"And 70 to 80 years in women"},{"idx":3,"proposition":"Diabetes is responsible for severe involvement from the outset, with more proximal involvement ","correct":false,"justification":"A more distal attack"},{"idx":4,"proposition":"Hypertension and diabetes are the two predominant cardiovascular risk factors in PAD","correct":false,"justification":"Diabetes and tobacco"}],"type":"custom"}
+{"_id":"AOMI-cardio-1","context":null,"enonce":"Concerning arteriopathy obliterans","item":"AOMI","matiere":"cardio","propositions":[{"idx":0,"proposition":"Symptomatic involvement affects 10 to 15% of people over 60 years of age","correct":false,"justification":"1-5% of people over 60. Asymptomatic forms affect 10-15% of this population"},{"idx":1,"proposition":"In the intermittent claudication stage, mortality at 5 years is 15%","correct":true},{"idx":2,"proposition":"It is estimated that for every symptomatic PAD case, there are two to four patients with a subclinical form of the disease.","correct":true},{"idx":3,"proposition":"The Leriche-Fontaine classification is the classification currently recommended to understand the severity of clinical involvement","correct":false,"justification":"It is supplanted today by the Rutherford classification."},{"idx":4,"proposition":"PAD should be tested for in any patient over 50 years of age with cardiovascular risk factors","correct":true}],"type":"custom"}
+{"_id":"AOMI-cardio-2","context":null,"enonce":"Concerning arteriopathy obliterans","item":"AOMI","matiere":"cardio","propositions":[{"idx":0,"proposition":"The disease is rapidly symptomatic","correct":false,"justification":"Long asymptomatic, due to a moderate hemodynamic impact and the progressive and compensatory development of collateral arteries"},{"idx":1,"proposition":"During intermittent claudication, symptoms disappear spontaneously within 10 minutes","correct":false,"justification":"In less than 5 minutes"},{"idx":2,"proposition":"Claudication is said to be severe if the walking distance is less than 300 meters","correct":false,"justification":"100 meters"},{"idx":3,"proposition":"The walking distances of claudication can be variable from one day to another, in the same patient","correct":true,"justification":"However, this is an atypical form."},{"idx":4,"proposition":"Critical ischemia is a clinical diagnosis exclusively","correct":false,"justification":"Clinico-hemodynamics: infusion pressure <50mmHg at the ankle or 30mmHg at the level of the big toe"}],"type":"custom"}
+{"_id":"AOMI-cardio-3","context":null,"enonce":"Concerning arteriopathy obliterans","item":"AOMI","matiere":"cardio","propositions":[{"idx":0,"proposition":"Leriche syndrome indicates femoral involvement","correct":false,"justification":"Aortoiliac involvement. As a reminder, Leriche syndrome associates gluteal claudication or fatigability with walking + erectile dysfunction"},{"idx":1,"proposition":"Pain at the pressure of the calf muscle masses testifies to moderate ischemia","correct":false,"justification":"Pain at the pressure of the muscle masses of the calf testifies to severe ischemia"},{"idx":2,"proposition":"Normal recoloration time is <5 seconds","correct":false},{"idx":3,"proposition":"The ABI is calculated by the ratio of the highest systolic pressure of the two arms to the higher pressure of the two ankles.","correct":false,"justification":"It's the opposite (ankle pressure \/ arm pressure)"},{"idx":4,"proposition":"Ulcers are generally very algic, small and hollow, on the support areas of the foot","correct":true}],"type":"custom"}
+{"_id":"AOMI-cardio-4","context":null,"enonce":"Concerning arteriopathy obliterans","item":"AOMI","matiere":"cardio","propositions":[{"idx":0,"proposition":"Two causes of medicalcosis arterial stiffness are diabetes and tobacco use.","correct":false,"justification":"Diabetes and the dialysis patient. This arterial stiffness results in an IPS >1,4"},{"idx":1,"proposition":"Trophic disorders are systematically sought especially in interdigital spaces","correct":true},{"idx":2,"proposition":"An abolished pedinous pulse testifies to obliterating arterial disease","correct":false,"justification":"Pediose pulse may not be present congenitally, in 5% of the population"},{"idx":3,"proposition":"SPI <0.9 characterizes critical ischemia","correct":false,"justification":"If the ankle infusion pressure is >50mmHg, no. An IPS <0.9 characterizes a PAD"},{"idx":4,"proposition":"In case of IPS >1.4, ankle infusion pressure should be used to make the diagnosis of PAD","correct":false,"justification":"In this case the ankle perfusion pressure is not interpretable: the perfusion pressure at the big toe is used."}],"type":"custom"}
+{"_id":"AOMI-cardio-5","context":null,"enonce":"Concerning arteriopathy obliterans","item":"AOMI","matiere":"cardio","propositions":[{"idx":0,"proposition":"To diagnose PAD, injected CT angiography is frequently used","correct":false,"justification":"CT angiography is only used if there is an indication for revascularization"},{"idx":1,"proposition":"Critical ischemia pain is improved in the declivated position","correct":true,"justification":"It forces you to get up at night or keep your leg out of bed"},{"idx":2,"proposition":"In case of discovery of PAD, a resting ECG and ultrasound of the abdominal aorta are systematic","correct":true},{"idx":3,"proposition":"A patient with asymptomatic PAD should receive treatment with a statin and an ACE inhibitor","correct":true},{"idx":4,"proposition":"Revascularization may be offered in case of intermittent claudication","correct":true,"justification":"In case of threatening lesions or disabling symptomatology despite optimal treatment for 3 months"}],"type":"custom"}
+{"_id":"AOMI-cardio-6","context":null,"enonce":"Which of the following are true for popliteal artery aneurysms?","item":"AOMI","matiere":"cardio","propositions":[{"idx":0,"proposition":"They are frequently associated with abdominal aortic aneurysms","correct":true},{"idx":1,"proposition":"They are rarely bilateral","correct":false,"justification":"Bilateral in almost half of the cases"},{"idx":2,"proposition":"The operative indication arises when they are greater than 15 mm","correct":false,"justification":"20 mm"},{"idx":3,"proposition":"The most common complication is embolism","correct":true},{"idx":4,"proposition":"They can manifest as compression of adjacent tissues","correct":true,"justification":"True, nerves, compressed TV, etc."}],"type":"custom"}
+{"_id":"AOMI-cardio-7","context":null,"enonce":"Among the following proposals, which are treatments to be implemented in case of stage I PAD according to the Leriche and Fontaine classification?","item":"AOMI","matiere":"cardio","propositions":[{"idx":0,"proposition":"Smoking cessation","correct":true,"justification":"True, avoid passive smoking too"},{"idx":1,"proposition":"Arterial revascularization","correct":false,"justification":"Not at stage 1"},{"idx":2,"proposition":"Walking rehabilitation","correct":false,"justification":"No problem walking in stage 1"},{"idx":3,"proposition":"Implementation of antiplatelet agents","correct":false,"justification":"Implementation of Statine, and IEC\/ARA2 if necessary"},{"idx":4,"proposition":"Balancing diabetes, if applicable","correct":true}],"type":"custom"}
+{"_id":"KcSNC-onco-0","context":null,"enonce":"Regarding the management of glioblastomas:","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"The median survival is about 1.5 years","correct":true,"justification":"18 months"},{"idx":1,"proposition":"Hormone therapy is applicable as a second line","correct":false,"justification":"Has no place in this care"},{"idx":2,"proposition":"Focal radiation therapy is often offered as a first-line treatment","correct":false,"justification":"In all intracerebral tumors, first-line excision is preferred, often supplemented by chemotherapy and\/or radiotherapy."},{"idx":3,"proposition":"Radiation therapy is often concomitant with chemotherapy","correct":true},{"idx":4,"proposition":"It is a deadly tumor in most cases","correct":true}],"type":"custom"}
+{"_id":"KcSNC-onco-1","context":null,"enonce":"What does a gliobastoma give on an MRI?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"A strong contrast gain in injected T1","correct":true},{"idx":1,"proposition":"Regular contours","correct":false,"justification":"Irregulars"},{"idx":2,"proposition":"Peripheral necrosis","correct":false,"justification":"Central necrosis"},{"idx":3,"proposition":"A hypoT1 image without injection of contrast medium","correct":true},{"idx":4,"proposition":"A hyperT2 image","correct":true}],"type":"custom"}
+{"_id":"KcSNC-onco-2","context":null,"enonce":"Among these tumor proposals, which are among the 4 cancers that metastasize the most intracranial?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Kidney","correct":true},{"idx":1,"proposition":"Lung","correct":true},{"idx":2,"proposition":"Breast","correct":true},{"idx":3,"proposition":"Melanoma","correct":true},{"idx":4,"proposition":"Prostate","correct":false}],"type":"custom"}
+{"_id":"KcSNC-onco-3","context":null,"enonce":"Which of these propositions are true?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"There are many more metastases than primary tumors, from an epidemiological point of view","correct":true},{"idx":1,"proposition":"85% of intracranial tumors are subtentorial","correct":false,"justification":"85% of them are sustenorial"},{"idx":2,"proposition":"There are more than 15 large entities of intrancranial tumors","correct":false,"justification":"There are 9"},{"idx":3,"proposition":"There are more than 240 subtypes of intrancranial tumors, almost all of which differ in their management.","correct":false,"justification":"There are about 80 subtypes of intracranial tumors. There is a lot of overlap between them."},{"idx":4,"proposition":"Type 3 glioma is called low-grade","correct":false,"justification":"Glioma types 1 and 2: low grade. Glioma types 3 and 4: high grade. Type 3 glioma is anaplastic. Type 4 glioma is a glioblastoma."}],"type":"custom"}
+{"_id":"KcSNC-onco-4","context":null,"enonce":"Regarding amydala engagement:","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"It concerns supratentorial tumors","correct":false,"justification":"Supratentorial tumors (85% of intracranial tumors) have a temporal commitment. It is the subtentorial tumors that cause tonsillar engagement"},{"idx":1,"proposition":"It results in hemiparesis, diplopia, ptosis and\/or unilateral areactive mydriasis","correct":false,"justification":"This is the case of temporal engagement"},{"idx":2,"proposition":"It concerns the middle pit","correct":false,"justification":"The posterior fossa"},{"idx":3,"proposition":"It can result in stiff neck and torticollis.","correct":true},{"idx":4,"proposition":"It is as serious and urgent as temporal engagement","correct":true}],"type":"custom"}
+{"_id":"KcSNC-onco-5","context":null,"enonce":"Which propositions are true?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Intratumoral hemorrhages are more common in primary tumors","correct":false,"justification":"They are more common in cases of metastases of kidney or skin tumors."},{"idx":1,"proposition":"Lumbar punctures are formally contraindicated in case of hydrocephalus","correct":false,"justification":"It depends on the type of hydrocephalus. If it is the tumor that prevents CSF from flowing, then PL is indeed contraindicated because it can cause, by << aspiration>>, occipital engagement. If, on the other hand, it is leptomeningeal proliferation that prevents the CSF from resorbing, then PL is possible."},{"idx":2,"proposition":"Choroidal plexus tumors can cause hypersecretion of CSF","correct":true},{"idx":3,"proposition":"Temporal engagement corresponds to the passage of the uncus and hippocampus in the Bichat cleft","correct":true,"justification":"Between the free edge of the cerebellum tent and the brainstem"},{"idx":4,"proposition":"Meningeal stiffness is rare in tumor meningitis","correct":true}],"type":"custom"}
+{"_id":"KcSNC-onco-6","context":null,"enonce":"Which of these tumor biomarkers have a good prognosis in diffuse gliomas in adults?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"The codeletion of chromosomes 1p and 19q","correct":true,"justification":"Result of an unbalanced chromosomal translocation"},{"idx":1,"proposition":"The mutation of the IDH gene","correct":true,"justification":"Encodes the enzyme isocitrate dehydrogenase involved in the energy metabolism of the cell"},{"idx":2,"proposition":"Acetylation of the MGMT gene","correct":false,"justification":"Methylation"},{"idx":3,"proposition":"The BRAF mutation","correct":false,"justification":"Melanoma"},{"idx":4,"proposition":"Amplification of NMYC","correct":false,"justification":"Prognostic marker for neuroblastomas"}],"type":"custom"}
+{"_id":"KcSNC-onco-8","context":null,"enonce":"Which of the following are signs of intracranial hypertension (ICPH)?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Areactive mydriasis","correct":true,"justification":"True, III (ptosis and mydriasis)"},{"idx":1,"proposition":"Ptosis","correct":true,"justification":"True, by reaching III"},{"idx":2,"proposition":"Paralysis of the abduction of the eye","correct":true,"justification":"True, achieved by VI"},{"idx":3,"proposition":"Impaired alertness","correct":true,"justification":"True, in case of severity"},{"idx":4,"proposition":"Hiccup","correct":true,"justification":"True, in severe ICTs"}],"type":"custom"}
+{"_id":"KcSNC-onco-9","context":null,"enonce":"Which of the following propositions concerning gliobastoma are true?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"High-grade brain tumour","correct":true,"justification":"True, it is a grade IV glial tumor"},{"idx":1,"proposition":"Prognosis is good","correct":false,"justification":"False"},{"idx":2,"proposition":"Prognosis is poor","correct":true},{"idx":3,"proposition":"Source cell line is neural","correct":false,"justification":"False"},{"idx":4,"proposition":"The source cell line is microglial","correct":false,"justification":"The cell line is astrocytic or oligodendrocytic, not microglial"}],"type":"custom"}
+{"_id":"KcSNC-onco-10","context":null,"enonce":"Which of the following are tumors metastasizing to the brain frequently?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Lung","correct":true},{"idx":1,"proposition":"Kidney","correct":true},{"idx":2,"proposition":"Breast","correct":true},{"idx":3,"proposition":"Pancreas","correct":false,"justification":"The 4 to know by heart are: lung, breast, kidney, melanoma."},{"idx":4,"proposition":"Bladder","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"KcSNC-onco-11","context":null,"enonce":"Which of the following proposals manifest itself in an image of a roundel on MRI?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Meningioma","correct":true,"justification":"Roundel = MAGIC. Meningioma, abscess, glioblastoma, infarction, contusion"},{"idx":1,"proposition":"Glioma","correct":false,"justification":"False"},{"idx":2,"proposition":"Glioblastoma","correct":true},{"idx":3,"proposition":"Meningitis","correct":false,"justification":"False"},{"idx":4,"proposition":"Abscess","correct":true}],"type":"custom"}
+{"_id":"KcSNC-onco-12","context":null,"enonce":"Which of the following are classic signs or symptoms of intracranial hypertension (ICPH)?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Abducens nerve damage","correct":true,"justification":"True, it is nerve VI, innervating the lateral right. Its involvement is responsible for horizontal binocular diplopia. It is the most 'fragile' cranial nerve"},{"idx":1,"proposition":"Paresthesia of the limbs","correct":false,"justification":"Not classic"},{"idx":2,"proposition":"Decubitus headaches","correct":true,"justification":"True, aggravated at the end of the night or in the morning"},{"idx":3,"proposition":"Jet vomiting","correct":true,"justification":"True, which relieve headaches"},{"idx":4,"proposition":"One-sided ptosis","correct":false,"justification":"Not a sign of HTIC"}],"type":"custom"}
+{"_id":"KcSNC-onco-13","context":null,"enonce":"Which of the following proposals manifest itself in an image of a roundel on MRI?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Alzheimer's disease","correct":false,"justification":"Roundel = MAGIC. Meningioma, abscess, glioblastoma, infarction, contusion"},{"idx":1,"proposition":"Meningioma","correct":true},{"idx":2,"proposition":"Extradural hematoma","correct":false,"justification":"Convex peripheral hematoma image"},{"idx":3,"proposition":"Bruise","correct":true},{"idx":4,"proposition":"Ischemic stroke","correct":true}],"type":"custom"}
+{"_id":"KcSNC-onco-14","context":null,"enonce":"Which of the following are tumors metastasizing to the brain frequently?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Kidney","correct":true},{"idx":1,"proposition":"Adrenal gland","correct":false,"justification":"False"},{"idx":2,"proposition":"Basal cell carcinoma","correct":false,"justification":"It does not give metastasis"},{"idx":3,"proposition":"Larynx","correct":false,"justification":"The 4 to know by heart are: lung, breast, kidney, melanoma"},{"idx":4,"proposition":"Melanoma","correct":true}],"type":"custom"}
+{"_id":"KcSNC-onco-15","context":null,"enonce":"Which of the following are true?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Primary cerebral lymphomas occur only in immunocompromised patients. ","correct":false,"justification":"False, the risk is increased in the immunocompromised patient (untreated HIV, organ transplant) but primary cerebral lymphomas exist in the immunocompetent."},{"idx":1,"proposition":"Meningiomas have estradiol receptors.","correct":true,"justification":"Meningiomas have estradiol receptors. Their discovery should stop all hormonal contraception, THM or cyproterone acetate treatment."},{"idx":2,"proposition":"Tobacco is a risk factor for primary brain tumours.","correct":false,"justification":"False: no absolute proof"},{"idx":3,"proposition":"In front of a glial tumor, it is necessary to look for certain molecular abnormalities for diagnostic and prognostic purposes.","correct":true,"justification":"True: \r\n-mutation IDH1 and IDH2 \r\n- codeletion 1P19Q\r\n-MGMT methylation (better prognosis and sensitivity to temozolomide)"},{"idx":4,"proposition":"In front of a medulloblastoma, we look for a SHH mutation","correct":true,"justification":"True: Prognostic and theranostic value (introduction of SHH inhibitors)"}],"type":"custom"}
+{"_id":"KcSNC-onco-16","context":null,"enonce":"Which of the following are true?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"In adults, the most common primary brain tumors are gliomas.","correct":true,"justification":"True: gliomas in 42% of cases then meningiomas in 32%"},{"idx":1,"proposition":"Meningiomas are more common in women.","correct":true},{"idx":2,"proposition":"Primary CNS tumors account for 10% of cancers","correct":false,"justification":"False, 1%"},{"idx":3,"proposition":"In adults, the most common brain tumors are gliomas.","correct":false,"justification":"False, these are metastases."},{"idx":4,"proposition":"CNS metastases are thought to affect at least 20% of cancers.","correct":true}],"type":"custom"}
+{"_id":"KcSNC-onco-17","context":null,"enonce":"Regarding the treatment of brain tumors, which proposals are accurate? ","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"In medulloblastomas, prophylactic craniospinal irradiation is performed in addition to irradiation of the tumor area.","correct":true,"justification":"True: because frequent intra-neuraxic metastases."},{"idx":1,"proposition":"Stereotactic radiation therapy can be performed on brain metastases","correct":true,"justification":"True: if small lesions circumscribed < 3 cm"},{"idx":2,"proposition":"Treatment of glioblastomas relies on chemotherapy alone","correct":false,"justification":"False: Surgical resection followed by radiotherapy and chemotherapy with TEMOZOLOMIDE"},{"idx":3,"proposition":"Treatment of meningioma is based on radiotherapy and chemotherapy.","correct":false,"justification":"False: no chemotherapy in meningioma, it is a benign tumor. Treatment is based on surgical resection or radiotherapy if not operable."},{"idx":4,"proposition":"Radiation therapy of the brain in toto may be recommended in young patients with primary cerebral lymphoma.","correct":true,"justification":"True: primary cerebral lymphomas are chemo and radiosensitive > chemotherapy with methotrexate and consolidation by radiotherapy of the brain in toto or intensification of chemo with HSC transplantation."}],"type":"custom"}
+{"_id":"KcSNC-onco-19","context":null,"enonce":"Regarding intracranial hypertension syndrome, which proposals are true?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"ICH headaches occur at the end of the day.","correct":false,"justification":"False: morning headache or second part night"},{"idx":1,"proposition":"Vomiting usually relieves headaches. ","correct":true},{"idx":2,"proposition":"There is classically an attack of the IV which has no localizing value. ","correct":false,"justification":"False: Reaching VI"},{"idx":3,"proposition":"In front of any ICH linked to a CNS tumor, it is essential to introduce high-dose corticosteroids. ","correct":false,"justification":"False: corticosteroids are formally contraindicated in case of primary CNS lymphoma (risk of negativation of the histo diagnosis)"},{"idx":4,"proposition":"In front of an HTIC, it is necessary to perform a lumbar puncture in first line in order to search for the etiology.","correct":false,"justification":"False: Never in first intention! Always perform brain imaging before to rule out an expansive process or hydrocephalus (otherwise risk of commitment)"}],"type":"custom"}
+{"_id":"KcSNC-onco-20","context":null,"enonce":"Regarding pilocytic astrocytoma, which proposals are accurate?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"It is a low-grade glioma ","correct":true,"justification":"It is a low-grade glioma (grade I astrocytoma)"},{"idx":1,"proposition":"This tumor usually occurs around 50-60 years of age. ","correct":false,"justification":"False: pilocytic astrocytoma occurs in young adults. These are grade III and IV gliomas that occur around 50-60 years of age."},{"idx":2,"proposition":"It can be associated with phacomatoses. ","correct":true,"justification":"True: associated with NF1 or Von Recklinghausen disease"},{"idx":3,"proposition":"These are well-circumscribed tumors, hypodense in CT, hyperintense in T2 MRI, taking the contrast and having a cystic component.","correct":true},{"idx":4,"proposition":"Treatment is mainly based on surgery.","correct":true,"justification":"True, if not operable and progressive, it is possible to offer radiotherapy or chemotherapy."}],"type":"custom"}
+{"_id":"KcSNC-onco-21","context":null,"enonce":"Regarding carcinomatous meningitis, what are the exact proposals? ","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"It results from the extension of a primary brain tumor to the subarachnoid spaces or the metastatic invasion of a systemic cancer","correct":true},{"idx":1,"proposition":"The diagnosis should be evoked in the face of any neurological symptoms in a patient with cancer","correct":true},{"idx":2,"proposition":"In imaging, there is abnormal meningeal or periventricular contrast taking","correct":true},{"idx":3,"proposition":"Meningeal stiffness is the main symptom","correct":false,"justification":"Meningeal stiffness is very rare in this type of meningitis."},{"idx":4,"proposition":"Lumbar puncture can be used to make the diagnosis ","correct":true,"justification":"True: the diagnosis can be made on imaging in case of typical image and\/or on PL if cancer cells"}],"type":"custom"}
+{"_id":"IRespA-urg-0","context":null,"enonce":"Regarding acute respiratory failure","item":"IRespA","matiere":"urg","propositions":[{"idx":0,"proposition":"Acute respiratory failure (AKI) is defined as the inability of a patient to maintain normal haematosis","correct":true},{"idx":1,"proposition":"• The haematosis disorder is accompanied by changes in blood gases with hypoxemia (defined as PaO2 < 90 mmHg), which may or may not be associated with hypercapnia (PaCO2 < 45 mmHg)","correct":false},{"idx":2,"proposition":"• Hypercapnia is not systematic, it may be absent or replaced by hypocapnia depending on the etiology of the AKI","correct":true},{"idx":3,"proposition":"• The appearance of signs of acute respiratory distress indicates the severity of a respiratory condition","correct":true},{"idx":4,"proposition":"An AKI is related to either the failure of the hematosis, or the failure of the acid-base balance function of the lung","correct":true}],"type":"custom"}
+{"_id":"IRespA-urg-1","context":null,"enonce":"Regarding acute respiratory insufficiency","item":"IRespA","matiere":"urg","propositions":[{"idx":0,"proposition":"Any situation causing fatigue of the respiratory muscles via an increase in ventilatory work can be a source of acute respiratory failure","correct":true},{"idx":1,"proposition":"Intrathoracic distension (\"trapping\" phenomenon in chronic respiratory failure) decreases the contraction of the diaphragm by flattening effect","correct":true},{"idx":2,"proposition":"Plasma pH varies between 7.36 and 7.42 at rest","correct":false,"justification":"Plasma pH varies between 7.38 and 7.42 at rest"},{"idx":3,"proposition":"Any pH value below 7.32 indicates the existence of associated metabolic acidosis","correct":false,"justification":"Any pH value below 7.30 indicates the existence of associated metabolic acidosis"},{"idx":4,"proposition":"Aggravaction of disorders of consciousness is an indcation to orotracheal intubation","correct":true}],"type":"custom"}
+{"_id":"IRespA-urg-2","context":null,"enonce":"Regarding acute respiratory insufficiency","item":"IRespA","matiere":"urg","propositions":[{"idx":0,"proposition":"Severe hypoxemia assessed by PaO2\/FiO2 ratio in mmHg","correct":true},{"idx":1,"proposition":"Minimal ARDS: PaO2\/FiO2 between 200 and 300 with PEEP or CPAP ≥ 5 cmH2O","correct":true},{"idx":2,"proposition":"An average ARDS PaO2\/FiO2 between 200 and 300 with PEEP or CPAP ≥ 5 cmH2O","correct":false},{"idx":3,"proposition":"3\/4SDRA severe: PaO2\/FiO2 ≤ 100 with PEEP ≥ 5 cmH2O","correct":true},{"idx":4,"proposition":"Average ARDS: PaO2\/FiO2 between 100 and 200 with PEEP ≥ 5 cmH2O","correct":true}],"type":"custom"}
+{"_id":"IRespA-urg-3","context":null,"enonce":"Which of the following proposals are additional examinations to be carried out urgently in the event of electrification?","item":"IRespA","matiere":"urg","propositions":[{"idx":0,"proposition":"ECG","correct":true},{"idx":1,"proposition":"Brain scan","correct":false,"justification":"False"},{"idx":2,"proposition":"Troponin","correct":true},{"idx":3,"proposition":"CPK","correct":true},{"idx":4,"proposition":"Urea","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"IRespA-urg-4","context":null,"enonce":"Which of the following are systematic reviews of paraclinical assessment in acute respiratory failure?","item":"IRespA","matiere":"urg","propositions":[{"idx":0,"proposition":"Chest X-ray","correct":true},{"idx":1,"proposition":"Blood gas","correct":true},{"idx":2,"proposition":"Cervical CT","correct":false,"justification":"False, only in case of obstruction of the VAS"},{"idx":3,"proposition":"Bronchial fibroscopy","correct":false,"justification":"False, not systematic"},{"idx":4,"proposition":"ECG","correct":true}],"type":"custom"}
+{"_id":"IRespA-urg-5","context":null,"enonce":"Which of the following are mechanisms involved in hypoxemia where the alveolo-arterial gradient for oxygen is normal?","item":"IRespA","matiere":"urg","propositions":[{"idx":0,"proposition":"Reduction of PiO2","correct":true},{"idx":1,"proposition":"True right-left shunt","correct":false,"justification":"False, increases the alveolo-arterial gradient for oxygen"},{"idx":2,"proposition":"Shunt effect","correct":false,"justification":"False, increases the alveolo-arterial gradient for oxygen"},{"idx":3,"proposition":"Diffusion disorder","correct":false,"justification":"False, increases the alveolo-arterial gradient for oxygen"},{"idx":4,"proposition":"Alveolar hypoventilation","correct":true}],"type":"custom"}
+{"_id":"jamberouge-urg-0","context":null,"enonce":"Which of these proposals is\/are erysipelas risk factors?","item":"jamberouge","matiere":"urg","propositions":[{"idx":0,"proposition":"A BMI below 21","correct":false,"justification":"Obesity is a risk factor"},{"idx":1,"proposition":"A BMI below 17","correct":false},{"idx":2,"proposition":"High blood pressure","correct":false},{"idx":3,"proposition":"An ulcer of the lower limbs","correct":true},{"idx":4,"proposition":"Kidney failure","correct":false}],"type":"custom"}
+{"_id":"jamberouge-urg-2","context":null,"enonce":"Regarding erisypela:","item":"jamberouge","matiere":"urg","propositions":[{"idx":0,"proposition":"First-line antibiotic therapy combines a penicilinase inhibitor","correct":false,"justification":"The erisypel is classically Streptococcus A. The first-line antibiotic is amoxicillin, without clavulanic acid"},{"idx":1,"proposition":"It is a dermo-hypodermatitis","correct":true},{"idx":2,"proposition":"It is caused by bacterial germs","correct":true},{"idx":3,"proposition":"She is usually non-febrile","correct":false,"justification":"She is feverish most often"},{"idx":4,"proposition":"It is necrotizing","correct":false,"justification":"It is non-necrotizing"}],"type":"custom"}
+{"_id":"jamberouge-urg-3","context":null,"enonce":"Regarding fasciitis:","item":"jamberouge","matiere":"urg","propositions":[{"idx":0,"proposition":"It is necrotizing","correct":true,"justification":"Indeed, its full name is \"necrotizing fasciitis\""},{"idx":1,"proposition":"There are no general signs","correct":false,"justification":"General signs are marked as well as infectious signs."},{"idx":2,"proposition":"The notion of animal bite must point towards a pasteurellosis of inoculation.","correct":true},{"idx":3,"proposition":"It is due to an allergy","correct":false,"justification":"It is an infectious pathology"},{"idx":4,"proposition":"It may be accompanied by a DIC.","correct":true}],"type":"custom"}
+{"_id":"jamberouge-urg-4","context":null,"enonce":"Which of these propositions are true about eczema?","item":"jamberouge","matiere":"urg","propositions":[{"idx":0,"proposition":"Its treatment is based on mid-dose antibiotic therapy","correct":false,"justification":"It is based on the eviction of the supposed allergen"},{"idx":1,"proposition":"The use of local corticosteroids leads to rapid improvement.","correct":true},{"idx":2,"proposition":"It is an immuno-allergic dermatosis due to hypersensitivity to a contact allergen.","correct":true},{"idx":3,"proposition":"Pruritus points to another diagnosis","correct":false,"justification":"The picture is clinically characterized by pruritus, the presence of vesicles on an inflammatory basis and crumbled border. It is usually located in the region of contact with the allergen."},{"idx":4,"proposition":"It can be concomitant with a leg ulcer","correct":true,"justification":"The mechanism is then unknown"}],"type":"custom"}
+{"_id":"malaise-urg-0","context":null,"enonce":"Which of the following are characteristic of syncope?","item":"malaise","matiere":"urg","propositions":[{"idx":0,"proposition":"Bite of the tip of the tongue","correct":true},{"idx":1,"proposition":"Quick start","correct":true},{"idx":2,"proposition":"Long duration","correct":false,"justification":"Short duration"},{"idx":3,"proposition":"It is due to global and transient cerebral hypoperfusion","correct":true},{"idx":4,"proposition":"Spontaneously resolutive","correct":true}],"type":"custom"}
+{"_id":"malaise-urg-1","context":null,"enonce":"Which of the following are true?","item":"malaise","matiere":"urg","propositions":[{"idx":0,"proposition":"Discomfort is a subjective feeling of malaise","correct":true},{"idx":1,"proposition":"Syncope is a loss of consciousness","correct":true},{"idx":2,"proposition":"Lipothymia is a decrease in postural tone without loss of consciousness","correct":true},{"idx":3,"proposition":"Syncope is a subjective feeling of malaise","correct":false,"justification":"False"},{"idx":4,"proposition":"Lipothymia is a loss of consciousness","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-0","context":null,"enonce":"Regarding interrogatory:","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Diagnosis of brutal BAV based on interrogation","correct":true},{"idx":1,"proposition":"The sensation of \"flying flies\" is myodesopsia","correct":true},{"idx":2,"proposition":"The speed of installation has little semiological value","correct":false,"justification":"Its speed of installation is fundamental in the diagnostic algorithm"},{"idx":3,"proposition":"Vision abnormalities never have associated pain","correct":false,"justification":"If. The interrogation specifies the presence or absence of associated pain and its type"},{"idx":4,"proposition":"Deep pain may radiate into the trigeminal territory","correct":true}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-1","context":null,"enonce":"Regarding interrogation and examination:","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Superficial pain suggests acute glaucoma","correct":false,"justification":"These are deep pains"},{"idx":1,"proposition":"'True' headaches suggest a neuro-ophthalmological cause","correct":true},{"idx":2,"proposition":"Ocular trauma can have an impact on eyesight but only if it is major","correct":false,"justification":"even minimal"},{"idx":3,"proposition":"Ophthalmological examination concerns only the pathological eye","correct":false,"justification":"It includes both eyes"},{"idx":4,"proposition":"Measurement of visual acuity from far and near is done without optical correction","correct":false,"justification":"With optical correction if necessary"}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-2","context":null,"enonce":"Regarding the ophthalmological examination:","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"pupillary reactivity is systematic","correct":true},{"idx":1,"proposition":"examination of the anterior segment includes vitreous and lens","correct":false,"justification":"examination of the anterior segment: cornea, anterior and crystalline chamber"},{"idx":2,"proposition":"Eye tone measurement is only done in rare cases","correct":false,"justification":"The measurement of eye tone is systematic"},{"idx":3,"proposition":"The examination of the fundus after pupillary dilation makes it possible to visualize the cornea","correct":false,"justification":"examination of the fundus after pupillary dilation: optic nerve, retinal vessels, retina"},{"idx":4,"proposition":"Complementary examinations such as OCT have become systematic","correct":false,"justification":"Additional examinations are not systematic and are guided by questioning and clinical examination:"}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-3","context":null,"enonce":"Regarding pathologies:","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"In acute keratitis, decreased visual acuity is accompanied by significant superficial pain","correct":true},{"idx":1,"proposition":"Fluids are clear and transparent in acute keratitis","correct":false,"justification":"There is a decrease in transparency of the cornea, a perikeratic circle and one or more corneal ulcerations"},{"idx":2,"proposition":"Acute angle-closure glaucoma is painless in most cases","correct":false,"justification":"Acute angle closure glaucoma: The pain is deep, intense, ocular and periocular radiating into the trigeminal territory"},{"idx":3,"proposition":"Often nausea or vomiting occurs in acute angle-closure glaucoma","correct":true},{"idx":4,"proposition":"The anterior chamber is narrow in acute keratitis","correct":false,"justification":"The anterior chamber is narrow in acute glaucoma by closure of the angle"}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-4","context":null,"enonce":"Regarding pathologies:","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"There is a major elevation of eye tone in acute glaucoma by angle closure","correct":true},{"idx":1,"proposition":"The decrease in visual acuity is most often minimal in acute glaucoma by closure of the angle","correct":false,"justification":"The decrease in visual acuity depends on corneal edema related to hypertonia and retinal perfusion, it is often significant"},{"idx":2,"proposition":"Acute anterior uveitis is iridocyclitis","correct":true},{"idx":3,"proposition":"Decreased visual acuity and pain is common in iridocyclitis","correct":true},{"idx":4,"proposition":"A perikeratic circle eliminates the diagnosis of acute anterior uveitis","correct":false,"justification":"A perikeratic circle may well appear"}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-5","context":null,"enonce":"Regarding uveitis:","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"A pupil in miosis by iridocrystalline synechiae is a sign of iridocyclitis","correct":true},{"idx":1,"proposition":"Tyndall's phenomenon is pathognomonic of posterior uveitis","correct":false,"justification":"It is in acute anterior uveitis that slit lamp examination reveals the presence of inflammatory cells in the anterior chamber (Tyndall's phenomenon), possibly with retrocorneal precipitates and iridocrystalline synechiae"},{"idx":2,"proposition":"The most common cause of choroiditis is ocular toxoplasmosis.","correct":true},{"idx":3,"proposition":"Posterior uveitis is responsible for recurrent retinochoroiditis","correct":true},{"idx":4,"proposition":"Retinitis is manifested by myodesopsias","correct":true}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-6","context":null,"enonce":"Concerning ocular pathologies:","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Treatment of ocular toxoplasmosis based on antibacterials","correct":false,"justification":"Treatment is based on the antiparasitic drugs – pyrimethamine (Malocide®) and sulfadiazine (Adiazine®) – prescribed if there is a threat to visual acuity"},{"idx":1,"proposition":"Neovascular glaucoma is seen in unbalanced diabetes","correct":true},{"idx":2,"proposition":"The postoperative context is suggestive of endophthalmitis","correct":true},{"idx":3,"proposition":"The hypopion has anterior chamber fibrin visible to the slit lamp","correct":true},{"idx":4,"proposition":"B-ultrasound may reveal a retinal tear","correct":true}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-7","context":null,"enonce":"Regarding intravitreal hemorrhages:","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Ultrasound B is contraindicated when the hemorrhage is massive because the retina is then not very visible","correct":false,"justification":"Ultrasound B is anyway always indicated when the retina is not visible to eliminate the presence of retinal detachment (+++)"},{"idx":1,"proposition":"Proliferative diabetic retinopathy is a cause of intravitreal hemorrhage","correct":true},{"idx":2,"proposition":"A retinal tear causes intravitreal hemorrhage only when there is retinal detachment","correct":false,"justification":"Hemorrhage in all cases"},{"idx":3,"proposition":"Terson syndrome is a genetic condition affecting chromosome 6 that increases the risk of intravitreous hemorrhage and subarachnoid hemorrhage.","correct":false,"justification":"Terson syndrome: unior bilateral intravitreal hemorrhage associated with subarachnoid hemorrhage due to intracranial aneurysm rupture (Terson syndrome may also be associated with traumatic subarachnoid hemorrhage)"},{"idx":4,"proposition":"Intermediate uveitis is a subgroup of uveitis where the vitreous is the main site of inflammation","correct":true}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-8","context":null,"enonce":"Which propositions are true?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Phosphenes are flashes of light","correct":true},{"idx":1,"proposition":"Metamorphopsies concern patients with color blindness ","correct":false,"justification":"Image distortion"},{"idx":2,"proposition":"Dyschromatopsias are a distortion of the image","correct":false,"justification":"Achievement of colour vision"},{"idx":3,"proposition":"Diploplolia has a purely central neurological origin","correct":false,"justification":"Can also be peripheral (oculomotor nerves)"}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-9","context":null,"enonce":"Which of these pathologies can cause monocular involvement?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"A stroke","correct":false,"justification":"Rather binocular"},{"idx":1,"proposition":"A vertebrobasillary TIA","correct":false,"justification":"Rather binocular. On the other hand, TIAs by unilateral carotid stenosis can cause monocular involvement."},{"idx":2,"proposition":"CRAOs and CRVOs","correct":true},{"idx":3,"proposition":"The HTIC","correct":true},{"idx":4,"proposition":"Focal seizures","correct":false,"justification":"Rather binocular"}],"type":"custom"}
+{"_id":"preventionnutri-nutri-0","context":null,"enonce":"What are the recommendations in terms of daily calorie intake for adult men?","item":"preventionnutri","matiere":"nutri","propositions":[{"idx":0,"proposition":"1500-1800 calories \/ day","correct":false},{"idx":1,"proposition":"2400-2600 calories \/ day","correct":true},{"idx":2,"proposition":"2200-2400 calories \/ day","correct":false},{"idx":3,"proposition":"1800-2000 calories \/ day","correct":false},{"idx":4,"proposition":"2800-3000 calories \/ day","correct":false}],"type":"custom"}
+{"_id":"preventionnutri-nutri-1","context":null,"enonce":"What are the recommendations in terms of daily calorie intake for adult women?","item":"preventionnutri","matiere":"nutri","propositions":[{"idx":0,"proposition":"1800-2200 calories \/ day","correct":true},{"idx":1,"proposition":"2400-2600 calories \/ day","correct":true},{"idx":2,"proposition":"2200-2400 calories \/ day","correct":false},{"idx":3,"proposition":"1800-2000 calories \/ day","correct":false},{"idx":4,"proposition":"2800-3000 calories \/ day","correct":false}],"type":"custom"}
+{"_id":"preventionnutri-nutri-2","context":null,"enonce":"Which propositions are true?","item":"preventionnutri","matiere":"nutri","propositions":[{"idx":0,"proposition":"A diet that is too salty is a risk factor for high blood pressure","correct":true},{"idx":1,"proposition":"A diet that is too fat is a risk factor for type 2 diabetes","correct":false,"justification":"It is a risk factor for high cholesterol"},{"idx":2,"proposition":"A diet rich in protein promotes colon cancer","correct":true},{"idx":3,"proposition":"A diet that is too sweet is a risk factor for type 2 diabetes","correct":true},{"idx":4,"proposition":"An unbalanced diet is a risk factor for osteoporosis in the elderly","correct":true}],"type":"custom"}
+{"_id":"preventionnutri-nutri-3","context":null,"enonce":"What are the recommended proportions of nutrients in a meal?","item":"preventionnutri","matiere":"nutri","propositions":[{"idx":0,"proposition":"20% carbohydrates","correct":false,"justification":"50% carbohydrates, 30% fat and 20% protein"},{"idx":1,"proposition":"80% protein","correct":false},{"idx":2,"proposition":"30% fat","correct":true},{"idx":3,"proposition":"10% fat","correct":false},{"idx":4,"proposition":"20% protein","correct":true}],"type":"custom"}
+{"_id":"ACR-urg-0","context":null,"enonce":"Concerning the major bases:","item":"ACR","matiere":"urg","propositions":[{"idx":0,"proposition":"Ischemic heart disease is the world's leading cause of death","correct":true},{"idx":1,"proposition":"In Europe, cardiovascular diseases are responsible for about 40% of deaths before the age of 75","correct":true},{"idx":2,"proposition":"Even imperfect CPR is always better than no CPR, even in children","correct":true,"justification":"See College Emergencies and Acute Failures, page 326"},{"idx":3,"proposition":"CPR should be initiated 30 seconds after loss of consciousness, in case the patient wakes up on his own","correct":false,"justification":"CPR should be initiated as early as possible and continued with the minimum of interruption by the first witness(ies) pending the arrival of specialized assistance"},{"idx":4,"proposition":"Any victim who is unconscious, not breathing or breathing abnormally, should be considered in CA","correct":true}],"type":"custom"}
+{"_id":"ACR-urg-1","context":null,"enonce":"Regarding cardiopulmonary resuscitation and circulatory arrest:","item":"ACR","matiere":"urg","propositions":[{"idx":0,"proposition":"The presence of agonic \"gasps\" at a frequency of 5-6\/min can be misinterpreted as ventilatory movements","correct":true},{"idx":1,"proposition":"Taking the pulse at the carotid level is the most reliable method to confirm the absence of circulation","correct":false,"justification":"Taking the pulse (at the carotid level or any other site) is an unreliable method to confirm the absence of circulation, even for healthcare professionals, and is therefore no longer recommended for diagnosing CA."},{"idx":2,"proposition":"There is no specific recommendation on the content or form of the alert to be given to the emergency services","correct":true},{"idx":3,"proposition":"In adults, the origin of CA is most often cardiac","correct":true},{"idx":4,"proposition":"The recommended optimal technique for chest compressions requires a frequency of at least 180\/min","correct":false,"justification":"The recommended optimal technique for chest compressions requires a frequency of at least 100\/min, with an amplitude of compressions of at least 5 cm in adults (not exceeding 6 cm), or at least one third of the anteroposterior diameter of the chest in infants and children"}],"type":"custom"}
+{"_id":"ACR-urg-2","context":null,"enonce":"Which propositions are true?","item":"ACR","matiere":"urg","propositions":[{"idx":0,"proposition":"The number of chest compressions per minute during CPR is an important determinant of return to spontaneous circulatory activity (RACS) and survival without sequelae","correct":true},{"idx":1,"proposition":"Total chest relaxation after each compression must be ensured with an equal time between compression and relaxation","correct":true},{"idx":2,"proposition":"CPR plus mechanical ventilation is much more effective than CPR with chest compressions alone in the first 5 minutes","correct":false,"justification":"CPR by chest compressions alone is as eective as CPR plus artificial ventilation in the first minutes after the onset of non-traumatic and non-asphyxia CA in adults"},{"idx":3,"proposition":"Numerous and serious cases of transmission of viral diseases such as HIV have been reported during artificial ventilation, which requires the use of protective devices.","correct":false,"justification":"Very few cases have been reported. The use of simple protective devices can reduce the transmission of diseases, but in practice it is only recommended if the victim is known to be carrying a serious infection."},{"idx":4,"proposition":"VF is the most common etiology among non-traumatic CA etiologies","correct":true}],"type":"custom"}
+{"_id":"ACR-urg-3","context":null,"enonce":"For CPR and specialized pulmonary CPR:","item":"ACR","matiere":"urg","propositions":[{"idx":0,"proposition":"CPR takes priority over defibrillation","correct":false,"justification":"Priority to defibrillation over CPR is confirmed"},{"idx":1,"proposition":"In hospitals, oxygen should be given as early as possible during CPR","correct":true},{"idx":2,"proposition":"Tracheal intubation is the gold standard technique for airway control","correct":true},{"idx":3,"proposition":"Pulmonary resuscitation is useless in hospital since a defibrillator is always present","correct":false,"justification":"You have to control the airway in less than 10 seconds"},{"idx":4,"proposition":"Once tracheal intubation is performed, chest compressions are continued continuously at a frequency of 100\/minute, regardless of insuations which are performed at a frequency of 10\/minute","correct":true}],"type":"custom"}
+{"_id":"ACR-urg-4","context":null,"enonce":"Regarding specialized cardiovascular resuscitation:","item":"ACR","matiere":"urg","propositions":[{"idx":0,"proposition":"Sternal punching should no longer be used to treat out-of-hospital KT","correct":true},{"idx":1,"proposition":"Sternal punching may be considered in a patient with atrial CA fibrillation","correct":false,"justification":"It may be considered in a patient with unstable ventricular tachycardia (TV) (including pulseless TV), occurring under the supervision of a specialized first aider, only if a defibrillator cannot be used immediately"},{"idx":2,"proposition":"Standard CPR allows coronary and cerebral perfusion equal to 100% of its physiological value","correct":false,"justification":"At best, standard CPR allows coronary and cerebral perfusion equal to 30% of its physiological value"},{"idx":3,"proposition":"The small-axis parasternal window is the one recommended in ETT to identify a reversible cause of CA","correct":false,"justification":"However, the performance of an ETT should not result in a prolonged interruption of the CPR, and the subcostal window, which seems to best meet this requirement, is the one recommended."},{"idx":4,"proposition":"The recommended position for the electrodes is anterolateral, with a subclavicular electrode","correct":true}],"type":"custom"}
+{"_id":"ACR-urg-5","context":null,"enonce":"Which of the following proposals are shockable rhythms?","item":"ACR","matiere":"urg","propositions":[{"idx":0,"proposition":"Asystole","correct":false,"justification":"False"},{"idx":1,"proposition":"Electromechanical dissociation","correct":false,"justification":"False"},{"idx":2,"proposition":"Ventricular fibrillation","correct":true},{"idx":3,"proposition":"Torsade de pointe","correct":true},{"idx":4,"proposition":"Ventricular tachycardia without pulse","correct":true}],"type":"custom"}
+{"_id":"ACR-urg-6","context":null,"enonce":"Which of the following proposals are shockable rhythms?","item":"ACR","matiere":"urg","propositions":[{"idx":0,"proposition":"Asystole","correct":false,"justification":"False"},{"idx":1,"proposition":"Electromechanical dissociation","correct":false,"justification":"False"},{"idx":2,"proposition":"Ventricular fibrillation","correct":true},{"idx":3,"proposition":"Torsade de pointe","correct":true},{"idx":4,"proposition":"Ventricular tachycardia without pulse","correct":true}],"type":"custom"}
+{"_id":"soinspal2-soinspal-0","context":null,"enonce":"Which of the following propositions are true about the person of trust?","item":"soinspal2","matiere":"soinspal","propositions":[{"idx":0,"proposition":"It is necessarily part of the family","correct":false,"justification":"Anyone around you can take on this role."},{"idx":1,"proposition":"It has veto power over medical decisions","correct":false,"justification":"His role is to be consulted by the medical team if the patient is no longer able to clearly express his will"},{"idx":2,"proposition":"Its designation is not mandatory","correct":true},{"idx":3,"proposition":"It is consulted when the patient is no longer able to clearly express his will","correct":true},{"idx":4,"proposition":"None of these propositions are true","correct":false,"justification":"None"}],"type":"custom"}
+{"_id":"soinspal2-soinspal-1","context":null,"enonce":"Which of the following are true?","item":"soinspal2","matiere":"soinspal","propositions":[{"idx":0,"proposition":"Palliative care is multidisciplinary","correct":true},{"idx":1,"proposition":"Palliative care is only for the sick patient","correct":false,"justification":"To the patient and all loved ones who need it"},{"idx":2,"proposition":"Palliative care is mandatory for patients at the end of life","correct":false,"justification":"They are proposed according to the context"},{"idx":3,"proposition":"Palliative care is contraindicated in children","correct":false,"justification":"No age-related contraindications"},{"idx":4,"proposition":"Palliative care can only be introduced with the patient's consent when possible","correct":true}],"type":"custom"}
+{"_id":"hemorroides-HGE-1","context":null,"enonce":"Regarding hemorrhoidal disease","item":"hemorroides","matiere":"HGE","propositions":[{"idx":0,"proposition":"Thus, the presence of bleeding during defecation is an alarm sign requiring a colorectal screening exploration","correct":true},{"idx":1,"proposition":"The treatment of hemorrhoidial thrombosis is based on the simple incision or excision of the thrombosed area that immediately relieves the patient when the patient is seen in the rapid aftermath of the constitution of the thrombosis","correct":true},{"idx":2,"proposition":"Hemorrhoid hemorrhages result in the emission of gleaming red blood in the immediate course of a defecatory episode usually mixed with the materials","correct":false,"justification":"Hemorrhoid hemorrhages They result in the emission of gleaming red blood in the immediate course of a defecatory episode usually not mixed with the materials"},{"idx":3,"proposition":"The presence of a permanent perianal swelling may be sequelale (marisque) but must evoke a benign associated condition (fistula, abscess) cancer","correct":true},{"idx":4,"proposition":"A manually reducible externalized procidence represents grade 3 hemorrhoids","correct":true}],"type":"custom"}
+{"_id":"hemorroides-HGE-2","context":null,"enonce":"Regarding hemorrhoidal disease","item":"hemorroides","matiere":"HGE","propositions":[{"idx":0,"proposition":"The diagnosis of hemorrhoidal disease is based solely on the data of the interrogation and clinical examination","correct":true},{"idx":1,"proposition":"In case of isolated bleeding, the hemorrhoidal origin can be affirmed after ensuring that there is no other colo-rectal cause for the described bleeding (colonic endoscopy)","correct":true},{"idx":2,"proposition":"Drug treatment relies on antibiotics, transit retarders and local topicals","correct":false,"justification":"Drug treatment is based on hygiene-dietary rules, control of transit disorders and local topicals"},{"idx":3,"proposition":"Endoscopic techniques are reserved for patients suffering regularly from procidence or bleeding related to medium-sized hemorrhoids","correct":true},{"idx":4,"proposition":"The instrumental method that seems to offer the best benefit\/risk ratio today is the elastic ligation.","correct":true}],"type":"custom"}
+{"_id":"hemorroides-HGE-3","context":null,"enonce":"Regarding hemorrhoidal disease","item":"hemorroides","matiere":"HGE","propositions":[{"idx":0,"proposition":"Traditional surgical treatment of hemorrhoidal disease is based on excision and\/or pedicle resection of vascular tissue and support of hemorrhoidal plexuses","correct":true},{"idx":1,"proposition":"Surgical treatment is usually offered after instrumental treatments have failed or because the anatomical disease is too severe.","correct":true},{"idx":2,"proposition":"Anoscopy should be done in all patients with hemorrhoidal symptomatology","correct":true},{"idx":3,"proposition":"The hemorrhoidal symptomatology remains very specific","correct":false},{"idx":4,"proposition":"The patient should be informed of the deleterious effects of long-term surgery as continence disorders.","correct":true}],"type":"custom"}
+{"_id":"hemorroides-HGE-4","context":null,"enonce":"Which of the following are true about hemorrhoids?","item":"hemorroides","matiere":"HGE","propositions":[{"idx":0,"proposition":"Treatment concerns only symptomatic forms","correct":true,"justification":"Non-symptomatic hemorrhoids are not treated +++"},{"idx":1,"proposition":"Treatment is based on surgery","correct":false,"justification":"Hygyieno-dietary rules and endoscopic gestures (elastic ligation, photocoagulations, etc.). Surgery is really a last resort"},{"idx":2,"proposition":"An anoscopy should be done in any patient with hemorrhoidal symptomatology","correct":true,"justification":"And it's not very pleasant"},{"idx":3,"proposition":"The risk of recurrence after surgery is zero","correct":false},{"idx":4,"proposition":"Surgery can induce continence disorders","correct":true}],"type":"custom"}
+{"_id":"cephalee-neuro-1","context":null,"enonce":"Regarding headaches and neuralgia:","item":"cephalee","matiere":"neuro","propositions":[{"idx":0,"proposition":"Headaches perceived by the patient as recent and unusual (\"acute\") are by definition essential headaches","correct":false,"justification":"These are secondary headaches until proven otherwise and require emergency examinations"},{"idx":1,"proposition":"Headaches recognized by the patient as old and usual (\"chronic\") are usually primary headaches and are managed without urgency.","correct":true},{"idx":2,"proposition":"Headaches can never be permanent","correct":false,"justification":"They can be paroxysmal (seizures) or permanent"},{"idx":3,"proposition":"Any recent change in an old and usual headache leads to suspicion of a secondary headache","correct":true},{"idx":4,"proposition":"Meningeal syndrome and intracranial hypertension syndrome are life-threatening emergencies","correct":true}],"type":"custom"}
+{"_id":"cephalee-neuro-2","context":null,"enonce":"Concerning additional examinations of headaches and neuralgia:","item":"cephalee","matiere":"neuro","propositions":[{"idx":0,"proposition":"Any recent and unusual headache should be considered secondary until proven otherwise.","correct":true},{"idx":1,"proposition":"In front of a first episode, the key examinations are brain imaging (CT and\/or MRI), cerebral and\/or cervical angiography (CT angiography, MRI-angiography) and lumbar puncture","correct":true},{"idx":2,"proposition":"In front of a first episode, the brain scan without injection looks for spontaneous hyperdensity (presence of blood)","correct":true},{"idx":3,"proposition":"Sections on the sinuses look for ethmoiditis","correct":true,"justification":"Ethmoiditis is technically sinusitis (but not the most common)"},{"idx":4,"proposition":"A CT scan without normal injection eliminates a cause of injury","correct":false,"justification":"A CT scan without normal injection does not rule out a lesional cause: CT scan is normal in 7% of subarachnoid hemorrhages after 24 hours, 30% of cerebral venous thrombosis, in almost all cervical artery dissections at the stage of local signs and in almost all meningitis"}],"type":"custom"}
+{"_id":"cephalee-neuro-3","context":null,"enonce":"Concerning additional examinations of headaches and neuralgia:","item":"cephalee","matiere":"neuro","propositions":[{"idx":0,"proposition":"Brain MRI is more sensitive than CT scan for all parenchymal or pituitary lesions","correct":true},{"idx":1,"proposition":"T2 FLAIR coronal cervical MRI sections are needed to look for arterial dissection","correct":false,"justification":"Axial cervical MRI (T1 FAT-SAT) sections are needed to look for arterial dissection"},{"idx":2,"proposition":"MRI is the most common examination in emergencies","correct":false,"justification":"MRI often remains unavailable in emergency"},{"idx":3,"proposition":"The lumbar puncture does not highlight a hemorrhage","correct":false,"justification":"The lumbar puncture makes it possible to highlight a subarachnoid hemorrhage not visible in imaging (xantochromia) (but also meningitis and to measure the pressure of the cerebrospinal fluid (CSF) in search of intracranial hypertension)"},{"idx":4,"proposition":"PL is to be performed as a first-line treatment in case of suspected meningitis, after eliminating contraindications","correct":true,"justification":"Contraindications include suspicion of commitment or intracranial hypertension, too much blood fluidity"}],"type":"custom"}
+{"_id":"cephalee-neuro-4","context":null,"enonce":"Concerning additional examinations of headaches and neuralgia:","item":"cephalee","matiere":"neuro","propositions":[{"idx":0,"proposition":"There are no contraindications to PL in case of emergency","correct":false,"justification":"Contraindications include local infection at the puncture site, severe hemostasis disorder, signs of intracranial hypertension with threat of engagement pointing to a lesion with mass effect. Imaging is therefore necessary when the lumbar puncture is performed for isolated headaches"},{"idx":1,"proposition":"In case of PL, the use of an atraumatic needle of the smallest possible caliber (25 G) minimizes the risk of headache by dural breach","correct":true},{"idx":2,"proposition":"An inflammatory syndrome can evoke Horton's disease or an infectious syndrome","correct":true},{"idx":3,"proposition":"Ophthalmological examination looks for bilateral papillary edema that is indicative of type 2 diabetes","correct":false,"justification":"Bilateral papillary edema = intracranial hypertension"},{"idx":4,"proposition":"Any sudden headache must suspect a vascular cause and in the first place a serious epistaxis","correct":false,"justification":"Suspect subarachnoid hemorrhage in the first place"}],"type":"custom"}
+{"_id":"cephalee-neuro-5","context":null,"enonce":"Regarding chronic headaches:","item":"cephalee","matiere":"neuro","propositions":[{"idx":0,"proposition":"Tension headaches can last from 30 minutes to 7 days","correct":true},{"idx":1,"proposition":"Cluster headaches can last between 3 and 14 days","correct":false,"justification":"Duration of the order of the hour: between 15 and 180 minutes in general"},{"idx":2,"proposition":"A migraine usually lasts between 4 and 72 hours","correct":true},{"idx":3,"proposition":"Cluster headaches are very intense","correct":true,"justification":"They are also unilateral, periorbital, frontal or temporal."},{"idx":4,"proposition":"During a migraine, the headache is often accompanied by photo-phonophobia and nausea","correct":true,"justification":"Nausea can induce vomiting. In case of migraine with aura, we will also observe transient visual, sensory or language disorders, of progressive and successive installation, preceding or accompanying the headache"}],"type":"custom"}
+{"_id":"cephalee-neuro-6","context":null,"enonce":"Which of these proposals can result in a normal non-injected CT scan?","item":"cephalee","matiere":"neuro","propositions":[{"idx":0,"proposition":"A 6-hour cerebral infarction","correct":false,"justification":"Cerebral infarctions appear on CT scan after 3 hours"},{"idx":1,"proposition":"Pituitary necrosis","correct":true},{"idx":2,"proposition":"Temporal arteritis","correct":true},{"idx":3,"proposition":"Acute sphenoidal sinusitis","correct":false,"justification":"It is seen on a scanner without injection"},{"idx":4,"proposition":"Hypertensive encephalopathies","correct":true}],"type":"custom"}
+{"_id":"cephalee-neuro-7","context":null,"enonce":"Which of these proposals are visible on the non-injected scanner?","item":"cephalee","matiere":"neuro","propositions":[{"idx":0,"proposition":"Intracranial hemorrhage","correct":true,"justification":"Hyperdensity"},{"idx":1,"proposition":"An ischemic stroke dating back 2 hours","correct":false,"justification":"Brain infarctions give signs on CT scan after 3 hours"},{"idx":2,"proposition":"Cerebral venous thrombosis","correct":false},{"idx":3,"proposition":"Acute sinusitis","correct":true,"justification":"Especially sphenoidal sinusitis"},{"idx":4,"proposition":"Dissection of the cervical arteries","correct":false}],"type":"custom"}
+{"_id":"cephalee-neuro-8","context":null,"enonce":"Which propositions are true?","item":"cephalee","matiere":"neuro","propositions":[{"idx":0,"proposition":"Any \"explosive\" headache with normal brain imaging requires a lumbar puncture to look for xanthochromia","correct":true},{"idx":1,"proposition":"An aneurysm-free SAH may correspond to reversible cerebral vasoconstriction syndrome (SVCR)","correct":true},{"idx":2,"proposition":"SAH (or subarachnoid hemorrhage) accounts for 10 to 30% of sudden headaches","correct":true},{"idx":3,"proposition":"Reversible Cerebral Vasoconstriction Syndrome (SVCR) is over-diagnosed","correct":false,"justification":"Underdiagnosed because it is a syndrome of recent description (2007)"},{"idx":4,"proposition":"SVCR accounts for 10 to 45% of \"thunderclap\" headaches","correct":true}],"type":"custom"}
+{"_id":"handicappsy-neuro-0","context":null,"enonce":"Some definitions:","item":"handicappsy","matiere":"neuro","propositions":[{"idx":0,"proposition":"The restriction of participation expresses the impact in social life","correct":true},{"idx":1,"proposition":"The concept of incapacity has given way to the notion of restriction of participation","correct":false,"justification":"Now activity restriction"},{"idx":2,"proposition":"The inability to read is a restriction of participation","correct":false,"justification":"Activity restriction"},{"idx":3,"proposition":"Loss of employment status due to impairment is a restriction of participation","correct":true},{"idx":4,"proposition":"An evaluation that is too difficult that puts the patient in check is useful to show him his limits","correct":false,"justification":"Absolutely useless and counterproductive! Evaluation must be conducted with tact and, above all, must be adapted"}],"type":"custom"}
+{"_id":"handicappsy-neuro-1","context":null,"enonce":"Which of these proposals are restrictions on participation?","item":"handicappsy","matiere":"neuro","propositions":[{"idx":0,"proposition":"The impossibility of dressing","correct":false,"justification":"Activity"},{"idx":1,"proposition":"Dependence for driving","correct":true},{"idx":2,"proposition":"Inability to drive","correct":false,"justification":"It is an activity restriction"},{"idx":3,"proposition":"Changes in family relationships","correct":true},{"idx":4,"proposition":"Loss of professional status","correct":true}],"type":"custom"}
+{"_id":"handicappsy-neuro-3","context":null,"enonce":"Regarding memory:","item":"handicappsy","matiere":"neuro","propositions":[{"idx":0,"proposition":"Declarative memory engages explicit processes","correct":true},{"idx":1,"proposition":"Episodic memory refers to facts and knowledge","correct":false,"justification":"Episodic memory referring to experiences that fit into a spatial context"},{"idx":2,"proposition":"Episodic memory is that of 'where? when? how?'","correct":true},{"idx":3,"proposition":"The memory of a birthday meal that took place with such protagonists will bring procedural memory into play","correct":false,"justification":"Episodic memory"},{"idx":4,"proposition":"Semantic memory refers to facts and knowledge","correct":true}],"type":"custom"}
+{"_id":"handicappsy-neuro-4","context":null,"enonce":"Which of these proposals are causes of mental disability?","item":"handicappsy","matiere":"neuro","propositions":[{"idx":0,"proposition":"Fragile X syndrome","correct":true},{"idx":1,"proposition":"Alzheimer 's","correct":false,"justification":"Cognitive disability (cf. College of Psychiatry page 565: mental disabilities are from birth)"},{"idx":2,"proposition":"Autism Spectrum Disorder","correct":true},{"idx":3,"proposition":"Schyzophrenia","correct":false,"justification":"Mental disability: begins in adolescence or adulthood, progressive, possible or even essential drug treatments."},{"idx":4,"proposition":"Down syndrome","correct":true,"justification":"Mental disability: early onset from birth, stable, infrequent medical care"}],"type":"custom"}
+{"_id":"handicappsy-neuro-5","context":null,"enonce":"According to the WHO, an IQ of 58 corresponds to:","item":"handicappsy","matiere":"neuro","propositions":[{"idx":0,"proposition":"A normal IQ","correct":false},{"idx":1,"proposition":"Severe mental retardation","correct":false},{"idx":2,"proposition":"Mild mental retardation","correct":true,"justification":"Mild mental retardation: between 55 and 70 IQ points"},{"idx":3,"proposition":"Moderate mental retardation","correct":false},{"idx":4,"proposition":"Severe mental retardation","correct":false,"justification":"Severe mental retardation: between 20 and 34 IQ points"}],"type":"custom"}
+{"_id":"handicappsy-neuro-7","context":null,"enonce":"The GEVA is offered by:","item":"handicappsy","matiere":"neuro","propositions":[{"idx":0,"proposition":"The ARS","correct":false,"justification":"The MDPH"},{"idx":1,"proposition":"The MDPH","correct":true},{"idx":2,"proposition":"The CHU","correct":false},{"idx":3,"proposition":"CMPs","correct":false},{"idx":4,"proposition":"Les SMASAH","correct":false}],"type":"custom"}
+{"_id":"LM-onco-0","context":null,"enonce":"From which cell does Reed Stenberg's cell derive?","item":"LM","matiere":"onco","propositions":[{"idx":0,"proposition":"Lymphocyte B","correct":true},{"idx":1,"proposition":"T cell","correct":false},{"idx":2,"proposition":"Lymphocyte NK","correct":false},{"idx":3,"proposition":"Monocyte","correct":false},{"idx":4,"proposition":"Platelet","correct":false,"justification":"Let's remember that a platelet is not a cell. It is a fragment of the Megakaryocyte"}],"type":"custom"}
+{"_id":"LM-onco-1","context":null,"enonce":"A lymph node biopsy in a 26-year-old woman, with no history, who has supradiaphragmatic lymphadenopathy, shows a lymph node architecture modified by broad bands of fibrosis delimiting cell nodules. Binucleolate giant cells of CD20-, CD30+, CD15+ phenotype are identified. \r\n\r\nWhich of the following are true?","item":"LM","matiere":"onco","propositions":[{"idx":0,"proposition":"This description is in favor of the diagnosis of diffuse large cell malignant B-cell lymphoma","correct":false,"justification":"Hodgkin lymphoma (phenotype corresponds to Hodgkin cells and binucleolate giant cells correspond to Reed-Sternberg cells)"},{"idx":1,"proposition":"CD20- phenotype supports T-cell lymphoma ","correct":false,"justification":"CD20- = lymphocyte B"},{"idx":2,"proposition":"Binucleolate giant cells correspond to Sternberg cells","correct":true},{"idx":3,"proposition":"This description is typical of Hodgkin lymphoma of the \"mixed cellularity\" subtype.","correct":false,"justification":"Scleronodular (because clears the lymph node architecture and has wide bands of fibrosis)"},{"idx":4,"proposition":"EBV virus expression can be found in 20% of cases","correct":true,"justification":"True. Caused by EBV in 20% of cases"}],"type":"custom"}
+{"_id":"LM-onco-2","context":null,"enonce":"A PET-CT scan regains intense hyperfixation of right jugulo-carotid lymphadenopathy and an anterior mediastinal mass, without other hypermetabolism.\r\n\r\nWhich of the following is Ann Arbor Stadium?","item":"LM","matiere":"onco","propositions":[{"idx":0,"proposition":"I","correct":false,"justification":"We have more than one area"},{"idx":1,"proposition":"II","correct":true,"justification":"True, 2 lymph node areas affected on the same side of the diaphragm"},{"idx":2,"proposition":"III","correct":false,"justification":"Only one side of the affected diaphragm"},{"idx":3,"proposition":"IV","correct":false,"justification":"Remote SAR"},{"idx":4,"proposition":"Impossible to conclude","correct":false,"justification":"None"}],"type":"custom"}
+{"_id":"LM-onco-4","context":null,"enonce":"Which of the following are characteristics of the Hodgkin cell?","item":"LM","matiere":"onco","propositions":[{"idx":0,"proposition":"CD20+","correct":false,"justification":"CD20-, these are not B lymphocytes"},{"idx":1,"proposition":"CD20-","correct":true},{"idx":2,"proposition":"CD30+","correct":true},{"idx":3,"proposition":"CD15-","correct":false,"justification":"CD15+"},{"idx":4,"proposition":"CD15+","correct":true}],"type":"custom"}
+{"_id":"MM-onco-0","context":null,"enonce":"Regarding renal damage:","item":"MM","matiere":"onco","propositions":[{"idx":0,"proposition":"Renal failure is found in about 50% of symptomatic cases","correct":true},{"idx":1,"proposition":"There is a decrease in endogenous EPO","correct":true},{"idx":2,"proposition":"Anemia is inflammatory","correct":false,"justification":"It is due to a decrease in EPO"},{"idx":3,"proposition":"Fanconi syndrome is a distal tubulopathy","correct":false,"justification":"Fanconi syndrome is proximal tubulopathy"},{"idx":4,"proposition":"NCM is the most common condition","correct":true}],"type":"custom"}
+{"_id":"amenorrhee-gyn-1","context":null,"enonce":"General and definitions:","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"proposition":"A woman may have ovulatory cycles without periods","correct":true,"justification":"For example in case of absence of uterus"},{"idx":1,"proposition":"The presence of menstruation affirms the presence of ovulatory cycles","correct":false,"justification":"It is possible to have anovulatory cycles with menstruation"},{"idx":2,"proposition":"The only physiological circumstance of amenorrhea is menopause","correct":false,"justification":"Also: pregnancy and lactation"},{"idx":3,"proposition":"Primary amenorrhea is defined as the absence of menarche at age 12","correct":false,"justification":"Defined at 16 years"},{"idx":4,"proposition":"Secondary amenorrhea is defined by stopping menstruation for more than 3 months without previous irregularities","correct":true}],"type":"custom"}
+{"_id":"amenorrhee-gyn-2","context":null,"enonce":"Among these proposals, which are signs of accompaniment of primary amenorrhea that must be specified during questioning?","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"proposition":"Irritability","correct":false,"justification":"Not a recognized sign"},{"idx":1,"proposition":"Anosmia","correct":true},{"idx":2,"proposition":"Headache","correct":true},{"idx":3,"proposition":"Fatigue","correct":false,"justification":"Not an interesting sign in this context, although it can orient in specific cases"},{"idx":4,"proposition":"Visual disturbances","correct":true}],"type":"custom"}
+{"_id":"amenorrhee-gyn-3","context":null,"enonce":"Regarding the interrogation in case of primary amenorrhea:","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"proposition":"Infectious pathologies such as meningitis are to be specified during questioning","correct":true,"justification":"Meningitis, tuberculosis, etc."},{"idx":1,"proposition":"A history of appendicitis is important to specify","correct":true,"justification":"Especially so complicated"},{"idx":2,"proposition":"Inguinal hernia cures are not relevant given their location in the iliac fossa","correct":false,"justification":"Very important because can affect the ovaries"},{"idx":3,"proposition":"Corticosteroid therapy can cause primary amenorrhea","correct":true,"justification":"As well as chemotherapy or radiotherapy"},{"idx":4,"proposition":"The interrogation must go back to the circumstances of pregnancy and childbirth","correct":true}],"type":"custom"}
+{"_id":"amenorrhee-gyn-4","context":null,"enonce":"Regarding the gynecological examination:","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"proposition":"Gynecological examination is performed with empty bladder","correct":true},{"idx":1,"proposition":"Inspection of the vulva makes it possible to specify the degree of hair","correct":true,"justification":"As well as the appearance of the labia, the size of the clitoris, etc."},{"idx":2,"proposition":"The appearance of the labia minora and labia majora does not matter","correct":false,"justification":"It is inspected and provides interesting information"},{"idx":3,"proposition":"The classification of pubertal stages is Turner's","correct":false,"justification":"Tanner Stadiums"},{"idx":4,"proposition":"Speculum examination can detect the presence of the uterine tubes","correct":false,"justification":"Vagina + Cervix"}],"type":"custom"}
+{"_id":"amenorrhee-gyn-5","context":null,"enonce":"Among these proposals, which are signs of hyperandrogenism?","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"proposition":"Clitoral hypertrophy","correct":true},{"idx":1,"proposition":"The absence of a vagina","correct":false,"justification":"No direct report"},{"idx":2,"proposition":"Cervical mucus very present","correct":false,"justification":"Sign of estrogenic impregnation"},{"idx":3,"proposition":"Losangic pubic hair","correct":true,"justification":"Especially if it goes down on the thighs"},{"idx":4,"proposition":"Hypertrophy of the vaginal mucosa","correct":false}],"type":"custom"}
+{"_id":"amenorrhee-gyn-7","context":null,"enonce":"Regarding supplementary examinations:","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"proposition":"The first test to order in case of secondary amenorrhea is the LH\/FSH to rule out pituitary adenoma","correct":false,"justification":"This is the plasma assay of βHCG in order to eliminate a pregnancy"},{"idx":1,"proposition":"The objective of the first examinations is to find the exact cause of amenorrhea","correct":false,"justification":"The first objective is to specify the level of amenorrhea, not its exact pathophysiology"},{"idx":2,"proposition":"Menothermic corube is required in all women","correct":false,"justification":"It is performed if secondary sexual characteristics are developed"},{"idx":3,"proposition":"The menothermic curve must be carried out over 1 month","correct":false,"justification":"2 months minimum"},{"idx":4,"proposition":"Ovulation occurs at the highest point of the temperature curve","correct":false,"justification":"Ovulation occurs at the lowest point of the menothermic curve before the temperature rises (thermal shift of about 0.5 °C)"}],"type":"custom"}
+{"_id":"amenorrhee-gyn-8","context":null,"enonce":"Regarding hormonal dosages:","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"proposition":"Radiography of the hand helps define bone age","correct":true,"justification":"It is prescribed in case of impubertism + primary amenorrhea"},{"idx":1,"proposition":"Sesamoid of the thumb appears for a bone age of 16 years","correct":false,"justification":"For a bone age of 13 years"},{"idx":2,"proposition":"Central involvement in low FSH","correct":true},{"idx":3,"proposition":"The involvement is ovarian in case of low FSH and high LH","correct":false,"justification":"The involvement is ovarian in case of elevated FSH"},{"idx":4,"proposition":"After checking the integrity of the genitals, the progestin test is offered as a first-line","correct":true}],"type":"custom"}
+{"_id":"amenorrhee-gyn-9","context":null,"enonce":"Regarding amenorrhea:","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"proposition":"Secondary amenorrhea is much more common than primary amenorrhea","correct":true,"justification":"Especially because of pregnancy"},{"idx":1,"proposition":"The first cause of primary amenorrhea is the impermeable hymen","correct":false,"justification":"It's the simple delay of periods"},{"idx":2,"proposition":"In front of a primary amenorrhea, the first examinations are the assay of FSH and prolactin, in particular","correct":true,"justification":"As well as hand X-ray and pelvic ultrasound"},{"idx":3,"proposition":"In case of secondary amenorrhea, a progestogen test is performed as a first-line","correct":false,"justification":"ATTENTION, we first eliminate a pregnancy"},{"idx":4,"proposition":"Turner syndrome is an important etiology of primary amenorrhea without secondary sex characteristics","correct":true,"justification":"As well as simple pubertal delay"}],"type":"custom"}
+{"_id":"SPSC-sp-0","context":null,"enonce":"Regarding psychiatric care without consent:","item":"SPSC","matiere":"sp","propositions":[{"idx":0,"proposition":"Free care must remain the rule","correct":true,"justification":"And care without consent, the exception"},{"idx":1,"proposition":"There are two distinct constraint procedures","correct":true,"justification":"By decision of the Prefect or at the request of a third party"},{"idx":2,"proposition":"They may be practised by decision of the Prefect.","correct":true},{"idx":3,"proposition":"They can be practiced at the request of a third party (=SDRE)","correct":false,"justification":"SDRE = decision of a state official"},{"idx":4,"proposition":"There are 5 conditions that can motivate them","correct":false,"justification":"2: mental disorders that make consent impossible and a condition requiring immediate care"}],"type":"custom"}
+{"_id":"SPSC-sp-1","context":null,"enonce":"Concerning the admission procedure under ordinary law:","item":"SPSC","matiere":"sp","propositions":[{"idx":0,"proposition":"It requires 2 documents","correct":false,"justification":"3 documents: 2 medical certificates and 1 application for admission from a third party"},{"idx":1,"proposition":"Medical certificates must be made by psychiatrists","correct":false,"justification":"Not necessarily"},{"idx":2,"proposition":"Verification of the patient's identity is carried out by the intake officer","correct":false,"justification":"By the director of the institution prior to any admission of the patient"},{"idx":3,"proposition":"Medical certificates must be less than 15 days old","correct":true},{"idx":4,"proposition":"The third party must be family","correct":false,"justification":"Or if it can justify the existence of relationships with the patient that make him act in his interest"}],"type":"custom"}
+{"_id":"AM-gyn-0","context":null,"enonce":"Regarding the areola:","item":"AM","matiere":"gyn","propositions":[{"idx":0,"proposition":"The pigmented appearance of the areola is strengthened during pregnancy","correct":true},{"idx":1,"proposition":"During pregnancy, the areola loses its sensitivity to tactile stimulation","correct":false,"justification":"It is more sensitive to tactile stimulation"},{"idx":2,"proposition":"During pregnancy, the areola completely loses its thermal sensitivity","correct":false,"justification":"Davatange sensitive to thermal stimulation"},{"idx":3,"proposition":"Montgomery's glands participate in the secretion of an odorous liquid","correct":true},{"idx":4,"proposition":"The odorous liquid is a powerful olfactory landmark for the newborn","correct":true}],"type":"custom"}
+{"_id":"AM-gyn-1","context":null,"enonce":"Regarding the mammary gland:","item":"AM","matiere":"gyn","propositions":[{"idx":0,"proposition":"The areola is a cone in the center of the nipple","correct":false,"justification":"It is of course the opposite: the nipple is a small cone in the center of the areola that contains many smooth muscle fibers and at its top, many pores to release milk"},{"idx":1,"proposition":"The mammary gland is composed of two lobes on the left and three on the right","correct":false,"justification":"Let's not confuse with the lung: the mammary gland consists of about fifteen lobes on the right and left"},{"idx":2,"proposition":"Each lobe behaves like an independent gland with its own excretory duct","correct":true},{"idx":3,"proposition":"The milk ducts have a very sinuous path and open at the top of the nipple through the pores","correct":true},{"idx":4,"proposition":"More than half of the mammary gland is 3 cm from the base of the nipple","correct":true}],"type":"custom"}
+{"_id":"AM-gyn-2","context":null,"enonce":"Which of these proposals are accurate?","item":"AM","matiere":"gyn","propositions":[{"idx":0,"proposition":"Prolactin has a negative lactogenic action","correct":false,"justification":"Prolactin has a positive lactogenic action!"},{"idx":1,"proposition":"Feeding causes elevated prolactin and oxytocin","correct":true},{"idx":2,"proposition":"Breast milk only has a nutritional function for the child","correct":false,"justification":"Breast milk has two main functions: nutritious and immunological"},{"idx":3,"proposition":"Its composition and quantity are constant over time but there is a small interindividual variation","correct":false,"justification":"Its composition and quantity are variable: water and trace elements, high lactose content, low casein but rich in soluble proteins (α-lactoglobulins), etc. Also, there is a modification of content from the 15th day to go towards a higher fat composition"},{"idx":4,"proposition":"The first breastfeedings are composed of 99% lactose","correct":false,"justification":"The first breastfeedings are composed of collostrum, a substance rich in IgA, glycoproteins, oligosaccharides, immune cells and low in fat"}],"type":"custom"}
+{"_id":"AM-gyn-3","context":null,"enonce":"Regarding some generalities:","item":"AM","matiere":"gyn","propositions":[{"idx":0,"proposition":"There is a change from the 15th day in transition milk increasingly rich in fat","correct":true},{"idx":1,"proposition":"Breastfeeding has little effect on immunity","correct":false,"justification":"It brings to the newborn passive immunity against certain infections"},{"idx":2,"proposition":"The composition of milk is common to all mammals and falls within the definition of these","correct":false,"justification":"Milk is a species-specific substance, each with milk of different content"},{"idx":3,"proposition":"Breast milk is translucent and relatively low in vitamin D","correct":true},{"idx":4,"proposition":"Infant formula is obtained by processing beef milk","correct":false,"justification":"Infant formula is obtained by processing cow's milk. The boeur being the male, it does not produce milk"}],"type":"custom"}
+{"_id":"AM-gyn-4","context":null,"enonce":"Among these proposals, which are a contraindication to breastfeeding:","item":"AM","matiere":"gyn","propositions":[{"idx":0,"proposition":"HIV status","correct":true},{"idx":1,"proposition":"Synthetic antithyoids taken by the mother","correct":true},{"idx":2,"proposition":"Type 2 diabetes","correct":false,"justification":"Not a known contraindication"},{"idx":3,"proposition":"Active HBV infection","correct":false},{"idx":4,"proposition":"Latent tuberculosis","correct":false,"justification":"Scalable only\""}],"type":"custom"}
+{"_id":"AM-gyn-5","context":null,"enonce":"Regarding breastfeeding:","item":"AM","matiere":"gyn","propositions":[{"idx":0,"proposition":"Artificial breastfeeding is in every way equivalent to breastfeeding","correct":false,"justification":"Artificial breastfeeding does not have the immunoprotective function of breastfeeding because it is derived from cow's milk while the immunological elements are species-specific."},{"idx":1,"proposition":"Breastfeeding should not begin before 12 p.m. postpartum","correct":false,"justification":"It is advisable to breastfeed immediately, if possible in the labor room"},{"idx":2,"proposition":"It usually takes one feeding every 12 to 24 hours at the beginning","correct":false,"justification":"Far too long! Every 2 to 3 hours at the beginning"},{"idx":3,"proposition":"Prohibiting smoking during breastfeeding is necessary","correct":true},{"idx":4,"proposition":"The only complication of breastfeeding is engorgement","correct":false,"justification":"Congestion and congestion"}],"type":"custom"}
+{"_id":"AM-gyn-6","context":null,"enonce":"Which of the following proposals designate the advantages of growing up milk over cow's milk?","item":"AM","matiere":"gyn","propositions":[{"idx":0,"proposition":"More fatty acids","correct":true},{"idx":1,"proposition":"More vitamin D","correct":true},{"idx":2,"proposition":"More iron","correct":true},{"idx":3,"proposition":"More protein","correct":false,"justification":"Less protein"},{"idx":4,"proposition":"All propositions are true","correct":false,"justification":"Growing up milk has about half as much protein as cow's milk"}],"type":"custom"}
+{"_id":"AM-gyn-7","context":null,"enonce":"Which of the following are the benefits of breastfeeding?","item":"AM","matiere":"gyn","propositions":[{"idx":0,"proposition":"decreases the risk of infection","correct":true},{"idx":1,"proposition":"decreases the risk of obesity","correct":true},{"idx":2,"proposition":"decreases the risk of atopic diseases","correct":true},{"idx":3,"proposition":"It is adapted to the nutritional needs of the newborn","correct":true,"justification":"True, up to the child's 6 months"},{"idx":4,"proposition":"It covers vitamin K needs","correct":false,"justification":"It is deficient in vitamin K. If it is exclusive, vitamin K 2mg PO should be supplemented at 1 month (after routine supplementation at birth)"}],"type":"custom"}
+{"_id":"grossesseN-gyn-0","context":null,"enonce":"Regarding the generalities of pregnancy","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Most pregnancies are normal and can be managed by a doctor or midwife","correct":true},{"idx":1,"proposition":"For these pregnancies without a risk situation or a low level of risk (follow-up A of the HAS), the management is medical and psycho-social with a screening and prevention approach.","correct":true},{"idx":2,"proposition":"Pregnancy monitoring aims to assess the only fetal risk of developing diseases","correct":false,"justification":"Pregnancy monitoring aims throughout pregnancy to assess fetal and maternal risk in order to prevent, screen, diagnose and manage by specialized teams abnormal situations detected"},{"idx":3,"proposition":"Pregnancy monitoring is the responsibility of a medical gynecologist","correct":false,"justification":"Pregnancy monitoring is a team effort that combines: medical and psycho-social problems"},{"idx":4,"proposition":"Pregnancy monitoring requires the collaboration of all specialists involved","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"grossesseN-gyn-1","context":null,"enonce":"Regarding pregnancy monitoring and the choice of maternity:","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Pregnancy monitoring can call on the services of PMI (maternal and child protection), CAF, psychologists, dieticians, etc.","correct":true},{"idx":1,"proposition":"Pregnancy monitoring includes 9 consultations per pregnancy covered 100% by the Health Insurance","correct":false},{"idx":2,"proposition":"There are two consultations per month between the 5th and 7th month normally scheduled","correct":true},{"idx":3,"proposition":"From the 7th month, it is preferable that it is the team that will ensure the birth that does the surveillance","correct":true},{"idx":4,"proposition":"Expectant parents always turn to the maternity wards of their choice","correct":false}],"type":"custom"}
+{"_id":"grossesseN-gyn-2","context":null,"enonce":"Regarding maternity wards in France:","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Level I maternity wards account for 80% of maternity wards","correct":false,"justification":"The three types of maternity are: • Level I maternity wards (49% of maternity wards): − management of low-risk pregnancies"},{"idx":1,"proposition":"Level 1 maternity wards have neonatal units with fewer than 6 beds","correct":false},{"idx":2,"proposition":"Level II maternity wards are intended for high-risk deliveries","correct":true},{"idx":3,"proposition":"Level 2a maternity wards have a neonatal intensive care unit","correct":false,"justification":"these maternity wards have: − a neonatal unit (level II a) (23%)"},{"idx":4,"proposition":"49% of maternity hospitals in France have a neonatal intensive care unit","correct":false}],"type":"custom"}
+{"_id":"grossesseN-gyn-3","context":null,"enonce":"Which of these proposals refer to the objectives of the first pregnancy consultation?","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Making the diagnosis of pregnancy exclusively clinically","correct":false,"justification":"Clinically + Biologically"},{"idx":1,"proposition":"Determine clinical term via ultrasound only","correct":false,"justification":"Clinic + Ultrasound"},{"idx":2,"proposition":"Talking about screening for trismia risk 13","correct":false,"justification":"Down syndrome"},{"idx":3,"proposition":"Inform about early prenatal maintenance","correct":true},{"idx":4,"proposition":"Legally declaring pregnancy","correct":true}],"type":"custom"}
+{"_id":"grossesseN-gyn-5","context":null,"enonce":"Regarding the beginning of pregnancy:","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"23% of maternity hospitals in France are level 3","correct":false},{"idx":1,"proposition":"Level 3 maternity wards have a neonatal resuscitation unit within a CH with an adult resuscitation unit","correct":true},{"idx":2,"proposition":"The first consultation of the pregnancy follow-up must take place in the first month of pregnancy","correct":false,"justification":"The first consultation of the pregnancy follow-up takes place before 3 months of pregnancy (the HAS in its recommendations of 2007 proposes two consultations in the 1st trimester one to 10 SA and one before 15 SA), the Health Insurance reimburses one at 100%"},{"idx":3,"proposition":"The diagnosis of pregnancy is based on the clinic and complementary examinations most often","correct":true},{"idx":4,"proposition":"The vaginal touch shows the increase in volume of the uterus which thickens from front to back giving a spherical shape","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"grossesseN-gyn-6","context":null,"enonce":"Which of these additional tests can be used to diagnose pregnancy?","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"The urine pregnancy test","correct":true},{"idx":1,"proposition":"Ultrasound of the ovaries","correct":false,"justification":"Ultrasound of the uterus. Pregnancy is then visible only from 5 SA and cardiac activity from 5.5 SA on vaginal ultrasound"},{"idx":2,"proposition":"Qualitative bHCG determination","correct":true},{"idx":3,"proposition":"Determination of quantitative bHCG","correct":true},{"idx":4,"proposition":"Vaginal ultrasound","correct":true}],"type":"custom"}
+{"_id":"grossesseN-gyn-7","context":null,"enonce":"Regarding the duration of a normal pregnancy:","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Uterine 'softening' begins at week 24","correct":false,"justification":"Uterine softening begins at week 8"},{"idx":1,"proposition":"Fetal heart sounds can be heard by the fetal Doppler apparatus at the end of the 1st month","correct":false,"justification":"Fetal heart sounds (BDC) can be heard with the fetal Doppler machine at the end of the 3rd month (sound signal heard at the 10th SA, sometimes as early as the 9th)"},{"idx":2,"proposition":"The duration of pregnancy varies between 280 and 290 days","correct":true},{"idx":3,"proposition":"The duration of pregnancy varies between 40SA and 41.3SA","correct":true},{"idx":4,"proposition":"The average length of pregnancy is 284 days","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"grossesseN-gyn-8","context":null,"enonce":"Among these proposals, which designate a cranio-caudal length in the standards:","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"11 13.6 SA: between 45 and 84 mm","correct":true},{"idx":1,"proposition":"12 SA: 56 cm","correct":false,"justification":"56 mm"},{"idx":2,"proposition":"14 SA: 105 mm","correct":false,"justification":"85 mm"},{"idx":3,"proposition":"11 SA: 25 mm","correct":false,"justification":"45 mm"},{"idx":4,"proposition":"13 SA: 72 mm","correct":true,"justification":"11SA = 45 mm, 12SA: 56 mm, 13SA = 72 mm, 14SA = 85 mm\""}],"type":"custom"}
+{"_id":"grossesseN-gyn-9","context":null,"enonce":"Among these proposals, which designate tests not recommended in patients during pregnancy?","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Determination of bHCG","correct":false,"justification":"Useful for determining pregnancy"},{"idx":1,"proposition":"Lipid profile","correct":true},{"idx":2,"proposition":"Measurement of SVR","correct":true},{"idx":3,"proposition":"Determination of IARs","correct":false,"justification":"Essential to do them"},{"idx":4,"proposition":"Determination of alkaline phosphatases","correct":true}],"type":"custom"}
+{"_id":"grossesseN-gyn-10","context":null,"enonce":"Concerning the course of a non-pathological pregnancy","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"For a woman who has a regular 28-day cycle and a last menstrual period on January 1, the beginning of pregnancy is January 14 and the expected term is August 14.","correct":false,"justification":"For a woman who has a regular 28-day cycle and a last period on January 1, the beginning of pregnancy is January 14 and the term is October 14."},{"idx":1,"proposition":"In case of IVF, the date of onset of pregnancy is defined by the date of puncture","correct":true},{"idx":2,"proposition":"In case of IVF, the date of pregnancy is the date on which the sounds of the heart are observed with Doppler, minus 3 months","correct":false,"justification":"In case of IVF, the date of onset of pregnancy is defined by the date of puncture (professional agreement)"},{"idx":3,"proposition":"Ultrasound dating is based on the antero-posterior length of the fetus","correct":false,"justification":"To reduce the risk of prolonged pregnancy, the CNGOF in its 2011 CPR recommends ultrasound dating of early pregnancy using ultrasound measurement of craniocaudal length, which ideally should be done between 11 and 13.6 SA (CCL between 45–84 mm): • CCL at 11 SA = 45 mm"},{"idx":4,"proposition":"Interrogation alone will define the mode of obstetric monitoring","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"grossesseN-gyn-12","context":null,"enonce":"Which of these proposals are oligatory biological examinations during normal pregnancy?","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"A double determination of blood group","correct":true},{"idx":1,"proposition":"A serology of rubella","correct":true},{"idx":2,"proposition":"A serology of systematic toxoplasmosis","correct":false,"justification":"Not if there are written results that allow immunity to be considered acquired"},{"idx":3,"proposition":"Albuminuria","correct":true},{"idx":4,"proposition":"Glycosuria","correct":true}],"type":"custom"}
+{"_id":"grossesseN-gyn-13","context":null,"enonce":"Regarding the follow-up of type B pregnancy","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Type B follow-up is the least at risk","correct":false},{"idx":1,"proposition":"In type B follow-up, regular follow-up can be done by an authorized midwife","correct":false,"justification":"Regular follow-up should be provided by an obstetrician gynecologist"},{"idx":2,"proposition":"If the patient does not have a complete blood group card, a double determination is mandatory","correct":true},{"idx":3,"proposition":"Screening for syphilis TPHA-VDRL is mandatory in all cases","correct":true},{"idx":4,"proposition":"Rubella serology is mandatory in all cases","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"grossesseN-gyn-14","context":null,"enonce":"Concerning the follow-up of non-pathological pregnancy","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Irregular antibody testing (IAR) is mandatory in all cases","correct":true},{"idx":1,"proposition":"The search for antibodies A and B is mandatory","correct":false,"justification":"excluding antibodies to A and B antigens"},{"idx":2,"proposition":"Toxoplasma serology is repeated every month from the 2nd prenatal examination in all cases","correct":false,"justification":"Toxoplasma serology is repeated monthly from the 2nd prenatal examination if immunity is not acquired"},{"idx":3,"proposition":"The search for albuminuria is to be done at the 3rd and 6th month only","correct":false,"justification":"The search for albuminuria is to be done every month during pregnancy"},{"idx":4,"proposition":"Obstetric ultrasound is a mandatory examination","correct":false,"justification":"Obstetrical ultrasound is not a mandatory examination but it is necessary for a good obstetrical follow-up"}],"type":"custom"}
+{"_id":"reeducation-mpr-0","context":null,"enonce":"From the following proposals, check the exact answer(s):","item":"reeducation","matiere":"mpr","propositions":[{"idx":0,"proposition":"The responsibility for whether or not to prescribe a rehabilitation program rests with the physician","correct":true},{"idx":1,"proposition":"The realization of rehabilitation is a prerequisite for the establishment of a","correct":true,"justification":"Cf College of MPR"},{"idx":2,"proposition":"The legislation distinguishes 84 rehabilitation professions","correct":false,"justification":"Seven: masseurskinesitherapists, occupational therapists, speech therapists, psychomotor therapists, orthoptists, pedicures-podiatrists and dieticians"},{"idx":3,"proposition":"There are 13 different rehabilitation programs that are chosen for each patient according to their situation","correct":false,"justification":"The rehabilitation program is adapted and personalized for each patient"},{"idx":4,"proposition":"A rehabilitation programme must be followed by the evaluation of results; involving the doctor and paramedics","correct":true}],"type":"custom"}
+{"_id":"reeducation-mpr-1","context":null,"enonce":"From the following proposals, check the exact answer(s):","item":"reeducation","matiere":"mpr","propositions":[{"idx":0,"proposition":"Simple rehabilitation programs involve the collaboration of the doctor regardless of his specialty and a medical assistant, physiotherapist or speech therapist mainly","correct":true,"justification":"Cf College of MPR"},{"idx":1,"proposition":"Complex rehabilitation programs require the collaboration of MPR and several rehabilitation auxiliaries","correct":true,"justification":"Cf College of MPR"},{"idx":2,"proposition":"Treatment of urinary incontinence in women requires complex rehabilitation","correct":false,"justification":"1st line treatment of UI in women: rehabilitation and treatment of contributing factors"},{"idx":3,"proposition":"Healing is the goal of rehabilitation","correct":false,"justification":"The overall goals of rehabilitation can be anatomical or functional recovery, maintenance or compensation for a disability."},{"idx":4,"proposition":"Edema and trophic disorders are indications for massage physiotherapy","correct":true}],"type":"custom"}
+{"_id":"hyperCa-nephro-0","context":null,"enonce":"Regarding hypercalcemia","item":"hyperCa","matiere":"nephro","propositions":[{"idx":0,"proposition":"It is necessary to distinguish true hypercalcemia, with elevation of ionized calcium from false hypercalcemia by increase in the protein-bound fraction","correct":true},{"idx":1,"proposition":"Hyperalbuminemia, by severe dehydration for example, leads to an increase in total calcium, but without an increase in ionized calcium","correct":true},{"idx":2,"proposition":"The assessment of hypercalcemia must therefore include an ionized calcium assay or an albuminemia assay","correct":true},{"idx":3,"proposition":"Severe or rapid onset hypercalcemia is accompanied by general signs, digestive disorders and often confusing neuropsychic manifestations","correct":true},{"idx":4,"proposition":"Signs of hypercalcemia are very specific ","correct":false}],"type":"custom"}
+{"_id":"hyperCa-nephro-1","context":null,"enonce":"Regarding hypercalcemia","item":"hyperCa","matiere":"nephro","propositions":[{"idx":0,"proposition":"Neuro-psychic signs are common (memory problems, depression or anxiety)","correct":true},{"idx":1,"proposition":"Digestive disorders (anorexia, nausea and vomiting) are common when serum calcium is > 2 mmol \/ L","correct":false,"justification":"Digestive disorders Anorexia, nausea and vomiting are common when serum calcium is > 3 mmol\/L"},{"idx":2,"proposition":"Hypercalcemia leads to a decrease in QT space and rhythm disorders","correct":true},{"idx":3,"proposition":"Chronic hypercalcemia can lead to renal lithiasis and chronic renal failure","correct":true},{"idx":4,"proposition":"Calcemia is regulated by two hormones: parathyroid hormone (PTH) and vitamin D, which control digestive calcium absorption, bone formation and renal excretion.","correct":true}],"type":"custom"}
+{"_id":"hyperCa-nephro-2","context":null,"enonce":"Regarding hypercalcemia","item":"hyperCa","matiere":"nephro","propositions":[{"idx":0,"proposition":"10 to 20% of cancer patients will have at least one episode of hypercalcemia during the course of their disease","correct":true},{"idx":1,"proposition":"Primary hyperparathyroidism results in 20% of cases a simple adenoma and in 15% of cases, hyperplasia of all four glands","correct":false,"justification":"Primary hyperparathyroidism results in 80% of cases a simple adenoma and in 15% of cases, hyperplasia of all four glands"},{"idx":2,"proposition":"Parathyroid carcinoma (malignant form of primary hyperparathyroidism) is exceptional (< 1%) and is accompanied by severe hypercalcemia (> 3.5 mmol \/ L) poorly tolerated","correct":true},{"idx":3,"proposition":"Parathyroid adenoma mainly affects women after 40 years","correct":true},{"idx":4,"proposition":"Primary hyperparathyroidism can be the consequence of chronic lithium intake","correct":true}],"type":"custom"}
+{"_id":"hyperCa-nephro-3","context":null,"enonce":"Which of the following are ECG signs of hypercalcemia?","item":"hyperCa","matiere":"nephro","propositions":[{"idx":0,"proposition":"QT segment elongation","correct":false,"justification":"False"},{"idx":1,"proposition":"ST segment shortening","correct":true},{"idx":2,"proposition":"QT segment shortening","correct":true},{"idx":3,"proposition":"Ventricular tachycardia","correct":true},{"idx":4,"proposition":"Atrioventricular block","correct":true}],"type":"custom"}
+{"_id":"hyperCa-nephro-4","context":null,"enonce":"Which of the following are signs related to hypercalcemia?","item":"hyperCa","matiere":"nephro","propositions":[{"idx":0,"proposition":"Nausea and vomiting","correct":true},{"idx":1,"proposition":"Abdominal pain","correct":true},{"idx":2,"proposition":"Mucocutaneous pallor","correct":false,"justification":"False"},{"idx":3,"proposition":"Sensory level","correct":false,"justification":"False"},{"idx":4,"proposition":"Skin fold","correct":true,"justification":"True, related to dehydration"}],"type":"custom"}
+{"_id":"hyperCa-rhumato-0","context":null,"enonce":"Regarding calcium metabolism","item":"hyperCa","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Ionized serum calcium varies between 1.15 and 1.3 mmol\/L","correct":true},{"idx":1,"proposition":"The determination of ionized calcium can be disturbed by pH and phosphate ","correct":true},{"idx":2,"proposition":"Calcium homeostasis is essentially based on three key organs (intestine, kidney and bone) and two regulatory hormones.","correct":true},{"idx":3,"proposition":"Digestive inputs are regulated by active vitamin D, also known as calcidiol (25-[OH]-vitamin D2), which promotes calcium absorption","correct":false,"justification":"The active vitamin D is calcitriol (1,25-[OH]2-vitamin D3)"},{"idx":4,"proposition":"Urinary excretion is regulated by renal reabsorption in the distal tubule which is promoted by PTH","correct":true}],"type":"custom"}
+{"_id":"hyperCa-rhumato-1","context":null,"enonce":"Regarding hypercalcemia","item":"hyperCa","matiere":"rhumato","propositions":[{"idx":0,"proposition":"PTH is the key hormone that supports serum calcium","correct":true},{"idx":1,"proposition":"PTH then stimulates the distal renal tubular reabsorption of calcium, the conversion by 1α-hydroxylase, of 25-OH-vitamin D3 into active vitamin D","correct":true},{"idx":2,"proposition":"Hypercalcemia is defined as a total calcium level (corrected if necessary) greater than 6 mmol\/L or an ionized serum calcium greater than 1.5 mmol\/L","correct":false,"justification":"Hypercalcemia is defined as a total calcium level (corrected if necessary) greater than 2.6 mmol\/L or an ionized serum calcium greater than 1.35 mmol\/L"},{"idx":3,"proposition":"The discovery of hypercalcemia requires a second confirmatory test, without delaying treatment if there are threatening signs","correct":true},{"idx":4,"proposition":"It is estimated that 40% of hypercalcemias are asymptomatic and incidentally discovered.","correct":true}],"type":"custom"}
+{"_id":"hyperCa-rhumato-2","context":null,"enonce":"Regarding hypercalcemia","item":"hyperCa","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Chronic hypercalcemia is often complicated by phosphate lithiasis or calcium oxalate (renal colic, hematuria or urinary tract infection), nephrocalcinosis, obstructive renal failure","correct":true},{"idx":1,"proposition":"Acute hypercalcemia is a medical emergency with a risk of death from heart rhythm disorders","correct":true},{"idx":2,"proposition":"An emergency ECG should be performed to look for rhythm disorders (tachycardia, QT shortening, early onset T waves) because there is a risk of ventricular fibrillation and sudden death.","correct":true},{"idx":3,"proposition":"The discovery of malignant hypercalcemia requires hospitalization to carry out emergency treatment","correct":true},{"idx":4,"proposition":"Calcitonin should be given urgently in acute hypercalcaemia","correct":false,"justification":"It includes the following measures:Calcitonin no longer has a place in the treatment of hypercalcemia"}],"type":"custom"}
+{"_id":"IC-cardio-0","context":null,"enonce":"About heart failure","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Most heart conditions if not detected or treated in time can lead to heart failure","correct":true},{"idx":1,"proposition":"HF is a syndrome that can be defined as the combination of symptoms and signs associated with cardiac dysfunction","correct":true},{"idx":2,"proposition":"The diagnosis of HF is, in most cases, easy to make","correct":false,"justification":"Relatively difficult generally. In doubtful cases, the clinical response favorable to appropriate treatment (diuretic) may be an argument in favor of the diagnosis"},{"idx":3,"proposition":"It is estimated that the prevalence of heart failure in the general population is between 15 and 20% in France","correct":false,"justification":"That would be far too much. It is estimated that the prevalence of heart failure in the general population is between 1 and 2%"},{"idx":4,"proposition":"The average age of diagnosis in Europe is around 40 years","correct":false,"justification":"Around 75 years"}],"type":"custom"}
+{"_id":"IC-cardio-1","context":null,"enonce":"About heart failure","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Population aging explains why the prevalence of HF tends to increase","correct":true},{"idx":1,"proposition":"Ejection fraction is the most widely used parameter to characterize diastolic function","correct":false,"justification":"Systolic function"},{"idx":2,"proposition":"In case of cardiac dysfunction, the body will react by bringing into play a number of compensatory mechanisms","correct":true},{"idx":3,"proposition":"Tachycardia under the dependence of the activation of the parasympathetic system helps to maintain cardiac output","correct":false,"justification":"Tachycardia is dependent on the activation of the (ortho)sympathetic system. It helps maintain cardiac output (DC = VES × HR)"},{"idx":4,"proposition":"Vasoconstriction in response to activation of the sympathetic system and renin angiotensin system helps maintain perfusion pressure","correct":true}],"type":"custom"}
+{"_id":"IC-cardio-2","context":null,"enonce":"About heart failure","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Exertional angina is often indicative of the disease","correct":false,"justification":"It is rather the dyspnea of effort that reveals the disease. There is rarely angina at the beginning of the disease"},{"idx":1,"proposition":"The degree of effort at which dyspnea appears makes it possible to quantify the functional tolerance of the disease","correct":true},{"idx":2,"proposition":"In severe or end-stage heart failure, respiratory disorders such as Cheynes-Stokes breathing sleep apnea syndrome may be observed.","correct":true},{"idx":3,"proposition":"Apart from an acute flare-up of the disease, the physical examination of the heart failure is often quite rich (dyspnea, pallor, edema, etc.)","correct":false,"justification":"Apart from an acute flare-up of the disease, the physical examination of heart failure is often quite poor, especially when HF is treated and controlled."},{"idx":4,"proposition":"At the cardiac level, palpation sometimes makes it possible to note a spike shock deviated at the top and right, related to left ventricular dilation","correct":false,"justification":"In case of dilation of the LV, the tip shock is deflected at the bottom and left, in the axis of the heart"}],"type":"custom"}
+{"_id":"IC-cardio-3","context":null,"enonce":"About heart failure","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"At a very advanced stage, heart failure can be accompanied by an alternating pulse, oliguria, muscle wasting, sometimes achieving a real cachectic state.","correct":true},{"idx":1,"proposition":"Cheynes-Stokes dyspnea is sometimes noted in patients with heart failure during sleep","correct":true,"justification":"Especially in cases of severe or terminal HF"},{"idx":2,"proposition":"ECG is low contributory to the diagnosis of heart failure","correct":true},{"idx":3,"proposition":"The existence of a branch block in particular left (duration of the QRS > 120 ms), is an important element to take into account given the current therapeutic implications","correct":true},{"idx":4,"proposition":"Chest X-ray is unnecessary","correct":false,"justification":"It is essential to appreciate the pleuropulmonary impact"}],"type":"custom"}
+{"_id":"IC-cardio-4","context":null,"enonce":"About heart failure","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"BNP or NT-proBNP can help in the diagnosis of heart failure, with good positive predictive value.","correct":false,"justification":"BNP or NT-proBNP can help in the diagnosis of heart failure, with a good negative predictive value; thus, normal values of BNP (< 100 pg\/mL) or NT-proBNP (< 125 pg\/mL) make the diagnosis of heart failure very unlikely in the presence of acute dyspnea with a good negative predictive value"},{"idx":1,"proposition":"There are values of BNP\/NT-proBNP for which the diagnosis is uncertain, the interpretation must imperatively take into account the clinical data","correct":true},{"idx":2,"proposition":"Transthoracic echocardiography (ETT) coupled with Doppler is the essential key test in case of suspected heart failure","correct":true},{"idx":3,"proposition":"Coronary angiography is a key test for suspected primary heart failure","correct":false,"justification":"Coronary angiography is usually offered in case of impaired systolic function (decreased ejection fraction [EF]) to rule out coronary artery disease."},{"idx":4,"proposition":"Ischemic heart disease is the leading cause of heart failure.","correct":true}],"type":"custom"}
+{"_id":"IC-cardio-5","context":null,"enonce":"About heart failure","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Pulmonary arterial hypertension is defined as a mean PAP greater than 25 mmHg","correct":true},{"idx":1,"proposition":"Normal cardiac output is 5 L\/min, cardiac index is 3 L\/min\/m2","correct":true},{"idx":2,"proposition":"All heart conditions can lead to heart failure","correct":true},{"idx":3,"proposition":"High blood pressure is also an important factor or cofactor in heart failure","correct":true},{"idx":4,"proposition":"Dilated cardiomyopathies (DCM) are defined by damage to the heart muscle that results in dilation and decreased LV ejection fraction.","correct":true}],"type":"custom"}
+{"_id":"IC-cardio-6","context":null,"enonce":"About heart failure","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"All left valvular heart disease can be complicated by heart failure (mitral or aortic insufficiency, mitral or aortic stricture)","correct":true},{"idx":1,"proposition":"Ventricular or supraventricular rhythm or conduction disorders can cause heart failure","correct":true},{"idx":2,"proposition":"Chronic anemia can cause heart failure","correct":true},{"idx":3,"proposition":"Pulmonary oedema in a young migrant, especially if it is associated with atrial fibrillation, should suggest the diagnosis of rheumatic valvular disease, especially mitral valve disease.","correct":true},{"idx":4,"proposition":"mortality remains high in heart failure, averaging 50% at five years but can reach up to 40-50% per year in severe heart failure (NYHA IV)","correct":true}],"type":"custom"}
+{"_id":"IC-cardio-7","context":null,"enonce":"About heart failure","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"HF is considered the leading cause of hospitalization after age 65","correct":true},{"idx":1,"proposition":"Hospitalization for cardiac decompensation is always a severity factor","correct":true},{"idx":2,"proposition":"Heart failure can be accompanied by anemia, iron deficiency, sleep apnea syndrome","correct":true},{"idx":3,"proposition":"Prevention of heart failure begins with management of cardiovascular risk factors","correct":true},{"idx":4,"proposition":"The success of treatment depends closely on the patient's education and understanding of the disease.","correct":true}],"type":"custom"}
+{"_id":"IC-cardio-8","context":null,"enonce":"Which of the following are true about the NT proBNP?","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Faced with acute dyspnea, he directs to a cardiac origin","correct":true},{"idx":1,"proposition":"It is a prognostic marker of heart failure","correct":true},{"idx":2,"proposition":"It is interpreted according to age","correct":true},{"idx":3,"proposition":"It is increased in case of heart failure","correct":true},{"idx":4,"proposition":"No proposition is true","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"IC-cardio-9","context":null,"enonce":"Which of the following are early complications of triple-chamber defibrillator implantation?","item":"IC","matiere":"cardio","propositions":[{"idx":0,"proposition":"Probe displacements","correct":true},{"idx":1,"proposition":"Infective tube endocarditis","correct":false,"justification":"Not early"},{"idx":2,"proposition":"Pericardial effusion","correct":true},{"idx":3,"proposition":"Low blood pressure","correct":false,"justification":"False"},{"idx":4,"proposition":"Decompensation of heart failure","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"epilepsie-neuro-2","context":null,"enonce":"About epilepsy","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"proposition":"The incidence of epilepsy is higher in children and after 60 years","correct":true},{"idx":1,"proposition":"About 1% of epilepsies begin before the age of 5","correct":false,"justification":"About 50% of epilepsies begin before the age of 10"},{"idx":2,"proposition":"EEG during juvenile myoclonus is characterized by generalized, bilateral, symmetrical and synchronous polyspikes-waves","correct":true},{"idx":3,"proposition":"EEG during the typical absence is characterized by a generalized, bilateral, symmetrical and synchronous paroxysmal discharge of wave-peaks at 3 Hz, abruptly beginning and ending, of a few seconds, interrupting normal background activity","correct":true},{"idx":4,"proposition":"Disorders of consciousness during focal seizures do not have a precise localizing value","correct":true}],"type":"custom"}
+{"_id":"epilepsie-neuro-3","context":null,"enonce":"About epilepsy","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"proposition":"When faced with an epileptic seizure in a known epileptic, it is necessary to do a brain imaging in first line","correct":false,"justification":"No. Antiepileptic drugs must be dosed as a first-line measure."},{"idx":1,"proposition":"The most common cause of seizures in an epileptic is lack of sleep","correct":false,"justification":"It is the lack of adherence, hence the fact of dosing antiepileptics in the first-line assessment in the known epileptic"},{"idx":2,"proposition":"Prevalence is about 1% in the general population","correct":true},{"idx":3,"proposition":"In 50% of cases, no cause of the seizure is found","correct":false,"justification":"In 25% of cases"},{"idx":4,"proposition":"The tonic phase of a tonic-clonic seizure lasts 30 seconds","correct":false,"justification":"It lasts 10 to 20 seconds. The clonic phase lasts about 30 seconds."}],"type":"custom"}
+{"_id":"epilepsie-neuro-4","context":null,"enonce":"Signs of severity of a seizure include:","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Repetition of crises","correct":true},{"idx":1,"proposition":"Mental confusion persisting for more than 15 minutes","correct":false,"justification":"Only 30 minutes left"},{"idx":2,"proposition":"Alcohol withdrawal","correct":true},{"idx":3,"proposition":"Head trauma","correct":true},{"idx":4,"proposition":"Fever > 38°C","correct":true}],"type":"custom"}
+{"_id":"epilepsie-neuro-5","context":null,"enonce":"Which of these proposals are suggestive of an epileptic seizure?","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"proposition":"The bite of the tip of the tongue","correct":false,"justification":"Lateral bite of the tongue"},{"idx":1,"proposition":"Rapid recovery in post-crisis","correct":false,"justification":"Recovery is slow, often in transport to the hospital. Confusion can last a long time"},{"idx":2,"proposition":"Generalized hypotonia","correct":true},{"idx":3,"proposition":"Head trauma","correct":false,"justification":"Often due to the fall and does not portend the character of the crisis"},{"idx":4,"proposition":"A fever","correct":false,"justification":"Fever is a criterion of severity of the seizure, but is not in itself an element pointing to an epileptic seizure"}],"type":"custom"}
+{"_id":"epilepsie-neuro-6","context":null,"enonce":"Regarding West syndrome:","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Its other name is Lennox Syndrome","correct":false,"justification":"These are two different syndromes, although their clinical impact is close"},{"idx":1,"proposition":"It affects patients over the age of 65","correct":false,"justification":"It concerns infants of about 6 months"},{"idx":2,"proposition":"It is characterized by generalized EEG discharge","correct":true,"justification":"EEG hysprarhythmia"},{"idx":3,"proposition":"Wave peaks usually have a frequency of 3hz","correct":false,"justification":"Very slow and wide waves are observed"},{"idx":4,"proposition":"EEG signs are bilateral","correct":true}],"type":"custom"}
+{"_id":"epilepsie-neuro-7","context":null,"enonce":"Regarding treatments in a woman of childbearing potential:","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"proposition":"In patients of childbearing potential, enzyme inducer treatments are preferred to be avoided","correct":true,"justification":"They decrease the effectiveness of oral contraception"},{"idx":1,"proposition":"Levetiracetam does not present an over-risk of malformation compared to the general population","correct":true},{"idx":2,"proposition":"Valproic acid should not be prescribed to a woman of childbearing age","correct":true},{"idx":3,"proposition":"Oxcarbazepine is contraindicated in Wilson's disease","correct":false,"justification":"It is contraindicated in case of porphyria"},{"idx":4,"proposition":"Lamotrigine is an enzyme inhibitor","correct":true}],"type":"custom"}
+{"_id":"epilepsie-neuro-8","context":null,"enonce":"Among these anti-epileptic molecules, which are also indicated for bipolar disorders?","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Levetiracetam","correct":false,"justification":"Broad-spectrum molecule whose main EI is asthenia. The route of elimination is renal and has a half-life between 7 and 11 hours."},{"idx":1,"proposition":"Lamotrigine","correct":true,"justification":"Also indicated in bipolar disorder, lamotrigine is a broad-spectrum anti-epileptic whose main AE is to aggravate myoclonus, Lyell's syndrome, insomnia and headache. Its elimination pathway is hepatic (it is an enzyme inhibitor) and has a half-life of about 1 day (25 hours)"},{"idx":2,"proposition":"Oxcarbazepine ","correct":false,"justification":"Narrow-spectrum anti-epileptic drugs with hyponatremia, rash, dizziness, and diplopia as main ARs. Its elimination pathway is mixed (hepatic and renal). It is an enzyme inducer"},{"idx":3,"proposition":"Topiramate","correct":false,"justification":"Broad-spectrum anti-epileptic drugs with urolithiasis and weight loss as AEs. It is also used in migraines (not in bipolar disorder)"},{"idx":4,"proposition":"Sodium valproate","correct":true,"justification":"Absolutely contraindicated in women of childbearing age. This question is based on this table: https:\/\/www.cen-neurologie.fr\/sites\/www.cen-neurologie.fr\/files\/files\/capture_decran_2019-12-19_a_14.41.14.png"}],"type":"custom"}
+{"_id":"epilepsie-neuro-9","context":null,"enonce":"Which of the following proposals regarding electroencephalogram (EEG) are true?","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"proposition":"An epileptic seizure is a clinical manifestation of the hyperactivity of a group of cortical and\/or subcortical neurons","correct":true},{"idx":1,"proposition":"A normal EEG rules out an epileptic cause","correct":false,"justification":"None"},{"idx":2,"proposition":"During epileptic seizures, we can find at the EEG paroxysmal activities of the poly-peak wave (PPO) type.","correct":true},{"idx":3,"proposition":"EEG may reveal paroxysmal intercritical activities","correct":true},{"idx":4,"proposition":"EEG abnormalities can be activated by sleep deprivation","correct":true}],"type":"custom"}
+{"_id":"RGO-HGE-0","context":null,"enonce":"Regarding gastroesophageal reflux disease or GERD","item":"RGO","matiere":"HGE","propositions":[{"idx":0,"proposition":"Gastroesophageal reflux refers to the passage through the cardia of gastric contents into the esophagus","correct":true},{"idx":1,"proposition":"20-40% of adults suffer from pyrosis","correct":true},{"idx":2,"proposition":"The key element of the RGP is the failure of the anti-reflux barrier forged by the lower esophageal sphincter (SIO) and the diaphragm","correct":true},{"idx":3,"proposition":"The combination of pyrosis acid regurgitations are almost pathognomonic of GERD","correct":true},{"idx":4,"proposition":"GERD diagnsotic is clinical","correct":true}],"type":"custom"}
+{"_id":"RGO-HGE-2","context":null,"enonce":"Regarding epidemiology in the general population, which propositions are true?","item":"RGO","matiere":"HGE","propositions":[{"idx":0,"proposition":"10% of people describe a pyrosis at least weekly","correct":true},{"idx":1,"proposition":"60% of people are subject to monthly GERD","correct":false,"justification":"No data in the college on monthly frequency"},{"idx":2,"proposition":" 2 to 5% of people experience GERD a daily pyrosis","correct":true},{"idx":3,"proposition":"20-40% of adults suffer from pyrosis","correct":true},{"idx":4,"proposition":"About 70% of adults complain of GERD","correct":false,"justification":"20 to 40%"}],"type":"custom"}
+{"_id":"RGO-HGE-4","context":null,"enonce":"Which of the following refers to the main mechanism of GERD in very young infants?","item":"RGO","matiere":"HGE","propositions":[{"idx":0,"proposition":"Pyloric stenosis","correct":false},{"idx":1,"proposition":"Inappropriate and transient relaxations of ORS","correct":true,"justification":"True, with 5-second episodes of relaxation ≥ independent of swallowing"},{"idx":2,"proposition":"Umbilical hernia","correct":false},{"idx":3,"proposition":"Delayed gastric emptying","correct":false},{"idx":4,"proposition":"Atresia of the esophagus","correct":false}],"type":"custom"}
+{"_id":"RGO-HGE-5","context":null,"enonce":"Which of the following proposals are part of the management of simple gastroesophageal reflux disease in small children?","item":"RGO","matiere":"HGE","propositions":[{"idx":0,"proposition":"Reassure parents about the benignity of regurgitation","correct":true},{"idx":1,"proposition":"Putting the child to bed in the supine position","correct":false,"justification":"Never advise this is a high risk factor for sudden infant death syndrome.  \r\nAccording to the college, the inclination of the cradle (proclive) as well as the eviction of passive smoking have no proven effectiveness."},{"idx":2,"proposition":"Contraindicate breastfeeding ","correct":false,"justification":"This is not at all a contraindication to breastfeeding, which is on the contrary advisable. \r\nIf hygiene-dietary rules are not enough, it is possible to express milk and thicken it."},{"idx":3,"proposition":"Splitting bottles","correct":true},{"idx":4,"proposition":"Thickening of milk if applicable","correct":true}],"type":"custom"}
+{"_id":"RGO-HGE-6","context":null,"enonce":"Which of the following are possible treatments for simple gastroesophageal reflux disease in a bottle-fed infant?","item":"RGO","matiere":"HGE","propositions":[{"idx":0,"proposition":"Sodium alginate","correct":false,"justification":"Alginates and other esophageal dressings are a controversial adjuvant measure of efficacy, especially in infants"},{"idx":1,"proposition":"Sodium bicarbonate","correct":false,"justification":"Alginates and other esophageal dressings are a controversial adjuvant measure of efficacy, especially in infants"},{"idx":2,"proposition":"Omeprazole","correct":false,"justification":"They have an antisecretory action acids. They are therefore only effective in case of acid reflux only. They have no effectiveness on regurgitation and are not used in simple GERD."},{"idx":3,"proposition":"Metoclopramide","correct":false,"justification":"Contraindicated in children under 18 years of age because risk of extrapyramidal syndrome."},{"idx":4,"proposition":"None of these proposals","correct":true}],"type":"custom"}
+{"_id":"RGO-HGE-7","context":null,"enonce":"Which of the following are complications of GERD?","item":"RGO","matiere":"HGE","propositions":[{"idx":0,"proposition":"Endobrachyoesophagus (EBO)","correct":true},{"idx":1,"proposition":"Peptic stenosis","correct":true},{"idx":2,"proposition":"Barrett's ulcer","correct":true},{"idx":3,"proposition":"Digestive obstruction","correct":false},{"idx":4,"proposition":"Squamous cell carcinoma (on EBO)","correct":false,"justification":"Adenocarcinoma"}],"type":"custom"}
+{"_id":"pancreatitechr-HGE-0","context":null,"enonce":"Regarding chronic pancretis:","item":"pancreatitechr","matiere":"HGE","propositions":[{"idx":0,"proposition":"It is a chronic inflammation of the pancreas resulting in progressive fibrosis of the pancreatic parenchyma","correct":true},{"idx":1,"proposition":"Chronic pancreatitis first affects exocrine tissue, then endocrine tissue","correct":true},{"idx":2,"proposition":"• At the initial stage, the disease is characterized by outbreaks of acute pancreatitis, and by chronic pain that represent the main clinical translation of the disease","correct":true},{"idx":3,"proposition":"• Prevalence of about 1\/1,000,000 inhabitants in Western countries","correct":false},{"idx":4,"proposition":"There is female predominance","correct":false}],"type":"custom"}
+{"_id":"pancreatitechr-HGE-1","context":null,"enonce":"Regarding chronic pancreatitis:","item":"pancreatitechr","matiere":"HGE","propositions":[{"idx":0,"proposition":"Excessive alcohol consumption is the cause of the majority of chronic pancreatitis (CP) in the West","correct":true},{"idx":1,"proposition":"Tobacco is a risk factor present in more than 80% of cases","correct":true},{"idx":2,"proposition":"Hypercalcemia is a rare cause of chronic pancreatitis","correct":true},{"idx":3,"proposition":"hereditary CP is an autosomal dominant disease characterized by an age of onset of less than 30 years","correct":false,"justification":"hereditary CP is an autosomal dominant disease characterized by an age of onset of less than 15 years"},{"idx":4,"proposition":"Transfixing epigastric pain relieved by alcohol intake is a main sign of chronic pancreatitis","correct":true}],"type":"custom"}
+{"_id":"pancreatitechr-HGE-2","context":null,"enonce":"Regarding pancreatitis:","item":"pancreatitechr","matiere":"HGE","propositions":[{"idx":0,"proposition":"A pseudocyst is a fluid collection containing either pure, clear pancreatic juice or liquefied pancreatic necrosis.","correct":true},{"idx":1,"proposition":"A pseudocyst complicates 2-4% of PCs","correct":false,"justification":"A pseudocyst: • complicates 20 to 40% of PCs; • can form as a result of an acute flare-up (necrosis) or by ductal retention (clear liquid); • may remain stable, regress or become complicated: compression of a neighborhood organ (bile duct, duodenum, splenoportal axis), (resulting in a pancreatic abscess), hemorrhage or rupture in a nearby hollow organ or in the peritoneal cavity or in a serous (pleura, peritoneum)"},{"idx":2,"proposition":"Stenosis of the main bile duct most often results in anicteric cholestasis","correct":true,"justification":"Rarely from jaundice"},{"idx":3,"proposition":"Digestive bleeding occurs in 10% of chronic pancreatitis","correct":true},{"idx":4,"proposition":"During CP, exocrine pancreatic insufficiency occurs almost inevitably after an average of ten years of evolution","correct":true}],"type":"custom"}
+{"_id":"pancreatitechr-HGE-3","context":null,"enonce":"Regarding chronic pancreatitis:","item":"pancreatitechr","matiere":"HGE","propositions":[{"idx":0,"proposition":"Chronic pancreatitis is a chronic inflammation of the pancreas that results in the death of the patient in the majority of cases","correct":false,"justification":"It is not a fatal pathology"},{"idx":1,"proposition":"Migration of a gallstone into the wirsung is the main cause of chronic pancreatitis","correct":false,"justification":"The main cause of CP is acute pancreatia"},{"idx":2,"proposition":"Stenosis of the main bile duct is a cause of CP","correct":true},{"idx":3,"proposition":"Diabetes mellitus is one of the complications of chronic pancreatitis","correct":true},{"idx":4,"proposition":"Pain management in a specialized unit is essential","correct":true}],"type":"custom"}
+{"_id":"raisonnement-sp-0","context":null,"enonce":"Concerning reasoning and decision in medicine","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"The medical decision precedes the decision","correct":false,"justification":"It is the medical reasoning that precedes the decision"},{"idx":1,"proposition":"The decision engages the responsibility of the doctor","correct":true},{"idx":2,"proposition":"The diagnostic approach corresponds to choosing the best therapy for the patient","correct":false,"justification":"This is the therapeutic approach"},{"idx":3,"proposition":"The therapeutic approach corresponds to the fastest and most effective way to arrive at the diagnosis","correct":false,"justification":"This is the diagnostic approach"},{"idx":4,"proposition":"The medical decision engages the responsibility of the hospital","correct":false,"justification":"The medical decision engages the responsibility of the one who makes it, therefore the doctor\""}],"type":"custom"}
+{"_id":"raisonnement-sp-1","context":null,"enonce":"Which of the following are true?","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"From the clinical signs will be built the diagnostic approach","correct":true},{"idx":1,"proposition":"Following the clinical interrogation, the doctor develops hypotheses based on his physiopathological clinical knowledge, in particular","correct":true},{"idx":2,"proposition":"Diagnostic hypotheses should always be verified by examinations such as imaging or biology.","correct":false,"justification":"These hypotheses will have to be verified by a guided clinical examination and possibly additional examinations"},{"idx":3,"proposition":"The choice of a complementary diagnostic (or therapeutic) examination must always be justified","correct":true},{"idx":4,"proposition":"The doctor is the one who makes the diagnosis","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"raisonnement-sp-2","context":null,"enonce":"Concerning the diagnostic approach","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"If there is a diagnosis, the doctor must assess its seriousness","correct":true},{"idx":1,"proposition":"When the diagnosis is made, the doctor should always propose a curative treatment if it exists","correct":false,"justification":"Situations where the proposal of a curative treatment is not a solution"},{"idx":2,"proposition":"The doctor usually has to inform the patient about his illness","correct":true},{"idx":3,"proposition":"When the main symptom does not correspond to any disease, the doctor should dismiss his patient and not prescribe anything","correct":false,"justification":"The doctor must try to find the motivation of the request for consultation for two reasons: to avoid medical nomadism and the prescription of unnecessary check-ups"},{"idx":4,"proposition":"Incidentalomas are a type of medical error","correct":false,"justification":"This is the detection of abnormalities unrelated to the main symptomatology\""}],"type":"custom"}
+{"_id":"raisonnement-sp-3","context":null,"enonce":"Concerning the therapeutic approach","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"Diagnosed pathologies should always be treated","correct":false,"justification":"Only when the benefit\/risk balance is in favor and the treatment is the patient's will"},{"idx":1,"proposition":"There are 5 possible reasonings that dictate the decision to treat","correct":false,"justification":"There are 3: analog reasoning, pharmacological reasoning, and evidence-based reasoning."},{"idx":2,"proposition":"Automatic reasoning is very common in internal medicine","correct":false,"justification":"It is common in medicines where the speed of action is important (eg emergency medicine, resuscitation, etc.)"},{"idx":3,"proposition":"Habit reasoning is an analogical type of reasoning","correct":true},{"idx":4,"proposition":"Reasoning by dictated behaviour is evidence-based","correct":false,"justification":"It is dictated by a line manager\""}],"type":"custom"}
+{"_id":"raisonnement-sp-4","context":null,"enonce":"About EBM","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"Medical knowledge has slowed down in recent years (few major discoveries)","correct":false,"justification":"The number of publications reaches peaks year after year, with great discoveries such as artificial intelligence, hepatitis and HIV treatments, CRISPR-Cas9, etc."},{"idx":1,"proposition":"EBM is a conscientious use of the best current evidence from basic biological research","correct":false,"justification":"According to the Public Health KB, EBM is the use of clinical research data (not basic research)"},{"idx":2,"proposition":"An EBM approach contains 6 steps","correct":false,"justification":"4 steps: question formulation, literature review, outcome assessment and application to the patient"},{"idx":3,"proposition":"Literature review must follow PICO criteria","correct":false,"justification":"The PICO criteria concern the formulation of the question (Patient, Intervention, Comparator and Outcome)"},{"idx":4,"proposition":"Patient decision making (step 4) should be based on the patient's experience","correct":true,"justification":"As well as patient preferences and available resources\""}],"type":"custom"}
+{"_id":"raisonnement-sp-5","context":null,"enonce":"Among these proposals, which are not components of the HBS:","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"The cost","correct":true,"justification":"The 3 components of HBS according to the KB of Public Health and the Cochrane French Centre: Clinical expertise, patient preferences and research data"},{"idx":1,"proposition":"Family preferences","correct":true,"justification":"Patient preferences"},{"idx":2,"proposition":"Hierarchical pressures","correct":true,"justification":"Of course not"},{"idx":3,"proposition":"Clinical expertise","correct":false},{"idx":4,"proposition":"Research data","correct":false}],"type":"custom"}
+{"_id":"raisonnement-sp-6","context":null,"enonce":"Regarding the levels of evidence of the HAS:","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"Grade A is the best level","correct":true,"justification":"Level 1 = Grade A = established scientific pereuve"},{"idx":1,"proposition":"Level 3 is the lowest","correct":false,"justification":"This is level 4"},{"idx":2,"proposition":"Grade C corresponds to level 4 only","correct":false,"justification":"Grade C corresponds to Level 3 and Level 4"},{"idx":3,"proposition":"Level 2 is that of scientific presumption","correct":true,"justification":"Level 2 = Grade B"},{"idx":4,"proposition":"Level 3 is a low level of scientific evidence","correct":true,"justification":"Level 3 = Grade C"}],"type":"custom"}
+{"_id":"raisonnement-sp-7","context":null,"enonce":"Regarding the levels and grades of proof of the HAS:","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"High-powered randomized controlled trials are grade C","correct":false,"justification":"Grade A = Level 1 = scientifically established evidence"},{"idx":1,"proposition":"Cohort studies are generally Grade C","correct":false,"justification":"Grade B = Level 2 = Scientific presumption"},{"idx":2,"proposition":"Low-powered randomized controlled trials are grade B","correct":true,"justification":"As well as cohort studies, and well-conducted non-randomized controlled studies"},{"idx":3,"proposition":"Case-control studies are grade C","correct":true,"justification":"And level 3"},{"idx":4,"proposition":"Retrospective studies are grade C and level 3","correct":false,"justification":"Only case-control studies are level 3. Retrospective studies are Grade C and Level 4"}],"type":"custom"}
+{"_id":"raisonnement-sp-9","context":null,"enonce":"The collegiate procedure may be requested by:","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"The patient's doctor","correct":true,"justification":"4 possibilities: the doctor, the family\/relatives, the person of trust and the patient himself by his advance directives"},{"idx":1,"proposition":"The support person","correct":true},{"idx":2,"proposition":"The patient's employer","correct":false,"justification":"Unless he is family or a relative"},{"idx":3,"proposition":"The patient","correct":true,"justification":"Through its advance directives"},{"idx":4,"proposition":"Parents","correct":true}],"type":"custom"}
+{"_id":"raisonnement-sp-10","context":null,"enonce":"Concerning the collegiate procedure","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"Most often, it is triggered by the person of trust","correct":false,"justification":"By the doctor most often (cf. KB Public Health, page 35)"},{"idx":1,"proposition":"Only the opinions of doctors are taken into account","correct":false,"justification":"The entire healthcare team, the support person, etc."},{"idx":2,"proposition":"The final opinion is taken by the family","correct":false,"justification":"By the physician only"},{"idx":3,"proposition":"The procedure is notified in the medical record","correct":true},{"idx":4,"proposition":"An external doctor is called in as a consultant","correct":true}],"type":"custom"}
+{"_id":"pathoOGE-endoc-0","context":null,"enonce":"Which of the following proposals regarding cryptorchidism is (are) accurate?","item":"pathoOGE","matiere":"endoc","propositions":[{"idx":0,"proposition":"Cryptorchidism describes an abnormal location of the testicle","correct":true},{"idx":1,"proposition":"Association with a hernia is possible","correct":true,"justification":"Hernia \/ cryptorchidism association is not uncommon"},{"idx":2,"proposition":"Cryptorchidism is bilateral in 75% of cases","correct":false,"justification":"In 20% of cases"},{"idx":3,"proposition":"The origin of cryptorchidism is genetic most often","correct":false,"justification":"It is most often unknown"},{"idx":4,"proposition":"The scrotal migration phase is testosterone-dependent","correct":true,"justification":"While the intra-abdominal migration phase would be dependent on the hormone INSL3"}],"type":"custom"}
+{"_id":"pathoOGE-endoc-1","context":null,"enonce":"Regarding hormonal explorations:","item":"pathoOGE","matiere":"endoc","propositions":[{"idx":0,"proposition":"At full-term birth, a penis smaller than 4 cm is a micropenis","correct":false,"justification":"Micropenis (penis < 2 cm in a term newborn)"},{"idx":1,"proposition":"Hormonal exploration is considered if cryptochidism persists at the end of puberty","correct":false,"justification":"It must be taken care of well before, from birth to find the etiology and the impact"},{"idx":2,"proposition":"When cryptorchidism is bilateral, the urgency is to eliminate an abnormality of the enzyme block type 21-hydroxylase","correct":true},{"idx":3,"proposition":"The most common abnormality of normal karyotype sexual development is the 21-hydroxylase block. ","correct":true},{"idx":4,"proposition":"A 17-hydroxyprogesterone assay allows screening for congenital hyperplasia of the spleen","correct":false,"justification":"17-hydroxyprogesterone assay allows screening for congenital adrenal hyperplasia"}],"type":"custom"}
+{"_id":"pathoOGE-endoc-2","context":null,"enonce":"Regarding cryptorchidism and anorchidism:","item":"pathoOGE","matiere":"endoc","propositions":[{"idx":0,"proposition":"AMH testing can assess the existence of testicular functional tissue","correct":true},{"idx":1,"proposition":"Ultrasound can detect Müllerian derivatives if the cryptorchidism is bilateral","correct":true},{"idx":2,"proposition":"Anorchidism is rare and affects only one in 40 newborns","correct":false,"justification":"Anorchidism is much rarer and its pathophysiology is poorly understood"},{"idx":3,"proposition":"AMH is indosable in true anorchidism","correct":true},{"idx":4,"proposition":"Surgical exploration in case of anorchidism makes it possible to look for the testicles in the abdominal area","correct":false,"justification":"Surgical exploration is, most often, not useful"}],"type":"custom"}
+{"_id":"pathoOGE-endoc-3","context":null,"enonce":"Regarding cryptorchidism:","item":"pathoOGE","matiere":"endoc","propositions":[{"idx":0,"proposition":"Cryptorchidism is a call sign of a hypogodatrophic pathology that is a diagnostic emergency in the newborn","correct":true,"justification":"Diagnostic and therapeutic emergency"},{"idx":1,"proposition":"Cryptorchidism is a developmental anomaly very often found in polymalformative syndromes","correct":true},{"idx":2,"proposition":"There is a risk of ischemic necrosis by traction of the vascular pedicle during surgical lowering of the gonad","correct":true},{"idx":3,"proposition":"Two-step surgical lowering reduces the risk of necrosis","correct":true},{"idx":4,"proposition":"Surgical management must wait until puberty","correct":false,"justification":"The first consultation with a pediatric surgeon should ideally take place within the first six months of life."}],"type":"custom"}
+{"_id":"pathoOGE-endoc-4","context":null,"enonce":"Regarding cryptorchidism in adults:","item":"pathoOGE","matiere":"endoc","propositions":[{"idx":0,"proposition":"In front of cryptorchidism in adults, hormonal exploration looks for type 1 diabetes","correct":false,"justification":"We look for hypogonadism (FSH, LH, total testosterone assay)"},{"idx":1,"proposition":"The determination of hCG is indicated in front of a testicular mass","correct":true},{"idx":2,"proposition":"A spermogram is performed to look for azoospermia or oligospermia","correct":true},{"idx":3,"proposition":"Testicular microlithiasis is indicative of malignant pathology","correct":false,"justification":"Their number greater than five should encourage vigilance given their frequent association with malignant testicular lesions."},{"idx":4,"proposition":"Any cryptorchidism requires early endocrine exploration","correct":true}],"type":"custom"}
+{"_id":"pathoOGE-endoc-5","context":null,"enonce":"Which of the following proposals regarding cryptorchidism is (are) accurate?","item":"pathoOGE","matiere":"endoc","propositions":[{"idx":0,"proposition":"Surgery is indicated before 12 months","correct":true,"justification":"According to a 2018 HAS care relevance report, it is preferable to perform this surgery between 6 and 12 months (spermatogenesis optimization). However, surgery should not be performed before the age of 6 months (apart from an inguinal hernia cure) because the testicle can descend spontaneously during the first months of life."},{"idx":1,"proposition":"Cryptorchidism surgery patients in childhood do not need special follow-up","correct":false,"justification":"They must be monitored and reviewed at puberty to assess the impact on gonadal functions"},{"idx":2,"proposition":"Cryptorchidism may be associated with infertility","correct":true,"justification":"The search for cryptorchid atcd is essential during infertility consultations. It can also be associated with hypogonadism."},{"idx":3,"proposition":"The relative risk of testicular cancer is zero with cryportchidism","correct":false,"justification":"Cryptorchidism increases RR of testicular cancer"},{"idx":4,"proposition":"Gynecomastia accompanying cryptorchidism points instead to hormonal dysregulation","correct":true}],"type":"custom"}
+{"_id":"amylose-hemato-0","context":null,"enonce":"About amyloidosis","item":"amylose","matiere":"hemato","propositions":[{"idx":0,"proposition":"Amyloidosis is a set of diseases characterized by extracellular tissue deposits of insoluble, fibrillar proteins, organized in folded, antiparallel beta sheets","correct":true},{"idx":1,"proposition":"The diagnosis of amyloidosis is histological","correct":true,"justification":"By biopsy of an affected organ, or, due to the dissemination of deposits, by biopsy of subcutaneous fat or accessory salivary glands"},{"idx":2,"proposition":"In amyloidosis, a normally insoluble protein will become soluble and form extracellular aggregates.","correct":false,"justification":"In amyloidosis, a normally soluble protein will become insoluble and form extracellular aggregates organized into folded, antiparallel beta sheets (amylose deposits or amyloid substance)"},{"idx":3,"proposition":"Amyloidosis is an inherited disease","correct":false,"justification":"Some amyloidosis are acquired diseases, others are hereditary (amyloidosis by mutated transthyretin ATTR deposits)"},{"idx":4,"proposition":"Amyloidosis deposits are composed of 95% fibrillar proteins, and 5% glycoproteins","correct":true}],"type":"custom"}
+{"_id":"amylose-hemato-1","context":null,"enonce":"Regarding amyloidosis","item":"amylose","matiere":"hemato","propositions":[{"idx":0,"proposition":"The biochemical nature of the amyloid fibrillar protein gives the name of the type of amyloidosis (example: amyloidosis type AL = immunoglobulin light chain)","correct":true,"justification":"Example: amyloidosis type AL = immunoglobulin light chain"},{"idx":1,"proposition":"Many proteins can cause amyloidosis deposits","correct":true,"justification":"Serum amyloid protein in AA amyloidosis, Ig light chains in AL amyloidosis, e.g."},{"idx":2,"proposition":"The histological aspect varies according to the type of amyloidosis","correct":false,"justification":"Regardless of the type of amyloidosis, the histological appearance is the same: fibrils in beta-pleated sheets. They are highlighted by the Congo Red, and are birefringents to polarized light"},{"idx":3,"proposition":"These extracellular deposits may affect only one organ (localized amyloidosis as a single mass) or several organs (generalized amyloidosis which can be life-threatening)","correct":true,"justification":"They can also affect several organs (generalized amyloidosis which can be life-threatening)"},{"idx":4,"proposition":"The organs preferentially affected depend on the type of amyloidosis","correct":true,"justification":"AL amyloidosis: renal (65%), cardiac (61%), and in about 20% of cases hepatic, neurological, soft tissue or digestive system involvement. AA amyloidosis: mainly renal and hepatic damage"}],"type":"custom"}
+{"_id":"amylose-hemato-2","context":null,"enonce":"Regarding amyloidosis","item":"amylose","matiere":"hemato","propositions":[{"idx":0,"proposition":"Kidney damage results in proteinuria, nephrotic syndrome, and renal failure","correct":true,"justification":"There is, classically, neither HTA nor hematuria"},{"idx":1,"proposition":"In case of suspicion of amyloidosis, a sample is sent to the laboratory, fixed in formalin for inclusion in paraffin for the detection of deposits, accompanied by a second sample sent fresh to be frozen for the typing of deposits","correct":true},{"idx":2,"proposition":"Deep rectal biopsies have a sensitivity of about 80%","correct":true,"justification":"They highlight gastrointestinal involvement of AL amyloidosis"},{"idx":3,"proposition":"Accessory salivary gland biopsies have a sensitivity of 80-85%","correct":true},{"idx":4,"proposition":"In case of amyloidosis, transparietal liver biopsy has a very high diagnostic interest","correct":false,"justification":"Frankly no interest. A blood enzyme assay is sufficient (greater increase in PAL than GGT). No cytolysis (normal TGO and TGP) and no jaundice (except in very rare cases, poor prognosis)"}],"type":"custom"}
+{"_id":"amylose-hemato-3","context":null,"enonce":"Regarding the skin involvement of AL amyloidosis:","item":"amylose","matiere":"hemato","propositions":[{"idx":0,"proposition":"Purpura can be observed","correct":true},{"idx":1,"proposition":"Bruising may be observed","correct":true},{"idx":2,"proposition":"Necrotic lesions may be observed","correct":false,"justification":"It's not described in colleges"},{"idx":3,"proposition":"They sit preferentially at the level of the legs","correct":false,"justification":"The preferred seat is the trunk and face"},{"idx":4,"proposition":"They may be accompanied by the sign of the shoulder pads","correct":true}],"type":"custom"}
+{"_id":"amylose-hemato-4","context":null,"enonce":"Regarding renal involvement of AL amyloidosis:","item":"amylose","matiere":"hemato","propositions":[{"idx":0,"proposition":"Renal failure appears in about half of cases","correct":true},{"idx":1,"proposition":"The kidney is affected in 15% of cases","correct":false,"justification":"Kidney damage is very common: in more than 70% of cases (according to the College of Internal Medicine)"},{"idx":2,"proposition":"Proteinuria is mainly composed of light chains ","correct":false,"justification":"Proteinuria is part of a glomerular syndrome (in a third of cases). It is therefore mainly composed of albumin and relatively abundant."},{"idx":3,"proposition":"Hematuria is found in 20% of cases","correct":false,"justification":"There is never hematuria"},{"idx":4,"proposition":"The size of the kidneys is increased","correct":true}],"type":"custom"}
+{"_id":"amylose-hemato-5","context":null,"enonce":"Regarding cardiac involvement:","item":"amylose","matiere":"hemato","propositions":[{"idx":0,"proposition":"It is present in 10% of patients at diagnosis ","correct":false,"justification":"It is present in 60% of patients at diagnosis"},{"idx":1,"proposition":"Cardiac involvement is the major prognostic factor ","correct":true},{"idx":2,"proposition":"It is manifested by ischemic cardiomyopathy","correct":false,"justification":"It is a restrictive hypertrophic cardiomyopathy"},{"idx":3,"proposition":"It progresses to asystole","correct":false,"justification":"It evolves towards adiastolia: the heart can no longer relax"},{"idx":4,"proposition":"It progresses to restrictive heart failure","correct":true}],"type":"custom"}
+{"_id":"amylose-hemato-7","context":null,"enonce":"What is the organ with the most severe prognosis?","item":"amylose","matiere":"hemato","propositions":[{"idx":0,"proposition":"The heart","correct":true,"justification":"True, mortality from amyloidosis is largely linked to cardiac involvement (restrictive cardiomyopathy). The appearance is brilliant in ultrasound. There is a QS V1-V3 microvoltage on the ECG."},{"idx":1,"proposition":"Liver","correct":false,"justification":"False"},{"idx":2,"proposition":"Spleen","correct":false,"justification":"False"},{"idx":3,"proposition":"The brain","correct":false,"justification":"No central neuronal involvement"},{"idx":4,"proposition":"The eye","correct":false,"justification":"No vitreous body damage"}],"type":"custom"}
+{"_id":"soinspsy-psy-0","context":null,"enonce":"General generalities:","item":"soinspsy","matiere":"psy","propositions":[{"idx":0,"proposition":"The Medical Psychological Centre (CMP) is the pivotal structure of the sector","correct":true},{"idx":1,"proposition":"The Medical and Psychological Centres (CMP) offer outpatient care","correct":true},{"idx":2,"proposition":"Liberal psychiatrists are very much in touch with the actors of general medicine","correct":true},{"idx":3,"proposition":"Multidisciplinary health homes are time-full hospitalization structures","correct":false,"justification":"Ambulatory. We also talk about a multi-professional health home."},{"idx":4,"proposition":"The financing of the health care system is provided by health insurance","correct":true}],"type":"custom"}
+{"_id":"soinspsy-psy-1","context":null,"enonce":"General:","item":"soinspsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Health insurance is based on a logic of compensation for illness","correct":true},{"idx":1,"proposition":"In general, health insurance guarantees the reimbursement of care provided as part of the \"Coordinated Care Pathway\".","correct":true},{"idx":2,"proposition":"In case of consultation with a medical specialist, the maximum reimbursement rate is guaranteed to the insured if the pathology is serious","correct":false,"justification":"If he is referred by his \"attending physician\""},{"idx":3,"proposition":"A patient between 16 and 25 years of age can consult a psychiatry without losing the usual rate of reimbursement","correct":true},{"idx":4,"proposition":"The use of the psychiatric care system is declining sharply","correct":false,"justification":"Rising sharply"}],"type":"custom"}
+{"_id":"soinspsy-psy-2","context":null,"enonce":"Regarding the organization of psychiatric care in France:","item":"soinspsy","matiere":"psy","propositions":[{"idx":0,"proposition":"The prevalence of mental disorders in the general population in France is about 3%","correct":false,"justification":"About 20%"},{"idx":1,"proposition":"The fight against stigmatization of people with psychiatric disorders is still relevant","correct":true},{"idx":2,"proposition":"The HSPT law of 2009 provides for the creation of ARS responsible for defining new health territories relevant to fight against health inequalities.","correct":true},{"idx":3,"proposition":"Psychiatry is the only medical discipline that can provide care without the consent of the person","correct":true},{"idx":4,"proposition":"The different types of care without consent can only be provided by public structures","correct":false,"justification":"The different types of care without consent (full inpatient or outpatient) are most often provided by public psychiatric services, but some private institutions may also provide this type of care."}],"type":"custom"}
+{"_id":"soinspsy-psy-4","context":null,"enonce":"Care in psychiatry:","item":"soinspsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Sequential care occurs after the CMP for the follow-up of the compensated patient","correct":false,"justification":"They allow intensive outpatient care"},{"idx":1,"proposition":"Part-time therapeutic reception centres (CATTP) provide therapeutic and occupational activities","correct":true},{"idx":2,"proposition":"Full-time hospitalization corresponds to \"traditional\" hospitalization within the hospital (24 hours a day), during the acute phase of the disease","correct":true},{"idx":3,"proposition":"The after-care centers are very short-stay units to ensure the compensation of the disease in 48 hours","correct":false,"justification":"After-care centres are medium-stay units, transitional units between hospital and return home"},{"idx":4,"proposition":"Care aims to limit disability and support the return to independence","correct":true}],"type":"custom"}
+{"_id":"soinspsy-psy-5","context":null,"enonce":"Which propositions are true?","item":"soinspsy","matiere":"psy","propositions":[{"idx":0,"proposition":"CMPs are free","correct":true},{"idx":1,"proposition":"The most used care structure in child psychiatry is the HDJ","correct":false,"justification":"This is the CMP"},{"idx":2,"proposition":"CMP and CMPP are the same thing","correct":false,"justification":"The CMPP is out of sector"},{"idx":3,"proposition":"The most widely used care structure in child psychiatry is the CMP","correct":false,"justification":"This is the HDJ"}],"type":"custom"}
+{"_id":"soinspsy-psy-7","context":null,"enonce":"Regarding CMPs:","item":"soinspsy","matiere":"psy","propositions":[{"idx":0,"proposition":"These are liberal medical structures","correct":false,"justification":"Multidisciplinary structure (doctors, nurses, social workers, psychologists, ...) public."},{"idx":1,"proposition":"They allow hospital care of decompensated patients","correct":false,"justification":"Management is outpatient"},{"idx":2,"proposition":"The reimbursement of consultations is made within 72 hours","correct":false,"justification":"CMPs are free"},{"idx":3,"proposition":"They are open 24 hours a day","correct":false,"justification":"However, this is the case for PACs."},{"idx":4,"proposition":"They ensure a diversity of care offer","correct":true}],"type":"custom"}
+{"_id":"soinspsy-psy-8","context":null,"enonce":"Regarding the epidemiology of the impact of mental disorders:","item":"soinspsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Mental disorders account for 15% of disabilities","correct":true},{"idx":1,"proposition":"Mental disorders cause more disability than cardiovascular disease","correct":false,"justification":"As much as cardiovascular disease"},{"idx":2,"proposition":"Mental disorders cause more disability than cancers","correct":true},{"idx":3,"proposition":"About 2% of the French population suffers from mental disorders","correct":false,"justification":"More than 15%"},{"idx":4,"proposition":"Mental disorders account for 30% of life days lost through preventable mortality or disability","correct":true}],"type":"custom"}
+{"_id":"somatopsy-psy-0","context":null,"enonce":"Regarding somatoform disorders:","item":"somatopsy","matiere":"psy","propositions":[{"idx":0,"proposition":"There are three main somatoform disorders","correct":true},{"idx":1,"proposition":"The distinction between somatoform disorder and psychosomatic disorder is clearly identified and clinically important","correct":false,"justification":"The distinction between somatoform disorder and psychosomatic disorder is not always easy and repeated changes in nosographic classifications have contributed to the confusion."},{"idx":2,"proposition":"The prevalence of somatoform disorders is around 0.1% in adults in the general population","correct":false,"justification":"The prevalence of somatoform disorders is difficult to identify and depends on diagnostic tools and context: it is probably in the range of 5 to 10% for all somatoform disorders in the general adult population (and much more so in a population of medical consultants)"},{"idx":3,"proposition":"Somatization disorder typically begins in late adolescence or young adulthood, at any age for conversion disorder and pain disorder","correct":true},{"idx":4,"proposition":"The ratio by sex is 2:1, with a more frequent presence in women","correct":true}],"type":"custom"}
+{"_id":"somatopsy-psy-1","context":null,"enonce":"Regarding the disorders:","item":"somatopsy","matiere":"psy","propositions":[{"idx":0,"proposition":"The prevalence of suicide attempts is a function of the depressive psychiatric comorbidity to be systematically sought","correct":true},{"idx":1,"proposition":"The association of multiple polymorphic and long-lasting functional complaints has been called Lighter syndrome","correct":true},{"idx":2,"proposition":"Symptoms and signs do not respect the anatomical organization of the central or peripheral nervous system in conversion disorder","correct":true},{"idx":3,"proposition":"In the case of the painful symptom, it is pain whose intensity must be evaluated by a visual analogue scale","correct":true},{"idx":4,"proposition":"We speak of acute painful symptoms if the duration is less than 6 months","correct":true}],"type":"custom"}
+{"_id":"fievrechr-infectio-0","context":null,"enonce":"Regarding prolonged fever:","item":"fievrechr","matiere":"infectio","propositions":[{"idx":0,"proposition":"A prolonged fever is defined as a temperature above 38°C for more than 3 weeks.","correct":true},{"idx":1,"proposition":"10% of prolonged fevers remain without identified etiology, and then require patient monitoring","correct":true,"justification":""},{"idx":2,"proposition":"The temperature is taken, at best, just after the meal","correct":false,"justification":"The temperature is taken away from meals and after 20 minutes of rest"},{"idx":3,"proposition":"The axillary or oral routes are usually used and the measured temperature must be increased by 2°C to obtain the core temperature.","correct":false,"justification":"The axillary or oral tract is usually used: the measured temperature must be increased by 0.5°C to obtain the core temperature"},{"idx":4,"proposition":"The drugs mainly involved in prolonged fivres are antibiotics (ßlactams, rifampicin ...), antiepileptics and antiarrhythmics","correct":true,"justification":"Iatrogenic etiology is one of the elimination diagnoses"}],"type":"custom"}
+{"_id":"fievrechr-infectio-2","context":null,"enonce":"Concerant prolonged fevers:","item":"fievrechr","matiere":"infectio","propositions":[{"idx":0,"proposition":"It will be necessary to look for a dental or sinus focus ","correct":true},{"idx":1,"proposition":"Malignant diseases are responsible for 20 to 30% of prolonged fevers","correct":true},{"idx":2,"proposition":" \"HORTON's disease is the most common immunoinflammatory cause\"","correct":true},{"idx":3,"proposition":"In case of drug cause, fever usually occurs between 7 and 28 days after the introduction of a new treatment","correct":true},{"idx":4,"proposition":"Hypereosinophilia is present in only 20% of drug-induced fever cases","correct":true}],"type":"custom"}
+{"_id":"fievrechr-infectio-3","context":null,"enonce":"What is the threshold for defining the prolonged nature of a fever?","item":"fievrechr","matiere":"infectio","propositions":[{"idx":0,"proposition":"7 days","correct":false,"justification":"3 weeks"},{"idx":1,"proposition":"2 weeks","correct":false,"justification":"3 weeks"},{"idx":2,"proposition":"3 weeks","correct":true,"justification":"True. A prolonged fever is defined as a body temperature above 38.3 degrees Celsius for more than three weeks."},{"idx":3,"proposition":"1 month","correct":false,"justification":"3 weeks"},{"idx":4,"proposition":"Three months","correct":false,"justification":"3 weeks"}],"type":"custom"}
+{"_id":"reactioninfl-infectio-0","context":null,"enonce":"Regarding the inflammatory reaction in general:","item":"reactioninfl","matiere":"infectio","propositions":[{"idx":0,"proposition":"Inflammatory diseases are the leading cause of death","correct":false,"justification":"It is the third leading cause of global mortality, after cancer (1) and cardiovascular disease (2)"},{"idx":1,"proposition":"About 30% of hospitalized patients have a general inflammatory reaction","correct":true},{"idx":2,"proposition":"Inflammatory diseases are often accompanied by AEG","correct":true,"justification":"AEG = anorexia, weight loss, asthenia"},{"idx":3,"proposition":"The 4 clinical signs of inflammation are: redness, warmth, pain, effusion","correct":false,"justification":"The 4 cardinal signs are rougueur, pain, edema and heat"},{"idx":4,"proposition":"Hypotermia eliminates the possibility of an inflammatory reaction","correct":false,"justification":"Some inflammatory diseases are accompanied by a body temperature < 36 degrees Celsius"}],"type":"custom"}
+{"_id":"reactioninfl-infectio-1","context":null,"enonce":"Which molecules are classically increased during an inflammatory reaction?","item":"reactioninfl","matiere":"infectio","propositions":[{"idx":0,"proposition":"The CRP","correct":true,"justification":"Within 24 hours"},{"idx":1,"proposition":"The VS","correct":true},{"idx":2,"proposition":"Ferritin","correct":true},{"idx":3,"proposition":"Albumin","correct":false,"justification":"Albumin is decreased. This is clearly seen in protein electrophoresis"},{"idx":4,"proposition":"Transthyrein","correct":false,"justification":"It is one of the diminished proteins"}],"type":"custom"}
+{"_id":"reactioninfl-infectio-2","context":null,"enonce":"What can be the causes of a normal ESR inflammatory syndrome?","item":"reactioninfl","matiere":"infectio","propositions":[{"idx":0,"proposition":"Leukocytosis","correct":true},{"idx":1,"proposition":"Kidney failure","correct":false,"justification":"Renal failure increases ESR (even without inflammatory syndrome)"},{"idx":2,"proposition":"Polyclonal hypergammaglobulinemia","correct":false,"justification":"Polyclonal hypergammaglobulinemia increases ESR, even in the absence of an inflammatory syndrome"},{"idx":3,"proposition":"Associated sickle cell disease","correct":true},{"idx":4,"proposition":"Dysthyroidism","correct":true}],"type":"custom"}
+{"_id":"FdRCV-cardio-0","context":null,"enonce":"Which of these proposals concerning cardiovascular prevention are true?","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"proposition":"A risk factor is a clinical or biological element associated with an increased risk of developing a disease, with a causal relationship between the factor and the disease.","correct":true,"justification":"In the case of a statistical association without a causal relationship, we speak of a risk marker"},{"idx":1,"proposition":"Removal or reduction of a risk marker does not change the course of a disease","correct":true,"justification":"A risk marker is not causally linked to the disease"},{"idx":2,"proposition":"Framingham study estimates cardiovascular mortality at 10 years","correct":false,"justification":"Risk of cardiovascular events, not mortality"},{"idx":3,"proposition":"In individual prevention, the effect of a prevention program is all the greater the higher the risk of the disease","correct":true},{"idx":4,"proposition":"Aspirin is systematically indicated for secondary prevention of cardiovascular risk","correct":true,"justification":"After a vascular event, the risk is considered very high, aspirin has a benefit"}],"type":"custom"}
+{"_id":"FdRCV-cardio-1","context":null,"enonce":"Which of these proposals concerning cardiovascular prevention are true?","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"proposition":"An absolute risk makes it possible to estimate the risk of an event in an individual over time","correct":true,"justification":"While relative risk allows for comparison"},{"idx":1,"proposition":"Absolute cardiovascular deaths lower in women than in men","correct":false,"justification":"The absolute number of cardiovascular deaths is higher in women (54%), but before age 65 the cardiovascular mortality of men is 3 to 4 times higher than that of women"},{"idx":2,"proposition":"The SCORE depends among other things on the LDLc level","correct":false,"justification":"Total cholesterol or HDLc, but not LDLc"},{"idx":3,"proposition":"The SCORE is valid for any adult under 65 years of age","correct":false,"justification":"The SCORE is valid between 40 and 65 years only"},{"idx":4,"proposition":"Dairy products are associated with increased cardiovascular risk","correct":false,"justification":"On the other hand, red meat is."}],"type":"custom"}
+{"_id":"FdRCV-cardio-2","context":null,"enonce":"Which of these proposals concerning cardiovascular prevention are true?","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Nicotine promotes coronary spasms","correct":true,"justification":"By sympathetic stimulation"},{"idx":1,"proposition":"Smoking lowers LDL-cholesterol levels and increases HDL-cholesterol levels","correct":false,"justification":"Lowering of HDL-cholesterol levels and increased oxidation of LDL-cholesterol, which participates in atherogenesis"},{"idx":2,"proposition":"SCORE tends to underestimate cardiovascular risk in desocialized patients","correct":true},{"idx":3,"proposition":"Sleep apnea syndrome increases cardiovascular risk by 70%","correct":true},{"idx":4,"proposition":"Erectile dysfunction is a cardiovascular risk factor","correct":false,"justification":"A risk marker"}],"type":"custom"}
+{"_id":"FdRCV-cardio-3","context":null,"enonce":"Which of these proposals concerning cardiovascular prevention are true?","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"proposition":"The share attributable to smoking in the occurrence of myocardial infarction is all the more important the younger the subjects","correct":true},{"idx":1,"proposition":"The risk of developing an abdominal aortic aneurysm is significantly increased in smokers","correct":true},{"idx":2,"proposition":"A high cardiovascular risk corresponds to a SCORE of 5-10%","correct":true},{"idx":3,"proposition":"Elevated fibrinogen is associated with coronary cardiovascular excess risk","correct":true},{"idx":4,"proposition":"High blood pressure exposes more to cerebrovascular risk than coronary risk","correct":true}],"type":"custom"}
+{"_id":"FdRCV-cardio-4","context":null,"enonce":"Which of these proposals concerning cardiovascular prevention are true?","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Dyslipidemia is a minor cardiovascular risk factor","correct":false,"justification":"They are a major risk factor"},{"idx":1,"proposition":"An EAL includes a determination of TG, LDLc and HDLc","correct":false,"justification":"LDLc is calculated, according to Friedewald's formula"},{"idx":2,"proposition":"Hypercholesterolemia is mainly due to too high intakes of unsaturated fatty acids","correct":false,"justification":"In saturated fatty acids"},{"idx":3,"proposition":"The diagnosis of hypertension is made on a single measurement when the blood pressure is greater than 180\/60 mmHg","correct":false,"justification":"The diagnosis of hypertension should not be made on a single measurement"},{"idx":4,"proposition":"A normal EAL should be rechecked at 5 years in the absence of an intercurrent event","correct":true}],"type":"custom"}
+{"_id":"FdRCV-cardio-5","context":null,"enonce":"Which of these proposals concerning cardiovascular prevention are true?","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"proposition":"The ambulatory measurement of blood pressure (MAPA) eliminates a \"white coat\" effect related to the presence of the doctor","correct":true},{"idx":1,"proposition":"A screening EAL is recommended for an 85-year-old smoker","correct":false,"justification":"No screening EAL indicated after age 80"},{"idx":2,"proposition":"A 45-year-old type 1 diabetic with no other cardiovascular risk factors or organ damage has a moderate cardiovascular risk","correct":false,"justification":"High cardiovascular risk"},{"idx":3,"proposition":"Abdominal obesity is an indispensable criterion in the diagnosis of metabolic syndrome","correct":false,"justification":"It is no longer an indispensable criterion"},{"idx":4,"proposition":"About 20 million French people are overweight, including 6 million obese","correct":true}],"type":"custom"}
+{"_id":"FdRCV-cardio-6","context":null,"enonce":"Which of the following are non-modifiable cardiovascular risk factors?","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Chronic renal failure","correct":false,"justification":"Modifiable because it can be taken care of and made sure that it is no longer a risk factor"},{"idx":1,"proposition":"Dyslipidemia","correct":false,"justification":"Non-pharmacological and pharmacological management"},{"idx":2,"proposition":"Age","correct":true},{"idx":3,"proposition":"Sex","correct":true},{"idx":4,"proposition":"Heredity","correct":true}],"type":"custom"}
+{"_id":"FdRCV-cardio-7","context":null,"enonce":"Which of the following designate situations in which the SCORE table is not usable?","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Diabetic patient","correct":true},{"idx":1,"proposition":"Smoking patient","correct":false,"justification":"Smoking taken into account"},{"idx":2,"proposition":"Elderly patient","correct":false,"justification":"Age"},{"idx":3,"proposition":"Chronic renal failure patient","correct":true},{"idx":4,"proposition":"Hypertensive patient","correct":false,"justification":"Systolic BP taken into account"}],"type":"custom"}
+{"_id":"FdRCV-cardio-9","context":null,"enonce":"Which of the following proposals fall within the scope of metabolic syndrome?","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Fasting blood glucose","correct":true},{"idx":1,"proposition":"Waist circumference","correct":true},{"idx":2,"proposition":"Blood pressure","correct":true},{"idx":3,"proposition":"LDL cholesterol","correct":false,"justification":"False"},{"idx":4,"proposition":"Triglyceridemia","correct":true}],"type":"custom"}
+{"_id":"TNC-neuro-0","context":null,"enonce":"Regarding delirium syndrome:","item":"TNC","matiere":"neuro","propositions":[{"idx":0,"proposition":"The diagnosis is biological","correct":false,"justification":"Purely clinical"},{"idx":1,"proposition":"A rise in cortisol levels can precipitate or maintain delirium","correct":true},{"idx":2,"proposition":"Oxidative brain metabolism is decreased","correct":true,"justification":"It is believed that the cholinergic system is largely involved"},{"idx":3,"proposition":"It corresponds to acute and severe brain dysfunction","correct":true},{"idx":4,"proposition":"It is responsible for an increase in morbidity and mortality in the following year.","correct":true}],"type":"custom"}
+{"_id":"TNC-neuro-1","context":null,"enonce":"Which of these proposals are part of the DSM-V diagnostic criteria?","item":"TNC","matiere":"neuro","propositions":[{"idx":0,"proposition":"Attention disturbance","correct":true,"justification":"It is the decrease in the ability to lead, focus, support and shift attention."},{"idx":1,"proposition":"Installation in a chronic mode","correct":false,"justification":"The installation is on a short time, from a few hours to a few days"},{"idx":2,"proposition":"It is necessary to highlight a break with the previous state","correct":true,"justification":"In particular through the interrogation of a relative"},{"idx":3,"proposition":"The increase in billirubine","correct":false,"justification":"No biological criteria. The diagnosis is purely clinical"},{"idx":4,"proposition":"There are 5 criteria in total","correct":true}],"type":"custom"}
+{"_id":"TTTKc-onco-0","context":null,"enonce":"Regarding 5-FU, which propositions are true?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Its full name is: 5-Fermanto-Uracile","correct":false,"justification":"5-Fluorouracil"},{"idx":1,"proposition":"It is an analogue of guanine","correct":false,"justification":"It is an analogue of pyrmidines (bases C, T and U)"},{"idx":2,"proposition":"It is an inhibitor of topoisomerases type II","correct":false,"justification":"Toposiomerase type 2 inhibitors are etoposide and anthracycline"},{"idx":3,"proposition":"It has heart type side effects","correct":true},{"idx":4,"proposition":"It has respiratory type side effects","correct":false,"justification":"It is not described in the college"}],"type":"custom"}
+{"_id":"TTTKc-onco-1","context":null,"enonce":"Which of these proposals is, or are, type 2 topoisomerase inhibitors?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Etoposide","correct":true},{"idx":1,"proposition":"Cyclophospamide","correct":false,"justification":"It is an alkylating agent"},{"idx":2,"proposition":"The 5-FU","correct":false,"justification":"It is an antimetabolic (analogue of pyramidin)"},{"idx":3,"proposition":"Anthracycline","correct":true},{"idx":4,"proposition":"Cisplatin","correct":false,"justification":"It is a platinum salt"}],"type":"custom"}
+{"_id":"TTTKc-onco-2","context":null,"enonce":"Which of these propositions is, or is, or is, true with respect to platinum salts?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Cisplatin is one of them","correct":true},{"idx":1,"proposition":"Oxaliplatin is one of them","correct":true},{"idx":2,"proposition":"Carboplatin is one of them","correct":true,"justification":"The three platinum salts are: cisplatin, oxaliplatin and carboplatin"},{"idx":3,"proposition":"These compounds are DNA alkylating agents","correct":true},{"idx":4,"proposition":"Cisplatin has renal toxicity that may cause acute tubular necrosis","correct":true}],"type":"custom"}
+{"_id":"TTTKc-onco-3","context":null,"enonce":"Which of these proposals are, or are, expected adverse effects of hydroxyurea?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Disruption of the blood count","correct":true,"justification":"Hydroxyurea is a myelosupressor: penias can be observed (leukopenia, thrombocytopenia, or even macrocytic anemia)"},{"idx":1,"proposition":"Lung damage","correct":false},{"idx":2,"proposition":"Heart damage","correct":false},{"idx":3,"proposition":"Digestive disorders","correct":false},{"idx":4,"proposition":"Skin damage","correct":true,"justification":"Ulcers in particular"}],"type":"custom"}
+{"_id":"TTTKc-onco-4","context":null,"enonce":"Which of these proposals are, or are, folic antimetabolics?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Mehotrexate","correct":true},{"idx":1,"proposition":"The 5-FU","correct":false,"justification":"It is a pyrimide antimetabolic, along with gemcitabine"},{"idx":2,"proposition":"Thiopurine","correct":false},{"idx":3,"proposition":"Cyclophosphamide","correct":false,"justification":"It is an alkylating agent"},{"idx":4,"proposition":"Pemetrexed","correct":true}],"type":"custom"}
+{"_id":"TTTKc-onco-5","context":null,"enonce":"Which of these proposals are, or are, stabilizers of the spindle?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Docetaxel","correct":true},{"idx":1,"proposition":"Etoposide","correct":false,"justification":"It is a type 2 topoisomerase inhibitor"},{"idx":2,"proposition":"Anthracycline","correct":false,"justification":"It is a type 2 topoisomerase inhibitor"},{"idx":3,"proposition":"Paclitaxel","correct":true},{"idx":4,"proposition":"Taxanes","correct":true}],"type":"custom"}
+{"_id":"TTTKc-onco-6","context":null,"enonce":"Which of the following are true about Denosumab?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"It is a bi-phosphonate","correct":false,"justification":"None"},{"idx":1,"proposition":"It is an anti-RANK-L antibody","correct":true},{"idx":2,"proposition":"It decreases bone resorption","correct":true},{"idx":3,"proposition":"There is a risk of hypocalcemia","correct":true},{"idx":4,"proposition":"It reduces bone pain","correct":true}],"type":"custom"}
+{"_id":"TTTKc-onco-7","context":null,"enonce":"Which of the following is true?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Platinum salts block chromosome depolymerization","correct":false,"justification":"This is the case with depolymerase inhibitors (taxanes such as Paclitaxel)"},{"idx":1,"proposition":"Platinum salts cause adducts with DNA inhibiting its replication","correct":true,"justification":"True, these are alkylating agents"},{"idx":2,"proposition":"Platinum salts inhibit folate synthesis","correct":false,"justification":"This is the case of antimetabolics"},{"idx":3,"proposition":"Platinum salts inhibit the action of topoisomerase I","correct":false,"justification":"This is the case of Tecans (irinotecan and topotecan)"},{"idx":4,"proposition":"Platinum salts inhibit the action of topoisomerase II","correct":false,"justification":"This is the case for anthracyclines and etoposide"}],"type":"custom"}
+{"_id":"TTTKc-onco-8","context":null,"enonce":"Which of the following are the toxicities of platinum salts?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Renal toxicity ","correct":true},{"idx":1,"proposition":"Cardiotoxicity","correct":false,"justification":"This is the case of 5-FU (coronary spasm) and anthracyclines (dilated cardiomyopathy)"},{"idx":2,"proposition":"Ototoxicity","correct":true},{"idx":3,"proposition":"Peripheral neuropathy","correct":true,"justification":"True, neuropathy in cold"},{"idx":4,"proposition":"Pulmonary fibrosis","correct":false,"justification":"This is the case of bleomycin"}],"type":"custom"}
+{"_id":"TTTKc-onco-10","context":null,"enonce":"Which of the following are recommended before starting Denosumab therapy?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Oral check-up","correct":true},{"idx":1,"proposition":"ECG and ETT","correct":false,"justification":"No cardiac toxicity"},{"idx":2,"proposition":"Calciuria","correct":false,"justification":"Useless"},{"idx":3,"proposition":"X-rays of the skeleton","correct":false,"justification":"Useless"},{"idx":4,"proposition":"Calculation of corrected serum calcium","correct":true,"justification":"True, in front of the risk of hypercalcemia"}],"type":"custom"}
+{"_id":"TTTKc-onco-11","context":null,"enonce":"Which of the following are complications of an autologous transplant?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Febrile aplasia","correct":true},{"idx":1,"proposition":"Need to transfuse","correct":true},{"idx":2,"proposition":"Graft vs host reaction (GvH)","correct":false,"justification":"The \"plugin\" comes from the host"},{"idx":3,"proposition":"Failure","correct":false,"justification":"The \"plugin\" comes from the host"},{"idx":4,"proposition":"Mucite","correct":true}],"type":"custom"}
+{"_id":"TTTKc-onco-12","context":null,"enonce":"Which of the following are true?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Anthracyclines have cumulative cardiac toxicity","correct":true},{"idx":1,"proposition":"Taxanes are spindle poisons","correct":true},{"idx":2,"proposition":"Cyclophosphamide is a platinum salt","correct":false,"justification":"It is an alkylating agent"},{"idx":3,"proposition":"Trastuzumab poses risk of myocardial toxicity","correct":true},{"idx":4,"proposition":"Anti-pyrimides are topoisomerase inhibitors","correct":false,"justification":"They are anti-metaboblic"}],"type":"custom"}
+{"_id":"TTTKc-onco-13","context":null,"enonce":"Which of the following are true for bentuximab?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"It is an anti-CD30 monoclonal antibody","correct":true},{"idx":1,"proposition":"It is a tyrosine kinase inhibitor","correct":false,"justification":"False, this is the case of Jakavi for example"},{"idx":2,"proposition":"It is administered orally","correct":false,"justification":"It is administered intravenously"},{"idx":3,"proposition":"There is a risk of peripheral neuropathy","correct":true},{"idx":4,"proposition":"It is conjugated to a spindle poison","correct":true}],"type":"custom"}
+{"_id":"TTTKc-onco-14","context":null,"enonce":"Which of the following proposals regarding the adverse effects of brain radiotherapy are true?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Cerebral focal radionecrosis","correct":true,"justification":"True, remote"},{"idx":1,"proposition":"Cerebral edema","correct":true,"justification":"True, in acute"},{"idx":2,"proposition":"Radiation leukoencephalopathy","correct":true,"justification":"True, remote"},{"idx":3,"proposition":"Cognitive impairment","correct":true,"justification":"True, due to transient diffuse demyelination"},{"idx":4,"proposition":"Fever","correct":true,"justification":"True, acute, but it's rare"}],"type":"custom"}
+{"_id":"anapathKc-onco-0","context":null,"enonce":"Which of these proposals make it possible to study isolated cells?","item":"anapathKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Biopsy of a VADS tumor","correct":false,"justification":"Biopsies of solid tumours extract tissue, not isolated cells."},{"idx":1,"proposition":"Biopsy of a gastric tumor induced by H. Pylori","correct":false,"justification":"Biopsies of solid tumours extract tissue, not isolated cells."},{"idx":2,"proposition":"A blood test","correct":true},{"idx":3,"proposition":"A urine sample","correct":true},{"idx":4,"proposition":"A myelogram","correct":true,"justification":"While the BOM makes it possible to study the fabric"}],"type":"custom"}
+{"_id":"anapathKc-onco-2","context":null,"enonce":"Among these colorations, which one or which ones make it possible to highlight Iron?","item":"anapathKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Perls","correct":true,"justification":"It makes it possible to highlight the iron fixed in hemosiderin colored blue by Prussian blue; The nuclei are highlighted by nuclear red."},{"idx":1,"proposition":"Hemalun-Eosin","correct":false,"justification":"Classic fabrics"},{"idx":2,"proposition":"Polarized light","correct":false,"justification":"Be careful, it does not count as a coloring. This is a different microscopy technique"},{"idx":3,"proposition":"Red Congo","correct":false,"justification":"Amyloid deposits"},{"idx":4,"proposition":"Grocott","correct":false,"justification":"It is used in histology for the visualization of fungi, certain pathogens, basement membranes"}],"type":"custom"}
+{"_id":"anapathKc-onco-4","context":null,"enonce":"Which of these stains can highlight lipids?","item":"anapathKc","matiere":"onco","propositions":[{"idx":0,"proposition":"India ink","correct":false},{"idx":1,"proposition":"Perls","correct":false},{"idx":2,"proposition":"Black Sudan","correct":true,"justification":"Sudan dyes are synthetic dyes characterized by a nitrogen group. Their main property is to be soluble in hydrocarbons, oils, fats and waxes, which are then colored."},{"idx":3,"proposition":"Formalin","correct":false,"justification":"It is not a coloring but a fixing agent"},{"idx":4,"proposition":"Ziehl","correct":false,"justification":"It is the dye used to highlight Acid-Alcohol-Resistant Bacilli (tuberculosis bacilli)"}],"type":"custom"}
+{"_id":"hemgenitale-gyn-0","context":null,"enonce":"General:","item":"hemgenitale","matiere":"gyn","propositions":[{"idx":0,"proposition":"Genital bleeding is a very rare reason for consultation in general practice","correct":false,"justification":"Frequent reason for consultation"},{"idx":1,"proposition":"The main etiology is urinary tract infection","correct":false,"justification":"2 main etiologies: hormonal dysfunctions + pregnancy"},{"idx":2,"proposition":"Pregnancy is a leading cause of genital bleeding","correct":true},{"idx":3,"proposition":"The essential complementary examination is the LH\/FSH assay","correct":false,"justification":"This is ultrasound"},{"idx":4,"proposition":"They are therefore not limited to uterine haemorrhages","correct":true}],"type":"custom"}
+{"_id":"hemgenitale-gyn-1","context":null,"enonce":"General:","item":"hemgenitale","matiere":"gyn","propositions":[{"idx":0,"proposition":"A distinction is made between vulvar hemorrhages, vaginal hemorrhages and cervical hemorrhages","correct":true,"justification":"These are the three subtypes of hemorrhages"},{"idx":1,"proposition":"In case of suspicion of adenomyosis, MRI is indicated","correct":true},{"idx":2,"proposition":"Postmenopausal endometrial cancer should be suspected","correct":true},{"idx":3,"proposition":"Upper genital hemorrhage originates from the cervix","correct":false,"justification":"This would be a lower genital hemorrhage. High = hutterine cavity externalized by the cervix"},{"idx":4,"proposition":"The duration of normal menstruation is between 3 and 6 days","correct":true,"justification":"Normal abundance is between 50 and 80 mL"}],"type":"custom"}
+{"_id":"hemgenitale-gyn-2","context":null,"enonce":"Regarding abnormal bleeding during menstruation:","item":"hemgenitale","matiere":"gyn","propositions":[{"idx":0,"proposition":"Conventionally the periods are more abundant the first 3 days and less abundant thereafter","correct":true},{"idx":1,"proposition":"Normal period blood is coagulable, like venous blood","correct":false,"justification":"Normal period blood is incoagulable"},{"idx":2,"proposition":"Menorrhagia.","correct":true},{"idx":3,"proposition":"Polymenorrhea are menorrhagia","correct":true,"justification":"Rules with anomalies of duration and abundance"},{"idx":4,"proposition":"The prevalence of menometrorrhagia is around 1% in the general population","correct":false,"justification":"Between 11 and 13%"}],"type":"custom"}
+{"_id":"hemgenitale-gyn-4","context":null,"enonce":"Regarding genital bleeding:","item":"hemgenitale","matiere":"gyn","propositions":[{"idx":0,"proposition":"Functional metrorrhagia are due to endometrial alteration","correct":true,"justification":"Often caused by an imbalance in the estrogen-progestin balance"},{"idx":1,"proposition":"Functional menorrhagia is non-existent","correct":false,"justification":"It can exist"},{"idx":2,"proposition":"Organic bleeding affects the cervix most often","correct":false,"justification":"Uterine, tubal or ovarian pathology. Bleeding from the cervix is part of lower genital bleeding"},{"idx":3,"proposition":"The causes of menoage and metrorrhagia are often intertwined","correct":true,"justification":"Especially non-menopausal"},{"idx":4,"proposition":"Genital bleeding is not limited to uterine hemorrhages","correct":true,"justification":"They are due to a permanent or temporary alteration of the endometrium caused by a hormonal imbalance of the estrogen-progestin balance"}],"type":"custom"}
+{"_id":"bioT-rhumato-0","context":null,"enonce":"Some general generalities:","item":"bioT","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Biotherapies have existed for a hundred years","correct":false,"justification":"Rather fifteen years"},{"idx":1,"proposition":"Biotherapies are molecules taken from the human body and injected in large quantities into sick people","correct":false,"justification":"They are substances produced and purified from the use of living organisms for the purpose of treating diseases"},{"idx":2,"proposition":"Background treatments are opposed to symptomatic treatments","correct":true},{"idx":3,"proposition":"DMARDs are Drug Modifing the Activity of the Rheumatic Disease","correct":true},{"idx":4,"proposition":"Synthetic and biological DMARDs are separated","correct":true}],"type":"custom"}
+{"_id":"bioT-rhumato-1","context":null,"enonce":"Regarding the nomenclature:","item":"bioT","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Methotrexate is a csDMARD","correct":true},{"idx":1,"proposition":"A distinction is made between original bDMARDs (boDMARDs) and biosimilar bDMARDs (bsDMARDs)","correct":true},{"idx":2,"proposition":"Biosimilars are copies of the original molecules but require the same technology to produce them.","correct":true},{"idx":3,"proposition":"The boDMARD are cheaper than the bsDMARDs","correct":false,"justification":"It's the other way around"},{"idx":4,"proposition":"-mumab are chimeric antibodies","correct":false,"justification":"They are completely humanized ACs"}],"type":"custom"}
+{"_id":"bioT-rhumato-2","context":null,"enonce":"Which propositions are true?","item":"bioT","matiere":"rhumato","propositions":[{"idx":0,"proposition":"The tsDMARDs are the targeted synthetic DMARDs","correct":true},{"idx":1,"proposition":"The bsDMARDs are the biological original DMARDs","correct":false,"justification":"These are the biosimilars"},{"idx":2,"proposition":"There are twelve biotherapies that have a MA in chronic inflammatory rheumatism and autoimmune diseases","correct":true},{"idx":3,"proposition":"The prescription of biomedicines is governed by an initial hospital prescription (PIH)","correct":true},{"idx":4,"proposition":"The first-line prescription in osteoarthritis is methotrexate","correct":false,"justification":"In RA"}],"type":"custom"}
+{"_id":"bioT-rhumato-3","context":null,"enonce":"Regarding the indications for targeted therapies:","item":"bioT","matiere":"rhumato","propositions":[{"idx":0,"proposition":"If contraindications to methotrexate in RA are prescribed.","correct":false,"justification":"Leflunomide if CI to methotrexate in RA"},{"idx":1,"proposition":"In RA, it is generally advisable to combine biotherapy with DMARD","correct":true},{"idx":2,"proposition":"Anti-TNF have indications in some SpA","correct":true},{"idx":3,"proposition":"Secukinumab has MA for ankylosing spondylitis","correct":true},{"idx":4,"proposition":"Secukinumab has MA only in ankylosing spondylitis","correct":false,"justification":"Also in psoriatic arthritis"}],"type":"custom"}
+{"_id":"transfusion-therapeutique-0","context":null,"enonce":"What are the indications for phenotyped red blood cells?","item":"transfusion","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Immunological thrombocytopenic purpura","correct":false,"justification":"No indication"},{"idx":1,"proposition":"Sickle-cell anemia","correct":true},{"idx":2,"proposition":"The woman in immediate post-menopause","correct":false,"justification":"The young woman, until menopause"},{"idx":3,"proposition":"IgG deficiency","correct":false,"justification":"Unless at risk of repetitive transfusions"},{"idx":4,"proposition":"Rhesus alloimmunization","correct":true}],"type":"custom"}
+{"_id":"acroSd-cardio-0","context":null,"enonce":"Which of these substances can cause secondary Raynaud's syndrome?","item":"acroSd","matiere":"cardio","propositions":[{"idx":0,"proposition":"Amiodarone","correct":false,"justification":"Class III antiarrhythmic according to the Vaughan-Williams classification. It delays the repolarization of the heart cell and extends the refractory period of the latter homogeneously. It has no significant effect on vasoconstriction of finger arteries."},{"idx":1,"proposition":"Beta-2 mimetics","correct":false,"justification":"It is the beta-blockers that cause peripheral vasoconstriction"},{"idx":2,"proposition":"Some chemotherapies","correct":true},{"idx":3,"proposition":"Les IEC","correct":false,"justification":"ACE inhibitors (which then reduce the production of angiotensin II) do not have significant effects on the arteries of the hands"},{"idx":4,"proposition":"Calcium channel blockers","correct":false,"justification":"calcium channel blockers, such as nifedipine or amlodipine, reduce the number of seizures and decrease their severity through their vasodilator effect"}],"type":"custom"}
+{"_id":"acroSd-cardio-1","context":null,"enonce":"Which of these proposals concerning Raynaud's syndrome is true?","item":"acroSd","matiere":"cardio","propositions":[{"idx":0,"proposition":"The syncopal phase is the final phase","correct":false,"justification":"This is the first phase"},{"idx":1,"proposition":"The syncopal phase begins the phenomenon","correct":true},{"idx":2,"proposition":"The syncopal phase is painful","correct":false,"justification":"It is painless"},{"idx":3,"proposition":"During the syncopal phase, the fingers are red","correct":false,"justification":"They are white and cold"},{"idx":4,"proposition":"The syncopal phase is accompanied by cutaneous hyperesthesia","correct":false,"justification":"Rather, there is cutaneous hypoaesthesia"}],"type":"custom"}
+{"_id":"acroSd-cardio-2","context":null,"enonce":"Which propositions are true?","item":"acroSd","matiere":"cardio","propositions":[{"idx":0,"proposition":"Raynaud's phenomenon is the most common acrosyndrome.","correct":true},{"idx":1,"proposition":"Acrosyndromes may be accompanied by trophic disorders","correct":true},{"idx":2,"proposition":"Scleroderma may accompany Raynaud's phenomenon","correct":true},{"idx":3,"proposition":"Raynaud's disease is the only etiology of Raynaud's phenomenon","correct":false,"justification":"Raynaud's phenomenon can have many etiologies: Rayaud's disease, scleroderma, Leo Burger, ..."},{"idx":4,"proposition":"Essential acrocyanosis finds hot and painful extremities","correct":false,"justification":"In essential acrocyanosis, the extremities are purple, cold, clammy and painless."}],"type":"custom"}
+{"_id":"acroSd-cardio-3","context":null,"enonce":"Which of these proposals are acrosyndromes?","item":"acroSd","matiere":"cardio","propositions":[{"idx":0,"proposition":"Rheumatoid purpura","correct":false},{"idx":1,"proposition":"Frostbite","correct":true,"justification":"Skin lesions after exposure to cold and\/or moisture"},{"idx":2,"proposition":"Livedo","correct":false},{"idx":3,"proposition":"PAD","correct":false},{"idx":4,"proposition":"Essential acrocyanosis","correct":true}],"type":"custom"}
+{"_id":"acroSd-cardio-4","context":null,"enonce":"Regarding Leo Buerger's disease:","item":"acroSd","matiere":"cardio","propositions":[{"idx":0,"proposition":"It is also called Thromboangiitis Obliterans","correct":true},{"idx":1,"proposition":"It is characterized by segmental and inflammatory obliteration of medium and small vessels","correct":true},{"idx":2,"proposition":"Tobacco is a protective factor","correct":false,"justification":"The role of tobacco appears essential in the initiation and clinical aggravation of the disease."},{"idx":3,"proposition":"It is benign and does not require further examination","correct":false,"justification":"An underlying immunological cause or thrombophilia (inflammatory or immunological assessment for ANCA, antiphospholipid antibodies, or antinuclear antibodies) must be ruled out and imaging tests are often required"},{"idx":4,"proposition":"Calcium channel blockers are proposed as a first-line treatment","correct":false,"justification":"There is currently no specific treatment for Buerger's disease. Only smoking cessation has been shown to be effective"}],"type":"custom"}
+{"_id":"PKRAD-nephro-0","context":null,"enonce":"The basics of autosomal dominant polycystic kidney disease (ADPKD):","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"Autosomal dominant polycystic kidney disease has a prevalence of 1\/1,000 in the general population","correct":true},{"idx":1,"proposition":"It causes about 60-80% of end-stage renal failure","correct":false,"justification":"The leading cause of ESRD is hypertensive nephropathy. ADPKD is responsible for 8-10% of IRTs"},{"idx":2,"proposition":"Transmission of the disease occurs in an autosomal dominant manner","correct":true},{"idx":3,"proposition":"The gene concerned is located on the Y chromosome","correct":false,"justification":"It is either chromosome 16 (for PKD1) or chromosome 4 (for PKD2)"},{"idx":4,"proposition":"ADPKD is genetically heterogeneous","correct":true}],"type":"custom"}
+{"_id":"PKRAD-nephro-1","context":null,"enonce":"Which propositions are true?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"PKD2 is more common than PKD1","correct":false,"justification":"It's the opposite: the frequency of PKD1 is 85%"},{"idx":1,"proposition":"About 5% of patients have a de novo mutation","correct":true},{"idx":2,"proposition":"Abdominal ultrasound can evoke the diagnosis","correct":true},{"idx":3,"proposition":"The diagnosis is most often made from the age of 60, when renal failure becomes terminal","correct":false,"justification":"It is usually in young adults (hypertension, abdominal thinker, etc.)"},{"idx":4,"proposition":"After the age of 40, the presence of less than 2 cysts excludes the disease","correct":true}],"type":"custom"}
+{"_id":"PKRAD-nephro-2","context":null,"enonce":"Which propositions are true?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"Ultrasound has a higher sensitivity than CT scan","correct":false,"justification":"The scanner is more sensitive to detect"},{"idx":1,"proposition":"Cysts are multiple and bilateral most often","correct":true},{"idx":2,"proposition":"Cysts are responsible for compression and progressive fibrosis of the non-cystic renal parenchyma","correct":true},{"idx":3,"proposition":"ADPKD is therefore glomerular nephropathy","correct":false,"justification":"Tubulointerstitial nephropathy"},{"idx":4,"proposition":"Cysts are fluid cavities","correct":true}],"type":"custom"}
+{"_id":"PKRAD-nephro-3","context":null,"enonce":"Which propositions are true?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"The exact characterization of the mutation in question is essential","correct":false,"justification":"Being a polygenic disease, with relatively independent management of the type of mutation, accurate genetic analysis is both complex and unnecessary"},{"idx":1,"proposition":"The mode of transmission concerns gonosomes","correct":false,"justification":"Chromosome 4 (PKAD 2) and 16 (PKAD 1) mostly"},{"idx":2,"proposition":"It is the cause of about 10% of ESRD","correct":true},{"idx":3,"proposition":"It requires a family tree for the identification and monitoring of relatives","correct":true},{"idx":4,"proposition":"It is linked to de novo mutations in 90% of cases","correct":false,"justification":"5 %"}],"type":"custom"}
+{"_id":"PKRAD-nephro-4","context":null,"enonce":"What are the symptoms possibly caused by autosomal dominant polycystic kidney disease?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"Macroscopic hematuria","correct":true},{"idx":1,"proposition":"High blood pressure","correct":true},{"idx":2,"proposition":"Testicular torsion","correct":false,"justification":"No link mentioned in the college"},{"idx":3,"proposition":"Major glomerulopathy","correct":false,"justification":"It is a tubulointerstitial disease"},{"idx":4,"proposition":"Vasculitis","correct":false,"justification":"No link mentioned in the college"}],"type":"custom"}
+{"_id":"PKRAD-nephro-5","context":null,"enonce":"What are the symptoms possibly caused by autosomal dominant polycystic kidney disease?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"Chronic renal failure","correct":true},{"idx":1,"proposition":"A urinary tract infection","correct":true},{"idx":2,"proposition":"Severe acute pyelonephritis","correct":true},{"idx":3,"proposition":"A ruptured cerebral aneurysm","correct":true},{"idx":4,"proposition":"Severe hypertension","correct":true}],"type":"custom"}
+{"_id":"PKRAD-nephro-6","context":null,"enonce":"Regarding the conscriptive cerebrity aneurysms of PKAD:","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"They are linked to the PKD2 gene only","correct":false,"justification":"PKD1 and PKD2"},{"idx":1,"proposition":"The prevalence of cerebral aneurysms is 40% in case of confirmed PKAD","correct":false,"justification":"8%, or 16% in case of family history of aneurysm. In the general population, the prevalence is 1.5%"},{"idx":2,"proposition":"They sit preferentially within the Willis polygon","correct":true},{"idx":3,"proposition":"The average age of rupture is 81 years","correct":false,"justification":"Much younger: at 41"},{"idx":4,"proposition":"Screening angio-MRI should be offered before age 50 to first-degree relatives of PKRAD patients who have ruptured a cerebral aneurysm","correct":true}],"type":"custom"}
+{"_id":"PKRAD-nephro-7","context":null,"enonce":"Which of the following are true?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"A brain aneurysm should be routinely tested for by MRI angiography in all patients with ADPKD","correct":false,"justification":"False. Only if a patient has a 1st degree family history of brain aneurysm, or if the patient is doing a risky job (e.g. airline pilot)"},{"idx":1,"proposition":"In a family with ADPKD, an unaffected person does not transmit the disease","correct":true},{"idx":2,"proposition":"About 5% of patients have a de novo mutation, i.e. one not transmitted by a parent","correct":true},{"idx":3,"proposition":"When faced with the diagnosis of ADPKD, it is not currently indicated to identify the genetic mutation in families, except in special cases ","correct":true},{"idx":4,"proposition":"If a mother with ADPKD wishes to have a child, she can have genetic counselling and pre-implantation diagnosis.","correct":false,"justification":"False. This is not provided for in the ADRP"}],"type":"custom"}
+{"_id":"PKRAD-nephro-8","context":null,"enonce":"In what circumstances(ies) can the diagnosis of ADKDP be affirmed?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"6 cysts per kidney in a subject over 60 years of age","correct":true,"justification":"True. ≥ 5 cysts \/ kidney from 60 years"},{"idx":1,"proposition":"1 cyst on the right kidney and 2 cysts on the left kidney in a 45-year-old subject","correct":false,"justification":"False. It takes ≥ 2 cysts \/ kidney between 40 and 60 years to make the diagnosis."},{"idx":2,"proposition":"4 cysts per kidney in a 63-year-old subject","correct":false,"justification":"False. It is necessary ≥ 5 cysts \/ kidney from 60 years"},{"idx":3,"proposition":"1 cyst on the left kidney and 2 cysts on the right kidney in a 33-year-old subject","correct":true,"justification":"True. ≥ 3 uni- or bilateral cysts if the subject is under 40 years of age."},{"idx":4,"proposition":"5 cysts on the right kidney and 4 cysts on the left kidney in a 69-year-old subject","correct":false,"justification":"False. ≥ 5 cysts \/ kidney from 60 years"}],"type":"custom"}
+{"_id":"PKRAD-nephro-9","context":null,"enonce":"Which of the following are true?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"A patient under 18 years of age with a parent with ADPKD should be screened by abdominal ultrasound","correct":false,"justification":"False. No screening of minors. Abdominal ultrasound will be done after 18 years"},{"idx":1,"proposition":"In a patient under 18 years of age with a parent with ADPKDP, paediatric follow-up with annual monitoring of hypertension is required.","correct":true},{"idx":2,"proposition":"Renal involvement is secondary to the progressive development of multiple cysts in both kidneys, responsible for compression and progressive fibrosis of the non-cystic renal parenchyma.","correct":true},{"idx":3,"proposition":"Cysts are developed only at the expense of the distal renal tubules ","correct":false,"justification":"False. Cysts are developed at the expense of any renal tubule"},{"idx":4,"proposition":"The growth of cysts results from a proliferation of the cells lining the cysts, and a secretion of fluid by these same cells","correct":true}],"type":"custom"}
+{"_id":"PKRAD-nephro-10","context":null,"enonce":"In front of a patient affected by ADPKD and who has macroscopic hematuria without fever, it is necessary to evoke what diagnosis(s)?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"Intracystic hemorrhage","correct":true},{"idx":1,"proposition":"Urolithiasis","correct":true},{"idx":2,"proposition":"Acute pyelonephritis","correct":false,"justification":"False. There would be a fever."},{"idx":3,"proposition":"Intracystic infection","correct":false,"justification":"False"},{"idx":4,"proposition":"None of these answers","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"PKRAD-nephro-11","context":null,"enonce":"Which of the following proposals may be present in a patient with ADPKD?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"Aortic insufficiency","correct":false,"justification":"False. Mitral insufficiency"},{"idx":1,"proposition":"Diverticular disease","correct":true},{"idx":2,"proposition":"Umbilical hernia","correct":false,"justification":"False. Inguinal hernia"},{"idx":3,"proposition":"Cerebral aneurysm","correct":true},{"idx":4,"proposition":"Pancreatic cysts","correct":false,"justification":"False. Hepatic cysts"}],"type":"custom"}
+{"_id":"PKRAD-nephro-12","context":null,"enonce":"Regarding the management of intracystic infections. Which of the following are true?","item":"PKRAD","matiere":"nephro","propositions":[{"idx":0,"proposition":"Urinary functional signs are uncommon","correct":true},{"idx":1,"proposition":"If ECBU does not show bacteria, the diagnosis of a kidney cyst infection may be rejected","correct":false,"justification":"False. ECBU is often sterile because the bacteria are in the cyst."},{"idx":2,"proposition":"Dual therapy with C3G + amikacin is recommended","correct":false,"justification":"False. Fluoroquinolone + Cotrimoxazole 3 to weeks"},{"idx":3,"proposition":"It is necessary to systematically puncture the cyst to evacuate its contents","correct":false,"justification":"False. A puncture of the cyst will be done when there is a persistence of fever > 7 days under dual antibiotic therapy"},{"idx":4,"proposition":"A PET scanner is systematically recommended","correct":false,"justification":"False. The PET scanner can be done in case of failure of antibiotic therapy"}],"type":"custom"}
+{"_id":"oedemes-nephro-0","context":null,"enonce":"Concerning generalized edema:","item":"oedemes","matiere":"nephro","propositions":[{"idx":0,"proposition":"Generalized oedema is the consequence of extracellular hyperhydration","correct":true},{"idx":1,"proposition":"An anasarca corresponds to edema of the lower limbs that do not disappear after 3 months","correct":false,"justification":"It is the association of generalized edema and effusions of serous"},{"idx":2,"proposition":"Generalized edema is not accompanied by ochre dermatitis","correct":true},{"idx":3,"proposition":"A venous obstacle can only involve generalized edema","correct":false,"justification":"Thrombophlebitis can result in IMO"},{"idx":4,"proposition":"The formation of edema requires increased purification of salt by the kidneys","correct":false,"justification":"On the contrary, sodium and water retention is observed by the kidneys"}],"type":"custom"}
+{"_id":"oedemes-nephro-1","context":null,"enonce":"What are the real propositions?","item":"oedemes","matiere":"nephro","propositions":[{"idx":0,"proposition":"The increase in capillary hydrostatic pressure corresponds to an increase in Starling force","correct":true},{"idx":1,"proposition":"Areas with minimal capillary hydrostatic pressure are deck zones.","correct":false,"justification":"The capillary hydrostatic pressure is, on the contrary, maximum in the detached zones. This is why edema is formed preferentially in these areas (lower limbs when the patient is in an upright position, lower back when he is in a horizontal position)"},{"idx":2,"proposition":"The amount of sodium contained in the human body determines the extracellular volume","correct":true},{"idx":3,"proposition":"The regulation of the body's sodium capital is carried out by the liver","correct":false,"justification":"Through the kidneys"},{"idx":4,"proposition":"True hypervolemia is sodium retention by the kidney","correct":true,"justification":"Seen during renal failure"}],"type":"custom"}
+{"_id":"oedemes-nephro-3","context":null,"enonce":"Regarding the etiologies of edema and their clinical signs:","item":"oedemes","matiere":"nephro","propositions":[{"idx":0,"proposition":"In heart failure, antinatriuretic systems are stimulated and reabsorb sodium and water","correct":true},{"idx":1,"proposition":"The increase in blood volume following the positive sodium and fluid balance increases filling pressures and improves cardiac function","correct":true},{"idx":2,"proposition":"True hypovolemia is observed in hepatic cirrhosis","correct":false,"justification":"It is an effective hypovolemia that is due to the sequestration of blood in the splanchnic territory"},{"idx":3,"proposition":"Clinical signs begin to be frank from 100 mL of edema","correct":false,"justification":"They are frank when they exceed 3% of body weight (2L at least)"},{"idx":4,"proposition":"Generalized edema is white, soft, painful and does not take the bucket","correct":false,"justification":"They are bilateral, symmetrical, declivated, white, soft, painless, taking the bucket"}],"type":"custom"}
+{"_id":"oedemes-nephro-4","context":null,"enonce":"Which propositions are true?","item":"oedemes","matiere":"nephro","propositions":[{"idx":0,"proposition":"Regular weighing of a patient is the best parameter to evaluate the effectiveness of the treatment put in place","correct":true},{"idx":1,"proposition":"Edema has no clear consequences on the biological balance","correct":false,"justification":"Hemodilution and decreased hematocrit and protein are observed"},{"idx":2,"proposition":"Natriueresis is preserved in the phase of constitution of edema","correct":false,"justification":"It is collapsed"},{"idx":3,"proposition":"Pleural effusions suggest anasarca","correct":true},{"idx":4,"proposition":"Chronic or acute viral hepatitis can cause edema","correct":true}],"type":"custom"}
+{"_id":"oedemes-nephro-5","context":null,"enonce":"Edema can be caused by: ","item":"oedemes","matiere":"nephro","propositions":[{"idx":0,"proposition":"An increase in systemic blood pressure ","correct":false},{"idx":1,"proposition":"An increase in capillary hydrostatic pressure ","correct":true},{"idx":2,"proposition":"An increase in plasma oncotic pressure ","correct":false},{"idx":3,"proposition":"An increase in plasma osmolality ","correct":false},{"idx":4,"proposition":"An increase in capillary permeability ","correct":true}],"type":"custom"}
+{"_id":"oedemes-nephro-6","context":null,"enonce":"A 50-year-old patient consults for edema of the lower limbs. The balance sheet finds a hypertension, an albuminemia at 20 g \/ L, a proteinemia at 50 g \/ L, a natremia at 120 mmol \/ L. BU: 3 cross of prot, a cross of red blood cells, no leukocyte. The patient presents: ","item":"oedemes","matiere":"nephro","propositions":[{"idx":0,"proposition":"Edema is explained by hyponatremia. ","correct":false,"justification":"Natremia reflection of the intraCR sector"},{"idx":1,"proposition":"Pure nephrotic syndrome ","correct":false},{"idx":2,"proposition":"Impure nephrotic syndrome ","correct":true,"justification":"Nephrotic SD: Proteinuria + Hypoabuminemia. Impure because hematuria and HTA."},{"idx":3,"proposition":"A nephretic syndrome ","correct":false},{"idx":4,"proposition":"A syndrome of redidivating hematuria ","correct":false}],"type":"custom"}
+{"_id":"pratiquespro-sp-0","context":null,"enonce":"Regarding the quality approach","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"The quality of care and the health system is a real public health issue","correct":true},{"idx":1,"proposition":"ANDEM was created in 1801 by Napoleon","correct":false,"justification":"Health system evaluation structures were created very late. The first (ANDEM) was created in 1989."},{"idx":2,"proposition":"The HAS (Haute Autorité de Santé) was created in 1946","correct":false,"justification":"2004. She is the descendant of ANAES (1996), herself who comes from ANDEM (1989)"},{"idx":3,"proposition":"The quality approach is inspired by the world of industry and services","correct":true},{"idx":4,"proposition":"The France is a pioneer in the field of","correct":false,"justification":"We started with a lot of delay.\""}],"type":"custom"}
+{"_id":"pratiquespro-sp-1","context":null,"enonce":"Quality of care is an approach that must allow:","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"To guarantee the patient to heal","correct":false,"justification":"To guarantee him the best care (not necessarily cure)"},{"idx":1,"proposition":"Have a minimum cost for acceptable results","correct":false,"justification":"Have a minimum cost for the best result (concept of efficiency)"},{"idx":2,"proposition":"Limit iatrogenic risk","correct":true},{"idx":3,"proposition":"To bring the best satisfaction to the stakeholders (patients and caregivers)","correct":true},{"idx":4,"proposition":"It is a concept of the HAS","correct":false,"justification":"implementation and defined by WHO"}],"type":"custom"}
+{"_id":"pratiquespro-sp-2","context":null,"enonce":"Concerning the generalities of the quality approach","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"The France was very early in the field of quality approach with many institutions created in the 19th century","correct":false,"justification":"The France has been slow to set up evaluation structures: ANDEM in 1989 (National Agency for the Development of Medical Evaluation), which became ANAES in 1996 (National Agency for Accreditation and Evaluation in Health), then HAS in 2004 (High Authority for Health)"},{"idx":1,"proposition":"The formalization of a \"quality approach\", inspired by the world of industry and services, gradually developed in France, after having imposed itself in Anglo-Saxon countries.","correct":true},{"idx":2,"proposition":"Quality is the set of properties of a product that make it last over time","correct":false,"justification":"Set of properties and characteristics of a product or product that give it service the ability to satisfy expressed or implicit needs (ISO 8402)"},{"idx":3,"proposition":"Quality assurance is the set of actions necessary to give the appropriate confidence that a product or service will meet the requirements","correct":true},{"idx":4,"proposition":"The quality approach is the set of actions to satisfy customers and users.","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"pratiquespro-sp-3","context":null,"enonce":"Which of these proposals are indicators of quality and safety of care?","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"Clinical relevance","correct":true},{"idx":1,"proposition":"Feasibility","correct":true},{"idx":2,"proposition":"Public satisfaction","correct":false,"justification":"It is an indicator. It does not validate one."},{"idx":3,"proposition":"Internal consistency","correct":true,"justification":"Part of the metrological qualities"},{"idx":4,"proposition":"Adjustment","correct":true}],"type":"custom"}
+{"_id":"pratiquespro-sp-4","context":null,"enonce":"Regarding quality and safety of care indicators:","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"They are divided into 5 types","correct":false,"justification":"3 types: structure indicator, process indicator, result indicator"},{"idx":1,"proposition":"There are 179 indicators in total","correct":false,"justification":"79"},{"idx":2,"proposition":"It is mandatory to collect them all","correct":false,"justification":"Some are mandatory, others are optional"},{"idx":3,"proposition":"They only concern public establishments","correct":false,"justification":"All health facilities are concerned"},{"idx":4,"proposition":"They are divided into two main themes","correct":true,"justification":"Cross-cutting themes and specialty themes\""}],"type":"custom"}
+{"_id":"pratiquespro-sp-6","context":null,"enonce":"Regarding the quality approach","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"Each hospital has the obligation to have a quality department with a quality manager.","correct":true},{"idx":1,"proposition":"The continuous quality improvement approach is symbolized by the Demin wheel","correct":true},{"idx":2,"proposition":"A quality and safety of care indicator is a tool for tracking the costs of safety procedures","correct":false,"justification":"Tool for measuring a state of health, one or the practical occurrence of an event, which makes it possible to evaluate in a valid and reliable way the quality of care and its variations in time and space"},{"idx":3,"proposition":"The scope of application of quality indicators is limited to peripheral CHU and CHU with more than 200 employees","correct":false,"justification":"Public and private health institutions by the HAS: IPAQSS program (Indicators for the Improvement of Quality and Safety Management of Care)"},{"idx":4,"proposition":"The HAS regularly informs the ARS of the commitment and progress of the establishments in the certification procedure.","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"pratiquespro-sp-7","context":null,"enonce":"Regarding the certification process for healthcare facilities","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"The interface document must be sent 3 weeks before sending the quality account","correct":false,"justification":"Sent by the establishment to the HAS in the 6 months preceding the sending of the Quality Account (i.e. 12 months before the visit)"},{"idx":1,"proposition":"The HAS chooses a visit date for certification and has the legal obligation to respect it","correct":false,"justification":"The HAS may postpone the certification visit if important points of patient safety management are not fulfilled by the institution, after analysis of the interface document"},{"idx":2,"proposition":"The method of analysis of the quality account is chosen and specific to each institution: it is not imposed by the HAS.","correct":true},{"idx":3,"proposition":"The HAS has the sole role of visiting the establishment and issuing (or not) the certification based on it only","correct":false,"justification":"It carries out a quality control of the Quality Account: it can request additional information"},{"idx":4,"proposition":"The visiting experts are appointed by the HAS","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"pratiquespro-sp-8","context":null,"enonce":"Regarding the different levels of certification:","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"They are classified from 1 to 5","correct":false,"justification":"From A (best) to E (non-certification)"},{"idx":1,"proposition":"Certification with improvement recommendation is valid for 3 years","correct":false,"justification":"Valid for 4 years"},{"idx":2,"proposition":"The decision to suspend certification requires a follow-up visit within 6 months","correct":true,"justification":"A new decision will be rendered at the end of this follow-up visit"},{"idx":3,"proposition":"Simple certification is valid for 4 years","correct":false,"justification":"6 years for Level A certification"},{"idx":4,"proposition":"Certification with improvement obligations requires the sending of a quality account 12 months before the visit","correct":true}],"type":"custom"}
+{"_id":"pratiquespro-sp-9","context":null,"enonce":"Regarding the quality approach","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"The HAS makes the decision to certify or not an establishment after analyzing the recommendations of the CREDO","correct":true},{"idx":1,"proposition":"The certification report is confidential and the health institution is prohibited from disseminating it","correct":false,"justification":"The institution must: ensure the widest possible dissemination of the certification report (CME, CDU ...) make available to the public the results of the quality and safety of care indicators"},{"idx":2,"proposition":"The institution's welcome booklet for inpatients must include information on the results of the various procedures for assessing the quality of care.","correct":true},{"idx":3,"proposition":"The HAS website must not contain hospital certification reports","correct":false,"justification":"The HAS publishes the certifications and the various reports on its website"},{"idx":4,"proposition":"The accreditation of doctors is implemented by the HAS","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"pratiquespro-sp-10","context":null,"enonce":"Which of these specialties are subject to accreditation?","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"All surgeries","correct":true},{"idx":1,"proposition":"General medicine","correct":false,"justification":"Obstrical ultrasound, gynecology-obstetrics, surgeries, anesthesia-resuscitation, intensive care and interventional specialties"},{"idx":2,"proposition":"Anesthesia-resuscitation","correct":true},{"idx":3,"proposition":"Neurology","correct":false},{"idx":4,"proposition":"Vascular medicine","correct":false}],"type":"custom"}
+{"_id":"MICI-HGE-0","context":null,"enonce":"Regarding Crohn's disease:","item":"MICI","matiere":"HGE","propositions":[{"idx":0,"proposition":"Crohn's disease can affect all segments of the digestive tract, most commonly the terminal ileum, colon and anus.","correct":true},{"idx":1,"proposition":"Crohn's disease can start at any age but its peak frequency is between 20 and 30 years","correct":true},{"idx":2,"proposition":"To make the diagnosis, it is necessary to perform an eso-gastro-duodenal endoscopy and an ileocolonoscopy with biopsies of the injured areas but also macroscopically healthy areas","correct":true},{"idx":3,"proposition":"The endoscopic lesions of Crohn's disease are very specific","correct":false,"justification":"The endoscopic lesions of Crohn's disease are not specific"},{"idx":4,"proposition":"Lesions extend into the digestive tract without leaving gaps of healthy mucosa","correct":false,"justification":"Intervals of healthy mucosa are possible,"}],"type":"custom"}
+{"_id":"MICI-HGE-2","context":null,"enonce":"Among the characteristics of ulcerative colitis:","item":"MICI","matiere":"HGE","propositions":[{"idx":0,"proposition":"Rectal involvement is constant","correct":true},{"idx":1,"proposition":"the anoperineal lesion is constant","correct":false,"justification":"It is absent: there is no involvement of the anus in UC"},{"idx":2,"proposition":"There is no lesion of the ileum","correct":true},{"idx":3,"proposition":"The colonic extension can reach, at most, the cecum","correct":true},{"idx":4,"proposition":"There are healthy mucosa intervals between lesions","correct":false,"justification":"Lesions do not leave a healthy mucosa gap"}],"type":"custom"}
+{"_id":"AV--ophtalmo-1","context":null,"enonce":"Regarding the etiologies of progressive visual acuity decreases:","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Cataract is a clouding of the vitreous humor","correct":false,"justification":"Crystalline lens"},{"idx":1,"proposition":"The topography of cataract clouding is always peripheral","correct":false,"justification":"It can be nuclear (central), cortical (peripheral) or posterior"},{"idx":2,"proposition":"Chronic open-angle glaucoma is immediately symptomatic","correct":false,"justification":"Long asymptomatic, unlike angle-closure glaucoma"},{"idx":3,"proposition":"The most common hereditary maculopathy is Stargardt's disease","correct":true},{"idx":4,"proposition":"Retinopathy pigmentosa concerns batônnets in priority","correct":true,"justification":"Sometimes the damage can extend to the cones and lead to complete blindness."}],"type":"custom"}
+{"_id":"AV--ophtalmo-3","context":null,"enonce":"Which of the following are part of the posterior segment?","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Iris","correct":false,"justification":"False"},{"idx":1,"proposition":"Cornea","correct":false,"justification":"False"},{"idx":2,"proposition":"Previous chamber","correct":false,"justification":"False"},{"idx":3,"proposition":"Sclera","correct":true,"justification":"It is on this fibrous support shell that the oculomotor muscles are inserted. It is also in its posterior part that the optic nerve is inserted."},{"idx":4,"proposition":"All proposals are wrong","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"AV--ophtalmo-4","context":null,"enonce":"Which of the following proposals are transparent environments of the eye?","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Macula","correct":false,"justification":"3 transparent media: vitreous body, aqueous humor, crystalline"},{"idx":1,"proposition":"Aqueous humor","correct":true,"justification":"True, as the name suggests"},{"idx":2,"proposition":"Vitreous humour","correct":true},{"idx":3,"proposition":"Crystalline","correct":true,"justification":"True, its clouding causes cataracts"},{"idx":4,"proposition":"Choroid","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"AV--ophtalmo-5","context":null,"enonce":"Where is the main lacrimal gland?","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Upper-outer part of the orbit","correct":true},{"idx":1,"proposition":"Infero-external part of the orbit","correct":false,"justification":"False"},{"idx":2,"proposition":"Upper inner part of the orbit","correct":false,"justification":"False"},{"idx":3,"proposition":"Infero-internal part of the orbit","correct":false,"justification":"False"},{"idx":4,"proposition":"Central part of the orbit","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"AV--ophtalmo-6","context":null,"enonce":"Which of the following proposals are part of the previous segment?","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Cornea","correct":true},{"idx":1,"proposition":"Iris","correct":true},{"idx":2,"proposition":"Previous chamber","correct":true},{"idx":3,"proposition":"Iridorodicorneal angle","correct":true},{"idx":4,"proposition":"All propositions are true","correct":true}],"type":"custom"}
+{"_id":"UGD-HGE-0","context":null,"enonce":"Regarding peptic ulcer disease","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"proposition":"The ulcer is an attack of the submucosa","correct":false,"justification":"An ulcer is defined as a loss of substance from the gastric or duodenal wall deeply affecting the muscular."},{"idx":1,"proposition":"Gastric or duodenal ulcers (UGD) result from the imbalance between chlorhydropeptic aggression and defense mechanisms (mucosal barrier) at a specific point in the mucosa","correct":true},{"idx":2,"proposition":"H. pylori is a gram-positive cocci that resists gastric acidity thanks to its urease activity and colonizes the surface of the gastric mucosa","correct":false,"justification":"H. pylori is a gram-negative bacillus"},{"idx":3,"proposition":"H. pylori infection is most often acquired in childhood by the oral-oral or faecal-oral route","correct":true},{"idx":4,"proposition":"Most often, gastritis with HP does not get complicated","correct":true}],"type":"custom"}
+{"_id":"UGD-HGE-1","context":null,"enonce":"Regarding peptic ulcer disease","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"proposition":"Selective NSAIDs (coxibs) that inhibit COX-2 by preserving COX-1 activity reduce the risk of ulcerative complications","correct":true,"justification":"They do not eliminate this risk but reduce it, in fact"},{"idx":1,"proposition":"Zolliger ellison syndrome should be evoked in case of multiple or recurrent ulcers, which are often complicated","correct":true},{"idx":2,"proposition":"\"Stress\" or psychological factors have no demonstrated role in the pathophysiology of ulcer","correct":true},{"idx":3,"proposition":"The incidence of DMUs has increased in developed countries over the past 3 decades","correct":false,"justification":"The incidence of GDU has declined in developed countries over the past 3 decades in line with the decline in gastric H-infection."},{"idx":4,"proposition":"Duodenal ulcer is less common than gastric ulcer before age 55","correct":false,"justification":"It is more common"}],"type":"custom"}
+{"_id":"UGD-HGE-2","context":null,"enonce":"Regarding peptic ulcer disease","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"proposition":"The mortality rate for ulcerative complications is about 10%","correct":true},{"idx":1,"proposition":"The typical ulcer syndrome is an association of epigastric pain, without irradiation, punctuated by meals with a free interval of 1 to 3 hours, type of cramp or painful hunger, calmed by taking food or antacids.","correct":true,"justification":"This is the classic definition. Beware, however, of atypical syndromes"},{"idx":2,"proposition":"Physical examination is normal in the absence of complications","correct":true},{"idx":3,"proposition":"Upper GI endoscopy allows to visualize the upper digestive tract up to the second duodenum and to perform biopsies","correct":true},{"idx":4,"proposition":"Gastrodudenal endoscopy is the key diagnostic test","correct":true}],"type":"custom"}
+{"_id":"UGD-HGE-3","context":null,"enonce":"Regarding peptic ulcer disease","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"proposition":"Duodenal ulcer is always benign","correct":true},{"idx":1,"proposition":"Gastric ulcer is at risk of cancerization","correct":true},{"idx":2,"proposition":"NSAIDs are responsible for one-third of ulcer complications","correct":true},{"idx":3,"proposition":"Duodenal ulcer requires systematic healing control","correct":false,"justification":"This is the case for gastric ulcer"},{"idx":4,"proposition":"The eradication treatment of H. pylori is based on antibiotics only, for 10 to 14 days depending on the chosen protocol","correct":false,"justification":"Antibiotics + PPI +\/bismuth salts according to protocol"}],"type":"custom"}
+{"_id":"UGD-HGE-4","context":null,"enonce":"Which of the following are true for Helicobacter pylori?","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"proposition":"It is a risk factor for gastric ulcer","correct":true},{"idx":1,"proposition":"It is a risk factor for MALT lymphoma","correct":true},{"idx":2,"proposition":"It is a risk factor for gastric carcinoma (in case of gastric atrophy)","correct":true},{"idx":3,"proposition":"It is a risk factor for pancreatitis","correct":false},{"idx":4,"proposition":"It is a risk factor for Barrett's ulcer","correct":false,"justification":"Also called Endobrachyoesophagus\r\nRisk factors tend to be overweight or chronic GERD"}],"type":"custom"}
+{"_id":"UGD-HGE-5","context":null,"enonce":"Which of the following are true for Helicobacter pylori?","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"proposition":"It is a risk factor for the occurrence of duodenal ulcer","correct":true},{"idx":1,"proposition":"It is a parasite","correct":false,"justification":"Gram-negative bacillus"},{"idx":2,"proposition":"It is a gram-positive bacillus","correct":false,"justification":"Gram-negative bacillus"},{"idx":3,"proposition":"It is contracted most often in childhood","correct":true,"justification":"True, oral-oral or faecal-oral"},{"idx":4,"proposition":"100% of Helicobacter pyloria infections progress to gastritis","correct":true,"justification":"True, according to Figure 9.2 of the 4th edition of the HGE College"}],"type":"custom"}
+{"_id":"grossessepatho-gyn-0","context":null,"enonce":"Regarding genital bleeding in the 1st trimester:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"Genital bleeding complicates about 25% of pregnancies","correct":true},{"idx":1,"proposition":"A molar pregnancy is a very rare cause of 1st trimester hemorrhage","correct":true},{"idx":2,"proposition":"Cervical cancer is a very rare cause of 1st trimester hemorrhage","correct":true},{"idx":3,"proposition":"The vaginal examination makes it possible to check the permeability of the cervix and the possible presence of a laterouterine mass","correct":true,"justification":"The vaginal touch makes it possible to appreciate the condition of the cervix, the uterine volume, the appendages. TRUE"},{"idx":4,"proposition":"Genital bleeding of the first trimester is frequent, it does not require additional examination","correct":false,"justification":"Any genital bleeding in a pregnant woman should be explored. The main complementary examinations are: • plasma assay of 'hCG in case of doubt about the state of pregnancy, an endovaginal ultrasound and a urine strip. A blood test will be performed in case of significant hemorrhage with hemodynamic impact."}],"type":"custom"}
+{"_id":"grossessepatho-gyn-1","context":null,"enonce":"Which of these signs is (are) in favor of spontaneous abortion?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"A disappearance of sympathetic signs of pregnancy","correct":true},{"idx":1,"proposition":"Dark blood hemorrhages without clots or debris","correct":false,"justification":"Light red blood, abundant, with clots and debris"},{"idx":2,"proposition":"A soft cervix permeable to the finger","correct":true},{"idx":3,"proposition":"A flattened ovular sac","correct":true},{"idx":4,"proposition":"An ovular sac with irregular contours","correct":true}],"type":"custom"}
+{"_id":"grossessepatho-gyn-3","context":null,"enonce":"Regarding signs in favor of an EMG:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"The presence of an intrauterine device is in favor of a GEU","correct":true,"justification":"If pregnant in a woman with an IUD, it is more likely to be a GEU. However, the IUD is not recognized as an ELT FDR. TRUE"},{"idx":1,"proposition":"A very large uterus is a clinical sign in favor of a GEU","correct":false,"justification":"In case of GEU, the uterus is smaller than the expected volume in case of intrauterine pregnancy."},{"idx":2,"proposition":"There is a loose and open collar in case of GEU","correct":false,"justification":"In case of GEU, the cervix will be rather toned and closed"},{"idx":3,"proposition":"The presence of a painless laterouterine mass is a clinical sign in favor of a GEU","correct":false,"justification":"The inconstant laterouterine mass (the GEU) will typically be painful, pain may be caused in the lateral or posterior cul-de-sac (signs of peritoneal irritation)"},{"idx":4,"proposition":"A well-centered intrauterine egg sac in the uterine cavity points to a normal pregnancy.","correct":false,"justification":"Be careful, the \"pseudo-bag\" is to be distinguished from the gestational sac. Unlike the gestational sac, the pseudo-sac is centered in the cavity and without trophoblastic crown (unlike the gestational sac which is lateralized and with a peripheral hypoechoic area): it is often a blood clot\nin the uterine cavity, in the process of expulsion, which can be found on ultrasound in case of GEU. Pseudo-sac is common and can lead to a misdiagnosis."}],"type":"custom"}
+{"_id":"grossessepatho-gyn-4","context":null,"enonce":"Regarding trophoblastic disease:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"It is a very common disease in France.","correct":false,"justification":"Trophoblastic disease or molar pregnancy is exceptional in the West, more common in Southeast Asia. It results from an abnormality of fertilization and is characterized by abnormal trophoblastic proliferation without possible normal embryonic development."},{"idx":1,"proposition":"A molar pregnancy results in a uterus that is smaller than gestational age would like.","correct":false,"justification":"On ultrasound: the uterus is larger than the management age would like. It is occupied by a heterogeneous, flaky mass, containing multiple small vesicles. The ovaries are large, polycystic"},{"idx":2,"proposition":"Ultrasound finds no ocular cavity or visible embryo in case of trophoblastic disease.","correct":true,"justification":"Indeed, there can be no embryonic development in case of trophoblastic disease. TRUE"},{"idx":3,"proposition":"The diagnosis of molar pregnancy is ultrasound","correct":false,"justification":"The diagnosis evoked on ultrasound requires aspiration under ultrasound control with systematic histopathological examination"},{"idx":4,"proposition":"The hCG level is abnormally low.","correct":false,"justification":"Molar pregnancy is accompanied by very intense sympathetic signs of pregnancy, as well as very high hCG levels. Treatment consists of aspiration of endouterine contents under GA, and monitoring of the correct decrease in hCG levels over time. In the absence of decay, invasive mole or cholangiocarcinoma (chemotherapy treatment) may be feared."}],"type":"custom"}
+{"_id":"grossessepatho-gyn-5","context":null,"enonce":"Regarding spontaneous abortions in the first trimester:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"The main cause of spontaneous abortions in the first trimester is teratogenic self-medication","correct":false,"justification":"Banal for the doctor, miscarriage is often experienced by the woman as a guilt-inducing trauma, a source of concern for the future. \nIt is important to devote a few minutes to information: • the usual cause (60% of cases) of ASP is a chromosomal abnormality of the embryo, due to chance. Miscarriage is a commonplace phenomenon that affects 10 to 15% of pregnancies and has no consequences on the future obstetrics."},{"idx":1,"proposition":"Physical activity is a factor in miscarriages","correct":false,"justification":"Physical activity and the car have nothing to do with it."},{"idx":2,"proposition":"Miscarriage is a commonplace phenomenon that affects 10 to 15% of pregnancies and has no impact on the future of obstetrics.","correct":true},{"idx":3,"proposition":"The expulsion of the stopped pregnancy is imperatively done by surgery.","correct":false,"justification":"Two methods are available: • medical treatment with prostaglandins if the egg is small and bleeding is small, surgical treatment in other cases."},{"idx":4,"proposition":"Repeated spontaneous abortions occur when at least five consecutive spontaneous abortions occur before 14 weeks.","correct":false,"justification":"At least three consecutive spontaneous abortions before 14 SA"}],"type":"custom"}
+{"_id":"grossessepatho-gyn-6","context":null,"enonce":"Among these proposals, which is (are) a possible etiology(s) of repeated spontaneous early abortion:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"Lupus","correct":true},{"idx":1,"proposition":"Chronic endometritis","correct":true},{"idx":2,"proposition":"Anti-phospholipid syndrome","correct":true},{"idx":3,"proposition":"Uterine malformation","correct":true},{"idx":4,"proposition":"Balanced diabetes","correct":false,"justification":"Unbalanced diabetes (controversial). Otherwise: the possible causes of repeated ASP are:\na uterine malformation (rather responsible for late-term abortions); a hysterography must be done \nlupus, an antiphospholipid syndrome \ngenetic causes (karyotype) \nchronic endometritis (which may be caused by a chronic infection to look for)\nhormonal and metabolic causes (dysovulation, hyperandrogenism, hypothyroidism, diabetes) that are classic but very controversial \nimmunological causes (immunization against spousal antigens). \nThe etiological balance is often negative.\""}],"type":"custom"}
+{"_id":"grossessepatho-gyn-7","context":null,"enonce":"Regarding repeated spontaneous abortions:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"An etiological investigation becomes legitimate in case of repeated spontaneous abortions","correct":true},{"idx":1,"proposition":"The etiological balance is often negative","correct":true},{"idx":2,"proposition":"Preventive treatment of recurrence with low-dose aspirin and low molecular weight heparin has been proposed","correct":true,"justification":"This treatment is effective in case of antiphospholipid syndrome (placental vascularization disorders). \nOtherwise, it has no interest. Some offer a low-dose preventive aspirin treatment based on the placebo effect. TRUE"},{"idx":3,"proposition":"Preventive treatment with aspirin and LMWH is effective in diabetes","correct":false,"justification":"This treatment is effective in case of antiphospholipid syndrome"},{"idx":4,"proposition":"Preventive treatment of recurrent ASP with misoprostol is proposed.","correct":false,"justification":"Misoprostol is a teratogenic PGE1 prostaglandin analogue used in medical terminations (GymsO, MisoOne)"}],"type":"custom"}
+{"_id":"grossessepatho-gyn-9","context":null,"enonce":"Regarding third trimester hemorrhages:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"A third trimester genital hemorrhage is an obstetric emergency","correct":true,"justification":"The diagnostic approach is focused on the differential diagnosis between the two main causes of placenta previa (inserted in part or in whole on the lower segment) and retroplacental hematoma, 2 therapeutic emergencies."},{"idx":1,"proposition":"Vaginal examination is contraindicated until placenta previa has been ruled out","correct":true,"justification":"Risk of severe maternal hemorrhage, risk of extremely serious fetal hemorrhage in case of rupture of a praevia vessel."},{"idx":2,"proposition":"The clinical examination focuses on fetal impact only","correct":false,"justification":"The examination focuses on: • maternal impact: pulse"},{"idx":3,"proposition":"A vascular context is in favor of a retroplacental hematoma","correct":true},{"idx":4,"proposition":"A small hemorrhage eliminates a retroplacental hematoma","correct":false,"justification":"Typically, retroplacental hematoma presents with:\na sparse, blackish, incoagulable hemorrhage associated with sudden, permanent uterine pain, which dominates the picture;\na severe maternal impact unrelated to the abundance of hemorrhages: prostrate woman, state of shock, tachycardia but variable BP, sometimes high (gestational hypertension, proteinuria)\na permanent and painful uterine contracture (\"wooden belly\")\nunperceived fetal cardiac activity (dead fetus) in full forms."}],"type":"custom"}
+{"_id":"grossessepatho-gyn-10","context":null,"enonce":"Regarding retroplacental hematoma:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"There is little maternal impact, due to the low abundance of hemorrhages.","correct":false,"justification":"The maternal impact can be severe, unrelated to the abundance of hemorrhage."},{"idx":1,"proposition":"A permanent and painful uterine contracture (\"wooden belly\") should evoke it.","correct":true},{"idx":2,"proposition":"A retroplacental hematoma without signs of severity can be managed on an outpatient basis","correct":false,"justification":"Treatment of an HRP is an emergency. The action to be taken involves hospitalization of the patient, urgent medical treatment (O2, filling, defibrination if necessary), the realization of a preoperative assessment and fetal extraction in emergency."},{"idx":3,"proposition":"Emergency obstetric ultrasound is required","correct":true},{"idx":4,"proposition":"Retroplacental hematoma is often visible on ultrasound","correct":false,"justification":"Rarely visible. A negative ultrasound does not eliminate the diagnosis"}],"type":"custom"}
+{"_id":"grossessepatho-gyn-11","context":null,"enonce":"Regarding the haemorrhage of delivery:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"Hemorrhage of delivery is an obstetric emergency","correct":true},{"idx":1,"proposition":"The hemorrhage of deliverance is life-threatening fetal but not maternal","correct":false,"justification":"In its severe or neglected forms, it is life-threatening to the maternal"},{"idx":2,"proposition":"It is currently the third leading cause of maternal mortality in France","correct":false,"justification":"It is currently the leading cause of maternal mortality in France"},{"idx":3,"proposition":"It occurs in about 0.7% of births","correct":false,"justification":"It occurs in about 7% of births"},{"idx":4,"proposition":"Its early diagnosis is based on rigorous monitoring of any woman who has given birth, especially during the 2 hours after delivery.","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"grossessepatho-gyn-12","context":null,"enonce":"Regarding the haemorrhage of delivery:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"Prevention is based on the injection of oxytocin at the time of placental expulsion.","correct":false,"justification":"The oxytocin injection is done at the time of release of the shoulder of the newborn (or in the seconds after birth), this is called directed delivery."},{"idx":1,"proposition":"The recognition of a hemorrhage of delivery requires a precise quantification of bleeding.","correct":true,"justification":"The hemorrhage of delivery is defined by bleeding > 500 ml. Management must be immediate."},{"idx":2,"proposition":"There are no risk factors found in more than 50% of cases of hemorrhage of delivery.","correct":true,"justification":"cf item"},{"idx":3,"proposition":"There are deliveries with a \"low risk\" of hemorrhage of delivery.","correct":false,"justification":"In more than half of the cases of hemorrhage of delivery, no risk factor is found: any woman who gives birth has a possible risk of hemorrhage of delivery. It is one of the\nReasons why we can never speak of \"low-risk\" birth."},{"idx":4,"proposition":"The presence of a scarred uterus is a protective factor against hemorrhage of delivery due to the slightest distension of the fibrotic uterus.","correct":false,"justification":"The risk factors are:\n• fibroids\n• Placenta previa\n• scar uterus\n• history of hemorrhage of delivery\n• the work triggered\n• very fast or prolonged work\n• hyperthermia\n• macrosomia, hydramnios, multiple pregnancy;\n• Greater multiparity\n• no uterotonic injection (oxytocin 5 to 10 IU IVD) in the seconds that\nfollow the birth of the child"}],"type":"custom"}
+{"_id":"grossessepatho-gyn-13","context":null,"enonce":"Regarding the management of a hemorrhage of delivery:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"The first step is to carry out an artificial delivery in emergency.","correct":true,"justification":"True, if the hemorrhage occurs before the placenta is expelled."},{"idx":1,"proposition":"Inspection of the genital tract under valve is systematic only in case of strong argument for a vaginal tear.","correct":false,"justification":"It is systematic in case of haemorrhage of delivery."},{"idx":2,"proposition":"The administration of uterotonics is done only in case of absence of previous injection of oxytocin.","correct":false,"justification":"The injection of oxytocin after artificial delivery should be systematic and is part of the treatment of hemorrhage of delivery, even if the injection has already been performed at birth."},{"idx":3,"proposition":"Antibiotic prophylaxis is imperative.","correct":true,"justification":"The management of the hemorrhage of delivery involves endouterine gestures (artificial delivery + uterine revision). Antibiotic prophylaxis should therefore be administered."},{"idx":4,"proposition":"In a second step, sulprostone can be injected.","correct":false,"justification":"In case of persistence of hemorrhage, the second usable uterotonic is suprostone (analogue of prostaglandin E2 with oxytocic activity). In the absence of improvement, interventional radiology (embolization of bleeding arteries) or surgery (ligation of uterine arteries, up to hysterectomy if necessary) will be used."}],"type":"custom"}
+{"_id":"grossessepatho-gyn-14","context":null,"enonce":"Regarding the management of a hemorrhage of delivery:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"Prostaglandin therapy should be administered within 30 minutes of the start of management if bleeding persists.","correct":true,"justification":"Administration of sulprostone should occur within 30 minutes of diagnosis of delivery haemorrhage. In case of oxytocin failure, this period may be shortened depending on the severity of the bleeding (reco CNGOF 2014)."},{"idx":1,"proposition":"The uterine revision is carried out immediately in front of any hemorrhage of delivery.","correct":false,"justification":"It is performed after artificial delivery if the expulsion of the placenta has not taken place, otherwise immediately after natural delivery."},{"idx":2,"proposition":"In some situations, it is possible to perform hemostasis by uterine tamponade with an intrauterine balloon.","correct":true,"justification":"If radiological and surgical techniques are not readily available, this may be a waiting solution until a possible transfer to a specialized unit."},{"idx":3,"proposition":"In case of unstable hemodynamics, the preferable management is surgical.","correct":true,"justification":"Management must be extremely rapid in case of unstable hemodynamics, which does not leave time to perform a transfer or radioembolization."},{"idx":4,"proposition":"Monitoring of the coagulation balance is not imperative.","correct":false,"justification":"The sometimes rapid evolution of coagulopathy during a hemorrhage of delivery justifies biological monitoring of coagulation (reco CNGOF 2014)"}],"type":"custom"}
+{"_id":"grossessepatho-gyn-15","context":null,"enonce":"Regarding normal pregnancy:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"There is a decrease in blood volume","correct":false,"justification":"Volume increases"},{"idx":1,"proposition":"GFR increases in the first quarter","correct":true},{"idx":2,"proposition":"Blood pressure remains unchanged","correct":false,"justification":"It decreases"},{"idx":3,"proposition":"Cardiac output decreases due to hypervolemia","correct":false,"justification":"It increases precisely to cope with vasodilation"},{"idx":4,"proposition":"Solidarity does not appear until the third trimester","correct":false,"justification":"It is precocious"}],"type":"custom"}
+{"_id":"grossessepatho-gyn-16","context":null,"enonce":"Regarding pre-eclampsia:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"It can only be diagnosed from 30 SA","correct":false,"justification":"From 20 SA"},{"idx":1,"proposition":"The PAd must be greater than 100 mmHg","correct":false,"justification":"One must objectify a HTA, ie a PAs greater than or equal to 140 mmHg and \/ or a PAd greater than or equal to 90 mmHg"},{"idx":2,"proposition":"Proteinuria is greater than 30 mg\/24h in pre-eclampsia","correct":false,"justification":"It is greater than 300mg\/24h"},{"idx":3,"proposition":"One of the consequences of pre-eclampsia can be intrauterine growth retardation","correct":true},{"idx":4,"proposition":"Pre-eclampsia can be complicated by OAP","correct":true}],"type":"custom"}
+{"_id":"grossessepatho-gyn-17","context":null,"enonce":"What are the blood pressure goals in a hypertensive pregnant woman?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"These are the same as in non-pregnant women","correct":false,"justification":"BP figures < 140\/90 mmHg are not targeted because this would result in fetal distress"},{"idx":1,"proposition":"PAs < 140 mmHg","correct":false},{"idx":2,"proposition":"PAd < 90 mmHg","correct":false},{"idx":3,"proposition":"PAs < 160 mmHg","correct":true,"justification":"The blood pressure objectives are a PAs < 160 mmHg and a PAd between 85-100 mmHg"},{"idx":4,"proposition":"PAd < 80 mmHg","correct":false}],"type":"custom"}
+{"_id":"grossessepatho-gyn-18","context":null,"enonce":"What are the reasons for a HELLP syndrome?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"Hemolysis","correct":true,"justification":"H = hemolysis. EL = Elevation of liver enzymes. LP = Low Platelets"},{"idx":1,"proposition":"An elevation of hemoglobin","correct":false,"justification":"A decrease"},{"idx":2,"proposition":"An increase in transaminases","correct":true},{"idx":3,"proposition":"A DICV","correct":false,"justification":"Not related to HELLP most often"},{"idx":4,"proposition":"Thrombocytopenia","correct":true}],"type":"custom"}
+{"_id":"grossessepatho-gyn-19","context":null,"enonce":"Which of the following are molecules that can be used for tocolysis?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"Beta-mimetics ","correct":false,"justification":"They can cause maternal undesirables sometimes serious. \r\nIt is recommended that they no longer be prescribed."},{"idx":1,"proposition":"Beta-blockers","correct":false,"justification":"They have no tocolytic effects"},{"idx":2,"proposition":"Calcium antagonists","correct":true,"justification":"True, Nifedipine for example"},{"idx":3,"proposition":"Atosiban","correct":true},{"idx":4,"proposition":"NSAIDs","correct":false,"justification":"It's not a tocolytic"}],"type":"custom"}
+{"_id":"grossessepatho-gyn-20","context":null,"enonce":"Which of the following are among the benefits of antenatal corticosteroid administration in case of threat of premature delivery?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"Reduced rate of jaundice in newborns","correct":false,"justification":"False"},{"idx":1,"proposition":"Reduction of neonatal death rate","correct":true},{"idx":2,"proposition":"Reduction in the rate of maternal-fetal infection","correct":false,"justification":"False"},{"idx":3,"proposition":"Reduction in the rate of hyaline membrane disease","correct":true},{"idx":4,"proposition":"Reduced rate of ulcerative-necrotizing enterocolitis","correct":true}],"type":"custom"}
+{"_id":"grossessepatho-gyn-21","context":null,"enonce":"Which of the following should be made upon admission of a patient at risk of preterm birth?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"Collection of a biological assessment including among others an NFS and CRP","correct":true,"justification":"True, in search of a biological inflammatory syndrome, in favor of an intrauterine infection"},{"idx":1,"proposition":"Single BU","correct":false,"justification":"We do an ECBU"},{"idx":2,"proposition":"Fetal ultrasound","correct":true},{"idx":3,"proposition":"Digital rectal examination","correct":false,"justification":"False"},{"idx":4,"proposition":"External electrocardiotocography ","correct":true}],"type":"custom"}
+{"_id":"pbsuitescouches-gyn-0","context":null,"enonce":"Regarding postpartum pathologies:","item":"pbsuitescouches","matiere":"gyn","propositions":[{"idx":0,"proposition":"The period of the postpartum period is between 2 hours postpartum and about 40 days","correct":true},{"idx":1,"proposition":"The most common cause of postpartum fever is milky rise and therefore does not require exploration","correct":false,"justification":"This is the milky rise, but it is a diagnosis of elimination so it is necessary to eliminate infectious etiologies, thromboembolics, etc."},{"idx":2,"proposition":"If breastfeeding is artificial, the main causes of postpartum fever are related to accumulated stress","correct":false,"justification":"No. In this case, the main causes of fever are endometritis, urinary tract infection and thromboembolic disease."},{"idx":3,"proposition":"Endometritis is a cause of postpartum fever","correct":true},{"idx":4,"proposition":"The diagnosis of endometritis is clinical","correct":true}],"type":"custom"}
+{"_id":"pbsuitescouches-gyn-1","context":null,"enonce":"Which of these proposals designate a factor promoting endometritis?","item":"pbsuitescouches","matiere":"gyn","propositions":[{"idx":0,"proposition":"Dystocic childbirth","correct":true},{"idx":1,"proposition":"Chorioamnionitis","correct":true},{"idx":2,"proposition":"Treatment with bisphosphonate","correct":false,"justification":"Has nothing to do with it"},{"idx":3,"proposition":"Psychosis","correct":false,"justification":"Not recognized"},{"idx":4,"proposition":"Placental retention","correct":true}],"type":"custom"}
+{"_id":"pbsuitescouches-gyn-2","context":null,"enonce":"About endometritis","item":"pbsuitescouches","matiere":"gyn","propositions":[{"idx":0,"proposition":"The onset of endometritis is often late, around 30 days postpartm","correct":false,"justification":"No, it is often early: 3 to 5 days after delivery"},{"idx":1,"proposition":"Stagnant uterine height and gaping cervix are signs of endometritis","correct":true},{"idx":2,"proposition":"Management of endometritis is most often ambulatory","correct":false},{"idx":3,"proposition":"In case of endometritis, antibiotic therapy is started when the susceptibility test is ready","correct":false,"justification":"It is started directly in IV and then adapted secondarily to the results of vaginal ECB"},{"idx":4,"proposition":"The optimal duration of antibiotic therapy is between 5 and 10 days","correct":true}],"type":"custom"}
+{"_id":"pbsuitescouches-gyn-3","context":null,"enonce":"Regarding endometritis and NAPs:","item":"pbsuitescouches","matiere":"gyn","propositions":[{"idx":0,"proposition":"Endometritis is rapidly favorable under appropriate treatment","correct":true},{"idx":1,"proposition":"The clinical picture of a urinary tract infection has nothing to do with postpartum, compared to the clinical picture of a UTI outside a pregnancy context","correct":false,"justification":"The clinical picture and principles of treatment are identical"},{"idx":2,"proposition":"ECBU confirms diagnosis of urinary tract infection","correct":true},{"idx":3,"proposition":"Renal ultrasound is of no use in acute postpartum pyelonephritis","correct":false,"justification":"It removes an obstacle"},{"idx":4,"proposition":"Antibiotic treatment lasts 5-10 days","correct":false,"justification":"Antibiotic treatment should be compatible with possible breastfeeding (3rd generation cephalosporins ± aminoglycoside) and continued for a total of 21 days. 5-10 days is the duration of treatment for endometritis"}],"type":"custom"}
+{"_id":"soinspal-soinspal-0","context":null,"enonce":"Regarding palliative care:","item":"soinspal","matiere":"soinspal","propositions":[{"idx":0,"proposition":"Palliative care occurs only in the last stage of the disease","correct":false,"justification":"It is care that accompanies the patient throughout his care, intended to relieve annoying symptoms such as pain"},{"idx":1,"proposition":"Palliative care only concerns people over the age of 65","correct":false,"justification":"They concern all patients"},{"idx":2,"proposition":"Palliative care is incompatible with curative care","correct":false,"justification":"They are quite compatible with the goal of curing the disease"},{"idx":3,"proposition":"Palliative care is reserved for patients with a VAS of pain greater than 6\/10","correct":false,"justification":"They concern all patients"},{"idx":4,"proposition":"None of the propositions are true","correct":true}],"type":"custom"}
+{"_id":"soinspal-soinspal-1","context":null,"enonce":"Which of the following are some medications that can cause constipation?","item":"soinspal","matiere":"soinspal","propositions":[{"idx":0,"proposition":"Methotrexate","correct":false,"justification":"Diarrhoea and vomiting"},{"idx":1,"proposition":"Carbamazepine","correct":true},{"idx":2,"proposition":"The 5-FU","correct":false,"justification":"The main drugs responsible for constipation are: morphine, most psychotropic drugs, thiazide diuretics, GABA analogues, platinum salts and iron."},{"idx":3,"proposition":"Loperamide","correct":true},{"idx":4,"proposition":"Gabapentin","correct":true}],"type":"custom"}
+{"_id":"soinspal-soinspal-2","context":null,"enonce":"Which of the following are palliative care goals?","item":"soinspal","matiere":"soinspal","propositions":[{"idx":0,"proposition":"Accelerating death","correct":false,"justification":"Of course not. It is about relieving pain and supporting patients by improving their quality of life."},{"idx":1,"proposition":"Provide supportive psychotherapy","correct":false,"justification":"The palliative care approach may be similar to some psychological techniques, but the latter are much more comprehensive and complex to be palliative care goals."},{"idx":2,"proposition":"Relieve the patient of symptoms altering his quality of life","correct":true,"justification":"True, like pain, constipation, etc."},{"idx":3,"proposition":"Supporting caregivers","correct":true},{"idx":4,"proposition":"None of the propositions are true","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"soinspal-soinspal-3","context":null,"enonce":"Which of the following are some medications that can cause constipation?","item":"soinspal","matiere":"soinspal","propositions":[{"idx":0,"proposition":"Morphine","correct":true},{"idx":1,"proposition":"Iron","correct":true},{"idx":2,"proposition":"Hyperhydration","correct":false,"justification":"The main drugs responsible for constipation are: morphine, most psychotropic drugs, thiazide diuretics, GABA analogues, platinum salts and iron."},{"idx":3,"proposition":"Spironolactone","correct":false,"justification":"Thiazide diuretics"},{"idx":4,"proposition":"Calcium","correct":false,"justification":"Iron"}],"type":"custom"}
+{"_id":"soinspal-soinspal-4","context":null,"enonce":"Which of the following are some medications that can cause constipation?","item":"soinspal","matiere":"soinspal","propositions":[{"idx":0,"proposition":"Morphine","correct":true},{"idx":1,"proposition":"Antiparkinsonians","correct":true},{"idx":2,"proposition":"Tacrolimus","correct":false,"justification":"The main drugs responsible for constipation are: morphine, most psychotropic drugs, thiazide diuretics, GABA analogues, platinum salts and iron."},{"idx":3,"proposition":"Furosemide","correct":false,"justification":"Thiazide diuretics"},{"idx":4,"proposition":"Magnesium","correct":false,"justification":"Iron"}],"type":"custom"}
+{"_id":"oeilR-D-ophtalmo-0","context":null,"enonce":"General:","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The sensation of grains of sand in the eye evokes conjunctivitis","correct":true},{"idx":1,"proposition":"Blepharospasm suggests angle-closure glaucoma","correct":false,"justification":"Acute keratitis"},{"idx":2,"proposition":"The pains are devastating and very intense in episcleritis","correct":false,"justification":"Episcleritis is accompanied by moderate pain"},{"idx":3,"proposition":"Severe pain with irradiation in the territory of the trigeminal nerve evokes acute glaucoma","correct":true},{"idx":4,"proposition":"Conjunctivitis is not accompanied by a decrease in visual acuity","correct":true}],"type":"custom"}
+{"_id":"oeilR-D-ophtalmo-1","context":null,"enonce":"Regarding the clinical examination:","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"A red eye without visual field abnormalities may suggest subconjunctival hemorrhage or episcleritis","correct":true,"justification":"Subconjunctival hemorrhage is not painful. Episcleritis is moderately painful."},{"idx":1,"proposition":"The clinical examination is bilateral and comparative","correct":true},{"idx":2,"proposition":"Visual acuity is measured from far and near, with possible optical correction","correct":true},{"idx":3,"proposition":"A conjunctival wound should be systematically searched, even without apparent trauma","correct":true},{"idx":4,"proposition":"MRI is indicated in emergency in case of intraocular foreign body","correct":false,"justification":"Contraindicated because risk of projection of the foreign body. An orbital CT scan is done."}],"type":"custom"}
+{"_id":"oeilR-D-ophtalmo-2","context":null,"enonce":"Concerning the clinical examination with the slit lamp and fluorescein:","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Eye redness is diffuse in case of conjunctivitis","correct":true},{"idx":1,"proposition":"Ocular redness is sectorized in case of episcleritis","correct":true},{"idx":2,"proposition":"Healthy corneal epithelium does not bind fluorescein","correct":true},{"idx":3,"proposition":"Localized ulceration with an adjacent white area suggests bacterial keratitis with a corneal abscess","correct":true,"justification":"Cf. Item in the latest edition of the College of Ophthalmology"},{"idx":4,"proposition":"A dendritic ulcer evokes posterior uveitis","correct":false,"justification":"A dendritic ulcer evokes herpetic keratitis"}],"type":"custom"}
+{"_id":"oeilR-D-ophtalmo-3","context":null,"enonce":"Regarding the iris, pupil and conjunctival cul-de-sac:","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Fluorescein is an orange dye","correct":true},{"idx":1,"proposition":"The presence of iridocrystalline synechiae is seen in anterior uveitis","correct":true},{"idx":2,"proposition":"Diabetes is a cause of iris atrophy.","correct":false,"justification":"Herpes most often"},{"idx":3,"proposition":"A miosis is found in acute keratitis or acute uveitis","correct":true},{"idx":4,"proposition":"Areflexive semimydriasis is found in neovascular glaucoma","correct":false,"justification":"In acute glaucoma"}],"type":"custom"}
+{"_id":"oeilR-D-ophtalmo-4","context":null,"enonce":"Regarding the clinical examination:","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"A narrow or flat anterior chamber suggests acute glaucoma or a puncture wound","correct":true},{"idx":1,"proposition":"The Tyndall effect is pathognomonic of retinitis","correct":false,"justification":"Retrocorneal precipitates found in anterior uveitis"},{"idx":2,"proposition":"The measurement of ocular tone is carried out with an air tonometer or flattening","correct":true},{"idx":3,"proposition":"Hypotonia is suggestive of a transfixing eye wound","correct":true,"justification":"Cf. Item in the latest edition of the College of Ophthalmology"},{"idx":4,"proposition":"Seidel's sign highlights an aqueous humor leak that washes the previously instilled fluorescein. ","correct":true}],"type":"custom"}
+{"_id":"oeilR-D-ophtalmo-5","context":null,"enonce":"Regarding eye pathologies:","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Viral conjunctivitis is accompanied by the presence of lymphoid follicles","correct":true},{"idx":1,"proposition":"Spontaneous subconjunctival hemorrhage is a major surgical emergency","correct":false,"justification":"Frequent, banal, painless, it regresses in a few weeks without treatment"},{"idx":2,"proposition":"Subconjunctival hemorrhage should be tested for high blood pressure (hypertension) and\/or a bleeding disorder","correct":true,"justification":"V"},{"idx":3,"proposition":"Conjunctivitis is manifested by a feeling of grains of sand in the eye","correct":true},{"idx":4,"proposition":"Conjunctivitis is very algic during the first 3 days","correct":false}],"type":"custom"}
+{"_id":"oeilR-D-ophtalmo-6","context":null,"enonce":"Regarding uveitis in sarcoidosis:","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Anterior uveitis is the most common ophthalmological presentation in sarcoidosis","correct":true,"justification":"Intermediate uveitis (= hyalitis) and posterior uveitis may also be present, but are rarer than anterior uveitis"},{"idx":1,"proposition":"The existence of thick retrocorneal precipts and nodules defines the granulomatous character of acute anterior uveitis in sarcoidosis","correct":true},{"idx":2,"proposition":"Chronic anterior uveitis (> 3 months) occurs preferentially in young subjects","correct":false,"justification":"In middle-aged women (50-60 years). In young subjects, acute uveitis is more common."},{"idx":3,"proposition":"Uveitis is typically acute and unilateral in sarcoidosis","correct":false,"justification":"It is most often chronic (> 3 months) and bilateral"},{"idx":4,"proposition":"Cysteoid macular edema is the main cause of decreased visual acuity in posterior uveitis","correct":true}],"type":"custom"}
+{"_id":"oeilR-D-ophtalmo-7","context":null,"enonce":"What are the 2 most common causes of intermediate uveitis (hyalitis)?","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Sarcoidosis","correct":true},{"idx":1,"proposition":"Behçet's disease","correct":false,"justification":"Especially seen in anterior uveitis"},{"idx":2,"proposition":"Ankylosing spondyloarthritis","correct":false},{"idx":3,"proposition":"Multiple sclerosis","correct":true,"justification":"Sarcoidosis and MS are the 2 main etiologies of hyalitis. But hyalite is mostly idiopathic. Cf. Sarcoidosis in the College of Internal Medicine."},{"idx":4,"proposition":"Systemic lupus erythematosus","correct":false,"justification":"Acute uveitis"}],"type":"custom"}
+{"_id":"oeilR-D-ophtalmo-8","context":null,"enonce":"Regarding the definition of uveitis","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Anterior uveitis is defined as iritis or iridocyclitis","correct":true,"justification":"Inflammation of the uvea of the anterior segment"},{"idx":1,"proposition":"Intermediate uveitis is pars planitis and\/or posterior cyclitis and\/or hyalitis","correct":true},{"idx":2,"proposition":"Posterior uveitis is focal or diffuse choroiditis or retinochoroiditis or retinitis","correct":true},{"idx":3,"proposition":"Panuveitis is an attack of the 3 segments of the eye","correct":true},{"idx":4,"proposition":"Posterior uveitis is a cause of red and painful eye","correct":false,"justification":"It is only the involvement of the anterior segment (anterior uveitis) that can cause a red and painful eye"}],"type":"custom"}
+{"_id":"allergiecut-immuno-0","context":null,"enonce":"About urticaria","item":"allergiecut","matiere":"immuno","propositions":[{"idx":0,"proposition":"Urticaria is a common inflammatory dermatosis due to mast cell activation","correct":true},{"idx":1,"proposition":"Diagnosis of urticaria is based on increased isolated IgE","correct":false,"justification":"The diagnosis is clinical"},{"idx":2,"proposition":"Urticaria corresponds to dermal edema with increased capillary permeability secondary to release by seortonin mast cells","correct":false,"justification":"Mast cells essentially release histamine. Hence the effectiveness of anti-histamines"},{"idx":3,"proposition":"Elementary lesions of superficial urticaria are edematous pustules","correct":false,"justification":"They are papules"},{"idx":4,"proposition":"Whatever the type of lesions, they are itchy, fleeting, and migratory.","correct":true}],"type":"custom"}
+{"_id":"allergiecut-immuno-1","context":null,"enonce":"About urticaria","item":"allergiecut","matiere":"immuno","propositions":[{"idx":0,"proposition":"In deep urticaria, the edema is pinkish-white, firm and itchy in consistency","correct":false,"justification":"It is not itchy but gives a feeling of tension or pain"},{"idx":1,"proposition":"Superficial urticaria is isolated in half of cases, associated with angioedema in 40% of cases","correct":true},{"idx":2,"proposition":"In 70% of cases, there is only angioedema","correct":false,"justification":"There is only angioedema in 10% of cases, which require a different diagnostic and therapeutic approach"},{"idx":3,"proposition":"Insect bites and bullous dermatoses in the pre-bullous stage represent differential diagnoses of urticare","correct":true},{"idx":4,"proposition":"When urticaria is atypical, little or not pruritic, fixed, other diagnoses should be evoked such as urticarial vasculitis","correct":true}],"type":"custom"}
+{"_id":"allergiecut-immuno-2","context":null,"enonce":"Regarding eczema and the different forms of urticaria:","item":"allergiecut","matiere":"immuno","propositions":[{"idx":0,"proposition":"Acute eczema of the face may be responsible for edema lesions are fixed, vesicular and oozing","correct":true},{"idx":1,"proposition":"The diagnosis of physical urticaria is made at the interrogation","correct":false,"justification":"Need for provocation tests"},{"idx":2,"proposition":"The diagnosis of cold urticaria is confirmed by the ice cube test","correct":true},{"idx":3,"proposition":"Confirmation of the diagnosis of solar urticaria is done by photo-test","correct":true},{"idx":4,"proposition":"The confirmation of urticarian dermographism is done by rubbing the skin with a foam tip","correct":true}],"type":"custom"}
+{"_id":"hyperTh-endoc-0","context":null,"enonce":"Which of the following is (are) correct?","item":"hyperTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"The thyroid is under the control of pituitary hormone TSH which stimulates all stages of thyroid hormone biosynthesis.","correct":true},{"idx":1,"proposition":"In children, it is usually a Graves' disease","correct":true},{"idx":2,"proposition":"In important forms, X-ray radiography of the Turkic saddle can measure the degree of protrusion","correct":false,"justification":"MRI is now used"},{"idx":3,"proposition":"Biosynthesis of thyroid hormones requires mercury","correct":false,"justification":"Iodine"},{"idx":4,"proposition":"Postpartum thyroiditis is autoimmune","correct":true}],"type":"custom"}
+{"_id":"hyperTh-endoc-1","context":null,"enonce":"Which of the following is (are) correct?","item":"hyperTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Hyperthyroidism is the set of disorders related to the hyperfunctioning of the thyroid gland","correct":true},{"idx":1,"proposition":"Thyrotoxicosis syndrome corresponds to the consequences of excess thyroid hormones when it is due to primary hyperthyroidism","correct":false,"justification":"Whatever its cause (for example, an excess of exogenous thyroid hormones)"},{"idx":2,"proposition":"The prevalence of hyperthyroidism is about 10% in the general population","correct":false,"justification":"The prevalence of hyperthyroidism is high but varies between countries (0.2 to 1.9% for all causes)"},{"idx":3,"proposition":"The sex ratio is about 7 women to 1 man","correct":true},{"idx":4,"proposition":"Thyroperoxidase, or TPO, allows the organification of iodide among other things","correct":true}],"type":"custom"}
+{"_id":"hyperTh-endoc-2","context":null,"enonce":"Regarding the causes and symptoms of hyperthyroidism:","item":"hyperTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Each of the TSHR, TPO, Tg proteins is likely to behave as an autoantigen","correct":true},{"idx":1,"proposition":"The thyroid mainly produces thyroxine (T4)","correct":true},{"idx":2,"proposition":"The half-life of T4 is approximately 5 days","correct":true},{"idx":3,"proposition":"Thyroid hormones have multiple effects by binding T3 to its membrane receptor","correct":false,"justification":"The T3 receptor, the active hormone, is nuclear. It enables rapid genomic response"},{"idx":4,"proposition":"The cardiovascular effects of hyperthyroidism are, in particular, regular tachycardia, sinus, exaggerated during efforts and emotions, persistent at rest","correct":true}],"type":"custom"}
+{"_id":"hyperTh-endoc-3","context":null,"enonce":"Regarding the diagnosis of hyperthyroidism:","item":"hyperTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Hyperthyroidism may be accompanied by hypotonic delirium that may be similar to depression","correct":false,"justification":"Neuropsychic disorders These disorders are characterized by: excessive nervousness, psychomotor agitation and mood lability; a n and regular tremor of the extremities (manoeuvre \"of the oath\"); on the contrary, we witness"},{"idx":1,"proposition":"Thermophobia is accompanied by excessive sweating, with warm hands","correct":true},{"idx":2,"proposition":"Weight loss due to hyperthyroidism is very often followed by weight gain due to excessive polyphagia","correct":false,"justification":"It is rarely followed by paradoxical weight gain. This is indeed the case when polyphagia \"exceeds\" hypercatabolism"},{"idx":3,"proposition":"Constipation is a master symptom","correct":false,"justification":"Increased frequency of bowel movements: by accelerating transit; sometimes with real motor diarrhea"},{"idx":4,"proposition":"The first-line biological examination is the determination of free T4","correct":false,"justification":"This is TSH. TSH has collapsed, except in certain exceptional cases (examination to be requested in the first line according to HAS)"}],"type":"custom"}
+{"_id":"hyperTh-endoc-4","context":null,"enonce":"Regarding thyrotoxicosis and hyperthyroidism:","item":"hyperTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"The elevation of free T4 and\/or free T3 (there are hyperthyroidism with elevated T3 alone) makes it possible to assess the importance of thyrotoxicosis","correct":true},{"idx":1,"proposition":"The main heart rhythm disorder in thyrotoxicosis is supraventricular to atrial fibrillation type","correct":true},{"idx":2,"proposition":"Heart failure is classically predominantly left","correct":false,"justification":"Heart failure is: usually associated with AF; classically predominantly straight; with high or normal cardiac output"},{"idx":3,"proposition":"Osteoporosis is due to the osteoclastic action of thyroid hormones and predominates in the spine with a risk of vertebral settlement","correct":true,"justification":"This phenomenon is mainly observed in postmenopausal women"},{"idx":4,"proposition":"In Europe, the most frequent causes are, in addition to iatrogeny, in descending order: Graves' disease; toxic multinodular goiter; toxic adenoma","correct":true}],"type":"custom"}
+{"_id":"hemorragie-hemato-0","context":null,"enonce":"Regarding haemorrhages","item":"hemorragie","matiere":"hemato","propositions":[{"idx":0,"proposition":"An abnormality of hemostasis may be evoked in the course of an suggestive clinical event (unexplained hemorrhage, unusual thrombosis) or because of an abnormal laboratory test systematically prescribed","correct":true},{"idx":1,"proposition":"The interrogation must specify, in particular, the spontaneous or provoked nature of the","correct":true},{"idx":2,"proposition":"Questioning and clinical examination help to distinguish a pathology of primary hemostasis from a coagulation disease, and point to a constitutional or acquired etiology","correct":true},{"idx":3,"proposition":"Petechial and \/ or echymotic purpura, spontaneous bleeding and \/ or caused point to an attack of hemostasis","correct":true},{"idx":4,"proposition":"Reference values in adults are usually between 30 and 40 seconds for the TCA","correct":true}],"type":"custom"}
+{"_id":"hemorragie-hemato-1","context":null,"enonce":"Regarding bleeding disorders","item":"hemorragie","matiere":"hemato","propositions":[{"idx":0,"proposition":"A significant prolongation of the TCA is defined by a ratio of sick time \/ control time greater than 1.2","correct":true},{"idx":1,"proposition":"Elongated TCA can detect antihemophilic factor deficiency when isolated","correct":true,"justification":"FVIII (antihemophilic factor A), FIX (antihemophilic factor B)"},{"idx":2,"proposition":"The prolongation of an TCA may indicate an asymptomatic deficiency, not predisposing to bleeding","correct":true,"justification":"FXII deficiency for example"},{"idx":3,"proposition":"The quick time explores the direct (so-called \"extrinsic\") pathway of coagulation","correct":true},{"idx":4,"proposition":"Bleeding time explores primary hemostasis as a whole","correct":true}],"type":"custom"}
+{"_id":"hemorragie-hemato-2","context":null,"enonce":"Regarding bleeding disorders","item":"hemorragie","matiere":"hemato","propositions":[{"idx":0,"proposition":"The expression in INR of the quick time is to be reserved for monitoring AVK treatments","correct":true},{"idx":1,"proposition":"Bleeding time (TS) is operator-dependent, with poor reproducibility and sensitivity","correct":true},{"idx":2,"proposition":"The result of bleeding time is predictive of bleeding risk","correct":false,"justification":"the result obtained is not predictive of the risk of bleeding"},{"idx":3,"proposition":"Willebrand disease is the most common constitutional pathology of hemostasis","correct":true},{"idx":4,"proposition":"Thrombopathy is suggested in the event of unexplained mucocutaneous bleeding, associated with a normal platelet count, normal TCA and TQ","correct":true}],"type":"custom"}
+{"_id":"hemorragie-hemato-3","context":null,"enonce":"About Willebrand disease","item":"hemorragie","matiere":"hemato","propositions":[{"idx":0,"proposition":"Willebrand disease is caused by a quantitative or qualitative deficiency of Wilebrand factor","correct":true,"justification":"FVIII deficiency is often associated"},{"idx":1,"proposition":"Willebrand disease is transmitted in the majority of cases in an autosomal dominant manner","correct":true},{"idx":2,"proposition":"The plasma level of wWF is between 50 and 150% in normal subjects","correct":true},{"idx":3,"proposition":"The clinical expression of Willebrand disease is very heterogeneous","correct":true},{"idx":4,"proposition":"Intramuscular injections are contraindicated in patients with willebrand disease","correct":true}],"type":"custom"}
+{"_id":"hemorragie-hemato-4","context":null,"enonce":"About hemophilia","item":"hemorragie","matiere":"hemato","propositions":[{"idx":0,"proposition":"Congenital hemophilia is due to a deficiency of FVIII (hemophilia A) or FIX (hemophilia B, 5 times less common)","correct":true},{"idx":1,"proposition":"Hemophilia is inherited in an autosomal < recessive manner","correct":false,"justification":"Hemophilia is transmitted in a sex-linked recessive manner, with the FVIII and IX genes located on the X chromosome"},{"idx":2,"proposition":"Only boys are affected and women are drivers","correct":true},{"idx":3,"proposition":"The severity of hemorrhagic syndrome depends on the severity of the FVIII or FIX deficiency: the deficiency may be severe (< 10%)","correct":false,"justification":"The severity of hemorrhagic syndrome depends on the severity of the FVIII or FIX deficiency: the deficiency can be severe (rate < 1%), moderate (rate between 1 and 5%) or minor (rate between 5 and 30%)"},{"idx":4,"proposition":"Clinical manifestations are dominated by bleeding caused by sometimes minimal shock","correct":true}],"type":"custom"}
+{"_id":"hemorragie-hemato-5","context":null,"enonce":"Which of the following are true?","item":"hemorragie","matiere":"hemato","propositions":[{"idx":0,"proposition":"Protein S is a coagulation inhibitor","correct":true},{"idx":1,"proposition":"Protein S is vitamin-K dependent","correct":true},{"idx":2,"proposition":"Protein S acts as a cofactor of activated protein C (PCa)","correct":true},{"idx":3,"proposition":"The determination of protein S is part of the thrombophilia balance sheet","correct":true},{"idx":4,"proposition":"All propositions are true","correct":true}],"type":"custom"}
+{"_id":"psychoT-psy-0","context":null,"enonce":"Regarding the generalities of psychotherapies:","item":"psychoT","matiere":"psy","propositions":[{"idx":0,"proposition":"It is 'Any method of treating psychic or bodily disorders using psychological means and, more precisely, the relationship between therapist and patient'","correct":true},{"idx":1,"proposition":"Simple verbal exchange is psychotherapy","correct":false,"justification":"Any verbal exchange\/conversation does not constitute psychotherapy although a simple verbal exchange can form a therapy provided it is structured around predefined criteria."},{"idx":2,"proposition":"Psychotherapy aims to cure illness when drug treatments are ineffective","correct":false,"justification":"Psychotherapy aims to improve the overall well-being of the patient. This sometimes allows healing but not only in desperation when drug treatment is ineffective."},{"idx":3,"proposition":"Psychotherapy is suitable for all patients because they can be almost totally passive","correct":false,"justification":"It implies on the part of the patient a request for care and change"},{"idx":4,"proposition":"All psychotherapy has a framework with its rules such as the number of sessions, their duration, etc.","correct":true}],"type":"custom"}
+{"_id":"psychoT-psy-1","context":null,"enonce":"Regarding the practice of psychotherapy:","item":"psychoT","matiere":"psy","propositions":[{"idx":0,"proposition":"A psychotherapist is an over-specialized psychologist","correct":false,"justification":"A psychotherapist can have different types of training: psychiatrist, psychologist, or specific training in psychotherapeutic technique without another degree."},{"idx":1,"proposition":"The title of psychologist is at bachelor's level","correct":false,"justification":"Master"},{"idx":2,"proposition":"The title of hypnotherapist escapes any regulation","correct":true},{"idx":3,"proposition":"The title of psychopractitioner requires a bac + 4 minimum","correct":false,"justification":"No regulation governs this title"},{"idx":4,"proposition":"Not all psychotherapy is applicable to every patient","correct":true}],"type":"custom"}
+{"_id":"psychoT-psy-2","context":null,"enonce":"Regarding psychotherapy:","item":"psychoT","matiere":"psy","propositions":[{"idx":0,"proposition":"A common point to all these psychotherapies is the establishment of a quality therapeutic relationship, based on empathy.","correct":true},{"idx":1,"proposition":"Psychotherapy is not just a conversation","correct":true},{"idx":2,"proposition":"It is generally easier to measure the effectiveness of therapies focused on a defined symptom (such as a phobia) than on a global syndrome.","correct":true},{"idx":3,"proposition":"Supportive psychotherapy is considered first-level psychotherapy","correct":true},{"idx":4,"proposition":"Supportive psychotherapy is the least used technique","correct":false,"justification":"It is the most used and least theorized psychotherapy but it responds to a precise framework and defined techniques"}],"type":"custom"}
+{"_id":"SCZ-psy-0","context":null,"enonce":"On the main generalities:","item":"SCZ","matiere":"psy","propositions":[{"idx":0,"proposition":"The diagnosis of schizophrenia is biological","correct":false,"justification":"Early clinical diagnosis"},{"idx":1,"proposition":"Delusions are characterized by their intensity and impact on normal ideation","correct":false,"justification":"Delusions are characterized by their theme, mechanism, systematization, adherence, and emotional and behavioral impact."},{"idx":2,"proposition":"Schizophrenia is a chronic disease","correct":true},{"idx":3,"proposition":"The impact of schizophrenia on life expectancy has recently become zero thanks to new management methods","correct":false,"justification":"Life expectancy is decreased, mainly due to comorbidities (including cardiovascular disease) and suicides"},{"idx":4,"proposition":"Management is based on pharmacological treatment with benzodiazepines","correct":false,"justification":"Management is based on antipsychotic pharmacological treatment, treatment of comorbidities and psycho-social rehabilitation (psycho-education, cognitive-behavioral therapy, cognitive remediation and psychosocial rehabilitation)"}],"type":"custom"}
+{"_id":"SCZ-psy-1","context":null,"enonce":"Schizophrenia:","item":"SCZ","matiere":"psy","propositions":[{"idx":0,"proposition":"Schizophrenia was described in the early twentieth century as a common and severe disease","correct":true},{"idx":1,"proposition":"This disease is currently classified by the WHO among the ten diseases that cause the most disability, especially in young people.","correct":true},{"idx":2,"proposition":"It is characterized in the foreground by an alteration of language and memory","correct":false,"justification":"It is one of the chronic psychotic disorders that are characterized by an alteration of contact with reality"},{"idx":3,"proposition":"The etiology mainly found is iatrogenic (adverse effects of drugs, vaccines and GMOs)","correct":false,"justification":"The hypothesis of a neurodevelopmental disorder, which prevails today, postulates that schizophrenia is the delayed consequence of neurodevelopmental abnormalities beginning years before the onset of the disease."},{"idx":4,"proposition":"The prevalence of schizophrenia is about 10% in the general population","correct":false,"justification":"About 0.6-1%"}],"type":"custom"}
+{"_id":"SCZ-psy-2","context":null,"enonce":"Prevalence and symptomatology:","item":"SCZ","matiere":"psy","propositions":[{"idx":0,"proposition":"The disease typically begins in late adolescence or in young adults between 15 and 25 years of age.","correct":true},{"idx":1,"proposition":"The age of onset is usually later in women compared to men by about 5 years","correct":true},{"idx":2,"proposition":"The emergence of schizophrenic symptoms is brutal and unexpected (thunderclap in a calm sky)","correct":false,"justification":"The emergence of schizophrenic symptoms is usually preceded by cognitive alterations and non-specific prodromal symptoms may be present 2 to 5 years before the emergence of the disorder"},{"idx":3,"proposition":"The sex ratio shows that women are more affected than men","correct":false,"justification":"The sex ratio is fairly balanced, although there is a slight predominance among men (x 1.4)"},{"idx":4,"proposition":"Delusions correspond to alterations in the content of thought resulting in an alteration of contact with reality","correct":true}],"type":"custom"}
+{"_id":"SCZ-psy-3","context":null,"enonce":"Regarding the symptomatology:","item":"SCZ","matiere":"psy","propositions":[{"idx":0,"proposition":"In schizophrenia, the prevalence of delusions is estimated at more than 90%","correct":true},{"idx":1,"proposition":"The theme of the delusional idea corresponds to the degree of reality of it","correct":false,"justification":"This is the main subject of this idea"},{"idx":2,"proposition":"The themes are often those of self-flagellation","correct":false,"justification":"The themes can vary infinitely, be unique or multiple, associate with each other in a more or less logical way"},{"idx":3,"proposition":"The mechanism of the delusional idea corresponds to the process by which the delusional idea is established and constructed.","correct":true},{"idx":4,"proposition":"There are 2 different types of mechanism at the origin of delusions: hallucination and imagination","correct":false,"justification":"There are 4 types of mechanism at the origin of delusions: interpretative, hallucinatory, intuitive and imaginative mechanisms"}],"type":"custom"}
+{"_id":"SCZ-psy-4","context":null,"enonce":"Delusions in schizophrenia:","item":"SCZ","matiere":"psy","propositions":[{"idx":0,"proposition":"The delusional idea theme evaluates the organization and coherence of delusions.","correct":false,"justification":"It is the degree of systematization that evaluates this"},{"idx":1,"proposition":"A delusional idea is considered unsystematized when the organization is fuzzy, vague and incoherent.","correct":true},{"idx":2,"proposition":"In schizophrenia, delusions are often very precise and systematized.","correct":false,"justification":"In schizophrenia, we find in the majority of cases delusions that are not systematized, fuzzy, without logic, incoherent, unlike the persistent delusional disorder of persecution type during which delusions are generally systematized and where coherence gives a certain logic to delusional production"},{"idx":3,"proposition":"Adherence to delusions is the degree of conviction the patient feels about these ideas.","correct":true},{"idx":4,"proposition":"When the conviction is unshakeable, inaccessible to reasoning and criticism, adherence is said to be \"not reasonable\"","correct":false,"justification":"We speak of \"total\" membership"}],"type":"custom"}
+{"_id":"SCZ-psy-5","context":null,"enonce":"Concerning delusions","item":"SCZ","matiere":"psy","propositions":[{"idx":0,"proposition":"When adherence is partial, the patient is able to criticize their own delusions.","correct":true},{"idx":1,"proposition":"Delusions very rarely induce self-aggression","correct":false,"justification":"Dangerousness for oneself or for others can be the direct consequence of delusions (escaping the conspiracy, atone's faults, taking revenge on a persecutor)"},{"idx":2,"proposition":"Persecution is a type of delusional idea in which the central theme for the subject is to be attacked, harassed, etc.","correct":true},{"idx":3,"proposition":"A somatic delusional idea has as its central theme the functioning of the body","correct":true},{"idx":4,"proposition":"A patient who explains that: \"At 8pm, Laurent Delahousse spoke to me through television to tell me that I had to save the world\" may be an example of a crazy idea of reference","correct":true}],"type":"custom"}
+{"_id":"SCZ-psy-6","context":null,"enonce":"Symptoms of schizophrenia:","item":"SCZ","matiere":"psy","propositions":[{"idx":0,"proposition":"Hallucination is defined as a perception without object","correct":true},{"idx":1,"proposition":"Schizophrenia is incompatible with real hallucinations","correct":false,"justification":"In schizophrenia, 75% of patients present with hallucinations, especially in the acute phase"},{"idx":2,"proposition":"Psychosensory hallucinations are sensory manifestations","correct":true},{"idx":3,"proposition":"In schizophrenia, all senses can be affected","correct":true},{"idx":4,"proposition":"Tactile hallucinations are extremely common and are found in more than half of patients with schizophrenia","correct":false,"justification":"Tactile hallucinations (superficial sense of touch) are present in about 5% of patients with schizophrenia"}],"type":"custom"}
+{"_id":"SCZ-psy-7","context":null,"enonce":"Semiology of schizophrenia:","item":"SCZ","matiere":"psy","propositions":[{"idx":0,"proposition":"Hallucinations affecting taste are very common in schizophrenia","correct":false,"justification":"Very rare"},{"idx":1,"proposition":"Olfactory hallucinations most often involve bad odors coming from the patient himself","correct":true},{"idx":2,"proposition":"Cenesthetic hallucinations concern internal sensitivity","correct":true},{"idx":3,"proposition":"Influence syndrome is characterized by the feeling of being directed and losing free will","correct":true},{"idx":4,"proposition":"Negative syndrome corresponds to depression associated with pre-existing schizophrenia","correct":false,"justification":"The negative syndrome includes clinical signs that reflect an impoverishment of psychic life"}],"type":"custom"}
+{"_id":"SCZ-psy-8","context":null,"enonce":"Regarding clinical signs:","item":"SCZ","matiere":"psy","propositions":[{"idx":0,"proposition":"An anhedonia is the loss of ability to experience pleasure","correct":true},{"idx":1,"proposition":"Clinophilia can ultimately lead to negligence","correct":true},{"idx":2,"proposition":"The syndrome of disorganization corresponds to the loss of the psychic unity between ideas, affectivity and attitudes","correct":true},{"idx":3,"proposition":"In this disease, the ability to speak is preserved","correct":false,"justification":"Disorganization at the cognitive level is also manifested by a symptomatology affecting language"},{"idx":4,"proposition":"Catalepsy is a waxy flexibility of the limbs with maintenance of imposed attitudes","correct":true}],"type":"custom"}
+{"_id":"precarite-psy-0","context":null,"enonce":"General and definitions","item":"precarite","matiere":"psy","propositions":[{"idx":0,"proposition":"Precariousness is defined as a state of fragility and social instability","correct":true},{"idx":1,"proposition":"The 2 essential health security identified by the WHO is access to medicines and drinking water.","correct":false,"justification":"The essential health security identified by the WHO is much more numerous than this: * housing, * access to education and information, * adequate food in quantity and quality, * have a sufficient, certain and stable income, * benefit from a stable, protective ecosystem, * rely on a sustainable supply of resources, * have the right to social justice and fair treatment."},{"idx":2,"proposition":"Precariousness corresponds to the modest social classes","correct":false,"justification":"Precariousness does not characterize a particular social category but a set of situations of insecurity and economic, social and family fragility."},{"idx":3,"proposition":"Precariousness is a dynamic, reversible and multifactorial situation","correct":true},{"idx":4,"proposition":"A subject in a precarious situation does not have the means to support himself","correct":false,"justification":"Be careful, a subject in a precarious situation is not necessarily poor or excluded"}],"type":"custom"}
+{"_id":"precarite-psy-1","context":null,"enonce":"On poverty and exclusion:","item":"precarite","matiere":"psy","propositions":[{"idx":0,"proposition":"Poverty is a term that generally refers to the financial dimension","correct":true},{"idx":1,"proposition":"Around 10% of the population lives below the poverty line","correct":true},{"idx":2,"proposition":"Exclusion is a static state that is difficult to adjust","correct":false,"justification":"Exclusion 113 Exclusion is a dynamic reality characterised by the absence for an individual, for a more or less long period, of the possibility of enjoying the same social rights as another individual"},{"idx":3,"proposition":"Exclusion is most often experienced","correct":true},{"idx":4,"proposition":"Exclusion requires medical care most often","correct":false,"justification":"Exclusion is not a disease, but it reduces perceived social support and creates a sense of social worthlessness and self-worthlessness that causes intense psychological suffering and difficulty in integrating into a social fabric."}],"type":"custom"}
+{"_id":"precarite-psy-2","context":null,"enonce":"Regarding the impact of precariousness:","item":"precarite","matiere":"psy","propositions":[{"idx":0,"proposition":"Exclusion is the extreme form of precariousness","correct":true},{"idx":1,"proposition":"The phenomenon of precariousness, in the sense of the absence of one or more securities, affects about 5% of the population","correct":false,"justification":"Epidemiology: The phenomenon of precariousness, in the sense of the absence of one or more security measures, affects 12 to 15 million people in France, or 20 to 25% of the entire population."},{"idx":2,"proposition":"In France, the gap in life expectancy at age 35 between blue-collar workers and senior managers is very small because of the welfare state.","correct":false,"justification":"It is important, from 8 years to 35 years and from 4.5 years to 60 years"},{"idx":3,"proposition":"Medical morbidity and mortality is not impacted by precariousness because access to emergency care is free","correct":false,"justification":"Medical morbidity and mortality is increased among individuals in precarious situations"},{"idx":4,"proposition":"Precariousness is a positive risk factor for the occurrence of psychiatric disorders","correct":true}],"type":"custom"}
+{"_id":"dysphagie-HGE-0","context":null,"enonce":"About dysphagia","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"It must be differentiated from the odynophagia pain felt during the progression of food in the esophagus but without feeling of blockage of the diet","correct":true},{"idx":1,"proposition":"Dysphagia is a sensation of discomfort or obstacle to the progression of the bolus of food occurring during swallowing","correct":true},{"idx":2,"proposition":"Gastro-duodenal endoscopy is the key examination to do in the first place in front of any dysphagia","correct":true},{"idx":3,"proposition":"Even in the case of normal mucosa, mucosal biopsies should be routinely performed to look for eosinophilic esophagitis.","correct":true},{"idx":4,"proposition":"Endoscopic ultrasound is the most precise examination of the esophageal wall","correct":true}],"type":"custom"}
+{"_id":"dysphagie-HGE-1","context":null,"enonce":"About dysphagia","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"If the gastro-duodenal endoscopy is normal, look for an esophageal motor disorder","correct":true},{"idx":1,"proposition":"Esophageal manometry: • is the key test for diagnosing motor disorders of the esophagus","correct":true},{"idx":2,"proposition":"Manotry may be useful to attach anginal-like chest pain to the esophagus","correct":true},{"idx":3,"proposition":"In case of lesional dysphagia, dysphagia in general predominates over fluids","correct":false,"justification":"dysphagia in general: • predominates over solids; • • and has an impact on the general condition"},{"idx":4,"proposition":"Eosinophilic esophagitis, which mainly affects humans, is associated in 50% of cases with atopic manifestations","correct":true}],"type":"custom"}
+{"_id":"dysphagie-HGE-2","context":null,"enonce":"About dysphagia","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"In case of eosinophilic esophagitis the endoscopy may be normal, or visualize the following lesions: whitish granita, thickened mucosa with presence of vertical linear fissures, single or multiple strictures and appearance in \"pseudo-trachea\"","correct":true},{"idx":1,"proposition":"In Zenker's diverticulum dysphagia is high and associated with food regurgitation sometimes triggered by cervical pressure","correct":true},{"idx":2,"proposition":"Zenker's diverticulum diagnsotic occurs on gastro-duodenal endoscopy","correct":false,"justification":"Zenker's diverticulum is CONTRAINDICATED to EOGD because of the risk of perforation"},{"idx":3,"proposition":"Achalasia is a primary motor disorder of the esophagus of unknown cause, defined by the complete absence of peristalsis in the body of the esophagus.","correct":true},{"idx":4,"proposition":"The most common organic causes of dysphagia are tumors and esophagitis","correct":true}],"type":"custom"}
+{"_id":"dysphagie-HGE-3","context":null,"enonce":"About dysphagia","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"The diagnosis of achalasia is endoscopic","correct":false,"justification":"It is manometric"},{"idx":1,"proposition":"Esophagitis with esopniphilia can cause food impaction","correct":true},{"idx":2,"proposition":"Esophageal cancer causes progressive dysphagia that starts with fluids","correct":false,"justification":"It focuses first on solids"},{"idx":3,"proposition":"Oro-pharyngeal dysphagia is essentially ENT or neurological","correct":true},{"idx":4,"proposition":"Secondary motor disorders of the esophagus may be observed in scleroderma or diabetes","correct":true}],"type":"custom"}
+{"_id":"dysphagie-HGE-4","context":null,"enonce":"Which of the following are true?","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"Gastro-duodenal endoscopy (EOGD) is the key test to do first in front of any dysphagia","correct":true,"justification":"Looking for organ lesions"},{"idx":1,"proposition":"CT is the most effective method for diagnosing esophageal and esophagitis tumours","correct":false,"justification":"EOGD is the most effective method for diagnosing esophageal and esophagitis tumors"},{"idx":2,"proposition":"EOGD allows both the precise study of the mucosa and the realization of biopsies","correct":true,"justification":"Great maneuverability and live << visualization>>"},{"idx":3,"proposition":"Even in case of normal mucosa, mucosal biopsies should be routinely performed to look for lymphocyte esophagitis","correct":false,"justification":"Eosinophilic esophagitis is sought, which is often associated with blood eosinophilia and atopic manifestations"},{"idx":4,"proposition":"The chest CT scan makes it possible to look for a mediastinal lesion and appreciates the parietal, mediastinal and lymph node extension of cancers","correct":true,"justification":"And even remotely for advanced forms"}],"type":"custom"}
+{"_id":"dysphagie-HGE-5","context":null,"enonce":"What is the extent of Eckart's score?","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"2","correct":false,"justification":"3"},{"idx":1,"proposition":"3","correct":true,"justification":"Eckart's score ranges from 0 to 3 and is for dysphagia."},{"idx":2,"proposition":"4","correct":false,"justification":"3"},{"idx":3,"proposition":"5","correct":false,"justification":"3"},{"idx":4,"proposition":"6","correct":false,"justification":"3"}],"type":"custom"}
+{"_id":"dysphagie-HGE-6","context":null,"enonce":"Which of the following are true?","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"Dysphagia is a feeling of discomfort or obstruction to the progression of the bolus of food occurring during swallowing","correct":true},{"idx":1,"proposition":"Odynophagia is pain felt during the progression of food in the esophagus but without a feeling of blockage of food","correct":true},{"idx":2,"proposition":"The \"globus hystericus\" is a sensation of cervical striction related to the endobrachy-esophagus","correct":false,"justification":"Globus hystericus is linked to anxiety"},{"idx":3,"proposition":"Odynophagia electively affects certain foods  ","correct":false,"justification":"No, but globus hystericus yes"},{"idx":4,"proposition":"Oropharyngeal dysphagia results in difficulty initiating swallowing and propelling the bolus into the esophagus.","correct":true,"justification":"True. The causes of oropharyngeal dysphagia are mostly ENT or neurological"}],"type":"custom"}
+{"_id":"dysphagie-HGE-8","context":null,"enonce":"Which of the following proposals may be responsible for esophagitis?","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"Doxycycline","correct":true},{"idx":1,"proposition":"Potassium chloride tablets","correct":true},{"idx":2,"proposition":"NSAIDs","correct":true,"justification":"Aspirin++"},{"idx":3,"proposition":"Biphosphonates","correct":true},{"idx":4,"proposition":"Antiparkinsonians","correct":false}],"type":"custom"}
+{"_id":"dysphagie-HGE-9","context":null,"enonce":"Which of the following are true for esophageal candidiasis?","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"The immunocompromised terrain is at risk","correct":true},{"idx":1,"proposition":"It may be responsible for dysphagia without stenosis","correct":true},{"idx":2,"proposition":"It may be responsible for regurgitation","correct":false},{"idx":3,"proposition":"It may be responsible for squamous cell carcinoma","correct":false},{"idx":4,"proposition":"False membrane deposits are found at FOGD","correct":true}],"type":"custom"}
+{"_id":"dysphagie-HGE-10","context":null,"enonce":"Which of the following proposals are in favor of adenocarcinoma of the esophagus?","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"Alcohol","correct":false,"justification":"In favor of squamous cell carcinoma of the esophagus"},{"idx":1,"proposition":"Tobacco","correct":false,"justification":"In favor of squamous cell carcinoma of the esophagus"},{"idx":2,"proposition":"Rapid weight loss","correct":true},{"idx":3,"proposition":"History of gastroesophageal reflux disease","correct":true,"justification":"Chronic GERD and overweight are the 2 main risk factors for EDA of the esophagus"},{"idx":4,"proposition":"Progressive dysphagia","correct":true}],"type":"custom"}
+{"_id":"dysphagie-HGE-11","context":null,"enonce":"Which of the following are possible causes of dysphagia?","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"Amyotrophic lateral sclerosis","correct":true,"justification":"True, is accompanied by fasciculations of the language"},{"idx":1,"proposition":"Radiation esophagitis","correct":true,"justification":"True, delayed complication of radiation therapy"},{"idx":2,"proposition":"Closed Rhinolalia","correct":false,"justification":"False, no direct impact"},{"idx":3,"proposition":"Meckel's diverticulum","correct":false,"justification":"Zencker's diverticulum (Meckel = digestive)"},{"idx":4,"proposition":"Scleroderma","correct":true}],"type":"custom"}
+{"_id":"dysphagie-HGE-12","context":null,"enonce":"Which of the following are possible causes of dysphagia?","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"All propositions are true","correct":true},{"idx":1,"proposition":"Squamous cell carcinomium of the pharynx","correct":true},{"idx":2,"proposition":"Adenocarcinoma of the esophagus","correct":true},{"idx":3,"proposition":"Esophageal candidiasis","correct":true},{"idx":4,"proposition":"Lupus","correct":true}],"type":"custom"}
+{"_id":"dysphagie-HGE-13","context":null,"enonce":"Which of the following are true about eosinophilic esophagitis?","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"They affect more men than women","correct":true},{"idx":1,"proposition":"Asthma is a contributing factor","correct":true},{"idx":2,"proposition":"Treatment is based on the prescription of antihistamines","correct":false,"justification":"Corticosteroids"},{"idx":3,"proposition":"5-year survival is 15%","correct":false,"justification":"False, survival relatively little impacted"},{"idx":4,"proposition":"Biopsies show infiltration by PNE 35% per field","correct":false}],"type":"custom"}
+{"_id":"toux-pneumo-0","context":null,"enonce":"Concerning the main generalities:","item":"toux","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The etiologies of chronic cough are more or less the same as those of acute cough","correct":false,"justification":"The etiologies are very different"},{"idx":1,"proposition":"The majority of acute coughs are allergic","correct":false,"justification":"Especially post-infectious and they do not require investigation"},{"idx":2,"proposition":"Chronic cough is often a defensive phenomenon in response to aggression","correct":true},{"idx":3,"proposition":"Coughing involves a reflex neural arc whose conduction pathways are still unknown to this day.","correct":false,"justification":"They are known in a fairly precise way"},{"idx":4,"proposition":"Cough is a relatively rare symptom in liberal","correct":false,"justification":"This is extremely common"}],"type":"custom"}
+{"_id":"toux-pneumo-2","context":null,"enonce":"Which propositions are true:","item":"toux","matiere":"pneumo","propositions":[{"idx":0,"proposition":"We speak of chronic cough when the duration is greater than 3 weeks in French literature","correct":true},{"idx":1,"proposition":"Post-infectious coughs require a biological work-up","correct":false,"justification":"No investigation"},{"idx":2,"proposition":"A chronic cough can cause a rib fracture","correct":true},{"idx":3,"proposition":"Urine loss associated with chronic cough should suggest overactive bladder","correct":false,"justification":"Are often due to the cough itself"},{"idx":4,"proposition":"Capsaicin stimulates C-fiber receptors and causes coughing","correct":true}],"type":"custom"}
+{"_id":"toux-pneumo-3","context":null,"enonce":"Which of the following suggest causes of iatrogenic cough?","item":"toux","matiere":"pneumo","propositions":[{"idx":0,"proposition":"IEC","correct":true},{"idx":1,"proposition":"Beta-blockers","correct":true},{"idx":2,"proposition":"Amniodarone","correct":false},{"idx":3,"proposition":"Aspirin","correct":false},{"idx":4,"proposition":"Sartans","correct":true,"justification":"There are also vaporized or inhaled drugs"}],"type":"custom"}
+{"_id":"toux-pneumo-4","context":null,"enonce":"Which of the following suggest causes of organic cough?","item":"toux","matiere":"pneumo","propositions":[{"idx":0,"proposition":"IEC intake","correct":false,"justification":"It is an iatrogenic cause, not an organic one"},{"idx":1,"proposition":"Asthma","correct":true},{"idx":2,"proposition":"Pertussis","correct":true},{"idx":3,"proposition":"Malaria","correct":false,"justification":"No cough"},{"idx":4,"proposition":"Chronic meningitis","correct":false}],"type":"custom"}
+{"_id":"nephroPinterst-nephro-0","context":null,"enonce":"Concerning the main generalities:","item":"nephroPinterst","matiere":"nephro","propositions":[{"idx":0,"proposition":"Chronic interstitial nephropathies include a wide variety of pathologies","correct":true},{"idx":1,"proposition":"Most often, the course is rapid and fatal without treatment","correct":false,"justification":"It is rather slow"},{"idx":2,"proposition":"Repeated history of UTIs supports a diagnosis of NIC","correct":true},{"idx":3,"proposition":"Sarcoidosis cannot cause NIC","correct":false,"justification":"This is one of the etiologies"},{"idx":4,"proposition":"Sjögren's syndrome is one of the etiologies of NIC","correct":true}],"type":"custom"}
+{"_id":"nephroPinterst-nephro-1","context":null,"enonce":"Which of these proposals are signs of NIC?","item":"nephroPinterst","matiere":"nephro","propositions":[{"idx":0,"proposition":"A very early and secondary hypertension","correct":false,"justification":"It is late in this type of nephropathy"},{"idx":1,"proposition":"Leukocyteturia","correct":true},{"idx":2,"proposition":"Polyuria","correct":true,"justification":"With nocturia"},{"idx":3,"proposition":"Type 2 diabetes","correct":false,"justification":"There is no indication of impact or link (in the repository in any case) between the T2D and the NICs"},{"idx":4,"proposition":"Acute renal failure","correct":false,"justification":"It is chronic and slow-growing. GFR drops by less than 5 ml\/min each year"}],"type":"custom"}
+{"_id":"nephroPinterst-nephro-2","context":null,"enonce":"Regarding the diagnosis:","item":"nephroPinterst","matiere":"nephro","propositions":[{"idx":0,"proposition":"Ultrasound shows significant dilation of the kidneys and possible cysts","correct":false,"justification":"The kidneys are reduced in size"},{"idx":1,"proposition":"Kidney biopsy is urgent for diagnostic purposes","correct":false,"justification":"Most often, it is not performed, because of the small size of the kidneys and the often very suggestive clinical context"},{"idx":2,"proposition":"Histology is non-specific to the cause of NIC","correct":true,"justification":"See item in the last (8th) edition of the college p.394"},{"idx":3,"proposition":"Anatomical pathology consistently reveals interstitial infiltration by cancer cells","correct":false,"justification":"Infiltration is due to mononuclear cells. The presence of granulomas can sometimes be observed (in the case of a corresponding etiology, e.g. sarcoidosis)"},{"idx":4,"proposition":"Glomeruli and vessels are most often preserved in the initial stages","correct":true}],"type":"custom"}
+{"_id":"nephroPinterst-nephro-3","context":null,"enonce":"Which of these proposals are urological causes of NIC?","item":"nephroPinterst","matiere":"nephro","propositions":[{"idx":0,"proposition":"Lead poisoning","correct":false,"justification":"Toxic cause"},{"idx":1,"proposition":"Sjögren's syndrome","correct":false,"justification":"Dysimmune cause"},{"idx":2,"proposition":"Hyperuricemia","correct":false,"justification":"Metabolic cause"},{"idx":3,"proposition":"Lithiases","correct":true},{"idx":4,"proposition":"Vesicoureteral reflux","correct":true}],"type":"custom"}
+{"_id":"nephroPinterst-nephro-4","context":null,"enonce":"Regarding NICs secondary to lithium intake:","item":"nephroPinterst","matiere":"nephro","propositions":[{"idx":0,"proposition":"30-45% of patients have functional renal abnormalities after 10-15 years of treatment ","correct":true},{"idx":1,"proposition":"There is a polyuropolidipsic syndrome ","correct":true},{"idx":2,"proposition":"There is central diabetes insipidus","correct":false,"justification":"Nephrogenic"},{"idx":3,"proposition":"There is proximal tubular acidosis","correct":false,"justification":"Distal"},{"idx":4,"proposition":"There are microcysts at biopsy ","correct":true}],"type":"custom"}
+{"_id":"nephroPinterst-nephro-5","context":null,"enonce":"The drugs responsible for NIC are:","item":"nephroPinterst","matiere":"nephro","propositions":[{"idx":0,"proposition":"Aminoglycosides","correct":false,"justification":"Direct NTA"},{"idx":1,"proposition":"Antineoplastics (e.g. cisplatin)","correct":true},{"idx":2,"proposition":"Anticalcineurins ( ciclosporin and tacrlimus ) ","correct":true},{"idx":3,"proposition":"Statins","correct":false,"justification":"Indirect NTA"},{"idx":4,"proposition":"Interferon","correct":false,"justification":"Immunological glomerular"}],"type":"custom"}
+{"_id":"nephroPinterst-nephro-6","context":null,"enonce":"NITU syndrome:","item":"nephroPinterst","matiere":"nephro","propositions":[{"idx":0,"proposition":"Means Interstitial and Tubular Nephropathy with Urethritis","correct":false,"justification":"Uveitis"},{"idx":1,"proposition":"It is a dysimmune pathology ","correct":true},{"idx":2,"proposition":"Is more common in adults than in children ","correct":false},{"idx":3,"proposition":"Is interstitial nephritis associated with uveitis ","correct":true},{"idx":4,"proposition":"Is treated with corticosteroids","correct":true}],"type":"custom"}
+{"_id":"fievreimmunoD-infectio-0","context":null,"enonce":"Regarding fever in immunocompromised patients","item":"fievreimmunoD","matiere":"infectio","propositions":[{"idx":0,"proposition":"Three therapeutic emergencies are identified: febrile neutropenia, asplenic fever, sepsis\/septic shock","correct":true},{"idx":1,"proposition":" The presence of immunosuppression requires taking into account the possibility of opportunistic infection","correct":true},{"idx":2,"proposition":"Any febrile neutropenia requires emergency antibiotic therapy","correct":true},{"idx":3,"proposition":"The symptomatology of febrile neutropenia is poor due to the absence of phagocytic effectors","correct":true},{"idx":4,"proposition":"Any fever in an asplenic should be treated with probabilistic antibiotic therapy amoxicillin + clavulanic acid ","correct":false,"justification":"Any fever in an asplenic should be treated with 3rd generation cephalosporin probabilistic antibiotic therapy (after blood cultures) because of the risk of fulminant pneumococcal infection"}],"type":"custom"}
+{"_id":"fievreimmunoD-infectio-1","context":null,"enonce":"Regarding fever in immunocompromised patients","item":"fievreimmunoD","matiere":"infectio","propositions":[{"idx":0,"proposition":"Immunosuppression has 3 consequences: the impossibility of setting up an adapted immune response vis-à-vis endogenous or exogenous infectious agents, reduced clinical signs making it difficult to assess the clinical severity that may be underestimated, the possibility of a more rapid multiplication of the infectious agent(s) involved","correct":true,"justification":"This is what makes diagnosis and management so difficult."},{"idx":1,"proposition":"Any acute fever in an immunocompromised patient is a diagnostic emergency","correct":true},{"idx":2,"proposition":"Any acute fever in an immunocompromised patient is infectious until proven otherwise.","correct":true},{"idx":3,"proposition":"Neutropenia is most often secondary to cancer chemotherapy with a delay of onset of 2 to 10 weeks","correct":false,"justification":"Time to onset of 2 to 10 days depending on chemotherapy"},{"idx":4,"proposition":"The term neutropenia applies below 1000\/mm3 neutrophils","correct":false,"justification":"The term neutropenia applies below 1500\/mm3 neutrophils (PNN)"}],"type":"custom"}
+{"_id":"fievreimmunoD-infectio-2","context":null,"enonce":"Regarding fever in immunocompromised patients","item":"fievreimmunoD","matiere":"infectio","propositions":[{"idx":0,"proposition":"The infectious emergency is frank when PNN < 500\/mm3","correct":true},{"idx":1,"proposition":"Febrile neutropenia is defined by PNN < 500\/mm3 and fever","correct":true},{"idx":2,"proposition":"The most frequent bacterial translocations originate in the digestive tract","correct":true},{"idx":3,"proposition":"The 3 most common gateways are the digestive tract, skin and lungs","correct":true},{"idx":4,"proposition":"The clinical examination is often poor in a febrile neutropenic patient, because of the absence of inflammatory focus","correct":true}],"type":"custom"}
+{"_id":"fievreimmunoD-infectio-3","context":null,"enonce":"Regarding infections in immunocompromised people","item":"fievreimmunoD","matiere":"infectio","propositions":[{"idx":0,"proposition":"Fever is often the main, if not the only, manifestation of the infection","correct":true},{"idx":1,"proposition":"The presence of sepsis marks the absolute urgency and the need for prompt referral to a continuing care unit","correct":false,"justification":"Intensive Care Unit"},{"idx":2,"proposition":" Pleiocytosis is constant in CSF in meningitis","correct":false},{"idx":3,"proposition":"Leukocyteturia is often absent in urinary tract infections","correct":true},{"idx":4,"proposition":"The frequency and severity of infections are proportional to the depth of neutropenia","correct":true,"justification":"The risk of infection is significant if PNN < 500\/mm3 and it is major if PNN < 100\/mm3"}],"type":"custom"}
+{"_id":"Kcfoie-onco-0","context":null,"enonce":"Regarding the biliary cyst:","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"This tumor affects 5% of the population","correct":true,"justification":"We speak of tumor (in the onco MedLine) and, indeed, it is quite common"},{"idx":1,"proposition":"The wall is unicellular","correct":true},{"idx":2,"proposition":"The contents are biliary","correct":false,"justification":"Independent clear fluid content (not communicating with the biliary tree)"},{"idx":3,"proposition":"They are often multiple","correct":true},{"idx":4,"proposition":"They are hyperintense in T1 sequence MRI","correct":false,"justification":"Hyperintense in T2"}],"type":"custom"}
+{"_id":"Kcfoie-onco-1","context":null,"enonce":"Regarding hemangioma:","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"It is a malignant tumor","correct":false,"justification":"This is quite benign"},{"idx":1,"proposition":"It affects 0.1% of the general population","correct":false,"justification":"It is a fairly common tumor that affects about 3% to 5% of the population (3% in the MedLine of oncology, 5% in the college of hepato-gastroenterology)"},{"idx":2,"proposition":"It requires mild chemotherapy","correct":false,"justification":"It does not require any treatment"},{"idx":3,"proposition":"It is hypervascularized","correct":true},{"idx":4,"proposition":"On MRI, it is hyperintense in T2 with an increasingly intense peripheral lump filling towards the center","correct":true}],"type":"custom"}
+{"_id":"Kcfoie-onco-3","context":null,"enonce":"Regarding hepatocellular adenoma: ","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"Diagnosis requires a biopsy most often","correct":true},{"idx":1,"proposition":"The lesion is hypoechoic","correct":true},{"idx":2,"proposition":"The lesion is hypodense","correct":true},{"idx":3,"proposition":"The lesion is hypointense in T1","correct":true},{"idx":4,"proposition":"The lesion is hyperintense in T2","correct":true}],"type":"custom"}
+{"_id":"Kcfoie-onco-4","context":null,"enonce":"Regarding abscesses and cysts:","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"The pyogenic abscess is hyper-dense on CT scan with a central enhancement","correct":false,"justification":"The pyogenic abscess is hypoechogenic and hypodense on CT scan with peripheral enhancement"},{"idx":1,"proposition":"A serology of amoebiasis must be carried out at the slightest doubt","correct":true},{"idx":2,"proposition":"The amoebic abscess is often unique","correct":true},{"idx":3,"proposition":"Hydatid cyst is caused by echinococcus fermantosus","correct":false,"justification":"Echinococcus granulosus (fermantosus is invented, it does not exist)"},{"idx":4,"proposition":"Alveolar echinococcosis is caused by echnicoccus multilocularis","correct":true,"justification":"Imaging in favor of sometimes invasive nodules, which can mimic neoplasia."}],"type":"custom"}
+{"_id":"Kcfoie-onco-5","context":null,"enonce":"Regarding metastatic lesions:","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"Metachrone metastases have a poorer prognosis than synchronous metastases","correct":false,"justification":"It's the other way around. Synchronous lesions can indeed sign a very weakened immune system"},{"idx":2,"proposition":"In general, metastases appear hypodense and do not rise to arterial time","correct":true},{"idx":3,"proposition":"If metastases appear within 8 years, in the context of a known primary tumor and imaging is considered compatible, the diagnosis is affirmed without recourse to biopsy","correct":false,"justification":"Within two years (according to the Oncology MedLine)"},{"idx":4,"proposition":"Biopsy is necessary if the patient has two primary cancers in their history","correct":true}],"type":"custom"}
+{"_id":"Kcfoie-onco-6","context":null,"enonce":"Regarding Hepatocellular Carcinoma (HCC):","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"It is the most common hepatic malignancy","correct":false,"justification":"Only in primary malignant lesions. Otherwise, it is mainly benign lesions (the simple biliary cyst affects almost 5% of the population). Also, there are more metastases than primary liver tumors."},{"idx":1,"proposition":"HCC is more common in women","correct":false,"justification":"HCC is more common in humans. The sex ratio is 6"},{"idx":2,"proposition":"The leading cause of HCC is hepatitis C virus","correct":false,"justification":"It is especially ethyl cirrhosis"},{"idx":3,"proposition":"Atoxin gives hepatocellular carcinomas on healthy liver by causing p53 mutations","correct":true},{"idx":4,"proposition":"Any nodular image on cirrhosis is a CHC until proven otherwise.","correct":true}],"type":"custom"}
+{"_id":"Kcfoie-onco-7","context":null,"enonce":"Which of the following are benign tumors that do not require monitoring?","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"Focal nodular hyperplasia","correct":true},{"idx":1,"proposition":"Benign hemangioma","correct":true},{"idx":2,"proposition":"Hepatocellular adenoma","correct":false,"justification":"It has the potential for degeneration and can be complicated by bleeding, so it should be monitored."},{"idx":3,"proposition":"Cholangiocarcinoma","correct":false,"justification":"It is a malignant tumor"},{"idx":4,"proposition":"All must be monitored","correct":false,"justification":"False, not UFH or benign hemangioma"}],"type":"custom"}
+{"_id":"Kcfoie-onco-8","context":null,"enonce":"Which of the following are risk factors for HCC?","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"Focal nodular hyperplasia","correct":false,"justification":"No risk of degeneration"},{"idx":1,"proposition":"A metabolic syndrome ","correct":true},{"idx":2,"proposition":"NASH","correct":true},{"idx":3,"proposition":"Cirrhosis","correct":true,"justification":"True, main risk factor"},{"idx":4,"proposition":"Alveolar echinococcosis","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"Kcfoie-onco-10","context":null,"enonce":"What is the proportion of HCC occurring on cirrhosis?","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"5%","correct":false,"justification":"False"},{"idx":1,"proposition":"25%","correct":false,"justification":"False"},{"idx":2,"proposition":"50%","correct":false,"justification":"False"},{"idx":3,"proposition":"90%","correct":true},{"idx":4,"proposition":"100%","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"Kcestomac-onco-0","context":null,"enonce":"Which of the following are true?","item":"Kcestomac","matiere":"onco","propositions":[{"idx":0,"proposition":"Malignant epithelial tumors are the most common ","correct":true},{"idx":1,"proposition":"Worldwide, stomach cancer is the fifth most common cancer ","correct":true},{"idx":2,"proposition":"The average age of onset is 70 years with a female predominance ","correct":false,"justification":"Male"},{"idx":3,"proposition":"The most used histological classification is Lauren's which distinguishes 2 types of adenocarcinoma ","correct":true},{"idx":4,"proposition":"The epidemiology of gastric cancer evolves differently depending on location and histological type ","correct":true}],"type":"custom"}
+{"_id":"Kcestomac-onco-1","context":null,"enonce":"Which of the following are true?","item":"Kcestomac","matiere":"onco","propositions":[{"idx":0,"proposition":"    In France, stomach cancer is the second most common cancer ","correct":false,"justification":"Fifth"},{"idx":1,"proposition":"In recent years, there has been an increase in the incidence of cancers of the cardia and diffuse types ","correct":true},{"idx":2,"proposition":"There is a decrease in the incidence of distal forms and intestinal adenocarcinoma","correct":true},{"idx":3,"proposition":"Helicobacter pylori is a risk factor","correct":true},{"idx":4,"proposition":"H. pylori is a gram-negative bacillus transmitted mainly in childhood  ","correct":true}],"type":"custom"}
+{"_id":"DBAI-dermato-0","context":null,"enonce":"Regarding definitions:","item":"DBAI","matiere":"dermato","propositions":[{"idx":0,"proposition":"Autoimmune bullous dermatoses are very common diseases, especially in post-puberty women","correct":false,"justification":"Autoimmune bullous dermatoses (IBD) are a heterogeneous group of infrequent diseases with variable prognosis, often pejorative."},{"idx":1,"proposition":"The diagnosis of DBAI is clinical","correct":false,"justification":"The diagnosis of IBAD requires a combination of clinical, pathological and immunopathological examinations"},{"idx":2,"proposition":"Desmosomes allow interkeratinocyte adhesion","correct":true},{"idx":3,"proposition":"the dermal-epidermal junction (JDE) is a morphologically complex region","correct":true},{"idx":4,"proposition":"There are two main groups of DBAI: supraepidermal and subepidermal","correct":false,"justification":"Intra-epidermal and subepidermal (there is nothing above the epidermis)"}],"type":"custom"}
+{"_id":"DBAI-dermato-1","context":null,"enonce":"Regarding definitions:","item":"DBAI","matiere":"dermato","propositions":[{"idx":0,"proposition":"Intraepidermal DBAI are part of the pemphigus group","correct":true},{"idx":1,"proposition":"Intraepidermal IABDs are due to acantholysis","correct":true},{"idx":2,"proposition":"Desmosome alteration is caused by circulating PNNs","correct":false,"justification":"By autoantibodies \"anti-intercellular substance\""},{"idx":3,"proposition":"A bubble is a superficial elementary fluid lesion larger than 15 mm","correct":false,"justification":"Size greater than 5 mm"},{"idx":4,"proposition":"The bubbles sit exclusively on the skin coating","correct":false,"justification":"It can sit on the skin or mucous membranes"}],"type":"custom"}
+{"_id":"DBAI-dermato-2","context":null,"enonce":"Regarding the clinic and histopathology:","item":"DBAI","matiere":"dermato","propositions":[{"idx":0,"proposition":"Nikolsky's sign corresponds to skin detachment caused by friction on healthy skin","correct":true},{"idx":1,"proposition":"An acantholysis is an intraepidermal detachment","correct":true},{"idx":2,"proposition":"A subepidermal bubble by cleavage between the dermis and the epidermis is a tense bubble","correct":true},{"idx":3,"proposition":"The contents of a subepidermal bubble are clear or haematic","correct":true},{"idx":4,"proposition":"An intraepidermal bubble by detachment of keratinocytes from each other is a tense bubble","correct":false,"justification":"It is a flaccid and fragile bubble (because the roof of the bubble is very thin due to intraepidermal cleavage)"}],"type":"custom"}
+{"_id":"DBAI-dermato-3","context":null,"enonce":"Regarding the diagnosis of DBAI:","item":"DBAI","matiere":"dermato","propositions":[{"idx":0,"proposition":"There is a list of known DBAI-inducing drugs","correct":true},{"idx":1,"proposition":"Bullous pemphigoid is an intraepidermal DBAI","correct":false,"justification":"Bullous pemphigoid (linear deposits of IgG and C3) is a subepidermal DBAI"},{"idx":2,"proposition":"ACE inhibitors are known inducers of pemphigus","correct":true},{"idx":3,"proposition":"Potassium-sparing diuretics are known inducers of bullous pemphigoid","correct":true},{"idx":4,"proposition":"The bubbles are stretched in the DBAI of the JDE","correct":true}],"type":"custom"}
+{"_id":"epistaxis-ORL-1","context":null,"enonce":"Concerning anatomo-histo-physiology:","item":"epistaxis","matiere":"ORL","propositions":[{"idx":0,"proposition":"Like all mucous membranes, that of the nasal cavity is composed of three layers","correct":true},{"idx":1,"proposition":"The epithelium is composed of a cell monolayer","correct":true},{"idx":2,"proposition":"The basement membrane is non-existent","correct":false,"justification":"a basement membrane is present"},{"idx":3,"proposition":"A chorion is composed of a single hypervascular layer","correct":false,"justification":"A chorion is composed of three layers"},{"idx":4,"proposition":"From the surface to the depth, there is the lymphoid layer, the glandular layer and the vascular layer","correct":true}],"type":"custom"}
+{"_id":"epistaxis-ORL-2","context":null,"enonce":"Regarding the vascularization of the nasal cavity:","item":"epistaxis","matiere":"ORL","propositions":[{"idx":0,"proposition":"Arterial vascularization of the nasal cavity is dependent on both carotid systems","correct":true},{"idx":1,"proposition":"These arterioles lack an internal elastic membrane","correct":true},{"idx":2,"proposition":"The artery of the subseptum vascularizes the anteroinferior part of the septum","correct":true},{"idx":3,"proposition":"The branches of the anterior ethmoidal remain independent from their birth to their passage through the microcirculation","correct":false,"justification":"The artery of the subseptum anastomoses with the artery of the septum and with the branches of the anterior ethmoidal"},{"idx":4,"proposition":"The vascular spot is an anastomosis area of three arterial systems","correct":true}],"type":"custom"}
+{"_id":"epistaxis-ORL-3","context":null,"enonce":"Regarding anatomy and diagnosis:","item":"epistaxis","matiere":"ORL","propositions":[{"idx":0,"proposition":"Kiesselbach's vascular spot is the main area of epistaxis","correct":true},{"idx":1,"proposition":"The venous system is distributed in three layers at the mucosal level","correct":true},{"idx":2,"proposition":"The veins of the nasal cavity have abundant anastomoses with the arterial system","correct":true},{"idx":3,"proposition":"Specifying the abundance and impact of epistaxis makes it possible to deduce the seriousness","correct":true},{"idx":4,"proposition":"Etiologies are never found","correct":false,"justification":"It happens that if: trauma, taking anticoagulant\/antithrombotic, etc."}],"type":"custom"}
+{"_id":"epistaxis-ORL-4","context":null,"enonce":"Regarding the diagnosis:","item":"epistaxis","matiere":"ORL","propositions":[{"idx":0,"proposition":"Ensuring hemostasis is the first therapeutic act to consider","correct":true},{"idx":1,"proposition":"In benign epistaxis, the flow is scarce, dripping through the nostril, at first almost always unilateral","correct":true},{"idx":2,"proposition":"The appreciation of the bleeding volume is essential to find and guides all the care","correct":false,"justification":"The appreciation of bleeding volume is always difficult to estimate, frequently overestimated by the patient or the entourage but sometimes misleading by default because swallowed. Rather, it is based on the objective hemodynamic impact"},{"idx":3,"proposition":"The presence of bleeding disorders makes bleeding control more difficult","correct":true},{"idx":4,"proposition":"Severe epistaxis is frequently unilateral","correct":false,"justification":"Examination of the nasal cavities is sometimes delicate due to the abundance of bleeding, frequently bilateral and anteroposterior"}],"type":"custom"}
+{"_id":"epistaxis-ORL-6","context":null,"enonce":"Regarding treatment:","item":"epistaxis","matiere":"ORL","propositions":[{"idx":0,"proposition":"An oral or injectable anxiolytic in an agitated and anxious patient may be proposed","correct":true},{"idx":1,"proposition":"The search for an etiology is urgent in the face of an epistaxis in progress","correct":false,"justification":"We first take care of the epistaxis"},{"idx":2,"proposition":"Drying up bleeding is the primary treatment","correct":true},{"idx":3,"proposition":"The examination of the nasal cavity will be performed using a rigid endoscope 0 or 30 degrees","correct":true},{"idx":4,"proposition":"Simple finger compression of the nose wing for 10 minutes can stop most epistaxis","correct":true}],"type":"custom"}
+{"_id":"epistaxis-ORL-7","context":null,"enonce":"Regarding epistaxis:","item":"epistaxis","matiere":"ORL","propositions":[{"idx":0,"proposition":"Compression by hemostatic buffer is possible in first line","correct":true},{"idx":1,"proposition":"cauterization of the vascular spot is done in the operating room","correct":false,"justification":"cauterization of the vascular spot is done at the patient's bed"},{"idx":2,"proposition":"In case of undetermined localization, endonasal coagulation of sphenopalatine arteries is the first-line treatment","correct":true},{"idx":3,"proposition":"It is common to transfusion patients who have been victims of severe epistaxis","correct":false,"justification":"Exceptional transfusion Apart from massive loss and deterioration of the general condition, it is preferable to replenish the martial reserves (oral iron or injectable) or to offer treatment with erythropoietin (EPO)"},{"idx":4,"proposition":"An essential epistaxis of the young is treated by anteroposterior tamponade most often","correct":false,"justification":"Simple compression for 10 minutes. See cauterization of vascular spot"}],"type":"custom"}
+{"_id":"epistaxis-ORL-8","context":null,"enonce":"Which of the following propositions concerning epistaxis are true?","item":"epistaxis","matiere":"ORL","propositions":[{"idx":0,"proposition":"First-line treatment is based on digital compression for previous bleeding","correct":true},{"idx":1,"proposition":"Ethmoidal artery embolization is the third-line treatment","correct":false,"justification":"Embolization of the ethmoid artery is contraindicated because it is a branch of the internal carotid artery (ICA). Its embolization therefore exposes to a risk of stroke or occlusion of the central artery of the retina (blindness). A ligature is therefore performed instead."},{"idx":2,"proposition":"Nasopharyngeal fibroid is a choanal vascularized tumor","correct":true,"justification":"True, it mainly affects boys at peripubertal age"},{"idx":3,"proposition":"Cauterization of the vascular spot is most often bilateral","correct":false,"justification":"Unilateral because risk of perforating the nasal septum if bilateral"},{"idx":4,"proposition":"The first measure to be carried out in case of severe epistaxis is the previous wicking","correct":false,"justification":"It is first necessary to perform a stripping because the clots, when they dissolve, cause even more bleeding"}],"type":"custom"}
+{"_id":"infdentaire-urg-0","context":null,"enonce":"Which of these propositions are true?","item":"infdentaire","matiere":"urg","propositions":[{"idx":0,"proposition":"Parsnip is an infection of the soft parts of the hand or fingers","correct":true},{"idx":1,"proposition":"Phlegmon is an infection that develops in an anatomical space of the hand or fingers","correct":true},{"idx":2,"proposition":"Acute infections of the soft parts are monobacterial most often","correct":true},{"idx":3,"proposition":"The most frequently involved bacteria are oral streptococci","correct":false,"justification":"These are Staphylococcus aureus"},{"idx":4,"proposition":"Treatment of phlegmon is surgical","correct":true,"justification":"This is an excision"}],"type":"custom"}
+{"_id":"infdentaire-urg-1","context":null,"enonce":"Which of these germs is, or is, responsible for impetigo?","item":"infdentaire","matiere":"urg","propositions":[{"idx":0,"proposition":"Staphylococcus Epidermidis","correct":false,"justification":"Cocci gram + occurring in clusters (like all staphylococcus). It is facultatively anaerobic and has no coagulase. In particular, it can be found in infectious endocarditis on equipment."},{"idx":1,"proposition":"Staphylococcus aureus","correct":true,"justification":"Cocci gram + occurring in clusters (like all Staphylococcus). The treatment of choice is amox-ac. clav or C3G IV. Other antibiotics may work depending on the indication: fluoroquinolones, cotrimoxazole, macrolides, or glycopeptides (non-exhaustive list). It can cause many infections such as sinusitis, panaris, abscesses, bursitis, etc."},{"idx":2,"proposition":"Streptococcus Gallolyticus","correct":false,"justification":"Cocci gram + presenting in diplococcus (like all streptococcus). It can be found in infectious endocarditis, rarely."},{"idx":3,"proposition":"Streptococcus Pyogenes","correct":true,"justification":"We see it, sometimes, in the impetigos. It is a gram + cocci presenting as a diplococcus (like all streptococci). It is also found in scarlet fever, tenosynovitis or panaris. It is a pyogenic germ, part of the Streptococci of Group A, which imposes additional contact precautions."},{"idx":4,"proposition":"Enterococcus Faecalis","correct":false,"justification":"It is a gram + cocci in chains (like all enterococcus)."}],"type":"custom"}
+{"_id":"infdentaire-urg-2","context":null,"enonce":"Which of these germs is, or is, most frequently responsible for boils?","item":"infdentaire","matiere":"urg","propositions":[{"idx":0,"proposition":"Staphylococcus Epidermidis","correct":false,"justification":"Cocci gram + occurring in clusters (like all staphylococcus). It is facultatively anaerobic and has no coagulase. In particular, it can be found in infectious endocarditis on equipment."},{"idx":1,"proposition":"Staphylococcus aureus","correct":true,"justification":"Cocci gram + occurring in clusters (like all Staphylococcus). The treatment of thing is amox-ac. clav or C3G IV. Other antibiotics may work depending on the indication: fluoroquinolones, cotrimoxazole, macrolides, or glycopeptides (non-exhaustive list). It can cause many infections such as sinusitis, panaris, abscesses, bursitis, etc."},{"idx":2,"proposition":"Streptococcus Gallolyticus","correct":false,"justification":"Coccy gram + presenting in diplococcus (like all streptococcus). It can be found in infectious endocarditis, rarely."},{"idx":3,"proposition":"Streptococcus Pyogenes","correct":false,"justification":"We see it, sometimes, in the impetigos. It is a gram + cocci presenting as a diplococcus (like all streptococci). It is also found in scarlet fever, tenosynovitis or panaris. It is a pyogenic germ, part of the Streptococci of Group A, which imposes additional contact precautions."},{"idx":4,"proposition":"Enterococcus Faecalis","correct":false,"justification":"It is a gram + cocci in chains (like all enterococcus)."}],"type":"custom"}
+{"_id":"infdentaire-urg-3","context":null,"enonce":"Which of these proposals about dacryocystitis are true?","item":"infdentaire","matiere":"urg","propositions":[{"idx":0,"proposition":"This is an infection of the eye","correct":false,"justification":"Dacryocystitis is an infection of the tear sac"},{"idx":1,"proposition":"Redness of the eye is observed","correct":false,"justification":"There is an unusual size of the inner corner of the eye"},{"idx":2,"proposition":"The edema caused can interfere with eyesight","correct":true,"justification":"The swelling can indeed generate the vision of the eye concern (internally)"},{"idx":3,"proposition":"Age is a risk factor","correct":true,"justification":"It is rare in children and more common in the elderly."},{"idx":4,"proposition":"It is often secondary to stenosis of the lacrimal glands","correct":true}],"type":"custom"}
+{"_id":"infdentaire-urg-4","context":null,"enonce":"Which of these signs and symptoms can be found at the stage of collected parsnip?","item":"infdentaire","matiere":"urg","propositions":[{"idx":0,"proposition":"Pain","correct":true,"justification":"These are the 4 cardinal signs of inflammation: edema, redness, heat and pain"},{"idx":1,"proposition":"Redness","correct":true},{"idx":2,"proposition":"Oedema","correct":true},{"idx":3,"proposition":"Haemorrhage","correct":false},{"idx":4,"proposition":"Dystonia","correct":false}],"type":"custom"}
+{"_id":"infdentaire-urg-5","context":null,"enonce":"Which of these treatment proposals is, or is, recommended in the case of collected parsnip?","item":"infdentaire","matiere":"urg","propositions":[{"idx":0,"proposition":"NSAIDs","correct":false},{"idx":1,"proposition":"Surgical excision","correct":true,"justification":"At the phlegmasic stage, the treatment consists of antiseptic baths (+\/- combined with antibiotic therapy depending on the case). At the collected stage, it is surgical excision and antibiotic therapy directed against staphylococcus."},{"idx":2,"proposition":"Amoxicillin","correct":false},{"idx":3,"proposition":"Amoxicillin - Clavulanic acid","correct":true},{"idx":4,"proposition":"C3G IV","correct":false}],"type":"custom"}
+{"_id":"DRA-CE-urg-0","context":null,"enonce":"Regarding acute breathatory shrinkage","item":"DRA-CE","matiere":"urg","propositions":[{"idx":0,"proposition":"The clinical examination • In all cases, the clinical examination, is the first fundamental step for the estimation of the severity and etiological orientation of respiratory distress","correct":true},{"idx":1,"proposition":"Cyanosis is rather predominant in the mucous membranes in case of circulatory cyanosis and rather at the extremities in case of breathatory cyanosis","correct":false,"justification":"Classically it is rather predominant in the mucous membranes in case of respiratory cyanosis (and called \"hot\") and rather at the extremities in case of circulatory cyanosis (and called \"cold\")"},{"idx":2,"proposition":"Blood gases will be taken arterial in adults","correct":true},{"idx":3,"proposition":"Blood gases will be collected from veins or capillaries in children and young infants without underlying chronic cardiopulmonary disease","correct":true},{"idx":4,"proposition":"Hypoxemia can only be analyzed on an arterial blood gas","correct":true}],"type":"custom"}
+{"_id":"DRA-CE-urg-1","context":null,"enonce":"Regarding acute breathatory shrinkage","item":"DRA-CE","matiere":"urg","propositions":[{"idx":0,"proposition":"– Hypercapnia will be observed during central neurological causes acting on the cerebral respiratory centers or during damage to the respiratory muscles","correct":true},{"idx":1,"proposition":"Any state of shock or severe infectious state may be accompanied by hypoxemia and therefore respiratory distress without pure respiratory cause found.","correct":true},{"idx":2,"proposition":"Foreign body of the child • Inhalation of foreign body mainly concerns children from 6 months to 6 years","correct":false,"justification":"Foreign body of the child • Inhalation of foreign body mainly concerns children from 6 months to 3 years, although inhalation can occur later and including in adults, sometimes giving tables of hypoxic cardiac arrest"},{"idx":3,"proposition":"A recurrent infectious pathology in the same territory and resistant to well-conducted treatment must evoke a foreign body of the respiratory tract and must discuss bronchial fibroscopy","correct":true},{"idx":4,"proposition":"• In case of doubt, on the inhalation of a foreign body bronchial endoscopy is the rule","correct":true}],"type":"custom"}
+{"_id":"DRA-CE-urg-2","context":null,"enonce":"Regarding acute respiratory distress","item":"DRA-CE","matiere":"urg","propositions":[{"idx":0,"proposition":"Epiglottitis is an absoule life emergency and occurs after 6 months and can be seen until adulthood.","correct":true},{"idx":1,"proposition":"It has become extremely rare since vaccination against Haemophilus influenzae b (1st causative agent), to be sought at the interrogation of parents","correct":true},{"idx":2,"proposition":"Haemophilus microabscesses are responsible for inflammatory edema of the epiglottis","correct":true},{"idx":3,"proposition":"Typically, in case of epiglottitis the child refuses to lie down","correct":true},{"idx":4,"proposition":"• Antibiotic therapy with amoxicillin and clavulanic acid is urgent (50 mg\/kg then 150 mg\/kg\/day)","correct":false}],"type":"custom"}
+{"_id":"DRA-CE-urg-3","context":null,"enonce":"Regarding acute respiratory distress","item":"DRA-CE","matiere":"urg","propositions":[{"idx":0,"proposition":"Transport to hospital should be medicalized and tongue depressors should not be used in epiglottia","correct":true},{"idx":1,"proposition":"In case of intubation, she will have to be a child in a sitting position, more or less under fibroscopy, by a trained operator, with tracheostomy equipment available","correct":true},{"idx":2,"proposition":"Acute laryngitis is a common condition in the general population, giving a barking cough and a hoarse voice, linked to inflammation of the vocal cords","correct":true},{"idx":3,"proposition":"Acute laryngitis can cause expiratory dyspnoea in infants and young children","correct":false,"justification":"It can cause inspiratory dyspnea in infants and young children"},{"idx":4,"proposition":"It is exceptional before the age of 6 months, and must in these cases seek an underlying condition (laryngeal stenosis, subglottic hemangioma, other rarer conditions)","correct":true}],"type":"custom"}
+{"_id":"dopage-psy-0","context":null,"enonce":"General information on doping:","item":"dopage","matiere":"psy","propositions":[{"idx":0,"proposition":"It is possible for some athletes to use certain treatments to manage an acute or chronic intercurrent health problem","correct":true},{"idx":1,"proposition":"The screening circumstances are set up by the HAS","correct":false,"justification":"Screening circumstances * set up by the AFLD, * carried out by a sworn person, * concerns all athletes participating in sports competitions or events, * collection of a urine sample, analyzed in an approved laboratory, * athlete's biological passport: hematological and endocrine module"},{"idx":2,"proposition":"AMPD provides anonymous consultations","correct":true},{"idx":3,"proposition":"One of the main objectives of doping is fatigue resistance","correct":true},{"idx":4,"proposition":"WADA will one day maintain the list of prohibited substances and methods","correct":true}],"type":"custom"}
+{"_id":"dopage-psy-1","context":null,"enonce":"General generalities:","item":"dopage","matiere":"psy","propositions":[{"idx":0,"proposition":"The World Anti-Doping Agency (WADA) annually updates a list of prohibited substances and methods, available annually","correct":true},{"idx":1,"proposition":"The French Anti-Doping Agency (AFLD) offers a search engine to check if a drug is banned","correct":true},{"idx":2,"proposition":"In France, almost 4% of doping controls carried out in 2012 contained prohibited substances (before verification of a possible ATU)","correct":true},{"idx":3,"proposition":"The Therapeutic Use Exemption (TUE) procedure allows certain athletes to use certain treatments to manage an acute or chronic intercurrent health problem","correct":true},{"idx":4,"proposition":"For diuretics, there is a need to deliver a TUE for any substance in or out of competition, in addition to that obtained for the diuretic","correct":true}],"type":"custom"}
+{"_id":"dopage-psy-2","context":null,"enonce":"Which propositions are true?","item":"dopage","matiere":"psy","propositions":[{"idx":0,"proposition":"There are urinary thresholds for the latter beyond which it is not an intentional therapeutic use","correct":true},{"idx":1,"proposition":"A controlled pharmacokinetic study in athletes can confirm therapeutic use","correct":true},{"idx":2,"proposition":"Taking EPO may be associated with handling blood for doping purposes","correct":true},{"idx":3,"proposition":"The violation threshold is equivalent to a blood alcohol concentration of 0.10 g\/L","correct":true},{"idx":4,"proposition":"Alcohol is never completely forbidden","correct":false,"justification":"For some sports if: aeronautics, automotive, karate, motorcycle, archery and powerboating"}],"type":"custom"}
+{"_id":"dopage-psy-3","context":null,"enonce":"Regarding screening circumstances:","item":"dopage","matiere":"psy","propositions":[{"idx":0,"proposition":"Gene doping is defined by WADA as \"transfer of nucleic acids or nucleic acid sequences\" and \"the use of normal or genetically modified cells\"","correct":true},{"idx":1,"proposition":"A direct screening measure is the verification of the drug-aided coat of arms","correct":false,"justification":"A direct measure: anti-doping controls. An untimely check of athletes' homes is of course illegal"},{"idx":2,"proposition":"Only professional athletes participating in a competition or event approved by a sports federation can be checked","correct":false,"justification":"Professional or amateur"},{"idx":3,"proposition":"Tests can take place during competitions but also during training for these competitions or events","correct":true},{"idx":4,"proposition":"They are set up by the AFLD","correct":true}],"type":"custom"}
+{"_id":"ulcere-cardio-0","context":null,"enonce":"About leg ulcer","item":"ulcere","matiere":"cardio","propositions":[{"idx":0,"proposition":"This is a leg wound that has not healed for more than 3 months","correct":false,"justification":"More than a month"},{"idx":1,"proposition":"Arterial ulcer is the most common case","correct":false,"justification":"Venous ulcer accounts for 80% of ulcer cases"},{"idx":2,"proposition":"The leg ulcer affects women prelaterially","correct":true},{"idx":3,"proposition":"In the case of venous ulcer, the measurement of the IPS is systematic","correct":true,"justification":"To look for arterial participation (IPS 0.7-0.9), which would constitute a mixed ulcer"},{"idx":4,"proposition":"To attribute an ulcer to an arterial cause, the ankle infusion pressure must be less than 30mmHg","correct":false,"justification":"Less than 50 mmHg"}],"type":"custom"}
+{"_id":"ulcere-cardio-1","context":null,"enonce":"About leg ulcer","item":"ulcere","matiere":"cardio","propositions":[{"idx":0,"proposition":"The ulcer of necrotic angiodermatitis is very painful","correct":true,"justification":"Insomnia pain"},{"idx":1,"proposition":"In case of venous ulcer, venous and arterial Doppler ultrasound is systematic","correct":false,"justification":"Venous only. Arterial Doppler ultrasound is indicated in case of clinical suspicion of PAD (including abnormal IPS)"},{"idx":2,"proposition":"In the case of ABI between 0.7 and 0.9, the ulcer is mixed predominantly arterial","correct":false,"justification":"Mixed predominantly venous (PAD does not explain the ulcer)"},{"idx":3,"proposition":"Ecthyma is an infectious ulcer due to Staphylococcus aureus: it is small in size and occurs after a blackish crust","correct":false,"justification":"Streptococcus A infection"},{"idx":4,"proposition":"The ulcer is frequently complicated by atopic dermatitis","correct":false,"justification":"Contact dermatitis"}],"type":"custom"}
+{"_id":"ulcere-cardio-2","context":null,"enonce":"About leg ulcer","item":"ulcere","matiere":"cardio","propositions":[{"idx":0,"proposition":"In case of ulcer, antibiotic prescription is systematic to avoid superinfection","correct":false,"justification":"No systematic antibiotic therapy: colonization is frequent and non-pathological"},{"idx":1,"proposition":"In the case of venous ulcer, cancerization is common and doubtless to be suspected in case of painful persistent ulcer","correct":false,"justification":"It is rare and late, but should still be mentioned, especially in case of pain or excessive budding on a chronic ulcer"},{"idx":2,"proposition":"Vasculitis ulcers are rare","correct":true},{"idx":3,"proposition":"Pellet transplantation is systematic in an arterial ulcer","correct":false,"justification":"Only in case of resistance to treatment for more than 6 months or larger than 10cm2"},{"idx":4,"proposition":"In case of ulcer infection, a silver dressing is indicated","correct":true,"justification":"For a maximum of 4 weeks"}],"type":"custom"}
+{"_id":"mvtsaN-neuro-0","context":null,"enonce":"Concerning the main generalities:","item":"mvtsaN","matiere":"neuro","propositions":[{"idx":0,"proposition":"Abnormal and\/or involuntary movements are most often caused by motor prefrontal gyrus disorder","correct":false,"justification":"Abnormal and\/or involuntary movements are most often caused by dysfunction, injury or degenerative pathology affecting the basal ganglia system (or basal ganglia) also called extrapyramidal system"},{"idx":1,"proposition":"The basal ganglia are responsible for programming and automatically executing learned motor sequences","correct":true},{"idx":2,"proposition":"Abnormal movements correspond to a disorder of programming and\/or execution of movement","correct":true},{"idx":3,"proposition":"Abnormal movements have two characteristics: they are little or not controlled by the will and occur in the absence of paralysis (except in cases of associated involvement of the pyramid system)","correct":true},{"idx":4,"proposition":"The positive diagnosis of these abnormal movements is biological","correct":false,"justification":"The positive diagnosis of these abnormal movements is clinical, but the etiological diagnosis sometimes requires additional biological (including genetic) or imaging examinations"}],"type":"custom"}
+{"_id":"mvtsaN-neuro-1","context":null,"enonce":"Regarding Parkinsonian tremors:","item":"mvtsaN","matiere":"neuro","propositions":[{"idx":0,"proposition":"They are present at rest and disappear during muscle contraction only","correct":false,"justification":"Also disappear during sleep"},{"idx":1,"proposition":"They concern the distorted limbs, the lips or chin, and the head","correct":false,"justification":"They affect the limbs in distal, lips or chin, but never the leader unlike essential tremors"},{"idx":2,"proposition":"They are unilateral or asymmetrical","correct":true},{"idx":3,"proposition":"They are aggravated by emotions and mental arithmetic.","correct":true},{"idx":4,"proposition":"They are examined in a resting position (hands resting on a plane or on the thighs, palms facing up in a relaxed patient)","correct":true}],"type":"custom"}
+{"_id":"mvtsaN-neuro-2","context":null,"enonce":"In case of Parkinsonian tremors:","item":"mvtsaN","matiere":"neuro","propositions":[{"idx":0,"proposition":"Wilson's disease can cause abnormal movement and parkinsonism","correct":true},{"idx":1,"proposition":"In case of parkinsonism related to an antipsychotic, it should be discontinued if possible and replaced if necessary by clozapine","correct":true},{"idx":2,"proposition":"A DaTSCAN® brain scan should only be performed if there is doubt between Parkinson's disease-related parkinsonian tremor and neuroleptic-related parkinsonian tremor","correct":true,"justification":"In practice, the DAT-scan can potentially be used for all problematic diagnostic orientations of parkinsonism syndrome."},{"idx":3,"proposition":"If the diagnosis of Parkinson's disease is strongly suspected and it is an individual over 40 years of age, no further examination is necessary.","correct":true},{"idx":4,"proposition":"In case of parkinsonian tremors before age 40, a brain MRI and cupric workup including cupremia, ceruleoplasminemia and cupruria for 24 hours are necessary to rule out Wilson's disease.","correct":true}],"type":"custom"}
+{"_id":"mvtsaN-neuro-3","context":null,"enonce":"Regarding essential tremors:","item":"mvtsaN","matiere":"neuro","propositions":[{"idx":0,"proposition":"The most common cause of postural tremor is parkinsonism","correct":false,"justification":"These are the essential tremors"},{"idx":1,"proposition":"Its frequency is 4 to 6 Hz","correct":false,"justification":"This is the case of parkisonian tremor. Essential tremor has a frequency of 6 to 12 Hz"},{"idx":2,"proposition":"Essential tremor is usually unilateral and asymmetric","correct":false,"justification":"The essential tremor is usually bilateral and symmetrical, with a frequency of 6 to 12 Hz, affecting the upper limbs, the leader"},{"idx":3,"proposition":"Action tremors are all willingly improved by alcohol intake but aggravated by emotions and caffeine.","correct":false,"justification":"This is the case of essential tremor. Not all action tremors are."},{"idx":4,"proposition":"In case of doubt between a tremor related to Parkinson's disease and an essential tremor, a DaTSCAN® can be performed (it is normal in essential tremor), in order to help in the diagnosis and start a suitable treatment","correct":true}],"type":"custom"}
+{"_id":"mvtsaN-neuro-4","context":null,"enonce":"Regarding essential tremor and cerebellar tremor:","item":"mvtsaN","matiere":"neuro","propositions":[{"idx":0,"proposition":"Brain MRI is normal in essential tremor","correct":true,"justification":"Brain MRI is normal in essential tremor and should not be performed when the picture is typical"},{"idx":1,"proposition":"The most effective treatments for essential tremors are beta-blocker propranolol and barbiturate primidone","correct":true},{"idx":2,"proposition":"Cererebellar tremor is a tremor of action that appears or is maximum when arriving at the target","correct":true,"justification":"It is an intentional tremor"},{"idx":3,"proposition":"Cererebellar tremor is highlighted during action with intent","correct":true,"justification":"For example: the finger-nose test, drinking a glass of water, etc."},{"idx":4,"proposition":"A walk with an enlargement of the lifting polygon evokes a cerebelous origin","correct":true,"justification":"There is also incoordination of movements"}],"type":"custom"}
+{"_id":"diverticulose-HGE-0","context":null,"enonce":"Concerning diverticular disease","item":"diverticulose","matiere":"HGE","propositions":[{"idx":0,"proposition":"A diverticulum colon is an acquired hernia of the mucosa and submucosa through an area of weakness in the muscular wall of the colon.","correct":true},{"idx":1,"proposition":"The predominant localization is in the sigmoid colon","correct":true},{"idx":2,"proposition":"• Sigmoid or sigmoid diverticulitis corresponds to inflammation occurring in the vicinity of one or more sigmoid diverticula","correct":true},{"idx":3,"proposition":"There is a predominance in developing countries","correct":false,"justification":"Predominance in countries with a Western-style lifestyle"},{"idx":4,"proposition":"Uncomplicated diverticular disease is by definition asymptomatic, most often discovered during a colonoscopy performed for other digestive symptoms.","correct":true}],"type":"custom"}
+{"_id":"diverticulose-HGE-1","context":null,"enonce":"Regarding diverticulosis and diverticulitis","item":"diverticulose","matiere":"HGE","propositions":[{"idx":0,"proposition":"No treatment is needed for divertiuclose colic","correct":true},{"idx":1,"proposition":"The 2 possible complications are: • diverticulitis and its complications (peritonitis, abscesses, fistulas, strictures) and diverticular hemorrhage","correct":true},{"idx":2,"proposition":"Dietary measures are to be implemented to prevent diverticulitis","correct":false},{"idx":3,"proposition":"Abdominopelvic computed tomography is the key emergency test for the diagnosis of diverticulitis","correct":true,"justification":"the diagnosis of diverticulitis which is based on 3 associated signs: thickening of colonic aroi to more than 4 mm, infiltration of pericolic fat, presence of diverticula"}],"type":"custom"}
+{"_id":"diverticulose-HGE-2","context":null,"enonce":"Regarding diverticulosis and diverticulitis","item":"diverticulose","matiere":"HGE","propositions":[{"idx":0,"proposition":"Ultrasound, abdomen without preparation, MRI and opaque enema are not indicated","correct":true},{"idx":1,"proposition":"A residue-free diet is not warranted during the diverticulitis episode","correct":false},{"idx":2,"proposition":"One-third of sigmoid diverticulitis are complicated by abscesses","correct":true},{"idx":3,"proposition":"If the abscess is accessible and of sufficient size, its radiological drainage is indicated","correct":true},{"idx":4,"proposition":"In case of impossibility or failure of drainage, a resection-anastomosis, possibly protected by an upstream stoma, is indicated","correct":true}],"type":"custom"}
+{"_id":"diverticulose-HGE-3","context":null,"enonce":"Regarding diverticulitis and diverticulosis","item":"diverticulose","matiere":"HGE","propositions":[{"idx":0,"proposition":"Diverticular hemorrhages are often brutal, by erosion of arterioles of the collar or the bottom of the diverticulum","correct":true},{"idx":1,"proposition":"Diverticular hemorrhages are the cause of 60% of lower gastrointestinal bleeding","correct":false,"justification":"The cause of one-third of sudden lower bleeding of red blood"},{"idx":2,"proposition":"The diagnosis of diverticulitis is generally suspected in the presence of pain in the left iliac fossa accompanied by transit disorders, fever, elevated serum C-reactive protein levels and hyperleukocytosis","correct":true},{"idx":3,"proposition":"Diverticulitis, in its usual form, is treated with antibiotics for 7 to 14 days","correct":false,"justification":"Diverticulitis, in its usual form, is treated with antibiotics for 7-10 days"},{"idx":4,"proposition":"• In case of diverticulitis complicated by abscess, peritonitis, or fistula, management is conditioned by the general condition of the patient and the severity of the peritoneal infection assessed according to the Hinchey classification","correct":true}],"type":"custom"}
+{"_id":"diverticulose-HGE-4","context":null,"enonce":"You suspect an attack of sigmoid diverticulitis. Which additional exam(s) do you prescribe urgently?","item":"diverticulose","matiere":"HGE","propositions":[{"idx":0,"proposition":"A total colonoscopy","correct":false,"justification":"Useless"},{"idx":1,"proposition":"A recto-sigmoidoscopy","correct":false,"justification":"Not in emergency"},{"idx":2,"proposition":"An unprepared abdomen","correct":false,"justification":"Useless"},{"idx":3,"proposition":"None of these proposals","correct":false,"justification":"The diagnosis must be confirmed by imaging"},{"idx":4,"proposition":"An abdominopelvic CT angiography","correct":true,"justification":"True. Allows diagnosis as well as to see complications (abscess for example)"}],"type":"custom"}
+{"_id":"HSA-urg-0","context":null,"enonce":"Which of the following are true for headaches in SAH?","item":"HSA","matiere":"urg","propositions":[{"idx":0,"proposition":"SAH (or subarachnoid hemorrhage) accounts for 10 to 30% of sudden headaches.","correct":true},{"idx":1,"proposition":"The typical headache is explosive","correct":true},{"idx":2,"proposition":"Typical headache is associated with other signs of meningeal syndrome","correct":true},{"idx":3,"proposition":"Headache cannot be isolated","correct":false,"justification":"However, the headache can be isolated, more progressive, or disappear in a few hours, especially in case of HSA of low abundance (headache called \"sentinel\" of a ruptured aneurysm, preceding a massive SAH)"},{"idx":4,"proposition":"All propositions are true","correct":false,"justification":"None"}],"type":"custom"}
+{"_id":"HSA-urg-1","context":null,"enonce":"Which of the following are the tests you request as a first-line treatment when you suspect a subarachnoid hemorrhage?","item":"HSA","matiere":"urg","propositions":[{"idx":0,"proposition":"Brain scan with injection right away","correct":false,"justification":"False"},{"idx":1,"proposition":"Cerebral arteriography","correct":false,"justification":"Invasive technique, not in first line"},{"idx":2,"proposition":"Brain scan without injection","correct":true,"justification":"True, this is the key diagnostic test. Its sensitivity is 95% on the first day"},{"idx":3,"proposition":"Lumbar puncture (LP)","correct":false,"justification":"Absolutely contraindicated in the first intention by the risk of commitment"},{"idx":4,"proposition":"Hemostasis assessment","correct":true,"justification":"True, especially for PL"}],"type":"custom"}
+{"_id":"HSA-urg-3","context":null,"enonce":"Which of the following are possible signs of subarachnoid hemorrhage?","item":"HSA","matiere":"urg","propositions":[{"idx":0,"proposition":"Initial loss of consciousness","correct":true},{"idx":1,"proposition":"Delirium","correct":true},{"idx":2,"proposition":"Phono-photophobia","correct":true},{"idx":3,"proposition":"Impaired alertness","correct":true},{"idx":4,"proposition":"Vomiting in jets","correct":true}],"type":"custom"}
+{"_id":"HSA-urg-4","context":null,"enonce":"Which of the following proposals regarding lumbar puncture in case of suspected subarachnoid hemorrhage are true?","item":"HSA","matiere":"urg","propositions":[{"idx":0,"proposition":"The recrudescence of headaches would contraindicate the realization of the lumbar puncture","correct":false,"justification":"Does not fall within the contraindications of PL, which are: local infections, severe hemostasis disorders and intracranial hypertension with threat of engagement"},{"idx":1,"proposition":"The absence of xanthochromia of the fluid after 12 hours helps to eliminate a subarachnoid hemorrhage","correct":true,"justification":"True, xanthochromia is present in all aneurysmal SAHS when CSF is collected between 12 hours and 14 days after the onset of symptoms and analyzed by spectrophotometry."},{"idx":2,"proposition":"The presence of a clear supernatant after centrifugation with the absence of blood pigment is in favor of a traumatic lumbar puncture","correct":true},{"idx":3,"proposition":"If imaging does not provide a diagnosis, a lumbar puncture should be done","correct":true,"justification":"True, even if the headache is gone"},{"idx":4,"proposition":"Headaches from subarachnoid hemorrhage may fluctuate","correct":true}],"type":"custom"}
+{"_id":"HSA-urg-5","context":null,"enonce":"Which of the following MRI propositions are true?","item":"HSA","matiere":"urg","propositions":[{"idx":0,"proposition":"MRI becomes more sensitive than CT beyond 24 hours","correct":true,"justification":"True, it is then the FLAIR and T2* sequences that can detect hemorrhages"},{"idx":1,"proposition":"MRI eliminates subarachnoid hemorrhage at all stages","correct":false,"justification":"After 24h. Before, it is the scanner that is more sensitive"},{"idx":2,"proposition":"MRI allows an exploration of the intracranial arteries without injection","correct":true},{"idx":3,"proposition":"MRI is a longer exam than CT","correct":true},{"idx":4,"proposition":"All these propositions are true","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"vascularite-immuno-0","context":null,"enonce":"Which of the following are true?","item":"vascularite","matiere":"immuno","propositions":[{"idx":0,"proposition":"Vasculitis can cause aseptic 🤒 fever ","correct":true},{"idx":1,"proposition":"Vasculitis corresponds to an inflammatory involvement of the lymphatic vessels","correct":false,"justification":"Vasculitis typically only concerns blood vessels"},{"idx":2,"proposition":"There are no causes of secondary vasculitis","correct":false,"justification":"Bacterial, viral, iatrogenic, parasitic causes, etc. Note also the deleterious role of cocaine 💮"},{"idx":3,"proposition":"The Chapel Hill classification to differentiate between different vasculitis","correct":true},{"idx":4,"proposition":"c-ANCA correspond to proteinase 3","correct":true,"justification":"True. X-ANCA with cathepsin G (PR, lupus) or lactoferrin (UC, sclerosing cholangitis) and p-ANCA with myeloperoxidase (MPA, Churg-Strauss, ...)"}],"type":"custom"}
+{"_id":"Frped-urg-1","context":null,"enonce":"Which propositions are true?","item":"Frped","matiere":"urg","propositions":[{"idx":0,"proposition":"Green wood fractures concern the lower limb","correct":false,"justification":"The 2 bones of the forearm, radius\/ulna"},{"idx":1,"proposition":"The butter fracture affects the lower quarter of the radius","correct":true},{"idx":2,"proposition":"An unusual fracture can lead to a tumor","correct":true},{"idx":3,"proposition":"An unusual fracture may point to hyperthyroidism","correct":false,"justification":"Does not usually cause this type of fracture"},{"idx":4,"proposition":"An unusual fracture may point to osteogenic imperfecta","correct":true}],"type":"custom"}
+{"_id":"Frped-urg-2","context":null,"enonce":"Which of these fractures are the most common in children?","item":"Frped","matiere":"urg","propositions":[{"idx":0,"proposition":"The motte de beure","correct":true,"justification":"The lower quarter of the radius"},{"idx":1,"proposition":"The bones of the skull","correct":false,"justification":"Happens only in case of head trauma normally"},{"idx":2,"proposition":"Joint fracture of the elbow","correct":true},{"idx":3,"proposition":"Carp","correct":true},{"idx":4,"proposition":"Odds","correct":false}],"type":"custom"}
+{"_id":"Frped-urg-3","context":null,"enonce":"Which of the following are true?","item":"Frped","matiere":"urg","propositions":[{"idx":0,"proposition":"Regional anaesthesia is contraindicated in children","correct":false,"justification":"It is to be dicutered (femoral block for example)"},{"idx":1,"proposition":"If fracture is suspected, the child should be left on an empty stomach","correct":true,"justification":"In anticipation of possible general anesthesia"},{"idx":2,"proposition":"The x-ray must allow to visualize the entire limb concerned","correct":false,"justification":"Not the whole limb, but systematically the over- and underlying joints"},{"idx":3,"proposition":"Radiography should include orthogonal incidences","correct":true,"justification":"Single incidence only in case of very painful obvious displaced fracture (single incidence, with subsequent additional incidences under anaesthesia)"},{"idx":4,"proposition":"Trauma to growth cartilage is radiotransparent","correct":true,"justification":"None"}],"type":"custom"}
+{"_id":"nvxne-gyn-0","context":null,"enonce":"Which propositions are true?","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"In the immediate postnatal period, most organs, except the heart and brain, are still in full development.","correct":false,"justification":"Especially the brain"},{"idx":1,"proposition":"The clinical examination of the newborn is legally mandatory before the 30th day of life","correct":false,"justification":"Day 8"},{"idx":2,"proposition":"The legal examination of the newborn ends with an interview with the parents","correct":true},{"idx":3,"proposition":"Anamnestic investigation is optional and reserved for complicated births","correct":false,"justification":"It is systematic"},{"idx":4,"proposition":"Maternal age below 18 years of age puts you at increased risk of prematurity","correct":true}],"type":"custom"}
+{"_id":"nvxne-gyn-1","context":null,"enonce":"Regarding the questioning of the family:","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"A maternal age > 35 years induces an increased risk of malformation and trisomy 21","correct":true},{"idx":1,"proposition":"Nephropathies and diabetes have no consequences on the fetus if they are balanced","correct":false,"justification":"If, in several ways: the drugs used, silent decompensations, the impacts of nephropathies that are difficult to balance, etc."},{"idx":2,"proposition":"Feto-pelvic disproportion is a common source of perinatal anoxia","correct":true},{"idx":3,"proposition":"The duration of pregnancy is determined from the onset of sympathetic signs (nausea, breast thickening, etc.)","correct":false,"justification":"The duration is arbitrarily determined in completed amenorrhea (AS) weeks"},{"idx":4,"proposition":"Any birth after 42SA is post-term","correct":true}],"type":"custom"}
+{"_id":"nvxne-gyn-2","context":null,"enonce":"Regarding the postpartum interrogation of pregnant women:","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"Maternal infection in the 1st trimester puts at risk of malformative embryopathy","correct":true},{"idx":1,"proposition":"Oligohydramnios is a sign of pulmonary hypoplasia or osteoarticular deformity","correct":true},{"idx":2,"proposition":"Hydramnios may be explained by lack of control of gestational diabetes","correct":true},{"idx":3,"proposition":"An anamnios may be a consequence of esophageal atresia","correct":false,"justification":"Atresia of the esophagus results in hydramnios"},{"idx":4,"proposition":"Amniotic fluid is normally clear","correct":true}],"type":"custom"}
+{"_id":"nvxne-gyn-3","context":null,"enonce":"Regarding amniotic fluid and immediate care:","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"Amniotic fluid is physiologically tinted","correct":false,"justification":"It is tinted in case of infection"},{"idx":1,"proposition":"Greenish amniotic fluid may indicate meconium emissions in utero","correct":true},{"idx":2,"proposition":"Physiological amniotic fluid has no particular odor","correct":true},{"idx":3,"proposition":"A liquid with a fetid odor can point to a risk of maternal-fetal infection","correct":true},{"idx":4,"proposition":"From birth, it is necessary to assess the condition of the child to initiate adapted resuscitation gestures if necessary","correct":true}],"type":"custom"}
+{"_id":"nvxne-gyn-4","context":null,"enonce":"What is the Agpar score of a newborn at 85 bpm, with normal breathing, pink skin color, hypotonic, who screams loudly?","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"6","correct":false,"justification":"It's 8 (85bpm = 1, breathing = 2, pink = 2, hypotonic = 1, cries = 2)"},{"idx":1,"proposition":"7","correct":false},{"idx":2,"proposition":"8","correct":true},{"idx":3,"proposition":"9","correct":false},{"idx":4,"proposition":"10","correct":false}],"type":"custom"}
+{"_id":"nvxne-gyn-5","context":null,"enonce":"Concerning the immediate postnatal","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"Morrison's score makes it possible to instantly judge the condition of the newborn","correct":false,"justification":"It is the Apgar score that makes it possible to judge instantly the condition of the newborn and guides the action to be taken"},{"idx":1,"proposition":"Agpar's score is assessed at 1 and 10 minutes postnatal","correct":false,"justification":"1 minute then 5 and 10 minutes"},{"idx":2,"proposition":"If the Apgar score is greater than 8 to 1 minute: the newborn is healthy","correct":true},{"idx":3,"proposition":"An agpar score of less than 3 to 1 minute implies emergency management","correct":true},{"idx":4,"proposition":"The assessment of the condition of the newborn and the practice of resuscitation gestures must be done with the child lying on a heated and illuminated table","correct":true}],"type":"custom"}
+{"_id":"nvxne-gyn-6","context":null,"enonce":"Concerning the immediate postnatal:","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"Checking the permeability of the choanas, esophagus and anus is to be carried out urgently postnatally","correct":false,"justification":"Checking the permeability of the choanas, esophagus and anus should be systematic before leaving the delivery room but not necessarily urgently from birth"},{"idx":1,"proposition":"The verification of the permeability of the orifices is done in particular by flexible probe","correct":true},{"idx":2,"proposition":"Administration of eye drops prevents Staphylococcus aureus conjunctivitis","correct":false,"justification":"Administration of eye drops prevents gonococcal conjunctivitis and vitamin K1 2 mg orally prevents hemorrhagic disease of the newborn"},{"idx":3,"proposition":"The initial examination must be done between the 3rd and 8th day of life","correct":false,"justification":"The initial examination must be done during the first hours of life, at best before leaving the delivery room"},{"idx":4,"proposition":"At birth the skin is covered with an adherent whitish coating called vernix caseosa","correct":true}],"type":"custom"}
+{"_id":"nvxne-gyn-7","context":null,"enonce":"Regarding the initial clinical examination of the newborn:","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"It is mandatory","correct":true},{"idx":1,"proposition":"spots are physiological","correct":true},{"idx":2,"proposition":"Peeling of the skin during the first few days is a sign of a skin infection that must be treated urgently","correct":false,"justification":"During the first days a more or less extensive desquamation appears, its evolution is spontaneously favorable"},{"idx":3,"proposition":"Simple hydration may be necessary in case of crevices in the folds","correct":true},{"idx":4,"proposition":"A mild rash made of minimal vesicles of the \"toxic erythema of the newborn\" type may occur within the first 3 days, and disappears spontaneously","correct":true}],"type":"custom"}
+{"_id":"nvxne-gyn-8","context":null,"enonce":"What is the threshold for heartbeat APGAR from 1 to 2?","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"25","correct":false,"justification":"False"},{"idx":1,"proposition":"50","correct":false,"justification":"False"},{"idx":2,"proposition":"100","correct":true},{"idx":3,"proposition":"130","correct":false,"justification":"False"},{"idx":4,"proposition":"150","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"nvxne-gyn-9","context":null,"enonce":"Which of the following are part of the Guthrie test?","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"PKU","correct":true},{"idx":1,"proposition":"Hepatitis C","correct":false,"justification":"Infections are not part of this test"},{"idx":2,"proposition":"Congenital adrenal hyperplasia","correct":true},{"idx":3,"proposition":"Adrenaloma","correct":false,"justification":"Tumors are not part of this test"},{"idx":4,"proposition":"Cystic fibrosis","correct":true}],"type":"custom"}
+{"_id":"nvxne-gyn-10","context":null,"enonce":"Which of the following are part of the APGAR score?","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"Heart rate","correct":true,"justification":"True, threshold at 100 (2 if beyond, 1 if below)"},{"idx":1,"proposition":"Coloring","correct":true,"justification":"True (Overall blue = 0 \/ blue ends = 1 \/ overall pink = 2)"},{"idx":2,"proposition":"Grasping","correct":false,"justification":"False. Does not fit into APGAR's score. It is one of the 6 archaic reflexes."},{"idx":3,"proposition":"Breathing","correct":true},{"idx":4,"proposition":"Muscle tone","correct":true}],"type":"custom"}
+{"_id":"nvxne-gyn-11","context":null,"enonce":"Which of the following proposals designate the two germs most often involved in a maternal-fetal infection in a full-term newborn?","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"E. coli","correct":true},{"idx":1,"proposition":"K. pneumoniae","correct":false,"justification":"False. E. Coli and GBS"},{"idx":2,"proposition":"L. monocytogenes","correct":false,"justification":"False. E. Coli and GBS"},{"idx":3,"proposition":"Group A Streptococcus","correct":false,"justification":"False. E. Coli and GBS"},{"idx":4,"proposition":"Group B Streptococcus","correct":true}],"type":"custom"}
+{"_id":"nvxne-gyn-12","context":null,"enonce":"Which of the following are risk factors for poor adaptation to ectopic life?","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"Severe gestational hypertension of the mother","correct":true},{"idx":1,"proposition":"Vaginal delivery","correct":false,"justification":"False"},{"idx":2,"proposition":"Mini-oscillated fetal heart rate","correct":true},{"idx":3,"proposition":"Diabetes","correct":true},{"idx":4,"proposition":"IUGR","correct":true}],"type":"custom"}
+{"_id":"nvxne-gyn-13","context":null,"enonce":"What pathologies are detected at birth by the Guthrie test?","item":"nvxne","matiere":"gyn","propositions":[{"idx":0,"proposition":"Congenital adrenal hypoplasia","correct":false,"justification":"Hyperplasia"},{"idx":1,"proposition":"Hyperthyroidism ","correct":false,"justification":"Hypothyroidism"},{"idx":2,"proposition":"Cystic fibrosis","correct":true},{"idx":3,"proposition":"Thalassemia","correct":false,"justification":"False"},{"idx":4,"proposition":"PKU","correct":true}],"type":"custom"}
+{"_id":"antithrombotiques-therapeutique-0","context":null,"enonce":"Regarding anti-thrombotics, which proposals are true?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Heparins are sulfated polysaccharides of varying size","correct":true},{"idx":1,"proposition":"Unfractionated heparins (UFH) are of porcine origin","correct":true},{"idx":2,"proposition":"UFH have an exclusive anti-Xa action","correct":false,"justification":"UFHs, like LMWHs, have anti-IIa and anti-Xa action. It is fondaparinux that has exclusive anti-Xa activity"},{"idx":3,"proposition":"Low molecular weight heparins (LMWHs) consist mainly of short chains","correct":true},{"idx":4,"proposition":"LMWH has predominant anti-IIa activity","correct":false,"justification":"LMWH has predominant anti-Xa activity"}],"type":"custom"}
+{"_id":"antithrombotiques-therapeutique-1","context":null,"enonce":"Regarding heparins, which propositions are true?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Treatment with curative doses of UFH should be monitored daily by measuring heparinemia","correct":true},{"idx":1,"proposition":"In case of curative dose UFH, the therapeutic target is 0.3 to 0.7 IU\/ml","correct":true},{"idx":2,"proposition":"For UFH monitoring in curative use, TCA is preferred over heparinemia","correct":false,"justification":"Heparinemia is preferred to TCA"},{"idx":3,"proposition":"A factor XII deficiency or the presence of a circulating anticoagulant such as antiprothrombinase makes monitoring by measuring heparinemia essential.","correct":true},{"idx":4,"proposition":"Heparinemia should be performed immediately after the first injection","correct":false,"justification":"Heparinaemia should be performed at least four hours after initiation of treatment or dose change and at any time with continuous IV infusion"}],"type":"custom"}
+{"_id":"antithrombotiques-therapeutique-3","context":null,"enonce":"When is LMWH treatment monitoring necessary?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"A BMI > 25","correct":false,"justification":"The College of Hematology indicates monitoring as necessary in obese patients, so BMI > 30 (BMI > 25 indicates overweight)"},{"idx":1,"proposition":"A weight < 50 kg","correct":true},{"idx":2,"proposition":"Cachexia","correct":true},{"idx":3,"proposition":"Renal failure, even mild","correct":true,"justification":"Creatinine clearance between 30 and 60 ml\/min indicates monitoring"},{"idx":4,"proposition":"Signs of drowsiness","correct":false}],"type":"custom"}
+{"_id":"antithrombotiques-therapeutique-4","context":null,"enonce":"Regarding heparins, which propositions are true?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"During UFH treatment, monitoring of platelet counts is essential","correct":true,"justification":"Indeed, and this is in order to detect heparin-induced thrombocytopenia. It is a rare complication (less than 1% of cases) but serious requiring immediate discontinuation of heparin or LMWH and switching to another fast-acting anticoagulant"},{"idx":1,"proposition":"UFH can be injected into IV","correct":true},{"idx":2,"proposition":"LMWH can be injected in IV","correct":false,"justification":"In the heparin family, only HnF can be injected into IV"},{"idx":3,"proposition":"LMWH can be injected into SC","correct":true},{"idx":4,"proposition":"Fondaparinux can be injected in IV","correct":false}],"type":"custom"}
+{"_id":"antithrombotiques-therapeutique-5","context":null,"enonce":"Which of these heparins has\/have 100% bioavailability after injection?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"The HnF","correct":false,"justification":"The bioavailability of HnF is highly variable from patient to patient. For this reason, surveillance of heparinemia, or failing that, ACT, is necessary."},{"idx":1,"proposition":"LMWH","correct":false,"justification":"Their bioavailability is high, but not 100%. The college of hematology indicates 90% (table 22.1 on page 264)"},{"idx":2,"proposition":"Fondaparinux","correct":true},{"idx":3,"proposition":"Les anti-GP IIb\/IIIa","correct":false,"justification":"Be careful, these are not heparins. They are anti-platelet agents."},{"idx":4,"proposition":"P2Y12 receptor inhibitors","correct":false,"justification":"Be careful, these are not heparins. They are anti-platelet agents."}],"type":"custom"}
+{"_id":"antithrombotiques-therapeutique-6","context":null,"enonce":"Which of the following are true about DRESS?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Poly-lymphadenopathy can be found","correct":true},{"idx":1,"proposition":"It is a toxiderma","correct":true,"justification":"True, severe toxiderma"},{"idx":2,"proposition":"Facial edema is an early sign","correct":true},{"idx":3,"proposition":"The onset time is a few hours","correct":false,"justification":"It is long, between 2 and 8 weeks"},{"idx":4,"proposition":"Regression is always rapid after early discontinuation of the drug","correct":false,"justification":"Rarely, slow regression can be observed."}],"type":"custom"}
+{"_id":"Exprenuptial-gyn-0","context":null,"enonce":"Regarding the prenuptial examination:","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"It was initially provided for in a regulatory and mandatory framework 6 months before any marriage","correct":false,"justification":"Initially planned in a regulatory and mandatory framework 2 months before any marriage"},{"idx":1,"proposition":"It was to be officially handed over to the parents of the bride and groom.","correct":false,"justification":"to be handed over by each of the bride and groom to the civil registrar"},{"idx":2,"proposition":"Without this examination, historically, the civil registrar could not celebrate a marriage.","correct":true},{"idx":3,"proposition":"It was to allow the future spouses to take stock of their state of health.","correct":true},{"idx":4,"proposition":"It was an opportunity for information on lifestyle and family planning.","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"Exprenuptial-gyn-1","context":null,"enonce":"Regarding the prenuptial examination:","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"It was suppressed at the liberation of 1945 due to the change of morals.","correct":false,"justification":"It was abolished by Law No. 2007-1787 of 20 December 2007 on the simplification of the law, partly because of the scarcity of married couples at the time of the first pregnancy, but also because of the cost"},{"idx":1,"proposition":"The interest of such a consultation is currently nil.","correct":false,"justification":"However, the interest of such a preconception approach as a mode of prevention for the health of young couples is highlighted in the information document for professionals entitled \"Pregnancy project: information, prevention messages, examinations to propose\" published in September 2009 by the High Authority of Health (HAS)"},{"idx":2,"proposition":"The consultation must be conducted by a doctor","correct":false,"justification":"The consultation can be conducted by a doctor (general practitioner, medical gynecologist, gynecologist-obstetrician), or a midwife, whether or not this professional follows the pregnancy afterwards."},{"idx":3,"proposition":"The future spouses are the main targets of this type of consultation, but not the only ones","correct":true},{"idx":4,"proposition":"Questioning relies almost exclusively on family history to screen for genetic diseases in the family.","correct":false,"justification":"This is the family and personal history, as well as the consultation of the health record\""}],"type":"custom"}
+{"_id":"Exprenuptial-gyn-2","context":null,"enonce":"Regarding the conduct of the pre-conception examination:","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"Addressing individual cardiovascular risk factors is not of interest in this type of consultation.","correct":false},{"idx":1,"proposition":"In case of family history or person of genetic damage, genetic counseling should be considered.","correct":true},{"idx":2,"proposition":"A conization or myomectomy are examples of gynecological history to look for","correct":true},{"idx":3,"proposition":"The gynecological examination focuses on the reproductive system","correct":false},{"idx":4,"proposition":"In case of positive rhesus, it is proposed to inform the woman of the interest of determining the blood group of the future father","correct":false,"justification":"in case of negative Rhesus, it is proposed to inform the woman of the interest of determining the blood group of the future father\""}],"type":"custom"}
+{"_id":"Exprenuptial-gyn-3","context":null,"enonce":"Regarding the interrogation and clinical examination during the pre-nuptial consultation:","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"Rubella serology is prescribed if there is a notion of previous negative serology (even if two vaccinations have been performed)","correct":false},{"idx":1,"proposition":"HIV serology is always offered","correct":true},{"idx":2,"proposition":"The benefit\/risk balance of any drug prescription should be carefully evaluated in a woman who expresses a desire for pregnancy","correct":true},{"idx":3,"proposition":"Pregnancy should be anticipated as much as possible","correct":true},{"idx":4,"proposition":"If pregnancy is desired, folate should be prescribed up to the 24th week of amenorrhea at a dose of 5 micrograms per day.","correct":false}],"type":"custom"}
+{"_id":"Exprenuptial-gyn-4","context":null,"enonce":"In case of planning pregnancy:","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"A catch-up\/booster of the DTP and pertussis vaccine should be offered in adults likely to become parents soon","correct":true},{"idx":1,"proposition":"Pertussis vaccination is crucial because of the vulnerability of children up to 1 1\/2 years","correct":false,"justification":"Pertussis vaccination is particularly important, given the vulnerability of newborns during their first two months"},{"idx":2,"proposition":"Varicella vaccination is possible if the pregnancy test is negative, and effective contraception for 3 weeks is recommended by the HAS","correct":false,"justification":"Vaccination is possible if the pregnancy test is negative, and according to MA (marketing authorization) data, effective contraception for 1 month is recommended after each dose of vaccine. According to this document from the transparency commission of the HAS (https:\/\/www.has-sante.fr\/upload\/docs\/evamed\/CT-17743_VARILRIX_PIS_RI_Avis2_CT17743.pdf), << Vaccination against chickenpox is contraindicated during pregnancy. Pregnancy should be avoided within one month of vaccination: women intending to start pregnancy should be advised to postpone their project.>>"},{"idx":3,"proposition":"Meat must be cooked to control the risk of toxoplasmosis","correct":true},{"idx":4,"proposition":"This consultation is an opportunity to highlight the risks of self-medication and remind that taking medication without a prescription is not recommended in case of pregnancy planning","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"Exprenuptial-gyn-5","context":null,"enonce":"Regarding preconception questioning in women:","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"Alcohol withdrawal is unnecessary unless chronic alcoholism is well documented","correct":false},{"idx":1,"proposition":"If consumption is occasional, it is advisable to stop taking alcohol as soon as pregnancy is proven by an ultrasound","correct":false,"justification":"In case of occasional consumption, stop drinking alcohol early in pregnancy"},{"idx":2,"proposition":"The medicine can offer help with smoking cessation if necessary","correct":true},{"idx":3,"proposition":"Tobacco has a negative effect on fertility and child development during pregnancy","correct":true},{"idx":4,"proposition":"All elements that relate to the patient's work concern the occupational physician only","correct":false,"justification":"Determine possible exposure to teratogenic products by contacting the occupational health physician if necessary\""}],"type":"custom"}
+{"_id":"Exprenuptial-gyn-6","context":null,"enonce":"Regarding the generalities of the preconception examination:","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"A cervical screening smear is to be performed again if the last one is more than 2 to 3 years old.","correct":true},{"idx":1,"proposition":"Folic acid supplementation in women who want pregnancy is a prophylactic procedure","correct":true},{"idx":2,"proposition":"The health record must be up to date, otherwise, reminders or catch-ups must be carried out, with caution","correct":true},{"idx":3,"proposition":"This consultation is an opportunity to raise awareness of the effects of smoking (decreased fertility, delayed child development, ...)","correct":true},{"idx":4,"proposition":"The preconception examination concerns exclusively married couples with a plan to become pregnant","correct":false,"justification":"The \"preconception examination, formerly a premarital examination, must be conceived in the more general context of information among women or couples planning to become pregnant, given the number of couples who currently conceive outside marriage.\""}],"type":"custom"}
+{"_id":"Exprenuptial-gyn-7","context":null,"enonce":"Regarding folic acid supplementation. Which of the following are true?","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"Folic acid helps reduce the risk of neural tube closure abnormalities ","correct":true},{"idx":1,"proposition":"For primary prevention, the dose of folic acid is 0.4 mg\/d","correct":true},{"idx":2,"proposition":"For secondary prevention, the dose of folic acid is 5 mg\/d","correct":true},{"idx":3,"proposition":"Folic acid should be taken 2 months before and 3 months after conception","correct":true},{"idx":4,"proposition":"Folic acid should be stopped at 12 SA","correct":true}],"type":"custom"}
+{"_id":"Exprenuptial-gyn-8","context":null,"enonce":"Which of the following are indications for prescribing 5 mg\/d of folic acid?","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"History of non-closure of the neural tube in a previous pregnancy","correct":true,"justification":"True. 5 mg\/d for secondary prevention."},{"idx":1,"proposition":"Epilepsy treated","correct":true,"justification":"True. Increased risk of neural tube closure abnormality due to anti-epileptic therapy"},{"idx":2,"proposition":"HTA in the mother","correct":false,"justification":"False. This is a dose of 0.4 mg\/d as it is not an indication for a dose of 5 mg\/d."},{"idx":3,"proposition":"Maternal diabetes","correct":false,"justification":"False"},{"idx":4,"proposition":"Maternal HIV","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"Exprenuptial-gyn-12","context":null,"enonce":"Which of the following are true?","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"The prenuptial certificate is always mandatory","correct":false,"justification":"False. The requirement for a prenuptial certificate for civil marriage was abolished in 2007. 50% of children are born out of wedlock."},{"idx":1,"proposition":"Toxoplasmosis and rubella serologies are part of the pre-conception assessment","correct":true,"justification":"True. On the other hand, rubella serology is not routine in a woman who has received 2 doses of the vaccine and who has proof of this vaccination."},{"idx":2,"proposition":"CMV serology is systematically part of the pre-conception assessment ","correct":false,"justification":"False. It is indicated in women in contact with children under 3 years of age."},{"idx":3,"proposition":"For diabetes screening, the OPGH is done as a first-line","correct":false,"justification":"False. For diabetes screening, fasting blood glucose (normal threshold < 0.92 g\/L) should be done first in the first trimester, and if it is negative, test at the OPGH in the second half of the year."},{"idx":4,"proposition":"Vitamin folic acid supplementation is routine up to 12 SA to prevent the risk of neural tube defect closure","correct":true}],"type":"custom"}
+{"_id":"Exprenuptial-gyn-13","context":null,"enonce":"Regarding vaccination in pregnant women. Which vaccine(s) are not recommended during pregnancy?","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"Whooping cough","correct":true,"justification":"True. It is not a live vaccine so it is not contraindicated during pregnancy, but it is not recommended to vaccinate pregnant women in France. On the other hand, it is desirable to vaccinate women before or after childbirth."},{"idx":1,"proposition":"Rubella","correct":true,"justification":"True. It is a live vaccine and therefore contraindicated in pregnant women. On the other hand, it is recommended to vaccinate all women with rubella-negative serology pre-conceptional. Women who have received 2 prior vaccinations should not be vaccinated, regardless of the result of serology if it is performed. Due to the teratogenic risk, it is necessary to ensure the absence of an early pregnancy and to avoid any pregnancy within one month of vaccination."},{"idx":2,"proposition":"Chickenpox","correct":true,"justification":"True. It is a live vaccine with a teratogenic risk. Women of childbearing age who have no history of chickenpox should be vaccinated. Vaccination is possible if the pregnancy test is negative. Effective contraception for 1 month is recommended after each dose of vaccine (2 doses in total)."},{"idx":3,"proposition":"Influenza","correct":false,"justification":"The flu vaccine is recommended for pregnant women because they are a population at risk of severe influenza (fetal death and maternal death, refractory hypoxemia, etc.)."},{"idx":4,"proposition":"Measles","correct":true,"justification":"True. It is a live vaccine, therefore teratogenic."}],"type":"custom"}
+{"_id":"Mgenetiques-gyn-0","context":null,"enonce":"General:","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"Trisomy 21 is the leading cause of hereditary intellectual disability","correct":false,"justification":"T21 is the leading cause of intellectual disability (ID). Comes in 2nd the fragile X syndrome which is the 1st cause of hereditary ID"},{"idx":1,"proposition":"Prenatal diagnosis is proposed to couples at risk of transmitting a genetic disease to their offspring","correct":true,"justification":"Proposing is different from obliging, of course."},{"idx":2,"proposition":"Fragile X syndrome is an incomplete mutation of the TIRx2 gene","correct":false,"justification":"Complete mutation of FMR1 with expansion of CGG triplets more than 200 times. Premutation (\"incomplete\" mutation) does not give fragile X syndrome."},{"idx":3,"proposition":"Cystic fibrosis involves the CFTR gene","correct":true,"justification":"The CFTR gene, present on chromosome 7, has many known mutations including F508 del, the most commonly involved in cystic fibrosis. FYI CFTR is involved in the flow of Cl ions and the acronym \"cystic fibrosis transmembrane conductance regulator\" makes it easy to find the English (and Quebecois) name of the disease, cystic fibrosis."},{"idx":4,"proposition":"2\/100,000 births are affected by cystic fibrosis","correct":false,"justification":"1\/4500 births in France"}],"type":"custom"}
+{"_id":"Mgenetiques-gyn-1","context":null,"enonce":"Regarding cystic fibrosis and trisomy 21:","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"Cystic fibrosis transmission is autosomal recessive","correct":true,"justification":"2 pathogenic variations in the CFTR gene are needed"},{"idx":1,"proposition":"The most common mutation in the CFTR gene that causes cystic fibrosis is C19947del","correct":false,"justification":"It is F508del whose exact nomenclature is c.1521_1523delCTT or p.Phe508del"},{"idx":2,"proposition":"The main risk factor for trisomy 21 is paternal age","correct":false,"justification":"Maternal age"},{"idx":3,"proposition":"The management of trisomy 21 also involves the psychological care of the family","correct":true,"justification":"and the subject reaches of course. This is the case for the majority of rare diseases."},{"idx":4,"proposition":"Trisomy 21 is an ALD","correct":true,"justification":"100% coverage with disability card"}],"type":"custom"}
+{"_id":"Mgenetiques-gyn-2","context":null,"enonce":"General information on mucovisciod, fragile X and trisomy 21:","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"The karyotype is of no interest in fragile X syndrome","correct":false,"justification":"Helps identify an additional cause of intellectual disability"},{"idx":1,"proposition":"The diagnostic triad of fragile X (intellectual disability, macro-orchidism and craniofacial dysmorphism) is pathognomonic and very constant","correct":false,"justification":"Inconsistent triad"},{"idx":2,"proposition":"Trisomy 21 is a chromosomal disease linked to the presence of a single chromosome 21","correct":false,"justification":"Chromosome 21 supernumerary, three in total although it is not always \"isolated\" (free and homogeneous)"},{"idx":3,"proposition":"Antenatal screening occupies an important place in terms of diagnostic circumstances in trisomy 21","correct":true,"justification":"This does not prevent postnatal diagnoses whose management must be attentive"},{"idx":4,"proposition":"The realization of a karyotype with parental consent allows the confirmation of the diagnosis of cystic fibrosis","correct":false,"justification":"Useless because it is not visible by the karyotype (mutation in the CFTR gene). Except very rare case of break point in the CFTR gene which is not on the program of ECN"}],"type":"custom"}
+{"_id":"Mgenetiques-gyn-4","context":null,"enonce":"Regarding trisomy 21:","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"The risk of giving birth to a child with T21 is 1\/700","correct":true},{"idx":1,"proposition":"The only known risk factor is tobacco","correct":false,"justification":"Maternal age and the existence of chromosomal variation involving chromosome 21 in one of the 2 parents"},{"idx":2,"proposition":"The risk of T21 is schematically 1\/50 when the mother is 42 years old","correct":true},{"idx":3,"proposition":"The clinical phenotype associates morphological abnormalities and intellectual disability","correct":true,"justification":"It is more or less severe"},{"idx":4,"proposition":"A disabled child requires careful medical follow-up and psychosocial measures","correct":true}],"type":"custom"}
+{"_id":"Mgenetiques-gyn-6","context":null,"enonce":"Which of these proposals correspond to serum markers measured in the first trimester?","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"PAPP-1","correct":false,"justification":"This is the PAPP-A"},{"idx":1,"proposition":"The Alpha fraction of HCG","correct":false},{"idx":2,"proposition":"The HCG beta chain","correct":true},{"idx":3,"proposition":"Serum albumin","correct":false},{"idx":4,"proposition":"Fasting blood glucose","correct":false,"justification":"Nothing to do with maternal serum markers"}],"type":"custom"}
+{"_id":"Mgenetiques-gyn-7","context":null,"enonce":"Regarding the screening and diagnosis of trisomy 21:","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"The calculation of the combined risk is based on ultrasound measurement of neck clarity and determination of maternal serum markers of the 1st trimester","correct":true},{"idx":1,"proposition":"Neck clarity measurement should be performed between 11 SA + 0 days and 13 SA + 6 days","correct":true,"justification":"LCC between 45 and 84 mm"},{"idx":2,"proposition":"Maternal serum markers should be measured 14 days after ultrasound","correct":false,"justification":"Performed at the same term as neck clarity measurement"},{"idx":3,"proposition":"Prenatal screening is mandatory","correct":false,"justification":"This examination is not mandatory but the information must be given to all pregnant women, regardless of their age"},{"idx":4,"proposition":"There are 5% false negatives","correct":false,"justification":"About 30%"}],"type":"custom"}
+{"_id":"Mgenetiques-gyn-9","context":null,"enonce":"Regarding cystic fibrosis:","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"Cystic fibrosis is the most common serious autosomal recessive disease affecting the Caucasian population","correct":true,"justification":"Incidence in France = 1\/4500 births. It is not considered a rare disease!"},{"idx":1,"proposition":"Cystic fibrosis is linked to a mutation in the CFTR gene, the most common of which is G18463del","correct":false,"justification":"The most common is F508del"},{"idx":2,"proposition":"Newborn screening is performed with the so-called Guthrie test at 3 days of life","correct":true,"justification":"Generalized since 2002"},{"idx":3,"proposition":"Newborn screening has been widespread since 1975","correct":false,"justification":"Since 2002"},{"idx":4,"proposition":"The saliva test is the complementary reference test for diagnostic confirmation","correct":false,"justification":"This is the sweat test"}],"type":"custom"}
+{"_id":"Mgenetiques-gyn-10","context":null,"enonce":"Regarding cystic fibrosis:","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"Management is multidisciplinary","correct":true},{"idx":1,"proposition":"Management is based in particular on daily chest physiotherapy","correct":true,"justification":"And the treatment of bronchopulmonary superinfections"},{"idx":2,"proposition":"Cystic fibrosis affects 1\/10000 births in France","correct":false,"justification":"1\/4,500 births in France"},{"idx":3,"proposition":"The frequency of heterozygous subjects is estimated at 1\/30","correct":true},{"idx":4,"proposition":"Cystic fibrosis is caused by mutations in the CFTR gene located on the long arm of the X chromosome","correct":false,"justification":"This condition is caused by mutations in the CFTR (Cystic Fibrosis Transmembrane Conductance Regulator) gene, located on the long arm of chromosome 7."}],"type":"custom"}
+{"_id":"Mgenetiques-gyn-11","context":null,"enonce":"Regarding cystic fibrosis:","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"In France, in 70% of cases, the mutation is the deletion of the 508th amino acid (F = phenylalanine), called F508del","correct":true,"justification":"It is F508del whose exact nomenclature is c.1521_1523delCTT or p.Phe508del"},{"idx":1,"proposition":"It is a disease of the respiratory system only","correct":false,"justification":"The mucus clogs different sites of the body, including the respiratory system but not only: also the digestive tract and its appendages (pancreas, bile ducts and liver), sweat glands and genital tract"},{"idx":2,"proposition":"Cystic fibrosis is a disease that does not impact life expectancy","correct":false,"justification":"Cystic fibrosis is a chronic disease that remains particularly severe"},{"idx":3,"proposition":"Follow-up is carried out by the pulmonologist and the general practitioner only","correct":false,"justification":"Multidisciplinary follow-up in specialized centers called Cystic Fibrosis Resource and Skills Centers (CRCM) is the rule, in order to best care for these patients and improve their prognosis and quality of life."},{"idx":4,"proposition":"Antenatal screening for cystic fibrosis is offered to all pregnant women","correct":false,"justification":"\"Generalized\" antenatal screening is not recommended to date by the National Consultative Ethics Committee (CCNE)"}],"type":"custom"}
+{"_id":"exanthemeped-infectio-0","context":null,"enonce":"Which of the following are true about enterovirus infections?","item":"exanthemeped","matiere":"infectio","propositions":[{"idx":0,"proposition":"Exanthema is morbiliform","correct":true},{"idx":1,"proposition":"There are mainly digestive signs","correct":true},{"idx":2,"proposition":"They mainly concern the elderly","correct":false,"justification":"Especially children 🧒"},{"idx":3,"proposition":"They are found especially during the winter","correct":false,"justification":"Relatively more frequent during the summer"},{"idx":4,"proposition":"An enanthema is found in 90% of cases","correct":false,"justification":"It is quite rare"}],"type":"custom"}
+{"_id":"exanthemeped-infectio-1","context":null,"enonce":"Which of the following are true about measles?","item":"exanthemeped","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is a reportable disease","correct":true},{"idx":1,"proposition":"Serology is only salivary","correct":false,"justification":"Saliva and blood"},{"idx":2,"proposition":"PCR is only blood","correct":false,"justification":"It is not sanguine, it is saliva, nasal, and urinary"},{"idx":3,"proposition":"We can find a sign of Koplik","correct":true,"justification":"True, they are bluish-white \"grains of salt\" on a red background near the molars."},{"idx":4,"proposition":"The bacterium involved is Coxiella burnetii","correct":false,"justification":"Coxiella is the agent of Q fever. The virus involved in measles is Morbillivus"}],"type":"custom"}
+{"_id":"exanthemeped-infectio-2","context":null,"enonce":"Which of the following are possible complications of measles?","item":"exanthemeped","matiere":"infectio","propositions":[{"idx":0,"proposition":"Viral pneumonitis","correct":true},{"idx":1,"proposition":"Bacterial pneumonitis","correct":true},{"idx":2,"proposition":"Meningitis","correct":false,"justification":"Rather encephalitis. Neurological complications are rare"},{"idx":3,"proposition":"Arteriovenous malformation","correct":false,"justification":"Measles does not impact angiogenesis"},{"idx":4,"proposition":"Deep vein thrombosis","correct":false,"justification":"No vascular involvement"}],"type":"custom"}
+{"_id":"exanthemeped-infectio-4","context":null,"enonce":"With regard to eruptive diseases of childhood, what are the right proposals?","item":"exanthemeped","matiere":"infectio","propositions":[{"idx":0,"proposition":"Diagnosed with megalerythema, the child should avoid contact with pregnant women because the virus in question can give birth defects such as cataracts and glaucoma.","correct":false,"justification":"False, parvovirus B19 (agent of epidemic megalerythema) in pregnant women gives fetal anemia or fetoplacental anasarca. It is rubella that gives these birth defects."},{"idx":1,"proposition":"Chickenpox can be transmitted through the respiratory route","correct":true,"justification":"True, transmission is respiratory before the eruptive phase"},{"idx":2,"proposition":"Clinically, infectious mononucleosis gives high fever, erythematopultaceous angina often associated with splenomegaly and lymphadenopathy.","correct":true,"justification":"True, biologically there is also leukocytosis, and hepatic cytolysis is also possible"},{"idx":3,"proposition":"During the eruptive phase of measles, a Köplick sign can be found","correct":false,"justification":"Köplinick's sign (white-blue punctiform spots on an erythematous jugal mucosa) is found during the invasion phase (with fever and cattarhe)"},{"idx":4,"proposition":"Chickenpox is a reportable disease","correct":false,"justification":"This is the case for measles and rubella"}],"type":"custom"}
+{"_id":"neuroPperiph-neuro-0","context":null,"enonce":"Which of the following definitions is true?","item":"neuroPperiph","matiere":"neuro","propositions":[{"idx":0,"proposition":"Mononeuropathy is the involvement of a nerve trunk","correct":true},{"idx":1,"proposition":"Multiple mononeuropathy is multineuritis","correct":true},{"idx":2,"proposition":"Multiple mononeuropathy is the involvement of several nerve trunks","correct":true},{"idx":3,"proposition":"Polyradiculoneuropathy is damage to the cell body of sensory neurons","correct":false,"justification":"It is defined by the involvement of all the sensory and motor nerve roots and nerve trunks (example of Guillain-Barré syndrome)"},{"idx":4,"proposition":"Guillain-Barré syndrome is polyradiculoneuropathy","correct":true}],"type":"custom"}
+{"_id":"neuroPperiph-neuro-1","context":null,"enonce":"Which propositions are true?","item":"neuroPperiph","matiere":"neuro","propositions":[{"idx":0,"proposition":"Motor neuronopathies are often asymmetric","correct":true},{"idx":1,"proposition":"Length-dependent axonal polyneuropathies result from diffuse and symmetrical involvement ","correct":true},{"idx":2,"proposition":"Length-dependent axonal polyneuropathies begin in the hands","correct":false,"justification":"They start at the feet (longest nerve fibers)"},{"idx":3,"proposition":"In long-term-dependent axonal polyneuropathies, subjective disorders affecting the extremities of the lower limbs are permanent, diurnal and willingly nocturnal","correct":true},{"idx":4,"proposition":"In length-dependent axonal polyneuropathy, the onset of motor symptoms are brutal and consist of permanent paralysis within a few weeks.","correct":false,"justification":"At first, the patient reports difficulty walking, abnormal fatigability"}],"type":"custom"}
+{"_id":"neuroPperiph-neuro-2","context":null,"enonce":"Which of the following proposals for length-dependent axonal polyneuropathy is true?","item":"neuroPperiph","matiere":"neuro","propositions":[{"idx":0,"proposition":"There are no vegetative disorders in length-dependent axonal polyneuropathies","correct":false,"justification":"Yes, vegetative disorders are related to damage to amylin fibers: orthostatic arterial hypotension, vesico-sphincter disorders, sexual (impotence), digestive disorders (diarrhea, constipation)"},{"idx":1,"proposition":"Clinical examination does not find amyotrophy","correct":false,"justification":"He finds: abolition of calcaneal reflexes (Achilles), motor deficit affecting the lifters of the foot, amyotrophy, sensory deficit that can be discreet, vegetative involvement (skin and appendages, hypotension)"},{"idx":2,"proposition":"There is no known etiology to length-dependent axonal polyneuropathies","correct":false,"justification":"Many etiologies. In children: rare and hereditary. In adults: nearly two hundred causes"},{"idx":3,"proposition":"The geographical focus of familial amyloidosis is Portugal","correct":true},{"idx":4,"proposition":"Diabetes is one of the most common causes of peripheral neuropathy","correct":true}],"type":"custom"}
+{"_id":"neuroPperiph-neuro-3","context":null,"enonce":"Which of the following propositions are true in the context of a right Brown Sequard?","item":"neuroPperiph","matiere":"neuro","propositions":[{"idx":0,"proposition":"A right Babinski sign","correct":true},{"idx":1,"proposition":"Thermo-algic sensory disorders on the left","correct":true},{"idx":2,"proposition":"Thermo-algic sensory disorders on the right","correct":false,"justification":"False"},{"idx":3,"proposition":"A sign from Babinski on the left","correct":false,"justification":"False"},{"idx":4,"proposition":"None of the proposals","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"neuroPperiph-neuro-4","context":null,"enonce":"Which of the following propositions about Brown Sequard syndrome are true?","item":"neuroPperiph","matiere":"neuro","propositions":[{"idx":0,"proposition":"It is a syndrome of the hemi-marrow","correct":true},{"idx":1,"proposition":"Spinal cord involvement is transverse and total","correct":false,"justification":"Only half of the bone marrow is affected"},{"idx":2,"proposition":"There is an engine deficit in homolateral","correct":true},{"idx":3,"proposition":"There is a proprioceptive deficit in contralateral","correct":false,"justification":"The motor and proprioceptive deficit is homolateral. In contralateral, there is a thermoalgic hypoaesthesia"},{"idx":4,"proposition":"There is a homolateral thermoalgic hypoesthesia","correct":false,"justification":"Thermoalgic hypoaesthesia is contralateral. In homolateral, there is a motor and propriceptive deficit"}],"type":"custom"}
+{"_id":"prurit-dermato-0","context":null,"enonce":"Regarding definitions:","item":"prurit","matiere":"dermato","propositions":[{"idx":0,"proposition":"Pruritus is a functional sign that is defined as \"a sensation that causes the need to scratch\"","correct":true},{"idx":1,"proposition":"Pruritus is always localized because it concerns a particular nervous territory","correct":false,"justification":"It can be localized or generalized"},{"idx":2,"proposition":"It only concerns the skin","correct":false,"justification":"Skin + some mucous membranes or semi-mucous membranes"},{"idx":3,"proposition":"Pruritus is always pathological","correct":false,"justification":"There is a pruritus that can be described as physiological"},{"idx":4,"proposition":"Physiological pruritus is major at birth","correct":false,"justification":"Physiological pruritus is discrete"}],"type":"custom"}
+{"_id":"prurit-dermato-2","context":null,"enonce":"Regarding lesions:","item":"prurit","matiere":"dermato","propositions":[{"idx":0,"proposition":"Histamine is the key element in the pathophysiology of any pruritus","correct":false,"justification":"Histamine may be involved but not always"},{"idx":1,"proposition":"The origin of pruritus is nervous only","correct":false,"justification":"Pruritus can sometimes start higher in the transmission routes (central or peripheral nervous system) or its origin can be cutaneous"},{"idx":2,"proposition":"Diagnosis of pruritus requires ultrasound of areas rich in sebaceous glands","correct":false,"justification":"The diagnosis of pruritus is clinical and on the interrogation"},{"idx":3,"proposition":"Excoriations may be consecutive to scratching","correct":true},{"idx":4,"proposition":"Prurigo may be secondary to chronic pruritus","correct":true}],"type":"custom"}
+{"_id":"prurit-dermato-3","context":null,"enonce":"Regarding scratching lesions and etiologies of pruritus:","item":"prurit","matiere":"dermato","propositions":[{"idx":0,"proposition":"Chronic pruritus can lead to lichenification","correct":true},{"idx":1,"proposition":"Pruritus cannot cause superinfection","correct":false,"justification":"It can lead to impetigo and pyoderma type superinfection"},{"idx":2,"proposition":"Scabies is responsible for morning recrudescence pruritus sparing the back","correct":false,"justification":"Scabies: nocturnal pruritus sparing the face"},{"idx":3,"proposition":"Body pediculosis is the cause of diffuse pruritus, predominant on the trunk and root of the limbs","correct":true},{"idx":4,"proposition":"Psoriasis lesions are almost never the cause of pruritus","correct":false,"justification":"Contrary to a classic notion, psoriasis lesions are itchy in more than half of patients and reworked by scratching."}],"type":"custom"}
+{"_id":"prurit-dermato-4","context":null,"enonce":"Regarding the etiologies of pruritus:","item":"prurit","matiere":"dermato","propositions":[{"idx":0,"proposition":"Pruritus often telltale in primary biliary cirrhosis","correct":true},{"idx":1,"proposition":"Pruritus is very common in acute renal failure","correct":false,"justification":"Chronic renal failure where it is common in hemodialysis patients"},{"idx":2,"proposition":"Pruritus is very common in hemodialysis patients","correct":true},{"idx":3,"proposition":"Any naked and chronic pruritus in a young adult must suggest lymphoma","correct":true},{"idx":4,"proposition":"Polycythemia vera causes pruritus after contact with water","correct":true}],"type":"custom"}
+{"_id":"ectoparasitose-infectio-0","context":null,"enonce":"Which of these proposals designates the main ectoparasite of scabies?","item":"ectoparasitose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Gallolipicus Siridens","correct":false},{"idx":1,"proposition":"Sarcoptes Scabei","correct":true,"justification":"The others are invented names"},{"idx":2,"proposition":"Severades Minota","correct":false},{"idx":3,"proposition":"Vivigallie Tarcoptei","correct":false},{"idx":4,"proposition":"Sarcota Aurea","correct":false}],"type":"custom"}
+{"_id":"ectoparasitose-infectio-1","context":null,"enonce":"Which of these incubation periods are compatible with scabies?","item":"ectoparasitose","matiere":"infectio","propositions":[{"idx":0,"proposition":"24 hours","correct":false,"justification":"The incubation period is from 5 days to 1 month"},{"idx":1,"proposition":"3 days","correct":false},{"idx":2,"proposition":"7 days","correct":true},{"idx":3,"proposition":"15 days","correct":true},{"idx":4,"proposition":"25 days","correct":true}],"type":"custom"}
+{"_id":"ectoparasitose-infectio-2","context":null,"enonce":"Which of these areas are spared from scabies?","item":"ectoparasitose","matiere":"infectio","propositions":[{"idx":0,"proposition":"The face","correct":true},{"idx":1,"proposition":"Back","correct":true},{"idx":2,"proposition":"Elbows","correct":false,"justification":"The only areas spared are the face and back"},{"idx":3,"proposition":"Feet","correct":false},{"idx":4,"proposition":"Hands","correct":false}],"type":"custom"}
+{"_id":"ectoparasitose-infectio-3","context":null,"enonce":"Which of these signs are in favor of Sarcoptes Scabei Hominis infection?","item":"ectoparasitose","matiere":"infectio","propositions":[{"idx":0,"proposition":"The presence of pearl vesicles","correct":true},{"idx":1,"proposition":"A diurnal recrudescence pruritus","correct":false,"justification":"The resurgence of pruritus is nocturnal"},{"idx":2,"proposition":"The presence of epidermal folds","correct":true},{"idx":3,"proposition":"The presence of scabéeux nodules","correct":true},{"idx":4,"proposition":"Risky sexual behaviour","correct":true}],"type":"custom"}
+{"_id":"ectoparasitose-infectio-4","context":null,"enonce":"Regarding pediculosis:","item":"ectoparasitose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Pediculosis is accompanied by alopecia","correct":false,"justification":"Lice do not cause hair loss"},{"idx":1,"proposition":"The main clinical sign is pruritus","correct":true},{"idx":2,"proposition":"Body pediculosis is accompanied by maculopapular rashes in the back and chest","correct":true},{"idx":3,"proposition":"Pediculesis is strictly human","correct":true},{"idx":4,"proposition":"Treatment of pediculosis of the scalp is a lotion of dimeticone","correct":true}],"type":"custom"}
+{"_id":"ectoparasitose-infectio-5","context":null,"enonce":"Which of the following are signs and symptoms of scabies?","item":"ectoparasitose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Epidermal furrows","correct":true},{"idx":1,"proposition":"Pearly vesicles","correct":true},{"idx":2,"proposition":"Scabious nodules","correct":true,"justification":"True, evidenced by India ink"},{"idx":3,"proposition":"Enanthemas of the face","correct":false,"justification":"Not described in scabies"},{"idx":4,"proposition":"Maculopapular rashes in the back and chest","correct":false,"justification":"Not in scabies. This is a sign of body pediculosis"}],"type":"custom"}
+{"_id":"ectoparasitose-infectio-6","context":null,"enonce":"Which of the following are true about scabies?","item":"ectoparasitose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Minimum incubation is 5 days","correct":true,"justification":"True, incubation can range from 5 days to 1 month (2-3 weeks on average)"},{"idx":1,"proposition":"Incubation can be up to 45 days","correct":false,"justification":"It can go up to 1 month maximum"},{"idx":2,"proposition":"Pruritus is on the morning upsurge","correct":false,"justification":"Pruritus is on the rise at nocturnal"},{"idx":3,"proposition":"The parasite cycle lasts 3 hours","correct":false,"justification":"It lasts about 3 weeks"},{"idx":4,"proposition":"Treatment is both individual and collective","correct":true}],"type":"custom"}
+{"_id":"ectoparasitose-infectio-7","context":null,"enonce":"Which of the following propositions are true about pediculosis?","item":"ectoparasitose","matiere":"infectio","propositions":[{"idx":0,"proposition":"There are 3 types of pediculosis: neurological, hepatic and splenic","correct":false,"justification":"Pediculosis is not a visceral pathology. There are 3 types of pediculosis: body, scalp, and phtiriasis (morpion)"},{"idx":1,"proposition":"Phtiriasis is an STI","correct":true,"justification":"True, it is an ectoparasitosis caused by Phritirus inguinalise also called Morpion in everyday language"},{"idx":2,"proposition":"The parasites concerned are strictly human","correct":true},{"idx":3,"proposition":"Body pediculosis is caused by Pediculus humanus capitis","correct":false,"justification":"This is the case of pediculosis of the scalp"},{"idx":4,"proposition":"None of the propositions are true","correct":false,"justification":"None"}],"type":"custom"}
+{"_id":"ectoparasitose-infectio-8","context":null,"enonce":"What are the non-drug measures to put in place in case of non-profuse scabies?","item":"ectoparasitose","matiere":"infectio","propositions":[{"idx":0,"proposition":"Decontamination of linen and bedding","correct":true,"justification":"60% wash recommended on Day 1 and Day 9"},{"idx":1,"proposition":"Declaration to the ARS","correct":false},{"idx":2,"proposition":"Routine treatment of persons who have had prolonged and\/or intimate contact with the patient","correct":true},{"idx":3,"proposition":"Environmental disinfection","correct":false,"justification":"Useless according to the College of Dermatology (page 184, 2017 edition) unless"},{"idx":4,"proposition":"Treatment of symptomatic contact cases","correct":true}],"type":"custom"}
+{"_id":"suiviMIT-sp-0","context":null,"enonce":"Regarding infectious disease surveillance:","item":"suiviMIT","matiere":"sp","propositions":[{"idx":0,"proposition":"In France, in 2021, there are 36 notifiable diseases","correct":true},{"idx":1,"proposition":"A pandemic is an unusual occurrence of a large number of cases in a limited time but in an unlimited geographical space","correct":true},{"idx":2,"proposition":"An epidemic is the existence of a large number of cases in a limited time and geographical space.","correct":false,"justification":"This is the definition of endemic"},{"idx":3,"proposition":"Horizontal transmission occurs from mother to child breastfeeding by hematogenous and\/or genital transplacental tract or","correct":false,"justification":"It is a vertical transmission"},{"idx":4,"proposition":"Prevalence is the proportion of people with a disease in a given population at a given point in time.","correct":true}],"type":"custom"}
+{"_id":"suiviMIT-sp-1","context":null,"enonce":"Concerning the monitoring of infectious diseases","item":"suiviMIT","matiere":"sp","propositions":[{"idx":0,"proposition":"The incidence rate is the proportion of people in a given population during a given period of time newly reached.","correct":true},{"idx":1,"proposition":"Cumulative incidence is the ratio between the number of new cases that occurred during a given period and the average population to be at risk of illness during that period.","correct":true},{"idx":2,"proposition":"Sensitivity is probability of having a negative test knowing that one is not sick","correct":false,"justification":"Specificity • Probability of having a negative test knowing that one is not sick"},{"idx":3,"proposition":"The predictive value is the Positive probability (PPV) of being sick knowing that one has a positive test","correct":true},{"idx":4,"proposition":"The VPN negative predictive value is the probability of being free of the disease knowing that the test is negative","correct":true}],"type":"custom"}
+{"_id":"suiviMIT-sp-2","context":null,"enonce":"Concerning the monitoring of transmissible mishelp","item":"suiviMIT","matiere":"sp","propositions":[{"idx":0,"proposition":"Communicable disease control relies on a national and international surveillance system","correct":true},{"idx":1,"proposition":"• There is no single surveillance system but several systems, adapted to the nature of the problem, detection and its health, social or economic consequences","correct":true},{"idx":2,"proposition":"In France, Santé Publique France (ex-lnVS) is at the centre of the surveillance system","correct":true},{"idx":3,"proposition":"The Health Agencies (ARS) define the scoping policies of monitoring and regulation","correct":false,"justification":"This is the role of the Directorate-General for Health, the ARS implements the policies decided at central level"},{"idx":4,"proposition":"The High Council of Public Health is an expert agency to the Ministry of Health","correct":true}],"type":"custom"}
+{"_id":"suiviMIT-sp-3","context":null,"enonce":"Notifiable diseases include: ","item":"suiviMIT","matiere":"sp","propositions":[{"idx":0,"proposition":"Tuberculosis","correct":true},{"idx":1,"proposition":"Measles","correct":true},{"idx":2,"proposition":"Indigenous urogenital schistosomiasis","correct":true},{"idx":3,"proposition":"Hepatitis C","correct":false},{"idx":4,"proposition":"Smallpox","correct":true}],"type":"custom"}
+{"_id":"suiviMIT-infectio-0","context":null,"enonce":"Concerning the surveillance of transmissible infectious malaides","item":"suiviMIT","matiere":"infectio","propositions":[{"idx":0,"proposition":"Communicable infectious diseases presenting a high risk of spread and involving public health action around the case must be declared by name without delay to the ARS medical inspector.","correct":true},{"idx":1,"proposition":"These are mainly tuberculosis, invasive meningococcal disease, measles and collective food-borne illnesses.","correct":true},{"idx":2,"proposition":"dCommunicable infectious diseases are defined by: the fact that they are caused by an infectious agent: bacteria, virus, parasite and that they can be transmitted between humans","correct":true},{"idx":3,"proposition":"All infectious diseases are transmissible between humans","correct":false,"justification":"Not all of them are transmissible between humans (for example: tetanus, botulism, legionellosis...)"},{"idx":4,"proposition":"Most transmissible infections are called endogenous","correct":false,"justification":"Most transmissible infections are said to be exogenous, i.e. the reservoir of infectious agents is located outside the infected organism."}],"type":"custom"}
+{"_id":"suiviMIT-infectio-3","context":null,"enonce":"Which of the following propositions are true regarding droplet isolation?","item":"suiviMIT","matiere":"infectio","propositions":[{"idx":0,"proposition":"It concerns pathologies with indirect transmission","correct":false,"justification":"Direct transmission"},{"idx":1,"proposition":"It requires the wearing of an FFP2 mask by caregivers","correct":false,"justification":"Surgical mask for everyone!"},{"idx":2,"proposition":"It requires the patient to wear a surgical mask when alone in his room","correct":false,"justification":"Not if he's all alone 😅"},{"idx":3,"proposition":"It requires visitors to wear a surgical mask","correct":true},{"idx":4,"proposition":"It requires limiting the patient's movements outside his room","correct":true}],"type":"custom"}
+{"_id":"suiviMIT-infectio-5","context":null,"enonce":"Which of the following propositions are true about air-type insulation?","item":"suiviMIT","matiere":"infectio","propositions":[{"idx":0,"proposition":"It concerns pathologies with direct transmission","correct":true},{"idx":1,"proposition":"It requires a single room","correct":true},{"idx":2,"proposition":"It requires, for the patient, the wearing of an FFP2 mask when moving (outside his room)","correct":false,"justification":"Surgical mask"},{"idx":3,"proposition":"It requires, for the patient, to limit his movements in his room","correct":false,"justification":"Limit his movements outside his room (he is not in prison wesh)"},{"idx":4,"proposition":"All propositions are true","correct":false}],"type":"custom"}
+{"_id":"suiviMIT-infectio-7","context":null,"enonce":"Which of the following proposals require the implementation of \"contact\" isolation?","item":"suiviMIT","matiere":"infectio","propositions":[{"idx":0,"proposition":"Chickenpox","correct":true},{"idx":1,"proposition":"Malaria","correct":false},{"idx":2,"proposition":"Scabies","correct":true},{"idx":3,"proposition":"Clostridium dificile colitis","correct":true},{"idx":4,"proposition":"HCV infection","correct":false}],"type":"custom"}
+{"_id":"sarcoidose-pneumo-0","context":null,"enonce":"Concerning sarcoidosis","item":"sarcoidose","matiere":"pneumo","propositions":[{"idx":0,"proposition":"It is characterized by tuberculoid granulomas with caseous necrosis in the affected organs","correct":false,"justification":"It is characterized by tuberculoid granulomas without caseous necrosis in the affected organs"},{"idx":1,"proposition":"Mediastinopulmonary involvement is observed in more than 90% of patients and is very useful for diagnosis","correct":true},{"idx":2,"proposition":"Extrathoracic localizations are polymorphic","correct":true},{"idx":3,"proposition":"Lung, ocular, cutaneous, peripheral lymph node and hepatic disorders are very common","correct":true},{"idx":4,"proposition":"Löfgren's syndrome combines febrile erythema nodosum or arthritis of the ankles and bilateral mediastinal and hilar lymphadenopathy","correct":true}],"type":"custom"}
+{"_id":"sarcoidose-pneumo-2","context":null,"enonce":"Concerning sarcoidosis","item":"sarcoidose","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Of unknown cause Characterized by infiltration of organs affected by epithelioid and gigantocellular immune granulomas (also called tuberculoid granulomas) without caseous necrosis","correct":true},{"idx":1,"proposition":"Diagnosis requires having eliminated the known causes of granulomas","correct":true},{"idx":2,"proposition":"Mediastinopulmonary involvement is by far the most common","correct":true},{"idx":3,"proposition":"mediastinopulmonary involvement is isolated in half of the cases","correct":true},{"idx":4,"proposition":"Tobacco is a risk factor for the disease","correct":false,"justification":"Tobacco would protect against sarcoidosis"}],"type":"custom"}
+{"_id":"sarcoidose-pneumo-4","context":null,"enonce":"Concerning sarcoidosis","item":"sarcoidose","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Löfgren's syndrome is self-limiting in more than 90% of cases within 2 to 4 months","correct":false,"justification":"Löfgren's syndrome is self-limiting in more than 90% of cases within 12 to 24 months"},{"idx":1,"proposition":"Significant asthenia may be in the 1st plan including in limited forms of the disease","correct":true},{"idx":2,"proposition":"Fever is rare outside of Löfgren's syndrome, febrile uveoparotitis with or without facial paralysis, liver or kidney damage","correct":true},{"idx":3,"proposition":"Weight loss can be observed in Löfgren's syndrome, or in multi-organ forms","correct":true},{"idx":4,"proposition":"No biological examination is specific for sarcoidosis only histology will confirm granulomatosis","correct":true}],"type":"custom"}
+{"_id":"sarcoidose-pneumo-5","context":null,"enonce":"Concerning sarcoidosis","item":"sarcoidose","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The diagnosis of sarcoidosis is based on 3 elements ine suggestive clinico-radiographic presentation with evidence of tuberculoid granulomatous lesions without caseous necrosis and elimination of other granulomatoses","correct":true},{"idx":1,"proposition":"Recent forms evolving for less than 2 years evolve favorably without treatment in less than 2 years most often","correct":true},{"idx":2,"proposition":"In chronic forms, evolving for more than 2 years, spontaneous regression is less likely","correct":true},{"idx":3,"proposition":"Chest X-ray is a key component of monitoring in combination with RFEs","correct":true},{"idx":4,"proposition":"Relapses occur most often within 2 to 6 months of treatment interruption and are exceptional after 3 years of setback without treatment.","correct":true}],"type":"custom"}
+{"_id":"systemeconv-sp-0","context":null,"enonce":"Concerning the dates marking the evolution of the conventional system","item":"systemeconv","matiere":"sp","propositions":[{"idx":0,"proposition":"He was born in 1945.","correct":false,"justification":"1971 births"},{"idx":1,"proposition":"The 2 sectors were created in 1995 on the occasion of the election of Jacques Chirac","correct":false,"justification":"In 1980"},{"idx":2,"proposition":"The carte vitale was launched in 1998","correct":true,"justification":"At the same time as the CMU"},{"idx":3,"proposition":"The coordinated care pathway (with the DMP, the notion of attending physician, etc.) was born in 1975.","correct":false,"justification":"2005"},{"idx":4,"proposition":"2016 is the year of the revaloratization of physician remuneration","correct":true}],"type":"custom"}
+{"_id":"systemeconv-sp-2","context":null,"enonce":"What are the main types of consultations set up by the 2016 Convention?","item":"systemeconv","matiere":"sp","propositions":[{"idx":0,"proposition":"Reference consultation","correct":true,"justification":"Most common situations of the liberal practitioner"},{"idx":1,"proposition":"Remedial consultation","correct":false,"justification":"Does not exist"},{"idx":2,"proposition":"Coordinated consultation","correct":true,"justification":"As part of the care pathway"},{"idx":3,"proposition":"Really difficult consultation","correct":false,"justification":"Does not exist. However, there is the very complex consultation: clinical situations requiring very complex management"},{"idx":4,"proposition":"Complex consultation","correct":true,"justification":"Management of a complex, unstable pathology or one with a high public health stake\""}],"type":"custom"}
+{"_id":"systemeconv-sp-3","context":null,"enonce":"Which of these specialties are concerned by remuneration based on public health objectives (ROSP)?","item":"systemeconv","matiere":"sp","propositions":[{"idx":0,"proposition":"Cardiologists","correct":true},{"idx":1,"proposition":"Vascular physicians","correct":true},{"idx":2,"proposition":"Neurologists","correct":false,"justification":"Are concerned: attending physicians, cardiologists, vascular physicians, gastroenterologists and hepatologists, and endocrinologists"},{"idx":3,"proposition":"Public Health Physicians","correct":false},{"idx":4,"proposition":"Urologists","correct":false}],"type":"custom"}
+{"_id":"systemeconv-sp-4","context":null,"enonce":"Concerning the Convention and PSRs","item":"systemeconv","matiere":"sp","propositions":[{"idx":0,"proposition":"The price of acts is fixed in the Convention","correct":true},{"idx":1,"proposition":"The lump sum payment is paid by the ANSM for care requiring drug prescriptions","correct":false,"justification":""},{"idx":2,"proposition":"There are several compensation packages","correct":true},{"idx":3,"proposition":"The ROSP was introduced in 2011","correct":true},{"idx":4,"proposition":"PSRO indicators are independent of each other","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"MTMV-nutri-0","context":null,"enonce":"What are the proven effects of physical activity?","item":"MTMV","matiere":"nutri","propositions":[{"idx":0,"proposition":"Reduction of premature mortality by 30%","correct":true},{"idx":1,"proposition":"Increased quality of life","correct":true},{"idx":2,"proposition":"Reduction of mortality","correct":false,"justification":"We cannot, a priori, reduce mortality. It is 100% in the long term"},{"idx":3,"proposition":"Maintenance of autonomy in the elderly","correct":true},{"idx":4,"proposition":"Reduction in the occurrence of colon cancer by 95%","correct":false}],"type":"custom"}
+{"_id":"MTMV-nutri-1","context":null,"enonce":"Regarding dietary prescription:","item":"MTMV","matiere":"nutri","propositions":[{"idx":0,"proposition":"The written medical prescription is mandatory in the hospitalized patient who requires a special diet","correct":true},{"idx":1,"proposition":"It is a medico-legal act engaging the responsibility of medicine","correct":true,"justification":"This is a medico-legal act engaging the responsibility of the doctor insofar as certain food textures may be at risk of \"wrong route\" in the presence of swallowing disorders and where certain diets are essential in the presence of certain pathologies (heart failure, renal, diabetes with risk of hypoglycemia, etc.)."},{"idx":2,"proposition":"The doctor must record the food texture","correct":true},{"idx":3,"proposition":"The doctor must record the number of snacks, if any,","correct":true},{"idx":4,"proposition":"Meal assistance (e.g. postural) is prescribed by the dietician","correct":false,"justification":"It is a medical prescription"}],"type":"custom"}
+{"_id":"MTMV-nutri-2","context":null,"enonce":"Which propositions are true?","item":"MTMV","matiere":"nutri","propositions":[{"idx":0,"proposition":"It is advisable to reduce the consumption of unsaturated fatty acids in case of hypercholestereolmia","correct":false,"justification":"It is the consumption of saturated fatty acids that must be reduced, especially palmitic acid"},{"idx":1,"proposition":"The use of margarine rich in phytosterols is advised in case of hypercholesterolemia","correct":true},{"idx":2,"proposition":"Hypertriglyceridemia should lead to a reduction in the consumption of monounsaturated fatty acids","correct":false,"justification":"Monounsaturated fatty acids, and especially omega 3, are recommended in this case"},{"idx":3,"proposition":"Rapeseed oil is rich in omega 7","correct":false,"justification":"In omega-3"},{"idx":4,"proposition":"Undernutrition worsens respiratory function in chronic respiratory failure","correct":true}],"type":"custom"}
+{"_id":"tbdelirantaigu-psy-0","context":null,"enonce":"Concerning the main generalities:","item":"tbdelirantaigu","matiere":"psy","propositions":[{"idx":0,"proposition":"Persistent delusional disorders begin around the age of 20-25 most often","correct":false,"justification":"Between 40 and 50 years"},{"idx":1,"proposition":"The different types are: erotomaniac, megalomaniac, jealousy, persecution, somatic type","correct":true},{"idx":2,"proposition":"Treatment includes antipsychotic treatment +\/antidepressant treatment","correct":true},{"idx":3,"proposition":"Most psychotic disorders were described in Europe in the early twentieth century","correct":true},{"idx":4,"proposition":"The lifetime prevalence of persistent delusional disorders is estimated at 8%","correct":false,"justification":"The lifetime prevalence of persistent delusional disorders is estimated to be 0.2% and the annual incidence is estimated to be between 1 and 3 per 100,000"}],"type":"custom"}
+{"_id":"tbdelirantaigu-psy-1","context":null,"enonce":"Concerning clinical semiology:","item":"tbdelirantaigu","matiere":"psy","propositions":[{"idx":0,"proposition":"Immigration is a risk factor","correct":true},{"idx":1,"proposition":"A delusional idea corresponds to an alteration of the content of thought, resulting in a loss of contact with reality.","correct":true},{"idx":2,"proposition":"A delusional idea is an \"internal evidence\" but one that does not seem plausible from the outside point of view.","correct":true,"justification":"This is an \"internal evidence\" that may seem plausible, but is generally not shared by the subject's socio-cultural group."},{"idx":3,"proposition":"The mechanisms encountered are mainly interpretative, intuitive, and imaginative","correct":true},{"idx":4,"proposition":"The hallucinatory mechanism is generally not predominant","correct":true}],"type":"custom"}
+{"_id":"tbdelirantaigu-psy-2","context":null,"enonce":"Regarding delusions and psychoses:","item":"tbdelirantaigu","matiere":"psy","propositions":[{"idx":0,"proposition":"Delusions are fuzzy just like in schizophrenia","correct":false,"justification":"Delusions are well systematized, that is, they take place in a logical and coherent way"},{"idx":1,"proposition":"They usually feature convoluted and multiple themes.","correct":false,"justification":"Usually a single theme"},{"idx":2,"proposition":"The subject totally adheres to his delusions","correct":true},{"idx":3,"proposition":"The emotional and behavioural impact should be assessed systematically, including the level of anxiety","correct":true},{"idx":4,"proposition":"We recognize 2 types of psychoses: paranoid psychoses (purely interpretative mechanism) and paraphrenia (hallucinatory mechanism)","correct":false,"justification":"History of psychiatry The French Psychiatric School recognizes three types of non-schizophrenic persistent delusional disorders differentiated according to their main mechanism: * paranoid psychoses (interpretative and intuitive mechanism), * chronic hallucinatory psychosis (hallucinatory mechanism), * paraphrenia (imaginative mechanism)"}],"type":"custom"}
+{"_id":"tbdelirantaigu-psy-3","context":null,"enonce":"Regarding the symptomatology of delusional disorders:","item":"tbdelirantaigu","matiere":"psy","propositions":[{"idx":0,"proposition":"The diagnosis is made in front of the presence of delusions evolving for more than six days without interruption","correct":false,"justification":"Evolution for more than a month"},{"idx":1,"proposition":"Delusional disorder may contain disorganization syndrome in some cases","correct":false,"justification":"To make the diagnosis there must be no disorganization syndrome or negative syndrome"},{"idx":2,"proposition":"Hallucinations are often associated and disabling by their intensity","correct":false,"justification":"If hallucinations are present they are not in the foreground"},{"idx":3,"proposition":"The different clinical forms of persistent delusional disorders are defined according to the intensity of delusions.","correct":false,"justification":"Depending on the theme of delusions"},{"idx":4,"proposition":"The erotomanic type is characterized by the erroneous belief of being loved by an individual","correct":true}],"type":"custom"}
+{"_id":"tbdelirantaigu-psy-4","context":null,"enonce":"Regarding the different types of delusional disorders:","item":"tbdelirantaigu","matiere":"psy","propositions":[{"idx":0,"proposition":"The erotomanic type is more common in men","correct":false,"justification":"It stems from an intuitive mechanism at first, then interpretative and is more common in women"},{"idx":1,"proposition":"The megalomaniac type is characterized by the belief of being adored by all.","correct":false,"justification":"Persistent delusional disorder of the megalomaniac type is characterized by delusions centered on the belief of being gifted with an unknown talent or power, or having made an important discovery."},{"idx":2,"proposition":"There is a persistent delusional disorder of jealousy type","correct":true},{"idx":3,"proposition":"Persistent persecution-type delusional disorder is called 'paranoid delirium' in ICD-10","correct":true},{"idx":4,"proposition":"Persistent delusional somatic disorder is characterized by delusions centered on sensations or bodily functions","correct":true}],"type":"custom"}
+{"_id":"tabac-psy-0","context":null,"enonce":"Regarding tobacco addiction and cessation:","item":"tabac","matiere":"psy","propositions":[{"idx":0,"proposition":"Smoking is often linked to behaviour acquired in adolescence","correct":true},{"idx":1,"proposition":"Smoking cessation must be organized without delay and regardless of the motivation of the smoker in case of scheduled surgery","correct":true},{"idx":2,"proposition":"Any medical consultation must be able to be the occasion of a stop advice","correct":true},{"idx":3,"proposition":"Nicotine-related physical dependence is assessed by the Fagerstrom test","correct":true},{"idx":4,"proposition":"Weaning is based on stimulating the patient's motivation through encouragement during consultations every two weeks","correct":false,"justification":"Withdrawal is based on a combination of cognitive-behavioural management (CBT), therapeutic education and nicotine replacement therapy."}],"type":"custom"}
+{"_id":"tabac-psy-1","context":null,"enonce":"Regarding smoking:","item":"tabac","matiere":"psy","propositions":[{"idx":0,"proposition":"Tobacco use is the 1st cause of preventable premature death worldwide","correct":true},{"idx":1,"proposition":"The primary current is inhaled by the smoker when he pulls on the cigarette","correct":true},{"idx":2,"proposition":"The secondary current is the passage of smoke through the bronchioles","correct":false,"justification":"The secondary current escapes from the cigarette through the glowing end between 2 puffs"},{"idx":3,"proposition":"The secondary current is the one that causes passive smoking","correct":false,"justification":"The tertiary current is the current exhaled by the smoker (cause of passive smoking) \/ but the secondary current also participates"},{"idx":4,"proposition":"There are more than 4000 components identified in tobacco smoke","correct":true}],"type":"custom"}
+{"_id":"tabac-psy-2","context":null,"enonce":"Regarding the composition of the cigarette:","item":"tabac","matiere":"psy","propositions":[{"idx":0,"proposition":"Nicotine is delivered to the brain in 30 minutes","correct":false,"justification":"It is sent to the brain by a quick shot (8 seconds) during each puff"},{"idx":1,"proposition":"Addiction to addictive substances includes the release of dopamine in the midbrain, activating the reward system in smokers","correct":true},{"idx":2,"proposition":"Tobacco smoke particles have an aerodynamic median diameter of 0.3 microns","correct":true},{"idx":3,"proposition":"Nitrosamines are carcinogens","correct":true},{"idx":4,"proposition":"Broadly similar components are found in cannabis smoke","correct":true}],"type":"custom"}
+{"_id":"tabac-psy-3","context":null,"enonce":"Regarding the consequences of tobacco and its epidemiology:","item":"tabac","matiere":"psy","propositions":[{"idx":0,"proposition":"The France had nearly 16 million smokers in 2013","correct":true},{"idx":1,"proposition":"Among men, the prevalence of regular smoking has been stable (around 32%) since 1990","correct":false,"justification":"Smoking prevalence has increased since 2005"},{"idx":2,"proposition":"The proportion of ex-smokers is increasing among women","correct":true,"justification":""},{"idx":3,"proposition":"Cancer pathologies: Active smoking is responsible for about 50% of bronchopulmonary cancers","correct":false,"justification":"Cancer pathologies:  Active smoking responsible for 90% of bronchopulmonary cancers (nearly 40,000 new cases\/year, nearly 30,000 deaths\/year)"},{"idx":4,"proposition":"Passive smoking is responsible for 2% of bronchopulmonary cancers in nonsmokers","correct":false,"justification":"More around 20% (it's discussed)"}],"type":"custom"}
+{"_id":"tabac-psy-4","context":null,"enonce":"Regarding the consequences of tobacco and its management:","item":"tabac","matiere":"psy","propositions":[{"idx":0,"proposition":"20% of COPD patients are unaware of it","correct":false,"justification":"COPD: 3.5 million people are affected in France of which 2\/3 are unaware"},{"idx":1,"proposition":"COPD is responsible for 17,000 deaths each year","correct":true},{"idx":2,"proposition":"Tobacco is not a known cause of arteritis","correct":false,"justification":"If: ischemic heart disease, thrombosis, arteritis, etc."},{"idx":3,"proposition":"The tobacco-atheroma relationship is clearly demonstrative","correct":true},{"idx":4,"proposition":"The measurement of expired CO level is not systematic in a diagnostic context","correct":true}],"type":"custom"}
+{"_id":"medmalade-psy-0","context":null,"enonce":"Which of these proposals correspond to a type of doctor-patient relationship?","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"Actf\/liability relationship","correct":true,"justification":"The 4 types of relationships are: active\/passive, consensual, cooperative and participatory."},{"idx":1,"proposition":"Confrontational relationship","correct":false,"justification":"FALSE"},{"idx":2,"proposition":"Cooperative relationship","correct":true},{"idx":3,"proposition":"Participatory relationship","correct":true},{"idx":4,"proposition":"Consensual relationship","correct":true}],"type":"custom"}
+{"_id":"medmalade-psy-1","context":null,"enonce":"Which of the following are true?","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"Transaction processes are an individual's efforts to adjust to stressful situations.","correct":true},{"idx":1,"proposition":"Transaction processes determine the adjustment strategies that the patient can put in place to adapt to the disease","correct":true},{"idx":2,"proposition":"The doctor-patient relationship is a friendly relationship","correct":false,"justification":"The doctor-patient relationship is an interpersonal relationship, involving several people (doctors, caregivers, patients, families, caregivers), which passes through the disease, which is exercised in a socio-cultural, unequal framework, made of expectation and hope."},{"idx":3,"proposition":"The doctor-patient relationship is an equal relationship","correct":false,"justification":"It is an unequal relationship on the patient's side because his request makes him dependent on the doctor but also because of his suffering, his fear, his uncertainties that handicap him and make him vulnerable"},{"idx":4,"proposition":"The patient is often passive (especially during acute phases) and often tends to seek the \"protection\" of caregivers","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"medmalade-psy-2","context":null,"enonce":"Regarding the different types of relationships","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"It is an unbalanced relationship on the doctor's side, because of his supposed knowledge","correct":true},{"idx":1,"proposition":"The increase in the frequency of chronic diseases in the 20th century led to the consideration of new types of doctor-patient relationships","correct":true},{"idx":2,"proposition":"The type of relationship called \"active\/passive\" (or \"paternalistic\") sometimes adapted to acute serious illnesses, has evolved into a relationship called \"participatory\" more adapted to chronic diseases, through a \"consensual\" and \"cooperative\" relationship.","correct":true},{"idx":3,"proposition":"The active\/passive relationship involves the patient speaking and the doctor passively listening","correct":false,"justification":"The active\/passive relationship does not involve any activity of the patient, it is the doctor who does his therapeutic act"},{"idx":4,"proposition":"The consensual relationship implies acceptance of care and cooperation between the patient and","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"medmalade-psy-3","context":null,"enonce":"Regarding the different types of relationships","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"In consensual relationships, the patient is already convinced of the need for medical care","correct":true},{"idx":1,"proposition":"The cooperative relationship involves the patient's acceptance and cooperation in the medical gesture.","correct":true},{"idx":2,"proposition":"A gynecological examination is an example of a cooperative relationship","correct":true},{"idx":3,"proposition":"The participatory relationship positions the patient as a passive actor in his care","correct":false,"justification":"The participatory relationship positions the patient as the privileged actor of remission and \/ or recovery who must then change his lifestyle and habits."},{"idx":4,"proposition":"The \"participatory\" relationship requires specific knowledge and skill on the part of the patient","correct":false,"justification":"The \"participatory\" type of relationship requires specific knowledge and skill on the part of the doctor.\""}],"type":"custom"}
+{"_id":"medmalade-psy-5","context":null,"enonce":"Concerning the medical interview","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"The \"learned theory\" corresponds to biomedical knowledge but is different from the own experience of the disease","correct":true},{"idx":1,"proposition":"The scholarly theory perfectly represents what patients experience, think and feel when they have a disease","correct":false,"justification":"It only incompletely represents what patients experience, think and feel when they have a disease."},{"idx":2,"proposition":"Medical knowledge confronts a secular theory of disease and health that influences patients' behavior, possible actions and relationships with physicians.","correct":true},{"idx":3,"proposition":"The doctor must therefore take into account scientific knowledge exclusively (= evidence-based medicine) in his doctor-patient relationship.","correct":false,"justification":"The doctor must therefore take into account both: his own representations concerning the disease (his scholarly theory), and the representations and values of the patient (his secular theory) during the interviews, but also those of the family environment (interview carried out with the patient in the presence of this entourage)"},{"idx":4,"proposition":"Patient consent or during an interview is essential to obtain","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"medmalade-psy-6","context":null,"enonce":"Regarding the process of empathy in the doctor-patient relationship","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"The patient's consent during an interview leads to a therapeutic alliance","correct":true},{"idx":1,"proposition":"Validating emotions and patient representation is crucial","correct":true},{"idx":2,"proposition":"Validating the emotions and representations of the patient essentially involves the gaze","correct":false,"justification":"In practice, validating the patient's emotions and representations involves reformulation (which mirrors the patient's own emotions and representations and tells him that he has been heard and that he is not alone)"},{"idx":3,"proposition":"Empathy is the ability to be friendly with others without being friendly deep down.","correct":false,"justification":"Empathy is the ability to understand others and make them understand that they have been understood."},{"idx":4,"proposition":"Empathy is different from sympathy which is the ability to feel the same as others.","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"medmalade-psy-7","context":null,"enonce":"Concerning resistance ","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"Most patients want caregivers to feel the same way they do.","correct":false,"justification":"Most patients don't want a caregiver to feel the same way they do, but to try to understand how they feel."},{"idx":1,"proposition":"An important element to which the doctor must remain attentive is the appearance of resistance that can arise","correct":true},{"idx":2,"proposition":"Resistance is a sign of ill will on the part of the patient","correct":false,"justification":"Resistance is not a sign of ill will on the part of the patient, but a natural reaction to a change in his or her life: the disorder or illness."},{"idx":3,"proposition":"A patient who resists change is a lost cause and no longer needs to be cared for","correct":false,"justification":"It needs to be handled differently"},{"idx":4,"proposition":"In the face of resistance, getting angry and scaring the patient is a technique that often works","correct":false,"justification":"A calm and serene emotional expression of the clinician in the face of resistance is essential\""}],"type":"custom"}
+{"_id":"medmalade-psy-8","context":null,"enonce":"Concerning the interview in the doctor-patient relationship","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"The physician will have to convey to the patient the feeling that he will not be judged, and that no decision will be imposed on him without it making sense to him in his own system of representations.","correct":true},{"idx":1,"proposition":"An important element for each interlocutor is the feeling of freedom","correct":true},{"idx":2,"proposition":"The patient's freedom means that behaviour change cannot be initiated","correct":false,"justification":"Appealing to the patient's freedom should not be a way for the physician to abandon any possibility of change with the patient."},{"idx":3,"proposition":"Motivation for change is not an immutable \"patient trait\"","correct":true},{"idx":4,"proposition":"The first step in the empathy process is the patient's expression of a thought (representation) or emotion.","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"medmalade-psy-9","context":null,"enonce":"About motivational interviewing","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"It's a participatory interview","correct":true},{"idx":1,"proposition":"It is an active\/passive interview","correct":false,"justification":"This is a type of participatory interview"},{"idx":2,"proposition":"It helps to strengthen the patient's own motivation for change","correct":true},{"idx":3,"proposition":"It's about convincing the patient to change","correct":false,"justification":"The goal is to explore with the patient the advantages and disadvantages of the problematic behavior and the alternatives available to him."},{"idx":4,"proposition":"Exploration must be empathetic and non-judgmental","correct":true}],"type":"custom"}
+{"_id":"medmalade-psy-10","context":null,"enonce":"Regarding the process of empathy in the doctor-patient relationship","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"The physician's recognition of the patient's thought\/emotion is accompanied by an understanding of the patient's representations and worldview.","correct":true},{"idx":1,"proposition":"The third step in the empathy process is the physician's expression of recognition and understanding of the patient's thought or emotion.","correct":true},{"idx":2,"proposition":"The fourth step in the empathy process is the patient's acceptance of recognition and the doctor's understanding of the thought or emotion.","correct":true},{"idx":3,"proposition":"The phase of receiving recognition by the patient is independent of the patient's personality","correct":false,"justification":"This reception phase is influenced as the expression phase by the symptoms, clinical signs and the patient's situation."},{"idx":4,"proposition":"An effective empathic process allows the patient to express in more detail his experience","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"medmalade-psy-11","context":null,"enonce":"Concerning the patient in the doctor-patient relationship","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"From the patient's point of view, a disease is not simply \"an underlying organic pathology\"","correct":true},{"idx":1,"proposition":"According to the 1946 WHO definition, health is \"a complete state of physical, mental and social well-being and not merely the absence of disease or disability.\"","correct":true},{"idx":2,"proposition":"The disease is a disruption of balance in a biological, psychological and social whole","correct":true},{"idx":3,"proposition":"Transaction processes are the cognitive, emotional, and behavioral efforts made by an individual to adjust to stressful situations, such as illness.","correct":true},{"idx":4,"proposition":"Transaction processes in the doctor-patient relationship determine the outcome of the consultation","correct":false,"justification":"They determine the adjustment strategies that the patient can put in place to adapt to the disease, also known as patient coping skills.\""}],"type":"custom"}
+{"_id":"medmalade-psy-12","context":null,"enonce":"Concerning the evaluation phase in the doctor-patient relationship","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"There are two phases of assessment: primary and secondary","correct":true},{"idx":1,"proposition":"Primary assessment is the \"perceived stress\" of the subject in the stressful situation","correct":true},{"idx":2,"proposition":"Perceived stress is more predictive of the patient's subsequent health than an objective measure of the stress situation","correct":true},{"idx":3,"proposition":"For the patient, the perceived control refers to social aid and protection","correct":false,"justification":"Perceived control corresponds to the inventory of his personal resources and his ability to control the situation and the perceived social support corresponds to the inventory of relational and social aids, protections and valorizations available to him."},{"idx":4,"proposition":"\"Perceived control\" and \"perceived social support\" are negative (inversely correlated) predictors of later health status","correct":false,"justification":"'Perceived control' and 'perceived social support' are positive predictors of later health by reducing the impact of stressful life events and facilitating the adoption of lifestyle changes needed in disease management.\""}],"type":"custom"}
+{"_id":"medmalade-psy-13","context":null,"enonce":"Concerning the adjustment phase and the interview in the doctor-patient relationship","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"A sense of loss of control or lack of social support proves deleterious for most patients","correct":true},{"idx":1,"proposition":"The adjustment or coping phase is the set of transactional processes that an individual interposes between him and the stressful situation in order to reduce its impact","correct":true},{"idx":2,"proposition":"Whatever the situation, the information provided must be fair, clear, appropriate, appropriate to the situation and understood by the patient.","correct":true},{"idx":3,"proposition":"Patient-patient interviews are always carried out one-on-one to respect medical confidentiality.","correct":false,"justification":"The patient may wish his relatives to be present during the transmission of information and this must be accepted"},{"idx":4,"proposition":"Teenagers and children cannot be seen without their parents","correct":false,"justification":"For teenagers in particular, we must not forget to offer a moment of exchange alone without the parents\""}],"type":"custom"}
+{"_id":"medmalade-psy-14","context":null,"enonce":"Concerning interviews in the doctor-patient relationship","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"It is necessary to choose a place of quiet information, known to the patient, where the doctor will take the time, as part of a personalized relationship","correct":true},{"idx":1,"proposition":"Information must be communicated to the patient and the entourage if the patient so wishes.","correct":true,"justification":"Information must be communicated to the patient and the entourage if the patient so wishes."},{"idx":2,"proposition":"The steps of the medical process can be used to explain to the patient the arguments on which the doctor's decisions were made.","correct":true},{"idx":3,"proposition":"It is essential to use medical terms so as not to make approximations","correct":false,"justification":"Giving alternative names that the patient can understand can be helpful"},{"idx":4,"proposition":"The management of a chronic disease involves a therapeutic patient education (TPE) strategy","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"medmalade-psy-15","context":null,"enonce":"Concerning FTE in the doctor-patient relationship","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"It is an ongoing process, integrated into care and focused on the patient rather than the disease.","correct":true},{"idx":1,"proposition":"It includes organized awareness-raising, information, learning and psycho-social support activities.","correct":true},{"idx":2,"proposition":"FTE is for the patient himself only","correct":false,"justification":"It aims to help the patient and their loved ones understand the disease and the treatment, cooperate with caregivers in a participatory relationship, live as healthily as possible while maintaining or improving quality of life."},{"idx":3,"proposition":"Therapeutic education must make the patient a scientific expert in his disease","correct":false,"justification":"Therapeutic education must enable the patient to acquire and maintain the strategies necessary to optimally manage his life with the disease, in the perspective of the WHO definition of health of 1984"},{"idx":4,"proposition":"In the context of an FTE, the physician must avoid any contra-attitude","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"PR-rhumato-0","context":null,"enonce":"Regarding the basics:","item":"PR","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Osteoarthritis is the most common chronic inflammatory rheumatism","correct":false,"justification":"Osteoarthritis is not inflammatory but mechanical. It is RA that is the most common chronic rheumatism"},{"idx":1,"proposition":"RA always starts after age 40","correct":false,"justification":"Most often around fifty years, but it can occur at any age. There are juvenile forms before 16 years"},{"idx":2,"proposition":"RA is three times more common in women before the age of sixty","correct":true},{"idx":3,"proposition":"The prevalence of RA in the general population is around 8%","correct":false,"justification":"Its prevalence in the general population is of the order of 0.3 to 0.8% in adults"},{"idx":4,"proposition":"There are no genetic factors in RA","correct":false,"justification":"The prevalence among first-degree relatives is approximately 2-4%"}],"type":"custom"}
+{"_id":"PR-rhumato-1","context":null,"enonce":"Regarding pathophysiology and diagnosis:","item":"PR","matiere":"rhumato","propositions":[{"idx":0,"proposition":"The pathogen(s) causing RA are unknown to date","correct":true},{"idx":1,"proposition":"RA is characterized by an overflow of pro-inflammatory cytokine production","correct":true},{"idx":2,"proposition":"Osteoclasts are the effector cells of bone erosions seen in RA","correct":true},{"idx":3,"proposition":"Early RA diagnosis is clinic-based","correct":false,"justification":"As well as biological and radiographic examinations plus an ultrasound if doubt"},{"idx":4,"proposition":"Treatment of RA only begins when it becomes disabling, from the age of 65-70","correct":false,"justification":"Diagnosis of RA should be as early as possible in order to institute background treatment very early"}],"type":"custom"}
+{"_id":"PR-rhumato-2","context":null,"enonce":"Regarding the diagnosis of RA:","item":"PR","matiere":"rhumato","propositions":[{"idx":0,"proposition":"RA only affects women","correct":false,"justification":"Sex ratio to the disadvantage of women but not exclusive"},{"idx":1,"proposition":"The picture of acromelic arthritis is extremely rare","correct":false,"justification":"This is the most common"},{"idx":2,"proposition":"RA is most often acute","correct":false,"justification":"evolving in a chronic mode (> 6 weeks) most often"},{"idx":3,"proposition":"The pain is mechanical","correct":false,"justification":"characterized by inflammatory joint pain (waking up at the end of the night and morning stiffness > 30 minutes)"},{"idx":4,"proposition":"The most frequent location is that of the wrists","correct":true,"justification":"most often located on the wrists:)"}],"type":"custom"}
+{"_id":"PR-rhumato-3","context":null,"enonce":"Regarding the diagnosis of RA:","item":"PR","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Metacarpophalangeal joints and proximal interphalangeal joints are frequent localizations","correct":true},{"idx":1,"proposition":"Spontaneously painful joints are most often painful under pressure","correct":true},{"idx":2,"proposition":"The skin coating is not usually affected","correct":true,"justification":"Unlike psoriatic arthritis, septic arthritis or microcrystalline arthritis"},{"idx":3,"proposition":"Distal interphalangeal joints are usually respected during RA","correct":true},{"idx":4,"proposition":"Tenosynovitis points to differential diagnosis and is incompatible with RA","correct":false,"justification":"Possible. Especially around the extensor tendons of the fingers or opposite the ulnar extensor of the carpus"}],"type":"custom"}
+{"_id":"PR-rhumato-4","context":null,"enonce":"Which propositions are true?","item":"PR","matiere":"rhumato","propositions":[{"idx":0,"proposition":"There is an increase in sedimentation rate (ESR) and\/or CRP in the majority of patients","correct":true},{"idx":1,"proposition":"Rheumatoid Factor (RF) arrives late in the disease","correct":false,"justification":"It is most often present at the first clinical signs of the disease"},{"idx":2,"proposition":"The positivity of the RF may precede the appearance of clinical signs by several months to several years","correct":true},{"idx":3,"proposition":"FR positivity is specific to RA","correct":false,"justification":"It is very possible during Sjögren's disease, systemic lupus, or systemic scleroderma"},{"idx":4,"proposition":"A positive RF can be found in patients who are not sick","correct":true}],"type":"custom"}
+{"_id":"erreurs-sp-0","context":null,"enonce":"Concerning the analysis of SAEs of therapeutic hazard","item":"erreurs","matiere":"sp","propositions":[{"idx":0,"proposition":"The analysis of SAEs involves their detection and reporting to the institution's risk manager.","correct":true},{"idx":1,"proposition":"Safety culture is optional and not paramount in patient care","correct":false,"justification":"Need for a culture of safety and risk management: Culture of reporting and positive culture of error (any error, malfunction or failure is an opportunity for individual and collective progress)."},{"idx":2,"proposition":"For a positive culture of error, \"no punishment\" or \"incentive to report\" measures must be put in place.","correct":true},{"idx":3,"proposition":"Data anonymization is a necessity in the conduct of SAE analysis","correct":true},{"idx":4,"proposition":"Analysis of the consequences of the SAE makes it possible to prevent them in the future","correct":false,"justification":"Analysis of causes\""}],"type":"custom"}
+{"_id":"erreurs-sp-1","context":null,"enonce":"Which of these proposals are factors for the success of risk management?","item":"erreurs","matiere":"sp","propositions":[{"idx":0,"proposition":"The commitment of the management of the establishment","correct":true},{"idx":1,"proposition":"Training and awareness","correct":true},{"idx":2,"proposition":"Punitive error management","correct":false,"justification":"It's useless. Non-punitive error management is needed"},{"idx":3,"proposition":"A non-punitive management of faults","correct":false,"justification":"Mistakes (not mistakes)"},{"idx":4,"proposition":"The understanding of the issues by all professionals","correct":true}],"type":"custom"}
+{"_id":"erreurs-sp-3","context":null,"enonce":"Concerning the prevention of damage to second victims","item":"erreurs","matiere":"sp","propositions":[{"idx":0,"proposition":"This term was introduced by Claude Bernard in 1849.","correct":false,"justification":"By Albert Wu in a 2000 BMJ editorial"},{"idx":1,"proposition":"The second victim is the person closest to the patient","correct":false,"justification":"This is the caregiver"},{"idx":2,"proposition":"The second victim is emotionally and professionally impacted","correct":true,"justification":"Emotionally: shame and guilt. Professionally: mistrust, damage to reputation, loss of trust, etc."},{"idx":3,"proposition":"One of the consequences may be burnout or suicide","correct":true},{"idx":4,"proposition":"The second victim, most often, files a complaint against the hospital for failure to assist a person in danger.","correct":false,"justification":"The second victim is the caregiver who made the mistake.\""}],"type":"custom"}
+{"_id":"erreurs-sp-4","context":null,"enonce":"Which of the following are true?","item":"erreurs","matiere":"sp","propositions":[{"idx":0,"proposition":"To prevent damage to the second victim, it is necessary to move from the latter to the first actor","correct":true},{"idx":1,"proposition":"The prevention barrier makes it possible to limit the consequences of a mistake already made","correct":false,"justification":"They prevent the occurrence of the error and the accident (action on latent and patent errors) PREVENTION Ex: the surgical checklist, which avoids forgetting perioperative antibiotic prophylaxis"},{"idx":2,"proposition":"The recovery barrier prevents the occurrence of the error and the accident","correct":false,"justification":"The error is made but recovered before having consequences Ex: antibiotic prophylaxis is prescribed but the nurse becomes aware of a penicillin allergy in the patient's medical file and alerts the prescriber who changes his prescriotion"},{"idx":3,"proposition":"The attenuation barrier prevents the consequences of the mistake already made","correct":false,"justification":"The accident is proven but the consequences are limited ATTENUATION barrier Ex: a patient who has not benefited from antibiotic prophylaxis is in septic shock, but blood cultures were carried out very early, the germ was identified quickly, a bed in intensive care is immediately available, treatment is initiated quickly."},{"idx":4,"proposition":"The root cause is the one that is at the origin of all the effects it is the most undesirable, upstream of the problem.","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"erreurs-sp-5","context":null,"enonce":"Which of the following are true?","item":"erreurs","matiere":"sp","propositions":[{"idx":0,"proposition":"It corresponds to the first hole of the first plate (in Reason's model)","correct":true},{"idx":1,"proposition":"We also talk about root cause","correct":true},{"idx":2,"proposition":"It is wiser to treat the racid cause than the consequences of the latter","correct":true},{"idx":3,"proposition":"Root cause analysis (RCA) analyzes and treats the causes of a problem rather than treating its symptoms.","correct":true},{"idx":4,"proposition":"The root cause forest is one of the root cause analysis methods","correct":false,"justification":"Tree of causes"}],"type":"custom"}
+{"_id":"erreurs-sp-7","context":null,"enonce":"Which of these proposals are compensated under national solidarity?","item":"erreurs","matiere":"sp","propositions":[{"idx":0,"proposition":"Medical accidents","correct":true},{"idx":1,"proposition":"The victims of the Mediator","correct":true},{"idx":2,"proposition":"Transfusion damage","correct":true},{"idx":3,"proposition":"Nosocomial infections","correct":true},{"idx":4,"proposition":"Iatrogenic diseases","correct":true}],"type":"custom"}
+{"_id":"erreurs-sp-8","context":null,"enonce":"Which of the following are true?","item":"erreurs","matiere":"sp","propositions":[{"idx":0,"proposition":"It's an accident","correct":true},{"idx":1,"proposition":"The therapeutic hazard occurs when the patient suffers a sudden aggravation in connection with the medical act but without there being a medical fault","correct":true},{"idx":2,"proposition":"Therapeutic hazard does not give right to any compensation","correct":false,"justification":"As medical risk is no longer accepted by patients, important reforms on damage compensation have been established."},{"idx":3,"proposition":"There can be no financial payment for patients suffering from therapeutic hazards","correct":false,"justification":"Following the Act of 4 March 2002 on the rights of patients, victims of risk may be compensated under national solidarity. (i.e. the State) when the responsibility of health professionals or institutions is not engaged."},{"idx":4,"proposition":"To be compensable, the damages invoked must have three cumulative conditions","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"erreurs-sp-9","context":null,"enonce":"Which of the following are true?","item":"erreurs","matiere":"sp","propositions":[{"idx":0,"proposition":"Compensation is paid by ONIAM","correct":true},{"idx":1,"proposition":"Proof must be provided by the applicant","correct":true},{"idx":2,"proposition":"The limitation period is 5 years","correct":false,"justification":"The limitation period is 10 years"},{"idx":3,"proposition":"The compensation procedure is fast and free of charge","correct":true},{"idx":4,"proposition":"It is only valid for medical accidents occurring after 6 August 1997.","correct":false,"justification":"Valid for the victim: fast and free procedure only for medical accidents occurring after 4 September 2001."}],"type":"custom"}
+{"_id":"diarrheeinf-infectio-0","context":null,"enonce":"Regarding the basics:","item":"diarrheeinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"Diarrhea is the elimination of at least 3 unmolded stools per day","correct":true},{"idx":1,"proposition":"Febrile diarrhea indicates enterocolic infection","correct":false,"justification":"Not necessarily: the acceleration of transit and the emission of liquid stools can be caused by many other infections (malaria, sepsis, etc.)"},{"idx":2,"proposition":"Acute diarrhea is less than 2 weeks","correct":true},{"idx":3,"proposition":"The majority of acute diarrhoea is of infectious origin","correct":true},{"idx":4,"proposition":"Diarrhoea often progresses to colonic performation and sepsis when left untreated","correct":false,"justification":"Spontaneously limiting most often"}],"type":"custom"}
+{"_id":"diarrheeinf-infectio-1","context":null,"enonce":"What are the emergency situations to be identified?","item":"diarrheeinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"More than 10 trips to the toilet per day","correct":false,"justification":"The number of times you have a bowel movement is not a sign of severity"},{"idx":1,"proposition":"Acute dehydration","correct":true,"justification":"Especially in at-risk subjects"},{"idx":2,"proposition":"Occlusive syndrome","correct":true},{"idx":3,"proposition":"The return of a malaria-endemic country","correct":true,"justification":"Always think about asking about travel"}],"type":"custom"}
+{"_id":"diarrheeinf-infectio-2","context":null,"enonce":"Regarding loperamide:","item":"diarrheeinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is a transit retarder","correct":true},{"idx":1,"proposition":"It is indicated in febrile diarrhea","correct":false,"justification":"It is contraindicated!"},{"idx":2,"proposition":"It is indicated in bloody diarrhea","correct":false,"justification":"Formal contraindication"},{"idx":3,"proposition":"It is indicated in non-febrile diarrhea of the infant","correct":false,"justification":"Contraindicated before 30 months of age"},{"idx":4,"proposition":"It has many side effects including frequent headaches","correct":true}],"type":"custom"}
+{"_id":"diarrheeinf-infectio-3","context":null,"enonce":"What are the indications for a stool culture?","item":"diarrheeinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"Febrile diarrhea","correct":true},{"idx":1,"proposition":"HIV infection","correct":false,"justification":"Only if immunosuppression"},{"idx":2,"proposition":"Dehydration","correct":true,"justification":"In case of signs of severity"},{"idx":3,"proposition":"A return of the tropics","correct":true},{"idx":4,"proposition":"A notion of storytelling","correct":false}],"type":"custom"}
+{"_id":"diarrheeinf-infectio-5","context":null,"enonce":"What situations require hospitalization during infectious diarrhea?","item":"diarrheeinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"Sepsis","correct":true,"justification":"Life-threatening emergency"},{"idx":1,"proposition":"Diarrhoea larger than 3 litres ","correct":false,"justification":"False"},{"idx":2,"proposition":"Pseudo-occlusive syndrome","correct":true},{"idx":3,"proposition":"Acute dehydration","correct":true,"justification":"Life-threatening emergency"},{"idx":4,"proposition":"Febrile diarrhoea returning from endemic country ","correct":true,"justification":"True, evoking a malarial attack"}],"type":"custom"}
+{"_id":"diarrheeinf-infectio-6","context":null,"enonce":"From what time frame do we speak of prolonged diarrhea?","item":"diarrheeinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"1 week","correct":false},{"idx":1,"proposition":"2 weeks","correct":true},{"idx":2,"proposition":"3 weeks","correct":false},{"idx":3,"proposition":"4 weeks","correct":false,"justification":"From one month, we talk about chronic diarrhea"},{"idx":4,"proposition":"14 days","correct":true}],"type":"custom"}
+{"_id":"diarrheeinf-infectio-7","context":null,"enonce":"From what time frame do we talk about chronic diarrhea?","item":"diarrheeinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"1 week","correct":false,"justification":"It is acute diarrhea"},{"idx":1,"proposition":"2 weeks","correct":false,"justification":"Acute diarrhea is called an episode < 2 weeks"},{"idx":2,"proposition":"3 weeks","correct":false},{"idx":3,"proposition":"4 weeks","correct":true},{"idx":4,"proposition":"6 weeks","correct":false}],"type":"custom"}
+{"_id":"diarrheeinf-infectio-8","context":null,"enonce":"Among the following proposals, what is the main risk in acute diarrhoea in children?","item":"diarrheeinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"Hypokalemia","correct":false},{"idx":1,"proposition":"Hyperkalemia","correct":false},{"idx":2,"proposition":"Undernutrition","correct":false},{"idx":3,"proposition":"Dehydration","correct":true,"justification":"Major risk, to be assessed (CI and EC according to the criteria) upon admission"},{"idx":4,"proposition":"Sepsis","correct":false}],"type":"custom"}
+{"_id":"strabismeped-ophtalmo-0","context":null,"enonce":"General:","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Childhood strabismus is a symptom of an underlying pathology","correct":true},{"idx":1,"proposition":"There are two types of strabismus: paralytic or normal mobility","correct":true},{"idx":2,"proposition":"Treatment is surgical","correct":false,"justification":"It is only indicated in case of persistence of strabismus with the port of total optical correction"},{"idx":3,"proposition":"Surgical treatment is performed under general anhesis","correct":true},{"idx":4,"proposition":"Strabismus is a lack of parallelism of visual axes","correct":true}],"type":"custom"}
+{"_id":"strabismeped-ophtalmo-1","context":null,"enonce":"Regarding the definition of strabismus:","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Strabismus is indicative of sensorineural impairment","correct":true},{"idx":1,"proposition":"The motor component involves an abnormal position of the deviated eye relative to the dominant eye","correct":true},{"idx":2,"proposition":"The child's strabismus is essentially the consequence of a disturbance in the interpretation of color","correct":false,"justification":"The strabismus of the child is essentially the consequence of a disturbance of the fusion (cortical integration aimed at bringing together the images perceived by each eye in a single image)"},{"idx":3,"proposition":"The purpose of fusion is to allow a simple perception of any fixed object.","correct":true},{"idx":4,"proposition":"Fusion is a pure sensory response","correct":false,"justification":"It results as a motor response (contraction–relaxation of the oculomotor muscles of both eyes) to binocular stimulations (vision of one image per eye)"}],"type":"custom"}
+{"_id":"strabismeped-ophtalmo-2","context":null,"enonce":"Concerning strabismus and its consequences","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Fusion creates the conditions for simultaneous vision of both eyes","correct":true},{"idx":1,"proposition":"Fusion enables stereoscopy","correct":true,"justification":"This is vision in space"},{"idx":2,"proposition":"Acute strabismus resulting in two different images implies visual confusion","correct":false,"justification":"In case of acute strabismus, two images of the same object can be perceived, it is diplopia"},{"idx":3,"proposition":"Old strabismus without complaints can lead to normal vision by pausing the retina of one of the two eyes","correct":false,"justification":"In ancient strabismus or in children who do not express complaints, the doubled image can be suppressed by a cortical phenomenon, neutralization (the image of one of the two eyes is ignored)"},{"idx":4,"proposition":"Amblyopia is the decrease in visual function due to early impairment of visual experience.","correct":true}],"type":"custom"}
+{"_id":"strabismeped-ophtalmo-3","context":null,"enonce":"Regarding strabismus:","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Some patients describe visual confusion","correct":true},{"idx":1,"proposition":"Visual confusion is related to the perception of two objects in the same place","correct":true},{"idx":2,"proposition":"All patients describe stereoscopic vision disturbance","correct":true},{"idx":3,"proposition":"Strabismus most often sets in in childhood","correct":true},{"idx":4,"proposition":"The prevalence of strabismus is estimated at 12% of the population","correct":false,"justification":"4% of the population"}],"type":"custom"}
+{"_id":"strabismeped-ophtalmo-4","context":null,"enonce":"Strabismus:","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Strabismus is never physiological","correct":true},{"idx":1,"proposition":"Strabismus screening should be performed in all children in late adolescence","correct":false,"justification":"Ideally for any child under 2 years old"},{"idx":2,"proposition":"The early appearance of strabismus determines its impact on binocular vision","correct":true},{"idx":3,"proposition":"The relative risk of strabismus in case of family history is not changed","correct":false,"justification":"It is increased"},{"idx":4,"proposition":"The prefix \"éso\" is used for convergent vertical strabisms","correct":false,"justification":"For convergent horizontal strabismus (esotropy and esophoria)"}],"type":"custom"}
+{"_id":"strabismeped-ophtalmo-5","context":null,"enonce":"Clinical examination:","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The differential diagnosis of convergent strabismus is epicanthus","correct":true},{"idx":1,"proposition":"The prefix \"exo\" is used for divergent strabismus (exotropy and exophoria)","correct":true},{"idx":2,"proposition":"A tropy is a permanent strabismus","correct":true},{"idx":3,"proposition":"A phoria is a permanent strabismus","correct":false,"justification":"A phoria is an intermittent strabismus (observed episodically on examination) and can be observed in convergence (esophoria) or divergence (exophoria)"},{"idx":4,"proposition":"In case of permanent strabismus, binocular vision is absent","correct":true}],"type":"custom"}
+{"_id":"strabismeped-ophtalmo-6","context":null,"enonce":"Ophthalmological examination in strabique children:","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Binocular vision is lost in intermittent strabismus","correct":false,"justification":"In intermittent strabismus, binocular vision is often retained when the eyes are aligned"},{"idx":1,"proposition":"The risk of amblyopia is major when the deviated eye is always the same","correct":true},{"idx":2,"proposition":"The risk of amblyopia is 99% in case of alternating fixation","correct":false,"justification":"The risk is moderate in this case"},{"idx":3,"proposition":"Concomitant strabismus does not find any systematized deficit of ocular motility","correct":true},{"idx":4,"proposition":"Concomitant strabismus is very rare in children","correct":false,"justification":"Concomitant strabismus account for the vast majority of childhood strabismus"}],"type":"custom"}
+{"_id":"strabismeped-ophtalmo-7","context":null,"enonce":"Concerning additional examinations in case of strabismus:","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The discovery of strabismus requires an urgent ophthalmological examination","correct":true},{"idx":1,"proposition":"Strabismus can reveal a retinal pathology such as retinoblastoma or macular scar","correct":true},{"idx":2,"proposition":"Nystagmus associated with strabismus requires the performance of an EEG","correct":false,"justification":"In case of associated nystagmus, an electroretinogram (ERG) will be performed to rule out retinal dystrophy and visual evoked potentials (EPI) and magnetic resonance imaging (MRI) of the optical pathways will be prescribed for the assessment of potential visual tract damage"},{"idx":3,"proposition":"Any strabic child should benefit from an objective refractive measurement under cycloplegic to determine whether it is an esotropy or an exotropy","correct":false,"justification":"Objective refractive measurement is the basic element of screening for ametropia and amblyopia in a child"},{"idx":4,"proposition":"The measurement of subcycloplegic refraction will look for ametropia","correct":true}],"type":"custom"}
+{"_id":"strabismeped-ophtalmo-8","context":null,"enonce":"Regarding associated pathologies:","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The presence of astygmatism is very common in case of strabismus","correct":false,"justification":"The presence of hyperopia is very frequently associated with strabismus"},{"idx":1,"proposition":"Any accommodation effort is associated with convergence","correct":true},{"idx":2,"proposition":"Objective refraction under cycloplegic makes it possible to measure the visual acuity with correction of a child","correct":true},{"idx":3,"proposition":"Any strabic child must wear total optical correction","correct":true},{"idx":4,"proposition":"The measurement of visual acuity makes it possible to objectify myopia which is frequently associated with strasbism","correct":false,"justification":"The measurement of visual acuity will highlight a possible amblyopia (difference in visual acuity between the two eyes of at least 2\/10th with correction)"}],"type":"custom"}
+{"_id":"strabismeped-ophtalmo-9","context":null,"enonce":"Principles of treatment","item":"strabismeped","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The presence of binocular vision is a major prognosis of treatment","correct":true},{"idx":1,"proposition":"Any strabic patient must wear total optical correction","correct":true},{"idx":2,"proposition":"Treatment of possible amblyopia will be maintained until the age of 2 years","correct":false,"justification":"Treatment of possible amblyopia will be maintained until the age of 6 to 8 years, which corresponds to the end of the child's visual development"},{"idx":3,"proposition":"Indications for orthoptic rehabilitation are marginal in the management of strabismus","correct":true},{"idx":4,"proposition":"The role of the orthoptist is especially major in the measurement of strabic deviations and binocular vision, as well as for the follow-up of amblyopia in support of the ophthalmologist","correct":true}],"type":"custom"}
+{"_id":"certifsport-nutri-0","context":null,"enonce":"The main purpose of the medical examination is:","item":"certifsport","matiere":"nutri","propositions":[{"idx":0,"proposition":"Evaluate achievable sports performance","correct":false},{"idx":1,"proposition":"Detect cardiovascular pathologies responsible for sudden death","correct":true},{"idx":2,"proposition":"To encourage the practice of sport","correct":false},{"idx":3,"proposition":"Discourage the practice of dangerous sports such as climbing or judo","correct":false},{"idx":4,"proposition":"To recall the dangerousness of doping products","correct":false,"justification":"This is one of the objectives, but the really main objective is the detection of cardiovascular pathologies, such as BAV or long QT, which can be responsible for sudden death."}],"type":"custom"}
+{"_id":"certifsport-nutri-1","context":null,"enonce":"Which propositions are true?","item":"certifsport","matiere":"nutri","propositions":[{"idx":0,"proposition":"The medical examination for fitness for sport is not reimbursed by health insurance","correct":true,"justification":"According to the College of Endocrinology"},{"idx":1,"proposition":"There are about 1 to 4 sudden deaths per 100,000 people over the age of 35.","correct":true},{"idx":2,"proposition":"If the sport is considered at risk, the consultation must be made by a sports doctor","correct":true},{"idx":3,"proposition":"ECG is mandatory","correct":false,"justification":"Update 2016 on HCSP recos, extract from the College of Pediatrics 2021: A complete clinical examination is usually sufficient. The HCSP recommends that the ECG should not be systematic but left to the judgment of the clinician (2016). Discomfort and\/or syncopes occurring during exercise should be considered as a warning sign of cardiac origin: a clinical cardiological assessment with at least one ECG, a stress test and echocardiography is then essential. The item is therefore false. (The item was previously corrected as true. Thanks to the external who reported the error)"},{"idx":4,"proposition":"Doping contraindicates the realization of a certificate of non-contraindication to the practice of sport","correct":true,"justification":"The patient must then be referred to see AMPD"}],"type":"custom"}
+{"_id":"certifsport-nutri-4","context":null,"enonce":"Under what conditions is a stress test indicated?","item":"certifsport","matiere":"nutri","propositions":[{"idx":0,"proposition":"An age greater than 20 years","correct":false,"justification":"Over 40 years"},{"idx":1,"proposition":"Male sex","correct":false},{"idx":2,"proposition":"Diabetes","correct":true,"justification":"To detect microangiopathic complications"},{"idx":3,"proposition":"The presence of 2 cardiovascular risk factors","correct":true},{"idx":4,"proposition":"Alcohol consumption","correct":false,"justification":"Alcohol is not a cardiovascular risk factor"}],"type":"custom"}
+{"_id":"SEP-neuro-0","context":null,"enonce":"Regarding the main generalities about MS:","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"Multiple sclerosis usually occurs after age 40","correct":false,"justification":"Occurs in young adults"},{"idx":1,"proposition":"The diagnosis is based on the notions of spatial dissemination and temporal dissemination","correct":true},{"idx":2,"proposition":"The lumbar puncture makes it possible to affirm the inflammatory nature of the CNS involvement","correct":true},{"idx":3,"proposition":"The criterion of dissemination over time is mandatory to make the diagnosis of MS","correct":false,"justification":"CNS inflammation objectified to CSF analysis may replace the criterion of dissemination over time if it is absent."},{"idx":4,"proposition":"There is no known treatment","correct":false,"justification":"There are treatments that aim to speed up symptom recovery, limit the frequency of flare-ups and disease progression, and improve symptoms."}],"type":"custom"}
+{"_id":"SEP-neuro-1","context":null,"enonce":"Regarding the epidemiology and risk factors of MS:","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"There is a male predominance","correct":false,"justification":"Female predominance (3 women to 1 man)"},{"idx":1,"proposition":"MS is more common when moving away from the equator","correct":true},{"idx":2,"proposition":"The prevalence is 5000 people per year in France","correct":false},{"idx":3,"proposition":"Less exposure to certain infections in childhood would increase the risk","correct":true},{"idx":4,"proposition":"Vitamin D deficiency is associated with an increased risk of disease","correct":true}],"type":"custom"}
+{"_id":"SEP-neuro-3","context":null,"enonce":"Regarding the different clinical forms:","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"Progression is defined as the continuous worsening, over a period of at least six months, of neurological symptoms.","correct":true},{"idx":1,"proposition":"The relapsing-remitting form is progressive from the beginning, without flare-up, consistently","correct":false,"justification":"It is the primary progressive form, which affects 15% of patients. The relapsing-remitting form is composed exclusively of flare-ups, which can leave sequelae"},{"idx":2,"proposition":"The secondarily progressive form is the late classical course of the relapsing-remitting form","correct":true},{"idx":3,"proposition":"The primary progressive form begins on average a little later, around 40 years of age","correct":true},{"idx":4,"proposition":"Types of symptoms depend on the clinical phase","correct":true}],"type":"custom"}
+{"_id":"SEP-neuro-4","context":null,"enonce":"Regarding the diagnosis:","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"In the relapsing-remitting form, there is most often an inaugural flare-up of partial myelitis or NORB","correct":true,"justification":"NORB = Retrobulbar optic neuritis"},{"idx":1,"proposition":"\"Partial myelitis\" is an MRI term that means that demyelination does not extend to the entire cross-section of the spinal cord.","correct":true},{"idx":2,"proposition":"Partial myelitis is of medullary topography","correct":true},{"idx":3,"proposition":"Motor disorders are never found in partial myelitis","correct":false,"justification":"There are sometimes motor and\/or sphincter disorders."},{"idx":4,"proposition":"The sign of Rutteau is very evocative","correct":false,"justification":"The sign of Lhermitte is very evocative: it is an impression of very brief electric discharge along the spine, sometimes limbs, triggered electively at the bending of the head forward"}],"type":"custom"}
+{"_id":"SEP-neuro-5","context":null,"enonce":"Regarding the analysis of cerebrospinal fluid in the MS:","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"The presence of oligoclonal bands replaces the criterion of temporal dissemination","correct":true,"justification":"According to McDonald's 2017 criteria"},{"idx":1,"proposition":"Lumbar puncture is mandatory for the diagnosis of MS","correct":false,"justification":"It is not mandatory"},{"idx":2,"proposition":"Oligoclonal bands are present in only 15% of MS","correct":false,"justification":"They are present in more than 90% of MS! An absence of oligoclonal bands should call into question the diagnosis of MS."},{"idx":3,"proposition":"A proteinorachy > 1 g\/L is suggestive of MS","correct":false,"justification":"No, it is suggestive of a differential diagnosis, such as bacterial meningitis, and must call into question the diagnosis of MS."},{"idx":4,"proposition":"Intrathecal IgG secretion > 0.7 g\/L suggestive of a diagnosis of MS","correct":true}],"type":"custom"}
+{"_id":"SEP-neuro-6","context":null,"enonce":"Regarding NORB in MS:","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"The NORB is inaugural in 25% of cases","correct":true},{"idx":1,"proposition":"NORB is specific to MS","correct":false,"justification":"NORB is also present in neuromyelitis optica (Devic disease), in HIV, in Horton's disease, and also caused by drugs (ethambutol, isoniazid)"},{"idx":2,"proposition":"There is blue-yellow dyschromatopsia","correct":false,"justification":"It is red-green dyschromatopsia (optic neuropathy). Blue-yellow dyschromatopsia is present in some retinal conditions."},{"idx":3,"proposition":"Papillary edema may be observed at the back of the eye","correct":true,"justification":"It is an inflammatory attack of the optic nerve. Edema is present in 10% of NORBs."},{"idx":4,"proposition":"In the static visual field, there is a central scotoma or caeco-central","correct":true}],"type":"custom"}
+{"_id":"SEP-neuro-7","context":null,"enonce":"What background MS treatment(s) is\/are likely to cause progressive multifocal leukoencephalopathy (PML)?","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"Natalizumab","correct":true},{"idx":1,"proposition":"Let's interfere betâ","correct":false,"justification":"Side effects: flu-like syndrome for ≈ 50% of patients after injection; Skin side effects"},{"idx":2,"proposition":"Glatiramer acetate","correct":false,"justification":"Immunomodulatory therapy that may cause skin side effects"},{"idx":3,"proposition":"Dimethyl fumarate","correct":true,"justification":"Immunomodulatory therapy that can cause flushing, digestive upset and prolonged lymphopenia (occurrence of opportunistic infections such as PML)"},{"idx":4,"proposition":"Mitoxantrone","correct":false,"justification":"Risk of acute myeloid leukemia"}],"type":"custom"}
+{"_id":"SEP-neuro-8","context":null,"enonce":"Good prognosis factors for MS include:","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"Young onset age","correct":true},{"idx":1,"proposition":"Male","correct":false,"justification":"It is the female sex"},{"idx":2,"proposition":"Initial sensory impairment","correct":true},{"idx":3,"proposition":"Remitting mode","correct":true,"justification":"The primary progressive form has a poor prognosis"},{"idx":4,"proposition":"Start with a NORB or motor signs","correct":false,"justification":"Initiation with NORB is a good prognosis factor, but onset with motor signs is a poor prognosis factor."}],"type":"custom"}
+{"_id":"SEP-neuro-9","context":null,"enonce":"Which of the following proposals are frequently included in a first outbreak of multiple sclerosis?","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"Proportional brutal hemiplegia","correct":false,"justification":"Not brutal (more reminiscent of vascular involvement), no hemiplegia"},{"idx":1,"proposition":"Decreased visual acuity","correct":true,"justification":"True, symptom of NORB"},{"idx":2,"proposition":"Paresthesias of a hemibody or lower limbs","correct":true},{"idx":3,"proposition":"Peripheral facial paralysis (PFP)","correct":false,"justification":"Not in the first push"},{"idx":4,"proposition":"Delirium","correct":false,"justification":"No cognitive impairment"}],"type":"custom"}
+{"_id":"SEP-neuro-10","context":null,"enonce":"Which of the following are additional tests that can lead to multiple sclerosis (MS)?","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"Brain MRI","correct":true},{"idx":1,"proposition":"Bone marrow MRI","correct":true},{"idx":2,"proposition":"Microbiological","correct":true},{"idx":3,"proposition":"ENMG","correct":false,"justification":"Totally unnecessary (central reach)"},{"idx":4,"proposition":"EEG","correct":false,"justification":"Totally useless"}],"type":"custom"}
+{"_id":"SEP-neuro-11","context":null,"enonce":"Which of the following are common features of retrobulbar optic neuritis (NORB)?","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"Central scotomome","correct":true},{"idx":1,"proposition":"A fundus usually normal in the acute phase","correct":true},{"idx":2,"proposition":"Pain when mobilizing the eyeball","correct":true},{"idx":3,"proposition":"Unilateral decrease in visual acuity","correct":true},{"idx":4,"proposition":"All propositions are true","correct":true}],"type":"custom"}
+{"_id":"splenomeg-HGE-1","context":null,"enonce":"Regarding the causes and consequences of spleen pathologies:","item":"splenomeg","matiere":"HGE","propositions":[{"idx":0,"proposition":"Lupus can be the cause of a splenectomy","correct":true},{"idx":1,"proposition":"Hemorrhagic shock due to rupture of the spleen can result in asplenism","correct":true},{"idx":2,"proposition":"Pneumococcal sepsis may be caused by splenomegaly","correct":false,"justification":"Asplenism"},{"idx":3,"proposition":"Any palpable spleen is pathological except in children","correct":true,"justification":"Source: https:\/\/lyon-sud.univ-lyon1.fr\/servlet\/com.univ.collaboratif.utils.LectureFichiergw?ID_FICHIER=1320402929586"},{"idx":4,"proposition":"Splenomegaly can cause hemodilution anemia","correct":true}],"type":"custom"}
+{"_id":"splenomeg-HGE-2","context":null,"enonce":"What can be the consequences of splenomegaly: ","item":"splenomeg","matiere":"HGE","propositions":[{"idx":0,"proposition":"Acute hepatitis","correct":false,"justification":"No, but may be the cause"},{"idx":1,"proposition":"Malabsorption","correct":false,"justification":"No, but celiac disease can cause splenopathy"},{"idx":2,"proposition":"Hemodilution","correct":true,"justification":"Inconstant although more or less proportional to the splenic volume, it depends on the etiology of splenomegaly"},{"idx":3,"proposition":"Leukocytosis","correct":false,"justification":"Rather leukopenia by sequestration. We readily find thrombocytopenia. In extreme forms, this can go as far as pancytopenia."},{"idx":4,"proposition":"Diarrhea","correct":false,"justification":"Not described in the college"}],"type":"custom"}
+{"_id":"splenomeg-HGE-3","context":null,"enonce":"In case of splenectomy:","item":"splenomeg","matiere":"HGE","propositions":[{"idx":0,"proposition":"Vaccinated against all encapsulated germs","correct":false,"justification":"Meningoto and pneumo vaccine only. There are many other encapsulated germs, including haemophilius influenzae."},{"idx":1,"proposition":"Vaccination against neisseria meningitidis","correct":true},{"idx":2,"proposition":"Streptoccocus pneumoniae is vaccinated","correct":true},{"idx":3,"proposition":"Listeria vaccinated","correct":false,"justification":"Not in the recommendations"},{"idx":4,"proposition":"Bouts of fever are immediately treated with fluoroquinolones","correct":false}],"type":"custom"}
+{"_id":"splenomeg-HGE-4","context":null,"enonce":"Which of the following are causes of splenomegaly?","item":"splenomeg","matiere":"HGE","propositions":[{"idx":0,"proposition":"High blood pressure","correct":false},{"idx":1,"proposition":"Gaucher disease","correct":true},{"idx":2,"proposition":"Cirrhosis","correct":true},{"idx":3,"proposition":"Hepatocellular carcinoma","correct":true},{"idx":4,"proposition":"Infective endocarditis","correct":true}],"type":"custom"}
+{"_id":"PF-neuro-0","context":null,"enonce":"Regarding central facial deficit:","item":"PF","matiere":"neuro","propositions":[{"idx":0,"proposition":"It predominates on the forehead","correct":false,"justification":"Lower part of the face. The two nuclei of the trunk of the facial nerves each receive afferences of 1st corticonuclear motor neurons of both hemispheres. However, the homolateral corticonuclear neuron innervates mainly the upper stage of the face. So in case of damage of the 1st neuron, central, the deficit will predominate on the lower floor."},{"idx":1,"proposition":"There is a deletion of the nasolabial fold","correct":true},{"idx":2,"proposition":"Fall of the labial commissure is rare","correct":false,"justification":"Frequent"},{"idx":3,"proposition":"It is associated with a motor deficit that is homolateral most often","correct":true},{"idx":4,"proposition":"It always includes automatic-voluntary dissociation","correct":false,"justification":"In general, not always. Sometimes dissociation is reversed"}],"type":"custom"}
+{"_id":"PF-neuro-1","context":null,"enonce":"Regarding peripheral facial paralysis","item":"PF","matiere":"neuro","propositions":[{"idx":0,"proposition":"The sign of Charles Bell shows a tilt of the eyeball upwards","correct":true,"justification":"This switch is physiological. The incomplete closure of the palpebral cleft makes it possible to observe it (by occlusion deficit of the eye) = Charles Bell's sign"},{"idx":1,"proposition":"There is an erasure of forehead wrinkles","correct":true},{"idx":2,"proposition":"There is an agueusia of the anterior 2\/3 of the tongue when the involvement is very proximal","correct":true,"justification":"It is a localizing sign of the lesion: upstream of the eardrum cord. So a FP related to a lesion downstream (eg compression by a parotid tumor) will not be associated with ageusia."},{"idx":3,"proposition":"Schumascher's test reveals drying up of tear secretions","correct":false,"justification":"Schirmer's test"},{"idx":4,"proposition":"The face is sluggish in case of facial diplegia","correct":true}],"type":"custom"}
+{"_id":"PF-neuro-2","context":null,"enonce":"Regarding idiopathic acute facial paralysis:","item":"PF","matiere":"neuro","propositions":[{"idx":0,"proposition":"It is called a frigore","correct":true},{"idx":1,"proposition":"It is a very rare cause of paralysis","correct":false,"justification":"By far the most common; \"very rare\" suggests the answer"},{"idx":2,"proposition":"It is, as a rule, isolated","correct":true},{"idx":3,"proposition":"Recovery is slow and sequelale in very few cases","correct":true,"justification":"About 10%"},{"idx":4,"proposition":"There is no specific treatment","correct":false,"justification":"Prescription of oral corticosteroid therapy (1 mg\/kg per day for 10 days). There are symptomatic treatments: eye protection, speech therapy,..."}],"type":"custom"}
+{"_id":"Kcpulm-onco-0","context":null,"enonce":"Which of the following are true?","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"proposition":"Platinum salts are the basis of chemotherapy","correct":true,"justification":"None"},{"idx":1,"proposition":"Treatment decisions must be validated in a multidisciplinary consultation meeting with 2 doctors of different specialties","correct":false,"justification":"3 different specialties"},{"idx":2,"proposition":"Survival at all stages is < 20% at 5 years","correct":true,"justification":"None"},{"idx":3,"proposition":"Its main risk factor is air pollution","correct":false,"justification":"Its main risk factor, tobacco, is clearly identified and preventable"},{"idx":4,"proposition":"     There is no recommendation for screening for CP currently in France ","correct":true,"justification":"None"}],"type":"custom"}
+{"_id":"orgamdt-mdt-0","context":null,"enonce":"Which of these principles apply to occupational medicine?","item":"orgamdt","matiere":"mdt","propositions":[{"idx":0,"proposition":"Universality: occupational medicine concerns all employees","correct":true},{"idx":1,"proposition":"It is curative and preventive","correct":false,"justification":"Exclusively preventive"},{"idx":2,"proposition":"It must be organized by the ANSM and the HAS","correct":false,"justification":"It must be organized by the employer"},{"idx":3,"proposition":"It is exercised within an SST","correct":true,"justification":"OHS = Occupational Health Service"},{"idx":4,"proposition":"It is independent of the State","correct":false,"justification":"The action of the MT is independent of the employer"}],"type":"custom"}
+{"_id":"orgamdt-mdt-1","context":null,"enonce":"Which of these proposals are actions potentially carried out by the occupational physician?","item":"orgamdt","matiere":"mdt","propositions":[{"idx":0,"proposition":"Workplace visits","correct":true},{"idx":1,"proposition":"Training for specific risks","correct":true},{"idx":2,"proposition":"The development and updating of the company file","correct":true},{"idx":3,"proposition":"Carrying out metrological measurements","correct":true},{"idx":4,"proposition":"Fracture management in the workplace","correct":false,"justification":"The role of TM is exclusively PREVENTIVE"}],"type":"custom"}
+{"_id":"orgamdt-mdt-2","context":null,"enonce":"Regarding the return to work visit:","item":"orgamdt","matiere":"mdt","propositions":[{"idx":0,"proposition":"It is always optional","correct":false,"justification":"It is mandatory in certain cases: after maternity leave, absence due to occupational disease, ..."},{"idx":1,"proposition":"It concerns in particular workers returning from maternity leave","correct":true},{"idx":2,"proposition":"It concerns in particular workers returning from paternity leave","correct":false},{"idx":3,"proposition":"It may conclude with a notice of incapacity","correct":true},{"idx":4,"proposition":"It can be replaced by the pre-return to work visit","correct":false,"justification":"The pre-resumption visit is different, it is organized during the work stoppage and has different objectives"}],"type":"custom"}
+{"_id":"osteoporose-rhumato-0","context":null,"enonce":"General generalities:","item":"osteoporose","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Osteoporosis is a generalized disease of the skeleton, characterized by decreased bone strength predisposing to a high risk of fracture","correct":true},{"idx":1,"proposition":"Bone strength is synonymous with bone density","correct":false,"justification":"Bone strength is the result of bone density and bone quality (alteration of bone microarchitecture in particular)\""},{"idx":2,"proposition":"Biomechanical studies show that bone mineral density (BMD) is the main determinant of bone fragility","correct":true},{"idx":3,"proposition":"The main complication of osteoporosis disease is malignant hypercalcemia","correct":false,"justification":"Fractures are \"the\" complication of osteoporotic disease and constitute the full severity of this disease"},{"idx":4,"proposition":"The scanner is the reference technique for measuring BMD","correct":false,"justification":"This is the DXA: Two-photon X-ray absorptiometry"}],"type":"custom"}
+{"_id":"osteoporose-rhumato-2","context":null,"enonce":"Regarding support:","item":"osteoporose","matiere":"rhumato","propositions":[{"idx":0,"proposition":"X-rays should be taken for vertebral fracture(s) in case of significant loss of size (≥ 4 cm)","correct":true},{"idx":1,"proposition":"The realization of a BMD is necessary in front of fractures of the ESF or vertebral only","correct":false,"justification":"When an osteoporotic-like fracture occurs (or is discovered on X-rays), or when one or more risk factors for osteoporosis are discovered by questioning, BMD must be performed"},{"idx":2,"proposition":"Vertebral fractures are osteroporotic only","correct":false,"justification":"In case of red flag (context or presentation or appearance rx), it is necessary to fear a secondary fracture (tumor, myeloma, spondylodiscite ..). In case of doubt, the realization of a CT scan and \/ or an MRI, will confirm the absence of signs suggestive of another origin, in particular tumor"},{"idx":3,"proposition":"In postmenopausal osteoporosis, serum calcium is increased","correct":false,"justification":"Calcium and phosphatemia are normal in postmenopausal osteoporosis. In case of primary hyperparathyroidism, however, there is hypercalcemia and hypophosphoremia"},{"idx":4,"proposition":"Vitamin D deficiency should be screened for osteoporosis","correct":true,"justification":"The dosage of 25 OH vitamin D is part of the assessment of weakening osteopathy to detect osteomalacia."}],"type":"custom"}
+{"_id":"osteoporose-rhumato-3","context":null,"enonce":"Which of the following are radiographic criteria for benign vertebral fracture?","item":"osteoporose","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Multiple settlements","correct":true},{"idx":1,"proposition":"Conservation of the posterior wall","correct":true},{"idx":2,"proposition":"Absence of paravertebral spindle","correct":true},{"idx":3,"proposition":"Gas translucency within the fracture","correct":true},{"idx":4,"proposition":"Soft parts involvement","correct":false,"justification":"In favor of malignant infringement"}],"type":"custom"}
+{"_id":"osteoporose-rhumato-4","context":null,"enonce":"Which of the following are radiographic criteria for malignant vertebral fracture?","item":"osteoporose","matiere":"rhumato","propositions":[{"idx":0,"proposition":"A T2 level fracture","correct":true,"justification":"True, like all fractures higher than T5"},{"idx":1,"proposition":"A setback of the back wall","correct":true},{"idx":2,"proposition":"An invasion of the soft parts","correct":true},{"idx":3,"proposition":"Lysis of bony cortical cortical","correct":true},{"idx":4,"proposition":"Respect for the posterior arch","correct":false,"justification":"Rather, there is a recoil of the posterior arch"}],"type":"custom"}
+{"_id":"osteoporose-rhumato-5","context":null,"enonce":"Which of the following are radiographic criteria for benign vertebral fracture?","item":"osteoporose","matiere":"rhumato","propositions":[{"idx":0,"proposition":"Multiple settlements","correct":true},{"idx":1,"proposition":"Conservation of the posterior wall","correct":true},{"idx":2,"proposition":"Absence of paravertebral spindle","correct":true},{"idx":3,"proposition":"Gas translucency within the fracture","correct":true},{"idx":4,"proposition":"Soft parts involvement","correct":false,"justification":"In favor of malignant infringement"}],"type":"custom"}
+{"_id":"asthme-immuno-0","context":null,"enonce":"Which of the following proposition(s) is true about asthma?","item":"asthme","matiere":"immuno","propositions":[{"idx":0,"proposition":"Pulmonary function tests (RFEs) find a reversible restrictive ventilatory disorder","correct":false,"justification":"EFRs regain reversible obstructive ventilatory disorder"},{"idx":1,"proposition":"Mortality is almost zero","correct":false,"justification":"It is about 1,000 per year"},{"idx":2,"proposition":"Asbestos causes asthma","correct":false,"justification":"No asthma caused by asbestos"},{"idx":3,"proposition":"The severity of asthma is defined by the number of annual exacerbations","correct":false,"justification":"It is defined by the necessary therapeutic level"},{"idx":4,"proposition":"Asthma contraindicates underwater scuba pongey","correct":true}],"type":"custom"}
+{"_id":"asthme-immuno-1","context":null,"enonce":"What is the prevalence of asthma in France? 🤔","item":"asthme","matiere":"immuno","propositions":[{"idx":0,"proposition":"0.1% 😯","correct":false,"justification":"False"},{"idx":1,"proposition":"1% 😩","correct":false,"justification":"False"},{"idx":2,"proposition":"6% 😨","correct":true},{"idx":3,"proposition":"10% 😰","correct":false,"justification":"False"},{"idx":4,"proposition":"16% 😱","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"asthme-immuno-2","context":null,"enonce":"Which of the following are signs of severity during an asthma exacerbation?","item":"asthme","matiere":"immuno","propositions":[{"idx":0,"proposition":"The presence of bilateral sibilants","correct":false,"justification":"This is normal even in classic asthma"},{"idx":1,"proposition":"Constipation","correct":false,"justification":"Not a sign of gravity"},{"idx":2,"proposition":"bradycardia","correct":true,"justification":"True, any hemodynamic instability is a sign of severity"},{"idx":3,"proposition":"Auscultatory silence","correct":true,"justification":"True, absence of vesicular murmur"},{"idx":4,"proposition":"Disorders of consciousness","correct":true,"justification":"True, like all acute neurological instabilities"}],"type":"custom"}
+{"_id":"asthme-immuno-3","context":null,"enonce":"What is the prevalence of rhinitis in France? 🤔","item":"asthme","matiere":"immuno","propositions":[{"idx":0,"proposition":"4% 🥴","correct":false,"justification":"False"},{"idx":1,"proposition":"14% 🤯","correct":false,"justification":"False"},{"idx":2,"proposition":"24% 😱","correct":true},{"idx":3,"proposition":"0.4 % 😬","correct":false,"justification":"False"},{"idx":4,"proposition":"34% 😵","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"fievreaigue-infectio-0","context":null,"enonce":"Regarding acute fever","item":"fievreaigue","matiere":"infectio","propositions":[{"idx":0,"proposition":"Any patient with acute fever is contagious until proven otherwise.","correct":true},{"idx":1,"proposition":"A diastolic BP < 100 mmHg is a sign of severity","correct":false,"justification":"Systolic, not diastolic,"},{"idx":2,"proposition":"Each degree above 37°C increases water loss by 400ml\/d","correct":true},{"idx":3,"proposition":"Fever and chills increase oxygen requirements","correct":true},{"idx":4,"proposition":"Social isolation is an indication for hospitalization for acute fever","correct":true}],"type":"custom"}
+{"_id":"fievreaigue-infectio-1","context":null,"enonce":"Regarding acute fever","item":"fievreaigue","matiere":"infectio","propositions":[{"idx":0,"proposition":"The core temperature considered normal is ≤ 37.5°C in the morning and ≤ 37.8°C in the evening.","correct":true},{"idx":1,"proposition":"Fever classically refers to a body temperature ≥ 38 ° C in the morning (38.3 ° C in the evening)","correct":true},{"idx":2,"proposition":"The term \"feverish\", imprecise, usually refers to a temperature > 37.5°C and < 36°C","correct":false,"justification":"The term \"feverish\", imprecise, usually refers to a temperature > 37.5°C and < 38°C"},{"idx":3,"proposition":"Rectal temperature measurement is the most used because it is extremely precise","correct":false,"justification":"Rectal intake is no longer used (risk of thermometric ulceration)"},{"idx":4,"proposition":"Fever is a symptom","correct":true}],"type":"custom"}
+{"_id":"fievreaigue-infectio-2","context":null,"enonce":"Regarding acute fever","item":"fievreaigue","matiere":"infectio","propositions":[{"idx":0,"proposition":"Etiologies are most often infectious","correct":true},{"idx":1,"proposition":"Acute fever especially if associated with dyspnea is a decantant factor of acute coronary syndrome","correct":true},{"idx":2,"proposition":"Pyelonephritis is systematically sought in women especially in the 3rd trimester","correct":true},{"idx":3,"proposition":"Lung, urinary and digestive infections dominate in the elderly","correct":true},{"idx":4,"proposition":"In valve prosthesis wearers, blood cultures are systematic before any antibiotic therapy to look for infectious endocarditis","correct":true}],"type":"custom"}
+{"_id":"fievreaigue-infectio-4","context":null,"enonce":"Faced with a fever without a precise diagnosis, which of these situations are indications for probabilistic antibiotic therapy in emergency?","item":"fievreaigue","matiere":"infectio","propositions":[{"idx":0,"proposition":"Splenectomized patient","correct":true},{"idx":1,"proposition":"Neutropenia < 500\/mm","correct":true},{"idx":2,"proposition":"Purpura fulminans ","correct":true,"justification":"Absolute urgency"},{"idx":3,"proposition":"In the presence of signs of sepsis ","correct":true,"justification":"Absolute urgency"},{"idx":4,"proposition":"A qSOFA score >2","correct":false,"justification":"Indication faux pas"}],"type":"custom"}
+{"_id":"AMP-gyn-0","context":null,"enonce":"Which of these proposals fall within the definition of an MPA technique?","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"IAC with spouse's sperm","correct":true,"justification":"IAC = artificial insemination"},{"idx":1,"proposition":"AI with donor sperm","correct":true,"justification":"This is the IAD: artificial insemination with donor sperm"},{"idx":2,"proposition":"IVF","correct":true,"justification":"ICSI or IMSI"},{"idx":3,"proposition":"Embryo transfer","correct":true},{"idx":4,"proposition":"Amniocentesis","correct":false,"justification":"Absolutely not\""}],"type":"custom"}
+{"_id":"AMP-gyn-1","context":null,"enonce":"Regarding general information on the GPA:","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"Assisted reproduction procedures allow in vitro conception in particular","correct":true,"justification":"Assisted reproduction (ART) procedures are \"all clinical and biological practices allowing in vitro conception, conservation of gametes, germinal tissues and embryos, embryo transfer and artificial insemination\" (Article 31 of the Bioethics Act of 07\/07\/2011)"},{"idx":1,"proposition":"These techniques have the sole purpose of fighting proven infertility","correct":false},{"idx":2,"proposition":"The pathological nature of infertility must be medically diagnosed before requiring ART","correct":true},{"idx":3,"proposition":"The indication for ART techniques has extended to the field of oncofertility during the decade 2010","correct":true},{"idx":4,"proposition":"The therapeutic management of couples most often begins with a simple induction of ovulation with scheduled sexual intercourse","correct":true}],"type":"custom"}
+{"_id":"AMP-gyn-2","context":null,"enonce":"Among these proposals, which impede embryo insemination or transfer:","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"The death of one of the members of the couple","correct":true},{"idx":1,"proposition":"Too old or too young","correct":true},{"idx":2,"proposition":"Important joint problems","correct":true,"justification":"Especially if cessation of cohabitation, or petition for divorce"},{"idx":3,"proposition":"HIV positive serology","correct":false,"justification":"This is not an obstacle at all, but will require a verification of serology and multidisciplinary care in a specialized center."},{"idx":4,"proposition":"An oral revocation of consent","correct":false,"justification":"The revocation must be in writing\""}],"type":"custom"}
+{"_id":"AMP-gyn-3","context":null,"enonce":"Regarding the GPA in general:","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"HIV 1 and 2, hepatitis B and C, syphilis should be checked","correct":true},{"idx":1,"proposition":"In case of STIs, MPA techniques are contraindicated","correct":false,"justification":"No, but the care is multidisciplinary and carried out in a specialized center"},{"idx":2,"proposition":"A consultation with a psychiatrist or psychologist must eliminate any contraindications of a psycho-social nature","correct":true},{"idx":3,"proposition":"ART is proposed as a first-line treatment in cases of confirmed infertility in all couples, in France","correct":false,"justification":"The AMP requires an investment of time, effort and emotions. If the couple does not seem to be able to assume this, the ART may not be proposed as a first line"},{"idx":4,"proposition":"Infertility is not managed (considered comfort care)","correct":false,"justification":"100% support. It is not at all a comfort, but a real pathology with psychosocial implications sometimes strong"}],"type":"custom"}
+{"_id":"AMP-gyn-4","context":null,"enonce":"Regarding the GPA:","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"Intrauterine insemination gives good results only in combination with stimulation of the ovary","correct":true},{"idx":1,"proposition":"Ovulation stimulation is passive and requires no supervision","correct":false,"justification":"Yes, monitoring by hromonal assays + repeated ultrasounds"},{"idx":2,"proposition":"The timing of insemination is one of the essential success factors","correct":true},{"idx":3,"proposition":"Insemination is ideally performed 36 hours after the artificial onset of ovulation, or the day after a spontaneous LH spike","correct":true},{"idx":4,"proposition":"Artificial insemination is concocted whatever the cause of infertility","correct":false,"justification":"The tubes must be permeable and the sperm must be of good quality"}],"type":"custom"}
+{"_id":"AMP-gyn-5","context":null,"enonce":"Regarding the indications of the IACs:","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"At least 1 million motile sperm must be deposited in insemination","correct":true},{"idx":1,"proposition":"Infertility of cervical origin is a great indication of artificial insemination","correct":true},{"idx":2,"proposition":"Infertility of cervical origin is mainly due to the HPV virus","correct":false,"justification":"Nothing to see: it is due to the asbence of mucus or mucus hostile to the passage or survival of spermatozoa"},{"idx":3,"proposition":"Ejaculatory mascular infertility is an indication for IAC","correct":true},{"idx":4,"proposition":"female permeable tube infertility is an indication for IAC","correct":true}],"type":"custom"}
+{"_id":"AMP-gyn-7","context":null,"enonce":"Regarding IAD:","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"The first indication of IAD is the sterility of the spouse","correct":true},{"idx":1,"proposition":"The donor may never have procreated","correct":true},{"idx":2,"proposition":"The average pregnancy rate is 17.3% with donor sperm","correct":true},{"idx":3,"proposition":"The result of the IAD depends on the rank of the attempt, including","correct":true,"justification":"That's right"},{"idx":4,"proposition":"Artificial insemination is always associated with ovulation stimulation","correct":true}],"type":"custom"}
+{"_id":"AMP-gyn-8","context":null,"enonce":"Which of the following dosages can be used to assess the follicular ovarian reserve?","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"FSH","correct":true,"justification":"None"},{"idx":1,"proposition":"LH","correct":true,"justification":"None"},{"idx":2,"proposition":"Testosterone","correct":false,"justification":"None"},{"idx":3,"proposition":"WHA","correct":true,"justification":"None"},{"idx":4,"proposition":"DHA","correct":false,"justification":"None"}],"type":"custom"}
+{"_id":"AMP-gyn-9","context":null,"enonce":"What are the particularities of AMH dosing?","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"Not reimbursed","correct":true,"justification":"None"},{"idx":1,"proposition":"Achievable at any point in the cycle ","correct":true,"justification":"None"},{"idx":2,"proposition":"Achievable only in the first part of the cycle ","correct":false,"justification":"None"},{"idx":3,"proposition":"Very reliable ","correct":true,"justification":"None"},{"idx":4,"proposition":"Unreliable","correct":false,"justification":"None"}],"type":"custom"}
+{"_id":"AMP-gyn-10","context":null,"enonce":"What should the FSH assay be coupled with to interpret follicular ovarian reserve?","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"SDHEA assay ","correct":false,"justification":"None"},{"idx":1,"proposition":"AMH determination","correct":false,"justification":"None"},{"idx":2,"proposition":"Determination of estradiol","correct":true,"justification":"Estradiol provides feedback to FSH and may distort its dosage."},{"idx":3,"proposition":"Endovaginal ultrasound","correct":false,"justification":"None"},{"idx":4,"proposition":"Hysteroscopy","correct":false,"justification":"None"}],"type":"custom"}
+{"_id":"ethique-psy-0","context":null,"enonce":"Regarding consent:","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"It must be free","correct":true},{"idx":1,"proposition":"It must be illuminated","correct":true},{"idx":2,"proposition":"He must be re-examined with each new situation","correct":true,"justification":"1 consent = 1 action"},{"idx":3,"proposition":"It cannot be revoked for cost reasons","correct":false,"justification":"Consents are revocable at any time"},{"idx":4,"proposition":"It can be oral","correct":true,"justification":"It can be written as well. When it is oral, the discussion should be mentioned in the medical record. Some cases must be written: \"This written consent concerns acts related to fertility or pregnancy (for example, voluntary termination of pregnancy), acts of removal of tissues, cells and collection of products from the human body, clinical research, examination of genetic characteristics. The law does not require written consent for surgery, but the physician is advised to obtain such consent in writing whenever it is an important decision.\""}],"type":"custom"}
+{"_id":"ethique-psy-1","context":null,"enonce":"Among these proposals, which are major principles of medical ethics:","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"Malfeasance","correct":false,"justification":"Non-maleficence"},{"idx":1,"proposition":"Non-charity","correct":false,"justification":"Charity"},{"idx":2,"proposition":"Proportionality","correct":true},{"idx":3,"proposition":"Heteronomy","correct":false,"justification":"Autonomy"},{"idx":4,"proposition":"Justice","correct":true}],"type":"custom"}
+{"_id":"ethique-psy-2","context":null,"enonce":"Among these proposals, which are criteria for brain death:","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"The absence of consciousness","correct":true},{"idx":1,"proposition":"The absence of brainstem reflexes","correct":true},{"idx":2,"proposition":"The absence of patellar reflex","correct":false,"justification":"Peripheral reflex"},{"idx":3,"proposition":"A single EEG showing an absence of brain activity","correct":false,"justification":"It takes two EEGs 4 hours apart to be able to conclude"},{"idx":4,"proposition":"An angiogram showing an absence of brain activity","correct":true}],"type":"custom"}
+{"_id":"ethique-psy-3","context":null,"enonce":"Concerning the generality of medical ethics","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"A pregnant woman can ask a doctor for an abortion at 24 weeks of amenorrhea","correct":false},{"idx":1,"proposition":"A medical termination of pregnancy after the 12th week requires the authorization of a multidisciplinary diagnostic center which has competence to decide which diseases justify it or not.","correct":true},{"idx":2,"proposition":"Prenatal diagnosis concerns only genetic analyses to verify chromosomal diseases","correct":false},{"idx":3,"proposition":"The absence of all brainstem reflexes is a criterion for brain death","correct":true},{"idx":4,"proposition":"Biomedical intervention research and research on healthy volunteers is governed by the Huriet-Sérusclat law","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"ethique-psy-4","context":null,"enonce":"Regarding the application(s) of medical ethics","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"The Huriet-Sérusclat law implies obtaining the agreement of the HAS","correct":false,"justification":"This law requires the sponsor to take out insurance, to obtain the favorable opinion of a committee for the protection of persons [CPP] and the authorization of the national agency for the safety of medicines and health products [ANSM]"},{"idx":1,"proposition":"No medical procedure may be performed without free and informed consent on the part of the patient, except in cases of emergency.","correct":true},{"idx":2,"proposition":"The physician must respect the wishes of the person who can refuse care","correct":true},{"idx":3,"proposition":"When the person is unable to express his will, no act can be carried out, even in an emergency.","correct":false,"justification":"When the person is unable to express his will, no act can be carried out, except in an emergency, without the person of trust, or the family, or failing that, one of his relatives maintaining close and stable links with the person having been consulted (law of 4 March 2002, known as the Kouchner law)"},{"idx":4,"proposition":"You can test a patient for a serious genetic disease without warning them to avoid scaring them","correct":false}],"type":"custom"}
+{"_id":"ethique-psy-5","context":null,"enonce":"Concerning medical ethics","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"Consent must be free, informed, special and revocable at any time","correct":true},{"idx":1,"proposition":"Legal protection only applies to patients whose mental faculties are impaired","correct":false},{"idx":2,"proposition":"The conditions for deciding to limit active therapies are defined by the Geneva Convention","correct":false},{"idx":3,"proposition":"The Clayes-Leonetti law obliges the doctor to stop treatment if the chances of survival are deemed low by an independent medical committee","correct":false,"justification":"It gives the right to interrupt or not to undertake treatments deemed useless, disproportionate or having no other purpose than the artificial maintenance of life and the possibility of using treatments with the intention of relieving the lady, even if they risk shortening life (principle of double eect)"},{"idx":4,"proposition":"In the event of a decision to limit treatment, the patient or his representatives will be informed and the decisions will be clearly recorded in the medical record.","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"ethique-psy-6","context":null,"enonce":"Which of the following are true?","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"The decision to limit treatment is made by the attending physician","correct":false,"justification":"The decision must be taken collectively"},{"idx":1,"proposition":"The word ethics comes etymologically from the Greek ETHOS which means way of being and behaving according to morals","correct":true},{"idx":2,"proposition":"Ethics can be thought of as the science of morality","correct":true},{"idx":3,"proposition":"We can envisage an \"applied ethics\" for each field of human activity, and therefore a \"medical ethics\"","correct":true},{"idx":4,"proposition":"Medical ethics is closely related to bioethics (biomedical ethics), but not identical to it.","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"ethique-psy-7","context":null,"enonce":"Which of the following are true?","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"The first principle of medicine is to do everything for the good of the patient without harming him.","correct":true},{"idx":1,"proposition":"Autonomy consists in saying that everything must be done so that the patient can move autonomously","correct":false,"justification":"Autonomy: The patient is the only one (provided he is in perfect lucidity) to be able to give his opinion and agreement to the treatments that are proposed and explained to him"},{"idx":2,"proposition":"The principle of justice requires us to refer to the court any criminal or penal information issued by the patient","correct":false,"justification":"Justice: all patients must be treated with the same care and respect"},{"idx":3,"proposition":"Voluntary termination of pregnancy (IVG) is an induced abortion, decided for non-medical reasons within the legal framework established by the Veil law of 1975","correct":true},{"idx":4,"proposition":"The law sets at 12 weeks of pregnancy (14 weeks of amenorrhea) the period during which a woman can request an abortion.","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"ethique-psy-8","context":null,"enonce":"Regarding abortion","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"Medical abortion (medical termination of pregnancy, IMG) is possible when the pregnancy endangers the woman's life","correct":true},{"idx":1,"proposition":"The IMG after 12 weeks of pregnancy requires the authorization of multidisciplinary diagnostic centers that have competence to decide which diseases justify it or not (notion of particular seriousness)","correct":true},{"idx":2,"proposition":"The costs of care and hospitalization related to a voluntary termination of pregnancy are covered by the patient or her family","correct":false,"justification":"Covered by social security Care and hospitalization costs related to a voluntary termination of pregnancy are 100% covered by health insurance (for all women since 2014)"},{"idx":3,"proposition":"The consent of the spouse is mandatory for an abortion to be done","correct":false,"justification":"The consent of the spouse must be as far as possible to the maximum sought, but is not mandatory"},{"idx":4,"proposition":"A minor woman may not have an abortion without the consent of her parents or legal guardian.","correct":false,"justification":"A minor woman may have an abortion without the consent of her parents or legal guardian, provided that she is accompanied by an adult.\""}],"type":"custom"}
+{"_id":"ethique-psy-9","context":null,"enonce":"Concerning abortion, contraception and PND","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"A psycho-social interview, conducted by a marriage counsellor, is offered to any woman who is considering an abortion.","correct":true},{"idx":1,"proposition":"The interview with a marriage counsellor is optional for minors who wish to have an abortion","correct":false,"justification":"It is mandatory for minors"},{"idx":2,"proposition":"There is a conscience clause whereby a doctor can refuse to participate in an abortion.","correct":true},{"idx":3,"proposition":"Contraception is not 100% reimbursed","correct":true},{"idx":4,"proposition":"Ultrasound is not an examination that is part of the prenatal diagnostic process","correct":false,"justification":"This diagnosis can be made non-invasively (ultrasound, analysis of DNA fragments of the fetal placenta contained in small quantities in the maternal blood) or invasive (amniocentesis or choriocentesis with a risk of miscarriage of about 1%) for chromosomal or molecular biology study\""}],"type":"custom"}
+{"_id":"ethique-psy-10","context":null,"enonce":"About PGD and organ donation","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"The main indication for PGD is to prevent couples with or carriers of a rare and serious genetic disease from passing it on to their child.","correct":true},{"idx":1,"proposition":"Pre-implantation diagnosis only concerns couples where both parents are carriers of a genetic problem","correct":false,"justification":"It also applies when one of the partners of a couple is a carrier of a chromosomal abnormality"},{"idx":2,"proposition":"Pre-implantation diagnosis poses in itself a problem of eugenics","correct":true},{"idx":3,"proposition":"The attestation of the irreversible nature of the brain destruction is by a clinical examination only","correct":false,"justification":"Medical ethics ¡ The attestation of the irreversible nature of the brain destruction must be by a paraclinical examination: * either two electroencephalographic (EEG) tracings without activity (isoelectric maximum amplification) for 30 minutes at 4-hour intervals"},{"idx":4,"proposition":"The removal of organs from a person whose death has been duly certified may be carried out if the latter has not made known during his lifetime his refusal of such removal (presumed consent)","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"ethique-psy-11","context":null,"enonce":"About organ donation","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"Such refusal may be expressed by any means by any person over 13 years of age, in particular by entry in an automated national register provided for that purpose.","correct":true},{"idx":1,"proposition":"Consent is irrevocable most often","correct":false,"justification":"It is revocable at any time"},{"idx":2,"proposition":"In the case of organ donation, the collection from relatives of the opposition expressed by the deceased during his lifetime must be systematic","correct":true},{"idx":3,"proposition":"The law on the modernization of the health system strengthened the principle of presumed consent as well as the role of the National Register of Refusals (main, but not exclusive, means of expressing refusal) of organ donation","correct":true},{"idx":4,"proposition":"Relatives must be informed of the purpose of the samples taken","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"ethique-psy-12","context":null,"enonce":"Concerning living donor specimens","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"The removal of an organ for the purpose of donation to others exposes the donor to risks to his health, he must be clearly and fairly informed","correct":true},{"idx":1,"proposition":"The removal of an organ from a living person, who donates it, can only be carried out in the direct therapeutic interest of a recipient","correct":true},{"idx":2,"proposition":"No organ removal for donation may take place from a living minor or from a living adult subject to a legal protection measure.","correct":true},{"idx":3,"proposition":"No payment in any form may be made to a person who takes parts from his body.","correct":true},{"idx":4,"proposition":"The Agency for Biomedicine must be informed prior to its realization, of any removal of organs for therapeutic purposes from a living person","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"ethique-psy-13","context":null,"enonce":"Concerning biomedical research","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"The CPP gives its opinion orally to the investigator on the conditions of validity of the research","correct":false,"justification":"The committee gives its opinion in writing to the investigator on the conditions of validity of the research, in particular the protection of individuals (information given, methods of obtaining consent, respect for autonomy) more particularly if they are vulnerable and on the general relevance of the project (objectives, means, experimenters)"},{"idx":1,"proposition":"The safeguards imposed and the type of consent vary depending on the level of risk to the patient","correct":true},{"idx":2,"proposition":"The Data Protection Act applies to all research projects that collect patients' personal data.","correct":true},{"idx":3,"proposition":"In the case of collection of digital patient data, research can only start after agreement of the EMA","correct":false,"justification":"The research can only start after authorization from the National Commission for Informatics and Liberties (CNIL), according to variable modalities depending on the complexity of the project and the nature of the data collected"},{"idx":4,"proposition":"Research on human beings must have a general purpose which aims to improve scientific knowledge without the interests of science and society taking precedence over the interests of individuals.","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"ethique-psy-14","context":null,"enonce":"Concerning biomedical research","item":"ethique","matiere":"psy","propositions":[{"idx":0,"proposition":"Biomedical research is a necessity","correct":true},{"idx":1,"proposition":"The thirst for knowledge or to develop knowledge must not be exercised without limits or precautions.","correct":true},{"idx":2,"proposition":"The rules of scientific validation of an experiment can be exceeded in case of emergency (research on covid19 for example)","correct":false,"justification":"The rules of scientific validation of an experiment must be strictly respected as well as the independence and safety of patients included in the studies"},{"idx":3,"proposition":"No biomedical research may be carried out on human beings if the foreseeable risk to the persons taking part in the research is disproportionate to the expected benefit to those persons or the interest of such research.","correct":true},{"idx":4,"proposition":"Respect for human dignity and human autonomy are core values","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"anemie-hemato-0","context":null,"enonce":"Regarding anemias","item":"anemie","matiere":"hemato","propositions":[{"idx":0,"proposition":"Normal hemoglobin varies with sex (in adults) and age","correct":true},{"idx":1,"proposition":"Clinical anemic syndrome may be latent and only discovered on blood count","correct":true},{"idx":2,"proposition":"Anemia is not a diagnosis but a symptom requiring etiological research","correct":true},{"idx":3,"proposition":"Central anemias show too much elimination of red blood cells produced","correct":false,"justification":"Central anemias testify to an attack on production either by damage to the hematopoitic cell or by damage to its environment"},{"idx":4,"proposition":"All central anemias have one biological sign in common: a reticulocyte count greater than 150 G\/L","correct":false,"justification":"They are aregenerative"}],"type":"custom"}
+{"_id":"anemie-hemato-1","context":null,"enonce":"Regarding peripheral anemia, which proposals are true?","item":"anemie","matiere":"hemato","propositions":[{"idx":0,"proposition":"In cases of peripheral anemia, bone marrow production is normal or even increased","correct":true},{"idx":1,"proposition":"These peripheral anemias have in common a biological sign: the high number of reticulocytes, greater than 150 G \/ L","correct":true},{"idx":2,"proposition":"They are called regenerative","correct":true},{"idx":3,"proposition":"Hemolysis induces a decrease in free bilirubin","correct":false,"justification":"Hemolysis induces an increase in free bilirubin reflecting the catabolism of hemoglobin and a low or even collapsed haptoglobin"},{"idx":4,"proposition":"High LDH and serum iron are indirect signs of hemolysis","correct":true}],"type":"custom"}
+{"_id":"anemie-hemato-2","context":null,"enonce":"Regarding sickle cell disease and thalassemia syndromes:","item":"anemie","matiere":"hemato","propositions":[{"idx":0,"proposition":"Sickle cell disease mainly affects people from South America","correct":false,"justification":"Sickle cell disease mainly affects people from black Africa and is linked to mutation of the beta chain of globin"},{"idx":1,"proposition":"Only sickle cell homozygotes are symptomatic and present with hemolysis from childhood associated with thrombotic manifestations in the form of joint or abdominal pain","correct":true},{"idx":2,"proposition":"Thalassaemic syndromes are characterized by an increase in the production of normal alpha globin chains","correct":false,"justification":"A decrease in normal chains"},{"idx":3,"proposition":"thalassemia syndromes mainly affect subjects around the Mediterranean basin and South-East Asia","correct":true},{"idx":4,"proposition":"The diagnosis of thalassaemic syndrome is based on bone marrow aspiration","correct":false,"justification":"Diagnosis of thalassemia syndrome is based on hemoglobin electrophoresis"}],"type":"custom"}
+{"_id":"anemie-hemato-4","context":null,"enonce":"Regarding biermer's anemia","item":"anemie","matiere":"hemato","propositions":[{"idx":0,"proposition":"Biermer's anemia occurs in women most often, it is due to a lack of secretion of intrinsic factor","correct":true},{"idx":1,"proposition":"Biermer's anemia is a common cause of vitamin deficiency","correct":true},{"idx":2,"proposition":"Concurrent diabetes eliminates diagnosis of Biermer's anemia","correct":false,"justification":"It is frequently associated with diseases such as vitiligo, autoimmune thyroiditis, diabetes"},{"idx":3,"proposition":"The picture is very clinically polymorphic, but medullary megaloblastosis is constant","correct":true},{"idx":4,"proposition":"The prognosis is sap even under lifelong vitamin therapy","correct":false,"justification":"Prognosis is benign under lifelong vitamin therapy"}],"type":"custom"}
+{"_id":"anemie-hemato-5","context":null,"enonce":"Regarding biermer's anemia","item":"anemie","matiere":"hemato","propositions":[{"idx":0,"proposition":"Without proper treatment, neurological complications are irreversible","correct":true},{"idx":1,"proposition":"Biermer's anemia is accompanied by atrophic glossitis and sensory disturbances in the absorption of hot or spicy dishes","correct":true},{"idx":2,"proposition":"There are no mucosal or skin disorders","correct":false,"justification":"Skin disorders can be observed: dry, flaky skin, brittle nails, hair loss"},{"idx":3,"proposition":"In its advanced form, the neurological picture is that of combined sclerosis of the spinal cord with quadriparesis associated with incontinence","correct":true},{"idx":4,"proposition":"Anemia is microcytic","correct":false,"justification":"It is macrocytic with MCV, usually greater than 110 fl"}],"type":"custom"}
+{"_id":"SCA-urg-0","context":null,"enonce":"Regarding myocardial markers:","item":"SCA","matiere":"urg","propositions":[{"idx":0,"proposition":"Troponin elevation is non-specific to heart tissue ","correct":false,"justification":"Troponin is a cardiac enzyme released in myocardial necrosis, it is specific to heart tissue and is therefore not elevated by other muscle damage."},{"idx":1,"proposition":"During a myocardial infarction, troponin rises about 3 hours after the onset of chest pain.","correct":true},{"idx":2,"proposition":"Myoglobin is a myocardial marker whose elevation persists up to 15 days","correct":false,"justification":"Myoglobin is an early marker that rises in about 2 hours, peaks between 8 and 12 hours and normalizes between 24 and 36 hours."},{"idx":3,"proposition":"LDL is one of the myocardial markers that rises during an ACS","correct":false,"justification":"It is the LDH (LDH1 +++) that will have an elevation (peak in 3-4 days) and normalization in 6 days"},{"idx":4,"proposition":"Myocardial markers are essential for the diagnosis of SCA ST+","correct":false,"justification":"The diagnosis is established by the clinic (prolonged chest pain > 30 minutes) coupled with the ECG"}],"type":"custom"}
+{"_id":"SCA-urg-1","context":null,"enonce":"Regarding myocardial infarction:","item":"SCA","matiere":"urg","propositions":[{"idx":0,"proposition":"ST myocardial infarction is a reflection of transmural myocardial involvement","correct":false,"justification":"NSTEMI = subendocardial infarction"},{"idx":1,"proposition":"STEMI occurs during total occlusion of a coronary artery  ","correct":true,"justification":"STEMI = SCA ST+ = total occlusion by rupture of atheromatous plaque most often"},{"idx":2,"proposition":"On ECG, a Q wave of necrosis directs us to transmural myocardial involvement ","correct":true},{"idx":3,"proposition":"The critical oral ECG should be obtained less than 10 minutes after the first medical contact when the patient presents to an emergency department","correct":true},{"idx":4,"proposition":"The presence of a ST segment shift is pathognomonic of a STEMI","correct":false,"justification":"An ST segment elevation can be found in various pathologies: SCA ST +, pericarditis, Brugada syndrome, aortic dissection, Prinzmetal's angina, left ventricle aneurysm, early repolarization, BBG"}],"type":"custom"}
+{"_id":"hernie-HGE-0","context":null,"enonce":"Concerning parietal herenia","item":"hernie","matiere":"HGE","propositions":[{"idx":0,"proposition":"A parietal hernia occurs when a peritoneal sac crosses the transverse fascia.","correct":true},{"idx":1,"proposition":"Congenital hernias account for more than 55% of hernias in children","correct":false,"justification":"Congenital hernias account for more than 95% of hernias in children"},{"idx":2,"proposition":"There is a swelling of the inguinal region appearing at prolonged standing during an inguinal henrni","correct":true},{"idx":3,"proposition":"The examination should be carried out lying down, without then with pushing efforts, then standing","correct":true},{"idx":4,"proposition":"The review is unilateral","correct":false,"justification":"It must be bilateral"}],"type":"custom"}
+{"_id":"hernie-HGE-1","context":null,"enonce":"Concerning parietal herenia","item":"hernie","matiere":"HGE","propositions":[{"idx":0,"proposition":"The diagnosis of uncomplicated groin hernia is clinical by palpation of painless, impulsive and expansive cough swelling","correct":true},{"idx":1,"proposition":"Among the risk factors for hernia have found chronic obstructive pulmonary disease, chronic cough, constipation, dysuria","correct":true},{"idx":2,"proposition":"In case of direct hernia, the hernia is reduced by a direct antero-posterior path, and the beats of the epigastric vessels are perceived outside","correct":true},{"idx":3,"proposition":"Coral hernia accounts for 30% of groin hernias","correct":false,"justification":"Coral hernia • 10% of groin hernias"},{"idx":4,"proposition":"Coral herenia almost always occurs in humans","correct":false,"justification":"Almost always in women"}],"type":"custom"}
+{"_id":"hernie-HGE-2","context":null,"enonce":"Regarding parietal hernia","item":"hernie","matiere":"HGE","propositions":[{"idx":0,"proposition":"Lipoma and inguinal lymphadenopathy are other causes of inguinal swelling but unlike unstrangulated hernias are irreducible","correct":true},{"idx":1,"proposition":"Eventration is a parietal complication following a wound, most often of surgical origin","correct":true},{"idx":2,"proposition":"Transillumination and non-reducible character allow differential diagnosis between hydrocele and internal oblique hernia","correct":false,"justification":"Transillumination and non-reducible character allow the differential diagnosis between hydrocele and external inguinal hernia"},{"idx":3,"proposition":"All hernias can be complicated by strangulation","correct":true},{"idx":4,"proposition":"Strangulation is more common in coral hernia than in inguinal hernia","correct":true}],"type":"custom"}
+{"_id":"hernie-HGE-3","context":null,"enonce":"Concerning parietal herenia","item":"hernie","matiere":"HGE","propositions":[{"idx":0,"proposition":"It is a common pathology with about 150,000 cases per year in France","correct":true},{"idx":1,"proposition":"The treatment of hernias is surgical and most often performed on an outpatient basis","correct":true},{"idx":2,"proposition":"Due to the risk of high strangulation, crural hernias must all be operated on.","correct":true},{"idx":3,"proposition":"Incinquinal herenia in a child less than 6 years younger is a formal indcation to surgery","correct":false,"justification":"e in a child over 6 months of age."},{"idx":4,"proposition":"In case of asymptomatic inguinal hernia the risk of strangulation is extremely low","correct":true}],"type":"custom"}
+{"_id":"hernie-HGE-4","context":null,"enonce":"Which of the following is needed to confirm the diagnosis of a hernia of the groin?","item":"hernie","matiere":"HGE","propositions":[{"idx":0,"proposition":"An abdominopelvic ultrasound","correct":false,"justification":"Clinical diagnosis"},{"idx":1,"proposition":"An abdominopelvic CT scan with injection of contrast medium (after checking for contraindications, including renal)","correct":false,"justification":"Clinical diagnosis"},{"idx":2,"proposition":"A pelvic MRI","correct":false,"justification":"Clinical diagnosis"},{"idx":3,"proposition":"An unprepared abdomen (ASP)","correct":false,"justification":"Clinical diagnosis"},{"idx":4,"proposition":"None of these proposals","correct":true,"justification":"True, the diagnosis is purely clinical"}],"type":"custom"}
+{"_id":"hernie-HGE-5","context":null,"enonce":"Which of the following are true?","item":"hernie","matiere":"HGE","propositions":[{"idx":0,"proposition":"Irritation on the path of the spermatic cord is classic of an inguinal hernia","correct":true,"justification":"True. In addition, coral hernia is very rare (90% of hernias are inguinal) and affects 10 women for 1 man"},{"idx":1,"proposition":"Coral hernia is more common in men than in women","correct":false,"justification":"10 times more in women"},{"idx":2,"proposition":"It is an impulsive cough injury when not strangled.","correct":true},{"idx":3,"proposition":"A reducible lesion has no indication for surgery","correct":false,"justification":"Coral hernia = surgery in all cases. Painful inguinal hernia\/child over 6 months = surgery."},{"idx":4,"proposition":"Hernias are always congenital","correct":false,"justification":"They can be acquired (coral hernia in elderly women)"}],"type":"custom"}
+{"_id":"PNO-urg-0","context":null,"enonce":"Concerning pneumothorax or PNO","item":"PNO","matiere":"urg","propositions":[{"idx":0,"proposition":"Pneumothorax (PNO) is defined by the presence of air in the pleural space","correct":true},{"idx":1,"proposition":"• PNO can be spontaneous or traumatic","correct":true},{"idx":2,"proposition":"Spontaneous PNO in young people affects women more frequently than hommzq","correct":false},{"idx":3,"proposition":"Slender morphotype and smoking are risk factors for spontaneous PNO","correct":true},{"idx":4,"proposition":"The entry of air into the pleural space via the visceral pleura results either from the rupture of peripheral alveoli, blebs, or emphysema bubbles","correct":true}],"type":"custom"}
+{"_id":"PNO-urg-1","context":null,"enonce":"Which propositions are true","item":"PNO","matiere":"urg","propositions":[{"idx":0,"proposition":"Traumatic PNOs are iatrogenic or caused by penetrating or non-penetrating chest trauma","correct":true},{"idx":1,"proposition":"Chest pain: pleural type, constant, sometimes violent in \"stabbing\", to type of side stitch, inhibiting breathing, radiating to the shoulder, unilateral supsected a pneumothorax","correct":true},{"idx":2,"proposition":"Pain most often occurs at rest","correct":false,"justification":"It most often occurs at rest"},{"idx":3,"proposition":"– Dyspnea is often associated, of varying intensity depending on the terrainA dry cough of pleural origin is common","correct":true},{"idx":4,"proposition":"– On physical examination: tympanism, abolition of vocal vibrations, decrease or disappearance of vesicular murmur on the side of the PNO","correct":true}],"type":"custom"}
+{"_id":"PNO-urg-2","context":null,"enonce":"About pneumothorax","item":"PNO","matiere":"urg","propositions":[{"idx":0,"proposition":"• X-ray Chest X-ray (RT) is the key examination","correct":true},{"idx":1,"proposition":"RT makes it possible to visualize a bordering line or pleural line delimiting the pulmonary parenchyma, sometimes reduced to a stump","correct":true},{"idx":2,"proposition":"• RT makes it possible to highlight signs of compression: contralateral displacement of the mediastinum","correct":true},{"idx":3,"proposition":"A complete detachment corresponds to the complete detachment corresponds to the detachment of the lung over its entire hatuer","correct":true},{"idx":4,"proposition":"• The RT in forced expiration (which aims to aggravate the PNO) is to be requested only in a second step, when the PNO is not visible on the radiograph in standard inspiration","correct":true}],"type":"custom"}
+{"_id":"PNO-urg-3","context":null,"enonce":"About pneumothorax","item":"PNO","matiere":"urg","propositions":[{"idx":0,"proposition":"Chest drainage is necessary in the first instance in case of underlying pulmonary pathology","correct":true},{"idx":1,"proposition":"The risk of homolateral recurrence is 15%","correct":false,"justification":"It is 30%"},{"idx":2,"proposition":"It is necessary to inform the patient about the need to consult urgently in case of a new painful episode","correct":true},{"idx":3,"proposition":"It is necessary to prevent the effors glottis closed","correct":true},{"idx":4,"proposition":"During a first episode of spontaneous PNO pleural symphysis is indicated if bubbling persists beyond 14 days","correct":false,"justification":"4 days"}],"type":"custom"}
+{"_id":"agitation-urg-0","context":null,"enonce":"Which of the following are possible etiologies of agitation or delirium?","item":"agitation","matiere":"urg","propositions":[{"idx":0,"proposition":"Hypoglycaemia","correct":true},{"idx":1,"proposition":"Hypoparathyroidism","correct":false,"justification":"Hyperparathyroidism can cause agitation. Hypothyroidism, on the contrary, can cause symptoms mimicking sadness."},{"idx":2,"proposition":"Subdural hematoma","correct":true,"justification":"True, as well as stroke or meningitis 🧠"},{"idx":3,"proposition":"Sepsis","correct":true},{"idx":4,"proposition":"Hypocorticism","correct":false,"justification":"Rather hypercorticism"}],"type":"custom"}
+{"_id":"agitation-urg-1","context":null,"enonce":"From what time frame is a delirium no longer considered acute?","item":"agitation","matiere":"urg","propositions":[{"idx":0,"proposition":"5 days","correct":false,"justification":"1 month"},{"idx":1,"proposition":"1 week","correct":false,"justification":"1 month"},{"idx":2,"proposition":"1 month","correct":true},{"idx":3,"proposition":"6 weeks","correct":false,"justification":"1 month"},{"idx":4,"proposition":"Three months","correct":false,"justification":"1 month"}],"type":"custom"}
+{"_id":"agitation-urg-2","context":null,"enonce":"Which of the following are true?","item":"agitation","matiere":"urg","propositions":[{"idx":0,"proposition":"Agitation accounts for 10-15% of emergency room visits","correct":true,"justification":"True. often via the entourage 👨 👩 👧 or the police. 🚔"},{"idx":1,"proposition":"Agitation is defined by excessive, often unproductive and stereotyped motor activity related to internal tension.","correct":true},{"idx":2,"proposition":"The biological 🩸 assessment is systematic","correct":true,"justification":"True. NFS-P, BES, Calcemia, Blood glucose, CRP."},{"idx":3,"proposition":"This is an emergency 🚨, which must be hospitalized 🏥 ","correct":true,"justification":"True, under duress if necessary"},{"idx":4,"proposition":"All propositions are true","correct":true}],"type":"custom"}
+{"_id":"IBP-infectio-0","context":null,"enonce":"Regarding acute bronchitis","item":"IBP","matiere":"infectio","propositions":[{"idx":0,"proposition":"Acute bronchitis is the most common lower airway infection: several million\/year in France","correct":true},{"idx":1,"proposition":"It is a viral infection in almost all cases","correct":true},{"idx":2,"proposition":"An upper airway infection may precede the symptomatology (rhinitis, pharyngitis)","correct":true},{"idx":3,"proposition":"The secondarily purulent character of sputum is a sign of bacterial superinfection","correct":false},{"idx":4,"proposition":"The chest X-ray should be performed systematically","correct":false,"justification":"No additional examination is justified to make the positive or etiological diagnosis 4"}],"type":"custom"}
+{"_id":"IBP-infectio-1","context":null,"enonce":"Regarding respiratory infections","item":"IBP","matiere":"infectio","propositions":[{"idx":0,"proposition":"The course is favorable spontaneously and no antibiotic therapy is indicated in acute bronchitis","correct":true},{"idx":1,"proposition":"The lack of improvement should reconsider the diagnosis of simple acute bronchitis","correct":true},{"idx":2,"proposition":"Tobacco is the most common cause of COPD","correct":true},{"idx":3,"proposition":"The clinic and the parameters of pulmonary function tests allow to classify COPD into 6 stages","correct":false,"justification":"The clinic and the parameters of the pulmonary function tests allow to classify COPD into 4 stages (classification of the Global Initiative for Chronic Obstructive Lung Disease (GOLD)"},{"idx":4,"proposition":"The exacerbation of COPD corresponds to the increase in dyspnea, cough, sputum volume and \/ or purulence","correct":true}],"type":"custom"}
+{"_id":"IBP-infectio-2","context":null,"enonce":"Regarding COPD exacerbation","item":"IBP","matiere":"infectio","propositions":[{"idx":0,"proposition":"Frankish greenish purulence of sputum is in favor of a bacterial origin","correct":true},{"idx":1,"proposition":"Exacerbations are infectious in 50% of cases","correct":true},{"idx":2,"proposition":"The risk of this exacerbation is severe acute respiratory failure","correct":true},{"idx":3,"proposition":"Cough suppressants moderate exacerbation of COPD","correct":false,"justification":"Contraindication of cough suppressants"},{"idx":4,"proposition":"Reassessment of antibiotic therapy if initiated is essential at 48-72 h","correct":true}],"type":"custom"}
+{"_id":"IBP-infectio-3","context":null,"enonce":"Concerning community-acquired acute pneumonia (CAP)","item":"IBP","matiere":"infectio","propositions":[{"idx":0,"proposition":"Community = acquired in an out-of-hospital setting (\"city\") or occurring less than 48 hours after admission","correct":true},{"idx":1,"proposition":"Auscultation finds a condensation syndrome (crackling, tubal murmur)","correct":true},{"idx":2,"proposition":"Main risk factors: smoking, age > 65 years, comorbidities","correct":true},{"idx":3,"proposition":"The terrain is the essential element of the prognosis","correct":true},{"idx":4,"proposition":"Case fatality averages 15%","correct":false,"justification":"Lethality: average 5%"}],"type":"custom"}
+{"_id":"IBP-pneumo-0","context":null,"enonce":"Regarding acute bronchitis","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Community-acquired lower respiratory infections (BRIs) in adults include three entities: acute bronchitis, acute exacerbation of chronic obstructive pulmonary disease (COPD), and acute community-acquired pneumonia (CABG).","correct":true},{"idx":1,"proposition":"Viral cause in 90% of cases","correct":true},{"idx":2,"proposition":"The diagnosis is clinical","correct":true},{"idx":3,"proposition":"No further examination is warranted","correct":true},{"idx":4,"proposition":"The absence of antibiotic therapy is the rule in healthy adults","correct":true}],"type":"custom"}
+{"_id":"IBP-pneumo-1","context":null,"enonce":"Regarding respiratory infections","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The evolution is spontaneously favorable with disappearance of fever in 3 days and respiratory signs in about ten days in acute bronchitis","correct":true},{"idx":1,"proposition":"1 An infection is community-acquired if it is acquired outside a hospital facility or occurs within the first 48 hours of admission to hospital.","correct":true},{"idx":2,"proposition":"Chest ultrasound may help diagnose pleural effusion associated with acute community-acquired pneumonia","correct":true},{"idx":3,"proposition":"The search for soluble urinary antigens (legionella & pneumococcus) is not decapitated by prior antibiotic therapy","correct":true},{"idx":4,"proposition":"Microbiological investigations should not delay antibiotic therapy in cases of acute community-acquired pneumonia","correct":true}],"type":"custom"}
+{"_id":"IBP-pneumo-2","context":null,"enonce":"Concerning acute community-acquired pneumonia","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The CRB 60 score is a useful score for the diagnosis of acute community-acquired pneumonia","correct":false},{"idx":1,"proposition":"Streptococcus pneumoniae is the most frequently isolated pathogen in CABG patients","correct":true},{"idx":2,"proposition":"Streptococcus pneumoniae and Legionnella pneumoniae are the 2 agents most frequently responsible for serious PAC in intensive care","correct":true},{"idx":3,"proposition":"Legionella antigenuria is an examination of good sensitivity and specificity","correct":true},{"idx":4,"proposition":"These infections are sometimes complicated by a pleural effusion that will have to be punctured to specify whether it is an aseptic parapneumonic effusion (reactive) or purulent pleurisy","correct":true}],"type":"custom"}
+{"_id":"tbauditif-ORL-0","context":null,"enonce":"Which propositions are true?","item":"tbauditif","matiere":"ORL","propositions":[{"idx":0,"proposition":"Genetic causes are very common","correct":true},{"idx":1,"proposition":"The best way to limit the impact on the communication of deafness is to make early diagnosis","correct":true},{"idx":2,"proposition":"Deafness screening is done if there is a family history only","correct":false,"justification":"It is systematic"},{"idx":3,"proposition":"Infant hearing loss is diagnosed in a few minutes","correct":false,"justification":"Long process with objective tests (PEA)"},{"idx":4,"proposition":"Chronic ear infections can cause deafness in children or adolescents","correct":true}],"type":"custom"}
+{"_id":"tbauditif-ORL-1","context":null,"enonce":"Which propositions are true?","item":"tbauditif","matiere":"ORL","propositions":[{"idx":0,"proposition":"The outer ear consists of the pinna and the external auditory canal","correct":true},{"idx":1,"proposition":"In the absence of the tympanossicular system, about 5 decibels are lost.","correct":false,"justification":"50 to 55 dB loss"},{"idx":2,"proposition":"Pathology of the outer ear can give conductive hearing loss","correct":true},{"idx":3,"proposition":"A pathology of the middle ear will give conductive hearing loss","correct":true},{"idx":4,"proposition":"Hearing loss is mild or moderate hearing loss","correct":true}],"type":"custom"}
+{"_id":"tbauditif-ORL-2","context":null,"enonce":"Which of the following are for mild hearing loss?","item":"tbauditif","matiere":"ORL","propositions":[{"idx":0,"proposition":"-15 dB","correct":false,"justification":"Between 0 and -20 dB: normal or subnormal hearing"},{"idx":1,"proposition":"-25 dB","correct":true},{"idx":2,"proposition":"-35 dB","correct":true,"justification":"True, between -20 and -40 dB: slight loss"},{"idx":3,"proposition":"-55 dB","correct":false,"justification":"Between -40 and -70 dB: average loss"},{"idx":4,"proposition":"-75 dB","correct":false,"justification":"Between -70 and -90 dB: severe loss"}],"type":"custom"}
+{"_id":"tbauditif-ORL-3","context":null,"enonce":"At what threshold of auditory stimulation can we speak of 'supraliminal stimulation'?","item":"tbauditif","matiere":"ORL","propositions":[{"idx":0,"proposition":"20 dB","correct":false,"justification":"False"},{"idx":1,"proposition":"40 dB","correct":false,"justification":"False"},{"idx":2,"proposition":"60 dB","correct":false,"justification":"False"},{"idx":3,"proposition":"80 dB","correct":true,"justification":"True. It makes it possible to collect the stapedial reflex"},{"idx":4,"proposition":"100 dB","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"tbauditif-ORL-4","context":null,"enonce":"Which of the following corresponds to average hearing loss?","item":"tbauditif","matiere":"ORL","propositions":[{"idx":0,"proposition":"-15 dB","correct":false,"justification":"Between 0 and -20 dB: normal or subnormal hearing"},{"idx":1,"proposition":"-25 dB","correct":false,"justification":"Between -20 and -40 dB: slight loss"},{"idx":2,"proposition":"-35 dB","correct":false,"justification":"Between -20 and -40 dB: slight loss"},{"idx":3,"proposition":"-55 dB","correct":true,"justification":"True. Between -40 and -70 dB: average loss"},{"idx":4,"proposition":"-75 dB","correct":false,"justification":"Between -70 and -90 dB: severe loss"}],"type":"custom"}
+{"_id":"tbauditif-ORL-5","context":null,"enonce":"Which of the following is severe hearing loss?","item":"tbauditif","matiere":"ORL","propositions":[{"idx":0,"proposition":"-95 dB","correct":false,"justification":"If loss greater than 90 dB: deep loss"},{"idx":1,"proposition":"-25 dB","correct":false,"justification":"Between -20 and -40 dB: slight loss"},{"idx":2,"proposition":"-35 dB","correct":false,"justification":"Between -20 and -40 dB: slight loss"},{"idx":3,"proposition":"-55 dB","correct":false,"justification":"Between -40 and -70 dB: average loss"},{"idx":4,"proposition":"-75 dB","correct":true,"justification":"True. Between -70 and -90 dB: severe loss"}],"type":"custom"}
+{"_id":"risquesfoetaux-infectio-0","context":null,"enonce":"Regarding the epidemiology of MFIs:","item":"risquesfoetaux","matiere":"infectio","propositions":[{"idx":0,"proposition":"In France, the incidence of Streptococcus B infection is 0.23 per 1000 pregnancies","correct":true},{"idx":1,"proposition":"In France, the prevalence of toxoplasome, per 10000 birthsm, is 3","correct":true},{"idx":2,"proposition":"Less than 20% of CMV infections are symptomatic","correct":true},{"idx":3,"proposition":"Congenital toxoplasmosis is linked to primary infection during the first days of life","correct":false,"justification":"TOXOPLASMOSIS Congenital toxoplasmosis ƒƒ Linked to primary maternal infection during pregnancy"},{"idx":4,"proposition":"In France, the seroprevalence of toxoplasmosis in pregnant women is 1%","correct":false}],"type":"custom"}
+{"_id":"risquesfoetaux-infectio-1","context":null,"enonce":"Regarding toxoplasmosis:","item":"risquesfoetaux","matiere":"infectio","propositions":[{"idx":0,"proposition":"The risk of transmission increases with the term while the severity decreases with the term","correct":true},{"idx":1,"proposition":"The serology of toxoplasmosis is systematic in the 1st trimester","correct":true},{"idx":2,"proposition":"There is no hygiene rule, apart from the eviction of cats, which exists to prevent the risk of toxoplasmosis","correct":false},{"idx":3,"proposition":"In immune women, serology should be re-monitored in the third trimester","correct":false,"justification":"Immune woman: no supervision or precautions"},{"idx":4,"proposition":"In case of confirmed primary infection, treatment is done with metronidazole and follow-up by the general practitioner","correct":false}],"type":"custom"}
+{"_id":"risquesfoetaux-infectio-2","context":null,"enonce":"Regarding malaria in pregnancy:","item":"risquesfoetaux","matiere":"infectio","propositions":[{"idx":0,"proposition":"Malaria during pregnancy can lead to abortion","correct":true},{"idx":1,"proposition":"In pregnant women, uncomplicated P. Falciparum malaria indicates hospitalization","correct":true},{"idx":2,"proposition":"In the first trimester, uncomplicated access to P. Falciparum can be treated with quinine","correct":true},{"idx":3,"proposition":"From the second trimester, in case of uncomplicated malaria attacks of Falciparum, atovaquone-proguanil should be preferred","correct":false,"justification":"From the second trimester, artemether-lumefantrine should be preferred"},{"idx":4,"proposition":"Pregnant women should be advised to avoid travel to malaria-endemic areas","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"risquesfoetaux-infectio-3","context":null,"enonce":"Regarding rubella infection during pregnancy:","item":"risquesfoetaux","matiere":"infectio","propositions":[{"idx":0,"proposition":"Primary rubella infection in the first trimester is teratogenic","correct":true},{"idx":1,"proposition":"Vaccination is recommended for infants","correct":false,"justification":"General population: mandatory immunization for infants of both sexes (MMR)"},{"idx":2,"proposition":"If serology is negative, vaccination is indicated in newly pregnant women","correct":false},{"idx":3,"proposition":"Performing rubella serology is mandatory in the 1st trimester of pregnancy","correct":false},{"idx":4,"proposition":"In non-immune women, serological control at 20 SA is indicated","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"risquesfoetaux-infectio-4","context":null,"enonce":"Regarding maternal-fetal infections (MFIs):","item":"risquesfoetaux","matiere":"infectio","propositions":[{"idx":0,"proposition":"Some infections in pregnant women can be transmitted to the fetus and are called maternal-fetal infections.","correct":true},{"idx":1,"proposition":"Most of the time, it is impossible to prevent maternal-fetal infections","correct":false,"justification":"These infections and their impact on the fetus and newborn can be prevented through prevention, monitoring and treatment."},{"idx":2,"proposition":"Prevention involves routine screening of pregnant women for toxoplasmosis, rubella, syphilis and HIV","correct":true},{"idx":3,"proposition":"Prevention involves routine screening of pregnant women for toxoplasmosis, rubella, syphilis and HIV","correct":true},{"idx":4,"proposition":"Maternal-fetal infections (MFIs) result from vertical transmission from mother to fetus","correct":true}],"type":"custom"}
+{"_id":"risquesfoetaux-infectio-5","context":null,"enonce":"Regarding maternal-fetal infections (MFIs):","item":"risquesfoetaux","matiere":"infectio","propositions":[{"idx":0,"proposition":"The impact on the fetus depends only on the type of infection","correct":false,"justification":"These infections have a more or less important impact on the fetus or newborn depending on the gestational age at which the infection occurs."},{"idx":1,"proposition":"Infections that cause miscarriage attack embryonic tissue","correct":false,"justification":"In a non-specific way, any infection leading to fever may be responsible for a spontaneous miscarriage, especially in early pregnancy, even if it did not directly affect the embryonic tissue."},{"idx":2,"proposition":"MFIs are viral in nature only","correct":false,"justification":"MFIs are protozoan (toxoplasmosis, malaria), viral (rubella, cytomegalovirus (CMV), herpes simplex virus (HSV), chickenpox, HIV, HBV, parvovirus B19, Zika), or bacterial (listeriosis, streptococcus B, syphilis, Q fever)"},{"idx":3,"proposition":"MFIs contaminate offspring only by hematogenous route","correct":false,"justification":"The mechanism of contamination is then by ascending route (HSV, streptococcus B) or by hematogenous route (rubella, CMV, chickenpox, HIV, parvovirus B19, listeriosis, syphilis, Q fever, toxoplasmosis) before birth"},{"idx":4,"proposition":"Contamination during childbirth concerns in particular bacteria of the vaginal commensal flora","correct":true,"justification":"Keep in mind that contamination during childbirth also concerns hematogenous bacteria such as hepatitis B, HSV, streptococcus B, HIV"}],"type":"custom"}
+{"_id":"risquesfoetaux-infectio-6","context":null,"enonce":"Which of these proposals are possible consequences of MFIs?","item":"risquesfoetaux","matiere":"infectio","propositions":[{"idx":0,"proposition":"Spontaneous healing","correct":true},{"idx":1,"proposition":"The death of the fetus","correct":true},{"idx":2,"proposition":"Embryopathy","correct":true},{"idx":3,"proposition":"Neonatal death","correct":true},{"idx":4,"proposition":"Microcephaly","correct":true,"justification":"All these proposals are fair"}],"type":"custom"}
+{"_id":"tetanos-infectio-0","context":null,"enonce":"About tetanus","item":"tetanos","matiere":"infectio","propositions":[{"idx":0,"proposition":"ƒƒ Severe toxi-infection with a lethality of 30%","correct":true},{"idx":1,"proposition":"ƒƒ Prevention is based on vaccination and administration of human-specific immunoglobulins","correct":true},{"idx":2,"proposition":"ƒƒ Indications for vaccine and immunoglobulins depend on tetanus vaccination status is routine","correct":false},{"idx":3,"proposition":"1 Basics to understand ƒƒ Tetanus is a serious acute toxi-infection due to CloThe tetanus germ is clostridium tetani, strict aerobic bacillus Gram positive, telluric","correct":true,"justification":"Strict anaerobic"},{"idx":4,"proposition":"ƒƒ The neurotoxin induces muscle spasms, predominant in the jaw initially (trismus not painful, without fever), then generalized","correct":true}],"type":"custom"}
+{"_id":"tetanos-infectio-1","context":null,"enonce":"About tetanus","item":"tetanos","matiere":"infectio","propositions":[{"idx":0,"proposition":"The association of a non-febrile trismus after a soiled wound (rusty nail, etc ...) should make the disease considered and prescribe vaccination and serotherapy (immunoglobulins specific for tetanus toxin) immediately without waiting for biological confirmation","correct":true},{"idx":1,"proposition":"ƒƒ Non-immunizing disease (–> need to vaccinate patients at the end) and non-contagious disease (no additional precautions)","correct":true},{"idx":2,"proposition":"ƒƒ Contamination by tetanus spores following mucocutaneous intrusion in an unvaccinated or poorly vaccinated subject","correct":true},{"idx":3,"proposition":"Only generalized tetanus is reportable","correct":true},{"idx":4,"proposition":"Trismus corresponds to a generalized tetanus excluding a pure cephalic form on local wound (localized tetanus = single limb or pure cephalic tenanos)","correct":true}],"type":"custom"}
+{"_id":"tetanos-infectio-2","context":null,"enonce":"About tetanus","item":"tetanos","matiere":"infectio","propositions":[{"idx":0,"proposition":"In a person up to date with his vaccinations with a wound of major gravity it is necessary to administer, in a low dose of vaccine and in the other arm immunoglobulin","correct":false,"justification":"It is the in the person not up to date in his vaccinations with a major wound"},{"idx":1,"proposition":"In a person who is not up to date with a minor wound a dose of vaccine should be administered immediately","correct":true},{"idx":2,"proposition":"Wound treatment consite in trimming, disinfection and dressing","correct":false,"justification":"Never sutuer or put a thought on the wound"},{"idx":3,"proposition":"Tetanos has become rare in Europe","correct":true},{"idx":4,"proposition":"Neonatal tetanus causes 150,000 deaths per year in non-developed countries","correct":true}],"type":"custom"}
+{"_id":"FA-cardio-0","context":null,"enonce":"Concerning the","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"AF is an irregular tachycardia of supraventricular origin, anarchic at the level of the atria with preservation of their hemodynamic efficiency","correct":false,"justification":"Atrial fibrillation (according to international nomenclature) or \"auricular\" or AF is an irregular tachycardia (arrhythmia), of supraventricular origin, due to rapid electrical activity (400–600\/min) anarchic of the atria with loss of their hemodynamic efficiency"},{"idx":1,"proposition":"In principle, AF is when the duration of the episode is greater than 30 seconds","correct":true},{"idx":2,"proposition":"It is the most common rhythm disorder ","correct":true},{"idx":3,"proposition":"AF is responsible for one-sixth of all strokes by cerebral embolism","correct":true},{"idx":4,"proposition":"AF may follow or be associated with typical or atypical atrial flutter.","correct":true}],"type":"custom"}
+{"_id":"FA-cardio-1","context":null,"enonce":"About AM","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Heart rate in AF depends on the effectiveness of filtering the beam of His","correct":false,"justification":"The bundle of His does not filter. It is the AV node that has this role"},{"idx":1,"proposition":"Cardioversion or AF reduction are the medical actions that restore sinus rhythm.","correct":true},{"idx":2,"proposition":"AF is said to be isolated when it is without underlying heart disease","correct":true},{"idx":3,"proposition":"AF is often revealed by a complication (stroke, heart failure flare-up)","correct":true},{"idx":4,"proposition":"It is often necessary to use ECG monitoring to make the diagnosis","correct":true}],"type":"custom"}
+{"_id":"FA-cardio-2","context":null,"enonce":"About AM","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Cardiac auscultation regains regular heart sounds and a more or less rapid rhythm","correct":false,"justification":"Heart sounds are irregular"},{"idx":1,"proposition":"Initial management should assess AF tolerance","correct":true},{"idx":2,"proposition":"The diagnosis of AF can only be confirmed on an ECG trace documenting it (ECG, Holter or monitoring)","correct":true},{"idx":3,"proposition":"AF with slow and regular QRS is indicative of an associated second-degree Mobitz 2 atrioventricular block","correct":false,"justification":"AF with slow and regular QRS: in this case there is an association between AF and complete atrioventricular block"},{"idx":4,"proposition":"The etiological assessment should include an ECG and an ETT only","correct":false,"justification":"As well as a standard laboratory workup and chest X-ray"}],"type":"custom"}
+{"_id":"FA-cardio-3","context":null,"enonce":"About AM","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Objectifying paroxysmal AF may be impossible despite the use of Holter's method","correct":true},{"idx":1,"proposition":"Cardioversion is done by Flecaine as a first-line treatment in most cases","correct":true},{"idx":2,"proposition":"Cardioversion is done urgently and in first line in front of a paroxysmal AF","correct":false,"justification":"It must be ensured that there are no thrombus in the OG. Often, a period of anticoagulation is required"},{"idx":3,"proposition":"After reduction of persistent AF, maintenance of sinus rhythm is ensured by digoxin","correct":false,"justification":"Maintenance of sinus rhythm is provided by amiodarone"},{"idx":4,"proposition":"In case of retroversion failure, AF is adhered to with frequency control by calcium channel blockers","correct":false,"justification":"In case of failure, AF is respected with frequency control by beta-blockers"}],"type":"custom"}
+{"_id":"FA-cardio-4","context":null,"enonce":"About AM","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"The embolic risk is high, justifying long-term VKA in all cases in AF on valvular pathology","correct":true},{"idx":1,"proposition":"Cardioversion should be preceded by three weeks (usually four weeks) of effective anticoagulation documented by weekly INRs","correct":true,"justification":"It is followed by 4 weeks of effective anticoagulation most often"},{"idx":2,"proposition":"This rule can be circumvented in case of prior ETT or if the onset of FMD is perfectly datable and less than 24–48 hours","correct":false,"justification":"This rule can be circumvented in case of prior ETO or if the onset of FMD is perfectly datable and less than 24–48 hours (which is rarely possible)"},{"idx":3,"proposition":"The elements of CHADS2VASC are used to assess the need for anticoagulation of AF","correct":true},{"idx":4,"proposition":"The assessment of this risk determines the acute prescription of oral anticoagulants","correct":false,"justification":"The assessment of this risk determines the long-term prescription of anticoagulants: • • if low risk, no anticoagulant; if very high risk (AF valvular) or high CHADS2 score > 1, then indicated anticoagulants; • if intermediate risk (CHADS2 = 0 or 1), then discussion on a case-by-case basis by weighing the benefit\/risk ratio"}],"type":"custom"}
+{"_id":"FA-cardio-5","context":null,"enonce":"About AM","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Prevention of thromboembolic risk is mandatory in case of persistent AF","correct":true},{"idx":1,"proposition":"Cardioversion is immediate in case of persistent AF","correct":false,"justification":"Place of cardioversion: • it should be immediate by electric shock only in case of vital emergency (shock)"},{"idx":2,"proposition":"cardioversion is delayed after three weeks of effective oral anticoagulation","correct":true,"justification":"3 to 4 weeks before. 3 to 4 weeks later"},{"idx":3,"proposition":"It is performed by electric shock under general anesthesia or by antiarrhythmic drugs (amiodarone) or both actions combined.","correct":true},{"idx":4,"proposition":"If it is a first episode, no long-term chronic antiarrhythmic treatment once sinus rhythm is restored","correct":true}],"type":"custom"}
+{"_id":"FA-cardio-6","context":null,"enonce":"About AM","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"The effectiveness of VKAs is monitored by INR, their antidotes are vitamin K dependent factors (II, VII, IX and X) as well as vitamin K","correct":true},{"idx":1,"proposition":"The effectiveness of new oral anticoagulants is monitored by INR","correct":false,"justification":"Monitoring is clinical. There are no specific antidotes."},{"idx":2,"proposition":"The most recommended VKA for prescription is fluindione","correct":false,"justification":"Fluidione is no longer recommended as an initial prescription. Coumadin\/warfarin is the most recommended molecule."},{"idx":3,"proposition":"Dabigatran and rivaroxaban are AODs","correct":true},{"idx":4,"proposition":"In valvular AF, only VKAs are recommended with a target INR of 2.5 (between 2 and 3), unless mitral mechanical valve or disc valve (in this case target INR 3–4.5)","correct":true}],"type":"custom"}
+{"_id":"FA-cardio-7","context":null,"enonce":"Concerning the","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"In nonvalvular AF, VKAs or other oral anticoagulants are mandatory for preventive purposes.","correct":false,"justification":"The CHADS-VASc score is useless in case of mitral narrowing (AVK from the outset)"},{"idx":1,"proposition":"Oral aspirin dose ranging from 75 to 325 mg \/ day (most often 75 mg \/ d) is a questionable alternative in case of low risk","correct":true},{"idx":2,"proposition":"In coronary patients, only amiodarone and sotalol can be used","correct":true},{"idx":3,"proposition":"Similarly, newer oral anticoagulants should be used with caution and at reduced doses after age 80.","correct":true},{"idx":4,"proposition":"Precautions or contraindications are frequent for these new molecules in case of renal failure","correct":true}],"type":"custom"}
+{"_id":"FA-cardio-8","context":null,"enonce":"Which of the following proposals for atrial fibrillation (AF) is true?","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Cardiac auscultation finds irregular heart sounds and an ever more or less slow pace","correct":false,"justification":"AF is tachycardia, the heartbeat is fast. It should be noted that there are, however, \"slow AF\" (case of an AF with high-degree BAV for example) but do not constitute the classic framework of an AF."},{"idx":1,"proposition":"It is responsible for one-sixth of all strokes by cerebral embolism.","correct":true},{"idx":2,"proposition":"The diagnosis of AF is clinical and can only be confirmed by stethoscope auscultation.","correct":false,"justification":"The diagnosis of AF can only be confirmed on an ECG trace documenting it."},{"idx":3,"proposition":"The embolic risk is very low not justifying long-term anticoagulants","correct":false,"justification":"The embolic risk is estimated by the CHAD2S-VASc score. A score >1 requires the implementation of anticoagulation"},{"idx":4,"proposition":"Cardioversion or AF reduction are medical actions that restore sinus rhythm","correct":true}],"type":"custom"}
+{"_id":"FA-cardio-9","context":null,"enonce":"Which of the following are included in the management of rapid non-valvular AF in case of CHADS-VASc score greater than 1?","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Double anti-platelet aggregation","correct":false,"justification":"Need for anticoagulation"},{"idx":1,"proposition":"Direct oral anticoagulant (DOAC) anticoagulation","correct":true},{"idx":2,"proposition":"Anticoagulation by anti-vitamin K (VKA)","correct":false,"justification":"VKA in valvular AF (regardless of CHADS-VASc)"},{"idx":3,"proposition":"Emergency electrical cardioversion ","correct":false,"justification":"False"},{"idx":4,"proposition":"Beta-blocker retarder treatment","correct":true}],"type":"custom"}
+{"_id":"FA-cardio-10","context":null,"enonce":"Which of the following are included in the management of rapid non-valvular AF in case of CHADS-VASc score greater than 1?","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Double anti-platelet aggregation by clopidogrel and Aspirin","correct":false,"justification":"Need for anticoagulation"},{"idx":1,"proposition":"Direct oral anticoagulant (DOAC) anticoagulation","correct":true},{"idx":2,"proposition":"Anticoagulation with anti-vitamin K (VKA), fluindione (Previscan) as a first-line","correct":false},{"idx":3,"proposition":"Electrical cardioversion in first line","correct":false,"justification":"False"},{"idx":4,"proposition":"Antihypertensive treatment if hypertension duly diagnosed","correct":true}],"type":"custom"}
+{"_id":"FA-cardio-11","context":null,"enonce":"Which of the following are included in the calculation of the CHADS2-VASc score?","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Age","correct":true},{"idx":1,"proposition":"Diabetes","correct":true},{"idx":2,"proposition":"Tobacco","correct":false,"justification":"False"},{"idx":3,"proposition":"High blood pressure","correct":true},{"idx":4,"proposition":"Hypertiglyceridemia","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"FA-cardio-12","context":null,"enonce":"Which of the following are procedures to be performed before an external electric shock (ECC) before 3 weeks of effective anticoagulation?","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"ETT and ETO","correct":true,"justification":"True, check for clots"},{"idx":1,"proposition":"Pre-anesthesia consultation","correct":true},{"idx":2,"proposition":"Myocardial scintigraphy","correct":false,"justification":"False"},{"idx":3,"proposition":"Stress test","correct":false,"justification":"False"},{"idx":4,"proposition":"Classification SCORE","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"FA-cardio-13","context":null,"enonce":"Which of the following are possible complications of atrial fibrillation?","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"Embolic stroke","correct":true},{"idx":1,"proposition":"Arterial embolisms","correct":true},{"idx":2,"proposition":"Heart failure","correct":true},{"idx":3,"proposition":"Deep vein thrombosis (DVT)","correct":false,"justification":"Arterial network"},{"idx":4,"proposition":"Acute limb ischemia","correct":true}],"type":"custom"}
+{"_id":"FA-cardio-14","context":null,"enonce":"Which of the following are included in the calculation of the CHADS2-VASc score?","item":"FA","matiere":"cardio","propositions":[{"idx":0,"proposition":"LVEF < 40%","correct":true},{"idx":1,"proposition":"History of stroke","correct":true},{"idx":2,"proposition":"Sex","correct":true},{"idx":3,"proposition":"Dyslipidemia","correct":false,"justification":"False"},{"idx":4,"proposition":"Tobacco","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"diuretiques-nephro-1","context":null,"enonce":"Regarding the different diuretics:","item":"diuretiques","matiere":"nephro","propositions":[{"idx":0,"proposition":"Loop diuretics work by inhibiting sodium reabsorption in the ascending branch of the loop of Henle","correct":true},{"idx":1,"proposition":"Thiazide diuretics are sulfonamides","correct":true},{"idx":2,"proposition":"Hydroxychlorothiazide inhibits sodium excretion through the distal tube","correct":false,"justification":"It is a thiazide diuretic. It therefore inhibits sodium reabsorption on the proximal part of the distal tube"},{"idx":3,"proposition":"Cortical collecting tube diuretics oppose Na\/K exchange","correct":true},{"idx":4,"proposition":"All sodium-carrying cells have NaK-ATPase-dependent pumps on their basolateral membrane","correct":true}],"type":"custom"}
+{"_id":"diuretiques-nephro-2","context":null,"enonce":"Which propositions are true?","item":"diuretiques","matiere":"nephro","propositions":[{"idx":0,"proposition":"Eplerone is a thiazide diuretic","correct":false,"justification":"It is a diuretic of the cortical collecting tube"},{"idx":1,"proposition":"Furosemide is a loop dietic","correct":true},{"idx":2,"proposition":"Chlortalidone is a proximal diuretic","correct":false,"justification":"Like hydrochlorothiazide and chlortalidone, it is a thiazide diuretic. Proximal diuretics are mannitol and acetazolamide"},{"idx":3,"proposition":"In the physiological state, most of the filtered Na is reabsorbed at the proximal bypassed tube and the loop of Henlé","correct":true},{"idx":4,"proposition":"Loop diuretics directly inhibit the reabsorption of Na, K, and Cl","correct":true}],"type":"custom"}
+{"_id":"diuretiques-nephro-3","context":null,"enonce":"Which of the following are possible side effects of thiazide diuretics?","item":"diuretiques","matiere":"nephro","propositions":[{"idx":0,"proposition":"hyperkalemia","correct":false,"justification":"Like loop diuretics, they are hypokalaemic (but much less)"},{"idx":1,"proposition":"hyperuricemia","correct":true},{"idx":2,"proposition":"hypernatremia","correct":false,"justification":"False"},{"idx":3,"proposition":"metabolic alkalosis","correct":true},{"idx":4,"proposition":"Volume depletion","correct":true}],"type":"custom"}
+{"_id":"diuretiques-nephro-4","context":null,"enonce":"Which of the following propositions regarding thiazide diuretics are true?","item":"diuretiques","matiere":"nephro","propositions":[{"idx":0,"proposition":"They inhibit Na-K-2Cl cotransport","correct":false,"justification":"This is the target of loop diuretics."},{"idx":1,"proposition":"They oppose the action of aldosterone","correct":false,"justification":"This is the case of anti-aldosterone (aldactone, spironolactone)"},{"idx":2,"proposition":"They allow sodium excretion of 20 to 25% of the amount of filtered Na","correct":false,"justification":"About 5%"},{"idx":3,"proposition":"They decrease calciuria","correct":true},{"idx":4,"proposition":"They are contraindicated in severe renal impairment","correct":true}],"type":"custom"}
+{"_id":"santepop-mpr-0","context":null,"enonce":"Concerning general information about disability","item":"santepop","matiere":"mpr","propositions":[{"idx":0,"proposition":"Very few people will face disability in their lifetime (<10%)","correct":false,"justification":"Disability is part of the human condition – virtually everyone, at some point in life, will have a temporary or permanent impairment and those who reach old age will experience increasing functional difficulties"},{"idx":1,"proposition":"Disability is complex and interventions to overcome disadvantages are multiple and general, varying with the context","correct":true},{"idx":2,"proposition":"The International Classification of Functioning, Disability and Health (ICF) defines disability as an umbrella term for impairments, activity limitations and participation restrictions.","correct":true},{"idx":3,"proposition":"The ICF gives a definition of disability based on positive characteristics (which is)","correct":false,"justification":"it refers to the negative aspects of the interaction between an individual with a health problem and personal and environmental factors (such as negative attitudes, inaccessibility of transport and public buildings, and limited social supports)"},{"idx":4,"proposition":"Disability is multifactorial","correct":false,"justification":"Disability being multifactorial and dependent on the countries where the populations studied are located, this synthesis has two parts: the first is quite general and deals with disability in the world, the second is more precise and focuses on the French population (adults and children)\""}],"type":"custom"}
+{"_id":"santepop-mpr-2","context":null,"enonce":"Regarding population health measurement tools:","item":"santepop","matiere":"mpr","propositions":[{"idx":0,"proposition":"In countries with life expectancy over 70 years, each individual will spend an average of 8 years or 11.5% of their life living with a disability.","correct":true},{"idx":1,"proposition":"YLDs are the average number of years lived with disability (disease-weighted) under current mortality and health conditions.","correct":true},{"idx":2,"proposition":"Disability-free life expectancy is defined as the average number of years lived without disability","correct":true},{"idx":3,"proposition":"Life expectancy depends very little on the region where one lives","correct":false,"justification":"These studies have also shown a wide variety of results between the Member States of the European Union."},{"idx":4,"proposition":"The DALY is a measure increasingly used in public health, particularly for the evaluation of health care systems","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"santepop-mpr-3","context":null,"enonce":"On general information on disability in France","item":"santepop","matiere":"mpr","propositions":[{"idx":0,"proposition":"The DALY is a measure that does not take into account the functional impact of diseases","correct":false,"justification":"This measure has the merit of taking into account mortality and the functional impact of diseases"},{"idx":1,"proposition":"The origin of the main pathologies causing disability depends on the environment and health policies of the countries","correct":true},{"idx":2,"proposition":"In developed countries, disability is most often born","correct":false,"justification":"In developed countries, it is pathologies due to aging, and in particular cardio-neuro-vascular pathologies that are most often at the origin of a situation of disability (Table 7"},{"idx":3,"proposition":"Disability is usually the direct consequence of illnesses","correct":false,"justification":"Finally, more than the diseases themselves, personal and environmental factors are often at the origin of disability situations."},{"idx":4,"proposition":"The HID survey estimates that around 3 million people are affected by disability in France","correct":false,"justification":"The HID survey estimates that around 23 million people are affected by disability in France\""}],"type":"custom"}
+{"_id":"santepop-mpr-5","context":null,"enonce":"Regarding the epidemiology of disability in France:","item":"santepop","matiere":"mpr","propositions":[{"idx":0,"proposition":"The most common cause of impairment is old age","correct":false,"justification":"The most common causes of impairments are illness (about a quarter of the disabled population suffers from an impairment due to illness), socio-family problems (13%) and old age (11%)"},{"idx":1,"proposition":"Impairments due to disease increase steadily with age","correct":true},{"idx":2,"proposition":"The accidental origin of the disability of young people is the most frequent","correct":true},{"idx":3,"proposition":"In general, the impairments that most affect the population are motor and intellectual impairments.","correct":true},{"idx":4,"proposition":"Overall, women are less affected than men","correct":false,"justification":"Overall, women are more affected than men.\""}],"type":"custom"}
+{"_id":"santepop-mpr-6","context":null,"enonce":"Regarding impairment and disability in France:","item":"santepop","matiere":"mpr","propositions":[{"idx":0,"proposition":"Motor impairments in children or adolescents are rare (1% and 3%, respectively)","correct":true},{"idx":1,"proposition":"In general, it can be seen that young people tend to suffer from multiple impairments, and older subjects from monodeficiency","correct":false,"justification":"It is young people who tend to suffer from monodeficiency, and older subjects from multiple disabilities"},{"idx":2,"proposition":"Impairments can lead to activity limitations","correct":true,"justification":"This is part of the definition of impairment"},{"idx":3,"proposition":"The inability to hear is the one most often reported among the French population","correct":false,"justification":"The inability to carry out activities related to effort (such as those related to distant travel) is the one most often reported among the French population"},{"idx":4,"proposition":"2.11% of the population has difficulty washing","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"santepop-mpr-8","context":null,"enonce":"Regarding the impact of disability on personal life, in France:","item":"santepop","matiere":"mpr","propositions":[{"idx":0,"proposition":"Difficulties in participating in social life have little impact on the quality of life of people with disabilities","correct":false,"justification":"This has a direct impact on the quality of life of people with disabilities."},{"idx":1,"proposition":"25% of people reporting at least one disability almost never or never go on vacation","correct":true},{"idx":2,"proposition":"Disability has no impact on professional integration","correct":false,"justification":"With regard to the professional integration of people under 60, here too, those who declare a disability have a significantly lower employment rate compared to the rest of the population."},{"idx":3,"proposition":"In 2009, there were 322,300 workers with disabilities working in the regular workplace.","correct":true},{"idx":4,"proposition":"Jobseekers with recognition as disabled workers represent 6% of all jobseekers","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"santepop-mpr-9","context":null,"enonce":"Regarding disability in France:","item":"santepop","matiere":"mpr","propositions":[{"idx":0,"proposition":"The unemployment rate for persons with administrative recognition of disability is 22%, more than double that for all persons aged 15 to 64.","correct":true},{"idx":1,"proposition":"Disability-related social protection benefits account for about 26.6% of all social benefits","correct":false,"justification":"F Medico-economic data Disability-related social protection benefits accounted for 6.6 per cent of total social benefits in 2007"},{"idx":2,"proposition":"Private insurance pays the majority of disability-related benefits","correct":false,"justification":"Social security schemes paid the majority of disability-related benefits (fig."},{"idx":3,"proposition":"In the general population, congenital malformations affect 12 to 13% of live births","correct":false,"justification":"In the general population, congenital malformations affect 2 to 3% of live births. a minority of these children (about 20%) will have severe impairment (less than 1% of all births)"},{"idx":4,"proposition":"The prevalence rate of severe disability in the eighth year of life is estimated to be between 6.2 and 6.6 per 1000 children","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"ECG-cardio-0","context":null,"enonce":"What are the real propositions?","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"proposition":"The ventricular T wave is a repolarization wave","correct":true},{"idx":1,"proposition":"A normal T-wave has the same polarity as the QRS","correct":true},{"idx":2,"proposition":"When a wave leaks the collecting electrode, it is positive","correct":false,"justification":"It is negative"},{"idx":3,"proposition":"D1, D2 and D3 are precordial leads","correct":false,"justification":"Front"},{"idx":4,"proposition":"Electrodes from V1 to V9 explore the transverse plane","correct":true}],"type":"custom"}
+{"_id":"ECG-cardio-1","context":null,"enonce":"What statements about the ECG are true?","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"proposition":"The QRS axis is measured using the Bailey double tri-axis","correct":true},{"idx":1,"proposition":"V4 is a lateral bypass","correct":false,"justification":"Apical"},{"idx":2,"proposition":"V1 explores the right atrium","correct":false,"justification":"The anterior wall of the left ventricle"},{"idx":3,"proposition":"V6, V7 and V8 are posterior leads","correct":false,"justification":"This is the case from V7 to V9. V6 is a low side bypass, just like V5"},{"idx":4,"proposition":"V3R and V4R explore the right ventricle","correct":true}],"type":"custom"}
+{"_id":"ECG-cardio-2","context":null,"enonce":"What value(s) is\/are normal in an ECG?","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"proposition":"A heart rate of 125 bpm","correct":false,"justification":"It is tachycardia"},{"idx":1,"proposition":"A P-wave that lasts 150 ms","correct":false,"justification":"It must be less than 120 ms"},{"idx":2,"proposition":"A PR distance of 45 ms","correct":false,"justification":"It would be reduced. A normal PR is between 120 and 200 ms"},{"idx":3,"proposition":"A QRS axis at 60 degrees","correct":true,"justification":"It is normally between -30 and +90 degrees"},{"idx":4,"proposition":"A Q wave of amplitude corresponding to half of the QRS","correct":false,"justification":"It would be a Q wave of necrosis. A normal Q wave lasts less than 40 ms and makes less than a third of the QRS"}],"type":"custom"}
+{"_id":"ECG-cardio-3","context":null,"enonce":"Which propositions are true?","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"proposition":"An electric LVH can be found by the sign of Sokolov","correct":true},{"idx":1,"proposition":"Sokolov's sign is QVA + SV5","correct":false,"justification":"SV1 + RV5 must be less than 35 mm"},{"idx":2,"proposition":"A negative lateral T-wave may indicate severe LVH","correct":true},{"idx":3,"proposition":"Severe LVH induces total left axial deviation","correct":false,"justification":"Very modest"},{"idx":4,"proposition":"Right ventricular hypertrophy cannot be seen on ECG","correct":false,"justification":"Several signs, including axial deviation of QRS greater than 110 degrees"}],"type":"custom"}
+{"_id":"ECG-cardio-5","context":null,"enonce":"Which of the following propositions are true about the ACFA?","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"proposition":"Regular tachycardia is often seen ","correct":false,"justification":"false, FMD is irregular"},{"idx":1,"proposition":"Often has bradycardia ","correct":false,"justification":"Tachycardia"},{"idx":2,"proposition":"QRS are expanded","correct":false,"justification":"Purposes"},{"idx":3,"proposition":"QRS are fine","correct":true},{"idx":4,"proposition":"There is a tremulation of the baseline with the presence of a P wave ","correct":false,"justification":"There must be an absence of P wave to make the diagnosis of AF"}],"type":"custom"}
+{"_id":"ECG-cardio-6","context":null,"enonce":"Which of the following are left branch block signs?","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"proposition":"Wide QRS","correct":true,"justification":"True, sign the branch block"},{"idx":1,"proposition":"Negative QS aspect in V6","correct":false,"justification":"Negative QS aspect from V1 to V3"},{"idx":2,"proposition":"Negative QS aspect in V2","correct":true},{"idx":3,"proposition":"Negative QS aspect in V1","correct":true},{"idx":4,"proposition":"A pseudo sub-ST can be associated","correct":true}],"type":"custom"}
+{"_id":"ECG-cardio-7","context":null,"enonce":"Which of the following are true about atrial flutter?","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"proposition":"This is supraventricular tachycardia","correct":true},{"idx":1,"proposition":"This is a junctional tachycardia","correct":false,"justification":"False"},{"idx":2,"proposition":"This is ventricular tachycardia","correct":false,"justification":"False"},{"idx":3,"proposition":"QRS are fine","correct":true},{"idx":4,"proposition":"The frequency is generally regular","correct":true}],"type":"custom"}
+{"_id":"ECG-cardio-8","context":null,"enonce":"Which of the following are signs of atrial flutter?","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"proposition":"Isoelectric line tremulation","correct":false,"justification":"Atrial fibrillation"},{"idx":1,"proposition":"F-waves on factory roofs","correct":true},{"idx":2,"proposition":"Retrograde P-waves","correct":false,"justification":"Junctional tachycardia"},{"idx":3,"proposition":"Sinus rhythm","correct":false,"justification":"Non-sinus"},{"idx":4,"proposition":"No return to the iso-electric line","correct":true}],"type":"custom"}
+{"_id":"ECG-cardio-9","context":null,"enonce":"Which of the following describe ventricular tachycardia?","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"proposition":"It is regular","correct":true},{"idx":1,"proposition":"QRS are wide","correct":true},{"idx":2,"proposition":"All propositions are true 🤡","correct":false},{"idx":3,"proposition":"It is irregular","correct":false,"justification":"Regular"},{"idx":4,"proposition":"It may precede ventricular fibrillation","correct":true}],"type":"custom"}
+{"_id":"nvxrisques-infectio-0","context":null,"enonce":"Regarding the basics:","item":"nvxrisques","matiere":"infectio","propositions":[{"idx":0,"proposition":"National stockpiles of medicines and vaccines are built up to address key threats","correct":true},{"idx":1,"proposition":"An \"emerging risk\" is defined as any risk that is both new and exponentially decreasing.","correct":false,"justification":"Both new and growing"},{"idx":2,"proposition":"Cancers are the first type of emerging biological risk","correct":false,"justification":"Among biological risks, environmental risks and infectious diseases are at the forefront"},{"idx":3,"proposition":"The emergence of an infectious disease is a phenomenon that results from the interaction between three factors: the host, the biological agent and the environment.","correct":true},{"idx":4,"proposition":"Climate change has no scientifically recognized impact on the emergence of new epidemics","correct":false,"justification":"Environmental changes have a proven impact"}],"type":"custom"}
+{"_id":"nvxrisques-infectio-1","context":null,"enonce":"Which propositions are true?","item":"nvxrisques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Deforestation does not impact the emergence of diseases","correct":false,"justification":"If: Hendra virus example"},{"idx":1,"proposition":"The spread of Aedes albopictus was through the tyre trade","correct":true},{"idx":2,"proposition":"Emerging diseases cannot re-emerge by definition","correct":false,"justification":"The history of humanity has been punctuated by emerging infections (recent example of the HIV pandemic) or re-emerging infections (example of influenza pandemics or syphilis)"},{"idx":3,"proposition":"There will be no more emerging diseases by 2030 thanks to advances in medicine","correct":false,"justification":"Everything suggests that these emergence phenomena will continue, which justifies maintaining an effective health monitoring system."},{"idx":4,"proposition":"Bioterrorism is defined as the use (or threat of use) of biological agents as a weapon, with a view to inducing disease or death in humans, animals and\/or plants.","correct":true}],"type":"custom"}
+{"_id":"nvxrisques-infectio-2","context":null,"enonce":"Concerning epidemiological monitoring and EIF:","item":"nvxrisques","matiere":"infectio","propositions":[{"idx":0,"proposition":"A \"biological agent\" is naturally found in the environment","correct":false,"justification":"Under the term \"biological agent\", we include natural infectious agents (bacteria, viruses, parasites, fungi), the toxins they produce, but also genetically modified infectious agents"},{"idx":1,"proposition":"Health surveillance is carried out worldwide by WHO only","correct":false,"justification":"Health surveillance is carried out worldwide by the WHO, in Europe by the European Center for Diseases Prevention and Control (ECDC) and in France by the France Public Health Agency and its regional structures."},{"idx":2,"proposition":"Any emergence of a new infectious agent is analyzed as potentially dangerous","correct":true},{"idx":3,"proposition":"According to the International Health Regulations, the DGS is responsible for reporting to WHO all health emergencies of international concern","correct":true},{"idx":4,"proposition":"Nearly 5 infectious agents have emerged in the last 50 years","correct":false,"justification":"Nearly 180"}],"type":"custom"}
+{"_id":"nvxrisques-infectio-3","context":null,"enonce":"Which propositions are true?","item":"nvxrisques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Two-thirds of emerging diseases are zoonoses","correct":true},{"idx":1,"proposition":"Government plans have been developed and are regularly updated","correct":true},{"idx":2,"proposition":"Each health institution must develop, as part of the white plan, procedures allowing it to develop a dedicated circuit, premises and organization","correct":true},{"idx":3,"proposition":"The realization of full-scale exercises is forbidden in hospitals because the organization would be extremely complex","correct":false,"justification":"Carrying out full-scale exercises is useful"},{"idx":4,"proposition":"During national alerts, a definition of suspected cases developed and disseminated by the HAS","correct":false,"justification":"By the Directorate General of Health through the ARS"}],"type":"custom"}
+{"_id":"tbmarchegeria-neuro-1","context":null,"enonce":"Regarding walking and balance disorders","item":"tbmarchegeria","matiere":"neuro","propositions":[{"idx":0,"proposition":"During a labyrinthine attack, standing and walking are impossible during vertiginous accesses","correct":true},{"idx":1,"proposition":"At a distance from the latter, walking is cautious and unstable with a lateral deviation from the walking line","correct":true},{"idx":2,"proposition":"When reaching the cerebellum, the standing person stands with his legs apart to widen his support polygon, with the arms in abduction and walking he progresses zigzagging and staggering, realizing the drunk gait","correct":true},{"idx":3,"proposition":"The parkinsonian gait is characterized by a walk with the trunk inclined forward, the limbs in slight extension with swinging of the arm preserved","correct":false,"justification":"The parkinsonian gait is characterized by walking with the trunk inclined forward, the limbs in slight flexion with loss of arm swing."},{"idx":4,"proposition":"At a more advanced stage of Parkinson's disease, walking is done in small steps with foot rubbing and a decomposed U-turn.","correct":true}],"type":"custom"}
+{"_id":"algiespelviennes-gyn-0","context":null,"enonce":"What are the 4 etiologies to discuss first? ","item":"algiespelviennes","matiere":"gyn","propositions":[{"idx":0,"proposition":"Acute appendicitis ","correct":true},{"idx":1,"proposition":"Upper genital infection ","correct":true},{"idx":2,"proposition":"Cholangitis","correct":false,"justification":"Not the same location most often. Many other clinical signs, such as fever or ictere, point to cholitis."},{"idx":3,"proposition":"The GEU","correct":true,"justification":"Always think about it in a woman of childbearing age"},{"idx":4,"proposition":"Annex twisting ","correct":true}],"type":"custom"}
+{"_id":"algiespelviennes-gyn-1","context":null,"enonce":"Which of these proposals can often cause acute pelvic pain? ","item":"algiespelviennes","matiere":"gyn","propositions":[{"idx":0,"proposition":"Post-miscarriage retention","correct":true},{"idx":1,"proposition":"Renal artery aneurysm ","correct":false,"justification":"Is not painful"},{"idx":2,"proposition":"Ovarian cyst rupture","correct":true},{"idx":3,"proposition":"Osteonecrosis of the femoral head ","correct":false,"justification":"Possible pelvic irradiation even rare"},{"idx":4,"proposition":"Pyelonephritis ","correct":true}],"type":"custom"}
+{"_id":"algiespelviennes-gyn-3","context":null,"enonce":"Regarding CCAs:","item":"algiespelviennes","matiere":"gyn","propositions":[{"idx":0,"proposition":"The pain is usually very intense in case of torsion of appendix","correct":true},{"idx":1,"proposition":"A gradual onset points to IGH or acute appendicitis","correct":true},{"idx":2,"proposition":"Pain of brief evolution eliminates the possibility of a complication of an ovarian cyst","correct":false,"justification":"On the contrary, it points towards cystic origin"},{"idx":3,"proposition":"The time of onset of pain is of little importance in terms of diagnostic orientation","correct":true},{"idx":4,"proposition":"Pain topography can be relied upon to identify the organs involved","correct":false,"justification":"This is made very difficult\/impossible by the mode of innervation of the pelvic organs."}],"type":"custom"}
+{"_id":"algiespelviennes-gyn-4","context":null,"enonce":"Regarding CCAs:","item":"algiespelviennes","matiere":"gyn","propositions":[{"idx":0,"proposition":"The unilateral character is more in favor of an adnexal pathology","correct":true},{"idx":1,"proposition":"In case of upper genital infection, the pain is willingly diffused to the entire pelvis","correct":true},{"idx":2,"proposition":"Pain with lumbar irradiation should be sought as a priority for hepatic origin","correct":false,"justification":"Lumbar origin: renal colic for example"},{"idx":3,"proposition":"An appendage torsion never radiates to the lumbar because of the mode of innervation of the tubes","correct":false,"justification":"Hypogastric and aortic plexus, so possible irradiation"},{"idx":4,"proposition":"– scapulalgia should be sought for intraperitoneal effusion","correct":true}],"type":"custom"}
+{"_id":"algiespelviennes-gyn-5","context":null,"enonce":"What does localized pelvic pain in the flanks remind you of?","item":"algiespelviennes","matiere":"gyn","propositions":[{"idx":0,"proposition":"Renal colic","correct":true,"justification":"Renal colic and pyelonephritis are to be evoked in front of a pain of the flanks, assessment to be completed by a BU and an ultrasound of the urinary tract"},{"idx":1,"proposition":"Acute appendicitis ","correct":false,"justification":"None"},{"idx":2,"proposition":"Cyst rupture","correct":false,"justification":"None"},{"idx":3,"proposition":"Pyelonephritis","correct":true,"justification":"None"},{"idx":4,"proposition":"Annex twisting","correct":false,"justification":"None"}],"type":"custom"}
+{"_id":"algiespelviennes-gyn-6","context":null,"enonce":"What are the etiologies of acute pelvic pain?","item":"algiespelviennes","matiere":"gyn","propositions":[{"idx":0,"proposition":"FCS","correct":true,"justification":"None"},{"idx":1,"proposition":"Renal colic","correct":true,"justification":"None"},{"idx":2,"proposition":"Annex twisting","correct":true,"justification":"None"},{"idx":3,"proposition":"Acute appendicitis ","correct":true,"justification":"None"},{"idx":4,"proposition":"Upper genital infection","correct":true,"justification":"None"}],"type":"custom"}
+{"_id":"algiespelviennes-gyn-7","context":null,"enonce":"What does localized pelvic pain in the flanks remind you of?","item":"algiespelviennes","matiere":"gyn","propositions":[{"idx":0,"proposition":"Renal colic","correct":true,"justification":"Renal colic and pyelonephritis are to be evoked in front of a pain of the flanks, assessment to be completed by a BU and an ultrasound of the urinary tract"},{"idx":1,"proposition":"Acute appendicitis ","correct":false,"justification":"None"},{"idx":2,"proposition":"Cyst rupture","correct":false,"justification":"None"},{"idx":3,"proposition":"Pyelonephritis","correct":true,"justification":"None"},{"idx":4,"proposition":"Annex twisting","correct":false,"justification":"None"}],"type":"custom"}
+{"_id":"algiespelviennes-gyn-8","context":null,"enonce":"What are the diagnoses to be discussed in priority in front of acute pelvic pain in women?","item":"algiespelviennes","matiere":"gyn","propositions":[{"idx":0,"proposition":"Pyelonephritis","correct":false,"justification":"Pyelonephritis"},{"idx":1,"proposition":"Normal pregnancy ","correct":false,"justification":"Think about the GEU"},{"idx":2,"proposition":"Upper genital infection","correct":true,"justification":"The term salpingite is dropped in the latest edition of the CNOG"},{"idx":3,"proposition":"Annex twisting","correct":true},{"idx":4,"proposition":"Cholecystitis","correct":false,"justification":"Evoke acute appendicitis instead"}],"type":"custom"}
+{"_id":"algiespelviennes-gyn-9","context":null,"enonce":"Which of the following are true?","item":"algiespelviennes","matiere":"gyn","propositions":[{"idx":0,"proposition":"There is a link between endometriosis and ovarian cancer","correct":false,"justification":"False. There is no link (HAS 2017 recommendations). Therefore, there is no need to screen patients with endometriosis for ovarian cancer."},{"idx":1,"proposition":"If there are no symptoms in a woman with endometriosis who is being treated, imaging should be done on an annual basis to monitor the progress of the lesions.","correct":false,"justification":"False. According to HAS, in the absence of symptoms, routine imaging monitoring of patients treated for endometriosis is not required."},{"idx":2,"proposition":"The definition of endometriosis is histological: presence of endometritis glands or stroma outside the uterus","correct":true},{"idx":3,"proposition":"There is no need to seek endometriosis in cases of isolated dysmenorrhea controlled by hormonal contraception, without other painful symptoms or immediate pregnancy wishes","correct":true,"justification":"True. See HAS 2017"},{"idx":4,"proposition":"The \"Endometriosis Health Profile-30\" questionnaire and its short version \"EHP-5\", or the SF-36 questionnaire, are questionnaires assessing the quality of life of women with endometriosis","correct":true}],"type":"custom"}
+{"_id":"RCIU-gyn-0","context":null,"enonce":"Regarding the epidemiology of prematurity:","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Prematurity is defined as a birth occurring before 42 weeks of amenorrhea","correct":false,"justification":"Prematurity is defined as a birth occurring before 37 weeks of amenorrhea (AS) and from 22 SA of a child weighing at least 500 g"},{"idx":1,"proposition":"60% of neonatal mortality comes from children born before 30 weeks","correct":true},{"idx":2,"proposition":"The preterm birth rate is 0.7% for all births","correct":false,"justification":"The preterm birth rate is 7.4 per cent for all births and 6.6 per cent for live births due to a high proportion of preterm infants among stillbirths."},{"idx":3,"proposition":"Among live births, the preterm birth rate is 6.6 per cent","correct":true},{"idx":4,"proposition":"About 75% of preterm births occur before 28 SA","correct":false,"justification":"About 10% of preterm deliveries occur before 28 weeks (extreme prematurity), 10 per cent occur before 28 to 31 weeks (severe prematurity) and 80% occur before 32 to 36 weeks (moderate prematurity)\""}],"type":"custom"}
+{"_id":"RCIU-gyn-1","context":null,"enonce":"What are the true statements?","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Extreme prematurity concerns births before 28 SA","correct":true,"justification":"Extreme prematurity < 28 SA. Severe prematurity < 32 SA. Moderate prematurity < 36 SA."},{"idx":1,"proposition":"Severe prematurity is between 28 and 42 SA","correct":false,"justification":"42 SA is a normal term"},{"idx":2,"proposition":"Moderate prematurity is in 32 and 38 SA","correct":false,"justification":"Between 32 and 36"},{"idx":3,"proposition":"A birth at 33 SA is moderate prematurity","correct":true},{"idx":4,"proposition":"A birth at 41 SA is normal","correct":true}],"type":"custom"}
+{"_id":"RCIU-gyn-2","context":null,"enonce":"Which of these proposals are possible causes of induced prematurity?","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Pre-eclampsia","correct":true},{"idx":1,"proposition":"GEU","correct":false,"justification":"First trimester pathology"},{"idx":2,"proposition":"Decompensated maternal heart disease","correct":true},{"idx":3,"proposition":"Retroplacental hematoma","correct":true},{"idx":4,"proposition":"Lupus","correct":false,"justification":"Not as such\""}],"type":"custom"}
+{"_id":"RCIU-gyn-3","context":null,"enonce":"Which of these proposals are recognized risk factors for preterm birth?","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Celibacy","correct":true,"justification":"RR 1-2"},{"idx":1,"proposition":"Alcohol","correct":true,"justification":"RR 1-2"},{"idx":2,"proposition":"Tobacco","correct":true,"justification":"RR 1-2"},{"idx":3,"proposition":"The single pregnancy","correct":false,"justification":"Multiple pregnancy yes, with RR between 4 and 10"},{"idx":4,"proposition":"Urinary tract infection","correct":true,"justification":"RR 1-3\""}],"type":"custom"}
+{"_id":"RCIU-gyn-4","context":null,"enonce":"Regarding preterm births:","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Spintaneous prematurity rarely occurs after spontaneous work with intact membranes","correct":false,"justification":"Spontaneous prematurity occurs after spontaneous labour with intact membranes (40–45%) or premature rupture of membranes (25–30%), while induced prematurity is most often induced for fetal or maternal pathology (30–35%)"},{"idx":1,"proposition":"Patients who have preterm rupture of membranes do not need induced delivery","correct":false,"justification":"Patients who have preterm rupture of membranes may also have an induced delivery if the condition of the newborn or mother requires induction of delivery or caesarean section."},{"idx":2,"proposition":"Distilbene has been shown not to promote preterm births","correct":false,"justification":"In addition, the risk of OA would be multiplied by a factor ranging from 2 to 5 in case of in utero exposure to Distilbene®."},{"idx":3,"proposition":"Cervico-isthmic gaping results in a late miscarriage at the end of the third trimester and with extremely algic and progressive uterine contractions","correct":false,"justification":"Clinically, it is accepted that it is in its typical form an event of sudden onset, unpredictable, little or no preceded by prior clinical cervical changes."},{"idx":4,"proposition":"A history of conization increases the risk of preterm birth","correct":true}],"type":"custom"}
+{"_id":"RCIU-gyn-5","context":null,"enonce":"Regarding risk factors for prematurity:","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"proposition":"In case of multiple pregnancy, the risk of prematurity is multiplied by 1.2","correct":false,"justification":"The rate of prematurity is 43%, a risk multiplied by 7 compared to single children"},{"idx":1,"proposition":"Twin pregnancies exclusively expose to the risk of moderate prematurity","correct":false,"justification":"Excess risk is observed for both moderate and severe prematurity"},{"idx":2,"proposition":"Hydramnios is always idiopathic","correct":false,"justification":"It may be the witness of an underlying fetal pathology (diabetes, fetal anemia by Rhesus alloimmunization or parvovirus B19 infection, fetal malformations or placental pathologies), idiopathic hydramnios remaining a diagnosis of elimination"},{"idx":3,"proposition":"Plana previa increases the risk of prematurity","correct":true,"justification":"It is associated with a 6 to 7 times increased risk of PA"},{"idx":4,"proposition":"Gestational vascular pathologies are mainly responsible for spontaneous prematurity","correct":false,"justification":"These pathologies are responsible for 25 to 30% of global prematurity and essentially induced prematurity\""}],"type":"custom"}
+{"_id":"RCIU-gyn-6","context":null,"enonce":"Among these propsitions, which prevent prematurity:","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Limit orthostatic work","correct":true},{"idx":1,"proposition":"Limit day work","correct":false,"justification":"Limiting night work"},{"idx":2,"proposition":"Smoking cessation","correct":true},{"idx":3,"proposition":"Alcohol withdrawal","correct":true},{"idx":4,"proposition":"Optimizing the balance of chronic diseases","correct":true,"justification":"Like diabetes, hypertension, asthma, etc.\""}],"type":"custom"}
+{"_id":"RCIU-gyn-7","context":null,"enonce":"Regarding intra-uterine growth retardation","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"proposition":"A newborn is said to be small for gestational age if its birth weight is below the 50th percentile","correct":false,"justification":"A newborn is said to be small for gestational age (PAG) if its birth weight is below the 10th percentile"},{"idx":1,"proposition":"PAG affects 10% of newborns","correct":true},{"idx":2,"proposition":"IUGR corresponds to a PAG and a break in the intrauterine growth curve","correct":true},{"idx":3,"proposition":"IUGR is said to be early if it appears before 35 SA","correct":false,"justification":"IUGR is said: • early if it appears in the 2nd trimester, versus late if it appears in the 3rd trimester"},{"idx":4,"proposition":"True IUGR is a purely intrauterine pathology that has no consequences after birth","correct":false,"justification":"Conversely, true IUGR is a pathology that exposes to complications: fetal death in utero, neonatal encephalopathy, abnormalities of psychomotor development\""}],"type":"custom"}
+{"_id":"RCIU-gyn-8","context":null,"enonce":"Which of the following proposals are favored by prematurity?","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Ulcerative-necrotizing enterocolitis","correct":true,"justification":"True, prevented by antenatal corticosteroid therapy"},{"idx":1,"proposition":"Early closure of the ductus arteriosus","correct":false,"justification":"The opposite: the persistence of the ductus arteriosus. It can be a source of pulmonary hyper-output (by aortopulmonary shunt at high pressure) and pulmonary arterial hypertension"},{"idx":2,"proposition":"Intraventricular cerebral hemorrhage","correct":true,"justification":"True, prevented by antenatal corticosteroid therapy"},{"idx":3,"proposition":"Hyaline membrane disease ","correct":true,"justification":"True, prevented by antenatal corticosteroid therapy"},{"idx":4,"proposition":"Hypercalcemia","correct":false,"justification":"HYPOcalcemia, HYPOGLYCEMIA, HYPOthermia"}],"type":"custom"}
+{"_id":"antiinf-infectio-0","context":null,"enonce":"Regarding penicillins:","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"Penicillin V is administered in IV","correct":false,"justification":"Per Os"},{"idx":1,"proposition":"The depot form of penicillins G\/V is benzathine penicillin","correct":true},{"idx":2,"proposition":"Amoxicillin is penicillin A","correct":true},{"idx":3,"proposition":"The most common combination with amoxicillin is clavulanic acid","correct":true},{"idx":4,"proposition":"Penicillin G is administered Per Os","correct":false,"justification":"Track IV"}],"type":"custom"}
+{"_id":"antiinf-infectio-1","context":null,"enonce":"Regarding penicillins:","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"They are bactericidal","correct":true},{"idx":1,"proposition":"They are concentration-dependent","correct":false,"justification":"Time-dependent"},{"idx":2,"proposition":"Penicillins V and G have a short half-life","correct":true},{"idx":3,"proposition":"The elimination of amoxicillin is done by urine at more than 70%","correct":true},{"idx":4,"proposition":"The diffusion is very good in the prostate","correct":false,"justification":"Very bad"}],"type":"custom"}
+{"_id":"antiinf-infectio-2","context":null,"enonce":"On which bacteria are penicillins A useful?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"Streptococci","correct":true},{"idx":1,"proposition":"Staphylococci","correct":false,"justification":"Clavulanic acid must be added"},{"idx":2,"proposition":"Group 2 and 3 Enterobacteriaceae","correct":false,"justification":"Only group 1"},{"idx":3,"proposition":"Fusobacterium","correct":true},{"idx":4,"proposition":"SARMs","correct":false,"justification":"By definition, they are resistant"}],"type":"custom"}
+{"_id":"antiinf-infectio-4","context":null,"enonce":"Which of the following are true?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"Any antibiotic therapy should be reassessed early","correct":true,"justification":"At 48-72h, it will take into account the efficacy, tolerance and possible bacteriological documentation"},{"idx":1,"proposition":"It is customary to reduce spectrum as soon as possible","correct":true},{"idx":2,"proposition":"Except in special cases, antibiotic therapy of more than 3 days is not justified","correct":false,"justification":"Most often does not exceed more than 10 days"},{"idx":3,"proposition":"There are treatments for only a minority of viruses ","correct":true},{"idx":4,"proposition":"Antivirals eradicate the viral presence most often","correct":false,"justification":"Their purpose may be to control long-term viral replication."}],"type":"custom"}
+{"_id":"antiinf-infectio-5","context":null,"enonce":"Which of the following are true about vancomycin?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is an aminoglycoside","correct":false,"justification":"Glycopeptides"},{"idx":1,"proposition":"Its toxicity is pulmonary","correct":false,"justification":"Kidney"},{"idx":2,"proposition":"Its activity is concentration dependent","correct":false,"justification":"Time dependent"},{"idx":3,"proposition":"It has no activity on gram-negative bacilli","correct":true},{"idx":4,"proposition":"It has activity on staphylococci","correct":true}],"type":"custom"}
+{"_id":"thromboP-hemato-0","context":null,"enonce":"Regarding thrombocytopenia","item":"thromboP","matiere":"hemato","propositions":[{"idx":0,"proposition":"Thrombocytopenia is a platelet count of less than 100 g \/ l regardless of age","correct":false},{"idx":1,"proposition":"Platelet depletion can lead to thrombotic syndrome","correct":false,"justification":"Hemorrhagic syndrome"},{"idx":2,"proposition":"Severe thrombocytopenia causes infiltrated petechial purpura, sometimes associated with large hematomas","correct":false,"justification":"Purpura from thrombocytopenia is not infiltrated"},{"idx":3,"proposition":"The discovery of a purpura requires the prescription of a blood count","correct":true},{"idx":4,"proposition":"Look for signs of infection, anemia, liver disease, splenomegaly or lymphadenopathy","correct":true}],"type":"custom"}
+{"_id":"thromboP-hemato-1","context":null,"enonce":"About thrombocytopenia","item":"thromboP","matiere":"hemato","propositions":[{"idx":0,"proposition":"Signs of severity of hemorrhagic syndrome are those related to the existence of mucosal bleeding","correct":true,"justification":"These include: intraoral hemorrhagic bubbles, metrorrhagia, gingerage and epistaxis"},{"idx":1,"proposition":"Disseminated ecchymotic purpura, associated with significant mucosal hemorrhages, headache, neurological clinical signs, raises fears of the occurrence of a severe hemorrhagic syndrome","correct":true,"justification":"The three most feared locations are cerebral, mucosal and digestive"},{"idx":2,"proposition":"When severe bleeding is suspected, preventive treatment is essential, as bleeding is often spontaneous and unpredictable.","correct":true,"justification":"Indeed, bleeding is often spontaneous and unpredictable."},{"idx":3,"proposition":"The presence of abnormal cells on the smear will suggest potentially malignant myelopathy","correct":true},{"idx":4,"proposition":"Vitamin B12 deficiency causes peripheral thrombocytopenia","correct":false,"justification":"Default medullary production plant. This is also the case for folate"}],"type":"custom"}
+{"_id":"thromboP-hemato-2","context":null,"enonce":"Regarding thrombocytopenia","item":"thromboP","matiere":"hemato","propositions":[{"idx":0,"proposition":"When severe bleeding is suspected, preventive treatment is essential","correct":true,"justification":"Because the bleeding is then often spontaneous and unpredictable (especially cerebromeningeal hemorrhages)"},{"idx":1,"proposition":"Platelet concentrates have a very rapid efficacy in thrombocytopenia of central origin but more moderate and fleeting in thrombocytopenia of peripheral origin","correct":true},{"idx":2,"proposition":"Pseudothrombocytopenia may be related to EDTA","correct":true,"justification":"When there are no clinical signs, it is then necessary to repeat the sample on a dedicated tube"},{"idx":3,"proposition":"The risk of bleeding is major if the platelet count is less than 70 G \/ L","correct":false,"justification":"The risk of bleeding is major if the platelet count is less than 20 G \/ L"},{"idx":4,"proposition":"Osteomedullary biopsy is always prescribed when the myelogram is non-demonstrative","correct":false,"justification":"Most often, we don't even do a medullogram"}],"type":"custom"}
+{"_id":"masseabdo-HGE-0","context":null,"enonce":"About hepatomegaly","item":"masseabdo","matiere":"HGE","propositions":[{"idx":0,"proposition":"Hepatomegaly is defined as an increase in liver volume","correct":true},{"idx":1,"proposition":"Hepatomegaly can be considered homogeneous or heterogeneous depending on the macroscopic appearance (palpation, examination of the section, or imaging examinations)","correct":true},{"idx":2,"proposition":"The liver is considered enlarged when its projection on the medioclavicular line is greater than 22 cm","correct":false,"justification":"The liver is considered enlarged when its projection on the medioclavicular line is greater than 12 cm"},{"idx":3,"proposition":"A mass of the right hypochondrium or epigastrium may be attached to hepatomegaly when it is mobile with breathing","correct":true},{"idx":4,"proposition":"Abdominal ultrasound makes it possible to specify the diagnsotic of hepatomegaly showing that the distance between the top of the time is of its lower edge, and the mid-clavicular line is greater than 12 cm","correct":true}],"type":"custom"}
+{"_id":"masseabdo-HGE-1","context":null,"enonce":"About hepatomegaly","item":"masseabdo","matiere":"HGE","propositions":[{"idx":0,"proposition":"Most liver diseases can cause hepatomegaly","correct":true},{"idx":1,"proposition":"A cirrhotic liver is soft in consistency with a sharp lower edge","correct":false,"justification":"It is of hard consistency"},{"idx":2,"proposition":"The clinical examination should look for hepatojugular reflux and systolic expansion of the liver","correct":true},{"idx":3,"proposition":"The clinical examination tries to find out if the liver is painful","correct":true},{"idx":4,"proposition":"To clarify the cause of heterogeneous hepatomegaly, contrast ultrasound, CT scan or MRI are often useful.","correct":true}],"type":"custom"}
+{"_id":"masseabdo-HGE-3","context":null,"enonce":"About hepatomegaly","item":"masseabdo","matiere":"HGE","propositions":[{"idx":0,"proposition":"Malignant or benign liver tumors are the most common cause of heterogeneous hepatomegaly","correct":true},{"idx":1,"proposition":"Steatosis is cirrhosis are the most frequent legoses of homogenic hepatomeaglia","correct":true},{"idx":2,"proposition":"Liver biopsy cannot be performed transparientally when haemostasis disorders are present","correct":true},{"idx":3,"proposition":"In front of an abdominal mass the clinical examination makes it possible to eliminate among other things a fecal impaction, a bladder globe, a herenia","correct":true},{"idx":4,"proposition":"Liver biospsia can be echoguided or scannoguided","correct":true}],"type":"custom"}
+{"_id":"securitepro-mdt-0","context":null,"enonce":"Which of the following is (are) correct?","item":"securitepro","matiere":"mdt","propositions":[{"idx":0,"proposition":"Every year there are about 10,000 accidents at work (AT) in France","correct":false,"justification":"More than 620,000 TAs were recorded in 2014"},{"idx":1,"proposition":"Each year, TAs are responsible for more than 500 deaths in France","correct":true,"justification":"More than 500 deaths by AT in France each year"},{"idx":2,"proposition":"Occupational diseases are constantly increasing","correct":true},{"idx":3,"proposition":"About 2% of the population is exposed to a carcinogen through work","correct":false,"justification":"More than 13% of the French population is exposed"},{"idx":4,"proposition":"Very few notices of incapacity lead to dismissal","correct":false,"justification":"Unfortunately, far too many opinions still lead to dismissal"}],"type":"custom"}
+{"_id":"securitepro-mdt-2","context":null,"enonce":"Which of the following is (are) correct?","item":"securitepro","matiere":"mdt","propositions":[{"idx":0,"proposition":"The state of health can never constitute a reason for dismissal","correct":false,"justification":"In case of incapacity and impossibility of redeployment, it may lead to dismissal"},{"idx":1,"proposition":"Medical incapacity is pronounced following a meeting between the patient, his manager at the workplace, and the doctor","correct":false,"justification":"Only the doctor can pronounce an incapacity, no consultation with a hierarchical superior is necessary"},{"idx":2,"proposition":"Unfitness for a job is always total","correct":false,"justification":"It can be total\/restricted, definitive\/temporary"},{"idx":3,"proposition":"There are 2 types of reclassification: upper and lower","correct":false,"justification":"There are 2 types of outplacements: internal or external"},{"idx":4,"proposition":"External redeployment calls on Pôle Emploi","correct":true,"justification":"This is the case with external redeployment"}],"type":"custom"}
+{"_id":"risques-infectio-0","context":null,"enonce":"Which propositions are true?","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Adverse events associated with care are rare conditions","correct":false,"justification":"Important points Adverse events associated with care are frequent, costly pathologies, responsible for significant morbidity and mortality Nosocomial infection: any infection – neither present nor incubating at management – occurring in a health facility, more than 48 hours after admission"},{"idx":1,"proposition":"The delay is extended to 15 days post-surgery","correct":false,"justification":"This period is extended to 30 days in case of surgery"},{"idx":2,"proposition":"Healthcare-associated infections include nosocomial infections and infections associated with out-of-hospital care","correct":true},{"idx":3,"proposition":"Prevention is essential and hand hygiene with hydroalcoholic solutions is the main measure","correct":true},{"idx":4,"proposition":"Nosocomial infections never occur at RHAs","correct":false,"justification":"Some nosocomial infections require reporting to CPias and ARS (e.g. death related to nosocomial infection\")"}],"type":"custom"}
+{"_id":"risques-infectio-1","context":null,"enonce":"Which propositions are true?","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Healthcare-associated infections (HAIs) are home care infections","correct":false,"justification":"This term HAIs refers to infections that appear during or during the course of a patient's management (diagnostic, therapeutic, palliative, preventive or educational), if the infection was neither present nor incubated at the beginning of management."},{"idx":1,"proposition":"Nosocomial infections (NOS) are those acquired at the patient's work","correct":false,"justification":"The term IN refers to infections acquired in health facilities: in practice, an infection is often considered nosocomial if it appears more than 48 hours after admission, but this period must be adapted to the incubation period of the disease"},{"idx":2,"proposition":"The definition of nosocomial infections in case of placement of foreign material is based on a period of 6 months","correct":false,"justification":"The definition of some NIs is based on longer delays: 30 days after surgery for surgical site infection 1 year in case of placement of foreign equipment"},{"idx":3,"proposition":"The 3 most frequently isolated microorganisms are Escherichia coli, Staphylococcus aureus and Streptococcus pneumoniae","correct":false,"justification":"Infectious agents responsible: Gram-negative bacilli in 60% of cases, Gram-positive cocci in 30% The 3 most frequently isolated microorganisms are Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa Fungi are becoming increasingly important in NIs"},{"idx":4,"proposition":"Overall, there is an increase in multidrug-resistant bacteria (MDR) and emerging \"Highly Resistant\" Bacteria (BHRe)","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"risques-infectio-2","context":null,"enonce":"Regarding surgical site infections (ISO):","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"The most frequently encountered BMRs are extended-spectrum betalactamase-producing enterobacteriaceae (ESBL) and methicillin-resistant Staphylococcus aureus (MRSA).","correct":true},{"idx":1,"proposition":"eBHRs include carbapenemase-producing Enterococcus faecium and vancomycin-resistant Enterococcus faecium","correct":true},{"idx":2,"proposition":"The presence of local inflammatory signs requiring a resumption of the incision is a sign of infection of the surgical site","correct":true},{"idx":3,"proposition":"Signs of infection observed during re-surgery indicate surgical site infection","correct":true},{"idx":4,"proposition":"A period of one year following the placement of equipment (prosthesis or implant) is compatible with an infection of the surgical site","correct":true}],"type":"custom"}
+{"_id":"risques-infectio-3","context":null,"enonce":"Which propositions are true?","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"The diagnostic criteria for a nosocomial urinary tract infection are identical to those for a community urinary tract infection","correct":true},{"idx":1,"proposition":"Regression of infectious signs within 48 hours of catheter removal strongly suggests that the infection is catheter-related.","correct":true},{"idx":2,"proposition":"Treatment of a nosocomial infection is always probabilistic without adaptation","correct":false,"justification":"Reassessment and reduction of spectrum if possible upon receipt of bacteriological results"},{"idx":3,"proposition":"Surgical site infection requires specialized management","correct":true},{"idx":4,"proposition":"Catheter-related infection is treated by removing the catheter only","correct":false,"justification":"CATHETER-RELATED INFECTION Catheter removal + broad-spectrum antibiotic therapy secondarily adapted to susceptibility testing"}],"type":"custom"}
+{"_id":"risques-infectio-4","context":null,"enonce":"Which propositions are true?","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Prevention of HIAs is essential","correct":true},{"idx":1,"proposition":"Urinary colonizations should be treated with appropriate antibiotic therapy","correct":false,"justification":"NOSOCOMIAL URINARY TRACT INFECTION Colonizations should not be treated with antibiotics except in cases of pregnancy or planned urinary tract intervention"},{"idx":2,"proposition":"In case of urinary tract infection on probe, the bladder tube can be kept in place for 48 hours if antibiotic therapy works","correct":false},{"idx":3,"proposition":"Asepsis is the removal of dirt adhering to a tissue or surface","correct":false,"justification":"DEFINITIONS Asepsis: set of measures to prevent any introduction of infectious agents to inert or biological surfaces"},{"idx":4,"proposition":"Sterilization is the removal of dirt adhering to living tissue or an inert surface","correct":false,"justification":"Cleansing: removal of dirt adhering to living tissue or an inert surface\""}],"type":"custom"}
+{"_id":"risques-infectio-5","context":null,"enonce":"Which propositions are true?","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Sterilization is the operation that aims to destroy all microorganisms of an object in a sustainable way on an inert medium","correct":true},{"idx":1,"proposition":"Decontamination and disinfection are synonymous","correct":false,"justification":"Decontamination: includes antisepsis and disinfection: temporary elimination of infectious agents"},{"idx":2,"proposition":"Mixing antiseptics of different nature makes it possible to broaden their spectrum","correct":false,"justification":"Rules for the use of antiseptics Avoid simultaneous or successive mixtures of products of different nature For antisepsis of healthy skin, the application of an antiseptic is always preceded by a deterioration phase"},{"idx":3,"proposition":"Chlorhexidine is contraindicated on the skin and reserved for mucous membranes","correct":false},{"idx":4,"proposition":"linen and instruments soiled with blood or any other product of human origin must be transported in leak-proof packaging","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"risques-infectio-6","context":null,"enonce":"Regarding hygiene:","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Alcoholic antiseptic should not be used in newborns","correct":true},{"idx":1,"proposition":"Chlorinated and iodine derivatives have a fairly reduced spectrum (centered on Gram-negative bacilli)","correct":false},{"idx":2,"proposition":"Manuporting is the main mode of cross-transmission of microorganisms","correct":true},{"idx":3,"proposition":"Hand hygiene is the most effective measure to significantly reduce the incidence rate of cross-transmission NIs by reducing transient skin flora by 99%","correct":true},{"idx":4,"proposition":"The friction of the hands must last at the mons 2mn30","correct":false,"justification":"Perform the friction of all areas until complete drying (= 30 seconds)\""}],"type":"custom"}
+{"_id":"risques-infectio-7","context":null,"enonce":"Regarding the wearing of gloves and additional precautions:","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Wearing gloves is advised to protect the patient from contact with the doctor's skin flora only","correct":false},{"idx":1,"proposition":"Wearing gloves replaces hand hygiene","correct":false},{"idx":2,"proposition":"Hand hygiene should be performed before and after removing gloves","correct":true},{"idx":3,"proposition":"The gloves are worn for about 3 hours, they must be kept from beginning to end with the same patient","correct":false,"justification":"Change gloves between 2 treatments in the same patient, between 2 patients"},{"idx":4,"proposition":"Additional precautions are adapted to the modes of transmission of infections","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"risques-infectio-8","context":null,"enonce":"Regarding additional hygiene precautions:","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"\"Air\" precautions are taken when only surfaces are contaminated","correct":false,"justification":"This is the case of contact precautions"},{"idx":1,"proposition":"Droplet precautions are taken when the patient emits persistent infective particles into the air","correct":false,"justification":"Not persisting in air"},{"idx":2,"proposition":"Air precautions are taken when the patient emits infective particles that do not persist in the air","correct":false,"justification":"Persistent airborne"},{"idx":3,"proposition":"Contact precautions are taken when surfaces are contaminated","correct":true},{"idx":4,"proposition":"15-micrometre particles persist airborne","correct":false,"justification":"These are particles smaller than 5 micrometers.\""}],"type":"custom"}
+{"_id":"risques-infectio-9","context":null,"enonce":"Concerning additional hygiene precautions","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Tuberculosis imposes air precautions","correct":true,"justification":"This is the case: tuberculosis, measles and chickenpox"},{"idx":1,"proposition":"Flu requires contact precautions","correct":false,"justification":"Droplet precautions"},{"idx":2,"proposition":"RMOs impose air precautions","correct":false,"justification":"Contact precautions are sufficient"},{"idx":3,"proposition":"Pertussis imposes droplet precautions","correct":true,"justification":"This is also the case for influenza, meningococcus, mycoplasma, rubella, mumps, Parvovirus B19 and RSV"},{"idx":4,"proposition":"Dificile clostidiodia requires contact precautions","correct":true,"justification":"This is also the case for eHRBs and BMRs, enteroviruses, RSV, scabies and pediculosis.\""}],"type":"custom"}
+{"_id":"risques-infectio-10","context":null,"enonce":"Concerning hygiene prevention measures:","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"The patient uses a surgical mask for air and droplet precautions","correct":true},{"idx":1,"proposition":"Carriers apply standard precautions and apron in case of contact precautions","correct":true},{"idx":2,"proposition":"Hand washing with mild soap should precede hydroalcoholic friction","correct":true},{"idx":3,"proposition":"For Clostridioides difficile, conventional disinfectant detergents are sufficient for contact precautions","correct":false,"justification":"For Clostridioides difficile, conventional disinfectant detergents are not effective, use bleach as a disinfectant Protective isolation Protective measure to protect the immunocompromised patient (especially situations of prolonged neutropenia) from external contamination, avoiding contact with infectious agents"},{"idx":4,"proposition":"Limiting the indications for urinary catheters and their duration is useless","correct":false,"justification":"It is an asset in the fight against nosocomial infections.\""}],"type":"custom"}
+{"_id":"risques-infectio-11","context":null,"enonce":"Regarding urinary tract infections and urinary catheters:","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"For neurological bladders, indwelling catheterization is preferred","correct":false,"justification":"Adverse Events Associated with Care (HIAC) Prefer multi-day survey to indwelling survey for neurological bladders"},{"idx":1,"proposition":"Measuring the voiding residue by ultrasound (bladder scan) rather than by round-trip sampling is a preventive measure for HIAs","correct":true},{"idx":2,"proposition":"Systematically changing the bladder tube (e.g. 1 time every 3 days) helps limit urinal infections","correct":false,"justification":"No systematic change of the bladder tube"},{"idx":3,"proposition":"Urinary catheters are only changed if they leak","correct":false,"justification":"Change if it malfunctions (obstruction, leakage ...) or in case of proven tissue infection after 24 h of effective antibiotic therapy (allows to place the 'clean' probe in an environment with lower inoculum, in the presence of antibiotics)"},{"idx":4,"proposition":"Epidemiological and microbiological monitoring of urinary tract infections to detect epidemic phenomena is important","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"risques-infectio-12","context":null,"enonce":"Which of the following are true?","item":"risques","matiere":"infectio","propositions":[{"idx":0,"proposition":"Overall, there is an increase in multi-resistant bacteria","correct":true},{"idx":1,"proposition":"The most frequently encountered BMRs are extended-spectrum betalactamase-producing enterobacteriaceae ","correct":true},{"idx":2,"proposition":"The term IN refers to infections acquired in health care facilities","correct":true},{"idx":3,"proposition":"The definition of certain NIs is based on longer deadlines","correct":true},{"idx":4,"proposition":"Mushrooms are taking an increasing place in NIs","correct":true}],"type":"custom"}
+{"_id":"dysphonie-neuro-0","context":null,"enonce":"A few reminders:","item":"dysphonie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Dysphonia (or hoarseness) is a purely objective alteration of the sound support of speech resulting in the isolated or combined impairment of the three acoustic parameters of the voice which are pitch, intensity and timbre","correct":false,"justification":"Dysphonia (or hoarseness) is an objective or subjective alteration of the sound support"},{"idx":1,"proposition":"The voice is a sound produced by the vocal cords under the influence of exhaled air","correct":true},{"idx":2,"proposition":"The larynx is an element of the upper airway","correct":true},{"idx":3,"proposition":"Phonation requires the abduction of the vocal cords and the maintenance of subglottic pressure","correct":false,"justification":"Vocal cord adduction"},{"idx":4,"proposition":"Hypophonia during acute or chronic respiratory failure is a type of dysphonia","correct":false,"justification":"It is an alteration of the voice related to a defect of respiratory capacity so not a dysphonia"}],"type":"custom"}
+{"_id":"dysphonie-neuro-1","context":null,"enonce":"Regarding the diagnosis:","item":"dysphonie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Open rhinolalia involve hypernasality","correct":true},{"idx":1,"proposition":"Teachers, lawyers, amateur or professional singers are more exposed to functional voice disorders","correct":true},{"idx":2,"proposition":"Dyspnea or associated dysphagia indicates an extensive lesion beyond the vocal cords","correct":true},{"idx":3,"proposition":"Ultrasound is the basic examination to be performed in front of a dysphonia whose evolution is not quickly favorable","correct":false,"justification":"The laryngoscopic examination is the basic examination to be performed in front of a dysphonia whose evolution is not quickly favorable"},{"idx":4,"proposition":"Only the dynamic CT scan in a conscious patient can obtain precise information on the mobility of the larynx and vocal cords","correct":false,"justification":"Only the laryngoscope allows it"}],"type":"custom"}
+{"_id":"dysphonie-neuro-2","context":null,"enonce":"Regarding the diagnosis:","item":"dysphonie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Dysphagia and a curtain sign are seen in facial nerve paralysis","correct":false,"justification":"Glossopharyngeal nerve paralysis (IX)"},{"idx":1,"proposition":"Velopharyngeal paralysis should be sought by nasal regurgitation and open rhinolalia in particular","correct":true},{"idx":2,"proposition":"Sensory signs are often very marked on the face","correct":false,"justification":"The sensory signs are not very marked: hypoaesthesia or hemianesthesia of the pharynx and veil on a limited area"},{"idx":3,"proposition":"Involvement of the accessory nerve XI (also called \"spinal\") internal results in paralysis of the wings of the nose","correct":false,"justification":"Involvement of the accessory nerve XI (also called \"spinal\") internal results in velopalatine paralysis"},{"idx":4,"proposition":"Stroboscopy allows you to visualize abnormalities of the pharynx","correct":false,"justification":"It allows, by the decomposition of the vibratory movement of the vocal cords, to visualize an anomaly localized at the level of the mucosa of the vocal cord (synechia, fibrous scar, beginning tumor)"}],"type":"custom"}
+{"_id":"dysphonie-neuro-3","context":null,"enonce":"Regarding diagnosis and etiologies:","item":"dysphonie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Laryngeal electromyography is useless and is reserved as a last resort for dysphonia more than 6 months of evolution","correct":false,"justification":"It confirms peripheral neurogenic syndromes (vocal cord paralysis), neuromuscular junction syndromes (myasthenic syndromes) and dystonic syndromes (spasmodic dysphonia)"},{"idx":1,"proposition":"The phoniatric examination consists of recording lip movements to assess a neurological cause","correct":false,"justification":"It consists, in addition to the laryngoscopic examination, in the realization of a voice recording and a study of the objective parameters of the voice"},{"idx":2,"proposition":"The reference imaging examination is ultrasound","correct":false,"justification":"CT scan or magnetic resonance imaging are the two useful tests for etiological diagnosis"},{"idx":3,"proposition":"In unilateral paralysis of the pneumogastric nerve, the voice is typically blown or bitonale","correct":true},{"idx":4,"proposition":"In Dysphonia by velopalatine paralysis, the voice is hoarse, deep and more intense","correct":false,"justification":"In unilateral paralysis, functional signs are reduced to a minimum: nasal voice, discrete swallowing disorders, fluids tending to flow back through the nose"}],"type":"custom"}
+{"_id":"AVC-urg-0","context":null,"enonce":"About the epidemiology of stroke","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"The average age of stroke is 83 years","correct":false,"justification":"73 years (70 years for men, 76 years for women)"},{"idx":1,"proposition":"The incidence is 150,000 patients per year","correct":true},{"idx":2,"proposition":"50% of strokes are recurrences","correct":false,"justification":"0.25"},{"idx":3,"proposition":"Stroke is the leading cause of acquired motor disability in adults in France","correct":true},{"idx":4,"proposition":"Stroke is the leading cause of death in men","correct":false,"justification":"First cause of death in women, third leading cause of death in men"}],"type":"custom"}
+{"_id":"AVC-urg-1","context":null,"enonce":"Regarding the main clinical manifestations of cerebral infarctions according to arterial territories:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"The anterior circulation includes the opthalmic artery, the anterior cerebral artery and the middle cerebral artery.","correct":true,"justification":"Anterior circulation = carotid axes"},{"idx":1,"proposition":"Involvement of the anterior cerebral artery can result in a predominantly brachiofacial motor deficit.","correct":false,"justification":"Predominantly crural. Involvement of the middle (sylvian) cerebral artery results in a predominantly brachiofacial motor deficit."},{"idx":2,"proposition":"Involvement of the vertebrobasilar territory can give Wallenberg syndrome.","correct":true,"justification":"Via an attiente of the PICA (branch of the vertebral artery)"},{"idx":3,"proposition":"In the superficial sylvian artery of the minor hemisphere, there may be motor aphasia and Broca's fluent. ","correct":false,"justification":"Doubly false. It is an attack of the major hemisphere that will give Broca's aphasia. Broca's aphasia is motor and not fluent."},{"idx":4,"proposition":"Involvement of the anterior choroidal artery causes a syndrome of 3 H: hemiplegia, hemianesthesia and lateral hemianopsia homolateral to arterial occlusion. ","correct":false,"justification":"Controlateral to arterial occlusion"}],"type":"custom"}
+{"_id":"AVC-urg-2","context":null,"enonce":"Regarding infarction of the territory of the middle cerebral artery (Sylvian artery):","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"A total sylvian cerebral infarction combines signs of superficial and deep cerebral infarction, but also a combined deviation of the head and eyes on the contralateral side to the lesion. ","correct":false,"justification":"The conjugated deviation of the head and eyes goes towards the lesion. Everything else in the statement is true."},{"idx":1,"proposition":"When the minor hemisphere is affected in superficial sylvian cerebral infarction, it is Anton-Babinksi syndrome.","correct":true,"justification":"This syndrome includes anosognosia, hemiasomatognosia and hemineglect."},{"idx":2,"proposition":"Deep sylvian cerebral infarction corresponds to an attack of the internal capsule, which causes a proportional massive hemiplegia.","correct":true,"justification":"Hemiplegia is proportional because all pyramidal fibers pass through the inner capsule. There will therefore be no coral or brachiofacial predominance at the clinic."},{"idx":3,"proposition":"There may be a homonymous lateral hemianopsia during a superficial sylvian cerebral infarction.","correct":true,"justification":"Caution: HLH is also present during damage to the posterior cerebral artery"},{"idx":4,"proposition":"Involvement of the minor hemisphere can cause anosognosia (non-recognition of the disorder), hemiasomatognosia (non-recognition of the paralyzed hemibody) and hemineglect","correct":true,"justification":"This is called Anton-Babinski syndrome."}],"type":"custom"}
+{"_id":"AVC-urg-3","context":null,"enonce":"Regarding infarction of the territory of the anterior cerebral artery:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"There is predominantly brachiofacial hemiplegia.","correct":false,"justification":"Coral predominance (involvement of the paracentral lobule)"},{"idx":1,"proposition":"There may be ideomotor apraxia of the hand","correct":true},{"idx":2,"proposition":"There may be a frontal syndrome (adynamia, dysexecutive syndrome)","correct":true},{"idx":3,"proposition":"During unilateral and complete involvement of the anterior cerebral artery, there is an akinetic mutism","correct":false,"justification":"This would be true in the event of a bilateral infringement."},{"idx":4,"proposition":"The anterior cerebral artery and the sylvian artery can be affected at the same time","correct":true,"justification":"Possible in the context of thrombosis of the termination of the internal carotid artery (\"carotid T\")"}],"type":"custom"}
+{"_id":"AVC-urg-4","context":null,"enonce":"Regarding infarctions of the arteries vascularizing the brainstem:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"An alternate syndrome is defined by involvement of a cranial nerve on the side of the lesion and involvement of a long (sensory or motor) contralateral pathway to the lesion","correct":true,"justification":"Alternating syndromes are secondary to ischemic brainstem involvement"},{"idx":1,"proposition":"The most common alternate syndrome is protuberantial infarction","correct":false,"justification":"Wallenberg syndrome or infarction of the lateral part of the medulla elongata"},{"idx":2,"proposition":"The \"locked-in syndrome\" is caused by a bilateral infarction of the foot of the bridge (or protuberance)","correct":true},{"idx":3,"proposition":"The only possible movement during a \"locked-in syndrome\" is a horizontal movement of the eyes","correct":false,"justification":"Vertical"},{"idx":4,"proposition":"Brainstem infarctions are caused by damage to the vascularization of the posterior cerebral artery or basilar trunk","correct":true}],"type":"custom"}
+{"_id":"AVC-urg-5","context":null,"enonce":"Regarding Wallenberg syndrome:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"It is an infarction of the lateral part of the medulla elongata (retrobulbar), by occlusion of the artery of the lateral dimple of the medulla elongata (from the posteroinferior cerebellar artery)","correct":true},{"idx":1,"proposition":"There may be a feeling of dizziness, balance problems and posterior headaches","correct":true},{"idx":2,"proposition":"On the side of the lesion, there will be damage to the spinothalamic bundle which causes thermoalgic anesthesia of the hemibody sparing the face","correct":false,"justification":"Alternate syndrome is defined as involvement of a cranial nerve on the side of the lesion and involvement of a long, sensory or motor pathway, contralateral to the injury. The spino-thalamic bundle is a long pathway, so there will be contralateral involvement to the lesion"},{"idx":3,"proposition":"On the side of the lesion, there will be: Claude Bernard-Horner syndrome (involvement of a sympathetic pathway), cerebellar hemisyndrome (involvement of the inferior cerebellar peduncle), vestibular syndrome with rotational nystagmus (involvement of VIII), phonation and swallowing disorders with paralysis of the hemiveil and hemipharynx (involvement of nerves IX and X) and anesthesia of the hemiface (involvement of the descending root of the V).","correct":true},{"idx":4,"proposition":"Wallenberg syndrome is also called alternate sensory syndrome","correct":true}],"type":"custom"}
+{"_id":"AVC-urg-6","context":null,"enonce":"The multideficiency condition caused by the multiplication of small deep infarcts can cause:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"A bulbar syndrome","correct":false,"justification":"A pseudobulbar syndrome = damage to the central motor neurons of the corticobulbar pyramidal bundles"},{"idx":1,"proposition":"Spasmodic laughter and crying","correct":true},{"idx":2,"proposition":"A walk with small steps","correct":true},{"idx":3,"proposition":"Sphincter disorders","correct":true},{"idx":4,"proposition":"Deterioration of cognitive function","correct":true}],"type":"custom"}
+{"_id":"AVC-urg-7","context":null,"enonce":"Regarding the dissection of the cervico-encephalic arteries:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"Neck pain or headache may be present","correct":true,"justification":"This is the essential sign of dissection, to look for in front of any infarction of the young subject (periorbital headache on carotid dissection, posterior on vertebral dissection)"},{"idx":1,"proposition":"There may be Claude Bernard-Horner syndrome","correct":true,"justification":"By pericarotid sympathetic plexus involvement (myosis, ptosis and enophthalmos)"},{"idx":2,"proposition":"There may be paralysis of the lower cranial nerves (IX, X, XI)","correct":true,"justification":"They travel along the internal carotid arer in the posterior subparotid space"},{"idx":3,"proposition":"There may be pulsatile tinnitus","correct":true,"justification":"By perception of the acceleration of blood flow in the intrapetrous carotid artery"},{"idx":4,"proposition":"The symptomatology associates an inconstant triad: neck pain \/ headache, local signs homolateral to dissection, and ischemic signs","correct":true}],"type":"custom"}
+{"_id":"AVC-urg-8","context":null,"enonce":"Regarding the etiologies of stroke:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"80% of strokes are ischemic and 20% are hemorrhagic","correct":true},{"idx":1,"proposition":"Horton's disease can cause ischemic stroke","correct":true,"justification":"Horton's disease is a vasculitis of the large vessels, mainly affecting the encephalic vessels"},{"idx":2,"proposition":"Ischemic strokes caused by cardiac embolism are more common than strokes caused by atherosclerosis","correct":false,"justification":"Atherosclerosis is the leading cause of ischemic stroke (30% of ischemic strokes). Heart emboli cause about 20% of ischemic strokes."},{"idx":3,"proposition":"In 50% of ischemic strokes, the etiology is unknown","correct":false,"justification":"0.25"},{"idx":4,"proposition":"A dissection of the cervicoencephalic arteries should be sought during an ischemic stroke in young subjects","correct":true,"justification":"Always look for a traumatic cause, chronic hypertension or pathology of the arteries (connective tissue disease such as Ehlers-Danlos disease, fibromuscular dysplasia)"}],"type":"custom"}
+{"_id":"AVC-urg-10","context":null,"enonce":"The territories most frequently affected in microangiopathy associated with chronic hypertension, causing intraparenchymal hemorrhage, are:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"Capsulothalamic","correct":true,"justification":"Most frequent location"},{"idx":1,"proposition":"Frontal cortex","correct":false,"justification":"The 3 most frequent locations are, in order of frequency: capsulothalamic, capsulolenticular and cerebellar"},{"idx":2,"proposition":"The brainstem bridge","correct":false},{"idx":3,"proposition":"Capsulolenticular","correct":true},{"idx":4,"proposition":"Cerebellar","correct":true}],"type":"custom"}
+{"_id":"AVC-urg-11","context":null,"enonce":"What is the leading cause of lobar intraparenchymal hemorrhage in the elderly?","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"Chronic hypertension","correct":false,"justification":"Typically deep"},{"idx":1,"proposition":"Long-term oral anticoagulants","correct":false},{"idx":2,"proposition":"Amyloid angiopathy","correct":true,"justification":"Often recurrent"},{"idx":3,"proposition":"Brain tumours","correct":false},{"idx":4,"proposition":"Infective endocarditis","correct":false}],"type":"custom"}
+{"_id":"AVC-urg-13","context":null,"enonce":"Which are MRI sequences that are part of the emergency protocol for a stroke less than 6 hours old?","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"T2•","correct":true,"justification":"Allows to visualize any intraparenchymal hemorrhagic lesion"},{"idx":1,"proposition":"Time of flight","correct":true,"justification":"Angio-MR sequence (MRA) performed without injection of contrast medium, for the study of the branches of the Willis polygon and the visualization of a possible arterial occlusion."},{"idx":2,"proposition":"Infusion","correct":false,"justification":"Visualization of a hypoperfused area: the subtraction between infusion and diffusion makes it possible to identify the area of penumbra where the lesions are potentially reversible under treatment. On the other hand, it is not mandatory in the management of a heart attack less than 6 hours old."},{"idx":3,"proposition":"Broadcast sequence","correct":true,"justification":"Visualizes cerebral infarction very early in the form of systematized hyperintensity"},{"idx":4,"proposition":"T2-FLAIR","correct":true}],"type":"custom"}
+{"_id":"AVC-urg-15","context":null,"enonce":"Regarding the control of blood pressure in the acute phase of a stroke:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"It is necessary to add an IV antihypertensive treatment (nicardipine type) if the BP > 140\/90 mmHg in a cerebral infarction.","correct":false,"justification":"The blood pressure surge is physiological in front of a stroke, to ensure adequate perfusion of the brain. Antihypertensive drugs should be introduced only when the BP > 220\/120 mmHg for cerebral infarction."},{"idx":1,"proposition":"Following treatment with thrombolysis or endovascular thrombectomy, blood pressure below 185\/110 mmHg must be maintained.","correct":true},{"idx":2,"proposition":"In front of intraparenchymal hemorrhage, the target BP is < 140\/90 mmHg","correct":true,"justification":"Increased BP may worsen intraparenchymal hemorrhage"},{"idx":3,"proposition":"High blood pressure should be routinely treated > 140\/90 mmHg in front of stroke","correct":false,"justification":"No, only if it is a hemorrhagic stroke"},{"idx":4,"proposition":"It is necessary to respect the blood pressure surge in front of an ischemic stroke","correct":true}],"type":"custom"}
+{"_id":"AVC-urg-16","context":null,"enonce":"Regarding thrombolysis IV:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"The drug for thrombolysis IV is rt-PA (Recombinant Tissue-Plasminogen Activator, Alteplase)","correct":true},{"idx":1,"proposition":"It can only be introduced if the stroke schedule is known and is less than 4:30 a.m.","correct":false,"justification":"Warning: it is possible to introduce it if there is a FLAIR-diffusion mismatch in MRI on a stroke of indeterminate schedule"},{"idx":2,"proposition":"It induces a risk of angioedema","correct":true,"justification":"Especially in patients treated with ACE inhibitors"},{"idx":3,"proposition":"It induces a high risk of cerebral hemorrhage and gastric hemorrhage","correct":true},{"idx":4,"proposition":"Target blood pressure after IV thrombolysis is 220\/120 mmHg","correct":false,"justification":"TA < 185\/110 mmHg"}],"type":"custom"}
+{"_id":"AVC-urg-17","context":null,"enonce":"Regarding the antagonization of anticoagulants in case of intraparenchymal hemorrhage:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"Under VKA, PPSB and vitamin K should be administered urgently, at doses independent of the patient's weight","correct":false,"justification":"Adapted to the patient's weight"},{"idx":1,"proposition":"Under dabigatran, it is necessary to add its antidose which is idarucizumab","correct":true,"justification":"Reminder: Dabigatran is the only AOD that has an antidote"},{"idx":2,"proposition":"Oral anti-Xa may benefit from a specific antidote","correct":false,"justification":"PPSB or FEIBA must be administered urgently"},{"idx":3,"proposition":"When bleeding on antiplatelet agents, platelets can be transfused","correct":false,"justification":"Lack of demonstration of benefit"},{"idx":4,"proposition":"It is possible to add LMWH at isocoagulant dose (in the absence of contraindications) 24 hours after the onset of intraparenchymal hemorrhage","correct":true,"justification":"LMWH or intermittent pneumatic back pressure (standard of care to prevent thromboembolic complications in intracerebral haemorrhage)"}],"type":"custom"}
+{"_id":"certificats-psy-0","context":null,"enonce":"Among these proposals, which are principles of organ donation:","item":"certificats","matiere":"psy","propositions":[{"idx":0,"proposition":"Free consent","correct":true,"justification":"Free, enlightened, revocable, special"},{"idx":1,"proposition":"Anonymity","correct":true},{"idx":2,"proposition":"Financial compensation","correct":false,"justification":"It must be free"},{"idx":3,"proposition":"The absence of advertising","correct":true},{"idx":4,"proposition":"Health security","correct":true,"justification":"The donation must be made safely for both parties\""}],"type":"custom"}
+{"_id":"certificats-psy-1","context":null,"enonce":"Which of the following are true?","item":"certificats","matiere":"psy","propositions":[{"idx":0,"proposition":"The law establishes the principle of inviolability (respect for the body) and non-patrimoniality (free donation) of the human body","correct":true},{"idx":1,"proposition":"Bioethics laws allow the removal of organs and tissues for therapeutic purposes in order to perform transplants and save lives","correct":true},{"idx":2,"proposition":"The state of brain death corresponds to the irreversible and isolated destruction of all intracranial nerve centers following complete brain circulatory arrest","correct":true},{"idx":3,"proposition":"The diagnosis of brain death is clinical","correct":false,"justification":"The diagnosis of brain death includes a clinical aspect and the use of confirmation by a paraclinical examination having medico-legal value in the context of a possible organ donation"},{"idx":4,"proposition":"There is no additional test to be done to diagnose a state of brain death","correct":false,"justification":"The paraclinical examinations to arm the diagnosis of brain death state are either two electroencephalograms (EEG) performed four hours apart under maximum amplification, or cerebral angiography (arteriography of the four cerebral vascular axes or cerebral angiography of easier realization)\""}],"type":"custom"}
+{"_id":"certificats-psy-2","context":null,"enonce":"Which of the following are true?","item":"certificats","matiere":"psy","propositions":[{"idx":0,"proposition":"The report of brain death must be signed by a doctor","correct":false,"justification":"The report of brain death is signed by two doctors"},{"idx":1,"proposition":"In case of death with \"heart stopped\", the report must be signed by a doctor","correct":true},{"idx":2,"proposition":"Consent to organ removal is no longer revocable when the donor enters the hospital","correct":false,"justification":"Consent to organ or tissue removal may be revoked at any time"},{"idx":3,"proposition":"Patients diagnosed with brain death (EM) are the main potential organ and tissue donors","correct":true},{"idx":4,"proposition":"It may be decided not to remove certain organs if the patient had expressed this wish during his lifetime.","correct":true}],"type":"custom"}
+{"_id":"certificats-psy-3","context":null,"enonce":"Regarding consent or refusal of organ donation","item":"certificats","matiere":"psy","propositions":[{"idx":0,"proposition":"The first kidney transplants were performed in the 1960s and 1970s while the first heart was successfully transplanted in 1967 (Professor Barnard in Cape Town)","correct":true},{"idx":1,"proposition":"The principle of inviolability of the human body means that an individual does not sell his body","correct":false,"justification":"Consent The principle of inviolability of the human body means that an individual cannot be compelled to suffer harm to his or her body."},{"idx":2,"proposition":"In France, the law specifies that organ or tissue removal may be carried out only if the deceased person has not made known his refusal during his lifetime (art.","correct":true},{"idx":3,"proposition":"Any elderly adult may register on the national register of refusals of organ removal","correct":false,"justification":"Anyone over the age of thirteen can register or unsubscribe confidentially on this register"},{"idx":4,"proposition":"In the case of an oral expression of the refusal, the medical team will ask the relatives to specify the circumstances and to sign the transcript that will be made in writing.","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"certificats-psy-5","context":null,"enonce":"Which communicable diseases are urgently detected in the donor?","item":"certificats","matiere":"psy","propositions":[{"idx":0,"proposition":"HIV1 and HIV2","correct":true},{"idx":1,"proposition":"Hepatitis A","correct":false,"justification":"Hepatitis B and C"},{"idx":2,"proposition":"Malaria","correct":false,"justification":"CMV, VRB, Syphilis, Toxoplasmosis, HIV1 and 2, HTLV1 and 2, HBV and HCV"},{"idx":3,"proposition":"Syphilis","correct":true},{"idx":4,"proposition":"Whooping cough","correct":false}],"type":"custom"}
+{"_id":"certificats-psy-7","context":null,"enonce":"Which of these reflexes can persist even in the event of brain death?","item":"certificats","matiere":"psy","propositions":[{"idx":0,"proposition":"The Achilles reflex","correct":true,"justification":"It is a spinal cord reflex"},{"idx":1,"proposition":"Babinsky's sign","correct":true,"justification":"Spinal cord reflex"},{"idx":2,"proposition":"Reaction myosis","correct":false,"justification":"It is a brainstem reflex. Patients in EME (brain death state) are in areactive mydriasis"},{"idx":3,"proposition":"The sign of lazarus","correct":true,"justification":"This is the abduction or adduction of the arm after nociceptive stimulation"},{"idx":4,"proposition":"The cutaneous-plantar reflex","correct":true,"justification":"Synonym of Babinski's sign\""}],"type":"custom"}
+{"_id":"certificats-psy-8","context":null,"enonce":"Regarding the diagnosis of EME","item":"certificats","matiere":"psy","propositions":[{"idx":0,"proposition":"The diagnosis of ME is only clinical","correct":false,"justification":"Diagnosis of brain death The diagnosis of ME is primarily clinical but must be confirmed by a paraclinical examination"},{"idx":1,"proposition":"Brain angio-CT is more used than arteriography to confirm an EME","correct":true,"justification":"Cerebral angio-CT is currently the most common examination performed"},{"idx":2,"proposition":"CT angiography is not recommended because it is less specific than arteriography.","correct":false,"justification":"It is a fast and minimally invasive technique with a protocol defined by the French Society of Neuroradiology, Radiology and the ABM"},{"idx":3,"proposition":"The angioscanner is mainly done at portal time to visualize the sinuses","correct":false,"justification":"It is performed at least 6 hours after the clinical diagnosis of ME and includes 4 series of acquisitions, 3 successive and identical after the injection of contrast medium, and a last 60 seconds after the start of the injection"},{"idx":4,"proposition":"CT angiography requires an average blood pressure greater than 65 mmHg","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"certificats-psy-9","context":null,"enonce":"Concerning the sampling in case of EME or stopped heart","item":"certificats","matiere":"psy","propositions":[{"idx":0,"proposition":"The diagnosis of ME is established at the end of the paraclinical examination whose time of realization signs the time of death of the patient","correct":true},{"idx":1,"proposition":"The report of encephalic death must be drawn up and signed by 2 doctors not belonging to the transplant services","correct":true},{"idx":2,"proposition":"Organ harvesting procedure can begin as soon as brain death is suspected","correct":false,"justification":"Once this diagnosis is established, the procedure of organ and tissue removal can be initiated while the organs and tissues are maintained in survival through resuscitation."},{"idx":3,"proposition":"If the heart stops, this organ may be considered to transplant a recipient in need.","correct":false,"justification":"The deceased donor with heart arrested (corpse) 52 Only tissue samples (corneas and skin) are possible in this context"},{"idx":4,"proposition":"For heart-stamped donors, we can do without respect for consent","correct":false,"justification":"Tissue samples are subject to the same legislation as in the case of EM concerning the rules of health safety and consent (search for the non-opposition of the donor on the RNR and with relatives)\""}],"type":"custom"}
+{"_id":"ProtU-nephro-2","context":null,"enonce":"Regarding proteinuria:","item":"ProtU","matiere":"nephro","propositions":[{"idx":0,"proposition":"Isolated tubular proteinurias are very common after age 75","correct":false,"justification":"They are rare and most often accompany Fanconi syndrome"},{"idx":1,"proposition":"Microalbuminuria is specific for glomerular involvement when the patient is diabetic","correct":true},{"idx":2,"proposition":"Microalbuminuria is an independent marker of high cardiovascular risk","correct":true},{"idx":3,"proposition":"Orthostatic proteinuria occurs during puberty","correct":true},{"idx":4,"proposition":"Orthostatic proteinuria requires MRI centered on the hypothalamic-pituitary area","correct":false,"justification":"Orthostatic proteinuria does not require any additional examination"}],"type":"custom"}
+{"_id":"ProtU-nephro-3","context":null,"enonce":"Regarding vascular thrombosis and coagulation abnormalities in nephrotic syndrome: ","item":"ProtU","matiere":"nephro","propositions":[{"idx":0,"proposition":"Thrombosis concerns only the arterial territory","correct":false},{"idx":1,"proposition":"Venous thrombosis of the renal veins and cerebral venous sinuses may occur ","correct":true},{"idx":2,"proposition":"There is increased urinary loss of procoagulant factors","correct":false,"justification":"Anticoagulant"},{"idx":3,"proposition":"There is an increased synthesis of procoagulant factors (antithrombin III, Protein S ...)","correct":false,"justification":"Antithrombin III and Prot S are anticoag factors. True if Factor V, VIII, fibrinogen ...)"},{"idx":4,"proposition":"Anticoagulant therapy is prescribed if albumin is < 30 g\/L ","correct":false,"justification":"20 g\/L"}],"type":"custom"}
+{"_id":"ProtU-nephro-4","context":null,"enonce":"Which of the following are secondary causes of nephrotic syndrome? : ","item":"ProtU","matiere":"nephro","propositions":[{"idx":0,"proposition":"Diabetes","correct":true},{"idx":1,"proposition":"HIV ","correct":true},{"idx":2,"proposition":"Isolated monoclonal gammopathy ","correct":true},{"idx":3,"proposition":"D-penicillamine","correct":true},{"idx":4,"proposition":"Pre-eclampsia ","correct":true}],"type":"custom"}
+{"_id":"ProtU-nephro-5","context":null,"enonce":"At the biospy of a nephrotic syndrome, we can find:","item":"ProtU","matiere":"nephro","propositions":[{"idx":0,"proposition":"Minimal glomerular lesions ","correct":true},{"idx":1,"proposition":"Extramembranous granular deposits of IgG and C3 without cell proliferation ","correct":true,"justification":"GEM can manifest as nephrotic syndrome"},{"idx":2,"proposition":"Mass deposits of IgA ","correct":true,"justification":"Rare that Berger's disease presents with nephrotic syndrome, svt hematuric syndrome"},{"idx":3,"proposition":"Extracapillary croissants ","correct":false,"justification":"Ds les GNRP"},{"idx":4,"proposition":"Amyloid deposits ","correct":true}],"type":"custom"}
+{"_id":"ProtU-nephro-6","context":null,"enonce":"Which of the following proposals would be in favor of extracellular hyperhydration?","item":"ProtU","matiere":"nephro","propositions":[{"idx":0,"proposition":"Weight gain","correct":true},{"idx":1,"proposition":"Jugular turgor","correct":true},{"idx":2,"proposition":"Declivated edema","correct":true},{"idx":3,"proposition":"Headache","correct":false,"justification":"Does not fit into this framework"},{"idx":4,"proposition":"Crackling of the 2 pulmonary bases","correct":true}],"type":"custom"}
+{"_id":"ProtU-nephro-7","context":null,"enonce":"Which of the following propositions concerning physiological proteinuria is or are true?","item":"ProtU","matiere":"nephro","propositions":[{"idx":0,"proposition":"It is by definition < 0.5g\/day","correct":false},{"idx":1,"proposition":"It is composed mainly of light chains","correct":false,"justification":"Especially low molecular weight proteins (< 70kDa)"},{"idx":2,"proposition":"It is composed mainly of low molecular weight proteins","correct":true},{"idx":3,"proposition":"It may be associated with orthostatic hematuria","correct":false,"justification":"No physiologically orthostatic hematuria"},{"idx":4,"proposition":"It can be detected by the urine strip","correct":false,"justification":"BU only detects albumin"}],"type":"custom"}
+{"_id":"IRC-nephro-0","context":null,"enonce":"Regarding general information on chronic kidney disease (CKD) and end-stage renal disease (ESRD):","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"proposition":"Chronic renal failure is defined by the irreversible decrease in glomerular filtration rate","correct":true},{"idx":1,"proposition":"The only treatment for end-stage renal disease is kidney transplantation","correct":false,"justification":"And\/or extrarenal purification (hemodialysis or peritoneal dialysis)"},{"idx":2,"proposition":"End-stage renal disease is more common in men than in women","correct":true},{"idx":3,"proposition":"The leading cause of end-stage renal disease is chronic interstitial nephropathy","correct":false,"justification":"It is vascular and hypertensive nephropathy (25%), followed closely by diabetic nephropathy (22%)"},{"idx":4,"proposition":"Obesity is a risk factor for CKD","correct":true}],"type":"custom"}
+{"_id":"IRC-nephro-1","context":null,"enonce":"Among these proposals, which are arguments of chronic kidney disease:","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"proposition":"Benign cysts detected on CT","correct":false,"justification":"CT = Scanner. They are often without impact on the kidney"},{"idx":1,"proposition":"Chronic hypocalcemia","correct":true,"justification":"By active vitamin D deficiency due to the absence of renal hydroxylation (in position 1. As a reminder, hepatic hydroxylation is in position 25)"},{"idx":2,"proposition":"Aregenerative anemia","correct":true,"justification":"Default production of erythropoietin. It is often normocytic and normochromic, as well as well tolerated because of progressive installation."},{"idx":3,"proposition":"Recurrent low urinary tract infections","correct":false,"justification":"Generally without impact on the renal parenchyma, unless they are pyelonephritis"},{"idx":4,"proposition":"Kidneys with a major axis of less than 10 cm on ultrasound","correct":true,"justification":"A decrease in the size of the kidneys is a morphological criterion\""}],"type":"custom"}
+{"_id":"IRC-nephro-2","context":null,"enonce":"Which propositions are true?","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"proposition":"In some tubulopathies, the diagnosis of CKD is based on the existence of blood ion abnormalities","correct":true},{"idx":1,"proposition":"The GFR can only be estimated by formulas ","correct":false,"justification":"GFR can be measured by measuring the clearance of exogenous tracers filtered as such by the kidney (such as inulin)"},{"idx":2,"proposition":"The Cockcroft and Gault formula is the most accurate for assessing GFR from creatitinemia","correct":false,"justification":"It is much less accurate than MDRD, and CKD-PPE when GFR is greater than 60. But it is calculable without a computer, so potentially requested for examination"},{"idx":3,"proposition":"The deadline to declare kidney disease as chronic is 3 months","correct":true},{"idx":4,"proposition":"There are 5 stages of CKD","correct":true,"justification":"They are differentiated by the GFR: >=90, 60, 45, 30, <15"}],"type":"custom"}
+{"_id":"IRC-nephro-3","context":null,"enonce":"Which propositions are true?","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"proposition":"The incidence of terminal IR is 1200 patients per million inhabitants in metropolitan France","correct":false},{"idx":1,"proposition":"There are areas where there are almost as many transplant patients as hemodialysis patients","correct":true},{"idx":2,"proposition":"An RCM can only be established after three months of GFR decline","correct":true,"justification":"Below 3 months, we can not talk about MRC"},{"idx":3,"proposition":"CKD is accompanied by metabolic alkalosis with increased bicarbonates","correct":false,"justification":"Metabolic acidosis is observed by decreased acid filtration"},{"idx":4,"proposition":"Significantly reduced kidneys are an anamnestic criterion for CKD","correct":false,"justification":"Morphological criterion"}],"type":"custom"}
+{"_id":"IRC-nephro-4","context":null,"enonce":"Which of these proposals are expected complications of IRC?","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"proposition":"Metabolic acidosis","correct":true,"justification":"By decreasing acid filtration, and is aggravated by protein catabolism. There are therapeutic proposals: bicarbonates, Vichy water..."},{"idx":1,"proposition":"A HTA","correct":true,"justification":"Volo-dependent, with consecutive HVG"},{"idx":2,"proposition":"Type 2 diabetes","correct":false,"justification":"Not a consequence, but a common cause"},{"idx":3,"proposition":"Normochrome normocytic aregenerative anemia","correct":true,"justification":"By EPO deficiency"},{"idx":4,"proposition":"Primary hyperparathyroidism","correct":false,"justification":"It is secondary to the decrease in serum calcium (itself due to the deficiency of hydroxylation of 25-OH-VitamineD by the kidney)"}],"type":"custom"}
+{"_id":"IRC-nephro-5","context":null,"enonce":"Regarding complications of CKD:","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"proposition":"Hyperuricemia can cause heart problems","correct":true},{"idx":1,"proposition":"Hyperuricemia is never symptomatic","correct":false,"justification":"It is often asymptomatic, but in case of a gout attack, treatment is necessary"},{"idx":2,"proposition":"Hyperphosphremia is often found","correct":true},{"idx":3,"proposition":"Is aimed at a blood pressure control with a BP < 140\/90mmHg in case of albuminuria < 30g \/ 24h","justification":"Small trap: take a good look at the units... (sorry)","correct":false},{"idx":4,"proposition":"IEC and ARA2 are so-called \"nephroprotective\" treatments","correct":true}],"type":"custom"}
+{"_id":"IRC-nephro-6","context":null,"enonce":"Which of the following propositions regarding dyalsis and transplantation are true?","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"proposition":"Hemodialysis is the most frequently used replacement technique in France","correct":true,"justification":"True, it is also the most expensive"},{"idx":1,"proposition":"Hemodialysis is based on two types of transfers: conductive and dynamic.","correct":false,"justification":"2 types of exchanges: diffusion and convection"},{"idx":2,"proposition":"Peritoneal dialysis is performed at home and is better tolerated hemodynamically","correct":true},{"idx":3,"proposition":"Peritoneal dialysis is a time-limited technique","correct":true,"justification":"True, mainly because of the alteration of the peritoneum which is a membrane that fibrosis by force"},{"idx":4,"proposition":"Kidney transplantation provides a better life expectancy than dyalsis","correct":true}],"type":"custom"}
+{"_id":"IRC-nephro-7","context":null,"enonce":"Which of the following propositions on kidney transplantation are true?","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"proposition":"Cadaveric donors can be heart-stamped","correct":true},{"idx":1,"proposition":"The grafts are managed by the ANSM","correct":false,"justification":"The Biomedicine Agency"},{"idx":2,"proposition":"Induction therapy may be anti-lymphocyte serum, rituximab or corticosteroids","correct":true},{"idx":3,"proposition":"Ciclosporin and tacrolimus are calcineurin inhibitors  ","correct":true},{"idx":4,"proposition":"Belatacept selectively blocks the interaction of CD80\/CD86 antigen-presenting cells with the CD28 molecule of the T cell","correct":true}],"type":"custom"}
+{"_id":"palpitations-cardio-0","context":null,"enonce":"Regarding palpitations","item":"palpitations","matiere":"cardio","propositions":[{"idx":0,"proposition":"Palpitations are an abnormal perception of normal or abnormal heartbeats","correct":true},{"idx":1,"proposition":"These are objective disorders that may or may not indicate a cardiac abnormality","correct":false,"justification":"Subjective disorders with or without cardiac abnormality"},{"idx":2,"proposition":"Often anxiety-provoking","correct":true},{"idx":3,"proposition":"The diagnosis is made mainly during the interrogation","correct":true},{"idx":4,"proposition":"Look for other symptoms that would immediately change management, such as chest pain, loss of consciousness\/syncope, dyspnea","correct":true}],"type":"custom"}
+{"_id":"palpitations-cardio-1","context":null,"enonce":"Regarding palpitations","item":"palpitations","matiere":"cardio","propositions":[{"idx":0,"proposition":"A pulse > 150 bpm is a sign of gravity","correct":true},{"idx":1,"proposition":"The initial ECG is often normal","correct":true},{"idx":2,"proposition":"Routine biological tests (ionogram, CBC, blood alcohol level, troponinemia, β-HCG, TSH in particular) are necessary in front of palpitations","correct":true},{"idx":3,"proposition":"Extrasystoles are not a pathological element in themselves, but are a clue to look for underlying heart disease or extracardiac pathology","correct":true},{"idx":4,"proposition":"Isolated extrasystoles may explain palpitations","correct":true}],"type":"custom"}
+{"_id":"palpitations-cardio-2","context":null,"enonce":"Regarding palpitations","item":"palpitations","matiere":"cardio","propositions":[{"idx":0,"proposition":"Common causes of extrasystoles include alcoholization, lung disease, bronchial neoplasia, hyperthyroidism, electrolyte abnormalities, pregnancy","correct":true},{"idx":1,"proposition":"Cardiac neurosis can cause palpitations but remains a diagnosis of elimination, sometimes self-maintained by management or iterative consultations","correct":true},{"idx":2,"proposition":"The diagnosis of cardiac neurosis is based on a strictly normal ECG at the time of palpitations, often obtained through long-term monitoring","correct":true},{"idx":3,"proposition":"Palpitations are a banal symptom that disappears behind a possible more serious symptom such as syncope, chest pain or dyspnea","correct":true},{"idx":4,"proposition":"The primary objective of management is to rule out signs of severity related to terrain, poor hemodynamic tolerance or immediate registration of ventricular rhythm disorder","correct":true}],"type":"custom"}
+{"_id":"palpitations-cardio-3","context":null,"enonce":"Regarding palpitations","item":"palpitations","matiere":"cardio","propositions":[{"idx":0,"proposition":"Once the immediate emergency is managed, the next two objectives are the search for heart disease or extracardiac disease and electrocardiographic documentation","correct":true},{"idx":1,"proposition":"Simultaneous ECG documentation of symptoms leads to the notion of electroclinical correlation","correct":true},{"idx":2,"proposition":"Electroclinical correlation may require in order of increasing complexity, standard ECG, Holter 24–96 hours, ambulatory monitoring 21 days, endocavitary electrophysiological study and implantable monitor","correct":true},{"idx":3,"proposition":"The final diagnosis may be limited to sinus tachycardia or extrasystoles whose extracardiac causes must be known.","correct":true},{"idx":4,"proposition":"Among the rhythm disorders responsible for palpitations, atrial fibrillation and flutter are the most common with following junctional tachycardia","correct":true}],"type":"custom"}
+{"_id":"dlrped-ped-0","context":null,"enonce":"Regarding pain in children:","item":"dlrped","matiere":"ped","propositions":[{"idx":0,"proposition":"It often has a triphase presentation: appearance, plateau, disappearance","correct":false,"justification":"Biphasic: acute then prolonged"},{"idx":1,"proposition":"Collaboration with parents is essential for good care","correct":true,"justification":"It's one of the situations where you have to include them"},{"idx":2,"proposition":"The first step in management is pain assessment","correct":true},{"idx":3,"proposition":"Therapy differs from adults and is specific to children","correct":false,"justification":"The therapeutic principles are close to those of adults"},{"idx":4,"proposition":"There is a specific MA for use in paediatrics","correct":true}],"type":"custom"}
+{"_id":"dlrped-ped-1","context":null,"enonce":"From what age a pain self-assessment can be proposed","item":"dlrped","matiere":"ped","propositions":[{"idx":0,"proposition":"1 year","correct":false,"justification":"4 years"},{"idx":1,"proposition":"4 years","correct":true},{"idx":2,"proposition":"8 years","correct":false},{"idx":3,"proposition":"6 years","correct":false},{"idx":4,"proposition":"10 years","correct":false}],"type":"custom"}
+{"_id":"dlrped-ped-2","context":null,"enonce":"From what age a pain self-assessment is reliable","item":"dlrped","matiere":"ped","propositions":[{"idx":0,"proposition":"1 year","correct":false},{"idx":1,"proposition":"4 years","correct":false},{"idx":2,"proposition":"8 years","correct":false,"justification":"6 years"},{"idx":3,"proposition":"6 years","correct":true},{"idx":4,"proposition":"10 years","correct":false}],"type":"custom"}
+{"_id":"dlrped-ped-3","context":null,"enonce":"Which of the following propositions concerning pain in children are true?","item":"dlrped","matiere":"ped","propositions":[{"idx":0,"proposition":"Tramadol is indicated in pediatrics for severe pain from the age of 3 years","correct":true,"justification":"True, EVA > 5\/10"},{"idx":1,"proposition":"Paracetamol is indicated in case of neuropathic pain","correct":false,"justification":"False, pain by excess of nociception especially. For neuropathic pain, amitryptilline (antidepressant) or gabapentin (antiepileptic) are used in MA"},{"idx":2,"proposition":"The dosage of paracetamol in children is 60 mg \/ kg \/ day in 4 doses","correct":true,"justification":"True, 15 mg\/kg per dose"},{"idx":3,"proposition":"Paracetamol is contraindicated in newborns","correct":false,"justification":"The AMM authorizes it from birth"},{"idx":4,"proposition":"Codeine is possible from the age of 12 (unless contraindicated)","correct":true}],"type":"custom"}
+{"_id":"dlrped-ped-4","context":null,"enonce":"Which of the following can be used in a 2-year-old child?","item":"dlrped","matiere":"ped","propositions":[{"idx":0,"proposition":"EVENDOL","correct":true,"justification":"True, always a hetero-evaluation before 4 years"},{"idx":1,"proposition":"Hetero-rating scale","correct":true},{"idx":2,"proposition":"Visual Analogue Scale (EVA)","correct":false,"justification":"Reliable self-assessment from 6 years old"},{"idx":3,"proposition":"Numerical scale","correct":false,"justification":"False"},{"idx":4,"proposition":"Face scale (Wong and Baker)","correct":false,"justification":"Validated self-report scale in adults and the elderly with difficulty using VAS, EN or EVS, e.g. in patients with verbalization difficulties"}],"type":"custom"}
+{"_id":"handicapped-mpr-0","context":null,"enonce":"Which propositions are true?","item":"handicapped","matiere":"mpr","propositions":[{"idx":0,"proposition":"The occurrence of a disability or chronic disease in children is a relatively common situation in France","correct":true},{"idx":1,"proposition":"Cerebral palsy is the leading cause of motor disability","correct":true},{"idx":2,"proposition":"Cerebral palsy is related to a brain injury that occurred in the antenatal or perinatal period","correct":true},{"idx":3,"proposition":"The main risk factor for cerebral palsy is genetic deficiency","correct":false,"justification":"The main risk factor for cerebral palsy is prematurity"},{"idx":4,"proposition":"trisomy 21 and fetal alcohol syndrome (FAS) are the leading cause of mental retardation, respectively hereditary and non-hereditary","correct":true,"justification":"V"}],"type":"custom"}
+{"_id":"handicapped-mpr-1","context":null,"enonce":"Regarding the generalities of disability in children:","item":"handicapped","matiere":"mpr","propositions":[{"idx":0,"proposition":"Multiple disability is a severe disability associated with severe and long-term impairment with severe or profound mental retardation.","correct":true},{"idx":1,"proposition":"Over-disability is the addition of secondary impairments or behavioural disorders to a pre-existing disability","correct":true},{"idx":2,"proposition":"The child's disabilities are always congenital","correct":false,"justification":"Can be acquired: trauma, iatrogenic, etc."},{"idx":3,"proposition":"The child is an adult in miniature","correct":false,"justification":"The child is a developing being! It is not an adult in miniature"},{"idx":4,"proposition":"The goal of rehabilitation care is to correct the disabling lesion","correct":false,"justification":"The goal of rehabilitation care is to assess and limit the consequences of this lesion and to stimulate the development of the child (brain plasticity)"}],"type":"custom"}
+{"_id":"handicapped-mpr-3","context":null,"enonce":"Concerning the management of disability in children:","item":"handicapped","matiere":"mpr","propositions":[{"idx":0,"proposition":"The care of a disabled child must be centered around the medical and psychological","correct":false,"justification":"It must be comprehensive: medically, psychologically, academically and socially."},{"idx":1,"proposition":"Support is personalized","correct":true},{"idx":2,"proposition":"The role of the team is to care for the child and reassure the family","correct":false,"justification":"The role of the team is to support, inform and guide them"},{"idx":3,"proposition":"The doctor specialized in PKD receives the child in his private practice and refers to the hospital if problem","correct":false,"justification":"The doctor specialized in PKD receives the child during outpatient and\/or multidisciplinary consultations in the hospital and in medico-educational structures (SESSAD, CAMPS, IEM, IME)"},{"idx":4,"proposition":"The MDPH must provide unique access to the rights and benefits of persons with disabilities and their families","correct":true}],"type":"custom"}
+{"_id":"dyspnee-pneumo-0","context":null,"enonce":"Regarding the general diagnosis of dyspnea:","item":"dyspnee","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Acute dyspnea is an emergency until proven otherwise","correct":true},{"idx":1,"proposition":"Inspiratory dyspnea indicates cardiac involvement","correct":false,"justification":"It indicates upper airway involvement"},{"idx":2,"proposition":"Orthopnea is a strong sign of heart failure","correct":true},{"idx":3,"proposition":"Wheezing dyspnea is pathognomonic of asthma","correct":false,"justification":"May also sign COPD or heart failure in the elderly"},{"idx":4,"proposition":"A pulmonary embolism is rarely expressed by isolated dyspnea","correct":false,"justification":"This is often the case"}],"type":"custom"}
+{"_id":"dyspnee-pneumo-1","context":null,"enonce":"Which propositions are true>","item":"dyspnee","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Dyspnea is synonymous with polypnea","correct":false,"justification":"This is different. Dyspnea = SUBJECTIVE discomfort with breathing"},{"idx":1,"proposition":"Smoking is a key criterion of interrogation","correct":true},{"idx":2,"proposition":"Dyspnea is respiratory discomfort for a level of activity that do not normally cause discomfort","correct":true},{"idx":3,"proposition":"Dyspnea and tachypnea are mutually exclusive","correct":false,"justification":"Often associated, but to differentiate semiologically"},{"idx":4,"proposition":"Involuntary respiratory control is found in the brainstem","correct":true}],"type":"custom"}
+{"_id":"dyspnee-pneumo-2","context":null,"enonce":"Which propositions are true?","item":"dyspnee","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Inspiratory dyspnea with horn signs bronchial pathology","correct":false,"justification":"Directs instead to the upper airway"},{"idx":1,"proposition":"Antepnea is a dyspnea that appears when the patient is leaning forward","correct":true},{"idx":2,"proposition":"Tachypnea and polypnea are synonymous","correct":true},{"idx":3,"proposition":"Cyanosis and sweating are signs of acute respiratory distress","correct":true},{"idx":4,"proposition":"A bradypnea corresponds to a FR < 10\/min","correct":true}],"type":"custom"}
+{"_id":"dyspnee-pneumo-3","context":null,"enonce":"Regarding acute dypnea:","item":"dyspnee","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Mottling is a sign of shock","correct":true},{"idx":1,"proposition":"Harzer's sign is a sign of acute right ventricular failure","correct":true},{"idx":2,"proposition":"Dyspnea with prolonged inspiratory time signs obstruction of the VAS","correct":true},{"idx":3,"proposition":"A horn signs the obstruction of the VAS","correct":true},{"idx":4,"proposition":"Right heart failure can cause obstruction of the VAS","correct":false,"justification":"3 etiologies: foreign body, angioedema, laryngitis"}],"type":"custom"}
+{"_id":"dyspnee-pneumo-4","context":null,"enonce":"Which propositions are true?","item":"dyspnee","matiere":"pneumo","propositions":[{"idx":0,"proposition":"A prolongation of the expiratory time evokes a pathology of the VAS","correct":false,"justification":"Rather bronchi"},{"idx":1,"proposition":"Wheezing and sibilants sign bronchial involvement","correct":true},{"idx":2,"proposition":"Asthma attack is the first etiology of dyspnea with inspiratory prolongation in the elderly","correct":false,"justification":"We think especially in the allergic young subject during an expiratory elongation with hissing and sibilants"},{"idx":3,"proposition":"A context of bed rest reinforces the suspicion of PE","correct":true},{"idx":4,"proposition":"Foamy coughs and sputum point to a cardiac cause","correct":true}],"type":"custom"}
+{"_id":"dyspnee-pneumo-5","context":null,"enonce":"Which propositions are true?","item":"dyspnee","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Normal auscultation eliminates the diagnosis of PE","correct":false,"justification":"It is often normal in PE"},{"idx":1,"proposition":"Hoover's sign is a sign of chronic respiratory failure","correct":true},{"idx":2,"proposition":"Pursed lip breathing is a sign of heart failure","correct":false,"justification":"Chronic respiratory failure"},{"idx":3,"proposition":"Anginal pain leads to a heart abnormality","correct":true},{"idx":4,"proposition":"Quantifying dyspnea in chronic situations is useless","correct":false,"justification":"This makes it possible to evaluate the evolution and impact of the care"}],"type":"custom"}
+{"_id":"dyspnee-pneumo-7","context":null,"enonce":"What is the norm of Respiratory Rate (per minute) in a 2-month-old child?","item":"dyspnee","matiere":"pneumo","propositions":[{"idx":0,"proposition":"40–60","correct":false,"justification":"Norm in infants"},{"idx":1,"proposition":"30–50","correct":true,"justification":"True. Norm between 1 and 6 months"},{"idx":2,"proposition":"20–40","correct":false,"justification":"Standard between 6 and 24 months"},{"idx":3,"proposition":"16-30","correct":false,"justification":"Standard between 2 and 12 years"},{"idx":4,"proposition":"12-20","correct":false,"justification":"Standard from 13 years"}],"type":"custom"}
+{"_id":"dyspnee-pneumo-8","context":null,"enonce":"What is the standard respiratory rate (per minute) in a 6-year-old child?","item":"dyspnee","matiere":"pneumo","propositions":[{"idx":0,"proposition":"40–60","correct":false,"justification":"Norm in infants"},{"idx":1,"proposition":"30–50","correct":false,"justification":"Norm between 1 and 6 months"},{"idx":2,"proposition":"20–40","correct":false,"justification":"Standard between 6 and 24 months"},{"idx":3,"proposition":"16–30","correct":true,"justification":"True, norm between 2 and 12 years"},{"idx":4,"proposition":"12–20","correct":false,"justification":"Standard from 13 years"}],"type":"custom"}
+{"_id":"palu-infectio-0","context":null,"enonce":"Regarding malaria:","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":" Any suspicion of malaria is a diagnostic and therapeutic emergency","correct":true,"justification":"See item in the latest edition of the college"},{"idx":1,"proposition":" Diagnosis is based on the combination of a sensitive technique (thick drop or molecular biology) on a thin blood smear","correct":true},{"idx":2,"proposition":"Only Plasmodium falciparum species (> 90% of accesses) can cause severe malaria attacks","correct":false,"justification":"P. knowleso (5% of accesses) too"},{"idx":3,"proposition":"The presence of signs of severity requires transfer to intensive care","correct":true,"justification":"See item in the latest edition of the college"},{"idx":4,"proposition":"Artesunate IV is the standard of care for severe malaria, with quinine used only if artesunate is not immediately available","correct":true,"justification":"See item in the latest edition of the college"}],"type":"custom"}
+{"_id":"palu-infectio-1","context":null,"enonce":"Regarding malaria:","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":" Artemisinin-based combinations are indicated as a 1st line in uncomplicated Plasmodium spp. import malaria","correct":true,"justification":"See item in the latest edition of the college"},{"idx":1,"proposition":"Vector control personal protection measures should be explained to any traveller travelling to malaria-endemic areas","correct":true,"justification":"See item in the latest edition of the college"},{"idx":2,"proposition":"In France, the HAS publishes annual health recommendations for travellers for health professionals.","correct":false},{"idx":3,"proposition":"Malaria is a protozoosis caused by a haematozoan of the genus Plasmodium","correct":true},{"idx":4,"proposition":"2 plasmodial species pathogenic to humans","correct":false}],"type":"custom"}
+{"_id":"palu-infectio-2","context":null,"enonce":"Regarding malaria:","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"The vector of malaria is the male anopheles","correct":false},{"idx":1,"proposition":"Anopheles does not make noise and its bite is painless","correct":true,"justification":"See item in the latest edition of the college"},{"idx":2,"proposition":"Manifestations of malaria are due to erythrocyte schizogonia","correct":true,"justification":"See item in the latest edition of the college"},{"idx":3,"proposition":"The severity of manifestations depends on the species of Plasmodium, parasitemia and host immunity","correct":true},{"idx":4,"proposition":"The clinical manifestations of malaria are mainly those of aregenerative anaemia","correct":false,"justification":"The clinical manifestations of malaria are essentially those of hemolytic anemia: fever, chills (hemolysis releases a pyrogenic substance), progressing by access, interspersed with periods of clinical remission"}],"type":"custom"}
+{"_id":"palu-infectio-3","context":null,"enonce":"Regarding malaria:","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Sub-Saharan Africa is the source of 90% of global cases, mostly due to P. knowlesi","correct":false,"justification":"Mostly due to P falciparum"},{"idx":1,"proposition":" Approximately 4,000 cases of imported malaria per year are reported in France","correct":true},{"idx":2,"proposition":"Antimalarial chemoprophylaxis, even if taken correctly, does not completely eliminate the risk","correct":true,"justification":"See item in the latest edition of the college"},{"idx":3,"proposition":"Any fever during a stay in a malaria-endemic area should evoke the diagnosis of malaria","correct":true},{"idx":4,"proposition":"Malaria attacks of Plasmodium falciparum can occur from 7 days after the first exposure in endemic areas and up to 3 months after leaving this area","correct":true,"justification":"See item in the latest edition of the college"}],"type":"custom"}
+{"_id":"palu-infectio-4","context":null,"enonce":"Which of the following are true?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Any fever returning from a tropical stay is malaria until proven otherwise.","correct":true},{"idx":1,"proposition":"The annual incidence is about 4000 in France","correct":true},{"idx":2,"proposition":"Malaria is caused by gram-positive bacteria","correct":false,"justification":"It is a protozoosis"},{"idx":3,"proposition":"Plasmodium knowlesi is the most common","correct":false,"justification":"It is rare (less than 1%). It is Plasmodium falciparum the most common (> 90%)"},{"idx":4,"proposition":"The incubation period can be up to 3 months","correct":true}],"type":"custom"}
+{"_id":"palu-infectio-5","context":null,"enonce":"Which of the following are signs or symptoms of malaria?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Fever & Chill","correct":true},{"idx":1,"proposition":"Jaundice","correct":true},{"idx":2,"proposition":"Thrombocytosis","correct":false,"justification":"Instead, thrombocytopenia is found"},{"idx":3,"proposition":"Sciatica","correct":false,"justification":"No report"},{"idx":4,"proposition":"Conspitation","correct":false,"justification":"Rather, diarrhea is found"}],"type":"custom"}
+{"_id":"palu-infectio-6","context":null,"enonce":"Which of the following propositions are true for first-line treatments for malaria?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Without vomiting: Dihydroartemisinin-Piperaquine PO","correct":true,"justification":"True, it is a derivative of artemisinin"},{"idx":1,"proposition":"Without vomiting: Artemether-Lumefantrine PO","correct":true,"justification":"True, it is a derivative of artemisinin"},{"idx":2,"proposition":"With vomiting: Quinine IV + Clindamycin","correct":true},{"idx":3,"proposition":"With vomiting: Artesunate IV","correct":false,"justification":"Treatment of severe malaria (with or without vomiting)"},{"idx":4,"proposition":"Without vomiting: Clindamycin PO","correct":false,"justification":"Clindamycin combines with IV Quinine for the treatment of single bouts with vomiting"}],"type":"custom"}
+{"_id":"palu-infectio-7","context":null,"enonce":"Which of the following are biological signs that lead us to consider the case as severe malaria?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Respiratory alkalosis","correct":false,"justification":"Metabolic acidosis"},{"idx":1,"proposition":"Hyperlactatemia","correct":true},{"idx":2,"proposition":"Hyperglycemia beyond 5g\/L","correct":false,"justification":"Hypoglycemia"},{"idx":3,"proposition":"Hyperparasitemia above 2%","correct":false,"justification":"Above 4%"},{"idx":4,"proposition":"Positive qualitative beta-HCG","correct":true,"justification":"True, a malaria attack in a pregnant 🤰 woman should be managed as a severe ⚠ malaria attack."}],"type":"custom"}
+{"_id":"palu-infectio-8","context":null,"enonce":"What type of anaemia can be observed in malaria?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Hemolytic","correct":true},{"idx":1,"proposition":"Iron deficiency","correct":false,"justification":"False"},{"idx":2,"proposition":"Folate deficiency","correct":false,"justification":"False"},{"idx":3,"proposition":"Haemorrhagic","correct":false,"justification":"False"},{"idx":4,"proposition":"Power plant","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"palu-infectio-9","context":null,"enonce":"Which of the following are biological signs that lead us to consider the case as severe malaria?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Respiratory alkalosis","correct":false,"justification":"Metabolic acidosis"},{"idx":1,"proposition":"Hyperlactatemia","correct":true},{"idx":2,"proposition":"Hyperglycemia beyond 5g\/L","correct":false,"justification":"Hypoglycemia"},{"idx":3,"proposition":"Hyperparasitemia above 2%","correct":false,"justification":"Above 4%"},{"idx":4,"proposition":"Positive qualitative beta-HCG","correct":true,"justification":"True, a malaria attack in a pregnant 🤰 woman should be managed as a severe ⚠ malaria attack."}],"type":"custom"}
+{"_id":"palu-infectio-10","context":null,"enonce":"Which of the following propositions are true for first-line treatments for malaria?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Without vomiting: Dihydroartemisinin-Piperaquine PO","correct":true,"justification":"True, it is a derivative of artemisinin"},{"idx":1,"proposition":"Without vomiting: Artemether-Lumefantrine PO","correct":true,"justification":"True, it is a derivative of artemisinin"},{"idx":2,"proposition":"With vomiting: Quinine IV + Clindamycin","correct":true},{"idx":3,"proposition":"With vomiting: Artesunate IV","correct":false,"justification":"Treatment of severe malaria (with or without vomiting)"},{"idx":4,"proposition":"Without vomiting: Clindamycin PO","correct":false,"justification":"Clindamycin combines with IV Quinine for the treatment of single bouts with vomiting"}],"type":"custom"}
+{"_id":"palu-infectio-11","context":null,"enonce":"Which of the following are true?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Fever is classically periodic","correct":true,"justification":"True. Third (J1 J3 J5 J7 J9 etc) for falciparum, vivax and oval. Fourth (J1 J4 J7 J11 etc) for malaria. Every 24h for knowlesii."},{"idx":1,"proposition":"Thrombocytopenia is a sign of severity","correct":false,"justification":"It is almost constant and is not a sign of gravity"},{"idx":2,"proposition":"Thin blood smear - thick drop is done at febrile peaks only","correct":false,"justification":"As a matter of urgency, never wait for a feverish peak."},{"idx":3,"proposition":"The thick drop allows the identification of the species","correct":false,"justification":"The thick drop allows the positive diagnosis of malaria. It is the thin blood smear that allows the identification of the species."},{"idx":4,"proposition":"The thin blood smear is used to measure parasitmeia","correct":true}],"type":"custom"}
+{"_id":"palu-infectio-13","context":null,"enonce":"Which of the following proposals about malaria are true?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is a reportable disease in all circumstances. ","correct":false,"justification":"Only Aboriginal cases are reportable."},{"idx":1,"proposition":"Any fever on return from an endemic country should evoke the diagnosis.","correct":true},{"idx":2,"proposition":"The incubation period for the Falciparum strain varies between a minimum of one week and 3 years.","correct":false,"justification":"False\r\nBetween one week and 3 months maximum"},{"idx":3,"proposition":"The manifestations of malaria are due to the hepatic merozoite form. ","correct":false,"justification":"The manifestations of malaria are due to the erythrocyte schizogony form."},{"idx":4,"proposition":"Antimalarial chemoprophylaxis protects 100% against malaria.","correct":false,"justification":"False, it does not completely eliminate the risk of infection even if properly followed."}],"type":"custom"}
+{"_id":"palu-infectio-14","context":null,"enonce":"Which of the following proposals regarding malaria treatment are true?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Artenimol-piperaquine is the first-line treatment for pregnant women in the 1st trimester","correct":false,"justification":"False, it is contraindicated in the 1st trimester, like all artemisinin derivatives"},{"idx":1,"proposition":"The Artemether-lumefantrine prescription requires the performance of an ECG beforehand. ","correct":true,"justification":"True\r\nIt causes QT prolongation, like all artemisinin derivatives"},{"idx":2,"proposition":"In case of complicated form with vomiting administration of IV Quinine is the first-line treatment ","correct":false,"justification":"False \r\nThis is true in uncomplicated forms\r\nIn severe forms the first-line treatment is Artesunate IV"},{"idx":3,"proposition":"Administration of artesunate requires haematological monitoring one month after discontinuation of treatment ","correct":true,"justification":"True\r\nRisk of delayed hemolysis."},{"idx":4,"proposition":"Doxycycline is the treatment of choice for pregnant women in the first trimester","correct":false,"justification":"False!!\r\nContraindicated in pregnant women"}],"type":"custom"}
+{"_id":"palu-infectio-15","context":null,"enonce":"Which of the following proposals regarding malaria prophylaxis are true?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Artenimol-piperaquine should be started on the first day of stay and continued one week after ","correct":false,"justification":"False\r\nIt is not indicated for prophylaxis"},{"idx":1,"proposition":"Mefloquine should be started 10 days before stay and continued 3 weeks after","correct":true},{"idx":2,"proposition":"Mefloquine should be taken daily at the same time throughout the stay ","correct":false,"justification":"False.\r\nOne intake per week"},{"idx":3,"proposition":"Atovaquone-Proguanil must be started on the first day of stay and continued 10 years after ","correct":true},{"idx":4,"proposition":"It is necessary to warn the traveler that any fever within 3 months of returning from an endemic area must be consulted urgently to look for Malaria ","correct":true,"justification":"True\r\nThe incubation period of Falciparum can be up to 3 months"}],"type":"custom"}
+{"_id":"palu-infectio-16","context":null,"enonce":"Which of the following proposals about malaria are true?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"A negative blood smear eliminates the diagnosis of malaria.","correct":false,"justification":"False\r\nA negative blood smear and a RDT (rapid diagnostic test) rule out the diagnosis."},{"idx":1,"proposition":"A negative epiasse drip examination eliminates the diagnosis.","correct":true},{"idx":2,"proposition":"A positive blood smear and a positive Rapid Diagnostic Test (RDT) are sufficient to make the diagnosis.","correct":true},{"idx":3,"proposition":"The epiasse drop examination requires expertise on the part of the biologist.","correct":true},{"idx":4,"proposition":"A negative RDT allows him to eliminate the diagnosis of malaria.","correct":false,"justification":"False, it takes a negative RDT + a negative blood smear to rule out the diagnosis."}],"type":"custom"}
+{"_id":"hypoTh-endoc-0","context":null,"enonce":"Regarding thyroid gland involvement:","item":"hypoTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"The diagnosis of primary hypothyroidism is based primarily on TSH testing","correct":true},{"idx":1,"proposition":"If TSH is elevated, free T3 measurement measures the severity of secretory deficiency","correct":false,"justification":"It is the dosage of free T4 that is carried out"},{"idx":2,"proposition":"Free thyroxine is dosed rather than total T4 because the latter is subject to multiple physiological variations","correct":true},{"idx":3,"proposition":"Normal free T4 indicates frustrated hypothyroidism","correct":true},{"idx":4,"proposition":"TSH is very elevated in subclinical hypothyroidism","correct":false,"justification":"TSH is low"}],"type":"custom"}
+{"_id":"hypoTh-endoc-1","context":null,"enonce":"Which of the following is (are) correct?","item":"hypoTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Low free T4 and increased TSH indicate overt hypothyroidism","correct":true},{"idx":1,"proposition":"Primary hypothyroidism is the most common","correct":true},{"idx":2,"proposition":"The diagnosis of hypothyroidism is often late because of the highly variable symptoms and clinical signs","correct":false,"justification":"Currently, by the generalization of the TSH assay (systematic assessment or asthenia), the diagnosis is most often early, made at the stage of crude hypothyroidism where only TSH is increased."},{"idx":3,"proposition":"A single moderately increased TSH assay makes it possible to make the diagnosis","correct":false,"justification":"A single moderately increased TSH assay is not sufficient to make the diagnosis of hypothyroidism and therefore justify treatment."},{"idx":4,"proposition":"Thyroid-impaired insufficiency constitutes less than 5% of hypothyroidism","correct":true}],"type":"custom"}
+{"_id":"hypoTh-endoc-2","context":null,"enonce":"Regarding thyrotropic involvement:","item":"hypoTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Thyrotropic insufficiency is very rarely part of a pituitary pathology context","correct":false,"justification":"On the contrary, this is almost always the case"},{"idx":1,"proposition":"T4L is always low in thyrotropic pathology","correct":true},{"idx":2,"proposition":"A slightly elevated TSH (but less than 10-12 mIU\/L) and a low T4L suggest rather a primitive involvement","correct":false,"justification":"In this case, TSH is immunoreactive but biologically inactive and contrasts with low T4L. This painting evokes hypothalamic involvement"},{"idx":3,"proposition":"The diagnosis of thyrotropic insufficiency is based on the determination of the T4L-T3L couple","correct":false,"justification":"Rather on the dosage of the T4L-TSH couple"},{"idx":4,"proposition":"The semeiology of hypothyroidism depends on its depth, age and origin","correct":true}],"type":"custom"}
+{"_id":"hypoTh-endoc-3","context":null,"enonce":"Which of the following is (are) correct?","item":"hypoTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Crude hypothyroidism is the most common form nowadays","correct":true,"justification":"Crude hypothyroidism, called subclinical, is the most common form, it is grouped into 3 categories according to the risk of conversion to overt hypothyroidism"},{"idx":1,"proposition":"Carotinosis can be observed by decreased transformation of carotene into vitamin A","correct":true},{"idx":2,"proposition":"Dry, flaky skin is symptomatic of thyrotoxycosis","correct":false,"justification":"Rather a symptom of hypothyroidism"},{"idx":3,"proposition":"Axillary depilation is promoted by hypothyroidism","correct":true},{"idx":4,"proposition":"Hypothyroidism increases sweating","correct":false,"justification":"sweating is decreased"}],"type":"custom"}
+{"_id":"hypoTh-endoc-4","context":null,"enonce":"Which of the following is (are) correct?","item":"hypoTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Hair is dry and brittle in overt hypothyroidism","correct":true},{"idx":1,"proposition":"Laryngeal involvement can result in a hoarse voice","correct":true},{"idx":2,"proposition":"Eustachian tube involvement is possible in hypothyroidism ","correct":true,"justification":"Involvement of the Eustachian tube can induce hearing loss"},{"idx":3,"proposition":"Tendonitis is very rarely due directly to hypothyroidism","correct":true,"justification":"Arthralgia, myalgia and cramps are more often seen"},{"idx":4,"proposition":"Deep primary hypothyroidism can cause hyperploactinemia","correct":true}],"type":"custom"}
+{"_id":"hypoTh-endoc-5","context":null,"enonce":"Which of the following are the signs and symptoms found in hypothyroidism?","item":"hypoTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Sweats","correct":false,"justification":"Decreased sweating"},{"idx":1,"proposition":"Tachycardia","correct":false,"justification":"Sign of thyrotoxicosis"},{"idx":2,"proposition":"Weight gain > 10kg","correct":false,"justification":"Not exceeding about 5kg"},{"idx":3,"proposition":"Depressive tendency","correct":true},{"idx":4,"proposition":"Hyponatremia","correct":true}],"type":"custom"}
+{"_id":"hypoTh-endoc-6","context":null,"enonce":"Which of the following are true about Hashimoto's thyroiditis?","item":"hypoTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"Goiter is firm","correct":true},{"idx":1,"proposition":"Goiter is regular","correct":false,"justification":"It is irregular"},{"idx":2,"proposition":"Anti-TSH antibodies are found","correct":false,"justification":"Anti-TPO positive antibodies. \r\nIf they are negative (rare), we dose the anti-Tg that are positive."},{"idx":3,"proposition":"It is the most common cause of hypothyroidism in women ♀ ","correct":true},{"idx":4,"proposition":"It can be part of autoimmune polyendocrinopathy","correct":true,"justification":"True, when it is associated with other autoimmune disorders such as vitiligo, celiac disease, Biermer's anemia, then pNEM2 must be suspected."}],"type":"custom"}
+{"_id":"AP-urg-0","context":null,"enonce":"Which of the following are true?","item":"AP","matiere":"urg","propositions":[{"idx":0,"proposition":"The lifetime prevalence of panic attacks is 3-5%","correct":true},{"idx":1,"proposition":"The predominance is female","correct":true},{"idx":2,"proposition":"The onset of crises is gradual","correct":false,"justification":"The beginning is brutal"},{"idx":3,"proposition":"The peak is reached in 45-60 minutes","correct":false,"justification":"The acme is reached in a few minutes"},{"idx":4,"proposition":"Postcritical asthenia is possible","correct":true}],"type":"custom"}
+{"_id":"AP-urg-1","context":null,"enonce":"Which of the following are possible treatments for panic attacks or acute anxiety attacks?","item":"AP","matiere":"urg","propositions":[{"idx":0,"proposition":"The introduction of anxiolytics ","correct":true},{"idx":1,"proposition":"Introduction of benzodiazepines","correct":true},{"idx":2,"proposition":"Introduction of antipsychotics","correct":false,"justification":"No indication"},{"idx":3,"proposition":"The introduction of antidepressants","correct":false,"justification":"No indication"},{"idx":4,"proposition":"Room with very loud rock music to distract the patient","correct":false,"justification":"Systematic measures: calming, reassurance, breathing control"}],"type":"custom"}
+{"_id":"LCA-sp-0","context":null,"enonce":"Which of the following are observational studies?","item":"LCA","matiere":"sp","propositions":[{"idx":0,"proposition":"Randomized controlled clinical trials","correct":false,"justification":"Interventional studies"},{"idx":1,"proposition":"Epidemiological studies","correct":true},{"idx":2,"proposition":"Most cross-sectional studies","correct":true},{"idx":3,"proposition":"Prospective cohort studies","correct":false,"justification":"Not all, there may be human intervention"},{"idx":4,"proposition":"Case-control studies","correct":true,"justification":"True, this is an analytical observational study"}],"type":"custom"}
+{"_id":"LCA-sp-1","context":null,"enonce":"Which of the following are scientific journals with an impact factor >10 😏?","item":"LCA","matiere":"sp","propositions":[{"idx":0,"proposition":" Nature","correct":true},{"idx":1,"proposition":"New England Journal of Medicine (NEJM)","correct":true},{"idx":2,"proposition":"Interventional Cardiology","correct":false,"justification":"IF of 0.45"},{"idx":3,"proposition":"Medicine\/Science","correct":false,"justification":"As French-language newspapers are rarely cited by the international community (which speaks mainly English), their impact factor remains limited 😕"},{"idx":4,"proposition":"Universal Surgery","correct":false,"justification":"IF of 0.08. Remember especially the major journals: NEMJ, Lancet, Nature, Science, PNAS, etc."}],"type":"custom"}
+{"_id":"LCA-sp-2","context":null,"enonce":"Which of the following are true about relative risk?","item":"LCA","matiere":"sp","propositions":[{"idx":0,"proposition":"It measures the association between an exposure factor and the event under study","correct":true},{"idx":1,"proposition":"It corresponds to the Odds Ratio (OR) in cohort studies ","correct":false,"justification":"Prospective cohort studies measure risk ratios (RRs). In case-control studies, an Odds Ratio (OR) is measured"},{"idx":2,"proposition":"A relative risk strictly less than 1 is a protective factor","correct":true},{"idx":3,"proposition":"A relative risk greater than 1 is a protective factor","correct":false,"justification":"A risk factor"},{"idx":4,"proposition":"Relative risk is a parameter that is measured in real life at the individual level","correct":false,"justification":"It is a parameter that is calculated in prospective studies"}],"type":"custom"}
+{"_id":"lesionart-urg-0","context":null,"enonce":"Which of the following are risk factors for prosthesis infection?","item":"lesionart","matiere":"urg","propositions":[{"idx":0,"proposition":"Obesity","correct":true},{"idx":1,"proposition":"Passive smoking","correct":false,"justification":"Active smoking"},{"idx":2,"proposition":"Cirrhosis","correct":true},{"idx":3,"proposition":"Diabetes","correct":true},{"idx":4,"proposition":"All propositions are true","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-1","context":null,"enonce":"General:","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Minor and moderate deficits are the most numerous and include ametropia or refractive disorders","correct":true},{"idx":1,"proposition":"Hyperopia is a refractive disorder","correct":true,"justification":"With myopsy and astigmatism"},{"idx":2,"proposition":"Strabismus does not affect children under 8 years of age","correct":false,"justification":"Several thousand children under the age of 8 are affected by strabismus"},{"idx":3,"proposition":"Severe deficits are very rare in children","correct":true},{"idx":4,"proposition":"It is estimated that 15 to 20% of children under 6 years of age have a visual abnormality","correct":true,"justification":"1 in 6 children"}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-2","context":null,"enonce":"Epidemiology and vision development:","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"0.4% of children have strabismus","correct":false,"justification":"About 4%"},{"idx":1,"proposition":"50% of children who have strabima are at risk of developing amblyopia if not treated promptly","correct":true},{"idx":2,"proposition":"Screening for visual disorders in children is a public health problem","correct":true},{"idx":3,"proposition":"During the first weeks of life, light reflexes testify to visual sensitivity","correct":true},{"idx":4,"proposition":"The photomotor reflex develops from 2 months","correct":false,"justification":"The photomotor reflex is present from birth but it is slow and of low amplitude"}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-3","context":null,"enonce":"Regarding the development of the vision:","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"The preferential look is developed around the third month","correct":true},{"idx":1,"proposition":"Eye-head-hand coordination appears at week 5","correct":false,"justification":"Eye-head-hand coordination appears around the 4th-5th month"},{"idx":2,"proposition":"The convergence reflex and the fixation reflex appear in the third month","correct":true},{"idx":3,"proposition":"First week: light reflex, photomotor reflex","correct":true},{"idx":4,"proposition":"The pursuit reflex is established around the age of 6 months","correct":false,"justification":"2nd–4th week: continuation reflex established around 2 months of age"}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-4","context":null,"enonce":"Vision development and prevention:","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"Week 4–12: fusion reflex, binocular coordination","correct":true},{"idx":1,"proposition":"The vision of forms is formed around the third month","correct":true},{"idx":2,"proposition":"Month 4–5: Eye-head-hand coordination","correct":true},{"idx":3,"proposition":"From 2 years old: measurable visual acuity","correct":true},{"idx":4,"proposition":"A first antenatal screening is performed by ultrasound during pregnancy","correct":true}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-5","context":null,"enonce":"At what age is the eye tracking reflex established?","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"between the ages of 2 and 4 months","correct":true,"justification":"True, according to the new College of Pediatrics (2021)"},{"idx":1,"proposition":"between the ages of 8 and 12 months","correct":false,"justification":"False"},{"idx":2,"proposition":"between the ages of 12 and 24 months","correct":false,"justification":"False"},{"idx":3,"proposition":"between the ages of 2 and 4 weeks","correct":false,"justification":"False"},{"idx":4,"proposition":"at birth","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-6","context":null,"enonce":"At what age does we achieve 10\/10th visual acuity?","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"1 year","correct":false,"justification":"False"},{"idx":1,"proposition":"2 years","correct":false,"justification":"False"},{"idx":2,"proposition":"3 years","correct":false,"justification":"False"},{"idx":3,"proposition":"4 years","correct":true,"justification":"True, according to the new College of Pediatrics (2021). 1 year: visual acuity at 4\/10th, 2 years: visual acuity at 6\/10th, 4 years: visual acuity at 10\/10th. (Note that the old frame of reference gives the age of 6 years for visual acuity at 10\/10th.)"},{"idx":4,"proposition":"6 months","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"oreillons-infectio-0","context":null,"enonce":"Regarding adult mumps ","item":"oreillons","matiere":"infectio","propositions":[{"idx":0,"proposition":" The diagnosis is essentially clinical, but can be supported by molecular biology","correct":true,"justification":"See item in the latest edition of the college"},{"idx":1,"proposition":" There is no specific treatment and prevention is based on vaccination of adults","correct":false},{"idx":2,"proposition":"It is an acute non-contagious viral infection","correct":false,"justification":"Acute, contagious, most often mild viral infection"},{"idx":3,"proposition":" The tank is strictly human","correct":true},{"idx":4,"proposition":"It is a non-immunizing disease ","correct":false,"justification":"Long-lasting immunity after disease"}],"type":"custom"}
+{"_id":"oreillons-infectio-2","context":null,"enonce":"Regarding mumps:","item":"oreillons","matiere":"infectio","propositions":[{"idx":0,"proposition":"Healing is spontaneous in 13 to 15 days","correct":false,"justification":"Spontaneous healing in 8 to 10 days"},{"idx":1,"proposition":"Testicular involvement is most often bilateral","correct":false,"justification":"Unilateral"},{"idx":2,"proposition":"Sequellar testicular atrophy is present in 50% of cases but sterility is rare","correct":true},{"idx":3,"proposition":"The eviction of the case is not mandatory and there is no specific measure to be taken vis-à-vis the contact subjects","correct":true},{"idx":4,"proposition":"Pancreatic involvement is exceptional","correct":true}],"type":"custom"}
+{"_id":"oreillons-infectio-3","context":null,"enonce":"Which of the following are true about mumps?","item":"oreillons","matiere":"infectio","propositions":[{"idx":0,"proposition":"The neurological manifestation may be bacterial meningitis","correct":false,"justification":"Viral meningitis since mumps is caused by an RNA virus"},{"idx":1,"proposition":"The neurological manifestation is common (>25% of mumps cases)","correct":false,"justification":"It is rare, but still possible"},{"idx":2,"proposition":"Mumps puts you at risk for Guillain-Barré syndrome","correct":true},{"idx":3,"proposition":"Mumps puts you at risk of encephalitis","correct":true},{"idx":4,"proposition":"There is no neurological impairment","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"oreillons-infectio-4","context":null,"enonce":"With regard to mumps, what are the exact proposals?","item":"oreillons","matiere":"infectio","propositions":[{"idx":0,"proposition":"Possible clinical pictures include: erythematous angina, mumps parotitis, acute pancreatitis, orchitis and purulent meningitis","correct":false,"justification":"False, mumps gives meningitis which is usually not very symptomatic with few sequelae. Pancreatitis is benign (edematous pancreatitis)"},{"idx":1,"proposition":"Vaccination is important despite the existence of antiviral treatment","correct":false,"justification":"False, there is no specific treatment. The main treatment is preventive by vaccination"},{"idx":2,"proposition":"Preventive treatment consists of 2 vaccinations at 12 and 16-18 months with the MMR vaccine","correct":true,"justification":"True, this is not a reminder. The second injection increases the responder rate."},{"idx":3,"proposition":"The purpose of vaccination is to prevent complications of infection such as: testicular atrophy, sterility, deafness, encephalitis","correct":true,"justification":"True, especially testicular atrophy is present in 50% of orchites"},{"idx":4,"proposition":"None","correct":false,"justification":"None"}],"type":"custom"}
+{"_id":"oreillons-infectio-5","context":null,"enonce":"With regard to mumps, what are the exact proposals?","item":"oreillons","matiere":"infectio","propositions":[{"idx":0,"proposition":"Possible clinical pictures include: erythematous angina, mumps parotitis, acute pancreatitis, orchitis and purulent meningitis","correct":false,"justification":"False, mumps gives meningitis which is usually not very symptomatic with few sequelae. Pancreatitis is benign (edematous pancreatitis)"},{"idx":1,"proposition":"Vaccination is important despite the existence of antiviral treatment","correct":false,"justification":"False, there is no specific treatment. The main treatment is preventive by vaccination"},{"idx":2,"proposition":"Preventive treatment consists of 2 vaccinations at 12 and 16-18 months with the MMR vaccine","correct":true,"justification":"True, this is not a reminder. The second injection increases the responder rate."},{"idx":3,"proposition":"The purpose of vaccination is to prevent complications of infection such as: testicular atrophy, sterility, deafness, encephalitis","correct":true,"justification":"True, especially testicular atrophy is present in 50% of orchites"},{"idx":4,"proposition":"None","correct":false,"justification":"None"}],"type":"custom"}
+{"_id":"oreillons-infectio-6","context":null,"enonce":"What is the incubation period for mumps?","item":"oreillons","matiere":"infectio","propositions":[{"idx":0,"proposition":"2 days","correct":false,"justification":"This is the incubation period of scarlet fever"},{"idx":1,"proposition":"18 days","correct":false,"justification":"This is the incubation period of measles"},{"idx":2,"proposition":"14 days","correct":false,"justification":"This is the incubation period of whooping cough"},{"idx":3,"proposition":"22 days","correct":true},{"idx":4,"proposition":"The incubation period is almost zero (a few hours)","correct":false,"justification":"RNA viruses take time to replicate in enough cells to give a clinical picture"}],"type":"custom"}
+{"_id":"oreillons-infectio-7","context":null,"enonce":"Which of the following is true about mumps?","item":"oreillons","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is a Gram-negative bacterium","correct":false},{"idx":1,"proposition":"It is a Cocci Positive Bacterium","correct":false},{"idx":2,"proposition":"It is an anaerobic bacterium","correct":false},{"idx":3,"proposition":"It is a DNA virus","correct":false},{"idx":4,"proposition":"It is an RNA virus","correct":true,"justification":"RNA virus with 22-day incubation"}],"type":"custom"}
+{"_id":"accouchementN-gyn-0","context":null,"enonce":"Regarding the Basics of Childbirth: Normal Childbirth","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"The work is composed of two stages: cervical dilation and delivery","correct":false,"justification":"The 4 stages of labour: cervical dilation, descent of presentation into the pelvic canal, delivery, return to normal"},{"idx":1,"proposition":"Dilation of the cervix conditions vaginal delivery","correct":false,"justification":"Commitment conditions vaginal delivery"},{"idx":2,"proposition":"Contraception should be discussed and offered postpartum during the maternity stay","correct":true},{"idx":3,"proposition":"Childbirth requires the passage of two obstacles: the cervix and the perineum","correct":false,"justification":"Childbirth requires the passage of three obstacles: • the cervix: closed during pregnancy, it expands under the influence of uterine contractions • the pelvis: crossing this rigid parade requires constant adaptation of the different parts of the fetus to the container • the perineum: its crossing constitutes expulsion"},{"idx":4,"proposition":"Expulsion occurs under the influence of uterine contractions reinforced by maternal abdominal thrust","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"accouchementN-gyn-1","context":null,"enonce":"Regarding the Anatomy of the Obstetric Pelvic Duct: Normal Childbirth","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"The pelvic girdle consists of 3 bony pieces","correct":false,"justification":"A Maternal pelvis 1 Bone pelvis The pelvic girdle is a symmetrical osteoarticular ring consisting of 4 bony parts and 4 joints: • the 4 bony pieces are: − the 2 coxal bones, − the sacrum, − the coccyx"},{"idx":1,"proposition":"The 4 joints of the pelvis are very mobile","correct":false},{"idx":2,"proposition":"The pelvic girdle has the shape of a funnel with a large lower base the large abdominal cavity with the pelvis through the lower strait (DI)","correct":false,"justification":"The pelvic girdle has the shape of a funnel with a large upper base that communicates the large abdominal cavity with the pelvis through the upper strait (SD)"},{"idx":3,"proposition":"The lower orifice consists of all the middle and lower straits","correct":true},{"idx":4,"proposition":"The upper strait is also called the Demelin \"engagement cylinder\"","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"accouchementN-gyn-2","context":null,"enonce":"Regarding the Anatomy of the Pelvis in Women: Normal childbirth","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"The promontory overlooks the pubic symphysis 8-9.5 cm","correct":true},{"idx":1,"proposition":"Note that the axis of the DS is oblique backwards and upwards","correct":false,"justification":"It should be noted that the axis of the DS is oblique backwards and downwards: it aims at the sacrococcygeal line spacing."},{"idx":2,"proposition":"The axis of the DS targets sacrococcygeal space","correct":true},{"idx":3,"proposition":"The circular section of the pelvic excavation is 18cm anteroposterior","correct":false,"justification":"Its circular section is of constant diameter at the level of all planes (about 12 cm)"},{"idx":4,"proposition":"The middle strait (MD) is an oblique plane passing through the two sciatic spines.","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"accouchementN-gyn-3","context":null,"enonce":"Regarding the Concerning the generalities about normal childbirth: normal childbirth","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"The lower strait (ID) is the lower opening of the pelvic canal","correct":true},{"idx":1,"proposition":"The posterior surface of the lower strait corresponds to the 2 ischia and the tip of the coccyx","correct":true},{"idx":2,"proposition":"The soft pelvis corresponds to Douglas's uterus, bladder and cul-de-sac","correct":false,"justification":"2 Soft pelvis It consists of: • the vagina • the pelvi-perineal diaphragm: musculotendinous hammock which includes: − a deep plane: fibers of the levator of the anus, ischiococcygeal muscles and large sacrosciatic ligament, − a superficial plane: muscles of the superficial perineum"},{"idx":3,"proposition":"The curled up fetus is amalgamated with a cube with 4 poles","correct":false,"justification":"1 Fetal head The fetal head has an ovoid shape with the small end corresponding to the chin and the large end to the occiput (Figure 30"},{"idx":4,"proposition":"The anterior fontannelle is called bregma","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"accouchementN-gyn-5","context":null,"enonce":"Regarding the Concerning the pregnant uterus: normal childbirth","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"The posterior fontanelle is called bregma","correct":false},{"idx":1,"proposition":"The pregnant uterus consists of 3 parts: the body, the lower segment and the cervix","correct":true},{"idx":2,"proposition":"The uterine body, in late pregnancy, has the shape of an ovoid with a large upper end","correct":true},{"idx":3,"proposition":"The axis of the body of the uterus in late pregnancy is always craniocaudal","correct":false,"justification":"Its axis depends on the tone of the anterior abdominal wall"},{"idx":4,"proposition":"In the frontal plane, the uterus is often tilted to the right side","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"accouchementN-gyn-6","context":null,"enonce":"Concerning the basics of normal childbirth","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"At the level of the inner circular layer, the fibers retract to erase the lumen of the vessels in order to reduce the hemorrhage of normal delivery (live ligatures)","correct":false,"justification":"At the level of the plexiform layer, the retraction of the fibers erases the lumen of the vessels, which has the effect of reducing the hemorrhage of normal delivery: this is the phenomenon of living ligatures"},{"idx":1,"proposition":"Uterine contraction is the driving force of childbirth","correct":true},{"idx":2,"proposition":"The mechanical study of uterine contraction requires expensive and rare electrophysiology equipment","correct":false,"justification":"1 Means of study The mechanical study of UC is commonly used in obstetrics thanks to monitors that allow simultaneous recordings of fetal heart rate and uterine contractions: • external tomography allows"},{"idx":3,"proposition":"External tocography makes it possible to note the duration of uterine contractions thanks to an intravenous sensor","correct":false,"justification":"thanks to an external sensor"},{"idx":4,"proposition":"Internal tocography provides basic tone and intrauterine pressure","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"accouchementN-gyn-7","context":null,"enonce":"What is the bi-trochanterian diameter? ","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"9 cm","correct":true,"justification":"These questions may seem tedious, but these measures are worth knowing according to the College"},{"idx":1,"proposition":"7.5 cm","correct":false,"justification":"Sacropubic diameter"},{"idx":2,"proposition":"9.5 cm","correct":false,"justification":"Sternodorsal diameter or bi-acromial diameter after settlement"},{"idx":3,"proposition":"8 cm","correct":false,"justification":"Biiliac diameter"},{"idx":4,"proposition":"12 cm","correct":false,"justification":"Bi-acromial diameter before settlement"}],"type":"custom"}
+{"_id":"accouchementN-gyn-8","context":null,"enonce":"What is the bi-iliac distance?","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"12 cm after settlement","correct":false,"justification":"This diameter is not reduced by compaction. It is 8 cm"},{"idx":1,"proposition":"6 cm","correct":false,"justification":"Sorry for these questions, but these measures are to be known according to the college :\/"},{"idx":2,"proposition":"8 cm","correct":true},{"idx":3,"proposition":"9.5 cm","correct":false,"justification":"This is the sterno-dorsal distance as well as the bi-acromial distance after settlement"},{"idx":4,"proposition":"7.5 cm","correct":false,"justification":"Sacropubic diameter"}],"type":"custom"}
+{"_id":"accouchementN-gyn-9","context":null,"enonce":"What is the sacropubic diameter? ","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"9 cm","correct":false,"justification":"Bi-trochanterian diameter"},{"idx":1,"proposition":"9.5 cm","correct":false,"justification":"Sternodorsal diameter or bi-acromial diameter after settlement"},{"idx":2,"proposition":"7.5 cm","correct":true,"justification":"None"},{"idx":3,"proposition":"75 mm","correct":true,"justification":"None"},{"idx":4,"proposition":"12 cm","correct":false,"justification":"Bi-acromial diameter before settlement"}],"type":"custom"}
+{"_id":"accouchementN-gyn-10","context":null,"enonce":"What is the sacropubic diameter?","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"12 cm","correct":false,"justification":"Bi-acromial diameter"},{"idx":1,"proposition":"9.5 cm","correct":false,"justification":"Sternodorsal diameter or bi-acromial diameter after settlement"},{"idx":2,"proposition":"8 cm","correct":false,"justification":"Sorry for these questions, but these measures are to be known according to the college :\/. 8 cm is the bi-iliac diameter"},{"idx":3,"proposition":"7.5 cm","correct":true},{"idx":4,"proposition":"9 cm","correct":false,"justification":"Bi-trochanterian diameter"}],"type":"custom"}
+{"_id":"accouchementN-gyn-11","context":null,"enonce":"What is the sterno-dorsal diameter?","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"9.5 cm","correct":true,"justification":"True! \r\nA bit tedious but to learn!"},{"idx":1,"proposition":"12 cm","correct":false,"justification":"Bi-acromial distance before settlement"},{"idx":2,"proposition":"7.5 cm","correct":false,"justification":"Sacropubic distance"},{"idx":3,"proposition":"8 cm","correct":false,"justification":"Biiliac distance"},{"idx":4,"proposition":"9 cm","correct":false,"justification":"Bi-trochanterian distance"}],"type":"custom"}
+{"_id":"accouchementN-gyn-12","context":null,"enonce":"What is the biacromial distance?","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"9 cm","correct":false,"justification":"Bi-trochanterian diameter. Sorry for these questions, but these measures are to be known according to the college :\/"},{"idx":1,"proposition":"12 cm","correct":true,"justification":"True, 9.5 cm after settlement"},{"idx":2,"proposition":"This distance can be reduced by settlement","correct":true},{"idx":3,"proposition":"8 cm","correct":false,"justification":"Biiliac distance"},{"idx":4,"proposition":"8.5 cm after settlement","correct":false,"justification":"9.5 cm after settlement"}],"type":"custom"}
+{"_id":"accouchementN-gyn-13","context":null,"enonce":"Which of the following proposals is\/are a risk factor for postpartum haemorrhage?","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Maternal infection","correct":true},{"idx":1,"proposition":"Very fast work","correct":true,"justification":"Very fast or too prolonged work is a ToR"},{"idx":2,"proposition":"Fibroids ","correct":true},{"idx":3,"proposition":"Antenatal corticosteroid treatment","correct":false},{"idx":4,"proposition":"No proposition is true","correct":false}],"type":"custom"}
+{"_id":"platre-urg-0","context":null,"enonce":"Regarding plasters, which proposals are true?","item":"platre","matiere":"urg","propositions":[{"idx":0,"proposition":"There are two types of plasters: circular and gutter","correct":true},{"idx":1,"proposition":"A cast should never hurt","correct":true,"justification":"Pain = problem = systematic removal of the cast for complete clinical examination"},{"idx":2,"proposition":"Conventionally, the cast contains the fractured limb and the underlying joint only","correct":false,"justification":"Underlying supra joint"},{"idx":3,"proposition":"Conventionally, the fingers of the hand are left free","correct":true},{"idx":4,"proposition":"Conventionally, the toes are left free","correct":true}],"type":"custom"}
+{"_id":"platre-urg-1","context":null,"enonce":"What are the delays in radiographic control of plaster?","item":"platre","matiere":"urg","propositions":[{"idx":0,"proposition":"J2","correct":true,"justification":"The deadlines mentioned by the college of orthopedics are: J2, J8, J21 and J45"},{"idx":1,"proposition":"J10","correct":false},{"idx":2,"proposition":"J20","correct":false},{"idx":3,"proposition":"J8","correct":true},{"idx":4,"proposition":"J40","correct":false}],"type":"custom"}
+{"_id":"platre-urg-2","context":null,"enonce":"What are the two main etiologies of paresthesias under plaster?","item":"platre","matiere":"urg","propositions":[{"idx":0,"proposition":"Neuromuscular dysjunction","correct":false},{"idx":1,"proposition":"Inflammatory arthralgia","correct":false},{"idx":2,"proposition":"Compression","correct":true,"justification":"Nerve or vascular compression"},{"idx":3,"proposition":"Venous thrombosis","correct":false},{"idx":4,"proposition":"Compartment syndrome","correct":true}],"type":"custom"}
+{"_id":"iatrogenie-therapeutique-0","context":null,"enonce":"Which of the following are frequently found in DRESS syndrome?","item":"iatrogenie","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Hypereosinophilia","correct":true},{"idx":1,"proposition":"Thrombocytosis","correct":false,"justification":"False"},{"idx":2,"proposition":"Hyperuricemia","correct":false,"justification":"False"},{"idx":3,"proposition":"Mononucleosis syndrome","correct":true},{"idx":4,"proposition":"Hepatic cytolysis","correct":true}],"type":"custom"}
+{"_id":"dlrpsy-psy-0","context":null,"enonce":"Regarding pain in a patient suffering from a psychiatric pathology:","item":"dlrpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Pain is a physical experience","correct":false,"justification":"Sensory and emotional experience"},{"idx":1,"proposition":"It has cognitive components","correct":true,"justification":"On attention and memory for example"},{"idx":2,"proposition":"It has behavioural components","correct":true},{"idx":3,"proposition":"The tools used to measure pain are specific to psychiatry","correct":false,"justification":"There is no specific tool in psychiatry to measure pain"},{"idx":4,"proposition":"Dental pain is often directly related to psychiatric pathology","correct":false,"justification":"No direct link, but an indirect link: psychiatric pathology -> poor hygiene -> no dental care -> dental pain"}],"type":"custom"}
+{"_id":"dlrpsy-psy-1","context":null,"enonce":"Regarding pain management:","item":"dlrpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"The placebo effect has no place in therapy","correct":false,"justification":"It can be very useful"},{"idx":1,"proposition":"Analgesic treatments are all medicated","correct":false,"justification":"Non-drug treatments have their place"},{"idx":2,"proposition":"The placebo effect is accompanied by the release of endogenous opioids","correct":true},{"idx":3,"proposition":"Tramadol has a dopaminergic effect","correct":false,"justification":"It has a serotonergic action"},{"idx":4,"proposition":"There is an addictive risk if taken care of morphine","correct":true}],"type":"custom"}
+{"_id":"dlrpsy-psy-2","context":null,"enonce":"Regarding acute pain:","item":"dlrpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"It is an alarm signal from the body","correct":true},{"idx":1,"proposition":"It is accompanied by bradychardie","correct":false,"justification":"Tachycardia"},{"idx":2,"proposition":"There are orthosympatic signs","correct":true},{"idx":3,"proposition":"Anxious manifestations make you forget the pain","correct":false,"justification":"They increase the painful sensation"},{"idx":4,"proposition":"It concerns 10% of the general population on the time of life","correct":false,"justification":"Everyone went through periods of acute pain"}],"type":"custom"}
+{"_id":"dlrpsy-psy-3","context":null,"enonce":"About chronic pain","item":"dlrpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"It is defined for a duration greater than 1 week","correct":false,"justification":"More than 3 months"},{"idx":1,"proposition":"It affects 20 to 50% of the population","correct":true},{"idx":2,"proposition":"It is accompanied by bipolar disorder","correct":false,"justification":"No, but often depressive symptoms. In addition, the psychiatric reference framework explains that about 50% of bipolar patients have a pain syndrome, mainly neck pain, back pain and arthralgia."},{"idx":3,"proposition":"The flagship treatment is long-term paracetamol","correct":false,"justification":"Not at all (beware of the risk of addiction): it is a multidisciplinary care based on medicamental and non-drug therapies that must be put in place"},{"idx":4,"proposition":"The intensity is often very high","correct":false,"justification":"It is moderate"}],"type":"custom"}
+{"_id":"Kcvessie-onco-0","context":null,"enonce":"Which propositions are true?","item":"Kcvessie","matiere":"onco","propositions":[{"idx":0,"proposition":"The average age of reporting a bladder tumour is around 60 years","correct":false,"justification":"Around 70 years"},{"idx":1,"proposition":"Bladder tumours affect both men and women","correct":false,"justification":"4 men for 1 woman"},{"idx":2,"proposition":"Deaths caused by bladder tumors account for 3% of cancer deaths","correct":true},{"idx":3,"proposition":"The main risk factor is alcohol consumption","correct":false,"justification":"It's tobacco"},{"idx":4,"proposition":"It can be recognized as an occupational disease","correct":true}],"type":"custom"}
+{"_id":"Kcvessie-onco-1","context":null,"enonce":"Which of these proposals are factors that promote squamous cell carcinomas?","item":"Kcvessie","matiere":"onco","propositions":[{"idx":0,"proposition":"Tobacco","correct":false,"justification":"Be careful, it promotes urothelial carcinoma (see the Medline, part \"trap to avoid\", on page 424)"},{"idx":1,"proposition":"Alcohol","correct":false,"justification":"Not cited as a risk factor for bladder tumours"},{"idx":2,"proposition":"Schistosomiasis","correct":true,"justification":"Especially in endemic areas in the Middle East and especially in Egypt"},{"idx":3,"proposition":"Nitrosamines","correct":false,"justification":"Be careful, they promote urothelial carcinoma (see the Medline, part \"trap to avoid\", page 424)"},{"idx":4,"proposition":"Polycyclic aromatics","correct":false,"justification":"Be careful, it promotes urothelial carcinoma (see the Medline, part \"trap to avoid\", on page 424)"}],"type":"custom"}
+{"_id":"Kcvessie-onco-2","context":null,"enonce":"Regarding the diagnosis of bladder tumors:","item":"Kcvessie","matiere":"onco","propositions":[{"idx":0,"proposition":"Voiding burns are in the foreground","correct":false,"justification":"There is mainly hematuria"},{"idx":1,"proposition":"Hematuria is often terminal or even total","correct":true},{"idx":2,"proposition":"In case of hematuria, clots can be found","correct":true,"justification":"Unlike hematuria of nephrological origin"},{"idx":3,"proposition":"Patients may describe urges","correct":true},{"idx":4,"proposition":"The TR regains pelvic armour","correct":true}],"type":"custom"}
+{"_id":"Kcvessie-onco-3","context":null,"enonce":"Regarding urinary cytological:","item":"Kcvessie","matiere":"onco","propositions":[{"idx":0,"proposition":"It is done on an ECBU","correct":true,"justification":"It will perform a cytological examination infondi via cystoscopy, after verification by the ECBU"},{"idx":1,"proposition":"Cystoscopy requires general anesthesia","correct":false,"justification":"Local anesthesia, is done in office"},{"idx":2,"proposition":"Urinary cytology has excellent negative predictive value (NPV)","correct":false,"justification":"An excellent VPP"},{"idx":3,"proposition":"Cytology has excellent positive predictive value","correct":true},{"idx":4,"proposition":"None of these propositions are true","correct":false}],"type":"custom"}
+{"_id":"Kcvessie-onco-7","context":null,"enonce":"Which of the following are true?","item":"Kcvessie","matiere":"onco","propositions":[{"idx":0,"proposition":"Follow-up includes regular endoscopic check-ups ","correct":true},{"idx":1,"proposition":"In 90% of cases, bladder tumours present immediately as a bladder tumour that infiltrates the IMTV muscle. ","correct":false,"justification":"MIVs are 20% at diagnosis"},{"idx":2,"proposition":"Survival of patients with MITV is greater than 90% at 5 years","correct":false,"justification":"Less than 50%"},{"idx":3,"proposition":"The main risks of a NMITV are recidivism in the form of one or more MINTVs","correct":true},{"idx":4,"proposition":"The urothelium covers the entire urinary tract","correct":true}],"type":"custom"}
+{"_id":"Kctesticule-onco-0","context":null,"enonce":"Which of the following are true?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"The normal testicle is formed by seminiferous tubules, contained in lobules ","correct":true},{"idx":1,"proposition":" Seminiferous tubules contain four types of cells ","correct":false,"justification":"Two cell types: Leydig and Sertoli"},{"idx":2,"proposition":"Germ cells and Sertoli cells are the two most important cell types","correct":true},{"idx":3,"proposition":" Sperm are produced in the seminiferous tubules","correct":true},{"idx":4,"proposition":" The Leydig cells that produce sperm are present in the stroma","correct":false,"justification":"Androgen production"}],"type":"custom"}
+{"_id":"Kctesticule-onco-1","context":null,"enonce":"Which of the following propositions are true?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"Non-germline tumours include gonadal stromal tumours ","correct":true},{"idx":1,"proposition":"The Doppler ultrasound makes it possible to define the lymph node and metastatic status of the patient on which the TNM stage of the disease will depend ","correct":true},{"idx":2,"proposition":"Staging of metastatic forms according to the IGCCCG classification ","correct":true},{"idx":3,"proposition":"Diagnosis is based on ultrasound which makes it possible to highlight hyperechoic areas ","correct":true},{"idx":4,"proposition":"More generally, the presence of grade 3 microcalcifications in a patient with gonadal dysgenesis syndrome warrants periodic clinical and ultrasound monitoring.","correct":true}],"type":"custom"}
+{"_id":"Kctesticule-onco-2","context":null,"enonce":"Which of the following are the side effects of cisplatin?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"Renal toxicity","correct":true},{"idx":1,"proposition":"Peripheral neuropathy","correct":true},{"idx":2,"proposition":"Ototoxicity","correct":true},{"idx":3,"proposition":"Dilated cardiomyopathy","correct":false,"justification":"This is the case of etoposide (inhibitor of topoisomerase type II)"},{"idx":4,"proposition":"Hand-foot syndrome ","correct":false,"justification":"Especially anthracyclines, docetaxel, 5FU and capecitabine"}],"type":"custom"}
+{"_id":"Kctesticule-onco-3","context":null,"enonce":"Which of the following are non-germline tumors?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"Leydig cell tumours","correct":true},{"idx":1,"proposition":"Gonadoblastomas","correct":true},{"idx":2,"proposition":"Pure seminomas","correct":false,"justification":"Germ cell tumours"},{"idx":3,"proposition":"Yolk sac tumour","correct":false,"justification":"Non-seminoma germ cell tumours, AFP synthesis"},{"idx":4,"proposition":"Choriocarcinoma","correct":false,"justification":"Non-seminoma germ cell tumours, hCG synthesis"}],"type":"custom"}
+{"_id":"Kctesticule-onco-4","context":null,"enonce":"Which of the following propositions are true about the extension balance?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"PET-CT is systematic","correct":false,"justification":"The PET-CT has no place in the initial assessment."},{"idx":1,"proposition":"Scrotal MRI should be performed to better characterize the mass ","correct":false,"justification":"False: scrotal MRI does not provide a decisive element to the local assessment."},{"idx":2,"proposition":"Bone scintigraphy is performed at the point of clinical call","correct":true},{"idx":3,"proposition":"The CT-TAP is the reference exam for the extension assessment","correct":true},{"idx":4,"proposition":"Brain imaging should be performed in case of extranodal metastatic disease","correct":true}],"type":"custom"}
+{"_id":"Kctesticule-onco-5","context":null,"enonce":"Which of the following should be put in place before taking cisplatin?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"Hyperhydration","correct":true,"justification":"True, renal toxicity"},{"idx":1,"proposition":"Anti-emetics","correct":true,"justification":"True, nausea-vomiting"},{"idx":2,"proposition":"Cardioprotectors","correct":false,"justification":"False"},{"idx":3,"proposition":"Insulin","correct":false,"justification":"False"},{"idx":4,"proposition":"Normacol","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"Kctesticule-onco-6","context":null,"enonce":"Which of the following proposals must be made before the treatment is implemented?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"Presentation of the file in Multidisciplinary Consultation Meeting (RCP)","correct":true},{"idx":1,"proposition":"Brain MRI","correct":false,"justification":"False"},{"idx":2,"proposition":"Proposal of a gamete collection to CECOS ","correct":true},{"idx":3,"proposition":"Diagnostic announcement according to the recommended modalities","correct":true},{"idx":4,"proposition":"Collection of free and informed consent","correct":true}],"type":"custom"}
+{"_id":"Kctesticule-onco-7","context":null,"enonce":"Which of the following are germ cell tumours?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"Embryonic carcinoma","correct":true},{"idx":1,"proposition":"Teratoma","correct":true},{"idx":2,"proposition":"Adenocarcinomas of the rete testis","correct":false},{"idx":3,"proposition":"Sertoli cell tumours","correct":false},{"idx":4,"proposition":"Leydig cell tumours","correct":false}],"type":"custom"}
+{"_id":"Kctesticule-onco-8","context":null,"enonce":"Which of the following serum tumor markers are relevant in germ cell tumors of the testicle?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"SCC","correct":false,"justification":"Useless here"},{"idx":1,"proposition":"Alpha-fetoprotein","correct":true},{"idx":2,"proposition":"total hCG","correct":true},{"idx":3,"proposition":"LDH","correct":true},{"idx":4,"proposition":"Ca125","correct":false,"justification":"Useless here"}],"type":"custom"}
+{"_id":"Kctesticule-onco-9","context":null,"enonce":"At what stage is the invasion of the spermatic cord established?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"T1","correct":false,"justification":"Tumor limited to the testicle and epididymis WITHOUT vascular invasion"},{"idx":1,"proposition":"T2","correct":false,"justification":"Tumor limited to the testicle and epididymis WITH vascular invasion OR with invasion of the tunica vaginal"},{"idx":2,"proposition":"T3","correct":true},{"idx":3,"proposition":"T4","correct":false,"justification":"Invasion of the scrotum"},{"idx":4,"proposition":"T5","correct":false,"justification":"No T5. The maximum is T4 (invasion of the scrotum)"}],"type":"custom"}
+{"_id":"Kctesticule-onco-10","context":null,"enonce":"Which of the following are risk factors for germline testicular tumors?","item":"Kctesticule","matiere":"onco","propositions":[{"idx":0,"proposition":"Early and regular cannabis use","correct":true},{"idx":1,"proposition":"Down syndrome","correct":true},{"idx":2,"proposition":"History of cryptorchidism","correct":true},{"idx":3,"proposition":"Tobacco","correct":false,"justification":"False"},{"idx":4,"proposition":"Overweight","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"MTEV-cardio-0","context":null,"enonce":"Regarding venous thrombosis and pulmonary embolism","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Pulmonary embolism (PE) is most often a complication of deep vein thrombosis (DVT)","correct":true,"justification":"70% of PEs are secondary to DVT"},{"idx":1,"proposition":"PE causes 5,000 to 10,000 deaths per year in France","correct":true},{"idx":2,"proposition":"PE results in an initial dead space and then a shunt effect by redistribution of blood flow and secondary bronchoconstriction","correct":true,"justification":"As a reminder: shunt effect = unventilated infused, and dead space = ventilated not infused"},{"idx":3,"proposition":"PE results in a picture of hypercapnic hypoxemia with ventilatory alkalosis","correct":false,"justification":"Hypocapnic hypoxemia (by hyperventilation, normocapnia in COPD), with ventilatory alkalosis"},{"idx":4,"proposition":"The hemodynamic consequences of PE (increased cardiac work by increased afterload) appear for obstruction >50-60% of pulmonary circulation","correct":false,"justification":"For obstruction >30%. If the obstruction is >50-60%, cardiogenic shock (drop in cardiac output and hypotension) = acute pulmonary heart is feared"}],"type":"custom"}
+{"_id":"MTEV-cardio-2","context":null,"enonce":"About venous thromboembolic disease (VTE)","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"For the diagnosis of DVT, D-Dimer should be age-appropriate","correct":false,"justification":"Age adjustment only in the case of PE and if elderly patient"},{"idx":1,"proposition":"D-Dimer have a PPV (positive predictive value) of 99% for PE and proximal DVT","correct":false,"justification":"A VPN (negative predictive value) of 99%: in case of negativity and low clinical probability, the diagnosis is excluded"},{"idx":2,"proposition":"In a patient suffering from cancer and faced with a suspicion of PE, a CT angiography will be requested immediately regardless of the clinical probability","correct":true,"justification":"DDimers have no value in the case of cancer (false positive)"},{"idx":3,"proposition":"On ECG, an S1Q3 associated with a right axial deviation and a right branch block is specific to pulmonary embolism.","correct":false,"justification":"Signs of suffering of the right heart, they can evoke PE but are not specific"},{"idx":4,"proposition":"In case of high clinical probability, a negative CT angiography does not exclude pulmonary embolism","correct":true,"justification":"This is an indication for ventilation\/perfusion scan or arteriography"}],"type":"custom"}
+{"_id":"MTEV-cardio-3","context":null,"enonce":"About venous thromboembolic disease (VTE)","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"In case of superficial venous thrombosis, Doppler ultrasound of the lower limbs is essential ","correct":true,"justification":"It excludes an associated PST"},{"idx":1,"proposition":"In case of distal DVT or spontaneous superficial venous thrombosis, 6 weeks of anticoagulant therapy is recommended","correct":true},{"idx":2,"proposition":"In PE, a cardiac ultrasound may show direct signs, such as a non-enlarged hypokinetic dilated right ventricle ","correct":false,"justification":"This is an indirect sign (acute pulmonary heart)"},{"idx":3,"proposition":"In PE, pulmonary angiography is particularly recommended in case of thrombi in the right atrium","correct":false,"justification":"It is contraindicated in this case"},{"idx":4,"proposition":"Severe PE is defined as a SBP <90 mmHg or a decrease in SBP of 20mmHg for more than 10 minutes","correct":false,"justification":"STEP <90mmHg or drop of 40mmHg for more than 15 minutes"}],"type":"custom"}
+{"_id":"MTEV-cardio-4","context":null,"enonce":"About venous thromboembolic disease (VTE)","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"In PE, the early onset of basithoracic pleural pain accompanied by a dry cough should suggest pulmonary infarction ","correct":true},{"idx":1,"proposition":"In case of surgery <3 months and prescription of LMWH, an NFS is recommended in the pretherapeutic workup, then 2 times a week for 1 month, then 1 time per week","correct":true,"justification":"Indications for NFS monitoring in LMWH: chir\/trauma <3 months, UFH\/LMWH <6 months, significant comorbidity at risk"},{"idx":2,"proposition":"The PESI score assesses the risk of developing a chronic pulmonary heart","correct":false,"justification":"The risk of death at 30 days"},{"idx":3,"proposition":"In PE in an 81-year-old patient with cancer and SBP at 85 mmHg, right ventricle ultrasound dysfunction and elevated BNP biomarkers: PE is of intermediate severity","correct":false,"justification":"STEP <90 mmHg = > severe PE"},{"idx":4,"proposition":"In severe PE, LMWH should be initiated as soon as possible in the absence of severe renal impairment","correct":false,"justification":"LMWH is contraindicated in severe PE. UFH is indicated in combination with fibrinolysis"}],"type":"custom"}
+{"_id":"MTEV-cardio-6","context":null,"enonce":"Which of these proposals fall within the scope of calculating the Geneva score?","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Epistaxis","correct":false,"justification":"Hemoptysis"},{"idx":1,"proposition":"Age over 55","correct":false,"justification":"65 years, as often in cardiology (it is at this age that it is considered a cardiovascular risk factor)"},{"idx":2,"proposition":"Tobacco","correct":false,"justification":"Neither alcohol, tobacco nor diabetes are recognized risk factors for DVT (Deep Vein Thrombosis) or PE (Pulmonary Embolism)"},{"idx":3,"proposition":"Tachycardia","correct":true},{"idx":4,"proposition":"Pain","correct":true}],"type":"custom"}
+{"_id":"MTEV-cardio-7","context":null,"enonce":"From what Geneva score do we do without D-Dimer and do we do a CT injected directly?","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"9","correct":false,"justification":"A Geneva score greater than or equal to 11 requires the performance of a chest CT angiography"},{"idx":1,"proposition":"10","correct":false},{"idx":2,"proposition":"11","correct":true},{"idx":3,"proposition":"12","correct":false},{"idx":4,"proposition":"13","correct":false}],"type":"custom"}
+{"_id":"MTEV-cardio-8","context":null,"enonce":"From what Wells score do we do without D-Dimer and do we do a Doppler ultrasound of the lower limbs directly?","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"1","correct":false,"justification":"A Wells score greater than or equal to 3 is strong. It requires the realization of a venous Doppler ultrasound of the lower limbs"},{"idx":1,"proposition":"2","correct":false},{"idx":2,"proposition":"3","correct":true},{"idx":3,"proposition":"4","correct":false},{"idx":4,"proposition":"5","correct":false}],"type":"custom"}
+{"_id":"MTEV-cardio-9","context":null,"enonce":"Which propositions are true?","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"D-dimer are specific products of fibrin degradation formed under plasmin action","correct":true},{"idx":1,"proposition":"The management of Deep Vein Thrombosis (DVT) is done in cardiovascular service only","correct":false,"justification":"Well-tolerated DVTs can be managed on an outpatient basis"},{"idx":2,"proposition":"A PESI score greater than or equal to 1 is intermediate","correct":true},{"idx":3,"proposition":"A BP (Systolic Blood Pressure) less than 90 mmHg classifies a PE as high risk","correct":true,"justification":"High PESI score: requires thrombolysis"},{"idx":4,"proposition":"The objective, in case of an intermediate PESI score, will be to dissolve the clot","correct":false,"justification":"Management with DOAC (direct oral anticoagulants) aims to prevent the appearance of new clots. DOACs, like VKAs or antiaggregants, are not thrombolytics."}],"type":"custom"}
+{"_id":"MTEV-cardio-10","context":null,"enonce":"Which of these proposals can elevate D-Dimers?","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Pregnancy","correct":true},{"idx":1,"proposition":"Sepsis","correct":true},{"idx":2,"proposition":"A DICV","correct":true},{"idx":3,"proposition":"Coronary artery insufficiency","correct":true},{"idx":4,"proposition":"An extensive hematoma","correct":true,"justification":"All these proposals are true!"}],"type":"custom"}
+{"_id":"MTEV-cardio-11","context":null,"enonce":"Which of these propositions are true?","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"The determination of D-dimer has an excellent negative predictive value in ambulatory patients for whom the clinical probability of diagnosis of DVT\/PE is not high.","correct":true},{"idx":1,"proposition":"The so-called \"antiphospholipid\" antibodies are specific for complexes associating anionic phospholipids and proteins which may be β2-glycoprotein I","correct":true},{"idx":2,"proposition":"APS (Anti-Phospholipid Syndrome) is linked to ANCA vasculitis","correct":false,"justification":"APS is linked to systemic lupus (ACAN)"},{"idx":3,"proposition":"Many antibodies\nantiphospholipids may be present transiently and are non-thrombogenic","correct":true}],"type":"custom"}
+{"_id":"MTEV-cardio-12","context":null,"enonce":"Which of these factors and proteins are involved in mutations that can cause VTE?","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Factor II","correct":true,"justification":"The prothrombin gene (F2 G20210A)"},{"idx":1,"proposition":"Protein C","correct":true},{"idx":2,"proposition":"Factor VIII","correct":false},{"idx":3,"proposition":"The Willebrand factor","correct":false,"justification":"4 proteins and factors to know: Protein C, Protein S, Factor III and Factor V"},{"idx":4,"proposition":"Factor V","correct":true}],"type":"custom"}
+{"_id":"IU-infectio-0","context":null,"enonce":"Which of the following identifies the most common germ in urinary tract infections?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"proposition":"E. coli","correct":true,"justification":"True, in almost 90% of cases"},{"idx":1,"proposition":"S. aureus","correct":false,"justification":"None"},{"idx":2,"proposition":"P. mirabilis","correct":false,"justification":"Comes in second place"},{"idx":3,"proposition":"K. pneumoniae","correct":false,"justification":"None"},{"idx":4,"proposition":"S. saprophyticus","correct":false,"justification":"Especially in young women"}],"type":"custom"}
+{"_id":"IU-infectio-1","context":null,"enonce":"Which of the following are mandatory examinations in case of suspicion of severe acute pyelonephritis?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"proposition":"NFS-P","correct":true},{"idx":1,"proposition":"Kidney function","correct":true,"justification":"True, Urea and Creatinine"},{"idx":2,"proposition":"RAY","correct":false,"justification":"Useless if you do not think you have to transfuse (this is the general case)"},{"idx":3,"proposition":"Ultrasound of the urinary tract","correct":false,"justification":"We prefer the uroscanner from the outset"},{"idx":4,"proposition":"Blood","correct":true,"justification":"True, before administration of antibiotic therapy (C3G IV + Aminoside IV)"}],"type":"custom"}
+{"_id":"IU-infectio-2","context":null,"enonce":"Which of the following are the probabilistic first-line treatments for severe acute pyelonephritis?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"proposition":"C3G IV","correct":true,"justification":"True, C3G IV + Aminoside"},{"idx":1,"proposition":"Aminoglycoside IV","correct":true},{"idx":2,"proposition":"Amikacin IV","correct":true,"justification":"True, it is the aminoglycoside that is preferred"},{"idx":3,"proposition":"Gentamicin IV","correct":false,"justification":"Amikacin is preferred"},{"idx":4,"proposition":"Fluoroquinolone","correct":false,"justification":"This is the case when it is not serious"}],"type":"custom"}
+{"_id":"IU-infectio-3","context":null,"enonce":"Which of the following are the probabilistic first-line treatments for severe acute pyelonephritis?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"proposition":"C3G IV","correct":true,"justification":"True, C3G IV + Aminoside"},{"idx":1,"proposition":"Aminoglycoside IV","correct":true},{"idx":2,"proposition":"Amikacin IV","correct":true,"justification":"True, it is the aminoglycoside that is preferred"},{"idx":3,"proposition":"Gentamicin IV","correct":false,"justification":"Amikacin is preferred"},{"idx":4,"proposition":"Fluoroquinolone","correct":false,"justification":"This is the case when it is not serious"}],"type":"custom"}
+{"_id":"IU-infectio-4","context":null,"enonce":"Which of the following propositions concerning simple acute cystitis are true?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"proposition":"The diagnosis of simple acute cystitis does not require the realization of a urine strip in the young woman","correct":false,"justification":"False"},{"idx":1,"proposition":"ECBU is not necessary in young women without comorbidities  ","correct":true},{"idx":2,"proposition":"First-line treatment is Fosfomycin-tromitamol as a single dose","correct":true},{"idx":3,"proposition":"Recurrence occurs only very rarely ","correct":false,"justification":"False\r\nRecurrence in 20-30% of cases"},{"idx":4,"proposition":"Macroscopic hematuria is a sign of severity","correct":false,"justification":"False\r\nIt is not a sign of the severity of the infection"}],"type":"custom"}
+{"_id":"IU-infectio-5","context":null,"enonce":"What is the significant threshold of bacteriuria in humans (with notable exceptions)?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"proposition":"10^3","correct":true,"justification":"True. 10^3 in all cases EXCEPT atypical Enterobacteriaceae (other than E. coli, Enterobacteriaceae, etc.) in women (in this case, the threshold is 10^4)"},{"idx":1,"proposition":"10^2","correct":false,"justification":"False"},{"idx":2,"proposition":"10^4","correct":false,"justification":"This threshold is allowed for atypical enterobacteriaceae in women"},{"idx":3,"proposition":"10^5","correct":false,"justification":"False"},{"idx":4,"proposition":"10^6","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"IU-infectio-6","context":null,"enonce":"What is the threshold of significant bacteriuria in women for E. coli?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"proposition":"10^2","correct":false,"justification":"False"},{"idx":1,"proposition":"10^3","correct":true,"justification":"True. 10^3 all the time, except in the case of atypical enterobacteriaceae (other than E. coli, enterobacteriaceae, etc.) in women (threshold of 10^4)"},{"idx":2,"proposition":"10^4","correct":false,"justification":"False"},{"idx":3,"proposition":"10^5","correct":false,"justification":"False"},{"idx":4,"proposition":"10^6","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"vieillissement-nephro-0","context":null,"enonce":"Some fundamentals:","item":"vieillissement","matiere":"nephro","propositions":[{"idx":0,"proposition":"Renal aging is the consequence of intrinsic genetic and extrinsic mechanisms, related to environmental factors and comorbidities","correct":true},{"idx":1,"proposition":"Renal aging concerns only endocrine functions","correct":false,"justification":"It concerns all the functions of the kidneys: elimination of waste and toxins, homeostasis, endocrine functions"},{"idx":2,"proposition":"Renal ageing is accompanied by 'physiological' proteinuria","correct":false,"justification":"Renal aging is not accompanied by proteinuria or significant hematuria"},{"idx":3,"proposition":"The finding of proteinuria is always pathological, regardless of age","correct":false,"justification":"There are transient and physiological proteinuria (orthostatic, effort ...)"},{"idx":4,"proposition":"Age-related structural and functional renal changes do not have significant consequences in normal situations","correct":true,"justification":"But they limit the capacity for self-regulation, thus increasing the risk of occurrence of an IRA"}],"type":"custom"}
+{"_id":"vieillissement-nephro-1","context":null,"enonce":"Regarding the renal physiology of the elderly:","item":"vieillissement","matiere":"nephro","propositions":[{"idx":0,"proposition":"The determination of serum creatinine gives a poor reflection of renal function in the elderly and overestimates the severity of renal failure","correct":false,"justification":"It most often leads to underestimation of the severity of renal failure"},{"idx":1,"proposition":"The GFR value should be estimated by the CKD-PPE formulas rather than by the MDRD formula which is not very precise after 75 years.","correct":false,"justification":"The GFR value should be estimated by the CKD-PPE or MDRD formulas rather than by the Cockcroft formula, which is imprecise after age 75 and should no longer be used."},{"idx":2,"proposition":"A plasma creatinine value > 135 μmol\/L may indicate severe chronic renal failure (stage IV) in the elderly","correct":true},{"idx":3,"proposition":"The decrease in GFR is continuous and of the order of 10 ml \/ min and per year from adulthood","correct":false,"justification":"Aging is accompanied from adulthood, without threshold effect, by a decrease in the glomerular filtration rate of the order of 0.7ml \/ min \/ year"},{"idx":4,"proposition":"Water-electrolyte disorders are common in the elderly because the adaptive capacities of the kidney are quickly exceeded","correct":true}],"type":"custom"}
+{"_id":"vieillissement-nephro-2","context":null,"enonce":"Regarding physiology:","item":"vieillissement","matiere":"nephro","propositions":[{"idx":0,"proposition":"Osmolar intakes tend to decrease with age","correct":true},{"idx":1,"proposition":"Body composition changes, with a lower percentage of fat mass and an increase in water volume","correct":false,"justification":"Lower percentage of total water and a higher percentage of body fat"},{"idx":2,"proposition":"Hyponatremia increases the risk of falls","correct":true},{"idx":3,"proposition":"The incidence of acute renal failure increases exponentially with age","correct":true},{"idx":4,"proposition":"Rapidly progressive glomerulonephritis syndrome is an urgent indication for renal biopsy","correct":true}],"type":"custom"}
+{"_id":"vieillissement-nephro-3","context":null,"enonce":"Which propositions are true?","item":"vieillissement","matiere":"nephro","propositions":[{"idx":0,"proposition":"Age does not increase the rate of progression of chronic kidney disease","correct":true},{"idx":1,"proposition":"Renal failure alters the pharmacokinetics of all drugs","correct":false,"justification":"Not all but a lot, and you have to be careful!"},{"idx":2,"proposition":"Contraindications to dialysis management should be discussed on a case-by-case basis","correct":true},{"idx":3,"proposition":"The occurrence of certain pathologies may lead to consider the cessation of extrarenal purification\n","correct":true},{"idx":4,"proposition":"Kidney transplantation cannot be performed after age 75","correct":false,"justification":"Must be prosposed if necessary up to 85 years according to the HAS"}],"type":"custom"}
+{"_id":"vieillissement-nephro-4","context":null,"enonce":"What is the threshold of red blood cells per mm3 for which we speak of microscopic hematuria?","item":"vieillissement","matiere":"nephro","propositions":[{"idx":0,"proposition":"5 GR\/mm3","correct":false,"justification":"The threshold is 10 GR\/mm3 or 10 to the power of 4 red blood cells per mL"},{"idx":1,"proposition":"10 GR\/mm3","correct":true},{"idx":2,"proposition":"30 GR\/mm3","correct":false},{"idx":3,"proposition":"50 GR\/mm3","correct":false},{"idx":4,"proposition":"100 GR\/mm3","correct":false}],"type":"custom"}
+{"_id":"vieillissement-nephro-5","context":null,"enonce":"Regarding renal aging, which proposal(s) is\/are accurate?","item":"vieillissement","matiere":"nephro","propositions":[{"idx":0,"proposition":"Albuminuria is physiological as long as it remains moderate","correct":false,"justification":"Albuminuria is never physiological"},{"idx":1,"proposition":"Microscopic hematuria is physiological after 80 years","correct":false,"justification":"Hematuria is never physiological"},{"idx":2,"proposition":"The GFR decrease, from the age of 40, is 10 points per year","correct":false,"justification":"The decrease in GFR from the age of 40 is 10 points per decade, or 1 point per year about"},{"idx":3,"proposition":"The decrease in GFR observed with age is about 0.7 per year","correct":true},{"idx":4,"proposition":"The best formula for estimating GFR is the Cockcroft-Gault in the elderly","correct":false,"justification":"We prefer to use MDRD or CKD-Epi"}],"type":"custom"}
+{"_id":"vieillissement-nephro-6","context":null,"enonce":"What are the exact suggestions regarding kidney size?","item":"vieillissement","matiere":"nephro","propositions":[{"idx":0,"proposition":"The size of the kidneys remains the same from the age of 20","correct":false,"justification":"The size of the kidneys decreases with age, at the expense of the cortex, which remain regular (no notches, no cysts, etc.)"},{"idx":1,"proposition":"The kidneys increase in size with age physiologically","correct":false},{"idx":2,"proposition":"There is a decrease in the size of the kidneys at the expense of the parenchyma","correct":false},{"idx":3,"proposition":"The decrease in kidney size is at the expense of the cortex","correct":true},{"idx":4,"proposition":"The cortex remains regular in physiological situation","correct":true}],"type":"custom"}
+{"_id":"vieillissement-nephro-7","context":null,"enonce":"Regarding renal aging, which proposals are accurate?","item":"vieillissement","matiere":"nephro","propositions":[{"idx":0,"proposition":"The CKD-Épi formula is preferred to the Cockcroft-Gault formula to estimate the GFR","correct":true},{"idx":1,"proposition":"Creatinineuria increases with age","correct":false,"justification":"It decreases due to the decrease in muscle mass, which can mask kidney failure."},{"idx":2,"proposition":"Creatinineuria decreases due to the decrease in GFR with age","correct":false,"justification":"It is increased by the decrease in GFR, it is decreased by the loss of muscle mass"},{"idx":3,"proposition":"The feeling of thirst is decreased with age","correct":true},{"idx":4,"proposition":"The dilution capacity of urine is increased with age, which increases the risk of dehydration","correct":false,"justification":"The dilution capacity of urine is decreased in the elderly"}],"type":"custom"}
+{"_id":"vieillissement-nephro-8","context":null,"enonce":"Regarding renal aging, which proposals are accurate?","item":"vieillissement","matiere":"nephro","propositions":[{"idx":0,"proposition":"GFR decreases by about 0.7 ml\/min\/1m73² per year","correct":true},{"idx":1,"proposition":"GFR decreases by about 10 ml\/min\/1m73² per decade from age 40","correct":true},{"idx":2,"proposition":"The renin angiotensin aldosterone system is potentiated by aging","correct":false,"justification":"RAAS is decreased with age"},{"idx":3,"proposition":"The decrease in the size of the kidneys occurs in the cortex","correct":true},{"idx":4,"proposition":"Chronic kidney disease progresses faster and faster with age","correct":false,"justification":"The MRC continues its course without being impacted by age"}],"type":"custom"}
+{"_id":"tumefactionpelv-gyn-0","context":null,"enonce":"General:","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"Fibroids are very common","correct":true},{"idx":1,"proposition":"Fibroids are not always symptomatic","correct":true},{"idx":2,"proposition":"Treatment of fibroids is mainly medicated","correct":false,"justification":"Essentially surgical"},{"idx":3,"proposition":"The essential complementary examination is pelvic ultrasound","correct":true},{"idx":4,"proposition":"Tumor markers are to be measured in second line possibly","correct":true,"justification":"As well as CT and MRI"}],"type":"custom"}
+{"_id":"tumefactionpelv-gyn-1","context":null,"enonce":"General:","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"The 3 most common pelvic swellings are uterine fibroid, ovarian cyst and pregnancy","correct":true,"justification":"Always think about pregnancy in a woman during genital activity"},{"idx":1,"proposition":"The bHCG test is unnecessary in women taking contraception","correct":false,"justification":"Do it quite systematically"},{"idx":2,"proposition":"Uterine fibroids are most often mucous when palpable","correct":false,"justification":"The uterine fibroid, when palpable, is most often subserous (types 5,6,7 according to the FIGO classification) or interstitial (types 3,4)"},{"idx":3,"proposition":"1-2% of women over the age of 35 have uterine fibroids","correct":false,"justification":"It is the most common tumor of the uterus: 20 to 30% of women over 35 years of age have it"},{"idx":4,"proposition":"Fibroids are extremely painful most often","correct":false}],"type":"custom"}
+{"_id":"tumefactionpelv-gyn-2","context":null,"enonce":"Regarding uterine fibroids:","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"Menorrhagia is the main telltale sign of uterine fibroids","correct":true,"justification":"Rules are increased in duration and abundance"},{"idx":1,"proposition":"In menorrhagia indicative of fibroids, menstruation is increased in abundance but not in duration","correct":false,"justification":"Rules are increased in duration and abundance"},{"idx":2,"proposition":"The Huntigton score specifies the number of diaper changes per day","correct":false,"justification":"The number of exchanges per day = Higham score"},{"idx":3,"proposition":"Sometimes endometrial hyperplasia is associated with fibroids","correct":true},{"idx":4,"proposition":"Dysmenorrhea is a sign eliminating the diagnosis of fibroid","correct":false,"justification":"It may be related to a fibroid of the cervix or isthmus interfering with the evacuation of menstrual flow."}],"type":"custom"}
+{"_id":"tumefactionpelv-gyn-3","context":null,"enonce":"Regarding fibroids:","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"A submucosal fibroid is very rarely hemorrhagic","correct":false,"justification":"A submucosal fibroid is often responsible for significant bleeding (especially if an IUD is present), which can lead to hyposideremic microcytic anemia"},{"idx":1,"proposition":"Subserous fibroids rarely cause bleeding","correct":true,"justification":"This is also the case with interstitial fibroids."},{"idx":2,"proposition":"Hyperplasia and nerve compression of a fibroid is the main cause of pain in fibroids","correct":false,"justification":"It is rather aseptic necrobiosis"},{"idx":3,"proposition":"Complications are multiple during pregnancy, often minor and low impact once pregnancy has set in.","correct":true},{"idx":4,"proposition":"Adenomyosis is a very common cause of pelvic tumours","correct":false,"justification":"They are rarely the cause of a pelvic tumor because the uterus is rarely palpable (does not exceed one x2 in size)"}],"type":"custom"}
+{"_id":"tumefactionpelv-gyn-4","context":null,"enonce":"About ovarian cysts:","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"Endometrial cancer is a common cause of palpable pelvic tumours","correct":false,"justification":"This is actually a very rare cause, which is then often an endocavitary tumor with cervical stenosis and intrauterine retention."},{"idx":1,"proposition":"Functional ovarian cysts are the most common of a woman's pelvic swellings during genital activity","correct":true},{"idx":2,"proposition":"Functional cysts are always follicular","correct":false,"justification":"Follicular cysts or lutein cysts (of the corpus luteum) whose regression is most often spontaneous"},{"idx":3,"proposition":"Organic cysts are most often malignant","correct":false,"justification":"Most often benign"},{"idx":4,"proposition":"70% of ovarian tumours are malignant or borderline","correct":false,"justification":"20% of ovarian tumours are malignant or borderline, and the risk of cancer increases with age"}],"type":"custom"}
+{"_id":"tumefactionpelv-gyn-5","context":null,"enonce":"About ovarian cysts:","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"The symptomatology of ovarian cysts is very specific: swelling, cyclical pain and menometrorrhagia","correct":false,"justification":"There is no specific symptomatology of ovarian cysts"},{"idx":1,"proposition":"Ovarian cyst is symptomatic in 10% of cases","correct":false,"justification":"In more than 50% of cases, the ovarian cyst is latent, and is discovered by incidentaloma"},{"idx":2,"proposition":"Sometimes the ovarian cyst is discovered during a complication","correct":true},{"idx":3,"proposition":"Acute pelvic pain from a cyst complication is mild and cyclical","correct":false,"justification":"It is a thunderclap in a serene sky not yielding and amplifying"},{"idx":4,"proposition":"Abdominal-pelvic pain begins abruptly from one second to the next and does not give way, getting worse.","correct":true}],"type":"custom"}
+{"_id":"tumefactionpelv-gyn-6","context":null,"enonce":"Regarding complications of ovarian cysts","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"In case of torsion, surgery is urgently needed to untwist the ovary or appendix and remove the cyst","correct":true},{"idx":1,"proposition":"Hysterectomy is preferred in young women to ensure 100% survival","correct":false,"justification":"It is necessary to be conservative in young women, even in case of late gesture and even if the appearance of the ovary is worrying"},{"idx":2,"proposition":"Intracystic hemorrhage often occurs in organ cysts","correct":false,"justification":"More often in functional cysts"},{"idx":3,"proposition":"A tusk is found in one of the two iliac fossa in case of intracystic hemorrhage","correct":true,"justification":"The cul de sac homolateral to pain is filled"},{"idx":4,"proposition":"Peritoneal effusion associated with intracystic hemorrhage is rare and indicates the severity and urgency of management","correct":false,"justification":"It is common to observe an associated peritoneal effusion"}],"type":"custom"}
+{"_id":"tumefactionpelv-gyn-7","context":null,"enonce":"Regarding the consultation in a woman with a very painful pelvic swelling:","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"Vaginal touch guides the diagnosis and is often very contributory","correct":false,"justification":"It is the essential examination because it helps to guide the diagnosis but it is often not very contributory because of the pain (see statement)"},{"idx":1,"proposition":"A uterus globally enlarged in volume most often corresponds to one or more interstitial fibroids","correct":true,"justification":"Or subserous"},{"idx":2,"proposition":"The clinical examination is emptied bladder","correct":true,"justification":"So as not to have a bladder globe that would trap us"},{"idx":3,"proposition":"Laterouterine masses in young women are always dependent on the uterus","correct":false,"justification":"Not at all, they can be independent if they interest the ovary for example"},{"idx":4,"proposition":"Transparietal and transvaginal pelvic ultrasound is the additional examination to be requested first","correct":true}],"type":"custom"}
+{"_id":"tumefactionpelv-gyn-8","context":null,"enonce":"Regarding pelvic masses:","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"Solid swellings most often correspond to ovarian cancers","correct":false,"justification":"Solid swellings most often correspond to uterine fibroids and ultrasound specifies their size, number and location"},{"idx":1,"proposition":"IGOF classification maps the uterus","correct":false,"justification":"FIGO"},{"idx":2,"proposition":"Cancer masses are rarely large enough to give pelvic masses","correct":true},{"idx":3,"proposition":"In case of a supposedly benign cyst, a cystectomy or appendectomy is performed depending on the age","correct":true},{"idx":4,"proposition":"Therapeutic abstention is promoted in case of asymptomatic fibroid less than 25 cm","correct":false,"justification":"Less than 10 cm"}],"type":"custom"}
+{"_id":"tumefactionpelv-gyn-9","context":null,"enonce":"What is the FIGO classification of an intramural uterine fibroid in contact with the endometrium?","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"3","correct":true},{"idx":1,"proposition":"4","correct":false,"justification":"Intramural interstitial fibroid (no contact with the endometrium)"},{"idx":2,"proposition":"7","correct":false,"justification":"Pedunculated subserous fibroma"},{"idx":3,"proposition":"1","correct":false,"justification":"Submural fibroid <50%"},{"idx":4,"proposition":"0","correct":false,"justification":"Intracavitary pedunculated submucosal fibroma"}],"type":"custom"}
+{"_id":"tumefactionpelv-gyn-10","context":null,"enonce":"What is the FIGO classification of a pedunculated subserous uterine fibroid?","item":"tumefactionpelv","matiere":"gyn","propositions":[{"idx":0,"proposition":"7","correct":true},{"idx":1,"proposition":"4","correct":false,"justification":"Intramural interstitial"},{"idx":2,"proposition":"3","correct":false,"justification":"Intramural interstitial in contact with the endometrium"},{"idx":3,"proposition":"5","correct":false,"justification":"Subserous ≥50% intramural"},{"idx":4,"proposition":"2","correct":false,"justification":"Submucosal ≥50% intramural"}],"type":"custom"}
+{"_id":"IUgrossesse-infectio-0","context":null,"enonce":"Which of the following propositions are true in pregnant women?","item":"IUgrossesse","matiere":"infectio","propositions":[{"idx":0,"proposition":"Fosfomycin (Monuril) is used as a single dose","correct":true},{"idx":1,"proposition":"Urinary colonizations should be treated probabilistic","correct":false,"justification":"After documentation if asymptomatic"},{"idx":2,"proposition":"Treatment of acute pyelonephritis is always hospitable","correct":false,"justification":"It can be ambulatory (good clinical tolerance, first AS)"},{"idx":3,"proposition":"Acute pyelonephritis requires ultrasound of the urinary tract","correct":true},{"idx":4,"proposition":"Cystitis never recurs","correct":false,"justification":"Recurrence is a common complication"}],"type":"custom"}
+{"_id":"IUgrossesse-infectio-1","context":null,"enonce":"Which of the following propositions are true in pregnant women?","item":"IUgrossesse","matiere":"infectio","propositions":[{"idx":0,"proposition":"Urinary colonizations should be screened by BU","correct":true},{"idx":1,"proposition":"Urinary colonizations should be screened monthly from the sixth month","correct":false,"justification":"Every month from the third month"},{"idx":2,"proposition":"Urinary colonizations put you at high risk of pyelonephritis","correct":true},{"idx":3,"proposition":"Urinary colonizations should be treated","correct":true},{"idx":4,"proposition":"Ultrasound of the urinary tract is systematic in case of urinary colonizations","correct":false,"justification":"No ultrasound in this case"}],"type":"custom"}
+{"_id":"IUgrossesse-infectio-2","context":null,"enonce":"Which of the following proposals correspond to a probabilistic antibiotic therapy for cystitis in pregnant 🤰 women?","item":"IUgrossesse","matiere":"infectio","propositions":[{"idx":0,"proposition":"Amoxicillin","correct":false,"justification":"Not indicated in urinary tract infection"},{"idx":1,"proposition":"Amoxicillin - Clavulanic Acid","correct":false,"justification":"Not indicated in urinary tract infection"},{"idx":2,"proposition":"Fosfomycin","correct":true,"justification":"True, in single dose, it is the first-line treatment"},{"idx":3,"proposition":"Ciprofloxacin","correct":true,"justification":"True, this is not the first-line treatment however (rather 3rd-4th line)"},{"idx":4,"proposition":"Pivmecillinam","correct":true,"justification":"True, this is second-line treatment"}],"type":"custom"}
+{"_id":"IUgrossesse-infectio-3","context":null,"enonce":"Which of the following proposals corresponds to the bacteriuria threshold requiring antibiotic management in pregnant women?","item":"IUgrossesse","matiere":"infectio","propositions":[{"idx":0,"proposition":"10.2 CFU\/mL","correct":false,"justification":"False"},{"idx":1,"proposition":"10.3 CFU\/mL","correct":false,"justification":"False"},{"idx":2,"proposition":"10.4 CFU\/mL","correct":false,"justification":"False"},{"idx":3,"proposition":"10.5 CFU\/mL","correct":true,"justification":"True, even asymptomatic"},{"idx":4,"proposition":"10.6 CFU\/mL","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"IUgrossesse-infectio-4","context":null,"enonce":"Which of the following is the probabilistic first-line treatment of acute pyelonephritis without signs of severity in pregnant 🤰 women?","item":"IUgrossesse","matiere":"infectio","propositions":[{"idx":0,"proposition":"Monuril (Fosfomycin-Trometamol)","correct":false,"justification":"It is the first-line treatment for simple acute cystitis"},{"idx":1,"proposition":"Amoxicillin","correct":false,"justification":"Not part of probabilistic treatments for urinary tract infections"},{"idx":2,"proposition":"Cotrimoxazole","correct":false,"justification":"False"},{"idx":3,"proposition":"Carbapenem","correct":false,"justification":"False"},{"idx":4,"proposition":"None of these proposals","correct":true,"justification":"True. Indeed, the treatment is based on C3G IV (same as for acute pyelonephritis at risk of complication outside pregnancy)"}],"type":"custom"}
+{"_id":"IUgrossesse-infectio-5","context":null,"enonce":"Which of the following is true?","item":"IUgrossesse","matiere":"infectio","propositions":[{"idx":0,"proposition":"Cystitis in pregnant women corresponds to simple cystitis","correct":false},{"idx":1,"proposition":"Cystitis in pregnant women corresponds to cystitis at risk of complications","correct":true,"justification":"Cystitis gravidarum is cystitis at risk of complications"},{"idx":2,"proposition":"Cystitis in pregnant women corresponds to complicated cystitis","correct":false},{"idx":3,"proposition":"Cystitis in pregnant women is assimilated to pyelonephritis without gravity","correct":false},{"idx":4,"proposition":"Cystitis in pregnant women is equated with severe pyelonephritis","correct":false}],"type":"custom"}
+{"_id":"psychotropes-psy-0","context":null,"enonce":"Regarding antipsychotics:","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Antipsychotic treatments are indicated in the treatment of psychotic disorders, by definition","correct":true},{"idx":1,"proposition":"Some antipsychotic treatments are indicated in bipolar disorder","correct":true},{"idx":2,"proposition":"Antipsychotic treatments are antagonists of D1 receptors","correct":false,"justification":"Dopaminergic D2 receptors"},{"idx":3,"proposition":"The combination of several antipsychotics is most often advised to increase the effects","correct":false,"justification":"Monotherapy is preferred in the general context"},{"idx":4,"proposition":"Adherence is a major issue in the drug treatment of psychiatric disorders","correct":true,"justification":"This is why a blood test is interesting to check"}],"type":"custom"}
+{"_id":"psychotropes-psy-1","context":null,"enonce":"Regarding antipsychotics and antidepressants","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Conventional antipsychotic treatments are not subject to a specific pre-therapeutic assessment","correct":false,"justification":"NFS-P, Ionogram, Uremia, Creatinine, Hepatic Function, bHCG, ECG and Metabolic Assessment"},{"idx":1,"proposition":"Neuroleptic malignant syndrome concerns antipsychotics","correct":true},{"idx":2,"proposition":"Serotonin syndrome concerns antipsychotics","correct":false,"justification":"Antidepressants"},{"idx":3,"proposition":"Antidepressants are contraindicated in anxiety disorders","correct":false,"justification":"Some of them are."},{"idx":4,"proposition":"Antidepressants increase intrasynaptic monoamine concentrations","correct":true}],"type":"custom"}
+{"_id":"psychotropes-psy-2","context":null,"enonce":"Which of these proposals designates an adverse effect of antipsychotics?","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Parkinson's syndrome","correct":true},{"idx":1,"proposition":"Syndrome Alzeihmer-like","correct":false,"justification":"Does not exist"},{"idx":2,"proposition":"Metabolic syndrome","correct":true,"justification":"Hence the pre-therapeutic assessment"},{"idx":3,"proposition":"Dystonias","correct":true},{"idx":4,"proposition":"Drowsiness","correct":true,"justification":"This is possible and it is related to the blockage of the a1 and H1 receptors. Example CPR clozapine, drowsiness is a very common disorder."}],"type":"custom"}
+{"_id":"psychotropes-psy-3","context":null,"enonce":"Which of these proposals designates an adverse effect of antipsychotics?","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Akinesia","correct":true},{"idx":1,"proposition":"Weight loss","correct":false,"justification":"Metabolic syndrome, hence EAL (Lipid Abnormality Explorations) in pre-therapeutic"},{"idx":2,"proposition":"Dry syndrome","correct":true,"justification":"Atropinic effect"},{"idx":3,"proposition":"Cholestasis hepatitis","correct":true},{"idx":4,"proposition":"Hyperprolactinemia","correct":true}],"type":"custom"}
+{"_id":"psychotropes-psy-4","context":null,"enonce":"Regarding benzodiazepines:","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"They decrease neuronal excitability","correct":true},{"idx":1,"proposition":"They are anti-GABA","correct":false,"justification":"They facilitate gaba-ergic transmission. GABA, unlike glutamate, is an action potential inhibitor"},{"idx":2,"proposition":"They are anorectic","correct":false,"justification":"They have an orogenic effect that can cause metabolic syndrome"},{"idx":3,"proposition":"They are strongly discouraged in case of respiratory failure","correct":false,"justification":"They are contraindicated in respiratory failure, since their muscle relaxant effect can be very dangerous"},{"idx":4,"proposition":"They lower the epileptogenic threshold","correct":false,"justification":"They have an anti-epileptic action. Clonazepam is also the first-line treatment for status epilepticus. So they increase the epileptogenic threshold"}],"type":"custom"}
+{"_id":"psychotropes-psy-5","context":null,"enonce":"Regarding benzodiazepines:","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"They have an amnesiac effect","correct":true},{"idx":1,"proposition":"They are indicated in case of myasthenia gravis","correct":false,"justification":"They are contraindicated in this case, since they have a muscle relaxant effect"},{"idx":2,"proposition":"Their use contraindicates driving","correct":true,"justification":"It is formal and we have an obligation to inform the patient."},{"idx":3,"proposition":"They are indicated in anxiety disorders","correct":true},{"idx":4,"proposition":"Their prescription must be limited to 12 weeks in case of prescription for insomnia","correct":false,"justification":"4 weeks in this case, knowing that it is a very limited indication"}],"type":"custom"}
+{"_id":"psychotropes-psy-8","context":null,"enonce":"Which of the following proposals is\/are a non-selective MAOI(s)?","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Fluoxetine","correct":false,"justification":"SSRI"},{"idx":1,"proposition":"Sertraline","correct":false,"justification":"SSRI"},{"idx":2,"proposition":"Clomipramine","correct":false,"justification":"Tricyclic"},{"idx":3,"proposition":"Iproniazid","correct":true},{"idx":4,"proposition":"Paroxetine","correct":false,"justification":"SSRI"}],"type":"custom"}
+{"_id":"psychotropes-psy-9","context":null,"enonce":"Which of the following is\/are tricyclic antidepressants?","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Fluoxetine","correct":false,"justification":"SSRI"},{"idx":1,"proposition":"Sertraline","correct":false,"justification":"SSRI"},{"idx":2,"proposition":"Clomipramine","correct":true},{"idx":3,"proposition":"Iproniazid","correct":false,"justification":"Non-selective MAOIs"},{"idx":4,"proposition":"Paroxetine","correct":false,"justification":"SSRI"}],"type":"custom"}
+{"_id":"psychotropes-psy-10","context":null,"enonce":"Which of the following is\/are serotonin reuptake inhibitor(s) (SSRIs)?","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Fluoxetine","correct":true},{"idx":1,"proposition":"Sertraline","correct":true},{"idx":2,"proposition":"Clomipramine","correct":false,"justification":"Tricyclic"},{"idx":3,"proposition":"Iproniazid","correct":false,"justification":"Non-selective MAOI"},{"idx":4,"proposition":"Paroxetine","correct":true}],"type":"custom"}
+{"_id":"psychotropes-psy-12","context":null,"enonce":"Which of the following proposition(s) is true about antidepressants?","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"The time of action is usually 3 weeks","correct":true},{"idx":1,"proposition":"The time for action is immediate","correct":false,"justification":"It is between 2 and 4 weeks"},{"idx":2,"proposition":"The doses required are usually very low","correct":false,"justification":"Doses often need to be increased"},{"idx":3,"proposition":"The mechanism of action of SSRIs is the inhibition of serotonin reuptake","correct":true},{"idx":4,"proposition":"Talking about treatment failure usually requires at least 6 months","correct":false,"justification":"At least 6 weeks"}],"type":"custom"}
+{"_id":"psychotropes-psy-13","context":null,"enonce":"Which of the following are included in anticholinergic syndrome?","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Acute urine retention","correct":true,"justification":"True, by inhibiting the parasympathetic system"},{"idx":1,"proposition":"Sinus tachycardia","correct":true,"justification":"True, as opposed to the bradycardizing effects of acetylcholine"},{"idx":2,"proposition":"Dry mouth","correct":true,"justification":"True, by blocking salivary secretions"},{"idx":3,"proposition":"Diarrhoea","correct":false,"justification":"False, rather constipation by antispasmodic action at the level of smooth muscle fibers"},{"idx":4,"proposition":"Bilateral miosis","correct":false,"justification":"False, bilateral mydriasis"}],"type":"custom"}
+{"_id":"psychotropes-psy-14","context":null,"enonce":"Which of the following are possible side effects of selective serotonin reuptake inhibitors?","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Hyponatremia","correct":true,"justification":"True, by inappropriate secretion of DHA (especially in the elderly)"},{"idx":1,"proposition":"Tremors","correct":true},{"idx":2,"proposition":"QT prolongation","correct":true},{"idx":3,"proposition":"Sleep Apnea Syndrome (SAS)","correct":false,"justification":"False"},{"idx":4,"proposition":"Bilateral mydriasis","correct":false,"justification":"False, no anticholinergic effect of SSRIs"}],"type":"custom"}
+{"_id":"psychotropes-psy-15","context":null,"enonce":"Which of the following proposals are part of the lithium pre-therapeutic assessment? 💉","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Calcemia","correct":true,"justification":"True, because risk of tubulointerstitial nephropathy"},{"idx":1,"proposition":"Blood ionogram ","correct":true,"justification":"True, because risk of kidney side effects"},{"idx":2,"proposition":"TSH","correct":true,"justification":"True, because risk of hypothyroidism"},{"idx":3,"proposition":"ECG","correct":true,"justification":"True, because risk of conduction and repolarization disorders"},{"idx":4,"proposition":"Assessment of renal function","correct":true,"justification":"True, because renal elimination"}],"type":"custom"}
+{"_id":"parkinson-neuro-0","context":null,"enonce":"Parkinson's disease is defined by:","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Akinesia","correct":true,"justification":"Akinesia is the only symptom of the Parkinsonian triad that must be systematically present for diagnosis."},{"idx":1,"proposition":"Hyperesthesia","correct":false,"justification":"Bradykinesia"},{"idx":2,"proposition":"Asthenia","correct":false,"justification":"May be present in concomitance but does not fall within the strict framework of Parkinson's disease (triad bradykinesia \/ plastic rigidity \/ resting tremors)"},{"idx":3,"proposition":"plastic rigidity","correct":true},{"idx":4,"proposition":"A resting tremor","correct":true}],"type":"custom"}
+{"_id":"parkinson-neuro-1","context":null,"enonce":"Regarding Parkinson's disease:","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Key elements of the diagnosis are: the absence of signs other than parkinsonism and the positive and prolonged response from levodopa","correct":true,"justification":"There may be other signs, but no red flags"},{"idx":1,"proposition":"The existence of parkinsonism indicates a cholinergical deficit","correct":false,"justification":"The existence of parkinsonism indicates a dopaminergic deficiency"},{"idx":2,"proposition":"The diagnosis of Parkinson's disease is clinical and does not warrant further examination in case of typical presentation","correct":true,"justification":"Only additional examinations will be done if there are red flags or if there is a diagnostic doubt"},{"idx":3,"proposition":"It is important to exclude Wilson's disease in a young patient (before 40 years) with parkinsonism","correct":true},{"idx":4,"proposition":"Prevalence and incidence increase gradually with age up to age 80","correct":true}],"type":"custom"}
+{"_id":"parkinson-neuro-2","context":null,"enonce":"Which propositions are true?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"It is the second leading cause of motor disability in the elderly","correct":true,"justification":"The first being stroke"},{"idx":1,"proposition":"The manifestation of signs of the parkinsonian triad is bilateral or symmetrical","correct":false,"justification":"The manifestation of the signs of the parkinsonian triad is asymmetrical"},{"idx":2,"proposition":"Asymmetry persists throughout the disease","correct":true},{"idx":3,"proposition":"Parkinson's disease tremors are present at rest and disappear with movement","correct":true,"justification":"This is the case classically. Keep in mind that tremor can have a postural component"},{"idx":4,"proposition":"Bradykinesia is the slowing down of the execution of a movement and the decrement of the speed","correct":true}],"type":"custom"}
+{"_id":"parkinson-neuro-3","context":null,"enonce":"Among these proposals, which are diagnostic arguments?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"The progressive appearance of bradycardia","correct":true,"justification":"There are dysautonomic prodromes, but these are not the main diagnostic arguments in the foreground."},{"idx":1,"proposition":"Stiffness and\/or resting tremor","correct":true,"justification":"It is a plastic rigor."},{"idx":2,"proposition":"The asymmetry of parkinsonism","correct":true},{"idx":3,"proposition":"The normality of neurological examination, apart from parkinsonism","correct":true},{"idx":4,"proposition":"Exaggerated osteoarticular reflexes","correct":false}],"type":"custom"}
+{"_id":"parkinson-neuro-4","context":null,"enonce":"Are causes of symmetric extrapyramidal syndrome:","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Progressive supranuclear palsy","correct":true,"justification":"Mnemonic : VIP"},{"idx":1,"proposition":"Idiopathic Parkinson's disease","correct":false,"justification":"It is an asymmetric extrapyramidal syndrome."},{"idx":2,"proposition":"Iatrogeny","correct":true,"justification":"Ex. neuroleptics"},{"idx":3,"proposition":"Multiple system atrophy","correct":false,"justification":"Asymmetric"},{"idx":4,"proposition":"Vascular Parkinson's","correct":true}],"type":"custom"}
+{"_id":"parkinson-neuro-5","context":null,"enonce":"Are red flags of Parkinson's disease:","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Cerebellar syndrome","correct":true},{"idx":1,"proposition":"Early dementia","correct":true},{"idx":2,"proposition":"REM sleep disorders","correct":false,"justification":"This is an enunciating sign of Parkinson's disease, and may be present years before the onset of the Parkinsonian triad"},{"idx":3,"proposition":"Pseudobulbar syndrome","correct":true},{"idx":4,"proposition":"Symmetrical tremor","correct":true,"justification":"Tremor is asymmetric in Parkinson's disease"}],"type":"custom"}
+{"_id":"parkinson-neuro-6","context":null,"enonce":"Why prescribe a dopaminergic agonist rather than L-DOPA early in a patient under 70 years of age?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Slowing the progression of the disease","correct":false},{"idx":1,"proposition":"Improve cognitive function","correct":false},{"idx":2,"proposition":"Achieve physiological dopaminergic stimulation","correct":false,"justification":"Their action is not to stimulate dopamine neurons but to 'replace' them."},{"idx":3,"proposition":"Delay the onset of motor complications","correct":true,"justification":"True, they work by directly activating receptors downstream of neurons in the substantia nigra."},{"idx":4,"proposition":"Stimulate neuronal regeneration","correct":false,"justification":"No medication can do this"}],"type":"custom"}
+{"_id":"parkinson-neuro-7","context":null,"enonce":"Among the following proposals, which are elements that should cast doubt on the diagnosis of Parkinson's disease in the face of parkinsonism syndrome?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"High free cupremia","correct":true,"justification":"True, we think of Wilson's disease"},{"idx":1,"proposition":"Asymmetric resting tremor at 4-6 Hz","correct":false,"justification":"Typical of Parkinson's disease"},{"idx":2,"proposition":"Rapid response to L-DOPA","correct":false,"justification":"Typical of Parkinson's disease"},{"idx":3,"proposition":"Unilateral Babinski sign","correct":true,"justification":"True, it indicates a pyramidal syndrome, which is contrary to Parkinson's disease (which is an involvement of the extrapyramidal pathways)"},{"idx":4,"proposition":"Early oculomotor disorders","correct":true,"justification":"True. No cranial nerve damage classically"}],"type":"custom"}
+{"_id":"parkinson-neuro-8","context":null,"enonce":"Which of the following proposals do you prescribe for a 62-year-old patient with Parkinson's disease?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Selective norepinephrine reuptake inhibitor (ISRNA)","correct":false,"justification":"No indication in Parkinson's disease"},{"idx":1,"proposition":"Monoamine oxidase B inhibitor (MAOI-B)","correct":true,"justification":"True, preferred in a subject under 70 years old"},{"idx":2,"proposition":"Dopaminergic agonist","correct":true,"justification":"True, to be preferred in a subject under 70 years, especially in case of Restless Legs Syndrome associated"},{"idx":3,"proposition":"L-DOPA","correct":true,"justification":"True, always possible"},{"idx":4,"proposition":"Anticholinergic","correct":false}],"type":"custom"}
+{"_id":"parkinson-neuro-10","context":null,"enonce":"Which of the following are atypical degenerative parkinsonian syndromes?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Multi-system atrophy","correct":true,"justification":"True, with dysautonomia and pyramid signs"},{"idx":1,"proposition":"Progressive supranuclear palsy","correct":true,"justification":"True, with symmetric parkinsonism"},{"idx":2,"proposition":"Corticobasal degeneration","correct":true,"justification":"True, with apraxia"},{"idx":3,"proposition":"Dementia with Lewy bodies","correct":true,"justification":"True, with cognitive impairment (hallucination and decreased alertness)"},{"idx":4,"proposition":"Amyotrophic lateral sclerosis","correct":false,"justification":"It is an impairment of the motor neuron"}],"type":"custom"}
+{"_id":"parkinson-neuro-11","context":null,"enonce":"Which of the following proposals can precede the motor disorders of Parkinson's disease by several years?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Hearing impairment","correct":false,"justification":"No hearing impairment classically"},{"idx":1,"proposition":"Headache","correct":false,"justification":"No headaches classically"},{"idx":2,"proposition":"Sleep disorders","correct":true,"justification":"True, low dopamine decreases motor inhibition during REM sleep. Patients describe animated dreams"},{"idx":3,"proposition":"Impaired sense of smell","correct":true,"justification":"True, is found in many neurodegenerative diseases"},{"idx":4,"proposition":"Constipation","correct":true}],"type":"custom"}
+{"_id":"parkinson-neuro-12","context":null,"enonce":"Which of the following is\/are recognized risk factors for Parkinson's disease?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Alcohol and tobacco intoxication","correct":false,"justification":"False"},{"idx":1,"proposition":"Obesity","correct":false,"justification":"False"},{"idx":2,"proposition":"High blood pressure","correct":false,"justification":"False"},{"idx":3,"proposition":"Pesticides","correct":true,"justification":"True, this is the only risk factor cited in the college"},{"idx":4,"proposition":"No risk factors are known","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"parkinson-neuro-13","context":null,"enonce":"Which of the following are true about Wilson's disease?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"The most common mode of disclosure in children is liver damage","correct":true},{"idx":1,"proposition":"Late discovery after 35 years is common","correct":false,"justification":"It is often in young adults (before 35 years)"},{"idx":2,"proposition":"Genetic testing can be done without informed consent","correct":false,"justification":"Never genetic testing without free and informed consent"},{"idx":3,"proposition":"Inheritance is autosomal dominant","correct":false,"justification":"Autosomal recessive (chromosome 13)"},{"idx":4,"proposition":"The accumulation of free copper is responsible for organic damage","correct":true}],"type":"custom"}
+{"_id":"parkinson-neuro-14","context":null,"enonce":"Which of the following are side effects of dopamine agonists?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Vomiting","correct":true},{"idx":1,"proposition":"Hypersexuality","correct":true,"justification":"True, as well as pathological gambling"},{"idx":2,"proposition":"Daytime sleepiness","correct":true},{"idx":3,"proposition":"Nausea","correct":true},{"idx":4,"proposition":"Palpitations","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"parkinson-neuro-15","context":null,"enonce":"Which of the following are synucleinopathies (neurodegenerative diseases characterized by the abnormal accumulation of synuclein protein aggregates)?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Parkinson's disease","correct":true,"justification":"True, the aggregate forms intracytoplasmic Lewy bodies in neurons of the nigrostriatal pathway (and especially in the substantia nigra, in the midbrain)."},{"idx":1,"proposition":"Alzheimer's disease","correct":false,"justification":"Instead, hyperphosphorylated Tau proteins are found in axons and extracellular Ab-42 peptides"},{"idx":2,"proposition":"Multi-system atrophy (AMS)","correct":true,"justification":"True, there is an asymmetric parkinsonism syndrome and dysautonomia. We can find a pyramidal syndrome (with plastic rigidity and positive Babinski). There is no significant impairment of higher functions"},{"idx":3,"proposition":"Dementia with Lewy bodies","correct":true,"justification":"True, there is an asymmetric parkinsonism with significant impairment of cognitive functions"},{"idx":4,"proposition":"Wilson's disease","correct":false,"justification":"There is an increased 24-hour cupruria associated with a decrease in serum cupremia and ceruleoplasminemia. Clinically, Kayser-Fleischer annals are observed at water level (copper deposit)."}],"type":"custom"}
+{"_id":"parkinson-neuro-16","context":null,"enonce":"Which of the following are signs or symptoms of parkinsonism in parkinsonism?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Resting tremor","correct":true},{"idx":1,"proposition":"Spastic rigidity","correct":false,"justification":"Spastic rigidity is part of pyramidal syndrome. Parkinson's syndrome is an extra-pyramidal syndrome in which plastic rigidity is found."},{"idx":2,"proposition":"Myoclonus","correct":false,"justification":"Not in this syndrome"},{"idx":3,"proposition":"Fasciculations","correct":false,"justification":"Not in this syndrome"},{"idx":4,"proposition":"Bradykinesia","correct":true,"justification":"True: slow walking, micrography, hypomimia, etc."}],"type":"custom"}
+{"_id":"parkinson-neuro-17","context":null,"enonce":"Which of the following proposals regarding the implantation of a stimulator are true?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"The main objective is to reduce fluctuations related to drug treatments","correct":true},{"idx":1,"proposition":"Deep brain stimulation consists of the implantation of electrodes in basal ganglia by radiological route","correct":false,"justification":"Neurosurgical pathway"},{"idx":2,"proposition":"The nucleus concerned is the caudate nucleus most often","correct":false,"justification":"It is the subthalamic nucleus"},{"idx":3,"proposition":"The electrodes allow high-frequency stimulation that has an inhibitory effect on the affected nucleus","correct":true},{"idx":4,"proposition":"Electrodes stimulate endogenous dopamine production","correct":false,"justification":"They stimulate the subthalamic nucleus which is a powerful inhibitor and therefore helps to alleviate the signs of dopaminergic over-stimulation due to drugs"}],"type":"custom"}
+{"_id":"bipolaire-psy-0","context":null,"enonce":"General:","item":"bipolaire","matiere":"psy","propositions":[{"idx":0,"proposition":"The typical onset of bipolar disorder is between the ages of 40 and 50.","correct":false,"justification":"Typical onset of bipolar disorder: 15-25 years"},{"idx":1,"proposition":"The manic episode is a medical-surgical emergency","correct":false,"justification":"Medical emergency. No surgical management on this pathology."},{"idx":2,"proposition":"Manic syndrome has a psychoaffective, psychomotor and phsyiological disturbances component","correct":true},{"idx":3,"proposition":"Diet and sexuality are often disturbed in this disorder","correct":true},{"idx":4,"proposition":"The gold standard treatment for manic episode is lithium","correct":true}],"type":"custom"}
+{"_id":"bipolaire-psy-1","context":null,"enonce":"Treatments:","item":"bipolaire","matiere":"psy","propositions":[{"idx":0,"proposition":"The only effective thymoregulator in suicide prevention is xeroquel","correct":false,"justification":"It's lithium. Xeroquel is a quetiapine (second generation antipsychotic)"},{"idx":1,"proposition":"The recommended dosage of Depakote is 750 mg\/day","correct":true},{"idx":2,"proposition":"Aripiprazole is a first-generation antipsychotic","correct":false,"justification":"2nd generation antipsychotic"},{"idx":3,"proposition":"Lithium is a treatment for the depressive episode characterized in the context of bipolar illness","correct":true},{"idx":4,"proposition":"Amotrigine is a preventive treatment for depressive episodes in bipolar disease","correct":true}],"type":"custom"}
+{"_id":"bipolaire-psy-2","context":null,"enonce":"Epidemiology and history:","item":"bipolaire","matiere":"psy","propositions":[{"idx":0,"proposition":"Quetiapine is a first-generation antipsychotic","correct":false,"justification":"Quetiapine = 2nd generation"},{"idx":1,"proposition":"Bipolar disorder is very rare","correct":false,"justification":"Bipolar disorder is a severe, chronic and common psychiatric disorder"},{"idx":2,"proposition":"This disease was discovered by Freud in the 1890s.","correct":false,"justification":"This disease has been described since ancient times and is characterized by pathological changes in mood and energy that can be increased (mania) or decreased (depression)"},{"idx":3,"proposition":"Bipolar disorder is pure genetic in origin but the exact loci are not known","correct":false,"justification":"Bipolar disorder is multifactorial in origin, mixing genetic and environmental risk factors"},{"idx":4,"proposition":"It is considered that 1 to 4% of the general population has typical forms of bipolar disorder.","correct":true}],"type":"custom"}
+{"_id":"dvlptbuccoD-cmf-0","context":null,"enonce":"Which of these proposals correspond to the development of the cephalic end?","item":"dvlptbuccoD","matiere":"cmf","propositions":[{"idx":0,"proposition":"Histogenesis","correct":true,"justification":"up to S2. (For information, S = week of development in utero)"},{"idx":1,"proposition":"Viventogenesis","correct":false,"justification":"does not exist"},{"idx":2,"proposition":"Organogenesis","correct":true,"justification":"Between S2 and S8"},{"idx":3,"proposition":"Buccogenesis","correct":false,"justification":"Does not exist"},{"idx":4,"proposition":"Morphogenesis","correct":true,"justification":"From S8 to birth"}],"type":"custom"}
+{"_id":"dvlptbuccoD-cmf-1","context":null,"enonce":"Which propositions are true?","item":"dvlptbuccoD","matiere":"cmf","propositions":[{"idx":0,"proposition":"The earlier a developmental abnormality is, the more severe it is","correct":true,"justification":"Generally"},{"idx":1,"proposition":"Phacomastoses are progressive tissue dysplasias that occur during histogenesis","correct":true,"justification":"Cellular abnormalities in primary blastema"},{"idx":2,"proposition":"Dystosis deformities reside mainly in the orbit and ear","correct":false,"justification":"They can sit in the orbit, nose, maxilla or mandibular (but not the ear)"},{"idx":3,"proposition":"The clinical expression of suturary involvement will be immediate in the face","correct":false,"justification":"Late because it is a discontinuous, multifactorial and long-term growth entity"},{"idx":4,"proposition":"The clinical expression of suturary involvement will be rapidly progressive in the cranial vault","correct":true,"justification":"It will be immediate and dependent on the brain"}],"type":"custom"}
+{"_id":"dvlptbuccoD-cmf-2","context":null,"enonce":"Regarding facial embryology:","item":"dvlptbuccoD","matiere":"cmf","propositions":[{"idx":0,"proposition":"The cephalic tip of the fetus begins to round at S24","correct":false,"justification":"From S4 at the embryo stage"},{"idx":1,"proposition":"The stomodeum is the primitive mouth","correct":true},{"idx":2,"proposition":"The nasofrontal bud will evolve into mandibular buds","correct":false,"justification":"It will give the frontal bud and the internal and external nasal buds"},{"idx":3,"proposition":"Cysts and fistulas result from a disorder of the coalescence of one or more facial buds and ectodermal inclusions at the junction of these structures","correct":true},{"idx":4,"proposition":"Treatment of cysts and fistulas is purely surgical","correct":true,"justification":"Complete excision to avoid recurrence"}],"type":"custom"}
+{"_id":"dvlptbuccoD-cmf-3","context":null,"enonce":"Regarding facial slits:","item":"dvlptbuccoD","matiere":"cmf","propositions":[{"idx":0,"proposition":"They result from a lack of attachment of one or more facial buds","correct":true},{"idx":1,"proposition":"They have a social and psychological impact exclusively","correct":false,"justification":"They also impact orofacial function and facial morpjology"},{"idx":2,"proposition":"The stomodeum is permanently obstructed by the pharyngeal membrane","correct":false,"justification":"Provisionally"},{"idx":3,"proposition":"Coloboma is very common","correct":false,"justification":"Very rare malformation (cleft between the upper maxillary bud and the outer nasal bud)"},{"idx":4,"proposition":"The macrostomy is a cleft between the upper and lower maxillary buds","correct":true}],"type":"custom"}
+{"_id":"dvlptbuccoD-cmf-4","context":null,"enonce":"Regarding lip opalatine clefts:","item":"dvlptbuccoD","matiere":"cmf","propositions":[{"idx":0,"proposition":"Cleft lip and palate are the most common facial clefts","correct":true},{"idx":1,"proposition":"They concern 1 birth in 50000","correct":false,"justification":"One in 750 births"},{"idx":2,"proposition":"Management is surgical exclusively","correct":false,"justification":"It is multidisciplinary: genetic counseling, psychological care, speech therapy, orthodontic follow-up, surgery, etc."},{"idx":3,"proposition":"She is always isolated","correct":false,"justification":"It can be part of a polymalformative syndrome"},{"idx":4,"proposition":"It most often results from an accident during organogenesis between S5 and S7","correct":true,"justification":"Infectious, traumatic, genetic, etc."}],"type":"custom"}
+{"_id":"droits-sp-0","context":null,"enonce":"Which of the following are true?","item":"droits","matiere":"sp","propositions":[{"idx":0,"proposition":"Medical confidentiality has been one of the pillars of medical practice since 1980","correct":false,"justification":"Introduction Since Hippocrates, medical secrecy has been one of the pillars of the practice of medicine: \"Admitted inside the houses, my eyes will not see what is happening there, my tongue will silence the secrets that will be entrusted to me...\" Because there is no care without confidences, confidences without trust, trust without secrecy"},{"idx":1,"proposition":"Physician-client privilege has a dual interest: private and public.","correct":true},{"idx":2,"proposition":"The doctor must guarantee secrecy to the person who confides in him","correct":true},{"idx":3,"proposition":"The history of secrecy surrounding the medical act testifies to a complex, sometimes conflictual, triangular relationship between physicians, society and patients","correct":true},{"idx":4,"proposition":"Society or state can never access medical information","correct":false,"justification":"Indeed, in certain circumstances, the law requires or authorizes the disclosure of certain information for a private and\/or public purpose, for example in the context of judicial requisitions.\""}],"type":"custom"}
+{"_id":"droits-sp-1","context":null,"enonce":"Which of the following are true?","item":"droits","matiere":"sp","propositions":[{"idx":0,"proposition":"The obligation to secrecy is now included in articles 226-13 and 226-14 of the 1994 Criminal Code.","correct":true},{"idx":1,"proposition":"In the penal code, we find the notion of medical confidentiality, reserved for health professionals","correct":false,"justification":"The Penal Code Compared to the old Code, the Penal Code of March 1994 no longer refers to doctors. It concerns any person holding confidential information."},{"idx":2,"proposition":"Revealing secret information can be punished by a fine but not by prison","correct":false,"justification":"Article 226-13: \"The disclosure of information of a secret nature by a person who is the custodian thereof, either by state, or by profession, or because of a function or a temporary mission, is punishable by one year's imprisonment and a fine of 15,000 euros."},{"idx":3,"proposition":"The Act of 8 March 2003 establishes a breach in medical confidentiality by allowing doctors to hand over a file to a judicial police officer, on simple requisition, without violating the principle of secrecy.","correct":true},{"idx":4,"proposition":"Under the 2003 Act, a judicial police officer may compel a doctor to hand over a patient's medical file.","correct":true,"justification":"When the medical file is requisitioned during a criminal case, for example, the seizure must be made in the presence of a doctor who ensures the proper maintenance of medical confidentiality as well as the seizure of the file according to good practices."}],"type":"custom"}
+{"_id":"droits-sp-2","context":null,"enonce":"Which of these proposed laws refer to medical confidentiality?","item":"droits","matiere":"sp","propositions":[{"idx":0,"proposition":"The Public Health Code","correct":true,"justification":"Law number 2002-303 of 4 March 2002"},{"idx":1,"proposition":"The Penal Code","correct":true,"justification":"Article 60 (1)"},{"idx":2,"proposition":"The Code of Criminal Procedure","correct":true},{"idx":3,"proposition":"The Code of Ethics of the Ordre des médecins","correct":false,"justification":"It is not a piece of legislation, but several elements have been extracted and inserted into the various codes by the legislator."},{"idx":4,"proposition":"The LFSS","correct":false,"justification":"This is the law on the financing of social security.\""}],"type":"custom"}
+{"_id":"droits-sp-3","context":null,"enonce":"Which of the following are true?","item":"droits","matiere":"sp","propositions":[{"idx":0,"proposition":"Professional secrecy, instituted in the interest of patients, is binding on every doctor under the conditions established by law.","correct":true},{"idx":1,"proposition":"Doctor's assistants are not subject to medical confidentiality if they are not doctors","correct":false,"justification":"The physician must ensure that the persons who assist him in his practice are informed of their obligations with respect to professional secrecy and comply with them"},{"idx":2,"proposition":"The physician must protect against any indiscretion the medical documents concerning the persons he has cared for or examined, regardless of the content and medium of these documents.","correct":true},{"idx":3,"proposition":"When using his experience or documents for scientific publication or teaching purposes, physicians must ensure that identification of persons is not possible.","correct":true},{"idx":4,"proposition":"Publishing a research paper with the name of an explicitly cited patient is illegal","correct":false,"justification":"Failing this, their agreement must be obtained."}],"type":"custom"}
+{"_id":"droits-sp-4","context":null,"enonce":"Concerning the case-law on professional secrecy","item":"droits","matiere":"sp","propositions":[{"idx":0,"proposition":"It is binding on all health professionals as well as all professionals involved in the health system.","correct":true},{"idx":1,"proposition":"Medical confidentiality prohibits the doctor from giving the cause of death of a patient to his family","correct":false,"justification":"Secrecy shall not prevent information concerning a deceased person from being delivered to his successors, insofar as it is necessary for them to know the causes of death, to defend the memory of the deceased, or to assert their rights, unless otherwise expressed by the person before his death."},{"idx":2,"proposition":"Case law tends to eliminate the notion of medical confidentiality","correct":false,"justification":"Jurisprudence, both judicial and administrative, has reinforced these provisions by proclaiming that medical confidentiality is of a general and absolute nature, as early as the nineteenth century."},{"idx":3,"proposition":"The doctor is not subject to medical confidentiality if the patient does not request it","correct":false,"justification":"the patient cannot release the doctor from his obligation of secrecy"},{"idx":4,"proposition":"Talking with co-interns about a patient at the staff restaurant is not in contradiction with medical confidentiality","correct":false,"justification":"Secrecy is required with regard to other doctors if they do not contribute to an act of care"}],"type":"custom"}
+{"_id":"droits-sp-6","context":null,"enonce":"Regarding the solicitor-client privilege application(s)","item":"droits","matiere":"sp","propositions":[{"idx":0,"proposition":"A doctor working for an insurer is subject to medical secrecy that he shares with his colleagues hospital doctors","correct":false,"justification":"They may not examine the medical file, or question the attending physician of a patient, without the express agreement of the latter."},{"idx":1,"proposition":"The doctor must communicate the medical file to the insurance companies for reimbursement","correct":false,"justification":"It is up to the patient to communicate his personal data to insurance doctors (the law of 4 March 2002 now gives him direct access to his file). Nevertheless, he can be helped by the doctor to fill out certain administrative forms. He remains the holder of all data concerning him."},{"idx":2,"proposition":"The medical officer of the social security is not bound by medical confidentiality","correct":false,"justification":"The exchange of information between the attending physician and the medical officer, who is himself bound to secrecy, is also recognized in the name of the principle of \"shared secrecy\" (medico-social consultation)."},{"idx":3,"proposition":"In criminal matters, the Code of Criminal Procedure allows judges to use coercive means to access medical information and the truth.","correct":true},{"idx":4,"proposition":"The scope of professional secrecy stops at written information. Information seen and heard is not subject to this secrecy.","correct":false,"justification":"Secret information Case law has long been ruling on the extent of professional secrecy, and this consistently, specifying that secrecy concerns all information entrusted, but also everything that may have been seen, heard, understood, or even interpreted during medical practice."}],"type":"custom"}
+{"_id":"droits-sp-7","context":null,"enonce":"Which of this information is covered by medical confidentiality?","item":"droits","matiere":"sp","propositions":[{"idx":0,"proposition":"Diagnostics","correct":true},{"idx":1,"proposition":"Medical prescriptions","correct":true},{"idx":2,"proposition":"Confidences of adultery","correct":true},{"idx":3,"proposition":"Medical records","correct":true},{"idx":4,"proposition":"Conversations at home during a visit","correct":true}],"type":"custom"}
+{"_id":"infnasosin-infectio-0","context":null,"enonce":"Regarding nasal sinus infections","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Nasopharyngitis is almost exclusively viral","correct":true},{"idx":1,"proposition":"Nasopharyngitis is the most common mode of expression of influenza in children","correct":true},{"idx":2,"proposition":"There is often viral sinus involvement in nasopharyngitis, which heals spontaneously","correct":true},{"idx":3,"proposition":"Acute bacterial sinusitis is a rare complication of nasopharyngitis","correct":false},{"idx":4,"proposition":"The presence of sinusitis in immunocompromised patients should suggest a fungal origin (aspergillosis, mucormycosis), especially in case of bone lysis on CT","correct":true}],"type":"custom"}
+{"_id":"infnasosin-infectio-1","context":null,"enonce":"Regarding nasal sinus infections","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Their transmission is droplet type","correct":true},{"idx":1,"proposition":"Bacterial sinusitis is not contagious","correct":true},{"idx":2,"proposition":"Most acute bacterial sinusitis complicates a viral infection of the upper airways","correct":true},{"idx":3,"proposition":"In case of doubt as to the viral or bacterial origin of acute maxillary sinusitis, clinical reassessment after 2 or 3 days of symptomatic treatment is advised","correct":true},{"idx":4,"proposition":"Imaging has no indication except in cases of unilateral maxillary sinusitis","correct":true}],"type":"custom"}
+{"_id":"infnasosin-infectio-2","context":null,"enonce":"Regarding nasal sinus infections:","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Ethmoidal sinusitis is mainly observed in adults","correct":false},{"idx":1,"proposition":"In case of bacterial infection with frontal, ethmoidal or sphenoidal localization, there is a risk of serious damage to the central nervous system by proximity diffusion","correct":true},{"idx":2,"proposition":"Chronic sinusitis is defined by the persistence of symptoms of nasal obstruction, pain and rhinorrhea for more than 2 weeks","jusification":"Pendant plus de douze semaines","correct":false},{"idx":3,"proposition":"In infants, a picture of gastroenteritis with diarrhea and abdominal pain may be in the foreground","correct":true},{"idx":4,"proposition":"The intensity and impact of symptoms are very variable depending on the individuals and episodes.","correct":true}],"type":"custom"}
+{"_id":"infnasosin-infectio-4","context":null,"enonce":"In which case(s) is the sinus scanner systematic for management?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Ethmoidite","correct":true},{"idx":1,"proposition":"Frontal sinusitis","correct":true},{"idx":2,"proposition":"Sphenoid sinusitis","correct":true},{"idx":3,"proposition":"Acute maxillary sinusitis","correct":false,"justification":"False. Sinus CT is indicated only if there is a diagnostic doubt, if there is doubt about complications, if there is resistance to first-line antibiotic treatment, or if it is chronic maxillary sinusitis"},{"idx":4,"proposition":"None. The diagnosis of sinusitis is clinical and only a CT scan is done if there is a diagnostic doubt. ","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"infnasosin-infectio-5","context":null,"enonce":"Which of the following are systematic indications for sinus CT?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Chronic unilateral maxillary sinusitis","correct":false,"justification":"Dental panoramic or dentascan, to search for a dental focus"},{"idx":1,"proposition":"Acute maxillary sinusitis","correct":false,"justification":"False, no imaging in this case"},{"idx":2,"proposition":"Frontal sinusitis","correct":true},{"idx":3,"proposition":"Ethmoidal sinusitis","correct":true},{"idx":4,"proposition":"Sphenoidal sinusitis","correct":true}],"type":"custom"}
+{"_id":"infnasosin-infectio-7","context":null,"enonce":"Which of the following are true?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Maxillary sinuses are formed from 3-4 years ","correct":true},{"idx":1,"proposition":"Frontal sinuses form around 5-10 years ","correct":true,"justification":"This is why we see frontal sinusitis only in adolescents\/adults"},{"idx":2,"proposition":"Sphenoid sinuses form around 5-10 years of age ","correct":false,"justification":"False, between 10 and 15 years old. These are the frontal sinuses that form between 5 and 10 years."},{"idx":3,"proposition":"Ethmoidal cells are formed from the first months of life ","correct":true},{"idx":4,"proposition":"Maxillary sinuses are formed from the first months of life ","correct":false,"justification":"From 3 years old. We can therefore not see maxillary sinusitis before 3 years"}],"type":"custom"}
+{"_id":"infnasosin-infectio-8","context":null,"enonce":"Which of the following are signs of simple nasopharyngitis?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"One-sided pain","correct":false,"justification":"Sign of sinusitis"},{"idx":1,"proposition":"Throbbing pain","correct":false,"justification":"Sign of sinusitis"},{"idx":2,"proposition":"Incomplete bilateral nasal obstruction","correct":true},{"idx":3,"proposition":"Clear rhinorhea","correct":true,"justification":"True, can then become purulent"},{"idx":4,"proposition":"Acme at night","correct":false,"justification":"Sign of sinusitis"}],"type":"custom"}
+{"_id":"infnasosin-infectio-9","context":null,"enonce":"Regarding the development of sinuses in children. Which of the following are true?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Maxillary sinuses are present from birth","correct":false,"justification":"False. 3 to 4 years."},{"idx":1,"proposition":"Sphenoid sinuses are present from the age of 5 to 10 years","correct":false,"justification":"False. Sphenoid sinuses are present from the age of 10 to 15 years."},{"idx":2,"proposition":"Ethmoidal cells are present from the age of 3 to 4 years.","correct":false,"justification":"False. Ethmoidal cells are present from the age of 1 month."},{"idx":3,"proposition":"The frontal sinus is present from the age of 5 to 10 years","correct":true},{"idx":4,"proposition":"None of these propositions are true.","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"infnasosin-infectio-10","context":null,"enonce":"Which of the following are sinusitis locations requiring Amoxicillin-Clavulanic Acid?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Front","correct":true},{"idx":1,"proposition":"Ethmoidale","correct":true},{"idx":2,"proposition":"Sphenoidal","correct":true},{"idx":3,"proposition":"Maxillary","correct":false,"justification":"Amoxicillin 7J"},{"idx":4,"proposition":"All proposals","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"infnasosin-infectio-11","context":null,"enonce":"What type(s) of sinusitis(s) can an infant have?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Maxillary sinusitis","correct":false,"justification":"False. The maxillary sinus is developed from the age of 3-4 years. It is impossible to have maxillary sinusitis before the age of 3."},{"idx":1,"proposition":"Frontal sinusitis","correct":false,"justification":"False. The frontal sinus is present from the age of 5 to 10 years."},{"idx":2,"proposition":"Sphenoidal sinusitis","correct":false,"justification":"False. The sphenoid sinus is present from the age of 10 to 15 years."},{"idx":3,"proposition":"Ethmoidal sinusitis","correct":true,"justification":"True. Ethmoidal cells appear as early as 1 month of age."},{"idx":4,"proposition":"None, sinusitis is not possible before the age of 3 years","correct":false,"justification":"False. Since ethmoid cells exist, it is possible to have ethmoid sinusitis."}],"type":"custom"}
+{"_id":"infnasosin-infectio-12","context":null,"enonce":"What sinus involvement(s) requires the realization of a CT scan?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Maxillary ","correct":false,"justification":"False"},{"idx":1,"proposition":"Ethmoidal ","correct":true},{"idx":2,"proposition":"Front","correct":true},{"idx":3,"proposition":"Sphenoid","correct":true},{"idx":4,"proposition":"Bilateral maxilla","correct":false,"justification":"false"}],"type":"custom"}
+{"_id":"infnasosin-infectio-13","context":null,"enonce":"Regarding the bacteria responsible for sinusitis. Which of the following are true?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Ethmoiditis is often caused by Moraxella catarrhalis","correct":false,"justification":"False. Moraxella catarrhalis is not a germ that often causes ethmoiditis. On the other hand, it is a germ that can cause maxillary, frontal or sphenoid sinusitis."},{"idx":1,"proposition":"Haemophilis influenzae is a gram-negative cocci","correct":false,"justification":"Haemophilis influenzae is a gram-negative bacillus"},{"idx":2,"proposition":"During acute maxillary sinusitis with dental entrance door, anaerobic germs and Aspergillus can be found.","correct":true,"justification":"True. Aspergillus is mentioned in the Pilly."},{"idx":3,"proposition":"If bone lysis is found on CT scan in the immunocompromised, it is necessary to evoke a fungal infection (Aspergillus and mucormycosis)","correct":true,"justification":"None"},{"idx":4,"proposition":"Streptococcus pyogenes is a gram+ chain cocci on direct examination that often causes maxillary sinusitis","correct":false,"justification":"It is a gram + cocci on direct examination, but it is not a germ that is often involved in maxillary sinusitis. It is a common germ for ethmoidites."}],"type":"custom"}
+{"_id":"risquesRx-sp-0","context":null,"enonce":"Which of these proposals are natural radioactive sources?","item":"risquesRx","matiere":"sp","propositions":[{"idx":0,"proposition":"Cosmic radiation","correct":true},{"idx":1,"proposition":"Medical radiation","correct":false},{"idx":2,"proposition":"Telluric radiation","correct":true,"justification":"From the earth's crust"},{"idx":3,"proposition":"The radiation of the human body","correct":true},{"idx":4,"proposition":"Radioactivity in the air","correct":true,"justification":"Mainly due to Radon"}],"type":"custom"}
+{"_id":"risquesRx-sp-1","context":null,"enonce":"Regarding units:","item":"risquesRx","matiere":"sp","propositions":[{"idx":0,"proposition":"The absorbed dose is expressed in Sieverts","correct":false,"justification":"In Gray"},{"idx":1,"proposition":"The effective dose is expressed in Sievert","correct":true},{"idx":2,"proposition":"The equivalent dose is expressed in Sievert","correct":true},{"idx":3,"proposition":"The absorbed dose is expressed in Gray","correct":true},{"idx":4,"proposition":"The equivalent dose is expressed in Gray","correct":false,"justification":"In sievert"}],"type":"custom"}
+{"_id":"risquesRx-sp-2","context":null,"enonce":"Regarding deterministic effects:","item":"risquesRx","matiere":"sp","propositions":[{"idx":0,"proposition":"They are constant above a threshold","correct":true},{"idx":1,"proposition":"Severity is independent of dose","correct":false,"justification":"It is proportional"},{"idx":2,"proposition":"The effects are early","correct":true},{"idx":3,"proposition":"They are common in medical imaging","correct":false,"justification":"Truly exceptional"},{"idx":4,"proposition":"They are irreversible","correct":false,"justification":"They are usually reversible"}],"type":"custom"}
+{"_id":"risquesRx-sp-3","context":null,"enonce":"Regarding stochastic effects:","item":"risquesRx","matiere":"sp","propositions":[{"idx":0,"proposition":"There is a notion of threshold","correct":false,"justification":"No notion of threshold. It's random"},{"idx":1,"proposition":"Onset is early","correct":false,"justification":"It is delayed"},{"idx":2,"proposition":"Severity is proportional to dose","correct":false,"justification":"It is independent of dose"},{"idx":3,"proposition":"Frequency is proportional to dose ","correct":true},{"idx":4,"proposition":"Cause and effect is easy to establish","correct":false,"justification":"Very difficult"}],"type":"custom"}
+{"_id":"pleuresie-pneumo-0","context":null,"enonce":"Which of the following are true?","item":"pleuresie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The space between the two leaflets of the pleura is completely virtual","correct":false,"justification":"There is a pleural fluid of 5 to 20 mL, physiological, which allows the slippage ✌ of both leaflets into the lungs"},{"idx":1,"proposition":"Any unproven exudate should undergo a pleural biopsy","correct":true},{"idx":2,"proposition":"Complicated parapneumonic effusions are evacuated as soon as possible","correct":true},{"idx":3,"proposition":"Any febrile pleural effusion should be punctured urgently\r\n","correct":true},{"idx":4,"proposition":"Any pleural effusion should be punctured","correct":false,"justification":"Not if its cause is known, if a\r\nheart failure is suspected or if effusion is minimal"}],"type":"custom"}
+{"_id":"pleuresie-pneumo-1","context":null,"enonce":"Which of the following are characteristics of transudates?","item":"pleuresie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Clear liquid","correct":true},{"idx":1,"proposition":"Healthy pleura","correct":true},{"idx":2,"proposition":"High protein content","correct":false,"justification":"Exudate"},{"idx":3,"proposition":"Low LDH","correct":true},{"idx":4,"proposition":"High lymphocytes","correct":false,"justification":"Lymphocyte exudate"}],"type":"custom"}
+{"_id":"pleuresie-pneumo-2","context":null,"enonce":"What is the triglyceride level that defines the diagnosis of chylothorax?","item":"pleuresie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"1.2 mmol\/L","correct":true},{"idx":1,"proposition":"1.1 g\/L","correct":true},{"idx":2,"proposition":"0.2 mmol\/L","correct":false,"justification":"It really wouldn't be much"},{"idx":3,"proposition":"4.3 g\/L","correct":false,"justification":"It would really be too much"},{"idx":4,"proposition":"There is no such thing as chylothorax","correct":false,"justification":"It's rare but possible"}],"type":"custom"}
+{"_id":"pleuresie-pneumo-3","context":null,"enonce":"Among the following propositions, what is the LDH threshold to define an exudate?","item":"pleuresie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"100 g\/L","correct":false,"justification":"2️0️⃣ ⃣0️⃣. The unit is IU\/L"},{"idx":1,"proposition":"200 IU\/L","correct":true},{"idx":2,"proposition":"300 IU\/L","correct":false,"justification":"2️0️⃣ ⃣0️⃣"},{"idx":3,"proposition":"400 IU\/L","correct":false,"justification":"2️0️⃣ ⃣0️⃣"},{"idx":4,"proposition":"500 IU\/L","correct":false,"justification":"2️0️⃣ ⃣0️⃣"}],"type":"custom"}
+{"_id":"pleuresie-pneumo-4","context":null,"enonce":"Which of the following are the causes of bilateral transudates?","item":"pleuresie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Heart failure 💟","correct":true,"justification":"True, this is the main cause"},{"idx":1,"proposition":"Nephrotic syndrome","correct":true,"justification":"True, loss of protein and decrease in oncotic pressure"},{"idx":2,"proposition":"Mesothelioma","correct":false,"justification":"It would be an exudate"},{"idx":3,"proposition":"Tuberculosis","correct":false,"justification":"Lymphocyte exudate"},{"idx":4,"proposition":"Pulmonary embolism","correct":false,"justification":"Unless it is bilateral, there would be a unilateral transudate"}],"type":"custom"}
+{"_id":"LED-immuno-0","context":null,"enonce":"Which of the following are the clinical diagnostic criteria(s) of ACR that would allow you to retain the diagnosis of Lupus?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"Hemolytic anemia","correct":false,"justification":"It is a biological criterion, not a clinical one."},{"idx":1,"proposition":"Leukocytosis","correct":false,"justification":"It is a biological criterion, not a clinical one. In addition, leukopenia is mentioned in the ACR criteria."},{"idx":2,"proposition":"Non-erosive polyarthritis","correct":true,"justification":"Be careful, it must be non-erosive."},{"idx":3,"proposition":"Photosensitivity","correct":true},{"idx":4,"proposition":"Pleurisy","correct":true}],"type":"custom"}
+{"_id":"LED-immuno-1","context":null,"enonce":"Which of the following are the clinical or biological diagnostic criteria(s) of the ACR that would allow you to retain the diagnosis of Lupus?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"Pericarditis","correct":true},{"idx":1,"proposition":"Mouth ulcers","correct":true},{"idx":2,"proposition":"Lymphopenia < 1,500\/mm3 2 times","correct":true},{"idx":3,"proposition":"A VDRLet TPHA+","correct":false,"justification":"We can find a false syphilitic serology (VDRL+ and TPHA-)"},{"idx":4,"proposition":"The presence of FAN","correct":true,"justification":"Without inducing drugs"}],"type":"custom"}
+{"_id":"LED-immuno-2","context":null,"enonce":"Which of the following criteria are the biological diagnostic criteria(s) that would allow you to retain the diagnosis of Lupus?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"Leukopenia < 4,000\/mm3 2 times","correct":true},{"idx":1,"proposition":"Lymphopenia < 8,500\/mm3 2 times","correct":false,"justification":"Lymphopenia is defined from < 1,500\/mm3"},{"idx":2,"proposition":"The absence of anti-Sm antibodies","correct":false,"justification":"The presence of anti-Sm antibodies is rare (~20%) but very specific"},{"idx":3,"proposition":"Convulsions","correct":false,"justification":"It is a clinical criterion"},{"idx":4,"proposition":"Proteinuria > 0.5\/day","correct":true}],"type":"custom"}
+{"_id":"LED-immuno-3","context":null,"enonce":"What treatment(s) background and crisis do you propose to treat active class IV lupus nephropathy, without joint involvement?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"NSAIDs","correct":false,"justification":"Unless joint damage"},{"idx":1,"proposition":"High-dose IV corticosteroids","correct":true},{"idx":2,"proposition":"High-dose morphines","correct":false,"justification":"Does not fit into the treatment of lupus. Normally, kidney damage does not hurt"},{"idx":3,"proposition":"Cyclosporine","correct":false,"justification":"Cyclophospamide IV"},{"idx":4,"proposition":"Low-dose IV corticosteroids","correct":false,"justification":"High doses in this case"}],"type":"custom"}
+{"_id":"LED-immuno-4","context":null,"enonce":"Which of the following are true about lupus?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"There is no arthritis but arthralgia","correct":false,"justification":"There can be both."},{"idx":1,"proposition":"Joint damage is usually migratory and fleeting","correct":true},{"idx":2,"proposition":"Joint damage exceptionally affects small joints","correct":false,"justification":"They affect PPIs more than PCAs"},{"idx":3,"proposition":"Jaccoud's hand appearance is a complication of lupus","correct":true,"justification":"True, it is reducible in lupus"},{"idx":4,"proposition":"Arthritis is erosive","correct":false,"justification":"There is no erosive damage"}],"type":"custom"}
+{"_id":"LED-immuno-5","context":null,"enonce":"Which of the following proposals are part of the biological assessment useful for the positive diagnosis of systemic lupus erythematosus?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"Immunophenotyping of lymphocytes","correct":false,"justification":"False"},{"idx":1,"proposition":"Anti-nuclear antibodies","correct":true,"justification":"True, positive if > 1\/160th"},{"idx":2,"proposition":"Anti-histone antibodies","correct":false,"justification":"False"},{"idx":3,"proposition":"Anti-DNA antibodies","correct":true,"justification":"True, useful for follow-up"},{"idx":4,"proposition":"Anti-Sm antibodies","correct":true,"justification":"True, quite specific"}],"type":"custom"}
+{"_id":"LED-immuno-6","context":null,"enonce":"Which of the following proposals are contraindicated during pregnancy 🤰?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"IEC","correct":true},{"idx":1,"proposition":"Azathioprine","correct":false,"justification":"Unlike cyclophosphamide, methotrexate or mycophenolate mofetil, azathioprine can be used"},{"idx":2,"proposition":"VKA","correct":true,"justification":"True, to be replaced by LMWH"},{"idx":3,"proposition":"Corticosteroids","correct":false,"justification":"No this"},{"idx":4,"proposition":"Dermocorticoids","correct":false,"justification":"No IC"}],"type":"custom"}
+{"_id":"LED-immuno-7","context":null,"enonce":"Which of the following are true?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"Class 1 glomerulonephritis is minimal","correct":true},{"idx":1,"proposition":"Class 2 glomerulonephritis is intracapillary proliferation","correct":false,"justification":"It is a mesangial LARP"},{"idx":2,"proposition":"There are 5 classes of lupus glomerulonephritis","correct":false,"justification":"There are 6 (1: minimal lesions, 2: mesangial proliferation, 3: focal proliferation with <50% of affected glomeruli, 4: diffuse proliferation with >50% of affected glomeruli, 5: extramembranous proliferation, 6: sclerotic)"},{"idx":3,"proposition":"Renal involvement affects about 5% of patients","correct":false,"justification":"Between 10 and 40%"},{"idx":4,"proposition":"Class 5 glomerulonephritis is an extramembranous involvement","correct":true}],"type":"custom"}
+{"_id":"LED-immuno-8","context":null,"enonce":"Which of the following are true?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"Native anti-DNA antibodies can be detected by PCR","correct":false,"justification":"Only DNA can be detected by PCR (and RNA for RT-PCR)"},{"idx":1,"proposition":"Native anti-DNA antibodies can be detected in ELISA","correct":true},{"idx":2,"proposition":"Lack of native anti-DNA antibodies eliminates diagnosis of lupus","correct":false,"justification":"Imperfect sensitivity"},{"idx":3,"proposition":"Native anti-DNA antibodies are essential for diagnosis ","correct":false,"justification":"Imperfect sensitivity"},{"idx":4,"proposition":"The level of native anti-DNA antibodies reflects disease activity","correct":true}],"type":"custom"}
+{"_id":"LED-immuno-9","context":null,"enonce":"Which of the following proposals is part of the first-line background treatment for systemic lupus erythematosus?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"proposition":"Oral methotrexate","correct":false,"justification":"False"},{"idx":1,"proposition":"Hydroxychloroquine orally","correct":true},{"idx":2,"proposition":"Oral corticosteroid therapy","correct":false,"justification":"False"},{"idx":3,"proposition":"Azathioprine per os","correct":false,"justification":"False"},{"idx":4,"proposition":"Aspirin per os","correct":false,"justification":"False"}],"type":"custom"}
+{"_id":"systemesoins-sp-0","context":null,"enonce":"Regarding the Beveridgian model:","item":"systemesoins","matiere":"sp","propositions":[{"idx":0,"proposition":"It was founded by Chancellor Beveridge","correct":false,"justification":"He was a Lord. The Beveridgian system comes from the UK while the Bismarckian system comes from Germany (Chancellor Bismark)"},{"idx":1,"proposition":"Medical care is free for those who work","correct":false,"justification":"Free for all"},{"idx":2,"proposition":"The system is financed by employers' contributions","correct":false,"justification":"By tax"},{"idx":3,"proposition":"It is based on 4 universal principles","correct":false,"justification":"3 principles (the 3 U's): universality, uniqueness and uniformity"},{"idx":4,"proposition":"This is the system in place in Ireland and Finland.","correct":true,"justification":"England, Sweden, Finland, Denmark and Ireland\""}],"type":"custom"}
+{"_id":"systemesoins-sp-1","context":null,"enonce":"The Bismarckian system:","item":"systemesoins","matiere":"sp","propositions":[{"idx":0,"proposition":"It was founded by Chancellor Bismarck at the end of the 19th century.","correct":true,"justification":"Before the First World War"},{"idx":1,"proposition":"It is reserved for employees","correct":true},{"idx":2,"proposition":"It is managed by the State","correct":false,"justification":"Decentralised management by employees and employers"},{"idx":3,"proposition":"It is implemented in Germany and Austria","correct":true,"justification":"Also in Belgium, the Netherlands, Switzerland and Luxembourg"},{"idx":4,"proposition":"It was originally intended to protect industrial workers.","correct":true}],"type":"custom"}
+{"_id":"systemesoins-sp-2","context":null,"enonce":"Which of these propositions are true?","item":"systemesoins","matiere":"sp","propositions":[{"idx":0,"proposition":"Each country has a system of santoe that has been built according to its political choices and traditions.","correct":true},{"idx":1,"proposition":"Health spending in England was 1.9% of GDP in 2014","correct":false,"justification":"Health expenditure: 9.1% of GDP in 2014"},{"idx":2,"proposition":"The state has a central role in England","correct":true},{"idx":3,"proposition":"The health system is named National Health Service (NHS)","correct":true},{"idx":4,"proposition":"The financing of the system in England is provided by taxes","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"systemesoins-sp-3","context":null,"enonce":"Which of these propositions are true?","item":"systemesoins","matiere":"sp","propositions":[{"idx":0,"proposition":"Healthcare in England is extremely expensive for users","correct":false,"justification":"Health care is almost free for all residents (co-payment for medicines)"},{"idx":1,"proposition":"Doctors are paid based on the medications they prescribe","correct":false,"justification":"Doctors are paid by the NHS according to the number of patients registered and certain procedures they perform."},{"idx":2,"proposition":"Doctors do not have complete freedom of installation","correct":true},{"idx":3,"proposition":"The GP is the mandatory gateway to specialists, hospitalizations, etc.","correct":true},{"idx":4,"proposition":"The English model, however, has the disadvantage of rationing care quantitatively.","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"systemesoins-sp-4","context":null,"enonce":"Which of these propositions are true?","item":"systemesoins","matiere":"sp","propositions":[{"idx":0,"proposition":"In Germany, health spending was 21.1% of GDP in 2014","correct":false,"justification":"Health expenditure = 11.1% of GDP in 2014"},{"idx":1,"proposition":"Public and private funds are in competition with each other and autonomous in their management","correct":true},{"idx":2,"proposition":"The Länder are responsible for hospital planning","correct":true},{"idx":3,"proposition":"Patients are free to choose their insurance fund","correct":true},{"idx":4,"proposition":"There is a regulation of medical demography","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"systemesoins-sp-5","context":null,"enonce":"Which of these propositions are true?","item":"systemesoins","matiere":"sp","propositions":[{"idx":0,"proposition":"The system is liberal and decentralized","correct":true},{"idx":1,"proposition":"The federal state covers major risks (the elderly, the severely disabled, people in need)","correct":true},{"idx":2,"proposition":"Health spending is very low","correct":false,"justification":"Health spending is very high: 17.1% of GDP in 2014 2.2. HEALTH INSURANCE VIA EMPLOYER sickness"},{"idx":3,"proposition":"Health insurance is most often job-related","correct":true},{"idx":4,"proposition":"Health insurance is optional","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"systemesoins-sp-6","context":null,"enonce":"Which of these propositions are true?","item":"systemesoins","matiere":"sp","propositions":[{"idx":0,"proposition":"About 25% of the population is covered by compulsory health insurance","correct":true},{"idx":1,"proposition":"MEDICARE is for the poorest people","correct":false,"justification":"MEDICARE: Elderly and Disabled People"},{"idx":2,"proposition":"MEDICAID is for the elderly and the disabled","correct":false,"justification":"MEDICAID: For the poorest. Financed by federal states (inequalities according to regions)"},{"idx":3,"proposition":"2 to 8% of Americans do not have health insurance in the US","correct":false,"justification":"16-18% of Americans"},{"idx":4,"proposition":"Without health insurance, individuals must pay the full cost of health care","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"systemesoins-sp-7","context":null,"enonce":"Which of these propositions are true?","item":"systemesoins","matiere":"sp","propositions":[{"idx":0,"proposition":"Historically, the health system in France is under the Bismarckian system.","correct":true},{"idx":1,"proposition":"The CMU was created in 1998","correct":true},{"idx":2,"proposition":"The state has an important role","correct":true},{"idx":3,"proposition":"One of the objectives of health policies is to promote health in all living environments","correct":true},{"idx":4,"proposition":"The organization of logical health pathways is one of the objectives of health policies","correct":true,"justification":"TRUE\""}],"type":"custom"}
+{"_id":"systemesoins-sp-8","context":null,"enonce":"Which of these proposals are actors in the health system?","item":"systemesoins","matiere":"sp","propositions":[{"idx":0,"proposition":"The patient","correct":true,"justification":"It is the beneficiary"},{"idx":1,"proposition":"The pharmaceutical industry","correct":true,"justification":"It is the producer of health services and goods"},{"idx":2,"proposition":"The ARS","correct":true,"justification":"It is a public institution"},{"idx":3,"proposition":"Journalists","correct":false,"justification":"Have nothing. Even health journalists are not actors in the healthcare system (role of commentators and not actors)"},{"idx":4,"proposition":"The school doctor","correct":true,"justification":"Of course\""}],"type":"custom"}
+{"_id":"SpA-rhumato-027650","context":null,"enonce":"Which of the following proposals are part of the pre-therapeutic assessment before the introduction of an anti-TNF alpha?","item":"SpA","matiere":"rhumato","propositions":[{"correct":true,"justification":"True (tuberculosis: indeed, the main immune pathway that allows the control of Koch's bacillus is based on TNF-alpha)","idx":0,"proposition":"Chest X-ray"},{"correct":true,"justification":"True, ± BK-tubing or ECBC if spit","idx":1,"proposition":"IDR or Quantiferon"},{"correct":false,"justification":"False","idx":2,"proposition":"Scanner TAP"},{"correct":false,"justification":"False, on the other hand we do: EPP-NFS, HBV-HCV-HIV, ECBU ± sinus-panoramic","idx":3,"proposition":"Hepatic ultrasound"},{"correct":false,"justification":"False","idx":4,"proposition":"Echo-Doppler of the 4 members"}],"type":"custom"}
+{"_id":"herpes-infectio-0479a7","context":null,"enonce":"Which of the following propositions regarding herpes virus infections are true?","item":"herpes","matiere":"infectio","propositions":[{"correct":false,"justification":"Very common, 90% of adults are HIV-positive ","idx":0,"proposition":"They are infrequent"},{"correct":true,"justification":" ","idx":1,"proposition":"Transmission can be salivary"},{"correct":false,"justification":"No, only atypical pictures or in some patients who need to document the infection ","idx":2,"proposition":"Diagnosis requires additional examinations "},{"correct":true,"justification":" ","idx":3,"proposition":"Transmission can be mucosal"},{"correct":false,"justification":"Several treatments are available, including Aciclovir, Valaciclovir...","idx":4,"proposition":"There is currently no treatment available"}],"type":"custom"}
+{"_id":"AV--ophtalmo-05b5b7","context":null,"enonce":"Which of the following are treatments for atrophic AMD, if any?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Wild AMD ","idx":0,"proposition":"Dynamic phototherapy"},{"correct":false,"justification":"Wild AMD ","idx":1,"proposition":"Anti-VEGF"},{"correct":true,"justification":"True, but a lot of research going on","idx":2,"proposition":"No therapeutics currently"},{"correct":false,"justification":"Part of the package for beginner AMD","idx":3,"proposition":"Zinc"},{"correct":false,"justification":"Part of the package for beginner AMD","idx":4,"proposition":"Lutein"}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-06b787","context":null,"enonce":"Which of the following are mainly unilateral etiologies?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Bilateral","idx":0,"proposition":"Proliferative diabetic retinopathy"},{"correct":false,"justification":"Bilateral","idx":1,"proposition":"Open glaucoma"},{"correct":false,"justification":"Bilateral","idx":2,"proposition":"Senescent cataract"},{"correct":true,"justification":"True","idx":3,"proposition":"Central retinal vein occlusion"},{"correct":true,"justification":"True","idx":4,"proposition":"Retinal detachment"}],"type":"custom"}
+{"_id":"pathoOGE-endoc-099537","context":null,"enonce":"Which of the following proposals are favored in case of cryptorchidism?","item":"pathoOGE","matiere":"endoc","propositions":[{"correct":true,"justification":"True, the RR is increased","idx":0,"proposition":"Testicular cancer"},{"correct":true,"justification":"True","idx":1,"proposition":"Infertility"},{"correct":false,"justification":"No report","idx":2,"proposition":"Phimosis"},{"correct":false,"justification":"No report","idx":3,"proposition":"Paraphimosis"},{"correct":true,"justification":"True","idx":4,"proposition":"Testicular atrophy"}],"type":"custom"}
+{"_id":"diabete-endoc-0a3287","context":null,"enonce":"Regarding the complications of diabetes, what are the true propositions?","item":"diabete","matiere":"endoc","propositions":[{"correct":false,"justification":"False, the complications are caused precisely by the excess of glucose in the endothelial cells that saturate their glucose metabolism pathway. Entry into these cells is through transporters that are not dependent on insulin. Insulin acts on GLUT4 receptors that concern adipocytes and rhabdomyocytes.","idx":0,"proposition":"Insulin resistance and then insulinopenia prevent the entry of glucose into the cells, which is the cause of complications of diabetes"},{"correct":true,"justification":"True","idx":1,"proposition":"Prevention of complications starts with good glycemic control"},{"correct":false,"justification":"False, first by the general practitioner. The diabetologist's advice is recommended only in case of complications of diabetes","idx":2,"proposition":"The management of the diabetic patient goes first through the diabetologist"},{"correct":true,"justification":"True, however, it is necessary to look for them immediately in type 2 diabetics","idx":3,"proposition":"Degenerative complications are rare when T1D is diagnosed"},{"correct":false,"justification":"It is annual from diagnosis, regardless of age","idx":4,"proposition":"The fundus is annual from 65 years"}],"type":"custom"}
+{"_id":"SPSC-sp-0ac05c","context":null,"enonce":"Which of the following are needed for classic TDPS?","item":"SPSC","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"2 medical certificates"},{"correct":true,"justification":"True, you cannot do SPDT for a minor (only SPDREs or PPOs are possible)","idx":1,"proposition":"Adult patient"},{"correct":true,"justification":"True","idx":2,"proposition":"One-third"},{"correct":false,"justification":"Only for SPDRE","idx":3,"proposition":"A prefectural decree"},{"correct":false,"justification":"Less than 15 days","idx":4,"proposition":"Certificates less than 30 days old"}],"type":"custom"}
+{"_id":"antiinf-infectio-107c54","context":null,"enonce":"What is(are) the main toxicity(s) of vancomycin?","item":"antiinf","matiere":"infectio","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"Brain"},{"correct":false,"justification":"Treatment of tuberculosis in particular","idx":1,"proposition":"Hepatic"},{"correct":true,"justification":"Vancomycin is ototoxic (like aminoglycosides) ","idx":2,"proposition":"Hearing"},{"correct":true,"justification":"True, to remember !! Another side effect to remember is the red man syndrome in case of injection too fast. ","idx":3,"proposition":"Kidney"},{"correct":false,"justification":"No digestive absorption","idx":4,"proposition":"Digestive"}],"type":"custom"}
+{"_id":"tbrefraction-ophtalmo-116ba8","context":null,"enonce":"Which of the following propositions are true about hyperopia?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is common in children"},{"correct":false,"justification":"This is the case of presbyopia","idx":1,"proposition":"It concerns all persons over 70 years of age"},{"correct":true,"justification":"True, the image forms behind the retina","idx":2,"proposition":"It is due to an eye that is too short"},{"correct":true,"justification":"True","idx":3,"proposition":"It can cause eye strain"},{"correct":false,"justification":"This is the case of myopia","idx":4,"proposition":"It protects against myopia"}],"type":"custom"}
+{"_id":"SpA-rhumato-131b3f","context":null,"enonce":"Which of the following are signs of spondyloarthritis?","item":"SpA","matiere":"rhumato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"dactylitis"},{"correct":true,"justification":"True, sacroiliitis, pyalgia, fessalgia","idx":1,"proposition":"inflammatory spinal pain"},{"correct":true,"justification":"True","idx":2,"proposition":"heel pain"},{"correct":false,"justification":"False","idx":3,"proposition":"dry syndrome"},{"correct":false,"justification":"HLA-B27","idx":4,"proposition":"HLA-G"}],"type":"custom"}
+{"_id":"tbrefraction-ophtalmo-143140","context":null,"enonce":"Which of the following propositions corresponds to a normal reading of the finest letters in the Parinaud scale?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"P1.5 - P2"},{"correct":false,"justification":"False","idx":1,"proposition":"P0.1 - P0.2"},{"correct":false,"justification":"False","idx":2,"proposition":"P1.5 - P3"},{"correct":false,"justification":"False","idx":3,"proposition":"P3 - P6"},{"correct":false,"justification":"False","idx":4,"proposition":"P30 - P20"}],"type":"custom"}
+{"_id":"allergie-pneumo-14481e","context":null,"enonce":"What is the prevalence of allergy (to any substance) in children under 15 years of age?","item":"allergie","matiere":"pneumo","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"3%"},{"correct":false,"justification":"False","idx":1,"proposition":"15%"},{"correct":false,"justification":"False","idx":2,"proposition":"20%"},{"correct":true,"justification":"True, and the prevalence of food allergy is 7% ","idx":3,"proposition":"30%"},{"correct":false,"justification":"False","idx":4,"proposition":"35%"}],"type":"custom"}
+{"_id":"ACR-urg-15508b","context":null,"enonce":"Which of the following proposals for particular cardiopulmonary resuscitation situations are true?","item":"ACR","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"In pregnant women (≥20 SA) the uterus should be reclinated to the left during cardiac massage to promote venous return"},{"correct":true,"justification":"True","idx":1,"proposition":"In pregnant women, the heels of the hands are applied higher than in non-pregnant women"},{"correct":false,"justification":"False, by 5 breaths","idx":2,"proposition":"In case of drowning, cardiopulmonary resuscitation should be started with 2 breaths "},{"correct":true,"justification":"True, however, it is necessary to quickly identify rapidly curable etiologies at the origin of an ACR in a traumatic context (compressive pneumothorax, hemorrhagic shock, etc.).","idx":3,"proposition":"RTAs of traumatic origin primarily follow the same recommendations as RTAs of \"medical\" origin"},{"correct":true,"justification":"True","idx":4,"proposition":"Abdominal compression is not indicated in case of drowning"}],"type":"custom"}
+{"_id":"SPSC-sp-162b37","context":null,"enonce":"Which of the following proposals are the rights of involuntary hospitalized patients?","item":"SPSC","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Right to vote"},{"correct":true,"justification":"True","idx":1,"proposition":"Right to a lawyer"},{"correct":false,"justification":"False","idx":2,"proposition":"be paid"},{"correct":false,"justification":"False","idx":3,"proposition":"be exempt from hospitalization costs"},{"correct":true,"justification":"True","idx":4,"proposition":"Practicing your religion"}],"type":"custom"}
+{"_id":"pancreatiteaigue-HGE-1708c1","context":null,"enonce":"In............ In cases, acute pancreatitis is life-threatening.","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"5%"},{"correct":false,"justification":"","idx":1,"proposition":"10%"},{"correct":true,"justification":"In 20–30% of cases, pancreatitis is severe (necrotizing) and life-threatening.","idx":2,"proposition":"20%"},{"correct":false,"justification":"","idx":3,"proposition":"50%"},{"correct":false,"justification":"","idx":4,"proposition":"70%"}],"type":"custom"}
+{"_id":"RCIU-gyn-193ff5","context":null,"enonce":"Which of the following are diseases associated with prematurity?","item":"RCIU","matiere":"gyn","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Diaphragmatic hernia"},{"correct":true,"justification":"True","idx":1,"proposition":"Hyaline membrane disease"},{"correct":false,"justification":"False","idx":2,"proposition":"Hypertrophic pyloric stenosis"},{"correct":true,"justification":"True, 10% of premature babies.","idx":3,"proposition":"Cavitary periventricular leukomalacia"},{"correct":false,"justification":"False","idx":4,"proposition":"Atresia of the bile ducts"}],"type":"custom"}
+{"_id":"AV--ophtalmo-1a0834","context":null,"enonce":"Which of the following are true about Stargardt disease?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is macular retinopathy"},{"correct":false,"justification":"False","idx":1,"proposition":"It is a pigmentary retinopathy"},{"correct":false,"justification":"False","idx":2,"proposition":"It is an X-linked retinopathy"},{"correct":true,"justification":"True, autosomal recessive","idx":3,"proposition":"It is an autosomal retinopathy"},{"correct":false,"justification":"False","idx":4,"proposition":"It is a dominant retinopathy"}],"type":"custom"}
+{"_id":"prothese-urg-1f47d2","context":null,"enonce":"Which of the following are true?","item":"prothese","matiere":"urg","propositions":[{"correct":true,"justification":"True, unless hemodynamic instability, surgical samples are first taken","idx":0,"proposition":"It is generally forbidden to introduce blind probabilistic antibiotic therapy in case of suspected infection on equipment"},{"correct":true,"justification":"True, alcohol is not","idx":1,"proposition":"Diabetes and obesity are risk factors for prosthetic infection"},{"correct":true,"justification":"True, by vascular involvement","idx":2,"proposition":"Tobacco is a delayed bone consolidation factor"},{"correct":false,"justification":"Three months","idx":3,"proposition":"The average duration of bone consolidation of a talus fracture is about 6 weeks"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"contraception-endoc-20447e","context":null,"enonce":"Regarding contraception, which of these answers is\/are true?","item":"contraception","matiere":"endoc","propositions":[{"correct":false,"justification":"False, only progestin-only contraception acts on the tube, which explains the fact that ectopic pregnancies are one of the main adverse effects.","idx":0,"proposition":"Estrogen-progestorative contraception acts on the endometrium, ovary, hormonal feedback to the pituitary gland and fallopian tube"},{"correct":true,"justification":"True, the Pearl Index is an indicator of the number of accidental pregnancies under contraception, the higher it is, the less effective contraception is","idx":1,"proposition":"So-called \"natural\" contraception (withdrawal, temperature measurement) have a high Pearl index"},{"correct":true,"justification":"True, as well as personal or family history of venous thromboembolic disease, history of arterial disease, or cardiovascular risk factors","idx":2,"proposition":"Among the contraindications of estrogen-progestin contraception, we find migraine with aura"},{"correct":true,"justification":"True","idx":3,"proposition":"A copper IUD is placed for 4 to 5 years"},{"correct":false,"justification":"False, taking emergency contraception is unique","idx":4,"proposition":"Following emergency contraception, emergency contraception must be continued for 7 days"}],"type":"custom"}
+{"_id":"diarrheeinf-infectio-221d56","context":null,"enonce":"Which of the following propositions are true for oral rehydration solutions (ORS) in children?","item":"diarrheeinf","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"ORS is the only essential treatment for dehydration in children."},{"correct":true,"justification":"True","idx":1,"proposition":"ORS does not stop diarrhoea but can prevent and\/or correct acute dehydration induced by diarrhoea and\/or vomiting, as well as secondary ionic disorders."},{"correct":true,"justification":"True","idx":2,"proposition":"The intake of ORS must be early, at the first symptoms."},{"correct":false,"justification":"Only if on prescription","idx":3,"proposition":"ORS in pharmacies are always reimbursed"},{"correct":false,"justification":"No, on the contrary","idx":4,"proposition":"ORS is contraindicated in cases of vomiting"}],"type":"custom"}
+{"_id":"oreillons-infectio-27e28c","context":null,"enonce":"Which of the following are true?","item":"oreillons","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Partotiditis is often bilateral"},{"correct":false,"justification":"No! The only one not reported among the 3 MMR vaccine. ","idx":1,"proposition":"It is a reportable disease"},{"correct":true,"justification":"True","idx":2,"proposition":"Transmission is by air"},{"correct":true,"justification":"True, 1 in 3 cases ","idx":3,"proposition":"It is often asymptomatic"},{"correct":false,"justification":"Treatment is symptomatic only","idx":4,"proposition":"Treatment combines ritonavir and antiplatelet agents"}],"type":"custom"}
+{"_id":"nutrigrossesse-endoc-29d360","context":null,"enonce":"What is the blood glucose goal at 2h post-prandial in a pregnant woman with type 2 diabetes?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"correct":true,"justification":"True. College of Gynecology (4th edition)","idx":0,"proposition":"< 1.20g\/L"},{"correct":false,"justification":"Threshold at 1h post-prandial","idx":1,"proposition":"< 1.40g\/L"},{"correct":false,"justification":"Threshold defining fasting type 2 diabetes (twice)","idx":2,"proposition":"< 1.26g\/L"},{"correct":false,"justification":"Threshold 1 hour after an OPGH","idx":3,"proposition":"< 1.80g\/L"},{"correct":false,"justification":"Threshold 2 hours after an OPGH","idx":4,"proposition":"< 1.56g\/L"}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-29d558","context":null,"enonce":"Which of the following are etiologies of intravitreal hemorrhage?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Proliferative diabetic retinopathy"},{"correct":true,"justification":"True, vein occlusion = blood cannot come out = aneurysm and edema = flammèche and spot hemorrhage, papillary edema, macular edema, cottony nodules, intravitreal hemorrhage","idx":1,"proposition":"Central retinal vein occlusion"},{"correct":false,"justification":"Artery occlusion = blood does not arrive = no bleeding","idx":2,"proposition":"Central retinal artery occlusion"},{"correct":true,"justification":"True, complicated or not retinal detachment.","idx":3,"proposition":"Retinal tear "},{"correct":true,"justification":"True","idx":4,"proposition":"Syndrome de Terson "}],"type":"custom"}
+{"_id":"noduleTh-endoc-2a4c68","context":null,"enonce":"Regarding the positive diagnosis of goiter. Which of the following propositions, which one or which are true?","item":"noduleTh","matiere":"endoc","propositions":[{"correct":false,"justification":"False. > 16 mL in adolescents. > 18 mL in adult women and > 20 mL in adult men","idx":0,"proposition":"Thyroid volume > 20 mL in adolescents"},{"correct":true,"justification":"True","idx":1,"proposition":"Thyroid volume > 18 mL in adult women"},{"correct":true,"justification":"True","idx":2,"proposition":"Thyroid volume > 16 mL in adolescents"},{"correct":true,"justification":"True","idx":3,"proposition":"The WHO definition of goiter is palpation of the surface of each lobe that exceeds that of the last phalanx of the thumb."},{"correct":false,"justification":"False. Thumb. ","idx":4,"proposition":"The WHO definition of goiter is palpation of the surface of each lobe that exceeds that of the last phalanx of the index finger."}],"type":"custom"}
+{"_id":"diarrheeinf-infectio-2b0914","context":null,"enonce":"Which of the following proposals cause enteroinvasive diarrhea?","item":"diarrheeinf","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Yersinia"},{"correct":false,"justification":"Choleriform diarrhea (secretory mechanism) ➡ fluid diarrhea without fever","idx":1,"proposition":"Cholera"},{"correct":true,"justification":"True","idx":2,"proposition":"Shigella"},{"correct":true,"justification":"True","idx":3,"proposition":"Clostridium difficile"},{"correct":true,"justification":"True","idx":4,"proposition":"Salmonella"}],"type":"custom"}
+{"_id":"RCIU-gyn-2b33f3","context":null,"enonce":"Which of the following are signs in favor of ulcerative-necrotizing enterocolitis?","item":"RCIU","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Sensitive abdomen"},{"correct":true,"justification":"True","idx":1,"proposition":"Fever"},{"correct":true,"justification":"True","idx":2,"proposition":"Rectorrhages"},{"correct":true,"justification":"True, which corresponds to air in the intestinal walls observed at ASP","idx":3,"proposition":"Intestinal pneumatosis"},{"correct":true,"justification":"True","idx":4,"proposition":"Occlusive table"}],"type":"custom"}
+{"_id":"suiviMIT-infectio-2c4a94","context":null,"enonce":"Which of the following are notifiable diseases?","item":"suiviMIT","matiere":"infectio","propositions":[{"correct":true,"justification":"True, since 2018! ","idx":0,"proposition":"Rubella"},{"correct":true,"justification":"True","idx":1,"proposition":"Listeria"},{"correct":true,"justification":"True","idx":2,"proposition":"Legionellosis"},{"correct":false,"justification":"False. The updated list is available on https:\/\/www.santepubliquefrance.fr\/maladies-a-declaration-obligatoire","idx":3,"proposition":"Covid-19"},{"correct":false,"justification":"False","idx":4,"proposition":"Klebsiella endocarditis"}],"type":"custom"}
+{"_id":"IUgrossesse-infectio-2edd6a","context":null,"enonce":"What is the significant bacteriuria threshold to confirm urinary gestational colonization?","item":"IUgrossesse","matiere":"infectio","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"10^2 CFU\/ml"},{"correct":false,"justification":"False","idx":1,"proposition":"10^4 CFU\/ml"},{"correct":false,"justification":"False","idx":2,"proposition":"10^3 CFU\/ml"},{"correct":true,"justification":"True, not to be confused with bacteriuria thresholds cf table p 143 of the pilly ","idx":3,"proposition":"10^5 CFU\/ml"},{"correct":false,"justification":"False","idx":4,"proposition":"10^6 CFU\/ml"}],"type":"custom"}
+{"_id":"SPSC-sp-2f33e0","context":null,"enonce":"Which of the following proposals are needed for emergency TDPS?","item":"SPSC","matiere":"sp","propositions":[{"correct":true,"justification":"True, as with classic TDPS","idx":0,"proposition":"One-third"},{"correct":true,"justification":"True, as with all procedures except SPDRE","idx":1,"proposition":"Acceptance by the Institutional Head"},{"correct":false,"justification":"Only one since it is in emergency","idx":2,"proposition":"2 medical certificates"},{"correct":false,"justification":"at 24 hours (with a new certificate)","idx":3,"proposition":"A reassessment at 12 hours"},{"correct":false,"justification":"True for SPDRE","idx":4,"proposition":"An established disturbance of public order"}],"type":"custom"}
+{"_id":"pancreatiteaigue-HGE-2f3923","context":null,"enonce":"In.......... of cases, acute pancreatitis is mild ","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"20%"},{"correct":false,"justification":"","idx":1,"proposition":"30%"},{"correct":false,"justification":"","idx":2,"proposition":"50%"},{"correct":true,"justification":"In 70-80% of cases, pancreatitis is benign, edematous (it will heal in a few days)","idx":3,"proposition":"70%"},{"correct":false,"justification":"","idx":4,"proposition":"90%"}],"type":"custom"}
+{"_id":"sterilite-endoc-312979","context":null,"enonce":"Which of the following proposals is part of the couple's first-line infertility assessment?","item":"sterilite","matiere":"endoc","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Spermogram in men"},{"correct":false,"justification":"False. J21. Progesterone is used to analyze the presence of ovulation.","idx":1,"proposition":"Progesterone on Day 3"},{"correct":false,"justification":"False. J3. It makes it possible to analyze the ovarian reserve. It is also not systematic in first line, unless indicated: woman > 35 years, ovulation disorders, indication of treatment with ART, history of ovarian aggression and family history of early ovarian failure","idx":2,"proposition":"Estradiol and FSH on Day 21"},{"correct":false,"justification":"False. It is part of the second-line balance sheet and is not reimbursed by social security. ","idx":3,"proposition":"WHA"},{"correct":true,"justification":"True. The examination analyzes the uterus and fallopian tubes","idx":4,"proposition":"Hysterosalpingography"}],"type":"custom"}
+{"_id":"prothese-urg-3165ff","context":null,"enonce":"Which of the following are radiological signs of prosthesis infection?","item":"prothese","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Periprosthetic clear border"},{"correct":true,"justification":"True","idx":1,"proposition":"Centrifugal periosteal appositions"},{"correct":false,"justification":"Description of osteoarthritis","idx":2,"proposition":"Diffuse joint pinching with subchondral geodes"},{"correct":true,"justification":"True","idx":3,"proposition":"Poorly defined osteolysis"},{"correct":false,"justification":"","idx":4,"proposition":"Osteophytes"}],"type":"custom"}
+{"_id":"pancreatiteaigue-HGE-31a204","context":null,"enonce":"What biological sign generally reflects an obstacle in the ampulla of Vater?","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"Low bilirubin "},{"correct":false,"justification":"","idx":1,"proposition":"Elevation of ASAT"},{"correct":false,"justification":"","idx":2,"proposition":"AST decline"},{"correct":false,"justification":"","idx":3,"proposition":"ALT elevation"},{"correct":true,"justification":"\"The elevation of total bilirubin (> 40 μmol \/ L) generally reflects the blockage of a stone in the ampulla of Vater\" cf College of HGE","idx":4,"proposition":"Elevation of bilirubin "}],"type":"custom"}
+{"_id":"tbrefraction-ophtalmo-356a74","context":null,"enonce":"Which of the following is used to measure visual acuity up close?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Visual acuity from afar","idx":0,"proposition":"Monoyer"},{"correct":true,"justification":"True. Near visual acuity (33 cm)","idx":1,"proposition":"Parinaud"},{"correct":false,"justification":"Classification of the different phototypes. From 1 (clear) to 6 (tanned)","idx":2,"proposition":"Fitzpatrick"},{"correct":false,"justification":"Classification of stomach cancers","idx":3,"proposition":"Lauren"},{"correct":false,"justification":"Classification of signs of severity of anaphylaxis","idx":4,"proposition":"Ring and Mesmer"}],"type":"custom"}
+{"_id":"pancreatiteaigue-HGE-38b9c6","context":null,"enonce":"What type of kidney failure is most commonly observed?","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":true,"justification":"It is functional in 75% of cases and organic in 25% of cases, it is a pejorative prognostic factor","idx":0,"proposition":"Functional"},{"correct":false,"justification":"","idx":1,"proposition":"Organic"},{"correct":false,"justification":"","idx":2,"proposition":""},{"correct":false,"justification":"","idx":3,"proposition":""},{"correct":false,"justification":"","idx":4,"proposition":""}],"type":"custom"}
+{"_id":"SPSC-sp-3a8f5b","context":null,"enonce":"The somatic examination must take place in:","item":"SPSC","matiere":"sp","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"12 hours"},{"correct":true,"justification":"True","idx":1,"proposition":"24 hours"},{"correct":false,"justification":"False","idx":2,"proposition":"48 hours"},{"correct":false,"justification":"False","idx":3,"proposition":"72 hours"},{"correct":false,"justification":"False","idx":4,"proposition":"6 hours"}],"type":"custom"}
+{"_id":"allergie-infectio-3c2446","context":null,"enonce":"What is the prevalence of food allergy in children in France?","item":"allergie","matiere":"infectio","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"0.5 %"},{"correct":false,"justification":"False","idx":1,"proposition":"2 %"},{"correct":true,"justification":"True. In France, the prevalence of food allergy is estimated at between 5 and 7% in children.","idx":2,"proposition":"6 %"},{"correct":false,"justification":"False","idx":3,"proposition":"10 %"},{"correct":false,"justification":"False","idx":4,"proposition":"15 %"}],"type":"custom"}
+{"_id":"VIH-infectio-3c32e1","context":null,"enonce":"Which of the following are signs or symptoms of primary HIV infection?","item":"VIH","matiere":"infectio","propositions":[{"correct":true,"justification":"True, hepatic cytolysis possible","idx":0,"proposition":"Increase in AST"},{"correct":true,"justification":"True, with AEG possible","idx":1,"proposition":"Fever"},{"correct":false,"justification":"Leukopenia","idx":2,"proposition":"Leukocytosis"},{"correct":true,"justification":"True, in 70% of cases according to the College of Dermatology (2017 edition)","idx":3,"proposition":"Febrile exanthema"},{"correct":true,"justification":"Digestive signs: acute diarrhea, nausea\/vomiting, abdominal pain (non-specific, not very sensitive)","idx":4,"proposition":"Vomit"}],"type":"custom"}
+{"_id":"VH-infectio-3d7190","context":null,"enonce":"Which of the viruses that cause viral hepatitis is chronic only in immunosuppression?","item":"VH","matiere":"infectio","propositions":[{"correct":false,"justification":"NO chronic hepatitis ","idx":0,"proposition":"HAV"},{"correct":false,"justification":"Chronicity possible even without immunosuppression, in 5 to 10% in adults (caution 90% in children) ","idx":1,"proposition":"HBV"},{"correct":false,"justification":"Chronicity possible even without immunosuppression, in 75% in adults ","idx":2,"proposition":"HCV"},{"correct":false,"justification":"Possible if co-infection or superinfection with HBV","idx":3,"proposition":"VHD"},{"correct":true,"justification":"True. The virus causes chronic hepatitis only in cases of immunosuppression.","idx":4,"proposition":"HEV"}],"type":"custom"}
+{"_id":"tbrefraction-ophtalmo-3e0fb2","context":null,"enonce":"Which of the following propositions are true about the hyperopia of the child?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The image of a point located at infinity is formed behind the retina"},{"correct":true,"justification":"True","idx":1,"proposition":"The farsighted eye is too short"},{"correct":true,"justification":"True","idx":2,"proposition":"The child can compensate for the lack of refractive power of his eye by accommodation"},{"correct":false,"justification":"Concave for myopia, convex for hyperopia","idx":3,"proposition":"Corrective lenses are concave spherical lenses"},{"correct":false,"justification":"Hyperopia and astigmatism, never myopia because there is no adaptation by accommodation","idx":4,"proposition":"Accommodative asthenopia is only possible in case of myopia "}],"type":"custom"}
+{"_id":"antithrombotiques-therapeutique-405eed","context":null,"enonce":"Which of the following are true?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The common toxicity of spindle poisons is peripheral neuropathy"},{"correct":true,"justification":"True, it's not nice to see (better to put the varnish) 😫","idx":1,"proposition":"Taxanes can cause onycholysis, which can be prevented by the use of solidifying nail polish"},{"correct":false,"justification":"False. This is the case with taxanes","idx":2,"proposition":"Vinca alkaloids can cause onycholysis, which can be prevented by the use of solidifying nail polish"},{"correct":true,"justification":"True, or also podophyllotoxin","idx":3,"proposition":"Etoposide is also called VP16"},{"correct":true,"justification":"True, another name for adriamycin","idx":4,"proposition":"Doxorubicin is an anthracycline"}],"type":"custom"}
+{"_id":"herpes-infectio-42017e","context":null,"enonce":"Which of the following propositions regarding herpes virus infections are true?","item":"herpes","matiere":"infectio","propositions":[{"correct":false,"justification":"Very common, 90% of adults are HIV-positive ","idx":0,"proposition":"They are infrequent"},{"correct":true,"justification":" ","idx":1,"proposition":"Transmission can be salivary"},{"correct":false,"justification":"No, only atypical pictures or in some patients who need to document the infection ","idx":2,"proposition":"Diagnosis requires additional examinations "},{"correct":true,"justification":" ","idx":3,"proposition":"Transmission can be mucosal"},{"correct":false,"justification":"Several treatments are available, including Aciclovir, Valaciclovir...","idx":4,"proposition":"There is currently no treatment available"}],"type":"custom"}
+{"_id":"allergie-infectio-42591b","context":null,"enonce":"Which of the following are trophallergenic proteins contained in eggs?","item":"allergie","matiere":"infectio","propositions":[{"correct":false,"justification":"Cow's 🐮 milk ","idx":0,"proposition":"casein"},{"correct":false,"justification":"Cow's 🐄 milk ","idx":1,"proposition":"α-lactalbumin"},{"correct":false,"justification":"Cow's 🐄 🐮 milk ","idx":2,"proposition":"β-lactoglobulin"},{"correct":true,"justification":"True","idx":3,"proposition":"Ovalbumin"},{"correct":true,"justification":"True. Mnemonic means: the two proteins starting with 'ov' = egg 🐣 ","idx":4,"proposition":"ovomucoid"}],"type":"custom"}
+{"_id":"ascite-HGE-426acb","context":null,"enonce":"Which of the following are complications of ascites?","item":"ascite","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Umbilical hernia"},{"correct":true,"justification":"True","idx":1,"proposition":"Infection"},{"correct":true,"justification":"True","idx":2,"proposition":"Hepatorenal syndrome"},{"correct":false,"justification":"Possible etiology of ascites","idx":3,"proposition":"Hepatocellular carcinoma"},{"correct":false,"justification":"Possible etiology of ascites","idx":4,"proposition":"Primary biliary cirrhosis"}],"type":"custom"}
+{"_id":"pathoOGE-endoc-42909d","context":null,"enonce":"Which of the following are true?","item":"pathoOGE","matiere":"endoc","propositions":[{"correct":false,"justification":"False, the fact that the testicle goes up to the abdomen relieves the patient. In favor of an orchitis. Against a twist","idx":0,"proposition":"The positive Prehn sign is in favor of this diagnosis"},{"correct":true,"justification":"True","idx":1,"proposition":"The cremasterian reflex is abolished on the torsion side"},{"correct":false,"justification":"False, 6 hours after the onset of pain (time before necrosis sets in)","idx":2,"proposition":"Exploration must be done within 24 hours"},{"correct":false,"justification":"False, Surgical emergency: ultrasound should not delay management (not very sensitive and not very specific)","idx":3,"proposition":"Ultrasound is mandatory to make the diagnosis"},{"correct":true,"justification":"True","idx":4,"proposition":"The surgical approach is scrotal"}],"type":"custom"}
+{"_id":"hemangiome-dermato-4392cd","context":null,"enonce":"infantile hemangiomas: ","item":"hemangiome","matiere":"dermato","propositions":[{"correct":true,"justification":"True ","idx":0,"proposition":"pale at compression "},{"correct":false,"justification":"False, unlike malignant tumors of infants, hemangiomas are elastic and not indurated ","idx":1,"proposition":"are indurated "},{"correct":true,"justification":"True ","idx":2,"proposition":"have in the majority of cases a phase of spontaneous involution in a few years "},{"correct":false,"justification":"False, they are neither flapping or quivering on palpation, nor blowing on auscultation unlike arteriovenous malformations. ","idx":3,"proposition":"Are flapping "},{"correct":false,"justification":"False, absent at birth, unlike vascular malformations and congenital hemangiomas (Differential diagnosis)  ","idx":4,"proposition":"Present at birth"}],"type":"custom"}
+{"_id":"nutrigrossesse-endoc-43de34","context":null,"enonce":"In which case should the dosage of peri-conceptional folic acid be increased?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"correct":true,"justification":"False","idx":0,"proposition":"Obesity"},{"correct":true,"justification":"True","idx":1,"proposition":"Epilepsy"},{"correct":false,"justification":"False","idx":2,"proposition":"Celiac disease"},{"correct":true,"justification":"True, these are the three indications where 5mg\/Day of B9 is administered (instead of 0.4mg\/D)","idx":3,"proposition":"History of spina bifida"},{"correct":false,"justification":"False","idx":4,"proposition":"Severe asthma"}],"type":"custom"}
+{"_id":"dlrphysiopath-mpr-4d2988","context":null,"enonce":"Which of the following propositions are true about Paroxysmal Pain Attacks (PDAs)?","item":"dlrphysiopath","matiere":"mpr","propositions":[{"correct":true,"justification":"True. This is the definition of Portenoy, 1990. Not to be confused with poorly controlled background pain, nor with painful bouts at the end of the dose","idx":0,"proposition":"Paroxysmal Pain Attack is a transient exacerbation of pain in patients with a stable chronic pain background, well controlled by opioids."},{"correct":false,"justification":"Any chronic pain","idx":1,"proposition":"They only concern cancer pain"},{"correct":true,"justification":"True, as the name suggests","idx":2,"proposition":"They are short-lived"},{"correct":false,"justification":"Paroxysmal pain attacks (PDA) of cancer justify the use of fast-acting transmucosal morphine. ","idx":3,"proposition":"They are well supported for a morphine Per Os"},{"correct":true,"justification":"True","idx":4,"proposition":"They may be of neuropathic mechanism"}],"type":"custom"}
+{"_id":"diplopie-ophtalmo-50ad4e","context":null,"enonce":"Which of the following are true?","item":"diplopie","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"This muscle is the only oculomotor muscle to be innervated by the fourth pair of cranial nerves (trochlear nerve)","idx":0,"proposition":"The superior oblique muscle is innervated by the sixth pair of cranial nerves"},{"correct":true,"justification":"True","idx":1,"proposition":"The superior rectus muscle is innervated by the third pair of cranial nerves"},{"correct":true,"justification":"True","idx":2,"proposition":"The inferior oblique muscle is innervated by the third pair of cranial nerves"},{"correct":true,"justification":"True","idx":3,"proposition":"The superior rectus muscle is innervated by the third pair of cranial nerves"},{"correct":false,"justification":"This muscle is the only oculomotor muscle to be innervated by the sixth pair of cranial nerves (abducens nerve)","idx":4,"proposition":"The lateral rectus muscle is innervated by the third pair of cranial nerves"}],"type":"custom"}
+{"_id":"pancreatiteaigue-HGE-50e069","context":null,"enonce":"Which of these endocrine pathologies is complicated in 5 to 10% of cases by acute pancreatitis?","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"Hypothyroidism"},{"correct":false,"justification":"","idx":1,"proposition":"Pituitary adenoma"},{"correct":true,"justification":"via increased serum calcium","idx":2,"proposition":"Hyperparathyroidism"},{"correct":false,"justification":"","idx":3,"proposition":"Hypoparathyroidism"},{"correct":false,"justification":"","idx":4,"proposition":"Hyperthyroidism"}],"type":"custom"}
+{"_id":"nutrigrossesse-endoc-537b9a","context":null,"enonce":"What is the blood glucose goal at 1h post-prandial in a pregnant woman with type 2 diabetes?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"< 1.60g\/L"},{"correct":true,"justification":"True","idx":1,"proposition":"< 1.40g\/L"},{"correct":false,"justification":"Goal at 2 hours post-HGPO","idx":2,"proposition":"< 1.53g\/L"},{"correct":false,"justification":"Goal at 1h post-HGPO","idx":3,"proposition":"< 1.80g\/L"},{"correct":false,"justification":"False","idx":4,"proposition":"< 1.20g\/L"}],"type":"custom"}
+{"_id":"prothese-urg-53c866","context":null,"enonce":"What is the hip replacement dislocation rate?","item":"prothese","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"2 to 3%"},{"correct":false,"justification":"False","idx":1,"proposition":"0.2 to 0.3 %"},{"correct":false,"justification":"False","idx":2,"proposition":"12 to 13%"},{"correct":false,"justification":"False","idx":3,"proposition":"22 to 23%"},{"correct":false,"justification":"False","idx":4,"proposition":"32 to 33%"}],"type":"custom"}
+{"_id":"ascite-HGE-56e3aa","context":null,"enonce":"Which of the following are etiologies of exudative ascites?","item":"ascite","matiere":"HGE","propositions":[{"correct":false,"justification":"Rich in protein","idx":0,"proposition":"An exudate is a low-protein liquid"},{"correct":true,"justification":"True","idx":1,"proposition":"Tuberculosis"},{"correct":true,"justification":"True","idx":2,"proposition":"Pancreatitis"},{"correct":true,"justification":"True","idx":3,"proposition":"Carcinoma"},{"correct":false,"justification":"Transudate","idx":4,"proposition":"Bilharzia"}],"type":"custom"}
+{"_id":"AV--ophtalmo-5993aa","context":null,"enonce":"By what is aqueous humor secreted?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Vitreous humour"},{"correct":true,"justification":"True Secreted permanently by ciliary processes, mood \r\naqueous is discharged at the iridocorneal angle through the trabeculum into the canal \r\nof Schlemm which joins the general circulation","idx":1,"proposition":"Ciliary trials"},{"correct":false,"justification":"False","idx":2,"proposition":"Choroid"},{"correct":false,"justification":"False","idx":3,"proposition":"Sclera"},{"correct":false,"justification":"False","idx":4,"proposition":"Zonum"}],"type":"custom"}
+{"_id":"antithrombotiques-therapeutique-5c6b3a","context":null,"enonce":"Which of the following propositions, which one or which are true?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"correct":false,"justification":"False. Irreversible 😵","idx":0,"proposition":"Bleomycin causes reversible pulmonary fibrosis"},{"correct":false,"justification":"False. Dose-dependent when the total cumulative dose exceeds 280 mg","idx":1,"proposition":"Bleomycin causes nondose-dependent pulmonary fibrosis"},{"correct":true,"justification":"True","idx":2,"proposition":"A DLCO\/VA ratio < 67% contraindicates the use or continuation of bleomycin"},{"correct":true,"justification":"True, according to Wikipedia; \"Biosynthesis of bleomycin is completed by glycosylation of the aglycones.\"","idx":3,"proposition":"Bleomycin is a chemotherapy that is derived from glycopeptides"},{"correct":false,"justification":"False. Germline testicular cancer","idx":4,"proposition":"Bleomycin is particularly used in metastatic non-germinal testicular cancer"}],"type":"custom"}
+{"_id":"tbiono-nephro-5de7f7","context":null,"enonce":"What are the possible causes of hypokalemia?","item":"tbiono","matiere":"nephro","propositions":[{"correct":true,"justification":"True, like any severe undernutrition","idx":0,"proposition":"anorexia nervosa"},{"correct":false,"justification":"False, alkalosis","idx":1,"proposition":"acidosis"},{"correct":true,"justification":"True","idx":2,"proposition":"vomiting or diarrhea"},{"correct":true,"justification":"True, cortisol has a strong affinity for aldosterone receptors","idx":3,"proposition":"hypercorticism"},{"correct":false,"justification":"","idx":4,"proposition":"All the proposals are false."}],"type":"custom"}
+{"_id":"nutrigrossesse-endoc-5de9ae","context":null,"enonce":"What is the goal of fasting blood glucose in a pregnant woman with type 2 diabetes?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"> 0.60 g\/L"},{"correct":false,"justification":"False","idx":1,"proposition":"> 0.50 g\/L"},{"correct":false,"justification":"False","idx":2,"proposition":"> 0.40 g\/L"},{"correct":false,"justification":"False","idx":3,"proposition":"> 0.70 g\/L"},{"correct":false,"justification":"False","idx":4,"proposition":"> 0.80 g\/L"}],"type":"custom"}
+{"_id":"AV--ophtalmo-5eb207","context":null,"enonce":"Which of the following are treatments for early stage AMD?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Vitamin C"},{"correct":true,"justification":"True","idx":1,"proposition":"Vitamin e"},{"correct":true,"justification":"True","idx":2,"proposition":"Zinc"},{"correct":true,"justification":"True","idx":3,"proposition":"Lutein"},{"correct":false,"justification":"False","idx":4,"proposition":"Magnesium"}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-5ed67f","context":null,"enonce":"Which of the following are possible genetic causes of hearing loss?","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Possible non-genetic cause ","idx":0,"proposition":"Meningitis"},{"correct":true,"justification":"True, ligament hyperlaxity and bone fragility","idx":1,"proposition":"Glass bone disease"},{"correct":true,"justification":"True, with kidney damage","idx":2,"proposition":"Alport syndrome"},{"correct":false,"justification":"Common but non-genetic cause","idx":3,"proposition":"Serous otitis"},{"correct":true,"justification":"True, no malformation of the ossicles \/ external ear canal","idx":4,"proposition":"Down syndrome"}],"type":"custom"}
+{"_id":"diarrheeinf-infectio-5f8bdd","context":null,"enonce":"Which of the following proposals suggest hemolytic uremic syndrome (HUS) in children?","item":"diarrheeinf","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Edema"},{"correct":true,"justification":"True","idx":1,"proposition":"Purpura"},{"correct":true,"justification":"True","idx":2,"proposition":"Pallor"},{"correct":true,"justification":"True","idx":3,"proposition":"Convulsions "},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"allergie-infectio-6004e9","context":null,"enonce":"Which of the following identifies the most common perennial pneumallergen?","item":"allergie","matiere":"infectio","propositions":[{"correct":true,"justification":"True. Dermatophagoids pteronyssinus and D. farinae","idx":0,"proposition":"Mites"},{"correct":false,"justification":"False","idx":1,"proposition":"Mould"},{"correct":false,"justification":"False","idx":2,"proposition":"Cockroaches"},{"correct":false,"justification":"False","idx":3,"proposition":"Pets"},{"correct":false,"justification":"These are seasonal allergens.","idx":4,"proposition":"Grass pollen"}],"type":"custom"}
+{"_id":"Exprenuptial-gyn-60baf5","context":null,"enonce":"What is the recommended duration of contraception after each dose of chickenpox vaccine in a woman of childbearing potential?","item":"Exprenuptial","matiere":"gyn","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"1 month"},{"correct":false,"justification":"False","idx":1,"proposition":"2 months"},{"correct":true,"justification":"True","idx":2,"proposition":"Three months"},{"correct":false,"justification":"False","idx":3,"proposition":"4 months"},{"correct":false,"justification":"False. Contraception is recommended. ","idx":4,"proposition":"Contraception is not required after the chickenpox vaccine. "}],"type":"custom"}
+{"_id":"noduleTh-endoc-6538f0","context":null,"enonce":"Which of the following propositions, which one or which are true?","item":"noduleTh","matiere":"endoc","propositions":[{"correct":false,"justification":"False. This is iodine deficiency. Tobacco, on the other hand, is a factor promoting goiter because it contains thyocyanate which is goitrigen.","idx":0,"proposition":"The first factor favoring goiter is tobacco"},{"correct":false,"justification":"False. Despite the fact that it is goitrigen, it does not increase the risk of thyroid cancer.","idx":1,"proposition":"Tobacco is a risk factor for thyroid cancer"},{"correct":true,"justification":"True","idx":2,"proposition":"Thyroid follicles have receptors for estrogen"},{"correct":true,"justification":"True. Lithium acts as a synthetic antithyroid.","idx":3,"proposition":"Lithium is goitrogenic"},{"correct":false,"justification":"False. 100 to 150 μg\/day for the majority of the population, but 200 to 250 μg\/day for pregnant women.","idx":4,"proposition":"Lithium requirements are 100 to 150 μg\/day for the entire population"}],"type":"custom"}
+{"_id":"dlrabdo-HGE-65c0d1","context":null,"enonce":"Abdominal pain of the child: \r\nWhich of the following are true?","item":"dlrabdo","matiere":"HGE","propositions":[{"correct":false,"justification":"False.\r\nIn practice it is a frequent reason ++ consultation in the emergency room (more precisely they come for crying).\r\nNot much effective treatment unfortunately, it's a lot of parental reassurance explaining that it will pass.\r\nIn practice we often offer abdominal massages, and probiotics that have a certain effectiveness.","idx":0,"proposition":"Treatment of infant colic is based on antispasmodics and laxatives."},{"correct":false,"justification":"False.\r\nParacetamol can be used from birth even in premature babies of 500g :).","idx":1,"proposition":"It is contraindicated to use paracetamol to treat abdominal pain in a child under 1 month of age."},{"correct":true,"justification":"True\r\nIn practice this is very common. It remains a diagnosis of elimination so often we make the diagnosis by doing an ultrasound to eliminate appendicitis. It is often secondary to an ENT infection just like primary acute intussusception.","idx":2,"proposition":"Mesenteric adenolympitis is a common cause of abdominal pain in children 2 to 12 years of age."},{"correct":true,"justification":"True","idx":3,"proposition":"Primary acute intussusception usually occurs in a child 2 months to 2 years of age."},{"correct":false,"justification":"False\r\nOn the contrary, we look for a secondary cause in children over 2 years of age.","idx":4,"proposition":"Acute intussusception occurring in a child under 2 years of age should investigate a secondary cause"}],"type":"custom"}
+{"_id":"prothese-urg-66a425","context":null,"enonce":"Which of the following are risk factors for prosthesis infection?","item":"prothese","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Rheumatoid arthritis"},{"correct":true,"justification":"True","idx":1,"proposition":"BMI > 40"},{"correct":true,"justification":"True","idx":2,"proposition":"Postoperative hematoma"},{"correct":true,"justification":"True","idx":3,"proposition":"Type 1 diabetes"},{"correct":true,"justification":"True","idx":4,"proposition":"Type 2 diabetes"}],"type":"custom"}
+{"_id":"IRA-urg-67e644","context":null,"enonce":"Which of the following are contraindications to non-invasive ventilation?","item":"IRenA","matiere":"urg","propositions":[{"correct":true,"justification":"True, inhalation risk","idx":0,"proposition":"Uncontrollable vomiting"},{"correct":true,"justification":"True, may worsen an undrained pneumothorax","idx":1,"proposition":"Bluffing chest wound"},{"correct":false,"justification":"False, it is precisely one of the formally validated indications of NIV","idx":2,"proposition":"Acute lung oedema with respiratory distress"},{"correct":false,"justification":"False, it may be an indication of NIV. (Table evoking pneumocystosis!) ","idx":3,"proposition":"Hypoxemic acute respiratory failure of the immunocompromised"},{"correct":true,"justification":"True","idx":4,"proposition":"Respiratory exhaustion"}],"type":"custom"}
+{"_id":"tbiono-infectio-6b857c","context":null,"enonce":"Which of the following proposals are plasmodial species pathogenic to humans?","item":"tbiono","matiere":"infectio","propositions":[{"correct":true,"justification":"True, responsible for 90% of severe malaria attacks","idx":0,"proposition":"P. falciparum"},{"correct":true,"justification":"True","idx":1,"proposition":"P. vivax"},{"correct":false,"justification":"There are more than 130 different plasmodial species. Only 5 are pathogenic for humans: falciparum, knowlesi, oval, vivax, malariae ","idx":2,"proposition":"P. diploglossi"},{"correct":true,"justification":"True","idx":3,"proposition":"P. malariae"},{"correct":true,"justification":"True","idx":4,"proposition":"P. knowlesi"}],"type":"custom"}
+{"_id":"ascite-HGE-709be6","context":null,"enonce":"Which of the following are transudative ascites etiologies?","item":"ascite","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A transudate is low in protein"},{"correct":true,"justification":"True","idx":1,"proposition":"Cirrhosis"},{"correct":true,"justification":"True","idx":2,"proposition":"Nephrotic syndrome"},{"correct":false,"justification":"Exudate","idx":3,"proposition":"Carcinoma"},{"correct":false,"justification":"Exudate","idx":4,"proposition":"Heart failure"}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-7102fe","context":null,"enonce":"Which of the following are complications of cataract surgery?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True, by Irvine Gass","idx":0,"proposition":"Macular edema"},{"correct":true,"justification":"True, by retinal detachment","idx":1,"proposition":"Intravitreal hemorrhage"},{"correct":true,"justification":"True","idx":2,"proposition":"Endophtamy"},{"correct":false,"justification":"False","idx":3,"proposition":"OACR"},{"correct":false,"justification":"False","idx":4,"proposition":"AMD"}],"type":"custom"}
+{"_id":"ectoparasitose-infectio-728822","context":null,"enonce":"What is the treatment for post-treatment eczematization?","item":"ectoparasitose","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Strong dermoticorticoids"},{"correct":true,"justification":"True","idx":1,"proposition":"Emollients"},{"correct":false,"justification":"Useless","idx":2,"proposition":"Antihistamines"},{"correct":false,"justification":"It is necessary to treat","idx":3,"proposition":"Therapeutic abstention"},{"correct":false,"justification":"Alternative to Benzyl Benzoate","idx":4,"proposition":"Permetrine"}],"type":"custom"}
+{"_id":"lesionart-urg-7345a4","context":null,"enonce":"Which of the following propositions are true concerning the anterior luxaion of the humerus?","item":"lesionart","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A fall on the hand can be the cause"},{"correct":true,"justification":"True","idx":1,"proposition":"The radial nerve may be damaged"},{"correct":true,"justification":"True","idx":2,"proposition":"The axillary nerve may be damaged"},{"correct":false,"justification":"Possible damage to the nerves of the hand (via brachial plexus injury)","idx":3,"proposition":"We never find hypoaesthesia of the fingers"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"prothese-urg-751997","context":null,"enonce":"Which of the following are risk factors for prosthesis infection?","item":"prothese","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Score ASA"},{"correct":true,"justification":"True","idx":1,"proposition":"Diabetes"},{"correct":true,"justification":"True","idx":2,"proposition":"Obesity"},{"correct":true,"justification":"True","idx":3,"proposition":"Cirrhosis"},{"correct":true,"justification":"True","idx":4,"proposition":"Active smoking"}],"type":"custom"}
+{"_id":"TED-psy-765b4b","context":null,"enonce":"Which of the following are differential diagnoses of autism spectrum disorder (ASD)?","item":"TED","matiere":"psy","propositions":[{"correct":true,"justification":"Children with intellectual disabilities frequently experience symptoms of ASD (in all 2 clinical areas). A psychometric assessment makes it possible to estimate the patient's IQ and to identify an intellectual disability and its level of severity.","idx":0,"proposition":"Intellectual disability"},{"correct":true,"justification":"The realization of an audiogram or auditory evoked potentials make it possible to eliminate this differential diagnosis","idx":1,"proposition":"Hearing loss and deafness"},{"correct":true,"justification":"Children have difficulties with verbal communication, but the difference with ASD is that children are able to compensate for this deficiency through non-verbal communication and maintained relational skills.","idx":2,"proposition":"Language acquisition disorders"},{"correct":true,"justification":"Patients with ADHD frequently have difficulties in social interactions (mainly related to symptoms of hyperactivity and impulsivity) but no deficit in social or emotional reciprocity, nor in steteotyped or restricted behaviors.","idx":3,"proposition":"ADHD"},{"correct":true,"justification":"Patients with schizophrenia frequently have difficulty in social interactions.","idx":4,"proposition":"Early onset schizophrenia"}],"type":"custom"}
+{"_id":"vaccin-infectio-76fb22","context":null,"enonce":"Which of the following are vaccines already delivered at 3 months of age?","item":"vaccin","matiere":"infectio","propositions":[{"correct":false,"justification":"M5 and M12","idx":0,"proposition":"meningococcal C vaccine"},{"correct":true,"justification":"True, M2 M4 M9","idx":1,"proposition":"dTP vaccine"},{"correct":false,"justification":"M12 and M16-18","idx":2,"proposition":"MMR vaccine"},{"correct":true,"justification":"True","idx":3,"proposition":"pneumococcal vaccine"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"hyperCa-nephro-774b23","context":null,"enonce":"Which of the following are true?","item":"hyperCa","matiere":"nephro","propositions":[{"correct":true,"justification":"True, acute (emergency) and chronic hypercalcemia ","idx":0,"proposition":"There are 2 main semiological tables of hypercalcemia that are quite distinct and do not involve the same management "},{"correct":false,"justification":"The reference is ionized calcium (active calcium), which is difficult to access. We can still rely on corrected plasma calcium ","idx":1,"proposition":"The reference measure of calcium is plasma calcium"},{"correct":true,"justification":"","idx":2,"proposition":"Acute hypercalcemia crisis is defined as a serum calcium threshold > 3.5 mmol\/L "},{"correct":false,"justification":"QT shortening","idx":3,"proposition":"The repercussions of hypercalcemia on the ECG include QT prolongation, early T waves, tachycardia, BAV. "},{"correct":true,"justification":"","idx":4,"proposition":"In hypercalcemia there is a tendency to extracellular dehydration "}],"type":"custom"}
+{"_id":"AV--ophtalmo-795ee4","context":null,"enonce":"Which of the following are the causes of macular pathologies?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Alcohol"},{"correct":true,"justification":"True","idx":1,"proposition":"Chloroquine"},{"correct":true,"justification":"True","idx":2,"proposition":"Diabetes"},{"correct":false,"justification":"Rather the periphery of the retina","idx":3,"proposition":"Retinopathy pigmentosa"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"AV--ophtalmo-7ae467","context":null,"enonce":"Which of the following are treatments for early stage AMD?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Vitamin e"},{"correct":true,"justification":"True","idx":1,"proposition":"Vitamin C"},{"correct":false,"justification":"False","idx":2,"proposition":"Vitamin A"},{"correct":false,"justification":"False","idx":3,"proposition":"Thiamine"},{"correct":false,"justification":"False","idx":4,"proposition":"Vitamin B9"}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-7dc032","context":null,"enonce":"Which of the following are causes of intravitreal hemorrhage?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Retinal tear "},{"correct":true,"justification":"True","idx":1,"proposition":"Retinal detachment"},{"correct":true,"justification":"True","idx":2,"proposition":"Proliferative diabetic retinopathy "},{"correct":false,"justification":"No neovessels = no bleeding","idx":3,"proposition":"OACR"},{"correct":false,"justification":"No neovessels = no bleeding","idx":4,"proposition":"CAM"}],"type":"custom"}
+{"_id":"nutriped-nutri-7f3ddf","context":null,"enonce":"When should diversification be introduced?","item":"nutriped","matiere":"nutri","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Between 4 and 6 months"},{"correct":false,"justification":"False","idx":1,"proposition":"Between 2 and 6 months"},{"correct":false,"justification":"False","idx":2,"proposition":"Between 8 and 10 months"},{"correct":false,"justification":"False","idx":3,"proposition":"Between 6 and 8 months"},{"correct":false,"justification":"False","idx":4,"proposition":"From 6 weeks"}],"type":"custom"}
+{"_id":"polytrauma-urg-7fe04e","context":null,"enonce":"Which of the following proposals regarding the pre-hospital management of a polytrauma patient are true?","item":"polytrauma","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A tension pneumothorax must be exuffled"},{"correct":false,"justification":"False, it is necessary to put 2 VVP of good caliber <16G","idx":1,"proposition":"Only one PVV must be installed"},{"correct":true,"justification":"True, the indications for intubation in the context of a polytrauma are among others a Glasgow ≤8, respiratory or hemodynamic distress","idx":2,"proposition":"If the patient requires mechanical ventilation, rapid sequence orotracheal intubation should be performed"},{"correct":false,"justification":"False, by noradrenaline","idx":3,"proposition":"Vasopressor therapy with dobutamine should be introduced if hypotension persists despite adequate filling"},{"correct":false,"justification":"False, the reduction of fracture foci is the first step in analgesic treatment of these and prevents fat embolism. They must also be immobilized afterwards to prevent secondary displacement that may be the cause of vascular and\/or nerve damage.","idx":4,"proposition":"In case of fractures, they should not be reduced in pre-hospital"}],"type":"custom"}
+{"_id":"noduleTh-endoc-8009df","context":null,"enonce":"Regarding the epidemiology of goiter. Which of the following propositions, which one or which are true?","item":"noduleTh","matiere":"endoc","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"10% of the population has a goiter"},{"correct":false,"justification":"False. 3 women for 1 man.","idx":1,"proposition":"The sex ratio of goiter is 5 women to 1 man"},{"correct":true,"justification":"True","idx":2,"proposition":"The sex ratio of goiter is 3 women to 1 man"},{"correct":false,"justification":"False. Prevalence increases with age.","idx":3,"proposition":"Prevalence decreases with age as there is a decline in TSH synthesis"},{"correct":false,"justification":"False. 10%","idx":4,"proposition":"1% of the population has a goiter"}],"type":"custom"}
+{"_id":"AV--ophtalmo-80d213","context":null,"enonce":"Which of the following are part of the posterior segment?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Sclera"},{"correct":true,"justification":"True","idx":1,"proposition":"Choroid"},{"correct":true,"justification":"True","idx":2,"proposition":"Retina"},{"correct":true,"justification":"True","idx":3,"proposition":"Vitreous humour"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"anesth-anesth-82c007","context":null,"enonce":"Regarding pre-oxygenation before general anesthesia out of emergency. Which of the following are true?","item":"anesth","matiere":"anesth","propositions":[{"correct":false,"justification":"False. At least 3 minutes of pre-oxygenation. The goal is to achieve a FeO2 ≥ 90%. ","idx":0,"proposition":"The patient is preoxygenated for at least 2 minutes"},{"correct":false,"justification":"False. 90%. This testifies to the almost complete denitrogenation of the lung (= replacement of nitrogen by O2)","idx":1,"proposition":""},{"correct":true,"justification":"True. It is the act of replacing nitrogen with O2. ","idx":2,"proposition":"The goal of pre-oxygenation is to achieve almost complete \"denitrogenation\" of the lung "},{"correct":true,"justification":"True","idx":3,"proposition":"100% FiO2 should be administered during pre-oxygenation"},{"correct":true,"justification":"True. This limits the risk of hypoxemia.","idx":4,"proposition":"The purpose of pre-oxygenation is to saturate the body's oxygen reserves, including the functional residual capacity of the lung, in order to ensure the longest possible safety apnea in case of difficulty accessing the airways during intubation"}],"type":"custom"}
+{"_id":"oreillons-infectio-853412","context":null,"enonce":"Which of the following are true for the treatment of mumps parotitis?","item":"oreillons","matiere":"infectio","propositions":[{"correct":false,"justification":"Treatment is symptomatic","idx":0,"proposition":"Amoxicillin - Clavulanic acid for 7 days"},{"correct":false,"justification":"Treatment is symptomatic","idx":1,"proposition":"Fluoroquinolones for 5 days"},{"correct":false,"justification":"Treatment is symptomatic","idx":2,"proposition":"3rd Generation cephalosporin alone for 10 days"},{"correct":false,"justification":"Treatment is symptomatic","idx":3,"proposition":"3rd Generation cephalosporin for 10 days plus Amikacin in single dose"},{"correct":true,"justification":"True, and especially primary prevention through MMR vaccination! ","idx":4,"proposition":"Only symptomatic"}],"type":"custom"}
+{"_id":"diplopie-ophtalmo-88e749","context":null,"enonce":"Which of the following are true for trochlear IV nerve palsy?","item":"diplopie","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True, all pitit pitit","idx":0,"proposition":"The trochlear IV nerve is the smallest of the cranial nerves"},{"correct":true,"justification":"True","idx":1,"proposition":"Diplopia is vertical"},{"correct":true,"justification":"True, the healthy eye can go, the affected eye can not","idx":2,"proposition":"Diplopia is maximum at the bottom and inside"},{"correct":false,"justification":"It is very embarrassing: climbing stairs, reading, ...","idx":3,"proposition":"Diplopia is very untroublesome"},{"correct":false,"justification":"The chin is lowered, the head is tilted to the healthy side","idx":4,"proposition":"The compensatory position includes a raised chin"}],"type":"custom"}
+{"_id":"ProtU-nephro-8c7f5b","context":null,"enonce":"Which of the following are true?","item":"ProtU","matiere":"nephro","propositions":[{"correct":true,"justification":"True, in nephrotic syndrome there is secondary hyperlipidemia to compensate for the loss of osmole.","idx":0,"proposition":"proteinuria can cause high cholesterol"},{"correct":false,"justification":"False, proteinuria of small proteins is physiological in small amounts","idx":1,"proposition":"Proteinuria is necessarily pathological"},{"correct":true,"justification":"True, if proteinuria is suspected at orthostatism, especially in 12-16 year olds, proteinuria should be measured after 2 hours of clinostatism.","idx":2,"proposition":"Proteinuria can be promoted by infection, fever or orthostatism, etc."},{"correct":true,"justification":"True, urinary protein electrophoresis will determine the content of urinated proteins: mostly albumin or mostly low molecular weight proteins","idx":3,"proposition":"To analyze the content of proteinuria an electrophoresis of urinary proteins is performed"},{"correct":false,"justification":"","idx":4,"proposition":""}],"type":"custom"}
+{"_id":"tbrefraction-ophtalmo-8f25a3","context":null,"enonce":"Which of the following proposals can cause eye strain?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Astigmatism"},{"correct":true,"justification":"True","idx":1,"proposition":"Farsightedness"},{"correct":true,"justification":"True","idx":2,"proposition":"Myopia"},{"correct":false,"justification":"Not an ametropia","idx":3,"proposition":"AMD"},{"correct":false,"justification":"Not an ametropia","idx":4,"proposition":"Glaucoma"}],"type":"custom"}
+{"_id":"ascite-HGE-8fabb3","context":null,"enonce":"Where is ascites?","item":"ascite","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"In the peritoneum"},{"correct":false,"justification":"","idx":1,"proposition":"In the liver"},{"correct":false,"justification":"","idx":2,"proposition":"In the pleura"},{"correct":false,"justification":"","idx":3,"proposition":"In the pericardium"},{"correct":false,"justification":"","idx":4,"proposition":"In the gallbladder"}],"type":"custom"}
+{"_id":"Kcos-onco-953727","context":null,"enonce":"Which of the following proposals are suggestive of a malignant lesion on imagery?","item":"Kcos","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Cortical rupture"},{"correct":true,"justification":"True","idx":1,"proposition":"Periosteal appositions"},{"correct":true,"justification":"True","idx":2,"proposition":"Invasion of soft parts"},{"correct":false,"justification":"Fuzzy boundaries","idx":3,"proposition":"Net limits"},{"correct":true,"justification":"True, these are spiculated multilamellar periosteal appositions","idx":4,"proposition":"Herb fire"}],"type":"custom"}
+{"_id":"diarrheeaigue-HGE-98ec63","context":null,"enonce":"With regard to acute diarrhoea in children, what are the right proposals?","item":"diarrheeaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"False, rotavirus viral diarrhea is the most common but vaccination is not part of the schedule (nb: withdrawn for increased risk of intussusception)","idx":0,"proposition":"The most common etiology is rotavirus, which is subject to mandatory vaccination in children under 6 months of age."},{"correct":true,"justification":"True, however it must be remembered that it is contraindicated for children under 2 years of age and contraindicated in general for bloody invasive diarrhea or with high fever","idx":1,"proposition":"Loperamide is a transit retarder"},{"correct":true,"justification":"True, it is necessary to evaluate the child to estimate his degree of dehydration.","idx":2,"proposition":"Symptomatic treatment is mainly aimed at dehydration"},{"correct":false,"justification":"False, there must be liquid stools several times a day (>3\/d in general).","idx":3,"proposition":"Diarrhea is defined by the occurrence of watery stool"},{"correct":false,"justification":"","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"nutrigrossesse-endoc-9930c3","context":null,"enonce":"Which of the following are true?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Insulin resistance during pregnancy is a physiological phenomenon "},{"correct":true,"justification":"True","idx":1,"proposition":"The prevalence of prior diabetes associated with pregnancy is <5%"},{"correct":false,"justification":"Classically in the second half of pregnancy","idx":2,"proposition":"Gestational diabetes typically appears from implantation"},{"correct":false,"justification":"Macrosomia","idx":3,"proposition":"The main risk of gestational diabetes is intrauterine growth restriction (IUGR)"},{"correct":false,"justification":"On risk factor: age >= 35 years, family history of diabetes, history of gestational diabetes, history of macrosome children, BMI >= 25 kg\/m2 ","idx":4,"proposition":"Screening for gestational diabetes is routine"}],"type":"custom"}
+{"_id":"PF-neuro-99f1f6","context":null,"enonce":"Which of the following are true?","item":"PF","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The facial nerve emerges from the bulboprotuberantial sulcus to the medial part of the lateral dimple of the medulla elongata"},{"correct":false,"justification":"They penetrate the rock at the level of the internal acoustic meatus","idx":1,"proposition":"The motor fibers of the facial nerve circulate in the pontocerebellar angle and penetrate the rock at the level of the middle acoustic meatus"},{"correct":false,"justification":"Vestibulocochlear nerve VIII","idx":2,"proposition":"They accompany the VI nerve abducens in the rock"},{"correct":true,"justification":"True, also called facial canal","idx":3,"proposition":"In the rock, the facial nerve is contained in the Fallop canal"},{"correct":false,"justification":"It comes out at the level of the stylomastoid foramen. The foramen ovale of the base of the skull (because the interatrial communication of the fetus is also called foramen ovale, be careful not to confuse) allows the mandibular nerve (branch 3 of the trigeminal nerve), the small fearful nerve (branch of the glossopharyngeal nerve IX) and the accesory meningeal artery to pass through. ","idx":4,"proposition":"The facial nerve exits the rock at the foramen ovale"}],"type":"custom"}
+{"_id":"SPSC-sp-99fdb2","context":null,"enonce":"How long are the initial medical certificates (C0) valid?","item":"SPSC","matiere":"sp","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"24 hours"},{"correct":false,"justification":"False","idx":1,"proposition":"5 days"},{"correct":true,"justification":"True, medical certificates for TDPS, SSPI and SPDRE must be less than 15 days old","idx":2,"proposition":"15 days"},{"correct":false,"justification":"False","idx":3,"proposition":"31 days"},{"correct":false,"justification":"False","idx":4,"proposition":"6 months"}],"type":"custom"}
+{"_id":"diabete-endoc-9a58fe","context":null,"enonce":"Regarding diabetic ketoacidosis, what are the true proposals?","item":"diabete","matiere":"endoc","propositions":[{"correct":true,"justification":"True, abdominal pain, nausea and vomiting are typical of ketoacidosis. Fever can be explained by an infection that would be the trigger for ketoacidosis.","idx":0,"proposition":"It can manifest as febrile abdominal pain"},{"correct":false,"justification":"False, it is first necessary to rehydrate because prolonged hyperglycemia and osmotic polyuria dehydrate. It will be rehydrated with NaCl then NaCl + Glucose to avoid hypoglycemia of insulin. Do not forget also potassium supplementation after checking hypokalemia due to renal leakage of potassium but also insulin therapy","idx":1,"proposition":"Treatment is simply the administration of rapid-acting insulin, as this is an insulin deficiency."},{"correct":true,"justification":"True, it is necessary to do an ECG, check the renal function with the ionogram ","idx":2,"proposition":"Possible complications of ketoacidosis are hypokalemia, renal failure but also cerebral edema"},{"correct":true,"justification":"True, note among others (for the rest of the \"others\" cf College) that arterial blood gas is not necessary","idx":3,"proposition":"The diagnosis is confirmed by a combination of hyperglycemia >2.5 g \/ L, venous pH <7.3 or bicarbonate <18mM and ketone >3mM or ketonuria of +++"},{"correct":true,"justification":"True","idx":4,"proposition":"The care is hospitable"}],"type":"custom"}
+{"_id":"palu-infectio-9f3120","context":null,"enonce":"Which of the following are true?","item":"palu","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"  Any suspicion of malaria is a diagnostic and therapeutic emergency"},{"correct":false,"justification":"The HCSP publishes annual health recommendations for travellers for health professionals   ","idx":1,"proposition":"Public Health France publishes annual health recommendations for travellers for health professionals   "},{"correct":true,"justification":"True","idx":2,"proposition":"  Artesunate IV is the standard treatment for severe malaria, with quinine used only if artesunate is not immediately available"},{"correct":false,"justification":"The anophele is a mosquito does not make noise and its bite is painless","idx":3,"proposition":"The anophele is a mosquito that does not make noise and whose bite is very painful"},{"correct":false,"justification":" P. Falciparum is the plasmodial species responsible for severe forms of malaria. P. Knowlesi can give exceptionally. ","idx":4,"proposition":" P. Malariae is the plasmodial species responsible for severe forms of malaria"}],"type":"custom"}
+{"_id":"AV--ophtalmo-9fcebb","context":null,"enonce":"Which of the following are possible causes of cataracts?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Long-term corticosteroids"},{"correct":true,"justification":"True","idx":1,"proposition":"Type 2 diabetes"},{"correct":false,"justification":"Hypoparathyroidism","idx":2,"proposition":"Hyperparathyroidism"},{"correct":false,"justification":"Radiation therapy of the facial mass","idx":3,"proposition":"Abdominal radiation therapy"},{"correct":false,"justification":"Chronic uveitis","idx":4,"proposition":"Keratitis"}],"type":"custom"}
+{"_id":"lesionart-urg-a046b7","context":null,"enonce":"Which of the following are Ottawa criteria?","item":"lesionart","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Age < 18"},{"correct":false,"justification":"Age > 55","idx":1,"proposition":"Age > 45"},{"correct":true,"justification":"True","idx":2,"proposition":"Normal walking impossible"},{"correct":true,"justification":"True","idx":3,"proposition":"Pain on palpation of the internal malleolus over 6 cm"},{"correct":true,"justification":"True","idx":4,"proposition":"Pain on palpation of the medial malleolus over 6 cm"}],"type":"custom"}
+{"_id":"algiespelviennes-gyn-a3beb6","context":null,"enonce":"What is the first-line paraclinical examination to diagnose endometriosis?","item":"algiespelviennes","matiere":"gyn","propositions":[{"correct":false,"justification":"False. 2nd Intention Exam","idx":0,"proposition":"Abdominal-pelvic MRI"},{"correct":false,"justification":"False. 3rd intention exam. This is the gold standard for diagnosis because histological samples can be taken ","idx":1,"proposition":"Diagnostic laparoscopy"},{"correct":true,"justification":"True. This is the first-line paraclinical examination recommended by the CNGOF","idx":2,"proposition":"Pelvic ultrasound"},{"correct":false,"justification":"False. It is not a paraclinical examination. On the other hand, it is a crucial examination for the diagnosis ","idx":3,"proposition":"Vaginal touch"},{"correct":false,"justification":"False. It is not a paraclinical examination. On the other hand, it is a crucial examination for the diagnosis ","idx":4,"proposition":"Speculum examination"}],"type":"custom"}
+{"_id":"infdermato-dermato-a46387","context":null,"enonce":"At what size is a canker sore << giant >>? (College of FJA, page 295)","item":"infdermato","matiere":"dermato","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"5 mm"},{"correct":true,"justification":"True","idx":1,"proposition":"10 mm"},{"correct":false,"justification":"False","idx":2,"proposition":"15 mm"},{"correct":false,"justification":"False","idx":3,"proposition":"20 mm"},{"correct":false,"justification":"False","idx":4,"proposition":"25 mm"}],"type":"custom"}
+{"_id":"diabete-endoc-a63a53","context":null,"enonce":"Regarding the treatment of type 1 diabetes, what are the right proposals?","item":"diabete","matiere":"endoc","propositions":[{"correct":true,"justification":"True, optimizing glycemic control tends to make lean mass gain weight. (This side effect is no longer mentioned in the new 2019 edition)","idx":0,"proposition":"Weight gain is one of the side effects of insulin"},{"correct":false,"justification":"False, it is necessary to maintain aerobic physical activities despite the risk of hypoglycemia","idx":1,"proposition":"In addition to insulin, aerobic physical activities that promote hypoglycemia should be avoided"},{"correct":false,"justification":"False, it is rather capillary blood glucose, 3 to 4 times a day, mainly before meals but also upon waking, bedtime, before and after physical activities (College of Endoc + Pediatrics)","idx":2,"proposition":"Self-monitoring relies mainly on venous blood glucose "},{"correct":true,"justification":"True, strengthen glycemic monitoring but also do a dosage of ketonuria or ketonemia if prolonged hyperglycemia, abdominal signs or during pregnancy","idx":3,"proposition":"Blood glucose monitoring should be strengthened in case of intercurrent events such as infections, surgery, stress etc."},{"correct":true,"justification":"True","idx":4,"proposition":"Treatment is for life"}],"type":"custom"}
+{"_id":"anesth-anesth-a7b305","context":null,"enonce":"Which of the following are true?","item":"anesth","matiere":"anesth","propositions":[{"correct":false,"justification":"False. There are 3 parts to the checklist. - Patient identity verification - Type of intervention - Patient's side ","idx":0,"proposition":"The course of anesthesia depends on a checklist of the HAS which includes 4 parts"},{"correct":false,"justification":"False. These drugs may be administered, but first a hypnotic must be used, then an analgesic and then a curare to facilitate orotracheal intubation.","idx":1,"proposition":"During the induction phase, 3 classes of drugs can be administered: first a curare, then a hypnotic, then an analgesic"},{"correct":false,"justification":"False. An opioid analgesic should be added to reduce pain through endotracheal intubation and the surgical or interventional procedure. Opioids control the neurovegetative response of pain-induced stress (tachycardia, hypertension, vagal shock) that may exist in an artificially sleeping patient. ","idx":2,"proposition":"There is no need to administer opioid analgesia during general anesthesia because the patient is unconscious and does not feel pain."},{"correct":true,"justification":"True","idx":3,"proposition":"During the induction phase, 3 drug classes can be used: hypnotics, opioid analgesics and curare."},{"correct":true,"justification":"True. It is an IV hypnotic antagonist of glutamate NMDA receptors (unlike other hypnotics which are rather GABA A agonists)","idx":4,"proposition":"Ketamine is a hypnotic"}],"type":"custom"}
+{"_id":"antiinf-infectio-a801fa","context":null,"enonce":"What is the treatment of choice for a methicillin-resistant Staphylococcus aureus?","item":"antiinf","matiere":"infectio","propositions":[{"correct":true,"justification":"True, no enteral absorption  \r\n(= always by way \r\nparenteral except treatment \r\n, C. difficile colitis). Bactericide. Dependent time activity. FYI, the only beta-lactamine acting on SARMs is ceftaroline.","idx":0,"proposition":"Vancomycin"},{"correct":false,"justification":"Resistance to all beta-lactam (except ceftaroline)","idx":1,"proposition":"Cefotaxime"},{"correct":false,"justification":"Resistance to all beta-lactam (except ceftaroline)","idx":2,"proposition":"Oxacillin"},{"correct":false,"justification":"Resistance to all beta-lactam (except ceftaroline)","idx":3,"proposition":"C36 - aminoglycosides"},{"correct":false,"justification":"No, the reference is vancomycin. SARMs are frequently resistant to fluoroquinolones. ","idx":4,"proposition":"Levofloxacin"}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-aafd33","context":null,"enonce":"By what is the anterior chamber, forward, delimited?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True. The aqueous humor fills the anterior chamber, bounded by \r\nthe cornea in front and the iris in the back","idx":0,"proposition":"Cornea"},{"correct":false,"justification":"Iris back","idx":1,"proposition":"Iris"},{"correct":false,"justification":"In the anterior chamber but does not delimit it","idx":2,"proposition":"Vitreous humour"},{"correct":false,"justification":"False","idx":3,"proposition":"Sclera"},{"correct":false,"justification":"False","idx":4,"proposition":"Ora Serrata"}],"type":"custom"}
+{"_id":"ectoparasitose-infectio-ac2821","context":null,"enonce":"What is the treatment of human scabies?","item":"ectoparasitose","matiere":"infectio","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Oral corticosteroid 14 days"},{"correct":false,"justification":"False","idx":1,"proposition":"Dermocorticoids 21 days"},{"correct":true,"justification":"True","idx":2,"proposition":"Ivermectin taken once, twice, 7 days apart"},{"correct":false,"justification":"Twice because is not active on eggs ","idx":3,"proposition":"Ivermectin as a single dose once"},{"correct":true,"justification":"True, body brushing, leave to act for 24 hours. To be carried out a second time at 2 or 7 days interval. ","idx":4,"proposition":"Benzyl benzoate"}],"type":"custom"}
+{"_id":"antiinf-infectio-ae310c","context":null,"enonce":"What is the treatment of choice for a methicillin-sensitive Staphylococcus aureus?","item":"antiinf","matiere":"infectio","propositions":[{"correct":false,"justification":"Poor oral bioavailability (oxacillin, 40%; cloxacillin, \r\n70%), saturable digestive absorption. Became obsolete in France!! ","idx":0,"proposition":"oxacillin orally"},{"correct":true,"justification":"True, it is the smallest 👌 spectrum And the one that acts the fastest. Important in severe situations, e.g. endocarditis! ","idx":1,"proposition":"oxacillin IV"},{"correct":false,"justification":"All these antibiotics have SAMS in their spectrum, but oxacillin IV has the smallest spectrum and is therefore indicated as a first-line treatment. The possible alternative is cefazolin (C1G).","idx":2,"proposition":"Vancomycin "},{"correct":false,"justification":"Spectrum too broad","idx":3,"proposition":"amoxicillin-clavulanic acid"},{"correct":false,"justification":"Works but is not the ATB of choice. Can be used in relay of oxa IV in combination with another PO antibiotic. ","idx":4,"proposition":"fluoroquinolone"}],"type":"custom"}
+{"_id":"nvxne-gyn-ae543c","context":null,"enonce":"Which of the following are risk factors for poor adaptation to ectopic life?","item":"nvxne","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Caesarean section"},{"correct":true,"justification":"True","idx":1,"proposition":"Plunger"},{"correct":true,"justification":"True","idx":2,"proposition":"Forceps"},{"correct":true,"justification":"True","idx":3,"proposition":"Maternal anasarcus"},{"correct":true,"justification":"True","idx":4,"proposition":"Very fast work"}],"type":"custom"}
+{"_id":"pancreatiteaigue-HGE-b0a7a8","context":null,"enonce":"What is the overall mortality rate from acute pancreatitis?","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"1%"},{"correct":true,"justification":"Overall mortality rate, it can reach 20% for the necrotizing form","idx":1,"proposition":"5%"},{"correct":false,"justification":"","idx":2,"proposition":"10%"},{"correct":false,"justification":"","idx":3,"proposition":"20%"},{"correct":false,"justification":"","idx":4,"proposition":"30%"}],"type":"custom"}
+{"_id":"pancreatiteaigue-HGE-b0f705","context":null,"enonce":"True or False: In acute pancreatitis, there is a linear correlation between the rate of lipasemia and the severity of pancreatitis","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"True"},{"correct":false,"justification":"There is no correlation between the rate of lipasemia and the severity of pancreatitis.","idx":1,"proposition":"False"},{"correct":false,"justification":"","idx":2,"proposition":""},{"correct":false,"justification":"","idx":3,"proposition":""},{"correct":false,"justification":"","idx":4,"proposition":""}],"type":"custom"}
+{"_id":"sterilite-endoc-b1187a","context":null,"enonce":"Regarding the epidemiology of infertility. Which of the following propositions, which one or which are true?","item":"sterilite","matiere":"endoc","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"40% of infertility is mixed"},{"correct":true,"justification":"True. 20% male alone, 40% mixed cause. ","idx":1,"proposition":"At least 50% of infertility has a male origin"},{"correct":true,"justification":"True","idx":2,"proposition":"20% of infertility is purely female"},{"correct":false,"justification":"False. 5% of couples are infertile","idx":3,"proposition":"5% of couples are infertile"},{"correct":true,"justification":"True. 1\/5 in the College of Gynecology, 1\/7 in the College of Endocrinology","idx":4,"proposition":"1 in 5 to 7 couples are infertile"}],"type":"custom"}
+{"_id":"nvxne-gyn-b1af50","context":null,"enonce":"Which of the following are true for congenital adrenal hyperplasia?","item":"nvxne","matiere":"gyn","propositions":[{"correct":false,"justification":"72h of life, up to 5d of life","idx":0,"proposition":"She is screened at 48 hours of life by the Guthrie test"},{"correct":true,"justification":"True","idx":1,"proposition":"The main deficient enzyme is 21-hydroxylase "},{"correct":true,"justification":"True","idx":2,"proposition":"It is autosomal recessive"},{"correct":true,"justification":"True, which causes adrenal hyperplasia","idx":3,"proposition":"Increased secretion of pituitary ACTH is observed"},{"correct":false,"justification":"50 births per year in France. It is very rare. Reminder: the threshold of rare disease is 1\/2000","idx":4,"proposition":"The incidence is 1\/1500"}],"type":"custom"}
+{"_id":"pancreatiteaigue-HGE-b207b8","context":null,"enonce":"What CRP threshold directs to severe pancreatitis?","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"CRP >15 mg\/L"},{"correct":false,"justification":"","idx":1,"proposition":"CRP >50 mg\/L"},{"correct":true,"justification":"True","idx":2,"proposition":"CRP >150 mg\/L"},{"correct":false,"justification":"","idx":3,"proposition":"CRP >150 g\/L"},{"correct":false,"justification":"","idx":4,"proposition":"CRP >300 mg\/L"}],"type":"custom"}
+{"_id":"diarrheeinf-infectio-b25903","context":null,"enonce":"Which of the following proposals is\/are germ(s) with a secretory mechanism?","item":"diarrheeinf","matiere":"infectio","propositions":[{"correct":false,"justification":"False it has an entero-invasive mechanism, it is E. coli enteroaggregative and E. coli enterotoxigenic which have a secretory mechanism. They are at the origin of TIAC and traveler's diarrhea, turista! ","idx":0,"proposition":"Enteropathogenic E. coli"},{"correct":false,"justification":"Enteroinvasive mechanism","idx":1,"proposition":"Shigella"},{"correct":false,"justification":"Enteroinvasive mechanism","idx":2,"proposition":"Yersinia"},{"correct":false,"justification":"Enteroinvasive mechanism","idx":3,"proposition":"Salmonella"},{"correct":true,"justification":"True, especially aureus which is a toxi infection. Secretory ➡ mechanism fluid diarrhea without fever","idx":4,"proposition":"Sstaphylococcus"}],"type":"custom"}
+{"_id":"infdermato-dermato-b51a3a","context":null,"enonce":"Which of the following are true about Candida albicans infections?","item":"infdermato","matiere":"dermato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Candida are mushrooms 🍄 "},{"correct":true,"justification":"True","idx":1,"proposition":"Candida belong to yeasts"},{"correct":false,"justification":"Unicellular","idx":2,"proposition":"Candida are multicellular"},{"correct":true,"justification":"True","idx":3,"proposition":"Candida albicans is never found on healthy skin"},{"correct":true,"justification":"True","idx":4,"proposition":"Candida may cause sepsis in immunocompromised patients"}],"type":"custom"}
+{"_id":"AV--ophtalmo-b54787","context":null,"enonce":"Which of the following proposals are validated for the treatment of early forms of AMD? (AREDS-2 study, 2013)","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True, with zeaxantin, lutein, vitamin E and C","idx":0,"proposition":"Zinc"},{"correct":false,"justification":"Vitamin E and C","idx":1,"proposition":"Vitamin A"},{"correct":true,"justification":"True","idx":2,"proposition":"Lutein"},{"correct":false,"justification":"No studies showed a difference in outcome versus placebo","idx":3,"proposition":"Homeopathy"},{"correct":false,"justification":"No reduction in risk of progression","idx":4,"proposition":"Omega-3"}],"type":"custom"}
+{"_id":"pancreatiteaigue-HGE-b87b8b","context":null,"enonce":"Renal failure is observed in ....... of cases ","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"5%"},{"correct":false,"justification":"","idx":1,"proposition":"10%"},{"correct":true,"justification":"Renal failure is observed in about 20% of cases, it is a pejorative prognostic factor","idx":2,"proposition":"20%"},{"correct":false,"justification":"","idx":3,"proposition":"50%"},{"correct":false,"justification":"","idx":4,"proposition":"80%"}],"type":"custom"}
+{"_id":"vaccin-infectio-b8d2b1","context":null,"enonce":"At what ages is the dTP vaccine injected?","item":"vaccin","matiere":"infectio","propositions":[{"correct":false,"justification":"No vaccine at birth","idx":0,"proposition":"Birth"},{"correct":true,"justification":"True. 1st dose","idx":1,"proposition":"2 months"},{"correct":true,"justification":"True. 2nd dose","idx":2,"proposition":"4 months"},{"correct":true,"justification":"True. Reminder","idx":3,"proposition":"11 months"},{"correct":false,"justification":"No vaccine is recommended at 6 months (5 months = Meningococcal C)","idx":4,"proposition":"6 months"}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-b93097","context":null,"enonce":"Which of the following are causes of brutal white eye and painless BAV?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Red and painful eye","idx":0,"proposition":"Acute anterior uveitis"},{"correct":true,"justification":"True, attention MS. NORB is painless in 20% of cases.","idx":1,"proposition":"Retrobulbar optic neuritis (NORB) in 20% of cases"},{"correct":false,"justification":"Red and painful eye (on intraocular hypertension)","idx":2,"proposition":"Neovascular glaucoma"},{"correct":true,"justification":"True","idx":3,"proposition":"Retinal detachment"},{"correct":true,"justification":"True","idx":4,"proposition":"Acute anterior ischemic optic neuropathy (AIO-A)"}],"type":"custom"}
+{"_id":"AV--ophtalmo-bc2834","context":null,"enonce":"Which of the following are cataract etiologies?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Strong myopia","idx":0,"proposition":"Strong hyperopia"},{"correct":true,"justification":"True, especially posterior uveitis requiring prolonged corticosteroid therapy","idx":1,"proposition":"Chronic uveitis"},{"correct":true,"justification":"True","idx":2,"proposition":"Down syndrome"},{"correct":true,"justification":"True","idx":3,"proposition":"Eye surgery"},{"correct":false,"justification":"False","idx":4,"proposition":"Scleritis"}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-bccbee","context":null,"enonce":"Which of the following are bilateral etiologies of decreased visual acuity most often?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Unilateral","idx":0,"proposition":"Central retinal artery occlusion"},{"correct":false,"justification":"Unilateral","idx":1,"proposition":"Acute anterior ischemic optic neuropathy"},{"correct":false,"justification":"Unilateral","idx":2,"proposition":"Retrobulbar ocular neuropathy"},{"correct":true,"justification":"True","idx":3,"proposition":"AMD"},{"correct":true,"justification":"True","idx":4,"proposition":"STROKE"}],"type":"custom"}
+{"_id":"IUgrossesse-infectio-beb943","context":null,"enonce":"What is the first-line treatment for urinary colonization of pregnancy in case of germ sensitivity?","item":"IUgrossesse","matiere":"infectio","propositions":[{"correct":false,"justification":"3rd line treatment. Avoid during the first two months of pregnancy (embryonic phase)","idx":0,"proposition":"Fosfomycin-Trometamol single dose"},{"correct":true,"justification":"True","idx":1,"proposition":"Amoxicillin for 7 days"},{"correct":false,"justification":"5th line treatment","idx":2,"proposition":"Amoxicillin-Clavulanic Acid for 7 days"},{"correct":false,"justification":"2nd line treatment","idx":3,"proposition":"Pivmecillinam for 7 days"},{"correct":false,"justification":"5th line treatment","idx":4,"proposition":"Nitrofurantoin for 7 days"}],"type":"custom"}
+{"_id":"nutrigrossesse-endoc-c26cde","context":null,"enonce":"Which of the following are recommended supplements for pregnant women?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"correct":true,"justification":"True. Folic acid 0.4 mg\/day in all women (increased dosage in case of history of spina bifida or epilepsy)","idx":0,"proposition":"Vitamin B9 in the periconception period"},{"correct":true,"justification":"True. 100,000 IU single dose","idx":1,"proposition":"Vitamin D in the third trimester"},{"correct":false,"justification":"Only in late pregnancy, if taking medication that interferes with vitamin K metabolism","idx":2,"proposition":"Vitamin K in the first trimester"},{"correct":false,"justification":"False, unless there is a deficiency","idx":3,"proposition":"Iron "},{"correct":false,"justification":"False, unless there is a risk of deficiency","idx":4,"proposition":"Iodine"}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-c3335f","context":null,"enonce":"Ultrasound in mode B conventionally allows to show:","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Intravitreal hemorrhage"},{"correct":false,"justification":"OCT","idx":1,"proposition":"Macular edema"},{"correct":true,"justification":"True","idx":2,"proposition":"Retinal detachment"},{"correct":false,"justification":"False","idx":3,"proposition":"A NOIAA"},{"correct":false,"justification":"Gonioscopy","idx":4,"proposition":"A closure of the iridocorneal angle"}],"type":"custom"}
+{"_id":"prothese-urg-c54f8c","context":null,"enonce":"Osteosynthesis:","item":"prothese","matiere":"urg","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Accelerates consolidation"},{"correct":true,"justification":"True","idx":1,"proposition":"Enables faster mobilization"},{"correct":true,"justification":"True","idx":2,"proposition":"Increases functional recovery"},{"correct":true,"justification":"True, centro-medullary nailing for example","idx":3,"proposition":"Can be done in a closed home"},{"correct":true,"justification":"True, the plates","idx":4,"proposition":"Can be done with an open fireplace"}],"type":"custom"}
+{"_id":"nutrigrossesse-endoc-c585f4","context":null,"enonce":"Which of the following are recommended vitamins for any woman in periconception and during pregnancy?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"correct":false,"justification":"False. It is teratogenic!","idx":0,"proposition":"Vitamin A"},{"correct":true,"justification":"True","idx":1,"proposition":"Vitamin B9"},{"correct":false,"justification":"Not especially","idx":2,"proposition":"Vitamin C"},{"correct":true,"justification":"True","idx":3,"proposition":"Vitamin d"},{"correct":false,"justification":"Only in case of treatment interfering with vitamin K metabolism","idx":4,"proposition":"Vitamin k"}],"type":"custom"}
+{"_id":"prothese-urg-c79452","context":null,"enonce":"Which of the following propositions are true regarding prosthesis wear?","item":"prothese","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is inevitable"},{"correct":true,"justification":"True","idx":1,"proposition":"It can accompany\/cause a loosening of prosthesis "},{"correct":false,"justification":"Mechanics","idx":2,"proposition":"The pain caused is inflammatory"},{"correct":false,"justification":"Macrophages","idx":3,"proposition":"It is linked to lymphocytes"},{"correct":false,"justification":"Treatment = change of prosthesis","idx":4,"proposition":"Treatment is functional most often"}],"type":"custom"}
+{"_id":"glaucomechr-ophtalmo-c7f59d","context":null,"enonce":"Which of the following are true?","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Beta-blocker eye drops decrease the secretion of aqueous humor"},{"correct":false,"justification":"Increase resorption","idx":1,"proposition":"Prostaglandin eye drops decrease aqueous humor secretion"},{"correct":true,"justification":"True","idx":2,"proposition":"Alpha 2-adrenergic agonist eye drops decrease aqueous humor secretion"},{"correct":false,"justification":"CI of eye drops also (systemic passage)","idx":3,"proposition":"COPD contraindicates subcutaneous beta-blockers only"},{"correct":true,"justification":"True. 2nd intention = laser trabeculoplasty (modest effect). 3rd line = filtering surgery","idx":4,"proposition":"Medical treatment is offered as a first-line treatment"}],"type":"custom"}
+{"_id":"puberte-gyn-c86fea","context":null,"enonce":"Which of the following are true?","item":"puberte","matiere":"gyn","propositions":[{"correct":true,"justification":"True. And this bone age corresponds to the appearance of sesamoid on X-rays of the hand and wrist.","idx":0,"proposition":"Puberty occurs at a bone age of 11 years in girls and 13 years in boys."},{"correct":true,"justification":"True","idx":1,"proposition":"Impubertism is pathological if the X-ray of the child's hand and wrist shows a sesamoid bone."},{"correct":false,"justification":"False. This is for peripheral pubertal delays because we look for ++ the Klinefelter in boys and the Turner in girls which are causes of peripheral pubertal delay.","idx":2,"proposition":"The karyotype is to be done in case of suspicion of peripheral precocious puberty as well as peripheral pubertal delay."},{"correct":true,"justification":"True","idx":3,"proposition":"Undernutrition can be the cause of delayed puberty."},{"correct":true,"justification":"True","idx":4,"proposition":"The association of delayed puberty and bilateral cryptorchidism excludes the diagnosis of simple pubertal delay."}],"type":"custom"}
+{"_id":"tbrefraction-ophtalmo-c8c56d","context":null,"enonce":"Which of the following is used to measure visual acuity from afar?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Monoyer"},{"correct":false,"justification":"Near visual acuity (33 cm)","idx":1,"proposition":"Parinaud"},{"correct":false,"justification":"Classification of PAD","idx":2,"proposition":"Leriche and Fontaine"},{"correct":false,"justification":"Classification of genital prolapse","idx":3,"proposition":"Baden-Walker"},{"correct":false,"justification":"Classification of mitral leakage mechanisms","idx":4,"proposition":"Carpentier"}],"type":"custom"}
+{"_id":"pancreatiteaigue-HGE-cc6a76","context":null,"enonce":"What pathogens can cause acute pancreatitis?","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"Mumps"},{"correct":false,"justification":"rather HBV","idx":1,"proposition":"Hepatitis C"},{"correct":false,"justification":"rather HBV","idx":2,"proposition":"Hepatitis A "},{"correct":true,"justification":"","idx":3,"proposition":"Coxsackie"},{"correct":true,"justification":"","idx":4,"proposition":"HIV"}],"type":"custom"}
+{"_id":"tbrefraction-ophtalmo-d06a57","context":null,"enonce":"Which of the following are possible indications for laser surgery?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Low myopia"},{"correct":true,"justification":"True","idx":1,"proposition":"Strong myopia"},{"correct":true,"justification":"True","idx":2,"proposition":"Farsightedness"},{"correct":true,"justification":"True","idx":3,"proposition":"Astigmatism"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"ascite-HGE-d4aef9","context":null,"enonce":"Which of the following are transudative ascites etiologies?","item":"ascite","matiere":"HGE","propositions":[{"correct":false,"justification":"Exudative","idx":0,"proposition":"Right heart failure"},{"correct":true,"justification":"True","idx":1,"proposition":"Hepatic cirrhosis"},{"correct":true,"justification":"True","idx":2,"proposition":"Renal failure"},{"correct":true,"justification":"True","idx":3,"proposition":"Anasarca"},{"correct":true,"justification":"True","idx":4,"proposition":"Hypoalbuminemia"}],"type":"custom"}
+{"_id":"MSN-urg-d4f89e","context":null,"enonce":"Which of the following are true in the event of unexpected infant death?","item":"MSN","matiere":"urg","propositions":[{"correct":false,"justification":"There is a systematic assessment to be carried out (HAS 2009)","idx":0,"proposition":"No assessment is systematic"},{"correct":false,"justification":"No, but it is always offered to parents","idx":1,"proposition":"The autopsy is systematic"},{"correct":true,"justification":"True, the prosecutor","idx":2,"proposition":"A suspicious death must lead the doctor to notify the judicial authorities"},{"correct":true,"justification":"True","idx":3,"proposition":"The examination of the child should look for suspicious lesions"},{"correct":true,"justification":"True ","idx":4,"proposition":"If the parents object to the transfer of the body to a referral centre, the doctor must tick the box \"medico-legal obstacle\" "}],"type":"custom"}
+{"_id":"KcVADS-onco-d5e4db","context":null,"enonce":"Which of the following are white precancerous lesions?","item":"KcVADS","matiere":"onco","propositions":[{"correct":false,"justification":"It is a red 🚨 mucosal lesion","idx":0,"proposition":"Erythroplasty of Queyrat"},{"correct":true,"justification":"True","idx":1,"proposition":"Leukoplakia"},{"correct":false,"justification":"Not a precancerous 😮 lesion","idx":2,"proposition":"Undifferentiated carcinoma"},{"correct":true,"justification":"True, white reticulate lesion","idx":3,"proposition":"Oral lichen"},{"correct":true,"justification":"True","idx":4,"proposition":"Fluid oral papillomatosis"}],"type":"custom"}
+{"_id":"prothese-urg-d66608","context":null,"enonce":"Which of the following are risk factors for prosthesis infection?","item":"prothese","matiere":"urg","propositions":[{"correct":false,"justification":"Rheumatoid arthritis","idx":0,"proposition":"Arthrosis"},{"correct":false,"justification":"High ASA","idx":1,"proposition":"ASA 1"},{"correct":false,"justification":"Active smoking","idx":2,"proposition":"Passive smoking"},{"correct":true,"justification":"True (BMI > 40)","idx":3,"proposition":"BMI > 45"},{"correct":true,"justification":"True","idx":4,"proposition":"Long delay between fracture and operation"}],"type":"custom"}
+{"_id":"pancreatiteaigue-HGE-d88ceb","context":null,"enonce":"What does the very high elevation of lipase in pleural or peritoneal fluids mean to you?\r\n","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"Crohn's disease"},{"correct":false,"justification":"","idx":1,"proposition":"Ulcerative colitis"},{"correct":false,"justification":"","idx":2,"proposition":"Infection à CMV"},{"correct":false,"justification":"","idx":3,"proposition":"Chronic pancreatitis"},{"correct":true,"justification":"","idx":4,"proposition":"Chronic fistula"}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-d8f953","context":null,"enonce":"Screening for deafness in infants is done by:","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Too young to answer 😋 you","idx":0,"proposition":"audiometry"},{"correct":false,"justification":"False","idx":1,"proposition":"The study of the stapedial reflex"},{"correct":true,"justification":"True","idx":2,"proposition":"Oto-acoustic emissions"},{"correct":true,"justification":"True","idx":3,"proposition":"Automated auditory evoked potentials"},{"correct":true,"justification":"True","idx":4,"proposition":"This screening is mandatory"}],"type":"custom"}
+{"_id":"anaphylaxie-urg-d9b85d","context":null,"enonce":"Which of the following are true for angioedema?","item":"anaphylaxie","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"He is firm"},{"correct":false,"justification":"No or slightly itchy, unlike urticaria","idx":1,"proposition":"It is very itchy"},{"correct":true,"justification":"True","idx":2,"proposition":"It is non-erythematosus"},{"correct":true,"justification":"True","idx":3,"proposition":"It is poorly limited"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"prurit-dermato-da498b","context":null,"enonce":"Which of the following are causes of pruritus sine materia?","item":"prurit","matiere":"dermato","propositions":[{"correct":false,"justification":"Hepatic cholestasis","idx":0,"proposition":"Hepatic cytolysis"},{"correct":false,"justification":"Chronic renal failure","idx":1,"proposition":"Acute renal failure"},{"correct":true,"justification":"True, cutaneous T-cell lymphoma in >50 years","idx":2,"proposition":"Syndrome de Sézary"},{"correct":true,"justification":"True","idx":3,"proposition":"Polycythemia vera"},{"correct":true,"justification":"True, as well as Graves' disease","idx":4,"proposition":"Hypothyroidism"}],"type":"custom"}
+{"_id":"anesth-anesth-dc86cc","context":null,"enonce":"Which of the following are true?","item":"anesth","matiere":"anesth","propositions":[{"correct":true,"justification":"True. = Recovery room. Part of the legal obligations with the pre-anesthetic consultation (if scheduled) and the visit. ","idx":0,"proposition":"After surgery, there is a mandatory passage in SSPI (post-interventional monitoring room)"},{"correct":false,"justification":"False. The only exception is the course of a morphine titration: it takes 1 hour of minimum monitoring after the last bolus","idx":1,"proposition":"No minimum monitoring time in IPPS is recommended"},{"correct":true,"justification":"True","idx":2,"proposition":"During morphine titration, there is a monitoring of one hour after the last bolus"},{"correct":false,"justification":"False. 30 minutes BEFORE the incision. As a reminder, antibiotic prophylaxis is administered according to the Altemeier classification. ","idx":3,"proposition":"If there is an indication of antibiotic prophylaxis to cover the surgical procedure, it will be administered 30 minutes after the incision"},{"correct":false,"justification":"False","idx":4,"proposition":"A curare is always essential during the maintenance phase of general anesthesia"}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-dd3adf","context":null,"enonce":"Which of the following are signs of CRVO at the fundus?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Retinal hemorrhage in flames"},{"correct":true,"justification":"True","idx":1,"proposition":"Retinal hemorrhage in spots"},{"correct":true,"justification":"True","idx":2,"proposition":"Cottony nodules"},{"correct":true,"justification":"True","idx":3,"proposition":"Papillary edema"},{"correct":true,"justification":"True","idx":4,"proposition":"Tortuosity of retinal veins"}],"type":"custom"}
+{"_id":"antithrombotiques-therapeutique-dd6669","context":null,"enonce":"The amount of topical corticosteroids on the phalangette of the index finger may cover:","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"A palm of a hand"},{"correct":true,"justification":"True, the phalangette unit of an adult is enough cream to treat the surface of both palms.","idx":1,"proposition":"Two palms"},{"correct":false,"justification":"False","idx":2,"proposition":"Three palms"},{"correct":false,"justification":"False","idx":3,"proposition":"Four palms"},{"correct":false,"justification":"False","idx":4,"proposition":"Five palms"}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-e015dc","context":null,"enonce":"Which of the following are etiologies of brutal white-eyed and painless BAV?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Central retinal vein occlusion"},{"correct":true,"justification":"True","idx":1,"proposition":"Central retinal artery occlusion"},{"correct":false,"justification":"Painful","idx":2,"proposition":"Angle closure glaucoma"},{"correct":true,"justification":"True","idx":3,"proposition":"Retinal detachment"},{"correct":true,"justification":"True","idx":4,"proposition":"Intravitreal hemorrhage"}],"type":"custom"}
+{"_id":"tbrefraction-ophtalmo-e0b3a5","context":null,"enonce":"Which of the following are spherical ametropias?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Myopia"},{"correct":true,"justification":"True","idx":1,"proposition":"Farsightedness"},{"correct":false,"justification":"Non-spherical","idx":2,"proposition":"Astigmatism"},{"correct":false,"justification":"Not an ametropia","idx":3,"proposition":"Chronic glaucoma"},{"correct":false,"justification":"Not an ametropia","idx":4,"proposition":"Keratitis"}],"type":"custom"}
+{"_id":"antithrombotiques-therapeutique-e63a3d","context":null,"enonce":"The amount of topical corticosteroids on the phalangette of the index finger corresponds to:","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"0.5 g"},{"correct":false,"justification":"False","idx":1,"proposition":"1 g"},{"correct":true,"justification":"True","idx":2,"proposition":"1.25 g"},{"correct":false,"justification":"False","idx":3,"proposition":"2 g"},{"correct":false,"justification":"False","idx":4,"proposition":"2.5 g"}],"type":"custom"}
+{"_id":"vaccin-infectio-e6d0d0","context":null,"enonce":"At 3 months, which vaccines are mandatory?","item":"vaccin","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"whooping cough"},{"correct":true,"justification":"True","idx":1,"proposition":"diphtheria"},{"correct":true,"justification":"True","idx":2,"proposition":"poliomyelitis"},{"correct":true,"justification":"True","idx":3,"proposition":"pneumococcus"},{"correct":true,"justification":"True","idx":4,"proposition":"Haemophilius"}],"type":"custom"}
+{"_id":"allergie-infectio-e947b8","context":null,"enonce":"Which of the following are atopic diseases?","item":"allergie","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Atopic dermatitis"},{"correct":false,"justification":"The so-called atopic diseases are: atopic dermatitis, allergic asthma, IgE-mediated food allergy and allergic rhinoconjunctivitis. (College of Pediatrics 2021)","idx":1,"proposition":"Autoimmune dermatosis"},{"correct":false,"justification":"False","idx":2,"proposition":"Bullous pemphigoid"},{"correct":true,"justification":"True","idx":3,"proposition":"Allergic asthma"},{"correct":true,"justification":"True","idx":4,"proposition":"Allergic rhinoconjunctivitis"}],"type":"custom"}
+{"_id":"ascite-HGE-eb15da","context":null,"enonce":"Which of the following are common etiologies of ascites?","item":"ascite","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Hepatocellular carcinoma"},{"correct":false,"justification":"Rather straight (we are in the frequent causes)","idx":1,"proposition":"Left heart failure"},{"correct":true,"justification":"True","idx":2,"proposition":"Hepatic cirrhosis"},{"correct":false,"justification":"😋","idx":3,"proposition":"All propositions are true"},{"correct":false,"justification":"Hepatorenal syndrome may be a consequence of ascites","idx":4,"proposition":"Acute renal failure"}],"type":"custom"}
+{"_id":"hemangiome-dermato-ec2383","context":null,"enonce":"Which of the following are true?","item":"hemangiome","matiere":"dermato","propositions":[{"correct":true,"justification":"True ","idx":0,"proposition":"Vascular tumors, most often capillaries, are characterized by proliferation of endothelial cells and mainly represented by hemangiomas of the infant"},{"correct":true,"justification":"True ","idx":1,"proposition":"In vascular malformations, endothelial cells are quiescent and may involve blood capillaries, veins, arteriovenous communications or lymphatic vessels."},{"correct":true,"justification":"true ","idx":2,"proposition":"Hemangiomas are benign endothelial cell proliferations that are more common in girls, premature infants and low birth weight infants"},{"correct":true,"justification":"True, superficial forms are willingly more nipple, and in relief than deep hemangiomas ","idx":3,"proposition":"The deep forms of the hemangioma are more elastic in consistency than the superficial forms  "},{"correct":false,"justification":"False, these are hemangiomas and AVMs that are fast flowing. Vascular malformations such as venous angiomas, lymphangiomas or planar angiomas are slow flow","idx":4,"proposition":"All vascular malformation Doppler ultrasounds show a richly vascularized fast-flow lesion"}],"type":"custom"}
+{"_id":"vaccin-infectio-eece83","context":null,"enonce":"What vaccinations are mandatory at 2 months?","item":"vaccin","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Dtp"},{"correct":true,"justification":"True","idx":1,"proposition":"Haemophilius influenzae"},{"correct":true,"justification":"True","idx":2,"proposition":"Whooping cough"},{"correct":true,"justification":"True","idx":3,"proposition":"Hepatitis B"},{"correct":true,"justification":"True","idx":4,"proposition":"Pneumococcus"}],"type":"custom"}
+{"_id":"AV--ophtalmo-ef0f30","context":null,"enonce":"Which of the following proposals are part of the previous segment?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Iris"},{"correct":true,"justification":"True","idx":1,"proposition":"Crystalline"},{"correct":true,"justification":"True","idx":2,"proposition":"Zonum"},{"correct":true,"justification":"True","idx":3,"proposition":"Ciliary body"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"angine-infectio-efe6e4","context":null,"enonce":"Which of the following are causes of tonsillar ulcer?","item":"angine","matiere":"infectio","propositions":[{"correct":false,"justification":"The cavum is the nasopharynx ","idx":0,"proposition":"Cavum tumour"},{"correct":true,"justification":"True","idx":1,"proposition":"Agranulocytosis"},{"correct":false,"justification":"Diphtheria is responsible for pseudomembranous angina ","idx":2,"proposition":"Diphtheria"},{"correct":true,"justification":"True","idx":3,"proposition":"Vincent's angina"},{"correct":true,"justification":"True","idx":4,"proposition":"Syphilis"}],"type":"custom"}
+{"_id":"parasitedig-infectio-f151f1","context":null,"enonce":"Which of the following proposals are parasitosis found in metropolitan France?","item":"parasitedig","matiere":"infectio","propositions":[{"correct":false,"justification":"It is present in tropical and subtropical areas: in Africa, South America, Asia and the Mediterranean basin. (Wikipedia) Corsican!! ","idx":0,"proposition":"Bilharzia"},{"correct":false,"justification":"They are present in Africa, Asia, and the Pacific, in tropical areas (more rarely in America)","idx":1,"proposition":"Filariasis"},{"correct":true,"justification":"True","idx":2,"proposition":"Oxyurosis"},{"correct":true,"justification":"True","idx":3,"proposition":"Distomatosis"},{"correct":true,"justification":"True","idx":4,"proposition":"Taenia"}],"type":"custom"}
+{"_id":"prothese-urg-f767b7","context":null,"enonce":"From what date is a prosthesis infection considered chronic?","item":"prothese","matiere":"urg","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"7 days"},{"correct":false,"justification":"","idx":1,"proposition":"2 weeks"},{"correct":true,"justification":"True, below = acute. Above = chronic.","idx":2,"proposition":"1 month"},{"correct":false,"justification":"","idx":3,"proposition":"6 months"},{"correct":false,"justification":"Time for nosocomial infection","idx":4,"proposition":"1 year"}],"type":"custom"}
+{"_id":"angine-infectio-f77746","context":null,"enonce":"What is the antibiotic therapy to be implemented in case of erythematopultaceous angina with RDT positive, in case of true allergy to beta-lactams?","item":"angine","matiere":"infectio","propositions":[{"correct":false,"justification":"Allergy","idx":0,"proposition":"Amoxicillin"},{"correct":false,"justification":"Allergy to amoxicillin. No indication of this association in tonsillitis (SBHA sensitive to amoxicillin alone)","idx":1,"proposition":"Amoxicillin-clavulanic acid"},{"correct":false,"justification":"Allergy","idx":2,"proposition":"C2G"},{"correct":true,"justification":"True. 3rd intention, if allergy to beta-lactam (<10% resistance)","idx":3,"proposition":"Macrolides"},{"correct":false,"justification":"No indication","idx":4,"proposition":"Glycopeptides"}],"type":"custom"}
+{"_id":"glaucomechr-ophtalmo-f89c78","context":null,"enonce":"Which of the following proposals are fundus abnormalities in CAPM?","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Greater than 0.2","idx":0,"proposition":"Cup\/disc ratio less than 0.2 between the 2 eyes"},{"correct":true,"justification":"True","idx":1,"proposition":"Papillary excavation"},{"correct":true,"justification":"True","idx":2,"proposition":"Haemorrhages in flames"},{"correct":false,"justification":"False","idx":3,"proposition":"Dry exudates"},{"correct":false,"justification":"Excavation","idx":4,"proposition":"Papillary edema"}],"type":"custom"}
+{"_id":"IUgrossesse-infectio-f9bc55","context":null,"enonce":"Which of the following propositions are true regarding urinary colonization?","item":"IUgrossesse","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"In the general population, screening for urinary colonization of pregnancy is performed by BU."},{"correct":true,"justification":"True ","idx":1,"proposition":"If the BU is positive (leukocytes or nitrites positive), confirmation by ECBU is required."},{"correct":false,"justification":"Not in women for atypical enterobacteriaceae (other than E. coli or enterococci) according to Pilly 2020","idx":2,"proposition":"ECBU is always positive when bacteuria is greater than 10^3 CFU"},{"correct":false,"justification":"ECBU and susceptibility testing are not treated","idx":3,"proposition":"In case of positive BU, treated with 1g of Amoxicillin three times a day for 7 days without ECBU"},{"correct":false,"justification":"ECBU and susceptibility testing are not treated","idx":4,"proposition":"In case of positive BU, treated with 3g in a single dose of Fosfomycin-Trometamol without ECBU"}],"type":"custom"}
+{"_id":"SPSC-sp-fba1cc","context":null,"enonce":"Which of the following propositions are true with respect to the interim placement order?","item":"SPSC","matiere":"sp","propositions":[{"correct":true,"justification":"True, or by the public prosecutor in case of emergency","idx":0,"proposition":"It is pronounced by the juvenile judge"},{"correct":true,"justification":"True","idx":1,"proposition":"It may be pronounced, in urgent cases, by the public prosecutor."},{"correct":false,"justification":"15 days","idx":2,"proposition":"It has an initial validity period of 7 days"},{"correct":false,"justification":"Parental authority retained","idx":3,"proposition":"Parents lose parental authority for the duration of the OPP"},{"correct":true,"justification":"True","idx":4,"proposition":"It concerns minors at risk"}],"type":"custom"}
+{"_id":"prurit-dermato-fd9a19","context":null,"enonce":"Which of the following proposals are part of the first-line biological assessment in case of pruritus sine materia?","item":"prurit","matiere":"dermato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"TSH"},{"correct":true,"justification":"True","idx":1,"proposition":"Renal assessment"},{"correct":true,"justification":"True","idx":2,"proposition":"Beta-HCG in women of childbearing potential"},{"correct":false,"justification":"Not in the first intention","idx":3,"proposition":"Immunophenotyping of lymphocytes"},{"correct":false,"justification":"Not in the first intention","idx":4,"proposition":"Blood ionogram"}],"type":"custom"}
+{"_id":"tbrefraction-ophtalmo-ff333a","context":null,"enonce":"Which of the following is a non-spherical ametropia?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Spherical","idx":0,"proposition":"Myopia"},{"correct":false,"justification":"Spherical","idx":1,"proposition":"Farsightedness"},{"correct":true,"justification":"True","idx":2,"proposition":"Astigmatism"},{"correct":false,"justification":"Not an ametropia","idx":3,"proposition":"OACR"},{"correct":false,"justification":"Not an ametropia","idx":4,"proposition":"CRVO"}],"type":"custom"}
+{"_id":"KcUt-onco-0790d8","context":null,"enonce":"Which of the following are organs whose cancers are associated with Lynch syndrome?","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"Ureter","idx":0,"proposition":"Kidney"},{"correct":true,"justification":"True","idx":1,"proposition":"None of the propositions are true"},{"correct":false,"justification":"False","idx":2,"proposition":"ENT"},{"correct":false,"justification":"False","idx":3,"proposition":"Lung"},{"correct":false,"justification":"Liver","idx":4,"proposition":"Spleen"}],"type":"custom"}
+{"_id":"KcUt-onco-12d06c","context":null,"enonce":"An MRI finds an endometrial tumor limited to the uterus, invading no neighborhood structure, infiltrating more than 50% of the myometrium. No lymphadenopathy is visualized\r\n\r\nWhat is the FIGO classification at this stage?","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"<50% of myometrium","idx":0,"proposition":"AI"},{"correct":true,"justification":"True, stage I because limited to the body of the uterus. Stage Ib because invades >50% of the myometrium","idx":1,"proposition":"Ib"},{"correct":false,"justification":"The pass is not invaded","idx":2,"proposition":"II"},{"correct":false,"justification":"The vagina is not invaded","idx":3,"proposition":"IIIb"},{"correct":false,"justification":"No distant metastasis","idx":4,"proposition":"Ivb"}],"type":"custom"}
+{"_id":"KcUt-onco-18cf14","context":null,"enonce":"Which of the following proposals is part of the endometrial cancer extension assessment? (except stage III FIGO or histological type II lesion)","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Brain CT"},{"correct":false,"justification":"False","idx":1,"proposition":"Bone scintigraphy"},{"correct":false,"justification":"If Stage III on MRI","idx":2,"proposition":"TAP CT if stage II"},{"correct":true,"justification":"True, systematic and necessary for FIGO classification (invasion of the cervix [stage II]? serous or appendages [stage IIIa? of the vagina [stage IIIb]? etc.) ","idx":3,"proposition":"Pelvic MRI"},{"correct":false,"justification":"False","idx":4,"proposition":"Pelvic CT"}],"type":"custom"}
+{"_id":"KcUt-onco-1e6d8d","context":null,"enonce":"Which of the following proposals corresponds to the type(s) of cancer for which follow-up by CTS may be useful?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True. In the College of Gynecology, the only place where SCC (Squamous Cell Carcinoma) is cited is for the follow-up of squamous cell carcinomas of the cervix.","idx":0,"proposition":"Squamous cell carcinoma of the cervix"},{"correct":false,"justification":"False","idx":1,"proposition":"Adenocarcinoma of the cervix"},{"correct":false,"justification":"Uterine fibroid","idx":2,"proposition":"Leiomyoma"},{"correct":false,"justification":"False","idx":3,"proposition":"Endometrial adenocarcinoma"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"KcUt-onco-2cafcb","context":null,"enonce":"Which of the following are risk factors for endometrial cancer?","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"Hormone-dependent cancer, so the more hormone, the more risk there is (so early puberty, late menopause, hormonal treatments)","idx":0,"proposition":"Late puberty"},{"correct":true,"justification":"True","idx":1,"proposition":"Polycystic Ovary Syndrome"},{"correct":true,"justification":"True","idx":2,"proposition":"Hormonal treatment of menopause"},{"correct":false,"justification":"Nulliparity","idx":3,"proposition":"Multiparity"},{"correct":true,"justification":"True, BMI > 25","idx":4,"proposition":"Overweight"}],"type":"custom"}
+{"_id":"KcUt-onco-2ea88e","context":null,"enonce":"Which of the following are organs whose cancers are associated with Lynch syndrome?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Ovaries"},{"correct":true,"justification":"True","idx":1,"proposition":"Stomach"},{"correct":true,"justification":"True, but extremely rare","idx":2,"proposition":"Brain 🧠 "},{"correct":true,"justification":"True, but rare sebaceous tumors","idx":3,"proposition":"Skin "},{"correct":false,"justification":"Heart cells do not renew, or very little. Therefore, there is almost no heart 😊 cancer","idx":4,"proposition":"Heart 💔 "}],"type":"custom"}
+{"_id":"KcUt-onco-307058","context":null,"enonce":"Which of the following are indications for colposcopy?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Cytological abnormalities suggestive of low-grade neoplasia on the smear"},{"correct":true,"justification":"True","idx":1,"proposition":"Cytological abnormalities suggestive of high-grade neoplasia on the smear"},{"correct":true,"justification":"True","idx":2,"proposition":"AUC-H cytological abnormalities on smear"},{"correct":false,"justification":"That if HPV test Positive","idx":3,"proposition":"AUC-US cytology abnormalities on smear without HPV test results"},{"correct":false,"justification":"That if HPV test Positive","idx":4,"proposition":"AGC-like cytological abnormalities (ganglion cell atypia) on smear with negative HPV test"}],"type":"custom"}
+{"_id":"KcUt-onco-37a804","context":null,"enonce":"Which of the following proposals corresponds to the FIGO stage of invasive endometrioid adenocarcinoma limited to <50% of the endometrium?","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"Insitu carcinoma","idx":0,"proposition":"Stage 0"},{"correct":true,"justification":"True","idx":1,"proposition":"Stage 1A"},{"correct":false,"justification":">50% of endometrial thickness","idx":2,"proposition":"Stage 1B"},{"correct":false,"justification":"Invasion of the pass","idx":3,"proposition":"Stage 2"},{"correct":false,"justification":"Invasion of the vagina","idx":4,"proposition":"Stage 3B"}],"type":"custom"}
+{"_id":"KcUt-onco-3eafbc","context":null,"enonce":"A 60-year-old woman comes to your office. She has no family or personal history of cancer. What cancers should she have been screening for until now?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True, screening organized between 50 and 74 years, with a bilateral mammogram with two incidences and double reading, every two years","idx":0,"proposition":"Breast cancer"},{"correct":false,"justification":"It was a joke huh 😅😂","idx":1,"proposition":"Prostate cancer"},{"correct":true,"justification":"True, immunological test (hemocult) every two years between 50 and 74 years","idx":2,"proposition":"Colon cancer"},{"correct":false,"justification":"No organized screening","idx":3,"proposition":"Lung cancer"},{"correct":true,"justification":"True, smear between 25 and 65 years every three years (after 2 normal smears 1 year apart)","idx":4,"proposition":"Cervical cancer"}],"type":"custom"}
+{"_id":"KcUt-onco-4b9786","context":null,"enonce":"Which of the following are true?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True, invasion of the serosa, vagina or pelvic nodes.","idx":0,"proposition":"Stage 3 requires a CT scan"},{"correct":false,"justification":"This is the case of 4A. 4B = distant metastases","idx":1,"proposition":"Stage 4B corresponds to rectal metastases"},{"correct":false,"justification":"Stage 0 = carcinoma in situ","idx":2,"proposition":"Stage 0 corresponds to a lack of anapath result"},{"correct":true,"justification":"True","idx":3,"proposition":"Stage 3C2 corresponds to an extension to the lumboaortic nodes"},{"correct":false,"justification":"1A = <50% of the myometrium. 1B = >50% of myometrium","idx":4,"proposition":"Stage 1A corresponds to carcinoma limited to more than 50% of the body"}],"type":"custom"}
+{"_id":"KcUt-onco-56138c","context":null,"enonce":"Which of the following proposals for squamous cell carcinoma of the cervix are true?","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"It develops at the expense of the ectocervix","idx":0,"proposition":"It develops at the expense of the endocervix"},{"correct":false,"justification":"It is the majority (70%)","idx":1,"proposition":"It accounts for 20% of cervical cancers "},{"correct":true,"justification":"True","idx":2,"proposition":"CIN1 corresponds to low-grade intraepithelial neoplasia"},{"correct":true,"justification":"True, just like CIN2","idx":3,"proposition":"CIN3 corresponds to high-grade intraepithelial neoplasia"},{"correct":false,"justification":"<5mm. Beyond that, it is invasive","idx":4,"proposition":"Microinvasive carcinoma measures <10mm"}],"type":"custom"}
+{"_id":"KcUt-onco-6c47c4","context":null,"enonce":"Which of the following are risk factors for endometrial cancer?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True, especially if mishandled","idx":0,"proposition":"History of hormone replacement therapy for menopause"},{"correct":false,"justification":"Cervix, oropharynx, esophagus","idx":1,"proposition":"History of HPV infection"},{"correct":false,"justification":"Late menopause","idx":2,"proposition":"Early menopause"},{"correct":true,"justification":"True","idx":3,"proposition":"History of tamoxifen treatment"},{"correct":true,"justification":"True","idx":4,"proposition":"Obesity"}],"type":"custom"}
+{"_id":"KcUt-onco-7f73ac","context":null,"enonce":"Which of the following are true about cancer of the body of the uterus?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It mainly concerns the endometrium"},{"correct":false,"justification":"This is adenocarcinoma.","idx":1,"proposition":"The most common histological type is squamous cell carcinoma"},{"correct":true,"justification":"True","idx":2,"proposition":"The most common symptom is metrorrhagia in postmenopausal women"},{"correct":true,"justification":"True","idx":3,"proposition":"The endometrium is thickened on intravaginal ultrasound"},{"correct":true,"justification":"True","idx":4,"proposition":"FIGO classification goes up to stage 4B"}],"type":"custom"}
+{"_id":"KcUt-onco-8f61b9","context":null,"enonce":"Regarding the FIGO classification for uterine fibroids. Which of the following are true?","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"False. 0 to 2 are submucosal","idx":0,"proposition":"Fibroids 0 to 3 are submucosal"},{"correct":true,"justification":"True. It is fibroids that are most at risk of causing bleeding and long-term iron deficiency anemia. ","idx":1,"proposition":"FIGO fibroids 0 to 2 are at risk of causing iron deficiency anemia"},{"correct":false,"justification":"False. FIGO 7 is a pedunculated subserous fibroid","idx":2,"proposition":"FIGO 7 corresponds to a non-pedunculated subserous fibroid"},{"correct":false,"justification":"False. This is FIGO 6. The FIGO 5 is a fibroid with more than 50% intramural","idx":3,"proposition":"FIGO 5: subserous fibroid with less than 50% intramural"},{"correct":true,"justification":"True","idx":4,"proposition":"FIGO 1: submucosal fibroid with less than 50% intramural"}],"type":"custom"}
+{"_id":"KcUt-onco-9df81d","context":null,"enonce":"Which of the following are true about colposcopy?","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"Local anesthesia is sufficient. But if the patient asks for GA, it is possible","idx":0,"proposition":"It requires general 💤 anesthesia"},{"correct":true,"justification":"True. Page 213 of the College of Gynecology (4th edition)","idx":1,"proposition":"It is essential to direct biopsies"},{"correct":true,"justification":"True","idx":2,"proposition":"It requires a binocular 🔎 magnifying glass"},{"correct":false,"justification":"The filter is green 🟢 (sorry for the trap 🙏)","idx":3,"proposition":"The yellow 🟡 filter can be used for vessel observation"},{"correct":true,"justification":"True","idx":4,"proposition":"It is after the application of the acetic acid solution that the cylindrical-squamous junction can be spotted "}],"type":"custom"}
+{"_id":"KcUt-onco-a56b20","context":null,"enonce":"At what age should the first cervico-uterine smear be offered?","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"15 years"},{"correct":false,"justification":"False","idx":1,"proposition":"20 years"},{"correct":true,"justification":"True","idx":2,"proposition":"25 years"},{"correct":false,"justification":"False","idx":3,"proposition":"50 years"},{"correct":false,"justification":"False","idx":4,"proposition":"35 years"}],"type":"custom"}
+{"_id":"KcUt-onco-abc6ec","context":null,"enonce":"Which of the following proposals corresponds to the type(s) of cancer for which follow-up by CTS may be useful?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True. In the College of Gynecology, the only place where SCC (Squamous Cell Carcinoma) is cited is for the follow-up of squamous cell carcinomas of the cervix.","idx":0,"proposition":"Squamous cell carcinoma of the cervix"},{"correct":false,"justification":"False","idx":1,"proposition":"Adenocarcinoma of the cervix"},{"correct":false,"justification":"Uterine fibroid","idx":2,"proposition":"Leiomyoma"},{"correct":false,"justification":"False","idx":3,"proposition":"Endometrial adenocarcinoma"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"KcUt-onco-bd29d0","context":null,"enonce":"Which of the following are true about cervical cancer?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True, 70% of cases","idx":0,"proposition":"Squamous cell carcinoma is the most common pathological expression"},{"correct":false,"justification":"The glands are on the endocervix, so adenocarcinoma concerns the endocervix.","idx":1,"proposition":"Adenocarcinoma concerns the ectocervix"},{"correct":false,"justification":"Columnar epithelium","idx":2,"proposition":"The endocervix consists of a squamous epithelium"},{"correct":true,"justification":"True","idx":3,"proposition":"FIGO III stage has a prognosis of 60% survival at 5 years"},{"correct":true,"justification":"True","idx":4,"proposition":"The incidence of cervical cancer is down slightly in France"}],"type":"custom"}
+{"_id":"KcUt-onco-be768e","context":null,"enonce":"Which of the following corresponds to the FIGO stage of invasive endocervix carcinoma limited to the cervix?","item":"KcUt","matiere":"onco","propositions":[{"correct":false,"justification":"Intraepithelial (carcinoma is invasive here)","idx":0,"proposition":"Stage 0"},{"correct":true,"justification":"True","idx":1,"proposition":"Stage 1"},{"correct":false,"justification":"Involvement of the vagina (except lower 1\/3 -> stage 3) or a parameter","idx":2,"proposition":"Stage 2"},{"correct":false,"justification":"Involvement of the lower 1\/3 of the vagina or kidney","idx":3,"proposition":"Stage 3"},{"correct":false,"justification":"Metastasis","idx":4,"proposition":"Stage 4"}],"type":"custom"}
+{"_id":"KcUt-onco-e481a4","context":null,"enonce":"Which of the following are organs whose cancers are associated with Lynch syndrome?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Rectum"},{"correct":true,"justification":"True","idx":1,"proposition":"Settler"},{"correct":true,"justification":"True","idx":2,"proposition":"Urothelial"},{"correct":true,"justification":"True","idx":3,"proposition":"Endometrium"},{"correct":true,"justification":"True","idx":4,"proposition":"Small intestine"}],"type":"custom"}
+{"_id":"KcUt-onco-eca11d","context":null,"enonce":"Which of the following propositions are true about the FIGO stage of endometrial cancers?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"AI: Invasion < 50% of the myometrium"},{"correct":false,"justification":"Bladder and\/or rectal. IVB otherwise","idx":1,"proposition":"VIA: Bladder and\/or hepatic metastasis"},{"correct":true,"justification":"True","idx":2,"proposition":"II: Invasion of the pass"},{"correct":false,"justification":"Loco-regional extension: serous (A), vagina (B), pelvic nodes (C1), or lumboarotic nodes (C2)","idx":3,"proposition":"III: Distant metastasis"},{"correct":false,"justification":"IIIC1: extension to pelvic nodes","idx":4,"proposition":"IIIC1: Extension to lumboaortic nodes"}],"type":"custom"}
+{"_id":"KcUt-onco-f52b37","context":null,"enonce":"Which of the following are true?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True, so it must be done outside of menstrual periods","idx":0,"proposition":"The cervico-uterine smear is not interpretable during menstruation"},{"correct":false,"justification":"Vaccines do not target all strains (only oncogenic ones)","idx":1,"proposition":"A well-conducted vaccination against HPV prevents contamination by the virus"},{"correct":false,"justification":"Non-hormone-dependent","idx":2,"proposition":"Cervical cancer is hormone-dependent"},{"correct":true,"justification":"True","idx":3,"proposition":"Endometrial cancer is hormone-dependent"},{"correct":false,"justification":"","idx":4,"proposition":""}],"type":"custom"}
+{"_id":"KcUt-onco-f5ff7d","context":null,"enonce":"Which of the following are true about cervical cancer?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A smear that finds atypical glandular cells (AGC) does not require a colposcopy to be performed immediately"},{"correct":true,"justification":"True","idx":1,"proposition":"An irregular red collar on colposcopy is suspicious "},{"correct":false,"justification":"Possible in case of low-grade dysplasia (LIEBG) but not in ISA","idx":2,"proposition":"Withholding from surveillance is possible for adenocarcinoma in situ (AIS)"},{"correct":false,"justification":"It is mainly found at the endocol-exocervix junction (transformation zone)","idx":3,"proposition":"The HPV virus is exclusively found in the deep endocervix"},{"correct":false,"justification":"It is recommended in humans since the new reco HAS","idx":4,"proposition":"HPV vaccination is not recommended in humans"}],"type":"custom"}
+{"_id":"330-urg-028095","context":null,"enonce":"Which of the following proposals are part of the mandible retro-dental sector?","item":"traumacrane","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Ramus"},{"correct":true,"justification":"True","idx":1,"proposition":"Condyles"},{"correct":false,"justification":"Dentate sector","idx":2,"proposition":"Symphysis"},{"correct":false,"justification":"Dentate sector. There are some great diagrams here: http:\/\/s3.e-monsite.com\/2011\/02\/15\/18671683osteologie-cranio-faciale-mandibule-pdf.pdf","idx":3,"proposition":"Parasymphysis"},{"correct":true,"justification":"True","idx":4,"proposition":"Angle"}],"type":"custom"}
+{"_id":"330-urg-f289d4","context":null,"enonce":"Which of the following proposals are part of the dentate sector of the mandible?","item":"traumacrane","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Mandibular arch"},{"correct":true,"justification":"True","idx":1,"proposition":"Symphysis"},{"correct":true,"justification":"True, mandibular arch = symphysis and horizontal branch (parasymphysis)","idx":2,"proposition":"Parasymphysis"},{"correct":false,"justification":"Retro-dental sector","idx":3,"proposition":"Ramus"},{"correct":false,"justification":"Retro-dental sector. Super Pattern of Death Kills: http:\/\/s3.e-monsite.com\/2011\/02\/15\/18671683osteologie-cranio-faciale-mandibule-pdf.pdf","idx":4,"proposition":"Condyles"}],"type":"custom"}
+{"_id":"330-urg-cdd192","context":null,"enonce":"Which of the following proposals are secondary brain aggressions of systemic origin (ACSOS)?","item":"traumacrane","matiere":"urg","propositions":[{"correct":false,"justification":"Secondary brain aggression of neurological origin","idx":0,"proposition":"Cerebral edema"},{"correct":false,"justification":"Secondary brain aggression of neurological origin","idx":1,"proposition":"Intracranial hypertension"},{"correct":true,"justification":"True. Anemia results in a decrease in oxygen transport to the cerebral parenchyma and is therefore deleterious","idx":2,"proposition":"Anaemia"},{"correct":true,"justification":"True. By decreasing cerebral blood flow, low blood pressure weakens the brain cells included in the ischemic penumbra (= the cells that can still be saved)","idx":3,"proposition":"Low blood pressure"},{"correct":true,"justification":"True. Hyperthermia is associated with increased brain metabolism ","idx":4,"proposition":"Hyperthermia"}],"type":"custom"}
+{"_id":"359-urg-a38675","context":null,"enonce":"What is Parker's maximum score?","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"3"},{"correct":false,"justification":"","idx":1,"proposition":"6"},{"correct":true,"justification":"True. We will try to evaluate the degree of autonomy of patients thanks to the PARKER score (yes\/no walk (3 pts), with or without technical aid (3 pts), home\/outdoor\/shopping (1\/2\/3 pts) for a maximum of 9 points in autonomous patients)","idx":2,"proposition":"9"},{"correct":false,"justification":"","idx":3,"proposition":"12"},{"correct":false,"justification":"","idx":4,"proposition":"15"}],"type":"custom"}
+{"_id":"359-urg-3368a6","context":null,"enonce":"⏰ An open fracture must be managed surgically in the ...","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"30 minutes "},{"correct":false,"justification":"","idx":1,"proposition":"1 hour"},{"correct":false,"justification":"","idx":2,"proposition":"3 hours"},{"correct":true,"justification":"True","idx":3,"proposition":"6 hours"},{"correct":false,"justification":"","idx":4,"proposition":"12 hours "}],"type":"custom"}
+{"_id":"359-urg-394141","context":null,"enonce":"You place your patient in the supine position, knee in flexion. You find pain in axial compression of the knee associated with rotational movements. What is this maneuver?","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":"ACL injury","idx":0,"proposition":"Lachman"},{"correct":false,"justification":"ACL injury","idx":1,"proposition":"Jerk Off Test"},{"correct":true,"justification":"True. This test is a sign of internal meniscopathy if the pain appears in external rotation. Conversely if the pain appears in internal rotation","idx":2,"proposition":"Appley's Grinding Test"},{"correct":false,"justification":"patellar pain","idx":3,"proposition":"Manoeuvring of the plough "},{"correct":false,"justification":"joint effusion","idx":4,"proposition":"Sign of the ice cube 🧊"}],"type":"custom"}
+{"_id":"359-urg-4673c6","context":null,"enonce":"The cervico-diaphyseal angle is:","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"30 degrees"},{"correct":false,"justification":"False","idx":1,"proposition":"150 degrees"},{"correct":false,"justification":"False","idx":2,"proposition":"90 degrees"},{"correct":false,"justification":"False","idx":3,"proposition":"60 degrees"},{"correct":true,"justification":"True","idx":4,"proposition":"120 degrees"}],"type":"custom"}
+{"_id":"359-urg-4a1339","context":null,"enonce":"Normally, the radioulnar index is:","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"Positive"},{"correct":false,"justification":"","idx":1,"proposition":"Nobody"},{"correct":true,"justification":"True, from -1 to -2 mm","idx":2,"proposition":"Negative"},{"correct":false,"justification":"","idx":3,"proposition":"We don't really know what to put as other proposals 😕"},{"correct":false,"justification":"","idx":4,"proposition":"🤷‍♂️🤷‍♂️🤷‍♂️"}],"type":"custom"}
+{"_id":"359-urg-ccbf7e","context":null,"enonce":"What is the usual management of a trochanteric fracture? 🤔","item":"Fr","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The goal is to provide podal support as quickly as possible 🚶 ♀️🚶 ♂️"},{"correct":true,"justification":"True","idx":1,"proposition":"Reduction and osteosynthesis"},{"correct":false,"justification":"False, indicated in cervical fractures (depending on the age and condition of the patient)","idx":2,"proposition":"Intermediate hip replacement"},{"correct":false,"justification":"False ✖✖","idx":3,"proposition":"Functional treatment"},{"correct":false,"justification":"False, indicated in cervical fractures (depending on the age and condition of the patient)","idx":4,"proposition":"Total hip replacement"}],"type":"custom"}
+{"_id":"359-urg-f6c78d","context":null,"enonce":"Regarding per-trochanterian fractures:","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":"False, most often they are not","idx":0,"proposition":"They are always geared"},{"correct":true,"justification":"True, by definition","idx":1,"proposition":"They are extra-articular"},{"correct":false,"justification":"This is the case with cervical fractures. The posterior circumflex artery is injured in femoral neck fractures, justifying the placement of a total hip replacement (in patients aged + 60 years).","idx":2,"proposition":"They are at risk of aseptic osteonecrosis of the femoral 😲 head"},{"correct":false,"justification":"Most often: reduction + osteosynthesis","idx":3,"proposition":"Functional treatment is sufficient 🤷 ♂️"},{"correct":false,"justification":"Most often: reduction + osteosynthesis. Orthopedic treatment is a waiting treatment (except CI at surgery)","idx":4,"proposition":"Orthopedic treatment is sufficient 🤷 ♂️"}],"type":"custom"}
+{"_id":"359-urg-d77845","context":null,"enonce":"Which of the following propositions are true about Garden's classification?","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":"This is the case of the Pauwels classification (stability \/ risk of pseudarthrosis of the fracture). There are 4 in the Garden","idx":0,"proposition":"There are 3 stadiums"},{"correct":false,"justification":"Only femoral neck fractures","idx":1,"proposition":"It is applicable to all fractures of the femur"},{"correct":false,"justification":"Hip\/Front pelvis","idx":2,"proposition":"It requires profile X-rays"},{"correct":true,"justification":"True","idx":3,"proposition":"It is used to predict the survival of the femoral head"},{"correct":true,"justification":"True","idx":4,"proposition":"It takes into account the displacement of fractured bones"}],"type":"custom"}
+{"_id":"359-urg-85067e","context":null,"enonce":"Which of the following is the normal version of the radial glenoid?","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"0°"},{"correct":true,"justification":"True","idx":1,"proposition":"10° anteversion"},{"correct":false,"justification":"","idx":2,"proposition":"10° retroversion"},{"correct":false,"justification":"","idx":3,"proposition":"20° retroversion"},{"correct":false,"justification":"","idx":4,"proposition":"20° anteversion"}],"type":"custom"}
+{"_id":"71-psy-60846c","context":null,"enonce":"Concerning psychotherapies, which of the following propositions are true?","item":"psychoT","matiere":"psy","propositions":[{"correct":true,"justification":"True, a psychotherapist refers to a psychiatrist, psychologist or someone with necessary training in the field (rarer)","idx":0,"proposition":"A psychiatrist is a psychotherapist"},{"correct":false,"justification":"False, it is by far supportive psychotherapy (think of the number of people who consult a psychologist for an unfortunate life event...)","idx":1,"proposition":"The most practiced psychotherapy in France is T.C.C (Cognitive Behavioral Therapy)"},{"correct":false,"justification":"False, she still has some (anxiety disorders, depressive disorders), but often she is preferred the TCC","idx":2,"proposition":"Analytical psychotherapy no longer has an indication in France"},{"correct":true,"justification":"True, it is THE therapy to favor in front of anxiety disorders (OCD, panic disorders, phobias ....)","idx":3,"proposition":"Cognitive behavioral therapy is very useful and effective on the management of anxiety disorders"},{"correct":false,"justification":"False, we must not confuse the \"defusing\" which is a brief management, directly in post-traumatic, of an EMDR which is a longer-term and often distant management of the trauma","idx":4,"proposition":"EMDR is a psychotherapy called \"defusing\", allowing to take charge in direct post-traumatic, the psychic consequences of a traumatic event"}],"type":"custom"}
+{"_id":"69-psy-acf639","context":null,"enonce":"Regarding eating disorders, which of the following propositions, are true?","item":"TCA","matiere":"psy","propositions":[{"correct":false,"justification":"False, it is by far the rarest eating disorder among the 3 main ones (binge eating disorder > bulimia > anorexia)","idx":0,"proposition":"Anorexia nervosa is the most common eating disorder in France."},{"correct":true,"justification":"True. This is a major point, absolutely essential to remember and research, on which I particularly emphasize.","idx":1,"proposition":"Eating disorders are very frequently associated with psychiatric and addictological disorders."},{"correct":true,"justification":"True, a thousand times true, it is the main drug, prescribed outside of oral nutritional supplements.","idx":2,"proposition":"In the management of eating disorders, antidepressants are readily used for their pro-orexigenous or anti-compulsive effect."},{"correct":false,"justification":"False, it is borderline personality disorder (rather in bulimic) or obsessive-compulsive personality disorder (rather in anorexics)","idx":3,"proposition":"The personality disorder most commonly found in eating disorders is antisocial personality disorder."},{"correct":false,"justification":"False, there are a myriad variety of oral nutritional supplements (cakes, biscuits, soups, soups, juices, desserts, flans etc ...)","idx":4,"proposition":"Oral nutritional supplements are only in the form of milk or juice."}],"type":"custom"}
+{"_id":"9-psy-d94981","context":null,"enonce":"Which of the following are vulnerability criteria taken into account in criminal law?","item":"certificats","matiere":"psy","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Age 🎅🤶"},{"correct":true,"justification":"True","idx":1,"proposition":"Disabling 🦯 chronic disease"},{"correct":true,"justification":"True","idx":2,"proposition":"Mental"},{"correct":true,"justification":"True","idx":3,"proposition":"Pregnancy 🤰"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"68-psy-0dd0ab","context":null,"enonce":"Concerning the psychic disorders of the elderly, which of the following propositions, which one or which are true?","item":"psyage","matiere":"psy","propositions":[{"correct":true,"justification":"True, indeed older people age differently! An 80-year-old person may not have physical or psychological comorbidities (which are the main risk factors for mental disorders) and a 60-year-old person may have them.","idx":0,"proposition":"Age is not a risk factor for depression in the elderly"},{"correct":true,"justification":"True, it is all the more visible in hospitalization","idx":1,"proposition":"Depression of the elderly may be manifested by functional complaints (asthenia, memory complaint, abdominal pain)"},{"correct":true,"justification":"True, if there are more suicide attempts among young people, there are fewer deaths by suicide among young people.","idx":2,"proposition":"The risk of suicide is greater in the elderly than in the young person"},{"correct":true,"justification":"True","idx":3,"proposition":"A severe depressive episode is a risk factor for Alzheimer's disease"},{"correct":true,"justification":"True, frontal tumors, for example, can mimic depression in the elderly","idx":4,"proposition":"Brain imaging can help to seek a differential diagnosis (such as a brain tumor) in the elderly person's depression"}],"type":"custom"}
+{"_id":"287-onco-2b543c","context":null,"enonce":"Secondary prevention is used to reduce:","item":"epidemioKc","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Prevalence"},{"correct":false,"justification":"Primary","idx":1,"proposition":"Impact"},{"correct":false,"justification":"Tertiary","idx":2,"proposition":"Disability"},{"correct":false,"justification":"Tertiary","idx":3,"proposition":"Morbidity and mortality"},{"correct":true,"justification":"True","idx":4,"proposition":"It is aimed at high-risk individuals"}],"type":"custom"}
+{"_id":"287-onco-072307","context":null,"enonce":"What is the only cancer in humans that can be managed by hormonal treatments?","item":"epidemioKc","matiere":"onco","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"Breast"},{"correct":true,"justification":"True, this is the only :)","idx":1,"proposition":"Prostate"},{"correct":false,"justification":"","idx":2,"proposition":"Settler"},{"correct":false,"justification":"","idx":3,"proposition":"Thyroid"},{"correct":false,"justification":"","idx":4,"proposition":"Pancreas"}],"type":"custom"}
+{"_id":"287-onco-366294","context":null,"enonce":"Which of the following are hormone-sensitive cancers?","item":"epidemioKc","matiere":"onco","propositions":[{"correct":false,"justification":"😬😬😬","idx":0,"proposition":"Prostate in women"},{"correct":true,"justification":"True","idx":1,"proposition":"Endometrium in women"},{"correct":false,"justification":"False","idx":2,"proposition":"Adrenal in humans"},{"correct":false,"justification":"False","idx":3,"proposition":"Testicle"},{"correct":true,"justification":"True","idx":4,"proposition":"Breast in women"}],"type":"custom"}
+{"_id":"287-onco-bd3506","context":null,"enonce":"Primary prevention is used to reduce:","item":"epidemioKc","matiere":"onco","propositions":[{"correct":false,"justification":"Secondary","idx":0,"proposition":"Prevalence"},{"correct":true,"justification":"True","idx":1,"proposition":"Impact"},{"correct":false,"justification":"Tertiary","idx":2,"proposition":"Disability"},{"correct":false,"justification":"Tertiary","idx":3,"proposition":"Morbidity and mortality"},{"correct":false,"justification":"To the general population","idx":4,"proposition":"It is aimed at high-risk individuals"}],"type":"custom"}
+{"_id":"287-onco-2314ef","context":null,"enonce":"What is the primary outcome of national screening campaigns?","item":"epidemioKc","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Mortality decline"},{"correct":false,"justification":"","idx":1,"proposition":"Decrease in morbidity"},{"correct":false,"justification":"","idx":2,"proposition":"Decrease in incidence"},{"correct":false,"justification":"","idx":3,"proposition":"Declining prevalence"},{"correct":false,"justification":"","idx":4,"proposition":"Decrease in healthcare consumption"}],"type":"custom"}
+{"_id":"287-onco-56e0a3","context":null,"enonce":"What is the main risk factor for cancer?","item":"epidemioKc","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Age"},{"correct":false,"justification":"","idx":1,"proposition":"Tobacco"},{"correct":false,"justification":"","idx":2,"proposition":"Alcohol"},{"correct":false,"justification":"","idx":3,"proposition":"Pesticides"},{"correct":false,"justification":"","idx":4,"proposition":"Infection par HPV"}],"type":"custom"}
+{"_id":"287-onco-c276fe","context":null,"enonce":"Tertiary prevention serves to reduce:","item":"epidemioKc","matiere":"onco","propositions":[{"correct":false,"justification":"Secondary","idx":0,"proposition":"Prevalence"},{"correct":false,"justification":"Primary","idx":1,"proposition":"Impact"},{"correct":true,"justification":"True","idx":2,"proposition":"Morbidity and mortality"},{"correct":true,"justification":"True","idx":3,"proposition":"Disability"},{"correct":true,"justification":"True","idx":4,"proposition":"It is only for the sick individual"}],"type":"custom"}
+{"_id":"287-onco-56f80b","context":null,"enonce":"What proportion of cancer is nutrition-related risk factor?","item":"epidemioKc","matiere":"onco","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"5 %"},{"correct":false,"justification":"","idx":1,"proposition":"10 %"},{"correct":true,"justification":"True","idx":2,"proposition":"25 %"},{"correct":false,"justification":"","idx":3,"proposition":"50 %"},{"correct":false,"justification":"","idx":4,"proposition":"1 %"}],"type":"custom"}
+{"_id":"287-onco-591f3d","context":null,"enonce":"What is the proportion of preventable cancers (accessible to primary prevention)?","item":"epidemioKc","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"40 %"},{"correct":false,"justification":"","idx":1,"proposition":"10 %"},{"correct":false,"justification":"","idx":2,"proposition":"20 %"},{"correct":false,"justification":"","idx":3,"proposition":"80 %"},{"correct":false,"justification":"","idx":4,"proposition":"100 %"}],"type":"custom"}
+{"_id":"74-gastro-b1e42d","context":null,"enonce":"Regarding Gayet-Wernicke encephalopathy. Which of the following propositions, which one or which are true?","item":"OH","matiere":"HGE","propositions":[{"correct":false,"justification":"False. Thiamine. ","idx":0,"proposition":"It is a vitamin B6 deficiency"},{"correct":true,"justification":"True. It is for this reason that chronic alcoholic patients should not be hydrated with G5, but with saline. ","idx":1,"proposition":"It can be aggravated by carbohydrate intake"},{"correct":true,"justification":"True. There may also be oppositional hypertonia","idx":2,"proposition":"The clinical triad includes oculomotor signs (oculomotor paralysis, nystagmus), static cerebellar syndrome, and delirium syndrome."},{"correct":false,"justification":"False. A hypersignal of the mammillary body","idx":3,"proposition":"MRI FLAIR shows a hypersignal of the corpus callosum"},{"correct":false,"justification":"False. It is reversible, unlike Korsakoff syndrome","idx":4,"proposition":"It is an irreversible encephalopathy"}],"type":"custom"}
+{"_id":"74-gastro-769984","context":null,"enonce":"Regarding biological markers of excessive alcohol consumption. Which of the following propositions, which one or which are true?","item":"OH","matiere":"HGE","propositions":[{"correct":false,"justification":"False. Macrocytosis","idx":0,"proposition":"Microcytosis is suggestive"},{"correct":true,"justification":"True. Lots of false positives. ","idx":1,"proposition":"MCV is the least sensitive marker"},{"correct":true,"justification":"True. This is CDT (Carbohydrate Deficient Transferrin)","idx":2,"proposition":"Deialylated transferrin is very specific"},{"correct":true,"justification":"True","idx":3,"proposition":"Gamma-GT is elevated without elevation of PALs"},{"correct":true,"justification":"True","idx":4,"proposition":"Macrocytosis is suggestive"}],"type":"custom"}
+{"_id":"74-gastro-185e41","context":null,"enonce":"Which of the following are true?","item":"OH","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Simple use is a term used only for the use of alcohol"},{"correct":true,"justification":"True. This is true for both men and women","idx":1,"proposition":"According to new WHO recommendations, simple alcohol use means less than 10 glasses of alcohol are consumed per week "},{"correct":false,"justification":"False. 10 g","idx":2,"proposition":"1 standard glass of alcohol contains 8g of alcohol"},{"correct":true,"justification":"True","idx":3,"proposition":"1 glass of wine of 10 cL corresponds to 10g of alcohol"},{"correct":true,"justification":"True","idx":4,"proposition":"1 glass of whiskey of 2.5 cL corresponds to 10g of alcohol"}],"type":"custom"}
+{"_id":"meningite-infectio-ffaa03","context":null,"enonce":"With regard to meningitis, which of the following proposals are accurate?","item":"meningite","matiere":"infectio","propositions":[{"correct":true,"justification":"True, essential and non-debatable point, the greatest urgency in front of a fever in children, adolescents and even young adults is the search for a purpura fulminans (IM \/ IV injection of 2g C3G).","idx":0,"proposition":"It is essential to completely undress any child with unexplained fever and\/or suspected meningitis"},{"correct":true,"justification":"True, overall there are three situations where the lumbar puncture will not be performed: septic shock, coagulation disorders and similar, signs of cerebral engagement \/ seizures or serious alertness disorders.","idx":1,"proposition":"Among the contraindications to lumbar puncture, we have coagulation disorders, thrombocytopenia (<50G \/ L) and signs of cerebral engagement for example."},{"correct":false,"justification":"False, they are to start in probabilistic once the direct examination is carried out (on the blood or the lumbar puncture)","idx":2,"proposition":"Except in the context of purpura fulminans, antibiotic therapy is to be started once the results of the culture with susceptibility testing have been received."},{"correct":false,"justification":"False, three times false. As for the suspicion of myocardial infarction, we CALL the SAMU to request a medical transport, which will go directly to intensive care. And we do the C3G IM in the office!","idx":3,"proposition":"Confirmed or suspected purpura fulminans requires sending the patient to the emergency room with a letter to perform blood cultures and lumbar puncture"},{"correct":false,"justification":"False, it is to be proposed in systematics (I was often fooled by this item)","idx":4,"proposition":"HIV testing, if favourable circumstances, is to be offered to the patient"}],"type":"custom"}
+{"_id":"meningite-infectio-4c788d","context":null,"enonce":"You are a pediatric intern and you hospitalized little Franz Oberhauser, an Austrian child on holiday in the Alps 🗻, for a suspicion of meningitis (in front of febrile headaches with meningeal syndrome). The laboratory calls you to send you the results of the lumbar puncture, very favorable to meningococcal 🦠 meningitis. Which of the following results are consistent with meningococcal meningitis?","item":"meningite","matiere":"infectio","propositions":[{"correct":true,"justification":"True, we have a proteinorachy >1g \/ L","idx":0,"proposition":"Proteinorachy at 1.7g\/L"},{"correct":true,"justification":"True, we have a decreased glycorachia, because bacteria consume a lot of sugars","idx":1,"proposition":"Glycorachia <40% of blood glucose"},{"correct":true,"justification":"True, it is a bacterial infection therefore predominant on PNN, this is what also gives the cloudy character of CSF","idx":2,"proposition":"Leukocytosis at 3000\/mm3, predominant on PNN"},{"correct":false,"justification":"False, remember that meningococcal is a gram-negative cocci (diplococcus)","idx":3,"proposition":"Culture of CSF highlighting gram+ cocci"},{"correct":false,"justification":"False, lactates most often indicate a bacterial infection so they are increased here ","idx":4,"proposition":"Lactates <3.2 mmol\/L"}],"type":"custom"}
+{"_id":"antiinf-infectio-b6ed99","context":null,"enonce":"Which of the following propositions are true about cefotaxime?","item":"antiinf","matiere":"infectio","propositions":[{"correct":false,"justification":"Time-dependent, bactericidal","idx":0,"proposition":"Concentration-dependent concentration"},{"correct":true,"justification":"True","idx":1,"proposition":"active on streptococci"},{"correct":true,"justification":"True","idx":2,"proposition":"bactericidal on susceptible gram-negative bacilli"},{"correct":false,"justification":"","idx":3,"proposition":"Active on anaerobes"},{"correct":false,"justification":"","idx":4,"proposition":"Active on enterococci"}],"type":"custom"}
+{"_id":"antiinf-infectio-7fcad6","context":null,"enonce":"Which of the following are true about amikacin?","item":"antiinf","matiere":"infectio","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"It is a glycopeptide"},{"correct":true,"justification":"True","idx":1,"proposition":"It is an aminoglycoside"},{"correct":false,"justification":"Concentration-dependent","idx":2,"proposition":"It's time dependent"},{"correct":true,"justification":"True","idx":3,"proposition":"It is active on gram-negative bacilli"},{"correct":false,"justification":"Indicated in severe NAPs","idx":4,"proposition":"It is nephrotoxic and therefore contraindicated in case of PNA"}],"type":"custom"}
+{"_id":"343-urg-192dab18-c108-408e-8ef0-e461f8fd270e","context":null,"enonce":"Which of the following are criteria for starting emergency dialysis?","item":"IRenA","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Threatening hyperkalemia"},{"correct":false,"justification":"We do not dialysis creat figures","idx":1,"proposition":"Creatinine > 1000 μmol\/L"},{"correct":true,"justification":"True","idx":2,"proposition":"Poor clinical tolerance of uremia"},{"correct":true,"justification":"True","idx":3,"proposition":"Oliguria resistant to loop diuretics with hydro-sodium overload"},{"correct":true,"justification":"True","idx":4,"proposition":"Severe metabolic acidosis"}],"type":"custom"}
+{"_id":"152-dermato-dac6c98a-fa9f-4404-8aef-73c57fee9a52","context":null,"enonce":"Substitute general practitioner, you receive Mr Carver, Elliott, 25 years old, who consults you for a \"rotten nail\" of the feet, which persists for several months and which he has never really cared about. The clinical examination reveals a classic dermatophytic onyxis. What do you do? ","item":"infdermato","matiere":"dermato","propositions":[{"correct":true,"justification":"True, it makes perfect sense","idx":0,"proposition":"Looking for dermatophytic intertrigos and other dermatophytic onyxis"},{"correct":false,"justification":"False, this type of examination can be done in a laboratory","idx":1,"proposition":"You write a letter for a dermatologist, for a biopsy of an affected nail"},{"correct":true,"justification":"True, cf. B","idx":2,"proposition":"You make a prescription for a laboratory, for a biopsy of an affected nail"},{"correct":false,"justification":"False, no probabilistic treatment ","idx":3,"proposition":"You make a prescription for an antifungal probabilistic treatment secondarily adapted to the identification of the fungus"},{"correct":true,"justification":"True, cf. D","idx":4,"proposition":"You make a prescription once the fungus is identified for an antifungal"}],"type":"custom"}
+{"_id":"pancreatitechr-HGE-39856c","context":null,"enonce":"Which of the following are complications of chronic pancreatitis?","item":"pancreatitechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Pseudocysts"},{"correct":true,"justification":"True","idx":1,"proposition":"Adenocarcinoma"},{"correct":true,"justification":"True","idx":2,"proposition":"Extrinsic compression of the bile ducts"},{"correct":true,"justification":"True","idx":3,"proposition":"Exocrine pancreatic insufficiency"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"splenomeg-HGE-6d018b","context":null,"enonce":"When should vaccinations be performed in case of scheduled splenectomy without emergency?","item":"splenomeg","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"2 weeks before surgery"},{"correct":false,"justification":"","idx":1,"proposition":"2 weeks after surgery"},{"correct":false,"justification":"","idx":2,"proposition":"3 weeks before surgery"},{"correct":false,"justification":"","idx":3,"proposition":"4 weeks before surgery"},{"correct":false,"justification":"","idx":4,"proposition":"6 weeks before surgery"}],"type":"custom"}
+{"_id":"nutrigrossesse-endoc-6efea1","context":null,"enonce":"Which of the following are some indications of screening for gestational diabetes in a pregnant woman?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Overweight"},{"correct":true,"justification":"True","idx":1,"proposition":"Diabetic father"},{"correct":true,"justification":"True","idx":2,"proposition":"36 years"},{"correct":true,"justification":"True","idx":3,"proposition":"First macrosome child"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"nutrigrossesse-endoc-90e68c","context":null,"enonce":"Which of the following are some indications of screening for gestational diabetes in a pregnant woman?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"correct":false,"justification":"From 35 years old inclusive","idx":0,"proposition":"32 years"},{"correct":false,"justification":"First-degree family history","idx":1,"proposition":"Diabetic cousin"},{"correct":false,"justification":"Not in the recos 🤷 ♂️","idx":2,"proposition":"Long-term corticosteroid treatment"},{"correct":false,"justification":"From 25 (overweight)","idx":3,"proposition":"BMI = 23"},{"correct":true,"justification":"True, yepaaa","idx":4,"proposition":"All proposals are wrong"}],"type":"custom"}
+{"_id":"menopause-uro-de601c","context":null,"enonce":"Regarding andropause (or age-related testosterone deficiency syndrome), what are the exact proposal(s)?","item":"menopause","matiere":"uro","propositions":[{"correct":false,"justification":"False, it is the testicles, senescent that have trouble secreting, and it will result in hypersecretion of FSH and LH at the pituitary level","idx":0,"proposition":"Andropause is linked to an age-related decrease in FSH and LH secretion."},{"correct":true,"justification":"True, this is the most important thing to remember from this little item. Compare the two and you'll see that it's blatant.","idx":1,"proposition":"Many of the symptoms of andropause are similar to those of menopause"},{"correct":false,"justification":"False, this is a diagnosis that combines clinical signs and a drop in total testosterone.","idx":2,"proposition":"The diagnosis of andropause is biological and based on the dosage, twice, of testosterone"},{"correct":true,"justification":"True, testosterone will act on the prostate and testicles mainly","idx":3,"proposition":"Testosterone treatment involves a prostate and endocrine assessment beforehand"},{"correct":false,"justification":"False, the treatment is administered transdermally or intramuscularly, null trap, but you never know...","idx":4,"proposition":"The treatment of andropause is based on a daily oral intake of free testosterone"}],"type":"custom"}
+{"_id":"tbmiction-uro-cd24d9","context":null,"enonce":"Mrs. Marple, a nice patient of 72 years, comes to see you in consultation of general medicine, for urinary problems quite \"shameful\" according to her own words. Indeed, she has had \"urinary leakage\" for several months, occurring with laughter or coughing, but sometimes she feels an urgent need to urinate which has caused \"some accidents\". By quickly going through the patient's file you note as the only antecedent 5 vaginal deliveries and a work in the textile industry. Among the 5 proposals for additional examinations\/opinions, which sequence do you choose?","item":"tbmiction","matiere":"uro","propositions":[{"correct":false,"justification":"False, as soon as there is an emergency we must eliminate a \"local\" cause of irritation of the bladder (cancer, stone etc ...) and this requires at least a urologist opinion","idx":0,"proposition":"Fasting blood glucose, Urine strip - Physiotherapist consultation for pelvic floor strengthening"},{"correct":false,"justification":"False, ditto answer A","idx":1,"proposition":"Fasting blood glucose, Urine strip, ECBU - Renal and bladder ultrasound - Physiotherapist consultation for pelvic floor strengthening"},{"correct":false,"justification":"False, the assessment here is too excessive, in imaging only ultrasound is necessary and the liver and kidney assessment is dispensable.","idx":2,"proposition":"Fasting blood glucose, CBC\/Iono\/Hepatic test\/Renal assessment, BU, ECBU, Urinary cytodiagnosis - Renal and bladder ultrasound + TAP CT - Urologist opinion"},{"correct":true,"justification":"True, no more and no less (here urgency + risk factor with the textile industry)","idx":3,"proposition":"Fasting blood glucose, BU+ECBU, Urinary cytodiagnosis - Renal and bladder ultrasound - Urologist opinion for urethrocystoscopy"},{"correct":false,"justification":"False, an emergency is an emergency diagnosis","idx":4,"proposition":"Voiding schedule and reassessment of symptoms at the next consultation in 3 months"}],"type":"custom"}
+{"_id":"tbmiction-uro-16f433","context":null,"enonce":"What do you typically find on a voiding calendar?","item":"tbmiction","matiere":"uro","propositions":[{"correct":true,"justification":"True, everything is true","idx":0,"proposition":"Volume urinated by urination"},{"correct":true,"justification":"True","idx":1,"proposition":"The rating of the voiding requirement"},{"correct":true,"justification":"True","idx":2,"proposition":"Fluid intake and type of beverages"},{"correct":true,"justification":"True","idx":3,"proposition":"Paroxysmal urinary functional signs"},{"correct":true,"justification":"True","idx":4,"proposition":"Bladder leakage and its circumstances"}],"type":"custom"}
+{"_id":"soinspal2-soinspal-2a5ab2","context":null,"enonce":"You are an intern in palliative care and you receive the family of Mrs. Onatopp, Xenia, 45 years old, in a situation of palliative care and limitation of care, for small cell lung cancer. Its situation is deteriorating and you have decided to stop subcutaneous hydration and feeding. The family does not understand why you stop this and let Ms. Onatopp \"die\". What is your response to the family? (A correct answer)","item":"soinspal2","matiere":"soinspal","propositions":[{"correct":false,"justification":"False, the benefit here of care is very meagre, and there is a greater risk of adverse effects (false roads, edema ...)","idx":0,"proposition":"\"I understand your outrage and I share it. The patient must benefit from the treatments to the end and I reintroduce nutrition and hydration\""},{"correct":false,"justification":"False, subcutaneous hydration is at risk of edema","idx":1,"proposition":"\"I understand your concern, but eating for her is too risky of false routes and complications. There is no need to continue feeding. However, we can agree on maintaining hydration which is harmless.\""},{"correct":false,"justification":"False, parenteral feeding is at high risk of sepsis","idx":2,"proposition":"\"I understand your fears and doubts, but eating for her has become too difficult and there is a risk of wrong routes for nutrition by mouth. However, we can relay the feeding by vein, to avoid as many complications as possible. There is no need to continue hydration, as the patient has enough fluid reserves in her cells.\""},{"correct":true,"justification":"True, it is the weight of the benefit \/ risk associated with a relay by comfort care","idx":3,"proposition":"\"I understand your doubts and fears, but today this care is more risky, vis-à-vis the benefit that the patient can expect. However, she will be given oral care to prevent her from being disturbed by dry mouth.\""},{"correct":false,"justification":"False, this is a leak of the speech...","idx":4,"proposition":"\"I understand your resentment, but it is not me who decided but my boss, talk to him\""}],"type":"custom"}
+{"_id":"soinspal3-soinspal-765f36","context":null,"enonce":"You attend the morning staff, in the palliative care unit, and you discuss with your senior the case of Mrs. Miranda Frost, 92 years old, hospitalized in your department for the palliative management of Amyotrophic Lateral Sclerosis. You decide to set up a situation of deep and continuous sedation maintained until death. What elements do you need to decide and carry out such care?","item":"soinspal3","matiere":"soinspal","propositions":[{"correct":true,"justification":"True, it allows to have a collegial decision, free from any hierarchical pressure","idx":0,"proposition":"A decision by two physicians who are not linked by a hierarchical relationship, approved by the health care team"},{"correct":false,"justification":"False, morphine and MIDAZOLAM, a kind of super-benzodiazepine that causes deep drowsiness, are used.","idx":1,"proposition":"Treatments: most often Propofol and Morphine"},{"correct":true,"justification":"True, they are essential until death to allow patient calming, dignity and a right to comfort","idx":2,"proposition":"Comfort care"},{"correct":true,"justification":"True, it is essential to know how to evoke this decision to relatives before and after the collegial meeting.","idx":3,"proposition":"Information to relatives"},{"correct":true,"justification":"True, it is not because these are treatments that can cause a double effect, that we will let with impunity the adverse effects (especially serious adverse effects) cause an inconvenience for the patient","idx":4,"proposition":"Regular reassessment of efficacy and safety"}],"type":"custom"}
+{"_id":"soinspal2-soinspal-76687a","context":null,"enonce":"Regarding care decisions, relating to a palliative care situation, what is the hierarchy vis-à-vis care decision-makers? Rank from most important > least important (only 1 correct answer)","item":"soinspal2","matiere":"soinspal","propositions":[{"correct":false,"justification":"False, cf. D","idx":0,"proposition":"Patient, verbally > Patient via advance directives> Palliative care physician > Attending physician> Trusted person > Relatives"},{"correct":false,"justification":"False, cf. D","idx":1,"proposition":"Patient, verbally > Patient via advance directives> Trusted person > Spouse > Relatives"},{"correct":false,"justification":"False, cf. D","idx":2,"proposition":"Palliative care specialist > Doctor in charge of the patient > Attending physician > Patient, orally > Patient, via advance directives > Trusted person > Relatives"},{"correct":true,"justification":"True, the patient is the first actor of his care it is he who decides in agreement with the doctor who does not CHOOSE FOR HIM. The doctor informs, collects and argues but does not decide. Then the advance directives are authentic, then the person of trust (who testifies to the patient's will), and finally his relatives","idx":3,"proposition":"Patient in person> Patient via advance directives > Trusted person > Relatives"},{"correct":false,"justification":"False, cf. D","idx":4,"proposition":"Patient in person> Patient via advance directives> Attending physician or trusted person > Relatives"}],"type":"custom"}
+{"_id":"soinspalped-soinspal-17e284","context":null,"enonce":"Regarding palliative care in pediatrics and neonatology, what are the exact proposal(s)?","item":"soinspalped","matiere":"soinspal","propositions":[{"correct":true,"justification":"True, it is not because he is in palliative care that we should not provide for his needs","idx":0,"proposition":"The child in palliative care, requires educational, social and existential needs"},{"correct":false,"justification":"False, this trap is absolutely to know, there are NO advance directives among minors, simply because advance directives are the will of the person who writes it.","idx":1,"proposition":"If the child is no longer able to express his or her own wishes, we must rely on the advance directives written by the parents."},{"correct":false,"justification":"False, it is the child who has his say and who decides. It is one of the few exceptions in pediatrics","idx":2,"proposition":"The decision of the parents or holders of parental authority takes precedence over that of the child"},{"correct":false,"justification":"False, it mainly concerns the consequences of prematurity","idx":3,"proposition":"Most palliative care in neonatology concerns fetal malformations and chromosic pathologies"},{"correct":true,"justification":"True, it is still a loss and a mourning, so they can intervene in this case too","idx":4,"proposition":"Paediatric palliative care also includes abortions and IMGs"}],"type":"custom"}
+{"_id":"soinspal3-soinspal-078d4a","context":null,"enonce":"Regarding euthanasia and assisted suicide, what are the exact answer(s)?","item":"soinspal3","matiere":"soinspal","propositions":[{"correct":true,"justification":"True, you have to know how to evoke and evaluate the three types of pain","idx":0,"proposition":"Faced with a request for assisted suicide or euthanasia it is imperative to seek physical, psychological and existential pain"},{"correct":false,"justification":"False, it is important to know that the Léonetti law dates \"ONLY\" from 2005 and that it has been revised (Leonetti Claeys Law of 2018)","idx":1,"proposition":"The laws that frame the definitions and legislation on euthanasia and assisted suicide date from the twentieth century"},{"correct":false,"justification":"False, the most important thing in this situation is to understand why the patient is making this request.","idx":2,"proposition":"Faced with a situation of request for euthanasia or assisted suicide, the main thing to do is to explain to the patient the illegal nature of the thing"},{"correct":true,"justification":"True, it is totally obvious, that this gesture is criminally reprehensible, that it can lead to professional and legal sanctions, and that it can lead to compensation...","idx":3,"proposition":"If a physician performs an act of euthanasia or assisted suicide in France, he is liable to an infringement of his professional, criminal and civil liability."},{"correct":false,"justification":"False, of course it is false. We hear more often that the patient asks to die rather than to want to be euthanized, the difference is important!","idx":4,"proposition":"There are more requests for euthanasia than requests for death in hospitals "}],"type":"custom"}
+{"_id":"dlrped-ped-ce63db","context":null,"enonce":"Which of the following are side effects of morphine in children?","item":"dlrped","matiere":"ped","propositions":[{"correct":false,"justification":"Constipation","idx":0,"proposition":"Diarrhoea"},{"correct":true,"justification":"True","idx":1,"proposition":"Bradypnea"},{"correct":true,"justification":"True","idx":2,"proposition":"Coma"},{"correct":true,"justification":"True","idx":3,"proposition":"Itch"},{"correct":false,"justification":"Urine retention","idx":4,"proposition":"Enuresis"}],"type":"custom"}
+{"_id":"dlrped-ped-03234b","context":null,"enonce":"Which of the following can be prescribed for a 2-year-old?","item":"dlrped","matiere":"ped","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Paracetamol"},{"correct":false,"justification":"From 3 years old","idx":1,"proposition":"Tramadol"},{"correct":false,"justification":"From 12 years old","idx":2,"proposition":"Codeine"},{"correct":true,"justification":"True","idx":3,"proposition":"Nalbuphine"},{"correct":true,"justification":"True","idx":4,"proposition":"MEOPA"}],"type":"custom"}
+{"_id":"retardSP-ped-feb24c","context":null,"enonce":"At 3 months, the birth weight is:","item":"retardSP","matiere":"ped","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Unchanged"},{"correct":true,"justification":"True","idx":1,"proposition":"Double"},{"correct":false,"justification":"False","idx":2,"proposition":"Triplet"},{"correct":false,"justification":"False","idx":3,"proposition":"Quadruplet"},{"correct":false,"justification":"of 7kg on average","idx":4,"proposition":"From 15kg on average"}],"type":"custom"}
+{"_id":"autonomiegeria-mpr-2ec831","context":null,"enonce":"Regarding autonomy and dependence in the elderly, what are the exact proposal(s)?","item":"autonomiegeria","matiere":"mpr","propositions":[{"correct":true,"justification":"True, this is the very definition\r\n","idx":0,"proposition":"A USLD is a residential service for chronic and disabling pathologies, and a UHR is a residential service for chronic and disabling psychiatric pathologies.\r\n"},{"correct":true,"justification":"True, it includes an organization of several face-to-face aids\r\n","idx":1,"proposition":"The SSIAD is a service combining personal assistance and administrative assistance\r\n"},{"correct":true,"justification":"True, it also allows a reassessment of the aid plan to relieve caregivers physically and psychically\r\n","idx":2,"proposition":"\"Respite hospitalizations\" are hospitalizations to allow caregivers to rest\r\n"},{"correct":false,"justification":"False, this MCQ was important to know the classic APA criteria (>60 years, France > 3 months) but also to know the IRM grid. It goes from GIR 6 (autonomous) to GIR 1 (moribund) and the APA is given for GIR 1 to 4.\r\n","idx":3,"proposition":"The APA (Personalized Autonomy Allowance) is available to people over 60 years old, living in France for at least 3 months, being classified in the GIR grid 2 to 6\r\n"},{"correct":true,"justification":"True, three times true. Auxiliaries, remote alarm, carrying meals, housing development, protections, HDJ, temporary accommodation, nursing homes","idx":4,"proposition":"The APA finances numerous physical, material and financial aids\r\n"}],"type":"custom"}
+{"_id":"allergie-pneumo-321480","context":null,"enonce":"Which of the following are possible allergens?","item":"allergie","matiere":"pneumo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Animal protein"},{"correct":true,"justification":"True. Allergens are proteins of animal or plant origin.","idx":1,"proposition":"Vegetable protein"},{"correct":false,"justification":"With some exceptions, carbohydrates (lactose in particular) and lipids are not allergenic.","idx":2,"proposition":"Carbohydrate"},{"correct":false,"justification":"False","idx":3,"proposition":"Lipids"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"tbsommeil-pneumo-3cd1e7","context":null,"enonce":"At what apnea\/hypopnea index threshold, are we talking about obstructive sleep apnea syndrome?","item":"tbsommeil","matiere":"pneumo","propositions":[{"correct":false,"justification":"False, this is the apnea threshold for the child","idx":0,"proposition":"Apnea index hypopnea at 3"},{"correct":true,"justification":"True","idx":1,"proposition":"Apnea index hypopnea at 5"},{"correct":false,"justification":"False, this is the threshold of severity of sleep apnea","idx":2,"proposition":"Apnea index hypopnea at 30"},{"correct":false,"justification":"False","idx":3,"proposition":"Apnea index hypopnea at 50"},{"correct":false,"justification":"False","idx":4,"proposition":"Index of apnea hypopneas at 100"}],"type":"custom"}
+{"_id":"tbsommeil-pneumo-62a040","context":null,"enonce":"Which of the following propositions regarding obstructive sleep apnea syndrome is true?","item":"tbsommeil","matiere":"pneumo","propositions":[{"correct":true,"justification":"True, OSA screening must be carried out in front of a risk terrain (cardiovascular comorbidities, cardiovascular risk factors, metabolic syndrome, respiratory pathologies) and \/ or revealing symptoms (snoring, pauses, suffocation, apnea, nocturia, anxio-depressive syndrome, daytime sleepiness ...)","idx":0,"proposition":"Any obese patient with snoring should be referred for consultation or should perform nocturnal oximetry screening for sleep apnea syndrome"},{"correct":false,"justification":"False, the Epworth score looks for daytime sleepiness. It is pathological when it is greater than 11","idx":1,"proposition":"Epworth score looks for nocturnal symptoms of sleep apnea through interrogation elements"},{"correct":false,"justification":"False, the screening is done by nocturnal oximetry (imagine it as a Holter of SaO2) and the diagnosis is done by ventilatory polygraphy or polysomnography","idx":2,"proposition":"Screening for obstructive sleep apnea syndrome is done by nocturnal ventilatory polygraphy. "},{"correct":true,"justification":"True, it is part of the comorbidities that may indicate bariatric surgery during a BMI >35 especially because its improvement in post-surgery is quite frequent","idx":3,"proposition":"Obstructive sleep apnea syndrome may be an indication for bariatric surgery in case of BMI > 35"},{"correct":true,"justification":"True, fatal risk to the patient due to drowsiness","idx":4,"proposition":"Obstructive sleep apnea syndrome is a temporary contraindication to driving"}],"type":"custom"}
+{"_id":"BPCO-pneumo-23d43c","context":null,"enonce":"What is the threshold of the Golde score defining intraalveolar hemorrhage?","item":"BPCO","matiere":"pneumo","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"10"},{"correct":false,"justification":"","idx":1,"proposition":"20"},{"correct":false,"justification":"","idx":2,"proposition":"50"},{"correct":true,"justification":"True","idx":3,"proposition":"100"},{"correct":false,"justification":"","idx":4,"proposition":"500"}],"type":"custom"}
+{"_id":"exantheme-dermato-1f19da","context":null,"enonce":"Regarding febrile rashes, which of these propositions are true?","item":"exantheme","matiere":"dermato","propositions":[{"correct":true,"justification":"True, a fever in children is rarely greater than 5 days, Kawasaki syndrome is sought with cardiac ultrasound and CBC","idx":0,"proposition":"A febrile rash of more than 5 days in children should be tested for Kawasaki syndrome"},{"correct":true,"justification":"True, these two forms of rashes are called \"large simulators\", HIV and syphilis can mimic many dermatological pathologies ...","idx":1,"proposition":"An atypical, poorly systematized rash in adults should be reminiscent of HIV or syphilis"},{"correct":false,"justification":"False, it is an erythema called in \"bellows\" (bright red cheeks and edematous) and \"gloves and socks\" (red hands and feet edematous)","idx":2,"proposition":"A so-called \"cervical cache\" erythema is found in Parvovirus B19 infection"},{"correct":true,"justification":"True, this is scarlet fever caused by a Strepto A infection.","idx":3,"proposition":"Of the most common febrile childhood rashes, only one is of bacterial origin"},{"correct":false,"justification":"False, there is only one flare-up during measles with a start behind the ear and a downward path.","idx":4,"proposition":"Unlike rubella, measles progresses in several outbreaks"}],"type":"custom"}
+{"_id":"prurit-dermato-9853ca","context":null,"enonce":"Regarding pruritus, what are the exact proposal(s)?","item":"prurit","matiere":"dermato","propositions":[{"correct":true,"justification":"True, it is to be distinguished from physiological pruritus which has no impact.","idx":0,"proposition":"Pruritus is said to be pathological when it causes lesions or functional repercussions"},{"correct":false,"justification":"False, a pruritus sine materia is a pruritus that does not have lesions except those caused by pruritus itself.","idx":1,"proposition":"A pruritus sine materia is a pruritus that does not present lesions and therefore and is synonymous with physiological pruritus"},{"correct":false,"justification":"False, nasty trap, but urticaria and psoriasis have dermatological lesions...","idx":2,"proposition":"Causes of pruritus sine materia frequently include dysthyroidism, medications, parasitosis, hives, psoriasis, cholestasis and hemopathies."},{"correct":true,"justification":"True, no more and no less","idx":3,"proposition":"The assessment of pruritus sine materia includes: NFS, CRP, Iono, BR, BH, TSH, HIV\/HBV\/HCV, abdominal ultrasound, chest X-ray"},{"correct":false,"justification":"False, we will favor topical treatments and if only the pruritus is too intense we can use antihistamines","idx":4,"proposition":"Benzodiazepines are the treatment of choice to soothe the patient to avoid pruritus"}],"type":"custom"}
+{"_id":"hemangiome-dermato-cc5714","context":null,"enonce":"Luke Marcheciel is a newborn baby who was born 24 hours ago. While you take the time to reread the letters and you have entrusted the clinical examination of the baby to your outpatient, he comes back proud because he thinks he has diagnosed a hemangioma! Suspicious, you congratulate him, but question his diagnosis. What elements of the clinical picture or examination will refute your external hypothesis?","item":"hemangiome","matiere":"dermato","propositions":[{"correct":true,"justification":"True, a hemangioma usually only sets in after several weeks of life, unlike the vascular malformation that is present from birth.","idx":0,"proposition":"Speed of installation"},{"correct":false,"justification":"False, color has no impact on the diagnosis.","idx":1,"proposition":"A raspberry color of the lesion"},{"correct":true,"justification":"True, a hemangioma is flexible, soft and has no pulsations or internal heat. Unlike vascular malformation","idx":2,"proposition":"A beating, warm and pulsatile mass"},{"correct":true,"justification":"True, varicose veins and vascular malformations are characteristic of congenital malformations ","idx":3,"proposition":"Associated varicose veins"},{"correct":false,"justification":"False, vascular malformation remains stable, unlike hemangioma","idx":4,"proposition":"An expansion of mass in the coming days"}],"type":"custom"}
+{"_id":"exantheme-dermato-1e84ac","context":null,"enonce":"During your Saturday standby, you go to your MPR department and you meet Mrs. Jeanne Dorian, 67 years old, who is gradually recovering from her stroke that occurred 1 month ago. She tells you that if the resumption of walking is gradual, she still has a lot of trouble grasping her glass of water with her right hand which is \"paralyzed\". She wonders how she will be able to play the violin with such a weak hand... Link the impact of the disability with the examples from the statement.","item":"exantheme","matiere":"dermato","propositions":[{"correct":false,"justification":"False, Deficiency","idx":0,"proposition":"Hemiplegia = Activity limitation"},{"correct":true,"justification":"True","idx":1,"proposition":"Difficulty grasping the glass of water = Activity limitation"},{"correct":true,"justification":"True","idx":2,"proposition":"Stop playing the violin = Restriction of participation"},{"correct":false,"justification":"False, Activity limitation","idx":3,"proposition":"Difficulty grasping the glass of water = Impairment"},{"correct":false,"justification":"False, Restriction of participation","idx":4,"proposition":"Stop playing the violin = Activity limitation"}],"type":"custom"}
+{"_id":"152-dermato-1086b55f-c6b1-4335-a827-6a24c6abb0c6","context":null,"enonce":"Regarding cutaneous-mucosal infections with Candida, what are the exact proposal(s)?","item":"infdermato","matiere":"dermato","propositions":[{"correct":true,"justification":"True, this kind of infection is very common ","idx":0,"proposition":"A perlèche is an intertrigo of the labial commissure, which may be of fungal origin"},{"correct":true,"justification":"True, this semiological finesse is important to distinguish the two causes and allow an adapted antifungal treatment","idx":1,"proposition":"Unlike dermatophytes, nail candidiasis has centrifugal extension and perionyxis"},{"correct":false,"justification":"False, it is necessary to know what is typical of candidiasis (under breast, abdominal fold, intergluteal) and dermatophyte (inguinal)","idx":2,"proposition":"An intertrigo of the inguinal folds is classic of candida infections"},{"correct":false,"justification":"False, one of the most important points of candidiasis is its physiological presence in the digestive and vaginal mucous membranes","idx":3,"proposition":"In front of an infection, vaginosis type, a positive Candida sample signs vaginal candidiasis"},{"correct":false,"justification":"False, these are systemic antifungals.","idx":4,"proposition":"Topical antifungals are mainly based on fluconazole or amphotericin B"}],"type":"custom"}
+{"_id":"DBAI-dermato-828ed3","context":null,"enonce":"Regarding autoimmune bullous dermatoses which of these propositions are true?","item":"DBAI","matiere":"dermato","propositions":[{"correct":true,"justification":"True, and far ahead of pemphigus","idx":0,"proposition":"The most common autoimmune bullous dermatosis in France is bullous pemphigoid"},{"correct":true,"justification":"True, which makes it can be confused with Behcet's disease or Cowden syndrome (do not remember Cowden syndrome)","idx":1,"proposition":"Clinically, pemphigus can present only through mouth or genital ulcerations."},{"correct":false,"justification":"False, indeed it is necessary to make several samples, but because there will be one that will be unfixed (for histological analysis) and one that will be fixed to highlight the areas of fixation of antibodies.","idx":2,"proposition":"It is essential to take several samples during the biopsy, with the main purpose of allowing a second opinion in case of diagnostic doubt"},{"correct":true,"justification":"True, these are also the same complications as pressure ulcers if you notice well.","idx":3,"proposition":"The main complications of autoimmune bullous dermatoses are infections, hypothermia, dehydration and undernutrition."},{"correct":false,"justification":"False, it has been shown for years, that local corticosteroid therapy has a similar effectiveness for fewer adverse effects","idx":4,"proposition":"The standard of care is based on systemic corticosteroid therapy"}],"type":"custom"}
+{"_id":"TED-psy-5faba8","context":null,"enonce":"Which of the following proposals may be present in a child with autism spectrum disorder?","item":"TED","matiere":"psy","propositions":[{"correct":true,"justification":"When parents smile at their child, the child does not smile at them. This is a very early sign of autism. ","idx":0,"proposition":"Absence or rarity of smiles answers"},{"correct":true,"justification":"True, by social clumsiness","idx":1,"proposition":"Children have difficulty accessing implicit and figurative language"},{"correct":true,"justification":"These are the difficulties in having reciprocal exchanges. The child will also have remarks that are focused on his own interests and does not take into account the point of life or the words of the interlocutor to register in a turn of turn (social clumsiness). ","idx":2,"proposition":"Conversations tend to be focused on the patient's interests"},{"correct":false,"justification":"The child has a lot of difficulty making friends. In addition, they are often not very interested in social relationships with peers (lack of social motivation). ","idx":3,"proposition":"The child has facilities to make friends"},{"correct":true,"justification":"True, very characteristic","idx":4,"proposition":"The child repeatedly uses objects"}],"type":"custom"}
+{"_id":"bipolaire-psy-7b3b02","context":null,"enonce":"Which of the following propositions regarding bipolar disorder is true?","item":"bipolaire","matiere":"psy","propositions":[{"correct":true,"justification":"True, hence sometimes the notion of bipolar disorder type III, manic disorders induced by antidepressants etc ...","idx":0,"proposition":"Although a distinction is usually made between type I and type II bipolar disorder, there are bipolar disorders that do not fit into this classification."},{"correct":true,"justification":"True, this is THE prodrome to know in the bipolar patient","idx":1,"proposition":"A manic crisis should be evoked in front of a bipolar patient, with recent insomnia without fatigue"},{"correct":false,"justification":"False, on the contrary, the fact that he is not \"paralyzed\" by depression, will promote the passage to the act","idx":2,"proposition":"In front of a patient with manic syndrome, it is useless to look for suicidal thoughts, since he presents an elation of mood"},{"correct":false,"justification":"False, treatment will be implemented remotely, once bipolar disorder is diagnosed and differential diagnoses have been ruled out.","idx":3,"proposition":"In front of a maniacal patient in the emergency room, lithium treatment must be initiated without delay, because of its long half-life and narrow therapeutic range."},{"correct":true,"justification":"True, as well as regular serum lithium","idx":4,"proposition":"Monitoring of lithium in chronic treatment is based in particular on TSH, urea and annual serum creatinine"}],"type":"custom"}
+{"_id":"TED-psy-352349","context":null,"enonce":"Regarding comorbidities with other neurodevelopmental disorders. Which of the following are true?","item":"TED","matiere":"psy","propositions":[{"correct":false,"justification":"40%","idx":0,"proposition":"30% of children with ASD have an intellectual disability"},{"correct":false,"justification":"30%","idx":1,"proposition":"20% of children with ASD have attention deficit hyperactivity disorder"},{"correct":true,"justification":"These are non-verbal ASDs","idx":2,"proposition":"20% of children have oral language acquisition disorders "},{"correct":true,"justification":"True","idx":3,"proposition":"Children often have sleep disorders"},{"correct":false,"justification":"20%","idx":4,"proposition":"10% of children with autism spectrum disorder will have epilepsy at some point in their lives"}],"type":"custom"}
+{"_id":"psygrossesse-psy-7ac150","context":null,"enonce":"Which of the following are risk factors for postpartum mental disorders?","item":"psygrossesse","matiere":"psy","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Social precariousness"},{"correct":false,"justification":"Rather single-parent family","idx":1,"proposition":"Large family"},{"correct":false,"justification":"Rather nulliparity","idx":2,"proposition":"Multiparity"},{"correct":true,"justification":"True","idx":3,"proposition":"Denial of pregnancy"},{"correct":true,"justification":"True","idx":4,"proposition":"Family history of psychiatric disorders"}],"type":"custom"}
+{"_id":"TED-psy-d0a76a","context":null,"enonce":"Among the following proposals, which additional examinations are part of the assessment to look for differential diagnoses of pervasive developmental disorders?","item":"TED","matiere":"psy","propositions":[{"correct":false,"justification":"Only to make the diagnosis of associated disease. Epilepsy is not a differential diagnosis.","idx":0,"proposition":"Wake and sleep EEG"},{"correct":true,"justification":"To look for deafness or hearing loss","idx":1,"proposition":"Audiogram and PEA"},{"correct":true,"justification":"Search for differential diagnoses and also associated diagnoses","idx":2,"proposition":"Psychomotor assessment"},{"correct":false,"justification":"These are scores to make the positive diagnosis. The ADI-R is a semi-structured interview with parents, which examines the current symptomatology as well as the developmental history of the child. ADOS is a semi-structured observation of the child's symptomatology. ","idx":3,"proposition":"ADI-R and ADOS"},{"correct":false,"justification":"These diagnostic tests are useful for diagnosing ASD syndromes, not for finding a differential diagnosis.","idx":4,"proposition":"Neurological, genetic, metabolic and brain MRI assessments"}],"type":"custom"}
+{"_id":"dvlptpsychoMo-psy-d565a7","context":null,"enonce":"Which of the following are true?","item":"dvlptpsychoMo","matiere":"psy","propositions":[{"correct":true,"justification":"True, at the maneuver we can observe a fall behind the head up to 2 months of age","idx":0,"proposition":"The pull-and-sit maneuver is used to evaluate the holding of the head"},{"correct":false,"justification":"False, at 4 months, he sits with support. At 8 months only, without support","idx":1,"proposition":"From 4 months, the child must sit without support"},{"correct":true,"justification":"True, walking alone can be observed from 9 to 18 months.","idx":2,"proposition":"The child can walk alone from 9 months"},{"correct":true,"justification":"True, reflex from bending the fingers to stimulating the palms of the hands or feet","idx":3,"proposition":"The reflex grasping is a reflex of the newborn"},{"correct":false,"justification":"False, she becomes a volunteer around 4-5 months. At 9 months the child can manipulate with 2 hands and also appears the thumb clamp index","idx":4,"proposition":"The grip becomes voluntary from 9 months"}],"type":"custom"}
+{"_id":"TED-psy-6aadcb","context":null,"enonce":"Regarding the schooling of patients with ASD, which are true?","item":"TED","matiere":"psy","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"The type of schooling adapted to the child will depend on the level of severity of ASD, the impact\r\nfunctional disorder and associated neurodevelopmental disorders and parental choice."},{"correct":false,"justification":"The children have an ordinary schooling, but there will be adjustments. The Personalized Support Project (PAP) and the Personalized Schooling Project (PPS) specify the arrangements that should allow schooling in an ordinary environment. Some patients will therefore be able to benefit from a School Life Assistant (AVS) when they have learning difficulties or difficulties with autonomy.","idx":1,"proposition":"Patients with mild ASD without another neurodevelopmental disorder\r\nassociated, and with a slight functional impact, have schooling in an ordinary environment, and will have no accommodation."},{"correct":true,"justification":"True","idx":2,"proposition":"Patients with mild ASD, another associated neurodevelopmental disorder (for example, mild intellectual disability), and with mild or moderate functional impact will be enrolled in ULIS (Localized Units for Inclusive Education) classes."},{"correct":true,"justification":"Medical-educational institutes","idx":3,"proposition":"Patients with moderate to severe ASD and another associated neurodevelopmental disorder (e.g., moderate intellectual disability), and with moderate or severe functional impact: IME orientation."},{"correct":false,"justification":"The statement is true, except for the PAP. Simple school arrangements made by the PAP do not need notification to the MDPH: the project is only validated by the school doctor.","idx":4,"proposition":"The implementation of school facilities (PAP, PPS, AVS) and school orientations (ULIS, IME) always require notification from the MDPH, which requires the drafting of a reasoned medical certificate."}],"type":"custom"}
+{"_id":"dlrpsy-psy-8fcc57","context":null,"enonce":"Regarding the links between pain and mental health, what are the exact proposition(s)?","item":"dlrpsy","matiere":"psy","propositions":[{"correct":true,"justification":"True, it is quite logical, psychic pain leads to physical pain and vice versa","idx":0,"proposition":"Patients with a characterized depressive episode more often have chronic pain complaints and vice versa"},{"correct":true,"justification":"True, the pathophysiological cause\/consequence is more difficult to pin down, but it does exist...","idx":1,"proposition":"A fibromyalgia patient has a higher risk of developing bipolar disorder than a person without chronic pain"},{"correct":false,"justification":"False, the urgency is the chest pain here that must quickly perform an ECG","idx":2,"proposition":"In front of a patient in the emergency room having a panic attack, who complains of chest pain at the same time, the urgency is to calm the patient by words or by a benzodiazepine"},{"correct":false,"justification":"False, the schizophrenic patient feels the pain but does not recognize it and cannot express it clearly","idx":3,"proposition":"The schizophrenic patient develops anesthesia to pain, which explains why he expresses it less because he feels it less"},{"correct":true,"justification":"True, a bit like the schizophrenic patient, he has trouble expressing his pain clearly and therefore the pain is to be sought!","idx":4,"proposition":"Children with autism spectrum disorder may exhibit withdrawal, aggression or mutilation behaviours in the face of pain"}],"type":"custom"}
+{"_id":"somatopsy-psy-cb0582","context":null,"enonce":"Regarding somatoform disorders, which of these propositions are true?","item":"somatopsy","matiere":"psy","propositions":[{"correct":true,"justification":"True, like any psychiatric illness. A child of a depressed parent is more likely to develop depression. Same with somatoform disorder","idx":0,"proposition":"There is polygenic genetic transmission of somatoform disorders "},{"correct":true,"justification":"True, extremely frequent. Any doctor will face this situation at some point.","idx":1,"proposition":"Among the functional signs often expressed in somatoform disorders, we readily find chest and abdominal pain"},{"correct":false,"justification":"False, it is an entire part of it. It is the erroneous belief of being overweight or obese.","idx":2,"proposition":"Dysmorphophobia is not part of somatoform disorders"},{"correct":false,"justification":"False, somatoform disorder is a diagnosis of elimination. Just because a patient has psychiatric disorders doesn't mean they can't have a heart attack or stroke!","idx":3,"proposition":"Faced with a physical complaint in a patient with multiple psychiatric history, it is necessary to know how to quickly evoke somatoform disorders"},{"correct":false,"justification":"False, the patient is convinced that he has a medical pathology, and the perpetuation of negative examinations only reinforces his certainty (the idea that his disease is not known to doctors, is not diagnosable etc ...)","idx":4,"proposition":"It is often recommended to multiply additional examinations and medical opinions in front of a somatoform disorder, to reassure the patient"}],"type":"custom"}
+{"_id":"psyage-psy-3a1765","context":null,"enonce":"Concerning mental disorders in the elderly, which of the following propositions are true?","item":"psyage","matiere":"psy","propositions":[{"correct":true,"justification":"True, these units are frequently found in geriatric clusters.","idx":0,"proposition":"The management of patients with chronic psychiatric disorders or psychiatric manifestations of neurodegenerative pathologies can be done in U.C.C (cognitive-behavioral units)"},{"correct":false,"justification":"Wrong, it's the other way around. ","idx":1,"proposition":"Schizophrenia in the elderly will manifest itself by a predominance of negative symptoms and disorganization and a lesser presence of positive symptoms"},{"correct":false,"justification":"False, usually we find delusions of persecution or misidentification","idx":2,"proposition":"In the psychiatric manifestations of neurodegenerative diseases we will find delusional ideas of grandeur or megalomania"},{"correct":false,"justification":"False, usually we start at half dose, to avoid the main side effects","idx":3,"proposition":"To prescribe psychotropic drugs in the elderly, we start at the same dose as in adults, but we increase the doses more gradually."},{"correct":true,"justification":"True, benzodiazepine abuse and addiction is extremely common in the general population.","idx":4,"proposition":"A memory complaint may be related to chronic addiction to benzodiazepines"}],"type":"custom"}
+{"_id":"certificats-psy-82219e","context":null,"enonce":"ITT stands for:","item":"certificats","matiere":"psy","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"total incapacity for work"},{"correct":false,"justification":"","idx":1,"proposition":"temporary incapacity for work"},{"correct":false,"justification":"","idx":2,"proposition":"Total temporary incapacity"},{"correct":true,"justification":"True","idx":3,"proposition":"Total incapacity for work"},{"correct":false,"justification":"","idx":4,"proposition":"All proposals are wrong"}],"type":"custom"}
+{"_id":"IU-infectio-511764","context":null,"enonce":"What are the additional examinations of acute non-serious pyelonephritis without risk of complications probably diagnosed?","item":"IU","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"DRANK"},{"correct":true,"justification":"True","idx":1,"proposition":"ECBU"},{"correct":false,"justification":"If second episode or hyperalgic form","idx":2,"proposition":"Ultrasound"},{"correct":false,"justification":"If PNA severe or at risk of complication","idx":3,"proposition":"Uroscanner"},{"correct":false,"justification":"If in doubt diagnosis","idx":4,"proposition":"Blood culture"}],"type":"custom"}
+{"_id":"PECKc-urg-3d795d","context":null,"enonce":"Which of the following propositions concerning pre-eclampsia are true?","item":"PECKc","matiere":"urg","propositions":[{"correct":false,"justification":"False, in 4 to 12% of pre-eclampsia. Pre-eclampsia affects 3 to 10% of pregnancies. ","idx":0,"proposition":"HELLP syndrome occurs in 4 to 12% of pregnancies"},{"correct":true,"justification":"True","idx":1,"proposition":"Immediate hospitalization is indicated before the discovery of pre-eclampsia"},{"correct":true,"justification":"True","idx":2,"proposition":"In front of any visual abnormality it is necessary to make a fundus in search of hypertensive complications. "},{"correct":true,"justification":"True, others are acute fatty liver disease (SHAG), HUS or thrombotic thrombocytopenic purpura (TTP)","idx":3,"proposition":"One of the differential diagnoses of pre-eclampsia is thrombotic microangiopathy. "},{"correct":false,"justification":"False, it is only necessary to undertake a vascular filling when a risk of hypovolemia is predictable. Overfilling can precipitate the occurrence of an OAP. ","idx":4,"proposition":"Vascular filling of patients with pre-eclampsia is essential. "}],"type":"custom"}
+{"_id":"359-urg-95ddc9af-8e9a-4f9f-aa0e-ac7b9b7868fa","context":null,"enonce":"Regarding fractures of the upper end of the femur. Which of the following are true?","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":"External rotation","idx":0,"proposition":"The typical deformation is in Shortening, Internal Rotation, Adduction.\r\n"},{"correct":true,"justification":"The trochanterian massif is mainly trabecular bone.","idx":1,"proposition":"The trochanterian massif is mainly trabecular bone."},{"correct":false,"justification":" Psoas","idx":2,"proposition":"The little trochanter is the insertion site of the gluteus medius"},{"correct":false,"justification":"gluteus medius","idx":3,"proposition":"The great trochanter is the insertion site of the Psoas"},{"correct":false,"justification":"False.","idx":4,"proposition":"During a pertrochanteric fracture, there is a risk of osteonecrosis of the femoral head."}],"type":"custom"}
+{"_id":"boiterieped-ortho-4d3340","context":null,"enonce":"Regarding superior femoral epiphysiolysis. Which of the following proposition(s) are true?","item":"boiterieped","matiere":"ortho","propositions":[{"correct":false,"justification":"False. 1st cause","idx":0,"proposition":"It is the second cause of hip lameness during the pubertal period, after osteoarticular infection."},{"correct":true,"justification":"True","idx":1,"proposition":"Being overweight is a risk factor"},{"correct":false,"justification":"False. External rotation. ","idx":2,"proposition":"The patient walks in internal rotation"},{"correct":true,"justification":"True","idx":3,"proposition":"There are two forms: the stable form and the unstable form"},{"correct":true,"justification":"True","idx":4,"proposition":"It is a growing cartilage disease of unknown cause."}],"type":"custom"}
+{"_id":"boiterieped-ortho-a970b5","context":null,"enonce":"Among the main germs found in children, we find which germ at what age?","item":"boiterieped","matiere":"ortho","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Kingella kingae in children from 6 months to 4 years"},{"correct":false,"justification":"False. Salmonella sp.","idx":1,"proposition":"Staphylococcus aureus is the majority in children with sickle cell disease"},{"correct":false,"justification":"False. This is Kingella kingae. ","idx":2,"proposition":"Pneumococcus is the most common germ in children from 6 months to 4 years"},{"correct":true,"justification":"True","idx":3,"proposition":"Staphyloccocus aureus is the majority in children over 4 years of age"},{"correct":true,"justification":"True. Infection during childbirth.","idx":4,"proposition":"E. coli and group B streptococcus are the majority in infants less than 3 months of age"}],"type":"custom"}
+{"_id":"boiterieped-ortho-6136eb","context":null,"enonce":"Which one(s) is part of the systematic assessment in the face of a suspicion of acute osteoarticular infection in children?","item":"boiterieped","matiere":"ortho","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Ultrasound of the affected joint, often comparative"},{"correct":false,"justification":"False. It is the best test for diagnosing IOA (more sensitive and specific than bone scan), but it is not indicated systematically. ","idx":1,"proposition":"Systematic MRI"},{"correct":true,"justification":"True","idx":2,"proposition":"Blood"},{"correct":true,"justification":"True","idx":3,"proposition":"Systematic block washing with sampling"},{"correct":true,"justification":"True","idx":4,"proposition":"NFS, CRP"}],"type":"custom"}
+{"_id":"radiculalgie-ortho-21b8bd","context":null,"enonce":"Which of the following refer to muscles innervated by the median nerve?","item":"radiculalgie","matiere":"ortho","propositions":[{"correct":false,"justification":"Ulnar nerve","idx":0,"proposition":"Interosseous"},{"correct":false,"justification":"Ulnar nerve","idx":1,"proposition":"Earthworms"},{"correct":false,"justification":"Extension is provided by the radial nerve","idx":2,"proposition":"Finger extenders"},{"correct":false,"justification":"Ulnar nerve","idx":3,"proposition":"The adductor of the thumb"},{"correct":true,"justification":"True","idx":4,"proposition":"None of the propositions are true"}],"type":"custom"}
+{"_id":"radiculalgie-ortho-ad68a1","context":null,"enonce":"Which of the following propositions refer to muscles of the hypothenar compartment?","item":"radiculalgie","matiere":"ortho","propositions":[{"correct":true,"justification":"True, all the muscles mentioned in these propositions are innervated by the ulnar nerve","idx":0,"proposition":"Opponent of the 5"},{"correct":true,"justification":"True","idx":1,"proposition":"Adductor of the 5"},{"correct":true,"justification":"True","idx":2,"proposition":"Flexor of the 5"},{"correct":false,"justification":"Thenarian Lodge","idx":3,"proposition":"Opponent of the thumb"},{"correct":false,"justification":"Thenarian Lodge","idx":4,"proposition":"Adductor of the thumb"}],"type":"custom"}
+{"_id":"radiculalgie-ortho-cced87","context":null,"enonce":"Which of the following are muscles innervated by the ulnar nerve?","item":"radiculalgie","matiere":"ortho","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Short deep flexor of the thumb"},{"correct":false,"justification":"Medial nerve","idx":1,"proposition":"Short superficial flexor of the thumb"},{"correct":false,"justification":"Medial nerve","idx":2,"proposition":"Opponent of the thumb"},{"correct":true,"justification":"True","idx":3,"proposition":"Adductor of the thumb"},{"correct":false,"justification":"Medial nerve","idx":4,"proposition":"Abductor of the thumb"}],"type":"custom"}
+{"_id":"radiculalgie-ortho-e83341","context":null,"enonce":"Regarding the gooseneck:","item":"radiculalgie","matiere":"ortho","propositions":[{"correct":false,"justification":"It is the evolution of a mallet finger","idx":0,"proposition":"It is the evolution of a buttonhole finger"},{"correct":true,"justification":"True","idx":1,"proposition":"The ligaments are retracted"},{"correct":true,"justification":"True","idx":2,"proposition":"It reflects the chronic involvement of the IPD extender"},{"correct":false,"justification":"False","idx":3,"proposition":"It reflects chronic involvement of the IPD flexor"},{"correct":false,"justification":"False","idx":4,"proposition":"It reflects chronic involvement of the PPI extender"}],"type":"custom"}
+{"_id":"dysphagie-HGE-eaefe0","context":null,"enonce":"Which of the following are true about Zenker's diverticulum?","item":"dysphagie","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The hernia develops in retroesophageal"},{"correct":false,"justification":"Perm","idx":1,"proposition":"Dysphagia is fluctuating"},{"correct":true,"justification":"True","idx":2,"proposition":"It can cause inhalation pneumonitis"},{"correct":true,"justification":"True","idx":3,"proposition":"Nasofibroscopy regains the sign of the tide 🌊"},{"correct":false,"justification":"Surgery: myotomy","idx":4,"proposition":"Treatment relies on PEPs"}],"type":"custom"}
+{"_id":"cirrhose-HGE-9de951","context":null,"enonce":"Which hepatitis virus(s) is\/are usually asymptomatic in the acute phase?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"HAV"},{"correct":true,"justification":"True, in 70% of cases","idx":1,"proposition":"HBV"},{"correct":true,"justification":"True, in 80% of cases","idx":2,"proposition":"HCV"},{"correct":false,"justification":"","idx":3,"proposition":"VHD"},{"correct":false,"justification":"","idx":4,"proposition":"HEV"}],"type":"custom"}
+{"_id":"hemorroides-HGE-70a76e","context":null,"enonce":"What is the lifetime prevalence of hemorrhoids?","item":"hemorroides","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"5%"},{"correct":true,"justification":"True","idx":1,"proposition":"33%"},{"correct":false,"justification":"","idx":2,"proposition":"50%"},{"correct":false,"justification":"","idx":3,"proposition":"75%"},{"correct":false,"justification":"","idx":4,"proposition":"90%"}],"type":"custom"}
+{"_id":"hernie-HGE-46b754","context":null,"enonce":"Regarding hernia, what are the exact answer(s)?","item":"hernie","matiere":"HGE","propositions":[{"correct":true,"justification":"True, unlike ventration","idx":0,"proposition":"It is the passage of abdominal contents through a natural orifice"},{"correct":true,"justification":"True, in front of the coral and umbilical","idx":1,"proposition":"Inguinal hernia is the most common"},{"correct":true,"justification":"True, very common","idx":2,"proposition":"There are 150,000 hernia cures per year"},{"correct":false,"justification":"95%","idx":3,"proposition":"25% of the child's hernias are congenital"},{"correct":false,"justification":"🙃🙃🙈","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"UGD-HGE-e20d82","context":null,"enonce":"Which of the following are possible complications of H. pylori infection?","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Malt lymphoma"},{"correct":true,"justification":"True","idx":1,"proposition":"Peptic ulcer"},{"correct":true,"justification":"True","idx":2,"proposition":"Gastric adenoarcinoma"},{"correct":false,"justification":"H. Pylori 👉 Adenocarcinoma","idx":3,"proposition":"Gastric squamous cell carcinoma"},{"correct":false,"justification":"Chronic","idx":4,"proposition":"Acute viral gastritis without chronicity"}],"type":"custom"}
+{"_id":"constipation-HGE-1603af","context":null,"enonce":"Which of the following are true for irritable bowel syndrome (IBS)?","item":"constipation","matiere":"HGE","propositions":[{"correct":false,"justification":"Absent at night, predominates in the morning and post-prandial","idx":0,"proposition":"Pain predominates at night"},{"correct":false,"justification":"Yes, we can have both (typical pain + <3 bowel movements per week)","idx":1,"proposition":"There is no IBS form - Constipation"},{"correct":true,"justification":"True","idx":2,"proposition":"There are no organic abnormalities of the intestine"},{"correct":true,"justification":"True","idx":3,"proposition":"Rest helps calm pain"},{"correct":false,"justification":"Increased pain in post prandial","idx":4,"proposition":"We talk about painful hunger"}],"type":"custom"}
+{"_id":"masseabdo-HGE-4ec5a4","context":null,"enonce":"Which of the following is one or more of the potential cause(s) of hepatomegaly?","item":"masseabdo","matiere":"HGE","propositions":[{"correct":true,"justification":"True, these are all causes :)","idx":0,"proposition":"Hemochromatosis"},{"correct":true,"justification":"True","idx":1,"proposition":"Wilson's disease"},{"correct":true,"justification":"True","idx":2,"proposition":"Syndrome de Budd Chiari"},{"correct":true,"justification":"True","idx":3,"proposition":"Liver polycystic disease"},{"correct":true,"justification":"True","idx":4,"proposition":"Prolonged cholestasis"}],"type":"custom"}
+{"_id":"lithiaseB-HGE-6107e8","context":null,"enonce":"How does the incidence of lithiasis change with age?","item":"lithiaseB","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It increases"},{"correct":false,"justification":"","idx":1,"proposition":"It decreases"},{"correct":false,"justification":"","idx":2,"proposition":"It does not change"},{"correct":false,"justification":"","idx":3,"proposition":"This has not been studied 🤷 ♂️"},{"correct":false,"justification":"It was necessary to find 4 distractors 😂","idx":4,"proposition":"Studies are contradictory 🤷 ♀️"}],"type":"custom"}
+{"_id":"diarrheeaigue-HGE-0573da","context":null,"enonce":"Which of the following are the providers of diarrhoea?","item":"diarrheeaigue","matiere":"HGE","propositions":[{"correct":true,"justification":"True, it is one of the most common treatments for diarrhea^^","idx":0,"proposition":"Amoxicillin + Clavulanic Acid"},{"correct":true,"justification":"True, ISIS to know","idx":1,"proposition":"Statins"},{"correct":true,"justification":"True, so important that it can go so far as to require stopping the treatment","idx":2,"proposition":"Metformin"},{"correct":true,"justification":"True, it is an antimetabolic (the lining of the intestine is renewed very quickly)","idx":3,"proposition":"Colchicine"},{"correct":true,"justification":"True, it's chemotherapy","idx":4,"proposition":"Anthracycline"}],"type":"custom"}
+{"_id":"vomisst-HGE-8280d5","context":null,"enonce":"Which of the following are anti-emetic drugs?","item":"vomisst","matiere":"HGE","propositions":[{"correct":false,"justification":"6 effects: anxiolytics, hypnotics, anti-convulsants, orexigen, muscle relaxants, amnesiacs","idx":0,"proposition":"Benzodiazepines"},{"correct":true,"justification":"True, very frequently used","idx":1,"proposition":"Metoclopramide"},{"correct":true,"justification":"True, very frequently used","idx":2,"proposition":"Metopimazine"},{"correct":true,"justification":"True, it is used in particular to counter the adverse effects of chemotherapy","idx":3,"proposition":"Setron"},{"correct":true,"justification":"True, used in combination with others","idx":4,"proposition":"Corticosteroids"}],"type":"custom"}
+{"_id":"diarrheeaigue-HGE-7278d2","context":null,"enonce":"Which of the following are signs of dehydration?","item":"diarrheeaigue","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Thirst"},{"correct":true,"justification":"True","idx":1,"proposition":"Dryness of mucous membranes"},{"correct":true,"justification":"True","idx":2,"proposition":"Weight loss"},{"correct":true,"justification":"True","idx":3,"proposition":"Prolonged skin fold"},{"correct":true,"justification":"True","idx":4,"proposition":"Dark circles "}],"type":"custom"}
+{"_id":"MICI-HGE-787edd","context":null,"enonce":"Which of the following are tests to request in the face of suspicion of Crohn's disease?","item":"MICI","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Gastro-duodenal endoscopy + systematic staged biopsies"},{"correct":false,"justification":"Biopsies are systematic","idx":1,"proposition":"Colonoscopy + biopsies if macroscopic abnormalities"},{"correct":true,"justification":"True, Essential to assess hail. The 3 systematic examinations are: endoscopy + ileocolonoscopy + entero-MRI. Biopsy is done anywhere it can :)","idx":2,"proposition":"Entero-MRI"},{"correct":false,"justification":"Useless","idx":3,"proposition":"Abdominal PET scan"},{"correct":false,"justification":"Useless","idx":4,"proposition":"Whole body CT"}],"type":"custom"}
+{"_id":"cirrhose-HGE-3cb87e","context":null,"enonce":"Which of the following are possible etiologies of cirrhosis?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Autoimmune hepatitis"},{"correct":true,"justification":"True","idx":1,"proposition":"Hemochromatosis"},{"correct":true,"justification":"True","idx":2,"proposition":"Syndrome de Budd-Chiari"},{"correct":true,"justification":"True","idx":3,"proposition":"Wilson's disease"},{"correct":false,"justification":"It is not a cause but a consequence","idx":4,"proposition":"Chronic hepatic encephalopathy"}],"type":"custom"}
+{"_id":"splenomeg-HGE-ab52b8","context":null,"enonce":"What is the normal weight of a spleen?","item":"splenomeg","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"25-50g"},{"correct":true,"justification":"True","idx":1,"proposition":"150-250g"},{"correct":false,"justification":"","idx":2,"proposition":"500-1000g"},{"correct":false,"justification":"","idx":3,"proposition":"1500-2000g"},{"correct":false,"justification":"","idx":4,"proposition":"2500-3000g"}],"type":"custom"}
+{"_id":"UGD-HGE-5a4124","context":null,"enonce":"Where does typical ulcer pain radiate?","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It does not irradiate"},{"correct":false,"justification":"","idx":1,"proposition":"To the umbilicus"},{"correct":false,"justification":"","idx":2,"proposition":"To the right iliac fossa"},{"correct":false,"justification":"","idx":3,"proposition":"Towards the hypogastrium"},{"correct":false,"justification":"","idx":4,"proposition":"In the back"}],"type":"custom"}
+{"_id":"cirrhose-HGE-50ec3b","context":null,"enonce":"Which of the following are possible etiologies of cirrhosis?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Alcohol"},{"correct":true,"justification":"True","idx":1,"proposition":"HBV"},{"correct":true,"justification":"True","idx":2,"proposition":"HCV"},{"correct":false,"justification":"Never chronic hepatitis (but acute hepatitis possible)","idx":3,"proposition":"HAV"},{"correct":true,"justification":"True","idx":4,"proposition":"Non-alcoholic steatohepatitis"}],"type":"custom"}
+{"_id":"dysphagie-HGE-d0a0e7","context":null,"enonce":"Which of the following are causes of primitive achalasia?","item":"dysphagie","matiere":"HGE","propositions":[{"correct":true,"justification":"True. Primitive = unknown etiology","idx":0,"proposition":"The etiology is unknown"},{"correct":false,"justification":"Cause of acute gastritis","idx":1,"proposition":"Viral (HSV CMV)"},{"correct":false,"justification":"","idx":2,"proposition":"Long-term PPI"},{"correct":false,"justification":"","idx":3,"proposition":"Hypercalcemia"},{"correct":false,"justification":"","idx":4,"proposition":"Helicobacter Pylori"}],"type":"custom"}
+{"_id":"UGD-HGE-5a6da1","context":null,"enonce":"Which of the following are true for gastroduodenal endoscopy in duodenal ulcer?","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True, clinical signs, even typical, are not enough","idx":0,"proposition":"It is essential for the positive diagnosis of ulcer"},{"correct":false,"justification":"Under anesthesia, in a block","idx":1,"proposition":"It is done in the office"},{"correct":false,"justification":"Duodenal ulcers never degenerate into cancers","idx":2,"proposition":"Biopsies remove a tumour"},{"correct":true,"justification":"True","idx":3,"proposition":"In case of hemorrhage, Forrest's classification can be used"},{"correct":false,"justification":"Systematic search for Helicobacter pylori","idx":4,"proposition":"It allows the systematic search for CMV infection"}],"type":"custom"}
+{"_id":"diverticulose-HGE-c5177e","context":null,"enonce":"Regarding sigmoid diverticulosis and acute diverticulitis what are the exact proposal(s)?","item":"diverticulose","matiere":"HGE","propositions":[{"correct":true,"justification":"True, you have to enjoy as much as you can 🎉","idx":0,"proposition":"These pathologies are very rare before the age of 30"},{"correct":false,"justification":"Not since the last recommendation in 2017. It is indicated in case of non-response to symptomatic treatment or in case of signs of severity","idx":1,"proposition":"Antibiotic treatment in uncomplicated diverticulitis is routine"},{"correct":false,"justification":"Unnecessary ultrasound. We make the diagnosis on the bio and the angioscan","idx":2,"proposition":"Diagnosis of diverticulitis is based on ultrasound"},{"correct":false,"justification":"Bristol scale = stool 💩 consistency. We are talking here about the Hinchey classification","idx":3,"proposition":"Bristol scale classifies complicated diverticulitis"},{"correct":true,"justification":"True, risk of perforation and peritonitis","idx":4,"proposition":"Active diverticulitis contraindicates colonoscopy"}],"type":"custom"}
+{"_id":"lithiaseB-HGE-9be36c","context":null,"enonce":"Which of the following are complications of cholecystectomy?","item":"lithiaseB","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Mortality is extremely low"},{"correct":false,"justification":"Complication of unoperated cholecystitis","idx":1,"proposition":"Cholecystoduodenal fistula"},{"correct":false,"justification":"Complication of unoperated cholecystitis","idx":2,"proposition":"Cholecystocolic fistula"},{"correct":false,"justification":"Complication of unoperated cholecystitis","idx":3,"proposition":"Choleperitoneum"},{"correct":true,"justification":"True, = infection","idx":4,"proposition":"Postoperative abscess"}],"type":"custom"}
+{"_id":"ictere-HGE-94e0c1","context":null,"enonce":"Which of the following propositions are true about physiological jaundice in newborns?","item":"ictere","matiere":"HGE","propositions":[{"correct":false,"justification":"False, it appears only after 24 hours of life (free interval)","idx":0,"proposition":"It is congenital"},{"correct":false,"justification":"Before D10","idx":1,"proposition":"It disappears before J20"},{"correct":false,"justification":"Free bilirubin","idx":2,"proposition":"It is a conjugated bilirubin jaundice"},{"correct":true,"justification":"True","idx":3,"proposition":"Stools are normal in colour"},{"correct":true,"justification":"True","idx":4,"proposition":"The neuronal toxicity threshold is 340 micromoles\/litre"}],"type":"custom"}
+{"_id":"lithiaseB-HGE-bc7915","context":null,"enonce":"Which of the following are classic signs of cholitis?","item":"lithiaseB","matiere":"HGE","propositions":[{"correct":false,"justification":"Right hypochondrium","idx":0,"proposition":"Pain in left hypochondrium"},{"correct":true,"justification":"True","idx":1,"proposition":"Fever"},{"correct":true,"justification":"True, triad fever pain jaundice","idx":2,"proposition":"Jaundice"},{"correct":true,"justification":"True","idx":3,"proposition":"Biological cholestasis"},{"correct":false,"justification":"to PNN","idx":4,"proposition":"Lymphocyte hyperleukocytosis"}],"type":"custom"}
+{"_id":"diverticulose-HGE-4ce4f6","context":null,"enonce":"Which of the following are among the following proposals for complicated diverticulitis?","item":"diverticulose","matiere":"HGE","propositions":[{"correct":false,"justification":"Hinchey Stage Ia = uncomplicated","idx":0,"proposition":"Phlegmon isolated less than 2 cm"},{"correct":true,"justification":"True","idx":1,"proposition":"Fistula"},{"correct":true,"justification":"True","idx":2,"proposition":"Peritonitis"},{"correct":true,"justification":"True","idx":3,"proposition":"Stenosis"},{"correct":true,"justification":"True","idx":4,"proposition":"Abscess larger than 2 cm"}],"type":"custom"}
+{"_id":"hernie-HGE-82b0bf","context":null,"enonce":"Which of the following proposals are features of unranged hernia?","item":"hernie","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Impulsive to cough"},{"correct":true,"justification":"True, impulsive = extensive = no strangulation","idx":1,"proposition":"Extensive cough"},{"correct":false,"justification":"Occlusive signs","idx":2,"proposition":"Nausea vomiting"},{"correct":true,"justification":"True","idx":3,"proposition":"Reducible"},{"correct":true,"justification":"True","idx":4,"proposition":"Non-painful"}],"type":"custom"}
+{"_id":"diarrheeaigue-HGE-afefbf","context":null,"enonce":"Up to what age is loperamide contraindicated?","item":"diarrheeaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"2 months"},{"correct":false,"justification":"","idx":1,"proposition":"5 years"},{"correct":true,"justification":"True. It is contraindicated before 2 years. Some adapted presentations are valid between 2 and 8 years.","idx":2,"proposition":"2 years"},{"correct":false,"justification":"","idx":3,"proposition":"6 years"},{"correct":false,"justification":"","idx":4,"proposition":"3 years"}],"type":"custom"}
+{"_id":"diverticulose-HGE-ea812d","context":null,"enonce":"Which of the following are criteria of severity leading to the treatment of uncomplicated sigmoid diverticulitis with antibiotics?","item":"diverticulose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"PAs < 100 mmHg"},{"correct":false,"justification":"Tachycardia is not a criterion of severity (unless really high)","idx":1,"proposition":"FC > 100 bpm"},{"correct":true,"justification":"True","idx":2,"proposition":"Confusion"},{"correct":true,"justification":"True, these are the qSOFA criteria","idx":3,"proposition":"FR > 22 per minute"},{"correct":true,"justification":"True","idx":4,"proposition":"Immunosuppression"}],"type":"custom"}
+{"_id":"ictere-HGE-cb1e74","context":null,"enonce":"Which of the following are etiologies of brown urine jaundice?","item":"ictere","matiere":"HGE","propositions":[{"correct":false,"justification":"No jaundice 🤗","idx":0,"proposition":"Taking rifampicin"},{"correct":true,"justification":"True","idx":1,"proposition":"Conjugated bilirubin jaundice"},{"correct":true,"justification":"True","idx":2,"proposition":"Cholestasis"},{"correct":false,"justification":"Normal urine","idx":3,"proposition":"Gilbert's disease"},{"correct":false,"justification":"Normal urine","idx":4,"proposition":"Criglet-Najjar disease"}],"type":"custom"}
+{"_id":"UGD-HGE-50b458","context":null,"enonce":"Which of the following are recognized risk factors for ulcers?","item":"UGD","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"IPP"},{"correct":true,"justification":"True","idx":1,"proposition":"NSAID intake"},{"correct":true,"justification":"True, several causes including PPIs, H. Pylori, autoimmune, ...","idx":2,"proposition":"Atrophic gastritis"},{"correct":true,"justification":"True, over 65","idx":3,"proposition":"Age"},{"correct":false,"justification":"No, but tobacco yes 🚬","idx":4,"proposition":"Alcohol 🍷"}],"type":"custom"}
+{"_id":"diverticulose-HGE-65e03a","context":null,"enonce":"Which of the following are included in the treatment of uncomplicated diverticulitis?","item":"diverticulose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Antibiotic therapy if symptomatic treatment failure"},{"correct":true,"justification":"True","idx":1,"proposition":"Paracetamol"},{"correct":true,"justification":"True","idx":2,"proposition":"Oral rehydration"},{"correct":false,"justification":"We don't go straight there^^","idx":3,"proposition":"Laparoscopy explorer if pain persists for > 10 days"},{"correct":false,"justification":"Useless","idx":4,"proposition":"Residue-free diet"}],"type":"custom"}
+{"_id":"RGO-HGE-e0c65b","context":null,"enonce":"Which of the following are true for the treatment of GERD without esophagitis that occurs less than once a week?","item":"RGO","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Antacids"},{"correct":true,"justification":"True","idx":1,"proposition":"Alginates"},{"correct":false,"justification":"Not in the first intention. This is the case if GERD happens more than once a week","idx":2,"proposition":"It is based on PPIs"},{"correct":true,"justification":"True","idx":3,"proposition":"H2 Repellent"},{"correct":false,"justification":"False","idx":4,"proposition":"Half-dose PPI for 4 weeks"}],"type":"custom"}
+{"_id":"dysphagie-HGE-11ad73","context":null,"enonce":"Which of the following propositions are true about primitive achalasia?","item":"dysphagie","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"We find an aperistalsis"},{"correct":true,"justification":"True","idx":1,"proposition":"There is resting hypertonia of the SIO"},{"correct":false,"justification":"","idx":2,"proposition":"Normal peristaltic waves are found"},{"correct":true,"justification":"True","idx":3,"proposition":"Endoscopy may be normal at first"},{"correct":true,"justification":"True","idx":4,"proposition":"Manometry is the exam of choice for a positive diagnosis"}],"type":"custom"}
+{"_id":"cirrhose-HGE-89f46c","context":null,"enonce":"What is the treatment of choice for primary biliary cirrhosis?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":false,"justification":"Autoimmune hepatitis","idx":0,"proposition":"Corticosteroids "},{"correct":true,"justification":"True","idx":1,"proposition":"Ursodeoxycholic acid"},{"correct":false,"justification":"Wilson's disease","idx":2,"proposition":"Copper chelators"},{"correct":false,"justification":"Hemochromatosis","idx":3,"proposition":"Blood subtraction"},{"correct":false,"justification":"NASH","idx":4,"proposition":"Statins"}],"type":"custom"}
+{"_id":"pancreatitechr-HGE-e74284","context":null,"enonce":"Which of the following are risk factors for chronic pancreatitis?","item":"pancreatitechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Tobacco 🚬"},{"correct":true,"justification":"True","idx":1,"proposition":"Alcohol 🍷"},{"correct":true,"justification":"True","idx":2,"proposition":"Hypercalcemia"},{"correct":true,"justification":"True","idx":3,"proposition":"Cystic fibrosis"},{"correct":false,"justification":"Nein","idx":4,"proposition":"Chronic hepatitis"}],"type":"custom"}
+{"_id":"UGD-HGE-a3a898","context":null,"enonce":"Regarding the incidence of gastric ulcer in developed countries:","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It goes down"},{"correct":false,"justification":"","idx":1,"proposition":"It increases"},{"correct":false,"justification":"","idx":2,"proposition":"It is stable"},{"correct":false,"justification":"It is not a DO disease but epidemiological studies can be done on all diseases","idx":3,"proposition":"It is not calculable because it is not a reportable 😏 disease"},{"correct":false,"justification":"","idx":4,"proposition":"All proposals are wrong"}],"type":"custom"}
+{"_id":"pancreatitechr-HGE-bbbf9d","context":null,"enonce":"If chronic pancreatitis is suspected, what is the imaging test to perform as a first-line treatment?","item":"pancreatitechr","matiere":"HGE","propositions":[{"correct":false,"justification":"It is not an imaging 🖼 test","idx":0,"proposition":"Gamma-GT and PAL"},{"correct":true,"justification":"True","idx":1,"proposition":"Abdominal CT angiography"},{"correct":false,"justification":"No longer done (useless in this indication)","idx":2,"proposition":".ASP"},{"correct":false,"justification":"","idx":3,"proposition":"MRI angiography"},{"correct":false,"justification":"","idx":4,"proposition":"PET-Scan"}],"type":"custom"}
+{"_id":"diarrheechr-HGE-261c15","context":null,"enonce":"Which of the following should be avoided in case of celiac disease?","item":"diarrheechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Gluten"},{"correct":true,"justification":"True","idx":1,"proposition":"Wheat"},{"correct":true,"justification":"True","idx":2,"proposition":"Barley"},{"correct":false,"justification":"","idx":3,"proposition":"Soybean"},{"correct":true,"justification":"True","idx":4,"proposition":"Rye"}],"type":"custom"}
+{"_id":"splenomeg-HGE-b8bef8","context":null,"enonce":"Which of the following are recommended vaccines for splenectomized?","item":"splenomeg","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Anti-pneumococcus"},{"correct":false,"justification":"Live attenuated vaccine","idx":1,"proposition":"Yellow fever"},{"correct":true,"justification":"True","idx":2,"proposition":"Anti-haemophilus B"},{"correct":false,"justification":"Live attenuated vaccine","idx":3,"proposition":"BCG"},{"correct":false,"justification":"Live attenuated vaccine","idx":4,"proposition":"Anti-malarial"}],"type":"custom"}
+{"_id":"ascite-HGE-ad5ecc","context":null,"enonce":"What is the PNN threshold that defines an infected ascites fluid? (mm3)","item":"ascite","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"50"},{"correct":false,"justification":"","idx":1,"proposition":"100"},{"correct":false,"justification":"","idx":2,"proposition":"150"},{"correct":false,"justification":"","idx":3,"proposition":"200"},{"correct":true,"justification":"True","idx":4,"proposition":"250"}],"type":"custom"}
+{"_id":"ictere-HGE-35ccb5","context":null,"enonce":"Which of the following propositions are true about Gilbert's disease?","item":"ictere","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is a disease with genetic polymorphism"},{"correct":true,"justification":"True","idx":1,"proposition":"It affects about 5% of the population"},{"correct":true,"justification":"True","idx":2,"proposition":"It is an unconjugated bilirubin jaundice"},{"correct":true,"justification":"True, asymptomatic most of the time","idx":3,"proposition":"It is a mild disease"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true "}],"type":"custom"}
+{"_id":"RGO-HGE-aa15a1","context":null,"enonce":"What test can determine whether GERD is acidic or non-acidic?","item":"RGO","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"pH-impedancemetry"},{"correct":false,"justification":"","idx":1,"proposition":"Endoscopy"},{"correct":false,"justification":"","idx":2,"proposition":"Fibroscopy"},{"correct":false,"justification":"","idx":3,"proposition":"Scanner"},{"correct":false,"justification":"","idx":4,"proposition":"Urea test"}],"type":"custom"}
+{"_id":"cirrhose-HGE-edcf21","context":null,"enonce":"Lille's score includes:","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Billirubine"},{"correct":true,"justification":"True","idx":1,"proposition":"Creatinine emia"},{"correct":true,"justification":"True","idx":2,"proposition":"Albumin"},{"correct":true,"justification":"True","idx":3,"proposition":"The TP"},{"correct":false,"justification":"","idx":4,"proposition":"The ATT"}],"type":"custom"}
+{"_id":"vomisst-HGE-19a0c3","context":null,"enonce":"Mallory Weiss syndrome corresponds to a rupture of:","item":"vomisst","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Cardia"},{"correct":false,"justification":"","idx":1,"proposition":"Fundus"},{"correct":false,"justification":"","idx":2,"proposition":"Large curvature"},{"correct":false,"justification":"","idx":3,"proposition":"Small curvature"},{"correct":false,"justification":"","idx":4,"proposition":"Duodenum"}],"type":"custom"}
+{"_id":"UGD-HGE-4933d5","context":null,"enonce":"What does bimuthea quadritherapy contain?","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Metronidazole"},{"correct":true,"justification":"True","idx":1,"proposition":"Bismuth salts"},{"correct":true,"justification":"True","idx":2,"proposition":"Tetracycline"},{"correct":true,"justification":"True","idx":3,"proposition":"Curative IPP"},{"correct":false,"justification":"Non-bismutheic therapy: amoxicillin, curative PPI, metronidazole, clarithromycin\/levfloxacin","idx":4,"proposition":"Amoxicillin"}],"type":"custom"}
+{"_id":"cirrhose-HGE-dd1d4c","context":null,"enonce":"What is the estimated survival of 1 year for Child Pugh C?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"100 %"},{"correct":false,"justification":"","idx":1,"proposition":"90 %"},{"correct":false,"justification":"","idx":2,"proposition":"80 %"},{"correct":true,"justification":"True","idx":3,"proposition":"45 %"},{"correct":false,"justification":"","idx":4,"proposition":"5 %"}],"type":"custom"}
+{"_id":"diverticulose-HGE-39365c","context":null,"enonce":"Which of the following are true for antibiotic treatment of uncomplicated sigmoid diverticulitis?","item":"diverticulose","matiere":"HGE","propositions":[{"correct":false,"justification":"After failure of symptomatic treatment (or in case of signs of severity)","idx":0,"proposition":"It is to be proposed from the outset"},{"correct":false,"justification":"Per Os","idx":1,"proposition":"It is based on augmentin IV"},{"correct":true,"justification":"True","idx":2,"proposition":"Second-line therapy is fluoroquinolones (or C3Gs) combined with metronidazole"},{"correct":true,"justification":"True, 7 days maximum","idx":3,"proposition":"Antibiotic treatment lasts less than 7 days"},{"correct":true,"justification":"True, this is most often the case (oral treatment)","idx":4,"proposition":"Treatment can be done on an outpatient basis"}],"type":"custom"}
+{"_id":"ictere-HGE-bb2b61","context":null,"enonce":"What time corresponds to the venous time on the injected scanner?","item":"ictere","matiere":"HGE","propositions":[{"correct":false,"justification":"Excretory time","idx":0,"proposition":"10 mn"},{"correct":false,"justification":"Late time","idx":1,"proposition":"3 min"},{"correct":true,"justification":"True","idx":2,"proposition":"70 seconds"},{"correct":false,"justification":"Arterial weather","idx":3,"proposition":"Thirty seconds"},{"correct":false,"justification":"SPC Time","idx":4,"proposition":"T0"}],"type":"custom"}
+{"_id":"lithiaseB-HGE-ce25f8","context":null,"enonce":"Which of the following are ultrasound signs of lithiatic cholecystitis?","item":"lithiaseB","matiere":"HGE","propositions":[{"correct":true,"justification":"True, ultrasound sign of Murphy","idx":0,"proposition":"Increased pain when passing the ultrasound probe"},{"correct":true,"justification":"True","idx":1,"proposition":"Vesicular wall > 4mm"},{"correct":false,"justification":"Calculations are hyperdense","idx":2,"proposition":"Hypodensity representing the calculation"},{"correct":true,"justification":"True","idx":3,"proposition":"Triple sheet appearance"},{"correct":false,"justification":"","idx":4,"proposition":"Absence of shadow cone"}],"type":"custom"}
+{"_id":"RGO-HGE-0b0028","context":null,"enonce":"Which of the following are indications for gastroduodenal endoscopy in GERD?","item":"RGO","matiere":"HGE","propositions":[{"correct":false,"justification":"50 years","idx":0,"proposition":"Age > 30"},{"correct":true,"justification":"True","idx":1,"proposition":"Difficulty in swallowing"},{"correct":true,"justification":"True","idx":2,"proposition":"Failure of well-conducted treatment"},{"correct":false,"justification":"False, on the other hand newly discovered asthma (contemporary with GERD may be an extradigestive sign)","idx":3,"proposition":"Allergic asthma diagnosed in childhood"},{"correct":true,"justification":"True","idx":4,"proposition":"Unexplained anemia"}],"type":"custom"}
+{"_id":"cirrhose-HGE-d2802c","context":null,"enonce":"Which of the following are signs of hepatic encephalopathy?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Asterixis"},{"correct":true,"justification":"True","idx":1,"proposition":"Insomnia"},{"correct":true,"justification":"True","idx":2,"proposition":"Confusion \/ Delirium"},{"correct":false,"justification":"Syndrome de Korsakoff","idx":3,"proposition":"Fabrications"},{"correct":false,"justification":"Not described in the college","idx":4,"proposition":"Amnesic ictus"}],"type":"custom"}
+{"_id":"cirrhose-HGE-fd6866","context":null,"enonce":"Which of the following are signs of portal hypertension?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Ascites"},{"correct":false,"justification":"","idx":1,"proposition":"Asterixis"},{"correct":false,"justification":"","idx":2,"proposition":"Stellar angiomas"},{"correct":true,"justification":"True","idx":3,"proposition":"Splenomegaly"},{"correct":true,"justification":"True","idx":4,"proposition":"Collateral venous circulation"}],"type":"custom"}
+{"_id":"vomisst-HGE-e442b1","context":null,"enonce":"Which of the following are true about vomiting during pregnancy?","item":"vomisst","matiere":"HGE","propositions":[{"correct":false,"justification":"In the first quarter","idx":0,"proposition":"They are physiological in the second trimester"},{"correct":true,"justification":"True","idx":1,"proposition":"They disappear spontaneously during pregnancy"},{"correct":false,"justification":"Early signs","idx":2,"proposition":"These are late signs of pregnancy"},{"correct":true,"justification":"True","idx":3,"proposition":"Pre-eclampsia may be accompanied by vomiting"},{"correct":true,"justification":"True","idx":4,"proposition":"Ionic disorders can impact the fetus"}],"type":"custom"}
+{"_id":"oeilR-D-ophtalmo-1aebca","context":null,"enonce":"Which of the following propositions are true regarding chemical trauma?","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True, they penetrate longer and deeper into the eye","idx":0,"proposition":"Basic chemical burns are more serious than acid burns "},{"correct":false,"justification":"it is the Roper-Hall classification that is used","idx":1,"proposition":"The ASA classification is suitable for burns of chemical origin"},{"correct":false,"justification":"The classification ranges from grade I to grade IV, with grade I being the best prognosis","idx":2,"proposition":"Grade IV is the best prognosis"},{"correct":true,"justification":"True with absence of limbic ischemia and corneal opacity","idx":3,"proposition":"Grade I is for pure epithelial involvement"},{"correct":false,"justification":"","idx":4,"proposition":"No proposition is true"}],"type":"custom"}
+{"_id":"oeilR-D-ophtalmo-0af31f","context":null,"enonce":"In what structure is the origin of the optic nerve inserted?","item":"oeilR-D","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"The cornea"},{"correct":false,"justification":"","idx":1,"proposition":"The iris"},{"correct":true,"justification":"","idx":2,"proposition":"The sclera"},{"correct":false,"justification":"","idx":3,"proposition":"The lens"},{"correct":false,"justification":"","idx":4,"proposition":"Other"}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-e3c3a7","context":null,"enonce":"Which of the following proposals are pathological in 1-year-olds?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":false,"justification":"Up to 18 months","idx":0,"proposition":"No walking"},{"correct":true,"justification":"True","idx":1,"proposition":"No clamp"},{"correct":false,"justification":"It is expected at this age","idx":2,"proposition":"Combines two syllables"},{"correct":true,"justification":"True","idx":3,"proposition":"Don't babble"},{"correct":true,"justification":"True, pathological at any age 🚨","idx":4,"proposition":"No photomotor reflex"}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-d90f47","context":null,"enonce":"Which of the following are possible infectious causes of prenatal hearing loss? ","item":"suivinourisson","matiere":"ped","propositions":[{"correct":false,"justification":"Mnemonic medium: TORCH (Toxoplasmosis, Mumps, Rubella, CMV, HSV)","idx":0,"proposition":"Maternal dengue infection"},{"correct":true,"justification":"True","idx":1,"proposition":"Infection of the mother with toxoplasmosis"},{"correct":true,"justification":"True","idx":2,"proposition":"Maternal infection with rubella"},{"correct":true,"justification":"True","idx":3,"proposition":"Active infection of the mother with CMV"},{"correct":false,"justification":"Not described in colleges anyway","idx":4,"proposition":"Maternal infection with yellow fever"}],"type":"custom"}
+{"_id":"AV--ophtalmo-7a86cf","context":null,"enonce":"Which of the following propositions designate the nerve on which the palpebral occlusion depends?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Facial nerve"},{"correct":false,"justification":"IV nerve, innervates the superior oblique","idx":1,"proposition":"Trochlear nerve"},{"correct":false,"justification":"Nerve VI, innervates the external\/lateral right","idx":2,"proposition":"Nerve abducens"},{"correct":false,"justification":"Nerve III, innervates the upper right, the medial right, the lower right and the inferior oblique","idx":3,"proposition":"Oculomotor nerve"},{"correct":true,"justification":"= facial nerve","idx":4,"proposition":"Nerve VII"}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-3db61f","context":null,"enonce":"What is the interval for mild hearing loss?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":false,"justification":"light = PAM between 21 and 40 dB; mean = PAM between 41 and 70 dB; severe = PAM between 71 and 90 dB; deep = PAM ≥ 90 dB; total (cophosis) = PAM ≥ 120 dB.","idx":0,"proposition":"None of the proposals"},{"correct":true,"justification":"True","idx":1,"proposition":"between 21 and 40 dB"},{"correct":false,"justification":"average","idx":2,"proposition":"between 41 and 70 dB"},{"correct":false,"justification":"severe","idx":3,"proposition":"between 71 and 90 dB "},{"correct":false,"justification":"Deep","idx":4,"proposition":"between 90 and 120 dB "}],"type":"custom"}
+{"_id":"diplopie-ophtalmo-e7c8f3","context":null,"enonce":"What is the field of action of the superior oblique muscle?","item":"diplopie","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Upstairs"},{"correct":false,"justification":"False","idx":1,"proposition":"Inside"},{"correct":false,"justification":"False","idx":2,"proposition":"Out"},{"correct":true,"justification":"True","idx":3,"proposition":"Below and inside"},{"correct":false,"justification":"False","idx":4,"proposition":"Downstairs and outside"}],"type":"custom"}
+{"_id":"tbrefraction-ophtalmo-41b5f2","context":null,"enonce":"Which of the following are true?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"It is \"too powerful\"","idx":0,"proposition":"A myopic eye is too convergent "},{"correct":false,"justification":"Too convergent (too powerful)","idx":1,"proposition":"A myopic eye is too divergent"},{"correct":true,"justification":"True","idx":2,"proposition":"A farsighted eye is too divergent"},{"correct":true,"justification":"True","idx":3,"proposition":"A farsighted eye is too short"},{"correct":false,"justification":"It is a question of sphericity, not depth, the refraction of the eye differs according to the plane in which the incident rays are located.","idx":4,"proposition":"An astigmatism eye is too divergent"}],"type":"custom"}
+{"_id":"diplopie-ophtalmo-cd64e4","context":null,"enonce":"What is the field of action of the inferior oblique muscle?","item":"diplopie","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Above and inside"},{"correct":false,"justification":"Lateral muscle","idx":1,"proposition":"Out"},{"correct":false,"justification":"Medial muscle","idx":2,"proposition":"Inside"},{"correct":false,"justification":"Superior oblique muscle","idx":3,"proposition":"Below and inside"},{"correct":false,"justification":"Superior rectus muscle","idx":4,"proposition":"Up and outside"}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-65c36d","context":null,"enonce":"Which of the following are true for congenital hip dislocation (CHL)?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":false,"justification":"Seat presentation is a risk factor","idx":0,"proposition":"There are no known risk factors"},{"correct":true,"justification":"True","idx":1,"proposition":"It must be screened in all children"},{"correct":false,"justification":"Ultrasound (if risk factor or suspicion)","idx":2,"proposition":"Low radiation hip X-ray is the first-line additional examination in case of suspicion of LCH"},{"correct":false,"justification":"Abduction limitation (outward)","idx":3,"proposition":"Adduction limitation is a clinical sign of CHL"},{"correct":true,"justification":"True","idx":4,"proposition":"Limb length asymmetry is a clinical sign of CHL"}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-6a5605","context":null,"enonce":"Which of the following proposals are correct and expected for a 3-month-old child born at term?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":true,"justification":"True, tachycardia from 150 bpm","idx":0,"proposition":"Resting heart rate at 120 bpm"},{"correct":true,"justification":"True","idx":1,"proposition":"Resting respiratory rate at 40\/min"},{"correct":true,"justification":"True, threshold at 40 mmHg","idx":2,"proposition":"PAM at 55 mmHg"},{"correct":true,"justification":"True, between 2 and 4 ml\/kg\/h","idx":3,"proposition":"Diuresis at 3 ml\/kg\/h"},{"correct":true,"justification":"True, >97%","idx":4,"proposition":"98% SaO2"}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-63fb64","context":null,"enonce":"Which of the following are true?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"At birth, a baby weighs about 3.5 kg"},{"correct":false,"justification":"This is the size of the newborn. The expected PC is 35 cm","idx":1,"proposition":"At birth, the expected head circumference (CP) is 50 cm"},{"correct":false,"justification":"This is the newborn's PC. The expected size is 50 cm","idx":2,"proposition":"At birth, the expected height is 35 cm"},{"correct":false,"justification":"1m (doubles its birth size)","idx":3,"proposition":"At 4 years old, the child measures about 1m25"},{"correct":true,"justification":"True, triples his birth weight","idx":4,"proposition":"At 1 year, the baby weighs 10 kg"}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-69fa18","context":null,"enonce":"Which of the following proposals suggest pathological strabismus?","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Rather physiological","idx":0,"proposition":"Convergent Strabismus"},{"correct":true,"justification":"True","idx":1,"proposition":"Divergent Strabismus"},{"correct":false,"justification":"According to the COUF: \"It should be remembered that strabismus is never normal and that any child with strabismus must benefit from a rapid specialized examination. This assertion must be qualified in the baby less than 3 months in whom an intermittent deviation can be tolerated.\" ","idx":2,"proposition":"Intermittent strabismus"},{"correct":true,"justification":"The child's strabismus is only a symptom. Any strabismus must seek an underlying organic pathology.","idx":3,"proposition":"Permanent Strabismus"},{"correct":false,"justification":"Convergent and intermittent strabismus require simple monitoring at the beginning","idx":4,"proposition":"All strabismus are pathological"}],"type":"custom"}
+{"_id":"AV--ophtalmo-905a38","context":null,"enonce":"Which of the following proposals are part of the previous segment?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Crystalline"},{"correct":false,"justification":"Posterior segment","idx":1,"proposition":"Sclera"},{"correct":false,"justification":"Posterior segment","idx":2,"proposition":"Choroid"},{"correct":true,"justification":"True","idx":3,"proposition":"Iridorodicorneal angle"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-b2145f","context":null,"enonce":"What is the formula for estimating the expected head circumference during the first year of life?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"(Size + 2) \/ 10"},{"correct":true,"justification":"True","idx":1,"proposition":"(Size \/ 2) + 10"},{"correct":false,"justification":"False, unisex formula","idx":2,"proposition":"(Size \/ 2) - 10 in girls"},{"correct":false,"justification":"False","idx":3,"proposition":"(Size * 2) + 10 in boys"},{"correct":false,"justification":"False","idx":4,"proposition":"Size - 10"}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-29e6a5","context":null,"enonce":"What is the expected size at 4 months?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":false,"justification":"Birth size","idx":0,"proposition":"50 cm"},{"correct":true,"justification":"True","idx":1,"proposition":"60 cm"},{"correct":false,"justification":"9 months","idx":2,"proposition":"70 cm"},{"correct":false,"justification":"At 1 year","idx":3,"proposition":"75 cm"},{"correct":false,"justification":"At 4 years old","idx":4,"proposition":"1 m"}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-ce8370","context":null,"enonce":"What is the interval of profound hearing loss?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":false,"justification":"light = PAM between 21 and 40 dB; mean = PAM between 41 and 70 dB; severe = PAM between 71 and 90 dB; deep = PAM ≥ 90 dB; total (cophosis) = PAM ≥ 120 dB.","idx":0,"proposition":"None of these proposals 🤷 ♀️"},{"correct":false,"justification":"severe","idx":1,"proposition":"between 71 and 90 dB"},{"correct":false,"justification":"Medium","idx":2,"proposition":"between 41 and 70 dB"},{"correct":false,"justification":"Light","idx":3,"proposition":"between 21 and 40 dB"},{"correct":true,"justification":"True","idx":4,"proposition":"between 90 and 120 dB"}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-a3fc2e","context":null,"enonce":"Which of the following are true for genu varum at 1 year?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":false,"justification":"Reassuring because bilateral","idx":0,"proposition":"Symmetrical character is disturbing"},{"correct":false,"justification":"Normal at this age","idx":1,"proposition":"It is abnormal at this age"},{"correct":false,"justification":"False","idx":2,"proposition":"It justifies a bilateral F+P radiological assessment"},{"correct":true,"justification":"True","idx":3,"proposition":"It corresponds to a normal evolutionary phase of the growing skeleton in most cases"},{"correct":true,"justification":"True","idx":4,"proposition":"It regresses over the years"}],"type":"custom"}
+{"_id":"glaucomechr-ophtalmo-155a29","context":null,"enonce":"Which of the following are drugs that decrease the secretion of aqueous humor?","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Beta-blockers"},{"correct":true,"justification":"True","idx":1,"proposition":"Carbonic anhydrase inhibitors"},{"correct":true,"justification":"True","idx":2,"proposition":"Alpha-2-adrenergic agonists"},{"correct":false,"justification":"They increase the elimination of aqueous humor","idx":3,"proposition":"Prostaglandins"},{"correct":false,"justification":"False","idx":4,"proposition":"Corticosteroids"}],"type":"custom"}
+{"_id":"suivinourisson-ophtalmo-dc20b7","context":null,"enonce":"Which of the following are risk factors for hearing impairment?","item":"suivinourisson","matiere":"ped","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Family history of deafness"},{"correct":true,"justification":"True","idx":1,"proposition":"Perinatal anoxia"},{"correct":true,"justification":"True","idx":2,"proposition":"History of pneumococcal meningitis"},{"correct":true,"justification":"True","idx":3,"proposition":"Recurrent ear infections"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"tbauditif-ORL-1ffca1","context":null,"enonce":"Which of the following propositions are true about AEPs?","item":"tbauditif","matiere":"ORL","propositions":[{"correct":false,"justification":"They do not allow it, it is one of their limits. Other limitations: profound deafness hinders the interpretation of latency curves, and the ranges explored concern only the treble","idx":0,"proposition":"They allow a frequency by frequency study"},{"correct":true,"justification":"True, by studying the latencies and conduction delays of the five peaks: I (cochlea), II (auditory nerve), III, IV, V (brainstem)","idx":1,"proposition":"They have topographic value in sensorineural hearing loss"},{"correct":false,"justification":"High frequencies, this is one of their limits","idx":2,"proposition":"They explore bass frequencies"},{"correct":false,"justification":"It is an objective examination, to be used especially in infants or non-cooperating patients","idx":3,"proposition":"This is a subjective examination"},{"correct":true,"justification":"True","idx":4,"proposition":"This is a non-invasive examination"}],"type":"custom"}
+{"_id":"tbauditif-ORL-6dcd70","context":null,"enonce":"Which of the following are functions of the outer 👂 ear?","item":"tbauditif","matiere":"ORL","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Mechanical protection of the eardrum"},{"correct":false,"justification":"","idx":1,"proposition":"All proposals"},{"correct":true,"justification":"True","idx":2,"proposition":"Amplification of conversational frequencies"},{"correct":true,"justification":"True","idx":3,"proposition":"Sound localization"},{"correct":false,"justification":"No role of the outer ear in balance. This is the case of the inner ear","idx":4,"proposition":"Equilibration"}],"type":"custom"}
+{"_id":"pathosalivaire-ORL-e7f5d3","context":null,"enonce":"Which of the following are true about the parotid gland?","item":"pathosalivaire","matiere":"ORL","propositions":[{"correct":false,"justification":"There are three main salivary glands: parotid, submandibular, sublingual 😊","idx":0,"proposition":"It is one of the two main salivary glands"},{"correct":true,"justification":"True, this is nerve VII","idx":1,"proposition":"It is crossed by the facial nerve "},{"correct":false,"justification":"Steno Canal. Wharton's duct is the duct of the submandibular gland","idx":2,"proposition":"Its excretory canal is the Wharton Canal"},{"correct":true,"justification":"True","idx":3,"proposition":"It is composed of two lobes"},{"correct":false,"justification":"This is the submandibular gland","idx":4,"proposition":"It is the most common site of salivary lithiasis"}],"type":"custom"}
+{"_id":"pathosalivaire-ORL-e7abc8","context":null,"enonce":"Regarding the salivary glands, which of the following propositions, which is\/are true?","item":"pathosalivaire","matiere":"ORL","propositions":[{"correct":false,"justification":"False, if the excretory duct of the parotid gland is indeed the Steno duct, it is blocked at the level of the homolateral upper 2nd molar (namely)","idx":0,"proposition":"The excretory duct of the parotid gland is the Steno duct and it plugs at the sublingual wattle."},{"correct":false,"justification":"False, do not confuse the sublingual glands (two small glands under the floor of the mouth) and the accessory salivary glands (there is, indeed, a multitude)","idx":1,"proposition":"There are multitudes of sublingual glands (about a thousand)"},{"correct":true,"justification":"True, these are the two main pathologies to master.","idx":2,"proposition":"While viral sialitis mainly affects the parotid glands, lithiasic sialitis mainly affects the submandibular glands"},{"correct":false,"justification":"False, it is pleomorphic adenoma, and it is a benign 😅 tumor","idx":3,"proposition":"The most common tumor of the parotid is a malignant 😱 tumor"},{"correct":true,"justification":"True, a low risk, but sufficient to indicate surgery for any pleomorphic adenoma.","idx":4,"proposition":"Pleomorphic adenoma has a risk of cancerization"}],"type":"custom"}
+{"_id":"pathosalivaire-ORL-bf45f0","context":null,"enonce":"The Steno Canal opens in front:","item":"pathosalivaire","matiere":"ORL","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"of the 1st or 2nd upper molar"},{"correct":false,"justification":"","idx":1,"proposition":"of the 1st or 2nd lower molar"},{"correct":false,"justification":"","idx":2,"proposition":"upper incisors"},{"correct":false,"justification":"","idx":3,"proposition":"of the 1st or 2nd upper premolar"},{"correct":false,"justification":"","idx":4,"proposition":"of the 1st or 2nd lower premolar"}],"type":"custom"}
+{"_id":"tbauditif-ORL-2b918b","context":null,"enonce":"Which of the following propositions are true about acoumetry?","item":"tbauditif","matiere":"ORL","propositions":[{"correct":false,"justification":"It is a qualitative measure of hearing (we have no number, the answer is a yes\/no)","idx":0,"proposition":"It is a quantitative measure of hearing"},{"correct":true,"justification":"True, this is its advantage!","idx":1,"proposition":"It can be performed at the patient's bedside"},{"correct":true,"justification":"True, i.e. the patient hears less well in air conduction than in bone conduction (which is not normal)","idx":2,"proposition":"Rinne's test is negative in case of conductive hearing loss"},{"correct":true,"justification":"True","idx":3,"proposition":"Weber's test consists of placing the tuning fork on the vertex"},{"correct":false,"justification":"It is lateralized on the left side","idx":4,"proposition":"The Weber is non-lateralized in case of left unilateral transmission hearing loss"}],"type":"custom"}
+{"_id":"tbauditif-ORL-63f986","context":null,"enonce":"Which of the following suggestions can guide you towards right otosclerosis?","item":"tbauditif","matiere":"ORL","propositions":[{"correct":false,"justification":"Weber on the right because right transmission deafness","idx":0,"proposition":"Weber's test is on the left"},{"correct":false,"justification":"Normal otoscopy","idx":1,"proposition":"Otoscopy regains tympanic retraction"},{"correct":true,"justification":"True","idx":2,"proposition":"Tonal audiometry regains right-sided one-sided conductive hearing loss"},{"correct":true,"justification":"True","idx":3,"proposition":"Presence of family history"},{"correct":true,"justification":"True","idx":4,"proposition":"On-off stapedial reflexes"}],"type":"custom"}
+{"_id":"pathosalivaire-ORL-035567","context":null,"enonce":"Which of the following propositions are true for pleiomorphic adenoma?","item":"pathosalivaire","matiere":"ORL","propositions":[{"correct":false,"justification":"The parotid is hard","idx":0,"proposition":"It is soft on palpation"},{"correct":true,"justification":"True","idx":1,"proposition":"It is epithelial"},{"correct":true,"justification":"True, as the name suggests (adenoma)","idx":2,"proposition":"It is benign"},{"correct":false,"justification":"It is the most common glandular tumor","idx":3,"proposition":"It is the rarest of the parotid tumors"},{"correct":true,"justification":"True","idx":4,"proposition":"Management is surgical"}],"type":"custom"}
+{"_id":"pathosalivaire-ORL-1c2840","context":null,"enonce":"Which of the following propositions are true for pleiomorphic adenoma?","item":"pathosalivaire","matiere":"ORL","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"She is HypoT1 in MRI"},{"correct":true,"justification":"True","idx":1,"proposition":"She is HyperT2 in MRI"},{"correct":false,"justification":"rCDA > 1.3","idx":2,"proposition":"The rCDA is < 1"},{"correct":false,"justification":"Adenoma = benign","idx":3,"proposition":"It is a malignant tumor"},{"correct":false,"justification":"Surgical","idx":4,"proposition":"Management is exclusively drug (antimitotics)"}],"type":"custom"}
+{"_id":"pathosalivaire-ORL-3d9194","context":null,"enonce":"Which of the following are true about salivary lithiasis?","item":"pathosalivaire","matiere":"ORL","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Glandular swelling is often per-prandial"},{"correct":true,"justification":"True","idx":1,"proposition":"They are most common in the submandibular gland"},{"correct":true,"justification":"True","idx":2,"proposition":"Sialodochitis is a ductal infection"},{"correct":false,"justification":"Ultrasound or CT scan is enough","idx":3,"proposition":"MRI is often needed to confirm lithiasis"},{"correct":true,"justification":"True","idx":4,"proposition":"Dental panoramic imaging is first-line imaging"}],"type":"custom"}
+{"_id":"88-ORL-169262c3-1f06-4854-8c25-751d13933fbe","context":null,"enonce":"Regarding the salivary glands among the following propositions, which one is\/are true?","item":"pathosalivaire","matiere":"ORL","propositions":[{"correct":true,"justification":"True, it is the same radiological semiology for all lithiasis: hyperechoic with posterior umbral cone. This is the case of renal lithiasis and cholelithiasis too 😊","idx":0,"proposition":"The first-line examination for lithiatic sialois is ultrasound to demonstrate hyperechogenicity with posterior shadow cone"},{"correct":false,"justification":"False, they are rare! But this risk of sequelar orchitis is the main justification for mumps 😏 vaccination","idx":1,"proposition":"Viral sialitis is formidable because it frequently leads to sequelar 😱 orchitis."},{"correct":true,"justification":"True, parotid involvement is found in Heerfordt and Mikulicz 🤓 syndromes","idx":2,"proposition":"Bilateral chronic parotid sialosis should suggest sarcoidosis"},{"correct":false,"justification":"False, a biopsy of the salivary glands ACCESSORIES (the famous BGSA)","idx":3,"proposition":"Sjögren's syndrome, a bilateral chronic sialosis, is diagnosed by a biopsy of the main salivary glands"},{"correct":true,"justification":"True, this is an exception in the tumor family...","idx":4,"proposition":"Malignant parotid tumors are most often painful"}],"type":"custom"}
+{"_id":"SpA-rhumato-2470b7","context":null,"enonce":"Which of the following are true?","item":"SpA","matiere":"rhumato","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"In chronic inflammatory enterocolopathies, classically, peripheral involvement evolves parallel to digestive involvement, unlike axial involvement which evolves on its own account."},{"correct":false,"justification":"Physical activity and physiotherapy are essential to reduce the progression of ankylosis in a bad position","idx":1,"proposition":"In ankylosing spondylitis, physiotherapy is not essential  "},{"correct":false,"justification":"The syndesmophyte is an ossification of a vertebral enthesis, specific to spondyloarthritis, unlike enthesophytes which can be the result of mechanical overloads ","idx":2,"proposition":"Syndesmophyte is not specific for Spondyloarthritis "},{"correct":false,"justification":"At least 2 NSAIDs should be tried successively over a total of 4 weeks before concluding that they have failed.","idx":3,"proposition":"After 4 weeks of treatment with the same NSAID without results, it can be concluded that the treatment has failed and it is then necessary to move on to background treatments "},{"correct":true,"justification":"","idx":4,"proposition":"Fiessinger-Leroy-Reiter syndrome is the most complete form of reactive arthritis, defined by the urethritis-conjunctivitis triad-arthritis. \r\n"}],"type":"custom"}
+{"_id":"arthrose-rhumato-a122e8","context":null,"enonce":"Regarding coxarthrosis, what are the exact proposal(s)?","item":"arthrose","matiere":"rhumato","propositions":[{"correct":true,"justification":"True, congenital hip dislocation and other dysplasias lead to early coxarthrosis","idx":0,"proposition":"A coxarthrosis of the young subject must seek a history of hip dysplasia"},{"correct":false,"justification":"False, it is the coxodynias, which can give projected pain in the knee","idx":1,"proposition":"Differential diagnoses include classical projected gonarthrosis"},{"correct":false,"justification":"False, it is the internal rotation that will lead to a functional limitation of the joint.","idx":2,"proposition":"The clinical examination will look for a limitation of external rotation, the first clinical sign of the functional limitation of the joint"},{"correct":true,"justification":"True, to put it simply, the covers are what allow the good mechanics of the joint","idx":3,"proposition":"The front X-ray and the false profile of Lequesne look for insufficient coverage of the VCE (external cover of the roof of the acetula) and the VCA (anterior coverage of the femoral head)"},{"correct":true,"justification":"True, be careful not to forget the hygiene-dietary rules (regular walking, possibly cane in contra-lateral, weight loss if obesity ...)","idx":4,"proposition":"First-line treatment is based on conventional level 1 analgesics and rehabilitation by physiotherapy"}],"type":"custom"}
+{"_id":"arthrite-rhumato-6bcfca","context":null,"enonce":"Which of the following proposition(s) is or is true?","item":"arthrite","matiere":"rhumato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"An effusion of a joint is always the translation of intra-articular suffering"},{"correct":false,"justification":"False. This is ultrasound.","idx":1,"proposition":"MRI is the exam of choice to quickly confirm or rule out joint effusion"},{"correct":true,"justification":"True. Sternoclavicular involvement should be investigated for SAPHO syndrome.","idx":2,"proposition":"SAPHO syndrome includes synovitis, acne, palmoplantar pustulosis, hyperostosis and osteitis"},{"correct":true,"justification":"True","idx":3,"proposition":"Digital osteoarthritis affects the proximal and distal interphalangeal joints with respect for the metacarpophalangeal joints"},{"correct":false,"justification":"False. < 50 g\/L","idx":4,"proposition":"Thrombocytopenia at 70 G \/ L contraindicates joint puncture"}],"type":"custom"}
+{"_id":"SpA-rhumato-156150","context":null,"enonce":"How many joints are affected at?","item":"SpA","matiere":"rhumato","propositions":[{"correct":false,"justification":"Oligoarthritis","idx":0,"proposition":"2"},{"correct":false,"justification":"Oligoarthritis","idx":1,"proposition":"3"},{"correct":true,"justification":"True","idx":2,"proposition":"4"},{"correct":false,"justification":"From 4","idx":3,"proposition":"5"},{"correct":false,"justification":"From 4","idx":4,"proposition":"6"}],"type":"custom"}
+{"_id":"SpA-rhumato-279546","context":null,"enonce":"Which of the following proposals corresponds to the first-line management of inflammatory spondyloarthritis?","item":"SpA","matiere":"rhumato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"NSAIDs in the absence of contraindications"},{"correct":true,"justification":"True","idx":1,"proposition":"Full diagnostic announcement"},{"correct":false,"justification":"Not in the first intention","idx":2,"proposition":"Anti-TNF alpha"},{"correct":false,"justification":"No MA for spondyloarthritis (except psoriatic arthritis)","idx":3,"proposition":"Methotrexate"},{"correct":false,"justification":"Not in the first intention","idx":4,"proposition":"Salazopyrin"}],"type":"custom"}
+{"_id":"rachialgie-rhumato-3940e4","context":null,"enonce":"Which of the following are elements indicating urgent neurosurgical management?","item":"rachialgie","matiere":"rhumato","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"bilateral root involvement"},{"correct":false,"justification":"","idx":1,"proposition":"L4 territory anesthesia"},{"correct":true,"justification":"True","idx":2,"proposition":"cauda equina syndrome"},{"correct":true,"justification":"True","idx":3,"proposition":"Engine deficit≤ 3\/5"},{"correct":false,"justification":"","idx":4,"proposition":"Abolition of the Achilles reflex"}],"type":"custom"}
+{"_id":"SpA-rhumato-258c0c","context":null,"enonce":"Which of the following are found in an inflammatory joint puncture fluid?","item":"SpA","matiere":"rhumato","propositions":[{"correct":false,"justification":"Sign infection of ascites fluid","idx":0,"proposition":"More than 250 PNN\/mm3"},{"correct":true,"justification":"True","idx":1,"proposition":"More than 2000 GB\/mL"},{"correct":false,"justification":"More than 40 g\/L of protein","idx":2,"proposition":"Less than 40 g\/L protein"},{"correct":true,"justification":"True","idx":3,"proposition":"Cloudy fluid"},{"correct":false,"justification":"Hemarthrosis","idx":4,"proposition":"> 150 red blood cells"}],"type":"custom"}
+{"_id":"rachialgie-rhumato-6d1cf8","context":null,"enonce":"Which of the following proposals can lead to a disco-radicular conflict in case of lumbo-cruralgia L4?","item":"rachialgie","matiere":"rhumato","propositions":[{"correct":true,"justification":"True, foraminal or extraforaminal -> touches the first digit (here L4)","idx":0,"proposition":"foraminal hernia L4-L5 "},{"correct":false,"justification":"foraminal or extraforaminal -> touches the first digit (here L3)","idx":1,"proposition":"foraminal hernia L3-L4"},{"correct":true,"justification":"True, median or paramedian -> touches the second digit (here L4)","idx":2,"proposition":"median hernia L3-L4"},{"correct":false,"justification":"True, median or paramedian -> touches the second digit (here L5)","idx":3,"proposition":"paramedian hernia L4-L5"},{"correct":true,"justification":"True, foraminal or extraforaminal -> touches the first digit (here L4)","idx":4,"proposition":"extraforaminal hernia L4-L5"}],"type":"custom"}
+{"_id":"arthrite-rhumato-4c1c2d","context":null,"enonce":"You perform a knee puncture. The liquid returns purulent. On direct examination, gram-positive cocci are observed in clusters. Which germ is most likely to be involved?","item":"arthrite","matiere":"rhumato","propositions":[{"correct":false,"justification":"Diplococcus gram +","idx":0,"proposition":"Streptococcus pyogenes"},{"correct":false,"justification":"Cocci gram + in chains","idx":1,"proposition":"Enterococcus faecalis"},{"correct":false,"justification":"Bacillus gram -","idx":2,"proposition":"Escherichia coli"},{"correct":false,"justification":"Rather found in case of infection associated with care (catheter, tube, etc.). But, indeed, it is a gram cocci + in clusters (this is the case of all staphylococcus).","idx":3,"proposition":"Staphylococcus epidermidis"},{"correct":true,"justification":"True, most likely","idx":4,"proposition":"Staphylococcus aureus"}],"type":"custom"}
+{"_id":"SpA-rhumato-b019c5","context":null,"enonce":"How to treat latent tuberculosis before starting biotherapy?","item":"SpA","matiere":"rhumato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Rifampicin + Isoniazid for 3 months"},{"correct":false,"justification":"False","idx":1,"proposition":"Rifampicin + Isoniazid + Ethambutol + Pyrazynamide for 3 months"},{"correct":true,"justification":"True, if allergy to Rifampicin","idx":2,"proposition":"Isoniazid for 9 months"},{"correct":false,"justification":"False","idx":3,"proposition":"It is the same treatment as tuberculosis disease"},{"correct":false,"justification":"Possible treatment 3 weeks after the end of well-conducted TB treatment","idx":4,"proposition":"Biotherapy is contraindicated for life because of the risk of tuberculosis reactivation"}],"type":"custom"}
+{"_id":"SpA-rhumato-bfbc33","context":null,"enonce":"Which of the following are true?","item":"SpA","matiere":"rhumato","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"Dactylitis is an inflammatory condition of the entire finger or toe"},{"correct":false,"justification":"In young adults. Forms with late onset (after 45 years) are rare ","idx":1,"proposition":"The majority of cases of spondyloarthropathy begin in the elderly "},{"correct":false,"justification":"To the lower limbs ","idx":2,"proposition":"In spondyloarthritis, all entheses can be affected, but enthesitis preferentially sits in the upper limbs "},{"correct":true,"justification":"","idx":3,"proposition":"The sacroiliitis results in the appearance of pain of the buttock of schedule most often inflammatory"},{"correct":true,"justification":"","idx":4,"proposition":"Entheses are the bony insertions of tendons, ligaments, capsules and fascia."}],"type":"custom"}
+{"_id":"SpA-rhumato-7c044d","context":null,"enonce":"Which of the following is the score assessing spondyloarthritis activity?","item":"SpA","matiere":"rhumato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"BASDAI"},{"correct":false,"justification":"Score assessing the functional impact (there is an F in it) of spondyloarthritis (AS for Ankylosing Spondylitis)","idx":1,"proposition":"BASFI"},{"correct":false,"justification":"Activity of rheumatoid arthritis","idx":2,"proposition":"DAS28"},{"correct":false,"justification":"Probability of survival burned patient.","idx":3,"proposition":"ABSI"},{"correct":false,"justification":"Activity of rheumatoid arthritis","idx":4,"proposition":"SDAI"}],"type":"custom"}
+{"_id":"anesth-anesth-6b967e","context":null,"enonce":"Which of the following propositions, is\/are true?","item":"anesth","matiere":"anesth","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Local anesthesia can be performed urgently or programmed by any doctor, regardless of his specialty"},{"correct":true,"justification":"True","idx":1,"proposition":"There are 2 loco-regional anesthesia techniques: perimedullary (around the spinal cord) or peripheral (around the nerve)"},{"correct":false,"justification":"False. At least 2 days","idx":2,"proposition":"The anesthesia consultation must be done at least 3 days before surgery"},{"correct":true,"justification":"True","idx":3,"proposition":"The pre-anesthetic visit must be done a maximum of 24 hours before surgery"},{"correct":true,"justification":"True, written consent is only required for certain specific acts: genetic research, clinical trial, organ removal, tissues, cells from living persons, gamete donation and use, sterilization, abortion. ","idx":4,"proposition":"Oral consent is sufficient for anesthesia during surgery outside of emergency situations "}],"type":"custom"}
+{"_id":"SpA-rhumato-cbc3f7","context":null,"enonce":"Which of the following are complications of anti-TNF-alpha therapy?","item":"SpA","matiere":"rhumato","propositions":[{"correct":true,"justification":"True, dermatological consultation 1x\/year","idx":0,"proposition":"over-risk of skin cancer"},{"correct":true,"justification":"True, annual influenza and pneumococcal vaccination + discontinuation of therapy in case of infection","idx":1,"proposition":"Over-risk of infection"},{"correct":false,"justification":"False","idx":2,"proposition":"over-allergic risk"},{"correct":false,"justification":"False","idx":3,"proposition":"over-risk liver"},{"correct":false,"justification":"False","idx":4,"proposition":"over-risk of AMD"}],"type":"custom"}
+{"_id":"SpA-rhumato-89a4d9","context":null,"enonce":"Which of the following are true?","item":"SpA","matiere":"rhumato","propositions":[{"correct":false,"justification":"False! Red flag, in the first place eliminate an organic cause.","idx":0,"proposition":"In front of back pain, the most likely cause is a static disorder, an X-ray face + profile of the dorsolumbar spine is sufficient"},{"correct":true,"justification":"","idx":1,"proposition":"The search for an indolent or pauci-symptomatic \"sausage\" toe is also very important, justifying the careful examination of patients' feet."},{"correct":false,"justification":"There are 4 stages from 0 to 3 ","idx":2,"proposition":"In conventional radio, the different evolutionary stages of enthesopathy are 3 in number.\r\n"},{"correct":true,"justification":"","idx":3,"proposition":"In the context of spondyloarthritis, there may be anterior acute uveitis, non-granulomatous in most cases, often pauci-symptomatic but sometimes severe. "},{"correct":false,"justification":"False, MRI has no contribution to the diagnosis, if the sacroiliitis is visible on radiography. ","idx":4,"proposition":"In case of sacroiliitis on conventional radio, MRI may have an interest to confirm the diagnosis"}],"type":"custom"}
+{"_id":"rachialgie-rhumato-e14165","context":null,"enonce":"Which of the following proposals correspond to the management of common (non-symptomatic) low back pain without red flag, neither deficit nor hyperalgic?","item":"rachialgie","matiere":"rhumato","propositions":[{"correct":false,"justification":"No imaging exam","idx":0,"proposition":"X-ray of the dorsolumbar spine"},{"correct":false,"justification":"No imaging exam","idx":1,"proposition":"Dorsolumbar CT scan"},{"correct":false,"justification":"On the contrary, normal mobilization","idx":2,"proposition":"Bed rest"},{"correct":true,"justification":"True","idx":3,"proposition":"Analgesics level I and II according to the EVA"},{"correct":true,"justification":"True","idx":4,"proposition":"Nonsteroidal anti-inflammatory drugs in the absence of contraindications, suitable for pain"}],"type":"custom"}
+{"_id":"vaccin-infectio-8ca8e9","context":null,"enonce":"According to the French vaccination schedule in force since 2018, the MMR vaccination schedule recommended in France includes:","item":"vaccin","matiere":"infectio","propositions":[{"correct":false,"justification":"M12 and M16-18","idx":0,"proposition":"2 doses of primary vaccination at 2 and 4 months"},{"correct":false,"justification":"The dose at 16-18 months is not a booster, but a catch-up. It is part of the basic vaccination schedule","idx":1,"proposition":"1 booster dose at 16-18 months"},{"correct":false,"justification":"M12 and M16-18","idx":2,"proposition":"2 doses at 6 and 12 months"},{"correct":false,"justification":"M12 and M16-18","idx":3,"proposition":"2 doses at 12 months and 6 years"},{"correct":true,"justification":"True","idx":4,"proposition":"2 doses at 12 months and 16-18 months"}],"type":"custom"}
+{"_id":"IST-infectio-6d146e","context":null,"enonce":"Which of the following are true about Syphilis?","item":"IST","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The incidence is currently increasing"},{"correct":false,"justification":"It is common ⚠","idx":1,"proposition":"HIV co-infection is rare"},{"correct":true,"justification":"True","idx":2,"proposition":"Transmission can occur transplacentally"},{"correct":false,"justification":"More than one year 📅","idx":3,"proposition":"The infection is said to be late if it is more than a month old"},{"correct":true,"justification":"True","idx":4,"proposition":"The chancre testifies to the replication of treponema at the front door"}],"type":"custom"}
+{"_id":"156-infectio-efaacbf6-352e-4e76-9cec-913b380fa662","context":null,"enonce":"With regard to tetanus, at what age are vaccinations associated with diphtheria and poliomyelitis done?","item":"tetanos","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"2-4-11 months"},{"correct":true,"justification":"True","idx":1,"proposition":"6 years"},{"correct":true,"justification":"True","idx":2,"proposition":"13 years"},{"correct":true,"justification":"True","idx":3,"proposition":"25 years and 45 years"},{"correct":true,"justification":"True","idx":4,"proposition":"65 years then every 10 years"}],"type":"custom"}
+{"_id":"vaccin-infectio-14491e","context":null,"enonce":"You are following Jean-Paul. He is 75 years old and has type 2 diabetes. He tells you he hasn't had a vaccination in a very long time and asks you which ones he should do. Your answers:","item":"vaccin","matiere":"infectio","propositions":[{"correct":true,"justification":"True, reminders at 6 years, 11-13 years, 25 years, 45 years, 65 years, 75 years and then every 10 years","idx":0,"proposition":"DTP Reminder"},{"correct":true,"justification":"True. Diabetic = immunocompromised = antipneumococcus + antiinfluenza","idx":1,"proposition":"anti-pneumococcal"},{"correct":true,"justification":"True","idx":2,"proposition":"seasonal anti-influenza"},{"correct":false,"justification":"","idx":3,"proposition":"anti-hepatitis B"},{"correct":false,"justification":"","idx":4,"proposition":"anti-meningococcal"}],"type":"custom"}
+{"_id":"IU-infectio-a0d66d","context":null,"enonce":"What are the hospitalization criteria for a non-serious NAP?","item":"IU","matiere":"infectio","propositions":[{"correct":true,"justification":"3 reasons: signs of severity, hyperalgic form, non-observant patient","idx":0,"proposition":"A hyperalgic form"},{"correct":true,"justification":"True","idx":1,"proposition":"Doubts about the patient's ability to adhere to antibiotic treatment"},{"correct":false,"justification":"The presence of bacteremia (when tested) does not change management","idx":2,"proposition":"Associated bacteremia"},{"correct":false,"justification":"The intensity of the fever without other argument of sepsis, and without particular terrain, is not in itself an indication of hospitalization","idx":3,"proposition":"A fever > 40°C"},{"correct":false,"justification":"Especially an argument to look for a favoring factor","idx":4,"proposition":"A history of repeated ANP"}],"type":"custom"}
+{"_id":"meningite-infectio-603bf3","context":null,"enonce":"Mr. X brings you his 2-year-old son for a fever. \"He's not like usual, he's all grumpy,\" he explains. You notice when you undress the child a necrotic-looking purpura appeared in the morning. What is the course of action?","item":"meningite","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"You contact the SAMU for a medical transfer to the nearest hospital"},{"correct":true,"justification":"True","idx":1,"proposition":"You immediately perform an injection of parenteral C3G IM or IV"},{"correct":false,"justification":"Purpura fulminans = immediate life-threatening emergency, requiring urgent parenteral C3G antibiotic therapy and resuscitation","idx":2,"proposition":"You prescribe symptomatic treatment with paracetamol and ask to see the child again the next day"},{"correct":false,"justification":"Purpura fulminans = immediate life-threatening emergency, requiring urgent parenteral C3G antibiotic therapy and resuscitation","idx":3,"proposition":"You send the child to perform a biology at the local laboratory"},{"correct":false,"justification":"SAMU call for medical transfer","idx":4,"proposition":"You ask the father to take his child to the emergency room right away"}],"type":"custom"}
+{"_id":"aNcycle-gyn-f6792f","context":null,"enonce":"Regarding menorrhagia and metrorrhagia, which of these propositions are true?","item":"aNcycle","matiere":"gyn","propositions":[{"correct":false,"justification":"False, we talk about menorrhagia when the Higham score is >100","idx":0,"proposition":"We talk about menorrhagia when the Higham score is >200"},{"correct":true,"justification":"True, these are the main consequences of bleeding.","idx":1,"proposition":"In the face of bleeding of gynecological origin it is essential to assess tolerance by looking for signs of shock and anemia"},{"correct":false,"justification":"False, the main causes of bleeding in the 3rd trimester of pregnancy are placenta previa and retroplacental hematoma","idx":2,"proposition":"In front of a hemorrhage of the 3rd trimester of pregnancy, the main causes of metrorrhagia to evoke are late miscarriage and ectropion"},{"correct":false,"justification":"False, pelvic ultrasound is performed as a first-line procedure, easier to access and practice than pelvic MRI","idx":3,"proposition":"In the event of genital bleeding, the complementary first-line examinations are BHCG, CBC and pelvic MRI"},{"correct":false,"justification":"False, any gynecological bleeding is cancer of the BODY of the uterus until proven otherwise (the endometrium is the cause of gynecological bleeding and is in the uterus not on the cervix)","idx":4,"proposition":"Any postmenopausal gynecological bleeding is cervical cancer until proven otherwise."}],"type":"custom"}
+{"_id":"nvxne-gyn-9241a6","context":null,"enonce":"Which of the following proposals are routinely included in the blotting paper biological newborn screening test?","item":"nvxne","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Congenital adrenal hyperplasia"},{"correct":true,"justification":"True","idx":1,"proposition":"Hypothyroidism"},{"correct":true,"justification":"True","idx":2,"proposition":"Cystic fibrosis"},{"correct":true,"justification":"True","idx":3,"proposition":"PKU"},{"correct":false,"justification":"That if risk factor","idx":4,"proposition":"Sickle-cell anemia"}],"type":"custom"}
+{"_id":"TED-psy-646a07","context":null,"enonce":"Which of the following proposals are part of the ASD assessment?","item":"TED","matiere":"psy","propositions":[{"correct":true,"justification":"For the assessment of IQ, adaptive behaviour (e.g. Vineland scale) and attentional abilities","idx":0,"proposition":"A psychological assessment"},{"correct":true,"justification":"For the evaluation of verbal and non-verbal language and language pragmatics","idx":1,"proposition":"A speech therapy assessment"},{"correct":true,"justification":"","idx":2,"proposition":"A psychomotor assessment"},{"correct":true,"justification":"Look for epilepsy (present in 20% of ASD)","idx":3,"proposition":"Wake and sleep EEG"},{"correct":true,"justification":"Systematics for the diagnosis of syndromic forms of ASD","idx":4,"proposition":"Brain MRI"}],"type":"custom"}
+{"_id":"psygrossesse-psy-21c20a","context":null,"enonce":"Which of the following are true about the baby blues?","item":"psygrossesse","matiere":"psy","propositions":[{"correct":false,"justification":"No treatment, it is physiological","idx":0,"proposition":"It must be treated with SSRIs for 6 weeks"},{"correct":true,"justification":"True","idx":1,"proposition":"Anxiety may be observed"},{"correct":true,"justification":"True","idx":2,"proposition":"Patients do not understand their symptoms (\"I have everything to be happy\")"},{"correct":true,"justification":"True","idx":3,"proposition":"We can find an emotional lability"},{"correct":false,"justification":"It can be very transient and last only a few hours (College of Gynecological)","idx":4,"proposition":"It lasts 2 days minimum"}],"type":"custom"}
+{"_id":"dvlptpsychoMo-psy-515600","context":null,"enonce":"Which of the following are true?","item":"dvlptpsychoMo","matiere":"psy","propositions":[{"correct":true,"justification":"True\r\nThink that PC as weight starts with 35 it helps :).\r\n","idx":0,"proposition":"The average parameters of birth of a term newborn are a weight of 3500g, a height of 50cm and a PC at 35cm."},{"correct":false,"justification":"FALSE\r\nIt is doubled at 4 months of life.","idx":1,"proposition":"The birth weight of a child is doubled at 1 year."},{"correct":true,"justification":"True\r\nBetween 20 and 30g per day indeed.","idx":2,"proposition":"During the first trimester of life, an infant is expected to take 25g per day."},{"correct":false,"justification":"False\r\nDefinition of a statural growth anomaly\r\n- Size< -2 DS according to the curves of the general population.\r\n- And\/or size< -1.5 SD relative to genetic target size\r\n- And\/or slowing down (or breaking the growth rate) (< 4cm per year after 4 years)","idx":3,"proposition":"A child with a height of -1.5 DS, has a delay in stature."},{"correct":true,"justification":"True\r\nImportant to know how to calculate. We must be careful because sometimes we can know a statural delay if we rely only on the \"raw\" size, with for example a child at -0.8 DS, which is absolutely normal if we look at that, but if there is a high parental target size, let's admit +2 DS, it will be late (because 2.8 DS difference).\r\nHence the importance of the 3 criteria in the definition.","idx":4,"proposition":"To calculate the genetic target height of a boy, it is necessary to: (Mother's height + father's height)\/2 +6.5"}],"type":"custom"}
+{"_id":"certificats-psy-ba9673","context":null,"enonce":"In the case of intentional violence, what is the threshold of days modifying the classification of the offence?","item":"certificats","matiere":"psy","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"5"},{"correct":true,"justification":"True. Below ➡ police court ticket ➡. Above ��� misdemeanor ➡ criminal court","idx":1,"proposition":"8"},{"correct":false,"justification":"","idx":2,"proposition":"3"},{"correct":false,"justification":"","idx":3,"proposition":"30"},{"correct":false,"justification":"Three months. This is the case for unintentional violence","idx":4,"proposition":"90"}],"type":"custom"}
+{"_id":"TED-psy-bd69ef","context":null,"enonce":"Which of the following are true?","item":"TED","matiere":"psy","propositions":[{"correct":true,"justification":"True, defined in repository","idx":0,"proposition":" The prevalence of ASD is 1% and the sex ratio is 4:1 in favour of boys"},{"correct":true,"justification":"True","idx":1,"proposition":" Like all neurodevelopmental disorders, ASD has a multifactorial origin"},{"correct":true,"justification":"That's why we talk about autism spectrum disorders.","idx":2,"proposition":" There is significant clinical heterogeneity of ASD"},{"correct":true,"justification":"","idx":3,"proposition":"Heterogeneity is related to the severity of symptoms in the 2 clinical areas of ASD as well as the presence of comorbidities with other neurodevelopmental disorders"},{"correct":false,"justification":"No, there are children who have a normal IQ (> 70). This is called Asperger's syndrome.","idx":4,"proposition":"All children with autism spectrum disorder have a mental disability"}],"type":"custom"}
+{"_id":"bipolaire-psy-53912c","context":null,"enonce":"Which of these propositions are true among bipolar disorder?","item":"bipolaire","matiere":"psy","propositions":[{"correct":false,"justification":"False, bipolar disorder usually appears between 15 and 25 years but it is often diagnosed at more than 30 years ...","idx":0,"proposition":"Bipolar disorder is a disorder that appears around the age of 30"},{"correct":false,"justification":"False, a bipolar disorder type 1 is diagnosed by the presence of a manic episode +\/- a depressive episode! (We cannot talk about bipolar disorder if there is only one depressive episode...)","idx":1,"proposition":"Bipolar disorder type 1 is diagnosed by the presence of a manic episode or a characterized depressive episode."},{"correct":false,"justification":"False, the semiology of a hypomanic syndrome being more frustrating, to speak of a bipolar disorder it is necessary the association of one or more hypomanic episodes and one or more depressive episodes","idx":2,"proposition":"Bipolar disorder type 2 is diagnosed by the presence of one or more hypomanic episodes"},{"correct":true,"justification":"True, lithium is one of the rare cases of the use of a metal as a medicine in medicine. ","idx":3,"proposition":"Treatment of choice for bipolar disorder uses metal-based medication"},{"correct":true,"justification":"True","idx":4,"proposition":"Cognitive remediation is a psychological rehabilitation technique "}],"type":"custom"}
+{"_id":"addpsychotropes-psy-d071a7","context":null,"enonce":"Regarding benzodiazepine addiction, which of the following propositions, which one or which are true?","item":"addpsychotropes","matiere":"psy","propositions":[{"correct":true,"justification":"True, these are the main actions of treatments","idx":0,"proposition":"Benzodiazepines are anxiolytic, hypnotic, amnesiac, anticonvulsant and muscle relaxant drugs"},{"correct":true,"justification":"True, this is why there is an addiction to benzodiazepines.","idx":1,"proposition":"Benzodiazepines are part of the treatments with tolerance and withdrawal"},{"correct":true,"justification":"True, the main cause of benzodiazepine addiction is \"automatic\" prescription renewal.","idx":2,"proposition":"When prescribing a benzodiazepine, it should always be considered that it is only a temporary treatment, and should be discontinued."},{"correct":false,"justification":"False, we never put more than one benzodiazepine.","idx":3,"proposition":"For the management of anxiety, a maximum of two anxiolytics can be combined, one short-lived and one long-lived"},{"correct":true,"justification":"True, abrupt withdrawal increases the risk of physical withdrawal syndrome.","idx":4,"proposition":"A gradual cessation is preferred to a sudden withdrawal."}],"type":"custom"}
+{"_id":"TED-psy-809b68","context":null,"enonce":"Which of the following are genetic or metabolic diseases causing autism spectrum disorder?","item":"TED","matiere":"psy","propositions":[{"correct":true,"justification":"Rett syndrome is a genetic disease. The disease causes a severe and comprehensive disorder of the development of the central nervous system, occurring only in girls. It results in multiple disabilities with intellectual disability and motor disability, which are often severe. (Source: https:\/\/www.orpha.net\/data\/patho\/Pub\/fr\/Rett-FRfrPub91.pdf)","idx":0,"proposition":"Syndrome de Rett"},{"correct":true,"justification":"Autonomic recessive genetic disease linked to a deficiency of phenylalanine hydroxylase, an enzyme that allows the transformation of phenylalanine into Tyrolean. It is responsible, in the absence of treatment, for severe psychomotor retardation. The disease is screened for blood (Guthrie) on Day 3 by measuring phenylalanine. ","idx":1,"proposition":"PKU"},{"correct":true,"justification":"","idx":2,"proposition":"Abnormality of creatinine metabolism"},{"correct":false,"justification":"Trisomy 21 is not in itself a genetic cause of ASD, but is an associated risk factor. 3% of children with trisomy 21 have ASD (p. 154 8th edition of the College of Pediatrics)","idx":3,"proposition":"Down syndrome"},{"correct":true,"justification":"","idx":4,"proposition":"Fragile X syndrome"}],"type":"custom"}
+{"_id":"dvlptpsychoMo-psy-6b5a9f","context":null,"enonce":"Which of the following proposals should be acquired at 2 months?","item":"dvlptpsychoMo","matiere":"psy","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Shake your finger"},{"correct":true,"justification":"True","idx":1,"proposition":"Smile-response"},{"correct":false,"justification":"4 months","idx":2,"proposition":"Holding your head"},{"correct":false,"justification":"4 months","idx":3,"proposition":"Laughing out loud"},{"correct":false,"justification":"6 months","idx":4,"proposition":"Hold seated with support"}],"type":"custom"}
+{"_id":"puberte-gyn-34d8ac","context":null,"enonce":"Which of the following are true?","item":"puberte","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The Tanner classification evaluates the appearance of secondary sex characteristics for monitoring the pubertal evolution of girls and boys."},{"correct":true,"justification":"True Hence the boys who often make small in middle school compared to girls 1) their puberty begins physiologically + late, 2) the statural acceleration begins at a later stage of puberty.","idx":1,"proposition":"The acceleration of the rate of stature growth begins at the first signs of puberty in girls (S2) and staggered in boys (G3) and rises up to 8 to 10 cm per year."},{"correct":false,"justification":"The appearance of the sesamoid of the thumb is contemporary with the onset of puberty, at a bone age of 11 years in girls and 13 years in boys.","idx":2,"proposition":"The appearance of the sesamoid of the thumb means that the growth of the child is almost complete."},{"correct":true,"justification":"True","idx":3,"proposition":"Bone maturation in children can be assessed by bone age, which is obtained by taking an X-ray of the left hand and wrist from the front."},{"correct":false,"justification":"Wrong, it's the other way around. Early puberty is defined as breast development in girls before the age of 8 and in boys testicular development before the age of 9.                          Puberty physio in girls 8-13 years, 9-14 years in boys.","idx":4,"proposition":"Precocious puberty is defined as breast development in girls before the age of 9 and in boys testicular development before the age of 8."}],"type":"custom"}
+{"_id":"Exprenuptial-gyn-8c92f3","context":null,"enonce":"Which of the following are teratogenic drugs?","item":"Exprenuptial","matiere":"gyn","propositions":[{"correct":false,"justification":"False. A pregnant woman with lupus can continue to take her background treatment.","idx":0,"proposition":"Hydroxychloroquine"},{"correct":false,"justification":"False","idx":1,"proposition":"Corticosteroids"},{"correct":true,"justification":"True. All ACE inhibitors and angiotensin II receptor antagonists (sartans) are contraindicated in the 2nd and 3rd trimesters of pregnancy. They are not contraindicated in the first trimester, but it is not advisable to maintain them during pregnancy. ","idx":2,"proposition":"IEC"},{"correct":true,"justification":"True","idx":3,"proposition":"Valproic acid"},{"correct":true,"justification":"True. Effective contraception should be initiated during this acne treatment, and maintained 4 weeks after stopping treatment.","idx":4,"proposition":"Isotretinoin"}],"type":"custom"}
+{"_id":"EI-cardio-659da3","context":null,"enonce":"You have in hospitalization in infectious disease Mrs. Bouvier, Pamela, 76 years old, who has a febrile heart murmur newly appeared for 1 week, poorly tolerated. Although you suspect infective endocarditis, blood cultures persist in coming back negative, and yet you have not initiated any antibiotic therapy 😑. You then think about the causes of negative blood culture endocarditis, what are they? 😏","item":"EI","matiere":"cardio","propositions":[{"correct":true,"justification":"True, the causes of negative blood culture endocarditis are: Whipple, Bartonella, Brucella, Coxiella, Chlamydia, H.A.C.E.K. but also Legionella, Mycoplasma, Rickettsia, Aspergillus, etc....","idx":0,"proposition":"Treponema whipplei endocarditis"},{"correct":true,"justification":"True","idx":1,"proposition":"Bartonella endocarditis"},{"correct":true,"justification":"True","idx":2,"proposition":"Coxiella endocarditis"},{"correct":true,"justification":"True","idx":3,"proposition":"Bacterial endocarditis of the H.A.C.E.K. group"},{"correct":true,"justification":"True","idx":4,"proposition":"Brucella endocarditis"}],"type":"custom"}
+{"_id":"EI-cardio-0b77ff","context":null,"enonce":"Which of the following are true for the diagnosis of infective endocarditis? 🤯","item":"EI","matiere":"cardio","propositions":[{"correct":false,"justification":"ETT-Hémoc wesh! Then ETO.","idx":0,"proposition":"CT angiography is the first-line examination"},{"correct":false,"justification":"The ETO is very often done as a second intention, after the ETT","idx":1,"proposition":"ETO is only needed in case of negative 🤷 ♂️ angioscan"},{"correct":false,"justification":"Not always, it is not found in 10% of cases ➡ bacteria of the HACCEK group (slow growing), prior antibiotic therapy, etc. In all cases, blood cultures must be repeated several times 😋","idx":2,"proposition":"Blood cultures always find the germ"},{"correct":true,"justification":"True, they contraindicate thrombolysis in stroke","idx":3,"proposition":"Brain MRI can find mycotic aneurysms"},{"correct":true,"justification":"True","idx":4,"proposition":"The presence of two major criteria (ultrasound + blood culture) make it possible to make the diagnosis of infective endocarditis"}],"type":"custom"}
+{"_id":"EI-cardio-7da7a2","context":null,"enonce":"Which bacteria are most common in infective endocarditis? 🙌","item":"EI","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Golden staph"},{"correct":true,"justification":"True","idx":1,"proposition":"Staphylococcus aureus "},{"correct":false,"justification":"Staph > Strepto","idx":2,"proposition":"Streptococcus pneumoniae"},{"correct":false,"justification":"Gram-negative cocci that lead to ear and upper and lower respiratory tract infections","idx":3,"proposition":"Moraxella catarrhalis"},{"correct":false,"justification":"This is not the most common. This germ often has a digestive origin (➡ perform a colonoscopy)","idx":4,"proposition":"Streptococcus D"}],"type":"custom"}
+{"_id":"EI-cardio-39c91d","context":null,"enonce":"Which of the following are true?","item":"EI","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The germ mostly found is Staphylococcus aureus"},{"correct":false,"justification":"90% = left heart","idx":1,"proposition":"The right heart is more often affected than the left 💔 heart"},{"correct":true,"justification":"True","idx":2,"proposition":"IV addiction is an important risk factor for endocarditis of the right heart"},{"correct":true,"justification":"True, risk of rupture of mycotic aneurysm","idx":3,"proposition":"IV thrombolysis in stroke is contraindicated (relatively) in case of a history of AE"},{"correct":false,"justification":"If ✅","idx":4,"proposition":"Age is not a risk factor"}],"type":"custom"}
+{"_id":"EI-cardio-9a8606","context":null,"enonce":"Which of the following are true about fungal endocarditis?","item":"EI","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"There is frequently a diagnostic delay"},{"correct":false,"justification":"They are very common","idx":1,"proposition":"There are no embolic complications"},{"correct":true,"justification":"True","idx":2,"proposition":"It is often necessary to combine surgical treatment with medical treatment"},{"correct":true,"justification":"True","idx":3,"proposition":"IV addiction is an important risk factor"},{"correct":false,"justification":"Almost all, sorry 🙏","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"EI-cardio-5f83fe","context":null,"enonce":"What is the procedure to take in case of dental avulsion in a patient who has had infective endocarditis and proven allergy to amoxicillin?","item":"EI","matiere":"cardio","propositions":[{"correct":false,"justification":"Sound familiar? 😋 This is the prophylaxis of pneumocytosis in immunocompromised 😉 people","idx":0,"proposition":"Prolonged antibiotic prophylaxis with bactrim 3x per week"},{"correct":false,"justification":"Not in case of proven 🙈 allergy","idx":1,"proposition":"2g of amoxicillin 1 hour before the gesture"},{"correct":true,"justification":"True","idx":2,"proposition":"Clindamycin 1 hour before the procedure"},{"correct":false,"justification":"","idx":3,"proposition":"Levofloxacin 1 day before the gesture"},{"correct":false,"justification":"","idx":4,"proposition":"Metronidazole 1h before the gesture"}],"type":"custom"}
+{"_id":"EI-cardio-9a8b5a","context":null,"enonce":"Which of the following are major criteria in infective endocarditis?","item":"EI","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Positive imaging"},{"correct":true,"justification":"True","idx":1,"proposition":"Positive blood culture"},{"correct":false,"justification":"","idx":2,"proposition":"Prolonged fever"},{"correct":false,"justification":"Minor criterion","idx":3,"proposition":"Janeway's Pupura"},{"correct":false,"justification":"Duke Criteria","idx":4,"proposition":"These are the Lauwers criteria."}],"type":"custom"}
+{"_id":"EI-cardio-2059a4","context":null,"enonce":"Which of the following are signs or symptoms of infective endocarditis?","item":"EI","matiere":"cardio","propositions":[{"correct":true,"justification":"True, always think about it in front of a prolonged fever! 🚨","idx":0,"proposition":"Prolonged fever"},{"correct":true,"justification":"True","idx":1,"proposition":"Splenic abscess"},{"correct":false,"justification":"Cerebral mycotic aneurysms (these are fake aneurysms eh)","idx":2,"proposition":"Coronary aneurysms"},{"correct":true,"justification":"True","idx":3,"proposition":"Janeway's erythematosus cupboard "},{"correct":false,"justification":"Glomerulonephritis pauci-immune","idx":4,"proposition":"Light chain proteinuria"}],"type":"custom"}
+{"_id":"EI-cardio-0b5a45","context":null,"enonce":"Which of the following are true for Libman-Sacks endocarditis?","item":"EI","matiere":"cardio","propositions":[{"correct":false,"justification":"Non-infectious endocarditis","idx":0,"proposition":"It is infective endocarditis"},{"correct":false,"justification":"","idx":1,"proposition":"It is endocarditis of the right heart"},{"correct":false,"justification":"Lupus","idx":2,"proposition":"It complicates Gougerot syndrome"},{"correct":true,"justification":"True, a bit of history 🧐 (from Wikipedia we admit 😇)","idx":3,"proposition":"The lesions were described by Emanuel Libman and Benjamin Sacks in 1924."},{"correct":true,"justification":"True","idx":4,"proposition":"This endocarditis can be asymptomatic"}],"type":"custom"}
+{"_id":"EI-cardio-1b5678","context":null,"enonce":"Which heart diseases are at high risk of developing infective endocarditis? 🤔","item":"EI","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Cyanogenic heart disease"},{"correct":true,"justification":"True","idx":1,"proposition":"History of infective endocarditis"},{"correct":true,"justification":"True","idx":2,"proposition":"Biological mitral valve"},{"correct":true,"justification":"True","idx":3,"proposition":"Mechanical aortic valve"},{"correct":true,"justification":"True, hence the need for antibiotic prophylaxis in case of invasive dental procedure","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"EI-cardio-bf9cc3","context":null,"enonce":"What is the mortality rate of fungal endocarditis? 🍄","item":"EI","matiere":"cardio","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"5 %"},{"correct":false,"justification":"","idx":1,"proposition":"20 %"},{"correct":true,"justification":"True","idx":2,"proposition":"> 50%"},{"correct":true,"justification":"True","idx":3,"proposition":"Surgical treatment should be discussed concomitantly with medical treatment"},{"correct":false,"justification":"More reserved prognosis (mortality rate of bacterial AEs around 20%)","idx":4,"proposition":"The prognosis is better than that of bacterial endocarditis"}],"type":"custom"}
+{"_id":"EI-cardio-d23456","context":null,"enonce":"Which of the following proposals can result in blood culture negative endocarditis?","item":"EI","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Bartonella"},{"correct":true,"justification":"True","idx":1,"proposition":"Coxiella burnetii"},{"correct":true,"justification":"True","idx":2,"proposition":"Tropheryma whipplei"},{"correct":true,"justification":"True, HACCEK Group","idx":3,"proposition":"H. parainfluenzae"},{"correct":true,"justification":"True, HACECK group","idx":4,"proposition":"Kingella kingae"}],"type":"custom"}
+{"_id":"EI-cardio-1107dc","context":null,"enonce":"What is the procedure to take in case of dental avulsion in a patient who has had infective endocarditis?","item":"EI","matiere":"cardio","propositions":[{"correct":false,"justification":"This is the case in prophylaxis of pneumocytosis in immunocompromised people","idx":0,"proposition":"Prolonged antibiotic prophylaxis with bactrim 3x per week"},{"correct":true,"justification":"True, indicated in case of infective endocarditis, cyanogenic heart disease or new valve. If allergy: clindamycin","idx":1,"proposition":"2g of amoxicillin 1 hour before the gesture"},{"correct":false,"justification":"","idx":2,"proposition":"2g of amoxicillin 1 day after the gesture"},{"correct":false,"justification":"Too long, I remind you that beta-lactam have a short lifespan (we made a fairly complete topo on insta, you can find it on the storys on the front page)","idx":3,"proposition":"1g of amoxicillin 1 week before the gesture"},{"correct":false,"justification":"","idx":4,"proposition":"Antibiotic prophylaxis is not necessary"}],"type":"custom"}
+{"_id":"suiviMIT-infectio-cc75d9","context":null,"enonce":"Which of the following diseases are notifiable diseases?","item":"suiviMIT","matiere":"infectio","propositions":[{"correct":true,"justification":"True, it is a notifiable disease because it is necessary to identify the food source to limit the risk of epidemic","idx":0,"proposition":"Listeriasis"},{"correct":true,"justification":"True, it is a reportable disease because it is necessary to identify the environmental source to limit the risk of epidemic.","idx":1,"proposition":"Legionellosis"},{"correct":true,"justification":"True since 2021 due to the implantation of this virus in the on of Europe (this is also the case for the tick-borne encephalitis virus which has become the 3rd cause in France of encephalitis)","idx":2,"proposition":"Infection par le virus West Nile"},{"correct":true,"justification":"True, like almost all arbroviruses (Dengue, Yellow fever, Zika) ","idx":3,"proposition":"Chikungunya"},{"correct":false,"justification":"False, invasive meningococcal invasions are reportable","idx":4,"proposition":"Meningitis"}],"type":"custom"}
+{"_id":"IBP-infectio-06c351","context":null,"enonce":"In front of bronchiolitis of the child, what are the criteria of severity?","item":"IBP","matiere":"infectio","propositions":[{"correct":false,"justification":"False, it has been changed it is an age of less than 8 weeks","idx":0,"proposition":"Age less than 6 weeks"},{"correct":true,"justification":"True, logically","idx":1,"proposition":"Difficulties of living conditions, precariousness"},{"correct":false,"justification":"False, it has been changed it is below 92%","idx":2,"proposition":"Desaturation below 94%"},{"correct":true,"justification":"True, logically","idx":3,"proposition":"Feeding difficulties"},{"correct":false,"justification":"False, it is severe signs of struggle that count!","idx":4,"proposition":"Signs of respiratory struggle"}],"type":"custom"}
+{"_id":"IST-infectio-e8d85a","context":null,"enonce":"What is the first-line treatment for Treponema pallidum infection?","item":"IST","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Penicillin G"},{"correct":false,"justification":"Neisseria gonorrhoeae","idx":1,"proposition":"Ceftriaxone "},{"correct":false,"justification":"Chlamydia trachomatis","idx":2,"proposition":"Doxycycline"},{"correct":false,"justification":"HSV","idx":3,"proposition":"Valaciclovir"},{"correct":false,"justification":"Trichomonas vaginalis","idx":4,"proposition":"Metronidazole "}],"type":"custom"}
+{"_id":"154-infectio-32e6bd67-83b7-41b5-9276-29648deb3f86","context":null,"enonce":"While visiting with your favourite outpatient in the infectious diseases department, you go to the room of Mrs. Solitaire, 55, who has gram-negative bacillus bacteremia. Your external will ask you if there is a need to do further examinations to look for a secondary location of bacteremia. You answer him that no, this is not the case here, but that there are certain germs for which it is necessary in case of bacteremia to systematically look for a secondary location or an endovascular relay. What are these germs?","item":"bacteriemie","matiere":"infectio","propositions":[{"correct":false,"justification":"False, we do not systematically look for a secondary location to this germ","idx":0,"proposition":"Enterococcus"},{"correct":false,"justification":"False, we do not systematically look for a secondary location to this germ","idx":1,"proposition":"Pneumococcus"},{"correct":true,"justification":"True, there is a very significant risk of Staphylococcus aureus endocarditis, which requires a transthoracic ultrasound","idx":2,"proposition":"Golden staph"},{"correct":true,"justification":"True, a candida fungemia must be sought for cardio and ocular localization and requires a transthoracic ultrasound and fundus","idx":3,"proposition":"Candida"},{"correct":false,"justification":"False, we do not systematically look for a secondary location of this germ","idx":4,"proposition":"Pseudomonas aeruginosa"}],"type":"custom"}
+{"_id":"vaccin-infectio-b00fe5","context":null,"enonce":"Which of the following are viruses against which vaccines exist?","item":"vaccin","matiere":"infectio","propositions":[{"correct":true,"justification":"True, this is a live attenuated vaccine","idx":0,"proposition":"yellow fever"},{"correct":true,"justification":"True, this is a live attenuated vaccine","idx":1,"proposition":"varicella-zoster"},{"correct":true,"justification":"True","idx":2,"proposition":"influenza"},{"correct":false,"justification":"","idx":3,"proposition":"hepatitis C"},{"correct":true,"justification":"True","idx":4,"proposition":"hepatitis B"}],"type":"custom"}
+{"_id":"IST-infectio-66fbc1","context":null,"enonce":"What is the first-line treatment for Chlamydia trachomatis infection?","item":"IST","matiere":"infectio","propositions":[{"correct":true,"justification":"True, replaced azithromycin as first-line treatment","idx":0,"proposition":"Doxycycline"},{"correct":false,"justification":"Neisseria gonorrhoeae","idx":1,"proposition":"Ceftriaxone "},{"correct":false,"justification":"HSV","idx":2,"proposition":"Valaciclovir"},{"correct":false,"justification":"Trichomonas vaginalis","idx":3,"proposition":"Metronidazole "},{"correct":false,"justification":"Treponema pallidum ","idx":4,"proposition":"Penicillin G"}],"type":"custom"}
+{"_id":"fievreaigue-infectio-b18db5","context":null,"enonce":"While you are an outpatient in your general medicine department, the nurse approaches you by telling you that Mrs. King, Elektra, 55 years old, admitted for 8 days for biological inflammatory syndrome, has a fever of 38.2 ° C.  Not knowing where to start you will see your intern who tells you to apply the rule of P, which makes it easy to look for nosocomial fevers. What are the \"Ps\" that are part of it?","item":"fievreaigue","matiere":"infectio","propositions":[{"correct":true,"justification":"True, the 5P rule is not to know for the ECN but it seems essential to me for your internships. The 5 Ps are Pee (Urinary Tract Infection), Lung (Pneumonitis), Skin (Erysipelas), Phlebitis (DVT) and Peripheral Puncture (Catheter)","idx":0,"proposition":"P for Pee, urinary tract infection"},{"correct":false,"justification":"False, cf. Has","idx":1,"proposition":"P for Prostate, Prostatitis"},{"correct":true,"justification":"True, cf. Has","idx":2,"proposition":"P for Skin, erysipelas"},{"correct":true,"justification":"True, cf. Has","idx":3,"proposition":"P for Phlebitis, Deep vein thrombosis"},{"correct":false,"justification":"False, cf. Has","idx":4,"proposition":"P for \"Pipeau\", factitious fever"}],"type":"custom"}
+{"_id":"vaccin-infectio-4cb4b7","context":null,"enonce":"Which of the following are true about influenza vaccination?","item":"vaccin","matiere":"infectio","propositions":[{"correct":false,"justification":"Inert vaccine","idx":0,"proposition":"It is a live attenuated vaccine"},{"correct":false,"justification":"1 annual injection is enough","idx":1,"proposition":"It requires 2 injections 1 month apart"},{"correct":false,"justification":"It is recommended!","idx":2,"proposition":"It is contraindicated in pregnant women"},{"correct":true,"justification":"True","idx":3,"proposition":"It must be renewed every year"},{"correct":true,"justification":"True","idx":4,"proposition":"Immunity appears 10-15 days after vaccination"}],"type":"custom"}
+{"_id":"vaccin-infectio-163c08","context":null,"enonce":"Which of the following are true about BCG vaccination?","item":"vaccin","matiere":"infectio","propositions":[{"correct":true,"justification":"True, it is a M. bovis attenuated in its pathogenicity","idx":0,"proposition":"It derives from Mycobacterium bovis"},{"correct":false,"justification":"Intradermal","idx":1,"proposition":"Administration is intramuscular"},{"correct":false,"justification":"Recommended","idx":2,"proposition":"It is mandatory in a child born in a country with a high tuberculosis endemic"},{"correct":false,"justification":"Recommended","idx":3,"proposition":"It is mandatory in a child with a family history of tuberculosis"},{"correct":true,"justification":"True, due to a risk of vaccine disease, as with all live attenuated vaccines","idx":4,"proposition":"It is contraindicated in case of cellular immunosuppression"}],"type":"custom"}
+{"_id":"IST-infectio-4aab71","context":null,"enonce":"Which of the following are true about HPV?","item":"IST","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Condylomas are always due to HPV"},{"correct":true,"justification":"True","idx":1,"proposition":"Infection is asymptomatic most of the time"},{"correct":false,"justification":"The treatment of condylomas is based, depending on their size and location, on the use of laser, local treatments (especially imiquimod) or surgery","idx":2,"proposition":"Treatment of warts is based on antivirals such as acyclovir"},{"correct":false,"justification":"Nonavalent vaccine is preferred","idx":3,"proposition":"Bivalent vaccine is preferred in most cases"},{"correct":true,"justification":"The HAS recommended in December 2019 to vaccinate all boys with the same vaccination schedule as in girls: two doses of Gardasil 9 vaccine (M0-M6) in 11-14 years old and catch-up in 15-19 year olds with 3 doses (M0-M2-M6). This recommendation has been in effect since January 1, 2021.","idx":4,"proposition":"Vaccination of boys and girls is recommended"}],"type":"custom"}
+{"_id":"160-infectio-23bd82eb-9469-4ab1-928e-ec020e10f6ba","context":null,"enonce":"Regarding measles, which of the following proposition(s) is true?","item":"exanthemeped","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The period of contagiousness extends from 5 days before to 5 days after the rash"},{"correct":true,"justification":"True, these are the white\/bluish rashes on the inner side of the cheek appearing at the 36th hour of the fever and persisting until the rash.","idx":1,"proposition":"Koplik's sign is pathognomonic"},{"correct":false,"justification":"False, NOT pruritic","idx":2,"proposition":"The maculopapular exanthema is itchy and begins behind the ears"},{"correct":true,"justification":"True","idx":3,"proposition":"Biological confirmation can be done by PCR or serology in blood or saliva"},{"correct":false,"justification":"False, up to 5 days after the rash","idx":4,"proposition":"The disease leads to eviction from the community up to 15 days after the eruption"}],"type":"custom"}
+{"_id":"IU-infectio-e9b5e0","context":null,"enonce":"Which of the following are criteria for classifying pyelonephritis as at risk? ","item":"IU","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"pregnancy"},{"correct":true,"justification":"","idx":1,"proposition":"male"},{"correct":false,"justification":"Age > 75 (or >65 with +2 Fried criteria), Urinary tree abnormality, pregnancy, IR or severe DI, male sex","idx":2,"proposition":"Type 1 diabetes"},{"correct":true,"justification":"True","idx":3,"proposition":"vesicoureteral reflux"},{"correct":true,"justification":"True","idx":4,"proposition":"post-voiding residue"}],"type":"custom"}
+{"_id":"fievreaigue-infectio-5c655b","context":null,"enonce":"With regard to acute fever, which of the following propositions, are true?","item":"fievreaigue","matiere":"infectio","propositions":[{"correct":false,"justification":"False, naughty trap, but to emphasize the importance of qSOFA, easy to perform and of which 2 of the 3 items among the following allows to define a serious sepsis (FR greater than or equal to 22, acute impairment of higher functions, TAs less than or equal to 100mmHg)","idx":0,"proposition":"In the emergency room, an assessment of the potential severity of the fever can be made via the SOFA"},{"correct":true,"justification":"True, let's particularly insist on dehydration especially on fragile grounds (elderly)","idx":1,"proposition":"The main complications of fever itself are dehydration, decompensation of comorbidities and neurological disorders."},{"correct":true,"justification":"True, this is the great fear of gynecologists and attending physicians.","idx":2,"proposition":"Any fever with flu-like illness in pregnant women should be tested for blood culture listerias."},{"correct":false,"justification":"False, it is often in these cases a urinary colonization, it is necessary to know how to look for clinical signs and urinary functional signs","idx":3,"proposition":"A positive ECBU in a febrile elderly should lead to the offer of antibiotic treatment"},{"correct":true,"justification":"True. For once, very tricky painting and already seen in internship","idx":4,"proposition":"A fever in children with abdominal pain and vomiting may indicate pneumonia"}],"type":"custom"}
+{"_id":"151-infectio-6f6278ae-1dfa-4c97-a619-452bbe1ce578","context":null,"enonce":"Regarding acute community lung disease, which of these propositions are true?","item":"IBP","matiere":"infectio","propositions":[{"correct":false,"justification":"False, in ambulatory the ONLY necessary examination is chest X-ray","idx":0,"proposition":"During an outpatient consultation at the general practice, additional examinations are limited to chest radiography and minimal inflammatory blood test (CBC, CRP)"},{"correct":false,"justification":"False, ECBC should be prescribed in case of productive cough because they make it very easy to identify germs","idx":1,"proposition":"In standard hospitalization, the biological assessment to identify the infecting germ is mainly based on blood cultures, the yield of ECBC being low, the latter are no longer widely used"},{"correct":true,"justification":"True, the only, the only.","idx":2,"proposition":"The reference antibiotic for pneumococcal pneumonitis is Amoxicillin"},{"correct":false,"justification":"False, it is recalled here that legionellosis is an infection that is transmitted from the environment (here infected water networks) to humans, but that there is no human-to-human transmission.","idx":3,"proposition":"When legionellosis is suspected, in addition to mandatory reporting, the patient should be isolated in a room with additional \"droplet\" type protection. "},{"correct":true,"justification":"True, this is the main complication to look for","idx":4,"proposition":"In case of dyspnea or febrile desaturation or reascent after the start of antibiotic therapy, a chest X-ray should be done to look for pleural effusion"}],"type":"custom"}
+{"_id":"159-infectio-c8d6a4f8-c482-4608-aa2e-d52175f992b0","context":null,"enonce":"With regard to whooping cough, which of the following propositions, which one or which are true?","item":"coqueluche","matiere":"infectio","propositions":[{"correct":false,"justification":"False, it's a gram bacillus -! Remember that cocci gram + it is staphylococcal \/ pneumococcus \/ enterococcal \/ streptococcus, bacillus gram + it is Listeria, Cocci gram _ it is meningococcal and gonococcal and the rest or almost it is bacillus gram -!","idx":0,"proposition":"Bordetella Pertussis is a small gram+ bacillus"},{"correct":false,"justification":"False! Big trap that I often got screwed on SIDES, whooping cough usually does NOT give a fever.","idx":1,"proposition":"Pertussis can be confused with CoVID 19 infection or with viral pneumonitis because of symptomatology functional signs ENT-fever-cough-muscle pain"},{"correct":true,"justification":"True, one of the only indications for nasal PCR after CoVID and influenza","idx":2,"proposition":"The diagnosis of pertussis is made by nasal swab PCR"},{"correct":false,"justification":"False, pertussis is a notifiable disease in clustered\/nosocomial cases","idx":3,"proposition":"Pertussis is a reportable disease"},{"correct":true,"justification":"True, it is the strategy of cocooning consisting in vaccinating the entourage of infants not yet vaccinated (vaccination starting at 2 months of life) in order to reduce the risk of potentially serious pertussis in the infant.\r\n","idx":4,"proposition":"Although boosters after age 25 are not mandatory, there is an infant protection strategy based on vaccinating adults and the elderly in preparation for pregnancy."}],"type":"custom"}
+{"_id":"IST-infectio-770dbe","context":null,"enonce":"Genital ulcers are mainly due to: (2 responses)","item":"IST","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Treponema pallidum"},{"correct":true,"justification":"True","idx":1,"proposition":"Herpes simplex 1 and 2"},{"correct":false,"justification":"urethritis and cervicitis","idx":2,"proposition":"Chlamydia trachomatis"},{"correct":false,"justification":"urethritis and cervicitis","idx":3,"proposition":"Neisseria gonorrhoeae"},{"correct":false,"justification":"non-sexual acquiring urinary tract infection","idx":4,"proposition":"Escherichia coli"}],"type":"custom"}
+{"_id":"158-infectio-857191d9-cbcb-4f43-8b94-dc850d24fca0","context":null,"enonce":"You receive in general medical consultation, the young Jeppe, 16 years old, who comes to see you because he has just changed partners, and that his new partner has told him about the screenings of \"STDs\". You decide to prescribe the standard screening, what tests do you do?","item":"IST","matiere":"infectio","propositions":[{"correct":true,"justification":"True, followed by a VDRL only in case of positivity. ","idx":0,"proposition":"Automated Qualitative Treponemal Test (EIA or ELISA)"},{"correct":false,"justification":"False. Hepatitis B screening is based on HBsAg, HBcAg and HBsAc.","idx":1,"proposition":"HBsAg alone"},{"correct":true,"justification":"True, it is one of the two valid methods to look for local infections (gonococcus, chlamydia) in humans.","idx":2,"proposition":"Urethral swab self-sampling to be brought to the laboratory for Gonococcus and Chlamydia PCR."},{"correct":true,"justification":"True, cf C.","idx":3,"proposition":"Collection of the first urinary stream for Gonococcus and Chlamydia PCR."},{"correct":true,"justification":"Inescapable","idx":4,"proposition":"HIV serology"}],"type":"custom"}
+{"_id":"153-infectio-6d7e5573-18e4-4c28-8e31-853cdd9e972a","context":null,"enonce":"You are a general practitioner in office and you receive in consultation Mr Kananga, type 2 diabetic for 40 years who has a superinfected plantar perforating disease. As a result, you explain that he will require hospitalization to assess his infection, with specialized care. But what will this support entail?","item":"IOA","matiere":"infectio","propositions":[{"correct":true,"justification":"True, plantar perforating disease arises from a combination of neuropathy and arterial disease.","idx":0,"proposition":"An evaluation of the vascular trunks with at least one IPS and at most an Echo-Doppler of the lower limbs"},{"correct":true,"justification":"True, the plantar perforating disease signs an imbalance of diabetes, so it is necessary to evaluate the biological impact.","idx":1,"proposition":"A reassessment of diabetes balance by fasting blood glucose and HbA1c"},{"correct":false,"justification":"False, the superficial sample would only show the saprophytic bacteria of the skin, it requires a deep sample, even surgical","idx":2,"proposition":"Bacteriological sampling of the wound by swab"},{"correct":true,"justification":"True, to do at will. ","idx":3,"proposition":"Local management with discharge of the foot and debridage of the wound"},{"correct":true,"justification":"True, do not forget in front of a wound ","idx":4,"proposition":"Reassessment of tetanus vaccination status"}],"type":"custom"}
+{"_id":"IST-infectio-931491","context":null,"enonce":"Which of the following propositions are true about syphilitic chancre?","item":"IST","matiere":"infectio","propositions":[{"correct":false,"justification":"Non-painful","idx":0,"proposition":"It is painful"},{"correct":true,"justification":"True","idx":1,"proposition":"It is thoroughly endured"},{"correct":true,"justification":"True, unendured and clean background","idx":2,"proposition":"It is clean"},{"correct":true,"justification":"True","idx":3,"proposition":"It disappears spontaneously"},{"correct":false,"justification":"Associated with one or more lymphadenopathy(s), most often inguinal(s) (depending on the site of the chancre), NOT inflammatory(s) 😬","idx":4,"proposition":"It is accompanied by lymphadenopathy (often inguinal) inflammatory"}],"type":"custom"}
+{"_id":"IBP-infectio-db6045","context":null,"enonce":"Which of the following are true?","item":"IBP","matiere":"infectio","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"In the northern hemisphere, influenza is rare in winter"},{"correct":true,"justification":"True","idx":1,"proposition":"Some coronaviruses can infect patients returning from the Arabian Peninsula"},{"correct":false,"justification":"Possible by PCR","idx":2,"proposition":"Diagnosis of certainty of coronavirus infections is impossible"},{"correct":true,"justification":"True","idx":3,"proposition":"PCRs are available for most respiratory viruses"},{"correct":true,"justification":"True, especially in the elderly or immunocompromised","idx":4,"proposition":"These respiratory infections can be life-threatening"}],"type":"custom"}
+{"_id":"IST-infectio-a246e0","context":null,"enonce":"In case of late syphilis, the IM injection of penicillin G in the form of delay should be repeated:","item":"IST","matiere":"infectio","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"1 time"},{"correct":false,"justification":"","idx":1,"proposition":"It must not be repeated"},{"correct":false,"justification":"","idx":2,"proposition":"2 times"},{"correct":true,"justification":"True, 3 IM injections 1 week apart","idx":3,"proposition":"3 times"},{"correct":false,"justification":"A little too much anyway 😆","idx":4,"proposition":"5 times"}],"type":"custom"}
+{"_id":"153-infectio-2bbd2b4b-b544-49cb-a38e-a8760c67426e","context":null,"enonce":"With regard to Community infectious spondylodiscitis, which of the following proposals are correct?","item":"IOA","matiere":"infectio","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"S. aureus spondylodiscite indicates a probable dermal origin of the infection"},{"correct":true,"justification":"True, like ANY involvement of the spine, it is necessary to look for a lesional syndrome (radiculalgia ...) and \/ or under lesional (urine retention, pyramidal irritation ...)","idx":1,"proposition":"If spondylodiscitis is suspected, always look for signs of spinal cord compression."},{"correct":false,"justification":"False, it's the opposite, tell yourself that infectious lesions in 99% of cases are hyper T2 and hypo T1 on MRI","idx":2,"proposition":"Signs of spondylodiscite on MRI are T1 hypersignal and T2 hyposignal"},{"correct":false,"justification":"False, it is based on penicillin M IV","idx":3,"proposition":"First-line antibiotic therapy is based on IV vancomycin"},{"correct":false,"justification":"False, it is only an analgesic immobilization and it is associated with rehabilitation from the first day","idx":4,"proposition":"Immobilization is necessary at the beginning of treatment to avoid creating a vertebral fracture"}],"type":"custom"}
+{"_id":"IU-infectio-e4d8ff","context":null,"enonce":"What are the additional examinations of acute non-serious pyelonephritis with risk of complications probably diagnosed?","item":"IU","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"BU + ECBU"},{"correct":false,"justification":"If in doubt diagnosis","idx":1,"proposition":"Blood culture"},{"correct":true,"justification":"True","idx":2,"proposition":"Uroscanner"},{"correct":true,"justification":"True","idx":3,"proposition":"CRP, urea, creatinine"},{"correct":false,"justification":"If second episode of a non-serious ANP without risk of complication (or hyperalgic form)","idx":4,"proposition":"Renal ultrasound"}],"type":"custom"}
+{"_id":"IST-infectio-b4297b","context":null,"enonce":"Urethritis and cervicitis are mainly due to: (2 responses)","item":"IST","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Neisseria gonorrhoeae"},{"correct":true,"justification":"True","idx":1,"proposition":"Chlamydia trachomatis"},{"correct":false,"justification":"","idx":2,"proposition":"Syphilis"},{"correct":false,"justification":"","idx":3,"proposition":"Herpes"},{"correct":false,"justification":"","idx":4,"proposition":"T. vaginalis"}],"type":"custom"}
+{"_id":"IU-infectio-7a5d66","context":null,"enonce":"What are the additional tests for a severe acute pyelonephritis probably a diagnosis?","item":"IU","matiere":"infectio","propositions":[{"correct":true,"justification":"True, in all cases in severe NAPs","idx":0,"proposition":"Blood culture"},{"correct":true,"justification":"True","idx":1,"proposition":"BU + ECBU"},{"correct":true,"justification":"True","idx":2,"proposition":"Uroscanner"},{"correct":false,"justification":"Uroscanner","idx":3,"proposition":"MRI of the urinary tract"},{"correct":true,"justification":"True","idx":4,"proposition":"NFS-P"}],"type":"custom"}
+{"_id":"158-infectio-03de6997-24c8-428d-961a-c956717ceccd","context":null,"enonce":"With regard to the salpigites, which of these proposals are correct?","item":"IST","matiere":"infectio","propositions":[{"correct":true,"justification":"True, salpingitis causes lateralized pelvic pain.","idx":0,"proposition":"Appendicitis, appendix torsion and ectopic pregnancy are the main differential diagnoses of salpingitis"},{"correct":true,"justification":"True, by definition, one STI always calls for another.","idx":1,"proposition":"Salpingitis is an indication to look for local and general STIs"},{"correct":true,"justification":"True, it is a tubal abscess.","idx":2,"proposition":"Pelvic ultrasound can highlight pyosalpinx"},{"correct":false,"justification":"False, C3G + Doxy + Metronidazole","idx":3,"proposition":"Salpingitis is treated first-line with Metronidazole monotherapy"},{"correct":true,"justification":"True, violin string syndrome, sequelae of chamydia in the liver capsule","idx":4,"proposition":"Complications of salpingitis include Fitz High Curtis syndrome"}],"type":"custom"}
+{"_id":"IST-infectio-43783b","context":null,"enonce":"Which of the following are ophthalmological manifestations of secondary syphilis?","item":"IST","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Uveitis"},{"correct":true,"justification":"True","idx":1,"proposition":"Retinitis"},{"correct":false,"justification":"","idx":2,"proposition":"Scleritis"},{"correct":false,"justification":"Only two etiologies to remember for NEC: Sarcoidosis and MS","idx":3,"proposition":"Intermediate uveitis"},{"correct":false,"justification":"","idx":4,"proposition":"Secondary cataract"}],"type":"custom"}
+{"_id":"IST-infectio-0b4a9b","context":null,"enonce":"Which of the following are true about neurosyphilis?","item":"IST","matiere":"infectio","propositions":[{"correct":false,"justification":"Not at the primary stage","idx":0,"proposition":"It can be present at all stages of the disease"},{"correct":true,"justification":"True","idx":1,"proposition":"Early neurosyphilis can be expressed as meningitis"},{"correct":false,"justification":"posterior radiculocord syndrome found in TARDIVE neurosyphilis","idx":2,"proposition":"Early neurosyphilis can be expressed in the form of tabes"},{"correct":true,"justification":"True","idx":3,"proposition":"Late neurosyphilis can be expressed as dementia"},{"correct":false,"justification":"LATE form","idx":4,"proposition":"Early neurosyphilis can manifest as memory problems"}],"type":"custom"}
+{"_id":"164-infectio-8d14609d-c38c-4a99-9ab1-97380c64aa5e","context":null,"enonce":"What is (are) the possible complication(s) of chickenpox in children?","item":"herpes","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Varicella pneumonia"},{"correct":true,"justification":"True","idx":1,"proposition":"Skin bacterial superinfection"},{"correct":true,"justification":"True","idx":2,"proposition":"Encephalitis "},{"correct":true,"justification":"True","idx":3,"proposition":"Cererebellity"},{"correct":true,"justification":"True","idx":4,"proposition":"Cerebral vasculitis"}],"type":"custom"}
+{"_id":"meningite-infectio-97023f","context":null,"enonce":"You are a general practitioner in the countryside. On a beautiful Saturday morning (where you work, because you are motivated and passionate about your job 🔥🚀❤❤), Mrs. Carrière, 32, brings you her son. A very energetic little boy of 13 months, he has had a temperature of 40 ° C for 48 hours. He is grumpy and has vomited 3 times 🤮. On clinical examination he presents axial hypotonia and the fontanelle is bulging. What diagnoses do you mention in view of these elements?","item":"meningite","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Viral meningitis"},{"correct":true,"justification":"True","idx":1,"proposition":"Bacterial meningitis"},{"correct":false,"justification":"Does not explain the bulging fontanel","idx":2,"proposition":"Acute pyelonephritis"},{"correct":false,"justification":"Does not explain the bulging fontanel","idx":3,"proposition":"Acute gastroenteritis "},{"correct":false,"justification":"Does not explain the fever (you may have a fever, but not a fever at 40)","idx":4,"proposition":"Subdural hematoma"}],"type":"custom"}
+{"_id":"203-pneumo-49ec1af9-b1b5-41cc-bf14-c84570058d09","context":null,"enonce":"Which of the following propositions are true about the hamartochondrome?","item":"opacitetho","matiere":"pneumo","propositions":[{"correct":false,"justification":"It is the most common benign lung tumor","idx":0,"proposition":"It is a malignant 🚨 tumor"},{"correct":false,"justification":"Often easy diagnosis on pathognomonic CT data of \"popcorn\" appearance, combining calcifications and fat densities","idx":1,"proposition":"The spiculated nodule appearance is pathognomonic 🤔"},{"correct":false,"justification":"Not mandatory in front of the popcorn appearance and the absence of malignancy criteria","idx":2,"proposition":"PET-CT is mandatory"},{"correct":true,"justification":"True","idx":3,"proposition":"PET-CT is negative"},{"correct":true,"justification":"True, note that histological verification (not excision) is desirable","idx":4,"proposition":"Excision is not necessary"}],"type":"custom"}
+{"_id":"175-gastro-252b8b1b-a2d4-4e27-a301-e101911a3930","context":null,"enonce":"You are a doctor of the ARS and you are dispatched to the sausage fair of Bourg en Bresse Peyronnas, in front of a strong suspicion of Collective Food Poisoning (at least 30 cases). On the road, you remember in mind which samples you are going to make... What are they?","item":"risquesenvironnemt","matiere":"HGE","propositions":[{"correct":true,"justification":"True, essential to research food origin","idx":0,"proposition":"On-site food sampling"},{"correct":false,"justification":"False, canteens\/catering places are obliged to keep control food, in case all food is eaten","idx":1,"proposition":"In case all the food has already been eaten, you can not take a sample from the food"},{"correct":true,"justification":"True, this is the only indication to vomiting sampling that you need to know for ECN","idx":2,"proposition":"Vomiting sampling of symptomatic persons"},{"correct":true,"justification":"True, logically","idx":3,"proposition":"Stool collection from symptomatic individuals"},{"correct":false,"justification":"False, it's not up to you to do the hygiene surveys of the place!","idx":4,"proposition":"Sampling at storage and refregiration sites"}],"type":"custom"}
+{"_id":"189-immuno-b3bd3d0e-1f7a-4ab1-89be-c14818c1f3bc","context":null,"enonce":"During which diseases are ENT involvement observed (rhinitis, sinusitis, nasal polyposis)?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"+++","idx":0,"proposition":"Granulomatosis with polyangiitis"},{"correct":true,"justification":"","idx":1,"proposition":"Eosinophilic granulomatosis with polyangiitis"},{"correct":false,"justification":"Rather a pulmonary involvement type of intraalveolar hemorrhage","idx":2,"proposition":"Microscopic polyarteritis"},{"correct":false,"justification":"","idx":3,"proposition":"Takayasu's disease"},{"correct":false,"justification":"","idx":4,"proposition":"Periarteritis nodosa"}],"type":"custom"}
+{"_id":"189-immuno-7c637d6e-286f-4aaf-87e6-7f746d726b5b","context":null,"enonce":"Which of the following are true for periarteritis nodosa?","item":"vascularite","matiere":"immuno","propositions":[{"correct":false,"justification":"In periarteritis nodosa, ANCA is ALWAYS negative","idx":0,"proposition":"C-ANCA are relatively susceptible to this disease"},{"correct":true,"justification":"","idx":1,"proposition":"This is necrotizing vasculitis"},{"correct":true,"justification":"","idx":2,"proposition":"It can cause vascular nephropathy (malignant nephroangiosclerosis) without glomerulonephritis"},{"correct":true,"justification":"","idx":3,"proposition":"Puncture renal biopsy is contraindicated"},{"correct":false,"justification":"There is necrotizing vasculitis of medium-sized vessels","idx":4,"proposition":"Vascular biopsy finds no abnormalities"}],"type":"custom"}
+{"_id":"189-immuno-367e27fc-eb3e-4e4e-9f7e-af2f1a4826ba","context":null,"enonce":"Which of the following are true for IgA vasculitis?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"It is also called rheumatoid purpura"},{"correct":true,"justification":"","idx":1,"proposition":"It is also called Henoch Schonlein Syndrome"},{"correct":false,"justification":"It mainly affects children but remains possible in adults","idx":2,"proposition":"It mainly affects men over 50 years of age"},{"correct":true,"justification":"","idx":3,"proposition":"Serum IgA elevation is inconsistent"},{"correct":false,"justification":"","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"189-immuno-15d2db40-10da-493e-8448-083abe391ddd","context":null,"enonce":"Which of the following are true about Takayasu's disease?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"It is granulomatous vasculitis"},{"correct":false,"justification":"It affects large arteries: aorta and its main branches, with a predilection for the carotid territory and subkeyboard","idx":1,"proposition":"It affects the vessels of the microcirculation"},{"correct":false,"justification":"Especially women under 50 (++ different with Horton)","idx":2,"proposition":"It mainly affects men under 50 years of age"},{"correct":true,"justification":"","idx":3,"proposition":"We can find vascular murmurs and an abolition of the pulse"},{"correct":true,"justification":"Blood pressure asymmetry = anisotension","idx":4,"proposition":"We can find a tensional asymmetry and limp of the limbs"}],"type":"custom"}
+{"_id":"189-immuno-b528c54d-96c4-468c-934f-46193678962a","context":null,"enonce":"Which of the following are true about Kawasaki disease?","item":"vascularite","matiere":"immuno","propositions":[{"correct":false,"justification":"From 1 to 5 years. Exceptional after!","idx":0,"proposition":"It mainly affects children from 1 to 15 years old"},{"correct":true,"justification":"","idx":1,"proposition":"It is a febrile adenocutaneous-mucosal syndrome"},{"correct":false,"justification":"A palmo-plantar desquamation, often late (the only Kawasaki I saw had no peeling at all but you have to remember what is in the college!)","idx":2,"proposition":"There is a desquamation of the trunk"},{"correct":true,"justification":"","idx":3,"proposition":"Lymphadenopathy is willingly cervical"},{"correct":true,"justification":"","idx":4,"proposition":"There is no biomarker available"}],"type":"custom"}
+{"_id":"189-immuno-3a8ec0bd-7f00-4176-b953-05f6bf434626","context":null,"enonce":"Which of the following propositions are true regarding the anatomical pathology expression of giant cell arteritis (Horton's disease)?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"Panarteritis"},{"correct":true,"justification":"","idx":1,"proposition":"Essentially mononuclear inflammatory infiltrate"},{"correct":false,"justification":"It is the INTERNAL elastic limiting that is destroyed (much less solid than the external elastic limiting)","idx":2,"proposition":"Destruction of the external elastic limiter"},{"correct":true,"justification":"","idx":3,"proposition":"Presence of giant cells"},{"correct":false,"justification":"They are found in Goodpasture's disease (vasculitis of microvessels)","idx":4,"proposition":"Presence of anti-MBG antibodies"}],"type":"custom"}
+{"_id":"189-immuno-ea0cbbfd-6b16-4e8a-a99e-5a1e170e2cc1","context":null,"enonce":"Which of the following proposals are common features of the 3 ANCA small vessel vasculitis?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"Peripheral neuropathies can be found"},{"correct":false,"justification":"Not microscopic polyangiitis (the term \"granulomatous\" is not found in the name of this vasculitis)","idx":1,"proposition":"They are granulomatous"},{"correct":true,"justification":"","idx":2,"proposition":"They are necrotizing"},{"correct":true,"justification":"","idx":3,"proposition":"Glomerulonephritis is rapidly progressive (GNRP)"},{"correct":true,"justification":"","idx":4,"proposition":"ANCA are not 100% sensitive"}],"type":"custom"}
+{"_id":"189-immuno-4ec2174d-80b4-46ab-a9b6-cf14b3f7f19b","context":null,"enonce":"Which of the following proposals are vasculitis concerning the large vessels (aorta and main collaterals)?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"Field: subject willingly elderly, >50 years old","idx":0,"proposition":"Giant cell arteritis"},{"correct":true,"justification":"Field: young woman, < 50 years old ","idx":1,"proposition":"Takayasu's disease"},{"correct":false,"justification":"Medium-gauge arteries","idx":2,"proposition":"Kawasaki disease"},{"correct":false,"justification":"Medium-gauge arteries","idx":3,"proposition":"Periarteritis nodosa"},{"correct":false,"justification":"Anti-MBG antibody vasculitis concerning capillaries","idx":4,"proposition":"Goodpasture disease"}],"type":"custom"}
+{"_id":"189-immuno-1dedaf52-8484-427b-8853-a81614d15643","context":null,"enonce":"Which of the following are true regarding the diagnosis of Granumolatosis with Polyangiitis (Wegener)?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"ANCA are found in 90% of systemic forms"},{"correct":false,"justification":"It is the only vasculitis that has ANCA type c (anti-proteinase 3) ","idx":1,"proposition":"ANCA are type p"},{"correct":true,"justification":"True","idx":2,"proposition":"ANCA are directed against the PR3 protein"},{"correct":true,"justification":"True","idx":3,"proposition":"Biopsy finds granulomatous pauci-immune necrotizing vasculitis"},{"correct":true,"justification":"True, it is a pauci-immune vasculitis","idx":4,"proposition":"Direct immunofluorescence on the biopsy piece is negative"}],"type":"custom"}
+{"_id":"189-immuno-ddf21ea0-7a00-4a74-8c5f-f5e0be12116f","context":null,"enonce":"Which of the following propositions are true about Behçet's disease?","item":"vascularite","matiere":"immuno","propositions":[{"correct":false,"justification":"It occurs mainly in men from the Mediterranean Basin (Turkey++), the Middle East (Turkey) or the Far East.","idx":0,"proposition":"It affects women more than men"},{"correct":false,"justification":"","idx":1,"proposition":"It predominates in Japan and Australia"},{"correct":false,"justification":"Behçet's disease begins around the age of 30","idx":2,"proposition":"Diagnosis cannot be made before the age of 50"},{"correct":true,"justification":"","idx":3,"proposition":"It combines oral and genital aphthosis, posterior uveitis, and sometimes joint, digestive, cardiac and \/ or cerebral damage"},{"correct":true,"justification":"Bipolar aphthosis with oral and genital involvement","idx":4,"proposition":"Aphthosis is called bipolar"}],"type":"custom"}
+{"_id":"189-immuno-2e032cb8-0663-4d5f-af93-715fd0c36ed1","context":null,"enonce":"Which of the following are true about microscopic polyangiitis?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"It is a necrotizing vasculitis"},{"correct":true,"justification":"","idx":1,"proposition":"It is a pauci-immune vasculitis"},{"correct":false,"justification":"It is the only vasculitis of ANCA small vessels that is non-granulomatous. The other two (Granulomatosis with Polyangiitis, and Eosinophilic granulomatous with Polyangiitis) are granulomatous, as their name suggests. Remember: often, EVERYTHING is in the name 😅","idx":2,"proposition":"It is granulomatous vasculitis"},{"correct":false,"justification":"The only vasculitis where c-ANCA is found is granulomatous with polyangiitis (Wegener)","idx":3,"proposition":"ANCA are c-ANCA"},{"correct":true,"justification":"","idx":4,"proposition":"Glomerulonephritis and pulmonary capillaritis are common"}],"type":"custom"}
+{"_id":"189-immuno-aa9e77fe-c9dc-4cb7-8fe6-a54e4cc8c9b0","context":null,"enonce":"Which of the following propositions are true about chronic atrophic polychondritis?","item":"vascularite","matiere":"immuno","propositions":[{"correct":false,"justification":"Like Behçet's disease and Cogan syndrome, it affects vessels of all sizes.","idx":0,"proposition":"It is a vasculitis that affects only small vessels"},{"correct":true,"justification":"This is the term used in the college","idx":1,"proposition":"It is an \"exceptional\" disease from an epidemiological point of view"},{"correct":true,"justification":"","idx":2,"proposition":"It is an inflammation of the cartilages of the ears and nose, aortic valves, aorta and trachea"},{"correct":false,"justification":"This is the description of Cogan syndrome, a vasculitis affecting vessels of all caliber (very rare)","idx":3,"proposition":"It is a non-syphilitic interstitial keratitis and audio-vestibular involvement"},{"correct":false,"justification":"This is the case of Behçet's disease","idx":4,"proposition":"It occurs mainly in Turkey"}],"type":"custom"}
+{"_id":"189-immuno-9b9111be-bc55-4ccc-ae02-6ed77ab91ff2","context":null,"enonce":"Which of the following are true about Takayasu's disease?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"It is granulomatous vasculitis"},{"correct":false,"justification":"It affects large arteries: aorta and its main branches. She has a predilection for the carotid territory and subkeyboard","idx":1,"proposition":"It affects the vessels of the microcirculation"},{"correct":false,"justification":"Especially women under 50","idx":2,"proposition":"It mainly affects men under 50 years of age"},{"correct":true,"justification":"","idx":3,"proposition":"We can find vascular murmurs and an abolition of the pulse"},{"correct":true,"justification":"","idx":4,"proposition":"We can find a tensional asymmetry and limp of the limbs"}],"type":"custom"}
+{"_id":"Kcsein-onco-12e317","context":null,"enonce":"Which of the following propositions are true for a 42-year-old woman with a pathogenic BRAC1 mutation in remission from breast cancer?","item":"Kcsein","matiere":"onco","propositions":[{"correct":true,"justification":"True. Bilateral appendectomy to be offered from age 40 for BRCA1 and age 45 for BRCA2","idx":0,"proposition":"He may be offered an oophorectomy"},{"correct":true,"justification":"True, the relevance of ultrasound is left to the discretion of the radiologist","idx":1,"proposition":"Breast monitoring is done by annual mammography for life, associated or not with an ultrasound (excluding mammectomy)"},{"correct":true,"justification":"True, no genetic testing in miners (unless there is immediate medical necessity, which is not the case for BRCA mutations)","idx":2,"proposition":"Genetic tests in offspring will be offered after they reach the age of majority"},{"correct":false,"justification":"BRCA: ovary and breast mainly","idx":3,"proposition":"The risk of digestive cancer is higher than in the general population"},{"correct":false,"justification":"From 30 years old","idx":4,"proposition":"He should have been offered a bilateral mastectomy from the age of majority."}],"type":"custom"}
+{"_id":"Kcsein-onco-2a9316","context":null,"enonce":"Which of the following are breast cancer risk factors?","item":"Kcsein","matiere":"onco","propositions":[{"correct":false,"justification":"False. There is no longer an over-risk of breast cancer when the pill was stopped more than 10 years ago","idx":0,"proposition":"The use of the estrogen-progestin pill 15 years ago"},{"correct":true,"justification":"True, it is a hormone-dependent cancer","idx":1,"proposition":"Late menopause (> 55 years)"},{"correct":false,"justification":"False. It is protective (decrease in the duration of hormonal impregnation)","idx":2,"proposition":"Breastfeeding"},{"correct":true,"justification":"True","idx":3,"proposition":"Late age at first pregnancy (> 30 years)"},{"correct":true,"justification":"True","idx":4,"proposition":"Hormone therapy for menopause"}],"type":"custom"}
+{"_id":"Kcsein-onco-7b32fd","context":null,"enonce":"Regarding the epidemiology of breast cancer, which of the following propositions are true?","item":"Kcsein","matiere":"onco","propositions":[{"correct":false,"justification":"False. About 58,000 cases per year (we must retain about 54,000 - 58,000 as an order of magnitude, this figure changes depending on the sources). It is the most common cancer AND the deadliest in women. ","idx":0,"proposition":"There are 78,000 new cases of breast cancer in France per year"},{"correct":true,"justification":"True. The first is lung cancer","idx":1,"proposition":"It is the 2nd most common cancer in France, all sexes combined"},{"correct":true,"justification":"True. It is the deadliest cancer in women. ","idx":2,"proposition":"Breast cancer causes 12,000 deaths per year in France"},{"correct":false,"justification":"False. The 5-year survival rate is 87% and 76% at 10 years. It is a cancer with a high survival rate thanks to mass screening that allows early detection of cancers (at stage N0)","idx":3,"proposition":"The 5-year survival rate is 50%"},{"correct":false,"justification":"False. 1 in 9 women","idx":4,"proposition":"1 in 5 women will develop breast cancer in her lifetime "}],"type":"custom"}
+{"_id":"Kcsein-onco-25eb3e","context":null,"enonce":"Regarding the BI-RADS classification of the ACR, which ones are true?","item":"Kcsein","matiere":"onco","propositions":[{"correct":false,"justification":"False. ACR 0 means that further investigation is required. ACR 1 means that the mammogram is normal. ","idx":0,"proposition":"ACR 0 means mammography is normal"},{"correct":true,"justification":"True","idx":1,"proposition":"ACR 3 means that the anomaly is probably benign but requires short-term monitoring (3 or 6 months)"},{"correct":false,"justification":"False. ACR 6 means that there is histological evidence of certainty of the malignancy of the lesion. ","idx":2,"proposition":"ACR 6 means that there is an abnormality suggestive of cancer"},{"correct":true,"justification":"True","idx":3,"proposition":"ACR 4 means that there is an undetermined or suspicious anomaly"},{"correct":true,"justification":"True","idx":4,"proposition":"ACR 5 means that there is an abnormality very suggestive of cancer"}],"type":"custom"}
+{"_id":"Kcsein-onco-62a861","context":null,"enonce":"Lymphatic drainage of the breast is done to which site(s)? ","item":"Kcsein","matiere":"onco","propositions":[{"correct":true,"justification":"True. Lymphatic drainage occurs to 3 main sites: axillary caval nodes, upper and subclavicular lymph nodes, and internal mammary chain nodes. ","idx":0,"proposition":"The lymph nodes of the axillary hollow "},{"correct":true,"justification":"True","idx":1,"proposition":"Supra- and subclavicular lymph nodes"},{"correct":false,"justification":"False","idx":2,"proposition":"The lymph nodes of the external breast chain"},{"correct":true,"justification":"True","idx":3,"proposition":"The lymph nodes of the internal breast chain"},{"correct":false,"justification":"False. It is a left supraclavicular lymph node, but it mainly drains the digestive system and is suggestive of digestive cancer (e.g. pancreas, colon). ","idx":4,"proposition":"The ganglion of Troisier"}],"type":"custom"}
+{"_id":"Kcsein-onco-88dbf6","context":null,"enonce":"Which of the following are genetic mutation(s) that can cause breast cancer?","item":"Kcsein","matiere":"onco","propositions":[{"correct":true,"justification":"True. It is also a syndrome that causes childhood cancer.","idx":0,"proposition":"Syndrome de Li-Fraumeni"},{"correct":true,"justification":"True. The mutation causes breast and ovarian cancer. ","idx":1,"proposition":"BRCA1"},{"correct":true,"justification":"True. The mutation causes breast and ovarian cancer. ","idx":2,"proposition":"BRCA2"},{"correct":false,"justification":"False. It causes, among other things, colon, endometrial and ovarian cancers.","idx":3,"proposition":"Syndrome de Lynch"},{"correct":false,"justification":"False","idx":4,"proposition":"Neurofibromatosis type 1"}],"type":"custom"}
+{"_id":"Kcsein-onco-99b87a","context":null,"enonce":"An ultrasound found an 18mm lesion in the right breast. On clinical examination, you do not find any skin involvement and the lymph node areas are perfectly free. No clinical signs elsewhere. What is the TNM classification of this lesion?","item":"Kcsein","matiere":"onco","propositions":[{"correct":false,"justification":"Mx because we did not make an extension assessment","idx":0,"proposition":"T1N0M0"},{"correct":false,"justification":"No axillary lymph nodes","idx":1,"proposition":"T1N1M0"},{"correct":true,"justification":"True. T1c more precisely (between 1 and 2 cm)","idx":2,"proposition":"T1N0Mx"},{"correct":false,"justification":"<2cm so T1","idx":3,"proposition":"T2N0Mx"},{"correct":false,"justification":"<5cm so not T3","idx":4,"proposition":"T3N0Mx"}],"type":"custom"}
+{"_id":"Kcsein-onco-482db4","context":null,"enonce":"Which of the following is the most common histological form of breast cancer?","item":"Kcsein","matiere":"onco","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Lobular carcinoma"},{"correct":false,"justification":"False","idx":1,"proposition":"Localized ductal carcinoma"},{"correct":true,"justification":"True","idx":2,"proposition":"Invasive ductal carcinoma"},{"correct":false,"justification":"False","idx":3,"proposition":"Invasive lobular carcinoma"},{"correct":false,"justification":"False","idx":4,"proposition":"Tuberous adenocarcinoma"}],"type":"custom"}
+{"_id":"189-immuno-7c127847-4b56-40c3-a0e5-62c007c4358b","context":null,"enonce":"Which of the following are true for giant cell arteritis (Horton's disease)?","item":"vascularite","matiere":"immuno","propositions":[{"correct":false,"justification":"Over 50 years old","idx":0,"proposition":"It occurs in subjects over 65 years of age"},{"correct":true,"justification":"True","idx":1,"proposition":"It predilection affects the carotid and vertebral territory (including the temporal artery)"},{"correct":true,"justification":"True","idx":2,"proposition":"We can find aortitis"},{"correct":false,"justification":"This is a NOIIA in giant cell arteritis. NORB is found in Multiple Sclerosis","idx":3,"proposition":"There is regularly a NORB"},{"correct":true,"justification":"True","idx":4,"proposition":"Pseudo-rhizomelic arthritis is often associated"}],"type":"custom"}
+{"_id":"103-neuro-59bda730-f3aa-4607-8a93-326f39b7c474","context":null,"enonce":"Regarding epilepsy-Absence of the child. Which of the following are true?","item":"epilepsie","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Treatment is Ethosuximide"},{"correct":true,"justification":"True","idx":1,"proposition":"Treatment is usually stopped after puberty"},{"correct":true,"justification":"True","idx":2,"proposition":"A genetic etiology is presumed"},{"correct":true,"justification":"True","idx":3,"proposition":"Attentional disorders are a common comorbidity to always look for in children with this syndrome."},{"correct":true,"justification":"True","idx":4,"proposition":"All of the above answers are true"}],"type":"custom"}
+{"_id":"103-neuro-5daa982a-ff8c-4eff-9960-28a6ad23c84a","context":null,"enonce":"Concerning centrotemporal peak epilepsy (CTEP) in children. Which of the following are true?","item":"epilepsie","matiere":"neuro","propositions":[{"correct":true,"justification":"True at Rolandic paroxysm","idx":0,"proposition":"It is a benign partial epilepsy"},{"correct":true,"justification":"Yes: at night","idx":1,"proposition":"This syndrome is morphelic"},{"correct":true,"justification":"True: Oral area, with hypersalivation, speech stoppage, hemifacial clonia, paresthesias of the tongue and gums.","idx":2,"proposition":"The beginning is focal: central opercular"},{"correct":false,"justification":"No, mindfulness syndrome","idx":3,"proposition":"There is a loss of consciousness"},{"correct":false,"justification":"No: before 15 years, and beginning of the syndrome usually around 10 years","idx":4,"proposition":"The prognosis is pretty good, with a cure before 10 years"}],"type":"custom"}
+{"_id":"103-neuro-c8817d00-c1b4-4326-ae63-bf60ba1c39bc","context":null,"enonce":"Regarding epilepsy-Absence of the child. Which of the following are true?","item":"epilepsie","matiere":"neuro","propositions":[{"correct":false,"justification":"no 5-10%","idx":0,"proposition":"accounts for 30% of childhood epilepsy "},{"correct":false,"justification":"not favoured by hypERpnea ","idx":1,"proposition":"Are multi-daily absences >10\/d, favored by hypopnea "},{"correct":false,"justification":"nop: 3 cyles \/seconds = 3Hz","idx":2,"proposition":"EEG is characterized by bursts of synchronous generalized polyspike-wave discharges at 3cycles \/ minute"},{"correct":true,"justification":"True","idx":3,"proposition":"It is an epileptic syndrome with a good prognosis, very pharmacosensitive (80%)"},{"correct":false,"justification":"","idx":4,"proposition":"All previous answers are wrong"}],"type":"custom"}
+{"_id":"341-urg-70fdb83d-7f7c-4a1d-aacc-b587914d339b","context":null,"enonce":"Which of the following are criteria for lumbar puncture during a febrile seizure in children?","item":"convulsionsped","matiere":"urg","propositions":[{"correct":false,"justification":"no, but it is a criterion for complex febrile seizure <6MONTHS","idx":0,"proposition":"<1year"},{"correct":true,"justification":"True","idx":1,"proposition":">15min"},{"correct":false,"justification":"No ","idx":2,"proposition":"Generalised"},{"correct":true,"justification":"True","idx":3,"proposition":"focal length"},{"correct":true,"justification":"True","idx":4,"proposition":"Bulging of the fontanel and anomaly of the tone"}],"type":"custom"}
+{"_id":"341-urg-361c1b63-90a2-42d8-9d7d-26dc05c9ea11","context":null,"enonce":"Which of the following are true about febrile seizures?","item":"convulsionsped","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Febrile seizures affect 5% of children"},{"correct":false,"justification":"No, a febrile seizure is by definition <5 years.","idx":1,"proposition":"A febrile seizure > 15min in a 6-year-old child is complex"},{"correct":true,"justification":"True: psychomotor delay = complex crisis","idx":2,"proposition":"A generalized febrile seizure of 5 minutes, without post-critical deficit, with normal neurological examination in a 2-year-old child who has just acquired standing with supports is a complex febrile crisis and justifies hospitalization."},{"correct":false,"justification":"nop: no PL criteria","idx":3,"proposition":"A generalized febrile attack of 12 minutes with a fever at 41 ° C, in a child of 3 years without post-critical deficit, without particular history, with a normal neurological examination requires a lumbar puncture."},{"correct":false,"justification":"No because > 1 year, <15min, generalized","idx":4,"proposition":"A generalized febrile seizure of 14 minutes with a fever at 42 ° C, in a 4-year-old child without post-critical deficit, without any particular history, with a normal neurological examination is a complex febrile seizure."}],"type":"custom"}
+{"_id":"178-mdt-4fd7fa5f-97b6-44b0-9513-1f56f8cfa48a","context":null,"enonce":"Regarding occupational health, what are the exact proposal(s)?","item":"securitepro","matiere":"mdt","propositions":[{"correct":true,"justification":"True, it makes sense. We will determine if a disease is of occupational cause if the disease occurs after exposure (chronological criterion) and if the lesions are semiologically compatible with exposure (semiological criterion)","idx":0,"proposition":"The imputability between disease and exposure is justified by chronological and semiological criteria"},{"correct":false,"justification":"False, it is by far the musculoskeletal disorders (carpal tunnel, meniscal involvement)","idx":1,"proposition":"The most common occupational diseases are occupational cancers"},{"correct":true,"justification":"True, completely! Some workers such as health professionals can contract these pathologies as a result of their work, so it is very clearly occupational ⚒️ diseases!","idx":2,"proposition":"Tuberculosis or viral hepatitis can be considered occupational diseases"},{"correct":true,"justification":"True, from the course.","idx":3,"proposition":"For job retention, the occupational physician may set up job changes, job adjustments or professional reclassifications."},{"correct":true,"justification":"True, if he is dismissed, it will be during the resumption visit that takes place after the resumption of work","idx":4,"proposition":"An employee cannot be dismissed during a work stoppage"}],"type":"custom"}
+{"_id":"178-mdt-81952c60-d8e6-4fb5-bfc5-710e265774b8","context":null,"enonce":"Regarding the follow-up visit in occupational medicine, which of these proposals is\/are true?","item":"securitepro","matiere":"mdt","propositions":[{"correct":false,"justification":"Wrong, it's the pre-resumption visit that!","idx":0,"proposition":"The follow-up visit is requested by the general practitioner, the patient or the medical officer of the health insurance"},{"correct":true,"justification":"True, it is done from a work stoppage for more than 1 month, so this is the case","idx":1,"proposition":"The follow-up visit is carried out at the end of a pregnancy\/maternity leave"},{"correct":true,"justification":"True, this is the purpose of the takeover visit","idx":2,"proposition":"The follow-up visit decides whether or not the employee is fit "},{"correct":true,"justification":"True, taken directly from college","idx":3,"proposition":"The resumption visit is done within 8 days of the resumption of work by the employee"},{"correct":false,"justification":"False, it can be decreased","idx":4,"proposition":"When transferring to another position in the company, in case of job adaptation, the salary remains the same for a period of 3 months"}],"type":"custom"}
+{"_id":"360-ortho-7c988182-40cc-448f-add4-a333ac69eea3","context":null,"enonce":"Regarding orthopedic treatment, which proposals are true?","item":"Frped","matiere":"ortho","propositions":[{"correct":true,"justification":" True","idx":0,"proposition":"Consolidation of fractures is faster in small children"},{"correct":true,"justification":" True","idx":1,"proposition":"The average duration of consolidation is shorter for epiphyseal detachments "},{"correct":false,"justification":"This is the case for diaphyseal fractures","idx":2,"proposition":"The consolidation of metaphyseal fractures is equivalent to that of adults"},{"correct":true,"justification":"Duration valid for a diaphyseal fracture in a child over 5 years of age (equivalent to adults)","idx":3,"proposition":"Fractures of the 2 bones of the forearm must be immobilized 90 days"},{"correct":false,"justification":"Analgesic immobilization, non-systematic, between 0 and 21 days","idx":4,"proposition":"A lump of butter fracture must be immobilized on average 45 days"}],"type":"custom"}
+{"_id":"340-ped-bd88049a-ea0b-419a-afb2-c13869698a18","context":null,"enonce":"Which of the following are systematic additional reviews for INM? (based on HAS, 2009)","item":"MSN","matiere":"ped","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"NFS-P"},{"correct":true,"justification":"True","idx":1,"proposition":"CRP"},{"correct":false,"justification":"False","idx":2,"proposition":"LDH"},{"correct":false,"justification":"False","idx":3,"proposition":"CPK"},{"correct":false,"justification":"False","idx":4,"proposition":"Hepatic test"}],"type":"custom"}
+{"_id":"340-ped-2fe0c635-97f9-48ca-88a7-1f888d36f040","context":null,"enonce":"Which of the following propositions are true regarding unexpected infant death?","item":"MSN","matiere":"ped","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"This is, according to the HAs, any \"death occurring suddenly in an infant under 2 years of age when nothing in his known history could have predicted\""},{"correct":true,"justification":"True","idx":1,"proposition":"Deaths that remain unexplained are grouped under the term unexplained IMN."},{"correct":true,"justification":"True","idx":2,"proposition":"In France, approximately 500 infants under 2 years of age die unexpectedly annually"},{"correct":false,"justification":"It is most often an infant aged between 2 and 4 months","idx":3,"proposition":"This is most often an infant between 20 and 24 months of age."},{"correct":false,"justification":"The supine sleeping position is a risk factor for MIN","idx":4,"proposition":"The supine sleeping position is a protective factor of MIN"}],"type":"custom"}
+{"_id":"340-ped-3dbf9f4f-9bff-4cfe-9ffb-c34d208b6f57","context":null,"enonce":"Which of the following are\/are risk factors for unexpected infant death?","item":"MSN","matiere":"ped","propositions":[{"correct":false,"justification":"This is the ideal temperature","idx":0,"proposition":"Room at 18-20 degrees"},{"correct":false,"justification":"Cosleeping is indeed not recommended","idx":1,"proposition":"Lack of co-sleeping"},{"correct":false,"justification":"It is absolutely necessary to avoid the supine position","idx":2,"proposition":"Child lying in a supine position"},{"correct":false,"justification":"Soft mattresses and duvets\/blankets should be avoided","idx":3,"proposition":"Use of a firm mattress"},{"correct":true,"justification":"True","idx":4,"proposition":"None of these propositions are true"}],"type":"custom"}
+{"_id":"dlrabdo-HGE-266148","context":null,"enonce":"Which of the following are true about pancreatic pain?","item":"dlrabdo","matiere":"HGE","propositions":[{"correct":false,"justification":"It sits mainly in epigastrium (possibly hypochondrium)","idx":0,"proposition":"It sits in the umbilical region most often"},{"correct":true,"justification":"True","idx":1,"proposition":"It is transfixing (radiates to the back)"},{"correct":false,"justification":"This is the case of the pain of the uclera. Pancreatic pain is aggravated by the meal, which can cause a fear of eating and therefore malnutrition","idx":2,"proposition":"She is calmed by the meal "},{"correct":true,"justification":"True, the famous gundog 🐶 position","idx":3,"proposition":"It is calmed by anteflexion"},{"correct":false,"justification":"It is rather cramp-type","idx":4,"proposition":"It is burn-type"}],"type":"custom"}
+{"_id":"dlrabdo-HGE-b45fa9","context":null,"enonce":"What is the threshold of days below which abdominal pain is considered acute?","item":"dlrabdo","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"1 day"},{"correct":false,"justification":"","idx":1,"proposition":"3 days"},{"correct":false,"justification":"","idx":2,"proposition":"5 days"},{"correct":true,"justification":"True, according to HGE College","idx":3,"proposition":"7 days"},{"correct":false,"justification":"","idx":4,"proposition":"10 days"}],"type":"custom"}
+{"_id":"dlrabdo-HGE-3027df","context":null,"enonce":"Which of the following are endocrinological (and therefore non-digestive) etiologies of abdominal pain?","item":"dlrabdo","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Pheochromocytoma"},{"correct":true,"justification":"True","idx":1,"proposition":"Diabetic ketoacidosis"},{"correct":true,"justification":"True","idx":2,"proposition":"Hypercalcemia"},{"correct":true,"justification":"True","idx":3,"proposition":"Acute adrenal insufficiency"},{"correct":false,"justification":"It is indeed a cause of abdominal pain (always do an ECG) but it is cardiac (not endocrinological, see statement). trap, I grant 💩 you","idx":4,"proposition":"Acute coronary syndrome"}],"type":"custom"}
+{"_id":"UGD-HGE-016e64","context":null,"enonce":"The Hiss angle corresponds to:","item":"UGD","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"The lair"},{"correct":false,"justification":"Corresponds to the angle of the lair","idx":1,"proposition":"The angular incissure"},{"correct":false,"justification":"","idx":2,"proposition":"The great curvature"},{"correct":true,"justification":"True. To see it in pictures: https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/57\/Stomach-fr.svg\/1200px-Stomach-fr.svg.png","idx":3,"proposition":"The incisure of the cardia"},{"correct":false,"justification":"That was a tough question, sorry! In addition, it is clearly not mandatory to know, so do not worry if you can not retain 😉 it","idx":4,"proposition":"All proposals are wrong ✖"}],"type":"custom"}
+{"_id":"UGD-HGE-a5ae3a","context":null,"enonce":"Which of the following are germs that can cause acute gastritis?","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"HSV"},{"correct":true,"justification":"True","idx":1,"proposition":"CMV"},{"correct":true,"justification":"True, then progresses to chronic gastritis","idx":2,"proposition":"H. Pylori"},{"correct":false,"justification":"Not per se, but induced immunosuppression promotes infection\/reactivation by\/of HSV and CMV","idx":3,"proposition":"HIV"},{"correct":false,"justification":"There are small subtleties 😛","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"UGD-HGE-cc761a","context":null,"enonce":"What is the sex ratio for gastric ulcer?","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"👩 1 - 1 👨"},{"correct":false,"justification":"","idx":1,"proposition":"👩 1 - 2 👨"},{"correct":false,"justification":"","idx":2,"proposition":"👩 1 - 3 👨"},{"correct":false,"justification":"","idx":3,"proposition":"👩 2 - 1 👨"},{"correct":false,"justification":"","idx":4,"proposition":"👩 3 - 1 👨"}],"type":"custom"}
+{"_id":"UGD-HGE-845b92","context":null,"enonce":"In the case of a gastric ulcer, treatment with curative PPI lasts for:","item":"UGD","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"4 weeks"},{"correct":false,"justification":"","idx":1,"proposition":"8 weeks"},{"correct":true,"justification":"True. 6 weeks of curative PPIs in addition to Helicobacter Pylori treatment","idx":2,"proposition":"6 weeks"},{"correct":false,"justification":"","idx":3,"proposition":"2 weeks"},{"correct":false,"justification":"","idx":4,"proposition":"10 weeks"}],"type":"custom"}
+{"_id":"UGD-HGE-f2707b","context":null,"enonce":"Among the following proposals, which are techniques that could be used for the detection of H. Pylori?","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True, reference technique to control post-treatment disappearance","idx":0,"proposition":"Urea breath test"},{"correct":true,"justification":"True, after biopsy","idx":1,"proposition":"Gastro-duodenal endoscopy + biopsies"},{"correct":true,"justification":"True","idx":2,"proposition":"Blood serology"},{"correct":false,"justification":"It's not the same organ 🙃","idx":3,"proposition":"Cytobacteriological examination of sputum (ECBC)"},{"correct":false,"justification":"It's not the same organ 🙃","idx":4,"proposition":"Bronchoalveolar lavage"}],"type":"custom"}
+{"_id":"UGD-HGE-66eaa0","context":null,"enonce":"Which of the following are true about gastritis?","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True, T cell elevation without symptoms","idx":0,"proposition":"Lymphocytic gastritis is often asymptomatic"},{"correct":true,"justification":"True, as well as gastritis under PPI and gastritis due to H. Pylori. These are the three causes of atrophiing gastritis.","idx":1,"proposition":"Autoimmune gastritis can progress to atrophy"},{"correct":false,"justification":"Woman over 50","idx":2,"proposition":"Autoimmune gastritis mainly affects children"},{"correct":false,"justification":"Chronic gastritis. Look for an allergy","idx":3,"proposition":"Eosinophilic gastritis is acute"},{"correct":false,"justification":"All gastritis is at risk of degeneration","idx":4,"proposition":"Granulomatous gastritis has no risk of malignant transformation"}],"type":"custom"}
+{"_id":"dvlptbuccoD-cmf-c6f6b2","context":null,"enonce":"Which of the following propositions are true about labialveolar clefts?","item":"dvlptbuccoD","matiere":"cmf","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"They are due to a defect of fusion of the buds of the face in the 1st trimester of pregnancy"},{"correct":false,"justification":"in Q1 ","idx":1,"proposition":"They are due to a defect of fusion of the buds of the face in the 2nd trimester of pregnancy"},{"correct":false,"justification":"Failure to merge the buds of the face in the 1st trimester ","idx":2,"proposition":"They are due to a defect of fusion of the neural crest in the 3rd trimester of pregnancy"},{"correct":false,"justification":"False","idx":3,"proposition":"They are associated with a IUGR"},{"correct":true,"justification":"True, no involvement of the bony palate and veil in the lip and alveolar cleft","idx":4,"proposition":"There are no attacks on the soft palate"}],"type":"custom"}
+{"_id":"dvlptbuccoD-cmf-fb30a8","context":null,"enonce":"Which of the following propositions are true regarding the total cleft lip-alveolo-palate?","item":"dvlptbuccoD","matiere":"cmf","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It affects the gum"},{"correct":true,"justification":"True","idx":1,"proposition":"It affects the dental arch"},{"correct":true,"justification":"True","idx":2,"proposition":"It touches the lip"},{"correct":true,"justification":"True","idx":3,"proposition":"She touches the veil of the palace"},{"correct":true,"justification":"True","idx":4,"proposition":"Its management is multidisciplinary"}],"type":"custom"}
+{"_id":"tbneuroSegeria-geria-741d2b","context":null,"enonce":"You receive in your general practice Mr. Emiliano Largo, 75 years old, who has just returned from a consultation with an ophthalmologist. He admits, a little embarrassed, that he did not understand what the ophthalmologist told him and that he had understood, however, that he will have cataract surgery on his right eye. You decide to do some therapeutic education. Which of the following proposition(s) are true?","item":"tbneuroSegeria","matiere":"geria","propositions":[{"correct":false,"justification":"False, cataract may be very common, it is a pathology of the lens. The aging of the lens will result more in presbyopia (lack of accommodation that will disrupt near vision)","idx":0,"proposition":"Cataract is a physiological aging of the lens, linked to a clouding of the latter"},{"correct":true,"justification":"True, these are quite characteristic and frequent signs of cataracts (hemeralopia = twilight vision disorder)","idx":1,"proposition":"Apart from decreased visual acuity, cataracts can be characterized by hemeralopia and yellowing of colors."},{"correct":false,"justification":"False, the examination with the slit lamp allows the diagnosis of cataract and specifies its topography, so it makes it possible to distinguish nuclear cataract, posterior subcapsular, cortical or total","idx":2,"proposition":"The slit lamp examination distinguishes a primary or secondary cataract"},{"correct":false,"justification":"False, this seemingly vicious trap between ultrasound in mode A and B makes it possible to return to an important point and misunderstood by students. Mode A ultrasound is a \"profile\" ultrasound that measures the axile length of the eye while mode B ultrasound is a frontal ultrasound that will explore \"the fundus\" of the eye and look for foreign bodies or retinal detachment.","idx":3,"proposition":"Before surgery by phacoemulsification of the lens, certain additional examinations are performed: ultrasound mode B and keratometry"},{"correct":false,"justification":"False, if the most common complication is this one, the most formidable is endophthalmitis!","idx":4,"proposition":"If secondary clouding of the lens is the most common complication, the most formidable complication is retinal detachment"}],"type":"custom"}
+{"_id":"pathogeria-geria-315c33","context":null,"enonce":"In your acute geriatric department, you have been hospitalized for a few hours Mr Traveylan, Alec, 88 years old, for acute pneumonia, of viral origin, related to CoVID 19, which led to a decompensation of his chronic heart disease. You ask your outpatient to summarize the overall care of the patient according to the Bouchon model or 1+2+3. Link the right number to the right pathology(s):","item":"pathogeria","matiere":"geria","propositions":[{"correct":true,"justification":"True, the 1 in the Bouchon model corresponds to physiological aging","idx":0,"proposition":"1: Physiological aging"},{"correct":false,"justification":"False, it is physiological aging","idx":1,"proposition":"1: Pathological aging"},{"correct":true,"justification":"True, the n°2 corresponds to chronic pathologies","idx":2,"proposition":"2: Chronic heart disease"},{"correct":true,"justification":"True, the n°3 corresponds to the decompensating factor","idx":3,"proposition":"3: CoVID 19 infection"},{"correct":true,"justification":"True, the n°3 corresponds to the decompensating factor","idx":4,"proposition":"3: Acute heart failure"}],"type":"custom"}
+{"_id":"179-mdt-3f31e69d-b184-4031-bce1-2ceec5b3cc80","context":null,"enonce":"Regarding the two types of possible health follow-ups in occupational health, which of the following proposals are accurate?","item":"orgamdt","matiere":"mdt","propositions":[{"correct":false,"justification":"False, hiring and periodic visits must be made by the occupational physician. The nurse can make intermediate visits","idx":0,"proposition":"The follow-up of an employee in a position at risk may include periodic follow-up visits by an occupational nurse"},{"correct":false,"justification":"False, at least every 4 years","idx":1,"proposition":"Periodic follow-up visits shall be carried out at least every two years"},{"correct":false,"justification":"False, for non-at-risk employees, there is no certificate of aptitude","idx":2,"proposition":"For employees in non-high-risk positions, the recruitment examination issues a certificate of suitability for employment"},{"correct":true,"justification":"True, from the course.","idx":3,"proposition":"The prevention information visit is done periodically at least every 5 years"},{"correct":true,"justification":"True, if he is not at risk, all mandatory visits can be made by an intern or a nurse","idx":4,"proposition":"An employee will not necessarily see the occupational physician in his professional life"}],"type":"custom"}
+{"_id":"179-mdt-600f6435-24b9-483b-bede-95c749803c72","context":null,"enonce":"Which of the following are true?","item":"orgamdt","matiere":"mdt","propositions":[{"correct":true,"justification":"True, this is part of the non-exhaustive list of roles of the occupational health service.","idx":0,"proposition":"The occupational health service has as its action the prevention of the consumption of toxic substances at work"},{"correct":true,"justification":"True, this is part of the non-exhaustive list of roles of the occupational health service.","idx":1,"proposition":"The occupational health service has as its action the prevention of sexual and moral harassment"},{"correct":false,"justification":"False, naughty trap, there are no psychomotor and occupational therapists ...","idx":2,"proposition":"The occupational health service may consist of nurses, psychologists, psychomotor therapists and occupational therapists."},{"correct":true,"justification":"True, double secret characteristic of the profession","idx":3,"proposition":"The occupational physician is bound by medical and professional secrecy"},{"correct":true,"justification":"True, 2021 College of Occupational Medicine Update","idx":4,"proposition":"The role of the occupational physician is only preventive"}],"type":"custom"}
+{"_id":"179-mdt-3d392e71-a80c-4491-a09d-b1871d1b9d1b","context":null,"enonce":"Regarding accidents at work and occupational diseases, what are the possible benefits received by the employee?","item":"orgamdt","matiere":"mdt","propositions":[{"correct":false,"justification":"False, cash benefit = compensation (think of cash as \"pay in cash\")","idx":0,"proposition":"Cash benefit: free care"},{"correct":false,"justification":"False, benefit in kind = free care","idx":1,"proposition":"Benefit in kind: daily allowances"},{"correct":true,"justification":"True, unlike other sick leave","idx":2,"proposition":"Not affected by the waiting day"},{"correct":true,"justification":"True, from the course","idx":3,"proposition":"Possible lifetime or lump sum annuity"},{"correct":false,"justification":"False, nothing to see it is the great war invalids \/ great war maimed","idx":4,"proposition":"Entitlement to the GIG\/GMG pension"}],"type":"custom"}
+{"_id":"myasthenie-neuro-8233ec","context":null,"enonce":"Which of the following are possible causes of ptosis?","item":"myasthenie","matiere":"neuro","propositions":[{"correct":false,"justification":"Levator muscle of the eyelid = oculomotor nerve III ","idx":0,"proposition":"Paralysis of the VI abducens nerve"},{"correct":false,"justification":"Levator muscle of the eyelid = oculomotor nerve III ","idx":1,"proposition":"Trochlear IV nerve paralysis"},{"correct":true,"justification":"True","idx":2,"proposition":"Oculomotor nerve paralysis III "},{"correct":true,"justification":"True","idx":3,"proposition":"Sign of Claude-Bernard-Horner"},{"correct":false,"justification":"False","idx":4,"proposition":"Vitamin B9 deficiency"}],"type":"custom"}
+{"_id":"myasthenie-neuro-dc1a58","context":null,"enonce":"Which of the following suggests a rapid test in consultation that can support the diagnosis of myasthenia gravis in case of ptosis?","item":"myasthenie","matiere":"neuro","propositions":[{"correct":false,"justification":"Test indicated when a patient suffers from ocular paralysis (and not ptosis). It consists of a graphic recording of ocular motor skills in different positions of the gaze.","idx":0,"proposition":"Test de Lancaster"},{"correct":true,"justification":"True, ptosis decreases after several seconds","idx":1,"proposition":"Ice cube test "},{"correct":false,"justification":"Useless for myasthenia gravis, not in consultation ","idx":2,"proposition":"EEG"},{"correct":false,"justification":"Unnecessary and unchanged\/normal in myasthenia gravis","idx":3,"proposition":"Visual field"},{"correct":false,"justification":"False","idx":4,"proposition":"No proposition is true"}],"type":"custom"}
+{"_id":"PF-neuro-2b9390","context":null,"enonce":"Regarding facial paralysis, which of the following propositions, which one or which are true?","item":"PF","matiere":"neuro","propositions":[{"correct":false,"justification":"False, the definition here corresponds to peripheral facial paralysis. We must not forget that we can have central facial paralysis, which corresponds to an attack of the central nervous system.","idx":0,"proposition":"Facial paralysis corresponds to distal involvement of nerve VII"},{"correct":true,"justification":"True, unlike a central facial paralysis where we will have a predominant lower facial involvement.","idx":1,"proposition":"Peripheral facial paralysis is characterized by upper and lower involvement of the face"},{"correct":true,"justification":"True, to have seen him in internship it is all the more bluffing. The eyes open we will have an asymmetry sometimes minimal, and the sign of Charles Bell can be revealed entirely at the closing of the eyes. ","idx":2,"proposition":"The sign of Charles Bell is revealed or increased when a patient is asked to close his eyes"},{"correct":false,"justification":"False, it is done on the healthy side. To help you remember tell you that it is the VII (motor nerve) that is abolished, so you have \"no muscle\" to stretch the mouth on the healthy side. But do not panic, I still confuse today the affected side ...","idx":3,"proposition":"Deviation of the mouth in unilateral peripheral facial paralysis occurs on the paralyzed side"},{"correct":true,"justification":"True, it is the main cause of facial paralysis, but you have to think about all the other causes too.","idx":4,"proposition":"Facial paralysis \"a frigore\" is the most common cause of facial paralysis and is characterized by restoration without sequelae in about 90-95% of cases"}],"type":"custom"}
+{"_id":"Kcsein-onco-0012ff","context":null,"enonce":"Regarding tamoxifen, which statement(s) are correct?","item":"Kcsein","matiere":"onco","propositions":[{"correct":false,"justification":"False. In premenopausal women. In postmenopausal women, anti-aromatases are indicated (Anastrozole, Letrozole)","idx":0,"proposition":"Tamoxifen is indicated in postmenopausal women with hormone receptor positive"},{"correct":true,"justification":"True. Tamoxifen increases the risk of endometrial cancer.","idx":1,"proposition":"In case of bleeding during tamoxifen treatment, endometrial cancer should always be ruled out and diagnostic hysteroscopy with biopsy curettage performed."},{"correct":true,"justification":"True","idx":2,"proposition":"Tamoxifen is prescribed for a period of 5 years"},{"correct":true,"justification":"True. Effective contraception is indicated.","idx":3,"proposition":"Tamoxifen is teratogenic"},{"correct":true,"justification":"True","idx":4,"proposition":"Tamoxifen is linked to an over-risk of thromboembolic complications"}],"type":"custom"}
+{"_id":"PF-neuro-ae6ca0","context":null,"enonce":"Which of the following are true about Lyme disease?","item":"PF","matiere":"neuro","propositions":[{"correct":true,"justification":"True, and more specifically borreliosis (infectious diseases caused by bacteria carried and transmitted to humans by ticks or lice)","idx":0,"proposition":"It is a spirochetosis"},{"correct":true,"justification":"True, the best way to remember it is to pronounce it (no I'm kidding)","idx":1,"proposition":"It is due to Borrelia burgdorferi"},{"correct":false,"justification":"Pertussis agent","idx":2,"proposition":"It is due to Bordetella pertussis"},{"correct":false,"justification":"Trench fever agent","idx":3,"proposition":"It is due to Bartonella quintana"},{"correct":true,"justification":"True","idx":4,"proposition":"Erythema migrans is looked for"}],"type":"custom"}
+{"_id":"329-urg-8ddecff5-a24a-4552-a1fe-7d0254301d78","context":null,"enonce":"Which of the following propositions, is (are) true regarding fat embolism?","item":"polytrauma","matiere":"urg","propositions":[{"correct":true,"justification":"True. CLINICAL diagnosis above all and not paraclinical that will guide. If you ever miss the clinic, the fundus will allow a retrospective diagnosis ","idx":0,"proposition":"The diagnosis is primarily clinical and is based on the discovery of hyperthermia, sinus tachycardia and polypnea a few hours after a limb fracture"},{"correct":false,"justification":"False. In addition there is only hypoxemia that is almost constant ","idx":1,"proposition":"The diagnosis is primarily paraclinical and based on the discovery of thrombocytopenia, hemolytic anemia and arterial hypoxemia. "},{"correct":true,"justification":"True. It can be used to make a retrospective diagnosis when clinical manifestations have been missed. ","idx":2,"proposition":"The fundus can find retinal hemorrhages, cottony nodules and retinal edema"},{"correct":true,"justification":"True! These manifestations are fickle, however. ","idx":3,"proposition":"The Gurd triad is based on the association of lesional pulmonary edema + neuro-psychic manifestations + petechiae of the trunk and mucous membranes "},{"correct":true,"justification":"True! HEMODYNAMICS to be monitored extremely rigorously in the context of (poly)trauma. Fat embolism was the subject of an entire question at ECNI 2021. All this information can be found in the latest college of anesthesia resuscitation p344: https:\/\/www.cnear.fr\/dfasm","idx":4,"proposition":"Preventive treatment is based on immobilization of fracture foci, maintenance of good hemodynamics and the fight against pain  "}],"type":"custom"}
+{"_id":"tbmarchegeria-neuro-8b1ae4","context":null,"enonce":"You receive in your acute geriatric department Mr. Dominique Greene, 89 years old, who comes for a classic fall care. You wonder what systematic assessment you are going to make and you note possible examinations \/ supports. What reviews will you NOT incorporate into your systematic review?","item":"tbmarchegeria","matiere":"neuro","propositions":[{"correct":true,"justification":"True, the fall assessment is as follows: Reassessment of the prescription, Evaluation of autonomy and functional independence by ADL and IADL\/\/\/\/\/NFS, CRP, Ionogram, Vitamin D, Blood glucose, Renal work, Liver test, CPK, Troponin, +\/- TSH, Albumin, \/\/\/\/ECG, IPS, Orthostatic hypotension test, +\/- ETT, Holter ECG, Brain imaging if call point","idx":0,"proposition":"MMS"},{"correct":false,"justification":"False","idx":1,"proposition":"Calcemia"},{"correct":true,"justification":"True","idx":2,"proposition":"Blood and urinary toxicants"},{"correct":true,"justification":"True","idx":3,"proposition":"Effort test"},{"correct":false,"justification":"False","idx":4,"proposition":"Orthostatic hypotension test"}],"type":"custom"}
+{"_id":"343-urg-aba09f67-6f87-457f-b786-501262657b76","context":null,"enonce":"Among the following proposals, which examination(s) of unscrambling for etiological purposes must \/ must imperatively be carried out in front of any acute renal failure?","item":"IRenA","matiere":"urg","propositions":[{"correct":false,"justification":"iodinated 😬 contrast medium injection","idx":0,"proposition":"uro-scanner"},{"correct":true,"justification":"True, systematic","idx":1,"proposition":"renal ultrasound"},{"correct":false,"justification":"useful only if parenchymal cause (eliminate pre-renal and post-renal cause before)","idx":2,"proposition":"puncture kidney biopsy"},{"correct":false,"justification":"not for etiological purposes","idx":3,"proposition":"Natremiah"},{"correct":true,"justification":"True, systematic","idx":4,"proposition":"Urinary ionogram"}],"type":"custom"}
+{"_id":"polytrauma-urg-2e7814","context":null,"enonce":"Which of the following proposals concerning the therapeutic management of a polytrauma patient are true?","item":"polytrauma","matiere":"urg","propositions":[{"correct":true,"justification":"True, A=Airway, B=Breathing, C=Circulation, D=Disability, E=Environment and ensures no source of potential instability is forgotten","idx":0,"proposition":"Treatment of vital distress follows sequence A, B, C, D, E"},{"correct":true,"justification":"True","idx":1,"proposition":"Stage E (Environment) mainly involves the fight against hypothermia"},{"correct":true,"justification":"True","idx":2,"proposition":"Stage D (Disability) focuses on neurological examination"},{"correct":true,"justification":"True","idx":3,"proposition":"The volume of blood lost during the first 6 hours post-traumatic of a femur fracture can reach 2000 mL"},{"correct":false,"justification":"False, hypocalcemia that results from the dilution and presence of citrate in PSL (calcium chelator)","idx":4,"proposition":"A massive transfusion exposes to the risk of hypercalcemia"}],"type":"custom"}
+{"_id":"dysphonie-neuro-df181d","context":null,"enonce":"Which of the following are causes of dysphonia with normal and mobile vocal cords?","item":"dysphonie","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Hypothyroidism"},{"correct":true,"justification":"True","idx":1,"proposition":"Hyperandrogenism"},{"correct":false,"justification":"False","idx":2,"proposition":"Rheumatoid arthritis"},{"correct":false,"justification":"It is not dysphonia (differential diagnosis)","idx":3,"proposition":"Rhinolalie"},{"correct":false,"justification":"It is not dysphonia (differential diagnosis), hypophonia is observed","idx":4,"proposition":"Chronic respiratory failure"}],"type":"custom"}
+{"_id":"RCIU-gyn-c53a59","context":null,"enonce":"Which of the following are recommendations for pregnant women who are not immune to toxoplasmosis?","item":"RCIU","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Avoid contact with cats 🐱"},{"correct":false,"justification":"Not cited in college","idx":1,"proposition":"Avoid contact with dogs"},{"correct":true,"justification":"True","idx":2,"proposition":"Washing raw fruit"},{"correct":true,"justification":"True","idx":3,"proposition":"Consumption of well-cooked meat"},{"correct":false,"justification":"There is no vaccine against toxoplasmosis","idx":4,"proposition":"Vaccination"}],"type":"custom"}
+{"_id":"dysphagie-HGE-7b90f6","context":null,"enonce":"Which of the following can cause lesional esophageal dysphagia?","item":"dysphagie","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Cancer of the cardia"},{"correct":true,"justification":"True","idx":1,"proposition":"Zenker's diverticulum"},{"correct":true,"justification":"True","idx":2,"proposition":"Caustic stenosis"},{"correct":true,"justification":"True","idx":3,"proposition":"Peptic stenosis"},{"correct":false,"justification":"Non-lesional dysphagia: perprandial retrosternal pain","idx":4,"proposition":"Diffuse spasm disease of the esophagus"}],"type":"custom"}
+{"_id":"TTTnonmedic-therapeutique-edd5ec","context":null,"enonce":"Which of the following proposals designate types of orthotics?","item":"TTTnonmedic","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True: reduced pain and deformities at rest","idx":0,"proposition":"Resting orthosis"},{"correct":false,"justification":"Does not exist","idx":1,"proposition":"Activity orthosis"},{"correct":true,"justification":"True. Reduces deformation","idx":2,"proposition":"Correction orthosis"},{"correct":false,"justification":"Does not exist","idx":3,"proposition":"Addition orthosis"},{"correct":false,"justification":"Does not exist","idx":4,"proposition":"Addition orthosis"}],"type":"custom"}
+{"_id":"ETP-therapeutique-58d28b","context":null,"enonce":"Which of the following proposals correspond to a situation where a doctor can prescribe off-label? 😱","item":"ETP","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Early access"},{"correct":true,"justification":"True","idx":1,"proposition":"Compassionate access"},{"correct":false,"justification":"False","idx":2,"proposition":"Palliative care"},{"correct":false,"justification":"False","idx":3,"proposition":"At the request of the patient"},{"correct":false,"justification":"I kindly remind you that general medicine is a specialty. 😇😇","idx":4,"proposition":"At the request of the specialist when you are a generalist"}],"type":"custom"}
+{"_id":"tbconscience-urg-b4a474","context":null,"enonce":"Which of the following are confusogenic molecules due to their anticholinergic activity?","item":"tbconscience","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Metoclopramide"},{"correct":true,"justification":"True, \"Atropine, it drives you crazy!\"","idx":1,"proposition":"Atropine"},{"correct":true,"justification":"True","idx":2,"proposition":"Imipramine antidepressants"},{"correct":false,"justification":"False","idx":3,"proposition":"Paracetamol"},{"correct":false,"justification":"No anticholinergic action. However, it can participate in dehydrating the patient (cause of confusion)","idx":4,"proposition":"Furosemide"}],"type":"custom"}
+{"_id":"339-urg-5bebf96e-7264-48df-b909-6627cae65ab6","context":null,"enonce":"Regarding preeclampsia, which of the following are true?","item":"PECKc","matiere":"urg","propositions":[{"correct":true,"justification":"True. Cf. 2020 CNGOF Recommendations. It is routinely put on to prevent complications of eclampsia.","idx":0,"proposition":"IV magnesium sulfate is indicated in all pregnant women with severe pre-eclampsia with at least 1 severity endpoint"},{"correct":true,"justification":"True","idx":1,"proposition":"HELLP syndrome is frequently associated with DIC."},{"correct":true,"justification":"True. Cf. 2020 CNGOF Recommendations. ","idx":2,"proposition":"The anti-hypertensive recommended in first line in front of severe hypertension in pre-eclampsia is labetolol"},{"correct":true,"justification":"True. First-line treatment: labetolol. Second-line therapy: calcium channel blocker (nicardipian) or uradipil, as monotherapy or in combination. ","idx":3,"proposition":"In case of contraindication or failure of first-line antihypertensive therapy, the second-line antihypertensive drug for severe hypertension in pre-eclampsia is a calcium channel blocker (nicardipine) or uradipil"},{"correct":false,"justification":"False. This is a difference with hypertension in adults and hypertension in pregnant women. In adults, it is ≥ 180 mmHg PAS and\/or ≥ 110 mmHg PAD. In pregnant women, it is ≥ 160 mmHg PAS and \/ or ≥ 110 mmHg PAD.","idx":4,"proposition":"Severe hypertension during pregnancy is defined as SBP ≥ 180 and\/or PAD ≥ 110 mmHg"}],"type":"custom"}
+{"_id":"ETP-therapeutique-abc05f","context":null,"enonce":"Which of the following are true?","item":"ETP","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The direct toxicity of a drug is dose-dependent 💊"},{"correct":false,"justification":"False","idx":1,"proposition":"Digestive absorption of drugs is age-dependent 👴"},{"correct":true,"justification":"True","idx":2,"proposition":"The hepatic first-pass effect is decreased in the elderly 🧓"},{"correct":false,"justification":"Most are not ➡ always checked on the CRAT website","idx":3,"proposition":"The drugs are for, mostly, fetotoxic 👶"},{"correct":false,"justification":"It decreases by hemodilution ↘","idx":4,"proposition":"Albuminemia increases during pregnancy 🤰 "}],"type":"custom"}
+{"_id":"dlrbuccale-neuro-35364b","context":null,"enonce":"Which of the following are true?","item":"dlrbuccale","matiere":"neuro","propositions":[{"correct":true,"justification":"True. Between 5 and 60 minutes for each symptom","idx":0,"proposition":"Symptoms of migraine aura last less than an hour"},{"correct":true,"justification":"True","idx":1,"proposition":"Tension ⚡ headaches have nothing to do with high blood pressure. "},{"correct":true,"justification":"True","idx":2,"proposition":"Headaches due to drug abuse may be due to paracetamol"},{"correct":false,"justification":"This is the case of cluster headache. For tension headaches, it is amitriptyline","idx":3,"proposition":"The background treatment for tension headaches is verapamil"},{"correct":true,"justification":"True","idx":4,"proposition":"Oxygen therapy is part of the treatment of cluster headache crisis"}],"type":"custom"}
+{"_id":"PECKc-urg-d8d03c","context":null,"enonce":"Which of the following proposals for pre-eclampsia are criteria for severity?","item":"PECKc","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A PEAK≥160 mmHg and\/or SAR≥110 mmHg"},{"correct":true,"justification":"True. Defined by mechanical hemolysis (schizocytes, LDH ≤ 600 IU\/L, total bilirubin ≥ 12mg\/L), hepatic cytolysis (AST≥70 IU\/L) and thrombocytopenia (≤100 G\/L)","idx":1,"proposition":"HELLP syndrome"},{"correct":false,"justification":"False, nephrotic syndrome with proteinuria ≥5g\/24h","idx":2,"proposition":"Proteinuria ≥300mg\/24h"},{"correct":false,"justification":"False, ≤ 100,000 g\/L","idx":3,"proposition":"Thrombocytopenia from ≤ 30,000 G\/L"},{"correct":true,"justification":"True","idx":4,"proposition":"Fetal impact"}],"type":"custom"}
+{"_id":"180-mdt-3bc91e69-0633-492e-af3c-0a2ff655e05c","context":null,"enonce":"Mr. Idaho, Duncan, 35 years old, comes to see you in your office because he would like to be recognized for his chronic lumbosciatica related to his profession, in occupational disease. Which of the following means qualify for recognition as an occupational disease?","item":"APMP","matiere":"mdt","propositions":[{"correct":false,"justification":"False, the presumption of imputability applies to accidents at work and not to occupational diseases. Attention, classic trap in MCQ.","idx":0,"proposition":"Presumption of accountability"},{"correct":true,"justification":"True, if the disease corresponds to the picture (physical injuries, delay etc ...) there is no need for additional evidence","idx":1,"proposition":"Presumption of origin"},{"correct":false,"justification":"False, the occupational physician cannot certify the occupational disease, just with a certificate","idx":2,"proposition":"Certificate from the occupational physician certifying the occupational origin of the disease "},{"correct":true,"justification":"True, the CRRMP allows to debate cases that do not fit completely in the tables or being outside the tables, overall, they will study in detail the links between illness and work and grant or not the disease as occupational or not.","idx":3,"proposition":"Recognition of the file before the Regional Committee for the Recognition of Occupational Diseases (CRRMP)"},{"correct":false,"justification":"False, 100% false.","idx":4,"proposition":"Pathology that started during labour and persisted for more than 5 years"}],"type":"custom"}
+{"_id":"masseabdo-HGE-2b2d0f","context":null,"enonce":"Which of the following are contraindications to transparietal PBH?","item":"masseabdo","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"TP < 50%"},{"correct":true,"justification":"True, special threshold to remember","idx":1,"proposition":"Platelets <60,000\/mm3"},{"correct":true,"justification":"True","idx":2,"proposition":"Lengthening of the ATT"},{"correct":true,"justification":"True, these are the 4 contraindications mentioned in the college 😉","idx":3,"proposition":"Ascites"},{"correct":false,"justification":"In this case, On","idx":4,"proposition":"Heterogeneous hepatomegaly"}],"type":"custom"}
+{"_id":"splenomeg-HGE-8e0c76","context":null,"enonce":"Which of the following are true for macrophage activation syndrome (SAM)?","item":"splenomeg","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"There is hepatomegaly"},{"correct":true,"justification":"True","idx":1,"proposition":"We find a fever"},{"correct":false,"justification":"Pancytopenia","idx":2,"proposition":"Leukocytosis is found"},{"correct":false,"justification":"Increased","idx":3,"proposition":"We find LDH in free fall"},{"correct":false,"justification":"Increased ferritin","idx":4,"proposition":"Hypoferritinemia"}],"type":"custom"}
+{"_id":"ETP-therapeutique-4b7dfc","context":null,"enonce":"Which of the following propositions are true about ALD?","item":"ETP","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Diabetes is ALD"},{"correct":false,"justification":"Each ALD has a fixed term, at the end of which renewal can be requested","idx":1,"proposition":"ALDs are valid for life"},{"correct":true,"justification":"True","idx":2,"proposition":"It is usually requested by the attending physician"},{"correct":false,"justification":"Only for care related to the pathology in question","idx":3,"proposition":"It offers the right to 100% coverage for all care"},{"correct":false,"justification":"False","idx":4,"proposition":"It makes it possible to free oneself from mutual insurance companies"}],"type":"custom"}
+{"_id":"diarrheechr-HGE-c192f0","context":null,"enonce":"How many loose\/watery stools per day are we talking about diarrhea?","item":"diarrheechr","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"1"},{"correct":false,"justification":"","idx":1,"proposition":"2"},{"correct":true,"justification":"True, diarhea if > 3 watery\/soft stools per day","idx":2,"proposition":"3"},{"correct":false,"justification":"","idx":3,"proposition":"4"},{"correct":false,"justification":"","idx":4,"proposition":"5"}],"type":"custom"}
+{"_id":"ictere-HGE-455ebb","context":null,"enonce":"Which of the following are causes of extrahepatic jaundice?","item":"ictere","matiere":"HGE","propositions":[{"correct":false,"justification":"Head of the pancreas","idx":0,"proposition":"Pancreatic tail cancer"},{"correct":true,"justification":"True","idx":1,"proposition":"Duodenal tumour"},{"correct":true,"justification":"True","idx":2,"proposition":"Gastric tumour"},{"correct":true,"justification":"True","idx":3,"proposition":"Hemolysis"},{"correct":true,"justification":"True","idx":4,"proposition":"Gilbert's disease"}],"type":"custom"}
+{"_id":"MICI-HGE-268b78","context":null,"enonce":"Which of the following are signs and\/or symptoms of UC?","item":"MICI","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Chronic dysenteric syndrome"},{"correct":true,"justification":"True","idx":1,"proposition":"Chronic diarrhea"},{"correct":true,"justification":"True","idx":2,"proposition":"Iron deficiency"},{"correct":false,"justification":"The anus is not affected","idx":3,"proposition":"Involvement of the anus"},{"correct":true,"justification":"True","idx":4,"proposition":"The diagnosis is made on a bundle of arguments"}],"type":"custom"}
+{"_id":"Frped-urg-b9207b","context":null,"enonce":"Which of the following are true?","item":"Frped","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A \"green wood\" fracture is a fracture where part of the cortical of the bone is ruptured, and the other side of the cortical is continuous."},{"correct":false,"justification":"False. Axial trauma. ","idx":1,"proposition":"A fracture in \"lump of butter\" results from a torsional mechanism"},{"correct":false,"justification":"False. 1st cause. ","idx":2,"proposition":"Traumatology is the second leading cause of death between 1 year and 19 years"},{"correct":true,"justification":"True","idx":3,"proposition":"The occurrence of a fracture in an infant who does not move must give rise to suspicion of abuse. "},{"correct":true,"justification":"True. The water density of the child's bone gives it greater plasticity.","idx":4,"proposition":"Fractures made of green wood and lump of butter are specific to the child"}],"type":"custom"}
+{"_id":"choc-urg-fe7d13","context":null,"enonce":"What is the main property of dobutamine?","item":"choc","matiere":"urg","propositions":[{"correct":true,"justification":"True, increased strength of \r\ncontraction. Continuous infusion with the self-pushing syringe","idx":0,"proposition":"Positive ionotrope"},{"correct":false,"justification":"Slightly chronotropic positive","idx":1,"proposition":"Negative chronotropic"},{"correct":false,"justification":"No effect on the conduction velocity of nerve impulses of myocardial muscle fibers","idx":2,"proposition":"Negative domotrope"},{"correct":false,"justification":"Positive ionotrope","idx":3,"proposition":"Negative ionotrope"},{"correct":false,"justification":"","idx":4,"proposition":"All proposals are wrong"}],"type":"custom"}
+{"_id":"cirrhose-HGE-bc27a3","context":null,"enonce":"Which of the following are signs of hepatocellular insufficiency?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Stellar angioma"},{"correct":true,"justification":"True","idx":1,"proposition":"Palar erythrosis"},{"correct":false,"justification":"Portal hypertension","idx":2,"proposition":"Ascites"},{"correct":false,"justification":"Portal hypertension","idx":3,"proposition":"Collateral circulation"},{"correct":true,"justification":"True","idx":4,"proposition":"Jaundice"}],"type":"custom"}
+{"_id":"dlrbuccale-neuro-54b255","context":null,"enonce":"Which of the following are true about migraines?","item":"dlrbuccale","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Migraine with aura is an independent risk factor for cerebral infarction, especially in women under 45 years of age."},{"correct":true,"justification":"True","idx":1,"proposition":"Migraine with typical aura involves visual, sensory or language disorders of gradual and successive installation"},{"correct":false,"justification":"Visual disturbances","idx":2,"proposition":"Sensory disorders are most common in migraines with aura"},{"correct":false,"justification":"auras can change over the course of life","idx":3,"proposition":"Auras are always the same throughout life"},{"correct":false,"justification":"Less than 15 days per month","idx":4,"proposition":"Episodic migraine lasts less than 25 days a month"}],"type":"custom"}
+{"_id":"tbconscience-urg-e6a32c","context":null,"enonce":"Which of the following are true for pellagreal encephalopathy?","item":"tbconscience","matiere":"urg","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"It is due to vitamin B1 deficiency"},{"correct":true,"justification":"True","idx":1,"proposition":"It is due to vitamin B3 deficiency"},{"correct":false,"justification":"False","idx":2,"proposition":"It is due to vitamin B6 deficiency"},{"correct":true,"justification":"True","idx":3,"proposition":"It is due to vitamin PP deficiency"},{"correct":false,"justification":"False","idx":4,"proposition":"No proposition is true"}],"type":"custom"}
+{"_id":"TTTnonmedic-therapeutique-9bde80","context":null,"enonce":"Which of the following are true?","item":"TTTnonmedic","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Rest orthoses prevent deformities"},{"correct":true,"justification":"True","idx":1,"proposition":"Resting orthoses reduce pain"},{"correct":false,"justification":"Replacement orthosis","idx":2,"proposition":"The dynamic muscle replacement orthosis is a corrective orthosis"},{"correct":false,"justification":"Canes and wheelchairs are external technical aids","idx":3,"proposition":"The cane is an orthosis"},{"correct":true,"justification":"True","idx":4,"proposition":"The stabilization orthosis allows the maintenance of activity despite an unstable limb"}],"type":"custom"}
+{"_id":"MTEV-cardio-430cf9","context":null,"enonce":"One of your patients is being treated with VKA for her PE. VKAs prevent hepatic synthesis of several coagulation factors. Which?","item":"MTEV","matiere":"cardio","propositions":[{"correct":false,"justification":"Factor II, VII, IX and X","idx":0,"proposition":"Factor I"},{"correct":true,"justification":"True","idx":1,"proposition":"Factor II"},{"correct":true,"justification":"True","idx":2,"proposition":"Factor VII"},{"correct":true,"justification":"True","idx":3,"proposition":"Factor IX"},{"correct":false,"justification":"","idx":4,"proposition":"Factor XII"}],"type":"custom"}
+{"_id":"ECG-cardio-5aa61a","context":null,"enonce":"Which of the following propositions are found in junctional tachycardia?","item":"ECG","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Regular rhythm"},{"correct":false,"justification":"False","idx":1,"proposition":"Irregular rhythm"},{"correct":false,"justification":"Purposes unless pre-existing branch blog","idx":2,"proposition":"Wide QRS"},{"correct":true,"justification":"True","idx":3,"proposition":"Fine QRS"},{"correct":true,"justification":"True, until you reach maximum heart rate (220 - age)","idx":4,"proposition":"Tachycardia often exceeds 150 bpm"}],"type":"custom"}
+{"_id":"85-ORL-cd19be8c-1d32-4770-a405-7552e32cf0be","context":null,"enonce":"A 57-year-old patient comes to see you for a left epistaxis of low abundance \r\n\r\nATCD: Repeated MTEV \r\nTTT: Fluindione \r\n\r\nWhat is the 1st measure to be carried out? ","item":"epistaxis","matiere":"ORL","propositions":[{"correct":true,"justification":"True. In front of an epistaxis: \r\n1. We decoiled by blowing the patient's nose \r\n\r\n2. Bidigital compression is done to try to stop the bleeding","idx":0,"proposition":"Stripping by blowing "},{"correct":false,"justification":"","idx":1,"proposition":"Bidigital compression "},{"correct":false,"justification":"","idx":2,"proposition":"Nasal sinus CT"},{"correct":false,"justification":"","idx":3,"proposition":"Return home"},{"correct":false,"justification":"","idx":4,"proposition":"Prescription of Group O+ phenotyped RGCs"}],"type":"custom"}
+{"_id":"tumefactionpelv-gyn-330651","context":null,"enonce":"What does the FIGO 0 classification of a uterine fibroid mean? ","item":"tumefactionpelv","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Fully intracavitary pedunculated submucosal fibroid"},{"correct":false,"justification":"FIGO 7","idx":1,"proposition":"Pedunculated subserous fibroma"},{"correct":false,"justification":"FIGO 3","idx":2,"proposition":"Interstitial fibroid in contact with the endometrium"},{"correct":false,"justification":"FIGO 6","idx":3,"proposition":"Subserous fibroid<50%intracavitary"},{"correct":false,"justification":"FIGO 1","idx":4,"proposition":"Submucosal fibroid<50% intracavitary"}],"type":"custom"}
+{"_id":"DgKc-onco-a4d967","context":null,"enonce":"Which of the following propositions are true regarding extemporaneous examination?","item":"DgKc","matiere":"onco","propositions":[{"correct":false,"justification":"It is always complemented by an analysis ","idx":0,"proposition":"The result given is final"},{"correct":false,"justification":"Not fixed","idx":1,"proposition":"The levy is fixed with formalin"},{"correct":false,"justification":"Not fixed","idx":2,"proposition":"The sample is fixed to saline"},{"correct":true,"justification":"True","idx":3,"proposition":"The result must be fast (in less than 30 minutes)"},{"correct":false,"justification":"","idx":4,"proposition":"All proposals are wrong"}],"type":"custom"}
+{"_id":"MICI-HGE-53cace","context":null,"enonce":"Regarding the epidemiology of Crohn's disease:","item":"MICI","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The incidence is increasing 📈"},{"correct":false,"justification":"","idx":1,"proposition":"The incidence is decreasing 📉"},{"correct":true,"justification":"True","idx":2,"proposition":" Prevalence is about 1\/1000"},{"correct":false,"justification":"The threshold for rare diseases is 1\/2000","idx":3,"proposition":"It is a rare disease"},{"correct":false,"justification":"About 1\/1000","idx":4,"proposition":" Prevalence is about 1\/6000"}],"type":"custom"}
+{"_id":"ictere-HGE-ef3411","context":null,"enonce":"Which of the following are etiologies of jaundice with normal urine?","item":"ictere","matiere":"HGE","propositions":[{"correct":false,"justification":"Brown urine","idx":0,"proposition":"Cholestasis"},{"correct":true,"justification":"True","idx":1,"proposition":"Dyserythropoiesis"},{"correct":true,"justification":"True","idx":2,"proposition":"Hemolysis"},{"correct":true,"justification":"True","idx":3,"proposition":"Beta-glucuronide transferase deficiency"},{"correct":false,"justification":"Rotor syndrome is a benign inherited liver disease characterized by predominantly conjugated chronic hyperbilirubinemia without hemolysis or histological hepatic abnormalities.","idx":4,"proposition":"Syndrome de Rotor"}],"type":"custom"}
+{"_id":"NFS-hemato-002159","context":null,"enonce":"Which of the following are the causes of hematocrit elevation?","item":"NFS","matiere":"hemato","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"None of these proposals"},{"correct":false,"justification":"Rather anemia","idx":1,"proposition":"Monoclonal gammopathy"},{"correct":true,"justification":"True, not hemoconcentration","idx":2,"proposition":"Extracellular dehydration"},{"correct":false,"justification":"Normal hematocrit polycythemia","idx":3,"proposition":"Thalassemia"},{"correct":true,"justification":"True. Cause of false polycythemia (ht\/hb increased but normal total mass). It often corresponds to young, sedentary, overweight men and other associated vascular risk factors. The measurement of the globular mass is normal.","idx":4,"proposition":"Syndrome de Gaisbock"}],"type":"custom"}
+{"_id":"suivivalv-cardio-40bcff","context":null,"enonce":"You are an intern in cardiology and your outpatient, asks you during the visit what are the main differences between mechanical prostheses and biological prostheses?","item":"suivivalv","matiere":"cardio","propositions":[{"correct":true,"justification":"True, unlike bioprostheses that often have a lifespan of 20 years.","idx":0,"proposition":"Mechanical prostheses have a theoretically unlimited lifespan"},{"correct":false,"justification":"False, because of their limited lifespan, we will rather implement these prostheses in elderly subjects.","idx":1,"proposition":"Biological prostheses are preferred in young subjects because they avoid taking an anticoagulant"},{"correct":false,"justification":"False, there is the same risk regardless of the type of prosthesis","idx":2,"proposition":"The risk of infective endocarditis is greater in front of a mechanical prosthesis than in front of a bioprosthesis"},{"correct":true,"justification":"True, finesse of the college of cardiology that I did not know but that an expert cardiologist could drop in IQ","idx":3,"proposition":"The risk of thromboembolic complications is higher for mitral prostheses than for aortic prostheses"},{"correct":true,"justification":"True, so make sure your patients take their blood thinning treatment!","idx":4,"proposition":"The main risk factor for thromboembolic event on prosthetic valve is insufficient anticoagulant therapy"}],"type":"custom"}
+{"_id":"greffe-immuno-1a6e67","context":null,"enonce":"Which of the following are true about corneal transplantation?","item":"greffe","matiere":"immuno","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"There is a risk of immune rejection of the graft"},{"correct":true,"justification":"True","idx":1,"proposition":"There is a risk of cell rejection of the graft"},{"correct":true,"justification":"True","idx":2,"proposition":"HIV serology is mandatory in the donor"},{"correct":false,"justification":"False","idx":3,"proposition":"EBV serology is mandatory in the donor"},{"correct":true,"justification":"True","idx":4,"proposition":"HBV serology is mandatory in the donor"}],"type":"custom"}
+{"_id":"Frped-urg-177104","context":null,"enonce":"Regarding the classification of Salter and Harris","item":"Frped","matiere":"urg","propositions":[{"correct":false,"justification":"The trait respects the germinative layer of the growth cartilage: the risk of epiphysiodesis is therefore low","idx":0,"proposition":"A Salter 1 fracture is characterized by a trait passing exclusively through the growth zone, which induces a high risk of epiphysiodesis"},{"correct":false,"justification":"Growth zone and metaphysis","idx":1,"proposition":"A Salter 2 fracture is characterized by a trait passing through the growth zone and the epiphysis "},{"correct":true,"justification":"The trait passes through the growth zone and the epiphysis (the germinative zone of cartilage is located towards the epiphysis)","idx":2,"proposition":"In a Salter 3 fracture, the germinative layer is always crossed by the fracture line "},{"correct":true,"justification":"The line goes from the metaphysis to the epiphysis: it crosses transversely the growth cartilage","idx":3,"proposition":"In a Salter 4 fracture, the fracture line is transverse to the growth cartilage"},{"correct":true,"justification":"It is generally associated with other fractures, in case of compression mechanism (axial trauma)","idx":4,"proposition":"A Salter 5 fracture does not exist in isolation"}],"type":"custom"}
+{"_id":"lithiaseB-HGE-a64bfc","context":null,"enonce":"Which of the following are risk factors for lithiasis?","item":"lithiaseB","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Hypertriglyceridemia"},{"correct":true,"justification":"True","idx":1,"proposition":"Pregnancy"},{"correct":true,"justification":"True","idx":2,"proposition":"Overweight"},{"correct":true,"justification":"True","idx":3,"proposition":"Age"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"lithiaseB-HGE-29fd53","context":null,"enonce":"Which of the following is the optimal management of asymptomatic cholelithiasis?","item":"lithiaseB","matiere":"HGE","propositions":[{"correct":true,"justification":"True, therapeutic abstention in front of asympatomatic cholelithiasis (80% are asympto)","idx":0,"proposition":"All proposals are wrong"},{"correct":false,"justification":"It is the management of hepatic colic calmed by analgesic \/ NSAIDs \/ antispasmodics","idx":1,"proposition":"Cold cholecystectomy (less than one month)"},{"correct":false,"justification":"This is the management of acute cholecystitis","idx":2,"proposition":"Emergency cholecystectomy"},{"correct":false,"justification":"This is the management of cholitis (with cholecystectomy)","idx":3,"proposition":"ERPC"},{"correct":false,"justification":"Never biliary lithotripsy","idx":4,"proposition":"Lithotripsy"}],"type":"custom"}
+{"_id":"diarrheechr-HGE-9b9da3","context":null,"enonce":"Regarding celiac disease:","item":"diarrheechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Prevalence is 1\/1000"},{"correct":true,"justification":"True","idx":1,"proposition":"There is villous atrophy"},{"correct":true,"justification":"True","idx":2,"proposition":"Screening is done the anti-tranglutamase IgA assay"},{"correct":false,"justification":"1%","idx":3,"proposition":"It is always symptomatic"},{"correct":false,"justification":"Confirmation:)","idx":4,"proposition":"Screening is done the anti-endomysium IgA assay"}],"type":"custom"}
+{"_id":"tbconscience-urg-33c3e3","context":null,"enonce":"Which of the following proposals are part of the initial assessment recommended urgently in the face of confusion? ","item":"tbconscience","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Capillary blood glucose"},{"correct":true,"justification":"True","idx":1,"proposition":"CRP"},{"correct":false,"justification":"False, renal assessment","idx":2,"proposition":"Hepatic test"},{"correct":false,"justification":"False, CRP lactates","idx":3,"proposition":"CPK"},{"correct":true,"justification":"True","idx":4,"proposition":"Protidemia"}],"type":"custom"}
+{"_id":"98-neuro-c8a40380-88e6-4894-83e6-12f9ada7cf35","context":null,"enonce":"Concerning Headaches in children. Which of the following are situations for a Brain Scan indication?","item":"cephalee","matiere":"neuro","propositions":[{"correct":false,"justification":"no, MRI :p CT scan before 3 years ","idx":0,"proposition":"Statural inflection in a 2-year-old child"},{"correct":false,"justification":"no, MRI :p CT scan before 3 years ","idx":1,"proposition":"An abnormality on neurological examination in a 3-month-old child"},{"correct":true,"justification":"True","idx":2,"proposition":"Positional headaches of decubitus, morning with vomiting in jets in a 7-year-old child"},{"correct":true,"justification":"True Occulomotor nerve compression III","idx":3,"proposition":"A progressive appearance of horizontal diplopia of the right eye that converges to the left associated with a headache in a 4-year-old child"},{"correct":true,"justification":"True","idx":4,"proposition":"Statural delay in a 5-year-old child associated with progressive onset headaches"}],"type":"custom"}
+{"_id":"176-sp-79f41abb-8da1-4241-ad82-e3951e5bbbaa","context":null,"enonce":"You are a nuclear medicine intern and you receive, Mr. Banner, Bruce, 76 years old, to have him perform a PET-CT, as part of a pulmonary cancer extension assessment. During this examination, you do everything to minimize the body's exposure to ionizing radiation. What factors influence this exposure?","item":"risquesRx","matiere":"sp","propositions":[{"correct":true,"justification":"True, notion of highly fallable course at the ECN","idx":0,"proposition":"Distance from source"},{"correct":true,"justification":"True, notion of highly fallable course at the ECN","idx":1,"proposition":"Type of rays used"},{"correct":false,"justification":"False, it's a stupid distractor because it needed one","idx":2,"proposition":"The dose previously received during a previous exposure"},{"correct":true,"justification":"True, notion of highly fallable course at the ECN","idx":3,"proposition":"Duration of exposure"},{"correct":true,"justification":"True, notion of highly fallable course at the ECN","idx":4,"proposition":"Thickness and composition of any screens"}],"type":"custom"}
+{"_id":"pancreatitechr-HGE-c8be19","context":null,"enonce":"Which of the following are true?","item":"pancreatitechr","matiere":"HGE","propositions":[{"correct":false,"justification":"Male","idx":0,"proposition":"The predominance is female 👩"},{"correct":false,"justification":"40 years","idx":1,"proposition":"The average age is 70 years"},{"correct":false,"justification":"In the back","idx":2,"proposition":"Pain radiates hypogastric"},{"correct":true,"justification":"True","idx":3,"proposition":"The pain is calmed by fasting"},{"correct":true,"justification":"True","idx":4,"proposition":"It can be complicated by diabetes"}],"type":"custom"}
+{"_id":"Kcprostate-onco-70d9dd","context":null,"enonce":"Which of the following are true about abiraterone acetate?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":true,"justification":"True, by irreversibly blocking CYP17","idx":0,"proposition":"It is a selective inhibitor of androgen synthesis"},{"correct":false,"justification":"False","idx":1,"proposition":"It is an androgen receptor antagonist"},{"correct":false,"justification":"Daily oral form in combination with prednisone (10 mg\/day)","idx":2,"proposition":"It is in the form of subcutaneous injection"},{"correct":true,"justification":"True","idx":3,"proposition":"It improves quality of life"},{"correct":true,"justification":"True","idx":4,"proposition":"It improves overall survival"}],"type":"custom"}
+{"_id":"Kcped-onco-4c97fc","context":null,"enonce":"Which of the following designates an essential isotopic examination in the assessment of neuroblastoma?","item":"Kcped","matiere":"onco","propositions":[{"correct":false,"justification":"Possible in the prostate cancer extension assessment","idx":0,"proposition":"PET Choline Scan"},{"correct":false,"justification":"False","idx":1,"proposition":"Bone scintigraphy"},{"correct":true,"justification":"True","idx":2,"proposition":"MIBG scintigraphy"},{"correct":false,"justification":"False","idx":3,"proposition":"PET Glucose Scan"},{"correct":false,"justification":"Not an isotope test","idx":4,"proposition":"TAP CT"}],"type":"custom"}
+{"_id":"MTEV-cardio-e66d1e","context":null,"enonce":"One of your patients is being treated with VKA for her PE. VKAs prevent hepatic synthesis of several coagulation factors. Which?","item":"MTEV","matiere":"cardio","propositions":[{"correct":false,"justification":"Factor II, VIII, IX and X","idx":0,"proposition":"Factor III"},{"correct":false,"justification":"","idx":1,"proposition":"Factor VIII"},{"correct":true,"justification":"True","idx":2,"proposition":"Factor VII"},{"correct":true,"justification":"True","idx":3,"proposition":"Factor IX"},{"correct":true,"justification":"True","idx":4,"proposition":"Factor X"}],"type":"custom"}
+{"_id":"nvxne-gyn-6cef1c","context":null,"enonce":"Regarding phenylketonuria:","item":"nvxne","matiere":"gyn","propositions":[{"correct":false,"justification":"Autosomal recessive","idx":0,"proposition":"It is transmitted in an autosomal dominant manner"},{"correct":true,"justification":"True","idx":1,"proposition":"It has an impact of 1\/16,000 in France"},{"correct":true,"justification":"True","idx":2,"proposition":"Phenylalanine (Phe) is an essential amino acid "},{"correct":false,"justification":"microcephaly ","idx":3,"proposition":"Macrocephaly may be observed"},{"correct":true,"justification":"True","idx":4,"proposition":"Clinical signs are due to accumulation of neurotoxic products "}],"type":"custom"}
+{"_id":"PF-neuro-a63171","context":null,"enonce":"The Ramsay-Hunt area mainly concerns:","item":"PF","matiere":"neuro","propositions":[{"correct":true,"justification":"True. It includes the eardrum, the posterior wall of the external auditory canal, part of the pinna of the ear (the conch) (according to Wikipedia, mentioned on page 84 of the 4th edition of the college of CMF)","idx":0,"proposition":"The outer 👂 ear"},{"correct":false,"justification":"False","idx":1,"proposition":"Language 😝 "},{"correct":false,"justification":"False","idx":2,"proposition":"Vocal cords 🗣"},{"correct":false,"justification":"False","idx":3,"proposition":"The tip of the nose 👃 "},{"correct":false,"justification":"False","idx":4,"proposition":"The between-eyebrows 👀"}],"type":"custom"}
+{"_id":"181-infectio-d47885cf-58db-4d49-8dd4-28e2dabcf9f8","context":null,"enonce":"Which of the following are the false causes of increased sedimentation rate?","item":"reactioninfl","matiere":"infectio","propositions":[{"correct":true,"justification":"True, I know it sucks, but there are many PH who do this kind of MCQ because they are simple MCQs... Refer to the table on page 110 of the College of Internal Medicine. To remember this I told myself that it was decreased when there were too many \"normal\" cells (polycythemia, leukocytosis, thrombocytosis) or not enough proteins (hypofibrinogemia, hypogammaglobulinemia). ","idx":0,"proposition":"Anaemia"},{"correct":false,"justification":"False","idx":1,"proposition":"Polycythemia"},{"correct":true,"justification":"True","idx":2,"proposition":"Hypergammaglobulinemia"},{"correct":false,"justification":"False","idx":3,"proposition":"Hypogammaglobulinemia"},{"correct":true,"justification":"True","idx":4,"proposition":"Pregnancy"}],"type":"custom"}
+{"_id":"98-neuro-8a87cd9d-5b54-4cbf-bed3-6017fc6c25c5","context":null,"enonce":"Which of the following are causes of idiopathic ICT?","item":"cephalee","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Estrogen-progestin pill"},{"correct":false,"justification":"No hypervitaminosis in water-soluble vitamins (the too full we piss!) --> Here cause of idiopathic HTIC = Hypervitaminosis A","idx":1,"proposition":"Hypervitaminosis B6"},{"correct":true,"justification":"True: cyclines","idx":2,"proposition":"Antibiotic Treatment PO for Acne"},{"correct":true,"justification":"True","idx":3,"proposition":"Addison's disease"},{"correct":false,"justification":"Not idiopathic because anomaly visible on imaging","idx":4,"proposition":"Brain abscess"}],"type":"custom"}
+{"_id":"diverticulose-HGE-25e93e","context":null,"enonce":"Which of the following propositions are true about diverticular hemorrhages?","item":"diverticulose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"They give in spontaneously most often"},{"correct":true,"justification":"True","idx":1,"proposition":"They are the cause of a third of lower bleeding"},{"correct":false,"justification":"Very often recurrent","idx":2,"proposition":"They never reoffend"},{"correct":true,"justification":"True","idx":3,"proposition":"They are brutal"},{"correct":false,"justification":"Or by angioscan","idx":4,"proposition":"The positive diagnosis can only be made by colonoscopy"}],"type":"custom"}
+{"_id":"tbconscience-urg-f9b6aa","context":null,"enonce":"Which of the following are possible pathophysiological explanations for confusional state?","item":"tbconscience","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Excess dopamine"},{"correct":true,"justification":"True","idx":1,"proposition":"Acetylcholine deficiency"},{"correct":false,"justification":"False","idx":2,"proposition":"Excess acetylcholine"},{"correct":false,"justification":"False","idx":3,"proposition":"Dopamine deficiency"},{"correct":false,"justification":"False","idx":4,"proposition":"Serotonin deficiency"}],"type":"custom"}
+{"_id":"suivivalv-cardio-a1f6d9","context":null,"enonce":"Regarding the monitoring of prosthetic heart valves, what are the exact proposal(s)?","item":"suivivalv","matiere":"cardio","propositions":[{"correct":false,"justification":"False, AOD are never indicated in case of prosthetic valves, only VKAs are used","idx":0,"proposition":"Treatment with VKA requires regular INR monitoring, but not treatment with DOAC, which promotes the use of the latter"},{"correct":false,"justification":"False, even if it can indeed be benign, it must know how to look for a prosthesis dysfunction","idx":1,"proposition":"The appearance of a new breath after valve surgery is common and benign"},{"correct":false,"justification":"False, the ECG is totally normal because the prosthesis has no connection with the electrical current of the heart unlike a pacemaker","idx":2,"proposition":"The ECG is classically slightly altered by the functioning of the valve prosthesis"},{"correct":false,"justification":"False, bioprostheses are organic tissue, unlike mechanical prostheses","idx":3,"proposition":"Bioprostheses are highly radiopaque on chest X-ray"},{"correct":true,"justification":"True, the ETT is the monitoring examination but does not allow the fine analysis of the valve or prosthesis","idx":4,"proposition":"ETO is performed in case of suspected thrombosis or prosthesis dysfunction "}],"type":"custom"}
+{"_id":"Kcsein-onco-126015","context":null,"enonce":"Which of the following are true?","item":"Kcsein","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Trastuzumab is always combined with chemotherapy"},{"correct":false,"justification":"False. If the HER is 2+ in immunohistochemistry, the FISH analysis should be completed. If it is not amplified in FISH, anti-HER2 treatment is not indicated. ","idx":1,"proposition":"Trastuzumab is still indicated if immunohistochemistry regains HER2 2+"},{"correct":true,"justification":"True","idx":2,"proposition":"The two most commonly used classes of chemotherapy for breast cancer are anthracylins and taxanes"},{"correct":true,"justification":"True","idx":3,"proposition":"Adjuvant radiotherapy is always indicated in a woman who has received conservative breast surgery (lumpectomy) for carcinoma in situ."},{"correct":true,"justification":"True","idx":4,"proposition":"Anti-aromatases may aggravate pre-existing osteoporosis requiring bone densitometry monitoring"}],"type":"custom"}
+{"_id":"341-urg-15b407e2-4450-448c-b22b-b9b091a0141f","context":null,"enonce":"Which of the following are risk factors for post-febrile seizure epilepsy?","item":"convulsionsped","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Psychomotor retardation"},{"correct":true,"justification":"True","idx":1,"proposition":"Previous neurological deficit"},{"correct":true,"justification":"True because Complex Febrile Crisis is a fdr","idx":2,"proposition":"Age <1 year during a febrile attack "},{"correct":true,"justification":"True because Complex Febrile Crisis is a fdr","idx":3,"proposition":"Febrile seizure ATCD > 15min"},{"correct":false,"justification":"NOP, not in the criteria","idx":4,"proposition":"Family history of 1st degree epilepsy"}],"type":"custom"}
+{"_id":"dysphagie-HGE-3cceca","context":null,"enonce":"Which of the following can cause lesional esophageal dysphagia?","item":"dysphagie","matiere":"HGE","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Scleroderma"},{"correct":false,"justification":"False","idx":1,"proposition":"Lupus"},{"correct":false,"justification":"False","idx":2,"proposition":"Sjögren's syndrome"},{"correct":false,"justification":"False","idx":3,"proposition":"Amyotrophic lateral sclerosis"},{"correct":true,"justification":"True. All these proposals are causes of non-lesional esophageal dysphagia","idx":4,"proposition":"None of these propositions is true"}],"type":"custom"}
+{"_id":"341-urg-38251add-fb46-4d27-a4c4-831e10584574","context":null,"enonce":"Which of the following are risk factors for recurrence of febrile seizures?","item":"convulsionsped","matiere":"urg","propositions":[{"correct":false,"justification":"No report","idx":0,"proposition":"Crisis >15min"},{"correct":true,"justification":"True = 1 year and 3 months","idx":1,"proposition":"Crisis <15months"},{"correct":true,"justification":"True","idx":2,"proposition":"Fever at 38°C during the febrile attack"},{"correct":false,"justification":"And no: it's <38.5 ° C, which is logical since the child had a feverish attack on a fever that was not that hot. So it can recur on low fever.","idx":3,"proposition":"Fever at 40°C during the febrile crisis"},{"correct":true,"justification":"True","idx":4,"proposition":"1st degree family history of febrile seizure"}],"type":"custom"}
+{"_id":"coma-urg-7b8935","context":null,"enonce":"Which of the following are nerves involved in the corneal reflex?","item":"coma","matiere":"urg","propositions":[{"correct":true,"justification":"True. Also called ophthalmic nerve. It is a mixed nerve involved in the afferent pathway of the corneal reflex.","idx":0,"proposition":"Trigeminal V nerve"},{"correct":false,"justification":"Motor nerve innervating the lateral right (abduction of the eye)","idx":1,"proposition":"Nerve VI abducens"},{"correct":false,"justification":"Motor nerve innervating medial right, inferior oblique, lower right, and superior right","idx":2,"proposition":"Oculomotor nerve III"},{"correct":true,"justification":"True. Mixed nerve involved in the efferent pathway of the corneal reflex","idx":3,"proposition":"Facial nerve VII"},{"correct":false,"justification":"Mixed nerve involved in many reflexes such as the reflex of the palé veil","idx":4,"proposition":"Vagus X nerve"}],"type":"custom"}
+{"_id":"181-infectio-2c9e3e51-fc72-4cf6-b041-52a4eeb72c99","context":null,"enonce":"Which of the following are pro-inflammatory cytokines or proteins increased during inflammation?","item":"reactioninfl","matiere":"infectio","propositions":[{"correct":true,"justification":"True, I know it may seem like detail to you, but remember that these are targets of certain biotherapies in chronic inflammatory diseases, so the MCQ can fall...","idx":0,"proposition":"Interleukin 1 and Interleukin 6"},{"correct":true,"justification":"True, see A. even more frequent MCQ on TNF alpha","idx":1,"proposition":"TNF alpha"},{"correct":true,"justification":"True, remember in general that ALL proteins of inflammation are positive except 3: albumin, transthyretin, transferrin.","idx":2,"proposition":"Fraction C3 of the complement"},{"correct":true,"justification":"True, cf D.","idx":3,"proposition":"Fibrinogen"},{"correct":false,"justification":"False, cf D.","idx":4,"proposition":"Transferrin"}],"type":"custom"}
+{"_id":"PECKc-urg-6a8c24","context":null,"enonce":"Which of the following are factors in the severity of pre-eclampsia?","item":"PECKc","matiere":"urg","propositions":[{"correct":false,"justification":"False. According to the new 2020 recommendations, it is > 90 μmol\/L. ","idx":0,"proposition":"Creatinine from > 135 μmol\/L"},{"correct":false,"justification":"False. > 2N","idx":1,"proposition":"ASAT \/ ALAT from > 3N"},{"correct":true,"justification":"True","idx":2,"proposition":"Epigastric pain in bar"},{"correct":true,"justification":"True","idx":3,"proposition":"Persistent tinnitus"},{"correct":true,"justification":"True","idx":4,"proposition":"Severe headache that does not respond to treatment"}],"type":"custom"}
+{"_id":"PF-neuro-750418","context":null,"enonce":"Which of the following propositions are true about House Brackmann's classification?","item":"PF","matiere":"neuro","propositions":[{"correct":false,"justification":"This is grade 1","idx":0,"proposition":"Grade 0 = normal"},{"correct":true,"justification":"True","idx":1,"proposition":"Grade 2 = discrete deficit, visible during movement"},{"correct":true,"justification":"True","idx":2,"proposition":"Grade 3 = complete palpebral occlusion possible with effort"},{"correct":false,"justification":"complete palpebral occlusion impossible, very asymmetrical movements, severe syncinesis and hypertonia","idx":3,"proposition":"Grade 4 = symmetrical smile"},{"correct":false,"justification":"Grade 6","idx":4,"proposition":"Grade 5 = no movement "}],"type":"custom"}
+{"_id":"masseabdo-HGE-23b915","context":null,"enonce":"Which of the following are parasites that can occur as liver nodules?","item":"masseabdo","matiere":"HGE","propositions":[{"correct":true,"justification":"True, hydatid cyst","idx":0,"proposition":"Hydatidosis"},{"correct":true,"justification":"True","idx":1,"proposition":"Amoebose"},{"correct":true,"justification":"True","idx":2,"proposition":"Alveolar echinococcosis"},{"correct":false,"justification":"","idx":3,"proposition":"Toxoplasmosis"},{"correct":false,"justification":"","idx":4,"proposition":"Malaria"}],"type":"custom"}
+{"_id":"103-neuro-28d00284-c237-4f5c-a0f2-616a9e47d369","context":null,"enonce":"What are the risk factors for recurrence of a complex febrile seizure in children? ","item":"epilepsie","matiere":"neuro","propositions":[{"correct":true,"justification":"True. To retain these criteria more simply, it is enough to remember that children at risk are those with \"a small brain sensitive to heat\". ","idx":0,"proposition":"Age < 15 months"},{"correct":true,"justification":"True","idx":1,"proposition":"Short time between onset of fever and seizure"},{"correct":true,"justification":"True","idx":2,"proposition":"A family history of febrile seizures"},{"correct":true,"justification":"True. A low fever at the time of the febrile attack testifies to this sensitivity to heat","idx":3,"proposition":"Low fever at the time of the febrile attack (< 38.5°C)"},{"correct":false,"justification":"False. It's a trap. It is a low fever at the time of the seizure that is a recurrence FDR.","idx":4,"proposition":"High fever at the time of the febrile attack (> 40°C)"}],"type":"custom"}
+{"_id":"MTEV-cardio-269f74","context":null,"enonce":"About high blood pressure in children\r\nWhich of the following are true?","item":"MTEV","matiere":"cardio","propositions":[{"correct":true,"justification":"True\r\nIn pediatrics we think a lot in percentile and standard deviation.","idx":0,"proposition":"In children, normal BP is below the 90th percentile."},{"correct":true,"justification":"True\r\nHyper important in practice. It gives you a first idea. In practice, still think about taking the size into account because if the child is tall for age, we can find a HTA with this formula which is not necessarily present if we are based on the size.","idx":1,"proposition":"To calculate the systolic blood pressure corresponding to the 95th percentile, one can use the formula: 100 + 2x Age (in years)"},{"correct":true,"justification":"True","idx":2,"proposition":"High blood pressure in children is defined as a BP measurement above the 95th percentile for the child's sex, age and height"},{"correct":false,"justification":"False.\r\nThe prevention of hypertension in children is estimated at 3.5%","idx":3,"proposition":"The prevalence of hypertension in children is estimated at 0.7%"},{"correct":false,"justification":"FAAUUUX\r\nUnlike the adult population, in pediatrics hypertension is always a priori secondary and must lead to the realization of an etiological assessment, which must be all the more exhaustive as the hypertension is of high level and the child is young.\r\n\r\nFor the record, we must not let a hypertension in children linger: last week at the CHU, HTA in a 5-year-old child, we did a Doppler ultrasound in search of stenosis of the renal arteries: highlighting a mass suggestive of neuroblastoma that compressed the renal artery ..","idx":4,"proposition":"As in adults, hypertension is a priori primary and it is necessary to leave a few months before making an etiological assessment."}],"type":"custom"}
+{"_id":"polytrauma-urg-017357","context":null,"enonce":"Which of the following proposals concerning the hospital management of a polytrauma patient is (are) true?","item":"polytrauma","matiere":"urg","propositions":[{"correct":false,"justification":"False, the first 15 minutes are devoted to the continuation of the acts of resuscitation initiated in pre-hospital, the conditioning of the patient and the realization of the clinical examination. The bodyCT will only be performed in a 3rd step if the patient has been stabilized. ","idx":0,"proposition":"The first 15 minutes are dedicated to the realization of a bodyCT"},{"correct":false,"justification":"False, everything must be done to fight against hypothermia, which is a contributing factor to bleeding disorders, among other things. ","idx":1,"proposition":"The patient must be put in hypothermia to protect him from brain damage"},{"correct":false,"justification":"False, the nasal route is contraindicated in a patient who has suffered facial or head trauma because of the risk of false route, especially intracerebral in case of ethmoid fracture. ","idx":2,"proposition":"The possible placement of a gastric tube must be done nasally in the context of facial trauma"},{"correct":false,"justification":"False, against tetanus","idx":3,"proposition":"Diphtheria vaccination status should be checked"},{"correct":true,"justification":"True","idx":4,"proposition":"The 2nd phase of care is dedicated to the realization of the biological and radiological assessment"}],"type":"custom"}
+{"_id":"295-onco-096e6173-76dd-45a0-acf6-5a938b331d4d","context":null,"enonce":"A 57-year-old patient comes to see you for a left epistaxis of low abundance \r\n\r\nATCD: Repeated MTEV \r\nTTT: Fluindione The patient also explains that he has lost weight and feels tired for 4 months. He also says he has the feeling of an obstruction of his left nasal cavity. \r\n\r\nWhat is the exact answer(s)? ","item":"KcVADS","matiere":"onco","propositions":[{"correct":false,"justification":" FALSE: In front of an epistaxis on bleeding disorder or angiomatosis: we use ABSORBABLE wicks","idx":0,"proposition":"It is necessary to carry out a previous stamping with greasy strands "},{"correct":true,"justification":"True","idx":1,"proposition":"Previous buffering with absorbable wicks must be performed"},{"correct":false,"justification":"FALSE. The INR is within its target (between 2-3 in this VTE situation). We are not dealing with serious bleeding. So no need to stop the VKA","idx":2,"proposition":"If the patient's INR is 2.6, VKAs should be stopped for 24 hours in this patient "},{"correct":true,"justification":"True","idx":3,"proposition":"You mention ethmoid cancer"},{"correct":true,"justification":"True. In front of unilateral epistaxis + progressive nasal obstruction + AEG => Suspicion cancer ETHMOID and CAVUM\r\n\r\nCAVUM cancer is also to be evoked in front of reflex otalgia or seromucosal otitis","idx":4,"proposition":"You mention cancer of the cavum"}],"type":"custom"}
+{"_id":"176-sp-bd802839-50c6-4dd0-a484-62a56254efad","context":null,"enonce":"Which of these health security agencies\/health vigilance missions pairs is accurate?","item":"risquesRx","matiere":"sp","propositions":[{"correct":true,"justification":"True, the ANSM's mission is pharmacovigilance, drug dependence, hemovigilance, materiovigilance, reactovigilance, cosmetovigilance, vigilance of tattoo products","idx":0,"proposition":"National Agency for the Safety of Medicines (ANSM) and Drug Dependence"},{"correct":true,"justification":"True, the missions of ANSES are nutrivigilance (including NOCs), toxicovigilance (toxic effects of substances on the body) and veterinary pharmacovigilance","idx":1,"proposition":"National Agency for Food, Environmental and Occupational Health and Safety (ANSES) and Nutrivigilance"},{"correct":false,"justification":"False, the missions of the biomedicine agency focus on biovigilance (organs, tissues, cells), ART","idx":2,"proposition":"Agency for Biomedicine and Haemovigilance"},{"correct":true,"justification":"True, cf C.","idx":3,"proposition":"Agency for Biomedicine and Vigilance with regard to medically assisted procreation"},{"correct":false,"justification":"False, see B","idx":4,"proposition":"National Agency for Food, Environmental and Occupational Health and Safety (ANSES) and Réactovigilance "}],"type":"custom"}
+{"_id":"TNC-neuro-9f2e9d","context":null,"enonce":"Which of the following are true?","item":"TNC","matiere":"neuro","propositions":[{"correct":false,"justification":"False, we distinguish precisely degenerative dementias from dementias with a vascular, inflammatory mechanism etc.","idx":0,"proposition":"Degenerative dementia may be due to vascular or inflammatory disease"},{"correct":true,"justification":"True, impaired autonomy is essential to talk about dementia","idx":1,"proposition":"Dementia is defined by impaired cognitive and\/or behavioural function associated with impaired autonomy"},{"correct":true,"justification":"True","idx":2,"proposition":"Alzheimer's disease is the leading cause of dementia"},{"correct":false,"justification":"","idx":3,"proposition":""},{"correct":false,"justification":"","idx":4,"proposition":""}],"type":"custom"}
+{"_id":"MICI-HGE-0be4a5","context":null,"enonce":"Which of the following are possible pathological signs in UC?","item":"MICI","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Bifurcations and glandular distortions"},{"correct":true,"justification":"True","idx":1,"proposition":"granite mucosa"},{"correct":true,"justification":"True","idx":2,"proposition":"Lymphoplasmacytic infiltrât of chorion"},{"correct":true,"justification":"True","idx":3,"proposition":"Banal plasmocytosis"},{"correct":true,"justification":"True","idx":4,"proposition":"Cryptic abscess"}],"type":"custom"}
+{"_id":"Kcped-onco-0f7f72","context":null,"enonce":"Which of the following are true about neuroblastoma?","item":"Kcped","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is a cancer affecting embryonic stem cells of the neural crest"},{"correct":true,"justification":"True","idx":1,"proposition":"It may be associated with Hirschsprung's disease"},{"correct":false,"justification":"Less than 2 years old. It is mainly found between 1 and 2 years","idx":2,"proposition":"It mainly concerns children under 6 months"},{"correct":true,"justification":"True","idx":3,"proposition":"It is the most common extracranial solid tumor in young children"},{"correct":false,"justification":"There are genetic forms (ALK or PHOX2B gene)","idx":4,"proposition":"It has no genetic component"}],"type":"custom"}
+{"_id":"Kcprostate-onco-be97ed","context":null,"enonce":"Which of the following are d'Amico's treatment options for intermediate-risk prostate cancers?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":false,"justification":"Low risk or if probability of survival < 10 years","idx":0,"proposition":"Active surveillance if probability of survival > 10 years"},{"correct":true,"justification":"True. + Cleaning if probability of survival > 10 years","idx":1,"proposition":"Total prostatectomy"},{"correct":true,"justification":"True. Or in combination with hormone therapy for 6 months","idx":2,"proposition":"External beam radiation therapy alone"},{"correct":true,"justification":"True. In gormes of best prognosis (PSA 10-15, GG2 or Gleason 3+4)","idx":3,"proposition":"Brachytherapy"},{"correct":false,"justification":"False","idx":4,"proposition":"Hormone therapy alone"}],"type":"custom"}
+{"_id":"nvxne-gyn-272db5","context":null,"enonce":"Which of the following propositions\/are true for biamniotic bichorial pregnancies?","item":"nvxne","matiere":"gyn","propositions":[{"correct":false,"justification":"They can be, but not necessarily","idx":0,"proposition":"The 2 twins are formally monozygotic"},{"correct":false,"justification":"False","idx":1,"proposition":"There is an antenatal risk of transfusion-transfusion syndrome (TTS)"},{"correct":false,"justification":"False, a twin pregnancy is a multiple pregnancy","idx":2,"proposition":"The term multiple pregnancy only applies when the uterus contains 3 or more fetuses."},{"correct":false,"justification":"They can be, but not necessarily","idx":3,"proposition":"The 2 twins are formally heterozygous"},{"correct":true,"justification":"True","idx":4,"proposition":"No proposition is true"}],"type":"custom"}
+{"_id":"constipation-HGE-4c6e8d","context":null,"enonce":"Constipation is chronic if greater than:","item":"constipation","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"3 weeks"},{"correct":false,"justification":"","idx":1,"proposition":"6 weeks"},{"correct":false,"justification":"","idx":2,"proposition":"10 days"},{"correct":true,"justification":"True","idx":3,"proposition":"6 months"},{"correct":false,"justification":"","idx":4,"proposition":"1 year"}],"type":"custom"}
+{"_id":"tbconscience-urg-6e4230","context":null,"enonce":"Which of the following are signs or symptoms of Korsakoff syndrome?","item":"tbconscience","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"False recognition"},{"correct":true,"justification":"True","idx":1,"proposition":"Fabrications"},{"correct":false,"justification":"False","idx":2,"proposition":"Retrograde amnesia"},{"correct":true,"justification":"True","idx":3,"proposition":"Anterograde amnesia"},{"correct":false,"justification":"It's a diagnosis, not a sign or symptom","idx":4,"proposition":"Amnesic ictus"}],"type":"custom"}
+{"_id":"hernie-HGE-ef386c","context":null,"enonce":"Which of the following are risk factors for hernia?","item":"hernie","matiere":"HGE","propositions":[{"correct":false,"justification":"Multiparity","idx":0,"proposition":"Nulliparity"},{"correct":false,"justification":"Obesity or extreme thinness","idx":1,"proposition":"BMI < 25"},{"correct":true,"justification":"True, by abdominal hyperpressure","idx":2,"proposition":"Constipation"},{"correct":false,"justification":"","idx":3,"proposition":"Age 🤶🎅"},{"correct":true,"justification":"True","idx":4,"proposition":"Syndrome de Marfan"}],"type":"custom"}
+{"_id":"TNC-neuro-1e2845","context":null,"enonce":"Regarding major neurocognitive disorders, what are the exact proposal(s)?\r\n","item":"TNC","matiere":"neuro","propositions":[{"correct":false,"justification":"A. Wrong, three times wrong! The MMS is a screening examination, the repetition of the latter allows to have an intuition on the evolution of the pathology, certainly, but it is much more advanced neuropsychological tests that allow the diagnosis in addition to the interrogation and the elimination of differential diagnoses\r\n","idx":0,"proposition":"Has. The repetition of MMS (Mini Mental State) makes it possible to make the diagnosis of a major neurocognitive disorder\r\n"},{"correct":true,"justification":"B. True, it makes it possible to rule out an expansive pathology (hematoma, infection, tumor) and to characterize brain damage (hippocampal damage for Alzheimer's and its relatives etc ...)\r\n","idx":1,"proposition":"B. MRI (or failing that, cCT) has an essential place in the evaluation of major neurocognitive disorders\r\n"},{"correct":true,"justification":"C. True, other causes are much rarer\r\n","idx":2,"proposition":"C. Alzheimer's disease and vascular encephalopathies account for the majority of causes of major neurocognitive disorders\r\n"},{"correct":false,"justification":"D. False, it is quite brief (NFS, CRP, TSH, Ionogram, Glycemia, Albuminemia) and the rest is performed on call point\r\n","idx":3,"proposition":"D. First-line laboratory work-up is comprehensive to eliminate all possible differential diagnoses\r\n"},{"correct":true,"justification":"E. True, HDJ memories are becoming more and more present, and allow active management of major neurocognitive disorders","idx":4,"proposition":"E. For the management of major neurocognitive disorders, there are day hospital treatments to perform cognitive remediation\r\n"}],"type":"custom"}
+{"_id":"hemorroides-HGE-3a4bd7","context":null,"enonce":"Which of the following are true?","item":"hemorroides","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"These are arterial lakes"},{"correct":true,"justification":"True","idx":1,"proposition":"These are venous lakes"},{"correct":true,"justification":"True","idx":2,"proposition":"They are physiological"},{"correct":false,"justification":"Pain","idx":3,"proposition":"The main symptom is prolapse"},{"correct":false,"justification":"4 grades: no procidence \/ procidence in the lumen of the anuscope \/ reducible \/ irreducible external procidence","idx":4,"proposition":"The classification consists of 6 grades"}],"type":"custom"}
+{"_id":"Kcprostate-onco-975d37","context":null,"enonce":"The digital rectal examination finds:","item":"Kcprostate","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It may be normal"},{"correct":true,"justification":"True","idx":1,"proposition":"A hard nodule"},{"correct":false,"justification":"Irregular nodule","idx":2,"proposition":"A regular nodule"},{"correct":true,"justification":"True","idx":3,"proposition":"An evolutionary nodule"},{"correct":false,"justification":"The nodule is non-painful according to the College of Urology (4th edition)","idx":4,"proposition":"A painful nodule"}],"type":"custom"}
+{"_id":"pancreatitechr-HGE-450e81","context":null,"enonce":"Which of the following propositions are true about biological examinations?","item":"pancreatitechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Normal apart from flare-ups or complications"},{"correct":true,"justification":"True","idx":1,"proposition":"High γGT and MCV support an alcoholic cause"},{"correct":false,"justification":"Clinical diagnosis","idx":2,"proposition":"Steatorrhea is based on stool culture"},{"correct":true,"justification":"True","idx":3,"proposition":"Signs of inflammation are found during flare-ups"},{"correct":true,"justification":"True","idx":4,"proposition":"Lipasemia is elevated in acute pancreatitis"}],"type":"custom"}
+{"_id":"securisation-sp-66835c","context":null,"enonce":"Which of the following propositions are true about MMR?","item":"securisation","matiere":"sp","propositions":[{"correct":true,"justification":"True, text the phrase of the HAS","idx":0,"proposition":"A morbidity and mortality review (MMR) is a collective, retrospective and systemic analysis of cases marked by the occurrence of a death, a complication, or an event that could have caused harm to the patient."},{"correct":true,"justification":"True, text the phrase of the HAS","idx":1,"proposition":"Its objective is to implement and monitor actions to improve patient care and care safety."},{"correct":true,"justification":"True","idx":2,"proposition":"The systemic analysis, conducted during the MMR, is a global analysis of the situation"},{"correct":false,"justification":"The medical-nursing team that brings together professionals, who usually work together, and who contribute to the management of a patient.","idx":3,"proposition":"Only doctors can do it"},{"correct":false,"justification":"","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"343-urg-60b6cc26-c714-4101-9338-a62acfd6e97f","context":null,"enonce":"Which of the following propositions are true about the urinary ionogram?","item":"IRenA","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A plasma urea\/plasma creatinine ratio of less than 50 supports organic AKI"},{"correct":true,"justification":"True","idx":1,"proposition":"A urinary Na\/K ratio greater than 1 is in favor of an organic ARI"},{"correct":false,"justification":"Organic","idx":2,"proposition":"A urinary Na\/K ratio greater than 1 supports a functional ARI"},{"correct":false,"justification":"This is the EF threshold for urea. The threshold for sodium is 1%","idx":3,"proposition":"A sodium excretion fraction of less than 35% would be in favor of a functional origin"},{"correct":true,"justification":"True","idx":4,"proposition":"Natriuresis can only be interpreted if diuretics have not been put in place"}],"type":"custom"}
+{"_id":"hemorroides-HGE-44aa8e","context":null,"enonce":"Which of the following are true?","item":"hemorroides","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"About 1 third of adults are affected by hemorrhoids"},{"correct":true,"justification":"True","idx":1,"proposition":"They can be complicated by fissure"},{"correct":true,"justification":"True","idx":2,"proposition":"They can be complicated by fistula"},{"correct":true,"justification":"True","idx":3,"proposition":"Hemorrhoids are not neoplastic"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"Kcprostate-onco-ded45d","context":null,"enonce":"Which of the following are true?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"In prostate cancer, the fraction of free PSA is lower than in benign prostatic hyperplasia"},{"correct":true,"justification":"True","idx":1,"proposition":"The actual contribution in clinical practice of urine tests has not been demonstrated"},{"correct":true,"justification":"True, at 1 month most often","idx":2,"proposition":"A high PSA must be almost systematically reassessed"},{"correct":false,"justification":"Urinary condition","idx":3,"proposition":"The USP questionnaire focuses on sexuality"},{"correct":false,"justification":"Sexual state","idx":4,"proposition":"The IIEF questionnaire focuses on urinary symptoms"}],"type":"custom"}
+{"_id":"MICI-HGE-0d4a45","context":null,"enonce":"Which of these proposals designate a serious access to RCH?","item":"MICI","matiere":"HGE","propositions":[{"correct":true,"justification":"True, severe acute colitis (Truelove-Witts criteria) can be complicated by: colectasia (dilation) and perforation","idx":0,"proposition":"The Truelove-Witts criteria (💞) define the severe RCH crisis"},{"correct":false,"justification":"Severity criterion = >37.5","idx":1,"proposition":"A temperature of 37.3"},{"correct":true,"justification":"True","idx":2,"proposition":"Important rectorrhages"},{"correct":true,"justification":"True","idx":3,"proposition":"Tachycardia"},{"correct":false,"justification":"Severity criterion below 10g\/L","idx":4,"proposition":"Anemia at 11g\/L"}],"type":"custom"}
+{"_id":"Kcprostate-onco-e60651","context":null,"enonce":"The ASP is:","item":"Kcprostate","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A glycoprotein"},{"correct":false,"justification":"False","idx":1,"proposition":"A glycosylated lipid"},{"correct":false,"justification":"False","idx":2,"proposition":"A membrane protein"},{"correct":false,"justification":"False","idx":3,"proposition":"A complex carbohydrate"},{"correct":false,"justification":"False","idx":4,"proposition":"A type of extracellular DNA"}],"type":"custom"}
+{"_id":"tbconscience-urg-4c5a75","context":null,"enonce":"Which of the following proposals are necessary to diagnose confusion?","item":"tbconscience","matiere":"urg","propositions":[{"correct":true,"justification":"True. Indeed, confusion is a clinical diagnosis.","idx":0,"proposition":"None of these proposals"},{"correct":false,"justification":"False","idx":1,"proposition":"Capillary blood glucose"},{"correct":false,"justification":"False","idx":2,"proposition":"Ionogram"},{"correct":false,"justification":"False","idx":3,"proposition":"Renal assessment"},{"correct":false,"justification":"False","idx":4,"proposition":"ECG"}],"type":"custom"}
+{"_id":"matraitanceped-sp-78fcfd","context":null,"enonce":"Which of the following are true about shaken baby syndrome?","item":"matraitanceped","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It most often occurs before 1 year"},{"correct":false,"justification":"Subdural hematomas of different age","idx":1,"proposition":"There are mainly extradural hematomas"},{"correct":true,"justification":"True","idx":2,"proposition":"The CT scan is the exam of choice for the diagnosis of lesions"},{"correct":true,"justification":"True","idx":3,"proposition":"The absence of bleeding disorders should always be checked"},{"correct":false,"justification":"They can also be cephalic, thoracic, ...","idx":4,"proposition":"The lesions are only cerebral"}],"type":"custom"}
+{"_id":"systemeconv-sp-1de8bc","context":null,"enonce":"The flat-rate remuneration of physicians is paid by:","item":"systemeconv","matiere":"sp","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Mutuals"},{"correct":false,"justification":"False","idx":1,"proposition":"private insurance"},{"correct":false,"justification":"False","idx":2,"proposition":"The State"},{"correct":true,"justification":"True","idx":3,"proposition":"Social security"},{"correct":false,"justification":"False","idx":4,"proposition":"The patient"}],"type":"custom"}
+{"_id":"HTA-cardio-36d0da","context":null,"enonce":"Regarding resistant hypertension, which of the following propositions are true?","item":"HTA","matiere":"cardio","propositions":[{"correct":false,"justification":"Resistant hypertension = persistent on oral antihypertensive therapy (including at least one diuretic) + HRD well followed","idx":0,"proposition":"It is defined by the persistence of hypertension despite well-followed hygiene-dietary rules."},{"correct":true,"justification":"True","idx":1,"proposition":"It may be due to unknown secondary hypertension."},{"correct":true,"justification":"True","idx":2,"proposition":"The patient's adherence to treatment can be assessed by the Girerd questionnaire."},{"correct":true,"justification":"True: HRD not followed","idx":3,"proposition":"It may be due to excessive consumption of dietary salt."},{"correct":true,"justification":"True","idx":4,"proposition":"A cardiological opinion should be systematically requested in front of a resistant hypertension."}],"type":"custom"}
+{"_id":"cirrhose-HGE-d8277e","context":null,"enonce":"Which of the following are possible etiologies of cirrhosis?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":false,"justification":"Possible complication","idx":0,"proposition":"Hepatocellular carcinoma"},{"correct":false,"justification":"Possible complication","idx":1,"proposition":"Umbilical hernia"},{"correct":false,"justification":"Possible complication","idx":2,"proposition":"Ascites"},{"correct":true,"justification":"True","idx":3,"proposition":"Alpha-1-antitrypsin deficiency"},{"correct":true,"justification":"True","idx":4,"proposition":"Primary biliary cirrhosis"}],"type":"custom"}
+{"_id":"tbconscience-urg-b3a992","context":null,"enonce":"Which of the following are symptoms or signs of Gayet-Wernicke encephalopathy?","item":"tbconscience","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Delirium"},{"correct":true,"justification":"True","idx":1,"proposition":"Oculomotor paralysis"},{"correct":false,"justification":"Syndrome de Korsakoff","idx":2,"proposition":"Fabrications"},{"correct":false,"justification":"Syndrome de Korsakoff","idx":3,"proposition":"Anterograde amnesia"},{"correct":false,"justification":"False","idx":4,"proposition":"Tremors of the extremities"}],"type":"custom"}
+{"_id":"ADP-hemato-30170e","context":null,"enonce":"An X neuroma could mimic lymphadenopathy:","item":"ADP","matiere":"hemato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"From the laterocervical chain"},{"correct":false,"justification":"Two differential diagnoses (DD): brachial plexus schwanoma or lung apex cancer","idx":1,"proposition":"From the supraclavicular chain"},{"correct":false,"justification":"DD of lymphadenopathy concerning this chain: ectopic thyroid, cyst of the thyroglossal tract or laryngocele","idx":2,"proposition":"From the pre-laryngeal chain"},{"correct":false,"justification":"2 schwannomas: that of the XI and that of the superficial cervical plexus","idx":3,"proposition":"From the spinal chain"},{"correct":false,"justification":"FALSE","idx":4,"proposition":"None of these channels"}],"type":"custom"}
+{"_id":"hemorroides-HGE-4deb8d","context":null,"enonce":"Which of the following are RHD treatments for hemorrhoidal disease?","item":"hemorroides","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Mucilage"},{"correct":true,"justification":"True","idx":1,"proposition":"Fibers"},{"correct":false,"justification":"Useless","idx":2,"proposition":"Gluten-free diet"},{"correct":false,"justification":"Useless","idx":3,"proposition":"Residue-free diet"},{"correct":false,"justification":"The opposite","idx":4,"proposition":"Fiber-free diet"}],"type":"custom"}
+{"_id":"coma-urg-2d0ffe","context":null,"enonce":"Which of the following are etiologies of non-traumatic coma?","item":"coma","matiere":"urg","propositions":[{"correct":false,"justification":"Traumatic cause","idx":0,"proposition":"Subdural hematoma"},{"correct":false,"justification":"Traumatic cause","idx":1,"proposition":"Lefort III untreated"},{"correct":true,"justification":"True","idx":2,"proposition":"Acute adrenal insufficiency"},{"correct":true,"justification":"True, <120 mmol\/L","idx":3,"proposition":"Hyponatremia"},{"correct":true,"justification":"True","idx":4,"proposition":"Carbon monoxide (CO) poisoning"}],"type":"custom"}
+{"_id":"PF-neuro-85fd2e","context":null,"enonce":"Which of the following are signs and symptoms of distal (intraparotid) facial nerve involvement?","item":"PF","matiere":"neuro","propositions":[{"correct":false,"justification":"Normal","idx":0,"proposition":"Pathological Schirmer test"},{"correct":false,"justification":"Normal","idx":1,"proposition":"Lowered stapedial reflex"},{"correct":false,"justification":"No hearing impairment because we are downstream","idx":2,"proposition":"Hearing loss"},{"correct":false,"justification":"Normal taste","idx":3,"proposition":"Impairment of taste"},{"correct":true,"justification":"True","idx":4,"proposition":"No proposition is true"}],"type":"custom"}
+{"_id":"diarrheechr-HGE-f269c3","context":null,"enonce":"From what time frame do we speak of prolonged diarrhea?","item":"diarrheechr","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"5 days"},{"correct":false,"justification":"","idx":1,"proposition":"10 days"},{"correct":true,"justification":"True","idx":2,"proposition":"2 weeks"},{"correct":false,"justification":"","idx":3,"proposition":"4 weeks"},{"correct":false,"justification":"","idx":4,"proposition":"6 weeks"}],"type":"custom"}
+{"_id":"FA-cardio-7b83eb","context":null,"enonce":"Which of the following are the side effects of amiodarone?","item":"FA","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Dysthyroidism"},{"correct":true,"justification":"True","idx":1,"proposition":"Photosensitization"},{"correct":true,"justification":"True","idx":2,"proposition":"Interstitial lung disease"},{"correct":true,"justification":"True","idx":3,"proposition":"Hepatitis"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"diarrheechr-HGE-94d219","context":null,"enonce":"Which of the following are extra-digestive signs of celiac disease?","item":"diarrheechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Arthralgia"},{"correct":true,"justification":"True","idx":1,"proposition":"Oral aphthosis"},{"correct":true,"justification":"True","idx":2,"proposition":"Hepatic cytolysis"},{"correct":false,"justification":"No achievement of the ❤","idx":3,"proposition":"Tachycardia"},{"correct":false,"justification":"No achievement of 🌬","idx":4,"proposition":"Dyspnea stage 2-3 NYHA"}],"type":"custom"}
+{"_id":"pbsuitescouches-gyn-342de6","context":null,"enonce":"Which of the following proposals are part of the immediate management of postpartum haemorrhage?","item":"pbsuitescouches","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Uterine revision"},{"correct":true,"justification":"True","idx":1,"proposition":"Urinary catheterization"},{"correct":true,"justification":"True","idx":2,"proposition":"Uterine massage"},{"correct":true,"justification":"True","idx":3,"proposition":"Antibiotic prophylaxis"},{"correct":true,"justification":"True","idx":4,"proposition":"IV oxytocin"}],"type":"custom"}
+{"_id":"Kcprostate-onco-a85bbb","context":null,"enonce":"Which of the following proposals can increase the PSA?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Benign prostatic hyperplasia"},{"correct":true,"justification":"True","idx":1,"proposition":"Transient inflammation"},{"correct":true,"justification":"True","idx":2,"proposition":"Acute urine retention"},{"correct":true,"justification":"True","idx":3,"proposition":"Digital rectal examination"},{"correct":true,"justification":"True","idx":4,"proposition":"Urinary catheterization"}],"type":"custom"}
+{"_id":"ictere-HGE-2a1201","context":null,"enonce":"What time corresponds to the excretory time on the injected scanner?","item":"ictere","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"10 mn"},{"correct":false,"justification":"Late time","idx":1,"proposition":"3 min"},{"correct":false,"justification":"Venous time","idx":2,"proposition":"70 seconds"},{"correct":false,"justification":"Arterial weather","idx":3,"proposition":"Thirty seconds"},{"correct":false,"justification":"SPC Time","idx":4,"proposition":"T0"}],"type":"custom"}
+{"_id":"RCIU-gyn-931c3f","context":null,"enonce":"Which of the following proposals are part of probabilistic antibiotic therapy for ulcerative-necrotizing enterocolitis?","item":"RCIU","matiere":"gyn","propositions":[{"correct":true,"justification":"True, cefotaxime","idx":0,"proposition":"C3G"},{"correct":true,"justification":"True, gentamicin","idx":1,"proposition":"Aminoglycoside"},{"correct":true,"justification":"True, metronidazole covers anaerobes","idx":2,"proposition":"Imidazole"},{"correct":false,"justification":"","idx":3,"proposition":"Penicillin"},{"correct":false,"justification":"","idx":4,"proposition":"Tetracycline"}],"type":"custom"}
+{"_id":"360-urg-224ce986-3317-4137-bd3f-2916f26df632","context":null,"enonce":"Concerning the fractures of the child, which of the following propositions, which are true?","item":"Frped","matiere":"urg","propositions":[{"correct":false,"justification":"Ultrasound is rare in emergencies. It can be useful for soft tissue lesions","idx":0,"proposition":"Ultrasound is systematic in emergency"},{"correct":true,"justification":"Orthopedic treatment++ in young children <6A, for any diaphyseal \/ metaphyseal FR (PAS for joint fractures: risk of stiffness)","idx":1,"proposition":"For a metaphyseal fracture in a 5-year-old child, first-line treatment is orthopedic, with or without reduction"},{"correct":false,"justification":"No risk of stiffness for non-articular fractures (see College of Pediatrics)","idx":2,"proposition":"For a diaphyseal fracture, prolonged orthopedic treatment induces a risk of stiffness"},{"correct":false,"justification":"In the opposite position of that which caused the fracture (for example, if wrist fracture in hyperextension: immobilization in flexion)","idx":3,"proposition":"Concerning orthopedic treatment: the limb must be immobilized in a neutral position"},{"correct":false,"justification":"Thromboembolic complications are exceptional in children. Anticoagulant therapy will be discussed only in adolescents","idx":4,"proposition":"Anticoagulant therapy is indicated in children in case of cast for more than 21 days"}],"type":"custom"}
+{"_id":"98-neuro-3c7174c1-4cbf-4ca0-a4cb-4ea354096802","context":null,"enonce":"Which of the following are causes of idiopathic ICT?","item":"cephalee","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Corticosteroids"},{"correct":true,"justification":"True","idx":1,"proposition":"Obesity"},{"correct":false,"justification":"No, abnormal imaging therefore not idiopathic ","idx":2,"proposition":"Vascular malformation"},{"correct":true,"justification":"True","idx":3,"proposition":"Hypervitaminosis A"},{"correct":false,"justification":"No","idx":4,"proposition":"Hypervitaminosis D"}],"type":"custom"}
+{"_id":"vomisst-HGE-b9abb3","context":null,"enonce":"Which of the following are true about Boerhaave syndrome?","item":"vomisst","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"This is a rupture of the cardia"},{"correct":false,"justification":"","idx":1,"proposition":"The tear of the stomach is longitudinal"},{"correct":false,"justification":"","idx":2,"proposition":"Hematemesis is very common"},{"correct":false,"justification":"","idx":3,"proposition":"Hematemesis occurs after vomiting"},{"correct":true,"justification":"True. They all concern Mallory Weiss syndrome","idx":4,"proposition":"None of the propositions are true"}],"type":"custom"}
+{"_id":"341-urg-80a2f9f5-bcdc-49d3-97ed-d4835e600608","context":null,"enonce":"Which of the following are the risk factors for prolonged febrile seizures >15 minutes?","item":"convulsionsped","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"1st febrile crisis of his life"},{"correct":true,"justification":"True","idx":1,"proposition":"Personal history of Febrile Crisis > 10min"},{"correct":false,"justification":"","idx":2,"proposition":"Fever >38.5°C during the febrile crisis"},{"correct":false,"justification":"","idx":3,"proposition":"Fever <38.5°C during the febrile crisis"},{"correct":false,"justification":"","idx":4,"proposition":"Age <1 year"}],"type":"custom"}
+{"_id":"matraitanceped-sp-fb959e","context":null,"enonce":"Which of the following proposals are included in the para-clinical assessment in case of suspected shaken baby syndrome?","item":"matraitanceped","matiere":"sp","propositions":[{"correct":true,"justification":"True, TP TCA Fibrinogen at least","idx":0,"proposition":"Coagulation balance"},{"correct":true,"justification":"True, differential diagnosis of bone lesions","idx":1,"proposition":"Calcemia"},{"correct":true,"justification":"True, looking for papillary edema and hemorrhages","idx":2,"proposition":"Fundus "},{"correct":false,"justification":"Skeletal X-rays","idx":3,"proposition":"Whole body scanner"},{"correct":false,"justification":"Brain scan","idx":4,"proposition":"Brain MRI"}],"type":"custom"}
+{"_id":"dlrbuccale-neuro-884961","context":null,"enonce":"Which of the following are true about migraines?","item":"dlrbuccale","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Their prevalence is 15%"},{"correct":false,"justification":"The opposite: more without aura than with aura","idx":1,"proposition":"There are more migraines with aura than migraines without aura"},{"correct":true,"justification":"True","idx":2,"proposition":"Headaches are often pulsatile"},{"correct":false,"justification":"No MRI for diagnosis","idx":3,"proposition":"The diagnosis is made by MRI"},{"correct":true,"justification":"True","idx":4,"proposition":"Migraine is three times more common in women than in men"}],"type":"custom"}
+{"_id":"MSN-urg-57cbf5","context":null,"enonce":"What are the mandatory clinical signs to be able to talk about the severe discomfort of the infant?","item":"MSN","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A change in tone (hypertonia or hypotonia)"},{"correct":false,"justification":"Is not a mandatory clinical sign. It may nevertheless be present during severe discomfort.","idx":1,"proposition":"Signs of respiratory struggle"},{"correct":true,"justification":"True. The 2 obligatory clinical signs are a change in tone and a change in the coloration of the integuments. In the absence of one of these 2 clinical signs, we can not speak of the severe discomfort of the infant.","idx":2,"proposition":"A change in the coloration of the integuments (pallor, cyanosis, sometimes erythrosis)"},{"correct":false,"justification":"Not mandatory.","idx":3,"proposition":"Loss of consciousness"},{"correct":false,"justification":"Not part of the criteria for severe infant discomfort.","idx":4,"proposition":"Tachycardia"}],"type":"custom"}
+{"_id":"dysphonie-neuro-54c69f","context":null,"enonce":"Which of the following proposals are part of the supraglottic stage?","item":"dysphonie","matiere":"neuro","propositions":[{"correct":true,"justification":"True, as the name suggests","idx":0,"proposition":"Epiglottis"},{"correct":true,"justification":"True","idx":1,"proposition":"Arthenoids"},{"correct":false,"justification":"Glottic stage","idx":2,"proposition":"Vocal cords"},{"correct":false,"justification":"Subglottic stage","idx":3,"proposition":"Cricoid cartilage"},{"correct":false,"justification":"Laryngeal = airway","idx":4,"proposition":"Oesophagus"}],"type":"custom"}
+{"_id":"lithiaseB-HGE-cf9d12","context":null,"enonce":"In cholitis, ERCP (endoscopic retrograde cholangiography) should be done:","item":"lithiaseB","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"In emergency"},{"correct":false,"justification":"","idx":1,"proposition":"Within the week"},{"correct":false,"justification":"","idx":2,"proposition":"Within a month"},{"correct":false,"justification":"","idx":3,"proposition":"As soon as the pain subsides"},{"correct":false,"justification":"","idx":4,"proposition":"ERCP is not done for cholitis"}],"type":"custom"}
+{"_id":"Kcprostate-onco-a81a5f","context":null,"enonce":"What is Amico's classification of prostate cancer with a PSA of 15 ng\/mL, a Gleason of 3+3 and a normal TR?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":false,"justification":"Intermediary before the PSA","idx":0,"proposition":"Weak"},{"correct":true,"justification":"True. Low: T1C or T2a AND PSA <= 10 AND Gleason <= 6.  Intermediate: T2b OR 10 > PSA < 20 OR Gleason 7. High: T2c and sup OR PSA >= 20 OR Gleason >= 8","idx":1,"proposition":"Intermediary "},{"correct":false,"justification":"Intermediary before the PSA","idx":2,"proposition":"High"},{"correct":false,"justification":"Intermediary before the PSA","idx":3,"proposition":"Not enough item"},{"correct":false,"justification":"Intermediary before the PSA","idx":4,"proposition":"The elements are contradictory"}],"type":"custom"}
+{"_id":"valeurspro-sp-306e7b","context":null,"enonce":"When was the Order of Physicians created in France?","item":"valeurspro","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"1945"},{"correct":false,"justification":"Code of Ethics Revision Date (112 articles)","idx":1,"proposition":"2002"},{"correct":false,"justification":"Date of creation of the Medical Association in Great Britain","idx":2,"proposition":"1858"},{"correct":false,"justification":"In the US","idx":3,"proposition":"1868"},{"correct":false,"justification":"False","idx":4,"proposition":"None of these propositions are true"}],"type":"custom"}
+{"_id":"tbsommeil-neuro-f38e91","context":null,"enonce":"Mrs. Clauss, panicked, brings you her 14-year-old son, Santa, who \"can't stay awake during the day.\" She worries because his academic performance is declining and she is afraid he may suffer from sleeping sickness. By argument of frequency and in front of this case what are the 2 pathologies that you will suspect first?","item":"tbsommeil","matiere":"neuro","propositions":[{"correct":false,"justification":"False, a rare disease in France.","idx":0,"proposition":"Narcolepsy or Gelineau disease"},{"correct":false,"justification":"False, even if it can stick in this patient, we find more this pathology in older women.","idx":1,"proposition":"Sleep-onset insomnia"},{"correct":true,"justification":"True, you should always think about eliminating cannabis poisoning.","idx":2,"proposition":"Substance abuse"},{"correct":true,"justification":"True, caricature in the teenager who goes to bed late and gets up early. Highlighted by a sleep diary and treated by hygienic measures and melatonin.","idx":3,"proposition":"Delayed phase syndrome"},{"correct":false,"justification":"False, night owlism does not cause daytime sleepiness","idx":4,"proposition":"Nocturnal parasomnias"}],"type":"custom"}
+{"_id":"353-HGE-d936e09a-8167-4757-9f24-20f849e330df","context":null,"enonce":"43-year-old patient, with a history of chronic alcoholism, presents to the emergency room for sudden onset epigastric pain \r\n\r\nWhat will be the exams to be carried out in a first 1 time?   ","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":true,"justification":"True. Lower myocardial infarction is a differential diagnosis to evoke in this situation ","idx":0,"proposition":"ECG"},{"correct":false,"justification":"False. Not right away. It can be done in a 2nd time if we find a cardiac ischemic cause to evaluate hemodynamics","idx":1,"proposition":"ETT"},{"correct":true,"justification":"True. The positive diagnosis of acute pancreatitis is based on the combination of PAIN + LIPASE > 3N. In addition, an associated significant cytolysis is in favor of a biliary origin of this pancreatitis","idx":2,"proposition":"Determination of lipase"},{"correct":false,"justification":"False. It has not been recommended for more than 5 years","idx":3,"proposition":"Determination of amylase"},{"correct":false,"justification":"False. Not right away. In case of confirmed acute pancreatitis, the AP CT scan should be performed at 48h-72h. On the other hand, abdominal ultrasound will be done as soon as the diagnosis is confirmed in order to eliminate a lithiatic cause","idx":4,"proposition":"Abdominal-pelvic CT"}],"type":"custom"}
+{"_id":"cirrhose-HGE-5e8541","context":null,"enonce":"Which of the following are signs of hepatocellular insufficiency?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Hepatic encephalopathy"},{"correct":true,"justification":"True","idx":1,"proposition":"Asterixis"},{"correct":true,"justification":"True","idx":2,"proposition":"Jaundice"},{"correct":false,"justification":"Portal hypertension","idx":3,"proposition":"Splenomegaly"},{"correct":false,"justification":"","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"341-urg-3e1c8016-548c-48dd-9c1c-77ea29c286ae","context":null,"enonce":"Which of the following are criteria for lumbar puncture during a febrile seizure in children?","item":"convulsionsped","matiere":"urg","propositions":[{"correct":false,"justification":"<6months","idx":0,"proposition":">6months"},{"correct":false,"justification":"<6months","idx":1,"proposition":"1-5years"},{"correct":true,"justification":"True","idx":2,"proposition":"Post-critical deficit"},{"correct":false,"justification":">15min","idx":3,"proposition":"<15min"},{"correct":true,"justification":"True","idx":4,"proposition":"Meningeal syndrome"}],"type":"custom"}
+{"_id":"malaise-urg-8224cd","context":null,"enonce":"Which of the following are true?","item":"malaise","matiere":"urg","propositions":[{"correct":false,"justification":"Much less: 2%","idx":0,"proposition":"Malaise and loss of consciousness account for about 60% of emergency room admissions"},{"correct":true,"justification":"True","idx":1,"proposition":"10 to 20% of syncopes are the expression of a life-threatening pathology in the short or medium term"},{"correct":true,"justification":"True","idx":2,"proposition":"The etiological diagnosis of malaise is primarily clinical"},{"correct":true,"justification":"True","idx":3,"proposition":"Capillary blood glucose and electrocardiogram are systematic"},{"correct":false,"justification":"Over 75","idx":4,"proposition":"The search for orthostatic hypotension is systematic in patients over 35 years of age"}],"type":"custom"}
+{"_id":"Kcprostate-onco-33c194","context":null,"enonce":"What is the Amico classification of prostate cancer with a PSA of 8 ng\/mL, a Gleason of 3+3 and a normal TR?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":true,"justification":"True. Low: T1C or T2a AND PSA <= 10 AND Gleason <= 6.  Intermediate: T2b OR 10 > PSA < 20 OR Gleason 7. High: T2c and sup OR PSA >= 20 OR Gleason >= 8\r\n","idx":0,"proposition":"Weak"},{"correct":false,"justification":"Weak","idx":1,"proposition":"Intermediary"},{"correct":false,"justification":"Weak","idx":2,"proposition":"High"},{"correct":false,"justification":"Weak","idx":3,"proposition":"Not enough item"},{"correct":false,"justification":"Weak","idx":4,"proposition":"The elements are contradictory"}],"type":"custom"}
+{"_id":"ETP-therapeutique-7364fb","context":null,"enonce":"Which of the following are true? 💊","item":"ETP","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"During treatment during pregnancy, the newborn may show signs of overdose at birth"},{"correct":true,"justification":"True","idx":1,"proposition":"During treatment during pregnancy, the newborn may show signs of withdrawal at birth"},{"correct":true,"justification":"True","idx":2,"proposition":"The pharmacist may substitute an originator by a generic of himself, unless otherwise stated"},{"correct":false,"justification":"Its MA does not require new studies if the molecule is exactly the same.","idx":3,"proposition":"A generic drug is subject to phase III studies before its marketing authorization"},{"correct":true,"justification":"True","idx":4,"proposition":"Adherence is one of the important parameters that determines the effectiveness of the treatments put in place"}],"type":"custom"}
+{"_id":"TTTnonmedic-therapeutique-7e8fac","context":null,"enonce":"Which of the following are true?","item":"TTTnonmedic","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Orthopedic insoles are on medical prescription"},{"correct":false,"justification":"False: they are often very analgesic","idx":1,"proposition":"Orthopedic insoles do not have an analgesic effect"},{"correct":true,"justification":"True","idx":2,"proposition":"Standard prostheses are << small appliances>>"},{"correct":false,"justification":"Not in push","idx":3,"proposition":"Rheumatoid arthritis in flare-up is an indication for spa ♨ treatment "},{"correct":true,"justification":"True","idx":4,"proposition":"Upper limb prostheses often have a mainly aesthetic role"}],"type":"custom"}
+{"_id":"ictere-HGE-d6cb68","context":null,"enonce":"What time corresponds to the late time on the injected scanner?","item":"ictere","matiere":"HGE","propositions":[{"correct":false,"justification":"Excretory time","idx":0,"proposition":"10 mn"},{"correct":true,"justification":"True","idx":1,"proposition":"3 min"},{"correct":false,"justification":"Venous time","idx":2,"proposition":"70 seconds"},{"correct":false,"justification":"Arterial weather","idx":3,"proposition":"Thirty seconds"},{"correct":false,"justification":"SPC Time","idx":4,"proposition":"T0"}],"type":"custom"}
+{"_id":"HTA-cardio-8319a4","context":null,"enonce":"Regarding the assessment to be carried out in front of an essential hypertension of grade 1, among the following additional examinations, which are to be carried out in first intention?","item":"HTA","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"ECG"},{"correct":false,"justification":"If vascular disease documented","idx":1,"proposition":"Doppler echo of ASD."},{"correct":false,"justification":"fundus if grade 2 or 3 hypertension or diabetic hypertensive patient","idx":2,"proposition":"Fundus"},{"correct":true,"justification":"True","idx":3,"proposition":"Serum creatinine assay. "},{"correct":false,"justification":"If cognitive impairment and\/or neurological symptoms.","idx":4,"proposition":"MRI or brain scan"}],"type":"custom"}
+{"_id":"Frped-urg-963f0d","context":null,"enonce":"Regarding the classification of Salter and Harris. Which of the following are true?","item":"Frped","matiere":"urg","propositions":[{"correct":true,"justification":"True. Growth cartilage is radiolucent. A non-displaced Salter 1 detachment will only be identifiable on the location of the pain and on the thickening of the soft parts. ","idx":0,"proposition":"A non-displaced Salter 1 detachment is invisible on radiography"},{"correct":true,"justification":"True","idx":1,"proposition":"A Salter V corresponds to a lesion on the germinative layer of cartilage by axial trauma"},{"correct":false,"justification":"False. Growth cartilage and metaphysis.","idx":2,"proposition":"A Salter II corresponds to a trait that passes through the growth cartilage and epiphysis"},{"correct":true,"justification":"True","idx":3,"proposition":"A Salter IV corresponds to a trait that passes through the growth cartilage, epiphysis and metaphysis"},{"correct":false,"justification":"False. Growth cartilage and epiphysis. ","idx":4,"proposition":"A Salter III corresponds to a trait that passes through the growth cartilage and metaphysis"}],"type":"custom"}
+{"_id":"pancreatitechr-HGE-0d81ba","context":null,"enonce":"Which of the following are scannographic signs of advanced chronic pancreatitis?","item":"pancreatitechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True, almost pathognomonic","idx":0,"proposition":"Pancreatic calcification"},{"correct":true,"justification":"True, frequent late complication","idx":1,"proposition":"Pseudocysts"},{"correct":false,"justification":"Possible at first","idx":2,"proposition":"Absence of anomaly"},{"correct":true,"justification":"True","idx":3,"proposition":"dilations, ductal irregularities"},{"correct":false,"justification":"Sign of acute pancreatitis rather","idx":4,"proposition":"lithiasis"}],"type":"custom"}
+{"_id":"ascite-HGE-02812b","context":null,"enonce":"What is the definition of an infection of ascites fluid that is controlled?","item":"ascite","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"50% drop in 24-hour NPCs"},{"correct":true,"justification":"True","idx":1,"proposition":"50% drop in PNN at 48 hours"},{"correct":false,"justification":"","idx":2,"proposition":"50% drop in PNN at 72h"},{"correct":false,"justification":"","idx":3,"proposition":"100% drop in PNN at 24h"},{"correct":false,"justification":"","idx":4,"proposition":"25% drop in 24-hour PNNs"}],"type":"custom"}
+{"_id":"103-neuro-33817097-6648-49ee-aa23-289b30ba47db","context":null,"enonce":"Concerning centrotemporal peak epilepsy (CTEP) in children. Which of the following are true?","item":"epilepsie","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"This syndrome includes 20% of childhood epilepsies"},{"correct":true,"justification":"True","idx":1,"proposition":"Hypersalivation is observed"},{"correct":true,"justification":"True","idx":2,"proposition":"There is a stop of speech"},{"correct":false,"justification":"False: Activated by sleep","idx":3,"proposition":"The EEG is classically in ample and diphasic waves, Centro temporal, calmed by sleep"},{"correct":false,"justification":"not necessarily treatment","idx":4,"proposition":"Treatment should always be undertaken."}],"type":"custom"}
+{"_id":"359-urg-6b58fdae-9697-46f6-8046-dcba8345a6f2","context":null,"enonce":"Regarding the reduction criteria to be checked in a fracture of the lower end of the radius, which of the following propositions, which are true?","item":"Fr","matiere":"urg","propositions":[{"correct":false,"justification":" or null and void","idx":0,"proposition":"Front: a negative radio-ulnar index -2mm non-zero"},{"correct":false,"justification":"False: profile","idx":1,"proposition":"Front: an anteversion of the radial glenoid"},{"correct":false,"justification":"False: inwards","idx":2,"proposition":"Front: Restoration of the bi-styloid line inclined 15° outwards"},{"correct":true,"justification":"True","idx":3,"proposition":"In profile: realignment of the cortical of the 2 radial fragments"},{"correct":true,"justification":"True","idx":4,"proposition":"Front: a negative radio-ulnar index -2mm or zero"}],"type":"custom"}
+{"_id":"nvxne-gyn-f0f52f","context":null,"enonce":"What diseases are included in newborn screening?","item":"nvxne","matiere":"gyn","propositions":[{"correct":true,"justification":"True, first disease to look for by the blotting paper test (guthria test)","idx":0,"proposition":"PKU"},{"correct":true,"justification":"True, not included in the blotting paper test but is part of the screening at birth","idx":1,"proposition":"Congenital hip dislocation"},{"correct":true,"justification":"True, is part of the blotting paper test, but is not systematic. Targeted according to parents' origins","idx":2,"proposition":"Sickle-cell anemia"},{"correct":true,"justification":"True, blotting paper test","idx":3,"proposition":"Cystic fibrosis"},{"correct":true,"justification":"True, hence the acoustic otoemission test to be done before discharge from maternity","idx":4,"proposition":"Congenital deafness"}],"type":"custom"}
+{"_id":"RGO-HGE-b4e5e3","context":null,"enonce":"How often is endobrachyoesophagus less than 3 centimetres monitored?","item":"RGO","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Every 5 years"},{"correct":false,"justification":"between 3 and 6 cm","idx":1,"proposition":"Every 3 years"},{"correct":false,"justification":"> 6 cm","idx":2,"proposition":"Every 2 years"},{"correct":false,"justification":"An OBE is always monitored","idx":3,"proposition":"No monitoring"},{"correct":false,"justification":"Control every year (2 times in the first year) if low-grade dysplasia","idx":4,"proposition":"Every 6 months"}],"type":"custom"}
+{"_id":"Kcped-onco-cbfd97","context":null,"enonce":"Which of the following are biomarkers that can be found disrupted in neuroblastoma?","item":"Kcped","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Urinary catecholamines"},{"correct":true,"justification":"True","idx":1,"proposition":"LDH"},{"correct":true,"justification":"True","idx":2,"proposition":"Ferritin"},{"correct":false,"justification":"False","idx":3,"proposition":"Calcemia"},{"correct":false,"justification":"False","idx":4,"proposition":"Urea"}],"type":"custom"}
+{"_id":"TTTnonmedic-therapeutique-74be2c","context":null,"enonce":"Which of the following are true?","item":"TTTnonmedic","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"An orthosis is a device that compensates for an absent or deficient function"},{"correct":false,"justification":"Prosthesis = replaces a missing element","idx":1,"proposition":"A prosthesis is a device that compensates for an absent or deficient function"},{"correct":true,"justification":"True","idx":2,"proposition":"Orthotics are most often custom-made"},{"correct":false,"justification":"By an orthopaedic technician","idx":3,"proposition":"Orthotics are placed by an orthoptist"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"coma-urg-23c610","context":null,"enonce":"Which of the following propositions are true regarding decortication?","item":"coma","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The upper limbs are in flexion"},{"correct":false,"justification":"Inflection","idx":1,"proposition":"The upper limbs are in extension"},{"correct":false,"justification":"Extension","idx":2,"proposition":"The lower limbs are in flexion"},{"correct":true,"justification":"True","idx":3,"proposition":"The lower limbs are in extension"},{"correct":false,"justification":"False","idx":4,"proposition":"The head is in extension"}],"type":"custom"}
+{"_id":"anemie-hemato-c0519a","context":null,"enonce":"With regard to anaemia in children, what are the right proposals?","item":"anemie","matiere":"hemato","propositions":[{"correct":false,"justification":"False, we judge his tolerance to effort classically during feedings.","idx":0,"proposition":"It is impossible to talk about dyspnea of effort in an infant because he does not have physical activity"},{"correct":true,"justification":"True, at birth the child has a high level of hemoglobin that drops sharply between 3 and 6 months to 9.5 g \/ dL as a low limit. From 6 months his Hb level increases little by little to reach the adult norm from 12 years","idx":1,"proposition":"From 12 years old anemia is considered with adult norms"},{"correct":true,"justification":"True, martial deficiencies of intake may be due to exclusive feeding of breast milk which is low in iron.","idx":2,"proposition":"It is necessary to diversify food intake from 6 months"},{"correct":false,"justification":"","idx":3,"proposition":""},{"correct":false,"justification":"","idx":4,"proposition":""}],"type":"custom"}
+{"_id":"Kcsein-onco-1b716e","context":null,"enonce":"Which of the following are criteria for poor prognosis of localized forms? (Cancer Medline, Table 2, page 393, 2018 edition)","item":"Kcsein","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Lymph node invasion (>N0)"},{"correct":false,"justification":"False","idx":1,"proposition":"T1"},{"correct":true,"justification":"True, T2 and beyond = poor prognosis","idx":2,"proposition":"T3"},{"correct":false,"justification":"Good prognosis","idx":3,"proposition":"HER2-"},{"correct":true,"justification":"True, SBR 8 or 9","idx":4,"proposition":"High histological grade"}],"type":"custom"}
+{"_id":"Frped-urg-57a8bc","context":null,"enonce":"What are the indications for surgical management of a fracture of the child","item":"Frped","matiere":"urg","propositions":[{"correct":false,"justification":"Orthopedic treatment in 1° intention for any diaphyseal \/ metaphyseal fracture of children under 6 years of age","idx":0,"proposition":"Femoral diaphyseal fracture in a 3-year-old child"},{"correct":true,"justification":"At school age, surgical management is preferred for certain diaphyseal or epiphyseal fractures for a faster resumption of walking (lower limb) or writing (upper limb)","idx":1,"proposition":"A fracture of the 2 bones of the forearm in an 8-year-old child"},{"correct":true,"justification":"Yes, to avoid joint stiffness in case of immobilization","idx":2,"proposition":"A joint fracture"},{"correct":false,"justification":"But surgical indication in the case of a pathological fracture (delayed healing in case of orthopedic treatment)","idx":3,"proposition":"Abuse"},{"correct":true,"justification":"Orthopedic treatment would complicate nursing care, which is already cumbersome in these cases.","idx":4,"proposition":"Polytrauma"}],"type":"custom"}
+{"_id":"securisation-sp-e7eb9f","context":null,"enonce":"How many physicians must be present, at a minimum, for CPR:","item":"securisation","matiere":"sp","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"1"},{"correct":false,"justification":"False","idx":1,"proposition":"2"},{"correct":true,"justification":"True, from different specialties","idx":2,"proposition":"3"},{"correct":false,"justification":"False","idx":3,"proposition":"4"},{"correct":false,"justification":"False","idx":4,"proposition":"5"}],"type":"custom"}
+{"_id":"anemie-hemato-ae0602","context":null,"enonce":"Which of these diseases can be revealed by peripheral anemia?","item":"anemie","matiere":"hemato","propositions":[{"correct":true,"justification":"True, it gives a central anemia by default of erythroblast production but also gives toxicity to red blood cells that can hemolyze with a reticulocyte response.","idx":0,"proposition":"Thalassemia"},{"correct":false,"justification":"False","idx":1,"proposition":"Iron deficiency"},{"correct":true,"justification":"True, also Minkowski Chauffard disease, autosomal dominant disease. By a membrane defect, RBCs are sequestered in the spleen and hemolyze. Classically manifests itself as jaundice of the newborn.","idx":2,"proposition":"Spherocytosis"},{"correct":true,"justification":"True, it is a thrombotic microangiopathy that by definition gives consumption thrombocytopenia and mechanical hemolytic anemia.","idx":3,"proposition":"Hemolytic uremic syndrome"},{"correct":true,"justification":"True, it is an enzyme deficiency that gives hemolysis when exposed to an oxidative stressor: infection, bean ingestion, drugs such as quinine.","idx":4,"proposition":"G6PD deficiency"}],"type":"custom"}
+{"_id":"securisation-sp-8f1a1e","context":null,"enonce":"Which of the following proposals are acts\/consultations for which it is not mandatory to go through the general practitioner to be reimbursed?","item":"securisation","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Psychiatric consultation, up to 25 years"},{"correct":true,"justification":"True","idx":1,"proposition":"ABORTION"},{"correct":true,"justification":"True","idx":2,"proposition":"Urgency"},{"correct":true,"justification":"True","idx":3,"proposition":"Mammography as part of organized screening"},{"correct":false,"justification":"False","idx":4,"proposition":"Cervico-uterine smear at 18 years old"}],"type":"custom"}
+{"_id":"PF-neuro-ab3293","context":null,"enonce":"Which of the following are functions performed by the facial VII nerve?","item":"PF","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Motor innervation of the skin muscles of the face"},{"correct":true,"justification":"True","idx":1,"proposition":"Motor innervation of the stapedial muscle"},{"correct":true,"justification":"True","idx":2,"proposition":"Innervation of the lacrimal and submandibular glands"},{"correct":false,"justification":"Sensory innervation","idx":3,"proposition":"Sensory innervation of the Ramsey-Hunt area"},{"correct":false,"justification":"Sensory innervation","idx":4,"proposition":"Sensory innervation of the anterior 2\/3 of the tongue"}],"type":"custom"}
+{"_id":"PF-neuro-a149a8","context":null,"enonce":"What is the number of the facial nerve?","item":"PF","matiere":"neuro","propositions":[{"correct":false,"justification":"Trigeminal","idx":0,"proposition":"V"},{"correct":true,"justification":"True","idx":1,"proposition":"VII"},{"correct":false,"justification":"Glossopharyngeal","idx":2,"proposition":"IX"},{"correct":false,"justification":"Optics","idx":3,"proposition":"II"},{"correct":false,"justification":"Hypoglossus","idx":4,"proposition":"XII"}],"type":"custom"}
+{"_id":"polytrauma-urg-6a0066","context":null,"enonce":"Which of the following proposals regarding the care of a burn victim are true?","item":"polytrauma","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A 1st degree burn is only painful erythema"},{"correct":false,"justification":"False, 1st degree","idx":1,"proposition":"A 2nd degree burn is only a dolourous erythema"},{"correct":false,"justification":"False, only 2nd degree","idx":2,"proposition":"Phlyctenes and epidermal detachment are present in 2nd and 3rd degree burns"},{"correct":true,"justification":"True","idx":3,"proposition":"Discoloration with vitropressure disappears in the 3rd degree"},{"correct":true,"justification":"True, in addition the appendages no longer adhere","idx":4,"proposition":"A 3rd degree burn is sluggish, dry, cardboard, insensitive and painless"}],"type":"custom"}
+{"_id":"MAI-immuno-4f3826","context":null,"enonce":"In which diseases can Rheumatoid Factor (RF) be found?","item":"MAI","matiere":"immuno","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"rheumatoid arthritis"},{"correct":true,"justification":"True","idx":1,"proposition":"systemic lupus erythematosus"},{"correct":true,"justification":"True","idx":2,"proposition":"cryoglobulinemia"},{"correct":true,"justification":"True","idx":3,"proposition":"chronic hepatitis C"},{"correct":true,"justification":"True","idx":4,"proposition":"infective endocarditis"}],"type":"custom"}
+{"_id":"pancreatitechr-HGE-25b3f2","context":null,"enonce":"The male\/female sex ratio is:","item":"pancreatitechr","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"1"},{"correct":false,"justification":"","idx":1,"proposition":"2"},{"correct":false,"justification":"","idx":2,"proposition":"8"},{"correct":true,"justification":"True","idx":3,"proposition":"4"},{"correct":false,"justification":"","idx":4,"proposition":"10"}],"type":"custom"}
+{"_id":"RGO-HGE-89f0f3","context":null,"enonce":"Which of the following are true for the treatment of mild esophagitis?","item":"RGO","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Treatment relies on PEPs"},{"correct":true,"justification":"True","idx":1,"proposition":"Half-dose PPI for 4 weeks"},{"correct":false,"justification":"Severe esophagitis","idx":2,"proposition":"Full dose PPI for 8 weeks"},{"correct":false,"justification":"Prevention of recurrence (if frequent)","idx":3,"proposition":"PPIs minimum dose"},{"correct":false,"justification":"If symptoms persist","idx":4,"proposition":"Full dose PPI"}],"type":"custom"}
+{"_id":"polytrauma-urg-eefefd","context":null,"enonce":"Which of the following propositions concerning polytrauma are true?","item":"polytrauma","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A severely traumatized person is a trauma patient whose violence or mechanism of trauma can result in life-threatening injuries."},{"correct":false,"justification":"False, the leading cause of death","idx":1,"proposition":"Injuries are the second leading cause of death among young people under 40"},{"correct":true,"justification":"True","idx":2,"proposition":"A defect in orientation of a polytrauma patient requiring secondary transfer to a specialized center is associated with excess mortality"},{"correct":true,"justification":"True","idx":3,"proposition":"Vittel's algorithm can be used to define a severe trauma patient and direct it to a structure adapted to its condition"},{"correct":false,"justification":"False, the Glasgow score assesses the severity of head injury. It can be used from the pre-hospital phase","idx":4,"proposition":"The Glasgow score is not usable in the context of polytrauma"}],"type":"custom"}
+{"_id":"MICI-HGE-aa9564","context":null,"enonce":"Which of the following proposals are more oriented towards Crohn's disease rather than ulcerative colitis?","item":"MICI","matiere":"HGE","propositions":[{"correct":true,"justification":"True, typical (but not constant) in crohn's","idx":0,"proposition":"Gigantocellullar granulomas without caseous necrosis "},{"correct":true,"justification":"True, continued achievement in UC","idx":1,"proposition":"Discontinuous colonic involvement"},{"correct":true,"justification":"True, non-transmural impairment in UC","idx":2,"proposition":"Transmural involvement"},{"correct":true,"justification":"True","idx":3,"proposition":"Severe ileitis"},{"correct":true,"justification":"True, anus spared in UC","idx":4,"proposition":"Proctological lesions"}],"type":"custom"}
+{"_id":"pbsuitescouches-gyn-742f30","context":null,"enonce":"Which of the following proposals are part of the initial additional assessment in case of suspected acute postpartum endometritis?","item":"pbsuitescouches","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"NFS-P"},{"correct":true,"justification":"True","idx":1,"proposition":"Vaginal sampling for bacteriological purposes"},{"correct":true,"justification":"True","idx":2,"proposition":"CRP"},{"correct":false,"justification":"False","idx":3,"proposition":"Thoracoabdom-pelvic CT"},{"correct":false,"justification":"False","idx":4,"proposition":"Peritoneal ultrasound"}],"type":"custom"}
+{"_id":"MICI-HGE-a9ec9e","context":null,"enonce":"Which of the following propositions are true regarding UC?","item":"MICI","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Imaging is normal"},{"correct":false,"justification":"This is the case for Crohn's disease","idx":1,"proposition":"The attack is transmural"},{"correct":false,"justification":"Normal MRI","idx":2,"proposition":"MRI is the exam of choice for a positive diagnosis"},{"correct":true,"justification":"True","idx":3,"proposition":"The RCH respects hail"},{"correct":true,"justification":"True","idx":4,"proposition":"Sclerosing cholangitis is a common association"}],"type":"custom"}
+{"_id":"MICI-HGE-fedb95","context":null,"enonce":"Which of the following are etiologies of gigantoepithelioid granuloma without caseous necrosis?","item":"MICI","matiere":"HGE","propositions":[{"correct":true,"justification":"True, it is very common not to find caseous necrosis in tuberculosis. But it must also be remembered that this pathology gives caseous necrosis","idx":0,"proposition":"Tuberculosis"},{"correct":true,"justification":"True","idx":1,"proposition":"Crohn's disease"},{"correct":true,"justification":"True","idx":2,"proposition":"Horton's disease"},{"correct":true,"justification":"True","idx":3,"proposition":"Sarcoidosis"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"splenomeg-HGE-f19ba4","context":null,"enonce":"Which of the following propositions are true regarding prophylaxis in a splecnectomized?","item":"splenomeg","matiere":"HGE","propositions":[{"correct":false,"justification":"Vaccination is combined with antibiotic prophylaxis with oral penicillin. It is generally recommended until adolescence in children and for one or two years in children.\r\nthe adult. ","idx":0,"proposition":"It is based on C3G"},{"correct":false,"justification":"","idx":1,"proposition":"It is based on vaccination only"},{"correct":true,"justification":"True","idx":2,"proposition":"It is based on oral penicillins and vaccination"},{"correct":false,"justification":"1 or 2 years","idx":3,"proposition":"Oral penicillin is to be taken for 3 months in adults"},{"correct":true,"justification":"True, according to Masson","idx":4,"proposition":"Oral penicillin is usually to be taken until adolescence in children"}],"type":"custom"}
+{"_id":"diarrheechr-HGE-aa8237","context":null,"enonce":"Which of the following are causes of malabsorption diarrhea?","item":"diarrheechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Exocrine pancreatic insufficiency"},{"correct":true,"justification":"True","idx":1,"proposition":"Celiac disease"},{"correct":true,"justification":"True","idx":2,"proposition":"IBD"},{"correct":false,"justification":"Exudative diarrhea","idx":3,"proposition":"Lymphangiectasias"},{"correct":false,"justification":"Volumonegic diarrhea","idx":4,"proposition":"Syndrome de Zollinger Ellison"}],"type":"custom"}
+{"_id":"vertige-neuro-f6a97a","context":null,"enonce":"Which of the following proposals favor peripheral nystagmus?","item":"vertige","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Horizonto-rotatory"},{"correct":true,"justification":"True","idx":1,"proposition":"No change of meaning depending on the look"},{"correct":true,"justification":"True","idx":2,"proposition":"Inhibitation by eye fixation"},{"correct":false,"justification":"False, rather central nystagmus","idx":3,"proposition":"Pure direction"},{"correct":false,"justification":"False, rather central nystagmus","idx":4,"proposition":"Concerns only one eye"}],"type":"custom"}
+{"_id":"ADP-hemato-ef4c7d","context":null,"enonce":"Which of the following are true about tularemia?","item":"ADP","matiere":"hemato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Tularemia is caused by Francisella tularensis"},{"correct":true,"justification":"True","idx":1,"proposition":"Hare hunters are on display"},{"correct":true,"justification":"True","idx":2,"proposition":"It is a reportable disease"},{"correct":false,"justification":"Cervical lymphadenopathy most often (especially in hunters)","idx":3,"proposition":"It presents as spinal lymphadenopathy"},{"correct":false,"justification":"Fluoroquinolones as a first-line treatment","idx":4,"proposition":"It is treated with C3G IM monodose in first line"}],"type":"custom"}
+{"_id":"MSN-urg-63c549","context":null,"enonce":"Which of the following are true?","item":"MSN","matiere":"urg","propositions":[{"correct":false,"justification":"Sudden infant death syndrome (SIDS) is an unexpected infant death (MIN) with no etiology found despite extensive investigations.","idx":0,"proposition":"Unexpected infant death (MIN) is sudden infant death syndrome (SIDS) with no etiology found despite exhaustive investigations."},{"correct":true,"justification":"","idx":1,"proposition":"Sudden infant death syndrome accounts for 6% of infant mortality."},{"correct":false,"justification":"Unexpected infant death is defined as a sudden death in a child under 2 years of age, when nothing in its known history could have predicted it.","idx":2,"proposition":"Unexpected infant death is defined as a sudden death in a child under 3 years of age, when nothing in his known history could have predicted it."},{"correct":true,"justification":"","idx":3,"proposition":"Abuse, acute dehydration and bedding accidents are among the most common etiologies of MIN."},{"correct":false,"justification":"The male sex of the infant, a young mother and the winter period are risk factors for sudden infant death syndrome (SIDS).","idx":4,"proposition":"The male sex of the infant, the old age of the mother and the summer period are risk factors for sudden infant death syndrome (SIDS)."}],"type":"custom"}
+{"_id":"prothese-urg-8aef22","context":null,"enonce":"Which of the following are complications of centromedullary nail osteosynthesis?","item":"prothese","matiere":"urg","propositions":[{"correct":true,"justification":"True, surgical revision for PTH","idx":0,"proposition":"displacement (scanning) of the cervical screw"},{"correct":true,"justification":"True","idx":1,"proposition":"Vicious Cal in Varus"},{"correct":true,"justification":"True","idx":2,"proposition":"infection"},{"correct":false,"justification":"False","idx":3,"proposition":"Aseptic osteonecrosis of the femoral head"},{"correct":false,"justification":"possible for prostheses","idx":4,"proposition":"dislocation"}],"type":"custom"}
+{"_id":"vomisst-HGE-844f29","context":null,"enonce":"Which of the following are complications of repeated vomiting?","item":"vomisst","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Dehydration"},{"correct":true,"justification":"True, inhalation","idx":1,"proposition":"Pneumonia "},{"correct":true,"justification":"True","idx":2,"proposition":"Syndrome de Mallory Weiss"},{"correct":true,"justification":"True","idx":3,"proposition":"Syndrome de Boerhaave"},{"correct":true,"justification":"True","idx":4,"proposition":"Esophagitis"}],"type":"custom"}
+{"_id":"TNC-neuro-6a97df","context":null,"enonce":"What elements are part of the C.A.M. classification useful in detecting and reassessing confusion?","item":"TNC","matiere":"neuro","propositions":[{"correct":true,"justification":"True, confusion can settle in a few minutes, hours or days and we are talking about a break with the previous state","idx":0,"proposition":"Brutal start"},{"correct":false,"justification":"Wrong, having a major neurocognitive disorder is different from being confused, certainly, but you can have both!","idx":1,"proposition":"Absence of major neurocognitive disorder"},{"correct":false,"justification":"False, they are not part of the C.A.M. classification.","idx":2,"proposition":"Memory problems"},{"correct":true,"justification":"True, this very item is used very often in emergencies to detect confusion","idx":3,"proposition":"Temporo-spatial disorganization and thought and language "},{"correct":true,"justification":"True, remember that a confusion is equal to a Glasgow at 14!","idx":4,"proposition":"Impaired alertness"}],"type":"custom"}
+{"_id":"Kcpancreas-onco-269d2b","context":null,"enonce":"Which of the following are true?","item":"Kcpancreas","matiere":"onco","propositions":[{"correct":false,"justification":"The only clearly established exogenous risk factor for pancreatic adenocarcinoma is tobacco ","idx":0,"proposition":"The only clearly established exogenous risk factor for pancreatic adenocarcinoma is alcohol"},{"correct":true,"justification":"","idx":1,"proposition":"Obesity is a risk factor as it is for many other cancers"},{"correct":true,"justification":"","idx":2,"proposition":"Familial pancreatic cancer"},{"correct":true,"justification":"","idx":3,"proposition":"The existence of an affected first-degree relative and tobacco use increase the risk of developing pancreatic adenocarcinoma by 5"},{"correct":true,"justification":"","idx":4,"proposition":"Pancreatic conditions predisposing to an endogenous risk of pancreatic cancer are diabetes and chronic alcoholic pancreatitis in particular"}],"type":"custom"}
+{"_id":"PF-neuro-040284","context":null,"enonce":"Which of the following are factors in poor prognosis for idiopathic (or frigore) paralysis?","item":"PF","matiere":"neuro","propositions":[{"correct":false,"justification":"Poor prognosis factor = quick installation","idx":0,"proposition":"Slow installation"},{"correct":true,"justification":"True","idx":1,"proposition":"Total character from the outset"},{"correct":true,"justification":"True","idx":2,"proposition":"Associated pain"},{"correct":true,"justification":"True","idx":3,"proposition":"Tinnitus"},{"correct":true,"justification":"True","idx":4,"proposition":"Dizziness"}],"type":"custom"}
+{"_id":"systemeconv-sp-4378f6","context":null,"enonce":"Which practitioners can set up in sector 2?","item":"systemeconv","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Former Assistant Clinic Managers"},{"correct":true,"justification":"True","idx":1,"proposition":"Former hospital assistants"},{"correct":true,"justification":"True","idx":2,"proposition":"Full-time hospital practitioners"},{"correct":false,"justification":"After 5 years","idx":3,"proposition":"Part-time hospital practitioners after 3 years "},{"correct":false,"justification":"Almost all 😛","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"SII-HGE-ee1808","context":null,"enonce":"Which of the following are relevant tips for the management of irritable bowel syndrome?","item":"SII","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Reduce caffeine"},{"correct":true,"justification":"True","idx":1,"proposition":"Reduce fiber"},{"correct":true,"justification":"True","idx":2,"proposition":"Antispasmodics may be helpful"},{"correct":true,"justification":"True","idx":3,"proposition":"Anti-diarrheals may have their place depending on the type of IBS"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"FdRCV-cardio-a515a9","context":null,"enonce":"Which of the following are modifiable cardiovascular risk factors?","item":"FdRCV","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Tobacco"},{"correct":false,"justification":"Not a cardiovascular risk factor","idx":1,"proposition":"Alcohol"},{"correct":false,"justification":"Age, sex and heredity are non-modifiable risk factors","idx":2,"proposition":"Heredity"},{"correct":true,"justification":"True","idx":3,"proposition":"Metabolic syndrome"},{"correct":true,"justification":"True","idx":4,"proposition":"Chronic renal failure"}],"type":"custom"}
+{"_id":"choc-urg-a6805c","context":null,"enonce":"What is the most common infectious entry point in case of septic shock?","item":"choc","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Respiratory"},{"correct":false,"justification":"","idx":1,"proposition":"Skin"},{"correct":false,"justification":"","idx":2,"proposition":"Urinary"},{"correct":false,"justification":"Second gateway","idx":3,"proposition":"Hepato-digestive"},{"correct":false,"justification":"","idx":4,"proposition":"ENT"}],"type":"custom"}
+{"_id":"Kcsein-onco-ea6e3c","context":null,"enonce":"Which of the following are true?","item":"Kcsein","matiere":"onco","propositions":[{"correct":false,"justification":"False. This is invasive carcinoma of nonspecific type (or invasive ductal carcinoma or invasive ductal adenocarcinoma)","idx":0,"proposition":"The most common type of cancer is invasive lobular carcinoma"},{"correct":false,"justification":"False. 50 to 74 years.","idx":1,"proposition":"Screening is routine for all women who are asymptomatic or without risk factors for BRCA1\/2 between 45 and 75 years of age"},{"correct":true,"justification":"True","idx":2,"proposition":"The most common metastatic sites are the bone, lungs and liver. "},{"correct":false,"justification":"False. It is a humanized antibody (-zumab). The suffix -mumab means that the monoclonal antibody is human. ","idx":3,"proposition":"Trastuzumab is a human monoclonal antibody targeting HER2 "},{"correct":true,"justification":"True","idx":4,"proposition":"Trastuzumab is cardiotoxic"}],"type":"custom"}
+{"_id":"PF-neuro-9c4458","context":null,"enonce":"Which of the following are signs of peripheral facial paralysis?","item":"PF","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Sign of Charles Bell"},{"correct":true,"justification":"True","idx":1,"proposition":"Sign of Souques"},{"correct":false,"justification":"Not in the device","idx":2,"proposition":"Automatic-voluntary dissociation"},{"correct":true,"justification":"True","idx":3,"proposition":"Total"},{"correct":true,"justification":"True","idx":4,"proposition":"Dry eye"}],"type":"custom"}
+{"_id":"Kcphysiopath-onco-0856de","context":null,"enonce":"Which of the following are carcinogens?","item":"Kcphysiopath","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Asbestos"},{"correct":true,"justification":"True","idx":1,"proposition":"HCV"},{"correct":true,"justification":"True","idx":2,"proposition":"HPV"},{"correct":true,"justification":"True","idx":3,"proposition":"HIV"},{"correct":true,"justification":"True","idx":4,"proposition":"H. pylori"}],"type":"custom"}
+{"_id":"antalgie-therapeutique-cabbb5","context":null,"enonce":"Regarding level II analgesics, what are the exact proposal(s)?","item":"antalgie","matiere":"therapeutique","propositions":[{"correct":false,"justification":"False, nefopam (or ACUPAN) is not a level II analgesic, but a co-analgesic.","idx":0,"proposition":"Level II analgesics include codeine, tramadol and nefopam among others"},{"correct":true,"justification":"True, the very definition of level II analgesics being \"weak opioids\".","idx":1,"proposition":"All level II analgesics are opioids. "},{"correct":false,"justification":"False, three times false. This is a mistake that is unfortunately very common, because even if the combinations of level 1 and level 2, specialties such as Lamaline or Izalgi are ALREADY a combination of opium powder and Paracetamol (+\/- caffeine). Prescribing these specialties with Paracetamol leads to an overload of Paracetamol harmful to the liver.","idx":2,"proposition":"It is not forbidden to prescribe combinations of level I and II together, such as Paracetamol + Lamaline or Paracetamol + Izalgi"},{"correct":true,"justification":"True, this is THE drug contraindication of tramadol","idx":3,"proposition":"Tramadol is contraindicated with MAOIs"},{"correct":false,"justification":"False, it is with level III analgesics (strong opioids). For level analgesics it is according to the symptoms","idx":4,"proposition":"The prescription of a laxative is systematic with opioid analgesics of level II"}],"type":"custom"}
+{"_id":"souffleped-cardio-18bcc2","context":null,"enonce":"Which of the following proposals should be sought primarily in case of Turner syndrome?","item":"souffleped","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Coarctation of the aorta"},{"correct":false,"justification":"Syndrome de Di-Georges","idx":1,"proposition":"Tetralogy of Fallot"},{"correct":false,"justification":"False","idx":2,"proposition":"Persistent ductus arteriosus"},{"correct":false,"justification":"False","idx":3,"proposition":"Ventricular septal defect"},{"correct":false,"justification":"False","idx":4,"proposition":"Inter-atrial communication"}],"type":"custom"}
+{"_id":"cirrhose-HGE-a4c99d","context":null,"enonce":"Maddrey's score includes:","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"TP"},{"correct":true,"justification":"True","idx":1,"proposition":"TQ"},{"correct":true,"justification":"True","idx":2,"proposition":"Total bilirubin"},{"correct":false,"justification":"","idx":3,"proposition":"INR"},{"correct":false,"justification":"","idx":4,"proposition":"Creatinine emia"}],"type":"custom"}
+{"_id":"329-urg-bc82f4cf-b2ef-445d-870f-465b1c169705","context":null,"enonce":"Which of the following propositions regarding compartment syndrome is true?","item":"polytrauma","matiere":"urg","propositions":[{"correct":false,"justification":"False. It is an immediate\/early complication that occurs within 24 hours. The development of unbearable pain at the site of the fracture is the diagnostic key to this complication.","idx":0,"proposition":"A. It is a late complication that can occur after fracture of a limb "},{"correct":false,"justification":"False false false !! The pulse is preserved. If they disappear, we should rather suspect acute ischemia of the limb ... or the very late stage of the compartment syndrome... that is, when the patient has lost his leg and is no longer in pain at all. So remember that \"PALOR\" and \"PULSELESSNESS\" are signs too late in the syndrome of the compartments","idx":1,"proposition":"Peripheral pulses are abolished"},{"correct":false,"justification":"False. The figure is correct: it is pathological if > 20 mmHg BUT the diagnosis is CLINICAL +++. So no need to make a pressure measurement to everyone","idx":2,"proposition":"The measurement of a pressure in the compartments > 20 mmHg is essential for diagnosis"},{"correct":true,"justification":"True! Nothing to say! ","idx":3,"proposition":"A discharge aponeurotomy is indicated within 6 hours"},{"correct":true,"justification":"True! It is related to a syndrome of the compartments of the forearm responsible for muscle retraction! Syndrome well to know that can be found in pediatrics when one performs poorly plasters (among others). \r\n\r\nAll this information can be found on page 343 of the last college of anesthesia resuscitation (not essential to read but it is free and online so it is the only one I have on hand","idx":4,"proposition":"Volkmann syndrome is responsible for a claw deformity of the hand "}],"type":"custom"}
+{"_id":"cirrhose-HGE-061073","context":null,"enonce":"Which of the following are compatible with cirrhosis?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Decline in TP"},{"correct":true,"justification":"True","idx":1,"proposition":"Decrease in factor V"},{"correct":false,"justification":"Increase in DRI (Decrease in TP)","idx":2,"proposition":"Decrease in DRI"},{"correct":true,"justification":"True","idx":3,"proposition":"Decreased albumin"},{"correct":false,"justification":"Increased free bilirubin","idx":4,"proposition":"Decrease in free bilirubin"}],"type":"custom"}
+{"_id":"algiespelviennes-gyn-6c2307","context":null,"enonce":"Regarding endometrioma. Which of the following are true?","item":"algiespelviennes","matiere":"gyn","propositions":[{"correct":true,"justification":"True. Endometrioma is ovarian endometriosis. See HAS 2017 recommendations.","idx":0,"proposition":"Pelvic ultrasound and pelvic MRI have similar performance for the diagnosis of endometriosis"},{"correct":true,"justification":"True","idx":1,"proposition":"If endometriosis is diagnosed, it is necessary to look for associated deep endometriosis"},{"correct":true,"justification":"True","idx":2,"proposition":"Endometrioma is ovarian endometriosis"},{"correct":true,"justification":"True","idx":3,"proposition":"The diagnosis of endometrioma should be made with caution after menopause so as not to ignore a malignant tumor"},{"correct":false,"justification":"False. Not at all. Endometrioma = ovarian endometriosis. Adenomyosis is the presence of endometrial cells in the myometrium.","idx":4,"proposition":"Endometrioma is synonymous with adenomyosis"}],"type":"custom"}
+{"_id":"MSN-urg-823cb7","context":null,"enonce":"Which of the following propositions are true about the MIN, when the doctor arrives at home?","item":"MSN","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Resuscitation maneuvers will be interrupted within a reasonable time in the absence of resumption of cardiac activity"},{"correct":false,"justification":"The doctor may propose to the parents, if they wish, to be present during the resuscitation","idx":1,"proposition":"If resuscitation maneuvers are undertaken, parents must leave the room"},{"correct":true,"justification":"True","idx":2,"proposition":"In the presence of the parents if they wish, it is recommended that the deceased child be completely stripped naked to be examined"},{"correct":false,"justification":"Intervention sheet + Examination of the child (as early as possible)","idx":3,"proposition":"No post-mortem gesture should be performed at home"},{"correct":true,"justification":"True","idx":4,"proposition":"The child's body must be transported to an MIN reference centre"}],"type":"custom"}
+{"_id":"ictere-HGE-368b2b","context":null,"enonce":"Which of the following are enzymes that sign cholestasis?","item":"ictere","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"STAKE"},{"correct":true,"justification":"True","idx":1,"proposition":"Gamma-GT"},{"correct":false,"justification":"Hepatic cytolysis","idx":2,"proposition":"ASAT"},{"correct":false,"justification":"Hepatic cytolysis","idx":3,"proposition":"ALAT"},{"correct":false,"justification":"Hepatic cytolysis","idx":4,"proposition":"TGO"}],"type":"custom"}
+{"_id":"Kcprostate-onco-7174d7","context":null,"enonce":"What is Amico's classification of prostate cancer with a PSA of 18 ng\/mL, a Gleason of 3+5 and a normal TR?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":false,"justification":"Raised in front of the Gleason","idx":0,"proposition":"Weak"},{"correct":false,"justification":"Raised in front of the Gleason","idx":1,"proposition":"Intermediary "},{"correct":true,"justification":"True. Low: T1C or T2a AND PSA <= 10 AND Gleason <= 6.  Intermediate: T2b OR 10 > PSA < 20 OR Gleason 7. High: T2c and sup OR PSA >= 20 OR Gleason >= 8","idx":2,"proposition":"High"},{"correct":false,"justification":"Raised in front of the Gleason","idx":3,"proposition":"Not enough item"},{"correct":false,"justification":"Raised in front of the Gleason","idx":4,"proposition":"The elements are contradictory"}],"type":"custom"}
+{"_id":"masseabdo-HGE-fd0599","context":null,"enonce":"Which of the following proposals are additional examinations to be carried out systematically upon discovery of hepatomegaly?","item":"masseabdo","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"NFS-P"},{"correct":true,"justification":"True","idx":1,"proposition":"Transaminases"},{"correct":true,"justification":"True","idx":2,"proposition":"Protein electrophoresis"},{"correct":false,"justification":"Depending on the clinic","idx":3,"proposition":"CRP"},{"correct":true,"justification":"True","idx":4,"proposition":"Billirubine"}],"type":"custom"}
+{"_id":"violence-gyn-ec85fb","context":null,"enonce":"With regard to sexual violence, which of these proposals are true?","item":"violence","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"16% of women say they have been raped or attempted rape in their lifetime"},{"correct":true,"justification":"True, DNA being fragile, it is necessary to take samples urgently to detect the presence of DNA to identify the aggressor","idx":1,"proposition":"A rape of less than 72 hours is a therapeutic emergency"},{"correct":false,"justification":"False, the lubricant may destroy the DNA or semen elements present in the vagina and thus \"contaminate\" the samples","idx":2,"proposition":"The clinical examination is done with caution, with a lubricated speculum"},{"correct":false,"justification":"False, the presence of toxic is made only if an element of the anamnesis or clinical examination indicates that there has been a possible consumption of toxics","idx":3,"proposition":"Among the samples systematically taken, we will look for STIs, the presence of pregnancy and the presence of toxic"},{"correct":true,"justification":"True, as well as the medical certificate that will be given to the patient or to the authorities in case of requisition","idx":4,"proposition":"Conventionally, among the documents given to the patient in case of rape there will be a prescription for emergency contraception, a prescription for preventive antibiotic therapy and a work stoppage"}],"type":"custom"}
+{"_id":"diarrheechr-HGE-b8ea55","context":null,"enonce":"From what time frame do we talk about chronic diarrhea?","item":"diarrheechr","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"3 days"},{"correct":false,"justification":"","idx":1,"proposition":"5 days"},{"correct":false,"justification":"","idx":2,"proposition":"15 days"},{"correct":true,"justification":"True","idx":3,"proposition":"4 weeks"},{"correct":false,"justification":"","idx":4,"proposition":"6 weeks"}],"type":"custom"}
+{"_id":"cirrhose-HGE-2a233f","context":null,"enonce":"Which of the following are signs of hepatic encephalopathy?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True, nycthemeral rhythm reversal","idx":0,"proposition":"Insomnia at night, hypersomnia during the day"},{"correct":true,"justification":"True","idx":1,"proposition":"Coma"},{"correct":true,"justification":"True, pyramid signs possible","idx":2,"proposition":"Babinsky sign"},{"correct":true,"justification":"True","idx":3,"proposition":"Behaviour change"},{"correct":false,"justification":"","idx":4,"proposition":"Jaundice"}],"type":"custom"}
+{"_id":"341-urg-efe35975-2a15-49bd-9494-2bfbb644720e","context":null,"enonce":"Which of the following propositions are true with regard to febrile seizures?","item":"convulsionsped","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A generalized febrile attack of 16 minutes with a fever at 41 ° C, in a child of 3 years without post-critical deficit, without particular history, with a normal neurological examination requires a lumbar puncture."},{"correct":true,"justification":"True","idx":1,"proposition":"A generalized febrile attack of 2 minutes with a fever at 38.5 ° C, in a child of 3 months without post-critical deficit, without any particular history, with a normal neurological examination requires a lumbar puncture."},{"correct":true,"justification":"True","idx":2,"proposition":"A generalized febrile attack of 2 minutes with a fever at 38.5 ° C, in a child of 3 months without post-critical deficit, without particular history, with a normal neurological examination requires monitoring of 4 hours in hospital."},{"correct":true,"justification":"True","idx":3,"proposition":"A febrile seizure with a focal onset of 22 minutes with a fever at 38.5 ° C, in a child of 3 years without post-critical deficit, without particular history, with a normal neurological examination requires the introduction of a background epileptic treatment."},{"correct":true,"justification":"True","idx":4,"proposition":"All answers are right"}],"type":"custom"}
+{"_id":"RGO-HGE-e71bea","context":null,"enonce":"Which of the following are true for the treatment of severe esophagitis?","item":"RGO","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Treatment relies on PEPs"},{"correct":true,"justification":"True","idx":1,"proposition":"Full dose PPI 8 weeks"},{"correct":false,"justification":"Mild esophagitis","idx":2,"proposition":"Half-dose PPI 4 weeks"},{"correct":false,"justification":"Prevention of recurrence","idx":3,"proposition":"PPIs minimum dose"},{"correct":false,"justification":"False","idx":4,"proposition":"Full dose PPI 4 weeks"}],"type":"custom"}
+{"_id":"RCIU-gyn-336276","context":null,"enonce":"Which of the following proposals are among the risk situations where screening for HCV infection is recommended?","item":"RCIU","matiere":"gyn","propositions":[{"correct":false,"justification":"Before 1990","idx":0,"proposition":"Recent transfusion"},{"correct":false,"justification":"Asian origin","idx":1,"proposition":"African descent"},{"correct":true,"justification":"True","idx":2,"proposition":"HCV+ Entourage"},{"correct":true,"justification":"True","idx":3,"proposition":"Drug addiction"},{"correct":true,"justification":"True","idx":4,"proposition":"HIV infection"}],"type":"custom"}
+{"_id":"recomedic-therapeutique-bdb5a6","context":null,"enonce":"Which of the following are true?","item":"recomedic","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A generic must have a qualitative composition in active substance equivalent to that of the originator medicinal product "},{"correct":true,"justification":"True","idx":1,"proposition":"A generic must have a quantitative active substance composition equivalent to that of the originator medicinal product "},{"correct":false,"justification":"Same scientific name but trade name (trademark) protected by intellectual property","idx":2,"proposition":"A generic can have the same trade name as the originator drug"},{"correct":true,"justification":"True","idx":3,"proposition":"A generic may be offered by the pharmacist instead of an originator drug"},{"correct":false,"justification":"Excipients differ","idx":4,"proposition":"A generic has excipients exactly identical to the originator drug"}],"type":"custom"}
+{"_id":"309-onco-76552a7b-16c5-4b9a-9935-487e7c99d133","context":null,"enonce":"Which of the following proposals regarding breast cancer is true?","item":"Kcsein","matiere":"onco","propositions":[{"correct":true,"justification":"True. Extension assessment to be carried out if invasive cancer T3\/T4 or N+","idx":0,"proposition":"Extension assessment is indicated in case of invasive ductal carcinoma stage T3"},{"correct":true,"justification":"True. The extension assessment is based on: TAP CT + bone scintigraphy OR PET-CT. Chest X-ray + abdo echo + bone scintigraphy is no longer done today (reason why it has disappeared from some referentials)","idx":1,"proposition":"The extension assessment can be based on the couple CT-TAP + bone scintigraphy"},{"correct":true,"justification":"True since the tumor is at the T2N0Mx stage. So no need a priori for an extension assessment if we stick to the recommendations of the reference system","idx":2,"proposition":"A patient with invasive ductal carcinoma of 3 cm on mammogram without lymph node involvement will not need an extension workup (a priori)"},{"correct":false,"justification":"FALSE, archi false!! The risk of lymphedema of the upper limb is major if we do this! This is a contraindication. For information, upper limb lymphedema and its management fell at the 2021 national white competition","idx":3,"proposition":"In case of axillary dissection, radiotherapy of the axillary hollow will be performed in addition "},{"correct":true,"justification":"TRUE: \r\n- Before menopause: anti-estrogens \r\n- After menopause: anti-aromatase \r\n\r\nDiscriminating notion: It is said in the course that anti-estrogens are responsible for endometrial cancers while they have a beneficial action on breast cancer...\r\n\r\nThis is because they act: \r\n- on receptors in the breast as inhibitors to the action of estrogen = rotector role against cancer \r\n\r\n- on endometrial receptors as ACTIVATORS to the action of estrogen = pro-oncogenic","idx":4,"proposition":"The hormone therapy of choice after menopause are anti-aromatase "}],"type":"custom"}
+{"_id":"diverticulose-HGE-c4d588","context":null,"enonce":"At what stage of the Hinchey classification is surgery mandatory?","item":"diverticulose","matiere":"HGE","propositions":[{"correct":false,"justification":"Radiological drainage possible (if >3-5 cm depending on the source)","idx":0,"proposition":"Ib"},{"correct":false,"justification":"Radiological drainage possible (if >3-5 cm depending on the source)","idx":1,"proposition":"II"},{"correct":true,"justification":"True, resection surgery (sigmoidectomy)","idx":2,"proposition":"III"},{"correct":false,"justification":"","idx":3,"proposition":"IV"},{"correct":false,"justification":"","idx":4,"proposition":"It is always mandatory"}],"type":"custom"}
+{"_id":"systemeconv-sp-4bbb34","context":null,"enonce":"Outside the care pathway, what percentage of the tariff is covered by social security (excluding exceptions such as emergencies)?","item":"systemeconv","matiere":"sp","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"0 %"},{"correct":true,"justification":"True","idx":1,"proposition":"30 %"},{"correct":false,"justification":"","idx":2,"proposition":"15 %"},{"correct":false,"justification":"","idx":3,"proposition":"50 %"},{"correct":false,"justification":"This is the case when it is in the care pathway","idx":4,"proposition":"70 %"}],"type":"custom"}
+{"_id":"Exprenuptial-gyn-cc61c0","context":null,"enonce":"Regarding vaccination in pregnant women. Which vaccine(s) are not recommended during pregnancy?","item":"Exprenuptial","matiere":"gyn","propositions":[{"correct":true,"justification":"True. It is not a live vaccine so it is not contraindicated during pregnancy, but it is not recommended to vaccinate pregnant women in France. On the other hand, it is desirable to vaccinate women before or after childbirth. ","idx":0,"proposition":"Whooping cough"},{"correct":true,"justification":"True. It is a live vaccine and therefore contraindicated in pregnant women. On the other hand, it is recommended to vaccinate all women with rubella-negative serology pre-conceptional. Women who have received 2 prior vaccinations should not be vaccinated, regardless of the result of serology if it is performed. Due to the teratogenic risk, it is necessary to ensure the absence of an early pregnancy and to avoid any pregnancy within 2 months of vaccination. ","idx":1,"proposition":"Rubella"},{"correct":true,"justification":"True. It is a live vaccine with a teratogenic risk. Women of childbearing age who have no history of chickenpox should be vaccinated. Vaccination is possible if the pregnancy test is negative. Effective contraception for 3 months is recommended after each dose of vaccine. ","idx":2,"proposition":"Chickenpox"},{"correct":false,"justification":"The flu vaccine is recommended for pregnant women because pregnant women are a population at risk of severe influenza (fetal death and maternal death, refractory hypoxemia, etc.). ","idx":3,"proposition":"Influenza"},{"correct":true,"justification":"True. It is a live vaccine, therefore teratogenic. ","idx":4,"proposition":"Measles"}],"type":"custom"}
+{"_id":"ADP-hemato-0527d5","context":null,"enonce":"Which of the following are differential diagnoses (DD) of right supraclavicular lymphadenopathy?","item":"ADP","matiere":"hemato","propositions":[{"correct":false,"justification":"It would give lymphadenopathy of the submandibular chain","idx":0,"proposition":"Mandibular cancer"},{"correct":false,"justification":"Not a DD but a sign + lymphadenopathy would be on the left","idx":1,"proposition":"Digestive cancer"},{"correct":true,"justification":"True","idx":2,"proposition":"Brachial plexus schwannoma"},{"correct":true,"justification":"True","idx":3,"proposition":"Cancer of the pulmonary apex"},{"correct":false,"justification":"It would give pre-laryngeal lymphadenopathy","idx":4,"proposition":"Cyst of the thyroglossal tract"}],"type":"custom"}
+{"_id":"droits-sp-10d132","context":null,"enonce":"How many years should a medical record be kept after a person's death?","item":"droits","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"10 years"},{"correct":false,"justification":"False","idx":1,"proposition":"14 years"},{"correct":false,"justification":"False","idx":2,"proposition":"20 years"},{"correct":false,"justification":"False","idx":3,"proposition":"25 years"},{"correct":false,"justification":"False","idx":4,"proposition":"5 years"}],"type":"custom"}
+{"_id":"231-cardio-9be21691-9029-415e-8cea-575cd0b315a5","context":null,"enonce":"Which of the following signs indicate the severity of aortic insufficiency?","item":"valvuloP","matiere":"cardio","propositions":[{"correct":false,"justification":"FALSE: The breath of aortic insufficiency is HOLODIASTOLIC decrescendo. The ejective systolic murmur is not a sign of severity but an added noise that can be heard in the IAo","idx":0,"proposition":"Ejective systolic murmur "},{"correct":true,"justification":"True","idx":1,"proposition":"Proto-diastolic gallop (B3)"},{"correct":false,"justification":"FALSE: Abolition of B2 is a criterion of severity of aortic stricture","idx":2,"proposition":"Abolition of B2"},{"correct":false,"justification":"","idx":3,"proposition":"A surface area < 0.6 cm²\/m² at the ETT"},{"correct":true,"justification":"True. In total, the signs of severity of aortic insufficiency are: - apexian flint rolling (= functional mitral narrowing) - protodiastolic gallop (B3) - enlargement of the peak shock - the regurgitated volume > 60 mL at ETT ","idx":4,"proposition":"A regurgitating volume > 60 mL at ETT"}],"type":"custom"}
+{"_id":"Kcphysiopath-onco-367503","context":null,"enonce":"Regarding Lynch syndrome:","item":"Kcphysiopath","matiere":"onco","propositions":[{"correct":true,"justification":"True, MisMatch Repair -> we can no longer repair errors😥","idx":0,"proposition":"The gene is caused is part of the MMR system"},{"correct":false,"justification":"Dominant","idx":1,"proposition":"It is autosomal recessive"},{"correct":true,"justification":"True","idx":2,"proposition":"One of the genes involved is MSH2"},{"correct":false,"justification":"","idx":3,"proposition":"All propositions are true"},{"correct":true,"justification":"True","idx":4,"proposition":"The risk of developing colorectal cancer is 70 to 80% over the course of a lifetime."}],"type":"custom"}
+{"_id":"cirrhose-HGE-0faf02","context":null,"enonce":"Which of the following are true about Meld's score?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It evaluates the prognosis of cirrhosis"},{"correct":true,"justification":"True","idx":1,"proposition":"It contains bilirubin"},{"correct":true,"justification":"True","idx":2,"proposition":"It includes INR"},{"correct":true,"justification":"True","idx":3,"proposition":"It includes serum creatinine"},{"correct":false,"justification":"This is the case of the score of Lille","idx":4,"proposition":"It contains albumin"}],"type":"custom"}
+{"_id":"droits-sp-a08e34","context":null,"enonce":"How many years should a medical record of a minor patient be kept?","item":"droits","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"10 years after reaching the age of majority"},{"correct":true,"justification":"True","idx":1,"proposition":"Until he turned 28"},{"correct":false,"justification":"","idx":2,"proposition":"5 years"},{"correct":false,"justification":"","idx":3,"proposition":"15 years"},{"correct":false,"justification":"","idx":4,"proposition":"25 years"}],"type":"custom"}
+{"_id":"diverticulose-HGE-b17750","context":null,"enonce":"Which of the following is an additional examination(s) to be performed to confirm diverticulitis?","item":"diverticulose","matiere":"HGE","propositions":[{"correct":false,"justification":"Useless, we see nothing 🙈","idx":0,"proposition":"Abdominal ultrasound"},{"correct":true,"justification":"True, cornerstone of diagnosis. We see diverticula, a colonic wall > 4mm, and fatty infiltration","idx":1,"proposition":"Abdominal angioscan"},{"correct":false,"justification":"Transaminases are useless. A NFS-P CRP (for PNN hyperleuco and biological inflammatory syndrome) Creatinine (before angioscan) is done. In women of childbearing age who do not have well-followed contraception, it is thought to ask for DDR +\/- b-HCG 🙃","idx":2,"proposition":"NFS CRP Transaminases"},{"correct":false,"justification":"","idx":3,"proposition":"Abdominal-pelvic MRI"},{"correct":false,"justification":"Don't go too far ahead on confirming diverticulitis 😬","idx":4,"proposition":"Digital rectal examination"}],"type":"custom"}
+{"_id":"PF-neuro-a0ec41","context":null,"enonce":"Which of the following are true about peripheral facial paralysis?","item":"PF","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The motor deficit is homogeneous"},{"correct":true,"justification":"True","idx":1,"proposition":"There is no automatic-voluntary dissociation"},{"correct":true,"justification":"True","idx":2,"proposition":"It concerns damage to the facial nerve VII"},{"correct":false,"justification":"No dissociation","idx":3,"proposition":"There is a frank automatic-voluntary dissociation"},{"correct":false,"justification":"It is homogeneous (sup + inf)","idx":4,"proposition":"The motor deficit concerns only the lower part of the face"}],"type":"custom"}
+{"_id":"lithiaseB-HGE-b87242","context":null,"enonce":"Which of the following are treatments for acute cholecystitis?","item":"lithiaseB","matiere":"HGE","propositions":[{"correct":false,"justification":"Accurate for isolated hepatic colic","idx":0,"proposition":"Therapeutic abstention"},{"correct":true,"justification":"True","idx":1,"proposition":"Antibiotics"},{"correct":true,"justification":"True","idx":2,"proposition":"Filling"},{"correct":true,"justification":"True","idx":3,"proposition":"Emergency cholecystectomy"},{"correct":false,"justification":"Cholangitis","idx":4,"proposition":"ERPC"}],"type":"custom"}
+{"_id":"Kcdermato-onco-d2a141","context":null,"enonce":"Which of the following is the main precursor of cutaneous squamous cell carcinomas?","item":"Kcdermato","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Actinic keratosis"},{"correct":false,"justification":"It is the main precursor of mucosal squamous cell carcinomas","idx":1,"proposition":"Leukoplakia"},{"correct":false,"justification":"Bright red erythematous lesion of the glans, well\r\nlimited, sometimes discreetly erosive -> it is carcinoma in situ","idx":2,"proposition":"Erythroplasia of Queyrat"},{"correct":false,"justification":"Benign epithelial tumor due to HPV2","idx":3,"proposition":"Common wart"},{"correct":false,"justification":"Benign epithelial tumor without malignant potential","idx":4,"proposition":"Condyloma"}],"type":"custom"}
+{"_id":"Kcdermato-onco-a845ea","context":null,"enonce":"Which of the following are tumours with a risk factor for sun exposure?","item":"Kcdermato","matiere":"onco","propositions":[{"correct":true,"justification":"True, short sun exposure, no precancerous lesion, clear phenotype","idx":0,"proposition":"Basal cell carcinoma"},{"correct":true,"justification":"True, solar burns in childhood","idx":1,"proposition":"Melanoma"},{"correct":true,"justification":"True, chronic and prolonged sun exposure","idx":2,"proposition":"Squamous cell carcinoma"},{"correct":false,"justification":"False","idx":3,"proposition":"Condyloma"},{"correct":false,"justification":"False","idx":4,"proposition":"The nevus"}],"type":"custom"}
+{"_id":"Kcprostate-onco-c3a3bc","context":null,"enonce":"Which of the following propositions are true about brachytherapy?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is a permanent implantation of iodine-125 grains perineally under ultrasound control"},{"correct":false,"justification":"This is done under AG or AL","idx":1,"proposition":"Anesthesia is general"},{"correct":false,"justification":"As well as two subgroups of intermediate risks: PSA between 10 and 15 and\/or presence of minority grade 4 (GG2)","idx":2,"proposition":"It concerns the low-risk group of Amico exclusively"},{"correct":true,"justification":"True","idx":3,"proposition":"It is contraindicated if the prostate is more than 60 mL"},{"correct":false,"justification":"This is the standard treatment option with the lowest risk of leading to erectile dysfunction.","idx":4,"proposition":"The risk of erectile dysfunction is maximum "}],"type":"custom"}
+{"_id":"systemeconv-sp-7f7ffa","context":null,"enonce":"Which of the following are PSRs for treating physicians?","item":"systemeconv","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Diabetes monitoring"},{"correct":true,"justification":"True","idx":1,"proposition":"Monitoring hypertension"},{"correct":true,"justification":"True","idx":2,"proposition":"Breast cancer screening"},{"correct":false,"justification":"","idx":3,"proposition":"Screening for Alzeihmer's disease"},{"correct":false,"justification":"Prescription of generics (in INN)","idx":4,"proposition":"Prescription of originators"}],"type":"custom"}
+{"_id":"choc-urg-b97eef","context":null,"enonce":"Which of the following proposals are shocks with decreased cardiac output?","item":"choc","matiere":"urg","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"Anaphylactic shock"},{"correct":false,"justification":"= Septic shock","idx":1,"proposition":"Vasoplegic shock"},{"correct":false,"justification":"","idx":2,"proposition":"Septic shock"},{"correct":true,"justification":"True, DC = LVEF x FC. Decrease in LVEF in hypovolemic shock","idx":3,"proposition":"Hypovolemic shock"},{"correct":true,"justification":"True, DC = LVEF x FC. Decreased HR in cardiogenic shock","idx":4,"proposition":"Cardiogenic shock"}],"type":"custom"}
+{"_id":"HTA-cardio-91445c","context":null,"enonce":"What are the real proposals?","item":"HTA","matiere":"cardio","propositions":[{"correct":false,"justification":"False, renin is the enzyme that cleaves angiotensinogen into angiotensin I. Angiotensinogen is of hepatic origin. Renin is of renal origin","idx":0,"proposition":"Renin is responsible for the secretion of angiotensinogens that will be metabolized to give angiotensin I"},{"correct":true,"justification":"True, renin is secreted in response to sympathetic nervous system stimulation, hypovolemia or increased natriuresis","idx":1,"proposition":"Autonomic neuropathy may decrease renin secretion"},{"correct":false,"justification":"False, angiotensin vasoconstrict large vessels as well as efferent arterioles of the glomeruli","idx":2,"proposition":"Angiotensin II is a powerful vasodilator"},{"correct":true,"justification":"True, angiotensin II stimulates vasoconstriction as well as adrenal aldosterone secretion","idx":3,"proposition":"Angiotensin stimulates the secretion of aldosterone"},{"correct":false,"justification":"","idx":4,"proposition":" "}],"type":"custom"}
+{"_id":"IC-cardio-93abcf","context":null,"enonce":"Which of the following are causes of dilated cardiomyopathies?","item":"IC","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Myocarditis"},{"correct":true,"justification":"True","idx":1,"proposition":"Myopericarditis"},{"correct":true,"justification":"True","idx":2,"proposition":"Vitamin B1 deficiency"},{"correct":false,"justification":"Rather hypertrophic cardiomyopathy","idx":3,"proposition":"High blood pressure"},{"correct":false,"justification":"Cause of heart failure","idx":4,"proposition":"Valvular heart disease"}],"type":"custom"}
+{"_id":"systemeconv-sp-d68e28","context":null,"enonce":"How many health professionals are there in France approximately?","item":"systemeconv","matiere":"sp","propositions":[{"correct":false,"justification":"This is the approximate number of doctors","idx":0,"proposition":"200 000"},{"correct":false,"justification":"False","idx":1,"proposition":"1 million"},{"correct":true,"justification":"True","idx":2,"proposition":"2 million"},{"correct":false,"justification":"False","idx":3,"proposition":"5 million"},{"correct":false,"justification":"False","idx":4,"proposition":"10 million"}],"type":"custom"}
+{"_id":"cirrhose-HGE-56b2e3","context":null,"enonce":"What is the estimated survival of 1 year for Child Pugh A?","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"100 %"},{"correct":false,"justification":"This is the case for Child Pugh C","idx":1,"proposition":"45 %"},{"correct":false,"justification":"","idx":2,"proposition":"90 %"},{"correct":false,"justification":"This is the case for Child Pugh B","idx":3,"proposition":"80 %"},{"correct":false,"justification":"","idx":4,"proposition":"5 %"}],"type":"custom"}
+{"_id":"103-neuro-d13dad8b-c047-4d22-86ba-572afafe52bb","context":null,"enonce":"Regarding infant epilepsy. Which of the following are true?","item":"epilepsie","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"A fall of the head with elevation of the arms must evoke West Syndrome."},{"correct":false,"justification":"False: infantile spasms of West syndrome are to be distinguished from myoclonus","idx":1,"proposition":"Myoclonus in flexion should evoke West Syndrome."},{"correct":false,"justification":"False: EEG hypsarrhythmia","idx":2,"proposition":"Psychomotor regression or stagnation of acquisitions associated with MRI hypsarrhythmia should suggest West Syndrome."},{"correct":true,"justification":"True","idx":3,"proposition":"Dravet syndrome is rare, and usually gives an intellectual disability"},{"correct":true,"justification":"True","idx":4,"proposition":"Dravet syndrome is resistant to treatment"}],"type":"custom"}
+{"_id":"Frped-urg-34521e","context":null,"enonce":"Which of the following are true?","item":"Frped","matiere":"urg","propositions":[{"correct":false,"justification":"Traumatology is the leading cause of death between the ages of 1 and 19 years","idx":0,"proposition":"Cancers are the leading cause of death between the ages of 1 and 19"},{"correct":true,"justification":"","idx":1,"proposition":"Before two years any trauma with invoice must always evoke abuse"},{"correct":true,"justification":"","idx":2,"proposition":"Solitary bone cyst is a cause of pathological fracture"},{"correct":true,"justification":"","idx":3,"proposition":"The ligament structures of the child are more resistant than the metaphyses"},{"correct":false,"justification":"They are rarer","idx":4,"proposition":"True sprains and isolated dislocations are more common than fractures"}],"type":"custom"}
+{"_id":"RCIU-gyn-0078e7","context":null,"enonce":"Which of the following proposals reduces the risk of hyaline membrane disease in premature infants?","item":"RCIU","matiere":"gyn","propositions":[{"correct":false,"justification":"Used for tocolysis","idx":0,"proposition":"Salbutamol"},{"correct":false,"justification":"Used for tocolysis","idx":1,"proposition":"Anti-calcium"},{"correct":true,"justification":"True","idx":2,"proposition":"Corticosteroids"},{"correct":false,"justification":"False","idx":3,"proposition":"NSAIDs"},{"correct":false,"justification":"Counteracts the risk of hypoglycemia","idx":4,"proposition":"Glucose"}],"type":"custom"}
+{"_id":"aNcycle-gyn-c246f6","context":null,"enonce":"Regarding the abnormalities of the menstrual cycle which of these propositions are true?","item":"aNcycle","matiere":"gyn","propositions":[{"correct":false,"justification":"Wrong, it's the other way around. In addition, the terms oligomenorrhea and spaniomenorrhea are synonymous.","idx":0,"proposition":"Hypomenorrhea are too infrequent, while oligomenorrhea are too low periods"},{"correct":true,"justification":"True, this is what corresponds to the rating of the Higham score which must be >100 to talk about menorrhagia","idx":1,"proposition":"To assess the abundance of gynaecological bleeding at the interrogation it is necessary to ask the number of protections used as well as the amount of blood on them."},{"correct":true,"justification":"True, hence the adage \"every woman of childbearing age is pregnant until proven otherwise\"","idx":2,"proposition":"Pregnancy should be systematically considered and ruled out by a BHCG assay"},{"correct":false,"justification":"False, in front of bleeding and a positive pregnancy test, the first cause to eliminate is ectopic pregnancy.","idx":3,"proposition":"Bleeding associated with a positive BHCG assay should eliminate a spontaneous miscarriage as a first line"},{"correct":true,"justification":"True, but also adenomyosis, bleeding disorders etc...","idx":4,"proposition":"Causes of menometrorrhagia include fibroids, myomas or endometrial cancers."}],"type":"custom"}
+{"_id":"polytrauma-urg-acf900","context":null,"enonce":"Which of the following proposals regarding the hospital management of a polytraumatized patient are true?","item":"polytrauma","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The biological assessment of a polytrauma patient necessarily contains the grouping and search for RAI"},{"correct":false,"justification":"False, in the middle cerebral arteries","idx":1,"proposition":"Transcranial Doppler looks for cerebral hypoperfusion in the anterior communicating artery. "},{"correct":false,"justification":"False, FAST is a rapid abdominal, pleural and cardiac ultrasound. ","idx":2,"proposition":"FAST ultrasound verifies the integrity of the vascular axes of the 4 limbs"},{"correct":false,"justification":"False, the whole body scanner is performed in 2nd step, without, then with injection of iodinated contrast medium. ","idx":3,"proposition":"The BodyCT, performed during the 3rd phase of management as part of the lesion assessment, is a whole body scanner without injection. "},{"correct":true,"justification":"True","idx":4,"proposition":"The thoracic part of the bodyCT allows among other things to find the 10-20% of pneumothorax that are not visible on the standard X-ray"}],"type":"custom"}
+{"_id":"Kcphysiopath-onco-3cf87f","context":null,"enonce":"Which of the following proposals designate oncogenic viruses?","item":"Kcphysiopath","matiere":"onco","propositions":[{"correct":true,"justification":"True, T-cell lymphoma","idx":0,"proposition":"HTLV1"},{"correct":true,"justification":"True","idx":1,"proposition":"HBV"},{"correct":true,"justification":"True","idx":2,"proposition":"EBV"},{"correct":true,"justification":"True","idx":3,"proposition":"HPV"},{"correct":false,"justification":"It's not a virus (sorry 😘)","idx":4,"proposition":"Helicobacter Pylori"}],"type":"custom"}
+{"_id":"nvxne-gyn-e942da","context":null,"enonce":"Which of the following are the following proposals for a normal umbilical cord?","item":"nvxne","matiere":"gyn","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"2 arteries and 2 veins"},{"correct":false,"justification":"False","idx":1,"proposition":"3 arteries and 1 vein"},{"correct":false,"justification":"False","idx":2,"proposition":"1 artery and 1 vein"},{"correct":false,"justification":"False","idx":3,"proposition":"1 artery and 2 veins"},{"correct":true,"justification":"True","idx":4,"proposition":"2 arteries and 1 vein"}],"type":"custom"}
+{"_id":"ascite-HGE-c20168","context":null,"enonce":"Regarding albumin compensation:","item":"ascite","matiere":"HGE","propositions":[{"correct":false,"justification":"From a certain volume (2L or 5L depending on the source)","idx":0,"proposition":"It is done regardless of the volume of ascites punctured"},{"correct":false,"justification":"Human albumin","idx":1,"proposition":"It is made from calf albumin"},{"correct":false,"justification":"Less than 10 g","idx":2,"proposition":"1 L of ascites corresponds to 20 g of albumin"},{"correct":false,"justification":"","idx":3,"proposition":"It is only below a certain blood pressure threshold"},{"correct":true,"justification":"True","idx":4,"proposition":"All proposals are wrong"}],"type":"custom"}
+{"_id":"diarrheechr-HGE-bf894c","context":null,"enonce":"Which of the following are causes of osmotic diarrhea (by attraction of water into the intestinal lumen)?","item":"diarrheechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Taking osmotic laxatives"},{"correct":false,"justification":"Diarrhea due to malabsorption","idx":1,"proposition":"Celiac disease"},{"correct":false,"justification":"No diarrhea","idx":2,"proposition":"Sigmoid"},{"correct":false,"justification":"Diarrhea with normal transit","idx":3,"proposition":"Irritable bowel syndrome"},{"correct":true,"justification":"True","idx":4,"proposition":"Lactase deficiency"}],"type":"custom"}
+{"_id":"MSN-urg-1aed96","context":null,"enonce":"Which of the following are true?","item":"MSN","matiere":"urg","propositions":[{"correct":false,"justification":"NIMs would occur more frequently when the socio-economic conditions of the family are unfavourable.","idx":0,"proposition":"NIMs would occur more frequently when the socio-economic conditions of the family are favourable."},{"correct":false,"justification":"Co-sleeping (the fact that the infant sleeps in the same bed as the parents) is a risk factor for MIN.","idx":1,"proposition":"To avoid unexpected infant death, co-sleeping should be encouraged."},{"correct":true,"justification":"True","idx":2,"proposition":"Unexpected infant death most often occurs in infants between 2 and 4 months of age"},{"correct":true,"justification":"","idx":3,"proposition":"In France, approximately 500 infants under 2 years of age die unexpectedly annually"},{"correct":false,"justification":"Between 18 and 20ºC","idx":4,"proposition":"To prevent unexpected infant death, the temperature of the chamber should be maintained at 24ºC."}],"type":"custom"}
+{"_id":"pancreatitechr-HGE-cf07cc","context":null,"enonce":"What is the main etiology of chronic calcifying pancreatitis in developed countries?","item":"pancreatitechr","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"Obesity"},{"correct":false,"justification":"","idx":1,"proposition":"Malnutrition"},{"correct":true,"justification":"True","idx":2,"proposition":"Alcohol"},{"correct":false,"justification":"","idx":3,"proposition":"Tobacco"},{"correct":false,"justification":"","idx":4,"proposition":"Genetics"}],"type":"custom"}
+{"_id":"PF-neuro-611a47","context":null,"enonce":"Which of the following are signs of facial paralysis?","item":"PF","matiere":"neuro","propositions":[{"correct":false,"justification":"No ptosis but, on the contrary, a difficulty in closing the eye","idx":0,"proposition":"Ptosis of the eye"},{"correct":false,"justification":"False","idx":1,"proposition":"Enlargement of the palpebral cleft"},{"correct":true,"justification":"True","idx":2,"proposition":"Sign of Charles Bell"},{"correct":true,"justification":"True","idx":3,"proposition":"Erasure of forehead wrinkles"},{"correct":true,"justification":"True","idx":4,"proposition":"Eye ectropion "}],"type":"custom"}
+{"_id":"Kcprostate-onco-f8920d","context":null,"enonce":"Which of the following are true about abiraterone acetate?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is contraindicated in case of treatment-refractory hypertension"},{"correct":true,"justification":"True","idx":1,"proposition":"The appearance of oedema should be monitored"},{"correct":false,"justification":"It is hepatic","idx":2,"proposition":"Toxicity is renal"},{"correct":false,"justification":"Hypokalemia","idx":3,"proposition":"It can cause hyperkalemia"},{"correct":false,"justification":"The toxicity of prednisone 10mg\/day should be monitored","idx":4,"proposition":"Concomitant corticosteroid therapy is too low to require monitoring"}],"type":"custom"}
+{"_id":"lithiaseB-HGE-bb9d49","context":null,"enonce":"What is the proportion of asymptomatic cholelithiasis?","item":"lithiaseB","matiere":"HGE","propositions":[{"correct":false,"justification":"The majority are asympto!","idx":0,"proposition":"0%"},{"correct":true,"justification":"True","idx":1,"proposition":"80%"},{"correct":false,"justification":"","idx":2,"proposition":"20%"},{"correct":false,"justification":"","idx":3,"proposition":"50%"},{"correct":false,"justification":"","idx":4,"proposition":"99%"}],"type":"custom"}
+{"_id":"ictere-HGE-38fc66","context":null,"enonce":"Which of the following are true?","item":"ictere","matiere":"HGE","propositions":[{"correct":false,"justification":"Red blood cells","idx":0,"proposition":"Bilirubin is a breakdown product of platelets"},{"correct":true,"justification":"True, upstream of the liver so unconjugated","idx":1,"proposition":"Hemolysis is a possible etiology of unconjugated bilirubin jaundice"},{"correct":true,"justification":"True","idx":2,"proposition":"Gilbert's disease is inherited autosomal recessive"},{"correct":false,"justification":"","idx":3,"proposition":"All propositions are true"},{"correct":false,"justification":"It's in micromoles 😊","idx":4,"proposition":"A normal billirubine is below about 20 millimoles"}],"type":"custom"}
+{"_id":"RCIU-gyn-bcb818","context":null,"enonce":"What is the prevalence of pregnant women not immune to toxoplasmosis?","item":"RCIU","matiere":"gyn","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"2%"},{"correct":false,"justification":"False","idx":1,"proposition":"5%"},{"correct":false,"justification":"False","idx":2,"proposition":"12%"},{"correct":false,"justification":"False","idx":3,"proposition":"20%"},{"correct":true,"justification":"True","idx":4,"proposition":"50%"}],"type":"custom"}
+{"_id":"greffe-immuno-49d9e1","context":null,"enonce":"Which of the following are true about corneal transplantation?","item":"greffe","matiere":"immuno","propositions":[{"correct":false,"justification":"Existing and mandatory national waiting list","idx":0,"proposition":"Unlike other types of transplants, there is no national waiting list for corneal transplantation."},{"correct":false,"justification":"The eye stays in place, we just scalp the cornea","idx":1,"proposition":"It consists, in the donor, in removing the eyeball"},{"correct":false,"justification":"No impact of age or abnormalities of refraction","idx":2,"proposition":"Myopic corneas cannot be removed"},{"correct":true,"justification":"True","idx":3,"proposition":"The transplant success rate is high (>80%)"},{"correct":true,"justification":"True","idx":4,"proposition":"Hepatitis infection is a contraindication to corneal sampling"}],"type":"custom"}
+{"_id":"dlrabdogrossesse-gyn-d4d2f9","context":null,"enonce":"Which of the following propositions are true regarding uterine rupture?","item":"dlrabdogrossesse","matiere":"gyn","propositions":[{"correct":true,"justification":"True. Text the explanatory sentence of the msd manual: https:\/\/www.msdmanuals.com\/fr\/professional\/gyn%C3%A9cologie-et-obst%C3%A9trique\/anomalies-et-complications-du-travail-et-de-accouchement\/rupture-ut%C3%A9rine","idx":0,"proposition":"Uterine rupture is a spontaneous tear of the uterus that can cause the fetus to expel into the peritoneal cavity."},{"correct":true,"justification":"True","idx":1,"proposition":"We think about it especially in case of history of caesarean section"},{"correct":false,"justification":"It is an absolute emergency, putting the child's ⚡ prognosis at stake","idx":2,"proposition":"The vital prognosis of the fetus is not at risk in the short term"},{"correct":false,"justification":"sudden acute pain, uterine deformity, red blood metrorrhagia (arterial) 🔴","idx":3,"proposition":"We find the triad: chronic pain gradually ascending, uterine deformity, metrorrhagia of blackish ⚫ blood"},{"correct":true,"justification":"True","idx":4,"proposition":"Fetal heart rhythm abnormalities are almost always found"}],"type":"custom"}
+{"_id":"MSN-urg-34a157","context":null,"enonce":"Which of the following are systematic additional reviews for INM? (based on HAS, 2009)","item":"MSN","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"CT or MRI Brain"},{"correct":true,"justification":"True","idx":1,"proposition":"Chest X-ray"},{"correct":false,"justification":"Front only","idx":2,"proposition":"X-ray of the profile pelvis"},{"correct":false,"justification":"Front only","idx":3,"proposition":"X-ray of the front and profile limbs"},{"correct":true,"justification":"True","idx":4,"proposition":"X-ray of the spine from the front and profile"}],"type":"custom"}
+{"_id":"RGO-HGE-4b2478","context":null,"enonce":"How often is endobrachyoesophageal monitoring longer than 6 centimeters?","item":"RGO","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Every 2 years"},{"correct":false,"justification":"Less than 3 cm","idx":1,"proposition":"Every 5 years"},{"correct":false,"justification":"between 3 and 6 cm","idx":2,"proposition":"Every 3 years"},{"correct":false,"justification":"An OBE is always monitored","idx":3,"proposition":"No monitoring"},{"correct":true,"justification":"True","idx":4,"proposition":"An OBE is always monitored"}],"type":"custom"}
+{"_id":"MAI-immuno-3e6660","context":null,"enonce":"Which of the following proposals is (are) a marker(s) of organ-specific autoimmune diseases?","item":"MAI","matiere":"immuno","propositions":[{"correct":true,"justification":"True, autoimmune diseases of the intestine","idx":0,"proposition":"Anti-transglutaminase antibodies"},{"correct":false,"justification":"","idx":1,"proposition":"Anti-nuclear antibodies"},{"correct":false,"justification":"","idx":2,"proposition":"Anti-cytoplasmic antibodies of neutrophils"},{"correct":true,"justification":"True, primary biliary cholangitis","idx":3,"proposition":"Anti-mitochondrial antibodies of type M2"},{"correct":false,"justification":"","idx":4,"proposition":"Anti-JO1 antibodies"}],"type":"custom"}
+{"_id":"cephalee-neuro-a946d7","context":null,"enonce":"What is the examination to request in first line in case of suspicion of non-traumatic subarachnoid hemorrhage?","item":"cephalee","matiere":"neuro","propositions":[{"correct":false,"justification":"False, rarely in the first intention","idx":0,"proposition":"Brain MRI"},{"correct":false,"justification":"False, IC if signs of commitment or ICH (common in case of subarachnoid hemorrhage)","idx":1,"proposition":"Microbiological"},{"correct":false,"justification":"False, useless for diagnosis","idx":2,"proposition":"Ultrasound of the carotid arteries"},{"correct":false,"justification":"False, not in the first intention","idx":3,"proposition":"Cerebral angiography"},{"correct":true,"justification":"True","idx":4,"proposition":"Brain scan"}],"type":"custom"}
+{"_id":"nvxne-gyn-3ed036","context":null,"enonce":"Which of the following propositions are true about transfusion-transfusion syndrome (TTS)?","item":"nvxne","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is also known as feto-fetal transfusion syndrome "},{"correct":true,"justification":"True, 60-100% in severe cases (wikipedia)","idx":1,"proposition":"Morbidity and mortality rate is high"},{"correct":false,"justification":"False","idx":2,"proposition":"It concerns all multiple pregnancies"},{"correct":true,"justification":"True","idx":3,"proposition":"It concerns monochorionic twin pregnancies"},{"correct":true,"justification":"True, before 26 weeks ","idx":4,"proposition":"It appears in the first half of pregnancy "}],"type":"custom"}
+{"_id":"puberte-gyn-78f51e","context":null,"enonce":"Which of the following are true?","item":"puberte","matiere":"gyn","propositions":[{"correct":true,"justification":"True. The onset of puberty is defined in girls by the appearance of breasts that occurs physiologically between 8 and 13 years of age.","idx":0,"proposition":"The onset of puberty is defined by the appearance of breasts (thelarche)."},{"correct":false,"justification":"The onset of puberty in boys is defined by the increase in testicular volume (volume > 4ml) observed between 9 and 14 years.","idx":1,"proposition":"The onset of puberty in boys is defined by an increase in the size of the penis."},{"correct":true,"justification":"True","idx":2,"proposition":"Voice molting in boys usually occurs between the ages of 14 and 15."},{"correct":true,"justification":"True On side in SX\/GX-PX Sometimes you can see AX that corresponds to the development of axillary pillosity that we also side in practice?","idx":3,"proposition":"The Tanner classification is used to assess an individual's pubertal development."},{"correct":false,"justification":"FALSE. There is no stage 0 in the Tanner classification. The absence of breast development corresponds to S1.","idx":4,"proposition":"In the Tanner classification, S0 corresponds to the absence of breast development."}],"type":"custom"}
+{"_id":"systemeconv-sp-fe31ef","context":null,"enonce":"What is the amount of the medical deductible in the general case for a consultation with a doctor?","item":"systemeconv","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"1 euro"},{"correct":false,"justification":"","idx":1,"proposition":"2 euros"},{"correct":false,"justification":"","idx":2,"proposition":"0.5 euro"},{"correct":false,"justification":"","idx":3,"proposition":"0 euro"},{"correct":false,"justification":"","idx":4,"proposition":"5 eurs"}],"type":"custom"}
+{"_id":"asthme-immuno-7c255c","context":null,"enonce":"Which of the following are true?","item":"asthme","matiere":"immuno","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Asthma is often associated with allergic rhinitis"},{"correct":false,"justification":"Per year","idx":1,"proposition":"Asthma is responsible for about 1000 deaths per month"},{"correct":false,"justification":"Chronic inflammatory disease","idx":2,"proposition":"Asthma is a chronic infectious disease"},{"correct":true,"justification":"True","idx":3,"proposition":"Asthma results from an interaction between genes and the environment"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"ETP-therapeutique-896ba0","context":null,"enonce":"Which of the following are true?","item":"ETP","matiere":"therapeutique","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"Adherence is often better in chronic pathologies than in acute pathologies"},{"correct":true,"justification":"True","idx":1,"proposition":"Adherence is often better in acute pathologies than in chronic pathologies"},{"correct":true,"justification":"True","idx":2,"proposition":"Lack of adherence can cause treatment failure"},{"correct":true,"justification":"True","idx":3,"proposition":"Adherence can be improved by simplifying medication intake"},{"correct":true,"justification":"True","idx":4,"proposition":"Generics can help reduce healthcare costs"}],"type":"custom"}
+{"_id":"systemeconv-sp-bac9d1","context":null,"enonce":"Concerning the rest to be charged:","item":"systemeconv","matiere":"sp","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"It corresponds to the user fee"},{"correct":false,"justification":"False","idx":1,"proposition":"It corresponds to the franchise"},{"correct":false,"justification":"False","idx":2,"proposition":"It corresponds to the flat-rate contribution"},{"correct":true,"justification":"True, flat-rate contribution = deductible (it's the same thing)","idx":3,"proposition":"It corresponds to the co-payment + flat-rate participation"},{"correct":false,"justification":"False","idx":4,"proposition":"It corresponds to the flat-rate contribution + medical deductible"}],"type":"custom"}
+{"_id":"103-neuro-f1735b9d-423e-45e7-8a6b-84868eea6b25","context":null,"enonce":"Regarding infant epilepsy. Which of the following are true?","item":"epilepsie","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Perinatal asphyxia is an etiology of West Syndrome, and gives it a poor prognosis"},{"correct":false,"justification":"Achromic tasks","idx":1,"proposition":"Bourneville's tuberous sclerosis, which gives brown spots, is a poor prognosis in West Syndrome"},{"correct":true,"justification":"True","idx":2,"proposition":"In 15% of cases, there is no underlying cause of West syndrome: it is therefore idiopathic"},{"correct":true,"justification":"True","idx":3,"proposition":"West syndrome is a therapeutic emergency: the appropriate treatment is often vingabatine"},{"correct":false,"justification":"Asynchronous","idx":4,"proposition":"The EEG characteristic of a West Syndrome gives continuous slow waves, diffuse multifocal peaks, synchronous amplitude, without background activity"}],"type":"custom"}
+{"_id":"constipation-HGE-4441ae","context":null,"enonce":"Which of the following are the causes of secondary constipation?","item":"constipation","matiere":"HGE","propositions":[{"correct":false,"justification":"Diarrhoea","idx":0,"proposition":"Hyperthyroidism"},{"correct":false,"justification":"Hypokalemia","idx":1,"proposition":"Hyperkalemia"},{"correct":true,"justification":"True","idx":2,"proposition":"Hypercalcemia"},{"correct":true,"justification":"True","idx":3,"proposition":"Metformin"},{"correct":true,"justification":"True","idx":4,"proposition":"Cauda equina syndrome"}],"type":"custom"}
+{"_id":"DgKc-onco-90a41a","context":null,"enonce":"Which of the following proposals make it possible to assess the general condition of the patient?","item":"DgKc","matiere":"onco","propositions":[{"correct":false,"justification":"Diverticulitis","idx":0,"proposition":"Classification de Hinchey"},{"correct":true,"justification":"True","idx":1,"proposition":"WHO classification"},{"correct":true,"justification":"True","idx":2,"proposition":"Performance Status (PS)"},{"correct":false,"justification":"Cirrhosis","idx":3,"proposition":"Child-Pugh"},{"correct":false,"justification":"Alcohol","idx":4,"proposition":"Questionnaire EDAT"}],"type":"custom"}
+{"_id":"hemorroides-HGE-73a7e8","context":null,"enonce":"Which of the following are clinical signs of hemorrhoidal thrombosis?","item":"hemorroides","matiere":"HGE","propositions":[{"correct":true,"justification":"True, see permanent","idx":0,"proposition":"The pain is very prolonged"},{"correct":true,"justification":"True","idx":1,"proposition":"The pain is intense"},{"correct":false,"justification":"Brutal pain","idx":2,"proposition":"Pain appears gradually"},{"correct":true,"justification":"True","idx":3,"proposition":"TR regains painful swelling"},{"correct":false,"justification":"","idx":4,"proposition":"TR is contraindicated"}],"type":"custom"}
+{"_id":"134-ped-5e35e98a-a8c1-4fd2-a416-8545aa4aebfd","context":null,"enonce":"You are a pediatric intern and the baby in front of you is in pain. What are the analgesic means you can use in this baby?","item":"dlrped","matiere":"ped","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Breastfeeding "},{"correct":false,"justification":"FALSE. The MEOPA has the MA from 1 month","idx":1,"proposition":"MEOPA (MA from birth)"},{"correct":false,"justification":"FALSE. The WMA says that EMLA patches are only possible in a full-term child. Even if in practice it can be prescribed off-label, for the ECNi we must stay on the rules of the CNG which say that we MUST stay on the MA ","idx":2,"proposition":"EMLA patch in premature infants possible according to the MA"},{"correct":false,"justification":"FALSE. Sugar solutions up to 6 months MAXIMUM! ","idx":3,"proposition":"Sugar solutions if it is a 9-month-old infant "},{"correct":true,"justification":"True. Not exceeding 60 mg\/kg\/24h [or even 30 mg\/kg\/24h in the < 1 year or < 10 kg] when taken PO","idx":4,"proposition":"Paracetamol IV or PO (MA from birth)"}],"type":"custom"}
+{"_id":"Kcphysiopath-onco-28e4cd","context":null,"enonce":"Which of the following are known carcinogens?","item":"Kcphysiopath","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Asbestos"},{"correct":true,"justification":"True","idx":1,"proposition":"Silica"},{"correct":true,"justification":"True","idx":2,"proposition":"Wood dust"},{"correct":false,"justification":"","idx":3,"proposition":"GMO"},{"correct":false,"justification":"","idx":4,"proposition":"All pesticides"}],"type":"custom"}
+{"_id":"souffleped-cardio-39c4ea","context":null,"enonce":"Which of the following proposals should be sought primarily in case of Di-Georges Syndrome?","item":"souffleped","matiere":"cardio","propositions":[{"correct":false,"justification":"Syndrome de Turner","idx":0,"proposition":"Coarctation of the aorta"},{"correct":true,"justification":"True","idx":1,"proposition":"Tetralogy of Fallot"},{"correct":false,"justification":"False","idx":2,"proposition":"Inter-atrial communication"},{"correct":false,"justification":"False","idx":3,"proposition":"Ventricular septal defect"},{"correct":false,"justification":"False","idx":4,"proposition":"Persistent ductus arteriosus"}],"type":"custom"}
+{"_id":"TTTnonmedic-therapeutique-d803d8","context":null,"enonce":"Which of the following are true?","item":"TTTnonmedic","matiere":"therapeutique","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Training to use equipment is part of what is called <<rehabilitation>>"},{"correct":false,"justification":"It's rehabilitation","idx":1,"proposition":"The integration of the equipment into daily life is part of what is called << rehabilitation>>"},{"correct":true,"justification":"True","idx":2,"proposition":"A prosthesis replaces a limb segment"},{"correct":false,"justification":"Not all of course (reading glasses for example)","idx":3,"proposition":"All devices require a medical prescription"},{"correct":true,"justification":"True","idx":4,"proposition":"Most equipment requires monitoring and follow-up"}],"type":"custom"}
+{"_id":"diverticulose-HGE-e340aa","context":null,"enonce":"Uncomplicated diverticulitis is, according to Hinchey's classification, stage:","item":"diverticulose","matiere":"HGE","propositions":[{"correct":true,"justification":"True, phlegmon isolated less than 2 cm","idx":0,"proposition":"AI"},{"correct":false,"justification":"Isolated abscess","idx":1,"proposition":"Ib"},{"correct":false,"justification":"Abscess > 2cm","idx":2,"proposition":"II"},{"correct":false,"justification":"Purulent generalized peritonitis ( ➡ surgery)","idx":3,"proposition":"III"},{"correct":false,"justification":"Stercoral peritonitis (➡ surgery)","idx":4,"proposition":"IV"}],"type":"custom"}
+{"_id":"183-immuno-1bf99832-5e9f-4ca2-aeee-bb4ca4fa44b4","context":null,"enonce":"You receive in office, little Heathcliff, 1 1\/2 years who presents an acute flare-up of atopic dermatitis. You decide to give some advice to parents...","item":"allergiecut","matiere":"immuno","propositions":[{"correct":true,"justification":"True, it maintains the disease","idx":0,"proposition":"Avoid contact with tobacco"},{"correct":true,"justification":"True, this is THE thing to remember, no herpetic contagion with atopic dermatitis, it gives a Kaposi Juliusberg a very serious form!","idx":1,"proposition":"Avoid herpes contagion at all costs, even in case of simple cold sores"},{"correct":false,"justification":"False, entirely false, there are no contraindications on vaccines","idx":2,"proposition":"Favor vaccines in periods of lull in the dermatological disease"},{"correct":true,"justification":"True, and avoid wool or synthetic clothing","idx":3,"proposition":"Favor cotton clothing"},{"correct":false,"justification":"False, there is no allergenic eviction to do","idx":4,"proposition":"Avoid nuts and exotic fruits, with high allergenic potential"}],"type":"custom"}
+{"_id":"valeurspro-sp-c85b3c","context":null,"enonce":"Which of the following proposals are medical or paramedical professions with an order?","item":"valeurspro","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Pharmacist"},{"correct":true,"justification":"True","idx":1,"proposition":"Dentist"},{"correct":true,"justification":"True","idx":2,"proposition":"Doctor"},{"correct":true,"justification":"True","idx":3,"proposition":"Midwife"},{"correct":true,"justification":"True","idx":4,"proposition":"Physiotherapist"}],"type":"custom"}
+{"_id":"329-urg-57a40e35-5983-4911-a154-1d31162e9209","context":null,"enonce":"Which of the following propositions, is (are) true regarding fat embolism?","item":"polytrauma","matiere":"urg","propositions":[{"correct":true,"justification":"True. CLINICAL diagnosis above all and not paraclinical that will guide. If you ever miss the clinic, the fundus will allow a retrospective diagnosis ","idx":0,"proposition":"The diagnosis is primarily clinical and is based on the discovery of hyperthermia, sinus tachycardia and polypnea a few hours after a limb fracture"},{"correct":false,"justification":"False. In addition there is only hypoxemia that is almost constant ","idx":1,"proposition":"The diagnosis is primarily paraclinical and based on the discovery of thrombocytopenia, hemolytic anemia and arterial hypoxemia. "},{"correct":true,"justification":"True. It can be used to make a retrospective diagnosis when clinical manifestations have been missed. ","idx":2,"proposition":"The fundus can find retinal hemorrhages, cottony nodules and retinal edema"},{"correct":true,"justification":"True! These manifestations are fickle, however. ","idx":3,"proposition":"The Gurd triad is based on the association of lesional pulmonary edema + neuro-psychic manifestations + petechiae of the trunk and mucous membranes "},{"correct":true,"justification":"True! HEMODYNAMICS to be monitored extremely rigorously in the context of (poly)trauma. Fat embolism was the subject of an entire question at ECNI 2021. All this information can be found in the latest college of anesthesia resuscitation p344: https:\/\/www.cnear.fr\/dfasm","idx":4,"proposition":"Preventive treatment is based on immobilization of fracture foci, maintenance of good hemodynamics and the fight against pain  "}],"type":"custom"}
+{"_id":"nvxne-gyn-e5deb9","context":null,"enonce":"In the absence of effective breathing movements, what is the very first resuscitation maneuver to be undertaken in a newborn who is not screaming?","item":"nvxne","matiere":"gyn","propositions":[{"correct":true,"justification":"True, right after drying and stimulation","idx":0,"proposition":"Nasopharyngeal aspiration and stimulation"},{"correct":false,"justification":"Adrenaline administration is a last resort","idx":1,"proposition":"Administration of adrenaline"},{"correct":false,"justification":"False","idx":2,"proposition":"Broncho-aspiration"},{"correct":false,"justification":"If bradycardia persists despite effective ventilation","idx":3,"proposition":"External cardiac massage"},{"correct":false,"justification":"As a second line, after nasopharyngeal aspiration","idx":4,"proposition":"Positive pressure mask ventilation"}],"type":"custom"}
+{"_id":"masseabdo-HGE-1ea7fd","context":null,"enonce":"The diagnosis of certainty of hepatomegaly requires:","item":"masseabdo","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"It is purely clinical"},{"correct":true,"justification":"True, ultrasound is necessary and sufficient","idx":1,"proposition":"Ultrasound"},{"correct":false,"justification":"","idx":2,"proposition":"The scanner"},{"correct":false,"justification":"","idx":3,"proposition":"MRI"},{"correct":false,"justification":"","idx":4,"proposition":"PET-SCAN"}],"type":"custom"}
+{"_id":"Kcpancreas-onco-001f1c","context":null,"enonce":"Which of the following are true?","item":"Kcpancreas","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"In 20% of cases, PD-NETs are revealed by symptoms related to hormonal secretion "},{"correct":false,"justification":"Pancreatic adenocarcinoma is by far the most common pancreatic tumor (90%)","idx":1,"proposition":"Endocrine tumours are the most common pancreatic tumour tumour "},{"correct":false,"justification":"The average age of onset is between 60 and 70 years","idx":2,"proposition":"The average age of onset is 30 years"},{"correct":true,"justification":"True","idx":3,"proposition":"In France, the incidence of adenocarcinoma of the pancreas has increased significantly over the past 20 years "},{"correct":false,"justification":"Its prognosis is poor with a median survival between 6 and 9 months if the cancer is metastatic and 18 to 24 months if it could be resected","idx":4,"proposition":"The prognosis for adenocarcinoma is very good, unlike neuroendocrine tumors"}],"type":"custom"}
+{"_id":"343-urg-c993792c-5133-4af0-9cc7-cd6ba1281abb","context":null,"enonce":"Which of the following proposals for acute renal failure and acute tubular necrosis is true?","item":"IRenA","matiere":"urg","propositions":[{"correct":false,"justification":"Natriuresis in an NTA is increased\r\n\r\nThere is one exception though... NTAs secondary to rhabdomyolysis or iodinated contrast media: natriuresis has collapsed\r\nFor rhabdomyolysis, this is because there is volume depletion activating RAAS --> Na+ reabsorption\r\nFor iodinated contrast media I don't know...","idx":0,"proposition":"Natriuresis has collapsed"},{"correct":false,"justification":"No hypertension, no edema in the NTA! The clinical picture of the different ARIs is to know by heart!","idx":1,"proposition":"Clinically we find hypertension and edema "},{"correct":true,"justification":"True","idx":2,"proposition":"It represents 80% of organic IRAs"},{"correct":true,"justification":"True","idx":3,"proposition":"NSAIDs are one of the causes of NTA"},{"correct":true,"justification":"True","idx":4,"proposition":"In NTA, glomerular flow is decreased due to pre- and post-glomerular vasoconstriction and increased intra-tubular pressure."}],"type":"custom"}
+{"_id":"systemeconv-sp-b09344","context":null,"enonce":"Approximately how many doctors are there in France?","item":"systemeconv","matiere":"sp","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"50 000"},{"correct":true,"justification":"True","idx":1,"proposition":"200 000"},{"correct":false,"justification":"False","idx":2,"proposition":"700 000"},{"correct":false,"justification":"False","idx":3,"proposition":"1 million"},{"correct":false,"justification":"This is the approximate number of health professionals","idx":4,"proposition":"2 million"}],"type":"custom"}
+{"_id":"diarrheechr-HGE-beb813","context":null,"enonce":"Which of the following are the causes of motor diarrhea?","item":"diarrheechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Hyperthyroidism"},{"correct":true,"justification":"True","idx":1,"proposition":"Functional bowel disorder"},{"correct":false,"justification":"Diarrhea due to malabsorption","idx":2,"proposition":"Celiac disease"},{"correct":false,"justification":"Exudative diarrhea","idx":3,"proposition":"Colitis"},{"correct":false,"justification":"Secretory diarrhea","idx":4,"proposition":"Parasitosis"}],"type":"custom"}
+{"_id":"tbconscience-urg-fabdb4","context":null,"enonce":"Which of the following are signs or symptoms of confusion?","item":"tbconscience","matiere":"urg","propositions":[{"correct":false,"justification":"Confusion = acute","idx":0,"proposition":"Gradual start"},{"correct":true,"justification":"True","idx":1,"proposition":"Reversal of the nyctemeral cycle"},{"correct":true,"justification":"True","idx":2,"proposition":"Amnesia"},{"correct":false,"justification":"It is a differential diagnosis","idx":3,"proposition":"Dementia"},{"correct":false,"justification":"False","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"RGO-HGE-3ec37b","context":null,"enonce":"What is the frequency of monitoring of endobrachyoesophagus between 3 and 6 centimeters?","item":"RGO","matiere":"HGE","propositions":[{"correct":false,"justification":"Less than 3 cm","idx":0,"proposition":"Every 5 years"},{"correct":true,"justification":"True","idx":1,"proposition":"Every 3 years"},{"correct":false,"justification":"More than 6 cm","idx":2,"proposition":"Every 2 years"},{"correct":false,"justification":"An OBE is always monitored","idx":3,"proposition":"No monitoring"},{"correct":false,"justification":"Control every year (2 times in the first year) if low-grade dysplasia","idx":4,"proposition":"Every 6 months"}],"type":"custom"}
+{"_id":"185-immuno-1801eb2d-b34b-4cfe-989e-2651a3255269","context":null,"enonce":"Regarding immune deficiencies, among the pairs type of deficiency - opportunistic pathogens, which one or which are accurate?","item":"immunoD","matiere":"immuno","propositions":[{"correct":true,"justification":"True, humoral deficiency does not lead to opportunistic infections but to severe pneumococcus, meningococcal and haemophilus infections.","idx":0,"proposition":"Humoral deficiency - encapsulated germs"},{"correct":true,"justification":"True, cellular immunodeficiency leads to parasitic, fungal, or viral opportunistic infections","idx":1,"proposition":"Cell deficiency - opportunistic infections"},{"correct":true,"justification":"True, we most often know meningococcal infections but it can also give serious sepsis","idx":2,"proposition":"Complement deficiency - invasive bacterial infections"},{"correct":true,"justification":"True, we know less about this subtlety but it's true","idx":3,"proposition":"Asplenia - Severe malaria"},{"correct":true,"justification":"True, a specificity related to PNN deficiency","idx":4,"proposition":"Phagocytic Deficiency - Pyogenic Infections"}],"type":"custom"}
+{"_id":"anemie-hemato-7820fb","context":null,"enonce":"Which of the following are true?","item":"anemie","matiere":"hemato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Folate deficiency is responsible for macrocytic anemia"},{"correct":true,"justification":"True","idx":1,"proposition":"Hemolysis gives macrocytic anemia"},{"correct":false,"justification":"A central cause causes normo- or macrocytic anemia","idx":2,"proposition":"Spinal cord invasion gives microcytic anemia"},{"correct":false,"justification":"Microcytic anemia","idx":3,"proposition":"Iron deficiency gives macrocytic anemia"},{"correct":false,"justification":"Peripheral cause","idx":4,"proposition":"Hemolysis is a central cause of anemia"}],"type":"custom"}
+{"_id":"polytrauma-urg-b3fce7","context":null,"enonce":"Which of the following propositions concerning Vittel's algorithm in the context of polytrauma are true?","item":"polytrauma","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Extreme gravity is defined as a Glasgow at 3, a SBP < 65 mmHg and\/or an SpO2 < 80% or impregnable"},{"correct":false,"justification":"False, > 6 meters","idx":1,"proposition":"A fall from a height greater than 4 meters is an element indicating violent kinetics and the need for treatment in a specialized center"},{"correct":true,"justification":"True","idx":2,"proposition":"Another passenger who died in the same vehicle is an element indicating violent kinetics and the need for care in a specialized center"},{"correct":true,"justification":"True","idx":3,"proposition":"A pelvic fracture is an anatomical lesion requiring management in a specialized center"},{"correct":true,"justification":"True","idx":4,"proposition":"A patient with normal vital signs, no evidence of violent kinetics and no anatomical lesions requiring specialized management, but where the shockproof pants are inflated requires transfer to a specialized center. "}],"type":"custom"}
+{"_id":"176-sp-c0a84fd5-2f2b-4ca2-b260-ed74ecaf7a05","context":null,"enonce":"Who are the actors involved in the system for reporting serious adverse events associated with care?","item":"risquesRx","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The patient"},{"correct":true,"justification":"True","idx":1,"proposition":"Healthcare professionals and healthcare facilities"},{"correct":true,"justification":"True","idx":2,"proposition":"The regional health agency"},{"correct":true,"justification":"True","idx":3,"proposition":"The High Authority for Health"},{"correct":true,"justification":"True","idx":4,"proposition":"Regional support structure"}],"type":"custom"}
+{"_id":"PF-neuro-cb9a3f","context":null,"enonce":"Which of the following are segments crossed by facial nerve VII?","item":"PF","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Labyrinthine segment"},{"correct":true,"justification":"True. It emerges at the level of the stylomastoid foramen","idx":1,"proposition":"Mastoidal segment"},{"correct":true,"justification":"True, we can guess it from the otoscope","idx":2,"proposition":"Tympanic segment"},{"correct":true,"justification":"True","idx":3,"proposition":"Parotid segment"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
+{"_id":"splenomeg-HGE-4191c2","context":null,"enonce":"When should vaccinations be performed in case of emergency splenectomy?","item":"splenomeg","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"2 weeks after surgery"},{"correct":false,"justification":"This is an emergency splenectomy (no time to wait 2 weeks)","idx":1,"proposition":"2 weeks before surgery"},{"correct":false,"justification":"","idx":2,"proposition":"At the time of the gesture"},{"correct":false,"justification":"","idx":3,"proposition":"4 weeks after surgery"},{"correct":false,"justification":"","idx":4,"proposition":"6 weeks after surgery"}],"type":"custom"}
+{"_id":"PF-neuro-0d4256","context":null,"enonce":"Where does the facial nerve emerge from?","item":"PF","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Bulbo-protuberancial furrow"},{"correct":false,"justification":"Emergence of the hypoglossal nerve XII (motor for the muscles of the tongue, passing through the hypoglossal canal)","idx":1,"proposition":"Bulb"},{"correct":false,"justification":"Emergence of oculomotor nerve III (motor, innervates the upper right, lower right, inferior oblique, medial right, passing through the superior orbital fissure)","idx":2,"proposition":"Mesencephalic tegmentum"},{"correct":false,"justification":"Trigeminal nerve V (mixed)","idx":3,"proposition":"Mesencephalo-pontobulbar origin"},{"correct":false,"justification":"Accessory nerve XI (motor)","idx":4,"proposition":"Cervical spinal cord"}],"type":"custom"}
+{"_id":"droits-sp-29b55b","context":null,"enonce":"Which of the following propositions are true about the person of trust?","item":"droits","matiere":"sp","propositions":[{"correct":false,"justification":"Anyone","idx":0,"proposition":"It only concerns patients with serious illness"},{"correct":false,"justification":"Not mandatory but recommended ++","idx":1,"proposition":"It is mandatory"},{"correct":true,"justification":"True","idx":2,"proposition":"The designation can be done on plain paper, signed and dated"},{"correct":false,"justification":"Quite possible (especially if the doctor is not treating)","idx":3,"proposition":"The designated person cannot be a doctor"},{"correct":false,"justification":"Writing","idx":4,"proposition":"The designation can be done orally"}],"type":"custom"}
+{"_id":"194-rhumato-8373cdc1-ffa1-4939-b6e7-e7ff0071ee7b","context":null,"enonce":"Regarding allopurinol, what are the exact answer(s)?","item":"rhumcrist","matiere":"rhumato","propositions":[{"correct":false,"justification":"False, it is 100mg per day, it is one of the only dosages that is required from you, because it is medico-legal","idx":0,"proposition":"Allopurinol is to be initiated at a dosage of 200mg per day"},{"correct":false,"justification":"False, as we will see below it is the DRESS syndrome. It is Febuxostat that has this type of side effects","idx":1,"proposition":"One of the most serious side effects of allopurinol is the occurrence of digestive disorders"},{"correct":false,"justification":"FALSE, +++ DRESS syndrome is a serious toxiderma and must always be suspected, especially with purveyor treatments such as Bactrim or Allopurinol!","idx":2,"proposition":"A rash after taking allopurinol is common and mild"},{"correct":true,"justification":"True, it is to start during symptomatic hyperuricemia","idx":3,"proposition":"Allopurinol is to be started after the first attack of gout or first uricemic renal colic"},{"correct":true,"justification":"True, they are both hyperuricemic treatments","idx":4,"proposition":"When re-evaluating treatment, it is necessary to look for thiazide diuretics or loop in the patient's prescription"}],"type":"custom"}
+{"_id":"235-cardio-fc5d0ed7-df20-4f35-bec2-89e8064a0a40","context":null,"enonce":"Mr MELARK, Peeta, 25 years old, comes to see you in general medicine consultation, because for a few months he has regular palpitations. He explains that he has already consulted a cardiologist who has ruled out all transient and extracardiac causes of palpitations and who would have vaguely told him about Bouveret's disease. He is very anxious because he is afraid of having \"a cardiac arrest\" like his uncle. What can you tell him about Bouveret's disease?","item":"palpitations","matiere":"cardio","propositions":[{"correct":true,"justification":"True, it is one of the two causes of junctional tachycardia with Wolff Parkinson White syndrome.","idx":0,"proposition":"This is a not uncommon cause of junctional tachycardia in young people"},{"correct":false,"justification":"False, these are the ECG features of Brugada syndrome, here in Bouveret's disease we find a fine QRS tachycardia with retrograde P waves","idx":1,"proposition":"The ECG conventionally finds negative T waves in V1 and V2"},{"correct":false,"justification":"False, another feature of Brugada syndrome. Bouveret's disease is benign and does not require defibrillation under any circumstances","idx":2,"proposition":"There is a risk of cardiac syncope and the need for defibrillation"},{"correct":true,"justification":"True, this is the typical symptomatology with pollakuria ","idx":3,"proposition":"The symptomatology is characterized by bouts of palpitations at the beginning and abrupt end"},{"correct":true,"justification":"True, these are two lesser-known methods of vagal maneuvers but which are much easier than carotid massage or eyeballs.","idx":4,"proposition":"A vagal maneuver by inverted Vasalva or ingestion of ice water can make the diagnosis"}],"type":"custom"}
+{"_id":"206-pneumo-43d992c6-8838-4a59-910a-c32402f0242b","context":null,"enonce":"You receive in consultation Mr Deux, Ramsès, 75 years old, who is followed in pneumology for idiopathic pulmonary fibrosis. However, he also caught CoVID 3 weeks ago, and he can no longer distinguish between the symptoms of his long CoVID and idiopathic pulmonary fibrosis. What symptoms can you relate to his idiopathic pulmonary fibrosis?","item":"PID","matiere":"pneumo","propositions":[{"correct":true,"justification":"True, quite simple this one, fibrotic patients present a dyspnea of effort becoming easier and easier with time, for an effort less and less important","idx":0,"proposition":"Exertional dyspnea"},{"correct":false,"justification":"False, it is a sign of influenza-like illness, so CoVID!","idx":1,"proposition":"Diffuse myalgia"},{"correct":true,"justification":"True, visible in both cases. Dry cough is clearly distinguished from fibrotic, unlike expectorant wet cough from COPD","idx":2,"proposition":"Dry cough"},{"correct":false,"justification":"False, grumbling is rather COPD! We find under crackling bases in fibrotic. To give you ideas, the ronchis is literally a \"fouling\" of the bronchi","idx":3,"proposition":"Diffuse Ronchis"},{"correct":true,"justification":"True, only extrarespiratory sign","idx":4,"proposition":"Digital Hippocratism"}],"type":"custom"}
+{"_id":"151-pneumo-312894cd-b92b-4872-9b34-8fcc6cdb157b","context":null,"enonce":"What is the most common progressive complication of acute community-acquired pneumonia in children?","item":"IBP","matiere":"pneumo","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"The skeptical shock"},{"correct":false,"justification":"False: Exceptional!!","idx":1,"proposition":"Post-pneumococcal hemolytic uremic syndrome"},{"correct":false,"justification":"False","idx":2,"proposition":"Hyponatremia by SIADH (syndrome of inappropriate secretion of anti-diuretic hormone)"},{"correct":true,"justification":"True => p677 in red box ","idx":3,"proposition":"Purulent pleurisy"},{"correct":false,"justification":"False: This is the 2nd most common just after pleurisy ++","idx":4,"proposition":"The abscess"}],"type":"custom"}
+{"_id":"206-pneumo-fce640dc-d61e-48cb-8b99-8e7061e612c0","context":null,"enonce":"Regarding additional examinations in diffuse interstitial lung disease, what are the exact proposal(s)?","item":"PID","matiere":"pneumo","propositions":[{"correct":true,"justification":"True, it is characteristic of diffuse interstitial lung diseases, the infiltration being \"around\" the structures where the air passes, it will compress the air and be restrictive","idx":0,"proposition":"EFRs regain a restrictive ventilatory disorder"},{"correct":true,"justification":"True, because of a lower respiratory volume, when there is an effort, the lung can not mobilize additional respiratory volumes","idx":1,"proposition":"There is a classic desaturation on exertion"},{"correct":true,"justification":"True, DLCO explores diffusion abnormalities between the alveolus and capillary transmitted by the interstitium. An abnormality of the alveolus (e.g. OAP), interstitium (PID) or capillary (HTP) can cause a decrease in DLCO","idx":2,"proposition":"DLCO is reduced <70%"},{"correct":false,"justification":"False, the so-called \"honeycomb\" cysts have a subpleural disposition","idx":3,"proposition":"Honeycombs are cysts located in contact with the mediastinum corresponding to bullous structures within the interstitium"},{"correct":true,"justification":"True, it is a highlighting of these anatomical structures, the septas","idx":4,"proposition":"Lines or cross-links are accentuations of anatomical structures that are usually not visible"}],"type":"custom"}
+{"_id":"210-hemato-9d99d174-2abc-4174-acae-bbb87c7e960b","context":null,"enonce":"Regarding thrombocytopenia in pregnant women, what are the exact proposal(s)?","item":"thromboP","matiere":"hemato","propositions":[{"correct":true,"justification":"True, it's not noted in the college, but given the prevalence of obesity in the general population I think it's not bad for your patients to retain this as a potential cause. ","idx":0,"proposition":"Pregnancy NASH (Nonalcoholic Steatose Hepatic) is a cause of thrombocytopenia"},{"correct":true,"justification":"True, as well as HBV and HCV","idx":1,"proposition":"Thrombocytopenia in pregnant women should be tested for HIV infection"},{"correct":true,"justification":"True, it's in its name (Hemolysis, Elevated Liver enzymes, Low Platelets)","idx":2,"proposition":"HELLP syndrome is a cause of thrombocytopenia in pre-eclamptic pregnant women"},{"correct":true,"justification":"True, as in the general population, but here there is more often heparin treatment because of the prothrombotic risk","idx":3,"proposition":"Prophylactic treatment with heparin may lead to thrombocytopenia  "},{"correct":true,"justification":"True, in >75% of cases it is physiological","idx":4,"proposition":"The most common cause of thrombocytopenia during pregnancy is benign"}],"type":"custom"}
+{"_id":"210-hemato-151f374d-ecba-488d-b5e3-cec6a5396916","context":null,"enonce":"You receive in hematology consultation, Mrs. EVANS Lucy, a 65-year-old patient who consults after he was found at the blood test a thrombocytopenia at 12G \/ L. Your colleague had performed a myelogram on this patient who found a marrow poor in megakaryocytes. What are the possible diagnoses in this patient?","item":"thromboP","matiere":"hemato","propositions":[{"correct":false,"justification":"Evans syndrome corresponds to peripheral autoimmune involvement of platelets and red blood cells. The patient has central thrombocytopenia with us","idx":0,"proposition":"Evans syndrome"},{"correct":true,"justification":"True, as with anemia, deficiency thrombocytopenia is central because it leads to a slowdown in central production.","idx":1,"proposition":"Vitamin B9 deficiency"},{"correct":false,"justification":"False, chronic lymphocytic leukemia causes anemia and not thrombocytopenia ...","idx":2,"proposition":"Chronic lymphocytic leukemia"},{"correct":false,"justification":"False, this is a \"burst\" of platelets in the blood, and not spinal cord damage","idx":3,"proposition":"Thrombotic microangiopathy"},{"correct":true,"justification":"True, here cancer cells take the place of megakaryocytes in the marrow","idx":4,"proposition":"Metastases of breast cancer"}],"type":"custom"}
+{"_id":"211-hemato-362343b2-7bd5-4dd7-bec1-8fae473fa469","context":null,"enonce":"Regarding purpuras, what are the elements suggestive of vascular purpura rather than thrombocytopenic purpura?","item":"purpura","matiere":"hemato","propositions":[{"correct":true,"justification":"True, thrombocytopenic purpura is flat a contrario","idx":0,"proposition":"Necrotic purpura"},{"correct":true,"justification":"True, it is also said that purpura is declivated, unlike thrombocytopenic purpura which are diffuse","idx":1,"proposition":"Purpura localized to the lower limbs"},{"correct":false,"justification":"False, the presence of hemorrhages rather indicates thrombocytopenia","idx":2,"proposition":"Purpura associated with clinical bleeding"},{"correct":false,"justification":"False, vascular purpura testifies to an attack of the small vessels with inflammation that leads to localized purpura, unlike thrombocytopenic purpuras which will be in sheets, because of an active hemorrhage.","idx":3,"proposition":"Purpura in tablecloths"},{"correct":true,"justification":"True, purpura will be raised and palpable, unlike thrombocytopenic purpura","idx":4,"proposition":"Infiltrated purpura"}],"type":"custom"}
+{"_id":"316-onco-51362943-943d-409b-b604-fce586cc76e3","context":null,"enonce":"Regarding Hodgkin's lymphoma, which propositions are true?","item":"LM","matiere":"onco","propositions":[{"correct":true,"justification":"True, in the young subject (about 25 years) and the elderly (about 80 years)","idx":0,"proposition":"There are 2 peaks of incidence ages "},{"correct":true,"justification":"True, very good effectiveness of treatments ","idx":1,"proposition":"After treatment, about 90% of patients are cured "},{"correct":true,"justification":"True, allows the Ann Arbor classification (which is not the case with Binet's classification in CLL, because the latter is a clinicobiological classification, which does not take into account imaging)","idx":2,"proposition":"PET-FDG is systematic in the extension balance "},{"correct":false,"justification":"False, the most common histological subtype in classical Hodgkin lymphoma is the scleronodular form (67% vs. 25%)","idx":3,"proposition":"Mixed cellularity histological subtype is the most common form of classical Hodgkin lymphoma "},{"correct":true,"justification":"True, for 2\/3 of cases ","idx":4,"proposition":"The localized stage (I\/II in the Ann Arbor classification) is most common at diagnosis "}],"type":"custom"}
+{"_id":"316-onco-de63e59e-ab22-4478-8b97-38b5e2d4c59b","context":null,"enonce":"Regarding non-Hodgkin lymphomas, what are the real proposals?","item":"LM","matiere":"onco","propositions":[{"correct":false,"justification":"False, T\/NK lymphomas account for only 15% of non-Hodgkin lymphomas ","idx":0,"proposition":"The majority of non-Hodgkin lymphomas are T-cell lymphomas "},{"correct":true,"justification":"True, it is a diffuse large B-cell lymphoma (CD20+, CD 10+, bcl-). It evolves very quickly (aggressive). There are endemic (African), sporadic (non-African) forms and linked to immune deficiency.","idx":1,"proposition":"EBV infection is a risk factor for Burkitt's lymphoma "},{"correct":true,"justification":"True, 35%. They require quick support","idx":2,"proposition":"One of the most common non-Hodgkin lymphomas is diffuse large cell B-cell lymphoma"},{"correct":false,"justification":"False, compressive syndrome is more common in non-Hodgkin lymphomas ","idx":3,"proposition":"Compressive syndrome is less common than in Hodgkin's lymphoma "},{"correct":true,"justification":"True","idx":4,"proposition":"Burkitt's lymphoma is very aggressive "}],"type":"custom"}
+{"_id":"316-onco-3ed10e9c-c91b-435a-a6f8-9b4fb5229964","context":null,"enonce":"Which of the following propositions about malignant lymphomas are true?","item":"LM","matiere":"onco","propositions":[{"correct":false,"justification":"False, they are characteristic of Hodgkin lymphomas","idx":0,"proposition":"The presence of Reed-Sternberg cells is characteristic of non-Hodgkin lymphomas "},{"correct":true,"justification":"True, acquired or congenital immunosuppression ","idx":1,"proposition":"The immunosuppression field promotes malignant lymphomas "},{"correct":false,"justification":"False, the diagnosis is based on lymph node biopsy because histological proof is absolutely necessary ","idx":2,"proposition":"Diagnosis of malignant lymphoma is based on lymph node aspiration "},{"correct":true,"justification":"True","idx":3,"proposition":"Superior cava syndrome is a therapeutic emergency "},{"correct":true,"justification":"True, to be carried out after agreement of the patient!","idx":4,"proposition":"Always think about performing an HIV serology "}],"type":"custom"}
+{"_id":"293-onco-82df7023-20dd-4a9c-b7be-834e0f886a88","context":null,"enonce":"Regarding agranulocytosis, which propositions are true?","item":"agranulocytose","matiere":"onco","propositions":[{"correct":true,"justification":"True, especially during a control blood count ","idx":0,"proposition":"It may be of fortuitous discovery "},{"correct":true,"justification":"True","idx":1,"proposition":"The clinical examination is often poor "},{"correct":false,"justification":"False, this is extrinsic accountability. The intrinsic imputability of agranulocytosis to a drug is based on semiology and chronology  ","idx":2,"proposition":"The method of intrinsic imputability of agranulocytosis to a drug is based on pharmacovigilance data"},{"correct":false,"justification":"False, the elevation of PNN occurs 48 hours after the appearance of monocytosis","idx":3,"proposition":"The appearance of monocytosis during follow-up is suggestive of the elevation of ANCs within 24 hours "},{"correct":false,"justification":"False, only if fever is present ","idx":4,"proposition":"Treatment is based on broad-spectrum antibiotic therapy even in the absence of fever "}],"type":"custom"}
+{"_id":"Kcprostate-onco-804b46","context":null,"enonce":"Which of the following are true about zoledronic acid?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is a drug for the prevention of complications of bone metastases"},{"correct":true,"justification":"True","idx":1,"proposition":"It is a bisphosphonate inhibiting bone resorption related to osteoclastic activity"},{"correct":true,"justification":"True","idx":2,"proposition":"It is injected in slow IV every month or so."},{"correct":true,"justification":"True","idx":3,"proposition":"Its toxicity is renal"},{"correct":true,"justification":"True","idx":4,"proposition":"There is a risk of osteonecrosis of the jaw and hypocalcemia"}],"type":"custom"}
+{"_id":"Kcpancreas-onco-eb7f36","context":null,"enonce":"Which of the following proposals designate cystic tumors of the pancreas that do not develop within the pancreatic ducts?","item":"Kcpancreas","matiere":"onco","propositions":[{"correct":false,"justification":"Not a cystic tumor","idx":0,"proposition":"Adenocarcninoma"},{"correct":true,"justification":"True","idx":1,"proposition":"Serous cystadenoma"},{"correct":true,"justification":"True","idx":2,"proposition":"Mucosal cystadenoma"},{"correct":false,"justification":"They develop within these channels themselves.","idx":3,"proposition":"TIPMP"},{"correct":false,"justification":"Not a cystic tumor","idx":4,"proposition":"Neuroendocrine tumours"}],"type":"custom"}
+{"_id":"40-gyn-1d131aab-d226-462e-adfd-6f38370683ed","context":null,"enonce":"Which of the following are true?","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"correct":true,"proposition":"Pregnancy is a cause of amenorrhea","justification":"True"},{"idx":1,"correct":false,"proposition":"In secondary amenorrhea, a low LH, FSH and estradiol assay points to an ovarian cause ","justification":"False, these results point to gonadotropic insufficiency (central origin)"},{"idx":2,"correct":true,"proposition":"A beta hCG test is essential when looking for the etiology of secondary amenorrhea","justification":"True, to eliminate pregnancy, physiological cause of amenorrhea"},{"idx":3,"correct":false,"proposition":"FSH assay is found collapsed in amenorrhea with PCOS as an etiology ","justification":"False, FSH dosage is normal"},{"idx":4,"correct":true,"proposition":"To explore gonadotropic insufficiency, a pituitary MRI is performed","justification":"True"}],"type":"custom"}
+{"_id":"239-endoc-033fa0a0-b36b-40f8-a619-9fa3f4db2602","context":null,"enonce":"Regarding thyroid goiters, which propositions are true?","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Estrogen is a goitrogenic factor ","justification":"True"},{"idx":1,"correct":true,"proposition":"If the TSH test comes back high, anti-TPO antibodies are dosed.","justification":"True, to look for Hashimoto's autoimmune hypothyroidism "},{"idx":2,"correct":false,"proposition":"If the TSH test comes back high, anti-TSH receptor antibodies are measured","justification":"False, anti-TSH receptor antibodies are dosed if the TSH dosage comes back low, to eliminate Graves' disease "},{"idx":3,"correct":true,"proposition":"De Quervain's subacute thyroiditis is a cause of goiter","justification":"True"},{"idx":4,"correct":false,"proposition":"A goiter can progress to thyroid cancer in 15% of cases","justification":"False, in only 4 to 5% of cases "}],"type":"custom"}
+{"_id":"239-endoc-cffcc69f-64fa-4121-a817-5bcdfebe9e63","context":null,"enonce":"Regarding thyroid nodules, what are the true propositions? (one or more true propositions)","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"Nodule size is synonymous with malignancy ","justification":"False, the size does not presume the malignancy of the nodule "},{"idx":1,"correct":false,"proposition":"The first-line examination in thyroid imaging is the scintigraphy ","justification":"False, the 1st intention examination is ultrasound "},{"idx":2,"correct":false,"proposition":"The determination of calcitonin is always recommended in the first-line assessment when a nodule is discovered","justification":"False, it must be practiced systematically in certain situations only: known hereditary context of medullary thyroid cancer, if suspicion of malignancy of the nodule at cytopuncture and before any intervention for goiter or nodule"},{"idx":3,"correct":false,"proposition":"A nodule with a score of 2 on the Bethesda cytological classification is a malignant nodule ","justification":"False, it is a benign nodule "},{"idx":4,"correct":true,"proposition":"The course of action for a Bethesda 6 non-functional nodule is surgery ","justification":"True"}],"type":"custom"}
+{"_id":"239-endoc-56bd348b-be3a-4997-a931-71c161335b1f","context":null,"enonce":"Regarding thyroid cancers, which proposals are true?","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Recurrent paralysis may be a clinical sign allowing the revelation of a thyroid nodule ","justification":"True"},{"idx":1,"correct":false,"proposition":"The most common vesicular carcinomas are differentiated vesicular cancers ","justification":"False, they represent only 5% of thyroid cancers. The most common is differentiated papillary carcinoma (85% of cases)"},{"idx":2,"correct":true,"proposition":"Anaplastic carcinomas require urgent management ","justification":"True"},{"idx":3,"correct":true,"proposition":"Medullary thyroid cancers develop at the expense of calcitonin-secreting C cells ","justification":"True"},{"idx":4,"correct":true,"proposition":"Medullary thyroid cancers can integrate into multiple endocrine neoplasia type 2 (MEN2) ","justification":"True"}],"type":"custom"}
+{"_id":"245-endoc-6cb051f5-09a8-4535-86af-946144dcd099","context":null,"enonce":"About diabetes and insulin types","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Insulin intermediate (NPH) is a suspended insulin (powder) that needs to be reconstituted","justification":"TRUE. NPH insulin is a powdered intermediate insulin that is injected subcutaneously"},{"idx":1,"correct":true,"proposition":"Rapid insulin works in 15-30 minutes and lasts about 4-6 hours ","justification":"TRUE! - Rapid insulin: Acts in 15-30 min and lasts 4-6h\r\n- Slow insulin: Acts in 1-2h and lasts 24h = \"insulin to live\""},{"idx":2,"correct":true,"proposition":"Slow insulin can only be injected in SC","justification":"TRUE! Page 280 of the new college (5th edition). Rapid insulin exists in IV\/IM\/SC\/pump form "},{"idx":3,"correct":true,"proposition":"Slow insulin acts in 1-2h","justification":"TRUE, unlike the fast one that acts in less than 30 minutes. Its action lasts 24 hours"},{"idx":4,"correct":true,"proposition":"A type 2 diabetic with HbA1c > 10% and cardinal syndrome will immediately require insulin treatment","justification":"TRUE! Overall here, the patient is unbalanced (HbA1c > 10%) with clinical decompensation (cardinal syndrome). This is an indication to introduce insulin from the outset"}],"type":"custom"}
+{"_id":"obesite-endoc-f996942","context":null,"enonce":"Which propositions are true?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"In France, the prevalence of obesity is around 15%","justification":"True"},{"idx":1,"correct":true,"proposition":"We become obese younger and younger","justification":"True"},{"idx":2,"correct":false,"proposition":"Obesity prevalence declines after age 65","justification":"It increases"},{"idx":3,"correct":true,"proposition":"The mutation of the melanocortin receptor would be responsible for less than 5% of severe obesity","justification":"True"},{"idx":4,"correct":false,"proposition":"Global prevalence of obesity declines","justification":"It increases"}],"type":"custom"}
+{"_id":"obesite-endoc-b3b8b6b","context":null,"enonce":"What element(s) are complications of obesity?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"Inflammatory joint pain","justification":"Mechanics (osteoarthritis)"},{"idx":1,"correct":true,"proposition":"Daytime sleepiness","justification":"True, OSA"},{"idx":2,"correct":true,"proposition":"Sadness of mood","justification":"True"},{"idx":3,"correct":true,"proposition":"Social isolation","justification":"True"},{"idx":4,"correct":true,"proposition":"Polyuropolydipsic syndrome","justification":"True, diabetes"}],"type":"custom"}
+{"_id":"obesite-endoc-e8d5831","context":null,"enonce":"What examinations are systematic in the face of obesity?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Uricemia","justification":"True"},{"idx":1,"correct":true,"proposition":"NFS","justification":"True"},{"idx":2,"correct":false,"proposition":"ETT","justification":"Systematic ECG"},{"idx":3,"correct":false,"proposition":"EFR","justification":"If respiratory elements at the clinic"},{"idx":4,"correct":true,"proposition":"Blood ionogram","justification":"True"}],"type":"custom"}
+{"_id":"obesite-endoc-ce8cc5a","context":null,"enonce":"A new patient comes in for consultation and asks you for surgical care. You explain the conditions according to the HAS. Check the true answer(s):","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"BMI > 35 alone","justification":"BMI > 40 alone"},{"idx":1,"correct":false,"proposition":"BMI > 30 with comorbidities","justification":"BMI > 35 with comorbidities"},{"idx":2,"correct":true,"proposition":"BMI > 40 alone","justification":"True"},{"idx":3,"correct":true,"proposition":"Need for management and follow-up of at least 6 months before","justification":"True"},{"idx":4,"correct":false,"proposition":"This care is impossible for minors","justification":"Possible under certain very strict and exceptional conditions"}],"type":"custom"}
+{"_id":"obesite-endoc-0fa28f5","context":null,"enonce":"What comorbidities are improved by surgical management of obesity?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"NASH","justification":"True"},{"idx":1,"correct":true,"proposition":"OSA","justification":"True"},{"idx":2,"correct":true,"proposition":"Type 2 diabetes","justification":"True"},{"idx":3,"correct":true,"proposition":"Arthrosis","justification":"True"},{"idx":4,"correct":true,"proposition":"All propositions are true","justification":"True"}],"type":"custom"}
+{"_id":"obesite-endoc-681ea02","context":null,"enonce":"What are the contraindications to bariatric surgery?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"persistent eating disorder","justification":"True"},{"idx":1,"correct":true,"proposition":"Prolonged medical follow-up not feasible","justification":"True"},{"idx":2,"correct":true,"proposition":"Unbalanced psychiatric disorders","justification":"True"},{"idx":3,"correct":true,"proposition":"alcohol dependence","justification":"True"},{"idx":4,"correct":true,"proposition":"All propositions are true","justification":"True"}],"type":"custom"}
+{"_id":"PRNA-neuro-a70214b","context":null,"enonce":"Which propositions are true?","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"There are 2 consecutive phases in Guillain Barré syndrome","justification":"3 phases "},{"idx":1,"correct":true,"proposition":"The first phase can last up to 4 weeks","justification":"True"},{"idx":2,"correct":false,"proposition":"The third phase can last up to 6 months","justification":"Up to 1 year and a half (18 months). Patients are then hospitalized for a long time (often in MRP wards). After 18 months, the lesions are considered fixed"},{"idx":3,"correct":false,"proposition":"The third phase is the plateau phase","justification":"This is the second phase. It can last up to 3 weeks"},{"idx":4,"correct":false,"proposition":"All propositions are true","justification":"Consequently..."}],"type":"custom"}
+{"_id":"PRNA-neuro-f65647f","context":null,"enonce":"What percentage of patients have permanent sequelae (motor deficit, ataxia) of Guillain Barré syndrome?","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"2","justification":""},{"idx":1,"correct":true,"proposition":"15","justification":"True"},{"idx":2,"correct":false,"proposition":"60","justification":""},{"idx":3,"correct":false,"proposition":"80","justification":""},{"idx":4,"correct":false,"proposition":"95","justification":""}],"type":"custom"}
+{"_id":"systemeconv-sp-988d73","context":null,"enonce":"Which of the following are PSRs for treating physicians?","item":"systemeconv","matiere":"sp","propositions":[{"idx":0,"correct":true,"proposition":"Tobacco prevention","justification":"True"},{"idx":1,"correct":true,"proposition":"Prevention of addictive behaviors","justification":"True"},{"idx":2,"correct":true,"proposition":"Efficiency in antibiotic prescribing","justification":"True"},{"idx":3,"correct":false,"proposition":"Covid vaccination","justification":"At least, not yet in June 2021"},{"idx":4,"correct":true,"proposition":"Influenza vaccination","justification":"True"}],"type":"custom"}
+{"_id":"297-onco-08262a1d-9753-4bea-93ea-a67693fa7ba0","context":null,"enonce":"You are a medical gynecology intern and you receive today Mrs. Z 28 years old to perform a cervical smear as part of cervical cancer screening. \nShe has the following background:\n- type 2 diabetes,\n- a Helicobacter pylori infection treated 2 years ago,\n- a solid organ transplant under immunosuppressive therapy since the age of 24.\nA few days after the consultation you receive the result of the smear: ASC-US.  What is the exact proposal(s)?","item":"KcUt","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"An HPV-HR test should have been performed as a first-line test before smear cytology.","justification":"Fake the patient at 29 years old and cytology on FCU must be performed in first line between 25 and 30 years!"},{"idx":1,"correct":false,"proposition":"Following the result of the smear, an immediate colposcopy should be performed.","justification":"False! If AUC-US = indeterminate = HPV test, if the latter is positive then a colposcopy will be done, otherwise a cytology at 1 year."},{"idx":2,"correct":true,"proposition":"Annual cervical cancer screening is recommended for this patient as part of a specialized follow-up.","justification":"True she is on immunosuppressant +++ = increased risk of cervical cancer or rapid progression to cervical cancer after HPV infection!"},{"idx":3,"correct":false,"proposition":"Type 2 diabetes is a risk factor for cervical cancer.","justification":"False! Risk factor for endometrial cancer!"},{"idx":4,"correct":true,"proposition":"If the smear result had been: LSIL, colposcopy would have been indicated.","justification":"True"}],"type":"custom"}
+{"_id":"300-onco-632893fd-1fe3-48c2-a4d4-5e525774a9cc","context":null,"enonce":"What are the risk factors for gastric adenocarcinoma?","item":"Kcestomac","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"Overweight","justification":"False, it is a risk factor for esophageal cancer"},{"idx":1,"correct":true,"proposition":"Sleeve gastrectomy","justification":"True, because partial gastrectomy leads to stagnation of stomach contents in the stump, which will lead to an additional risk of cancer. This is why we do control fibroscopies in the follow-up of sleeve (at 2 and 5 years)"},{"idx":2,"correct":true,"proposition":"Excessive consumption of brine","justification":"True, i.e. salt and nitrites, which partly explains why low socioeconomic status is also a risk factor"},{"idx":3,"correct":true,"proposition":"Biermer's disease","justification":"True, because like all gastritis there is inflammation and therefore a risk of cancerization"},{"idx":4,"correct":false,"proposition":"Presence of chronic GERD for more than 20 years","justification":"False, distractor here"}],"type":"custom"}
+{"_id":"300-onco-b79b87d4-f1d4-4803-af95-0fa7180bb8b8","context":null,"enonce":"You receive in digestive oncology consultation Mr RAT, Paddy, 75 years old that you have brilliantly operated on a gastric adenocarcinoma, via a total gastrectomy. You will now explain the necessary elements for the rest of the support","item":"Kcestomac","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Meal splitting (6 to 7 meals per day in small quantities)","justification":"True, simply the stomach can not hold more food, so to avoid dilating the stump, we split the meals"},{"idx":1,"correct":false,"proposition":"Taking proton pump inhibitor therapy","justification":"False, some surgeons can do it, but there is no clear indication."},{"idx":2,"correct":false,"proposition":"Taking carbohydrates every 2 hours to avoid dumping syndrome","justification":"False, completely fanciful! Dumping syndrome corresponds to hypoglycemia related to the delay in the absorption of carbohydrates in the body (basically the pancreas detects carbohydrates in the stomach, and secretes insulin when we have not even sent carbohydrates into the blood, to schematize roughly that's it)"},{"idx":3,"correct":false,"proposition":"Antiplatelet therapy for a period of 6 months","justification":"False, no antiaggregant necessary except possibly in case of postoperative hyperplatektosis and still it is discussed."},{"idx":4,"correct":false,"proposition":"PO Vitamin B12 Supplementation","justification":"Wrong, big trap! It's intramuscular!!! You no longer have a stomach so you can no longer absorb Vitamin B12... (even if you will see that the literature retains that we can supplement PO anyway, but not to ECN)"}],"type":"custom"}
+{"_id":"303-onco-0278c1ac-ff46-4ec1-a1cb-2be109ba7087","context":null,"enonce":"What are the signs on pelvic ultrasound of an ovarian tumor in favor of malignancy?","item":"Kcovaire","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Ovarian wall thickening","justification":"True, a thick and irregular wall"},{"idx":1,"correct":false,"proposition":"Multifollicated ovary","justification":"False, it is seen in particular in the hormonal stimulations of ART, to ovulate many oocytes to the patient"},{"idx":2,"correct":true,"proposition":"Bilateral involvement","justification":"True, it often indicates contralateral and advanced involvement"},{"idx":3,"correct":true,"proposition":"Endo or exocystic vegetations","justification":"True, vegetations are often signs of cancer"},{"idx":4,"correct":false,"proposition":"Peripheral hypervascularization","justification":"False it is a central hypervascularization"}],"type":"custom"}
+{"_id":"303-onco-9ba29e59-9499-4d1d-b334-0d261d1cd384","context":null,"enonce":"Mrs. DAPHNIS, Chloé, 75 years old, comes to consult you in oncology appointments, because she has just been diagnosed with ovarian cancer. Very familiar with item 303 of the ECN, she asks you questions about the BRCA1 and BRCA2 genes that are predisposing to ovarian cancer. What can you say to him?","item":"Kcovaire","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"BRCA 1 and BRCA 2 genes are oncogenes","justification":"False, these are tumor suppressor genes! Generally oncogenes are autosomal recessive and autosomal tumor suppressor genes dominant, I remembered like that!"},{"idx":1,"correct":true,"proposition":"BRCA 1 and BRCA 2 genes are inherited in an autosomal dominant manner","justification":"True, it is enough to have only one mutated to express the disease"},{"idx":2,"correct":true,"proposition":"There is a higher risk of developing ovarian cancer when you have mutated BRCA1 compared to mutated BRCA2","justification":"True, up to 50% for BRCA versus 25% for BRCA2 (versus about 12% in non-mutated women, and 6% in the general non-mutated population)"},{"idx":3,"correct":true,"proposition":"Any diagnosed ovarian cancer requires testing for mutated BRCA","justification":"True, cancer so rare that it requires genetic research (Lynch and \/ or BRCA often involved)"},{"idx":4,"correct":false,"proposition":"For mutated BRCA, treatment for ovarian cancer is based on targeted monotherapy","justification":"False, there are many targeted therapies with PARP inhibitors but they are in addition to chemotherapy."}],"type":"custom"}
+{"_id":"304-onco-678c24c6-186f-415c-a36c-a257bcc41518","context":null,"enonce":"For biopsies of primary and secondary bone cancers, what are the exact answer(s) among the following?","item":"Kcos","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Bone biopsy is an essential act for the characterization and diagnosis of primary bone tumor ","justification":"True, as with almost any cancer! The biopsy is the heart of diagnosing the type of cancer (primary, secondary) and its grade"},{"idx":1,"correct":true,"proposition":"In case of suspicion of primary bone cancer, a Multidisciplinary Consultation Meeting must take place, but the latter must be approved of its specialty in primary bone tumors","justification":"True, completely convoluted sentence, to say that, since these are rare tumors, CPR must be done in a reference center in the field"},{"idx":2,"correct":true,"proposition":"Biopsy samples will be frozen and copies will be stored in the tumour database","justification":"True, as these are rare tumors, they must be frozen to be references and benefit from additional analyzes"},{"idx":3,"correct":true,"proposition":"Biopsy alone can diagnose the severity grade of primary bone cancer","justification":"True, the gradification of cancer severity is based on cyto and histological elements, so the biopsy alone makes the grade"},{"idx":4,"correct":false,"proposition":"High-grade osteosarcoma is more deadly than high-grade chondrosarcoma","justification":"False, both almost always fatal at 5 years, distractor because it was necessary one"}],"type":"custom"}
+{"_id":"304-onco-fc6ebd27-387a-435e-992b-fd92dc676c46","context":null,"enonce":"Which of the following are primary bone tumours?","item":"Kcos","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Osteosarcoma","justification":"True, to retain malignant tumors benign tumors for bone tumors there is a small and very simple way, namely, all tumors that end in sarcoma or that include sarcomas are malignant tumors (bone sarcoma, leiomyosarcoma, osteosarcoma, Ewing's sarcoma, chondrosarcoma). Everything else is benign"},{"idx":1,"correct":true,"proposition":"Ewing sarcoma","justification":"True, cf. Has"},{"idx":2,"correct":false,"proposition":"Chordoma","justification":"False, cf. Has"},{"idx":3,"correct":false,"proposition":"Osteochondrome","justification":"False, cf. Has"},{"idx":4,"correct":false,"proposition":"Osteoclastosarcoma","justification":"False, small trap this tumor does not exist"}],"type":"custom"}
+{"_id":"306-onco-90102c15-fdf6-4d69-b3e3-9463fbec7c71","context":null,"enonce":"Regarding biopsy in the context of lung cancer diagnosis, what are the exact answer(s)?","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"The biopsy is done under general anesthesia","justification":"False, it can totally be considered under local anesthesia"},{"idx":1,"correct":false,"proposition":"The biopsy is done with a rigid bronchoscope","justification":"False, a flexible bronchoscope is indicated to allow better passage through the bronchi"},{"idx":2,"correct":true,"proposition":"The performance of the biopsy is improved by the realization of a cytological brushing and \/ or a directed lavage for cytological aspiration","justification":"True, it allows for additional cytological analysis and that's just a bonus."},{"idx":3,"correct":false,"proposition":"In some cases, cytological analyses of sputum may point to the type of tumor","justification":"False, there is no indication and no interest in performing it"},{"idx":4,"correct":true,"proposition":"Transparietal needle puncture-biopsy is at risk of pneumothorax","justification":"True, logically, the pleura is on the way"}],"type":"custom"}
+{"_id":"306-onco-d42d8a7c-00ac-4ff9-8217-b9d0c59cc0d2","context":null,"enonce":"You are a general practitioner, and you receive Mr PARKER, Peter, 76 years old, for his prescription renewal.\nThis former repairman on the shipyard, smoking like a firefighter, with a smoking rated at 180PA is at risk of lung cancer. You regularly screen for lung cancer, monitoring its respiratory signs and doing repeated imaging tests, but your external who attends your consultation tells you that you must also watch for paraneoplastic syndromes in this case too...\nWhat paraneoplastic syndromes can be found in lung cancer?","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"Syndrome de Sweet","justification":"False, this febrile neutrophilic dermatosis is found mainly in hemopathies, and in no case in lung cancers."},{"idx":1,"correct":true,"proposition":"Syndrome of inappropriate secretion of anti-diuretic hormone","justification":"True, or ex-Schwartz Barttner syndrome, it is characterized by deep hyponatremia"},{"idx":2,"correct":true,"proposition":"Pneumic hypertrophiant osteoarthropathy","justification":"True, or Pierre-Marie syndrome, it will be characterized by a digital hippocratism and pain of the joints of the limbs, with imaging an engainant periodosis."},{"idx":3,"correct":true,"proposition":"Lambert Eaton's pseudomyasthenia gravis","justification":"True, it mimics in every way a myasthenia gravis except that we will not have the antibodies!"},{"idx":4,"correct":false,"proposition":"Syndrome de Stauffer","justification":"False, this hepatomegaly with anicteric cholestasis is found in kidney cancer"}],"type":"custom"}
+{"_id":"307-onco-01a87ebd-25c0-4ef8-966d-469a7423e3c4","context":null,"enonce":"You receive in consultation Mr HARKNESS, Jack, 67 years old, completely panicked! Indeed he tells you that his \"PSA is much too high\" and he thinks he has prostate cancer. You try to reassure him by explaining the possible causes of PSA elevation... What are they?","item":"Kcprostate","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Benign prostatic hyperplasia","justification":"True, the prostate is bigger, so it produces more PSA! 1ng\/mL per cm3 of prostate (volume assessed on MRI)"},{"idx":1,"correct":true,"proposition":"Taking testosterone","justification":"True, testosterone stimulates prostate cells and therefore the production of PSA"},{"idx":2,"correct":true,"proposition":"Prostatitis","justification":"True, prostate irritation transiently increases PSA levels"},{"idx":3,"correct":true,"proposition":"Prostate cancer","justification":"True, of course"},{"idx":4,"correct":true,"proposition":"Recent ejaculation","justification":"True, unknown cause, absent from several referentials, but that we must know. Simply because ejaculation stimulates the prostate for protein secretion and therefore stimulates the production of pSA"}],"type":"custom"}
+{"_id":"307-onco-c6c5afcc-8b37-41bd-b0ef-0476aaf147b4","context":null,"enonce":"Regarding the prognostic classification of prostate cancer and the appropriate therapeutic options, validate the corresponding couples.","item":"Kcprostate","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Low risk - Brachytherapy","justification":"True, for low risks the possibilities are active surveillance, brachytherapy, radiotherapy, prostatectomy"},{"idx":1,"correct":false,"proposition":"High risk - Total prostatectomy alone","justification":"False, for high risk the only possibility is radiotherapy and hormone therapy for 3 years, or total prostatecomia + lymph node dissection as part of a multimodal treatment"},{"idx":2,"correct":false,"proposition":"Moderate risk - Radiation therapy and hormone therapy for 3 years","justification":"False, for moderate risk the possibilities are prostatectomy and radiotherapy with hormone therapy for 6 months"},{"idx":3,"correct":true,"proposition":"Low Risk - Active Surveillance","justification":"True, see A"},{"idx":4,"correct":false,"proposition":"High Risk - Chemical Castration","justification":"False, treatment of resistant or metastatic forms"}],"type":"custom"}
+{"_id":"308-onco-4a47794f-84be-413e-b604-cc82470f098d","context":null,"enonce":"What are the hereditary forms of kidney cancer?","item":"Kcrein","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Bourneville's tuberous sclerosis","justification":"True, one of the two hereditary forms to remember for the ECN, sorry to make a MCQ on it, but it is a small detail to have in mind for a fifteenth question"},{"idx":1,"correct":false,"proposition":"Le syndrome de Cowden","justification":"False, this pathology is at risk of digestive cancer"},{"idx":2,"correct":true,"proposition":"Von Hippel Lindau's disease","justification":"True, one of the two hereditary forms to remember for the ECN, sorry to make a MCQ on it, but it is a small detail to have in mind for a fifteenth question"},{"idx":3,"correct":false,"proposition":"Le syndrome de Pugh-Hurtis-Weisz","justification":"False, does not exist, but remotely resembles Fitz-Hugh-Curtis syndrome, which corresponds to perihepatic violin strings in advanced C. Trachomatis infections."},{"idx":4,"correct":false,"proposition":"The NMS 2","justification":"False, gives thyroid cancers"}],"type":"custom"}
+{"_id":"Kcoeso-onco-24eada0","context":null,"enonce":"What are the risk factors for adenocarcinoma of the esophagus?","item":"Kcoeso","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"No proposition is true","justification":"True"},{"idx":1,"correct":false,"proposition":"HPV","justification":"Squamous cell carcinoma"},{"idx":2,"correct":false,"proposition":"Syndrome de Plummer-Vinson","justification":"Squamous cell carcinoma"},{"idx":3,"correct":false,"proposition":"Chest radiation therapy","justification":"Squamous cell carcinoma"},{"idx":4,"correct":false,"proposition":"Hot drinks","justification":"Squamous cell carcinoma"}],"type":"custom"}
+{"_id":"Kcoeso-onco-b582d6d","context":null,"enonce":"What are the risk factors for adenocarcinoma of the esophagus?","item":"Kcoeso","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"Being a woman","justification":"Being a man"},{"idx":1,"correct":true,"proposition":"Endobrachyoesophagus","justification":"True"},{"idx":2,"correct":true,"proposition":"Overweight","justification":"True"},{"idx":3,"correct":true,"proposition":"Obesite","justification":"True"},{"idx":4,"correct":true,"proposition":"Tobacco","justification":"True, risk factor for all types of esophageal cancer"}],"type":"custom"}
+{"_id":"Kcpulm-onco-1e6705e","context":null,"enonce":"What are the possible markers of neuroendocrine tumors?","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Chromogranin A","justification":"True"},{"idx":1,"correct":true,"proposition":"Synaptophysin","justification":"True"},{"idx":2,"correct":true,"proposition":"CD56","justification":"True"},{"idx":3,"correct":false,"proposition":"ACE","justification":"Colon tumours"},{"idx":4,"correct":false,"proposition":"SCC","justification":"Squamous cell carcinomas"}],"type":"custom"}
+{"_id":"Kcpulm-onco-24b2b44","context":null,"enonce":"Regarding TTF1 in cancers:","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Adenocarcinomas are classically TTF1 positive","justification":"True"},{"idx":1,"correct":true,"proposition":"Adenocarcinomas are classically p40 negative","justification":"True"},{"idx":2,"correct":true,"proposition":"TTF1 stands for: Thyroid Transcription Factor-1","justification":"True"},{"idx":3,"correct":false,"proposition":"It is relatively specific to squamous cell carcinomas","justification":"It is found in adenocarcinomas "},{"idx":4,"correct":false,"proposition":"It is a marker of neuroendocrine tumors","justification":"It is found in adenocarcinomas "}],"type":"custom"}
+{"_id":"Kcpulm-onco-2b6543e","context":null,"enonce":"What is the overall 5-year survival in percentage for all tumours?","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"17","justification":"True"},{"idx":1,"correct":false,"proposition":"5","justification":""},{"idx":2,"correct":false,"proposition":"85","justification":""},{"idx":3,"correct":false,"proposition":"50","justification":""},{"idx":4,"correct":false,"proposition":"33","justification":""}],"type":"custom"}
+{"_id":"Kcpulm-onco-8550f99","context":null,"enonce":"Regarding the left lung:","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"There are two scissures","justification":""},{"idx":1,"correct":false,"proposition":"There is a large and a small split","justification":""},{"idx":2,"correct":true,"proposition":"There are two lobes","justification":"True, there are two lobes (upper and lower, distinguishable with the sign of the cardiac silhouette) separated by a \"large\" split"},{"idx":3,"correct":false,"proposition":"There are three lobes","justification":""},{"idx":4,"correct":false,"proposition":"There are three splits: one large, one medium and one small","justification":""}],"type":"custom"}
+{"_id":"Kcpulm-onco-c0d7b4e","context":null,"enonce":"Regarding platinum salts:","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"They are topoisomerase 2 inhibitors","justification":"This is the case of anthracyclines"},{"idx":1,"correct":true,"proposition":"They act throughout the cell cycle","justification":"True"},{"idx":2,"correct":true,"proposition":"Oxaliplatin is used in colorectal cancer","justification":"True, FOLFOX protocol"},{"idx":3,"correct":true,"proposition":"Cisplatin is ototoxic","justification":"True"},{"idx":4,"correct":false,"proposition":"They are all highly neurotoxic","justification":"Especially oxaliplatin which gives neuropathies in the cold"}],"type":"custom"}
+{"_id":"PF-neuro-88453b3","context":null,"enonce":"What is the leading cause of facial paralysis?","item":"PF","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"Idiopathic","justification":"True, i.e. a frigore"},{"idx":1,"correct":true,"proposition":"A frigore","justification":"True, i.e. idiopathic"},{"idx":2,"correct":false,"proposition":"SEP","justification":""},{"idx":3,"correct":false,"proposition":"VZV","justification":""},{"idx":4,"correct":false,"proposition":"HIV","justification":""}],"type":"custom"}
+{"_id":"163-infectio-06f42df6-e05a-43c7-86dc-c2cd149552ce","context":null,"enonce":"Which of the following are true?","item":"VH","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"The severity of acute hepatitis is based on the value of transaminases ","justification":"False: The assessment of the severity of acute hepatitis (HA) is based on clinico-biological signs reflecting a functional impact: the value of TP and\/or factor V (hemostasis disorders) and the presence of signs of hepatic encephalopathy (severe prognosis).                "},{"idx":1,"correct":true,"proposition":"A PT < 50% requires hospitalization of the patient in a specialized center close to a liver transplant center","justification":"True: acute hepatitis with < PD  50% corresponds to severe HA and requires hospitalization in a specialized center. "},{"idx":2,"correct":true,"proposition":"The definition of fulminant hepatitis is based on the association of a PD < 50% and the installation of hepatic encephalopathy ","justification":"True. HA fulminant = TP < 50% associated with signs of hepatic encephalopathies of recent onset < 2 weeks."},{"idx":3,"correct":false,"proposition":"Sub-fulminant hepatitis develops within less than 2 weeks ","justification":"False. HA fulminant = installation < 2 weeks. Sub-fulminant HA = installation 2 weeks-3 months. "},{"idx":4,"correct":false,"proposition":"All acute hepatitis occurring on a cirrhotic liver is acute alcoholic hepatitis. ","justification":"False. Acute alcoholic hepatitis is a diagnosis to look for but all causes of acute hepatitis can occur in a cirrhotic patient!"}],"type":"custom"}
+{"_id":"163-infectio-cd679557-71e2-46b1-af63-9ee2ca1d09a8","context":null,"enonce":"What are the true propositions concerning hypertransaminasemia? ","item":"VH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"There are extrahepatic causes responsible for elevated BP ","justification":"True. These are the differential diagnoses to keep in mind: celiac disease, myopathies, hemolysis, heart damage, violent efforts. "},{"idx":1,"correct":false,"proposition":"The two main causes of BP < 10N (low to moderate) are drug-induced and viral hepatitis. ","justification":"False. The two main causes of BP < 10N: alcohol and metabolic syndrome. "},{"idx":2,"correct":true,"proposition":"Hepatic ultrasound is part of the etiological assessment in front of acute hepatitis with BP > 10N. ","justification":"True. 4 causes to look for acute hepatitis with BP > 10N: viral (=serologies+++), drug\/toxic (paracetamol+++), lithiasis (echo+++) and hepatic hypoxia (Budd Chiari, Heart failure, shock...) "},{"idx":3,"correct":true,"proposition":"Acute hepatitis with a fever > 38.5 should be investigated for acute herpes hepatitis.","justification":"True. HSV PCR to do ++++"},{"idx":4,"correct":false,"proposition":"The majority of viral algae hepatitis is clinically characterized by Caroli's triad: headache, arthralgia, urticaria. ","justification":"False. The majority of acute viral hepatitis is ASYMPTOMATIC. "}],"type":"custom"}
+{"_id":"163-infectio-dade0e47-d4f6-4ff5-90d2-a8fc685cfed8","context":null,"enonce":"What are the true propositions concerning hypertransaminasemia? ","item":"VH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"There are extrahepatic causes responsible for elevated BP ","justification":"True. These are the differential diagnoses to keep in mind: celiac disease, myopathies, hemolysis, heart damage, violent efforts. "},{"idx":1,"correct":false,"proposition":"The two main causes of BP < 10N (low to moderate) are drug-induced and viral hepatitis. ","justification":"False. The two main causes of BP < 10N: alcohol and metabolic syndrome. "},{"idx":2,"correct":true,"proposition":"Hepatic ultrasound is part of the etiological assessment in front of acute hepatitis with BP > 10N. ","justification":"True. 4 causes to look for acute hepatitis with BP > 10N: viral (=serologies+++), drug\/toxic (paracetamol+++), lithiasis (echo+++) and hepatic hypoxia (Budd Chiari, Heart failure, shock...) "},{"idx":3,"correct":true,"proposition":"Acute hepatitis with a fever > 38.5 should be investigated for acute herpes hepatitis.","justification":"True. HSV PCR to do ++++"},{"idx":4,"correct":false,"proposition":"The majority of viral algae hepatitis is clinically characterized by Caroli's triad: headache, arthralgia, urticaria. ","justification":"False. The majority of acute viral hepatitis is ASYMPTOMATIC. "}],"type":"custom"}
+{"_id":"meningite-infectio-1d2de4e","context":null,"enonce":"Which germs are gram-positive cocci in chains?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Hemolytic alpha streptococcus","justification":"True, is seen in endocarditis"},{"idx":1,"correct":true,"proposition":"Group A hemolytic beta streptococcus","justification":"True, also called pyogenes"},{"idx":2,"correct":true,"proposition":"Group B hemolytic beta streptococcus","justification":"True, also called agalactiæ "},{"idx":3,"correct":true,"proposition":"Gamma hemolytic streptococcus","justification":"True, all streptococci are chained at ECN"},{"idx":4,"correct":false,"proposition":"Staphylococcus epidermis","justification":"In clusters"}],"type":"custom"}
+{"_id":"meningite-infectio-7c662c5","context":null,"enonce":"What are gram-negative cocci?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Neiserria meningitidis","justification":"True"},{"idx":1,"correct":true,"proposition":"Neiserria gonorroheæ","justification":"True"},{"idx":2,"correct":true,"proposition":"Moraxella catarrhalis","justification":"True"},{"idx":3,"correct":true,"proposition":"Acinetobacter ","justification":"True"},{"idx":4,"correct":false,"proposition":"Listeria monocytogenes","justification":"Gram-negative bacillus"}],"type":"custom"}
+{"_id":"194-rhumato-8adc0ddc-db1e-434e-bca6-d6d4d5100ca1","context":null,"enonce":"You have in hospital, Mr. Langdon, Robert, 55 years old, who presents for a gout attack occurring on his right knee. Which of the short-, medium- and long-term treatment options will you remember?","item":"rhumcrist","matiere":"rhumato","propositions":[{"idx":0,"correct":true,"proposition":"Resting the joint with icing","justification":"True, all non-drug measures are to be preferred because we can always take advantage of them"},{"idx":1,"correct":false,"proposition":"Colchicine started on the second or third day of hospitalization at a maximum dose of 3mg, to take advantage of the decrease in infection","justification":"False, colchicine is to start as early as possible, because it is all the more effective"},{"idx":2,"correct":false,"proposition":"In case of macrolide treatment for digestive infection, there is a contraindication to NSAIDs","justification":"False, a contraindication to colchicine, due to the interaction with cytochromes"},{"idx":3,"correct":true,"proposition":"The therapeutic target of hypouricemic treatment is 360micromoles per liter","justification":"True, which corresponds to the crystallization threshold of sodium urate"},{"idx":4,"correct":true,"proposition":"The patient will have to curb his consumption of alcohol, fast sugar and offal","justification":"True, as well as red meats and seafood"}],"type":"custom"}
+{"_id":"Kcpulm-onco-c9c1080","context":null,"enonce":"What is the chemotherapy of choice for lung tumors?","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Platinum salts","justification":"True"},{"idx":1,"correct":false,"proposition":"Bleomycin","justification":"No, especially since it has pulmonary toxicity type of pulmonary fibrosis"},{"idx":2,"correct":false,"proposition":"The 5-FU","justification":""},{"idx":3,"correct":false,"proposition":"Cyclophosphamide","justification":""},{"idx":4,"correct":false,"proposition":"Irinotecan","justification":""}],"type":"custom"}
+{"_id":"Kcpulm-onco-efc798a","context":null,"enonce":"Regarding imaging in the diagnostic assessment:","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"Brain MRI is systematic","justification":"ATTENTION: the question concerns the DIAGNOSTIC assessment (and no extension)..."},{"idx":1,"correct":true,"proposition":"To speak of a systematized abnormality, the lesion must be extended to an entire lobe or lung segment","justification":"True"},{"idx":2,"correct":false,"proposition":"Mediastinal lymphadenopathy can easily be confused with blood vessels","justification":"parenchymal lymphadenopathy*"},{"idx":3,"correct":false,"proposition":"Chest CT should be coupled with PET","justification":"In the extension assessment, we do a TEP. But not in the diagnosis"},{"idx":4,"correct":false,"proposition":"All propositions are true","justification":""}],"type":"custom"}
+{"_id":"Kcrein-onco-de988e5","context":null,"enonce":"Which of these proposals designates the most common histological type of malignant renal tumor?","item":"Kcrein","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"angiomyolipoma","justification":"Benin"},{"idx":1,"correct":true,"proposition":"clear cell carcinoma","justification":"True"},{"idx":2,"correct":false,"proposition":"adenocarcinoma","justification":"No adenocarcinoma"},{"idx":3,"correct":false,"proposition":"Oncocytoma","justification":"Benin"},{"idx":4,"correct":false,"proposition":"chromophobic carcinoma","justification":"Very rare (about 5%)"}],"type":"custom"}
+{"_id":"246-nutri-b64e9d97-ce5f-4b42-9a48-59dacbd12551","context":null,"enonce":"Mr. Williams, Rory, 45 years old, overweight, with a BMI of 27 comes to see you for consultation because \"Enough is enough, I want to eat better!\". He asks you what he should actually do as a meal and what portion of each food he should put on his plate. What do you say to him?","item":"preventionnutri","matiere":"nutri","propositions":[{"idx":0,"correct":true,"proposition":"All-you-can-eat water during and between meals","justification":"True, essential, it is obvious! "},{"idx":1,"correct":false,"proposition":"Starchy foods, one serving per day","justification":"False, starchy foods are \"solid\", this is what allows you to stall during meals, so it is to be private for lunch and dinner"},{"idx":2,"correct":true,"proposition":"5 fruits and vegetables per day","justification":"True, public health message that everyone knows ;)"},{"idx":3,"correct":false,"proposition":"Focus on vegetable fats and saturated fatty acids","justification":"False, small trap here to insist that it is INsaturated fatty acids that are to be preferred (vegetable fats) rather than saturated fatty acids (cold cuts etc ...)"},{"idx":4,"correct":false,"proposition":"3 dairy products per day","justification":"False, recommendation that has been revised downwards, due to a highlighting of dairy lobby, currently it is 2 per day that is recommended for adults"}],"type":"custom"}
+{"_id":"247-nutri-9b34f801-52b5-4047-81df-7dd5a393eb97","context":null,"enonce":"Regarding dietary modifications recommended in common clinical situations, what are the following exact pathologie\/dietary recommendations?","item":"MTMV","matiere":"nutri","propositions":[{"idx":0,"correct":true,"proposition":"Hypertriglyceridemia and Decreased consumption of simple carbohydrates and alcohol","justification":"True, we sometimes make a false amalgam between triglycerides = eat fat, but it is especially sugar and alcohol that causes a peak of hypertriglyceridemia"},{"idx":1,"correct":true,"proposition":"Osteoporosis and increased vitamin calcium intake","justification":"True, in a very logical way, a vitaminocalcium intake improves bone remodeling"},{"idx":2,"correct":true,"proposition":"Gastroesophageal reflux disease and limitation of alcohol, chocolate and coffee consumption","justification":"True, quite logical there too, these are hot drinks that can irritate the esophageal mucosa and promote reflux"},{"idx":3,"correct":false,"proposition":"Irritable bowel syndrome and diet with FODMAP exclusion","justification":"False, quite important point, because if the FODMAPs-free diet has been quite popularized lately it is a very very restrictive diet (with exclusion of many foods) which is very restrictive and which should only be considered in case of drug failure and failure of other dietary care."},{"idx":4,"correct":false,"proposition":"Diverticular disease and residue-free diet","justification":"False, it is that in the case of acute diverticulitis that a diet without residues is prescribed."}],"type":"custom"}
+{"_id":"248-nutri-f6bd5529-a671-4009-8c76-b7d49f269caa","context":null,"enonce":"Freshly appointed intern in geriatrics in the department of SSR Geriatric of your municipality, you receive in your department Mr Dicarpaccio, Leonardo, 89 years old, hospitalized for 1 week in acute geriatrics for fall with prolonged ground station, complicated bedsores. You look at the file with your senior and you notice that he has not eaten for 1 week. Your boss then tells you at 5pm to prescribe nutritional supplementation while paying attention to inappropriate renutrition syndrome. Thoughtful, you plunge back into the characteristics of this syndrome. What are the clinical and biological signs and what prevention should be applied in case of risk of this syndrome?","item":"denutrition","matiere":"nutri","propositions":[{"idx":0,"correct":true,"proposition":"The syndrome can manifest as edema of the lower limbs","justification":"True, edema of the lower extremities is a clinical sign of severe undernutrition, but also a sign of inappropriate renutrition. In short, watch the legs of your at-risk patients!"},{"idx":1,"correct":true,"proposition":"Biologically, the syndrome is manifested by hypophosphoremia, hypomagnesemia, hypokalemia","justification":"True, the cause of inappropriate renutrition syndrome is an acute consumption of electrolyte reserves provided by the diet, namely phosphorus, magnesium, potassium."},{"idx":2,"correct":false,"proposition":"In case you decide to implement parenteral nutrition, you should adapt the flow of the nasogastric tube starting at a low flow rate.","justification":"False, small trap (because I have often been fooled...) everything is true except that it is ENTERAL nutrition"},{"idx":3,"correct":false,"proposition":"Routine phosphorus supplementation of at-risk patients is sufficient to correct phosphorus deficiencies and dispenses with follow-up biological assessment","justification":"False, preventive supplementation is not like its name... that preventive and does not dispense with biological monitoring every two days of phosphorus"},{"idx":4,"correct":false,"proposition":"Regular weight gain in the first days of renutrition is reassuring","justification":"False, rapid weight gain will most often testify to edema of renutrition raising fears of an inappropriate renutrition syndrome."}],"type":"custom"}
+{"_id":"249-nutri-b66daa4a-ca80-4b77-9315-fa8937599576","context":null,"enonce":"Which of the following pathologies are causes of weight loss with hyperphagia?","item":"amaigrissemt","matiere":"nutri","propositions":[{"idx":0,"correct":true,"proposition":"Type 1 diabetes","justification":"True, it is even part of the diagnostic criteria for type 1 diabetes. Weight loss with polyphagia"},{"idx":1,"correct":false,"proposition":"Parkinson's disease","justification":"False, there is most often a deficiency of intake related to swallowing disorders"},{"idx":2,"correct":false,"proposition":"Chronic ethylism","justification":"False, there is most often a normal diet, but with deficiencies."},{"idx":3,"correct":true,"proposition":"Hyperthyroidism","justification":"True, Épinal's image of hyperthyroidism shows a skinny woman eating a lot but losing weight!"},{"idx":4,"correct":true,"proposition":"Taeniosis","justification":"True, since it is the worm that eats everything in the patient's place, the patient is naturally hungry!"}],"type":"custom"}
+{"_id":"preventionnutri-nutri-d510224","context":null,"enonce":"1 gram of carbohydrate corresponds to how many kcal?","item":"preventionnutri","matiere":"nutri","propositions":[{"idx":0,"correct":false,"proposition":"1","justification":""},{"idx":1,"correct":false,"proposition":"2","justification":""},{"idx":2,"correct":false,"proposition":"3","justification":""},{"idx":3,"correct":false,"proposition":"5","justification":""},{"idx":4,"correct":true,"proposition":"4","justification":"True, 1g Carbohydrate and protein = 4 Kcal"}],"type":"custom"}
+{"_id":"preventionnutri-nutri-7778444","context":null,"enonce":"How many kcal is 1 gram of protein?","item":"preventionnutri","matiere":"nutri","propositions":[{"idx":0,"correct":false,"proposition":"1","justification":""},{"idx":1,"correct":false,"proposition":"10","justification":""},{"idx":2,"correct":false,"proposition":"8","justification":""},{"idx":3,"correct":false,"proposition":"5","justification":""},{"idx":4,"correct":true,"proposition":"4","justification":"True, 1g Carbohydrate and protein = 4 Kcal"}],"type":"custom"}
+{"_id":"preventionnutri-nutri-3708c8d","context":null,"enonce":"1 gram of fat corresponds to how many kcal?","item":"preventionnutri","matiere":"nutri","propositions":[{"idx":0,"correct":false,"proposition":"1","justification":""},{"idx":1,"correct":false,"proposition":"4","justification":""},{"idx":2,"correct":true,"proposition":"9","justification":"True"},{"idx":3,"correct":false,"proposition":"15","justification":""},{"idx":4,"correct":false,"proposition":"2","justification":""}],"type":"custom"}
+{"_id":"211-hemato-340feaab-4968-4b25-b22b-b8bb0c169338","context":null,"enonce":"You receive in the emergency room, Zenigata, Koichi, 45 years old, a man brought by the PASS, who explains to you that it is a homeless man who spends most of his nights outside. On clinical examination, you notice a perifollicular petechial purpura, as well as many oral hemorrhages with thickening of the gums leading to dental loosening. What pathology do you suspect?","item":"purpura","matiere":"hemato","propositions":[{"idx":0,"correct":false,"proposition":"Osler's endocarditis","justification":"False, Osler's endocarditis would be evoked before a fever with conjunctival purpura."},{"idx":1,"correct":false,"proposition":"Ehlers Danlos disease","justification":"False, it is manifested by ligament and cutaneous hyperlaxity with healing disorders"},{"idx":2,"correct":false,"proposition":"NSAID angiitis","justification":"False, no notion of NSAID consumption"},{"idx":3,"correct":true,"proposition":"Scurvy","justification":"True, here the context of homelessness is favoring vitamin C deficiency. The clinical description shows facilitated bleeding with hyperinfiltration of the gum mimicking a hematological disease with loosening of the teeth."},{"idx":4,"correct":false,"proposition":"AL amyloidosis","justification":"False, it is manifested by a hematoma in glasses"}],"type":"custom"}
+{"_id":"281-HGE-bcac4352-1942-459c-8c68-96ebad1fcf46","context":null,"enonce":"You receive in general medical consultation, Mrs. Kyle, Selena, 37 years old, who comes to see you for a table of various gastroenterological symptoms (abdominal pain, bloating, diarrhea), which you attach to a possible irritable bowel syndrome. The very concerned patient asks you if she should have a colonoscopy. To answer his request you explain the different indications of colonoscopy in the context of irritable bowel syndrome.","item":"SII","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"History of colorectal cancer in the father","justification":"True, it is quite logical, generally faced with a history of colorectal cancer, we are not cautious, patients usually have an endoscopic examination to eliminate adenomas, polyps and cancers."},{"idx":1,"correct":true,"proposition":"Age >50","justification":"True, because we join the, the limit of standard screening. Overall, a complete colonoscopy is done to reassure that the symptoms are of functional origin"},{"idx":2,"correct":false,"proposition":"Alternating diarrhea constipation at the level of the clinical picture","justification":"False, symptom intensity (except recent modification) does not count in the decision criteria for colonoscopy"},{"idx":3,"correct":true,"proposition":"Presence of rectal bleeding","justification":"True, very logically, irritable bowel syndrome does not give rectal bleeding"},{"idx":4,"correct":false,"proposition":"Intense abdominal meteorism","justification":"False, symptom intensity (except recent modification) does not count in the decision criteria for colonoscopy"}],"type":"custom"}
+{"_id":"cirrhose-HGE-0b5ff08","context":null,"enonce":"Regarding hepatorenal syndrome:","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"It corresponds to a renal failure of functioning origin that does not correct itself despite maximum management","justification":"True"},{"idx":1,"correct":false,"proposition":"It appears at an early stage of cirrhosis","justification":"Advanced stage"},{"idx":2,"correct":false,"proposition":"It is most often observed in cases of severe liver failure with significant ascites and a prothrombin level still above 50%","justification":"Rather when the TP is <50%"},{"idx":3,"correct":false,"proposition":"The long-term treatment is terlipressin and adrenaline","justification":"These are treatments whose beneficial effect is only temporary. The only long-lasting treatment is liver transplantation"},{"idx":4,"correct":true,"proposition":"It may be responsible for hepatic encephalopathy","justification":"True"}],"type":"custom"}
+{"_id":"cirrhose-HGE-176d498","context":null,"enonce":"What are the triggers of hepatic encephalopathy?","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"Bacterial infections","justification":"True"},{"idx":1,"correct":true,"proposition":"Digestive bleeding","justification":"True"},{"idx":2,"correct":true,"proposition":"Sedative medications","justification":"True"},{"idx":3,"correct":true,"proposition":"Renal failure","justification":"True"},{"idx":4,"correct":true,"proposition":"Hyponatremia","justification":"True"}],"type":"custom"}
+{"_id":"cirrhose-HGE-5a899ba","context":null,"enonce":"What are the triggers of hepatic encephalopathy?","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"Constipation","justification":"True"},{"idx":1,"correct":true,"proposition":"Presence of an acquired TIPS","justification":"True"},{"idx":2,"correct":true,"proposition":"Presence of a spontaneous portosystemic shunt","justification":"True"},{"idx":3,"correct":false,"proposition":"Presence of hyperleukocytosis","justification":"Not a triggering factor in itself (but bacterial infection is one), so it's not a direct link (so not to check)"},{"idx":4,"correct":false,"proposition":"Presence of anemia","justification":"Not a triggering factor in itself (but digestive bleeding is one), so it's not a direct link (so not to check)"}],"type":"custom"}
+{"_id":"cirrhose-HGE-f8e0109","context":null,"enonce":"You take care of a patient who complains of a \"bloated belly\". \n\nOn clinical examination you find: 130\/90 mmHg, 75 bpm, apyretic, 99% in ambient air, G15. \n\nNEUROLOGY: the patient is calm, conscious and oriented. You do not find abnormalities in the cranial pairs or other focal neurological deficits. ROTs are normal. No asterixis found, no tremors of the extremities. \n\nCARDIOVASCULAR: Heart sounds are regular without breaths, no signs of left or right heart failure. Peripheral pulses are perceived, no abdominal beating mass. \n\nABSTATIC: the abdomen is tense, depressible and painless. BHAs are correctly perceived. You find a hepatomegaly of hard consistency. No perceived splenomegaly. Presence of abdominal collateral circulation. Presence of dullness declive on percussion. Hernial orifices are free. \n\nMUCOSAL CUTANEOS: stellar angiomas, white nails, palmar erythrosis. \n\nWhat are the exact proposals?\n","item":"cirrhose","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"You suspect hepatocellular insufficiency","justification":"True, in front of stellar angiomas, white nails, palmar erythrosis"},{"idx":1,"correct":true,"proposition":"You suspect portal hypertension","justification":"True, in front of the tense abdomen and declivated dullness (= ascites) and collateral venous circulation"},{"idx":2,"correct":false,"proposition":"You suspect delirium tremens","justification":"No confusion"},{"idx":3,"correct":false,"proposition":"You suspect thrombosis of the inferior vena cava","justification":"Very uncommon + no clinical sign here"},{"idx":4,"correct":false,"proposition":"You suspect encephalopathy","justification":"No neurological signs"}],"type":"custom"}
+{"_id":"ictere-HGE-c503890","context":null,"enonce":"Which propositions are true?","item":"ictere","matiere":"HGE","propositions":[{"idx":0,"correct":false,"proposition":"Conjugated bilirubin jaundice is always due to biliary stasis","justification":"Many other causes of increased conjugated bilirubin exist. For example, large hemolysis leads to functional cholestasis "},{"idx":1,"correct":true,"proposition":"Conjugated bilirubin jaundice causes dark urine","justification":"True"},{"idx":2,"correct":true,"proposition":"Free bilirubin jaundice is conventionally accompanied by clear urine","justification":"True"},{"idx":3,"correct":true,"proposition":"Free bilirubin jaundice does not conventionally cause pruritus","justification":"True"},{"idx":4,"correct":false,"proposition":"free bilirubin is eliminated in the urine","justification":"It is transformed by hepatocytes, which eliminate it in the bile"}],"type":"custom"}
+{"_id":"BPCO-pneumo-24c3015","context":null,"enonce":"A 70% post-bronchodilator FEV1 classifies COPD as stage:","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"1","justification":""},{"idx":1,"correct":true,"proposition":"2","justification":"True"},{"idx":2,"correct":false,"proposition":"3","justification":""},{"idx":3,"correct":false,"proposition":"4","justification":""},{"idx":4,"correct":false,"proposition":"5","justification":""}],"type":"custom"}
+{"_id":"BPCO-pneumo-a766144","context":null,"enonce":"A 10% post-bronchodilator FEV1 classifies COPD as stage:","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"1","justification":""},{"idx":1,"correct":false,"proposition":"2","justification":""},{"idx":2,"correct":false,"proposition":"3","justification":""},{"idx":3,"correct":true,"proposition":"4","justification":"True"},{"idx":4,"correct":false,"proposition":"5","justification":"No stage 5"}],"type":"custom"}
+{"_id":"BPCO-pneumo-a5ed1b7","context":null,"enonce":"A 90% post-bronchodilator FEV1 classifies COPD as stage:","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"1","justification":"True"},{"idx":1,"correct":false,"proposition":"2","justification":""},{"idx":2,"correct":false,"proposition":"3","justification":""},{"idx":3,"correct":false,"proposition":"4","justification":""},{"idx":4,"correct":false,"proposition":"5","justification":""}],"type":"custom"}
+{"_id":"BPCO-pneumo-aa59a4d","context":null,"enonce":"A 55% post-bronchodilator FEV1 classifies COPD as stage:","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"1","justification":""},{"idx":1,"correct":true,"proposition":"2","justification":"True"},{"idx":2,"correct":false,"proposition":"3","justification":""},{"idx":3,"correct":false,"proposition":"4","justification":""},{"idx":4,"correct":false,"proposition":"5","justification":""}],"type":"custom"}
+{"_id":"BPCO-pneumo-dc1d55d","context":null,"enonce":"How many possible stages are there in the COPD GOLD classification based on post-bronchodilator FEV1?","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"1","justification":""},{"idx":1,"correct":false,"proposition":"2","justification":""},{"idx":2,"correct":false,"proposition":"3","justification":""},{"idx":3,"correct":true,"proposition":"4","justification":"True, the cut off are 80%, 50% and 30%"},{"idx":4,"correct":false,"proposition":"5","justification":""}],"type":"custom"}
+{"_id":"meningite-infectio-2434d89","context":null,"enonce":"What are gram-positive bacilli?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Corynebacterium diphteriae","justification":"True"},{"idx":1,"correct":true,"proposition":"Listeria monocytogenes","justification":"True"},{"idx":2,"correct":true,"proposition":"Bacillus anthracis","justification":"True"},{"idx":3,"correct":true,"proposition":"Clostridium dificult","justification":"True"},{"idx":4,"correct":true,"proposition":"Clostridium perfringens","justification":"True"}],"type":"custom"}
+{"_id":"meningite-infectio-df58822","context":null,"enonce":"What are gram-negative bacilli?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Bartonella ","justification":"True, cat scratch disease"},{"idx":1,"correct":true,"proposition":"Bordetella pertussis","justification":"True, whooping cough"},{"idx":2,"correct":true,"proposition":"Hæmophilus influenzæ","justification":"True, ENT and lung infections"},{"idx":3,"correct":true,"proposition":"Legionnella","justification":"True"},{"idx":4,"correct":false,"proposition":"Listeria monocytogenes","justification":"Gram-positive bacillus"}],"type":"custom"}
+{"_id":"VH-infectio-00d8e88","context":null,"enonce":"What are the risk groups for C virus infection? ","item":"VH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Subjects who received blood or blood derivatives before 1992","justification":"True"},{"idx":1,"correct":true,"proposition":"Hemodialysis patients","justification":"True"},{"idx":2,"correct":true,"proposition":"Intravenous drug addicts","justification":"True"},{"idx":3,"correct":true,"proposition":"Subjects originating from a hyperendemic area","justification":"True, Mediterranean basin"},{"idx":4,"correct":true,"proposition":"All propositions are true","justification":"True"}],"type":"custom"}
+{"_id":"VH-infectio-43fe210","context":null,"enonce":"What is the preferred marker of HCC?","item":"VH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Alpha-fetoprotein ","justification":"True"},{"idx":1,"correct":false,"proposition":"B-HCG","justification":"Psa a tumor marker"},{"idx":2,"correct":false,"proposition":"Total HCG","justification":"Testicular tumour"},{"idx":3,"correct":false,"proposition":"ACE","justification":"Adenocarcinoma of the lung"},{"idx":4,"correct":false,"proposition":"SCC","justification":"Squamous cell carcinomas"}],"type":"custom"}
+{"_id":"272-HGE-b1ab55bd-a3a6-4090-9a0f-b63491c3fe1a","context":null,"enonce":"Which of the following are true?","item":"splenomeg","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"Adrenal tumors may be a differential diagnosis ","justification":"True, only for left adrenal tumors "},{"idx":1,"correct":false,"proposition":"The diagnosis of splenomegaly is mostly ultrasound ","justification":"False, mostly clinical "},{"idx":2,"correct":true,"proposition":"Hypersplenism can cause thrombocytopenia ","justification":"True, it is a sequestration cytopenia "},{"idx":3,"correct":true,"proposition":"Viral hepatitis be a cause of splenomegaly ","justification":"True"},{"idx":4,"correct":true,"proposition":"A splenic infarction can be revealed by left basithoracic pain associated with hyperthermia ","justification":"True"}],"type":"custom"}
+{"_id":"radiculalgie-ortho-20b9edc","context":null,"enonce":"What are the secondary causes of carpal tunnel syndrome?","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"correct":true,"proposition":"Repetitive trauma","justification":"True"},{"idx":1,"correct":true,"proposition":"Rheumatoid arthritis","justification":"True"},{"idx":2,"correct":true,"proposition":"Acromegaly","justification":"True"},{"idx":3,"correct":false,"proposition":"Hyperthyroidism","justification":"Hypothyroidism"},{"idx":4,"correct":false,"proposition":"Idiopathic","justification":"It is a primitive cause (and not secondary, so does not answer the question) 😊"}],"type":"custom"}
+{"_id":"radiculalgie-ortho-c94726b","context":null,"enonce":"What are the secondary causes of carpal tunnel syndrome?","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"correct":true,"proposition":"Pregnancy","justification":"True"},{"idx":1,"correct":true,"proposition":"Type 2 diabetes","justification":"True"},{"idx":2,"correct":true,"proposition":"Lipoma","justification":"True"},{"idx":3,"correct":true,"proposition":"Lupus","justification":"True"},{"idx":4,"correct":true,"proposition":"Amylose","justification":"True"}],"type":"custom"}
+{"_id":"radiculalgie-ortho-3a26f89","context":null,"enonce":"What are the secondary causes of carpal tunnel syndrome?","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"correct":true,"proposition":"Arthrosis","justification":"True"},{"idx":1,"correct":true,"proposition":"Hypothyroidism","justification":"True"},{"idx":2,"correct":false,"proposition":"Down syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Hyperparathyroidism","justification":"Hypothyroidism"},{"idx":4,"correct":true,"proposition":"Drop","justification":"True"}],"type":"custom"}
+{"_id":"214-hemato-7cc32a5a-22ce-4b69-ac4d-ddb56ca1dfe5","context":null,"enonce":"What parasitosis is associated with eosinophilia?","item":"hyperEo","matiere":"hemato","propositions":[{"idx":0,"correct":true,"proposition":"Infection à Taenia Solium","justification":"True, the purpose of this hyper catalog MCQ is twofold: knowing which parasitosis give eosinophilia is hard and complex, better to remember those that do not: Malaria, Giardiosis, Amoebiasis. In addition, it also makes it possible to remember which parasite is associated with which disease."},{"idx":1,"correct":false,"proposition":"Infection à Entamoeba Histolytica","justification":"False, amoebiasis does not give hypereosinophilia."},{"idx":2,"correct":true,"proposition":"Infection à Echinococcus Granulosus","justification":"True, cf A. echinococcosis gives eosinophilia "},{"idx":3,"correct":true,"proposition":"Enterobius vermicularis infection","justification":"True, pinworm gives eosinophilia"},{"idx":4,"correct":false,"proposition":"Infection à Giardia Duodenalis","justification":"False, giardiasis gives fatty diarrhea after returning from travel"}],"type":"custom"}
+{"_id":"ADP-hemato-120e780","context":null,"enonce":"Cervical lymphadenopathy drains the following territories:","item":"ADP","matiere":"hemato","propositions":[{"idx":0,"correct":true,"proposition":"Scalp","justification":"True"},{"idx":1,"correct":true,"proposition":"ENT spheres","justification":"True"},{"idx":2,"correct":true,"proposition":"Oral spheres","justification":"True"},{"idx":3,"correct":true,"proposition":"Thyroid","justification":"True"},{"idx":4,"correct":false,"proposition":"Mediastinum","justification":"Supraclavicular"}],"type":"custom"}
+{"_id":"ADP-hemato-bf37e75","context":null,"enonce":"Supraclavicular lymphadenopathy drains the following territories:","item":"ADP","matiere":"hemato","propositions":[{"idx":0,"correct":true,"proposition":"Lungs","justification":"True"},{"idx":1,"correct":true,"proposition":"Alimentary canal","justification":"True"},{"idx":2,"correct":true,"proposition":"Testicles","justification":"True"},{"idx":3,"correct":false,"proposition":"Upper limbs","justification":"Axillary"},{"idx":4,"correct":false,"proposition":"Breasts","justification":"Axillary"}],"type":"custom"}
+{"_id":"ADP-hemato-8a3a267","context":null,"enonce":"Cervical lymphadenopathy drains the following territories:","item":"ADP","matiere":"hemato","propositions":[{"idx":0,"correct":true,"proposition":"Scalp","justification":"True"},{"idx":1,"correct":true,"proposition":"ENT spheres","justification":"True"},{"idx":2,"correct":true,"proposition":"Oral sphere","justification":"True"},{"idx":3,"correct":true,"proposition":"Thyroid","justification":"True"},{"idx":4,"correct":false,"proposition":"Mediastinum","justification":"Supraclavicular"}],"type":"custom"}
+{"_id":"ADP-hemato-275c7e9","context":null,"enonce":"Axillary lymphadenopathy drains the following territories:","item":"ADP","matiere":"hemato","propositions":[{"idx":0,"correct":false,"proposition":"Anus","justification":"Inguinal"},{"idx":1,"correct":false,"proposition":"Scrotum","justification":"Inguinal"},{"idx":2,"correct":true,"proposition":"Upper limbs","justification":"True"},{"idx":3,"correct":true,"proposition":"Breasts","justification":"True"},{"idx":4,"correct":false,"proposition":"Lungs","justification":"Supraclavicular"}],"type":"custom"}
+{"_id":"ADP-hemato-69c94da","context":null,"enonce":"Inguinal lymphadenopathy drains the following territories:","item":"ADP","matiere":"hemato","propositions":[{"idx":0,"correct":true,"proposition":"Anus","justification":"True"},{"idx":1,"correct":true,"proposition":"Penis","justification":"True"},{"idx":2,"correct":true,"proposition":"Scrotum","justification":"True"},{"idx":3,"correct":true,"proposition":"Vulva","justification":"True"},{"idx":4,"correct":true,"proposition":"Lower limbs","justification":"True"}],"type":"custom"}
+{"_id":"226-cardio-55f4abcf-57ce-4044-9f1d-ee7d18d05551","context":null,"enonce":"You have in geriatric hospitalization, Mrs. Everdeen, Katniss, 85 years old, hospitalized for a \"difficult home support\". During your careful clinical examination you will highlight multiple venous lower limb ulcers. The nurse of the service then asks you \"what to do\", what do you decide to do as local treatments?","item":"ulcere","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"For ulcer cleansing, you prefer the use of hydrogen peroxide after careful antisepsis","justification":"False, the \"washing\" of ulcers is done with simple water, antisepsis is a mistake because it will promote more than prevent infections, by modifying the skin flora. It has an indication only in case of bacterial dermohypodermatitis"},{"idx":1,"correct":false,"proposition":"To promote skin budding, you use vaseline tulle with lanolin or Peruvian balm","justification":"False, then we use vaseline tulles or \"greasy dressings\" to bring material to the skin to rebuild, but we must avoid in all cases the use of allergens such as lanolin, Peruvian balsam, fragrances, which can lead to contact dermatitis "},{"idx":2,"correct":false,"proposition":"Hydrocolloid or hydrocellular is a type of dressing that brings \"fat\" to the wound, promoting budding","justification":"False, as seen above, it is the vaseline tulles that have this role. Hydrocolloids are moist dressings with optimal pH that promote budding, through controlled maceration."},{"idx":3,"correct":true,"proposition":"Silver dressings are not systematic in the management of ulcers","justification":"True, to use only in inflammatory ulcers at risk of becoming infectious"},{"idx":4,"correct":true,"proposition":"In the case of this patient, in the absence of PAD with IPS <0.7 venous compression will be systematic","justification":"True, the main treatment for ulcer!"}],"type":"custom"}
+{"_id":"226-cardio-704ffab8-3419-4e22-b941-0c63296eb6c4","context":null,"enonce":"Regarding ulcers, what are the main complications of the latter?","item":"ulcere","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Erysipelas or necrotizing fasciitis","justification":"True, this is the main complication to look for, it is a wound that can be the gateway to an erysipelas"},{"idx":1,"correct":true,"proposition":"Very common periostitis","justification":"True, poorly known, but it is a diffusion of inflammation at the level of the underlying periosteum"},{"idx":2,"correct":true,"proposition":"Extracellular dehydration","justification":"True, just like protein malnutrition it is a complication to think about in front of any wound, especially in the elderly and dependent"},{"idx":3,"correct":false,"proposition":"Hemorrhage mainly in the context of an arterial ulcer","justification":"False, hemorrhage is mainly observed in front of venous ulcers and not in front of arterial ulcers"},{"idx":4,"correct":true,"proposition":"Squamous cell carcinoma in front of a chronic ulcer","justification":"True, existing chronic complication in front of a resistant chronic ulcer"}],"type":"custom"}
+{"_id":"acroSd-cardio-8281231","context":null,"enonce":"Which of the following are NOT indicators of secondary Raynaud's phenomenon?","item":"acroSd","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Family history","justification":"True"},{"idx":1,"correct":true,"proposition":"Tobacco","justification":"True"},{"idx":2,"correct":true,"proposition":"Damage to the toes","justification":"True"},{"idx":3,"correct":false,"proposition":"Presence of megacapillaries","justification":""},{"idx":4,"correct":false,"proposition":"One-handed","justification":"The factors that are in favor of a secondary Raynaud and to know are: male sex, age of onset > 40 years, unilateral involvement, involvement of the thumb, absence of pulse, abnormal Allen, trophic disorders, absence of summer remission, photosensitivity and presence of mega-capillaries to capillaroscopy. As a P1 DOUBLE WOULD SAY: BY PRIMING HEART!"}],"type":"custom"}
+{"_id":"adenomehypoP-endoc-186a012","context":null,"enonce":"Where is IGF1 mainly synthesized? (> 50% of production)","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Liver","justification":"True. IGF-1 production is virtually ubiquitous, but the main producing tissue is the liver (more than 50% of plasma concentrations)"},{"idx":1,"correct":false,"proposition":"Muscle","justification":""},{"idx":2,"correct":false,"proposition":"The kidney","justification":""},{"idx":3,"correct":false,"proposition":"The lung","justification":""},{"idx":4,"correct":false,"proposition":"Spleen","justification":""}],"type":"custom"}
+{"_id":"adenomehypoP-endoc-c7a8921","context":null,"enonce":"What are the complications of acromegaly to look for?","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Myocardial hypertrophy","justification":"True"},{"idx":1,"correct":true,"proposition":"Arthropathy","justification":"True"},{"idx":2,"correct":true,"proposition":"Diabetes","justification":"True"},{"idx":3,"correct":true,"proposition":"Sleep apnea syndrome","justification":"True"},{"idx":4,"correct":true,"proposition":"Hepatomegaly","justification":"True"}],"type":"custom"}
+{"_id":"obesite-endoc-9b0a4c8","context":null,"enonce":"What proposals are true about the by-pass?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"It is an obstructive method","justification":""},{"idx":1,"correct":true,"proposition":"It is a restrictive method","justification":"True, like gastric band and gastrectomy"},{"idx":2,"correct":false,"proposition":"Vitamin supplementation lasts 6 to 12 months, while the rest of the intestine adapts","justification":"She is for life"},{"idx":3,"correct":false,"proposition":"It causes malabsorption in 2 out of 10 cases","justification":"Always a malabsorption (that's the goal, somewhere)"},{"idx":4,"correct":true,"proposition":"It is a reversible method","justification":"True"}],"type":"custom"}
+{"_id":"255-nephro-f8fee290-3905-49f9-bbce-d79c925b3dc7","context":null,"enonce":"You check this noon the biological assessment of several of your patients, including that of Mr Ren, Kylo, 65 years old, known by the service for his chronic renal failure at 19mL \/ min. You then explain to your outpatient that kidney failure is often chronic, when we have arguments for its chronicity such as small kidneys, hypocalcemia and anemia. But the latter tells you that each time in MCQ he is asked for exceptions and that he can never remember them... Can you help?","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Chronic renal failure on Sarcoidosis with hypercalcaemia ","justification":"True, chronic pathologies leading to excess calcium, classically myeloma and sarcoidosis lead to chronic renal failure with hypercalcemia"},{"idx":1,"correct":false,"proposition":"Chronic renal failure on myeloma with polycythemia ","justification":"False, there is no polycythemia in myeloma but anemia"},{"idx":2,"correct":true,"proposition":"Chronic renal failure with increased size of kidneys or kidneys of normal size, on diabetes","justification":"True, just like hydronephrosis, autosomal dominant polycystic kidney disease, amyloidosis or HIV-related nephropathy, diabetes does not cause a decrease in kidney size."},{"idx":3,"correct":false,"proposition":"Chronic renal failure with increased size of the kidneys or kidneys of normal size, on chronic vesicoureteral reflux","justification":"False, it does not cause an increase in kidney size"},{"idx":4,"correct":true,"proposition":"Acute renal failure with hypocalcaemia on tumor lysis syndrome ","justification":"True, but generally the context with the history of serum creatinine makes that we will be less wrong ;)"}],"type":"custom"}
+{"_id":"255-nephro-d35e4743-7073-4038-b2e6-da295915b7d3","context":null,"enonce":"What is the biological sign(s) of functional acute renal failure?","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Decrease in plasma urea in favor of plasma serum creatinine","justification":"False, in the context of functional acute renal failure, one literally has a drying of the body. As a result, we \"no longer urinate\" because we have \"not enough water\". Thus the concentrations of urea and serum creatinine will increase because we have more water."},{"idx":1,"correct":true,"proposition":">10 urinary urea concentration compared to plasma urea","justification":"True, simply because the urine that continues to be manufactured, no longer has all the components. In the urine, we have creatinine, urea, sodium and water to dilute all this among others. If we have more water in the urine, it is because the little we have left, we leave it in the blood to avoid complete dehydration. So more water in the urine, we have a concentration of urea in the urine very intense, more intense than in the blood (or there is still a little water)"},{"idx":2,"correct":false,"proposition":"<30 concentration of creatinineuria versus serum creatinine","justification":"False, same principle as for the B"},{"idx":3,"correct":true,"proposition":"Decreased natriuresis","justification":"True, you know as well as me, that extracellular hydration is governed by salt, so if we dehydrate, in fact we lose a lot of salt, which carries water with it. Therefore, we will avoid pissing the salt, to reabsorb the water! CQFD!"},{"idx":4,"correct":true,"proposition":"Secondary hyperaldosteronism","justification":"True, to reabsorb salt, the hormone that makes it possible to do this, is aldosterone!"}],"type":"custom"}
+{"_id":"262-nephro-13254ad3-f4be-4074-95e1-c8db8050d9b1","context":null,"enonce":"You are an emergency intern in the emergency department of Ouessant (we can dream a little), and you receive Mr. Jones, Indiana, 39 years old, who back from Peru, did not hydrate well on the plane and has a picture of renal colic with a fever at 39 ° C.  You are looking to do an imaging and you have all the latest devices at home! What do you do?","item":"lithiaseU","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Couple Abdomen without preparation and Renal ultrasound","justification":"False, because here we are in the context of a complicated renal colic (febrile) and in this case there is only one examination to do, cf. C."},{"idx":1,"correct":false,"proposition":"Uro-CT","justification":"False, uro CT is never done in the context of renal colic"},{"idx":2,"correct":true,"proposition":"Abdominopelvic CT without injection","justification":"True, this is the reference examination in front of complicated renal colic "},{"idx":3,"correct":false,"proposition":"Nephro-MRI","justification":"False, it doesn't exist"},{"idx":4,"correct":true,"proposition":"If you receive his partner Marion Ravenwood, pregnant with 8SA, for the same symptoms, you would only have one imaging choice.","justification":"True, namely ultrasound! The rest is irradiating and therefore toxic to the fetus"}],"type":"custom"}
+{"_id":"262-nephro-53b6e4ed-95cf-429c-874a-fe87d7082b07","context":null,"enonce":"Regarding the urological treatments of stones what are the exact proposal(s)?","item":"lithiaseU","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Extracorporeal lithotripsy is contraindicated in case of aortic or renal arterial aneurysm","justification":"True, these are wave pulses, so imagine in case of anticoagulant treatment, fetus or arterial aneurysm, the destructive potential that it can have..."},{"idx":1,"correct":true,"proposition":"Ureteroscopy is the treatment of choice in a patient on antiaggregant or anticoagulant","justification":"True, because it is the only one that theoretically does not cause tissue damage "},{"idx":2,"correct":false,"proposition":"In case of obstructive pyelonephritis, urological treatment takes precedence over antibiotic treatment","justification":"Wrong, we are not going to operate in infected urine!"},{"idx":3,"correct":true,"proposition":"Extracorporeal lithotripsy is not very effective in obese patients","justification":"True, because shock waves have a harder time passing"},{"idx":4,"correct":false,"proposition":"Percutaneous nephrolithotomy is the most common treatment performed today.","justification":"False, it is clearly a second-line treatment"}],"type":"custom"}
+{"_id":"tbiono-nephro-8bccae6","context":null,"enonce":"Which propositions are true?","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"DHA (vasopressin) is produced by the hypothalamus","justification":"True"},{"idx":1,"correct":false,"proposition":"DHA (vasopressin) is produced by the pituitary gland","justification":""},{"idx":2,"correct":false,"proposition":"DHA (vasopressin) is released from the anterior pituitary gland","justification":"Posterior pituitary gland"},{"idx":3,"correct":false,"proposition":"The role of DHA is sodium reabsorption","justification":"Reabsorption of pure water"},{"idx":4,"correct":true,"proposition":"Diabetes insipidus is central if there is a defect in DHA production","justification":"True"}],"type":"custom"}
+{"_id":"autonomiegeria-mpr-20b4bcc","context":null,"enonce":"What activities belong to Katz's ADL? ","item":"autonomiegeria","matiere":"mpr","propositions":[{"idx":0,"correct":true,"proposition":"The toilet ","justification":"True"},{"idx":1,"correct":false,"proposition":"Telephone ","justification":"False, belongs to the IADL "},{"idx":2,"correct":true,"proposition":"Eating ","justification":"True"},{"idx":3,"correct":false,"proposition":"Taking medication ","justification":"False, belongs to the IADL "},{"idx":4,"correct":true,"proposition":"Continence ","justification":"True"}],"type":"custom"}
+{"_id":"LCA-sp-20ad854","context":null,"enonce":"You are in the emergency room and you receive Mr. XU Shang-Chi, 23 years old, for an attempt at drug autolysis with benzodiazepines. While he \"slept\" well until now he wakes up restless and sweaty and asks you for \"something to calm him\". In this context, you tell yourself that using a placebo is not a bad idea... But the nurse who is with you, fears a nocebo effect. You scratch your head and try to remember your pharmacology classes on the subject...","item":"LCA","matiere":"sp","propositions":[{"idx":0,"correct":true,"proposition":"If you give the patient PARACETAMOL instead of a benzodiazepine, you are giving an impure placebo.","justification":"True, an impure placebo is a placebo that is composed of another active substance."},{"idx":1,"correct":true,"proposition":"The placebo effect will have to be re-evaluated over time because it is short and runs out over time.","justification":"True, it is very logical because it is related to taking the treatment"},{"idx":2,"correct":false,"proposition":"Factors that condition the placebo effect include the name of the treatment","justification":"False, it includes color, shape, taste but not name"},{"idx":3,"correct":false,"proposition":"Chest pain, paresthesias and dysgeusia are the most common nocebos effects","justification":"False, nasty trap, but if you have understood that it is the administration of the treatment that makes the placebo you will have to logically deduce that the nocebos effects, also related to the taking of the treatment are mainly diarrhea, but also headache and drowsiness."},{"idx":4,"correct":false,"proposition":"The nocebos effects are due to the composition of the placebo","justification":"False, it is related to the administration of the treatment"}],"type":"custom"}
+{"_id":"dermatosefaciale-dermato-3905a4d","context":null,"enonce":"What are the different forms of rosacea? ","item":"dermatosefaciale","matiere":"dermato","propositions":[{"idx":0,"correct":true,"proposition":"Hypertrophic form ","justification":"True, hypertrophic form = rhinophyma"},{"idx":1,"correct":true,"proposition":"Rhinophyma ","justification":"True, cf 1"},{"idx":2,"correct":true,"proposition":"Papulo-pustular form ","justification":"True"},{"idx":3,"correct":false,"proposition":"Atrophic form ","justification":"False, no atrophic form in rosacea"},{"idx":4,"correct":true,"proposition":"Paroxysmal vascular form ","justification":"True"}],"type":"custom"}
+{"_id":"dermatosefaciale-dermato-870dddf","context":null,"enonce":"What are the treatments for rosacea? ","item":"dermatosefaciale","matiere":"dermato","propositions":[{"idx":0,"correct":false,"proposition":"Dermocorticoids","justification":"False, topical corticosteroids are contraindicated in rosacea because they aggravate it!! "},{"idx":1,"correct":true,"proposition":"Metronidazole gel ","justification":"True, for minor forms "},{"idx":2,"correct":true,"proposition":"Systemic doxycycline","justification":"True, for more diffuse forms and especially ocular "},{"idx":3,"correct":false,"proposition":"Isotretinoin ","justification":"False, acne treatment "},{"idx":4,"correct":false,"proposition":"Benzoyl peroxide ","justification":"False, acne treatment "}],"type":"custom"}
+{"_id":"dermatosefaciale-dermato-763a4d0","context":null,"enonce":"What localizations are classically affected in seborrheic dermatitis? ","item":"dermatosefaciale","matiere":"dermato","propositions":[{"idx":0,"correct":true,"proposition":"Nasolabial folds ","justification":"True"},{"idx":1,"correct":false,"proposition":"Palms ","justification":"No, it is a facial dermatosis"},{"idx":2,"correct":false,"proposition":"Upper limbs ","justification":"No, it is a facial dermatosis"},{"idx":3,"correct":true,"proposition":"Scalp ","justification":"True"},{"idx":4,"correct":true,"proposition":"Glabella ","justification":"True"}],"type":"custom"}
+{"_id":"AV--ophtalmo-f5b9241","context":null,"enonce":"How many cataract operations per year in France?","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"correct":true,"proposition":"700 000 ","justification":"True, this is the most common surgery!"},{"idx":1,"correct":false,"proposition":"100 000 ","justification":""},{"idx":2,"correct":false,"proposition":"300 000 ","justification":""},{"idx":3,"correct":false,"proposition":"200 000 ","justification":""},{"idx":4,"correct":false,"proposition":"70 000 ","justification":""}],"type":"custom"}
+{"_id":"AV--ophtalmo-ce27e9a","context":null,"enonce":"What type of cataract can occur as leukocoria?","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"correct":false,"proposition":"Nuclear","justification":""},{"idx":1,"correct":true,"proposition":"Total","justification":"True, leukocoria is the fact of having the white pupil, and it must worry, especially in the new nose in which it must suspect rare eye tumors"},{"idx":2,"correct":false,"proposition":"Posterior subcapsular","justification":""},{"idx":3,"correct":false,"proposition":"Cortical","justification":""},{"idx":4,"correct":false,"proposition":"No proposition is true","justification":""}],"type":"custom"}
+{"_id":"AV--ophtalmo-cf623b9","context":null,"enonce":"What is the form of cataract that is accompanied by index myopia?","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"correct":false,"proposition":"Cortical","justification":"Global BAV"},{"idx":1,"correct":true,"proposition":"nuclear","justification":"True, involvement of the crystalline nucleus, predominance of a decrease in visual acuity (BAV) by far so index myopia"},{"idx":2,"correct":false,"proposition":"Total","justification":"Very severe overall BAV"},{"idx":3,"correct":false,"proposition":"posterior subcapsular","justification":"Saucer opacification in front of the posterior capsule, identical discomfort from far and near. Thinking about the metabolic and iatrogenic origin"},{"idx":4,"correct":false,"proposition":"No","justification":""}],"type":"custom"}
+{"_id":"AV--ophtalmo-fce1191","context":null,"enonce":"Among the following proposals concerning the assessment to be carried out pre-operative of a cataract, which are true?\n","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"correct":false,"proposition":"Mode A ultrasound eliminates retinal detachment","justification":"It is the ultrasound in mode B that allows this. See this ultrasound image in mode B: https:\/\/www.realites-ophtalmologiques.com\/wp-content\/uploads\/sites\/4\/2017\/02\/article-du-27_02-702x336.jpg"},{"idx":1,"correct":false,"proposition":"Optical biometry is done by ultrasound in mode A","justification":"Ultrasound mode A = axial ultrasound biometrics. Used to calculate the size of the implant.\nThe most recent technique of ophthalmic biometry is axial ultrasound biometrics. Ultra-difficult question but the college makes the difference."},{"idx":2,"correct":false,"proposition":"Macular OCT is mandatory","justification":"OCT is only useful for retinal conditions"},{"idx":3,"correct":true,"proposition":"Keratometry measures the refractive power of the cornea","justification":"True"},{"idx":4,"correct":true,"proposition":" The normal refractive power of the lens is about 20 diopters","justification":"True"}],"type":"custom"}
+{"_id":"IRespA-urg-d89764","context":null,"enonce":"Which of the following propositions concerning the mechanisms involved in hypoxemia are true?","item":"IRespA","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"The shunt effect is the most common mechanism of hypoxemia.","justification":"True"},{"idx":1,"correct":true,"proposition":"Obesite-hypoventilation syndrome may be a cause of alveolar hypoventilation","justification":"True"},{"idx":2,"correct":true,"proposition":"The higher you go, the lower the O2 inspired pressure would be.","justification":"True, PiO2 = FiO2 x (Patm-PH20)"},{"idx":3,"correct":false,"proposition":"A shunt effect corresponds to the presence of well-infused but poorly ventilated lung areas. ","justification":"Wrong, it's the other way around."},{"idx":4,"correct":true,"proposition":"A cause of alveolo-capillary diffusion disorder is pulmonary fibrosis","justification":"True: diffusion depends on the thickness of the different tissues separating the alveolar air from the capillary blood, and fibrosis increases this thickness"}],"type":"custom"}
+{"_id":"329-urg-c83f8e1d-b283-441c-b65a-53c0c0c7bb79","context":null,"enonce":"Which of the following propositions regarding post-traumatic rhabdomyolysis are true?","item":"polytrauma","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"It is linked to the destruction of a large number of myocytes and the release of elements of these myocytes into the circulation.","justification":"True! Post-traumatic rhabdomyolysis is, as its name suggests, linked to the destruction of a large number of myocytes in the direct consequences of trauma to the limbs or its complications (compartment syndrome in particular)"},{"idx":1,"correct":true,"proposition":"The hydroelectric disturbances observed are hyperkalemia, hyperphosphoremia, hypocalcemia","justification":"True! Rhabdomyolysis is the bursting of muscle cells. So all the content passes into the blood and we can measure this content via a blood test: \n- Increased K+ and phosphorus\n- Decrease of Ca++ by transfer from the vascular medium to the muscular environment \n- Increased muscle enzymes: CPK, LDH, myoglobin, AST +++, ALT +\/-"},{"idx":2,"correct":true,"proposition":"Acute renal failure complicates about 50% of cases and determines the vital and functional prognosis","justification":"True! Nothing to say "},{"idx":3,"correct":true,"proposition":"Acute renal failure due to post-traumatic rhabdomyolysis is responsible for a sodium ejection fraction < 1% (functional)","justification":"True! There are different causes of rhabdomyolysis. Generally we oppose: \n- Post-traumatic rhabdomyolysis: Which is mainly related to the destruction of myocytes but also favored by HYPOVOLEMIA !! This explains why the observed ARI GENERALLY has a FeNa+ < 1% (functional)! It is the elderly subject who fell and did not manage to get up for 12 hours: he crushed his myocytes on the ground and did not drink. - Infectious\/toxic rhabdomyolysis\/by electrification\/by taking lipid-lowering agents... etc.: Is related to the destruction of myocytes but here the volume is normal. The observed IRA will therefore have a FeNa + > 1% (organic)"},{"idx":4,"correct":true,"proposition":"The treatment is based primarily on crystalloid filling","justification":"True! Treatment is symptomatic above all (filling, hydroelectric rebalancing, extra-renal purification if indicated). SOURCE: College of Anesthesia Resuscitation 2020 Edition page 346"}],"type":"custom"}
+{"_id":"IOA-infectio-03dc3f7","context":null,"enonce":"What clinical signs are found in spondylodiscitis? ","item":"IOA","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Spinal mechanical pain ","justification":"False, inflammatory rachialgia, tenacious, without triggering factor and poorly calmed by rest (the suffix \"-ite\" means inflammation)"},{"idx":1,"correct":true,"proposition":"Major vertebral stiffness ","justification":"True"},{"idx":2,"correct":true,"proposition":"Fever","justification":"True, in 50% of cases at diagnosis"},{"idx":3,"correct":false,"proposition":"Effusion ","justification":"False, no effusion in spondylodiscitis, rather in peripheral septic arthritis "},{"idx":4,"correct":true,"proposition":"Radicular pain ","justification":"True, these are complications of inflammatory spinal pain "}],"type":"custom"}
+{"_id":"IOA-infectio-44980e8","context":null,"enonce":"What is the reference imaging test in the diagnosis of spondylodiscitis? ","item":"IOA","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Standard X-rays ","justification":"False, radio-signs shifted by 3-4 weeks, they are often normal at diagnosis "},{"idx":1,"correct":true,"proposition":"MRI ","justification":"True"},{"idx":2,"correct":false,"proposition":"Scanner","justification":"False, indicated only to guide a puncture-biopsy or if contraindication of MRI "},{"idx":3,"correct":false,"proposition":"Technetium scintigraphy ","justification":"False, lower specificity than MRI. Used if contraindicated to MRI"},{"idx":4,"correct":false,"proposition":"Ultrasound","justification":"False"}],"type":"custom"}
+{"_id":"radiculalgie-ortho-e16c5af","context":null,"enonce":"Regarding syringomyelia:","item":"radiculalgie","matiere":"ortho","propositions":[{"idx":0,"correct":true,"proposition":"Syringomyelic syndrome reflects the involvement of spinothalamic fibers that decuss at the level of each metamer","justification":"True, they are more sensitive to compression by fluid inside the spinal cord"},{"idx":1,"correct":false,"proposition":"The initial sensory deficit relates to proprioception","justification":"On thermo-algic sensitivity (first involvement of spinothalamic \/ extra-lemniscale fibers)"},{"idx":2,"correct":true,"proposition":"Arnold-Chiari malformation is the main cause of synringomyelia","justification":"True"},{"idx":3,"correct":true,"proposition":"The topography of the lesion syndrome is said to be \"cape\"","justification":"True, cause of upper limb deficit without lower limb deficit (excluding sublesional syndrome)"},{"idx":4,"correct":false,"proposition":"All propositions are true","justification":""}],"type":"custom"}
+{"_id":"212-hemato-e1e83d1d-f317-42e6-b197-b20f81b10aac","context":null,"enonce":"Which of the following propositions about Willebrand disease are true?","item":"hemorragie","matiere":"hemato","propositions":[{"idx":0,"correct":true,"proposition":"There may be a decrease in factor VIII in Willebrand disease ","justification":"True because von Willebrand factor transports and stabilizes factor VIII"},{"idx":1,"correct":false,"proposition":"Willebrand disease is defined by a von Willebrand factor level < 50%","justification":"False, by a von Willebrand factor rate < 30%"},{"idx":2,"correct":false,"proposition":"Willebrand disease is a pathology of coagulation ","justification":"False, it is a pathology of primary hemostasis "},{"idx":3,"correct":true,"proposition":"Von Willebrand factor allows platelets to adhere to each other and to collagen under endothelial","justification":"True"},{"idx":4,"correct":false,"proposition":"Boys are more affected than girls ","justification":"False, sex ratio = 1"}],"type":"custom"}
+{"_id":"212-hemato-60df0653-28c6-4f42-b7a6-5e27e02c2015","context":null,"enonce":"Which of the following propositions about hemophilia are true?","item":"hemorragie","matiere":"hemato","propositions":[{"idx":0,"correct":false,"proposition":"The hemostasis assessment finds a prolongation of the TCA and a decrease of the TP ","justification":"False, only an isolated prolongation of the TCA because only the endogenous pathway is affected "},{"idx":1,"correct":true,"proposition":"Externalized bleeding can be a symptom ","justification":"True"},{"idx":2,"correct":false,"proposition":"Hemophilia is the most common inherited bleeding disorder ","justification":"False, it is Willebrand disease "},{"idx":3,"correct":true,"proposition":"Drugs depressing hemostasis are contraindicated in hemophiliacs ","justification":"True"},{"idx":4,"correct":true,"proposition":"Arthropathy can be a complication of hemophilia ","justification":"True, it is a hemophilic arthropathy secondary to the aggression of cartilage by blood waste and their degradation "}],"type":"custom"}
+{"_id":"212-hemato-6c0d2f4c-23e6-4000-b912-331e1bd91e05","context":null,"enonce":"Regarding hypovitaminosis K, what are the true propositions?","item":"hemorragie","matiere":"hemato","propositions":[{"idx":0,"correct":false,"proposition":"Factor V is a vitamin K-dependent factor ","justification":"False, vitamin K-independent; it is the X, IX, VII, and II (we can retain the year 1972) which are vitamin-K dependent"},{"idx":1,"correct":false,"proposition":"The majority of vitamin K intake is endogenous via the intestinal flora ","justification":"False, the majority of vitamin K intake is exogenous via diet (70% intake)"},{"idx":2,"correct":true,"proposition":"One of the differential diagnoses is hepatocellular insufficiency ","justification":"True, the 2 diagnoses are differentiated by the determination of factor V, vitamin K-independent"},{"idx":3,"correct":true,"proposition":"The TCA is lengthened and the PT is decreased at hemostasis ","justification":"True"},{"idx":4,"correct":false,"proposition":"C- and S-clotting proteins are vitamin K-independent ","justification":"False, they are vitamin K-dependent "}],"type":"custom"}
+{"_id":"293-onco-f8ec25de-86dd-46cb-a3d4-bad97cebe6b3","context":null,"enonce":"Regarding the assessment to be carried out in case of fever during drug agranulocytosis, what are the true proposals?","item":"agranulocytose","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"It is carried out urgently ","justification":"True"},{"idx":1,"correct":true,"proposition":"It includes blood cultures ","justification":"True"},{"idx":2,"correct":true,"proposition":"It includes an ECBU ","justification":"True"},{"idx":3,"correct":true,"proposition":"It has a chest X-ray ","justification":"True"},{"idx":4,"correct":true,"proposition":"It may include stool farming depending on the orientation ","justification":"True"}],"type":"custom"}
+{"_id":"MM-onco-c8cf4e6","context":null,"enonce":"You are an intern and your intern has asked you to present a slideshow on the topic of myeloma. By having you recite it asks you what are the clinical forms of myeloma besides symptomatic multiple myeloma. You hesitate, and mentally try to summarize each clinical form in one sentence. Which of the following are the exact proposals?","item":"MM","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Indolent multiple myeloma has no clinical involvement and only biological abnormalities","justification":"True, as its name suggests, indolent myeloma has no active clinical form, however it has a poor prognosis because it is at risk of progression to multiple myeloma"},{"idx":1,"correct":true,"proposition":"A solitary plasmacytoma will be associated with a negative myelogram","justification":"True, a plasmacytoma is by definition a tumor isolated (like a sarcoma) in a tissue, and therefore without invasion of the spinal cord."},{"idx":2,"correct":false,"proposition":"Mild chain multiple myeloma causes monoclonal peak at serum protein electrophoresis","justification":"False, light chain myeloma does NOT cause monoclonal spike on serum protein electrophoresis"},{"idx":3,"correct":false,"proposition":"POEMS syndrome corresponds to a monoclonal gammopathy associated with bone lyses at the punch","justification":"Wrong, I admit this question is hard, because most of you will never have heard of POEMS: it is a form of myeloma with osteocondensation associated with splenomegaly, neuropathy and endocrine damage. It is rank C."},{"idx":4,"correct":false,"proposition":"Waldenström's disease is a form of myeloma with osteocondensing lyses","justification":"False, Waldenström's disease is the MAIN differential diagnosis of myeloma"}],"type":"custom"}
+{"_id":"Kcpulm-onco-be5ba0c","context":null,"enonce":"What is the percentage survival of patients with lung cancer treated at stage I, at 5 years?","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"90","justification":"True"},{"idx":1,"correct":false,"proposition":"50","justification":""},{"idx":2,"correct":false,"proposition":"33","justification":""},{"idx":3,"correct":false,"proposition":"17","justification":""},{"idx":4,"correct":false,"proposition":"5","justification":""}],"type":"custom"}
+{"_id":"Kcpulm-onco-c49f4d3","context":null,"enonce":"What is the survival of patients with lung cancer treated at the metastatic stage (V), at 5 years, in percentage?","item":"Kcpulm","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"5","justification":"True"},{"idx":1,"correct":false,"proposition":"17","justification":""},{"idx":2,"correct":false,"proposition":"90","justification":""},{"idx":3,"correct":false,"proposition":"55","justification":""},{"idx":4,"correct":false,"proposition":"62","justification":""}],"type":"custom"}
+{"_id":"antiinf-infectio-340c9ef","context":null,"enonce":"Which propositions are true?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"β-lactam is useless on mycoplasmas","justification":"True because they don't have a wall"},{"idx":1,"correct":true,"proposition":"Glycopeptides are useless on BGN","justification":"True because the molecule does not pass the outer membrane"},{"idx":2,"correct":true,"proposition":"C3G is useless on listeria","justification":"True"},{"idx":3,"correct":false,"proposition":"Metronidazole is useless on anaerobes","justification":"This is its main indication"},{"idx":4,"correct":false,"proposition":"Penems are useless on Pseudomonas aeruginosa","justification":"Only ertapeneme that does not work on enterococci and on Pseudomonas"}],"type":"custom"}
+{"_id":"antiinf-infectio-3b5c018","context":null,"enonce":"Which ones are concentration-dependent?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Fluoroquinolones","justification":"True"},{"idx":1,"correct":true,"proposition":"Aminoglycosides","justification":"True"},{"idx":2,"correct":true,"proposition":"Metronidazole","justification":"True"},{"idx":3,"correct":false,"proposition":"Glycopeptide","justification":""},{"idx":4,"correct":false,"proposition":"Betalactam","justification":""}],"type":"custom"}
+{"_id":"antiinf-infectio-549afa6","context":null,"enonce":"Imipenème is associated with:","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"epileptic seizures","justification":"True"},{"idx":1,"correct":false,"proposition":"strokes","justification":""},{"idx":2,"correct":false,"proposition":"DVT","justification":""},{"idx":3,"correct":true,"proposition":"Anti-pseudomonas activity","justification":"True, unlike ertapeneme"},{"idx":4,"correct":false,"proposition":"amyloidosis","justification":""}],"type":"custom"}
+{"_id":"antiinf-infectio-895e6c4","context":null,"enonce":"What is the target of aminoglycosides?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"The ribosome","justification":"True"},{"idx":1,"correct":false,"proposition":"The wall","justification":"Beta-lactam"},{"idx":2,"correct":false,"proposition":"DNA","justification":""},{"idx":3,"correct":false,"proposition":"the plasma membrane","justification":""},{"idx":4,"correct":false,"proposition":"Chaperone proteins","justification":""}],"type":"custom"}
+{"_id":"antiinf-infectio-d2f18c9","context":null,"enonce":"Which ones are bacteriostatic?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Erythromycin","justification":"True"},{"idx":1,"correct":true,"proposition":"Tetracycline","justification":"True"},{"idx":2,"correct":false,"proposition":"Fluoroquinolone","justification":"Concentration-dependent bactericide"},{"idx":3,"correct":false,"proposition":"C3G","justification":"Time-dependent bactericidal"},{"idx":4,"correct":false,"proposition":"Aminoglycosides","justification":"Concentration-dependent bactericide"}],"type":"custom"}
+{"_id":"palu-infectio-1ae043f","context":null,"enonce":"What is the weekly malaria chemoprophylaxis?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Atovaquone-proguanil ","justification":"Daily"},{"idx":1,"correct":false,"proposition":"Doxycycline","justification":"Daily"},{"idx":2,"correct":true,"proposition":"Mefloquine","justification":"True"},{"idx":3,"correct":false,"proposition":"Quinine","justification":"Cure"},{"idx":4,"correct":false,"proposition":"Artenimol-piperaquine","justification":"Cure"}],"type":"custom"}
+{"_id":"palu-infectio-274ba52","context":null,"enonce":"Which of the following proposals for protective measures against Anopheles bites is recommended?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Use of antihistamines","justification":""},{"idx":1,"correct":false,"proposition":"Using a fan","justification":""},{"idx":2,"correct":true,"proposition":"wearing loose and covering clothing","justification":"True"},{"idx":3,"correct":true,"proposition":"Use of household repellents and insecticides","justification":"True"},{"idx":4,"correct":true,"proposition":"mosquito net","justification":"True"}],"type":"custom"}
+{"_id":"vaccin-infectio-0744772","context":null,"enonce":"Against which germs is the hexavalent vaccine, administered in children under 1 year of age at M2 M4 and M11?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Haemophilus influenzae de type B","justification":"True"},{"idx":1,"correct":true,"proposition":"Poliomyelitis","justification":"True"},{"idx":2,"correct":false,"proposition":"Meningococcal C","justification":""},{"idx":3,"correct":false,"proposition":"Pneumococcus","justification":"It does not fit into the hexavalent (it is all alone)"},{"idx":4,"correct":false,"proposition":"Measles","justification":"MMR to M12 and M16-18"}],"type":"custom"}
+{"_id":"vaccin-infectio-36ae313","context":null,"enonce":"Against which germs is the hexavalent vaccine, administered in children under 1 year of age at M2 M4 and M11?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Diphtheria","justification":"True"},{"idx":1,"correct":true,"proposition":"Tetanus","justification":"True"},{"idx":2,"correct":true,"proposition":"Poliomyelitis","justification":"True"},{"idx":3,"correct":true,"proposition":"Whooping cough","justification":"True"},{"idx":4,"correct":true,"proposition":"HBV","justification":"True"}],"type":"custom"}
+{"_id":"vaccin-infectio-6f2a904","context":null,"enonce":"A patient wants to go to Cameroon for 6 months. What vaccination(s) do you prescribe?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"yellow fever","justification":"True"},{"idx":1,"correct":true,"proposition":"typhoid","justification":"True"},{"idx":2,"correct":false,"proposition":"tick-borne encephalitis","justification":""},{"idx":3,"correct":true,"proposition":"hepatitis A","justification":"True"},{"idx":4,"correct":false,"proposition":"malaria","justification":"No malaria vaccine"}],"type":"custom"}
+{"_id":"vaccin-infectio-92834c9","context":null,"enonce":"What situations are at risk of invasive pneumococcal disease, and therefore constitute an indication for preventive vaccination against pneumococcus?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"asplenia","justification":"True"},{"idx":1,"correct":true,"proposition":"sickle-cell anemia","justification":"True"},{"idx":2,"correct":false,"proposition":"thalassemia","justification":""},{"idx":3,"correct":false,"proposition":"lead poisoning","justification":""},{"idx":4,"correct":true,"proposition":"HIV","justification":"True"}],"type":"custom"}
+{"_id":"voyagetrop-infectio-a884433","context":null,"enonce":"For which stays is the yellow fever vaccine mandatory?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Pilgrimage to Mecca","justification":"Tetravalent meningococcal vaccine ACYW135 conjugate"},{"idx":1,"correct":true,"proposition":"Amazonia","justification":"True"},{"idx":2,"correct":true,"proposition":"Intertropical Africa","justification":"True"},{"idx":3,"correct":false,"proposition":"India","justification":"typhoid"},{"idx":4,"correct":false,"proposition":" Pakistan and Philippines","justification":"Japanese encephalitis vaccine"}],"type":"custom"}
+{"_id":"voyagetrop-infectio-b328067","context":null,"enonce":"What is the probability of death during a tropical trip?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"1\/10","justification":""},{"idx":1,"correct":false,"proposition":"1\/100","justification":""},{"idx":2,"correct":false,"proposition":"1\/1000","justification":""},{"idx":3,"correct":false,"proposition":"1\/10 000","justification":""},{"idx":4,"correct":true,"proposition":"1\/100 000","justification":"True"}],"type":"custom"}
+{"_id":"voyagetrop-infectio-ce0f36d","context":null,"enonce":"What propositions are true about typhoid fever?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"The tank is human only","justification":"True"},{"idx":1,"correct":false,"proposition":"The virus involved is Typhus viridae","justification":"Salmonella enterica: it is a baceria"},{"idx":2,"correct":false,"proposition":"Transmission is sexual","justification":"Faecal-oral transmission"},{"idx":3,"correct":true,"proposition":"Incubation is 10 days to 3 weeks","justification":"True"},{"idx":4,"correct":false,"proposition":"The vaccine is in one dose, valid for life","justification":"True for yellow fever. The salmonella vaccine is not very effective, and must be redone every 3 years"}],"type":"custom"}
+{"_id":"vaccin-infectio-d53bba7","context":null,"enonce":"How many dose(s) for yellow fever vaccine?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Two","justification":""},{"idx":1,"correct":true,"proposition":"Just one","justification":"True"},{"idx":2,"correct":false,"proposition":"Three","justification":""},{"idx":3,"correct":false,"proposition":"Four","justification":""},{"idx":4,"correct":false,"proposition":"Five","justification":""}],"type":"custom"}
+{"_id":"vaccin-infectio-d9e313c","context":null,"enonce":"Regarding typhoid vaccination:","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Vaccination protects in 100% of cases from the occurrence of salmonellosis","justification":"60% effectiveness, than against certain strains"},{"idx":1,"correct":false,"proposition":"vaccination must be renewed every ten years","justification":"every three years"},{"idx":2,"correct":true,"proposition":"vaccination does not protect against Salmonella enterica serotypes of Salmonella enterica paratyphi A and B","justification":"True"},{"idx":3,"correct":false,"proposition":"Vaccination is mandatory for healthcare workers","justification":"microbiology laboratory personnel in contact with stool"},{"idx":4,"correct":true,"proposition":"Vaccination for typhoid is possible from the age of two","justification":"True"}],"type":"custom"}
+{"_id":"voyagetrop-infectio-271d030","context":null,"enonce":"What pathologies do ticks have as a vector?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Lyme disease","justification":"True"},{"idx":1,"correct":true,"proposition":"Tick-borne encephalitis","justification":"True, as the name suggests. No trap here"},{"idx":2,"correct":true,"proposition":"Tularemia","justification":"True"},{"idx":3,"correct":true,"proposition":"Mediterranean spotted fever","justification":"True"},{"idx":4,"correct":false,"proposition":"Dengue fever","justification":"Aedes"}],"type":"custom"}
+{"_id":"voyagetrop-infectio-46aa966","context":null,"enonce":"What pathologies do Aedes have as a vector?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Trench fever","justification":"Lice"},{"idx":1,"correct":true,"proposition":"Dengue fever","justification":"True"},{"idx":2,"correct":true,"proposition":"Yellow fever","justification":"True"},{"idx":3,"correct":true,"proposition":"Zika","justification":"True"},{"idx":4,"correct":false,"proposition":"Relapsing fever","justification":"Lice"}],"type":"custom"}
+{"_id":"196-rhumato-b3dfb19c-dd4d-4b49-b9f6-8758af4553d1","context":null,"enonce":"In what situations can joint fluid be inflammatory? ","item":"arthrite","matiere":"rhumato","propositions":[{"idx":0,"correct":true,"proposition":"Rheumatoid arthritis","justification":"True"},{"idx":1,"correct":false,"proposition":"Meniscal lesions","justification":"False, mechanical liquid "},{"idx":2,"correct":false,"proposition":"Arthrosis ","justification":"False, mechanical liquid "},{"idx":3,"correct":true,"proposition":"Microcrystalline arthropathy ","justification":"True, we also find in the joint fluid micro-crystals (urate, PPCa, Ca phosphate ...)"},{"idx":4,"correct":true,"proposition":"Septic arthritis","justification":"True. The causes of inflammatory fluid (i.e. with more than 2000 cells per mL) are: septic arthritis, gout, chondrocalcinosis, RA, spondyloarthritis, ... Causes of mechanical fluid: osteoarthritis and meniscus injury"}],"type":"custom"}
+{"_id":"198-rhumato-5414b63c-022c-415c-94de-d3981fe575e9","context":null,"enonce":"Which of the following can be part of the pre-therapeutic assessment prior to the initiation of targeted therapy? ","item":"bioT","matiere":"rhumato","propositions":[{"idx":0,"correct":true,"proposition":"Serum protein electrophoresis (EPS)","justification":"True"},{"idx":1,"correct":true,"proposition":"HIV serology","justification":"True, with HBV and HCV serology"},{"idx":2,"correct":true,"proposition":"X-ray of the front chest","justification":"True"},{"idx":3,"correct":true,"proposition":"Detection of peripheral lymphadenopathy","justification":"True"},{"idx":4,"correct":true,"proposition":"Lipid profile ","justification":"True, for anti-IL6 and anti-JAK treatment"}],"type":"custom"}
+{"_id":"osteoporose-rhumato-9e2ef66","context":null,"enonce":"From what score can we speak of densitometric osteoporosis in adults? ","item":"osteoporose","matiere":"rhumato","propositions":[{"idx":0,"correct":false,"proposition":"T-score< -1","justification":""},{"idx":1,"correct":false,"proposition":"Z-score ≤ -2.5","justification":"False, the Z score is used in children who have not reached the peak of bone mass. "},{"idx":2,"correct":false,"proposition":"Z-score < -1","justification":""},{"idx":3,"correct":true,"proposition":"T-score≤ -2.5","justification":"True, according to the WHO. "},{"idx":4,"correct":false,"proposition":"T-score≤ -3","justification":""}],"type":"custom"}
+{"_id":"osteoporose-rhumato-2f492f9","context":null,"enonce":"Which of the following fractures are severe? ","item":"osteoporose","matiere":"rhumato","propositions":[{"idx":0,"correct":true,"proposition":"Fracture of the upper end of the femur ","justification":"True, the famous EFSF"},{"idx":1,"correct":true,"proposition":"Fracture of the upper extremity of the humerus ","justification":"True"},{"idx":2,"correct":false,"proposition":"Wrist fracture ","justification":"False, frequent but not severe fracture "},{"idx":3,"correct":true,"proposition":"Vertebra fracture ","justification":"True, also called vertebral settlement"},{"idx":4,"correct":true,"proposition":"Fracture of the pelvis ","justification":"True. The complete list: vertebral, pelvis \/ pelvis \/ sacrum, upper end of humerus, upper end of femur"}],"type":"custom"}
+{"_id":"osteoporose-rhumato-0cc8304","context":null,"enonce":"Which osteoporosis treatments are osteotrainers? (one or more correct answers)","item":"osteoporose","matiere":"rhumato","propositions":[{"idx":0,"correct":false,"proposition":"Raloxifene ","justification":"False, it is a selective estrogen receptor modulator (SERM), which slows bone resorption. Contraindicated after 70 years. Not active on peripheral bones"},{"idx":1,"correct":false,"proposition":"Bisphosphonate","justification":"False, it is an anti-osteoclastic treatment, slowing bone resorption "},{"idx":2,"correct":false,"proposition":"Menopausal hormone therapy (THM)","justification":"False, it is a treatment that slows bone resorption"},{"idx":3,"correct":false,"proposition":"Denosumab ","justification":"False, it is an anti-RANK-L antibody (biotherapy), which slows bone resorption "},{"idx":4,"correct":true,"proposition":"Teriparatide","justification":"True, it is a recombinant fragment of PTH, which stimulates bone formation. Trade name = Forsteo. One subcutaneous injection every day at the same time for 18 months"}],"type":"custom"}
+{"_id":"osteoporose-rhumato-d844f87","context":null,"enonce":"What biological arguments are in favor of osteomalacia? ","item":"osteoporose","matiere":"rhumato","propositions":[{"idx":0,"correct":true,"proposition":"Hypocalcemia","justification":"True"},{"idx":1,"correct":true,"proposition":"Hypophosphatemia ","justification":"True"},{"idx":2,"correct":false,"proposition":"Decrease in alkaline phosphatases ","justification":"False, they are increased "},{"idx":3,"correct":true,"proposition":"Collapsed vitamin D ","justification":"True"},{"idx":4,"correct":false,"proposition":"Hypercalciuria ","justification":"False, we will rather have hypocalciuria. According to the college: Osteomalacia is a diffuse, rarefizing, weakening osteopathy of bone tissue characterized histologically by a significant delay in mineralization of the newly formed organic matrix, which leads to an accumulation of osteoid tissue. The biological arguments are: a decrease in serum calcium and phosphatemia; an increase in alkaline phosphatase; a collapse of 25(OH)-vitamin D (reserve form) < 5 ng\/ml; hypocalciuria and hyperparathyroidism secondary to hypocalcaemia."}],"type":"custom"}
+{"_id":"arthrite-rhumato-fc4bb96","context":null,"enonce":"What elements are in favor of an inflammatory joint fluid? ","item":"arthrite","matiere":"rhumato","propositions":[{"idx":0,"correct":false,"proposition":"Low-cell fluid ","justification":"False, cell-rich liquid "},{"idx":1,"correct":true,"proposition":"Purulent liquid ","justification":"True"},{"idx":2,"correct":true,"proposition":"Presence of calcium pyrophosphate crystals ","justification":"True"},{"idx":3,"correct":false,"proposition":"Leukocytes < 2,000\/mm3","justification":"False, Leukocytes > 2,000\/mm3"},{"idx":4,"correct":true,"proposition":"Presence of germs ","justification":"True, on direct examination or after cultivation"}],"type":"custom"}
+{"_id":"PR-rhumato-703e654","context":null,"enonce":"A DAS28 to 3.0 score defines rheumatoid arthritis: ","item":"PR","matiere":"rhumato","propositions":[{"idx":0,"correct":false,"proposition":"In remission","justification":"False, in remission 👉 DAS28 < 2.6"},{"idx":1,"correct":false,"proposition":"Very active ","justification":"false, very active 👉 DAS28 > 5.1"},{"idx":2,"correct":true,"proposition":"Low level of activity","justification":"True, low activity 👉 level 2.6 < DAS28 < 3.2"},{"idx":3,"correct":false,"proposition":"Moderately active ","justification":"False, moderately active 👉 3.2 < DAS28 < 5.1"},{"idx":4,"correct":false,"proposition":"None of the previous answers","justification":"False "}],"type":"custom"}
+{"_id":"PR-rhumato-4788d72","context":null,"enonce":"Which of the following are possible extra-articular manifestations of RA? ","item":"PR","matiere":"rhumato","propositions":[{"idx":0,"correct":true,"proposition":"Asthenia","justification":"True"},{"idx":1,"correct":true,"proposition":"Secondary Sjögren's syndrome ","justification":"True"},{"idx":2,"correct":true,"proposition":"Diffuse interstitial lung disease ","justification":"True, hence a systematic chest X-ray to discover RA"},{"idx":3,"correct":false,"proposition":"Digital gooseneck deformations","justification":"False, osteoarticular manifestation of RA"},{"idx":4,"correct":true,"proposition":"Rheumatoid nodules","justification":"True"}],"type":"custom"}
+{"_id":"SpA-rhumato-98d439f","context":null,"enonce":"What can be the extra-articular disorders of spondyloarthritis? ","item":"SpA","matiere":"rhumato","propositions":[{"idx":0,"correct":true,"proposition":"Anterior uveitis ","justification":"True"},{"idx":1,"correct":true,"proposition":"Psoriasis ","justification":"True"},{"idx":2,"correct":false,"proposition":"Coxite","justification":"False, joint involvement of the coxofemoral joint "},{"idx":3,"correct":true,"proposition":"Crohn's disease ","justification":"True"},{"idx":4,"correct":false,"proposition":"Fessalgia ","justification":"False, pain reflecting joint involvement of the sacroiliac "}],"type":"custom"}
+{"_id":"rhumcrist-rhumato-258371e","context":null,"enonce":"What can be the manifestations of gout? ","item":"rhumcrist","matiere":"rhumato","propositions":[{"idx":0,"correct":true,"proposition":"Tophus","justification":"True, the famous gouty tophus"},{"idx":1,"correct":true,"proposition":"Renal colic ","justification":"True, radio-transparent lithiasis with uric acid (represents 10% of urolithiasis)"},{"idx":2,"correct":false,"proposition":"Dactylitis ","justification":"False, hallux dactylitis should not be confused with gouty attacks of MTP1. Dactylitis is found in spondyloarthritis for example"},{"idx":3,"correct":false,"proposition":"Radiopaque lithiasis ","justification":"False, radio-transparent lithiasis"},{"idx":4,"correct":true,"proposition":"Acute access of the first TPM ","justification":"True"}],"type":"custom"}
+{"_id":"SDRC-rhumato-df74a22","context":null,"enonce":"What elements can be found when diagnosing complex regional pain syndrome (CRPS)? ","item":"SDRC","matiere":"rhumato","propositions":[{"idx":0,"correct":false,"proposition":"Inflammatory joint fluid","justification":"False, mechanical fluid, with less than 2000 elements (other causes: osteoarthritis, meniscalgia)"},{"idx":1,"correct":false,"proposition":"Augmented CRP","justification":"False, normal CRP, no biological abnormalities in CRPS"},{"idx":2,"correct":true,"proposition":"Regional bone demineralization ","justification":"True, on radiography"},{"idx":3,"correct":true,"proposition":"Hyperfixation to the 3 stages of scintigraphy ","justification":"True"},{"idx":4,"correct":false,"proposition":"MRI always normal ","justification":"False, may be normal but sometimes presence of edema especially osteomedullary "}],"type":"custom"}
+{"_id":"meningite-neuro-1cc9e59","context":null,"enonce":"Which tumors can classically give paraneoplastic syndromes responsible for autoimmune encephalitis?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"Small cell lung cancer","justification":"True. These are CBPC, testicular and ovarian cancers, and hemopathies and related diseases (thymoma)"},{"idx":1,"correct":true,"proposition":"Gonad cancers","justification":"True"},{"idx":2,"correct":true,"proposition":"Lymphoma","justification":"True"},{"idx":3,"correct":true,"proposition":"Thymoma","justification":"True"},{"idx":4,"correct":true,"proposition":"Leukaemia","justification":"True"}],"type":"custom"}
+{"_id":"meningite-infectio-eef0ae7","context":null,"enonce":"What are the 2 most common germs found in meningitis in children under 2 months of age?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Escherichia coli","justification":"True, by contamination by proximity to the digestive tract during childbirth most often"},{"idx":1,"correct":false,"proposition":"Neisseria meningitdis","justification":"False, it's between 18 and 25 years old"},{"idx":2,"correct":true,"proposition":"Streptococcus agalactiae","justification":"True, also called group B beta-hemolytic streptococcus (SBHB), hence the importance of systematically looking for it before delivery via a vaginal swab"},{"idx":3,"correct":false,"proposition":"Haemophilus influenzae","justification":"False, it is rather in the child over 2 years old unvaccinated"},{"idx":4,"correct":false,"proposition":"Streptococcus pneumoniae","justification":"False, it is rather in children between 1 and 2 years, then in adults over 25 years"}],"type":"custom"}
+{"_id":"meningite-infectio-54298ea","context":null,"enonce":"You are a country doctor in a very under-endowed area thanks to your CEPA, and you are called for Monique, a farmer, 48 years old, who has been feverish since this morning, and has small crimson spots, all black, hollow, trunk multiplying at high speed. His cat, who is a fine semiologist, has noticed that they do not fade when he presses on them to chase them away. Her husband is warming up the engine of the 308 a little tired to transport it to the emergency room when you arrive aboard your brand new 🛵 Vespa. What are the real propositions?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"It is a vital emergency, her husband cannot transport her, medical transport is needed","justification":"True, it is a purpura fulminans 👉 we inject the C3G that is in our emergency bag and we call the 15"},{"idx":1,"correct":true,"proposition":"It is a legal obligation for any liberal doctor to have on him enough to perform an IM injection of C3G in this type of situation","justification":"True, even ophthalmologists and psychiatrists!"},{"idx":2,"correct":true,"proposition":"If you don't have C3G, you can inject amoxicillin IM","justification":"True, it's not as good, but it's much better than nothing."},{"idx":3,"correct":false,"proposition":"You call the multi-purpose medicine at the nearest clinic to hospitalize the patient as soon as possible","justification":"False, this patient must be hospitalized urgently in intensive care or intensive care"},{"idx":4,"correct":false,"proposition":"You need to put on an FFP2 mask to protect yourself","justification":"False, it is an isolation droplets, a surgical mask will be enough"}],"type":"custom"}
+{"_id":"meningite-infectio-9a61490","context":null,"enonce":"Which of these CSF biochemistries are normal?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Rock water, 0 element, glycorachia at 0.9 x glycemia, 0.20g\/L proteinorachia, 0.25mM lactates","justification":"True, standards are \na) < 5 figurative elements (without PNN or red blood cells, with 60% lymphocytes and 40% monocytes), \nb) glycorachia greater than 2\/3 x blood glucose\nc) a proteinorachia of less than 0.40 g \/ L\n(d) a lactatorachia less than 3.2 mM"},{"idx":1,"correct":false,"proposition":"Rock water, 4 elements (1 red blood cell, 3 monocytes), glycorachia at 0.7 x glycemia, 0.5g\/L proteinorachia, 0.25mM lactates","justification":"False, the presence of red blood cells can make suspect a traumatic PL (bad external bouuuh! [this is not true]). In addition, we have a little too much protein"},{"idx":2,"correct":false,"proposition":"Cloud, 500 elements (majority of PNN), glycorachia at 0.2 x glycemia, 1.50g\/L proteinorachy, 5.43mM lactates","justification":"False, and it is even very suggestive of purulent meningitis (in view of PNN, glycorachia, significant proteinorachia and lactates)"},{"idx":3,"correct":false,"proposition":"Rock water, 500 elements (mostly lymphocytes and monocytes), glycorachia at 0.5 x glycemia, 1.20g\/L proteinorachia, 3.2mM lactates","justification":"False, and it's quite suggestive of lymphocytic meningitis"},{"idx":4,"correct":true,"proposition":"Rock water, 4 elements (2 lymphocytes, 2 monocytes), glycorachia at 0.7 x glycemia, 0.35g\/L proteinorachia, 3.0mM lactates","justification":"True"}],"type":"custom"}
+{"_id":"meningite-neuro-25e0156","context":null,"enonce":"What are the two infectious agents that cause rhombencephalitis?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"CMV","justification":""},{"idx":1,"correct":true,"proposition":"VZV","justification":"True, children who have chickenpox often walk not straight! It's benign and it regresses alone most often"},{"idx":2,"correct":false,"proposition":"Streptococcus B","justification":""},{"idx":3,"correct":false,"proposition":"HSV","justification":""},{"idx":4,"correct":true,"proposition":"Listeria monocytogenes","justification":"True: in front of a pregnant woman who does not walk straight, before fetal alcohol syndrome, look for listeriosis!"}],"type":"custom"}
+{"_id":"meningite-neuro-9f3de61","context":null,"enonce":"Which of these patients need a check-up before their lumbar puncture? Which exam is it?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"An 18-year-old woman, with no history, with normal clinical and neurological examination other than stiff neck, photophonophobia, and fever","justification":"No, it can be assumed that she has a TP > 50%, a TCA < 1.5, and platelets greater than 50G\/L since she has no particular history"},{"idx":1,"correct":true,"proposition":"An 82-year-old man on RIVAROXABAN","justification":"True, it must be made sure that it has a TP > 50%, a TCA < 1.5, and platelets greater than 50G \/ L"},{"idx":2,"correct":false,"proposition":"A 3-month-old child with clonic movements of the right hand since this morning associated with high fever and photophonophobia","justification":"False, he has a typical picture of meningitis and, before 5 years, the only signs of localization that should have an MRI performed are hemicorporal crises"},{"idx":3,"correct":true,"proposition":"A 35-year-old adult with clonic movements of the right hand since this morning associated with stiff neck and fever","justification":"True, in humans over 5 years of age, any sign of localization must have a cMRI performed before PL to avoid engagement"},{"idx":4,"correct":true,"proposition":"A 4-year-old child with twitching of the upper and lower right limbs associated with a sunset gaze","justification":"True, it has a sign of localization (clonies of the right hemibody). He also has a sign of HTIC, which must also have an imaging assessment done before the PL"}],"type":"custom"}
+{"_id":"meningite-neuro-2e5fb4e","context":null,"enonce":"In which cases should a first dose of antibiotic therapy be given before PL in front of a meningitis chart?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"Hospital care impossible in less than 60 minutes","justification":"That's 90.... (sorry)"},{"idx":1,"correct":true,"proposition":"Hemodynamic instability","justification":"True, it sucks, we are close to the cata, we go into cowboy mode (we do hemocs quickly done before anyway)"},{"idx":2,"correct":true,"proposition":"Known and uncorrectable hemostasis abnormality","justification":"True, you need a PT, a TCA, and normal platelets before going"},{"idx":3,"correct":false,"proposition":"Isolated rapidly worsening alertness disorders","justification":"False! Not as long as they are isolated (so not associated with hemodynamic disorders)"},{"idx":4,"correct":true,"proposition":"Indication for prior brain imaging","justification":"True! Always do antibiotics before imaging. Indications for brain imaging:\n-signs of HTIC\n-hemicorporeal seizures before 5 years\n-focal or generalised seizures after 5 years \/ signs of localization"}],"type":"custom"}
+{"_id":"meningite-neuro-1d8800a","context":null,"enonce":"What elements are part of encephalitic syndrome?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"Neck stiffness","justification":"False, in meningeal syndrome"},{"idx":1,"correct":true,"proposition":"Impaired consciousness","justification":"True, these are globally the contraindications relating to PL in front of meningoencephalitis: signs of localization, vigilance disorders (rarely isolated), delirium syndrome, epileptic seizures (most often partial), neurovegetative disorders"},{"idx":2,"correct":true,"proposition":"Signs of localization","justification":"True, cf 2"},{"idx":3,"correct":true,"proposition":"Pulse irregularity","justification":"True, neurovegetative disorder"},{"idx":4,"correct":false,"proposition":"Phonophobia without photophobia","justification":"Distractor, photophonophobia is in meningeal syndrome"}],"type":"custom"}
+{"_id":"meningite-infectio-5437a70","context":null,"enonce":"Regarding precautions for meningococcal meningitis:","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Caregivers should wear FFP2 before the first dose of antibiotic","justification":"Caregivers must wear a surgical mask for up to 24 hours after the first dose of antibiotic. We are on an additional droplet protection "},{"idx":1,"correct":false,"proposition":"Caregivers should wear FFP2 for up to 24 hours after the first dose of antibiotic","justification":"surgical mask"},{"idx":2,"correct":false,"proposition":"Caregivers should wear FFP2 for up to 48 hours after the first dose of antibiotic","justification":"surgical mask up to 24h"},{"idx":3,"correct":true,"proposition":"Antibiotic prophylaxis should be available to caregivers who have practiced mouth-to-mouth and those who have spent at least one hour with the patient without a mask","justification":"True"},{"idx":4,"correct":false,"proposition":"Caregivers must wear a surgical mask until the first dose of antibiotic","justification":"24 hours later"}],"type":"custom"}
+{"_id":"meningite-neuro-6691ea3","context":null,"enonce":"In front of a typical picture of pure encephalitis without associated meningitis in pregnant women, probabilistic treatment will include:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"VALGANCICLOVIR","justification":"We are not trying to cover the CVMP:) It is HSV that gives encephalitis"},{"idx":1,"correct":true,"proposition":"AMOXICILLIN","justification":"True, to cover listeria because she is pregnant; If it wasn't, it would be debatable."},{"idx":2,"correct":false,"proposition":"CEFTRIAXONE","justification":"We do not try to cover streptococcus or meningococcal in encephalitis"},{"idx":3,"correct":true,"proposition":"ACICLOVIR","justification":"True, to cover HSV Let's go IV (and therefore not VALACICLOVIR)"},{"idx":4,"correct":false,"proposition":"DEXAMETHASONE","justification":"False. Indeed, in the pilly 2021, the indications for corticosteroid therapy are very clear (and do not include HSV encephalitis): diagnosis of pneumococcal or meningococcal meningitis of adults or tuberculous meningoencephalitis. (This proposal was counted true by mistake until May 14, 2022, when an external reported the error, thanks to her!)"}],"type":"custom"}
+{"_id":"grossessepatho-gyn-25777c0","context":null,"enonce":"What statements are true about Listeria monocytogenes?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"correct":true,"proposition":"Gram-positive bacillus","justification":"True"},{"idx":1,"correct":false,"proposition":"Gram-negative bacillus","justification":""},{"idx":2,"correct":false,"proposition":"Gram-positive cocci","justification":""},{"idx":3,"correct":false,"proposition":"Gram-negative cocci","justification":""},{"idx":4,"correct":false,"proposition":"Mycobacterium","justification":""}],"type":"custom"}
+{"_id":"grossessepatho-gyn-23204b6","context":null,"enonce":"What statements are true about Listeria monocytogenes?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"correct":true,"proposition":"It is a bacillus with facultative intracellular development","justification":"True"},{"idx":1,"correct":false,"proposition":"He is killed by the cold","justification":"It is able to multiply at low temperatures (4°C)."},{"idx":2,"correct":true,"proposition":"It has natural resistance to cephalosporins","justification":"Yes, this bata**🙄. But it can be beamed with amox (+genta, for good measure). Germs naturally resistant to C3G are LLEIA (as in Star Wars): Legionella, Listeria, Enterococci, Intracellular (-> macrolides) and Strict anaerobes (-> metronidazole)"},{"idx":3,"correct":true,"proposition":"It can colonize food and contaminate the cold chain","justification":"True, possible TIAC agent#montDOr"},{"idx":4,"correct":true,"proposition":"It is a reportable infection","justification":"True"}],"type":"custom"}
+{"_id":"grossessepatho-gyn-9817ce2","context":null,"enonce":"What statements are true about Listeria monocytogenes?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"correct":true,"proposition":"It can cross the intestinal barrier","justification":"True"},{"idx":1,"correct":true,"proposition":"It can cross the blood-brain barrier","justification":"True"},{"idx":2,"correct":true,"proposition":"It can cross the placental barrier","justification":"True"},{"idx":3,"correct":true,"proposition":"Immunosuppression worsens Listeria infection","justification":"True, at the same time it's pretty much always true, huh, \"immunosuppression worsens...\""},{"idx":4,"correct":true,"proposition":"Mortality can reach 45% in Listeria septicaemia","justification":"True, rare but serious infection"}],"type":"custom"}
+{"_id":"grossessepatho-gyn-4d383f5","context":null,"enonce":"How do you get contaminated with Listeria?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"correct":true,"proposition":"Cheeses made from raw milk except pressed pasta","justification":"True"},{"idx":1,"correct":true,"proposition":"Unpasteurized dairy products","justification":"True"},{"idx":2,"correct":true,"proposition":"Uncooked deli meats","justification":"True"},{"idx":3,"correct":false,"proposition":"Hot baths","justification":"Legionella"},{"idx":4,"correct":true,"proposition":"Listeria does not alter the taste of food","justification":"True"}],"type":"custom"}
+{"_id":"meningite-neuro-a45136c","context":null,"enonce":"Which of the following are sequelae of herpetic meningitis? (one or more true propositions)","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"Anxiodepressive disorders","justification":"True"},{"idx":1,"correct":true,"proposition":"Syndrome de Klüver-Bucy","justification":"True, it is most often secondary to a viral infection (reminder: hyperorality, hyperphagia, hypersexuality)"},{"idx":2,"correct":true,"proposition":"Syndrome de Korsakoff","justification":"True, memory disorders in general, which can go as far as Korsakoff with anterograde amnesia and fantasies"},{"idx":3,"correct":true,"proposition":"Character change","justification":"True, we also retain epilepsies"},{"idx":4,"correct":false,"proposition":"Schizophrenia","justification":""}],"type":"custom"}
+{"_id":"lesionart-urg-02c7ce3","context":null,"enonce":"Which tests concern the subspinatus and small round muscles? (one or more correct answers)","item":"lesionart","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"Leg","justification":""},{"idx":1,"correct":false,"proposition":"Jobe","justification":"Supraspinatus"},{"idx":2,"correct":false,"proposition":"Jerk test","justification":"LCA"},{"idx":3,"correct":false,"proposition":"Belly press","justification":"Subscapular"},{"idx":4,"correct":false,"proposition":"Throw up","justification":"Subscapular"}],"type":"custom"}
+{"_id":"lesionart-urg-98a899f","context":null,"enonce":"What tests can highlight an acromioclavicular conflict?","item":"lesionart","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"Cross-arm test","justification":""},{"idx":1,"correct":false,"proposition":"Throw up","justification":"Subscapular"},{"idx":2,"correct":false,"proposition":"Hawkins","justification":"Subacromial conflict"},{"idx":3,"correct":false,"proposition":"Neer","justification":"Subacromial conflict"},{"idx":4,"correct":false,"proposition":"Jobe","justification":"Supraspinatus"}],"type":"custom"}
+{"_id":"lesionart-urg-d48f2f1","context":null,"enonce":"What tests concern the subscapularis muscle? (one or more true answers)","item":"lesionart","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"Throw up","justification":""},{"idx":1,"correct":true,"proposition":"Belly press","justification":""},{"idx":2,"correct":false,"proposition":"Leg","justification":"Subspinatus and small round"},{"idx":3,"correct":false,"proposition":"Jobe","justification":"Supraspinatus"},{"idx":4,"correct":false,"proposition":"None of these proposals","justification":""}],"type":"custom"}
+{"_id":"lesionart-urg-e3ecab9","context":null,"enonce":"What tests concern the supraspinatus muscle? (one or more correct answers)","item":"lesionart","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"Jobe","justification":""},{"idx":1,"correct":false,"proposition":"Leg","justification":"Under spiny and small round"},{"idx":2,"correct":false,"proposition":"Hawkins","justification":"Searches for subacromial conflict"},{"idx":3,"correct":false,"proposition":"Subscapular","justification":"Gerber and Belly press"},{"idx":4,"correct":false,"proposition":"Grinding test","justification":"Concerns the Menisci"}],"type":"custom"}
+{"_id":"lesionart-urg-4e59d14","context":null,"enonce":"Regarding knee ligaments, which proposals are true?","item":"lesionart","matiere":"urg","propositions":[{"idx":0,"correct":false,"proposition":"LLI prevents external rotation","justification":"This is the case of the PAPI"},{"idx":1,"correct":true,"proposition":"LLE prevents varus","justification":""},{"idx":2,"correct":false,"proposition":"IPO prevents valgus","justification":"It prevents internal rotation. Valgus is countered by the LLI"},{"idx":3,"correct":true,"proposition":"PCL is extrasynovial","justification":""},{"idx":4,"correct":false,"proposition":"PAPI can cause Segond's fracture","justification":"This is the case of the LCA"}],"type":"custom"}
+{"_id":"adenomehypoP-endoc-5724093","context":null,"enonce":"What are the complications of acromegaly to look for?","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"Type 1 diabetes","justification":"Secondary diabetes or glucose intolerance"},{"idx":1,"correct":false,"proposition":"Goiter with thyroid adenoma","justification":"It is multinodular goiters that are common"},{"idx":2,"correct":true,"proposition":"Colon polyps","justification":"True"},{"idx":3,"correct":true,"proposition":"Splenomegaly","justification":"True"},{"idx":4,"correct":true,"proposition":"Increased basal cardiac output","justification":"True"}],"type":"custom"}
+{"_id":"noduleTh-endoc-2a22c68","context":null,"enonce":"What are the etiologies of white scintigraphy with increased T4L?","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":" De Quervain's thyroiditis","justification":"True"},{"idx":1,"correct":true,"proposition":"Iodine overload","justification":"True"},{"idx":2,"correct":false,"proposition":"Multinodular goiter","justification":"Scintigraphy that fixes heterogeneously"},{"idx":3,"correct":false,"proposition":"All propositions are true","justification":""},{"idx":4,"correct":false,"proposition":"Non-productive papillary carcinoma","justification":"Normal T4L"}],"type":"custom"}
+{"_id":"noduleTh-endoc-45f7340","context":null,"enonce":"What propositions are true about ARI therapy?","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"The molecule used is iodine-123","justification":"This is iodine-131"},{"idx":1,"correct":true,"proposition":"The molecule used is iodine-131","justification":"True"},{"idx":2,"correct":true,"proposition":"It allows the targeted destruction of thyroid residue","justification":"True"},{"idx":3,"correct":true,"proposition":"Thyroid residues are able to selectively capture iodine-131","justification":"True"},{"idx":4,"correct":false,"proposition":"Treatment is indicated in all patients who have undergone total thyroidectomy","justification":"Treatment is only indicated in patients who have undergone total thyroidectomy and are at high risk of recurrence"}],"type":"custom"}
+{"_id":"noduleTh-endoc-4820ce4","context":null,"enonce":"You explain to your patient the need for thyroid surgery (total thyroidectomy), and inform them of the potential complications of the procedure:","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Hypocalcemia","justification":"True"},{"idx":1,"correct":true,"proposition":"Dysphonia","justification":"True"},{"idx":2,"correct":true,"proposition":"Anaesthetic risks","justification":"True"},{"idx":3,"correct":false,"proposition":"Phrenic nerve damage","justification":"The phrenic nerve originates from C4 and innervates the diaphragm. Not to be confused with laryngeal nerves"},{"idx":4,"correct":false,"proposition":"Hyperparathyroidism ","justification":"Hypoparathyroidism 👉 hypocalcemia"}],"type":"custom"}
+{"_id":"noduleTh-endoc-4b59b7f","context":null,"enonce":"From what size, in centimeters, is a thyroid nodule rather suspicious?","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"2","justification":""},{"idx":1,"correct":true,"proposition":"3","justification":"True, table 16.1 of item 'Nodule'"},{"idx":2,"correct":false,"proposition":"4","justification":""},{"idx":3,"correct":false,"proposition":"5","justification":""},{"idx":4,"correct":false,"proposition":"6","justification":""}],"type":"custom"}
+{"_id":"VIH-infectio-129471a","context":null,"enonce":"Who is the definitive host of Toxoplasma gondii?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"The cat","justification":"True"},{"idx":1,"correct":false,"proposition":"Beef","justification":""},{"idx":2,"correct":false,"proposition":"The dog","justification":""},{"idx":3,"correct":false,"proposition":"The rabbit","justification":""},{"idx":4,"correct":false,"proposition":"The human being","justification":"It is an intermediate host"}],"type":"custom"}
+{"_id":"VIH-infectio-242ce69","context":null,"enonce":"What are the typical aspects of brain toxoplasmosis on MRI?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Multiple abscesses","justification":"True"},{"idx":1,"correct":false,"proposition":"White matter hyperintensity","justification":""},{"idx":2,"correct":true,"proposition":"Roundel appearance","justification":"True"},{"idx":3,"correct":false,"proposition":"Comet tail sign","justification":"Sign of a meningioma"},{"idx":4,"correct":true,"proposition":"Hypointense halo around T1 abscesses","justification":"True, corresponds to edema"}],"type":"custom"}
+{"_id":"VIH-infectio-2c43b53","context":null,"enonce":"What are the possible clinical forms of toxoplasmosis in immunocompromised people?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Brain","justification":"True, especially if CD4 < 200"},{"idx":1,"correct":true,"proposition":"ocular","justification":"True, type of chorioretininte"},{"idx":2,"correct":true,"proposition":"pulmonary","justification":"True, type of interstitial lung disease"},{"idx":3,"correct":true,"proposition":"Disseminated","justification":"True"},{"idx":4,"correct":false,"proposition":"hepatic","justification":""}],"type":"custom"}
+{"_id":"VIH-infectio-5498342","context":null,"enonce":"What elements are part of the table of primary toxoplasmosis infection of the immunocompetent subject?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"fever","justification":"True"},{"idx":1,"correct":true,"proposition":"asthenia","justification":"True"},{"idx":2,"correct":true,"proposition":"Possible eosinophilia","justification":"True"},{"idx":3,"correct":true,"proposition":"mononucleosis syndrome","justification":"True"},{"idx":4,"correct":true,"proposition":"chorioretinitis","justification":"True, 5-10% of cases"}],"type":"custom"}
+{"_id":"VIH-infectio-84e7d87","context":null,"enonce":"Regarding HIV testing in pregnant women:","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"It is mandatory","justification":"It is recommended"},{"idx":1,"correct":false,"proposition":"It is done in the third trimester","justification":"In Q1"},{"idx":2,"correct":true,"proposition":"HIV does not cause embryofetal disease","justification":"True"},{"idx":3,"correct":true,"proposition":" The risk of transmission is 0.3% if the mother's viral load is undetectable","justification":"True"},{"idx":4,"correct":false,"proposition":"HIV infection warrants emergency IMG","justification":"No damage to the fetus but possible contamination"}],"type":"custom"}
+{"_id":"VIH-infectio-a45461f","context":null,"enonce":"In how many cases, in general, is the primary toxoplasmosis infection of the immunocompetent subject symptomatic?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Never","justification":""},{"idx":1,"correct":true,"proposition":"20 %","justification":"True"},{"idx":2,"correct":false,"proposition":"70 %","justification":""},{"idx":3,"correct":false,"proposition":"90 %","justification":""},{"idx":4,"correct":false,"proposition":"Always","justification":""}],"type":"custom"}
+{"_id":"VIH-infectio-f8a606f","context":null,"enonce":"Toxoplasma gondii is:","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"A parasite","justification":"True"},{"idx":1,"correct":true,"proposition":"A cosmopolitan protozoan","justification":"True"},{"idx":2,"correct":true,"proposition":"A zoonosis","justification":"True"},{"idx":3,"correct":false,"proposition":"Arbovirus","justification":""},{"idx":4,"correct":false,"proposition":"A virus","justification":""}],"type":"custom"}
+{"_id":"meningite-infectio-2ffe642","context":null,"enonce":"What meningitis causes normoglycorachic CSF?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Listeriosis","justification":"Hypoglycorachia"},{"idx":1,"correct":true,"proposition":"HSV","justification":"All viral meningitis"},{"idx":2,"correct":false,"proposition":"Carcinoma meningitis","justification":"Often hypoglycorachia"},{"idx":3,"correct":true,"proposition":"Syphillis","justification":"True"},{"idx":4,"correct":true,"proposition":"Lyme disease","justification":"True"}],"type":"custom"}
+{"_id":"meningite-infectio-3d3ce05","context":null,"enonce":"Anissa, 12, is on holiday in Corsica when she is hospitalized in intensive care for meningococcal meningitis. With regard to public health aspects, which proposals are true?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Her nanny, who looks after her 4 hours a day, and who last saw her 12 days ago, must benefit from antibiotic propylaxis.","justification":"Cf 4"},{"idx":1,"correct":false,"proposition":"His mother, who is allergic to quinolones which are the antibiotic of choice, may receive cefotaxime instead.","justification":"Cf 4"},{"idx":2,"correct":false,"proposition":"His father, who is allergic to quinolones and C3G, will receive the last line of antibiotic prophylaxis: rifampicin.","justification":"Cf 4"},{"idx":3,"correct":true,"proposition":"His brother, who is allergic to rifampicin which is the antibiotic prophylaxis of choice, may receive a single dose of C3G or quinolone.","justification":"True, antibiotic prophylaxis of meningococcal meningitis:\n1) Applies to individuals who have spent more than one hour within one metre of the case in the 10 days prior to diagnosis\n2) applies to caregivers who have practiced mouth-to-mouth, or have intubated\/aspirated the patient without a surgical mask\n\nand \n\n3) consists of RIFAMPICIN 600mg x 2 per day for 2 days (or 10mg\/kg per dose but not exceeding 600mg per dose) as a first line\n4) may consist of CEFTRIAXONE 250mg IV single dose (125mg in children) or CIPROFLOXACIN 500mg PO single dose (20mg\/kg in children)"},{"idx":4,"correct":false,"proposition":"Children in the household will be offered to vaccinate them, but not adults because catch-up only takes place until 25 years of age.","justification":"False, we vaccinate the whole household"}],"type":"custom"}
+{"_id":"voyagetrop-infectio-1b73087","context":null,"enonce":"What are arboviruses?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Malaria","justification":""},{"idx":1,"correct":true,"proposition":"Dengue fever ","justification":"True"},{"idx":2,"correct":true,"proposition":"Chikungunya","justification":"True"},{"idx":3,"correct":true,"proposition":"Zika","justification":"True"},{"idx":4,"correct":true,"proposition":"Yellow fever","justification":"List: Japanese encephalitis\nTick-borne Encephalitis\nWest-Nile encephalitis\nDengue fever \nChikungunya\nZika\nYellow fever\n"}],"type":"custom"}
+{"_id":"voyagetrop-infectio-1cbe999","context":null,"enonce":"What are the diseases with faecal-oral transmission?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"HAV","justification":"True"},{"idx":1,"correct":false,"proposition":"HBV","justification":"Virus encapsulated and therefore fragile in the external environment (just like HCV and VHD)"},{"idx":2,"correct":true,"proposition":"HEV","justification":"True"},{"idx":3,"correct":true,"proposition":"Enterotoxigenic E. coli","justification":"Turista "},{"idx":4,"correct":true,"proposition":"Typhoid","justification":"True, Salomonella enterica"}],"type":"custom"}
+{"_id":"voyagetrop-infectio-2d831bb","context":null,"enonce":"What is the clinic of the typhoid fever invasion phase?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"High fever but not yet on plateau","justification":"True"},{"idx":1,"correct":true,"proposition":"digestive disorders","justification":"True"},{"idx":2,"correct":true,"proposition":"neurological disorders","justification":"True"},{"idx":3,"correct":false,"proposition":"Tuphos","justification":"State phase: Plateau fever at 40°C, Tuphos, dig disorders, rash, Duguet's angina (ulcerations)\n"},{"idx":4,"correct":false,"proposition":"rash","justification":""}],"type":"custom"}
+{"_id":"voyagetrop-infectio-5d41b9e","context":null,"enonce":"What are the infectious etiologies to evoke in case of diarrhea in return from tropical countries if the patient is apyeric?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Shigella","justification":"Glairo-bloody diarrhea"},{"idx":1,"correct":true,"proposition":"Intestinal ameobosis","justification":"True"},{"idx":2,"correct":true,"proposition":"Giardiosis","justification":"True"},{"idx":3,"correct":true,"proposition":"Cholera","justification":"True"},{"idx":4,"correct":false,"proposition":"Closridium difficile","justification":"Febrile diarrhea: Salmonellosis, Shigellosis, Campylobacter, Clostridium difficile, Viral hepatitis, Malaria, Primary HIV infection"}],"type":"custom"}
+{"_id":"voyagetrop-infectio-687dd75","context":null,"enonce":"How to confirm typhoid fever?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Serology","justification":""},{"idx":1,"correct":false,"proposition":"PCR","justification":""},{"idx":2,"correct":true,"proposition":"Coproculture if diarrhea","justification":"True"},{"idx":3,"correct":false,"proposition":".EPS","justification":"It is not a parasite"},{"idx":4,"correct":true,"proposition":"Blood culture","justification":"True"},{"idx":5,"correct":false,"proposition":"Microbiological","justification":""},{"idx":6,"correct":false,"proposition":"Rectal swab","justification":""},{"idx":7,"correct":false,"proposition":"Liver biopsy","justification":""},{"idx":8,"correct":false,"proposition":"C3G Proof Treatment","justification":"Does not confirm positive infection"}],"type":"custom"}
+{"_id":"voyagetrop-infectio-6a28938","context":null,"enonce":"What is the vector of leishmaniasis?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Aedes","justification":"Arbovirus, stings during the day"},{"idx":1,"correct":false,"proposition":"Anopheles female","justification":"Malaria, bites at night"},{"idx":2,"correct":true,"proposition":"Female sandfly","justification":"True, bites at night"},{"idx":3,"correct":false,"proposition":"Culex","justification":"West-Nile viral encephalitis \/ Japanese, bites at night"},{"idx":4,"correct":false,"proposition":"Tick","justification":"Borreliosis, Rickettsia, Tick-borne viral encephalitis"}],"type":"custom"}
+{"_id":"voyagetrop-infectio-d81d46c","context":null,"enonce":"What are the two mandatory vaccinations for travellers that can be requested at customs when travelling to endemic areas?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Yellow fever vaccine","justification":"True, in intertropical Africa and the Amazon"},{"idx":1,"correct":true,"proposition":"ACYW135 meningococcal vaccine","justification":"True, during a pilgrimage to Mecca (recommended otherwise) "},{"idx":2,"correct":false,"proposition":"BCG vaccine","justification":""},{"idx":3,"correct":false,"proposition":"MMR vaccine","justification":""},{"idx":4,"correct":false,"proposition":"Rabies vaccine","justification":""}],"type":"custom"}
+{"_id":"voyagetrop-infectio-d977907","context":null,"enonce":"What are the two leading tropical causes of fever after returning from a stay in the tropics?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Malaria","justification":"True"},{"idx":1,"correct":true,"proposition":"Dengue fever","justification":"True"},{"idx":2,"correct":false,"proposition":"Typhoid fever","justification":""},{"idx":3,"correct":false,"proposition":"Turista","justification":"Cause of diarrhea without fever during travel"},{"idx":4,"correct":false,"proposition":"Tuberculosis","justification":""}],"type":"custom"}
+{"_id":"voyagetrop-infectio-dab31b0","context":null,"enonce":"What is the most common cause of non-febrile diarrhea when returning from a trip to tropical countries?\n","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"HIV","justification":"Diarrhea from primary HIV infection is febrile"},{"idx":1,"correct":false,"proposition":"Cholera","justification":"Rarer"},{"idx":2,"correct":false,"proposition":"Salmonella","justification":"Febrile diarrhea"},{"idx":3,"correct":true,"proposition":"Giardiasis","justification":"True, test treatment with Metronidazole, diagnosis with EPS"},{"idx":4,"correct":false,"proposition":"Dengue fever","justification":"Febrile arbovirus, no diarrhea classically"}],"type":"custom"}
+{"_id":"meningite-infectio-4a04b58","context":null,"enonce":"What are the infectious agents that can give acute encephalitis accompanied by single nucleosic syndromes?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"CMV","justification":"True"},{"idx":1,"correct":true,"proposition":"HSV","justification":"True"},{"idx":2,"correct":false,"proposition":"VZV","justification":"Does not give mononucleosic syndrome."},{"idx":3,"correct":true,"proposition":"EBV","justification":"True"},{"idx":4,"correct":false,"proposition":"HHV-6","justification":"HHV6 does give a mononucleosis syndrome but classically no encephalitis."}],"type":"custom"}
+{"_id":"meningite-infectio-4d1795f","context":null,"enonce":"The mother of 8-month-old Josephine wants to take her on a pilgrimage to Mecca. What can you tell him about vaccination?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Mecca is located in the meningitis belt","justification":"That's the whole point."},{"idx":1,"correct":true,"proposition":"Her daughter may be offered a meningococcal C conjugate vaccine","justification":"Yes, absolutely. Mandatory vaccination for children born since January 1, 2018 is also mandatory, with a dose at the age of 5 months and a booster at the age of 1 year. Catching up until the age of 24 is possible."},{"idx":2,"correct":true,"proposition":"Her daughter may be offered a polysaccharide vaccine against meningococci A and C","justification":"Yes, because the area it crosses also has a circulation of serotype A, and this from 6 months"},{"idx":3,"correct":false,"proposition":"All propositions are true","justification":""},{"idx":4,"correct":false,"proposition":"Daughter may be offered a meningococcal B protein vaccine","justification":"False, only in immunocompromised patients (allogeneic HSCT, asplenia, properdin deficiency, terminal complement deficiency)"}],"type":"custom"}
+{"_id":"creatplus-nephro-0","context":null,"enonce":"Concerning the main generalities:","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"The value of creatinine in plasma is inversely related to the Glomerular Filtration Rate"},{"idx":1,"correct":false,"proposition":"The more kidney function increases, the more serum creatinine increases","justification":"Increased creatinine signs a deterioration in kidney function"},{"idx":2,"correct":false,"proposition":"The value of creatinine in plasma depends only on renal function","justification":"Also muscle production of creatinine"},{"idx":3,"correct":false,"proposition":"Creatinine is a perfect marker of kidney function","justification":"Very imperfect because dependent on muscle function, very variable from one individual to another"},{"idx":4,"correct":false,"proposition":"A value of 150 μmol\/L is normal in women","justification":"Acceptable values: between 50 and 90 μmol\/L in women and between 80 and 115 μmol\/L in men"}],"type":"custom"}
+{"_id":"creatplus-nephro-1","context":null,"enonce":"Regarding the estimation of creatinine clearance:","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"The formula of Cockcroft and Gault was established in antiquity","justification":"Renal physiology was still largely unknown until the Renaissance. Cockroft and Gault's formula was published in 1976."},{"idx":1,"correct":false,"proposition":"The Cockcroft and Gault formula allows direct estimation of GFR","justification":"It is an estimate of creatinine clearance which is itself an estimate of GFR"},{"idx":2,"correct":false,"proposition":"The Cockcroft and Gault formula takes as a parameter the rate of muscle mass and the height of the patient","justification":"4 parameters of age, sex, weight and serum creatinine"},{"idx":3,"correct":true,"proposition":"The result obtained through the Cockcroft and Gault is not indexed to body surface area"},{"idx":4,"correct":false,"proposition":"The formula of Cockroft and Gault is recommended in the elderly","justification":"Poor performance in the elderly and obese subject"}],"type":"custom"}
+{"_id":"creatplus-nephro-2","context":null,"enonce":"Which propositions are true?","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"The MDRD and CKD-EPI formulas estimate a GFR that is indexed to body surface area"},{"idx":1,"correct":false,"proposition":"MDRD and CKD-EPI include weight, sex, age and serum creatinine","justification":"Ethnicity, not weight"},{"idx":2,"correct":false,"proposition":"CKD-PPE is more recommended than MDRD for high serum creatinine values","justification":"This is the case for low values of creat"},{"idx":3,"correct":false,"proposition":"note that they cannot be used: in children (use Boyd's formula)","justification":"It should be noted that they can not be used: in children use Schwartz's formula!"},{"idx":4,"correct":true,"proposition":"Chapter 15): GFR is normal between 90 and 120 ml\/min\/1.73 m2; Between 60 to 89 ml\/min\/1.73 m2, chronic renal failure is mild"}],"type":"custom"}
+{"_id":"creatplus-nephro-4984954","context":null,"enonce":"The Cockcroft formula takes into account: ","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Creatinineuria ","justification":"False, serum creatinine "},{"idx":1,"correct":false,"proposition":"Urea ","justification":"False "},{"idx":2,"correct":true,"proposition":"Weight ","justification":"True: serum creatinine, age, sex and weight "},{"idx":3,"correct":true,"proposition":"Sex ","justification":"True "},{"idx":4,"correct":true,"proposition":"Age ","justification":"True "}],"type":"custom"}
+{"_id":"epidemioKc-onco-d319e00","context":null,"enonce":"Mass cancer screening in France is justified if:","item":"epidemioKc","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"cancer is common OR serious","justification":"AND"},{"idx":1,"correct":false,"proposition":"The short pre-clinical phase","justification":"As a result, we would not have time to detect him that he would already be there"},{"idx":2,"correct":true,"proposition":"the cost of testing is considered acceptable by society ","justification":"And more precisely, by the representatives of the company"},{"idx":3,"correct":false,"proposition":"The overall survival gain has been proven in France by serious studies","justification":"Not in France. Most often, these are international studies"},{"idx":4,"correct":false,"proposition":"No proposition is true","justification":""}],"type":"custom"}
+{"_id":"TTTperso-therapeutique-bc6d110","context":null,"enonce":"You receive in general medical consultation, Mr BINDINGOF, Isaac, 83 years old, who has just moved into France, so this is the first time you see him in consultation. He presents you with a prescription \"as long as the arm\" including no less than 18 drugs. Among these are 5 anti-hypertensives, 3 analgesics, 4 psychotropic drugs, creams \/ ointments, a statin and so on! You break your head and decide to review this prescription a little... What do you do?","item":"TTTperso","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"Check that the patient is taking his treatments and following non-drug measures","justification":"True, this is the MAIN measure to be carried out before prescribing \"triple therapy for everything\" as we often say in general medicine. In addition, the patient will not often spontaneously say that he does not take his treatments... It must be seen that a prescription with 18 drugs is an ordeal for the patient who will often take according to his moods! (Situation experienced during internship)"},{"idx":1,"correct":false,"proposition":"Spontaneous discontinuation of benzodiazepines due to low level of evidence in the elderly","justification":"False... Even if we do not like benzodiazepines too much (and rightly so!) for their risk of sedation, falling, in the elderly, we must not make a sudden stop! It is necessary to reduce the doses, space the doses, in short to make a long and tedious weaning but it must be done!"},{"idx":2,"correct":true,"proposition":"Check the dosages of treatments, to look for a minimum effective dosage","justification":"True, some drugs require dosage adjustment due to the physiological aging of the body. We will therefore think about evaluating kidney function with a small blood test well felt, and liver function also, even if it is more complicated."},{"idx":3,"correct":false,"proposition":"Do not prescribe tablets in the face of the risk of false routes","justification":"False, even if often true in geriatrics or nursing homes, advanced age alone is not a contraindication to taking tablets! The risk of false routes and swallowing disorders must be assessed before"},{"idx":4,"correct":true,"proposition":"Check the MA of treatments to avoid off-label therapies","justification":"True, it is better to prescribe \"safe\" treatments in the elderly and not to try too much off-label or off-recommendations. In fact, at ECNs, it is always true that one should not prescribe off-label."}],"type":"custom"}
+{"_id":"atherome-cardio-f9e4ab4","context":null,"enonce":"Regarding therapeutics: ","item":"atherome","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"It is not necessary to remove or treat all modifiable risk factors","justification":"False "},{"idx":1,"correct":true,"proposition":"Aspirin and statins help reduce inflammation. ","justification":"True "},{"idx":2,"correct":false,"proposition":"Statins reduce the accumulation of LDL but not stabilize plaques. ","justification":"False, they are used to reduce the accumulation of LDL, stabilize plaques, regression of the volume of plaques. "},{"idx":3,"correct":true,"proposition":"Antihypertensive treatments reduce mechanical stress.","justification":"True, blood pressure puts mechanical stress on blood vessels"},{"idx":4,"correct":false,"proposition":"When rupture of plaque, antiplatelet and heparin drugs must be used, but not urgently.","justification":"False, urgently. "}],"type":"custom"}
+{"_id":"ulcere-cardio-11e7a91","context":null,"enonce":"What arguments are in favor of an arterial leg ulcer? ","item":"ulcere","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Lengthening of the TRC ","justification":"True, skin coloration depends on the oxygenation of the blood, therefore arterial blood"},{"idx":1,"correct":true,"proposition":"Decreased skin heat ","justification":"True, in obliterating PAD the limbs are cold because they are not vascularized (they are also very painful and hard, and there is no pulse, but we go astray)"},{"idx":2,"correct":false,"proposition":"History of deep vein thrombosis ","justification":"False, in favor of a venous ulcer "},{"idx":3,"correct":false,"proposition":"White atrophy ","justification":"False, in favor of a venous ulcer "},{"idx":4,"correct":true,"proposition":"Gradient erythrocyanosis ","justification":"True"}],"type":"custom"}
+{"_id":"ulcere-cardio-c9769d7","context":null,"enonce":"What arguments are in favor of a venous leg ulcer? ","item":"ulcere","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Perileolar ulcer ","justification":"True"},{"idx":1,"correct":false,"proposition":"Abolition of peripheral pulse ","justification":"False, in favor of an arterial ulcer "},{"idx":2,"correct":false,"proposition":"Hollow ulcer ","justification":"False, in favor of an arterial ulcer "},{"idx":3,"correct":true,"proposition":"Mild pain ","justification":"True"},{"idx":4,"correct":true,"proposition":"Ochre dermatitis ","justification":"True"}],"type":"custom"}
+{"_id":"valvuloP-cardio-ee19d65","context":null,"enonce":"About the Carpentier classification: ","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"It is used for the classification of aortic insufficiency. ","justification":"False, in the MITRAL inadequacies. "},{"idx":1,"correct":true,"proposition":"Type I corresponds to mitral valves that remain in the same plane as the ring. ","justification":"True. "},{"idx":2,"correct":false,"proposition":"Type II corresponds to at least one valve exceeding the plane of the ring, the valve play is then decreased. ","justification":"False, valve play is increased in type II. "},{"idx":3,"correct":true,"proposition":"Type IIIa corresponds to a valve set decreased in systole and diastole. ","justification":"True. "},{"idx":4,"correct":false,"proposition":"Type IIIb corresponds to a valvular set decreased in systole and diastole. ","justification":"False, type IIIb = systolic restrictive. "}],"type":"custom"}
+{"_id":"191-immuno-d2e0e8f1-7e14-4445-a3a3-23eed8b19ae6","context":null,"enonce":"Which of the following proposals about Horton's disease or giant cell arteritis is true?","item":"ACG","matiere":"immuno","propositions":[{"idx":0,"correct":false,"proposition":"Horton's disease affects the large vessels, including the carotid vessels, aorta and femoral vessels.","justification":"False, large vessels are represented by the carotids, aorta and iliac arteries. "},{"idx":1,"correct":true,"proposition":"Horton's disease headaches are temporal, beating, with hyperesthesia of the scalp","justification":"True, this is also called the comb sign (when patients paint themselves, it hurts, because of hyperesthesia)! To look for during the clinical examination"},{"idx":2,"correct":false,"proposition":"A decrease in visual acuity occurring during headache should suggest a CRAO","justification":"False! It's NOIAA! To better remember:\n- OACR is an ischemic occlusion of the vessel responsible for the vascularization of the retina, the central artery of the retina, completely painless because the retina is not sensorily innervated,\n-NAOA is an acute ischemia of the head of the optic nerve, by occlusion of the posterior ciliary artery which is also a terminal branch of the internal carotid artery. It is also painless. The BAV is always total (\"blackout\"), while the OACR can sometimes leave a very diminished vision.\n\nRemember the NOIAA because it is the real emergency in Horton's disease (general corticosteroid +++)"},{"idx":3,"correct":false,"proposition":"Corticosteroid therapy is imperative after biopsy of the temporal artery, because the latter may be negativated by the treatment","justification":"False, even if corticosteroid therapy may negative the biopsy, in case of strong clinical suspicion, or clinical emergency, treatment should be initiated"},{"idx":4,"correct":true,"proposition":"The biopsy conventionally finds a giganto cell epitheloid granuloma without caseous necrosis with edematous panarteritis and rupture of the internal elastic limiting ","justification":"True, to know by heart in detail, because this item falls ALL the time"}],"type":"custom"}
+{"_id":"LED-immuno-4787b2e","context":null,"enonce":"What are the biological signs in favor of a PAS?","item":"LED","matiere":"immuno","propositions":[{"idx":0,"correct":true,"proposition":"Thrombocytopenia","justification":"In 20% of cases"},{"idx":1,"correct":true,"proposition":"Anaemia","justification":"True"},{"idx":2,"correct":true,"proposition":"Dissociated syphilitic serology","justification":"VDRL positive (contains phospholipids) and TPHA negative"},{"idx":3,"correct":false,"proposition":"Leukopenia","justification":"Sign of lupus"},{"idx":4,"correct":false,"proposition":"Hypereosinophilia","justification":"No link to an APS"}],"type":"custom"}
+{"_id":"MAI-immuno-97ecdf8","context":null,"enonce":"Which of the following are the causes of polyclonal hypergammaglobulinemia?","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"correct":true,"proposition":"AA amyloidosis","justification":"True, proposition of rank C (the rest is rank A)"},{"idx":1,"correct":true,"proposition":"Autoimmune hepatitis","justification":"True, IgG"},{"idx":2,"correct":true,"proposition":"Primary biliary cirrhosis","justification":"True, IgM"},{"idx":3,"correct":false,"proposition":"Myeloma","justification":"Monoclonal"},{"idx":4,"correct":false,"proposition":"Myasthenia","justification":"No hypergamma + autoantibodies (therefore monoclonal)"}],"type":"custom"}
+{"_id":"MAI-immuno-c5eda7e","context":null,"enonce":"Which of the following are the causes of polyclonal hypergammaglobulinemia?","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"correct":true,"proposition":"HIV","justification":"True"},{"idx":1,"correct":true,"proposition":"Syndrome de Gougerot","justification":"True"},{"idx":2,"correct":true,"proposition":"Chronic bacterial infections","justification":"True"},{"idx":3,"correct":true,"proposition":"Systemic lupus","justification":"True"},{"idx":4,"correct":true,"proposition":"Sarcoidosis","justification":"True"}],"type":"custom"}
+{"_id":"MAI-immuno-ff9aa13","context":null,"enonce":"Which of the following tests are useful for suspected dermatomyositis?","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"correct":true,"proposition":"Electromyogram","justification":"True, finds a myogenic syndrome"},{"idx":1,"correct":true,"proposition":"Muscle biopsy","justification":"True, confirms the diagnosis"},{"idx":2,"correct":true,"proposition":"Muscle MRI","justification":"True, allows to target the biopsy"},{"idx":3,"correct":true,"proposition":"PET-CT","justification":"True, allows you to look for cancer. About 20% of dermatomyositis are paraneoplastic"},{"idx":4,"correct":false,"proposition":"Determination of anti-M2 antibodies","justification":"Antibodies for primary biliary cirrhosis"}],"type":"custom"}
+{"_id":"asthme-immuno-a5fd823","context":null,"enonce":"What are the clinical symptoms of allergic rhinitis? ","item":"asthme","matiere":"immuno","propositions":[{"idx":0,"correct":true,"proposition":"Itch ","justification":"PAREO symptoms: \n-Itch \n-Anosmia \n-Rhinorrhea \n- Sneezing \n- Nasal obstruction \n+ possible eye symptoms (conjunctivitis) "},{"idx":1,"correct":true,"proposition":"Nasal obstruction ","justification":""},{"idx":2,"correct":false,"proposition":"Dyspnoea ","justification":""},{"idx":3,"correct":false,"proposition":"Cough ","justification":""},{"idx":4,"correct":false,"proposition":"Wheezing ","justification":""}],"type":"custom"}
+{"_id":"EI-infectio-9f0b1af","context":null,"enonce":"\nWhat are the infectious agents responsible for infective endocarditis? \n","item":"EI","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Oral streptococci mostly 20%. ","justification":"False, second at 20% behind Staphylococcus aureus. "},{"idx":1,"correct":true,"proposition":"Staphylococcus aureus at 30%. ","justification":"True. "},{"idx":2,"correct":false,"proposition":"E. coli at 13%. ","justification":"False, Streptococcus gallolyticus 13%. "},{"idx":3,"correct":true,"proposition":"Enterococci and coagulase-negative Staphylococci equal (10%). ","justification":"True. "},{"idx":4,"correct":false,"proposition":"Blood cultures are negative in only 2% of cases. ","justification":"False, in 5-10% of cases. It is necessary to specify \"endocarditis research\" on the request to the lab so that the culture is prolonged!"}],"type":"custom"}
+{"_id":"EI-infectio-eb2e51a","context":null,"enonce":"Among these pathologies, which belong to group A of infectious endocarditis said to be at high risk of infective endocarditis? ","item":"EI","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Valvular heart disease. ","justification":"False. "},{"idx":1,"correct":true,"proposition":"A mitral biological prosthesis. ","justification":"True, all prostheses in all positions!"},{"idx":2,"correct":true,"proposition":"A mitral mechanical prosthesis. ","justification":"See 2"},{"idx":3,"correct":false,"proposition":"A history of 1st degree infective endocarditis. ","justification":"False, personal ATCD. "},{"idx":4,"correct":false,"proposition":"Non-cyanogenic ischemic heart disease.","justification":"False, NOT cyanogenic = NOT high risk (except atrial septal defect). "}],"type":"custom"}
+{"_id":"VH-infectio-50ad7d9","context":null,"enonce":"What are the extrahepatic complications of HCV?","item":"VH","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Panarteritis nodosa","justification":"This is one of the possible complications of HBV infection"},{"idx":1,"correct":true,"proposition":"Cryoglobulinemia","justification":""},{"idx":2,"correct":true,"proposition":"Lymphoma","justification":""},{"idx":3,"correct":true,"proposition":"Glomerular syndrome","justification":"By secondary GEM for example"},{"idx":4,"correct":false,"proposition":"HCV is not accompanied by extrahepatic involvement","justification":""}],"type":"custom"}
+{"_id":"VIH-infectio-1205f9f","context":null,"enonce":"What is the treatment to be systematically initiated in a child born to an HIV+ mother?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Ziduvodine for 4 weeks","justification":"True"},{"idx":1,"correct":false,"proposition":"Ziduvodine single dose","justification":""},{"idx":2,"correct":false,"proposition":"Ritonavir for 4 weeks","justification":""},{"idx":3,"correct":false,"proposition":"Tenofovir for 4 weeks","justification":""},{"idx":4,"correct":false,"proposition":"There is no systematic treatment","justification":""}],"type":"custom"}
+{"_id":"VIH-infectio-5907f43","context":null,"enonce":"Which infectious pathologies are favored by the AIDS stage?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Influenza","justification":"True"},{"idx":1,"correct":true,"proposition":"Pneumococcal pneumonia","justification":"True"},{"idx":2,"correct":true,"proposition":"HBV","justification":"True"},{"idx":3,"correct":true,"proposition":"HCV","justification":"True"},{"idx":4,"correct":false,"proposition":"HEV","justification":"The full list: Pneumococcal pneumonia, influenza, STIs in general, HBV and HCV"}],"type":"custom"}
+{"_id":"antiinf-infectio-16eba0e","context":null,"enonce":"For which germs is the addition of clavulanic acid useless?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"MRSA","justification":"True, because modification of the target (not a production of penicillinase)"},{"idx":1,"correct":true,"proposition":"Pneumococcus of decreased sensitivity to penicillins","justification":"True, because modification of the target (not a production of penicillinase)"},{"idx":2,"correct":false,"proposition":"E. Coli","justification":""},{"idx":3,"correct":false,"proposition":"Klebsiella pneumoniae","justification":""},{"idx":4,"correct":true,"proposition":"Pseudomonas aeruginosa","justification":"Pyo never sensitive to either amox or augmentin so adding unnecessary clavulanic acid"}],"type":"custom"}
+{"_id":"antiinf-infectio-9a63b1a","context":null,"enonce":"Which bacteria are most sensitive to amoxicillin?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Group 1 Enterobacteriaceae","justification":"True"},{"idx":1,"correct":false,"proposition":"Group 2 Enterobacteriaceae","justification":"Susceptible to augmentin and cephalosporins"},{"idx":2,"correct":false,"proposition":"Group 3 Enterobacteriaceae","justification":"C3G sensitive only"},{"idx":3,"correct":true,"proposition":"Proteus miribilis","justification":"True"},{"idx":4,"correct":true,"proposition":"Salmonella","justification":"True"}],"type":"custom"}
+{"_id":"bacteriemie-infectio-7015de0","context":null,"enonce":"What are the modalities of vascular filling?","item":"bacteriemie","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"By csristalloïde","justification":""},{"idx":1,"correct":true,"proposition":"Per salted serum 0.9% generally ","justification":""},{"idx":2,"correct":false,"proposition":"By colloids ","justification":"Colloids have no demonstrated efficacy in this indication but an increased risk of acute renal failure. We NEVER tick colloids at the ECN (they are almost no longer used in practice, except by people very specialized in very specialized indications)"},{"idx":3,"correct":true,"proposition":"The flow rate is about 500mL in 15 min","justification":"True, in adults. In children, 20mL\/kg is retained in the syringe."},{"idx":4,"correct":true,"proposition":"Filling is done in free flow","justification":"True in adults. A filling (unlike hydration) is done in free flow on a track of good caliber. This makes about 500mL of solute pass in 15 minutes"}],"type":"custom"}
+{"_id":"infdermato-infectio-b98bdfb","context":null,"enonce":"How long is eviction in impetigo after starting treatment?","item":"infdermato","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"No eviction recommended","justification":""},{"idx":1,"correct":false,"proposition":"24 h","justification":""},{"idx":2,"correct":false,"proposition":"48 h","justification":""},{"idx":3,"correct":true,"proposition":"72 hrs","justification":"As in scabies 🤗"},{"idx":4,"correct":false,"proposition":"5 days","justification":""}],"type":"custom"}
+{"_id":"meningite-infectio-b044cc9","context":null,"enonce":"Neurology intern brilliantly received at ECN, you receive a 40-year-old patient with fibromyalgia, irritable bowel syndrome, and psychogenic non-epileptic seizures. She consults you for a heterogeneous table. It reports:\n-severe pain in the territories C7 left, T10 bilateral, L3 right, S1 right;\n-bilateral facial paralysis;\n-a history of red ring that spread quickly following a walk in the forest in Alsace 6 months ago.\nShe is convinced she has Lyme disease. What do you propose to him?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"In view of the field, it is very likely that his symptoms are part of a somatoform disorder, so you refer him to a specialized psychiatrist colleague and avoid multiplying unnecessary examinations because it increases the symptoms","justification":"False! It's a typical picture! Multiradicular involvement + bilateral FP in the aftermath of erythema migrans!\nIf we should not multiply the examinations in a patient with a somatoform disorder, most patients with this type of disorder also have poorly managed organic comorbidities, and rectifying these treatments reduces psychiatric symptoms!"},{"idx":1,"correct":true,"proposition":"You offer to perform a lumbar puncture, and you expect to come across normoglycorachic lymphocytic meningitis","justification":"Exactly the CSF of Lyme meningitis"},{"idx":2,"correct":true,"proposition":"You propose to perform a Lyme serology and a PCR on CSF + blood","justification":"True, that's how secondary phase diagnosis is made."},{"idx":3,"correct":false,"proposition":"Neurological damage to Lyme is conventionally installed in the tertiary phase, it's too early","justification":"No, it's good from the secondary phase"},{"idx":4,"correct":false,"proposition":"There is no Lyme disease in Alsace","justification":"Unfortunate! https:\/\/www.santepubliquefrance.fr\/les-actualites\/2021\/borreliose-de-lyme-donnees-epidemiologiques-2020"}],"type":"custom"}
+{"_id":"meningite-infectio-cdf9772","context":null,"enonce":"Regarding the treatment of bacterial meningitis:","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Probabilistic treatment of meningitis depends on direct examination of the PL","justification":"Ben, voui"},{"idx":1,"correct":false,"proposition":"If direct examination for PL is negative, dexamethasone + C3G + amoxicillin + gentamicin is most often offered","justification":"Ohla, the Sécu is good, but the selection of resistant germs, less! This is what is proposed in case of strong suspicion of listeriosis. For \"simple\" meningitis, we are satisfied with C3G + dexa, it covers pneumococcus and meningococcal"},{"idx":2,"correct":false,"proposition":"If direct examination of PL finds diplococci, regardless of their Gram, we will propose a C3G IV for 14 days and dexamethasone 4 days","justification":"It's almost true:\n-Gram-negative diplococcus: meningococcal -> C3G IV 4-7d + dexa 4d\n-Gram-positive diplococcus: pneumococcus -> C3G IV 10-14d + dexa 4d\nAnd if you ever get it out (unlikely):\n-gram-positive bacillus: listeria -> amoxicillin 21d + gentamicin 5d"},{"idx":3,"correct":true,"proposition":"In the presence of a C3G-resistant pneumococcus, potentiation with vancomycin","justification":"True, we speak of resistance when the MIC is greater than 0.5"},{"idx":4,"correct":true,"proposition":"The doses of C3G are: Cefotaxime 300mg\/kg\/day IVSE after a bolus of 50mg\/kg over 1h, or in 4 IVL Ceftriaxone 100mg\/kg\/day in 2 IVL","justification":"True, it seems that we must know them"}],"type":"custom"}
+{"_id":"otite-infectio-a10ffc9","context":null,"enonce":"What are the risk factors for impaired pneumococcus for penicillin (PSDP) in children?","item":"otite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"less than 18 months of age","justification":"Less than a year and a half"},{"idx":1,"correct":true,"proposition":"Community life","justification":"Easier to be in contact with a resistant germ in community (in the same way, there are more MRSA in hospitals than in the Aveyron countryside [heart on it by the way])"},{"idx":2,"correct":true,"proposition":"recent history of acute otitis media","justification":"Reinfection with treatment-resistant germs given at previous AOM"},{"idx":3,"correct":true,"proposition":"taking penicillin less than 3 months ago","justification":"Selection of the resistant strain that took a few months to reproduce and give the new otitis"},{"idx":4,"correct":false,"proposition":"taking fluoroquinolones less than 3 months ago","justification":"No report"}],"type":"custom"}
+{"_id":"reactioninfl-infectio-1d32c16","context":null,"enonce":"Which bacterial infections are not responsible for neutrophil polynucleosis?","item":"reactioninfl","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Tuberculosis","justification":""},{"idx":1,"correct":true,"proposition":"Syphilis","justification":""},{"idx":2,"correct":true,"proposition":"Brucellosis","justification":""},{"idx":3,"correct":true,"proposition":"Whooping cough","justification":""},{"idx":4,"correct":true,"proposition":"Typhoid fever","justification":"Conventionally, bacterial infections are accompanied by a reaction of the innate immune system that recruits neutrophils to fight bacteria. However, in some cases (tuberculosis, brucellosis, syphilis, whooping cough or thyphoid fever infections), there is no polynucleosis but rather hyperlymphocytosis. This is an interesting feature to keep in mind, both for the NEC and for future clinical practice."}],"type":"custom"}
+{"_id":"risques-infectio-2740fee","context":null,"enonce":"What are the national structures for the control of nosocomial infections? ","item":"risques","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Ministry of Health","justification":"It is he who implements the plan to fight against NI"},{"idx":1,"correct":true,"proposition":"InVS","justification":"The National Institute for Health Surveillance is a network for the Alert, Investigation and Surveillance of nosocomial infections"},{"idx":2,"correct":false,"proposition":"BLINKING ","justification":"The Centre for Coordination and Control of NI is a regional network."},{"idx":3,"correct":false,"proposition":"EOHH","justification":"The Hospital Hygiene Operational Team acts, as its name suggests, at the local level"},{"idx":4,"correct":false,"proposition":"ANSM","justification":"The ANSM's mission is not to fight against nosocomial infections."}],"type":"custom"}
+{"_id":"vaccin-infectio-47bdef6","context":null,"enonce":"At what age is the pertussis vaccine booster?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"6 years","justification":""},{"idx":1,"correct":true,"proposition":"25 years","justification":"True, and then we reassess if the patient is in a cocooning (takes care of a child under 6 months)"},{"idx":2,"correct":false,"proposition":"65 years","justification":""},{"idx":3,"correct":false,"proposition":"15 years","justification":""},{"idx":4,"correct":false,"proposition":"8 months","justification":""}],"type":"custom"}
+{"_id":"vaccin-infectio-6570733","context":null,"enonce":"What are the contraindications of BCG? ","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"HIV infection ","justification":"Live vaccines contraindicated in immunosuppression "},{"idx":1,"correct":true,"proposition":"Pregnancy ","justification":"Live vaccines contraindicated in pregnancy "},{"idx":2,"correct":true,"proposition":"In a renal transplant patient ","justification":"Live vaccines contraindicated"},{"idx":3,"correct":false,"proposition":"Splenectomized patient ","justification":"No contraindications to live vaccines "},{"idx":4,"correct":false,"proposition":"Renal failure ","justification":"No contraindications to live vaccines "}],"type":"custom"}
+{"_id":"vaccin-infectio-b7ff63b","context":null,"enonce":"What is pneumococcal polysaccharide vaccine?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Unconjugated pneumococcal vaccine VP23","justification":"True"},{"idx":1,"correct":false,"proposition":"Pneumococcal vaccine VP23 conjugate","justification":""},{"idx":2,"correct":false,"proposition":"Unconjugated pneumococcal vaccine VP13","justification":""},{"idx":3,"correct":false,"proposition":"Pneumococcal vaccine VP13 conjugate","justification":""},{"idx":4,"correct":false,"proposition":"None of these proposals","justification":""}],"type":"custom"}
+{"_id":"voyagetrop-infectio-3317499","context":null,"enonce":"What is found in the biology of dengue?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Leukopenia","justification":"True"},{"idx":1,"correct":true,"proposition":"Thrombocytopenia","justification":"True"},{"idx":2,"correct":false,"proposition":"Cytolysis","justification":"No cytolysis"},{"idx":3,"correct":false,"proposition":"Augmented CRP","justification":"No inflammatory syndrome"},{"idx":4,"correct":false,"proposition":"Augmented VS","justification":"No inflammatory syndrome"}],"type":"custom"}
+{"_id":"voyagetrop-infectio-374e11c","context":null,"enonce":"What does Caroli's triad contain, which corresponds to the pre-icteric phase of infection with a hepatotropic virus?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Hives","justification":"True"},{"idx":1,"correct":true,"proposition":"Influenza-like illness","justification":"True"},{"idx":2,"correct":true,"proposition":"Arthralgia","justification":"True"},{"idx":3,"correct":false,"proposition":"Mononucleoside syndrome","justification":"It's a clinical triad"},{"idx":4,"correct":false,"proposition":"Maculopapular exanthema","justification":"No rash in viral hepatitis most often"}],"type":"custom"}
+{"_id":"voyagetrop-infectio-76afc43","context":null,"enonce":"Loperamide, anti-diarrheal retarder, is contraindicated below:","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"6 months","justification":""},{"idx":1,"correct":true,"proposition":"2 years","justification":"True, it is also contraindicated in case of invasive diarrhea (dysenteric syndrome) because it decreases the elimination of the bacteria  "},{"idx":2,"correct":false,"proposition":"10 years","justification":""},{"idx":3,"correct":false,"proposition":"18 years","justification":""},{"idx":4,"correct":false,"proposition":"It is allowed at all ages","justification":""}],"type":"custom"}
+{"_id":"voyagetrop-infectio-7b7b003","context":null,"enonce":"Which specific vaccine should be recommended when travelling to Eastern European countries (especially Austria) and Asia?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Tick-borne encephalitis","justification":"True"},{"idx":1,"correct":false,"proposition":"Japanese encephalitis","justification":"Pakistan and the Philippines"},{"idx":2,"correct":false,"proposition":"Typhoid fever","justification":"Intertropical Africa and the Amazon"},{"idx":3,"correct":false,"proposition":"Rabies","justification":"Adventurous stays in Asia, Africa including North Africa, South America...\n"},{"idx":4,"correct":false,"proposition":"HAV","justification":"Precarious hygiene conditions in an endemic country"}],"type":"custom"}
+{"_id":"peritonite-urg-42b9ab7","context":null,"enonce":"Regarding the nasogastric tube in case of occlusion:","item":"peritonite","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"The nasogastric tube most often suppresses nausea","justification":""},{"idx":1,"correct":true,"proposition":"The nasogastric tube most often suppresses vomiting","justification":""},{"idx":2,"correct":true,"proposition":"The nasogastric tube does not contraindicate oral hydration","justification":""},{"idx":3,"correct":false,"proposition":"Nasogastric tube contraindicates oral liquid feeding","justification":"The nasogastric tube does not contraindicate hydration or oral fluid feeding, but occlusion may contraindicate them depending on its severity"},{"idx":4,"correct":false,"proposition":"The nasogastric tube should always be placed if the patient pulls it off.","justification":"Not systematically: we must first understand the reason for the patient's reaction and reassess the benefit\/risk ratio"}],"type":"custom"}
+{"_id":"tbauditif-ORL-6b9fdc6","context":null,"enonce":"Where is the acoustic-facial package?","item":"tbauditif","matiere":"ORL","propositions":[{"idx":0,"correct":true,"proposition":"Ahead of the pontocerebellar angle","justification":""},{"idx":1,"correct":true,"proposition":"Behind the sphenoid sinus","justification":""},{"idx":2,"correct":false,"proposition":"It crosses the external carotid artery","justification":"Everything is explained here 👉 https:\/\/www.researchgate.net\/figure\/Croisement-entre-lAICA-gauche-fleche-rouge-et-le-paquet-acoustico-facial-fleche_fig3_281713908"},{"idx":3,"correct":true,"proposition":"In front of the cerebellum","justification":""},{"idx":4,"correct":true,"proposition":"Behind the temporal lobe","justification":""}],"type":"custom"}
+{"_id":"IBP-pneumo-18545ca","context":null,"enonce":"What is (are) the clinical sign(s) of hypercapnia? (one or more propositions are true)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"Costal draw","justification":"This is a sign of struggle. Signs of struggle are: tachypnea, pulling (supraclavicular, sussternal or intercostal), abdominal exhalation and flapping of the wings of the nose. More than their presence, it is their intensity that makes the seriousness of the attack."},{"idx":1,"correct":true,"proposition":"Sweats","justification":""},{"idx":2,"correct":true,"proposition":"Asterixis","justification":""},{"idx":3,"correct":false,"proposition":"Cyanosis ","justification":"Sign of hypoxia"},{"idx":4,"correct":false,"proposition":"Paradoxical breathing","justification":"This is a sign of bankruptcy. The signs of bankruptcy are: thoraco-abdominal swing, bradypnea (therefore hypercapnia and hypoxemia), neurological involvement (confusion, asterixis), hemodynamic involvement (cyanosis, paradoxical pulse, hypertension)."}],"type":"custom"}
+{"_id":"IBP-pneumo-1f21066","context":null,"enonce":"What is the main infectious agent of winter bronchiolitis, involved in 60 to 90% of cases according to the authors? (one or more propositions are true)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"VRS","justification":""},{"idx":1,"correct":false,"proposition":"Morbilivirus","justification":""},{"idx":2,"correct":false,"proposition":"Myxovirus","justification":""},{"idx":3,"correct":false,"proposition":"Haemophilius","justification":""},{"idx":4,"correct":false,"proposition":"Staphylococcus","justification":""}],"type":"custom"}
+{"_id":"IBP-pneumo-342f81e","context":null,"enonce":"What treatments are not indicated for bronchiolitis?","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"Nose wash","justification":""},{"idx":1,"correct":true,"proposition":"Mucolytic","justification":""},{"idx":2,"correct":true,"proposition":"Oral corticosteroids","justification":""},{"idx":3,"correct":true,"proposition":"Antibiotics ","justification":""},{"idx":4,"correct":true,"proposition":"Inhaled corticosteroids","justification":""}],"type":"custom"}
+{"_id":"IBP-pneumo-3bcb3ff","context":null,"enonce":"The duration of treatment for pneumococcal pneumonitis is classically : (one or more propositions are true)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"7 days","justification":""},{"idx":1,"correct":false,"proposition":"14 days","justification":""},{"idx":2,"correct":false,"proposition":"21 days","justification":""},{"idx":3,"correct":false,"proposition":"5 days","justification":""},{"idx":4,"correct":false,"proposition":"4 to 6 weeks","justification":""}],"type":"custom"}
+{"_id":"IBP-pneumo-480355a","context":null,"enonce":"At what age is the first booster of pneumococcal vaccine in children?","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"M2","justification":"First dose"},{"idx":1,"correct":false,"proposition":"M4","justification":"Second dose"},{"idx":2,"correct":true,"proposition":"M11","justification":"First reminder"},{"idx":3,"correct":false,"proposition":"6 years","justification":"Second reminder"},{"idx":4,"correct":false,"proposition":"12 years","justification":"Third reminder. The next ones are at 25, 45, then every ten years from 65."}],"type":"custom"}
+{"_id":"IBP-pneumo-7b9f693","context":null,"enonce":"In case of bronchiolitis, what are the systematic complementary examinations?","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"No further examination","justification":"Non-severe form without sign of severity = no additional examination."},{"idx":1,"correct":false,"proposition":"Blood","justification":""},{"idx":2,"correct":false,"proposition":"ECBC","justification":""},{"idx":3,"correct":false,"proposition":"Multiplex PCR","justification":""},{"idx":4,"correct":false,"proposition":"Pneumococcal antigenacuria","justification":""}],"type":"custom"}
+{"_id":"IBP-pneumo-81cad68","context":null,"enonce":"Which of the following germs are responsible for atypical bacterial pneumonitis? (one or more true propositions)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":" Mycoplasma pneumoniae","justification":""},{"idx":1,"correct":true,"proposition":"Chlamydophila psittaci","justification":""},{"idx":2,"correct":true,"proposition":"Chlamydophila pneumoniae","justification":""},{"idx":3,"correct":true,"proposition":"Coxiella burnetti","justification":"Q fever"},{"idx":4,"correct":false,"proposition":"Legionella pneumophila","justification":"It is not an atypical germ. The picture is close to that of pneumococcus."}],"type":"custom"}
+{"_id":"IBP-pneumo-834d7e1","context":null,"enonce":"In obstructive CKD, the indication for long-term home oxygen therapy is based on the result of 2 blood gas measurements performed at rest, in ambient air, in a steady state, at least 2 weeks apart. Which of the following are indications for long-term oxygen therapy reimbursed by social security? (one or more propositions are true)\n\n","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"PaO2 at 52 mmHg","justification":"PaO2 < 55 mmHg"},{"idx":1,"correct":true,"proposition":"PaO2 at 43 mmHg","justification":"PaO2 < 55 mmHg"},{"idx":2,"correct":false,"proposition":"PaO2 at 68 mmHg with a hematocrit of 58%","justification":"PaO2 is greater than 60 mmHg, so no indication."},{"idx":3,"correct":true,"proposition":"PaO2 at 58mmHg with a hematocrit of 58%","justification":"PaO2 between 55 and 60 mmHg with the presence of polycythemia (hematocrit > 55%)"},{"idx":4,"correct":true,"proposition":"PaO2 at 58mmHg with signs of right heart failure","justification":"PaO2 between 55 and 60 mmHg with clinical signs of right ventricular failure"}],"type":"custom"}
+{"_id":"IBP-pneumo-c272764","context":null,"enonce":"What are the 4 germs responsible for post-influenza pneumonia?","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Pneumococcus","justification":"The clinic corresponds to an influenza episode followed by worsening after 5-7 days."},{"idx":1,"correct":true,"proposition":"Staphylococcus","justification":"It is therefore necessary to initiate active antibiotic therapy on staphylococcus, such as Augmentin or C3G IV."},{"idx":2,"correct":true,"proposition":"Haemophilius influenzae","justification":""},{"idx":3,"correct":true,"proposition":"S. pyogenes","justification":""},{"idx":4,"correct":false,"proposition":"Anaerobes","justification":""}],"type":"custom"}
+{"_id":"IBP-pneumo-d72b812","context":null,"enonce":"Which proposals are true about the CAP?","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":" The essential chest X-ray","justification":""},{"idx":1,"correct":true,"proposition":"Reassessment is systematic after 48-72 hours of antibiotic therapy","justification":""},{"idx":2,"correct":true,"proposition":"If worsening or no improvement, look for a loco-regional complication  ","justification":""},{"idx":3,"correct":false,"proposition":"It is mandatory and systematic to test for HIV for pneumonia, especially if pneumocystosis","justification":"No. It is mandatory to PROPOSE screening. This is different"},{"idx":4,"correct":false,"proposition":"The three nosological entities of bronchopulmonary infections are nasopharyngitis, acute bronchitis, acute exacerbation of chronic obstructive pulmonary disease ","justification":"Acute bronchitis \/ COPD exacerbation \/ CABG"}],"type":"custom"}
+{"_id":"IBP-pneumo-f30d46f","context":null,"enonce":"What are the physical signs found classically during a PAC? (one or more propositions are true)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Crackling","justification":""},{"idx":1,"correct":true,"proposition":"Decreased vesicular murmur","justification":""},{"idx":2,"correct":true,"proposition":"Tubal murmur","justification":""},{"idx":3,"correct":true,"proposition":"Increased vocal vibration","justification":""},{"idx":4,"correct":true,"proposition":"Dull on percussion","justification":"All these signs are markers of alveolar condensation (the alveoli fill with pus from bacteria)."}],"type":"custom"}
+{"_id":"IBP-pneumo-fbfc86b","context":null,"enonce":"What is lingula? (one or more propositions are true)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"Right lower lobe of the lung","justification":""},{"idx":1,"correct":false,"proposition":"Middle lobe of the lung","justification":""},{"idx":2,"correct":false,"proposition":"Right upper lobe of the lung","justification":""},{"idx":3,"correct":false,"proposition":"Left chamber of the heart 💞","justification":""},{"idx":4,"correct":true,"proposition":"Lower upper lobe of left lung","justification":"The lingula is part of the upper lobe of the left lung. It is located in the caudal (lower) part of this lobe and is ventilated by the lingular bronchus, a segmental (3rd generation) bronchus that branches off from the upper lobar bronchus of the left lung.\n\nIt corresponds in a way to the topographical situation of the middle lobe of the right lung. Unlike the right lung, which has 3 lobes (upper, middle and lower), the left lung has only two lobes (upper and lower). This is due to the presence of the heart which occupies a large volume on this side of the rib cage. However, the upper lobe of the left lung is anatomically divided into two subsets.\n\n(According to Wikipedia, content shared without modifications, licensed under CC https:\/\/creativecommons.org\/licenses\/by-sa\/3.0\/deed.fr)"}],"type":"custom"}
+{"_id":"IBP-pneumo-fc91755","context":null,"enonce":"What are the two treatments of choice for inhalation pneumonitis?","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Augmentin ","justification":" Anaerobes and Enterobacteriaceae should be targeted."},{"idx":1,"correct":true,"proposition":"C3G + Metronidazole","justification":""},{"idx":2,"correct":false,"proposition":"Fluoroquinolones","justification":""},{"idx":3,"correct":false,"proposition":"Macrolides","justification":""},{"idx":4,"correct":false,"proposition":"Vancomycin","justification":""}],"type":"custom"}
+{"_id":"IBP-infectio-a75cb68","context":null,"enonce":"What are the additional examinations carried out on an outpatient basis during a CAP? (one or more true propositions)","item":"IBP","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"None","justification":"Chest X-ray is necessary for the diagnosis of CAP"},{"idx":1,"correct":true,"proposition":"Chest X-ray","justification":""},{"idx":2,"correct":false,"proposition":"Blood culture","justification":"Only in case of hospitalization"},{"idx":3,"correct":false,"proposition":"ECBC","justification":"Only in case of hospitalization"},{"idx":4,"correct":false,"proposition":"Pneumococcal antigenacuria","justification":"Unlike legionella antigenuria (which is performed upon hospitalization), pneumococcal antigenuria is reserved for hospitalization in intensive care."}],"type":"custom"}
+{"_id":"IBP-infectio-f265741","context":null,"enonce":"Legionella is naturally resistant:","item":"IBP","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Aux C3G","justification":""},{"idx":1,"correct":false,"proposition":"To fluoroquinolones","justification":"It is a possible treatment"},{"idx":2,"correct":false,"proposition":"To macrolides","justification":"It is a possible treatment"},{"idx":3,"correct":false,"proposition":"With rifampicin","justification":"It is a possible treatment"},{"idx":4,"correct":true,"proposition":"Aux C2G","justification":""}],"type":"custom"}
+{"_id":"IBP-infectio-f295a3a","context":null,"enonce":"What is the classic clinical presentation of acute bronchitis? (one or more propositions are true)","item":"IBP","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Dry cough","justification":""},{"idx":1,"correct":true,"proposition":"Prolonged cough","justification":""},{"idx":2,"correct":true,"proposition":"Sputum secondarily purulent","justification":"Which are not synonymous with bacterial superinfection"},{"idx":3,"correct":false,"proposition":"Crackling on auscultation","justification":"No crackling, no fireplace. We can have some aspecific bronchial rales."},{"idx":4,"correct":false,"proposition":"Dull on percussion","justification":"No dullness, by tympanism."}],"type":"custom"}
+{"_id":"antiinf-infectio-3bf3663","context":null,"enonce":"Which of the following proposals are part of the amoxicillin\/clavulanic acid spectrum?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Streptococcus","justification":"The entire spectrum of amoxicillin (pneumococcus, enterococci faecalis, listeria, meningococcus, borrelia, group 1 enterobacteriaceae) and the addition of a penicillinase-sensitive inhibitor (methicillin-sensitive staphylococcus, haemophilius, moraxella, E. coli, group 2 enterobacteriaceae)"},{"idx":1,"correct":false,"proposition":"Chlamydia","justification":"Chlamydia is a bacterium sensitive to macrolides (clarithromycin, erythromycin), tetracyclines, fluoroquinolones"},{"idx":2,"correct":true,"proposition":"Pneumococcus","justification":""},{"idx":3,"correct":false,"proposition":"Legionella","justification":"The three families used for the treatment of legionellosis are macrolides, fluoroquinolones, and rifampicin (never monotherapy)"},{"idx":4,"correct":true,"proposition":"SAMS","justification":""}],"type":"custom"}
+{"_id":"purpura-hemato-7672927","context":null,"enonce":"What evidence supports idiopathic thrombocytopenic purpura (ITP)?","item":"purpura","matiere":"hemato","propositions":[{"idx":0,"correct":true,"proposition":"the non-infiltrated nature of purpuric lesions","justification":"True"},{"idx":1,"correct":true,"proposition":"presence of thrombocytopenia on NFS-P","justification":"True"},{"idx":2,"correct":true,"proposition":"lack of a specific history","justification":"True"},{"idx":3,"correct":false,"proposition":"the presence of organomegaly","justification":"What we do not have in an ITP: organomegaly, abnormality of the blood smear, DIC, Hepatocellular insufficiency, ... Immunological thrombocytopenic purpura (ITP) is an autoimmune pathology characterized by isolated thrombocytopenia of < 100 G \/ L. It is a diagnosis of elimination, but also the first to evoke in front of isolated thrombocytopenia."},{"idx":4,"correct":false,"proposition":"an age between 9 and 15 years","justification":"Peak between 2 and 5 years. Second peak, less important, after 60 years."}],"type":"custom"}
+{"_id":"purpura-hemato-e5f097e","context":null,"enonce":"What tests are unnecessary in the diagnosis of ITP?","item":"purpura","matiere":"hemato","propositions":[{"idx":0,"correct":true,"proposition":"Bleeding time","justification":"True, Table IV, page 291 of the College of Internal Medicine, 3rd edition "},{"idx":1,"correct":true,"proposition":"Complement Dosage","justification":"True"},{"idx":2,"correct":true,"proposition":"Dosage of TPO","justification":"True"},{"idx":3,"correct":true,"proposition":"Search for cross-linked platelets","justification":"True"},{"idx":4,"correct":false,"proposition":"TSH and antithyroid antibodies","justification":"Systematic review, with: CBC, Pap smear, PPE, HIV HBV HCV serology, liver test, ANA, Creatinine, PT TCA Fibrinogen, RAI grouping"}],"type":"custom"}
+{"_id":"IC-cardio-947e141","context":null,"enonce":"Mrs. Minerva McGonagall has dyspnea when she puts on her cape but also permanent fatigue of rest. What is its NYHA stadium? ","item":"IC","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"Stage I. ","justification":"False. "},{"idx":1,"correct":false,"proposition":"Stage II. ","justification":"False. "},{"idx":2,"correct":false,"proposition":"Stage III. ","justification":"False. "},{"idx":3,"correct":true,"proposition":"Stage IV. ","justification":"True, dyspnea of rest and for minimal effort. "},{"idx":4,"correct":false,"proposition":"Stage V. ","justification":"False, only 4 stages in the NYHA classification. "}],"type":"custom"}
+{"_id":"dermatosefaciale-dermato-3bb5f2a","context":null,"enonce":"What is the main risk of seborrheic dermatitis?","item":"dermatosefaciale","matiere":"dermato","propositions":[{"idx":0,"correct":true,"proposition":"Blepharitis","justification":"If eye damage"},{"idx":1,"correct":false,"proposition":"Facial paralysis","justification":""},{"idx":2,"correct":false,"proposition":"Uveitis","justification":""},{"idx":3,"correct":false,"proposition":"Cancerization","justification":""},{"idx":4,"correct":false,"proposition":"Upper airway obstruction","justification":""}],"type":"custom"}
+{"_id":"addpsychotropes-psy-e6e39e7","context":null,"enonce":"Regarding buprenorphine and pregnancy:","item":"addpsychotropes","matiere":"psy","propositions":[{"idx":0,"correct":true,"proposition":"In opioid substitution therapy, discontinuation of buprenorphine for pregnancy is not warranted","justification":""},{"idx":1,"correct":true,"proposition":"Buprenorphine can be used regardless of the term of pregnancy","justification":""},{"idx":2,"correct":false,"proposition":"The amount of buprenorphine ingested via milk is too much for the newborn","justification":"It is very weak, it can be used during breastfeeding without worry, unlike opiates, which it helps prevent the consumption ;)"},{"idx":3,"correct":true,"proposition":"Published data in women exposed to buprenorphine during pregnancy are numerous and reassuring","justification":""},{"idx":4,"correct":false,"proposition":"Neonatal opioid withdrawal syndrome is rare with chronic buprenorphine use until delivery","justification":"It is common but not serious most of the time"}],"type":"custom"}
+{"_id":"deuil-psy-147e3c0","context":null,"enonce":"What are the risk factors for pathological bereavement?","item":"deuil","matiere":"psy","propositions":[{"idx":0,"correct":true,"proposition":"Violent death","justification":"True"},{"idx":1,"correct":true,"proposition":"Suicide","justification":"True"},{"idx":2,"correct":true,"proposition":"Death of a child","justification":"True"},{"idx":3,"correct":true,"proposition":"Strong attachment to the deceased","justification":"True"},{"idx":4,"correct":true,"proposition":"Repetition of deaths of loved ones in a short time","justification":"True - basically, anything that makes you say \"Ouch, this is even worse than I imagined\", is worth"}],"type":"custom"}
+{"_id":"tabac-psy-6c1aacd","context":null,"enonce":"Concerning smoking status ","item":"tabac","matiere":"psy","propositions":[{"idx":0,"correct":true,"proposition":"A non-smoker has smoked less than 100 cigarettes in his lifetime ","justification":""},{"idx":1,"correct":false,"proposition":"The withdrawal period allowed to define an ex-smoker is 6 months ","justification":"False, commonly accepted time = 12 months "},{"idx":2,"correct":true,"proposition":"An active smoker is a smoker who has not been weaned for 12 months ","justification":""},{"idx":3,"correct":true,"proposition":"An ex-smoker is a smoker who has totally and permanently quit smoking for a certain period of time.","justification":""},{"idx":4,"correct":false,"proposition":"All propositions are true ","justification":""}],"type":"custom"}
+{"_id":"tabac-psy-8b79e60","context":null,"enonce":"What are the 2 most important questions of the Fagerström test? ","item":"tabac","matiere":"psy","propositions":[{"idx":0,"correct":false,"proposition":"Which cigarette would you give up the hardest? ","justification":""},{"idx":1,"correct":false,"proposition":"Do you smoke at shorter intervals in the early morning hours than in the rest of the day? ","justification":""},{"idx":2,"correct":true,"proposition":"How many cigarettes do you smoke per day? ","justification":"These 2 questions are the most important because they are the most sensitive and specific, and constitute the simplified Fagerström test. "},{"idx":3,"correct":true,"proposition":"How soon after waking up do you smoke your 1st cigarette? ","justification":""},{"idx":4,"correct":false,"proposition":"Do you find it difficult to abstain from smoking in places where it is prohibited? ","justification":""}],"type":"custom"}
+{"_id":"tabac-psy-d861c72","context":null,"enonce":"Concerning the epidemiology of tobacco consumption ","item":"tabac","matiere":"psy","propositions":[{"idx":0,"correct":false,"proposition":"The proportion of smokers increased between 2016 and 2018","justification":"False in overall decrease"},{"idx":1,"correct":false,"proposition":"Occasional smoking is predominant ","justification":"Predominant daily smoking "},{"idx":2,"correct":true,"proposition":"Smoking prevalence higher among men ","justification":""},{"idx":3,"correct":false,"proposition":"The decrease in smoking prevalence is faster among women ","justification":"Faster in humans "},{"idx":4,"correct":false,"proposition":"Tobacco experimentation is done for the first time around 12 years old ","justification":"Around 14 years old "}],"type":"custom"}
+{"_id":"adenomehypoP-endoc-6c9106a","context":null,"enonce":"Regarding the physiology of GH, indicate the exact answers:","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"Secretion is constant and mainly diurnal","justification":""},{"idx":1,"correct":true,"proposition":"The secretion is pulsatile and mainly nocturnal ","justification":"True, hence the myth (not so mythological as that) that we grow up at night 😊\nThis myth is also due to the fact that the intervertebral discs decompress at night which makes it possible to gain a few centimeters."},{"idx":2,"correct":true,"proposition":"Secretion is stimulated by ghrelin ","justification":"True, produced by the stomach (when we eat, we grow!)"},{"idx":3,"correct":true,"proposition":"Secretion is stimulated by GHRH","justification":"True, produced at the hypothalamic level. It is decreased by somatostatin. According to Wikipedia: Somatostatin, also called GHIH or SRIF, is a protein hormone that inhibits growth hormone. It exists in two active forms, produced by an alternative cleavage of the same pre-protein: one of 14 amino acids, another of 28 amino acids."},{"idx":4,"correct":false,"proposition":"Secretion is hypothalamic","justification":"Pituitary"}],"type":"custom"}
+{"_id":"diabete-endoc-66cce82","context":null,"enonce":"Which of the following are sulfonamides?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Gliclazide","justification":"Most common"},{"idx":1,"correct":true,"proposition":"Glimepiride","justification":""},{"idx":2,"correct":true,"proposition":"Glibenclamide","justification":""},{"idx":3,"correct":false,"proposition":"Liraglutide","justification":"Analogue of GLP1, like all drugs that end in -tide."},{"idx":4,"correct":false,"proposition":"Gliptins","justification":"Gliptins are inhibitors of DPP4 (they are, like GLP1 analogues, incretins)."}],"type":"custom"}
+{"_id":"diabete-endoc-b8a22c9","context":null,"enonce":"Which anti-diabetic treatments are incretins?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Liraglutide","justification":"Analogues GLP-1"},{"idx":1,"correct":true,"proposition":"Exenatide","justification":"Analogues GLP-1"},{"idx":2,"correct":true,"proposition":"Dulaglutide","justification":"Analogues GLP-1"},{"idx":3,"correct":true,"proposition":"Gliptins","justification":"IDPP4 "},{"idx":4,"correct":false,"proposition":"Repaglinide","justification":"Glinides are insulin-secreting hypoglycemic secretors. \n\nThomas Marc and Redwane Rakza made an excellent recap: \n\nInsulin-sensitizer:\n• Biguanides = Metformin\n\nInsulin secretors hypoglycemic agents:\n• Sulfonamides = Gliclazide, Glimepiride, Glibenclamide\n• Glinide = Repaglinide\n\nIncretins:\n• GLP-1 analogues = Liraglutide, exenatide, dulaglutide\n• IDPP4 = -gliptin\n\nA-glucosidase inhibitors:\n• Acarbose, Miglitol"}],"type":"custom"}
+{"_id":"hypoGly-endoc-0d57d7c","context":null,"enonce":"What symptoms are adrenergic signs in hypoglycemia? ","item":"hypoGly","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Tremors ","justification":"Adrenergic signs are also those found in stressful situations;)"},{"idx":1,"correct":false,"proposition":"Sensory disorders ","justification":"Neuroglucopenic disorders! "},{"idx":2,"correct":false,"proposition":"Visual disturbances ","justification":"Neuroglucopenic disorders! "},{"idx":3,"correct":false,"proposition":"Confusion ","justification":"Neuroglucopenic disorders! "},{"idx":4,"correct":true,"proposition":"Nausea ","justification":""}],"type":"custom"}
+{"_id":"noduleTh-endoc-7f40b2c","context":null,"enonce":"What are the etiologies of white scintigraphy?","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"De Quervain's thyroiditis","justification":"True, the thyroid is homogeneously destroyed"},{"idx":1,"correct":true,"proposition":"Iodine overload","justification":"True, the thyroid cannot bind labeled iodine, since its receptors are saturated"},{"idx":2,"correct":false,"proposition":"Graves' disease","justification":"Homogeneous hyperfixation"},{"idx":3,"correct":false,"proposition":"Nodular goiter","justification":"Heterogeneous hyperfixation"},{"idx":4,"correct":true,"proposition":"Central hypothyroidism","justification":"True"}],"type":"custom"}
+{"_id":"noduleTh-endoc-a6824b5","context":null,"enonce":"What thyroid volumes define a goiter? ","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"> 18 mL in adolescents ","justification":""},{"idx":1,"correct":true,"proposition":"> 16 mL in adolescents","justification":""},{"idx":2,"correct":false,"proposition":"> 25 mL in men","justification":"> 20 mL in men "},{"idx":3,"correct":false,"proposition":"> 20 mL in women ","justification":""},{"idx":4,"correct":true,"proposition":"> 18 mL in women ","justification":""}],"type":"custom"}
+{"_id":"noduleTh-endoc-aa38a2c","context":null,"enonce":"What are the etiologies of white scintigraphy with normal TSH and T4L?","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Moderate iodine contamination","justification":"True"},{"idx":1,"correct":true,"proposition":"Ectopic thyroid","justification":"True, rare +++"},{"idx":2,"correct":false,"proposition":"Postpartum thyroiditis","justification":"Increased T4L"},{"idx":3,"correct":false,"proposition":"Fake thyrotoxicosis by hidden intake of levothyrox","justification":"Increased T4L"},{"idx":4,"correct":false,"proposition":"Paraneoplastic secretion of T4L","justification":"Increased T4L"}],"type":"custom"}
+{"_id":"nutrigrossesse-endoc-4132468","context":null,"enonce":"What does not cross the blood-placental barrier?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"glucose","justification":""},{"idx":1,"correct":false,"proposition":"Ketones","justification":""},{"idx":2,"correct":false,"proposition":"free fatty acids","justification":""},{"idx":3,"correct":false,"proposition":"amino acids","justification":""},{"idx":4,"correct":true,"proposition":"insulin","justification":"True"}],"type":"custom"}
+{"_id":"certificats-psy-6693e90","context":null,"enonce":"What are the positive signs of death among the following propositions?","item":"certificats","matiere":"psy","propositions":[{"idx":0,"correct":true,"proposition":"Cooling","justification":"Early sign"},{"idx":1,"correct":true,"proposition":"Lividity","justification":"Early sign"},{"idx":2,"correct":true,"proposition":"Rigidity","justification":"Early sign"},{"idx":3,"correct":true,"proposition":"Green task","justification":"Late sign"},{"idx":4,"correct":true,"proposition":"Phlyctenes","justification":"Late sign"}],"type":"custom"}
+{"_id":"tbrefraction-ophtalmo-76be448","context":null,"enonce":"What are the possible complications of high myopia?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"idx":0,"correct":true,"proposition":"Chronic glaucoma","justification":"True"},{"idx":1,"correct":true,"proposition":"Retinal detachment","justification":"True"},{"idx":2,"correct":true,"proposition":"Cataract","justification":"True"},{"idx":3,"correct":false,"proposition":"Early presbyopia","justification":"Myopic are rather protected from early presbyopia"},{"idx":4,"correct":false,"proposition":"Uveitis","justification":"No report"}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-c05fd30","context":null,"enonce":"What is a rupture of the Bruch membrane?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"correct":true,"proposition":"Choroid rupture","justification":"True, another guy who liked his last name too much"},{"idx":1,"correct":false,"proposition":"Sclera rupture","justification":""},{"idx":2,"correct":false,"proposition":"vitreous mood breakdown","justification":""},{"idx":3,"correct":false,"proposition":"Rupture of the lens","justification":""},{"idx":4,"correct":false,"proposition":"rupture of the uvea","justification":""}],"type":"custom"}
+{"_id":"tbvisionbrutal-ophtalmo-ffda27e","context":null,"enonce":"What is the definition of iridodialysis?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"idx":0,"correct":true,"proposition":"It is the disinsertion of the base of the iris","justification":"True"},{"idx":1,"correct":false,"proposition":"This is the rupture of the iris sphincter","justification":""},{"idx":2,"correct":false,"proposition":"This is the subluxation of the lens","justification":""},{"idx":3,"correct":false,"proposition":"It is a rapid increase in the iridocorneal angle","justification":""},{"idx":4,"correct":false,"proposition":"It is an erosion of the cornea","justification":""}],"type":"custom"}
+{"_id":"SPSC-sp-d6aac22","context":null,"enonce":"What are the essential documents for the establishment of an ASPDREu? ","item":"SPSC","matiere":"sp","propositions":[{"idx":0,"correct":true,"proposition":"Municipal by-law","justification":"True"},{"idx":1,"correct":true,"proposition":"1 certificate or medical opinion outside the premises","justification":"True"},{"idx":2,"correct":false,"proposition":"1 certificate or medical opinion within the establishment","justification":""},{"idx":3,"correct":false,"proposition":"2 off-site medical certificate or opinion","justification":"ASPDT"},{"idx":4,"correct":false,"proposition":"No proposition is true","justification":""}],"type":"custom"}
+{"_id":"progrossesse-sp-dbe209b","context":null,"enonce":"Which propositions are true?","item":"progrossesse","matiere":"sp","propositions":[{"idx":0,"correct":true,"proposition":"The employer has the obligation to reclassify a pregnant woman if she is exposed to certain occupational risks","justification":"True"},{"idx":1,"correct":true,"proposition":"The employer cannot dismiss an employee during pregnancy","justification":"True"},{"idx":2,"correct":false,"proposition":"The employer cannot dismiss an employee during the 3 months following the maternity leave","justification":"During the month following maternity leave"},{"idx":3,"correct":false,"proposition":"The pregnant woman is obliged to inform her employer of the pregnancy","justification":"No, but it is advisable to do so if there is a need to arrange the workstation"},{"idx":4,"correct":true,"proposition":"The employer may dismiss a pregnant woman if there is serious professional misconduct. The dismissal then takes effect as soon as protection ends.","justification":"True"}],"type":"custom"}
+{"_id":"278-HGE-c2e25675-4cc4-4664-8b8e-35cc9a5a5bc1","context":null,"enonce":"Regarding chronic pancreatitis, which propositions are true?","item":"pancreatitechr","matiere":"HGE","propositions":[{"idx":0,"correct":false,"proposition":"About 80% of heavy drinkers will develop chronic pancreatitis ","justification":"False, less than 5%. On the other hand, 80% of chronic pancreatitis is linked to excessive alcohol consumption for more than 10 years. "},{"idx":1,"correct":true,"proposition":"Pancreatic pain can lead to weight loss ","justification":"True, by dietary restriction because diet triggers pain "},{"idx":2,"correct":true,"proposition":"Pain is often present in the early phase of the disease ","justification":"True, and it tends to disappear in the evolution towards the late phase. "},{"idx":3,"correct":false,"proposition":"Pancreatic exocrine insufficiency leads to diabetes ","justification":"False, diabetes is secondary to pancreatic endocrine insufficiency "},{"idx":4,"correct":true,"proposition":"Exocrine pancreatic insufficiency involves steatorrhea confirmed by a lowered assay of fecal elastase on a stool sample ","justification":"True"}],"type":"custom"}
+{"_id":"PRNA-neuro-0deff1e","context":null,"enonce":"What are the criteria for poor prognosis for Guilain-Barré syndromes?","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"A very rapid worsening phase","justification":"True"},{"idx":1,"correct":true,"proposition":"initial bilateral facial involvement","justification":"True"},{"idx":2,"correct":false,"proposition":"an age greater than 40 years","justification":"60 years"},{"idx":3,"correct":true,"proposition":"nerve unexcitability at the ENMG","justification":"True"},{"idx":4,"correct":true,"proposition":"prolonged ventilation","justification":"True, and always true, regardless of the disease"}],"type":"custom"}
+{"_id":"PRNA-neuro-15739f7","context":null,"enonce":"When should physiotherapy be started?","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"Back home","justification":""},{"idx":1,"correct":true,"proposition":"Upon resuscitation","justification":"True, always in real, because limits stiffness and, once the patient is conscious, atrophy"},{"idx":2,"correct":false,"proposition":"In SRH","justification":""},{"idx":3,"correct":false,"proposition":"There is no physiotherapy indicated","justification":""},{"idx":4,"correct":false,"proposition":"All proposals are wrong","justification":""}],"type":"custom"}
+{"_id":"PRNA-neuro-35ba0e2","context":null,"enonce":"What is the percentage of PRNAI deaths in studies?","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"0","justification":""},{"idx":1,"correct":true,"proposition":"5","justification":"True"},{"idx":2,"correct":false,"proposition":"18","justification":""},{"idx":3,"correct":false,"proposition":"30","justification":""},{"idx":4,"correct":false,"proposition":"52","justification":""}],"type":"custom"}
+{"_id":"PRNA-neuro-4dfee32","context":null,"enonce":"What propositions are true regarding lumbar puncture in PRNAI?","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"Meningitis on Lyme disease or HIV can give a similar picture","justification":"True"},{"idx":1,"correct":true,"proposition":"Lumbar puncture may show albuminocytological dissociation","justification":"True (this is a significant increase in albumin levels while cytology is normal)"},{"idx":2,"correct":true,"proposition":"Lumbar puncture may be normal","justification":"True"},{"idx":3,"correct":false,"proposition":"There are between 4 and 50 nucleated elements per mL of spinal fluid","justification":"It's in MS"},{"idx":4,"correct":false,"proposition":"There are oligoclonal bands with normal glycorachia","justification":"It's in MS"}],"type":"custom"}
+{"_id":"PRNA-neuro-84aa854","context":null,"enonce":"Regarding EMG in PRNAI:","item":"PRNA","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"Segmental demyelination occurs","justification":"True"},{"idx":1,"correct":true,"proposition":"There is a prolongation of latencies","justification":"True, because myelin participates in the conduction velocity but not in the amplitude of the signal"},{"idx":2,"correct":true,"proposition":"Normal amplitudes are found in the demyelinating form","justification":"True, cf 2"},{"idx":3,"correct":true,"proposition":"Decreased amplitudes are found in the AMAN form","justification":"True"},{"idx":4,"correct":true,"proposition":"There is a decrease in conduction velocity","justification":"True"}],"type":"custom"}
+{"_id":"deficitMo-neuro-50d755f","context":null,"enonce":"What is just in front of the fourth ventricle?","item":"deficitMo","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"Vermis","justification":"It is located behind"},{"idx":1,"correct":true,"proposition":"The bridge","justification":"Synonyms = metencephalon, protrusion"},{"idx":2,"correct":false,"proposition":"The cerebellar hemispheres ","justification":"Back, on either side of the vermis"},{"idx":3,"correct":false,"proposition":"The atlas","justification":"We are far away (it's C1)"},{"idx":4,"correct":false,"proposition":"The axis","justification":"Ditto (it's C2)"}],"type":"custom"}
+{"_id":"deficitMo-neuro-99b9301","context":null,"enonce":"What are the causes of painful III paralysis?","item":"deficitMo","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":" Aneurysm of a. posterior cerebral","justification":"True"},{"idx":1,"correct":true,"proposition":"Supraclinoid internal carotid aneurysm","justification":"True"},{"idx":2,"correct":true,"proposition":"Horton's disease","justification":"True"},{"idx":3,"correct":true,"proposition":"Syndrome de Tolosa-Hunt","justification":"Rank C"},{"idx":4,"correct":false,"proposition":"Carotid dissection","justification":"Gives a Claude Bernard Hoerner "}],"type":"custom"}
+{"_id":"deficitMo-neuro-a62cc05","context":null,"enonce":"What does the famous midbrain aqueduct, also called Sylvius Aqueduct, do?","item":"deficitMo","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"He buys a Nimbus 2000 from Harry Potter","justification":"A bit of jokes in this world of bullies 😂😂"},{"idx":1,"correct":true,"proposition":"It connects 3rd to 4th ventricle","justification":"Exactly. It connects the 3rd ventricle, which is in the brain, to the fourth ventricle, which is in the cerebellum. To do this, it navigates to the posterior part of the midbrain."},{"idx":2,"correct":false,"proposition":"It connects the bridge to the midbrain","justification":""},{"idx":3,"correct":false,"proposition":"It connects the occipital lobe to the cerebellar hemispheres","justification":""},{"idx":4,"correct":false,"proposition":"It connects the vermis to the cervical marrow","justification":""}],"type":"custom"}
+{"_id":"epilepsie-neuro-01d1ad7","context":null,"enonce":"What is the definition of a tonic crisis?","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"Sustained segmental muscle contractions","justification":"True"},{"idx":1,"correct":false,"proposition":"Repetitive and rhythmic segmental muscle twitches","justification":"Clonies"},{"idx":2,"correct":false,"proposition":"Contraction of agonist and antagonist muscles, alone or in bursts","justification":"Myoclonus"},{"idx":3,"correct":false,"proposition":"Loss of consciousness","justification":""},{"idx":4,"correct":false,"proposition":"Loss of contact","justification":""}],"type":"custom"}
+{"_id":"epilepsie-neuro-77a7d5a","context":null,"enonce":"What is the definition of a myoclonic crisis?","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"Sustained segmental muscle contractions","justification":"Tonic crisis"},{"idx":1,"correct":false,"proposition":"Repetitive and rhythmic segmental muscle twitches","justification":"Clonic seizure"},{"idx":2,"correct":true,"proposition":"Contraction of agonist and antagonist muscles, alone or in bursts","justification":"True"},{"idx":3,"correct":false,"proposition":"Loss of consciousness","justification":""},{"idx":4,"correct":false,"proposition":"Loss of contact","justification":"Epilepsy absence"}],"type":"custom"}
+{"_id":"meningite-neuro-02954de","context":null,"enonce":"Which of the following are true about herpetic meningoencephalitis? (one or more propositions are correct)","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"It is exceptional in an immunocompetent subject","justification":"Quite common (in the rarity of meningitis): this is the first cause of clear fluid meningoencephalitis."},{"idx":1,"correct":false,"proposition":"Treatment is based on IV aciclovir for 5 days","justification":"3 weeks"},{"idx":2,"correct":false,"proposition":"Treatment is based on IV valganciclovir","justification":"Aciclovir IV for 3 weeks"},{"idx":3,"correct":false,"proposition":"T1 and T2 hyposignals are found on temporal MRI","justification":"Hyposignal T1, hypersignal T2 and Flair"},{"idx":4,"correct":true,"proposition":"No proposition is true","justification":""}],"type":"custom"}
+{"_id":"meningite-neuro-29996b8","context":null,"enonce":"What is Kluver-Bucy syndrome?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"Memory problems","justification":"➡︎ By temporal lobe injury: Herpetic meningoencephalitis +++"},{"idx":1,"correct":true,"proposition":"Hyperorality","justification":""},{"idx":2,"correct":true,"proposition":"Hypersexuality","justification":""},{"idx":3,"correct":false,"proposition":"Hypersomnia ","justification":"Hypersomnia is found in Kleine-Levin syndrome, of unknown cause."},{"idx":4,"correct":false,"proposition":"Sudden aphasia","justification":""}],"type":"custom"}
+{"_id":"meningite-neuro-4b0be55","context":null,"enonce":"We often hear that clear fluid meningitis is not serious. Nevertheless:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"10% of children die, and 2% of adults","justification":"It's the other way around"},{"idx":1,"correct":true,"proposition":"40% of patients will have neuropsychological sequelae","justification":"True"},{"idx":2,"correct":true,"proposition":"The causative agent is not found in one out of two cases","justification":"True"},{"idx":3,"correct":false,"proposition":"25% are HIV-related","justification":"No, 25% are related to HSV, remember that 90-100% of adults are infected with HSV"},{"idx":4,"correct":false,"proposition":"25% are related to CMV","justification":"Cf 4"}],"type":"custom"}
+{"_id":"meningite-neuro-5c07535","context":null,"enonce":"Which of the following are signs of seriousness requiring hospitalization in intensive care in case of meningitis? (one or more propositions are correct)","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"Extensive and necrotic purpura","justification":"It's called a purpura fulminans, it falls every year, and it's the only thing that can take you to court as an outsider if you don't think about it. All right? 0:)"},{"idx":1,"correct":true,"proposition":"Glasgow less than 9","justification":""},{"idx":2,"correct":true,"proposition":"Signs of brainstem suffering","justification":""},{"idx":3,"correct":false,"proposition":"All meningitis is managed in intensive care","justification":"Benign viral meningitis is usually managed on an outpatient basis. Bacterial meningitis can be managed in conventional medicine, intensive care unit, or intensive care."},{"idx":4,"correct":false,"proposition":"Thrombocytopenia with platelets below 100G\/L","justification":""}],"type":"custom"}
+{"_id":"meningite-neuro-93e97ca","context":null,"enonce":"What are the notifiable etiologies of meningitis or meningoencephalitis?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"HIV","justification":""},{"idx":1,"correct":true,"proposition":"Listeria","justification":""},{"idx":2,"correct":true,"proposition":"Meningococcus","justification":""},{"idx":3,"correct":false,"proposition":"Syphilis","justification":"Syphilis has been a long time since 😊 OD"},{"idx":4,"correct":false,"proposition":"Borrelia","justification":"The complete and up-to-date list is available here: https:\/\/www.santepubliquefrance.fr\/maladies-a-declaration-obligatoire\/liste-des-maladies-a-declaration-obligatoire"}],"type":"custom"}
+{"_id":"meningite-neuro-9d749db","context":null,"enonce":"What elements are part of the semiology of autoimmune encephalitis?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"Meningeal syndrome","justification":"No, it is most often absent"},{"idx":1,"correct":true,"proposition":"Subacute onset","justification":"Or even acute"},{"idx":2,"correct":true,"proposition":"Anterograde amnesia","justification":"True"},{"idx":3,"correct":true,"proposition":"Temporal epilepsy","justification":"Yes, they are also called limbic encephalitis because they mainly affect the internal temporal lobe (so also give visual hallucinations, such as frontotemporal dementia :) )"},{"idx":4,"correct":false,"proposition":"Drowsiness","justification":"Rather behavioral disorders"}],"type":"custom"}
+{"_id":"meningite-neuro-cd621e3","context":null,"enonce":"Which of the following proposals promote invasive pneumococcal disease? (one or more propositions are correct)","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"HIV","justification":""},{"idx":1,"correct":true,"proposition":"Asplenia","justification":""},{"idx":2,"correct":true,"proposition":"Sickle-cell anemia","justification":"Sickle cell disease is a cause of functional asplenia by multiple spleen infarction leading to either splenic sequestration of immune cells or cessation of their splenic production\/maturation"},{"idx":3,"correct":true,"proposition":"Nephrotic syndrome","justification":"By leakage of immunoglobulins"},{"idx":4,"correct":false,"proposition":"External hearing implant","justification":"Only the cochlear implant is a risk factor"}],"type":"custom"}
+{"_id":"EDC-psy-01145be","context":null,"enonce":"What are the four true propositions?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"correct":true,"proposition":"Adjustment disorder is rare in children","justification":"Fortunately:)"},{"idx":1,"correct":true,"proposition":"The allowance for the supervision of a disabled child (AEEH) is allocated by the MDPH","justification":""},{"idx":2,"correct":false,"proposition":" ADHD is statistically linked to the occurrence of OCD and ASD","justification":"TBI (conduct disorder) and\/or OD (Defiant Opposition Disorder) can be found in children\nIn adults, there is an increased risk of other pathologies such as mood disorders and delusional disorders, but this is outside your program."},{"idx":3,"correct":true,"proposition":"Methylphenidate is the standard drug treatment for ADHD","justification":"Yes, it is an amphetamine derivative prescribed on secure prescription for 28 days, with a prescription limited to certain professionals: psychiatrists and child psychiatrists, neurologists, and pediatricians"},{"idx":4,"correct":true,"proposition":"Educational assistance in an open environment is provided at the parents' home, at home","justification":""}],"type":"custom"}
+{"_id":"EDC-psy-1c3ffc4","context":null,"enonce":"A suicide:","item":"EDC","matiere":"psy","propositions":[{"idx":0,"correct":true,"proposition":"Is a survivor of a suicide attempt","justification":"At least one: 80% of TS are recurrences"},{"idx":1,"correct":false,"proposition":"Is a person with suicidal ideation","justification":""},{"idx":2,"correct":false,"proposition":"Is a person in a suicidal crisis","justification":"After the suicidal crisis"},{"idx":3,"correct":false,"proposition":"Is a person with a high RUD","justification":"Not necessarily, but at least moderate, because a history of TS is a major FdR of suicide, so increases the R"},{"idx":4,"correct":false,"proposition":"All proposals are wrong","justification":""}],"type":"custom"}
+{"_id":"EDC-psy-7229865","context":null,"enonce":"What do you find during a panic attack?","item":"EDC","matiere":"psy","propositions":[{"idx":0,"correct":false,"proposition":"Gradual onset of symptoms","justification":"Brutal"},{"idx":1,"correct":true,"proposition":"Catastrophic cognitions","justification":""},{"idx":2,"correct":true,"proposition":"Derealization","justification":""},{"idx":3,"correct":true,"proposition":"Depersonalization","justification":""},{"idx":4,"correct":false,"proposition":"Ideas of ruin","justification":"Delusional idea, often present in melancholic depressions"}],"type":"custom"}
+{"_id":"EDC-psy-af8c816","context":null,"enonce":"Regarding generalized anxiety disorder (GAD):","item":"EDC","matiere":"psy","propositions":[{"idx":0,"correct":false,"proposition":"Frequency is higher in men than in women","justification":""},{"idx":1,"correct":true,"proposition":"Asthenia can be found","justification":""},{"idx":2,"correct":true,"proposition":"We can find difficulties of an intellectual nature","justification":"It's hard to perform intellectually when you're anxious, remember your last staff presentation..."},{"idx":3,"correct":false,"proposition":"Anxiety is anticipatory between paroxysmal episodes","justification":"There are no paroxysmal episodes. Anxiety is continuous, not associated with identified triggering events, excessive and uncontrollable."},{"idx":4,"correct":true,"proposition":"We talk about GAD after 6 months","justification":""}],"type":"custom"}
+{"_id":"asthme-immuno-b2b7c8e","context":null,"enonce":"What are the symptoms found in asthma? ","item":"asthme","matiere":"immuno","propositions":[{"idx":0,"correct":true,"proposition":"Dyspnoea ","justification":""},{"idx":1,"correct":true,"proposition":"Cough ","justification":""},{"idx":2,"correct":false,"proposition":"Spittle ","justification":"Everything is true except sputum (page 78 of the pneumo college). "},{"idx":3,"correct":true,"proposition":"Whistles ","justification":""},{"idx":4,"correct":true,"proposition":"Chest tightness ","justification":""}],"type":"custom"}
+{"_id":"grossessepatho-gyn-e8a0686","context":null,"enonce":"What is the definition of RPM (premature rupture of membranes)?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"correct":true,"proposition":"Rupture of membranes occurring before the start of labour","justification":""},{"idx":1,"correct":false,"proposition":"Rupture of membranes occurring before release","justification":"It doesn't make too much sense, right? 😅 How can the baby get out without breaking the membrane?"},{"idx":2,"correct":false,"proposition":"Rupture of membranes occurring before engagement","justification":"Ditto"},{"idx":3,"correct":false,"proposition":"Rupture of membranes occurring for more than 12 hours before delivery","justification":""},{"idx":4,"correct":false,"proposition":"Rupture of membranes occurring for more than 24 hours before delivery","justification":""}],"type":"custom"}
+{"_id":"tbpaupieres-ophtalmo-826a0cf","context":null,"enonce":"Regarding eyelid pathologies, what are the exact proposal(s)?","item":"tbpaupieres","matiere":"ophtalmo","propositions":[{"idx":0,"correct":true,"proposition":"A stye usually manifests as a painful pustule, centered on an eyelash.","justification":"True, this is the definition of stye"},{"idx":1,"correct":true,"proposition":"Chalazion usually manifests as inflammation of the Meibomus gland","justification":"True, this is the definition of chalazion"},{"idx":2,"correct":true,"proposition":"Chalazion or stye does not cause decreased vision","justification":"True, unlike differential diagnoses"},{"idx":3,"correct":true,"proposition":"Blepharitis or dacryocystitis is a differential diagnosis","justification":"True, it is the case"},{"idx":4,"correct":false,"proposition":"Treatment of chalazion is based on antibiotics","justification":"False, based on corticosteroids"}],"type":"custom"}
+{"_id":"353-HGE-c7327398-fd52-48e3-a256-2363d7b601f7","context":null,"enonce":"Regarding acute pancreatitis, which propositions are true?","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"Acute pancreatitis is a common digestive emergency ","justification":"True"},{"idx":1,"correct":false,"proposition":"The most common form of acute pancreatitis is acute necrotizing pancreatitis","justification":"False, 80% of cases of acute pancreatitis are benign and are described as edematous "},{"idx":2,"correct":true,"proposition":"They may be accompanied by vomiting related to a reflex ileus","justification":"True"},{"idx":3,"correct":true,"proposition":"Lower myocardial infarction may be a differential diagnosis of acute pancreatitis","justification":"True"},{"idx":4,"correct":true,"proposition":"Diagnosis is based on a combination of suggestive abdominal pain and lipasemia > 3N ","justification":"True"}],"type":"custom"}
+{"_id":"UGD-HGE-1325963","context":null,"enonce":"Which of these proposals are not risk factors for peptic ulcers? (three proposals expected)","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"Alcohol","justification":""},{"idx":1,"correct":true,"proposition":"coffee","justification":""},{"idx":2,"correct":true,"proposition":"GERD ","justification":""},{"idx":3,"correct":false,"proposition":"tobacco","justification":"It is indeed a risk factor for ulcers. Other risk factors to be aware of are: H. pylori, NSAIDs and Aspirin, Zollinger-Ellison Syndrome, genetic predispositions and certain vasculitis"},{"idx":4,"correct":false,"proposition":"Syndrome de Zollinger-Ellison","justification":"Gastrinoma 👉 gastrin 👉 hypersecretion decrease in pH (which therefore becomes more acidic) 👉 multiple and recurrent ulcers"}],"type":"custom"}
+{"_id":"UGD-HGE-54f13ae","context":null,"enonce":"Acute gastritis due to H. pylori is most often: (only one response expected)","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"asymptomatic","justification":""},{"idx":1,"correct":false,"proposition":"responsible for nausea","justification":""},{"idx":2,"correct":false,"proposition":"responsible for vomiting","justification":""},{"idx":3,"correct":false,"proposition":"responsible for cancer","justification":""},{"idx":4,"correct":false,"proposition":"responsible for diarrhoea","justification":""}],"type":"custom"}
+{"_id":"UGD-HGE-5a08d2b","context":null,"enonce":"Zollinger-Ellison syndrome is secondary to:","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"Gastrinoma ","justification":"It is an endocrine tumor that lowers the pH of the stomach and can cause recurrent postbulbar multiple ulcers."},{"idx":1,"correct":false,"proposition":"insulinoma","justification":""},{"idx":2,"correct":false,"proposition":"Biermer","justification":""},{"idx":3,"correct":false,"proposition":"cholangiocarcinoma","justification":""},{"idx":4,"correct":false,"proposition":"Pancreatic adenoma","justification":""}],"type":"custom"}
+{"_id":"UGD-HGE-62b3ad3","context":null,"enonce":"In what proportion of cases, on average, does H. pylori infection progress to acute gastritis?","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"100%","justification":"Almost all HP infections progress to acute gastritis"},{"idx":1,"correct":false,"proposition":"50%","justification":""},{"idx":2,"correct":false,"proposition":"20%","justification":""},{"idx":3,"correct":false,"proposition":"5%","justification":""},{"idx":4,"correct":false,"proposition":"70%","justification":""}],"type":"custom"}
+{"_id":"UGD-HGE-7703c3b","context":null,"enonce":"Zollinger-Ellison syndrome is accompanied by a: (only one expected response)","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"Hypergastrenemia ","justification":""},{"idx":1,"correct":false,"proposition":"Hyperinsulinemia","justification":""},{"idx":2,"correct":false,"proposition":"Hyperglucagonemia","justification":""},{"idx":3,"correct":false,"proposition":"Hypersomatostatinemia","justification":""},{"idx":4,"correct":false,"proposition":"Peripheral hypercorticism","justification":""}],"type":"custom"}
+{"_id":"UGD-HGE-8787993","context":null,"enonce":"Which gastritis are at risk for gastric adenocarcinoma?","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"HP atrophic gastritis","justification":"Only atrophic gastritis is at risk of gastric adenocarcinoma"},{"idx":1,"correct":true,"proposition":"Biermer's disease (autoimmune atrophic gastritis)","justification":""},{"idx":2,"correct":false,"proposition":"Tuberculosis granulomatous gastritis","justification":""},{"idx":3,"correct":false,"proposition":"Idiopathic gastritis","justification":""},{"idx":4,"correct":false,"proposition":"Eosinophilic gastritis","justification":""}],"type":"custom"}
+{"_id":"UGD-HGE-b98c0f5","context":null,"enonce":"An ulcer, by definition, reaches up to: (only one expected response)","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"The Muscularous","justification":""},{"idx":1,"correct":false,"proposition":"submucosa","justification":"Ulceration "},{"idx":2,"correct":false,"proposition":"the mucosa ","justification":"Erosion "},{"idx":3,"correct":false,"proposition":"The Serous","justification":""},{"idx":4,"correct":false,"proposition":"None of these proposals are accurate","justification":""}],"type":"custom"}
+{"_id":"UGD-HGE-cb393e7","context":null,"enonce":"What is the preferred location of H. pylori in the stomach? (only one answer expected)","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"The lair","justification":""},{"idx":1,"correct":false,"proposition":"Fundus","justification":""},{"idx":2,"correct":false,"proposition":"The cardia","justification":""},{"idx":3,"correct":false,"proposition":"The pylorus","justification":""},{"idx":4,"correct":false,"proposition":"The body","justification":""}],"type":"custom"}
+{"_id":"UGD-HGE-e583b68","context":null,"enonce":"H. pylori infection in childhood occurs mainly by: (only one response expected)","item":"UGD","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"Oral","justification":""},{"idx":1,"correct":false,"proposition":"Sexual","justification":""},{"idx":2,"correct":false,"proposition":"sanguine","justification":""},{"idx":3,"correct":false,"proposition":"matero-fetal","justification":""},{"idx":4,"correct":false,"proposition":"no exact proposal","justification":""}],"type":"custom"}
+{"_id":"ascite-HGE-b558070","context":null,"enonce":"In addition to evacuative punctures, the treatment of ascites is based on:","item":"ascite","matiere":"HGE","propositions":[{"idx":0,"correct":false,"proposition":"Sodium diet","justification":"to avoid because promotes undernutrition"},{"idx":1,"correct":false,"proposition":"Water restriction","justification":"No indication here"},{"idx":2,"correct":true,"proposition":"Low-sodium diet","justification":"True, to maintain for life"},{"idx":3,"correct":true,"proposition":"Spironolactone, or even furosemide in case of insufficient response","justification":"True, to decrease gradually when ascites is controlled, until a complete stop. To be resumed if ascites reappears."},{"idx":4,"correct":false,"proposition":"Hydroxychlorothiazide","justification":"No indication here"}],"type":"custom"}
+{"_id":"ACR-urg-c22021f","context":null,"enonce":"In xxx of the cases, cardiocirculatory arrest is related to a ventricular rhythm disorder. xxx corresponds to:\n","item":"ACR","matiere":"urg","propositions":[{"idx":0,"correct":false,"proposition":"100%","justification":""},{"idx":1,"correct":true,"proposition":"1\/3","justification":""},{"idx":2,"correct":false,"proposition":"0% (never)","justification":""},{"idx":3,"correct":false,"proposition":"2\/3","justification":""},{"idx":4,"correct":false,"proposition":"No proposition is true","justification":""}],"type":"custom"}
+{"_id":"IRespA-urg-5373e5c","context":null,"enonce":"What causes hypoxemia?","item":"IRespA","matiere":"urg","propositions":[{"idx":0,"correct":false,"proposition":"dead space","justification":"hypercapnia"},{"idx":1,"correct":true,"proposition":"Arterial hypoventilation","justification":""},{"idx":2,"correct":true,"proposition":"True shunt","justification":""},{"idx":3,"correct":true,"proposition":"shunt effect","justification":""},{"idx":4,"correct":true,"proposition":"Diffusion disorders","justification":""}],"type":"custom"}
+{"_id":"IRespA-urg-9e429fb","context":null,"enonce":"What are the different clinical signs of struggle to look for in favor of ARD?","item":"IRespA","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"Superficial polypnea","justification":"= Tachynea"},{"idx":1,"correct":true,"proposition":"Recruitment of accessory respiratory muscles","justification":"= Suprasternal, supraclavicular and intercostal draw"},{"idx":2,"correct":true,"proposition":"Active abdominal exhalation","justification":""},{"idx":3,"correct":true,"proposition":"Flapping of the nose ales","justification":""},{"idx":4,"correct":true,"proposition":"All propositions are true","justification":"Not to be confused with signs of bankruptcy:\n- Paradoxical abdominal breathing (= thoraco-abdominal swing);\n- Hypoxemia with cyanosis;\n- Hypercapnia with neurological impact (G < 15)"}],"type":"custom"}
+{"_id":"PNO-urg-57d6983","context":null,"enonce":"What advice should I give to patients with pneumothorax?","item":"PNO","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"Smoking cessation","justification":"tobacco = risk factor ++"},{"idx":1,"correct":false,"proposition":"Rest","justification":"No interest"},{"idx":2,"correct":false,"proposition":" limitation of physical activities","justification":"No interest"},{"idx":3,"correct":true,"proposition":" For flights in pressurized aircraft, a delay of 2 to 3 weeks is recommended after a PNO","justification":"without, however, formal proof of this period"},{"idx":4,"correct":true,"proposition":"definitive contraindication of diving if detection of bullous lesions in spontaneous PNO ATCD lengths","justification":""}],"type":"custom"}
+{"_id":"SCA-urg-36df92a","context":null,"enonce":"What are the treatments of a coronary patient after revascularization of an ST+ SCA? ","item":"SCA","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"Aspirin ","justification":""},{"idx":1,"correct":true,"proposition":"ACE inhibitor ","justification":""},{"idx":2,"correct":false,"proposition":"Calcium channel blocker","justification":"Not indicated: we are talking here about the famous C-BASIC ☺️"},{"idx":3,"correct":true,"proposition":"Statine ","justification":""},{"idx":4,"correct":true,"proposition":"P2Y12 inhibitor","justification":""}],"type":"custom"}
+{"_id":"anaphylaxie-urg-f833c07","context":null,"enonce":"Regarding Ring and Meisner's classification:","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"correct":false,"proposition":"Grade II = Mucocutaneous signs (urticaria, angioedema)","justification":"Grade I"},{"idx":1,"correct":false,"proposition":"Grade III = Moderate multi-organ involvement (mucocutaneous signs, respiratory tightness, tachycardia, hypotension < 20 mmHg)","justification":"Grade II"},{"idx":2,"correct":false,"proposition":"Grade IV = Severe multi-organ disease (respiratory distress, severe bronchospasm, laryngeal oedema, collapse, bradycardia)","justification":"Grade III"},{"idx":3,"correct":false,"proposition":"Grade I = Cardiac arrest","justification":"Grade IV"},{"idx":4,"correct":true,"proposition":"No proposition is true","justification":""}],"type":"custom"}
+{"_id":"choc-urg-882e4fc","context":null,"enonce":"What signs are in favor of a hypovolemic cause?","item":"choc","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"polytraumatized with abdominal pain and defense","justification":""},{"idx":1,"correct":true,"proposition":"Signs of extracellular dehydration","justification":""},{"idx":2,"correct":false,"proposition":"Increased pulsed pressure (PAs - PAd)","justification":""},{"idx":3,"correct":true,"proposition":"Decreased pulsed pressure (PAs - PAd)","justification":""},{"idx":4,"correct":true,"proposition":"Pallor","justification":""}],"type":"custom"}
+{"_id":"intox-urg-7c4d137","context":null,"enonce":"What are the clinical signs consistent with heroin poisoning?","item":"intox","matiere":"urg","propositions":[{"idx":0,"correct":false,"proposition":"Polypnea","justification":""},{"idx":1,"correct":false,"proposition":"Agitation","justification":""},{"idx":2,"correct":false,"proposition":"delirium","justification":""},{"idx":3,"correct":false,"proposition":"Hallucinations","justification":""},{"idx":4,"correct":true,"proposition":"None of these proposals","justification":"Hypotonic calm coma. Tight miosis. Bradypnea. This is common to benzodiazepine or opioid poisoning (such as heroin).\nConversely, SSRIs\/Tricyclics\/Atropine\/Cocaine\/Amphetamines cause restless coma with mydriasis, hypertonia and ROT vivid"}],"type":"custom"}
+{"_id":"polytrauma-urg-707af75","context":null,"enonce":"The hemodynamic profile of a severe burn is close to shock:","item":"polytrauma","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"hypovolemic ","justification":"by creating a third sector"},{"idx":1,"correct":false,"proposition":"septic","justification":""},{"idx":2,"correct":false,"proposition":"anaphylactic","justification":""},{"idx":3,"correct":false,"proposition":"cardiogenic","justification":""},{"idx":4,"correct":false,"proposition":"None of the proposals","justification":""}],"type":"custom"}
+{"_id":"260-nephro-16a8c6af-841a-4dad-b490-9df054b4ad99","context":null,"enonce":"It's 4am and you're called by internal medicine for a 50-year-old patient, with chronic alcoholism being weaned improvised by the patient. \n\nThe patient has rapidly deteriorated neurologically (GSC 4), he presents with respiratory failure with PaO2 52 mHg pCO2 60. \n\nOn biology you note: \n- Hb 7 g\/dL, VGM 93 fL, \n- Platelets 25 g \/ L, \n- Schizocytes with a smear,  \n- LDH 245, collapsed haptoglobin, \n- Acute renal failure with serum creatinine 235 \n- Normal vitamin B12, slightly decreased B9\n\nYou take him in intensive care and do the necessary resuscitatory measures\nAt D+2, while you are trying to lift the sedations to assess neurological functions, the patient has a seizure","item":"nephroPvascu","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Thrombotic microangiopathy is possible","justification":"TRUE. Mechanical hemolytic anemia with thrombocytopenia and acute renal failure + neurological picture. So it's quite possible!"},{"idx":1,"correct":true,"proposition":"A dosage of complement and ADAMTS13 is relevant","justification":"TRUE! - Supplement to know if it is consumed or not (especially in atypical HUS): mutations will cause endothelial lesions by deposition of pieces of supplements that wander. \n\n- ADAMTS13 is a metalloprotease that cleaves the Willebrand factor that wanders in small pieces in the microcirculation of organs. The problem... it is that these small pieces of Willebrand factor attach the platelets nearby --> Obstruction of the lumen of the vessels"},{"idx":2,"correct":true,"proposition":"Thrombotic microangiopathy is characterized by obstruction of the lumen of capillaries and arterioles","justification":"True. "},{"idx":3,"correct":false,"proposition":"HUS is characterized by a neurological picture in the 1st plane","justification":"FALSE! HUS = acute renal failure table"},{"idx":4,"correct":true,"proposition":"TTP is characterized by a neurological picture in the 1st plane","justification":"TRUE! TTP = neurological picture "}],"type":"custom"}
+{"_id":"266-nephro-6bc58133-150e-45fd-8a8e-6f40bdab76ea","context":null,"enonce":"What is found in the laboratory workup of primary hyperparathyroidism? ","item":"hyperCa","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Low phosphatemia","justification":"True, phosphatemia is low because PTH decreases phosphate reabsorption "},{"idx":1,"correct":false,"proposition":"High phosphatemia ","justification":"False, see proposal A"},{"idx":2,"correct":true,"proposition":"High calciuria ","justification":"True, because it is adapted to hypercalcemia caused by primary hyperparathyroidism"},{"idx":3,"correct":false,"proposition":"Low calciuria","justification":"False, see proposal B"},{"idx":4,"correct":false,"proposition":"Low serum calcium","justification":"False, in primary hyperparathyroidism, serum calcium is elevated "}],"type":"custom"}
+{"_id":"IRC-nephro-5b1867a","context":null,"enonce":"What disorders of phospho-calcium metabolism can be found in chronic renal failure?  ","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Secondary hyperparathyroidism","justification":"True"},{"idx":1,"correct":false,"proposition":"Hypercalcemia ","justification":"False hypocalcemia leading to secondary hyperparathyroidism "},{"idx":2,"correct":true,"proposition":"Hyperphosphatemia ","justification":"True, by decreasing renal excretion of phosphates"},{"idx":3,"correct":true,"proposition":"Vitamin D deficiency","justification":"True"},{"idx":4,"correct":false,"proposition":"Normophosphatemia ","justification":"False, hypophosphatemia "}],"type":"custom"}
+{"_id":"IRC-nephro-f5c1bb1","context":null,"enonce":"What can be the heart damage of chronic renal failure?","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Right ventricular hypertrophy ","justification":"False, left ventricular hypertrophy! "},{"idx":1,"correct":true,"proposition":"Coronary calcifications ","justification":"True"},{"idx":2,"correct":true,"proposition":"Valve calcifications ","justification":"True "},{"idx":3,"correct":true,"proposition":"Ischemic heart disease ","justification":"True"},{"idx":4,"correct":false,"proposition":"None of the previous proposals ","justification":""}],"type":"custom"}
+{"_id":"creatplus-nephro-3f88ac9","context":null,"enonce":"The CKD-EPI and MDRD formulas take these factors into account: ","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Age ","justification":"True "},{"idx":1,"correct":true,"proposition":"Ethnic group ","justification":"True "},{"idx":2,"correct":false,"proposition":"Weight ","justification":"False, it is the Cockcroft that takes into account the weight. Cachexia or obesity are not factors that are taken into account for the calculation of GFR by the CKD-Epi or MDRD formulas"},{"idx":3,"correct":true,"proposition":"Creatinine emia ","justification":"True "},{"idx":4,"correct":false,"proposition":"BMI ","justification":"False, for the same reason that weight is wrong"}],"type":"custom"}
+{"_id":"creatplus-nephro-5f05ddf","context":null,"enonce":"What are the arguments in favor of an AKI in the face of elevated serum creatinine? ","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Kidneys of decreased size ","justification":"False, rather in favor of an IRC "},{"idx":1,"correct":true,"proposition":"Recent elevation of serum creatinine ","justification":""},{"idx":2,"correct":true,"proposition":"Recent shock context ","justification":""},{"idx":3,"correct":false,"proposition":"History of kidney disease","justification":"False, rather in favor of an IRC "},{"idx":4,"correct":false,"proposition":"Normochrome normocytic aregenerative anemia ","justification":"False, rather in favor of CKD except in the case of hemolytic uremic syndrome or hemorrhagic shock"}],"type":"custom"}
+{"_id":"creatplus-nephro-633c494","context":null,"enonce":"What parameters are taken into account in the calculation of GFR by the CKD-PPE formula? ","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Age","justification":""},{"idx":1,"correct":false,"proposition":"Weight ","justification":"False, not used for MDRD and CKD-PPE, but it is used in Cockcroft and Gault's formula "},{"idx":2,"correct":true,"proposition":"Ethnic group ","justification":""},{"idx":3,"correct":true,"proposition":"Creatinine emia ","justification":""},{"idx":4,"correct":true,"proposition":"Sex","justification":""}],"type":"custom"}
+{"_id":"creatplus-nephro-66d0c1d","context":null,"enonce":"What CKDs can occur with large or normal sized kidneys?","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Autosomal dominant polycystic disease","justification":""},{"idx":1,"correct":false,"proposition":"Hemorrhagic shock ","justification":"False, cause of acute renal failure with anemia "},{"idx":2,"correct":true,"proposition":"Diabetes ","justification":"Common cause ++"},{"idx":3,"correct":false,"proposition":"Sepsis ","justification":"False, cause of IRA"},{"idx":4,"correct":true,"proposition":"Amylose","justification":""}],"type":"custom"}
+{"_id":"creatplus-nephro-6f3dade","context":null,"enonce":"In which cases can I have CKD without hypocalcemia?","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Rhabdomyolysis ","justification":"False, cause of AKI with hypocalcemia "},{"idx":1,"correct":true,"proposition":"Myeloma ","justification":""},{"idx":2,"correct":false,"proposition":"Tumor lysis syndrome","justification":"False, cause of AKI with hypocalcemia "},{"idx":3,"correct":false,"proposition":"HIV-associated kidney disease","justification":"False, gives rather CKD with large kidneys but with hypocalcemia "},{"idx":4,"correct":true,"proposition":"Sarcoidosis ","justification":""}],"type":"custom"}
+{"_id":"creatplus-nephro-d092d39","context":null,"enonce":"In which cases is it not possible to estimate GFR by MDRD and CKD-PPE? ","item":"creatplus","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"In children ","justification":"True, use of Schwartz's formula up to about 15 years (the exact age varies in practice depending on the morphology)"},{"idx":1,"correct":true,"proposition":"In a subject with decompensated hepatic cirrhosis","justification":"This situation is conducive to acute renal failure (first functional and then organic if not managed) which makes the calculation of GFR not recommended"},{"idx":2,"correct":true,"proposition":"In an amputee","justification":"True, because significant muscular atrophy "},{"idx":3,"correct":true,"proposition":"In a pregnant woman","justification":"The GFR is physiologically changed in pregnant women, the calculation by these formulas will find an underestimated result"},{"idx":4,"correct":true,"proposition":"In a quadriplegic subject ","justification":""}],"type":"custom"}
+{"_id":"hyperCa-nephro-79edce6","context":null,"enonce":"What are the causes explaining, between them, 80% of hypercalcemia?\n","item":"hyperCa","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Neoplasia","justification":""},{"idx":1,"correct":false,"proposition":"granulomatosis","justification":"Rarer"},{"idx":2,"correct":true,"proposition":"hyperparathyroidism","justification":""},{"idx":3,"correct":false,"proposition":"hypothyroidism","justification":"No hypercalcemia classically"},{"idx":4,"correct":false,"proposition":"vitamin D poisoning","justification":"Very rare"}],"type":"custom"}
+{"_id":"tbiono-nephro-0e8c009","context":null,"enonce":"Natrimia:","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Is increased in case of edema","justification":""},{"idx":1,"correct":false,"proposition":"Is decreased in case of edema","justification":"Edema are markers of extracellular hydration status (HEC: extracellular hyperhydration). Since natremia is an indicator of intracellular hydration status, it is not influenced by the absence or presence of edema."},{"idx":2,"correct":true,"proposition":"Is increased in case of intracellular dehydration","justification":""},{"idx":3,"correct":false,"proposition":"Is decreased in case of intracellular dehydration","justification":""},{"idx":4,"correct":true,"proposition":"Provides information on extracellular osmolarity","justification":"Indeed, to calculate the extracellular osmolarity, the formula is used: Osm = 2Na + Glucose (normal: 285 mOsm \/ L)"}],"type":"custom"}
+{"_id":"tbiono-nephro-12e59dc","context":null,"enonce":"What causes ketoacidosis? ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Biguanide poisoning ","justification":"False, responsible for lactic acidosis "},{"idx":1,"correct":true,"proposition":"Alcohol ","justification":""},{"idx":2,"correct":true,"proposition":"Fasting ","justification":""},{"idx":3,"correct":true,"proposition":"Diabetes ","justification":""},{"idx":4,"correct":false,"proposition":"Methanol poisoning ","justification":"False, is not responsible for ketoacidosis "}],"type":"custom"}
+{"_id":"tbiono-nephro-388e646","context":null,"enonce":"What abnormalities are in favor of ketoacidosis? ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Positive urinary anion hole ","justification":"False, the urinary anion hole is not used during metabolic acidosis with indosed substances "},{"idx":1,"correct":false,"proposition":"Normal plasma anion hole ","justification":"False, the plasma anion hole is increased "},{"idx":2,"correct":true,"proposition":"Positive ketone ","justification":""},{"idx":3,"correct":true,"proposition":"Increased plasma anion hole ","justification":""},{"idx":4,"correct":true,"proposition":"Ketonurie","justification":""}],"type":"custom"}
+{"_id":"tbiono-nephro-7380a56","context":null,"enonce":"Which blood gas elements support hyperchloremic metabolic acidosis of tubular origin? (one or more exact propositions)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Normal plasma anion hole","justification":""},{"idx":1,"correct":false,"proposition":"Negative urinary anion hole ","justification":"False, it is negative when the origin is digestive. Here the urinary anion hole must be positive "},{"idx":2,"correct":false,"proposition":"PCO2 at 50 mmHg ","justification":"False, PCO2 in metabolic acidosis is decreased to compensate "},{"idx":3,"correct":false,"proposition":"Bicarbonates at 35 mmol\/L","justification":"False, bicarbonate is decreased in metabolic acidosis "},{"idx":4,"correct":true,"proposition":"Arterial pH = 7.35","justification":"True, the pH to be in acidosis must be less than 7.38"}],"type":"custom"}
+{"_id":"tbiono-nephro-8389ace","context":null,"enonce":"Are signs of hyperkalemia on ECG: (one or more exact proposals)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"QT prolongation","justification":"QT is unchanged in hyperkalemia"},{"idx":1,"correct":true,"proposition":"Atrioventricular block","justification":"Type 1 (PR elongation)"},{"idx":2,"correct":true,"proposition":"Atrioventricular block","justification":"The pointed head (pointed T waves) of the grandfather (elongation of the PR) widens the priest (widening of the QRS) without his fart (disappearance of the P wave)."},{"idx":3,"correct":true,"proposition":"Ventricular fibrillation","justification":""},{"idx":4,"correct":false,"proposition":"U-waves","justification":"Hypokalemia"}],"type":"custom"}
+{"_id":"tbiono-nephro-892a38f","context":null,"enonce":"Water constitutes about X of the weight in an adult: (one or more exact propositions)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"40%","justification":""},{"idx":1,"correct":false,"proposition":"50%","justification":""},{"idx":2,"correct":false,"proposition":"90%","justification":""},{"idx":3,"correct":true,"proposition":"60%","justification":"You won't forget it like that 🤗"},{"idx":4,"correct":false,"proposition":"80%","justification":""}],"type":"custom"}
+{"_id":"tbiono-nephro-92f7ba9","context":null,"enonce":"Regarding proximal tubular acidosis type 2? (one or more exact propositions)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"It is due to a defect in proximal secretion of bicarbonates ","justification":"False, proximal tubular reabsorption defect of bicarbonates"},{"idx":1,"correct":true,"proposition":"The anionic hole is little modified ","justification":""},{"idx":2,"correct":true,"proposition":"We can find phospho-gluco-amino diabetes ","justification":"True, it's Fanconi syndrome "},{"idx":3,"correct":true,"proposition":"Acetazolamide may be responsible ","justification":""},{"idx":4,"correct":false,"proposition":"Potassium is increased","justification":"False, it is low and is aggravated by the contribution of alkaline "}],"type":"custom"}
+{"_id":"tbiono-nephro-a768686","context":null,"enonce":"What are the abnormalities found in respiratory acidosis being compensated? (one or more exact propositions)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Arterial pH = 7.45","justification":"False, it is an alkalosis "},{"idx":1,"correct":true,"proposition":"Venous pH = 7.36","justification":""},{"idx":2,"correct":false,"proposition":"Bicarbonate = 21 mmol\/L","justification":"False, decreased bicarbonate in metabolic acidosis "},{"idx":3,"correct":true,"proposition":"PCO2 = 50 mmHg","justification":"True, increased PCO2 by hypoventilation "},{"idx":4,"correct":false,"proposition":"None of the previous proposals true ","justification":""}],"type":"custom"}
+{"_id":"tbiono-nephro-cd9edaf","context":null,"enonce":"Which of the etiologies responsible for hypotonic hyponatremia (< 285 mOsm\/L), which is (are) associated with a normal extracellular hydration state? (one or more exact propositions)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Nephrotic syndrome","justification":"The extracellular compartment is increased, with the presence of edema, ascites, pleurisy, pegardic effusion, etc."},{"idx":1,"correct":false,"proposition":"Chronic diarrhea","justification":"The extracellular compartment is decreased. We have dehydration (skin fold, hypotension, tachycardia, ...)"},{"idx":2,"correct":true,"proposition":"Hypocortisolism","justification":"These are the three causes to know hyponatremia (Na < 135) hypotonic hypotonic (Osm < 285) with normal extracellular sector (no edema, no skin fold)."},{"idx":3,"correct":true,"proposition":"SIADH","justification":""},{"idx":4,"correct":true,"proposition":"Hypothyroidism","justification":""}],"type":"custom"}
+{"_id":"tbiono-nephro-dbe9188","context":null,"enonce":"A repetitive discharge of muscle fibers (in a muscle disease) or neurons (in epilepsy) can be caused by several situations. Which? (one or more exact propositions)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"A failure to activate Na+ channels","justification":"To be in a situation of repetitive discharge, the membrane potential must increase. So whether there is an exit of the anions, or an entry of the cations (to go from -70, i.e. the basic membrane potential, to a higher potential). So we want to open the K+ channels, lower the operation of the Na+\/K+ pump, close the Cl- channels."},{"idx":1,"correct":true,"proposition":"A lack of inactivation of Na+ channels","justification":""},{"idx":2,"correct":true,"proposition":"A failure to activate K+ channels","justification":"True. If the K+ channels no longer open, the K+ remains in the cell and increases the membrane potential"},{"idx":3,"correct":false,"proposition":"A K+ channel inactivation defect","justification":"If the K+ channels remain open, all the K+ will come out, there will be much fewer cations in the cell, the membrane potential will decrease"},{"idx":4,"correct":true,"proposition":"A lack of permeability of Cl- channels","justification":"True, the lower the Cl- enters, the less the membrane potential decreases."}],"type":"custom"}
+{"_id":"tbiono-nephro-e955e06","context":null,"enonce":"How to tell the difference between potomania and diabetes insipidus? (one or more exact propositions)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"DHA test ","justification":"If diabetes insipidus is peripheral, it's not going to change anything"},{"idx":1,"correct":false,"proposition":"Diuretic test","justification":""},{"idx":2,"correct":true,"proposition":"Fluid restriction test","justification":"True. If polyuria stops: potomania. Otherwise: diabetes insipidus."},{"idx":3,"correct":false,"proposition":"Troponin Determination","justification":""},{"idx":4,"correct":false,"proposition":"Insulin hypoglycemia","justification":""}],"type":"custom"}
+{"_id":"tbiono-nephro-f0e8ff6","context":null,"enonce":"What changes can lead to membrane hyperpolarization? (one or more exact propositions)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Increased Na+\/K+ ATPase pump activity","justification":"True"},{"idx":1,"correct":false,"proposition":"Opening of Na+ channels","justification":"The opening of the Na+ channels causes Na+ to enter the cell, which participates in depolarization. "},{"idx":2,"correct":true,"proposition":"Opening of K+ channels","justification":"True. Hyperpolarization is an increase in the absolute value of the membrane voltage = the membrane potential becomes super negative. In general, a normal resting potential is considered to be around -70 mV. For it to decrease even more, it is necessary: either that there is an exit of cations (i.e. K+ or Na+) or that there is an entry of anions (i.e. Cl-). For potassium to leave the cell, there must be an opening of the K+ channels (the ions come out on their own because they are much more concentrated in the cell than outside). For the Na+ to come out, the Na+\/K+ ATP pump must work more (it brings out Na+ to bring in K+).\n\n"},{"idx":3,"correct":false,"proposition":"Channel fitting Cl-","justification":"The anions (chlorine) would have to enter the cell to increase the anions and thus lower the membrane potential, making the cell hyper-polarized"},{"idx":4,"correct":false,"proposition":"Hypothermia","justification":""}],"type":"custom"}
+{"_id":"tbiono-nephro-fd49e86","context":null,"enonce":"What are the signs of intracellular hyperhydration? (one or more exact propositions)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"Jugular turgor","justification":"It is a sign of extracellular hyperhydration"},{"idx":1,"correct":true,"proposition":"Headache","justification":""},{"idx":2,"correct":true,"proposition":"Impaired alertness","justification":""},{"idx":3,"correct":false,"proposition":"Ascites","justification":"It is a sign of extracellular hyperhydration"},{"idx":4,"correct":true,"proposition":"Epileptic seizure","justification":""}],"type":"custom"}
+{"_id":"rhumcrist-rhumato-0211898","context":null,"enonce":"You receive in consultation Mr DESBOIS Robin, 76 years old, who describes himself as a \"bon vivant\". He limps when he arrives at your consultation and has his right foot bare. He says that the pain started in the middle of the night, and that since then he throws him, whether he walks or not. You examine it and brilliantly diagnose a first attack of gout on the 1st metatarsophalangeal, which you treat just as well. You see him again two weeks later at your consultation, to talk to him about the rest. What are the real propositions? (one or more exact propositions)  ","item":"rhumcrist","matiere":"rhumato","propositions":[{"idx":0,"correct":false,"proposition":"In this patient, you need to wait for 2 gout attacks before introducing treatment","justification":"False, hypouricemic treatment is introduced at the first gout attack"},{"idx":1,"correct":true,"proposition":"Foods rich in uric acid are organ meats and seafood","justification":"True, foods rich in purines and suppliers of uric acids are organ meats, brewer's yeast, seafood, tea, strong alcohol, sodas and beer even without alcohol."},{"idx":2,"correct":false,"proposition":"This patient is advised to stop beer, but he can continue non-alcoholic beer.","justification":"False, cf. B."},{"idx":3,"correct":false,"proposition":"If treatment is introduced, the uric acid target will be 70mg\/L","justification":"The target is 60mg\/L one of the few standards that we must know by heart!"},{"idx":4,"correct":true,"proposition":"In this patient we will choose Allopurinol or Febuxostat as background treatment","justification":"True, these are the two background treatment options"}],"type":"custom"}
+{"_id":"rhumcrist-rhumato-b751e4a","context":null,"enonce":"You have introduced a background treatment with ALLOPURINOL, and you explain to the patient the side effects of this treatment and in particular serious side effects, requiring a consultation in the emergency room. Which of the side effects described below may be attributable to ALLOPURINOL? (one or more exact propositions)  ","item":"rhumcrist","matiere":"rhumato","propositions":[{"idx":0,"correct":false,"proposition":"Kaposi's syndrome","justification":"False, Distractor"},{"idx":1,"correct":true,"proposition":"Syndrome de Lyell","justification":"True, there is a concern for a serious allergic reaction during treatment with ALLOPURINOL. These are not the only side effects (neutropenia, digestive disorders), but they are essential to remember"},{"idx":2,"correct":false,"proposition":"Lofgren's syndrome","justification":"False, Distractor"},{"idx":3,"correct":false,"proposition":"Syndrome de Sézary","justification":"False, Distractor"},{"idx":4,"correct":true,"proposition":"Syndrome de Stevens Johnson","justification":"True, there is a concern for a serious allergic reaction during treatment with ALLOPURINOL. These are not the only side effects (neutropenia, digestive disorders), but they are essential to remember"}],"type":"custom"}
+{"_id":"BPCO-pneumo-037abca","context":null,"enonce":"In which cases may alpha-1-antitrypsin be indicated? (one or more exact propositions)  ","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Early COPD (before age 45)","justification":""},{"idx":1,"correct":false,"proposition":"Smoking COPD ","justification":"COPD with little or no smoking "},{"idx":2,"correct":true,"proposition":"Family history of emphysema ","justification":""},{"idx":3,"correct":false,"proposition":"Predominant bronchitis phenotype ","justification":"Predominant emphysema phenotype "},{"idx":4,"correct":false,"proposition":"None of the previous answers are true ","justification":""}],"type":"custom"}
+{"_id":"BPCO-pneumo-0e64030","context":null,"enonce":"What non-drug measures are indicated for the treatment of COPD? (one or more exact propositions)  ","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"Pneumococcal vaccination ","justification":"False, drug measure "},{"idx":1,"correct":true,"proposition":"Adapted physical activity ","justification":""},{"idx":2,"correct":true,"proposition":"Smoking cessation ","justification":""},{"idx":3,"correct":false,"proposition":"Short-acting bronchodilators if dyspnea ","justification":"False, drug measure "},{"idx":4,"correct":true,"proposition":"Bronchial drainage physiotherapy ","justification":""}],"type":"custom"}
+{"_id":"BPCO-pneumo-41274c6","context":null,"enonce":"What are the differential diagnoses of COPD? (one or more exact propositions)  ","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Asthma ","justification":""},{"idx":1,"correct":false,"proposition":"Pulmonary fibrosis ","justification":""},{"idx":2,"correct":true,"proposition":"Cystic fibrosis","justification":""},{"idx":3,"correct":true,"proposition":"Dilation of the bronchi ","justification":""},{"idx":4,"correct":false,"proposition":"All previous answers are true ","justification":""}],"type":"custom"}
+{"_id":"BPCO-pneumo-6c99d7c","context":null,"enonce":"Which antibiotics are used as a 1st line in an exacerbation of COPD? (one or more exact propositions)  ","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Amoxicillin - clavulanic acid ","justification":""},{"idx":1,"correct":false,"proposition":"3rd generation cephalosporins ","justification":"Reserved for special cases, not systematic "},{"idx":2,"correct":true,"proposition":"Pristamycin ","justification":""},{"idx":3,"correct":true,"proposition":"Macrolides ","justification":""},{"idx":4,"correct":false,"proposition":"Fluoroquinolones active on pneumococcus ","justification":"Reserved for special cases, not systematic "}],"type":"custom"}
+{"_id":"BPCO-pneumo-8145f7a","context":null,"enonce":"What are the possible treatments for COPD? (one or more exact propositions)  ","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Beta-2 bronchodilators agonists ","justification":""},{"idx":1,"correct":false,"proposition":"Antitussives ","justification":"NO interest in COPD"},{"idx":2,"correct":true,"proposition":"Anticholinergic ","justification":""},{"idx":3,"correct":false,"proposition":"Anti-leukotrienes ","justification":"NO interest in COPD"},{"idx":4,"correct":true,"proposition":"Corticosteroids","justification":""}],"type":"custom"}
+{"_id":"BPCO-pneumo-96b95e9","context":null,"enonce":"What results of EFR can be found in COPD? (one or more exact propositions)  ","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"FEV1\/FVC < 0.7 prebronchodilator ","justification":""},{"idx":1,"correct":false,"proposition":"FEV1\/FVC > 0.7 post-bronchodilator ","justification":"False, rather found in asthma which is a reversible TVO "},{"idx":2,"correct":true,"proposition":"FEV1\/ FVC < 0.7 post bronchodilator ","justification":""},{"idx":3,"correct":true,"proposition":"CPT> 120% ","justification":"CPT> 120% defines chest distention, possibly found in COPD "},{"idx":4,"correct":false,"proposition":"CPT < 80% ","justification":"CPT< 80% defines a TVR! COPD is an ORT "}],"type":"custom"}
+{"_id":"IBP-pneumo-24e9115","context":null,"enonce":"What is the systematic screening offered for any pneumonia? (only one answer expected)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"HIV","justification":""},{"idx":1,"correct":false,"proposition":"EBV","justification":""},{"idx":2,"correct":false,"proposition":"HPV","justification":""},{"idx":3,"correct":false,"proposition":"CMV","justification":""},{"idx":4,"correct":false,"proposition":"HHV6","justification":""}],"type":"custom"}
+{"_id":"IBP-pneumo-39d3126","context":null,"enonce":"What are the 3 criteria for hospitalization of bronchiolitis? (HAS 2019, included in the College of Pediatrics 2021)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"age < 8 weeks","justification":""},{"idx":1,"correct":true,"proposition":"SaO2< 92%","justification":""},{"idx":2,"correct":true,"proposition":"Feeding difficulties","justification":""},{"idx":3,"correct":false,"proposition":"respiratory rate greater than 30 per minute","justification":"No cut-off for respiratory rate in 2021 College of Pediatrics"},{"idx":4,"correct":false,"proposition":"heart rate greater than 150 per minute","justification":"No cut-off for heart rate in 2021 College of Pediatrics"}],"type":"custom"}
+{"_id":"IBP-pneumo-583248f","context":null,"enonce":"What germs can cause community-acquired acute pneumonia? (one or more exact propositions)  ","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"SARS-CoV2","justification":""},{"idx":1,"correct":true,"proposition":"Streptococcus pneumoniae ","justification":""},{"idx":2,"correct":true,"proposition":"Chlamydophila psittaci","justification":""},{"idx":3,"correct":true,"proposition":"Legionnella pneumoniae ","justification":""},{"idx":4,"correct":true,"proposition":"VRS ","justification":""}],"type":"custom"}
+{"_id":"IBP-pneumo-6e0267f","context":null,"enonce":"From what age can we no longer talk about bronchiolitis? (only one answer expected)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"12 months","justification":""},{"idx":1,"correct":false,"proposition":"24 months","justification":""},{"idx":2,"correct":true,"proposition":"36 months","justification":"From three years old 👼"},{"idx":3,"correct":false,"proposition":"4 years","justification":""},{"idx":4,"correct":false,"proposition":"5 years","justification":""}],"type":"custom"}
+{"_id":"IBP-pneumo-6ea47c9","context":null,"enonce":"What are the four different causes of excavated pneumonia?","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Bronchial cancer","justification":""},{"idx":1,"correct":true,"proposition":"Tuberculosis","justification":""},{"idx":2,"correct":true,"proposition":"Aspergillosis","justification":""},{"idx":3,"correct":true,"proposition":"Histoplasmosis","justification":"It is a fungus of the sweet name of Histoplasma capsulatum "},{"idx":4,"correct":false,"proposition":"Staphylococcal","justification":""}],"type":"custom"}
+{"_id":"IBP-pneumo-82ed9d6","context":null,"enonce":"What are the two treatments of choice for a CAP by superinfection of influenza?\n","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Augmentin ","justification":"to touch Staph Aureus"},{"idx":1,"correct":true,"proposition":"C3G IV","justification":"to touch Staph Aureus"},{"idx":2,"correct":false,"proposition":"Amoxicillin","justification":""},{"idx":3,"correct":false,"proposition":"Macrolides","justification":""},{"idx":4,"correct":false,"proposition":"Fluoroquinolones","justification":""}],"type":"custom"}
+{"_id":"IBP-pneumo-8d57dcd","context":null,"enonce":"What are the 3 entities of adult community lower respiratory infections?","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Acute bronchitis ","justification":""},{"idx":1,"correct":true,"proposition":"Acute exacerbation of COPD","justification":""},{"idx":2,"correct":true,"proposition":"Community-acquired acute pneumonia ","justification":""},{"idx":3,"correct":false,"proposition":"Acute ventilator-related pneumonia ","justification":"False, nosocomial infection! "},{"idx":4,"correct":false,"proposition":"None of the previous answers ","justification":""}],"type":"custom"}
+{"_id":"IBP-pneumo-9a78142","context":null,"enonce":"What clinical signs support acute bronchitis? (one or more exact propositions)  ","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Dry then productive cough ","justification":""},{"idx":1,"correct":true,"proposition":"Bronchial rails ","justification":""},{"idx":2,"correct":false,"proposition":"Crackling moans in a hearth ","justification":"Their absence is an important negative sign "},{"idx":3,"correct":true,"proposition":"No polypnea ","justification":""},{"idx":4,"correct":false,"proposition":"Dyspnoea ","justification":"No dyspnea, no physical signs usually apart from fever and viral symptoms "}],"type":"custom"}
+{"_id":"IBP-pneumo-b83bbef","context":null,"enonce":"What is the probabilistic antibiotic combination of choice in ICU\/REA of a CAP in a non-immunocompromised patient? (only one exact answer)","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"C3G + Macrolide IV","justification":""},{"idx":1,"correct":false,"proposition":"Piperacillin-Tazobactam + Carbapenem","justification":"This is a relatively useless combination since it covers the same germs"},{"idx":2,"correct":false,"proposition":"Carbapenem + Macrolide IV","justification":"This combination targets P. aeruginosa. It is therefore only put in place in case of risk factors (bronchiectasis, bronchial dilation, cystic fibrosis, immunosuppression, ...)"},{"idx":3,"correct":false,"proposition":"C3G + Macrolide IV + Cotrimoxazole","justification":"Cotrimoxazole is added for immunosuppression only."},{"idx":4,"correct":false,"proposition":"Augmentin","justification":"It is the antibiotic of choice for the elderly (outpatient or hospitalized)"}],"type":"custom"}
+{"_id":"IBP-pneumo-dbe42ea","context":null,"enonce":"What are the treatments for acute bronchitis in healthy adults? (one or more exact propositions)  ","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Antipyretics ","justification":"In particular paracetamol "},{"idx":1,"correct":false,"proposition":"Antibiotics ","justification":"Absence of antibiotics as a rule "},{"idx":2,"correct":false,"proposition":"Corticosteroids ","justification":"Not recommended and potentially harmful"},{"idx":3,"correct":false,"proposition":"NSAIDs ","justification":"Not recommended and potentially harmful"},{"idx":4,"correct":false,"proposition":"Expectorants ","justification":"Not recommended and potentially harmful"}],"type":"custom"}
+{"_id":"IBP-pneumo-e7bd581","context":null,"enonce":"What are the criteria for CRB 65? (one or more exact propositions)  ","item":"IBP","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Confusion ","justification":""},{"idx":1,"correct":false,"proposition":"Heart rate> 100 bpm ","justification":"No heart rate in this score! "},{"idx":2,"correct":false,"proposition":"Respiratory rate≥ 22\/min ","justification":"FR ≥ 30\/min "},{"idx":3,"correct":true,"proposition":"Age ≥ 65 ","justification":""},{"idx":4,"correct":true,"proposition":"PITCH < 90 mmHg or PAD ≤ 60 mmHg ","justification":""}],"type":"custom"}
+{"_id":"IRespiC-pneumo-6c04b76","context":null,"enonce":"What consequences can chronic respiratory failure have? (one or more exact propositions)  ","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Increased risk of thrombosis ","justification":"Chronic hypoxemia is compensated by polycythemia that leads to blood hyperviscosity and an increased risk of thrombosis "},{"idx":1,"correct":true,"proposition":"Edema ","justification":"Declated oedema due to fluid retention attributed to an abnormality in the regulation of natriuretic factor or as a result of pulmonary hypertension "},{"idx":2,"correct":true,"proposition":"Pulmonary hypertension ","justification":""},{"idx":3,"correct":true,"proposition":"Acute respiratory failure ","justification":"Due to decompensation of chronic respiratory failure "},{"idx":4,"correct":false,"proposition":"Anaemia ","justification":""}],"type":"custom"}
+{"_id":"IRespiC-pneumo-6e486d5","context":null,"enonce":"What etiologies of chronic respiratory failure are RVCs? (one or more exact propositions)  ","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"Cystic fibrosis ","justification":"Mixed disorder: restrictive and obstructive "},{"idx":1,"correct":true,"proposition":"Obesity hypoventilation syndrome ","justification":""},{"idx":2,"correct":true,"proposition":"Kyphoscoliosis ","justification":""},{"idx":3,"correct":true,"proposition":"Myasthenia ","justification":""},{"idx":4,"correct":true,"proposition":"Idiopathic pulmonary fibrosis ","justification":""}],"type":"custom"}
+{"_id":"IRespiC-pneumo-8523434","context":null,"enonce":"Which etiologies of respiratory failure are mixed ventilatory disorders? (two answers expected)","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"COPD ","justification":"False, it's a TVO! "},{"idx":1,"correct":false,"proposition":"Amyotrophic lateral sclerosis ","justification":"False, it's a TVR! "},{"idx":2,"correct":true,"proposition":"Dilation of the extensive bronchi ","justification":""},{"idx":3,"correct":false,"proposition":"Poliomyelitis ","justification":"False, it's a TVR! "},{"idx":4,"correct":true,"proposition":"Cystic fibrosis","justification":""}],"type":"custom"}
+{"_id":"IRespiC-pneumo-98df853","context":null,"enonce":"What are the main causes of exacerbation of chronic respiratory failure? (one or more exact propositions)  ","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Bronchitis ","justification":"The 3 main causes of exacerbation to look for: \n- Lower respiratory infections: pneumonia, bronchitis \n- Dysfunction of the left ventricle (pulmonary edema) and rhythm disorders \n-Pulmonary embolism "},{"idx":1,"correct":true,"proposition":"Pulmonary embolism ","justification":""},{"idx":2,"correct":true,"proposition":"Heart rhythm disorders ","justification":""},{"idx":3,"correct":true,"proposition":"Pulmonary edema ","justification":""},{"idx":4,"correct":true,"proposition":"Pneumonia ","justification":""}],"type":"custom"}
+{"_id":"IRespiC-pneumo-ba39f89","context":null,"enonce":"What are the treatments for chronic respiratory failure? (one or more exact propositions)  ","item":"IRespiC","matiere":"pneumo","propositions":[{"idx":0,"correct":true,"proposition":"Long-term oxygen therapy ","justification":""},{"idx":1,"correct":true,"proposition":"Non-invasive ventilation ","justification":""},{"idx":2,"correct":true,"proposition":"Smoking cessation","justification":""},{"idx":3,"correct":true,"proposition":"Respiratory rehabilitation ","justification":""},{"idx":4,"correct":false,"proposition":"None of the answers ","justification":""}],"type":"custom"}
+{"_id":"dyspnee-pneumo-0bfedf5","context":null,"enonce":"Which of the following conditions are etiologies of acute dyspnea (and not chronic dyspnea)? (one or more exact propositions)  ","item":"dyspnee","matiere":"pneumo","propositions":[{"idx":0,"correct":false,"proposition":"COPD","justification":"Chronic dyspnea"},{"idx":1,"correct":true,"proposition":"Obstruction of the upper airway by a foreign body ","justification":""},{"idx":2,"correct":true,"proposition":"Pulmonary embolism ","justification":""},{"idx":3,"correct":false,"proposition":"Emphysema ","justification":"Chronic dyspnea"},{"idx":4,"correct":false,"proposition":"None of the previous proposals ","justification":""}],"type":"custom"}
+{"_id":"asthme-immuno-ef46d3c","context":null,"enonce":"What is the prevalence of asthma in adults in France? ","item":"asthme","matiere":"immuno","propositions":[{"idx":0,"correct":false,"proposition":"50% ","justification":""},{"idx":1,"correct":false,"proposition":"12% ","justification":""},{"idx":2,"correct":false,"proposition":"24% ","justification":""},{"idx":3,"correct":true,"proposition":"6% ","justification":"True. "},{"idx":4,"correct":false,"proposition":"80% ","justification":""}],"type":"custom"}
+{"_id":"RCIU-gyn-5e29e10","context":null,"enonce":"What is the proportion of disharmonious IUGR?","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"correct":false,"proposition":"20 %","justification":"This is the proportion of IUGR harmonious"},{"idx":1,"correct":false,"proposition":"30 %","justification":""},{"idx":2,"correct":false,"proposition":"50 %","justification":""},{"idx":3,"correct":false,"proposition":"5 %","justification":""},{"idx":4,"correct":true,"proposition":"80 %","justification":"True"}],"type":"custom"}
+{"_id":"RCIU-gyn-69330e9","context":null,"enonce":"What is Manning's score for?","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"correct":true,"proposition":"Studying fetal distress","justification":"True"},{"idx":1,"correct":false,"proposition":"Look for oligohydramnios","justification":"Is done on ultrasound by quantifying amniotic fluid"},{"idx":2,"correct":false,"proposition":"Looking for placental insufficiency","justification":"Is done with Doppler of the uterine arteries"},{"idx":3,"correct":false,"proposition":"Looking for an increase in placental resistance","justification":"Fetal umbilical Doppler"},{"idx":4,"correct":false,"proposition":"Looking for brain sparing secondary to hypoxia","justification":"Fetal cerebral Doppler"}],"type":"custom"}
+{"_id":"grossessepatho-gyn-1caf0d8","context":null,"enonce":"How many AS is Rophylac injected in Rh- patients?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"correct":false,"proposition":"12","justification":""},{"idx":1,"correct":true,"proposition":"28","justification":"True"},{"idx":2,"correct":false,"proposition":"36","justification":""},{"idx":3,"correct":false,"proposition":"Just before giving birth","justification":""},{"idx":4,"correct":false,"proposition":"It is only offered to Rh+ patients","justification":"Rophylac aims to prevent immunization of Rh- mothers against Rh+ fetuses (among others). It is therefore never offered to Rh+ patients, who cannot be immunized against the Rh antigen, since they are constitutionally carriers of it."}],"type":"custom"}
+{"_id":"grossessepatho-gyn-d997391","context":null,"enonce":"What is the prevalence of premature rupture of membranes (RPM)?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"correct":true,"proposition":"About 5%","justification":""},{"idx":1,"correct":false,"proposition":"About 25%","justification":""},{"idx":2,"correct":false,"proposition":"About 45%","justification":""},{"idx":3,"correct":false,"proposition":"About 65%","justification":""},{"idx":4,"correct":false,"proposition":"About 85%","justification":""}],"type":"custom"}
+{"_id":"grossessepatho-gyn-f9f0714","context":null,"enonce":"What antibiotics is Listeria naturally resistant to?","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"correct":true,"proposition":"cephalosporins","justification":"True"},{"idx":1,"correct":true,"proposition":"oxacillin","justification":"True"},{"idx":2,"correct":true,"proposition":"lincosamides ","justification":"True"},{"idx":3,"correct":false,"proposition":"Amoxicillin","justification":""},{"idx":4,"correct":false,"proposition":"These are acquired resistances","justification":"Acquired resistance to L. monocytogenes is exceptional"}],"type":"custom"}
+{"_id":"TTTperso-therapeutique-dbf3ceb","context":null,"enonce":"Which of the following treatments are nephrotoxic?","item":"TTTperso","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"Tacrolimus","justification":"True, just like cyclosporine, immunosuppressants have an effect on kidney vessels and tubules."},{"idx":1,"correct":true,"proposition":"Cisplatin","justification":"True, THE anti-cancer treatment that causes tubulopathies. Do not forget other treatments that can be nephrotoxic such as Methotrexate, Gemcitabine or Mithomycin C"},{"idx":2,"correct":true,"proposition":"Warfarin","justification":"True, warfarin gives tubulopathies!"},{"idx":3,"correct":true,"proposition":"NSAIDs","justification":"True, more than classic, overall you can forget the NSAIDs that give vascular, interstitial and glomerular damage"},{"idx":4,"correct":true,"proposition":"Aminoglycosides","justification":"True, very classic case of tubular toxicity!"}],"type":"custom"}
+{"_id":"antithrombotiques-therapeutique-0ffff35","context":null,"enonce":"Regarding VKAs:","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"Fluindione is no longer given as a first-line treatment","justification":"It is no longer administered at all, EXCEPT in patients who are already on fluindione and who are stable."},{"idx":1,"correct":true,"proposition":"INR measurement reflects the dose ingested 3 to 5 days in advance","justification":"This is the time it takes for the liver to make clotting factors."},{"idx":2,"correct":true,"proposition":"Vitamin K antagonists have many drug interactions","justification":""},{"idx":3,"correct":false,"proposition":"There are no contraindications to VKAs","justification":""},{"idx":4,"correct":false,"proposition":"Renal failure is a contraindication to VKAs","justification":"VKAs are metabolized by the liver 🍻"}],"type":"custom"}
+{"_id":"antithrombotiques-therapeutique-2930e2f","context":null,"enonce":"Level 2 analgesic medications include:","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"codeine","justification":"Molecule = Dihydrocodeine"},{"idx":1,"correct":true,"proposition":"Tramadol","justification":"Tramadol is a molecule with both opioid properties (by acting directly on mu receptors) and pro-norepinephrine\/serotonin. It can be combined with paracetamol."},{"idx":2,"correct":false,"proposition":"aspirin","justification":""},{"idx":3,"correct":false,"proposition":"Nefopam","justification":"Nephopam, like NSAIDs, nalbuphin and paracetamol, are level 1 analgesics."},{"idx":4,"correct":true,"proposition":"Opium","justification":"Lamalin, for example, is a specialty that includes opium and paracetamol."}],"type":"custom"}
+{"_id":"antithrombotiques-therapeutique-4ef4d2a","context":null,"enonce":"What are the side effects of corticosteroids?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"correct":false,"proposition":"Hyperkalemia","justification":"Hypokalemia"},{"idx":1,"correct":false,"proposition":"Hypernatremia","justification":""},{"idx":2,"correct":false,"proposition":"Hyponatremia","justification":"No action on sodium"},{"idx":3,"correct":false,"proposition":"Hypophosphatemia","justification":"No action on phosphate"},{"idx":4,"correct":true,"proposition":"Hypercalciuria","justification":"It is a cause of hypercalciuria with normal serum calcium"}],"type":"custom"}
+{"_id":"antithrombotiques-therapeutique-7c5b0b7","context":null,"enonce":"Regarding oral antidiabetics:","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"correct":false,"proposition":"Sulphonylureas stimulate insulin production","justification":"They stimulate its secretion! And it's not the same 😬"},{"idx":1,"correct":true,"proposition":"Sulfonamides stimulate insulin secretion","justification":""},{"idx":2,"correct":true,"proposition":"DPP4 inhibitors are gliptins","justification":""},{"idx":3,"correct":false,"proposition":"Biguanides stimulate insulin secretion","justification":"Metformin is an insulin-sensitizer. It does not work in the pancreas. This is why there is no risk of hypoglycemia"},{"idx":4,"correct":false,"proposition":"SGLT2 inhibitors are contraindicated in renal impairment with GFR < 70","justification":"They are contraindicated from a GFR < 45 (nasty trap, I admit... but useful! You won't forget it now!)"}],"type":"custom"}
+{"_id":"antithrombotiques-therapeutique-82b2378","context":null,"enonce":"Regarding statins:","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"If transaminase levels are above three times normal, statins should not be introduced","justification":""},{"idx":1,"correct":true,"proposition":"Iatrogenic diabetes is one of the side effects of statins","justification":""},{"idx":2,"correct":true,"proposition":"Statins should not be used at the same time as fibrates","justification":""},{"idx":3,"correct":false,"proposition":"CPK on statins is monitored","justification":"They are monitored under fibrates, if the patient complains of myalgia"},{"idx":4,"correct":false,"proposition":"The second-line anti-lipidemic is the PCSK9 inhibitor","justification":"This is ezetimibe, which is a therapeutic alternative in case of intolerance to statins."}],"type":"custom"}
+{"_id":"antithrombotiques-therapeutique-967a418","context":null,"enonce":"Side effects of potassium-sparing diuretics include:","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"hyperkalemia","justification":""},{"idx":1,"correct":false,"proposition":"hypernatremia","justification":""},{"idx":2,"correct":true,"proposition":"gynecomastia","justification":""},{"idx":3,"correct":true,"proposition":"metabolic acidosis","justification":"Overall, we can remember that H+ ions (which acidify the blood) go where potassium goes (it's very schematic, but it works 😉)"},{"idx":4,"correct":false,"proposition":"Ventilatory alkalosis","justification":""}],"type":"custom"}
+{"_id":"antithrombotiques-therapeutique-b175762","context":null,"enonce":"During an accident of anticoagulants (hemorrhage under VKA with very high INR), the administration of vitamin K acts by:","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"correct":false,"proposition":"Immediately","justification":""},{"idx":1,"correct":false,"proposition":"30 minutes","justification":""},{"idx":2,"correct":false,"proposition":"2 to 4 hours","justification":""},{"idx":3,"correct":true,"proposition":"8 to 12 hours","justification":"Unlike CCP infusion which acts immediately. It is therefore necessary to control the action of the latter about 30 minutes after the end of the infusion by an INR assay."},{"idx":4,"correct":false,"proposition":"Vitamin K administration has no place in the management","justification":""}],"type":"custom"}
+{"_id":"antithrombotiques-therapeutique-bcf2417","context":null,"enonce":"What is the pre-therapeutic assessment of direct oral anticoagulant anti-IIa (dabigratran)?","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"Complete blood count","justification":"We will not give it if its hemoglobin is at 5 😅"},{"idx":1,"correct":true,"proposition":"Creatinine","justification":"Contraindicated in renal impairment"},{"idx":2,"correct":true,"proposition":"TCA","justification":"We will not give it if its TCA is at 5 😅"},{"idx":3,"correct":false,"proposition":"Factor II","justification":""},{"idx":4,"correct":false,"proposition":"Factor X","justification":""}],"type":"custom"}
+{"_id":"antithrombotiques-therapeutique-dc91f81","context":null,"enonce":"The contraindication(s) of B-blockers is:","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"Raynaud's syndrome","justification":""},{"idx":1,"correct":true,"proposition":"Deep Bradycardia","justification":""},{"idx":2,"correct":true,"proposition":"Asthma","justification":""},{"idx":3,"correct":true,"proposition":"Acute heart failure","justification":""},{"idx":4,"correct":true,"proposition":"All propositions are true","justification":""}],"type":"custom"}
+{"_id":"iatrogenie-therapeutique-2efc9d0","context":null,"enonce":"Which of the following combinations Adverse reaction - Inducer drug(s) are accurate?","item":"iatrogenie","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"QT prolongation - Neuroleptics","justification":"True, this is why we do an ECG in psychiatry before administering psychotropic drugs!"},{"idx":1,"correct":false,"proposition":"Hyperlipidemia - Allopurinol","justification":"False, allopurinol on the other hand is at risk of hepatitis and allergic reaction!"},{"idx":2,"correct":true,"proposition":"Rhabdomyolysis - Fibrates","justification":"True, just like statins, fibrates are also at risk for rhabdomyolysis"},{"idx":3,"correct":true,"proposition":"Tendinopathy - Fluoroquinolones","justification":"True, one of the most well-known side effects!"},{"idx":4,"correct":true,"proposition":"Syndrome de Lyell\/Stevens Johnson - Lamotrigine","justification":"True, lamotrigine is a very allergenic treatment                                                                                                                 "}],"type":"custom"}
+{"_id":"iatrogenie-therapeutique-430b699","context":null,"enonce":"You receive in consultation, Mr BRISANCHOYEUR, Archibald, 54 years old, in whom you prescribe for the first time morphine. As a result, you make a prescription for narcotics. What are the particularities of this order?","item":"iatrogenie","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"It is printed on watermarked paper","justification":"True, to secure it!"},{"idx":1,"correct":true,"proposition":"The prescription period is usually 28 days, but it can be 14 days or 7 days","justification":"True, it is indeed possible"},{"idx":2,"correct":false,"proposition":"Renewal is possible, but only once","justification":"Wrong, we can't renew it!"},{"idx":3,"correct":false,"proposition":"If the new order is drafted before the end of the period covered by the previous one, it is therefore null and void.","justification":"False, it will be in addition to the previous ordinance"},{"idx":4,"correct":false,"proposition":"The overlap of two prescriptions is possible for a shorter period of 3 days","justification":"False overlap is prohibited!"}],"type":"custom"}
+{"_id":"iatrogenie-therapeutique-56a8a9d","context":null,"enonce":"Regarding adverse drug reactions and pharmacovigilance, what are the exact answer(s)?","item":"iatrogenie","matiere":"therapeutique","propositions":[{"idx":0,"correct":false,"proposition":"Immuno-allergic side effects are most often predictable","justification":"False, it is the opposite, they are usually unpredictable because allergies are never predicted in advance."},{"idx":1,"correct":false,"proposition":"DRESS syndrome is a bullous rash secondary to medication","justification":"False, it's Lyell syndrome! DRESS syndrome is manifested by erythroderma with eosinophil infiltration"},{"idx":2,"correct":false,"proposition":"The declaration of adverse drug reactions is done on the ANSM website","justification":"False, it is carried out on the website of the CRPV (regional pharmacovigilance center) which transmits the notifications to the ANSM which, it, will evaluate the notifications"},{"idx":3,"correct":true,"proposition":"Almost half of the medicines sold on the Internet in Europe, apart from legal sites are fake","justification":"True, a point that reminds us that counterfeit medicines are a global scourge, with very lucrative markets..."},{"idx":4,"correct":true,"proposition":"If the damage related to a medical accident due to the therapeutic hazard exceeds 24%, the patient will be compensated by ONIAM","justification":"True, from the College of Pharmacology and Public Health"}],"type":"custom"}
+{"_id":"usagemedic-therapeutique-0ee5023","context":null,"enonce":"Melting Pot n°2! Which of the following proposals concerning pharmacology are true?","item":"usagemedic","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":"Patients can report adverse drug reactions online","justification":"True, essential information that often falls into MCQ"},{"idx":1,"correct":true,"proposition":"One of the quality criteria of an ordinance is its computer writing and not its handwritten writing.","justification":"True, very logical when we see the hieroglyphs of some"},{"idx":2,"correct":true,"proposition":"3% of hospitalizations are due to adverse drug reactions","justification":"True, small epidemiological figure that is good to keep in mind"},{"idx":3,"correct":false,"proposition":"The MIC of antibiotics is the maximum inhibitory concentration, which is equivalent to its bactericidal or bacteriostatic effect","justification":"False, the MIC is the MINIMUM inhibitory concentration, the lower it is, the more powerful the antibiotic is and allows to define if the bacterium is sensitive, intermediate or resistant"},{"idx":4,"correct":false,"proposition":"Prescription of unfractionated heparin leads to pharmacokinetic monitoring","justification":"False, it is a dosage of activity, anti Xa activity so a pharmacodynamic monitoring"}],"type":"custom"}
+{"_id":"usagemedic-therapeutique-d9118cd","context":null,"enonce":"Melting pot! Which of the following proposals concerning pharmacology are correct?","item":"usagemedic","matiere":"therapeutique","propositions":[{"idx":0,"correct":false,"proposition":"INR is a pharmacokinetic follow-up","justification":"False, this is a pharmacodynamic follow-up. Pharmacodynamic monitoring aims to see the effectiveness of the treatment while pharmacokinetic monitoring aims to see the concentration of the drug"},{"idx":1,"correct":true,"proposition":"The equilibrium dose is usually reached at 5 half-lives","justification":"True, this is the commonly accepted dose of equilibrium"},{"idx":2,"correct":true,"proposition":"The prescription of oral NEFOPAM as an analgesic is an off-label prescription","justification":"True, this is one of the best known off-label prescriptions. If you look in VIDAL you will not find an oral dosage."},{"idx":3,"correct":false,"proposition":"The use of certain psychoactive drugs must be declared to the ANSM","justification":"False, it must be declared to the regional pharmacovigilance centre"},{"idx":4,"correct":false,"proposition":"WHO's list of essential medicines is updated every 5 years","justification":"False, every two years or so"}],"type":"custom"}
+{"_id":"matraitanceped-sp-79b1b49","context":null,"enonce":"What are the risk factors for child maltreatment?","item":"matraitanceped","matiere":"sp","propositions":[{"idx":0,"correct":false,"proposition":"The Baby Blues","justification":"False, the Baby Blues is physiological and does not lead in any case to an excess risk of abuse unlike postpartum depression"},{"idx":1,"correct":true,"proposition":"A history of childhood abuse in one of the parents","justification":"True, as is often said, parents reproduce what they went through together."},{"idx":2,"correct":false,"proposition":"Disadvantaged social class","justification":"False, trap, abuse affects all social classes without exception"},{"idx":3,"correct":true,"proposition":"Addiction to a psychoactive substance in one of the parents","justification":"True, do not forget alcohol and nicotine, which can be the cause of abuse"},{"idx":4,"correct":true,"proposition":"Child placed in an incubator at birth","justification":"True, a separation at birth, or a complicated end of pregnancy increases the stress of the couple and can be the cause of abuse"}],"type":"custom"}
+{"_id":"matraitanceped-sp-ef9c96a","context":null,"enonce":"Regarding child abuse, what are the exact answer(s)?","item":"matraitanceped","matiere":"sp","propositions":[{"idx":0,"correct":true,"proposition":"A fracture in a child of non-walking age is abuse until proven otherwise","justification":"True, great pediatric adage, always have it in mind."},{"idx":1,"correct":true,"proposition":"Dropping out of school can be a sign of abuse","justification":"True, we often see a sharp break in academic results."},{"idx":2,"correct":false,"proposition":"Legally, it is mandatory during the consultation to have the adult always in the company of the child","justification":"False, the doctor (even general practitioner) can see the child alone if he wishes"},{"idx":3,"correct":false,"proposition":"In case of strong suspicion of ill-treatment with alleged perpetrator in the child's home, information of concern must be sent to the CRIP","justification":"False, in this case, the life of the child is in danger and the doctor must, for the survival of the child, contact the hospital and make a report to the public prosecutor."},{"idx":4,"correct":true,"proposition":"The physician may be liable if he or she directly or indirectly names the alleged perpetrator of the abuse","justification":"True, never name someone or their role (father, mother) in a certificate, mark \"the aggressor\""}],"type":"custom"}
+{"_id":"CCR-onco-9429409","context":null,"enonce":"What should lead to the prescription of a microsatellite instability test?","item":"CCR","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Colorectal cancer < age 60","justification":""},{"idx":1,"correct":false,"proposition":"Colorectal cancer < 80","justification":""},{"idx":2,"correct":true,"proposition":"Multiple synchronous cancers of the Lynch syndrome spectrum in the same patient","justification":""},{"idx":3,"correct":true,"proposition":"Multiple metachronous cancers of the Lynch syndrome spectrum in the same patient","justification":"The three things to know are: \n- Colorectal cancer < 60 years, \n- Multiple cancers (synchronous or metachronous) of the Lynch syndrome spectrum in the same patient, \n- Colorectal cancer + family history of Lynch syndrome spectrum cancer (at least one first-degree relative< 50 years or two related, first or second degree relatives, regardless of age) "},{"idx":4,"correct":false,"proposition":"Ovarian cancer","justification":""}],"type":"custom"}
+{"_id":"Kcsein-onco-024ddf3","context":null,"enonce":"The most common histological type in breast cancer is:","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"invasive ductal carcinoma","justification":""},{"idx":1,"correct":false,"proposition":"ductal carcinoma in situ","justification":"does not exist"},{"idx":2,"correct":false,"proposition":"carcinoma in situ","justification":""},{"idx":3,"correct":false,"proposition":"anaplastic carcinoma","justification":""},{"idx":4,"correct":false,"proposition":"lobular carcinoma","justification":""}],"type":"custom"}
+{"_id":"TTTKc-onco-9b09865","context":null,"enonce":"Side effects of cisplatin are:","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Renal failure","justification":""},{"idx":1,"correct":false,"proposition":"Hepatic impairment","justification":"Renal failure"},{"idx":2,"correct":true,"proposition":"Nausea and vomiting","justification":""},{"idx":3,"correct":true,"proposition":"Tinnitus","justification":"and deafness (high ototoxicity)"},{"idx":4,"correct":false,"proposition":"Urinary burns","justification":"Cisplatin:\n- hematological toxicity\n- nausea\/vomiting\n- peripheral neuropathy\n- kidney damage\n- ototoxicity\nno alopecia (cyclophosphamide, irinotecan, anthracycline, etoposide, paclitaxel, docetaxel, 5FU)\nno hand-foot syndrome (anthracycline, docetaxel, 5fu, capecitabine)\nno diarrhoea (oxaliplatin, irinotecan, anthracycline, paclitaxel, docetaxel, 5FU)\nno cardiac involvement (anthracycline and 5FU)\nno skin necrosis if extravasation (antracycline)"}],"type":"custom"}
+{"_id":"epidemioKc-onco-8307e01","context":null,"enonce":"Which propositions are true?","item":"epidemioKc","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"Cancer is the leading cause of death in France","justification":""},{"idx":1,"correct":false,"proposition":"Cardiovascular diseases are the third leading cause of death in France","justification":"The second"},{"idx":2,"correct":true,"proposition":"Cancer incidence higher in men than in women","justification":"Cancer is still a predominantly male disease"},{"idx":3,"correct":false,"proposition":" Cancer mortality rises steadily for both men and women","justification":"It decreases"},{"idx":4,"correct":false,"proposition":"Cancer incidence is 0 before the age of 5","justification":""}],"type":"custom"}
+{"_id":"epidemioKc-onco-aba8b45","context":null,"enonce":"What is the global incidence of cancer in 2018?","item":"epidemioKc","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":"18 million new cases","justification":""},{"idx":1,"correct":false,"proposition":"48 million new cases","justification":""},{"idx":2,"correct":false,"proposition":"8 million new cases","justification":""},{"idx":3,"correct":false,"proposition":"1 million new cases","justification":""},{"idx":4,"correct":false,"proposition":"180 million new cases","justification":""}],"type":"custom"}
+{"_id":"epidemioKc-onco-d83e770","context":null,"enonce":"What is the global mortality of cancers in 2018?","item":"epidemioKc","matiere":"onco","propositions":[{"idx":0,"correct":true,"proposition":" 9.6 million deaths","justification":""},{"idx":1,"correct":false,"proposition":" 96 million deaths","justification":""},{"idx":2,"correct":false,"proposition":" 960 million deaths","justification":""},{"idx":3,"correct":false,"proposition":"0.6 million deaths","justification":""},{"idx":4,"correct":false,"proposition":" 59 million deaths","justification":""}],"type":"custom"}
+{"_id":"AOMI-cardio-6b5f4cd","context":null,"enonce":"Which IPS are to be considered normal:","item":"AOMI","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"0,65","justification":"No. > 0.9"},{"idx":1,"correct":false,"proposition":"0,85","justification":"No. > 0.9"},{"idx":2,"correct":true,"proposition":" 0,95","justification":""},{"idx":3,"correct":true,"proposition":"1,25","justification":"N: 0.9-1.3 (1.4 depending on sources)"},{"idx":4,"correct":false,"proposition":"1,45","justification":"N < 1.3 (or 1.4 depending on the source)"}],"type":"custom"}
+{"_id":"ECG-cardio-7fbfcc8","context":null,"enonce":"Which of the following leads will show an elevation in a high outboard SCA ST+? (one or more exact propositions)","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"I and aVL","justification":""},{"idx":1,"correct":false,"proposition":"V1, V2 and V3","justification":""},{"idx":2,"correct":false,"proposition":"II, III and aVF","justification":""},{"idx":3,"correct":false,"proposition":"V5 and V6","justification":""},{"idx":4,"correct":false,"proposition":"V7, V8 and V9","justification":""}],"type":"custom"}
+{"_id":"FA-cardio-f75a430","context":null,"enonce":"What is the molecule of choice to slow down poorly tolerated atrial fibrillation (OAP) in acute?","item":"FA","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Digoxin ","justification":""},{"idx":1,"correct":false,"proposition":"Verapamil ","justification":"Calcium channel blockers are contraindicated in heart failure (whether acute or chronic)"},{"idx":2,"correct":false,"proposition":"Diltiazem ","justification":"Calcium channel blockers are contraindicated in heart failure (whether acute or chronic)"},{"idx":3,"correct":false,"proposition":"β-blocker","justification":"It can worsen acute heart failure"},{"idx":4,"correct":false,"proposition":"None, do not slow down atrial fibrillation since the patient is in OAP","justification":"On the contrary, the patient is in OAP because the left atrium contracts too quickly and uncontrollably for the atrial systole to be effective. The heart rate needs to drop so that the mitral valve stays open longer, so that blood has more time to pass into the left ventricle."}],"type":"custom"}
+{"_id":"FdRCV-cardio-3198858","context":null,"enonce":"Which cardiovascular risk factors are modifiable? ","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"Age","justification":"Non-modifiable cardiovascular risk factor "},{"idx":1,"correct":true,"proposition":"Diabetes ","justification":""},{"idx":2,"correct":true,"proposition":"Tobacco","justification":""},{"idx":3,"correct":false,"proposition":"Alcohol","justification":"Alcohol is not a cardiovascular risk factor! "},{"idx":4,"correct":true,"proposition":"High blood pressure ","justification":""}],"type":"custom"}
+{"_id":"HTA-cardio-35c961d","context":null,"enonce":"Angiotensin II: (one or more exact proposals)","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"Is ionotropic negative","justification":""},{"idx":1,"correct":true,"proposition":"Is ionotropic positive","justification":""},{"idx":2,"correct":false,"proposition":"Is ionotrope indifferent","justification":""},{"idx":3,"correct":true,"proposition":"Stimulates adrenal release of aldosterone","justification":""},{"idx":4,"correct":false,"proposition":"Stimulates adrenal release of renin","justification":""}],"type":"custom"}
+{"_id":"HTA-cardio-4aae21a","context":null,"enonce":"Regarding DHA:","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"This hormone is released by the hypothalamus into the pituitary gland","justification":""},{"idx":1,"correct":true,"proposition":"This hormone stored in the pituitary gland","justification":""},{"idx":2,"correct":false,"proposition":"This hormone is the main hormone regulating blood pressure","justification":"It is rather aldosterone 😉"},{"idx":3,"correct":true,"proposition":"This hormone can be released inappropriately ","justification":"This is the famous SIADH"},{"idx":4,"correct":false,"proposition":"This hormone can cause hypertonic hyponatremia","justification":"Hypotonic hyponatremia (plasma osmolarity < 285)"}],"type":"custom"}
+{"_id":"HTA-cardio-7ccf194","context":null,"enonce":"What are the side effects of beta-blockers? (one or more exact propositions)","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Bradycardia","justification":""},{"idx":1,"correct":true,"proposition":"Worsening asthma","justification":"Active asthma is also a contraindication"},{"idx":2,"correct":true,"proposition":"Impotence","justification":""},{"idx":3,"correct":false,"proposition":"Cough","justification":"They are found more in IEC\/ARA2"},{"idx":4,"correct":false,"proposition":"All propositions are true","justification":""}],"type":"custom"}
+{"_id":"HTA-cardio-b974000","context":null,"enonce":"Which of the following diuretics is not contraindicated in chronic renal failure with GFR < 30? (one or more exact propositions)","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Furosemide","justification":""},{"idx":1,"correct":true,"proposition":"Loop diuretic","justification":""},{"idx":2,"correct":false,"proposition":"Thiazide","justification":""},{"idx":3,"correct":false,"proposition":"Spironolactone","justification":""},{"idx":4,"correct":false,"proposition":"Aldactone","justification":""}],"type":"custom"}
+{"_id":"HTA-cardio-b993adc","context":null,"enonce":"Your patient, Roberta, 62, comes to your office smiling. She feels very well and has no history other than high blood pressure that you brilliantly diagnosed several months ago. It is under ACE inhibitor (ACE inhibitor) and calcium channel blocker (CI). However, its last blood pressure self-measurement that it presents to you is at 146\/89 mm of mercury. How do you adapt the treatment in this patient in order to balance her high blood pressure? (one or more exact propositions)","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"Maintaining the same treatment, it will settle down over time","justification":""},{"idx":1,"correct":true,"proposition":"Addition of a thiazide diuretic","justification":"It is the triple therapy of choice"},{"idx":2,"correct":false,"proposition":"Addition of a loop diuretic","justification":"Not conventionally used in hypertension, except for example in cases of renal failure and heart failure."},{"idx":3,"correct":false,"proposition":"Adding an ARA2","justification":"We avoid associating IEC and ARA2"},{"idx":4,"correct":false,"proposition":"Addition of a central antihypertensive drug","justification":"Only considered after trying triple therapy containing thiazide"}],"type":"custom"}
+{"_id":"HTA-cardio-bfa0e97","context":null,"enonce":"What elements are found in the Kirkendall classification (hypertensive retinopathy)?","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Retinal hemorrhages","justification":"Stage 2"},{"idx":1,"correct":true,"proposition":"Arterial narrowing","justification":"Stage 1"},{"idx":2,"correct":true,"proposition":"Dry exudates","justification":"Stage 2"},{"idx":3,"correct":true,"proposition":"Cottony nodules","justification":"Stage 2"},{"idx":4,"correct":true,"proposition":"Papillary edema","justification":"Stage 3"}],"type":"custom"}
+{"_id":"HTA-cardio-ded0c0a","context":null,"enonce":"What are the adrenal pathologies associated with hypertension?","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Conn's adenoma","justification":""},{"idx":1,"correct":true,"proposition":"Pheochromocytoma","justification":""},{"idx":2,"correct":true,"proposition":"Congenital adrenal hypoplasia","justification":"We do not see this pathology at the ECN! This is congenital adrenal hyPERplasia"},{"idx":3,"correct":false,"proposition":"Cushing's disease","justification":"It is a pituitary pathology and not adrenal (as the question asks)"},{"idx":4,"correct":false,"proposition":"None of these proposals","justification":""}],"type":"custom"}
+{"_id":"HTA-cardio-fa2adb0","context":null,"enonce":"Where is renal sodium reabsorption most important?","item":"HTA","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"proximal tube","justification":"Nearly 70% of reabsorbed sodium is reabsorbed at the beginning 😉"},{"idx":1,"correct":false,"proposition":"Collector tube","justification":""},{"idx":2,"correct":false,"proposition":"distal tube","justification":""},{"idx":3,"correct":false,"proposition":"Henlé branch","justification":""},{"idx":4,"correct":false,"proposition":"everywhere and nowhere at once 🤷 ♂️","justification":"I admit that we were not very inspired for the last proposal 😬😬"}],"type":"custom"}
+{"_id":"IC-cardio-a5db2f1","context":null,"enonce":"What are the signs visible on chest X-ray when heart failure is suspected? ","item":"IC","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"A pneumothorax. ","justification":"False. "},{"idx":1,"correct":true,"proposition":"Cardiomegaly, defined as a cardiothoracic ratio (RCT) > 0.5. ","justification":"True. "},{"idx":2,"correct":false,"proposition":"A vascular redistribution from the vertices to the base. ","justification":"False, from the bottom to the top. "},{"idx":3,"correct":true,"proposition":"An interstitial syndrome with Kerley B-lines. ","justification":"True. "},{"idx":4,"correct":false,"proposition":"A pulmonary embolism. ","justification":"False. "}],"type":"custom"}
+{"_id":"IC-cardio-ee77668","context":null,"enonce":"What are the additional tests to be performed when heart failure is suspected? ","item":"IC","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"ECG ","justification":"True. "},{"idx":1,"correct":true,"proposition":"NT\/pro-BNP. ","justification":"True. "},{"idx":2,"correct":true,"proposition":"ETT. ","justification":"True, indispensable +++. "},{"idx":3,"correct":true,"proposition":"NFS, blood ionogram, serum creatinine, liver test, TSH, serum iron, ferritin, CST. ","justification":"True. "},{"idx":4,"correct":true,"proposition":"Chest X-ray. ","justification":"True. "}],"type":"custom"}
+{"_id":"MTEV-cardio-cdd6faa","context":null,"enonce":"What are the possible complications of DVT?","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Pulmonary embolism","justification":""},{"idx":1,"correct":true,"proposition":"STROKE","justification":"Possible via a permeable foramen oval. This is called a paradoxical embolism"},{"idx":2,"correct":true,"proposition":"Acute ischemia","justification":""},{"idx":3,"correct":true,"proposition":"Chronic venous insufficiency","justification":""},{"idx":4,"correct":true,"proposition":"Post-thrombotic syndrome","justification":""}],"type":"custom"}
+{"_id":"acroSd-cardio-65e17db","context":null,"enonce":"What is the balance sheet of a secondary Raynaud?","item":"acroSd","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"NAA","justification":""},{"idx":1,"correct":true,"proposition":"Capillaroscopy","justification":"These are the two systematic complementary reviews."},{"idx":2,"correct":false,"proposition":"ACAN","justification":""},{"idx":3,"correct":false,"proposition":"EPP","justification":""},{"idx":4,"correct":false,"proposition":"Renal assessment","justification":""}],"type":"custom"}
+{"_id":"palpitations-cardio-33c21f9","context":null,"enonce":"In what type of tachycardia can we see a pre-excitation delta wave and a short PR space < 120 ms? ","item":"palpitations","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"Atrial fibrillation (AF). ","justification":"False. "},{"idx":1,"correct":true,"proposition":"Wolf Parkinson White syndrome. ","justification":"True, on the resting ECG. "},{"idx":2,"correct":false,"proposition":"Myocardial infarction. ","justification":"False. "},{"idx":3,"correct":false,"proposition":"Atrial tachycardia. ","justification":"False. "},{"idx":4,"correct":false,"proposition":"Ventricular tachycardia. ","justification":"False. "}],"type":"custom"}
+{"_id":"palpitations-cardio-356d1f9","context":null,"enonce":"What can be the causes of palpitations? ","item":"palpitations","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Taking stimulants. ","justification":"True. "},{"idx":1,"correct":true,"proposition":"Alcohol. ","justification":"True. "},{"idx":2,"correct":true,"proposition":"Pregnancy. ","justification":"True. "},{"idx":3,"correct":true,"proposition":"Hyperthyroidism. ","justification":"True. "},{"idx":4,"correct":true,"proposition":"Sleep apnea syndrome. ","justification":"True. "}],"type":"custom"}
+{"_id":"palpitations-cardio-8e094ed","context":null,"enonce":"Until proven otherwise, any regular tachycardia with wide QRS is: ","item":"palpitations","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"Atrial tachycardia. ","justification":"False, with QRS fines. "},{"idx":1,"correct":true,"proposition":"Ventricular tachycardia. ","justification":"True +++. "},{"idx":2,"correct":false,"proposition":"A torsade de pointe. ","justification":"False, polymorphic tachycardia. "},{"idx":3,"correct":false,"proposition":"Junctional tachycardia. ","justification":"False, there is regular tachycardia with fine QRS but we always think first of ventricular tachycardia. "},{"idx":4,"correct":false,"proposition":"Ventricular fibrillation. ","justification":"False, anarchic rapid ventricular activity. "}],"type":"custom"}
+{"_id":"palpitations-cardio-f13386e","context":null,"enonce":"Until proven otherwise, any irregular tachycardia with fine QRS is: ","item":"palpitations","matiere":"cardio","propositions":[{"idx":0,"correct":false,"proposition":"A torsade de pointe. ","justification":"False. "},{"idx":1,"correct":false,"proposition":"Ventricular fibrillation ","justification":"False, with wide QRS. "},{"idx":2,"correct":false,"proposition":"Atrial tachycardia ","justification":"False, regular tachycardia. "},{"idx":3,"correct":true,"proposition":"Atrial fibrillation (AF) ","justification":"True. "},{"idx":4,"correct":true,"proposition":"In the AM, there is a tremulation of the baseline. ","justification":"True. "}],"type":"custom"}
+{"_id":"valvuloP-cardio-f9064c7","context":null,"enonce":"What are the etiologies of primary mitral insufficiency among those proposed below? ","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Dystrophic mitral insufficiency. ","justification":"True. "},{"idx":1,"correct":false,"proposition":"Chronic left ventricular remodeling post-infarction. ","justification":"False. "},{"idx":2,"correct":false,"proposition":"Dilated cardiomyopathy. ","justification":"False. "},{"idx":3,"correct":true,"proposition":"Rheumatic mitral insufficiency. ","justification":"True. "},{"idx":4,"correct":false,"proposition":"Idiopathic mitral insufficiency. ","justification":"False. "}],"type":"custom"}
+{"_id":"IBP-infectio-d48f3cf","context":null,"enonce":"What propositions are true regarding the epidemiology of infectious agents? (one or more propositions are true)","item":"IBP","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Enterobacteriaceae are the bacteria most often found in community urinary tract infections","justification":"Like E. coli, Klebsiella, Proteus mirabilis, etc."},{"idx":1,"correct":false,"proposition":"Meningococci are the bacteria most often found in bacterial meningitis in a 30-year-old adult","justification":"Meningococcal = 18 to 25 years. After that, it's pneumococcus."},{"idx":2,"correct":false,"proposition":"Meningococci are the bacteria most often found in bacterial pneumonia","justification":"Meningococci are not involved in pneumonia at all."},{"idx":3,"correct":false,"proposition":"Listeria is the bacteria most often found in pneumonia after age 50","justification":"Listeria is found mainly in meningitis after 50 years"},{"idx":4,"correct":true,"proposition":"Staphylococci are frequently found in post-influenza pneumonia","justification":""}],"type":"custom"}
+{"_id":"IST-infectio-3e9f1c2","context":null,"enonce":"Which of the following proposals may be responsible for genital ulceration? (one or more answers are correct)","item":"IST","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Behçet","justification":"Oral and genital canker sore is characteristic"},{"idx":1,"correct":true,"proposition":"Syphilis","justification":"The famous syphilitic chancre"},{"idx":2,"correct":false,"proposition":"Gonococcus","justification":"Gonococcus gives high STIs or ervicites with urethritis, yellow-green purulent leucorrhoea, urination burns, etc. No ulcerations at the rendezvous"},{"idx":3,"correct":true,"proposition":"Herpes simplex virus 2","justification":""},{"idx":4,"correct":true,"proposition":"Chlamydia ","justification":"The primary chlamydia lesion is usually genital site with small, non-indurated papule, often erosive, painless, rapidly limiting. Sound like syphilis? Is it a potential differential diagnosis:)"}],"type":"custom"}
+{"_id":"IST-infectio-9458444","context":null,"enonce":"Which of the following are causes of TPHA- \/ VDRL+? (one or more answers are correct)","item":"IST","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"lupus ","justification":""},{"idx":1,"correct":true,"proposition":"SAPL","justification":""},{"idx":2,"correct":true,"proposition":"mycoplasma lung infections","justification":""},{"idx":3,"correct":true,"proposition":"Lyme disease","justification":""},{"idx":4,"correct":true,"proposition":"pregnancy","justification":""}],"type":"custom"}
+{"_id":"IST-infectio-cde6850","context":null,"enonce":"Which of the following are characteristic of trichomonas? (one or more answers are correct)","item":"IST","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Abundant leucorrhoea","justification":""},{"idx":1,"correct":true,"proposition":"Greenish leucorrhoea","justification":""},{"idx":2,"correct":true,"proposition":"dyspareunia","justification":""},{"idx":3,"correct":true,"proposition":"Malodorous leucorrhoea","justification":"smell of fresh plaster"},{"idx":4,"correct":true,"proposition":"raspberry neck","justification":""}],"type":"custom"}
+{"_id":"IU-infectio-1cadac3","context":null,"enonce":"What are the risk factors for urinary tract infection in women?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"spermicides","justification":""},{"idx":1,"correct":true,"proposition":"Pre-menstrual period","justification":""},{"idx":2,"correct":true,"proposition":"pregnancy","justification":""},{"idx":3,"correct":false,"proposition":"BPH","justification":"A priori, women do not have a prostate 🤭 (sorry for the trap, but it is important to read the statements. Often, in the annals, we make stupid mistakes because we did not read the question correctly)"},{"idx":4,"correct":false,"proposition":"prostate cancer","justification":"A priori, women do not have a prostate 🤭 (sorry for the trap, but it is important to read the statements. Often, in the annals, we make stupid mistakes because we did not read the question correctly)"}],"type":"custom"}
+{"_id":"IU-infectio-2ff5a38","context":null,"enonce":"Which propositions are true?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Physiologically, urine is sterile","justification":""},{"idx":1,"correct":true,"proposition":"only the distal urethra is colonized by perineal flora","justification":""},{"idx":2,"correct":false,"proposition":"Hematogenous infection is the main cause of cystitis","justification":"It is rather an ascending infection ++ from the distal urethra"},{"idx":3,"correct":true,"proposition":"Being a woman, especially postmenopausal, is a risk factor for UTI","justification":""},{"idx":4,"correct":true,"proposition":"BPH is a risk factor for UTI","justification":"All causes of obstructive uropathy (BPH, stenosis, cancer) are risk factors"}],"type":"custom"}
+{"_id":"IU-infectio-338afe9","context":null,"enonce":"The hematuria at the BU is positive if:","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"> 10^4\/mL","justification":"Positive hematuria if > 10^4\/mL = 10\/mm3"},{"idx":1,"correct":false,"proposition":"> 10^2\/mL","justification":""},{"idx":2,"correct":false,"proposition":"> 10^3\/mL","justification":""},{"idx":3,"correct":false,"proposition":"> 10^5\/mL","justification":""},{"idx":4,"correct":false,"proposition":"> 10^6\/mL","justification":""}],"type":"custom"}
+{"_id":"IU-infectio-51049db","context":null,"enonce":"Which antibiotics are effective on EBLSE-producing beta-lactamase-producing enterobacteriaceae? (four proposals expected)","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Carbapenem","justification":""},{"idx":1,"correct":true,"proposition":"Fosfomycin-Trometamol","justification":""},{"idx":2,"correct":false,"proposition":"Cefotaxime","justification":"Beta-lactams do not work (except Piperacillin-Tazobactam, Carbapenem and Cefoxitin)"},{"idx":3,"correct":true,"proposition":"Nitrofurantoin","justification":""},{"idx":4,"correct":true,"proposition":"Pivmecillinam ","justification":""}],"type":"custom"}
+{"_id":"IU-infectio-538285e","context":null,"enonce":"Which bacteria do not produce nitrites?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Staphylococci","justification":"And especially S. saprophyticus (young woman)"},{"idx":1,"correct":true,"proposition":"Enterococci","justification":"PMAs do not produce them"},{"idx":2,"correct":true,"proposition":"Pseudomonas æruginosa","justification":"Aerobic BGN does not produce it, most often"},{"idx":3,"correct":true,"proposition":"Acinetobacter","justification":""},{"idx":4,"correct":false,"proposition":"E. Coli","justification":"That's a lot of nitrites + to the bu :)"}],"type":"custom"}
+{"_id":"IU-infectio-54b6d63","context":null,"enonce":"How long is treatment with Pivmecillinam? ","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"5D","justification":"This is the probabilistic second-line treatment for simple acute cystitis. No systematic follow-up consultation (only if the patient's need is felt)"},{"idx":1,"correct":false,"proposition":"10D","justification":""},{"idx":2,"correct":false,"proposition":"7D","justification":""},{"idx":3,"correct":false,"proposition":"Single dose","justification":""},{"idx":4,"correct":false,"proposition":"Until ECBU negativation","justification":"In simple acute cystitis, there is never ECBU"}],"type":"custom"}
+{"_id":"IU-infectio-585d246","context":null,"enonce":"The control of the negativation of the ECBU is indicated in case of: ","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"pregnancy","justification":""},{"idx":1,"correct":true,"proposition":"persistence of symptoms","justification":""},{"idx":2,"correct":true,"proposition":"early recurrence","justification":""},{"idx":3,"correct":false,"proposition":"Severe NAP","justification":""},{"idx":4,"correct":false,"proposition":"NAP with risk of complication","justification":""}],"type":"custom"}
+{"_id":"IU-infectio-73c9d2b","context":null,"enonce":"What is the pathology that does not require ECBU?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"simple acute cystitis","justification":""},{"idx":1,"correct":false,"proposition":"Non-serious NAP","justification":""},{"idx":2,"correct":false,"proposition":"NAP without risk of complication","justification":""},{"idx":3,"correct":false,"proposition":"Recurrent cystitis","justification":""},{"idx":4,"correct":false,"proposition":"Cystitis at risk of complications","justification":""}],"type":"custom"}
+{"_id":"IU-infectio-79cab7c","context":null,"enonce":"S. saprophyticus is naturally resistant to: (only one response expected)","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"fosfomycin-trometamol","justification":""},{"idx":1,"correct":false,"proposition":"nitrofurantoin","justification":"First-line treatment in young women with nitrite negative"},{"idx":2,"correct":false,"proposition":"Augmentin","justification":""},{"idx":3,"correct":false,"proposition":"Pivmécilliam","justification":""},{"idx":4,"correct":false,"proposition":"No natural resistance","justification":""}],"type":"custom"}
+{"_id":"IU-infectio-9d3bfde","context":null,"enonce":"The urinary tract infection is:","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"The 1st cause of community infection","justification":""},{"idx":1,"correct":true,"proposition":"The 1st cause of nosocomial infection","justification":""},{"idx":2,"correct":false,"proposition":"The prerogative of male individuals","justification":"The sex ratio is in favor of women F >> H"},{"idx":3,"correct":true,"proposition":"1\/3 of women will have a urinary tract infection","justification":""},{"idx":4,"correct":false,"proposition":"recurrent if there are more than 3 episodes per year","justification":"More than 4 episodes per year (more than one every 3 months). Severe if more than one episode per month."}],"type":"custom"}
+{"_id":"IU-infectio-acd0e8a","context":null,"enonce":"What are the 3 clinical forms of cystitis to identify in order to adapt the management? ","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Simple acute cystitis","justification":"3 notions to remember and differentiate. The care follows directly from this:)"},{"idx":1,"correct":true,"proposition":"Cystitis at risk of complications","justification":""},{"idx":2,"correct":true,"proposition":"Recurrent cystitis","justification":""},{"idx":3,"correct":false,"proposition":"Severe NAP","justification":""},{"idx":4,"correct":false,"proposition":"NAP without risk of complication","justification":""}],"type":"custom"}
+{"_id":"IU-infectio-adb99f5","context":null,"enonce":"What is the only mandatory examination to perform in case of simple hyperalgic NAP? (apart from BU and ECBU)","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Doppler ultrasound of the urinary tract","justification":""},{"idx":1,"correct":false,"proposition":"NFS","justification":"If risk of complication"},{"idx":2,"correct":false,"proposition":"CRP","justification":"If risk of complication"},{"idx":3,"correct":false,"proposition":"Uroscanner","justification":"If risk of complications, at a distance from the episode"},{"idx":4,"correct":false,"proposition":"Blood culture","justification":"Only done if there is a diagnostic doubt"}],"type":"custom"}
+{"_id":"IU-infectio-b5052ad","context":null,"enonce":"What are the two indications to treat asymptomatic bacteriuria?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Elderly","justification":""},{"idx":1,"correct":true,"proposition":"Pregnant woman","justification":""},{"idx":2,"correct":true,"proposition":"Scheduled invasive urological surgery","justification":""},{"idx":3,"correct":false,"proposition":"diabetic","justification":""},{"idx":4,"correct":false,"proposition":"Neurological bladder","justification":""}],"type":"custom"}
+{"_id":"IU-infectio-d87beaf","context":null,"enonce":"What are the four causes of aseptic leukocyturia?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Urogenital tuberculosis","justification":""},{"idx":1,"correct":true,"proposition":"Bladder cancer","justification":""},{"idx":2,"correct":true,"proposition":"Renal colic","justification":""},{"idx":3,"correct":true,"proposition":"Interstitial nephropathy","justification":""},{"idx":4,"correct":false,"proposition":"Diabetes","justification":"We will rather find a microalbuminuria in case of significant 😊 renal damage"}],"type":"custom"}
+{"_id":"IU-infectio-f77b2b0","context":null,"enonce":"The ECBU is done by: ","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"I don't care","justification":""},{"idx":1,"correct":false,"proposition":"Start of jet","justification":""},{"idx":2,"correct":false,"proposition":"End of jet","justification":""},{"idx":3,"correct":true,"proposition":"Jet medium","justification":"Before any ATB, after a peritoneal toilet, in non-sterile condition, 4 hours after the last urination, and in the middle of the jet"},{"idx":4,"correct":false,"proposition":"We don't really have an idea for the fifth proposal 🤷 ♂️","justification":"The main thing is to remember that it is not at the beginning of the jet, unlike the samples for sexually transmitted 😊 infections (it is on this notion that you can be trapped)"}],"type":"custom"}
+{"_id":"antiinf-infectio-f4bf340","context":null,"enonce":"Regarding cyclines, which proposals are true?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"They can cause photosensitivity","justification":""},{"idx":1,"correct":true,"proposition":"They have an almost complete absorption orally (PO)","justification":""},{"idx":2,"correct":true,"proposition":"They are contraindicated during pregnancy","justification":""},{"idx":3,"correct":true,"proposition":"They are active on plasmodium","justification":"Doxycycline is used to prevent malaria. It is taken 1x \/ D during the stay and 4 weeks after the return."},{"idx":4,"correct":true,"proposition":"They work by inhibiting protein synthesis","justification":""}],"type":"custom"}
+{"_id":"fievreimmunoD-infectio-34e4657","context":null,"enonce":"\nConcerning the neu\nRegarding febrile neutropenia: \nRegarding febrile neutropenia: \n\nRegarding febrile neutropenia: \n","item":"fievreimmunoD","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"It is defined by neutropenia (PNN < 500\/mm3) or fever. ","justification":"False, AND. "},{"idx":1,"correct":true,"proposition":"The digestive tract is the majority gateway. ","justification":"True, then skin, central venous catheters and lungs. "},{"idx":2,"correct":false,"proposition":"The clinical examination is often rich in clinical signs. ","justification":"False, often poor because no inflammatory focus. "},{"idx":3,"correct":true,"proposition":"Central venous catheters promote infections. ","justification":"True. "},{"idx":4,"correct":false,"proposition":"Chest X-rays often show a focus at the onset of fever. ","justification":"False, 40% of neutropenic patients with pneumonia have a normal chest X-ray at the onset of fever (see PILLY p 327). "}],"type":"custom"}
+{"_id":"fievreimmunoD-infectio-5944311","context":null,"enonce":"What are the 3 therapeutic emergencies? What are the 3 therapeutic emergencies? ","item":"fievreimmunoD","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Any fever in asplenic ","justification":"True "},{"idx":1,"correct":false,"proposition":"Cardiogenic shock ","justification":"False "},{"idx":2,"correct":true,"proposition":"Sepsis or septic shock ","justification":"True "},{"idx":3,"correct":false,"proposition":"Febrile lymphopenia ","justification":"False "},{"idx":4,"correct":true,"proposition":"Febrile neutropenia ","justification":"True "}],"type":"custom"}
+{"_id":"meningite-infectio-168661f","context":null,"enonce":"Which of the following are viruses that can cause encephalitis? (one or more propositions are correct)","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"measles","justification":""},{"idx":1,"correct":true,"proposition":"VZV","justification":"We also find: mumps, HIV, EBV and CMV."},{"idx":2,"correct":true,"proposition":"HSV","justification":"HSV1 > HSV2. Involvement occurs mainly in the temporal lobes"},{"idx":3,"correct":true,"proposition":"Rabies","justification":""},{"idx":4,"correct":false,"proposition":"Novovirus","justification":"He has diarrhea. 💩 Enteroviruses can cause meningitis"}],"type":"custom"}
+{"_id":"meningite-infectio-4cee171","context":null,"enonce":"Which of the following proposals are part of the semiology of herpetic meningoencephalitis? (one or more propositions are correct)","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Progressive onset of symptomatology in 15 days","justification":"Brutal"},{"idx":1,"correct":true,"proposition":"Impaired alertness","justification":""},{"idx":2,"correct":true,"proposition":"Memory disorders","justification":""},{"idx":3,"correct":true,"proposition":"febrile confusion","justification":""},{"idx":4,"correct":false,"proposition":"absence of fever most often","justification":"Most often, fever is high"}],"type":"custom"}
+{"_id":"meningite-infectio-d4b7a0c","context":null,"enonce":"Which of the following proposals corresponds to the meningococcal serotype mainly responsible for meningitis? (only one exact proposal)","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Has","justification":""},{"idx":1,"correct":true,"proposition":"B","justification":""},{"idx":2,"correct":false,"proposition":"C","justification":"Meningo C vaccine is mandatory"},{"idx":3,"correct":false,"proposition":"D","justification":""},{"idx":4,"correct":false,"proposition":"E","justification":""}],"type":"custom"}
+{"_id":"voyagetrop-infectio-7eb84d2","context":null,"enonce":"What should we mention if urticaria in return from tropical travel?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Schistosomosis in invasion","justification":"True"},{"idx":1,"correct":true,"proposition":"Pre-icteric viral hepatitis","justification":"True, Caroli's triad"},{"idx":2,"correct":true,"proposition":"Rickettsiosis","justification":"True"},{"idx":3,"correct":false,"proposition":"Legionellosis","justification":""},{"idx":4,"correct":false,"proposition":"Listeria","justification":""}],"type":"custom"}
+{"_id":"voyagetrop-infectio-c018ce9","context":null,"enonce":"What is special about colonic amoebosis?","item":"voyagetrop","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"No fever","justification":"True, unlike hepatic amoebosis. Treatments, clinical presentation and prognosis differ"},{"idx":1,"correct":false,"proposition":"No diarrhoea","justification":""},{"idx":2,"correct":false,"proposition":"No abdominal pain","justification":""},{"idx":3,"correct":false,"proposition":"No incubation period","justification":""},{"idx":4,"correct":false,"proposition":"No contagiousness possible","justification":""}],"type":"custom"}
+{"_id":"pathoOGE-endoc-7d63967","context":null,"enonce":"What additional examinations do you want to perform in front of a torsion of the spermatic cord?","item":"pathoOGE","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"Abdomen without preparation","justification":""},{"idx":1,"correct":false,"proposition":"Scrotal ultrasound","justification":""},{"idx":2,"correct":true,"proposition":"None","justification":"Given the urgency of torsion of the spermatic cord, no additional examination is necessary, unless there is a diagnostic doubt"},{"idx":3,"correct":false,"proposition":"Abdominopelvic CT scan","justification":""},{"idx":4,"correct":false,"proposition":"Pelvic MRI","justification":""}],"type":"custom"}
+{"_id":"pathoOGE-endoc-e4a925b","context":null,"enonce":"How quickly should testicular torsion be treated?","item":"pathoOGE","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"1h","justification":""},{"idx":1,"correct":false,"proposition":"2h","justification":""},{"idx":2,"correct":true,"proposition":"6am","justification":"Torsion of the spermatic cord is an emergency, which must be treated surgically within 6 hours. Beyond that, arterial ischemia can become irreversible."},{"idx":3,"correct":false,"proposition":"12:00","justification":""},{"idx":4,"correct":false,"proposition":"24h","justification":""}],"type":"custom"}
+{"_id":"pathoOGE-endoc-ba32a9a","context":null,"enonce":"What germs can be responsible for Fournier's gangrene?","item":"pathoOGE","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Streptococcus","justification":""},{"idx":1,"correct":true,"proposition":"Pseudomonas aeruginosa","justification":""},{"idx":2,"correct":false,"proposition":"Golden staph","justification":""},{"idx":3,"correct":true,"proposition":"E. Coli","justification":""},{"idx":4,"correct":false,"proposition":"All answers are true","justification":""}],"type":"custom"}
+{"_id":"HBP-uro-0c8a594","context":null,"enonce":"In a patient with lower urinary tract symptoms (UAB), what are the differential diagnoses of benign prostatic hyperplasia? (one or more exact propositions)","item":"HBP","matiere":"uro","propositions":[{"idx":0,"correct":true,"proposition":"urinary tract infection","justification":"You have to do an ECBU"},{"idx":1,"correct":true,"proposition":"urethral stenosis","justification":"At the slightest doubt, it is necessary to perform a urethral fibroscopy"},{"idx":2,"correct":true,"proposition":"bladder hypoactivity","justification":"The presence of peripheral neurological pathology must suggest bladder hypoactivity, objectified to the urodynamic balance (BUD)"},{"idx":3,"correct":true,"proposition":"Type 2 diabetes","justification":"To be eliminated by a blood test"},{"idx":4,"correct":true,"proposition":"prostate cancer","justification":"To be eliminated by a digital rectal examination, and a PSA in case of doubt (which must be normal in BPH)"}],"type":"custom"}
+{"_id":"HBP-uro-144f8db","context":null,"enonce":"What are the side effects of treatment with alfuzosin (alpha-blocker)?","item":"HBP","matiere":"uro","propositions":[{"idx":0,"correct":true,"proposition":"orthostatic hypotension","justification":"AE of alpha-blockers: HO, anejucalation, IC before eye surgery"},{"idx":1,"correct":true,"proposition":"anejaculation","justification":""},{"idx":2,"correct":false,"proposition":"libido disorder","justification":"5-alpha-reductase inhibitor AEs: libido\/erectile dysfunction. Divides PSA by 2"},{"idx":3,"correct":false,"proposition":"retrograde ejaculation","justification":"AEs of phospho-di-esterase 5 (IPDE5) inhibitors"},{"idx":4,"correct":false,"proposition":"division of the PSA by 2","justification":""}],"type":"custom"}
+{"_id":"HBP-uro-23f6ec2","context":null,"enonce":"Which of the following are exact in benign prostatic hyperplasia? ","item":"HBP","matiere":"uro","propositions":[{"idx":0,"correct":true,"proposition":"The clinical complaint is not proportional to the volume of the prostate","justification":""},{"idx":1,"correct":true,"proposition":"The digital rectal exam finds a flexible prostate","justification":""},{"idx":2,"correct":false,"proposition":"Digital rectal examination is usually painful","justification":"TR: flexible, painless, smooth, regular, disappearance of the median groove"},{"idx":3,"correct":false,"proposition":"A post-voiding residue is a disorder of the voiding phase","justification":"Impact on the lower urinary tract: voiding phase (dysuria, weak stream) and post-voidition (drops, post-voiding residue)."},{"idx":4,"correct":false,"proposition":"ECBU is routine to rule out bladder cancer","justification":"It eliminates an infection"}],"type":"custom"}
+{"_id":"HBP-uro-524b407","context":null,"enonce":"What are the risk factors for clinical progression of benign prostatic hyperplasia?","item":"HBP","matiere":"uro","propositions":[{"idx":0,"correct":false,"proposition":"Age over 30","justification":"Age over 60"},{"idx":1,"correct":true,"proposition":"Volume >31mL","justification":""},{"idx":2,"correct":true,"proposition":"The PSA > 1.6","justification":""},{"idx":3,"correct":false,"proposition":"An IPSS score greater than 2","justification":"The IPSS score is to be done systematically but is not a risk factor for complications"},{"idx":4,"correct":false,"proposition":"All proposals are accurate","justification":""}],"type":"custom"}